NATURAL STRATEGIES TO MANAGE ECZEMA

Eczema is an inflammatory disease caused by certain triggers such as food allergies, dry weather, clothing material, certain ingredients in personal care products, or emotional triggers. It belongs to a group of skin diseases called dermatitis and is characterized by dry, itchy, and sometimes oozing patches on skin. Ayurvedic texts describe some skin conditions  that are analogous to dermatitis. The root cause for the disease is linked to improper digestion of food. Thus the main principles of eczema management in Ayurveda are those of proper diet and eating habits. In contrast, allopathic treatment is focused on managing symptoms using steroids in topical creams or internally to manage inflammation. Long term medication with steroids comes with side effects such as increased appetite leading to weight gain, acne, mood swings, and muscle atrophy. This guide outlines Ayurvedic principles to manage eczema.
Disclaimer: This article is for informational purposes only. I am not a medical professional and do not guarantee medical results. Do your research and work with appropriate medical personnel for your medical needs. 

1. Scientific perspective on eczema
2. Preventive strategies using Ayurveda 
3. Skincare guidance ​​

 

Scientific perspective on eczema
An understanding of the pathology of eczema is far from complete. The cause of eczema is attributed to a combination of factors such as epidermal barrier dysfunction, and immune dysregulation. The following factors can increase an individual's risk for atopic dermatitis, a class of skin diseases of which eczema is an example:

• genetic factors
• family history which can dramatically increase the risk of a child developing eczema
• environmental factors such as pollution, climate, and season
• cosmetics and personal care products containing harsh ingredients such as strong surfactants, preservatives, and fragrances
• diet triggers 
• immune triggers (example certain toxins)
• stress

The diagnosis for eczema is primarily based on clinical observation by a dermatologist. Symptoms must include the following to be diagnosed as eczema:

• Major criteria: itchy skin
• Three of the following minor criteria: skin lesions (damage), history of dry skin, asthma, skin rashes that tingle, burn, or ooze liquid

Atopic dermatitis can be classified based on the age of onset into "very early onset", occurring in babies (less than two years), "early onset", occurring in children between ages 2 to 6, "childhood onset", occurring in children between 6 to 14, "adolescent onset", occurring between 14 and 18 years of age, and "adult onset", in adults between 20 and 60. Very early onset eczema typically resolves after the age of two and is not the topic of the discussion here. 

The link between impaired epidermal barrier function and the immune system
Skin protects our body from external pathogens, pollutants, and toxic chemicals. The outermost layer, the epidermis, also serves the function of limiting water loss from the body. There is growing evidence that points to impaired skin barrier function being a symptom of an abnormal immune system. Several factors impact the immune system:

• Genetic factors
• Certain medical conditions
• Poor diet - micro and macronutrient imbalance
• Sedentary lifestyle
• Obesity
• Chronic stress
• Poor sleep
• Alcohol and tobacco consumption

With the exception of genetic factors, we have the power to control the other factors using lifestyle and diet. 

Treatment of eczema
Eczema is typically treated using topical and oral steroids to manage symptoms. Topical corticosteroids are prescribed to manage itching. Oral steroids are added to the treatment regimen in severe cases. Oral steroids work by suppressing the immune system. Steroids are intended for short term use as prolonged use can lead to several side effects. Oral steroids are especially risky as they can lead to kidney and liver dysfunction if used long term. ​

 

Preventive strategies using Ayurveda
In Ayurveda, the specific skin disease that matches the clinical manifestations of eczema is called Vicharchika.  All major Ayurvedic texts (Charaka Samhita, Ashtanga Hridayam, Sushruta Samhita) point to improper diet as the major root cause of eczema. Improper diet includes:

• Incompatible food combinations leading to improper digestion of food - Agni mandya 
• Excessive consumption of sour foods, such as yogurt, fermented foods, citrus foods, vinegar, tamarind etc.
• Excessive consumption of heavy foods such as dairy products, fried foods, raw foods, and processed foods
• The doshas involved in eczema are Pitta and Kapha. Thus the general approach in treating this disease involves strategies to balance these two doshas. 

Ayurveda sees food sensitivities as a symptom of poor digestion which may be reversed by strengthening one's Agni. However, food allergies are considered to be genetically encoded and thus must be avoided to prevent flare ups. 
General eating guidelines

• Eat only when hungry. Food must be completely digested before eating the next meal. It takes a few hours for digestion to complete. Frequent snacking, drinking (other than hot water), or having more than three meals a day are strongly discouraged in Ayurveda. 
• Eat in a pleasant ambience without distraction. Ayurveda advocates that one should fully focus on eating and enjoy the process and strongly discourages multitasking while eating, even talking. 
• Chew your food thoroughly and eat at an optimal pace; neither too fast nor too slow. 
• Exercise portion control; understand what fullness means to you and eat only up to three quarters of that threshold. 
• Eat food that is hot, cooked, and fresh. Minimize eating out, eating leftovers older than twenty four hours, and salads. 
• Ayurveda advocates Incorporating the six tastes, sweet, salty, sour, pungent (hot or spicy), bitter, and astringent, in our diet. For people suffering from eczema, bitter and astringent taste are beneficial while sour, salty and pungent must be reduced. 
• Eat per the season. Eat hot, cooked foods in fall/winter; cooling foods in summer. Minimize ice cream, cold water, salads, dry foods (cereal bars, crackers, nuts etc.) in winter. Minimize sour and hot/spicy foods year around if you suffer from eczema. 
• Avoid drastic changes in your diet. We generally eat a diet we are used to. For example, vegetarian diet, pescatarian diet, eating specific foods for breakfast, etc. Changes to the diet must be introduced slowly, even if it is perceived to be a highly beneficial change. 
• Minimize all sour foods, including fermented foods like soy, yogurt, citrus fruit, sour fruit, and vinegar. 
• Drink organic pomegranate fruit juice in winter and coconut water in the summer. 
• Avoid incompatible food combinations. This is important in the management of eczema and is discussed in more detail below. 

Incompatible food combinations
There is a laundry list of foods which cannot be combined per Ayurveda. Incompatible food combinations weaken the digestive fire over time which is the root cause of all diseases per Ayurveda. It can be very stressful to break this down into what is OK to eat and what is not if you're new to Ayurveda. But we can distill things into a few guidelines listed below:
The following foods can be safely combined: 

1. Veggies and meat, salads especially are recommended 
2. Cooked veggies and grains
3. Lentils and beans with grains
4. Oils, butter, or ghee with lentils, beans, veggies, and grains

• If you're combining anything other than what's listed above, be thoughtful. An incompatibly combined meal once in a while is OK. Repeated consumption of incompatible foods lead to impaired Agni over time. 

The worst food combinations that lead to improper digestion are:

1. Milk with anything other than some cooked grains. Cereal, cooked grains with milk are OK.  Combining milk with fruit (smoothies), eating cookies with milk (yeast containing products should not be combined with milk), salty or sour snacks with milk, meat and veggies with milk are considered improper combinations. 
2. Yogurt, cheeses, and paneer are considered to be unwholesome per Ayurveda. People with eczema should minimize consumption of these foods. Buttermilk is wholesome, so substitute yogurt with buttermilk. Yogurt should never be consumed at night. 
3. Eat fruit alone; no smoothies, or fruit yogurt. Avoid high acid fruit - citrus fruit, all sour fruit, pineapple etc. 
4. Don't combine animal and plant protein. 
5. Go easy on nightshades - potatoes, tomatoes, eggplant, and chili peppers in particular.

 

Skincare and lifestyle guidance
​Appropriate skincare must be used along with diet management strategies to manage eczema. It is as important to avoid certain ingredients that can trigger a flare up as it is to include certain others to nourish the skin. Less is more when it comes to products. 

• Avoid fragrances. Even natural plant oils like lavender etc. can be irritating. Eliminate all scented products including scented deodorants, candles, air fresheners etc. 
• Use fresh, unpreserved skincare. Anything you buy from the store containing water (body washes, lotions, serums) have preservatives that will kill the skin's microbiome and further aggravate eczema. Saroya Natural's Resuscitate Serum is a safe alternative without any harsh preservatives. 
• Use a body oil instead of a cream. Creams are mostly water, wax, and a bit of oil. They prevent water loss from the skin’s surface. Oils penetrate the skin barrier and are more nourishing. Use pure sunflower seed oil, coconut, sesame, or sweet almond oil followed by the cream. If you're allergic to nut oils, jojoba oil may be used. 
• Get rid of soapy body washes or soaps that remove the body’s natural sebum and disturb the skin's pH. Surfactants found in commercial body washes and preservatives used in all water based products disturb the skin's surface lipid structure which can aggravate eczema. Ayurveda advocates the use of powder cleansers made of grains, lentils, and herbs. Saroya Natural's Creamy Pomegranate Bliss body wash not only preserves the skin's sebum instead of stripping it like most body washes and soaps, but also has beneficial herbs targeted to manage eczema. ​
• Avoid showering in hot water and scrubbing skin using loofas, brushes, or washcloths. 
• Manage stress using mind-body techniques such as meditation, yoga, or calming breath work. 

Herbs used to treat eczema
Look for the following herbs in your skincare if you have eczema:

• Aloe vera
• Calendula
• Hemp
• Vetiver
• Licorice
• Mugwort (Artemesia vulgaris)
• Neem
• Manjishta
• Bakuchi

There are some classical Ayurvedic oil formulations that help with eczema management. These are:

• Paranathyadi tailam
• Eladi keram
• Marichadi tailam

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