Where this starts

I grew up in a small town outside Beaumont, Texas, in a house where everyone worked with their hands.

My mom was a CNA at the regional hospital for thirty-one years. My dad ran a small HVAC outfit out of the garage. I am the oldest of three. We were not poor and we were not comfortable. We were the family that knew exactly what every grocery item cost and exactly which bills were going to be late if anything broke that month.

I knew I wanted to be a nurse from the time I was about twelve. My mom would come home from a double, sit at the kitchen table without taking her shoes off, and tell us about the patients. Not the diagnoses. The patients. The eighty-six-year-old man whose wife came every day for six weeks. The teenager nobody visited. She talked about the work the way other people talk about a calling, because for her that's exactly what it was.

When I was seventeen, my grandmother went into hospice. The nurse who came to the house every afternoon, her name was Patricia, sat with my grandmother for an hour at a time, sometimes longer. Patricia did not rush. Patricia made my grandmother feel like the most important person in the room because to Patricia, in that hour, she was. I watched Patricia work for six weeks and I knew. That was the job. That was what I was going to do.

Year three · The hands

It started as redness across the knuckles. Then a tightness across the back of the hand that didn't go away between shifts.

By the end of year three I had visible cracks on every knuckle of both hands and a permanent split on the side of my right thumb that opened, and closed, and opened again, every week, for about eighteen months straight. The first hand wash of the morning made me catch my breath. The first sanitizer pump made me hiss into my mask. I started keeping the hand cream in my scrub pocket and putting it on between every patient, and it didn't matter, because the next wash took it off.

I tried CeraVe. I tried Aquaphor. I tried O'Keeffe's Working Hands and Eucerin and Vanicream and Curél and the Vaseline-and-cotton-gloves-overnight thing my grandma used to do. My dermatologist gave me a prescription steroid. I tried that too. The steroid worked for about eight days and then everything came back, plus my skin was thinner.

At the worst of it I had a moment in the staff bathroom where I stood at the sink, with the soap dispenser empty and my hands open under the faucet, and I cried. Not the dramatic kind of cry. The exhausted kind, where you don't have anything in you to make it stop. I had blood on the cuff of my scrub top from where my thumb had reopened. I was thirty-one years old and my hands looked like an eighty-year-old woman's hands.

I started hiding them. In photos with friends. At dinner with my husband's family. Holding my coffee with one hand wrapped over the other so the cracks weren't the first thing you saw. That's the part I want every nurse reading this to understand. I wasn't insecure about my hands. I was hiding the evidence that the job I loved was destroying me.

The day everything changed

In January 2023, infection control pulled me off the floor.

It is a thing that happens, although nobody wants to talk about it. If your hands have visible open fissures or active eczema, you can become a contamination route, both ways. You can carry pathogens in. You can carry pathogens home. The hospital had a duty. They put me on a two-week reassignment. Chart audit work. No bedside care. They said it was "until your hands heal." I said okay because I did not have a real argument.

I sat in a windowless office for fourteen days, doing chart audits, and what I felt was not embarrassment. It was anger. I was a good nurse. I was an experienced nurse. I had patients I loved. I had been pulled off the unit because of a cosmetic problem that, on the surface, should have been the easiest thing in the world to fix. It is hand cream.

Except it wasn't. None of it was working. I had spent six years on the floor washing my hands the right number of times the right way with the right products and the system the consumer category had built had no answer for it.

That was the night I went home and started reading the actual research.

Six months in my kitchen

I do not pretend to be a chemist. I am a nurse who could read a paper.

I started by reaching out to a cosmetic chemist named Maya in Austin who consulted for two of the dermatology brands I trusted. I sent her my reading list. I told her what I wanted. Ceramides, cholesterol and free fatty acids in 3:1:1 ratio, in a multilamellar W/O emulsion that would hold the bilayer geometry, buffered to pH 5.0, with niacinamide at 4% to push the skin's own pathway, panthenol to support repair, and not one ingredient that would not pay rent. No fragrance. No alcohol. No essential oil. No "optical brightener." Nothing that would sting on a fissure.

Maya looked at the brief and said, "This is more rigorous than what most clinical brands run." We took six months. I prototyped the application feel myself, on my own hands, on my coworkers' hands, on a charge nurse named Janelle who had sweated through three other "barrier creams" that year. We rejected the first four versions. The fifth one, in October 2023, was the one where Janelle handed me the empty 30 ml sample at the start of her next shift and said, "I need a real tube of this."

That was the first time I knew it was a product, not a project.

What Lioren is now

Lioren is one product. It is the cream I built because the lotion aisle was not going to make it.

It is sold in a tub that looks like the cream every nurse already has in her break-room drawer because that silhouette is the silhouette my tribe trusts. We chose it on purpose. The trust earned by another brand's tub is borrowed, then we have to keep it. So far the day-14 emails say we are.

I still work the unit. I'm at Memorial Hermann four shifts a month. The other days I work on Lioren. I am the only person in the company who has been pulled off a floor for cracked hands and I am not letting another nurse get pulled off a floor for the same reason if I can help it.

If your knuckles are bleeding by the end of your third shift in a row, the cream you have been using is not the one. Try this one. If it does not visibly reduce cracks and redness in fourteen days, send the empty tube back. We refund every penny and we keep the empty tube.

I would rather lose the twenty dollars than be one more cream you stopped trusting.

With respect,
Sarah

Sarah, RN · Founder, Lioren · ICU, Memorial Hermann · Houston, TX