When this naturopathic doctor recommends topical steroids for eczema (!) – The case of baby Benjamin
Benjamin* is the baby who was always scratching himself. This little guy had to wear baby mittens because otherwise he would scratch his skin until it bled. Poor little guy! I diagnosed him with eczema around 4 months of age during one of his well-visits. His eczema was relatively mild at that point, but he went through a few eczema flares as we tried many therapies to heal his skin.
(*Benjamin is not his real name, and this is not a real photo of him, to protect his privacy.)
What is eczema?
Eczema is a rash where the skin becomes rough and inflamed. This rash also has the potential to cause blistering and weeping and can be very itchy. Eczema can occur on the face, chest, arms, and legs. It is most commonly found in the inner elbows and behind the knees. No one knows what exactly causes eczema, but it tends to be passed down from parent to child. People with eczema have an over-reactive immune system that when triggered by an outside event will cause inflammation of the skin. These triggering events can include stress, allergies, and irritants (like soap, detergent, etc…). Eczema is typically treated with over the counter or prescription steroid creams that will stop or decrease the inflammation. Many people find relief with steroid creams, but the steroid cream does not treat or stop the triggering event. That was my job when working with Benjamin, to help stop or reverse the negative impact that triggering events had on his skin.
Here at Naturopathic Pediatrics we have lots of articles about eczema. Check out these articles if you need a better overview of eczema:
Healing from the inside out: the role for good bacteria (probiotics)
As a naturopathic physician my goal is to always to treat the cause, not just the symptom.
Benjamin was born via cesarean section after mom tried for a natural childbirth. Babies who are born vaginally ingest mom’s good bacteria in the birth canal. This good bacteria populates the baby’s digestive tract and communicates with the infant’s immune system. Babies who are born via cesarean section often don’t get this good bacteria to help “jump-start” their digestive tract. Research has shown that this good bacteria is important for preventing atopic dermatitis (eczema) and asthma because it is encouraging the immune system to not overreact.
Probiotic treatment was one of the very first therapies I started Benjamin on given his history of caesarean birth. I had him take an infant specific probiotic – there are many different types of probiotics out there, so I wanted him on one that was specifically meant for his age and one that was good quality. I will often have the breast-feeding parent increase their consumption of probiotic rich foods, like saurkraut, yogurt, kimchi, kombucha, and take their own high dose probiotic supplement in order to transfer some of the good bacteria through their breast milk to baby. Benjamin’s mom was not able to breast feed, so we could only increase his probiotic consumption with his own supplementation.
(For more information about why probiotics can be helpful for eczema read: Allergies, asthma and eczema: The Th1/Th2 story)
When is topical steroid cream naturopathic?
In conventional medicine the first line treatment for eczema is topical steroids. Unfortunately this really does nothing for treating the underlying cause, and doesn’t help the body heal from the inside out.
However, there are some times that steroid cream is necessary, and even naturopathic! This little guy was a great candidate for topical steroid cream because he was so itchy and all the scratching made him more prone to skin infections. I really like using compounded steroid cream mixed with an antimicrobial cream and a thick barrier cream. A compounded cream needs to be specially made at a compounding pharmacy, which tends to be a little more expensive, but again, I find that it works really well. The barrier cream is just what the name says, as it provides a barrier to the rash from other elements. It might seem odd that a naturopathic doctor is recommending prescription steroid cream, but sometimes that is what is needed to calm down the inflammation of the eczema while we are working on treating the cause.
I also recommended that Benjamin use wet wrap therapy along with the compounded topical cream. Wet wraps do a great job of helping to seal in moisture to the skin. Wet wraps are pretty easy to use – I had Benjamin’s family apply the cream and then place wet wraps on him as long as he could tolerate, it is recommended that wet wraps be worn overnight if possible. Wet wraps can be made out of gauze strips, old clothing, or you can purchase specific wet wraps made for eczema. You soak the material that you are using in water and then apply the wrap around an arm, leg, or any other part of the body that is affected.
Why treat the digestive tract in eczema?
Benjamin was also referred to the local allergy clinic because I wanted him to be tested for food and environmental allergies given the severity of his eczema. He tested positive for a variety of foods including gluten, dairy, pork, peanut, and beef. It was evident to me given his food allergies that we needed to work on treating his digestive system. I chose to start him on an amino acid supplement called glutamine. Glutamine helps to maintain the integrity of the intestinal barrier. Newborns have what is considered an “open gut,” also referred to as intestinal permeability. This means that the cells that line their digestive tract have spaces between them, which allows for nutrients to be absorbed into the blood stream. These spaces typically close around 1 month of age. There is some evidence that when the spaces between these cell are persistently kept open that this can lead to food allergies. I suspected that Benjamin’s allergy to dairy along with his regular intake of dairy-based formula resulted in persistent opening of his intestinal cells. There is so much more to say on this complex topic, but we can save that for another blog post.
For more information about allergy testing check out our article: Understanding Food Allergy and Food Sensitivity (IgA vs IgG vs IgE reactions)
Healing skin from the inside out:
One of the other therapies I utilized with Benjamin was omega 3 fatty acids. Omega 3 fats are found in foods, such as, walnuts and cold water fish. Remember that eczema is caused by an overreactive immune response and the omega 3 fats help to regulate this immune response. I advised Benjamin’s family to give him cod liver oil on a daily basis to make sure he was getting plenty of these omega fatty acids. Cod liver oil also contains Vitamins A and D, which help to support the impaired skin barrier that occurs with eczema.
Benjamin’s family continues to see improvement with his eczema. He has even been able to add in some of the allergenic foods without a problem! He still has flares of the eczema periodically and this is when the family will use the compounded steroid cream and wet wraps while doubling the dose of his probiotic and cod liver oil. We continue work in conjunction with his allergist to determine when to try those past allergenic foods. You can see with Benjamin’s case there are many avenues that can be taken to treat eczema!
*Not his real name or photo to protect his privacy.
Gerlich, J., et al. Pregnancy and perinatal conditions and atopic disease prevalence in childhood and adulthood. European Journal of Allergy and Clinical Immunology 2017; November 73(5): 1064-1074.
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Taylor, S. N., Basile, L. A., Ebeling, M. & Wagner, C. L. Intestinal Permeability in Preterm Infants by Feeding Type: Mother’s Milk Versus Formula. Breastfeed 2009. Med. 4, 11–15.
Yoshida, S., Yasutomo, K., Watanabe, T. Treatment with DHA/EPA ameliorates atopic dermatitis-like skin disease by blocking LTB4 production. J Med Ivest 2016. 63(3-4): 187-191.