October is National Eczema Awareness Month, a time when dermatologists who are members of the National Eczema Association collectively work to shed light on this inflammatory skin disease that impacts the quality of life of 31.6 million people in the US. 

Happi asked Dr. Vivian Y. Shi, MD, assistant professor of medicine in dermatology at the University of Arizona, where she directs the Eczema and Skin Barrier Specialty Clinic, about this chronic skin condition, ingredients that can help —like CBD—and more. Dr.Shi has extensive clinical and research experience in eczema and repair of the skin’s natural protective barrier. Her principal focus is atopic dermatitis (AD), and she’s a longtime AD sufferer herself. 
 
HAPPI: Eczema has no known cure, so when adult patients come to you, where are they typically in the “lifecycle” of their disease? Have they tried to deal with it on their own, self-treat etc. How is their spirit in terms of finding a solution or relief?

Dr. Shi: Most of my adult patients have been battling with eczema since childhood. Frequently, by the time they show up in my office, they have seen multiple providers and have tried numerous treatments. They have done self-treatments including supplements, food eliminations, and complementary alternative methods without satisfactory response. Understandably they are exhausted, frustrated and anxious. There is also a sense of guilt, especially from parents of eczema children, thinking they have failed in taking good care of their child’s eczema. Adult patients also come with disappointment about their skin disease, as they didn’t “grow out” of it as many other children did, or they have grown out of it but it suddenly came back with a vengeance for no reason. That said, most of my adult patients come to me with a sense of hope that I can help them make a big breakthrough and end the vicious cycle of eczema. While I don’t have all the answers, the truth is that we are only in the infancy of understanding the multifactorial causes of eczema, I do promise to do my very best to design an individualized treatment plan for them and “hold their hands” while we take control of their disease. My patients know that we are in it together and I am their “eczema person” and that has been very helpful!
 
HAPPI: In addition to any prescriptions (topical and/or medication), what do you suggest in terms of OTC topical treatments/skincare products that can benefit these patients?

Dr. Shi: Moisturization is one of the cornerstones of eczema care, as it repairs the defective natural skin barrier. Selecting the “right” OTC topical product can be tricky, because what works for one person may contain allergen for another. There’s simply not a product that works for all skin types and conditions. I wish one existed! That would have made our lives so much easier. Generally, it’s good to select a product without fragrance, alcohol and preservatives. Unfortunately, many products marketed for eczema or sensitive skin contain known allergens. When trying out a new product, avoid applying it all over the body or on areas with sensitive skin such as the face. Apply a small amount (about size of a quarter) on the inner arm and wait up to one week to see whether your skin reacts before applying to other parts of the body. Typically, products marketed for eczema, sensitive skin and have the NEA-seal are gentler and more suitable for eczema skin. I like CeraVe products and Burt’s Bee’s Sensitive Skin line.

HAPPI: What are the ingredients that you believe hold the greatest benefit for eczema in a topical formulation and why?

Dr. Shi: The ideal moisturizer for eczema should do several things: decrease water evaporation, introduce and hold on to hydration, fight Staphylococcus aureus colonization and infection, and have anti-inflammatory properties. It doesn’t have to be complicated. The practical advice that I give my patients is: pick one that is affordable and one that you would actually like to use! Ask your dermatologist for some samples or buy a travel size, check out the texture/smell first before committing to a big jar/bottle. Ceramide-containing moisturizers are good options. Ceramide is a natural fat in the skin barrier and many eczema patients are lacking it in their skin. Cold-pressed or virgin coconut oils and sunflower seed oils are also good for eczema as they have antimicrobial and anti-inflammatory properties, respectively. These oils have been specifically studied in eczema patients to show benefit. Borage seed oil is another good option as it contains essential fatty acids that are the building blocks of the skin barrier and are deficient in eczema skin. 
 
HAPPI: Does CBD hold any promise in terms of treating eczema (topically or ingestible?)

Dr. Shi: We don’t quite know yet! Early studies hold some promise, and more research is needed. Right now, we can only approach CBD with cautious optimism. It is important to distinguish CBD from THC (the compound in cannabis plants that makes you “high”). CBD contains little to no psychogenic property and they have been shown to modulate a multitude of functions. Our body actually produces endo-cannabinoids (also known as intrinsic cannabinoids) which are fatty acids that modulate skin function such as cell turnover, immune defense, inflammation, skin sensation (itch and pain) and aging. Early clinical studies that looked at CBD-containing moisturizers in eczema patients have shown some promise, with comparable anti-inflammatory effects as low to mid potency topical steroids. 
 
HAPPI: How do you wish skin care brands would address this skin disease in order to make it a more open discussion and more readily available treatment option for everyday consumers?

Dr. Shi: I wish there would be more transparent and standardized ingredient reporting and product testing. Consumers and practitioners alike are looking for clinical evidence on how well and safely the products work. Medical students and dermatology residents have limited training on topical product/medication compounding and formulation. Many practitioners I talk to would like more product education—and I think there’s a real opportunity for collaboration between the industry and academicians on improving education.