Eczema

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Eczema

Need to Know

Eczema
Soothe your eczema irritation. This common skin condition is characterized by dry, itchy skin. According to research or other evidence, the following self-care steps may be helpful.
  • Avoid allergens and irritants

    Work with a qualified professional to identify airborne allergens, chemicals, foods, and irritants that make your condition worse

  • Take fatty acids

    Supply anti-inflammatory fatty acids missing in many people with eczema by taking 500 to 1,000 mg a day of GLA (gamma-linolenic acid) from evening primrose oil or borage oil, or 1,800 mg a day of EPA (eicosapentaenoic acid) from fish oils; children should take amounts proportionately less according to body weight

  • Help children avoid allergies with beneficial bacteria

    Pregnant women and newborns should get probiotic supplements that contain 10 billion colony-forming units a day of lactobacillus-type bacteria to reduce risk of eczema in early life

About

About This Condition

Eczema is a common inflammatory condition of the skin.

Many skin diseases cause symptoms similar to those of eczema, so it is important to have the disease properly diagnosed before it is treated.

Symptoms

Eczema is characterized by scaling, thickened patches of skin that can become red and fissured. It may also appear as tiny blisters (called vesicles) that rupture, weep, and crust over. The most troublesome and prevalent symptom of eczema is itching, which may be constant.

Holistic Options

Numerous trials have reported that hypnosis improves eczema in children and adults.1 A preliminary trial emphasizing relaxation, stress management, and direct suggestion in hypnosis showed reduced itching, scratching, and sleep disturbance, as well as reduced requirements for topical corticosteroids. All of the patients studied had been resistant to conventional treatment.2

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why Get started
Cut out coffee Some people with eczema may be allergic to coffee. Avoiding coffee may lead to improvements in eczema symptoms.

Cut out coffee

It has been reported that when heavy coffee drinkers with eczema avoided coffee, eczema symptoms improved.3 In this study, the reaction was to coffee, not caffeine, indicating that some people with eczema may be allergic to coffee. People with eczema who are using a hypoallergenic diet to investigate food allergies should avoid coffee as part of this trial.
Uncover allergies Eczema can be triggered by food allergies, an elimination diet can help identify your sensitivities.

Uncover allergies

Eczema can be triggered by allergies.4 , 5 Most children with eczema have food allergies, according to data from double-blind research.6 A doctor should be consulted to determine whether allergies are a factor. Once the trigger for the allergy has been identified, avoidance of the allergen can lead to significant improvement.7However, “classical” food allergens (e.g., cows’  milk, egg, wheat, soy, and nuts) are often not the cause of eczema in adults. A variety of substances have been shown, in a controlled trial, to trigger eczema reactions in susceptible individuals; avoidance of these substances has similarly been shown to improve the eczema. Triggers included food additives, histamine, salicylates, benzoates, and other compounds (such as aromatic compounds) found in fruits, vegetables, and spices.8 These reactions do not represent true food allergies but are instead a type of food sensitivity reaction. The authors of this study did not identify which substances are the most common triggers.

Supplements

What Are "Star" Ratings?

a7_3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.


Supplement Amount Why
Calendula
(Radiation-Induced Dermatitis)
 Refer to label instructions 2 stars   Radiation therapy for breast cancer frequently causes painful dermatitis. Breast cancer patients who topically applied calendula had significantly fewer cases of severe dermatitis.

2 stars  Calendula

Radiation therapy for breast cancer frequently causes painful dermatitis at the radiation site. In a study of women undergoing radiation therapy for breast cancer, those who topically applied Calendula officinalis had significantly fewer cases of severe dermatitis, compared with those who used a standard medication.9 Calendula treatment was begun after the first radiation session and was applied twice a day or more, depending on whether dermatitis or pain occurred.

Supplement Amount Why
Chamomile
 Apply 5 to 6% herbal extract several times per day 2 stars   Topical applications of chamomile have been shown to be moderately effective in the treatment of eczema.

2 stars  Chamomile

Apply 5 to 6% herbal extract several times per day

Topical applications of chamomile have been shown to be moderately effective in the treatment of eczema.10 , 11 One trial found it to be about 60% as effective as 0.25% hydrocortisone cream.12

Supplement Amount Why
Evening Primrose Oil
 Adults: 500 to 1,000 mg a day of GLA; children: proportionately less, according to body weight 2 stars   Supplementing with evening primrose oil can supply anti-inflammatory fatty acids that are missing in many people with eczema.

2 stars  Evening Primrose Oil

Adults: 500 to 1,000 mg a day of GLA; children: proportionately less, according to body weight

Researchers have reported that people with eczema do not have the normal ability to process fatty acids, which can result in a deficiency of gamma-linolenic acid (GLA).13 GLA is found in evening primrose oil (EPO), borage oil, and black currant seed oil. Some,14 , 15 , 16 but not all,17 , 18 , 19 , 20 double-blind trials have shown that EPO is useful in the treatment of eczema. An analysis of nine trials reported that the effects for reduced itching were most striking.21 Much of the research uses 12 pills per day; each pill contains 500 mg of EPO, of which 45 mg is GLA. Smaller amounts have been shown to lack efficacy.22

Supplement Amount Why
Fish Oil
 Adults: 1,800 mg a day of EPA; children: proportionately less, according to body weight 2 stars   Supplementing with fish oil can supply anti-inflammatory fatty acids that are missing in many people with eczema.

2 stars  Fish Oil

Adults: 1,800 mg a day of EPA; children: proportionately less, according to body weight

Ten grams of fish oil providing 1.8 grams of EPA (eicosapentaenoic acid) per day were given to a group of eczema sufferers in a double-blind trial. After 12 weeks, those using the fish oil experienced significant improvement.23 , 24 According to the researchers, fish oil may be effective because it reduces levels of leukotriene B4, a substance that has been linked to eczema.25 The eczema-relieving effects of fish oil may require taking ten pills per day for at least 12 weeks. Smaller amounts of fish oil have been shown to lack efficacy.26

One trial using vegetable oil as the placebo reported that fish oil was barely more effective than the placebo (30% vs. 24% improvement).27 As vegetable oil had previously been reported to have potential therapeutic activity, the apparent negative outcome of this trial should not dissuade people with eczema from considering fish oil.

Supplement Amount Why
Galacto-oligosaccharides and Fructo-oligosaccharides
(Infants)
 90% galacto-oligosaccharides and 10% fructo-oligosaccharides mixture added daily to infant formula 2 stars   In one study, adding a mixture of 90% galacto-oligosaccharides and 10% fructo-oligosaccharides to infant formula prevented the development of eczema in babies who were at high risk of developing eczema.


2 stars  Galacto-oligosaccharides and Fructo-oligosaccharides

90% galacto-oligosaccharides and 10% fructo-oligosaccharides mixture added daily to infant formula

In a double-blind trial, the addition of a mixture of 90% galacto-oligosaccharides and 10% fructo-oligosaccharides to infant formula prevented the development of eczema in infants who were at high risk of developing eczema. The incidence of eczema in the first six months of life was 9.8% in the group receiving oligosaccharides, compared with 23.1% in the placebo group, a statistically significant difference. The product used in this study was designed to mimic the oligosaccharide content of human milk, and was added at a concentration of 0.8 grams per 100 ml.28

Supplement Amount Why
Probiotics
 10 billion colony-forming units daily of lactobacillus-type bacteria 2 stars   Pregnant women and newborns who take probiotic supplements may reduce risk of eczema in early life.

2 stars  Probiotics

10 billion colony-forming units daily of lactobacillus-type bacteria

A double-blind trial reported that use of a hypoallergenic infant formula plus probiotics (500 million organisms of Lactobacillus GG bacteria per gram of formula, taken for one month) initially led to improvement in eczema symptoms in infants with suspected allergy to cow's milk.29 However, by the end of two months, both the group receiving Lactobacillus GG and the placebo group had improved approximately the same amount. In the same report, a preliminary trial giving 20 billion lactobacilli twice per day to breast-feeding mothers led to significant improvement of their allergic infants’ eczema after one month. However, another double-blind trial found that Lactobacillus GG was no more effective than a placebo in infants with mild to moderate eczema.30 In another double-blind trial, a different probiotic preparation (1 billion organisms of Lactobacillus fermentum VRI-033 PCC taken twice a day) reduced the severity of eczema in a group of young children with moderate or severe eczema.31 Probiotics may reduce allergic reactions by improving digestion, by helping the intestinal tract control the absorption of food allergens, and/or by changing immune system responses.


Supplement Amount Why
St. John’s Wort
 Apply a cream containing 5% of an herbal extract standardized to 1.5% hyperforin twice per day 2 stars   A topical cream containing St. John’s wort was shown in one study to greatly improve the severity of eczema. The herb appears to have anti-inflammatory and antibacterial effects.

2 stars  St. John’s Wort

Apply a cream containing 5% of an herbal extract standardized to 1.5% hyperforin twice per day

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.32 Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

In a double-blind trial, people with eczema applied a cream containing an extract of St. John’s wort to the affected areas on one side of the body, and a placebo (the same cream without the St. John’s wort) to the other side. The treatment was administered twice a day for four weeks. The severity of the eczema improved to a significantly greater extent on the side treated with St. John’s wort than on the side treated with placebo.33 Although the mechanism by which St. John’s wort relieves eczema is not known, it might be due to the anti-inflammatory and antibacterial effects of hyperforin, one of its constituents. The cream used in this study contained 5% of an extract of St. John’s wort (standardized to 1.5% hyperforin). As topical application of St. John’s wort can cause sensitivity to the sun, care should be taken to avoid excessive sun exposure when using this treatment.

Supplement Amount Why
Witch Hazel
 Apply 10 to 20% herbal extract two to three times per day 2 stars   A cream prepared with witch hazel and phosphatidylcholine has been shown to be effective in the topical management of eczema.

2 stars  Witch Hazel

Apply 10 to 20% herbal extract two to three times per day

A cream prepared with witch hazel and phosphatidylcholine has been reported to be as effective as 1% hydrocortisone in the topical management of eczema, according to one double-blind trial.34

Supplement Amount Why
Zemaphyte Chinese Herbal Formula
 One or two packets mixed in hot water and taken once daily 2 stars   Zemaphyte, a traditional Chinese herbal preparation that includes licorice as well as nine other herbs, has been successful in treating childhood and adult eczema in trials.

2 stars  Zemaphyte Chinese Herbal Formula

One or two packets mixed in hot water and taken once daily

Zemaphyte, a traditional Chinese herbal preparation that includes licorice as well as nine other herbs, has been successful in treating childhood and adult eczema in double-blind trials.35 , 36 , 37 One or two packets of the combination is mixed in hot water and taken once per day. Because one study included the same amount of licorice in both the placebo and the active medicine, it is unlikely that licorice is the main active component of Zemaphyte.38

Several Chinese herbal creams for eczema have been found to be adulterated with steroids. The authors of one study found that 8 of 11 Chinese herbal creams purchased without prescription in England contained a powerful steroid drug used to treat inflammatory skin conditions.39

Supplement Amount Why
Burdock
 Refer to label instructions 1 star   Burdock has been used historically to treat people with eczema.
Calendula
 Refer to label instructions 1 star   Topical preparations containing calendula, chickweed, or oak bark have been used traditionally to treat people with eczema.


1 star  Calendula

Topical preparations containing calendula, chickweed, or oak bark40have been used traditionally to treat people with eczema but none of these has been studied in scientific research focusing on people with eczema.

Radiation therapy for breast cancer frequently causes painful dermatitis at the radiation site. In a study of women undergoing radiation therapy for breast cancer, those who topically applied Calendula officinalis had significantly fewer cases of severe dermatitis, compared with those who used a standard medication.41 Calendula treatment was begun after the first radiation session and was applied twice a day or more, depending on whether dermatitis or pain occurred.

Supplement Amount Why
Chickweed
 Refer to label instructions 1 star   Topical preparations containing calendula, chickweed, or oak bark have been used traditionally to treat people with eczema.

1 star  Chickweed

Topical preparations containing calendula, chickweed, or oak bark42have been used traditionally to treat people with eczema but none of these has been studied in scientific research focusing on people with eczema.

Supplement Amount Why
Licorice
 Refer to label instructions 1 star   Licorice may help eczema through its anti-inflammatory effects and its ability to affect the immune system.


1 star  Licorice

Zemaphyte, a traditional Chinese herbal preparation that includes licorice as well as nine other herbs, has been successful in treating childhood and adult eczema in double-blind trials.43 , 44 , 45 One or two packets of the combination is mixed in hot water and taken once per day. Because one study included the same amount of licorice in both the placebo and the active medicine, it is unlikely that licorice is the main active component of Zemaphyte.46

Several Chinese herbal creams for eczema have been found to be adulterated with steroids. The authors of one study found that 8 of 11 Chinese herbal creams purchased without prescription in England contained a powerful steroid drug used to treat inflammatory skin conditions.47

Supplement Amount Why
Oak
 Refer to label instructions 1 star   Topical preparations containing calendula, chickweed, or oak bark have been used traditionally to treat people with eczema.

1 star  Oak

Topical preparations containing calendula, chickweed, or oak bark48have been used traditionally to treat people with eczema but none of these has been studied in scientific research focusing on people with eczema.

Supplement Amount Why
Oats
 Refer to label instructions 1 star   Wild oats have been used historically to treat people with eczema.

1 star  Oats

Burdock , sarsaparilla, red clover, and wild oats have been used historically to treat people with eczema, but without scientific investigation.

Supplement Amount Why
Onion
 Refer to label instructions 1 star   Onion injections into the skin and topical onion applications have been shown to inhibit skin inflammation in people with eczema, according to one trial.

1 star  Onion

Onion injections into the skin and topical onion applications have been shown to inhibit skin inflammation in people with eczema, according to one double-blind trial.49 The quantity or form of onion that might be most effective is unknown.

Supplement Amount Why
Red Clover
 Refer to label instructions 1 star   Red clover has been used historically to treat people with eczema.

1 star  Red Clover

Burdock , sarsaparilla, red clover, and wild oats have been used historically to treat people with eczema, but without scientific investigation.

Supplement Amount Why
Sarsaparilla
 Refer to label instructions 1 star   Sarsaparilla has been used historically to treat people with eczema.

1 star  Sarsaparilla

Burdock , sarsaparilla, red clover, and wild oats have been used historically to treat people with eczema, but without scientific investigation.

Supplement Amount Why
Shelled Hemp Seed
 Refer to label instructions 1 star   Theoretically shelled hemp seed or its oil may be useful for people with eczema due to its essential fatty acid content.

1 star  Shelled Hemp Seed

Though it has not been studied, theoretically shelled hemp seed or its oil may be useful for people with eczema due to its content of essential fatty acids.50

Supplement Amount Why
Shiunko
 Refer to label instructions 1 star   Shiunko, a Japanese topical ointment, has been reported to help improve eczema symptoms, according to preliminary research.

1 star  Shiunko

A Japanese topical ointment called Shiunko has been reported to help improve symptoms of eczema, according to preliminary research.51 The ointment contains sesame oil and four herbs (Lithospermum radix, Angelica radix, Cera alba and Adeps suillus) and was applied twice daily along with petrolatum and 3.5% salt water for three weeks. Clinical improvement was seen in four of the seven people using Shiunko.

Supplement Amount Why
Vitamin C
 Refer to label instructions 1 star   Vitamin C might be beneficial in treating eczema by affecting the immune system.

1 star  Vitamin C

In 1989, Medical World News reported that researchers from the University of Texas found that vitamin C, at 50–75 mg per 2.2 pounds of body weight, reduced symptoms of eczema in a double-blind trial.52 In theory, vitamin C might be beneficial in treating eczema by affecting the immune system, but further research has yet to investigate any role for this vitamin in people with eczema.

References

1. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol 2000;136:393–9.

2. Stewart AC, Thomas SE. Hypnotherapy as a treatment for atopic dermatitis in adults and children. Br J Dermatol 1995;132:778–83.

3. Veien NK, Hattel T, Justesen O, et al. Dermatoses in coffee drinkers. Cutis 1987;40:421–2.

4. Sampson HA, Scanlon SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr 1989;115:23–7.

5. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity. J Pediatr 1988;113:447–51.

6. Niggemann B, Sielaff B, Beyer K, et al. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy 1999;29:91–6.

7. Atherton DJ. Diet and atopic eczema. Clin Allerg 1988;18:215–28 [review].

8. Worm M, Ehlers I, Sterry W, Zuberbier T. Clinical relevance of food additives in adult patients with atopic dermatitis. Clin Exp Allergy 2000;30:407–14.

9. Pommier P, Gomez F, Sunyach MP, et al. Phase III randomized trial of *Calendula officinalis* compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. *J Clin Oncol* 2004;22:1447–53.

10. Nissen HP, Blitz H, Kreyel HW. Prolifometrie, eine methode zur beurteilung der therapeutischen wirsamkeit kon Kamillosan®-Salbe. Z Hautkr 1988;63:184–90.

11. Aergeerts P, Albring M, Klaschka F, et al. Vergleichende prüfung von Kamillosan®-creme gegenüber seroidalen (0.25% hydrocortison, 0.75% flucotinbutylester) and nichseroidaseln (5% bufexamac) externa in der erhaltungsterpaie von ekzemerkrankungen. Z Hautkr 1985;60:270–7.

12. Albring M, Albrecht H, Alcorn G, Lüker PW. The measuring of the antiinflammatory effect of a compound on the skin of volunteers. Meth Find Exp Clin Pharmacol 1983;5:75–7.

13. Manku MS, Horrobin DF, Morse NL, et al. Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 1984;110:643–8.

14. Schalin-Karrila M, Mattila L, Jansen CT, et al. Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins. Br J Dermatol 1987;117:11–9.

15. Lovell CR, Burton JL, Horrobin DF. Treatment of atopic eczema with evening primrose oil. Lancet 1981;I:278 [letter].

16. Wright S, Burton JL. Oral evening-primrose oil improves atopic eczema. Lancet 1982;ii:1120–2.

17. Skogh M. Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids). J Am Acad Dermatol 1986;15:114–5.

18. Bamford JTM, Gibson RW, Renier CM. Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids). J Am Acad Dermatol 1985;13:959–65.

19. Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Child 1996;75:494–7.

20. Whitaker DK, Cilliers J, de Beer C. Evening primrose oil (Epogam) in the treatment of chronic hand dermatitis: disappointing therapeutic results. Dermatology 1996;193:115–20.

21. Morse PF, Horrobin DF, Manku MS, et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol 1989;121:75–90.

22. Berth-Jones J, Graham-Brown RAC. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Lancet 1993;341:1557–60.

23. Bjørneboe A, Søyland E, Bjørneboe GE, et al. Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis. Br J Dermatol 1987;117:463–9.

24. Bjørnboe A, Søyland E, Bjørnboe GE, et al. Effect of n-3 fatty acid supplement to patients with atopic dermatitis. J Intern Med Suppl 1989;225:233–6.

25. Søyland E, Rajka G, Bjørneboe A, et al. The effect of eicosapentaenoic acid in the treatment of atopic dermatitis. A clinical Study. Acta Derm Venereol (Stockh) 1989;144(Suppl):139.

26. Berth-Jones J, Graham-Brown RAC. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Lancet 1993;341:1557–60.

27. Søyland E, Funk J, Rajka G, et al. Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind multicentre study. Br J Dermatol 1994;130:757–64.

28. Moro G, Arslanoglu S, Stahl B, et al. A mixture of prebiotic oligosaccharides reduces the incidence of atopic dermatitis during the first six months of age. Arch Dis Child 2006;91:814–819.

29. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179–85.

30. Gruber C, Wendt M, Sulser C, et al. Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy 2007;62:1270–6.

31. Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005;90:892–7.

32. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500–4.

33. Schempp CM, Windeck T, Hezel S, Simon JC. Topical treatment of atopic dermatitis with St. John’s wort cream—a randomized, placebo controlled, double blind half-side comparison. Phytomedicine 2003;10(Suppl 4):31–7.

34. Laux P, Oschmann R. Witch hazel –Hamamelis virgincia L. Zeitschrift Phytother 1993;14:155–66.

35. Sheehan MP, Atherton DJ. One-year follow up of children treated with Chinese medical herbs for atopic eczema. Br J Dermatol 1994;130:488–93.

36. Sheehan MP, Rustin MH, Atherton DJ, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992;340:13–7.

37. Sheehan M, Stevens H, Ostlere L, et al. Follow-up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year. Clin Exp Dermatol 1995;20:136–40.

38. Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J Dermatol 1992;126:179–84.

39. Keane FM, Munn SE, du Vivier AWP, et al. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ 1999;318:563–4.

40. Weiss RF. Herbal Medicine. Gothenberg, Sweden: Ab Arcanum and Beaconsfield: Beaconsfield Publishers Ltd, 1988, 328–9.

41. Pommier P, Gomez F, Sunyach MP, et al. Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 2004;22:1447–53.

42. Weiss RF. Herbal Medicine. Gothenberg, Sweden: Ab Arcanum and Beaconsfield: Beaconsfield Publishers Ltd, 1988, 328–9.

43. Sheehan MP, Atherton DJ. One-year follow up of children treated with Chinese medical herbs for atopic eczema. Br J Dermatol 1994;130:488–93.

44. Sheehan MP, Rustin MH, Atherton DJ, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992;340:13–7.

45. Sheehan M, Stevens H, Ostlere L, et al. Follow-up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year. Clin Exp Dermatol 1995;20:136–40.

46. Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J Dermatol 1992;126:179–84.

47. Keane FM, Munn SE, du Vivier AWP, et al. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ 1999;318:563–4.

48. Weiss RF. Herbal Medicine. Gothenberg, Sweden: Ab Arcanum and Beaconsfield: Beaconsfield Publishers Ltd, 1988, 328–9.

49. Dorsch W, Ring J. Suppression of immediate and late anti-IgE-induced skin reactions by topically applied alcohol/onion extract. Allergy 1984;39:43–9.

50. Fitzsimmons S. Hemp seed oil: Fountain of youth? Br J Phytother 1998;5:90–6.

51. Higaki S, Kitagawa T, Morohashi M, Yamagishi T. Efficacy of Shiunko for the treatment of atopic dermatitis. J Int Med Res 1999;27:143–7.

52. Anonymous. Severe atopic dermatitis responds to ascorbic acid. Med World News 1989;April 24:41.

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