As a result of my various skin issues, resulting from allergies and chemical sensitivities, I have spent a lot of time searching for personal and household products that I can use without risk of breakout or flare-up. Below are the item that I use regularly. If it isn't listed here, I don't use it! There are recipes available online if you choose to make your own products. I'm a little lazy, though, so like to purchase premade products if possible, though in some cases I haven't found a suitable commercial product so have been making my own.
Skin Care
Soap
Dr. Bronner's Citrus Orange bar soap
Ingredients: Organic Coconut Oil, Organic Palm Oil, Sodium Hydroxide, Water, Organic Orange Oil, Organic Olive Oil, Organic Hemp Oil, Organic Jojoba Oil, Organic Lemon Oil, Organic Lime Oil, Salt, Citric Acid, Tocopherol
This is a great soap! I would recommend it even for people who don't have allergies or skin issues. Lathers very nicely, not drying, gentle enough for use on face and sensitive skin, but still get the soapy job done. The smell is great, too. And for someone who has to stay away from items with fragrances, having a yummy smelling soap that doesn't irritate my issues is a big bonus!
Body Lotion
I make my own body lotion from a recipe that a friend passed on to me. It works surprisingly well, even in harsh Canadian winters! Combine the following ingredient in a plastic squeeze bottle. Be sure to give it a good shake before each use.
1 part apple cider vinegar
1 part grapeseed oil
2 parts water
Face Lotion
Desert Essence Daily Essential Moisturizer
Ingredients: Water (Aqua), Aloe Barbadensis Leaf Juice, Glyceryl Stearate (Vegetable Derived), Stearic Acid (Vegetable Derived), Cetyl Palmitate (Plant Derived), Simmondsia Chinensis (Jojoba) Seed Oil, Carthamus Tinctorius (Safflower) Seed Oil, Cetyl Alcohol (Vegetable Derived), Propanediol (Corn Derived), Sesamum Indicum (Sesame) Seed Oil, Glycerin (Plant Derived), Gluconolactone, Sodium Hydroxide, Sodium Benzoate, Geranium Maculatum Oil (Plant Derived)
This is a very light facial moisturizer. Strong enough to keep my skin soft all day long, but not oily or heavy. I have acne prone skin (in addition to my various other issues) and this lotion does not aggravate my acne. I find, however, that I rarely use a facial moisturizer anymore. Since cutting out all cosmetics and switching to a soap that is non-irritating, my skin is naturally moist and smooth most of the time.
Toner
Thayer's Alcohol-Free Unscented Witch Hazel toner with aloe vera
Ingredients: Purified Water, Aloe Barbadensis Leaf (Certified Organic Filet Of Aloe Vera), Glycerin (Vegetable), Hamamelis Virginiana (THAYERS® proprietary un-distilled Witch Hazel) Extract, Citric Acid, Citrus Grandis (Grapefruit) Seed Extract, Tocopheryl (Vitamin E) Acetate
I use this toner when my skin feels greasy, oily or dirty throughout the day. It doesn't dry my skin out, but leaves it feeling fresh, clean and moisturized.
Lip Moisturizer
I have found a locally made, soy-based lip balm that works very well for me.
Eczema Cream
Uremol 20 Urea Cream
Ingredients: 20% urea in an emollient cream base. Carbomer 940, ceteareth-12, ceteareth-20, citric acid anhydrous, decanoic acid triglceride, germaben II, glyceryl monostearate, octyl dodecanol, potassium phosphate monobasic, purified water, sodium hydroxide, sodium phosphate dibasic
This is a strong moisturizer that, so far, has prevented cracking when my dyshidrotic eczema flares up.
I have also used Glaxal Base in the past.
Ingredients: Water, Petrolatum, Cetearyl Alcohol, Paraffinum Liquidum, Cereareth-20, Sodium Phosphate, p-chloro-m-cresol.
I prefer the consistency of Glaxal Base to Uremol, but so far feel that Uremol does a better job at keeping my skin moist. Glaxal Base feels less oily, which can be good in some cases, though I prefer a more oily emollient for dealing with my eczema flare ups.
Cosmetics
I don't wear much, if any, make-up on a regular basis. I have a few items on hand for when I need to make a good first impression, but day-to-day I don't wear any. I have seen some very positive changes to my skin since removing cosmetics from my daily routine.
However, if you do wish to use cosmetics, then check out the following sites. I have had luck with both.
Raindance Cosmetics
These people will send sample sizes of most of their items! Very helpful!
Beauty Without Cruelty
I use their shampoo (see below) and have a tube of their mascara on hand. I'm quite pleased with the mascara. It covers well and lasts most of the day. Mascara usually smears a lot for me, and this was no worse than the average brand. This mascara will still irritate my eyes if worn for a long period of time, but that probably speaks more to my sensitivities than the product quality.
Hair Care
Shampoo
Beauty Without Cruelty Daily Benefits Shampoo
Ingredients: Betula alba leaf, Betula alba sap, Melilotus officinalis blososn, Tussilago farfara, Euisetum arvense, Urtica diolca, Achillea millefollum, inositol, Rosmarinus officinalis, Salvia officinalis in purified water, sodium c14-16 olefin sulfonate, cocamidopropyl betaine, panthenol, hydrolysed soy protein, niacin, Aloe barbadensis leaf juice, soy protein, yeast extract, citric acid, phospholipids, sodium benzoate, potassium sobate, ethyl hexyl glycerin, Cympobogon flexuosus oil, cirtus aurantium oil, Lavandula hybrida oil
This is the shampoo I am using currently. The large bottle is very affordable. The shampoo is quite nice, lathers well, rinses clean and smells great.
I have also used Cliniderm Gentle Shampoo in the past.
Ingredients:Aqua, disodium cocoamphodiacetate, disodium laureth sulfosuccinate, sodium chloride, cocamidopropylamine oxide, PEG-150 pentaerythrityl tetrastearate, citric acid, PEG-12 dimethicone, disodium EDTA, potassium sorbate
It worked well as a shampoo, though was quite expensive for a small bottle. It's quite concentrated, so not a lot is needed, in theory, to clean the hair. However, it is very low foaming, so does not spread very easily through the hair. Virtually no scent, which can be a big plus! But the price was a deal-breaker for me, when other cheaper products are available that work just as well.
Hair Gel
Kiss My Face Upper Management styling gel
Ingredients: Purified, Deionized Certified Organic Floral Water of Nettle, Calendula and Chamomile, Hyaluronic Acid, Sodium Hydroxymethylglycinate (Amino Acid derived), Yeast Extract, Panthenol, Tocopherol (Vitamin E), Grapefruit Extract
I have short, natural curly hair. I use a little dollop of this gel each morning before drying my hair. It holds the curl all day long, and is not crunchy or hard.
Pet Shampoo
Bark 2 Basics Crystal Clear shampoo
I can't find any ingredients for this product, but the label says "Our products contain no fillers, thickeners, harsh additives, oils, lanolins, or silicones. Bark 2 Basics products are biodegradable, environmentally friendly and cruelty free. ... No colors or fragrances."
The product is concentrated 16:1, so a little bit goes a long way! It is clear and colorless and has virtually no smell. It lathers nicely, cleans well, and does a decent job at whitening the white bits on your pet. Rinses easily and leaves fur soft and shiny.
Detergents/Household Cleaners
Surface Cleaning
Most of my surface cleaning is done with a mixture of 50:50 white vinegar:water and a spray bottle of hydrogen peroxide. I mix up the vinegar:water solution in a spray bottle and keep it on hand for daily cleaning. Spray the surface with the vinegar:water solution and leave for a couple of minutes before wiping. For particularly soiled surfaces, I will spray a layer of hydrogen peroxide on top of the vinegar:water solution before allowing to sit. Baking soda makes for a good abrasive for real tough scrubbing.
Fabric Freshener
I use the same spray bottle of 50:50 vinegar:water for fabric freshener. Spray liberally on furniture, carpet, or drapery to neutralize odors. If you want something pretty smelling, add a couple drops of essential oils. Only a couple drops are necessary, a little bit goes a LONG way!
Laundry Detergent
I'm as surprised as anyone that a big brand name product is okay for my skin issues! But I have been using Tide Free Liquid laundry detergent for many years now with no issues.
Ingredients: Borax, citric acid, diethylenetriamine pentaacetate, amylase, protease, disodium diaminostilbene disulfonate, diquaternium ethoxy sulfate, polyethyleneimine ethoxyltate, calcium formate, dimethicone, ethanolamine, propylene glycol, sodium formate, water, alcoholethoxy sulfate, lauramine oxide, lareth-9, linear alkylbenzene sulfonate
Toilet Bowl Cleaner
Nature Clean Toilet Bowl Cleaner
Ingredients: water, citric acid, fatty polyglycoside, sodium citrate, cellulose gum, australian tea tree oil, benzoic acid
Thursday, August 4, 2011
Wednesday, August 3, 2011
Allergy Patch Tests
In February of this past year, I saw a dermatologist for allergy patch testing. I had been experiencing bouts of contact dermatitis on my neck and chest. The patches started as just small areas of red discoloration located on the sides of my neck. Over the course of a couple of weeks, they became very itchy and spread to cover the entire front of my neck and onto my chest.
I had patch tests for contact allergies when I was in my teens, and they indicated that I was allergic to some compounds in detergents, so I had already cut out scented laundry detergents and was using a sensitive skin "hypoallergenic" brand. In attempts to determine what was causing the recent bout of contact dermatitis, I attempted an elimination diet of sorts. I cut out all cosmetics and lotions. I switched to Dove soap, but continued using the same shampoo for lack of other ideas. The elimination routine didn't clear up the contact dermatitis, but my doctor prescribed Elidel for topical treatment and gave me a referral to see the specialist. The Elidel cleared the dermatitis up nearly immediately!
The patch testing occurred about 4 months later. I was tested for the general panel of contact allergens, consisting of 59 different compounds. The patches were applied to my back and left in place for 48 hours, after which time the patches were removed and the level of reaction was scored at home. An additional 48 hours later, I met with the dermatologist again, the patches were re-scored, and the results were discussed.
Out of 59 compounds, I tested positive for allergic reaction to 16 compounds. These include:
4-Phenylenediamine
Amerchol
Potassium dichromate
Nickel sulfate hexahydrate
Paraben mix
Methldibromoglutaronitrile
Frangrance mix I
Bronopol
Sesquiterpene lactone mix
Frangrance mix II
Disperse blue 106/124
Cobalt chloride hexahydrate
Compositae mix
Cetylstearyl alcohol
Formaldehyde
Hydromethyl pentyl cychexene carboxaldehyde
The underlying theme is that most of these compounds are commonly found in lotions, creams, soaps, shampoos, hair products, cosmetics, detergents, dyes, and fragrances.
As a result of these test outcomes, I made some pretty serious changes to my normal daily routine. The main part of my routine that has changed is that I now read ALL labels! Turns out that nearly every daily skin/hair care product that I was using contained at least one, of not more, of the compounds that I tested allergic to. I found a local retailer of "natural" items and was able to find new products to take the place of many of my previous products. Check out my "List of What I Use" (coming soon!) for full details. By eliminating all of my triggers, I have been able to remain contact dermatitis free for nearly a year now!
Though I have found soap, lotion, shampoo, and hair gel that works with my set of allergens, many other safe products are difficult to come by. There are some suppliers of cosmetics that do not contain my allergens, but I have yet to find cosmetic products that really work for me. As such, I rarely ever use make-up any more. I was pleasantly surprised to see that after a number of weeks of not wearing any cosmetics, my general skin condition has improved vastly! My skin appears naturally clear and supple. It does not feel dry at all, and I do not feel the need to use lotion daily. This includes during harsh Canadian winters, when extreme cold temperatures and artificial heating can wreak havoc on skin. My adult acne, while still present, has improved dramatically also, since eliminating make-up from my daily routine.
I had patch tests for contact allergies when I was in my teens, and they indicated that I was allergic to some compounds in detergents, so I had already cut out scented laundry detergents and was using a sensitive skin "hypoallergenic" brand. In attempts to determine what was causing the recent bout of contact dermatitis, I attempted an elimination diet of sorts. I cut out all cosmetics and lotions. I switched to Dove soap, but continued using the same shampoo for lack of other ideas. The elimination routine didn't clear up the contact dermatitis, but my doctor prescribed Elidel for topical treatment and gave me a referral to see the specialist. The Elidel cleared the dermatitis up nearly immediately!
The patch testing occurred about 4 months later. I was tested for the general panel of contact allergens, consisting of 59 different compounds. The patches were applied to my back and left in place for 48 hours, after which time the patches were removed and the level of reaction was scored at home. An additional 48 hours later, I met with the dermatologist again, the patches were re-scored, and the results were discussed.
Out of 59 compounds, I tested positive for allergic reaction to 16 compounds. These include:
4-Phenylenediamine
Amerchol
Potassium dichromate
Nickel sulfate hexahydrate
Paraben mix
Methldibromoglutaronitrile
Frangrance mix I
Bronopol
Sesquiterpene lactone mix
Frangrance mix II
Disperse blue 106/124
Cobalt chloride hexahydrate
Compositae mix
Cetylstearyl alcohol
Formaldehyde
Hydromethyl pentyl cychexene carboxaldehyde
The underlying theme is that most of these compounds are commonly found in lotions, creams, soaps, shampoos, hair products, cosmetics, detergents, dyes, and fragrances.
As a result of these test outcomes, I made some pretty serious changes to my normal daily routine. The main part of my routine that has changed is that I now read ALL labels! Turns out that nearly every daily skin/hair care product that I was using contained at least one, of not more, of the compounds that I tested allergic to. I found a local retailer of "natural" items and was able to find new products to take the place of many of my previous products. Check out my "List of What I Use" (coming soon!) for full details. By eliminating all of my triggers, I have been able to remain contact dermatitis free for nearly a year now!
Though I have found soap, lotion, shampoo, and hair gel that works with my set of allergens, many other safe products are difficult to come by. There are some suppliers of cosmetics that do not contain my allergens, but I have yet to find cosmetic products that really work for me. As such, I rarely ever use make-up any more. I was pleasantly surprised to see that after a number of weeks of not wearing any cosmetics, my general skin condition has improved vastly! My skin appears naturally clear and supple. It does not feel dry at all, and I do not feel the need to use lotion daily. This includes during harsh Canadian winters, when extreme cold temperatures and artificial heating can wreak havoc on skin. My adult acne, while still present, has improved dramatically also, since eliminating make-up from my daily routine.
Pompholyx in Photos
The occurrence that finally tipped the scales for me and convinced me to start this blog was a recent outbreak of pompholyx. As I type this, I am in the middle of an outbreak. I finally received a diagnosis for what exactly is happening to me only yesterday, just over 24 hours ago. This is not my first flare up of pompholyx. I had my first experience with it in 2006, with sporadic flare ups since that time.
I am currently on day 5 of the current flare up. I will continue to take photos and update this post as the flare up continues. I will document what treatment I follow each day, and try to describe both the good and the bad.
Day 1 - July 30, 2011
I fear that my own stupidity may have brought this current flare up into action. Many years ago, I underwent some allergy patch tests that indicated that I am allergic to some compounds in fabric sizing. As such, I am always sure to wash newly purchased clothing a couple of times before wearing them. However, on July 30th I purchased a very cute pair of shorts, and at the risk of sounding girly and ridiculous, I just couldn't wait to wear them! That afternoon, I had plans to make a public appearance at a therapy dog demonstration, so decided to wear my new shorts before washing them, as I would only have them on for an hour or two at most. I wore the shorts for a total of 1.5 hours, and by the time I got home after the demonstration, the flare up had begun.
It started with the palms of my hands feeling tingly and numb. It's a difficult sensation to describe, but imagine that you are wearing a very tight pair of leather gloves. You can still feel when you are touching things, but are unable to discern the little nuances of texture. At the same time, hard contact feels painful, and temperature changes register as more extreme.
The first visible signs of the flare up are patchy red blotches on the palms of my hands. These tend to be worse around the heel and thumb base pad, the "meaty" parts of my hand. The red blotches are delimited to the keratinized skin of my palm, and stop abruptly when the skin transitions to the thinner, less keratinized skin of the back of my hand and wrist.
Day 2 - July 31, 2011
Upon waking the next morning, the condition of my hands has worsened. The entire palm is red and slightly swollen. Small, very deep seated, fluid filled vacuoles are present on the "meaty" portions of the heel of my palm and the thumb base. These vacuoles are tiny, and the surface of the skin is smooth. It does not appear raised over these vacuoles. Sensation in my hands is more extreme than normal, painful to the touch and temperature fluctuations are likewise painful. Small raised bumps are present on my finger tips and around my fingernails. A few small bumps are also present at the border of the keratinized palm skin and the thin skin on the back of my hand. There is a sporadic dull ache in the joints of my hands and wrists. This ache does not persist, though is very noticeable when it does occur. In addition to the hand eczema, the skin on my torso, specifically the skin that is normally covered by undergarments, is red and slightly swollen, though not overtly itchy. Small red bumps are visible on the inside surface of my forearm. These bumps are not itchy, and disappear later in the day.
Since it is Sunday morning of a long weekend, my regular doctor is unavailable. I make a trip to a nearby walk-in clinic and consult with the doctor on duty. He appears stumped by my symptoms, and I wonder what his treatment approach would have been if I had not mentioned my suspicions of an allergic reaction. He prescribes two oral antihistimines (Ranitidine and Cetirizine) to be taken twice daily and a strong topical steroid (Clobetasol) to be applied twice daily.
Day 3 - August 1, 2011
Visible and sensory symptoms are very similar to Day 2. Vacuoles increase in number and spread across my entire palm. I continue with the oral antihistimines and topical steroids. The antihistimines do not appear to have any affect, apart from making me very dopey and irritable. The prescribing doctor indicated that these antihistimines are non-drowsy, but I frequently have adverse reactions to medications, even when touted as being "non-drowsy". I frequently feel dopey, groggy, unable to focus, and irritable when I take medications such as those for cold and flu, muscle aches, etc. I wonder if my propensity for allergic reactions, chemical sensitivities, and skin inflammation is somehow related to my over-sensitivity to medications. If my body is unable to tolerate environmental toxins, might it also be inappropriately tolerating oral medications?
Day 4 - August 2, 2011
At the end of February, 2011, I had an appointment with a dermatological specialist regarding allergy testing. On a whim, I decided to call his office with the news that I am in midst of an allergy/eczema outbreak, as my appointment with him earlier in the year coincided with a time when I was not having any sort of reaction. The receptionist said that if I could rush over to the office immediately, he would see me this morning. I explained the flare up to date, and he confirmed my suspicions and gave a diagnosis of pompholyx (also known as dyshidrotic eczema, dyshidrosis, and acute vesiculobullous hand eczema). He also indicated that flare ups could be brought on by contact with an allergen, contact with an irritant, or as result of an autoimmune reaction to an endogenous trigger. Essentially, it is possible that I could confine myself to a bubble and still have eczema flare ups. Not necessarily the news I want, but at least it gives me a direction to head in!
I spent some time on the internet looking for information regarding pompholyx, and came up with disappointingly little to go on. What few sites I could easily find appeared to all have the same information word-for-word copy-and-pasted from a single source. However, I did find a couple of suggestions to get me started. A few sites recommended a salt-water soak to dry out the vacuoles and potentially prevent the mass peeling that I experienced in previous flare ups. I decided to conduct a little experiment, whereby I soaked my left hand only in a bowl of room temperature salt water for 40 minutes. I then applied my steroid cream to both hands, and covered them with vinyl gloves for about half an hour to enhance the absorption of the cream. I will review tomorrow whether there appears to be a difference between the salt-soaked and unsoaked hands.
I took both of the oral antihistimines in the morning, as prescribed, but discussion with the dermatologist indicated that the oral antihistimines would do no good for the pompholyx. Since the antihistimines were causing me to be groggy and sleepy, I decided to discontinue the Ranitidine. I continue to take the Cetirizine twice daily, as the rash on my torso persists and becomes moderately itchy at times.
Regarding symptoms, visually my hands appear unchanged from Day 3. Small vacuoles persist, with a few becoming raised at the surface. My hands are becoming quite itchy, though scratching is painful. Rubbing them together or on my pants provides the most relief.
Day 5 - August 3, 2011
The fluid filled vacuoles that were previously small and deep-seated, have now expanded in size and are becoming somewhat raised at the surface. My palms are noticeably swollen and it feels as though they are filled with fluid, similar to a water balloon. The swelling, pain, and redness is still limited to my palms. The backs of my hands appear completely normal, apart from a slight redness around my fingertips and fingernails. Both hands are "fluid filled", though the left hand (which was soaked in salt-water the previous evening) appears less affected than the right unsoaked hand. There are small darkened patches on my left hand that appear to be dried out vacuoles. These darkened patches are not present on my right hand.
The fluid-filled portions on both hands are quite painful, and feel as if they are pressurized or "blown up" like a balloon. Rolling the thumb of one hand along the heel of my palm of the other hand produces a very strange sensation. It is as if there are multiple small bubbles under my skin, and applying a rolling pressure "pops" these bubbles, merging them into larger blisters. The sensation is similar to that of tiny bubble wrap. When one of these larger bubbles bursts, it releases a surprisingly large amount of clear, odorless fluid. I don't know if I should be popping these blisters or not, but it is surprisingly satisfying and helps to relieve the pressure in my palms. As confirmation of earlier findings, the blisters on my left (salt-soaked) hand are much smaller and cover less overall area than on my right (unsoaked) hand.
I applied the topical steroid in the morning, and wore a pair of vinyl gloves for half an hour after application. During the day, I repeatedly applied Glaxal Base lotion.
This evening, I soaked both hands in room temperature water with dissolved epsom salts for 40 minutes each. After soaking, my hands feel much less "pressurized" and the skin feels much softer and more pliable. I drained all of the blisters. While my palms are still painful to the touch, they are much less sore than prior to soaking and draining.
In previous flare ups, I have not soaked my hands and have tried to refrain from popping the blisters. I applied Glaxal Base lotion frequently. The result is that my hands peeled excessively, and revealed very raw and tender skin beneath. I have since looked into the ingredients in Glaxal Base, and have found that one of the compounds to which I tested positive for allergic reactions to earlier this year is found among them. As such, I picked up a new emollient cream on the way home from work today, and will give it a shot tonight. I hope that the steps I have taken this time will prevent the extreme peeling of previous episodes.
There are a few other symptoms that I have noticed over the past couple of days. I have been monitoring my weight for the past year in efforts to drop some extra pounds. Prior to this flare up, I was steadily losing weight at a rate of about 1-2lb per week. Over the past 5 days, since the visible signs of the flare up, I have gained 2.5lb. All despite maintaining a healthy eating plan, drinking upwards of 12 cups of water daily, and running 5km every other day. Additionally, this morning I noticed what appears to be a vaginal yeast infection. I am not prone to yeast infections, having only had a couple, the last one many years ago. These symptoms, combined with the pompholyx flare up and the disperse rash on my torso, hints at a possible system-wide disruption. My suspicion is that there was exposure to an allergen, causing the rash on my torso and triggering the pompholyx flare up on my hands. Combined, these have resulted in water retention, leading to the weight gain, and have lowered my immune defenses allowing a yeast infection to form. Makes sense in my head, but is all speculation at this point.
Day 6 - August 4, 2011
My hands feel so much better today! They still look horrible, but I can tell that things are starting to heal up. The soaking and draining of the blisters yesterday seems to have made a big difference. The heels of my hands that were previously filled with fluid are mostly dried up. There is a small patch on my right hand that appears to still have some fluid, but the rest of the vacuoles have dried up and the swelling has gone down. The skin on my palms has become hardened and thick, slightly raised above where the vacuoles were. The hardened patches are very dark red in color, with some appearing almost brown-ish in color.
My finger tips are still fluid filled and quite tender. Those vacuoles do not seem to be drying out at the same rate as those on my palms. However, the skin on my finger tips feels as if it is thickening as well, so perhaps they will skip the large blister stage.
The pain is much less today than yesterday, primarily, I believe, because of the lessened pressure from the drained blisters. My hands are still very tender, however, and repetitive use is very uncomfortable. The thickened dry skin feels as though it would crack easily at this point, so I have been moisturizing frequently with Uremol cream. I have also avoided getting my hands wet, when possible, by wearing powder-free vinyl gloves.
I am continuing to take the Cetirizine twice daily and applying the Clobetasol morning and evening. This is the first day using Uremol as an emollient. My hands feel slightly tacky after applying the lotion, but I don't know if this is due to the lotion itself or the strange texture of my skin at the moment. I will update on this as healing progresses.
Day 7 - August 5, 2011
This is getting really old, but at least I am seeing changes daily. The vacuoles have all essentially dried up. The vacuoles that were closer to the surface or under thinner skin (such as those on the sides of my fingers and around my finger nails) are darkened to a reddish-brown color, though the individual vacuoles (or what remains of them) are still distinguishable. The skin on my palms where the majority of the raised fluid-filled blisters (bullae) were located is likewise darkened to a reddish-brown color. The skin over my entire palms and the palmar surface of my fingers is also quite hardened. It's difficult to describe how the hardened skin feels, especially as my finger tips are also covered with it, so determining texture is hard to do. The hardened skin feels smooth and not overly dry. It appears to be thick, as when I lightly tap my hand on a hard surface, it makes a knocking/tapping sound. The thickened, hardened skin has not yet begun to peel, though I can see that on the near horizon. It is not yet cracked, but moving my fingers or hand too much results in sharp pain that I believe heralds cracking and peeling soon. I've been moisturizing frequently with Uremol, but it doesn't appear to be absorbing very well. In addition to the thickened skin, my finger nails have thickened as well, with the pink attached portion regressing to reveal more whiteness.
As a follow-up to the salt-soak, I really do think that it is a good tool to use, though there appears to be a limited window of time when it is effective. I started by soaking my left hand on Day 4, when there were multiple small deep-seated vacuoles that had not yet become completely raised or bullous. By Day 5, the vacuoles had all become raised bullae and I had worked to pop them after soaking both hands in epsom salts. By Day 7 (today) my left hand is dry and hardened, but not as severely as my right hand. The hardened skin on my right hand seems thickest and most painful directly over where the large bullae had burst a couple days earlier. The skin on my left hand (the one that was soaked) is slightly less thick and doesn't feel as if it is going to crack when I move it. I would wager that the salt soak is most effective for the couple of days when the vacuoles are present but not raised or bullous. This appears to have dried out the small vacuoles and prevented the large bullae from forming, which eventually leads to the thick, hard skin.
Day 8 - August 6, 2011
WARNING: Some people may find the following pictures gross and disturbing. If you have pompholyx, you might as well scroll down and look because this could very well be your hands or feet. But if you have a queasy stomach when it comes to things like peeling skin flakes, you might want to skip this day's update.
The thick leathery skin from yesterday has begun to peel. It starts with an area appearing to be lighter in color than the rest of my palm. In truth, this lighter color is caused by the leathery surface skin becoming detached from the deeper layer. A small crack or hole will develop in the top layer and this will easily peel off in very large sheets. The peeling layer is not dry and flaky, but holds its shape quite well. The peeling started where the skin was the thickest, around the base of my thumb and the heel of my palm. My palm feels slightly itchy, though not unreasonably so. Once the top layer peels, the revealed skin is quite sensitive and raw. It dries out very easily and appears excessively wrinkled. When the skin peels, it comes off of my palm very easily, but stops peeling abruptly at the borderline where the keratinized skin of my palm meets the thin skin of my wrist or the back of my hand.
I've continued to moisturize with Glaxal Base every 15-20 minutes. The skin dries out that quickly. Note that some lotions will sting and burn the sensitive skin! I find that Glaxal Base does not sting, where something like Uremol is very painful to use.
Day 13 to 19 - August 11 to 17, 2011
For the past 6 days, my hands have continued to peel. The large, thick sheets were mostly gone on the first day of peeling. For the past 6 days, the peeling has mostly been on my fingers, finger tips, webbing between my fingers, and around the edges of my palms. My hands continue to be quite dry, though I can get away with moisturizing only every hour or two, instead of multiple times per hour. When stretched tight, the skin on my palms appears very shiny. Though when my hands are relaxed, the skin is very very wrinkled. If left to dry out too much, the skin is prone to cracking and bleeding along the "wrinkle" lines. My palms still appear more red than normal, and they are somewhat sensitive, though no where near what it was like a week or two ago. I have noticed that my cuticles look really clean and nice. The cuticle skin around my nails has completely peeled off.
I am currently on day 5 of the current flare up. I will continue to take photos and update this post as the flare up continues. I will document what treatment I follow each day, and try to describe both the good and the bad.
Day 1 - July 30, 2011
I fear that my own stupidity may have brought this current flare up into action. Many years ago, I underwent some allergy patch tests that indicated that I am allergic to some compounds in fabric sizing. As such, I am always sure to wash newly purchased clothing a couple of times before wearing them. However, on July 30th I purchased a very cute pair of shorts, and at the risk of sounding girly and ridiculous, I just couldn't wait to wear them! That afternoon, I had plans to make a public appearance at a therapy dog demonstration, so decided to wear my new shorts before washing them, as I would only have them on for an hour or two at most. I wore the shorts for a total of 1.5 hours, and by the time I got home after the demonstration, the flare up had begun.
It started with the palms of my hands feeling tingly and numb. It's a difficult sensation to describe, but imagine that you are wearing a very tight pair of leather gloves. You can still feel when you are touching things, but are unable to discern the little nuances of texture. At the same time, hard contact feels painful, and temperature changes register as more extreme.
The first visible signs of the flare up are patchy red blotches on the palms of my hands. These tend to be worse around the heel and thumb base pad, the "meaty" parts of my hand. The red blotches are delimited to the keratinized skin of my palm, and stop abruptly when the skin transitions to the thinner, less keratinized skin of the back of my hand and wrist.
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| Day 1 - Left palm showing red patches |
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| Day 1 - Right palm showing red patches |
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| Day 1 - Right wrist showing border between affected and unaffected skin |
Day 2 - July 31, 2011
Upon waking the next morning, the condition of my hands has worsened. The entire palm is red and slightly swollen. Small, very deep seated, fluid filled vacuoles are present on the "meaty" portions of the heel of my palm and the thumb base. These vacuoles are tiny, and the surface of the skin is smooth. It does not appear raised over these vacuoles. Sensation in my hands is more extreme than normal, painful to the touch and temperature fluctuations are likewise painful. Small raised bumps are present on my finger tips and around my fingernails. A few small bumps are also present at the border of the keratinized palm skin and the thin skin on the back of my hand. There is a sporadic dull ache in the joints of my hands and wrists. This ache does not persist, though is very noticeable when it does occur. In addition to the hand eczema, the skin on my torso, specifically the skin that is normally covered by undergarments, is red and slightly swollen, though not overtly itchy. Small red bumps are visible on the inside surface of my forearm. These bumps are not itchy, and disappear later in the day.
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| Day 2 - Right hand and wrist |
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| Day 2 - Right hand and wrist |
Day 3 - August 1, 2011
Visible and sensory symptoms are very similar to Day 2. Vacuoles increase in number and spread across my entire palm. I continue with the oral antihistimines and topical steroids. The antihistimines do not appear to have any affect, apart from making me very dopey and irritable. The prescribing doctor indicated that these antihistimines are non-drowsy, but I frequently have adverse reactions to medications, even when touted as being "non-drowsy". I frequently feel dopey, groggy, unable to focus, and irritable when I take medications such as those for cold and flu, muscle aches, etc. I wonder if my propensity for allergic reactions, chemical sensitivities, and skin inflammation is somehow related to my over-sensitivity to medications. If my body is unable to tolerate environmental toxins, might it also be inappropriately tolerating oral medications?
Day 4 - August 2, 2011
At the end of February, 2011, I had an appointment with a dermatological specialist regarding allergy testing. On a whim, I decided to call his office with the news that I am in midst of an allergy/eczema outbreak, as my appointment with him earlier in the year coincided with a time when I was not having any sort of reaction. The receptionist said that if I could rush over to the office immediately, he would see me this morning. I explained the flare up to date, and he confirmed my suspicions and gave a diagnosis of pompholyx (also known as dyshidrotic eczema, dyshidrosis, and acute vesiculobullous hand eczema). He also indicated that flare ups could be brought on by contact with an allergen, contact with an irritant, or as result of an autoimmune reaction to an endogenous trigger. Essentially, it is possible that I could confine myself to a bubble and still have eczema flare ups. Not necessarily the news I want, but at least it gives me a direction to head in!
I spent some time on the internet looking for information regarding pompholyx, and came up with disappointingly little to go on. What few sites I could easily find appeared to all have the same information word-for-word copy-and-pasted from a single source. However, I did find a couple of suggestions to get me started. A few sites recommended a salt-water soak to dry out the vacuoles and potentially prevent the mass peeling that I experienced in previous flare ups. I decided to conduct a little experiment, whereby I soaked my left hand only in a bowl of room temperature salt water for 40 minutes. I then applied my steroid cream to both hands, and covered them with vinyl gloves for about half an hour to enhance the absorption of the cream. I will review tomorrow whether there appears to be a difference between the salt-soaked and unsoaked hands.
I took both of the oral antihistimines in the morning, as prescribed, but discussion with the dermatologist indicated that the oral antihistimines would do no good for the pompholyx. Since the antihistimines were causing me to be groggy and sleepy, I decided to discontinue the Ranitidine. I continue to take the Cetirizine twice daily, as the rash on my torso persists and becomes moderately itchy at times.
Regarding symptoms, visually my hands appear unchanged from Day 3. Small vacuoles persist, with a few becoming raised at the surface. My hands are becoming quite itchy, though scratching is painful. Rubbing them together or on my pants provides the most relief.
Day 5 - August 3, 2011
The fluid filled vacuoles that were previously small and deep-seated, have now expanded in size and are becoming somewhat raised at the surface. My palms are noticeably swollen and it feels as though they are filled with fluid, similar to a water balloon. The swelling, pain, and redness is still limited to my palms. The backs of my hands appear completely normal, apart from a slight redness around my fingertips and fingernails. Both hands are "fluid filled", though the left hand (which was soaked in salt-water the previous evening) appears less affected than the right unsoaked hand. There are small darkened patches on my left hand that appear to be dried out vacuoles. These darkened patches are not present on my right hand.
The fluid-filled portions on both hands are quite painful, and feel as if they are pressurized or "blown up" like a balloon. Rolling the thumb of one hand along the heel of my palm of the other hand produces a very strange sensation. It is as if there are multiple small bubbles under my skin, and applying a rolling pressure "pops" these bubbles, merging them into larger blisters. The sensation is similar to that of tiny bubble wrap. When one of these larger bubbles bursts, it releases a surprisingly large amount of clear, odorless fluid. I don't know if I should be popping these blisters or not, but it is surprisingly satisfying and helps to relieve the pressure in my palms. As confirmation of earlier findings, the blisters on my left (salt-soaked) hand are much smaller and cover less overall area than on my right (unsoaked) hand.
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| Day 5 - Right hand showing fluid filled heel |
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| Day 5 - Close up of the large fluid filled blisters on my right palm |
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| Day 5 - Multiple small raised blisters/vacuoles on right palm |
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| Day 5 - Small raised bumps and redness around the fingernails of my right hand |
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| Day 5 - Close-up of the many small fluid filled vacuoles on my right palm |
This evening, I soaked both hands in room temperature water with dissolved epsom salts for 40 minutes each. After soaking, my hands feel much less "pressurized" and the skin feels much softer and more pliable. I drained all of the blisters. While my palms are still painful to the touch, they are much less sore than prior to soaking and draining.
In previous flare ups, I have not soaked my hands and have tried to refrain from popping the blisters. I applied Glaxal Base lotion frequently. The result is that my hands peeled excessively, and revealed very raw and tender skin beneath. I have since looked into the ingredients in Glaxal Base, and have found that one of the compounds to which I tested positive for allergic reactions to earlier this year is found among them. As such, I picked up a new emollient cream on the way home from work today, and will give it a shot tonight. I hope that the steps I have taken this time will prevent the extreme peeling of previous episodes.
There are a few other symptoms that I have noticed over the past couple of days. I have been monitoring my weight for the past year in efforts to drop some extra pounds. Prior to this flare up, I was steadily losing weight at a rate of about 1-2lb per week. Over the past 5 days, since the visible signs of the flare up, I have gained 2.5lb. All despite maintaining a healthy eating plan, drinking upwards of 12 cups of water daily, and running 5km every other day. Additionally, this morning I noticed what appears to be a vaginal yeast infection. I am not prone to yeast infections, having only had a couple, the last one many years ago. These symptoms, combined with the pompholyx flare up and the disperse rash on my torso, hints at a possible system-wide disruption. My suspicion is that there was exposure to an allergen, causing the rash on my torso and triggering the pompholyx flare up on my hands. Combined, these have resulted in water retention, leading to the weight gain, and have lowered my immune defenses allowing a yeast infection to form. Makes sense in my head, but is all speculation at this point.
Day 6 - August 4, 2011
My hands feel so much better today! They still look horrible, but I can tell that things are starting to heal up. The soaking and draining of the blisters yesterday seems to have made a big difference. The heels of my hands that were previously filled with fluid are mostly dried up. There is a small patch on my right hand that appears to still have some fluid, but the rest of the vacuoles have dried up and the swelling has gone down. The skin on my palms has become hardened and thick, slightly raised above where the vacuoles were. The hardened patches are very dark red in color, with some appearing almost brown-ish in color.
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| Day 6 - Left palm. Dark red patches are dried vacuoles |
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| Day 6 - Close-up of dried patches on left palm |
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| Day 6 - Right palm. Dark patches are dried vacuoles |
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| Day 6 - Close-up of dried patches on right palm. |
My finger tips are still fluid filled and quite tender. Those vacuoles do not seem to be drying out at the same rate as those on my palms. However, the skin on my finger tips feels as if it is thickening as well, so perhaps they will skip the large blister stage.
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| Day 6 - Raise fluid-filled blisters on the side of my finger tip. |
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| Day 6 - Small, deep-seated fluid-filled vacuoles on the tip of my finger |
The pain is much less today than yesterday, primarily, I believe, because of the lessened pressure from the drained blisters. My hands are still very tender, however, and repetitive use is very uncomfortable. The thickened dry skin feels as though it would crack easily at this point, so I have been moisturizing frequently with Uremol cream. I have also avoided getting my hands wet, when possible, by wearing powder-free vinyl gloves.
I am continuing to take the Cetirizine twice daily and applying the Clobetasol morning and evening. This is the first day using Uremol as an emollient. My hands feel slightly tacky after applying the lotion, but I don't know if this is due to the lotion itself or the strange texture of my skin at the moment. I will update on this as healing progresses.
Day 7 - August 5, 2011
This is getting really old, but at least I am seeing changes daily. The vacuoles have all essentially dried up. The vacuoles that were closer to the surface or under thinner skin (such as those on the sides of my fingers and around my finger nails) are darkened to a reddish-brown color, though the individual vacuoles (or what remains of them) are still distinguishable. The skin on my palms where the majority of the raised fluid-filled blisters (bullae) were located is likewise darkened to a reddish-brown color. The skin over my entire palms and the palmar surface of my fingers is also quite hardened. It's difficult to describe how the hardened skin feels, especially as my finger tips are also covered with it, so determining texture is hard to do. The hardened skin feels smooth and not overly dry. It appears to be thick, as when I lightly tap my hand on a hard surface, it makes a knocking/tapping sound. The thickened, hardened skin has not yet begun to peel, though I can see that on the near horizon. It is not yet cracked, but moving my fingers or hand too much results in sharp pain that I believe heralds cracking and peeling soon. I've been moisturizing frequently with Uremol, but it doesn't appear to be absorbing very well. In addition to the thickened skin, my finger nails have thickened as well, with the pink attached portion regressing to reveal more whiteness.
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| Day 7 - Right palm |
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| Day 7 - Close up of hardened skin on the heel of my right palm |
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| Day 7 - Left palm |
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| Day 7 - Close up of hardened skin of left palm |
Day 8 - August 6, 2011
WARNING: Some people may find the following pictures gross and disturbing. If you have pompholyx, you might as well scroll down and look because this could very well be your hands or feet. But if you have a queasy stomach when it comes to things like peeling skin flakes, you might want to skip this day's update.
The thick leathery skin from yesterday has begun to peel. It starts with an area appearing to be lighter in color than the rest of my palm. In truth, this lighter color is caused by the leathery surface skin becoming detached from the deeper layer. A small crack or hole will develop in the top layer and this will easily peel off in very large sheets. The peeling layer is not dry and flaky, but holds its shape quite well. The peeling started where the skin was the thickest, around the base of my thumb and the heel of my palm. My palm feels slightly itchy, though not unreasonably so. Once the top layer peels, the revealed skin is quite sensitive and raw. It dries out very easily and appears excessively wrinkled. When the skin peels, it comes off of my palm very easily, but stops peeling abruptly at the borderline where the keratinized skin of my palm meets the thin skin of my wrist or the back of my hand.
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| Day 8 - Left palm showing partially peeled region. The edges are lighter in color indicating that the top layer of thick skin is separating from the layer beneath. |
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| Day 8 - Large flap of peeling skin still partially attached to my left palm. |
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| Day 8 - After the thick skin is removed, the skin beneath is very red, prone to driness, and appears wrinkled. Small drops of blood near my wrist shows that, while the skin peels easily from my palm, it stops peeling abruptly when the skin type changes at my wrist. |
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| Day 8 - My right palm, mostly peeled. You can see the border of the peeled region, with brighter red skin in the peeled region and duller/darker skin that is yet to peel. |
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| Day 8 - My left (moisturized) hand next to some large peeled sections of skin. This is to show that the peeling skin is not flaky, dry, or thin. Rather the skin is quite thick, allowing large sheets to peel off and hold together. |
I've continued to moisturize with Glaxal Base every 15-20 minutes. The skin dries out that quickly. Note that some lotions will sting and burn the sensitive skin! I find that Glaxal Base does not sting, where something like Uremol is very painful to use.
Day 13 to 19 - August 11 to 17, 2011
For the past 6 days, my hands have continued to peel. The large, thick sheets were mostly gone on the first day of peeling. For the past 6 days, the peeling has mostly been on my fingers, finger tips, webbing between my fingers, and around the edges of my palms. My hands continue to be quite dry, though I can get away with moisturizing only every hour or two, instead of multiple times per hour. When stretched tight, the skin on my palms appears very shiny. Though when my hands are relaxed, the skin is very very wrinkled. If left to dry out too much, the skin is prone to cracking and bleeding along the "wrinkle" lines. My palms still appear more red than normal, and they are somewhat sensitive, though no where near what it was like a week or two ago. I have noticed that my cuticles look really clean and nice. The cuticle skin around my nails has completely peeled off.
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| Day 13 - Dry, red and wrinkled. |
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| Day 19 - Still dry, red and wrinkled. |
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| Day 19 - Close up of the thumb base of my right hand. Very wrinkled and still peeling in areas. |
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| Day 19 - The side of my right hand, showing that the peeling and redness stops abruptly at the border of my palm and the back of my hand. |
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| Day 19 - A small bleeding crack along one of the wrinkle lines of my pinky finger. |
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| Day 19 - My cuticles have completely peeled away. 8 of 10 fingers are like this. |
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