Ask #SkinishMom – Why Can’t the Doc Just Give Me the Allergy Test?

#SkinishMom Parenting Skin Expert

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

My kid has eczema and we haven’t figured out what is the trigger. I’ve been asking the doc about taking an allergy test but the doctor either say that my kid’s eczema is only at a certain area, so no testing is needed or say that it’s those common allergens that affect almost every child, so again no testing is needed. But there’s no CONCRETE EVIDENCE of WHAT’S TRIGGERING MY CHILD’S ECZEMA – why can’t the doc just give me the test?

Frustrated Mom

I totally understand, many moms feedback the same and many docs replied the same. The short reply is if taking an allergy test is on your mind 24/7, just demand it. If the dermatologist that you’re seeing refuses to prescribe one, go to another doctor. After all, eczema is a long-term situation that requires much working and communication with your doc; if you can’t even agree on something as basic as whether or not to allergy test, it’s unlikely that this is a doctor that you can work with.

Allergy test for eczema child

On presenting both sides of the story:

From the parents’ view:

  1. You’re tearing your hair out figuring out the triggers, you need an allergy test to get some answers.
  2. You’re growing day by day fearful of applying corticosteroid cream on your child, figuring out the trigger means less flare-ups and less need for the steroid.
  3. You’re breastfeeding still and you seriously are going nuts on what you can or cannot eat.

From the doctors’ view:

  1. Your child’s eczema is localized, say on the face, thus likely due to saliva or food residue irritating the child’s skin. 
  2. Allergy testing is unlikely to be accurate for a baby (less than 6 months) and therefore, testing and working on the inaccurate results may turn out to be even more confusing for the parents.
  3. It is true that most of the children are affected by the common allergens of cow’s milk, egg, soy, wheat, seafood, dust mite, pet dander and pollen. Younger children are more affected by food while older children are commonly affected by dust mite. It is therefore a waste of money to be testing for something when you’d already know the test results.

SkinishMom’s view:

  1. Go for allergy testing, even if it’s going to turn out results you’d expect (so you know for sure).
  2. Go for allergy testing at the clinic/hospital where you’d want to see the doctor, because the results have to be interpreted and collaborated, with future action plan for eczema care
  3. Don’t go for allergy testing online or some ‘innovative’ allergy tests – skin prick, blood IgE and skin patch are the standard tests

Do what you (as a mom/dad) think it’d give you peace,

SkinishMom

Life Threatening Skin Rash series – Toxic Shock Syndrome

Toxic shock syndrome eczema

Picture taken from http://www.healthline.com/health/toxic-shock-syndrome#Overview1

Toxic shock syndrome is rare but life threatening, caused by bacterial toxins from staphylococcus aureus. Toxic Shock Syndrome commonly affects teens and young adults, from age 15 to 35 and majority, female.

What Causes Toxic Shock Syndrome?

Toxic Shock Syndrome is due the bacterial infection via the skin, vagina or pharynx into the bloodstream. While it is not uncommon for Staph bacteria to colonize the skin, a cut, surgery or wound in some individuals may lead to the bacteria entering the blood without immunity to fight it. The conducive environment for the toxin is protein-rich and oxygen, which is what the use of tampons during menstruation provides. Tampons with higher absorbency (polyester, carboxymethylcellulose and polyacrylate) increases the risk of TSS. The toxins can cross the vaginal wall to the blood stream, possibly through tear when inserting the tampon.

Symptoms of Toxic Shock Syndrome

  • Flu-like symptoms
  • Confusion, dizziness due to low blood pressure
  • Skin rash
  • Swelling and redness in mucous membrane
  • Shock
  • Multi-organ failure

Diagnosis is made based on physical examination, blood or urine test or swaps from the cervix, vagina and throat.

Stages of Toxic Shock Syndrome

  1. High fever, sore throat, fatigue, muscle ache, nausea, fatigue, diarrhea, headache, dizziness (low blood pressure), confusion
  2. Reddish tongue, inflamed mucous membrane (eyes)
  3. Swelling of joints and eyelids
  4. Skin rash – generalized, flat and red (characterized by turning white when pressed)
  5. Shock occurs when the blood pressure cannot be maintained
  6. Skin rash disappears on recovery.
  7. Skin on palms of hands and soles of feet flake and peel off.
  8. Fingernails, toenails and hair may fall out.

Types of Toxic Shock Syndrome

  • Toxic Shock Syndrome due to bacteria Staphylococcus aureus
  • Streptococcal Toxic Shock Syndrome due to bacteria Streptococcus pyogenes

Treatment of Toxic Shock Syndrome

TSS is considered a medical emergency that required hospitalisation. An intravenous antibiotic will be prescribed to fight the bacteria infection, or medication to stabilize blood pressure and to prevent dehydration. Injections may also be given to suppress inflammation and increase body’s immunity. Also the cause of the bacterial infection will be removed, for instance, removal of the tampon or draining pus from the skin wound.

Complications of Toxic Shock Syndrome

If the internal organs are affected, it can lead to liver, kidney, heart failure, seizure and shock. Early detection of toxic shock syndrome has a much higher chance of recovery. The mortality rate is about 5-15% and rate of recurrence at 30-40%.

Toxic Shock Syndrome and Eczema

It is observed that patients recovering from TSS tend to develop chronic eczema. I couldn’t find literature on the likelihood of having TSS if one has eczema. I wonder if there’s increased risk since the skin of eczema patients tend to have staph bacteria colonization.

Prevention of Toxic Shock Syndrome

Certain precautions for menstruating female who uses tampon are to change the tampon every 4 to 8 hours and to use a low-absorbency tampon. Wash hands and keep skin cuts and wounds clean with frequent dressing change. TSS may recur, thus tampon should not be worn by those who had TSS before.

Anyone have experience with toxic shock syndrome? Do share, it will be useful to the rest of us and to be more aware of the risks.

Ask #SkinishMom – Is Eczema Driving My Child Nuts?

Psychological Impact of Childhood Eczema

Yes, some studies indicate evidence of behavioural disturbances for children with severe eczema from a young age (childhood anxiety, withdrawal, depression). Parents of eczema kids would know there’s likely psychological impact without reading research. Why?

  1. No Sleep, Brain can’t function – cranky.
  2. So much stress as an infant, something may just go wrong as the brain is wiring itself loads at that time. (If you’re a parent of a very young baby with eczema, you can visibly see the discomfort and agony caused by the itchy rash. Plain torture.)
  3. Being looked at with curious eyes. Being avoided. Being bullied.
  4. Whole family is stressed and short-fused. No one dare say living in such environment is conducive for health.

School bullies Eczema

So how to reduce the chance of your kid going nuts?

The model answer is:

  1. Control the eczema, seek treatment.
  2. Recognize signs of depression.
  3. Seek a support group.
  4. Try relaxation techniques.
  5. Educate and raise awareness in your child’s school.

#SkinishMom answer is:

  1. Sleep whenever you can.
  2. Love yourself, love your spouse, love your child. The whole family united can take on challenges.
  3. Chill
  4. Indulge
  5. Positive mindset.

What’s your survival techniques?

#SkinishMom

Life Threatening Skin Rash series – Stevens Johnson Syndrome

Stevens Johnson Syndrome by EczemaBlues.com

Pictures taken from http://dermnetnz.org/reactions/sjs-ten.html

Stevens-Johnson Syndrome (SJS) is a rare, severe disorder that causes pain, red/purplish skin, blisters and shedding of skin. It can be drug-induced or due to infection. It is a medical emergency and takes from weeks to months to recover. It is more common in adults or older people and men who use more of the possible drugs that trigger the SJS.

What Causes Stevens-Johnson Syndrome?

Its cause is largely drug-induced (more than 70%) or due to infection. However, genetics, family history and weakened immune system are also risk factors.

From Mayo’s Clinic website:

  • Anti-gout medications, such as allopurinol
  • Pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)
  • Medications to fight infection, such as penicillin
  • Medications to treat seizures or mental illness (anticonvulsants and antipsychotics)
  • Radiation therapy

The infectious causes listed by Medscape are:

Viral diseases:

  • Herpes simplex virus
  • AIDS
  • Coxsackie viral infections
  • Influenza
  • Hepatitis
  • Mumps

In children, Epstein-Barr virus, enteroviruses and upper respiratory tract infection.

Bacterial diseases:

  • Group A beta-hemolytic streptococci
  • Diphtheria
  • Brucellosis
  • Lymphogranuloma venereum
  • Mycobacteria
  • Mycoplasma pneumoniae
  • Rickettsial infections
  • Tularemia
  • Typhoid

 Symptoms of Stevens-Johnson Syndrome

  • Flu-like symptoms
  • Rash – Pain, Red, Purplish Skin
  • Blisters
  • Shedding Skin (Nikolsky’s sign)
  • Eye-related – Painful red eye, purulent conjunctivitis, photophobia, blepharitis

Diagnosis is usually made via physical examination or skin biopsy.

Stages of Stevens-Johnson Syndrome

  1. Fever, sore throat or mouth sores
  2. Fatigue, cough, headache
  3. Swelling (face, tongue), Hives
  4. Rash – Pain, Red, Purplish Skin, Symmetric on face and torso
  5. Formation of blisters on skin and mucous membranes of mouth, nose, eyes, genitals
  6. Shedding of skin

Types of Stevens-Johnson Syndrome

The types are categorized by the extent of the body surface area (BSA) affected:

  • Stevens-Johnson syndrome: Less than 10% BSA detached
  • Toxic epidermal necrolysis: More than 30% of the BSA detached

Treatment of Stevens-Johnson Syndrome

Finding out the cause, in particular for drug-induced cases, is critical. Discontinue the drug. Treatment is to reduce pain, control itch, prevent dehydration, infection and inflammation. Oral corticosteroids and antibiotics may be prescribed. The patient is usually hospitalized.

Similar to Pemphigus Vulgaris, mouth/blister care is required.

Care of the Skin

Care of the skin includes application of lotions and wet dressings (wound care, wet compress). Particular to Stevens-Johnson Syndrome, eye care is also important to clean and prevent dry eyes.

Complications of Stevens-Johnson Syndrome

Complications include sepsis (blood infection), secondary skin infection (cellulitis), eye inflammation (tearing and scaring of cornea and even blindness) and permanent skin discoloration and damage (including nails).

Anyone have had SJS? Do share in the comments, thanks loads for spreading encouragement and experience.

Ask #SkinishMom – Are Color Pencils ever Enough?

#SkinishMom Parenting Skin Expert

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

To #SkinishMom

Hey, this may seem like a minor, petty issue but color pencils, markers, crayons, poster colors are overflowing my kid’s play boxes and spilling to dining table tops. But I can’t stop buying them

  1. 1.    They look so darn nice.
  2. 2.    They are sometimes on sale.
  3. 3.    Every new box of coloring keeps my kid occupied longer than an old box, which is VERY GOOD as it keeps the eczema scratching off!

But it’s increasingly becoming a point of contention – are we being materialistic? Is this encouraging hoarding? Is it wasteful? Is this not teaching my kid a sense of responsibility and inculcating frivolous-ism?

What do you think? Give me an honest answer.

Anonymous Mom

Parenting Coloring Kids

Wow, it’s like you read my mind. Have you been spying my daughter’s play boxes? I’ve 3 full boxes of coloring + stamping stuff. Honestly, yes, it’s wrong. No question.

Even more honestly, if you HAVE TO BUY them, buy them. In my usual investigative style, here’s the pros and cons to buying (and keep buying) that color pencil.

1.    It makes you, as a mom who likes colors and doodling, happy.

2.    It makes your kid happy.

3.    It makes you feel like a good mom.

4.    It keeps the eczema scratching off double the time with a new set of coloring.

5.    It makes you be able to enjoy a restaurant meal with your spouse.

6.    It is useful and spikes creativity.

The cons:

1.    It is technically not a good use of money (to spend on stuff you already have loads of).

2.    It makes your kid think he/she only uses new stuff.

3.    It may make your spouse upset if both don’t see the pros.

4.    It clutters your home and creates work when you clean up.

5.    The coloring markers may dry up if not used, rendering something useful, useless.

So – 6 pros, 5 cons, go for it.

Checking out the latest cool stationery this weekend,

#SkinishMom

Eczema Support Group – 28 March Wet Wrap Workshop

Wet Wrap session with Singapore Eczema Support Group

Wet Wrap session for Singapore Eczema Support Group

Hi to Singaporean readers!

On 28 March, Saturday, the Eczema Support Group under the National Skin Centre has organized a wet wrap demonstration and presentation, in collaboration with Tubifast. The session will have

  • Presentation by Mölnlycke Health Care, the company with Tubifast wet wrap (read here to understand more on wet wrap)
  • Wet wrap demonstration – How to do a double-layer wrap, moist inner layer with a dry outer layer
  • Wet wrap sizes and techniques – It can get quite difficult to wrap parts with bends or that slip off + how to wet wrap for younger kids

study had been released on the efficacy of wet wrap, citing a 71% reduction in symptoms out of the 72 children who took part in the study. Healthy skin is maintained one month after returning home with reduced reliance on medication. So come and learn this technique to add to your ‘arsenal’ of skincare for dry, eczema skin!

28 March 2015 (Saturday) – Venue, National Skin Centre Singapore Room 401, 9.45 am to 11.15 am

The program:

1. 9.45 am to 10.00 am Breakfast and Kids have balloon sculpture and jigsaw puzzles to keep them occupied

2. 10.00 to 11.00 am Tubifast demonstration and presentation

3. 11.00 to 11.15 am Q&A time

Note:No doctor will be present but a senior dermatologist, Sister Wong who is an esteemed guest speaker for our group will be attending. No selling anything or pretending to be a parent of eczema child and the session is for parents with eczema kids. Information on my blog is not pre-approved by NSC.

4. YOU MUST RSVP – It will then be possible for us to prepare breakfast and for the Tubifast team to prepare the relevant product. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids (and age, so the right size wrap can be prepared for presentation) coming.

One last thing, the session would be ending on-time, so please don’t come late and expect it to drag, it won’t – simply cos I have to run! Look forward to seeing you! Mei

Life Threatening Skin Rash series – Pemphigus Vulgaris

Pemphigus vulgaris eczema

Pemphigus Vulgaris (PV) is a rare, auto-immune disease that mistakes skin cells and mucous membranes as foreign matters and attacks them. This results in blisters and sores of the skin and the mucous membranes. It is more common in middle-aged and older people. PV is not infectious.

What Causes Pemphigus Vulgaris?

Pemphigus vulgaris is caused by an increase in the desmoglein antibodies where these antibodies incorrectly binds to protein desmoglein 3, which is found in desmosomes in the keratinocytes near the bottom of the epidermis. It then results in a separation of the skin layer and formation of blisters. The triggers of this faulty immune systems are not fully known though genetics play a part. 

Types of Pemphigus Vulgaris

Mucosal PV: Only the mucous membranes are affected, but not the skin. This may include the mucous membranes lining the mouth, nose, throat and genitals.

Mucocutaneous PV: Both the mucous membranes and skin are affected.

Symptoms of Pemphigus Vulgaris

  • Fever, Chills
  • Muscle aches
  • Rash, first appearing in mouth and then to rest of the skin
  • Blisters
  • Raw, moist, tender skin
  • Peeling Skin 
  • Fluid loss
  • Pain

Diagnosis is usually made by a skin specialist because it is uncommon, thus not often seen by general practitioners. Physical examination and lesion biopsy (including immunofluorescence to assess level of antibodies) are used to diagnose PV. Early treatment helps to prevent PV from being widespread.

Stages of Pemphigus Vulgaris

  1. Formation of blisters and sores around the mouth
  2. Bursting of mouth blisters, similar to ulcers
  3. More widespread blisters at other parts of skin with oozing, crusting and peeling of skin.
  4. Separation of outer layer skin with gentle touch (“Nikolsky’s sign”)
  5. Recovery of raw skin (6 to 8 weeks)

Treatment of Pemphigus Vulgaris

There is no treatment that specifically cures PV but instead treatment is to reduce blistering and limit flare-up. This is often via immunosuppressant therapy. Oral corticosteroids and immunosuppressive drugs may be prescribed. In more severe cases, it can be via intravenous methylprednisolone and cyclophosphamide (Pulsed therapy) which can last from 6 months to a year. Dosages are typically higher at the start of treatment and gradually reduces when the condition is stable (without flare-up). 

For severe cases, the patient will be hospitalized in the burn unit as the skin requires similar care to burns. Apart from immunosuppressant therapy, treatment also encompasses (i) pain relief, (ii) anesthetic lozenges to reduce mouth ulcer pain, (IiI) prevention of dehydration through intravenous drip, (Iv) medication to prevent bacterial or fungal infection

Care of the Skin

Care of the skin includes application of lotions and wet dressings (wound care, wet compress). Also minimize contact sports to avoid skin trauma.

Mouth Blisters and Care

If blisters occur in the voice box (larynx), the voice will be hoarse. If the blisters occur in the gullet, swallowing is painful. Where mouth blisters make it difficult to eat, supplements may be prescribed. Steroid, antiseptic or anesthetic mouth wash may also be prescribed for the mouth blisters. Avoid foods that may irritate the inside of mouth such as spicy, acidic or hard foods.

Pemphigus Vulgaris and Eczema

PV is sometimes diagnosed late as mistaken for dyshidrotic eczema or pompholyx which also has blisters. However, dyshidrotic eczema is not life threatening and believed to be due to stress or allergies.

Complications of Pemphigus Vulgaris

It is a difficult condition to treat as it is an autoimmune disease that has no cure. The mortality rate is 10%. There can also be complications associated with long-term use of oral corticosteroids and immunosuppressants. Other complications are secondary skin infection, dehydration and sepsis (bloodstream infection).

Anyone have had PV? Do share in the comments, thanks loads for spreading encouragement and experience!

Mom NeedyZz Cartoon – Breast Milk Storage Bags Should Not be Bias

Mom NeedyZz Cartoon Breast Milk Storage Bias

I totally empathize with this one.

Don’t say there isn’t enough place to store your breast milk in front of Mommy Kate. For more cartoons on Kate and Mark, see here.

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