Eczema News – ‘Lipid fingerprint’ Treatment Approach

At end September 2015, it was announced on various medical new sites that Oregon State University’s researchers have developed a new approach to treat eczema that is

  • Personalized; and based on
  • Individual lipid deficiencies (akin to lipid fingerprint)

The new system patented (yet to be developed) requires testing of skin and lipid samples (from sticking and pulling off a piece of tape on/from the skin), using a mass spectrometry. The testing is non-invasive and suitable for infants and elderly as well.

Target Lipid Deficiency for Eczema Treatment

Target Lipid Deficiency for Eczema Treatment

It is established that eczema skin is often lacking in lipids, the reason why many moisturizers have active ingredients to restore the skin lipid levels such as ceramides, cholesterol and free fatty acids. However, there are many types of skin lipids and researchers at OSU believe that choosing the skincare and therapeutic product that specifically target one’s deficient lipids will help eczema sufferers.

Hopefully when developed, the ‘lipid fingerprint’ system will address:

  • Steroid usage which has side effects with long-term use
  • ‘One size fits all’ method of moisturizer selection
  • Reduce costs associated with doctor consultation and that of using the ‘wrong’ products – when the deficient lipids can be identified, it can then be known which lipid composition is missing, i.e. those that serve protective or barrier or antimicrobial function.

Associate Professor Arup Indra explained in an interview that “Lipids in our skin help retain moisture, they act like a blanket that protects against irritation and infection, You could think of skin cells as the bricks of a wall, but lipids are the mortar that prevent things from getting through the cracks. When they are deficient, problems can develop.”

Previous research by A/P Indra and other researchers has identified a protein (Ctip2) that is critical for forming and maintaining the skin barrier in mice, and for skin lipid metabolism. Mice that had Ctip2 removed had dry and scaly skin, and developed skin lesions. The removal of Ctip2 also led to increased inflammation, with presence of high levels of inflammatory proteins, enlarged lymph nodes and spleen in the mice. Without Ctip2, TSLP (another protein that has been known to activate other cells to be pro-inflammatory, linked to eczema and asthma) also became 1000-fold higher in the mice.

It is interesting research by the College of Pharmacy at OSU and my personal thought is that even if targeting deficient lipids alone may not ‘cure’ eczema for everyone, it will definitely help to reduce the cost of buying moisturizers that are not the ‘right lipid fit’. Keeping fingers crossed that R&D in atopic dermatitis will have breakthrough in the next few years to provide relief for all eczema sufferers.

Selection of Moisturizer (II) – Moisturizer and Ingredients

Last week, we’ve covered the 10 Moisturizer Selection Tips. This week, (as promised!), I’ve compiled ingredient listing for common moisturizers found in pharmacy (in Singapore/Asia as some brands are marketed under different brand names in the US/UK).

There are broadly 3 generations of moisturizers:

1st, 2nd and 3rd generation moisturizers - Pros and Cons

1st, 2nd and 3rd generation moisturizers – Pros and Cons

1st generation moisturizers are occlusive – these act as a layer to prevent transepidermal water loss (TEWL). These ingredients are petrolatum, mineral oil, paraffin and triglycerides. Creams/ointments with higher concentration of these are sometimes termed ‘intensive’, ‘suitable for very dry skin’ as the ointment does not evaporate as quickly as lotion but it often leaves a stain on clothing or doesn’t feel as comfortable as lotion.

2nd generation moisturizers are humectant – these are sometimes referred to having natural moisturizing factors (NMFs) as they can pull moisture from the environment to the upper layer of skin (and also from inner layer of skin to the upper layer). These ingredients include glycerin, hyaluronic acid, sodium salt of pyrrolidone carboxylic acid, sorbitol, lecithin, panthenol, salicornia extract, amino acids and urea.

3rd generation moisturizers have skin repair properties – often a combination of both occlusive and humectant, these moisturizers include ingredients that help to repair the skin barrier, either by replacing lost skin components (ceramides and skin lipids) or reduce inflammation, itch and bacterial activity.

A moisturizer’s quality is also dependent on how well it delivers these properties (stability and structure) and what ingredients it does not have (which are allergens). Safety and product quality control are also important considerations.

Let’s zoom into the ingredient list of the below common moisturizers and see what we can understand they contain!

Brands Ingredients Irritants Free from Irritants/ pH
Aqueous cream

Functions: Occlusive

Number of ingredients: 7

Liquid Paraffin 6% w/w, White Soft Paraffin 15% w/w, purified water, emulsifying wax (containing cetostearyl alcohol, sodium lauryl sulfate), chlorocresol 0.1% w/w Sodium lauryl sulfate, Cetostearyl alcohol, Paraffin may irritate Free from perfume, propylene glycol, lanolin, colorpH 6.5 to 7.5
QV cream

Functions: Occlusive, Humectant

Number of ingredients: 14

Aqua (Water), Paraffinum Liquidum, Glycerin, Petrolatum, Cetearyl Alcohol, Squalane, Dimethicone, Ceteth-20, Glyceryl Stearate SE, Stearic Acid, Laureth-3, Glyceryl Stearate, Methylparaben, Dichlorobenzyl Alcohol Parabens, Dichlorobenzyl alcohol (preservatives that kill microbes so that product won’t spoil before expiry), Paraffin, petrolatum, Cetearyl alcohol may irritate Free from perfume, propylene glycol, lanolin, color

pH 6

QV Intensive Moisturiser

Functions: Occlusive, Humectant

Number of ingredients: 7

Aquaphor Healing Ointment

Functions: Occlusive, Humectant (bisabolol enhance healing)

Number of ingredients: 7

QV Intensive Moisturizer

Light Liquid Paraffin (Paraffinum Liquidum), Petrolatum, Isopropyl Myristate, Polyethylene, Cetearyl Alcohol, Silica, Dimethicone

Aquaphor Healing Ointment

Petrolatum (41%), Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol

Polyethylene, silica (mineral oil) may irritateLanolin QV

Free from perfume, propylene glycol, lanolin, lanolin, paraben, colorpH not disclosed

Aquaphor

Free from perfume, propylene glycol, paraben, color

pH not disclosed

Physiogel AI cream

Functions: Occlusive, humectant, repair

Number of ingredients: 16

Aqua, Olea Europaea Fruit Oil, Glycerin, Pentylene Glycol, Olus Oil, Elaeis Guineensis Oil, Hydrogenated Lecithin, Squalane, Betaine, Palmitamide MEA (PEA), Sarcosine, Acetamide MEA, Hydroxyethylcellulose, Carbomer, Sodium Carbomer, Xanthan Gum Free from perfume, propylene glycol, lanolin, paraben, colorpH not disclosed
Physiogel Daily Moisture Therapy Cream

Functions: Occlusive, humectant, repair

Number of ingredients: 13

 

 

 

 

 

Cerave Moisturizing Cream

Functions: Occlusive, humectant, repair

Number of ingredients: 25

Physiogel

Aqua, Caprylic/Capric Triglyceride, Glycerin, Pentylene Glycol, Cocos Nucifera Oil, Hydrogenated Lecithin, Butyrospermum Parkii Butter, Hydroxyethylcellulose, Squalane, Carbomer, Xanthan Gum, Sodium Carbomer, Ceramide 3

Cerave

Purified Water, Glycerin, Ceteareth-20 and Cetearyl Alcohol, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate, Cetearyl Alcohol, Cetyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Petrolatum, Dimethicone, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Disodium EDTA, Phenoxyethanol, Methylparaben, Propylparaben, Phytosphingosine, Carbomer, Xanthan Gum

Cetearyl Alcohol, petrolatum, parabens Physogel

Free from perfume, propylene glycol, lanolin, paraben, color

pH not disclosed

 

 

 

 

 

 

Cerave

Free from perfume, propylene glycol, lanolin, color

pH not disclosed

Cetaphil moisturizing cream

Functions: Occlusive, humectant

Number of ingredients: 20

Water, glycerin, petrolatum, dicaprylyl ether, dimethicone, glyceryl stearate, Cetearyl alcohol, prunus amygdalus dulcis (sweet almond) oil, PEG-30 stearate, tocopheryl acetate, acrylates/C10-30 alkyl acrylate crosspolymer, dimethiconol, benzyl alcohol, phenoxyethanol, methylparaben, propylparaben, glyceryl acrylate/acrylic acid copolymer, propylene glycol, disodium EDTA, sodium hydroxide Parabens, propylene glycol, Benzyl alcohol is a natural grape preservative and scent, Petrolatum, cetearyl alcohol may irritate, Sodium hydroxide is to modulate pH of product and can be an irritant Free from lanolin, colorpH not disclosed
Cetaphil intensive moisturizing cream

Functions: Occlusive, humectant, repair

Shea butter is a plant lipid, Chlorhexidine to reduce bacteria

Number of ingredients: 15

 

Water, glycerin, PEG-2 stearate, cetearyl alcohol, Butyrospermum parkii (shea butter), ethylhexyl methoxycinnamate, oleth-12, dimethicone, stearyl alcohol, glyceryl stearate, PEG-100 stearate, methylparaben, tocopherol, arginine PCA, chlorhexidine digluconate Parabens, Cetearyl alcohol may irritate Free from lanolin, propylene glycol, fragrancepH not disclosed
Cetaphil RestoraDerm Eczema Calming Body Lotion

Functions: Occlusive, humectant, repair

Number of ingredients: 28

Water, Glycerin, Caprylic/Capric Triglyceride, Helianthus Annus (Sunflower) Seed Oil, Pentylene Glycol, Butyrospermum Parkii (Shea Butter), Sorbitol, Cyclopentasiloxane, Cetearyl Alcohol, Behenyl Alcohol, Glyceryl Stearate, Tocopheryl Acetate, Hydroxypalmitoyl Sphinganine, Niacinamide, Allantoin, Panthenol, Arginine, Disodium Ethylene Dicocamide PEG-15 Disulfate, Glyceryl Stearate Citrate, Sodium PCA, Ceteareth-20, Sodium Polyacrylate, Caprylyl Glycol, Citric Acid, Dimethiconol, Disodium EDTA, Sodium Hyaluronate, Cetyl Alcohol Cetearyl alcohol may irritate Free from perfume, lanolin, propylene glycol, paraben, colorpH not disclosed
Ezerra cream

Functions: Occlusive, humectant, repair (contain antihistamine for itch relief)

Number of ingredients: 17

Water, Oleic/Linoleic Triglyceride, Saccharide Isomerate, Hydrogenated Polydecene, Pentaerythrityl Distearate, Glycerin, Cetearyl Alcohol, Dimethicone, Spent Grain Wax, Butyrospermum Parkii (Shea Butter) Extract, Argania Spinosa Kernel Oil, Phenoxyethanol, Sodium Stearyl Glutamate, Acrylates/ C10-C30 Alkyl Acrylate Crosspolymer, Ethylhexylglycerin, Octadecyl Di-t-butyl-4-hydroxyhydrocinnamate, Disodium EDTA Cetearyl Alcohol may irritate Free from perfume, lanolin, paraben, propylene glycol, colorpH not disclosed

MarcieMom’s take:

On 1st generation moisturizer – The low cost emollient tend to perform mainly occlusive function, with ingredients such as petrolatum, paraffin and emulsifying agent to thicken the moisturizer. If you don’t have sensitive skin, or patch tested not to be affected by these ingredients, basic creams can help prevent moisture loss. However, if you have eczema skin, it is not suitable as these mosturizers tend to be more alkaline than our skin pH and the ingredients may irritate your skin. There is also no ingredient in these creams to help repair your skin barrier.

Pros: Low cost, perform basic occlusive function

Cons: Irritate sensitive skin, drying for skin for alkaline products, no skin barrier repair function

On 2nd generation moisturizer – If water is the first ingredient, it is likely that preservatives have to be used to keep the product from spoiling. Paraben is the ingredient that has received a lot of negative press due to its linkage with cancer. This is not proven but paraben is one of the more common irritants. Other names for parabens from (Derm Net NZ) are:

Methylparaben
Ethylparaben
Propylparaben
Butylparaben
Benzyl-parahydroxybenzoate (p-hydroxybenzoate)
Methyl-parahydroxybenzoate (p-hydroxybenzate)
Ethyl-parahydroxybenzoate (p-hydroxybenzoate)
Propyl-parahydroxybenzoate (p-hydroxybenzoate)
Butyl-parahydroxybenzoate (p-hydroxybenzoate)
Parahydroxybenzoate (p-hydroxybenzoate)

I like to look at the number of ingredients and the absence of common irritants when comparing second generation moisturizer. For the same price range, I’d prefer to choose one with fewer ingredients and less irritants to reduce likelihood of irritating my eczema child’s skin. Another way is to rotate your moisturizer (in the hope!) to reduce the duration which your skin is exposed to the irritant.

Pros: Hydrate skin, some brands are affordable

Cons: Granted for the price range, you may not get ingredients like ceramides, lipids that repair your skin. But don’t choose one with many ingredients or irritants.

On 3rd generation moisturizer – These more costly moisturizers are less likely to have irritants (still check though, don’t take for granted!) but whether it is worth the price is another matter. % of ingredients is not listed and the stability of how long the reparative function last is not known. Personally, I use these on weeks where my child’s skin tend to be persistently dry or itchy despite moisturizing regularly with 1st & 2nd generation moisturizer.

Pros: Repair skin

Cons: Cost prohibitive + paying so much means you want to be sure that ingredients are not common irritants

I have to admit that this post is a very amateur attempt to analyse skincare products. Many websites that specialize in skincare products do a much better job, such as Paula’s Choice and EWG’s Skin Deep. What I hope to have helped is a way for lay(mom and dad) to make sense of products’ ingredient list and choose a better product for your child. I’d be contacting the brands mentioned in this post and see if they have more to add on their products. (If you don’t see updates or comments in this post, it means the brands mentioned have not responded.)

Skin Expert Tips on Selection of Moisturizer

In June 2015, there was an eczema public forum held at the National Skin Centre Singapore and one of the talks wasMaking the Right Choices for Your Skincare – Expert tips on Selection of the Right Moisturizer and Skincare Products” by A/P Professor Giam Yoke Chin. There was a segment of her talk where she shared about the evolution of moisturizer and what key ingredients are in them.

Seeing the high level of interest that the audience had in moisturizers, I’m inspired to write a post on the common moisturizers found in pharmacy (in Singapore/Asia as some brands are marketed under different brand names in the US/UK). So this 2-post series is mix of what I’ve learnt in Prof Giam’s talk and my own compilation of moisturizer’s ingredients; let me know (in the comments) what moisturiser has worked for you/ your child with eczema!

10 Moisturizer Selection Tips

We are blessed with many dermatologists and skincare experts sharing their views on moisturizer in this blog, here are the 10 Moisturizer’s Must Know I’ve learnt from them:

Selecting a right moisturizer can be tricky and confusing! Here are 10 selection tips, suited for those with eczema or sensitive skin

Selecting a right moisturizer can be tricky and confusing! Here are 10 selection tips, suited for those with eczema or sensitive skin

1. Labeling such as the term natural‘, ‘hypoallergenic‘, ‘organic‘ (if no certification is mentioned), ‘dermatologist-tested’ (one dermatologist is also ‘dermatologist-tested’), ‘for sensitive skin’, ‘for baby skin’ are unregulated and up to the product company to define.

2. The fewer the ingredients, the less likelihood for hypersensitive skin reaction

3. The first ingredient has the highest content – typically, if it’s water, it means it’s lotion form. Having water in the ingredients will mean requiring preservatives to keep it from spoiling. A lotion/cream can deliver the ingredients to the skin faster as it’s easier to be absorbed vs ointment that’s longer lasting.

4. Use product within expiry date and period after opening date

5. Do not use moisturizer that is too expensive to use of sufficient amount for your skin (Eczema skin requires quite a lot of moisturizing!)

6. Avoid top irritants in a moisturizer such as perfume, fragrance, preservatives, parabens, propylene glycol, lanolin, colorant/dye, sodium lauryl sulphate

7. Moisturizers should hydrate your skin. if you’re not able to apply it frequently, you may want to opt for ointment (for longer lasting effect). If you can apply frequently (and depending on the weather/season), a lotion/cream may feel better on hot, humid days. Look out for ingredients such as cross-linked hyaluronic acid, sodium salt of pyrrolidone carboxylic acid, panthenol, salicornia extract, glycerin, amino acids and urea that can hydrate your skin. These are typically called natural moisturizing factors, referring to moisturizers with humectant property that attract water from environment to the skin.

8. If you can afford, use moisturizer that has the ability to repair the skin barrier. These ingredients that help restore the skin barrier, especially in increasing the ceramides, fatty acids and cholesterol in skin which is deficient for those with eczema.

9. Select products that are close to the skin pH which is slightly acidic from 4.6 to 5.6. The more alkaline a product, the more drying it is for the skin. It has been studied that the skin pH can affect enzyme balance on our skin and the more alkaline a product, the less enzymes are produced that are able to increase our skin’s ceramides and lipids. Reduced ceramides lead to our skin not being able to protect against skin inflammation and bacteria.

10. There are creams that have ingredients to reduce itch, inflammation and bacteria, for instance, antioxidants, oatmeal, acetyl-hexapeptide-15 and honey.

References:

Skin pH with Dr Cheryl Lee – Over Acidic or Over Alkaline

Skin pH with Dr Cheryl Lee – Eczema and Skin pH

Sensitive Skin Product series with Dr Verallo-Rowell and Laura Verallo Rowell Bertotto – How many ingredients

Sensitive Skin Product series with Dr Verallo-Rowell and Laura Verallo Rowell Bertotto – What ingredients to avoid

Sensitive Skin Product series with Dr Verallo-Rowell and Laura Verallo Rowell Bertotto – Understanding ingredients and patch test

Science of skincare products with Dr Elisabeth Briand – Eczema Supportive Care

Science of skincare products with Dr Elisabeth Briand – Stability 

Science of skincare products with Dr Elisabeth Briand – Safety and Product Expiry Date

Reinforcing amount to moisturize eczema child with Dr Jeff Benabio

International Dermal Institute – Repairing Ingredients

Dermascope – Healthy skin starts with a healthy barrier

Science of Skincare Products – Eczema Supportive Care

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me again for this last part of our skincare products. Ive covered in this blog that moisturizer has preventive effect on eczema and for those with eczema, moisturizing frequently is able to reduce the use of corticosteroid cream. What I would like to focus in this interview is whether the type of cream, how we apply and when we apply will make a difference in the functions of the moisturizer.

MarcieMom: We are aware that the more liquid a moisturizer is, the shorter time it will last but it is more comfortable to apply than an ointment (which has little to no water content), especially in hot and humid weather like Singapore or during summer. Does the nature of whether it is lotion, cream or ointment affects the efficacy of the skincare product? For instance, does being lotion meant it is more easily absorbed and being ointment meant it will be longer-lasting?

Dr Elisabeth: Many kinds of products are indeed available to help and promote skin health. The same principles as those described earlier work for all of them: products with few ingredients and safe ones will be better for sensitive and fragile skins.

Various kinds of products will, as you said, give different kind of feel and the aim may (or may not) be different as well. The purpose of the two products is different, while ointment is often used to bring a lot of fatty acids the skin and add an occlusive layer to reduce the TEWL (Transepidermal Water Loss or water that is lost through the skin), cream is more used to bring water to the epidermis, as well as other hydrophilic compounds that could be of interest. Creams bring also hydrophobic compounds (fatty acids, hydrophobic active ingredients, …) but to a lesser extent.

The long-term efficiency of a product will depend on how it is structured and how quickly the compounds are delivered to the skin and absorbed. For ointment, they generally have an occlusive layer that will remains on top of the skin, which is the purpose of these ingredients so that it can prevent water to evaporate from skin. So the feel it gives and that specific function will last for a rather long time. On the contrary, water and active compounds are delivered quickly and evaporate or absorbed quickly by skin. As a consequence, the moisturizing feel disappears rather quickly

One of the achievements that may be reached by using innovative structure is to make cream that have a feel comparable to a classical cream, but will display a long-lasting delivery of the active ingredients, and then combined some of the advantages from an ointment (long-lasting relief and effect) and from a classical cream (pleasant feel, bringing water to the skin).

Skincare Moisturizer as Eczema Support

MarcieMom: The other bigquestion that all parents have is each skincare company claims that their product is able to hydrate, build the skin structure better. These typically belong to the group of moisturizers that contain ceramides or have the ability to restore the skin lipids. In your view Elisabeth, is there certain characteristic (such as ingredients or process) that will differentiate a category of moisturizer as being better at restoring skin functions than others?

Dr Elisabeth: Efficiency is claimed by all companies, of course, because all products will bring the element that will help skin moisturizing, at least in the short term. It is clear however that some products will be more efficient than others; just like some products will have better feel than others etc. As mentioned in our previous discussion, this is why scientific innovation and knowhow comes into play: in our view, they are the key to make better, more efficient and safer products

Ceramides are indeed one of the components that enter in the composition of skin membranes and seems to play a role in its restoration. There are however several types of ceramides and all of them do not seem to display the same efficiency according to various recent publications. What will help skin to be restored is to protect it from threats, and nourish it with proper ingredients. A general appellation of Natural Moisturizing Factor has been created to describe these ingredients that can play a positive role in skin restoration. Ceramides are only one of them. For example, vegetal oils are mainly made of fatty acids that interact with skin cell membrane and help it to be “nourished”. Some of these oils also have additional compounds that will play a positive role. Glycerin, urea, aminoacids, cholesterol, and many other ingredients can play a role in restoring skin functions. What is important is to determine which ingredients will be helpful in a specific situation, and how you can maximize the efficiency of this ingredient in the molecular structure that you create inside the product.

MarcieMom: Readers of this blog are familiar with basic skincare, such as moisturizing right after shower and making sure to moisturize enough. Either due to cost or belief of effectiveness of certain way of moisturizing, some parents may

  • apply brand A moisturizer in the day, and brand B at night; or
  • apply brand A on certain days of the week and brand B on others (or alternate by weeks);
  • apply brand A (a lotion) and brand B (an ointment) over it.

In your view, which is the skincare moisturizing method that make sense? For instance, with constraints that many families have, such as budget and time to moisturize (e.g. child in school or simply to reduce the number of times moisturizing is needed).

Dr ElisabethA daily moisturizing routine is indeed driven by various factors, lifestyle included. A product can be efficient, but if it is a hassle to use it, it won’t be used properly and will become inefficient. I would say there is no “you have to” routine, just find one that is working for you. If you keep in mind the principles I already described: using efficient products with few and safe ingredients, you can find what works the best for you. And it may be completely different from what works for another person. And it can be the same product or products for a very long period of time. Regularly changing skincare products from time to time can be a good idea when you are using products that contain a lot of ingredients. or that contain an ingredient you are slightly sensitized to. So you will give a rest to your skin that would otherwise be exposed to some ingredients that could become unhealthy with time and regular use.

MarcieMom: Many eczema sufferers feel that rotating the emollient seems to make it more effective than always using the same emollient. Is there some basis for that?

Dr ElisabethThe efficiency of a product is determined by its ability to bring what is needed by the skin to be protected to help restore its functions. Rotating products can be a way to bring various efficient ingredients that are not found in only one products. But as I just mentioned before, there can be other reasons that can make an emollient less efficient, so you have to switch from it for a while. Some ingredients can lead to some sensitization of the skin. Not strong enough to give a rash, but strong enough to lead to some irritation if used over long periods of time, that would explain why a product would become less efficient. Reducing the number of ingredients can decrease this risk and in that case, your emollient will work for a longer time.

Thank you Elisabeth of being ever so patient in this series of interviews on skincare products, tackling specifically the science behind it. It is truly enlightening and practical!

For all interviews under this Science of Skincare Products series:

Science in the Bottle

Safety and Product Expiry Date

Stability

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Science of Skincare Products – Stability

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for sharing with us your knowledge on skincare products. So far, we have covered the basics of the ‘science’ in skincare formulation and safety, expiration of skincare products. Today we are learning about the concept of stability in a skincare product.

Is it possible that a moisturizer has not spoilt but is no longer effective? Is technology required to hold the ingredientstogether to be stable?

Stability in Skincare Product ingredients

Dr ElisabethGenerally yes. The best skincare products can be quite sophisticated, “high tech” products, so if the structures that hold the different ingredients are degraded, then there can be a significant loss of efficiency. To make a parallel, if you stomp onto your mobile phone and it is crushed, you will still have all the components of the phone, but the structure will be destroyed and the phone may not work any more! Using industrial processes enable to make structures that will increase the stability of a product. You will not be able to achieve these structures with a bowl and a mixer. A lot of scientific and industrial knowledge is necessary to make products that will last for a long period of time.

At Skintifique, we have developed products that have very novel internal structures, which is what give them distinctive properties, be it for moisturizing the skin, protecting it from common allergens and irritants such as Nickel and other metals, or providing long lasting moisturizing and soothing.

MarcieMom: Any tips for parents to make sure that they are buying a product that is safe and stable and not using one which has stopped being so?

Dr ElisabethChoosing a product that is safe and efficient is a major concern for parents and people with sensitive skins. The first tip I would recommend is to choose skincare with the least number of ingredients. No ingredient is completely safe for everyone, and by reducing the number of ingredients you are exposed to, you minimize the probability your skin will react to one of the constituents. So in that case, fewer means safer. Of course, the better known the ingredients, the safer the products: a skincare product that would only contain 8 ingredients but 3 of which no one has ever heard of, or used in a skincare, would not necessarily be the safest choice…

I would recommend buying skincare from a brand you trust and that must fulfill stringent regulation. It can be established brands but also new ones (and as a representative of a new brand, I can only emphasize that some new brands can be even safer and better than established ones!), a keypoint is : do I trust this brand or do I have reasons to? Of course, one sometimes needs to try new products, if only to get better benefits than with current products, so then another keypoint is: can I make a test, eg buying initially 1 tube, or getting a sample etc. Some tips can help to reassure about the professionalism of a company: is there an easy way to contact them, are there some credential that tell you who is behind, are they prone to answer your question to one of their products, are their products manufactured in reliable places

Use products that have been designed for sensitive skins or children. They have been assessed by independent experts in toxicology with more stringent criteria, especially in the EU.

Since 2013, there is a new regulation (european cosmetic regulations) that have clarified what is necessary for a product, and fair labeling is a major part of it. Evidence has to be provided before a product can be labeled as suitable for children and sensitive skin. An independent toxicologist expert is mandated to consider all the evidences claimed for a product. What is not done yet is a previous approval of cosmetic product before it is commercialized, but you have to give all these information as soon as a state authority requests it. So if you are a serious skincare company, you have all the tests done, certificates needed and so on in a « cosmetic file » that is ready to be consulted by state authority. There can always be untrusted company that are selling  products with not all the tests made but if it is discovered, consequences can serious…
What is not described in the regulation is the exact method and tests you have to performed to build your evidence, but some consensual recommendations are coming out from bench of experts in toxicologist. As an example, one of these recommendations is to use much more stringent safe limit for a product destined for a child. To illustrate it, this is roughly how is estimated the toxicology profile of a cosmetic product for an adult and a child:
To determine if a product is safe for an adult and how much of this product, at the maximum, it is advised to applied on skin, you determine the exact concentration of each ingredient, and how much of each of these compound is applied on the skin. You have toxicological profile for each ingredient allowed in cosmetics, with the maximale dose at which it is not toxic. The limit of exposure for each of the component of the cream is determined, and the maximum amount of a skincare that can be applied daily is determined by the ingredient with the lower dose of exposure allowed.
To determine if a product is safe for a child, you make the same analysis, but with more stringent criteria. For exemple, the maximale dose of each ingredient allowed per day is divided by a factor of 2.3 and since you have to take into account the various mass of people (generally a factor 12 between a child and an adult), the overall factor of safety is about 27 compare to a product designed for an adult.

As long as it is within the expiry date or period after opening (PAO), and unopened, it should be safe, but as soon as the product has changed in color, odor, aspect, throw it away.

Thank you Elisabeth – now we all know what to look out for especially when most of us have so many creams and lotions at home for our eczema child and after keeping for some time, we struggle whether to throw it out or still use it.

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Science of Skincare Products – Safety and Product Expiry Date

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me again for this series. Im looking forward to this interview as its focused on safety and stability. Quite a few times I look at a product and wonder what will happen after the expiry date, and if it will spoil without visible change.

MarcieMom: Lets first discuss expiry date. How is this expiry date determined? Is there a real need for an expiry date, as in will certain ingredients really spoil?

Dr Elisabeth: Every product sold in established market must pass mandatory regulatory requirements that are essentially designed to ensure safety of the products for consumers. Expiry date of a product is one of the aspects that is often covered by regulatory requirements. I will talk here more about products produced or sold in European Union, which is one of the most stringent worldwide. It means the product must pass several tests that prove it will not spoil during that period of time.

To ensure the safety of a product, you can strictly follow the regulations that are mandatory, or you can also add extra care to that aspect. Regulation is the minimum required, and you can always do better by putting yourself higher internal requirements.

In products produced and/or sold in E.U., you can have two mentions of expiry, one is an actual expiry date, and the second one is Period After Opening or PAO.

If a product has passed tests that will prove it is stable for at least 36 months, expiry date is optional, but you have to indicate how long this product can be used safely after it has been opened. 

Period after opening symbol skincare

Period-After-Opening Symbol

Some other products will display an expiry date. There are multiple reasons to indicate an expiry date. It can be because

  1. the products did not pass the test for a period corresponding to three year/ 36 months,  
  2. it has not been tested for this long period of time or
  3. it has passed the test for that period of time, but for various reasons, it has been decided to shorten its shelf life.

In the last case, the reason behind is often to ensure a maximum of safety. The tests that mimic product aging are well known and well controlled but are still tests. Real life can be quite different than what has been modelized in a lab, and adding an expiry date is a way to ensure a maximum safety for customers.

Using a product for a longer period that is indicated may not be necessarily harmful, and the product can still be good, but you are on your own. There is no data to support the fact that it is safe or not…

Safety and Expiry Date in Skincare Product

MarcieMom: I suspect that an organic skincare lotion I bought may have got bacteria because after a few weeks of using, my daughter developed impetigo (or of course, the impetigo could simply be a complication from eczema and the scratching everywhere). What are the factors that increase the chance a skincare product will spoil? Is it the type of ingredients, where they are made and flown to, or what temperature they are kept in?

Dr Elisabeth: A serious skincare company will take great care of offering products with the best quality, to avoid risk of products spoiling.

The first factor that will induce spoiling of the product is the quality of raw ingredients used in the product and the quality of the manufacturing process. Having strict controls over these factors will help to avoid problems of contamination and oxidation, which are the most frequent causes of product degradation.

The quality of raw ingredients is obviously essential, as any contaminant present in the ingredients with contaminate the final products. Another source of contamination can be the material that is used to manufacture or package the product. Finally, the last main source of contamination is humans that work on the preparation of the cream. They must take great care of personal hygiene before working (washing hands, using single-use gloves, round cap and masks) and only do so under the highest safety and quality standards. The preservatives used in the skincare provide a good reassurance and generally protect the products reasonable well, but reducing the amount of microbiological contamination from the start, ie from the moment the ingredients are sourced and they are manufactured, is the best way to avoid spoiling later on. In E.U., manufacturers of skincare have to follow “good manufacturing practices” regulation, and at Skintifique, for instance, we have applied extremely strict criteria when choosing our suppliers of raw materials and our industrial partners, precisely so as to have the highest assurance on the quality and safety of our products

Stability tests are made to ensure a safe use of the product, but as I said earlier, these tests are designed to mimic quite standard situations. Real life conditions can be harder than what has been modelized. For example, sunscreen creams that have been forgotten in the car on a back sit, and stayed for a long time in a very warm environment, under the sun, have experience several cycles of heat/cooling, which is one of the harder conditions a skincare product can experience. These conditions exceed what have been tested in a lab, and the product can go bad earlier than what is said on the packaging. To ensure that a product will not spoil, you should keep them away from heat and UV. Putting them in a fridge can help keeping them, but may induce a change in the structure of the product (its texture won’t be the same).

MarcieMom: Thank you Elisabeth for sharing about safety and expiry dates of skincare products – next time when I’m offered the chance to visit a skincare company’s plant, I shall look out for these areas! Next week, we will touch on the stability of a product. Can’t wait to learn more!

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Science of Skincare Products – Science in the Bottle

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me for this series. I’m really excited about it because most parents (me included) wonder the differences between skincare products and whether it’s better to get one from a company with the ‘science’ background (or home-made is better).

Let’s start with what’s in the bottle – the ingredients. From a previous interview series, we have learned a few general principles relating to skincare products, to choose those

  1. Without the common irritants, such as fragrance, preservatives, parabens, propylene glycol, lanolin and dye
  2. With as few ingredients as possible, to reduce the likelihood of sensitivity to ingredients
  3. Whether labeled as natural or organic, the overriding factor is whether these ingredients lead to hypersensitive reaction for our skin

Science in skincare product bottle

MarcieMom: How is the selection process of ingredients determined? For instance, is there always a need for a ‘base’ for a skincare product and then add on active ingredients? Do these ingredients have to work together?

Dr Elisabeth: The choice of ingredients is indeed key to develop a skincare product. Some ingredients will be chosen for their activity, some others for making a support for these active ingredients. Ideally, a very strict and rigorous selection process should be carried out. Each company has its own priority for this; for instance, some will prioritize on ingredients they believe give a distinctive feel (texture, fragrance) when applying a product, some others will focus their research on how improving the efficiency of a product by using one specific ingredient. At Skintifique, we focused on a new innovative approach: using both a minimum number of ingredients and very safe ingredients. Making a product safe, efficient and pleasant to use within these constraints require a lot of skills and knowledge in various fields (physic-chemistry, formulation, microbiology and pharmacology).

One way to make a skincare product is to add a set of ingredients with a specific function (eg moisturizing, or protecting the skin from specific allergens or irritants) to a “base” that has a well-known profile of safety, texture and efficiency. In that case, the base will bring the safety and the basic functions a moisturizer must have (generally, humectant, emollient and occlusive function, it sustains stability and safety tests) and the added specific ingredients will bring the specific features of a product (soothing, …).

At Skintifique, we have focused our work on how developing new materials that will enable the use of very few ingredients while maximizing their effects. It means developing products with a new approach, based on how molecules can interact with each other. That’s why the composition of our products may seem very simple, but the products are actually based on very sophisticated science, both in the base(s) that we use, in the functions we add to them and in the ability to mix these functions into the base.

MarcieMom: There are various functions of an emollient/moisturizer.

  1. Occlusive, as protection for the skin
  2. Humectant, the ability to draw water from the environment into the skin
  3. Moisturize, smooth the skin and fill in cracks

MarcieMom: I noted that your product has patent technology. Does a patent technology that enable the functions of the moisturizer to be better than non-patent technology? In other words, what is it about being developed in a lab that makes the skincare product more effective than just the sum of ingredients?

Dr Elisabeth: A lab facility is required when you want to make innovative products.

Developing a skincare product can be done rather easily if you are looking for a product with basic moisturizing functions or just a feel good benefit. There is a long history in the process of making a cream and the principles that drive the stability and the efficiency of classical moisturizer are rather well known.

If you want to add extra features to a product, for example a release in time of active ingredients, a longer stability, or something revolutionary such as having a activity that reflects the needs of the skin (eg the cream is more active when the skin needs it), while using a very low number of ingredients, then you have to think differently of how it is traditionally made. It requires a lot of research. This is the type of products we strive to do at Skintifique and that is why we protect, with patents and otherwise, the technologies that are used in our products. To achieve the development of our products, we have to make numerous tests and iterations that are possible only in a lab. We needed specific equipment to process and also analyze the various formulations.

It is a little bit like in cooking. Using eggs, flour, milk and sugar, you can make simple cakes (which will not harm you if you eat them, but which will not provide anything special in terms of taste and feeling), or you can also achieve a new culinary chef d’oeuvre, if you put a lot of knowledge, expertise and skills only a chef can bring in making it.

MarcieMom: Can you briefly describe the key processes to make a skincare product from sourcing to making the final cream/lotion. How is it different for a company like Skintifique versus say, a company that does not have the laboratory or facilities?

Dr Elisabeth: The general process to make a skincare product is simple at high level: decision on what the properties of the skincare should be and how to make it (e.g. a highly moisturizing product with few ingredients for people with sensitive skin vs a skin tanning product for fun), then identify, or invention of, the best technologies to do the product, including choice of raw ingredients that must fulfill strict criteria in terms of safety and purity, then a lot of trials in the lab and with real life volunteers, then industrial production, quality check and then, commercialization. For serious skincare companies, quality is a major priority and a lot of quality-check procedures are made all through the process (raw ingredients, industrial process, finished products…)

Making innovative products requires a lot of research and development work, and the results will condition the industrial process. For instance, using only a few ingredients to make a product like our Hydrating Gel requires modifying a lot the various steps needed to process a product. That is why a strong effort is made both on the invention work in the lab and on industrial scale-up phases. For more classical cream, this scale-up process is less critical.

MarcieMom: Thank you Elisabeth for helping us in this post – it is enlightening as we now understand the key components of a skincare product and how having technology and laboratory affects the final product. I look forward to next week’s interview where we learn more about the safety and stability of a product.

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Eczema News – Testing Water Evaporation from Skin for Babies

I shared in this post (and the comments) that moisturizing has been studied to have a protective effect over eczema. Similarly, Dr Cheryl Lee MD shared in the Skin pH interview series that moisturizing from 3 weeks of age has been shown by Simpson et. al., to be a safe and effective time to start moisturizing the skin of a newborn who is at high risk of developing atopic dermatitis. 

The question is it is not always clear whether the baby has high eczema risk. If a baby can get a non-invasive test and parents are then alerted to moisturize their baby early, many babies can have a chance of not suffering from eczema. More about this test:

EST SKIN prevent eczemaTitle of study: Skin barrier dysfunction measured by transepidermal water loss (TEWL) at 2 days and 2 months predates and predicts atopic dermatitis at 1 year.

Method: Measure water evaporation in the skin of 1,903 newborn babies in Cork University Hospital, and followed them up until 12 months of age.

How: Small probe placed on the child’s arm to measure the level of water evaporation at day 2 and 2-month & 6-month old.

Results: A higher water loss at 2-day and 2 month strongly predict eczema at 12 months.

There are also other risk factors, such as family history and whether there is a low level of the filaggrin gene. Similarly to what I have posted before on the outside-in hypothesis, Prof Hourihane said that prevention of eczema may also prevent the development of asthma and food allergy, which are strongly associated with eczema, because the allergens get through the broken skin and cause the development of allergies. This view is also shared in Dr Cheryl Lee’s interview here.

This study is only published in 22 Jan 2015, I’m interested to see if this test will be adopted by pediatricians. Maybe you can bring this up to your doctor to see if such a test can be arranged for your newborn! If you did talk to your doctor, let me know the response so that other parents can benefit from it.

Skin pH with Cheryl Lee Eberting, M.D.– Eczema and Skin pH

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

This is the 5th and last post of Skin pH series: Read the 1st post on Understanding Skin pH and its Impact here, 2nd post on Overly Acidic and Alkaline Skin here, 3rd post on Diet, Environment on Skin here and 4th post on Moisturizing and Skincare Products’ impact on Skin and Skin pH here.

We are privileged to have Board Certified Dermatologist Cheryl Lee Eberting, M.D. again for this 5-week skin pH series. Read more on Dr Cheryl Lee here. Dr. Eberting invented the TrueLipids skin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.  Dr. Eberting’s expertise in treating eczema  has led people to come from all over the world to seek her care and to the development of a dedicated eczema care clinic online.

MarcieMom: Thank you Dr Cheryl Lee for being with us for the past 4 weeks and today, we focus on eczema skin – a topic which parents/readers of this blog would most certainly be keen to find out!

Eczema and Skin pH

MarcieMom: I read that alkaline pH is associated with skin dryness. Since eczema is characterized by skin dryness, does this mean all eczema skin is too alkaline? Came across a study that even the uninvolved skin of eczema adults have higher alkaline pH than those without eczema. It was stated as 6.13±0.52 on the eczema lesions, 5.80±0.41 on perilesional skin and 5.54±0.49 on uninvolved skin. In the control group, the mean pH of the skin surface was 5.24±0.40.

Dr Cheryl: Yes.  If you have dry skin, eczema, a rash, or an infection on your skin, then the pH is too high.  In atopic dermatitis, there are 7 major problems that lead to the abnormal skin barrier and they are all interrelated with each other.  The problems are as follows:

  1. Skin lipid deficiencies (phytosphingosine, phytosphingosine-containing ceramides like Ceramide 3, cholesterol esters, and very long chain fatty acids have been shown to be particularly deficient in atopic skin, dry skin and aged skin).
  2. Excessive loss of water due to skin lipid deficiencies. (white petrolatum in the gold standard water loss inhibitor.  Paraffin is likely even more effective than petrolatum however.  Certain lipids have also been shown to be very good at inhibiting water loss.  The lipid isostearyl isostearate is one of the most effective lipids as preventing water loss from the skin.
  3. Abnormal pH (partly caused by the lipid deficiencies above, but also then CAUSES a lipid deficiency because the enzymes that make epidermal lipids only work within the optimal skin pH range)
  4. Susceptibility to infection (caused by the lipid deficiencies—some of these lipids are anti-staphylococcal—and caused by the overly alkaline pH).
  5. Inflammation (cause by lipid deficiencies that cause desiccation and entrance of allergens and infection into the lower levels of the epidermis which then leads to infection.)
  6. Allergy (atopic skin is susceptible to allergic contact dermatitis to certain chemicals at higher rates than non-atopic skin.  This is also a result of all of the above problems.)
  7. Abnormal calcium gradients.  (The epidermis has calcium gradients that lead to lipid production and to normal cell cycling.  In atopic dermatitis, these gradients are disrupted and contribute to lower levels of lipid production and dysfunctional cell cycling.)

These 7 problems are present in the entire skin barrier of an atopic and this is why is it so very important to focus on skin barrier optimization that addresses all 7 of these problems simultaneously.

MarcieMom: What skincare measures (if any) should parents of eczema children take to help the child’s skin to reduce its alkalinity?

Eczema and Skin pH - Steps to take

 

Dr Cheryl Lee:

1. Bleach Baths Really Work:

As I discussed in this post, I think bleach baths work as part of the eczema skin care regimen, but they also alkalinize the skin a little bit too.  The target concentration of a bleach bath is .005% hypochlorite ion.  Because there are different sizes of bathtubs around the world, it is difficult to just tell you how much bleach to put it.  In the United States, we have a standard-sized tub that most people have in their homes. (And we have ridiculously large tubs too).  For the regular-sized American tub, I recommend 1/8 cup if the tub is 1/4 full, or 1/4 cup is the tub is 1/2 full or 3/8cup is the tup is 3/4 full.  For very mild cases of eczema, bleach baths may not be needed, but if there is any crusting or scabbing, try taking the bath three times a week.  The more severe it is, the more frequently you should take a bleach bath.

Special Trick for Babies with eczema:  If your child will not stay in the bathtub long enough to have an effective bleach bath (about 20 minutes), then try using a large tupperware/plastic container INSIDE your shower for your child to play in.  I recently discovered this on my own children and now I can’t get them to STOP taking a bath (which is bad for eczema too;  too many baths can dry out the skin and make it worse).

Of note, we have always thought that the bleach bath is working because it is killing the Staph. aureus on the skin.  Well, recent studies showed that it is not only the killing of the Staph, but it is also due to the low level oxidation exposure.  When the skin is exposed to very low levels of oxidation, the skin then turns on anti-inflammatory and reparative pathways.  This is totally counter-intuitive, but is very, very interesting and makes me thing that our creator really knew what he was doing!

2. pH-Adjustment After Bathing and After Bleach Baths OR If you Don’t Have Access to Bleach:

After taking a bleach bath, use a pH-protecting gel with vinegar in it or use a vinegar spray diluted with one part vinegar and six parts water to all affected areas.  (white vinegar or apple cider is best—no rice or balsamic vinegar).  This should then be covered with a pH-optimized moisturizer (pH 4.6 to 5.6….a little more acidic may be beneficial, but more alkaline is bad).

Of note, I had a patient come to see me all the way from Cambodia.  When she went home to Cambodia, she was unable to find bleach anywhere.  If this is the case, I have seen similar benefits from vinegar baths (it takes A LOT of vinegar–around 6 cups to a half-full regular American-sized tub).  Or, you can do the vinegar spray or pH-protecting vinegar gel if you cannot take a bath.

3. Moisturize the Skin Barrier AT LEAST Two Times a Day With Skin Barrier Optimizing Moisturizers, But Four Times Works Better and Faster:

I think it is very important to moisturize atopic skin at least twice a day WHEN IT IS NORMAL LOOKING.  When it is broken out AT ALL, I always advise that my patients use their eczema products (we use the TrueLipids Eczema Experts 1% Hydrocortisone Cream followed by the TrueLipids Relieve & Protect Ointment) up to four times a day UNTIL the skin is normal looking.  Once the skin LOOKS and FEELS normal, then my patients switch to the TrueLipids Ceramide+ Cream followed by the ointment twice a day for maintenance.  It is very important to treat ALL affected areas and not just the areas that are scabby looking.  What I mean by this is that even the areas of the body like the stomach and back that may look a lot better that the worst areas on the arms and legs, must also be treated until they ARE normal; normal looking and normal feeling.

The skin on the trunk often has what we call folliculocentric atopic dermatitis where each little hair follicle is more accentuated and is a little bit lighter in color than the skin around it.  This is active disease and needs to be treated just as much as the scabby, inflamed areas do.  The skin on the trunk usually heals much more quickly than does the skin on the arms and legs and, as it heals and goes to normal, the hydrocortisone can be replaced with the Ceramide+ Cream.

4. The Maintenance Moisturization Phase is Just as important as Treatment Phase:

I cannot stress the importance of maintenance moisturization.  Plan on at least twice daily moisturization for the rest of your life.  You must avoid all common allergens in your skin care products too.  There are certain allergenic chemicals that are known to be more common in people who have atopic dermatitis and you should at the very least avoid them.  I will write more about this in a later post.  By optimizing the skin barrier, you can prevent it from breaking down into eczema and can probably also control other allergic diseases like asthma and hay fever too.

5. Wet Wrap Therapy if Your Eczema is Severe:

If your eczema is very, very severe, you will need to do wet wrap therapy where you take your bleach bath, then do your pH adjustment and then wrap the skin in WHITE COTTON (not wrinkle-free type fabric because is often has formaldehyde in it) pajamas or bandages every day.  I have even had a few patients who have needed to do wet wraps during the day too.  Don’t use ACE wraps or anything that has latex or spandex in it as this can be allergenic for atopic skin too.  Once the wraps or pajamas are on, spray them down with water and cover with a layer of dry clothing and go to bed.

6. Break Through Low Dose Steroid Maintenance in Severe Cases:

For more severe cases, once the skin is completely back to normal, I recommend using the TrueLipids 1% hydrocortisone cream twice as part of your maintenance routine.  Studies have shown that low levels of hydrocortisone like this can keep one in remission and prolong time between relapse. Studies have also shown this benefit from treatment a few times a week with Elidel or Protopic, but I do not prefer them as I don’t find them to be very effective, they are very expensive and they are not the safest drugs in the world. (That being said, if you are allergic to glucocorticoids, then Elidel and Protopic can be a lifesaver.)

Also very important is that of glucocorticoid allergy.  Studies have shown that between 24 and 90% of children with atopic dermatitis who are patch tested are allergic to at least one glucocorticoid.  If your child is one who seems to either not get better with hydrocortisone or who gets a little better but then seems to get worse, he/she may be allergic to it.  It is always a good idea in this case to get your child patch tested to see what they are allergic too and to learn what classes of gluccocorticoids that your child can use.

7. Allergen Avoidance and Patch Testing if Needed:

I cannot stress enough how important it is so avoid allergens in your skin care products, soaps, detergents AND in the products that family members are using.  Find a dermatologist who is experienced in patch testing (not prick testing) for allergic contact dermatitis (ACD).  ACD is an allergy to a chemical that is coming in contact with the skin.  For example, fragrance allergy is one of the most common allergens in atopic dermatitis.  If daddy is wearing cologne and baby touches his shirt, this can equal a month of eczema flare for baby.

The whole family needs to avoid the allergen triggers.  In addition to fragrance (which cross reacts with essential oils and many plant extracts), common allergens in atopic dermatitis include nickel, formaldehyde releasing preservatives, propolis (in beeswax), neomycin, bacitracin and more.

Thank you Dr Cheryl Lee for going through with us the factors that affect skin pH with practical steps on what parents can do. It will definitely help parents to be committed to these measures with the right understanding of why to take them. Thank you once again!

Skin pH with Cheryl Lee Eberting, M.D.– Moisturizer and Skincare Products

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

This is the 4th post of Skin pH series: Read the 1st post on Understanding Skin pH and its Impact here, 2nd post on Overly Acidic and Alkaline Skin here and 3rd post on Diet, Environment on Skin here.

We are privileged to have Board Certified Dermatologist Cheryl Lee Eberting, M.D. again for this 5-week skin pH series. Read more on Dr Cheryl Lee here. Dr. Eberting invented the TrueLipids skin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.  Dr. Eberting’s expertise in treating eczema  has led people to come from all over the world to seek her care and to the development of a dedicated eczema care clinic online.

MarcieMom: Thank you Dr Cheryl Lee for helping us understand skin pH and sharing with us last week on what to watch out for in our diet and environment. Today we focus on the skin’s itself and the products we use on it!

Endogenous Factors and Skin pH

I understand that newborn baby’s skin is of higher pH of about 7. Moreover, certain parts of the body is more acidic/alkaline than others.

MarcieMom: What are the key endogenous factors parents should note to help manage the child’s skin pH? For instance, not let sweat stay on skin? What about ethnic and genetics?

Moisturizer and Skincare Skin pH)

 

Dr Cheryl: Babies are born with a relatively alkaline skin pH because they’ve been incubating inside the mother’s more alkaline amniotic fluid.  Newborn skin is covered with an amazing moisturizer called vernix caseosa; a waxy coating that obviously works to make the babies relatively waterproof while in the womb.  Within days of birth, the pH of the newborn skin begins to dry out, acidifies and then the acid mantle becomes intact.  For this reason, it is important to use moisturizers that are in the optimal pH range for babies too.  In a recent preventative study of the infant siblings or children of those who have atopic dermatitis, twice daily moisturization with a hypoallergenic (meaning no fragrances, no essential oils, no plant extracts, no formaldehyde-releasing preservatives, no lanolin, no neomycin, no bacitracin, no methylchloroisothiazolinone) moisturizer in these newborn babies lead to an approximately 50% reduction in rates of new onset atopic dermatitis.   I love this study because it tells us a lot about the connection between our skin barrier and our immune system.  By optimizing your skin barrier and sealing it off from the outside world, and by avoiding as many chemical exposures as possible, we can prevent the immune system from developing the inflammation associated with eczema!

I would also venture to say that this may be the way to avoid asthma as wellWhen allergens come in contact with the skin, then the allergic type of inflammation is turned on.  On the other hand, it has been shown that if you can avoid letting allergens (including foods!) from coming in contact with the skin long enough, then your child’s immune system will build up tolerance to the food when it is presented to the immune system of the gut. What this tells us is that, in susceptible populations, the skin barrier needs a little help as it is maturing. By using a pH-optimized and hypoallergenic moisturizer twice a day, you may be able to help your baby to build an effective skin barrier that is not as overreactive as it is in eczema.  Our skin is truly the window to our immune system and skin barrier optimization (SBO) is extremely important in treating and preventing atopic dermatitis.

As for ethnic variability in the skin barrier, there have been documented differences in relative concentrations of lipids in the skin of caucasian versus asian versus black skin thought the relative ratios are all the same.  To my knowledge, there is no interethnic difference in the optimal skin pH.

Genetics absolutely play a role in the propensity to develop atopic dermatitis.  Conditions like ichthyosis vulgarism predispose one to dry skin, an overly alkaline skin pH and to the development of atopic dermatitis.

As for sweat, the biggest problem is the irritancy of the sweat itself.  The salts from sweat can crystalize and act as an irritant to the skin.  If you can see that your baby’s sweat has dried and has a salty residue, then I would recommend rinsing it off with plain water (no soap) to prevent it from becoming an irritant.  If the sweat is not crystalized, I wouldn’t worry about it much.

Food on the skin; again this is another issue of major importance in atopic dermatitis.  Studies have shown that when food is left on the skin for extended periods of time in early infancy, the child is more likely to develop an allergy to that food.  Be sure to wash your child’s hands and face after eating!

Products and Skin pH

Marcie Mom: Many products are marketed as of ‘skin’s natural pH’ or ‘pH-balanced’. What does this mean? When can a parent start moisturizing baby’s skin (given the pH changes)?

Dr Cheryl: The term “pH-balanced” is completely unregulated and could mean anything—including that the product could actually be alkaline.  The consumer has no way to knowing what the pH of a product is unless they actually test is with a pH meter or if the manufacturer were to put the pH ON the package.  As for the TrueLipids products, we conducted long term stability studies on the pH of our formulations so we know that they are within the optimal range of 4.6 to 5.6 for extended periods of time and even in high-heat environments.  Additionally, many products contain benzoic, lactic, sorbic or citric acids to bring the pH down to the acidic levels.  These acids can sometimes be allergens (sorbic acid and benzoic acid can cause hives when they come in contact with the skin.  Benzoic acid can cross react with those who have fragrance or balsam of Peru allergies which are common in atopic dermatitis) or these acids can act as an irritant if they are formulated in such a way that the acid can precipitate and turn into a salt easily.  The pH system in the TrueLipids products employs and acid called gluconolactone.  I chose this poyhydroxy acid in my formulations because it is not only an effective way to acidify a formulation without crystallization of the acid (in my own experimentation), but it has also been shown to reduce the loss of water from the skin and has anti-oxidant and DNA-repairative properties as well.

As for the appropriate time to start moisturizing the skin of a newborn, the skin of the newborn acidifies within the first few days of life.  Three weeks of age has been shown by Simpson et. al., to be a safe and effective time to start moisturizing the skin of a newborn who is at high risk of developing atopic dermatitis.  In this study, the babies were moisturized at least once a day and 50% fewer cases of atopic dermatitis were noted by the age of six months!  The skin of a newborn acidifies within the first few days of life and so I do not think it is necessary nor beneficial to use a more alkaline moisturizer on a newborn.  It is probably best to leave the skin of brand new babies alone until they are three weeks old.  Of note, studies have shown olive oil to be detrimental to the newborn skin barrier, so it is best avoided.

MarcieMom: Which products are clearly bad for skin due to its pH level? For instance, detergent and soaps? These anti-bacterial products (containing benzoyl peroxide, triclosan, sodium lauryl sulphate and sodium laureth sulphate) help to kill staph bacteria but its pH level (and ingredients) lead to skin irritation. What is the skincare approach to ensure killing staph bacteria adequately without causing skin dryness?

Dr Cheryl: First of all, it is best to limit the use of soaps altogether when possible.  Soap should only be used when needed to remove dirt or oils that don’t belong on the skin.  Otherwise, soaps should be revered for washing of hands and hair when it is dirty.

Soaps, cleansers, shampoos and body washes should all be in the optimal acidic range of 4.6 to 5.6 and should be non-alkaline.  Products that deposit and oil as you use them can also be beneficial.

Avoid any surfactants with the word “sulfate” at the end.  Sulfates have been demonstrated to be very destructive to the skin barrier and remove the lipids from the skin barrier leading it to dry out and to develop allergies to chemicals more easily.

As for optimal soap surfactants, there is a lot of very interesting science that can direct us to make the best choices for our sensitive skin.  Surfactants are designed to remove dirt and oils from the skin, but the problem is that they can also remove the lipids from the skin as well.  This leads to disruption in the skin barrier and exacerbates all the skin barrier problems in atopic dermatitis.

The best Soap to use for atopic dermatitis:

It has been postulated that charged anionic surfactants may be more detrimental to the skin barrier than nonionic surfactants, but it has been noted that nonionic surfactants more efficiently remove stearic acid (a fatty acid in the epidermis) than to anionic surfactants.  Anionic surfactant-based cleansers also alter the lipids of the epidermis more than do the anionic surfactant sodium cocoyl isethionate.  Another factoid about surfactants is that the larger the polar head group on the surfactant, then the less it is able to interact with and remove lipids from the skin barrier.

Of note, a recent study by Belsito et. al., showed that the surfactant cocamidopropyl betaine (CAPB) is more likely to cause allergic contact dermatitis in people with atopic dermatitis than in those who do not have atopic dermatitis.  

I also like to avoid the glucoside surfactants as they are also relatively common allergens in the general population and can cause eczema of the eyelids and hands that can be very tricky to figure out.  I have been working on a cleanser that is optimized for atopic skin and it will be available next spring.  It will have the best surfactants for sensitive skin.

One more little note in regards to cleansing atopic skin; never use anything to scrub the skin other than your hands or a very gentle wash cloth.  Loofah sponges, and scrubbing brushes do not belong on atopic skin (or normal skin for that matter).

Thank you Dr Cheryl for sharing what to look out for in cleaning and moisturizing our eczema child’s skin. Next week, we will focus on Eczema and Skin pH, and how to reduce the alkalinity of eczema skin.

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