Tuesday, 27 March 2018

Complex complexions: patch test upshot and my top topical tips for dealing with dermatitis

Queued for ingredient reading!
When I was a kid, I remember my mother going to the local pharmacy and asking for a moisturiser called 'Pretty Face'. "Sorry", said the chemist, "We don't stock that, but I do have 'Happy Feet'?" Or maybe it was the other way about, but whatever, it still makes me smile.

Now to create a mash up of the two products, I have not had a 'Happy Face' for over forty years, in terms of the state of my skin. For I have been an acne sufferer without interruption - but with lots of eruptions! - since I was 15, then about two years ago I was diagnosed with contact dermatitis AND another kind of eczema that manifests itself as red blotches with or without a kind of white scurfiness. I hope you are not reading this at a mealtime. A condition possibly known as seborrheic dermatitis, but I am way too scared and squeamish to look in Google images, with it being as we all know a bottomless pit of grossness, pretty much regardless of what you look up of a medical nature.

But the distinction between the two is that I get symptoms of contact dermatitis when I use a skincare or beauty product that contains a specific ingredient to which I am allergic, while the causes of seborrheic eczema - if that is indeed what it is - are harder to pinpoint. They include stress, cold, dry weather and hormonal changes, as well as things like harsh chemicals, detergents etc, where it crosses over with the other kind of dermatitis.

So in short I now have a double whammy of skin ailments, triple if you include the acne of yore. I was moved to write this post because last weekend I happened to be back in Preston, staying at the very same guest house where the notorious 'Clarins cleanser incident' occurred in April 2016, triggering this latest on-off phase of contact dermatitis. I wasn't in the same room thankfully, but one of my friends was. He looked much the same at breakfast, so I assume that no such dermatological disaster befell him in the night.

Source: booking.com

While remembering back to this trouble all kicking off two years ago, I realised that I never did do the follow up post about my allergy tests last June(!) and their upshot. It might also be useful to recount how I have gone on since in terms of experimenting with skincare products of varying degrees of innocuousness.

I had the patch tests during the hottest few days of last year - it was 35C in my car on the drive down to Wolverhampton, and I was absolutely drenched in sweat by the time I got to the hospital. And no, I don't have air con in my car in case you were wondering. ;) As a result, my back was far from the ideal substrate to have a load of sticky fabric strips affixed to it, in which dozens of would-be allergens nestled in little pockets. I had some 120 different substances split across ten strips and the nurse drew notches at intervals in black marker pen all the way down both sides of each strip to facilitate the reading of any reactions. I was told to come back in a couple of days for a review, and again about five days later (the exact time frame is approximate as it was a while ago). During that period I was told not to wash my back and to stay cool and dry! Well, fat chance of that, as I was semi-liquefied on arrival, and the presence of ten strips of gauze taped to my back made me feel itchy and uncomfortable, and if anything more inclined to perspire in these extreme weather conditions.

Black marks still visible after patch removal!

After what seemed like an eternity, the day of the final 'reveal' arrived, and the strips were whipped off my back. The tests showed three different allergies:


Now nickel by any other name is very common, to the point of being dull and boring, like the house sparrow of allergens. It is found in jewellery, coins, household utensils - the list is endless.

"The Centers for Disease Control and Prevention estimates that 10 to 20 percent of the population is allergic to nickel. The reactions can be unpleasant, but not fatal."

That's reassuring. You can't really avoid nickel in life, so I basically moved on to...


This is an interesting one, as I used to use acne medications with this as the active ingredient, and found it really harsh and liable to bring me out in a worse reaction than I had to start with. Actually, if you read all its applications, it doesn't sound too appealing:

"This chemical is used to bleach edible oils, flour, bread and other food. It is also used in some dental applications, for the treatment of acne and as an antiseptic and local anaesthetic in the treatment of burns and ulcers. It is also used in vinyl flooring, in fast drying printing inks and in mixed fabrics with viscose, silk or cotton. Further research may identify additional product or industrial usages of this chemical."

Hey, you can stop right there for me with your research - I am sufficiently put off as it is! I don't think this allergen has anything to do with my recent outbreaks, however, because I ditched the acne creams decades ago, and I don't eat much bread, haha. Leaving us with the final culprit, which the nurse said was the main one:

Tocopherol...aka Vitamin E

Oh my lord, this is also a tough one to avoid, for Vitamin E is added to a ton of toiletries, make up and skincare products, including both the suspects I featured in my last post on this subject.

Only at that time my finger of suspicion was pointing to two other chemicals: a formaldehyde-releasing microbial preservative called 2-BROMO-2-NITROPROPANE-1, 3-DIOL (in some makeup removing wipes that had triggered an isolated, but earlier attack in early 2014), and METHYLISOTHIAZOLINONE, a controversial preservative found in the Clarins cleanser I used in Preston. And instead the villain is the harmless - nay, positively benign-sounding - Vitamin E! Surely vitamins are meant to nourish and feed the skin, not sent it into paroxysms of allergic mayhem.

And what a pain it was to eliminate tocopherol in its various forms from my wash bag...! My gut feel was that the synthetic form of tocopherol, where it is combined with acetic acid to become tocopherol acetate, was more likely to be dodgy than the naturally occurring Vitamin E you get in many facial oils, so over the next few months or so I set about cautiously testing toiletries one by one to see what happened. I did also throw out any that had tocopherol acetate very high up in the ingredients list, but kept an open mind about any that had it as a middle ranking one!, which was more typical. Because logically the amount of the chemical may have a bearing on the matter, also whether it was present along with a whole bunch of other fairly aggressive things such as the two mentioned above, even if the tests had not revealed an allergy to those in particular - and they did test for both. I still don't like the sound of them, and quite a lot of other chemicals if I am honest!

Nine months on, I have a routine of skincare that broadly works. I have had no reactions as bad as the one in the picture below(!), but I do get shadows under my eyes and extra wrinkles in a sort of sweeping semi circle - the "engraved" look I developed after the make up wipes disaster of 2014. I think stress could be a trigger on its own, mind, and also lack of sleep, but the problems tend to occur more when I am travelling. This suggests that it could partly be a reaction to unfamiliar toiletries in hotels, though I do try to take my own. That said, there may be nefarious effects from the manky bits of moisturiser I shouldn't still be keeping in my travel pots! ;) Oh, and of course who knows what fumes are emitted from the aggressively laundered bedding I have blogged about recently.

Me on a very bad dermatitis day before the tests!

Here is a round up of the main products I use now:

Morning cleanser

Liz Earle Cleanse & Polish


Dr Organics range from Holland & Barrett

Actually I don't think what I put on my head is the issue here, or I am working on that assumption. So I do still use shampoo freebies in hotels, but NOT those generic 'hand and body and hair and everything washes' in those wall mounted dispensers to which hotels are increasingly migrating, which don't have an ingredient list you can inspect.


Olay Regenerist Daily Regenerating Serum

Daytime moisturiser

Paula's Choice Resist Super-Light Daily Wrinkle Defense Normal / Oily / Combination SPF30 (when it is sunny!)


Nivea Daily Essentials Light Moisturising Day Cream for Normal to Combination Skin SPF 15 (when it is dull!)

The former doubles up as a foundation on good skin days, as it is slightly tinted, so were it not for the price I would use it all the time.

Source: Paula's Choice

Make up removal

La Roche-Posay Toleriane

I do additionally use one or two micellar waters specifically to take off eye make up, though they can sting a bit. And sweet almond oil is a good standby for stubborn areas.

Acid toner (once or twice a week)

Bravura Purifying Calendula Toner

Nighttime moisturiser 

Cerave Facial Moisturizing Lotion PM (with ceramides, niacinamide, and hyaluronic acid).

How much do I love this product!, which I was put onto by a blog reader. It is cheap and packs a lot of skin boosting goodies for the money.

Source: Dermstore

Sometimes, if my skin feels a bit twitchy, I just use a very neutral moisturiser for sensitive skin such use Avene Skin Recovery Cream for Hypersensitve and Irritable Skin. You can use it in the day but it doesn't have any SPF. Or even just slather my face in coconut or sweet almond oil to mix things up a bit, taking care not to get oil all over the pillow.

And that is it more or less, though I occasionally ring the changes round the margins beyond what I have described. But here is the kicker...several of these products have Vitamin E in them, also in its synthetic form! And I appear to be completely fine with that, much like Eleanor Oliphant. So assuming the tests were in fact accurate, all I can say is that the precise amount of tocopherol in each must be at a sufficiently low level not to trouble me. From which I also take that there is no point having a knee jerk response and ditching literally everything containing the allegedly offending allergen. For that way lies baby and bath water throwing.

Meanwhile, controlling the seborrheic eczema is a whole other game, and the bottom line is that I frankly don't think I can. Or rather I cannot stop it coming back every few days - which doesn't sound like controlling to me! - mostly on my forehead (mercifully screened by a fringe), above one eye only, and in both eyebrows. The only thing that really shifts it is hydrocortisone ointment at the very gentle 0.5% strength, making it suitable for the delicate eye area. Though I still don't like using it very often as it is said to thin the skin. Tara kindly gave me a new eczema remedy called Gladskin - I need to have a few more go's with that before I can definitively report on the outcome. And am a bit wary of using it round my eyes.

Have you every had patch testing? If so, what did it find, and how did you go about rejigging your skincare routine?

I would love to hear anyone else's experiences!


Hazel said...

I had the patch test, but my primary skin problem is a deficient enzyme which, until they can come up with a way of rejigging my DNA I’m stuck with. Secondary skin problem is reaction to creams and cosmetics of which I am normally tolerant, when stressed. However, since I am normally stressed, I am now normally intolerant (and not just of make up). Tertiary skin problem is living in Caledonia stern and wild where the weather frequently tries to gnaw your face off in any case.

Tara said...

VITAMIN E???!!!! What on earth, V.
I can't believe it was last June that you had the allergen back test. Good to get a follow-up post on that. You do wonder how helpful it's been in your case but I guess you can eliminate the most suspect products, as you have done. Considering I've long believed Vitamin E to be healing for the skin, it really is rather ridiculous.
The eczema has come back on my left eyelid (to join my neck and a patch on my cheek) but I've started on my tube of Gladskin and so far so good. As you know though, nothing seems to work long-term but we'll see. It really is misery making. I hope it helps you. I did email the company and they said it's fine to use on the eye area.
I did smile at the Eleanor O reference :)

Vanessa said...

Hi Hazel,

I am sorry that you are afflicted with such bothersome skin problems, yet I couldn't help but chuckle at your comment. FWIW, I do think rejigging your DNA may be just round the corner, the way science is going. Stress though is a whole other ball game. I also laughed at the double intolerance. Better than the other kind of double '-nce'. And yes, the weather does not help one jot.

Vanessa said...

Hi Tara,

Vitamin E seems to make no sense at all, I agree. It is like being allergic to kind old ladies or money. I didn't realise you had eczema on your face - commiserations - and thanks for confirming that it is okay to use Gladskin on the eye area. I will have a go again at my forehead, which did seem to work for a bit, and then brave lower down. The skin there is way thinner and crepey-er than on you, with me being older, so am particularly cautious in that area. So far the Gladskin seemed not unlike the hydrocortisone, ie helped make it go away, but not for very long. Yes, Eleanor O is very much in my mind. Am hoping that Hazel above will give it a whirl!

Earl Gray said...

Wow, I had no idea Vitamin E could be allergic or irritating, it's full of goodness for so many people! Bravo for not throwing the baby out with the bathwater - tis the dose that makes the poison - and missing out on some lovely skincare products that agree with you.

I had acne for 15 years and for me the main causes were 1) hormones and 2) stress, in that order. It was very frustrating that there were no magic ingredients to put on (or leave off) my skin. And how typical that even after allergy testing, it's kind of the same deal for you. Though I cannot imagine dealing with not one, but three skin conditions at once! And thankfully finding time to blog about perfume ;)

Anonymous said...

Sorry to hear about your ongoing struggles. I just about jumped out of my chair when I read Tocopherol. Vitamin E!?! Then again, some things are better used internally. :)

About seborrheic ecxema. Word just means sebum as in natural (but often excess) skin oil. On the scalp there are two kinds of dandruff, the familiar dry flaky kind and seborrheic which means the flakes clump together from the excess oil and cling on the scalp. I know this might seem daft, but I suggest you use a small bit of dandruff shampoo, eg Head and Shoulders or Selsun to gently wash the affected areas, especially under the fringe and the eyebrows maybe once a week. Cuts down on excess sebum and clumping skin cells without being too harsh. See if it works. They may have the evil Metho etc preservative, but Paula says it's okay for rinse off products. (Ditch the parabens and come up with something worse.)

I'm wondering about the coconut and sweet almond oils. No acetate but I'd be very cautious about them. Camelia oil has received good reports. And, it's not something nature designed to be eaten. ;)

Also changing pillow slips daily can help prevent excess sebum from being transferred back onto your face.
As for cortisone, personally I find it quite drying. Helps take down the swelling but is no friend to the skin as you note. I'd opt for the Gladskin if it works.

Your list of face products sounds very well thought out. Isn't it interesting how simpler and less expensive products can be better.

Patch testing about 30 years ago. Came up with the usual things like pollen, mold etc. Strongest reaction was apples! So what, it's not like I'm putting them on my skin. ;) Besides, an apple a day.... Unfortunately I never did learn to sweep and dust more.


Tara said...

I'm 'lucky' it's mostly on my neck. The patch on my cheek is tiny and I've only recently got it back on my eyelid. I wash off the miscellar water I use to take off my mascara but will change to a natural version (by A'kins) when the Bioderma runs out.
I'm using Gladskin tentatively on the eye area. I heard a Dermatologist on the radio yesterday say it's a life-long condition. I've gone for years without it but maybe now I need to give up looking at a cure and just find a regime that minimises it. Will look into Eucerin next. I think I sent you the link to the Caroline Hirons vid?

Hamamelis said...

So sorry to read about your continuous skin predicament! Now with regards to tocopherol (but maybe you've done some googling yourself) is there are many kinds (I have some training in supplements)! There is synthetic vit. E, and semi synthetic, and natural mixed ones. Maybe you are allergic to just one of those. To make life even more complicated, it could be that you are allergic to the source of tocopherol (ie soybean) and using it from another source (ie sunflower) is no problem. Also...I remember a good friend being allergic to apples, but not to organic apples...was she allergic to a pesticide? Anyway I hope this helps solve some of the tocopherol conundrum!

Vanessa said...

I like the sound of that natural micellar water as the ones I have tried do tend to sting a bit, even if you pat them carefully on. I did use Bioderma a long time ago and it was better in that regard, though not so easy to pick up on the go.

The medical opinion is certainly along those lines ie that you don't get shot of eczema once your auto-immune system decides to mutiny. BUT our friend Dr Rangan Chatterjee claims to have cured people of it by lifestyle changes alone. Unfortunately, his precise MO is not covered in The Four Pillar Plan that I read!

You didn't send me that video link, no, just the one with Trinny in it. I have considered Eucerin, and wondered if it would help, but never tried it.

Vanessa said...

Hi Earl Gray,

You are not by any chance the ghost hunter from Dorset of that name? If so, we have met...;)

On balance probably not, given that this is a perfume blog. Anyway, thanks for dropping in to share your own experiences with skin ailments, and sorry to hear that you were a fellow acne sufferer. I infer that that is a closed chapter for you now, thankfully. I think my acne - which has always been primarily hormonal - is also aggravated by stress. Am working on methods to relax and calm the heck down, but I do live on my nerves a bit by nature!

Vanessa said...

Dear Lindaloo,

Do you realise that I would have had to pay £250 for a consultation with a dermatologist at our local Rowley Hall Clinic to receive such detailed advice of this high calibre?! Thank you very much - lots of food for thought there.

I don't have dandruff in my hair, just the odd scaly whiteness on my forehead and in my eyebrows as the red patches heal. Do you reckon that by using a dandruff shampoo that could also help with oil reduction in that general area, including the forehead, where the patches do occur? I had never thought of tackling the issue from the top down, as it were, but I see the logic...

What's the problem with those facial oils exactly? They feel quite beneficent, but you may mean they clog pores or something? I did try rosehip oil once but think it was a bit stingy, and camelia oil is a new one on me. I also have jojoba and argan oil in spades!

And yes, I will give the Gladskin another whirl as hydrocortisone is very much a curate's egg solution.

LOL at your not sweeping or dusting more. If I was told I had an allergy as all-pervasive as that, I would just give up. I am way too lazy to be de-moulding the entire house. I do get hayfever now which I never used to, so pollen must be on the list too, though the patch tests I had were mostly of artificial substances.

Vanessa said...

Hi Hamamelis,

Thanks for your sympathy! I have indeed googled the many kinds of tocopherol and would you believe that the specialist I saw at the hospital didn't even know that much? I mentioned tocopherol acetate and she looked completely blank, which didn't exactly fill me with confidence. I had asked her the very same question, namely could I be allergic to a subset of this family, as I was so surprised that I had an issue with Vitamin E at all! And I suspect the allergy test may have been too blunt an instrument to do that, if they even knew which kind of tocopherol was on my back. Your examples about the soybean and apples illustrate the point that it is so very hard to pinpoint precise sources of allergies. I don't want to think I might have trouble with food too, come to think of it. It is all a bit like Russian dolls or peeling an onion, trying to go back and back to the offending ingredient / chemical.

Undina said...

I won't repeat anything that others said, but wanted to mention that in your case it might make sense to bring not only your own washing products and not use whatever hotels provide (unless it's Le Labo - but even then ;) ), but also your own pillow case: this way you'll be sure what touches your face at night.

On a separate note, today I was unpleasantly surprised: I discovered - by pure chance - that 2 products on Paula's Choice site, one with SPF 30+ and one with SPF 50, have identical ingredients - both active (including %%) and other. I wrote them a request asking how it was possible, and based on what one provides just SPF 30 while the other one - SPF 50. I really hope that they'l answer that this is a mistake, and correct the ingredients. But if they do not respond or try telling me that 30+ does not necessarily mean "not 50," I'll launch war in reviews.

Vanessa said...

Hi Undina,

What a great idea about taking a pillow case with me on my travels! That would be dead easy to pack, unlike an extra pillow, which I have often wished I had brought with me. ;)

That sounds rather concerning about those two Paula's Choice products. I hope you get a satisfactory answer and if not, go into battle, absolutely!

Anonymous said...

Hi Undina. Neutrogena has exactly the same issue. The pharmacist couldn't explain it. All I can think of is that the higher SPF is a thicker formula stays on long enough to provide a longer protection time. Or that one ends up actually putting on the full dose recommended.

-- Lindaloo

Anonymous said...

Re the oils, they are more occlusive, but I was thinking more about the potential for you becoming allergic to them in the way of Vitamin E.
Not surprised about the rosehip. Many people can't tolerate it -- Vitamin C often stings. Recommended to start with Vitamin C once a week and slowly build up.J have some cosmetic Vitamin C. Not using it. Doesn't sting, but has a metallic smell I can't stand.
Jojoba has s good reputation and is like the body's natural sebum. Stripping sebum just ends up creating more. Nice for massages too.

Re dandruff shampoos. They do treat dandruff without drying scalp. It's the zinc pyrithione. Just checked Wikipedia. It's antifungal and antibacterial and, lo snd behold, is used in the treatment of seborrheic dermatitis!!

I can from the context understand curates egg, but I'd love to know the derivation.

Anonymous said...

You may want to read the Mayo Clinic article on seborrheic dermatitis. It isn't daunting and has no pictures.

-- Lindaloo

Vanessa said...

I think I am fine with the facial oils - and they feel lovely - I would surmise that it is more the synthetic forms of Vit E that are the problem.

Is Vit C the same as retinol? I thought eczema sufferers should avoid that one. Can't remember if it was Paula who said so or my doctor, hehe. I remember the thing about stripping sebum, which acne sufferers instinctively want to do, but you can embrace oil in fact!

Well, well about the dandruff shampoos... I could really do with the doctor telling me definitively which kind of dermatitis I do in fact have.

Re the origin of the term 'a curate's egg' - as in something partly good, partly bad:

"early 20th century: from a cartoon in Punch (1895) depicting a meek curate who, given a stale egg at the bishop's table, assures his host that ‘parts of it are excellent’."

Vanessa said...

PS Thanks for the Mayo Clinic tip off - I do often browse that site in fact, as it pops up a lot in Google.

Anonymous said...

Thanks for the curate's egg history.

It would be useful to get a definitive diagnosis re type of ecxema.

Re Vitamin C: not the same as retinol which is a Vitamin A derivative. It can be by prescription, Tretinol -- for serious acne. Females have to prove they cannot get pregnant or must take birth control while using. A much less potent form can be found in cosmetics. Yes, retinol is to be avoided for damaged skin. Causes serious redness and flakes. Remember how your skin reacted when you used more than a pea-sized dose. Definitely not "more is better." Cosmetic version used to smooth out wrinkles by strengthening skin density. Haven't tried it myself.
My skin probably needs both cosmetic retinol for wrinkles and Vitamin C to smooth, but I will take advice and never use them the same night. Of course the real advice I need is to actually start using something!

-- Lindaloo

parfumista5 said...

Dearest Vanessa! This is not a advert..promise...but the ordinary has some really good and seemingly clean products you may want to look into...like niacinamide... also check the subreddits skincareaddiction and Asian beauty...so much peer reviewed advice on products.. especially from people with similar skin issues that you have....also skincare does not have to break the bank...;-) Hope your skin feels better soon! Cheers Wendy

Vanessa said...

Ah, got my vitamins muddled. I don't think I have ever been considered for Tretinol - or Roaccutane. I could look out for it in skincare products, certainly. With you being such a fountain of knowledge, you do surprise me when you say you are not using something for your skin, haha.

Vanessa said...

Hi Wendy,

Thanks for adding your thoughts to the debate. I do have a couple of products from The Ordinary ready to go when I have finished my CeraVe night cream: one is a serum involving Hyaluronic acid, and one is based around something called Matryxl. Thanks for those links too. I may well find some more things to try there!

Anonymous said...

I'm a reader not a doer. ;)

Vanessa said...


Earl Gray said...

I do in fact have some Dorset heritage, but I am no ghost hunter, and Derek Acora is the only one of them I know of (not 'know' - note the distinction!) You obviously meet some more interesting people than me :D

And yes, the acne has been over for me for a while. Probably alot to do with having therapy tbh...the mind-body connection can't be underestimated. So don't be afraid to explore that route. Having said that, catching up on the comments below has reminded me of one thing that has helped calm my breakouts - azelaic acid, of which the Ordinary does a cheapo. That's just fire fighting though. Good luck with your route causes x

Vanessa said...

Oh, interesting...and I do. I only met this ghost hunter once, at a friend's house, but he had been to over 400 'hunts', which seemed impressive.

I hear what you are saying about the mind-body connection and suffer a lot from stress related ailments, I feel sure. Well, this eczema is definitely aggravated by stress, if not caused by it entirely.

I did have some azelaic acid serum thingy from Paul's Choice - Resist Multi-Correction blah blah? (I am making this up) - and liked it a lot. I only stopped for price reasons, but would buy it again. Or maybe I should check out The Ordinary's one! Thanks for all your thoughts on the matter.