doctors with eczema?

[Suncrusher]

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so I'm coming to terms with a recent (~4-5 month) diagnosis of pretty bad eczema. Topical steroids barely make a difference, oral ones help a lot but I want to use those as sparingly as possible, and the only other thing that slows down its return after using the oral glucocorticoids is avoiding touching any detergents and slathering myself in lotion.

What do I do now in clinical settings? Since I need to avoid washing with any soaps, will I catch any flak from patients or attendings if, instead of washing my hands each time, I put on the non-sterile gloves present in all exam rooms (or use alcohol on the gloves) before patient interactions? Should I carry around a big bottle of Cetaphil in my white coat pockets to wash my hands with? Hand sanitizer might be an option, but I'm not sure yet how I'll react to the drying effects of the alcohol. What about my surgical rotation?

Halp.

 

[Fox800]

so I'm coming to terms with a recent (~4-5 month) diagnosis of pretty bad eczema. Topical steroids barely make a difference, oral ones help a lot but I want to use those as sparingly as possible, and the only other thing that slows down its return after using the oral glucocorticoids is avoiding touching any detergents and slathering myself in lotion.

What do I do now in clinical settings? Since I need to avoid washing with any soaps, will I catch any flak from patients or attendings if, instead of washing my hands each time, I put on the non-sterile gloves present in all exam rooms (or use alcohol on the gloves) before patient interactions? Should I carry around a big bottle of Cetaphil in my white coat pockets to wash my hands with? Hand sanitizer might be an option, but I'm not sure yet how I'll react to the drying effects of the alcohol. What about my surgical rotation?

Halp.

Honestly, have you asked your doctor for advice about this stuff? Are you seeing a family practice physician or a dermatologist? I have it too, but nowhere near as bad as you, and not on my hands...sorry I can't help.

 

[Suncrusher]

yeah i had a full workup by a dermatologist and GI; we've run out of treatment options so I just have to keep it controlled. I'm not here for medical advice, I just want to know how other doctors or med students deal with hand-washing limitations.

 

[Cali2]

Even if you wear gloves, you still need to wash/use the alcohol wash on your hands between seeing patients. You need to talk to your doctor about options for lotions etc to minimize the adverse effects of this.

 

[SirGecko]

I have seen people do new gloves for each patient rather than washing their hands. You still pretty much reflexively use that hand rub stuff going into and out of each patient's room. I will say you won't be able to totally get around washing your hands though. (as you have to actually wash them for some bugs, people with contact precautions)

Surgical rotation you will have to wash you hands (with betadine or chlorhexidine) in the morning at least. After that most hospitals will let you scrub in with avagard which should prob be better. (and I believe I have heard that there was actually a study out now saying it was fine for the first scrub of the day as well though I don't know if anyone has changed policy because of it yet, correct me if I'm wrong about that)

 

[rocketbooster]

I have seen people do new gloves for each patient rather than washing their hands. You still pretty much reflexively use that hand rub stuff going into and out of each patient's room. I will say you won't be able to totally get around washing your hands though. (as you have to actually wash them for some bugs, people with contact precautions)

Surgical rotation you will have to wash you hands (with betadine or chlorhexidine) in the morning at least. After that most hospitals will let you scrub in with avagard which should prob be better. (and I believe I have heard that there was actually a study out now saying it was fine for the first scrub of the day as well though I don't know if anyone has changed policy because of it yet, correct me if I'm wrong about that)

No no no. Avagard has chlorhexidine in it. It is still 1% chlorhexidine and yes would be better than doing a full scrub with the chlorhexidine soap but would probably still trigger the eczema. I have the same problem as the OP...it's only an issue when scrubbing in, though. My hands and arms usually do fine with washing hands in between patients. They might slightly start to break out if I do it excessively, but lotion is enough to control it. Try to use the alcohol lather outside rooms when you can since I noticed it doesn't dry out my skin quite as much as doing a full soap wash. If there's C diff exposure, though, then you have to use soap and water. That really isn't very often, though.

In the OR, I tried using betadine instead of chlorhexidine. It doesn't trigger my eczema quite as bad as the chlorhexidine but it still makes me break out quite a bit. One doctor at another hospital told me their OR has sponges with another kind of soap for ppl with betadine and chlorhexidine sensitivity. I think he told me it has chloroxylenol instead. I'm going to try to see if my OR area has it tomorrow and test it out.

As for treatment, my initial reaction to chlorhexidine triggered a terrible eczema exacerbation and ended up spreading all over my body haha. I had to finally get a steroid shot (70 mg of methylprednisolone I think) to get rid of it. At that time I was given a prescription steroid cream that I still occasionally use for maintenance. It surprisingly is able to control it now as long as I treat it when it first breaks out on my hands and arms and use it for a few days. You might want to try getting a more potent prescription steroid cream that you can use for maintenance and see if it works. Works better than the weak OTC ones and less systemic effects of oral steroids.

I'll let you know how I react to the chloroxylenol soon. The scrub sinks also have a pedal for soap dispensing and I have seen packaged sponges without any chemical on them. I wonder if you're allowed to scrub in by using that sponge and just dispensing the soap on it using the pedal? Not sure but I might have to try it.

 

[Suncrusher]

^ thanks. Honestly, I might do just fine with the chlorhexadine or betadine or other non-detergent sterilizers, in which case my surgery rotation might not be a problem at all. Fingers crossed. But I know for sure if I wash my hands at the sink with hand soap each time I see a patient that I will have big problems; I'm already using the two most powerful prescription steroid creams with little effect. I guess I can just put on new non-sterile gloves whenever I enter a room and use the alcohol dispensers on the wall to sanitize the gloves whenever indicated(?)

 

[rocketbooster]

^ thanks. Honestly, I might do just fine with the chlorhexadine or betadine or other non-detergent sterilizers, in which case my surgery rotation might not be a problem at all. Fingers crossed. But I know for sure if I wash my hands at the sink with hand soap each time I see a patient that I will have big problems; I'm already using the two most powerful prescription steroid creams with little effect. I guess I can just put on new non-sterile gloves whenever I enter a room and use the alcohol dispensers on the wall to sanitize the gloves whenever indicated(?)

I can almost guarantee you'll react severely to the chlorhexidine, maybe not the betadine though. During our OR orientation the scrub nurse specifically cautioned us about chlorhexidine if you have any kind of skin sensitivity. It's harsh stuff. The first I tried was 4% chlorhexidine and broke out pretty bad all over my hands and arms. Then I tried 2% chlorhexidine a few weeks later and the reaction was even worse lol. I haven't even tried the Avagard, although it's 1%, since I've had enough of dealing with weeks of itchy rashes from each prior exposure haha. I was pretty surprised when I broke out to the betadine last week, but like I said it wasn't quite as severe as the chlorhexidine and it's already gone after a few days of using the prescription cream.

I'm praying I find the chloroxylenol tomorrow and don't react to it. My eczema is also triggered by friction, so I'm wondering how much the physical scrubbing contributes. Haven't tested it since I've always used the betadine or chlorhexidine with the sponges.

It's pretty annoying having an eczema rash on your hands and arms when in the OR. It's really itchy, and the warmth of the gloves and any stress just makes it worse ha.

 

[newno55]

I've had eczema for most of my life and I'm terrified about starting med school this fall. I currently work in a lab, and can sympathize with everyone here... gloves on and off, on off all day... washing hands all day too.

When Friday finally comes my hands are all red and scaly... they usually get better over the weekend, then it's right back to it. I've found sweat inside the gloves irritates my skin as well, so I try to change often, and keep my hands as dry as possible. I wonder if for me (and you) a cotton liner would be helpful...?

I don't think the gloves and hand washing is the root of my eczema (I have a suspicion it's somehow related to my digestive system) as flare-ups come and go even when i'm, not at work. The gloves/ hand washing definitely irritates my skin though.

I've found that even white creams (which usually contain alcohol) don't help that much. I've recently bought some eucerin aquaphor and it's been working well. It's a little thicker than vasaline, but a similar type of ointment (clear, a bit greasy) but really gets a good barrier going for your hands.

Regarding steroid creams. I've used prescription steroid creams for 10+ years to the point where the skin on my hands is quite thin. I get cut fairly easily (ex, can't usually open a beer bottle without cutting up my palm), and I now have an increased sensitivity to hot and cold.

ugh

 

[Suncrusher]

that's what I'm afraid of : [

 

[newno55]

Not being able to open beer bottles as easily 😛 ?

good luck with your search for a solution. I'm at my wits end already with this. I can tolerate my current state, but if it gets worse (from even more frequent hand washing during clinicals etc) I don't know what I'll do.

 

[newno55]

Randomly found these in another lab here at the hospital, thought I'd share 🙂

http://www.aloetouch.com/

I emailed them and they are super friendly. Sent over two boxes for me to try. I'm not sure how helpful it will be, but it's worth a shot. I'm trying the "Aloetouch Ice" nitrile gloves right now... haha

 

[Slack3r]

Randomly found these in another lab here at the hospital, thought I'd share 🙂

http://www.aloetouch.com/

I emailed them and they are super friendly. Sent over two boxes for me to try. I'm not sure how helpful it will be, but it's worth a shot. I'm trying the "Aloetouch Ice" nitrile gloves right now... haha

How are you carrying those with you in the hospital?

 

[bunnyr]

I would say that you haven't tried all possible options if you were diagnosed less than 6 months ago. It took me years of trying different things to find something that worked well.

Elidel and Protopic are what worked best for me. Topical steroids didn't do too much and I had to use them to get rid of it as well as prevent it (the eczema came back quickly when I stopped using it).

Have you been tested for allergies? If you have, are you being treated adequetely? I have allergies and my eczema would flare up at the same time as allergies and they have been less correlated now that I'm getting allergy shots.

Spectro makes some products that are worth trying.
http://www.spectroskincare.com/eczemacare_product.aspx

 

[newno55]

How are you carrying those with you in the hospital?

Ah, I actually currently work in a lab within a hospital. So I just put the boxes in the rooms I work in most. (not starting medical school for a few months). I don't have to stuff my pockets full or anything 😛

 

[newno55]

I would say that you haven't tried all possible options if you were diagnosed less than 6 months ago. It took me years of trying different things to find something that worked well.

Elidel and Protopic are what worked best for me. Topical steroids didn't do too much and I had to use them to get rid of it as well as prevent it (the eczema came back quickly when I stopped using it).

oh yes... I was given Elidel/ Protopic too... I've used it a total of 3 times, because I'm literally scared. Last time I used it, I wiped it off 10 minutes later haha.

The manufacturer's website says things like "WARNING: The safety of using Protopic, and drugs like it, for a long period of time is not known. A very small number of people who have used Protopic have had cancer (for example, skin or lymphoma). "


And the warning label says, "...a
statistically significant elevation in the incidence of pleomorphic lymphoma in
high dose male (25/50) and female animals (27/50) and in the incidence of
undifferentiated lymphoma in high dose female animals (13/50) was noted in
the mouse dermal carcinogenicity study. Lymphomas were noted in the mouse
dermal carcinogenicity study at a daily dose of 3.5 mg/kg (0.1% tacrolimus
ointment) (26X MRHD based on AUC comparisons). No drug-related tumors
were noted in the mouse dermal carcinogenicity study at a daily dose of
1.1 mg/kg (0.03% tacrolimus ointment) (10X MRHD based on AUC
comparisons)."

What was I prescribed?.... the 0.1% dose. I'm actually really upset my dermatologist didn't discuss ANY of these issues with me. The cream cost me almost $100 to boot! 👎

 

[Instatewaiter]

In between patients use an ointment not a cream. The easiest to use is called surgeon's secret. It's beeswax and comes in a tube so you can put it only on areas you want to. You can't use steroids all day long. It will destroy your hands in the long run.

http://www.shoppingnexus.com/health...secret-3-piece-unscented-travel-set-1-st.html

 

[g a m b 1 t]

Any of you folks had this problem in anatomy lab? I never had eczema my entire life, then I went thru anatomy lab and lo and behold its on my hands and all over my arms (washing my hands/arms after dissections led to the break out, i assume). As instatewaiter said, anything beeswax helps tremendously since it doesn't wash completely off even after multiple soap/water washes

 

[bunnyr]

oh yes... I was given Elidel/ Protopic too... I've used it a total of 3 times, because I'm literally scared. Last time I used it, I wiped it off 10 minutes later haha.

The manufacturer's website says things like "WARNING: The safety of using Protopic, and drugs like it, for a long period of time is not known. A very small number of people who have used Protopic have had cancer (for example, skin or lymphoma). "


And the warning label says, "...a
statistically significant elevation in the incidence of pleomorphic lymphoma in
high dose male (25/50) and female animals (27/50) and in the incidence of
undifferentiated lymphoma in high dose female animals (13/50) was noted in
the mouse dermal carcinogenicity study. Lymphomas were noted in the mouse
dermal carcinogenicity study at a daily dose of 3.5 mg/kg (0.1% tacrolimus
ointment) (26X MRHD based on AUC comparisons). No drug-related tumors
were noted in the mouse dermal carcinogenicity study at a daily dose of
1.1 mg/kg (0.03% tacrolimus ointment) (10X MRHD based on AUC
comparisons)."

What was I prescribed?.... the 0.1% dose. I'm actually really upset my dermatologist didn't discuss ANY of these issues with me. The cream cost me almost $100 to boot! 👎

ehhh skin cancers are really common in my family, I figure I'm probably going to get it anyways so I'm not too worried about it because I know how to recognize it and I moniter my skin pretty closely.

That's pretty irresponsible of the derm to not mention it, but at the same time you should always ask these kinds of questions.

 

[bunnyr]

I accidentally lied in my first post, a steriod did help me, a lot. It was ratio-Ectosone (betamethasone valerate). When I use it on small spots they're usually completely gone in 2 days (with one application a day) and I used it on some large spots the other day 3x6inches and they were completely healed in 4 days (they were broken skin and oozing).

 

[kadwajooth]

i hv had atopic dermatitis all my life... before i started med school it was only in flexor surfaces - places i could hide.. now that i hv finished med school, it is over my face and hands too.... hands got worse after wearing gloves... i dont think thr is any work around.. the only option is to, when u r done with the day, keep hands as moist as possible and wear cotton gloves..

i got tested for allergies and got shots for immunotherapy... thats what made my face skin hyper-reactive... so i would advise caution !


i have tried using this recently : http://www.amazon.com/Tamanu-Oil-Ce...TF8&qid=1361280168&sr=8-2&keywords=tamanu+oil

its just been 2 weeks but seems to work better than most moisturizers so far, though i get some results with eucerin hand creme also...

 

[MediCane2006]

I have a contact allergy to the propellant used in a lot of the gloves in the hospital, which, since I'm a surgeon, has been interesting to say the least. Ultimately you are going to have to use trial and error to figure out what works for you and what worsens your exzcema. Agree with most of what has been said in this thread, including:

Alcohol-based sanitizer is usually ok and I use it almost exclusively in day-to-day inpatient scenarios. Carry a neutral Unscented moisturizer in your coat pocket to keep your Han from drying out

Avoid avoid avoid the chlorhexidine based scrubs in surgery. If you have to scrub, use betadine. Interestingly I've found that the abrasive trauma of scrubbing is actually more irritant than the low concentration of chlorhexidine in Avagard so I use the Avagard whenever possible. You may have a different experience.

If you have sensitive skin you may react to the gloves as well. There are hypoallergenic gloves available at most hospitals, as well as glove liners that can be used if you have a hypersensitivity.

Good luck!

 

[newno55]

To add to this thread some more...

I had a bad break out a few weeks ago, that I am only now recovering from. I try to do everything steroid free now, as I don't know how much life my hands have left in them. Skin's so thin as it is.

Anyways, I'm vitamin D deficient... so I started up again with the vitamin D, but this time added another pill with vitamin A + cod liver oil and my skin reacted almost as fast as with the prescription meds. I'm on day oh.... 3 or 4 of these supplements and there is a dramatic reduction in the eczema, not as much itch and NO BLISTERS!

What's even more interesting, is I moved into a new place this weekend, and without gloves, I was cleaning and scrubbing for hours (soaps, and detergents on my hands etc)- something I never do because of my hands, and believe it or not, my hands continued to improve over the weekend.

Just thought I'd share that, I know how debilitation having bad hands can be...


ps: nice Avatar avatar MediCane2006.

 

[rocketbooster]

I wanted to share my recent breakthrough in eczema control with scrubbing in.

Third year was often a nightmare because I was excited to be in the OR but also dreaded the aftermath of developing itchy, painful plaques after using betadine or chlorhexidine that are only controlled by topical steroids. I decided to go into a surgical field anyway because I don't want to be limited by something as dumb as eczema. Although the school didn't really seem to care to get new soaps for me in the OR, I figured it would be different when I'm a resident/attending and have authority to demand occupational health make adjustments for me.

However, I may have found a solution! I scrubbed in at a random VA recently and I didn't react to their scrub soap. They also have betadine and chlorhexidine, but they do not have sponges already absorbed in the chemicals. Instead, they only have dry sponges and then betadine or chlorhexidine foams that you have to dispense with a pedal onto the sponges yourself. I think the foams must have a lower concentration plus it's really up to you how much foam you're putting on the sponge. I put as much foam needed to match my normal scrub pattern and I have not reacted at all to it. So, I would suggest try using a dry sponge and then dispensing the soap on it yourself. Might do the trick. Don't know if only the foam is the answer or if being able to dispense your own amount of liquid betadine/chlorhexidine onto a dry sponge would also work.

They also had an alternative to Avigard (the worst thing ever for me) in which it was 70% ethyl alcohol. You're allowed to use it after you have done one full scrub that day. I did not get a chance to try it, but I think I would be fine since I don't really react to the ethanol-based hand sanitizers on the floor.

Anyways, just thought I'd share.

 

[combatdoctor]

Bro, this may or may not work, but whenever you can, (say 3 times a day, after washing your hands), apply virgin cold pressed coconut oil to your hands, as if you are using a moisturizer.

If it works, it's way than topical steroids: (ie no known side effects). Just give it a try.

 

[dismorfik]

Just skimmed the previous commments....

You say topical roids haven't helped, but you might not be applying them correctly. Apply topical steroids to moist wet skin. Add vaseline over top. (Yes I know there is a debate over vaseline safety and how it is an occlusive.) If you are able, wrap affected areas in saran wrap overnight. You really need to LOCK IN the moisture and the roids. they are your best bet and are far superior to the Elidel and Protopic side of things.