Tag Archives: skin care

Dupixent, eczema

Starting Dupixent for Eczema and Asthma

Two days before Christmas I took my Dupixent (dupilumab) loading dose in an empty dermatology clinic room. I’ve resisted started a second biologic (I’m still taking Skryizi for psoriasis) for almost five years. The unknown of what two biologics would do to my body kept me from taking this plunge–until now.

The last month I’ve had a miserable eczema flare. While I wanted to enjoy the holidays, I struggled mightily with rashes all over my body. The eczema on my back is the worst it’s been in a long long time. I’ve tried every treatment from a variety of topicals, moisturizers, wet wraps, antihistamines. I’ve modified my diet, increased exercise, and taken it easy at work. Not much has helped.

Hitting a Wall of Rashes

Dr. C believes that this eczema flare built up throughout the fall season. I traveled to the Bay Area a couple of times for meetings. Trips to Oregon and Dallas for conferences increased my exposure to allergens. The trip to Oregon, in particular felt triggering for my eczema and asthma.

The trip to Santa Cruz, about a 3 hour drive from my home, turned out great for work, but poor for health. I reacted (as usual) to the old hotel room that carried the smells of perfume drenched toiletries provided in the bathroom. Oregon is a beautiful place to visit if you love the outdoors and mountain views. What I didn’t enjoy on my trip to central Oregon was the dust, smoke, dry air (low humidity, and slightly scented sheets in my AirBnB bedroom. Here is a photo from downtown Bend, OR.

My skin also didn’t take well to my trip to Dallas where the hotel room had a musty smell to it and the Texas BBQ brought on a night of restlessness. Busy conference schedules, especially those early morning meetings after only sleeping for a few hours due to itchy wakefulness, stress my body and my skin.

By Thanksgiving I felt grateful for a busy travel season to end, but my immune system, decided to push back hard. The bumpy, itchy rash on my forearm, chest, and upper back serve as the proverbial canary in the coal mine warning me of much worse to come. Soon my forehead, scalp, trunk, and later, legs, joined the inflammation party.

Decided How to Treat the Flare

My standard go to treatment when eczema flares is wet wrap therapy. Here is how I describe it in my linked blog post:

The treatment is primarily for eczema, but it helps my psoriasis too. WWT involves bathing, slathering (my doctor’s word not mine) a medium strength topical corticosteroid ointment on my skin, then covering it with wet clothes. Over the wet clothes I put a layer of dry clothes which helps keep the wet clothes damp. After about an hour I re-wet the wet layer of clothes. Some leave the wet clothes on overnight, or for some hours. I usually leave it for about two to three hours in the evening. The treatment moisturizes the skin, allows the medicine to penetrate the skin, and cools inflammation.

I tried wet wrapping a number of times, but the eczema only became more inflamed and angry. I felt at a loss what to do next. Waiting the flare out sometimes works, but can take weeks. So, I contacted Dr. C for a consult. Thankfully, she had an appointment for me in a couple of days.

Dr. C confirmed the flare is primarily eczema. Skyrizi is managing psoriasis quite well after five years amazingly. She offered systemic steroids pills as a way to suppress the inflammation, but I balked at the idea. For decades doctors told me that systemic steroids could severely flare psoriasis.

She then thought we should put Dupixent back on the table as an option. I’ve felt concerned about taking two biologics concurrently. Would insurance over the cost? Would it flare psoriasis? My allergist pointed me to studies that showed Dupixent triggering new cases of psoriasis or exacerbating existing ones. That didn’t sound great.

I left that urgent appointment with just topical medications tacrolimus and Opzelura (ruxolotinib) to try instead of the medium strength topical steroid (TCS) treatment.

Will Dupixent Work?

With just over a week since the Dupixent loading dose I’m hoping it will kick in soon. The itchiness at night is still really intense as I’ve only slept through the night a handful of times in the past month, and that’s with antihistamines.

I’m wary of whether or not it will trigger my psoriasis or existing eye issues (more on these in a coming post). Other potential side effects aren’t too far behind in my worries. For now we’ll wait and see.

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psoriasis, Psoriasis Treatments

Finding the Right Moisturizer for Psoriasis & Eczema

[This article originally posted on The Itch to Beat Psoriasis, Everyday Health on July 7, 2017.  In the article I did not mention any products. Here I’ll say that the moisturizers I use currently are CereVe Moisturizing Cream, Cetaphil Moisturizing Cream, Eucerin Creme, and Aquaphor Ointment. My use is not a product endorsement, but could be ideas to get you started if you’re looking to try something new.] 

I didn’t grasp the importance of using moisturizers on my dry skin until my mid-thirties. Back then I broke all the rules. I used my lotions and creams intermittently, not routinely. I took two showers a day, which I later learned was stripping my skin of natural oils. At every clinic appointment, my dermatologist noted the parched, dry desert that was my skin. I ignored his pleas for me to moisturize my skin.

Then I endured the worst stretch of skin health in my life. Psoriasis covered more than 95 percent of my body, and I was overwhelmed by feelings of depression. My dermatologist referred me to the Psoriasis Treatment Center at the University of California in San Francisco.

One nurse told me that their patients moisturize every two hours. I just nodded my head in agreement, not mentioning how my lotions and creams sit idle most days. Even though I didn’t end up receiving treatment there, I learned a valuable lesson that stays with me to this day: Moisturize your skin regularly.

Why Moisturize?

Since I have both psoriasis and eczema, I have double the reason to moisturize my skin.

On its website, the National Psoriasis Foundation (NPF) states that “keeping the skin lubricated on a daily basis is an important part of psoriasis care because it reduces redness and itching and helps the skin heal.”

Vivian Shi, MD, assistant professor of dermatology and director of the Eczema and Skin Barrier Clinic at The University of Arizona in Tuscon, has written that moisturizers work by “directly hydrating the skin,” and “bolstering the skin barrier to prevent the skin from losing water.”

I first met Dr. Shi when she was a resident at the University of California in Davis dermatology clinic in Sacramento, and I came to know her work better when I volunteered for an eczema study she conducted. I enjoyed catching up with her over the phone recently about skin moisturizers. On the call, she reinforced the importance of finding an effective moisturizer, as well as adhering to a skin moisturizing plan.

Narrowing Your Search

I asked Shi what was the right moisturizer to use on my skin. “Find the one that you will use,” she says. “At the end of the day, you have to pick one that you will use.” She cautioned me to avoid parabens, dyes, fragrances, and other allergens since I have sensitive skin.

Skin-care products dominate entire stores shelves. so how do you narrow your search for a moisturizer? One way is to look for stamps of approval from organizations such as the National Eczema Association (NEA). I also read articles like the NPF’s blog post, 10 Must-Have Lotions for Under $10, to get ideas. Physicians will often provide free samples to try at home, and I also enjoy sharing moisturizer and treatment ideas with friends and acquaintances.

Part of searching for a moisturizer is learning more about them. For example, Shi’s article taught me the difference between “fragrance-free” (no substances are used to impart an odor) and “unscented” (the product may have a fragrance that’s masked by another substance). She recommends fragrance-free products.

What about the difference between ointment, cream, and lotion? Ointments are the thickest moisturizers and do a great job of preventing water loss. Creams are less greasy than ointments, as they mix greases with a liquid, such as water. But according to the NEA, creams may “contain stabilizers and preservatives to prevent separation of their main ingredients, and these additives can cause skin irritation or even allergic reactions for some people.” Shi notes that lotions contain more liquid or water than grease. Since this liquid evaporates quickly, lotions generally don’t moisturize dry skin as well as ointments and creams.

I’ve used many ointments and creams over the years. Personally, I don’t mind a moisturizer that’s greasier, but I don’t like the feel of something like pure petroleum jelly. I tolerate thicker creams best. Cost and availability are also considerations. By weighing my needs and preferences, I’ve settled on products that I will use routinely.

Developing a Routine

Finding the right moisturizer is only half the battle. As Shi says, “the moisturizer is only good when applied on the skin.” I can certainly relate when she says that about 50 percent of people forget their doctor’s moisturizing directions as soon as they leave the office.

Over the last decade, I’ve refined a routine that works for my skin and lifestyle — a process that begins with a discussion with my doctor about my skin needs. I set aside time to moisturize at least twice a day. After I shower at night, I apply moisturizing cream within minutes of patting my skin dry. Then I apply topical prescription medication on affected skin lesions. When the weather is dry, I apply another layer of moisturizer after the topical medication.

I have the same routine in the morning, but without the shower. And keeping moisturizers in my backpack and at the office gives me the opportunity to moisturize outside of my two regular times if I feel the need.

Your routine will no doubt vary from mine. Some people, for example, set alarms on their phones to remind them to moisturize. Whatever you decide, stick to a routine that works. If you need to, modify your routine so that the moisturizers you’ve carefully chosen and paid for don’t sit idly on the shelf.

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