Dry Skin/Eczema

While this will feel better to us, the dryness that comes from this change will cause dry skin and eczema to worsen. As the temperature falls, the humidity falls with it, causing dryness. Some patients with severe eczema will need to wear scarfs/gloves, etc when outside as the weather drops to less than 45-50 degrees, especially when windy. The most important thing to remember is to take shorter showers and consider soaking in a tub. A long hot shower will dry your skin out, a long hot bath will moisturize your skin. I like to use the example of a greasy frying pan, when held under running hot water, loses it’s grease down the drain, just like a hot shower will cause your body oils to go down the drain, but placing that same greasy pan in a sink full of water, the grease will stay in the pan, as soaking in a tub will keep more body oils on the skin. You do not have to soak for a long time-15- 20 minutes will do( you can lounge as long as you like). After either shower or bath it is important to moisturize when the skin is still damp to trap the moisture in the skin. Especially important after a shower as evaporation can make the skin drier than before the shower. I do not like anything in the bath water to moisturize as most products can make the tub slippery and dangerous- better to apply after the bath/shower. There is one exception, product made by Avene , called the trixera+ selectiose emollient cleansing bath (not Aveeno). It is the only bath product that I found that does not moisturize the tub, only the skin. ABSOLUTELY NO BUBBLE BATHS!!!! – the detergent action of the bubbles dries the skin.

As for soaps, use unscented and no antibacterial or deodorant based soaps. They ALL dry your skin. If you have a specific condition that requires an antibacterial wash, use chlorhexidine (brand name hibiclens, which is OTC) to the affected areas only. Deodorant/ anti bacterial soaps have been shown to be ineffective in reducing bacteria(which cause odor) and sweating. They are very effective in drying your skin, however.

As far as which moisturizing cream to use, the reason there are many choices in the store is that all skin is not the same so different ingredients may work better for one person than another. More importantly, there is no one perfect moisturizer. I prefer unscented products(scent or perfumes can dry the skin). The one you use works the best…. There are some prescription moisturizers, which have been shown to be more effective than the OTC products, but they are VERY expensive and insurance coverage is difficult.

There are also some cooling water sprays which we suggest with eczema patients that cool the skin by 5- 10 degrees, and add water to the top layers. Kids really seem to like this one- and you can use it many times during the day. Laroche Posay and Avene make these type of products. More effective in warmer weather, due to the cooling effect but can be used year round.

Lastly with severe eczema, the term soak ‘n smear has been applied to soaking for 20- 30 minutes then smearing with Vaseline after ( any moisturizer will due) up to 7 days a week, has a tremendous effect upon eczema, rivaling that of systemic steroids in terms of effectiveness. One can also use ¼ cup chlorox in a FULL adult bath tub to soak in (lesser amounts for child tubs) which will mimic swimming pool chlorinated water. This works best in more severe cases with a lot of scratches due to itching, which will increase the bacteria count in the skin and worsen the eczema, as the chlorine knocks out the bugs.

For little ones that wake up in the night with uncontrolled eczema, simply place them fully clothed in footie pj’s in the shower until soaking wet and then let them sit in their wet clothes until almost dry-15 minutes or so and that will calm the skin down very quickly. Remember to grease them up once clothing is removed. Little ones with severe eczema learn very quickly that certain environmental changes irritate their skin. Changing clothes, in and out of bed, in and out of the tub causes temperature changes that drive their skin crazy. They like old worn out clothes better than scratchy new ones (esp little ladies and dresses). When their skin bothers them they learn that sitting still drives them crazy so their activity level increase dramatically(hyper activity)- I can almost make the diagnosis of out of control eczema by the noise/activity level I can hear in the hallway before entering the room. Same for sleep-can’t happen with out of control eczema. School performance may suffer as they simply cannot concentrate. The best way to fix this is to not let it get out of control-soak, soak soak, but if not working see your doctor as soon as you can as the flares accelerate sometimes very quickly and will cause us to rely on systemic therapy to calm things down.

Remember dry skin itches, which results in scratching and that trauma causes a chemical to be released that causes more itching, which causes more scratching,etc. The end result can be skin infection from scratching, which may require systemic antibiotics(infection) and /or systemic steroids (itching), which we try to avoid, especially in little ones, but the eczema can flare overnight so never wait too long if you cannot control the symptoms before seeing your doctor. Remember that the vast majority of eczema’s symptoms are the result of dryness to the skin, nothing more than that, so the vast majority of therapy is directed to moisturizing the skin, to prevent symptoms and minimize the use of steroid/antibiotic creams and systemic therapy.

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