Watch out for aqueous cream!

Apparently, many GPs--at least in the UK--are prescribing cream that could be making eczema even worse for their patients. Aqueous cream was developed as an alternative to soap and some doctors are giving it to patients to use as a moisturizer, as reported here. Unfortunately, the cream does not contain much to moisturize the skin and also contains sodium lauryl sulphate, which can irritate sensitive skin. Eczema patients should educate themselves about which products are helpful and seek out the advice of a dermatologist.

Itchiness and Stress

A new study in the Archives of Dermatology explored the relationship between itch and stress (see coverage by Reuters here). Unsurprisingly, chronic itch, or pruritus, can be stressful. The more persistent the itch, the higher the stress level. While this may suggest that stress management techniques can be useful to those suffering from pruritius, it also suggests that the impact of diseases for which pruritius is a symptom, such as severe atopic dermatitis, is much deeper than what is seen on the surface of the skin.

Comparing Lotions

With the dry air of winter all around, I thought it might be useful to compare lotions on the market. Which are best for dry, itchy skin?

My personal favorite is Lubriderm's Sensitive Skin Therapy. This is great for anyone prone to flare-ups or skin reactions. It is moisturizing, not sticky, and causes no irritation. Great to use several times a day.

An alternative is Aveeno Daily Moisturizing Lotion. This also is not likely to irritate, but it is a bit lighter and I feel doesn't offer quite as much moisture as the Lubriderm lotion. Others may prefer this lightness.

For heavier lotions, I have used Eucerin's Calming Creme. This is thicker, but not as thick as Vaseline, and feels particularly nice on very dry, winter days. I have not found this to be irritating to my skin, either.

Finally, I sometimes use CeraVe Moisturizing Creme. This is more expensive (although none of these lotions are cheap!) but it claims to have ceramides to help those with eczema. While it has never seemed to cure a flare-up, it does moisturize well and gives me some psychological benefit to think that it may actually be improving my eczematious skin.

More on Acupuncture and Eczema

In an earlier post, I recounted my experience trying acupuncture to reduce eczema symptoms. Reuters has just reported on a study done by German researchers, which found that acupuncture can reduce itchiness if done immediately after exposure to an allergen and that exposure after acupuncture results in a less intense reaction. The researchers compared results when using true acupuncture points to both no treatment and the use of "placebo points," or acupuncture points that are not true points used in Chinese acupuncture. After being exposed to an allergen, those getting the "true points" treatment reported lower levels of itch. The abstract of the study, published in the journal Allergy, is online here.

For those interested in seeing if acupressure on the points would work, the two points used in the study are LI11 and SP10. The former is on the outer side of the elbow crease and the later is roughly above the knee and towards the inside of the leg.

More on nickle allergies

In an earlier post, it was noted that eczema is part of the atopic triad and thus people with atopic dermatitis often also have allergies or asthma. Contact dermatitis --an allergic reaction to something touching your skin--can often be confused with atopic dermatitis. After a round of allergy testing suggested by my dermatologist several years ago, I learned I had a nickel allergy, which was causing reactions that looked like eczema on my neck from the jewelry I was wearing. A devoted reader (full disclosure: the devoted reader is actually my step-dad!), brought to my attention a Wall Street Journal article that said last year, nickel was named the "Allergen of the Year"!

Apparently the number of people with nickel allergies had been growing and people can develop reactions even after years of having no problems with nickel. And it is not just jewelry that can cause problems. It turns out nickel is in some cell phones, leading to rashes on people's ears and faces. Due to the rise in allergies, the EU has actually placed restrictions on its use. If you are allergic to nickel, you can order a kit online to test jewelry and other objects. If it is something you just can't get rid of, coating it with clear nail polish can form a temporary barrier.

Book Review: The Eczema Solution

The Eczema Solution, by Sue Armstrong-Brown, outlines a program to stop scratching and thus heal the skin of chronic atopic eczema sufferers. The approach was developed at the Chelsea and Westminster Hospital. The underlying principle is that if patients can stop scratching, they can reduce their itching, as discussed in an earlier post, and reduce the rash, since this is triggered by the scratch. Severe eczema patients can tell you that even though a good scratch is satisfying in the moment, it simply leads to even more intense itching and much more severe rashing and inflammation of the skin. While this is known in theory, the trick is being able to actually keep your nails off your skin in the face of intense itching.

That's where this book comes in. The author notes that chronic eczema suffers have developed a habit of scratching, even when when they are completely unconscious of the behaivor. This continuous scratching is very damaging to the skin and prevents healing, exacerbating the condition. Each chapter in the book presents exercises that the reader does before moving on to the next chapter. The exercises are designed to break the habit of scratching. At the same time, you continue to use emollients and steroids to treat flare-ups (indeed, the author argues for using steroids for some period even after the skin looks healed.)

Breaking the habit of scratching begins with logging every time you scratch with a hand tally counter. This sounds a bit crazy--and it is. For weeks, I walked around with a little clicker that I had to press each time my hands moved to my skin. This is a truly eye-opening experience. I was scratching hundreds of times a day. The counting exercise really did make me aware of all the unconscious scratching. Once aware of it, you can being to slowly reduce the amount you scratch using some habit-changing exercises presented in the book.

The book is written by someone who has suffered from atopic eczema her entire life: she has coped with the itching, been hopitalized for her eczema more than once, and tried every treatment available. It is comforting to read a book about severe eczema that is written by someone who completely gets it. The one downside is that I personally found that the book over-promises the level of relief to expect from the program. This may be because I had already learned not to scratch hard at the itchy spots or else I'd have to face worse symptoms and devastatingly ugly flare-ups! I think this book could be more profound for those who are not yet able to stop scratching at any level. Learning to control the scratch reflex can improve the look of your skin (and therefore reduce anxiety) and does, to some extent, reduce itching. It does not, however, "cure" the eczema or completely eliminate itching and sleepless nights, as the author promised. But it does help some and is worth a try, at the very least for the awareness it brings about your own unconscious habits.

Some uncommon but potentially useful treatments?

Common treatments for eczema include moisturizers/emollients, steroids, calcineurin inhibitors (Elidel and Protopic), UV treatment, and antihistimines.

Some patients have found some less common treatments and approaches that improve their eczema. Some of these are mentioned by Adnana Nasis in his book, Eczema Free for Life. He cautions that there is not conclusive research on any of these (see his book for more information). Still, when you feel discouraged by traditional approaches try one of these:

• evening primrose oil supplements
• eliminating dust mites
• Chinese medicine
• massage with lotions and emollients that are known not to cause flare-ups
• biofeedback
• Ranitidine (antihistimine)
• salt baths
• oolong tea
• Gloves in a Bottle
  

Eczema and your Emotions

Dr. Nasir, in his book Eczema-Free For Life, discusses the emotional toll that eczema can have on patients. The unpredictability of flare-ups can be stressful, and as all patients know, the itching can be overwhelming and the lack of sleep can cause irritability. Stress also makes eczema worse. Dr. Nasir explains that when you are stressed, your blood vessels attract white blood cells, which cause inflammation. For eczema patients, stress leads to inflammation being triggerd inside and outside the body. Thus, finding ways to combat negative feelings is essential.

The first step is to take control of your eczema. Develop a careful skincare routine and stick to it. Make any lifestyle changes necessary to improve your condition. Learn about your disease. Read some of the great books written about it. Find a dermatologist you like and trust to help you manage your condition.

Second, accept your emotional responses as part of the disease. Dr. Nasir notes that patients may develop self-loathing about the way they look, anger at having to suffer from the condition, fear at facing a life having to cope with unending itching, stress about flare-ups, and also depression when it seems like no treatments help and the suffering has no end in sight. Accepting these emotions instead of suppressing them is critical.

Next, try ways to improve your emotional outlook when your eczema gets you down or angry. Maybe there is music that lifts your spirits or funny movies you enjoy. Make a list of positive things in your life. Perhaps guided meditation tapes or yoga classes can recenter you and take your mind off the eczema. Be kind to yourself. If your anger or depression becomes severe, be sure to find professional help. A professional that can help you improve your mental outlook will also improve your skin.

Finally, develop a support network of friends and family to help you cope. Educate them about eczema and about what you need from them to be able to handle your condition better. Be sure to explain to them the challenges you face in dealing with your eczema. Non-sufferers will not fully understand what it is like to live with the condition. Being clear and honest can be the most effective. Dr. Nasir recommends being able to say things like: "My rash is acting up, I feel uncomfortable and itchy. I'm sorry, I'll have to stay home, but I'd love to talk to you tomorrow."

Also, make sure you get enough sleep. This can really alter your emotional response and thus the condition of your skin. If you are having trouble sleeping, ask your doctor about an antihistamine to make you drowsy.

Can Acupuncture Cure Eczema?

After Western medicine failed to provide sufficient relief for endless itching and sleepless nights, I decided to try acupuncture. I did not know anyone in my city that had tried acupuncture before, so I went on Yelp and read reviews. I found an acupuncturist whose patients all said good things about him and who also had an MD, which made me feel more comfortable. I called his office. Before scheduling an appointment, he asked about what was bothering me. I described the itch and the eczema, and he thought he might be able to help. At his suggestion during the first consultation, I started with appointments twice a week for two weeks, then decreased to once a week for a few weeks, and then spaced it out to between 10 days and 2 weeks between appointments. He also gave me Chinese herbs, but they made me nervous and I ultimately did not take them.

First, the experience of acupuncture.
When I was called to a room, I would lie down on my back on a table that was like a massage table. I had to roll up any sleeves and roll up my pants to my knees so he could access certain points for the needles. My acupuncturist would put needles at my ankles, on the side of my shin just below my knees, right above my knees, in the crease between my thumb and second finger, at my wrist, to the side of the bend in my arm at my elbow, and then sometimes on top of my head and/or on my forehead. Inserting the needles never hurt, maybe just an occasional prick. After all the needles were in, however, he would manipulate them slightly. This could cause a range of sensations from tingling to slight pain - mostly at the site of the needles, but occasionally it would induce a shock of sorts up my arm or leg. He would then leave me lying on the table for 20 to 30 minutes. I would try to relax while I stayed very still. The needles could lead to a variety of sensations. Sometimes the site of the needles would tingle, sometimes it would burn, sometimes I would feel a dull ache. Most times I felt calm when the needles were in and tried to meditate or clear my mind. A couple times, the needles made me feel like I had nervous energy and those times I was more than ready when the doctor came back to take out the needles.

Did it help?
While the needles were in and I was lying on the table I experienced no itching (except, every so often, on the side of my nose). This was absolutely astonishing and marvelous. I think it is the only time in my life where I have been perfectly still, focusing on my skin, and actually NOT itched (even when I was on strong oral steroids my dermatologist claimed would get rid of the itch, they did no such thing). I loved going just for these few minutes of relief. After the needles came out, though, the results were more mixed. I think in general it probably did relive my itching somewhat, in the days after the treatment, but it certainly did not eliminate it. After the first two sessions I was still having trouble sleeping because the itch was so bad. I mentioned this to him and he added 3 new points to the treatment, 2 sort-of below and to the side of my ears that he did on both sides and one on my stomach. The first time after this, I was immediately very tired. I was glad it was an end-of-day session! The next few times did not have such a drastic effect, and I started going in the morning, but my sleep did noticeably improve.

The End Result
If acupuncture was free and acupuncturists made house calls, I'd have it done every night before sleep. It relieved the itching during the treatment and then left me relaxed (and actually tired when certain points were used). But, the treatments aren't free and my insurance did not cover them so it was a large out-of-pocket expense every month and when I had them in the morning, the effect was much reduced by the end of the day. So I have stopped going. But I am still very glad I tried it and I know it is there if I ever want to resume. There is also a physiological benefit to knowing that there is something that does relieve itch, even it costs $100 for 30 minutes and requires lying totally still with needles in you!

Recession Induced Flare-ups?

Most eczema patients will tell you that stress exacerbates their itching, scratching, and rash. I just came across an interesting news blurb that reports on recent research that claims the recession and the stress it causes has led to an increase in skin diseases like eczema. Apparently lots of people are suffering from economic anxiety induced flare-ups. In times of stress, be extra vigilant about maintaining good skin care routines and try hard not to unconsciously scratch as this breaks the skin and leads to the itch-scratch cycle. Common stress reduction techniques can help these types of flare-ups (just avoid other triggers, like scented bath oils or long hot showers!). Try:

• meditation tapes
• deep breathing
• focusing on things you are grateful for
• happy music
• quiet walks
• funny movies
• exercise (but shower off sweat quickly and apply moisturizers!)
• find support in friends and family
• biofeedback
• get enough sleep