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.