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Two-Part Eczema Treatment
Good afternoon everyone,
I’ve been working on a treatment for someone with chronic and widespread eczema and I’ve found a combination that has shown minor results so far.
First, a 40% Urea Lotion is applied to eczema flare ups and left on for 20 minutes. Next, they shower to remove the cream and use a soft cloth to gently exfoliate their flare ups. Lastly, they apply a Colloidal Oatmeal & Ceramide Moisturizer.
The idea is that a high concentration of urea would act as a keratolytic agent and soften the top layer(s) of the flareups. Then that top layer could be gently removed in the shower and the skin underneath would be moisturized by the second product. I also expect that the petrolatum, mineral oil, and ceramides would help restore the skin’s barrier function. As a whole I hope the treatment will slow the skin’s turnover rate and help reduce the size of flare ups.
I consulted with a dermatologist before starting the treatment to be sure I wouldn’t be making anything worse. He recommended I add ceramides and HA (not convinced HA is doing any more than glycerin is) to the second step but besides that he said everything looked safe.
Results:
After a 3 weeks of use they said their flare ups felt less rough. At 5 weeks their flareups had more pigmentation (severe flare ups on African American skin look grayed out). At 6 weeks I took a look at the pictures before they started the treatments and I think the flare-ups have shrunk slightly but it isn’t very noticeable change. They have an overall decrease in itchiness.
I expected the treatment to have a more rapid effect. Because of this I’ve been a bit disappointed with the results (but hey at least I didn’t make it worse). Which leads me to my post and the following questions.
Questions:
1) Is my understanding of how these products are affecting the skin sound?
2) Is there anything in my post that is incorrect/unclear?
3) Is there anything in the formulas you would change for better efficacy?
4) I’m thinking of increasing the time between applying the urea lotion and showering. How long can a 40% urea lotion be safely left on skin?
5) Does anyone have other ideas for reducing the size of flare ups?
6) How has your day been so far? : )I’m about to leave work in a few minutes so I might not reply today but I will be sure to reply tomorrow.
Urea Lotion:
DI Water 34.1998Carbomer 980 0.2500Light Mineral Oil 3.9000Snow White Petrolatum 10.0000Glyceryl Stearate SE 3.4000Cetyl Alcohol 5.0000Propylene Glycol 0.5000Xanthan Gum 0.0002Urea 40.0000Phenoxyethanol (and) Ethylhexylglycerin 1.000Vitamin E Acetate 0.500NaOH 1.2500Packaged in a plastic squeeze tube.pH = 6.56
Colloidal Oatmeal & Ceramide Cream:
DI Water 57.600 Ceramide EOP (and) Ceramide NS (and) Ceramide NP (and) Ceramide
AS (and) Ceramide AP (and) Cholesterol (and) Hydrogenated Lecithin (and)
Glyceryl Stearate (and) 2,3-Butanediol3.000 Acrylamide/Sodium Acrylate Copolymer (and) Paraffinum Liquidum
(and) Trideceth-60.800 Disodium EDTA 0.100 C12-15 Alkyl Benzoate 1.500 Glyceryl Stearate (and) PEG-100 Stearate 2.500 Cetearyl Alcohol 2.500 Glycerin 4.000 Petrolatum 5.000 Shea Butter 1.000 Mineral Oil 1.500 Dimethicone 10000cst 3.000 Glycereth-26 1.000 DI Water 10.000 Colloidal Oatmeal USP 1.000 Aqua (and) Sodium Hyaluronate (1% Solution) 2.000 Sodium PCA (and) Wheat Amino Acids (and) Panthenol (and)
Glycerin (and) Sodium Hyaluronate (and) Hydroxyproline2.500 Benzyl Alcohol (and) Benzoic Acid (and) Sorbic Acid 1.000 Triethanolamine q.s Packaged in a plastic jar.
pH = 4.96 -
26 Replies
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@Adamnfineman
Eczema (or dermatitis) is a very vague term. What is the exact diagnosis? The treatment will depend on the diagnosis. How do those flare ups look/ Can you describe them in detail? At what parts of the body do those flare ups occur?
A cursory glance - it looks like 40% Urea is too much. This % is usually used on the nails or on the thick skin type (palms or soles).
I am afraid that this kind of treatment stimulates the skin cells’ turnover instead of results you expect, because Urea at 40% works as a strong keratolytic (reed peeling). Why do you need to slow the skin’s turnover? Does your patient have psoriasis? -
@Adamnfineman
Re: Oatmeal cream
I would rid of the following:
-Shea butter (stimulates irritation in those with eczematous lesions)
-Oatmeal (can also be additional irritant for the patients with skin diseases)
You may also probably need to replace the preservative system for paraben blends (the current one can be a severe irritant). TEA replace with TRIS Amino or Arginine.
I would also increase Petrolatum ( up to 7-10% depending on formulation), Glycerin up to 6-7. -
Keep in mind that many people with eczema have a mutation in a gene that helps the skin maintain a healthy barrier with the external environment. Since their skin barrier is more porous, their immune system overreacts to certain substances, leading to eczema symptoms. Different sorts of situations can trigger disease flares. Medication is usually given to tame the overactive immune response in the form of cream (corticosteroids) for small lesions or IL-13 inhibitors for serious outbreaks. A cream or lotion may be used to help the skin from drying, but is unlikely to cure eczema.
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@Syl It depends on the type of eczema. IL-13 inhibitors are effective in type1 hypersensitivity (it most often manifests in a form of asthma outbreaks, angioedema, anaphylaxis) while corticosteroids play role in therapy as immunosuppressants to inhibit the immune response. We don’t know the exact diagnosis in this current case. It looks like our colleague deals with some chronic disorder.
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@Vitalis, agreed, he should visit a dermatologist.
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I would say make only one product with 5% petrolatum+ 20% glycerin+ pH 4-4.5+ if you want 0.5% salicylic acid for anti inflammation
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vitalys said:@Adamnfineman
Eczema (or dermatitis) is a very vague term. What is the exact diagnosis? The treatment will depend on the diagnosis. How do those flare ups look/ Can you describe them in detail? At what parts of the body do those flare ups occur?Good morning @vitalys,
They were diagnosed with atopic dermatitis, the flare ups occur at the creases of the elbows and knees, on the wrists/hands, on the back of the thighs, on the neck, and on the upper lip. They look like darker patches of rough dry skin, no flaking off skin. They have gone to a dermatologist who has prescribed a 0.05% fluocinonide cream to use if the flare ups become more severe.I don’t feel comfortable sharing their pictures but this is one from google that is similar.
vitalys said:A cursory glance - it looks like 40% Urea is too much. This % is usually used on the nails or on the thick skin type (palms or soles).
I am afraid that this kind of treatment stimulates the skin cells’ turnover instead of results you expect, because Urea at 40% works as a strong keratolytic (reed peeling). Why do you need to slow the skin’s turnover? Does your patient have psoriasis?I had originally made a 20% urea cream with similar ingredients but was told that if they tolerated it well I could increase it to 40%. They haven’t had any desquamation from this though. I may be wrong but I thought eczema flare ups were caused by having an impaired skin barrier and the dry skin on the surface is layers of skin prematurely dying. The idea was to remove the dead skin on the surface and moisturize the skin underneath. I assumed if I could keep the skin moisturized it would slow the skin’s turnover.
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vitalys said:@Adamnfineman
Re: Oatmeal cream
I would rid of the following:
-Shea butter (stimulates irritation in those with eczematous lesions)
-Oatmeal (can also be additional irritant for the patients with skin diseases)
You may also probably need to replace the preservative system for paraben blends (the current one can be a severe irritant). TEA replace with TRIS Amino or Arginine.
I would also increase Petrolatum ( up to 7-10% depending on formulation), Glycerin up to 6-7.I can remove the shea butter and increase the petrolatum/glycerin. The TEA isn’t actually in the formula my bad, the pH was in an acceptable range without it I forgot to remove it.
I thought oatmeal was recommended to help soothe irritation for people with eczema? I’d like to read up on that, do you have a source for this?
I have heard of sensitization from PE9010 and I was planning on changing preservatives but was reassured by @MarkBroussard in another post that he was working on an eczema suite and this preservative blend was the most well received. Also the paraben blends I tried greatly reduced the viscosity of the emulsion.
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Syl said:Keep in mind that many people with eczema have a mutation in a gene that helps the skin maintain a healthy barrier with the external environment. Since their skin barrier is more porous, their immune system overreacts to certain substances, leading to eczema symptoms. Different sorts of situations can trigger disease flares. Medication is usually given to tame the overactive immune response in the form of cream (corticosteroids) for small lesions or IL-13 inhibitors for serious outbreaks. A cream or lotion may be used to help the skin from drying, but is unlikely to cure eczema.vitalys said:@Syl It depends on the type of eczema. IL-13 inhibitors are effective in type1 hypersensitivity (it most often manifests in a form of asthma outbreaks, angioedema, anaphylaxis) while corticosteroids play role in therapy as immunosuppressants to inhibit the immune response. We don’t know the exact diagnosis in this current case. It looks like our colleague deals with some chronic disorder.
Thank you for the informative responses. They do have a very sensitive immune system, they have many allergies. They occasionally have asthma outbreaks, and angioedema when coming in contact with allergens. They definitely get minor anaphylaxis a few hours after eating shrimp or tomatoes (No matter how many times I tell them not to).
Abdullah said:I would say make only one product with 5% petrolatum+ 20% glycerin+ pH 4-4.5+ if you want 0.5% salicylic acid for anti inflammationThank you for replying, I might make something simpler like this in the future.
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@Adamnfineman Thank you for the detailed picture.
Good news it is not psoriasis. Bad news is that disease affects large surfaces of the body. You are completely correct that moisturizing along with the skin barrier recovery slows down the basal cell’s turnover. However, the repeated applications of the highly concentrated Urea solutions work as a skin peel making cells to divide even faster. The principle of “slowly but surely” (in terms of dead cells removal) will be more efficient in atopic dermatitis patients. Since your first formulation is a rinse-off product, consequently you use only keratolytic properties of Urea, not moisturizing here. I also surmise that the current treatment plan may become too complicated, annoying and inconvenient for your patient, which can lead to nonadherence and failure of the therapy later.
Why not formulate a formula that can combine all key actives in one comfortable cream/lotion or even a spray? You may combine the following:
Urea - 10-12%
Glycerol - 7%
Petrolatum up to 10%
Ceramide combo - 3% (as you already use)
Lactic acid -2-3%
Caprilic/Capric triglycerides and/or Stearic acid - as a source of fatty acids to maintain the lipid barriers along with ceramides.
Squalane -2-3% or Hemisqualane
You may also consider the use of Laureth-9 or 7 -3-4%(sometimes the latter gives some more pronounced effect) as antipruritic agents.
In order to make the final product even more efficient and prolong the activity of the active ingredients and keep the occlusive film on the skin, which will work as an artificial protective layer, it would be better to use w/o emulsion with modern w/o emulsifiers as Cithrol PGTL(combining it with Laureths you will get a liquid o/w emulsion for spray application, which will maintain the quite resistant occlusive film) or similar.
Keep emulsion at pH 4-4.20. Use Triacetin or Triethyl Citrate (better) for Urea stability.
Re: Patient’s immunity
I am sorry that they don’t follow the recommendations, which are essential for the allergic patients. They have to keep to the correct diet and avoid contacts with allergens. That is why we usually exclude all the ingredients that can be potentially irritating. If they already had an episode of the anaphylaxis in the past, the next episode may lead to fatal results. If they don’t follow the recommendations the use of any topical products doesn’t show the full efficacy as the allergic inflammatory mediators are continuously produced by cells… Unfortunately, the oatmeal (I assume due to its popularity) shows some negative results in patients with sensitive skin or allergic patients or in patients with food allergies. -
@Abdullah
When it comes to the massive chronic skin barrier disruption, especially when they emerge on the large surfaces of the skin, salicylic acid is rarely used to avoid the risk of salicylism and furthermore the applications of salicylic acid solutions may be too painful on the damaged skin and provoke even more severe inflammation. The feasible therapeutic effects start at 2% and up. However, it is useful sometimes when the scalp is involved in the rinse -off applications. -
vitalys said:I also surmise that the current treatment plan may become too complicated, annoying and inconvenient for your patient, which can lead to nonadherence and failure of the therapy later.
@vitalys
You hit the nail on the head here, it was a struggle at first to make sure they were adhering to the treatment plan. I will definitely take your advice and look into making just one product that can be quickly and easily applied.vitalys said:Why not formulate a formula that can combine all key actives in one comfortable cream/lotion or even a spray? You may combine the following:
Urea - 10-12%
Glycerol - 7%
Petrolatum up to 10%
Ceramide combo - 3% (as you already use)
Lactic acid -2-3%
Caprilic/Capric triglycerides and/or Stearic acid - as a source of fatty acids to maintain the lipid barriers along with ceramides.
Squalane -2-3% or Hemisqualane
You may also consider the use of Laureth-9 or 7 -3-4%(sometimes the latter gives some more pronounced effect) as antipruritic agents.
In order to make the final product even more efficient and prolong the activity of the active ingredients and keep the occlusive film on the skin, which will work as an artificial protective layer, it would be better to use w/o emulsion with modern w/o emulsifiers as Cithrol PGTL(combining it with Laureths you will get a liquid o/w emulsion for spray application, which will maintain the quite resistant occlusive film) or similar.
Keep emulsion at pH 4-4.20. Use Triacetin or Triethyl Citrate (better) for Urea stability.Thank you for taking the time to write this all out. I like the idea of a spray on product. We have everything on hand except Laureth-9/7 and Cithrol PGTL.
Though I’ve read about it in several threads here, I’ve never personally made a w/o emulsion. Do you have any tips?
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Adamnfineman said:The idea is that a high concentration of urea would act as a keratolytic agent and soften the top layer(s) of the flareups. Then that top layer could be gently removed in the shower and the skin underneath would be moisturized by the second product.Quite the opposite, wear loose clothes and avoid friction.
Use soap free or very mild cleanser/shampoo or in some cases only rinse the lesions with warm water.
Moisturizer 2-4 times a day.Adamnfineman said:0.05% fluocinonide cream to use if the flare ups become more severe.Yes, continue.
Adamnfineman said:vitalys said:I also surmise that the current treatment plan may become too complicated, annoying and inconvenient for your patient, which can lead to nonadherence and failure of the therapy later.@vitalys
You hit the nail on the head here, it was a struggle at first to make sure they were adhering to the treatment plan. I will definitely take your advice and look into making just one product that can be quickly and easily applied.vitalys said:Why not formulate a formula that can combine all key actives in one comfortable cream/lotion or even a spray? You may combine the following:
Urea - 10-12%
Glycerol - 7%
Petrolatum up to 10%
Ceramide combo - 3% (as you already use)
Lactic acid -2-3%
Caprilic/Capric triglycerides and/or Stearic acid - as a source of fatty acids to maintain the lipid barriers along with ceramides.
Squalane -2-3% or Hemisqualane
You may also consider the use of Laureth-9 or 7 -3-4%(sometimes the latter gives some more pronounced effect) as antipruritic agents.
In order to make the final product even more efficient and prolong the activity of the active ingredients and keep the occlusive film on the skin, which will work as an artificial protective layer, it would be better to use w/o emulsion with modern w/o emulsifiers as Cithrol PGTL(combining it with Laureths you will get a liquid o/w emulsion for spray application, which will maintain the quite resistant occlusive film) or similar.
Keep emulsion at pH 4-4.20. Use Triacetin or Triethyl Citrate (better) for Urea stability.Thank you for taking the time to write this all out. I like the idea of a spray on product. We have everything on hand except Laureth-9/7 and Cithrol PGTL.
Though I’ve read about it in several threads here, I’ve never personally made a w/o emulsion. Do you have any tips?
Keep it simple as they will have to continue for months.
Comfortable cream/lotion or even a spray - yes, comfortable as they will have to apply it 4 times a day. spray - no experience, no comment.
Ceramides and HA or other active is optional, depends on their budget, normal 5% urea cream works well too as long as they apply it regularly.
You may have to work on their cleanser as well.
If still no improvement, they might have to consult with board certified dermatologist who specialized in people of colour’s skin.
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@Adamnfineman
Cithrol PGTL is from Croda and they offer very detailed TDS along with the basic formulations. I find it the easiest w/o emulsifier especially for HIPE (high internal phase emulsion) and you can incorporate up to 80% of water to get stiff gel like cream. As with any other w/o emulsifiers add salts (Mg2SO4, etc), and I highly recommend the homogenization in the end of the process. When you pair it with high HLB emulsifier you will get o/w emulsions. Another alternative could be silicone-based w/o emulsifiers such as Cetyl PEG/PPG-10/1 Dimethicone.
Laureths may vary from manufacturer to manufacturer. If you are in the US L-9 from Nikkol (Barnet) and from Omya Kinetik seem to show the best results. L-7 from Protameen. -
@Pattsi Excellent input! Loose clothes are a must. The choice of the right cleanser is also important.
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@Adamnfineman Probably, you’ll find this clinical report interesting to read
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Pattsi said
Keep it simple as they will have to continue for months.
Comfortable cream/lotion or even a spray - yes, comfortable as they will have to apply it 4 times a day. spray - no experience, no comment.Ceramides and HA or other active is optional, depends on their budget, normal 5% urea cream works well too as long as they apply it regularly.
You may have to work on their cleanser as well.If still no improvement, they might have to consult with board certified dermatologist who specialized in people of colour’s skin.
@Pattsi Thank you for taking the time to reply.
I’m going to omit the HA from the next formula but I’ll keep the ceramides because cost isn’t a factor. They use Cetaphil Gentle Skin Cleanser as their body and hand cleanser. I think that’s mild enough, what do you think?
vitalys said:@Adamnfineman
Cithrol PGTL is from Croda and they offer very detailed TDS along with the basic formulations. I find it the easiest w/o emulsifier especially for HIPE (high internal phase emulsion) and you can incorporate up to 80% of water to get stiff gel like cream. As with any other w/o emulsifiers add salts (Mg2SO4, etc), and I highly recommend the homogenization in the end of the process. When you pair it with high HLB emulsifier you will get o/w emulsions. Another alternative could be silicone-based w/o emulsifiers such as Cetyl PEG/PPG-10/1 Dimethicone.
Laureths may vary from manufacturer to manufacturer. If you are in the US L-9 from Nikkol (Barnet) and from Omya Kinetik seem to show the best results. L-7 from Protameen.@vitalys
Thank you for the tips and suggesting more emulsifiers, I’ve ordered some samples so now we wait.vitalys said:@Adamnfineman Probably, you’ll find this clinical report interesting to readThis was a very informative and properly conducted report. Thank you for sending it.
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As much as I appreciate the help, I’m very disappointed none of you answered question 6.
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@Adamnfineman LOL Thank you! My day has just begun but I bet it is going to be alright
Re: Cetaphil. It is very simple (which is good). I hope your patient’s skin tolerates SLS - that is good news too. If not, there are plenty of “milder” solutions, including the relatively new surfactants like Lauroyl Glutamic Acid’s salts, which are also known as Amino soaps (very popular in Korea, Japan, etc). What I like is that the formulations based on LGA have low pH and allow you to incorporate some useful actives - acids, etc. They also look very attractive to a user - like a regular clear soap bar. The people with skin problems love it despite the price. -
vitalys said:@Adamnfineman LOL Thank you! My day has just begun but I bet it is going to be alright
@vitalys
I’m very glad to hear that! ::smiley:vitalys said:Re: Cetaphil. It is very simple (which is good). I hope your patient’s skin tolerates SLS - that is good news too. If not, there are plenty of “milder” solutions, including the relatively new surfactants like Lauroyl Glutamic Acid’s salts, which are also known as Amino soaps (very popular in Korea, Japan, etc). What I like is that the formulations based on LGA have low pH and allow you to incorporate some useful actives - acids, etc. They also look very attractive to a user - like a regular clear soap bar. The people with skin problems love it despite the price.Did you mean SCI? According to the ingredient list on amazon and cetaphil’s cite there isn’t any SLS in there. The ingredients are: Water, Glycerin, Cetearyl Alcohol, Panthenol, Niacinamide, Pantolactone, Xanthan Gum, Sodium Cocoyl Isethionate, Sodium Benzoate, Citric Acid.
If I do have to make a cleanser for them I will see if I can get some samples of those surfactants. Do you know of a product that includes it so I can take a look?
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@Adamnfineman No, I meant the link you shared. The product contains: water, cetyl alcohol, propylene glycol, sodium lauryl sulfate, stearyl alcohol, methylparaben, propylparaben, butylparaben.
So SLS is the only active surfactant here. Frankly, despite the fact that SLS is still demonized, it works great when properly formulated even for the sensitive or injured skin.
However, SCI works great for the conditions that your patient has too.
As for LGA I don’t know any suppliers in the US. This surfactant had been introduced by Ajinomoto long before it appeared in the US. It is also available from Chinese manufacturers. -
@vitalys Cetaphil Gentle Skin Cleanser formulation changed recently. In the US, anyway. The SLS version is the old one, SCI is the new one. They also got rid of the parabens.
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@justaerin Thank you for the clarification
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My day has been good so far (I guess), thank you for asking, how’s yours?
Cetaphil, CeraVe, Aveeno, Sebamed, … is fine, just avoid soap-based or soap bar. One has been switching to shower oil and they say it good for them so there’s this option too if budget is no concern.
Life style adjustment is also advised, no smoking, less alcoholic drinks, more veggies, light exercise regularly, avoid direct sun exposure, avoid stress and no scratching please.Encourage moisturization.
Keeping track of daily life, make a note which products/foods they have been using/eating. Accurate information would be useful if they were to see dermatologist next time.
Wishing them well very soon.
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Pattsi said:My day has been good so far (I guess), thank you for asking, how’s yours?
@Pattsi
I’m also good, a little hungry though.Cetaphil, CeraVe, Aveeno, Sebamed, … is fine, just avoid soap-based or soap bar. One has been switching to shower oil and they say it good for them so there’s this option too if budget is no concern.Life style adjustment is also advised, no smoking, less alcoholic drinks, more veggies, light exercise regularly, avoid direct sun exposure, avoid stress and no scratching please.
Encourage moisturization.
Keeping track of daily life, make a note which products/foods they have been using/eating. Accurate information would be useful if they were to see dermatologist next time.
Wishing them well very soon.
I’ll relay all of this information to them, thank you. The amount of scratching has been a struggle to deal with but I remind them every time I catch them. They moisturize morning and night and sometimes in between if they feel they need.
I’ll ask them to start logging their food intake and see if making certain changes would help. I’ll pass along your well wishes too, thank you!
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