Lifestyle factors are critical for maintaining healthy skin. Smoking can cause dryness and premature aging of the skin. Sun exposure is associated with an increased risk of skin cancer, premature aging, and hyperpigmentation of the skin, requiring a limit to sun exposure and the use of sunscreen during prolonged exposure. Clinically, exercise has been shown to help promote a radiant, glowing complexion.
Optimal intake and assimilation of nutrients is also essential for promoting healthy skin. A deficiency of EFAs often manifests as dry, flaky skin and a predisposition to inflammatory conditions, such as eczema. Vitamin A is a crucial nutrient for healing tissues and regenerating epithelial tissues including the skin. Vitamin A deficiency can manifest as follicular hyperkeratosis, poor wound healing, and acne. Vitamin E can prevent scarring from blemishes and incisions. Vitamin C is an important nutrient for the skin both internally and topically because the vitamin helps to inhibit free-radical damage and promotes collagen production. The B vitamins promote skin health and offer stress relief, with vitamin B6 being particularly helpful for preventing premenstrual acne. Zinc deficiency is common in acne and other skin problems.
Probiotics, such as acidophilus and bifidobacteria, contribute to maintaining healthy and balanced gastrointestinal (GI) bacterial flora to enhance nutrient absorption and prevent the overgrowth of toxin-producing yeast and bacteria in the gut. Foods that contain sulfur, such as onions, garlic, and asparagus, provide the skin with this much-needed nutrient and support the liver's
354 CLINICAL NATURAL MEDICINE HANDBOOK Table 31-1. Skin and Nutritional Imbalances
(dark circles under the eyes) Cheilosis Jaundice
Low B vitamins (B2) Liver, increased bilirubin,
Cyanosis Dry skin Vitiligo Eczema
Pallor hemolytic anemia Anemia, shock Hypoxia, cyanide poisoning Dehydration, hypothyroid Autoimmune
Psoriasis Liver spots (lipofuscin)
or external Liver function Low antioxidants, high free-radical burden detoxification pathways. Finally, plenty of filtered or spring water also helps the body to remove wastes and keep the skin hydrated and healthy.
Eczema, or atopic dermatitis, is a common skin condition characterized by a chronic, itchy red rash. Eczema is thought to affect approximately 9% of the population in the United States, mostly children, and appears to be increasing.1 It is believed to be an allergic, immediate hypersensitivity disease also involving other immune responses. It often occurs as part of the "atopic triad'' of asthma, hay fever, and eczema. A positive family history of allergies is found in two-thirds of patients who have eczema. Serum immunoglobulin E (IgE) levels are elevated in 80% of patients with eczema, and they often test positive on skin, radioallergoabsorbant (RAST), or other allergy tests.2 White blood cells from patients with atopic dermatitis have decreased cyclic adenosine monophosphate (cAMP) levels as a result of increased AMP-phosphodiesterase activity. This lack of cAMP results in increased histamine release and decreased bactericidal activity.3 Patients with atopic dermatitis appear to have altered EFA and prostaglandin metabolism as well.4
Food allergies play a major role in producing atopic dermatitis. Identifying and avoiding food allergens may be an essential component of a thorough treatment plan for treating eczema. Breast-feeding infants has been found to offer significant protection from developing atopic dermatitis and allergies in general.2 In older or formula-fed infants, the most common offending food allergens are milk, eggs, peanuts, wheat, fish, and soybeans.5 If breast-fed infants develop atopic dermatitis, it is usually the result of allergic antigens in the breast milk being transferred from the mother to the infant. The mother's avoidance of common allergens is helpful for resolving such cases.6 Methods for diagnosing food allergy include the elimination diet, challenge, and the enzyme-linked immunoabsorbent assay and IgE and IgG assays. Food allergens in the diet may also contribute to the "leaky gut'' syndrome. This increased gut permeability causes an increased antigenic load on the immune system and can increase the likelihood of developing additional allergies.7 Clinically, often replenishing beneficial GI flora with lactobacillusand bifobacteriumstrainsalong with fructo-oligosaccharides is helpful, particularly when a patient has a history of antibiotic use. An overgrowth of Candida albicans in the GI tract has been identified as a causative factor in allergic conditions, including atopic dermatitis. Therapy to address Candida overgrowth may ameliorate atopic dermatitis significantly.8
The active ingredient of coleus, forskolin, most often used orally, may be helpful both orally and topically for ameliorating eczema.
Essential fatty acids may be useful for treating eczema. Borage (Borago officinalis) oil, a rich source of the omega-6 fatty acid gamma-linolenic acid, has been found to reduce skin inflammation, dryness, scaliness, and itching.9 Omega-3 fatty acids may be even more effective for relieving eczema symptoms. Fish oils appear to be a particularly good source of omega-3 fatty acids for patients with eczema because these oils contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).10 Consumption of cold-water fish, including salmon, mackerel, and herring, may also be useful. Zinc may also provide benefit for managing eczema due to the fact that zinc deficiency is common in atopic dermatitis and that zinc is crucial for proper fatty-acid metabolism.11
Plant-based therapies may also be indicated for managing eczema. Agents that stimulate cAMP production and=or inhibit cAMP phosphodiesterase may help to reduce the inflammatory process of atopic dermatitis by reducing shunting to histamine. Coleus (Coleus for-skolhii) is a strong stimulant of cAMP.12 The active ingredient of coleus, forskolin, most often used orally, may be helpful both orally and topically for ameliorating eczema. Flavonoids may help to reduce inflammation because of their ability to reduce mast-cell degranulation and inhibit cAMP phosphodiesterase. Helpful sources of flavonoids include quercitin, grape (Vitis vine fera) seed, pine (Pinus spp.) bark, green tea (Camellia sinensis), and ginkgo (Ginkgo biloba).11,13 Licorice (Glycyrrhiza glabra) root, used either topically or internally, may also help to alleviate eczema symptoms.14 Other herbs to consider for topical use are chamomile (Matricaria chamomilla), calendula (Calendula officinalis), and oak (Quercus alba), all of which are known for their anti-inflammatory properties.
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