Eczema and dermatitis

Superficial inflammation of the skin, characterized by vesicles (when acute), redness, edema, oozing, crusting, scaling, and usually itching. (The Merck Manual)

The terms eczema and dermatitis are the cause of much confusion. In keeping with the broad guidelines given in The Merck Manual, we shall use these terms synonymously to indicate superficial inflammation of the skin. The dermatologist subdivides dermatitis and eczema into a range of different disease entities distinguished by location and appearance. For the phytotherapist, however, the most important distinction is between cases with an internal or endogenous cause and those with a contact or exogenous cause.

In cases of dermatitis or eczema of exogenous cause, it is often possible to solve the problem simply by removing or avoiding the surface irritant, if it can be identified! Such problems, often called contact dermatitis, are commonly caused by:

  • • Industrial solvents
  • • Dyes
  • • Nickel and other metals
  • • Leather-tanning chemicals
  • • Some soaps

In such cases, eczema is the final result of a complex series of internal reactions to allergens and irritants. It is often associated with other allergic diseases, such as hay fever and asthma, but may also occur alone. The rash of eczema is very itchy, peeling, thickened, and sometimes weepy, and is typically seen in the creases of joints and around the trunk. The rash may fluctuate seasonally and can even change over the course of the day. Scratching may lead to bleeding and infection. Blood tests in individuals with eczema reveal increased levels of cells and chemicals associated with general allergic reactions.

One variation of eczema occurs on the palms of the hands and sometimes on the soles of the feet. This type may be quite frustrating to treat, because the common exposure to moisture, irritants, and injury of these areas leads to self-perpetuation of the disease. Furthermore, the thickness of the skin in these regions makes topical therapy more difficult.

A number of factors can aggravate eczema, although the specifics vary from person to person. Dietary factors are particularly important, especially in children. Milk and milk products are the most common triggers. Primary aggravating factors for eczema are:

  • • Stress
  • • Mechanical irritation
  • • Heat
  • • Dietary factors

Treatment of Eczema

Eczema requires the practitioner to be at his or her most insightful. Ideally, the nature of the underlying cause will identify what systems call for toning. However, with the exception of obvious allergies or contact irritants, this can be problematic for a skin problem like eczema.

The skin obviously needs support, but in addition the nervous system, digestive system and liver, immune system, and others may need attention. In many ways, the therapeutic conclusion will depend upon the herbalist’s theoretical interpretation of eczema, rather than the patient’s case history.

Actions Indicated

Alteratives are the classic remedies for the treatment of eczema. How they work is unclear, but they can often be dramatically effective.

Antipruritics, remedies that reduce the sensation of itching, are indicated, not simply to make the patient feel better, but also to reduce physical trauma caused by scratching.

Anti-inflammatories applied topically and taken internally speed the curative work of the alteratives, but do not replace them.

Lymphatic, tonics, which may be considered a type of alterative, are especially helpful for eczema in children.

Nervine relaxants help with the commonly associated problem of anxiety. They also often ease itching and even inflammation in the skin because of their relaxing effect on the peripheral nerves of the autonomic nervous system.

Diuretics ensure adequate elimination through the kidneys. Diuretic alteratives are most relevant.

Hepatks will contribute support for liver function and the digestive process. Hepatic alteratives are best here.

Vulneraries support the healing of skin lesions when applied topically, but do not replace appropriate internal treatment.

Astringents, used topically, reduce any weeping or oozing of fluids.

Emollient herbs are suitable for topical applications where soothing is needed. The demarcation among emollient, anti-inflammatory, and antipruritic herbs is rather meaningless here.

Specific Remedies

For internal treatment, the leafy alteratives are often considered the closest to specifics for this often intransigent condition. These are also often diuretic and lymphatic remedies. Herbs in this group include:

  • Fumaria officinalis (fumitory)
  • Galium aparine (cleavers)
  • Scrophularia nodosa (figwort)
  • Trifolium pratense (red clover)
  • Urtica dioica (nettle)
  • Viola tricolor (heartsease)

The rooty alteratives tend to be hepatic in nature. They can often be too strong for eczema, aggravating the problem instead of healing it. For intransigent cases unresponsive to the herbs already listed, stronger remedies are indicated. For eczema, effective examples include:

  • Arcthim lappa (burdock)
  • Hydrastis canadensis (goldenseal)
  • Mahonia aquifolium (Oregon grape)

Relevant herbs for topical use abound. However, always bear in mind that healing must be based upon internal medication, not salves. Select remedies according to the actions most appropriate for the individual’s specific symptoms. The choice often will also depend on factors such as availability and aesthetics. Examples include:

  • Calendula officinalis (calendula)
  • Hydrastis canadensis (goldenseal)
  • Plantago spp. (plantain)
  • Stellaria media (chickweed)
  • Urtica dioica (nettle)

A Prescription for Eczema

  • Galium aparine 1 part
  • Urtica dioica 1 part
  • Trifolium pratense 1 part

Dosage: up to 5 ml of tincture three times a day. In addition, the patient should drink an infusion of fresh Urtica dioica or Galium aparine two or three times a day.

Table Actions Supplied by Prescription for Eczema

AlterativeGalium aparine, Urtica dioica, Trifolium pratense
Lymphatic tonicGalium aparine, Urtica dioica
Nervine relaxantTrifolium pratense
Anti-inflammatoryGalium aparine
DiureticGalium aparine, Urtica dioica
Hepatic (mild)Galium aparine, Trifolium pratense

A Prescription for Persistent Eczema Unresponsive to Mild Alteratives

  • Galium aparine 1 part
  • Arctium lappa 1 part
  • Scrophularia nodosa 1 part

Dosage: 2.5 ml of tincture three times a day. Build up the dosage to 5 ml three times a day. In addition, the patient should drink an infusion of fresh or dried Urtica dioica two or three times a day.

Care should be taken initially with Scrophularia nodosa, as it can produce the opposite of the desired result in some patients. If there is a flare-up of the skin eruption, cut down on the Scrophularia and try again. This is not a healing crisis!

Table Actions Supplied by Prescription for Persistent Eczema

AlterativeScrophularia nodosa, Galium aparine, Urtica dioica, Arctium lappa
Lymphatic tonicGalium aparine, Urtica dioica
Nervine relaxantTrifolium pratense
Anti-inflammatoryGalium aparine
DiureticGalium aparine, Urtica dioica, Arctium lappa
Hepatic (mild)Galium aparine, Arctium lappa

A Prescription for Atopic Eczema Associated with Asthma

  • Urtica dioica 2 parts
  • Trifolium pratense 2 parts
  • Dyspnea Formula 1 part ()

Dosage: up to 5 ml of tincture three times a day The relative proportion of alterative herbs to Dyspnea Formula will depend upon the patient’s specific needs. In addition, the patient should drink an infusion of fresh Urtica dioica or Galium aparine two or three times a day.

Broader Context of Treatment

If dietary triggers can be identified, it is essential for the patient to avoid them completely. Often, patients may find it challenging to adhere to specific food restrictions, especially young children. The parents who must enforce the diet will need much support from the therapist (and maybe some Scutellaria!). Even if no obvious food triggers exist, it is always worth excluding milk and milk products. This may be particularly relevant for children who were not breast-fed or were weaned too soon. Researchers at the Hospital for Sick Children in London have shown that children often develop eczema when weaned from breast milk to cow’s milk or other foods. Goat’s milk, sheep’s milk, and soy milk rarely trigger allergy problems. Here are some common eczema triggers:

  • • Cow’s milk
  • • Eggs
  • • Cheese
  • • Fish
  • • Sugar
  • • Food additives

Supplements suggested for inclusion in a broad therapeutic approach to the treatment of eczema by Drs. Pizzorno and Murray in Textbook of Natural Medicine include:

  • Vitamin A: 50,000 IU/day
  • Vitamin E: 400 IU/day (mixed tocopherols)
  • Zinc: 50 mg/day as picolinate (decrease dosage as condition clears)
  • Quercetin: 200 to 400 mg three times a day (taken 5 minutes before meals)
  • EPA and DHA: 540 mg and 360 mg/day, or flaxseed oil: 10 g daily
  • Evening primrose oil: 3,000 mg/day

Other authorities have recommended supplementation with vitamin C and vitamin B complex in addition to the other supplements listed.