Tuesday, February 18, 2014

9 Month Update: Is Moisturizing Harmful? Let's Find Out!


Is it time to give birth to my new skin yet? (get it, 9 months)

Well, it sure has been a long a$$ time since I've been dealing with this. I feel like I'm on the verge but I just can't get over that last hump.

My skin is in limbo right now. It's not getting better, not getting worse. I've noticed when I stop taking allergy medicine my sleep worsens and I scratch more, so I still have to keep this in my routine.

Arms/face look almost normal to a laymen but the skin is still thin and delicate, shedding all the time. However, I have a nasty eczema spot growing on my armpit. Worst place to have it because it won't dry down and cool down unless I raise my arm! And I can't be doing that all day. Behind the knees have pesky spots that won't go away. Ankles and wrists are still thick elephant skin when bent, especially my left ankle which looks like there's deep permanent lines.

Moisturizer withdrawal notes

At this point, I've been also doing moisturizer withdrawal for about 1 and a half months. At the beginning, it seemed like there was a drastic improvement but for the last 2-3 weeks, there seems to have been a standstill. Any very eczematic-like scaly spots just kind of stay there and don't change day to day (or week to week!). Now, this is okay if the skin is closed and not in high movement areas: my chest and shoulder have some of these fairly inocuous spots that just stick around and aren't bothersome. However, in high mobility areas (i.e. my feet) it seems to be more of an issue.

Let me elaborate. The top of my feet, as I documented previously, was an oozy mess and finally, with the help of moisturizer withdrawal, dried down to kind of a thick scab. This is great, except for when I'd walk around for the day, the scabby bits are rubbing against each other and have opened up into a crack (or many cracks), thus perpetuating the cycle of irritated skin.

I was resigned to just deal with this until I went in for my annual physical. My doctor, aware of my choice to withdraw from steroids, looked at my feet with a little concern. She said the issue here is infection and having cracks open on your skin are just asking for trouble. I told her I was using tea tree oil to help prevent infection but unfortunately no in vivo experiments have been done to prove its effectiveness in this application so she was skeptical. "Your feet look like some of my senior patients," she said, and strongly urged me to try any sort of lubrication to reduce the irritation that my skin was exhibiting.

Well, I went home pretty resistant to the idea. Dammit, I'm on my course, I'll just stick to it. But then I realized this was the perfect platform to test the hypothesis: Is moisturizing going to slow down the healing process?

My Experiment

So I needed to use something relatively innocuous. I think we can all agree that olive oil is the worst choice because publications have shown its deleterious effects to the skin layer (Citation: Now a classic, Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care.). 

I went with Vaseline, a.k.a. patroleum jelly, per the suggestion of my doctor. It has been my fail safe moisturizer over the years. Other one ingredient lubricants I've tried have have irritated my skin one way or the other: olive oil, shea butter, coconut oil (I'm allergic to this) have given me negative reactions on my skin.

(Side note: I was moisturizing with my beeswax, olive oil, honey mixture for months before moisturizer withdrawal. Was this what caused my possible delay in healing??)

I also think overmoisturizing, and the mechanical rubbing of the skin, impact the skin layer negatively. If I rub my dry topical steroid withdrawing skin, ooze comes out. Thus, I needed to make sure that I moisturized minimally. I decided on a thin layer of Vaseline 2 times per day, applied with minimal pressure to my right foot. Any other treatment to my skin, I would apply to both feet. 

TL;DR Left foot no moisturizer, Right foot light layer of vaseline 2x per day.

So... I took 9 days of photos but I'll just keep it short and simple and include a three day progression:

Day 1: Both feet are about the same, cracks are more prevalent on right foot but for both feet, covered with dry skin which is brown and thickened. 

Day 5: Right foot cracks disappeared after 2nd day. Subsequent shedding of skin is thinner but integrity of skin has remained the same. *note* both feet are "wettened" in this photo for a fair comparison.

Day 9: Right foot irritated area has shrunken compared to left, which has not much improvement in condition. 2nd toe on right has almost no rashy skin remaining while left remains irritated on 2nd and 3rd toes. *note* both feet are dried down for a fair comparison. 

Discussion and conclusion

I was not expecting such a drastic difference by the end of this experiment (which I set to when the sides differentiated themselves). In this experiment, it appears that applying a lubricating substance to the skin allowed for proper healing of cuts, resulting in less irritated skin overall. 

I must point out that through the course of this experiment, I didn't refrain from scratching. In fact, I can freely admit that I have no self control and scratched both sides pretty aggressively. From previous experience, I assumed the moisturizing side would break easier and regress after scratching, however the skin has held up under these conditions and perhaps the non moisturized side got it worse because there were thick scabs which would rub against each other and result in broken skin. 

Given these results, I have begun lightly moisturizing (vaseline, thin coat, 2x a day) chronically irritated areas which have not healed in weeks. The result is yet to be determined but with this experimentation, I feel a little more comfortable applying small amounts of moisture as needed again. 

Currently, my right foot isn't 100% healed (day 9 picture) but it looks like it's closer than the beginning of this experiment. I'll keep you guys posted if and when it heals.

For now, I am only moisturizing as needed. I do find that I can still reach that point where I moisturize a bit too much and my skin feels a little wet so I have to let it dry it down again. It's a delicate balance!

Anyway, I'm looking forward to getting back to life (starting to work out and get a routine back). Hope you all are healing up nicely as well!