Hormones, Eczema and How Nutrition Can Help

Dry, itchy, red and inflamed, yes, we are talking about dermatitis, most commonly known as eczema.

Dermatitis is an inflammatory skin condition and is commonly found on the skin of the neck, hands, feet, elbows and the back of the legs. It refers to a group of conditions and includes many different subtypes [1]. The most well-known ones are atopic dermatitis, contact dermatitis and seborrheic dermatitis [2]. Atopic dermatitis (atopic means ‘with a genetic predisposition’) is the most common form, affecting 1 in 5 children and 1 in 12 adults in the UK [3]. The exact cause of eczema is still under review but from emerging evidence, it is clear that eczema is a multifactorial disease. Skin barrier abnormalities, immune system dysregulation, genetics, stress and environmental exposure are all thought to play a part [4].

In this article, we’ll explore common triggers; foods that we should include and avoid to manage symptoms and eczema’s fascinating connection with hormones and immunity. 

What causes an eczema flare-up?

Identifying triggers, that lead to flare-ups, is essential for keeping your symptoms under control and staying comfortable [5]. Eczema affects everyone differently; one person’s triggers may not be a trigger for others. Also, eczema flare-ups can happen at different times of the year and often on different areas of the body. 

Here we explore the main triggers and how we can help you identify them.

Food. You may experience a flare-up after eating certain foods. There are countless foods beyond the usual suspects (dairy, gluten, lectins, egg, soy, corn) that may trigger your symptoms. If you’re sensitive to specific foods, it may be worth doing an elimination diet. When you reintroduce the food group, carefully watch your symptoms. More on this later. 

Our food intolerance tests will help us to identify and eliminate key allergens so inflammation can be reduced and the gut lining and the body can be given the opportunity to heal.

Stress and anxiety. Stress is a key modulator in many inflammatory and autoimmune conditions and is often responsible for triggering an inappropriate immune response in the body. As such, it is paramount that supporting your nervous system is carefully tailored into your eczema protocol and we target stress in our functional medicine approach. Get in touch for a complimentary discovery call to find out how we can support you.

Skin infections and imbalance of the microbiome. Just like the gut, our skin has its own microbiome, a community of bacteria, fungi and viruses that protect against pathogens, helping to modulate the skin’s immune response [6] and provides the skin’s barrier function. Disruption of the skin microbiome can impair the integrity of the epidermis, increasing the risk of translocation of toxins and microbes into the deeper layers, leading to inflammation. Many common skin conditions are associated with an imbalance of the skin’s microbiome [7]. In atopic dermatitis, there appears to be a predominance of the bacteria strain Staphylococcus aureus when there is a flare [8]. 

Poor gut health. Dysbiosis of the gut flora, poor intestinal barrier function, possible pathogenic bacteria, fungal or parasitic overgrowth are all known triggers in the complex pathogenesis of eczema. You may find that your eczema is triggered following antibiotic treatment as it has a negative impact on the gut’s microbiome and seems to reduce the gut’s beneficial bacteria.

Environmental toxins (detergents, scented products and certain fabrics). Your skin’s delicate microbiome is easily disrupted by environmental toxins so try and opt for more natural household products to minimise exposure to toxic load.

Hormonal changes may also affect the symptoms of eczema. In females, this is due to the drop in oestrogen, which can occur during menopause, pregnancy and right before a menstrual cycle. More on this below.

Why does my skin flare up before my period?

In women, hormone fluctuations may act as a trigger for eczema, causing a flare of symptoms. The fluctuations of these hormones are commonly experienced just before and during menstruation, during pregnancy, following pregnancy and during menopause. The main hormones involved in regulating skin health appear to be oestrogen and progesterone.

The skin has numerous oestrogen receptors and cyclical hormonal fluctuations may influence the skin’s ability to produce lipids, influence the skin’s thickness, skin hydration and barrier function. Thanks to this fascinating connection, oestrogen has been implicated in many functions of the skins. 

• Modulating collagen and sebum production.
• Influencing water binding capacity and fluid retention.
• Providing elasticity thus improving wound healing. 

When oestrogen drops, which occurs during the premenstrual period, there are profound effects on the skin. These changes include increased water loss, imbalance of the skin’s microbiome and decreased wound healing. These processes can aggravate the skin that may already have compromised integrity due to the lack of a protein called filaggrin [9]. The damaged skin barrier might result in decreased hydration, changes in pH and dry skin, allowing pathogens to penetrate the skin.

It is estimated that around 47% of women with Atopic Dermatitis experience worsening of their symptoms during the premenstrual week [10]. This condition is often referred to as premenstrual dermatitis or oestrogen dermatitis [11]. 

What autoimmune diseases are associated with eczema?

As mentioned above, eczema is a complex, multifactorial disease that often involves a nexus of physiological processes but at its core, the immune system has a lot to answer for. 

A well-balanced immune system usually relies on two branches of the adaptive immune system: T helper cell 1 (Th1) and T helper cell 2 (Th2) working in harmony. Th1 cells generate a response to intracellular pathogens (bacteria, virus, abnormal cells) whilst Th2 cells target extracellular pathogens (toxins, parasites, allergens). After one of these branches are activated, they should always return to balance to maintain immune homeostasis. 

However, C section births, formula feeding, low maternal Vitamin D status and early antibiotic use will impair the proper development of the infant’s gut microbiome and ultimately their immunity. Indeed, Th2 dominance has been observed in many autoimmune conditions including eczema, as early as infancy [12]. 

A recent study demonstrated that an overactive immune system skewed toward allergy alters lipid formation in the skin of eczema patients, which affects the skin’s barrier. Studies show it is that change in the skin’s barrier that then leads to the dry, cracked, itchy skin that plagues those who live with atopic dermatitis [13]. 

Furthermore, a new review has revealed that atopic dermatitis was significantly associated with one or more autoimmune diseases. The strongest associations were related to autoimmune conditions of the skin and joint (ie Rheumatoid arthritis) but celiac disease was also associated with AD in men [14]. 

Is eczema a sign of something more serious?

Eczema is a multifactorial disease and many different pathways play a part in the development of its complex pathophysiology. Here at our clinic, we can explore and investigate all pieces of the puzzle through our very detailed functional medicine approach. Here are the key mechanisms we would look at: 

Skin dysbiosis and impaired skin structure

Disruption to the skin’s microbiome can affect the skin’s epidermal integrity, leading to increased access of toxins, microbes and allergens which then might drive the inflammation further.

Genetics

Single Nucleotide Polymorphism (SNP) of the gene FLG which encodes profilaggrin (a protein that binds to keratin fibres and crucial for moisturising the skin) may lead to increased permeability of the skin’s epithelium, increasing the risk of Atopic dermatitis development [15]. Another gene called CLDN-1, which encodes claudin, a tight junction protein, may also be implicated in the progress of Atopic dermatitis [16]. 

Detoxification

Although there may be fully functioning pathways in place, we do need to support them, especially in an increasingly toxic world. Investigating liver, kidney and gut function is important when addressing skin issues to ensure these processes are functioning properly. If indicated, we would explore if your liver pathways (phase 1 and phase 2) are working well. 

The gut-skin axis

Gut health is possibly the most important part of solving the eczema puzzle. Poor gut health is strongly correlated with most skin conditions, including eczema.

• Chronic intestinal hyperpermeability (leaky gut) has been implicated in the development of eczema as it allows antigens to penetrate the gut barrier which can drive chronic inflammation and a hypersensitive immune system. The degree of intestinal hyper-permeability is associated with the severity of atopic dermatitis.
• Gluten and dairy aren’t the only two key trigger foods. Cross-reactive foods such as lectin may be the culprit of eczema flare-ups. Other lifestyle factors may also be instrumental in the progression of eczema such as stress, alcohol, intensive exercise, mycotoxins and disruption to your circadian rhythm as well. 
• Low microbial diversity and reduced bifidobacteria have been linked to atopic dermatitis and it may also contribute to an imbalance of gut immune function.

Gut health testing allows us to understand exactly what types of bacteria or other pathogens have overgrown, where it has overgrown and the imbalance it may have caused. This knowledge allows us to bring the gut back to a state of health. 

Foods that cause eczema

Maintaining an eczema friendly diet is key to the overall management of the symptoms. Not everyone will have the same reactions or flare-up to the same foods. We would always recommend working with a practitioner as they can help you identify your trigger foods. 

Eliminating foods that may put a burden on your immune system is a great place to start. Read our article on how to do an elimination diet here.

• Food allergens: Dairy, wheat, gluten eggs and in some cases, lectins have been shown to exacerbate eczema symptoms.
• High histamine foods may lead to skin reactions due to their histamine content: these include ferments, citrus, cheese, processed meat.
• Reduce exposure to pesticides: buy more organic foods to reduce the consumption of environmental toxins. 
• Reduce refined sugars as they may increase inflammation of the skin due to their effect on insulin.
• Other problematic foods might include acidic fruits, yeast, tomatoes, fried or processed foods.

We also have several IV nutrient drips that are specifically designed to support skin health and vitality. Get in touch and find out more about our Anti-Ageing and Energy IV nutrient therapy available here at our clinic in London and as part of our very exciting IV home service.

Foods that can help with eczema

Eating an anti-inflammatory diet may help lessen eczema symptoms. 

For barrier function and hydration:

• Support barrier function with vitamins such as Vitamin A, C, D, E and zinc. Find out more about these nutrients in our Ultimate skin guide.
• Zinc supports skin integrity and immunity [17] and also reduces inflammation of the skin and improves eczema symptoms. Good sources include oysters, crab, organic beef, pumpkin seeds, cashews, chickpeas, almonds, kidney beans, spinach.
• Include Omega 3 rich foods as they improve skin hydration and reduce inflammation [18]. Mackerel, sardines, anchovies are good sources but always make sure they are from sustainable and traceable sources. Flax, chia, seaweed, spirulina and some nuts and seeds are good veggie alternatives.
• Add water-rich foods such as watermelon, strawberries, and cucumber. These can help give your skin and body the hydration it needs to look and feel its best.

For gut health and immunity:

• Include probiotic–rich foods such as kombucha, kimchi, sauerkraut, fermented tofu and kefir to support the skin’s (and the gut’s!) microbiome [19]. 
• Increase your fibre intake to support your gut microbiome and the final phase of detox, elimination. 
• Include apples, blueberries, cherries as they are high in quercetin a plant-based flavonoid. It’s a powerful antioxidant and antihistamine and has the ability to reduce inflammation as well as levels of histamine in your body.

For the management of stress and anxiety:

• Magnesium gets depleted very quickly when we’re stressed. It’s found in foods such as; green leafy vegetables (spinach, rocket, chard), legumes, and fruit (avocado, bananas). It’s quite hard to attain an adequate amount of magnesium from the diet alone so you may need to supplement to reach therapeutic doses. 
• Try and aim for a diet that is low in refined carbohydrate and high in good quality fat. A bit like a ‘Palaeolithic’ diet that helps to maintain blood sugar and supports thyroid and adrenal function.

For detoxification and antioxidant protection:

• Include green foods such as broccoli, spinach and kale as they provide folate, a super potent antioxidant called sulforaphane and chlorophyll, all crucial for antioxidant protection and liver detoxification [20] [21].  
• Use spices, especially turmeric and rosemary, when cooking to offset the formation of unhealthy compounds that form with heat [22].

Eczema is considered to be predominantly an inflammatory condition of the skin but other factors such as liver function, gut health, exposure to environmental toxins and oxidative stress should also be considered. Therefore, it is important to work with an experienced practitioner to individualise an approach that considers your unique body, genetics and health status. At the London Clinic of Nutrition, we combine industry-leading nutrition and functional medicine expertise, alongside the latest in-house testing, so we can attend to all your health needs in one trip. 

Get in touch for a complimentary discovery call to discuss your health concerns and how to match you with the most suitable practitioner.

Related articles:

• Acne Diets: Nutritionist Approved Foods For Clear Skin (2020 / 2021)

• The Best Vitamins For Skin Health – An Ultimate Guide

• How To Get Clear Skin Naturally: A Timeline For Results