To mark National Eczema Week, we've delved deep into our magazine archives to find a case study about eczema from the Winter 2014/15 issue of Optimum Nutrition, by Dr Natascha Van Zyl.

Four-year-old Sarah had been suffering from an itchy rash on her wrists for several months. When the rash got worse and spread to her abdomen and face, her mother Debbie brought her to see me.

Their GP had diagnosed eczema and prescribed topical steroids and emollients, but any relief was temporary and Debbie was eager to see what else could be done for her daughter in the long term.

During the consultation, Sarah told me all about her "itchy spots" and showed me her skin. The skin eruptions were inflamed with pinhead-sized weeping blisters as well as dry, flaking skin, which covered a significant portion of her arms, abdomen and face.

Eczema's genetic component

I wanted to determine whether she had contact eczema (commonly known as contact dermatitis) or atopic eczema.

Contact eczema develops when skin in sensitive individuals is exposed to an irritant such as wool or nylon clothing, metal, make-up, detergents, chemicals or certain foods.

Atopic eczema affects people with a family history of asthma, hay fever or hives (also known as urticaria).

Because Sarah’s family had a history of eczema and asthma, hereditary factors could not be ruled out while I set about identifying the relevant irritant or allergen.

Sarah's nutritional therapy consultation

During the consultation, I explored Sarah’s eating habits and food preferences, daily routines and sleeping patterns.

It was clear that she had a good appetite and enjoyed a varied diet, which included fruits, vegetables, nuts, soya, chicken, fish and a lot of dairy.

Sarah was an active little girl who loved the outdoors and because of this, her parents applied sunscreen to her skin regularly. She also slept very well, except when her skin was particularly irritated.

Recommendations from a nutritional therapist

Sarah had not been tested for allergies before, so I referred her back to her GP for allergy and nutritional status testing. While waiting for the results of these tests, there were a few things we could do immediately.

Sarah’s diet was good but dairy, soya and nuts are known to cause problems in sensitive individuals, so initially we eliminated these foods from her diet for two weeks, aiming to reintroduce one food type at a time to establish which – if any – caused an effect.

Debbie could use dairy alternatives such as rice or oat milk during the interim and so reduce any risk of calcium loss from Sarah’s diet.

I told her what to look out for while monitoring Sarah's progress; for example, skin flushing shortly after ingesting food is often a sign of sensitivity or intolerance to that food.

Soothing the afflicted skin

For Sarah’s sore and inflamed skin, I suggested a soothing oatmeal soak, which is inexpensive and easy to make at home. By placing 50-100g of oatmeal into an old knee-high sock and tying off the end, Sarah could use this like a bath bomb.

Debbie could also add a tablespoon of bicarbonate of soda to the bathwater; this is very useful for relieving itching.

For topical application, I suggested the use of calendula cream during eczema eruptions, as well as gel freshly squeezed from the leaf of an aloe vera plant.

As a daily skin moisturiser, I advised the use of coconut oil or sweet almond oil and asked Debbie to ensure that Sarah wore natural fibres, such as cotton or bamboo, which are non-irritating.

Sarah was also to use soaps and personal care products that were free from dyes, parabens and sodium lauryl sulphate – this included products used to wash her clothes.

Air quality and sunlight for eczema

Air humidity was another important consideration as dry air leads to dry skin.

Debbie could humidify the air without buying a humidifier by using house plants to naturally increase the amount of moisture in the air, or by placing a bowl of water beneath a radiator or heat source. As the water heats it evaporates, adding moisture to the air.

Lastly, I suggested Debbie might reduce the use of sunscreen and allow Sarah to have around ten minutes’ unprotected exposure to the sun before applying it.

Direct sun exposure for short periods of time encourages the synthesis of vitamin D and is good for the skin.

Eczema: allergies, intolerances and healing

The test results later confirmed that Sarah was allergic to dairy protein and had a clinical vitamin D deficiency and a low essential fatty acids profile.

I recommended a children’s nutritional supplement that contained the omega-3 fatty acids DHA and EPA together with vitamins A, C, D and E.

After the first two weeks of taking these at twice the normal dosage, Sarah’s skin showed a marked improvement.

The dose was then reduced for a further two weeks, by which time her skin was clear. Sarah continued to take the normal dose of this supplement to maintain the improvement.

Longer-term dietary changes were also implemented, including the elimination of dairy products. Sarah responded very well to her new regime and her skin remained clear.

Although just a little girl, she did all the things I suggested, and it worked. I was thrilled for her.

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