Hey all! So there have been some new developments (15 years in the making, so not really all that new) around here. This entire post will be about my journey with dyshidrotic eczema, so if you're not into reading about skin conditions and the myriad of treatments that go along with them, you might want to skip this one. However, if you or someone you know suffer from eczema or any other itchy, uncomfortable, debilitating skin issue, it might be worth the read.
So, from the beginning. I have had chronically dry skin since before I can even remember...to the point that I've been using medical grade moisturizers since I was about 13 years old. I remember itching so badly at night (always at night) that I would wake up in the morning with blood all over my legs and under my fingernails. I wasn't even aware that I had been itching. I started cutting my fingernails super short and wearing socks on my hands to bed just to try to keep me from ripping all my skin off while I slept. I even tried wearing footie pajamas as a way to keep a barrier between my fingernails and my skin. I had to take soaking baths using colloidal oatmeal to try to soothe my irritated skin. My friends will remember me hauling around my trusty blue-and-white tub of Vanicream with me everywhere I went. Vanicream is made in Rochester, MN and is used by the Mayo Clinic for a lot of their compounded creams and ointments for dermatological conditions. For the last decade or so it's been widely available everywhere, but when I first started travel nursing back in 2006, I could only find it in pharmacies in Rochester and had to stock up when I was home in Minnesota because it was impossible to find on the road. Having to use Vanicream and only Vanicream kept me from enjoying all the lotions and soaps from Bath & Body Works and other fun bath product places as well. So while my friends were going around smelling like candied apples and rose-scented geraniums, I smelled like...well...nothing, really, as my lotion had no scent at all. For a large part of my teens and early 20's, my skin and I coexisted relatively well, with only minor flare-ups here and there necessitating I go on an "elimination" regimen of bath products; meaning I cut out all my regular bath products, switched to medical grade hypoallergenic products, and then added in my regular products one by one until I figured out the culprit of the flare-up. Sometimes I never did figure out what caused the flare-up, which is probably due to the fact that I've also had environmental allergies and asthma for most of my life, which also makes me react to things at random. Do I sound like a mess? I sound like one...on paper, anyway. ;)
When I was 25, I started noticing this weird, itchy patch of skin on the middle finger of my right hand. It didn't really bother me all that much, but it was definitely something that hadn't been there before, and was also noticeably different from the skin issues I had had in the past. I had recently purchased and started wearing a tungsten ring on that finger, and so I thought maybe it was due to a metal sensitivity, which is something I'd dealt with in the past. As a child and young adult, if I wore any sort of cheap jewelry, whether it was a ring, a watch, or earrings, I would almost immediately break out in a rash in the exact location that the metal was touching my skin. I learned early on that most of my jewelry had to be sterling silver, surgical steel, or gold, which meant having an entire arsenal of cute dangly earrings from Claire's was out of the question. Perhaps that's why I've never been much of a jewelry person, as for most of my life it's caused me considerable discomfort. I had my doubts that the itchy patch on my finger was caused by my tungsten ring, as I had done research on tungsten and it was supposed to be non-allergenic. So I continued to wear the ring and carried on with life, itchy finger be damned.
It wasn't long after getting the tungsten ring that I started travel nursing. As most of you know or can imagine, travel nursing entails a considerable amount of stress. Driving across the country, moving into a new apartment, learning a new city, learning a new hospital, meeting new coworkers, making new friends. I was doing that every three months. The little itchy spot on my middle finger turned into big itchy spots on not only my middle finger, but also the ring finger and pointer finger on my right hand. I started to get a little concerned, but I continued to moisturize frequently and I bought an over-the-counter steroid for really bad flare-ups and that seemed to keep things relatively calm, most of the time. What I didn't realize at the time, and wouldn't realize for probably a decade after I first noticed that initial itchy patch, is that the flare-ups were cyclical, and definitely followed a pretty distinct pattern, stress level being a major contributor.
I remember going to see a doctor in St. Paul, MN when I was 27, as the itchy spots were no longer just itchy spots...they started out as little tiny water blisters that were horrifically itchy...like nothing I'd ever experienced before. The water blisters would then pop, the skin would be open and raw, and then it would dry out and look like a callous, at which point the skin would crack open and bleed. It was a pretty terrible progression, and I wasn't prepared for how to deal with it. At this point I had resorted to wearing bandaids on all my fingers and had switched to using Neutrogena Norwegian hand cream, which was more of an ointment than a cream, and I was applying that so often that I was going through almost a tube a week. At that time it seemed like the only thing that was kind of working. The doctor, who was a GP (general practitioner) and not a dermatologist, diagnosed me with atopic dermatitis, one of several types of eczema, and prescribed me a steroid cream that was stronger than what I could get in the drugstore. I didn't know it then, but I had been misdiagnosed. It turns out there are many different types of eczema, and while I would come to find out later that I had one of the more rare versions, I was initially diagnosed with one of the more common versions. It turns out that treatment matters, but for the time being, the steroid commonly used to treat atopic dermatitis was mostly working.
When I was 28, Simon and I started travel nursing together, and our first assignment was in Denver, CO. The eczema went completely off the rails within my first week of being there. I thought maybe it had something to do with an allergen that my body wasn't used to, as previously any time I had spent in Colorado had been very brief. The blisters on my fingers this time were huge, super painful, and so incredibly itchy. The blisters were now on multiple fingers of both hands, leaving me with incredibly painful open wounds. Once again my fingers were covered in bandaids or soft cotton dressings as the adhesive on the bandaids was too painful on my open skin, and there was no way to keep the adhesive off the open areas, since they were everywhere. I had to miss three days of work as I could barely stand to get my hands wet, let alone use hand sanitizer or wash them with soap and water frequently. I was also concerned about being in a hospital environment with open wounds; we come into contact with a lot of different infectious organisms in the hospital, and I didn't want to make myself sick. Off I went again to the doctor, but this time I made sure to see a dermatologist. He took one look at my hands and diagnosed me with dyshidrotic eczema; still eczema, but the treatment was going to be a little different. I was prescribed a different topical called Clobex, which was still a steroid, but a different steroid. Within hours of applying the ointment I had relief of the pain and itching and noticed the blisters shrinking. It was actually pretty amazing to experience. For the next several years, I would suffer occasional flare-ups, but the combination of the Clobex and the Vanicream mostly kept things under control.
The hardest part about having dyshidrotic eczema during those early years of my diagnosis was that there really wasn't much information out there about it. All of the information was mostly centered around atopic dermatitis, which is the most common form of eczema. Unfortunately, dyshidrotic eczema and atopic dermatitis are just similar enough that while some of the treatments have some overlap, they are just different enough that some of the treatments are ineffective. I frequently Googled dyshidrotic eczema, trying to find other things that might be contributing to my flareups. Was it something I was eating? Was it my hand soap? My laundry soap? Was my trusty Vanicream failing me after all these years? Were my environmental allergies contributing? Years later I would come to find out that yes, all of those things, yes. But in the meantime, I continued to navigate flareup after flareup, hoping that maybe someday it would just go away. There is some literature out there to suggest that dyshidrotic eczema typically affects people (mostly women) from their mid-20s to their late 30s/early 40s. As I neared 40 I got more and more optimistic that maybe the eczema was on its way out; I'm currently 41 and it's showing no signs whatsoever of vacating the premises anytime soon.
So just a little tidbit about eczema...eczema and all its variations (including dyshidrotic) is considered an autoimmune disorder, which means that for whatever reason, the immune system starts attacking your body, resulting in unfavorable, uncomfortable, debilitating, and sometimes life-threatening symptoms. Type 1 diabetes, rheumatoid arthritis, Hashimoto's, multiple sclerosis, celiac disease, and lupus are some of the more commonly known autoimmune disorders. There has been some recent research indicating that asthma is also an autoimmune disorder, as it responds to immunosuppressive therapy. There is a lot of research out there indicating that once a person has one autoimmune disorder, the probability that they will suffer additional autoimmune disorders is highly likely. I've had asthma since I was about 9 years old, and I've read several articles indicating that individuals with asthma frequently also suffer from eczema. Some only have the eczema as children and outgrow it, but some people suffer from it their entire lives with varying severity. My brothers and I all have asthma, which we have mostly outgrown, but we also all currently have or previously had eczema of one form or another. I find that very interesting.
In 2012 Simon and I moved to Flagstaff, AZ. Cue up the eczema, which again went right off the rails. While the blisters themselves stayed relatively small this time, nearly all my fingers on both hands and the upper parts of both of my palms were covered in them. Which then lead to cracking, itching, pain...all the usual suspects showed up for the party. I found a wonderful dermatologist here in town, who truly changed my life with regard to my skin. I was prescribed a different steroid, which I still use to this day. At this time, there was still very little information related specifically to dyshidrotic eczema, so I continued to carry on with life as usual, using the steroid ointment as necessary, which as the years went on, became more and more, to the point that I was using it almost daily earlier this year.
In late February/early March of this year, I again had a really nasty flareup that caused me to miss a whole week of work as I sorted things out. I went to my dermatologist again, and this time she had some new information for me, along with a new treatment regimen that included using CeraVe lotion, which has ceramides in it, which promote health and healing of dry, damaged, reactive skin (funny story, Simon's mom had told me about CeraVe years ago, but I had been using Vanicream for so long with good results that I hadn't been interested in changing up my regimen at that time...had I only known!!). I don't leave home without a little tube of CeraVe in my purse, and I even have a tube of it that I use at work. I apply the lotion after every hand washing, and in-between washings when my skin feels dry. I use CeraVe cream on my hands at night, along with CeraVe healing ointment, which feels like Vaseline. Since March the eczema has been better, but still not as in control as I would like.
So here's the elephant in the room that I had been overlooking for far too long...my worst flareups are almost completely related to stress. When I go back and look at all my worst flareups, I was stressed out. I was moving, I was starting a new job, I was traveling, I was having oppositional work relations with a coworker, etc. When I'm stressed I don't eat well and I don't sleep well, which just causes more stress. And what was happening in March of this year? COVID. At baseline I can be a high-strung, reactionary person to even the tiniest of stressors, and I try my best to manage it as well as I can. Sometimes I do, sometimes I don't. It's the times that I don't that I notice the eczema popping in to say hello. Of course my flareups are always worse on my workdays; in part due to stress, in part due to all the hand washing and hand sanitizer use. Being a nurse is stressful (exponentially so during the pandemic), and I wish there were better ways for me specifically to manage my work-related stress. I've tried having soothing essential oils for me to sniff periodically; I've tried deep breathing; I've tried stepping off the unit periodically to get away from the beeping IVs, the call lights, the interruptions, and the noise; I've tried keeping a special little snack in my lunch box for me to have when I need a little uplift (no, not that kind of snack...like a piece of chocolate or a bubbly water). I stepped down from the charge nurse role in May after a series of (in my opinion) questionable institutional changes in the midst of COVID added a considerable amount of stress to my job and left me in tears three nights in a row. Until those shifts, I could count on one hand with fingers to spare the number of times I'd cried at work; three days in a row is unprecedented for me. The stress level has been better since leaving the charge role, but it's more than I'd like, and is probably more than is healthy for me. Periodically I consider a change in career. Not necessarily outside of the nursing profession, but maybe outside of the hospital setting. Doing nothing but giving flu shots all day long sounds like a dream to me. Seriously. I've been working hard as a floor nurse in the hospital for over 18 years. Maybe it's time I took a break from all that. I think that would help considerably with my stress, and probably my eczema as well.
I stumbled upon some new research on dyshydrotic eczema the other day that seems promising. Apparently there have been some new studies exploring the relationship between foods and dyshidrotic eczema; previously I was able to find all kinds of diet modifications for atopic dermatitis, but nothing specifically for dyshidrotic eczema. This is literally the research I've been looking for, as I've suspected that in addition to all the environmental triggers I was trying to manage, there had be to something that I was eating that was also contributing to my flareups. Studies have shown that foods high in nickel contribute in general to eczema flareups, and more specifically to dyshidrotic eczema flareups. Remember way back in one of the first paragraphs when I talked about my sensitivity to metals when I was young? It was the nickel I was reacting to (which I'd known about for a long time, and have been intentionally avoiding for decades). Having a nickel sensitivity isn't a rare thing, I'm sure you've seen jewelry that says nickel-free or low-nickel content on the packaging...there are a lot of people out there who have a physical sensitivity to nickel, which is typically found in low-quality jewelry. There was no way I would have ever correlated my skin's physical sensitivity to nickel with the nickel-containing foods I was eating, and I was so elated to find this new research. I about swung from the rafters with joy; that is, until I saw chocolate on the list. There are actually a few of my daily faves that made the list of high-nickel content foods to avoid. Briefly (in order of foods I enjoy most to least): chocolate, whole grains, raspberries, nuts (including nut butters), seeds, shellfish, brown rice, pineapple, beans/legumes, leafy greens, soy (which is in pretty much anything and everything that's processed), and pretty much anything canned (there is nickel in the metal of the cans, and the heating of the cans during the canning process causes the nickel to leech out into the food). I'm trying to not be devastated as I remove those items from my diet for the next month or so to see if there's any difference. Those of you who know my affinity for peanut butter cups (and peanut butter in general) know how difficult this is going to be for me, but if it works, it'll all be worth it, and hopefully maybe down the road I can start adding things back one by one to see if I react. Thankfully coffee and wine didn't make the list of things to avoid...I might have had a complete melt down. I was a little surprised to see that dairy and non-whole grain wheat products didn't make the list of foods to avoid, as those products have been shown to have inflammatory properties as well. I'm going to use those sparingly here in the beginning just to try to hedge my bets.
I started keeping a food diary again, documenting everything I eat. I'm also documenting any symptoms of blisters, itching, or skin cracking to see if there are more foods not on the low-nickel list that I should try eliminating. Typically symptoms of sensitivity can show up anywhere from an hour to 24 hours after the food has been ingested, so keeping a daily log of food and symptoms might help me to narrow down what it is I'm reacting to. I've switched up my skin care regimen to only using Aveeno body wash, which was recommended by the Eczema foundation, and Cetaphil Gentle Daily Cleanser, which is a non-soap cleanser. I'm not sure how a non-soap cleanser works, but it's way less caustic to my skin than other hand soaps I've been using. I no longer use bar soaps, as bar soaps are more harsh than liquid soaps due to the ingredients used to keep them in bar form. I've eliminated all products containing lanolin, as my dermatologist said that lanolin has inflammatory properties that trigger eczema flareups, and I've actually experienced my skin being red, raw, and itchy after using lanolin-containing products (it was shocking to me to see how many intense hand creams recommended for nurses had lanolin in them). I'm also working on using up/throwing away all my personal care products with added fragrance, which in addition to being almost a little overwhelming scent-wise, is also known to contribute to allergy symptoms. I'm going to use up most of the Monat shampoo, conditioner, and facial skin care that I bought, and once that's gone I'm probably going to switch to Beauty Counter products, which have less additives and less fragrance. I'll probably continue to use the Monat hair styling/treatment products, as my hair has never looked as good as it does now, but if I find something a little more gentle yet effective in the coming months, I'll probably switch that out as well. Perhaps Monat will start removing/decreasing the added fragrance to their products, which would be wonderful as I like their products but don't necessarily appreciate all the fragrance, and I don't think my eczema or environmental allergies do either. The EWG app/website has been a great resource for me in finding products that are non-toxic/low allergy. It can be a little overwhelming at first, but with a little help from my friend Rita (a Beauty Counter associate), I've been able to figure out some products that might work for me moving forward.
I'm taking a daily antihistamine (well, taking being a relative term...I'm terrible at daily medicine regimens) to help curb my environmental allergies as well. That should hopefully help. Not having pets in the house would also probably be a big help as I'm allergic to them, but that's not going to happen. Some dog-shaped allergens are worth keeping around for my mental health and overall wellbeing.
So yeah...I'm hopeful, I'm optimistic, I'm hoping that maybe these recent changes will help and I can kick this dyshidrotic eczema on its butt once and for all. And if I can't kick it completely, my hope is that at the very least, maybe I can make it a little more bearable. If you have any experiences with dyshidrotic eczema or you have something that has worked for you, by all means please share! And of course, if any of you have questions about my experience specifically, including the topicals I use, the dermatologist I see, the personal care products I've had luck with, please let me know. I'm happy to help and it would be nice to know that all my trial and error could benefit someone else. :)
Be well my friends!
