Integrative Treatment of Eczema: Addressing the Gut-Skin Connection

Dr. Leah Hassall, ND

Eczema is a general term used to describe a group of skin conditions where the skin becomes red, inflamed and itchy. Sometimes the skin will weep or become hard and scaly. In infants, eczema typically appears on the scalp, face and elbows/knees. In older children and adults, it is more often in the creases of the elbows and knees, on the face, neck, hands and feet but it can be found anywhere on the body. Eczema is a condition that I commonly see in practice; especially in the fall and winter. For many people, their eczema will flare in those seasons because it becomes aggravated by cold, dry air and the irritation that comes with wearing more clothing that rubs on skin.

There are two common types of eczema: atopic dermatitis and contact dermatitis. The difference between the two is related to their different causes. Contact dermatitis occurs about 48 hours after contact with an allergen (i.e. nickel, dyes, perfumes, cosmetics, chemicals, soaps, cleaners and detergents). In infants, allergic contact dermatitis usually occurs after 6 months of age and is often a reaction to elastics, creams, dyes and wipes. If it is localized to the diaper area or over the front and sides of the thighs we call it the “saddle sign”.

Atopic dermatitis is the most common form of eczema. Atopic dermatitis is one piece of what we call the “atopic triad”. This infamous triad includes asthma, eczema and hay fever (allergic rhinitis). There seems to be a connection between these three conditions that is rooted in family genetics. This means that if either parent has one of these three conditions, chances are greater that their children will also one of them. It also means that up to 80% of children with atopic dermatitis will develop asthma or hay fever as they grow up if the eczema is not effectively treated.

Integrative Treatment of Eczema

Naturopathic doctors treat eczema with a two-prong approach: topical skin treatments and correcting gut dysfunction.

The Skin

Part of what happens to skin when it becomes irritated, inflamed, damaged from scratching is that its primary function of preventing foreign material from entering the body becomes compromised. This can trigger the immune system to create even more inflammation. Our goal is to break the vicious “itch-scratch-itch” cycle and prevent infection by soothing, healing and moisturizing the skin. Keeping fingernails short, antihistamines and cool compresses can be helpful to prevent itching. I will often prescribe soothing, lukewarm oatmeal baths and wet wraps followed by the application of a thick, ceramide cream. If there is oozing or infection, the addition of anti-bacterial herbs or medical grade Manuka honey can help to control infection. Too many showers or using water that is too warm can cause drying of the skin, more irritation and itching.

When the heating comes on in the winter, it can also be drying to the skin. Using a humidifier to keep the humidity between 45% and 55% can help to keep to prevent this. Of course, if you live on the West coast like I do, you have the opposite problem. When the humidity is too high, it creates the perfect environment for dust mites and mold, which can contribute to allergies. A dehumidifier would clearly be helpful in this case.

Topical corticosteroids (hydrocortisone, betamethasone etc.) and oral corticosteroids (prednisone, cyclosporine) for severe eczema are often a main-stay treatment for eczema. They reduce the redness and inflammation associated with eczema, however they come with some undesirable side effects. Topical corticosteroids cause thinning of the skin with prolonged use which makes the skin more delicate and “leaky” to allergens. As with all conditions, there needs to be a thoughtful balance between relieving symptoms and treating the root cause of disease. I always keep in mind the profound affect that can have on a person’s sleep, self-confidence and mental state.

The Gut

There is a growing awareness in the medical community of the connection between the composition and health of the microbial residents of the gut and the role they play in skin inflammation. Much of our immune system is located in our digestive tract as part of the GALT system, which makes sense as the gut is our connection with the outside world. New research is emerging about how the overuse of antibiotics, dysbiosis and overgrowth of bacteria in the small intestine of the gut (SIBO) is causing changes to the gut-related immune system and how our body reacts (or over-reacts in some cases) to foreign particles that we are exposed to every day. When a patient has eczema, there tends to be digestive issues – constipation, diarrhea, bloating, nausea, gas and/or heartburn. Through testing for bacterial overgrowth using the SIBO lactulose breath test and using food sensitivity testing to look for foods that may be causing inflammation in the gut, we can effectively reduce gut and skin inflammation. Anti-inflammatory diets, herbs and omega 3 oils are also some of the things we use to help reduce inflammation. Treat the gut first…and the skin will follow.

Eczema is often cause by a combination of an overactive immune system, disruption to the skin barrier, and changes in the microbiome found in the gut. A naturopathic doctor works to provide eczema relief by treating these root causes and supporting the body’s inherent self-healing abilities.


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