Welcome to the third episode of our podcast series, “Atopic Dermatitis In Skin of Color.” The podcast series examines the importance of diagnosing, managing and treating atopic dermatitis (also called eczema) in people of all skin colors.
This episode is “Skin Care Strategies and Lifestyle Changes for Atopic Dermatitis in All Skin Colors.”
The podcast is a joint collaboration between Allergy & Asthma Network and The Itch Podcast led by co-hosts Kortney Kwong Hing and allergist/immunologist Payel Gupta, MD. In this episode, Kortney and Dr. Gupta once again welcome special guest and social media influencer Shiv Sewlal.
You can also listen to or download the podcast on ItchPodcast.com for listening anytime, anywhere. The podcast can be downloaded at:
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In this Episode…
- 1:50 – What happens to the skin barrier that causes eczema
- 3:14 – Preventing the itch-scratch rash cycle and how to bathe with eczema
- 5:45 – All about moisturizing and what people with skin of color should know
- 8:15 – Fragrances, perfumes and eczema
- 9:06 – True or false: you can never moisturize too much
- 10:12 – How the environment can impact your eczema (with Shiv Sewlal)
- 13:10 – Preventing eczema at home and getting a good night’s sleep
- 15:08 – Cleaning products in the home and why wearing gloves is key
- 16:05 – A quick note about hand sanitizers and eczema
- 17:35 – How clothing – and those annoying tags – can impact your eczema
- 18:54 – Stress and eczema, and the value of therapy (with Shiv Sewlal)
- 23:40 – You’re not alone: joining a supportive online community
- 25:28 – Reducing stress to prevent eczema: meditation and yoga
- 27:10 – More strategies to prevent the itch-scratch rash cycle
Transcript
Kortney Kwong Hing: You’re listening to The Itch, a podcast exploring all things allergy, asthma and immunology. I’m your co-host Kortney, a real-life allergy, asthma and eczema girl.
Payel Gupta, MD: And I’m your second co-host, Dr. Payel Gupta, a board-certified allergy, asthma and immunology doctor. Kortney and I hope to balance each other out so that we get you all the information that you want and need about allergies, asthma and immunology.
Kortney: Welcome back to our “Atopic Dermatitis in Skin of Color” series in partnership with Allergy & Asthma Network. Today we are going to talk about skin care strategies for atopic dermatitis in all skin colors. These are things that you can do every day to help maintain a healthy skin barrier. We will talk about treatments – things like steroids, medications and biologics in our next episode, so if you’re waiting and hoping to hear about that, it’s coming. Don’t worry.
In this episode, again, we’re going to be talking about skin care strategies. If this is your first time listening in, this is the third of five episodes we’re doing. If you need a little bit of an introduction, you can check out our first episode, which is “Understanding Atopic Dermatitis in Skin of Color,” and our second episode, which is “Diagnosing AD in Skin of Color.” Since we have a lot to talk about in this episode, check out episodes 1 and 2 because that’s where you’ll get your foundational understanding.
So let’s jump into it. Doctor G, can you quickly review how skin and people with atopic dermatitis – which actually is also known as eczema or AD, so we’ll be using those words interchangeably in this episode – can you tell us why skin barrier in people with AD is different and why it needs all of the moisturizing it can get?
Dr. Gupta: Yes, so there’s been a lot of research done on the skin barrier and it’s thought that eczema leads to the skin being leaky. So the amount of water and moisture in the skin is actually less. And some people have a defect in a gene that’s found in the skin called filaggrin. A deficiency in filaggrin leads to a leaky skin barrier, again, that allows higher than normal water loss and leads to the dry, scaly skin. It also allows allergens to enter through the epidermis, or the top layer of the skin, where they trigger an allergic immune response and that causes inflammation.
So when your skin is dry, irritated or inflamed, that causes the sensation of itching. And with an allergic trigger, you also have the release of histamine that also causes itching. So this starts the itch-scratch rash cycle, as we like to call it, where the skin starts to itch. Then you scratch it to the point where it’s very red and flamed, and that causes more itching, and that causes a rash, and so on and so on. So the key in eczema treatment is interrupting this itch-scratch rash cycle with the goal of healing the skin barrier.
Kortney: How do you avoid this itch-scratch rash cycle? What can we do to prevent that?
Dr. Gupta: Yes, so the most important part of all of this is keeping that skin barrier intact, which is harder to do in patients with eczema because of everything we just spoke about with the filaggrin gene. That is really the issue with eczema – that skin barrier is just more compromised and doesn’t hold moisture as easily. So we need to keep our skin hydrated externally by drinking lots of water and making sure that we are being gentle with the skin.
It starts with bathing. We want to keep our skin clean, but we don’t want to overdo it. So we don’t want to use harsh soaps, soaps with too many ingredients or anything with fragrance. You don’t want to use a harsh loofah, for example, or other tools to scrub the skin. You just want to use your hands or a very gentle towel or other loopholes that can be gentle. And I would avoid anything that says scrub in the description of the body wash that you’re using.
So you want to also use cold water if you can, but never hot. Lukewarm is probably the best for most people because not many people can take cold showers. But hot water can dry the skin, and so that’s why we want to avoid too high temperatures. It’s going to dry out the skin and cause that irritation, dryness and then again, the itch.
Once you’re out of the shower or bath, you want to pat your skin and again, not rub it hard and not rub it dry. You want to pat it dry. And lastly, you want to put moisturizers on while your skin is still a little moist from the water, because this will help the creams or lotions or ointments get into the slightly open pores and penetrate into the skin as the skin is drying.
Kortney: What I’m hearing is that you do not want to break your skin barrier. So unfortunately for us AD people, no sugar scrubs. What I’m also hearing, which is interesting to me, is that being hydrated does not mean chilling out in the bath for hours. It actually means lathering yourself in a healthy amount of moisturizer so that you seal in the hydration for your skin. So when you hear hydrate, or at least when I hear hydrate, I think water, water, water – but it’s actually keeping that water in, and that’s what creams and lotions do. So is there anything that people with skin of color should note about moisturizing?
Dr. Gupta: Yes, so we mentioned this in an earlier episode, but research is actually showing that patients with skin of color have differences in that top layer of their skin or their epidermal structure. It is especially important to go the extra mile to use the best possible moisturizing agents and barrier repair strategies to treat atopic dermatitis. And patients with skin of color, particularly those of African ancestry – we want to ensure that we are doing all that we can to improve that barrier in these patients.
Kortney: And are all moisturizers made equal?
Dr. Gupta: So, with respect to cleansers and moisturization, I recommend patients use moisturizing cleansers as opposed to traditional soaps, which can dry the skin excessively. So there’s something called a syndet bar and moisturizing liquid cleansers with occlusives and humectants built in that can minimize any drying of the skin while showering or bathing. So syndet bars are made differently from regular soap bars and are derived from oils, fats or petroleum products rather than traditional soap.
Companies that make syndet bars are Dove, Cetaphil, Eucerin. Lotions are thicker than a solution, creams are even thicker and ointments are even thicker, and therefore they’re greasier. Sometimes they’re not as well tolerated by people because of their consistency, but to be honest, those are most often commonly used when the eczema gets more severe and they work the best. And so, again, the lotions and creams that you should use shouldn’t have any fragrance.
Kortney: I definitely use a greasy ointment and I am a shiny, shiny person, but at the end of the day, my skin is happy and I’m a happy person. I also use an oil-based body wash and I don’t use soap at all. And it was hard to get used to because you’re not getting that squeaky clean feeling, but your skin is really softer. And I guess that’s the goal is that we want to have really moisturized, soft skin and not like squeaky clean, because squeaky clean generally means dry for me and maybe the same for you guys. So I’m curious, since we can’t use fragrances and essentially smell super nice, what about using perfume?
Dr. Gupta: Yes, perfumes can also be irritating to the skin because they contain a fragrance mix, which we test often for people who have what we call contact dermatitis. And I would recommend staying away from them if possible. But I personally have been gifted perfumes and I have eczema. So what I do as a trick, first at the back of my neck as a test spot and keep it on for the day and make sure that I don’t have a reaction. And the second thing I do is, I actually apply it to my clothes as opposed to putting it directly on my skin, and that might make a difference.
Kortney: Okay, that’s a good tip. Thank you. It’s good to know in case we want to smell divine one day. So, before we jump into other ways to manage your atopic dermatitis other than what you can actually do for and onto your skin, I was told by my dermatologist that I can never moisturize too much. What do you say about that?
Dr. Gupta: Yes, I absolutely agree with that statement. If you are using a product that you do well with, then applying it throughout the day is the ideal way to keep your skin hydrated. But that’s hard for people to do because they’re in school, they’re working. It just gets cumbersome, especially if you have a large area of your body that’s affected. But I would say that for a lot of people, the hands can be problematic because we’re washing them often. So at least remoisturizing your hands throughout the day after you wash them is a good baseline to try to get used to.
Kortney: And a little pro tip is, you can keep a little moisturizer in all different places of your house. So on your desk, by your door, anywhere where you think, ‘Okay, I might need to moisturize.’ That helps me definitely with the hands.
So now we have our skincare routine down and outside of medication, of course, which we’ll cover in the next episode. What are other ways we can help maintain a healthy skin barrier?
A big question would be, what does the environment have to do with it? And before Dr. G tells us a little bit more about the environment, we’ve been talking with Shiv Sewlal. She has participated in our first two episodes, and she’s participating again in this one. And she talks to us a little bit about how she moved to different cities and how by moving to a different city, her skin improved. And I know that that happens to me, but the opposite way. I moved cities, and my skin got worse.
So let’s hear from Shiv, and then we can jump into a little bit more about how the environment can impact your atopic dermatitis.
Shiv Sewlal: I’m constantly reapplying my creams. I keep one on me. I moisturize with my full body cream multiple times a day, but I have this trusty cream that I moisturize the bad spots all the time. And I think the best thing for me was moving. It really helped with the flare-ups. I don’t have them as often, so it’s just one of those things.
Dr. Gupta: So this is a great clip and showing how the environment can play a really big role in atopic dermatitis. We discuss triggers in our first episode, and knowing what your triggers are by getting tested can help. But triggers like pollen, pet dander, all of these things are environmental triggers.
So moving can be tricky because you may be allergic to pollen in your new city, or you may be less allergic to pollen in your area, or you may become allergic to new pollen as you live in your new city longer. So I don’t think it’s practical to move for your allergies necessarily because of pollen. But I have seen patients move their apartment because of smoke exposure from a neighbor that triggers their asthma, for example, or if there are animals in the building that someone is allergic to and it’s triggering all of their atopic symptoms, including atopic dermatitis.
There are little tricks that you can do if you are allergic to the environment outside to help prevent the symptoms from getting severe. One of these things is air purifiers. They can help with these airborne triggers by removing some of these allergens. Or if you’re allergic to a pet, you want to make sure to keep that pet outside of your sleeping area to prevent being exposed to that allergen for 7-8 hours while you sleep.
And then we’ll be talking about this more in the next episode, but there’s also immunotherapy to decrease the sensitivity that you have to different allergens that you can think about if you are being triggered by environmental allergies.
Kortney: So you mentioned sleep and I’d love to just jump into that really quickly because I feel like sleep and atopic dermatitis go hand in hand. And by that, I mean sometimes you can’t sleep because of it. Are there things that we can do to our environment to help with sleep that people should be aware of?
Dr. Gupta: Yes. So nighttime symptoms are actually very common in a lot of allergic conditions, including atopic dermatitis and asthma, because when we’re lying still, we’re able to feel the sensations of our body more than when we’re running around doing things and our mind is preoccupied. You want to keep that in mind that your nighttime symptoms may be worse, and it’s because of that partially.
But other things that you can do is keep your room cool, which is very important. As I said, heat causes the skin to become dry and that causes it to feel itchy. And then also sweating can affect the skin and be an irritant.
In addition, keeping the humidity levels at around 40% to 50% but not higher is a good rule of thumb. Too little humidity causes the skin to get dry and too much results in dust mites thriving and the possibility of mold growth in your environment, which as we know can both be triggers for atopic dermatitis. And so with pollen allergies, you can also keep your windows shut to protect your bedroom and living space from having pollen-covered sofas and beds.
Kortney: What about things in the house like curtains and carpets? I know these are things I look out for with my asthma triggers. Is it the same for eczema?
Dr. Gupta: Any allergic person should try to be in an environment with as few carpets or curtains as possible, but that’s not always possible. So if you are in a home with a lot of curtains and carpets and things, you just need to make sure that you’re taking care of cleaning these areas so that you’re limiting the amount of dust mites and other triggers that can get into the carpeting and the curtains.
Kortney: And not every vacuum is made the same. So if you are looking for a new vacuum, make sure it’s got a good filter so that you aren’t just spreading more dusty stuff all over your house. That’s one tip that I can definitely also add in.
And since we’re talking a little bit about cleaning, what about the cleaning products you use? Should we also be watching out for those?
Dr. Gupta: Yes. So using harsh chemicals, that absolutely can be problematic in what we’re cleaning our house with. We want to make sure that we are wearing gloves while we’re cleaning, as any cleaning agent, even if gentle, can be irritating to the skin. Next, I will try to use fragrance-free products for cleaning, and make sure that you’re diluting cleaning agents like bleach as recommended.
So I’ve seen people use just pure bleach to clean, and that’s really not how it’s meant to be used. And I think especially with the recent pandemic, I think that people have become overly obsessed with keeping things clean. So, again, using bleach products without diluting them is dangerous for the person who’s using the products and also for the people who are in the environment after the cleaning is done.
And then I also wanted to make a quick point about hand sanitizers, because they are alcohol-based and can also be very drying to the skin. So you want to be careful about hand sanitizers if you have sensitive skin, because they are most likely not going to be good for your skin.
Kortney: That’s so nice to hear, because I know that during the pandemic, whenever we were going into certain shops, they wanted us to sanitize our hands, and I was like, I just can’t do that. I have pretty bad eczema on my hands, especially in the winter. And it was kind of a weird conversation to have with someone being like, ‘I’m sorry, I really won’t touch anything, but I can’t use that hand sanitizer because my skin is just much too sensitive, and I can wear gloves if you want me to, like my winter gloves. And I won’t touch anything, I promise.’ It was kind of a weird thing. So thank you for saying that about hand sanitizer, because I think that sometimes we feel like we have to use it even though it’s not going to be good for us.
And I also just wanted to say that gloves are really helpful for cooking, too – if certain things trigger your hand eczema. I know that certain acidic foods can be a problem, so we always have a box of gloves in our house. I also ask because I’ve been doing this lately, as I’ve been on a bit of a shopping spree for non-itchy clothes. This summer has been just epic for me, and I feel like my clothes are just being very bothersome. So can we also consider our clothing as something that might impact our atopic dermatitis?
Dr. Gupta: Yes, clothing is super close to your skin, so it can definitely affect your skin. You want to stay away from anything that can be harsh on your skin. I personally cannot wear wool sweaters in the winter, for example, because they’re very itchy and I will get a rash and be uncomfortable. So I would recommend soft materials like cotton are honestly the best. And if you do want to wear that wool sweater. You could wear a cotton shirt underneath and then put the wool sweater over.
Also, synthetic materials like polyester can aggravate the skin. And then, lastly, tight clothing can be irritating for people with eczema because it can cause that rubbing and it can cause that friction that causes the skin to be more itchy.
Kortney: Yes. About the rubbing, I know that sometimes I wear certain shirts inside out, and I cut off all tags. All tags, because those are little nasty rubbers. If you can say that – I don’t know if that sounded weird, but yes, I definitely agree. And I think cutting off all your tags, no matter what age you are, is a good thing to do.
We’ve talked about the house, and we’ve talked about clothing, and these are things we can control around us. One trigger that’s much harder to control is stress.
Dr. Gupta: So one thing that I’d like to mention, because we’re trying to highlight certain things for patients with skin of color and atopic dermatitis, is that in skin of color, as we mentioned in episode 1, we find that their disease is worse. And therefore, with worse disease, you have worse itching. You have worse skin issues like discoloration, the hypopigmentation, the hyperpigmentation we’ve discussed.
And all of those things can lead to increased levels of stress and stress related to the condition, and that vicious cycle kind of repeats itself. So I want to highlight the importance of really finding ways to manage stress, especially in patients that have more severe disease.
Shiv was brave enough to open up about her and her mother’s experience in managing her atopic dermatitis, which we will share with you now.
Shiv Sewlal: I’ve dealt with a lot in the past with negative comments, and sometimes I react badly to it, and sometimes I like to just brush it aside. But I’ve actually gone to therapy since I was small because of some people’s comments. I was bullied by my older sister’s friends. But my worst experience, which impacted me the most, would be when I was 5 or 6 years old. I remember going to ballet classes, and when we were all changing into our tutus, the other kids would just stare or move away from me.
Now that I’m older, I can understand that because of the lack of awareness around AD, they assumed I was contagious. But back then, the most hurtful thing to witness is someone you’re just trying to be friends with, running away scared each time you go near them. I joined gymnastics as well, and the same thing occurred. I ended up quitting both sports, but the best thing that I could ever do was go to therapy.
My mom and I both went to therapy because eczema doesn’t only affect the patient, but the whole family as well. It really helped build my confidence and explain the reason why the kids reacted that way, and that it wasn’t my fault in any way.
My mom was affected a lot when I was going through that first severe stage when I was around 3 years old. Seeing your child waking up bleeding and screaming and crying really impacted her. It got to a point where they advised her to step away from me, let my dad and my granny help dress me and clean my bandages out, because they said I could sense my mom’s stress and my mom’s being upset. That in turn made me stress and made me flare. So she was very emotional and I could pick up on that. So she also had to go to therapy and had to get more stronger in how she dealt with me. And she taught me a lot about positivity and taking lemonade out of lemons.
So this is the main thing of how I started my social media platform, really bringing that positivity in what she taught me and the backstory about how she also doubted and had to learn coping mechanisms and really utilizing that, seeing it from the patient as well as the whole family. I also know that my sisters, even though they have very mild eczema, were still impacted by my eczema and my journey. And even my dad, who is very quiet and silent, was impacted in his own way. So it really impacts the whole family.
Dr. Gupta: So Shiv brings up such an important topic. Going to therapy can not only help you understand how you might be able to look at your stressors differently, but it can also just help us figure out what those stressors actually are, because sometimes we don’t even know what is affecting us and how life is affecting us and causing us to be stressed.
Sometimes just talking about it can help us realize what exactly is causing the stress. Sometimes stress can cause the condition, but also sometimes stress can be caused by the condition, which is what we saw for Shiv and her family. Her mom watching Shiv have this condition really caused a lot of stress for her and that turned into a vicious cycle because then it ultimately led to stress for Shiv.
So it really sounds like therapy and family therapy allowed them to put into place some alternative ways by which to manage their condition at home, separating mom during times of high stress so that both her and mom can step away and hopefully ultimately improve her condition.
Kortney: Yes, I think that was so good to hear from Shiv. And family and friends are really important in the process of dealing with a chronic condition. You really don’t have to go at it alone and your family and friends are also impacted. Like you said, Shiv’s mom is obviously impacted by her AD.
I know that personally when I started to share how my skin made me feel, not just physically on the outside, but also emotionally, I started to gain more confidence just to be in my body, and talking about what was going on can be a great release. And it was a great release for me in times of high stress. If I told someone how I was feeling, I felt a little bit less stressed, because really, at the end of the day, you’re bottling it up. And bottling it up is not a great coping strategy.
And I also know that there are some really good online communities if family and friends aren’t really connecting with you and they’re not helping you along in your journey. And Shiv, for instance, has a great community where she’s really normalizing life with eczema and helping other people feel more comfortable and confident in their skin. So if you are looking for someone to help you along, you can maybe start with Shiv as well.
Dr. Gupta: Yes. And knowing that others, as you said, are experiencing similar issues is very important in helping us feel like we are not alone. But it is also important to make sure that we’re in communities online, especially, that are positive, like Shiv, and like you. As we all know, social media can also be harmful if we get into the wrong circles, and it can actually lead to negative emotions. So we just want to be very careful.
Kortney: Yes, you have to vet your information. That’s so true, because it also can be kind of triggering. I do have to say, as much as family and friends are really important, sometimes I just need to be alone and to deal with my demons, if you will.
And I know things that have helped me are meditation, which I couldn’t get behind at the beginning. I was like, I don’t understand why people do this, but actually if you stick with it, it truly can help your eczema. So meditation – I also know that breathing exercises and yoga have been really important tools for me in managing my stress and in managing my atopic dermatitis.
Dr. Gupta: Yes, and we actually addressed these tools in another series we did with Allergy & Asthma Network for asthma. So we’ll link to that episode in our Show Notes, because I think that all of those concepts are very pertinent to any condition, but definitely to atopic dermatitis.
Essentially, we know from research that meditation and exercise in whatever form you want can be very therapeutic and can help lower stress levels for most people. So if you want to hear more details on how these tools are helpful, we will link the episode in our Show Notes. We did the episode with a yoga instructor, and she reviewed some basic techniques that you can actually try as a beginner from home.
Kortney: And I just really want to quickly mention one more time, because they are episodes based on asthma, but they are also very relatable for eczema. I know that meditation and yoga and breathing have helped me really break that itch-scratch rash cycle. Sometimes you get into a scratch trance. You just can’t stop, and you need something to kick you out of that. And meditation and breathing has helped me just calm myself, put myself into my body, and then remove my fingernails away from the parts of my body that are itchy.
Before we round out this episode, I do want to share a few other techniques about the itch-scratch cycle that help me because I can, like I said, get into this itch-scratch rage-scratch transmission. I just can’t stop. It’s amazing. My brain just turns off and my hands just go at it. So doing things like light exercise, going for a walk, just moving my body slightly helps me. Also, doing things that kind of occupy your mind – so doing puzzles has been really helpful. I’ll listen to a podcast and I’ll puzzle. I know some people like to knit or bake. Basically, you just want to occupy your hands.
And last thing is, watching TV is great. If you find that you watch TV and then you unconsciously start to scratch, have something in your hand that you can play with, like a fidget spinner. Or there’s like these pop things. I don’t know, they’re like these silicone things that you pop. Just something so that your hands aren’t going at it without you realizing it. And hopefully that will help you prevent that itch-scratch rash cycle, because at the end of the day, we want to keep our skin as intact as possible.
Dr. Gupta: Those are great tips, Kortney, I actually love all the content that you share on your social media accounts, and that Shiv shares on her social media accounts, to really help patients understand what you do to help your eczema on a daily basis. And it’s nice that you guys share those little tips and tricks. Hopefully, they can be helpful to those beginner eczema patients.
Kortney: Thanks. Yeah. Sometimes people don’t realize that living with atopic dermatitis is something that you have to manage every day. And once you find those strategies, it feels less and less like a big thing and a big part of your life because you’ve got it managed. But it’s about getting control first.
So with that, we’re going to say thank you for listening. We hope that you have found some new ways to manage your atopic dermatitis and daily life that doesn’t involve medication, because that’s what we’re talking about next time.
For now, check out parts 1 and 2 in this “Atopic Dermatitis In Skin of Color” series and go to our Show Notes for more information about the Allergy & Asthma Network, Shiv and some other episodes that you might want to listen to about eczema.
Dr. Gupta: Thank you for listening to today’s episode. Remember that all information you hear today is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and or medical treatment of a qualified physician or healthcare provider.
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