If your child suffers from eczema, then you probably know how uncomfortable and irritating it is for them. Some kids are real troopers and take the itch and skincare routine on board, whereas others don’t cope that well and are often quite irritable and tetchy.
The itchy burning skin can often disrupt sleep and eczema is known to affect focus and mood in some children. Eczema doesn’t look very pleasant either, which is not good for self-esteem; and sometimes you can’t even cover it up as clothing can irritate it further. This is all hard work for the parent too and sometimes it’s an uphill battle keeping the itch at bay and skin well moisturised.
You are never alone, as it is thought that eczema affects one in five children worldwide and one in three children in developing countries. It can be a life-long condition that many people need to manage every single day and for other people, it waxes and wanes over their lifetime.
The medical approach to eczema treatment and maintenance is to apply emollient or hydrocortisone creams to the skin on a regular basis with the hope that the child will “grow out of it”. For many eczema sufferers, they need to keep up the moisturising and topical treatments every day for their entire life and they never grow out of it.
The Naturopathic Approach
My saying has always been that eczema is just as much about being itchy on the inside as it is on the outside. Often our clients will say that they feel irritated and inflamed systemically and find they get particularly tired and emotional when their eczema is flaring. Often a dysregulated and irritated gut accompanies the eczema and studies have found that adults with atopic allergy symptoms have a higher incidence of irritable bowel syndrome.
From a naturopathic perspective, and taking on board the extensive medical research, eczema is seen as a systemic inflammatory condition which can reflect poor gut health and lowered oral and digestive tolerance to certain foods and environmental triggers. The eczema may be worse if there is an imbalance in the gut flora and the health of the gut microbiome is reflected in the skin microbiome – this is known as the gut-skin axis.
Psychiatry is now linking long-term inflammatory skin conditions with poor mental health. It is thought that chronic inflammatory cytokines in such atopic conditions may be a possible reason why up to 30% percent of eczema suffer from anxiety and depression.
It may be because chronic itching shares many neural pathways with chronic pain and inflammatory pathways. We find that if you can downregulate the inflammatory pathways, then the skin improves, and a child seems more settled and happier.
Equally, itch and pain neurons respond similarly to acute stress and many people report their eczema is worse when they are stressed. This is where stress management can help many people manage their eczema better.
Why Does A Child Get Eczema?
There is a very strong genetic component to eczema and if you have a family history of atopic diseases including allergy, asthma and eczema then a child will be more likely to develop eczema triggered by foods or environmental allergies. The Filaggrin gene, which is a common genetic mutation in families prone to eczema, can potentially mean that hard water irritates skin more than softer water.
Those children who carry this gene mutation have been found to be three times more likely to develop eczema if they bathe in hard chalky water. Many children are sensitive to washing powders and parents need to choose extra gentle skin care products suitable for sensitive skin.
Certain foods and environmental allergens may also provoke the eczema, and these can change over a lifetime. The food allergens and intolerances in eczema-prone kids that seem to pop up all the time in our clinic are milk, egg and nuts.
Recent research has found that baby milk formula or formula-heavy mixed-feeding led to more milk allergy related cases of eczema. On the other hand, breastfeeding and breast-milk heavy mixed-feeding were associated with egg-allergy related eczema.
Environmental allergens and triggers are common too, such as allergies to house dust mites, pet fur, feathers, tree and grass pollen and moulds as well as sensitivity to cold, dry or damp weather.
Research has found that children with eczema have a higher potential for gut permeability and we find that “leaky-gut” is common in the eczema-prone kids that we see in our clinic, which can be triggered by a reaction to gluten (zonulin), histamine overload or an intestinal bacterial infection (bacterial-derived lipopolysaccharides known as LPS).
Gut permeability markers can be tested together via a blood test. Stool tests can also point towards whether these issues are part of the picture. A stool test can also analyse any imbalances in the gut microbiome as well as identify any key functional gut issues.
A mother’s diet when pregnant can influence whether a baby will develop eczema and it seems that if the mum-to-be eats plenty of the key allergen potential foods when pregnant then this may be a step to preventing eczema in their offspring. One study found that moderate eggs consumption (3-4 times a week) during pregnancy was protective against egg allergy compared with low consumption (2 eggs or less a week).
There is evidence that eating a diet rich in oily fish, vitamin D, probiotic-rich foods and a Mediterranean style diet helps too. It is also better if mummy keeps to a healthy weight when pregnant, as studies have linked excess weight during pregnancy with baby allergies and eczema.
If a pregnant mum to be is prescribed antibiotics during the pregnancy, at the birth or whilst breastfeeding then this can be a risk factor for eczema in the baby. Antibiotics given directly to the baby during their first year of life can get the ball rolling and eczema often appears for the first time shortly after this.
The good news is that probiotic supplementation during pregnancy and infancy can help to prevent atopic dermatitis and eczema in children and research has found that a mixture or Lactobacillus and Bifidobacterium has a better effect.
It’s also important for mum and a weaned baby to eat diet rich in prebiotics, probiotics and polyphenols to keep the microbiome replete with beneficial bacteria. These foods include kefir, yoghurt, apple cider vinegar, miso, sauerkraut and well as a wide range of vegetables, salads, fruits, nuts, seeds, pulses and olive oil.
It is also thought that early exposure to antimicrobials – such as hand sanitiser, antibacterial wipes and sprays may affect the microbiome diversity and immune function in children. Parabens and Triclosan have been identified as potential antimicrobials to avoid in skincare and cleaning products.
Triclosan is now only allowed in toothpastes, hand soaps, body soaps/shower gels and deodorant sticks at a maximum concentration of 0.3%, however, some purists would say this is still too much. There are lots of paraben-free baby skin products now and it is important to pick lovely natural skincare for little ones prone to sensitive skin.
PFASs (perfluoroalkyl substances) found in non-stick cooking pans, microwave popcorn bags, stain-resistant carpets and soft furnishing covers have been associated with increased allergies and eczema in children.
In the same vein, BPA exposure from plastics during pregnancy can also upregulate inflammatory pathways in the mother which may lead to more allergies and eczema in her child. This is one of the main reasons why it is important to drink out of a non-plastic water bottle and to avoid too much plastic food packaging.
Prevention & Management
When you trawl through the research into the nutritional factors that can help with eczema prevention and help to manage the condition, then key points often come up:
Feed Them Oily Fish
The omega 3 essential fatty acids in salmon, trout, mackerel, sardines, anchovies and shellfish help to down-regulate systemic inflammation and also help to bolster the gut microbiome with anti-inflammatory bacterial colonies. Prenatal consumption of oily fish is just as important as the baby or child’s diet; and if you are not a fish eater, then supplement with a good quality fish oil or vegan omega 3 algae supplement.
Enough Vitamin D
There is some evidence that vitamin D can help reduce the severity of eczema. Vitamin D again is important for immunity, down-regulating systemic inflammation and for keeping the gut microbiome healthy and replete with beneficial flora.
This is as important to maintain in pregnancy as well as in the child, and research has found that pregnant mums who keep their vitamin D levels topped up are less likely to have kids with allergies. This is why getting lots of sunshine and eating foods rich in Vitamin D like eggs, fish and grass-fed milk and meat helps.
Building up a healthy gut microbiome in pregnancy, when breastfeeding and in the child’s diet is thought to help reduce the severity of eczema. Probiotic rich foods include kefir, live yoghurt, sauerkraut, miso and apple cider vinegar and your gut microbiome flourishes when we eat a wide variety of fresh fruits, vegetables, salads, nuts, seeds, cocoa and olive oil.
Our clients often report that their eczema or their child’s eczema is worsened after they have taken a round of antibiotics as this wipes out the beneficial bacteria and depletes the microbiome. A course of probiotics after the antibiotics may help to rebalance things.
If your child’s eczema responds well to prescribed or over the counter antihistamines then it is worth seeking out IgE food and environmental allergy testing to identify the allergen triggers. We can arrange a full classic allergy IgE testing via a blood test for all ages, even in young babies which can be much less stressful than pin prick skin testing in a hospital.
Sometimes it is not a specific food that is causing the allergic reactions, but a build-up of histamine in the gut due to a microbial imbalance or an excess intake of histamine foods such as tomatoes, avocado, banana, walnuts and fermented foods like yoghurt.
If your child gets rashes, itchiness or a runny nose after eating these foods, then it might worth getting them checked for histamine intolerance. This happens because people do not produce enough of an enzyme called diamine oxidase in the gut to efficiently break down the naturally occurring histamine in foods and this is something our clinical team can help identify and support.
Sometimes eczema can get out of hand and get infected. This is usually by a bacterial infection called staphylococcus aureus that can spread easily. Antibiotics are often prescribed by a medical doctor and you can also apply creams and gels with antimicrobial properties to get on top of the infections.
Sometimes the antibiotics are not successful and there are natural antimicrobials that we can recommend in our clinic. Many people with eczema report that their eczema gets worse when they are run down and have poor immunity, so this is a reason to build in a more resilient immune system.
Excess hand washing
If the eczema is worse on the hands, then this may be due to excess handwashing with soap and this is one complication that in the Covid-19 era that needs to be considered for eczema prone children. It is thought that washing hands with water alone helps to manage eczema considerably better, or you can try changing the soap to something simpler.
We know how troublesome eczema can be and many people need to deal with it every day, which is horrible. If you or your child is suffering from eczema and it is making your child miserable and the itching and dry skin is difficult to manage, then get in touch with our clinical team to discuss how to take the functional medicine approach and seek out the root causes of that pesky itch!