Do you or someone you know have skin that appears dry, flaky and red, or have the uncontrollable feeling to scratch? And no matter how much you scratch, the itchy feeling doesn’t go away, and sometimes results in skin tears and bleeding. Sounds familiar? This is commonly known as “eczema”.
Eczema, also known as atopic dermatitis, is a type of chronic, inflammatory skin condition. Eczema can range in its severity, and symptoms can either flare up or subside from day to day. It can last for several days, weeks, months, and even up to years.
When it happens, patches of the skin become red and irritated, leading one to scratch uncontrollably. As a result, blisters containing small amounts of fluid form, and the affected area(s) can weep. Weeping occurs when bacteria has infected the affected area(s). Chronic eczema not only cause the skin to appear leathery or scaly, but it can also affect a person’s quality of life.
Fortunately, eczema, though incurable, can be treated and managed.
Demographics of eczema
Generally, eczema can happen to anyone and at any time of your life. Health statistics have shown that eczema is most prevalent during early childhood, usually affecting infants below 2 years old. According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), there are three classifications of eczema, depending on the age of the person when eczema strikes:
Most common during the first 6 months of life, and generally improves when the child reaches the age between 2 to 5 years old. Typical symptoms include a rash that is red and itchy, along with dry skin.
This may develop from infantile eczema or suddenly appear between the age of 2 to 4 years old, and usually improves with age. Although some children eventually outgrow this, most will continue into adulthood with a high tendency to develop dry and sensitive skin. Childhood eczema can affect the skin in elbow creases, behind the knees, and across the ankles. Sometimes skin on the face, neck and ears can get affected, too.
Similar to childhood eczema, adult eczema generally affects skin at the neck, elbow creases, wrists, behind the knees and ankles; and affected areas usually appear very dry, red and itchy. Weeping may also appear in the area(s) affected by eczema. This condition generally has a tendency to improve in middle life; and although rare to appear in the elderly, there is still a chance that adult eczema appearing in the elderly.
Causes of eczema
Eczema happens when your skin barrier is unable to repair itself, and has a decreased ability to retain water (moisture). This results in a loss of moisture, resulting in dry and scaly skin. With a poor healing ability, the skin exposes itself to environmental allergens and irritants. These enter the body and trigger an immune system response, i.e. inflammation. This is when skin becomes red, inflamed and itchy.
One is usually more inclined to get eczema if there is a family history of eczema or other allergic conditions, such as hay fever (allergic rhinitis) or asthma. Besides carrying a hereditary risk, environmental triggers and/or food allergies can also cause an eczema flare. An eczema flare happens when eczema worsens.
Eczema is not contagious!
Examples of environmental factors that can trigger an eczema attack include:
- Dry skin
- Viral or bacterial infections
- Swimming in chlorinated swimming pools
- Inhalant allergens, e.g. pollen during spring and summer months
- Irritants such as fragranced perfumes and soap, woollen or synthetic fabrics, dust mites
- Temperature changes (such as heat) or overly heated rooms (think: saunas)
- Stress (which can worsen eczema, but eczema is not a psychological condition)
The above-mentioned factors are not exhaustive, and may not be relevant to all individuals with eczema. Hence, one should take note what the potential trigger(s) is/are, and to avoid accordingly. If in doubt, one should always seek medical advice.
- Cow’s milk
- Soy and soy products
- Fish and shellfish
- Gluten/ Wheat
What to eat?
First, it is important to rule out food allergy-related eczema. If you suspect the eczema is due to food allergy, it is important that you consult a medical specialist (clinical immunologist/allergy specialist) and a dietitian trained in handling food allergies before undergoing an elimination diet. This is to avoid unnecessary removal of foods/food groups from the diet. With an improper elimination diet, and without the supervision of a dietitian, nutritional deficiencies may result.
An elimination diet refers to a diet plan involving the removal of food(s) or ingredient(s) suspected to cause allergies.
- When symptoms improve, the suspected food(s) or ingredient(s) can slowly be added back to the diet to see if an eczema flare results.
- If no improvement is seen after two weeks, then it can be said that the eczema flare is not related to food.
With food allergy-related eczema ruled out, let us now take a look at what foods should be incorporated into the diet if you are suffering from eczema.
Foods rich in omega-3
Besides having cardiovascular benefits, omega-3 fatty acids can reduce the severity of eczema symptoms due to their anti-inflammatory properties. Omega-3 fatty acids are classified as essential fatty acids as our bodies cannot make them. The only way to get omega-3 into our bodies is through dietary means (i.e. from food). Examples of foods rich in omega-3 fatty acids are fatty fish (salmon, sardines, mackerel). For our vegetarian friends, the alternatives are walnuts, linseeds (or flaxseeds), and chia seeds.
Quercetin is a type of flavonoid (pigment) found in deeply-coloured fruits and vegetables. It displays antioxidant and antihistamine properties. As an antioxidant, its job is to “mop up” free radicals generated from oxidative stress. This slows down the ageing process in our body. Oxidative stress generally arises from exposure to environmental/chemical toxins, leading stressful lifestyles, and eating a poor quality diet.
Sneezing, watery eyes, swollen eyes and/or lips, and red, itchy skin are common signs of an allergic reaction. This typically happens when the body comes into contact with a foreign substance. The immune system releases a chemical substance responsible for allergic reaction features (known as histamine) when it detects an allergy or sensitivity. Being a natural antihistamine, quercetin can help dampen the immune system’s release of histamine, thus lessening the allergic symptoms. In summary, quercetin is another anti-inflammatory food which you should add to your diet.
Good food sources of quercetin include:
- dark-coloured berries (blueberries and blackberries) preferably
- green and black tea
- cruciferous vegetables (broccoli, Brussel sprouts)
- dark, green leafy vegetables like spinach and kale
- citrus fruits
Vitamin C, known for its immune-strengthening and antioxidant properties, boosts your skin’s health. It helps build collagen in our skin and supports wound healing. Signs of vitamin C deficiency include scurvy (bleeding gums), easy bruising, poor wound healing, and the high tendency to fall sick.
As mentioned earlier, antioxidants help scavenge free radicals, which in excess can increase ageing process in our bodies. One example would be reduced skin elasticity as free radicals would damage the collagen fibres in our skin. That is why it is unsurprising to find vitamin C added to topical products as well as oral supplements, e.g. collagen supplements.
Managing eczema with vitamin C
Eczema sufferers should incorporate more fresh fruits and vegetables into their diet. Here are some things to take note of:
- Vitamin C is a heat sensitive vitamin, so try to cook your vegetables in the quickest time possible. Compared to boiling (vegetables), steaming is the preferred option not only because it uses less oil, but also because it retains vitamin C better. Vitamin C is a water-soluble vitamin, and when we boil our vegetables, we usually end up throwing away the water, which means throwing away the precious vitamin C as well!
- Eat whole fruits and vegetables rather than juices, as juices contain little or no fibre. Fibre is important for bowel regularity and for good blood sugar control, thus keeping hunger pangs at bay and is also beneficial for people with diabetes.
Probiotics, as defined by the World Health Organisation, are ‘live microorganisms which when administered in adequate amounts confer a health benefit on the host’. As most of these probiotics are found in our gastrointestinal tract, oral consumption has been promoted to help achieve a healthy gut microflora. This helps in managing allergies such as eczema since eczema is an immune system response.
By incorporating probiotics into our diet, the immune system is strengthened indirectly as probiotics support a healthy gut lining. This is particularly useful in preventing leaky gut syndrome, a condition where the gut integrity is weak and damaged (i.e. “leaky”). A weakened gut integrity allows substances which it does not normally allow to pass through – such as proteins, toxins, undigested food particles – to enter the bloodstream. Our immune system senses these substances as foreign and goes into an (inflammatory) immune reaction. This immune reaction can trigger an eczema episode.
Probiotics and infants
There is some evidence that probiotics may help prevent an eczema episode in infants. A systematic review has found a decreased risk in eczema development (including atopic eczema) when probiotic supplementation is given to pregnant mums, breastfeeding mothers and infants. However, the authors of this review concluded there is insufficient evidence at this point to deduce with certainty that probiotic supplementation is an effective treatment for eczema. This is due to differences in study design and probiotic strains used in the studies reviewed. Other points to consider include dosage strength, the timing of administration and duration.
Probiotics in your diet
Whilst the jury is still out on whether probiotic supplementation can become the mainstream treatment of eczema, there is still some good in incorporating it into one’s diet. Including probiotic supplementation or probiotic-rich foods in the diet – since these friendly bacteria can assist in healthy digestion – helps reduce gas and bloating, and promotes bowel regularity. Fermented foods such as yoghurt, kefir, miso, kimchi, tempeh and sauerkraut are rich food sources of probiotics.
What not to eat?
If the type of eczema that you have is not related to food allergy, there are some ingredients in foods that can trigger or worsen the eczema symptoms. Examples are:
- Foods containing artificial flavourings, colourings and preservatives like fast food and processed foods.
- Foods rich in refined sugar – these foods are digested quickly, resulting in an insulin spike, and this is considered to be inflammatory for the body. Common examples include sugar-sweetened beverages, pastries, and cakes.
Other management tips
Apart from the dietary management of eczema, there are other ways one can adopt to treat and manage eczema.
For a person with eczema, the skin barrier is weak and usually drier due to loss of moisture, hence it is important to keep the skin well moisturised. Other factors that can further dry the skin include excessive washing, exposure to cold or hot temperatures (i.e. winter temperatures, taking hot showers or visiting saunas), and using harsh soaps. A dry skin will usually prompt one to scratch, and the more one scratches, eczema worsens. This “ itch and scratch” cycle is also distressing for the sufferer. Hence keeping skin moisturised is the key, as it becomes a protective barrier for the skin.
What type of moisturizer is good for eczema?
Moisturizers generally fall into three categories – ointments, creams, and lotions; the difference between them is the oil-to-water ratio that they contain. Of the three, ointments and creams are the best for eczema skin as they have a higher oil concentration, hence are much better at moisturizing skin than lotions. The (oil) barrier is needed to keep skin moisturized but also prevent environmental irritants from entering the skin. The best time to apply moisturizers would be immediately after washing your hands or showering.
Skin barrier creams are useful when used in conjunction with moisturizers. Such creams usually contain lipids and ceramides that are found naturally in healthy skin barriers. These creams help keep moisture in the skin and prevent entry of irritants, whilst allowing the affected skin to heal and become resistant to eczema symptoms such as itch and dryness. Skin barrier creams are typically applied to the area that is affected by eczema or as directed by your dermatologist.
Sometimes other treatment methods such as steroids (oral and/or topically), use of phototherapy and immunosuppressant medications may be prescribed by your dermatologist if eczema remains severe.
Topical products: What to look out for/use?
For skin that is prone to or is healing from eczema flare, one should use ingredients provide moisturising, healing, soothing, anti-inflammatory (calming) properties as well as strengthening the skin’s natural barrier functions. Below lists some useful ingredients to look out for and include in your skincare regime:
Shea butter, glycerine, and lanolin
These ingredients not only double-up as great moisturisers, but they also help your skin repair and look healthier. Look for skin care products that list either one of these ingredients as the first, second, or third on the ingredients list (Note: Ingredients in the ingredient list are usually listed in descending order, i.e. from largest concentration to lowest).
Hyaluronic acid (HA)
HA is a naturally-occurring glycosaminoglycan (a group of carbohydrates, aka polysaccharides, which are an important component of our body’s connective tissues) in the body. HA is found in high concentrations in the extracellular matrix (supporting tissues of cells), such as skin and joint. However, as we age, HA levels in the body declines. The main function of HA is to help “lock” moisture in the skin, giving skin its “fullness” look as well as lubricate joints. HA is commonly present in skincare products as sodium hyaluronate, so the next time when you go shopping, keep a lookout for this ingredient.
Niacinamide (vitamin B3)
This vitamin can help strengthen skin’s natural barrier, thereby reducing redness caused by eczema.
This oil is great for eczema skin in many ways – helps keep moisture in the skin by repairing the skin’s natural barrier; is soothing; and has natural antimicrobial properties, meaning it can help fend off any harmful bacteria which the skin has come into contact with during the day. Choose coconut oil that is “virgin”, “extra virgin”, or “cold pressed”, as these forms of oil extraction do not make use of chemicals that could potentially irritate skin (further).
Anti-inflammatory, and helps in retaining moisture by strengthening the skin’s natural barrier function. However, avoid using this oil if you are allergic to sunflower seeds.
Contains vitamin E to aid in skin repair and reduce inflammation.
Extremely soothing, and is a highly moisturising and anti-inflammatory agent.
Probiotic-containing skincare products
Scientists are beginning to discover how topical application of probiotics can benefit the skin. This is especially so in skin management, as in eczema, acne and rosacea. When applied to the skin, probiotics form a protective layer on our skin, preventing irritants like bad bacteria from “destroying” our skin cells, thus stopping an immune response (usually negative) from happening. Other benefits of using probiotics-containing skincare products include antimicrobial and calming effects.
Topical products: What to avoid?
Generally speaking, eczema sufferers should avoid skincare products/ingredients that are too harsh on the skin. Such as:
Some soaps can be harsh on your skin, and make it prone to eczema and dry out. Choose gentle soap cleansers or soap-free cleansers instead.
These may make your products smell wonderful, but did you know they can irritate the skin and trigger a flare? Choose products that say “fragrance-free” on the label the next time you shop for your skincare products.
Glycolic acid, salicylic acid, and retinol
These products are often not recommended for the eczema-prone skin as they tend to weaken its natural barrier. A weakened barrier means quicker moisture evaporation and increased vulnerability to environmental irritants. The end result is skin becomes dry and/or irritated, and an eczema results.
One of the most common preservatives found in skincare products and cosmetics. They may keep skincare products and cosmetics “fresh” by preventing bacterial growth; but the downside is, parabens can irritate skin and cause eczema to flare up. Parabens can be easily identified from the ingredient list as they usually end off with “parabens”, e.g. methylparaben or butylparaben.
Alcohol-containing skincare products may give a cooling sensation (especially on a hot day!), but it is bad for your skin. Alcohol not only dries the skin, but it also weakens the skin’s natural (protective) barrier; resulting in a thin and irritated skin. Examples of the common alcohols found in skincare products include benzyl alcohol, denatured alcohol, isopropyl alcohol, ethanol, ethyl alcohol, methanol, and SD alcohol.
Sodium laureth sulfate (SLS):
A foaming ingredient commonly added to shampoos, cleansers, bubble baths and shower creams, to give you the “clean” feeling. Think of SLS as a detergent – that doesn’t sound nice, does it? Using SLS-containing skincare products may strip the layer of oil found naturally on the skin. This leads to dry, irritated, flaky and/or reddening skin.
Bottom line, eczema is a chronic inflammatory skin condition that can be effectively treated. This can include managing diets (except for food allergies), applying suitable moisturizers and/or taking prescribed medications. Taking steps to avoid known irritant(s) is critical as well. However eczema is not curable, neither is it a contagious condition.