A friend of mine wrote to me this morning – “My skin is driving me crazy with itching. The doctor gave me a prescription, but I still itch. I remember you mentioned you use something really good for dry skin. Could you please tell me what it is?” Now I’m not a pharmacist or a doctor. I don’t even play one on TV. But after 55 years on the planet and lots of health challenges of my own I have learned one thing: medicine as it is practiced in the US is great if you’ve suffered some kind of trauma or have an acute illness. Otherwise, approach with caution! I called my friend. “What did your doctor prescribe?” I asked. “Cortisone cream.” “Did she tell you why?” “Well, she said I have dry skin. But it’s strange. Only my hands and forearms itch, and sometimes they itch so bad that I scratch until there’s a blister.” So we discussed cleaning products and pet products or any and everything else she may have gotten her hands into that could have caused the itching. There’s been no chemical contact she is aware of. No allergies. But her doctor prescribed hydrocortisone cream and I wondered why. “Does the cream help?” I asked. “For a little while.”
Itchy skin is one of those broad, grey areas that physicians hate because there is no single-bullet approach to curing it. There must be a hundred things that can cause it – some serious, but most not. The worst thing that might happen to you is getting caught scratching with your fork at your spouse’s black-tie business affair. Most doctors don’t think too much about it. They don’t know why you have it, either. Write out a prescription for hydrocortisone cream – the ubiquitous skin remedy. Case closed.
Hydrocortisone is a “steroid hormone produced by the adrenal cortex and used medicinally to treat inflammation resulting from eczema and rheumatism.” It’s used to treat insect bites, poison oak/ivy, eczema, dermatitis, rashes and itching because it reduces the swelling, redness and inflammation that can occur in these types of conditions. Sounds good, so far – yes? But the small print on the packaging may cause you to think again. It’s not to be used on the face or underarms. It cannot be used as needed – only up to 4 times a day. And it shouldn’t be used long-term. Steroids are serious business, even topical ones. They can cause thinning and discoloration of the skin, easy bruising, permanent dilation of certain blood vessels, “burn” marks on the skin, dermatitis and itching (wait a minute, wasn’t itching the reason it was prescribed?!), kidney or liver damage and worse. The skin on the face, underarms and groin is thinner than other places on the body, yet are all places where eczema, rashes and allergic rashes are particularly common. Where the skin is thin, topical medications tend to penetrate more deeply. Once steroids hit the bloodstream they can cause all kinds of havoc, so you really shouldn’t put the cream on those areas. But if your doctor prescribed it you’ll probably put it there anyway and hope for the best. Oh, and if it only kind of helps, as in my friend’s case, you may also disregard the warning to only use it for a maximum of 7 days. Topical steroids can also be purchased OTC and overuse can cause the skin to develop a resistance (called tachyphylaxis) to the medication. As a result, in order to have the desired medical effect, a stronger and more potent steroid may be needed, which may cause even more potential side effects. Call me crazy, but something’s just not right here. The diagnosis was dry skin and dry skin is a chronic, not acute condition like poison ivy or a bee sting. So why prescribe something that should only be used for 7 days? One woman who used cortisone cream long-term had this to say about it: “When I was using this cream I thought it was great. It always seem to clear up my eczema on my face and hand, but now after using this cream for years I’ve discovered it’s the cause of the brown rings and wrinkly condition around my eyes. So I’m dumping all my creams and I’m going to kick my doctor’s ass.” Yeah. And don’t forget your steel-toed boots.
Don’t get me wrong. Topical steroid creams definitely have their place, especially in acute situations where inflammation is involved. But any physician prescribing it for chronic conditions is either lazy or ill-informed. Or both. There are SO many others approaches to dry skin one can take other than resorting to a topical steroid. Lotions can help temporarily, but can actually cause the oil glands to produce less natural moisture when the situation calls for more. One simple solution is to make sure to drink enough water. Eight glasses a day keeps skin hydrated and flushes out toxins. Use a good sunscreen and block out damaging UV rays. Wear gloves when working with household chemicals that rob the skin of oils and moisture. Use a humidifier in the winter when furnaces dry the air and the skin.
What we eat has a definite effect on the skin’s health. Omega-3 fatty acids support the skin’s lipid layer and help it hold in more moisture. As we age we need to make sure we get enough. Lots of foods are high in fatty acids, like salmon, flax seeds and walnuts. Eating one ounce of walnuts per day is said to have a healing effect on the skin for some in as little as two weeks. And fatty acids can also help with depression,
fatigue, Type-2 diabetes and joint pain. If you’re not fond of nuts and fish, or even if you are, consider taking 500 mg of black currant seed oil every day. Black currant seed oil is an excellent source of GLA (gamma-linoleic acid), which the University of Maryland Medical Center lists as an essential fatty acid used to treat a variety of ailments. Dr. Andrew Weil, a practitioner of both traditional Western and natural medicine, says black currant oil “offers a wide range of benefits, from acting as an effective anti-inflammatory agent (with none of the side effects of anti-inflammatory drugs) to promoting the healthy growth of skin, hair and nails.” I started using it years ago, when swimming pool chemicals were turning my skin into something resembling alligator hide. It works.
We are, sadly, an instant-fix society. I am just as annoyed as anyone else when my computer doesn’t change pages right NOW! But I’ve learned to carefully consider every prescription my doctor writes for me. “Get a high-quality lotion like AmLactin to use on your hands and arms in the interim,” I said to my friend, “because black currant oil takes about 6 weeks to kick in. But if what you have really is dry skin, you can kiss that tube of cortisone goodbye.”