My understanding and philosophy about eczema have changed and grown over time. I’m working on updates to the site — and working on a campaign to fund a medical study, stay tuned — but here’s what I believe in a nutshell:
First, these are my opinions — based on an extensive review of medical literature and much discussion with chemists, microbiologists, medical professionals, and many, many parents of children with eczema over the years, but my opinions nevertheless, not accepted medical views. I am not a doctor.
Based on everything I have seen and read, I believe the majority of infantile eczema results from high levels of (often unrecognized) detergents in the environment, especially the home environment. These substances affect the permeability of skin, have a startling physiological impact at even very low levels of exposure, affect people in “atopic families” more, and are absorbed at much higher rates by infant skin. Detergents increase skin permeability, antigen penetration, and thus antigen load. (I describe what I mean by detergents on the web site, it’s not what most people think.)
As children get older, their skin becomes naturally less permeable, they spend less time with their faces on their parents’ clothing and against their hair, and less time crawling across surfaces, and can seem to “outgrow” the eczema, but a lot of these children will go on to develop asthma and allergies, the so-called “atopic march”. As they go through these transitions, kids are also becoming more active, and breathing in more and more — to sensitive lung tissue, the optimal function of which depends on biological surfactant — large amount of synthetic surfactants from indoor environments (dust comprised mainly of skin cells, lint, hair, etc., all of which come with detergents in modern environments).
I have observed and heard over and over again in the years since I put up my site that:
1) When people make the changes I recommend on my site, not only are they able to get rid of the eczema, they go from thinking of it as a random problem to understanding exactly when and why their families are affected, how to prevent breakouts, and how to end them quickly if the exposures can’t be avoided.
2) Along with eliminating the eczema, people see the skin begin to heal and become more substantial, normal, and less dry over a period of about two months.
3) Because entire households have to make the changes for them to be effective, and because atopic families benefit most, I hear frequently that changes made for the benefit of a child with eczema have a marked beneficial effect on other family members’ skin problems, allergies, and asthma.
4) If someone is very focused about it, the changes can be effected for an entire household in as little as a week. People with hard water typically underestimate the impact of water hardness on their ability to make the changes (but many persist). Even if the recommendations address the sole source of the eczema, sometimes infected eczema has to be treated for the problem to go away.
5) Most people have incorrect assumptions, particularly about how green or “natural” what they are already using in their homes is, that contribute to their difficulty coming to this solution on their own. The most effective are those who read through all the information and understand it.
I do not believe environmental detergents are the sole cause of eczema. I do, however, believe that there are only a few other causes and that those causes tie in with this one. I do not believe that there are many causes of eczema, as I so often hear — there are many “triggers” when the cause is not eliminated, but I believe there are only a few causes and that they are related by an underlying biological basis.
Our bodies make detergents for various biological purposes. For lack of standard terminology, I call them biological surfactants. One of these maintains proper pulmonary function (“surfactant” in the lungs). Biological surfactants help us control skin membrane permeability. This is why I believe sodium lauryl sulfate — a chemical analog of biological surfactants — is so problematic.
Another function of biological surfactants is to denature proteins in the blood stream. I believe this is why one segment of people gets full-body eczema from ingesting certain foods, particularly protein-rich foods like milk, especially when their guts are immature (or otherwise compromised) — the “leaky gut” phenomenon may result in increased circulating biological detergent (coupled with unnatural detergent levels in the gut and on the skin from environmental sources). Skin permeability is dramatically and unnaturally increased, antigen penetration and load increases, etc., similar to when the gut isn’t a factor.
Probiotics, beneficial bacteria, have been shown to reduce eczema rates in infants if given to pregnant women. This leads some people to try them when their children get eczema and abandon them if they don’t “work”, but I think they could be used more effectively with a better understanding of when and why they sometimes work. I believe the probiotic effect ties in with the observations I have made on my web site, and with my theories about why eczema and asthma have risen so dramatically in recent decades. I won’t go into this more here, but I would note the following:
1) Probiotics, beneficial bacteria, secrete biological surfactants that help repair gut membranes (see last paragraph).
2) We have evolved to need some bacteria to turn on certain genes in infant intestines for proper digestion.
3) In the last 100 years, we have significantly altered our relationship with natural intestinal flora and with certain fungal species, particularly yeasts, which can degrade gut membrane function under certain conditions.
4) The medical literature is full of references to antifungal medications helping in some cases of very severe eczema, but somehow not curing it.
5) Fungal organisms more closely resemble human skin cells than they do other microbial organisms like bacteria.
We do know that following some viral illnesses, children especially will develop full-body eczema — and I have seen at least one research paper describing high levels of circulating biological detergent following such viral illnesses.
From everything I have seen, people can track down the cause of their eczema and solve it. I don’t mean chase after triggers their whole lives, I mean find, understand, and have control over the underlying reason for their children’s eczema.
Here is what one mom wrote to me recently (I’m perpetually bad about posting feedback, but she graciously sent photos and permission to share, I will post them soon):
“I wanted to take a moment and thank you for your reply and let you know how successful we’ve been at clearing up our daughter’s eczema. She is now 15 months and has beautiful, clear skin. It’s not just the broken patches on her skin that have cleared up- it is her complete skin tone. Previously she always had underlying red patches on her face, even those have gone now. This is really a miracle, because we’ve tried EVERYTHING (probiotics, elimination diet, olive and flaxseed oil, bleach and salt baths) since she was a few months old and would scratch herself bloody everyday. … This is what I’ve wished/prayed/cried for, for a long time. I only wish we had found your site a year earlier.”