Patients, parents have environmental concerns about skin products

Renee Howard, MD: “A lot of these families are purchasing alternative products. Sometimes these alternatives are great and sometimes they are not so great.”

Environmental concerns have added another layer of complexity to dermatologic practice. Parents worried about protecting their children and patients concerned about their own exposure to potentially toxic skin care products could ignore treatment recommendations that affect clinical outcomes.

“Worries about toxic exposures from topical medications are nothing new,” said Renee Howard, MD, associate clinical professor of dermatology at the University of California, San Francisco. “But those worries have extended from not wanting to apply topical steroids to not wanting to use over-the-counter moisturizers and sunscreens. A lot of these families are purchasing alternative products. Sometimes these alternatives are great and sometimes they are not so great.”

Dr. Howard explored the burgeoning field of “Eco-Dermatology: A Practical Approach to Addressing the Concerns of Environmentally Minded Patients and Parents in Your Office” (U016) on Aug. 8. Distrust of commercial products may have begun in San Francisco and New York, she said, but has become a more generalized cultural and social phenomenon. Dermatologists need to explore their patients’ attitudes and product preferences to help them make the most appropriate decisions.

Another area of controversy is sunscreen use. It is not enough to simply recommend a sunscreen, Dr. Howard explained. The discussion should include patients’ attitudes and knowledge. Dermatologists need strategies to deal with patient concerns. Parents are reluctant to apply products they perceive as containing toxic chemicals; likewise, dermatologists have a desire to limit exposures, particularly for infants.

“We have a kind of common ground,” Dr. Howard said. “When we talk about sunscreen and sun protection, we can make suggestions about different forms of sun protection such as clothing and hats. We can have a ready list of sunscreens that don’t have ingredients such as oxybenzone. We need to know websites such as the Environmental Working Group that parents may use and the kinds of recommendations they are likely to see.”

Many parents are more willing to use zinc-based products that create a physical barrier versus products that use “chemicals,” she said. Zinc is as much a chemical as oxybenzone, but is often perceived as being less toxic and more acceptable than other compounds.

Moisturizers can be another problem area. Parents may be reluctant to use petrolatum because it is a hydrocarbon and seen as toxic or environmentally harmful. At the same time, many parents are happy to use vegetable-based oils or products containing vegetable oils. Sunflower seed oil and olive oil are both trendy products. While neither has been subjected to the intensive scrutiny given to petrolatum over the decades, studies suggest that sunflower seed oil can be a useful moisturizer for mild to moderate atopic dermatitis. Other studies suggest that olive oil may have a less positive effect on the skin barrier.

“Dermatologists are just learning about some of these alternative therapies and which ones might be useful,” Dr. Howard said. “It is helpful to have some of them in your back pocket for those times when it looks like parents are not willing to use petrolatum and you need something else to offer them.”

Topical steroids also are a common problem area. Many parents link topical steroids used to treat inflammation with anabolic steroids. Education can help, she said. It also can help to point out that topical steroids are available in multiple strengths and that the mildest products are used for children.

“I talk about anti-inflammatories with my parents, which is what these agents are,” Dr. Howard said. “The other thing is to emphasize that not treating itchy eczema is terribly disruptive to the child and his or her life. There are concrete risks with not treating, such as learning problems and depression in older kids. Just reframing the conversation around anti-inflammatories and the need for control can make a big difference in parents’ acceptance of treatment.”

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