Causation

Eczema, both acute and chronic, which constitutes so large a proportion of all cases of skin diseases, is provoked by different causes, but in a great number of instances its origin is directly traceable to dietetic faults. These may be of three kinds - namely, the eating of (1) too much food; (2) insufficient food; (3) improper food.

1. Cases Due To Overeating

The ills of overeating have been elsewhere described (p. 371). Its relation to eczema consists in the additional burden thrown upon the skin of attempting to eliminate waste products, which are accumulated in the blood faster than they can be got rid of. The cutaneous glands, like the kidneys, are constantly stimulated and overworked, and the character of their secretion is altered. The skin, for a long time irritated, finally succumbs to a definite eruption.

It is for this reason that robust persons apparently in the best of health and with too vigorous appetites will sometimes be surprised with the sudden appearance of eczema, which they have always attributed solely to " bad blood".

Treatment

This class of cases is to be treated by reducing the quantity of food, and by prescribing a very simple diet. In bad cases of general eczema it may be best to put the patient upon a milk or bread-and-milk diet for one, two, or three weeks. From two to two and a half quarts are taken daily with toast or crackers. Marked improvement will occasionally follow this course. For others, simply reducing the diet by excluding meat and desserts for a time, may be all that is necessary. Meats - either beef, mutton, or chicken - should not be allowed more than once a day. Piffard reports that 56 per cent of his patients were accustomed to eat meat in excess three times a day.

Fish, either boiled or broiled, may be substituted for meat to advantage in neurotic subjects (Bulkley), for though it may excite urticaria, it does no harm in eczema in spite of the popular belief to the contrary. I have known the eating of shellfish, however, to intensify chronic cases considerably.

Typical Diet For Eczema

The following simple diet may serve as an example:

Breakfast

Bread and milk, or porridge, or wheaten grits, or cracked wheat, without cream, and salt or lemon juice may be added if preferred. Every other day a soft-cooked egg may be eaten.

Dinner

No soup, entrees, or dessert. Roast beef or mutton or chicken may alternate with broiled fresh fish with white meat, one or two green, light vegetables, such as haricots, spinach, lettuce, green peas, or macaroni. As Jackson says: "It is a good rule to tell the patient he may eat what he likes, but not of more than two dishes at a meal. It is unlikely that he will then overeat." Fresh, ripe fruits, except apples, may be allowed.

Supper

Bread or toast or crackers and milk, custard, or simple rice pudding, not too sweet. A little fresh fruit. Stimulants are not usually required, but if needed for nutritive or tonic effect, dilute liquor, brandy, whisky, or Hollands is the best form.

Malt liquors of all sorts, as well as wines, should be forbidden. It is generally believed that tea and coffee are harmful in eczema, and drunk in excess they certainly are so, not only from disordering and retarding digestion, but from their undue stimulating effect.

Unless they are taken in great moderation and but once a day, it is better to forbid their use entirely. The same is true of sweet chocolate, but cocoa may be allowed.

2. Cases Due To Insufficient Food

Too little food results in impoverished nutrition, and the skin, being one of the most sensitive organs of the body, is among the first to suffer. The habits of filth which so often accompany semi-starvation among the poor are contributing causes which combine to provoke skin eruptions.

The diet required for these cases does not essentially differ from those of the preceding class. An effort should be made to restore the impoverished nutrition of the body as quickly as possible by suralimentation if necessary (p. 471).

3. Cases Due To Improper Food

Improper food is also capable of exciting outbreaks of eczema, and this is particularly true of chronic or relapsing cases. Oatmeal, for example, while it may not cause the disease, is generally believed to be capable of intensifying it. It is not possible to always forewarn against the particular articles of diet which will do this, as they vary in different persons and often in the same person at different times, but, in general, food which is called "rich" is to be avoided, such as highly seasoned meats, soups, sauces, gravies, strong condiments, sweets, pastry, hot breads, pickles, preserves, and fancy desserts of all kinds. Bulkley especially forbids sweet potatoes, fried eggplant, cabbage, cheese, bananas, apples, soda water with sirups, as well as salt food, such as ham, corned beef, and salt pork. A little bacon or a salt herring, however, is permissible. All fried food, with the above exceptions, is strictly forbidden, and " fritters," fried oysters, etc., are highly injurious. In a word, all those articles which are liable to excite temporary dyspepsia and overload the urine with phosphates, urates, and calcium oxalate must be avoided.

The staple diet should consist of whole-meal bread, fresh, plainly cooked vegetables, eggs, milk, and a little chicken, fresh fish, or meat not oftener than once a day.

There are obstinate cases of chronic eczema which fail to yield to any dietetic regulations, but it is always desirable to thoroughly try the value of dietetics, and very often the result will be surprisingly gratifying. In conjunction with dietetic treatment the urine should be always carefully examined, and the bowels must of course be regulated.

It is very important to control the general habits of the patient in regard to meals. He should eat at regular and proper hours and observe uniformity in the quantity of food consumed. He should be very careful to eat slowly and thoroughly masticate his food, and not drink so much fluid with meals as to dilute the gastric juice excessively. The general rules for the treatment of dyspepsia (p. 530) and its avoidance are especially applicable to all skin diseases which are in any way amenable to dietetic influence. It should also be remembered that eczema frequently is associated with gouty and strumous diatheses, and the reader is referred to the sections upon these subjects.