Eczema, Steroid Treatment, And Insulin Resistance: Our Story
My daughter was diagnosed with eczema as a toddler. A respected dermatologist recommended the usual treatment: fewer baths, mild soap, Aveeno® bath oil, and steroid ointment. As she grew, her eczema got worse in spite of treatment. She became allergic to Aveeno. The moisturizers the doctor recommended weren't effective and stung her sensitive skin. I found myself applying the steroid ointment on more and more of her body, without any real improvement.
When I became concerned about the long-term effects of using steroids on so much of my daughter's skin, the doctor assured me I had no need to worry because there were no real dangers.
At age 8 or so, my daughter, who had always been a thin child, began to gain weight. When her weight gain didn't respond to a lower-calorie diet, I began to suspect diabetes. I took her to an endocrinologist, who confirmed that my daughter had insulin resistance—also known as pre-diabetes or metabolic syndrome.I learned that long-term topical steroid treatment can cause permanent changes in the way the body uses sugars and fats, leading to insulin resistance or even type 2 diabetes. I've spent five years researching the links between eczema, steroid treatment, and diabetes. I wrote this page to help people with eczema understand these links and learn safer ways to control eczema and insulin resistance with diet and nutrition.
Eczema, topical steroids, and diabetes: A Vicious Circle
The risks of long-term steroid treatment, with nutritional guidelines for managing eczema and insulin resistance
If you are reading this page, you or your child has probably been diagnosed with eczema. You have a lot of company: According to the National Institutes of Health, up to 20 percent of infants and young children experience symptoms of eczema and about 60 percent of these children go on to have eczema as adults. About 15 million adults in the United States suffer from eczema.(1)
A Google search for "eczema" brings up nearly 8.5 million pages. The Wikipedia page actually provides a pretty good overview. Here are two sites that in my opinion offer some of the best information available:
DermNet NZ (New Zealand). An overview of eczema can be found here:
A more detailed guide to different types of eczema and dermatitis, including pictures of eczema, can be found at DermNet NZ.
An informative page from the National Institutes of Health can be downloaded as a pdf.
Eczema is commonly treated with topical ointments or creams containing steroid hormones known as corticosteroids or glucocorticoids. These medications reduce the symptoms of eczema—the inflammation and itching—by mimicking natural inflammation-reducing hormones produced in the body by the adrenal glands. However, steroids absorbed through the skin can cause both immediate and long-term changes in the functioning of the adrenal glands, leading to insulin resistance and possibly steroid-induced diabetes.(2, 3)
While topical steroids are generally quite effective at reducing the signs and symptoms of eczema, they do not cure its underlying causes.
A healthy body produces natural oils that form a skin barrier that keeps skin soft and slightly acidic (pH between 4.5 and 6, depending on age, with an optimum at around 5.5), helping skin to resist infection by disease-causing bacteria. When the body is unable to produce these natural oils, the skin becomes very dry and the skin barrier is damaged, exposing the skin to infection.(4) To make matters worse, the body's immune system may overreact to common substances, causing inflammation and further damaging the skin.(5)
Current research focuses on why the body is unable to produce these natural oils. Central to this research is an enzyme called delta-6-dehydrogenase (D6D), which converts the linoleic acid in dietary vegetable fats into gamma linolenic acid (GLA), an essential fatty acid necessary for maintaining healthy skin.(6) (More on D6D and GLA later.) In both eczema and diabetes, the D6D enzyme may be impaired--it may not function properly.(7, 8) Levels of the specific vitamins and minerals required for D6D to function are often very low in people with eczema or diabetes.(9-15) Nutritional supplementation to increase the levels of these nutrients may reduce or eliminate the symptoms of eczema and help stabilize insulin and glucose metabolism.(15-21)
Contact eczema (also called contact dermatitis or allergic dermatitis) is not the same thing as atopic eczema. Contact eczema is caused by external factors such as dust, metals, fabrics, or chemicals. It can usually be cleared up with a short course of a steroid ointment. Further breakouts can be prevented by avoiding—if possible—the offending substance. However, many people with atopic dermatitis are also prone to contact eczema. (1, 21)
A zinc deficiency may be misdiagnosed as eczema
Formula-fed babies may also be deficient in vitamins or in essential fatty acids.(25-27) Some babies may not be able to utilize the vitamins and fats in baby formula, or the formula itself may not provide enough of them. Before exposing your baby to steroid drugs, talk to your doctor or a knowledgeable nutritionist about supplementing safe levels of vitamins and essential fatty acids—especially docosahexaenoic acid (DHA) and GLA.
Bathing your baby with Epsom salts (magnesium sulfate) or Dead Sea salts is a safe way to reduce inflammation(28) and supplement with magnesium (which is well-absorbed through the skin(29)) at the same time. A special kind of zinc can also be applied as a topical cream for absorption through the skin. Be sure to use a good, fragrance-free baby oil after the bath to hold moisture in the skin.
Food allergies may cause eczema in infants and children
In formula-fed babies, changing the formula may eliminate the problem. Special, easy-to-digest hydrolyzed formulas (formulas where the proteins are partially broken down) are often recommended for formula-fed babies with food allergies. Adding probiotics or prebiotics--beneficial bacteria that live in the gut and help digest food--to infant diets helps to reduce or prevent both food allergies and other illnesses.(33-35)
Breastfeeding longer, introducing solid foods late (after 6 months), introducing new foods one at a time, and waiting to introduce allergenic foods until after the baby is about a year old help reduce the risk of allergic reactions. Most babies outgrow early allergies to milk and eggs, although peanut allergy is more likely to persist to adulthood. However, children with food allergies are more likely to develop asthma or other atopic diseases when they grow older.
If you suspect a food allergy in your baby or child, talk to your doctor. A food elimination diet should only be utilized under a doctor's supervision, to limit the risk of nutrient deficiency.
Long-term treatment with topical steroids can lead to insulin resistance (pre-diabetes)--and worsened eczema.
Despite the risks, topical steroids are often used for the long-term control of eczema, even in young children. This can start a chain of events that eventually leads to diabetes—and, ironically, worsened eczema.
How topical steroids can cause insulin resistance
High levels of steroids may be absorbed through the skin during steroid therapy for eczema,(36, 37) which is where the trouble starts. Children absorb proportionately more of the drugs because their skin is thinner and because they have more skin surface area relative to their body mass. (36)
Because the synthetic glucocorticoid hormones used in topical steroid medicines mimic the body's own hormones, long-term use can permanently damage the body's own ability to produce these necessary hormones. (38) Glucocorticoid hormones are essential to regulating the body's ability to convert sugars and fats into the energy needed by every cell in the body. If this regulatory function is impaired, the body is unable to maintain the delicate balance between insulin and glucose, resulting in insulin resistance or diabetes.
Insulin resistance inhibits D6D enzyme activity, leading to eczema
GLA is one of the most important substances in the body. It is essential for the healthy functioning of the nervous system, the brain, and the heart. GLA helps control inflammation. It also plays an important part in creating a healthy skin barrier between the body and the outside world.
When the D6D enzyme can't produce GLA, diabetes, allergies, asthma--and eczema--(as well as heart disease, eye diseases, rheumatoid arthritis, osteoporosis and cancer) may be the result.(40)
How to recognize steroid-induced insulin resistance
Acanthosis nigricans may be misdiagnosed as eczema
Acanthosis nigricans may be misdiagnosed as eczema, even by experienced dermatologists. Such misdiagnosis is easy to understand when you see a definition of eczema like this one from WebMD:
Acanthosis nigricans may be a warning sign of steroid-induced insulin resistance. (My daughter's dermatologist failed to recognize her acanthosis nigricans for years and simply prescribed more hydrocortisone ointment, which may have made the underlying insulin resistance worse.) If your or your child's "eczema" does not respond to topical steroids, suspect acanthosis nigricans and see an endocrinologist immediately.
Nearly every discussion of acanthosis nigricans associates it with obesity, but anyone with insulin resistance may develop this condition, whether obese or not! Acanthosis nigricans is more common in people with darker skin.
Acanthosis nigricans often responds quickly to changes in the body's insulin status. As a result, it may be a useful diagnostic tool for figuring out whether insulin resistance is improving or worsening.
Low levels of zinc, magnesium, and selenium often accompany eczema and insulin resistance.(9-15) These nutrients, along with some of the B vitamins (especially B6) are necessary for the D6D enzyme to work properly and produce the essential fatty acid GLA. Recent research shows that Vitamin D is also extremely important in the development and management of both eczema and diabetes.(42-44)
It's interesting that the same group of vitamins and minerals are essential for both optimal D6D function and optimal insulin metabolism. Supplementation with these vitamins and minerals may be a safe way to help manage both eczema and insulin resistance. By following this regimen you may be able to stop or reduce your use of topical steroids or insulin-regulating drugs.
My recommended diet and supplement regimen provides support for D6D enzyme activity as well as a direct source of GLA. Other vitamins and minerals are included to provide balanced nutrition. The amounts listed are within the United States Recommended Dietary Allowances or, if higher, have extensive research to support the higher doses.
Eat a healthy low-carbohydrate, high-protein diet
Supplement safety guidelines
Vitamin supplements and drugs may interact with eachother, so it's a good idea to check first. An extensive database of drug-vitamin interactions can be found on the University of Maryland website. An interaction does not necessarily mean that you can't use the supplement; it does mean that you should be careful and do so with your doctor's supervision.
A supplement may even reduce your need for certain drugs; for instance, both magnesium and chromium can reduce the need for diabetes and heart medicines. To safely use supplements and drugs together, start with a low dose of the supplement and work up to the full dose. Have your doctor test you and adjust your medication as necessary.
Test, test, test
Baseline testing--testing specific nutrient levels in your body before starting a supplement regimen--lets you know where you're starting from. Continue to test once every six months at first and then at least once a year, to be sure your nutrient levels are where you want them to be, and adjust your supplements and medicines accordingly.
Why not just take a multivitamin?
All vitamins are not created equal
Disclaimer: I have no ties with any of the companies that manufacture or sell the vitamins I recommend.
Some nutrients lose effectiveness when taken together
[ back to top ]
For insulin resistance, you may add:
NOTE: Chromium picolinatehas been studied extensively for its role in helping to improve insulin sensitivity. However, it is controversial as some studies have found it may cause DNA damage, while other studies found it to be safe. Consult a trusted doctor or nutritionist before adding chromium to your supplement regimen.
Recommended Supplement Brands
Vitamin B Complex
DHA/EPA oil blend
Look for any brand of zinc picolinate, the most bioavailable form. Purchasing a lower-dose zinc--around 25 mg, rather than 50 mg--will allow you to regulate your dose more effectively. Too much zinc can reduce levels of copper, another essential nutrient. Once again, testing--both zinc and copper--is key to balancing these nutrients.
[ back to top ]
The statements on this page have not been evaluated by the FDA (U.S. Food & Drug Administration). They are not intended to diagnose, cure or prevent any disease. The information provided by this website is not a substitute for a consultation with your physician, and should not be construed as individual medical advice.
Softress make fragrance-free, chemical free body oils for sensitive skin and dry skin care. Go to our home page to find out more.
Atopic or atopy: A term used to describe conditions, including allergies, asthma, and eczema, in which the body's immune system overreacts to common substances, causing inflammation.
Corticosteroids, glucocorticoids, cortisol, hydrocortisone: Terms used to describe both steroid medications and/or steroids produced naturally by the body. In the body, glucocorticoids control metabolism (transformation) of sugars and fats into energy, among other things.
Diabetes: Diabetes is a family of disorders in which there is a problem with the production or use of insulin, causing levels of the sugar glucose to rise too high in the blood.
Delta-6-dehydrogenase (D6D): an enzyme in the body that converts linoleic acid, a fatty acid found in vegetable oils, into gamma-linolenic acid, an essential fatty acid used by nearly every cell in the body.
Dermatologist: A medical doctor who diagnoses and treats disorders of the skin.
Endocrinologist: A medical doctor who diagnoses and treats disorders of glands and the hormones they produce.
Essential fatty acids (EFAs): Chemical components of fats that are essential to healthy functioning of the human body.
Eczema, atopic dermatitis, or atopic eczema: General terms used to describe a host of skin conditions characterized by very dry, inflamed skin. Symptoms may include redness, itching, scaling, peeling, cracking, and even blisters.
Enzyme: a protein molecule that catalyzes (facilitates and speeds up) chemical reactions in the body and enables the transformation of one chemical substance into another. Most biochemical reactions in the human body require specific enzymes to go to completion.
Gamma-linolenic acid (GLA): An essential fatty acid necessary for proper functioning of the heart, the brain, and the nervous system and many of the body's chemical reactions. It also helps the body control inflammation.
Hormone: Strictly speaking this is a chemical produced by the cells in one part of the body that is carried by the blood and acts in a different part of the body. It also refers to any synthetic substance that acts like a hormone.
Inflammation: Inflammation occurs when the body detects an injury, irritant, or foreign substance and sends white blood cells and chemical agents to fight it. This response can be beneficial, such as when it helps wounds heal. But it can cause problems when skin is too sensitive, which occurs in eczema and some other skin diseases.
Insulin: A hormone produced in the body that allows cells to take up glucose from the blood and use it for energy. It also stores excess glucose in the liver as glycogen, or “animal starch.”
Insulin resistance, pre-diabetes, metabolic syndrome, “syndrome X”: A condition in which the body's cells don’t respond properly to insulin and so absorb little glucose. The body responds by making more insulin, resulting in too much insulin in the blood. Insulin resistance can lead to type 2 diabetes if not caught early enough.
Topical: applied to the skin.Topical steroids: Anti-inflammatory medicines that mimic glucocorticoids, hormones the body produces to metabolize sugars and fats and fight inflammation. Topical steroids are divided into seven classes depending on their strength. A list of medicines by strength and brand name can be found here.