 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 1 in 10 kids have it, and about 3% of adults, where you get patches of red, itchy skin. Typical steroids like cortisone cream is the mainstay of treatment, since it's 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 into their surprise. It worked, but so did the corn oil alone without the vitamin D that they were using as a control. Others reported cases improving after feeding flaxseed oil, or even lard that 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, they get better, but maybe they would have 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 been just due to the usual treatments, with perhaps a dash of enthusiasm. By then, hydrocortisone was out and 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 linoleic acid and 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. And so the results show that the effects of some brand of primrose oil supplement was almost always significantly better than placebo. Case closed, right? Well, the analysis was funded by the supplement company itself, which can 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 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 good night to the evening primrose oil story, perhaps we'll awaken to a world where all clinical trial data reach the light of day. Borage oil actually has twice the gamelan-melanic acid as evening primrose oil, and still didn't work, but that didn't stop researchers from trying hemp seed oil, which has evidently been used as a food and medicine for thousands of years. They tried giving about a quarter cup of hemp seeds 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, C buckthorne oil, hemp seed, or sunflower oil, overall no convincing evidence that taking supplements improved eczema. Well, that's disappointing, but wait a second, that's just for oral supplements. What about natural remedies applied topically? We'll find out next.