A Smaller Target: Eczema

Weight: still no scale. :(

In my post on the packaging of my new loofah (wow, what an exciting blog this must be), I mentioned that I have eczema. Bronwen asked about how I manage it and I promised to write about it. So here goes.

First, eczema is a broad diagnosis that covers a lot of different things. I'm always reluctant to give advice because it's one of those frustrating chronic problems that (it seems anyway) that everyone has advice about with variations of diet, bathing, supplements, creams, lotions, blah blah blah. I've spent thousands on different "cures" over the years. So please please don't take this post as an invitation to send me information on what works for your sister-in-law's cousin. The odds are pretty good I've already heard about it and tried it. This definitely includes following various "cure" diets that are intended to eliminate yeast growth from the colon and eliminating caffeine. Neither made any difference.

In my case, my eczema ranges from moderate to severe. It's specific diagnosis is "Atopic Eczema" and is triggered by allergies and tends to effect people who also have asthma and hay-fever. It's most commonly seen in children; that's true of all eczema: 90% of people with eczema are under 12 and most --though clearly not all-- will outgrow it. My rashes tend to be "wet" and weepy, with inflammation and bleeding. At its worst (before I had a break-down at the student health clinic and demanded that something be done immediately), I was covered with eczema from my scalp to my feet --much of my body looked like it had 2nd or 3rd degree burns. The rashes extended to places I couldn't even reach.

While sometimes my skin develops hives that open and split on their own, generally the rashes are caused by scratching. Here's where we get to the vicious circle problem. Eczema has been described as the itch that rashes, with many of the associated rashes being caused by scratching caused by itching. So the simple solution given by helpful doctors is to not scratch. Sadly that's not really possible without serious drug intervention. When my skin is flaring, unless the hives have split and are thus too sore to even bear touching, not scratching is close to impossible. How does it feel? Literally like swarms of ants are crawling around beneath my skin. As a child I was sure that there were some sort of creatures living in there and I would wish I could have all my skin peeled off in the hope that I could then grow "new" clear skin.

The "behind the knees" location that Bronwen mentions as her daughter's location is a very typical one. My worst place is the back of my elbows, but any place where skin consistantly touches other skin (like the neck) is a flare spot. (Can anyone guess why post-weight loss my eczema has been slowly getting worse and worse?)

Aside from the discomfort, there's also other practical problems. If I wear dark clothing, the flaky (new skin is fragile and can be dry and flaky) skin can show up, making it look like I suffer from body dandruff (ick!). However, white or very light clothing can show blood if my skin opens up.

Let's not talk about how many sets of sheets I've ruined. :(

So, now that you have a sense of the severity of my eczema, let's talk a bit out how it can be treated. The BIG caution I have here is to say this is what works for me. I don't recommend any part of it to anyone else as any sort of cure.

Reduce Irritation: This is a big one and has been important my whole life. It partly involves very careful selection of fabrics. Wool in all forms is bad. Cotton is generally good with knits being worse than smooth weaves. Silk is great --I wear a silk undershirt designed for skiers year round. I cut tags out of everything and check always to make sure that seams aren't going to rub. Also, I try not to wear anything next to my skin that could have dry cleaning fluid in it. Finally, my sheets need to be 350+ thread count and as smooth as possible.
Reduce Irritation 2: I said it was big and I meant it. Laundry detergent is huge. The only one I can consistently tolerate is Dreft. Anything else, including a number of the so-called "clear" or "naturals" and I start to get hives. It's important not just for my clothes but also even more important for sheet and towels. Anything touching my skin. In a perfect world (one in which we had our own washed and dryer), I'd double wash clothing and linens --first time with soap and second with just water to make sure that the soap was all gone. As it stands, quarters being of limited quantity, I make due with using a lower amount of detergent. And I always use Dreft.
Manage Allergies: I suppose this is another form of "reduce irritation" but that's getting a bit repetitive. I'm very allergic to dust mites (which is why my allergies went crazy during the months I was living in the UK). So our mattresses are cased and so are our pillows. Our comforters aren't down but are pimaloft so that they can be laundered. We chose an apartment with hardwood floors throughout so we can cut more dust out. And we live close to the ocean for the same reason.
Let the Sunshine In: For me, having sun and saltwater on my skin has always helped reduce my rashes. This isn't true for everyone, but UV light is one form of treatment for some of us eczema. Any day it's sunny I try and uncover and sit out in the sun. When my rashes are bad this can be a bit embarrassing, but I try not to see people who stare.
Managing Allergies 2: Foods. Even without weight loss surgery, I have to watch what I eat. In fact, it was the fact my diet already has a number of restrictions that made the DS feel like a better choice for me than RnY. Example: 3 years ago, after my worst flare ever, I was diagnosed (via blood and scratch allergy tests) as being extremely allergic to yeast. Since I eliminated it from my diet (which means not only no bread, but also no wine, grapes and hundreds of other things that yeast makes its way into), my eczema has improved about 80%. I'm also allergic (though less severely) to wheat, dairy and eggs. I watch my skin and the quantities of each and eliminate or reduce the amounts of each.
Skin care: I pay pretty careful attention to the ingredients in everything that goes on my skin. Anything with alcohol in the first 5 is automatically out -- it'll hurt and dry my skin. I also don't have very much tolerance for any cream or lotion with either mineral oil or petroleum jelly -- both tend to inflame my skin, leaving it feeling hot (and therefore itchy). This isn't the norm, but is probably connected to over-exposure back when my skin was so raw. So what do I use? I bath using grapeseed oil and moisturize using products from Burt's Bees, primarily their Buttermilk Baby Lotion for my body and their Evening Primrose Night cream (which I use day and night) for my face. It gets pricey (I wish they sold in bigger bottles), but the stuff works and doesn't hurt me. I moisturize 2X a day, but I suspect I should do it more like 5X. But unless I go on disability, I'm not sure where I'd find that kind of time.
Skin Care 2: I've found that bathing frequently doesn't cause me trouble so long as I don't use soap very often. Instead I gently exfoliate with a loofah and rub oil into my skin both during and right after the bath. When my eczema is bad, I also use dead sea salts in the bath. They soothe the itch (though hurt for the first couple minutes) and seem to cleanse the rashes.
Working out: though it hurts a bit, sweating as part of a workout seems to be good for my skin's overall health.
Daily Meds: I take allergy meds plus doses of doxiphine and hydroxyzine which relieve itching and also the associated anxiety and insomnia. I use some topical creams with both steroids and also the more expensive elidal / protopic variety. (Note that those both cost a fortune, even with insurance coverage).
Nuke It!: When all else fails and I notice my eczema moving from mild to severe, I've gotten really good about demanding medication before it gets completely out of control. This means the use of oral steroids.

I think that's about it. Questions? ;)

Comments

Thanks! I bathe Miss Peanut in an oatmeal bath, and that seems to work well for her. All the creams, etc... that say "Eczema" on them, though, make her cry "It hurts, it burns!" so I'll try those Burt's Bees products you mentioned and maybe avoid the whine-fest that accompanies the moisturization process.

Peanut's truly isn't that bad, and it's my fervent hope that she "grows out of" it, as my pediatrician has assured me she may.

Posted by: Bronwen | October 12, 2006 at 04:57 PM

Have you tried detoxing - like colonics or a skin detox treatment? Does it help? Skin issues run in my family, and while I have *some* issues, they are not nearly as bad as what you experience. Scalp, eyebrows, and skin folds are all a problem for me. Oh - and that area just above the elbow, and right at the back of my knees where my arms & legs tend to rest on furniture.

Also, are you planning any reconstructive surgery to reduce/eliminate exess skin from the weight loss?

Posted by: Blackthorne | October 16, 2006 at 08:58 PM

Bronwen: You're very welcome and I hope the BB products work for you and Miss Peanut. I also really really hope she's one of the many who outgrow this. :)

Blackthorne: Yup, I've tried the detoxing thing (and colonics) a number of times both on my own and also supervised by a very wonderful doctor at Napier when we were in London. She was convinced that my problem was caused by candida overgrowth. Sadly, the detox didn't clear up my skin problems, although I felt pretty good in other respects. What *did* help that Napier discovered was getting away from the mineral oil based moisturizers.

What does help (when I can afford it) is going to an area spa and having a combination of body scrub and then (don't laugh) being covered in a combination of wax and volcanic mud.

I have a consult with a plastic surgeon at USC next Thursday. I'm hoping that reconstructive surgery will help, especailly on my arms, thighs and breasts. We'll have to see how the $$ situation shakes down. If my insurance approves this, it'll be covered at 90% which would be great.

Sorry to hear this runs in your family. As you know, it's a real bitch when it's bad.

Posted by: Ezpy | October 17, 2006 at 09:36 AM