Dermatologists explain the nuts and bolts of virtual care and share tips for getting the best results from online appointments.
Published On: Oct 5, 2020
Last Updated On: Oct 6, 2020
The epidermis is the largest and perhaps one of the most fundamental organs of our body. Not only is it a protective guardian against harmful bacteria strains like Staphylococcus aureus, it’s also a faithful gatekeeper, allowing oxygen, moisture and other nourishing elements in.
People with eczema need to be especially mindful of what they’re putting on their skin to keep it healthy and safe, while also knowing which things to avoid so as not to trigger inflammation and flare-ups. We asked two dermatologists to share top skincare ingredients to avoid if you are living with eczema or caring for a child with the condition.
Peter Lio, MD, assistant professor of clinical dermatology and pediatrics dermatology at Northwestern University Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center, and Jeff Yu, MD, a dermatologist specializing in allergic contact dermatitis and occupational dermatitis in adults and children at Massachusetts General Hospital in Boston, offer the following advice:
“Fragrances are added to make products smell delightful and sometimes to cover the odor of unpleasant ingredients (a so-called ‘masking fragrance’),” Lio said. “However, they are a relatively common allergen and many patients with sensitive skin can react to them. In general, for those with sensitive skin or AD, fragrance should be avoided whenever possible.”
“Contrary to popular belief, natural fragrances are equally as likely to cause allergies as synthetic fragrances,” Yu said.
“Tea tree oil, for instance, is a natural superhero,” Lio noted. “It has anti-acne, anti-fungal and anti-bacterial properties, and is used in a variety of skincare products. However, it can be both irritating and can cause an allergic contact dermatitis, so it is probably best avoided for patients with AD.”
“Urea can be a fantastic ingredient for certain skin conditions. In particular, it can be a keratolytic, helping pull off thick, adherent scale in psoriasis, calluses and corns,” Lio noted. “However, in atopic dermatitis (AD), it can be irritating and can contribute to damaging the acid mantle of the skin. While it may be expertly formulated for AD patients, it is probably best avoided outside of special situations.”
“While lanolin is derived from sheep’s wool and has excellent emollient properties, a subset of patients with AD can actually develop an allergy to lanolin,” Yu said. “Popular moisturizing products that contain lanolin may instead cause atopic dermatitis to continue flaring.”
“Retinoids are an amazing class of medicines related to vitamin A. They play an important role for both acne and anti-aging, but they come with a price: they are often irritating and can trigger eczema flares. These should generally be avoided in patients with sensitive skin or at least used very, very carefully,” said Lio.
“This is a common foaming agent used in various shampoos, conditioners and body washes. Touted for its tear-free properties (often in baby shampoos), it can cause allergic contact dermatitis in adults and children,” said Yu.
“This is an emulsifier that’s hidden in a lot of common topical moisturizers and creams. In addition, it’s also present in many topical steroid and anti-inflammatory medications to treat eczema. It’s also present in liquid antihistamines,” Yu noted. “People who are allergic to propylene glycol can paradoxically flare when treated with topical steroids or oral antihistamines.”
“Ethanol (alcohol) is often an ingredient in gels. These are lightweight, cooling and evaporate in seconds, which makes them great preparations for hair-bearing areas. However, for patients with AD and sensitive skin, alcohols can sting, burn and dry out the skin, so are best avoided,” Lio said.
“Notably, however, these are not the same as the ‘fatty alcohols’ such as Cetyl alcohol, which are generally well-tolerated by the skin and are often present in a number of time-tested eczema preparations.”