Can a Functional Medicine approach to eczema achieve skin health success?

How to successfully heal your eczema damaged skin, the Functional Medicine way...

If you suffer from eczema (atopic dermatitis), you’re not alone.

Eczema is a common chronic inflammatory condition that causes the skin to become red, itchy and dry, and in some cases, become cracked.

Functional Medicine approach to eczema blog flyer showing young woman scratching skin

As we’ll discover, a Functional Medicine approach to eczema / atopic dermatitis can help.

Eczema can appear anywhere on the body and can affect people of all ages, although typically symptoms start in early childhood.

While medically, there is no cure for eczema, there are treatments that can help to reduce the symptoms and keep the condition under control.

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With the right approach, people with eczema can enjoy healthy and comfortable skin.

Keep reading to learn more about eczema and how you can find relief.

Signs & Symptoms of eczema / atopic dermatitis

The signs and symptoms of eczema are:

The most common places where eczema appears are the:

How prevalent is eczema?

Skin conditions are very common in the industrialised world and eczema / atopic dermatitis is one of them.

The overall incidence of eczema / atopic dermatitis is between 11-20% for children and 5-10% for adults (1).

Eczema is commonly seen in infants but it can also appear in older children and adults.

In children, AD is mainly seen until around the age of seven.

Some children seem to grow out of eczema but will continue with sensitive skin, and in later years can develop other related conditions such as asthma and hayfever.

Studies show that the breakdown of the skin barrier can lead to exposure to allergens via the skin (2).

Exposure to these allergens can result in the production of IgE antibodies, and the development of eczema symptoms (3).

An estimated 50-70% of children with eczema develop an allergy to at least one food, most commonly to cow’s milk, egg and / or peanuts (4), and non-food allergens such as house dust mites, pollen and pets (5).

Common triggers and different types of eczema

The following factors may play a major role in developing eczema / atopic dermatitis:

There are two forms of atopic dermatitis:

Extrinsic atopic dermatitis

Extrinsic atopic dermatitis is where IgE-mediated allergic reactions play a role in the development of eczema.

Extrinsic atopic dermatitis accounts for 70-80% of cases.

Extrinsic eczema usually occurs when an allergic reaction (i.e. IgE-mediated) in genetically susceptible people is triggered by an environmental exposure to something.

The most common environmental triggers include:

Intrinsic atopic dermatitis

Intrinsic atopic dermatitis is non IgE-mediated, where non-specific factors such as irritants or psychosomatic influences, appear to be of major importance.

Intrinsic atopic dermatitis accounts for an estimated 20-30% of cases.

What medical treatments are usually used for atopic dermatitis?

In conventional medicine, medications and other interventions are used to help manage the flares and reduce symptom severity, such as:

Other treatments may include:

What’s the Functional Medicine approach to eczema / atopic dermatitis?

A Functional Medicine approach to eczema / atopic dermatitis includes the consideration of a diverse range of potential triggers and underlying causes:

Functional Medicine approach to eczema infographic showing 8 factors we consider in treating eczema

1. Immune system

The immune system plays a key role in skin conditions, and assessing immune system health is a critical factor in a Functional Medicine approach to eczema / atopic dermatitis.

Good development of the immune system in the early years is very important for reducing the risk of developing allergies later in life.

During birth and in the early years of development, children are exposed to different pathogens, which can also increase the risk of infections as their immune system is not yet fully functional.

However, during labour, as the baby makes his or her way through the birth canal, and during breastfeeding, some immune protection is transferred to the infant from the mother (mainly in the form of antibodies).

Therefore, how you are born and whether you are breastfed or not, can influence the development and functioning of the immune system.

Antibiotic treatment early in life can also affect the development of the immune system, so while antibiotic treatment may be absolutely necessary, for eczema sufferers who have received antibiotics, the gut bacteria balance is an important consideration.

In addition, the exposure to different microbes during infancy helps the immune system to develop. 

The different exposures are essentially ‘training’ the immune system so that it can learn what it should be responding to, and what it doesn’t need to respond to.

A lack of exposure of the developing immune system to different pathogens in early life may result in the immune system becoming dysregulated (as it hasn’t received the ‘proper training’). 

Using multiple detergents, disinfectants, wipes, bleach containing products etc, rids the baby’s environment of these pathogens, that would otherwise be vital ‘training tools’ for the developing immune system.

This scenario is commonly referred to as the ‘Hygiene Hypothesis’ and is considered a factor in the increased rates of allergies and incidence of eczema.

Supporting the immune system with immune modulating and anti-inflammatory nutrients, optimising the microbiome (which communicates with the immune system), and removing drivers for immune system imbalances, can help to calm the inflammation, reducing eczema symptoms.

2. Food allergies

Food allergies are linked to a physiological state commonly referred to as ‘leaky gut’ (the proper terminology for leaky gut is ‘increased intestinal permeability’).

Food allergies and increased intestinal permeability are important considerations in a Functional Medicine approach to eczema.

Food allergies constantly overwhelm the immune system with increased ‘antigen load’, which can lead to the development of additional allergies.

The elimination of allergenic foods appears to stop the development of new allergies.

Studies show that hypoallergenic (low allergen) diets decrease intestinal permeability (which is a good thing) and are associated with improvements in eczema / atopic dermatitis (7).

There are many drivers to developing increased intestinal permeability which would be explored by your Nutritional Therapist or Functional Medicine practitioner.

Besides the avoidance of allergens, reducing intestinal permeability through nutritional and lifestyle interventions can help to reduce the severity of the allergic responses (meaning the IgE antibody levels can be reduced).

3. Filaggrin

An important risk factor for developing eczema / atopic dermatitis, is having a faulty gene responsible for producing a protein called filaggrin

Filaggrin is found in the epidermis of the skin and plays a vital role in skin barrier integrity, keeping the skin hydrated and in supporting skin pH.

An estimated 50% of eczema / atopic dermatitis patients have a mutation of the filaggrin gene (8).

4. Candida albicans

Another common cause of eczema /atopic dermatitis can be an overgrowth of the yeast candida albicans, which can be also linked to increased intestinal permeability.

The Coho Functional Medicine approach to eczema therefore always considers not only increased intestinal permeability, but also candida.

Very often, individuals with eczema have increased levels of anti-candida antibodies, and there is a correlation between the severity of lesions to the levels of antibodies to candida. (9)

Changing your diet and lifestyle can help to reduce levels of candida, thereby reducing symptom severity. 

Herbal and nutraceutical therapy can help drive down levels of candida.

And as our understanding of a yeast overgrowth and how best to tackle it improves, we now understand that a strict ‘anti-candida’ diet may NOT be the best solution

Any dietary changes would be carefully considered by your practitioner and you may be doing more harm than good by adopting one of the numerous ‘anti-candida’ diets out there.

5. Compromised digestion

Compromised digestion may impact the breakdown of proteins.

The failure to break down protein can be linked to low stomach acid.

Stomach acid is needed to activate an enzyme called pepsin which breaks down proteins into smaller molecules that the body can then absorb.

Studies have shown that the proteins in dairy, eggs, and gluten can be problematic for individuals suffering from eczema (10).

An elimination diet can be considered in order to discover which foods cause adverse effects, and in our clinical experience this approach often achieves good results in eczema / atopic dermatitis.

6. Complement proteins

Another issue found in eczema is an elevated levels of complement proteins (11).

Complement proteins are a part of innate immune system response, and this imbalance can lead to an increased susceptibility to skin infection, such as Staphylococcus aureus (12).

7. Stress and anxiety

As discussed above, eczema is a chronic inflammation of the skin.

And this inflammation can be increased by stress and anxiety, which impact the function of anti-inflammatory prostaglandins (13).

Therefore, we should always remember that stress has a huge impact on our health, and is a key driver for eczema flares. 

Most people with eczema will already recognise that stress is a trigger for their flare-ups.

There are many reasons why we get stressed and anxious, some are very obvious such as relationship issues, high work-related stress, or the symptoms of eczema itself causing stress.

Some reasons are more subtle that are less often considered – such as the way, and what, we eat.

Not eating regularly, not making the healthiest food choices, and a high consumption of simple carbohydrates, can all contribute to imbalanced blood sugar levels.  

And imbalanced blood sugar levels can cause a stress response in the body.

A Functional Medicine approach to eczema / atopic dermatitis includes consideration of stress levels, and strategies to promote increased relaxation – reducing stress hormone responses that may serve as a driver for eczema symptoms.

8. Compromised liver function

Sub-optimal liver function is also associated with eczema (14).

An exposure to environmental toxins and substances (e.g. caffeine, sugar, alcohol, chemicals in cleaning products and in cosmetics) that is more than the liver can efficiently deal with can lead to insufficient detoxification – the consequences of this can impact skin health.

Phase 1, 2 and 3 liver detoxification pathways can be supported through nutrition and supplemental protocols.

Functional Medicine testing for eczema / atopic dermatitis

Just like other skin conditions, healing from the inside out can provide significant and sustainable improvements in eczema symptoms.

In a Functional Medicine approach to eczema / atopic dermatitis, testing is an important component of the treatment plan.

This involves finding individual triggers and then addressing the underlying imbalances, rather than simply managing the symptoms.

As each case is unique, functional testing can help to pinpoint exactly what your unique triggers and imbalances involved are.

Addressing imbalances, improving the diet by avoiding problematic foods, and assessing environmental factors, can help to bring the inflammation down and promote the skin repair processes.

An example of some of the Functional testing options that we may consider (on a case by case basis) at Coho Health, includes:

Food sensitivity and allergy testing

Food sensitivity and allergy testing, such as the tests by Cyrex Labs, can be very useful in identifying the trigger or triggers of eczema / atopic dermatitis.

Cyrex Array 3 is the ‘Wheat/Gluten Reactivity Screen’.

Cyrex Array 4 is the ‘Gluten Associated Cross Reactivity Screen’,

Cyrex Array 10 is the ‘Multiple Food Reactivity Screen’. 

Another great food allergy and sensitivity test is the Precision Diagnostics P88 Dietary Antigen Test

There are numerous other food reaction panels that we frequently use.

Comprehensive stool testing

In our clinical experience, comprehensive stool testing can also be useful, such as:

  • Genova Diagnostics GI Effects
  • Invivo Clinical’s GI Ecologix
  • or Diagnostic Solutions GI-MAP

These advanced gastrointestinal tests help to assess digestion, absorption, the microbiome, yeast (like candida) and parasites.

Imbalances in pathogens, bacteria balance, or gut function can adversely affect eczema.

The wrap...

Eczema, like other skin problems, is a condition that can be extremely uncomfortable, challenging to manage, and disruptive to stress hormones, sleep and day to day life.  

Unfortunately, eczema also can reduce self-confidence, causing psychological and emotional difficulties.

While conventional medicine can offer a range of treatments, and these may offer some respite, they are largely designed to target the symptoms of eczema, rather than the underlying triggers and root causes.

With a Functional Medicine approach to eczema / atopic dermatitis, we take a deeper dive into the triggers and root causes of eczema, which are highly individual.

Through this approach, we see fantastic results in our clinics – not just temporary respite from the symptoms, but long term remission, meaning a life full of confidence and free from frustrating symptoms.

To your optimised, healthy future,

Aga & the Coho Health team

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