Delving deeper into the link between the skin and nutrition, psychodermatologist Dr. Alia joins Kurami’s nutritionist for another episode of our Instagram series, The Beauty of Balance. This series explores the impact of food and lifestyle habits on the mind and skin, as well as a range of methods that we can use to optimise our skin health.
Eczema is a skin condition that millions of people experience around the world, and it is seen most commonly in children. In our most recent Instagram Live, eczema is examined at a much more informative level, including a range of potential causes, as well as an even wider range of solutions that we can use to combat this condition.
G: Good morning, Dr. Alia! We are pleased to have you back with us to discuss the correlation between the skin and nutrition. For our new viewers, would you like to describe your role as a psychodermatologist?
I am a consultant psychodermatologist, and I have a special interest in the psychological impact on skin conditions. Psychodermatology is the part of dermatology that looks at the mind and skin together and that includes looking at lifestyle management; this includes diet management, exercise, stress and relationships. Not many people realise that their lifestyle choices can have an impact on their skin.
G: Today we are discussing eczema. Would you like to delve deeper into the complexities of this condition and how it can affect the skin?
Eczema is classically defined as chronic, meaning it is usually a long-term condition, however “flare-ups” can often occur; this includes dry, red, or itchy skin—dry skin can lead to itchiness, leading to thicker skin or even micro-tears and secondary infection. Moreover, people who have had eczema for a long time may have changes in texture as well as pigmentation. After an individual’s skin has been inflamed for an extended amount of time, the colour of the skin can become darker or lighter.
It is common that you see eczema within your paediatric population; 1 or 2 children in 10 can have eczema, however in adults, only 1 or 2 in 100 may have it. This is because the younger population tend to grow out of this condition. However, what we tend to forget is that, generally, eczema can also be a multitude of factors. One being the changes in weather. I see this a lot in the slightly older population as soon as winter arrives; when we all have our heating on and our skin care practices may not be as regular as our skin is mostly covered, these changes can lead to drier skin, and soon, red and itchy skin.
G: What do you believe are the main causes and concerns of eczema with regards to food?
Usually, when a child has eczema, there is a lot of fear around this topic as parents can be worried that their eczema is worsened by certain foods. It is important to combat this with clear, documented association, which can further be supported by an allergy test. As mentioned previously, children may grow out of these allergies which is commonly the case.
When discussing food allergies and eczema, if there is a definite food that worsens the condition, then it is suggestible to cut it out, however do not cut out too many foods as you may be losing out on important nutrients. Discuss any dietary decisions firstly with a healthcare professional such as a dietitian or an allergist.
G: Food seems to be one of the first things that people tend to worry about when it comes to eczema, however we are interested to know, does stress have a role to play in initiating eczema or skin flares?
Yes, stress is definitely a causing factor, and there is a lot of research to support this. What we know is that when you feel stressed, you release a hormone called cortisol, and it can have a number of effects on a number of organs, your skin included. What we tend to see in the skin is that this hormone can drive inflammation, so if you already have eczema it can lead to the worsting of this condition, as well as other existing skin conditions. Additionally, when you are stressed, your skin barrier also responds; your barrier can release any of ‘the good things’ , whilst all of ‘the bad things’ are permitted to enter. There are many effects on the skin that can occur due to stress, eczema especially.
G: What is the process of eczema flare ups?
Some people have a tendency to have a low-level of eczema or an eczema that is controlled—maybe from using moisturisers regularly, however it can get worse. This can be identified by the appearance of a sudden patch on your abdomen or leg, and there is a possibility that these patches can become infected. When these patches begin to worsen, this is when you need to step your treatment up; you may need to think about using a topical steroid, or using moisturiser more often. What I tend to do is provide my clients with a plan, separating what they do on a “normal” day, as well as what to do when their skin is experiencing a flare up. If an individual experiences a flare that simply will not settle, I definitely advise seeking help from a health care professional.
Being ill with something else can also drive your eczema. This can be caused by the body’s stress response; when your body is ill, it attempts to save itself. You may also be losing a lot of water, or there may be an impairment of the skin barrier, altogether causing things to get out of control. You may be doing everything that you can, however if you or your child has a viral illness such as diarrhoea or a cold, this is a natural way of the condition to respond, as all of your organs are linked.
G: You mentioned steroids which can be quite a controversial topic! How do you manage balance within the use of steroids, as well as moisturiser?
The first thing to do when you have any type of dry skin condition is to regularly replenish your skin barrier; you can use bland emollients, creams, or ointments. The types of ingredients to look for in topical treatments such as these are ceramides, glycerin, hyaluronic acid, as well as a texture that really sticks to your skin. It is important that you are applying this moisturiser regularly; my advice is to apply the cream during the day as it is much lighter and more easily absorbed, and ointments during the evening as they can usually be quite thick and heavy on the skin.
What I tend to say is, if your skin is not getting better by using more emollient and sticking to the suggested regime, then you may need to move on to steroids. Any professional avoids suggesting a steroid that may be too strong, and we suggest to only use these if you are flaring. Where things can go wrong with steroids is when you do not wean it off properly. If you suddenly remove it from your routine, this can cause a rebound flare. Moreover, if you find that you are not able to wean off of that steroid, that is when we need to think about whether the steroid is right for your skin, or if you are consuming enough of it. You have to use a steroid for a long time, at a high potency, for it to lead to problems with your skin. We can also switch our clients to a non-steroid alternative; these are otherwise known as Calcineurin inhibitors. These are immunosuppressant creams that do not contain any steroids.
Overall, there are so many options that we can offer to people who experience eczema, however it all comes down to seeking the right professional to provide the right option for you.
A: As a nutritionist, how do you believe people can further support their skin health through food during this time?
Firstly, let us talk about the skin barrier, in which you mentioned earlier!
There is almost a debate around the food that we eat, and whether it should be taken as a supplement or applied topically. Essentially, these are two pathways, but nothing beats a good diet and eating wholesome, balanced meals. These meals include key nutrients that are vital for maintaining nourished skin. A few examples of these nutrients are vitamin A, B vitamins, vitamin C, zinc, and copper. When you look into food sources, these vitamins can easily be provided by such a wide range of foods.
A few weeks ago we also talked about fat. This macronutrient is important for the skin barrier to be optimised, as it can maintain the skin barrier’s integrity. It is so important that we always aim for a balanced diet, including a range of macro and micronutrients, to provide our skin with a spectrum of what we truly do need.
A: During winter, I usually want to eat more as a form of comfort! Many people also tend to crave different things, and perhaps eat a higher amount of food during this season. Do you believe that this can have an effect on skin health as well?
There is no robust evidence around a clear change of energy intake in this time of the year, however we do feel that our dietary habits might be changing, as our routines also change during these months; days become shorter, evenings become longer, and festive celebrations increase during the winter. We can associate this time with feeling as if we are indulging more, however this may not be the case. What is really important is building your awareness around the kind of foods that you may be craving, and mindfully stocking your cupboards up with nourishing foods for when you do experience cravings or any bouts of hunger throughout the day.
A: What practices do you believe can bring balance to people during the winter to maintain nourished skin?
Firstly, water is important in order to keep our skin nourished and hydrated, and this is often something that we tend to forget about during the winter. Another important factor is eating a variety of fruit and vegetables. When it comes to seasonal fruit and vegetables, UK supermarkets are usually well-stocked! I recommend consuming a large variety of fruit within the winter, as well as root vegetables, sprouts, kale, and many more.
A: What can we expect from Kurami throughout this season? Are new and nourishing meals on the horizon that are more suited to the weather?
We are definitely launching a new seasonal menu which is very exciting indeed. Many warming and filling products are included such as new soups, exciting new flavours, and a special Kurami exclusive that will be delivered on Christmas Eve. This Christmas special includes a festive soup, a Christmas Risotto, a delicious roast with a vegan option, and a festive dessert! All of which are nutritionist-approved, and crafted by our talented team of chefs.
G: To finish off our discussion, what are 3 habits that our audience can practice throughout the winter to manage eczema from a holistic point of view, and discover beauty from within?
1. Make sure that you are using an emollient regularly, and an emollient that works!
2. Change the formulation according to the time of day. I recommend using a lighter emollient during the day so it is easier to use, and a thicker ointment during the evening.
3. If you are experiencing flares, be mindful of what triggers to avoid. This can be anything from intense heat sources, to particular garments and textures.
4. Applying moisturiser as soon as you leave the shower can be useful. Damp skin can lock the moisture in!
5. Be aware of what works for you when you do have a flare. Have certain products prepared, and know what products work best for your skin.
6. Learn to train the mind. Eczema can be intensely itchy, and lead to scratching unconsciously. There is a tool called habit reversal, which includes training your mind to replace the scratching with a non-skin damaging behaviour. These behaviours can vary from squeezing a stress ball, distracting yourself with your hands, and more.
7. Breathing exercises, meditation, and muscle relaxation can also help when you are itchy! These methods can relax your mind and ease your scratching.
8. These are a few simple habits that I would advise people to practice! This goes alongside eating a colourful, balanced diet, as well as hydrating yourself with an abundance of water. This can bring balance to the gut, which we know is linked to the skin.
Overall, it all comes down to balance! Exercise, diet, stress management, as well as medical treatment all comes into play, and each can contribute to managing eczema as well as other skin conditions that one may be suffering with.
Although food is most definitely a factor that can trigger an eczema flare up, there are many other s that one should consider alongside this--stress being a particularly important one. To manage eczema or any skin condition that you may be suffering with, it is recommended to tackle it holistically; practice balance in all areas, and discover beauty from within.
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Dr Alia sees NHS patients in the Frimley Health Foundation Trust. She consults privately at The Bridge Clinic (Maidenhead) and Epsom Skin Clinic. Please click here to find out more about Dr Alia, or follow her on instagram here.