Case Study: Eczema Resolution in a 7-Year-Old Boy — Food Sensitivity Elimination and Gut Microbiome Restoration Using the Functional Health Matrix

Illustrative composite — not a single patient. This case study is a teaching composite synthesised from anonymised patterns in the published clinical literature and Nutri-Link case-history references. It does not describe a specific identifiable patient seen by Codenutri Ltd or any single practitioner. Names, demographic specifics, and quoted dialogue are constructed for educational illustration. Always work with a registered clinician for individual care.

Key learning points

• Paediatric eczema is frequently the cutaneous expression of a gut-driven inflammatory process, not an isolated skin condition.
• Caesarean delivery, formula supplementation, and repeated antibiotics create a well-documented risk profile for gut dysbiosis and atopic disease.
• Targeted elimination based on IgG4 food sensitivity testing, with planned reintroduction, can reduce inflammation while minimising nutritional risk.
• Lacticaseibacillus rhamnosus GG at 10 billion CFU daily has RCT evidence (ProPAD) for improving SCORAD in paediatric atopic dermatitis.
• In paediatric functional medicine, the family is effectively the patient; parental buy-in, kitchen reorganisation, and caregiver wellbeing are central to outcomes.

Patient presentation

Leo (composite), age 7, presented with moderate–severe chronic eczema (SCORAD 48), nocturnal pruritus (2–3 wakings/night), and a highly restricted diet (~12 foods). Onset was at 3 months of age.

Key background factors:

• Emergency caesarean at 39 weeks
• Formula supplementation in first 48 hours, then breastfeeding
• Six oral antibiotic courses before age 3 (otitis media, impetigo)
• Worsening of skin after each antibiotic course
• Potent topical corticosteroid use 4–5 days/week
• Failed, incomplete dairy-free and gluten-free trials

Growth was within reference ranges but on a declining centile trajectory, consistent with risk from multiple-food restriction without structured replacement.

Initial clinical assessment

Skin and mucous membranes

• Widespread flexural eczema (antecubital/popliteal fossae, wrists, ankles, posterior neck)
• Erythema, excoriations, lichenification
• Angular cheilitis suggesting possible iron, B2, and essential fatty acid insufficiency

Digestive system

• Bloating most days
• Bowel movements every 2–3 days, alternating hard pellets with loose, urgent stools
• Post-prandial abdominal pain, especially after dairy
• History consistent with paediatric gut dysbiosis and increased intestinal permeability

Immune system

• 4–5 URTIs per year
• Oral thrush twice in previous year (mucosal immune compromise, likely yeast overgrowth)
• Clinical picture of Th2-dominant atopic state (part of the atopic march)

Nervous system and sleep

• Restlessness and poor concentration at school, strongly correlated with nights of poor sleep
• Sleep fragmented by itch (2–3 wakings/night)

Growth

• Weight 30th centile, height 45th centile, down from ~60th centile weight at age 4
• Pattern compatible with growth attenuation seen in poorly planned elimination diets

Functional Health Matrix assessment

Leo was scored across the seven Functional Health Matrix nodes (0–5 scale):

• Structural Integrity: 3/5 — impaired skin barrier; otherwise normal musculoskeletal status
• Defence & Repair: 1/5 — frequent infections, slow wound healing, oral thrush, Th2 bias
• Energy Production: 3/5 — adequate but unstable energy linked to high-glycaemic diet
• Biotransformation & Elimination: 2/5 — constipation tendency; antibiotic history
• Transport: 3/5 — cardiovascular status normal; suspected malabsorption
• Communication: 2/5 — HPA axis stress from chronic sleep loss; itch–scratch cycle
• Assimilation: 1/5 — root disturbance: C-section, early formula, antibiotics, dysbiosis, restricted diet, bloating, irregular bowels, likely fungal overgrowth

Total score: 15/35, indicating a moderately compromised system with Assimilation and Defence & Repair as primary therapeutic priorities.

Wheel of Life assessment

Lifestyle domains were scored 1–10:

• Nutrition & Diet: 2/10 — ~12 beige foods, minimal fibre, vegetables, or omega-3; no fermented foods
• Sleep & Recovery: 1/10 — 6–7 hours fragmented sleep vs 9–11 hours recommended
• Movement & Exercise: 6/10 — active when skin allows; restricted during flares
• Stress Management: 3/10 — chronic illness burden, social anxiety, parental stress
• Relationships & Community: 6/10 — supportive family; peer teasing about skin
• Purpose & Meaning: 7/10 — engaged with hobbies; self-esteem impacted by appearance
• Environment & Toxins: 4/10 — standard cleaning products, synthetic bedding, weekly chlorinated swimming
• Spiritual Practice: 3/10 — no formal practice; limited nature exposure

Total: 32/80, with major issues in Nutrition, Sleep, and Environment.

Functional testing

Comprehensive stool analysis (GI Effects — paediatric)

• Faecal calprotectin: 156 µg/g (elevated; low-grade intestinal inflammation)
• Pancreatic elastase: 282 µg/g (normal)
• Stool zonulin: 198 ng/mL (markedly elevated; increased intestinal permeability)
• SCFAs: butyrate 3.8 µmol/g (low), acetate/propionate low quartile
• Commensals: Bifidobacterium 1+, Lactobacillus 1+, Akkermansia muciniphila undetectable
• Opportunists: Clostridium spp. 3+, Enterococcus 3+
• Yeast: Candida spp. 3+ (moderate overgrowth)
• Ova/parasites: none detected

IgG4 food sensitivity panel (96 foods)

• Grade 3: cow’s milk, egg white, wheat gliadin, brewer’s yeast
• Grade 2: soya, peanuts, almonds
• Grade 1: oats, corn, oranges

Nutritional evaluation (blood spot)

• 25-OH vitamin D: 32 nmol/L (deficient)
• Omega-3 Index: 2.9% (severely low)
• RBC zinc: 9.8 µmol/L (low)
• Ferritin: 22 µg/L (low–normal)
• hs-CRP: 3.2 mg/L (elevated systemic inflammation)
• Total IgE: 486 kU/L (markedly elevated; atopic state)

Sleep diary (7 days)

• Average sleep: 7.1 hours/night
• Night wakings: 2.4/night
• Sleep latency: 42 minutes
• Parent sleep disturbance (Pittsburgh modified): 14/21 (severe impact)

Overall, testing confirmed a gut-centric, immune-driven condition: dysbiosis, increased permeability, multiple IgG4 food sensitivities, micronutrient deficiencies, and systemic inflammation.

Intervention protocol

Three phases were implemented over 12 weeks, prioritising the Assimilation node.

Phase 1 (Weeks 1–4): Remove triggers and stabilise

Targeted elimination diet

• Removed: cow’s dairy, eggs, wheat (including hidden sources), yeast-containing foods, soya, peanuts, almonds
• Introduced: quinoa, brown rice, lamb, poultry, wild-caught salmon, cooked vegetables, avocado, olive oil
• Parent education: label reading, school meals, social events
• Daily diary: itch score, sleep, bowel habit, mood

Gut antimicrobial support

• Saccharomyces boulardii: 5 billion CFU twice daily (weeks 1–4)
• Emulsified oregano oil (paediatric): 50 mg daily (weeks 3–4)

Gut barrier and digestion

• L-glutamine powder: 2.5 g daily
• Zinc carnosine: 37.5 mg daily (≈8 mg elemental zinc)
• Paediatric digestive enzymes: 1 capsule with main meals

Skin barrier care

• Liberal emollients 3–4 times daily
• Steroid step-down: potent mometasone to mild hydrocortisone 1% (short, targeted use only)
• Virgin coconut oil as adjunct emollient on non-lesional dry skin

Micronutrient repletion

• Vitamin D3: 2,000 IU daily (loading for deficiency)
• Omega-3 (algal EPA/DHA): 500 mg DHA + 250 mg EPA daily

Phase 2 (Weeks 5–8): Microbiome restoration and immune rebalancing

Probiotics

• Lacticaseibacillus rhamnosus GG: 10 billion CFU daily (ProPAD protocol-aligned)
• Bifidobacterium lactis BB-12: 10 billion CFU daily

Prebiotic

• Partially hydrolysed guar gum (PHGG): 2.5 g daily to support butyrate producers and Akkermansia expansion

Immune modulation

• Liposomal curcumin (paediatric): 100 mg daily
• Vitamin D3: reduced to 1,000 IU daily (maintenance)
• Omega-3: continued at Phase 1 dose

Phase 3 (Weeks 9–12): Food reintroduction and lifestyle integration

Structured food reintroduction

• Week 9: soya challenge (1 serving/day × 4 days)
• Week 10: almonds
• Week 11: oats
• Cow’s milk, egg, wheat, and yeast: deferred for ≥6 months, with plan for supervised oral food challenge

Sleep optimisation

• Bedtime routine: 19:30 lukewarm bath with emollient wash; 20:00 story; lights out 20:15
• Environment: cotton bedding/pyjamas, 18 °C bedroom, blackout curtains
• Magnesium glycinate: 100 mg at bedtime
• Parent coaching: 45-minute session on managing bedtime anxiety and itch–scratch cycle

Skin microbiome and environment

• Emollient-only wash products
• Temporary cessation of chlorinated swimming
• Daily outdoor play ≥30 minutes

For practitioners: see these tools in action

The Functional Health Matrix and Wheel of Life visualisations shown in this case study are native tools inside the EPINUTRI practitioner platform. They generate automatically from patient intake data and update in real time as clinical outcomes are recorded. In paediatric cases, the platform supports family-system scoring alongside the child’s clinical assessment.

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