Eczema is an allergic reaction that occurs in the skin. It consists mainly of itchy, inflamed patches on the face, elbows, knees, and wrists. Eczema is most commonly found in infants and young children. Eczema is closely associated with asthma and hay fever. All together, they are called atopy. Atopy tends to run in families.
Medical treatment for eczema consists mainly of antihistamines and topical steroid creams.
Probiotics are health-promoting bacteria. The most famous probiotic is Lactobacillus acidophilus , used to make yogurt. Probiotics are thought to have immune-regulating actions. Use of probiotics during pregnancy and after childbirth may reduce risk of childhood eczema, presumably by, in some unknown fashion, normalizing immune response.
The benefits of probiotics for eczema prevention were seen in a small 2001 study. 11 Also, in a very large, long-term, double-blind study, 1,223 pregnant women were given either placebo or a probiotic mixture (containing lactobacilli and bifidobacteria) beginning 2-4 weeks before delivery. 38 Their newborn children then received either probiotics or placebo for 6 months. The results showed that the probiotics mixture markedly reduced incidence of eczema, but not other allergic diseases. A follow-up study of these 1,223 mother-child pairs found that probiotics for mother and infant were not associated with reduced eczema, allergic rhinitis or asthma in children followed through age 5 years. 51 Another study yielded marginal results, 42 and a third study found no benefit at all for the prevention of eczema. This latter study actually demonstrated a modestly increased risk of wheezing bronchitis in those infants who took the lactobacilli. 47 Finally, researchers in another study concluded that not all probiotics are created equal. In this placebo-controlled study involving pregnant women and their infants, Lactobacillus rhamnosus reduced the incidence of eczema in the children, but a strain of Bifidobacterium animalis did not. 49
Lactobacillus plantarum was effective in reducing the severity of eczema symptoms. The randomized trial included 118 children aged 1-13 years with eczema comparing L. plantarum to placebo for 12 weeks. 56
In addition, some but not all double-blind trials have found evidence that infants and children who already have eczema may benefit from the use of probiotics. 12,13,20,21,33-34,39,53 However, in a careful review of 12 studies involving a total of 781 children researchers concluded that there is no convincing evidence that probiotics can effectively treat eczema. 50
If probiotics are beneficial for childhood eczema, they are probably more effective at preventing the condition rather than treating it. 54 Three reviews of numerous studies cautiously conclude that probiotics may help reduce the risk of eczema in infants and children, particularly in those at high risk and when probiotics are given both to mother (before giving birth) and infant. 44,46,48 However, in a double-blind, placebo-controlled study of 231 infants born to women with allergies, giving Lactobacillus acidophilus to the infants failed to reduce their risk of developing eczema. 40 A review of 29 trials (some of which may be summarized above) found that probiotics used by the mother during pregnancy, or during breastfeeding, and probiotics given directly to infants may reduce the risk of eczema in infants. However, the trials evaluated have at least a moderate risk of bias, which can affect the outcomes of the trials. 58
For more information, including dosage and safety issues, see the full Probiotics article.
Early exposure of the infant to allergenic substances found in infant formula may play a role in the development of eczema. Breastfeeding might, therefore, help prevent this condition.
A large study lends credence to this theory. 8 More than 17,000 women in the Republic of Belarus were enrolled. About half were entered in a program that encouraged them to breastfeed (the "intervention group"), while the other half were enrolled in a different program that did not instigate any particular method of infant feeding (the "control group").
The results showed that women encouraged to breastfeed were much more likely to do so than other women. Furthermore, children of women in the intervention group showed almost a 50% reduction in the incidence of eczema.
Interpreting this study is trickier than it might appear. Technically, it does not prove that breastfeeding reduces risk of eczema. Rather, it shows that counseling to breastfeed reduces risk of eczema. However, the implication is fairly compelling: if you breastfeed your child, he or she is less likely to develop eczema.
A combination of traditional Chinese herbs has shown promise as a treatment for eczema. This proprietary formula contains Ledebouriella seseloides , Potentilla chinensis , Akebia clematidis , Rehmannia glutinosa , Paeonia lactiflora , Lophatherum gracile , Dictamnus dasycarpus , Tribulus terrestris , Glycyrrhiza uralensis , and Schizonepeta tenuifolia . In paired double-blind, placebo-controlled trials carried out by one research group, the mixture produced significantly better effects than placebo for both adults and children. 22,23
Each study enrolled approximately 40 people and used a cross-over design in which all participants received the real treatment and placebo for 8 weeks each. Use of the herbal combination significantly reduced eczema symptoms compared to placebo. However, a subsequent study of similar design performed by a different research group failed to find significant benefit. 24 The reason for this discrepancy is not clear.
In a 12 week, double-blind study, a different traditional Chinese herbal formula also failed to prove more effective than placebo for treatment of eczema. 41
Asian herbal creams marketed for eczema have often been found to contain high potency corticosteroid drugs that are not listed on the label. 28
For more information, including safety issues, see the Traditional Chinese Herbal Medicine article.
Topical creams made from chamomile , licorice , or calendula , alone or in combination, are widely used in Europe to treat eczema. One study of 161 individuals found chamomile cream equally effective as 0.25% hydrocortisone cream for the treatment of eczema. 14 However, the report didn't state whether doctors or patients were blinded as to which treatment was which, so it isn't clear how reliable the results may be. (For information on why "blinding" is essential, see Why Does This Database Rely on Double-Blind Studies?
A study by the same authors (also not double-blind), involving 72 individuals with eczema, found somewhat odd results. In this trial, chamomile was not significantly more effective than placebo, but both were better than 0.5% hydrocortisone cream. 15 It is difficult to interpret what these results actually mean, but they certainly cannot be taken as proof that chamomile cream is effective.
A double-blind study of 30 people compared 1% and 2% licorice cream against placebo cream for eczema. 29 Both proved more effective than placebo, and the 2% preparation was more effective than the 1%.
The herb St. John’s wort is most often used for the treatment of depression. St. John’s wort contains a substance, hypericin, that is thought to have anti-inflammatory properties, making it potentially useful in eczema as well. In a double-blind study, a cream containing St. John’s wort extract was compared against placebo cream in 21 people with mild to moderate eczema symptoms. 25 Study participants used real cream on one arm and the placebo cream on the other. The results indicated that use of St. John’s wort cream significantly reduced symptoms.
Another placebo-controlled, double-blind study, enrolling 49 people with eczema, found benefit with a cream containing vitamin B 12 at a concentration of 0.07%. 30 Topical B 12 is thought to work in eczema by affecting local levels of a substance called nitric oxide (NO). A small study of 21 children aged 6 months to 18 years found that topical application of vitamin B 12 for up to 4 weeks improved skin check scores compared to placebo. 52
A double-blind, placebo-controlled study of 88 people with eczema tested a cream containing extracts of Mahonia aquifolium , Viola tricolor , and Centella asiatica . 45 The results failed to show benefit overall. A post-hoc (after the fact) analysis noted benefits among those participants who were not tested in the hottest time of the year. However, due to the mathematical laws of statistics, such retroactive evaluations are of limited meaningfulness.
Evening primrose oil, taken orally, has been widely used in Europe for the treatment of eczema. Evening primrose is a rich source of the essential fatty acid gamma-linolenic acid (GLA) . Other sources of GLA include borage oil and black currant oil. However, the most recent and best-designed studies have failed to find GLA supplements helpful for eczema. 3-6,31 More recently, topical application of GLA has been tried. 45
A review of all studies reported up to 1989 found that oral use of evening primrose oil reduced the symptoms of eczema after several months of use, with the greatest improvement noticeable in the level of itching. 1 However, this review has been sharply criticized: it included studies of very poor design, and also, apparently, misinterpreted the results of some of the studies it evaluated. 2
Better designed studies published subsequent to this review have not shown promising results. A double-blind, placebo-controlled study that followed 58 children with eczema for 16 weeks found no difference in effectiveness between evening primrose oil and placebo. 3 A 24-week, double-blind study of 160 adults with eczema failed to find benefit with GLA from borage oil, 4 as did a 12-week study of 151 adults and children. 31 In addition, GLA from evening primrose either alone or in combination with fish oil failed to provide benefits in a 16-week, double-blind, placebo-controlled study of 102 people with eczema. 5 A fourth double-blind trial followed 39 people with hand dermatitis for 24 weeks. Evening primrose oil at a dosage of 6 g daily produced no significant improvement as compared to the placebo. 6
Only one double-blind trial performed subsequent to the 1989 review found therapeutic benefit with evening primrose oil, but it used very high doses of the supplement and found only marginal benefits. 7
The bottom line: At the present time, the balance of the evidence suggests that GLA taken orally is probably not effective for treating eczema.
However, an interesting double-blind study tested the use of undershirts coated with borage oil for treatment of eczema. 45 In this 2-week study of 32 children aged 1-10 years old, use of these coated undershirts appeared to reduce eczema symptoms. However, additional higher quality research studies need to be undertaken to establish whether or not this method of delivery really works.
For more information, including dosage and safety issues, see the full GLA article.
The herbs burdock , red clover , and Coleus forskohlii , and the supplements quercetin and zinc have also been recommended for eczema, but there is as yet no meaningful evidence that they really work.
Similarly, an 8-week, double-blind trial of zinc at the high dose of 67 mg daily failed to find any benefit for eczema symptoms. 18 Another that tested a combination of Eleutherococcus , yarrow , and Lamium album also came up with negative results. 36
A widely publicized study supposedly found oral use of the plant sea buckthorn ( Hippophae rhamnoides ) helpful for eczema, but in fact placebo treatment proved equally or more effective. 32
A 2012 review of 11 randomized trials investigating the benefits of various dietary supplements on eczema found only limited evidence for the effectiveness fish oil (rich in omega-3 fatty acids) and the combination of vitamins D and E. 55 A review of 8 trials of 3,366 pregnant and breastfeeding women found evidence that fish oil reduced the risk of eczema for the first year in babies with high allergy risk. The controlled trials which compared fish oil supplements to placebo or no supplementation did not find benefits for general population. 57
Although it is widely believed that food allergies are a major contributor to eczema, this assumption may be incorrect. 37,43
1. Morse PF, Horrobin DF, Manku MS, et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol. 1989;121:75-90.
7. Biagi PL, Bordoni A, Hrelia S, et al. The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis. Drugs Exp Clin Res. 1994;20:77-84.
10. Niggemann B, Binder C, Dupont C, et al. Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow's milk allergy/intolerance and atopic dermatitis. Pediatr Allergy Immunol. 2001;12:78-82.
14. Aertgeerts P, Albring M, Klaschka F, et al. Comparison of Kamillosan cream (2 g ethanolic extract from chamomile flowers in 100 g cream) versus steroid (0.25% hydrocortisone, 0.75% fluocortin butyl ester) and non-steroid (5% bufexamac) external agents in the maintenance therapy of eczema [translated from German]. Z Hautkr. 1985;60:270-277.
19. Von Berg A, Koletzko S, Grubl A, et al. The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: The German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol. 2003;111:533-534.
30. Stucker M, Pieck C, Stoerb C, et al. Topical vitamin B—a new therapeutic approach in atopic dermatitis—evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial. Br J Dermatol. 2004;150:977-983.
31. Takwale A, Tan E, Agarwal S, et al. Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial. BMJ. 2003;327:1385.
35. Belloni G, Pinelli S, Veraldi S, et al. A randomised, double-blind, vehicle-controlled study to evaluate the efficacy and safety of MAS063D (Atopiclair®), in the treatment of mild to moderate atopic dermatitis. Eur J Dermatol. 2005;15:31-36.
36. Shapira MY, Raphaelovich Y, Gilad L, et al. Treatment of atopic dermatitis with herbal combination of Eleutherococcus, Achillea millefolium, and Lamium album has no advantage over placebo: a double blind, placebo-controlled, randomized trial. J Am Acad Dermatol. 2005;52:691-693.
38. Kukkonen K, Savilahti E, Haahtela T, et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: A randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2006 Oct 27. [Epub ahead of print]
39. Folster-Holst R, Muller F, Schnopp N, et al. Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis. Br J Dermatol. 2006;155:1256-1261.
40. Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 months of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: a randomized controlled trial. J Allergy Clin Immunol. 2007;119:184-191.
41. Hon KL, Leung TF, Ng PC, et al. Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study. Br J Dermatol. 2007 May 14. [Epub ahead of print]
42. Abrahamsson TR, Jakobsson T, Bottcher MF, et al. Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119:1174-1180.
43. Brand PL, Vlieg-Boerstra BJ, Dubois AE. Dietary prevention of allergic disease in children: Are current recommendations really based on good evidence? Pediatr Allergy Immunol. 2007 Jun 11. [Epub ahead of print]
45. Kanehara S, Ohtani T, Uede K, et al. Clinical effects of undershirts coated with borage oil on children with atopic dermatitis: A double-blind, placebo-controlled clinical trial. J Dermatol. 2007;34:811-815.
47. Kopp MV, Hennemuth I, Heinzmann A, et al. Randomized, double-blind, placebo-controlled trial of probiotics for primary prevention: no clinical effects of lactobacillus GG supplementation. Pediatrics. 2008 Mar 10.
49. Wickens K, Black PN, Stanley TV, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: A double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2008 Aug 31.
51. Kuitunen M, Kukkonen K, Juntunen-Backman K, et al. Probiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohort. J Allergy Clin Immunol. 2009;123:335-341.
54. Kim JY, Kwon JH, Ahn SH, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010;21(2 Pt 2):e386.
57. Gunaratne AW, Makrides M, Collins CT. Maternal prenatal and/or postnatal n-3 long chain polyunsaturated fatty acids (LCPUFA) supplementation for preventing allergies in early childhood. Cochrane Database Syst Rev. 2015;7:CD010085.
58. Cuello-Garcia., Brozek JL, Fiocchi A, et al. Probiotics for the prevention of allergy: a systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2015;136(4):952-961.
Last reviewed December 2015 by EBSCO CAM Review Board
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