Eczema

This post is an accumulation of various posts from my other blog.  This has nothing to do with planner, but I thought it would be useful for someone.  Since I sort of turned off my other blogs now.


 I have also found this article this week, so I am adding this to my already very long post, but this is helpful to eczema sufferers.

So, you’ve come to the conclusion that you’re most probably suffering from eczema or you officially have a diagnosis from a physician. As difficult or painful as it may sometimes be, it’s important to remember that you are not alone. Eczema affects 10-20% of the population and chances are many in your circle of family and friends suffers with this often itchy and uncomfortable skin condition.

We want to be able to help you with all your eczema concerns or questions. If you are new to eczema, or even if you’re a seasoned pro who has read and tried it all, this Educational Eczema Series 101-104 is a must read. Make sure to click through the other posts in the series which together discuss the various types of eczema, as well as causes and natural treatments that are definitely worth trying out.
Please keep in mind that although these tips and information have worked for several sufferers, we are in no way medical professionals. If you’re experiencing severe symptoms or have a topical infection, it is always best to seek medical advice immediately.
Prior to discussing the types of eczema that exist, it’s important to actually understand what eczema is.

What Is Eczema?

Although researchers still do not know what is eczema, studies have finally proven eczema is an autoimmune disease (1), similar to psoriasis, lupus and many other immune disorders. Eczema has also been linked to an overactive response by the body’s immune system to an irritant which can create a leaky skin barrier. With leaky skin, staph, viruses, allergens, etc., can all enter the body through the skin which in turn triggers inflammation, itchy skin, and all the factors we relate to eczema. On the flip side, eczema often seems to be triggered by what’s going on inside the body and things like the food we eat, how we digest food and if a leaky gut is present or if there is a liver imbalance, to name a few, have all been known to either trigger eczema initially or further exacerbate it.

Types of Eczema

Before pointing out typical symptoms of eczema, it’s important to define the various types of eczema.

Atopic Dermatitis

This form of dermatitis is also referred to as eczema, atopic eczema, atopic dermatitis, and dermatitis. It is most commonly seen in children and creates both dry and scaly patches on the scalp, forehead, cheeks and face. These patches can also be extremely itchy and can ooze pus in some cases. The term ‘atopic’ is used to describe a group of conditions that include asthma, eczema and hay-fever. The term atopic march refers to children who start with eczema and then as they get older also develop asthma and then hay fever/pollen allergies, but many times with eczema symptoms lessening along the way. Children with atopic dermatitis frequently follow this atopic march or progression into other allergic conditions.

Seborrheic Dermatitis

If you experience dandruff or your child suffers with cradle cap, then you or your child are actually suffering from a mild case of scalp seborrheic dermatitis. However, with a more severe condition, skin becomes sensitive, sore, itchy, flaky and even greasy. It can even cause scaling or crust on the scalp, itching and soreness behind the ears, across the eyebrows and around the nose or chest.

Contact Dermatitis

This type of eczema is caused by contact with something in the environment such as pets, dander, dust mites and more. Contact dermatitis usually affects the hands, arms, face and legs. When exposure to the irritant is ceased, the eczema should clear up eventually and not return.

Nummular Dermatitis/Discoid Eczema

This type of eczema is very distinct in that it causes skin to become itchy, red and swollen in circular patches that look like coins. It looks very similar to ringworm, so it’s always best to get checked by your medical practitioner to verify it is in fact a type of eczema.

Dyshidrotic Eczema

Small blisters filled with clear liquid identify this type of eczema. It usually occurs on the hands or feet, but can occur in other locations. It is extremely itchy and for unknown reasons, is much more common in women then men.

Hand Eczema

Although this type of eczema strictly relates to only one part of the body, the hands, it is so common that it has its own sub-type. Check out our best tips for healing hand eczema.
To learn more about other types of dermatitis, beyond eczema, make sure to check out our blog post: How to Identify The Type of Dermatitis You Have

Will My Child Out Grow Eczema?

If your child has eczema, it can be so incredibly hard to see them suffer and surely you’re consumed by wondering how you can help ease their discomfort, which we hope you’ll learn a bit more about later on in this Educational Eczema Series 101-104. But if you’ve wondered if your child will one day finally outgrow their eczema, then THIS post is definitely worth a read!

For more information on what causes eczema, make sure to check out this post with video from dermatologist Dr. Peter Lio: What Causes Eczema?

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This post is an extension of my previous eczema post.  This include my recent flare and lots of past info I have already posted, but I repost them again so they will all be in one place.  This is not intend to heal or cure any conditions, but just my personal experience.  This is not a sponsor post.

A few months back (I think around August?), my eczema was acting up again and bad enough that I wanted to try Tradition Chinese Medicine again.  I had some good experience with it years ago with some other skin issue and was ready to give it another go.  However, I find that TCM does not help much this time.  It was not helping much with the symptoms, though I understand taking care of the source is the ultimate goal.  But after going consistently for around 3 months, I have to stop.  Real improvement was after I stopped going.  Things were starting to get better (MUCH better).  My legs were the first place that shows improvement.  Then the back of my hands and then my palm.  My face got the minimal irritation, but it also has improved a great deal.  Then I went to my old dermatologist (who does not use steroid) shortly after Christmas and I am almost completely clear.  Almost.  My hands do still get some mini flare now and then from my Dyshidrosis/Pompholyx eczema, but the blisters are not as strong and they don't last as long.  I understand a healthier diet is the ultimate way to go and I am working on it.


Here is a comparison photo of my hand when it was at its worst (photo not available). The eczema spread from my palms to the back of my hands and it is always worse on my left hand too.  TCM was not doing much help then (which made me sad).


Scary looking, isn't it?  It was very red, and textured and itchy.  You can see a few small areas that were not affected.  The right side of the photo was taken today.  I am sooooo grateful that I am getting much better and can see real skin again. I do not take this for granted.
During my flare, my hands are in pain all the time... and not to mention itchy... and even some small tasks are difficult to do.  My hands  were much worse than my legs and feet.  And my left hand is worse than my right as well.  I just have to focus on healing and other things other than the pain and itch.  One day at a time.  One of the things I have done is to track how I feel in a planner (or journal).

Some things that have helped...

• Emu Oil.  You should read up on the benefits of this amazing oil.  A big one for me is it helps with the pain. [here]
• MetaDerm Hyper Moisturizing cream.  Love this cream.  Does not sting and it's thick and not greasy. [here]
• MetaDerm Eczema Natural Soothing Spray. [here]
• Cream from my dermatologist.
• Rocky Mountain Soap Body Butter.  I used it as the "topper", a last step to seal in all the cream I have used. [here]
• Herbal salve.  I recommend Chargrin Valley [here].
• Hurraw Moon Balm (for my lips) [here]
• Natural soap for cleansing.

I also want to share how I apply lotion.  I apply lotion all over in the morning after shower (if you have eczema on your body, I find bleach bath helps too.  There are additional info in this post as well, keep scrolling); after I wash my hands and all over at night as well.

After shower I would spray the eczema spray anywhere is needed.  Then I will apply emu oil everywhere, followed by cream.  I pumped the cream in my palm generously and then spread them all over my palms and then pat them all over waist up and then rub them in.  And then I do the same thing for waist down too.  I am very generous when I use the cream.  When I am lazy, I just mix the emu oil with the cream. 

Other resources:
Home Remedy.  I found this site years ago.  So glad I have found it.  Because that's where I learned to mix T Gel and T Sal shampoo for my problematic scalp.  I still use it.


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Below is a summary of many many past posts for your convenience.

Eczema and a whole bunch of information

Today's post is about taking care of your skin, especially skin with eczema.  I will be posting various sections from my other blog(s).  The first section will be about moisturizing.  This is important for everyone, no matter if you are into nail art or not. I initially created the post for eczema.  But everyone should moisturize anyway.  It is essential for everyone everyday.  Then it will also cover baths and other useful information.  As a eczema fighter (which is currently fighting), I hope this will help you.

A little back ground, I have dyshidrotic eczema for a few years (or more) now.  I refuse to use steroid and have been seeking help via TCM.

Pompholyx

What is pompholyx?

Pompholyx is a common type of eczema affecting the hands (cheiropompholyx), and sometimes the feet (pedopompholyx).
Pompholyx is also known as dyshidrotic eczema or dyshidrosis.

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What is Dyshidrosis (Pompholyx)?

An overview of dyshidrosis, also known as dyshidrotic eczema or pompholyx, a painful skin condition.

Dyshidrosis, also called dyshidrotic eczema or pompholyx, is a non-contagious skin condition which affects the hands and/or feet. This painful ailment begins with blisters which then break and weep. After the weeping dries, the area cracks and peels. One cycle of dyshidrosis generally lasts three weeks. Some sufferers return to normal after one cycle, while others begin again once skin has recovered from the last cycle.

An Overview of Dyshidrosis Symptoms
Dyshidrosis begins with an inflamed area on the fingers, toes or soles. Inflammation causes fissures to form between cells, trapping fluid. This fluid then causes extremely itchy blisters or vesicles to form on the surface of the skin. Sufferers are cautioned not to scratch as this will accelerate and exacerbate the condition. Once the blisters rupture, the fluid oozes from the skin, leaving the area dry, cracked and painful to the touch.

Causes of Dyshidrosis
There is no known cause for dyshidrosis. Outbreaks seem to be linked to stress, allergic reactions through either skin contact or ingestion, or contact with a drying substance such as alcohol or harsh detergent. There has also been a suggestion of a genetic link to this painful condition.

Diagnosis of Dyshidrosis
Dyshidrosis is diagnosed by sight, however, a skin scraping may be preformed to rule out a fungal infection. No other tests for dyshidrosis exist, unless your physician believes the condition is linked to an allergic reaction. In this case, standard allergy testing may be implemented.

Treatment of Dyshidrosis
Several treatments are prescribed for dyshidrosis. Antihistamines, moisturizers, and strong topical steroids are most ofter prescribed. Other treatments include oral steroids, steroid injections, Burrow's solution soaks, Epsom salt soaks, and ultraviolet light therapy.

Complications Associated with Dyshidrosis
The most harmful complication stemming from dyshidrosis is a secondary bacterial infection that enters through cracks in dry skin. Another risk of this skin condition is a hardening of the skin. Excessive scratching leads to extreme dryness rendering the skin thick and hoofy, which hinders the use of fingers.

Prognosis of Dyshidrosis
There is no cure for dyshidrosis, however most sufferers return to normal after only a few cycles. Dyshidrosis can recur at a later date.
If you suspect you have this condition, see your health care provider for confirmation and treatment. As with any health condition, early treatment can save you undue suffering, and possibly a “self-mis-diagnosis.”
Sources
Mayo Clinic. “Dyshidrosis” (accessed January 2, 2011)
Right Health. “Dyshidrotic Eczema Guide” (accessed January 2, 2011)
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So if you are too lazy to read that blog post by Lab Muffin.  It's basically apply water based moisturizer first.  The water in your body will attract the water in the lotion and that's how they are "locked" and when you use oil based moisturizer later, that will act as a protective barrier and the water will not escape (or takes much longer).


Here are bits I copied and pasted from her site:
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Occlusives - these are greasy oils that block water from evaporating. Common examples are petroleum jelly, mineral oil (both super effective), lanolin, silicones (e.g. dimethicone), olive oil, carnauba wax, and beeswax. 

Humectants - these are water-attracting molecules which grab hold of water and slow down its evaporation. Examples are glycerin/glycerol, 

hyaluronic acid, propylene glycol, sorbitol, pathenol, and honey.

Emollients - these lighter oils sink into the skin and replace natural skin oils, helping to bind the skin cells back together into a nice solid layer, which feels soft and smooth to the touch. Examples include silicones, isopropyl palmitate, jojoba oil, propylene glycol, and vitamin E. 

The main scientific concept that's at play here is that oil repels water. You know how when you put oil and water together, the oil and water don't mix, and when you put a greasy spoon into plain water, you can't scrub the grease off without adding soap? This is exactly how layering works!

The other thing to remember is that water evaporates, but oils don't.

Now what happens when you do the reverse, and apply watery moisturiser first, then top with an oil-based moisturiser? This time, the water is right next to your skin, and the oil actually seals in the water so it has time to enter your skin. After the watery layer is mostly absorbed, the emollient oils will do their job and the occlusive oils keep the whole shebang in your soft, hydrated skin.

The most effective order of layering then, if you want maximum moisturisation, would be:

- Immediately after a shower (when your skin is still damp with water)
- Apply a humectant-rich moisturiser
- Add an emollient-based moisturiser
- Seal it all in with an occlusive oil.


I hope you find this post and Lab Muffin's information useful.

And while I am at it, I also find bleach bath helps with my eczema.

Use regular strength – 6 percent – bleach for the bath. Do not use concentrated bleach.

Measure the amount of bleach before adding it to the bath water. For a full bathtub of water, use a half cup of bleach. For a half-full tub of water, add a quarter cup of bleach. For a baby or toddler bathtub, add one teaspoon of bleach per gallon of water.

Subjects will take diluted bleach bath (0.005% Sodium Hypochlorite) for 5-10 minutes twice a week for 12 weeks.
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An eczema bleach bath — a bath with a small amount of bleach added to the water — may help lessen symptoms of chronic eczema (atopic dermatitis), an itchy skin condition.
A bacterial infection often accompanies eczema, worsening symptoms. An eczema bleach bath is thought to kill the bacteria on the skin, reducing itching, redness and scaling. This is most effective when combined with other eczema treatments, such as medication and moisturizers.
If properly diluted and used as directed, a bleach bath is safe for both children and adults. For best results:

• Add 1/2 cup (118 milliliters) of bleach to a 40-gallon (151-liter) bathtub filled with warm water (measures are for a U.S.-standard-sized tub filled to the overflow drainage holes).
• Soak the limbs and torso or just the affected areas of skin for five to 10 minutes. Do not submerge the head.
• Dry skin thoroughly, and generously apply moisturizer.
• Take a bleach bath no more than twice a week.

A bleach bath can cause skin dryness if too much bleach is used or if the bath is done too often. If your skin is cracked or extremely dry, any bath — including a bleach bath — may be painful. Talk to your doctor before trying an eczema bleach bath.

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Discussion on bleach bath for adults.
Dilute Bleach Bath How To:
1/4 cup household bleach for half tub.
Soak 10-20 minutes.
Pat dry gently.
Apply topical medications to affected areas.
Apply emollients to the entire body.
Bleach baths can be done daily or as little as twice weekly.

Do rinse after bleach bath.
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"In fact, he tells parents to use as little as a tablespoon of bleach in a tubful of water.  'That little amount of bleach is antiseptic and is very effective way to kill all the bacteria without having to give the patient antibiotics."
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Bleach bath therapy--video
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Bathing
(Posting this mostly for my convenience)



Eczema is a chronic recurring skin disorder that results in dry, easily irritated, itchy skin. There is no cure for eczema, but good daily skin care is essential to controlling the disease. When your skin is dry, it is not because it lacks grease or oil, but because it fails to retain water. For this reason, a good daily skin care regimen focuses on the basics of bathing and moisturizing.
Wind, low humidity, cold temperature, excessive washing without use of moisturizers, and use of harsh, drying soaps can all cause dry skin and aggravate eczema.

Taking Care of Dry Skin

The most important treatment for dry skin is to put water back in it. The best way to get water into your skin is to briefly soak in a bath or shower and to moisturize immediately afterwards. Use of an effective moisturizer several times every day improves skin hydration and barrier function. Moisturizer should be applied to the hands every time they are washed or in contact with water.
Some dermatologists recommend that you perform your bathing and moisturizing regime at night just before going to bed. You are unlikely to further dry out or irritate your skin while sleeping, so the water can be more thoroughly absorbed into your skin.
If you have hand eczema dermatologists recommend that you soak your hands in water, apply prescription medications and moisturizer (preferably an ointment), and put on pure cotton gloves before going to sleep.

Basics of Bathing

TAKE AT LEAST ONE BATH OR SHOWER PER DAY.

Use warm, not hot, water for at least 10 to 15 minutes. Avoid scrubbing your skin with a washcloth.

USE A GENTLE CLEANSING BAR OR WASH, NO SOAP.

During a severe flare, you may choose to limit the use of cleansers to avoid possible irritation.

WHILE YOUR SKIN IS STILL WET

(within three minutes of taking a bath or shower), apply any special skin medications prescribed for you and then liberally apply a moisturizer. This will seal in the water and make the skin less dry and itchy.

Ways Water Helps Your Skin

• Water hydrates the stratum corneum (the top layer of skin).
• Water softens skin so the topical medications and moisturizers can be absorbed.
• Water removes allergens and irritants.
• Water cleanses, debrides, and removes crusted tissue.
• Water is relaxing and reduces stress.

Is Water an Irritant or a Treatment?

Water IRRITATES skin IF…

• Skin is frequently wet without the immediate application of an effective moisturizer.
• Moisture evaporates, causing the skin barrier to become dry and irritated.

Water HYDRATES skin IF…

• After skin is wet, an effective moisturizer is applied within 3 minutes.
• Hydration is retained, keeping the skin barrier intact and flexible.

Cleansing Tips

• Gently cleanse your skin each day.
• Use mild, non-soap cleansers.
• Use fragrance-free, dye-free, low-pH (less than 5.5) cleansing products.
• Moisturize immediately after cleansing while your skin is still wet.
• Avoid scrubbing with a washcloth or towel; pat instead.

What Cleansing Products Should I Use?

Our skin surface is much more acidic than soap: the average pH of soap is 9 – 10.5 while the normal pH of skin is 4 – 5.5. Some non-soap cleansers are specially formulated with a lower pH to be less irritating. NEA Seal of Acceptance^™ Product Directory provides excellent suggestions for appropriate cleansers for eczema.

What Does Cleansing Remove?

• Sebum (an oily substance produced by certain glands in the skin)
• Apocrine and eccrine secretions (skin gland secretions, discarded cells)
• Environmental dirt
• Bacteria, fungus, yeast and other germs
• Desquamated keratinocytes (dead skin cells that are the normal product of skin maturation)
• Cosmetics, skin care products, medications

Bath or Shower?

Either a bath or shower (about 10 – 15 minutes long) will keep the skin from drying out.
DO NOT rub your skin.
DO NOT completely dry your skin after your shower or bath. Instead, pat yourself lightly with a towel if needed.

Types of Baths

A soak in a tub of lukewarm water for 10 – 15 minutes will help the skin absorb water. You may wish to try one of the following for specific treatment:

BLEACH BATHS:

Bleach baths make the tub into a swimming pool! Soak for about 10 minutes and rinse off. Use 2 – 3 times a week. Bleach baths decrease the bacteria on the skin and decrease bacterial skin infections. Use ½ cup household bleach for a full bathtub, ¼ cup for a half bath.

VINEGAR BATHS:

Add one cup to one pint of vinegar to the bath. Can be used as a wet dressing too as it kills bacteria.

BATH OIL BATHS:

Oils in the bath are a favorite of some providers and patients. Bath oils can leave the tub slippery—be careful. They can also leave a hard-to-clean film. See if they work for you.

SALT BATHS:

When there is a significant flare the bath water may sting or be uncomfortable. Add one cup of table salt to the bath water to decrease this side effect.

BAKING SODA BATHS:

Baking soda added to a bath or made into a paste can be used to relieve the itching.

OATMEAL BATHS:

Oatmeal added to a bath or made into a paste can be used to relieve the itching.


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Useful article I found from National Eczema Association.  Credit/source is given at the end of the articles.

Moisturizers for Skin Diseases: New Insights

By Lidia Schettle, PA-C, and Peter A. Lio, MD. Originally published in Practical Dermatology, May 2013. Reproduced with permission.
One of the most critical functions of the skin is to provide a barrier from the outside world: to keep water in and keep allergens, irritants, and infectious agents out. When the skin barrier is not performing optimally—due to a genetic disease, the presence of inflammation, or physical disruptors such as scratching—the vicious cycle of eczema may ensue. When this occurs, moisturizers can act in a number of ways to stand in for the normal skin barrier function, ideally while also helping to restore the skin to its natural state.
Moisturizers are thus used in the treatment of numerous skin conditions, such as eczema, psoriasis, and irritant dermatitis, protecting and rehydrating the skin where needed. Commercially available preparations cover the range of excipients: from water-dominant lotions to greasy ointments, and many intermediate preparations. Consumers spend billions of dollars each year¹ on these products in hopes of a simple solution for dry and irritated skin. Despite all the popularity and a dizzying array of options, no accepted treatment guidelines exist for the use of moisturizers in dermatology, forcing consumers and clinicians to rely on advertising, a patchwork of research, and personal experience to make sense of all the formulations.

Moisturizers and Dermatologic Conditions

Moisturizers continue to be an important adjunct therapy for a variety of dermatologic conditions. as we learn more about skin barrier function and mechanisms leading to barrier dysfunction, new technologies lead the way in our search for the perfect moisturizer.
Eczema (atopic dermatitis) is perhaps the “poster child” for moisturizers and there is reasonably good evidence that using moisturizers more frequently directly relates to improvement in eczema severity.² The structural protein filaggrin helps maintain the integrity of the epidermal barrier, an important line of defense. Loss of function mutations that prevent expression of filaggrin play an important role in the development of both atopic disease and ichthyosis vulgaris.³ Indeed, filaggrin deficiency leads to a defective skin barrier that allows increased water loss and increased allergen exposure through the skin, which may lead to inflammatory reactions.⁴; however, even in patients with normal filaggrin genes, the presence of inflammation in the skin (specifically iL-4 and iL-13) causes significantly reduced filaggrin gene expression, resulting in functional filaggrin deficiency.⁴ In other words, irritated skin from many causes can make for an impaired skin barrier, making moisturizers just as important in restoring epidermal barrier function in these patients.
Psoriasis, though thought to consist of a predominantly th1-type of inflammatory response (versus the th2-type seen in atopic dermatitis⁵), has long been known 
to respond favorably to moisturizer use.⁶ the role of moisturizers in psoriasis treatment seems to be to help normalize skin growth and differentiation as well as elicit anti-inflammatory effects, which may be similar to those in eczema.⁷

Moisturizer Classification

Moisturizers can be subdivided into several components based on their ingredients and mechanisms of action. The main functions of moisturizers are reducing transepider-mal water loss (tewL), attracting water to the stratum corneum, and repairing the overall barrier function. some of the important components include:
Occlusives, which physically block tewL in the stratum corneum and enhance the penetration of ingredients. Most effective occlusives are (in order of effectiveness): petrolatum, lanolin, mineral oil, and silicones.⁸ They are generally very greasy, which can lead to poor adherence in some patients. When overused, they may cause folliculitis.⁸
Emollients are oil-in-water or water-in-oil preparations and include fatty acids, cholesterol, and ceramides. Emollients play a role in the water retention capability of the stratum corneum and function to make the skin smooth and supple.⁹
Humectants are hygroscopic 
(water-attracting) substances 
that actively pull water and
hydrate the stratum corneum.
Examples of humectants include
 glycerin, alpha hydroxy acids,
and other sugars. Their function is to restore the skin’s ability to attract, hold, and redistribute water.¹⁰
Moisturizers are made in a variety of formulations, which continue to become more complex with new technological advancements. Popular water-based products include gels, lotions, suspensions, and aqueous creams. Water-based preparations are generally more cosmetically elegant and preferred by consumers, as they do not leave a sticky residue. However, they may lack some occlusive properties as com- pared to the ointment-based vehicles, and can actually end up adding very little water to the skin in some cases.¹¹ Certain water-based formulations (particularly lotions and gels) can cause stinging and burning sensations, especially when applied to cracked or fissured skin.¹⁰
Ointment-based preparations are predominantly greases or oils, with little or no water. These tend to have excellent occlusive properties and generally do not sting or burn. However, they may not be able to add hygroscopic molecules to the skin or barrier components and may be perceived as unpleasantly greasy.⁹
Emulsions span a wide range of formulations, from water-based lotions and gels to greasy ointments. These can be predominantly oil-based with some water (water-in-oil) or predominantly water based with some oil (oil-in-water). Many of the most commonly recommended products fall into this category, and there
is potential to have all of the important components of moisturization represented in a good emulsion.
There have been several attempts to better quantify the consistency or “feel” of moisturizers, with a recent study describing a measurement called the “hydrophilic index.”¹² This index is based on a physical assay that measures the amount of water retained by a sample of moisturizer or excipient, in order to approximate the “greasiness” of a particular formulation.
Beyond these, moisturizers can be categorized based on their pH. Topical products that fall within the physiological skin pH range of 4 to 6 may stabilize or improve the protective acid mantle of the skin. They may also prevent and treat skin conditions that disrupt the skin barrier and its antimicrobial functions.¹³ Ideally, those moisturizers with a pH near the ideal range (or perhaps even a bit more acidic) would be selected. However, there is more research to be done on this topic, as it is likely more complex than the measured pH alone.

Novel Moisturizer Technologies

Some of the newest formulations contain ceramides or waxy lipid molecules composed of sphingosine and fatty acids. ceramides restore skin water permeability barrier function, and there are recent studies to suggest that decreased ceramide levels disease.¹⁴ The stratum corneum contains an exceptionally high concentration of ceramides (as much as 50 percent of total lipids) with nearly equimolar ratios of cholesterol and essential/nonessential fatty acids. This ratio is believed to be responsible for the normal functioning of the epidermal barrier. Furthermore, changing the ratio to 3:1:1:1 with cholesterol being the dominant molecule has shown to accelerate epidermal barrier recovery.¹⁵ Prescription barrier creams are commonly formulated with ceramides coupled with cutting-edge delivery technologies to provide a controlled release of ingredients over time. Some of these delivery mechanisms utilize biologically inert micro- scopic polymer particles (microspheres) that absorb, trap, or bind to specific ingredients. Some prescription barrier creams have been shown in some cases to be nearly as effective as topical corticosteroids in the prevention and treatment of atopic dermatitis.¹⁶ However, over-the-counter moisturizers, including some simple petroleum-based products, appear to have similar efficacy profiles at much lower cost.¹⁷

Natural Oils

Natural oils are used extensively throughout the world as moisturizers and to treat and prevent dermatologic condi- tions such as atopic dermatitis, acne, and rosacea. In spite of their growing popularity, there is surprisingly limited data on their efficacy and safety profile. It has recently been suggested that the skin hydrating and protecting properties of natural oils are largely dependent upon a particular phytochemical composition of the compound. More specifically, it seems that the ratio of oleic acid (OA) to linoleic acid (LA) in natural oils determines their effect on the skin. Positive effects are generally associated with low OA and high LA ratios.¹⁸ High LA concentrations have been shown to accelerate skin barrier development and repair, hydrate the skin, and, as a result, reduce the severity of atopic dermatitis and be steroid sparing.¹⁸ Some natural oils with the highest LA/OA ratios are safflower oil, sunflower seed oil, and sea buckthorn seed oil.
In contrast, olive oil, with its relatively low LA/OA ratio, can significantly damage the skin barrier and induce erythema by disrupting the lipid structure of the stratum corneum and inhibiting homeostasis.¹⁸ Further research is necessary on the safety and efficacy of natural oils for the prevention and treatment of dermatologic conditions.

Preservatives

Preservatives are commonly added to moisturizers to inhibit the growth of bacteria, yeast, fungi, or algae.
 They stabilize the products and give them a cosmetically elegant feel, as well as extend the shelf life. Some of the most common preservatives in cosmetics include parabens, formaldehydes, and benzyl alcohol. Recent controversy with the use of parabens stems from a 2004 study that found increased levels of parabens in the tissue of patients with breast cancer.¹⁹ Even though parabens have estrogenic properties, it should also be noted that the European Cosmetic Toiletry and Perfumery Association (COLIPA) found that parabens are hydrolyzed in the skin and that they do not enter the bloodstream.²⁰ The estrogenic properties of parabens, depending on the compound, are up to one million times less than estradiol, and they also possess aromatase-inhibiting properties, thereby reducing the conversion of testosterone to estrogen. Parabens are not officially identified or listed as an endocrine disrupting chemical by any governmental or regulatory agency, but public pressure has influenced some countries to introduce regulations on the use of parabens in consumer products. Furthermore, parabens are added to cosmetics in very small amounts that do not exceed 1 percent of total weight, making the possibility of systemic absorption miniscule.²¹ Additionally, the study author herself (Dr. Darbre) stated in reply to concerns raised about the paper: “Nowhere in the manuscript was any claim made that the presence of parabens had caused the breast cancer, indeed the measurement of a compound in a tissue cannot provide evidence of causality.” Despite these points, there has been a growing consumer push to avoid paragons in all forms, and a compensatory upswing in products touting “parabens free” from many manufacturers. 

Conclusion

Moisturizers continue to be an important adjunct therapy for a variety of dermatologic conditions, especially atopic dermatitis. As we learn more about skin barrier function and mechanisms leading to barrier dysfunction, new technologies lead the way in our search for the perfect moisturizer. with such a vast array of options, it can be challenging for an average consumer to choose the best option for their skin type, condition, and budget. This underscores the importance for dermatologists to keep abreast of new commercially available as well as prescription products, their efficacy, safety profile, and cost-effectiveness.

The National Eczema Association extends a special thank you to Lidia Schettle, PA-C; Peter Lio, MD; and Ted Pigeon, Practical Dermatology, for allowing the re- publication of this article 

 

1. US Department of Commerce. Bureau of Economic Analysis. http://www.bea. gov/iTable/iTable.cfm?reqid=12&step=1 &acrdn=2#reqid=12&step=1&isuri=1.
2. Cork MJ, Britton J, et al. Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. Br J Dermatol. 2003;149(3):582-9.
3. Weller R, McLean WHI. Filaggrin and Eczema. J R Coll Physicians Edinb. 2008;38:45-7.
4. Howell MD, Kim BE, Gao P, et al. Cytokine modulation of atopic dermatitis filaggrin skin expression. J Allergy Clin Immunol. 2007;120(1):150-5.
5. Schlaak JF, Buslau M, Jochum W, et al. T cells involved in psoriasis vulgaris belong to the Th1 subset. J Invest Dermatol. 1994;102(2):145-9.
6. Draelos ZD. Moisturizing cream ameliorates dryness and desquamation in participants not receiving topical psoriasis treatment. Cutis. 2008;82(3):211-6.
7. Fluhr JW, Cavalotti C, Berardesca E. Emollients, moisturizers, and keratolytic agents in psoriasis. Clin Dermatol. 2008;26(4):380-6.
8. Kraft JN, Lynde CW. Moisturizers: what they are and a practical approach to product selection. Skin Therapy Lett. 2005;10(5):1-8.
9. Loden M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol. 2003;4(11):771-88.
10. Loden M, Maibach H. Dry skin and moisturizers chemistry and function. New York:CRC Press 1999.
11. Caussin J, Rozema E, Gooris GS, et al. Hydrophilic and lipophilic moisturizers have similar penetration profiles but different effects on SC water distribution in vivo. Exp Dermatol. 2009;18(11):954-61.
12. Shi VY, Tran K, Lio PA. A comparison of physicochemical properties of a selection of modern moisturizers: hydrophilic index and pH. J Drugs Dermatol. 2012;11(5):633-6.
13. Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006;19(6):296-302.
14. Choi MJ, Mainach HI. Role of ceramides in barrier function of healthy and diseased skin. Am J Clin Dermatol. 2005;6(4):215-23.
15. Zettersten EM, Ghadially R, Feingold KR, et al. Optimal ratios of topical stratum corneum lipids improve barrier recovery in chronologically aged skin. J Am Acad Dermatol. 1997;37(3 Pt 1):403-8.
16. Sugarman JL, Parish LC. Efficacy of a lipid-based barrier repair formula- tion in moderate-to-severe pediatric atopic dermatitis. J Drugs Dermatol. 2009;8(12):1106-11.
17. Miller DW, Koch SB, Yentzer BA, et al. An over-the-counter moisturizer is
as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol. 2011;10(5):531-7.
18. Danby SG, AlEnezi T, Sultan A, et al. Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care. Pediatr Dermatol. 2013;30(1):42-50.
19. Darbre PD, Aljarrah A, Miller WR, et al. Concentration of parabens in human breast tumours. J Appl Toxicol. 2004;24(1):5-13.
20. Lobemeier C, Tschoetschel C, Westie S, et al. Hydrolysis of parabens by extracts from differing layers of human skin. Biological Chemistry. 1996;377(10):647-51.
21. Kirchhof MG. The health controversies of parabens. Skin Therapy Lett. 2013;18(2):5-7.

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Tips for Choosing a Moisturizer

Finding a moisturizer that works for you or someone you care about can be a challenge. What works for one person may not work for another. As the condition of your skin changes so can the effectiveness of a product. A manufacturer may also change the formulation of a product from one year to the next. Take the following steps when introducing a new product to your skin:

1. If you know you are allergic to a particular ingredient, check a product’s label before you buy it.
2. Review the list of moisturizers that have received the National Eczema Association Seal of Acceptance™ to see if the product you are interested in is on it.
3. The first time you use a new product apply a small amount (about the size of a pea) to the pulse of your wrist or the crook of your elbow. Do not wash the area for 24 to 48 hours and watch for any allergic reaction, such as redness, a rash, any form of breakouts on the skin, itchiness, pain, or flaking.

The NEA Seal of Acceptance™ Review Panel considers testing data on sensitivity, safety testing, and toxicity, 
as well as the ingredients, content, and formulation data when reviewing products. Every year NEA checks with the manufacturer to make certain the formulation has not changed. If it has, the product must be reviewed again.
The following is a list of moisturizers that have received the NEA Seal of Acceptance™. For the most up-to-date list, including product reviews, go to the NEA website (nationaleczema.org) and click on Eczema Products.
Albolene® Moisturizing Cleanser
AVEENO® Baby Eczema Therapy Moisturizing Cream
AVEENO® Baby Eczema Therapy Soothing Bath Treatment
AVEENO® Eczema Therapy Moisturizing Cream
AVEENO® Eczema Therapy Bath Treatment
Avène TriXéra+ Selectiose Emollient Cream
BabySpa® Calming Eczema Relief Cream
CapriClear® Spray-On Moisturizer
CeraVe® Moisturizing Cream
CeraVe® Moisturizing Lotion
CeraVe® SA Renewing Cream
CeraVe® SA Renewing Lotion
CeraVe® Therapeutic Hand Cream
Cetaphil® RESTORDERM® Moisturizer
Curél® Itch Defense Skin Balancing Moisture Lotion
Exederm™ Body Lotion
Exederm™ Body Oil
Exederm™ Intensive Moisture Cream
Exederm™ Baby Lotion
Exederm™ Baby Moisturizing Cream
Exederm™ Baby Oil
Glaxal Base® Moisturizing Cream
Hydrolatum®
MD Moms® Baby Silk Daily Skin Protection Moisturizing Balm
MD Moms® Baby Silk Daily Skin Protection Moisturizing Balm
— unfragranced
MD Moms® Baby Silk Dry Skin Rescue Extreme Care Cream
— unfragranced
Mustela® Dermo-Pediatrics Stelatopia Milky Bath Oil
Mustela® Dermo-Pediatrics Stelatopia Moisturizing Cream
Mustela® Dermo-Pediatrics Stelatopia Lipid-Replenishing Balm
Neosporin® Eczema Essentials™ Daily Moisturizing Cream
Remarlé ® Skin Moisturizing Shea Butter Crème
Theraplex™ Clear Lotion
Theraplex™ Eczema Therapy
Theraplex™ Emollient
Triple Cream®
Vanicream™ Moisturizing Skin Cream
Vanicream™ Lite Lotion
Vaniply Ointment®
Source: 4Q The Advocate Magazine

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Bathing & Moisturizing

What is eczema? Eczema is a chronic recurring skin disorder that results in dry, easily irritated, itchy skin. There is no cure for eczema, but good daily skin care is essential to controlling the disease. What are the characteristics of dry skin? When your skin is dry, it is not because it lacks grease or oil, but because it fails to retain water. For this reason, a good daily skin care regimen focuses on the basics of bathing and moisturizing.

What other factors create dry skin?

Wind, low humidity, cold temperature, excessive washing without use of moisturizers, and use of harsh, drying soaps can all cause dry skin and aggravate eczema.

How do I take care of my dry skin?

The most important treatment for dry skin is to put water back in it. The best way to get water into your skin is to briefly soak in a bath or shower and to moisturize immediately afterwards.
Use of an effective moisturizer several times every day improves skin hydration and barrier function. Moisturizer should be applied to the hands every time they are washed or in contact with water.
The goal of bathing and moisturizing is to help heal the skin. To repair the skin, it is necessary to decrease water loss.
Some dermatologists recommend that you perform your bathing and moisturizing regime at night just before going to bed. You are unlikely to further dry out or irritate your skin while sleeping, so the water can be more thoroughly absorbed into your skin.
If you have hand eczema dermatologists recommend that you soak your hands in water, apply prescription medications and moisturizer (preferably an oinment), and put on pure cotton gloves before going to sleep.

If I am on prescription drugs for my eczema, do I still need to moisturize?

Basic skin care can enhance the effect of prescription drugs, and it can prevent or minimize the severity of eczema relapse.

What are the basics of Bathing & Moisturizing?

TAKE AT LEAST ONE BATH OR SHOWER PER DAY. Use warm, not hot, water for at least 10 to 15 minutes. Avoid scrubbing your skin with a washcloth.
USE A GENTLE CLEANSING BAR OR WASH, NO SOAP. During a severe flare, you may choose to limit the use of cleansers to avoid possible irritation.
WHILE YOUR SKIN IS STILL WET (within three minutes of taking a bath or shower), apply any special skin medications prescribed for you and then liberally apply a moisturizer. This will seal in the water and make the skin less dry and itchy.
BE SURE TO APPLY ANY SPECIAL SKIN MEDICATIONS TO AREAS AFFECTED WITH ECZEMA BEFORE MOISTURIZING. The most common skin medications used to treat skin inflammation are prescription and non-prescription topical steroids or prescription topical immunomodulators (TIMS). Be sure to use these medications as directed. Remember that TIMS can sting if applied to wet skin, so apply a thin coat to affected areas only.
BE SURE TO APPLY MOISTURIZER ON ALL AREAS OF YOUR SKIN WHETHER IT HAS OR HAS NOT BEEN TREATED WITH MEDICATION. Specific occlusives or moisturizers may be individually recommended for you.
MOISTURIZERS ARE AVAILABLE IN MANY FORMS. Creams and ointments are more beneficial than lotions. Petroleum jelly is a good occlusive preparation to seal in the water; however, since it contains no water it works best after a soaking bath.

How does water help my skin?

• Water hydrates the stratum corneum (the top layer of skin).
• Water softens skin so the topical medications and moisturizers can be absorbed.
• Water removes allergens and irritants.
• Water cleanses, debrides, and removes crusted tissue.
• Water is relaxing and reduces stress.

Is water an irritant or a treatment?

Water IRRITATES skin IF…

• Skin is frequently wet without the immediate application of an effective moisturizer.
• Moisture evaporates, causing the skin barrier to become dry and irritated.

Water HYDRATES skin IF…

• After skin is wet, an effective moisturizer is applied within 3 minutes.
• Hydration is retained, keeping the skin barrier intact and flexible.

What are some cleansing tips?

• Gently cleanse your skin each day.
• Use mild, non-soap cleansers.
• Use fragrance-free, dye-free, low-pH (less than 5.5) cleansing products.
• Moisturize immediately after cleansing while your skin is still wet.
• Avoid scrubbing with a washcloth or towel; pat instead.

What cleansing product should I use?

Our skin surface is much more acidic than soap: the average pH of soap is 9 – 10.5 while the normal pH of skin is 4 – 5.5. Some non-soap cleansers are specially formulated with a lower pH to be less irritating. 
Following are a few suggestions:

• Aquaphor® Gentle Wash & Shampoo
• AVEENO® Baby Cleansing Therapy Moisturizing Wash
• Basis® Sensitive Skin Bar
• Bella Dry Skin Formula Moisturizing Body Bar
• CeraVe™ Hydrating Cleanser
• Cetaphil® Restoraderm® Body Wash
• Cetaphil® Gentle Skin Cleanser
• CLn® Body Wash
• Dove® Sensitive Skin Unscented Beauty Bar
• Eucerin® Calming Body Wash
• Exederm® Cleansing Wash
• Kiss of Nature Oh My Baby!!  Moisturizing Castile Body Bar
• Mustela® Stelatopia Cream Cleanser
• MD Moms® Baby Silk Gentle All-Over Clean Hair & Body Wash
• Neosporin® Moisture Essentials Daily Body Wash
• Oilatum® Cleansing Bar
• Vanicream™ Cleansing Bar or Free & Clear Liquid Cleanse

What does cleansing remove?

• Sebum (an oily substance produced by certain glands in the skin)
• Apocrine and eccrine secretions (skin gland secretions, discarded cells)
• Environmental dirt
• Bacteria, fungus, yeast and other germs
• Desquamated keratinocytes (dead skin cells that are the normal product of skin maturation)
• Cosmetics, skin care products, medications

What is preferable, a bath or a shower? For how long?

Either a bath or shower (about 10 – 15 minutes long) will keep the skin from drying out.
DO NOT rub your skin.
DO NOT completely dry your skin after your shower or bath. Instead, pat yourself lightly with a towel if needed.

What type of bath should I take?

A soak in a tub of lukewarm water for 10 – 15 minutes will help the skin absorb water. You may wish to try one of the following for specific treatment:
BLEACH BATHS: Bleach baths make the tub into a swimming pool! Soak for about 10 minutes and rinse off. Use 2 – 3 times a week. Bleach baths decrease the bacteria on the skin and decrease bacterial skin infections. Use ½ cup household bleach for a full bathtub, ¼ cup for a half bath.
VINEGAR BATHS: Add one cup to one pint of vinegar to the bath. Can be used as a wet dressing too as it kills bacteria.
BATH OIL BATHS: Oils in the bath are a favorite of some providers and patients. Bath oils can leave the tub slippery—be careful. They can also leave a hard-to-clean film. See if they work for you.
SALT BATHS: When there is a significant flare the bath water may sting or be uncomfortable. Add one cup of table salt to the bath water to decrease this side effect.
BAKING SODA BATHS: Baking soda added to a bath or made into a paste can be used to relieve the itching.
OATMEAL BATHS: Oatmeal added to a bath or made into a paste can be used to relieve the itching.

What does moisturizing do?

Moisturizing improves skin hydration and barrier function.
Moisturizers are more effective when applied to skin that has been soaked in water.

What are the different kinds of moisturizers?

There are three basic classes of moisturizers:
OINTMENTS are semi-solid greases that help to hydrate the skin by preventing water loss. Petroleum jelly has no additional ingredients,whereas other ointments contain a small proportion of water or other ingredients to make the ointment more spreadable. Ointments are very good at helping the skin retain moisture but they are often disliked because of their greasiness.
CREAMS are thick mixtures of greases in water or another liquid. They contain a lower proportion of grease than ointments, making them less greasy. A warning: creams often contain stabilizers and preservatives to prevent separation of their main ingredients, and these additives can cause skin irritation or even allergic reactions for some people.
LOTIONS are mixtures of oil and water, with water being the main ingredient. Most lotions do not function well as moisturizers for people with dry skin conditions because the water in the lotion evaporates quickly.

What moisturizer should I use?

The importance of moisturizing cannot be over emphasized as a treatment for eczema and sensitive skin. Moisturizers maintain skin hydration and barrier function. Generic petroleum jelly and mineral oil (without additives) are two of the safest, most effective moisturizing products.
Following are a few suggestions:

• Albolene Moisturizing Cleanser®
• Aquaphor® Healing Ointment
• AVEENO® Eczema Therapy Moisturizing Cream
• CeraVe™ Moisturizing Lotion or Cream
• Cetaphil® Moisturizing Cream
• Cetaphil® Restoraderm® Moisturizer
• Crisco Regular Shortening
• Curél Itch Defense Skin Balancing Moisture Lotion
• Eucerin® Calming Creme or Original Cream
• Exederm® Intensive Moisture Cream
• Hydrolatum®
• La Roche-Posay® Lipikar Balm
• MD Moms® Baby Silk Daily Skin Protection 
Moisturizing Balm
• Moisturel® Therapeutic Cream
• Mustela® Stelatopia Moisturizing Cream
• Neosporin® Eczema Essentials Daily Moisturizing Cream
• Theraplex® Emollient or Lotion
• Triple Cream®
• Vanicream™ Moisturizing Skin Cream
• Vaseline® Petroleum Jelly

Apply moisturizer to your skin immediately after your bath or shower and throughout the day whenever your skin feels dry or itchy. Some people prefer to use creams and lotions during the day and ointments and creams at night. If you can’t find the product you want, ask a pharmacist to order it for you in the largest container available. Buying your moisturizers in large containers like one-pound jars may save you a great deal of money.

What are proper moisturizing techniques?

• Just as it is important to use proper bathing techniques, it is important to properly apply moisturizers to your skin within three minutes of showering or bathing.
• While your skin is still wet, apply prescription medications, and then apply a moisturizer to all your skin.
• A thick bland product is best.
• Dispense the moisturizer from large jars with a clean spoon, butter knife, or pump to avoid contamination.
• Take a dollop of moisturizer from the jar, soften it by rubbing it between your hands, and apply it using the palm of your hand stroking in a downward direction.
• Do NOT rub by stroking up and down or around in circles.
• Leave a tacky film of moisturizer on your skin; it will be absorbed in a few minutes.

Everyone has different preferences concerning how products feel on their skin, so try different products until you find one that feels comfortable. Continue use of the moisturizer(s) even after the affected area heals to prevent recurrence.

How can I reduce skin irritation?

After bathing and moisturizing, the next important step is to attempt to reduce skin irritation.

• DON’T SCRATCH OR RUB THE SKIN. These actions can worsen any itch. Instead, apply a moisturizer whenever the skin feels dry or itchy. A cool gel pack can provide some relief from itch.
• WASH ALL NEW CLOTHES BEFORE WEARING THEM. This removes formaldehyde and other potentially irritating chemicals which are used during production and packing.
• ADD A SECOND RINSE CYCLE TO ENSURE THE REMOVAL OF SOAP IF YOU ARE CONCERNED. Use a mild detergent that is dye-free and fragrance-free.
• WEAR GARMENTS THAT ALLOW AIR TO PASS FREELY TO YOUR SKIN. Open-weave, loose-fitting, cotton-blend clothing may be most comfortable. Avoid wearing wool.
• WET WRAP THERAPY CAN EFFECTIVELY REHYDRATE AND CALM THE SKIN. Soak in a bath, and then apply moisturizer. Medication should also be applied if currently prescribed. The bandages, moistened in warm water until they are slightly damp, are then wrapped around the area. Dry bandages are wrapped over the wet bandages. In place of bandages, athletic socks, or moistened pajamas worn underneath a set of dry pajamas can be used with children and infants.
• WORK AND SLEEP IN COMFORTABLE SURROUNDINGS with a fairly constant temperature and humidity level. Cooler temperatures are preferred but not so cool as to initiate chilling.
• KEEP FINGERNAILS VERY SHORT AND SMOOTH by filing them daily to help prevent damage due to scratching.
• MAKE APPROPRIATE USE OF SEDATING ANTIHISTAMINES, which may reduce itching to some degree through their tranquilizing and sedative effects.
• USE SUNSCREEN ON A REGULAR BASIS AND ALWAYS AVOID GETTING SUNBURNED. Use a sunscreen with an SPF of 15 or higher. Sunscreens made for the face are often less irritating than regular sunscreens. Zinc oxide or titanium dioxide–based products are less irritating.
• GO FOR A SWIM, which can provide good hydration. Chlorine can also decrease bacteria on the skin that can cause itching or develop into an infection. Of course, residual chlorine or bromine left on the skin after swimming in a pool or hot tub may be irritating, so take a quick shower or bath immediately after swimming, washing with a mild cleanser from head to toe, and then apply an appropriate moisturizer while still wet.

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