Atopic dermatitis (eczema) affects approximately 20% of Irish children — one of the highest rates in Europe — and persists into adulthood in a significant proportion. Ireland's cool, damp climate and high prevalence of indoor living (central heating, carpets, pet ownership) creates ideal conditions for dust mite exposure, which is the dominant indoor allergen triggering eczema flares. The condition causes significant suffering: relentless itch, disrupted sleep, skin infections, and a profound effect on quality of life for both children and adults.
Conventional treatment centres on emollient therapy (moisturisers), topical corticosteroids, and in severe cases, immunosuppressants and biologics (dupilumab). Natural approaches are widely used alongside conventional treatment and some have meaningful supportive evidence. None replace prescribed treatment for moderate-to-severe eczema.
Evening primrose oil (EPO) and borage oil (starflower oil) are rich sources of gamma-linolenic acid (GLA), an omega-6 fatty acid. In atopic dermatitis, there is evidence of impaired delta-6-desaturase enzyme activity — the enzyme that converts linoleic acid to GLA. This metabolic block may contribute to a deficiency in anti-inflammatory eicosanoids derived from GLA. Supplementing GLA directly bypasses this enzymatic step.
A 1995 meta-analysis in the British Journal of Dermatology of 9 RCTs found EPO significantly superior to placebo for overall eczema severity, itch, and scaling. However, a larger 2003 RCT published in the BMJ and a subsequent Cochrane review (2013) found no significant benefit for EPO or borage oil compared to placebo in children or adults. The Cochrane review concluded the evidence was inconsistent and overall did not support EPO for eczema. This is a genuinely mixed evidence picture — some populations may respond while others do not, and dose and formulation vary enormously between studies.
EPO supplements are very safe, inexpensive, and may provide benefit for some individuals. The risk of a 12-week trial at 3–4g daily is low. However, parents should not delay or skip prescribed emollient and steroid therapy in favour of EPO.
Vitamin D deficiency is extremely prevalent in Ireland — a 2011 TILDA study found 40% of Irish adults have insufficient vitamin D levels (below 50 nmol/L), rising to 80%+ in winter months. Ireland's latitude (51–55°N), cloud cover, and indoor-oriented winter lifestyle make dietary and supplemental vitamin D essential for many people.
Vitamin D plays important roles in skin barrier function and immune regulation. Low vitamin D levels correlate with eczema severity in multiple epidemiological studies. A 2014 RCT in Journal of Allergy and Clinical Immunology found vitamin D3 supplementation (1000 IU daily) significantly improved winter eczema in children with documented deficiency. A 2016 systematic review in the British Journal of Dermatology concluded that vitamin D supplementation shows consistent benefit in eczema patients, particularly those who are deficient at baseline.
This is particularly relevant for Irish eczema patients: vitamin D testing and supplementation (typically 1000–2000 IU daily for adults, 400–800 IU for children — always confirm with GP) is a simple, safe intervention that many patients are not receiving. The Irish Government HSE recommends vitamin D supplementation for all infants, pregnant women, and breastfeeding women. The HPSC recommends all adults consider supplementation during winter months (October–April).
The "gut-skin axis" refers to the bidirectional communication between the gut microbiome and skin immunity. Research over the past decade has revealed that eczema patients have altered gut microbiome composition — reduced microbial diversity, lower levels of Bifidobacterium and Lactobacillus species, and altered short-chain fatty acid production — compared to healthy controls. These gut microbiome changes influence systemic immune responses that drive atopic inflammation.
Probiotic intervention trials in eczema have shown the most consistent benefit in prevention: a 2018 Cochrane review (29 RCTs, n=2599) found that probiotics significantly reduced risk of eczema development when given to pregnant mothers and newborns in the first year of life. The strains with the best evidence include Lactobacillus rhamnosus GG, Lactobacillus rhamnosus HN001, and mixed Lactobacillus/Bifidobacterium preparations. For treatment of established eczema, the evidence is more modest — probiotics may reduce severity scores and antibiotic use for skin infections, but the effect size is smaller.
Aloe vera gel has anti-inflammatory, antimicrobial, and wound-healing properties relevant to eczema. A 2015 Iranian RCT found topical aloe vera gel comparable to 1% hydrocortisone cream for eczema severity scores after 8 weeks, without the skin-thinning side effects of long-term topical steroid use. Aloe vera is best used as a cooling, soothing complementary treatment for mild flares rather than a substitute for prescribed emollients in severe eczema. Look for products with ≥98% pure aloe vera gel with minimal added ingredients.
Colloidal oatmeal (finely ground oats suspended in cream or lotion) is one of the most evidence-supported topical treatments for eczema itch and barrier restoration. The FDA has approved it as an over-the-counter skin protectant. Multiple studies confirm it reduces itch, scaling, and disrupted sleep in atopic dermatitis. Products like Aveeno Eczema Therapy (which contains colloidal oatmeal and is widely available in Irish pharmacies) have the most consistent evidence base.
| Claim | Evidence Level | Source |
|---|---|---|
| Vitamin D supplementation improves eczema severity | Moderate | JACI 2014 (RCT); Br J Derm 2016 (systematic review) |
| Probiotics reduce eczema risk when given perinatally | Strong | Cochrane 2018 (29 RCTs, n=2599) |
| Evening primrose oil for eczema — inconsistent evidence | Weak – Cochrane neutral | Cochrane 2013 |
| Topical aloe vera comparable to 1% hydrocortisone | Moderate | Iranian RCT 2015 |
| Colloidal oatmeal reduces itch and scaling | Strong | Multiple RCTs; FDA approved skin protectant |
Evening primrose oil: safe for most adults; avoid in seizure disorders; do not use with phenothiazine medications. Vitamin D: safe at recommended doses; excessive doses (>10,000 IU/day long-term) cause toxicity — always test levels with GP before high-dose supplementation. Probiotics: safe for healthy individuals; those who are immunocompromised should seek medical advice. Aloe vera topically: patch test first — rare contact allergy occurs.
Eczema in infants and young children should always be reviewed by a GP or paediatric dermatologist. Skin infections (bacterial — impetigo; viral — eczema herpeticum, which requires urgent treatment) are a serious complication of eczema and should be assessed by a GP. If eczema is significantly affecting sleep, schooling, or quality of life, prescription treatments (topical immunomodulators, dupilumab) offer substantial benefits and should be discussed with a GP or dermatologist.
Find vitamin D, evening primrose oil, and skin health supplements at our partner store
Shop at The Honey Pot → Ireland Health Shop →