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.

Brown Eczema: After the Rash is Gone

Dear Mahogany,

The primary difference between a brown skin person with eczema and another person with eczema is how the skin heals. A Caucasian person suffering from eczema may choose to take a corticosteroid (hydrocortisone, triamcinalone, etc.) or a TIM (protopic, elidel), after a few days the rash will have gone away, and only a red mark remains. The redness will soon fade as well. 

People of color have melanocytes, not only in the lowest layer of skin, but through out all three layers. When our rashes heal, a hyperpigmented area remains. A dark spot remains.

The rash is removed, the skin is healed. But your body still looks as if you are broken out because the darkened areas still remain where the rashes once were.

There are a few options that you and your dermatologist may discuss, after the rash is gone:

1. WAIT.

Even though dark spots remain where the rashes once were, they will fade away. For a dark skin person of my complexion it will take 6-12 months for the hyperpigmented area to clear up. That is 6 to 12 months without another outbreak in that same area. 

2. Bleaching Creams.

No, it's not the 70s. This is not to change your complete complexion. I'm sorry you weren't born with fairer skin. These may be prescribed and even recommended by some dermatologists to return the color of the darkened areas where rashes once were back to normal.

3. Corticosteroid Injections or Oral Medication

I am not sure why Atopic Steroids and Topical Immunomodulators (TIMs) leave hyperpigmentation and Corticosteroid Injections not only clear up the rash itself, but the hyperpigmentated area as well.  Oral Corticosteroid injections may actually remove hyperpigmentation as well.

Until the rash is gone, after the rash is gone, keep loving yourself until the dark spots are gone too. 

Love,

Lhea J.

Eczema Files: Triamcinalone

Dear Itchy Body,

I have a love-hate relationship with Triamcinalone creams and ointments.  Mainly hate.

Triamcinalone is a steroid often administered to patients with chronic eczema.

The first-time I was prescribed Triamcinalone was while I was in college. At the time, my eczema was only located in 6 distinct locations: the back of both knees, the inside of both elbows, the back of my neck, and the bridge between my lips and nose.

Most importantly, my skin only created raised, tough rashes. My skin never flaked, never dried up, never shed.

After the first time I used triamcinalone, I had a widespread reaction.  My entire neck broke out for the first time. My entire arm began to break out for the first time.  And spots of rashes began to appear all over my legs.

After a few days, my skin begun a lichenification and shedding process that never occurred any of the 21 years before. 

Since using triamcinalone, my eczema-rashes now occur all over my body.

Does triamcinalone work? Yes. While it may cause localized rashes to spread... it does eventually lessen the reaction and clear the rash. 

Another horrible side effect, it thins your skin. After a few years of use, you will find that your skin breaks from simply rubbing your skin too hard. 

If your doctor recommends triamcinalone- and you just have a few rashes on your body-Consider declining and requesting a higher percentage of hydrocortisone instead. 

If your case of eczema is as bad, and wide spread as mine is now... consider using the triamcinalone ointment over the thick cream. Personal preference.

Love,

Lhea J.

Brown Eczema: Do You Need a Black Dermatologist?

Dear Brown Skin, 

To be a member of a community which prides itself on its style/appearance and have eczema can be a devastating phenomenon. What is a black woman if she does not have her looks?

Luckily, you may never have to find the answer to that question.

The first step is to find a great dermatologist. While you don't need an African-American dermatologist, you do need a skin specialist who is used to observing Black skin. 

In the mean time, there are a few simple steps that you may take to keep your skin healthy and most importantly, within your control.

PREVENTION

to decrease the chances of flare-ups...

• Find a great dermatologist with experience in treating Black skin
• Increase your water intake (8-12 glasses per day)
  
• Olive Oil and Baby Oil Gel soothe the skin
  
• Cera Ve Cream or Cetaphil Cream lock in moisture
  
• Avoid extremely hot showers and baths (dries skin faster)
• Oatmeal, itself, or Oatmeal-based soaps (such as Aveeno) are gentle
  

REACTION

to decrease the effect of flare-ups, once they have occurred...

• Monitor your diet: Caffeine increases breakouts that already begun
  
• Monitor your diet: Citrus often increases breakouts that have already begun
  
• Monitor your diet: Soy may increase breakouts that have already begun
  
• During bathing, cloths may irritate skin
  
• After bathing, do not towel dry
  
• After bathing, apply Olive Oil, Baby Oil Gel or Cream while still wet
  
• Prescriptions: An antibiotic may stop reaction. Reactions are often perpetuated by an infection
  
• Prescriptions: Hydrocortisone may decrease flare-up
  
• Prescriptions: Protopic (non-steroid) is better on the face
  
• Prescriptions: Triamcinalone will decrease flare up, if Hydrocortisone no longer works. Please note: Use of Triamcinalone WILL make your skin thinner. Your skin will tear and bleed much easier than it did prior to use.
  
• Prescriptions: Predisone (oral or injection) will decrease flare up, but may have long term effects on internal organs. Please ask your doctor about all long term side-effects before using the medication.
  

What Flare ups look like, on Black skin: (Face, Arm & Neck, shown below)