Chapter 7
Your skin is constructed, repaired and maintained using nutrients obtained from your daily diet. However, when you have eczema a little extra help from the outside is a welcome relief too. A healthy skin care routine can speed up the healing process and soothe the itch. On the other hand, the wrong skin care routine can damage the skin barrier function and delay healing, so let’s begin by looking at the skin care ingredients to avoid.
Problematic ingredient | Uses (found in) | Problems |
|---|---|---|
| Sulfates: especially sodium lauryl sulfate (SLS) | Foaming detergent, emulsifier (foaming toiletries, aqueous cream, commercial toothpastes, shampoos, cleansers, hand wash, baby shampoos and bubble bath) | SLS can cause contact dermatitis, alters the skin’s pH, thins the skin barrier (damage can last for 4 weeks after use), water loss from the skin, rashes, dandruff, hair loss and dry skin (Tip: favour ‘sulfate-free’ products) |
| milder sulfates include: sodium lauryth sulfate, sodium C14–16 olefin sulfate, TEA-lauryl sulfate | ||
| Formaldehyde (formaldehyde and its Derivatives imidazolidinyl urea and DMDM hydantoin) | Preservative (shampoos, liquid hand soap, hair products, hair gel, cosmetics, nail polish and moisturisers) | Releases formaldehyde, skin irritant, allergic reactions/rashes and it may affect breathing in asthmatics |
| Fragrance (4000 varieties of fragrance or ‘parfum’, many are synthetic) | Hides undesirable smells (moisturisers, cosmetics, deodorant, cleansers, hair conditioners and shampoos, baby shampoo, perfumes, cosmetics and colognes) | Aggravates hand eczema, dermatitis, dizziness, hyper-pigmentation of the skin, hyperactivity and irritation in children and some adults (Tip: choose products labeled ‘fragrance-free’) |
| Isopropyl alcohol (isopropanol) | Anti-bacterial solvent made from petroleum (toners, shaving creams and other men’s skin care products) | Drying and irritating, strips the skin’s natural acid mantle making it vulnerable to bacteria and fungus, promotes liver spots and pigmentation, and can irritate the eyes and skin |
| DEA and MEA (such as lauramide DEA, cocamide DEA, and cocamide MEA) | Emulsifier used to mix oil and water in products and a foaming agent (shampoos) | Contact allergies such as skin rashes |
There is not one definitive group of skin care ingredients that will be eczema-safe for everyone. For example, I’ve had eczema patients who say plain sorbolene cream is the only product their skin can tolerate, while others find sorbolene cream irritates their skin and yet natural, herbal-based moisturisers offer them some relief. So this list has been compiled with a lot of thought and comes with a note of caution: as your skin is broken, irritation can occur, so always test a product on undamaged skin before applying to your eczema.
The following ingredients work best when used within a skin care product containing a range of ingredients, and it is not necessary or advised to use all these ingredients at once.
Beneficial skin care ingredients | Properties |
|---|---|
| Aloe vera | Anti-inflammatory, anti-bacterial |
| Blackcurrant seed oil (Ribes nigrum) | Anti-inflammatory, moisturising properties, omega-3 |
| Borage oil | Anti-inflammatory, contains gamma-linolenic acid/GLA and omega-3 |
| Calendula (Calendula officinalis) | Anti-inflammatory, antiseptic, anti-bacterial and astringent, flavonoids |
| Chamomile (Anthemis nobilis) | Astringent, anti-bacterial, anti-inflammatory, contains fatty acids, rutin and quercetin |
| Cocoa butter | Moisturising properties, contains antioxidants such as vitamin E |
| Emu oil | Anti-inflammatory, essential fatty acids, omega-3 |
| Evening primrose oil | Anti-inflammatory, contains gamma-linolenic acid/GLA |
| Jojoba oil | Protects skin from water loss, similar to your skin’s own sebum |
| Licorice root/licorice extract (Glycyrrhiza glabra) | Anti-inflammatory, anti-viral, anti-bacterial |
| Manuka honey | Anti-inflammatory, anti-bacterial, antioxidants, moisturising |
| Rosehip oil (good quality rosehip oil should be a rich amber colour) | Moisturising properties, antioxidants, vitamin C, transretinoic acid (natural vitamin A), lycopene, carotenoids, essential fatty acids |
| Sea buckthorn berry oil | Anti-inflammatory, moisturising properties, antioxidants (vitamins A, C and E), unique 1:1 ratio of omega-3 and omega-6 oils, palmitoleic acid (a fatty acid in human skin sebum) |
| Shea butter (Butyrospermum parkii) | Excellent moisturising properties, contains fatty acids and a small amount of natural UV factor, anti-inflammatory |
| Vitamin E, natural (d-alpha-tocopherol or tocopherol) | Natural preservative and antioxidant (do not use oils that are 100 per cent vitamin E oil as they may cause pigmentation of the skin and avoid synthetic ‘dl’ vitamin E such as ‘dl-alpha-tocopherol’) |
Natural essential oils blended into an eczema cream may be beneficial for the skin, however keep in mind they can also cause skin irritation, especially if you are sensitive to salicylates.
Unpreserved or poorly preserved skin care products can become contaminated with bacteria and can lead to bacterial infections if you have broken skin such as eczema. To reduce the risk of contaminating your skin care products, do not put your fingers into pots of ointment or skin creams, and throw out older products. Although there is a risk of stinging from preserved skin care products, favour products that are preserved.
Various types of moisturisers are collectively referred to as ‘emollients’. The following list of emollients, listed from thickest to thinnest in consistency, can help to make shopping for a skin care product easier.
Ointments, such as Vaseline and pawpaw ointment, are thick and greasy and they are useful for scaly skin and extremely dry patches. A thick coat of ointment can protect your skin from stinging when you go for a swim in the ocean or chlorinated pool (although it’s best to avoid chlorine if you can help it). On the down side ointments can stain your clothes and they can cause rebound dryness when you stop using the product. Vaseline and pawpaw ointments are petroleum-based, however there are petroleum-free pawpaw ointments available. According to the National Eczema Society in the United Kingdom, ointments do not contain preservatives so they should not be used on weeping eczema or broken skin.
Note: It is important to avoid putting your fingers into the pot of ointment as bacterial contamination can occur. Use a clean utensil to transfer some of the ointment into another clean container before applying.
Studies show that damaged skin barrier function can be partially restored by applying oil-based moisturisers as they contain fatty acids and other nutrients and help to prevent water loss. On the down side, moisturisers may not be protective enough for very dry and irritated skin. When eczema flares up, a non-irritating moisturiser can be applied two to four times daily, and in severe cases up to six times a day.
These are thin in consistency and rapidly soak into the skin. On the down side, creams and lotions need to be reapplied more often and they may not offer enough protection for very dry and itchy skin.
Note: Before purchasing an emollient check the ingredient list and, if possible, test it on a patch of healthy, unbroken skin to see if irritation occurs.
Normal, healthy skin should have a pH of 5.5 but after soap use the skin’s pH increases to more than 7.5. This is because most soaps and cleansing products are highly alkaline (with a pH range of 9–11). Most cleansing products also contain sulfates so they disrupt the skin’s protective acid mantle and break down the skin’s valuable barrier. Skin cleansers, soaps, detergents and other foaming agents can cause dryness, swelling, flaking, tightness, roughness and thinning of the skin barrier and they can leave the skin vulnerable to microbes, irritants and allergens.
Verdict: Do not use soaps, commercial hand washes or soap-free bars. Look for natural liquid hand soaps that are ‘sulfate-free’ and preferably a plain unscented formula (available from health food shops). There are also sensitive skin liquid hand soaps available at most pharmacies—look for ones that are sulfate free and with a pH range of 5 to 6.
Body washes usually come in ‘liquid soap’ form that foams when friction is applied. Babies with eczema do not generally need to be washed with a body wash as it may irritate their eczema. If necessary, use sensitive skin body washes to cleanse under the arms and feet, and wash dirty hands.
Verdict: Use with caution. Look for products that are labelled ‘sulfate-free’ containing no sodium lauryth sulfate or sodium lauryl sulfate, and with a balanced pH of 5 to 6. These products should be low foaming or non-foaming.
Cleansers are used to dislodge dirt, pollution and make-up. The risk with using a foaming cleanser is that it may contain ingredients that strip the skin’s natural oils, giving your skin a ‘squeaky clean’ effect. If your skin feels tight and dry after cleansing then the product is too harsh. A good cleanser can remove dirt and pollution without stripping your skin of all of its protective sebum.
Verdict: Look for non-foaming cleansers labelled ‘sulfate-free’ that feel creamy, not soapy, and that are non-bubbly when applied to the skin. Pure almond oil or jojoba oil can be used to remove make-up and, like all products, discontinue use if an adverse reaction occurs.
A well-designed toner can help to restore the natural acidic pH of the skin. However, toners can cause skin irritations so do not apply them to eczema or sensitive skin.
Verdict: Skip the toner in your beauty routine and spend your money on a good moisturiser instead.
Make-up can have a place in your skin care routine if you choose. Be aware that all products deteriorate over time and bacteria from your fingers can contaminate make-up products and this might infect your eczema. As a general rule, make-up should be replaced within three years after leaving the factory. Natural make-up products that use natural preservatives, such as herbs, will have a shorter use-by-date so if using these products refer to the packaging for further details (there will probably be a symbol of a container with an opened lid and below it a reference to how many months it will last once opened). When a product deteriorates, you might see mould or a change in texture, consistency and/or smell. Avoid natural products that don’t use preservatives as there is an increased risk of bacterial contamination when you have eczema or broken skin.
Make-up use-by-dates are shown in the table overleaf.
Product | Estimated shelf life after opening | FYI (for your information) |
|---|---|---|
| Mascara | 3–6 months | The pumping action can push bacteria to the bottom of the container |
| Moisturiser | 3–12 months (refer to packaging) | Fingers dipped into a moisturiser tub can hasten bacterial contamination; enclosed pump or pourable containers are best |
| Cleanser | 6–12 months (refer to packaging) | Use a non-foaming cleanser containing anti-inflammatory oils |
| Blusher and eye shadow | 1–2 years | Wash brushes regularly using hand soap and warm water |
| Facial powder, eyeliner, lipstick and lip liner | 2 years | Don’t share make-up |
| Foundation and concealer | 12–18 months | Fingers can hasten bacterial contamination |
Exfoliating scrubs are creams and gels that contain granules or beads which dislodge skin flakes and smooth roughness. Do not use sharp scrubs made with crushed apricot kernels and don’t exfoliate on or near eczema-affected areas or pimple-prone areas as this can cause irritation and spread infection. It’s best to avoid exfoliators and body scrubs while you have eczema.
Deodorants are body sprays that use fragrance, alcohol and chemicals to mask body odour. Antiperspirants can contain chemicals, parabens and aluminium and work by affecting the sweat gland to prevent sweating.
Verdict: Avoid chemical antiperspirants and use ‘sensitive skin’ deodorants when necessary: for example, if exercising or in hot weather. Most days, opt for a natural mineral salt deodorant (they look like a shaped crystal or a smooth salt rock). When moistened and rubbed under your arms, the minerals stop odour-causing bacteria. They are free of aluminium, are hypoallergenic and are fragrance-and paraben-free. If you have eczema in your armpits avoid all forms of deodorants and use a moisturiser and dietary changes to improve your symptoms.
It is important to protect eczema from excess sun exposure as sunburn can cause skin damage. However, in sensitive individuals, sunscreens can cause irritation if applied directly onto eczema. If using sunscreen, favour ‘sensitive skin’ sunscreens formulated for children and babies (as they are generally lower in chemicals than regular sunscreens) and avoid sunscreens that are artificially coloured.
Verdict: Protect your skin with clothing and a hat and apply sunscreen on unaffected areas.
Note: Some sun exposure, free of sunscreen, is necessary for healthy skin and 10 minutes of direct sunlight on the skin daily is enough to prevent vitamin D deficiency.
Here is an example of a simple face cleansing regime for morning and evening.
Note: If you cleansed your face the night before, then you don’t need to use a cleanser in the morning; it’s better to avoid over-cleaning your face so that your natural oils can work their magic.