Skin Care: part two

Last time, we discussed the importance of eliminating the likely triggers to flare you and your little’s skin and the most crucial step to treating your sensitive skin. So, it’s time for a pop quiz!

What ARE those 2 biggest triggers to flare sensitive skin? And what is the first step to treating your sensitive skin? (Don’t worry, answers will be below!)

So, with that knowledge as a foundation, we move on step two. Now, I’ll caveat step two that if you’ve already been diligently following the recommendations of part one of our series, then by step two, you likely would benefit from seeing your primary physician or pediatrician and, if your clinician agrees, proceeding with a referral to either an allergist or dermatologist in your area. So, I encourage you to use this information as a reference tool. Chances are that your primary physician, allergist and/or dermatologist all will echo the topics we will discuss below and this information will serve as a great reminder for when you go, “What did he/she say to do again?”

With that said, let’s begin! I felt that this discussion would be best approached by talking about the following three broad categories: Moist wraps, OTC options and food triggers.

Moist Wraps:

Remember what we said was the first step in treating your sensitive, dry skin? MOISTURE. So, moist wraps do exactly that. The goal is to trap moisture on your skin as much as possible. This is one of the best tricks for treating very dry, sensitive skin. Here’s what I recommend to my pediatric patients. After your child’s bath (remember 5-7 minutes in warm water), pat dry and apply that thick, goopy emollient all over but especially on those dry, cracked areas of skin. Then, take a pajama thats a couple of sizes bigger than your babe. Dampen that pajama slightly, then wring it dry. It will still be a little damp.  Then put that damp pajama over your goopy child, followed by your child’s dry pajama. Remember, the goal is to lock in moisturize, but please keep the pajama just damp enough to get to that goal. The reason I recommend a slightly bigger pajama is so you can wrap their feet and hands once they fall asleep with the damp pajama. For my adult readers, adapt this formula by using an ACE bandage that you’ve dampened and then wrap around those stubborn, dry areas. I promise, this trick, when used correctly, works like a charm.  My patients usually see a change within a 1-2 weeks.

OTC options:

After you’ve exhausted the moisturizing piece (and I mean REALLY exhausted it!) with that bland emollient, if you or your child are still struggling with itchy, rough, dry skin, it may be time to put some medicated ointments on your skin. The treatment for eczema (after your moisturizer) is topical steroids. At the drug store, you’ll find an array of brands but the bottom line is that without a prescription, your option is hydrocortisone 1% cream. Now, for mild eczema, this strength will be fine and be likely effective. But for more severe eczema, you’ll need to talk to your physician. Topical steroids should be applied twice daily and the stronger ones should only be used for up to 10-14 days at a time. Please consult your physician about any side effects or other specifics on those prescribed agents.

Now a word of caution: not everything that is dry, scaly and itchy is eczema or a reaction of sensitive skin. Specifically, topical fungal infections can look a lot like eczema. So, if it’s not responding to the moisturizing plan as outlined above or the topical steroid is making it worse, go see your physician. Above all, if something doesn’t make sense, go see your doc!

One last piece I’d like to give for those of you struggling with kids who are itching throughout the night because of their dry skin. Many parents gravitate to benadryl to get that itching-edge off. Benadryl works great but it really alters your child’s sleep-wake cycle, especially when used consistently. A better option that is also over the counter now is an oral antihistamine — zyrtec (generic is cetirizine) or claritin (generic is loratadine). These are great 24 hour medications that block the cycle of itching from the core. Talk to your physician about it! When you’re at this stage, it’s a really great idea to talk to your doctor and create a customized plan for you or your child’s personal skin needs.

Foods?

As an allergist in training, this is a common question we see in the clinic. Could a certain food be triggering my child’s eczema flare? The answer to this question gets a little complicated because it gets a little scientific. I don’t want to bore you with all the details but suffice it to say that there are 4 broad types of hypersensitivity. In the realm of food allergy, we talk about immediate versus delayed hypersensitivity. Classic food allergy is IgE mediated and has an immediate response. So, you eat a peanut and immediately (within minutes) you develop hives, swelling, difficulty breathing, etc and need a shot of epinephrine to make things better again. It is also reproducible each time you eat the food to which you’re allergic.

Delayed hypersensitivity is a little more complicated and, quite frankly, less understood. Classic allergy testing doesn’t pick up on delayed hypersensitivity very well either, further making this diagnosis challenging. So sometimes, after much discussion with your allergist, you might try an elimination diet to determine if your skin symptoms are improved with avoidance of a certain food. This piece should really be done with the guidance of your allergist, especially for those pediatric patients. The reason is that elimination diets are very popular now and, unfortunately, we see kids deprived of essential nutrients often unnecessarily. Your allergist will really be a champion to you in navigating the difficult journey of adequately feeding your child as well as treating his/her sensitive skin.

Whew! And that’s a wrap! Remember, this page should really used as a reference tool and I do hope it’s helpful to you. Your physician is your greatest asset in determining if a consult to either allergy or dermatology is appropriate. If you’re at this step, chances are that you’ll find yourself in their office soon.

Have a great day, ya’ll! Stay cool and moisturized!  And pic of my cutie pie just for fun

Love, Maya

*** answers: 1) Dyes and Fragrances and 2) MOISTURIZE with emollients NOT lotion ***