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moisturizer withdrawal for eczema

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Moisturizer withdrawal (MW) is a hotly controversial topic in the field of eczema (especially in regards to topical steroid withdrawal). The medical community generally is anti-MW, while there are some specific doctors and communities that are very much for it.

Some of the pros I’ve read about on giving up moisturizer include:

  • moisturizers seal in heat, which makes going through eczema/topical steroid withdrawal more uncomfortable
  • your skin produces cortisol naturally, but adding moisturizer can suppress this production (more on that in a bit)
  • you are losing so much skin (more in reference to TSW) that you don’t want to try to lubricate the dead skin and slow your body’s attempt to rid itself of the old tissue
  • most moisturizers have something in them (usually to help them be more shelf stable) that does not help the natural skin biome. As such, they may hinder healing because more resilient skin bacteria, ones that can survive the pH and chemical changes created by said moisturizers, are usually not the benign ones

I then proceeded to go down a rabbit hole in studies trying to understand more about the skin and its own ability to create cortisol (again this was more in reference to trying to understand how to overcome TSW more easily/quickly). The rabbit hole led me to read about keratinocytes and how our skin reacts to stressors.

Keratinocytes (a type of outer skin cell) can create cortisol in response to adrenocorticotropic hormone (ACTH), as studied in cultured keratinocytes (meaning keratinocytes on petri dishes or other lab-made mediums) and in human skin samples. Keratinocytes also make glucocorticoids (GCs) which are known to block wound healing, but also block pro-inflammatory cytokines (something we know run rampant in those going through topical steroid withdrawal). So, it’s my thinking that the GCs could help as a balancing factor with the excessive inflammation that comes with eczema and TSW. The amount of cortisol produced also changes in response to things like trauma and UV light and dryness. It was the dryness that intrigued me because with conditions like topical steroid withdrawal, we are taught to combat it by applying more moisturizers to prevent dryness, but what if that is decreased the skin’s ability to hit a homeostatic level and kick up its cortisol production?

In Japan, there is a doctor (Dr. Kenji Sato) known for his treatment of eczema and topical steroid withdrawal, and he works in a hospital (Hannan Chuo Hospital) on a program where people enter specifically for TSW and then they stay for an average of 40 days or so and then leave, supposedly healed. Note, they are healed from TSW, but they can still have eczema flares, though those usually aren’t as bad. I’ve been curious about his treatments for a while, especially because the regime doesn’t require strict diets, and the main things it requires are keeping your nails really short, exercising everyday, and not using any moisturizers (no soap, no lotions or creams or ointments, and any showers must be shorter than 1 minute). For those interested in the hospital, there were two comics I came across a while back that tell stories of what it was like to be a patient at this hospital. The first is done on the artist’s personal experience, and the second was created after an interview with a fellow patient.

Personally, I am starting to think moisturizer withdrawal may be the way to go (for myself). I’ve noticed that I itch horribly after baths and sometimes showers, and itch even worse when I put on my lotion or creams on wet skin (which is usually the recommendation of the medical community to help seal in the moisture). To be fair, I do tend to take baths/showers that are too hot by those same medical recommendations, but water tends to cause me pain at any level of exposure so I think I enjoy hot water because it’s a different pain sensation so it blocks out the burning of open wounds.

After thinking about it, as it is currently winter in Massachusetts, this would be a terrible time to go through moisturizer withdrawal. My skin tends to fissure something horribly when it’s dry and especially in winter/when indoors with the heat on. I will think about going through MW in the spring/summer and post about a 40 day trial then.

 

REFERENCES

Cirillo N, Prime SS. Keratinocytes synthesize and activate cortisol. J Cell Biochem. 20011 Jun; 112(6): 1499-1505.

Zhu G, Janjetovic Z, Slominski A. On the role of environmental humidity on cortisol production by epidermal keratinocytes. Exp Dermal. 2014 Jan; 23 (1): 15-17.

Vukelic S, Stojadinovic O, Pastar I, Rabach M, Krzyzanowska A, Lebrun E, Davis SC, Resnik S, Brem H, Tomic-Canic M. Cortisol Synthesis in Epidermis is Induced by IL-1 and Tissue Injury. J Biol Chem. 2011 Mar 25; 286(12): 10265-10275.

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cultivating simple pleasures

pexels-photo-92612.jpeg
Photo by Matthias Zomer on Pexels.com

Today’s post is silly and short.

I remember the reoccurring theme in the French movie Amélie when the narrator tells us what each of the characters likes and dislikes. Because the protagonist Amélie grew up with no friends, she was said to have learned to cultivate an appreciation for the finer things in life, like collecting smooth stones for skipping, sliding her fingers into large burlap sacks of dried beans, and cracking freshly made crème brulée.

Well I too have devised my own version of weirdly satisfying simple pleasures for one living with eczema that I will share with you all so you can all be tantalized by these delicious (and mostly improbable) thoughts. Sorry if some of them are gross; I have a weird mind.

And so, without further ado, my current running list of cultivated simple eczema pleasures:

  • Dipping eczema flaky feet into those ponds of fish that lightly nibble dead skin.
  • Getting Elmer’s white glue all over the top of the hands and then pulling off the dried result (like we did as kids to our palms), and watching the dead skin pieces go with it.
  • Getting a Korean exfoliation skin massage and watching the bits of skin slew off (if this didn’t entail probably wrecking eczema-afflicted skin).
  • Having a lint roller for dead skin that can just roll the excess skin away.
  • Going into a mud bath equivalent of what was in the movie Spirited Away, and coming out all silky smooth as the mud deeply moisturized the skin cracks.

Then I have ideas for all these even more so crazy impossible scenarios, like a skin cheese peeler that only goes as deep as the dead cells and doesn’t hurt any new skin growth, and other weird things like that.

Clearly I’m feeling flaky these days. I’ve started to identify the fall season time as being when I identify most with a bear. I alternate between just wanting to roll up in blankets and hibernate for months and wanting to emerge to rub my itchy body on trees.

pole-dancing-bear.gif

Yeah, that’s me in a nutshell. Bears get me.

all posts, treatments

review: moisturizers

abandoned antique architecture building
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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).