Any other toddler's battling eczema? I need your advice please!

Manda - posted on 02/07/2010

I've got a 4 year old son and a 2 year old daughter and both have had eczema from birth, which got worse for them around after their first birthday. They each have a different reaction to it; my son would scratch so much, he'd have large patches of bleeding skin, and my daughter got a very itchy rash that covered her whole torso. Consequently, I've done a lot of research and gotten great advice from our pediatrician. We have a very extensive list of what/how/what not to do, and I've seen such great improvement in my kids the last year, we stick to it. Here's what we do:



Per Pediatrician- Break the itch-cycle and then keep it moisturized to prevent the itching from returning. She says it's about managing it, not really treating it. Some kids may outgrow it, but some kids do not, so just be prepared to keep managing it. These are her instructions.

1. Lotion: 4 times a day use Eucerin Original Moisturizing Creme, strip them down and do their whole body (we've tried a lot of lotions/cremes and this one really is the best; don't get the itchy skin one, stick to the original- it's thick in a jar)

2. Bathing: Baths only once a week and use eucerin immediately after(this was very hard for me to do at first, but just changing baths from twice a week to once a week makes a huge difference).

3. Cool Mist Humidifier - run it where they sleep and keep it clean.

4. If it gets more extreme (due to winter air, wind burnt/sunburt skin, just skipping to many lotionings, etc.) use the Eucerin Auqafor Ointment.

5. If the ointment doesn't work for itching, she said use otc 1% hydrocortisone cream and if that didn't work she gave us an rx for 2.5% hydrocortisone cream (warning any kind of hydrocortisone should never be applied to face or hands! It thins the skin too much.) *we have used the 1% but never actually had to use the 2.5% yet*



What I've Learned from my own research and trial and error:

Partial prevention is attainable. We limit what is applied to our kids skin all the time. We very rarely use sunscreen or bug spray, we stay mostly in the shade and go in if the bugs come out. I only allow the eucerin creme, aquafor ointment, and normal hand soap to be used on their skin. The eucerin original creme and aquafor ointment (both recommended by pediatrican as listed above) are really the best out there though it is a bit pricy; we have literally tried almost every other kind of lotion and creme and none of them come close to these. I recommend telling people what can and can't be used on their skin with anyone who (even shortly) watch your child because we have had both family members, and our church preschool apply a few different things that we do not allow. I now list their eczema along with a note of "eczema-apply nothing to skin" in the medical info section (or tell if it's just family/babysitters) everywhere they go, preschool, church, sports, babysitters, daycare, etc. We do not use hand sanitizers, they work by striping off not only the outler layer of germs but the oil from your skin as well (not good for people with eczema). I use unscented and undyed laundry detergent and fabric softener (not just the kids clothes, sheets and towels, etc too). We also use a cool mist humidifiers in their rooms. We limit swimming (one summer we did lessons and they were miserable!) and any other kind of activites where they get very dirty. I actually plan their weekly bath right after these kind of activites to keep them the cleanest (and of course occasionally they will get two baths a week - sometimes that can't be helped with young ones!) Baths also follow some guidelines, warm water (not hot as it can strip away the skin oils), we don't use a wash rag, just our hands (wash rags will strip away the oils too), they are no longer than 10 minutes, and we let them play in clean water (no soap/bubble bath) with toys for the first part of the bath and then wait until the end to soap them up (so the soap doesn't strip too many oils... see the pattern? lol), and pat their skin dry, don't rub. I also only use the eucerin baby wash (honestly I've not sampled very many like we did for the lotion so I can't say for sure it is the best, but it's the best we've used by far - baby washes we've used are huggies, johnson&johnson, generic brands, and Arbonne).

I have also heard omega-3's are good for eczema (gummies in the vitamin isle), but we haven't been consistent with it, so I don't have any input on that yet.



Results:

If you only do the eucerin 4x's a day (full body) everyday you will break the itch cycle and their skin will (if your kids are like mine) be the softest it has ever been. Guaranteed. However, doing this 4x's a day per kid for busy families can be a challenge.



To be honest, I would let one lotioning slip then another and then another; and their skin would get bad again. So I would make sure we didn't miss any lotionings. As time went on and we learned more and more, we started out changing one or two things at a time and everytime we added on new changes, their skin improved. If we strayed from these habit changes, their skin got worse. So little by little their skin has improved with each new step we take. And the best part? Less lotionings. During this last spring, summer and fall, we have been able to dramatically cut down our lotionings without bringing back the itching and super dryness. Was their skin super soft like when we do lotionings 4x's a day? No, but it also wasn't very dry, just slightly dry and not itchy! Winter is harder on their skin as it is every year, but it's been much better this winter than past winters.



All the little stuff really adds up for my kids and has made a huge difference in their skin. The biggest helpers by far are the eucerin lotion and the once/week bath, if you do nothing else, give these two things a try (even just 2x's/day on the lotion will make a big improvement).



Hope all this helps someone! Sorry it's so long!

Alexis - posted on 02/07/2010

my daughter loralie has had eczema since she was 6 month and it seems 2 b gettin worse as she gets older she baths in oatmeal baths n when she has a bad flare up gets put on oral steriods. i try n keep it under control by lathering her in paraffin wax 3 times a day. i suggest seeing a specialist so they can determine the cause as some r due 2 different foods or weather if its food related u can remove it from their diet. hope that helps

Crystal - posted on 02/07/2010

Theresa, The Lanolish breast feeding cream is expensive. You can get some off brand of lanolin which is the same thing. Also try using the Drift laundry soap and fabric softener. If Drift does not fix in your budget because it is to expensive try the ALL brand soap they have a baby ALL. My 2 year old has eczeme on his arms and legs. The oatmeal baths also do help. The best thing I have found lotion wise is Lubriderm un scented lotion. It really helps keep down the itch. It contains vitamins B5 &E both which are really good for the skin. Also plan vitamin E oil works wonders. I hope some of this helped.

ADRI - posted on 02/07/2010

Hi there, My son had eczema aswell. I used propolis cream which is an all natural product made from propolis (from bees) You should be able to get it from most healthstores or honey places.The other thing that my doctor told me, was not to use any soaps,shampoo etc. when you bathe him ,as anything more than water will be an irritation to the skin, untill the eczema cleared.When it cleared up a bit I used Elizabeth Annes Top to toe cream wash or anything without any fragrance (Eucerin products are also good) ,the pink bottle ,usually used on newborns. (As little as possible). I also put Rooibos teabags in the bathwater.It also helps to let them run naked for a while after a bath so that he dries off properly especially in the creases (i.e. Behind the knees and on the inside of the arm where the elbow bends.)Lastly do not overdress him. It's best to keep the affected areas without cover as much as possilbe.Hope this helps. This helped for my son and he is now nearly 4 and Eczema free.

Melissa - posted on 02/07/2010

I use Aveeno shampoo and lotion. I only use cornstrach baby powder. These keep it under control for my son and nefew. I use huggies natral care wipes to. Do not use anything that has achol....

Melanie - posted on 02/07/2010

im using aveeno soothing baby bath treatment.its powder that you have to mix with water in the tub..i also use small amount of my aveeno lotion with oatmeal...it works for my baby

Samantha - posted on 02/07/2010

i use dermaveen soap free wash on my daughter i also use a anti fungle/ cortizone ointment that you buy over the counter at a chemist it works wonders for her.

Shelley - posted on 02/07/2010

Hi Tara, Give Paw paw Ointment a try it's natural and may take a little while to work but it's gotta be better than steroid cream as this will affect his skin later on in life. Also it may be some foods that are makinf his skin react such as acidic foos like tomatoes etc. Also make sure he has pleanty of water. Hope i could be of helpp... take care!!

Jackie - posted on 02/07/2010

I just bought some stuff from balmex multipurpose healing ointment and it seems to be working the best so far for my daughter who is 27 months. She gets it really bad on her hands and arms and back. So far it seems to be working

Diandra - posted on 02/07/2010

My two youngest have it....my daughter had it like your son when she was a baby. I used the steroid cream it worked wonders...they say don't use it excessively because it can cause discoloration in the skin.....keep him moisturized and the only thing that may help is vaseline.....we live by it in my house. Don't let him stay in the tub for too long water dries the skin out. Watch his diet....stay away from citrus fruits, orange juice and strawberries....all the things our kids love....but get the eczema under control first. My daughter has grown out of hers....she only gets it on her hands and creases in her arms....my sons gets it on his legs.....trust me it gets better ask your doctor for an ointment called Triamcinolone Acetonide it helps

Judy - posted on 02/07/2010

My son is 18 months now. He was diagnosed with eczema at about 6 months. he had it pretty bad and within two applications of the prescription lotion Cloderm ($100 a tube!) it was gone. He still has flare ups when his skin is pretty dry, but it's manageable with a good moisturizer. The Cloderm did wonders though.

Malinda - posted on 02/07/2010

Pure tea tree oil mixed with petroleum jelly. Not the greatest smell but it worked wonders for us.

Elisa - posted on 02/07/2010

Hello Tara,my daughter had realy bad eczema all over her body then i found out about goats milk which is said to be very good for eczema and asma.As soon as too weeks of giving it to her it was all gone,but i did also change the washing soap to ecover wich is made with natural ingridients,tried to use diferent soap but she gets a rash of eczema within 24h.Hope this helps and good luck

Brenda - posted on 02/07/2010

My son is 3 now and has had bad eczema his whole life. We used Aquaphor wash for bath time, we now use Dove. We also used Aquaphor gel lotion when he was little, we now use Aveeno. We also have to use the steroid cream when it gets really bad, but we usually only have to use it for a couple of days, before we can go back to only using the lotion.

Patti - posted on 02/07/2010

Hi there I use a great line of skincare products that I shop for online and they get delivered to my door. The Comany has and full line of steroid free product that are specifically made to help with Eczema it has eliminated it in our house.

Jagdeep - posted on 02/07/2010

I would recommend that you consult with a pediatric dermatologist. Especially for around the eyes there is a different medication that might help, its not a steroid, either Elidel or Protopic cream.

Lara - posted on 02/07/2010

Both my boys have it too. Baths every day followed by lots of lotion while damp and lotion one or two other times in the day (we use Aveeno all over and Spectro Kids on their flare-up areas) works great for us.

Elissa - posted on 02/07/2010

My step daughter had it when she was very young. When she was 6 years old she had it really bad all over her face. Everything the doctor gave her for it wouldn't work. When she was at her dads and my house I stayed on top of putting it on her, keeping those areas clean, and trying to keep her from scratching it. It always would start to clear up some by the time she went home to her moms. I know that moisture in the home can really irritate it and the skin being too dry can too. Just keep working on it and he should grow out of it. Good luck!

Terri - posted on 02/07/2010

I've used Aquaphor ointment on my son's skin (he's eight months old) and it seems not only to soothe the burning he feels but relieves the redness and dry skin. I put it on him atlease two to three times a day and it seems to help him. Hope it works for your son. P.S. Some kids that have eczema also have asthma. My son does. Keep a watch out for that.

Carmen - posted on 02/07/2010

My doctor told me the same thing- to throw out all of it. I always used Baby Bee wash, and cetaphil afterward and thats it. She also limited her baths to every other day, until she was 11 mnths old and started getting into everything, but by then the eczema was well under control. Also want to look into allergies. Eczema is linked to food allergies, and my daughter did end up with a strong allergy to milk- its been soy products eversince!! :)

Carmen - posted on 02/07/2010

CETAPHIL!!!!!!!! the cream that comes in the jar, not the pump. This stuff is MIRACULOUS!!!!!!! It was recommended to me by a family member, and after my pediatrician said it would be fine to use, I did and NEVER had to buy any other cream ever again!!!! and we went through all of them!!! ( Aquaphor, Eucerin, to name a few) they would only make her greasy but her skin never really absorbed it to give her relief. I have been using cetaphil since she was five months old and have NEVER had eczema issues ever again. I used to put it on in the mornings when dressing her and before bed- now that it is under control I only do it before bed. During winter months when the heater is on Ill do it two times a day. Really hope this helps, I know how horrible it is!! :)

Fran - posted on 02/07/2010

My husband and I were desperate as well...seemed we tried everything until our son's asthma specialist recommended this 1 item and it WORKS! I couldn't believe it! Not only did it control his itching it actually cleared his Eczema! This is a household product that you will probably find in your kitchen right now and doesn't cost a fortune..it is CRISCO! We bathe our son then apply or shall I say LATHER the Crisco on his entire body while he is still a little damp..not completly dry. Apply on face also if you wish. This has been God sent to out little boy and I hope it will also help your little one.

Andrea - posted on 02/07/2010

my doctor told me to take away all soap products, like johnsons babywashes and any high in soap clothing washing products, and use soap free products, he hasnt had it since i made the switch and our dr didnt have to prescribe a cream to help him, that might work for your little one

Lorraine - posted on 02/07/2010

from the time my son started teething he seemed to get worse at first i thought it was only heat or nappy rash but then his mouth would get so red that it was stinging so bad i was ending up at the doctors more, first they gave him the steroid cream didn't work just made you oily then my doctor gave me ELOCON CREAM = mometasone furoated 1mg it is fantastic the next day was a big improvment but he was drewling so much when he was teething that the excess saliva would act like acid on his face so i was forever keeping his mouth dry then putting a little cream on you don't need a lot because it is exspensive for only 15g but it beats that steroid cream any day he is 2 1/2 still drewls a bit but not as bad but i find it only flares up when it's hot he can get it under his arm on the nappy line and on the face but now i know not to let it get so bad.

Jill - posted on 02/07/2010

i have heard goats milk soap works well

Madeline - posted on 02/07/2010

My son has it! I found that QV wash and moisturizer has cleared it up... :)

Desigee - posted on 02/06/2010

hi, my daughter has eczema, but i have used a non steroidal cream....ELIDEL, manufactured by novartis. it is non steroidal and can be used on areas around the eye, and nappy area. it really does work well. also get an allergy teat done, as using different medications wont help if the undrerlying problem is an allergy. We found my daughter to allergic to peanuts, grass, wheat, oats, fruit like guava, pineapple. i moisutize her skin with the SBR range, there is skin repair and lipocream . hope it helps.

Kim - posted on 02/06/2010

My boy is 18 months and has had eczema since about 2 months old. I have tried lots and nothing has worked for very long. I don't like the steroid creams from the docs and fond they only work temporarily anyway. Best things so far have included really good moisturising creams to keep his skin moist, honey smeared on the skin to help repair it. manuka honey if you can afford it (you need to test this first tho to make sure he doesn't have a reaction) Manuka based creams are good too. Baking soda in the bath to ease the itch. I had my son allergy tested and the only allergy ended up being to dust mites however when I put him back on wheat he had a definate reaction. So while he is not allergic he certainly is intolerant. We are still trying to work out all the intolerances. We don't use any soaps on him just good old plain water and baths that are not too hot (as they dry out the skin). Oats as in rolled oats for porridge and in the bath are also good as oat has a nerve healer and skin healer properties. Otherwise there is lots of patience and perseverance needed. Good luck

Sasha - posted on 02/06/2010

My son also suffers from it and i always tried to keep it moisturized as much as possible and using only fragrence free lotions ,. i use aveno. and i let my son take extra long bath and put baby oil in it BEFORE he gets out which really locks in all the moisture he gets while taking his long bath,. i also dont use any sort or bubbles and fragrence free baby wash ,. i dont know if it will help your child but i know it really works for my sons skin ,. his skin gets real bad on dry days and feels really rough ,. but i guess conssistancy is best :)

Natasha - posted on 02/06/2010

try sorbalene creme and cornflour. or sudocreme

it worked on my baby boy when he had eczema

Gen - posted on 02/06/2010

My little girls dermatologist prescribed derma-smooth. its a body oil that you put on as soon as they come out of the bath but before you dry them off. once thats on you put eucerin (aquaphor) on to lock in the moisture. She had it pretty bad. I couldnt even have warm water touch her body cause it would flame up. This was last winter. As soon as it started to cool down outside i started the regimen all over again and have been able to avoid the flame up so far this winter. try asking your dermatologist for a sample and see if it helps.

Kim - posted on 02/06/2010

My son is now 2 yrs. old. He had eczema since he was born. His eczema was on the ankles, toes and wrist areas. At around 22 months I took him to an Allergy and Asthma specialist. I found out that many kids who have eczema also have different allergy's and sometimes asthma. After having a skin test at the allergy specialist, it came back that he was allergic to eggs and peanuts. He had never had peanuts so I knew that was not causing the eczema, but occasionally he would eat foods with eggs in them (bake goods). I did notice that he would itch his skin more after having certain foods with eggs. I have since stopped giving him these foods. Also, the allergy speciallist told me to give him Childrens Zyrtex - 1/2 teaspoon before bed each night. This can be found over the counter at any drugstore. WITHIN A FEW DAYS OF STARTING THE ZYRTEX HIS ECZEMA WENT AWAY AND HAS NEVER RETURNED!!! We have not needed to use any of the steriod cream since starting Zyrtex. This has been a miracle bacause his eczema was so bad it would keep him up at night. So, if you have not done so already, I would have your son see a allergy speciallist. I would ask them if Zyrtex is ok for a 16 month old (my son was 22 months when he started it) Best of luck!!!

Cynthia - posted on 02/06/2010

Our pediatrician recommended using Eucerin and then locking it in with Vaseline. My daughter would sometimes get little patches on her legs. She still does in the summer when wearing shorts all the time. Darn that dry, dry skin! Good luck and god bless.

Denise - posted on 02/06/2010

Have you looked at his diet? Often times dairy and other common allergens are to blame. When we eliminated all dairy from my daughter's diet her eczema disappeared. For occassionaly roughness (pre-breakout for when dairy did get slipped in) the Nature's Natural eczema lotion nipped it in the bud. Good luck!

Sherry - posted on 02/06/2010

I have 2 kids that have the same problem. I do baths nightly, but every other night we Use no soap or bubbles. warm, not hot water. Before I get them out of the tub I use baby oil on them. Then I coat them in the Aveeno and put them in loose fitting cotton pajamas. It can be caused by allergies, and with my kids I think it is. I have not pinpointed the specific foods yet. The good news it that they usually grow out of it. The pediatrician did not seem too concerned. He said in some kids nightly baths work wonders and in others every 2 or 3 days work better. Just see what helps the most and go with it. I am opposed to the steroid creams myself.

ZEISHA - posted on 02/06/2010

MA SON HAS REALLY BAD ECZEMA HIS SELF DA DOCTOR HAD GAVE ME DA STEROIDS CREAM I WASNT REALLY FEELING IT I GIVE HIM COCOA BUTTER SKIN THERAPY OIL WIT VITAMIN E,EUCERIN DRY SKIN THERAPY ITCH RELIEF TREATMENT N AQUAPHOE HEALING OINTMENT N HIS SKIN IS DOING SO MUCH BETTER NOW FOR DA BATHS U CAN USE VANILLA OATMEAL N EUCERIN CALMING BODY WAS DAILEY OIL SHOWER IT WILL HELP ALOT HOPE EVERYTHING WORKS OUT

Becky - posted on 02/06/2010

Hey i have a boy with eczema and my dr refuses to perscribe steroid cream for any child under 6, i was told it it bothers us more then it bothers him. I do use the Aveeno oatmeal bath and LOVE IT, redues redness and you only have to use half a pack at a time. I also use unsented lotion, anything thick like Aveeno, or huggies. Both work great. Just keep it hydrated. If all fails a light layer of vasilene works too =).

Sarah - posted on 02/06/2010

have you tried using oilatum in his bath and using the cream afterwards?
my son has it but not so bad it seems to flair up now and again but not bad after bathing him in this stuff morning and night keep him cool and dress him in cotton clothes

hope this helps ask doc for some piratin as well might help keep him from itching as i was told they get hot inside when they have eczema

Rebecca - posted on 02/06/2010

My 4 yr old has it bad bad on his arms and Elbows are the worst. I have found that when i give him a warm bath and them put the steroid cream on right when he gets out and drys off that it helps alot. i get the parents choice baby bath org. and that has help. some of the soaps for it burn. and cordizon 10 work for the itching between the steroid. but dont let him scratch. that only makes it worse and it can spread. Theresa my doctor did tell me to put his cream on his arms really thick and then rap them up loose with a banage for over night. i found one that has velcro.. it helped wonders I do all of this right after he get out of the bath and is getting ready for bed when his pores are really good and open.

Melissa - posted on 02/06/2010

Post a reply My youngest had very bad Eczema, the creams were not working and we developed staph. It was horrible. Then we tested her for food allergies. She was positive for an allergy in milk egg whites peanuts and wheat and soy. I was breastfeeding her and the small amounts that came in the breastmilk were aggervating the condition. After removing the allergens we were able to treat the Eczema. Check with your ped to see if they think your child should be tested.

Kerri - posted on 02/06/2010

my son is now 3 and has had it since birth,i got some dermol cream from the doc,its brilliant,u can use it just as a cream and to wash skin and hair,with just plain water in the bath. Also if you go onto www.originalsprout.com they do this hair and body wash specifically designed for problem skin which ive been using for months now,its about £14 for a bottle but to be honest i only use a tiny amount each time its enough and if it helps his skin i dont think its a problem spending that,and also it lasts along time.I hope this is of some help x

Amelia - posted on 02/06/2010

my doctor has me using an oinment called Triamcinolone. I find I use it when it flared up badly and it takes it away by the next day but it does return. My doctor told me to put it on all the time but i mainly use it when I see it starting up again.

It has done wonders for my son but everyone is different.
Good luck.

Veronica - posted on 02/06/2010

My two boys have eczema too, My son when a baby eczema had it so bad all we could do was moisturise moisturise mosturise, in bath, after bath. When my son went on to solids we discovered is eczema was food related, acidic foods like peaches reacted badly, knowing this we cut any acidic food out of his diet and saw some improvement. It is very disheartening when the eczema comes and goes and gets worse before it gets better. From my own experience all I did/still do is bath in Aquerous Cream, apply after bath, if you find the cream not working stop and just bath your 16mth in water. Take notes when the eczema gets worse and what causes it, is it food related?



Hope all our advice helps :)



Veronica

Mum of 2

NZ

Kenyetta - posted on 02/05/2010

MY SON ALSO HAS IT REALLY BAD IN HIS EYES AN PARTS OF HIS BODY. I HAVE FOUND AFTER 4 YEARS THAT OF SEARCHING THAT MOMETASONE FUROATE OINTMENT 0.1% WORKS GREAT CLEARING UP HIS EYES AN HYDROCORTISONE OINTMENT 1% FOR IS BODY . AS FAR AS ITCHING I USE BENADRYL AN LIGHT RUBBING WHEN NEEDED HOPE I HELPED

Jane - posted on 02/05/2010

Both my kids had severe excema. You are right to stay away form the steriods - baby skin is too fragile and beware all petrochemical based products like sorbelene and QV and almost everything that is not a natural based product.I have best results by looking at the cause and treated their sensivities by visiting AAEclinics.com.au. It is a bit of a long process and is expensive but to look at my 2 beautiful excema free kids these days it was worth every cent. After each treatment I saw improvements and some excema was caused by different allergies - Toby now 2 was allergic to a mould that was active at night in my house, amongst many other things but that only flared on his face. My daughter was sensitive to chrorine in pools amongst other things and that affected the backs of her knees. The worst excema Toby had was amazingly from lactose in my breast milk and also from a reaction to his DPT shots at 4 months. AAE treatments and homeopathic antidotes for the DPT worked almost overnite. Good luck - it is very distressing. If I can be of any other help no worries

Madie - posted on 02/05/2010

Eucerin works awesomely! :) So does Renew, but Eucerin is easier to get:)

Lydia - posted on 02/05/2010

I agree with Kati also the lotion is abriderm (i hope i spelled it right) there is also a shampoo that u can use but i don't remember the name but it's also in the baby section..

Chelsea - posted on 02/05/2010

My son has awful skin period... I use no fragrance soaps, shampoos, lotions, and detergent. My doctor prescribed a steroid cream and he was allergic too it. Vaseline helps too

Katy - posted on 02/05/2010

Don't bathe everyday. Use Aquaphor lotion daily. Clean and Clear Tide/dryer sheets.

Kelly - posted on 02/05/2010

i have worked in dermatology for over 3 years. my daughter is 2 1/2 who also has eczema
i use CERVA, faithfully. i use the wash and cream. i use the ALL clear degernt. my daughter has sensitive skin.
i bath her every other day in luke warm water, using the CERVA wash, then just pat her dry and slather the hell out of her in the cream-i use the CERVA lotion in summer.
CERVA has ceramides and is the only brand out there that has it. it help repair the skin.
we reccomend CERVA or Cetaphill to our patients. try using a degernt that is color/perfume free, it will make a difference. when you bath them, use luke warm water. (warm water to them does more harm than good, thier skin is 45% thinner than ours) use cleansers that are perfume and odor free. when applying creams, make sure it is right out of the tub when the skin is slightly damp and the pores are still open.
CERVA and Cetaphill can be found with the facial products or the baby isle. or ask your dermatologist for some samples
hope it helps, let me know if you have more questions