The itch-scratch cycle

Keep the nails short if you're prone to scratching.
Keep the nails short if you’re prone to scratching.

Have you ever noticed that the more you scratch, the more a spot itches?  That in turn leads you to scratch even more, and thus you get the vicious itch-scratch cycle.

This vicious itch-scratch cycle also makes eczema worse.  While you might think sheer will could interrupt this cycle, that is actually a very tall order.  For any of you who have eczema, or have had a bad bug bite, you know what I mean.

So what can you do about it?

– Treat the itch. Work with your doctor to find the right combination of prescription and non-prescription methods to treat the itch.  These may include topical medications and pills too.

– Create a barrier.  Wraps over an offending area can create a barrier.  Similarly, gloves over the fingers can help.

– Decrease the trauma of your scratching by keeping your fingernails short. This will also help keep your nails from cutting open your skin, which can increase the likelihood of an infection.

What other methods have worked for you?

Moisturize moisturize moisturize!

Choose a fragrance-free hypo-allergeneic moisturizing cream or ointment.
Choose a fragrance-free hypo-allergeneic moisturizing cream or ointment.

It’s amazing what havoc a simple change of the weather can wreak. As our days and nights in the Northeast have gotten drier and cooler, I’ve noticed that my skin is needing more moisturizer to stay supple and comfortable. More of my patients are also coming back with flares of their eczema. Accompanying the eczema is dry skin.

So what is one key step to battling eczema and dry skin? Moisturizing! By moisturizing, we put the hydration back into the skin. Some of us have a genetic predisposition to getting dry skin. Others of us have occupations which may lead to frequent washing and dry skin. And for all of us, the inevitability of time and age also leads to a decreased ability to keep our skin supple.

So what is the proper way to moisturize? And how do you choose a moisturizer?

Well, if you are coming out of a bath or if you just washed your hands, then you want to pat dry instead of rubbing dry. Immediately put on a fragrance-free hypo-allergenic moisturizing cream or ointment. Creams tend to be thick and white while ointments tend to be greasier like Vaseline ointment. Lotions tend to be watery and less effective of a “sealant.” Slather on your moisturizing cream liberally.

Throughout the day, you can re-apply your moisturizer as needed.

For those hard to reach areas, you may need someone to help you apply your moisturizer or get a moisturizer applicator.

What is your favorite moisturizer?

October is Eczema Awareness Month!

October is Eczema Awareness month. Check out the National Eczema Associattion website: www.nationaleczema.org for more information
October is Eczema Awareness month. Check out the National Eczema Associattion website: nationaleczema.org for more information

October is upon us and so is eczema! October is eczema awareness month. For many people, the nippier drier weather of the fall leads to flares of eczema. Indeed, I’ve been seeing a lot more folks in clinic coming in with dry skin and eczema flares.

Sometimes it’s helpful to hear from a community of other eczema patients as well as caregivers with expertise in eczema. Check out the National Eczema Association’s webpage at www.nationaleczema.org and also their Facebook page.

In coming posts, we’ll talk about issues related to eczema.

Wet wraps for atopic dermatitis at the Mayo Clinic

In a follow-up post to September’s post on wet wraps, I thought we would review one of the articles from the Mayo Clinic on the use of wet wraps in pediatric patients with bad atopic dermatitis.

The Mayo Clinic has had a tradition of using wet wrap therapy for a multitude of skin conditions including atopic dermatitis.  In their paper in the July 2012 issue of the Journal of the American Academy of Dermatology (JAAD), the authors reviewed their medical charts as it pertained to the use of wet wrap therapy with steroids over a period of 30 years and in examining 218 patients.  Pediatric patients with severe atopic dermatitis were admitted to the Mayo Clinic where they received wet wrap therapy.  Patient were treated with topical steroids and moisturizer which were covered with wet wraps (with either water or vinegar soaks) which were then covered with dry wrappings and a warm blanket.  They had these applied 5-8 times a day, and had dressings removed every 3 hours for dressing changes (and so that the child could walk around, urinate, etc).  A number of these patients also did get oral antibiotics for skin infection over the eczema.  The authors found that many of their patients had good results. For instance, 45% were deemed to have 75-100% improvement.

This study highlights that wet wraps with topical steroids is an important potential therapy to consider. While there are limitations to the study design, it is worth educating patients, their families, and other providers about this therapy.

Wet Wraps for Eczema

Continuing on the theme of eczema after the wonderful guest post by Marcie’s Mom, I thought we could talk about wet wraps in more detail.

Wet wraps have been shown in research studies to be quite effective in helping to treat and prevent eczema and is a remedy that can be easily done at home.  And it’s not expensive!  So what does it entail?

1) The skin must be moistened and hydrated. And by moistened, I mean in a bathtub ideally.  After stepping out of the bath (or shower if you don’t have a tub), pat the skin dry. Avoid rubbing.

2) Apply a thick moisturizer or topical medications as instructed by your physician.

3) Prepare a set of damp cotton pajamas by soaking it in a tub of lukewarm water and then wringing dry.  If you want to get fancy, you can buy special pajamas or wraps for this purpose.  Put on the pair of pajamas — it may be more comfortable to have the seams facing outward.

4) You can wear a set of dry pajamas on top.

Some people like having waterproof bedding just in case there is some dampness that seeps through.

MarcieMom’s Experience & Top Three Tips to Manage Baby’s Eczema

http://eczemablues.com/2012/06/45-of-the-101-things-that-moms-with-eczema-child-do-differently-stop-scratching/ 

Experience of a First-time Mom of Eczema Baby

Being a first-time mom is already a huge challenge and having an infant with eczema only made it tougher. We first noted rashes on my baby Marcie’s face at two weeks old and she’s diagnosed with eczema at her one-month checkup.

I would say the challenges were manifold, truly blood and sweat type!

Mental & Emotional

“Sleep like a Baby” – this phrase hardly described how my baby slept since her rashes came at 2 weeks old till date! Those days and nights which I had to swaddle her, hold her hands and co-sleep (we’re still co-sleeping!) were truly stressful. It’s about worrying about blood from baby’s scratching even when you’re taking a pee, and half the time, I try not to. For the first time ever, my dentist said my teeth were dirty as I often cut short my brushing to hold my baby’s hands!

Other emotions like blame and resentment could easily creep in – either with spouse not doing enough or contributing the ‘eczema gene’ or with (very often) your closest family and friends who don’t understand eczema and offer miracle cure or insinuate it’s due to the mom’s negligent care.

Physical

For the parents, it’s more of fatigue and stress. For the baby, it’s the lack of sleep and constant irritation. Allergy tests aren’t accurate before the baby is at least 6 month old, so very often, pediatricians will recommend switching to hypoallergenic milk formula or for moms who are breast-feeding, you’ll start to wonder if it’s anything in your diet. My baby did not take well to the formula switch, and I faced huge drop in milk feed (and huge rise in worry), colic and reflux for her.

MarcieMom’s Top Three Baby Eczema Tips

Managing eczema requires being a multi-tasking mom – there are so many factors to look out for! To make it less stressful, let’s concentrate on the top 3:

  • Once your baby reaches 6-month old, take an allergy test

Once my baby took hers at 7-month old, it really helped A LOT! First, we found out she’s not allergic to anything, so we could feed her solids without worrying about which food triggers her eczema. Second, we could stop being paranoid about everything, such as too much dust or walking past a cat or a dog in the park. You can read more about allergy test, including my Q&As with leading doctors in Singapore here.

like crazy!

  • Moisturize like crazy!

Moisturize lots, within three minutes after shower and at every diaper change and do use a lotion or cream that does not contain the top allergens. You can click here to learn about reading label of sensitive skincare products. There are also studies showing that moisturizing reduces the severity of eczema and may help to prevent the allergic march.

  • Don’t be steroid-phobic!

I know this would draw flak from some but truly, eczema needs to be managed and part of that management, is the application of topical steroid. Steroid has to be used under doctor’s supervision, who will advice the frequency and the strength of steroid. I was once steroid-phobic but realized that it’s so much more practical to quickly treat the eczema rash rather than let my baby suffer the itch, inflammation and damage to skin from scratching. To learn more about steroids, read here.

Hope above will help to prepare a first-time parent for baby’s eczema and whenever you feel stressed, drop by my blog to read the cartoons, 101 things that Moms with Eczema Child do Differently!

 

Mei, also known as Marcie Mom (on twitter), has baby girl Marcie who had eczema from two weeks old. Mei runs a blog, EczemaBlues.com, a comprehensive and light-hearted resource for parents with eczema children. Mei is also the co-chairperson of Singapore’s Eczema Support Group and has initiated an eczema fund for low-income patients in Singapore. Mei has also published a wonderful children’s picture book, called “A to Z Animals Are Not Scratching!”.

Crisco for the skin?

I’m seeing a lot of folks come in now with flares of their eczema. We always tout the use of nice thick moisturizers. A few of the brands that make fragrance-free thick creams include Eucerin, Aquaphor, Cetaphil, and Cerave. And you can’t go wrong with Vaseline.

Well, here’s a new recipe for vegetable shortening. If you’re looking for a really inexpensive non-irritating protectant, try vegetable shortening. Yes, like Crisco. You get a big tub of it for not a lot of money. Those other creams can really add up in cost. If you do go the Crisco route, use a clean spatula or spoon instead of your hand to apply it to your skin. And consider keeping it in the fridge.

Have you tried using Crisco for your skin? Let us know how it worked out!

Eczema skin care tips

An example of hand eczema. Courtesy of Wikipedia user Topbanana.

It’s getting cool and dry up here in New England and we’re seeing flares of eczema again. Here are some tips for good skin against eczema/atopic dermatitis.

1. Moisturize with a thick hydrating cream. Plain old vaseline works but not everyone can tolerate its greasiness during the day! Some brands that make good thick emollients include Cerave, Cetaphil, Eucerin, etc. Avoid creams with lots of fragrance and avoid watery lotions.

What’s your favorite moisturizer?

2. Minimize contact with water — especially hot water. This means taking lukewarm instead of scalding hot water and limiting the length of time you spend in the shower or bath. If you do a lot of dishwashing, washing your child, or if your job puts you in contact with water (nursing, hairdressing, bartending, etc.), wear gloves to protect your hands. And remember to moisturize your hands after water contact.

3. Try not to scratch the area. The itch-scratch cycle makes eczema tough to beat. Scratching can lead to more itching which in turn leads to more scratching, etc. Keep your nails short and try not to scratch! Your doctor can recommend medications to help with the itch.

4. See your doctor. You may need special medications to help your eczema/atopic dermatitis go away. These may entail creams of ointments. When severe, you may need pills, or even light therapy (aka phototherapy — a fancy light box that you stand in). It’s also important to see a doctor because eczema can get infected with bacteria or viruses.