Dr. Cockerell answers itchy skin questions for our readers!

The Journey To Itch & Scratch Free

Dr. Cockerell answers itchy skin questions for our readers!

We loved the depth & variety of the questions that YOU submitted. We also want to thank Dr. Clay Cockerell for being available to answer our questions as he is one of the doctors behind CLn Body Wash.

CLn Body Wash is a highly diluted form of a bleach bath that can be placed on the affected areas only instead of the entire body, without any irritation. It prevents adding too much or too little bleach to bath water to get rid of the infection and can be applied to sensitive places, such as the neck and face. This is especially important for little ones.  An additional benefit, it can be applied to the affected area for a few minutes, rather than sitting a bleach bath for 30 minutes.

While we are advocates of trying natural solutions for itchy skin, I understand there are times when medication and other forms of treatment are necessary to address various skin conditions that are infected, not healing and/or getting worse.

We want to thank everyone for submitting questions during National Eczema Awareness month and reading Jennifer’s post about how CLnWash helped her son’s severe eczema!

If you have any follow up questions or need more information, feel free to email us at info [at] scratchmenot.com or leave a comment below.

About Dr. Clay Cockerell:

Dr. Clay Cockerell founded TopMD along with Dr. Azam Anwar
in 2007.  Both are doctors behind CLn Body Wash. He is an internationally renowned dermatologist and
dermatopathologist who is recognized as a leading authority in
his field. In addition to his work as a clinical dermatologist, he is
the director of a dermatopathology laboratory and serves as a
consultant to more than 1,300 physicians.

Dr. Cockerell has personally interpreted more than 2 million skin
biopsy specimens in his career. He has published extensively
and is a highly sought after lecturer in  his field.

He is a past president and secretary-treasurer of the American Academy of
Dermatology, the largest dermatology organization in the world. He also is a clinical
professor of dermatology and pathology and director of the Division of
Dermatopathology at the University of Texas Southwestern Medical Center in Dallas,
Texas.

Tons of great questions poured in, so we gave Dr. Cockerell the first 20 to answer.

1) What combination of skin treatments should be used and in what order? (steroid creams,
Aquaphor and lotion). We were doing steroids first then Aquaphor and I have experimented
with adding lotion. Should lotion go before or after steroids?

As all of these will absorb into the upper layer of the skin, it generally does not matter. We
usually recommend applying the steroids first and then the moisturizers afterward, but I
would recommend experimenting and seeing which seems to give the best response. Each
person is different.

2) How often do you recommend baths? Seems to be opposite views between dermatologists
and allergists.

For patients with eczema, over bathing can be a problem. When water dries on the skin, it
makes it dryer, and excessively dry skin worsens eczema. We usually tell our patients not
to bathe every day and never twice a day. They should use a mild cleanser, and when they
get out of the bath or shower, pat dry and within the first 30 seconds, apply a moisturizer
to “lock” the water into the skin rather than letting it dry. This would also be the time to
use any topical steroids or other agents that have been recommended. When bathing or
showering, the use of a clinically tested, gentle cleanser for infection prone skin such as
CLn® BodyWash is a good idea, as well.

3) Is there anything that can be taken internally to help the skin heal? (foods, natural remedies,
vitamins, etc.)

There has been no documented oral agent or food that has been shown to help or treat
eczema. However, a good, healthy diet is important to keep the immune system strong so
fad diets or unhealthy diets are not a good idea.

4) Is Protopic considered safe? Should parents have any concerns about long-term use of
prescriptions – both steroid and non-steroid.

Protopic is safe when applied as directed under the recommendation of a dermatologist.
Systemic steroids may definitely lead to problems, and long-term topical steroid use can as
well if they are of high potency. They can lead to thinning of the skin and systemic effects
if used for prolonged periods, i.e. Cushing’s disease, where the face develops a moon-like
appearance and there is abnormal distribution of fat and muscle wasting. Steroids should
be administered only under the supervision of a dermatologist or other physician familiar
with their use in eczema and our goal is to try to wean patients from them as soon as
possible.

5) My two year old son has food allergies to milk, egg, and oat. He also has eczema.

a) Is the eczema a skin reaction to his food allergies? (We have eliminated these foods from
his diet and he still has the eczema) or could he also have an environmental allergy as
well? or is the eczema unrelated to his allergies?

There is not always a direct relationship to food allergies and eczema, although in
some cases, avoidance of a food to which the person is allergic can improve the eczema.
Many patients diligently avoid these foods, however, and the eczema continues to flare.
Dermatologists generally treat the skin condition independent of any food allergies and
recommend that patients attempt to avoid foods to which they are allergic and see if it
makes any difference. If not, they can generally eat these foods without restriction.

b) I would love to find out what is triggering his eczema so that I can help prevent his flare
ups.

There are many different triggers for eczema flares ranging from changes in the weather
(either too hot with excessive sweating or too cold and dry with the skin getting overly dry),
excessive bathing, wearing of irritating clothing, stress and very importantly, development
of bacterial infection such as Staph. Each patient is different, and it requires detective
work to find out what causes worsening in a given individual. I would recommend seeing a
dermatologist and working with him or her to try to come up with the best regimen to keep
the flares to a minimum.

6) I have a couple of questions about bleach baths. I’ve been told that they would help my son,
however I’m nervous about the idea of placing my son in bleach water. Can you tell me if
this is safe and/or if there are any concerns associated with it?

There have never been any concerns about bleach baths with the possible exception
of overusing them and the skin getting too dry. The concentration of the bleach in a
bleach bath is very low. Bleach baths are somewhat cumbersome and patients are poorly
compliant. The bleach also will bleach clothing and requires cleaning the tub, etc. A new
product, Cln® Bodywash, can be used in the shower and as it is a propriety formulation for
eczema-prone skin, it does not cause bleaching of clothing or hair and is very easy to use. It
is quite cosmetically elegant, takes two minutes to use and is an excellent replacement for
traditional bleach baths.

7) Is it true that having my son sit in bleach water over time can cause him to become sterile?

No, this is untrue. The amount of bleach in a bleach bath is very low and the exposure time
is rather short at 10 minutes. Additionally, swimming pools have a low concentration of
bleach (chemical sodium hypochlorite) and are not associated with sterility either. Bleach
baths, when prepared properly, have concentrations of bleach at less that 1/1000th of
household bleach.

8) What can a dermatologist do for people who seem to have tried everything, but can’t
determine what is triggering their child’s eczema?

The dermatologist is an expert at skin disease and can often determine what the triggers
are that the patient or family may not be able to figure out. In some cases, a pediatric
dermatologist will be called in to evaluate the condition as they are subspecialists who are
especially trained in childhood skin disorders. Sometimes additional testing, like cultures and
patch or allergy testing, may be performed.

9) Is Elidel and/or Protopic safe for 4-6 month olds?

If used in the correct fashion and prescribed and monitored by a dermatologist, yes, it is safe.

10) How does CLn Body Wash work to prevent infections and itching due to eczema?

CLn® BodyWash is a product formulated with soaps and sodium hypochlorite. It is designed to
cleanse infection-prone skin. In laboratory testing and in clinical studies, it was noted to kill
bacteria and reduce Staph bacteria on the skin. Bacteria commonly superinfect patients with
eczema, and this has been shown to worsen the condition. CLn® BodyWash is an over-the-
counter cleanser and is an effective, adjunctive product for those with compromised skin like
in those with eczema.

11) For parents leery of steroids, parabens, steroids, and other harsh ingredients, what natural
skincare products and non-toxic ingredients would you recommend for children with
eczema?

CLn® BodyWash mentioned above contains no steroids, parabens or harsh ingredients and
is very effective for cleansing the skin of children with eczema. Many excellent moisturizers
contain essentially no preservatives such as parabens. Some of these include Vaseline and
Aquaphor.

12) My 14-month-old daughter has eczema from head to toe. It comes and goes in severity.
After much observation, I have narrowed down the triggers to mold and/or dust mites and
have removed most of these sources in our home. Her skin is constantly covered and her
skin care is only Aquaphor after her evening bath. We occasionally used topical steroids
when it’s very bad. However, recently I have started lathering her body in Boudreaux’s butt
paste daily! My thinking is the zinc will help heal all the damaged skin (along with some
good protein sources in her diet.) The once red spots are now white AND she doesn’t reach
to her arms or legs to scratch when I’m doing a diaper or clothing change.

a) Is a lotion with 16% zinc safe to apply to her skin daily?

Yes, this lotion is safe to apply to the skin.

b) Is there another healing cream that I am better off using?

If this cream is working, there is no need to change. Other agents that we commonly
recommend include mild emollients and moisturizers such as those mentioned above.

13) How frequently should I use CLn Body Wash for my toddler that has moderate eczema?
Should it be used just for flare ups? Every day?

We recommend using it at least three times a week, and if the eruption is severe, it can be
used daily. Once the flare ups have improved, it is a good idea to use it at least one to two
times a week in an ongoing fashion to prevent another flare up.

14) What cream/moisturizer do you recommend using alongside of CLn Body Wash?

Any well-known moisturizer, such as those mentioned above, are excellent. I recommend
that patients try different moisturizers until they find one that they like and that works
optimally as each patient is different.

15) My daughter has eczema and we’ve been treating it with aquaphor and steroids, however I
think the eczema being caused by some type of food and/or her seasonal allergies. I want to
get allergy tests done, but I’ve gotten mixed reviews about the results from parents and the
internet.

a) Can you tell me, what is the best way to figure out what is causing her eczema?

The best way is to consult with a dermatologist and possibly an allergist and go over
all the various things that seem to make it worse. Allergy tests may reveal something
that is contributing to the problem, but in many cases, there is not a good relationship
between the results of allergy testing and the severity of the eczema.

b) Would you recommend an Elimination Diet if I suspect it’s food triggering it and skip the
allergist all together?

You could attempt an elimination diet and see if it helps, although they do not work in
the majority of patients. Furthermore, they are difficult to follow.

16) It’s winter time and I’ve been seeing parents talk about wet wraps online. Is it ok to wet
wrap my son at night without him catching a cold?

a) When I wet wrap should I just use 2 sets of pajamas, the dry one over a wet one or
apply the medicated creams on his skin, then the wet/dry PJ combination?

While some patients may get better by hydrating and following this by the application
of moisturizers and other agents such as Protopic, Elidel and steroids, some patients
cannot tolerate water or wraps like this. Furthermore, it is very important not to let
the water dry on the skin as it will make the skin even drier and can flare the eczema.
I would recommend against using cold wraps, and if you do elect to try this treatment,
I would use lukewarm temperature water, not cold.

17) My son has been scratching the same places over and over and now has hard thick skin on
his knees. Will this go away with time? Should I do something extra to help his skin become
soft again beyond applying Vaseline? He still scratching on and off, depending if there is a
flare up but for the most part, he doesn’t scratch nearly as much.

What you are describing is “lichenification,” and it is a thickening of the skin that
develops as a consequence of long-standing rubbing and scratching. If the patient
stops this, it will go away and the skin will return to normal after about six weeks or
so. However, it is essential to understand why the patient is rubbing. In your son’s
case, it is due to his eczema, so that needs to be addressed first and then he will stop
rubbing and the skin will return to normal.

 

 Thank you again for submitting your questions! We’ll be doing features with other types of doctors in the future to answer more of your questions about itchy skin!

For more information about bacteria, read Eczema Blues’ staph bacteria series with Dr. Cockerell.

 

  1. Jennifer
    Jennifer11-08-2012

    Thank you for your replies Dr. Cockerell. I see you’re on the CLn’s medical board and you were one of the creators. I hope it helps a lot of children with eczema, but it is certainly not a natural and non-toxic product, which was what I was looking for with my question. SODIUM LAURETH SULFATE commonly causes skin irritation and may be contaminated with ethylene oxide, a known human carcinogen. SODIUM HYPOCHLORITE is bleach. So, that could be helpful if you recommend bleach baths for children with eczema, but it is a chemical, not natural.

    Do you have any thoughts on something that is natural and non-toxic?

    Thank you.
    Jennifer

    • smn
      smn11-10-2012

      Jennifer, your question has been resubmitted to Dr. Cockerell and we’ll post an answer soon.

      Thank You!

  2. James Hilton
    James Hilton07-29-2013

    Here Is Some Guide For Eczema And Flaky Skin – Learn More – Flaky Skin Care Center And Nice Suggestion Dr.

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