Dr. Skotnicki-Grant: Dyshidrotic eczema, also known as pompholyx, is indeed a genetic skin disease, characterized by fluid-filled blisters on your hands, sides of your fingers and soles of your feet. The blisters, known as vesicles or bullae, usually come and go in three-week cycles. And I’m sure I don’t have to tell you that although the condition can vary in severity from mild to severe, it causes intense and sometimes even debilitating itching.

We don’t know exactly why people get dyshidrotic eczema, but we do know what aggravates it. Irritants, including harsh detergents like sodium lauryl sulfate, used in many cleaning and hygiene products, can make it a lot worse. Be sure to use non-foaming, fragrance-free hand cleanser. Sweat can cause dyshidrotic eczema to flare up, so don’t wear rubber gloves for more than 20 minutes at a time, or wear cotton gloves under the rubber ones. Unfortunately, even water itself can worsen the condition, so don’t wash your hands more than you need to. Over-the counter barrier creams such as Prevex and Cetaphil Barrier Cream can protect the skin from irritants.

As a general rule, allergy has little to do with dyshidrotic eczema, but it wouldn’t hurt to get it ruled out, as it can mimic the condition.

Find Dr. Skotnicki’s clinic at baydermatologycentre.com.

First published in Allergic Living magazine.
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Dr. Skotnicki-Grant: At the age of 8, your daughter likely has a genetic form of eczema which is referred to as atopic eczema. This is a chronic and recurrent condition that usually flares in what we call the skin “flexures”, such as folds of arms and behind the knees. Many children will grow out of it.

However, while she has it, approaching the disease in a preventative manner will be the most beneficial. This means taking great care with all aspects of her skin care. Assess every product she uses from her head to her toes, adopting a “less is more” approach. All products should be fragrance-free and botanical-free.

Get the shampoo, conditioner, moisturizer, soap, and fragrance-free laundry detergent (no fabric softener!) in order. For soap, I like the Dove Sensitive Skin Beauty Bar, and suggest not to use body washes. Then you should ask her doctor to prescribe an appropriate corticosteroid cream for flares. Keep in mind that if she avoids irritants in her day-to-day life she will have fewer flares, and require less corticosteroid cream.

Also note that using a medium to strong corticosteroid cream can treat a flare very quickly and get the skin back on track. In the long run, she will use much less corticosteroid than if she uses a mild corticosteroid cream for many days.

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

Dr. Skotnicki: The rash you get from touching poison ivy is an allergic response to the plant’s resin, called urushiol. Poison ivy allergic contact dermatitis usually appears 24 hours after exposure and can range from being mildly red, swollen and itchy to severe vesicles (bubbles of liquid) and large blisters.

This is an allergy that’s quite common. However, it is a specific immune response and not every person who touches the plant will react. Repeat exposure to the plant can lead to sensitization and a lifelong allergy. With each contact the allergic response can become worse, leading to more severe dermatitis.

The allergy is not life-threatening, but can be quite uncomfortable.

The best way to treat poison ivy allergic contact dermatitis is avoidance. It’s important to be able to identify the plant (knee height, with three green, pointed leaves, which turn red in the fall). Once identified, someone who is not allergic should remove it from areas close to your cottage or home.

Never burn the poison ivy plant, as the allergen can become airborne.

There is also a product available online called IvyBlock, which acts as a shield against poison ivy, poison oak and poison sumac by physically blocking contact with their resin. It will not treat the rash, but it is a preventative barrier.

If your son does get allergic contact dermatitis from exposure, treat it with cool water compresses followed by application of a prescription-strength hydrocortisone cream (see your doctor).

Benadryl can help with the itch but won’t improve the dermatitis.

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Summer 2010 issue of Allergic Living magazine.
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Dr. Skotnicki-Grant: Parabens are one of the most commonly used preservatives in the cosmetic and toiletry industry as well as in the food industry. They are so widely used because – contrary to what most people believe – they are one of the best and least reactive preservatives.

With the new wave of using everything natural, they get a bad name because they are synthetic preservatives. The actual incidence of true allergic contact dermatitis to parabens is very low, less than 2 per cent. They are also not very irritating. So it is unlikely that the skin reactions you are having are related to parabens.

The one area where parabens can cause problems is with inflamed skin. This is known as the “Paraben Paradox”. In essence, parabens almost never cause a problem on normal skin, but can cause allergic dermatitis when used on active skin disease, such as wounds or eczema. This is why parabens are never used to preserve topical hydrocortisone creams or antibiotic ointments.

What is more common to cause both allergic and irritant skin reaction or dermatitis is the fragrance added to toiletry products. Fragrance is still the number one cause of allergic contact dermatitis to toiletry products, with an incidence of about 4 per cent within the North American population. It would be wise to see a dermatologist to figure out whether fragrance is behind your breakouts.

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Allergic Living magazine.
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Dr. Skotnicki-Grant: Most shampoos today contain fragrance, and fragrance that includes botanical ingredients is the number one cause of allergic contact dermatitis for all cosmetics and toiletry products. On the scalp, allergic contact dermatitis can manifest as itchy and dry, red patches. You may also experience irritation rather than true allergy, with immediate burning on the scalp, itching or redness.

Troublesome shampoo allergy ingredients are:

1. Fragrances

2. Botanicals such as mint, rosemary, lavender, ylang-ylang, tea tree oil and chamomile.

3. Surfactants, which create foam or lather.

The most important one to avoid is cocamidopropyl betaine, derived from coconut. Dermatologists are seeing many cases of allergic contact to this ingredient. Patients don’t always react to it on the scalp, but get dry patches on the eyelids, face, ears and neck.

There are only a few shampoos on the market that do not contain fragrance or cocamidopropyl betaine, such as Cliniderm Gentle Shampoo and Exederm.

My advice to patients who may be getting irritation rather than allergy is to avoid the shampoos that have the extras like ylang-ylang or lavender. Plain but mildly fragrant shampoos are a good start. Sulfates are not an issue and remember, botanicals are not safer.

Find Dr. Skotnicki’s clinic at baydermatologycentre.com.

First published in Allergic Living magazine.
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Dr. Skotnicki-Grant: The best anti-aging product is still sunblock. Unless you’re spending a lot of time outside, a moisturizer with added SPF 15 is enough for the winter. Steer clear of products that contain glycolic acids and Retin-A, which can be irritating.

I like the fragrance-free Kinerase line, which has some good science behind its anti-aging promises. In terms of ingredients, matrixyl is non-irritating and has scientific data to support its anti-aging claims. (Look for it in StriVectin and Olay’s Regenerist line.)

Stabilized vitamin C, found in Active C by La Roche-Posay, is also gentle and proven to decrease fine lines, increase collagen production and reduce pigmentation.

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Winter 2006-07 issue of Allergic Living magazine.
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Dr. Skotnicki-Grant: Many patients develop itchy, red, raised lesions while on a sun holiday, or during the spring in Canada. Though this reaction is often referred to as a sun allergy, it’s not a true allergic reaction. The correct medical term is Polymorphous Light Eruption, and it’s characterized medically as an abnormal cutaneous (skin) reaction to ultraviolet light.

Lesions usually occur on the second or third day of prolonged sun exposure, with reactions lasting about seven days. The condition improves after repeated sun exposure as the skin “hardens” and the abnormal reaction to the sun decreases – which is why it occurs during the spring in Canada and improves over the summer months.

The best treatment is prevention. Happily, the newer sunscreen technology is enough to block most reactions. I recommend Ombrelle SPF 45 for kids as it contains titanium dioxide, stabilized Parsol 1789 and Mexoryl SX – all ingredients that block the longer UVA wavelengths, thought to be the primary cause of Polymorphous Light Eruption. I also like La Roche-Posay Anthélios Lait SPF 45, which is fragrance-and preservative-free, and the Anthélios L SPF 60 sunscreen, for heavy-duty protection.

Remember to apply sunscreen 30 minutes before sun exposure and reapply every two hours.

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Summer 2006 issue of Allergic Living magazine.
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Dr. Skotnicki-Grant: Because the skin around the eye is the thinnest on the body, it’s easily irritated by toiletry products, cosmetics, ophthalmic medications, even the elements. If you have a genetic tendency towards eczema or dermatitis, you’ll also be more prone to developing irritation around the eye.

Don’t use creams meant for the hands or body on the face because they’re formulated differently, and might have concentrations not meant for the more delicate face and eye areas. Make sure you choose products that are fragrance-free and that list their ingredients, such as Marcelle, Almay and Clinique. Olay has a great eye cream for sensitive skin, too. Remember that many lines labelled “sensitive skin” or “hypoallergenic” might still have allergens or irritants in their formulations, so look for a complete list of ingredients.

If flaking and itching continue, see a dermatologist, because you may have developed allergic contact dermatitis (flaky, red, itchy skin resulting from a reaction to a chemical) to an ingredient. Only about 3.4 per cent of North Americans have allergic contact dermatitis to fragrance – so it’s more likely that you’re experiencing irritation to chemicals in your skincare and makeup products.

Common irritants include perfume, sunscreen and many botanicals. Remember, just because it’s natural doesn’t mean it will work for you – poison ivy is natural!

Related:
• Preventing atopic eczema flare-ups
• Avoiding parabens in cosmetics
• What is eczema and what are the best treatments?

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Allergic Living magazine.
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Dr. Skotnicki-Grant: Characterized by inflamed, scaly and red skin, eczema is a problem that those with asthma, allergies and/or hayfever are particularly prone to developing. The good news is that eczema can be managed.

Here’s how:

1. Avoid fragrance. It’s an unnecessary additive and a potential irritant. I suggest using unscented laundry detergents such as Tide Free and Cheers Free, and unscented dryer sheets like Bounce Free.

2. The same goes for beauty products. Facial and body soaps should be mild and unscented, like the bars from Dove, Cetaphil and Allenbury. Stay away from body washes, which are often scented and contain irritating ingredients.

3. Moisturize the entire skin daily. Go unscented with moisturizers like Vaseline Creamy Problem Skin Therapy Unscented, Glaxal Base and La Roche Posay Lipikar Baume.

4. Take short showers. Too much water can dry out the skin, so keep showers and baths to between 10 and 15 minutes, and make sure the water isn’t too hot. Pat dry – don’t rub, and always moisturize after bathing. Moisturizer is most effective when applied to damp skin.

5. Cool down. If you don’t have much control over your central heating, a cool mist humidifier can add moisture to your air.

6. See a doctor. Painful or inflamed areas should be treated by a dermatologist.

Related:
• A special bath that can fight eczema
• Am I allergic to exercise?
• The rise of nickel allergy

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Winter 2005-06 issue of Allergic Living magazine.
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Dr. Skotnicki-Grant: Rosacea, or acne rosacea, is a skin condition characterized by facial redness, flushing, pimples and broken blood vessels. The most important thing to remember regarding skin care for rosacea is that less is more. Avoid scented cleansers and moisturizers, which can aggravate. Also steer clear of cleansers that strip the skin, and those that contain sodium lauryl sulfate, a harsh ingredient used to make cleansers foamy.

A skin care line that I often recommend to rosacea patients is Toleraine, made by La Roche-Posay. The brand is made specifically for people with intolerant skin – it’s unscented and contains few irritating ingredients.

In terms of a skin care routine, I suggest using Toleraine Dermo-Cleanser, a milk cleanser that does not foam, twice daily. (A less expensive alternative is Spectro-jel.) The next step is to use a moisturizer – I usually don’t suggest a toner for those with rosacea, as it is drying. I like moisturizers from the Toleraine line and other unscented lines such as Marcelle and Clinique. With this condition, it’s best to pick moisturizers without anti-aging ingredients.

If you do apply makeup, try to buy unscented lines. I like Clinique, Marcelle, Almay and some MAC products. For more information, I recommend visiting www.rosaceainfo.com.

Find Dr. Skotnicki-Grant’s clinic at baydermatologycentre.com

First published in Fall 2005 issue of Allergic Living magazine.
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