all posts, the eczema body

why do i have wrinkles on my knees?!

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My skin is going through what I believe to be another topical steroid withdrawal. My reasoning? I have excessive wrinkling on the extensor surfaces of my skin (I call this stage of skin my “elephant” phase, and I’m not alone; see the study here), and I was on a moderately potent steroid ointment for most of my body and a lower potent one for my face/crooks of elbows and knees when I found out I was pregnant. What finding out I was pregnant meant for my skin was that, because the more potent one was not necessarily safe for a growing baby, I was taken off of it earlier than planned and told to use just the lower potency one all over my body instead. Unfortunately my thicker skin areas were used to the higher one so the response was less than ideal and I ended up still flaring a lot as I did my low potency taper. I gradually phased out using the lower one despite some discomfort because having to use topical steroids over such a large surface area of skin does increase the risk of it being absorbed into the bloodstream, making it more likely to affect my baby.

So in a nutshell I had a fairly quick taper and now am cold turkey off all topical steroids again. The result has been interesting. This winter has dragged on which means I have been starved for vitamin D, more sluggish from being trapped indoors, and cold. Whenever I have a withdrawal, my skin is hotter to the touch because it is acting as an impaired barrier and letting my core temperature heat go. The result? I am a grouchy popsicle of a human.

Luckily, we have finally seen a break in the northeast chill, and I was able to enjoy the weekend basking in the sun and walking for miles. Hopefully getting outside and playing more will help me get my skin back to its old equilibrium before the baby comes.

Nighttime presents its own problems. Though I am less stressed about losing sleep nowadays (having a remote job helps), I do find that physically sleeping is still a trigger. The last few days I have had hives that appear on my back when I am in bed (but not in the same part of my back each day which would have made me think it was my sheets or  lotion). I also tend to get heat rash-like symptoms on whatever side of my body I am laying on, or even if I roll over to lay on my back for a bit. I haven’t figured out why that is, but it’s extremely irritating and usually affects my IT band area on my legs the most. And naturally since I am awake weird hours, I notice how my skin dries out as the night goes on (but I am usually too tired to actually get up and re-apply another coat of lotion/moisturizer).

My methods of combatting this withdrawal flare are the following:

  1. keeping calm. I have been extraordinarily unfazed by my skin this time round. I am not worried it will never heal, and I am not worried when I miss sleep (I just try to take more cat naps later on or go to bed the next day at crazily early times like 5pm).
  2. diluted bleach baths. I tend to take one many once every one or two weeks just to make sure I keep the potential infections at bay. I usually know when I have had bad scratching bouts or see signs of what I think may be early infections, and I decide when to do these baths by those feelings.
  3. sugar reduction. Yes, despite being a sugar-lover, I am trying to cut down on added sugars. I don’t even put sugar in my oatmeal anymore (instead I cut up a fresh green apple into it or add berries if I have them). I let myself have one treat on Saturday and Sunday, but I make it so I have to work for it (like walk 2 miles to get the treat, then walk back).
  4. finding a good product for the skin presentation. Lately I’m hooked on Exederm’s daily care moisturizer. It doesn’t stop me from still drying out and flaking but it also usually doesn’t burn or cause excessive itching (except sometimes at night, but my skin is an unpredictable animal at night).
  5. living the “motion is lotion” motto. I have been trying to increase my NEAT (non-exercise activity thermogenesis) meaning I have been trying to reduce the time I am a sedentary lump. The warming weather is helping (I will happily walk anywhere in my town even if it is a 1-3 mile walk one way), and I have been doing a 100 push-up challenge every night before bed (I do modified pushups as my belly has been getting bigger!). I also started incorporating more hip workouts and squats/lunges to keep my legs in shape as this baby grows. All in all, “I like to move it, move it”.
  6. showers first thing. When I get up from bed (which sometimes is a struggle in itself), I get into the shower to start my day. One, I find it therapeutic, the feeling of water. Two, it helps me soften the skin and wash off some of the dead skin so that the lotion/moisturizer can be better absorbed. Three, it bases me in a routine.

All in all I feel like I am handling this withdrawal much better than previous ones. My skin has more or less remained skin-colored this time (instead of reddening everywhere). I’ll give updates if it starts to subside or if it gets worse in time.

Oh and here is a photo of what I mean when I say I have elephant skin (this is my right knee):

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REFERENCES

Sheary B. Steroid Withdrawal Effects Following Long-term Topical Corticosteroid Use. Dermatitis. 2018 Jul;29(4):213-218.

all posts, community

baby and the beast: caretaking with eczema

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So many searches come up with how to be a caretaker for a person or child with eczema, but I haven’t heard from, or found research more about the challenges and options for when the caretaker is the one with eczema.

This week I am watching my baby cousin. He’s about 7 months old now and his mom leaves him with me starting around 7am until anywhere from 6-8pm. It’s my first time watching an infant and though he is a delight, today required some adjustments to my routine as I overslept. Normally, when I have a rough night, I can sleep from 6-8am and catch up on some of the lost time. And then the first  thing I do when I get out of bed is take a warm shower and then apply lotion (as it helps my skin absorb it better when I shower first. Also for those interested, I am currently using Exederm lotion as my go-to).

Today however, I failed to get up before my cousin had to leave so instead I just rolled out of bed and got the baby, dry flaky skin and all. As I haven’t had enough time to zip off to take my usual shower, because I obviously can’t leave him alone for long periods of time (and I am not familiar enough with his nap schedule to know if I have enough time to shower during one), the day has come down to being a lot of a mind over matter deal about my skin. Yes I still itch, and my hands especially are quite dry, but mostly I’ve focused on the mini wheat, and by doing so I have been able to ignore my own normal tweaks and discomforts. There’s actually a fair amount of studies that show that being able to have a distraction helps decrease the itch sensation due to how itching is perceived via the brain (but more on that in a post coming soon about addiction to scratching).

Though I understand the necessity of taking care of oneself physically and mentally, before others (such as with the oxygen masks on airplanes), I do recognize when handling my skin is less than urgent. Yes, I am dry and theoretically could desperately use some more lotion, but I feel well enough that I can handle waiting to do my usual routine until tonight. That being said, after changing his diaper I did have to wash and soap my hands thoroughly which caused some cracking so I did apply lotion then. The rest of my body is holding up well enough in the meantime.

Plus the advantages of babysitting an infant are that they keep you up and moving. I probably feel relatively good because I haven’t stopped moving around with him, adding validity to the “motion is lotion” mantra. Although sweat-inducing physical activity has been seen as eczema-provoking, overall it seems there still hasn’t been enough research done to figure out what kinds of exercise are the best for people suffering from eczema. Research for moderate, non-sweat-inducing activity helping eczema has been fairly supported by organizations like the National Eczema Association, which encourages trying low-intensity activities such as yoga, tai chi, pilates, walking, and gardening. I’d love to take my cousin out for a walk but it’s currently 45F and down pouring so I’ll settle for doing some squats with the extra baby weight. 🙂

I think one of the most important things when you have a flop day in terms of your care of a chronic (non-fatal) disease is to not get too stressed out. As we all say, life happens, and so sometimes it’s best to just roll with the punches and let that bad day pass on by. So long as it doesn’t become a habit of mis-care to yourself, you’ll most likely be okay.

And so, all in all though I look like a ragamuffin and clearly didn’t take proper care of my skin today, I am not upset and I know I’ll survive one less than ideal day.

Are there any other caretakers (parents, guardians, babysitters, senior home workers, etc) who suffer from eczema and have had to forgo their usual skin care every now and then in order to take care of someone else?

 

REFERENCES

Fuller, John. “Eczema and Exercise: The challenge of enjoying exercise without exacerbating your eczema can be a delicate balancing act.” National Eczema Association, https://nationaleczema.org/eczema-exercise/. Accessed 16 Apr 2018.

Kim A, Silverberg JI. A systematic review of vigorous physical activity in eczema. Br J Dermatol. 2016 Mar; 174(3):660-662.

Mochizuki H, Kakigi R. Itch and brain. The Journal of Dermatology. 2015 Aug 5;42(8):761-767.

all posts, nutrition

skin deep it’s not so sweet: all about sugar

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[For background context: I am currently still interning with EChO-Eradicate Childhood Obesity Foundation, and so I spend a lot of time thinking about and researching sugars].

Ask anyone- I love sweets. I’m pretty indiscriminate about what types (though I tend to prefer baked goods to pure candy). At either rate, one thing I have worried about over the years (and not necessarily due to any scientific reasoning) was that my previously very high sugar consumption as a child/teen had somehow contributed to my global body eczema flares now (despite not eating as much sugar these days). This has led me to be particularly interested in researching more about sugar, and it’s potential links with eczema.

So let’s get into the nitty-gritty about sugar. The term sugar, much like the term bacteria, often gets a bad rep. Sugar is a type of carbohydrate (the others being polysaccharides and oligosaccharides), that is best defined as either monosaccharides or disaccharides (‘saccharide’ means ‘sugar’). Monosaccharides include simple sugars like glucose (dextrose), fructose (levulose), and galactose. Disaccharides includes sucrose (or what we know as table sugar) which is made of glucose and fructose, maltose (a sugar from grains made of 2 glucose molecules), and lactose (a sugar from milk and made of glucose and galactose). You may have heard fructose (the sugar that makes fruit sweet) getting a bad rap, and that’s because the way the brain processes fructose versus glucose differs. Studies done on rats show that when glucose was consumed, a “satiety” response eventually kicks in because glucose triggers the hormone insulin to be released, but when fructose was consumed, there wasn’t enough of an insulin response to cause the same feeling of satiation. What does this mean globally? Well, consuming fructose sugars may take longer for you to feel full or done eating, and so as a result you are more likely to eat/consume more of whatever food/drink it’s in before you feel done. But why are fruits okay to consume (in moderation)? Because they are packaged naturally with fiber and other nutrients and are not just added fructose (think like how many products, like sodas, often have/had high fructose corn syrup, or extra fructose in them but no fiber or other healthier aspects to balance them out).

It is also worth noting about polyols. Some sources consider this to be a type of sugar (such as the World Sugar Research Organization), while others say it is not a sugar, but it is a carbohydrate (Polyols Organization). Polyols can sometimes be called ‘sugar alcohols’ because their structure looks somewhat like a sugar molecule and somewhat like an alcohol molecule. Polyols include: erythritol, hydrogenated starch, hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. They are seen as a new alternative to sugar because they don’t spike blood glucose levels, and they generally have fewer calories per gram. Currently the warning with them is that they may make still be addictive and cause people to consume larger quantities of foods that contain them and/or start to dislike products that don’t have them. The adverse side effect listed by the FDA of excess consumption of polyols is usually related to digestive issues (gas, bloating, diarrhea, etc). Anyway…

The function of sugar in our bodies is to produce energy. When we eat carbohydrates our body breaks it down into glucose and uses those molecules to do important functions like activating our muscles. However, the rates at which sugar affects our blood sugar levels varies. Simple carbohydrates (like sucrose, or table sugar) increases our blood glucose levels quickly, while complex carbs (whole grains, beans, etc) affect blood glucose levels more slowly. In this case we have another example of how slow and steady wins the health race- fast blood glucose level spikes means insulin is released quickly (insulin is used to help cells take in glucose), as a result, you’ll want more sugar again more quickly after eating a blood glucose spiking diet and also, diseases like diabetes and heart disease are related to blood glucose level spikes.

So why are some sugars considered worse than others? The term “added sugars” is a more recent addition to our nutrition world vocabulary and is used to talk about when products include sugars that are not naturally in food (such as when we add a table sugar to the cake batter we are making for a birthday). For example as mentioned before, fruits contain the sugar fructose, but it is considered a natural sugar because one, it is naturally created by the fruit, and two, because it is packaged in the fruit with a balance of fiber and other micronutrients. The problem is that a lot of our processed foods have more added sugar than we think, and dietary guidelines about how much sugar we should maximally eat in a day are being exceeded (according to the American Heart Association, women should eat no more than a total of 6 teaspoons of added sugar a day, and men no more than 9 teaspoons). So if you had a seasonal tall (aka a small) Starbucks Pumpkin Spice Latte this fall with 2% milk and no whipped cream, you consumed about 37 grams of added sugar, or 7.4 teaspoons, exceeding the max a women should have in a day and getting close to the men’s max as well, with one beverage.

But how does sugar impact skin? It affects it in a few ways: by causing inflammation, by aiding candida infections (people with eczema often have a higher risk of candida infections), via glycation, and by messing up our sleep.

When it comes to inflammation, the issue tends to be that sugar (fructose in particular) as its metabolized by the liver can cause free radicals to be made, which are known to cause inflammation. Inflammation results in cell damage, and with a condition such as eczema where your body is already in hyperdrive of attacking its own cells, increasing cell damage is the last thing you want. Interestingly enough, studies on rats have shown that strength training helps to control inflammation even with a high-fructose diet, but I’ll talk about exercise and activity in another post.

Candida albicans is a type of yeast (or fungus) that many healthy people carry orally, and can be non-pathogenic if there is not an overgrowth of it. When there is too much (or any other type of Candida yeast), the condition is called candidiasis. Though there are many reasons for why we’ve seen an increase in candida infections, some of the major culprits are increases in antibiotic use, use of topical or oral corticosteroids (or other local immune suppressors), as well as refined sugars changing our pH, and allowing for easier growth of this yeast. The problem with candidiasis is it can lead to bloodstream infections, and it can cause increased production of acetaldehyde, a chemical that breaks down DNA and impairs cellular repairs. Now it stands to say again that sugar isn’t the only cause for increased risk of candidiasis, but in tandem with taking corticosteroids and antibiotics, it doesn’t help.

Glycation (or more technically described as advanced glycation end products, or AGEs), are products created by a reaction called the Maillard/browning reaction- a reaction that occurs in normal metabolism, but if too many AGEs are made that’s when it becomes a problem because they can increase inflammation and oxidation stress in the body. Usually, AGEs are released by cooking animal-based foods at high heats, more so than by cooking fruits, veggies, whole grains, etc (unless the fruits/veggies/whole grains are made with added fats, in which case the dietary AGEs are also drastically increased). Increased AGEs can also impact collagen and elastin production (due to the oxidation effects), which would impair wound healing. So how does this relate to sugar? Well sugars such as fructose, in combination with some animal protein components heated together increases the dietary AGE production. A low dietary AGE intake, much like a low sugar diet, can help fix insulin sensitivity and improve wound healing (especially with the subsequent decrease of inflammation that occurs). But if your snack/sweet of choice are baked goods made with animal/protein-rich products and includes fructose, chances are you are upping your AGEs, therefore decreasing wound healing, increasing inflammation, and impairing insulin sensitivity.

And lastly, sleep. Simply put, if you eat a lot of sugar, your body has to spend more time trying to convert it into energy and/or store it as fat, and so if you are eating enough to have the ‘food coma’ effect at night, chances are you are slowing your body’s recuperating abilities as it spends the time trying to handle sugar, instead of focusing on general repairs (such as healing eczema rashes and cuts). When we ultimately hit the sugar crash point, our bodies produce cortisol, which results in a higher heart rate, and subsequently less good sleep. Ironically it’s a cyclical pattern. The more you lose good sleep, the more likely you may be to crave sweets!

So the takeaway? Sugar (and specifically added sugars) definitely don’t help eczema, especially when eaten in excess.

 

REFERENCES

Aubrey, Allison. “Sugar and Sleep: More Rest May Dull Your Sweet Tooth.” National Public Radio: The Salt, https://www.npr.org/sections/thesalt/2018/01/18/578604700/sugar-and-sleep-more-rest-may-dull-your-sweet-tooth. Accessed 12 Apr 2018.

Botezelli JD, Coope A, Ghezzi AC, Cambri LT, Moura LP, Scariot PPM, Gaspar RS, Mekary RA, Ropelle ER, Pauli JR. Strength Training Prevents Hyperinsulinemia, Insulin Resistance, and Inflammation Independent of Weight Loss in Fructose-Fed Animals. Scientific Reports. 2016 Aug 4;6(33106).

Gainze-Cirauqui ML, Nieminen MT, Novak Frazer L, Aguirre-Urizar JM, Moragues MD, Rautemaa R. Production of carcinogenic acetaldehyde by Candida albicans from patients with potentially malignant oral mucosal disorders. J Oral Pathol Med. 2013 Mar;42(3):243-249.

“Healthy Eating Tip of the Month: Does Sugar Feed Cancer?” University of Michigan, https://www.med.umich.edu/pfans/_pdf/hetm-2016/0416-sugarcancer.pdfAccessed 12 Apr 2018.

Lawson M, Jomova K, Poprac P, Kuča K, Musílek K, Valko M. Free Radical and Antioxidants in Human Disease. Nutritional Antioxidant Therapies: Treatments and Perspectives. 2018 Mar 11;283-305.

Ott C, Jacobs K, Haucke E, Santos AN, Grune T, Simm A. Role of advanced glycation end products in cellular signaling. Redox Biology. 2013 Dec 19;2():411-429.

Page KA, Chan OC, Arora J, Belfort-DeAguiar R, Dzuira J, Roehmholdt B, Cline GW, Naik S, Sinha R, Constable T, Sherwin RS. Effects of Fructose vs Glucose on Regional Cerebral Blood Flow in Brain Regions Involved with Appettite and Reward Pathways. JAMA. 2013 Jan 2;309(1):63-70.

Patil S, Rao, RS, Majumdar B, Anil S. Clinical Appearance of Oral Candida Infection and Therapeutic Strategies. Front. Microbiol. 2015 Dec 15.

“Sugar 101.” American Heart Association, https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugar-101#.Ws9onWbMzowAccessed 12 Apr 2018.

“Sugar Alcohols.” FDA, https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/sugar-alcohol.html. Accessed 12 Apr 2018.

Uribarri K, Woodruff S, Goodman S, Cia W, Chen X, Pyzik R, Yong A, Striker GE, Vlassara H. Advanced Glycation End Products in Foods and a Practiacl Guide to Their Reduction in the Diet. J Am Diet Assoc. 2010 Jun;110(6):911-916.e12.

“Your Questions Answered.” Polyols, https://polyols.org/frequently-asked-questions/. Accessed 12 Apr 2018.

 

all posts, treatments

review: moisturizers

abandoned antique architecture building
Photo by Pixabay on Pexels.com

I think one of the universal aspects of having a skin condition is you get used to using a bunch of different topical creams and lotions and ointments. At this point in my life, I am no stranger to the variety of products in the market (though new ones are always being developed) and I’ve formed my own opinions about what works or doesn’t work for my skin (though that also varies depending on what stage my skin is in at the moment).

A+D – First Aid Ointment: Generally, I use this much like I use Neosporin (mostly for cuts and scratches). This does have lanolin which can cause allergic reactions for people. I think this works fine if you don’t have allergies, though it’s too sticky to apply over the whole body. I think Neosporin generally works a bit better (maybe because it usually has a type of antibacterial in it?).

Aquaphor Advanced Healing Therapy Ointment Skin Protectant: I’ve used this brand and the retail store-brand versions. This feels a bit like applying Neosporin to the skin, but more watery. Generally it didn’t feel bad on the skin, but was a bit sticky. Overall, it didn’t really help me enough to keep moisture in to warrant repurchasing it at the time, though I wouldn’t mind using it again if I had another bottle of it lying around.

AveenoActive Naturals Daily Moisturizing Lotion: I find this type to be a bit watery, and it tends to burn a little bit if the skin is raw. To be fair though, I haven’t tried a lot in their line besides this particular product. Apparently their Aveeno Eczema Therapy Moisturizing Cream helps improve the diversity of the skin’s biome.

Avène Eau Thermale Avène Skin Recovery Cream: I actually haven’t tried this brand at all yet, but I have heard good things about it, and this cream I would love to try. Avène has a spring called Saint Odile in France that apparently has very lovely healing properties, and so spas and other treatments have developed there using the water, including hydrotherapy. There is also an Avene company in the USA, which I think also uses the water from France.

Burt’s BeesShea Butter Hand Repair: I’ve been using this along my whole body and generally love it. It is a little thick, but as you spread it, it melds well into the skin and is pretty effective as keeping some moisture in so long as I wear layers over the skin. Downsides is the amount isn’t made for someone using it along their whole body (and technically isn’t made for the whole body as it’s a hand cream!).

Cera Ve Moisturizing Cream: I’ve used a variety of their products. While I have no complaints with them, they are generally a bit too pricey for me for the amount I need and don’t offer as good of benefits as other brands. When I did buy it, I usually went for the bulk size one to get the best price per quantity.

CetaphilMoisturizing Cream for Dry/Sensitive Skin: Generally feels like a watered down Cera Ve. I’m not a huge fan of them. Note: A friend recently told me that Cetaphil products contain almond oil- so for those with a nut allergy, this is not the lotion for you!

(NEW!) Chuckling GoatCalm Down Kefir Lotion: I use these for the inflamed days as it seems to help dry out the excess heat and redness. It doesn’t help keep in moisture so I use it early in the day and then apply something stronger to keep in moisture later on. It goes on fairly gently.

(NEW!) Chuckling GoatSoothing Kefir Lotion: This one smells nice but didn’t feel as good as the Calm Down version.

Coconut Oil (pure) –  Vita Coca Organic Virgin Coconut Oil: I’ve heard great things about the benefits of coconut oil for keeping staph infections at bay and helping to reduce a lot of eczema symptoms. Personally I do like using coconut oil but it feels like it doesn’t absorb as well in to the skin, and it doesn’t really provide lasting moisturizing effects throughout the day so I have to use it with something else. It does seem to help with skin redness though.

ConquererSoothing Dry Skin Balm: This is Abby Lai’s brand (of Prime Physique Nutrition) and lately I am loving it. When my skin is cracking, this is one of the few products that can help calm the skin down, though it does take a while. My only complaints would be the size of the container (I’d love a larger tub of it), and that it is somewhat grainy and so it took a lot of rubbing in to get it to melt into the skin. The latter isn’t a deal breaker though- and I’m not sure if it was just my container from heat or cold transportation that caused it to become so granular.

Curél Ultra Healing Lotion: I have used this product a few times but so intermittently that I can’t really accurate review it. It feels nicer on application than Cera Ve and Cetaphil.

DoveDermaseries Eczema Relief: This is Dove’s new line. I generally like it though it is more on the lighter scale. It’s a bit pricey and also doesn’t last as long if applied after a shower/bath as I would like.

(NEW!) Eczema HoneyHoney Natural Healing Cream: This one tends to provide a better barrier and seal in moisture, plus the honey works as a natural antibiotic. The downside is that it separates from the oil in the mixture pretty quickly so I have to stir it a bit before use. Also, as it is mostly honey, it’s sticky!

EucerinAdvanced Repair Cream: This is one of the lighter types of their line. I liked it because the normal Eucerin was just too thick (and also didn’t absorb well into the skin if the skin was wet/damp). This version however, can tend to burn on application.

(NEW!) ExedermEczema Care Daily Lotion: I recently came across this in CVS and gave it a go because it was endorsed by NEA. I found that it really did help relief the intense dry/cracking I have been having, especially with my hands, but it doesn’t last long as a moisturizer (but to be fair, I got the daily lotion, not the daily moisturizer). All together I am using this product almost exclusively now and am pretty happy with it for the dry/cracking/wrinkly skin face (google TSW knee/hand/wrist wrinkles for an idea of what my skin looks like during this phase). The one down side is, this product tends to be hard to find and not in many stores yet (or at least not that I’ve seen).

(NEW!) Exederm Intensive Daily Moisturizer: I’ve been using this product a lot (pretty much exclusively for a few weeks now). It isn’t too watery, and coats my skin nicely and does get absorbed well. I’ve noticed it can cause me a bit of itchiness if I apply it after a hot shower/bath (which I technically should be avoiding anyway).

L’OréalParis Collagen Moisture Filler Day Night Cream: I grabbed this because I was looking for a creme to apply to my skin that contained collagen. This one is okay. It is quite fragrant which I’m not a fan of, and it tends to dry me out after application within a few minutes. Overall I don’t think I’d buy it again, though if I couldn’t find any other collagen-infused creams I might repurchase it.

(NEW!) MG 217 – Eczema Body Cream with 2% Colloidal Oatmeal: This is a newer one I’ve been trying. It has a smell that reminds me a bit of menthol and it feels a bit stickier when it goes on, but it generally doesn’t burn and it dries quickly. I like it because it feels like it coats the skin evenly, but it often is unable to help me stop my drying out when I’m in that aggressive phase of that stage. All things considered I will be getting it again.

NeosporinOriginal First Aid Ointment: I generally only use this for cuts or deeper scratches, and then try to cover them with band-aids to keep in the moisture. Neosporin generally feels good on the skin (no burns or anything- and some types contain pain relievers), but is quite oily and I wouldn’t suggest it for use for the whole body. I do use it overnight a lot when my hands and feet are cracked

Reviva: Collagen Night Creme: I do enjoy this collagen cream, though it only comes in small quantities. It helped reduce a pretty red flare that was starting on my face in two days, which was a great relief. I usually saved it for my face and hands because it does come in so little amounts, but I think it helps overall.

Sunflower Oil (pure) – Spectrum Naturals Organic: Sunflower oil also has studies supporting its use for people with eczema (so long as you don’t develop an allergy to it). It is a bit of a hassle to apply as it is a pure oil, and it does dry pretty quickly, and overall I don’t dislike it. I don’t really use it anymore because I did develop an allergy to it over time.

VanicreamMoisturizing Skin Cream for Sensitive Skin: I received samples of these to try from my phototherapy sessions. They didn’t burn during application which was nice, but they did feel a bit watery and didn’t real help retain moisture.

Vaseline Pure Petroleum Jelly: I have mixed feelings about Vaseline (and in generally petroleum jelly). In general, I hate the feeling of being sticky and having to apply it is a nightmare. When I do use it, I use the pure thick stuff and it used to help keep moisture in my skin but more so when I was on antibiotics and oral steroids. When I’m not on those medications and/or when my skin is not flaring, I find Vaseline to be too much and it often makes me breakout in acne. When my skin is flaring too aggressively, Vaseline tends to trap heat better than it traps moisture. Lately I tried it when my skin was unbearably dry and nothing was working, and Vaseline didn’t help. It just made me feel sticky.

YORO NaturalsOrganic Manuka Skin Soothing Cream: I am loving this product. It feels a little more sticky than the usual culprits (like Exederm), but it keeps my skin hydrated longer. It smells pretty good as well. My only complaint is that it comes in such small amounts.

 

I’ll add more products to this post as I use more (or remember which ones I’ve used in the past).

all posts, the eczema body

worried about lymphoma?

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One of the most frustrating aspects of having chronic atopic dermatitis is that many of the symptoms overlap with Hodgkin’s lymphoma, but since the latter is rare, it is seemingly unlikely that a person will have it while also being difficult to have enough concrete signs and symptoms that a doctor will feel it warrants further investigation.

For example, the primary symptoms of Hodgkin’s described by the cancer organization are enlarged lymph nodes (especially in the neck, armpit, or groin), intermittent or constant fever, night sweats, weight loss, itchy skin, loss of appetite, and tiredness. Chronic eczema for me has hit virtually all of those but a fever (and I never have fevers even when I am sick… in fact I didn’t even have a fever when I had a staph infection in my lymph nodes some years back!).

The other rub (possibly because of the overlap of symptoms with eczema) is that Hodgkin’s is generally not detected early on, and so unless symptoms changed drastically over a short duration (which I’m not sure this type of cancer does), it would be hard to know if what I had was Hodgkin’s or just another day of swollen lymph nodes, without getting a biopsy of said lymph nodes to confirm. Even then, apparently it can be necessary to need multiple samples to track what’s happening with the lymph node over time.

This is why I believe it is crucial to one, keep track of your own symptoms and body and immediately go in to see someone when something feels off. You are the only person that lives in your body and so it is important for you to be able to track what is going on because no one else will have the lifetime of records that you do. Two, it is so important to find a PCP/provide who you trust and feel able to develop a working relationship with as time goes on. It is necessary to build this relationship over time and feel confident that you are being heard, and always ask questions when you don’t understand or aren’t sure what will happen next. A lot of the preventative care comes from making sure you are ready and informed about what is going on with your body.

I’m currently on that second stage- working towards getting a new PCP (as I recently moved into a new town), in order to establish some kind of plan to understand when my symptoms are just eczema, and when they could be indicative of something more.

Today, I had a check up at my OB/GYN office where they gave me the glucose test (you drink a really sugary drink and they draw your blood an hour later to see if you produce enough insulin to handle the drink). Along with the blood draw testing my insulin levels, I got back data on my WBC, RBC, and the breakdowns. Apparently I have higher than average WBC, and a variation of out-of-range monophil, lymphocyte, esophil, and neutrophil levels that basically make it seem like I am fighting a bacterial/fungal infection or something of the sort, but also still could fall into the realm of someone with lymphoma. So in a nutshell I am still destined to schedule a PCP to try and make sense of all this data and see if there is a cluster of data points that would help more or less clear up the sensitivity or specificity of whether or not I need to get checked for lymphoma.

 

REFERENCES

“Signs and Symptoms of Hodgkins Lymphoma.” American Cancer Society, https://www.cancer.org/cancer/hodgkin-lymphoma/detection-diagnosis-staging/signs-and-symptoms.html. Accessed 4 Apr 2018.

miscellaneous, the eczema body, treatments

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.

all posts, treatments

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.