#SkinishMom investigates – Acne and Vitamin B12

A recent study by researchers at UCLA examined the link between Vitamin B12 and acne, as it had been suggested in numerous studies or published observations of vitamin B12-induced acne. It was observed in the small sample of 10 participants that after taking Vitamin B12, there were higher levels of the vitamin on the skin. This led to a skin bacterium Propionibacterium acnes to produce more porphyrins, a molecule that is pro-inflammatory. The researchers stressed that the take-away from their study was that skin bacteria is a critical part of understanding acne (and the take-away should not be to stop taking vitamin B).

Acne is linked to the increase of oil/sebum on the skin but the development of acne is not entirely lucid. In an interview MarcieMom had with dermatologist Dr Lynn Chiam, Dr Lynn shared her insight on acne and also tips for those suffering from both acne and eczema.

  1. Acne can be divided into whiteheads or predominantly inflammatory with papules (zits) and pustules (zits filled with pus)
  2. Large and deep zits can result in permanent scarring
  3. Acne usually starts during teen years
  4. Acne can be triggered by increased facial sebum, oily face creams, hormonal changes (pregnancy/ starting or stopping birth control pills/ menstruation), smoking, pollution and high humidity
  5. Mild acne can be treated with creams containing benzoyl peroxide, antibiotics and tretinoin
  6. Avoid applying steroid creams (for eczema) on acne as steroid creams can make the acne worse
  7. Anti-acne cream can cause skin dryness, so avoid applying over eczema skin

The key objectives of acne treatment is to heal the pimples, stop new ones and prevent scarring.

Tips for Caring for Acne Prone Skin

Tips for Caring for Acne Prone Skin

Tips for Acne-Prone Skincare

  • Clean away excess oil from the face and wash using gentle (non-soap) cleanser
  • Do not scrub the acne or squeeze, pinch, or pick the pimples as that increases the risk of scars or dark spots
  • Shave carefully – never dry shave or use a blunt blade
  • Stay out of the sun, if on topical medication
  • Choose oil free and noncomedogenic makeup

Do you have a special regime to care for your skin and any particular diet? Share with #SkinishMom in the comments!

Teledermatology – Different Forms of Skin Consultations

With many people having access to cameras and internet, teledermatology is gaining popularity with the potential of getting a dermatologist’s consultation in a shorter time (compared to a long referral wait). This 5-part series explore the numerous aspects of teledermatology, much of the information is from dermatology associations like the American Telemedicine Association, American Academy of Dermatology, British Association of Dermatologists (BAD) and numerous published research/review papers.

What is Teledermatology?

Teledermatology is a skin consultation carried out remotely using telecommunications, it can take different forms such as:

Store and Forward – This refers to images being stored, sent to the dermatologist with patient information who will then revert with the consultation. Thus, it is not ‘real time’.

Real-time Interactive – This uses videoconferencing.

Direct-to-patient – Images are sent to the dermatologist and there is a live interaction.

Triage consultation – This involves two physicians, where one physician (referring physician) will send the patient information and images to the dermatologist and interact with the dermatologist. The patient interacts with the referring physician.

Store and Forward – When is it Used?

Store and forward is increasingly used, in various forms of skin consultations.

In direct-to-patient teldermatology, store and forward is between:

  • Patient and Dermatologist
  • Patient sends his medical history and images directly to dermatologist
  • Dermatologist provides care directly to patient

Store and forward can also be used in teletriage, whereby:

  • Referring physician interacts with patients, to obtain medical history and skin images
  • Referring provider sends the patient information to dermatologist
  • Dermatologist decides on next step – in-person consultation, tele consultation or no specialist consultation required
  • If it is to be via tele consultation, the dermatologist provides a consultative report back to the referring provider with a skin management plan
  • Referring physician is responsible to carry out the treatment recommendations

Some ‘Get Started’ Pointers for Patients:

Teledermatology Get Started Pointers for Skin Patients

Pointers for Patients considering Teledermatology

#1 Be clear about what you sign up for

As there are various forms teledermatology can take, make sure you find out which one your referring provider has in mind – will he remain as your primary care doctor or it is expected to eventually lead to a referral to see a dermatologist directly

#2 Licensure and board certification of dermatologists

In certain countries/states, there are regulations that mandate patients have a choice of dermatologist, access to where the dermatologist is licensed and what are his/her board certifications. Sometimes dermatologists can provide teledermatology only in states where he/she is licensed. Other states regulate that prescription can only be provided when there is a live interaction. Being licensed in a particular state may also mean being familiar with the health care infrastructure and the resources you (as the patient) have access to.

#3 Access to in-person followup

It would be ideal for you to have the option to access to the dermatologist in-person even if the teledermatology is currently not direct-to-patient form. Where the teledermatology is direct-to-patient, dermatologists are expected to have met you in person or to do so via a live video conferencing before prescribing medication.

#4 Expect your medical history to be stored and transmitted

As opposed to in-person consultation where images of your skin may not be taken, teledermatology relies on the storage of such images to be transmitted to a dermatologist. There are guidelines on collection of patient data and on privacy. Some data that are required to be collected are:

Medical history – for instance, history of eczema or atopic conditions in family

Medical records – past treatment given and current treatment will be documented electronically for all physicians in your care team to have access to. The patient’s existing primary care physician and dermatologist (if any) should be identified.

#5 Right doctor at right time and place

No matter what form of  teledermatology, it should be no less effective and efficient than a in-person referred consultation. The main advantage of teledermatology is the potential to receive a specialist consultation sooner and to have access to the right doctor. The teledermatology process should not end up being convoluted and time-consuming.

Have you tried teledermatology? Has it benefited you? Share in the comments so that the rest of us can benefit!

Mom NeedyZz Cartoon – Sleep Deprivation = Memory Loss

Mom NeedyZz Cartoon Sleep Deprivation Memory Loss

From WebMD, it’s stated that “In 2009, American and French researchers determined that brain events called “sharp wave ripples” are responsible for consolidating memory. The ripples also transfer learned information from the hippocampus to the neocortex of the brain, where long-term memories are stored.” Don’t forget that you haven’t had a good night’s sleep and go sleep now! For more of Mom NeedyZz cartoons > here!

#SkinishMom Investigates – Summer Foods and Skin

Summer Foods for Skin-  #SkinishMom.pngThere are quite a few articles out there on what summer foods you can eat in order for glowing skin and #SkinishMom decides to investigate! You can never take for granted that if a food is recommended on numerous health/ beauty websites, it means that it is the summer (super) food to eat for your skin – sometimes it’s just one website copying another. So #SkinishMom compiles the common summer foods and look at what they are recommended for (vitamins, antioxidants) and research Pubmed to see if there is a scientific basis for such recommendations.

For Water

This has been covered in this #SkinishMom column where it’s concluded (based on general dermatologists’ views online and research (or rather, lack of, since no one can earn money from researching water!) that being dehydrated is bad for the skin but excess water does not benefit the skin.

Foods to eat for water during summer is watermelon, cucumber, celery, cantaloupe, tomatoes and strawberries.

Vitamin C

Vitamin C is studied to varying extent (meaning: the trial is either small scale, or it may be at higher dosage than in a fruit or for application instead of oral or studied in mice) to:

  • Increase collagen production
  • Protect against damage from UVA and UVB rays
  • Helped skin healing, including pigmentation problems
  • Improve inflammatory skin condition (do you know mice are injected with a pro-inflammatory chemical to create inflammation, then administered an oral supplement to test the results, gasp!)

Summer fruits loaded with vitamin C are citrus fruits, oranges, grapefruits, lemons, limes and watermelon.

Antioxidants

Our skin, being the largest surface of our body, is subject to oxidative stress – from the sun, air pollutants, stress, alcohol and the foods we eat. Free radicals are formed during our body’s natural metabolism and oxidative stress but our skin have antioxidants to balance the free radicals. Intake of antioxidants have been studied to prevent carcinogenesis (formation of cancer cells) and protect cells from oxidative damage (e.g. limit the effects of sunburn). One study showed that sunburn to cells was decreased by antioxidant treatment via (i) protection from free radical and (ii) increasing epidermal thickness.

Foods with antioxidants that are popular during summer are blackberries, blueberries, raspberries and strawberries. Drink up green tea too!

Lycopene

This compound is studied to for collagen production and quite extensively known for its anti-cancer properties for melanoma (along with proanthocyanidins in grape seeds). Together with soy isoflavones, vitamin C, vitamin E, fish oil, lycopene has been studied to induce an improvement in the depth of facial wrinkles after long-term use.

Foods rich in lycopene are guava, water melon, papaya, grapefruit and cooked tomatoes.

Vitamin A

Retinoic acid is essential for skin and bone growth and in the studies, mostly linked with cell development and use in cancer treatment. Be careful about taking too much neonatal vitamin A supplement as it has been studied to be linked to atopy and wheezing in children.

Foods rich in vitamin A are carrots, sweet potatoes and pumpkins (but these are considered fall vegetables). The case for beta-carotene for skin isn’t so clear in studies though.

Vitamin E

Vitamin E protects skin membrane and guard against UV damage as it has UV absorptive properties.

Avocado, broccoli and tomatoes are foods rich in vitamin E.

Omega 3

Essential fatty acids are essential from the time of our development in our mother’s womb! It’s critical for brain development (our brains are actually quite full of fats!) and for our skin, omega 3 is able to regulate oil production, have antimicrobial and anti-inflammatory properties. Omega 3 is also studied to maintain our skin (stratum corneum permeability) barrier, inhibit pro inflammatory compounds and elevate our sunburn threshold and promote wound healing.

Experiment different recipes using avocado, chia seeds and salmon! 

Green tea polyphenols

Geen tea polyphenols (GTP) inhibits chemical carcinogen, induced by UV radiation. Green tea being calorie-free is a healthy drink to acquire a taste for.

So this summer, drink enough water and eat some of these summer foods to help protect your skin – sun protection is still a must though!

#SkinishMom

Eczema News – Child car seats – Home for House Dust Mites

House dust mites in child car seatsHouse dust mites is one of the most common allergen triggering eczema in older children. We often think of house dust mites residing on the bed sheets, pillows and mattresses. One often overlooked area is the child car seat. This team of researchers from Ireland studied the type and amount of allergens in the child car seats and (oops, add one more thing to your to-do chores) it turned out child car seats are quite loaded with dust mites and allergens. Here’s a quick look at the study.

Sample: Dust samples collected from 106 child car seats and driver seats

Results: 12 species of mites, of which nine are known to produce harmful allergens, were recorded from 212 dust samples. Over 80% of drivers’ seats and over 77% of child car seats had house dust mites and its allergens. Over 12% of driver seats and 15% of child car seats contained house dust mite levels sufficient to be risk factors for sensitization and allergic reactions. From the samples examined, the house dust mites were breeding (not dead).

What it means: For those with eczema, asthma and rhinitis, you’d have to add car seats to your list of items to clean. Especially if you spend long hours in the car, even more critical to vacuum your car seats regularly. Plus it is compulsory for your child to be in a child car seat for safety.

Why dust mites love car seats: The researchers pointed out that the materials of the car seats, being made of polyester and/or cotton, trap shed human skin and other organic matter (like food) that are the food sources of house dust mites.

Read also these posts for more on:

Eczema Support Group – Public Forum at NSC Singapore

Come this Saturday to the National Skin Centre Singapore for Public Forum on Eczema

Come this Saturday to the National Skin Centre Singapore for Public Forum on Eczema

This coming Saturday, National Skin Centre is holding an Eczema Support Group Forum on the Effective Management of Eczema. There will be 3 informative talks by dermatologists on the following topics:

A/Prof Mark Tang, Senior Consultant Dermatologist, will be sharing on new treatments for eczema

A/Prof Giam Yoke Chin, Senior Consultant Dermatologist, will be sharing her expert tips on the right selection of moisturiser and skincare products

Dr Eugene Tan, Associate Consultant Dermatologist, will share his insights on how to maximise treatment success and minimise risk

This forum is free for Eczema Support Group members, but S$5 for non-members. Do register early by calling 65-63508273. If you are interested in becoming a member and registering for the event, do leave a comment or email me at [email protected] and I’d get a NSC staff to contact you on membership and RSVP.

Mark your calendar for the event!
Date:   27 June 2015, Saturday
Time:   1.30pm to 4.30pm
(registration starts at 12:45pm. Event starts at 1:30pm sharp)
Venue: National Skin Centre, Level 5 Auditorium. 

See you!

Ask #SkinishMom – Holiday is so not Relaxing!

#SkinishMom Parenting Skin Expert

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

Hi #SkinishMom:

I’m so upset, holiday is supposed to be fun and relaxing right? But it never turned out that way. If we actually go for a holiday, I’d end up packing everyone’s bags, planning the itinerary, cleaning up the home and the dirty clothes. That’s still not the worse part. The worse is when we actually stay at home and entertain guests – gosh, my spouse and I would always end up quarreling and tension run sky-high. What’s up with hols, is it just me?

So-not-liking-holiday-Mom

It is so nooorrrrmal (yawn). It happens all the time – my theory?

Holidays Couple Quarrel

Theory of Failing Expectations

When we are up to our neck dealing with a regular workday, we don’t have time to quarrel. My guess is no one in the family has had the time to even look (like really look and appreciate the other person, as opposed to Yo, Where are my socks?) at each other, let alone talk. If you don’t have time to talk, you can’t quite quarrel.

But on a holiday, especially one where you stay at home – you’d have started a long weekend with the hope of getting your own stuff done (sorting photos, getting that manicure, baking a new recipe) but by the time you reach the middle of your break, you realized that it’s so not going to happen. Instead, you have to rush to the grocery store to get ready for the home party, clean up the house for the guests (and the thought of cleaning up after is already killing you), cook and then pretend to be the calm hostess while inside, you’re screaming everyone’s head off. Then the quarrel and tension come whenever it’s just you and your spouse – blaming about not doing fair share of work, mostly.

I came across other interesting theories too:

Narcissism of Small Differences (from the Atlantic)

This theory is from Sigmund Freud that small differences among people who are similar lead to them being hostile to each other. So family members who are similar tend to be hostile over a minor difference like which candidate to vote for!

Jealousy

Survey showed that jealousy is the common reason why most couples quarreled during vacation, because the men had wondering eyes for other women! Others were worried over everyday issues (finance) or wanted to be in control of what to do during the vacation.

Exhaustion

This is a given. Do not associate holidays with rest. Full-day, 24/7 care for your kids (school and alternative caregivers like your parents are having holidays, remember?) is bound to lead to exhaustion. No afternoon coffee breaks and gym workouts at lunch will upset you more than you think. Exhaustion is one of the key reasons why couples quarrel on holiday and when you think of it, it’s not just physical exhaustion. It’s mental as well – exerting mind control over your eczema child to pleeaaase moisturize and your hubby to just clean that up!

It’s the June/ summer holidays – be mindful of the above, lower your expectations on what can be accomplished during this ‘break’, do less and consider not meeting people who will set you off. No excuses for the men with lustful eyes for other ladies; if you happen to be with one during your vacation, dump him and your baggage be lighter!

Heading off for a coffee break and trying not to let all the bad long weekends and hols get to me,

#SkinishMom

Eczema News – Review of Clinical Trials for Eczema Therapeutics in Children

Recently, Hong Kong researchers published a review article ‘Eczema therapeutics in children: what do the clinical trials say?‘ in Hong Kong Medical Journal. Categorized by major treatment methods, previous clinical trials were examined for each individual treatment option. Below is my quick and dirty summary, for the full paper that is available for free, see here.

Clinical Trials Review on Eczema Treatment

#1 Emollient

There is no evidence to show that any emollient is superior to their counterparts, including a small trial that compared the results of using a (cheap) petroleum-based cream versus an (expensive) ceramide-based cream. >> Use a cream you can afford

Aqueous cream has been shown to cause skin irritation, thinning of the cornea stratum (ie skin layer), and increased transepidermal water loss following twice daily application for a few weeks. >> Avoid aqueous cream and sodium lauryl sulphate

There is a lack of evidence for other bathing practices like addition of emollients to bathing water, while use of emollients immediately after bathing as ‘soak and seal’ can help maintain hydration >> You were right about the ‘3 minutes, quickly moisturize after shower!

I hope I don't look like a crazy mom charging my eczema daughter to shower after swimming!

I hope I don’t look like a crazy mom charging my eczema daughter to shower after swimming!

Two studies showed that the use of emollients might prevent development of atopic dermtitis in high-risk patients >> Moisturize your next baby from young

#2 Topical Corticosteroids (TCS)

Guidelines on use of topical steroids – NICE guidelines for children recommend use of the
corresponding potency of TCS for severity of atopic eczema; mild potency for the face and neck and moderate potency only for short-term (3-5 days) use in severe flares; moderate or potent preparations for short periods only (7-14 days) for flares in vulnerable
sites such as axillae and groin.

Potent fluorinated corticosteroids should be avoided for infants and sensitive skin areas.

Systematic reviews of studies that compared the frequency of application of newer-generation moderately potent to very potent steroids identified no benefit in outcome for more frequent applications over once-daily application. >> Keep to once a day, no more than twice.

Topical corticosteroids are generally safe with few serious reported adverse effects. Risks of side-effects increase with higher potency, occlusion, thinner skin areas, severity of eczema, young age and longer duration of use. >> Be careful if your usage falls into these categories!

#3 Wet Wrap

All studies reported improvement in eczema scores, though the methods of wet wrap vary, for e.g., some used diluted steroid + moisturizer while another used chlorhexidine + moisturizer.

The most common reported adverse effects include discomfort, mostly due to chills, and
folliculitis more commonly caused by ointment.

#4 Topical immunomodulants

There is strong evidence that TCIs have a steroid-sparing effect and long-term use up to 12 months can prevent flares. Topical calcineurin inhibitors are particularly useful for sensitive sites including the face, neck, and skin flexures. It’s now studied that there is no statistically significant cancer risk.

#5 Proactive approach with topical anti-inflammatory therapy

The results suggested that for a patient with moderate-to-severe eczema and chronic relapsing lesions, maintenance treatment with topical anti-inflammatory therapy twice a week may be a better strategy to prevent eczema flares and topical corticosteroids more effective than topical calcineurin inhibitors. The rationale is that there is inflammation in the underneath layer of skin that is not visible, ie has not presented itself as rash.

#6 Antimicrobials and antiseptics

Bacteria count was reduced and there was significant improvement in mean eczema EASI (Eczema Area and Severity Index) for those using diluted bleach bath. >> I use chlorhexidine-wash for my daughter with eczema twice a week.

#7 Antihistamines

There is no strong evidence that oral antihistamines are effective anti-pruritics. They are safe to use and their sedative effects, where present, may be useful to promote better sleep quality.

More treatment options that are less often prescribed are covered in the review article, like oral medication. Read up and let me know what you think!

Mom NeedyZz Cartoon – Depression and Sleep Deprivation

Mom NeedyZz Cartoon Sleep Deprivation Depression

Sleep deprivation is associated with depression – it’s not sure though which causes which, but they go hand in hand! Anyone feel emotional and depressed when lack of sleep? For more of Mom NeedyZz cartoons > here!

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