could physical therapists treat eczema?

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Back in my physical therapy student life, we had guest speaker Pamela Unger come in to talk to use about the role of wound care in PT. Much of what we talked about I applied (in my head) to eczema and ways to help treat it for myself. I’ll share some of my thoughts below meshed in in italics with things I learned from Pamela, but note: these are ideas I came up with and are in no way necessarily endorsed or supported by research.

To begin, we need to know that wound healing normally has 3 phases: inflammation, proliferation, and remodeling. During all 3 phases there is vasodilation (aka the blood flow increases to help close up the wound).

The inflammation phase: As we with eczema have constant inflammation, this made me think maybe we are having trouble with this phase of wound healing in particularDuring this phase, the wound works to regain balance of its cells, and also fights to prevent infection, the latter which interested me because people with eczema are generally more susceptible to staph and other skin infections. Is it because our systems start attacking our own good cells and not just the infectious bacteria? Cellularly during this phase, inflammatory mediators are released (so do people with eczema lack these mediators?) and various cells like macrophages/neutrophils consume the bacteria, but presumably less successfully if patients with eczema get staph frequently. The intended results of this phase are that the bacteria and other foreign materials are cleaned out of the wound, and that inflammation is controlled.

During the proliferation phase, the wound starts to fill in and close. Cells called fibroblasts start making collagen (collagen is an important building block for skin cells), the extracellular matrix (a molecular substance that supports the structure of cells) is made, and there is new development of blood vessels (called angiogenesis). The intended results of this phase are that new blood vessels are made, the template for new cells is made (call the scaffold), and re-epithelialization occurs (which means epithelial cells move to form a barrier between the environment and the wound).

During the remodeling phase, the scar is developing and maturing. Cellularly, the collagen fibers start to line up and the skin becomes stronger especially to tensile stress (being pulled/stretched). The intended result of this phase is that the collagen fibers cross over one another adding strength to the wound. The only aspect of this phase that I think ties to eczema is when individuals have healed eczema scars that itch more than open or unhealed areas, but that would mean something chemical is happening and I don’t know why scar tissue would itch more than the other parts of the skin. Though I suppose it could also be assumed that if during a topical steroid withdrawal, the skin becomes excessively wrinkly, it could be a problem with collagen production? 

 

Now that we have the basics, we can talk about a chronic wound. I loosely decided that eczema is a chronic wound by this definition: a skin injury that fails to heal through the normal phases, in a normal amount of time.
A chronic wound can have one of two thickness classifications (usually applied to specific types of ulcers). The first is partial thickness, meaning the epidermis (or outer layer of skin) is broken, but the next layer (the dermis) may not be. A full thickness means the dermis is also broken as well as the fascia, and there may be a breakdown into the muscle/tendon/bone level. I believe generally eczema wounds are partial thickness, though I am sure there are some exceptions/particularly bad wounds that occur.

Generally wound healing can be stalled because of 4 main things:
1. a bacterial infection,
2. inadequate electrical potential (for we are beings of electricity! More on this and the idea of E-stim for eczema management in another post),
3. not having enough microcirculation (aka circulation of blood in the smallest vessels), or
4. too much pressure from interstitial edema (or swelling in between cell layers).

Other factors like age, nutrition, and topical/oral steroids also can slow healing. With nutrition, the biochemical aspects doctors check for wound care would be albumin, pre-albumin, hemoglobin, and hematocrit. They would also want to check that a person has enough protein, calories, and fluid in their diet. We know that when you have eczema, it is especially important to drink lots of fluid and have a balanced diet, but I am unsure if the four other biochemical factors have a correlation with eczema sufferers, though I would assume people with eczema would have decreased levels of albumin (because it’s a protein).

 

So how does one really maintain their skin health? Pamela’s big takeaways were to:
1. keep the skin clean and dry (a big reason we need to clean out the wound is because a biofilm (of bacteria) easily grows in a wound and blocks healing by messing up the chemicals needed to heal),
2. use warm water (not hot) on the skin (because hot water can cause us to have more water evaporation from our skin),
3. use daily hygiene techniques, and
4. MOISTURIZE.

For wound control, Dr. Unger broke it down to 4 steps.
1. Protect the wound surface. Think using gauze, bandaids, wet wraps, cotton clothing, etc. Wet wraps would also help keep in moisture. If excessive moisture, collagen can be useful for absorption (maybe that is why I was able to use a collagen night cream to heal my facial eczema when it was raw).
2. Control bacteria. She mentioned silver ions and slow-release iodine. I believe new eczema products are trying silver so another overlap may be indicated.
3. Control odor. Unclear if this is as application to eczema but she mentioned activated charcoal and I believe there are some eczema products that have charcoal (though I could be wrong).
4. Affect cells. She mentioned using collagen (though how it would apply to eczema wounds specifically, like if it should be orally taken or topically applied, I am not sure).

The last things Pamela mentioned in her wound care lecture that I thought tied well to eczema management were:
1. massage (it has been documented that massage can help eczema, though aggressive massage around a wound may impede blood flow and slow healing, rather than help. So if a person suffering from eczema has lots of open wounds, massage may be more detrimental than useful),
2. avoiding excessive pressure (as excessive pressure or friction can cause wounds, it stands to reason that slumping in a seat, or staying in one position for too long doesn’t help the skin of people with eczema. Getting up and moving seems to have more importance than just general health, mood boosts, and circulation!), and
3. keeping the eczema wounds moist rather than letting them dry out (in the past people believed wounds needed to air out and be dry, but Pamela explained this makes it harder for the wound to heal because it needs a level of fluid movement. I believe dermatologists would support this as I have heard /read about them saying that dry skin leads to itching, and scratching the itch is what causes the rashes).

So could a physical therapist treat eczema? Like the answer I got through most of my physical therapy graduate classes: it depends.

my addicted (skin) life

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As the science of skin (dermatology) progressed, more information was understood about what this large organ is made of, how it works, and how to keep it healthy.

I won’t go into the skin anatomy today but one thing that was more or less universally accepted was: dry skin = bad skin. So in practice this meant that doctors prescribed patients to take baths and let our skin absorb lots of water and then get out, lightly pat dry, and apply the topical medication. An NEA webinar mentioned you need to get the topical medication on within 3 minutes of getting out of the water, which for a full grown adult with eczema over the entire body, proves to be a bit of a challenge.

So now let’s go more into the specifics about topical medications, let’s start with steroids. Topical steroids come in 7 classes: from Super Potent to Least Potent. A high potency topical steroid is one we’d put on our hands/feet/wrist/ankles or the areas that are more likely to have excessive thickening. A mid-strength topical steroid may be safer for the whole body but only for a 3–5 days for thin skin areas (around the eyes, mouth, genital areas). A low potency topical steroid includes the things you can get over the counter like hydrocortisone (1%).

A useful fact to keep in mind is you should know the name of the steroid you will/are using as well as the concentration (listed as a percentage). When in doubt, it doesn’t hurt to google up your specific steroid to see what strength it is if you are not sure, or ask your doctor.

Now for the more recent developments in the eczema world: the non-steroidal anti-inflammatory medications (like Protopic and Elidel). Both are types of topical calcineurin-inhibitors (TCIs), which is a big term that just means they block T cells and stop the too much cytosine (a protein that can cause redness, inflammation, and itching) from being released. TCIs are great because they help the skin without decreasing the amount of healthy cells, and without going as deeply into the skin layers (unlike topical steroids, which cause thinning of the skin if used for a long time).

Protopic is usually stronger than Elidel, but both are often seen as medications to be used after you’ve finished the course of a mid-strength topical steroid, the reason being is that the TCIs can be used for longer periods of time. They are said to be safe to use around those thin-skinned areas, but that they generally don’t work on lichenified (or thickened) skin.

An even newer development was Eucrisa. This is a non-steroidal topical ointment that works by blocking an enzyme called phosphodiesterase (which is increased in immune cells of people with eczema), which then also blocks out the production of excessive cytokines. More research is still to come, but Eucrisa seems to be another promising non-steroidal option.

Lastly, let’s talk about topical corticosteroid (TCS) withdrawal (also known as topical steroid withdrawal or TSW). The health community is still hotly torn on this issue. On the one hand, in 2015 it was stated that the TCS withdrawal is a potential adverse effect of prolonged use of topical steroids, though it was said to be a rare occurrence with not a lot of evidence backing it, and that it was probably caused by topical steroids being used incorrectly. To be honest though, it seems it would be difficult not to have misused topical steroids in the past as the research behind how much to use and how often has changed over the years.

On the other side, there are organizations like the International Topical Steroid Addiction Network (ITSAN) or individuals like Dr. Rapaport that argue that the Red Skin Syndrome (RSS) is directly because of the topical steroid use/overuse/abuse in societies.

An interesting blog post I came across talked about how much cortisol a healthy body can normally produce, and how the commonly prescribed topical corticosteroids measure up. His analysis was that the potency of prescription steroids are often so much higher than what our bodies could naturally produce, which might explain why it seems so much more common to hear about people’s skins getting addicted. He was testing out how using very low potencies and/or low doses to mirror how much cortisol our bodies could normally produce, and see if that helped him maintain his skin throughout the winter.

Also food for thought, we know that studies are incredibly expensive to fund, and so to get a lot of evidence backing up TCS withdrawal or RSS, there would need to be big companies supporting the research. However, if these studies could then have results that jeopardize major supporters (like a pharmaceutical company), it becomes less likely any such companies will want to fund said studies. I’d bet it will be a while before we get a lot of evidence around more specifics of TCS withdrawal/RSS.

 

REFERENCES

Carr WW. Topical Calcineurin Inhibitors for Atopic Dermatitis: Review and Treatment Recommendations. Pediatr Drugs. 2013 Aug;15(4):303-310.

Hajar T, Leshem YA, Hanifin JM, Nedorost ST, Lio PA, Paller AS, Block J, Simpson EL. A systematic review of topical corticosteroid withdrawal (“steroid addiction”) in patients with atopic dermatitis and other dermatoses. JAAD. 2015 Mar;72(3):543-549.e2.

Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, Eichenfield LF, Forsha DW, Rees WC, Simpson EL, Spellman MC, Stein Gold LF, Zaenglein AL, Hughes MH, Zane LT, Hebert AA. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep;75(3):494-503.e6.

 

there are germs on my skin! part 1

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A few years back I read a book called Farmacology by Daphne Miller. Miller is a physician who travelled around the United States to study farm practices and connect what she learned to how our bodies work as well as how the farming practices affect our health.

From that book I was inspired to learn more about sustainable habits and understand the complicated relationship between us and our land/food. I thought more about dirt and how we as humans wash and bathe excessively nowadays to kill all the germs, when some are not germs at all, but friendly non-harmful bacteria.

In 2013 I had a bad flare of eczema, and also got a staph infection. From thinking about the book again I realized that all systems have ecosystems of their own, including our skin, and that maybe the reason I had gotten a skin infection may have been because my natural skin cultures were not balanced (or in other words I had more of the bad kind of bacterias than the good). Studies are saying now, when you have a healthy mix of bacteria, they balance one another out and keep the “bad” bacteria in check, and as a result you get a strong skin barrier. When you lack the bacterial diversity, that’s when things go bad, and usually you’ll have an excess of Staphyloccocus aureus, which makes you more likely to have a skin flare. A study in 2013 showed that Staph a. makes a toxin that cause a release of other molecules we know are involved in the dysfunction of the skin in people with atopic dermatitis. It has become clear that unbalanced skin microflora can have particularly devastating consequences.

I’m going to briefly go into a little bit more about the skin and the skin biome. My information is coming from various articles including this one by NIH.

The job of our skin is to keep foreign organisms, dirt, etc out of our bodies. It has its own ecology with millions of diverse micro-organisms, some of which help the immune system learn which similar organisms are detrimental. As I said before, in healthy skin there is a balance of micro-organisms but when that balance gets disrupted it can result in infections or other skin issues.

Healthy skin is usually acidic and dry, and a cool temperature. Areas like the arms and the legs tend to be drier than other skin areas (like the groin, armpits, etc) and so they experience more temperature fluctuations. The acidity prevents certain bacteria, like Staphylococcus aureus, from colonizing the skin.  Other ways the skin fends off bacteria like Staph a. include using the hair follicles. The follicles have sebaceous glands that make sebum, a fatty substance that helps protect the skin by coating it with an acidic and antibacterial shield. Interestingly enough, in my experience, when my flares have gotten bad, I notice my hair (specifically on my arms and legs) falls out.

The skin is made up of multiple layers including the epidermis, which has a top layer called the stratum corneum that’s made of something called squames. Squames are the bits that are shed from the skin after about 4 weeks. I’d bet that the rate of squame shedding is what increases when someone has eczema, and the reason we shed so much when flaring/coming out of a flare.

Everything from clothing, antibiotic use, soaps, moisturizers, age, sex, exposure to environmental bacterias (like dirt and animals), and more can affect the micro biome.

A company that came up on my radar was Mother Dirt with their research partner AOBiome (I have no affiliation to either but I do think they are interesting!). AOBiome study chemicals in our modern skin/hair products and how they mess up our skin bacteria diversity. In particular, they look at a bacteria called Nitrosomonas that was on our skin before we used soap and detergents that messed up the bacteria’s ability to survive on us. AOBiome correlates that the decrease in this nonharmful bacteria is related to the increase in inflammatory skin issues.

Therefore, the goal of AOBiome is to create products that allow Nitrosomonas to live on our skin again, and at the same time help reduce skin inflammation. They are also researching eczema and how their products may be able to help (though according to their website they are still between phase I and phase II of 3 phases of product development). They are definitely a company to keep tabs on for the future.

 

REFERENCES

“AOB, Inflammatory Conditions, and Systenic Effects.” AOBiomeTherapeutics, https://aobiome.com/aob-inflammatory-conditions-and-systemic-effects/. Accessed 27 Sept 2018.

Grice E & Segre J. The skin microbiome. Nat Rev Microbiol. 2011 Apr;9(4): 244-253.

Kong HH, Oh J, Deming C, Conlan S, Grice EA, Beatson MA, Nomicos E, Pollet EC, Komarow HD, Murray PR, Turner ML, Segre JA. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 2012 May;22(5):850-890.

Nakamura Y, Oscherwitz J, Cease KB, Chan SM, Muñoz-Planillo R, Hasegawa M, Villaruz AE, Cheung GY, McGavin MJ, Travers JB, Otto M, Inohara N, Núñez G. Staphylococus delta-toxin induces allergic skin disease by activating mast cells. Nature. 2013 Nov 21;503(7476):397-401.

 

let’s get creative! (aka freeform fiction writing)

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As I child I always loved reading and subsequently writing as I developed my own worlds in my mind. I have a story I started when I was about 12 years old that I have since molded to reflect various stages in my life over the last 14 years or so. Recently, inspired by my current eczema flare, I decided to personify the flare as a new section of that story. Below is an excerpt. At some point perhaps I’ll continue it.


Another goddamn visit from a Flare. This time it’s the more benign cousin of the usual suspects. She comes only with her mild temper, and only the occasional and light irritation under my skin. Though she does confuse me as to how to get rid of her- and she is particularly chiding to my cheeks and around my neck like an ever present wind that buries under my scarves.
Still, she, who I’ll call M as she is far down the crisis scale, is a mystery. She is particularly nary after I shower and irritates the fuck out of me, but then within 10 minutes or so she leaves me be more or less, minus the occasional heated moment. She tends to be a bit of a blowhard at night, especially when I am trying to get comfortable and sleep, but minus waking me up intermittently until I toss onto my other side, she mostly lets me get my rest. I much prefer her to some of her relatives, though I do wonder how I can slow some of her persistence. Perhaps she’ll leave me alone if I go and soak in the bath for a while. Though I don’t think she comes in barring infections, you never know with these unwanted guests.

“Well boys. It looks as though we’ve got another one,” the detective mused, adjusting his increasingly baggy pants waistline with one hand while he scanned the note held by tweezers in his other. His men picked themselves up from various places in the crime scene and ambled over towards him, hankering to see over his shoulder at the note’s contents.
“Another Flare has been through town. What is the point of the mayor’s extensively expensive Flare-reduction policies, if he can’t keep a- a ‘benign cousin’ from rolling through and wreaking havoc!”

His men grumbled ascension sounds in response. One officer, looking back over the crime scene absent-mindedly, almost unconsciously piqued “But sir, what if this is a worser Flare than we think? It’s possible the hostage was under duress and just using some of those techniques the good head doc has been lecturing. You know ‘mindfulness practices’ and whatnot. Or maybe the hostage has been tormented by so many Flares already, she barely knows when she’s in a bad situation anymore. Couldn’t we have a situation like that at hand here? Until we have the biopsies, we won’t know which Flare we were actually dealing with.”

The detective swiveled around to turn to look at the officer. Swiveling was getting easier now that he’d finally taken up his wife’s request and stopped indulging Sweets.

Officer McCormick. He was a newer recruit, coming from a larger town. Before working in the Eczema Dept he had worked in Staph A. and it was rumored though he was good, the stress got to him so management reassigned him to Eczema to give him some time to find his bearings. He still seemed a bit strung out though.

“Now son,” the detective started gently. “We’ve been dealing with Flares in this town since the town was first declared, and none of them has been higher than a crisis scale of H. And even then it was the result of a consumables gang-mix up triggering some interest on the low grade Flares radars. I know you must have seen a lot coming from where you did, but here in ChroniCity we don’t jump to conclusions until the evidence points us that way. Red will collect the samples for the biopsy and we’ll know who we are dealing with soon.”
“But what if it is more serious! Shouldn’t we alert Anti-Bac and Court’roids just in case we’ll need them here quickly-”
“McCormick! This small town doesn’t have the budget to be dragging out higher-ups on every whim. Like I said before, our ChroniCity is usually pretty peaceful so we will proceed as usual unless we find evidence to the contrary. Got it?”
“Understood, sir.” McCormick responded, feeling unjustly chastised. The other men shuffled about uncomfortably, all unused to hearing the detective bark out.


 

how to find dr. right (dermatology edition)

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As one of many people who sees a dermatologist for some kind of reoccurring eczema or atopic dermatitis (AD) and as someone who has cycled through the what feels like all options for treatment (often never finding that perfect product, the lifestyle management, or that patient-doctor connection), and as someone always searching to get to my dream skin, I am always hunting for ways to build a relationship with my future Dr. Right.

The most important part of having a good working relationship with your dermatologist is being able to speak your concerns. I have gotten to a point in my life where, when meeting a new dermatologist, I throw out my entire skin background in a verbal paragraph; the goal being to test the waters of this new budding relationship. Here are some examples below for personal context:

  • I have had topical steroid withdrawal (TSW) before because of my excessive use of steroidal topical ointments in my earlier years, and I am somewhat hesistant to use them now. I am also not entirely interested in oral steroids again, because of their shopping list of side effects. It is important to speak your fears of strong medications, so your derm knows what you need to discuss.
  • I have been using coconut oil on my skin and have had no problems with it except that it didn’t prevent a flare. This bit of information is shared because it’s true (and you never know when new research will come out saying that coconut oil is not as good as we thought it was… e.g. what happened with olive oil) but it also can be used to get the derm’s opinion on natural products/non-dermatologically created alternatives.
  • I have been avoiding gluten and soy (because they are common allergens and because I have other legume allergies) for a while and worry that me starting to eat them again this summer may be part of the reason for my flare. This is brought up to bridge into the field of nutrition to figure out my new derm’s opinions on diet in regards to its effect on eczema and management.
  • I know about the current new drugs on the market (Dupixent) and wonder about its effect on pre/peri/post natal women. It’s crucial to remember to bring up reproduction-related information if you are going to start a drug that hasn’t been tested on men or women for reproductive side effects, if you are interested in having children one day.
  • What is the plan for me and what will my management entail going forward? After all, I want to know she isn’t just going to prescribe me a crap ton of drugs and wish me the best with my life… continuity of care is extremely important for preventative care and management.

In the case with AD, I was hesitant about both topical and oral steroids as the major component of my management, and my derm was receptive to my initial hesitation. However, she also argued with the need for inflammation management, because in an untreated state, chronic inflammation will damage other organs and systems in time. So she walked me through the details about what she was thinking for both types of steroids- the dosages planned and how long she planned to keep me on them. If you are confused about what the drugs do or their safety, it doesn’t hurt to inquire more (for example 60mg of prednisone is on the high end of how much doctors will prescribe).

My derm told me of her roadmap for my management (an important thing you want your dermatologist to bring up!)- how long she’d want me on the oral steroids, which topical steroid was for my face versus which for the rest of my body, how we’d cycle through a 2-week steroidal/1-week non-steroidal topical cycle, and the need for more frequent bleach baths to prevent staph infections from other healthy-skinned people (because everyone carries some level of staph on their skin).

When I asked her my big question — what can I do to prevent these flares from coming back aggressively again, she also brought up diet changes, as well planning future appointments to monitor how the preventative measurements were going. All in all I left with a sense of her being committed to making sure things worked, not just prescribing me all the meds I could carry and hoping I didn’t ever need to come back.

The big takeaway from being a frequent flyer of the dermatology world is that it is okay to need to find a dermatologist who fits with you. You want someone you feel comfortable with, who you can talk to openly and feel like they both have the time to listen and are receptive to your ideas and where you are in your health literacy (i.e. do you like written or oral directions, how familiar are you with the drugs/treatments/interventions, how much you feel you understand or care to understand about the condition as a whole, how it works genetically, immunologically, neurologically, etc).

You should feel like you are leaving with enough information to get you by AND also with your questions answered, but also that you know what to expect and when to reconnect with the derm in the event that something isn’t working just right. You don’t want to feel like you’ve heard it all before, or that there is something the derm just isn’t getting about you. The relationship needs to be out on the table and the communication level high. If you have persistent remaining questions- ask them! If you are frustrated by something, voice it!

With any chronic disease, management relies on the ability to be able to communicate your feelings and symptoms, and on the ability of the provider to be able to give you the support and care contingency to make sure that you don’t falls through the cracks in the system. So when working to develop a fruitful and useful relationship with your dermatologist, don’t be afraid to be a bit selective and work through difficult questions to see if you have found your Dr. Right.

 

Here’s a photo of my own hands October 2016 (left) and March 2017 (right):

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here’s the skin-y

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Photo by Dom J on Pexels.com

Who am I: I’m a woman with eczema. I love reading, gardening (mostly indoors lately, as I live up north), writing, playing music (though I am a bit out of practice for both viola and piano), daydreaming, sunshine and warm weather, exploring areas by foot, watching horror movies with my husband and constantly talking through them, engaging in random bursts of physical activity, being ridiculous, and spending time with family and friends, and of course, storytelling.

My eczema history: I’m one of the people who was born with eczema where it initially only bothered me on the crooks of my elbows and knees, but as I grew up it progressed. Winter 2012 I had my worst flare and a Staphylococcus aureus infection (as discovered by a fluid sample from a lymph node in my neck). I believe that was the first time I went on both oral steroids and antibiotics. Since then I have had intermittent periods of flares of varying lengths of time and degrees of severity. I have been suffering from multiple occurrences of topical steroid withdrawal periods (the longest being out 13 months) and had tried various dietary modifications (avoiding gluten, avoiding legumes, avoiding dairy, eliminating added sugars). Currently I am only doing one dietary change- reducing added sugars. Throughout my eczema journey, I’ve underwent many of the traditional routes to managing the flares, corticosteroid creams/ointments, oatmeal/bleach/epsom/essential oil baths, vaseline/eucerin lotioning, repetitive lotioning, phototherapy, antibiotics, prednisone, gluten-free/dairy-free/sugar-free/legume-free diets, seeing a naturopath, taking supplements/herbal medicines, the list goes on and on. Though I’m sure some of those solutions work for others to help manage their skin issues, the long-term result is that I still have flares and that I need to learn to control said flares in new ways, because unfortunately there really are no individual guidelines when it comes to eczema. As I was briefly a graduate student in a physical therapy doctorate program, I have been using what I learned to try to apply the concepts to my own life in regards to eczema management. I have been wondering about a few other alternatives to do to help my skin during a flare, inspired by things I’ve learned while still in PT school, and I’ll post about them over time.

Other related health stuff: I have allergies, some I was born with (food ones) and some that I developed over time (animal). The foods I am allergic to are peanuts, pistachios, and cashews; environmental factors are mold, dust, grass; animals are cats, rabbits, some types of dogs. I also have a history of asthma, though I’ve been fortunate enough to have mostly outgrown it, and haven’t had to use an inhaler since I was 8.

Impact of eczema on my life: How has eczema has affected my life? I am a person that has eczema over my entire body (at least since 2012). It changes which areas are the worst, but in general, all my skin gets impacted when I flare. This has altered my exercise habits (sweating during a flare can be intolerable), how I can sit/relax (certain materials or positions cause my skin to heat up and rash more), whether or not I can sleep through the night (my skin heats up at night and my core temperature drops so I end up feeling cold while my skin feels hot, damp, and rashy ), and what my daily life habits are (I tend to itch worse when waking up, after a shower, after applying lotion, when sitting for a while, in cold rooms). The largest change I took was deciding to leave my physical therapy doctorate in 2017 program because I wasn’t sleeping, couldn’t handle manual manipulations due to necessary skin contact at times, and because I was more prone to infection from contact with healthy skinned-people who carry Staph.

What I am doing now: I have since switched into a Masters of Health Studies and am building my program as I go along. Professionally, I’ve started thinking about how to build my own company of providing information assistance to health-related businesses, nonprofits, etc. Currently, I am an intern with Eradicate Childhood Obesity Foundation, where I do anything from grant writing, to outreach, to basic website design, blog writing and editing.

Dreams: One day I think I’d like to start my own nonprofit related to addressing health disparities in communities and increasing health literacy. I’ve also had a long term dream of becoming a librarian (but more so a feral librarian, meaning a librarian that isn’t formerly schooled in a librarian sciences education) to use the opportunity to expand what people think libraries do to showcase the real potential for community outreach and modern change that libraries can hold. Bridging the two dreams, maybe I could create a nonprofit health library that offered services such as the ability to “check-out” doctors and health providers for general consultations/patron questions, as well as rental spaces and exercise equipments to host fitness and activity classes, and education seminars on various important health topics and new research.

Weird unrelated hobbies: I enjoy setting up for parties by lightly theming a room, and then leaving it like that indefinitely. Some favorite inspirations for decorating are Harry Potter and Alice in Wonderland.

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