News item (2/4/24):
“A report by the US Centers for Disease Control and Prevention claims antifungal creams and combinations of antifungal treatments with corticosteroids are likely to be contributing to the rise and spread of severe skin, scalp, and nail fungal infections.”
The article goes on to note the common misdiagnoses by dermatologists who are apparently to blame for everything that does not heal by tomorrow. Then again, just to rub salt in the lesion, it is not a trade secret that over 80% of actinic keratoses (pre-cancerous lesions) are incorrectly diagnosed by derms.
The business dropout rate for dermatologists is probably the highest of all medical specialties. When poison ivy, eczema, rosacea, floor burns, bug bites and forty other skin ailments look about the same even to a skilled observer, is it any wonder many go babbling off to the desert in search of a peyote cactus?
The point is this: many of the visible skin problems have for so long been clinically addressed by confounded dermatologists with a Does Everything immune suppression corticosteroid that now we have an educated, crafty crowd of agile microbes who have found workarounds to the drug.
These “cortisone creams” are found in almost every medicine chest and to their credit most dermatologists will advise to apply these only briefly to knock down an inflammation, regardless of what caused it. But, to say it again, this everywhere for everything usage of cortisone has weakened its effectiveness – nature has found ways to get around the drug.
Continued use of corticosteroids will often create a rash itself and most certainly a rebound effect when the application period of more than a few days stops – a rebound that is often worse than the original inflammation. The body does not like to be told NO. Corticosteroids weaken the skin terribly.
The new fungal problems the article mentions are a combination of exposure and adaptation. More widespread human to human exposure to tropical and semi-tropical fungi and adaptation to the skin drugs used to combat these have created this perfect storm.
The prescriptive “anti-fungal” creams are notoriously inflammatory, poorly tolerated and yet another reason to wonder why they are still on the shelf – it would be helpful if more dermatologists applied these products to their own skin just to experience the less than amusing sensation they bring. Alas.
Other skincare professionals (estheticians and medical estheticians) have noted the recent jump in visible problems that dermatologists have had almost zero success in knocking down with their pharma topicals or oral medicants.
Usually the horseback diagnosis by the client or the esthetician is “eczema” to explain any rash or itching. In fact, as already noted, the skin can be inflamed from many causes.
Suppression of an over-reactive immune response is NOT the answer. The topical approach must be done carefully – the skin is in a highly reactive way. For certain it cannot be ‘cured’ with a hammer (aka corticosteroids).
If you are faced with a troubling inflammation that seemingly arose out of nowhere, there is a process of discovery to get a handle on the cause. When you have a pretty good idea of what is behind the curtain you can consider a solution.
Oral and topical medications or esthetic skincare products are the PRIMARY cause of most “eczema.” If you skin is inflamed on the face, bet on the esthetic products. If your skin is unstable in areas not limited to the face, then oral products or dietary influences (including gut or skin microbiome) are in the mix. And, of course, free floating pathogens – that fungus that is among us. Don’t kiss your donkey is advice I hear around the dermatology water cooler.
Anyway, when a chemical substance, oral or topical, is in play as a cause of significant skin inflammation then what you apply to your skin must be very carefully chosen or that “eczema” can become a full blown dermatitis. Same is true of a fungal problem that showed up after a swim in Lake Infestation.
Obviously, eliminating the orally dosed chemical is a first step. If that is not possible then changing the oral dose or chemical class of the drug is next in line in desirability. Talk with the prescribing physician. Microbiome of the gut is an area that those who suffer from chronic pustular acne need to resolve. This is a separate topic for another post.
Topically, the first step is to stop ALL topicals. There is no wiggle room here. Stop everything. You will never stop a chemically induced skin inflammation with another topical chemical and that includes corticosteroids.
Now what?
Leave the skin alone. Let it settle down.
Fungal problems however will tend to come in cycles and orally dosed drugs are worth a shot. Topical approaches are hit and miss, the Skin Dork has observed. More on that below. Ringworm is often resolved topically though, so it depends on the problem. A bit of hunt and peck on the search engines will lead you to a variety of approaches.
Topical products might hold things in visible check, but the spore location has to be identified and it usually is in the microbiome arena. This is a complicated subject and not much practical has emerged so far. It is impractical to dose the skin repeatedly with a wide scope anti-fungal and not have a new problem of dermatitis arise.
In the meantime, many have found that anti-histamines, orally, make a difference for unexpected, continued skin inflammation. Aspirin and other more potent choices like Benadryl®, Claritin®, Zyrtec® do the trick. Some like to include turmeric, orally, not topically. That works.
The Skin Dork is not a fan of “Chinese herbalist” concoctions for this. The number of cases that became emergency room qualified after these ‘treatments’ has put me off on all of it. Well meaning people with long fine needles and bags of plant droppings can ruin your day.
Recall also that even seasonal pollen can set off a topical reaction, especially when skin is at a subclinical threshold of inflammation from topical products. Add in that pollen, or spicy food, or wine (or all of the above) and settle back for the sudden onslaught of “eczema.”
For cleansing, the 302 Skincare choice is REVIVE. This will often relieve itching and is mild enough for all but the most serious cases. But, use nothing else until the skin has normalized. You won’t look fifteen years old again, but your skin will be stable. First, though, do nothing. Let the skin settle down after a flare-up. That may take a day or even a week.
For the fungal problems a variety of topical choices are out there. Natural “fungi-stats” are found in polyphenols usually in unrefined oils from avocado and olive. You apply these oils allow to soak in and then wash off after several minutes. There are other choices. Fungi-stats are different than fungicides. The “stats” hold the line, the “ides” are killers. The “ides” are often wildly inflammatory.
302 Skincare has a FACE & BODY BAR with unrefined avocado oil that when combined in a cleansing program with REVIVE is very effective in holding the line on visible fungal problems, often found in the scalp or peri-oral zones.
Most superfatted soaps are guilty of increasing inflammation shortly after gaining initial success. This is because of other ingredients included in the bar or lotion cleanser. The formulas are just not well thought out.
The message here is that cleansing is how to address “eczema” and that also requires giving up everything else. The skin is weak and cannot possibly utilize/metabolize more topical products. NO moisturizers allowed.
Surface products, that is, those that are not going to ‘go deep’ as the esty’s say, are things like zinc oxide creams. These must be carefully chosen. They can provide protection IF well formulated.
302 Skincare offers REMEDY. A smidgen mixed with REVIVE as a leave-on is useful after the initial blow up inflammation has naturally subsided.
To sum up: for the all inclusive “eczema,” use an orally dosed anti-histamine and/or an anti-inflammatory like turmeric, no topicals, let things settle down and then begin the REVIVE to cleanse and soon after bring in the REMEDY.
For anti-fungals, find the source, pursue orally dosed approaches, use FACE & BODY BAR.
Now recite the Skin Dork mantra: Less is always best when using topical products.
