Eczema News – Impetigo for Eczema Child

Picture taken from bupa.co.uk  Impetigo infection around the mouth a 7-year old girl.

Picture taken from bupa.co.uk
Impetigo infection around the mouth a 7-year old girl.

Impetigo is a common bacterial infection for children ages 2 to 5, and more likely for a child with pre-existing skin condition such as eczema. Today’s article aims to find out more about impetigo, its signs (how to recognize it early), its treatment, prevention and the correlation between impetigo and eczema/atopic dermatitis.

What is Impetigo?

Impetigo is a skin infection that is caused by bacteria (i) Staphylococcus aureus or (ii) Streptococcus pyogenes (same as that causing strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) also causes impetigo. Impetigo is contagious and affect preschoolers most often.

Should impetigo appear as large blisters, it is known as bullous impetigo or non-bullous impetigo if they are crusted. Non-bullous impetigo is more common, often starting out as tiny blisters, then bursting to become wet patches of reddened weeping skin. It then form a yellowish crust. 

Signs of Impetigo

Blisters or sores on the face (nose, mouth), neck, hands, forearms and diaper area – these areas are within easy ‘scratching’ reach and often carries more bacteria from contact with surfaces with bacteria. The blisters burst and form a yellowish crust. Impetigo can also present as folliculitis, whereby the hair follicles also blister and burst to become wet patches. Impetigo may also be itchy and be painful if it occurs around lymph nodes. In a study, the areas most commonly infected by impetigo are the head and neck (65.4%), followed by 19.6% on an upper extremity and by 7.5% each on the trunk and a lower extremity.

Treatment of Impetigo

For localized, yet to spread impetigo, antibiotic ointment can help (mupirocin (Bactroban) or fusidic acid) . For more widespread impetigo, oral antibiotic is prescribed for a faster recovery (few days versus few weeks) and control of the blisters. The area has to be washed and covered up to prevent scratching and spreading the bacteria to other parts of the body. Generally, after 48 hours of antibiotic treatment, the child may be cleared to return to preschool.

Prevention of Impetigo

As impetigo is caused by bacteria, good hygiene such as hand-washing, not touching other surfaces, biting fingers, scratching can help prevent it. For children with eczema, it is good to bring them for swimming, consider cleaning with chlorhexidine or bleach bath in order to keep the bacteria count low and minimize the chance of skin infection. As there is staph bacteria present in the nose, children should refrain from ‘digging’ nose and touching the rest of the body. Fingernails should be kept short and ensure no sharing of towels, bed linen or clothing with other family members. 

Impetigo and Eczema

Impetigo is more likely to affect children with already a weakened skin barrier, either generalized as in eczema or localised as in insect bites, cuts or rashes from contact allergens. As it is spread by contact with the bacteria, it most often affects children who scratch, thus often affecting eczema kids. For children in hot and humid climate/ during summer, the likelihood of impetigo infections is higher (higher chance of insect bites, scratching). Eczema skin is more often colonized with staph bacteria and for those with history of eczema herpeticum, the impetigo infection may be via MRSA bacteria.

All in, impetigo is a condition that parents with eczema kids should definitely be aware of. Especially if your child, like mine, live in hot, humid climate, goes to preschool and scratches/bites and simply can’t follow good hygiene! (did I hear a ‘bummer’ from one of you?)

Eczema Support Group Sharing – Tender Skin

Eczema Support Group - Skincare session for Elderly and KidsLast Friday, the support group had a small and cozy turnout with majority of senior ladies interested in better care for their eczema skin. We learnt a few tips from Sister Wong, who shared graciously on her experience on caring for patients’ skin.

1. The skin comprises of epidermis, dermis, and subcutaneous tissue. The epidermis is the outer layer of the skin. The thickness of epidermis varies, with the thinnest on the eyelid (of 0.05mm) to the thickest at the soles and palm.

2. Some of the moisturizers aim to replenish the defective skin barrier, for instance, ceramides which make up 40-50% of stratum corneum (outermost layer of epidermis).

3. The dermis also varies in thickness, with the thinnest at the eyelid (of 0.6mm) to 3mm on the back, palm and sole. Collagen fibers make up 70% of the dermis, providing strength and toughness. The other components of dermis are elastic fibers, proteoglycans, blood vessels and sweat glands, nerve fibers and immune cells.

4. The baby skin is different in that their epidermis is 20-30% thinner than the adult. It is thus more easily penetrated by irritants as the skin barrier is not fully developed. Infant skin also absorb and lose moisture more quickly. Therefore, gentle products without irritants (see compiled list here) are a good starting point for product selection.

5. Baby skin is also less able to cope with sweat, thus more susceptible to milia/heat rash.

6. Ageing skin, like baby skin, is also thinner. It is more susceptible to blisters, tears and grazes. Its reduce moisture retention ability leads to dry skin. There is also less elasticity and shows signs of color or texture changes from sun damage.

After learning about the skin, we shared about different products and it was a heartwarming to see many of these senior ladies taking very good care and attention to their skin! Thanks to everyone who helped out and next month’s session would likely be on a Saturday, focusing more on kids. Subscribe to blog post and newsletter to be kept updated!

Mom E-votional : Making Do

Christian devotional for eczema familyRecently, we had a road trip to Malaysia with 2 other families with young children – if there’s anything we learn, it is making do. Out of 2 cars, 1 broke down; out of 6 adults, 2 had food poisoning; out of 5 children, 4 had various health problems. We improvise, accommodate as we go along and make do with what we have.

It reminded me of parenting an eczema child. A lot of time we have to make do – given that we have less sleep, more skin issues to manage and most times, little time to rest. Sometimes I feel like if I’m ‘losing out’ on time, luxury, rest, ambitions, life?! But I always remember that there is no ‘making do’ in the kingdom of God, God is able to redeem our lives, give us more than our hearts desire and even a child to Sarah at 90 years old.

Bible verse:

Ephesians 3:20 Now to him who is able to do far more abundantly than all that we ask or think, according to the power at work within us, to him be glory in the church and in Christ Jesus throughout all generations, forever and ever. Amen

Dear God, we may have to make do, sacrifice, forgo things that we would like to have. But nothing is in vain to You and You will bless us abundantly in ways we never expect!

With God, there is no need to Make Do.

 

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!

Life of Eczema Girl – Reward Chart II – Ought Not To Scratch

Eczema_Cartoon_Reward_Preschooler_2

Sounds familiar to anyone? This is the 51st of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. This month, it’s all fun poke at parents on reward charts!

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