A Better Way to Diagnose Eczema Also Shows How to Treat It

Dr. Janet Zand

October 25, 2019



If you’ve ever talked to a doctor about treating eczema, you may have found the process to be unexpectedly frustrating. That’s because in order to diagnose eczema, doctors have to look at a variety of symptoms. Then they rate them on a scale.

It can be challenging to get a clear answer about whether you’re truly dealing with eczema or just some skin irritation. Now, researchers are working to improve the diagnosis process. And the route they’re taking may surprise you. And it may give you a great way to treat the problem.

You probably know that your body is host to quite a few bacteria. When most of us think about microbiomes, we likely assume the term refers to the gut.

It’s true that the gut houses about 95% of our microbiome. But the skin also has its very own microbiome that is impacted by our gut microbiome. And researchers are just beginning to unpack the astonishing amount of information the skin’s microbiome can supply.

For example, researchers are now learning that the microbiome can supply information about skin health. One study is specifically looking at eczema. This skin condition affects up to 30% of children worldwide. And plenty of adults struggle with it too.

For this study, the researchers looked at children from three cities: Beijing, China; Qingdao, China; and Denver, Colorado. They assessed the children’s microbiomes. And they found 25 genera of bacteria that they could use to create a diagnostic tool. They called it the Microbial index of Skin Health (MiSH).

Using the MiSH, the researchers were able to identify eczema in the children with up to 95% accuracy. Across all three cities, the accuracy rate was 86.4%. Interestingly, by looking at the skin microbiome, the researchers were also able to predict which city the child was from with near-perfect accuracy. Each city had its own bacterial pattern, which shows just how much your environment can affect your skin.

Help With Diagnosing Eczema

The researchers hope that the MiSH will be an important tool in helping doctors diagnose eczema. It also seems to be able to help classify types of eczema. It does this by identifying the microbes involved.

This is important because various types of eczema may appear exactly the same, even to a trained eye. But the microbes can respond very differently to various treatments. This tool may even help predict the skin’s risk of developing eczema.

This study supports the work of other researchers who have found important connections between imbalances in the microbiome and eczema flares. For example, studies have found that people with eczema typically have a higher concentration of the bacteria S. aureus on their skin.

Following this trail helped researchers determine that people with eczema typically have fewer cells responsible for building up the skin barrier. With the barrier weakened, S. aureus abounds.

S. aureus bacteria are able to “talk” to each other to know the best time to release the enzymes and toxins that break down the skin barrier. When the barrier is already weak, it’s easy for these bacteria to invade the skin. This causes those painful eczema flare-ups.

By studying these bacteria on mouse skin, researchers have found that “good” bacteria can help prevent this communication process. When S. aureus bacteria don’t know when to release toxins, they can’t invade the skin as easily.

How to Protect Your Skin Against Eczema

Of course, the next question is how to defend the skin against S. aureus. Researchers at the University of Edinburgh’s MRC Centre for Inflammation Research have been tracking down answers. They’ve found that a naturally occurring substance called human beta-defensin 2 (hBD2) might play a key role.

This compound helps kill dangerous bacteria like S. aureus. And it helps keep the skin barrier intact. Then these bacteria can’t invade the skin and wreak havoc.

The problem is that in people with eczema, the damaged skin cells don’t turn on hBD2 production. But the researchers have found a way to instruct skin cells to begin making it. This could be important for both treatment and prevention.

Common treatments of eczema, such as steroid creams, carry side effect risks. And they can be minimally effective. That may be in part because, like I said above, doctors don’t yet have a good way to pinpoint the type of eczema they’re dealing with.

These new tools can help doctors and researchers develop better prevention and treatment options. For now, though, there are a few options I can recommend.

Natural Solutions for Eczema

You probably know that I prefer natural solutions whenever possible. But some of the newer targeted drug therapies can treat eczema quite well. I like these options, which include an ointment called crisaborole, because they are non-steroidal. This is an important quality for both adults and children. There is also a cream called Kamillosan Salbe (available at www.Walmart.com and other websites), which is from the chamomille plant. It contains natural steroids that help reduce inflammation and don’t minimize the skin’s own natural defense system.

Beyond bacterial imbalances, systemic inflammation is often a major cause of eczema. To reduce inflammation and eczema, start with the obvious solutions. Clean up your diet. Try to determine if there are any particular foods or products you're sensitive to. An allergist, naturopath, or functional physician may be able to help you with this process.

If you made any changes to anything you're putting in or on your body around the time the eczema cropped up, that's a good place to start as well. Take a look at your household cleaning items too. For instance, laundry soap can cause problems. Opt for sensitive skin options. The same is true for dish soap. Reliable brands include Method, Seventh Generation, and Ecover.

You can also help treat eczema from the inside out with bone broth (look for organic if you're buying it rather than making it yourself) and good hydration. Supplements such as extra virgin cod liver oil or fermented cod liver oil (which are full of omega-3 fatty acids) can help, as can vitamins A and D. Just be sure you choose a reputable brand, such as Carlson Labs, Nordic Naturals, or Green Pastures.

A New Form of “Biotics” Might Help

Interestingly, another promising “inside out” strategy has to do with another microbiome. This time, we are talking about your gut. That’s because the gut is often where systemic inflammation begins. You probably know that taking probiotics is good for your digestion. You also may know that prebiotics provide food for probiotics. But have you ever heard of synbiotics?

Don't worry if you haven't – and don't feel overwhelmed about having to learn about yet another "biotic." Synbiotics are simply a mixture of prebiotics and probiotics that can help support the bacteria in your gut.

But that's not all it can do. The journal JAMA Pediatrics published research indicating that taking synbiotics can help treat eczema in children. In fact, it took only eight weeks before the eczema began to clear up. The researchers aren't yet sure if synbiotics can actually prevent eczema. But they're planning to do more research to find out.

Another study, published in Clinical and Experimental Allergy, found that taking just probiotics also improved eczema in children. For this study, 220 children ages 18 or younger with moderate to severe eczema received either probiotics or a placebo for three months.

Those who received the probiotics showed statistically significant improvement in their eczema compared to the placebo group. And these effects lasted up to four months after the participants stopped taking the probiotics. Children under 12 saw the greatest benefits.

It’s true that these studies were with children. But there’s a good bit of research linking probiotics to decreased levels of inflammation. These recent studies indicate that synbiotics, prebiotics, and probiotics can help clear up this inflammatory condition in adults as well. 

The synbiotics researchers also found that prebiotics alone might be just as helpful as synbiotics in clearing up eczema. But this is probably the case only if you already have a good balance of healthy bacteria in your gut. If you don't, you can add them by eating fermented foods, drinking kombucha, or taking a supplement, such as Advanced Probiotic Formula. Then you can try feeding those bugs with a special prebiotic or simply eating plenty of fiber.

I also have had eczema patients experience healing and relief using probiotics topically. They just open up one of their probiotic capsules, mix the contents with coconut oil, and apply it to the affected areas. This can be an especially effective treatment if a bacterial imbalance is the key driver of your eczema.

People with mild eczema may be able to find relief with some other topical strategies as well. For example, oatmeal baths can be helpful. Oats contain beta glucans, which are soothing and healing for the skin.

Having eczema can be frustrating – especially when even the diagnosis is uncertain. This new research on the skin’s microbiome should help. And keep your gut microbiome in mind as well. It’s easy to assume that bacteria is bad for the skin. And some of it is. But having the right bacteria in the right places – inside and out – can make a big difference in how your skin looks and feels.

And hopefully soon these diagnostic tools will be more widely available. Getting clear answers can go a long way toward helping you get clear skin.

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