Eczema is a chronic and often distressing skin condition presenting itself as dry itchy skin. It can affect people of all ages, including 5% of adults, but it is more common amongst children. Of those affected, 60% develop it within the first year of life and 85% before the age of five. Atopic eczema, where someone has a genetic predisposition to allergies, is the most common form of eczema although many grow out of it during their childhood or teenage years.
Atopic eczema varies in severity: some people are only mildly affected and may have just a small, contained area of dry and occasionally itchy reddened skin. In its most extreme case however, eczema can manifest severe symptoms such as cracked, sore and bleeding skin. Opened skin can also lead to infection, which may need to be treated separately.
Whilst the exact cause of atopic eczema is unclear, it is known that over activity of the immune system plays a significant role. Furthermore, eczema often occurs together with allergies such as hay fever or asthma, and is frequent within families, suggesting a genetic element to the condition.
Given this possible interaction between genes and environment, it is important to identify and address any existing allergies. These can range from foods such as eggs and dairy, to inhalant allergies such as dust mites and animal dander.
Contact eczema, or ‘contact dermatitis’, as it name suggests, results in a skin reaction following direct contact with irritants such as detergents and cosmetics, and is usually localised to one area, such as the hands when exposed to cleaning detergents such as washing up liquid.
While healthy skin is plumped up with oils and water to make a tight seal, the skin of someone with eczema does not produce as much oil, and therefore does not retain as much water, leading to dry skin with gaps between cells. As a result, moisture is easily lost from the deeper layers of the skin and irritants can get through the skin barrier more easily.
Emollients (moisturisers containing both water and oils) are recommended on a daily basis, after bathing, to lock in moisture and keep skin supple and flexible. There are plenty of creams and ointments available and for mild to moderate eczema, emollients alone may be enough to keep itchy skin under control.
For someone with severe eczema, topical steroids may be given to reduce inflammation, which will help to calm redness and itching, allowing skin to heal after a flare-up. Antihistamines and immune suppressant medication may also be prescribed in severe cases.
Some products intended for the skin, such as shower gels, can have a drying effect by breaking down its natural oils. As eczema-prone skin is constantly ‘open’, materials and products with harsh ingredients are very likely to aggravate it. Chemicals, synthetic fragrances and other potential irritants are therefore best avoided. Shampoos, cleaning products, perfume and make-up are among some of the worst offenders, so always read the label carefully! Less obvious perhaps, but equally as irritating potentially, are of course swimming pools because of their chlorine content.
Certain materials such as wool and chemicals in materials in clothes and sofas can also cause aggravation. Choose cotton or silk and breathable natural fabrics.
Reasonable exposure to sunlight may help to improve skin health, while simultaneously supporting vitamin D levels and immune function, however be careful to avoid burning the skin, as this can make it even itchier. Over sweating in hot climates can also exacerbate skin problems for some individuals with eczema, so wear loose-fitting light clothing when hot.
The role of diet and nutrition in the management of eczema is gaining increasing attention and is often used alongside pharmaceutical treatment or in some cases, as a complete alternative.
There has been extensive research into consumption of foods containing fat such as oily fish and evening primrose oil, with one particular area of interest being the role that ‘long-chain’ polyunsaturated fatty acids (such as omega-3 EPA) play in regulating inflammation and immune reactions in eczema.
There are many different types of omega-3 and omega-6 fatty acids; omega-3 EPA seems to have the most beneficial effects on controlling inflammation in the body and may therefore help to calm inflamed reddened skin. The level of these omega-3 EPA fats in the human body is directly related to omega-3 intake in the diet, mostly from oily fish. Other ‘short-chain’ plant based fatty acids such as linseed oil and other nuts and seeds also contain omega-3 fatty acids (ALA), however the body then needs to convert these short-chain fats into the long-chain fatty acids. In a healthy individual with a nutrient-dense diet (containing adequate magnesium, vitamin B6 and zinc), this conversion is made possible with the use of enzymes, delta-5 and delta-6 desaturase. The conversion of plant-based oils containing omega-3 ALA into omega-3 EPA is an important process, especially if you do not eat enough fish. This is because omega-3 EPA plays such a specific and important regulatory role in inflammatory and immune function. Unfortunately, many individuals with eczema have slow-functioning delta-5 and delta-6 desaturase enzymes, which means fatty acids are not converted as they should be. There are two main options to overcome this issue: one is to increase your intake of long-chain omega-3 EPA from fish (aim for at least two portions of oily fish a week), the other is to support your enzyme function by including plenty of foods rich in magnesium, vitamin B6 and zinc.
Magnesium can be found in dark green leafy vegetables such as spinach, nuts, seeds, lentils, beans fish and wholegrains; zinc is found in high quantities in liver, beef, wheat germ and pumpkin seeds, and vitamin B6 is found at good levels in nuts, seeds, fish, herbs, spices and rice.
Fish, fish, fabulous fish!
Studies have shown that early introduction of fish into the diet can influence the development of eczema in children. The Prevention of Allergy among Children in Trondheim study, a prospective birth cohort study in primary healthcare in Trondheim, Norway, followed 3086 children prospectively from one year to approximately two years of age. The primary outcome variable was parental reported asthma and eczema at two years, but the findings suggested a reduced risk of developing eczema if the child was eating fish once or more a week within the first year of life (Oien et al, 2010).
Significant research also shows that the introduction of fish during pregnancy and early infancy may also reduce the risk and severity of eczema in offspring, compared to the consumption of other foods. The consumption of fats containing omega-6 LA such as corn oil and sunflower oil on the other hand, when consumed during pregnancy, has actually shown to increase risk of eczema in offspring.
Indeed, increasing your intake of fish may be one of the most effective methods to improve skin health, however it must be noted that fish can contain contaminants such as methylmercury. Where possible opt for smaller fish, such as anchovies, sardines, mackerel and herring. Larger fish such as tuna should only be consumed occasionally as they can accumulate toxins from eating smaller fish.
In addition to oily fish, other anti-inflammatory foods to consider are brightly coloured fruits and vegetables, which contain an array of antioxidants such as vitamin A and C. Quercetin is a particularly powerful antioxidant found in foods such as red onions and watercress that may help to further reduce allergic reactions. To provide additional support to your immune system, follow a diet low in sugar and refined foods.
Glaser C, Heinrich J, Koletzko B. (2010) Role of FADS1 and FADS2 polymorphisms in polyunsaturated fatty acid metabolism. Metabolism. 59:993-9.
Oien T, Storrø O, Johnsen R. (2010) Do early intake of fish and fish oil protect against eczema and doctor-diagnosed asthma at 2 years of age? A cohort study. J Epidemiol Community Health. 64:124-9.
Hesselmar B1, Saalman R, Rudin A, Adlerberth I, Wold A. (2010) Early fish introduction is associated with less eczema, but not sensitization, in infants. Acta Paediatr. Dec;99(12):1861-7.
Chung BY1, Kim JH, Cho SI, Ahn IS, Kim HO, Park CW, Lee CH. (2013) Dose-dependent effects of evening primrose oil in children and adolescents with atopic dermatitis. Ann Dermatol. Aug;25(3):285-91
Sausenthaler S1, Koletzko S, Schaaf B, Lehmann I, Borte M, Herbarth O, von Berg A, Wichmann HE, Heinrich J;LISA Study Group. (2007) Maternal diet during pregnancy in relation to eczema and allergic sensitization in the offspring at 2 y of age. Am J Clin Nutr. Feb;85(2):530-7.
If you’re not a fan of fish or you find it hard to meet the recommended two portions a week, supplementing directly with omega-3 EPA may be of benefit. Preformed omega-3 EPA directly increases cell and tissue levels with a corresponding increase in anti-inflammatory by-products, which are helpful for regulating eczema symptoms.
Supplementing with omega-3 EPA also bypasses the risk of potentially ingesting contaminants such as methylmercury, PCBs and dioxins, as fish oils can be purified. The use of purified fish oils as an addition to, or alternative to fish consumption certainly has numerous benefits. Highly purified oils such as those produced from molecular distillation in pure form, offer a safe and convenient method of increasing omega-3 intake to therapeutic doses without the risk of contamination associated with eating both farmed and wild fish. All Igennus EPA oils adhere to strict purification standards undergoing molecular distillation and are independently batch-tested. Igennus supplements also contain the active ingredient EPA to up to 90% concentration, compared to as low as 18% in some standard fish oils. Such a high concentration also means that a high dose of EPA can be obtained easily in small capsules.