In terms of interventions, the patient should employ a well-rounded approach that includes:
- Identifying and avoiding triggers – click to access article
- Addressing the itch, reducing inflammation, maintaining moisture levels and managing barrier dysfunction
- Managing sleep and reducing psycho/emotional/social stress – click to access article
This article (2) covers the topic of addressing the itch, reducing inflammation, maintaining moisture levels and managing barrier dysfunction.
Reducing damage created by scratching:
Here are some tips:
- Keep fingernails short
- After moisturizing a lesion, you can cover it with gauze dressing, which acts as a barrier as well as a counterirritant
- Wear gloves over hands
- Line body with body-hugging clothing
- Learn to pat the lesion instead of scratching it – easy to say, hard to do. ☺
Addressing skin dryness and inflammation and itch:
Moisturizing after a shower replenishes the skin barrier with lipids that are easily depleted in individuals suffering from AD. This prevention of transepidermal water loss helps to reduce itch. In fact there is strong correlation between the degree of transepidermal water loss and itch intensity. It could be due to increased exposure of sensory nerve fibres in skin with barrier dysfunction.
Here we cover how some of the topical ointments/creams/lotions out there seek to address skin dryness, inflammation and itch.
- Phygiogel and QV contain squalene, Physiogel also contains ceramide, together with other substances like olive and coconut. QV has petroleum jelly to lock moisture in the skin, as well as paraffin. Cetaphil and Eucerin can be lumped in the same category as Physiogel and QV because of a huge proportion of the ingredients being synthetic chemicals; both together with QV contain methylparaben.
- Sebamed and Eucerin play on skin pH, Sebamed staying at a balanced skin pH of 5.5, while Eucerin goes down to pH5. Both are paraben-free.
- Ceramide is one such lipid found naturally within the skin. The question is whether replenishing with ceramide is “the only way.” A-Derma contains Filaxerine, inducing substance of filaggrin and omega-6 to restore the cutaneous barrier. Robertson’s Skin Repair Ointment contains natural cod liver oil. Atopiclair contains other moisturizing elements like hyaluronic acid and shea butter.
- Dermaveen is also similarly predominantly synthetic, but decides to add a colloidal oatmeal component, which supports moisture retention but also combats inflammation.
Apart from using various forms of lipid to moisturize the skin, substances are added to help combat inflammation. Oatmeal is just one of them. Vitamin E and C are well-known antioxidants: the former is included as tocopheryl acetate in Sebamed’s product, while both together with grapeseed extract are included in Atopiclair’s cream. A-Derma contains Rhealba Oat Plantlets Extract, while Derma E goes the botanic way, with inclusions of Neem, nurdock, bearberry and vitamins A & E.
(For a more comprehensive overview, here is a review of synthetic emollients with added function.)
Then comes the natural oils. For example, with Salcura Bioskin Derma Spray, we are spraying a host of oils that include sunflower, safflower, grape vine, sea buckthorn, eucalyptus, lavender, rosemary etc. The Home Apothecary’s Lemongrass Balm is similarly inclined, with all manner of oils mixed together with lemongrass for use. Four Cow Farm’s is similar, except that the two products are Tea Tree or Calendula.
Then, there is Moogoo’s ISB which is free of petroleum based chemicals, while its MSM Soothing cream contains organic sulphur in the form of MSM.
(Here is an overview of natural creams and ointments for eczema and atopic dermatitis.)
Last of all, there is also the option of just using natural oils on their own, e.g. coconut oil, rosehip oil, jojoba oil, sweet almond oil, emu oil etc. Some patients of mine report doing well with they own preferences. Some with just coconut oil. Others with a nice mix.
As can be seen, most of the creams out there include a moisturizing component as well as an anti-inflammatory component. Some of the herbal anti-inflammatories are also anti-microbial.
Other Soothing Alternative to Consider
Oats contain avenanthramides, which are moisturizing while being anti-inflammatory and anti-itch. Use 1 cup of oatmeal wrapped in cheesecloth can be placed in bathwater, and even placed on eczema patches as a compress for quick relief.
Baking soda / Sodium Bicarbonate:
Like salt, baking soda is naturally antiseptic and cleansing. In many parts of the world, salts are used to dress and sterilize wounds, and baking soda can do that job in a much gentler way than traditional hard salts can. Mixing baking soda with clean, warm water will create a mud-like paste. Work on the ratio of soda to water until you get a thick, heavy consistency that can be applied directly to a flare up. This is a great way to cleanse and protect areas that may be too sensitive for scrubbing. After 3-5 minutes, just rinse off the mixture and apply ointment to seal in the hydration.
Baking soda is also one of ingredients used to clean your surroundings in a natural way.
This is a caffeine-free tea that is chalk-full of antioxidants, flavonoids and phenolic acids, all beneficial. In particular, rooibos contains aspalathin, an antioxidant that, to my knowledge is unique to rooibos. Anecdotal reports of success have come by placing 2-3 rooibos tea bags in the bath to reduce eczema symptoms. Or take it internally as a tea.
Because of its anti-inflammatory properties as well as its ability to act as an antioxidant, zinc has been used to treat eczema. Topical applications were found to improve symptoms of eczema in study participants, easing severity and itching.