Based on my research and observations, and my experience trying to help people on the eczema side, I see so many misconceptions about what causes dry skin, that after writing the first post, I pretty much gave up on trying to make a separate set of instructions for ameliorating skin dryness. The best I can do is recommend: Read and understand the SolveEczema.org website! (It’s not what you think when you first look at it.) The principles work for dryness whether you have eczema or not.
You may have to dig a little bit, and keep an open mind. SolveEczema was never built to be the most efficient way to best explain the new concepts of how to problem-solve eczema this way, because, again, people’s preconceived notions get in the way. The site was built for people with infants, and to best help the most number of people—given the most common preconceived hurdles—to see this very different way of looking at skin health and persist in getting the benefits in their unique circumstances.
I think medical research, and basic biological principles, are at least pretty clear that the modern eczema epidemic is above all an environmental problem, with a genetic susceptibility. But there seems to be an underlying assumption that the environmental influence happens early and that children and adults with eczema have a fundamental immunological or skin defect that stems from an early environmental circumstance that can no longer be reversed. This assumption is wrong, and I believe I can demonstrate that it’s wrong.
When I went to solve my child’s eczema, I could see that the one indisputable aspect of the problem, according to research, was that it is primarily environmental, something about the modern environment, but I didn’t see anything that I recognized as environmental problem solving anywhere. So that’s what I did. This is why the SolveEczema site is basically an environmental problem-solving guide. Sometimes I despair of ever helping most people understand so they don’t keep suffering from what I believe is the completely solvable problems of eczema and atopic asthma, and even the majority of dry skin.
In solving eczema, it became really clear that everyone is affected by these same environmental influences even if they don’t have eczema—and I don’t just mean people, I also mean animals (indoors and outdoors), but that’s a topic for another day—and that the impacts are both short-term and long-term. Both short- and long-term impacts on membranes are reversible with the right environmental changes. The best results come from understanding and ameliorating both the short-term and long-term consequences of those environmental influences, but people can do a lot to solve dry skin just by understanding and ameliorating the short-term impacts.
Now that everyone is washing their hands frequently because of the coronavirus pandemic—since washing is superior to hand sanitizer when it comes to preventing the spread of infection—I’d like to try sharing this very different way of looking at skin dryness again. Because when people understand it, they can wash their hands really well, getting them very clean and even scrubbing, without drying out their skin and without needing moisturizers.
This kind of advantage is critical for medical professionals because damaged skin can harbor microorganisms and make doctors susceptible to infections themselves through broken, bleeding skin. Let’s face it, damaged skin just plain makes people not want to wash their hands frequently, too. Hand sanitizers, while important for when hand washing is not possible, don’t work as well as washing, and the alcohol (and other chemicals) in them can be absorbed. Sanitizers don’t work at all against some viruses like norovirus. Sanitizers have nevertheless become ubiquitous even where hand washing is available because handwashing is harder, and let’s face it, often times painful, because of the drying. It doesn’t have to be.
It’s so ingrained that washing well damages skin, there’s even a pandemic commercial that shows a medical professional scrubbing and proudly holding up red raw hands, as if it is an inevitable sacrifice. In my experience, for the majority of people who understand this different perspective, this familiar outcome of handwashing is not necessary, there is a better way.
If you’re willing to follow along and understand this very different perspective, at the end of this article, I will share a simple experiment you can do to demonstrate these principles at home.
With that goal in mind, the first and most important point I need to make is this:
Point #1: Washing hands to get them really clean, washing hands often and really thoroughly, is NOT what is drying your skin.
Let me say that again another way: the reason your hands get dry, cracked, and raw when you wash them a lot, is not, as is commonly believed, because you are stripping oils from your skin when you wash.
Yes, there is something about the washing process that is making your skin dry and raw, but what you and pretty much everyone else have assumed and concluded about why is wrong. Understanding this can change everything.
The second critical point I need to make, and which I have made for over a decade on this blog, and tried to make more memorable by giving it a dopey name (my apologies), is Lumsdaine’s Law:
Point #2: Lumsdaine’s Law: For most people, under most conditions, eczema and dry skin are more the result of what is left on the skin than what is stripped from the skin by washing.
Your skin is not getting dry from washing away oils. Your skin is getting dry because the residue of whatever you washed with—and there will be a residue, no matter what the product maker promised about rinsing—has unnaturally increased the permeability of your skin so that it loses more moisture than the natural dynamic repair processes of the skin can replace on an ongoing basis.
This is especially true for modern synthetic detergents like sodium lauryl sulfate, even the organic ones. (The important characteristic being the molecular properties of the products, notably, how hydrophilic—attracted to water, and thus, how good at increasing membrane permeability—they are, not the starting ingredients.) This characteristic of modern synthetic detergents has been amplified beyond anything possible in traditional soaps, and more so over time (in step with the allergy epidemic since WWII, I would note.)
Even a layer of water on the skin, all by itself, increases the permeability of skin. Not as dramatically as detergents do, and especially detergents with a layer of water, but you can see this if you wash your hands in the winter and don’t dry them properly, they chap. Your hands feel “moist” just after applying the water, but over time, they lose excess water because that extra layer of externally applied water increases the permeability of the skin. (Though few people would know the effect of water alone anymore since the vast majority of people have residues of detergents on their hands even if they rinse just with water. But the effect is the same.)
The molecular properties of surfactants that make them good at destroying surface tension/mixing with water and therefore good at cleaning also happen to make the residues left on skin good at unnaturally increasing the permeability of skin. Modern synthetic detergents (as defined on SolveEczema.org) are inevitably far more hydrophilic than soaps (also as defined on SolveEczema.org) and thus increase the permeability of skin far more. This is an underlying principle of SolveEczema. Even tiny residues of modern detergents left on the skin (yes, even “organic” ones) can unnaturally increase the permeability of skin on an ongoing basis.
Translation: Rinsing with hard water left more detergent residues on people’s skin. The detergent residues remaining on the skin increased the loss of water from the skin and were associated with irritation, especially in people who are genetically prone to having eczema and allergies.
This still doesn’t address the, in my experience, wrong idea that skin dryness is the result of oils being stripped from the skin from washing, but it’s a start. (I will write more about this later, but based on my research, it seems that this idea, that washing away oils causes skin dryness, is more the consequence of innovations in 20th century advertising than scientific evidence.)
Point #3 Using creamy moisturizers and “moisturizing” washing products backfires. Skin seems moisturized right after using them, but over time, they cause the skin to lose water.
This is also described in SolveEczema.org. I’ve heard this phenomenon described as the skin becoming “addicted” to the moisturizer and not producing enough oils because of the externally applied moisturizing, and that if people just stop moisturizing, after a painful period of adjustment, skin will be less dry. Again, this is a wrong interpretation that sadly causes unnecessary suffering and poor results.
What’s really happening, as I describe in SolveEczema.org, is that the creamy moisturizers are creating a condition much like water on the skin, in which it is temporarily externally hydrated in a way that causes increased permeability and excess water loss over time, and thus, dry skin.
A test Here’s that test I promised to prove all this to yourself, if you are able to handle very dry skin for a couple of days. (Note: if you have hard water, the results could be affected by the water hardness, per the paper I cited above. Given the need to wash hands because of Covid-19, I wouldn’t do this full test if you have to be out in the world and need handwashing for serious infection control. “Moisturizing” soaps don’t tend to clean very well, for one.) It’s a 3- to 6-day test, so set aside a time when you don’t expect to go out much.
First step: Get a “moisturizing” bar soap. Also get a very neutral bar soap (like from my list of favorites, such as Sappo Hill unscented, which you can get by the bar at Whole Foods) that doesn’t feel especially oily or moisturizing and does a good job cleaning. Stick with “soap” as defined on SolveEczema.org, at least for the neutral soap. Do not use a product with detergent ingredients for the neutral bar soap. If you use a product with detergent ingredients (detergents as defined on SolveEczema.org) for moisturizing soap, then it may take more time to restore your skin to “normal,” possibly a lot more time. For the sake of keeping as many things controlled as possible, if you want to try a detergent in the first phase, maybe do a second trial after trying it first with only soaps (again, as defined on SolveEczema.org).
Glycerine “soaps” are perfect for the “moisturizing” one, although you can use any soap that feels really oily when you touch it, with added moisturizing ingredients. Such soaps won’t feel like they clean very well, but seem to leave “moisturizing” residues when you wash. (If you use them, you will see why I no longer recommend glycerine soaps at all, even though they are not detergents as defined on my site. They’re not really drying enough to cause eczema, in my experience, but … you’ll see.)
Second step: Once you have the two products, for the next 3 days, ONLY wash with the “moisturizing” product every time you wash your hands (showering counts, but use the soap in the shower then). Rinse well. Remember, don’t use a different product because you’ll wash off the residues of the test product. If you aren’t a SolveEczema site user, please recognize that your skin is regularly touching and absorbing detergents in your environment. Dry your hands for all of these tests with a paper towel (not a washed towel) to minimize that influence after you wash hands. Important: Don’t use a separate moisturizer for the duration of the test.
Comment: Immediately after using a glycerine bar or very moisturizing product, the skin seems very soft and hydrated. But then over time, over a period of hours in the short-term, and days in the long-term, it gets really dried out. You’ll probably see the effect within a day, but if you want to have no doubts, go 3 days. (Unless you get fed up from the dry skin earlier, in which case, move forward.)
Third step: After 3 days, wash your hands one more time with the “moisturizing”/glycerine soap, and wait for the moisturized-feeling phase to wear off—probably a couple of hours but may be shorter—so that your skin feels really dry.
Fourth step: Get out the neutral soap, like the Sappo Hill unscented (the best is an aged bar), and wash your hands really well. Get them super sudsed up, between your fingers, the back of your hands. Rinse them really well. Then dry them with a paper towel.
Wait the same amount of time that it took your skin to feel super dry after washing with the glycerine soap. (Try not to do things that would get more detergents on your skin, such as handling dust or clothing.) How do your hands feel? Your skin should be considerably less dry, more supple. If the cause of the dryness had been stripping oils from your skin, your skin would have been only more dry.
Keep washing with only this new neutral soap for 3 days. Notice the difference.
The Sappo Hill (or whichever product you chose) isn’t especially moisturizing or oily. It washes away oil and dirt better than products that are.
Having substances on the skin that increase the permeability so much that the skin’s natural dynamic repair processes can’t restore water fast enough is what is causing dry skin. You can wash those substances away; when you do that, your skin can replace water and become less dry fairly rapidly. It’s not days like the people who subscribe to the oil-moisturizer-addiction perspective think, it’s more like tens of minutes or hours, and the results are far better. If you don’t follow the SolveEczema site strategies, you are likely to be introducing hydrophilic substances that can cause drying to your skin in ways you don’t appreciate, which have long-term effects, but you should still be able to see the results of this test.
If you still want to moisturize your skin after this process, and you may, wash with the neutral soap, dry with a paper towel, and use a thin later of Aquaphor (which you can even wipe off with a paper towel—again, not a washed towel—almost entirely so it isn’t greasy, seriously that will work just as well or better than lots of product). If you keep using the neutral soap (and you don’t have exposure to other surfactants like the detergents that comprise virtually all commercial shampoos including the organic ones), you probably won’t need to use the barrier again. Note: this same principle is at play with all of the surfactants you come into contact with: the laundry detergent, the detergents in personal care products, the dishes and household surfaces, the dust in your home (which is made up so much by lint, skin cells, and hair). It has been my experience and that of others using the SolveEczema site that changing to less-permeability-inducing household products can improve skin dramatically in the longer term, too.
Point #4 Read my previous post about aging soap. Aged true soap may be less alkaline, I’ll have to do some testing on that. Regardless, a true soap that is neutral (non-oily) yet drying when you use it, will typically no longer be drying after it’s aged. If it has tons of moisturizing ingredients, though, so that the bar feels oily when you touch it and/or your skin feels like it has a coating of something moisturizing after you use it, aging the soap will never make it better.
Point #5 Water hardness has such a dramatic impact on the performance of soaps and detergents—how well they suds, remove dirt, and rinse off—in my observation, water softness/hardness is typically a more important factor in cleaning performance than exactly what brand of soap/detergent one chooses. It is also a factor in dryness.
Over and over again I find with my site users that people with hard water have the most difficult time getting the detergents washed out of their clothing. Research has shown that there is more eczema in hard water areas than those with soft water. Soap doesn’t work well in hard water, and it forms insoluble residues. Detergents do, too, just not to the same degree. Those residues are why soft white fabrics get grey and coarse after repeated washing. When washed in real soap and soft water, soft light-colored fabrics stay light-colored and soft over time.
People tend to use a LOT of detergent when they have hard water, too, because hard water doesn’t allow sudsing or rinse as well and thus leaves a lot of residue (see the paper above). This is not an intuitive fact, because soaps and detergents develop lather and suds so much more easily with soft water, it can seem harder to rinse off. The reality is that with soft water, you can get things clean with far less product, and you can SEE the suds. That squeaky feeling people get when rinsing with hard water is actually residue, not actual clean.
This is not common knowledge, in fact there is a lot of misinformation on the internet about whether hard or soft water rinse better. Remember, the 2018 paper above showed that more detergents are left on the skin from HARD water rinsing. But because people see the suds disappear faster with hard water, they assume hard water rinses better. Even the Unites States Geological Survey gets that wrong: They wrote: “Hard water is actually much better at binding with the molecules in soap, allowing us to use less water to wash soap away, and making our skin feel “squeaky clean”.” That is exactly WRONG!!!
Remember what the research study above proved? “Sites washed with hard water had significantly increased sodium lauryl sulfate deposits.” And “Softening the water to remove calcium and magnesium ions significantly reduced the level of SLS deposition.”
Hard water doesn’t rinse away detergents well. Soft water rinses much better, and you can use less soap or detergent to begin with in soft water. Those residues increase membrane permeability, which increases water loss from your skin.
The USGS example is one of many you can find, which are likely the result of rationalizing from a simple observation, rather than using direct scientific testing. The same is true of old beliefs about dry skin and washing away oils, which as near as I can tell, came about because of advertising innovations mid-20th century.
At a time when washing hands well is so important to reducing spread of disease, it’s probably also important to know the difference between hard and soft water, and how each affects the performance of soaps and detergents, in particular, rinsing microbes away.
The best results come from following the SolveEczema site strategies fully. When fully and properly implemented, Solveeczema.org strategies typically result in a long-term improvement to skin which is most obvious in the first two months after full implementation. (Note: As I say frequently on my site for good reason, do not implement without first understanding it fully and keeping your doctor in the loop, it is a very different perspective and things can go wrong.)
When I was younger, if I traveled, I inevitably got cracked, dry, bleeding hands. Using those thick workmen hand creams only helped some, and they were a messy hassle. I thought for sure it was the dry air on airplanes. After implementing the site, I just take my own true soap (as defined on SolveEczema.org) with me in a pocket foaming dispenser to wash my hands with when I travel, and I don’t ever have dry skin anymore. I usually take Aquaphor with me but almost never have to use it. My soap is neutral, not moisturizing, and cleans really well—which is why it isn’t drying even when I have to wash frequently. Washing away the many harsh detergent residues I come into contact with when traveling also helps—so washing becomes an important way to prevent dry skin!
I would really love to impart this benefit to every doctor and nurse in the country who is suffering from handwashing, not just since the Covid-19 crisis, so that they can wash their hands as often as they need to, get them very clean, yet not suffer the kind of dry skin they may be suffering now.
Over the years, I have been thanked by many people who used SolveEczema.org just to solve a dry skin problem, even if they did not have eczema. I have been thanked by many parents and more than one doctor who realized they could wash their hands frequently when necessary, without drying their skin out. As I am very clear about on my website, I am not a doctor, this is based on my own personal observation and research. Getting results relies on capitalizing on that new perspective, so it is essential to understand that new perspective first. (I also fundamentally approach things from a Safety First standpoint — I will never suggest doing anything in a way that should make anything worse, or that has to be “toughed out,” so it’s important to understand first AND always keep a doctor in the loop even if they don’t know the site, in case the unexpected happens.)
I am writing this to share what we — and now many others — have done using the Solveczema.org perspective to get unexpected, out-of-the-box results with ameliorating dry skin, for those who maybe can’t seem to find any moisturizing cream thick enough to prevent painful cracked skin during the winter or on travel, or who struggle with washing the dishes even with gloves.
Obviously, I can’t promise a “cure” without a traditional medical study, the title above is just a restatement of the usual idiom and my opinion about its applicability, although this is a perfect set up for a clinical study. I believe this perspective could not only improve the health of health providers’ skin, but also improve compliance with handwashing, and thus help reduce hospital-borne infection.
If you are ready to try this, first read the SolveEczema site disclaimer, watch the SolveEczema site video linked from the home page (note, I made it for a long-concluded crowdfunding for my book and haven’t been able to update the ending, it’s an amateur effort — sorry, it puts me to sleep, too — but it’s only about 45 minutes and is still a good summary of the site). Read everything here, use your judgment, talk with your physician as needed for health and safety issues, and don’t make any changes until you understand how different this is. It’s not about individual products, it’s about learning how to have optimal skin health without treatments or moisturizing, by understanding what, in my observation, is really going on.
It’s only two pages — please refer to the Analysis and Observations section for essential novel observations.
Again, with my apologies for the presumption of giving this a personal, alliterative name like this in hopes of making it more memorable, I also need to restate this very different-from-traditional view of why skin becomes dry after washing, per my own observations, because it’s crucial for getting results:
Lumsdaine’s Law:For most people, under most conditions, eczema and dry skin are more the result of what is left on the skin than what is stripped from the skin by washing.
Photo of dry hand courtesy of Wikimedia
Water alone on the skin increases the membrane permeability. Membrane permeability is basically just how easily certain substances — like water molecules — can pass through the membrane, from within and without. If you wash your hands in the winter and don’t dry them well afterwards, your hands chap even if you only washed in water, because the water left on the skin increases the permeability and accelerates water loss.
Under normal conditions, the restoration of water in the skin is quite rapid; if someone washes and it takes days for the skin to rehydrate, my contention is that it’s because of what is on the skin in the meantime, not usually from what was stripped from the skin by normal washing. Detergents on the skin (see the paper) in combination with a small layer of water, including from sweat, dramatically increases permeability and subsequent water loss.
Until I can finish a book or publish papers, I really can’t do this topic justice. And I’m not really sure users of my site (SolveEczema.org) really need much explanation. Once people really read and understand the site, and put the strategies into practice, what I’m about to say is pretty obvious.
A lot has been written in recent years about the “Farm Effect” — an astute observation made by pioneering eczema/hygiene hypothesis researchers that people who live on farms tend to have less eczema than people who don’t. This led to speculation about whether the reason had to do with dirt or microorganism exposure.
Researchers found a far higher rate of allergy, asthma, and eczema among children aged 6-12 who were from families of Swiss non-farmers than Swiss farmers. They also found the Swiss farmers had a higher rate than Amish in the US (who tend to be farmers, though not all). Researchers may have chosen the comparison with Amish in the US because they originally came from Switzerland, and may be genetically similar, although the comparison would have been even more useful if they had also surveyed the Amish-like communities still in Switzerland.
So, to summarize: The Amish had the lowest rates of allergy, asthma, and eczema. The Swiss farmers had less allergic diseases than non-farmer general population, but higher than the Amish. This relative difference was true also for allergic sensitization to various allergens on testing.
The significant difference between the Amish and the farm families suggests the need to consider other influences.
Swiss cows everywhere and up close in Switzerland
Additionally, Switzerland is such a small country where farming and the farming community is simply not that isolated from the rest of the nation. It’s nothing like the US where you might have to drive a hundred miles to see a cow (or a farmer).
Swiss horses in the path
While Switzerland is an extremely clean country, let’s face it, the dairy industry is pretty important — it’s hard not to notice that there are a great many animals and a great many flies because dairy is so well integrated into the landscape. I just can’t see making a strong case that any population is that well isolated from any other there microbially.
Swiss goats are everywhere, too.
But in terms of lifestyle, the general Swiss population of non-farmers is using the same kinds of new surfactants that everyone else in the industrialized world is using where eczema and asthma are so high. They spend more time in homes breathing the detergent “dust” from this use than do farmers, who spend more time outdoors.
Swiss farmers may or may not be using less of such products. While I doubt they are making their own soap anymore — though I do not know — they do spend more time outdoors, away from breathing such dusts. Recall that these substances increase antigen penetration of membranes, including lung, i.e., to the immune system, it’s as if there is more allergen in the environment.
In the US, farming communities gave up making their own soap later than everyone else. In some farming communities, soapmaking remains a strong tradition. The Amish are one of those communities, probably the most significantly so. Although acceptance of the modern can vary among Amish communities, there is a strong tradition of soapmaking among the Amish. This essay about Amish life in the 19th century (search on the word “soap”) describes the process. While it can be truly difficult to get specific data, it’s very unlikely that this tradition has changed much, if at all.
This relatively new environmental factor — the use of these highly hydrophilic modern surfactants that I believe are amplifying “normal” allergic processes — has a much more consistent and close ecological link to allergy, asthma, and eczema increases than any of the other explanations, across time and geography. This factor should be included in these types of studies, because of the potential to reconcile so much seemingly contradictory evidence, not just when it comes to the “Farm Effect”, but also when it comes to the research on allergy and exposure to pets like dogs and cats (especially the contradictory evidence when it comes to cats), or studies of allergy in households that handwash versus dishwasher wash the dishes. Getting into details is a long discussion for another day. However, because these surfactants can so powerfully influence human membranes in a way that is known and directly speaks to allergy, I think it’s too bad the studies don’t include anything at all about this factor. Especially since, as in the study above, there is likely to be a big difference in usage between the populations.
The SolveEczema.org perspective reconciles the major inconsistencies in the research of most of these different factors, such as the Farm Effect. And the SolveEczema.org strategies, from experience, happen to lead to dramatic reduction of asthma and allergies in concert with eczema amelioration, not just for the child with eczema, but everyone in the household. And it doesn’t require getting dirty or rolling around in cow or horse … um … microbes.
This room was one part of a structure also housing a mountain café, where day hikers frequently stop for tea or hot cocoa. Note the nearly brand new calf. OK – this isn’t a common sight in Switzerland – but cows (and their microbes) are.
One of the goals when I started to write a book about SolveEczema.org (still in the works!) was to find a way to bring the ideas into a mainstream medical and scientific forum for discussion and validation, including also writing a scientific paper. After years considering how to publish something so different, I published in a new open source platform called The Winnower, which offers post-publication peer review.
I know this probably sounds very dry to site users, but for anyone who has asked the question “Why didn’t my doctor give me this information?!” (too many to count have emailed me the same question), you may be interested in the scientific validation of this work, because it will mean other children will be spared the same suffering. Although many doctors have used and referred SolveEczema.org to patients over the years, it will be tough to reach everyone or work on solving related health conditions without the validation of peer review.
I’m having some computer problems lately, so rather than trying to compose a post to explain, here are some edited excerpts from recent letters I wrote:
SolveEczema.org represents the novel application of modern technical problem solving, in particular, the engineering method, to solving a medical condition, eczema and related allergy. The engineering method has been described as “The use of heuristics to cause the best change in a poorly understood situation within the available resources.” (BV Koen, The Bent of Tau Beta Pi, 1985)
When an environmental cause underlies a medical condition, complex environmental and exposure differences can translate to seemingly intractable person-to-person variability. This work involves the unraveling of this seeming complexity by using heuristics that allow individuals to focus on controlling what’s important to problem solve in their own circumstances. The paper presents a number of insights that came about as part of the problem solving process and subsequent research, such as why a key aspect of the solution has been overlooked to date and why a new approach is needed for the validation of heuristic solutions.
A letter to a doctor who expressed an interest in a collaboration:
The article mentions how this perspective could reconcile seemingly contradictory hygiene hypothesis research. For example, for awhile, researchers said owning dogs and cats was protective, then they said it was just dogs, etc. The issue the research didn’t take into account was developments in cleaning equipment (e.g. better, filtered vacs, and more frequent cleaning of pet hair), and the fact that cats use cat litter which is just loaded with detergents that they track through homes. Birth order – anyone with a first child with allergies is going to make changes in the home environment and products, which are bound to be preventive for the later children, also never taken into account. Breastfeeding and allergies, too – the studies used to show a protective effect, then later studies said no. I think both are probably right (the later studies looked at older children, where detergents were by then probably a more significant influence).
And (same person):
You are spot on about related health issues. I think ultimately this issue is as major an environmental problem as smoking was, in some ways worse because other creatures in the environment are affected. (I think it’s highly likely that frogs, bats, and honeybees, possibly even otters, may be experiencing serious unrecognized harm, but that’s another discussion.) Asthma, allergies, dry skin, and even wrinkles are major related issues. I have been surprised at how much the changes markedly decreased the propensity for sunburn (which could have a major impact downstream on skin cancer). Over the years, I have been thanked on several occasions by doctors specifically over the issue of having good skin despite constant handwashing – perhaps that’s something we could collaborate over. The physician handwashing issue touches on many health problems: hospital-borne infection, possible improving willingness to wash hands over using sanitizers (which is probably healthier for providers who don’t absorb so much through their skin, and reducing infections since washing is better than sanitizers), maintaining a better barrier on providers’ hands to reduce the harboring of microbes, possibly reducing the general need for antimicrobial chemicals in handwashes in some settings if mechanical means are less damaging (reducing development of resistant strains), etc.
I have been thinking a lot lately about whether it would be possible to design a case-control study. Unfortunately, the barrier is that the engineering method relies on heuristics – when an environmental cause underlies a disease, unless it is very simple to remove the cause, there is no way to apply a completely controlled treatment or course of anything. To solve the problem in every individual case, it’s necessary for people to use a heuristic tool to apply the solution in the best way for their individual environmental exposures, health status, genetic profile, etc. Then the concern is how well each person uses the heuristic tool versus how well the tool works for them. Additionally, with the engineering method, it wouldn’t make sense to apply the tool exactly the same for everyone, then judge what percentage were helped – the whole point of it is that if one case isn’t solved 100%, the unresolved case doesn’t become data, it becomes a resource to revise the heuristic tool to encompass new information to achieve the same standard of outcome or solution for that person and everyone.
That isn’t a problem-solving approach currently in use in medicine, and it clashes with normal epidemiological methods. The method itself would have to be the subject of peer review, in the context of a solution like this being peer reviewed. Just yesterday I heard an oncologist (The Death of Cancer) speak on the radio about how “regulations” were keeping him from solving problems for individual cancer patients. The ideal he described, what he really wanted to do, was really the engineering method. I think some doctors are using heuristics in other areas of medicine because they get better outcomes for their patients, and the lack of overt discussion of heuristics is, IMO, causing some of the bigger medical controversies of our time. Finding a way to ethically, with all the right safeguards, incorporate the engineering method into medicine, I believe could result in many currently unsolved disease problems being solved. No new scientific or medical breakthroughs are needed, just problem solving we already know how to do in other technical arenas.
Validating the site work – peer review is a start – would prove eczema and atopy are solvable problems, on an individual and general disease problem level. That sounds simple, yet it’s an earth-shattering idea. Believe it or not, the biggest challenge here is overcoming the idea, the really hard-ingrained prejudice, that a major, complex, seemingly intractable medical problem could even possibly be solved.
So, yes, finding a route to peer-review and publication has been challenging (ironically more challenging than solving my child’s severe eczema and helping thousands around the world do the same over the past >10 years). You can view the paper at: https://thewinnower.com/papers/3412-abnormal-ampli-fication-observations-from-applying-the-engineering-method-to-solving-eczema-and-atopic-disease
I still regularly hear from people who experienceasthma improvementsfrom implementing the SolveEczema site strategies. I would like to share a letter I received a year ago from Julie Leung, a mom in Canada who implemented SolveEczema.org strategies to solve her children’s eczema, and with whom I have been corresponding. She describes the benefit to her own asthma as an adult. I’ve heard this a lot, the benefits even to those who don’t have eczema, particularly to asthma and skin quality. I thought her description was very powerful.
“Baby In Hospital” by Sura Nualpradid Freedigitalphotos.net
Even though people breathe in a great deal of detergent in “dust” these days because the dust in most home indoor environments comes largely from hair, skin cells, lint, I have always downplayed the potential benefits to asthma and other lung conditions pending research validation, and because I do not believe environmental detergents (as defined on my site) are the underlying cause of asthma, but an amplifier, abnormally influencing the membrane and the normal function of the immune system (for the reasons discussed on SolveEczema.org). Additionally, unlike with eczema, there is no way to give people simple GRAS (generally regarded as safe) recommendations that provide the kind of direct feedback that people with eczema experience when they properly implement SolveEczema strategies. Until there are studies, it’s much harder to convince people to do what is necessary if they don’t have the immediate feedback of those with eczema. Nevertheless, because so many people describe their improvements, I feel it’s important to share what is possible.
First, the caveats:
Photo by Arvind Balaraman Freedigitalphotos.net
I am posting this to help people who are proactive and looking for better answers in their own health journeys. It is not intended in any way as medical advice (as everyone who reads my site knows, I am not a doctor), nor intended to replace the relationship between doctor and patient. In fact, please only read further if you have a good relationship with a doctor managing your asthma. Implementing the strategies from SolveEczema.org is not trivial and requires understanding a very different perspective. Things can go wrong, too. A relationship with a physician is essential. Implementing the strategies may help, but given the range of contributors to asthma, I do not want anyone to think I am suggesting a replacement for sound medical advice, follow up, and care. Asthma medications can save lives. Implementing the site strategies for asthma takes time, on the order of months, and unfortunately can be all too quickly reversed because of modern environmental influences that are sometimes out of people’s control. Do NOT make changes to care based on a website (mine or anyone else’s) without thoroughly understanding and consulting with your physician. Only make changes per SolveEczema if you’re willing to understand and do it safely, with your doctor in the loop.
Here is the letter [story and personal photos from Julie Leung, except where noted, all rights reserved, used with permission]. Many thanks to Julie for writing and being willing to share. I would add that in terms of what Julie did, described below, in pushing herself to see how much her lungs had improved — that’s for information and is a “Do not try this at home” FYI only! She is a very detail-oriented, highly analytical person with a science background, was (and is) actively in asthma medical care and management, with a history of excellent physical fitness and those adventure sports. I recommend against readers “testing” improvements that way!:
In addition to the successes we’ve had with our children’s eczema, I wanted to share the surprisingly positive impact on my long-standing asthma. I hope my testimony, so to speak, might help someone else.
When my husband and I began implementing the framework given on your site, I was on a year long maternity leave from work after the birth of our daughter and was spending most of my time in our detergent-free home. By January of 2013, I discovered that my asthma had gone away completely and it seemed correlated to the detergent removal in our home.
Stop Asthma by Stuart Miles Freedigitalphotos.net
From what I had already read on your site, my asthma disappearing was not an altogether unexpected result, but the extent of the improvement was wholly astonishing, and felt nearly miraculous. I later returned to work and therefore to regular daily detergent exposure outside my home, and the resulting return of my asthma has convinced me of the significant impact that detergents have on my asthma. What it also showed me was that I can have control over my well-being in a way I never would have thought possible before reading your site.
I’ve had asthma since I was a teenager, and in my adulthood, it came “under control” through regular use of steroid inhalers. Consistent with widely-accepted asthma management protocol, I was told that need of a “quick response” inhaler (like Ventolin) more than a few times a week meant my asthma was “out of control” and needed to be quieted by increasing the frequency and/or dosage of my steroid inhaler.
You’d pointed out to me that “steroid fears” are well-documented in the medical literature, and I found myself reflected in those profiles — I have always felt uneasy about taking so much steroid. Over the years, I’ve constantly tried to use as little as possible, or wean myself off them completely. Off, or on an inappropriately low dosage of, the drugs, my asthma is fine until I get a cold or exercise above my typical intensity. Then, inevitably suffering from constant wheezing that isn’t relieved by my “quick response” inhaler, I begrudgingly ramp up my steroid usage and maintain this dosage for at least 2 weeks, until my asthma once again comes under control.
When I found your site, we implemented the changes in our household to help our children, but I considered that I might also benefit from them. I stopped taking my steroid inhalers, almost subconsciously, at the same time we started detergent removal from our home. It is important to note that there was a period of about 9 months where I was no longer regularly exposed to detergents because I was spending almost all my time in my home because I was on maternity leave and also trying to minimize my baby’s exposure to detergents while problem-solving her eczema.
Within 4 months of starting detergent removal, I started to feel that I was perhaps not experiencing the same depth or sensitivity of asthma as I did prior. I started to tell a few people tentatively, always clarifying that I still thought I had asthma, but it seemed to be better. I seemed more resistant to triggers, didn’t wheeze as easily, or it took more physical exertion to have the asthma show up; when it did, it didn’t linger as long, and didn’t seem to need the short-acting inhaler to resolve.
7 months after starting detergent removal, I was invited on a snowshoeing trip in the mountains. The trip was in an area in which I used to cross-country ski frequently a number of years ago, and so my body was generally familiar with the terrain, conditions and weather. Back when I was cross-country skiing regularly, I was exceptionally fit and this seemed to also help mitigate the asthma, raising the threshold of physical exertion before wheezing. However, I always got asthma while skiing, and I always had to stop and take a puff or two of my short-acting inhaler, typically within 5 minutes of starting to cross-country ski, and often again later on in my 4-6 hour workout. At the time of the snowshoeing trip, I had every reason to expect to be wheezy. Not only had I become relatively out of shape, but at this point I hadn’t taken any inhalers for at least 6 months.
I brought my inhaler along just in case, but I was really curious to see whether I’d be asthmatic or not. After the initial steps, getting into the groove, I listened to my body, tentatively, half expecting to need my inhaler. No wheezing, not too much tightness in the chest. So far so good. I kept on. And on. And on. 2.5 hours into the trip, I suddenly realized, that despite climbing up and down a canyon, breaking through undisturbed snow at times, and talking while walking, I hadn’t needed my inhaler.
At the point of my no-asthma discovery, everyone on the trip was tired, but I had lots of energy because I was so excited! I wanted to try to “incite” the asthma by pushing myself to the limits of physical exertion. I didn’t think I would have many other chances to “test” the condition of my asthma. I nearly ran up a 90 foot incline to the top of a dam, so fast that it was a few minutes before anyone else in our party caught up to me after I stopped. I experienced no wheezing! I could not remember the last time I exercised hard, started breathing hard, and did not feel the familiar tightening of my chest and wheezing coming on. I was elated!
Less than a month after that first trip, I went on another snoeshowing trip in the mountains where the level of activity was closer to what I’d regularly done when younger. 4 hours of constant movement and some chatting with my companions through the mountain landscape in cold weather yielded no wheezing whatsoever. Again, I was floored.
Less than a month after that trip, my maternity leave ended and I returned to work and into a detergent-filled environment. Within 4 days of returning to work, I ran for the bus for 15 seconds and had the most severe asthma attack I’d experienced in over a year: the familiar sharp, stabbing pain in my chest, the wheezing and compressed lung capacity, and the taste of blood in my lungs — all symptoms typical of my asthma attacks.
As you’ve pointed out to me during problem-solving for my children, scientists often test for causation by removing the stimulus they hypothesize is causing an issue, then reintroducing the stimulus. To show causation, it’s not enough that the issue resolves when the stimulus is removed; the issue needs to return when the stimulus is re-introduced. As I reflect, I realize that’s precisely what I’ve inadvertently tested — when detergent are absent, my asthma disappears; re-introduce detergents, my asthma re-appears.
When I returned to work, I was in a detergent-filled environment for about 10-12 hours a day, 5 days a week. I eventually needed my steroid inhalers to control my asthma again, but only needed about a quarter of my previous dose for control. Over time, I ratcheted my dose down and used the steroid inhaler so infrequently that I was not considered to have my asthma under “drug control”. Eventually, my asthma settled to a place where it was definitely worse than while I was on maternity leave, but better than the symptoms I’d had my entire life. Overall, compared to before detergent removal, it took more or longer physical exertion or exposure to allergens for my asthma to show up, the symptoms were not as severe when it did show up, and it required less drug to control.
In the summer of 2014, I went for spirometry testing. At the time, I was using next to no drug and was feeling some frequent, general chest tightness, as I had since returning to work. The respiratory therapist took 3 different measurements. Surprisingly, she indicated that the numbers from all tests were very good and said that if she saw the numbers alone, without knowledge of my clinical history of long-term asthma, she would think that the patient did not have asthma! In her report to my doctor, she indicated, “Asthma is under control”, despite the fact that she and I both agreed I wasn’t taking enough steroid to consider my asthma as under control from drugs! The respirologist who reviewed my spirometry results seemed to question whether the asthma diagnosis was even correct, something that had never happened before despite decades of treatment.
I know that I’m still an asthma sufferer, and, with the “right” conditions (such as long enough exposure to animals I’m allergic to, or if I’m in an really detergent-y environment for a long enough time), I will “express” my asthma. But, I feel also that the clearing of detergents and detergent-laden dusts in my home environment has allowed my lungs to heal in a way that has significantly increased my thresholds to reacting in my lungs, much like it has for my daughter on her skin. And, my results, coupled with observations I’ve made about my son, strongly indicate that I may also have delayed or perhaps even avoided the onset of asthma, or, at the very least, potentially reduced its severity if it does develop, in my children.
I hope that my story encourages those that are considering detergent removal or those who have already done so and are hard at work problem-solving for their families. For as depressing as it is that our world is now inundated with chemicals that may have caused such a great degree of unnecessary sickness and suffering, it is hopeful that there is still something we can do about it.
To read more about Julie Leung’s allergy journey, or to find the list of products she uses in Canada, please see: http://allergyjourney.com
Happy Holidays — Best Wishes for a Healthy, Eczema-free (and Asthma-free) New Year!
I can’t believe so much time has passed since my last post. Much has happened. (Much of what I learned that allowed me to do this — SolveEczema.org — came from many lessons in my own health journey, which continues. Please pardon my slowness!)
Since publishing that poster, I have been trying to publish a scientific paper for peer review. One roadblock I expected, but was surprised to find even more from open source publication outlets, is that everything about this is simply too new and different. The observations and solutions of SolveEczema resulted from the engineering method, which makes use of heuristics. The goal is to most optimally solve a problem, within available resources (see my poster for more). Although I thought about how to do so for a long time myself, there is no way to overlay a traditional study design. So to editors of scientific journals, I may as well be trying to publish Sunday morning cartoons. But forcing this into a traditional format will destroy what allowed me to find a solution in the first place.
When the cause of a health condition is an infection, different people may have different symptoms, and there may be a range of symptoms and manifestations across a population of people with the same disease, but ultimately the solution involves finding the one thing in common, the infectious agent, and almost ignoring that range of differences. A traditional study design is adequate to validate the treatment: it’s possible to give everyone a single treatment, or small variations on a single treatment, and a placebo to mimic treatment for comparison.
When the cause of a health condition is environmental — as researchers basically agree the modern eczema/asthma epidemic is fundamentally — then the different symptoms people have, the range of manifestations across a population of sufferers, are the result in every case of different environmental conditions and exposures, different genetics, and different immunological states. There may be a common thread or solution, but even once that is found, actually solving the problem for every individual inherently involves problem solving in the context of each person’s exposures, genes, and health status. The differences between people for an infectious disease cause are, in some ways, almost beside the point, whereas in the environmental health cause, they are the point.
The engineering method, which uses heuristics, is well suited to finding the environmental cause in the first place, and is essential for validating the solution, because it’s not possible to validate a proposed solution through a traditional double-blind study in which every person does or uses the same exact treatment. There is no way to set up a treatment or series of steps for everyone to follow exactly and get the same results as individuals problem-solving in their own environments using a well-developed heuristic tool to do whatever it takes to get the best outcome. What is held constant in each case is not the treatment, but the aimed-for outcome (by the engineering method), which by current treatment validation paradigms (using the scientific method) isn’t considered possible to do. The scientific method, in this instance, will never be an adequate problem-solving tool to achieve what we consider cure or solution. Where a heuristic solution is applied, when a case is not resolved by properly applying the heuristic, then the heuristic (not the aimed-for outcome of problem solving) is revised or expanded to encompass the outlier circumstance.
In publishing, not only the solution and the revision of the hygiene hypothesis, plus all the novel observations I am proposing, need peer review and validation, but also the use of heuristics in disease problem solving and treatment. Using the engineering method in medical problem solving and treatment, basically, needs and deserves peer review. (As always, stay tuned.)
P.S. Come to think of it, was this “citizen science” or was it “citizen engineering”?….