Search for tag: "dermatitis"

Dr. Tarbox: Hello and welcome to "Skincast," the podcast for people who want to learn how to take the very best care of the skin they're in. I'm Dr. Michelle Tarbox, a dermatologist and dermatopathologist at Texas Tech University Health Sciences Center in beautiful sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, everybody. This is Dr. Luke Johnson. I'm a pediatric dermatologist and a general dermatologist with the University of Utah in Salt Lake City.

Dr. Tarbox: So today we're going to talk about something you hopefully don't run into personally, poison ivy.

Dr. Johnson: That's right. Poison Ivy is the alter ego taken by Dr. Pamela Lillian Isley, an eco terrorist and prominent enemy of Batman who first appeared in Batman #181. Just kidding. This is a dermatology podcast, so we're going to talk about the plant.

Dr. Tarbox: But great nerd culture. I'm proud of you.

Dr. Johnson: Thanks. So the rash that you get from poison ivy is technically allergic contact dermatitis, or ACD. You can get allergic contact dermatitis to all kinds of stuff. Think of something, you can get allergic contact dermatitis to that thing. But today, we're just going to talk about the plant types of allergic contact dermatitis: poison ivy, poison oak, and poison sumac.

Dr. Tarbox: So the poison plants all have the ability to produce a significant rash in humans upon contact. The first one we're talking about, of course, is poison ivy, because it's sort of the leader of the pack, if you will, of the itchy gang.

So Toxicodendron is its actual name. It's such a nasty plant it has toxic right there in the title. This plant is found everywhere in the United States, except for Alaska and Hawaii. Even in places where it was less common, it's starting to have territory expansions.

And it can really be just about anywhere, because it sometimes gets accidentally shipped with nursery plants around the base of a tree or shrub that's taken from one part of the country to be grown in another part of the country. So you can actually run into it pretty well in most places. Do they have it in Utah, Luke?

Dr. Johnson: They do. It shows up just about everywhere in Utah. How about in Texas?

Dr. Tarbox: Not as much in the part where I live because it's very dry and that plant likes a lot of moisture. But when we have our wet years, we end up with some expansions of the growth of those things out from around the bases of the nursery plants. And it's out in the countryside most places in the country.

Dr. Johnson: "Leaves of three, let it be." That's the saying, because this plant has what they call compound leaves with three leaflets. So a little plant stem will actually have three little leaves coming out of it, and the middle leaf is kind of longer than the others.

When I was learning dermatology, I remember complaining that, "Man, I'm already a doctor, and now they want me to be a botanist? And I'm also supposed to learn about bugs and be an entomologist and all that stuff?"

There are pictures of these plants. We can talk about what they look like. The edges of the leaves can be smooth or toothed. The surface can be glossy or dull. But I discovered that there are now apps that can identify plants. So instead of trying to memorize pictures or torturing our dermatology residents, we should probably just use these apps.

So some that I found are PlantSnap, Leafsnap, and Planta. So if you're going to go out hiking or camping, especially if it's somewhere kind of new for you, you might want to download one of those apps first and make sure that your children aren't tromping around at a big poison ivy patch.

Dr. Tarbox: I like that plan. One of the things that we kind of can unify with these plants is that they all have an oil that they make that is the problem child, the thing that causes the rash. And so that makes the rashes look a little kind of shiny or glossy, a lot of the time but not all of the time.

Dr. Johnson: They only produce this stuff at certain times of the year, certain seasons, or when the plants are doing whatever plant things they do. But sometimes these little black dots show up and that's the urushiol.

Poison oak and poison sumac also exist and are kind of similar. Poison oak is found in western North America and the Southeastern US. It's not a tree, despite the fact that oak is in the name. That was surprising to me. It's more like a shrub or a vine. And it kind of similarly to poison ivy has the three leaflets, and in the spring it has white flowers. So if you find something in the spring that has red flowers, you're probably good.

Dr. Tarbox: Yeah, white flowers, that could be a problem. Could you imagine if somebody made a bouquet out of those and then just . . .? Their poor little hands.

Poison sumac is also a thing. Less common. It is a shrub or a small tree up to about 30 feet and it tends to grow in wooded swampy areas like Florida in the southeastern portion of the United States. It's also present in wet, wooded areas in the Northern United States. So you and I probably don't have a lot of sumac in our areas, Luke.

Dr. Johnson: I don't think so. So they're easy to avoid, which is what you should do for all of these if you can. Just don't come into contact with them. Stay in your house, play video games, everybody will be fine. Well, probably not. Actually, there are some dermatologic conditions that can be associated with excessive video game playing.

So if you do come into contact with a plant, well, you want to wash the affected area. Not necessarily with just normal soap either. You want to use laundry soap, dish detergent, rubbing alcohol, and rinse. You want to get that plant juices out of anywhere that it could have gone, so rinse onto your nails. And remember, it could have gotten on your clothes, so carefully remove your clothes, perhaps with gloves or something, and put them in the wash.

Dr. Tarbox: And you want to wash your whole body surface because we may touch parts of our body with our hands that made contact with oil and transfer it. So one almost emergency situation that more commonly affects men is when they have contact with the plant and then maybe they go to the bathroom. And you can imagine that the severe allergic contact dermatitis on that part of your body might be significantly uncomfortable.

There are products that are made specifically to help you to remove the oil that causes the rash. One of the most common ones you can find is called Ivy Block. Again, we have no relationship with any commercial product. We just like people to be able to find the product in the stores.

So the active ingredient in Ivy Block is something called bentoquatam, and it tends to protect the skin like a shield against the poison ivy, poison sumac, poison oak by kind of blocking skin contact with their resin. They also make a soap that can help you to rinse off the oil very well.

Any of these preventative products, of course, you wouldn't want to get in your eyes. You obviously don't want to get poison ivy residue in your eyes either.

And one very important thing is to not try to go all vengeance on the plant and burn it. I've had several patients who actually, after they determined what had caused their rash was poison ivy, then sort of in retribution ripped the plant out of the ground and burned it. The problem is if you burn it, then you aerosolize the oil and you can actually give yourself a chemical pneumonitis. You can give yourself poison ivy in your lungs if you burn this stuff, so you should never burn it.

If you think you've been exposed to airborne, poison ivy resin from burning that kind of thing, you may need to seek medical care. So do not burn anything you think is poison ivy.

Dr. Johnson: "Leaves of three, let it be." Do not incinerate.

Dr. Tarbox: Now what about the rash, Luke? Does everyone who touches poison ivy get a rash?

Dr. Johnson: Interestingly, no. Maybe only about half of people seem to actually get this allergic contact dermatitis to poison ivy. And like other allergies, if you've already been exposed in the past, that means your immune system is extra ticked off if it sees it again. So if you've had a poison ivy rash in the past, and you get exposed to poison ivy again, you'll probably get a rash within a few hours of touching the plant.

However, if you've never seen poison ivy before . . . well, if you have not ever touched poison ivy before, and you end up touching it, then the rash might take a couple of weeks to show up. So remember how you were hiking in the woods two weeks ago? Do you have a rash now? Maybe it was poison ivy.

And it occurs where the leaves brush against the skin. So sometimes dermatologists refer to something looking like an "outside job." So if we're having an immune reaction within our body against something that's going on in our body, not a reaction to something outside our body, it usually doesn't show up as nice lines or swirls or curves and things like that. So if it looks like someplace where a leaf may have brushed and left a rash there, well, it could have been something like this.

Dr. Tarbox: So what do you say we should do if patients get this? How do we take care of it?

Dr. Johnson: Well, if it's not too bad, you can just treat it with over-the-counter stuff like soothing lotions and things and mild steroid creams and steroid ointments like hydrocortisone. A dermatologist or another doctor can prescribe you stronger medicines if necessary.

For really bad poison ivy, especially these people who burn poison ivy, we can sometimes even do steroids by mouth to help get over the reaction because it can be really, really horrible and it can last two or three weeks.

Dr. Tarbox: It can be quite awful. So the really best thing to do is just avoid it. If you, of course, know what the plant looks like, that helps. I encourage people to kind of refresh their memory about what these plants look like before they go on a hiking or camping trip.

You can also wear clothing that will protect the skin from both the sun and from the brush of those leaves. So a lot of sun-protective clothing with long sleeves or long pant legs can be preventative in terms of preventing skin contact. And then you can wear the Ivy Block when you're out and about in areas where the plant might live.

Dr. Johnson: The rash can blister, by the way. So if you see that you've got a blistering rash, it still could be poison ivy.

That's most of the poison ivy/oak/sumac stuff I wanted to talk about. I want to talk about Mr. Freeze next.

Dr. Tarbox: Okay.

Dr. Johnson: Thanks. Was waiting for that.

You can get allergic contact dermatitis to other types of plants as well. Compositae is a super common type of plant that causes allergic contact dermatitis. It doesn't cause it in nearly as many people as poison ivy does, which I guess is why it's not called poison sunflowers. They're just called sunflowers. But there are all kinds of plants in this family, sunflowers and things that kind of look like sunflowers with that kind of circle/radiate/Starburst appearance. It's a common thing we see in dermatology. Tulips can do it too.

Dr. Tarbox: Alstroemeria.

Dr. Johnson: What's that?

Dr. Tarbox: Alstroemeria. So there's a kind of Peruvian Lily that is used very frequently in floral bouquets because it's a hardy plant, and it lasts for a long time and has really beautiful blooms. So the Peruvian Lily or Alstroemeria can also cause contact dermatitis.

Dr. Johnson: So we like plants, but they might not always be your friends. In addition to allergic contact dermatitis, there's also irritant contact dermatitis. So the difference is that to have allergic contact dermatitis, your particular immune system has to be angry for some reason, whereas in irritant contact dermatitis you're coming into contact with something that is just irritating to human skin. A chemical burn is a good example of an irritant contact dermatitis.

And some plants can do it too, including plants that we eat, like garlic. So sometimes especially people who prepare a lot of food with these plants can start to get irritation of their fingertips, for example.

And also, there's this funny condition that some plants can cause called phytophotodermatitis. It's one of my favorites. There are particular plants that have a chemical in their juices and when the juice gets on the skin and then sunlight shines on the juice, you get this big reaction and it can kind of look almost similar to poison ivy. And its significant forms can be this itchy blistery rash. That calms down pretty quickly, but then you're left with this pink-brown discoloration that can last for like two years.

So common plants that can do that are citrus plants like limes. So some people refer to margarita hands. If you were on vacation in Mexico smashing limes for margaritas, you were probably hanging out in the sun too and bam, margarita hands.

There are also different weeds and things, like hogweed, that can do it. So sometimes we'll see this in people who are doing yard work or something.

Dr. Tarbox: And there are also plants that cross-react with a person's allergy to poison ivy. So for some people, it'll be mango peel. If you have a significant poison ivy response, then making significant contact with the peel of a mango fruit can potentially cause you allergic contact dermatitis.

So if you're one of those people who likes to get every last bit of mango out of the mango slice, and your skin is coming in contact with that mango peel, if you've had a reaction to poison ivy in the past, you may get a rash from that. So it's probably safer to just cut the peel off.

Patients can also react to ginkgo leaves or potentially cashew plants if they've reacted previously to poison ivy.

Dr. Johnson: That's all for today. Thanks for hanging out with us, guys. And thanks to our institutions. Thanks to the University of Utah for supporting the podcast, and thanks to Texas Tech for lending us Michelle.

If you like to nerd out about dermatology, you might be interested in our other podcast as well. It's called "Dermasphere." We say it is the podcast by dermatologists for dermatologists and for the dermatologically curious. We talk about dermatosis you can get from video game playing, for example. And I think we've even talked about Super Villains at one point, like they're depicted as having less hair than heroes. So we talk about some fun stuff. You can find that in Apple Podcasts or wherever you get your podcasts.

"Skincast" episodes you can also find on Apple Podcasts or wherever you get your podcasts, and, in two weeks, right in your earbuds. We'll see you then.

Parents will often bring their kids in to see me for skin issues, and I also get a lot of phone calls about rashes. Well, the hard part is I can't see your child's rash over the phone. Rashes are one of those things that your pediatrician will need to see in person or through a video visit in order to determine what the cause of the rash is and what to do about it.

Babies and diaper rashes are one very common concern. Babies get diaper rashes very easily, even within days of being born, because their skin is super sensitive. In fact, their skin is not fully developed until about 6 months old, which is why we say no sunscreen or bug spray until then.

Babies are also in diapers and they pee and poop a lot. Diaper rashes are basically contact skin issues due to the diaper fibers and due to the normal body chemicals and bacteria in the urine and stool.

Some babies are okay with just having diaper rash cream put on their bums. Others get more like burns. We used to even make our own diaper rash cream for our older son. His skin was so sensitive we joked that he would get a diaper rash if we looked at him wrong. We ended up using burn cream mixed with zinc oxide for him.

Parents often ask which diaper cream I recommend. My answer? Whichever works for your baby. I don't have a personal preference, and some creams work better for some babies than others.

If the diaper rash is red and bumpy, though, that's a yeast diaper rash. It's more in the front of the diaper area and less on their bottoms. Any over-the-counter yeast cream can help with that.

Then there are dry skin issues. Every winter, I have parents bringing their children to me for an all-over body rash that can be itchy. That's often either just dry skin dermatitis or eczema. For both, start with a cream that says "dry sensitive skin." And you can try mixing a little over-the-counter hydrocortisone with it and apply it twice a day for a few days.

Some kids with really bad eczema end up needing prescription creams, and that's when a trip to your pediatrician is needed.

There are all sorts of rashes. Most are viral, some are bacteria, but for all other rashes, it's best to have your child seen so we can check it out and see what treatment is needed.

Viral rashes need no treatment. They'll go away on their own. Bacterial ones sometimes just need topical antibiotics, but sometimes need a prescription for oral antibiotics.

If you have a concern about your child's skin, go ahead and bring your child in to see their pediatrician. Chances are we've seen your child's rash before and are able to help.

Dr. Tarbox: Hello and welcome to "Skincast," the podcast for people to learn about skincare. I'm Michelle Tarbox. I'm a dermatologist in beautiful sunny Lubbock, Texas. And I'm being joined by . . .

Dr. Johnson: I'm Luke Johnson, dermatologist at the University of Utah in Salt Lake City, Utah.

Dr. Tarbox: So we're making this podcast to help educate people about how to take the very best care of their skin, and we plan to release an episode every two weeks. On this podcast, we will mention specific skincare products that we have found in our medical opinion to be very helpful and beneficial to our patients. We are not sponsored in any way or supported by any of the manufacturers of these products.

Dr. Johnson: Nope, but we are medical doctors.

Dr. Tarbox: I like it. Dermatologists are medical doctors who specialize in the care of the skin and of the hair and the nails. We're going to talk about skincare in the COVID era. So, Luke, what do you think is the most important aspect of skincare in this very unusual time we're all living through?

Dr. Johnson: Well, everybody is washing their hands a lot more because of the Coronavirus, which I think is a good idea. But a lot of people have noticed that their poor hands just get so dry and chapped afterwards. We say they have irritant contact dermatitis. Dermatitis, inflammation of the skin, because of contact with an irritant, in this case water. And it's helpful to know what to do if your poor hands get all dry and chapped.

Dr. Tarbox: And that definitely can happen in this day and age when we're all having to clean our hands very frequently. I think now more than ever it's really important to have a good skin care regimen that helps protect the integrity or the intactness of your skin, because our skin is important. It helps to protect us from the world, from bacteria, and viruses, and chemicals, and so we need to take the very best care of it. So what's your favorite moisturizer, Luke?

Dr. Johnson: Well, I love just plain old petroleum jelly. The brand name is Vaseline, but you can buy just the generic brand petroleum jelly. It's great for so many reasons. I have written a small love letter to Vaseline. It doesn't rhyme or anything. But first of all, it's super cheap, especially if you buy the generic version. You can get a big tub of it for about $3. It does a great job moisturizing the skin. So, in dermatology, we talk about transepidermal water loss, the water loss through the skin, and petroleum jelly prevents 99% of it. Also, nobody gets allergic to petroleum jelly. Love it.

Dr. Tarbox: It's easy to find, most people have access to it, and it works very well. Now, I know some people aren't always comfortable using petroleum jelly for various reasons. So, if you're one of those people, and we just can't convince you with our passionate love of Vaseline, we can . . .

Dr. Johnson: It's great.

Dr. Tarbox: It is fantastic. But we can recommend some other things as well. For some patients who don't want to use Vaseline or petroleum jelly, the nut butters may be beneficial. So shea butter can be helpful. Some of my patients have liked a product called Waxelene, which is actually derived from beeswax and is sort of a crunchy granola replacement for Vaseline or petroleum jelly. But the important thing is just to use it regularly.

Dr. Johnson: Waxelene?

Dr. Tarbox: Waxelene. I know. That's what it's called. You can find that usually in health food stores or Whole Foods markets.

Dr. Johnson: What I tell my patients often is that I know Vaseline is not for everybody. It's kind of messy and greasy. So, if you don't like it, use something you like. So just find the thickest, greasiest thing that you kind of like putting on your skin. In general, things that you have to scoop out of a jar are going to be more effective than things that squirt out of a bottle.

Dr. Tarbox: I kind of love that analogy, and that's definitely true. So you want your lotion that you're going to use to moisturize your hands in this unusual time to be more like icing and less like chocolate syrup. So when we are talking about moisturizers, if you're wanting to use something that's more of a cream, there are several over-the-counter products that I think Luke and I can agree on are very helpful to the skin and are very minimally irritating, so they don't have any excess fragrances or harsh preservatives.

Dr. Johnson: Well, if people don't buy into Vaseline, I usually don't have anything specific in mind. But the point of all this is not just to make your hands feel better, though it will. But there is a little bit of concern amongst some dermatologists that if you've developed little cracks in your skin, that could actually be a portal of entry for the Coronavirus. So the Coronavirus likes to attach to certain proteins in order to get into cells and those proteins might be present in those cracks in your hand. We call those fissures. So helping them to heal up is important, and these moisturizers will help that happen.

Dr. Tarbox: Absolutely. Now, a lot of people are using hand soap to wash their hands. Your choice of soap is also very important. Some soaps are going to really strip the natural oils from the skin, and others may be irritating because of fragrance or chemical content. So using a soap that's designed to be gentle is a good choice. What's your favorite?

Dr. Johnson: Well, as far as I can tell, the party line among dermatologists across the world is white Dove bar soap. Everyone seems to really like it.

Dr. Tarbox: I like that one. I also like . . . Vanicream makes a bar soap as well that's very hypoallergenic. Another good product is CeraVe Hydrating Cleanser. This is a cleanser that won't foam. It doesn't have the ingredient that makes soaps foam, which is usually something called sodium lauryl sulfate, which can be a little bit more dehydrating to the skin. But you don't actually need the foam to cleanse. It's just something we associate with cleanliness. So that's a great product as well and it's very gentle.

Dr. Johnson: Though I'll admit at my home I use just random generic liquid soap because my hands don't seem all that sensitive, but I do put moisturizer on them afterward.

Dr. Tarbox: It's a good idea. There's also, of course, hand sanitizer that people are using. And remember that it has to have a certain percentage of alcohol in it for it to be effective against the Coronavirus. Now, alcohol is naturally dehydrating. That's one of the ways that it actually works against enveloped viruses like the coronavirus. But that same property where it can be dehydrating can make it a little bit hard on your skin.

Dr. Johnson: And of course, in general in terms of the Coronavirus, as you'll hear everywhere, if you can avoid touching your face, that's great. In dermatology, we learned that people just touch their faces all the time for no good reason. In fact, I think I touched mine over the past two minutes like five times. So just bear in mind that there could be dirt or other nasty things on your hands that you don't want to put on your face.

Dr. Tarbox: Yeah, I think that it's something that we all have to kind of monitor our subconscious activities with and really try to pay attention to that behavior and stop it before it potentially transmits a virus we really don't want to deal with.

Dr. Johnson: Well, we mentioned moisturizers in general earlier, but this is a special spot where my favorite Vaseline really outperforms. So something nice and greasy will help it heal. Wounds heal best when they're kept moist and greasy. So I've talked to a number of patients who have said, "Won't my wound heal better if I leave it to dry?" And it's interesting because the medical community used to feel that that was the case. But something like 20 years ago, we realized it's not. If it's moist, then the new skin cells can crawl across the surface more easily. So, if you remember hearing, "You should leave your wounds dry for them to heal," that's outdated knowledge. Now, keep them greasy with Vaseline.

Dr. Tarbox: I like to think of it like trying to regrow a dead patch in a yard. So, if you think about where you've got your grass and you want it to grow back over a place where the grass has been lost for some reason or another, is it going to grow better if you have a nice moist soil that's easy for the grass to grow back through? Or is it going to grow best if you have hard, dry dirt?

Dr. Johnson: I do not have a green thumb, but I'm guessing the moist one.

Dr. Tarbox: Exactly. So I think that that's a very important thing now.

Dr. Johnson: Just don't wear a mask.

Dr. Tarbox: Ah, ba-dum.

Dr. Johnson: No, a joke. I mean, I guess if you can avoid wearing a mask because you are staying at home or whatever, that's fine. But masks are pretty important to prevent the spread of the Coronavirus, so they're a necessary evil. Avoiding other stuff that's on your face under the mask, specifically makeup. So I admit I don't wear a lot of makeup.

Dr. Tarbox: What?

Dr. Johnson: But it seems to me that if you are going to be wearing a mask anyway, then why put makeup on the part of your face that's going to be covered? It can exacerbate the problem. It also kind of messes up the masks and makes them harder to reuse if we end up needing to do that.

Dr. Tarbox: I agree. I've actually taken this whole time as a little permission to be a little less involved with my beauty routine. So while I'm paying very good attention to my skin health, and I'm trying to kind of baby that skin and be gentle with it, I'm really not using makeup hardly at all, because what's the point? It's underneath the mask and no one is going to see it. So I don't understand why I would do that anyway.

Dr. Johnson: How do you wash your mask, Michelle? Do you just throw it in the washing machine with everything else?

Dr. Tarbox: The masks that I've had, I've had some that have actually been made by people in my community, who are just wonderful, lovely volunteers. So, in my free time, I actually enjoy participating in community theater. And when this whole outbreak began, the seamstresses and costumers that are a part of the theater made this beautiful effort and sewed all of these fantastic masks out of 100% cotton and then took them to the hospitals and gave them to the doctors and nurses there. And I thought that was a wonderful thing that they did. I found that just washing them like you would wash normal clothes is a very appropriate way to take care of them.

Dr. Johnson: I like that one, and I like the Costco version of it. I don't remember what it's called. Kirkland brand Free and Clear, or something like that.

Dr. Tarbox: I found that the Tide cleansers are a little bit more harsh to the skin, and even their Tide Free and Clear still causes problems for me and some of my patients. So I tend to avoid that one.

Dr. Johnson: Sometimes it's not time to do laundry and I still want to wash my mask. So we've just washed them by hand just with a little bit of laundry detergent on our fingers, or wash them in the kitchen sink and then put them in the dish dryer to dry. That seems to work okay.

Dr. Tarbox: I think that's a great way to do that. And then you also want to make sure that if you are having to wear a mask every day, your skin can get really irritated. There are some adaptations that you can make. Some of the masks tie behind the headset instead of behind the ears. So potentially altering the style of mask you wear day to day might help protect that skin behind your ears. There are also little straps or buttons on headbands to clip behind the head that will hold the ear loops of the mask.

Dr. Johnson: And for anybody out there who's an aspiring dermatology nerd, there are medical, fancy terms for all this stuff. So the medical term for maskne is Acne Mechanica, and it can also occur with anything else that's sort of rubbing or lying on the skin. I know it's seen in military recruits who have to wear backpacks all the time, for example. And then the medical term for your poor sore earlobes after you've been wearing a mask all day is acanthoma fissuratum. There you go. We make up words to sound smarter than we are.

Dr. Tarbox: Science! So, before this outbreak, the most common place that I would see what we call maskne, what we technically call Acne Mechanica, was in my football players who were wearing chin straps and masks because they were playing football. And it being Texas, you see a lot of that.

Dr. Johnson: And the other thing I think is that's helpful to know is if you do get some of the acne stuff onto your mask, one of my favorite over-the-counter products is benzoyl peroxide. It's in a lot of acne treatment products. So look for that particular ingredient. It comes in a lot of different ways. It comes as little spot treatment pads or gels or cleansers. I kind of like it as a cleanser, because I figure you're washing your face anyway, might as well put some medicine in there, but it works fine as a spot treatment if you just have one or two spots.

Dr. Tarbox: It will bleach your towels.

Dr. Johnson: And potentially your clothing.

Dr. Tarbox: And if you have lighter colored hair, it can get your hair.

Dr. Johnson: And I want to agree with everybody that the Coronavirus sucks. I'm sick of it.

Dr. Tarbox: One hundred percent. It is not our favorite thing. If you are treating the acne, you want to be a little bit more gentle than you normally would be. So I wouldn't go for the mega acne control hot lava cream. Use the sensitive skin products right now. Take it a little bit easy on your skin.

Dr. Johnson: Yes, I'm very proud to be part of the University of Utah Department of Dermatology. It's a great place to live, Salt Lake City. It's great place to work. And if you are a super dermatology nerd and are interested in sort of some of the research behind it, Michelle and I have another podcast. It's called "Dermasphere" and it's really intended for dermatologists. Maybe you're a dermatologist. What do I know? But maybe you're just dermatologically curious. If so, you can check out "Dermasphere" on your podcast platform as well.

Dr. Tarbox: Well, we'll be releasing a new episode in two weeks and we hope to see you there. Thank you for learning with us about the skin today here at "Skincast."

Dr. Miller: Your child has eczema. How do you stop that scratching and itching that's driving them crazy? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Miller: I'm here with Dr. Mark Eliason. He's an assistant professor in dermatology. Mark, how do you help kids get through eczema?

Dr. Eliason: I'd love to talk about that. Eczema also called atopic dermatitis in children. It's a condition that occurs . . .

Dr. Miller: Atopic, what does that mean?

Dr. Eliason: Oh, atopic means that someone develops eczema with kind of a family disposition. It's not that they ran into something that caused the eczema, it's not that they're doing something wrong, their skin just tends to do this easily on its own.

Dr. Miller: So they tend to come from a family of scratchers and itchers?

Dr. Eliason: A lot of people in their family probably have it. So, when we help and we counsel parents who have children who have atopic dermatitis, we talk to them about some strategies they can use at home. In addition to some of the medications they can get from their pediatrician or dermatologist, there are some simple things that they can do to make it better. One of them is to try to make sure the skin stays moist. Kids with atopic dermatitis dry out a lot faster than the average person, and their skin doesn't always look dry. It doesn't always look flaky or look like it's peeling off, but it is dryer than the average person's skin.

Dr. Miller: So would that be more common in dry climates?

Dr. Eliason: It's exacerbated and worsens in dry climates such as Nevada and Utah.

Dr. Miller: Perfect.

Dr. Eliason: Yeah. So what we often talk to people about are ways to avoid making the skin dryer. And this sounds pretty counter-intuitive, but bathing can actually be a problem. Our skin stays moist, not because of water, but because of oils that we produce naturally, and children with atopic dermatitis make less of this oil and they can't keep it in there like a normal person can.

Dr. Miller: So too frequent bathing could definitely be a cause . . .

Dr. Eliason: Right.

Dr. Miller: . . . or an exacerbant.

Dr. Eliason: Precisely. In our culture, we encourage people to bathe every day, but in actuality, our skin doesn't actually need it, and it can actually be harmful. It's okay to take a bath that's warm, that's comfortable. But a bath that's blazing hot is not good. Or a bath that's too long, longer than 10 minutes or so can actually start to pull more oils out than they have and it will make things worse when they get out of the bath.

Dr. Miller: Now what would be the typical age range for children with eczema? What would be the peak ages, if there is such a thing for eczema?

Dr. Eliason: Well so it happens at any time. For most kids, it happens before puberty, and then it will sometimes happen though in adulthood.

Dr. Miller: It tends to get better after puberty?

Dr. Eliason: So it's a rough estimate, but about a quarter of kids grow out of it as they go through adolescence. When we talk to parents also, we talk to them about simple things they can also try to help their kids with, which includes things like when kids are bathing, you want to use milder cleansers, not the harsh bar soaps but maybe mild soaps, the kinds that don't bubble up or form a lot of lather.

Dr. Miller: Such as?

Dr. Eliason: Cetaphil cleansers is one example. Eucerin cleansers, a lot of these soaps that are kind of targeted towards dry skin or hypoallergenic can be helpful. Soaps that have fragrances in them can also be irritants. When your kid get out of the bath tub, it's also a useful thing to do is to moisturize them right away using creams instead of lotions, as lotions don't really moisturize as well as the cream does.
Kids that still are having problems beyond that sometimes benefit from the use of antihistamines, things like Benadryl in the evening. Again, you want to make sure they're safe to take those, but those can take away some of the itching, and by helping kids get a little bit sedated will actually help them fall asleep sometimes when the flares are really bad.

Dr. Miller: So frequent bathing, not a great idea, use mild soaps, and use creams to keep the skin moist.

Dr. Eliason: Exactly. And we even have children sometimes be on creams into ointments or things that have names like Aquaphor or even Vaseline is a simple, very effective thing that can keep the skin very moist and lubricated, and it helps to avoid overuse of some of the prescription medicines that doctors use.

Dr. Miller: And so if those things aren't working, maybe see the dermatologist?

Dr. Eliason: Definitely.

Dr. Miller: Thanks very much, Mark.

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