Elderly Skin Conditions series – Incontinence Associated Dermatitis

Adult Diaper Skin Rash Incontinence Dermatitis This is another 4-part series, focusing on elderly. For those of you who have been following this blog, you know I’ve been passionately persevering in bringing you information for eczema children. This month, however, I’m inspired to focus on elderly because (i) I see a desire among elderly ladies in the eczema support group meeting to care for their skin and (ii) I am ashamed that I can’t convince my own elderly parents of the right skincare. Hopefully, with this series, elderly who surf the internet and found this blog will find the series useful and adult kids (yes, you and me included!) will be empowered to help their aged parents with the correct skincare. So here we go!

Last week, we covered a very common skin condition affecting elderly, Stasis Dermatitis. For those of you with aged parents with hyper-pigmented, itchy, swollen/ulcerated skin on the legs, coupled with varicose vein condition, read more in last week’s post. This week, we’re covering another common skin condition affecting elderly with incontinence issue who have to wear adult ‘diapers’. They may be too embarrassed to share with you their skin problem at the genital area, so it’s good to know so that you can ask gently about it.

What is Incontinence Associated Dermatitis (IAD)?

It is an inflammatory skin condition that affects elderly who wear absorptive products to manage their urinary or fecal incontinence issues. Incontinence associated dermatitis is also known as perineal dermatitis. Its prevalence range from 5% to as high as over 20% in various studies. It is characterized by skin damage, inflammation and erythema (skin redness).

Is it Eczema? If not, what causes IAD?

Eczema is atopic dermatitis, meaning there is atopy/allergic reaction involved that triggered the skin reaction. In the case of incontinence associated dermatitis, it is the constant contact to the urine/stool in the adult diaper that damages the skin. This skin damage weakens the skin barrier and leads to deteriorating skin functions, mainly protective and moisture retention functions.

The skin barrier becomes less protective and more susceptible to penetration of irritants (urine/stool), thus more likely to suffer from irritant dermatitis (vs atopic dermatitis).

The skin barrier’s ability to retain moisture already weakens with age and further exposure to urine/liquid stool/sweat increases the rate of this water loss (known as trans-epidermal water loss TEWL).

Skin damage via friction with absorptive products is higher in elderly with IAD and it is possible that the constant exposure to urine raises the skin pH level which makes it more susceptible to damage from friction/pressure.

For elderly with both urine and fecal incontinence (known as double incontinence), there is higher likelihood of skin damage as the liquid stools/stools mixed with urine, leads to higher volume of digestive enzymes that breakdown the fats and proteins of the skin layer.

Just the genital area?

No, incontinence associated dermatitis can extend beyond the genital area to the buttocks and upper thighs.

Complications of Incontinence Associated Dermatitis

A frequent complication of skin inflammation is skin infection. The other complication is candidiasis (fungal infection from yeast called Candida albicans) that appears like a red/brownish red rash with ‘satellite’ lesions. Incontinence associated dermatitis should be differentiated from skin ulcers, which is pressure ulcer/deep tissue damage from pressure (sometimes at area of bone prominence).

Prevention of IAD

  • Minimize time wearing absorptive products, for instance use of hand-held urinal or catheter
  • Frequent change of the adult diapers to minimize the amount of time the skin comes into contact with urine
  • If there is diarrhea or liquid stools, be sure to change adult diaper frequently
  • Daily proper cleaning (without using harsh soap) of genital area at each change of absorptive products and protection with moisturizer (non-fragrance and without common irritants). An ointment containing zinc oxide, similar to baby diaper cream/ointment can also be used to protect against irritant/urine/stool.
  • Similar to baby skin care, frequent washing, use of hot water, rubbing dry with towel should be avoided to minimize drying and wear and tear of skin.

Other methods to manage the incontinence issue can be explored, such as diet/fluid management, pelvic muscle and bladder training and toileting technique. Surgical procedure is often presented as an option, but the pros and cons have to be weighed properly given that no surgical procedure is 100% risk-free. Particularly for an elderly, being subject to a surgical procedure so as not to have to wear ‘diaper’ may end up with more complications (This is outside the scope of this skin post, but more can be read here and here).

For those of us with elderly family members with continence issue, maybe tactfully drop reminder of extra skincare when they are wearing the absorptive products. Share your experience in the comments too, we all need support!

Life of Eczema Girl – Renewing Skin

Eczema Flood Renew Skin Cartoon

I wonder how often we and our kids wish our skin can restart!

This month I’m plagued by a curiosity of the child’s mind (esp. an eczema child!) when learning about creation. And the more I think about it, the more questions I have, guess it’s time to polish up on my bible knowledge! This is the 62nd of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here.

(ScratchMeNot) Mom E-votional : No longer Allergic!

Andrea on Childcare Eczema ScratchMeNot When we realized she was no longer allergic, I realized the extent of our journey.

Summer of 2014 marks a new adventure for us! My daughter is no longer allergic to dairy, tomatoes, or corn!

Ever since she was 2 months old, we as a family, have been battling her eczema. There were long days & long nights of scratching, searching and wanting to understand why eczema was making our world crazy! We wanted her to be comfortable and NOT SCRATCH! I didn’t take a lot of pictures of her during her flare-ups, because it hurt to see her in such pain. Remembering those times is still challenging. Through testing, we learned that she was sensitive to many foods, while only being allergic (anaphylactic) to nuts. As a nursing mom, both of us had to stop eating her list of “no foods”. I had come to the resolve that I wanted her to understand that we are grateful for what we can have, even though we want some thing we can’t have. We must remember, everyone’s load is different; we must persevere with joy.

Our family did our best to show her foods she could eat, instead of focusing on what she couldn’t eat. I knew she was curious, yet she ate her food with pride. Sure there were moments, she wanted to be like other kids and eat ice cream & spaghetti and be ok. Those moments challenged me and made us stronger. I had to answer some hard questions, like “Why can’t I eat it, but she can?” On the flip side, I’m also VERY positive that she snuck a few cheese crackers on a few occasions and giggled about it afterwards. Then IT happened. After eating some cheese crackers at church (a story for another day), she told me about it and was not scratching. No redness, no eczema.

I gave her a few cheese crackers after this, with success. As a family, we decided to do a test of our own. Knowing she wasn’t anaphylactic to dairy, we took her out for her first taste of ice cream. I could feel the excitement as we raced to a local creamery. Between birthday parties and fun days at school, ice cream is THE thing to eat for a kid her age.

As we drove to the land of dairy, I thought of the countless times we enjoyed sorbet as an alternative. Now it was her chance to have her own ice cream. As she began to eat it, I was holding my breath, praying she didn’t break out or flare up. And she didn’t!! Although her face began to frown because she didn’t like it at all! Thankfully, not one reaction was seen that day or even days later.

I was curious if she’d outgrown other foods. Weeks later, we slowly incorporated other foods back into her diet, tomatoes, and citrus, there were NO REACTIONS! Relief, excitement, joy and a different peace settled in.

Our journey continues, as she’s still very allergic to nuts and sensitive to a few other foods. We’re hopeful that she’ll outgrow them all, but if not, we’re blessed.
Our journey continues, as she’s still very allergic to nuts and sensitive to a few other foods. No matter the outcome, I know we were blessed whether her condition got better or worse. Blessings are peace, hope & joy. Even during our hardest bouts with allergies & eczema, we’ve had to focus on what true blessings are.

1 Corinthians 13:7 “Love bears all things, believes all things, hopes all things, endures all things.”

Andrea, founder of ScratchMeNot, had shared about how she managed childcare in 2013 Someone Managed Eczema series here.

Elderly Skin Conditions series – Stasis Dermatitis (Varicose Eczema)

 

Picture taken without permission, duly credited Medscape. Click on picture to be directed to Medscape Stasis Dermatitis page

Picture taken without permission, duly credited Medscape. Click on picture to be directed to Medscape Stasis Dermatitis page

This is another 4-part series, focusing on elderly. For those of you who have been following this blog, you know I’ve been passionately persevering in bringing you information for eczema children. This month, however, I’m inspired to focus on elderly because (i) I see a desire among elderly ladies in the eczema support group meeting to care for their skin and (ii) I am ashamed that I can’t convince my own elderly parents of the right skincare. Hopefully, with this series, elderly who surf the internet and found this blog will find the series useful and adult kids (yes, you and me included!) will be empowered to help their aged parents with the correct skincare. So here we go!

Last week, we talked about the elderly skin differences and the loss of skin functions. This week is on stasis dermatitis, very likely if you start noticing, you’d see many elderly with this skin condition.

Stasis dermatitis is a common inflammatory skin condition that occurs on the lower extremities (our body from the hip to the toes, including also the knee, ankle joints, the thigh, leg and foot). Stasis dermatitis is also known by various names, such as varicose eczema, venous eczema, venous dermatitis and gravitational dermatitis.

Its prevalence is about 7% in elderly persons above the age of 50 and can be up to 20% for those above age 70. The main cause of stasis dermatitis is venous insufficiency, which has been reported to affect more than 50% of elderly above age 50 internationally (thus, making stasis dermatitis a common skin condition for elderly).

What Causes Stasis Dermatitis?

Venous insufficiency is the main cause – a term that you’d see being commonly mentioned.

Venous insufficiency refers to the poor blood circulation, commonly due to weakening of the valvular function with age. The malfunction allowed a backflow of the blood from deep venous system into the superficial venous system, creating venous hypertension.

It is hypothesized that this increased pressure leads to the dermal capillaries being more permeable. This results in the leaking out of macromolecules (fibrinogen) that eventually polymerized and form a cuff (fibrin cuff) that reduces oxygen to the skin cells. White blood cells that help the body to fight inflammation becomes activated and trapped in the fibrin cuff resulting in a hyper state of inflammation.

Who gets Stasis Dermatitis?

Typically middle-aged and elderly patients, from age 50s onward

Patients with venous insufficiency due to surgery, trauma or thrombosis (blood clot)

Women, due to increased stress on the lower extremity venous system from pregnancy

Patients with health conditions such as high blood pressure (hypertension with diastolic dysfunction) and congestive heart failure

Patients taking medications such as antihypertensive medication, e.g. amlodipine

Sedentary lifestyle and Obesity

Symptoms of Stasis Dermatitis

Symptoms may show at area at the lower leg and around the ankle, such as

  • Itch
  • Hyperpigmentation/discoloration, usually reddish-brown skin
  • Atrophic skin patches (small/white scarred skin that is decreasing/thinning)
  • Edema (swelling from excess fluids, e.g. blood pooling from faulty varicose veins)
  • Dilated superficial veins
  • Infection with honey-colored crust over infected area
  • Pain
  • Slow healing of open sores
  • Lichenification (thickening of skin from repeated scratching)

 Complications of Stasis Dermatitis

Chronic stasis dermatitis where the skin is inflamed severely for prolonged period can lead to weeping patches, plaques (solid, raised lesion), on-healing venous ulcers and higher likelihood of contact dermatitis. It can also aggravate into other conditions such as:

Cellulitis – Streptococcus or staphylococcus bacteria entering through a break in the skin, causing infection that can spread quickly from a reddened skin to lymph nodes/blood stream

Lipodermatosclerosis – Underlying fat necrosis (degeneration of fat cells), with appearance of “inverted champagne bottle” on the inner leg

Prevention of Stasis Dermatitis

To prevent stasis dermatitis, measures can be taken to reduce venous insufficiency. This can be prompt treatment of varicose veins, treatment of health conditions, management of venous insufficiency and preventing deep vein thrombosis.

  1. Leg elevation – above the heart when lying down to improve blood circulation and reduce swelling
  2. Compression socks – also improve circulation
  3. Not standing for long periods
  4. Taking regular walks
  5. Moisturizing (avoiding harsh soaps and perfumed products)
  6. Protecting from further injury (e.g. knocks or falls)

Treatment of Stasis Dermatitis

Treating the cause of the venous insufficiency is one part of treating the skin condition. Avoid scratching and follow the nurse’s instruction for wound care. Antibiotics may be prescribed, either topically or orally, if there is infection. Topical steroid may be prescribed but since the skin is already thin, talk to the doctor about alternative non-steroid options or be careful to apply only the low potency for limited time.

As I look through the pictures of stasis dermatitis, I really feel very sad. It’s an age-related problem and the thought that our parents who bore the hard work to raise us have to bear this pain is very heart-breaking. The irony is that they don’t quite believe in skincare or compression stocking – encourage one another to stay positive in helping our parents!

Life of Eczema Girl – Rest after Creation

Sleep Rest Eczema Creation cartoon

The right answer should be God set a pattern for us to work and rest, only God need not sleep!

This month I’m plagued by a curiosity of the child’s mind (esp. an eczema child!) when learning about creation. And the more I think about it, the more questions I have, guess it’s time to polish up on my bible knowledge! If you have a funny Sunday school experience, drop me an email or a comment and I may just turn it into a cartoon! This is the 61st of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here.

Mom E-votional : Food for Thought

Eczema devotional Food for Thought SkinKnow the phrase ‘Food for Thought’? It means something worth thinking about seriously. But to many parents, it might really be worth thinking food for ‘brain’ as it seems to be a faster-than-rat race to be smarter younger. For myself, I do think about anti-inflammatory foods (see Julie Daniluk’s recipes here and Jennifer Iserloh’s recipes here) and here are 3 foods I’d go for:

1. Oily fish for Omega 3 essential fatty acids. Omega 3 is not only a brain food (see Dr Sears’ talk here), but also one of the very few foods that have been studied to improve eczema. Don’t like that fishy smell? Go for a good quality fish oil supplement or flax seed oil.

2. Yoghurt/ Probiotics – Probiotics is the other ‘food’ that is studied to improve eczema (read here). As to how probiotics/yoghurt works for the skin, the mechanism is not entirely clear but may got to do with improving the gut flora also improves the skin flora. Since ‘bad’ bacteria can tip the scales and leads to skin inflammation and reduced efficacy of eczema treatment, adding good bacteria regularly makes sense. However, the dosage studied to be effective is fairly high, in 10billion CFU – so I’m not sure if regular yoghurt has that.

3. Broccoli/Cauliflower – I’m fortunate that my daughter loves this superfood vegetable! It is a brain food because it has choline and vitamin B, both good for brain development. Also, it is an anti-inflammatory food with beta carotene, vitamin A and C. It reduces allergic reaction and also help skin repair. See chef Jennifer’s Broccoli with Garlic Sauce recipe and nutritionist Julie’s recipe for Broccoli Seaweed Salad.

Jesus is also big on food. Jesus feeds 5,000 with 5 loaves and 2 fish in Matthew 14:13-21. God feeds the Israelites for 40 years with a bread from heaven, known as manna. Manna is like coriander seed, baked wafer with honey. Whatever manna is, I’m sure it has all the nutrition needed since it is the only food source in the dessert! I love it when there’s so much healthy food we have access to and for parents with eczema kids, make sure your child is really tested allergic to a certain food before removing the suspected food from child’s diet. Read this eczema research focus news on link between eczema and allergy.

Bible verse:

John 6:35 Jesus said to them, “I am the bread of life; whoever comes to me shall not hunger, and whoever believes in me shall never thirst.

Trust God to be your food and for your food

Elderly Skin Conditions series – Elderly Skin, How does Skin Age?

Elderly Skin Conditions Eczema and Age This is another 4-part series, focusing on elderly. For those of you who have been following this blog, you know I’ve been passionately persevering in bringing you information for eczema children. This month, however, I’m inspired to focus on elderly because (i) I see a desire among elderly ladies in the eczema support group meeting to care for their skin and (ii) I am ashamed that I can’t convince my own elderly parents of the right skincare. Hopefully, with this series, elderly who surf the internet and found this blog will find the series useful and adult kids (yes, you and me included!) will be empowered to help their aged parents with the correct skincare. So here we go!

How does Skin Age?
It is obvious that our skin ages as we age – even if we don’t look into the mirror or care to look at our own skin, the number of anti-ageing, whitening and anti-wrinkle products remind us that our skin grow old. Aging can be intrinsic (i.e. genetics) and extrinsic, with the main factor being sun exposure, although lifestyle (smoking, alcohol, obesity, diet, exercise) and pollution also play a role.

We have covered skin functions in this blog, so below explains how our skin age and loses its ability to perform its functions.

Differences in Elderly Skin

  1. Thinner skin that appears more transparent, due to loss of epidermis (surface layer of skin)
  2. Decreasing and increasingly fragmented collagen, thus less supple skin
  3. Wrinkles, from sagging of elastic fibres and more reasons here
  4. More fragile skin due to flattening of skin cells, prone to blisters, burns and tears
  5. Loss of elasticity (from less fibroblasts), thus ‘loose’ skin
  6. Fewer Langerhans cells, which are immune cells of skin
  7. Reduced lipids within skin
  8. Reduced sebum (oil) production, leading to dry/itchy skin
  9. Reduced cutaneous blood flow
  10. Reduced sweat glands, from shrinkage of eccrine glands
  11. Reduced pigment cells
  12. Photaging, due to sun exposure
  13. Lower cell replacement
  14. Less acidic pH of epidermis
  15. Thinner blood vessel walls at the dermis, thus easier to bruise

Skin Function Loss for Elderly

With the above skin changes, there is associated loss of skin function:

  • Weakening of the skin barrier function, more permeable to irritants
  • Less able to regulate temperature, due to loss in fats and sweat glands
  • Less able to protect against sun
  • Less able to retain water in skin (stratum corneum)
  • Less able to repair the skin and heal wound, aggravated by health conditions that reduce healing such as diabetes
  • More susceptible to infection (from fewer AND less responsive Langerhans cells)
  • More susceptible to injury due to reduced ability to sense pressure and temperature, and thinner blood vessel walls

With the skin changes in elderly, there are numerous skin conditions that affect them. Most of the skin disorders have signs of skin inflammation and itch (pruritus). General itch without an underlying skin disorder is very common and mainly due to the breakdown of skin barrier, thus normally tolerated soaps and detergents start to trigger rash and itch (i.e. increasing risk of contact dermatitis). Atopic dermatitis is also common because of increased penetration of allergens via the defective skin barrier. As eczema, contact dermatitis and itch has been discussed in this blog (type into search box for all related posts), this series won’t cover these skin conditions despite being very common in elderly (as well as kids!).

For this series, I’m covering 3 skin disorders which are common and that I see in elderly around me (aka Singapore). These are Statis Dermatitis (affecting varicose vein area), Incontinence Associated Dermatitis (from exposure to urine or stools) and Asteatotic eczema (cracked skin). Older people may also have health conditions where either the condition itself predisposes them to skin disorders (atherosclerosis, diabetes, HIV, congestive heart failure) or the medication might. For instance, non-enzymatic metabolites, diuretics and calcium blockers affect the skin. So take time to Google, research and ask the doctor for elderly in your family about potential side effects of the medication they are taking. Elderly who are immobile (i.e. always on the chair or bed) or live in homes are also at higher risk of skin disorders.

Catch up next week on Statis Dermatitis and meanwhile, drop me a comment if you have a condition for elderly skin that you’d like me to look into!

My Book Giveaway at #Dadchat on #Eczema and #Allergies

Come join me at #Dadchat - the most authentic, parenting chat with international dads and moms, hosted by Bruce Sallan

Come join me at #Dadchat – the most authentic, parenting chat with international dads and moms, hosted by Bruce Sallan

This Thursday evening for those in US timezone, 6-7pm PT or 9-10pm ET, or for those in Singapore 9-10am GMT+8, come to twitter and join #Dadchat. This is a weekly chat, hosted by Bruce Sallan, who is a TV producer turned dad, writer (with his column A Dad’s Point of View published in over 100 newspapers), radio host and THE DAD behind #Dadchat – to have a sense of how popular #Dadchat is, even Guy Kawasaki is a guest on the chat and on a personal level, it is a chat that I’ve been attending for years because it is real, non-advertisey with parents all over the world who truly care about their families and kids and openly discuss them!

Bruce is also no stranger to this blog, he had shared his views on How to be a Better Dad here.

So come and there’d be my book Living with Eczema: Mom Asks, Doc Answers as giveaway, along with my co-author Professor Hugo van Bever’s other book on allergies, both published and giveaway sponsored by World Scientific. For more on the chat, see Bruce’s post and see you!

Life of Eczema Girl – Vegetarian Diet

Vegetarian Eczema Creation Cartoon

Don’t take my biblical knowledge for real, I’m quite confused on this too!

This month I’m plagued by a curiosity of the child’s mind (esp. an eczema child!) when learning about creation. If you have a funny Sunday school experience, drop me an email or a comment and I may just turn it into a cartoon! This is the 60th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here.

Mom E-votional : Realistic Parenting

Errrr... is this image realistic? Yes for me, but not on all nights!

Errrr… is this image realistic? Yes for me, but not on all nights!

I came across a parenting article on ivillage ‘The Most Practical (and Realistic) Parenting Advice you will Ever Read‘, it’s kind of funny, offering tips such as:

  • It’s ok if you miss a day of bathing your kids
  • You aren’t the first to give in to tantrum
  • You don’t have to do homework
  • Sometimes feeling hurried and harassed is part of being a parent

To me, I try my best – go home early, spend time with kid on activity and reading with them. We discover authors that are funny with bright illustration, such as Mo Williems, Jan Thomas and Allen Plenderleith. Do I laugh with my daughter when reading? Yes. But hey, some nights I can’t wait to get it over and grab some zzz myself! Esp. given how late her bedtime is, how much scratching and crazy ‘eczema’ habits she picked up over the short (or excruciating long!) 5 years of her life, I really just want to sleep and not parent!

God is also a parent, father to Jesus and christians. I don’t think God does ‘realistic parenting’ as in he doesn’t have enough energy to parent us. But I think he’s realistic in another sense, that he knows us so well and understands when we fall short.

Bible verse:

Matthew 6:26 Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they?

Father in heaven, you know us and how we parent. Yet being so aware of our shortfall, you love us. Help us to parent our children with the same love and give us wisdom to juggle so many aspects of life – work, children, chores, aged parents and eczema too!

We are the best parents for our children, that’s real!

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