Eczema and nutrition: Are the two related?

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The internet is rife with advice on what to eat—and what not to eat—to promote skin health. And in some cases, that advice treads boldly beyond the territory of basic health to address bona fide skin conditions, like eczema.

But as we’ve learned time and again, though the internet may be rife with advice, there’s no guarantee that the advice is right. And when it comes to eczema, even scientists at the cutting edge of the disorder’s pathology are only beginning to untangle the complicated web of factors behind it.

So any online buzz over a nutritional eczema “cure” isn’t just wildly preliminary; it’s wild, full-stop. But as for the possibility of soothing eczema’s sting via supplementary intervention: Well, that’s a prospect that may eventually be within reach. And for those suffering from that sting—or itch, or redness—the prospect of relief can’t come soon enough.

Constellation of Conditions

Part of what makes eczema such a complicated concern is that it’s not, in fact, a single concern. As Amanda Frick, ND, LAc, vice president of medical affairs, Thorne (New York City), puts it, “Eczema is a broad term for a group of inflammatory skin conditions often associated with dry and itchy skin. And though there’re multiple types, the three most common are atopic dermatitis, contact dermatitis, and seborrheic dermatitis.”

Atopic dermatitis (AD) is the most familiar to the general public, and it often manifests as red, itchy patches in the elbow creases, behind the knees, and on the arms, legs, hands, and face. It tends to afflict those with a family history of allergies or asthma, notes Ariati Aris, scientific affairs specialist, PhytoGaia Sdn Bhd (Kuala Lumpur, Malaysia), and usually first emerges in childhood, with occasional flare-ups persisting into adulthood. And in terms of prevalence, AD is “quite common,” she notes, “with approximately one out of every 10 babies and young children developing symptoms.”

Contact dermatitis, meanwhile, “occurs when the skin reacts to substances that come into contact with it,” Aris continues, “such as irritants like chemicals or detergents, or allergens like poison ivy, fragrances and preservatives, or certain metals.”

And seborrheic dermatitis, as its name suggests, affects skin rich in sebaceous—i.e., oil—glands, as on the face (particularly around the eyebrows and nose), scalp, chest, back, and underarms. And as Aris points out, “It often presents as waxy, flaky, red skin and is commonly associated with dandruff.”

Breaching Barriers

None of this sounds very fun—and it isn’t. As Paula Simpson, a nutricosmetics innovation and formulation expert and founder of Nutribloom Consulting (New York and Toronto), points out, “Eczema can affect any part of the body, from the head to the feet,” and in addition to the typical itching, crusting, and inflammation, “in more severe cases individuals may experience blisters, oozing of clear fluid during flare-ups, and the development of scaly patches.”

Eczema can even elevate the risk of infection. As Aris explains, “The skin’s outermost layer, the epidermis, acts as a barrier to protect against moisture loss and external irritants. In individuals with eczema, this barrier is often compromised, allowing irritants to enter and moisture to escape, leading to dryness and inflammation.”

Exploring the mechanism at the molecular level, it appears that increased quantities of the skin’s endogenous proteolytic enzymes, coupled with a decrease in the amount of ceramides—compounds that help the epidermis retain moisture—desiccate the skin, “setting up perfect conditions for pathogens, antigens, and irritants to enter the body through tiny pores and thus trigger both inflammation and potential infection^1,” Simpson says.

Quality Killer

But the condition’s symptoms aren’t just physical. As Aris explains, “Living with a chronic skin condition like eczema can take a toll on a person’s mental health.” Red, scaly, or weeping lesions—especially on the face and other visible features—can do a number on one’s confidence and self-esteem, she notes, “particularly in adolescent and adults,” and that makes anxiety, depression, and social isolation “all common among those with eczema.”

Adds Frick, “The constant irritation and itching causes distraction and physical discomfort that can severely impact quality of life. And to make things even more complicated, many eczema sufferers also experience flare-ups or exacerbation from the same emotional factors that the condition can cause.”

Managing eczema imposes its burdens, too, Aris adds—yet given that management is the closest we have to a cure, “it’s understandable that individuals with eczema may feel a considerable impact on their peace of mind and overall well-being,” she concludes.

That’s the Rub

Indeed, Frick notes, “Part of what makes eczema such a difficult condition is that we really haven’t identified solid causes or ways to treat the cause. The treatments we do have usually involve topical relief, as with steroid creams, to stem irritation, but these aren’t cures—merely palliative options.”

What we do know, however, is that a combination of genetic, environmental, and immune factors may underlie eczema.

For example, Simpson notes that mutations in the filaggrin gene, which is crucial to maintaining the epidermis’s structural integrity, “have been observed in connection with the condition.

“And people with eczema tend to have immune systems that react excessively to certain triggers, leading to skin inflammation and irritation,” Aris adds.

Atopic dermatitis specifically appears to associate with immune-system dysregulation, “primarily within two key subsets of CD4+ cells: T-helper 1 and T-helper 2,” notes Simpson. The condition can also elevate levels of eosinophils—white blood cells that participate in the body’s immune defense against allergens and infections. And in eczema’s allergic or extrinsic type, which Simpson says accounts for 70% to 80% of cases, “patients also often exhibit high serum levels of the antibody IgE.”¹

Eating Away at Eczema

And though diet doesn’t typically rank among eczema’s primary causes, “it can play a role in triggering or exacerbating symptoms,” Aris concedes.

Frick agrees, adding that because of eczema’s relationship to allergies, “allergenic and inflammatory foods can certainly play a role in triggering symptoms.”

On the other hand, she continues, “Anti-inflammatory foods like those high in omega-3 fatty acids and flavonoids, or anti-inflammatory diets, whether the Mediterranean diet or an Eastern-medicine diet based in TCM or Ayurveda, can help moderate systemic inflammation, which may give relief to eczema sufferers.”

Gut Reaction

So with inflammation and immunity both feeding into eczema’s symptomatic cascade, it should come as no surprise, then, that “From a functional medicine perspective,” as Frick puts it, “the health of the gut is closely linked to the health of the skin.”

Simpson agrees, adding that “a mounting body of evidence highlights the intricate interplay between the microbiome, immunity, and the integrity of the gastrointestinal tract in influencing this skin condition.”

It all traces back to the gut-skin axis that we hear so much about lately. And while the finer points of how that axis fully functions awaits elucidation, there’s no doubt that our microbiome “plays a crucial role in connecting the gut and skin through this axis,” Simpson concludes.

For example, Simpson describes the gut microbiota as “pivotal in regulating epithelial-cell renewal and maintaining intestinal integrity—which, in turn, significantly impact the immune system and skin health.” Our intestinal microbes also shape the body’s immune response to dietary and environmental antigens—which can also affect the skin. And by converting “complex indigestible polysaccharides” into both essential vitamins like K and B12 and the short-chain fatty acids butyrate and propionate, good gut bugs bolster the integrity not only of the intestinal barrier, but of the epithelium, too.

Thus, explains Simpson, “A recurring idea among various hypotheses is that inflammation—whether in the gut or the skin—might ultimately stem from intestinal dysbiosis, which serves as the initial trigger for the gut-skin axis to adversely affect the skin.” More specifically, “An irregular abundance of commensal bacteria produces the imbalance, which potentially sets off systemic inflammation and, in turn, a disruption of skin homeostasis.”^2,3

Thus, concludes Simpson, “Nurturing and supporting the gut’s health and microbiome via nutrition and supplementation is one area of consideration when looking at diet for eczema.”

E Ticket

So, too, is using diet to control inflammation and oxidative stress. And here, Aris says, science points us to the role of vitamin E, which she claims has “great potential as an eczema-management option owing to its potent antioxidant and anti-inflammatory properties.”

But not all vitamin E is created equal. Like eczema, vitamin E is an umbrella term covering two differing classes of compounds—tocopherols and tocotrienols—which differ mainly in the structure of their isoprenoid side chains.

In tocotrienol’s case, that side chain has three unsaturated residues, which not only permits its more even distribution throughout the cell’s lipid-bilayer membrane—where it helps defend against oxidation—but also confers upon it “remarkably higher physiological antioxidant activity under conditions of oxidative stress” relative to tocopherols,⁴ Aris says. In fact, early research found tocotrienol to possess 40 to 60 times more potency in preventing lipid peroxidation than garden-variety alpha-tocopherol⁵, she says.

“Another interesting fact is that tocotrienol, either applied topically or taken orally, has been shown to preferentially accumulate at the stratum corneum—the uppermost 5 microns of the skin,” Aris continues. “This makes it the skin’s first line of defense.^4,6” And tocotrienol appears to display anti-inflammatory activity at concentrations as low as 0.5 µg/ml in cell culture, which she claims is “a concentration readily achievable in humans with dietary supplementation.⁷”

Taking all this into account, a 12-week, open-label, single-arm, single-center clinical trial recently investigated whether or not topical administration of a vitamin E tocotrienol moisturizer could help children with mild to moderate AD. In the study, 30 young subjects received application of the moisturizer on skin lesions three times daily for the 12-week duration, with results showing “significant improvement in the children’s skin condition following use of the tocotrienol-rich moisturizer,⁸” Aris says.

And this study is only the start. “The research on tocotrienol’s role in eczema management holds significant promise for the future,” Aris predicts. With forthcoming trials involving more subjects and longer assessment periods, “Scientists will delve deeper into the precise mechanisms through which tocotrienols exert their effects on eczema, potentially leading to more targeted and effective approaches,” she says.

Adds Bryan See, PhytoGaia’s vice president, “There’s also potential for combination therapies with conventional medications and specialized tocotrienol-based topical formulations to enhance treatment outcomes and minimize side effects.”

In fact, PhytoGaia recently developed and launched STGaia, a concentrated oil extracted from palm fruit (Elaeis guineensis) that contains not only palm’s natural tocotrienols but plant-derived squalene—“one of the most popular ingredients in skincare products due to its powerful antioxidant and moisturizing activities,” See says.

“Individually,” he explains, “squalene and tocotrienols are potent natural antioxidants with scientific evidence for maintaining skin health and immune enhancement, as well as holistic wellness.” Combined in the new product, he adds, they deliver “impressive synergistic cosmeceutical health benefits.”

Is it a cure for eczema? Not yet. But it’s a start, and for those deep in the condition’s throes, it may offer a measure of the relief they’re looking for.

References

1. Choopani, R.; Mehrbani, M.; Fekri, A.; Mehrabani, M. Treatment of atopic dermatitis from the perspective of traditional Persian medicine: presentation of a novel therapeutic approach. J Evid Based Complementary Altern Med. 2017, 22 (1): 5-11. DOI: 10.1177/2156587215598610
2. Mahmud, M. R.; Akter, S.; Tamanna, S. K.; et al. Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut Microbes. 2022, 14 (1): 2096995. DOI: 10.1080/19490976.2022.2096995
3. Sinha, S.; Lin, G.; Ferenczi, K. The skin microbiome and the gut-skin axis. Clin Dermatol. 2021, 39 (5): 829-839. DOI: 10.1016/j.clindermatol.2021.08.021
4. Traber, M. G.; Podda, M.; Weber, C.; Thiele, J.; Rallis, M.; Packer, L. Diet-derived and topically applied tocotrienols accumulate in skin and protect the tissue against ultraviolet light-induced oxidative stress. Asia Pac J Clin Nutr. 1997, 6 (1): 63-67. https://pubmed.ncbi.nlm.nih.gov/24394657/
5. Serbinova, E.; Kagan, V.; Han, D.; Packer, L. Free radical recycling and intramembrane mobility in the antioxidant properties of alpha-tocopherol and alpha-tocotrienol. Free Radic Biol Med.1991, 10 (5): 263-275. DOI: 10.1016/0891-5849(91)90033-y
6. Suzuki, Y. J.; Tsuchiya, M.; Wassall, S. R.; et al. Structural and dynamic membrane properties of alpha-tocopherol and alpha-tocotrienol: implication to the molecular mechanism of their antioxidant potency. Biochemistry. 1993, 32 (40): 10692-19699. DOI: 10.1021/bi00091a020
7. Wu, S. J.; Liu, P. L.; Ng, L. T. Tocotrienol-rich fraction of palm oil exhibits anti-inflammatory property by suppressing the expression of inflammatory mediators in human monocytic cells. Mol Nutr Food Res.2008, 52 (8): 921-999. DOI: 10.1002/mnfr.200700418
8. How, K. N.; Chang, H. W.; Lai, O. M. Open-label, single-arm, single-center clinical study on the effectiveness and safety of a moisturizer containing tocotrienol-rich composition in children with mild to moderate atopic dermatitis. J Cosmet Dermatol. 2023, 22 (10): 2746-2754. DOI: 10.1111/jocd.15793