Referred to more broadly as atopic dermatitis, its cause is unknown, but nature and nurture may both be at play. Eczema is a chronic inflammatory process that involves symptoms of itching pain, rashes and redness. Adults tend to have eczema in the moderate-to-severe range.
Treatments range from over-the-counter creams and lotions to prescription steroid creams to oral steroids and, now, injectable biologics. Some use phototherapy for severe cases, but research is scant.
Also, dietary modifications may play an important role. Studies have shown an association between eczema and fractures, which we will investigate further.
Eczema doesn’t just scratch the surface
In an observational study, results showed that those with eczema had a 44 percent increased risk of injury causing limitation and an even more disturbing 67 percent risk of bone fracture and bone or joint injury for those 30 years and older.
If you have both fatigue or insomnia and eczema, you are at higher risk for bone or joint injury than having one alone. One reason for increased fracture risk, the researchers postulate, is the use of corticosteroids in treatment.
Steroids may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density. Chronic inflammation may also contribute to the risk of bone loss.
There were 34,500 patients involved in the study. For those who have eczema and have been treated with steroids, it may be wise to have a bone scan.
Are supplements the answer?
Two well-known supplements for helping to reduce inflammation are evening primrose oil and borage oil. Unfortunately, study results are mixed, leaning toward ineffective.
In a meta-analysis involving seven randomized controlled trials, evening primrose oil was no better than placebo. The researchers also looked at eight studies of borage oil and found there was no difference from placebo.
Where are we on the drug front?
A biologic monoclonal antibody, dupilumab, showed good results in trials. This injectable drug improved outcomes for moderate to severe eczema sufferers when topical steroids alone were not effective.
Do probiotics have a place?
In preliminary in-vitro in a test tube studies, results show that topical probiotics from the human gut could potentially work as well as steroids. This may be part of the road to future treatments; however, this is in very early stage of development.
What about lifestyle modifications?
In a Japanese study involving over 700 pregnant women and their offspring, results showed that when the women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there were reductions in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest-to-lowest consumption quartiles.
Elimination diets may also play a role. One study showed that when eggs were removed from the diet in those who were allergic, according to IgE testing, eczema improved significantly.
From an anecdotal perspective, I have seen very good results when treating patients who have eczema with dietary changes. My patient population includes about 15 to 20 percent of patients who suffer some level of eczema.
For example, a young adult had eczema mostly on the extremities. When I first met the patient, these were angry, excoriated lesions. However, after several months of a vegetable-rich diet, the patient’s skin had all but cleared.
Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life. There may be promising topical probiotics ahead and medications for the hard to treat.
It’s best to avoid long-term systemic steroid use; it could not only impact the skin but also may impact the bone. Lifestyle modifications appear to be very effective.
For further information, visit medicalcompassmd.com or consult your personal physician.