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THE ECZEMA PODCAST SEASON 2, EPISODE 5 TRANSCRIPT:
Abby: Hi everyone. I am here with Dr. Peter Leo. You may have seen him from one of my podcast episodes that I’ve done. I’ve done two with him. And today we’re going to talk about pregnancy and eczema.
Dr. Leo is very well-versed in eczema. He’s a dermatologist and I know that he works with a lot of eczema patients. Thank you so much Dr. Leo for being here today.
Dr. Leo: It’s my pleasure. Thank you for having me.
Abby: No problem. I know a lot of people are really curious to see how the linkage between pregnancy and eczema is and how it actually works. Because sometimes people flare up and then sometimes people don’t during pregnancy. I guess I just want to talk a little bit more about this with you and to find out more about it.
Dr. Leo: It is a really interesting area. And I will say that when you look at the studies it’s sort of a mixed bag. About half the patients seem to get better or stay the same, and the other half gets worse or stays the same. So it’s sort of this even split.
In my experience that really does fit with my clinical experience. When patients say, “What do you think is going to happen?” I say I just don’t know. It might be not much different, it might get really bad. Or some people, the lucky ones really go through a really nice remission phase and they’re just totally blissful and happy during their pregnancy.
But it’s really strange we don’t understand why, because the hormones probably are doing a lot of things at once. And depending on the type of eczema that somebody has and their particular triggers it could make it better or worse.
Abby: Do you find that, let’s say if someone gets better in one trimester could they possibly get worse in another one?
Dr. Leo: Yes, that is possible. There are a couple of skin conditions that are also associated with pregnancy that can bring out eczema and make it much worse. One of the things that we see is a thing called cholestasis of pregnancy. And that’s a terrible itch.
There’s a little bit of slowing down of the movement of the liver and the gall bladder. And so you kind of retain some of these metabolic breakdown products that your body is supposed to be getting rid of. And by retaining them you get itchy. And so this itch can be a terrible trigger for patients who already have an atopic dermatitis or sensitive skin.
There’s also a thing called an atopic eruption of pregnancy which is a version of atopic dermatitis but it’s a little bit more limited in pregnancy. Many of the patients had a history of AD or something like it, but that can happen.
And then of course we have a thing called PUPPP which a lot of people have heard about, maybe the most common pregnancy-related dermatoses. And it stands for pruritic urticarial papules and plaques of pregnancy.
And that’s interesting because that usually happens in the third trimester. So people could be doing great or coming along great with their pregnancy. And then in the third trimester, bam, they get these terribly itchy bumps.
Usually it starts on the belly. And classically it starts actually in the stretch marks happening on the belly. And it can drive people crazy. And I had a number of patients who are just miserable. They’re so itchy and uncomfortable. If they already have atopic dermatitis then they’re incredibly miserable. They’re scratching, and rubbing, and everything so nuts.
Abby: Oh no. That sounds really difficult. If someone flares up in one pregnancy does that mean that they’re going to flare up if they have another pregnancy or does it change?
Dr. Leo: It definitely changes. And I’ve had people who say their first pregnancy was terrible, their second pregnancy was great, and the opposite. It’s really unpredictable. I think the disease is confusing. There are so many different triggers.
A lot of times patients will say, “I want that one root cause.” You know I’m interested in this maybe more than anybody, except for the patients who suffer constantly with it.
What I find is that it’s not an easy an answer to it. There are probably multiple factors driving it. And so that’s why it makes sense to a certain extent that pregnancy which is really shaking everything up could be good for some people and bad for others, and even pregnancy to pregnancy.
Of course we know things like nausea can also vary significantly from pregnancy to pregnancy. One time the person says she was just miserable the whole pregnancy, then next time they say, “I didn’t feel sick at all.” It’s again strange like that.
Abby: I would love to know what type of treatments you usually use when someone does have a flare up during pregnancy and what they can do to calm their skin down.
Dr. Leo: It is one of the hardest things because during pregnancy we have to be extra careful. We don’t want to put the baby at any undue risk. We don’t want to put the mother at any extra risk. So we often show that we’re fighting with one hand tied behind our back.
We do feel that topical steroids are okay to use in pregnancy. Generally we don’t want to use the most potent ones if we don’t have to. And ideally we want to keep the body surface area we’re using relatively low.
So long as we do those things we feel like the baby probably can’t even detect and difference. We know that people absorb topical steroids in their blood if you use enough over a large surface area. But if you don’t generally you can’t tell it from the normal cortisol that our body makes each day. If we’re careful about it it should be totally safe.
We’ve had this for more than 50 years. And even though people hate steroids it’s a natural product. So to some extent your body knows exactly what this is, exactly what to do with it. But if we can avoid that or minimize it that’s important.
Sometimes we’ll lean on things like light therapy, phototherapy much more quickly in pregnancy because especially if somebody is covered in atopic dermatitis I don’t want to have them putting this all over. I certainly don’t want to put them on prednisone if I don’t have to. And we can’t use the big guns if you will, like cyclosporine and azathioprine, methotrexate, they’re all not able to be used during pregnancy.
We’ll often have people do light therapy, which is really great and really safe. It’s basically filtered sunlight. So if you can go out in the sun you can get light therapy. Very safe and gentle. It helps with itch really quickly too.
You can use things like sedating and the histamines, things like hydroxyzine or Benadryl to help you sleep at night and calm things down. We love all of our physical modalities like ice packs and cooling, wet wraps. We like using great moisturizers. Of course that’s critical to get that skin barrier strong and happy.
And then there are some anti-itch creams that you can use in small amounts. Things like Sarna which is camphor and menthol. We can’t use too much. We don’t want to absorb too much. But little areas can be really cooling and soothing. And usually we can get people through it with those things.
Abby: Okay, that’s great. And then if people are looking for something even more natural, they really want to avoid the medicine route are there any suggestions that you usually provide with them?
Dr. Leo: You know I’m a big fan of coconut oil. I’m a big fan of sunflower seed oil. Those are two of my favorite oils. As long as you’re not allergic those are awesome. They help the skin barrier. Coconut oil is actually anti-bacterial as well to a certain extent which is really cool.
I also like the concept of doing bath oils. And there are a couple of new bath oil products on the market that you can kind of soak in the tub. Dilute bleach pads are sort of on the border of natural but I still think they’re pretty amazing. And it turns out that very dilute bleach, which again sounds a little spooky. It’s like, “Ah, bleach.” But if you go on the swimming pool you’ve done a bleach bath already. You’ve done a whole bunch.
And what’s cool about it is that there is a recent paper last year that showed it’s not just anti-bacterial that it’s helping, it is actually anti-inflammatory and anti-itch directly.
And so it’s kind of neat. You can have people just do either a compress. If it’s just localized areas or you can have them soak in the tub for a little bit, very, very safe and very gentle. If people are nervous about bleach, or occasionally people find that it’s irritating, particularly people with asthma don’t like the bleach. The smell gets to them. Then we can talk about using a dilute apple cider vinegar bath which is kind of neat. And I do that for a number of patients.
And then for people that want to get really natural and avoid all this kind of stuff we have a concoction that we’ve looked up that is topical vitamin B12. Vitamin B12 is a water soluble vitamin. It’s super-duper safe. You can’t really overdose on it. And so we’d mix this up in Shea butter base. We call it pink magic because it comes out of this really bright shocking pink color. But it’s really good and very, very soothing.
Another similar product on the market that you can get more widely available is a product, it goes by the brand Florasone, which sounds kind of like a cortisone but it’s not. I think they did that on purpose so people would think this is like cortisone. But actually it’s not. It’s a plant extract. And the plant extract is called cardiospermum extract.
Anti-inflammatory, anti-itch, very, very safe. And, again, I’d feel very comfortable if the person who’s pregnant to use that on their skin.
Abby: That’s great. I saw a recent article that said that sunflower seed and olive oil weakens the barrier of the skin. I wasn’t sure about that. I know you’ve seen the effectiveness in some patients. I don’t know if you’ve heard anything about studies like that.
Dr. Leo: I did see that study and I thought that was a terrible study and really an unfair study. It was super small. It actually was not powered to look at any clinical findings. What they actually did was they used a surrogate marker for skin barrier.
It’s a really crummy marker that is not well-studied. And they did this goofy test and said, “Well, when we put the sunflower seed oil the test thing kind of went down. So that would suggest it’s bad, and therefore you shouldn’t use it.”
What really upsets me is that a lot of evidence-based medicine proponents, which over time, one for sure… I don’t want to do crazy things that don’t have some studies support it. But they would get very upset if I bring up things like coconut oil.
There are only a few studies that show it helps. That’s not enough. We need a lot of studies before you make a big proclamation. And I say I don’t make a proclamation. I make a suggestion. I said this is the exact thing that they’re blaming us for all the time, doing it the opposite direction.
They have one goofy study that has some finding and they’re making a proclamation. This is dangerous. We should avoid this. But I really do think there’s a push to try to dispel that alternative concept because I think it’s scary. I think a lot of traditional practitioners are frightened of it. It’s overwhelming. It’s scary. It’s difficult. It’s time consuming to talk to a patient.
Because, of course if you bring all alternative medicine into a discussion you could talk all day. It’s like, “Well, what do you think about vinegar? What do you think about the spas? What do you think about this thing I saw on the internet? What about this plant extract?” You could go all day.
And so I think one way to sort of get rid of it is just to say it’s garbage. It’s debunked. Get it away from us. And so I think there’s that pressure.
But to that point I think sunflower seed oil actually has enough support that it is probably okay. I don’t think that’s good advice to totally avoid.
And olive oil, we’ve talked about it before, there are some studies that suggest it may not be good for the skin barrier. That might be on point to sort of avoid that one.
Abby: Okay, that’s actually really interesting. That’s good to know. I had some readers ask me about that as well. After people usually give birth, like if flared up during their pregnancy, how does it usually work post pregnancy?
Dr. Leo: For many people once they deliver they feel better very, very quickly. The hormones start to reset quickly. So hopefully that’s going to happen after flaring. For a few patients who are unlucky it does go on and on and on.
And, again, we take it each day at a time and we do everything we can to break that cycle. My philosophy very much is that you can create a vicious cycle with atopic dermatitis. And that you can also therefore break that cycle.
And so if we are aggressive and stop this itch scratch, stop the inflammation we can really help. And so at the first sign of it I try to be very aggressive and cool things down because I am afraid that if we don’t we’re going to be going on for weeks or months.
Abby: That definitely makes a lot of sense. It sounds like we are quite limited to what we can do but there are some things that can still be done during pregnancy. And it’s very individualized for each person as to whether they all flare up or not. But I guess the key is just managing it.
Dr. Leo: Absolutely.
Abby: Do you have any last words of advice for people who might be going through a flare up during pregnancy?
Dr. Leo: It is always challenging. Don’t be afraid to reach out. And don’t be afraid to use your medicine. So long as your doctor is coaching you through it… I think some patients are just so worried they say, “Gosh, I don’t want to use anything unnatural during the pregnancy.”
I totally get it. But I think that if god-forbid the eczema flares up bad enough that you get an infection and you’re in the hospital getting antibiotics. It’s like, my golly, that was probably too far and we’ve actually hurt ourselves in spite of trying out ourselves.
Getting on top of it and try and control it as best we can I think is worthwhile and may prevent having to use more dangerous things for the pregnancy,
Abby: That’s good advice. I think if it does get to a serious point, even just a little bit of medication might be necessary.
Dr. Leo: For the suffering or the poor moms. Moms go through a lot of stuff, and so they don’t need any more reasons to suffer. They need to be at their strongest and their best especially when the baby comes out. Because then their job really doubles in intensity. I think that I want them to be happy, comfortable, healthy, and more rested.
Abby: Thank you so much for speaking on this topic about pregnancy and eczema. It was definitely very useful. And I’m sure it’ll help a lot of my listeners as well. So thank you so much.
Dr. Leo: Thank you.
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Abby is a Registered Holistic Nutritionist who helps clients achieve optimal health. She is passionate about seeing people use health and nutrition to transform lives. She hopes that her experiences and knowledge can help educate others on natural remedies that will help eczema. Follow her on Twitter, Facebook, Pinterest, Instagram, or YouTube for more updates!
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