In 2020, when COVID was emerging Dr. Deryn Thompson PhD, MN, Bn, PC Allergy Nursing wrote this article to help people see how they might save some money. In his latest post, Dr Thompson adds additional tips to consider in these even trickier times.
Managing eczema in tricky times
With the cost of fuel, basic food and staples of daily living, and mortgage interest rates rocketing up, many families are trying even harder to work out how to stretch the weekly income. For families where one or more family members have eczema (atopic dermatitis) their dollar needs to stretch even further. Annual costs of creams and medical appointments are not uncommonly, thousands of dollars $$$$. Many people striving to find solutions to best manage their health conditions have not received intensive education from nurses in primary, secondary or tertiary care. Often these nurses can help them optimise the management of their condition, using evidence-based best practice, in cost effective ways (Thompson 2019). For World Atopic Eczema Day, I have re-emphasised and explained some tips and added a few more tips help you maximise the impact and perhaps lessen what you outlay.
1. Ensure you have read the recommendations of using emollients and steroid creams to check you ARE using enough.
When moisturisers and steroid creams are developed the scientists do tests to work out how much needs to be used for the product to work properly. This is very important for the “steroid” creams. In steroid cream the medication that will reduce the itch and redness is mixed with the creamy/greasy part of the product, so it spreads on nicely. Remember it has to have enough cream/ointment containing the medication to work both underneath and on the skin (more details on steroid creams below).
Using moisturisers (emollients): Eczema care guidelines worldwide recommend people use certain volumes per week to moisturise their skin enough to fill up the gaps in the skin cells and to put a barrier back onto the skin. This barrier has gaps in it in people who have eczema (atopic dermatitis).
500gms per week teenagers & adults
250gms per week children
125gms per week for babies
More details on using moisturisers is found in Eczema Support Australia’s Resource Library. It is also important to use moisturising products for at least 2-3 weeks to see an improvement (if you get a worse rash on the area or a blistery rash, which may be an allergy to the preservative in the cream you must stop using preparation and see your doctor as soon as possible).
Try also to avoid believing unreliable claims of creams/treatments that will cure eczema. We cannot yet cure eczema, even with the newer biologic medications.
Using ‘steroid’ cream/ointment: Despite some Health professionals (commonly pharmacists and GPs) telling you to use “the steroids sparingly”, reliable scientific research has worked out how much you need to apply to have the medication in the cream/ointment to work. The fingertip unit helps you to “see” how much to use, and how much of your skin to cover with the medicated cream/ointment. This link shows you how. 1 fingertip covers the area of 2 adult palms. When you start to manage your eczema properly, using this method helps you to practise getting used to usingthe amount needed to reduce the itch and redness. To use an analogy, if you had a bad headache you would be unlikely to only take ¼ of the recommended headache dose and expect it to work. The same logic applies to your steroid cream/ointment. The doctor prescribing it has taken the scientific recommendations into account, and expects that you will use it as recommended.
Remember to ask the doctor, nurse or Nurse Practitioner for a demonstration of how much to use, if you have not used the cream before. Another great resource is found here:How to apply steroids.
2. Look out for your treatment/management items on sale
Many stores (pharmacies – especially the bigger chains, and supermarkets) have regular sales where they offer between 25-40% of the recommended price of their product range. I have found these stores tend to go in cycles. If you have an email account or social media account that can receive bulletins from stores (in particular pharmacies), sign up. If you do not want your usual email account cluttered with these emails, create a special account (e.g. Gmail or Hotmail account with your different user name and password to your usual account) to receive the bulletins.
If you have family members who support various charities by buying “the Entertainment book (now an APP)” annually, this group also have various monetary e-cards at 3-5% reduction at different times during the year (e.g. Priceline or Woolworths). Purchase such cards when they are reduced, then you can usually use them at sale time as well, to get even more reduction.
If you like the more expensive brands, perhaps you can ask relatives/friends to give these products to you as a gift for birthdays or special events. It is a sensible option.
3. How do I get the rest of my cream out of the container?
Two years ago I monitored this with an overseas brand of pump pack (400ml container). The container always felt heavy when I could not get anymore out. Patients/families had also reported similar experiences in the Eczema clinic. Over 4 weeks of using the product (1 pump pack per week in line with recommendations), I cut the bottom off the container and weighed what was left. Each time around 45gms of cream was in the bottom. Over the 4 bottles that equalled 180mls!
So take precautions to not cut yourself, and cut the bottom of pump packs. For tubes, you can use the scissors (also using safety precautions). Then use a clean spoon to scoop/scrape out the remaining cream. Using a spoon lessens the likelihood you will cut your hand/finger removing the product. It also lessens the risk of getting germs into the cream. You can follow the same steps to remove the maximum amount possible from your tubes of prescription medicated creams/ointments.
Put the unused portions you have saved into a clean ziplock bag, labelled so you remember what it is.
5. What about my hair? The special shampoos and conditioners are hard to find money for now food and fuel cost more.
The beauty industry has convinced most of us that the hundreds of shampoo products will do magic things to our hair. Many of the ingredients in the traditional shampoos contain chemicals with long names, that are not good on our skin. People with eczema need to think about their hair care in a different way.
Remember that your scalp is still your skin. You are washing the rest of your skin in a non-soap-based wash/cleanser. You have found one you like and suits your skin. Why not try that on your hair, perhaps on a weekend when you are not at work/school. This approach won’t cost you more money!! (I have not used conventional shampoo for 12 years and can say that most of the cleansers work really well as “shampoo”. Often I have not even had to use conditioner.
Without favouring any brands over another some of those that work well are Aveeno; Dermaveen; QV Gentle wash; Dermeze wash; Lipikar Syndet wash). If you find you are not happy with what you try, QV and Dermaveen have special eczema shampoos and conditioners (however, this does create extra cost for you).
If you use the hairdryer, please use the medium heat setting rather than hot, as hot air is more drying to your scalp.
5. Soap-free does not mean irritation free: Non-soap-based preparations can still contain ingredients that further damage eczematous skin. A few key products to avoid in shampoos, conditioners and body washes:
Methylchloroisothiazolinone (MCI) or Methylisothiazolinone (MIT): These compounds have been used in cosmetic and wash products since the 1970’s. As the product is also used in glue production, detergents, paints, and fuels, this suggest it is not a helpful product to use on eczematous or dry skin.^^ Note that several chemist wash/cleanser lines in the cheaper price range contain these ingredients that should not be used on eczematous skin: Some examples: 24daily dry skin soap-free wash, Redwin Sorbolene Soap-free body wash; Dove deep moisture and many non-soap washes.
Choice did some research in 2018 on Skincare for Sensitive skin (Bray 2018). The article highlighted that companies can interpret the regulations to best suit their product. A common way to test skin product is using a “repeat insult patch test”, but this test has no Australian standard/procedure that the companies need to follow. (A patch of the ingredient is put on the skin, left for 24 hours. The patch is remover and checked after 48 hours.) That means, in plain speak, that companies can chose the tests that make their product look ‘good”. Many of the reputable companies making the “plainer” products dermatologists and allergists recommend, leave out many of the questionable ingredients, and can mostly be relied upon to protect their name. However, as a consumer, you need to be aware that the hypo-allergenic, dermatologically tested and allergy free, may not be what you think it is!!
6. Allergists suggest that children with eczema should avoid products that have food or plant-based products in them.
These include (but there are many, many more) calendula, lavender, rosemary, limonene, sunflower, chamomile, avocado, evening primrose, wheat protein, goat milk, nut oils,
7. One Final Note:
We suggest that you do not try to make your own products at home in the kitchen as you would be unlikely to have stringent infection control guidelines to follow. Remember that eczema skin has some barrier damage which can let extra germs in. Also, it is very hard to get exact weights of ingredients to add.
Article written by: Dr. Deryn Thompson PhD, MN, Bn, PC Allergy Nursing. Eczema and Allergy RN & Educator MyProderm & AllergySA, Lecturer University of South Australia.