What happens when there’s no simple fix to your flare-up of eczema or psoriasis? Sometimes, you need to bring in a team for help—like a GP, a dermatologist, a facialist, a TCM practitioner, and a nutritionist. Here’s their advice on how to tackle tricky skin conditions, especially when one size does not actually fit all.
Eczema
If you have eczema you’ll be all too familiar with those cracked, dry, and scaly patches of skin that show up a bright red on paler skin tones or an ashy, almost grey on darker skin. Left untreated, eczema becomes scalier, itchier, thicker, and more hyperpigmented.
The GP
“There are two primary causes of eczema: a leaky gut—increased intestinal permeability—which creates a low-grade inflammation in reaction to food particles leaking through your gut wall, and/or abnormal gut flora, or dysbiosis, which is when the trillions of bugs in your gut become out of balance, driving inflammation. This is caused by a high-sugar, refined-carb, low-fiber, processed diet,” says general physician Sabine Donnai, whose hi-tech diagnostic clinic in London, Viavi, prides itself on a holistic approach. “But there are other culprits, such as chemicals and other substances in creams, lotions, and detergents, as well as household cleaning products.” Her advice is to look at the whole, rather than treat the surface. “The creams, antibiotics, and other topical solutions are really just short-term solutions. You wouldn’t address every yellowing leaf of the plant if the problem is that the roots need more water!”
The dermatologist
“There are three pillars for eczema we try to tackle,” says consultant dermatologist Emma Wedgeworth. “Firstly, strengthen the skin barrier using moisturizers that can replenish. Secondly, we look at the abnormality in the skin’s immune system, treating itchy patches with medicated creams—there are more targeted creams, called phosphodiesterase inhibitors, currently in development in the US, which dampen inflammation. If these don’t work, we use light therapy, as well as immunosuppressants in the form of injections and tablets.”
The facialist
Pietro Simone, who has a clinic in London at Flemings Mayfair Hotel, says, “Avoid glycolic acid, colorants, fragrances, mineral oils, unstable vitamin C, and retinol.”
The Traditional Chinese Medicine practitioner
“Acupuncture improves skin health, restores the skin barrier, and alleviates discomfort in people with eczema,” says Traditional Chinese Medicine Doctor John Tsagaris, who practices at the Harrods Wellness Clinic. “We use herbs to complement it, including licorice, chrysanthemum, and peony, and often use High Factor Peony Root Skin Remedy to help my patients.
The nutritionist
“Detoxification is key, as systemic toxic levels make eczema worse,” says Lucy Miller, a registered, clinically qualified nutritional therapist based in Bath and London. “A whole-food, anti-inflammatory, low-allergenic diet that contains lots of pre and probiotic foods, fiber, and good fats is vital. It needs to be low in processed foods, sugar, refined carbohydrates, and alcohol to help balance blood sugar, all of which helps to control inflammation, balance hormones, and improve immunity.”
Psoriasis
This is an autoimmune condition that causes an excess turnover of skin cells that can build up into thickened plaques. There is no quick fix, but treated correctly it can be managed well, with minimal flareups.
The GP
“Take away the things that cause the problem and add those that make it better. In the vast majority of cases, this will naturally heal psoriasis,” says Donnai. She advises her patients to focus on eight things.
- Eat a whole-food diet.
- Remove any food sensitivities such as gluten and dairy.
- Test for heavy metal toxicity (mercury and other metals can trigger or exacerbate psoriasis).
- Fix your gut (“Studies suggest intestinal permeability, or leaky gut, can contribute to psoriasis”).
- Use the right supplements.
- Exercise regularly.
- Sleep for eight hours every night.
- Practice deep relaxation.
The dermatologist
“Psoriasis can be associated with lifestyle, with sufferers having higher rates of smoking, alcohol, and higher BMIs, so sometimes making a change of this nature can help,” says Wedgeworth. Psoriasis also looks different according to ethnicity, with more redness in whiter skins and more associated problems with pigmentation in darker skins. Depending on its severity, Wedgeworth will start treatment with vitamin D creams, moving on to light therapy, “which dampens it down.”
The facialist
“Less is more. Keep it simple,” says Katharine Mackenzie Paterson, founder of KMP Skin. “Avoid heavily fragranced products and use occlusive creams to help reduce the roughness. LED—such as Dermalux Flex—can also be fantastic for psoriasis.”
The Traditional Chinese Medicine practitioner
“Psoriasis is one of the most common and well-researched conditions we treat with Chinese medicine,” says Tsagaris. “It’s triggered by an immunological response to various environmental, systemic, or psychological factors. Acupuncture effectively alleviates stress, a common trigger of psoriasis flares. It can also relieve pain, especially in cases of psoriatic arthritis.” Tsagaris also prescribes Chinese herbs, including salvia, licorice, or ligusticum to calm the inflammation and restore a healthy skin barrier.
The nutritionist
“A high level of zonulin, a protein that controls the size of the gap junctions in the gut, which can indicate if you have a leaky gut, is often associated with psoriasis, so ask for a blood test to measure it,” says Miller. Her vitamin and mineral recommendations include vitamins A, B, and D, omega-3, and quercetin. Plenty of soluble fiber will also help control blood sugar and reduce inflammation.