Ask #SkinishMom – Present for Mom of Eczema Kid

#SkinishMom Parenting Skin Expert

Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

I want a surprise! A present! I’ve worked so hard (at work + at home), and we all know that eczema isn’t the easiest condition to manage. Can you make some suggestions on what presents my husband should get for me so that all dads reading your column will ‘GET IT’.. (got it?)

Surprise-Deprived Mom

You are so right! We love presents, especially for those of us whose love language is ‘Receiving Gifts’ (click here for your love language test from Dr Gary Chapman). Here are some suggestions, for men to get your spouse:

Presents and Love Language for Mom with Eczema Child

Gift Ideas for Mothers with Eczema Children!

#1 Time off – Sometimes your wife may seem like she has it all under control and she may even appear not to trust you with eczema care. BUT she may have been wishing for you to step up and volunteer to spend some daddy-child bonding time so that she gets time-off. You never know if you don’t ask, and ask on the day you bring flowers home.

#2 Cheesecake and Coffee – If you don’t know the type she likes, buy a different one each time or even those where you can mix different flavors. Top this with time alone without kids/chores to do when she’s savoring them

#3 Beauty products – Sometimes it can get maddening when you’re applying all the moisturizers on your child but your own skin is dry. Getting beauty products for a mom of eczema child has a deeper meaning – you appreciate her efforts in your child’s skincare (please don’t get one with irritants on the list! Check this ingredients to avoid interview with dermatologist Dr Verallo-Rowell)

#4 Hotel staycation – Even with children along, this is a break from the daily routine. The important part? Be in-charge of packing and playing with your kids during the staycation!

#5 Love – Any small ways you show love is good, including doing your share of chores and not adding to the chore list, hugs and kisses, not snapping at her but showering praise instead. Comes from the heart, man.

Wishing my spouse is reading this too! xoxo, #SkinishMom

Teledermatology – Was your Remote Eczema Skin Consultation helpful?

This is the final post of the 5-part series and today, I will try to apply all that we have learnt in the past 4 posts to eczema skin consultations. I have presented it in survey format for each step of teledermatology and look forward to hearing your experience!

Teledermatology Checklist - Did you Remote Eczema Consultation go well?

Teledermatology Checklist – Did you Remote Eczema Consultation go well?

Before the Teledermatology Process

Q1 Were you given a leaflet to explain teledermatology and what form of teledermatology is available to you?

Q2 Were you aware that you do not have to consent to teledermatology?

Q3 Were you told that if an in-person consultation is deemed required during the process, you will have access to the dermatologist?

Q4 Were you told if it is going to be stored and forward or live videoconferencing?

Q5 Were you told that your eczema is suitable or not suitable for teledermatology? For instance, full body eczema, or rashes in scalp, private parts or pigmented rash are difficult to capture fully in images. Or that your eczema is localised and can be clearly identified in image.

Q6 Were you told that teledermatology may not be as accurately diagnosed than face-to-face consultation?

Starting the Teledermatology Process

Q7 Were you told who is the dermatologist and his/her licensure and board certification?

Q8 Were you told what images of your eczema will be taken and how these will be stored and protected?

Q9 Were you given the instructions on how you can access your own patient record?

Q10 Did you feel that the referring physician is comprehensive in recording your medical history?

Q11 Were you asked these questions on your eczema?

  • Previous treatment for eczema and response to medication
  • Personal and family history of skin disease and atopy
  • Known allergies
  • Active problem list
  • Body map is recommended to show the site of lesions and the extent of inflammation at each site

Q12 Did you feel you were treated with dignity during the photography session?

Q13 Were you told that you can have a companion during the consultation with the referring physician?

Skin Management Plan

Q14 Were you provided with a skin management plan? e.g. what medication, for how long/ which part of skin/ frequency/ how much to use

Q15 Was it made clear to you who is responsible for your care? e.g. to communicate with you and ensure that treatment is clearly communicated

Q16 Was there nursing staff to help you with skin care? e.g. guidance on how to moisture and wet wrap

Q17 Could your referring physician explain clearly which type of eczema you have, and the steps to reduce flare-ups e.g. allergy avoidance, active steps to reduce staph bacteria

Follow-up with Face-to-Face Skin Specialist Consultation

Q18 Did you have to wait longer than traditional referral to see the dermatologist who has provided the skin management plan?

Q19 Did you have to provide the same information again at the skin specialist clinic?

If you were referred for videoconferencing with the dermatologist,

Q20 Did the dermatologist have your information and referral form?

Q21 Was the videoconferencing set up in advance and smooth?

Q22 Were you told beforehand where you would need to uncover for the skin to be imaged?

Q23 Were all the persons in the room identified?

In instances where the set up or preparation for teledermatology is inadequate, the dermatologist may only confirm a diagnosis/ provide a treatment plan in-person. As such, it may end up being more time consuming to engage in teledermatolgy. What’s your experience? How many of the 23 questions were ‘checked’ for you?

For all other posts in this 5-part series, see

Ask #SkinishMom – How to Love when You’re Tired

#SkinishMom Parenting Skin Expert

Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

Is it possible to love when you’re tired? I’m too tired to think, feel or do anything, can I still actively love someone? Some days I ought to smile more, hug more or even really look at my loved ones more, but I’m too tired. Eczema parenting + full-time work.. love, it’s (almost) out of the window.

Tired Mom

Love when you tired #Marriage

Have you loved when you’re tired?

Close that window.

Totally understand that it is difficult to love when you’re tired. I feel the same way too. Some days my eyes are only looking at the computer at work or looking at the floor, or the sink or the clothes hangers. But some days I think back of how doing something I know is good and loving will refresh me.

When I was living in Shanghai, I had to travel all the way from city area to the very west end of Shanghai for bible study. Almost every Friday, I felt like skipping bible study, especially while jostling in the cramped train (it’s so cramped that when the driver announced to get ready and move to the door for alighting at the next stop, he really meant it!). But every time at the end of the bible study, I felt refreshed and not tired – my husband felt the same. I kept this in my heart, knowing that if traveling so far, under such crowded (and often stale air) conditions, I could still feel refreshed, week after week for two years. Then, maybe I can love when I’m tired too.

Whoever are your loved ones are the people who God had put on earth for you to love, with the full knowledge that life on earth is no bed of roses. Love and your loved one was never meant to be a burden from the time of Adam and Eve (though that was the start of the ‘blame game’ among couples!). So how can a tired mom love? Especially if you have a child who needs extra care.

6 #SkinishMom Love-When-You-Are-Tired Tips

#1 Don’t blame or beat yourself up on bad days when you snapped or didn’t show TLC to your loved ones

#2 Don’t blame anyone, for anything

#3 If you are constantly too tired, then you should do something about it – ask for help, cut down on work that don’t matter

#4 Smile – Mother Teresa said

“Every time you smile at someone, it is an action of love,

a gift to that person, a beautiful thing.”

#5 Hug – it’s de-stressing, from Dr Mercola’s website

Hugs are one of the most succinct ways to encourage your body to release oxytocin, and the more oxytocin your pituitary gland releases, the better able you are to handle life’s stressors.

Oxytocin decreases the level of stress hormones (primarily cortisol) your body manufactures and lowers your blood pressure response to anxiety-producing events

Oxytocin has also been found to reduce the cravings of drug and alcohol addiction, as well as for sweets. It even has a positive influence on inflammation and wound healing.

#6 Warm someone’s heart – When I’m tired, I’m bogged down by too many things to do. Usually none of these things satisfy my heart (it satisfied my brain though cos I’d have checked off my to-do list!). When you love, someone else who may be as tired as you has been loved. Knowing that you have done something to warm another heart will warm yours too.

I hoped this post has warmed your heart too, #SkinishMom

“Do not think that love in order to be genuine has to be extraordinary. What we need is to love without getting tired. Be faithful in small things because it is in them that your strength lies.

Mother Teresa

Teledermatology – Advantages of Remote Skin Consultation

Last 3 weeks we have covered 3 posts in this 5-part series on Teledermatology:

Teledermatology takes away the need to travel and meet in person with the skin specialist. This brings about numerous advantages such as:

Many advantages of teledermatology but the set-up at both doctors' clinics have to support it

Many advantages of teledermatology but the set-up at both doctors’ clinics have to support it

Shorter wait time – Compared to traditional referrals, a referring physician that a patient sees (nearer and more accessible) can help to capture, store and transmit the patient information and skin images to a dermatologist. The access to a dermatologist is therefore faster.

Accessibility for patients who live in areas without dermatology care – Singapore is small but in many other countries, specialist dermatology department may only be available in certain areas and teledermatology is a way for patients living in more remote areas to have access to specialist care.

Familiarity – For skin issues that both the referring clinician and the dermatologist feel that it is appropriate for the dermatologist to prescribe a skin management plan and the referring clinician to administer and be responsible for the patient interaction and care, the patient will then be seeing the same doctor (referring clinician) who he/she has already established a relationship with.

Convenience – Potentially faster, cheaper and less stressful than to travel and visit another doctor.

More detailed record – As the process of teledermatology is reliant on the transmission of patient information, images and then the relay of the diagnosis and treatment plan, followed with the outcome of previous treatment, there is a well documented record of the patient information and the skin condition. This record may be more detailed in in-person consultation.

Reduction of waiting lists at dermatology clinics – As certain skin conditions do not warrant establishing a relationship with dermatologist but rather straightforward in the diagnosis and treatment, the waiting lists at dermatology clinics can be shortened.

However, it is NOT ALWAYS that these advantages can materialize and both the referring physician and dermatologist can take actions and have systems in place to ensure success in teledermatology:

At the Referring Physician

  1. Proper record of patient information, medical history and the history of the skin lesions
  2. Staff to take skin images that meet the guidelines of images in teledermatology – dermatology nurse trained to take high quality skin images
  3. Integrated system at the referring physician to incorporate teledermatology
  4. Proper planning of the consultation process at the referring physician to take the images required after the consultation
  5. Selection of patient – Patients who are resistance to teledermatology, for instance, elderly, shy or young patients, or with rash at private parts should not be pressured to consent to teledermatology
  6. Educational materials on the diagnosed skin condition to be available for the patient and the care team

At the Dermatologist

  1. Dermatologists who signed up for teledermatology should have the resources to promptly feedback on the information provided by the referring clinician
  2. Dermatologists should have resources for the referring clinician and his/her clinic on various skin conditions
  3. Close communication and record of patient care with a system to obtain feedback and address weakness in the process
  4. Patients should not have to furnish information all over again if referred for an in-person consultation at the skin specialist clinic, i.e. teledermatology should be integrated with the specialist clinic system
  5. Patients should have a shorter waiting time for in-person specialist skin consultation compared to traditional referral
  6. Patients should have easy access to dermatologist for face-to-face session
  7. Patients should be given clear skin management plan

If traveling to the dermatologist is not an issue to begin with and the mode of teledermatology is video conferencing, there may not be much cost/time-savings involved. On the other hand, it benefits certain situations such as elderly living in a home who may not have access to specialist care if not for teledermatology.

If you want to understand more of the quality standards in teledermatology, do read British Association of Dermatologists’ standards. Share in the comments if you have benefited from teledermatology and what advice you have for patients to get the most out of it, your sharing will help another!

Mom NeedyZz Cartoon – Sleep Deprivation affects Judgment

Mom NeedyZz cartoon Sleep Deprivation affects Judgment

I wonder what Kate’s baby is thinking!

Seriously sleep deprivation affects judgment and interestingly, studies showed that we judged poorly on the fact that we are sleep deprived! (ie we don’t even KNOW we need more sleep!) Next week, all the past two months of sleep deprivation is heading towards a breakdown. For more Mom NeedyZz cartoon, see here.

#SkinishMom Investigates Confusing Citrus on Skin

It was reported end June 2015 that an association (not causal link) was found between the consumption of citrus fruits (grapefruits and oranges) and skin cancer. Key points in these reports were:

  • Increased risk of skin cancer melanoma with drinking orange juice and eating grape fruit
  • Association, not causal
  • Possible (in theory) that psoralens and furocoumarins in citrus fruits make the skin more photo-sensitive
  • Association found from questionnaires filled by about 100,000 health professionals

#SkinishMom looked up Pubmed for more on citrus fruits and got into ‘Citrus Confusion’ – studies seemed in general to point to benefits from citrus fruits, including that of skin cancer protection. Below are the studies:

Citrus Confusion - Is it causing or protecting against skin cancer?

Citrus Confusion – Is it causing or protecting against skin cancer?

  1. Citrus peel use is associated with reduced risk of squamous cell carcinoma of the skin – showed that peel consumption, the major source of dietary d-limonene, is not uncommon and may have a potential protective effect in relation to skin squamous cell carcinoma
  2. Hesperetin induces melanin production in adult human epidermal melanocytes -Hesperidin, a flavonoid in citrus fruits, may protect from photodamage if its capacity to increase melanin production in human melanocyte cultures could be reproduced on human skin
  3. Topical hesperidin prevents glucocorticoid-induced abnormalities in epidermal barrier function in murine skin – Hesperidin can stimulate epidermal proliferation and differentiation, therefore protect against the side effects of topical glucocorticoids
  4. Protective effect of red orange extract supplementation against UV-induced skin damages: photoaging and solar lentigines – Red orange extract intake can strengthen physiological antioxidant skin defenses, protecting skin from the damaging processes involved in photo-aging and leading to an improvement in skin appearance and pigmentation
  5. Oral dose of citrus peel extracts promotes wound repair in diabetic rats – showed significant reduction in blood glucose and time to wound closure. Tissue growth and collagen synthesis were significantly higher

It is true though that psoralen (compound in citrus fruits) make the skin more photo-sensitive; there is a treatment for severe atopic dermatitis (eczema) in adults that prescribed psoralen to be taken 1.5 to 2 hours before phototherapy so that the skin will be more sensitive to the light (“PUVA“).

Taken together, #SkinishMom isn’t going to stop taking citrus fruits but always, sun protection please.

Teledermatology – Shortfalls in Teleconsultation

Last week we covered a critical part of the teledermatology process – getting quality patient information and skin images (for Store and Forward). This week we break down the various steps in teledermatology and explore why each step may not work as well as in-person consultation.

Face to face consultation remain the gold standard as there are many areas where teledermatology may fall short. The referring provider and the dermatologist must be familiar and trained to conduct teleconsultation to mitigate these shortfalls.

Understand these potential shortfalls in teledermatology and see if your doctor is mitigating them when treating your skin

Understand these potential shortfalls in teledermatology and see if your doctor is mitigating them when treating your skin

Step 1 – Understanding the Patient

In face to face consultation, non-verbal cues can be noted including signs of stress that may be important in measuring the quality of life and severity of skin condition e.g. eczema. In triage teledermatology, it is often limited to paper documentation or standard referral letter.

Mitigating factors – There should be a system in place at the referring physician clinic to understand the patient. For instance, comprehensive questionnaires, trained doctors and nurses to capture patient information and images and sufficient time to do so.

Step 2 – Skin Evaluation

In face to face consultation, the physician can use sense of touch and able to see ALL the skin areas. In teledermatology, it is limited to the skin area where the photograph has taken. There are certain skin areas where it is recommended to have an in-person consultation, such as:

  1. The whole body has skin problems, for instance, generalized eczema rather than localized. Physicians have to note to treat the patient as a whole, even when the information is centered on the lesions (a potential pitfall of teledermatolgoy is focusing only on the skin lesion).
  2. The skin conditions are on areas of skin with hair that cover up the skin rash, for instance, the scalp.
  3. The skin lesions if pigmented are harder to view as an image.
  4. Mucosal lesions and orifices, e.g. genital, present difficulty to take accurate image.

Mitigating factors – Skin images have to be taken from various angles, with mid close-up and macro close-up distance and skin lesions clearly marked. Therefore, the referring physician who takes the image or review the suitability of the image has to be trained. Special lighting or dermatoscopes may be required.

Step 3 – Administering the Treatment

It is more likely for the treatment to be carried out as prescribed if there is in-person interaction. Patients have an opportunity to ask their questions directly to the dermatologist and such interaction provide opportunity to optimize patient care.

Mitigating factors – If the treatment is to be handled by the referring physician, educational materials may need to be provided for both the referring physician and the patient. There ought to be close communication between the referring physician and the dermatologist so that the treatment and skin management plan for the patient is agreed and both physicians feel confident with the plan.

Step 4 – Responsibility for the Patient Care

It should be clear within the care team and clearly communicated who is responsible for the patient. In particular, in the quality standards by BAD, it is stated under ‘Patients with long-term skin conditions (eg eczema or psoriasis)’ that

Patients with chronic inflammatory skin disease should be managed through teledermatology only if the referring clinician has the facilities and clinical experience to provide on-going patient support and review based on the skin care management plan provided by the reporting skin specialist.

The rationale is that these skin conditions fluctuate significantly in severity and may require complex treatment plans for safe and effective long-term management. Patients (and parents/carer) should have access to suitable nursing expertise for treatment, counseling, education and advice. Another rationale is that these skin conditions may come with significant physical, social and psychological impairment and therefore the ability to provide on-going patient support is critical to patient care.

There is a reported loss of rapport with the patient through the teledermatology. As such for certain skin conditions that are chronic, fluctuating and require long-term care, teledermatology may not be suitable.

Next week, we will explore what are the advantages of teledermatology. Have you tried teledermatology? Did you feel at any time that your health and skin conditions are not fully understood? Was your referring physician convinced with the skin management plan and were you confident in following through with it?

Share in the comments, especially important as teledermatology is gaining in popularity and we want to do our little part to steer it in the right direction for skin/eczema patients!

#SkinisMom Investigates – Tattoo Skin Rash

There was a recent study published “Self-reported adverse tattoo reactions: a New York City Central Park study” where lead researcher Dr Marie Leger, Assistant Professor at NYU Lagone Medical Center, and her team surveyed about 300 people. It was noted that up to 6 percent suffered from rash, itch or swelling that lasted longer than 4 months. About 10 percent surveyed had short-term skin complications.

This again highlight that we ought to take tattooing seriously – it is not just ‘fashion’ because tattoo works by damaging skin barriers. Tattoo also cannot be ‘taken off’, as the process of doing so is a series of painful laser treatments to remove the skin layers that can take months.

As covered in this post, red ink results in the most allergic reactions. However, it is not clear what about the tattoo ink causes the reactions (dye, preservatives or brighteners). There is no easy way to know ahead if you will get a rash/ hypersensitive reaction because patch test may not be accurate since patch testing is meant to test for contact reactions (not when the chemicals are embedded into the skin layer). Tattoo presents a risk of skin rash or irritation/ swelling AND such skin reaction will change the way the tattoo looks! Wrinkled skin will also change the tattoo appearance.

Why Tattoo is Becoming Popular

Tattoos were once popular among sailors, bikers but for the past few years have been increasingly popular among celebrities. Today, ordinary folks in traditional occupations like teachers and government work also spot tattoos. For some, tattoo is about lending a voice to their life with tattoos that mean something to them. Other reasons include beauty, art, group affiliation, on impulse or addiction.

Step by Step Tattoo Safety Tips from #SkinishMom

Step-by-step Tattoo Safety Tips

Step-by-step Tattoo Safety Tips

#1 Is your skin generally hypersensitive? If yes, it’s best to skip it. As patch testing is not full-proof, there’s no absolute way to know you won’t get any skin reaction. Some reactions can appear months later and get only be rid of by removing the tattoo.

#2 Consider patch testing for the common chemicals used in a tattoo, such as mercury sulfide (cinnabar), ferric hydrate (sienna), sandalwood or brazilwood. Each ink has different components so you can decide on your colours and then patch test the ingredients. It is not a full-proof though.

#3 Check regulation monitoring tattoo establishment. Different country and state has different regulation, including inspection and equipment/supplies (contact with blood) handling procedures. You may even want to travel to a state that has stricter regulations.

#4 Go to regulated tattoo establishment.

#5 Get a tattoo you won’t regret! It is reported that more than 20% of adults regretted their tattoo choice… for instance, do you really want the name of an ex-girlfriend on your skin?

#6 Check the batch number of the pigment used. Also check if the brand of tattoo pigment is from more established companies, such as Millennium Colors Inc. Also make sure that sterilization is practiced.

#7 Protect your tattoo by keeping it clean and out of the sun. The better your skin heals, the better your tattoo will look.

Have you tattooed? and how did it work? Recommend your tattoo artist, brand or inks in the comments!

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