Data from worldwide epidemiological studies have shown that the prevalence of many allergic conditions have steadily increased every decade since the 1940's to the 1990's, especially allergic rhinitis, asthma and eczema (Howarth, 1998). The skin of eczema patients is dry, thickened and itchy. Lesions may occur, sometimes worsened by scratching, with papules, red patches, weeping fluid and, in advanced cases, hyper-pigmented plaques with a ridges appearance. Eczema patients often develop asthma.

Allergy- and eczema-prone children and adults are often severely deficient in omega-3 fatty acids and have digestive problems. A food allergy connection to eczema is clear, especially in infants and younger children. For example, there is often marked intestinal inflammation and food allergy (Majamaa, et. al., 1999). Beginning solid foods too early seems (before the age of four months) can cause more than double the incidence of eczema (Ferguson and Horwood, 1994), and this can be explained by the passage of the new foods into the immature GALT (gut-associated lymphoid tissue), causing immune reactions.

The severity of inflammation caused by food allergy is often underestimated. Among the problems associated with milk allergy, for example, are allergic shock in the newborn, skin and respiratory airway inflammation, acute and chronic gastro-enteritis, and atrophy of the intestinal villi (Fourrier, 1997).  As we learned in our discussion of digestion, dietary improvements and testing for food reactions can quickly and directly reduce the activation of inflammatory mediators in the gut, so attention to diet and food allergy in the obvious first step in these cases. Simple use of acidophilus, for example, can significantly improve the clinical scores of infants with allergic skin conditions (Majamaa et. al., 1997).

In infants, many experts promote breastfeeding as a primary mechanism of preventing atopic dermatitis (Chandra, 1997), but in breastfed babies who have the condition, cessation of breastfeeding may eliminate the problem (Isolauri, et. al., 1999). This would logically point to the health of the mother's breast milk, and at our clinic I have seen various children's ailments cleared up by directly treating the breastfeeding mother. For example, Ayurvedic doctors use turmeric root to purify breast milk. They use a simple test of letting a drop of breast milk fall into a glass of water and watching it dissolve. The more uniformly it disperses into the water, the healthier the milk.

There are many abnormalities in the microcirculation of the skin in eczema patients.  There is a visible blanching of pallor, and a measurable reduction of the radiating skin temperature  (Hornstein et. al., 1992). The effects are often baffling, as the blanching worsens with application nicotinic acid, which normally acts as a vasodilator (Heyer, 1995). These reactions could be explained by the presence of potent and long-acting immune mediators of vasoconstriction and inflammation such as endothelins, which are associated with allergic inflammation and asthma (Sampaio et. al., 2000, Xu and Zhong, 1999). There are three important clinical issues in this subset of analysis - (1) improving microcirculation, (2) strengthening the underlying tissue matrix and fatty layers to improve the physical support structures that deliver nutrients and removes wastes, and (3) addressing pathogenic skin organisms that may contribute to the abnormalities.

Collectively, these findings point to the importance of an integrated approach to eczema, starting with treatment of food allergies and digestive abnormalities. Lowered levels of stomach acid must often be treated as well.  While many patients will benefit from the use of healthy oils, a subset of patients (especially children or people whose problems started in childhood) may have difficulty in properly or fully metabolizing fatty acids. The body must first transform linolenic acid to gamma-linoleic acid (GLA) using an enzyme called delta-6-desaturase. If this chemical process is impaired for any reason, the use of "ready-made" evening primrose oil or DHA may then become very effective (Pizzorno, 1996, Horrobin, 1993).

During the course of treatment, local attention to the skin inflammation itself is necessary to reduce itching and prevent tissue damage. This is especially important to help prevent the problems that result from topical steroid use (Forsdyke and Watts, 1994). Emollient substances can be useful, and I prefer using olive oil with aloe vera gel.  Topical application of witch hazel (Hamamelis virginiana) or castor oil can also be useful, as can soaps or oils containing white sandalwood (chandanam or Santalum album).  Many uncomplicated eczema cases respond to such simple strategies, but these methods will not treat the underlying skin pathology.  For that purpose hyaluronic acid cream or other specialized skin care products may be helpful.

Once all these causative factors have been examined and cared for, it is then possible to treat the problem directly with herbs based upon signs and symptoms:

•  In cases where there are signs of increased coldness and deficiency, emphasize blood-nourishing and blood moving formulas that contain herbs like dang gui root, shou wu root, red peony root, red clover blossom tincture, stinging nettle tincture, and shilajatu.

• In cases of increased heat and inflammation, use formulas with herbs that reduce inflammation in the liver and blood, such as burdock root, Oregon grape root (Berberis aquafolium), neem leaf, bromelain, quercetin, turmeric root, raw rehmannia root, licorice root, and gotu kola.  Other Chinese herbs of note include moutan bark, scrophularia root (xuan shen or (S. ningpoensis) and kochia fruit (di fu zi orK. scoparia).  It is interesting to note that both TCM doctors and Western herbalists use scrophularia root and burdock root to treat eczema.  Gotu kola is especially important, due to its skin-healing effects and ability to improve cutaneous microcirculation (Cesarone et al., 1994).

• Treatment failure in eczema is common using the above methods for two important reasons. The first is that long term steroid use can severely damage the skin. The second is that it may be necessary to weather temporary exacerbations without use of steroids, a feat many people cannot handle. If these discharges are suppressed by steroids, the full healing cannot take place.