A Life With Eczema – Michael’s Routine

When I first met Michael, he revealed to me that he had pretty severe eczema. From head-to-toe, he had suffered since he was a child with the itchy, scaly patches of dry skin. It had left him scarred in unusual places, like his ankles and elbows. Carrying around a bottle of Aveeno was a must, as uncontrollable itches and dryness consumed every waking moment of his life.

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Michael

It was shortly after I met him that I began recommending products to him — things he still uses today that have, according to him, “controlled his eczema eighty-percent,” or as many doctors have told him, “probably as good as it can get for eczema this severe.”

Eczema is an immune disease, where the skin almost completely lacks the ability to hold onto moisture naturally. I’ve always described it as a deficiency of the moisture barrier of the skin. It is characteristically dry and thus, inflamed at virtually all times. It usually appears as a rash that can crust and scale and itches to all hell. Without treatment, skin can be traumatized, thickening and scarring into what is called lichenification. Treatments are typically corticosteroids, which over long-term use can permanently thin the skin.

It is the most common type of dermatitis and typically starts in childhood. In the US alone it affects 10-30% of people. It’s twice as common in women than men. It’s occurs about three times more frequently in individuals with celiac’s disease, and about two times more frequently in relatives of those with celiac’s disease. [3]

It is frequently confused with sebhorrheic dermatitis.

There are some factors that put you at higher risk for eczema. The American Academy of Dermatology Association lists them as family history of eczema, asthma and allergies, as well as living in cities or heavily polluted areas.

Most people with allergies experience contact eczema (or atopic dermatitis) at some point in their lives. For many, it is due to an allergen they are exposed to regularly, like a pet, sweating, dust, soaps, wool, or laundry detergent with fragrance. For the unlucky few, it is a disease that begins in their youth and continues into adulthood. Michael is one of those cases.

For this post, I asked him to talk a little bit about his eczema: what has worked for him as well as what’s next, and what his day-to-day routine looks like. Hopefully those of you with eczema will be able to find some value in this, as well as some comfort in your discomfort.


When did your eczema start? How did it present?

My eczema has been around since I can remember. I know that at least by age of 4 I was scratching at myself and had some pretty intense patches of dryness. I’m not sure if I exhibited symptoms from birth, but I definitely remember being very itchy from the beginning.

When I first noticed it (and when my parents noticed) it was in the form of dry, inflamed patches. Not scattered bumps, but a child’s hand-sized patch. As I grew older, wider swaths of skin became dry and irritated, and it has remained persistently patchy for as long as I can remember. While the expanses of my skin were always itchy, areas around my joints became especially dry, red, and raised due to sweat, friction, or other environmental factors. On the whole, I was dry, but it worsened on the insides of my elbows and knees, my neck, arm pits, ankles, and anywhere a crease naturally occurred. As I entered into the later single-digits, anywhere my skin folded would develop a sore or a patch of eczema.

It became the worst around the ages of 9-12. It was nearly impossible to control. As a kid, I didn’t have discipline in terms of moisturizing and proper care. I scratched non-stop, so much that my eyebrows disappeared for about two years. In pictures I have of that time, my skin is almost purple with the abuse it was suffering at my own hands. It was at that time that my parents started taking me to a dermatologist in earnest. I was told it was one of the worst cases he had ever seen, which mirrored what my pediatricians had said in the past. Often I would have to go on a burst of prednisone in order to come back from a flareup.

Eczema is a pretty genetic disease. What is your family history surrounding skin conditions?

Apparently, the men on my father’s side had patchy eczema as children, but it had gone away in pre-teen and teenage years. My hope as a child was that my condition would similarly have abated.

However, I wasn’t so lucky. Allergies, eczema, asthma and other disorders seem to be semi-prevalent on that side of the family, at least in the early years of the other men.

What has it been like to live with eczema? Has it created complications in your life?

When I entered my pre-teens and teens — probably with the onset of puberty — it began to improve slightly, but also migrated and manifested in different ways. I no longer had dark patches everywhere — from my eye sockets to my armpits — but I did have a lot more general dryness and extremely painful symptoms such as skin thickening, scaling, weeping, cracking, scabbing, inflamed sores, and crusting. I was a little better with a routine at this point, since I was getting up every day and moisturizing. In the past it had been just my parents lotioning me up after showers and baths.

By my teenage years, I had managed to get a decent moisturizing routine going, but I didn’t really know the specifics about how I should be bathing, at what temperature, for what length, and I probably did a good job of irritating it even more due to my love (at the time) for long hot showers. I remember exiting the shower bright red and tearing at myself, even after moisturizing. I was using some corticosteroids at the time (triamcinolone mostly) but didn’t really use them in the capacity I should have been.

Being a child with eczema, I was teased pretty bad. No other children understood my condition. As I moved into young adulthood, the teasing began to subside, but it definitely hit me in the self-confidence area. Luckily, I had a pretty developed enough sense of self that it didn’t affect me as much socially, rather it just made me uncomfortable in my own skin, so to speak.

Typically, children’s eczema presents differently than adult eczema. Has it changed at all over the years?

When I entered college, I had something resembling a normal routine. I didn’t take as long of showers, I was using more gentle soaps and shampoo, and I was always putting on moisturizer after showers as well as when I woke up. When I moved to New York City for college, the water was a little less harsh than it had been in my hometown of Buffalo, so that also helped. At that point however, friction was my enemy. Doing a lot of walking in NYC changed the dynamic into a highly localized sort of eczema, in severely itchy and damaged skin patches. Due to years of scratching, I now had significant lichenification (traumatized, thickened skin) of the affected areas which were prone to further dryness and often receiving the brunt of my scratching, leaving me with open lesions most of the time. However, I was now using my triamcinolone regularly, which had it’s benefits and detriments. I was more able to manage eczema patches and dryness, but it caused significant skin thinning in areas where my skin creased or folded.

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Traumatized skin with lichenification (not Michael’s skin)

When I left college, my skin was about 60% under control, I feel. I was using Aveeno lotion on the regular, and had learned to use steroids effectively. I had learned how to shower effectively (hilarious how long it takes as a kid to figure this stuff out) and I learned I could wrap inflamed patches/lesions with gauze or bandages. Layering triamcinolone on the skin itself plus a mixture of lotion and Vaseline on a bandage significantly helped localized symptoms.

By the time I had left NYC and moved to Los Angeles, I had gotten to about 70% control, but new problems started to emerge as some of my historically bad symptoms had receded. I didn’t get patches quite as bad (though overall I was still very dry) since I was decent with my daily routine and shower protocol. I did however start developing very painful, acne-like symptoms from the overuse of steroids. My face especially started to develop almost cystic breakouts which eventually produced a pustule, but not after being a visible and inflamed mass for a week or so.

As I moved into my late 30s, I feel I’ve gotten things about 80% controlled, at least as much as I can do with with topicals and shower care.

What kind of advice did your doctor’s give you?

Unfortunately my doctors weren’t a huge help. Eczema largely still has a fair amount of mystery around it to this day, and it seems to tie in with other over-active immunological responses, such as allergies. There was often debate between my different practitioners. My primary care physician would just okay my prescription medications and leave me be. My dermatologists would emphasize moisturizing and give me steroid bursts when needed. They didn’t focus too much on daily care aside from that, which left me in the dark for quite a number of years before I figured out a healthy routine. Allergists I saw felt my skin’s problems were largely a result from environmental factors but this conflicted with the opinions of the dermatologists. It was a lot of back and forth for quite some time.

One thing I learned is that most of the medical professionals I saw didn’t give any real advice for daily care or healthy routines aside from moisturizing and avoiding irritants. There were a lot of home remedies prescribed, and intense steroids, but nothing about how to wash my skin, how to repair the long-term damage, or how to bring the skin up to a manageable baseline. Not until later did I understand that a daily routine of gentle cleansing and layering all of my topicals could do me wonders and reduce the need to be reactive in my treatment.

What are some of your triggers? What do you have to avoid?

Most everything is a trigger, especially the standard allergies of house pets, grass, trees, dust, dust mites, and tons of other environmental factors. Humidity and heat are extremely problematic since I tend to overheat easily, sweat a lot, and itch profusely as a result. I have trouble with anything but 100% cotton clothes, and even some specific sorts of cotton weaves, since some levels of softness, or sheen, tend to feel very uncomfortable. I avoid harsh laundry detergents, dryer sheets, cologne, and other additives to fabrics.

Water can also be extremely problematic depending on what’s coming out of the shower head. Hard water absolutely destroys me, and requires me to use at least 30% more topical medications/moisturizers when I’m somewhere water isn’t soft. I avoid any chlorinated water, from pools to waterparks. The only way I can go to a pool is if it uses Baquacil, a water treatment that uses bisbiguanides and peroxide rather than chlorine. Saltwater can sometimes still irritate me, but it’s been the most cooperative of any water. I’ve used pools which use salinated water and getting into the ocean isn’t really a problem as long as I have some moisturizer on hand after I get out.

Stress is also a problem. I’ve had a general heightened level of anxiety my whole life and the onset of agitation, frustration, or panic can cause my skin to itch more than usual, drawing increased scratching.

What other things have you noticed as a result of eczema?

Cyst-like acne tends to be a common problem since I’ve used corticosteroids most of my life. This has left me with an increased risk for skin infection and caused other more long-term deficiencies in my skin, which need time to be repaired. Staph infections, at least in a minimal sense, can be common, especially with my facial pores. My forehead, neck, and nose can also pretty easily develop very deep, not-quite-pimples which take a while to either form a head or decrease in severity. Thinned skin and excessive topical steroid use also tends to leave my pores fairly clogged which creates a sort of paradox. I need to keep my face clean to avoid infection, but I need the topicals to keep my skin properly moist. However, those topicals seem to clog my pores and can create issues with blackheads, hardened oil, and irritated hair follicles.

I was exposed to cold sores early in life and therefore have the herpes virus hanging around my system until I die. Since physically touching a sore can make it possible to transplant the virus somewhere else on the skin, there is pretty much nowhere on my face (aside from my forehead) where a cold sore can’t pop up. I have pretty hefty medications that can deal with it, but it is still a nuisance and something I have to be extremely careful with when an outbreak occurs.

Shaving can be difficult, as shaving too close too often will create irritation and sometimes cuts, but having facial hair too long can cause a different sort of irritation. I mainly shave with a trimmer that touches the skin rather than an electric razer.

What has helped you the most?

A daily gentle cleansing routine in the morning and especially at night have done wonders. Going to bed having cleaned my face and applying 3 layers of topicals sets me up to not wake up completely dried out and lets my skin heal overnight. Using an even gentler cleansing routine when I wake up ensures I’m not stripping away moisture I’ve regained from the night. Adhering to the morning and night cleansing/application makes me need to use topical steroids less and makes me less prone to the acne-like symptoms.

The introduction of a daily bleach bath in a bottle with CLn has made the act of disinfecting my skin much easier. Sometimes it’s hard to see what inflamation is a result of eczema or bacteria. Using the CLn has taken a lot of the bacteria out of the question.

What would you tell someone living with the disease currently?

Daily gentle cleansing and moisture are a must. Specifically, cleansing with something that will actually reduce bacteria but in a way that’s not stripping/damaging to the skin. Quickly following up with not only a moisturizer, but something which can lock in topicals and promote healing goes a long way to making the day-to-day less miserable. It’s all about finding a balance where healing is part of the equation. Giving the skin more time to heal, and lessening the prevalence of micro-cracks, abrasion, and lesions will eliminate at least some need to be reactive with steroids.

Not using hot water is essential. While it can feel nice, gently bathing and washing is preferable to heat and scrubbing. You’re doing yourself a great deal of damage if you’re scrubbing, making up for a cleanser that’s sub-optimal for you. I currently feel that the cleanser should do it’s job just sitting on the skin, rather than having to be worked in too much.

Things can get easier over time, but if you’ve got something acute and atypical like me, routine is super important. With the right routine, you can be more comfortable over the long haul but you still have to maintain some level of vigilance. It’s not easy, but it can be manageable. You can do yourself a favor by keeping gentle, daily care of your skin’s cleanliness and moisture rather than having to nuke an area with steroids when something flares up.

In terms of treatments, what is next for you?

I’ve realized that I’m probably in about 80-90% control of my eczema at this point. I can always do better, but I’m probably as controlled as I can get with just topical treatments and cleansing.

I’m going to be trying Dupixent, which is a new injectable treatment for eczema. The allergist I’m seeing has high hopes for it, so if the absolutely terrible American health insurance system approves my prescription maybe I’ll get my miracle cure!

In addition to the new injectable, I’ll be getting allergy shots from the same allergist, who has identified that I’m still allergic to pretty much everything in life. This should go some way in making environmental triggers less potent and will hopefully have a splash effect on my asthma.

Aside from that, I’m going to continue to try new, proven products, especially ones which are mild, to improve my daily routine. I’ll get as far as I can with topicals and focus on getting my skin in a state where it can more effectively heal. After all, I’ve done a fair amount of abuse to it my whole life, it’s about time I give it a break.


Michael’s Routine

Michael has a pretty simple routine that is about killing the bacteria on the skin that exacerbates eczema, maintaining and preserving moisture, and ultimately repairing his skin barrier. He has to be very careful with most products and spot tests new products on his forearm prior to application on his face, and even then only applies to one portion of his forehead for a few days, eventually moving to half of his face, and then full face.

I’ve worked with him to find additional products that help him, but one of the biggest issues is that so many thick creams feel really sticky and thick on the skin. This makes adding another product that is by itself sticky and thick, like a sunscreen, difficult. He has had good luck with my sunscreen (CoTZ Sensitive SPF 40 with 20% Zinc Oxide), and I feel like it soothes his eczema, but he still does not wear sunscreen regularly as much as he simply avoids the sun, only using sunscreen when we go out for long periods of time, such as Disneyland or the beach.


Cleansing

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CLn Body Wash, CeraVe Hydrating Facial Cleanser. Not pictured: CeraVe Hydrating Body Wash.

CLn Body Wash

WATER (Aqua), SODIUM LAURETH SULFATE, COCAMIDOPROPYL BETAINE, COCAMIDE MEA, DISODIUM EDTA, SODIUM HYPOCHLORITE.

I found CLn Body Wash for Michael while looking for more comfortable solutions for bleach bathing. It is essentially a bleach bath in a bottle, which is much more comfortable for a majority of people than soaking in a warm bath for twenty minutes. In studies, it was shown to be as effective as bleach baths and significantly easier to use. [1] Best part: it is easily purchased on Amazon.

It is also recommended for use with follicullitis or acne, though neither of us can speak to the efficacy of it for these conditions.

Michael has credited CLn with virtually clearing his skin of eczema and has made a huge difference for him since he began using it a year or so ago. I cannot understate how valuable it has been for him. It simply works.

To use, he adds some to his hands and works it over his body gently (sans legs — he notes that it dries out his legs, so he uses CeraVe in those locations). To get his back, he uses a sponge on a stick. He lets it sit while focusing on other areas, such as inside of his ears, and then rinses it away after a minute or so. He uses it every shower and at night time on his face.

CeraVe Hydrating Facial Cleanser

Purified Water, Glycerin, Behentrimonium Methosulfate, Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Polyoxyl 40 Stearate, Glyceryl Monostearate, Stearyl Alcohol, Polysorbate 20, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Cetyl Alcohol, Disodium EDTA, Phytosphingosine, Methylparaben, Propylparaben, Carbomer, Xanthan Gum.

A creamy cleansing staple, CeraVe Hydrating is what Michael uses on his legs and on his face every AM. It is creamy (and extremely mild) enough to not dry him out, and is easy to obtain at every major grocery store or drugstore chain when we go out of town.

To use, he pumps a bit into damp hands and works it over his face gently, rinsing away with cool (almost cold) water.

CeraVe Hydrating Body Wash

Water, Cocamidopropyl Betaine, White Petrolatum, Lauric Acid, Sodium Cocoyl Glycinate, Glycerin, Glycine Soja (Soybean) Oil, Urea, Stearic Acid, Sodium Cocoyl Isethionate, Sodium Hydroxypropyl Starch Phosphate, Sodium Lauroamphoacetate, Sodium Methyl Cocoyl Taurate, Sodium Chloride, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Phenoxyethanol, Guar Hydroxypropyltrimonium Chloride, Sodium Hydroxide, Sodium PCA, Ophiopogon Japonicus Root Extract, Tetrasodium EDTA, Ethylhexylglycerin, Sodium Lauroyl Lactylate, Phytosphingosine, Cholesterol, Carbomer, Xanthan Gum.

A fairly new addition, Michael left this at his parent’s across country on a recent trip, and was incredibly heartbroken to discover it missing from his bag.

It is creamier and spreads a little easier for the body than the Hydrating Facial Cleanser.

When he has it, he uses it in place of the Hydrating Facial Cleanser on his legs.


Moisturizing and Treating

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Aveeno Daily Moisturizing Lotion, CeraVe Moisturizing Cream, CeraVe Healing Ointment, Triamcinolone .1% (prescription), Stratia Liquid Gold

Aveeno Daily Moisturizing Lotion

Active Ingredient: Dimethicone 1.25% Inactive Ingredients: Water, Glycerin, Distearyldimonium Chloride, Petrolatum, Isopropyl Palmitate, Cetyl Alcohol, Avena Sativa (Oat) Kernel Flour, Benzyl Alcohol, Sodium Chloride.

A staple in his routine since the beginning. This was the only real lotion around when Michael was diagnosed with eczema, and he has used it ever since. It is not quite moisturizing/sealing enough for his skin and must be used with other products to really be effective, but it is the base of his moisturizing routine every night due to it’s soothing oat.

To use, he applies it liberally to freshly cleansed skin after every shower, and first thing to dry skin every morning. It goes on both his face and his body. He isn’t shy about the amount, and frequently goes through a bottle of Aveeno every two or three weeks. It is also his go-to lotion during the day when he is feeling dry or itchy.

CeraVe Moisturizing Cream

Purified Water, Glycerin, Ceteareth-20 And Cetearyl Alcohol, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate And Cetearyl Alcohol, Cetyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide I, Hyaluronic Acid, Cholesterol, Petrolatum, Dimethicone, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Disodium EDTA, Phenoxyethanol, Methylparaben, Propylparaben, Phytosphingosine, Carbomer, Xanthan Gum.

CeraVe has become a staple in Michael’s routine since I met him. It is the second layer in his routine, and has done wonders to soothe, seal, and moisturize his skin in ways that Aveeno could not, most likely due to the inclusion of petrolatum versus dimethicone (remember: dimethicone acts as an occlusive to non-broken, non-irritated skin, but is water permeable, so it is not the most ideal of occlusives).

To use, he applies it liberally to his skin, after Aveeno, immediately after a shower and first thing to his skin every AM. It also goes on both his face and his body.

Triamcinolone .1%

1 mg of Triamcinolone Acetonide per gram in a base containing Emulsifying Wax, Cetyl Alcohol, Isopropyl Palmitate, Sorbitol Solution, Glycerin, Lactic Acid, Benzyl Alcohol and Purified Water.

Triamcinolone is Michael’s topical corticosteroid, which shares anti-inflammatory, anti pruritic (itch-inhibiting), and vasoconstrictive actions.[2]

Due to the severe nature of his eczema, he used to use it each day, sometimes twice a day. It has resulted in skin thinning, particularly around his joints (elbows and knees especially). Unfortunately, it is what works, and without it, the itching returns.

To use, he applies to bare skin, before Aveeno or CeraVe. He avoids using it on his face as much as possible, and due to the CLn, is able to use it only after showers instead of daily.

Stratia Liquid Gold

Water (Aqua), Propylene Glycol, Ethoxydiglycol, Niacinamide, Polyglyceryl-3 Methylglucose Distearate, Rosa Mosqueta (Rose) Hip Oil, Hippophae Rhamnoides (Sea Buckthorn) Seed Oil, Hippophae Rhamnoides (Sea Buckthorn) Fruit Oil, Panthenol, Dimethicone, Glycerin, Squalane (olive-derived), Cetyl Alcohol, Vaccinium Macrocarpon (Cranberry) Seed Oil, Tocopherol, Camellia Sinensis Leaf Extract, Ceramide NP, Ceramide AP, Ceramide EOP, Phytosphingosine, Cholesterol, Sodium Hyaluronate, Sodium Lauroyl Lactylate, Carbomer, Xanthan Gum, Diazolidinyl Urea, Methylparaben, Propylparaben, Disodium EDTA.

While he has only been using it for a couple of weeks, I can say for sure that Stratia has vastly improved his facial skin, particularly his inflammation.

Michael’s facial skin is particularly prone to inflammation around the edges, like next to his ears, or in his nasolabial area. Using Stratia Liquid Gold has soothed these areas, bringing his skin more in line with what is “normal.”


What His Routine Looks Like

AM:

  • Wash my face very gently with cool/lukewarm water.
  • Apply steroids only where there may be localized irritation, no widespread use.
  • (Face) Apply ample amounts of Aveeno.
  • (Face) Apply Stratia Liquid Gold.
  • (Face) Apply CeraVe cream.
  • Apply a light coat of Aveeno on the rest of my body, mainly on dryer areas like joints.

PM:

  • Wash my face gently with lukewarm water and CLn cleanser.
  • (Face) Apply ample amounts of Aveeno, followed by CeraVe creme, followed by CeraVe ointment.
  • Apply a light coat of a Aveeno on my back and some joints (I don’t like to go to bed too greasy).

After Shower Care:

  • Wash in lukewarm/warm water only, not spending too long in the shower.
  • CLn cleanser on my face, neck, upper body (light scrubbing on my back), and arms.
  • CeraVe body wash on my legs — they tend to get a little more dry after a shower.
  • Plain Dial soap in the armpits, crotch, butt, and feet for a slightly heavier clean.
  • T-Sal shampoo since I tend to get something akin to dandruff or light eczema on my scalp.
  • After the shower, application of triamcinolone cream only on problem spots, sometimes using a light coat on my face since I’ve just used CLn to disinfect.
  • Heavy amounts of Aveeno all over the body, followed by CeraVe cream all over and CeraVe ointment on my face and any problem spots.
  • Stand and let things soak in. I don’t get dressed immediately since that can scrape away the topicals. Also, I make sure I’m in loose-fitting cotton after soaking in a bit as to not lose any of the topicals.

 

Enormous thanks to Michael for lending his experience and time to making this post a possibility. ❤

 


Sources:

  1. Novel Sodium Hypochlorite Cleanser Shows Clinical Response and Excellent Acceptability in the Treatment of Atopic Dermatitis
  2. TRIAMCINOLONE ACETONIDE
  3. Celiac Disease and Dermatologic Manifestations

 

 

Posted by

Game developer by day. Real-life gremlin. Amateur photographer. Mental health advocate. Skincare lover and science devotee. In 2011, I began a journey into skincare that became a life-long passion. I've written numerous articles on reddit.com on skincare and helped hundreds of people as they begin their own journey into a better understanding of their skin. I am an advocate for science-based skincare, and want to help others achieve their goals of better skin.

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