Dr. Frank Lichtenberger MD, PhD, Medical Director at AD RescueWear
Plant Based Alternative Treatments for Eczema.
By Dr. Frank Lichtenberger MD, PhD, Medical Director at AD RescueWear
Many of my patients, and many of the participants in the AD RescueWear Facebook discussions have tried or have been using plant based oils, essential oils, and many other supplements to complement their atopic dermatitis (eczema) treatment plans. Most of the people I have talked to received their advice from friends and family, or by other word of mouth. What surprises most of them, is that these “alternative” therapies have been scientifically studied for over a decade and there is solid evidence about what is effective and what isn't.
First off, when scientists are looking at atopic dermatitis (eczema), the most important factors which they measure success in treating eczema are: SCORAD - which is a number based on the area affected + the intensity and swelling; and TEWL - which is a measurement of how much water is being passed through the skin (dryness). These are objective measurements of the extent that a person is affected by atopic dermatitis (eczema). These are not usually measured in a doctor’s office, so they might not be familiar to most people with atopic dermatitis (eczema).
Supplemental oils can be used topically – directly on the skin, or orally – taken as food. When used directly on the skin, they act to protect and soothe the skin, and when taken orally, they are supposed to help the body heal and repair itself either by lowering inflammation or by increasing the amount of raw materials the immune system needs for healing.
There have been several studies which compared virgin coconut oil (VCO) to mineral oils (Vaseline®, Eucerin®, Aquaphor®), and other oils such as olive oil. VCO was more than twice as effective as mineral oils at improving SCORAD and TEWL when used over short (2 weeks) and longer periods (>8weeks). Virgin coconut oil was able to reduce TEWL by 75%!
While coconut oil did show some remarkable improvement when used topically, keep in mind that it is extracted seed oil, and may contain allergens. About 0.08% of North American children have a sensitivity to coconut; coconut allergy has not been studied rigorously enough to know if the coconut meat, oil, or both is the primary cause of coconut allergy in those affected. Generally the people with coconut allergy have other similar allergies such as soy glycinin, walnut, and hazelnut. It is not known exactly how frequent coconut oil allergy affects people, and I have seen it only a few times in clinical practice. In the cases that I was able to diagnose coconut allergy as part of the atopic process, switching from coconut oil to mineral-based oil was able to improve eczema scores rapidly.
When olive oil was compared to sunflower oil, scientists showed that sunflower oil improved the strength of the skin, while olive oil was somewhat irritating when used topically on skin every day. Neither of these oils showed any improvement in eczema scores when taken as an oral supplement. When hempseed oil was used as an oral supplement, there was a significant reduction in reported itchiness and TEWL. The authors of that study showed that this improvement coincided with increased amounts of essential fatty acids in the bloodstream (linoleic, alpha/gamma-linoleic acid).
While there is good evidence that fish oil supplements can reduce overall body inflammation, there was no difference in eczema scores when using this as an oral supplement. There have only been trials of using fish oil orally, I don’t think anyone has developed an experiment using it topically…..for obvious, very smelly reasons.
In summary, there is good science to back up the use of some plant-based oils for improving eczema. The best evidence was shown when virgin coconut oil was used topically, and when hempseed oil was taken as an oral supplement. While this research certainly does not apply to every individual with eczema, it certainly gives us a good basis to start from.
Danby SG, AlEnezi T, Sultan A, Lavender T, Chittock J, Brown K, Cork MJ. Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care. Pediatr Dermatol. 2013 Jan-Feb;30(1):42-50.
Verallo-Rowell VM, Dillague KM, Syah-Tjundawan BS. Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis. Dermatitis. 2008 Nov-Dec;19(6):308-15.
Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol. 2014 Jan;53(1):100-8.
Bath-Hextall FJ, Jenkinson C, Humphreys R, Williams HC. Dietary supplements for established atopic eczema. Cochrane Database Syst Rev. 2012 Feb 15;2:CD005205.
Callaway J, Schwab U, Harvima I, Halonen P, Mykkänen O, Hyvönen P, Järvinen T. Efficacy of dietary hempseed oil in patients with atopic dermatitis. J Dermatolog Treat. 2005 Apr;16(2):87-94.