What cream do you turn to when you scratch off your own skin with a knife?

Has this ever happened to you?

What about the desire to scald your skin to take away the itch? Ever had that?

I know what that feels like and I know I’m not alone.

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Eczema and other chronic skin conditions are no joke and while I appreciate the well-meaning efforts of those caring for their eczema prone loved ones, I mostly find them lacking in understanding of what it’s really like to prefer the pain of no skin to your own itchy stuff.  It’s dysfunctional.

Most people I meet want to ‘cure’ their loved ones eczema with a natural cream as nature is best. That’s the logic.  I truly get that but I grew up with steroid cream, petroleum and parabens and in the professional eczema space, nothing much has changed because that shit works.

I’m not a dermatologist so I won’t pretend to sum up the pro’s and con’s of steroids in a cosmetic chemist blog post but suffice to say that when your itching has rendered you sleepless and in danger of sepsis, the relief that steroids bring is heavenly albeit in a fingers-crossed kind of way as you hope that you rid yourself of the itch before your skin thins.  Steroids aren’t a long-term fix.

Barrier and aqueous creams are more of a long-term essential for those prone to any of the above and if you are bad enough to need long-term dermatological support they will most likely suggest petroleum-based, nothing-fancy products. These simple, old-fashioned formulations are not prescribed because god hates you,  all dermatologists are sponsored by big petroleum/big oil/ big daddy or because the dermatology world forgot to check ‘what’s hot’ in cosmetics.  No, these things are prescribed or recommended because they are, themselves, pretty inert.

Pretty inert doesn’t mean nothing by the way…

A month or so ago I was explaining petroleum oils vs vegetable oils to a client and I said that ‘the reason petroleum derived oils have a long shelf life is because they are already dead whereas vegetable oils are not’.  I feel like the customer took that quite literally as in ‘OMG, who would want dead things on their skin, that’s another reason why petroleum derivatives are bad, they are dead and dead is bad’.   Noting this was not quite the response I wanted I attempted to re-frame my analogy:  ‘I meant ‘dead’ as in less likely to chemically change in ways that could be detrimental. I probably should have used the term ‘chemically stable”.  I went on to say that ‘vegetable oils are still in a dynamic chemistry state and will inevitably oxidise as their triglycerides break down. One break-down product being free oleic acid, a dermal penetration enhancer and potential skin irritant.  That’s not all but that’s fairly significant in terms of their potential to precipitate a negative skin reaction or flair-up in skin that’s already damaged’.   However, as is with life,  once a person has had a light bulb turn on, albeit prematurely and in the wrong room, it is very difficult to pursued them to reconsider.

So what I was trying to say was..

Petroleum derivatives are intentionally chosen for products aiming at atopic skin because they are predictable, un-reactive and very slow to change. Vegetable oils are the opposite of that.

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How I attempt to handle my own skin. 

My own experience shows me that there are three distinct phases in coping with an eczema type skin situation and in each phase, different ‘treatment’ products may be of use.  I’m giving my own experience, observations and preferences here as something to ponder on, not as a prescriptive view of how everyone with eczema is and prefers to manage it.  Also note that if I was a wiz at managing my eczema it wouldn’t still be plaguing me today, 44 years after it first started (boohoo).

Stage 1 = the stinger

This is trauma central and is the phase that I opened with, where you quite literally want to scratch, boil or chew off your own skin.  In this stage everything, even water stings and irritates and the thought of soothing skin like this in coconut oil, soap or anything else is quite repugnant to me.  When I’m like this I reach for the antihistamine (to reduce the itch),  relaxation (to reduce the subconscious impulse to scratch), cooling (clothes, foods and environments (to reduce a scratch trigger = sweating, over-heating) and then after that I’ll go for a product.  If my itching is very bad still or I’m worried about infection I’d go for a cortisone cream. If not I’ll go for a basic barrier cream.  I choose a cream rather than an ointment or balm because I have a real problem with the skin feeling over-heated or occluded so a water-and-oil product suits me best unless I’m in a very dry and cold environment in which case I might use a balm.  Remember that at this point in time the above will sting me and I’ll need to use mind-over-matter to stick with the program and get my barrier back in one piece.

Stage 2= The wounded soldier.

This is where we have recovered from rock-bottom but it’s still a long way from happiness. Here I’ll be mostly reaching for loads of aqueous cream to just provide the skin with hydration and a little barrier protection while it rebuilds.  I’ll probably apply this once or twice an hour in the beginning as my skin is ripped to shreds and dehydrates quickly when in this phase. Also I find the pulling sensation of dry skin gets confused in my brain with itching so I can subconsciously scratch again and end up back at stage 1.  At this stage I’d be concerned about using creams that are too ‘active’ as the skin is still a long way from normal.  That’s why I’d advocate against vegetable oils, too much too soon.

Stage 3= Almost normal.

I say ‘almost’ because skin like mine is never completely normal, it’s quite fragile and can easily be tripped into disfunction again. However, in this stage the barrier is repaired, it’s no longer itchy and I am no longer stinging at the touch of water.   This is where I am more able to tolerate ‘active’ creams if that’s what I want. However, for me, I still have to be careful not to use products that make my skin feel sweaty and occluded as that can kick-start a new round of scratching for me.  I have often wondered if natural ‘essential fatty acid’ rich oil creams are best for my skin during this time but to be honest, I’ve not noticed any particular benefits, on my hands at least (and it’s my hands that are most affected these days).  Maybe it’s because my hands are so often exposed to surfactants (washing up, washing hands etc) that they are already primed for irritation, I don’t know.  I can’t see any reason why a lovely, natural fatty acid enriched cream wouldn’t be good for my skin in this stage as long as it didn’t itch whether I’d notice the benefit would really depend on what else was going on in my life at the time.  I feel that for my skin it’s not what I put on it as much as what I take out of it (put it through) that matters if you know what I mean.

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The bottom line for me as an eczema sufferer is that I want people selling into this space to be aware of the phases that us itchy folk go through. I think it would be really useful if wanna-be brand owners think about their ‘solutions’ be they cosmetic (maintaining your good skin) to therapeutic (stopping the dysfunction) in a holistic way and not just as a one-size-fits-all.  It would be awesome is brand owners could demonstrate an understanding of the huge emotional, physical and economic impact itchy skin has and to be sensible and measured in their response (rather than jumping on each and every cure-all band wagon).  Finally, I’d like brand owners in this space to understand that for some of us, sometimes (or even all the time) petroleum-based, simple creams are lifesavers mostly because dead things are more predictable.