Eczema is a common rash, red, itchy, sometimes blistering or exuding fluid, worsened by various exposures such as contact with certain fabrics or toiletries. The various forms of eczema—contact dermatitis, dyshydrotic dermatitis, seborrheic dermatitis and others—tend to occur in people who also suffer (the increasingly common collective syndrome of ) asthma, allergies and hay fever, and food sensitivities. And the number of people, especially children, who experience eczema is on the rise, having quadrupled in frequency since the mid-twentieth century.
The medical approach to eczema involves prescribing steroids, steroid, and steroids, then graduating to a relatively new topical drug called crisaborole (Eucrisa) now flooding TV time with direct-to-consumer ads and priced around $700 for a 60-gram tube. The previous tendency for doctors to shrug their shoulders and blame genetics for experiencing eczema has more recently fallen apart, with genetics likely playing only a minor role. The doctor occasionally asks about various topical exposures or performs allergy testing, but the search for an underlying cause virtually always ends there.
As with so many modern chronic health conditions, primitive cultures who hunt and gather their food, never take antibiotics, are not exposed to herbicides and pesticides in their food, don’t take other prescription drugs, etc. have virtually no problems with eczema or other skin rashes (excepting those that are infectious), suggesting that something peculiar to modern life underlies skin rash, also consistent with its recent rise in modern times. What might that be?
Arrows are pointing at several underlying causes that, when addressed, provide not only relief from eczema and other forms of skin rashes, but other health benefits. Those potential causes include:
- Sugar, fructose, wheat and grain consumption—Although fungi “prefer” to consume sugars, white flour and whole grain products that yield glucose upon digestion pose a double-whammy, as both are known to increase intestinal permeability as well as nourish fungi.
- Small intestinal bacterial overgrowth, SIBO—The intestinal microbiome plays a major role in autoimmune and inflammatory conditions and the severe dysbiosis—alterations in species composition combined with ascendency up the gastrointestinal tract—appears to be a major player in generating eczematous skin conditions.
- Small intestinal fungal overgrowth, SIFO—Proliferation of fungal species, such as various Candida species, that ascends up into the upper gastrointestinal tract and often accompanies SIBO can be expressed as skin rashes, possibly via allergic or immune reactions against fungal cell components. Interestingly, sometimes the skin rash itself may contain fungal organisms, suggesting that intestinal fungal proliferation serves as a source that “seeds” other body sites such as skin, mouth, airway, vagina, and elsewhere—brain? (Emerging evidence also suggests a connection between fungal overgrowth and Alzheimer’s dementia.)
- Skin dysbiosis—Changes in the composition of skin flora that, for instance, favors proliferation of unhealthy species such as Staphylococcus aureus while reducing benign species such as Staphylococcus epidermidis, may be a causal factor (or consequence?) in eczema. It suggests that part of the solution may be to address skin flora composition.
Testing for food intolerances can also pinpoint various foods that trigger eczematous rashes. Eliminating those foods can thereby help subdue the rash. But, like reducing exposure to FODMAPs, histaminergic foods, nightshades, or lectins, this avoids the fundamental question: Why did such food intolerances develop in the first place? This causes us to once again circle back to sugar, wheat, and grain consumption, SIBO, and SIFO, all associated with increased intestinal permeability that underlies the development of food intolerances.
I believe we are getting closer and closer to pinpointing the underlying causes of eczematous rashes, rather than simply suppressing the abnormal response with steroids or drugs like crisaborole. For the present, it means that, if you or someone you know has eczema, it would be productive to start with the wheat/grain-free, limited-carb diet we use in the Undoctored program, explore the questions of SIBO and SIFO, and take some efforts to address skin dysbiosis such as avoiding use of toiletries and perhaps even topically applying something with probiotic properties, such as yogurt or kefir. We shall be discussing the details of our therapeutic efforts in our Undoctored Inner Circle reports and virtual meetups.