managing eczema on the wards

[nehruhoodies]

I am a medical student starting on the wards in Janaury. I have moderate-to-severe eczema, and am worried about how continuous hand-washing and sanitizing will affect my skin. I was wondering if anyone in a similar situation had tips, recommended sanitizers/lotions/other products, or other thoughts. Especially with increased focus on sanitation during the COVID pandemic, I'm concerned that this will be a significant burden during my rotations.

As further background, my eczema is currently well-controlled with a combination of dupilumab, tacrolimus ointment, and steroid ointment for flares. I see a dermatologist regularly but they were not the most helpful about this specific situation. I am aware that a steroid ointment would "solve" the problem, but I worry about using steroids daily for a long period of time, especially if this problem will be recurring for my entire career.

Looking forward, I'm also curious how surgeons with eczema have navigated skincare issues--scrubbing sounds like an eczema patients worst nightmare.

---

Members don't see this ad.

 

[Redpancreas]

I am a medical student starting on the wards in Janaury. I have moderate-to-severe eczema, and am worried about how continuous hand-washing and sanitizing will affect my skin. I was wondering if anyone in a similar situation had tips, recommended sanitizers/lotions/other products, or other thoughts. Especially with increased focus on sanitation during the COVID pandemic, I'm concerned that this will be a significant burden during my rotations.

As further background, my eczema is currently well-controlled with a combination of dupilumab, tacrolimus ointment, and steroid ointment for flares. I see a dermatologist regularly but they were not the most helpful about this specific situation. I am aware that a steroid ointment would "solve" the problem, but I worry about using steroids daily for a long period of time, especially if this problem will be recurring for my entire career.

Looking forward, I'm also curious how surgeons with eczema have navigated skincare issues--scrubbing sounds like an eczema patients worst nightmare.

This post outlines things some good practices but I am not training nor have I trained as a Dermatologist. Please seek counsel/care from your established Dermatologist before doing any of this.

1. I don't want to tell you to avoid stress so instead I'll tell you to limit caffeine, unnecessary night shifts as able but things happen so you're going to have to accept some level of it and unfortunately it's going to occur in your career. As a kid it probably hit your face, then growing up maybe flexural areas, and then potentially scalp in your 20s, etc. There's a natural evolution to it and it comes during periods of stress. The main issue with eczema is you're missing a little bit of the skin component so moisturizing can add an artificial barrier and help.
2. Moisturize after every shower (after applying the protopic). Everyone is different, I prefer Gold Bond. My friend prefers Cerave (sp?). Only use lukewarm water.
3. Moisturize prior to bed so you're not tempted to scratch off. If you feel your skin burning after application, take a cold cloth and gently remove the moisurizer/protopic and reapply less. At night consider coconut oil. I'm not big into alternative medicine but this has helped me.
4. What potency steroid are you using? Ask your dermatologist about going up (at least for flexural areas, hands if that's a problem) if you're experiencing a flare. It's better to use Clobetasol for a week than Hydrocortisone daily for months. Please talk to your doctor about facial/mucosal steroids. It's controversial and I don't want to give an opinion there.
5. The problem will get worse, but you will adapt. Learn to manage it well now.
6. Carry a portable moisturizer tube and take a pea size quantity after every foam out. Your fingers may get a little slippery but you fix the eczema issue.

Good luck!

 

[angeloflogic]

Hey, I'm a fourth year with moderate to severe eczema too. I'm on basically the same regiment as you, minus the dupilumab because my insurance is acting up on me. I'm personally a big fan of Vaseline as it's more of an "ointment" than cream and feel like it moisturizes better. I really only had one bad flare up during my surgery rotation (lots of scrubbing in the middle of winter while also only getting like 5 hours of sleep per night), and oral steroids knocked that down real fast. Not sure if you've done a trial of an oral steroid. Betadine with a plain scrub brush felt better in general than Avagard or the premade scrub brush for me at least.

I honestly did very fine because I was so busy having fun doing real medicine third year that it kind of helped distract me from any itches. Considering you're on dupilumab, you'll probably fare even better than I did. If you need to reach out, DM me.

 

[MissRibeye]

Is it regular eczema or dishydrotic? Dishydrotic is what I have, which is far more problematic if you get a flare and I worry about that for when I get on wards and into surgery. At home or when volunteering in a kitchen, I just keep one part of gloves on and wash those, but I doubt that's gonna fly. The good news with dishydrotic is that there are two major causes of it, a chemical allergy or systemic nickel allergy.

For me, mine is caused by systemic nickel allergy (second leading cause) so I just have to be super strict on eating low-nickel foods, taking vitamin C after every meal, and no alcohol and it stays pretty limited, but stress definitely predisposes me to small flares. Please let us know what you end up learning/doing!

 

[hmockingbird]

I only have mild eczema but have found I do better with certain antibacterials than others. Personally the foam does not get along with my skin. I ended up keeping a supply of regular Purell both on my person and in my work area so I rarely had to foam. I’m not the only person I know who does something similar so that is one small thing I’d recommend once you figure out which affects your skin the least.

 

[Redpancreas]

Hey, I'm a fourth year with moderate to severe eczema too. I'm on basically the same regiment as you, minus the dupilumab because my insurance is acting up on me. I'm personally a big fan of Vaseline as it's more of an "ointment" than cream and feel like it moisturizes better. I really only had one bad flare up during my surgery rotation (lots of scrubbing in the middle of winter while also only getting like 5 hours of sleep per night), and oral steroids knocked that down real fast. Not sure if you've done a trial of an oral steroid. Betadine with a plain scrub brush felt better in general than Avagard or the premade scrub brush for me at least.

I honestly did very fine because I was so busy having fun doing real medicine third year that it kind of helped distract me from any itches. Considering you're on dupilumab, you'll probably fare even better than I did. If you need to reach out, DM me.

Agreed, any petroleum-jelly stuff really serves as good barrier protection.

 

[sflanigan23]

Idk what the rules wherr your doing your rotations but I wear two pairs of gloves. I wear one really tight ones (xs) and then another on top (s) and just switch out the top pair, you can even use hand sanitizer on the bottom gloves if you really want. But I just put a **** ton of lotion on my hands and then keep the bottom pair of glove on so they aren’t “exposed” to all the things that could mess up my hands

you could also try hand sanitizer with aloe? I think that’s a little more moisturizing