Old Wine in New Bottles
Recently, Dr. William James, Professor of Dermatology at the University of Pennsylvania has resurrected and improved a method to treat many chronic inflamed skin disorders. He has kindly made this Public Domain. Your physician will give you specific guidelines. Dr. James' handout is as follows:
Soak and Smear Educational Instruction Sheet
Prepared by William James, U Penn Dept. of Dermatology
Eczema is a chronic condition of the skin that can cause itchiness and redness. Patients with eczema have sensitive skin, more sensitive than normal skin. Sensitive skin is more easily irritated (which causes the itchiness) by dryness and irritants in the environment (such as wool in clothing or chemicals in lotions). Eczema can be controlled with good skin care and environmental measures (avoiding things that irritate your skin).
Soaking & Smearing
This is an aggressive treatment that is both messy (find an old pair of pajamas) and time consuming. This regimen may use a medication you have used before without success. But this medicine is being used in a different way as part of an intensive treatment regimen that must be followed exactly to work. This treatment can lead to marked improvement in even a couple of days. The number of nights of soaking and smearing depends on the severity of the disease and how long it takes to get under control. Usually patients do the soaking and smearing at night for 4 nights to 2 weeks. The soaking and smearing treatments are done at night because the ointment on your skin will get on your pajamas instead of your clothes (that you wear during the daytime) and the ointment will be on your skin for several hours while you sleep. After the skin is under control, the soaking is stopped but the nighttime smears with an ointment or moisturizer should continue.
Soak in a bath (not a shower) in plain water for 20 minutes (use a timer) at night, THEN Smear immediately, without drying the skin, with the ointment prescribed by your doctor (steroid) for the number of days recommended by your doctor.
For hand dryness and cracking, soak your hands continuously in a pan of water for 20 minutes at night and follow with the smearing as above. Use of thin cotton gloves worn over the ointment will be helpful.
After the skin is under control, the soaks at night can be stopped. But continue to smear the ointment each night. Throughout the treatment period you can apply an emollient cream to the worst areas in the morning. The soaking will allow water to go into the skin and hydrate it, then smearing on the ointment will (1) trap the water in the skin (because water cannot move through oil) and moisturize the skin and (2) allow the anti-inflammatory ingredient in the ointment to get deep into the skin.
Maintenance Treatment: Prevent Drying/Irritation. Repeated wetting (i.e. baths, showers, swimming) without moisturization will actually dry out the skin more. So when showering or washing your hands, it is necessary to apply a moisturizer such as Aquaphor of Hydrophilic Ointment on your slightly moist skin to prevent drying. These less thick moisturizers may be used during the daytime, with Vaseline® petroleum jelly always available for more intense moisturization at night.
SOAP: Using soap in the shower can further dry out the skin by removing the oils the skin naturally produces. There are three types of glands found in the skin. The sebaceous gland produces an oily substance, called sebum, which is the body’s natural moisturizer. The sebaceous glands are found over most of the body with the highest amount on the face and upper trunk and the fewest on the arms and legs. These latter places are usually the sites that become dry the earliest. The second kind of gland is the eccrine sweat gland, which produces sweat when we are hot. The sweat that is made has the same consistency as water so will be removed from your skin when water (no soap needed) runs over your skin in the shower. The third gland is the apocrine gland. This gland is responsible for producing the odor known as “body odor.” The apocrine glands are found only in the armpits and groin, not on the arms or legs. Therefore, you can get clean and help your skin by limiting the use of soap to the armpits and groin. You should then pat dry (preferably leaving some water on the skin surface) and apply moisturizer. This should be the way you shower from now on to help prevent future breakouts.
This treatment is simple, safe and remarkably effective. Good Luck! We will value your feedback.