DIY Treatment Tips to Tame Eczema with Gowri Kabbur, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host. It's often said that people wear stress across their faces, but in truth, signs of stress can appear anywhere on your body as eczema. Dry, red and itchy skin is often a byproduct of stressful times, and once eczema flares up, well, that irritation can lead to even more stress and anxiety. It's truly a vicious cycle. Today, we're going to look at why this happens and, better yet, how you can stop it. Joining us is dermatologist Gowri Kabbur, one of the many experts at Cleveland Clinic who popped into our weekly podcast to help you live a little healthier. Now, let's see what we can do to scratch eczema off of your worry list. Welcome to the podcast, Dr. Kabbur. We appreciate you stopping by to chat.

Dr. Gowri Kabbur:

Thank you, John. I'm excited to be here.

John Horton:

So when it comes to eczema, everyone's first thought centers on how uncomfortable it makes you feel and just stopping that itch, but there are also some real and potentially serious health concerns connected to the condition, right?

Dr. Gowri Kabbur:

Yes. Yeah, totally. Eczema, while it is common, it can be a complex skin condition, it's a combination of an overactive immune system, changes to normal skin bacteria and issues with the skin barrier. So, because of those, patients who have bad eczema can have increased risk for serious skin infections like fungal, bacterial and viral infections. So it's important to treat it when it does come about so that they don't suffer with those infections.

John Horton:

Wow. I mean, that's serious enough to almost make you forget about all that itching, but since we know people don't, let's jump right into what folks can do to kind of treat their eczema at home and stop that itch, starting with colloidal oatmeal. What is the magic of using what sounds like a breakfast option?

Dr. Gowri Kabbur:

Well, aside from being nutritious in the morning, it actually has been used for a really long time — even, like, in the ancient Egyptian times for skincare. It helps relieve inflammation, itching, it can regulate skin pH. It’s almost a prebiotic, in a way, and it can provide skin barrier protection. It has some natural vitamin E in it, which is an antioxidant, so it really can help with sun damage and also skin itching and inflammation. So it's really excellent as a treatment option for eczema and it can be found in bath forms. So there's colloidal oatmeal baths that you can buy from the store, cleansers, and, of course, lotions and creams.

John Horton:

It's hard to believe it's been around that long, but I guess if something works, people find it.

Dr. Gowri Kabbur:

Exactly. Yeah, there's a reason it's stuck around for so long.

John Horton:

Another at-home treatment option, bleach baths, really caught my eye because it sounds like something that you just shouldn't do. So, how does [a] bleach bath work, and is it safe?

Dr. Gowri Kabbur:

Well, thank you for bringing that up because that’s actually something I feel really passionate about. Bleach baths have been around for decades. They’ve been used for various skin conditions, but there’s actually very good evidence for its use in eczema. And it's championed by a lot of dermatologists and pediatric dermatologists as a safe, effective at-home method that can help control eczema. It's important to know the amount of bleach that we're talking about is really little. Think about the concentration of a chlorinated swimming pool. That's kind of what we're aiming at. So it's really safe when used in low concentrations and high dilutions, but it's been proven to reduce itch in atopic dermatitis patients. And initially, we thought that it helped reduce bacteria on the skin, but we think it actually helps regulate the skin microbiome and that's why patients get so much relief when they do the treatment.

It can vary how much you use based on the size of the person or if it's a child or a baby. About a quarter-cup of plain bleach into a full bathtub two to three times a week and soaking in it for about 10 minutes can really make a big difference.

John Horton:

It is one of those things that you hear it and it doesn't sound right, but yet it sounds like it really does work.

Dr. Gowri Kabbur:

Yeah, it can, and I think that it's important to also choose the right kind of product. A lot of the things in the grocery store and the stores have splash-free or color-slate-safe additives to the bleach. We want to avoid those because that can actually increase irritation in the skin. But the very plain sodium hypochlorite bleach works really well, and if you're nervous about using that, there are sodium hypochlorite body washes that you can purchase. So you just use it like a normal body wash in the shower. But I think daily bleach is making a comeback. It's in cosmetic products now, so I don't think you've heard the last of it.

John Horton:

And since you had mentioned if you are a little intimidated by doing it, I also saw where apple cider vinegar is another option people can use that's maybe a little less caustic than bleach, but it can still get the job done.

Dr. Gowri Kabbur:

Yeah, there are some reports of its use. In general, I prefer the dilute white vinegar more than the apple cider vinegar. There are some studies that show that it didn't really alter the skin microbiome and help with the skin integrity. And there was a study that showed really no difference in patients who are treated with dilute apple cider vinegar and water. So it's not my favorite because, sometimes, it can cause irritation, and not all apple cider vinegar is created equal. There's different types of sediment and the distillation process can be different. I think if you are leaning towards something like vinegar, you'd be better off using something like a white vinegar.

John Horton:

Well, since we're already in the kitchen here, let's look at some other things. I saw where raw coconut oil is also recommended for it. Is that really a thing?

Dr. Gowri Kabbur:

Yeah, it actually is. Coconut oil is excellent. It's antimicrobial. It has anti-inflammatory properties. It's high in some of those good fats that we need to maintain our skin barrier. So, raw virgin coconut oil can be used as a moisturizer in patients who have atopic dermatitis. It's actually been tested in preemie infants and actually can [help] with transepidermal water loss.

John Horton:

Wow. If you can use it on infants, it's got to be pretty gentle on your skin.

Dr. Gowri Kabbur:

Yeah, it's pretty safe. Another one that has good evidence is sunflower seed oil. It's been tested quite a bit. There's a lot of published literature on it and it has a high percentage of the fatty acid that's actually found in our skin barrier. So it really can help maintain the skin barrier or reduce inflammation, and that's also been tested in infants and children and works well as a moisturizer.

John Horton:

I got to tell you, this conversation is seeming very similar to what I usually talk about with our dietitians. So we're all over the kitchen, but I know we've touched on a few of those items from the cupboard and a couple cleaning solutions. So let's actually shift over just to the medicine cabinet and Vaseline®. That's an old-school solution. I'm assuming that it still remains a valid go-to item.

Dr. Gowri Kabbur:

You're definitely right, John. Vaseline is probably our workhorse in dermatology. It's very safe, it's very affordable, and it's an excellent skin emollient. So it really just helps seal [in] moisture in the skin, and it works great for patients with eczema. The biggest complaint we get about it is that it’s a little greasy, which makes sense. Things that can be helpful to improve that greasiness is, some patients can actually put it on while they’re still in the shower.

John Horton:

Wow.

Dr. Gowri Kabbur:

If you keep the tub with you in the shower, so while your skin is still wet, you take the Vaseline, put it on, it’ll be a lot easier to rub in. And then just towel off [like] normal. So it kind of gets rid of some of the excess greasiness, but it’s still on the skin and providing that moisturization.

John Horton:

That’s a great tip. I would’ve never thought to do that.

Dr. Gowri Kabbur:

Yeah. Think of it as an in-shower kind of moisturizer, in a way.

John Horton:

That's fabulous. What else can people use to try to deal with their eczema at home?

Dr. Gowri Kabbur:

I think an important thing to avoid is anything that has excessive fragrance. Patients who have eczema, atopic dermatitis, they're very sensitive to different triggers. That can be environmental triggers, fragrances, essential oils — all of that can sometimes cause irritation and flare the eczema. So I usually recommend sticking to fragrance-free products. That includes avoiding fragrance in your detergent and your personal care products. Other things that you can do is also try to avoid super-hot showers or going to a sauna or a really hot jacuzzi tub because that hot water really can dry out your skin, especially if you're not moisturizing immediately afterwards. So it's really important to try to stick to more lukewarm showers so that your skin doesn't get too dry. You could also try to avoid anything that's scratchy, like wool clothing that can cause irritation just externally. So sticking to cotton fabrics that are more breathable can help reduce flares of eczema.

John Horton:

We all have that one shirt that just makes you itch. So trust your instincts with that, huh?

Dr. Gowri Kabbur:

Definitely.

John Horton:

Let's talk about some eczema remedies that people might want to think twice about using. We all see these products out there and they're just...you're so tempted. What's not worth the time and effort?

Dr. Gowri Kabbur:

Well, I touched on one. I think essential oils can sometimes actually worsen the problem, in some cases. These are really highly concentrated natural products or botanicals, and sometimes at that concentration level, it's not good for the skin. It can cause issues with the skin barrier and then flare up the eczema.

I think other things to avoid are anti-itch sprays because, sometimes, the aerosol and the spray can irritate the skin. Topical anti-itch creams like Benadryl® sometimes can have ingredients that can cause irritation. So I usually try to recommend avoiding those, in general. Evening primrose oil, I think, has been reported to be used just to help as a calming treatment, but there’s really not great evidence for that.

Another thing that’s more natural is olive oil. I think that it’s really gained in popularity recently as a skincare ingredient. However, I really wouldn’t recommend it in patients who have eczema. There are some studies that have shown decreased skin barrier function in patients with eczema who are using olive oil. It doesn’t really have an antibacterial effect like coconut oil and it can actually cause a fungal rash called —

John Horton:

Wow.

Dr. Gowri Kabbur:

— Malassezia in some patients. So I would recommend keeping that more in your diet and off your skin.

John Horton:

With a lot of these that you just mentioned, is it that they irritate the skin or do people actually have allergic reactions to these products?

Dr. Gowri Kabbur:

No, it can kind of be a bit of both, and that can sometimes be hard to separate. Patients who have eczema are more prone to developing allergies, whether that’s contact allergies or internal allergies. That doesn’t necessarily mean that their allergy is causing a skin reaction. However, there is a little bit of an association there.

John Horton:

It sounds like they just go hand in hand a bit.

Dr. Gowri Kabbur:

They can, in some ways. So I think, in general, it's best to try to avoid irritants of all kinds and really just stick to a simple, gentle skin care regimen that won't flare up the rash.

John Horton:

Now, eczema can happen to anyone at any age, but it is far more common in the kiddos. So do you have any tips for parents to help children get through a serious case of the itches?

Dr. Gowri Kabbur:

Yeah, that's a great question because it can be really tough in kids, especially when they're scratching and you can't really tell a kid not to scratch. They won't understand. But some things that can be helpful is making sure that their nails are trimmed short because sharp, long nails can actually cause tears in the skin that can then increase risk for infections and flares of eczema. It’s also best to try to distract them. So if you see them scratching, give them something to do or try to stimulate their mind in a different direction so they take their mind off of the itching.

Skin protection is, of course, important because children's skin is still fragile, and their immune systems aren't fully developed yet. So you definitely want to make sure you're using a good moisturizer after bathing, putting it on everywhere, and then trying to avoid things that can irritate the skin. So that bubble bath and bath bomb that you buy from the mall can maybe make the skin worse and may not be appropriate for a young child.

John Horton:

Mr. Bubble causing problems, though. What about if you are seeing an eczema breakout and things like that? Should you check for food allergies or things like that to see if there's an underlying cause?

Dr. Gowri Kabbur:

That's a great point to bring up. Like I said before, patients who have eczema may have [a] higher likelihood of having food allergies, but having a food allergy itself doesn’t always manifest as a skin rash. So I think it can be kind of a slippery slope if you start eliminating a lot of foods out of a kid’s diet without knowing for sure, and that can affect their nutrition and growth. So if you’re unsure about whether your child has a food allergy, I would work with your pediatrician or an allergist to try to figure out a safe way to check and to do an elimination diet to see if that is indeed something they’re dealing with. But from what we know about eczema, it isn’t caused by food intake. It’s a completely separate process.

John Horton:

You’re right. With the kids, it is so hard. We had three and I still remember putting socks on their hands when they had stuff. So that way, they couldn't really get those nails in on that skin.

Dr. Gowri Kabbur:

Yeah, definitely, because they can really go to town if given [a] little chance.

John Horton:

We've covered a lot of ground here, Dr. Kabbur, but is there anything that we missed or something you'd like to add about dealing with eczema?

Dr. Gowri Kabbur:

I would say that eczema can be a really difficult thing to deal with — especially in young kids, because of the itching and the external rash that's present that can sometimes make it hard for them in social interactions. So if this is something that's affecting their physical health, mental health, I would encourage parents and patients who have eczema to seek care because we do have a lot of excellent treatments for eczema, both prescription and nonprescription, as we discussed today. So there are methods that can help control this issue so that it doesn't affect your day-to-day life as much.

John Horton:

That's great advice, Dr. Kabbur. Thank you very much for stopping by today, and I look forward to having you back on.

Dr. Gowri Kabbur:

Thank you, John.

John Horton:

Stress can leave its mark on your body in numerous ways, including eczema breakouts on your skin. If you're feeling overwhelmed and experiencing skin rashes, take steps to de-stress and address your emotional needs. [With] any luck, your skin issues will melt away along with that stress. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.