"Eczema Treatment with Evening Primrose Oil, Borage Oil vs. Hempseed Oil"
Atopic dermatitis, more commonly known as eczema,
is ranked as the skin disease with perhaps the greatest
global health burden, because it’s just so common.
Maybe one in 10 kids has it and about 3% of adults,
where you get patches of red, itchy skin.
Topical steroids, like cortisone cream, have been the mainstay
of treatment since their Nobel Prize winning discovery in 1950.
People are scared of steroids, though.
It’s not uncommon for patients to express irrational fear and anxiety
about using steroid creams and ointments,
a phobia that may arise from confusing topical steroids
with oral or injected steroids, which have different effects.
Really potent topical steroids can thin your skin,
but skin thickness should return to normal a month after stopping.
So yes, it can cause side effects,
but the concern people have seems out of proportion
to the small risk they pose.
Still, if there’s a way you can resolve a problem without drugs,
that’s generally preferable.
What did they do for eczema before the 1950s?
Well, in the ‘30s, some researchers tried using vitamin D
dissolved in corn oil, and to their surprise it worked—
but so did the corn oil alone without the vitamin D
they were using as a control.
Others reported cases improving after feeding
flaxseed oil, or even lard!
The National Livestock and Meat Board
did not want to be left out of the action.
The problem is that none of these studies had a control group.
So yeah, feeding someone corn oil for 12 to 18 months
and they get better;
but, maybe they would have just gotten better anyway.
You don’t know until you put it to the test.
All these researchers that claimed benefit from the use
of various fats apparently lacked any great interest
in doing controlled studies,
but, not this researcher who tried out some oils
and found no evidence of benefit over routine treatment.
Most got better either way,
which suggests that the previous benefits claimed
may have just been due to the usual treatments
“with perhaps a dash of enthusiasm.”
By then, hydrocortisone was out;
so, the medical community gave up on dietary approaches,
until this letter was published in 1981
about the treatment of eczema with supplements
of evening primrose oil, which contains gamma linolenic acid,
an anti-inflammatory omega-6.
And indeed, when it was put to the test, it seemed to help.
But then, a subsequent larger study found no effect.
Whenever there are conflicting findings,
it helps to do a meta-analysis,
where you put all the studies together.
There was the study that showed benefit,
the one that didn’t, and then seven other studies,
and seven out of the seven showed benefit.
So, the results showed that the effects
of some brand of primrose oil supplement
were almost always significantly better than placebo.
Case closed, right?
Well, the analysis was funded by the supplement company itself,
which could be a red flag.
Where exactly were these other seven studies published?
They weren’t.
The company just said they did these studies
but never released them.
And, when they were asked to hand them over,
they said they would but never did,
even threatening a lawsuit against researchers
who dared to question their supplement's efficacy.
An independent review failed to find evidence
that evening primrose oil or borage oil
worked better than placebo.
And so, as we bid goodnight to the evening primrose oil story,
perhaps we will awaken to a world
where all clinical trial data reach the light of day.
Borage oil, actually, has twice the gamma linolenic acid
as evening primrose oil, and still didn’t work;
but, that didn’t stop researchers from trying hempseed oil,
which has evidently been used as food and medicine
for thousands of years.
They tried giving about a quarter cup of hempseeds worth of oil
to people every day for a few months
and found significant improvements in skin dryness,
itchiness, and the need for medications,
but not compared to placebo.
In fact, dietary supplements across the board,
whether fish oil, zinc, selenium, vitamin D, E, or B6,
sea buckthorn oil, hempseed, or sunflower oil,
overall, no convincing evidence
that taking supplements improved eczema.
That’s disappointing, but wait a second—
that’s just for oral supplements.
What about natural remedies applied topically?
We’ll find out, next.