Nutrition Notes

Getting to the Root of Eczema

If you or someone you know suffers from atopic dermatitis, more commonly known as eczema, then you know the red, swollen, itchy skin that it causes can have debilitating effects on quality of life. Particularly severe flare-ups can leave people with eczema feeling so ashamed of their skin’s appearance that they decline social engagements and other fun activities in order to avoid being seen.

There is debate regarding the exact causes and triggers of eczema. There is likely a genetic component, and flare-ups sometimes result after use of products that are irritating to the skin, such as certain soaps, shampoos, lotions, and other cosmetics. It is generally accepted that there is some degree of allergy underlying eczema, and up to 80% of children with eczema will also develop hay fever and/or asthma. Moreover, a significant body of research indicates that eczema may be an autoimmune condition—meaning, the immune system gets confused and starts attacking the person’s own body. Other autoimmune conditions include rheumatoid arthritis (attack against the joints), and type-1 diabetes (attack against the insulin-producing cells of the pancreas). In the case of eczema, the immune system may be attacking skin cells.

If this is the case, it would explain why many of the common treatments—such as creams to control itching and fight infection, and oral or injected steroids and anti-inflammatories, are often ineffective, or are effective only for a short time. Moreover, many of the common treatments have unpleasant and harmful side-effects.

If eczema is an autoimmune disorder, then the most effective way to treat it would be to address the root cause, through restoring healthful immune function, rather than attacking the symptoms piecemeal, by employing skin creams and antibiotics. Between one third and two thirds of young people with eczema also have food allergies, the most common of which are wheat, dairy, eggs, soy, and nuts & seeds. The fact that all of these foods are typically eliminated in most dietary protocols that address autoimmune conditions lends more weight to the likelihood that there is, in fact, an autoimmune component underlying the condition. Additionally, autoimmune conditions often flare up when the afflicted individuals are under high amounts of psychological and physiological stress, and this is known to be true for eczema.

Autoimmune conditions are often associated with—and potentially caused, at least in part, by—small intestinal permeability, which you might know by its less formal name, “leaky gut.” When the small intestine, or gut, is leaky, undigested proteins can make their way into the bloodstream, where they normally do not appear. In response, the immune system—doing exactly what it is supposed to do—launches an attack against what it perceives to be “invaders” inside the body. If the chemical structures of these undigested proteins resemble parts of the human body, this can cause the immune system to mistakenly attack the body’s own tissues. This is why leaky gut is associated with most autoimmune conditions.

For eczema, it is understood that there is something called the “gut-skin axis,” wherein a leaky gut may have effects far removed from the digestive tract, such as in the skin. Several studies of patients with eczema show that the condition does have a significant autoimmune component, and that the immune system targets keratinocytes, which make up about 90% of the cells in the outermost layer of skin.

Operating under the idea that eczema is, at least in part, an autoimmune disorder, a small study was conducted in which researchers gave six patients with intractable eczema a drug that is used to reduce inflammation in rheumatoid arthritis (RA), a known autoimmune condition. All six subjects reported significant reductions in itching, skin redness and thickening, as well as improved sleep. (The itching and other discomfort associated with eczema often results in difficulty sleeping.) These were patients who did not experience symptom relief from conventional treatments, so the dramatic improvements conferred by the drug are especially promising.

Another way to tackle the underlying autoimmune dysfunction in eczema is through diet and lifestyle modification. Stress reduction is key, and the dietary strategy would start with a Paleo-style diet, free of grains, legumes, and dairy, which would remove three of the most common food allergens that may cause and/or exacerbate a leaky gut. A stricter autoimmune dietary protocol would call for eliminating eggs, nuts & seeds, and possibly also nightshade vegetables, although the latter are more frequently implicated in exacerbating RA, specifically. Many nutritional supplements are also helpful for a leaky gut, such as probiotics, L-glutamine, digestive enzymes, and deglycyrrhizinated licorice (DGL).



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  2. Tang TS, Bieber T, Williams HC. Does "autoreactivity" play a role in atopic dermatitis? J Allergy Clin Immunol. 2012 May;129(5):1209-1215.e2.
  3. Paddock, C. Eczema successfully treated with arthritis drug. Medical News Today. July 21, 2015.