She had wisely trimmed her fingernails to avoid injuring her own skin, but as she sat in my office she continuously rubbed one part of her body or another with the ball of her thumb in order to relieve the itching.
Tracy was in her 20s and accompanied by her mother. Although I could see that Tracy was quite pretty, her face looked as if someone had splashed reddish-pink paint on it and one eyelid was swollen half shut. On the desperation scale, Tracy’s mom was clearly off the chart, distraught that her otherwise smart, lovely daughter should have been dealt such an unfortunate hand.
They spoke at the same time, “I have/my daughter has eczema.”
Tracy was a theatre major at nearby DePaul University. She’d always been a sensitive child. Lots of ear infections as a toddler, and lots of antibiotics given in response. Skin rashes throughout childhood came and went and then came back again with daunting persistence. Tracy had been to most of the leading dermatologists in the city as well as getting an audience with the big kahunas over at one of the university hospitals.
From her mom: Cortisone. Steroids. That’s all anyone ever gives her. And antihistamines for itching, but those make her too sleepy to think straight. Since she’s been four years old I’ve been slathering Tracy with steroids. And sure, they work fine…until you stop using ‘em. And they say they’re all harmless, but I can’t believe it doesn’t get into your system. They also offered serious drugs to suppress her immune system, but when I read the side effects…
I smiled and focused on the patient. “Tracy,” I began. “You’ve lived with this for years. Tap in to your factory-installed women’s intuition and start listing everything you know that makes your eczema worse.”
Her mother piped up, “Well, for one thing…”
This time Tracy and I spoke in unison, “Please, let me/let your daughter do this…”
(I made a mental note to discuss family dynamics with mom. I even toyed with a fantasy surgical procedure called a mommy-ectomy.) I motioned for Tracy to continue.
Tracy tells her own story
“When I eat junk food, for one,” she started. “There’s so much of it in the vending machines in the dorm. Oh, and stress. Like when I was assigned a show to direct, which was exciting but so stressful. And my period. I’m pretty sure I have PMS and eczema together.” She paused. “I can’t seem to think of anything else.”
“Tell me about your eating habits. A typical day. Even the meals you skip, or the snacks you pop down when you get ravenous.”
Tracy rolled her eyes. “OK, this is embarrassing. Especially with her (glancing at her mother) sitting here. Well, first, I usually don’t have time for breakfast, but I sometimes grab a bagel and some coffee on the way to class. When I do eat breakfast, it’s those yucky dehydrated scrambled eggs in the cafeteria. Maybe before lunch, I’ll also have a granola bar or some corn chips or a turkey jerky. The rest of the day I eat in the cafe because of my meal ticket. Burger, fries, spaghetti, pizza. The fried chicken is really good. Never fish, I hate fish. Some cookies or yogurt for dessert.”
“And to drink?”
“Milk, pop, coffee. I like milk. Sometimes orange juice in the morning.”
“The doctors already tested her for food allergies,” volunteered mom. “The scratch tests all came back negative.”
I explained that the scratch tests done by allergists looked for immediate reactions to foods, like when your lips swell with strawberries or you start itching with shrimp. Food sensitivities, on the other hand, occur more slowly, two or three days after eating a culprit food. First you eat the food, digest and absorb it, and then if you’re sensitive your immune system creates antibodies against it.
“We’re going to look for the antibodies because it’s these antibodies attacking food molecules that are responsible for your eczema.”
Then I examined Tracy’s skin and hair. It struck me that everything about her was extremely dry. Even the areas of skin not affected by the eczema were flaky, as was her scalp. And her hair was unhealthy looking.
“Tracy,” I began again. “It’s not just that I think your diet is pretty awful, which it is, but I think you might be sensitive to a lot of your daily fare. The usual food sensitivity suspects are dairy, egg, corn, gluten grains, citrus, and even soy. If you look over your typical day, every meal contains something that includes these ingredients.
Also, eating like you are you probably have some vitamin and mineral deficiencies, as well as deficiencies in what are called essential fatty acids.”
I watched as Tracy counted the six common offending foods on her red and itchy fingertips. Then, like a chorus, the two of them, “I/my daughter can’t stop eating. I’ve/she’s got to eat!”
I continued, “Tracy, really, starvation is reserved only for my worst cases. Why don’t you and your mom meet with our nutritionist and she’ll review our food allergy elimination diet. You’ll stop eating the culprits for several weeks and then reintroduce them to see which cause your eczema to flare.”
In addition to the food elimination diet, I recommended two important diagnostic tests. First, a blood test that checks for sensitivities to 96 commonly eaten foods, and second, a simple urine test she do at home to determine if she had leaky gut syndrome, also called intestinal hyperpermeability.
I wrote out a list of supplements she’d be taking. In addition to some high-potency vitamins to bolster her suboptimal nutrition, I wanted her to start taking herbs for PMS and other herbs to calm her body’s response to stress.
Finally, we’d introduce her to my associate, Dr. Gemelas, to reverse her sensitivities with a treatment called low-dose immunotherapy.
All this is quite different from the type of skin testing she had in the past. And because of all those childhood antibiotics, I also wanted to test Tracy for candida (yeast) overgrowth, a real villain when it comes to leaky gut.
Our nutritionist walked Tracy and her mom through the food allergy elimination diet, offering all sorts of healthful and tasty substitutions that are rarely linked to any allergic reactions.
A second route to treating chronic skin infections, especially psoriasis but eczema as well, is to work with Mari Stecker using traditional Chinese medicine. Mari has taken postgraduate work in dermatology and prepares individualized herbal formulations that have produced remarkable results. Don’t worry if you’re acupuncture needle-shy. Chinese dermatology is almost exclusively herbal.
Since a school production was coming up and Tracy would be on stage in a few weeks, it wasn’t too difficult to extract a promise that she’d make every effort to comply with her new way of eating.
Three weeks later
Three weeks later, mom without Tracy showed up during Tracy’s scheduled return visit to review the food sensitivity blood test and the leaky gut results. Apparently the patient herself had an unexpected rehearsal that coincided with the appointment.
I told her mother that the food sensitivity blood tests clearly showed several culprit foods. In addition, Tracy’s small intestine was, like a sieve, leaking large molecules of incompletely digested food.
A photo of Tracy on her mom’s phone showed significant progress in clearing the eczema, this a result of the food elimination diet. Then, apparently for dramatic effect, her mom pulled out a paper bag and dumped onto the examining table 23 twisted sticky tubes of various cortisone creams and six half-empty bottles of antihistamines.
Mom smiled. “I had to show you what her life had been. Now I can throw them out.” And she swept them all into a nearby wastebasket.
“Her skin looks great. Something has been irritating her skin all these years. Now, on this elimination diet, when she starts getting a little tired of rice, she looks in the mirror, laughs with sheer pleasure, and asks for a second helping.”
“And the supplements?”
“Her ritual, twice a day, never misses a dose.”
“And how are you doing with all this?”
She paused. “What can I say? I’m her mother. I used to look at her, at those terrible rashes and my heart would break. She’s…so beautiful, even if I am her mother. When I peeked in and saw her looking in the mirror, touching her cheek and smiling, I realized I’d never seen her do that and I started crying. Then she saw me and we both started crying. She’s very happy. We’re very happy. You’ll come and see her show?”
David Edelberg, MD