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:

NICKEL(II)SULFATE HEXAHYDRATE
BENZOYLPEROXIDE
TOCOPHEROL

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...

Benzoylperoxide

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

Shampoo

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.

Serum

Olay Regenerist Daily Regenerating Serum

Daytime moisturiser

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

OR

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!

Grojsman On The Gurney: Perfume Conversations You Never Thought You'd Have

Last Thursday was a date in the diary to which I was very much looking forward: it was the day of my trip to London to The Perfume Diaries exhibition and talk. This Thursday, however, was an altogether different matter, for I had a minor surgical procedure involving a suspect mole in a sensitive place... I donned comfortable, loose fitting clothes, and applied no make up or perfume. It was not that sort of a day, plus I thought it was more in keeping with hospital protocol. Mr Bonkers came with me to the hospital in Cannock, in case I felt a bit queer afterwards and not like driving myself back. We had about 20 minutes to kill in the waiting room, and sat staring at the soothing tank of tropical fish. The largest fish was headbutting a chunk of cucumber from one end of the tank to the other, occasionally pausing to munch on it, before briefly cleansing its palate with gravel from the bottom of the tank, and spitting it out again. Then before I knew it I was called in, had put on one of those back to front gowns, and been taken aside by the consultant who explained the risks of the surgery, namely bleeding, infection, scarring and "distortion" of the body part in question. I signed the consent form, deliberately skipping the section on "next of kin", because he was sitting outside. Next up I was in an ante-room and on a trolley - or gurney, as they call it across the pond - which a nurse trundled the five paces to the operating theatre itself. I could have walked that far, I thought, even in my nervy state. The operating theatre was a huge, freezing cold room with bright spotlights. At the sight of two nurses wearing masks I decided to close my eyes and keep them squeezed tightly shut until further notice. The consultant had an avuncular manner, and I didn't squeal as he administered the local anaesthetic. I didn't even feel the second dose he added for good measure, knowing that my only other experience of day surgery at a hospital had involved an injection which DIDN'T take - and the worst pain in my life. "We're doing quite well", he remarked jovially. "Except for the fact that we haven't actually started." I was trembling slightly, but still not squealing when he asked for the scalpel, and not long after, there was a gentle tugging sensation, and I knew that he was sewing me back up. Then, out of the blue, came the friendly inquiry: "So what do you like to do?" "Do?" I asked, slightly startled at his interest. "Do you mean...like hobbies?" "Yes, that's right." And so I told him........only to find that the consultant was fascinated by perfume too - well, the scientific side at least. He explained that he needed to be quite well up in the formulation of perfumes because of the issue of contact dermatitis. He had even attended a talk given by a senior figure from Coty! "I gather perfumes are all synthetic now", he added after a slight pause (to re-thread the needle?) "You know, with none of these natural ingredients like musks and civet." I replied that naturals still had a place in modern perfumery, although they were very much in the minority these days - as far as typical mainstream fragrance went, anyway. I added that I didn't care for civet myself. I even mentioned my screen name on Basenotes! (VM I hate civet). I said I wrote a blog! He asked me the name of it. Needle in, needle out...."So do you like cologne then?" I inquired. "No, not really - my interest is mainly professional. I usually get my wife Trésor or Paris. They're the only modern perfumes I like. I would describe them as floral and fruity, but most perfumes these days smell of fly spray to me." I told him that he was a man after my partner's heart - the chap sitting outside watching the fish - and that he had been known to use that very phrase to describe perfumes he found especially offensive. I went on to mention that I thought Paris and Trésor were both by the same perfumer, Sophia Grojsman, though I wouldn't swear to it. Tug, tug... "So I take it you know about that new oakmoss substitute?" (I didn't get the name of it, but it sounded like the Latin for "inverted prunes".) I admitted that I was not so well versed in the chemical names of ingredients, though I was aware of the broad issues surrounding oakmoss. "Well, well", he remarked. "I have finished now and I wish I had asked you about your hobbies sooner, as you brightened up no end!" So there you have it - yet another therapeutic aspect to fragrance, without even putting it on. : - ) And while I don't suppose chatting about perfume will take the place of lidocaine and adrenaline any time soon, it certainly made getting through this tricky day a little bit easier... Photo of Cannock Chase Hospital from bpas.org, photo of operating theatre from servaccom.co.uk, photo of syringe from faqs.org, photo of Tresor from lelong.com.my