<h2>Practice points</h2><ul><li>Probiotics, alone or together with prebiotics, have a positive impact on eczema severity in children. Probiotics may improve skin barrier function that has been disrupted with eczema. Lactobacillus rhamnosus (L. rhamnosus) GG reduces the risk of developing eczema in the first two years of life and prevents eczema for up to seven years in children.</li><li>Omega-3 fatty acids from fish oil (eicosapentaenoic acid or EPA and docosahexaenoic acid or DHA) may reduce the severity of symptoms associated with eczema.</li><li>Evening Primrose Oil can help modulate the inflammatory response in individuals with skin disorders; it reduces interleukin-2 (IL-2) mediated inflammation.</li><li>Zinc plays an important role in skin immune function. Inflammatory skin conditions such as eczema may result from a deficiency in zinc. Supplementation decreases itching in children with atopic dermatitis. Topical zinc may also play a role in managing eczema.</li><li>Vitamin D is important. Individuals with eczema have lower vitamin D levels than healthy individuals. Vitamin D decreases the severity of symptoms associated with eczema and decreases skin colonisation by S. aureus.</li></ul><h2>Description</h2><ul><li>Eczema, or atopic dermatitis, is a chronic inflammatory skin condition affecting up to 20% of children and up to 3% of adults. Research suggests its prevalence worldwide is increasing1</li><li>A family history of eczema or allergies is a risk factor1</li><li>Eczema is commonly associated with allergic conditions such as asthma and hayfever, although it is still unclear whether allergies are a cause or consequence of eczema2</li><li>Decreased skin microbial diversity may contribute to an altered inflammatory response and favours the growth of Staphylococcus aureus (S. aureus)3</li><li>Stress can disturb the skin microbiome, damage skin barrier function and alter immune function. It is an important factor in the initiation and aggravation of eczema4</li><li>Symptoms may resemble contact dermatitis or psoriasis</li></ul> <h2>Download PDF</h2><table> <tr><td><a href="-/media/ab93b40d77bf452ca23a706c801fff24.ashx">-/media/ab93b40d77bf452ca23a706c801fff24.ashx</a><a href="-/media/9a8c3f8cd1434029ba59ea6c1bde6ded.ashx">-/media/9a8c3f8cd1434029ba59ea6c1bde6ded.ashx</a> </td></tr> </table>

<h2>Management principles</h2> <ul><li>Recommend the appropriate treatment where required. In cases of extreme exacerbations, topical anti-inflammatory agents such as corticosteroids in combination with emollients and antimicrobial therapies may be indicated1.</li><li>It is important to note that long-term use of topical corticosteroids can have a number of negative effects, including damaging skin structure, interfering with skin repair, and increasing susceptibility to infections1.</li><li>Consider factors affecting both the gastrointestinal and skin microbiomes, particularly in pregnant mothers and newborn babies.</li><li>Consider dietary and lifestyle influences, such as stress and environmental triggers.</li><li>Recommend evidence-based nutritional supplements where appropriate.</li></ul>

Management

<h2>Primary recommendations</h2><h2>Probiotics</h2>Mechanism of Action<ul><li>Produce bacteriocin and short chain fatty acid (SCFA) </li><li>Modulate gut inflammatory mediators to improve gut barrier function and permeability </li><li>Improve skin barrier function </li></ul>DosageIn capsule and powder form: L. rhamnosus GG: 20 billion CFUs/day.12Adverse effects<ul><li>Orally, probiotic species are well tolerated. A few adverse reactions have been confirmed in immunocompromised individuals.13</li></ul>Key interactions<a href="~/link.aspx?_id=4471DACF65C148EA8FD82B23FD6712D4&_z=z">Refer to the Complementary medicine interactions guide</a><h2>Omega-3 fatty acids</h2>Mechanism of Action<ul><li>Modulate production of pro-inflammatory compounds</li></ul>DosageIn capsule and oil form: 1.8 g EPA/day and/or 5.4 g DHA day.14,15Adverse effects<ul><li>Omega-3 fatty acids are very well tolerated. Up to 3 g/day EPA+DHA is generally recognised as safe (GRAS).16</li></ul>Key interactions<a href="~/link.aspx?_id=4471DACF65C148EA8FD82B23FD6712D4&_z=z">Refer to the Complementary medicine interactions guide</a>

Primary

<h2>Diet and lifestyle recommendations</h2><ul><li>Improve general nutrition as proper nutritional intake is essential for skin health.5 A healthy eating pattern that emphasises fruits, vegetables, wholegrains and legumes and is low in simple sugars and saturated fats is associated with healthy skin.6</li><li>Increase essential fatty acid intake with a balance of omega-3 and omega-6 fatty acids from fish, nuts and plant oils to maintain epidermal integrity and regulate inflammation and immune activity in the skin.7</li><li>Food allergy may play a role in eczema, with eggs, cow’s milk, wheat, soy, and peanuts all being likely triggers. For people with known food allergies, elimination of the allergenic foods from the diet can be helpful.8</li><li>Avoid food additives as removing certain food additives may help reduce eczema symptoms in some individuals.9</li><li>Keep hydrated by drinking a minimum of 2 litres of water daily, as this has been shown to maintain deep and superficial skin hydration.10</li><li>Counselling may help as emotional stress can precipitate or exacerbate inflammatory skin disorders such as eczema.11</li><li>Psychotherapy and cognitive behavioural therapy have been used to treat skin disorders.11</li><li>Mind-body relaxation techniques with relaxation training, hypnosis, and stress management have been used to treat skin disorders.11</li></ul>

Diet & lifestyle

<h2>References</h2> 1. Wollenberg A, Feichtner K. Atopic dermatitis and skin allergies - update and outlook. Allergy. Dec 2013;68(12):1509-1519. 
 2. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16.
 3. Biedermann T. et al. Regulation of T Cell Immunity in Atopic Dermatitis by Microbes: The Yin and Yang of Cutaneous Inflammation. Front Immunol. 2015;6:353.
 4. Bailey MT. Psychological Stress, Immunity, and the Effects on Indigenous Microflora. Advances in experimental medicine and biology. 2016;874:225-246.
 5. Park K. Role of micronutrients in skin health and function. Biomolecules &amp; therapeutics. May 2015;23(3):207-217
 6. Katta R, Desai SP. Diet and dermatology: the role of dietary intervention in skin disease. The Journal of clinical and aesthetic dermatology. Jul 2014;7(7):46-51.
 7. Anderson K, Hamm RL. Factors That Impair Wound Healing. The journal of the American College of Clinical Wound Specialists. Dec 2012;4(4):84-91.
 8. Mohajeri S, Newman SA. Review of evidence for dietary influences on atopic dermatitis. Skin Therapy Lett. Jul-Aug 2014;19(4):5-7.
 9. Catli G. et al. Is Patch Testing with Food Additives Useful in Children with Atopic Eczema? Pediatr Dermatol. 2015 Sep-Oct;32(5):684-689
 10. Palma L. et al. Dietary water affects human skin hydration and biomechanics. Clin Cosmet Investig Dermatol. 2015;8:413-421.
 11. National Eczema Association. Available at https://nationaleczema.org/eczema/treatment/complementary-and-alternative/
 12. Kalliomaki M. et al. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo- controlled trial. J Allergy Clin Immunol 2007;119:1019-1021.
 13.Braun L, Cohen M. Herbs &amp; Natural Supplements. 4th ed. Chatswood: Elsevier; 2015.
 14. Natural Database. Available at https://naturalmedicines.therapeuticresearch.com
 15. Koch C. et al. Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial. Br J Dermatol. 2008;158:786-792.
 16. Bjørneboe A. et al. Effect of n-3 fatty acid supplement to patients with atopic dermatitis. J Intern Med Suppl. 1989;731:233-6.

Eczema - Atopic Dermatitis

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