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  • Writer's pictureDr. Alla Arutcheva


Updated: Mar 26, 2019

Multifactoral Elucidation of Atopic Dermatitis

Eczema is a skin disorder that may result in multiple effects on quality of life. Eczema is not only skin diseases but it involves other body organs and systems. Eczema is a general term for many types of skin inflammation (mostly atopic dermatitis, contact irritant eczema and contact allergic eczema) and may appear anywhere on the body.

Hand eczema is a common dermatological disorder in adults. This complication has annual prevalence of 10% and may cover more than 4% of the population (1).

Irritant contact eczema is a localized reaction that includes redness, itching, and burning where the skin has come into contact with an irritant such as a detergent (soap, body wash), some acids or other chemicals and some fabric.

Allergic contact eczema is a red, itchy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as nickel, gold, latex, perfume, poison ivy or certain preservatives in creams and lotions. Most cases of contact dermatitis (irritant and allergic) go away on their own once the substance is no longer in contact with the skin.

Atopic dermatitis (AD) is the most common and sever type of eczema and has a genetic mutation in their skin protein called filaggrin (1).

Some people can have a combination of different types of eczema.

Chronic exposure to irritants, frequent washing hands, using disinfectants, wet-work conditions disturbs the natural skin barrier and causes inflammation.

Symptoms of Eczema

Signs and symptoms of eczema vary widely from person to person and include: • Dry, sensitive and swollen skin •

Itching, which may be severe, especially at night •

Red or brown patches •

Raised bumps with fluid •

Thickened, cracked, scaly skin

Atopic dermatitis/Eczema

Although the pathophysiology of or atopic dermatitis (AD) has not been fully elucidated, it is currently believed to be due to a combination of genetic predisposition, skin barrier dysfunction, immune dysregulation, and environmental factors (2).

Our skin is a reflection of the inner health. In recent decades, a growing body of evidence demonstrates that AD and any other ‘skin disease’, can be accompanied by a variety of systemic disorders. Multiorgan involvement can be possible common underlying mechanisms of AD.

Multifactorial Elucidation of Atopic Dermatitis

Gut‐skin axis

Several dermatoses, including eczema, appear to have a gut‐skin connection (3). Eczema may be seen as a possible manifestation of a systemic problem involving gut dysbiosis and increased intestinal permeability (leaky gut), which may occur even in the absence of gastrointestinal signs.

Conventional anti‐inflammatory and antimicrobial therapies for skin disorders provide only temporary symptomatic relief. However, underlying factors such as intestinal permeability (4) and dysbiosis are mostly ignored. In addition, antibiotic therapy contributes to the development of antibiotic‐resistant microbes (5), destroy normal intestinal flora (Lactobacilli and Bifidobacteria) and promote overgrowth of Candida species.

AD has been found to be three times more common in patients with celiac disease than others (6,7).

Eczema and skin rash have also been reported in the people with ‘non‐celiac gluten sensitivity’ (8,9).

Skin lesions and atopic dermatitis are significantly associated with inflammatory bowel disease (IBD) (10).

Small intestinal bacterial overgrowth (SIBO) is being linked to a list of human health problems, including skin conditions (11). SIBO treatment in these patients has led to marked clinical improvement (12). Possible reasons for skin lesion development in SIBO include nutritional deficiency; impaired lipid metabolism; impaired immune‐system functioning; increased intestinal permeability. Intestinal bacteria produce a toxin (LPS), which spread all over the body with subsequent damage to the skin structure and barrier function (13).

Liver and skin

Our liver has numerous vital functions. One of the liver’s important roles is breaking down and eliminating toxins in the body. In case of AD and other skin problems the liver is not functioning optimally, becomes congested and less effective at broken down and eliminating toxins. So, these toxins are forced to be eliminated via the skin that damage and inflame the skin and resulting in different skin diseases. The weak liver function impacts the skin and provoke itching, rash, vesicles and cracking of the skin (14,15). AD is highly associated with changes in lipid metabolism regulated by the liver (16 17). Hence, poor skin quality is an indicator of weak liver function.

Minimizing stress

Over 80 years ago, two dermatologists, Stokes & Pillsbury (18) proposed a connection between gastrointestinal disorders, depression, anxiety and skin conditions and called it gut‐brain‐skin axis (19). It was suggested that emotional states might alter the normal intestinal microflora, increase intestinal permeability and contribute to systemic inflammation. Since then, many aspects of this gut‐brain‐skin axis have been validated (11).

It was shown that stress can impair the integrity and protective function of the epidermal barrier of skin, and increase the severity of infection and inflammation in the skin (20,21).

Alternative Approaches

Many patients are very interested in alternative therapies for the treatment of eczema. Alternative therapies encompass a wide range of possibilities. Natural treatment is perceived to be lower in risk than conventional therapies (22).


There are many types of diets that are recommended for eczema, including dairy free, gluten-free, low-allergen, no sugar, no dyes, no yeasty foods, alkaline foods, and many, many more.

Eating natural, organic, unprocessed and balanced foods with allergic food avoidance is the best diet for people with eczema.

One-third of AD patients have hypersensitivity food allergies (23) that can aggravate skin condition. An evaluation for food allergy should be considered.

Wheat ingestion can cause symptoms of eczema (24). Many cereals, including wheat, rye and barley, contain gluten (9) and a high level of fermentable carbohydrate.

Diet low in fermentable carbohydrates is preferable for people with AD.


Patients with eczema have disrupted bacterial flora both on the skin and in the gut. Disruptions in normal gut flora have been found not only in people with AD but also with other skin disorders including acne (25,26).

A recent meta-analysis concluded that treatment with probiotics significantly improve skin condition and should be used for prevention and treatment of human AD (27,28. Great benefit showed treatment of skin disorders with a mixture of different bacterial species of Lactobacillus with Bifidobacterium. Some probiotic strains such as Lactobacillus rhamnosus GG display potent immune‐modulatory properties at the skin level and seemed to be effective in preventing human AD and reducing the severity of AD (29).


There are a number of vitamins that may help with eczema. Studies show that more severe eczema is correlated with lower levels of vitamin D. Supplementing vitamin D can help eczema. Another study demonstrated increased benefit from combining vitamin D with vitamin E supplementation (30). Topical vitamin D while helpful in psoriasis may actually flare eczema.

Vitamin B12 ointment

Topical B12 ( Vitamin B-12 cream, Life-Flo) has been shown to successfully improve atopic dermatitis in both children and adults (31). It was demonstrated that, despite the size of the molecule, the skin is permeable to vitamin B12. The proposed mechanism is nitric oxide synthase inhibition, an important step in one AD inflammation pathway (32,33).

Nitric oxide (NO)

There are three forms of nitric oxide synthesized in the human body. However, one form of NOS, the inducible NO synthase (iNOS) has been found to be involved in the pathogenesis of atopic eczema and psoriasis (34,35) and stimulate inflammation process in the skin (36).

A feeling of irritation and itching of the skin causing a desire to scratch, is the most constant distressing symptom in atopic dermatitis. An explanation for this effect would be the detection of iNOS in the skin with atopic dermatitis. In the normal skin iNOS is absent. Nitric balance supplement need to reduce iNOS expresion.

Fatty acid

A deficiency in essential fatty acids (EFA) of the skin is one factor suspected of playing a role in eczema. Atopic eczema may be a minor inherited abnormality of EFA metabolism (37). Encouraging results were noticed when combined omega-3 and omega-6 fatty acid treatment with vitamins A and D (38).

Evening primrose oil (EPO) and borage seed oil (BO) are two “natural” supplements that have been frequently used as a treatment for eczema. Both are high in gamma-linolenic acid (GLA), a substance which may play a role in eczema.

Sunflower seed oil (Helianthus annuus) has been shown to have both anti-inflammatory and barrier restoring effects. Its major lipid is linoleic acid, which decrease inflammation in the skin and improve the skin barrier (39).

Olive oil was found to be detrimental to the skin barrier.

Virgin coconut oil (Cocos nucifera) has shown benefit as both an excellent emollient and natural antibacterial agent (40,41).

Moisturizers (emollients)

Epidermal barrier failure can be controled with moisturizers. Moisturizers are a daily part of skin care in atopic dermatitis and patients often use a variety of products based on personal preferences. Cracks in the skin lead to water loss from the skin and this can trigger an inflammatory response and infection.


Homeopathy has recently increased in popularity among patients with skin disease. Atopic eczema is one of those diseases where homeopaths claim to have good success. (42). Several studies suggests that homeopathic treatment could be regarded as an effective choice for patients with AD (43); 88% of complete recovery was reported (44).


People with eczema have a wool intolerance (45). Wearing alternative fabrics such as cotton and silk is recommended (46). The use of fabrics impregnated with borage oil-treated garments, gloves (for people with hand eczema) improve skin moisture and restore lipids (47).

Massage, relaxation, water bath, hypnosis, and aromatherapy have been explored as complimentary approaches in treatment of AD.

As you can see many factors may contribute to the chronic skin disease, including psychological factors (emotional stress, stressful life events), weak function of liver, impaired intestinal tract. Therefore, effective management of treatment should not be limited only skin.

Individualized treatment of eczema with the holistic approach can be developed after whole body health evaluation, including stress level determination.

Based on evaluation results Dr. Arutcheva will design a useful strategy to heal eczema.


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