How to manage Atopic dermatitis (eczema) – an ayurvedic approach by Krya

This post was last updated on April 10, 2023 by Preethi Sukumaran

Do you or your child suffer from Atopic dermatitis or dry, itchy, easily irritated skin? Have you been asked to use a special medicated soap or a lotion to help control the skin itchiness? Are you looking for natural remedies and safe skin care alternatives to manage this condition better? Read on for more information on Atopic dermatitis, the extent of the problem, possible causes and triggers and Ayurvedic advice on this condition.

What is Atopic dermatitis?

Atopic dermatitis is a chronic condition where the skin is dry, itchy , sometimes reddish and irritable for a long period of time. The condition can keep flaring up and trigger in the skin. The rash can sometimes inflame and then ooze clear fluid. If the skin is severely dry and cracked, it may also bleed.

Atopic dermatitis is not considered contagious. However western medical science is unable to pinpoint an exact cause / trigger. It is considered a genetically inherited condition. It is also linked to other allergic conditions like asthma, wheezing, allergic rhinitis. This condition also tends to flare up in the presence of environmental allergens like cosmetics, laundry products, perfumes, make up, pollen, dander, cold & dry weather, stress, etc. It can also flare up with high sweating, high stress and high physical exercise.

Western medicine suggests that atopic dermatitis cannot be completely cured. The skin can be managed with the aid of corticosteroid based topical application products. It usually manifests before 5 years in 90% of Adult sufferers.

How common is Atopic dermatitis in India?

The Indian journal of Dermatology estimates that Atopic dermatitis currently affects nearly 15% of the population in India and has been increasingly rising with time (earlier estimates pegged it at 5% of the population). Studies from developed countries indicate that treatment and management of Atopic dermatitis is a “significant burden on health care budgets”.  The condition almost always starts in childhood and can continue throughout adulthood flaring and subsiding on and off.

Researchers across the world have called Atopic dermatitis a “costly and expensive disease”, both emotionally and financially. An estimate in UK suggests that parents spent 47 million pounds to manage Atopic dermatitis among children between 1 – 5 in one year alone : 75% of this went towards OTC prescription creams, ointments and soaps to manage this condition.

Costs in India are also high. The Indian journal of Dermatology estimates that Atopic dermatitis is as expensive a disease as chronic Adult Diabetes with high recurring costs. A recent study in an OP department of a hospital estimated that parents spent Rs. 12000 annually to manage Atopic dermatitis – which was about 15% of their stated family income! This estimate increases with an increase in severity of the disease. In countries like Australia, severe Atopic dermatitis cost families nearly $1225 annually (close to 40, 000 Rs).

What are the trigger factors for Atopic dermatitis ?

The Indian Journal of Pediatrics cites several studies, white papers and discussions in various symposia on the phenomenon of Atopic dermatitis. While there is no conclusive “ONE” factor that contributes to this disease, we have several practical hypotheses to explain why Atopic dermatitis occurs.

Many of us know the standard theories behind the spread of these “idiopathic” conditions like Atopic dermatitis.

1. Hygiene theory as a cause for Atopic dermatitis:

Atopic dermatitis is much more common in urban , and relatively higher sanitary conditions. This is especially true of Western countries.  As the immune system is relatively “untested” due to clean surroundings , repeated use of strong cleansers, the immune system tends to aggressively respond to relatively harmless antigens leading to development of Atopic dermatitis.

Studies indicate that the severity of Atopic dermatitis is much higher in countries like U.K and U.S.A compared to India due to the above reason.

This and the hereditary theory are the main 2 theories behind skin conditions like Atopic dermatitis (eczema). Apart from the above, we would like to highlight, 2 very critical hypotheses behind the spread of Atopic Dermatitis.

2. IgE triggers -cause for Atopic dermatitis

IgE is Immunoglobulin E. This is an antibody produced by the body’s immune system in response to invasion of the skin by micro organisms or allergens. When the body is introduced to certain allergen triggers, IgE production along with Basophils and Activated Eosinophils leads to a hypersensitivity reaction.

Here the body responds to this allergen threat by doing 2 things to control the entry of the allergen into the body:

• It seals off the skin by tightening the brick and mortar structure of the skin: so skin pebbles up and feels tighter
• It contains the allergens inside a sealed closed off environment in the form of red, visible, external bumps / cysts
• It restricts the airway passages restraining the amount of allergen filled air being breathed in: simultaneously, it triggers mucous formation, enabling the body to sneeze, cough and expel the allergens that have invaded, OUT of the body

This response is a well thought through, fantastic piece of intelligent and adaptive design in our body. But, it is designed for an obvious, temporary allergen dose. It is not designed for frequent, in-your-face , subtle allergen attacks.

The question will arise: where are these frequent, in-your-face, subtle allergen attacks to be found?

a. Enzyme based detergents & household products – trigger Atopic dermatitis

A common IgE triggers is the enzyme Der P1 analogous to Papain . Der P1 is an enzyme present in the feces of the house dust mite. Dust mites can breed in homes where there is limited sunlight, where there are food sources available for the dust mite (they prefer feeding on fungal dandruff flakes from your head!) and also where bed linen is not changed periodically.

Even if you do not have a dust mite infestation, you could still be triggering an IgE reaction. How?

By using enzyme based household products like laundry and dishwashing detergents, contact lens cleaners !

Enzymes can also be found in cosmetic face washes and cleansers, make up removal products, cleansing wipes and sometimes even in synthetic processed foods.

Another known IgE triggering enzyme is Subtilisin , a bacteria derived enzyme. Subtilisin is a protease enzyme that is linked to both allergic rhinitis, allergy triggered asthma and atopic dermatitis. Subtilisin has been identified as a IgE trigger for both air and skin allergic reactions over the last 40 years.

Enzyme activism – strongly opposed by Industry

Any activism to sensitize users to the potential effects of using these enzymes always faces a strong backlash from the industry. Despite several studies linking the handling of industrial enzymes to contact allergies in workers and animal models, the Industry continues to state that industrial enzymes are safe for home use. They insist that at these doses, it is not possible to develop IgE triggers or allergic reactions.

Allergic reactions need only very minute doses of allergens to trigger the Immune response. Estimates suggest that the average pollen allergy sufferer is exposed to 1 millionth of a gram per year – however even this dose is enough to produce asthma, allergic rhinitis and even anaphylaxis in extreme cases.

The enzyme onslaught around is very high: they have even found their way into food and medical applications. Papain, is commonly used in meat processing to tenderize meat. Chymopapain, a closely linked variant, is used in medical sciatica procedures – one of the rare documented side effects of chymopapain is anaphylaxis!

b. A1 dairy linked allergic pathway to Atopic dermatitis:

In the last few years there has been a tremendous amount of research work that has emerged on the inflammatory and allergy inducing properties of commercial dairy. A dairy allergy is fast emerging as a quick diagnosis after nuts and shellfish allergies. Medical practitioners and patients who see a quick reversal in allergic symptoms, reduction of atopic dermatitis and eczema and improvement in asthmatic conditions erroneously conclude that the fault lies in dairy as a whole.

Ayurveda and traditional sciences teach us about the dhatu building and curative properties of carefully sourced dairy. The key point to note here is that “dairy: in Ayurveda and Siddha assumes dairy products sourced for the indigenous, humped Desi cow, which produces A2 milk. Unfortunately, a majority of us today consume commercially extracted, A1 milk. The milk is many times adulterated. The commercial dairy industry , like the commercial poultry industry is notorious with pumping hormones, weight enhancers, and antibiotics into dairy cattle – all of this trigger a wide ranging set of responses in the body.

But apart from the commercialization of dairy and the consequences of drinking this milk, there is another critical issue with the dairy products we receive today: most of commercial dairy farming is sourced from cross bread Jersey / Holstein cattle which usually produce A1 milk or a mixture of A1 and A2 depending on the cross breeding.

c. Histidine mutation in modern A1 milk – possible trigger to Atopic dermatitis

Casein is the main milk protein in milk forming about 80% of the protein constituent of milk. Casein is divided into 4 groups, which are represented in milk: S1 Alpha, S2 Alpha, Beta & Kappa type.  Beta Casein is a very important component of milk protein – it forms 30% of Milk’s total protein content.

Beta caesin has 13 variants of which A1 and A2 variant are the most common.  A2 Milk comes from pure bred Asian and African cattle. In this milk, a nucleotide called PROLINE is the 67^th position of the amino acid chain. The nucleotide variation in this single position contributes to the difference between A1 and A2 milk.

With the migration of cattle to Europe, a mutation developed in this 67^th position in the amino acid chain in Beta Casein. Instead of Proline, European cattle mutated to HISTIDINE in the 67^th position in the chain. Initially the entire bovine population contained only the A2 allele. The A1 allele developed after the histidine mutation when bovine cattle migrated to Europe. This is a mutation that did not occur in human or other animal species even though they too migrated to Europe.

With modern breeding techniques, European dairy cattle have developed further mutations along the 209-amino acid protein chain, but the most significant change from A2 native cattle is the presence of histidine.

Histidine and Proline are processed very differently in the human body. During digestion, Proline is much more stable compared to histidine . Histidine can cleave and break during digestion to release Beta Casomorphin (BCM) oppoid peptides including a variant called BCM-7.

While there has been research on Casomorphins for over 30 years, it was only post 2009 that researchers started focusing on the effect of CMs and BCM-7 release in the body after consuming A1 milk.

BCM 7 in particular and other variants of BCM do the following:

• Reduce gastric motility increasing constipation:
• Slows down time taken to digest food – leading to higher Ama buildup in the body
• Interfere with nutritional uptake in the body by increasing mucous in the GI system
• Alter the pattern and behavior of the Gut Immune system – leading to greater risk of inflammatory gut disease

Apart from these issues, consumption of A1 milk has also been linked to SIDS, autism, schizophrenia type 1 diabetes, etc. Most importantly, for this article, Beta Casomorphins trigger the IgE response, leading to increased wheezing, rhinitis and atopic eczema and Atopic dermatitis, particularly itchy, inflamed skin.

 Diet linked Allergen pathway to Atopic dermatitis:

We have already explored the correlation between enzyme exposure,  certain kinds of Dairy and allergy induced Atopic dermatitis. Apart from these triggers, natural triggers for Atopic dermatitis include the following:

• Pollen allergy
• Dust mites
• Shell fish
• Eggs,
• Nuts and tree nuts (these allergens differ by country and exposure)

Causes for Atopic dermatitis from an Ayurvedic perspective

Ayurveda lists many causes / Hetu for development of Vicharchika (Atopic dermatitis / eczema) and other skin disease. Apart from these reasons, we can add the above to the already existing reasons of allergens and pollutants as a cause.

• Ahara Hetu – Food based causes
  • Viruddha ahara – incompatible food combinations – radish + curd, sour fruits + milk / curd, honey + hot water, eating new cereals and pulses, excessive intake of sesame and jaggery, etc

• Vihara Hetu (Habits / Lifestyle based causes)
  • Exercising and sun exposure after meals
  • Day sleep
  • Withholding natural urges (like the urge to go to the toilet due to fear of contamination, etc)

• Achara Hetu (Mental conduct / thinking based causes)
  • Earing money by adharmic means
  • Behaving badly towards good people
  • Being disrespectful of Guru / Acharya and Wise and learned men
  • This is a larger subject covered beautifully i Ayurveda. Please start with this article written by us on Spiritual Sadhana.

Ayurvedic diet (pathya) & herbs to manage Atopic dermatitis

Ayurvedic pathya (diet) for Kushta (skin diseases) is also very strict and asks the patient to avoid certain standard skin disease-triggering foods. These include:

• Pitta-Kapha aggravating foods like Sesame seeds, Jaggery, Eggs, Curd, Cheese, Paneer, Cashew (all nuts in general trigger Pitta and Kapha unless processed properly, eaten in the right season and chosen as per body type)
• Kushta (skin disease) triggering foods like brinjal, eggs, commercial poultry, fish

• Reduction of extremely sour, salty and spicy food
• Eating native gourds, aged grains and cereals,
• Eating grains like wheat, barley, etc is also considered pathya for these skin conditions

Some of the herbs recommended for Atopic dermatitis are:

• Khadira
• Manjishta
• Karanja
• Kusta
• Daruharidra
• Haridra
• Guduchi
• Nannari, etc.

The choice of herbs will depend upon age of the patient, season and symptoms . For example, if the presentation involves a higher Pitta based reaction like redness, inflammation, burning sensation, or warmth, Pitta balancing herbs should be chosen over other herbs like Nimba, Khadira, etc.

If the presentation is Kapha based, for example scaling, thickening, or oozing, Kapha balancing herbs should be chosen like Kushta, Haridra, Daruharidra etc. Such cases can also benefit by using herb-based dusting powders to dry up the area.

Ayurvedic Line of treatment suggested for Atopic dermatitis:

Ayurveda recommends the use of herb infused bath steeps, Lepas, Oils and bathing powders that are based on skin health improving herbs to manage Atopic dermatitis and eczema. Panchakarma treatment to correct deranged Kapha and Pitta are also recommended to correct the dosha imbalances in the body.

Apart from this, as a high percentage of Atopic dermatitis is linked to environmental allergens and food allergens, necessary changes are advised to ensure exposure to these allergens is limited.

For serious, chronic conditions like weeping eczema with exudates, it is best to consult a good vaidya.

Adults with such challenging skin conditions greatly benefit by following an Ayurvedic Pathya diet and in severe cases benefit greatly by getting a proper Panchakarma process done. It is important to do this under the auspices of a well qualified Vaidya who has good experience in treating these disorders.

Adults should also follow the 3 pronged approach of examining their Ahara (food), Vihara (lifestyle) and Achara (mental conduct) and eliminate any skin disease inducing patterns. Many modern food diets and “health practices” fall under the list of Vriddha Ahara – like the practices of eating fruit and vegetable smoothies with curd, over dependence on jaggery and high use of nuts like sesame, cashew, etc.

Achara (mental conduct) is extremely critical in managing chronic skin conditions. There is a strong link between dosha aggravation and mental states as described in Ayurveda. Our diet influences our thinking and our moods and vice versa. So if you have strong rage issues, anger management issues , envy, jealousy, etc, these are all manifestations of unchecked Pitta dosha working on your mental and emotional state. Such mental states and ways of thinking WILL contribute to flaring up of conditions like Atopic dermatitis.

How to choose the right products that can help soothe Atopic dermatitis

The products chosen for skin must be chosen with a great deal of care. We must remember that skin which is already hypersensitive can quickly react to enzyme based triggers, artifical fragrances, presence of irritants like SLS and SLeS, etc in skin and personal care products.

Therefore if you have developed atopic dermatitis, we advise completely replacing ALL personal care products with completely natural, soothing alternatives.

The products we suggest to replace are:

• Shampoo, conditioner and any hair products (SLS, SLeS, Silicones, and fragrances can all trigger itchiness and sensitivity)
• Facial cleansers
• Body washes / soaps / body cleansing gels
• Perfumes used (cut down or reduce use)
• Deodorants (best to be avoided until skin flare up comes under control)

In addition, we also suggest eliminating and checking allergic reaction to the following household cleansing products:

• Detergents
• Dishwash detergents
• Air freshener / Room spray
• Fabric softener
• Phenyl / Tile cleaner

We will suggest alternatives to these products below.

Ayurvedic skin care protocol for Atopic Dermatitis

After eliminating any possible allergens in skin care and household care, Ayurveda focuses on soothing and balancing skin imbalance through careful regimen of skin care.

This protocol is as follows:

• Bathe in herb treated water – this improves skin health , and reduces the chance of further skin irritation from the synthetics present in city water

• You can choose from simple available herbs in your neighbourhood – some examples are neem leaf, khadira twigs / barks, Pongamia leaves / twigs
  • Alternatively, Krya has a Kashaya Snana choornam product for sensitive skin. You can make a decoction out of this and add it to hot bathing water or make a larger batch and bathe exclusively in it – this second option is suggested for babies / young children with atopic dermatitis or eczema

• Pre-oil the skin (especially in dry parts) with a small amount of carefully chosen Ayurvedic skin oil. You may choose an oil suggested by your vaidya for sensitive skin.

• Alternatively, you can use the Krya sensitive Skin oil for Adults. 
• For babies and toddlers with dry flaky sensitive skin, please use the Krya Vata Sensitive Baby Oil
• For babies and toddlers with red, rashy sensitive skin, please use the Krya Pitta Sensitive Baby Oil

• After skin is pre-oiled, bathe with a Snana choornam specially formulated for sensitive skin. For sensitive skin, we would want to avoid very drying formulations like ubtans made with a lot of hot or astringent herbs. We would instead choose a soothing Snana choornam that calms down itchiness, and cleanses sensitive skin extremely gently. Using a soap or body wash can further dry out the skin making it even more dry and flaky
  • Krya has a Sensitive Bodywash Snana choornam for Adults. It is carefully formulated to cleanse gently, soothe itchiness and support skin as it naturally heals. It is very mild and very sensitive.
  • For babies and toddlers with dry flaky skin, please use the Krya Vata Baby Sensitive Body wash
  • For babies and toddlers with red, rashy sensitive skin, please use the Krya Pitta Baby Sensitive body wash
  • For older toddlers and children with chronic dry skin with a tendency towards skin flaking and peeling, please use the Krya Toddler Sensitive Bodywash. 

How to deal with atopic dermatitis in a baby or young child? 

Ayurveda tells us that skin is inherited from the Mother – in Ayurveda, the traits are passed on in a much more complex fashion. The parent’s mental state, time of conception, readiness to have the child, the food, and lifestyle practices during pregnancy all play a factor in determining skin health and overall health. 

This is why there is a great emphasis on following a suitable diet and following lifestyle practices taking specific herbs in every stage of the pregnancy in Ayurveda.

That said, in our work, we find that many babies and children suffer from atopic dermatitis and eczema not necessarily because it has been passed on by the parents. Many parents with healthy skin are puzzled to see skin sensitivity develop in babies.

This could be attributed to the high amount of chemical triggers present in modern day homes due to household cleaning products, and personal care products. An important step would be to “detox” your home and remove all potential allergens like enzyme-based synthetic cleansers, aerosols, cosmetic wipes, baby wipes, etc and adopt clean , non-allergenic food.

In breastfed babies, correcting the mother’s diet and removing any Hetu (causes ) like Viruddha Ahara (incompatible food), and correcting lifestyle practices like heavy afternoon sleep, etc can also have a good impact. We suggest consulting a good vaidya if you feel this could help you. 

Along with this , a simple shift from a  commercial skin cleanser and moisturizing lotion to Krya’s baby cleansers and baby oils greatly helps young babies with itchy, irritable, Atopic dermatitis-prone skin.

Babies and children respond very quickly to these changes and there is a good improvement in their skin condition without having to use medicated corticosteroid-based creams, special soaps and cleansers.

When parents follow the dietary recommendations for skin disorders and also take an effort to remove environmental and food-based allergens, the effect is further enhanced. The biggest and best change you can do for food is to switch to unpasteurized, indigenous A2 cow’s milk for the family. This has excellent health, nutritive, and skin benefits. Please ensure you also follow the relevant changes in Vihara (lifestyle) suggested below to help your child.

Ayurvedic lifestyle (Vihara) protocol to heal Atopic dermatitis:

Always check the temperature of the water before bathing. Skin conditions like dermatitis do best in luke warm and not hot water. We suggest using a herb enriched bath water for bathing as often as possible.

Choose your detergent and cleaning products very carefully. Avoid any products which focus on high stain removal and these are likely to contain industrial enzymes. Avoid using fragrance-based cleaning products, even if choosing natural products. Unscented products are best. Choose completely natural cleaning products whenever possible.

In Krya’s cleaning range we suggest the following products in conditions like atopic dermatitis. All the products suggested are fragrance-free – we do not even use essential oils in these products:

• Krya Classic Detergent – 100% soapberry based detergent powder which is anti allergenic, antibacterial and antifungal naturally
• Krya Classic Dishwash – fragrance free combination of ayurvedic herbs including Soapberry, Triphala and Khadira – excellent for dishes and gentle on skin
• Krya Sookshma floor cleaner – made from a well researched combination of ayurvedic herbs and plant gums – fragrance free and suitable for those with asthma, respiratory and skin allergies
• Krya Tile Cleaner – excellent for tiles, porcelain and other bathroom surface cleaning – free from all potential allergens and strong fragrances

Sun all bedding every fortnight and change linen every fortnight or ideally once a week. As  dust mite feces are a strong trigger in skin conditions, this precaution helps reduce build up of dust mite droppings.

Switch to carefully sourced genuine, unpasteurized A2 milk. Avoid commercial dairy preparations like cheese, paneer, Greek yoghurt, milkshakes, ice creams, etc

In summer, high pitta aggravation can cause the sweat secretion in the body to be extremely acidic, which in turn provokes atopic dermatitis. Ensure you follow the correct ayurvedic diet in Summer to avoid spiking Pitta. A natural Pitta balancing Snana choornam will also help cleanse skin and Srotas thoroughly to avoid this problem.

For adults, a gentle exercise programme helps better with Atopic dermatitis. Avoid very strenuous and intensive exercise regimens.

Manage stress by doing less, regular hair oiling , nourishing food and sufficient time out to “stop and stare”. Stress is a strong trigger for Atopic dermatitis.

To sum up: Understanding & managing Atopic dermatitis naturally

We hope this article was able to help you understand how Ayurveda analyses, diagnoses and treats chronic skin conditions like Atopic dermatitis. By adopting safe, natural, tried and tested ayurvedic herbs and oils, many of our consumers have been able to control the severity and incidence of chronic skin conditions like Atopic dermatitis.

As with all ayurvedic advice, following a multi pronged approach of internal medication, the right diet, positive and uplifting thinking helps work on such chronic skin conditions more holistically and effectively. Ayurveda is a thorough and detailed science. For all internal treatment, we advise going to experienced and renowned Ayurvedic physicians who can diagnose your condition correctly and suggest the right treatment that can help you.

If you need any help on choosing the right Krya products to manage Atopic dermatitis, please DM us on WhatsApp or email us.