In the previous post, we learnt that Gladskin’s eczema skincare products contain Micreobalance™ – a patented smart protein that that actively rebalances the good and bad bacteria that naturally live on eczema-prone skin. This leaves the good bacteria on your child’s skin intact. In this post, we want to ask the questions that will help you to decide whether to choose Gladskin.
This is a 2-week series focused on Gladskin’s targeted approach in improving eczema skin, through maintaining a healthy skin microbiome. I’m honored to have the President of Gladskin USA, Skyler Stein, to help in this series. Read his bio here.
Choosing a Skincare Product – What else other than Killing Bacteria
We know that there are certain problems causing bacteria that are major culprits in eczema, and therefore, Gladskin’s targeted approach to rebalancing the skin microbiome as it moisturizes offers a logical solution that can be used daily.
By contrast, you are less likely to use antimicrobial cleansers daily because you do not want to remove the good bacteria on a daily basis. However, you may have a lot more considerations other than killing bacteria in your skincare product choice, so let’s check with Gladskin’s Skyler Stein on how they decide what goes into their Eczema Cream.
Hypoallergenic is a term that is not regulated, and taken to mean that it is less likely to create an allergic reaction.
MarcieMom: Can you explain what hypoallergenic means to Gladskin – for instance, do you see it as the exclusion of certain ingredients or maintaining a limit for potential irritants?
Skyler Stein: We perform extensive clinical safety testing on our products. For the Gladskin Eczema Cream we performed Repeated Patch Insult Test, 21 Day Cumulative Irritation Testing, and a phototoxicity safety panel on the formulation. In addition, we formulate our product to be free of ingredients that are commonly irritating to eczema-prone skin, including steroids, preservatives, fragrances, drying alcohols, sulfates etc
Interaction of Skincare Products – What Happens when You Use More than One Eczema Cream
MarcieMom: I read on your FAQ page that ingredients in other skincare products may reduce the efficacy of Gladskin. I am assuming that this has to do with Micreobalance™. However, parents may be applying mild corticosteroids on eczema lesions, how would that affect Gladskin? How would you recommend applying steroid cream with Gladskin, for instance, is there an interval to wait before steroids can be applied or should parents apply steroid cream first?
Skyler Stein: Yes, you are correct. The Gladskin formulation is designed to maximize the efficacy of the Micreobalance. It is possible that ingredients in other products may inactivate the Micreobalance. Gladskin can be used in combination with other treatments (i.e. corticosteroids), however, we recommend waiting 5-10 minutes after applying Gladskin to apply any other product so that the Micreobalance has time to work.
MarcieMom: Personally, when a certain cream is expensive and cannot be generously applied on the whole of my child’s body, I may use it as a first layer cream over the skin areas more affected by eczema, followed by a cheaper moisturizer over her whole body. But as I want to reduce the time taken for this routine, I would usually apply the creams consecutively. How would that affect Gladskin? Is there a list of skincare ingredients to be avoided when using Gladskin?
Skyler Stein: We do not have an exhaustive list of ingredients that should be avoided while using Gladskin and it can be the combination of different products that may inactivate the endolysin. This is why we recommend waiting 5-10 minutes before applying any other products. If possible we recommend avoiding preservatives and other ingredients that may have a negative effect on the skin microbiome.
We recommend waiting 5-10 minutes before applying any other products.
Skyler Stein: Gladskin can withstand temperatures of over 100ºF for a week, and 3 months at room temperature. If you plan to keep Gladskin longer than 3 months we recommend storing it in the refrigerator. It’s safe to take with you to the park on a hot summer day, but we don’t recommend keeping it in a hot car for months.
Thank you Skyler for letting us have an insight into how you choose the ingredients that go into Gladskin Eczema Cream and how to use it for maximum effect. It is certainly a novel approach for people with eczema. Gladskin users are seeing really amazing results, often within the first few days of using it. You can read current customers stories at https://us.gladskin.com/pages/reviews
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 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!
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
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
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:
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.)
In June 2015, there was an eczema public forum held at the National Skin Centre Singapore and one of the talks was “Making 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
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.
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.
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.
This 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. Read more about Dr Briand here.
MarcieMom: Thank you Elisabeth for joining me again for this last part of our skincare products. I’ve 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.
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 to 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).
Ceramides in Moisturizer for Eczema, Dry Skin
MarcieMom: The other ‘big’ question 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. Ceramidesare 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 and other Natural Moisturizing Factors
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.
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 Elisabeth: A 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 Elisabeth: The 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!
This 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. Read more about Dr Briand here.
MarcieMom: Is it possible that a moisturizer has not spoilt but is no longer effective? Is technology required to ‘hold the ingredients’ together to be stable?
Dr Elisabeth: Generally 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.
Tips on Buying a Safe and Stable Skincare Product
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 Elisabeth: Choosing 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…
Fewer ingredients means Safer
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 key point 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 key point 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…
EU Regulated Sensitive Skin Product Labeling
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 maximal 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 maximal 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.
MarcieMom: 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.
This 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. Read more about Dr Briand here.
MarcieMom: Thank you Elisabeth for joining me again for this series. 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.
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.
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 36 months, 2. it has not been tested for this long period of time, 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…
Quality of Raw Materials – Product Spoilage
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 on Skincare Product
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).
To ensure that a product will not spoil, you should keep them away from heat and UV.
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!
Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. 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.
This 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.
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
Without the common irritants, such as fragrance, preservatives, parabens, propylene glycol, lanolin and dye
With as few ingredients as possible, to reduce the likelihood of sensitivity to ingredients
Whether labeled as natural or organic, the overriding factor is whether these ingredients lead to hypersensitive reaction for our skin
Skincare Product Ingredients – Active & Support
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.
Functions of Skincare Product Ingredients
Occlusive, as protection for the skin
Humectant, the ability to draw water from the environment into the skin
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.
Development Process for Skincare Product
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 – I just want to let readers 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 could 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!
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:
Title 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.
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 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 TrueLipidsskin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.
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:
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).
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.
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)
Susceptibility to infection (caused by the lipid deficiencies—some of these lipids are anti-staphylococcal—and caused by the overly alkaline pH).
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.)
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.)
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?
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 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 TrueLipidsskin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.
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?
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 well. When 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.
This is the fourth of baby skincare series, focusing on shower. The previous three videos were on Common Baby Rash I Sun Protection for Kids I How to Shower Baby. I NEED YOUR SUPPORT, do subscribe to my EczemaBlues channel here. As I’m just starting out, and camera-shy, the video is my voice over slides that I prepared. Do share your comments pleeease on how I can improve them.
Firstly, for babies with normal skin, it may not be that critical to moisturize (but good practice since baby’s skin is thinner and more susceptible to moisture loss). However, for babies with dry skin or eczema, moisturizing has been studied to reduce the need for topical medication and lessen the severity of eczema.
Many parents ask what is the best moisturizer to buy? In short, there isn’t a best one in terms of formulation but one that your child likes and within your budget to use generously. The functions of moisturizer deal with maximizing moisture for the skin while acting as additional protective layer. Choosing a moisturizer that is without the top irritants is a wiser purchase than starting with the cheapest (and leading to irritated skin).
How to moisturize is also covered in the video, and the main thing to remember is always right after shower. For expert tips on reading skincare product label and moisturizing, click on the links.
Do watch the video for more details and as always, appreciate you sharing your experience, thank you!
Today’s topic is on Moisturizer, does Eczema need the fancy stuff? Any parent with eczema child would have come across moisturizing, after all it is standard treatment of eczema. Moisturizing is a topic that has generated MANY comments among parents, two of the more popular posts are
Many dermatologists have also shared their moisturizing tips on this blog (see the ‘moisturizer’ tag) and some of these are
Sensitive Skincare Product series with Dr Verallo-Rowel and the CEO of VMV Hypoallergenics, Laura – much time had been devoted for this series, and this post is worth printing out and bringing out with her when you shop for moisturizer – Ingredients to Avoid
Topical Treatment, part of Combined Approach series with Dr Bridgett
Today, I want to look at the latest eczema related studies published on moisturizer, with the hope of finding out the type of moisturizer. When doing so, I found this article from National Eczema Association, new insights for moisturizers for skin diseases which have explained
Functions of moisturizer – Occlusive (preventing water loss) and as humectant (helping to attract moisture)
Ceramide-based moisturizer studied to help eczema, but over the counter moisturizer also helps
Natural oil not studied to help, and if using, those with the highest linoleic acid /oleic acid ratios are better, such as safflower oil, sunflower seed oil, and sea buckthorn seed oil (vs olive oil).
So what’s the research on moisturizer?
Improves eczema as reduce inflammation and water loss (here)
Update for a study in October 2014 that has many dermatologists excited because it is the first randomized controlled trial evidence that daily full-body emollient therapy from birth can prevent atopic dermatitis. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention.
Another study in October 2014 that concluded daily application of moisturizer during the first 32 weeks of life reduces the risk of atopic dermatitis/ eczema in infants. Allergic sensitization during this time period is associated with the presence of eczematous skin but not with moisturizer use.
(no specific brand mentioned in studies)
What moisturizer to buy? I think one that you can afford, your child does not object and does not contain the top irritants. What moisturizer are you using? And which ones have you found useful and which ones would NEVER recommend? Do share in the comments, thank you!
Today’s video is “How to get the most from your Skincare Products“. For this video, I’ve interviewed Dr Joshua Zeichner, M.D., who is the Director of Cosmetic and Clinical Research in Dermatology, Mount Sinai Medical Center in New York and board-certified in Dermatology. He is Board Certified in Dermatology and considered one of the country’s key opinion leaders in treating acne and rosacea.
MarcieMom: Dr Zeichner, thank you for taking time to help with this AAD video series.
Cross-Reactivity in Beauty & Skincare Products
For individuals with sensitive skin using multiple products, say facial cleanser, moisturizer and make-up, is there any guideline to ensure that there is no cross-reactive ingredient? e.g. choosing the same brand or ensuring that each does not have certain ingredient?
Dr Joshua: If you are sensitive to skin care products, your dermatologist can perform patch testing, an exam to determine what ingredients you may be allergic to. You should avoid products with those particular ingredients. Unfortunately, you cannot necessarily just stick to one brand because individual products do vary in their composition. However, some brands in general do stick to being fragrance free, etc.
Medication or Moisturizer – Which to Apply First?
MarcieMom: It is recommended to wash the face first, followed by medication, then moisturizer or sunscreen, followed by make-up. What is the interval between applying moisturizer and sunscreen? Does the moisturizer have to dry before applying sunscreen?
Dr Joshua: We do not have great data on this. We do not really know if it is best to moisturize or medicate first. In general, I recommend applying one product in a thin layer, allowing it to dry for about 60 seconds, then applying the next layer. If you apply too much cream it may take longer to dry.
Does sunscreen have moisturizing effect and therefore, can skip applying moisturizer?
Dr Joshua: Only if you are specifically using a facial moisturizer with sunscreen. Straight sunscreens for the beach are not designed to be moisturizers.
Common Irritants for Children Eczema Skin
MarcieMom: What are the ingredients that frequently irritate a child’s sensitive/eczema skin?
MarcieMom: Thank you Dr Joshua for your reply, I’d be sure to remember applying moisturizer even when I’d be applying sunscreen for my child with eczema, and thankfully, we found skincare products that don’t irritate her eczema skin.
Tina and her family, Tina shares on moisturizing for her daughter with eczema
This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Tina Santiago-Rodriguez, whose three-year-old daughter has had eczema since a year old and shares her journey in figuring out what to moisturize her child with. Tina is an award-winning writer at TrulyRichMom on her Catholic faith, homeschooling and parenting.
Marcie Mom: Hi Tina, thanks for taking part in my new blog series ‘Someone has Eczema’! Can you share with us the severity of your daughter’s eczema and what triggers her eczema?
Tina: Hi Mei! Thanks for “having me over” here on your blog. My daughter’s eczema is most seen on her legs — usually the back of her upper thighs to behind her knees. The rashes, when they come out, are quite itchy. Usually, the eczema is triggered when she eats certain food like chicken and eggs, or when there are changes in weather or the environment.
Marcie Mom: As we discussed which aspect of life you’d like to share, what oils you’re using for your daughter seem to come to your mind first – why is that so? Is your daughter allergic to some skincare products you’ve used and that motivated you to find the right one for her?
Tina: I was actually looking for skincare products that were not “artificial” i.e. natural and made from organic, natural sources. She didn’t/doesn’t seem to be allergic to other skincare products but I wanted to use products that are as gentle and “safe” as possible, which is why I was led to use nature-based oils.
Marcie Mom: Many parents have sort of settled on the bath oil and moisturizer to use for their child, and everyone goes through a process of figuring it out (I’m sure ALL of us had, at one point or another, shelves full of different brands!). Do share with us your journey to figure out what works for your daughter.
Tina: Actually, we’re still on that journey to find out what works for her, haha! Seriously though, I’m still using different brands of nature-based oils to see which works best for her. I have, however, chosen to limit her baths to once a day if possible, so that her skin won’t dry out that much. Come to think of it, we SHOULD probably try to use bath oil in her bathing water — I’ve never tried that! I have tried bath salts that were claimed to be good for skin conditions like eczema when she was younger, but they didn’t seem to work for her. So, you could say we’re still figuring things out. Hopefully, we’ll be able to come up with a good skincare regimen for her.
Marcie Mom: One final question – is there a super oil that you’d absolute swear by, one that you’d bring if your family is off for a holiday?
Tina: Yes, I’d TOTALLY recommend Mommy Patch’s Argan oil, which is available on Multiply and has distributors not only in the Philippines but also in Singapore, Malaysia and India. I noticed that when I use it, even just a bit, my daughter’s eczema improves considerably even in a short time.
Marcie Mom: Thanks Tina for taking time to share your journey with moisturizing oils; while every parent will decide on something that works for their child, it’d certainly be amusing and heartwarming to read each other’s journey!
No photos please! Only the dog can be photographed! Balloon Sculpture to occupy children during the sharing session
I had a wonderful time meeting up, learning and sharing with other parents of eczema children last Saturday, the very first of a monthly support group session held under the Eczema Support Group.
Everything shared was in confidence, so no specifics or pictures would be published (none taken in fact!) But for those who missed last Saturday’s sharing or waiting at the sidelines before taking the jump to meet up, below is a quick snapshot of how the sharing session went.
1. Good turnout – the meeting room was packed and thank you to my hubby for occupying the children with balloon sculpture & puzzles!
2. Topic was moisturizing and everyone shared readily about their moisturizing and eczema management experience.
3. Tubifast came to demonstrate how to wet wrap their bandage on various parts of the body, such as face and hand.
4. People brought food and everyone was happy, I hope! Because I know I’m happy and thrilled it went well, thank you to everyone including NSC staff for making it so!
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Oh & before I forget, I asked Dr Mark Tang, one of our doctors on the Eczema Support Group’s advisory panel, questions I noted:
1. If steroid is put on the skin before moisturizer, will the steroid be diluted? Answer is putting steroid before or after is more of a personal preference and there is no clinical difference noted in either.
2. How frequent can a child with eczema go for swimming? About 15 minutes each time, 3 times per week.
3. Should rotating various moisturizing brands be practiced? No clinical basis for rotation.
4. Are natural or organic skincare products better? Natural/organic doesn’t mean no allergy reaction, best to look into ingredients.
Dr Benabio (DermDoc) is board certified in dermatology and is a fellow of the American Academy of Dermatology. He is also the author of numerous scientific articles, a book and quoted in notable publications such as O, The Oprah Magazine, Dermatology News, Dermatology World, CNN and WebMD. He is the chief of dermatology at Kaiser Permanente, San Diego.
This is a combination of two previous posts – the first one was an explanation of Dr Benabio’s ‘Great hack to help your kid with eczema’ video that he tweeted me and the second a short Q&A with him. The videos are no longer available which is why I’ve combined the two posts into one to be more informative.
The simple message is to moisturize your child enough.
How much is enough? It’s about half ounce a day, equivalent to about 12 pumps. Dr Jeff Benabio has an insanely simple way to hold your kid responsible for moisturizing enough, i.e. by marking the bottle. Also, parents tend to underestimate the amount of moisturizer to put on our child.
I’ve blogged about this before, as I also have wondered how much is enough. Here’s the link to my post How Much Moisturizing is Enough? I mentioned 400-500ml/week!
Causes of Childhood Eczema
Marcie Mom: In the video, Dr Jeff explained that eczema is mainly due to an overactive immune system and damaged skin, where the damaged skin allows bacteria to penetrate, resulting in a vicious cycle of inflammation, itching, scratching and more damage to skin (more on causes of eczema here).
Here’s a question – For parents whose children are more likely to have eczema due to family history of eczema in parents or siblings, what would you recommend the parents to do before pregnancy, during pregnancy, after birth to reduce the likelihood of eczemaand/or the severity of eczema in the child?
Dr Jeff: Great questions here. Unfortunately, there’s little that parents can do to prevent it. There is some evidence that taking probiotics during pregnancy and up to 6 months post pregnancy if breast-feeding can reduce the risk of eczema in the child. There is some evidence that some foods can make atopic dermatitis more severe if the child is allergic to that food. Common suspects include: cow’s milk, soy, nuts, eggs, and wheat. There’s some evidence that living on a farm can help — I’m not kidding. Here are a couple of links to studies:
Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at AtopicSkinDisease.com
The Combined Approach includes topical treatment using emollient and steroid. Moisturizing is a HUGE part of topical treatment, as emollients both lubricate and moisturize. Dr Bridgett’s advice on moisturizing is Thinly, Gently, Quickly and Often. There are a few other points mentioned in the ‘Atopic Skin Disease’:
Thinnest possible application without ‘rubbing it in’
More on exposed areas such as the head, neck and hands
Pump dispensers preferable to open tubs due to bacteria infection
Applying topical steroid first, then emollient over both the skin and the steroid
Cream preferred over lotion
Can you explain why thinnest possible application is preferable for emollient?
(I’d usually slather on my child as I find applying a thin layer leads to more rubbing to spread the emollient)
Also, can you explain why topical steroid first?
(I’d written on this here and it does generate some discussion!)
Can you explain why cream is preferable over lotion?
Dr Bridgett: Your three questions answered:
Thin applications of moisturizer allows heat to escape, but insulates against water loss.
If moisturizer is applied often enough, when the steroid is applied directly onto the eczema, it is applied to skin that has been recently moisturized. We get then the best results by putting moisturizer on over topical steroid, and moisturizing all the skin, not just that which has the eczema.
The thicker the moisturizer, the better the moisturizing effect. Also, often there are less additives in thicker moisturizers, as thicker moisturizers “keep” longer. There is less chance that a sensitivity reaction will occur with an ointment, compared with a cream. See http://atopicskindisease.com/articles/20110801
Explaining Topical Treatment – Steroid
It is stated in ‘Atopic Skin Disease’ manual that steroid cream work by inhibiting protein synthesis, secretion of products, cell division and migration of cells. The epidermis can benefit from reduced cell division, and the dermis from reduced cellular and lymphokine activity. Can you explain what this means, and
why it is important to continue steroid treatment after epidermis healing (‘2-stage in steroid effect’)?
Dr Bridgett: It seems the steroid anti-inflammatory effect is partly achieved by reducing over-activity in the skin, allowing natural healing then to lay down healthy skin again. By the time the seems good to look at, the healing is not complete through and through – there is more that is needed under the surface, so we recommend continuing with the topical steroid, beyond The Look Good Point: do not stop too soon. See http://atopicskindisease.com/articles/TT7
Many parents are very concerned with the skin-thinning side effects of steroid and also the ‘withdrawal’ symptoms once steroid treatment is discontinued. I read in your manual that side-effects are associated with inappropriate use of topical steroid and the risk is usually inadequate treatment (i.e. stopping steroid cream too early or using one of too low strength).
How do you normally convince parents that steroid cream is safe? And what guidelines would you give them to gauge if the steroid cream of correct potency, frequency and amount is used?
Dr Bridgett: Steroid side-effects come especially from using topical steroids long-term and in an unsupervised way. The method we use in The Combined Approach includes more supervision than is usually given, with a programme of several clinic visits, involving careful discussion of all anxieties and concerns. Using The Combined Approach, including therefore habit reversal, which allows natural healing alongside the good steroid effect. Then less topical steroid is used overall, for good effects, not side effects!
We offer information about the potency groups of the topical steroids, and how they are usually used. The thicker the skin, the stronger the topical steroid to be used. See http://atopicskindisease.com/categories/20110423_11
Each application of any cream needs to be sparingly applied – whether it is an emollient or a topical steroid: only a shine is required.
MarcieMom: Thank you Dr Christopher Bridgett for explaining the topical treatment that is part of The Combined Approach. In our next post, we will understand more on habit reversal techniques.
I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.
VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker.
Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil (picture from vmvhypoallergenics.com)
Marcie Mom: I note with interest that your product Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil can prevent diaper rash.
What is the ingredient that prevents this rash and how it is different from the off-the-shelf diaper rash cream?
Dr. Verallo-Rowell: The USDA- certified Organic Virgin Coconut Oil and Monolaurin
Both ingredients – no reported allergies, irritations from either one.
1. Virgin coconut oil prevents the diaper rash by its giving an additional barrier film of protection on top of the skin to help protect the skin from irritating chemicals: urine, feces, sweat, preservatives, possibly antiseptics that may be used by manufacturers of diapers. Paper / tissue products are often preserved, some even with formaldehyde or formaldehyde-like chemicals. In addition, virgin coconut oil under the influence of natural skin bacteria that contain lipases (the same lipase enzymes that break down the sebum/fats produced by our skin glands to produce fatty acids that give the skin is acidity or acid mantle – an innate antiseptic function from the skin) – produce monoglycerides of its lauric, capric and caprylic fatty acids. These are well studied to have broad-spectrum antiseptic properties.
2. The purified monolaurin produced in the laboratory of Dr. John Kabara wrote and worked on this ingredient since the 1960s… is added for additional protection of the skin.
Laura: Most diaper rash creams primarily contain just zinc oxide and petroleum jelly.
One dermatological (prescriptive) diaper rash ointment contains an antifungal drug (many diaper rashes are actually a fungal condition) and cannot be obtained without a prescription (it also costs around US$300).
We mimic both the effects of the above in Oil’s Well in that the Virgin Coconut Oil provides a bit of the barrier function of zinc oxide and petroleum jelly, and the monolaurin provides an antiseptic, antibiotic and antifungal action. Note that monolaurin is also present in breast milk as another innate or natural antibiotic provided by nature from breastfeeding infants.
Prevent Diaper Rash
Marcie Mom: For prevention of diaper rash, your recommendation is to apply where the skin comes into contact with wetness. However, for eczema rash, I read that it’s least likely to be where the skin is wet.
Dr. Verallo-Rowell: Need to know the context of this statement because wetting the skin in those with eczema does make the skin more moisturized (water is the best moisturizer) but that wetness must not be chronic to macerate it such as in the diaper and around the mouth areas from saliva, mucus, sweat, food, etc.
Diaper Rash vs Eczema
Marcie Mom: My baby often gets rashes and scratches around the diaper waist band and the upper thigh joint areas. How can a parent differentiate between diaper rash and eczema rash? And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse?
Dr. Verallo-Rowell: Yes. Can be from pressure (a form of dermographism) or actual irritation (rarely at that age, allergy), by the chemicals in the elastic material of the waist and thigh band or even the chemicals in laundry soap.
How can a parent differentiate between diaper rash and eczema rash? By the presence of the rash in other areas more commonly involved by atopic eczema rash in babies: outer areas of the upper and lower extremities, the face.
And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse? Yes if the moisturizer has ingredients that are irritating to the skin usually by virtue of its scent, preservatives, antibiotics, dyes, non-medical grade lanolin, etc. Note that vitamin E and tea tree oil, propolis, and some other natural ingredients are top allergens in the allergens list.
Marcie Mom: A BIG THANK YOU to Dr. Verallo-Rowell and Laura for helping us in this series on sensitive skin products. We’ve learnt SO much from you and SO much more confident on how to choose and manage the sensitive skin of our children.
I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.
VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker.
In our previous interviews, we have learnt what to look out for in the product packaging, including understanding the list of ingredients. In this interview, we wish to focus on the use of sensitive skin products on the parts of the child which are more delicate.
Marcie Mom: Thanks Laura for taking time to help us learn more about managing the delicate parts of our child’s skin. First, let’s all be on the same page relating to what defines delicate skin?
Is it where the skin is thinner, like eyelid, face, neck, underarm and groin area?
Dr. Verallo-Rowell:Yes, where the skin is thinner: eyelids, neck, groin because of the easier absorption of chemicals. Plus, often wet areas such as cheeks, around the mouth from milk and food, neck and maybe the chest, and of course the diaper areas where maceration and heat “thins” the skin. Also from trauma and sweating of physical activities in school and at play with the use of play devices or clothing and shoe wear — hence the need sometimes for milder laundry soaps.
PLUS the following conditions:
– Those diagnosed with an atopic problem: asthma, hay fever, and of course atopic dermatitis/ including a family history especially when (+) in both sides of the family. To treat and to prevent barrier loss because barrier dysfunction is a basic problem in those with atopic skin.
– Those with medical conditions that make them “sensitive” Example: being off and on antibiotics a lot which disturbs the balance of naturally opposing bacteria and fungi in skin and the natural, healthy dominance of one over the other; those on maintenance drugs which make them prone to drug allergies or even photosensitivity; those who are obese and prone to sweatiness (or who are otherwise prone to sweatiness).
Washed-off Product Use
Marcie Mom: I also read that rinsing the product immediately is stated in many of your products’ instruction. For eczema children, they may need to soak in bath oil (my baby soaks in colloidal oatmeal bath oil).
How long would you advise parents to let their child soak?
Dr. Verallo-Rowell: I generally like colloidal oatmeal bath oil but am careful to read the ingredients list for any additional ingredients as listed above and elsewhere. For the more sensitive I prefer the pure virgin coconut oil in water for 5 to 15-minute soaks.
Marcie Mom: And can they do so if they have a rash at the groin area?
Dr. Verallo-Rowell: Yes with the virgin coconut oil. I have seen extremely irritated skin, however, where even water makes them sting. In these cases, I prescribe the total removal of all products with just a bit of the VCO applied very lightly and gingerly, section by section — which I’ve found to be soothing until the oil can be applied all over. Once less sensitive, soaking in it can be done.
Laura: In case you’re reading instructions of “rinse immediately” for things like shampoo…this is important for ALL wash-off products. Wash-off products contain ingredients that are, as the name implies, meant to be washed off (such as surfactants or soaping/bubbling ingredients). Their action is cleansing, and they are not meant to stay on the skin for more than a few seconds at a time in the shower or bath. But oils and moisturizers? Or oils in a soak? These are usually fine to “marinate” in for a while 🙂 Again, with the caveats above of hypoallergenicity.
Shampoo & Shower Tips
Marcie Mom: When I’m showering my 2 year old, I apply shampoo on her hair and bath oil on her tummy, back and legs. For her face, neck, underarm and groin, I don’t apply any bath oil on them but just rinse with water (I assume some of the bath oil would inadvertently flow to these areas when I’m rinsing). Is this the correct technique and clean enough?
Dr. Verallo-Rowell: Wise and smart. Another technique I use is the pure VCO as the cleansing oil on any irritated/irritable/potentially irritable skin. It’s all in one: functions as a mild cleanser, barrier and for healing.
Marcie Mom: Lastly, the eyelid. Eyelid eczema is not uncommon for children and furthermore, children tend to scratch their eyes when sleepy or tired. I normally wipe my baby’s eyes with cotton pad soaked in slightly warm cooled boiled water followed by a thin layer of moisturizer.
What would be your advice on treating rash on the child’s eyelid? Is there any ingredient that is a no-no for the eyelid?
Dr. Verallo-Rowell: Wet with a little water the way you do it above, then apply the VCO alone or with pure plain petroleum jelly to lock in the water. The oils “melt” in a few minutes. Gently pat into the skin and if necessary (not usual) wipe off any excess to avoid their getting into the eye.
Laura: A nice alternative to the plain petroleum jelly can be our popular Big, Brave Boo-Boo Balm, which is petroleum jelly but with the coconut-derived monolaurin.
Marcie Mom: Thanks so much again, it sure gives me some peace on what I can do for the sensitive part of my baby’s skin.
