Dealing with Eczema

Isn’t it crazy to think of all the different kinds of foods so many of us eat every day? Chips, cookies, burgers, fries. Our bodies dutifully process whatever it is we choose to swallow – regardless of whether or not what we eat could actually harm us or shorten our lives.  Our bodies are amazing as they try and pull out nutrients while trying to protect us from all the garbage.  So – maybe – just maybe – we should try and give our bodies a break. 

I’m Dr. Michael Greger and you’re listening to the Nutrition Facts podcast.  I’m here to tell you that nutrition matters.  We could choose a diet proven to not only prevent and treat but reverse our #1 killer, heart disease, along with other deadly diseases such as type 2 diabetes and high blood pressure. But many of us – don’t make that choice. 

Our goal today is to help you make that choice – and present you with the results of the latest in peer-reviewed nutrition and health research, presented in a way that’s easy to understand.

Atopic dermatitis – also known as eczema – is a condition that makes your skin red and itchy. It’s common in children but can occur at any age. No cure has been found for it, but treatments and self-care measures can relieve itching and prevent new outbreaks.

Are there dietary supplements that can help with atopic dermatitis?  Let’s look at the research.  Atopic dermatitis,” more commonly known as eczema, is ranked as “the skin disease with [perhaps] the greatest [global] health burden,” because it’s just so common. Maybe one in ten kids have it, and about 3% of adults, where you get patches of red, itchy skin. Topical steroids, like cortisone cream, is “the mainstay of treatment” since its Nobel Prize winning discovery in 1950.

People are scared of steroids, though. It’s “not uncommon for patients to express irrational fear and anxiety about using” steroid creams and ointments—a “phobia” that may arise from confusing topical steroids with oral or injected steroids, which have different effects. Really potent topical steroids can thin your skin, but skin thickness should return to normal a month after stopping. So yes, it can cause side effects, but the concern people have “seems out of proportion” to the small risk they pose. Still, okay, if there’s a way you can resolve a problem without drugs, that’s generally preferable. What did they do for eczema before the 1950s?

Well, in the ‘30s, some researchers tried using vitamin D dissolved in corn oil, and to their surprise, it worked—but so did the corn oil alone, without the vitamin D that they were using as a control. Others reported cases improving after feeding flaxseed oil—or even lard! The “National Livestock and Meat Board” did not want to be left out of the action. The problem is that none of these studies had a control group. So, yeah, feeding someone corn oil for 12 to 18 months, and they get better; but, maybe they would have gotten better anyway. You don’t know until you put it to the test.

All these researchers that claimed benefit from the use of various fats apparently lacked “any great interest” in doing controlled studies. Most got better either way, which suggests that the previous “benefits claimed may [have been just] due to the usual treatments, with perhaps a dash of enthusiasm.”

By then, hydrocortisone was out, and so, the medical community gave up on dietary approaches, until the treatment of eczema with supplements of evening primrose oil, which contains gamma linolenic acid, an anti-inflammatory omega-6. And indeed, when it was put to the test, it seemed to help. But then, a subsequent larger study found no effect.

Whenever there are conflicting findings, it helps to do a meta-analysis, where you put all the studies together. There was the study that showed benefit, the one that didn’t, and then seven other studies, and seven out of the seven showed benefit. And so: “The results show that the effects of [some brand of primrose oil supplement was] almost always significantly better than…placebo.” Case closed, right?

Well, the analysis was funded by the supplement company itself, which can be a red flag. Where exactly were these other seven studies published? They weren’t. The company just said they did these studies, but never released them. And, when they were asked to hand them over, they said they would, but never did—even threatening a lawsuit against researchers who dared question their supplements’ efficacy.

An independent review failed to find evidence that evening primrose oil or borage oil worked better than placebo. And so, “As we bid goodnight to the evening primrose oil story, perhaps we [will] awaken to a world where all clinical trial data…reach the light of day.”

Borage oil actually has twice the gamma linolenic acid as evening primrose oil, and still didn’t work. But, that didn’t stop researchers from trying hempseed oil, which has evidently been used as a food and medicine for thousands of years. They tried giving about a quarter-cup of hemp seeds’ worth of oil to people every day for a few months and found significant improvements in skin dryness, itchiness, and the need for medications—but not compared to placebo.

In fact, dietary supplements across the board, whether “fish oil, zinc, selenium, vitamin D, …E, [or] …B6, sea buckthorn oil, hempseed, [or] sunflower oil,…overall, no convincing evidence that taking supplements improved…eczema.”

Well, that’s disappointing, but wait a second—that’s just for oral supplements. What about natural remedies applied topically? We’ll find out, next.

“Despite the availability of [drugs] with proven efficacy” for eczema, like topical steroids, many patients seek out natural alternatives. “Which plant [then, should be used] for which skin disease?” Well, in the case of eczema, two appeared to beat out placebo. One was licorice root. Smearing on a placebo gel didn’t appear to help much with clearing redness or itchiness after one week or two weeks, but a 1% licorice gel, and especially a 2% gel, did seem to clear the symptoms in most patients. They conclude that “licorice extract could be considered…an effective [eczema treatment] agent.”  The other successful trial was with St. John’s wort cream, showing a reduction in eczema severity scores week by week superior to that of placebo. So, it works better than nothing, but the question is: Does it work better than drugs, better than topical steroids? That we don’t know.

Sometimes, the drugs don’t work, though: so-called “recalcitrant” atopic dermatitis. So, these researchers in Japan asked patients to try drinking four cups of oolong tea every day for a month, and most patients “showed marked [or at least] moderate improvement,” starting after one or two weeks, and then, most remained better even five months after they stopped. The problem is that there was no control group. So, we don’t know how many would have gotten better on their own. But, since drinking tea is healthy anyway, why not give it a try?

Back to topical treatments: a vitamin B12 cream beat out the same cream, without the B12. Most of the patients and doctors rated the results of the B12 cream as good; better than they rated the placebo cream.

Regardless of what topical agent you use, steroid or otherwise, “[f]irst and foremost, though, it is essential that the skin barrier [be] protected and maintained with the use of emollients,” meaning moisturizers, “ideally…once or twice” a day, especially right after showering, to lock in the moisture. Petroleum jelly, like Vaseline, is highly effective, but it’s kind of greasy and messy. What about something like coconut oil, which is less greasy? It was found to improve skin dryness, though no better than mineral oil, which is cheaper. Is mineral oil safe, though?

Exposure to mineral oil was found to be associated with rheumatoid arthritis, but that was occupational exposure to industrial mineral oils, like hydraulic fluid. The same group of researchers subsequently found that cosmetic-grade mineral oil did not seem to carry the same risk. In general, topically applied mineral oil shouldn’t present any health risk.

That doesn’t mean you can safely inject it into your penis, as that “may have devastating cosmetic and sexual function consequences.” There is, however, one good use for mineral oil on the penis, and that’s for “penile zipper entrapment.” “The skin of the [penis] is susceptible to entrapment in the zipper of careless young boys, particularly those who fail to wear undergarments. Understandably, this mishap provokes distress in the unfortunate victim, in his parents, and ultimately in the healthcare provider charged with the task of liberating the organ.” A recommended textbook approach is surgery, believe it or not, but just liberally dose with some mineral oil and you can just slip the zipper off, minimizing trauma for all involved parties.

But, just because it works as well as coconut oil for dry skin, doesn’t mean it works as well for eczema. Head-to-head, topical virgin coconut oil works better than topical mineral oil at decreasing eczema severity, with twice as many children experiencing an excellent response after two months’ treatment. “Thus, among pediatric patients with mild to moderate [eczema], topical application of [virgin coconut oil] was superior to that of mineral oil.”

But, what about compared to virgin olive oil? Olive oil worked, dropping eczema severity, but coconut oil worked better. What do these numbers mean? Like, what does it mean going from a severity score of 35 down to 20 look like?

Now, we know coconut oil has a lot of saturated fat; so, we don’t want to eat it. But, the saturated fat isn’t absorbed into your skin unless you’re a baby, where your skin is so thin you can actually absorb saturated coconut fat into your bloodstream. But, in older children and adults, using coconut oil on your skin or hair is considered safe. Now, that still doesn’t mean you can inject it into your penis. “He…certainly achieved enlargement,” the medical student noted, “looking at the swollen, red, oozing mass before [her].”

Okay, but what about treating eczema with just plain Vaseline? Eczema can already be expensive to deal with. The average out-of-pocket cost can be $274 a month; that’s more than a third of a typical family’s disposable income. And, you can rub a kid head to toe with petroleum jelly for like four cents, whereas coconut oil or some of the fancier over-the-counter moisturizers can be many times more expensive—though not as bad as some prescription moisturizers that can cost over a hundred dollars per tube, and work no better than the over-the-counter stuff. No evidence of superiority over the traditional petroleum jelly-based over-the counter-products that can be 65 times cheaper.

Yeah, but doesn’t virgin coconut oil have like active ingredients, whereas petroleum jelly is just “inert”? Vaseline has been around since 1872, but it took the scientific community 144 years to put it to the test. And, it’s not inert at all, significantly upregulating genes that fight infection, and inducing the expression of genes that help with barrier function, increasing the thickness of the protective outer layer of skin, and actively reducing inflammation. Yeah, but is it safe? Not, if you inject it into your—. What is it with men injecting stuff into their penis? “In…less severe cases, the problem [can] be solved [with] basic surgery.” Otherwise, it may require major reconstruction. Evidently, done a lot by prisoners, giving a whole new meaning to the term Jailhouse Rock. An unbelievable one in six inmates at the largest prison in Hungary “admitted [to] Vaseline self-injection.” Or, how about actual rocks, the surgical implantation of stones in the penis?  Or injecting “industrial silicone.” I will never look at the term “silicone caulk” the same way, ever again.

When men were asked why they were injecting fishy substances into their penises, most explained that it was because they felt under-endowed, but one guy said he just wanted to give it a try. But, why inject cod-liver oil into your penis when you can just inject the mercury directly, and cut out the middle fish.

Anyways, based on 77 studies of moisturizers for eczema, no reliable evidence that one moisturizer is any better than the other, though a consensus of experts concluded that petroleum jelly may be best for skin barrier function protection.

To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page.  There, you’ll find all the detailed information you need plus links to all the sources we cite for each of these topics.

Be sure to also check out my new How Not to Die Cookbook, beautifully designed, with more than 100 recipes for delicious, life-saving, plant-based meals, snacks, and beverages. And, like all my books, DVDs, and speaking engagements, all the proceeds I receive are donated to charity. 

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Thanks for listening to Nutrition Facts. I’m Dr. Michael Greger.

This is just an approximation of the audio content, contributed by Allyson Burnett.