What can I do to treat scalp eczema during a flare?
Published On: Jan 4, 2021
Last Updated On: Aug 20, 2021
In Ask the Ecz-perts, leading medical experts answer your most pressing questions about eczema and its related conditions.
In this edition of Ask the Ecz-perts focusing on Eastern medicine, Mamta Jhaveri, assistant professor of dermatology, Johns Hopkins Medicine, Washington, D.C., answers questions related to mindfulness meditation. Olivia Hsu Friedman, founder of Amethyst Holistic Skin Solutions in Chicago and chair of the American Society of Acupuncturists, discusses Traditional Chinese Medicine.
What types of mindfulness activities are most helpful for people with eczema? I practice yoga several times a week, but generally an energetic vinyasa style. Are restorative classes more beneficial or meditation?
It definitely depends on your own eczema and how heat/sweat sensitive you are. In general, I find that most eczema patients do well with vinyasa or restorative yoga but have trouble with hot yoga (as sweating and heat can cause more itching and inflammation). Yoga is great because it incorporates mindfulness meditation, breathing and movement.
Regular meditation helps tremendously with eczema and its related itch. We’ve found it can help decrease the inflammatory markers that lead to more itching and eczema. Also, after an eight-week course of meditation, people with eczema had a decrease in their itch and eczema intensity score and improvement in their quality of life. Meditation helps retrain the way we deal with stressors (including the urge to itch) and teaches us that, with time, this too shall pass.
Do you have any advice for managing unbearable itch without scratching?
Trying to practice mindfulness meditation regularly is going to help the most with itch because it will decrease the stress response when the itch sensation arises. But when you have what I call an “itch fit” or flare, it is helpful to recruit your breathing and meditation techniques to help the itch pass faster. You want to try to practice regularly (ideally at the same time each day) so that it will naturally kick in during the moment of an itch flare. You will find that, with time, you can retrain the way your mind and body respond to the sensation of itch.
Additionally, you may want to try different techniques to help during the flare itself. Itch is transmitted by skin receptors to our mind, so you can often dampen the sensation of itch by applying something cold to the area (an ice pack, cold washcloth or cold lotion). The itch sensation is then received and processed in the mind, so using breathing techniques (like slow breathing or cooling breaths) and meditation can help retrain our immediate need to respond to it.
Do you have any suggested morning or night routines or small actions throughout the day that can improve mindfulness? Are there any meditation courses that you recommend?
Regarding meditation courses, an eight-week mindfulness-based stress reduction (MBSR) class is a great way to learn techniques and get you into a regular meditation practice. It’s also a great way to build a community. Currently, there are many great meditation resources available online such as Headspace or CALM. Also, meditation and breathing are a part of yoga, so finding a good online or local yoga studio is another way to incorporate mindfulness.
With regard to morning and nighttime routines, it is most important to find one that works best for you. For nighttime, when itch hormones are the highest, I think it is very helpful to do a 10-minute body scan meditation and listen to peaceful music (delta waves have been shown to help improve sleep).
Before starting the meditation, you want to make sure that the temperature of the room is ideal, that you completed your skincare routine and that you are in a comfortable position (sitting or lying down). In the morning, you can incorporate sun salutations to get positive energy and flexibility flowing along with journaling and drinking a glass of water (with or without lemon).
Do you have any suggestions on using mindfulness to help with itch for my newborn and toddler?
Since it is hard to ask newborns to be mindful, it is important to focus on your own mindfulness so that you can control how you react to their itching. One mindfulness technique that helps with both eczema and itch for newborns is infant massage.
Start with an oil (or moisturizer) of your choice. You want to create a calm atmosphere, begin with one body part at a time, and create a regular routine. This also helps with bonding. There are a few different methods of infant massage (including Chinese massage and Ayurvedic). Here is a one-minute video that I find helpful.
For your toddler, I recommend family mindfulness time when you do breathing exercises together. Instead of asking your toddler to stop scratching when they feel itchy, you can try to redirect them to their breath; ask if they would like to take a few deep breaths with you.
A popular option is to think of the belly as a balloon and to inflate and deflate the balloon. You can also use the imagery of a butterfly to help them learn about their thoughts. Many meditation apps and courses have options targeted toward children, and there are some free videos on YouTube for mindfulness kids’ meditation (including a body scan).
Early on in my eczema journey, I researched meditation as it relates to itchiness and found that my itchiness significantly decreased with regular practice and breath control exercises like Sitali breathing.
Yes, Sitali breathing is very good for eczema, as it is a cooling, cleansing breath, helps remove some built up heat in our skin, and moves our energy to the right areas. In Ayurveda, it is used to decrease a pitta (fire) imbalance, typically found with eczema. For context, here’s some information on how to do Sitali breathing.
Mamta Jhaveri, MD, assistant professor of dermatology, Johns Hopkins Medicine, Washington, D.C.
Are there any natural ingredients that you recommend to treat the symptoms of eczema?
I would say everyone has very different reactions to ingredients; therefore, I am never comfortable offering any blanket suggestions. Most of my patients have considerably different sensitivities, so what works for one person might be harmful for another.
From an Eastern perspective, treating all health conditions is a very individual journey. We (society) really need to better understand the importance of differentiating conditions and how to treat them specifically instead of using our current one-size-fits-all mantra.
Has Traditional Chinese Medicine (TCM) for eczema treatment changed with current research and new understandings of eczema?
No. Eczema was something the Chinese have treated for over a thousand years. What probably has changed is what we now can see in the laboratory; how these herbs work on certain mechanisms. Clearly, that was not something we could do before.
How long does a moderate to severe eczema patient take to respond to TCM treatment, or does it vary widely?
It depends on the practitioner. I personally don’t have a problem with meeting patients wherever they are, with another medication or without. I work with them regardless of their goals, whether it’s minimizing side effects of existing drugs or working to get off current drugs. The length of treatment will depend on you and your unique presentation, but typically, you will see changes all throughout the treatment, and that’s what keeps people incentivized to continue.
Are you familiar with small intestinal bacterial overgrowth (SIBO), and is this common in people with eczema? Is this another gut/skin connection?
From the Chinese medicine perspective, we are a collective whole of systems, each one interdependent on the other. As such, it is not surprising that the largest organ of the body — the skin — would eventually affect the gut, or that gut issues would affect the skin. As such, Chinese herbalists typically do a longer intake to figure out what all the contributing factors are for your skin condition.
Are Chinese herbal blends more effective ingested or as soaks?
It depends on the situation and condition. I do both depending upon what the patient needs, how old they are and what they physically can handle best.
Olivia Hsu Friedman, DACM (Derm), Dipl.OM, L.AC., founder of Amethyst Holistic Skin Solutions in Chicago and chair of the American Society of Acupuncturists