Published April 9 2018
Skin conditions are common in those with thyroid and autoimmune thyroid conditions. Eczema, also referred to as atopic eczema or atopic dermatitis, is a chronic condition that is characterized by red and itchy skin. While it can sometimes be challenging to overcome eczema and other skin conditions, there are natural treatment options that can help, which of course I’ll discuss in this article.
Eczema is especially common in those with autoimmune conditions such as Graves’ disease and Hashimoto’s thyroiditis. Because other skin conditions are common, how can one know if they have eczema? Typically it will be diagnosed based on the appearance of rashes, the parts of the body where the rashes are present, and how long someone has had these rashes for. Seborrheic dermatitis is sometimes confused with eczema, but itching isn’t as common, and it frequently clears up on its own after a few weeks or months (1).
Eczema is more common in childhood, and while most cases will resolve before adolescence, approximately 25% will continue to have eczema as an adult. In children, teenagers, and adults, eczema commonly affects the backs of their knees, the inside of their elbows, and the back of their neck, although it may also affect the palms of their hands and soles of their feet (1). In babies it more commonly appears on the cheeks and outer surfaces of the arms and legs (1).
What Causes Eczema?
There can be numerous causes of eczema, and just as is the case with Graves’ disease and Hashimoto’s thyroiditis, genes can play a role. The risk of getting eczema is around 75% in identical twins, but only 30% in dizygotic (fraternal) twins (2), and so there definitely is a genetic component. I’ve mentioned the triad of autoimmunity in the past, and some sources question whether eczema itself is a separate autoimmune condition. Either way, while genetics seem to be a factor, lifestyle and environment are greater factors, which is also the case with Graves’ disease and Hashimoto’s. This is good news, as while someone might have a genetic predisposition for eczema, addressing environmental factors and improving your immune system health is likely to help you overcome this condition.
There are two proposed theories as to why eczema develops:
Theory #1: one theory states that eczema is caused by an imbalance of the adaptive immune system, specifically T helper cells and regulatory T cells (3). According to this theory, atopic dermatitis is considered to be a Th2 dominant state. As I’ve discussed in past articles and blog posts, most cases of Graves’ disease are also considered to be Th2 dominant conditions, while Hashimoto’s is usually a Th1 dominant condition. As a result, if this theory is true then we would expect eczema to be more common in those who have Graves’ disease, and less common in those with Hashimoto’s.
However, the immune system is complex, and while a number of years ago numerous healthcare practitioners would recommend specific nutrients or herbs based on whether someone was Th1 or Th2 dominant, this isn’t as commonly practiced these days. For example, in autoimmune conditions, one of the main goals is to increase regulatory T cells, while decreasing Th17 cells. Th17 cells are associated with autoimmunity, and a few studies show that these cells are also present in eczema (4) (5).
Theory #2: the other theory relates to defects in the skin barrier, which can be related to mutations in the filaggrin gene (6). According to this theory, those with this mutation will produce less filaggrin, which in turn leads to skin barrier dysfunction and transepidermal water loss.
Keep in mind that it’s likely that a combination of these two theories are responsible for the development of eczema, and I’ll talk more about how a defective skin barrier can play a role later in this article. Also keep in mind that there can be other mechanisms that have not yet been identified. Regarding the first theory, which involves an imbalance of the immune system, the obvious goal should be to address those factors which have caused the immune system dysregulation. Just as is the case with Graves’ disease, Hashimoto’s thyroiditis, and other autoimmune conditions, we usually need to look at the following four categories of triggers:
Diet. Food allergens such as gluten, dairy, and corn can cause an imbalance of the immune system. And while exposure to food allergens isn’t the cause of eczema in everyone, it makes sense to at least go on a 30-day elimination/AIP diet to see if this helps.
Stress. A few different studies show a correlation between psychological stress and atopic dermatitis (7) (8). One of these studies mentioned that dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is present in patients with atopic dermatitis due to the effects of chronic stress on the immune system (8).
Infections. According to the research, the skin of the patient with atopic dermatitis is often colonized with Staphylococcus aureus (9). However, this doesn’t mean that antibiotics or natural antimicrobials need to be taken, especially in mild cases of eczema. In addition, other infections can be secondary causes of eczema. For example, someone can have an infection with H. pylori or Blastocystis hominis, which in turn can cause dysregulation of the immune system and lead to eczema.
Environmental chemicals. A few studies have demonstrated that both indoor and outdoor air pollutants are related to the prevalence, development, and exacerbation of atopic dermatitis (10) (11). Some of the air pollutants that can play a role include VOCs, formaldehyde, heavy metals, carbon monoxide, tobacco smoke, and ground level ozone (10). One of the studies also mentioned how cosmetics, fragrances, and botanicals are also important causes of both irritant and allergic contact dermatitis, as well as food additives (10). I also came across a study which showed a relationship between hard water, chlorine, and eczema (12).
The Gut vs. Skin Microbiome
When talking about the “microbiome”, most people have a tendency to think about the gut. However, there is also a “skin microbiome”. And just like the gut, the skin microbiome consists of different microbes including bacteria, fungi, and viruses (13). While some people consider the outer layer of the skin a bunch of “dead cells”, it actually is biologically active, and it’s important not only for the health of the skin, but overall health as well (14).
Most people reading this are familiar with a leaky gut, which involves a disruption of the intestinal barrier. However, disruptions of the epidermal barrier of the skin can also be problematic. In fact, eczema is frequently the first manifestation of a defective skin barrier (14). While there are tests to determine if someone has a leaky gut, I’m not aware of any testing to determine if you have disruption of the skin barrier.
So what can you do to have a healthy skin barrier? Just as is the case with the gut microbiota, you need to have healthy skin microbiota. I’ve spoken about “intestinal” dysbiosis, but you can also have dysbiosis of your skin microbiota.
Both your gut and skin microbiome are shaped in utero and after birth. Obviously you can’t go back in time and change this, but keep in mind that what you eat, drink, breathe, and apply to your skin will also affect your skin microbiome. As a result, when I talk about natural treatment methods for eczema below, the ultimate goal will be to improve the health of both your gut and skin microbiome through lifestyle and environmental modifications.
Conventional Treatment Options For Eczema
The following are some of the common conventional treatment methods used for someone with eczema:
- Oral and topical corticosteroids. There are more than 30 different topical steroids for the treatment of eczema (15). Hydrocortisone is a lower potency corticosteroid that is commonly recommended, although sometimes higher potency corticosteroids are given for more severe cases. Since oral corticosteroids have an increased risk of side effects they are not as commonly recommended.
- Calcineurin inhibitors. In 2000–2001 topical formulations of two calcineurin inhibitors (tacrolimus and pimecrolimus) were approved for short-term or chronic intermittent treatment of eczema in patients older than two years of age, in whom other treatments have been ineffective or contraindicated (16). The way they work is by inhibiting the formation of proinflammatory cytokines (17). Although these can be effective, there has been some concern over whether these drugs can increase the risk of lymphoma. Fortunately there are plenty of natural alternatives to help lower proinflammatory cytokines.
- Systemic immunosuppressants. These usually are only recommended in more severe cases of eczema. Examples of immunosuppressant drugs given include azathioprine, cyclosporine A, and methotrexate.
- Oral antihistamines. These may help to reduce the itching, and are commonly given when night-time itching interferes with sleep.
- Phototherapy. Numerous studies show that phototherapy can benefit those with eczema (18) (19). The procedure involves standing in a booth that contains light tubes that give off UV light. Narrowband UVB und UVA1 are the most frequently applied regimens in those with eczema (18). It’s considered by many to be safe, although there are some risks, including photodamage, xerosis, erythema, actinic keratosis, sunburn, tenderness, and possibly cancer (19).
Natural Treatment Solutions For Eczema
Let’s go ahead and list some of the natural treatment options for reversing eczema:
Clean up your diet. As I mentioned earlier, it makes sense to follow an elimination diet for at least 30 days, as both food allergens and food additives can potentially cause eczema. And even if food allergens aren’t the culprit, it of course will benefit your overall health to eat well and avoid common food allergens, food additives, etc.
Improve your stress handling skills. I also mentioned how some studies show a correlation between stress and eczema. And while chronic stress probably isn’t the main cause of eczema in the majority of people, most people deal with chronic stress, and it definitely won’t hurt to do things to improve your stress handling skills. The key is to get into the routine of stress management, and so I would recommend starting out by blocking out 5 to 10 minutes per day. What you specifically choose to do is of course up to you, as some people prefer meditation, others will practice yoga, while other people will incorporate a different type of mind body medicine.
Minimize your exposure to environmental chemicals. In this day and age it is impossible to completely eliminate your exposure to environmental toxins. But you can take measures to reduce your exposure, especially in your own home. Purchase natural household products, try to eat mostly organic foods, drink purified water, and consider investing in a good quality air purification system. And of course you also want to try to support your detoxification pathways, which you can accomplish by eating plenty of vegetables, although supplementation can sometimes be beneficial. Infrared sauna therapy can also help with the excretion of chemicals through the sweat.
Correct nutrient deficiencies. Certain nutrient deficiencies may cause or exacerbate atopic dermatitis. A few studies have shown that a zinc deficiency can play a role in eczema (20) (21). Vitamin D is important for optimal immune system health, and a few studies show that vitamin D can decrease the severity of eczema (22) (23). Another study suggested that 400 IU/day of vitamin E can improve the symptoms and the quality of life in those with eczema (24).
Lower histamine levels. There is evidence that eating a low histamine diet can help with some cases of eczema (25). Natural agents which can help to reduce histamine include quercetin, vitamin C, and vitamin B6.
Reduce proinflammatory cytokines. Earlier I mentioned how calcineurin inhibitors are commonly given to reduce proinflammatory cytokines. But there are also natural agents that can help with this, including fish oils, vitamin D, ginger, turmeric, and resveratrol.
Improve the health of your gut and skin microbiome. A healthy gut is necessary for a healthy immune system, and as a result, you want to do what you can to optimize your gut health. This includes removing any infections that might be present, addressing bacterial or yeast overgrowth, and if someone has a leaky gut then of course this needs to be addressed. However, I also discussed the importance of a healthy skin microbiome, and while the same factors that can have a negative effect on your gut microbiota can also impact your skin microbiota, you especially want to be cautious about chemicals that you apply on your skin. Try your best to use natural soaps and cosmetics.
I also mentioned how hard water and chlorine might be a factor. Getting a water softener and/or a good quality shower filter can help with this. Most swimming pools are chlorinated, and while I can’t say that I never swim in chlorinated swimming pools, if you have eczema then you might want to at least consider taking a break from swimming to see if this helps.
In summary, many people with Graves’ disease and Hashimoto’s thyroiditis have eczema. Because it is considered to be a Th2 dominant state it is more common in those with Graves’ disease, although I’ve also worked with Hashimoto’s patients with eczema. One theory is that eczema is caused by an imbalance of the adaptive immune system, while another theory relates to defects of the skin barrier. Conventional treatment methods for eczema include corticosteroids, calcineurin inhibitors, systemic immunosuppresants, oral antihistamines, and phototherapy. Natural treatment options include cleaning up your diet, improving your stress handling skills, minimizing your exposure to environmental chemicals, correcting nutrient deficiencies, lowering histamine levels, and improving the health of your gut and skin microbiome.