Review: Coconut oil

Coconut oil was initially recommended to me (via my Mum) by someone else who had a child with eczema but we have personally found that coconut oil has a very drying effect on our daughter’s skin. After a week or so of bathing in it everyday, her skin actually worsened/dried out and her eczema came back quite badly

After some ‘light’ reading, it seems that coconut oil is higher in oleic acid than it is in linoleic acid, therefore potentially drying skin out further (see the review about olive oil). Coconut oil is also commonly used as a soap base or surfactant – something that is not the best for ezcema-affected/prone skin:

A shortened form of “surface-active agent”, a surfactant is a chemical that stabilizes mixtures of oil and water by reducing the surface tension at the interface between the oil and water molecules. Because water and oil do not dissolve in each other a surfactant has to be added to the mixture to keep it from separating into layers. Surfactants in cosmetics provide one or more of six functions:

• Detergents – for cleansing
• Wetting agents – in perms
• Foaming agents – for shampoos
• Emulsifiers – in creams and lotions
• Conditioning agents – in skin and hair-care products
• Solubilizers – for perfumes and flavors

Source: From Heather Brannon, MD, former About.com Guide, updated March 16, 2007 (About.com Health’s Disease and Condition content is reviewed by the Medical Review Board) http://dermatology.about.com/od/glossarys/g/surfactant.htm

Review: Olive oil

One would think that a natural oil like olive oil would be okay for applying to a child’s or adult’s skin? However, you need to be aware that it can potentially be harmful to skin, especially if the skin tends to be dry or if it is already affected by eczema.

Olive oil is low in linoleic acid (a fatty acid) and high in oleic acid (another fatty acid).

Linoleic acid (not to be confused with linolenic acid) is from the Omega-6 fatty acids family, having “anti-inflammatory, acne reductive, and moisture retentive properties when applied topically on the skin” (Wikipedia). You would really be looking to apply oils with higher linoleic acid content, not less.

On the other hand, oleic acid improves the permeability of the skin, meaning water and oil can be absorbed in and released out of the skin easier. This can be a good thing for most people. However, in dry skin or eczema-affected skin that already struggles to retain moisture, this could lead to more water/moisture loss and worsen the skin’s condition.

More reading about olive oil can be found below…

Daily Mail UK “How ‘gentle’ skin creams could give your baby eczema”

Another substance commonly applied to babies’ skin is olive oil — but Professor Cork says this is also unsuitable as it has a very poor balance of oleic and linoleic oil, which is damaging to skin before it develops properly.

The acid-alkali balance in these oils (measured on the pH scale) is not suitable for a baby’s sensitive skin, as it hydrates it for several minutes but then has a drying effect.

Read more: http://www.dailymail.co.uk/health/article-1315728/How-gentle-skin-creams-baby-eczema.html#ixzz1f8U5fTBk

Baby Centre UK “Is Olive Oil okay for baby massage?”

http://www.babycentre.co.uk/baby/dailycare/olive-oil-for-baby-massage/

Department of Dermatology University of Connecticut Health Center  “Healing fats of the skin: the structural and immunologic roles of the omega-6 and omega-3 fatty acids”

Linoleic acid and alpha-linolenic acid both give rise to other long-chain fatty acid derivatives, including gamma-linolenic acid and arachidonic acid (omega-6 fatty acids) and docosahexaenoic acid and eicosapentaenoic acid (omega-3 fatty acids). These fatty acids are showing promise as safe adjunctive treatments for many skin disorders, including atopic dermatitis, psoriasis, acne vulgaris, systemic lupus erythematosus, nonmelanoma skin cancer, and melanoma.

http://www.ncbi.nlm.nih.gov/pubmed/20620762

Moisturisers (Emollients) – essential for eczema and skin care

Image by abdultaiyeb via Flickr

The following is quoted from Emollients – Parent Information sheet, provided by the Nurse Eczema Clinic, Child Health Service, Wellington Hospital, Capital & Coast District Health Board. Please download the full information sheet from the Regional Public Health Skin website Skin Health Emollients – Parent Information (PDF 884kb).

Emollients are heavy moisturisers that help manage and control eczema. When used adequately, emollients have a number of important functions that will help you child:

• put moisturise back in the skin, which relieves itching or if very dry, pain
• where the skin is broken or weeping, will help the skin heal faster and feel more comfortable
• decreased the shedding of skin
• improves the skin barrier function so that the skin is not so irritated by conditions, allergens and less open to infection
• decreases redness and swelling
• decreases the length of time and strength of steriod you need to apply to the skin.

To work well and for optional results, emollients have to be used in bathing/showering and regular skin care.

Using emollients as a preventative measure:

Using emollients preventatively is the key to helping control eczema.

It’s important to recognise what are the irritants for your child’s skin. For example, put emollient around the child’s mouth & chin before eating something that is possibly irritating, emollient on face and neck before and after going out in the wind and cold or before and after playing in sand and water.

It’s important to appy emollient to affected areas just before going to sleep even if the child was only bathed an hour before. Children tend to scratch more at night (unknowingly in their sleep) as the bed (& covers etc) warms up their skin, which dries out and gets itchy.

Handy hints:

Remember to use positive language with your child while applying emollients.

Only apply emollient when you are feeling positive. If you are feeling fed up, angry, negative, even without a word being spoken, your child will know how you feel by how you touch and respond to them during the emollient application. Avoid making it a negative experience for your child!

Remember when your child is itchy / scratchy, you can help relieve their itching, minimise damage to their skin and help skin heal by applying emollient, even when the skin is scratched red and raw.

It’s important to put emoliient in smaller containers so that it can be available for wherever your child is, e.g. bedroom, bathroom, kitchen, school bag. If emollient is only in one room of the house, you and your child are less likely to apply it when its needed.

My personal note: I made up a silly catchy action song to help put some fun & light heartedness into the process of putting moisturisers on while my daughter was itchy as well as the times when she was just really unhappy with the itchiness and discomfort of the eczema.. It really helped!

Review: Moisturisers (Emollients) for eczema

One of the MOST important things in overcoming and controlling eczema is moisturising the skin. Moisturise, moisturise, moisturise all the time… in the morning before changing, throughout the day (every few hours or even more often!), after a bath, and before bed time especially. Even if you think the skin doesn’t look dry or red… if it feels rough, then moisturise!

Another important thing is that if you also use a steroid cream / hydrocortisone in treating the eczema, always ensure you moisturise with emulsifying wax or a moisturiser on top of it as steroid creams just reduce the inflammation and initial itch but are just quick “band aid” fixes that do not moisturise and do not improve the skin’s natural condition long term.

Here is a review of the common moisturisers / emoillients used for eczema:

If you are able to afford to, try out Hope’s Relief Premium Eczema Cream from the very start. It has been the best thing I’ve ever used – antiseptic bath washes, steroids and waxes are out the window and could never have improved my daughter’s skin to what is it now. Pros: Awesome product! It is natural, and has not only stopped the eczema but the skin looks normal now! Cons: Expensive at $26.50 – $35+ per tube, and the cream is not super-thick so I tend to moisturise with Essenchi Aquaderm cream on top of it just to give the skin a real moisturising soak : )

Aqueous cream is a very popular prescription by GPs for dry skin and eczema but it is NOT effective and can make things worse! We were advised NOT to use it by our specialist eczema nurse at Wellington Hospital. DO NOT USE IT!
Pros: Cheap or fully funded. Widely prescribed as a generic soap substitute and a moisturiser.
Cons: It contained Sodium Lauryl Lulfate (SLS) – a detergent – and Phenoxyethanol (an alcohol) as an antimicrobial preservative. These cause skin to dry out even more, so it is NOT a moisturiser, and a real no-no if you seriously want to overcome the eczema. It may also sting a bit on application to raw areas. You may like to read an article in BBC News about aqueous cream aggravating eczema (October 2010).

HealthE Fatty Cream is another popular prescription.
Pros: Cheap or fully funded. Had no other obvious pros to us.
Cons: Stung badly on raw areas. Also contains parabens as preservatives. These two factors never made us try it ever again.

Dermasoft Sorbolene Cream, initially prescribed by our paediatrician as a trial cream to moisturise.

Pros: A general moisturiser for dry skin?
Cons: Not funded so can get costly. Still stung, and also contained high amounts of parabens as preservatives.

Emulsifying ointment is a very cheap and super effective moisturiser (free/funded if prescribed by your GP) and a must have to melt in for every bath! If you use this properly (for very dry / affected skin),
a) for moisturising & bathing, you’ll use about 1x 500g every 2 – 3 days.
b) for bathing only, you’ll go through about 1x 500g tub every 5 – 7 days.

Pros: It’s the best neutral moisturiser to apply when skin is really bad and raw as it does not sting the skin. It was the only moisturiser that worked for our daughter at her worst stages of eczema. It just about seals in the skin and stops any moisture being lost from the skin.

Cons: I’ve heard that some people may be allergic to it, so test a little on the skin before plunging your child into it! It is very very thick & messy to spread and can be very uncomfortable for the child. Our daughter ended up really detesting the feel and texture of it. She also started breaking out into nasty pimples after prolonged use (i.e. past raw skin stage) as the skin just could not breathe. The skin covered by this ointment ends up sweating underneath it, and heats up the child as the child’s skin can’t breathe properly. We eventually moved onto a slightly lighter moisturiser, Essenchi Aquaderm cream.

We were also was getting a bit put off by the 100% petroleum base of emulsifying ointment, and after hearing many goods thing about Essenchi Aquaderm cream (from other parents who had young children with eczema AND overcome it!), started using that and it is GREAT!!

Pros: It’s all natural (free from parabens, mineral oils, perfumes, artificial colourants, animal products and alcohol). It contains vitamin B5 which helps heal the skin faster too. It is super moisturising, the best we’ve found after trying so many different moisturisers.

Cons: Cost – it is definitely pricier than the free or paid for Emulsifying Ointment (over 4 times the price of the ointment, as it is about NZ$30+ for a 500g tub of Essenchi Aquaderm cream). Caution: if the skin is very very raw, it may sting a tiny bit, depending on your child’s pain tolerance.

We’ve also tried the following and they are note worthy as they are all 100% natural and petroleum free:

XmaEase, however it doesn’t moisturise well enough as the cream is too thin, though it is cooling to the skin so can feel nice on hot itchy spots. You’d have to apply a lot more and a lot more often to get the same amount of moisture back into the skin. Costs a lot too.

Naturalene’s Invisible Glove didn’t seem to moisturise the skin much as such. Invisible Glove is a very good waterproofing / barrier application for skin areas that get exposed to water, but you still need to moisturise under it otherwise it seems to end up drying the skin. We use either Aquaderm or this as a protective barrier before our daughter gets into a swimming pool.

PURE nutraceuticals PawPaw Ointment with Calendula seemed good at first, but we found after prolonged use (e.g. over a week), it didn’t have any more impact or ended up actually making the skin go backwards in condition again. Pawpaw (aka papaya fruit) is also not advised for under 1 year olds as it “eats” into the skin a little to remove the dead cells, which is probably what happened with our daughter and made her skin worsen after initially getting better. It is also very costly!