Dermatitis: What Can We Do?

Tejasvani Knowledge Desk

Dermatitis presents as a chronic, recurring skin condition that often poses significant therapeutic challenges. International treatment guidelines emphasize restoring the skin’s barrier function while managing inflammation and preventing recurrence. Although conventional treatments can provide symptom relief, they often come with limitations, making it necessary to explore complementary and supportive approaches.

Understanding Dermatitis (Atopic Dermatitis – AD)

Atopic Dermatitis (AD) is an inflammatory skin condition affecting the dermis and superficial epidermis. It develops through a complex interaction of genetic predisposition, immune imbalance, environmental exposure, and microbial changes.

Although not life-threatening, AD can severely impact quality of life — physically and psychologically.

Common symptoms include:

• Persistent itching

• Redness (erythema)

• Papules and blisters

• Skin barrier breakdown and ulceration

• Sleep disturbance due to itching

Studies show strong associations between AD and anxiety, depression, and emotional stress, particularly in chronic cases.

Causes of Atopic Dermatitis

1. Genetic Factors

Genetics account for approximately 82% of the risk for developing AD. Mutations in the filaggrin (FLG) gene, essential for skin barrier integrity, play a major role.

2. Environmental Factors

Contributing factors include:

• Air pollution

• Dietary changes

• Chemical exposure

• Urban lifestyle stressors

These account for the remaining 18% of disease risk.

Pathogenesis of Atopic Dermatitis

AD arises from multiple overlapping dysfunctions:

Skin Barrier Dysfunction

The skin barrier — especially the stratum corneum (SC) — prevents water loss and blocks pathogens. In AD:

• Intercellular lipid deficiency weakens the barrier

• Trans-epidermal water loss (TEWL) increases

• Skin becomes vulnerable to allergens and microbes

Microbial Imbalance (Skin Dysbiosis)

Healthy skin hosts a diverse microbiome. In AD:

• Microbial diversity is reduced

• Staphylococcus aureus colonization increases dramatically

Research shows:

• ~70% of lesional skin

• ~39% of non-lesional skinharbor S. aureus in AD patients

Fungal imbalance is also observed, with reduced Malassezia and increased Candida in severe cases.

Immune Dysfunction

AD is characterized by immune imbalance, particularly:

• Dysregulation between Th1 and Th2 helper T cells

• Overproduction of inflammatory cytokines

• Elevated IgE-mediated responses

This immune shift worsens inflammation and itching.

The Itch–Scratch Cycle

Itching is the most distressing symptom of AD.

• Inflammatory mediators activate mast cells

• Histamine release triggers itching

• Scratching damages the skin barrier

• More allergens penetrate → more inflammation

This vicious cycle leads to increased release of cytokines such as:

• IL-31

• TSLP

• CCL2, CXCL1

Breaking this cycle is essential for healing.

How Essential Oils Can Help

1. Reducing Itching (Pruritus)

Certain essential oils have demonstrated antipruritic effects:

• Peppermint oil activates cold receptors, reducing itch sensation

• Geraniol (found in rose, clove, lemongrass oils) shows anti-inflammatory action

• Aromatherapy massage has been shown to reduce itching and stress

Experimental models show increased itch threshold and reduced scratching frequency when essential oil emulsions are applied.

2. Managing Pathogenic Microorganisms

Up to 90% of AD patients carry Staphylococcus aureus on their skin.

Essential oils:

• Inhibit S. aureus growth

• Reduce oxidative damage

• Improve microbiome diversity

Compounds like thymol (from thyme oil) have been shown to:

• Suppress inflammatory cytokines

• Reduce immune overactivation

• Mitigate flare-ups linked to bacterial vesicles

3. Reducing Inflammation

Essential oils help regulate inflammation by:

• Inhibiting histamine release

• Suppressing mast-cell activation

• Reducing inflammatory mediators like TNF-α, IL-6, IL-1β

This supports both immune balance and skin barrier repair.

Role of Essential Fatty Acids (EFAs)

EFAs play a crucial role in skin health.

• Linoleic acid (LA) converts into gamma-linolenic acid (GLA)

• GLA supports anti-inflammatory prostaglandin (PGE1) production

• Deficiency leads to AD-like skin symptoms

Evening Primrose Oil (EPO) is a natural source of LA and GLA and has shown promising anti-inflammatory benefits in AD management.

What We Can Do: Practical Application

A supportive topical approach may include:

• Essential oil blend diluted in carrier oils such as:

  • Virgin coconut oil

  • Jojoba oil

  • Sweet almond oil

  • Olive oil

Suggested dilution:

• 10 ml essential oil blend in 500 ml carrier oil

Usage:

• Apply multiple times daily on affected areas

• Occasional full-body application for barrier support

Final Thoughts

Dermatitis requires a holistic approach — restoring the skin barrier, calming immune responses, balancing the microbiome, and relieving itching. While conventional therapies have their place, natural adjuncts like essential oils and EFAs offer promising supportive benefits when used responsibly.