Alternative therapies in eczema care

Peter Lio, M.D., assistant professor of clinical dermatology and pediatrics, Northwestern University Feinberg School of Medicine, Chicago, and director of the Chicago Integrative Eczema Center, says eczema patients and their families often come to him looking for alternative treatments.

“Sometimes people come in and say, ‘I don’t want to use any Western medicine,’ and I’ll say if it’s the mildest eczema, perhaps we can get by. But for anything more severe, we really need to do this as part of a plan with the hopes of minimizing the amount of more powerful medicines by strengthening the skin and doing these other good things,” Dr. Lio says.

Here’s some of the advice Dr. Lio gives patients, according to what’s thumbs up, jury’s out and thumbs down.

Thumbs up

1. Sunflower seed oil (Dr. Lio’s favorite)

“It comes in a number of different forms. There are some products that have it built in. There are some bath oils that have it. I’m happy with any of those, but I really like just the pure sunflower seed oil,” he says.

Apply it to damp skin twice a day. Sunflower seed oil naturally boosts the skin barrier function and has anti-inflammatory properties.

There is no downside to using it, the dermatologist says.

“There is a theoretical risk that putting things on the skin that we eat can potentially make us allergic to them. But it does not appear to be a significant risk with sunflower seed oil, in my experience. If someone has a known allergy to sunflower seeds, however, then I would definitely avoid it,” he says.

2. Coconut oil.

People can buy it off the shelf, but should make sure it’s virgin or cold-pressed coconut oil. Why? There might be residues of extraction chemicals in other coconut oil types.

Apply it once or twice a day to damp skin, if possible. Coconut oil has been shown to reduce staph bacteria on the skin and it acts as an emollient, according to Dr. Lio.

Is it safe for use on children with nut allergies? “Coconut is a distant cousin of tree nuts. Some allergists put it in that group. It’s a rare allergen, but certainly avoid if you’re allergic to coconuts,” Dr. Lio says.

3. Acupressure.

Dr. Lio uses just one acupressure point and has found it makes a difference for his patients. Patients or parents can apply the pressure at home, once they learn how, he says.

“Some say that it is simply working as a distraction: it’s something to do with your hands rather than scratch,” Dr. Lio says. “I am OK with that, but it may also be working in other ways, having more direct effects on the neurological mechanisms of the itch itself.”

Dr. Lio was senior author of a study examining acupressure’s efficacy in eczema. The researchers compared a standard care control group of adults with atopic dermatitis to an intervention group performing a specific type of acupressure for three minutes, three times a week for four weeks. Twelve adult patients finished the study. Those in the intervention group showed improvement in pruritus and lichenification, while people in the control group experienced no change (Lee KC, Keyes A, Hensley JR, et al. Acupunct Med. 2012;30(1):8-11).

Jury’s out

1. Probiotics.

“The data has been up and down,” Dr. Lio says. “There are some really promising studies that show prevention of atopic dermatitis, and some where probiotics even seem to help existing eczema. However, there are also studies where it doesn’t seem to do much at all. It may be that we need to learn more about the right types of probiotics, the right patients and the right dosing schedule, and this continues to be an exciting area.”

Dr. Lio was co-author of an article in Practical Dermatology, May 2014, “Probiotics: The search for bacterial balance,” in which the authors examined the use of probiotics for the prevention and treatment of eczema. He and the co-authors reported a 2010 review of trials found insufficient data to endorse the use of probiotics to prevent or manage atopic dermatitis. In contrast, a 2012 meta-analysis of trials found probiotic usage was associated with about 20 percent decreased atopic dermatitis incidence in children (Van der Aa LB, Heymans HS a, van Aalderen WMC, Sprikkelman AB. Pediatr Allergy Immunol. 2010;21(2 Pt 2):e355-e367; Pelucchi C, Chatenoud L, Turati F, et al. Epidemiology. 2012;23(3):402-414).

2. Dietary modification, particularly gluten-free, casein-free (milk protein-free) diet.

“I have many patients who have been instructed by their integrative or holistic practitioner to cut diary and gluten. To some extent, I think that big dietary changes can be good, overall, for some people, and can effect sweeping changes in their life. However, when I have patients do it in earnest, my honest opinion is it’s not the solution for most. I wish it were. It would be great if we could just make a diet change,” Dr. Lio says. “It sure seems to work for some people, but it sadly doesn’t work for everybody.”

3. Chinese herbs.

“There are some really exciting studies that show great improvement in some patients, but we really need to learn more about it. And we need to figure out how we can do this in a more standard fashion because it’s not easy to apply to everybody, especially outside of a traditional Chinese medicine framework,” Dr. Lio says.

Thumbs down

1. Evening primrose oil.

It’s a nice oil with good properties but it hasn’t been shown to help with eczema, according to Dr. Lio.

2. Borage oil.

Same thing as with evening primrose oil. “A lot of people want to take it by mouth but it has not really been shown to help,” he says.

3. Homeopathy.

“It’s compelling and some patients swear by it. But I think there’s enough data to say, overall, homeopathy is not something we can recommend in good faith,” Dr. Lio says. 

Resources:

Lio PA. Curr Allergy Asthma Rep. 2013;13(5):528-538

Lio PA, Lee M, LeBovidge J, et al. J Allergy Clin Immunol Pract. 2014;2(4):361-369; quiz 370

Monick S, Schettle L, Lio PA. Practical Dermatology. 2014;59-60