What Are the Root Causes of Eczema? A Holistic Nutritionist Explains

Abby Tai dealt with severe eczema for much of her childhood and into her young adult years—until she finally was able to get to the root causes of eczema and heal. When she was suffering, she made a promise to herself that if she ever got better, she would share her story with as many people around the world as she could and help them overcome the crippling skin condition like she did. Today, Tai is a holistic registered nutritionist, founder of Eczema Conquerors, and host of the The Eczema Podcast, and she joined WellBe to share what she’s learned on her personal and professional eczema journey. Read on to learn more about the root causes of eczema, the connection between gut health and eczema, differentiating eczema versus psoriasis, the side effects of topical steroids, and more. 

*This is a short clip from our interview with Abby Tai. Click here to watch the whole thing.*

You can also listen to Adrienne’s interview with Abby Tai on The getWellBe Podcast

Abby Tai’s Story: From Disabled to Empowered

Tai describes her eczema journey as very up and down, with many moments that felt like rock bottom. “There’s been a lot of moments where I would classify myself as having been disabled because of [my eczema], which is really strange,” she says. “You would never think of having a skin condition as something that could actually disable you, but it’s possible when it gets so severe that everything becomes painful.” 

Her eczema began when she was a baby, though it was mild. When she moved from Canada to Hong Kong as a teenager, however, things got worse. “It wasn’t terrible. It was still manageable,” she says.

It was only when she was around 15 years old when things really took a turn. Her first boyfriend broke up with her, and the emotional fallout was vast; her teenage heart was broken, and she felt like her world had ended. “I just remember things being so difficult and painful, and I just released so much anger and stress onto my skin,” she recalls. From that moment on, her eczema was out of control. It covered 95% of her body from head to toe. It became painful to move, to walk, to take a shower, to wash her face—even sleeping was painful—and she was bleeding frequently.  

“That is the moment when I felt like eczema started to take away my life,” Tai says. The physical discomfort combined with the shame she felt about her appearance at school took a toll on her mental health. “I remember asking God to end my life because it was just so terrible,” she says.

When she moved back to Canada for college, her skin began to clear up naturally because the environment was better for her skin. The relief was short-lived, however, as her skin began to flare yet again. Moving again wasn’t an option, so at that point, she realized that she needed to find a way to heal the actual root causes of her eczema. “I really had to find alternative ways to get better,” she says.

Tai began changing her diet as well as digging into other root causes of her condition, and, like magic, her skin cleared up. She switched to all clean products and eliminated wheat, sugar, processed foods, MSG, and other common allergens from her diet, focusing on vegetables, fruits, whole grains, and superfoods. Now, she says, “I really believe that there’s a way to heal and to get better. So that’s what I’m here to bring, that hope, and to help encourage people that it’s possible to reverse this and get better.”

Eczema Versus Psoriasis: Understanding the Difference

Before we get too into the nitty gritty of eczema, we wanted to clear up a common source of confusion: what’s the deal with eczema versus psoriasis? 

“Eczema is characterized by itchy, red, inflamed skin,” explains Tai. “It can also become really dry and flaky as well.” Eczema is also known as atopic dermatitis, and both genetic and environmental factors play a role in its development. When scratched, eczema-affected skin will usually turn into a rash. It’s usually seen in children, but also shows up in adults, and most commonly appears on parts of the body that bend and flex: inside the elbows, behind the knees, and in the front of the neck. “But it can happen anywhere,” Tai specifies. “For some people who have it really severely, it can be all over the body, including the scalp and face.”

While psoriasis also comes with rashes, dryness, and redness, it is a chronic immune-mediated inflammatory skin disease that tends to appear on the elbows and knees (but the front/outside rather than the back/inside), lower back, and scalp, among other places. It can also get into the joints. It has a strong genetic component, but environmental factors also play a role. 

“Our skin cells usually turn over every 30 days,” says Tai. “But with psoriasis, it happens a lot more quickly. It can happen every three to four days. The skin cells build up really quickly and it can become flaky.” This happens because the body’s immune system becomes overactive, attacking normal, healthy skin cells. 

Tai also explains that both conditions have different comorbidities. While psoriasis can come with arthritis (called psoriatic arthritis) and liver issues, eczema is associated with heart disease, osteoporosis, and depression.   

The Relationship Between Gut Health and Eczema

At WellBe, we talk a lot about how your gut health impacts almost every other aspect of your health, and eczema is no different. To illustrate that fact, consider two studies that Tai and Adrienne discussed in their conversation:

• A 2018 study showed that babies of women who took probiotic supplements while pregnant had a reduced risk of eczema and food allergies. 
• A 2021 study showed that babies of women who used disinfectant while pregnant had higher rates of eczema. The gut connection here is that disinfectants wipe the good bacteria off of the skin’s microbiome, and since a mother’s microbiome affects the microbiome of her child, the child’s gut health is negatively impacted. 

To explain the relationship between gut health and eczema, Tai uses the bucket analogy (which Dr. Brooke Kalanick also employed when talking about histamine response). “Everyone can handle a different load of inflammation in their body,” she says. “If someone is showing symptoms on their skin, it means their bucket has overflowed. So if you picture a bucket, whenever we add more inflammation-causing things to it — toxins, medications, inflammatory foods, antibiotics, and other things that disrupt the gut microbiome — we start to fill the bucket, and once we get to the top, it starts to overflow and we see symptoms happen.”  

Because everyone has a different sized bucket (meaning everyone can tolerate different levels of inflammation) and everyone has different inflammatory loads, that means that some people are more sensitive to inflammatory inputs than others. Imagine two people with eczema: one of them has removed as many toxins as possible from their products, manages their stress well, avoids antibiotics, and generally eats an anti-inflammatory diet; the other uses conventional, toxin-filled products, has high stress levels, and takes a load of OTC medications. If the two of them go out to McDonald’s, the first person might be able to enjoy some fries and McNuggets with no effect on their skin, whereas the second person will likely have a flare-up after just a few bites. “If someone has a bucket that’s overflowing, if they eat just a little bit of junk food, their body can’t tolerate it and they can flare up right away.” 

When thinking about gut health and eczema, conditions like leaky gut also come into play. If someone has leaky gut, they’re not digesting food properly, and these undigested food components make their way into the bloodstream. From there, they cause reactions that can manifest in skin flare-ups.

For those with eczema, the good news is that once you improve your gut health by emptying out your bucket, not only does skin tend to improve but you also become able to tolerate a lot more foods. “At one point, my skin was so flared up and so red, so inflamed, and I remember that the moment I ate the wrong food, the moment it touched my tongue, I would have a reaction. Immediately, my tongue would tingle, my fingers would tingle. At one point I couldn’t even tolerate eating meat. Even fats, even things like coconut oil,” Tai says. “Thankfully, a lot of that has reversed. There’s a lot of linkage between digestion and our skin.”

What Are the Root Causes of Eczema? 

In her work, Tai encounters client after client sharing the same story: their doctor continues to prescribe them medication after medication rather than figure out what’s really causing their eczema. She explains that doctors tend to give patients topical creams or oral steroids, which she calls a “Band-Aid approach,” meaning it covers up symptoms but doesn’t get to the root of what’s happening. “It tends to be an outside-in approach,” she says. “Our goal is to really take an inside-out approach and look at what some of these root causes can be.”

So what can those root causes of eczema be? According to Tai, there’s a long list of potential culprits, including:

• Overgrowth of bacteria 
• Fungal overgrowth
• Yeast overgrowth
• Candida
• Parasites
• Heavy metals
• Nutrient deficiencies
• Mold 
• Hormonal imbalances

“Not everyone will have all of these root causes,” says Tai. “But it’s usually a combination of them, for example three or four of them.”

One root cause of eczema that may be surprising to some is dental issues. Tai explains that 45% of your oral bacteria overlaps with the bacteria in your gut microbiome; and so, because of the link between gut health and eczema, issues in your mouth can start to affect your skin. In her work, she’s spoken with integrative dentists who have seen patients’ eczema clear up within a week of removing infected teeth. (Learn more about the far-reaching effects of your dental health in our interview with Hannah Bronfman.)

The Side Effects of Topical Steroids

Treating eczema with a Band-Aid approach like topical or oral steroids is suboptimal because it doesn’t get to the root causes of eczema. But there’s another reason these prescriptions are a risky choice for your health: side effects.

Tai explains that topical steroids work by essentially neutralizing your immune system, reducing the inflammation caused by an overactive immune response. This makes the eczema symptoms go away at least temporarily, but it’s also blowing up your all-important immune system (which we usually want to be stronger, not weaker, right?). And when the symptoms are suppressed, you’re essentially shutting up the cries for help your body is sending you in the form of eczema, rather than listening to it and finding true healing. Tai sums up the flaw in this approach with a saying: “When you treat something externally, you will be treating it eternally.” 

There are several side effects of topical steroids that people might experience while taking them, including:

• Thinning of the skin
• Making eczema worse in the long run
• Skin irritation
• Acne
• Rosacea

Understanding Topical Steroid Withdrawal

But some of the worst side effects actually come after someone stops using topical steroids. Tai explains that there’s something called topical steroid withdrawal, which many people with eczema experience when they try to stop using topical steroid creams. “When people have used steroids for some time, they find that when they come off it, there’s a rebound effect and their skin gets so much worse than when they started,” she explains. “For some people, it’s leaving them disabled, for some people it’s leaving them bedridden, they’re not able to leave their house. I have a friend who went through a divorce because of it.” 

Tai says that there can be a lot more side effects with topical steroid withdrawal than there are with eczema. It can come with seriously unpleasant symptoms, such as chills or sweats, the feeling of ants crawling on your skin, or the sensation of being electrocuted or zapped (which are called “zingers”). “It’s really uncomfortable and just so difficult to live with,” she says.

The WellBe Takeaway on Eczema

A staggering 10% of the United States population has some form of eczema, and yet it remains misunderstood by many, leading to ineffective and side effect-riddled treatment for millions of people. Here’s what to remember about this common and unpleasant skin condition:

• Eczema is a skin condition characterized by dry, inflamed, itchy, red skin. It’s frequently confused with psoriasis, another skin condition, but the two are different. Psoriasis is a chronic immune-related disease that occurs when the immune system attacks healthy skin cells, causing skin cells to turn over too quickly, leading to flaky skin.
• Your gut health has a huge impact on the health of your skin, and, thus, poor gut health can cause eczema to flare up. For eczema sufferers with low levels of inflammation and generally good gut health, they can occasionally eat some processed or other inflammatory food without seeing the effect on their skin; but for those who have high levels of inflammation (whether through toxin exposure, stress, poor diet, or otherwise), even small amounts of inflammatory food can take a toll on their gut health and cause a skin flare-up. By eating an anti-inflammatory diet and removing other sources of inflammation, people with eczema can improve their skin and also become more tolerant when they experience small sources of inflammation.
• Most doctors treat eczema by prescribing oral or topical steroids that suppress symptoms but don’t get to the root cause of the eczema. There are many potential root causes of eczema, including bacterial overgrowth, fungal overgrowth, yeast overgrowth, candida, parasites, heavy metals, nutrient deficiencies, mold, hormonal imbalances, and dental issues. Most people with eczema will have three or four root causes contributing to their skin condition.
• Topical steroid creams not only prevent people from getting to the root cause of their eczema, but also come with side effects. Steroids stop the overreaction of your immune cells, which causes symptoms to go away but also means you’re neutralizing your all-important immune system. When using topical steroids, people can experience thinning of the skin, acne, rosacea, and skin irritation, among other issues. 
• What’s worse, when someone stops using steroids after using them for some time, they can experience what’s called topical steroid withdrawal. This is a serious but underrecognized condition that occurs because a person’s skin has become dependent on the steroid. With topical steroid withdrawal, a person will experience all the symptoms of eczema but more intensely, along with symptoms like chills, sweats, the sensation of ants crawling on their skin, and even “zingers,” or the feeling of being zapped or electrocuted.

Watch our full interview with Abby Tai to learn the link between suicide and eczema, the scary psychological side effects of oral steroids for eczema, why eczema seems to come and go for many people, why people in urban areas tend to have more eczema than those in rural areas, why water filters can help prevent eczema, and much more.

You can also listen to the interview on The getWellBe Podcast

Have you ever struggled with eczema? How did (or are you) treating it? Let us know in the comments below!

Citations:

1. Nemeth V, Evans J. Eczema. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
2. Raharja A, Mahil SK, Barker JN. Psoriasis: a brief overview. Clin Med (Lond). 2021 May;21(3):170-173. doi: 10.7861/clinmed.2021-0257. PMID: 34001566; PMCID: PMC8140694.
3. Tiwari V, Brent LH. Psoriatic Arthritis. [Updated 2022 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547710/
4. Prussick R, Prussick L, Nussbaum D. Nonalcoholic Fatty liver disease and psoriasis: what a dermatologist needs to know. J Clin Aesthet Dermatol. 2015 Mar;8(3):43-5. PMID: 25852814; PMCID: PMC4382145.
5. Wu CY, Lu YY, Lu CC, Su YF, Tsai TH, Wu CH. Osteoporosis in adult patients with atopic dermatitis: A nationwide population-based study. PLoS One. 2017 Feb 16;12(2):e0171667. doi: 10.1371/journal.pone.0171667. PMID: 28207767; PMCID: PMC5313211.

The information in this article comes from our interview with Abby Tai, Registered Holistic Nutritionist and founder of Eczema Conquerors and Conqueror Skincare, and host of The Eczema Podcast. She completed her nutritionist training at the Canadian School of Natural Nutrition. Claims and opinions from this interview are Abby Tai’s and do not reflect an editorial position on any topic. You can learn more about Abby here.