Skin care

Easing the Pain of Eczema

If you or a loved one suffers from eczema or dry, itchy skin, then you know how miserable it is. With constant scratching, unsightly skin, painful bloody scabs and sleepless nights, your skin can dictate every moment of your life.

I have focused my years of research and training on solutions for dry, itchy and eczema prone skin. There is now groundbreaking technology that is scientifically engineered to address the problems of the abnormal skin barrier; lipid deficiency, abnormal pH, abnormal growth of bacteria, inflammation and chemical sensitivities or allergies. When these problems are addressed simultaneously and an appropriate skincare regimen is implemented at the same time, then countless skin problems such as itching and eczema can benefit greatly.

The more severe one’s eczema is, the more steps are needed to bring it under control and to then maintain it. The maintenance part is just as important and the getting it under control part. A few tips for treating eczema are:

Replace the lipids that are missing from the abnormal skin barrier. Lipid deficiencies are associated with all forms of eczema and with aging and dry skin too. Dry skin, aged skin and eczema prone skin share some common lipid (fat) deficiencies. These lipids are what make your skin chemical proof, waterproof, bacteria proof and are involved in preventing collagen and elastin loss. When these lipids are deficient, the skin dries out, breaks down, becomes itchy, is more prone to developing allergic reactions and gets very inflamed and uncomfortable. There are many skincare products on the market that focus on supplementing the skin with the lipids that are present in normal skin, but I believe that the real problem needs to be addressed—the lipids that are actually deficient need to be replaced.

There are now solutions that contain a sort of lipid supplement for your skin. These are the only products in the world that focus on replacing the lipids that are deficient from abnormal skin. Unlike other products that focus on normal skin lipid replacement, these products focus on replacing the lipids that are actually known to be deficient from abnormal skin. When your skin has a problem, there is a physical reason. I believe that one of the biggest reasons is the deficiency of these lipids.

Restore the naturally acidic pH of your skin with pH-modulating skin care products to help increase skin lipid production and to discourage the growth of bad bacteria. Abnormal skin has an elevated pH. When we use soap and water or even bleach baths, the pH of the skin goes up even more. The enzymes in the skin that make skin lipids are chopped up and stop working. The skin dries out even more and becomes even more susceptible to infection. Control bacterial overgrowth in eczema prone skin with bleach baths. During my dermatology training at the National Institutes of Health, I spent my time working with a group of patients who had very severe eczema and infection with a bacteria called Staphylococcus aureus. If you have the common form of eczema called atopic dermatitis, you may know that it is also susceptible to infection with Staphylococcus aureus, which makes the eczema flare. This is one of the main drivers of atopic dermatitis. At the NIH, we started treating our patients with dilute bleach baths. I was one of the first dermatologists in the world to introduce this technique back in 2004. Bleach baths are now recommended to eczema sufferers all over the world.

To do a bleach bath: Soak in the tub for about 20 minutes, 2 to 3 times a week when your eczema is flared or has any crusting or scabbing. For more severe crusting, more frequent baths are needed. If you have a typical sized bathtub (not a garden tub), and it is filled half way, mix in 1/4 cup of bleach into warm water. Address the inflammation. There are ways to do this with and without topical steroids. If you or your child has significant eczema, then you understand the concern about using prescription steroids on your eczema all of the time. The skin can thin out, get stretch marks and your body’s cortisol production can be disrupted if you use too much. As a dermatologist, I frequently counsel my patients to not be afraid of using these steroids if they are needed. Sometimes just a tiny whiff of topical steroids is all that you need to turn the corner and then you can step down to steroid-free moisturizers.

Many of the prescription steroid creams have chemicals in them that eczema sufferers are allergic to. But, there are specifically formulated products that make topical medications free of these allergens in a base that is engineered to maximize skin barrier repair. This is a great option for severe eczema patients or for patients who have chemical allergies and who are just not clearing on the regular prescription steroid creams. Moisturize unaffected skin too. It can look pretty normal when it really is on the verge of breaking down into active eczema patches. I always tell my patients to look at the skin on their tummies—often it feels a little rough and bumpy. If you look closely, you can see small whitish bumps on every single hair follicle. We call this folliculocentric eczema. I think of this as your skin’s way of telling you that if it doesn’t get moisturized properly, it is going to break out into eczema.  Moisturize this skin twice a day or as frequently as needed until the skin feels normal, soft and smooth again. Avoid products that contain toxic or allergenic chemicals and those that are known to worsen eczema. Approximately 36 to 50 percent of people who have atopic dermatitis also have an allergy to a chemical that they are putting on their skin. Most of these people and their doctors have no idea that they are allergic to something, they just think that their eczema is flaring all the time. If you have severe chronic eczema and it is concentrated on the face, eyelids, hands or neck folds, chances are that you have a chemical allergy and should consider being patch tested. This is a type of allergy testing that some dermatologists do.

Many eczema care products, and even the gold-standard “hypoallergenic” moisturizers contain allergens and toxins in them like lanolin, PEGs, sorbic acid, petrol-based propylene glycol, beta-hydroxy toluene (BHT), behentrimonium methosulfate, phenoxyethanol, bacitracin, neomycin, fragrances, formaldehyde releasers and parabens. These chemicals are all either a significant allergen that can worsen eczema or they are a toxin—avoid them!

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