Ask DrB: Shaving and Atopic Eczema

Sometimes there seems to be as many opinions as there are people

I began working with The Combined Approach to atopic eczema many years ago, in 1989.  To do this I learnt a great deal from two dermatologists: Dr Richard Staughton here in London, UK and Dr Peter Norén in Uppsala, Sweden. But I also learnt at least as much from listening to my patients, and finding answers for their questions. I still get asked some questions for the first time.

Last month I was asked about the use of leg wax to remove hair: was it OK if there was still chronic eczema? It did not seem a good idea, but I asked Dr Staughton, and we decided to advise against waxing, at least for the time being. During The Combined Approach the principle is to allow the skin to recover its natural structure, by avoiding any form of activity or contact that could cause damage or irritation. We suggested trying a foil electric razor, without actually touching the skin surface – “hovering” as close to the skin as possible.

I then realized with surprise that I had never been asked about shaving and atopic eczema before, by men or women. I therefore had a look on the internet to see what is discussed, and have discovered there are as many opinions as there are people!

Perhaps therefore it would be useful to open up the discussion here with my thoughts so far:

•  Whether or not to shave off body hair is up to the individual: it is not a medical issue. Many men regularly want to shave off their facial hair, and many women regularly want to remove leg, and facial, hair. For men it’s dry or wet shaving, for women the same, plus waxing, creams, threading, sugaring, electrolysis, and laser treatments. Each person and place have a preferred method.

•  When there is atopic eczema as well, the eczema should be given priority, and first treated effectively. Any atopic eczema that has been present for more than a few days may need The Combined Approach: optimal topical treatments and habit reversal for scratching. During the few weeks it takes for The Combined Approach to clear the chronic eczema, shaving off unwanted hair may be feasible – wet or dry methods – but with care not to irritate or damage the skin. If in doubt, leave it.

•  Then, in the three months after using The Combined Approach successfully, continue to use caution removing unwanted hair. The skin is still recovering its natural resilience, and will remain more sensitive than it will be later. During this recovery period we recommend vigilance for acute relapse and aggressive use of optimal topical treatment.

•  After that, it seems reasonable to use whichever method of hair removal that is preferred, and seems feasible. “Trial and error” seems to be the approach most people use to find what works for them, but continuing to prevent drying of the skin will be important for all.

What do you think? Comments welcome below…