Eczema Beyond the Skin

The Forgotten Treatments, Immune Physiology, and Neurobiology of Atopic Dermatitis

By Dr. David Traster, DC, MS, DACNB
Co-owner, The Neurologic Wellness Institute
Boca Raton • Chicago • Waukesha • Wood Dale
www.neurologicwellnessinstitute.com

For decades, eczema—also called atopic dermatitis—was treated largely as a superficial skin disorder. The approach was often straightforward: reduce inflammation, suppress the rash, stop the itching. But modern research has increasingly revealed that eczema is far more complicated than a simple skin irritation. It is a disorder involving the immune system, nervous system, skin barrier, microbiome, stress physiology, environment, and in some cases even the gut.

One fascinating review article explored not only conventional therapies, but also many alternative, complementary, and historically forgotten treatments that have been used to help patients with eczema. The paper did not present these therapies as miracle cures. Instead, it showed how many of them may target specific components of eczema physiology—barrier dysfunction, bacterial overgrowth, immune dysregulation, neuroinflammation, or chronic itch signaling.

The article paints eczema as a systems-based disease in which inflammation, microbes, stress, barrier breakdown, and scratching continuously amplify one another.

The Skin Barrier Is Not Just Skin

Healthy skin acts as one of the body’s most important immune and neurological interfaces with the outside world. It prevents excessive water loss, protects against allergens and microbes, and constantly communicates with the immune system and sensory nerves.

In eczema, this barrier becomes compromised. Tiny defects develop between skin cells, allowing moisture to escape and irritants to penetrate more deeply into tissue. The immune system then responds aggressively to exposures that would normally be harmless.

Research discussed in the article highlights abnormalities in:

• Skin lipids

• Ceramide content

• Filaggrin proteins

• Water retention

• Local immune signaling

This helps explain why eczema skin becomes dry, inflamed, hypersensitive, and prone to cracking and infection.

Because of this, one of the central treatment goals in eczema is restoration of the barrier itself.

Moisturizers and Barrier Repair Therapies

The article strongly emphasizes moisturization as a foundational therapy rather than merely cosmetic skin care.

Barrier repair treatments discussed include:

• Emollients

• Petrolatum-based occlusives

• Hydrating creams

• Ceramide-supportive products

• Natural oils

Several oils were specifically discussed.

Coconut Oil

Virgin coconut oil has gained interest because it may provide both moisturizing and antimicrobial effects. Studies have shown it may help reduce colonization of Staphylococcus aureus, a bacterium frequently elevated in eczema patients.

Potential mechanisms include:

• Barrier support

• Reduced water loss

• Antimicrobial activity

• Reduced inflammation

Sunflower Seed Oil

Sunflower seed oil was discussed as another potentially beneficial barrier-supportive oil that may improve hydration without some of the irritation associated with other plant oils.

Bathing and Hydration Strategies

The article also discussed:

• Frequent moisturizing

• Controlled bathing

• Hydration immediately after bathing

• Occlusive layering

These strategies help trap water within the skin and reduce barrier disruption.

Wet Wrap Therapy

One of the most strongly supported nonpharmaceutical approaches discussed was wet wrap therapy.

This technique involves:

1. Applying moisturizer and/or topical medication

2. Covering the skin with damp fabric

3. Adding a dry outer layer

This creates prolonged hydration and cooling effects.

Potential benefits include:

• Reduced itching

• Enhanced medication absorption

• Improved hydration

• Reduced scratching

• Faster flare reduction

Wet wraps are often especially helpful in children with severe eczema flares.

Conventional Medical Therapies Reviewed

Although the article focused on complementary and forgotten treatments, it also acknowledged the role of conventional therapies.

These included:

• Topical corticosteroids

• Topical calcineurin inhibitors

• Antihistamines

• Antibiotics when secondary infection occurs

However, the authors emphasized that these treatments often do not fully address:

• Barrier dysfunction

• Microbiome imbalance

• Stress physiology

• Environmental triggers

• Chronic itch sensitization

The Skin Microbiome and Antimicrobial Therapies

One of the most important themes in the article was the role of bacterial imbalance in eczema.

Many eczema patients develop excessive Staphylococcus aureus colonization. These bacteria can produce toxins that worsen inflammation and immune activation.

This has led to growing interest in antimicrobial therapies.

Bleach Baths

Dilute bleach baths were discussed as a low-cost intervention that may reduce bacterial burden and decrease eczema severity in some patients.

The concentrations used medically are extremely diluted and intended to reduce microbial overgrowth rather than sterilize the skin.

Potential benefits:

• Reduced bacterial toxins

• Reduced inflammation

• Reduced recurrent infections

• Improved flare control

Honey

Honey was discussed because of its:

• Antimicrobial properties

• Wound-healing potential

• Anti-inflammatory effects

Historically, honey has been used in various skin conditions because it may inhibit bacterial growth while supporting tissue healing.

Saltwater and Mineral Bathing

The article also reviewed:

• Saltwater therapy

• Mineral baths

• Balneotherapy

These therapies may help:

• Reduce bacterial burden

• Calm inflammation

• Improve hydration

• Support skin healing

This may partly explain why some eczema patients improve in ocean environments or at mineral-rich spas.

Coal Tar Therapy

Coal tar is one of the oldest dermatologic treatments and was highlighted as a “forgotten” therapy.

Although less commonly used today, coal tar has historically been used for inflammatory skin conditions because of potential:

• Anti-inflammatory effects

• Antipruritic effects

• Skin turnover regulation

Its use has declined partly because of odor, messiness, irritation risk, and newer pharmaceutical options.

Acupuncture and Neuroimmune Regulation

The article explored acupuncture as a possible adjunctive therapy for eczema.

Potential mechanisms discussed included:

• Nervous system modulation

• Reduced itch signaling

• Stress reduction

• Altered inflammatory pathways

Although evidence remains mixed, some studies suggest acupuncture may help reduce itch intensity and improve quality of life in certain patients.

Stress, the Nervous System, and Eczema

The paper strongly emphasized the relationship between stress and inflammatory skin disease.

Stress may:

• Increase inflammatory cytokines

• Alter cortisol signaling

• Heighten itch perception

• Increase sympathetic nervous system activity

• Worsen sleep quality

The authors discussed psychoneuroimmunology—the interaction between the brain, nervous system, and immune system—as an important framework for understanding eczema.

Because of this, therapies aimed at calming the nervous system may indirectly improve skin health.

These included:

• Meditation

• Relaxation training

• Behavioral therapy

• Stress management

• Sleep optimization

The Itch-Scratch Cycle

One of the most important clinical concepts reviewed was the itch-scratch cycle.

Scratching:

• Damages the skin barrier

• Increases inflammation

• Promotes bacterial entry

• Sensitizes itch pathways in the brain

• Increases immune activation

Over time, chronic itch may become neurologically reinforced within the central nervous system.

This means eczema is not only occurring in the skin. The brain itself may become increasingly efficient at generating itch responses.

Probiotics and the Gut-Skin Axis

The article reviewed growing evidence linking gut microbes to immune regulation and eczema severity.

Potential probiotic mechanisms include:

• Increased T regulatory cell activity

• Reduced Th2 dominance

• Improved intestinal barrier integrity

• Reduced systemic inflammation

The evidence was described as mixed, but promising in some populations, especially children.

Not all probiotic strains appear equally effective.

Dietary Therapies and Supplements

Several nutritional interventions were reviewed.

Fish Oil

Fish oil may potentially influence:

• Inflammatory signaling

• Cell membrane composition

• Cytokine production

Vitamin D

Vitamin D was discussed because of its effects on:

• Immune regulation

• Skin barrier function

• Antimicrobial peptide production

Zinc

Zinc may support:

• Tissue healing

• Immune function

• Skin repair mechanisms

Evening Primrose Oil

Evening primrose oil has historically been used because of its gamma-linolenic acid (GLA) content, which may influence inflammatory pathways.

Elimination Diets

Elimination diets were discussed cautiously.

The article emphasized:

• Food triggers are not universal

• Some children with allergic tendencies may benefit

• Overly restrictive diets can become problematic

The evidence was described as highly variable between patients.

Botanical and Traditional Therapies

The review also explored a variety of botanical and traditional approaches.

These included:

• Herbal therapies

• Traditional remedies

• Plant-based anti-inflammatory compounds

The authors cautioned that evidence quality varies significantly and that some herbal preparations may themselves cause allergic reactions in susceptible individuals.

A Systems-Based View of Eczema

Perhaps the most important message from the article is that eczema is not caused by one single mechanism.

It involves interactions between:

• The skin barrier

• Immune activation

• Bacterial ecosystems

• Environmental triggers

• Stress physiology

• The nervous system

• Sleep

• Diet

• Microbial exposures

• Chronic itch signaling

This helps explain why many patients improve most with multidimensional treatment strategies rather than relying on a single cream or medication.

For some individuals, the most effective approach may involve combining:

• Conventional dermatology

• Barrier repair

• Microbiome management

• Nervous system regulation

• Stress reduction

• Nutritional support

• Sleep optimization

• Lifestyle modification

Eczema may appear on the surface of the skin, but the biology driving it reaches throughout the entire body.

REFERENCE:

Lyons, J. J., Milner, J. D., & Stone, K. D. (2015). Atopic dermatitis in children: Clinical features, pathophysiology, and treatment. Immunology and Allergy Clinics of North America, 35(1), 161–183. https://doi.org/10.1016/j.iac.2014.09.008