let’s get receptive: the relationship between pain and itching

black and brown coat animal on brown trunk
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When I was still in my physical therapy graduate program, we had a lecture on pain and neural pathways, and I stayed after class to ask the professor about the relationship between pain and itching because I noticed my itches sometimes felt like they traveled along a nerve (such a perk of being a PT student, you’ve got to know your nerve branchings!).

I’m reading this book now called Living with Itch by doctors Gil Yosipovitch and Shawn G. Kwatra. This book first got on my radar when I was reading a National Eczema Association post called “Itching for Answers”, and it mentioned Dr. Yosipovitch and talked about how cytokines (one of the molecules secreted by the body’s immune cells that we usually blame for our overactive immune responses), are also located in the nerve cells. The thought is that some of the nerves may have “faulty wiring” and so they are constantly firing and sending up itch signals when there is low to no itchy stimuli.

Anyway, the book goes into detail about various chronic itch-related disorders/diseases as well as the anatomy behind the itch, and it depicts the relationship of pain and itching to be almost inverse. As the book explains, we have a bunch of different sensory receptors on our external body to send information from what we encounter in our environment to our brain. One such receptor type, located in the epidermis layer (the shallow most skin layer) is the C nerve fiber, which relays information about, you got it, pain and itching. These C nerve fibers send the sensation information to a structure called the dorsal root ganglion, and then the info crosses the spinal cord and goes up the opposite side of the lateral spinothalamic tract to get to the thalamus in the brain. There the thalamus sends info about the itch sensation to other parts of the body that link it to our physical, cognitive, and emotional responses. The lateral spinothalamic tract also relays information about pain and temperature, which is important and I’ll get to in a minute.

So what do we know about pain and itching? We know our bodies’ physical response to pain versus itch is very different. With pain, we withdrawal the part of the body that comes in contact with the painful stimuli; step on a nail, you immediately try to pull your foot away. But with an itch, we immediately go to a scratch reflex. The book goes into more detail about why that is, saying that the scratch reflex causes a sort of pain, which effectively masks the itch, and we now know that is precisely because the two stimuli types do share that same lateral spinothalamic tract. And because temperature also can share that tract, this is why using cold on inflamed skin, or taking a hot bath can also mute the itch.

Lastly the book goes into why chronic pain and chronic itch can be similar. The biggest commonality is that both involve the nerve fibers being overactive, so we perceive the pain/itch to be even more intense (this is called hyper sensitization). And yes, when the sensations are that heightened, like say you are always itchy due to eczema or another condition, something that should be painful like an electric shock, or pouring rubbing alcohol on your scratch wounds (the latter which I’ve done…) might just make you itch more!

The most recent medications/treatments on the market are called biologics (and include names such as Dupixent), and they target the cytokines that give us so much grief. For eczema, those cytokines include interleukins 4 and 13 (IL-4 and IL-13) so far, and they are working to make treatments that target more ILs in the future.

One other takeaway from the book that I thought was relevant is that the epidermis layer, when sufficiently compromised (like after it’s been scratched a lot), can have more sensitive nerve fibers because they are more exposed by the broken skin barrier. So one important treatment in managing eczema is helping to try to repair and protect the skin barrier to subsequently protect the nerve fibers. The book mentions two ways of going about this:

  1. using moisturizers with ceramide in them to help coat the skin barrier as the skin barrier lacks the protein filaggrin*
  2. using moisturizers and cleansers that are more acidic so that they help get the skin back to its normal pH range of about 4-6 (with 1-6 being acidic, 7 being neutral, and 8-14 being alkaline). Note that most soap bars are alkaline.

*A cool way to know if you genetically are lacking filaggrin is to look at your palms. People with crazy amounts of lines are generally lacking filaggrin. I’ll be talking more about filaggrin in a post later this week. Meanwhile look at my lack of filaggrin below!

2018-10-26 13.12.40.jpg

What I am curious about is why then, is it advised by so many dermatologists to take bleach baths? I understand that when diluted, bleach can still help kill a lot of germs on the skin, but if bleach is a pH level around 12 (so pretty basic/alkaline and maybe gets diluted to around 9 when in a bath), it is very far from the desired pH of our skin. If we are adding an element that further changes our skin pH, how does that help our healing? Though I guess if the pH of our skin is higher than 9, bringing it down to 9 with bleach baths would be beneficial then too.

I haven’t searched super thoroughly yet, but the most recent study I found so far indicated that bleach baths with a course of topical steroids was no more effective than just doing the course of topical steroids alone. A review tested a treatment group using bleach baths and mupirocin (a topical antibiotic) versus a control group using normal baths and petroleum jelly and found that the former was more effective, at one month at reducing Staphylococcus aureus (the bad Staph we all know), but again this is not comparing bleach baths in isolation (and the study went on to say that at 3 months there was unchanged frequency of Staph in the treatment group meaning it was still as widespread on the body, though they didn’t test the concentration to see if the quantity of Staph had changed).

Yet another study supported that the topical antibiotics with diluted bleach baths were most efficient at killing Staph, yet also noted all groups (no bleach, bleach with topical antibiotics, etc) had reoccurrence rates of Staph after 4 months. A different review on using diluted bleach talked about how bleach is awesome because it’s a ubiquitous cheap house product that kills bacteria, viruses, and fungi alike and doesn’t cause bacteria to become resistant. However, then it also talks about why the studies using it for infected eczema are lacking, and includes reasons that one might one to avoid using it such as:

  • the amount in a cleaner can vary
  • its strength can degrade over time
  • it can make dermatitis worse
  • it often contains fragrances
  • the studies done didn’t have enough people in them, and
  • there is no consensus on the optimal amount of bleach to use or how frequently use it to effectively stave off future Staph infections.

And again, I’m not sure what the role of a diluted bleach bath would be for those of us avoiding topical steroids/going through withdrawal and not currently on antibiotics.
However, given the pH of bleach alone, and then adding the fact that so many studies mentioned the frequency of Staph reoccurrence, as my skin is going okay right now, I’ll personally be using apple cider vinegar baths more frequently instead.

Amended: This does not mean I no longer take bleach baths, because I still do. I just treat them as a more aggressive maintenance treatment for the management of my skin, and subsequently take them sparingly, but as needed.

 

REFERENCES

Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australasian Journal of Dermatology. 2013 Nov; 54(4): 251-258.

Chang MW, Hirschmann JV. Bleach Baths for Atopic Dermatitis. NEJM Journal Watch Dermatology. 2009 Jun 5;(nd).

Crane, Margaret. “Itching for Answers.” National Eczema Association, https://nationaleczema.org/itching-for-answers/. Accessed 23 Oct 2018.

Fritz SA, Camins BC, Eisenstein KA, Fritz JM, Epplin EK, Burnham C Dukes J, Storch GA. Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft Tissue Infections: A Randomized Trial. Infect Control Hosp Epidemiol. 2011 Sep; 32(9): 872-880.

Gonzalez ME, Schaffer JV, Orlow SJ, Gao Z, Li H, Alekseyenko AV, Blaser MJ. Cutaneous microbiome effets of fluticasone proprionate cream and adjunctive bleach baths in childhood atopic dermatitis. J Am Acad Dermatol. 2016 Sep; 75(3): 481-493.e8.

Panther DJ, Jacob SE. The Importance of Acidifucation on Atopic Eczema: An Underexplored Avenue for Treatment. J Clin Med. 2015 May; 4(4):970-978.

there are germs on my skin! part 2

selective focus photography of person wearing three bangles
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It’s my favorite time of year and I just received my Chuckling Goat package (but more on that in a bit).

2018-10-02 13.40.38

A few months back I wrote a post about the skin biome and how I was excited by the small movement of companies creating products geared towards helping it. Since then there have been developments about different companies creating products to help either work with the natural skin biome or to help reintroduce micro-diversity to create an appropriate balance for healthy skin.

I didn’t know it previously, but Johnson and Johnson had a movement a while back to create products that didn’t mess up the skin microbiome of babies’ skin. Such products, like Aveeno Eczema Therapy Moisturizing Cream have a trial indicating that they actually help to increase the microbiome diversity of the skin with use over time.

The company has become skin microbiome-focused in a multitude of ways, including offering use of their JLINX incubator under the JLABS. S-Biomedic has joined JLINX and is working to create products that remove the bad bacteria and replace it with good ones to balance out the diversity of the skin back to a healthy level. This idea of balance is becoming more and more accepted as it is found that overuse of antibiotics is causing more harm than good for conditions like eczema. Studies are showing that balanced diversity is what we need for our skin biome, rather than sterility (noting that antibiotics still have their place, including when surgery or infection is involved). Microbiome transplants are now no longer a thing of the future but are instead potentially the next big medical treatment protocol!

More recently, I read a book called The Good Skin Solution by Shann Nix Jones, that talked about the gut and skin microbiome and Jones’ personal experience as to how she came to develop a treatment to help manage her young son’s eczema. The goal was to help increase the diversity of both microbiome using the probiotics in kefir made from their goats’ milk. When it was a success with their son, her and her husband decided to sell their products and hence the Chuckling Goat business was born.

Jones reintroduced me the theory that you need to fix your gut microbiome to have any really lasting effect on your skin, but she added the idea that it’s best to treat both at the same time, (hence her her program that includes probiotics for both the skin and the gut). Needless to say I was intrigued so I looked into her products and went on to order some (but unfortunately I can’t get the kefir drinks because I live in the states and they don’t ship that outside of the UK).

Today the soaps and lotions arrived and I am beyond excited to receive them (happy as a clam… or a ceramic jack-o-lantern!). See my spoils below:

2018-10-02 13.40.42

I’ll have to figure out what to do to increase my gut flora diversity in lieu of kefir, as I was advised to avoid dairy while breastfeeding to see if that helped with Fi’s digestive woes. I’m not sure if goat milk would be okay since it is supposed to have less allergenic components than milk. I may just wait until Fi is done breastfeeding.

 

REFERENCES

Capone K, Klein SL, Kirchner F, Tierney N. “Effects of Topical Lotions on the Atopic Dermatitis Skin Microbiome and Associations with Itch and Skin Barrier Function.” 76th Annual Society for Investigatiev Dermatology (SID) Meeting, Portland, OR. 26-29 Apr, 2017. Poster presentation.

Myles IA, Earland, NJ, Anderson ED, Moore IN, Kieh MD, Williams KW, Saleem A, Fontecilla NM, Welch PA, Darnell DA, Barnhart LA, Sun AA, Uzel G, Datta SK. First-in-human topical microbiome transplantation with Roseomonas mucosa for atopic dermatitis. JCI Insight. 2018 May 3;3(9):e120608.

Parikh-Das A, Ganopolsky I, Nunez C, Moreira L. A clinical trial to evaluate the efficacy of a OTC colloidal oatmeal skin protectant cream in the management of mild to moderate atopic dermatitis in infants and toddlers. JAAD. 2017 Jun 76(6);AB10.

Puniewska, Madgalena. “How the Microbiome Could Transform Your Skin in Surprising Ways.” Johnson&Johnson Innovation, 12 Oct. 2017, https://www.jnj.com/innovation/how-the-microbiome-could-transform-your-skin-in-surprising-ways.

 

using boob milk for more than the baby

agriculture animal blue sky breakfast
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As some of you may know I am currently nursing my 3 month old baby girl, and in doing so as she is my first, I’ve learned that leaking is a thing (sometimes it occurs when she’s nursing on one side- the other side will start to drip milk, and other times they seem to leak for no apparently reason at all). As I wear nursing pads in my shirts during the day, the problem begins at night when I’m in bed trying to sleep. The leakage then can be really annoying. So my most recent solution has been spreading the milk on my skin, because why not- it’s already leaking all over it anyway.

My less impulsive logic for trying this experiment came from some research I had been doing a few weeks ago about breastmilk and its health benefits for the baby. Fi got sick and I wanted to know how her immature immune system could handle sickness when she only intakes breastmilk as her food source. This search led me to an internet viral photo showing how a mom’s breast milk changed when her infant got sick. The 2013 study mentioned in that post talks about breast milk’s immunological function and explains how when the mom or baby get sick, the number of leukocytes (aka white blood cells) in the breast milk drastically increases to help protect them, because leukocytes help fight disease (which I found to be such a cool example of symbiosis. I personally have also noticed that breastfeeding seems to keep both me and the baby from getting too severe of sicknesses. In fact, my mom, mother-in-law, and husband each got sick after the baby was born yet Fi and I were fine!).

I also read an article by NPR addressing the breastfeeding versus formula debate for poor countries.  A point it stated made me more curious about breast milk; it said formula can cause increased risks of diarrhea and respiratory infections. I assumed this is so because it requires using water to make (and clean sources are not always available in impoverished countries) but maybe it’s also because formula doesn’t have the same chemical and bacterial composition to allow it to be readily accepted by the baby’s developing digestive and immune systems? By extension I supposed that breast milk had to have some component in it that generally allows it to not irritate the digestive and immune systems*… which is my big sign to think “MICROBIOME” (* this of course is excluding when the baby has allergies or sensitivities to something the mom is eating that is going into her breast milk). The article also talked about how it’s weird that we are constantly trying to research the benefits of breastfeeding when it’s as natural as “breathing, chewing, hearing, passing stool”. But we live in a society where we need evidence and so I decided to play the game of informal (and badly controlled) science to see if I could test my own theory, that breast milk may help with (eczema) healing.

I did not participate in the rigors of the scientific process because I am lazy and I doubt Fi would be content amusing herself long enough for me to do it, but instead I just dabbed some breast milk on my shallow cuts every now and then instead of using neosporin or leaving the cut alone. My observations: it would seem as though breast milk can help with reducing the pain of shallow cuts (I tried it on the cracks on my knuckles and outer ears, cuts on my ankles and hands), and helps to speed up the healing of said cuts. It does not moisturize (the spots I put it on tended to be drier the next day… though that could be because when cuts heal on me, they start skin flaking…) but overall, the spots I put it on did seem to heal up and achieve a cleaner scab and softer skin around it.

Apparent cons of this experiment? The milk can sometimes burn (but again, everything burns when it touches my inflamed skin spots… even water) and it’s also a little sticky but it dries sticky-free. Fun fact, I have a pet peeve about being sticky. I hate it. So much.

After this self experiment, I was more curious to support why I might be seeing the results I saw so I did some low level cursory research. Also speaking of research, I received my diploma the other day. I officially have a Master of Science in Health Sciences from MGH Institute of Health Professions. I am now a MASTER of science. The academic title of master seems somewhat archaic; I envision myself similar in status to an entry-level alchemist or and mage, as I have established myself in a trade, but it will still take years to perfect my craft. Anyway…

There’s not a lot of recent research being done (or at least it’s not readily available yet) but I did come across two recent ones. This first paper, of which I could only access the abstract, tested wound healing of the cornea (yes, of the eye) in mice using human breast milk, milk from mice, artificial tears, and the control group. The results were that the human breast milk caused the fastest healing, followed by the mouse milk. The other two groups (artifucial tears and the control) were still not healed by the end of day two. The other study I found was published in 2015 in Nature, and it was titled, “Human milk proresolving mediators stimulate resolution of accuse inflammation”. It came to the conclusion that the lipid mediator-specializing proresolving mediator profile (a ratio of sorts between lipid mediators and specialized proresolving mediators) in human milk helped the macrophages (or cells that engulf bad bacteria) to contain pathogens and remove dead cells (in a process called efferocytosis- my word of the day). It is important to note that this was seen in vivo (in mice), and that breast milk was not applied topically to the skin. If the results are applicable to humans, I see this study as being useful because people with eczema suffer high levels of inflammation internally not just on their skin, and because turning off the inflammatory phase is also important in wound healing (more on this in a later post).

After that article I backtracked and wanted to know more about what breast milk is, which led me to this document that included the various components of breast milk (though I can not find the professor or the molecular virology lab anywhere else on the web…). Also note that the tables say the various factors are tested “in vitro” meaning not in the organism (for example, secretory IgA from breast milk was probably removed from breast milk and tested in a petri dish against E. coli). Even so, the breadth of potential abilities of breast milk, due to its staggering list of factors alone was interesting in its own right.

In conclusion, though I don’t think breast milk applied externally heals the mother’s eczema or TSW, I do think it can help me with superficial wounds, especially when it’s the middle of the night and I am otherwise unmotivated to leave the bed even if I’ve been scratching.

 

REFERENCES

Arnardottir H, Orr SK, Dalli J, Serhan CN. Human milk proresolving mediators stimulate resolution of acute inflammation. Mucosal Immunology. 2016, May 9;9(3):757-766.

Asena L, Suveren EH, Karabay G, Durson Altinors D. Human Breast Milk Drops Promote Coreanl Epithelial Wound Healing. Curr Eye Res. 2017 Apr;43(4):506-512.

Brink, Susan. “Why The Breastfeeding Vs. Formula Debate Is Especially Critical In Poor Countries.” Goats and Soda, https://www.npr.org/sections/goatsandsoda/2018/07/13/628105632/is-infant-formula-ever-a-good-option-in-poor-countries?utm_source=npr_newsletter&utm_medium=email&utm_content=20180719&utm_campaign=goatsandsoda&utm_term=nprnews. Accessed 1 Oct 2018.

how to handle a baby when you have eczema

white bed spread near a human foot during night time
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For the first few days after having my little one, I was on such a high of nerves and adrenaline that I felt great!  I had been on antibiotics while in the hospital, and after getting home my skin started to feel really dry. I started taking some probiotics and focusing on drinking lots of water (I knew getting enough sleep was a lost cause), and keeping my stress down.

Initially, my skin was calm enough that I had no problem doing skin-to-skin contact with baby Fi, but around week 4 or so I started to experience more flare symptoms- sweating, itching, redness- whenever I had the baby lay on me for too long. I started to have to wear long sleeves when holding her to not get overheated. I’m not exactly sure when this happened, but it may have also correlated when the humidity increased, and the temperature with it.

I’m not sure if it was due to the antibiotics, the temperature, the lack of sleep, the terrible diet I had in the hospital (think chicken fingers and ice cream for multiple meals in a day), or the hormone fluctuations but my skin definitely became more sensitive post-pregnancy. Though estrogen has been considered one of the reasons women can flare-up worse during pregnancy (see my post about pregnancy and eczema), after pregnancy the estrogen drops so it’s unclear what would be provoking my symptoms (besides the above mentioned items).

Either way I’ve had to be more creative about adjusting to life with a newborn. The biggest aspect I’ve had to cultivate is endless patience mixed with quick stress-reduction habits. My lackadaisical approach to getting house and life stuff done has been somewhat of a saving grace because my little one has wreaked havoc on my schedule. I’m exhausted in the afternoons, I have no idea what it feels like to sleep more than 3 hours at a time anymore, I tend to eat a bit worse now (mostly eating too many carbs and too much) because I lack the self control to stay as dietarily balanced when I’m sleep deprived. It’s something I’ll have to work on in the coming months.

I find ways to not focus on my skin when it’s getting all sweaty from holding her and I have learned to wear light layers or wrap a small blanket between her and myself when breastfeeding to avoid irritating the more sensitive skin areas like my stomach.

There are some inherently awesome aspects to having a newborn when you have eczema (at least in my experience). For one, I tend not to think about myself as much so I am not as aware when I am itchy. She keeps me busy to such an extent that even when I’m immersing my hands in water (which is traditionally a huge irritant) to give her a bath, I barely notice. Also, lately my core temperature seems to be evening out even as my skin fluctuates (which means that the hot, sweaty skin nights and cold shivers have been decreasing). I actually enjoy the cold temperature more than I used to, and I don’t enjoy basking in the sun for quite as long.

And overall I do think that my skin has been able to consistently heal slowly but surely. I feel as though I look more or less human again, what with the redness decreasing.  I think the hormones from breastfeeding are helping my skin heal to some extent; I know my hair has gotten shinier, which is an awesome boon.

how my skin made me take the road less traveled

gray pathway surrounded by green tress
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Today’s post is all about trying to convey what life with eczema is like for me. The first thing I need to stress is that my condition was not always this severe. I can remember a “before”, as my condition didn’t start affecting my skin globally until I was 21 or 22.

So how has eczema affected me?

  • insomnia – Some nights I was unable to sleep until 6am. More recently off and on I have difficulty sleeping from midnight to about 6am.
  • food paranoia – Given that I have legitimate food allergies to peanuts, pistachios and cashews, I know how to deal with food allergies that cause anaphylaxis. What I don’t know how to deal with is the thought that some common food might have developed into being the cause for the severity of my skin issues. Also sometimes I’ll eat something that is usually fine for consumption, and I’ll break out in hives in my mouth inexplicably and the next time I consume said food, it won’t happen.
  • many different diets – I have tried the gambit of elimination diets, auto-immune diets, vegetarianism, paleo diets, sugar-free diets, low-carb diets, detox diets, etc).
  • food-related social repercussion – You have no idea how frustrating it is to have people think I am “just being picky” when I am avoiding certain foods or diets. It’s usually when I’m avoiding gluten, dairy, or soy or other common American-diet staples. What I don’t understand is why people think I enjoy avoiding these foods… do they not know my undying love for pizza and ice cream?
  • intimacy issues – picture not being able to cuddle on the couch while watching a scary movie without covering myself in a blanket to make sure my skin doesn’t touch my husbands. Long drawn out hugs? Nope.
  • skin-to-skin with baby issues – I have adapted to the lifestyle of needing to put a barrier between me and my baby’s skin. When I feed her, I throw a cloth on or wear long sleeves before I put her head on my arms. When I have her in a carrier, I try to put a layer between her face and my chest, or else I know I’ll have to take her out earlier as my chest will start turning red, flushing, and itching.
  • exercise limitations – Up until my junior year of college I was doing many different sports and activities including soccer, track and field, long runs on my own, ultimate frisbee, generically running around like an idiot, etc. Post-eczema life, unless I can get a flare to calm down for months, cardio is a nightmare. Hell, at this point in time, just going for a long walk in the summer induces itching everywhere that takes at least 10 minutes in an air-conditioned building to relieve.
  • summer nightmare – See what I mentioned about walking above and now just add that to general life in the summer. I do well if I don’t move, and if I avoid direct sunlight. Though I also need sunlight for vitamin D (and in my previous life I loved the sun) so I’ll pop outside for a few minutes to bask in the sun’s warm embrace and then I’ll overheat and have to come inside. At least the itching only starts if I sweat.
  • pain (cracked skin) – During certain stages of a flare I dry out (especially at night or after washing my hands or other random times) and my skin will crack. The worst areas are my hands (which will fissure all over) and my ears, as well as sometimes under my eyes.
  • obsession – I spend so much time thinking about my skin and worrying over if I am doing something to make it worse, or not doing enough. It gets exhausting really.
  • career switching – I dropped out of my physical therapy doctorate program because I just couldn’t deal with my skin. I wasn’t sleeping, I was uncomfortable sitting (more on that in a bit), and I couldn’t stand being in an air-conditioned room (see below), or being touched or coming in contact with another’s skin, which made it incredibly difficult to practice the hands on aspects of PT. I am now still in a stage of making my own career, which while exciting, is stressful when I have to talk about it because it’s not a clear cut “oh, yeah, I do X” anymore.
  • fear of infections – As my skin barrier is compromised so often, the risk of infections, primarily Staph, is high. I spend a lot of time wondering if I am infected and worrying when I catch a cold or something that I have contracted Staph (again).
  • hand washing (pain/itching) – Imagine how many times you have to wash your hands or use hand sani when you are a PT student working in a clinic. Doing dishes is irritating enough. Sometimes even just taking a shower will irritate my skin.
  • cleaning frequency – Given that I shed skin faster than the average human, I spend a lot of time cleaning to try to not live in my own skin dust filth.
  • social situation aversion – When I am flaring, I have no desire to go out, not only because I worry about the stares I get for physical appearances, but also because it takes so much energy to deal with varying temperatures, varying foods, varying stressors, usually a lot of sitting, the inability to play/dance without itching, etc.
  • general discomfort (pain, itch, smell) – Eczema this severe is uncomfortable. The obvious is that it itches, and not like a “I have a random little itch” but more on the level of if a swam of mosquitoes bite you all over your body but instead of having angry welt-y bite marks externally, they are all inside your body and not visible to anyone. The pain comes from the cracking I mentioned above, as well as the pain of the self-inflicted wounds from scratching too hard. When I have a bad flare, I develop this scent that I call the burning rubber skin that I loathe.
  • depression and anxiety – It’s no surprise that aggressive and long lasting flares take an emotional toll. As I spend time in pain, itching, paranoid about foods I eat, avoiding people, and unable to exercise and play as I normally would, sometimes my moods take a nose dive.
  • money spent – From skin care lotions and moisturizers, general soaps, bath products (bleach, epsom salt, apple cider vinegar), natural house cleaning products, dry brushes, the rebounder, to the doctors’ visits, etc, this condition isn’t cheap.
  • doctor visits (dermatologists, endocrinologists, neurologists) – There is something very frustrating about seeing many doctors and still getting no relief. I have moved a few times in the last past 4 years and as a result have an even larger number of individual doctor visits under my belt. The general consensus? I am fine (as in no underlying crazy cause of my skin issues like cancer), but I have eczema. Oh and have I tried using steroids creams? -.-
  • hormone imbalances – Since I spent so much time inflamed, I usually have a highly elevated level of immune stuff, like my white blood cell count. When my skin first started going haywire, I also have high cortisol level, which made doctors think I had a hormonal imbalance and first order an MRI of my brain.
  • forever fielding questions – “Have you tried X??” “What’s wrong with your skin?” “Do you use lotion?”
  • excoriation disorder (dermatillomania) – Due to very often having flaky skin, I have developed a picking disorder where I spend inordinate amounts of time trying to remove dead skin from my body. It’s become partially therapeutic and partially me trying to exert control over my uncontrollable presentation.
  • scratching OCD – I scratch all the time. In my sleep, when I’m stressed, when I’m relaxing. I don’t even notice I’m doing it sometimes.
  • scarring – Go figure from all that scratching I’d have scars.
  • ring wearing/jewelry/piercings – I no longer wear my wedding band on my left hand because the ring finger on that side is usually swollen. I wear it on my right now. I also had to take out my belly button piercing, my nose piercing, and all ear piercings except tragus one because the skin started itching so badly around them all.
  • hot inflamed skin with cold chills/shivering – One of the worst stages of a flare is when my skin is constantly wet and weeping and heated, but I’m losing so much heat that I am internal freezing and will shiver uncontrollably.
  • winter is bad – It’s hard enough to regulate my body temperature without the weather outside being frigid.
  • sensitivity to pressure contact (sitting/laying down) – This made PT school very trying. Hell, going to a doctors office and laying on the table, or sitting on a chair for too long made my skin feel terrible and heat up and start itching. This is even through wearing long sleeves and pants.
  • nervousness = flares – Some nervousness is good for keeping our brains alert. Unfortunately, any little bit of social nervousness (like before a practical or talking to new people) would cause me to start to flare and itch.
  • wrinkly, swollen skin – Still not sure why this happens (maybe it’s a product of topical steroid withdrawal) but the skin around my joints especially, on the extensor side, starts to look like that of an elephant.
  • discoloration – From redness to drying out gray/white, I am a veritable human mood ring.

And since people love me and will forever want to help, here is a list of what I have already tried:

  • topical steroids (for a good 20 years as this was the main accepted solution to eczema for decades)
  • topical medicines that are not steroids (Elidel/protopic, etc)
  • oral steroids
  • lotions/moisturizers (cetaphil, cera ve, aquaphor, dove eczema line, exederm, burt’s bees, obscurely-named-other-ones, etc)
  • going moisturizer free (actually does help with the red/weeping stage)
  • ocean water
  • chlorinated pools
  • naturopathy
  • acupuncture (including herbs, cupping, and massage)
  • diet (gluten free, soy free, dairy free, vegetarian, sugar free)
  • phototherapy (clinically done in light boxes, and just being in the sun)
  • antihistamines
  • sleep aid pills
  • yoga, meditation, and deep breathing
  • coconut and sunflower oil
  • bleach, epsom, and apple cider vinegar baths
  • antibiotics
  • collagen powder (edible)
  • collagen cream
  • wound care
  • probiotics

Update: I have not tried any biologics because I have been pregnant and am now nursing.

Despite all the shit that comes with eczema, there have been some silver linings in my experience including:

  • Having to deal with eczema year round has made me live much more seasonally. In the warmer months I try to take advantage of being able to walk outside for hours and garden to get vitamin D and get exposed to bacteria in the soil (and as stress relievers). In the colder months I turn to herbal teas and nourishing soups, and bundle up well to go on walks to get fresh air. I pay a lot more attention to what can grow when, and try to eat accordingly (like lighter foods in the summertime).
  • Having dealt with the difficulties of eczema for so long, in juxtaposition pregnancy wasn’t half bad (though to be fair my belly was small and I didn’t have morning sickness… but discomfort with sleeping? Aversions to certain foods? Tired randomly? Feeling generally uncomfortable? Yep, I was used to that all already).
  • In effort to control my flares, I am constantly open to trying new things (though my wallet isn’t!).
  • When I first came up to visit Jake, before we were dating, we had an honest conversation about eczema and I told him how bad it gets for me, and he still wanted to be with me. To this day, I’ve never had insecurity about my skin around him.
  • I have learned to really appreciate the good days. As a result, I’m generally even happier of a person.

yoga for the atopically inclined

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This is a post I initially wrote after talking about the different alternative medicines and their content. I never ended up posting it because I had the baby and promptly forgot I wrote it. But without further ado, here is a post that focuses a bit more on the physical aspects of one of those holistic practices; yoga.

Though I love exercising, I am no stranger to avoiding heavy aerobically-intense exercise because of the nasty skin side effects that occur during a flare (the flushing sensations, the heating skin, the sweating/wetness in flexor surfaces, the rashes, and the insatiable itching). One of the times I got the best reprieve from my flares and related skin symptoms was February of 2016 when I was doing a 200-hour yoga teacher training. I took anywhere from 1-3 classes, 5-7 days of the week in rooms with high temperatures and lots of humidity. As I breathed through new poses and slowly worked my muscles and  focused on breathing and meditation, I felt stronger and better day by day. I won’t say my eczema went away because it didn’t, but the movements and concentration on my breathing did help my skin improve a lot, and in February no less (usually the winter months are worse for my skin).  At the same time, practicing that much yoga naturally made me want to eat cleaner because I felt heavy if I tried to practice after eating unhealthy foods (so at the time I tried out the Whole 30 Diet).

As I tried to recover from the particular cold, damp prolonged and lingering last bit of the Northeast winter weather, I decided I wanted to make use of my teacher training and research the best exercises to promote blood flow, skin healing, and stress reduction. My goal? To help my own skin maintenance (and the skin of anyone else who wishes to try this routine). So first I’ll give a brief explanation of some the theories behind how yoga can help eczema. Then later in the post I’ll show a few poses that have been said to be most beneficial to add to a yoga practice (and mostly ones that a beginner could do) to help the skin.

From my teacher training I learned that in yoga, there are 7 major chakras, or energy cluster points, that line up with the spinal column where nadis, or channels intersect. These channels carry prana or our life force energy. Of the 7 chakras, each corresponding to a respective spot on our spinal column, the 3rd chakra, Manipura is said to be unbalanced when we see skin conditions like eczema. Manipura is located in the solar plexus and corresponds to physical body parts such as the detox organs (liver, spleen, etc). When this chakra is unbalanced, as in it is underactive, people may feel a lack of control or a tendency to withdrawal from social situations. Poses said to help invigorate this chakra include core strengthening poses such as those that entail isometric contractions, and breathing focus. This can include poses that entail twists (because they engage the core muscles to be able to do the poses well, and are said to help with detoxing).

So first off, does yoga truly help eczema? Well, some studies have show that it helps reduce inflammation after moderate to strenuous exercise. Others indicate it helps with the glycation process (mentioned in my post about sugar’s effects on eczema), by increasing the muscles’ glucose uptake, and therefore reducing blood sugar levels.

Yoga also entails a lot of focus on breathing (which can be beneficial for both getting you to distract your mind away from the itch and improving circulation of O2). It also often includes a meditative component, and meditation has also been seen to help eczema. It can be useful for reducing stress levels and improving sleep as well.

In general all of those effects would help alleviate a lot of the issues that eczema comes with, and personally I got more into yoga because it was one activity that didn’t induce worser flares for me. Plus getting a good night’s sleep is huge, since we do so much healing when we are catching some z’s.

Here is my take on poses for eczema, though most of these poses are somewhat “general” because they are known to help symptoms of eczema (such as inflammation, bad circulation, stress), aka they benefit the skin generally. Then again, there is no “cure” for eczema in isolation, so getting up and moving and in this case doing yoga will most likely help with eczema too.

Here are specific poses I found listed on various websites that were said to help the skin (with photos of me demonstrating! Note: I won’t demo the twists as I am over 8 months pregnant at the moment).

Livestrong.com suggests a lot of inversions (or poses with the head below the heart) including:

  • Legs Up a Wall (beginner friendly. I only stayed here for a few seconds to take this picture before getting off my back because it’s not the most comfortable when 38 weeks pregnant).

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  • Camel Pose (can be modified to be more beginner friendly. Note: keeping your hips pushing forward so they are lined over your knees. Also note that I am not reaching for my ankles because I am too pregnant to keep good form attempting that so I’m just reaching my arms downwards).

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  • Wheel (needs a level of back/hip flexor mobility… wouldn’t suggest it for pure beginners and I will update myself doing it when eventually).

From healthline.com we have asanas for beginners to yoga with the intent to decrease stress (in this case for psoriasis, but stress is stress):

  • Child’s Pose (my big toes are touching and my knees are out wide as the mat, and I am sinking my hips down and back while reaching my arms forward. Though I am limited to how far I can stretch downwards by the baby).

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  • Salutation Seal (never knew it was called this, but essentially you sit cross-legged, keep your back nice and tall, and bring your hands to your chest like you are praying).

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And lastly, a few from HolisticVanity who brings up poses to help with inflammation:

  • Seated Twist (again I’ll get around to adding this photo)
  • Revolved Chair (ditto this one)
  • Warrior 1  (note that my lower back has a lot of curvature here, which is not ideal. The baby is pulled me forward and it’s hard to compensate, but generally you want to reduce some of that low back curving to make sure you are setting yourself up for the best alignment to continue the safest practice).

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  • Chair (note: I have my feet hips width distance apart to accommodate the baby, but normally the feet are together will a little space between the heels. Also I need to relax my shoulders down more and pull my ribs in to have better form, but my ribs are also flared out because I’m 38 weeks pregnant!!).

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REFERENCES

Beri K. Breathing to younger skin: ‘reversing the molecular mechanism of skin aging with yoga’. Future Sci OA. 2016 June; 2(2): FS0112.

NEA. “Can Mediation Help Ease Eczema Itch?” National Eczema Association, https://nationaleczema.org/meditation-ease-eczemas-itch/. Accessed 30 Jul 2018.

Vijayaraghava A, Doreswamy V, Narasipur OS, Kunnavil R, Srinivasamurthy N. Effect of Yoga Practice on Levels of Inflammatory Markers after Moderate and Strenuous Exercise. J Clin Diagn Res. 2015 Jun;9(6):CC08-CC12.

Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011 Jul-Dec;4(2):49-54.

Ziel, Erica. “The 5 Best Yoga Poses for Pregnancy and 4 to Avoid.” Livestrong, https://www.livestrong.com/article/332706-yoga-poses-avoid-during-pregnancy/. Accessed  30 Jul 2018.

where’s my glow? (pregnancy with eczema)

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Today I decided to dig a bit more into the world of eczema for us pregnant folk.

I started by watching a podcast done by Abby Lai (of Prime Physique Nutrition) in which she talked with Dr. Peter Lio (he’s done a few National Eczema Association webinars). Link to Abby’s podcast is here.

The major points were:

  • It’s not really understood why but about 1/2 of pregnant women have worsened symptoms and 1/2 have bettered symptoms. Dr. Lio likened it to how some women get nausea during pregnancy.
  • You can have a flare in one pregnancy, but not in the next. Also you can have changes in skin between trimesters.
  • Dr. Lio mentioned a few itching conditions that can occur during pregnancy such as cholestasis (when liver and gall bladder slow down their bile flow which causes a terrible itch), atopic eruption of pregnancy, PUPPP (or pruritic urticarial papules and plaques of pregnancy which usually occurs during the 3rd trimester).

He and Abby then talked about treatments used during pregnancy including such as:

  • how topical steroids are okay but not most potent ones. The goal is to keep body surface area that you apply the topical steroids to relatively low (so not WHOLE body), because topical steroids go in blood if they are used long enough or over large surface areas.
  • light/phototherapy
  • Benadryl and other anti-histamines
  • wet wraps, icing, moisturizers (see my post on products I’ve tried here)
  • anti-itch creams in small amounts (such as camphor and menthol)
  • natural oils like coconut and sunflower seed oil (if not allergic)
  • dilute bleach baths (he also mentioned a recent paper shows it’s anti-inflammatory and anti-itch directly, as well as being antibacterial)
  • topical vitamin B 12 (water soluble) – pink magic

The takeaway advice he gave was don’t be afraid to use medicine so long as you have a doctor helping you.

 

I was having trouble finding full access studies but I did stumble across a PDF from the National Eczema Association about getting pregnancy, skin tips during pregnancy, and after pregnancy advice. It also talked about the likelihood of the baby getting eczema and things to hopefully prevent it.

The same study also mentioned that avoiding soap can also help decrease the disruption to the skin barrier.

In regards to when the mothers are postpartum, there can be challenges with breastfeeding if the mother develops eczema around the area. In that case, the study said low to moderate potency topical steroids can be used so long as they are washed off before the next breastfeeding.

 

(NEW) The National Eczema Association posted a new article May 2018 called Oh baby! Eczema from pregnancy to menopause that goes into more detail about why women may experience more incidences of eczema during pregnancy. It mentions how a researcher at the University of California-San Francisco (Dr. Jenny Murase) found that when a woman is pregnant, her body shifts from Th1-dominant to Th2-dominant immunity in order to protect the fetus (because Th1 attacks foreign material that get into our cells, aka it would attack the fetus since they have half of the father’s cells). Th2-dominant immunity means the mom’s body attacks allergens and whatnot that are flowing around outside her cells, protecting the fetus, but not helping when it comes to eczema. The blog post said that the shift from Th1 to Th2 is driven by the surge of estrogen. Perhaps that is also why women generally have higher rates of eczema than men? Unfortunately I couldn’t find the study that the NEA article cited so I can’t follow up with more, though I did find an abstract from Dr. Murase et al, that mentioned how psoriasis tends to improve during pregnancy correlating with those higher estrogen levels… so maybe one of the immunity-linked causes of eczema and psoriasis are opposite in origin?

My personal experience with being pregnant while having eczema has been that I have to be more mindful about how I treat my eczema relative to general lifestyle changes too. For example, no longer can I go and drink tons of kombucha (due to varying alcohol content and the light risk of bacteria), enjoy whatever random herbs I feel will help me heal, go jump into a hot yoga class unprepared (because getting dizzy affects another being besides myself), eat whatever fish I want whenever (I am a tuna fan and enjoy sushi when not pregnant), run and jump into a hot springs all willy nilly, etc. I have to be more mindful about sharing my body and not just jumping into whatever new protocol or thing I want to try out to help my skin. I can’t decide to just go on a particularly aggressive dietary change that involves caloric restrictions or drastic nutritional adjustments.

That being said, being pregnant has also had a lot of changes that might be helping my skin. In my first trimester I was very sugar and meat adverse, so I ended up eating a lot more veggies. Now in my third trimester I tend to crave veggies as a way to keep my guts feeling good, and to keep indigestion at bay. I also eat smaller meals more frequently, and don’t really accidentally binge eat big meals mindlessly, which is great because it means my body isn’t overtaxed in digestion (more time to heal the skin!). Pregnancy has me feeling a bit more tired (and much like with a flare, also avoiding high intensity activities), so I tend to stick to lower impact, longer duration activities like going for walks for miles or remembering to get in 100 modified push-ups a day.

Anyway, I’ll stop there and leave you with a current photo of me. I’m about 31 weeks pregnant now and you can see my arms and hands in particular are especially topically-challenged.

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REFERENCES

Crane, Margaret W. Oh, baby! Eczema from pregnancy to menopause. National Eczema Association, https://nationaleczema.org/oh-baby-eczema/. Accessed 30 Apr 2018.

Lawton, Sandra. “Pregnancy and eczema”. Exchange, https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=20&ved=0ahUKEwj3hO2D-9jaAhWmc98KHRNhAusQFgjGATAT&url=http%3A%2F%2Fwww.eczema.org%2Fdocuments%2F711&usg=AOvVaw2fS6lrX7fvyosOV1imHE4p. Accessed 30 Apr 2018.

Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post partum. Arch Dermatol. 2015 May;141(5):601-606.

Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health demographic factors: a US population-based study. J Allergy Clin Immunol. 2013 Nov;132(5):1132-1138.