Vitamin C
In a randomized, double-blind, crossover study, significant symptomatic improvement was found in 10 severely affected patients aged 3 to 21 years following 6 months of supplementation with 50 to 75 mg/kg of slow-release vitamin C.
Treated patients required half as many courses of antibiotics for skin infections as those given placebo. Improvements in lymphocyte transformation and neutrophil chemotaxis were also seen, suggesting that vitamin C may act by boosting the immune response.¹

Selenium Deficiency
Patients sometimes have reduced erythrocyte levels of glutathione peroxidase, a selenium-containing enzyme,² suggesting the possibility of a marginal selenium deficiency.
In an open trial, patients who had low levels of glutathione peroxidase showed encouraging improvements as enzyme levels rose over 6 to 8 weeks following supplementation with selenium along with vitamin E.³ When, however, an unselected group of patients were given similar supplementation in a double-blind study, the supplement was found to be ineffective.²

Sodium Restriction
Sweat sodium is reported to be increased in atopic eczema.⁴ Back in 1912, it was reported that reducing salt intake was beneficial to certain patients, primarily those with a major secretory component to their rash. Responders noted a lessening of lesions and improvement in pruritus within 3 to 4 days, with major improvement in about 3 weeks.⁵ More recently, a preschool girl was described whose eczema improved following a change to low-salt table water.⁶

Zinc Deficiency
A sub-group of patients appears to be hypozincemic.⁷ It appears that reduced serum zinc levels are correlated with the severity of the lesions⁸ and a tendency towards recurrent skin infections.7 There is also evidence that both serum⁹ and hair¹⁰ copper may be elevated in children with eczema. (Elevated copper would decrease zinc absorption and increase its urinary excretion).¹¹
An anecdotal report suggests that supplementation with 50 mg of chelated zinc 3 times daily, together with other indicated nutritional treatments, may be strikingly effective, with full remission occurring in 3 to 8 months in most patients.¹² However, an 8-week double-blind trial using less than one-third the zinc dosage (and nothing else) was unsuccessful.¹³ Obviously, a longer double-blind study using a larger dosage of zinc — and preferably limited to patients with marginal zinc deficiencies — is needed to resolve the issue of its efficacy.

Essential Fatty Acids
Patients with atopic eczema may have impairment of the enzyme delta-6-desaturase causing defective desaturation of alpha-linolenic (omega-3) and linoleic (omega-6) acids. The resulting changes in prostaglandins and leukotrienes could affect the immune response and thus promote the condition.¹⁴

Omega-3 Fatty Acids
In a double-blind study, patients supplemented with 1.8 gm EPA daily had reduced scaling, itching, and overall subjective severity of skin lesions compared to olive oil-treated controls.¹⁵ However, another double-blind study — which neglected to state the EPA dosage and used a mixture of saturated fatty acids as the placebo — failed to confirm these findings.¹⁶

Omega-6 Fatty Acids
In a meta-analytic analysis of ⁹ placebo-controlled studies, evening primrose oil (a source of GLA) was significantly more effective than placebo, especially in reducing itching.¹⁷ Since then, however, additional placebo-controlled studies have failed to confirm the efficacy of GLA,¹⁸ leaving the issue unresolved.

Doctor Werbach cautions that the nutritional treatment of illness should be supervised by physicians or practitioners whose training prepares them to recognize serious illness and to integrate nutritional interventions safely into the treatment plan.

References
1. Kline, Glen. Presentation to the Annual Meeting, American Academy of Allergy and Immunology, 1989
2. Fairris GM et al. The effect on atopic dermatitis of supplementation with selenium and vitamin E. Acta Derm Venereol (Stockh) 69(4):359-62, 1989
3. Juhlin L et al. Blood glutathione-peroxidase levels in skin diseases: Effect of selenium and vitamin E treatment. Acta Derm Venereol (Stockh) 62:211-14, 1982
4. Liebke C et al. Sweat electrolyte concentrations in children with atopic dermatitis. Letter. Lancet 350:1678-9, 1997
5. Finkelstein H. Lehrbuch der Säuglingkrankheiten: Fischer's medicin. Berlin, Buchhandlung h Kornfeld, 1912
6. Barthel HR, Stuhlmuller B. Improvement in atopic dermatitis with change in low-salt table water. Letter. Lancet 344:1089, 1994
7. David TJ et al. Low serum zinc in children with atopic eczema. Br J Dermatol 111(5):597-601, 1984
8. Endre L et al. [Incidence of food allergy and zinc deficiency in children treated for atopic dermatitis.] Orv Hetil 130(46):2465-9, 1989
9. David TJ et al. Serum levels of trace metals in children with atopic eczema. Br J Dermatol 122(4):485-9, 1990
10. Di Toro R et al. Zinc and copper status of allergic children. Acta Paediatr Scand 76(4):612-17, 1987
11. Scott KC, Turnlund JR. A compartmental model of zinc metabolism in adult men used to study effects of three levels of dietary copper. Am J Physiol 267(1 Pt 1):E165-73, 1994
12. Wright JV. Dr. Wright's Book of Nutritional Therapy. Emmaus, Penn., Rodale Press, 1979
13. Ewing CI et al. Failure of oral zinc supplementation in atopic eczema. Eur J Clin Nutr 45(10):507-10, 1991
14. Galland L. Increased requirements for essential fatty acids in atopic individuals: A review with clinical descriptions. J Am Coll Nutr 5(2):213-28, 1986
15. Bjorneboe A et al. Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis. Br J Dermatol 117(4):463-69, 1987
16. Kunz B et al. Eicosapentaenoic acid (EPA) treatment in atopic eczema (AE): a prospective double-blind trial. Abstract. J Allergy Clin Immunol 83:196, 1989
17. Morse PF et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogram in the treatment of atopic eczema: relationship between plasma essential fatty changes and treatment response. Br J Dermatol 121:75-90, 1989
18. Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Child 75:494-7, 1996

Modified from Werbach MR with Moss J. Textbook of Nutritional Medicine. Tarzana, CA, Third Line Press, Inc., 1999.

Doctor Werbach's voluminous Nutritional Influences on Illness CD-ROM, with 4,200 pages of text and covering over 100 different illnesses, makes it easy to search the nutritional literature. For information, contact Third Line Press Inc., 4751 Viviana Drive, Tarzana, California 91356 USA; 800-916-0076; 818-996-0076; FAX: 818-774-1575; E-mail: tlp@third-line.com; Internet: http://www.third-line.com).

Nutritional Influences on Illness
by Melvyn R. Werbach, MD
4751 Viviana Drive • Tarzana, California 91356 USA
Phone 818-996-0076 • Fax 818-774-1575

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