table - amazon s3€¦ · we hope this will be a helpful resource for anyone who is living with...

table of contentsIntroduction .......................................................................................................3

I. The Good & Bad Hygiene Practices:

How to Clean? .................................................................................................. 7

II. Soak, Smear and Seal:

Optimize Your Skincare Regimen .....................................................................13

III. Prescription Medications:

Rescue & Maintenance Treatments ..................................................................20

IV. Managing Inner and Outer Stresses ......................................................31

V. Diet and Supplement ...................................................................................37

Conclusions ..................................................................................................... 46

Dr. Steven Q. Wang is a board certified dermatologist at Memorial Sloan-Kettering Cancer Center. Dr. Wang has an active & successful clinical research program focused in photoprotection, antioxidants, nanotechnology, and skin health. Gui T. Wang Lac, is a licensed acupuncturist who has been practicing acupuncture and herbal treatments for more than 40 years. He serves as the Founder and Director of the New York City Acupuncture Center.

http://www.drwangskincare.com/pages/about-us

1 | DrWangSkincare.com

Eczema, also known as atopic dermatitis, is a chronic disease

defined by frequent remission and relapse. It is a very complicated

disease influenced by multiple factors such as genetic variations,

environmental exposures, emotional stresses, and even food. It is also a

frustrating skin condition where sufferers struggle with severe itch and

widespread rashes. More troubling, many eczema patients have other

medical conditions. They often have trouble sleeping, which affects

their performance in school and at work.

Conventional medicine and treatment plans have helped many eczema

patients; yet, it has its limitation. There is a significant portion of

patients who are not responding to those treatments and are looking

for alternatives other than topical steroids.

In their pursuit to find relief, many eczema patients have found

support groups where members not only provide moral support, but

also valuable treatment and healthy advice. Sometimes the advice is

keenly insightful and medically sound, but other times, the discussions

generate and foster misconceptions that are not grounded by science,

facts or clinical data.

http://www.drwangskincare.com/

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One misconception is you can beat or cure eczema without medication.

Although, people have done it, the odds of succeeding are small. It will

take a long time. Not to mention, what does one do in times of flares

with severe itching?

On the flip side, it is also not acceptable to only use steroids for the management of eczema.

A holistic comprehensive approach is

needed to deal with eczema. You need

to inquire about the available medical

options, follow an optimal skin

care regimen, know stress-induced

triggers, change your diet or add

natural or herbal supplements to help improve your eczema.

”“

In this effort to create the most comprehensive and exhaustive guide

to help eczema patients, our team interviewed over 70 dermatologists,

pediatricians, acupuncturists, and naturopathic doctors. We also

consulted medical literature, scientific studies, and trusted websites,

such as the American Academy of Dermatology and National Eczema

Association. After months of research, we created this guide.

holistic, natural, and medicinal

We hope this will be a helpful resource for anyone who is living with

eczema or caring for loved ones with eczema.

Please leave your comments, suggestions, or your own experience that

can benefit all of us who are fighting against this disease.


part I


It is a major misconception that eczema is caused by poor hygiene

or not keeping clean. In fact, incidence of eczema is highest in

developed world and low in developing world where the population do

not bathe or wash everyday. Also, how to clean and wash is a part of

the important skin care regimen in managing eczema. If inappropriate

techniques are applied, daily washing and cleansing can trigger eczema

flare. Here are some valuable tips we gathered:

1. Avoid excessive and frequent showers & baths. Bathe no more than

once per day. Make sure each session is no more than 10 minutes.

2. Shower or bathe only in lukewarm water. Never use hot water, as it

can dry the skin and trigger eczema flares. Also, hot water can make

your skin itch.

exCeSSIVe SHOWerInG anD BaTHInG


| DrWangSkincare.com5

Use mild and gentle soaps such as: • Vanicream Cleansing bar

• Free & Clear Liquid cleanser

• Neutrogena Fragrance-Free

• Transparent Facial Bar

• DHS Body Wash, Cetaphil Cleanser

• CeraVe Cleanser

• Vanicream Bar

• Dove Bar for Sensitive Skin

5. Use mild and gentle shampoo for the scalp and hair. Some good products are: • Free & Clear Shampoo

• DHS Sal Shampoo

• Neutrogena T/Sal Therapeutic Shampoo

• Scalp Build-up Control for dandruff.

Avoid harsh soaps such as Ivory soap.

Avoid antibacterial soaps.

There is no need to use soap or cleanser

on the entire body every time you

shower or bath. It can dry out your skin.

Instead, you can limit the use of gentle

soap or cleanser every time to specific

body parts, such as groin, armpit and toe

webs, and use soap or cleanser on other

parts of the body a few times a week.

Apply

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10. There is no need to use soap or cleanser on the entire body

every time you shower or bath. It can dry out your skin. Instead, you can limit the use of gentle soap or cleanser every time to specific body parts, such as groin, armpit and toe webs, and use soap or cleanser on other parts of the body a few times a week.

If you’re living in a community with very hard water, consider getting a shower filter and a water softener. One inexpensive, but good brand, is WaterStick. Many people have reported to have skin improvements after changing the quality of their water.Do not exfoliate or scrub your skin with towels, washcloths, poufs, sponges, loofah or pumice stone. Scrubbing will destroy your skin barrier.

Bubble bath may be fun for your child, but avoid it, as it can dry out their skin.

Avoid hot tubs. Hot tubs use very hot water, which is not good for your skin.

Bleach baths work well to control eczema flares. It sounds scary to wash yourself or your child in a bleach bath, but it really works. You are washing with dilute bleach not full bleach water, so it is not dangerous. There are numerous studies supporting the efficacy of bleach bath. It can reduce microbial carriage and ultimately limit flares. See link for directions to make a bleach bath.

Click here for bleach bath directions


https://www.aad.org/public/diseases/eczema/atopic-dermatitis#bleach-bath


When to use a bleach bath:

16. If you notice any signs of redness or flares of

eczema, consider taking a bleach bath 2x per week.

Use a dilute bath when you see raw and weeping skin.

These may be early signs of skin infection and flares.

If you cannot do a bleach bath, consider taking a

shower and using a bleach wash, such as Cln Wash.

Your kids may not like, or even hate, bleach baths.

Here are some good ideas to distract them:

• Place a few rubber toys in the bath.

• Let them play games on a digital device (e.g.,

iPad) enclosed in a waterproof case.

20. You can set a timer so that the child knows how

long he/she needs to be in the bath.

Just like regular baths and showers, do not spent

more than 10 minutes in a bleach bath. Do not take a

bleach bath everyday, as it can dry out the skin.



Avoid baby wipes with

fragrance or scent. Consider

buying dry wipes and

then soaking them with

water before use. It is an

inconvenience, but occasionally

babies and toddlers may be

supersensitive to fragrances.

Always use scissors or clippers

to remove dead skin. Never try

to pull off dead skin.

Avoid using rubbing alcohol to

clean your body. Alcohol can

strip away the natural oils and

fatty acid on your skin, making

it excessively dry and irritated.

Avoid getting a professional

pedicure. Soaking your feet in

unclean bath water may lead to

fungal and bacterial infection.

For those with hand eczema,

do not wash your hands too

often. Try to minimize getting

your hands wet no more than

five times per day.

28. If you have hand eczema, consider using

hand sensitizers with moisturizer, instead of

washing hands with soap and water.


part II


T he cornerstone of keeping eczema at bay is aggressive

moisturization. Yes, you read it correctly. It is not topical

steroids or other fancy medications. It is simple moisturization!

Change your mindset. Do not think of your cream and ointment

as mere moisturizers. They are an important part of your medical

regimen that will keep your eczema at bay. All the dermatologists we

interviewed emphasized the importance of this step.

Applying moisturizers on your skin everyday replenishes the natural

moisturizing factor, natural oils, and fatty acid back into skin.

Moisturization helps to rehydrate the skin and help the skin to

retain water better. All these factors help to rebuild the skin barrier.

Without an intact & functional skin barrier, the skin cannot hold

onto water, becomes dry, and susceptible to allergens and irritants.

These aggregations can penetrate the skin and trigger undesired

inflammation. All these changes translates to flares of eczema.



Here are some good tips:

30. Apply more moisturizer during the fall and winter seasons.

Dry skin takes place as the seasons change from spring/

summer to fall/winter. Dry skin (xerosis) is the number one trigger

causing eczema flares.

Continue to moisturize even when you feel like you or your child do not

need them.

Apply moisturizer at least once per day. This is a must! Daily

application of moisturizers can prevent skin going into new flare cycle.

Apply moisturizers on your baby as early as possible. A new research

study showed daily use of a simple bland emollient on infants reduced

the risk of developing atopic dermatitis (eczema) later in childhood by

about 50%. That is a powerful preventive action!

This may sound like an easy task, but it can be

difficult for a wide range of reasons. There are many

misconceptions about how to moisturize. Again, like

cleaning and washing, if you don’t do it correctly,

moisturization will not have that powerful impact to

reduce the frequency of flare.

Let’s talk about how to moisturize.




Apply a moisturizer

immediately after

stepping out of the

shower or bath. Pat,

not rub, your skin

dry. Do not pat it

completely dry. Make

sure your skin is still

mildly wet or damp.

Apply a moisturizer

immediately (within

30 seconds after

drying) to seal and

lock the water into

the skin. You want to

do this right away to

replenish the natural

oils on the skin that

were washed off

during the shower or

bath.

Apply a moisturizer

liberally even if

you don’t feel your

skin is dry. Some

doctors even tell

their patients to put

so much moisturizer

on until the skin is

almost too slippery to

hold.

Be thorough. Apply

a moisturizer from

head to toe, covering

every part of your

skin. Don’t forget the

areas behind the ears

and groin.

It is important to

know that not all

moisturizers are the

same. In general,

ointment is better

than cream, and

cream is better than

lotion.

35. Lotion has

more water

and it is more dilute.

It is less effective

than a thick cream or

ointment to create the

artificial barrier to

lock in the water.

If your skin has red or

open areas, consider

using ointment on

those areas of skin.



If you feel stinging

or itchiness after

applying lotions or creams,

consider switching to

ointments. Creams and lotions

require the mixture of oils

with water. Surfactants and

emulsifiers are needed to

homogenize and keep oils and

water together. Without them,

water and oil will eventually

separate from each other.

Surfactants and emulsifiers

can be irritating and cause

burning, itching, and painful

sensations.

Choose ointments and

creams containing ceramides.

Ceramides are a part of

natural moisturizing factors

that are effective in rebuilding

the skin barrier.

In addition to creams and

ointments, you can also use

natural oils, such as sunflower

oil, safflower oil, jojoba oil,

calendula oil, and coconut oil.

These natural oils have a high

content of polyunsaturated

fatty acid. Coconut oil derived

from cold press also has

You may be wondering how to use

oils. Apply oil to wet skin while still

in the shower, then pat the skin dry.

40. You can also combine oils with

creams or ointments. While the skin

is still damp, apply oil followed by a

thick layer of cream or ointment to

lock in both the water and oils.

It is not only okay, but often

encouraged, to place moisturizers in

the refrigerator. It can improve the

texture and feel of the moisturizer.

Also, the cool sensation of the

moisturizer helps to reduce the

intensity of itch.

Choose moisturizers without

fragrance.

antibacterial and anti-inflammatory

properties. Oils are especially good for

babies and kids.




Do not apply perfumes,

colognes, after-shave or

pre-shave on any part of the

body or clothing.

Do not use any exfoliants.

Beware of anti-aging products

and anti-acne skin care

products with retinoids, as they

can be irritating.

45.People who have

eczema or sensitive

skin are more susceptible to

being sensitized to chemicals in

creams and lotions. Ask your

doctors for recommendations

on products with no or few

potential allergens.

Here are some moisturizers

recommended by our panel of

dermatologists:

• Cerave

• Vanicream

• Vaniply

• Aquaphor

• Dr. Wang eczema Ointment.

47. Our interviewed experts

also shared that if all

fails, consider using wet wraps.

After a shower, bath or bleach

bath, apply a moisturizer with or

without medications (e.g., steroids,

protopic) to damp skin. Wrap the

affected arms and legs in a moist

compress, followed by a wrap with

dry dressing over the wet wrap.


15

48. Wet wraps take considerable time to complete.

When correctly done, it can make a large

difference. Ask your doctor about how to do wet wraps

correctly.

For hand eczema, use cotton gloves under vinyl gloves for

all wet work or irritant exposure (cooking, cleaning, etc.).

part III


A ppropriate cleansing techniques in a shower or bath, plus adequate

and frequent moisturization, help to rebuild the skin barrier and

prevent flare ups; however, despite our best efforts, flare ups can still

occur. At those times, you will need help from medical professionals

who will prescribe medications. Here are some of the common treatment

options shared by our panel of dermatologists.

The most important key is to find a good pediatrician and dermatologist

you can work with. Aside from being knowledgeable and professional,

here are few other important traits you should look for in your doctor:

A good doctor will explain, educate, and alleviate your

concerns.

A good doctor has an “open door policy.” If you have a

bad flare-up, you can get them on the phone and get in

to see them on the same day or next day.

A good doctor will explore other causes and reasons

why you or your loved ones are not getting better.

A good doctor is open-minded to hearing other non-

medical approaches to heal or reduce flares of eczema.

50. a good pediatrician/dermatologist will listen, but more importantly, hear your concerns.


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55.Managing your

expectation on the first

doctor visit is important. Eczema is a chronic condition. Understand at

the initial visit, your doctor is largely aimed to assess your condition.

The treatment plan created on that visit is a work-in-progress. The

plan will most likely need adjustment over subsequent visits.

You need to be compliant with medication and treatment regimens.

This is hard to do as some of the treatments are time consuming,

complicated, and long-term based. You may not see any major

improvement right away. That is why you need a good doctor who can

be your coach, partner, and motivator.

Your doctor is your partner. Finding a

doctor with all those traits is half of the

battle against eczema.

Make sure your skin is not infected. People with eczema

have an impaired skin barrier, making them more

susceptible to various bacterial and viral infections.



If someone has a history of Herpes virus, beware of eczema

herpeticum. This rare, but serious viral infection of herpes

virus is found throughout large parts of the skin. In addition to skin

findings, there may also be fever or enlargement of lymph nodes. See

your doctor for medical attention immediately.

If you have repeat or recurrent infections, your doctor may do a culture

swab inside of your nose, armpits, and genital areas to make sure you

do not have S. aureus bacteria.

If you are a Staphylococcal carrier, your doctor will often prescribe

the topical antibiotic: Mupirocin. You need to apply the medicine to

the inside of your nose, armpits, genital areas or any other area where

there is S. aureus.

60. One interviewed physician suggests treating the entire family to

make sure that no members have S. aureus.

Most doctors we interviewed advocated treating skin infection early.

Apply Mupirocin to yellow crusted patches of skin, as that is a sign of

skin infection. If topical antibiotics do not work, oral antibiotics will be

used.



Some of the doctors we interviewed

warned their patients about over-

the-counter antibiotics, specifically

Neosporin and bacitracin antibiotic

ointment, because a significant

portion of eczema patients can

be allergic to these medications.

Bacitracin was voted as the Top

Allergen in 2003 by the American

Contact Dermatitis Society.

Neosporin contains bacitracin,

neomycin, and polymyxin B.

63. Performing wet wraps

can control and shorten

the duration of flare.

Your doctor may have you come to

his/her office 2-3 times per week

to apply a steroid (e.g., topicort),

moisturizer and wet wraps with

washcloths.

Your doctor may instruct you how to

perform wet wraps, so you can do it

yourself

If the flare up is really bad, your

doctor may have to admit you to

the hospital where the nursing

team will do wet wraps and other

treatments.



Many of interviewed physicians

endorse wet wraps. They have seen

dramatic difference as soon as the

next morning after the first wet

wrap treatment.

Make sure you tell your physicians

about all the over-the-counter

medications, moisturizers, and

other skincare products you are

currently using. Many popular

skincare products and OTC

medications can have ingredients

you might be allergic to.

When you’re not getting better

despite all the treatments and

skincare regimen, you may have an

allergy. Your doctor may perform

an allergy patch test. That is why it

is important to have a doctor who

is willing explore other options and

reasons.

*BOnUS: Go one step further,

for your initial visit, write

down all the skincare

products on a piece of paper

and give it to your doctor as

a part of the medical record.

70. Topical steroids are

the most common

medications prescribed for

treating eczema; however,

many patients and the public

have concerns about potential

side effects, both in the short

and long term. In fact, there

are a large number of patients

in the ITSAN community who

report significant negative

sequelae after applying steroids

to their skin. Increasingly,

the medical community is

beginning to recognize these

negative aspects of steroids.


Most importantly, steroids

should not be used without

any follow-up or monitoring

from your doctors. Here are

some valuable suggestions

and feedbacks from our

panel of physicians who

shared how they prefer to use steroids:

73. Some doctors prefer to use low or

medium potency steroids for a limited

period of time.

74. Apply steroids

first and then add a

moisturizer. This allows the steroids to enter the skin. If

the application order is reversed, the steroid may work less

effectively as it may be blocked from entering into the skin

by the moisturizing creams and ointments.

75. For severe flare-up, doctors may prescribe oral prednisone

or other immunosuppressive drugs (e.g., cyclosporins).

76. Some doctors prefer to inject steroids into the lesions or

muscles

77. Many doctors we interviewed prefer proactive treatment.

They instruct their patients to “apply steroids early to abort

or even to prevent flares.”

“I actually prefer high potency with less frequent application, than a low potency on a daily basis.”

72.




78. Start with potent steroids (e.g., clobetasol), then switch to less

potent steroids (e.g., hydrocortisone) over time. The ultimate goal being

to stop steroid treatment.

are no active flares at the moment, some doctors

instruct their patients to use mild steroids or

topical calcineurin inhibitors (i.e., Protopic or

Elidel) only during the weekend to reduce the

frequency and intensity of flares. The efficacy of

this weekend-based dosage has been validated in

clinical studies. Many doctors also believe that

over the long run, this maintainence regimen can

reduce the total usage of medications.

79. Start with a

potent steroid. As

flares improve, mix

that steroid with

moisturizer of your

choice every week.

For example, for

week 1, you start

with clobetasol. Week

2, mix clobetasol

with Vaseline in a

1:1 ratio. Week 3,

mix clobetasol with

Vaseline in a 1:2

ration. Continue to

dilute as the eczema

improve.

80. Some doctors

like to combine

steroids with topical

calcineurin inhibitors

(i.e., Protopic or

Elidel). For example,

the doctors instruct their patients to alternate the use of steroids with Protopic or Elidel on daily basis. Other doctors prefer to pulse the topical steroids (e.g., twice a day x 2 days a week) and use Protopic or elide twice a day x 5 days a week.

81. These are just

some of the different

ways to wean or

taper people off

steroids. The feeling

is this approach

can reduce the side

effects of steroids

induced atrophy.

82. Pay attention to

areas of skin that are

chronically affected.

Even when there

Most doctors like to taper, dilute or wean their patients off steroids over

time. Here are just some of the suggestions from our panel of physicians:



Steroids required on the torso, arms, and legs

may be too strong for the face, genital area,

and skin creases. This is why you may receive

different strengths of steroids. Make sure

that you understand which medications are

for which body parts.

Be sure to ask about the groin or genital areas

if you have eczema in those areas. Don’t be

embarrassed or hesitant to bring it up. Don’t

simply use the same medication cream for

your body on your face and genitals. It may

be too strong and cause more side effects.

85. Many doctors agree that patient education

on topical steroids is very important.

Patients on multiple topical steroids need

to be followed closely. As one doctor stated,

“Topical steroids have to be used judiciously

and appropriately. When used appropriately,

steroids work and have few side effects.”

Topical calcineurin inhibitors (i.e., Protopic

or Elidel) can also be used daily or weekly as

a maintenance medication to control flares.

It is important to ask your doctors about the

side effects, as both medications have FDA

issued Black Box Warnings.



87. One doctor suggested

supplementing steroids with

hypochlorous acid (Alevicyn).

It is a weak bleach that is

claimed to be harmless, has

antibacterial properties, and

relieves itch.

Ask your doctors about the risks and benefits of

topical steroids, such as:

• Data of systemic absorption.

• Risk of skin atrophy, dilation of blood

vessels, and other systemic effects.

• Help you put these risks into the context of

sleep disorders, risk of infection with skin

breakdown, and stigma caused by eczema.

For itch control, doctors can prescribe oral

antihistamines

90. If topical and oral drugs aren’t working,

your doctor may consider using narrow-band

UVB light. You’re often required to visit the

doctor’s office three times/week to receive the

light treatment. In some cases your doctor will

prescribe a home-based UVB machine.



Topical PDE inhibitors: Crisaborole is not a steroid medication. It is

a topical drug candidate, that as of 2015, was under development by

Anacor Pharmaceuticals for the topical treatment of psoriasis and

atopic dermatitis.

Dupilumab – this is a fully human monoclonal antibody that target the

interleukin-4 receptor alpha subunit (IL-4Ra). Through this effect, it

blocks IL-4 and IL-13 and alleviates symptoms associated with eczema.

The drug is developed by Regeneron Pharmaceuticals. Clinical trials are

positive for people with severe disease.

If all else fails, ask your doctor for a referral to

see a national eczema expert in your country.

Ask your doctors if there are any ongoing

clinical trials. We are living in a very exciting

time. In the next few years, there will be more

and more new drugs being studied to treat or

even cure eczema. So, don’t give up hope.

Here are two emerging new drugs that will hopefully come onto the market soon:

91.

92.



part Iv


For all of us who have been living with eczema, it is very clear

that stress makes eczema worse. Frequently, when we

discuss stress, we only consider the mental and psychological stresses

in our lives; however, there are many different types of other stress

factors, especially environmental stresses, that can trigger flares.

Finding these triggers are half of the battle in controlling your eczema.

Below is a list of stresses and suggestions on how to cope:



Temperature & Humidity

95. Controlling

your home

moisture level is

very important. In

the wintertime,

use a humidifier.

If you have a large

home, you may need

multiple humidifiers in

different rooms. In the

winter, definitely place

a humidifier in your

child’s bedroom if he

or she has eczema.

During the summer,

use dehumidifiers in

the house to pull out

the ambient moisture.

If your kids play in

the basement, be

sure to turn on the

dehumidifier everyday.

You will be surprised

how much water can

be collected each

session.

When the weather

is cold, minimize

time outside. Cold air

can dry out the skin

quickly.

When it’s hot and

humid, crank up the

AC. Sweat & heat can

make the skin itchy,

which can trigger the

itch-scratch cycle.

Many people,

especially kids,

report eczema flares

when they get hot

and sweaty. One

dermatologist shared

an observation from

his patient:

He noticed that

his eczema flared

whenever he went

golfing around noon.

He soon realized that

it was the heat, and

subsequently started

to play golf in the late

afternoon to avoid the

sun. It helped!



100. Use an appropriate blanket or cover

to avoid over heating and sweating

at nighttime. This advice is especially helpful for

children as many parents have a tendency to protect

their kids from the cold with layers of blankets.

Minimize and reduce dust mites. Wash new bed covers

with hot-water and hot drying.

Handle emotional Stressing Factors

102. Beware of situations or

people that make you stressed.

One eczema patient reports that

whenever she gets anxious or

upset, her skin becomes very

itchy. She scratches and itches,

which causes a flare up.

If you find yourself flustered

or emotionally stressed, try

meditation or deep breathing

exercises.

Make sure you have an exercise

regimen. Certain exercises, such

as yoga or even deep stretching,

can reduce stress.

105. Learn TaiChi or QiGong,

two powerful exercises that can

reduce stress.

To cope with your stress,

consider seeking help from a

psychiatrist or social worker.

They usually have a wide range

of methods to help.

Make sure you get enough sleep.

Develop a bedtime routine that

relaxes and calms you before

sleeping.

Cut back on coffee. Drink green

tea.

Pursuing a hobby, reading a

good book, participating in a

sports team, or hanging out with

friends can all help with stress

management.



110. Wash all new clothes, especially

for your kids, before wearing.

This simple step will remove excess dyes,

fabric finishers and other irritants.

Wash everything (plush toys, bedding,

blankets, parent and caregiver clothes,

towels) your baby comes into contact with

before first-time use.

Wash your baby’s’ clothes, bedding, and

towels separately from other laundry loads.

Use your washing machine’s second or

“extra rinse” setting, if it has one. You

want to thoroughly rinse off any chemicals

or detergent from your clothing.

Avoid any fragrance in clothing,

particularly from fabric softeners or dryer

sheets.

115. Do not wear wool, synthetic or rough

fabric clothing that might make you itch.

Clothing related Stresses

Choose products (from detergents to fabric

softeners) that are hypoallergenic, free of

dyes and fragrances, and formulated for

sensitive skin. Here are some examples:

• All Free Clear Liquid detergent

• All Free Clear Mighty Pacs detergent

• All Free Clear Liquid fabric softener.

Try liquid detergent and

softener products, as

they tend to leave fewer

residues than powders.

These liquid products

may be less irritating

to people with sensitive

skin.



117. Avoid cigar or cigarette smoke, as they can be a trigger for eczema

flares. One dermatologist shared with us the story of a patient with

significant erythema, edema, and crusting of her face not controlled

with steroids and even cyclosporine. After repeat questions and

searching, the patient and doctor realized that her flares seem to

be associated with her boyfriend’s smoking. When the boyfriend

eventually stopped smoking cigars around her, her face cleared and she

got off cyclosporine and other medication.

Beware of both outdoor and indoor

air pollutants.

Be consistent in avoiding potential

allergens and irritants.

120. Swimming in chlorinated

swimming pools can make your

eczema worse. One remedy you can

try is apply emollients both before

swimming and after showering.

Do not use any decorative pillows

on the bed. They can gather dust

and allergens that will trigger

flare.

Avoid dusty surroundings. Make

sure to vacuum your carpet.

If you think you have an allergy,

keep a diary to find your eczema

triggers.

For babies and young children,

avoid as much chemical exposure

as possible.

125. Avoid excessive exposure to

low-grade and seemingly harmless

irritants such as water. Yes, water!

Too much washing and cleaning

with hard and hot water can

worsen your eczema.

Environmental Stresses


part v


Many people with eczema often want to know if their eczema is

caused by their diet. So far, the majority of clinical studies have

shown that food plays no or minimal role in triggering the flare of

eczema; however, there are plenty of anecdotal stories from countless

eczema sufferers who swear that the right diet has made a world of

difference.

Whether or not you think food plays a role in eczema, one thing is for

certain, a healthy diet combined with appropriate supplements will

improve one’s health.

We will share some of the tips on diet, supplements, and herbal

remedies that can improve your skin and overall health. Hopefully,

these tips can also make your eczema better:



129. Dietary factors may exacerbate eczema flares for some. If

triggers can be identified, restricting the intake of those culprit

food items can make your eczema better.

130. Keep a food log if you suspect food items are making your

eczema worse. Meticulous note keeping is needed to track and

identify the culprit food items.

• Make a one month calendar diary in which you are tracking

two different parameters. How to make a food diary or log: Day

one: note when the eczema flares

• Day two: eat the particular suspected food. Do not pay

attention to any perceived association while you are keeping

this log. If there is a flair, it will usually not be immediate. If

you have an association, reaction or flare will usually take 2 to

3 days after eating the suspected food.

• At the end of the month, review the calendar and to find a

pattern.

134. Most patients with eczema have no food

allergy. However, if you have known food

allergies, you need to avoid that food item. This simple

change will improve your skin condition.



General & Common Sense Rules to Remember:

135. Eat fresh fruits and vegetables as

often as you can.

Eat food items with bright colors, e.g., red and

orange peppers, green celery & broccoli, red

beets, and orange carrots. Food items with

bright colors have high levels of antioxidants,

such as polyphenols, Vitamin A and C. Those

antioxidants can neutralize free radicals

coming from inside and outside of the body.

Cut back consumption of meats, especially red

meat. It may taste good, but over consumption

will be harmful to your body.

Avoid all processed and junk food as much

as you can. Avoid any food items that have

many ingredients with long chemical names

that you don’t recognize or don’t know how to

pronounce.

Eat high fiber diet to facilitate bowel

movement. You should try to have at least one

daily bowel movement. This helps eliminate

the toxins and waste in your body.



140. Avoid all food cooked with

trans fat.

Avoid fried food. Try steamed, broiled,

poached, baked or stir-fried food.

Avoid eating from fast food restaurants that

serve high calorie and high fat diet.

Reduce the number of time eating out.

Restaurants tend to cook their meals with

lots of butter, fat, salt, and sugar. That is

understandable because these tasty, but

unhealthy ingredients are what make us want

to go back to these restaurants again.

Pay attention to the expiration date of all food

items. Throw away any expired or soon-to-be

expired food. Eating spoiled food may not get

you sick each time, but it will generate plenty

of inflammation in your body.



145. Cut back on alcohol consumption.

Heavy drinking can damage your

liver. The liver is the second largest organ after

the skin. It receives blood from the digestive

tract that is rich with nutrients from your diet.

It also processes and detoxify many harmful

substance in the blood. A healthy liver can

absorb good nutrients and eliminate waste.

Eat in moderation. Studies show that people and

animals with low caloric intake are healthier

and live longer. So avoid any buffet restaurants!

Eat every meal and don’t skip meals

Eat breakfast like a king; eat lunch like a prince;

eat dinner like a pauper.

Drink plenty of water. It is recommended to

drink at least 6-8 oz of water everyday. For most

busy people, it is hard to do. You should at least

drink enough water so your urine is clear.

Cut back on sugary drinks. Sugar triggers

inflammation.

Drink tea over coffee. Here are some good tea

choices : saffron tea, mullein tea, green tea,

oolong tea, chamomile and elm bark tea.




152.Cut back on food with gluten such as barley, oats, wheat,

and rye. Although most people don’t have gluten allergy or

sensitivity, reduction of gluten can help to decrease inflammation.

Eat slowly, chew your food, and savor the meal. This process helps the

overall digestion.

Select unprocessed breads (ie, whole-grain) pasta or rice (ie. brown

rice).

The above list is very lengthy, but can be summarized succinctly as eat the stuff

that you most likely hate to eat, and avoid the food items you love to have.

That is the price you pay for a healthy life and healthy skin.

Maintain proper acid & alkaline balance in your diet

155.Acidity & alkalinity describe the pH.

It’s recommended for optimal health,

a person’s blood level should be slightly alkaline

(pH of 7.3 to 7.5). There are certain foods we eat

will make our blood more acidic, and while other

foods that will make our blood more alkaline.



Here are some alkaline foods that are

good for you:

• Add fresh lemon juice to water

and tea.

• Fresh fruits like grape, apple,

pear, mango, pineapple and

papaya.

• Raw vegetables or vegetable

juices from carrots, celery,

beets spinach, cabbage.

Here are some acidic foods to avoid:

• sugars such as sweets and in

alcohol

• meats such as pork, veal, beef,

processed meats like pepperoni

and sausage

• shelfish such as clams,

shrimp, crabs and lobster



154. Fish oil (containing omega-3

fatty acids) 3 grams/day reduces

the frequency and intensity of

flare ups.

155. Eat flax seeds.

156. Add some bacteria in your

diet.

157. Eat low-fat yogurt.

158. Consider taking daily

probiotic (one billion cultures of

Lactobacillus GG).

Dietary Supplements

159. Ideally if you have a

balanced diet and good digestive

system, you don’t need any

supplements. However, in reality,

we are busy, and don’t eat well or

healthy. Hence, supplements can

make up the difficiency.

160. At minimum, take a multi-vitamin

pill once a day.

161. Take extra doses of Vit C, E & D.

162. For digestive & liver health, consider

milk thistles.

Consider taking alpha lipoic acid and

Q10 for extra energy boosting effects.163.

eat Good Fats

AnD fInALLY



For those who have been living with eczema for a long time

know that this disease can wax and wane. You may have

weeks or even years of clear skin, but suddenly struggle with a severe

flare. It is also disheartening for those who struggle. Everyone’s eczema

condition can vary significantly with different degrees of severity,

triggers, and responses to various treatments. It is frustrating to go

through bouts of flare and setbacks. We hope these tips assist you on

your journey to healthy skin!

Thank you for choosing to start your journey to healthier skin with

Dr. Wang. Please leave your comments, suggestions, or your own

experience that can benefit all of us who are fighting against this

disease. If you are interested in continuing your journey with us follow

us on Facebook and Twitter for updates.

Copyright © 2016 by Dr. Steven Wang

All rights reserved. This book or any portion thereof

may not be reproduced or used in any manner whatsoever

without the expressed written permission of the publisher

except for the use of brief quotations in a book review.


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