Treating Sensitive, Itchy, Eczema-Prone Skin

Airdate: 3/21/14

In perhaps the most personal show Paula has done, she reveals her nearly lifelong struggles with eczema and how she finally got relief. Together with Bryan, Paula reveals the best ways to bring soothing relief to dry, itchy skin. You’ll also find out when you should seek a doctor’s help for easing eczema—and which prescription options research has shown are best.

Paula Begoun: Hello. I’m Paula Begoun, the Cosmetics Cop, here with my co-writer and research director for Paula’s Choice, Bryan Barron. We’re the best-selling authors of Don’t Go to the Cosmetics Counter Without Me. And actually in its many editions, in its nine editions, we’ve been best-selling authors for all nine of those. We have been for a long time because the book is still around and in its ninth edition.
Bryan Barron: Ninth edition.
Paula Begoun: And we’re talking about a tenth. But Bryan won’t talk to me about it, so I’m actually talking to myself! We’re here to keep you beautifully informed so you can make the best decisions about everything from skincare to makeup, hair care, Botox, cosmetic surgery. You name it, we’ll discuss it. We’ll tell you the truth. We’ll tell you what the research says.
00:00:37 We’ll tell you what the fiction is. And we’ll take your questions on our Facebook page. And today we’re actually talking about a topic that is actually really emotional for me. And that’s eczema. That also is called atopic dermatitis.
00:01:01 And that’s because as a kid, and even a little bit now still in life, I struggled with horrendous, terrible, debilitating eczema. Very little was known about eczema at the time. And actually not that much more is known today, but definitely more than when I was young. I had wounds and - well, not really wounds, but self-inflicted wounds from scratching and itching, reacting to my itchy, terribly fissured skin for most of my life.
Bryan Barron: And it’s so relentless because when that itching starts you can’t not itch.
Paula Begoun: You can’t not itch.
Bryan Barron: But then what does the itching do?
00:01:46 It begets more itching.
Paula Begoun: And wounds. And then you get infections. And I had terrible infections along with my eczema. I don’t have words to describe what that torture is when you are somebody struggling with eczema-prone skin. And eczema-prone skin is not the same as sensitive skin.
00:02:12 And it isn’t the same as allergy-prone skin. It’s a very different animal, eczema. And so just to separate it out, an allergic response that causes itching is you are reacting to a substance that releases histamines in your body that you then react to. Eczema is not associated with histamines. You take an antihistamine, it doesn’t affect eczema. Not in the least.
00:02:43 It also isn’t about sensitive skin, although it can be more sensitive but generally with sensitive skin if you stop using whatever is causing you to be sensitive it goes away. Eczema never really goes away. Eczema tends to, well, I mean, you can outgrow it. It often is a disorder of young people and you tend to outgrow it as you get older. That’s not always the case, but often the case.
00:03:13 So, somebody with sensitive skin generally when they stop using whatever is causing them to be sensitive it goes away. You don’t have the problem anymore. Eczema persists, it can come and go. Definitely if you’re more reactive to sensitizing agents when you have eczema, but the itching just exists.
00:03:35 For example, for me personally one of the worst places I had eczema was on the bottoms of my feet. Now, I wasn’t - nothing came in contact, the bottom of -
Bryan Barron: Is that a usual spot for it to show up?
Paula Begoun: The typical spots where people get eczema is in the crooks of their arms, on their hands because hands interact with detergents and other irritating -
Bryan Barron: They’re always exposed.
Paula Begoun: And absolutely -
Bryan Barron: And then behind the knees, too, right?
Paula Begoun: Behind the knees. Right.
00:04:05 Generally where you perspire and between the toes is very typical.
Bryan Barron: Ooh, okay.
Paula Begoun: Because of the same reasons you could get it between your fingers, but you know I used to get it on my knuckles of my hand. I mean, I had it all over. Behind the ears is a typical place.
Bryan Barron: Between the toes, how would you differentiate eczema from - ?
Paula Begoun: Athlete’s Foot?
Bryan Barron: From Athlete’s Foot, yeah.
Paula Begoun: Because it’s itching and athlete’s foot usually doesn’t itch. Athlete’s foot is a fissure along the base of the skin that never heals.
00:04:41 And usually rarely does athlete’s foot itch. And when you put a topical antifungal on athlete’s foot and you dry up the foot and you wear clean socks and, you know, do the things for athlete’s foot, it gets better. It goes away.
00:05:00 Mostly is that it doesn’t itch. The major difference with eczema is the incessant, intolerable, painful itching that goes along with the disorder. So, your itching, you might get little bubbly fissure like - what do you call it, watery sacks that you then itch that cause itching. That sometimes occurs with -
Bryan Barron: Not a blister though?
Paula Begoun: It looks like a blister but it just comes up out of nowhere. It’s not from rubbing. I used to get those on the palms of my hands a lot, on my fingers, in between my arms, and then that would itch.
Bryan Barron: Ugh.
Paula Begoun: Eczema is a strange disorder that they’re still not sure what cases it to happen.
00:05:47 There are things that we know trigger it, that make it worse, but when you’re somebody with eczema-prone skin it is most likely genetic and it is most likely an immune problem, meaning that your body overreacts to itself or to the environment or to triggers that somebody else wouldn’t. So -
Bryan Barron: No.
00:06:09 The triggers are mostly external or can they be internal as well?
Paula Begoun: They can be internal. They can be dietary. They can just be being reactive to your own body. But most typically it’s about being over reactive to your environment, to clothing, to detergents, to cleansing agents.
Bryan Barron: Fabrics.
Paula Begoun: To fabrics.
00:06:32 To fragrance.
Bryan Barron: Oh, fragrance, that’s a big one.
Paula Begoun: To somebody else is wearing. To just even briefly come in contact with certain foods, citruses, and limes can... - I remember as a kid eating an orange just could send my hands into itching like you wouldn’t believe.
00:06:57 Or detergents that you wash your clothes in and then you put on tight clothing. Somebody with eczema-prone skin could have a reaction to. And, again, to differentiate, sensitive skin generally doesn’t itch. The major differentiation between atopic dermatitis/eczema, another kind of interchangeable names, and sensitive skin is sensitive skin usually doesn’t itch. It’s really the terrible itching that is associated with eczema that makes it so very frustrating.
Bryan Barron: Also with eczema it isn’t just about having dry skin?
00:07:40 In other words like if my skin type is dry, am I more predisposed to eczema?
Paula Begoun: No. No. Babies have eczema and they don’t have dry skin.
Bryan Barron: Oh, cradle cap.
Paula Begoun: Kids have - no, cradle cap is associated with psoriasis, not with eczema. Eczema is still different.
00:08:00 Cradle cap doesn’t itch. The major differentiation between things like psoriasis and seborrhea dermatitis is that they usually don’t itch, or if they itch they itch a little bit. It’s not this - I know this is radio, so you can’t see my fingers clawing - that nonstop sensation of itching to the point where you’re destroying your skin. And you simply can’t stop. And that’s how it was for me forever.
Bryan Barron: So, worst mosquito bite imaginable?
Paula Begoun: Worst mosquito imaginable in huge areas. And you keep -
00:08:38 And actually part of - it’s funny you say mosquito bites. One of the ways my eczema still shows up is that when I do get a mosquito bite I get an eczema trigger, meaning I can’t, even once it starts going away, because the mosquito bite doesn’t last that long, it kicks in an eczema response where I just can’t stop itching.
00:08:59 Now, some of it is what I’ve been told by physicians is that I really don’t have eczema anymore, but I have such an old pattern of itching kind of meshed into my brain from the 30 plus years I struggled with eczema that that’s just my response when I get a mosquito bite is that I can’t - it triggers me to just want to stay at it. It’s that itching and the thing that happens, and you don’t even know it, is that for people who have severe eczema where wounds stay open because you’re constantly itching.
00:09:35 Is you get infections and you don’t even know you have developed a staph infection, because you already have weepy, irritated, inflamed skin from the constant itching.
Bryan Barron: Yes.
Paula Begoun: And you don’t even necessarily know that you’ve developed an infection. And we’re going to talk about some of the things you can do and the treatments because when you do get those kind of infections from the scratching and skin damage that’s associated with eczema, the infection makes it worse.
00:10:06 It makes it itch even more. Yeah, I know.
Bryan Barron: Is there a gender or race predisposition?
Paula Begoun: Doesn’t seem to be. I haven’t seen any research on that. It seems to be pretty prevalent regardless.
Bryan Barron: I have read that if your parents suffer from eczema -
Paula Begoun: You’re more likely.
Bryan Barron: Up to 80% more likely.
Paula Begoun: Right. A genetic relationship.
Bryan Barron: There does seem to be a genetic component, which makes sense given it is - I think it’s fair to describe eczema as an immune disorder.
Paula Begoun: It is absolutely... - Most people would suggest that it is -
Bryan Barron: Or an immune dysfunction.
00:10:46 Over-functioning.
Paula Begoun: Right. They say it’s an over-functioning, not that -
Bryan Barron: Hypersensitive immune system.
Paula Begoun: That your immune system is triggering itching reaction to anything and everything depending on the severity in your environment.
00:10:59 My father did have eczema.
Bryan Barron: Did he?
Paula Begoun: Actually my father also had acne. Could I just like slap him around? I mean, may he rest in peace. Forgive me dad of blessed memory, but yeah, I inherited most of my skin problems, which was really, I mean, talk about a tragedy as a kid, because I did have terrible eczema very, very young. And actually into my thirties. And then, of course, at the age of 11 I got acne.
00:11:26 Actually, the only place I didn’t have eczema really was on my face and then I got acne there. Yeah, I wasn’t -
Bryan Barron: Life ain’t fair.
Paula Begoun: I wasn’t lucky as a kid in that regard. But let me say that what’s good to know now, what we have the knowledge we do have now about treating eczema is important to pay attention to.
Bryan Barron: So, let’s talk about treating eczema in two ways, the first one being with over-the-counter skincare products.
Paula Begoun: Well, actually, right. So, let’s do it in three ways.
00:12:00 Let’s talk about what you need to stay away from.
Bryan Barron: Okay.
Paula Begoun: Let’s talk about some of the dietary stuff you can consider doing. And then we’ll jump into skincare and then medicine.
Bryan Barron: Okay.
Paula Begoun: Traditional medicine, because I think that some of the stuff I wish I had known when I was younger, had the information been there, then I would have never eaten an orange or done the dishes when my mom told me do the dishes.
00:12:30 I mean, I would have done the dishes because I would have been in lots of trouble had I not done the dishes. I would have worn gloves. I would have been far more careful about what I interacted with in the world. I would have absolutely been very cautious about how and what I washed my hands with. I would have paid more attention and that would have absolutely made things better. Now, it wouldn’t have done it 100%, right, because for example as I said I had severe eczema on my feet.
00:13:07 But how I washed my feet, soaps, because there weren’t any really body cleansers, gentle body cleansers as an option when I was a kid.
Bryan Barron: No, no.
Paula Begoun: So, what you interact with in your environment, including animals, because even though you may or may not because eczema is not an allergy response, it can be made worse by an allergic response because you’re just hyper interactive with anything.
00:13:36 And I actually, it does turn out even though now in my old age I really don’t give a darn that I’m allergic to dogs, but I’m allergic to dogs. I’m definitely allergic to cats. But I’m allergic to dogs. I just don’t care that much. You know, I’ll sneeze, and I don’t itch like I did. But as a kid had I known, because of the severity of the type of eczema I had I wouldn’t have -
Bryan Barron: Did you have a dog as a kid?
Paula Begoun: I did. And had my parents, or I don’t even know if there were allergy tests like, I mean, there must have been allergy tests like that that were around when I was a kid.
00:14:07 But people didn’t know back in the day that that could have triggered, because it isn’t that the dog causes eczema, but because of my natural allergic reaction to a dog, that made the itching from my immunized comprised little body want to itch worse. So, there would have been things hopefully my parents and I would have done differently to take a look at what could be triggers. Keep in mind you have eczema because you’re eczema-prone.
00:14:38 And then there’s the triggers that you need to consider to stay away from - strong detergent cleansers, animals or plants you may be allergic to, you know, poinsettias at Christmas time, rolling around in the grass in the summer.
Bryan Barron: Wool sweaters.
Paula Begoun: Oh my gosh. Oh, to this day I still can’t get near wool sweaters without itching like crazy. That will trigger an eczema response.
00:15:02 It doesn’t cause eczema. It’s not the same as being sensitive to it. It’s that horrendous itching reaction that is generated for someone who has eczema. The other thing is although there is very little research about diet, because you’ll see a lot of stuff on the internet about green tea and probiotics and vitamin D, there really is very little - and I think I can say, although lord knows there’s always more research I can do - there is very little research about diet impacting eczema one way or the other.
00:15:45 But what we know about eczema is that the worst thing is the damage to the barrier that is caused from the itching. So, anything you can do to help the barrier of your skin be healthy is better just in general for skin, but particularly for somebody with eczema-prone skin. So, then you’re going to want to look at a diet that helps improve the barrier of skin, like omega-3, omega-6 fatty acids, the fattier fish oils that they have in supplements or you can eat from a nice hunk of good fish.
00:16:18 There is a diet high in antioxidants, anti-inflammatory ingredients, because eczema is an inflammatory disorder, right? Your skin -
Bryan Barron: As is acne.
Paula Begoun: As is acne, because an anti-acne diet would be the same thing.
Bryan Barron: Yes.
Paula Begoun: Where you are consuming things that improve the barrier, which is omega-3, omega-6 fatty acids, what they call the three fatty acids, the unsaturated fatty acids. And then there are the antioxidants that you consume that greatly reduce inflammation.
00:16:56 And that’s all the dark green leafy vegetables, all the beautiful dark wonderful fruits, the herbs, and particularly the herbs - not very typical in an American diet, but the Indian herbs, the curries.
Bryan Barron: Cumin.
Paula Begoun: All of those are so rich in antioxidants and are absolutely anti-inflammatory, helping to reduce the inflammation. Because once you start itching, the thing with eczema, that inflammation sets in. It’s almost impossible. I am carrying on about this.
00:17:30 It really does bring up incredible memories.
Bryan Barron: I know you mentioned earlier that obviously people listening to the show can’t see us in the studio, but yeah, you are physically getting worked up talking about this.
Paula Begoun: It was a tragic part of my childhood because so much of my body had wounds from self-inflicted itching. I actually did get infections, but one year of my life when I was 12 my infection actually went systemic.
00:18:07 And they should have probably just stuck me - now they would have put me in the hospital and put me on IV antibiotics. They didn’t know to do that then, or I just had really stupid ass doctors. I mean, I don’t know. But I was sick for about - very, very, very, very sick for about three to four months because they just couldn’t kick out the infection because they hadn’t realized that I was just constantly getting re-infected systemically from the infections from my wounds on the outside of my body.
00:18:39 I would - healthcare would have been, I like to think, that healthcare would have been very different. But, yeah, the itching and the wounds and the -
Bryan Barron: And your sisters didn’t have this?
Paula Begoun: No, I was the only one. No, nobody else has - well, actually neither of them have acne or skin... - I mean, my older sister, [Avis], has very, very dry sensitive skin. But, no, none of them had, no, I’m the one who got it from dad.
00:19:08 Actually, let’s talk a little bit about medication. I was going to go to skincare first, but medication actually I think might be a better place to jump to. Because one of the things that happens for people... - Oh, I’m sorry, let me just say one other thing about diet. Vitamin D, a lot of association between skin and vitamin D.
00:19:32 In terms of relationship to eczema there really is no research. However, that doesn’t mean you shouldn’t get your vitamin D levels checked. A lot of people have problems with vitamin D levels in the world anyway for various different reasons. So, when you get your - if you have eczema or just in general want to get your blood levels of vitamin D tested and then you can find out if you’re deficient.
Bryan Barron: Yeah.
Paula Begoun: And overall for health just in general it is helpful to have appropriate levels of vitamin D in your body for bones and prevents certain cancers. I mean, on and on.
00:20:08 Vitamin D is important, but it can be helpful theoretically, people are saying, to help eczema. There are probiotics that there is some anecdotal information about probiotics, that’s yogurts and all of the good bacteria. Probiotics meaning -
Bryan Barron: What about probiotics - I’m sorry, go on. Like Lactobacillus.
Paula Begoun: Lactobacillus acidophilus.
00:20:35 The healthy bacteria that should be in the body that often don’t get to be there because we don’t have, you know, the healthy diets that keep them at a healthy level.
Bryan Barron: What about probiotics in skincare? Should people with eczema be looking to apply a moisturizer or a serum with probiotics? For example, Estee Lauder’s Night Repair Serum has a form of a probiotic as one of its major ingredients.
00:21:03 We looked into the research on that and there really wasn’t anything there.
Paula Begoun: Yeah. I haven’t seen any research that says that putting strains of probiotics, meaning healthy bacteria, on top of the skin does anything for eczema. Because of the way probiotics work, they’re a body flora. They don’t migrate into the upper layers of skin.
00:21:29 The way they exert an energy on the skin is really their anti-inflammatory affect on the whole body which keeps the substances in skin that get triggered to cause an irritation reaction. Topically on skin, whether or not they work as anti-inflammatories doesn’t seem to be clear. Do I think it’s bad? I doubt that it’s bad. I think putting yogurt on your hands would make you itch like anything if you had eczema.
00:22:00 But it is really the oral consumption that creates the whole body working better in terms of an anti-inflammatory situation so you’re less likely to itch. So, yes, that’s all about diet. Yeah, I don’t see anything about probiotics topically at all that would lead me to think that that would be something you would want to consider. However, moving to skincare, what you absolutely want to look at is being as absolutely gentle as possible as you can.
Bryan Barron: Mm-hmm.
Paula Begoun: You don’t use soap.
00:22:37 Soap is deadly. You don’t use strong cleansers. You don’t do dishes without gloves on. You use incredibly emollient moisturizers. By the way, eczema is rare if almost nonexistent on the face and they don’t know why. You can get it behind your ears, in front of your ears, on your neck, on your arms. I had it on my rear end. On your legs. On your thighs. On your feet.
00:23:03 But it is incredibly rare to actually have it on your face, which for me as a kid to have had acne and eczema on my face, I think I would have killed myself. But, yes, it’s rare that it’s on the face. So, on the body emollient moisturizers with fatty acids - the triglycerides and the phospholipids and the lecithins and the cholesterols and the thick, rich moisturizers that build up the barrier of skin.
00:23:33 And, yes, fancier ingredients are actually good for skin all over the body, particularly for compromised skin because it builds up. It helps skin heal. What you’re ripping away when you’re itching it gives back to the layers of skin. You’ve got to stay away from irritants. You’ve just got to stay away from anything that will trigger eczema.
00:23:57 Whatever is sensitizing to somebody is worse for somebody with eczema because it will trigger the itching response. That means fragrance of any kind, natural or synthetic. Eucalyptus, menthol, peppermint, the citruses.
Bryan Barron: Lavender.
Paula Begoun: Lavender. It’s great to smell, you know, put a - well, actually if you have eczema I wouldn’t even put it on because where it touches your skin is likely to cause a sensitizing reaction.
Bryan Barron: Buy a scented candle. Or buy the essential oil and put it one of those burning diffusers.
Paula Begoun: Put a little bit on your clothing if you want to wear it as a fragrance. But when you have eczema and you put fragrance on your skin, where you put that fragrance you are highly likely to get an allergic response. Highly allergic. Not allergic, sorry, eczema response.
Bryan Barron: What about, more so for women, but would also apply to men for undergarments, but what about the bra strap?
Paula Begoun: Well, where you’re likely to get an allergic, sorry, I keep saying allergies. Eczema is not allergy.
00:25:02 Where you are likely to get a reaction triggered to turn into eczema is under your breast where it’s moist as opposed to around your breast. Although, yes, if you’re wearing a tight bra then that can be a problem. And then you’re going to want to look at a looser, lighter weight fabric bra, a camisole top or something. And then that’s something you have to experiment. But it’s really the area under the breast that you want to keep dry because that’s the area, that sweat, that irritation, the salt from the sweat that causes the problem of triggering and itching reaction.
Bryan Barron: So, someone who exercises or works out at the gym frequently may very well see that their eczema flares up as a result of that physical activity.
Paula Begoun: Yeah.
00:25:46 Yeah, I’m not going to tell anybody not to exercise, but as soon as you get done exercising if you can take a clean cloth and where you tend to get eczema reactions to gently not scratch, I know it’s so hard. I used to take wash clothes and just rip at my - I would take anything I could to scratch - I’ll stop talking about it.
00:26:11 But I know that people -
Bryan Barron: It’s making me itchy.
Paula Begoun: I know! It’s making me itch, too.
Bryan Barron: The more people talk about it, “You know when you get that really bad itch and you just can’t scratch it?”
Paula Begoun: But I know people out there who have eczema who are listening to me know that I would take anything I could to itch my - when my nails didn’t work to get at it, anything I could get my hands on.
00:26:34 Okay, I’ll stop. So, but if you take a clean, damp cloth with tepid warm water; hot water just triggers itching. So, although lord knows I did used to put boiling hot water thinking it would stop the itching. And it did temporarily, but then it does tend to trigger it.
Bryan Barron: Come back.
Paula Begoun: Yeah. Because it triggers it. It’s a stimulating effect. It’s inflammatory causing, not anti-inflammatory, hot water. So, you take tepid or warm water and just the areas that tend to have eczema just make sure you get the salt from sweating off like from behind the ears, behind the knees, in the crooks of your arms.
Bryan Barron: So, products we tend to see for eczema, for example a couple of body washes come to mind. Cetaphil has in their Restore Derm line a very moisturizing body wash. It’s got a lot of Shea butter in it which is an emollient. And they specifically market it to people with eczema. And then Eucerin has a Calming Oil Body Cleanser that’s also marketed to eczema.
00:27:38 So, when you’re shopping for products for eczema, in addition to avoiding fragrance, making sure that the products are gentle. You can always check our reviews on Beautypedia if you’re not sure. Is it about looking for products that are going to moisturize?
Paula Begoun: Well, cleansers that moisturize.
Bryan Barron: Do you want creamy?
Paula Begoun: Well, what you want is anything that’s gentle and soothing.
00:27:59 The problem with using body washes that are oily is slipping and sliding in your tub, or in your shower.
Bryan Barron: Yes.
Paula Begoun: The Cetaphil, not the old Cetaphil one, the one you’re referring to, what it tends to usually have is a cleansing agent of some kind and then lots of emollients to buffer against the skin. And those are just fine. The problem is is that for under your arms and in your private areas you probably will want to use a soap, a gentle soap, because you don’t want to be greasy under your arms. That’s just going to build up the bacteria.
00:24:40 That doesn’t make for great body odor. So, I generally what I did when I eventually learned about soap and harsh cleansers and what it did to my eczema is I would use soap on some parts of my body, but then on the areas that had eczema, particularly for my neck and ears and areas like that, then I would use an emollient body wash.
00:29:04 I never used ones with oils because they were just so slippery and greasy. It just didn’t feel comfortable. And then that’s when I discovered, I mean, we’re talking how many years ago about gentle water soluble cleansers. I will never forget when I first found out that they actually existed. And now there are actually almost more of them - actually, there are more of them on the market than bar soap in terms of choices for women.
Bryan Barron: It’s the rare skincare line -
Paula Begoun: That sells soap anymore.
Bryan Barron: That sells soap anymore. Neutrogena still does.
Paula Begoun: Yeah.
00:29:34 I do take credit for that. By the way, you do know I take total credit for that, because back in the day when I wrote my first book saying not to use soap you would have thought I was telling people not to eat.
Bryan Barron: Yes!
Paula Begoun: You know, starve, never eat food again. It took up until just recently, I’d say within the past five, six years, that you now even see dermatologists.
00:29:57 Dermatologists held fast. Fast to the idea that you had to use soap.
Bryan Barron: Oh, they did.
Paula Begoun: Probably because of all the soaps the pharmaceutical companies make that -
Bryan Barron: Well, when I was still in high school and I was seeing a dermatologist for acne and he prescribed Retin-A which I had to tell him to do that because of what I read in your books, way back when.
Paula Begoun: There are just a few years between us.
Bryan Barron: There are a few. I remember him saying that I had to use Purpose gentle cleansing soap.
Paula Begoun: Right.
Bryan Barron: That was the cleanser I had to use with that.
00:30:32 And I knew it was going to be a problem, but I tried it anyway. I followed his advice.
Paula Begoun: He’s a dermatologist. Right.
Bryan Barron: Yeah. Exactly. And it was horrible.
Paula Begoun: It was horrible.
Bryan Barron: It was horrible. And I immediately went back to Cetaphil gentle skin cleanser, which at the time this was in the early ‘90s.
Paula Begoun: Was the best one on the market.
Bryan Barron: And now I wouldn’t - you couldn’t pay me to use Cetaphil gentle. Well, you probably could pay me, but.
Paula Begoun: Ha!
Bryan Barron: It’s not a terrible cleanser, but I much prefer, I’ve been using the same one from Paula’s Choice for years.
Paula Begoun: We all have a price. No, but at the time it was one of the - it actually was one of the only ones. It was one of the only water soluble cleansers on the market.
Bryan Barron: So, one of my other theories about your earlier work when you were just getting known was that you helped make Cetaphil a household name.
Paula Begoun: I did.
Bryan Barron: It was this tiny little obscure.
Paula Begoun: Yeah.
Bryan Barron: Maybe a few dermatologists knew about it.
Paula Begoun: Right.
Bryan Barron: It was kind of in the pharmacy section of a drugstore.
00:31:26 It wasn’t with all the soaps.
Paula Begoun: But once women, I think, and some of - I mean, hopefully I had other information there, too. But I do think that, well, I know I did. But I do think that when women stopped using soap and started using something gentle on their face is when they started seeing dramatic differences in how their skin reacted. I think it was like a light went on. And to this day, you know, I do think we have brilliant products, but sometimes women’s reaction to our products I know is because so many other products out there contain irritants, separate from the packaging and the fact that - or they might be badly formulated, meaning they don’t really contain anything beneficial.
00:32:12 But when they contain irritating ingredients, I know sometimes women when they change to our products it’s just their not being irritated anymore so their skin just does so much better. You don’t even know how good your skin can look and feel because you don’t know that you’re using products that actually are causing irritation and sensitization. And when you have eczema you’re as likely to be irritated and get sensitizing and then itch.
00:32:43 An uncontrollable itching. So, for everyone the irritants are bad. For everyone the strong detergent cleansers are bad. For everyone using irritating plant extracts and fragrance on skin is a problem, but for somebody with eczema when that happens then what’s going to happen is you’re going to start itching and you won’t be able to stop. And, yes, the emollient moisturizers are absolutely the best because they keep the barrier which is compromised from the itching, the outside layers of skin protected.
00:33:17 It puts a layer over the skin. You want that moisturizer on top of your skin as a buffer against the environment you could be coming in contact with.
Bryan Barron: So, before we take a few questions from the Paula’s Choice Facebook page, in terms of seeing a dermatologist for your eczema. What would a dermatologist, what options does a dermatologist have at their disposal.
Paula Begoun: God, I get so carried. I forgot. Sorry.
00:33:47 The two primary things medicine prescription-wise for eczema are corticosteroids, cortisones, strong cortisones, stronger than you can get over-the-counter at the drugstore. And also immune modulating drugs. And I want to make sure I get the names -
Bryan Barron: Like Protopic?
Paula Begoun: The active ingredient is halometasone is probably one of the current ones that have some decent research about it. It is very strong.
00:34:25 And that’s a corticosteroid. And then the immune modulating would be [pimecrolimus]. Am I pronouncing that right? Let me make sure I’m pronouncing that right.
Bryan Barron: Tacrolimus. Oh, then there’s [Elidel].
Paula Begoun: There’s Elidel. There’s -
Bryan Barron: That’s the pimecrolimus.
Paula Begoun: Pimecrolimus. Whatever. Pimecrolimus cream and tacrolimus. And Elidel is the one that contains the one with the P, right?
00:34:59 Which one does Elidel contain?
Bryan Barron: Elidel is the one with the P.
Paula Begoun: With the P. Sorry, these names are way too long and hard to pronounce. Those two drugs are immune modulating drugs. So, they have been shown to reduce the substances in skin that are causing your immune system to react negatively to either what’s going on in your body or to your environment. So, it reduces the sensitization reaction of itching.
Bryan Barron: Okay.
Paula Begoun: Corticosteroids work to jut reduce inflammation. Corticosteroids, I use Fluconazole. I’ve used it for years.
00:35:45 Reduce inflammation. So, the immune modulating drugs that we mentioned reduce the skin’s body’s immune response to sensitizing triggers in the environment or in the body. And then cortisones reduce inflammation, so whatever triggers there are it reduces the reaction of itching and sensitizing. The negative thing about using corticosteroids/cortisones on a regular basis is that they thin skin.
00:36:16 They break down collagen.
Bryan Barron: Yeah.
Paula Begoun: That scares a lot of people. They think, “Oh, well, I can never use cortisone. My skin is going to hang down around my knees and it’s going to be terrible.” Well, first of all, it’s not worse than sun damage. So, don’t get all concerned about cortisone.
00:36:35 There’s no way cortisone is anywhere near compared to unprotected sun damage in the long run. However, what I want people to know is that you don’t have to use - if you’re doing everything else we talked about, an anti-inflammatory diet, you’re being careful about the skincare products you use, the clothing, the detergents you wash your clothing in, the fabrics.
00:37:01 How you wash dishes. How you wash your body. The kind of moisturizers you use. If you’re paying attention to everything we’re saying then using a cortisone cream occasionally for flare-ups is what you may primarily be dealing with. And that’s what I finally came to in life is that as I learned what to do in terms of reducing the triggers then I only needed cortisone creams when I had flare-ups.
00:37:35 And so back in my thirties I would use cortisone creams occasionally. And actually even now I might still need a cortisone cream every now and then because I can still get triggered. But, you don’t have to worry about using it every day. If you have mild to moderate eczema it might not be an everyday thing if you follow the things, doing the things we’ve just been talking about.
00:38:01 Occasional use of cortisone does not thin the skin. It is the chronic continued use of cortisone that can thin skin. And I do know, because I particularly had cortisone for the longest and the worst on my hands, I do have thinner skin on my hands than say somebody else my age might, especially given how I don’t have much sun damage. But had I known and I knew these other things we’ve been talking about I might have only had to use the cortisone cream occasionally.
Bryan Barron: Yeah.
Paula Begoun: You see the doctor -
00:38:35 If everything we’re talking about and the over-the-counter cortisone creams aren’t helping, or you have severe eczema, then you absolutely need to see a dermatologist. By the way, there is some talk on the internet about acupuncture for eczema. I mean, I don’t think there’s any reason not to do it, but in terms of any research showing it will help. I wouldn’t put up with a terrible, painful itching.
00:39:03 Again, I don’t think it means you shouldn’t give it a try, but in terms of what will reduce that itching and that compromised skin, and you don’t want infections, then you are looking at occasional or prescribed use of cortisone creams and then the potential of using an immune modulating cream, a topical, that a physician can give you.
00:39:27 I’ll calm down now.
Bryan Barron: Okay.
Paula Begoun: Did we cover it?
Bryan Barron: I think so. I think hit all the -
Paula Begoun: I’m exhausted!
Bryan Barron: All the major notes.
Paula Begoun: It’s so emotional for me! Oh my god! Nathan, are you okay out there?
Nathan Rivas: Whoops, I had the wrong one. Yeah. No, I’m absolutely here. Actually it was a fascinating show really to get all that information all kind of put together at once. I know it’s very difficult for people who have eczema to find all that information just by looking around the internet. Because as you mentioned a few times there’s a lot of kind of miscellaneous bits and pieces out there that it’s hard to distinguish fact from fiction.
Paula Begoun: Thank you, Nathan.
00:40:03 I needed that. I needed some insight. Bryan and I were getting very emotional here! Do we have time for a couple of questions? I don’t even know how long we’ve been talking.
Bryan Barron: It’s a tempest of emotions in this small booth.
Paula Begoun: Do we have time for a couple of questions?
Bryan Barron: We do. I managed to escape - my father has terrible eczema and two of my sisters suffer as well.
Paula Begoun: Oh, no kidding.
Bryan Barron: I lucked out. Because it’s not on my mom’s side of the family, but every now and then I think - so one of the things I wanted to ask earlier is you mention that eczema tends to come on in childhood and often be worse during the childhood years and then kind of -
Paula Begoun: Tapers down.
Bryan Barron: Tapers down.
00:40:43 So, if you’ve never had eczema how likely are you to get it into your forties -
Paula Begoun: Not very likely. You can, but it’s not very likely.
Bryan Barron: Okay.
Paula Begoun: What sometimes can happen is as you get older and your skin barrier becomes thinner then that propensity that would already be with you, because your genetics don’t change as you get older.
Bryan Barron: Right.
Paula Begoun: Because eczema is thought to be, as you said, 80% if not totally genetically - have a genetic component, that then your barrier as it becomes thinner is less likely to be able to fight off the triggers.
Bryan Barron: Okay.
Paula Begoun: And so they say the eczema was probably always there, but you just don’t have the protection like you used to.
00:41:31 But generally speaking you get it younger in your teen years and it doesn’t show up older.
Bryan Barron: Okay. So, non-eczema related topic.
Paula Begoun: Oh, thank god! Because I’m exhausted.
Bryan Barron: Here we are, moving on. Joshua on our Facebook page asks, “Is fragrance in hair products as bad as fragrance in skincare products?”
Paula Begoun: No. No. It’s not. Bryan and I often disagree with this one, but no, it’s not at all. The issue with fragrance and shampoo and conditioner is you’re rinsing them off. They’re going down the drain. They’re in contact with the body very little.
00:42:06 They’re not absorbing in. It’s really about the length of time of contact and the absorption. In terms of hair care products you spray on your hair like silicone serum, or you rub on your hair, lotions and creams and stuff, they’re in contact with hair. Rarely with scalp. Your hair is dead. Drop dead dead. Not alive. Your hair doesn’t itch, thank god.
00:42:31 But in contact with your scalp, yes, if you were to be rubbing it into your scalp then you would have a risk, especially if you have dandruff or other scalp disorders. Yeah, then it would be triggered. You’d get an irritant trigger response just like you would on any other part of your body. But, no, for hair it’s far less of an issue than it is with skin. I mean, hair versus scalp. Scalp is skin. Hair is dead. Scalp is alive. It’s more of a problem if it comes in contact with your scalp and you’re not washing it off.
Bryan Barron: Got it.
00:43:02 Okay. Susan wants to know about sebaceous filaments.
Paula Begoun: A filament? A sebaceous filament? I don’t know what that is.
Bryan Barron: She says, “How do I get rid of them without drying out my skin and causing the dreaded flakies?”
Paula Begoun: Sebaceous filaments?
Nathan Rivas : Sebaceous filaments are the not quite blackheads, not quite white heads. They’re kind of like this little sort of milky-ish looking clog to a pore. And it’s sort of naturally present. It’s not like anything you can do. I mean, you can kind of squeeze them to push them out if you like, but they’re always going to be there.
00:43:40 You’re really going to drive yourself crazy trying to get rid of them.
Paula Begoun: Okay. So, obviously I have to do some research on this because just when I think I know everything there is about skincare -
Bryan Barron: I stumped the Cosmetics Cop!
Paula Begoun: Exactly. It’s actually - Nathan, it’s actually a skin disorder, a recognized skin disorder?
Nathan Rivas: It’s not a disorder.
00:44:02 It’s just something that’s just naturally present in skin. I mean, it’s just the -
Paula Begoun: Is it a precursor to a blackhead?
Nathan Rivas: No. It’s just actually the collection of substances of sebum and that sort of thing in pores. It’s nothing that is a dysfunction or a disorder of skin. It’s not an indicator of a blemish or a breakout that’s on the way. It’s just there.
Bryan Barron: So, it’s defined as a tiny collection of sebum. And sebum is oil. And dead skin cells around the hair follicle which usually takes the form of a small hair-like strand. They usually have a white or yellow color and can be expressed from the skin by pinching.
00:44:45 These filaments are naturally occurring and are not a sign of infection or any other ailment. They help to channel the flow of sebum within a given pore allowing it to seep gradually to the surface.
Paula Begoun: How do you like that? I have no clue.
Bryan Barron: Sebaceous filaments are usually only notable around the thin skin of the nose. They’re often confused with blackheads, a type of comedone. Unlike blackheads, however, they cannot be removed and are a permanent part of the human skin.
00:45:12 They may diminish in old age, however the sebaceous glands begin to produce less sebum.
Paula Begoun: So, this filament is a typically unseen fiber like extension from a hair follicle that for some people who are probably using a magnifying mirror. Ha!
Nathan Rivas: Ten times magnifying mirror.
Bryan Barron: Yeah.
Paula Begoun: Can see it that you wouldn’t normally see with the naked eye. Because hair follicles around the hose in particular are pretty, I mean, they almost never express a hair. So, this must be part of the physiology that allows, separate from the hair, that allows oil to travel to the surface.
00:46:00 And I -
Bryan Barron: I’m wondering if a course, not that this -
Paula Begoun: Wow, how do you like that?
Bryan Barron: I’m suggest this lightly because this is a very serious medication, but I’m wondering if a case of a course of Isotretinoin would actually shrink the size of the oil glands. I wonder if that would take care of the problem.
Paula Begoun: Well, it sounds like you have this - so obviously, this was Susan, right? So, Susan, we actually, obviously this will be a bit of a discussion in our next research meeting.
00:46:33 But my initial reaction to say is that from what we can tell just with our initial discussion is that it’s pretty much natural. It isn’t a disorder. It isn’t a problem. You might be looking too closely at your face. And I can’t imagine that an AHA or a BHA in a gentle washcloth or in Nathan’s case the Clarisonic wouldn’t take care of the situation for you.
00:47:05 But you’ve got us working on it. Stay tuned. We’ll post something on Facebook in a little bit here.
Bryan Barron: Yeah. Last question. Let’s take this from Laura. She says, “First, I would like to tell you I’m a huge fan. I have listened to every one of your radio shows for almost four years.” Have we been doing this that long?
Paula Begoun: Have we been doing this for four? I guess we have if she’s been listening.
Bryan Barron: “And I have them all downloaded on my computer.” Laura, you are a super fan.
Paula Begoun: We love you, Laura! Kiss, kiss, kiss!
Bryan Barron: “Here is my question. Can I apply my 2% BHA liquid on my neck also?”
Paula Begoun: Yes. Of course you can.
Bryan Barron: “I’ve been using it on my face for four years now and I can see a difference - not too radical - between my face and neck’s color, and also both my mother and grandmother have very lax necks and I’m starting to obsess about it.”
Paula Begoun: Well, yeah, I’m sorry. I misunderstood what you might be wanting to use the BHA for.
00:47:58 So first of all skincare is from the chest up. It’s actually from the ankles up. But really in terms of the skin that gets exposed to the sun and shows most -
Bryan Barron: What we think of as facial skincare.
Paula Begoun: Right. Really needs to be done breasts up. So, the chest, the neck, the face, all the products that you put there almost without exception can go and should go there.
00:48:25 However, the reason the neck ages is very different than why the face and the chest age. For example, the neck unless you have really been a sunbather usually doesn’t get brown spots, usually doesn’t get cross wrinkling and, again, unless you’ve been a sunbather. But for the most part, especially walking around, your neck is naturally in shadow just from your head sticking out over your neck. So, the reason the neck sags has more to do with the fact that the skin is just hanging off the neck.
00:48:59 There is no real -
Bryan Barron: Not a lot of support.
Paula Begoun: No support. It’s a drape hanging off of a saggy rod. So, there’s limitations. You can get some tightening. It is not going to be the way you dream of. It’s not going to replace what a surgeon can do. But whatever you’re putting on your face, especially for sun care, especially for exfoliation, products with healthy ingredients, moisturizers, you should be putting on from the chest and the neck.
Bryan Barron: Right.
00:49:30 So, just to add to that and Paula’s comment that the neck ages differently than the face, which is true, it does not mean that you need to go out and look for a product labeled “Neck Cream.”
Paula Begoun: Ooh! Thank you, Bryan. Yes, yes, yes. Different but no ingredients, no product targeted at the neck that’s going to change how the neck ages. It isn’t that the skin is different. It has to do with body structure, how the skin hangs off of the body. Not that the skin itself is different.
Bryan Barron: And I’ve seen the demos, particularly at the Chanel and the Clarins counter, because it’s almost always the French that think that every single part of the body needs its own product.
00:50:12 And they’ll show you, they’ll tell you that the way you can counteract sagging on the neck is to apply the neck cream in firm, upward, massaging strokes.
Paula Begoun: So, if I put a cream on my breasts in upward massaging strokes they won’t sag either? Is that what it takes?
Bryan Barron: This is Clarins and Chanel. They have bust products, too.
Nathan Rivas: You remember the Clarins video that we watched - ?
Paula Begoun: Oh, that suction?
Nathan Rivas: That lady was doing like yoga.
Bryan Barron: Yes!
00:50:39 And I think that was directed toward the Asian market. Because I went to their US site and they did not have that video there.
Paula Begoun: You know, I remember, I wonder - this was probably well past your time, but I think it was Clarins, or Dior, or Chanel, some product line that actually had a cream you put on and then you put some kind of vacuum-like suction thing on your breast.
Bryan Barron: I think that was Clarins.
Paula Begoun: Was that Clarins?
Bryan Barron: Yes!
Paula Begoun: I hate the cosmetics industry.
00:51:09 So, just to be very, very, very, very clear, it doesn’t matter which direction you apply a moisturizer, up or down, it is the movement of the skin that sags it. It is the breaking down of the collagen. That is why you don’t sag going up. You sag going down. It’s gravity.
00:51:30 Anything you do that pulls at skin, think of it like a rubber band, it doesn’t matter if you pull the rubber band from the top or the bottom, it’s going to become lax. That’s the same thing with skin. It doesn’t matter which direction you go. But if you want to massage up, massage up. Have a good time. It’s not going to change anything. I’m done. This was quite the show. Ooh, Bryan, oh my goodness! To all our Facebook fans, to everybody who listens to us on our radio show, thank you.
00:51:58 I’m Paula Begoun, the Cosmetics Cop, with Bryan Barron, who is really the Cosmetics Cop. I just kind of hang around with him.
Bryan Barron: Nah.
Paula Begoun: We love our books, Don’t Go to the Cosmetics Without Me. Our website, where all of our information and products are at PaulasChoice.com. Come visit us. Thank you for listening to us. And thank you for letting me tell you my story.
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