Introduction to Eczema
Eczema is a descriptive term that refers to itchy, red, thickening and
scaling skin eruptions. Dermatology texts will list a number of conditions under
the term eczema and the classification can be confusing. Itching is the dominant
symptom and can be severe.
Atopic dermatitis is the prototype of food allergic skin disease. This type
of eczema often appears on the face as patches of reddish, scaling skin. As
eczema worsens, the skin becomes itchier, red, thickened, grooved, and may
blister, weep, and crack. The typical distribution of eczema is on the face,
behind the ears, on the front of the elbows, the back of the knees, the hands,
neck, and trunk. Food allergy probably accounts for much eczema; the rest is
external allergy-irritants, infection, and injury to the skin through vigorous
itching. House dust mite allergy is an important external cause of eczema.
Infection with staphylococci is a common cause of sudden worsening of eczema.
Eczema can become a severe disease that involves generalized symptoms of food
allergy and symptoms from complicating infections. Atherton summarized food
allergic skin disease in 1984 putting urticaria (hives) and eczema at the top of his
list. Eczema has always been included with hay fever and asthma as an atopic
disease. Atherton emphasized the distinction between immediate and delayed food
reactions and recommended a trial of an low-allergy diet; a simple set of foods
that have low allergy risk. This approach is taken in the Alpha Nutrition
begins in infancy and is common in toddlers. The most common type of eczema is a
topical dermatitis and occurs in people of all ages with an allergic
disposition. Some people have a life-long tendency to develop eczema and tend to
have periods of skin activity lasting months to years, interspersed with normal
periods. Eczema sometimes merges with other skin conditions - hives are
common and occasionally psoriasis and eczema will overlap. Diaper rash is
commonly associated in infants.
We find it helpful to think in terms of the
origin of the problem and classify eczema in a simple way; the skin condition is
either allergic (immune -mediated) or something else is going on. If allergic,
the triggers are either food or surface contact materials or both.
If the skin is reacting in an allergic manner, you ask; where is the trigger
- on the surface or in the food supply? Your speculations should lead you to a
solution by eliminating the cause. Sure, there are topical treatments, but none of the
treatments are satisfactory and all are short-term. Removing the cause has to be
your best bet, even if the task seems difficult.
Solution - Diet Revision and Alpha ENF
Villaveces and Heiner reported remission of symptoms in six patients with
severe atopic dermatitis by replacing food with an elemental nutrient formula
for at least a week and then reintroducing foods to determine reactivity. Ratner
et al reported similar success in 16 children and 14 adults with moderate to
severe eczema. Sixty percent achieved significant remission after 3-12 days on
an elemental nutrient formula. They noted that half the food challenge reactions
were immediate and the other half delayed.
Although eczema is included in the atopic group, its mechanism clearly goes
beyond type 1 hypersensitivity. Chronic inflammatory changes in the skin,
eosinophilic recruitment, circulating IgA, IgG, IgE immune complexes, and
demonstrations of associate increased gut permeability implicate all four
hypersensitivity mechanisms in the pathogenesis of this common skin disorder.
IgG complement-fixing immune complexes have been demonstrated in children with
eczema. Complete diet revision is the best way to treat this disorder rather
than selective elimination of foods either by history or skin test.
An Italian study of 5500 newborn infants with a family history of allergy
found 4677 with elevated IgE levels in cord blood. The parents of these infants
were encouraged to take preventive action to prevent atopic disease; breast
feeding with reduction in the maternal diet of cow's milk, egg, tomato, fish was
recommended for six months. Soya formula was used beyond six months -13.3% of
infants on the prescribed regime developed atopic disease; 54.7% of the
non-compliant group developed AD. 73.3% of the afflicted infants had skin
involvement. Zeigler et al demonstrated a lower incidence of atopy at 12 month
in infants whose diet and mothers diet excluded cow's milk, wheat, corn, soya,
A prospective, randomized control study of 120 infants showed that avoidance
of allergenic foods and smoke prevents allergy. Lactating mothers avoided milk,
egg, fish, nuts and excluded these foods as well as soy, wheat, and orange in
the infant's diet for the first 12 months. The restricted group had
significantly less eczema and asthma.
James et al performed double-blind food challenges in a group of 320 children
with atopic dermatitis and conformed food allergy in 64% of patients who had
cutaneous reactions; itchy red rashes and urticaria.