Eczema Treatment with Evening Primrose Oil, Borage Oil vs. Hempseed Oil

Eczema Treatment with Evening Primrose Oil, Borage Oil vs. Hempseed Oil
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Are there dietary supplements that can help with atopic dermatitis?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“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 Live Stock 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. But, not this researcher, who tried out some oils, and found no evidence of benefit over routine treatment. Most got better either way, which suggests that the previous “benefits claimed may [have just been] due to the usual treatment, with perhaps a dash of enthusiasm.”

By then, hydrocortisone was out, and so, the medical community gave up on dietary approaches, until this letter was published in 1981 about 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 were] 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.”

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

Please consider volunteering to help out on the site.

Icons created by Luis Prado, Ian Shoobridge, Academic Technologies, Zidney, and Nico Ilk from The Noun Project.

Image credit: Marek Isalski. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“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 Live Stock 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. But, not this researcher, who tried out some oils, and found no evidence of benefit over routine treatment. Most got better either way, which suggests that the previous “benefits claimed may [have just been] due to the usual treatment, with perhaps a dash of enthusiasm.”

By then, hydrocortisone was out, and so, the medical community gave up on dietary approaches, until this letter was published in 1981 about 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 were] 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.”

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

Please consider volunteering to help out on the site.

Icons created by Luis Prado, Ian Shoobridge, Academic Technologies, Zidney, and Nico Ilk from The Noun Project.

Image credit: Marek Isalski. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

Meta-analyses can be skewed the other way, too, when negative results are quietly shelved so only positive findings are published. Antidepressant medications are a classic example of this publication bias. Check out my coverage of it in Do Antidepressant Drugs Really Work?.

As I queued up at the end, I cover topical natural treatments in my next video, Eczema Treatment with Coconut Oil vs. Mineral Oil vs. Vaseline.

What about skipping the lard and trying to eat more healthfully? See what happened in Treating Asthma and Eczema with Plant-Based Diets.

For more on skin health, check out:

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