I was planning to write today about red skin syndrome (RSS). I had written most of the post, but then started to find information from the other side of the debate about topical steroids, and didn’t feel comfortable making statements about it as fact. Instead, I’ll leave some links at the bottom of this page to allow you to draw your own conclusions.
One thing that did become clear, both with scientific articles recently brought to light and that I found while researching RSS. Evidence about eczema, symptoms that occur alongside the condition, and possible treatments. I use eczema here to refer to the rash that can be caused by both internal, external, and allergic factors (ie. a condition, rather than a cause).
Both Atopic and Allergic Dermatitis are Related to the Barrier Function of the Skin
Source: Wikipedia
In healthy, properly-functioning skin, the epidermis acts as barrier to prevent water loss from the skin and prevent the admission of foreign bodies. Poor function of this barrier allows dryness and reactivity to occur. Anything that further damages this barrier’s protective function, like the dryness and cracking that often occur with eczema, or chemicals that erode the skin, can make eczema worse. Anything that helps to improve the barrier can cause eczema to improve.
A recent study found that a material applied topically which helps repair the skin’s barrier function through the body’s own natural processes may be a new treatment option (once it goes through trials and comes to market). Another thing found to help repair the skin barrier was high levels of DHA, both ingested and applied topically. Unfortunately, these levels are beyond what might be taken easily using off-the shelf capsules, and thus this remedy is best applied under a doctor’s supervision. I can’t imagine rubbing fish oils all over my skin. Still another possible treatment for eczema symptoms is sea salt/epsom salt. I have been using epsom salts on my scalp for some time to help reduce itching and irritation, and there is some evidence that these high-mineral salts can help to improve or help heal the skin’s barrier function.
Eczema Sufferers Tend to Have Higher Staph Colonization on Their Skin than Non-Sufferers
Staphylococcus
The connection between staphylococcus aureus and eczema has not been fully studied. What we do know is that many eczema sufferers average many more staph skin infections than in the rest of the population (everyone has some staphylococcus aureus on their skin, but the extent varies considerably). One study found that 90% of eczema sufferers were found to have staph colonization on their skin. It is not 100% confirmed whether the staph colonization causes the rash or whether the rash makes the skin more susceptible to staph colonization, and staph bacteria take advantage of this weakness.
There are some who take dilute bleach baths to kill excess staph on the skin. These people say that their symptoms (especially itching) are dramatically improved by the baths. A dermatologist specializing in eczema for 30 years was asked about the validity of this treatment. He did not deny that antibiotics that kill staph are helpful to eczema sufferers (and thus staph-killing bleach treatments may help), but expressed concern that the bleach may erode or dry the skin, damaging it and making it more susceptible to eczema flares as well. Personally, my skin cannot handle chlorinated water, so chlorine bleach is out for me. The same people who suggest bleach baths often suggest dilute vinegar baths. Unfortunately, vinegar as a treatment has less basis in fact because pH alone does not kill staph bacteria. They thrive in basic pH and create an acidic environment in the course of their feeding and reproduction. Another suggested treatment, peroxide, is a possible but unhealthy option. At low concentrations of peroxide, staph bacteria feed and convert the peroxide to water and oxygen, harmless products. It is only at high concentrations of peroxide that it effectively kills staph bacteria (high enough concentrations that the peroxide cannot all be metabolized). These concentrations are harmful to the body’s skin cells as well, which could damage skin’s barrier function.
Whatever the reason, reducing staph bacteria on the skin does tend to help eczema sufferers, though washing alone can remove excesses of these bacteria without resorting to additional chemicals.
Eczema is or is Related to a Systemic Condition
Whether the eczema is caused by external or internal reactions and factors, it causes systemic inflammation. This inflammation creates an increased risk for a number of conditions, including heart disease, Alzheimers, and even cancer. The best way to reduce these risks is to reduce the inflammation, and the best way to do that is avoidance of allergens/triggers, proper self-care to support a healthy skin barrier, and treatment of symptoms.
Oils Alone Will Not Rehydrate Skin
Being water-free, oil-based ointments and oils themselves will not help to hydrate skin (This includes petroleum jelly/petrolatum/Vaseline). They do help to seal the skin and prevent further moisture loss. This is why emollients (products that contain water and help to rehydrate skin) are often suggested by dermatologists for eczema sufferers, to relieve symptoms. Unfortunately, water-based products also usually contain preservatives to prevent bacterial growth – preservatives that can cause allergic reactions for some eczema sufferers. If one chooses to use oils or oil-based products, they should be applied to hydrated (just-washed) skin, and possibly over top of emollients, if possible. This will help to seal in the existing moisture. There is some new evidence that oils (sunflower and olive oils were the specific oils tested) may actually stop the skin from putting up as strong a barrier to water loss and contaminants, but more study is needed. Studies also show positive short-term skin barrier repair with use of petrolatum, but long-term results are less clear.
Washing is Both Helpful and Harmful to the Skin of Eczema Sufferers
While eczema sufferers are encouraged to wash less frequently, even with just water, washing also helps to reset skin’s pH and wash away excess bacteria. The key is to wash at a frequency that balances these positive and negative factors, and to ensure that the skin does not dry out after washing, either by working to heal the skin barrier or by moisturizing. This applies to both the skin and the scalp.
References:
- Barrier-Repairing Therapies in Atopic Dermatitis: Current Approaches and Future Perspectives
- Docosahexaenoic Acid Alleviates Atopic Dermatitis in Mice by Generating T Regulatory Cells and M2 Microphages
- Increasing Comorbidities Suggest that Atopic Dermatitis is a Systemic Disorder
- Possible New Eczema Treatment Uses Body’s Natural Defenses
- Staph. Aureus: Resistant or Sensitive to H2O2? (Student experiment, but conclusions supported by doctor supervising experiment)
Red Skin Syndrome
I hope the above information is as helpful to you as it was interesting to me. As promised, below are the links to information about RSS. There are a multitude of websites discussing it, but very few doctors who agree. Come to your own conclusions. The first two websites have information throughout supporting their points of view.