Natural treatments for eczema

• DEFINITION: Treatment of allergic reactions of the skin.
• PRINCIPAL PROPOSED NATURAL TREATMENTS:
• OTHER PROPOSED NATURAL TREATMENTS: Burdock, Coleus forskohlii, combination cream containing Mahonia aquifolium, probiotics (treatment), quercetin, red clover, red vine leaf and licorice, sea buckthorn (Hippophae rhamnoides), Viola tricolor and Centella asiatica, zinc
• PROBABLY INEFFECTIVE TREATMENT: Oral use of gamma-linolenic acid from evening primrose oil or borage oil

Introduction

Eczema, sometimes called atopic dermatitis, is an allergic reaction of the skin and consists mainly of itchy, inflamed patches on the face, elbows, knees, and wrists. Eczema is most commonly found in infants and young children, and it is closely associated with asthma and hay fever. Together, these types of eczema are called atopy. Atopy tends to run in families. Medical treatment for eczema consists mainly of antihistamines and topical steroid creams.

Principal Proposed Natural Treatments

Probiotics. Probiotics are health-promoting (friendly) bacteria. The best-known probiotic is Lactobacillus acidophilus, which is used to make yogurt. Probiotics are thought to have immune-regulating actions. Using probiotics during pregnancy and after childbirth may reduce the risk of childhood eczema, presumably by normalizing the immune response.

The benefits of probiotics for eczema prevention were seen in a small 2001 study. Also, in a large, long-term, double-blind study, 1,223 pregnant women were given either a placebo or a probiotic mixture (containing Lactobacilli and Bifidobacteria) beginning two to four weeks before delivery. Their newborn children then received either probiotics or a placebo for six months. The results showed that the probiotics mixture markedly reduced the incidence of eczema but not of other allergic diseases.

A follow-up study of these mother-child pairs found that probiotics for mother and infant were not associated with reduced eczema, allergic rhinitis, or asthma in children followed through age five. Another study yielded marginal results, and a third study found no benefit for the prevention of eczema. This latter study demonstrated a modestly increased risk of wheezing bronchitis in those infants who took the lactobacilli. Finally, researchers in another study concluded that not all probiotics are created equal. In this placebo-controlled study involving pregnant women and their infants, L. rhamnosus reduced the incidence of eczema in the children, but a strain of Bifidobacterium animalis did not.

In addition, some double-blind trials have found evidence that infants and children who already have eczema may benefit from using probiotics. However, in a careful review of twelve studies involving 781 children, researchers concluded that there is no convincing evidence that probiotics can effectively treat eczema. Alternately, a team at the University of California, San Diego, published a study that found using beneficial bacteria swabbed from patients' own skin mixed with moisturizing lotion had a powerful effect in clearing up the patients' eczema in a short period. Specifically, the microbes Staphylococcus hominis and Staphylococcus epidermidis were found to combat Staphylococcus aureus, another bacteria that has been shown to be a component of eczema.

If probiotics are beneficial for childhood eczema, they are probably more effective at preventing the condition rather than treating it. Three reviews of numerous studies cautiously conclude that probiotics may help reduce the risk of eczema in infants and children, particularly in those at high risk and when probiotics are given to both mother (before giving birth) and infant. However, in a double-blind, placebo-controlled study of 231 infants born to women with allergies, giving L. acidophilus to the infants failed to reduce their risk of developing eczema.

Researchers at the US National Institute of Allergy and Infectious Diseases developed a topical probiotic cream with the common bacteria Roseomonas mucosa. After seven years of research, this treatment was announced in mid-2024. It was shown to have few side effects and safely relieved symptoms in adults and children.

Breastfeeding. Early exposure of the infant to allergenic substances found in infant formula may play a role in the development of eczema. Breastfeeding might, therefore, help prevent this condition.

A large study lends credence to this theory. More than seventeen thousand women in the Republic of Belarus were enrolled. About one-half were entered into a program that encouraged them to breastfeed (the intervention group), while the other half was enrolled in a different program that did not instigate any particular method of infant feeding (the control group). The results showed that women encouraged to breastfeed were much more likely to do so than other women. Furthermore, children of women in the intervention group showed almost a 50 percent reduction in the incidence of eczema.

This study does not prove that breastfeeding reduces the risk of eczema. Rather, it shows that counseling to breastfeed reduces the risk of eczema. However, the implication is fairly compelling: If a woman breastfeeds her child, the child may be less likely to develop eczema.

Most modern research does not support a link between breastfeeding and the likelihood of developing eczema. For example, one review involving over 5,500 participants found no connection between breastfeeding and eczema. It is more likely that formula may aggravate a child's sensitivity to soy or dairy, which can often be remedied by switching formula types or using special infant formulas that are less allergenic.

Chinese herbal medicine. A combination of traditional Chinese herbs has shown promise as a treatment for eczema. This proprietary formula contains Ledebouriella seseloides, Potentilla chinensis, Akebia clematidis, Rehmannia glutinosa, Paeonia lactiflora, Lophatherum gracile, Dictamnus dasycarpus, Tribulus terrestris, Glycyrrhiza uralensis, and Schizonepeta tenuifolia. In paired double-blind, placebo-controlled trials carried out by one research group, the mixture produced significantly better effects than the placebo for adults and children. Though these studies were positive, there were design issues in almost all of them.

Each study enrolled approximately forty people and used a crossover design in which all participants received the real treatment and a placebo for eight weeks each. The use of the herbal combination significantly reduced eczema symptoms compared with the placebo. However, a subsequent study of similar design performed by a different research group failed to find significant benefit. The reason for this discrepancy is not clear. In a twelve-week double-blind study, a different traditional Chinese herbal formula also failed to prove more effective than the placebo for the treatment of eczema. Asian herbal creams marketed for eczema have often been found to contain high-potency corticosteroid drugs that are not listed on the label.

Vitamins. Research increasingly indicates that vitamin supplements may help with eczema. Studies have shown that vitamin D supplements can benefit eczema sufferers and that the disease itself is associated with low levels of vitamin D, although supplements remain somewhat controversial. Likewise, a growing body of evidence suggests that vitamin B₁₂ may have a positive effect. However, further research is needed to prove these treatments.

Topical treatments. Topical creams made from chamomile, licorice, or calendula, alone or in combination, are widely used in Europe to treat eczema. One study of 161 persons found chamomile cream just as effective as 0.25 percent hydrocortisone cream for the treatment of eczema. However, the report did not state whether doctors or study participants were blinded as to which treatment was which, so it is not clear how reliable the results may be.

A study by the same authors (also not double-blind), involving seventy-two persons with eczema, found somewhat odd results. In this trial, chamomile was not significantly more effective than the placebo, but both were better than 0.5 percent hydrocortisone cream. It is difficult to interpret what these results mean, but they certainly cannot be taken as proof that chamomile cream is effective.

A double-blind study of thirty people compared 1 and 2 percent licorice cream with a placebo cream for eczema. Both proved more effective than the placebo, and the 2 percent preparation was more effective than the 1 percent preparation.

The herb St. John’s wort is most often used for the treatment of depression. St. John’s wort contains a substance, hypericin, that is thought to have anti-inflammatory properties, making it potentially useful in eczema, too. In a double-blind study, a cream containing St. John’s wort extract was compared with the placebo cream in twenty-one people with mild to moderate eczema symptoms. Study participants used real cream on one arm and the placebo cream on the other. The results indicated that using St. John’s wort cream significantly reduced symptoms.

Another placebo-controlled double-blind study, which enrolled forty-nine people with eczema, found benefit with a cream containing vitamin B₁₂ at a concentration of 0.07 percent. Topical B₁₂ is thought to work in eczema by affecting local levels of a substance called nitric oxide. A small study of twenty-one children aged six months to eighteen years found that topical application of vitamin B₁₂ for up to four weeks improved skin check scores compared with the placebo.

A double-blind, placebo-controlled study of eighty-eight people with eczema tested a cream containing extracts of Mahonia aquifolium, Viola tricolor, and Centella asiatica. The results failed to show benefit overall. A post hoc (after the fact) analysis noted benefits among those participants who were not tested at the time of the year with the hottest temperatures. However, because of the mathematical laws of statistics, such retroactive evaluations are of limited meaningfulness.

The National Eczema Association lists several other complementary and alternative treatments that may be helpful to eczema sufferers, noting that these methods generally require further study. Among the natural topical treatments considered to have some benefit are coconut oil and sunflower seed oil. Studies have shown that virgin or cold-pressed coconut oil applied topically can reduce levels of S. auereus bacteria, helping lower instances of infection. Sunflower oil has been shown to help the skin seal in moisture and improve its barrier properties, while also acting as an anti-inflammatory agent.

Other Proposed Natural Treatments

A cream containing red vine leaf and licorice extract has shown some promise for the treatment of eczema. Another study found that four weeks of massage therapy performed by the parents (after a one-time training session with a massage professional) significantly decreased eczema symptoms in children.

The herbs burdock, red clover, and Coleus forskohlii and the supplements quercetin and zinc have also been recommended for eczema, but there is no meaningful evidence that they really work. A small, thirty-day, double-blind trial failed to find vitamin B₆ at a dose of 50 milligrams (mg) daily helpful for eczema. Similarly, an eight-week double-blind trial of zinc at a high dose of 67 mg daily failed to find any benefit for eczema symptoms. Another study that tested a combination of Eleutherococcus, yarrow, and Lamium album also came up with negative results.

A widely publicized study reportedly found the oral use of the plant sea buckthorn (Hippophae rhamnoides) helpful for eczema, but the placebo treatment proved equally or more effective. Additionally, although it is widely believed that food allergies are a major contributor to eczema, this assumption may be incorrect. Treatments, such as hypnosis, acupuncture, and massage therapy, have also been proposed to treat eczema, underlying triggers, such as stress, or symptoms. However, evidence for these treatments is limited.

Evening primrose oil and gamma-linolenic acid. Evening primrose oil, taken orally, has been widely used in Europe for the treatment of eczema. Evening primrose is a rich source of the essential fatty acid gamma-linolenic acid (GLA). Other sources of GLA include borage oil and black currant oil. However, other studies have failed to find GLA supplements helpful for eczema. Topical application of GLA has been tried, but this, too, has failed to show effect.

Later, better-designed studies have not shown promising results. A double-blind, placebo-controlled study that followed fifty-eight children with eczema for sixteen weeks found no difference in effectiveness between evening primrose oil and the placebo. A twenty-four-week double-blind study of 160 adults with eczema failed to find benefit with GLA from borage oil, as did a twelve-week study of 151 adults and children. In addition, GLA from evening primrose, either alone or with fish oil, failed to provide benefits in a sixteen-week, double-blind, placebo-controlled study of 102 people with eczema. A fourth double-blind trial followed thirty-nine people with hand dermatitis for twenty-four weeks. Evening primrose oil at six grams daily produced no significant improvement compared with a placebo. Only one double-blind trial performed after the 1989 review found therapeutic benefit with evening primrose oil, but it used very high doses of the supplement and found only marginal benefits. The balance of the evidence suggests that borage oil and evening primrose oil have been convincingly shown to be ineffective for treating eczema, leading the National Eczema Association to recommend removing them from treatment discussions.

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