Eczema: Dermatitis - Article

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Eczema: Dermatitis

http://www.healthy.net/asp/templates/Article.asp?PageType=Article & Id=1613

 

 

© David L. Hoffmann B.Sc. (Hons), M.N.I.M.H.

 

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Superficial inflammation of the skin, characterized by vesicles (when

acute), redness, edema, oozing, crusting, scaling and usually itching.

 

The terms eczema and dermatitis are the cause of much confusion amongst

students and practitioners alike! Here we shall follow the broad

guidelines given in the Merck Manual and use them synonymously to mean a

superficial inflammation of the skin. The dermatologist will subdivide

into a range `disease entities' differentiated by location and

appearance, but this is not too helpful for the phytotherapist. The most

important sub-division is between those cases where the cause is an

internal or endogenous one, as opposed to a contact or exogenous cause.

In the latter cases it is possible to solve the problem by avoidance of

the surface irritant, if it can be identified! Such problems, often

referred to as Contact Dermatitis, are commonly caused by, for example:

industrial solvents,

dyes,

nickel and other metals,

leather tanning chemicals,

some soaps.

 

In this case eczema is the final result of a complex series of internal

reactions to exposure to such allergens and irritants. It often

accompanies other allergic diseases such as hay fever and asthma, but

may also occur alone.

 

The rash is a very itchy, peeling, thickened, sometimes weepy area,

typically noted in the creases of joints and about the trunk. The rash

may fluctuate both seasonally and over the course of the day. Scratching

may lead to bleeding and infection. Blood tests reveal increased levels

of cells and chemicals associated with allergic reactions in general.

 

A variation of eczema occurs on the palms of the hands, and sometimes on

the soles of the feet. This type may be quite frustrating, since the

common exposure to moisture, irritants, and injury of these locations

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 specifics will vary

from person to person. These include:

stress

mechanical irritation

heat

dietary factors are important, especially in children. Milk and milk

products are the commonest triggers.

 

Actions indicated for the processes behind this disease:

Alteratives are the classic remedies for the treatment of eczema. How

they work is unclear, but they can often be dramatically effective.

Anti-Pruritics, remedies that reduce the sensation of itching, are

indicated to lessen the intense irritation that characterizes some

cases. This is not simply to make the patient feel better, but to reduce

the degree of physical trauma caused by scratching.

Anti-Inflammatories applied topically and taken internally will speed

the curative work of the alteratives, but not replace them.

Lymphatic Tonics are especially helpful in childrens' eczema. Of course,

these herbs are a variety of alterative.

Nervine Relaxants help with the commonly associated problem of anxiety.

and will often ease discomfort in the skin because of the relaxing

effect upon the peripheral nerves of the autonomic nervous system. This

will reduce itching, and even inflammation to some extent.

Diuretics are important in ensuring adequate elimination through the

kidneys. The diuretic alteratives are most relevant.

Hepatics will contribute their special support for liver function and

the digestive process. The hepatic alteratives are best here.

Vulnerary herbs will support the healing of skin lesions when applied

topically, but do not replace appropriate internal treatment.

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

Emollient herbs are suitable for topical applications where soothing is

needed. The demarcation between emollient, anti-inflammatory and

anti-pruritic is rather meaningless here.

 

System Support

This is a case where the practitioner must be at their most insightful.

Ideally the nature of any underlying cause would identify what systems

call for toning. However, with the exception of obvious allergy or

contact irritant, this is problematic in a skin problem such as eczema.

The skin calls for support, but additionally we can add the nervous

system, digestive system, liver, immune system etc. etc. In many ways

the conclusion will depend upon the herbalists personal theoretical

interpretation of eczema, rather than the patients case history.

 

Specific Remedies

For internal use, the leafy alteratives are often considered the closest

we have to specifics for this often intransigent condition. These are

also often diuretics and lymphatic remedies. Herbs that would be

included in this group include:

 

Fumaria officinalis -- Galium aparine -- Scrophularia nodosa

Trifolium pratense -- Viola tricolor -- Urtica dioica

 

The rooty alteratives tend to be hepatic in nature. They can often be

too strong for eczema, aggravating the problem rather than healing. For

intransigent case, unresponsive to the herbs above, stronger remedies

are indicated. Effective examples for eczema are:

 

Arctium lappa -- Berberis aquifolium -- Hydrastis canadensis

 

There are an abundance of relevant herbs for topical application. The

choice will often be decided on factors such as availability and

esthetics. Examples here are:

 

Calendula officinalis -- Hydrastis canadensis -- Stellaria media

Plantago spp. -- Urtica dioica

 

Relevant herbs for topical use abound. It must be bourne in mind that

healing must be based upon internal medication and not salves. Select

remedies based upon the actions most appropriate for the individuals'

specific symptoms.

 

Anti-pruritic: Chickweed (Stellaria media) is an extremely effective

remedy for the relief of itching. The only situation is does little in

is the itching of jaundice. It is most effective in a non-greasy form

such as a bath, fomentation, poultice, lotion or cream. Distilled Witch

Hazel (Hamamelis virginiana) is another effective application.

 

Anti-Infammatory: Plantain (Plantago spp.), Calendula (Calendula

officinalis), St. John's Wort (Hypericum perforatum), Chamomile

(Matricaria recutita) and the anti-inflammatory essential oils can all

be used.

 

Emmolient: Comfrey (Symphytum officinalis), Marshmallow (Althaea

officinalis), Mallow (Malva sylvestris), Slippery Elm (Ulmus fulva) etc.

 

Astringent: Witch Hazel (Hamamelis virginiana), Yarrow (Achillea

millefolium)

 

Vulnerary: Comfrey (Symphytum officinalis)

 

Anti-microbial: Essential oils are all anti-microbial, most notably

Thyme (Thymus vulgaris), Eucalyptus (Eucalyptus globus), Ti Tree

(Melalucca spp.). Also consider Myrrh (Commiphora mol-mol) and Golden

Seal (Hydrastis canadensis). This is discussed in more depth in the

section on infection.

 

One possible prescription for eczema:

Galium aparine

Urtica dioica

Trifolium pratense equal parts to 5 ml of tincture three times a day

Urtica dioica or Galium aparine

an infusion of the fresh herb drunk 2 or 3 times a day.

 

This combination for internal use supplies the following actions:

Alterative: Galium aparine, Urtica dioica, Trifolium pratense

Lymphatic Tonic: Galium aparine, Urtica dioica

Nervine Relaxant: Trifolium pratense

Anti-Inflammatory: Galium aparine

Diuretic: Galium aparine, Urtica dioica

Hepatic: Galium aparine, Trifolium pratense (both are very mild thus

avoiding over stimulation)

 

A possible prescription for persistent eczema, unresponsive to mild

alteratives :

Galium aparine

Arctium lappa

Scrophularia nodosa equal parts to 2.5 ml of tincture three times a day

build up dosage to 5ml three times a day

Urtica dioica an infusion of the fresh or dry herb

drunk 2 or 3 times a day.

 

Care should be taken with Scrophularia nodosa initially as it can

produce the opposite of the desired 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'!

 

This combination for internal use supplies the following actions:

Alterative: Scrophularia nodosa, Galium aparine, Urtica dioica, Arctium

lappa

Lymphatic Tonic: Galium aparine, Urtica dioica

Nervine Relaxant: Trifolium pratense

Anti-Inflammatory: Galium aparine

Diuretic: Galium aparine, Urtica dioica, Arctium lappa

Hepatic: Galium aparine, Arctium lappa (both are very mild thus avoiding

over stimulation)

 

One possible prescription for atopic eczema associated with asthma:

Urtica dioica 2 parts

Trifolium pratense 2 parts

Dyspnoea mixture 1 part to 5 ml of tincture three times a day

the relative proportion of alteratives to dyspnoea mixture depends upon

the patients specific needs.

Urtica dioica or Galium aparine

an infusion of the fresh herb drunk 2 or 3 times a day.

 

Broader Context of Treatment:

If dietary triggers can be identified, it is essential to avoid them

completely. Often the specifics food restrictions that are called for

can be a challenge to adhere to. This is especially the case with young

children. The parents who must enforce the diet will need much support

from the therapist (maybe some Scutellaria!). Even if there are no

obvious food triggers, it is always worth excluding milk and milk

products. It seems that this is especially the case with children who

were not breast-fed, or 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 cows' milk or other foods. Goats', soya

or sheep's milk rarely trigger allergy problems. Common eczema triggers

that are relatively easy to exclude include :

Cows' milk

Eggs

Cheese

Fish

Sugar

Food additives

 

Supplements suggested for inclusion in a broad therapeutic approach to

the treatment of eczema by Drs. Pizzorno & Murray in A 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 as conditions clears)

Quercetin 1/8 - 1/4 teaspoonful 3 times a day

Evening Primrose oil 2-4 capsules 3 times a day. As patient improves,

switch to the less expensive flaxseed oil.

 

Other authorities have recommended Vitamin C and Vitamin B complex in

addition.