Saturday, May 19, 2012

Which alternative therapies for eczema are worth considering?

The recent issue of The Advocate, the newsletter of the National Eczema Association, features two positive articles on alternative therapies for eczema--an account of an acupressure study conducted by Peter Lio of Northwestern University in Chicago, and a review of alternative, complementary, and integrative medicine that Lio seems to have had a hand in editing.

The review is well done, and mentions a new center set up at the NIH to study these therapies, but my initial reaction was one of dismay. There is nothing physical that operates outside the rules of Western science. I'm 100% for evidence-based medicine and I think most alternative treatments offer nothing more than a placebo effect.

But I like to treat people fairly, so I had a look at the Wikipedia page for traditional Chinese medicine. My opinion was reinforced. The theories--what a load of hogwash. It's like going back to medieval days, when doctors believed illnesses were caused by an imbalance in the four Hippocratic humours--blood, phlegm, black bile and yellow bile--and treated nearly everything with leeches.

But, as I keep reminding myself that this blog has a POSITIVE outlook on eczema research and therapies, and that the point is not to get caught up in criticizing quack medicine or poor studies, as much fun as that may be, I decided to map out for myself whether I could get enthusiastic about any alternative therapies at all.

I drew a plot of where common alternative therapies for eczema lie on two axes: how probable it is that they will do what the people promoting them say they will, and how probable it is that they could cause harm to a patient in some way. Here's my plot. For comparison, I included two standard treatments for eczema: straight-up moisturizing, with something like Eucerin or Aveeno; and low-potency steroids such as 1% hydrocortisone.

I found it illuminating to do this. Let me elaborate my thoughts:
  • Homeopathy, the practice of ultra-diluting reagents, has zero chance of working. You're just drinking water.
  • NAET, in which practitioners claim to diagnose allergies by "applied kinesiology," not only has zero chance of working, but could actually harm patients if they take the practitioner's word that they aren't allergic to a substance that they really are.
  • Acupressure and acupuncture might counteract the itch stimulus with pressure or pain. But based on the mediocre results from small-group studies I've read, I don't really think they do anything. And with acupuncture you are poking holes in your skin, which is never a good idea.
  • Vitamin D is a fad, but it seems true that many people have levels below the recommended 30 ng/ml. Taking vitamin D to boost your levels to normal makes sense. Taking more does not. You could poison yourself if you took too much.
  • Probiotics--consuming foods that contain live, benign microbes to normalize your gut flora--make a lot of sense (especially since more links between gut flora and systemic inflammation are emerging) but I haven't seen any knock-'em-dead studies that really show they significantly relieve eczema.
  • Herbal Chinese medicine does hold promise for eczema therapies. (Tiger penis and rhino horn, not so much.) There are real drugs hiding in there. Artemisinin, for example, is a scientifically verified antimalarial isolated from a traditional Chinese herb. But I won't believe in the efficacy or safety of any Chinese therapy until it has been verified by the full spectrum of clinical trials. In short--when it's not alternative anymore, but mainstream. And if a drug works, it is going to have side effects and interactions with other medications. So there's definitely the potential for Chinese herbs to produce some good therapies in the future--the pharma company Glaxo Smith Kline now has a traditional Chinese medicine division. There are also other storeholds of incredible biodiversity, such as marine compounds from the Malaysian coastline. But it could be decades before we see any drugs hit the market from these sources.
My plot is too simple to make clear that I think it's possible that some drugs isolated from Chinese herbs might be more effective than low-potency steroids such as hydrocortisone. They could be better. But on average I'd be surprised if they were. And if it's true (according to Wikipedia) that a typical herbal treatment from a traditional Chinese practitioner is decocted from 9-18 herbs, I have to wonder what exactly the active ingredients are and how sure the practitioner is of the dose and proportions.

I also worry that we just don't know what some of these herbal compounds are doing. What are the side effects? And where were the herbs harvested? Do they contain arsenic and heavy metals? China's not famous for its environmental policies.

The Chinese multi-component treatment does have a parallel with Western pharma approaches such as the "triple cocktail" antiretroviral for HIV, or combination chemotherapy. The Chinese herbal compounds just haven't been rigorously identified, categorized, and tested in the way that they need to be.
I clearly find Chinese herbal medicine intriguing. You can expect me to investigate Chinese herbal eczema therapies in this blog. I'll also consider vitamin D and probiotics, although from what I've seen, they do not promise anything but slight improvement for the average patient.


  1. It occurred to me that treating HIV or cancer almost demands multiple drugs because in both cases the virus or cancer is continually mutating and can quickly evolve resistance to single drugs. That is not a factor in eczema so I'd guess that, in a therapy with nine components, eight of them would be superfluous.

  2. After I began eating home made kimchi and yoghurt, containing large amounts of probiotics, I have experienced major improvements in my eczema, almost to the point of complete recovery. What is great about probiotics is that nobody has to be making money on it, since you can make it yourself.

    I also take 70-100 µg vitamin D every other day, drink plenty of water with a pinch of salt, try to avoid ready made food, use non-fragrant laundry detergent, avoid foods rich in nickel (I have strong nickel allergy), moisturize my skin with cream and so on.

    I would really look forward to hear about it, if you decide to make your own probiotics, from home made kimchi, yoghurt or something else. What have you got to lose, apart from red and itchy skin? :-)


  3. I agree that out of that set the chinese herbals are an interesting one - there seems to be some affect, but seem to be some significant dangers ( ), which references a couple of deaths from CH medications prescribed for skin treatments.

    Scientific analysis of what is really going on with the mixtures that have a positive effect and understanding the dangers is the way forward.

  4. Anonymous--I too love probiotic foods, just because they tend to taste good. I haven't noticed them making my own eczema better though. The general feeling I get from reading research papers is that any benefit from probiotics occurs when a person is two years old or younger. But that's "just" eczema. Everyone benefits from good digestion!

    Dave--thanks for that reference. I'm starting from almost zero as far as what I know about TCM.

  5. @Spanish Key: Yeah, I love the taste too. I think I tasted kimchi when I was traveling in Asia ten years ago, so I am not 100% sure if my kimchi is similar or not, but it tastes delicious.

    Do you make your own (kimchi/sauerkraut/yoghurt) or do you buy it in a shop, ready-made? Because then it has most likely been pasterurized, which kills off most of the probiotics. This is why you have to make it yourself, if you want to reap the benefits of the probiotics.


  6. Of these I only buy and eat yogurt regularly. It's live culture Bifidus.

    I like and will eat the fermented cabbage foods when they're in front of me, but don't seek them out. Good point about the pasteurization.

  7. I do believe that it's much better to make your own yoghurt, since it won't be pasteurized. Also, if you ferment the milk for 48 hours, all the lactose, which some people have problems digesting, will be eaten by the probiotics.

    Here is a quote by Dr Mercola about making your own kimchi, sauerkraut or other fermented foods:
    "Fermented foods not only give you a wider variety of beneficial bacteria, they also give you far more of them, so it’s a much more cost effective alternative. Here’s a case in point: It’s unusual to find a probiotic supplement containing more than 10 billion colony-forming units. But when my team actually tested fermented vegetables produced by probiotic starter cultures, they had 10 trillion colony-forming units of bacteria. Literally, one serving of vegetables was equal to an entire bottle of a high potency probiotic! So clearly, you’re far better off using fermented foods."

    Is something holding you back from trying to make your own probiotics? If you want a recipe I will be more than happy to share my Kimchi recipe with you. Like your motto says "There will be a cure But only if we make it happen." Are you up for it?


  8. The yogurt I buy is live culture even if the milk was pasteurized first. So it is going to be as effective as anything I make myself.

    Just because the fermented veggies had 1,000 times as many bacteria as supplements doesn't "clearly" mean you're better off (exactly what species ARE those bacteria, botulinum?). But anyway please share your kimchi recipe. The time I tried making it, the cabbage didn't soften properly, so I ended up with a crunchy, stinky mess. I still have a huge bag of Korean pepper that I could use.