Natural Eczema Care

January 21, 2014 Written by JP    [Font too small?]

Several weeks ago I was in the midst of one of the most stressful periods in my life. My wife and I were preparing for two moves (ours and my mother-in-law’s), while renovating an old townhouse that we all moved into together. Lots of changes, financial concerns and long days with a seemingly never-ending string of problems that needed solutions. In addition to the obvious stress of the circumstances, there were also many environmental insults (infuriated neighbors, earsplitting construction noise, endless dust, dirt, fumes, etc.). And, as a result, my diet wasn’t as “clean” as it normally is. A little more wine, some foods containing gluten and, generally speaking, a higher carbohydrate count were some of the highlights or lowlights of this recent period. Consequently, I began to notice an “angry” rash on my neck. It was inflamed, itchy, red and began to spread to my arms, chest and face. The severity of the rash worsened by the day. The next several weeks were downright miserable.

I knew from previous experience that most doctors, be they conventional or naturopathic, would likely be unable to diagnose and treat this condition successfully. So, my wife and I began to research the topic to try to come up with holistic solutions on our own. After sifting through countless papers and photographs, we determined that I likely had a skin infection known as seborrheic dermatitis – an inflammatory skin disorder which is related to eczema. As it turns out, lack of sleep, stress and the transition to winter weather frequently coincides with eczema incidence. In some cases, such as seborrheic dermatitis, other factors, including a fungal infection of the oil producing glands involving the yeast Malassezia, likewise play an important role.

Strongly suspecting seborrheic dermatitis as the cause of my skin dysfunction, I adopted several body-mind approaches to address it. In the course of my own treatment program, I discovered some recent developments in the field of integrative eczema management. The following briefly outlines my own path to healing and the latest scientific findings about natural alternatives for eczema in general.

I started with the basics. I re-adopted a diet that centered around nutrient-dense, whole foods which are very low in starches and sugar. I avoided most common allergens, including unfermented soy and all sources of gluten. From a supplemental perspective, I focused on those that antagonize fungi (organic, unrefined coconut oil and probiotics), modulate the immune system and limit excess inflammation (evening primrose oil, fish oil, mangosteen extract and Vitamin D). Also, I attribute my now 100% recovery in part to the use of organic tea tree oil. I began by using a gentle, all-natural baby shampoo with added aloe vera gel and tea tree oil to my daily shower. I applied it generously as a body wash and shampoo. After showering, I immediately moisturized with a natural hydrating cream which featured a high percentage of tea tree oil (5%), aloe vera and some additional Vitamin E. Rounding out my treatment protocol was an emphasis on adequate sleep and daily meditation to manage stress more effectively. Simply put, this approach worked wonders for me. But, it did require diligence, patience and time.

The latest news about natural remedies for eczema is quite promising, though you wouldn’t necessarily know this based on popular reviews by the conventional medical establishment. For instance, a 2013 summary by the prestigious Cochrane Database concluded that oral borage and evening primrose oils, sources of GLA – a rare and therapeutic fatty acid, are ineffective in improving eczema. However, this assertion is disputed by an 8 week trial from August 2013 which determined that 320 mg of GLA daily (evening primrose oil) markedly reduces eczema severity. Fish oil provides a different class of fatty acids, namely omega-3s, which modulate the immune system in those with eczema or other conditions that involve a selectively overactive immune response. Additional research supports a link between a lack of healthy bacteria in the gut and Vitamin D in those living with eczema. This explains why supplementation with probiotics and Vitamin D often yields favorable outcomes. Lastly, a recent review and study support the use of coal tar bath products, a traditional remedy, and ointments containing Nigella sativa or black cumin. The review documents the physiological mechanisms behind the historical skin benefits associated with coal tar products. And, a trial published at the end of 2013 found that a black cumin ointment was more effective than two conventional treatments: Betamethasone, an anti-inflammatory, immunosupressive glucosteroid, and Eucerin, a popular, soothing over-the-counter moisturizer.

I strongly believe that most skin problems are a reflection of a greater dysfunction in the body as a whole. So, while I encourage the use of creams, lotions and supplements to safely reduce or relieve symptoms, I also suggest taking a deeper look for other causative factors. Typically, lifestyle choices which support general well-being will also improve skin disorders. Make positive changes in your diet, focus on psychological health, look for natural alternatives such as chlorine filters for your shower, humidifiers during dry conditions, and skin care products that are free of unnecessary additives and chemicals. And, perhaps most importantly, try to find some sort of meaning while you work towards better skin health. Even at the lowest points of my current skin episode, I knew that something positive would come of this. I’m confident that someone reading this will find hope and/or part of their solution because of my challenging experience.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Oral Evening Primrose Oil and Borage Oil for Eczema (link)

Study 2 – Dose-Dependent Effects of Evening Primrose Oil in Children and (link)

Study 3 – A Randomized Controlled Double-Blind Investigation of the Effects of (link)

Study 4 – Do Fast Foods Cause Asthma, Rhinoconjunctivitis & Eczema? Global … (link)

Study 5 – Microarray Analysis Reveals Marked Intestinal Microbiota Aberrancy in (link)

Study 6 – A Protective Effect of Lactobacillus Rhamnosus HN001 Against Eczema ... (link)

Study 7 – Changing of Fecal Flora and Clinical Effect of L. Salivarius LS01 in Adults (link)

Study 8 – Fish Oil Supplementation in Early Infancy Modulates Developing Infant (link)

Study 9 – Comparison of Therapeutic Effect of Topical Nigella w/ Betamethasone (link)

Study 10 – Old King Coal – Molecular Mechanisms Underlying An Ancient (link)

High Dose Evening Primrose Oil Reduces Eczema Symptoms

Source: Ann Dermatol. 2013 Aug;25(3):285-91. (link)

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Posted in Alternative Therapies, Detoxification, Mental Health

23 Comments & Updates to “Natural Eczema Care”

  1. Sylvia Stewart Says:

    Very interesting to learn the combination of changes that yielded positive results for what sounds like was a miserable condition. Grateful for their success and that you found relief!

  2. JP Says:

    Many thanks, Sylvia! 🙂

    Be well!


  3. G.Paul F. Says:

    Hi JP,

    This stressful episode in your life yielded the opportunity to be able to cure yourself thanks to your proficient research and discipline. We are blessed to have access to current research through the internet.

    I am happy you selected the appropriate treatments thanks to your ability to discern supported by your years of experience and analysis of the conditions.
    You could make a superb doctor!



  4. JP Says:

    Thank you, Paul! I appreciate your kind words and support!

    The Internet is a genuine blessing. It affords so many resources that, in the past, weren’t available to laypeople such as myself. 🙂

    Be well!


  5. JP Says:

    Dietary and/or supplemental zinc may also be helpful:

    Acta Derm Venereol. 2014 Jan 28. doi: 10.2340/00015555-1772.

    Hair Zinc Levels and the Efficacy of Oral Zinc Supplementation in Patients with Atopic Dermatitis.

    Kim JE, Yoo SR, Jeong MG, Ko JY, Ro YS.

    Zinc deficiency in patients with atopic dermatitis (AD) and the use of zinc supplementation is still controversial. We measured hair zinc levels in 58 children with AD and 43 controls (age range 2-14 years). We also investigated the efficacy of oral zinc supplementation in AD patients with low hair zinc levels by comparing eczema assessment severity index (EASI), transepidermal water loss (TEWL), and visual analogue scales for pruritus and sleep disturbance in patients receiving zinc supplementation (Group A) and others not receiving supplementation (Group B). At baseline, the mean zinc level was significantly reduced in AD patients (113.1 μg/g vs. 130.9 μg/g, p = 0.012). After 8 weeks of supplement, hair zinc level increased significantly in Group A (p <  0.001), and EASI scores, TEWL, and visual analogue scales for pruritus improved more in Group A than in Group B (p = 0.044, 0.015 and < 0.001, respectively). Thus, oral zinc supplementation may be effective in AD patients with low hair zinc levels.

    Be well!


  6. Craig Says:

    Well researched post!

    I too struggle with eczema. I have recently managed to get it under control to the point where it has completely cleared up. Similar to the article I have had to implement a regime of:
    – eat clean & healthy (no dairy/ little gluten)
    – reducing stress;
    – daily DHA/ EPA;
    – 1-2g of Vitamin C per day;
    – Probiotic daily;
    – Using soaps/ shampoos which contain few/ no chemicals.
    If any of these change i.e. stop taking fish oil then the eczema slowly returns.

    I have taken the positive, that eczema returning is my body telling me that I am not being as awesome as I could be.


  7. JP Says:

    Thank you, Craig! Do you supplement with Vitamin D or spend non-peak time in the sunshine? I’ve found that helpful as well.

    Be well!


  8. JP Says:

    Update: More support for natural topical preparations …

    Clin Cosmet Investig Dermatol. 2014 Nov 11;7:321-7.

    A cosmeceutical formulation based on boswellic acids for the treatment of erythematous eczema and psoriasis.

    BACKGROUND: Boswellic acids (BAs) show anti-inflammatory properties in a variety of inflammatory diseases, including rheumatoid arthritis, osteoarthritis, and asthma. A topical administration route is currently used to deliver active compounds in psoriatic and eczematous patients. In this double-blind study we compare a novel BA formulation (containing Bosexil(®), INCI [International Nomenclature of Cosmetic Ingredients]: lecithin, Boswellia serrata resin extract) with a placebo formulation. A third arm of the trial received a formulation of Vaccinium myrtillus seed oil, previously demonstrated as an effective local treatment for psoriatic lesions.

    METHODS: Patients with psoriasis or erythematous eczema were randomly assigned, in a 1:1:1 ratio, to Bosexil(®), V. myrtillus seed oil, or placebo. In order to evaluate the effects of treatment, the changes of scales and erythema from diagnosis to the end of treatment were scored in psoriatic patients, while changes in itch and erythema were analyzed for erythematous eczema patients. Psoriasis Area Severity Index and Eczema Area and Severity Index scores were also calculated.

    RESULTS: In patients with psoriasis, scales and erythema improved both with Bosexil(®) and the V. myrtillus seed oil treatment in comparison with placebo. In particular, the treatment with Bosexil(®) formulation improved scales (70% of cases) and erythema (50% of cases) without any case of worsening. In patients with eczema, the administration of placebo did not result in any improvement in 90% of cases, and in the remaining 10% worsened both itch and erythema. Bosexil(®) formulation improved both itch (60% of cases) and erythema (60% of cases) without any case of worsening. V. myrtillus seed oil improved itch and erythema in 66.7% and 77.8% of patients, respectively.

    CONCLUSION: A topical formulation of Bosexil(®) may be promising for the treatment of psoriasis and erythematous eczema. Long-term studies are recommended to evaluate the adherence to this topical treatment and its clinical benefits in real life.

    Be well!


  9. JP Says:

    Update 06/26/15:

    PLoS One. 2014 Sep 5;9(9):e107003.

    Importance of fatty acid compositions in patients with peripheral arterial disease.

    OBJECTIVE: Importance of fatty acid components and imbalances has emerged in coronary heart disease. In this study, we analyzed fatty acids and ankle-brachial index (ABI) in a Japanese cohort.

    METHODS: Peripheral arterial disease (PAD) was diagnosed in 101 patients by ABI ≤0.90 and/or by angiography. Traditional cardiovascular risk factors and components of serum fatty acids were examined in all patients (mean age 73.2±0.9 years; 81 males), and compared with those in 373 age- and sex-matched control subjects with no evidence of PAD.

    RESULTS: The presence of PAD (mean ABI: 0.71±0.02) was independently associated with low levels of gamma-linolenic acid (GLA) (OR: 0.90; 95% CI: 0.85-0.96; P = 0.002), eicosapentaenoic acid∶arachidonic acid (EPA∶AA) ratio (OR: 0.38; 95% CI: 0.17-0.86; P = 0.021), and estimated glomerular filtration rate (OR: 0.97; 95% CI: 0.96-0.98; P<0.0001), and with a high hemoglobin A1c level (OR: 1.34; 95% CI: 1.06-1.69; P = 0.013). Individuals with lower levels of GLA (≤7.95 µg/mL) and a lower EPA∶AA ratio (≤0.55) had the lowest ABI (0.96±0.02, N = 90), while the highest ABI (1.12±0.01, N = 78) was observed in individuals with higher values of both GLA and EPA∶AA ratio (P<0.0001).

    CONCLUSION: A low level of GLA and a low EPA∶AA ratio are independently associated with the presence of PAD. Specific fatty acid abnormalities and imbalances could lead to new strategies for risk stratification and prevention in PAD patients.

    Be well!


  10. JP Says:

    Update 06/30/15:

    Nutrients. 2015 Jun 25;7(7):5098-5110.

    A Traditional Diet Is Associated with a Reduced Risk of Eczema and Wheeze in Colombian Children.

    BACKGROUND: Diet might influence the risk of allergic diseases. Evidence from developing countries with high prevalence of childhood asthma is scant.

    METHODS: Information on wheeze, rhinitis, and eczema was collected from 3209 children aged 6-7 years in 2005, who were taking part in the International Study on Asthma and Allergy in Children (ISAAC) in Colombia. Intake frequency of twelve food groups was assessed. Associations between each food group and current wheeze, rhino-conjunctivitis, and eczema were investigated with multiple logistic regressions, adjusting for potential confounders. Simes’ procedure was used to test for multiple comparisons.

    RESULTS: 14.9% of children reported wheeze in the last 12 months, 16% rhino-conjunctivitis, and 22% eczema. Eczema was negatively associated with consumption of fresh fruits and pulses three or more times per week (adjusted Odds ratio (aOR): 0.64; 95% Confidence Interval (CI): 0.49 to 0.83; p value = 0.004; and aOR: 0.62, 95% CI: 0.47 to 0.80; p value < 0.001, respectively). Current wheeze was negatively associated with intake of potatoes (aOR: 0.44, 95% CI: 0.31 to 0.62, p value = 0.005), whilst this outcome was positively associated with consumption of fast food (aOR: 1.76, 95% CI: 1.32 to 2.35, p value = 0.001). These associations remained statistically significant after controlling for multiple comparisons. CONCLUSIONS: A traditional diet might have a protective effect against eczema and wheeze in Colombian children, whilst intake of fast foods increases this risk. Be well! JP

  11. JP Says:

    Updated 08/17/15:

    Clin Exp Dermatol. 2015 Jul 30.

    Dairy and nondairy beverage consumption for childhood atopic eczema: what health advice to give?

    BACKGROUND: Many parents of children with atopic eczema (AE) practise empirical dietary avoidance and supplementation, and seek healthcare advice on whether consumption of dairy and nondairy beverages may be beneficial or detrimental for this condition.

    AIM: We investigated if frequency of consumption of beverages was associated with disease severity and quality of life (QoL).

    METHODS: Parent-reported frequency of drinks and beverages were recorded in consecutive children with AE, and disease severity (Nottingham Eczema Severity Score; NESS), QoL (Children’s Dermatology Life Quality Index; CDLQI), skin hydration (SH), transepidermal water loss (TEWL), blood pressure (BP), resting heart rate (RHR) and body mass index (BMI) were evaluated.

    RESULTS: AE was associated with worse QoL than miscellaneous non-AE skin diseases (P < 0.001). Compared with children without AE, there was a trend for children with AE to drink less milk (P = 0.06) and more miscellaneous beverages (such as Chinese herbal tea and soymilk; P = 0.03). In children with AE, NESS correlated with CDLQI (ρ = 0.66, P < 0.001) and reduced SH (ρ = -0.32, P < 0.001), whereas CDLQI correlated with a higher RHR (ρ = 0.25, P < 0.01). Multiple logistic regression showed that male sex (OR = 0.44, 95% CI 0.20-0.97; P = 0.04) and drinking fresh milk (OR = 0.42, 95% CI 0.20-0.93; P = 0.03) were independent factors associated with less severe disease. Moderate to severe impairment of CDLQI was associated with NESS (OR = 1.48, 95% CI 1.28-1.71; P < 0.001) and RHR (OR = 1.05, 95% CI 1.02-1.08; P < 0.01) but not with reported habits of beverage consumption. Concerning cardiovascular health in AE, frequency of formula milk consumption was associated with RHR (ρ = 0.17, P = 0.04), and soft drink consumption was associated with higher systolic blood pressure (SBP) (ρ = 0.18, P = 0.04). CONCLUSION: This study provides evidence for parental/patient guidance. Children with AE who reported more fresh milk consumption had less severe disease. There was no correlation between consumption of nondairy beverages with disease severity or QoL, but frequency of soft drink consumption correlated with SBP. With these results being supported by a literature review, it is reasonable to advise parents that fresh milk can be consumed by unsensitized children with AE. Soft drinks and other beverages should not be consumed in excess for optimal cardiovascular health and for other health reasons. Be well! JP

  12. JP Says:

    Updated 08/17/15:

    Allergy. 2015 Jul 27.

    Breast milk fatty acid composition has a long-term effect on the risk of asthma, eczema, and sensitization.

    BACKGROUND: Levels of n-3 polyunsaturated fatty acids (PUFAs) and n-6 PUFAs in breast milk are associated with development of allergic diseases up to school age. However, it is unknown if this relationship persists when the child becomes older. We therefore studied the association between levels of n-3 PUFAs and n-6 PUFAs in breast milk of allergic- and non-allergic mothers and asthma, eczema and sensitization up to the age of 14 years.

    METHODS: The study was nested in the ongoing PIAMA birth cohort. At the child’s age of 3 months, 276 mothers provided a breast milk sample. Asthma (Ntotal=269) and eczema (Ntotal=274) were self-reported up to the child’s age of 14 years. Specific serum IgE levels were measured at the ages of 4, 8, and 12 years (Ntotal=216). Generalized estimating equations analyses were used to take account of repeated observations.

    RESULTS: Asthma up to the age of 14 years is less prevalent in children of allergic mothers receiving breast milk with higher levels of n-3 long chain polyunsaturated (LCP) fatty acids (OR 0.50; 95% CI 0.31-0.79), and more prevalent in children of non-allergic mothers receiving breast milk with higher levels of n-6LCP (OR 1.86; 95% CI 1.14-3.03). Weaker associations in similar direction were observed for eczema and sensitization. Direction of associations were consistent and of similar magnitude throughout childhood.

    CONCLUSION: The association between breast milk fatty acid composition and asthma, eczema, and sensitization persists up to the age of 14 years in children of both allergic and non-allergic mothers. This article is protected by copyright.

    Be well!


  13. JP Says:

    Updated 12/17/15:

    J Dermatolog Treat. 2015 Dec 10:1-4.

    β-Glucan-based cream (containing pleuran isolated from pleurotus ostreatus) in supportive treatment of mild-to-moderate atopic dermatitis.

    BACKGROUND: Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases with serious impact on quality of life. β-Glucans are natural substances with potent immunomodulatory and anti-inflammatory activity.

    METHODS: In a multicentre open split-body study, we studied the effect of Imunoglukan P4H® cream in a group of 105 patients with AD (39 males, 37%). Evaluation of subjective (visual analogue scale, VAS) and objective (EASI score, eczema area and severity index) characteristics of AD was carried out.

    RESULTS: In total, 80 patients (76.2%) completed the study. Topical β-glucan application resulted in the significant improvement of both objective and subjective symptoms of AD. On the application side, significant decline in the number of days with AD exacerbation and its severity was observed. Moreover, the subjects experienced decline of pruritus on the β-glucan half of the body (VAS score: 1.68 vs. 1.95, p < 0.001). During the study, the continual and significant decline of EASI scores on the site of β-glucan application was observed (V4: 1.57 vs. 1.85, p < 0.001). The preparation was in general well tolerated. CONCLUSIONS: This is the first study evaluating and confirming the potential use of β-glucan-based cream as a supportive complementary therapy of atopic dermatitis. Be well! JP

  14. JP Says:

    Updated 05/14/16:

    Eur J Pharmacol. 2016 Apr 12. pii: S0014-2999(16)30234-5.

    Gamma-linolenic acid, Dihommo-gamma linolenic, Eicosanoids and Inflammatory Processes.

    Gamma-linolenic acid (GLA, 18:3n-6) is an omega-6 (n-6), 18 carbon (18C-) polyunsaturated fatty acid (PUFA) found in human milk and several botanical seed oils and is typically consumed as part of a dietary supplement. While there have been numerous in vitro and in vivo animal models which illustrate that GLA-supplemented diets attenuate inflammatory responses, clinical studies utilizing GLA or GLA in combination with omega-3 (n-3) PUFAs have been much less conclusive. A central premise of this review is that there are critical metabolic and genetic factors that affect the conversion of GLA to dihommo-gamma linolenic acid (DGLA, 20:3n-6) and arachidonic acid (AA, 20:4n-6), which consequently affects the balance of DGLA- and AA- derived metabolites. As a result, these factors impact the clinical effectiveness of GLA or GLA/(n-3) PUFA supplementations in treating inflammatory conditions. Specifically, these factors include: 1) the capacity for different human cells and tissues to convert GLA to DGLA and AA and to metabolize DGLA and AA to bioactive metabolites; 2) the opposing effects of DGLA and AA metabolites on inflammatory processes and diseases; and 3) the impact of genetic variations within the fatty acid desaturase (FADS) gene cluster, in particular, on AA/DGLA ratios and bioactive metabolites. We postulate that these factors influence the heterogeneity of results observed in GLA supplement-based clinical trials and suggest that “one-size fits all” approaches utilizing PUFA-based supplements may no longer be appropriate for the prevention and treatment of complex human diseases.

    Be well!


  15. JP Says:

    Updated 12/06/16:

    Nutrients 2016, 8(12), 789;

    Vitamin D Status and Efficacy of Vitamin D Supplementation in Atopic Dermatitis: A Systematic Review and Meta-Analysis

    Abstract: Recent literature has highlighted the possible role of vitamin D in atopic dermatitis (AD), and that vitamin D supplementation might help to treat AD. This study determined the relationship between vitamin D level and AD, and assessed the efficacy of vitamin D supplementation. We searched the MEDLINE, EMBASE, and Cochrane databases up to May 2015. Observational studies and randomized controlled trials were included based on the available data on the serum 25-hydroxyvitamin D (25(OH)D) level and quantified data available for severity assessed using the Scoring Atopic Dermatitis (SCORAD) index or Eczema Area and Severity Index (EASI) score. Compared with healthy controls, the serum 25(OH)D level was lower in the AD patients of all ages (standardized mean difference = −2.03 ng/mL; 95% confidence interval (CI) = −2.52 to −0.78), and predominantly in the pediatric AD patients (standardized mean difference = −3.03 ng/mL; 95% CI = −4.76 to −1.29). In addition, the SCORAD index and EASI score decreased after vitamin D supplementation (standardized mean difference = −5.85; 95% CI = −7.66 to −4.05). This meta-analysis showed that serum vitamin D level was lower in the AD patients and vitamin D supplementation could be a new therapeutic option for AD.

    Be well!


  16. JP Says:

    Updated 02/13/17:

    J Dermatolog Treat. 2017 Jan 24:1-19.

    Dietary modifications in atopic dermatitis: patient-reported outcomes.

    BACKGROUND: Patients with atopic dermatitis (AD) commonly turn to dietary modifications to manage their skin condition.

    OBJECTIVES: To investigate patient-reported outcomes and perceptions regarding the role of diet in AD.

    METHODS: One hundred and sixty nine AD patients were surveyed in this cross-sectional study. The 61-question survey asked about dietary modifications, perceptions and outcomes.

    RESULTS: Eighty seven percent of participants reported a trial of dietary exclusion. The most common were junk foods (68%), dairy (49.7%) and gluten (49%). The best improvement in skin was reported when removing white flour products (37 of 69, 53.6%), gluten (37 of 72, 51.4%) and nightshades (18 of 35, 51.4%). 79.9% of participants reported adding items to their diet. The most common were vegetables (62.2%), fish oil (59.3%) and fruits (57.8%). The best improvement in skin was noted when adding vegetables (40 of 84, 47.6%), organic foods (17 of 43, 39.5%) and fish oil (28 of 80, 35%). Although 93.5% of patients believed it was important that physicians discuss with them the role of diet in managing skin disease, only 32.5% had consulted their dermatologist.

    CONCLUSIONS: Since dietary modifications are extremely common, the role of diet in AD and potential nutritional benefits and risks need to be properly discussed with patients.

    Be well!


  17. JP Says:

    Updated 04/13/17:

    J Dermatolog Treat. 2017 Apr 2:1-9.

    Efficacy and safety of an over-the-counter 1% colloidal oatmeal cream in the management of mild to moderate atopic dermatitis in children: a double-blind, randomized, active-controlled study.

    PURPOSE: The purpose of this study is to evaluate the efficacy and safety of an over-the-counter (OTC) 1% colloidal oatmeal cream versus a prescription barrier cream in children with mild-to-moderate atopic dermatitis (AD).

    MATERIALS AND METHODS: Eligible patients (6 months-18 years) were randomized to OTC or prescription cream. Eczema Area and Severity Index (EASI) scores, Investigator’s Global Atopic Dermatitis Assessment (IGADA) scores, patients’ and/or caregivers’ assessment of itch using 10-cm visual analog scale (VAS) on day 0, weeks 1, 2, and 3 were assessed. The intention to treat (ITT) and per protocol (PP) populations were analyzed.

    RESULTS: Ninety patients (mean [SD] age, 8.1 [4] years; boys, 45.6%; African American, 54.4%) were randomized (OTC cream, 45; prescription cream, 45). At week 3, EASI scores showed that the OTC cream was non-inferior (non-inferiority margin = 1.5) to the prescription cream (adjusted mean change [95% CI] from baseline: ITT, 0.18 [-0.35, 0.70]; PP, 0.14 [-0.42, 0.70]). IGADA (adjusted mean between group difference, 0.106 [-0.130, 0.341]) and VAS itch (0.103 [-0.831, 1.038]) scores improved in both groups. No safety issues were identified.

    CONCLUSION: OTC 1% oatmeal cream was equally effective and safe as the prescription barrier cream for the symptomatic treatment of mild-to-moderate AD in children.

    Be well!


  18. JP Says:

    Updated 08/16/17:

    Clin Cosmet Investig Dermatol. 2017 Jul 27;10:275-283.

    An open-label forearm-controlled pilot study to assess the effect of a proprietary emollient formulation on objective parameters of skin function of eczema-prone individuals over 14 days.

    BACKGROUND: This study examines the efficacy of a new plant-based emollient and assesses product acceptability.

    METHODS: Primary efficacy endpoints were improvement in transepidermal water loss, hydration, skin elasticity and firmness, erythema, and skin roughness and smoothness as measured using the versions of Tewameter, Corneometer, Cutometer, Mexameter, and Visioscan VC98, respectively. The cream was applied twice daily by 32 participants to an area of one forearm unaffected by eczema, while the same area of the other forearm was used as a control. Measurements were taken at day 0 and day 14. Secondary endpoints assessed the acceptability of the product.

    RESULTS: At the end of 2 weeks, transepidermal water loss, hydration, skin elasticity and firmness, erythema, and skin roughness and smoothness improved. All changes were statistically significant (p<0.01). The rate of satisfaction with the emollient properties was 82%, and the rate of absorption into the skin was 88%. Results show that the emollient hydrates and repairs eczema-prone skin with high levels of acceptability.

    Be well!


  19. JP Says:

    Updated 10/16/17:

    Benef Microbes. 2017 Oct 12:1-8.

    Lactobacillus plantarum IS-10506 supplementation reduced SCORAD in children with atopic dermatitis.

    Lactobacillus plantarum IS-10506 is a novel probiotic isolated from dadih, an Indonesian traditional fermented buffalo milk. It’s in vitro and in vivo probiotic properties have been assessed. Probiotic function has been shown in vivo by the suppression of allergic reactions in BALB/c mice through the action of T-regulatory cells cytokines by balancing Th1 and Th2 immune response. Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease characterised by the imbalance of Th1 and Th2. The aim of the study was to assess the probiotic function of L. plantarum IS-10506 in children with mild and moderate AD. A randomised double-blind placebo-controlled trial comparing microencapsulated L. plantarum IS-10506 (1010 cfu/day) and placebo (skim milk-Avicel) twice daily for 12 weeks was conducted in an outpatient clinic on children with mild and moderate AD. The trial included 22 AD children divided into intervention and control groups of n=12 and n=10 patients, respectively. Scoring Atopic Dermatitis Index (SCORAD) and serum immunoglobulin E (IgE), interleukin (IL)-4, interferon gamma (IFN-γ), forkhead box P3 (Foxp3+)/IL-10, and IL-17 levels were assessed. Demographic and baseline characteristics were not significantly different between the two groups. SCORAD and levels of IL-4, IFN-γ, and IL-17 were significantly lower in the probiotic group than those in the placebo group, while the IgE levels were not significantly changed. The ratio of Foxp3+ to IL-10 was significantly higher in the probiotic group than that in placebo group. Supplementation with the probiotic L. plantarum IS-10506 offered a potential treatment for children with AD. Further long-term studies with a larger sample size are required to confirm the therapeutic efficacy of L. plantarum IS-10506 in AD.

    Be well!


  20. JP Says:

    Updated 1/17/18:

    J Drugs Dermatol. 2018 Jan 1;17(1):78-82.

    The Use of an Over-the-Counter Hand Cream With Sweet Almond Oil for the Treatment of Hand Dermatitis.

    Hand dermatitis is estimated to affect greater than 15% of the general population. Childhood eczema, frequent hand washing, and occupational exposure to chemicals are predisposing factors. Hand dermatitis treatment involves both prevention of outbreaks and treatment of active disease. Moisturizers are essential to protect the skin from the environment, enhance hydration, and repair the skin barrier. They have been shown in large studies to prevent occupational related breakouts. Natural oils are commonly used in moisturizers for their moisturizing and emollient properties. Sweet almond oil is an oil that contains high levels of fatty acids and has been used for centuries to treat skin diseases such as eczema and psoriasis. In this study, a moisturizer with 7% sweet almond oil and 2% colloidal oatmeal was found to be both safe and effective in treating patients with moderate to severe hand dermatitis.

    Be well!


  21. JP Says:

    Updated 06/02/18:

    Ann Dermatol. 2018 Jun;30(3):304-308.

    The Beneficial Effect of Korean Red Ginseng Extract on Atopic Dermatitis Patients: An 8 Weeks Open, Noncomparative Clinical Study.

    Background: Atopic dermatitis (AD) is a chronic or chronically relapsing, eczematous, severely pruritic inflammatory skin disorder. Korean red ginseng (KRG) has been shown previously to exhibit diverse biological effects including anti-inflammatory and antipruritic effects in a murine model.

    We aimed to investigate the beneficial effects of KRG on AD patients, to determine whether there was improvement in disease severity, skin barrier function, pruritus and sleep disturbance relief.

    Methods: An open, noncomparative clinical study that utilized KRG tablets (500 mg/tablet) was conducted. This study included 41 patients with mild to moderate AD diagnosed by the Korean atopic dermatitis guidelines. Three visits to the hospital at days 1, 28±7, and 56±7 for evaluation were made. The effects of KRG were assessed by measuring eczema area and severity index (EASI) score, transepidermal water loss (TEWL), the visual analogue scale (VAS), total amount of topical agents used in recent 8 weeks and investigator global assessment (IGA).

    Results: Patients taking KRG tablets showed significant decreases in EASI score and TEWL, and the VAS of pruritus and sleep disturbance were significantly reduced. The amount of topical agents used was reduced but not by a statistically significant amount. IGA at the third visit showed improvement of AD compared to the second visit, but the difference was not statistically significant.

    Conclusion: KRG can be safely used as a health food to achieve clinical improvement of AD as well as improving overall quality of life, and has potential for further development.

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  22. JP Says:

    Updated 08/07/18:

    Ann Dermatol. 2018 Aug;30(4):409-416.

    Effect of Evening Primrose Oil on Korean Patients With Mild Atopic Dermatitis: A Randomized, Double-Blinded, Placebo-Controlled Clinical Study.

    Background: Atopic dermatitis (AD) is related to a deficiency of delta-6-desaturase, an enzyme responsible for converting linoleic acid to gamma-linolenic acid (GLA). Evening primrose oil (EPO) as a source of GLA has been of interest in the management of AD.

    Objective: The aim of this randomized, double-blinded, placebo-controlled clinical study is to evaluate the efficacy and safety of EPO in Korean patients with AD.

    Methods: Fifty mild AD patients with an Eczema Area Severity Index (EASI) score of 10 or less were enrolled and randomly divided into two groups. The first group received an oval unmarked capsule containing 450 mg of EPO (40 mg of GLA) per capsule, while placebo capsules identical in appearance and containing 450 mg of soybean oil were given to the other group. Treatment continued for a period of four months. EASI scores, transepidermal water loss (TEWL), and skin hydration were evaluated in all the AD patients at the baseline, and in months 1, 2, 3, and 4 of the study.

    Results: At the end of month 4, the patients of the EPO group showed a significant improvement in the EASI score (p=0.040), whereas the patients of the placebo group did not. There was a significant difference in the EASI score between the EPO and placebo groups (p=0.010). Although not statistically significant, the TEWL and skin hydration also slightly improved in the EPO patients group.

    Conclusion: We suggest that EPO is a safe and effective medicine for Korean patients with mild AD.

    Be well!


  23. JP Says:

    Updated 09/28/18:

    Eur J Pediatr. 2018 Sep 26.

    Effect of synbiotic supplementation on children with atopic dermatitis: an observational prospective study.

    The objective of this observational single-cohort prospective study was to assess the effect of synbiotic supplementation for 8 weeks in children with atopic dermatitis (AD). The synbiotic product contained Lactobacillus casei, Bifidobacterium lactis, Lactobacillus rhamnosus, Lactobacillus plantarum, fructooligosaccharide, galactooligosaccharide, and biotin. Patients were examined at baseline and at 8 weeks. Effectiveness of treatment was assessed with the Scoring Atopic Dermatitis (SCORAD) index. A total of 320 children (mean age 5.1 years, range 0-12 years) were included. The mean (SD) SCORAD index decreased from 45.5 (15.5) at baseline to 19.4 (14.6) at the end of treatment (P < 0.001), VAS score for pruritus decreased from 5.7 (2.2) to 2.3 (2.2) (P < 0.001), and VAS score for sleep decreased from 3.1 (2.5) to 1.1 (1.8) (P < 0.001). Percentage of children with moderate-severe disease decreased from 92.4% at baseline to 28.1% at week 8. In the multiple linear regression analysis, higher baseline SCORAD index (OR 0.51; 95% CI 0.41-0.61) and higher adherence (OR 7.29; 95% CI 1.85-12.73) were significantly associated with greater decrease in SCORAD index. CONCLUSION: Supplementation with the multistrain synbiotic product may improve AD in children. What is known: • Pediatric atopic dermatitis (AD) is a common, troublesome condition with limited treatment options, which has been shown to be associated with dysbiosis in the intestinal microflora. • Results of controlled clinical trials (RCTs) on the effect of probiotics in children with AD have been disparate, although overall, the data favor probiotics over placebo, with multistrain supplements associated with better improvements in AD. What is new: • The results of this observational, prospective, open-label, single-cohort study on 320 children with AD younger than 12 years old suggest that supplementation with multistrain synbiotics (Lactobacillus casei, Bifidobacterium lactis, Lactobacillus rhamnosus, Lactobacillus plantarum, fructooligosaccharide, galactooligosaccharide, and biotin) helps to improve AD symptoms in children. • More than 80% of children experienced improvement in AD symptoms, as measured by Severity Scoring of Atopic Dermatitis (SCORAD) index and assessed by parents and physicians. The main predictive factors for improvement was adherence to synbiotic treatment and high baseline SCORE index; the change in SCORAD did not depend on age, gender, presence of concomitant treatment, duration, and type of AD (persistent vs with flares), other concomitant allergies or history of parental allergy. Be well! JP

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