Eczema/Dermatitis Root Cause Protocol

Eczema (atopic dermatitis) affects 31+ million Americans, especially children. Red, itchy, scaly patches (elbow/knee creases, face, hands). Atopic march: Eczema → food allergies → asthma → allergic rhinitis (progression in childhood). Barrier dysfunction: Eczema is defective skin barrier (filaggrin gene mutations in many patients). Allows allergens/irritants in, water out (transepidermal water loss). Moisture barrier repair is foundation. Gut-skin axis: 80% of immune system in gut. Eczema patients have dysbiosis (different microbiome), increased intestinal permeability. Probiotics (especially L. rhamnosus GG) reduce eczema in RCTs, especially if started prenatally/infancy. Food allergies: Subset of eczema driven by food allergies (especially dairy, eggs). IgE testing can identify but not always correlate (IgG testing controversial). Elimination trial is gold standard. Staph aureus: 90% of eczema patients colonized (vs 5% general population). Staph worsens eczema (releases toxins triggering immune response). Bleach baths reduce colonization (sounds harsh but evidence-based - dilute concentration). Steroid creams: Mainstay of conventional treatment, effective for flares but not root cause. Long-term use causes skin atrophy, rebound. Use short-term only. Calcineurin inhibitors (tacrolimus, pimecrolimus) are non-steroid alternatives for face/eyelids. Dupixent: Biologic revolution for severe eczema - blocks IL-4 and IL-13 (Th2 cytokines driving eczema). 75%+ improvement in severe cases. Well-tolerated (conjunctivitis main side effect). Expensive but insurance often covers. GLA: Eczema patients have fatty acid metabolism defect (delta-6-desaturase impairment). Evening primrose oil (GLA source) theoretically corrects. Studies mixed but helps subset. Itch-scratch cycle: Scratching damages skin further → more inflammation → more itch. Break cycle with moisturizers, cold compresses, antihistamines, trim nails. Root-cause approach addresses gut, food allergies, barrier repair, stress. Many children outgrow eczema but some continue into adulthood. Aggressive management prevents atopic march.