A Different Way Out

As some of you may recall, I've been on methotrexate since 2008. However it was helping only partially and I was suffering from side effects. Reducing it didn't go so easy, as my body reacted to the lack of drug - the atopic all came back, full-blown with edema around the eyes, scratching all the time, the works.
Prof. B, when he saw me, said I should go back to the methotrexate. But he also knew I was in USA and he pulled out a name of a famous doctor from Oregon. Dr. HN was a pioneer in the field of atopic dermatitis and has seen it all. We decided to go.
Dr. HN's treatment was nothing I'd ever heard of. He took all my bath oils out ("You might've developed contact dermatitis") and made me bathe in plain water. Immediately after the bath, while the skin wet, I applied a steroid cream (betamethasone) on the entire body - including face(!). I did this twice a day for two days.
At this point I was willing to try anything so I gave it a shot. Believe it or not, it worked. The skin was nearly entirely clear at the end of those two days. Once that happened, I started tapering the creams (with Dr. HN's instruction) down to once a day, every other day, and so on until I now put it on twice a week. The face, neck and breasts get protopic (a non-steroidal, immunosuppressant cream), also twice a week.

I also added UV therapy, on which I won't write today.

Bottom line - my skin is clear, without systemic pills that kill my liver and who knows what else. While I'm not thrilled at the thought of putting steroids on, at least I'm treating where it hurts - the skin. And it's working! It's been four months now and my skin is clear as can be (except for my scalp - that's a matter for another post).

The real deal: products I actually use

After years and years of testing, I'm bound to have some insights of my own, right?

Well I do. And here they are in front of you.
Please note I am not paid by any of these products/companies to endorse them.

Moisture Creams

My baseline, the best of all and most used by far, the one off of which all else is tested is the one and only Vanicream. This is your all-purpose moisturizer. I use jars of it. I use it twice a day for my entire body and carry it with me at all times (in a much smaller container, though). It basically has practically nothing to irritate your skin - the label says: "Free of dyes, Fragrance, ..." and so on. I use it because it's the best. In years of testing I've never found anything better than Vanicream for pure moisturizer. The only one that I've ever substituted for this is Eucerin, specifically Rambam's hospital-brewed version with extra olive oil.

Now, for some variety I use A-Derma's Exomega emollient cream ("for face and body"). It's good for flaky skin, as it seems to expedite new skin growth. I don't use it at all times but keep it in my closet for those flaky skin patches that tend to show up every once in a while.

Another moisturizer I recently discovered is Neutrogena's "Norwegian Formula: Moisture Wrap Body Lotion". This one helped me out of a tight spot, or rather, a red spot. I had a redness that wouldn't go away, and this one helped it disappear. This came at a cost, though - the skin was flaky when I finished, so take note.

Type-Specific Creams

I always keep a couple of prescription steroidal creams handy. These are good for rashes, scratches, and any nasties of that type.

Another type of cream I like to have is something containing Calendula, and I use it for rapid-healing of scratches or open wounds. It's amazing how fast these work. Right now I use Weleda Calendula Baby Cream, but pretty much any Caledula product will do the trick.

Finally, I keep an antibiotic cream handy for the folliculitis, or other infections that tend to cling to the skin.

Bath Products

I use a combination of two products for my bath: Balneum Hermal and Emol. Emol has a small bit of soap in it which helps keep infections away. I use a mix of 1:2 - 1 measuring cup of Balneum for every 2 cups of Emol. However, while Balneum is available from Canada, Emol is not to be found. I'll let you know what I find throughout my new tests...

What constitutes a treatment

So, what constitutes a treatment for Atopic Dermatitis - according to conventional medicine, anyway?

According to Dr. H (dermatologist), here's what can constitute a treatment (I'm pretty sure he meant for medium to severe atopic):

1. Topical Steroids. Topical means on the spot, or in plain English, creams spread on your skin. in order to actually treat the atopic, they need to have steroids (cortisons) in them.
   
2. Immunosuppressants. These agents may calm your atopic dermatitis by way of lowering the resistance of your entire immune system.
   
3. Phototherapy - certain types of UV rays may be helpful for some cases of atopic dermatitis.
   

Now, each of these treatments has its own dangers and complications, I won't go into details right now. Let's just say, "don't try this at home". Consult an expert for the right options for you.

In a future post I'll write, accordingly, what doesn't constitute an actual treatment (but may well act as prevention).

One word of caution, according to Prof. B. (dermatologist): Systemic steroids (i.e. taken through the mouth, injected, etc.) should NOT be used for atopic, as they tend to cause a rebound reaction once the drug is discontinued. There is evidently a major difference in opinion among doctors on this point. Allergists and physicians may tend to recommend this type of treatment because it is effective for asthma and so assume it will work for atopic as well. Personally, I've experienced the rebound effect in both times I've taken systemic steroids. Readers beware.

Crème de la Crème

One thing that did not come as a surprise to me at the hospital was the insistence on moisturizing. I had been taking baths and putting creams on my skin for ages. However, the precise nature of these was slightly different than I was used to, especially regarding the creams.

The treatment began with very cortisone-heavy creams. However, as the days passed and my skin cleared up, these were gradually decreased - lower dosages, smaller areas, etc. The main treatment, they explained, will be the immuno-suppressants... and that I gotta keep up the moisture.

So, which creams? Up until now I had been using Vanicream for years. In the hospital they used Eucerin, but not the store-brand one. They mix it up with... olive oil. Precise measurements to follow soon. They recommended I keep using it, and I intend to for now. It leaves the skin feeling quite smooth.

Oh, one more thing. They recommend keeping the creams refrigerated. The idea, as I understand it, is that when you put on the cold cream it has a further soothing effect. Just don't keep it too cold.

And how should you spread the cream? With the palms of your hands, not your fingers. From top to bottom, in the direction of the hair growth, to avoid folliculitis (inflammation of the hair roots).

Baths will come in a separate post.

Edit: with cortisones you're supposed to spread a thin layer, but with the moisturizers, don't be stingy. Other than cost, there's practically no reason not to apply liberally. Just don't forget to use the fragrance-free, paraben-free, everything-free version.

Things that were, and things yet to come

Phew. I haven't been very active lately, but there were some good reasons for that. So, I am going to tell you a little bit about what has been going on. I'm also going to mention a lot of things that will receive my fullest attention in separate posts. I want to do this right, so I will devote a post to any topic that seems relevant and not go into too many details here. So to avoid repeating myself a lot, I'll write "TBE" - to be explained - wherever I want to write more later. [Edit (6.4.08): these TBE's are now links to the relevant posts, wherever I actually wrote them.]

Around the last time I posted, my situation was already pretty severe, and it was getting worse by the day. I somehow managed to function although I was barely sleeping at nights, scratching constantly and so on.
My situation can be likened to the proverbial boiling frog. For nearly two years my situation was going from bad to worse, with only temporary remissions brought upon by use of cortisones in different formats. I will write a separate post about all the warning signs I missed, should have seen, or didn't know existed... TBE#1. But for now suffice it to say that by the beginning of August, I was near the boiling point.
In hindsight, my situation was actually dangerous (TBE [6.4.08 - due to infections and sleepless nights]). To make a long story short, I came to an appointment with an allergist. As I was waiting for him to show up, the nurses told me in no uncertain terms that they think I should go to the emergency room - a statement which managed to dull the surprise when the allergist took one look at me and said I needed hospitalization. Most importantly he said this should be seeing a dermatologist - that he as an allergist couldn't do enough for me (TBE).
So the very next morning I showed up in the Rambam hospital in Haifa, which evidently hosts one of Israel's best skin departments (if not the best one). I came to the upstairs clinic first, and met with the department head. He was also very clear on the fact that I needed to be hospitalized, and so I was admitted to the hospital.
I spent the following ten days there, and received all-around treatment that has turned my skin upside down, inside-out and altogether amazingly healthy. To me the best part of this was that I received no systemic cortisones but rather a combination of other treatments (TBE), the most important of which being an immuno-suppressive (TBE). Within two days of being there my skin was nearly entirely cleared up. I was still itching, though, and not sleeping at nights; this improved later on (TBE). Finally I was discharged home, and I will continue some of the treatments at home while others are over (TBE...).

With so many things yet to be explained, I want to wrap up this post now with a note of cautious optimism. Right now, my skin is in a wonderful condition, and I intend to do everything in my power to help it stay this way. To this end, and also to help other people be healthier, I plan to post a series of short posts on specific topics that I encountered immediately before and during the hospitalization. I hope that I can follow through with these ambitions.