September 20, 2020
Dr. Stacy San Diego, M.D.
Atopic Dermatitis is known to the general public as skin asthma, eczema, allergies and so on. It affects children, young adults and the elderly. It can be mild as seasonal allergies or as severe as any debilitating skin disease. Its etiopathogenesis is incompletely understood, it is increasingly common, and it waxes and wanes often without clear precipitants, opening up many opportunities for misinterpretation. Treatment has been the same for several years which include corticosteroids , immunomodulators and emolients with outcomes that are either satisfactory or none at all. People who are being treated for AD do not like the dependency they develop with the steroids and these patients are the ones susceptible to the marketing techniques of these unconventional therapies.
There seems to be tremendous interest in alternative and complementary approaches to treating AD perhaps because it sits in the eye of a perfect storm of attributes: it is widely studied and researched and yet no one cure for all has been practiced, several complaints regarding the side effects has been reported and of course there is this notion amongst the people the “natural” is better.
A functional definition for alternative and complementary medicine can simply be approaches that are not evidence-based. Overwhelmingly, however, this is because there is simply insufficient evidence rather than evidence against the therapy.
Wool intolerance is a well known feature of AD. Wearing alternative fabrics such as cotton and silk has been shown to reduce pruritus and aid in emollient absorption. The use of fabrics impregnated with antimicrobial materials such as silver, zinc, and “anions,” as well as specially coated antimicrobial silk, has been investigated in AD with some benefit. Borage oil-treated garments have also been developed to improve skin moisture and restore lipids. Studies have found that these developments that results are weak but are generally safe. Cost of these specialized garments is another consideration.
CLIMATE AND TEMPERATURE
Temperature and climate plays a role in exacerbation and control of AD symptoms. There is low burden of respiratory allergens at higher elevation as well as atmospheric pressure and air temperature optimization for balance of heat and water loss in the skin. Climatotherapy is became an alternative treatment option that has been utilized for both atopic dermatitis and asthma.
In a large, population-based study there was reduced eczema prevalence in areas with high relative humidity, high UV index, high mean temperature, reduced precipitation, and fewer days of central heating use. With this information, Climatotherapy is became an alternative treatment option that has been utilized for both atopic dermatitis and asthma.
It involves specialized eczema clinics where patients stay for a period of weeks to months that combines anti-inflammatory therapies with a “healing” environment. Studies have shown disease activity was decreased in the majority of patients at the end of therapy. Topical and systemic corticosteroid use was also reduced.
WATER AND BATHING
Several attempts have been made to replicate these natural, mineral-rich spring water conditions (similar to the Dead Sea of Israel and Avene hydrotherapy spa). The proposed mechanisms for the benefit of these natural minerals include some form of immunomodulation. It is suggested that bathing in these type of waters should include UVB phototherapy.
Moisturization has been one of the cornerstone of AD treatments. A wide variety of these creams exist, many contain one or more of the following ingredients, each of which has measurable effects on skin barrier function and inflammatory mediators: ceramides, hyaluronic acid, dimethicone, licorice extract (glycyrrhetinic acid), and palmitoylethanolamide. Many of these ingredients can also be found in over-the-counter (OTC) products.
Sunflower seed oil and virgin coconut oil are one of the most common natural oils used in the treatment of AD. Sunflower seed oil has some properties in improving the skin barrier and possessing anti-inflammatory benefits. Virgin coconut oil (VCO, Cocos nucifera) has shown benefit as both an excellent emollient and natural antibacterial against S. aureus.
The process involves applying topical medication and/or moisturizer to damp skin, followed by a layer of damp cloth or gauze, and subsequent application of a dry layer of cloth or gauze. These layers are left in place for several hours or overnight while sleeping. Occlusive moisturization increases water content in the skin and improves the epidermal barrier. The physical barrier of the wrap can also reduce trauma associated with scratching, particularly overnight.
The concept of gluten sensitivity and its proposed associations with inflammatory skin disease paved the way of patients to avoid gluten with the help of the vast options of gluten free products. Studies have shown that a percentage of AD patients had had detectable serum IgG antibodies to gliadin. Another study looked at over 1,000 patients with celiac disease and found that atopic dermatitis was about three times more common in these patients than in the general population.
Oral Vitamin D has been shown to demonstrate improvement in AD patients especially when combined with Vitamin E. Topical B12 (cobalamin) has been shown to successfully improve atopic dermatitis in both children and adults.
It has been suggested that the enzyme responsible for converting linoleic acid to GLA (delta-6-desaturase) may be deficient in in patients with AD. Evening primrose oil (Oenothera biennis, EPO), black currant seed oil (BCSO), and borage oil (BO) contain relatively high levels of GLA and therefore have been an area of investigation in the realm of supplemental management in AD. But a review of previous studies have failed to show benefit from either oral fatty acid supplement when compared to placebo.
The strains of probiotics investigated as oral supplements include Lactobacillus species such as L. rhamnosus, L. plantarum, L. salivarius, and L. acidophilus, as well as Bifidobacterium breve. Probiotics are taken to treat a number of diseases and is taken to create a normal or a healthy balance. To this day, few studies can ultimately cement the use of probiotics in the treatment of AD but there are studies that support its projected benefits.
TRADITIONAL CHINESE MEDICINE, ACUPUNCTURE and HERBAL MEDICINE
Effects of these methods were mostly positive and treatment itself were actually well tolerated. Results revealed significant improvement in disease severity, improvement in appearance, and quality of life, and need for concurrent pharmacotherapy. But the results were not convincing enough to certain limitations hence it is not widely accepted. Herbal medicines are still not being encouraged due to lack of understanding of its properties and it may pose a a great risk because it may be contaminated by heavy metals.
Acupoint stimulation has been successful in reducing pruritus associated with a number of pruritic (itching) conditions, including atopic dermatitis. Previous studies have shown that Quchi is the acupoint most commonly used for symptom management.