A Day in the Life: When Skin Falls

After 13 years of suffering from eczema, my skin began to change. My skin, which normally forms a thickened rash when aggravated, began to dry and flake. This new, flaky skin comes off when I towel dry it, rolls off when I put lotion on it, brushes off when I touch it and falls off while I sleep.

The use of triamcinalone and hydrocortisone ointments have helped to thin my skin.

Now, after 3 years of shedding dry skin, my skin is so weak that healthy skin rolls off when I rub it or put lotion on.

Dermatologists don't seem to think that there is anything hazardous about thin skin. But, how can you ward off unwanted bacteria, if there are openings and cuts all over your skin?

So far, the thinning of the epidermis seems to be an irreversible side effect of topical and oral corticosteroids. I'll keep searching for solutions. 

Love,

Lhea J.

A Day in the Life: Weeping Eczema

Dear Concerned,

The first time that one's skin begins to weep can be a very scary period. If you continue with your normal dietary, hygienic, professional and recreational activities, ceteris paribus, unfortuanately sometimes your body chemistry may still change.

Weeping eczema, also knows as wet eczema, is characterized and identified by a thin, colorless film that is emitted from damaged skin tissue. This fluid adheres to the skin, dries, scabs and begins the lichenification of the affected area of skin. Lichenification is when an affected area of skin thickens to the point of a leathery, bark-like, reptile-like appearance. 

Despite the thickness lichenified skin, the area often rips easily especially if it is located in an area where the muscles move frequently such as the neck or face. When a lichenified area rips, the oozing, weeping process begins again. And the affected area become stiffer, less elastic, thicker, rougher and more uncomfortable.

The lichenified/weeping areas exacerbates the itch-scratch-rash process that normal eczema patients experience. If you neck is covered with a lichenified rash, making normal head movements is enough to crack the skin and cause the affected area to weep.

If you are experiencing lichenification and weeping skin simultaneously, you must take the highest safety measures to prevent the area from getting infected.

Normal lotions and emollients that normally sooth your eczema breakouts and rashes, may cause the immune system to overreact and make the skin weep more. The very process of gently applying a steroid or topical immunomodulator to a lichenified/weeping area of skin is often enough to break the skin and cause the leaking of more fluid.

Covering the area with a thick coat of petroleum jelly/vaseline may be enough to sooth the itching. Covering the area with a bandage, gauge, or cotton fabric (a soft cotton scarf, cleaned daily, for an affected neck) may protect the area from potention irritants and remind you to not scratch, or even move the affected area that much. 

In these cases oral medication and supplements works much better than apply topical ointments to a weeping area.  An oral corticosteroid or oral anti-biotic is the best bet to clear up an area of weeping/lichenified eczema.

The best way to treat weeping eczema, is to prevent it. Begin to treat sensitive rash areas before the lichenification and weeping process begins.

Hope this helps.

Love,

Lhea J.

InSKINcurities: Steroids and Antidepressants

Dear Melancholy,

Dealing with skin disruptions and disorders can be quite a bit to handle. And honestly, if your condition becomes chronic, it can have long term effects on your self-image, your self-esteem, your mood.

Friends and family member may become concerned. Someone may even consider  antidepressants to cope with your mood, which probably fluctuates as often as your skin does.

The fact of the matter is,  by the time your condition becomes chronic -- you are probably taking a combination of corticosteroids and antibiotics to cope with the constant inflammation of your skin. 

So how do Steroids and Antidepressants interact? If neither your dermatologist or your psychiatrist can't answer this question... you need to find a new dermatologist and/or psychiatrist. Don't worry. I had to.

Remember, it's your health. It's your life.

(And personally, I think most doctors don't do enough reading anyway. Too many practicing doctors don't keep up with recent medical research, anyhow.  Your best bet would be to find a practicing doctor who also does research, probably affiliated with a university -- at least you know he or she is keeping up with the latest and greatest.)

It turns out that cortisol and other corticosteroids also affect mood, behavior and cognition through "genomic and nongenomic" mechanisms. Many anti-depressants are effective because they increase corticosteroid receptors and actually lower cortisol levels.

Meanwhile your corticosteroids are working to raise cortisol levels.  Cortisol, is an immunosuppressant which when increased lowers inflammatory effects.

On the other hand, the first month I used Cephalexin... it felt like an antidepressant. Taking it seemed to make me feel so great. I asked my doctor if antibiotics had any antidepressant qualities. She assured me they did not. I guess I was just so happy to have beautiful, healthy skin again... Meanwhile, each time I accidently forgot to take the anti-biotic for the day my mood dramatically dropped. But, hey... maybe that's just me.  Sometimes my body does what it wants, anyhow.

Stay healthy, stay aware. 

Love,

Lhea J.

Eczema Files: Systemic Steroids

Dear Anxious,

So you've been living with eczema you whole life, eh? I bet your doctors told you when you were younger, not to worry, that you would grow out of it. And, let me guess, it only got worse. 

So, you've been waiting your entire life for a miracle cure... something to ease the pain of constant itching and soreness... something to rid the embarrassment of rashes and hyper- pigmentation.

Well, I am here to give you good news and bad news. The good news is that there is a miracle cure for extreme, chronic eczema, they are called Systemic Steroids.

The bad news is: all miracle cures have side effects. 

When steroids are taken orally or injected into a muscle they are called systemic steroids, since they affect your entire body.  The systemic steroids are made to mimic cortisol, your body's natural hormone, and suppress the activity of the immune system. 

A person who is having a reaction due to chronic, contact eczema may have many open lesions, cuts and scars on the surface of their skin.  Unfortunately, when molecules enter their body through these openings, the immune system begins treating many of the molecules as if they are invaders. The molecules may just be additives from soaps and detergents or fragrances from lotions and conditioners. The immune system rushes a host of white blood sells to the area of contact and begins an unnecessary healing process similar to the formation of a scab.

Well, by suppressing the immune system, we can slow down or stop the unnecessary scabbing and rashing that occurs in the skin of people with eczema.

And, often systemic steroids return the skin cells to normal without signs of hyper-pigmentation. (No sorry, I haven't figured out the science behind that one, yet.)

Now, here's the bad news. The side effects of long term steroid usage:

--Obesity (The redistribution of fat in your body)

--Osteoporosis (The thinning of your bones. Take calcium! Take vitamin D!)

 --Glaucoma and Cataracts (Eye problems)

--High Blood Pressure

--Heart Disease

Think you want to take steroids short term? Well there are side effects for that too. After you stop taking steroids, your body goes through withdrawal and often can't even produce/regulate it's own natural cortisol.

It's a sticky situation.

Just remember, there are no miracle drugs. Everything you do has an effect. You can't just let your eczema bubble over, rash, lichenify, and leak... you'll catch an infection so quick. And your immune system will be so used to fighting off things that aren't really invaders, it won't know what to do when a real threat enters your body.

But while curing the infections with antibiotics, and lessening the inflammation with steroids, you are creating short term and long term hazards as well.

It's a tough road. Talk with your dermatologist closely. It's your health!

Love,

Lhea J.