Complementary therapies

Herbal medicine is commonly referred to as phytotherapy . Herbal medicines are selected mainly to stimulate the immune system or strengthen the body’s normal functions to heal itself. Herbal medicines should be used with the same care and respect as conventional medicines, as they can still potentially cause harm. Being natural does not always mean they are safe, and they can cause problems if you are also taking other medicines. 

Evidence for the effectiveness of herbal medicines is generally very limited. 

Not all herbal medicines are regulated. Remedies specially prepared for individuals do not need a licence, and those manufactured outside the UK may not be subject to regulation. If you wish to try a herbal medicine, look out for a traditional herbal registration (THR) marking on the product packaging. This means the medicine complies with quality standards relating to safety and manufacturing, and information about how and when to use the medicine is provided. Please be aware that THR products are intended for conditions that can be self-medicated (e.g. a cold). 

Do bear in mind that the risks of obtaining fake, substandard, unlicensed or contaminated medicines are increased by buying medicines online or by mail order. Unlicensed herbal medicines manufactured outside the UK may not be subject to regulation. 

We strongly advise that you patch test any new cream on a small area of skin that is unaffected by eczema. The area to test is generally the inner arm just below the elbow joint. It is important to do this once daily for 3-5 consecutive days, as sensitisation (becoming sensitive to an allergen) often takes a while to develop. 

Herbal remedies can have powerful side effects. The Medicines and Healthcare products Regulatory Agency (MHRA) is the government agency responsible for ensuring that medicines and medical devices meet acceptable quality, performance and safety standards. The MHRA website provides a list of herbal ingredients that are prohibited or restricted in medicines. Since 1 May 2014, all herbal medicinal products sold in the UK that fall under Directive 2004/24/EC require either a full marketing authorisation (MA) or a traditional herbal registration (THR) in order to remain on the market. These are listed on the MHRA website and are considered safe so long as you have checked with your doctor that they will not interfere with any conventional treatments you are using. 

You should exercise extreme caution with creams that come from other parts of the world (often available on the internet and market stalls), as some have been found to contain topical steroids of varying potencies, including Dermovate, which is very potent. There can be a 100-fold difference between mild and very potent topical steroids. Potent steroids have been found in Wau Wa cream, OSAS (an intensive body lotion with aloe vera) and Chinese herbal creams (e.g. Zudaifu cream). 

Chinese herbal medicine is a part of traditional Chinese medicine. In accordance with traditional Chinese diagnosis, the herbalist will prescribe an individualised herbal selection in the form of tinctures, extracts, infusions, decoctions or creams. 

There is some research evidence for the effectiveness of Chinese herbal preparations. However, there have also been reported cases of topical steroids in creams, and liver and kidney damage resulting from Chinese herbal medicine. We therefore recommend that if you decide to try Chinese herbal medicine, you do your research carefully in choosing a practitioner, and always ask for a list of the ingredients that have been prescribed for you. You should also talk to your GP before you try Chinese herbal medicine, as you will need to have regular blood tests to check on your liver and kidneys. 

Homeopathy involves treating a person with highly diluted substances. Based on symptoms, the homeopath will match the most appropriate medicine(s) to each patient, with a principle of treating like for like. This means that a substance that causes certain symptoms is thought to also help remove those symptoms. 

Investigations into the effectiveness of homeopathy have found there is no good quality evidence that it is effective as a treatment for any health condition. A 2010 House of Commons Science and Technology Committee report concluded that homeopathy is no more effective than a placebo (dummy treatment). In 2017, NHS England announced it would no longer fund homeopathy on the NHS, as the lack of evidence for its effectiveness did not justify the cost. This was backed by a High Court judgment in 2018. 

Aromatherapy uses concentrated, volatile plant extracts (essential oils and hydrosols) and vegetable oils for their therapeutic properties. Some people may find that antiinflammatory oils help their skin and that the activation of a different sensory pathway (smell) distracts them from scratching and promotes a sense of calm and wellbeing. 

Many people with eczema are sensitive to fragrance (including airborne fragrance, e.g. from a candle or diffuser) and cannot tolerate aromatherapy oils in any form. Many essential oils can cause allergic contact dermatitis. If you wish to use essential oils for massage or bathing, make sure you patch test them on your inner arm, just below your elbow joint, for 3-5 consecutive days, in case your skin has an adverse reaction. Do not use them on broken skin. 

Aromatherapy oils are commonly applied via massage, but this is often inappropriate for people with eczema, especially during an acute flare-up. Massaging inflamed or broken skin is not recommended because of the risk of spreading infection and aggravating inflammation. 

Please note that olive oil is no longer recommended as a carrier oil for aromatherapy oils. Oils made from nuts, such as arachis oil or almond oil, should also be avoided, as rubbing nut-based oils into the skin increases the risk of developing a nut allergy. Vegetable oils tend to be better absorbed by the skin than mineral oils, although mineral oils can be very useful ingredients for eczematous skin and are included to some degree in all prescription emollients. 

Reflexology works on the principle that every system and organ in the body has a corresponding point or zone in the feet or hands, which can be accessed through touch. Using the thumbs, the practitioner applies a varying degree of pressure to massage each of these points or zones to help relieve tension and remove energy blocks. Some people find that it helps them relax, enabling them to let go , which, in turn, allows the body s own healing response to be activated. 

Reflexology may be a good option if you are going through a flare-up and should not be massaged, but the reflexologist should avoid touching areas of broken skin. 

The research evidence for nutritional approaches is wideranging, with many nutritional supplements having been studied. Vitamin E, pyridoxine, selenium, zinc and evening primrose oil have all been researched and shown not to offer any overall benefits for people with eczema. 

A key clinical review in 2015 proposed a link between eczema and lower levels of vitamin D, and found that vitamin D helped protect the skin barrier and suppress inflammation. A 2018 systemic review found that children under 18 with low vitamin D levels had more severe eczema, with 67% seeing improvements after taking vitamin D supplements. Research published in the British Journal of Dermatology revealed that babies had a lower risk of developing atopic eczema in their first year if their mothers took 25mcg of vitamin D daily from 14 weeks of pregnancy until delivery. However, overall, there is not enough evidence that vitamin D affects the development of atopic eczema. 

It is important (and especially so with infants and children) that dietary changes are undertaken only with the advice and supervision of a qualified dietitian or nutritionist. 

Probiotics (live microorganisms) and prebiotics (nondigestible sugars that encourage the growth of friendly bacteria ) have been studied to see whether they can help prevent eczema or improve symptoms. Results so far have shown no direct benefit for eczema, although there may be other health benefits to taking them. While probiotics do not improve established eczema symptoms, studies show that they can help prevent eczema from developing in babies that are predisposed to eczema. For this to work, the mother would have to take probiotics during the last trimester of pregnancy, and ideally the baby would receive supplements as well. It is not possible to say with certainty, though, which probiotics would be the best ones to take, as the studies used various combinations of lactobacillus and bifidobacterium probiotic preparations. 

Hypnotherapy is a psychological treatment in which the therapist aims to address and make suggestions to the client’s subconscious mind through the use of hypnosis. It should be carried out by a skilled professional who has had rigorous training in hypnotherapy, who usually also has a background in medicine, nursing or psychology. 

Hypnosis is a state of mind, enhanced by mental and physical relaxation, in which our subconscious mind is able to communicate with our conscious mind. The hypnotherapist engages the client’s imagination through storytelling, imagery, symbolism or direct suggestions to effect beneficial change. This is not the same as stage hypnosis. People cannot be hypnotised against their will, and remain in control throughout the process. 

Most hypnotherapists combine hypnosis with other counselling and therapeutic techniques. Hypnotherapy, like other relaxation techniques, can help people with eczema cope better with the itch- scratch cycle and manage and reduce the stress and anxiety that may make their eczema worse. 

Eczema can be a cause of stress. Stress may make people with eczema scratch more, which, in turn, causes their skin to flare. Relaxation and deep breathing techniques can be helpful by providing valuable time out , inducing a sense of peace and wellbeing and generally making life seem a little easier to cope with. Below are details of a few relaxation techniques you may find helpful. 

Autogenic training is a series of mental exercises designed to switch off the body s responses to stress and switch on those related to deep relaxation. 

Meditation can be helpful in promoting a sense of calm and wellbeing. Loving kindness meditation focuses on feelings of compassion and kindness (including towards oneself). 

Mindfulness is based on the idea that we are present in the here and now in a non-judgmental way. By developing our skills in mindfulness, we can become better at responding to stress. 

Yoga is well-known for the calming effects of its asanas (postures) and controlled deep breathing techniques