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 Herbal Medicine : Eczema: Dermatitis 
Superficial inflammation of the skin, characterized by vesicles (when acute), redness, edema, oozing, crusting, scaling and usually itching.

The terms eczema and dermatitis are the cause of much confusion amongst students and practitioners alike! Here we shall follow the broad guidelines given in the Merck Manual and use them synonymously to mean a superficial inflammation of the skin. The dermatologist will subdivide into a range `disease entities' differentiated by location and appearance, but this is not too helpful for the phytotherapist. The most important sub-division is between those cases where the cause is an internal or endogenous one, as opposed to a contact or exogenous cause. In the latter cases it is possible to solve the problem by avoidance of the surface irritant, if it can be identified! Such problems, often referred to as Contact Dermatitis, are commonly caused by, for example:
  • industrial solvents,
  • dyes,
  • nickel and other metals,
  • leather tanning chemicals,
  • some soaps.

In this case eczema is the final result of a complex series of internal reactions to exposure to such allergens and irritants. It often accompanies other allergic diseases such as hay fever and asthma, but may also occur alone.

The rash is a very itchy, peeling, thickened, sometimes weepy area, typically noted in the creases of joints and about the trunk. The rash may fluctuate both seasonally and over the course of the day. Scratching may lead to bleeding and infection. Blood tests reveal increased levels of cells and chemicals associated with allergic reactions in general.

A variation of eczema occurs on the palms of the hands, and sometimes on the soles of the feet. This type may be quite frustrating, since the common exposure to moisture, irritants, and injury of these locations leads to self-perpetuation of the disease. Furthermore the thickness of the skin in these regions makes topical therapy more difficult.

A number of factors can aggravate eczema, although specifics will vary from person to person. These include:
  • stress
  • mechanical irritation
  • heat
  • dietary factors are important, especially in children. Milk and milk products are the commonest triggers.

Actions indicated for the processes behind this disease:
are the classic remedies for the treatment of eczema. How they work is unclear, but they can often be dramatically effective.
Anti-Pruritics, remedies that reduce the sensation of itching, are indicated to lessen the intense irritation that characterizes some cases. This is not simply to make the patient feel better, but to reduce the degree of physical trauma caused by scratching.
Anti-Inflammatories applied topically and taken internally will speed the curative work of the alteratives, but not replace them.
Lymphatic Tonics are especially helpful in childrens' eczema. Of course, these herbs are a variety of alterative.
Nervine Relaxants help with the commonly associated problem of anxiety. and will often ease discomfort in the skin because of the relaxing effect upon the peripheral nerves of the autonomic nervous system. This will reduce itching, and even inflammation to some extent.
Diuretics are important in ensuring adequate elimination through the kidneys. The diuretic alteratives are most relevant.
Hepatics will contribute their special support for liver function and the digestive process. The hepatic alteratives are best here.
Vulnerary herbs will support the healing of skin lesions when applied topically, but do not replace appropriate internal treatment.
Astringents, used topically, will reduce any `weeping' or oozing of fluids.
Emollient herbs are suitable for topical applications where soothing is needed. The demarcation between emollient, anti-inflammatory and anti-pruritic is rather meaningless here.

System Support
This is a case where the practitioner must be at their most insightful. Ideally the nature of any underlying cause would identify what systems call for toning. However, with the exception of obvious allergy or contact irritant, this is problematic in a skin problem such as eczema. The skin calls for support, but additionally we can add the nervous system, digestive system, liver, immune system etc. etc. In many ways the conclusion will depend upon the herbalists personal theoretical interpretation of eczema, rather than the patients case history.

Specific Remedies
For internal use, the leafy alteratives are often considered the closest we have to specifics for this often intransigent condition. These are also often diuretics and lymphatic remedies. Herbs that would be included in this group include:

Fumaria officinalis -- Galium aparine -- Scrophularia nodosa
Trifolium pratense -- Viola tricolor -- Urtica dioica

The rooty alteratives tend to be hepatic in nature. They can often be too strong for eczema, aggravating the problem rather than healing. For intransigent case, unresponsive to the herbs above, stronger remedies are indicated. Effective examples for eczema are:

Arctium lappa -- Berberis aquifolium -- Hydrastis canadensis

There are an abundance of relevant herbs for topical application. The choice will often be decided on factors such as availability and esthetics. Examples here are:

Calendula officinalis -- Hydrastis canadensis -- Stellaria media
Plantago spp. -- Urtica dioica

Relevant herbs for topical use abound. It must be bourne in mind that healing must be based upon internal medication and not salves. Select remedies based upon the actions most appropriate for the individuals' specific symptoms.

Anti-pruritic: Chickweed (Stellaria media) is an extremely effective remedy for the relief of itching. The only situation is does little in is the itching of jaundice. It is most effective in a non-greasy form such as a bath, fomentation, poultice, lotion or cream. Distilled Witch Hazel (Hamamelis virginiana) is another effective application.

Anti-Infammatory: Plantain (Plantago spp.), Calendula (Calendula officinalis), St. John's Wort (Hypericum perforatum), Chamomile (Matricaria recutita) and the anti-inflammatory essential oils can all be used.

Emmolient: Comfrey (Symphytum officinalis), Marshmallow (Althaea officinalis), Mallow (Malva sylvestris), Slippery Elm (Ulmus fulva) etc.

Astringent: Witch Hazel (Hamamelis virginiana), Yarrow (Achillea millefolium)

Vulnerary: Comfrey (Symphytum officinalis)

Anti-microbial: Essential oils are all anti-microbial, most notably Thyme (Thymus vulgaris), Eucalyptus (Eucalyptus globus), Ti Tree (Melalucca spp.). Also consider Myrrh (Commiphora mol-mol) and Golden Seal (Hydrastis canadensis). This is discussed in more depth in the section on infection.

One possible prescription for eczema:
Galium aparine
Urtica dioica
Trifolium pratense
equal parts to 5 ml of tincture three times a day
Urtica dioica or Galium aparine
an infusion of the fresh herb drunk 2 or 3 times a day.

This combination for internal use supplies the following actions:
  • Alterative: Galium aparine, Urtica dioica, Trifolium pratense
  • Lymphatic Tonic: Galium aparine, Urtica dioica
  • Nervine Relaxant: Trifolium pratense
  • Anti-Inflammatory: Galium aparine
  • Diuretic: Galium aparine, Urtica dioica
  • Hepatic: Galium aparine, Trifolium pratense (both are very mild thus avoiding over stimulation)

A possible prescription for persistent eczema, unresponsive to mild alteratives :
Galium aparine
Arctium lappa
Scrophularia nodosa
equal parts to 2.5 ml of tincture three times a day
build up dosage to 5ml three times a day
Urtica dioica an infusion of the fresh or dry herb
drunk 2 or 3 times a day.

Care should be taken with Scrophularia nodosa initially as it can produce the opposite of the desired in some patients. If there is a flare up of the skin eruption, cut down on the Scrophularia and try again. This is not a `healing crisis'!

This combination for internal use supplies the following actions:
  • Alterative: Scrophularia nodosa, Galium aparine, Urtica dioica, Arctium lappa
  • Lymphatic Tonic: Galium aparine, Urtica dioica
  • Nervine Relaxant: Trifolium pratense
  • Anti-Inflammatory: Galium aparine
  • Diuretic: Galium aparine, Urtica dioica, Arctium lappa
  • Hepatic: Galium aparine, Arctium lappa (both are very mild thus avoiding over stimulation)

One possible prescription for atopic eczema associated with asthma:
Urtica dioica 2 parts
Trifolium pratense 2 parts
Dyspnoea mixture 1 part to 5 ml of tincture three times a day
the relative proportion of alteratives to dyspnoea mixture depends upon the patients specific needs.
Urtica dioica or Galium aparine
an infusion of the fresh herb drunk 2 or 3 times a day.

Broader Context of Treatment:
If dietary triggers can be identified, it is essential to avoid them completely. Often the specifics food restrictions that are called for can be a challenge to adhere to. This is especially the case with young children. The parents who must enforce the diet will need much support from the therapist (maybe some Scutellaria!). Even if there are no obvious food triggers, it is always worth excluding milk and milk products. It seems that this is especially the case with children who were not breast-fed, or weaned too soon. Researchers at the Hospital for Sick Children in London have shown that children often develop eczema when weaned from breast milk to cows' milk or other foods. Goats', soya or sheep's milk rarely trigger allergy problems. Common eczema triggers that are relatively easy to exclude include :
  • Cows' milk
  • Eggs
  • Cheese
  • Fish
  • Sugar
  • Food additives

Supplements suggested for inclusion in a broad therapeutic approach to the treatment of eczema by Drs. Pizzorno & Murray in A Textbook of Natural Medicine include:
Vitamin A 50, 000 IU/day
Vitamin E 400 IU/day (mixed tocopherols)
Zinc 50 mg/day as picolinate (decrease as conditions clears)
Quercetin 1/8 - 1/4 teaspoonful 3 times a day
Evening Primrose oil 2-4 capsules 3 times a day. As patient improves, switch to the less expensive flaxseed oil.

Other authorities have recommended Vitamin C and Vitamin B complex in addition.
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 About The Author
David Hoffmann BSc (Hons), MNIMHWhilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it......more
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