Atopic dermatitis more commonly known as eczema is a chronic condition characterized by red swollen itchy skin. It is most common in babies and children but it is estimated that between 9 and 30 percent of the American population is affected by one of the many forms of eczema. While eczema is neither life-threatening nor contagious the unsightly visible evidence on the skin–particularly on the face and other regularly exposed areas—can have debilitating effects on quality of life as sufferers may feel compelled to avoid social engagements during particularly severe flare-ups.

There is debate regarding the exact causes and triggers of eczema. There may be a genetic component and flare-ups may result after use of products that are irritating to the skin such as certain soaps shampoos lotions and other cosmetics. It is generally accepted that there is some degree of allergy underlying eczema and up to 80% of children with eczema will also develop hay fever and/or asthma. Moreover a significant body of research indicates that eczema may be an autoimmune condition. If so this would explain why many of the common treatments—such as creams to control itching and fight infection and oral or injected anti-inflammatories—are often ineffective or are effective only for a short time. Moreover many of the common treatments have unpleasant and harmful side-effects. 

If eczema is an autoimmune disorder then the most effective way to treat it would be to address the root cause through restoring healthful immune function rather than attacking the symptoms piecemeal via skin creams and antibiotics. Between one third and two thirds of young people with eczema also have food allergies the most common of which are wheat dairy eggs soy and nuts and seeds. The fact that all of these foods are typically eliminated in most dietary protocols that address autoimmune conditions lends more weight to the likelihood that there is an autoimmune component underlying the condition. Plus autoimmune conditions often flare up when an affected individual is under high amounts of psychological and physiological stress and this is known to be true for eczema.

Autoimmune conditions are often associated with—and potentially caused at least in part by—small intestinal permeability also known as “leaky gut.” There is increasing awareness in medicine about the “gut-skin axis” wherein a leaky gut may result in extra-gastrointestinal manifestations of allergy such as acne and eczema. A systematic review of studies looking at autoimmunity and eczema determined that the prevalence of autoimmune states in eczema patients ranged from 23 to 91 percent. Based on plausible mechanisms involving IgE autoantibodies IgG autoantibodies and T-helper 1 (Th1) autoreactivity the review authors concluded that autoimmunity may indeed be a cause of eczema. Other studies support this view as the serum of patients with severe eczema contains IgE auto-antibodies that target self-keratinocytes.

Operating under the idea that eczema has an autoimmune component a small study was conducted in which researchers gave six patients with intractable eczema the drug tofacitinib citrate which is used to reduce inflammation in rheumatoid arthritis (RA) a condition with an established autoimmune basis. All six subjects reported significant reductions in itching skin redness and thickening as well as improved sleep. (The itching and other discomfort associated with eczema often results in difficulty sleeping.) These were patients who did not experience symptom relief from conventional treatments so the dramatic improvements conferred by the drug are especially promising. 

Another way to tackle the underlying autoimmune dysfunction in eczema is through diet and lifestyle modification. Stress reduction is key and the dietary strategy would start with a Paleo-style diet free of grains legumes and dairy which would remove three of the most common food allergens that may cause and/or exacerbate a leaky gut. A stricter autoimmune dietary protocol would call for eliminating eggs nuts and seeds and possibly also nightshade vegetables although the latter are more frequently implicated in exacerbating RA specifically. Many nutritional supplements are also helpful for repairing a leaky gut such as probiotics L-glutamine digestive enzymes and deglycyrrhizinated licorice (DGL).