How to care for your sensitive skin, including eczema and psoriasis

[Intro] Hey, everyone. Welcome back to Facially Conscious with myself, Trina Renea, esthetician, Dr. Vicki Rapaport, dermatologist, Rebecca Gadberry, the cosmetic ingredient guru, and our fabulous, overly-educated consumer, Julie Falls. We are gathered here together with you to talk about this crazy world of esthetics. It's confusing out there in this big wide world. 

That's why we are here to help explain it to you all, subject by subject. We will be your go-to girls, and from our perspective without giving medical advice, we will keep things facially conscious.

Let's get started. 

00:59 Julie Falls: Welcome to Facially Conscious. I'm Julie Falls. Hi, ladies. 

01:03 Trina Renea: Hi. 

01:04 Dr. Vicki Rapaport: Good morning. 

01:04 Rebecca Gadberry: Hello. 

01:05 Julie Falls: We are going to talk today about how to care for your sensitive skin. We're also going to talk a little bit about eczema. 

01:16 Trina Renea: And psoriasis. 

01:17 Julie Falls: And psoriasis, yes. You know, depending upon what time of year it is, our skin goes through so many different changes. Let's get right to it with Dr. Vicki Rapoport, who is our board-certified dermatologist. She's going to give us a little tip about what we can do if we have a sensitive skin. Vicki. 

01:36 Dr. Vicki Rapaport: My favorite tip of the minute is to have a very thick moisturizer, hand cream, body cream, whatever your area of sensitivity is next to your bed, i.e., I have a jar of Vaseline for my dry hands in the winter. And when I'm ready to fall asleep, not before I actually even get into bed, when I'm actually in bed and ready to fall asleep, I then reach over, I grab my jar of Vaseline, I take the most obnoxiously large dollop and I rub it all over my hands because it's the only time of the day that I could handle it. It's so greasy, right? Because I'll be sleeping and I won't know the difference. 

Sometimes I'll put a little tiny, tiny bit with a finger tap on my eyes and I fall asleep. And in the morning, my hands are very hydrated.

02:24 Trina Renea: But doesn't it get all over your sheets and pillows? Do you put little…

02:27 Julie Falls: Socks on it.

02:28 Trina Renea: Socks or like hand moisturizer?

02:30 Dr. Vicki Rapaport: I'm sure it gets all over everything. I don't care. I need it. It's the only thing that's going to work.

02:36 Trina Renea: My daughter gets really dry hands and I have her put the Aquaphor all over, and I bought her these little tiny thin moisturizer gloves from Target. 

02:43 Julie Falls: Or I put tube socks on my hands. 

02:45 Trina Renea: Or socks, yeah. 

02:46 Dr. Vicki Rapaport: Socks is great. We have parents do that for little kids. To me that's just an extra step I'm not willing to do, but, yes, I do love that extra step. 

02:53 Trina Renea: I put them on my feet too. I'll rub it on my feet and put socks on.

02:56 Dr. Vicki Rapaport: Beautiful. I'm into it. 

02:58 Trina Renea: I like it. 

03:00 Julie Falls: So, right now we're in the colder months. Are you seeing in your practice, Dr. Vicki, and your practice, Trina— Trina Renea is our skin master. 

03:11 Trina Renea: Hello. 

03:12 Julie Falls: We're also here with Rebecca Gadberry, our legendary skin care pioneer. 

03:15 Rebecca Gadberry: Hello.

03:16 Julie Falls: And I'm Julie Falls, a highly educated consumer. Tell us a little bit about how skin reacts to the different seasons, different weather. What are you seeing now in your practice? 

03:28 Dr. Vicki Rapaport: So much eczema. So much itchy skin. So much “winter itch”. It's kind of sad in a way that it's so unknown, I think, as a diagnosis, because I feel like it's pretty easy to treat. Hopefully, maybe today, after today, people will be educated about it and tell their family members, because I feel like you don't necessarily, unless it's really, really bad, you don't necessarily have to see the dermatologist. 

Early stages of eczema can be treated by over-the-counter products. But, yes, right now, lots of eczema flares. 

I'm so amazed. The first question I ask patients with eczema is, what do you use to moisturize? And they look at me like they're confused. “What do you mean? I have to moisturize?”

04:12 Trina Renea: Oh, my God, really? 

04:13 Dr. Vicki Rapaport: Yes.

04:16 Julie Falls: Isn't eczema an autoimmune situation? Or is that…?

04:19 Dr. Vicki Rapaport: Eczema is a genetic, chronic inflammatory disease, but not autoimmune. 

04:24 Julie Falls: Not autoimmune.

04:26 Trina Renea: So like if somebody is out in the middle of nowhere and they can't get to a doctor and they're having this issue, what can they do? Like the Vaseline or the Aquaphor, will that help with the itchy skin? 

04:39 Dr. Vicki Rapaport: Absolutely. Another good tip would be after a shower, after a bath, don't pat yourself dry. I know we've spoken about this a lot, but it really does work. Leave a little tiny, tiny, tiny, tiny layer of moisture on your skin of the water from the bathing and then seal it in with a body cream. 

I actually love Eucerin has good eczema body creams. Aveeno has great eczema body creams, Vaseline, Aquaphor. And yes, it's goopy, and yes, it's greasy, but it works. 

I think also you have to do it multiple days in a row. Don't just do it once and expect to be better. Do it a couple days in a row. I think you'll be really, really surprised. 

But what we do, obviously, in the practice is we'll also prescribe medications if they're bad enough to come in and see us. And remember, eczema can look a lot of different ways. Some people don't even realize it’s eczema. 

In a brand new baby, it's pretty classic looking. You can go online and say, “Oh, I think my baby has eczema,” and they come in. But sometimes people come in with these little patches. They have no idea. We diagnose them with eczema. We give them a little topical steroid, which are miracle medications. Don't be afraid of a little bit of steroid. They get better. They repair their barrier. And if they keep it up by moisturizing on a regular basis, they maintain, they often don't even need to see the dermatologist for the next flare next year. 

05:58 Trina Renea: Can they get that cortisone over the counter at CVS or…? 

06:02 Dr. Vicki Rapaport: The over-the-counter is a 1% cortisone, very, very, very weak. Not prescription strength. It's over-the-counter strength. It can be helpful, but sometimes it actually just fans the flames of the eczema. But I'm actually fine. It's safe. It's over-the-counter. If people want to try it, there are two forms. There's actually 0.5% and there's 1%. The 1% is a little bit stronger. It's not strong but it's stronger than 0.5%. 

And then I like the ointment over the cream. Sometimes the ointments are not on the shelves, but you can probably find them online or maybe ask the pharmacy to buy it for you and…

06:35 Trina Renea: What do you mean the ointment? A hydrocortisone ointment? 

06:37 Dr. Vicki Rapaport: Yeah, a hydrocortisone ointment, not cream. Creams are typically on the shelves. Ointments are a little harder to come by. But in general, in winter, whether it's eczema or sensitive skin, dermatologists choose ointments over creams. 

06:50 Trina Renea: I find that people who have really dry hands or dry skin in this weather, they say that when they put a moisturizer on, it burns. 

06:59 Dr. Vicki Rapaport: Yes. 

07:00 Trina Renea: So what do they do about that? Rather than use the Vaseline or Aquaphor, something occlusive like that? 

07:06 Dr. Vicki Rapaport: Oh, my God, it's like I led you to ask me that question, because it's a great question. When I was a kid, I guess I had eczema. Now, I look back, I didn't even realize it was eczema. I just thought it was dry hands, but it was definitely eczema. 

And my mom would be driving down the 405 and my hands are burning. They're cracked. She'd, like, throw me a lotion from her purse. She’d just chuck it in the back. I’d put it on. This is in the ‘70s.

07:33 Julie Falls: And she's a dermatologist's wife. 

07:35 Dr. Vicki Rapaport: She's the wife of a dermatologist. My dad was a dermatologist. 

07:37 Rebecca Gadberry: A very famous and well-known, well-respected dermatologist. 

07:41 Dr. Vicki Rapaport: Oh, thank you. Okay. And it would burn. I’d put it on my hands, it would burn. “Mom, why did you give this to me? My hands are burning.” Because there was perfume in it. It was disgusting ‘70s body lotion, hand lotion. I don't even know what it was. 

07:54 Julie Falls: Mommy lotion.

07:56 Dr. Vicki Rapaport: And I had to wipe it off and clean it off. Really, that one had perfume, but generally speaking, a lot of them don't have perfume but just some of the preservatives can burn. Some of the other ingredients are irritants. That's why we like ointment-based. They don't have the same preservatives. They don't have the same ingredients to keep them stable. They don't need to necessarily be kept stable, like a white cream, and they don't burn. 

08:21 Trina Renea: So, ointments, meaning like a greasy kind of gel.

08:27 Dr. Vicki Rapaport: Petroleum-based.

08:28 Trina Renea: Petroleum-based. 

08:29 Rebecca Gadberry: Petrolatum-based. 

08:30 Trina Renea: Petrolatum-based.

08:31 Rebecca Gadberry: Big difference between petroleum and petrolatum. And we're going to talk about that when we talk about misconceptions in an upcoming episode. 

08:39 Julie Falls: What's the difference between psoriasis and eczema?

08:43 Dr. Vicki Rapaport: Two different genetic causes, completely different. Totally different ways of treating them. Well, topically, we can treat them very similarly, but orally, if we have to go that far with oral medication. 

08:54 Julie Falls: What's that commercial that’s always on TV for the person and that shows their arms are getting better…?

08:59 Dr. Vicki Rapaport: Psoriasis.

09:01 Julie Falls: That's psoriasis. Okay. 

09:01 Trina Renea: And so can you please explain to our…

09:03 Julie Falls: And is that an autoimmune? 

09:05 Dr. Vicki Rapaport: Genetic. 

09:07 Trina Renea: Can you explain to our audience what eczema looks and feels like and how they would know the difference if they have that or if they have psoriasis? Just the difference between those two. 

09:20 Dr. Vicki Rapaport: Eczema can be very non-distinct and very ill-formed and ill-defined. Psoriasis is very, very, very perfectly round, typically. So a perfectly round, super scaly silvery plaque is psoriasis. A dry, scaly, ill-defined, bordered area is eczema. That's super basic. 

09:42 Trina Renea: Does eczema itch more than psoriasis or can psoriasis itch just as much? 

09:46 Dr. Vicki Rapaport: Typically speaking, eczema is a little itchier, but there are definitely psoriasis patients that go crazy with the itch. Sometimes, the reason why people don't treat their psoriasis is because it's actually not that itchy. It can be all over their body and you look at them and go, “Wow, that's pretty impressive. Does it bother you?” 

“No.”

“Okay. Do you want to treat it?”

“No.”

With eczema, they're going crazy scratching. Crazy, crazy itching. And eczema can be, on day one, you can have a baby with eczema, and then babies can grow out of their eczema, and then they can grow back into their eczema. You grow in and out of eczema. Psoriasis is pretty unusual in a baby, but you can have children with psoriasis. Five, six, seven-year-old, you can start developing psoriasis.

Not typically, unfortunately, growing in and out of. Psoriasis can be pretty permanent, but easier to treat these days because we have a lot of amazing biologics for it. 

10:37 Trina Renea: So those two situations, eczema and psoriasis, if it's bothering you, go to a dermatologist? 

10:46 Dr. Vicki Rapaport: Yes. Generally speaking, the dermatologist will be able to get you much faster relief and much more informed information. I mean, there is a National Eczema Society. There is the National Psoriasis Society. I'd go to those places for information, not my blog of psoriasis.com where they're telling you to take turmeric and you'll be cured or eat a vegan diet. 

I'm a Western-trained doctor. Like, that's fine and good. But if you're suffering, we can get you better very, very quickly and safely and then have a long-term plan for you. 

11:22 Trina Renea: So I had one moment of eczema. I happened to be working in your doctor's office at the time. I'm Trina, the esthetician. So I got to experience what that feels like. I just remember it would itch and so I would scratch it, and then it would swell and itch more, like it would itch so bad. And there would be all these little tiny red bumps. 

11:47 Julie Falls: Is it hives? That sounds like hives. 

11:49 Trina Renea: No, she said it was eczema and she gave me a treatment for it and it went away, eventually, and that was it. But it was like one spot. It was one spot on my arm. And I just remember, like if you scratched it, it would itch more. 

12:05 Dr. Vicki Rapaport: So there is that vicious cycle. It's the itch scratch cycle, which you really have to stop. I know it's very, very difficult to stop actually scratching. We, as dermatologists, have to help the itch so that you stop scratching. 

And then eczema is interesting because you can literally have one patch or you can have it all over your body. Same thing with psoriasis. You can have one little stubborn patch in your scalp, stubborn patch on your palm, stubborn patch on your body, and then there are patients with it 100% body surface area and everything in between. 

Dermatologists can usually look at it and in two seconds tell you which one it is. I'm surprised that you said eventually went away, because usually eczema is much easier to treat than psoriasis so I'm sure I gave you probably a topical steroid. Usually, if people are consistent, and again being consistent is important. Don’t put the cream on for one day and expect it to go away. It can take up to two weeks, but you can manage it pretty well with topicals.

13:01 Trina Renea: I have a question about the itch. When I was a kid and I would get a mosquito bite and it would be super itchy, my dad would take a spoon and he would put it under really hot water. Then he would touch the hot spoon to the itch and it would feel good because it was like taking that itch away. Then the itch would go away.

Recently, they've come out with an actual device. It's made in Germany, that I got online that somebody told me about. It's you push a button and it actually burns the spot, like the same technique. It actually gets super hot, but it's made for that. Can you use that to take away an itch in an eczema? 

13:49 Dr. Vicki Rapaport: I mean, the opposite. Heat is a trigger, is an exacerbator, so we recommend ice. Literally the opposite. 

13:55 Trina Renea: Wow. 

13:56 Dr. Vicki Rapaport: So if you're going crazy itching, a kid in the woods or whatever you were describing, no access to doctors, ice will help you in 30 seconds, 60 max. The itch will disappear. Then you could put Vaseline on it or over-the-counter steroid. 

Heat might feel good for the moment, and the classic is like somebody wants a long hot shower. It helps their eczema on their body. In the shower, it feels good. They come out, it's a nightmare. The itching is tenfold worse. So, ice and cool over heat. I do not know what that device is. it sounds kind of hocus pocus to me.

14:31 Trina Renea: I actually burned Taylor with it. Poor Taylor. Because she has, her skin, she's a little darker in color. I gave her hyperpigmentation.

14:41 Dr. Vicki Rapaport: Uh-oh. Yeah, that doesn't sound good. 

14:43 Trina Renea: But they sell it, online.

14:46 Dr. Vicki Rapaport: Yikes. Okay. 

14:48 Julie Falls: What were you trying to…? 

14:50 Trina Renea: It's because we had mosquitoes over the summer that were just attacking us.

14:51 Julie Falls: She did it on her mosquito…

14:52 Trina Renea: Well, I did it on myself, and then I was like, “Look, this is what it feels like,” and she was like, “Ow.” It literally burned her and then she got a pigment. Is it still there? No? Sorry. 

Okay, so let's move into just sensitive skin in general. Like people's skin tend to get more sensitive and really dry, cold, using heaters and stuff. The regular creams and serums and things they normally use aren't working so well and they're starting to get this sensitive skin, or sometimes people can sensitize their skin. But when you get that red, irritated skin, what's the best thing to do for sensitive skin? What can they do? 

15:40 Dr. Vicki Rapaport: I think sensitive skin is on the spectrum of eczematous skin. When you truly have eczema, you're called an atopic person. Eczema is also called atopic dermatitis. What is an atopic person? Atopic person is somebody that reacts to everything. Does that mean you have allergies? Maybe. 

It's under the umbrella of allergic tendencies. So asthma is allergies of the lungs. People who have postnasal drip or some people have allergies of the upper airway. Eczema is kind of like having allergies of the skin, if you want to kind of describe it that way. And when you have sensitive skin, it's like a couple rungs below truly having eczema.

So, your skin lipid barrier is probably not intact. You might be reacting to something in the environment. Maybe you're reacting to weather. The best way is to moisturize. It's as simple as that. 

Body moisturizer, face moisturizer, hand moisturizer. Keep your skin lubricated. Keep the barrier up. Keep your transepidermal water loss at bay and it can really make a huge difference. Short showers, not such hot, long showers. All these little tiny things work. But again, it does take a couple of days of being really consistent with it and you can feel much, much, much better. Your sensitive skin will calm down. 

Ice packs over hot. So if people want to put a little cool pack on their face or their body where they have sensitive skin, IT can make a huge difference, because you want to decrease the inflammation. 

What is sensitive skin? It's like an underground version of a little bit of inflammation. 

17:14 Julie Falls: Is there sensitive skin on the face that's different than you get on your body? Like, people have whether it's rosacea or whatever, is that the same as eczema? People have reactions on their face that they don't necessarily get on their body that might be different.

17:33 Dr. Vicki Rapaport: I think when you say sensitive skin, I don't think rosacea. I think dry, a little rough…

17:38 Julie Falls: Reactive burning.

17:39 Dr. Vicki Rapaport: A little sandpapery, a little itchy, a little irritated, a little different than the rest of their face. So, yes, you can have patches of sensitive skin on your face but not on your body. And the opposite. You can have patches of sensitive skin on your body and your face is perfectly fine, because there's a lot of sebaceous glands on your face to grease it up and keep it hydrated.

17:57 Trina Renea: One thing that I tell clients when they come in and they're like, “My skin is so sensitive right now,” is I'll remind them to back off on any exfoliation that they're doing. So no glycolics, no retinols, no scrubs. Just back off for a while. 

And then also, just be careful with your cleansing. Make sure you're using a very gentle cleanser and maybe just make sure you're just cleansing once a day so your barrier can repair itself, because we have oil glands on every pore and that oil comes up and that's your natural moisture barrier that comes out. So if you're going to over wash your face and over cleanse your face, you sometimes can irritate the sensitivity that you currently are having. So just be cautious of that.

18:43 Julie Falls: That comes to the slugging.

18:45 Rebecca Gadberry: Slugging. 

18:48 Dr. Vicki Rapaport: Slugging, which is the Vaseline…

18:50 Rebecca Gadberry: You slug through slugging. 

18:52 Dr. Vicki Rapaport: But don't forget all the— I agree with you backing off. When the weather is changing or you're feeling sensitive, back off on your retinols, back off maybe even on your vitamin C, back off on all those devices that you're using. 

I had a patient who came in just this week and bright red face. It was actually more of like a contact dermatitis than truly rosacea. She did get better right away. Because one of the things she was doing was she was doing the Clarisonic every single day. She's like 70-something. Because she's like the more scrubbing, the more scrubbing, the better. 

19:22 Trina Renea: No.

19:22 Dr. Vicki Rapaport: And I said, “You need to stop scrubbing. Let your barrier repair.” It was like actually three days and she was better.

So, yes, all those things. Just, again…

19:32 Julie Falls: Do we like Clarisonic? 

19:35 Dr. Vicki Rapaport: They don't exist anymore. 

19:35 Trina Renea: Yeah, they're old. No, I love Clarisonic. I did, but it's not meant to be used twice a day. It's not even meant to be used every day. Also, you have to make sure it's very clean, because a lot of people would just leave it in their shower, and then it gets mold underneath the brush. But anyways…

19:54 Julie Falls: Why did you stop using it?

19:56 Trina Renea: Because it went out of business. 

19:57 Julie Falls: You couldn't even get the heads.

19:58 Trina Renea: Can't get the heads anymore. You can't get anything. They went out of business in COVID. 

20:02 Julie Falls: Why did it go out of business?

20:03 Rebecca Gadberry: It's a long story and I'm not going to get into it right now, because we're talking about something else. But one of the things that I wanted to say here is that when you're 70 years old or older, you have a different skin than you did even 10 years before. The barrier is very thin. You also have tissue that can be very thin underneath it. When I'm talking tissue, I mean dermis. 

So, doing the things that you even did at 60 could be harmful to the skin, like you're saying, Dr. V. 

20:37 Julie Falls: Interesting. 

20:37 Trina Renea: Yeah. Your skin definitely changes with age. 

20:41 Julie Falls: Each decade. 

20:43 Trina Renea: Is there anything else that we need to touch on on sensitive skin? Also, everyone, if you do want some recommendations or we touched on something that you have a question about, please email us at info@faciallyconscious and we can answer those questions or give you some advice as well. 

21:00 Rebecca Gadberry: And I'd like to suggest we also, if you have sensitive skin, to stay away from certain ingredients. For instance, your ascorbic acid form of vitamin C can be very harsh for the skin. Use something that's got an A-T-E on the end, like, I hate to say this word, but tetrahexyldecyl ascorbate. So you're going to look for the ascorbate version, not the ascorbic acid version. It's gentler on the skin and it's time released for the skin so it doesn't flood into the skin. 

Be concerned about your alpha-hydroxy acids, the lower pH ones, your fragrance, but I think you probably mentioned. 

21:44 Trina Renea: When she's talking about alpha-hydroxy acids, she's talking about glycolic and lactic.

21:47 Rebecca Gadberry: Glycolic and lactic predominantly.

21:49 Julie Falls: So check your ingredients in your products, especially if you're having a sensitive time.

21:53 Rebecca Gadberry: Mandelic is very gentle so you can use that one on sensitive skin. Then look out for certain types of preservatives that can inflame sensitive skin. For instance, phenoxyethanol and methylisothiazolinone. I will put that in the Show Notes, because that can be very harsh on the skin. 

22:22 Dr. Vicki Rapaport: And I think people know…

22:24 Rebecca Gadberry: Isothiazolinone, excuse me. 

22:26 Trina Renea: I hope you spelled that right, Taylor. Just could be like that really long word you said.

22:33 Dr. Vicki Rapaport: And people will know when it feels wrong. You're going to know. You're not going to use that product because it burned or it made you red. I do talk about trying to help people without having to come into the dermatologist office, but just one last little bit about that would be we do have lots of amazing things that are also non-steroidal. We have steroid-sparing agents that are topical, we have some amazing injectables that really change people's lives. So, don't be afraid. 

23:00 Rebecca Gadberry: For eczema and psoriasis? 

23:01 Dr. Vicki Rapaport: Yes. 

23:01 Rebecca Gadberry: Wow. That's incredible. I have no idea. 

23:04 Dr. Vicki Rapaport: It's a whole new world of medications that have really changed people's lives and their quality of life is much improved. So don't be afraid to come in. 

I think that, as a dermatologist, I love to educate the patient about their disease. A lot of times, patients don't want to hear it, and that's fine too. But if you do want to hear it, your doctor will educate you.

Then, like I said, you're going to be able to manage it so much better on your own at home.

23:30 Trina Renea: Do you still treat a lot of your father's red patients?

23:36 Dr. Vicki Rapaport: Yes.

23:37 Rebecca Gadberry: Red patients?

23:38 Dr. Vicki Rapaport: Red skin syndrome. We can talk about that on another episode.

23:40 Rebecca Gadberry: That would be interesting.

23:42 Dr. Vicki Rapaport: Patients who have been over-steroided. But, yeah, I do see them. We see them a lot, actually.

23:51 Trina Renea: We'll talk about that when we get to know Dr. Vicki Rapaport on an episode coming up.

23:58 Rebecca Gadberry: And Taylor, that methylisothiazolinone is abbreviated MIT. 

24:04 Trina Renea: Just MIT?

24:05 Rebecca Gadberry: Just MIT. 

24:07 Trina Renea: It seems like it needs two more letters.

24:09 Julie Falls: So if anybody has any more questions, where is a good place for them to go and look for more information, Rebecca? 

24:16 Rebecca Gadberry: Well, you could go to our blog at Faciallyconscious.com, and you can also send us a message via email at info@faciallyconscious.com. We're very happy to answer your questions because we love to hear from you listeners. 

And if you have an episode idea, please let us know. 

24:35 Julie Falls: Yeah. And there's no bad ideas and there are no bad questions. We'll take them all. So happy to be of service. 

24:40 Rebecca Gadberry: That’s right. Thanks, ladies. 

24:44 Dr. Vicki Rapaport: Very informative. 

24:45 Trina Renea: Yes. I love talking about sensitive skin, because I feel like people are spinning all over the place when it comes to that. So it's good that we can help them a little bit. 

All right. We'll see you next time. 

24:59 Julie Falls: Bye-bye. 

24:59 Trina Renea: Bye.

24:59 Dr. Vicki Rapaport: Bye everybody. 

[Outro] This podcast is so needed in the world right now. There's so much information out there that it's hard to know who to believe and if it's right for you. We are very excited to be your guides and bring you Facially Conscious. You can find info we talked about today in our show notes and on Instagram, YouTube, and Facebook. 

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