Eczema: Dermatitis

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.

David L. Hoffmann BSc Hons MNIMH Written by David L. Hoffmann BSc Hons MNIMH

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