Treating Eczema in Children: An Integrative Approach

According to the American Academy of Pediatrics, at least 1 in 10 children have eczema. Known more specifically as atopic dermatitis, this condition is found in 20% of infants and will usually manifest before age five.

Children with eczema have more sensitive skin and are more likely to develop other atopic conditions like asthma, rhinitis, or food allergies. Eczema develops from the combination of genetic risk factors and environmental triggers.

There is no known cure for eczema. The conventional treatment aims to reduce itching and skin inflammation and prevent infection. Taking a root cause approach with functional medicine may offer more than just treating symptoms. Through what is understood about the microbiome, epigenetics, and systemic inflammation, a functional medicine practitioner might provide more answers and better results by looking at the whole body and not just symptoms on the skin.  

What is Eczema?

Eczema is a general term for a group of skin conditions that cause skin irritation. It is a chronic inflammatory condition that develops from a drop in the skin's ability to act as a defensive barrier. This results in red, itchy rashes that appear in patches.

There are many types of eczema. The most common that affect children are atopic dermatitis, contact dermatitis, dyshidrotic eczema, and seborrheic dermatitis (also called "cradle cap" in infants). Rashes can look different for each child. Dermatitis, like eczema, is a general term and literally means "inflamed skin."

Eczema typically goes through periods of exacerbation (or "flares") and times of improvement or remission. Some experience this ebb and flow into adulthood, while others "outgrow" eczema.

Atopic dermatitis is a chronic condition and affects 13% of children under the age of 18. It is thought to result from an overreaction by the immune system to triggers outside the body.

What Does Eczema Look Like?

Eczema symptoms may present differently from child to child and can be either short-term or chronic.

Beyond dry skin, common symptoms include:

• Itching that can be severe
• Swelling
• Inflammation
• Red, purple, or brown rashes
• Small, fluid-filled bumps that may crust over
• Cracked skin
  

Typically, it is the intense itchiness along with the rash that points to the diagnosis of eczema. These rashes can appear anywhere on the body. They can be all over or only in a few spots. In infants and babies, eczema likely occurs on the scalp, cheeks, forehead, and around the mouth. It is not common to develop in the diaper area. In older children, eczema is more likely to show up in the bends of the elbows or knees.

Eczema rashes are not contagious. However, excessive scratching may open the skin up for infection.

What Causes Eczema in Kids?

There are multiple known causes of eczema, including family history, food sensitivities or allergies, genetic variations, and gut and skin microbiome health.

Family History

Children with a family history of eczema, hay fever, or asthma are more likely to have atopic dermatitis.

Food Allergies & Food Sensitivities

Food allergies and sensitivities are caused by different antibodies but can produce the same physical reactions, such as eczema. A food allergy can cause an immediate immune response (IgE-mediated). In contrast, food sensitivity responses can be delayed up to 48 hours (IgG-mediated), making the particular trigger food hard to pinpoint.

Food Allergies: 40% of children with moderate to severe atopic dermatitis also have been diagnosed with food allergies. Cow's milk and eggs are two of the most common allergens.

Food Sensitivities: Children with eczema commonly have higher IgG-mediated (delayed) reactions to food sensitivities. Dairy, gluten, and eggs were the most common foods to which patients were highly reactive. These foods could have even been an issue before the introduction of solid foods since food sensitivities can be passed through breastfeeding.

Filaggrin (FLG) Gene Mutation

A problem with the skin barrier can also cause eczema. Some people have a genetic variation that leads to a compromised skin barrier. Filaggrin is a protein with a significant role in the skin's protective barrier. If the body doesn't correctly make this protein, it leads to an inability to retain moisture or protect against microbes or environmental irritants (i.e., tobacco smoke and allergens). 50% of severe eczema patients have the genetic variation that causes filaggrin deficiency.

Gut Microbiome Imbalance

Disruption of the gut microbiome may also lead to eczema. Specifically, this was found when antibiotics were used within the first six months of life. A retrospective cohort study of 426 children found that exposure to commonly prescribed antibiotics is associated with any allergic disease, including eczema.

Skin Microbiome Imbalance

Changes to the microbiome of the skin may also cause eczema. Healthy skin relies on a balanced community of microbes. Staph aureus provokes atopic dermatitis and colonizes the skin in 90% of patients with atopic dermatitis. While the exact mechanism is yet to be determined, research shows a link between skin health and the gut microbiome. Therefore, impairments in the gut may trigger imbalances in the skin's microbiome.

Functional Medicine Labs to Test for Root Cause of Eczema in Kids

A root-cause approach to treating eczema in children usually requires some specialty lab tests. The results from these test help practitioners individualize treatment options.

Comprehensive Stool Analysis

The GI-map provides an in-depth analysis of the gut environment, inflammatory markers, digestion, nutrient absorption, and immune function.

Blood Spot for Food Allergy and Sensitivity

Blood spot (or finger prick) testing for children offers a less invasive way to assess food allergies and sensitivities effectively. These tests analyze the immune system response to many of the most consumed antigens. Diagnostic Solutions offers a test that measures IgE antibodies for screening food allergies and IgG antibodies for food sensitivities. If the child is breastfed, it is suggested that the mother take the test to see what sensitivities she could be passing on via the breastmilk.

FLG Gene Mutation Testing

Other labs may include genetic testing for the FLG gene mutation. This test's results are helpful for risk assessment for atopic diseases and atopic disease-associated asthma and genetic counseling for family members.

Functional Medicine Treatment for Eczema in Kids

Conventional treatment includes using corticosteroids to suppress symptoms. While there is no cure for eczema, a functional medicine approach will address the root cause and support symptomatic relief.  

Eczema Diet

A low-inflammatory, whole-food diet that eliminates IgE and IgG-mediated foods is the first step to reducing overall inflammation and allowing the skin barrier to heal. The AIP diet is commonly prescribed for three months to allow the gut and skin microbiome to heal. The goal of the AIP diet is to:

• Reduce inflammation
• Support a healthy microbiome
• Allow phytonutrients to heal the gut
• Reduce the toxic burden
• Identify food triggers
  

Based on the food sensitivity results, highly reactive foods would also be removed from the child's diet for at least three months. After three months, food sensitivities can be retested, and the restricted food list should be modified based on the results. This can allow a greater variety of foods if the gut has healed. As an alternative, the elimination diet can be continued for six months without reintroducing foods, and retesting can be done at that point.

Modifying a child's diet can feel overwhelming; some kids are picky or have certain comfort foods. In addition, elimination diets can be challenging because they must be followed 100% of the time to be successful. Therefore it is essential for parents to set the example and not eat eliminated foods in front of their children.

Moisturizers

Besides gut health, keeping the skin moisturized is one of the most critical factors in treating eczema. A major component of healthy skin barriers is naturally occurring lipids called ceramides. Ceramide-containing products keep moisture in the skin and help resist itching and burning. It is preferable to use products with ingredients that help eczema (i.e., shea butter, aloe, vitamin E, hyaluronic acid) and avoid lotions with hormone-disrupting chemicals. EWG is a great place to look up products.

Oatmeal or Dead Sea Mineral Baths

Soaking in a bathtub can offer relief to eczema and a relaxing and practical way to effectively cover the affected areas. Colloid oatmeal baths have been shown to help protect the skin and soothe eczema symptoms. Salts from the Dead Sea may also offer relief and protection. Compared to the control group, a magnesium-rich Dead Sea salt solution significantly improved skin barrier function and reduced inflammation (roughness, redness). Short warm baths are better than longer ones, as hot soaks can dry out the skin.

Phototherapy

Also referred to as light therapy, phototherapy reduces itchiness and soothes inflammation. Typically, phototherapy is only used with children when their eczema cases are severe. According to the National Eczema Association, it may take 1-2 months of consistent therapy to see improvement.

Sodium Hypochlorite

Since Staphylococcus aureus is known to provoke eczema, sodium hypochlorite may offer some defense against this pathogenic microbe. Washing the body in a solution of sodium hypochlorite (NaOCl) has been found to ameliorate the populations of staph aureus in children with moderate to severe eczema.

Vitamin D

According to the National Eczema Association, vitamin D is a common supplement used to manage eczema. A 2013 comparative study found lower serum vitamin D levels were associated with a higher frequency of bacterial skin infections. The results showed that vitamin D supplementation reduced the clinical signs of eczema.

Probiotics

Supplementing with probiotics (especially Lactobacillus rhamnosus strain GG) may reduce the risk of developing and reduce the severity of atopic diseases, such as eczema. A 2015 meta-analysis of 4,755 children showed that infants treated with probiotics had a significantly lower risk of eczema compared to controls. Studies also find that giving probiotics to breastfeeding mothers during the prenatal period is a safe and helpful option for preventing eczema. The comprehensive stool analysis can help practitioners prescribe specific probiotics that may be low in the sample.

Herbal Therapy

Traditional Chinese Medicine (TCM) is a form of medicine that consider all aspects of the body when managing health issues. Any herbs prescribed for skin disorders will focus on the root cause of the disease itself alongside herbs to treat individual symptoms.

• For red, itchy, dry eczema, herbs that reduce heat and inflammation are prescribed.
• For oozing eczema, herbs that dry "damp" will be prescribed.
  

Some practitioners will also prescribe topical herbs to help with the moisture barrier and ease discomfort.

Summary

Eczema goes by different names and can appear anywhere. Knowing what triggers it and how to control flare-ups requires diligence in tracking foods and what comes in contact with the skin. Avoiding future flare-ups through eliminating known triggers and keeping the skin moisturized makes managing eczema easier. Applying a root cause approach helps understand how the body's largest organ, the skin, is connected to other systems and may lessen the burden and irritation of eczema, which goes beyond just managing symptoms.