I received a letter recently with a request to better explain how to find products that meet the SolveEczema site criteria.  I get product questions enough that I thought I’d just post my reply here on the blog:

My letter:

I’m glad the site helped!  I know it’s confusing to tell which products meet the site criteria and not — if it helps, I have difficulties evaluating product ingredients myself!  (Unfortunately, the majority of products available on store shelves do not meet the site criteria, which is why so many people have problems finding ones that do.)

First, you researched your daughter’s problem and implemented something that helps — so you are a problem solver, and that’s what’s important here.  I come across many moms who are very systematic, determined, and smart, many of whom have no science background whatsoever — and they’re as and sometimes even more effective than someone whose training might at first be a barrier to looking at the problem a new way. So don’t feel like it’s you.  It’s just the position we are all in because of what’s in our environment, how ubiquitous that influence is, and how poor the information we have is to assess it.

I have had friends who told me, “Just tell me what to use” — which works up to a point, but getting the best result takes understanding what is going on and problem-solving in your own environment.  Often people think they are detergent-free yet miss even very obvious influences until they do understand.

Plus, products are different everywhere — I get letters from all over the world — and companies change their products all the time.  I just got a letter from another mom who ordered some products from a company I recommended, Eco-Me, and there were sugar detergents in the products she received.  I looked on the company’s website, and they had different pages on their site for those same products with completely different ingredients.  I remember when I first checked them out, everything they made was okay per the site, but no longer.  They may be in the process of reformulating.  Worse, they have used the word “soap” in the INGREDIENTS list for something that is not a traditional soap.  It’s the first time I’ve seen “soap” used in the ingredients for something that isn’t a true traditional soap.  However, if you understand, you should be able to figure that out when you evaluate even those products.

One of the most important reasons to understand is for parents to really see the problem as environmental and not a “defect” in their children.  There’s a huge difference, psychologically, between needing a chronic treatment and knowing the problem isn’t you, especially for kids.

The video slideshow overview explains everything fairly simply, in case you haven’t already watched it.  You may want to take a look again at the slide showing the difference between soap and detergent chemical names, it may help.

So, everyone has trouble assessing ingredients.  I have trouble assessing ingredients.  If this were easy, more people would have figured it out.

The underlying principle is this:  I believe “normal” eczema and allergies are a signal from the immune system to the conscious brain, the way pain is for the nervous system.  Whether the “signal” is expressed or not depends on whether a certain threshold is crossed, and that depends to some extent on the state of the immune system, genetic factors affecting skin and immunity, environmental factors affecting skin (such as local humidity, but also whether the skin is damaged because of long-term exposure to detergents, etc), the state of the gut and whether certain proteins are crossing into the bloodstream (and, I suspect, necessitating increased circulating biological detergent to denature those proteins), etc.  But by far the greatest influence now comes from the effect of modern synthetic detergents, which (because of how they are designed) dramatically and unnaturally increase the permeability of skin.  In my experience, the expression of the eczema is proportional to the effect on the permeability.

Removing detergents is not very successful with water alone, residues are incredibly persistent.  As the site says, it’s necessary to use something else to get them out.  Plus, people need a way to get clean in the normal course of life.

So, what else can be used?  Something that doesn’t increase the permeability of the skin beyond a certain point.  The major class of washing products that work appears to be, empirically, traditional alkaline soaps.  Luckily, because they are made in such a narrowly defined way per the relevant characteristics of the end products, they’re pretty much all okay (provided the individual ingredients aren’t allergenic for a given person).

The rise in eczema, asthma/atopy around the world in the latter half of the 20th century has coincided with the increased use of detergents.  Many of the observations that led to the hygiene hypothesis take on new meaning when looked at in that light.  For example, people in many rural areas have less eczema than in urban areas.  One proposed interpretation is that people on farms are less clean and are around certain germs that challenge the immune system.  I’d make the separate observation that soapmaking is traditional in rural environments, farmers spend more time out-of-doors (instead of in indoor environments with the greatest exposure to detergents and detergent dusts).  Amish farm families have an even lower rate of eczema than farmers in the same regions; the Amish still make and use their own soap.

Anyway, back to the issue at hand…

As I describe in detail on the site, words like “soap”, “detergent”, “surfactant”, “emollient” and others, are used very differently in different consumer contexts.  Common definitions have changed over time.  I define the words in a way that allows people to get results with my site, and my definitions are definitely supportable on technical grounds.  However, that’s not how those words are necessarily used when labeling products you buy.

The word “surfactant” just means surface active agent — substances used to reduce the surface tension of water — and covers both traditional soaps AND detergents (by my definition of those words).  HOWEVER, on ingredients labels, the word “surfactant” is invariably used to describe synthetic detergents.  Often it is used to avoid using a name with more negative connotations for consumers.  Lots of products containing SLS or similar detergents describe them as “coconut-based surfactants”.

So, to be very technical about it, no, you don’t have to avoid all surfactants, because soap is a surfactant, but you probably do need to avoid anything LABELED as having a “surfactant” for the time being, because invariably it means it contains a synthetic detergent.

To use the site, you can use borax, baking soda, vinegar, or other non-surfactant washing products I mention.  And you can use any traditional alkaline soap (so long as you don’t have an individual allergy to the ingredients and it’s not so alkaline as to be badly drying).  There is a short list of the most commonly used soaps and their chemical names on my slideshow.  If the label says “saponified [oil]”, that’s soap, or if the label lists an oil and potassium or sodium hydroxide, and no detergents, that’s soap.  Castile soap is soap made with olive oil.  Fortunately, the number of pure soap products seems to be growing.

Sometimes products list only the oils in the ingredients, and it’s not clear whether the products are traditional soap or not.  In that case, if you want to try the product, it’s better to call or write the company first to verify what the product is.  Is it just oil?  Is it saponified oil? Or is it something else made from those oil ingredients (which would make it a detergent by my site definition).

Natural products companies in the last few years have begun to heavily use sugar detergents, which seem to be more mild than other syndets (a “syndet” is a synthetic detergent), and at first I cautiously recommended them.  But I’ve heard from too many people for whom they did not work, so I’ve conditionally withdrawn my recommendation and am hoping for a better sense of these over time.  (I generally suggest problem-solving only with products you can be very sure of, and experimenting with things like these later once you know what you may be dealing with.)

As I say on the site, check ingredients.  I do have one caveat, though.  I tell people to ignore the front label, and to read the ingredients label, which tends to be more accurate and precise.  The front of the product may say “soap” but the product may be entirely detergent.  Usually the ingredients label, however, will be more clear.  If it says something is a “saponified” oil or a “soap” it’s usually traditional alkaline soap.

IMPORTANT NOTE:  However, another mom brought to my attention recently those Eco-Me products I mentioned above, that used to all be non-detergent — they used the word “soap” on the label of their dish soap product for a detergent.  It’s the first time I’ve seen that.  The label (Suzy dish soap) includes:  ” Coconut-base Soap (Decyl Glucoside)” — “Decyl glucoside” is a sugar detergent.

Given the trend in the “natural” product industry, it’s probably a good idea to search the names of the most common sugar surfactants and know what they are.  You’ll generally see the roots of the words for sugar in the names (glucose <=> decyl glucoside).  And also to just know the chemical names of the most common soaps.

The only reason I mention charge properties (anionic, nonionic) is that soap is anionic, so if a surfactant ingredient is described as an amphoteric or nonionic surfactant, you know it’s not soap.  However, many harsh detergents are anionic, too — sodium lauryl sulfate is anionic, as are many problematic syndets.

Additionally, it’s important to realize just how problematic hard water can be. Few people really appreciate just how much of a factor water hardness is to getting results.  Soaps clean so much better in soft water, far less product can be used, and everything rinses better.  Skin and hair feel so much better, too.  Soaps don’t work very well in hard water.  Nothing rinses well.  Very hard water can mean the detergent removal process effectively takes months rather than weeks or days.  Many if not most of the people who contact me with problems, it turns out, have hard water.

I do my best to give a list of products that will work, and I check the ingredients very carefully.  But most companies that sell soap products also sell some or many products that don’t meet the site criteria.  Products change, and there’s no way for me to keep up on everything.  I go to a great deal of trouble to describe how to figure out products on the site, but unfortunately, the difficulty is just because of the situation we are all in, it’s not you, and it’s not for a lack of scientific skills.

I know you asked for a “dumbed down” explanation; please let me know if anything is still unclear.  It will help me know what I need to do a better job explaining for the book.

I hope it helps.  Good luck to your family and your baby for a regular no-eczema childhood!