An Eczema Experiment: Measuring Skin Barrier Reparation

Sam's skin has been clear and soft for so long now that I feel quite confident recognizing exposure and healing patterns, as well as the distinct difference between detergent-reactive eczema and infection. He rarely has issues, but when he does, it is a relief to know just what to do to quickly eliminate his eczema.

We currently maintain Sam's clear skin by consistently doing three things:  

1.  We avoid all obvious detergents and all products containing less obvious detergent ingredients.
2. We use only pure, true soap products for all household and personal care needs. (Water is not sufficient, and I will explain why in a moment).
3. We protect his skin from the environmental detergent residues outside our control by using clothing or ointment barriers to minimize exposure and maintain healing. 

Since Sam's skin is now a blank slate, I am able to experiment with products and situations and then judge the effects more easily than I could when his skin was red and broken.  This process of trying new things, and making connections from repeat observations, is fascinating to me. I am learning so much about contact eczema.


The Experiment

Several weeks ago, I purposely allowed Sam to break out in eczema.  I did this by allowing him to walk around the house without pants or socks on for an entire day. He spent twelve hours in direct contact with our ancient, detergent-saturated carpet. This is significant because last year, in the months immediately following his miraculous healing, even 30 minutes in contact with our carpet was enough to cause relapse of what looked like large red burns on his skin. I wanted to find out if, after 10 solid months of detergent-free healing, Sam's eczema would look and present differently due to a much stronger and improved skin barrier.


The Hypothesis My thinking was that steroid creams and environmental detergent residues each magnify the damaging effects of the other, playing off one another in cyclical fashion to increase skin barrier deterioration and skin permeability, thus increasing susceptibility to eczema over time. However, in the long term absence of both damaging sources (steroids and detergents), the skin barrier could begin the work of repairing itself, become stronger, less permeable, and therefore less susceptible to severe breakouts. If this was the case, then the resulting eczema from spending a day in contact with the carpet should be much less than it was with the same exposure time last summer or fall.

(*I must credit the ideas and foundation for this hypothesis to AJ Lumsdaine who said the skin barrier will strengthen over time when spared detergent exposure, and also naturally over time, with age.  I suppose I am actually putting her hypothesis to the test and applying it to a slightly different situation where steroids were a factor.)


How It All Went Down

I didn't think to take a "before" photo but I can assure you his legs were completely clear, with the exception of a faint hint of redness around the knees (the ever persistent remnants of skin candida which must run really deep because I've yet to be able to get rid of that last little bit! At least its under control).

And here is the result of twelve hours of bare-skinned exposure to a ten-year-old detergent saturated carpet:

Not bad at all! I was surprised how limited the eczema was. This eczema presentation falls more closely in line with what I remember his eczema looking like pre- steroids;  spotty, faint, with lots of clear skin in between. The worst spot, as you can see, was on his left knee where he still has a bit of yeast infection. The detergent exposure seems to have really aggravated the infection, and caused it to flare and spread far beyond what it was the day before. Interesting! So it seems that while steroids definitely play a major role in creating ideal conditions for infection to take hold, detergent exposure plays its roll in exacerbating infections as well.


Conclusion

I think I can safely say that Sam's skin barrier has improved and that there has been much reparation these past ten months.  I wanted to share my observations to encourage others going through this process that in the absence of steroids and detergents, the skin barrier can in fact bounce back from the damage. While Sam will probably always be susceptible to detergent reactive eczema because of his skin type, in the continued absence of steroid treatment and constant detergent exposure I feel confident that he will never again have to deal with the same severity of eczema that he faced in his first two years of life.


Getting It All Cleared Up:  The Miracle of Soap Washing

I also wanted to demonstrate, in practice, how we regularly eliminate eczema (sometimes before it can even manifest)  and just how swiftly healing can occur by washing the skin with simple bar of unadulterated soap.

That night of our experiment, after taking the above photos, I scoured Sam's body and legs with soap. An important principle of the SEO (SolveEczema.Org) method for healing eczema is that water alone can not remove detergent residues from skin. Whatever detergent residues Sam picks up during his day, outside the home, (and in an industrial society every space is literally coated in detergent!) those residues remain in the skin unless we wash them out with something other than water. According to AJ Lumsdaine, the best thing to remove traces of detergent residue from skin and clothing is a true, pure soap.  True or pure soap refers to the kind of soap humans used for hundreds of thousands of years to wash clothing, hair, and skin, long before the invention of detergents and without the widespread skin problems we face globally today.  

Just to reiterate (forgive me if I come across as patronizing, some people just don't get this or believe it!) if I had only rinsed Sam's skin with water, the eczema would have remained, because the detergent would have remained, deep in the tissue. I wash Sam with soap every single night and that is one of the primary reasons his skin can stay clear!

The effect of soap washing is not always immediate. Right after his bath, his skin did not look noticeably improved. However, 48 hours later  you can see the drastic improvement:

Day 2: After 2 Soap Washings

                         


The eczema spots are still visible, but  just barely. They have faded considerably! His flare on his knees is all but gone.

Day 4: After 4 Soap Washings

The eczema is pretty much gone and all the itch and discomfort has long since vanished. I've found that the itching can typically be stopped right away, actually, even before rashes are visibly healed, with the first bath.


The Importance of Barriers
One more thing, because this is very important too: After each  nightly soap bath,  I always clothe Sam from wrist to toe. The clothing acts as a barrier so that the skin remains in a perpetual state of healing. Soap-washing the skin and following up with a barrier prevents future detergent exposures and thus prevents the return of eczema. For exposed skin on hands and face, that cannot be clothed, a thick barrier ointment like Aquaphor or Vaseline can be applied to create an artificial shield and give the skin healing time throughout the day.   For outings where it is not prudent to clothe the entire body, Sam wears regular summer clothing and then if he has a break out it can still be managed quite well or at least eliminated quickly by washing the skin and re-clothing after arriving home.

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Note: The same children who have detergent reactive eczema may also have food allergies, and/ or infection as factors in their eczema.  Eczema caused by infection or food allergies will not respond directly to soap washing. However, if food allergies or infection are addressed and the treatment only partially improves the eczema, it is likely that detergent is a dual factor and the remaining eczema might be eliminated completely by following principles of detergent removal and soap washing.   See solveeczema.org for the complete theory and to understand why this method is so effective.

Does your child have any of the  Signs of Detergent Reactive Eczema?

The Relationship Between Topical Steroid Use and Spreading Yeast Infections

I last wrote about Sam's fully body yeast infection, which I believe was just one unfortunate side effect of long term improper topical steroid use.  After seeing heartbreaking photos of another little boy on the solve eczema user's forum who looked a lot like Sam used to look, and was also on high potency steroids, I decided to do some research to see if I could find scientific support for my suspicions.

My findings strongly support my long-standing suspicions regarding topical steroids and their propensity to create an ideal environment for and proliferate spreading of infection, especially skin candida (yeast). Symptoms of candida infection include redness, raised or swollen patches, burning sensation, intense itchiness, and indistinct (or scalloped) rash edges. Such infections of the skin are  hellish to endure, but if treated properly and aggressively, recovery can be surprisingly swift and circumvent needless suffering.

Infected eczema on Sam's legs, May 2012

The problem with out of control infections like these, is that even if a child's eczema is 100% detergent related, once that eczema becomes infected you must treat and eliminate the infection first before you will see any results from detergent removal or soap washing.  We addressed both at the same time - the infection and the underlying detergent reactive eczema, which made the recovery process very comfortable and near painless. 

Some interesting tidbits:

The normal presentation of superficial infections can be altered when topical corticosteroids are inappropriately used to treat bacterial or fungal infections. Steroids interfere with the natural course of inflammation, potentially allowing infections to spread more rapidly.
source: http://www.aafp.org/afp/2009/0115/p135.html


Alteration of Infection
Because topical steroids change the way the immune system functions, they can inhibit the skin’s ability to fight off bacterial or fungal infections. A typical example of this is seen when someone applies a topical steroid to an itchy groin rash. If this is a fungal infection, the rash gets redder, itchier, and spreads more extensively than a typical fungal infection. The resulting rash is a bizarre pattern of widespread inflammation with pustules called tinea incognito.
source: http://dermatology.about.com/cs/medications/a/steroideffects.htm


Steroids are another type of medication that can cause women to develop a vaginal infection from yeast. The higher the dose and the longer you use them, the greater the risk, but even low-strength topical steroid creams may make yeast infections more likely.
source: http://www.everydayhealth.com/womens-health/yeast-infections/living/index.aspx


But, things may go quite wrong, when used on the wrong condition, wrong location, or wrong duration.
For instance, topical steroids may appear to help fungal infections, but they actually suppress the
body’s ability to fight the infection and make it worse. (Figure 1) Other diseases, including impetigo and rosacea, may appear temporarily to get better, as well, but these conditions are likely to become worse. Therefore, minor irritations can be well treated by topical steroids, but the wise patient understands what he or she is treating. The weakest of these agents, over-the-counter hydrocortisone in the United States is required to be labeled with a statement to the effect of: “stop use if condition worsens, symptoms persist more than 7 days or clear up and occur within a few days.” This required warning is well founded
source: http://www.iacdworld.org/skin/steroid.pdf



Use of potent topical steroids to inadvertedly treat fungal infections can result in a partial suppression of the signs and symptoms but do not treat the infection, which can then spread. This can also be seen in the presence of viral skin infections, where topical steroids should be avoided
source: http://www.topicalsteroids.co.uk/what_ar....ide_effects.htm



Steroids are best avoided in the presence of infection as these can exacerbate infections.
source: http://suite101.com/article/how-to-avoid....49#.UWSuMZPCaSo


Topical steroids may lead to superinfection, including staphylococcal folliculitis, dermatophytosis (10) and candidiasis, (3) particularly when they are applied to flexural sites or used with polyethylene occlusion. When a fungal infection is treated with topical steroids, widespread and unusual clinical patterns may develop.
source: http://www.drplace.com/Guidelines_for_us....ds.16.28969.htm


And check this out- situations where yeast infection are more likely to develop, see the bolded bullet point!:

The chance of a candidal skin infection developing is more likely in the following situations:
• Areas of skin that are moist or sweaty are ideal for candida to thrive. Therefore, the common sites affected are in the folds of skin in the groin, armpits, and under large breasts. (Another name for inflammation within a fold of skin or under a breast is 'intertrigo'. Candidal infection is a common cause of intertrigo.) Nappy rash is sometimes due to candida. Obese people may develop candidal infection between folds of skin. It can also affect skin between fingers and toes, and the corners of the mouth.
• If you have diabetes.
•If you take a long course of antibiotics or steroid medication.
• If you have a poor immune system. For example, if you have AIDS, or have chemotherapy, or have certain types of serious blood disorder.

Okay, so here's some information on treatment. Looking at this I am actually thinking that an anti-fungal cream might help clear the infection faster than ACV baths, which was the primary route I used to eliminate Sam's widespread infection.  But it couldn't hurt to do both at the same time! We never even tried anti-fungals because I didn't have a doctor at the time that I felt I could trust. Keep in mind many anti-fungals contain detergents.  The solve eczema mom, AJ, recommends Perrigo brand Nystatin in ointment as one of the safer anti-fungal creams for kids with underlying eczema.  If you are looking to treat infection while using the solve eczema website, you might want to ask your doctor about prescribing this particular anti-fungal. 

What is the treatment for candidal skin infection?
• An antifungal cream usually clears the infection within a week or so.
• Sometimes a mild steroid cream is added to reduce inflammation whilst the antifungal cream is working. (However, a steroid cream alone will make the condition worse as soon as the steroid is stopped.)
• Occasionally, if the rash is widespread, antifungal tablets are prescribed.
source: http://www.patient.co.uk/health/Candidal-Skin-Infection.htm


And, here I found some symptoms of candida skin growth which confirms to me that what I saw with Sam was most likely yeast infection. This list describes his rash perfectly... it explains the intense itching and potentially even the 'pimply' appearance we saw for a time on his torso and back:

Symptoms
• Itching (may be intense)
• Skin lesion or rash
o Growing red, inflammed area
o Infection of hair follicles (folliculitis) may look like pimples
o Located on the skin folds, genitals, trunk, buttocks, under the breasts, or on other skin areas
o Macule or papule
o May have satellite lesions (smaller lesions next to bigger ones)
o Skin redness or inflammationhttp://health.nytimes.com/health/guides/disease/cutaneous-candidiasis/


Most websites listed moist places on the body and skin folds as the most likely places for infection, and I think this is the medical mainstream understanding of how and where yeast occurs.  However the quote above that states that "widespread and unusual clinical patterns may develop" with the infection caused by steroids seems to describe what I saw with Sam and what others might be seeing as well.

Be cautioned that if you go to a doctor to have something like this diagnosed, my experience with two pediatricians, a pediatric dermatologist, allergist, and specialist I drove two hours to see, is that they knew nothing of widespread skin candida nor how to go about diagnosing it.  However the fact that this phenomenon is showing up on multiple medical websites across the world confirms the knowledge is out there- perhaps it is not publicized because of the concern over steroid fears.  Many parents on our forum have had similar experiences with doctors not having anything to say about widespread skin infections, though a  lucky few have found supportive doctors willing to work with them so its always best to try to get your doctor on board before treating.   It would be irresponsible of me to encourage anyone to go about self-diagnosing or treating without their doctor's guidance, however, as was our case, sometimes when doctors will not be of help you need to go with your intuition and look outside the box for a more effective cure.

Yeast Skin Infection and Eczema

Sam's initial 'healing' took place in August.  Then in mid October, we started seeing slightly raised, red areas growing and spreading around his knees and ankles. For awhile I thought it was his eczema getting out of control, and that I must be doing something wrong. However, no amount of soap washing was putting a dent in this rash. Then I remembered back to the initial detergent removal process, and how it took a  good 10 weeks to see clear skin, and how during that time we also had been doing Apple Cider Vinegar baths at AJ's recommendation since she and I had both suspected possible fungal infection.  (Eczema caused by infection or food allergy will not clear up via soap washing, and these must be treated in other ways before the remaining detergent-reactive eczema can be eliminated.)    

The most recent October yeast rash:

It occurred to me, this was probably yeast infection as we'd suspected before. So I started up again with daily ACV baths-  1 cup ACV to 1/2  or 3/4 full tub, soak for a full 20 minutes every night.  We would precede and follow each bath with a soap rinse as well.   This time around, after one week we saw remarkable progress:

 Such a difference!!

And below, more photos of yeast infected eczema, for comparison.  This first photo was taken in March of 2012. I had not found solveeczema.org, and I was noticing at this time Sam's eczema beginning to look and behave a bit differently. Rather than a scant, lacy rash with shifting, changing spots that I'd observed previously with his eczema,  I was now seeing these large, clearly defined red spots with distinct edges, that did not ever budge but seemed to grow outward and rapidly multiply. (By multiply I mean it started with one or two large, raised red areas, then those grew and other seemed to pop up and follow the same spreading pattern,with more and more skin surface covered each week.)

So above was March, below is May, just two months later, notice how the yeast has now entirely engulfed the backs of his knees and has "crawled" and spread to the upper thigh as well.

And here is the front of his legs, entirely covered in yeast, during the same time period early May 2012 (just before we'd discovered solveeczema.org.)  This yeasty rash started several months earlier with visible satellite spots with lots of clear skin in between, but as it grew you can see that after a period of time there was almost no clear skin in between patches and it almost looks like one big red rash.

Sam's yeast infection (which I did not know was yeast or fungal  at the time) covered all of his arms and legs at its worst, and there was also a band of it around his middle. It took us 6 to 8 weeks worth of regular baths to start seeing improvement.  With fungal related eczema you have to be consistent, persistent, and I'd recommend continuing the baths or other treatments until well after you think you've eliminated the entire infection. We stopped too soon, when there was still a remnant of redness and I'm pretty sure that's why we saw it come back with a vengeance in October. 

For anyone trying the SEO (solveeczema.org) methods, who is not seeing results within a couple of weeks of diligent effort, I'd recommend some level of control treatment for potential infection. From all the families I've seen in the Solve Eczema User's Forum, and friends with children who have eczema, infection seems to be more common than any of us had presumed before. And, as we'e collectively discovered, you almost just have to experiment because this is something a a doctor or dermatologist can not very easily diagnose either.

 Some things you can do to treat for yeast while working on detergent removal:

-ACV baths: we did the daily baths where possible but if you can only manage 4 or 5 days that will still do a great amount of good. 

-Daily, regular probiotics (yes they really work! I've noticed a huge difference this time around treating yeast with the addition of probiotics added daily to Sam's yogurt) We use this probiotic brand but there are many good ones, I actually do not recommend ordering online, you should buy at a local health food store from a refrigerated section and refrigerate as soon as you get home to keep the probiotics live.

- It's also recently been suggested to me by a member of the forum that yeast may be helped to clear up by swabbing the area with hydrogen peroxide. I have not tried this personally though and I imagine you would not want to apply this over a larger area, but perhaps just to help with small stubborn patches once you've tackled the majority of infection by other methods. If the skin is broken at all, do not use the peroxide as it will burn! Only over top of small, healed over patches with unbroken skin. 

This is the apple cider vinegar we use, it is raw and supposedly has "the mother", a healing enzyme left out of regular grocery ACV but I don't know if that 100% accurate, it just made me feel better about using it. If anyone knows if regular table ACV works just as well let me know. :)

Now that we have the yeast under control and minimized again, the little eczema patches that Sam gets with detergent exposure are easily washed away within a day or two, and sometimes as little as a few hours.  

Oh, I also want to mention that yeast and other fungal infection on the skin seem to be largely opportunistic.  The borders of infection followed exactly where Sam's eczema was the worst previously, in other words, he only had yeast where he'd already had eczema and also where we had used the most topical steroid. I have absolutely no scholarship in this area but my guess is that the steroid contributes to favorable conditions for yeast growth and other microbes to take hold. 

*Please do not take any of this as medical advice (!), these are strictly my speculative observations and most educated explanation as to what has occurred with my son's skin. Please feel free to leave additional questions in the comments section.

For more information on the possible influence of steroid medication on spreading  yeast skin infections, see my follow up post.