Moisturizers and eczema

 

Our long-term relationship with moisturizers

Moisturizing is a critical element in the treatment of eczema. They are found in the form creams, ointments and lotions.

Creams  contain a mixture of fat and water and feel light and cool to the skin. I have used them on my daughter during the hot summer months and during the day in the winter months.

Ointments are very thick and can be very greasy but they are very effective at holding water in the skin and hence are useful for very dry and thickened skin. I use these for Aiyana at night and as a soap substitute while bathing during the dry season.

Lotions contain more water and less fat than creams and can be used for moisturizing the skin in case of mild dryness.

All of the above may be suitable to be used at various points in time depending on whether a person’s eczema reacts to a specific ingredient or ingredients in an emollient, the humidity and the severity of eczema. Also for eczema (especially in case of children) such moisturizers necessarily have to be non cosmetic  and fragrance free since products containing alcohol, perfumes, lanolin, or preservatives tend to cause eczema breakouts.

Ever since we realised that Aiyana has eczema, I have been looking for the most suitable moisturizer for her. In this regard I have noticed that there is no one ideal moisturizer which has suited her at all times. I have changed her moisturizer brands over the years due to various reasons but I am always looking for a better one for her. I have used a type of cream on her earlier known as aqueous cream which is now believed to be more harmful than beneficial due to its sulphate content. In any case we noticed her skin did not get moisturized properly and I stopped using it more than a year back. (Source: http://www.eczema.org/aqueous)

Thus I have used quite a few products on my daughter, some of which are available in India and others are not. These have been recommended not only by her doctors but also by other parents across the world in their blogs and websites. Maybe you will find one here which will work better for your child as well.

HydromolOver the past few years I have used moisturizer brands like E45 cream, Exomega, Epaderm, Oilatum, Aveeno, Eucerin, California Baby, Mustela, Cetaphil, Burt’s Bees and Pure Potions at various points in  time. All these brands are not available here in India as of now. It can be very confusing to know which cream is suitable for your child and even I have learned through trial and error.

Although I have tried all the creams that I have mentioned, the ones which I found to have a creamier consistency ( these have seemed to work well with Aiyana) are the oat based ones like Aveeno and Exomega cream. I have used both of these interchangeably depending on their availability in Mumbai. But I had to shift from oat based moisturizers to others since she tested positive to the oat allergen last June in the IgE blood allergy test.

Another moisturizer which worked well for her last year is the ubiquitous coconut oil. In fact, when she had developed Erythroderma, we had used coconut oil (Parachute brand suited her better than the organic one) since her skin used to burn if we used any creams at all. It worked well as a moisturizer overall and seemed to really soothe her skin. But it was not as effective during the dry months. Also, Pure Potions amongst the ones I have mentioned has a “skin salvation” ointment which is a thick cream and supposed to have restorative properties and has helped Aiyana to some extent.

Currently I am using Hydromol cream on her(I switch to Hydromol ointment during the dry months) which seems to suit her skin and is effective in keeping her skin just moist. I had started using Hydromol Ointment on Aiyana in the dry months (December 2012 onwards) based on a UK-based doctor’s recommendation. I wanted to change her moisturizers to sulphate and paraben free creams (more on this in a separate post) and hence the change. And I have stuck to this brand ever since as it suits her skin. Amongst the other brands of creams, skincare and bath products (bath wash, shampoo, bath emollient) that have worked for her and have been highly recommended by other parents are the organic, sulphate and paraben free ones like California Baby (US), Burt’s Bees (US) and Pure Potions (UK). But these are on the expensive side as compared to the other brands and I have used these sparingly from time to time.

The other relatively less expensive mosisturizing bath products I have used in the past which I have found to be good for her are the fragrance free washes and shower/bath emollients from Aveeno, Oilatum and E45 out of which Oilatum is readily available in India. Currently I use California Baby bath products extensively for both my children since I have found them to be very gentle on their skin, especially for my daughter. ( I will elaborate on her skin care routine and her bath routine separately).  California Baby wash

Availability

  • Hydromol range is a UK based brand and is available online at amazon.co.UK through a seller-Mistry’s Pharmacy (all the sellers do not ship to India) as well as all the BOOTS pharmacies in UK.
  • Exomega range of products by Aderma, Cetaphil, Oilatum are available in big pharmacies in Mumbai like Rakhangi Medical( Worli), Asian Chemist (Bandra West) , Sterling Chemist (Pedder Road) amongst others as well as stores like Just Moms (Breach Candy), Green Bell (Juhu) and Amarsons.
  • Other brands like Mustela, Aveeno, Eucerin, California Baby, E45 and Burt’s Bees products are available in stores like Just Moms (in Breach Candy), Green Bell (Juhu) and to some extent Amarsons.
  • Pure Potions and Epaderm range are available on Amazon.co.uk as well as some other websites but may not be shipped to India.

I have tried to highlight as many options as possible keeping in mind different budgets. I have also compiled a list of the brands that we have used and their availability in Mumbai…I hope this helps incase you do decide to try any of these for your child. I would love to hear from you about what has worked for your child. Also, please feel free to ask me for any clarifications or any further information.

Some basic truths about Eczema

I have realised over the years while dealing with my daughter’s eczema that there are a lot of misconceptions and also lack of awareness about this condition in our society. Unlike in Western countries where it is very common, here in India, it is not. This leads to a lot of questions, doubts, stares and occasionally not so kind comments which we have faced as a family and my daughter has had to face on her own as well. I would like to highlight some basic facts about Atopic Dermatitis (which is one of the different types of eczema).

  • Eczema is essentially a very dry skin condition where the skin lacks the protective barrier which is critical for retaining moisture and keeping out irritants, germs and other foreign substances. Atopic Dermatitis is a type of eczema which is quite common. It usually begins in infancy or childhood but can strike people at any age. It is also a highly individual condition and varies from person to person. The skin condition is usually very dry and can be scaly, itchy, inflamed in mild cases and crusting, bleeding and oozing in severe cases.
  • Non contagious– Atopic Dermatitis is not contagious and affects only the person with this skin condition. This cannot be spread to another person through touch or in any other manner. This is one of the key areas of ignorance as far as eczema is concerned in our country.

Source: http://www.uichildrens.org/

NFM-  natural moisturizing factor

Stratum corneum- portion of the outer layer of dead skin

Barrier lipid- natural skin oil and fat

  • Moisturize! Moisturize! Moisturize! For people with healthy skin the skin serves as a strong protective barrier against infection or irritation and the fats and oils (lipid barrier) in healthy skin help retain moisture. Effectively the skin cells act as bricks and the fats and oils act as cement that keeps everything together just like a seal. Thus, a critical part of the treatment of eczema is fortifying the protective barrier of the skin by first getting water absorbed by the outer layer of the skin and second to seal the water before it evaporates.  Sealing and retaining the water is done by using emollients ( moisturizers). I will be discussing this in further details in my subsquent articles.
  • Symptoms Some (but not all) of the common symptoms of eczema are as mentioned below–
  • Broken/dry/cracked skin
  • Many areas of the skin will be itchy and sometimes raw if scratched a lot
  • Some areas may become red, inflamed, develop blisters and ooze liquid
  • Scratching may result in thickened skin which usually returns to normal once scratching stops
  • Although these patches of dry skin may occur anywhere, in Atopic Dermatitis they are usually located on the neck, behind the knees, elbow joints, ankles, wrists, face, hands, feet, arms and upper chest.
  • Controlling eczemaPeople often ask me how I manage  Aiyana’s eczema. She has had eczema since she was 1 year old, so we have been dealing with it for about 6 years now.  There are some things that have worked for her and some that have not. The first line of treatment consists of emollients (moisturizers) which are used all the time and topical (applied directly onto the skin) cortisteroids or steroid creams as they are ususally known which are used on areas of the skin as required. When these measures fail to work the second line of treatment is prescribed which consists of antihistamines to control the itching; ultraviolet light therapy for children with severe eczema; immunosuppressants like closporine, azathioprine when other medications have failed; immunomodulators like Protopic and Elidel which are medicated creams to control inflamation and reduce immune system reactions and oral cortisteroids like prednisolone in extreme cases. We have had to apply both the first and second line of treatment for my daughter both of which I will discuss separately.
  • Others  Since we have been dealing with Aiyana’s eczema for some time now, I have been able to incorporate a few other steps that have helped other children by interacting with their parents both online and personally.
  • We have made some lifestyle changes like using mattress covers for all the beds in our house to prevent flare ups due to dust mites; changing from traditional detergent based laundry and dish washing cleaners to natural ones like reetha (soap nuts) and shikakai  etc. 
  •  Also we are very strict with her clothing which is always 100% cotton since sweating makes her itch 
  • We are always very careful about her food intake since some foods like nuts tend to aggravate her skin condition and bring about rashes
  • We have changed the heavy drapes in our house for light cotton curtains and have given gave away all her soft toys since both of these tend to collect a lot of dust This house dust is a major trigger for eczema in a lot of people.

These are some of the measures I have taken over the years to help my daughter live as normal a life as possible inspite of having eczema. I will be discussing these in greater details separately so that you do not have to carry out the kind of extensive search that I did to find out about these products and their availability in India.  I hope that through my experience with my daughter you will be able to help your child as well.