Eczema

What is Eczema?

Eczema is a group of skin conditions that cause inflamed, itchy skin, and the most common form is atopic dermatitis. Atopic dermatitis is a chronic, relapsing condition with recurring eczema-like patches and intense itch, and it affects people of all ages.^[1]

Common symptoms

Itch is the main symptom, and it is often worse at night. Repeated scratching sets off an itch-scratch cycle that damages the skin further.^[2]

• Dry, red, inflamed patches, commonly in the creases of the elbows and knees, and on the hands, feet and face
• Scaling, oozing or crusting during flares
• Thickened, leathery skin where scratching has gone on for a long time
• Small itchy blisters on the palms, fingers or soles in dyshidrotic eczema
• Coin-shaped patches in nummular eczema

Scratched skin can become infected, and poor sleep and low mood are common.^{[1, 2]}

Causes and risk factors

Atopic dermatitis involves a strong inherited tendency, a weakened skin barrier and immune activity that drives inflammation in the skin.^[1] It is often found together with food allergy, asthma and allergic rhinitis, and a family history of these conditions raises the chance of developing it.^{[1, 2]}

Common triggers include irritants such as soaps, detergents and fragrances, allergens, dry or extreme weather, skin infections and stress. Contact dermatitis, sometimes called contact eczema, is caused by direct exposure to an irritant or allergen such as nickel.^[3]

How it is diagnosed and treated conventionally

A doctor diagnoses atopic dermatitis from your symptoms and the appearance of your skin using standard criteria. Patch testing may be done when an allergic contact cause is suspected.^{[2, 3]}

Daily moisturizers and soap-free cleansers are the base of treatment. In a Cochrane review of 77 trials, moisturizers lowered disease severity and flares, although the quality of the trials varied.^[4] Topical corticosteroids are the usual first-line treatment for flares, and topical calcineurin inhibitors and ultraviolet phototherapy are other options. Antibiotics treat secondary infection. Oral antihistamines are not recommended for itch because they do not reduce it.^[2] Newer targeted treatments are now available for more severe disease.^[1]

Why Eczema calls for a whole-person approach

Eczema is not only a skin-surface problem. The skin barrier, the immune system, itch, sleep and mood all interact, and each can make the others worse.

Treating the skin remains the foundation. Complementary care is aimed at the surrounding factors that affect how a person feels and copes between flares.

Immune activity and the skin barrier

Atopic dermatitis combines an impaired skin barrier with immune activity that is mostly driven by allergy-type (type 2) pathways, although other pathways also take part.^[1] This is why moisturizers and anti-inflammatory creams are both needed.

Itch and the itch-scratch cycle

Intense itch is the defining symptom of atopic dermatitis. Scratching damages the skin and feeds more inflammation and itch.^[2]

Sleep

A meta-analysis of 32 studies with about 86,000 participants estimated that 43.4% of people with atopic dermatitis have a sleep disorder.^[5]

Stress and mood

Atopic dermatitis is associated with a higher risk of mental health conditions, including depression and anxiety.^[1] Supporting stress and mood is a reasonable part of care for someone living with a chronic, visible skin condition.

Acupuncture for Eczema

What the research shows

Research suggests acupuncture may reduce itch in atopic dermatitis, but the trials are small and the overall evidence is limited. A 2024 meta-analysis of 8 randomized trials with 463 participants found lower severity scores, lower itch scores and better quality of life with acupuncture. It found no clear difference in the EASI score, and the authors said the number and quality of studies were limited.^[6] Another meta-analysis of 8 trials, most done in China, found acupuncture better than conventional medicine on some measures. It could not separate the effect of needling from other effects because most trials were not sham-controlled.^[7]

A sham-controlled trial of 36 adults with mild to moderate atopic dermatitis gave acupuncture twice a week for 4 weeks. Severity scores fell by about 12 points with real acupuncture and were unchanged with sham.^[8] A larger open trial of 121 adults found no difference in overall severity after 12 weeks, but itch was lower with acupuncture than with routine care alone, and the authors called this exploratory.^[9]

A broader review of complementary treatments for acne, atopic dermatitis and psoriasis found the evidence insufficient to recommend them,^[10] while an earlier review of 70 trials of complementary therapies for atopic dermatitis found some higher-level evidence for acupuncture, with the caution that studies were small and of poor quality.^[11]

How acupuncture may work

How acupuncture affects eczema is not settled. In a small crossover trial of 30 adults with atopic eczema, acupuncture at specific points lowered itch and shrank the wheal-and-flare reaction to an allergen skin test compared with no acupuncture. This points to an effect on allergic itch signaling.^[12] Needling at a placebo point also lowered itch in part of that trial, so the effect may not be point-specific.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the arms, legs and body, usually left in place for about 20 to 40 minutes. The sham-controlled trial used two visits a week for 4 weeks.^[8] We reassess after a short course of visits. Needling should be avoided through broken, weeping or infected skin.

Serious problems are rare. In prospective studies about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Eczema

The Ayurvedic view

Ayurveda describes eczema-like skin disease under the name Vicharchika, a form of Kushtha (skin disorder).^[14] In this traditional framework it is linked mainly to Pitta and Kapha imbalance and to disturbed blood (rakta). These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine adjusted to the person, often avoiding foods considered heating or aggravating
• Herbs, taken by mouth or applied to the skin, such as turmeric and neem
• Soothing oil preparations for dry skin, used on intact skin
• Panchakarma cleansing procedures such as Virechana (a medicated purgation), where traditionally appropriate^[14]

Panchakarma is not appropriate during pregnancy, acute illness or frailty, on infected or weeping skin, or before a doctor has assessed the rash. Herbal preparations applied to the skin (transdermal medication therapy) may be considered, with no efficacy claim made for them here.

What the research shows

The research on Ayurveda for eczema is very limited. We found no randomized controlled trials of Ayurvedic treatment for eczema. The published material is mostly case reports, such as one of a 45-year-old man with an itchy, oozing eczema-type rash on the feet. A single case report cannot show that a treatment works.^[14]

A systematic review of turmeric and curcumin in skin disease found 18 clinical studies across many conditions, including atopic dermatitis. It described early evidence of benefit and noted that the studies were limited.^[15] It does not show that turmeric treats eczema.

Herbal medicine for Eczema

Herbs and formulas that have been studied

Most research is on multi-herb Chinese formulas for atopic dermatitis, taken by mouth or applied to the skin. The herbs and combinations differ widely between trials.^{[16, 17]} One recent trial tested Huoxiang Zhengqi oral liquid, a Chinese formula, in adults with mild eczema.^[18]

What the research shows

The evidence is limited and the trials are mostly of low quality. A Cochrane review of 28 trials with 2,306 participants found that most had a high risk of bias and inconsistent results. It concluded there was no conclusive evidence that Chinese herbs, by mouth or on the skin, reduce eczema severity.^[16]

A 2023 meta-analysis of 17 trials with 1,624 patients found a higher overall recovery rate and a lower recurrence rate with Chinese herbal medicine. The benefit on severity scores was not robust, and there was no clear difference in EASI score or quality of life.^[17] In the 218-adult Huoxiang Zhengqi trial, EASI scores fell slightly more than with placebo after 4 weeks. The trial was short and included only people with mild disease.^[18]

Safety and herb-drug interactions

Herbs are active substances and can cause allergic skin reactions of their own, which can be mistaken for an eczema flare. They can also interact with medicines, including blood thinners such as warfarin, immune-suppressing drugs and antidepressants.^[19]

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually by a qualified practitioner. Tell us about every cream, pill and supplement you use, and whether you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes red, itchy, oozing eczema as wind, heat or damp-heat in the skin, and dry, scaly eczema as blood dryness. Researchers study things that loosely parallel this picture: allergic itch signaling, the skin's inflammatory response and the immune pathways behind atopic dermatitis.^{[1, 12]}

Ayurveda's Pitta and Kapha imbalance and disturbed blood describe heat, redness and oozing. No study has shown that a dosha or a pattern corresponds to a specific immune or skin process.

How this care fits with your medical care

Integrative care for eczema is complementary. Keep seeing your doctor or dermatologist, keep using prescribed creams, light therapy and other medicines as directed, and do not stop or change them without your prescriber. We do not diagnose eczema or its type, so a new or changing rash should be evaluated by a physician.

Please bring your diagnosis, any patch test or allergy results, a full list of creams, medicines and supplements, and notes on known triggers.

When to seek urgent medical care

Eczema can become infected, and some skin reactions need prompt care.^[2]

• Skin that is painful, swollen, warm or leaking pus, especially with fever
• Clusters of painful blisters or punched-out sores on eczema skin, which may be a herpes infection
• A rash that spreads quickly over much of the body, or widespread red, peeling skin
• Swelling of the face, lips or tongue, or trouble breathing
• A rash that began after starting a new medicine
• Eye pain or vision changes with a facial rash

If any of these occur, call 911 or go to the nearest emergency department.