How to do the 3 step Product Elimination Diet

Step 1- Stop all your skin, hair, body, hand and laundry detergents regardless of where your rash or sensitivity is.

Why do you have to stop all your products.  Here is an example: I often get patients coming back with the same recurrent eyelid, facial or body rash that caused them to visit me in the first place. “Did you stop using all your products?” I ask. “Well,” they say, if they’re dealing with an eyelid rash, “I stopped all myeye makeup.” Or they changed it to something labeled as hypoallergenic—which unfortunately doesn’t to help as this term is not regulated.

The issues keep happening because your facial cleanser, and moisturizer, and hair care and skin and hand care can all touch your eyelid skin. Even your nail polish touches your eyelid skin. (That’s actually interesting. True allergy to nail polish won’t cause a problem on your nails—or even the skin around your nails. Rather, it most often creates a rash on the eyelids and neck.)

Shampoo is another product that commonly spreads itself around the body. People think shampoo would cause a reaction only on the scalp. But most shampoo-triggered reactions don’t start there; the scalp tends to be more resistant to reactions. Shampoo ingredients rinse from the scalp on down the face and neck, and then over the rest of the body. So shampoo doesn’t just affect your hair. Many shampoo products will affect the eyelids and neck before they irritate the scalp and its an epidemic!

Or take body moisturizers. They’re put on the body with your hands—and then get on your face when you touch your face with your fingertips or palms. An irritating ingredient may not provoke a reaction on your forearms or shins, but when the same fingertips that applied the stuff touch the eyelid, then a rash can result.

So, the most important first step is to stop everything. Regardless of where your recurrent skin reactions occur.

Just like a food-elimination diet, you have to go all in— You have to commit. You can’t do this on some days and not others. You can’t use products on one part of your body and not another. If you have a facial skin issue, you have to avoid all the things on the list for all your body—not just your face. But don’t panic, it’s not forever!

So when I say restrict your use of skincare products to the things on the list, I mean it. And that includes everything: Hair products, face products, body and hand products!

One quick caveat: You may not be the only one who needs to stop using all skincare and beauty products. I’ve had some patients struggling with sensitive, reactive skin who have contracted skin reactions from their partners. A husband, say, who reacts to his wife’s face cream. Face washes, body washes and moisturizers of all kinds have been known to trigger partner-to-partner reactions. So if you’re romantic with someone and leaping into the product-elimination diet, you might consider asking your partner to join you—or refrain from intimacy as you go through the process.

PRODUCTS TO STOP USING

1. Hair care products, including shampoos, conditioners, mousse, gels, oils, rinses, perms, hair dyes and colouring (this is most important if you’re getting rashes on your eyelids)

2. Facial products, including eye drops (unless medicated)

3. Body and hand soaps, cleansers and moisturizers

4. Makeup

5. Nail care products and polish

6. Perfumes, colognes and aftershave

7. Shaving creams or lotions

8. Prescription topical skin medication

9. Incense, essential oils and fragranced candles

Step 2 – Use the Product Elimination Diet list

After you stop all your face, hair and body care you use the product elimination diet list . These are products I have reviewed by examining their ingredient lists to ensure that they’re genuinely non-irritating and actually hypoallergenic. These are the products you can use while you wait for your reaction to clear up. Together, they’re called the Low-Contact Allergy and Irritant List.  In general all the product on the list have no fragrance, no allergenic or irritating plant based botanicals, no formaldehyde or methylisothiazolinone group preservatives.  They do have some ingredients that rarely can be problematic, but this list will help the vast majority of patients suffering from reactive, sensitive skin.  If it doesn’t, then visit a Dermatologist for allergic patch testing as you may be allergic to a less common allergenic ingredient in skincare.

The list is important because you can’t just tell a patient to go and get a mild soap or a hypoallergenic skin cream . . . since labels like “mild” and “hypoallergenic” aren’t reliable.

Many patients are tempted to substitute for things on the list. They go to the drugstore and a cosmetician or pharmacist might acknowledge that they don’t carry this or that product. Then comes a suggestion to try another product. “This is from the same manufacturer,” the pharmacist might say. Or, “Try this—it’s for sensitive skin.” I’d tell a patient to use Dove Sensitive Skin Beauty Bar and she’d come back with Dove Go Fresh Revive Pomegranate & Lemon Verbena Body Wash. Which, like most body washes, has irritants and allergens—in particular, the lemon verbena.

No no no no no no no.

The patients would return for an appointment no better than they were when they left. So I started adding this at the bottom:

THE NAMES ON THIS LIST REFER TO SPECIFIC PRODUCTS THAT ARE NOT TO BE INTERCHANGED OR SUBSTITUTED. This is an important point for consumers to know: one name change on a product name from the same brand and the ingredient list could be completely different.

Use the products on the list. The product names are very specific. You can’t just use anything from companies known to cater to people with more reactive skin, like Dove or Aveeno, because these companies make dozens of products, and some of them have problematic ingredients.

Again, the products featured below have ingredient lists that I’ve assessed. The makers of these products achieved what they set out to do. They nailed it—most of these products actually are hypoallergenic. The ingredient lists avoid allergens and irritants. The products avoid fragrances, sidestep allergenic and irritant botanicals and expel the preservatives associated with allergies.

USING THE LOW-CONTACT ALLERGEN AND IRRITANT LIST

1. Use exactly the products I suggest on the list! Remember that there are many different types of similar products from the same company. One name change on the product, and it has a different ingredient list.

2. If you can’t find any of the products I’ve listed in a given category and are desperate for something, choose products that are soap-, fragrance- and botanical-free and have fewer than 10 ingredients. But I’d really prefer that you just use what’s on the list. If you can’t find the products at your local pharmacy, search the Internet for online stores that carry them—and bear in mind that many of these sell direct to consumers at their own websites.

3. If you’ve been diagnosed with rosacea, seborrheic dermatitis or atopic eczema, or some other skin malady, then you’re likely on some sort of medication to treat it. That medication may be necessary to attain clear skin, so continue using it while still avoiding allergens and irritants in all other products. An exception is acne. Many topical acne medications are irritating, so I suggest you stop them while going through the elimination protocol.

Occasionally, a product on my list may contain an ingredient that can be allergenic in rare cases as mentioned. So many different allergens exist that it’s impossible to avoid every single one. Some of these products may contain parabens, sulphates, polyethylene glycols or other chemicals that someone or other on the Internet may claim is toxic and should be avoided. Some fears about some of these chemicals are real, but others are overblown. In general, I tend to be agnostic about whether a product features natural substances or synthetic chemicals. I’m much more concerned about allergens and irritants—and this list is designed to feature the minimum of each. Stick with the list, solve your skin problems and then try all the natural, paraben-free skincare products you like in a controlled manner—as described in step three below, which outlines how to reintroduce your old products.

Step 3. Re-introducing old products including all hair, face, body products one per week

Many of those who begin using the products on the Low-Contact Allergen and Irritant List end up using them for life. They like how bare-bones and simple they are. Another thing that’s nice about them is the price—many are drugstore brands, which are cost-effective and there are also a few plant based options.

Others have complaints. They say, “I want more natural.” Or, “I want some anti-aging products.” Or, “The lipid-free cleansers don’t create enough suds to make me feel clean.” Some say the cleansers are so mild that they don’t remove all their makeup. (One way to address that problem is to use micellar water to double-cleanse.) The complaint I understand most is the one about the medicinal smell of some of these products. So I’ve created a protocol designed to allow my patients to return to at least some of the products they were using before their skin reactions happened.

Hair products are the ones my patients want to return to most often. People really like fragrance in their hair care. Plus, hair can be highly idiosyncratic. Some people need to use just the right combination of products or their hair looks flat, or frizzy, too oily or too dry. Something, anyway.

So here’s how to get back to some of the products you were using before your skin reaction. By this point in the product-elimination diet, you’ve stopped using all your products and have stuck with the suggestions on the list. If you do that, your skin reaction should clear within weeks—and sometimes days.

Once the reaction is gone, you can start to introduce the products from your former beauty and skincare regimen. But don’t just leap into your old routine. Rather, proceed in a step-by-step fashion. Reintroduce one product per week.

Usually a hair product is the first thing the patient reintroduces. So let’s say you go back to your old shampoo. Give yourself a full week after the shampoo’s reintroduction before you add a second product from your old routine.

This applies to anything. No matter where your rash was, again, limit yourself to reintroducing one product a week. That goes for all beauty and skincare products, cleansers, conditioners and lotions, whether it’s something for the hair, face, hands or body.

By waiting a week, you’re giving the product time to cause a skin reaction. It may take several days for your skin to react. If you do react during that week, then you’ll know it was the newly reintroduced product that caused the reaction. After all, that’s the only thing that changed in your regimen. Stop using the product—and in fact, throw it away. Toss it in the garbage. That product is causing you skin problems and you’re going to have to find something else to use in its place.

If no reaction happens after a week, you’re free to reintroduce a second product. The following week you can introduce a third, and so on. Where it gets complicated is when the reactions happen after the third, fourth or fifth new product. Because at that point, it may not be just the single new product you happened to introduce that week. It could also be the combination of products, thanks to cumulative irritation.

What is cumulative irritation? You’ve begun the product-elimination diet. Your skin has cleared. You’ve reintroduced your cleanser, shampoo and moisturizer. Next: eyeshadow for a week. All good. But the next week, when you introduce mascara, your eyelids react. The problem may not just be the mascara. Rather, it’s all of it together. Your face cleanser, moisturizer and shampoo plus your eyeshadow and mascara have triggered a cumulative irritation that gives you some minor redness and scaling on your eyelids. So you stop the mascara, keep the cleanser, shampoo, moisturizer and eye shadow and try again.

In other words, you stop using the last product you reintroduced and wait for the reaction to clear. Once it does, keep using everything you had in your rotation before that last final product. Then introduce something else. Somewhere down the line, a few weeks later, you can test out the product that preceded the reaction.

In cases where the problem is cumulative irritation, it may be necessary to pare down the number of products you’re using. For this reason, you may want to prioritize the products you reintroduce. Start the reintroduction process with the products you miss the most from your old regimen. Then move on to other products that you don’t like as much.

In this step-by-step, one-product-per-week manner, even patients with reactive and sensitive skin can typically work out which combination of products is best for them. And if you can’t, consider making an appointment with a dermatologist to discuss your progress. You may require patch testing to learn more about the source of the reaction.

Babies and Children

Product labels with “for babies” are not reliable and not regulated.  The products on the product elimination diet are what I would suggest for babies and children with the exception of some of the body cleansers.  Keeping skin pH of babies low and avoiding highly foaming and potentially irritating sulfate detergents in babies is very important to maintain their skin barrier and skin microbiome.  Here is a list of cleansers for babies and children. The rest of the list stays the same.

1. Cetaphil Restoraderm Nourishing Body Wash

2. CeraVe Baby Wash and Shampoo—No fragrance or unnecessary botanicals. This product does have the synthetic detergent, decyl glucoside, which can be allergenic in rare cases.

3. Avène Trixéra+ Selectiose Emollient Cleansing Gel—A good cleanser with a long and complicated name. Only caveat: It does have a mild anionic surfactant, disodium laureth sulphosuccinate, but no fragrance; ingredients phenoxyethanol and vitamin E can be allergenic in rare cases.

4. Aveeno Baby Soothing Relief Creamy Wash—Contains Cocamidopropyl betaine, which is allergenic in rare cases, but no fragrance. This is a cream wash that doesn’t create much lather—remember, you don’t need suds to clean!

5. Skinfix Baby Wash—For those who seek a more natural and organic option, the Skinfix product contains no sulfate detergents. It does contain decyl glucoside and vitamin E, which can be allergenic in rare cases, as well as the allergenic botanical ingredients calendula, rosemary, and chamomile.

Submit Your Question

If you have a question about a certain product you are using. Feel free to submit a question to Dr. Sandy Skotnicki for review.