One little girl suffering from severe eczema told her mother that rather than going to Disneyland, her biggest wish in life was to be able to wear shoes without pain. She had eczema all over her body and had it so severely on her feet that they were covered in painful scabs.
She was in constant pain. In fact, when she came in to see me, she would only take off one shoe to show me because it hurt so much to take them off. She and her mom had tried so many creams and lotions and nothing seemed to make a difference.
This blog post is for her and for every other person suffering from severe eczema who wants nothing more than to live a life without the constant pain. This is not a one-time miracle procedure but is a system and a way of life.
There is a lot of science behind this list. I won’t go too deep into it here, I will simply outline the basic principles.
The answer for severe eczema the answer is consistency of bleach or vinegar baths and wet wraps, vinegar spray, taper therapy, maintenance moisturization, chemical and allergen avoidance.
1. Bleach or Vinegar Baths
If you have a normal-sized (not a garden-size) tub, fill it full enough to immerse as much of the body as possible. For a baby or toddler, this may be ¼ of the way full, and you would add 1/8 cup of bleach. If this is an older child, fill the tub ½ full and add ¼ cup bleach. Immerse the body or sit in the tub with a wet white cotton towel wrapped around the surface area that is not immersed for at least 20 minutes. For smaller children who are wiggly, try to a big tupperware container to take a bath it.
Some people just cannot tolerate bleach baths. If you are one of those, try doing a vinegar bath. You will need A LOT of vinegar to actually bring the water to an optimal pH.
In general, you will need about 3-5 cups depending on how full the normal-sized tub is. If you have a pH meter or some pH paper, the ideal pH is between 4.6 and 5.6 and you should add enough vinegar to get the water down to a pH of about 4.6.
2. Wet Wrap Therapy
Finish bath time as above (at night) and get out of the tub, dry off. Apply TrueLipids Eczema Experts 1% Hydrocortisone Cream followed by the TrueLipids Relieve & Protect Ointment and then put on some clean, white, 100% cotton long johns. Put the child/adult in the shower and get the long johns wet. Blot dry and put dry clothes on top and then go to bed. Do this nightly until the skin is normalized.
If your skin is very crusty or especially scabby, then this step is essential and you should be doing bleach baths rather frequently. With severe cases I have seen great benefits from doing these wet wraps up to three times a day followed by the application of TrueLipids. Though a recent study showed that over bathing can be detrimental, it depends on how you do it and what you do after that bath.
3. Vinegar Spray
After a bleach bath, spray down the very worst areas with diluted vinegar (I like to use 1 part vinegar to 6 parts water). The bleach is crucial for killing bacteria on your skin, but its high pH will inhibit your skin from producing the lipids it needs. The vinegar spray helps to bring the pH of the skin back down into the healthy, acidic range, where the skin-lipid-producing enzymes can make skin lipids. Surprisingly, you really won’t stink once the spray is dried.
4. Taper Therapy
5. Maintenance Moisturization
I do not have a clinical trial that can tell you this, but I can tell you what I have seen in real life with my patients. This means that you could require maintenance moisturization for your entire life. It is very important to use truly hypoallergenic emollients like the TrueLipids products. These products are specifically designed to be the most hypoallergenic and scientifically based emollients for eczema and allergy-prone skin.
Studies have even shown that twice daily use of moisturizers like these may even prevent the development of eczema in babies who are genetically prone to get eczema (Simpson et. al, 2010). Sealing off the skin barrier from toxins and allergens in the environment will prevent the onset of inflammation and eczema and maybe even assist with asthma too!
6. Chemical & Allergen Avoidance
The importance of avoiding chemicals in topical moisturizers cannot be stressed enough. There are many chemicals including fragrances, preservatives, lanolin, beeswax and more that are known to be particularly strong triggers for eczema and skin allergies. Please avoid them!
Please do not put any antibiotic ointments that contain Bacitracin or Neomycin on the skin of someone with Atopic Dermatitis. These chemicals are very common allergens and can really cause a problem for those with chronic eczema. The eczema may seem to get a little bit better, but then it never heals because there is an underlying allergy.
How Staph Can Be Involved
People with Atopic Dermatitis are particularly susceptible to over growth of a bacteria called Staphylococcus aureus. Staph makes the eczema flare and bleach or vinegar baths may help to decrease the amount of Staph on the skin. Staph especially likes to live in the folds of the skin, and that is likely why the eczema is usually worse there. The diluted bleach will decrease the amount of Staph on the skin and make it so the skin can heal more effectively. You may not need to add bleach to the bath every time you do this, but when you are scabby and crusty, it won’t hurt to do it at least once a day with bleach and twice a day with regular tap water.
Everyone who is opposed to topical steroids can skip this section, but I want to clarify something: When your skin is totally broken down, thick, scabby and itchy, it is very inflamed. The inflammation needs something powerful for at least a few days in order to turn off the inflammation. Sometimes all the skin needs is just a little whiff of topical steroids to get around the bend. Think of the following three items as steps in a journey. Severely affected skin will become moderately affected skin will become mildly affected skin will become normal skin, at which time you will finally reach the most important phase: normal skin maintenance.
Severe Areas: Thickened and scratched or scabby areas that are NOT in the folds or the armpits, neck, groin or face: apply a potent topical steroid ointment right after the vinegar spray. I like to use Fluocinonide compounded (i.e. custom made prescription) in TrueLipids Ceramide+ Cream 2x a day, followed by Relieve & Protect Ointment 4x per day. Avoid folds of the skin as you will get stretch marks when you use potent topical steroids in these areas. As the skin improves, step down to a less potent steroid. I like to compound .025% fluocinonide as above.
Moderate areas: Apply Fluocinonide .025% compounded in Ceramide+ Cream. Apply 2x daily for a few days until you are almost back to normal. Apply Relieve & Protect Ointment 2-4x per day in addition to the steroids.
Mild areas: Apply Eczema Experts 1% Hydrocortisone Barrier Cream followed by Relieve & Protect Ointment directly on top 2x per day until the skin is back to normal. Apply Ceramide+ Cream or Relieve & Protect Ointment at least 2x per day in addition to the hydrocortisone cream.
For normal skin and all areas that have returned to normal: Apply Ceramide+ Cream followed by Relieve & Protect Ointment directly on top. This is your 2x per day maintenance. Some people will note that they only need one or the other of these products to maintain their skin in an eczema-free state. If you have severe eczema however, you will need both.
Atopic Dermatitis is a genetic problem associated with skin lipid deficiencies. Some people will grow out of atopic dermatitis as they age, but many people won’t. In my opinion and experience, I think the people that use hypoallergenic and therapeutically optimized moisturizers like TrueLipids are the ones who have less severe disease, fewer flares and grow out of it sooner.
Studies have shown the benefits of bleach baths and emollients in treating the broken down skin of Atopic Dermatitis. If an antibiotic is needed, it should probably be Mupirocin or an oral antibiotic, and it should be used very sparingly. Talk to your doctor about this, and try the above treatments as well. In my ten years of practice, I almost never (I can remember two times) have had to use oral antibiotics for atopic dermatitis if the above skin barrier repair tricks are used just right. This combination of bleach baths or vinegar baths and TrueLipids is truly magical!
The following image is from a patient that we patch tested this patient and found that she was allergic to Bacitracin. The allergic reaction in this case looks like a small patch of eczema where the
Bacitracin was tested on her skin for 48 hours. Bacitracin is one of the most common contact allergens in the world and is found in triple antibiotic creams and ointments.
More Tips & Tricks
As you combat your severe eczema, here are a few tips and tricks that will also help:
- Don’t ever allow a scab to form on your skin! It is so important to understand that you do not want your skin to ever form a scab. Today one of my patients told me that she was worried that her daughter’s skin was not forming scabs anymore as we are treating her. She thought that it was healthy for a scab to form and that scabs were necessary for healing. In reality, the opposite is true. Scabs are kind of like little rocks in the middle of a wound bed—the new little baby skin cells want to grow in, but they can’t because there is a big “rock” in the way that must be moved and lifted out. This process takes FOREVER! Instead, be sure to apply Relieve & Protect Ointment frequently enough throughout the day to prevent the skin from forming a scab. You will notice much faster healing when the skin is not allowed to scab.
- Don’t ignore the rest of the body. The parts of the body that are not severe are usually still pretty abnormal. Be sure to treat these areas as in #4 above throughout the treatment duration.
As for my sweet little patient who had scabs all over her feet, we started three times daily wet wraps and bleach baths with vinegar spray in addition to the compounded steroid treatment followed
by the TrueLipids products. We also patch tested her and found that she is allergic to bacitracin! She and her mom had been putting it on every scab on her body…and the eczema would never go away.
Now that she has stopped using the bacitracin, her skin is not busy making an allergic reaction to bactracin, so we can focus on her atopic dermatitis. She is much better now and might be planning a trip to Disneyland after all! This makes me very, very happy.
I hope this will help to bless someone’s life today.