Eczema News – Is Baby Wipes causing the Rash?

Contact dermatitis_ rash_baby_MI

In the beginning of the year, there was a ‘scare’ – news circulated that baby wipes is the cause of terrible rash on the face of babies. This is in response to a study published from observations of 6 children, with ‘disfiguring patches to crusting, swelling, blistering and tiny cracks in the mouth, cheek, hands and/or buttocks’. Even though it’s half a year since that news, many parents are still very wary about baby wipes. Now, let’s admit it – baby wipes do come in very handy, so let’s take it as we still need baby wipes. So what do we know about these rash-causing baby wipes in order to choose the ones that are safe?

Putting it into Perspective

The rashes can be various types of dermatitis –

Atopic dermatitis where the child is allergic to ingredient, and rashes develop very quickly even for small amount of contact.

Contact dermatitis where sensitization occurs overtime, i.e. the irritant has been in contact with the skin for some time. This is more common.

In both types of dermatitis, the ingredient to look out for (and avoid) is methylchloroisothiazolinone or methylisothiazolinone. The treatment is similar – avoidance + prescription to reduce skin inflammation. The potency of the cream will depend on each patient and also where the rashes are. Avoid wiping the baby’s face (more sensitive, thinner skin) with wet wipes, especially when you are not clear about its ingredients.

Research Studies

I looked through the research on methylisothiazolinone published in 2013 and 2014, the more common conclusions are:

1. Increasing reports of sensitization to methylisothiazolinone (MI), with many studies citing it as an ‘epidemic’. MI is also named 2013 “Allergen of the Year” by the American Contact Dermatitis Society.

2. MI is an ingredient contained in baby wipes, and it is a preservative used in cosmetics, household, and industrial products to prevent bacterial and fungal contamination.

3. The % of sensitization range from about 2% to 4%, so it is not a sure thing that your child will react to it.

4. A patch test can be requested to check if there is hypersensitivity to methylisothiazolinone and in this regard, improvements to patch test for this have been suggested to modify the test solution concentration and also to increase the length of observation to 7 days.

5. The age group most susceptible to this is female above 40 years (6% sensitization), on the face due to cosmetics. Certain occupations are painters and beauticians. Parents are also affected due to the use of baby wipes, so not just the kids! Studies here and here.

So my take is if your child or yourself doesn’t react to baby wipes, you can continue using but take care to use less often, not on the face, and find those brands without MI if possible. What’s your favorite brand?

Eczema Support on Skincare this Friday, Singapore

Eczema Support Group - Skincare session for Elderly and Kids

Reminder of this Friday’s Eczema Support Group lunch on Tender Skin’s Care.

Come join us on 25 July, National Skin Centre Room 402, 12.30pm to 1.30pm.

Both elderly and children have tender skin and senior dermatology nurse Sister Wong will be sharing tips for tender skincare. Another nurse will be showing your elderly parents how to care for their skin daily.

Lunch will be provided so that you do not have to rush to grab lunch on your workday. Do RSVP by Wed evening so that we can get ready your lunch. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids coming, and a NSC staff will confirm your RSVP.

Look forward to seeing everyone! Mei

Life of Eczema Girl – Reward Chart III – RewardUP

Eczema_cartoon_Reward_Preschooler_3

I have no idea if this is how it is these days! Any parent can drop a comment to share what you reward your child with? This is the 52nd of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. This month, it’s all about reward charts!

Mom E-votional : Parenting Help!

Family devotional parentingParenting is not easy. For one, parents are not perfect super-humans. We feel drained, tired, cranky (not only kids ‘crank’!) and sometimes, ridden with guilt, doubt and worry. As a parent of an eczema child, I can think of MANY scenarios where I simply decide to slip up in my parenting. Forget about imposing boundaries and just let my child do whatever she wants, as long as it’s not scratching. I’m tempted to turn on that TV, toss that iPad over and just chill.

One source of comfort is that our father God in heaven models for us parenting and understands the struggles. After, we are sometimes the most whiny (think the Israelites in the desert), ungrateful (think of the many generations under Judges) and sometimes, outright don’t love Him. While we are on earth, parenting will never be perfect but we know that we are not alone in this journey, hang onto God and your spouse!

Bible verse:

Matthew 18:12-14 What do you think? If a man has a hundred sheep, and one of them has gone astray, does he not leave the ninety-nine on the mountains and go in search of the one that went astray?  And if he finds it, truly, I say to you, he rejoices over it more than over the ninety-nine that never went astray. So it is not the will of my Father who is in heaven that one of these little ones should perish.

Father in heaven, please make up where our parenting lacks. Please be our father and help us be faithful children and raise our children likewise. Extra strength to those of us with eczema children, it’s tough, Lord!

God will never let go of His children, that’s parents and your kids!

Eczema News – Outgrowing Eczema for Children

Outgrow Eczema for babies and childrenMany parents are concerned with whether (and W-H-E-N) their child will outgrow eczema – the stress, the sleep deprivation, the constant itch and scratching that comes with eczema can indeed be very challenging for both parents and the child. Are there any factors that give us hope that our child will have a higher chance of outgrowing eczema? Is there anything that we can do to increase the likelihood of ‘outgrowing’?
1st things 1st – What’s Outgrowing?
There is no definition for having ‘grown out’ of eczema – how would you as a parent deemed your child to be free from eczema? No rash within a certain time period? A reasonable amount of sleep, dry skin without rashes that requires daily moisturizing? The majority of babies (40% -70%) with eczema will have it in remission by the grade school or teen years (study here, and here). Dry skin with occasional flare-ups would be considered as having outgrown eczema.

Key Predictive Factors
1. Severity of Atopic Dermatitis – The more severe the eczema/ AD, the less likelihood the chance of outgrowing. There is also a study that the more severe the AD in a child, the less likelihood the child can outgrow milk and egg allergy. The interplay between eczema and allergy is not fully understood – does one lead to another? There is this study that showed food allergy being associated with an earlier onset of age for eczema in children. Conversely could a defective skin barrier render the immune system more vulnerable to an onslaught of allergens? Or both can co-exist independently? Similarly the mechanism for outgrowing isn’t clear. Is untreated eczema reducing the chance of outgrowing?

2. Gender – Various studies had highlighted a difference between teenage males vs females, for instance in this study, eczema is more likely to develop for teen girls while teen boys are more likely to outgrow it.

3. Presence of other allergic conditions – Having other allergic conditions like asthma and allergic rhinitis associated with a lower likelihood of outgrowing eczema.

There are many factors involved in eczema, but specifically on outgrowing, it seems that the above 3 are the most predictive. The BIG question is what can parents do and I’d say that treating the eczema is of utmost importance. The longer it goes untreated (aka the longer you try alternative/unvalidated treatment while the skin is constantly inflamed and child is scratching), the higher chance of infection, the thicker the skin gets from scratching (thus even more difficult to treat) and the likelihood of more allergens/irritants penetrating via the defective skin barrier.

What’s your take on this? Do share in the comment!

Mom E-votional : Resist

mOM_ECZEMA_devotional_scratchingRecently, I thought my child the word “RESIST’. I think we could be talking about ice-cream or chocolate milkshake or marshmallow (something sweet I’m sure!) and I suddenly ask, ‘Can you resist?’ We then started exploring ways to understand this word and it was quite confusing when you try explaining ‘Can Resist’ = ‘Can Don’t Have it’ versus “Cannot Resist’=‘Must Have!’. It then occurred to me to ask myself if there’s anything I cannot resist in life, am I being tempted by anything? (I’m just going to let this question ‘hang’, cos there’s no way I’m telling it to you, on the world wide web!’)

As I’m not the one with eczema, I don’t know if there’s a point when scratching becomes one of these ‘Can’t Resist’ things in life. A blog post that I wrote 3 years ago (that’s how long I’ve been keeping on at this blog!) is titled ‘Scratching feels so good, but is so bad.’ Scratching may feel good because it temporarily blocks off pain information, thus getting rid of the itch feeling. The exact mechanism between how itch and pain (from scratching) gets processed from our brain is not entirely clear. When we think about it, scratching is like say ice-cream, it may feel good for that moment but really is bad for our body.

Bible verse:

1 Corinthians 10:13 : No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.

Oh Lord, help me guard my heart (and also my mouth, my actions) against temptations. There are things we can’t resist in life. Help our children also to resist doing things they should not (scratching, tantrums and pride). Help us to be patient, loving, kind and exercise self-control in our parenting. Extra help for us with eczema kids!

God help us to resist the ‘bad’ and grace for more of ‘good’

Eczema Support Group Friday Lunch – Tender Skin Care

Eczema Support Group - Skincare session for Elderly and Kids

This month’s session promises to be an exciting one because

1. It’s the first time the session caters for both the young and the elderly. After the speaker’s sharing, a dermatology nurse will facilitate the sharing with the elderly while I’d be chatting with the parents! Both groups tend to have different concerns, so the sharing will be separate but we are all still in the same room.

2. Both groups (elderly and kids) have tender skin – infants’ skin is thinner and has less oil and pigment cells (read more here) while the elderly’s skin is also thinner, fragmented collagen and higher trans epidermal water loss (TEWL) (read more here in Dr Claudia’s video). Thus, this topic on Tender Skin Care is very applicable for both elderly and children. Moreover, eczema skin is defective and has many of the ‘tender’ aspects like dry skin, more permeable, increased TEWL (read more here in interview with Dr Lynn Chiam).

The speaker for this session is Sister Wong who has shared last year on Step-by-Step skincare.

She is the Senior Nurse Educator at National Skin Center and trained in Dermatology and STI (Sexually Transmitted Infections) Nursing in UK. She had spent many years in the inpatient nursing care in CDC and currently based in outpatient services in National Skin Centre. She is also in charge of training programmes for the nurses in Dermatology.

3. Relaxing Friday lunch, FOC!

25 July 2014 (Friday) – Venue, NSC Room 402, 12.30 noon to 1.30pm

1. 12.30 – 12.35 pm Introducing Ourselves – we can do this with our mouths full (lunch provided).

2. 12.35 – 1.10 pm Sister Wong will be speaker on Tender Skin Care

3. 1.10 – 1.30 pm Elderly and parents (with kids) will split into respective group to share among yourselves, each with a facilitator and Sister Wong will be there to answer both groups’ questions.

Do note though that this is not a consultation session. For those bringing your child, there will be balloons for sculpturing, puzzles and coloring to occupy your children.

Same note: Information shared is not medical advice, please still see a doc. No selling anything or pretending to be a parent of eczema child. Information on my blog is not pre-approved by NSC.

YOU MUST RSVP – You must RSVP so that we can order lunch and arrange the layout for the seats. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids coming, and a NSC staff will confirm your RSVP.

Look forward to seeing everyone! Mei

Eczema News – Herpeticum for Atopic Child?

Has Eczema Herpeticum recur for your child?

Has Eczema Herpeticum recur for your child?

Eczema herpeticum has been covered in this blog before, and for the past few months, there seem to be more parents contacting me or commenting on this topic. There are a few key questions, with the main one being whether a child with eczema/atopic dermatitis is more susceptible to eczema herpeticum and whether once a child gets it, he/she will keep getting it. Let’s look into research in this area:

Quick Basics of Eczema Herpeticum

Eczema herpeticum happens when a patient with eczema gets infected with the herpes simplex virus, the same virus responsible for cold sores. Symptoms of eczema herpeticum are painful, rapidly worsening eczema with blisters, sores, accompanied by fever. A child can get the virus from sharing towel or in general, coming into contact with the mucus of someone who has the virus (who may not necessarily have the cold sores/ herpeticum).

Treatment includes anti-viral medication, oral acyclovir. In view of how fast the drug can work to control the herpeticum in conjunction with the increasing length of hospital stay when not treated fast enough, it is usually advisable to administer acyclovir expediently (see article here, here and here).

Are Children with Eczema/ Atopic Dermatitis more prone to Eczema Herpeticum?

Yes, generally due to the defective skin barrier and lower immune system, eczema kids ‘catch’ skin infection much easier. This article suggest that those with skin inflammation that is uncontrolled are more likely to get eczema herpeticum. Other possible hypothesis of eczema kids getting herpeticum involve the gene, gene expression (also here), filaggrinhistory of food allergy/asthma and early onset of AD.

Will Eczema Herpeticum Recur?

Yes, and it is also possible to get secondary bacterial infection, i.e. from Staph aureus bacteria. For more on staph, see here. I’ve found a study (on mice) that noted the mice infected with staph bacteria get higher penetration of the herpes virus. More on herpeticum here.

Mis-Diagnosis

It is quite often heard of delayed administration of the anti-viral drug because of misdiagnosis, being confused with impetigo. Anti-bacterial drug will not treat herpeticum and delayed treatment can severely affect the body, leading to blindness (keratoconjunctivitis) and death. Hospitalization was required for half of the patients, and those who are hospitalized had a higher likelihood of recurrence (article here).

Share your experience in this post, esp. when studies in this area is difficult to conduct, experiences may just help!

Photo Credit: NIAID via Compfight cc

Life of Eczema Girl – Reward Chart I – Shoulda?

Eczema_Cartoon_Reward_Preschooler

Funny look at reward charts this month!

This is the 50th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. This month, I’m really inspired by the reward charts that I’ve been implementing, so not all the cartoons are directly eczema related, but you know they are all of THE eczema gal!

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