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