Eczema kids – not just itchy on the outside!

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, where 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.

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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 eczema and studies have found that adults with atopic allergy symptoms have a higher incidence of irritable bowel syndrome. At NatureDoc we find most kids with eczema also experience a combination of reflux, bloating, gas, mushy difficult to wipe stools, ochre-yellow stools or see undigested food in the stool. Many can also experience regular gut pain and are often err more towards constipation, often only passing a stool every 2 or 3 days. If your child is not passing healthy “hazelnut coloured sausages” on a daily basis this maybe a clue there is some kind of disruption within the gut.

Eczema typically presents itself as more than just a condition characterised by red, hot, and itchy skin; it can also subtly stir up inflammation within your body. In light of substantial medical research, naturopathy views eczema as a widespread inflammatory disorder that may signal suboptimal gut health and a decreased tolerance to certain foods and environmental triggers in the oral and digestive system. If there’s a disruption in the balance of gut flora, it can aggravate the symptoms of eczema. The health status of the gut microbiome is mirrored in the skin microbiome, a relationship often referred to as the gut-skin axis.

Psychiatry is currently making connections between persistent inflammatory skin conditions and deteriorating mental health. The theory is that chronic inflammatory cytokines present in such atopic conditions could potentially be the reason as to why up to 30% of individuals with eczema suffer from anxiety and depression. This could be due to the fact that chronic itch shares numerous neural pathways with chronic pain and inflammation. It has been observed that if you can reduce the activity of these inflammatory pathways, not only does the skin’s condition improve, but a child also appears to be more content 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?

Genes

There is a very strong genetic component to eczema and if you have a family history of atopic diseases including allergy, hay fever, mat cell activation, histamine intolerance, asthma and eczema then a child will be more likely to develop eczema triggered by foods or environmental allergies or sensitivities.

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.

Allergies

Certain foods and environmental allergens may also provoke the eczema, and these can change over a lifetime. The food allergens and intolerances in the eczema 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.

Leaky-Gut

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 kids that we see in our clinic, which can be triggered by a reaction to gluten (zonulin), eating too many sugary or ultra-processed convenience foods, histamine overload or an intestinal bacterial infection (bacterial-derived lipopolysaccharides known as LPS). Gut permeability markers can be tested together via blood, urine or stool tests. A stool test can also analyse any imbalances in the gut microbiome as well as identify any key functional gut issues.

Maternal Diet

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.

Antibiotics

If a pregnant mum to be is prescribed antibiotics during the pregnancy, at the birth or whilst breastfeeding then this can pose a risk factor for eczema in the baby. Antibiotics given direct to the baby during their first year of life can get the ball rolling and the 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 in beneficial bacteria. These foods include kefir, yoghurt, apple cider vinegar, miso, pickled cucumbers, sauerkraut and well as a wide range of vegetables, salads, fruits, nuts, seeds, pulses and olive oil.

Environment

It is also thought that early exposure to antimicrobials – such 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 expose 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 these key points often come up – which one can you relate to the most?

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. These can be fed to all ages including a weaning baby from 6 months.

Prenatal consumption of oily fish is just as important as the baby or child’s diet; and if you not a fish eater, then supplement with a good quality fish oil or vegan omega 3 marine algae supplement. Good quality omega 3 oils and dietary fats can also help to lubricate dry skin from within so you might need less moisturisers.

Enough Vitamin D

There is some evidence that sufficient 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.

Encourage Probiotics

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, especially if eczema has become exacerbated after a period of illness. Probiotics also help to support the overall immune system which in turn can reduce inflammation.

Avoid Ultra Processed Food (UPF) & Refined Sugar Ingredients

These are often (but not always) labelled as E-numbers on a food label include preservatives, emulsifiers, thickeners, flavourings and colourings have the potential to disrupt the gut microbiome and drive up gut and skin inflammation in sensitive people.

These UPF ingredients are in most convenience shop bought foods and drinks nowadays and it is thought that up to two thirds of a young child’s diet contains UPF ingredients. Unfortunately most free-from allergy-friendly foods which many kids with allergies rely on contain UPF ingredients. Cooking from scratch will help to reduce exposure to these UPF ingredients and it is thought that reducing UPF containing foods to less than 20% of your diet is ideal.

Ultra-processed foods also tend to contain lots of refined modified starches and sugars which are known to be proinflammatory and again in turn can flare up the eczema. So, switching to whole grains and unrefined sweeteners such as fruit: fresh, stewed compote or dried; as well as vanilla, cinnamon, coconut sugar, honey and maple syrup can make a difference.

Reduce Histamine

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.

Infections/Hygiene

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 enough and you need to take a “belt and braces” approach by adding in natural antimicrobials. 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 with foods abundant in zinc, vitamin D and vitamin C.

If the eczema is worse on the hands, then this may be due to excess handwashing with soap and this is one complication that stems from 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 and natural.

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 NatureDoc clinical team to discuss how to take the functional medicine approach and seek out the root causes of that pesky itch!