Itching for Relief: Dry Skin Care

Written by Sara Wilchowski PA-C
Edited by Dr. Paul M. Graham

We are officially at the start of the winter season and the cold dry air is wreaking havoc on our skin. For those who live in regions where the weather changes dramatically, this time of year can be quite a challenge. To help make it easier for everyone, we have several recommendations for the treatment of dry skin, as well as some interesting facts on eczema.

• Eczema and atopic dermatitis are variants of the same disease process, both of which have a decreased ability of the skin to hold on to moisture. 
• 31.6 million people suffer from eczema. 
• If a parent has eczema or atopic dermatitis, there is a 50% chance of passing this on to children.
• Eczema is not a contagious disease, so it is impossible to “catch” it or pass it on to one another.
• A customized skin care regimen is the key to treating and preventing flares of eczema during the winter season.    

What are eczema and atopic dermatitis
Eczema is a skin condition in which the skin loses the ability to hold onto moisture within the skin secondary to a compromised skin barrier. Eczema is most commonly caused by exposure to environmental irritants and allergens. The skin barrier acts to protect the entrance of foreign substances from the environment into the skin, while simultaneously preventing the loss of excess water. When the skin barrier is compromised, this allows exposure of the skin’s immune system to the outside world causing inflammation. This inflammation is seen clinically as red, scaling, cracking, and weeping patches and plaques.

Atopic dermatitis is a chronic form of eczema that is often associated with asthma and allergies. This is typically seen in early childhood and persist throughout life. A common genetic defect that tends to predispose individuals to the development of atopic dermatitis is a mutation in a protein called filaggrin. This protein is responsible for the formation of the structural components of the skin barrier. When this protein is nonfunctional, the skin barrier is compromised, leading to the development of eczema.

Types of eczema
Many different types of eczema exist, but hand eczema tends to be the most common form during the winter months. Approximately 10% of the population are affected by hand eczema at least once per year. Additionally, it accounts for approximately 80% of all occupational skin conditions. We all work with our hands, which explains the increased prevalence at this location.

Eczema triggers

• Hot, long showers or baths
• Harsh drying soaps
• Low humidity
• Wool/mohair fibers
• Household chemicals
• Excess sweating
• Perfumes and scented lotions (fragrances)

Bathing/showering:
Improper bathing can cause dry skin even in those who do not normally have eczema. It is important to use lukewarm water, not hot, and limit showers to once per day. When showering, limit the shower to 5 minutes or less. Use a 100% cotton towel to gently pat the skin dry as rubbing vigorously can lead to skin damage. Only apply cleansers to “dirty” skin, avoiding areas that are irritated. Avoid using washcloths or loofah sponges as these may cause more irritation to the skin, inevitably leading to more damage to the skin barrier. Washing your hands constantly throughout the day can also have a significant drying effect. It is imperative to apply a moisturizer after every hand washing to restore the moisture extracted by soaps.  

Soak and Smear: This is a technique that can be done several times a week to help lock in moisture in the upper layers of the skin. Adding several tablespoons of olive oil in water may help to augment moisture retention. Soak in a luke-warm bath for at least 10 minutes without the use of soaps or cleansers. Pat the skin dry and smear a large amount of thick cream or ointment-based moisturizer immediately afterward, followed by the application of cotton pajamas. This technique is often very useful in children with severe atopic dermatitis with the involvement of large surface areas of the skin.  

Bleach Baths: some medical providers advise using dilute bleach baths during active eczema flares to help prevent the development of a secondary bacterial infection of the skin. Add approximately ¼ cup of regular household bleach to a full tub of lukewarm bath water, mixing the water to ensure the bleach has been evenly distributed. Soak for 10 minutes then rinse. Immediately following the bath, pat dry and apply liberal amounts of moisturizer to damp skin.

Soaps/Cleansers: True soaps such as Ivory, Dial or Lever 2000 strip the skin of the natural fats and moisture required to maintain a functional skin barrier. We recommend using a hydrating soap such as Aveeno, CereVe, Cetaphil, or Dove. As mentioned previously, loofah sponges and washcloths may lead to skin irritation, therefore disrupting the skin barrier. Cleansers are soap-free products that have been specifically designed to maintain the skin barrier and skin pH levels. Applying the cleanser to the entire body is unnecessary. We recommend using cleansers in areas such as the armpits, groin, hands, feet, and the face. During acute eczema flares, it may be best to use only water, resuming cleansers once the flare as resolved. Of note, it is important to avoid products with fragrance or dyes as these may cause or worsen eczema flares.

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Recommendations: CeraVe Cleansing Bar and Body Wash, Neutrogena Creamy Cleanser, Cetaphil Restoraderm Body Wash, CLn Body Wash

Moisturizers:
All moisturizers are not created equal. Using ceramide-based moisturizers is very important as they help restore the skin’s natural barrier. These moisturizers contain a mixture of the natural constituents of the skin, therefore acting as a replacement for the components lost during eczema flares. Moisturizers are one of the most important aspects of skin care. Additionally, it is best to use a cream or ointment over a lotion, as lotions contain alcohol which may lead to further skin irritation and pain. Use liberal amounts of moisturizer while only partially rubbing it in on the entire skin’s surface prior to bedtime for the greatest moisturizing effect. In severe cases of eczema, plastic wrap (Saran wrap) may be used to wrap the affected area over the moisturizer to increase penetration of the product. Placing the moisturizer in the refrigerator may help to decrease the sensation of itch, therefore further decreasing the damage to the skin’s barrier. Lastly, if the skin is severely inflamed, we recommend using an ointment-based moisturizer as they tend to have a more moisturizing effect, while simultaneously acting as a temporary skin barrier. 

We recommend the following:

 

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*Recommendations: CeraVe Cream, CereVe Healing Ointment, Cetaphil Restoraderm Lotion, Aveeno Eczema Therapy 

Antihistamines:
These oral medications work by decreasing the release of histamine, which functions in signaling the sensation of an itch. Every time the skin is scratched/rubbed, it results in the formation of micro-tears, which leads to barrier disruption and further perpetuation to scratch. Taking an antihistamine such as Benadryl in the evening may be beneficial to reduce nighttime scratching.

Understanding the basic concepts of eczema and following these simple tips can help successfully reduce the development of eczema flares during the tough winter months. Please leave any questions you may have in the comment section below. 

Dimensional Dermatology
http://www.dimensionaldermatology.com
dimensionaldermatology@gmail.com

Photo Credit:

Billiegoatsoap.com.au, Era-soap.com, Komforte.hu, WebMD.com, Dermareport.com, Cereve.com, Cetaphil.com, Aveeno.com

References:

• Eczema products.  National Eczema Association. Accessed: November 23, 2016.  Available: https://nationaleczema.org/eczema-products/
• Dry Skin Relief.  American Academy of Dermatology.  Accessed: November 23, 2016. Available: https://www.aad.org/public/skin-hair-nails/skin-care/dry-skin-relief
• James, William D, Dirk M. Elston, Timothy G. Berger, and George C. Andrews. Andrews’ Diseases of the Skin: Clinical Dermatology. London: Saunders/ Elsevier, 2011. Print.

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