5 Pillars of Atopic Dermatitis and Evidence-Based Alternative Treatments

5 Pillars of Atopic Dermatitis and Evidence-Based Alternative Treatments

May 04, 2022

Alternative Eczema Treatment Options 


In the article titled, A Multidisciplinary Toolbox for Atopic Dermatitis Treatments, written by Dr. Peter Lio, Dr. Vivian Shi, and Helena Ma, the authors discuss how eczema affects individual of all ages. 

Both Dr. Lio and Dr. Shi are renowned experts, nationally and internationally, in Eczema/Atopic Dermatology. To learn more on Dr. Lio and Dr. Shi, please see the About the Physicians section towards the end of this article.

The article examines the complexity of eczema and its impact on the quality of life of those who suffer from this condition. Unfortunately, many traditional treatments come with side effects. Thus, the authors propose alternative treatments to what they refer to as the “5 Pillars of Atopic Dermatitis”. 


  • Skin Barrier 
  • Psyche
  • Inflammation
  • Microbiome
  • Itch


Pillar 1: Skin Barrier

In our recent blog, The Skin Barrier: Your Body’s First Line of Defense, we discussed the skin barrier and its importance in protecting the body from various external elements, pathogens, such as staphylococcus aureus, and irritants. When skin is severely dry and compromised due to conditions such as eczema, cracks and fissures form in the skin and create a gateway for bacteria, allergens, and other potential harmful agents.  

A healthy skin barrier plays an integral part in helping skin retain moisture and preventing the symptoms associated with eczema flares, i.e.- redness, swelling, itching, and infections. 

This blog takes a look at the other four pillars and the role they play in helping to alleviate the many symptoms of eczema skin. 

skin barrier

Pillar 2: Psyche

The second pillar is psyche. The various symptoms associated with eczema are miserable for sufferers. Eczema can affect mental health and lead to symptoms of depression, anxiety, and stress. (4) Constant focus on skin barrier maintenance, potential triggers and physical appearance can cause all three symptoms. Stress and anxiety serve only to make eczema symptoms worse. However, there are some tools to help relieve stress and anxiety prompted by dealing with eczema. These include massage therapy and meditation. 

Studies have shown massage therapy to be significantly effective in reducing itching, redness, and loss of sleep. Sleep disruption is a major struggle for eczema sufferers. Massage therapy offers a safe and inexpensive alternative in the management of eczema-related stress and anxiety. 

Acupuncture is another massage technique which is discussed in more detail later in the blog. 

Mindfulness meditation is another technique to relieve stress and anxiety. It is a mental exercise that involves concentration on a particular object, thought or activity in order to “train their brain” to stay focused on the present moment, with no judgment, in order to achieve mental clarity and a state of emotional calmness. (3) 


Pillar 3: Microbiome

Human skin is colonized by a diverse system of bacteria, fungi, and other organisms which interact with both each other and the human body. (3) This system makes up our microbiome and is essential in maintaining healthy skin and skin barrier function. 

The microbiome of eczema patients can actually drive the disease. People with eczema contain higher levels of Staphylococcus aureus on their skin which triggers inflammation and damages skin barrier function. (1) This is due to reduced diversity and increased pathogenic bacteria like S. aureus. (3) 

Both coconut oil and silk clothing can help maintain a healthy microbiome. 

Coconut Oil – Not only does coconut oil help to protect the skin barrier, but it also has antibacterial properties which help to prevent staphylococcus aureus. Be sure to select pressed or virgin coconut oil. 

Sunflower Oil – Helps to boost skin barrier function and helps with skin moisture retention. Sunflower oil also has anti-inflammatory properties. (3) 

Silk Clothing – Smooth surfaces minimize friction against skin, but silk clothing also has been shown to have potential antimicrobial and anti-inflammatory properties.


Pillar 4: Inflammation

Inflammation is a common symptom of eczema which is one of the most bothersome for eczema sufferers. Topical steroids are the standard treatment for inflammation, but not without risk. Extended use of steroids can damage skin and cause atrophy, stretch marks, and discoloration of the skin, doing more harm than good. There are a number of alternatives being explored which have been to prove just as effective as topical steroids.


Certain vitamins have been studied and found to be a nonsteroidal alternative to alleviating inflammation and other symptoms associated with eczema. These vitamins are B5, B12, C, and D. Properties of these vitamins are:

B5 – encourages wound healing

B12 – helps to prevent eczema flares and reduce eczema symptoms

C – is an antioxidant which neutralizes free radicals, increases collagen production, and helps decrease hyperpigmentation (dark spots). (2)

D (oral) – while topical vitamin D has been shown to exacerbate eczema symptoms, oral vitamin D helps to decrease the severity of eczema symptoms and has widespread effects on the immune reactivity and skin barrier integrity.

Natural Alternatives

There are several natural alternatives to prescription therapies which can serve as replacements or supplementary treatments.

Botanicals – Chamomile is believed to have anti-inflammatory properties

Tea – Oolong, black, and green teas have various properties

  • Oolong tea helps to relieve and reduce inflammation and possesses antihistamine properties
  • Black tea possesses anti-inflammatory properties

Tip: Wet dressings with black tea offer an effective, well-tolerated, and low-cost treatment for facial eczema. Black tea compress - soak a soft cloth in weak black tea and apply to the affected area for 20 minutes.

  • Green tea contains both antioxidant and anti-inflammatory properties

Tip: Add green tea extracts to baths three times a week provides as a safe and effective treatment for eczema

Cannabinoids (without psychoactive effects) can be used topically to help reduce inflammation and itching and also provides pain relief

Phototherapy also referred to as light therapy, involves using UV light to reduce itch and inflammation. It can be used as a full body treatment or specifically with one area, such as the hands. (3)

Circadian Rhythm can be coordinated with various eczema treatments to offer maximum efficacy of the treatment. The body’s circadian rhythm has important implications in the treatment of eczema because of its effects on blood flow to the skin, the skin’s immune function, and skin barrier function. Administering eczema drugs at peak times of the circadian rhythm cycle can maximizes therapeutic benefits.

Melatonin can be beneficial in helping to reduce eczema symptoms. Poor sleep quality due to itching exacerbates eczema symptoms. Addressing sleep disturbances is an integral component of an eczema treatment plan. Melatonin has the ability to regulate the circadian rhythm by increasing sleepiness and lowering core body temperature. Fewer sleep disturbances results in a decrease of severe eczema symptoms such as itching and scratching and helps to moderate the immune system.


Pillar 5: Itch

 Chronic itching is one of the most notable and miserable symptoms of eczema. Itching effects sleep, attention deficit, and can cause social withdrawal. The following are several alternatives which may help to reduce itching in eczema sufferers.  

Acupuncture & Acupressure – studies have shown both acupuncture and acupressure techniques to be effective in significantly reducing itching intensity. Acupuncture involves the insertion of fine needles into strategic points on the body. Acupressure is similar to acupuncture, but uses physical pressure applied to certain body points rather than needles. (3) 

Dietary Hempseed Oil – is a rich source of omega-6 and omega-3 polyunsaturated fatty acids which have anti-inflammatory properties. 

Menthol – is an effective alternative method to ice, gel packs, cool compresses, and cold water to cool skin and reduce both itching and erythema. 




In conclusion, eczema remains a complex and challenging disease which manifests differently in each person. The afore mentioned treatments provide alternative and/or personalized options which offer a variety of therapies to include in an integrated treatment plan. 

 Please discuss these alternatives with your physician to make sure they are suitable to incorporate into your treatment plan. 

About the Physicians

Peter A. Lio, MD

In addition to his clinical practice at Medical Dermatology Associates of Chicago, Dr. Lio is a Clinical Assistant Professor of Dermatology & Pediatrics at Northwestern University Feinberg School of Medicine, a Fellow of the American Academy of Dermatology, and a Diplomate of the American Board of Dermatology (board-certified in Dermatology). 

Dr. Lio received his medical degree from Harvard Medical School, completed his internship in Pediatrics at Boston Children’s Hospital, and his Dermatology training at Harvard where he served as Chief Resident in Dermatology. While at Harvard, he received formal training in acupuncture.

Dr. Lio is the founding director of the Chicago Integrative Eczema Center and has spoken nationally and internationally about eczema and atopic dermatitis, as well as alternative medicine. 

Vivian Shi, MD

Dr. Shi is an Associate Professor in the Department of Dermatology at the University of Arkansas for Medical Sciences (UAMS). Prior to her tenure at UAMS, she was the Director of Dermatology Clinical Trials, Director of the Inflammatory Skin Research Fellowship Program, and Director of both the Eczema Specialty Clinic as well as Hidradenitis Suppurativa Specialty Clinic at the University of Arizona Banner Medical Center in Tucson, Arizona. 

Dr. Shi received her undergraduate degree in physiological sciences from UCLA, and subsequently spent a year performing research on gene regulation in pathogenic bacteria in the Department of Microbiology at UCLA. She earned her medical degree from the University of Illinois at Chicago. During that time, she also completed a fellowship in the Skin Immunology Laboratory. She was an integral part of the team characterizing the pathophysiology of atopic dermatitis. She then completed her internship in Internal Medicine at the University of Chicago – NorthShore Health System, followed by a dermatology residency at the University of California, Davis, where she also served as chief resident.

Dr. Shi’s research and clinical interests are in complex inflammatory skin conditions (such as atopic dermatitis, hidradenitis suppurativa, and psoriasis), skin barrier repair, transepidermal drug delivery, and integrative dermatology.




1 https://practicaldermatology.com/articles/2021-feb/a-multidisciplinary-toolbox-for-atopic-dermatitis-treatments

2 https://www.mindbodygreen.com/articles/is-your-collagen-supplement-missing-this-the-extra-ingredient-it-needs

3 https://nationaleczema.org

4 https://www.medicalnewstoday.com/articles/323493

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