Eczema News – Hydrolyzed Milk Impact on Childhood Eczema

What milk to give a baby with eczema or a baby who is at high risk of eczema is ONE question that all parents ask – there are various options when it comes to milk:

(i) Breast milk – Recognized as the milk for babies up to six months of age, due to the natural protective benefits of breast milk and its ease of digestion, coupled with no artificially added sugar, salt and fats

(ii) Cow’s milk – An alternative to breast milk or supplement for breast milk; however, cow’s milk protein is the most common food allergen in young children (where the protein size is 10kD and more to act as an allergen)

(iii) Partially hydrolyzed milk – Commercially available, whereby the milk protein is broken down to protein size of less than 5kD; however, there is no strict definition of what qualifies as partially hydrolyzed formula and some partially hydrolyzed milk formula have about 20% of the peptides exceeding 6kD (kD is a measurement of its molecular weight)

(iv) Extensively hydrolyzed milk – Not commercially available in some countries, on prescription, whereby the milk protein is extensively broken down to protein size of less than 3kD.

(v) Other non cow’s milk formula, excluding goat’s milk as the goat milk protein is similar to that of cow’s milk

The Key Question is whether partially hydrolyzed milk protein is effective in preventing eczema. This is often examined alongside the questions of (i) whether it is cost effective to be put on hydrolyzed formula and (ii) inferior nutritional value of hydrolyzed formula.

Limited evidence (there's still some evidence) of protective effect of partialy hydrolyzed formula for high risk babies

Limited evidence (there’s still some evidence) of protective effect of partialy hydrolyzed formula for high risk babies

Let’s examine the research on whether partially hydrolyzed milk protein is effective in eczema prevention.

  1. I have briefly looked into this in 2011 (post) and the research then showed that partially hydrolyzed milk is recommended for high-risk babies but not if there is a proven milk allergy. For those interested in learning more about hydrolyzed formula, refer to FDA archived presentation.
  2. In 2013 (post), research’s recommendation was for high-risk infants who cannot be 100% breast-fed, partially hydrolyzed milk is recommended.
  3. Other more recent research: Allergic manifestation 15 years after early intervention with hydrolyzed formulas – the GINI Study where it is concluded that eczema is reduced in children who took partially and extensively hydrolyzed formula, with lower prevalence up to adolescents (11 to 15 year old).  The GINI Study is German Infant Nutritional Intervention program study of birth cohorts, with many other interesting allergic conditions’ studies here
  4. In a paper published in Clinical and Translational Allergy, Partially hydrolysed, prebiotic supplemented whey formula for the prevention of allergic manifestations in high risk infants: a multicentre double-blind randomised controlled trial, it was found that there was no preventive effect to early feeding with a partially hydrolyzed formula with added prebiotics.
  5. In a paper published in the Expert Review of Clinical Immunology, The Role of Partially Hydrolyzed Whey Formula for the Prevention of Allergic Disease, authors warned that due to limitations on studies on partially hydrolyzed milk, the recommendation should still be ‘breast is best’.

On the question of costs,

In a paper published in the Annals of Nutrition and Metabolism, Cost-Effectiveness of Partially Hydrolyzed Whey Protein Formula in the Primary Prevention of Atopic Dermatitis in High-Risk Urban Infants in Southeast Asia, the finding was that overall costs (even after including the cost of milk formula) of taking partially hydrolyzed formula (as opposed to cow’s milk formula) for high-risk infants would be lower than the costs of managing eczema.

On the question of nutritional value,

Dr Sears (this blog has featured several of his and his sons’ talks, tweet chat and collaborated blog series), Dr Sears’ view is that unless recommended by doctor, parents should not opt for hydrolyzed milk on their own due to

  • High content of sweeteners to make hydrolyzed formula palatable
  • Artificially carbohydrates in the form of corn syrup, sucrose, corn starch or tapioca
  • High salt content
  • Artificially added fats

It seems though that partially hydrolyzed milk formula is in practice recommended by doctors due to cow’s milk being the most common food allergen in infants. Research wise, there has yet to be a conclusion due to difficulty of conducting unbiased studies with sufficient (mother and baby) participants. What’s your experience in this? Do share in the comments!

Skin Facts – Water Loss from Children and Eczema Skin

This is the third week of ‘Skin Facts’ and last week, we’ve looked into the sun protection function of children vs adult skin, and how the sun affects eczema skin. Today, we’re looking into another critical function of skin and one that is very relevant for eczema skin – our skin’s moisture retention property. One can also view it as how much moisture is lost from our skin, known as Transepidermal Water Loss (TEWL). TEWL is studied by dermatologists, as excessive TEWL points to a defective skin barrier, and in severe cases, affect the ability of the body to function. Let’s go “water deep” into this skin function!

Water and our Body
Water makes up a large point of our body weight, here are some interesting facts about the water in our body from (the US Geological Survey website):

Water content in our Body

  • Lungs 83%
  • Muscle 79%
  • Kidneys 79%
  • Brain 73%
  • Heart 73%
  • Liver 71%
  • Skin 64%
  • Bones 31%

Percentage of Body Weight that is Water

  • Fetus 94%
  • Infant at birth 78%
  • One-year old 65%
  • Female 55% (due to higher fat content)
  • Male 60%
  • Elderly 50%

Functions of Water in our Body

  • Forms the building material of cell
  • Regulates body temperature by sweating and respiration
  • Transport via the bloodstream
  • Flushes waste via urination
  • Absorbs shock for brain and spinal cord, also lubricates joints
  • Forms saliva
Moisture Loss and Retention from Children, Normal and Eczema Skin

Moisture Loss and Retention from Children, Normal and Eczema Skin

Water Loss from our Skin
Our skin allows water to be lost through it, as part of insensible perspiration (or transepidermal diffusion) and sweating. Insensible refers to us not being aware of it (another insensible loss of water is from respiration). Sweating helps regulate our body temperature, via cooling of the skin. However, sufficient intake of water is required in order for sweating to not dehydrate the body and continue to be effective in cooling our body temperature.

Much of the water is lost through the stratum corneum, the upper most layer of the epidermis made up of a dead cell layer. A defective stratum corneum layer will allow excessive epidermal water loss and potentially, increase risk of irritant and allergen sensitivity. Water loss from evaporation from our skin is about 400ml daily in an adult. For research news on how the skin can be a channel for allergy, see Food Sensitization from Eczema.

Transepidermal Water Loss (TEWL) from Children Skin
TEWL from baby skin is higher than normal adult skin, due to their thinner stratum corneum. For premature infants less than 30 weeks, there are also fewer layers of stratum corneum resulting in increase fluid and heat loss. Interestingly, infant skin is found to have higher water content and able to absorb more water but lose excess water faster than adult skin. TEWL was also strongly predictive of AD at 12 months (study here). The natural moisturizing factor (protein breakdown products such as small amino acids, urea, pyrrolidone carboxylic acid, ornithine, citrulline, urocanic acid) in infant is also lower than an adult.

How this Impact Parents Caring for Baby Skin
Protection of the stratum corneum is important, and this can be via:

Reduced bathing – Washing baby skin with a washcloth during the first 4 weeks of life is associated with increased TEWL and decreased stratum corneum hydration compared with simply soaking in water. The recommendation is to use a mild liquid cleanser with water (less drying than water alone), and that bathing should be brief (10 minutes or less) and no more than every other day with spot cleaning in between.

Good bathing regimen – Includes not using hot water, not scrubbing the skin dry (but pat dry), keeping it short to 10 minutes, not using soap and moisturizing right after (see video)

Good skincare regimen – Moisturizing protects the skin barrier (see video). It is important to note that given the thinner stratum corneum of infants, their higher surface area to body ratio, infants are more vulnerable to toxicity of products. Therefore, be sure you understand the product label (there’s a comprehensive Sensitive Skin Products blog series to help you with that).

Transepidermal Water Loss (TEWL) from Eczema Skin

TEWL is studied to be higher in eczema skin and also dry skin (without eczema). The water content of stratum corneum is also lower in adults with eczema than normal skin. It is also studied at the natural moisturizing factor of eczema skin is defective, lacking in proteins that are able to play a role in the skin’s humectant property – the ability to pull moisture from the environment and retain this water (which is why 2nd generation moisturizers incorporated humectant property, learn more here).

Drinking Water and Skin
A myth. Dehydration will affect skin but drinking excess water will not lead to ‘glowing’ skin. Drinking enough water will also not prevent skin aging or wrinkles as these are related to genetics, sun and oxidative stress brought on by pollutants. Read this #SkinishMom Investigation! – Drinking water for dry skin

To round-up, we learnt that water is integral to our body and to our skin. We have insensible water loss and a thinner stratum corneum in baby skin and a defective stratum corneum in eczema skin both results in increased transepidermal water loss (TEWL). This knowledge should encourage (not discourage!) us to be more committed to a good bath and skincare routine.

What’s your take in this?


Eczema News – Do Elimination Diets Work?

Elimination diets are often tried out at home to see if the child’s eczema improved after eliminating certain foods. The common food allergens for young children are eggs, cow’s milk, soy and wheat and in certain cases, parents may

  • (Scenario 1) eliminate such foods when tested positive in allergy tests, or
  • (Scenario 2) eliminate such foods even when allergy tests didn’t return positive (for many reasons such as suspecting it’s food intolerance which doesn’t show in allergy test or not trusting that the tests are accurate), or
  • (Scenario 3) eliminate such foods without testing for allergies, either because doctors didn’t recommend allergy testing or such facility is not easily available where the family lives.

The question then is whether Scenario 2 and 3 are valid for parents trying out elimination diets for their child. A paper published in July 2015, in the College of Family Physicians of Canada sought to study the papers that have been published on elimination diets, specifically with regard to eliminating eggs and cow’s milk.

Insufficient evidence to support elimination diets

Insufficient evidence to support elimination diets

Result of study: There is insufficient evidence about the benefit of eliminating cow’s milk in unselected patients with atopic dermatitis (AD). Some evidence suggests that egg elimination might benefit those children with AD who are suspected of being allergic to eggs and who are sensitized to eggs.

MarcieMom’s digest on the paper:

#1 Go for allergy testing

I’m a supporter of allergy testing, simply because given that tests are fairly accurate and you can always take a few tests at different development stages of the child to corroborate what he is allergic (or not allergic to), I feel that taking allergy test beats the worry that comes with second-guessing.

#2 Outside-in versus Inside-out

It has been covered in this blog before on the possibility (and doctors are accepting that possibility with more research) that food sensitization can come from outside-in: meaning it is the defective skin barrier that allows food allergens in the air (on the skin) to result in the body being sensitized to the food allergen. It reinforces the importance of protecting the child’s skin barrier with good skincare routine, even from birth for infants at high risk.

#3 Observations can be misleading

Elimination diets rely on observing if there’s any change in the skin/ increase in rashes after consumption of food. However, this can be misleading because (i) allergic reactions may not show up immediately and (ii) prevailing allergens such as to house dust mite can ‘confuse’ the observations because it triggers eczema flares from time to time.

#4 Lesser case for elimination diet

It is mentioned in the paper that40% to 90% of infants with moderate to severe AD are food sensitized based on positive results of skin-prick tests to 1 or more food allergens” but “only 35% to 40% of food-sensitized children with AD have clinical signs and symptoms of food allergy according to multiple double-blind, placebo-controlled food challenge studies“. This means that it is more likely that a child will be tested positive to a food that he can actually consume and not trigger a food allergic reaction. As such, it seems to not justify eliminating a food when it is not even tested positive in the first place.

#5 Studies where elimination diets improve eczema

There were two studies mentioned in the paper that reported an improvement in eczema after elimination diet, (i) was eliminating eggs for infants who are sensitized to eggs, and (i) was using hydrolyzed milk.

#6 Elimination diet risks

The risks of elimination diets are

  1. Nutritional deficiency – the paper mentioned that calcium, vitamin D and E were deficient.
  2. Turning intolerance due to elimination – the paper mentioned that early low-dose cutaneous exposure to food allergens leads to allergic sensitization, whereas early oral consumption of food proteins induces immune tolerance. This means that taking a food, suspecting it is an allergen for the child and eliminating it, make it more likely to have a food allergy as opposed to not eliminating that food.

The above is why the medical community generally only recommend elimination diets when tested positive, and after reviewing various test results and understanding the roles that other allergens play. When evaluating all the double-blind placebo-controlled food challenges, only about 6% of the children with eczema had a reaction to the suspected food allergen. It is therefore, more likely than not, that the eczema rash is not due to the suspected food.

What’s your experience in elimination diet? Has it improved your child’s eczema? Do share in the comments especially when many parents are interested in how other eczema families cope with diet.

Learning Wet Wrap for Eczema Kids

Reminder of next Saturday’s hands-on wet wrap session for those with eczema kids in Singapore. Wet wrap is an accepted form of eczema therapeutics in children, that is worth learning as it has been studied to improve eczema. This Saturday’s eczema support group session at the National Skin Centre, Singapore 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; dry wrap will also be explained
  • Wet wrap sizes and techniques – It can get quite difficult to wrap parts with bends or that slip off + what sizes are suitable for younger kids

Do RSVP for the session, details below:

Wet wrap - a proven therapy for eczema kids

Wet wrap – a proven therapy for eczema kids

28 November 2015 (Saturday) – Venue, National Skin Centre Singapore,

Level 4, Staff Lounge, 10 am to 11.30 am

The program:

1. 10.00 to 10.30 am Tubifast demonstration and presentation

2. 10.30 to 11.00 am Trying out wet wrap

3. 11.00 to 11.30 am Q&A and refreshments

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 starting on-time and information on my blog is not pre-approved by NSC.

Look forward to your RSVP and meeting you!

Skin Facts – Sun Protection in Adult, Infant and Eczema Skin

We have started learning skin facts last week, specifically on the skin (surprise) isn’t the largest organ and that well, we don’t really know what’s in our dust. This week, we’re taking up a notch on going ‘intensive’ into the difference in the sun protection function of adult, child and eczema skin.

Normal Adult Skin

Sun Protective Function of our Skin

Sun Protective Function of our Skin and how it differs for Baby Skin and Eczema Skin

Adult skin has a fully developed sun protection function, in the form of pigment melanin which gives the skin its color. Therefore, the darker one’s complexion, the higher the sun protection. Melanocytes are the melanin-producing skin cells and it is the activity of the melanocytes, i.e. the amount of melanin produced, and not the number of melanocytes that determine the skin color.

When one is exposed to sun, more melanin is produced to help protect the skin against UV rays, thus giving a ‘tan’. Melanin can reduce the oxidative damage caused by UV rays but isn’t able to fully protect from the damaging effects of UV rays (see this news on potential harm of ‘sun-activated’ melanin to our skin).

Children Skin

An infant’s skin has not fully developed in many ways that make a baby more vulnerable to the damaging effects of UV rays – it has less pigment/ melanin, thinner skin/ stratum corneum and a higher surface area to body ratio.

Studies have also pointed to infants with exposure to UV rays will show skin pigmentation on exposed skin from as young as one year old (first summer). This was true even for infants who used sun protection when outdoors but not when in the car, in the shade or on a cloudy day. There are also studies showing that exposure to UV during childhood and adolescence can lead to skin cancer later in life.

Eczema Skin

There is no study that points to differences in melanocytes/ melanin due to eczema. However, the sun is known to both improve and aggravate eczema, for instance:

  • Some eczema sufferers report improved eczema during holiday when outdoors more often (no study confirmed why holiday seems to improve eczema).
  • Phototherapy is used as an eczema therapy for adults.
  • Active eczema flare-up should stay away from the sun as it can worsen eczema, and increase vulnerability to sun burn.
  • Certain skincare products increase sensitivity to sun, such as those containing ingredients alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), salicyclic acid, glycolic acids, Retin-A and hydrocortisone. Moisturized skin may get sun burn more easily, thus put on moisturizer and wait for 30 minutes before applying sunscreen.

Sun – We need it, but not too much of it.

Our skin play an important role in the synthesis of vitamin D, where vitamin D can increase the production of skin proteins (cathelicidin) and antimicrobial peptide (AMP) which protects against skin infection. However, just 15 minutes a day is enough and it’s referring to getting sun on the face and arms (i.e. no need to be in a bathing suit!). During summer, 2-3 direct sun exposures of 20 minutes per week is sufficient. Short frequent sun exposure is better than long exposure.

Rays from the Sun

There are 3 different rays from the sun:

  1. UVA – 320 to 400 nm : passed through the atmosphere
  2. UVB – 290 to 320 nm : passed through the atmosphere
  3. UVC – 100 to 290 nm : most dangerous, but filtered and do not pass through the atmosphere

UVA – UVA activates melanin already present in the upper skin cells but the tan is lost quickly. Penetrates deeper into the skin, damages the dermis (middle skin layer), accelerates aging, causes wrinkles, increases oxidation and suppresses cutaneous immune function.

UVB – UVB stimulates the production of new melanin, and a longer lasting tan. Also stimulates a thicker epidermis. Absorbs by the epidermis (top skin layer).

It’s not just the sun, it’s also the ozone.

We all know that the ozone layer is thinning and the thinner ozone has allowed more UVB rays to come through the atmosphere.

Sun protection

Sun protection has been covered in various interviews with dermatologists on this blog but the point to emphasize is that for babies, it is very important to avoid the sun and practice sun protection because:

  1. Thinner skin
  2. Less melanin-producing skin cells
  3. Larger surface area to body ratio
  4. Increased absorption of chemicals and vulnerability to irritants in sunscreen products make sun avoidance a wiser choice

Lips and eyes are also affected by UV rays, thus wearing a wide-brimmed hat and sunglasses are also part of sun protection.

More in interviews with dermatologists:


It is recommended to use physical blockers/ inorganic filters such as zinc oxide (more UVA protection) and titanium dioxide (more UVB protection). As opposed to chemical absorbers, physical blockers do not penetrate more than two layers of stratum corneum and therefore less likely to induce skin irritation and sensitization. Moreover, infants tend to rub their eyes and may inadvertently rub the sunscreen into their eyes and won’t be able to ‘get rid’ of it as (i) their tear secretions and (ii) their blinking mechanism are not fully developed.

A note on SPF

SPF is the measure of ratio of UV rays before sunburn and SPF 30 means that the skin is able to take 30 times higher dose of UV rays before sunburn. The amount of sunscreen to apply is 2mg/cm2. Broad spectrum refers to additional UVA absorbers (avobenzone and octocrylene) being added to the physical blockers.


Eczema News – Childhood Eczema linked to Headaches

In a paper published August 2015 Journal of Allergy and Clinical Immunology, Dr Jonathan Silverberg studied an association between eczema and headaches. The cause of headaches could have come from (i) sleep disturbances or (ii) fatigue that eczema children suffer from.

Method of study: Analysis of data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children’s Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997-2013.

Childhood Eczema and Headaches

Childhood Eczema and Headaches

Results: From the analysis, eczema was associated with headaches in 14 of 19 studies. It was found that eczema children had a higher prevalence and likelihood of headaches. In particular, children with eczema that was associated with atopy, fatigue, excessive daytime sleepiness, insomnia, and only 0 to 3 nights of sufficient sleep had even higher odds of headache than eczema alone.

MarcieMom’s take – I couldn’t find other studies on Pubmed that examine this association but it wouldn’t come as a surprise that there is one; after all, how many of us adults don’t have a headache if we’re chronically deprived of sleep? A few other thoughts on sleep and headaches:

#1 Don’t mistake the headache for other illness

In adults, we may reach for the painkiller but this probably isn’t suitable for a child and can’t be taken long-term. Possibly explore antihistamines to see if it help with a better night sleep and of course, treating the eczema to reduce the itch.

#2 Sleep better

Easier said than done – it is still something that our family struggles with, though to a much lesser extent than when the eczema was severe. A few posts that may give you ideas on how to improve sleep at night:

I’ve recently found that dry wrap (as opposed to wet wrap which I have not tried) seemed to reduce the scratching at night. Singapore is pretty humid so instead of wet wrap, sometimes I put a layer of moisturizer (again) before sleep time, and put over a wrap bandage. Marcie’s skin usually appear better the next day and there’s less scratching on the wrapped spot at night. More on wet wrap in link.

Facts about Our Skin (vs Children vs Eczema Skin)

For these 8 weeks, we’re going ‘intensive’ into skin facts. Many articles have shared about adult skin facts, but in #SkinishMom style, we’re ‘digging’ deeper into children’s skin and eczema skin. (Note: all skin facts have published data for children and eczema skin)

Skin facts - Adult, Children and Eczema Skin

Some ‘Skin Investigation’ may turn up with unexpected facts!

Skin Fact #1 Skin is (NOT!) the largest organ in the body

Oops, doesn’t everyone say that skin is the largest organ? That’s why some ‘skin’ investigation is required for ‘skin journalism’. Located a letter to editor in the Journal of Investigative Dermatology that skin is not the largest organ in the body. The skin can be considered the largest BY WEIGHT for ‘medium-sized’ organs, excluding musculoskeletal system.

  • Skin (epidermis and dermis) weights 3.86kg, about 5.5% of a 70kg man
  • Subcutaneous tissue (layer of fats under the dermis layer) is not consider skin
  • Skin is not the largest organ by surface area, about 1.7 sqm but lung airway is 70sqm, and gastrointestinal tract is about 30-40sqm (note in the letter to editor, it’s stated as about football field, but in a paper that subsequently published in 2014 Scandinavian Journal of Gastroenterology, scientists measured the inner surface of gastrointestinal tract of a healthy average man; previous estimates of the gastrointestinal tract were made post-mortem where the tract has relaxed to a much longer length! ‘Interesting!’)

Skin Fact #2 Adult skin sheds about 17kg to 52kg over a lifetime

From research and as explained by Dr Claudia Aguirre on Quora (Dr Claudia is a featured guest of this blog), humans shed their entire outer layer of skin every 2-4 weeks at the rate of 0.001 — 0.003 ounces of skin flakes every hour. This worked out mathematically to be 17kg to 52kg (or 37 to 115 pounds) for someone who live up to over 70 years old (I’d suppose that the 0.001 to 0.003 ounces is for an average adult, thus strictly speaking, you can’t simply multiply by 70 due to (possibly?) less skin shed for a child (by weight, but given larger surface area to volume ratio, a child may shed ‘more’ skin).

Eczema skin – Eczema skin, characterized by dry skin, shed more skin (and add the scratching!). The outer skin layer (epidermis) has four layers of keratinocytes (skin cells). The keratinocytes at the basal layer continually grow and move upwards to the stratum corneum, changing from plump cells to dead, flattened cells that are shed. This takes about 28 days. I couldn’t find research on how much skin an eczema sufferer shed, but there’re two ‘opposite’ skin conditions worth mentioning:

Exfoliative Dermatitis – characterized by extensive red skin, followed by skin shedding (similar to life-threatening conditions covered in this blog: Stevens Johnson Syndrome and Erythroderma); the skin shedding is so extensive in these conditions that it affect the normal functioning of the body, in particular temperature regulation and moisture retention, requiring care in hospital.

Psoriasis – this condition is marked by only taking 3 to 4 days to mature and does not shed but the skin cells pile up on the skin surface, forming plaques and lesions.

Many eczema sufferers reported seeing massive skin shed on the bed and floor but I wonder why the skin cells shed appear so visible (as opposed to normal skin). Found an explanation that the cells on dry skin may stick together, thickening the stratum corneum and when they are shed, it is shed as visible sheets, aka scales.

Skin Fact #3 Dead skin cells comprised an UNKNOWN part of our dust at home

This is another ‘fact’ that could turn out to be a myth – most of the sites state that our dead skin made up anywhere from 50% to 90% of our dust at home. In a study by Layton and Beamer whose study was to find out how much of contaminated soil and outdoor pollutants would get into home dust, it was estimated that about 60% would come from outdoors. Dust is very complicated, with different home, season, surrounding and the type of dust in the air and on the floor being different. It cannot be simplified to state as most of the dust are dead skin cells.

What we have to know is dead skin cells are food for house dust mites and they literally sleep with us, in our bedsheet, pillow, pillow case and mattress. Read the following posts to understand more about dust mites:

There’s sooo much more skin facts to cover, I think we’re good for discovering these till end of the year!


  1. Journal of Investigative Dermatology September 2013 ‘Letter to Editor’
  2. Scandinavian Journal of Gastroenterology June 2014 Surface area of the digestive tract – revisited.
  3. Clinical Pharmacist September 2010 Atopic eczema: Clinical features and diagnosis
  4. Healthline: Exfoliative dermatitis
  5. Dermal Institute: the Biology behind Eczema and Psoriasis
  6. PDR Health: Dry skin
  7. Environmental Science and Technology November 2009: Migration of Contaminated Soil and Airborne Particulates to Indoor Dust
  8. Time February 2010 What’s in Household Dust? Don’t Ask
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