Updated by Stuart Millar
Problem: Sudden onset of skin sensitivity, even after previously using SmartLotion®
Some patients experience skin changes in a way that increases their skin's sensitivity. They may have had a regular routine of using SmartLotion® as a preventative, but after a brief lapse, they find that SmartLotion® is causing burning sensations and/ or flaking skin, similar to what can happen for new users with extreme atopic dermatitis. These skin sensitivity issues are often caused by seasonal changes, but could be caused by a large number of various reasons.
Solution: See below
In a nutshell, for the sudden onset of skin sensitivity, Dr. Harlan’s patients follow essentially the same protocol as for severe dermatitis and acute sensitivity.
Dr. Harlan first has the patient make sure they are using the gentlest of cleansers or just plain water to gently cleanse oil, dead skin cells, and microbes from the skin daily. Scrubbing and scrubbing particles should never be used in these cases. No strong liquid cleansers or shower gels should be used. Basis® bar soap, Cetaphil® bar, and Dove® bar soaps are favorites.
Patients begin by applying whatever moisturizing product they can tolerate, i.e. Aquaphor®, Vaseline®, Eucerin®. They then apply Ice for two minutes, in a plastic bag covered with a clean cotton dish towel. (A course of 25mg Prednisone X 5 days and 20mg X 5days should also be considered from the dermatology prescriber for the most severe cases).
Patients are asked to twice daily apply a small amount of SmartLotion® to their inner forearm to test for new intolerances caused by seasonal changes.
After a few days of moisturizer and icy compress, combined with testing for intolerances on the forearm, the patients are asked to begin applying SmartLotion® directly to the dermatitis 2 or 3 times per day immediately after applying the moisturizer, and then once again to use the icy compress for two minutes afterwards. After a few days, the moisturizing should no longer need to be applied immediately before the SmartLotion®. The icy compress should also become unnecessary.
When SmartLotion® therapy is helpful and producing results, after two weeks, patients begin reducing the SmartLotion to once or twice a day, and by 4 weeks, Dr. Harlan likes his patients to be using SmartLotion® anywhere from once daily to three times weekly. They should also be using a moisturizer with more ability for barrier repair, like CeraVe® cream or Cetaphil® lotion (Vaseline® and greasy ointments do not allow repair of the skin barrier).
Continue the moisturizer everyday to help keep the skin barrier stay healthy. Dr. Harlan’s patients are seen once or twice yearly for supervision once they are doing well.
If the condition is not improving, and intolerance continues to exist to SmartLotion®, Dr. Harlan either tests the patient with allergy patch testing, or asks their Allergist to perform patch testing for contact allergens on the intolerant patient. New allergies can develop. Finally, it’s always been known that there are approximately 1% of patients with sensitive skin who have intolerance problems with SmartLotion®. These patients should seek further prescription therapy from an expert in Atopic dermatitis.