We asked two experts—Ashley James, a naturopath in Toronto, and Dr. Catherine Zip, a dermatologist in Calgary—how they treat this common skin condition. Here’s what they said.
The naturopath: Ashley James, Bay Dermatology Centre, Toronto
"To treat eczema, I first want to identify any food triggers and intolerances. One way to do this is for the patient to do an elimination diet, which involves removing all common triggers, such as dairy, eggs, citrus fruit, strawberries, chocolate, wheat and members of the nightshade family, which includes tomatoes, eggplant and peppers. Once these foods are avoided for six to eight weeks, the patient can start reintroducing them to see if they cause flares. Patients should resume eating the eliminated foods one at a time, looking out for symptoms in the three to five days following reintroduction; if none appear, it's safe to move on to the next food. Patients should also add anti-inflammatory foods to their diet, such as unroasted and unsalted nuts and seeds, olives and most brightly coloured fruit and vegetables.
"I also recommend taking high-quality fish- or flax-oil supplements—they repair the skin's lipid layer, so you're less likely to have that dryness—and a human strain of probiotic [supplements that contain the same species of bacteria native to our intestinal systems], which replaces any bad gut bacteria that causes some skin issues. People with eczema should drink at least two litres of water a day and make sure their bowels are moving; that's one way your body gets rid of excess toxins.
"When an eczema flare-up is caused by a particular material—for example, nickel in a necklace, which might cause a rash on your neck—it's contact dermatitis. If patients are prone to this type of eczema, it's important to look at the ingredient lists of household products and to choose cleaning products, laundry soap, makeup and skin-care items without synthetic fragrances, dyes and preservatives. Lastly, patients can wrap a cup of oatmeal in cheesecloth and let it sit with them while they're taking a bath. It's very anti-inflammatory and anti-itch."
The dermatologist: Dr. Catherine Zip, Dermatology Centre, Calgary
"Eczema, or dermatitis, is more likely to get worse in the winter because the skin's barrier function is diminished in cold, dry weather. The first thing I talk to patients about is improving the hydration of their skin. They should use a nonsoap, nonperfumed cleanser made for sensitive skin. Then, for moisturization, they should apply a heavy cream or ointment, not a lotion, right after bathing.
"Next, I recommend using a topical ointment or cream on the affected areas; I often tell patients to apply that cream at night, plus moisturize twice a day. There are two options: corticosteroids and calcineurin inhibitors, which improve eczema by reducing inflammation in the skin and are better suited for more sensitive areas, such as the face and neck. You wouldn't typically apply them at the same time to the same place, but sometimes I'll suggest using them in combination— corticosteriods can increase your risk of skin-thinning, so it's better to use a calcineurin inhibitor for milder flares and save the corticosteroid, which is stronger, for severe ones.
"If neither cream works, I'll offer the option of doing a type of allergy assessment called patch testing. It will show if patients have a reaction to perfumes, rubber, nickel, preservatives found in creams or other materials that come in contact with your skin that we know can cause eczema. This type of eczema is called allergic contact dermatitis. If we find an allergy, patients should look at the ingredients in the products they're using to make sure they're not inadvertently getting exposed to an allergen.
"Some patients are so itchy at night that they wake up scratching, so I'll recommend antihistamines as a short-term management option to help them sleep while they're waiting for the treatment to start working."