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...

Testing, testing: How to Test New Products

There comes a time in every (atopic patient's) life when a new skincare product comes along. Maybe it looks good, or is cheap, sounds interesting or comes with a recommendation from a doctor or friend. How do you know if it's good for you?

Step 1. Think outside the box. Check the description, does it say "for dry skin"? Sensitive skin? Hypoallergenic? Those are a good start. Check the list of ingredients for any obvious no-nos. Fragrances are not recommended. Lanolin or Urea acid might be turn-offs as well.

Also pay attention to the descriptors. This may sound obvious, but "lotion", "cream" and "ointment" are different things, all belonging to the same family - things you spread on your skin. Whereas things that say "cleansing", "body wash" or the like are actually soap-like products to cleanse the skin, either in or out of the shower/tub. Separate once again from the bath oils family (and one that seems entirely absent from USA pharmacies). You probably need at least one product from each family, maybe more. (Why more? One cream might be too expensive to use on the entire body, but great quality, so you use it for your face, while using a second cream for the body. Or you may use a different product for different symptoms - one for rashes, one for scratches, one for infections AKA folliculitis, etc.)

Step 2. Try it once. Try it on a small area. Make sure the world didn't fall apart and neither did your skin. I admit I sometimes skip this step once I get the feeling the product is truly for sensitive skin. Do so at your own risk: you may have an adverse reaction to certain products.

Step 3. Try it methodically. Designate an area of the skin to try out the new product: e.g. one arm. Use the new product instead of your regular alternatives on this area only, and compare the two areas (say arms) after one day, and again after one week of usage. Notice any differences in skin texture, scabbing, rashes and so on. One cream may be better for rashes while another is better for healing scratches. One may leave your skin feeling smoother. Pay close attention.

Notice this step won't work for bath oils, you can't apply on one part of the bath. You just have to try and hope for the best.

Step 4. Make up your mind. Which is better for you? Often there will be no major difference, but sometimes you'll notice an improvement and that's great! Now you have a new member to your product arsenal. Use it as needed and as your budget allows. And you did it without exposing your skin to something harmful.

Coming up next:
The real deal: products I actually use.

Urk! Urea/Uric Acid

I don't do this often, but some things have just got to be stated.

If you have Atopic Dermatitis and you're looking for a moisturizer, here's a really important tip. Make sure the moisturizer you're about to buy (and possibly pay ridiculous sums of money for), does not, I repeat does not contain Urea, or Uric Acid.

I repeat once again. Be extremely careful with products with Urea or Uric Acid. If possible, just don't use them. (Those two are not quite the same thing; but they have the same effect anyhow.)

Why such an outright negative reaction, you ask?
The answer is simple - painful experience.

Many pharmacists hear about your dry skin and recommend products that contain Uric Acid, or Urea (I'll just say Urea from now on). Even (unknowing) doctors will sometimes recommend such products. They do so because Urea, which is actually a product of urine, can do wonders for extremely dry or chapped skin.

What they (and you) may not realize is that Urea may have a devastating effect on your atopic-sore skin. A small dab of a cream containing Urea on the skin can send an atopic patient into a small, personal hell. It creates a burning sensation (sometimes very extreme) in the area that may last for several minutes. And due to the slightly delayed action of the Urea on the skin, you may manage to cover large areas with the cream before realizing the pain involved.

As far as I understand it, this burning sensation is caused when the Uric Acid meets the atopic skin, that is not just dry, but actually contains dozens of miniature cracks that may not be visible, as well as open wounds, cuts, and lesions. For all these, the Uric acid acts like alcohol or saltwater on an open wound - it burns, with a vengeance.

So be cautioned - read the label well before starting a new cream.

And with all new products for your skin, test them on your skin in a small area first, see how it reacts (even overnight), and only then move on to larger areas.

An Ounce of Prevention

The following can be considered preventive measures, and may be very helpful a such, as per the adage that "an ounce of prevention is worth a pound of cure". Still, they do not constitute a treatment, and once your situation gets real bad, they may not cut it by themselves.

1. Moisture, moisture, moisture. Oi, moisture. Dry skin is the enemy of atopics worldwide. Take a daily bath with oils, put moisture-loving creams on, the whole nine yards. Other methods may help (primrose oil AKA Omega 6 is claimed by some to be a good skin-moisture helper).
   
2. Antihistamines. Lots of atopics are reacting to allergens, so do your body some good by helping it deal with the allergic reactions (histamine cells).
   
3. Avoidance. Find out what you're allergic and/or sensitive to (those are two different things, by the way) and avoid it. Minimizing dust for example may be a huge factor for people allergic to dust. Contact with chemical agents can make life worse (hire a cleaning lady if you can afford it). Choose your clothes with care. Etc. I may write more about this someday.
   
4. Climate control. Rapid temperature changes make life difficult. If you live in a cold place, dress warmly and cover up as many areas as you can when stepping outside. Keep a relatively moist environment in the winter (AC for heating is bad; radiators are much better). For the summer, try not to sweat because sweating induces itching (AC is great then). Air pollution can make matters worse. In Israel, for example, there are dusty days ("ovech" in Hebrew); try to stay indoors in those days.
   
5. Stay cool in the other sense as well. Stress, anger and emotional pressure can worsen the situation. I know it sounds impossible, but try to keep your cool. Different approaches on this one, including my own varied attempts, but meditation and self-hypnosis can help to extend calm further. Work out your issues if you have any. See a shrink if you need one. Whatever works for you.
   
6. Keep your hands and your mind busy... I don't mean that you need to be a workaholic (or any other -holic either). But anything that makes you feel good and keeps you busy enough to forget scratching, is worth doing. Hand-engaging hobbies that you love may serve a double purpose by keeping both your mind and your hands off scratching.
   

Again, I want to stress that these methods are not likely to improve your situation once it is bad. But apply them at all times and you may just help yourself - if not totally preventing, they will certainly slow down any potential deterioration in your situation and possibly keep status quo.

Still, don't forget that when things get bad, you need to actually treat the situation. Here's a reminder for how to recognize things are going bad.

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.

Refreshing treatments

So as of yesterday I started refreshing my day-to-day treatments. In fact, when it comes to antihistamines for atopic, doctors recommend you change your medication every so often as it stops being effective. Something about the receptors becoming blocked. Later you can switch back - the block isn't permanent. I forgot about this trick for a while there, but around March I went to an allergist/immunologist that reminded me of this, Dr. BZ. So I switched from Aerius(mornings) and Zyllergy(nights) to Profiten twice daily.

[Side note: some people get drowsy or sleepy from the antihistamines. Not me. Doesn't do a thing. Or like my mom would tell the doctors when I was a kid: "I wish it made her sleep".]

Seeing as my atopic's been getting worse lately, my mom reminded me of the switching scheme again just the other day. So now I'm back to the old regime: Aerius mornings, Zyllergy (aka Histazine) nights.

Plus, my boyfriend (smart guy) reminded me of a more natural tack that I had taken in the past and we agreed helped - Evening Primrose Oil. This natural dietary supplement is supposed to make your skin healthier and more moist. And indeed, I must say that last year when I stopped taking it I felt a marked decrease in the skin moisture, so I went back to it. For some odd reason I stopped taking it again later in the year and forgot about it completely. Well, now I'm back on it.

All this, by the way, is in addition to:

• the homeopathic remedy that I've been taking for the past half year;
• the moisturizing creams I use constantly; and
• the oil and/or oat baths I take twice a day.

Sometimes it's hard to know what helps and what harms. But I do my best to figure that out as best I can.

Edit (29.9.07) : looking up drugs for this post, it turns out that Dr. BZ was pretty far off the mark in the actual recommendation. Profiten is more of an asthma prevention drug than a generic antihistamine. So even if it's a good idea to switch, don't be so sure that profiten is the drug of choice for atopic dermatitis.