Mom E-votional : Daily Skincare

Daily Skincare for Eczema ChildrenThis graphic similar to airline arrival and departure time reminds me of how parents of eczema kids run by the clock. Apart from thinking of a day as morning, afternoon and night, sometimes I think of the day as moisturizing, shower and freshening up since my child seems to scratch more when hot and sweaty.

Do you feel like you are like a mouse, running up and down the clock (Hickory Dickory Dock!)? Don’t forget to add in some ‘transit’ stops during the day – Jesus reminded his disciples to rest too!

Bible verse:

Mark 6: 31 And He said to them, “Come aside by yourselves to a deserted place and rest a while.”

God, sometimes we feel that life becomes running round the clock. Teach us how to rest while time never stops.

Daily Skincare does not mean no Self (Parent) Care

Skin pH with Cheryl Lee Eberting, M.D.– Diet, Environment on Skin

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

This is the 3rd post of Skin pH series: Read the 1st post on Understanding Skin pH and its Impact here and 2nd post on Overly Acidic and Alkaline Skin here.

We are privileged to have Board Certified Dermatologist Cheryl Lee Eberting, M.D. again for this 5-week skin pH series. Read more on Dr Cheryl Lee here. Dr. Eberting invented the TrueLipids skin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.  Dr. Eberting’s expertise in treating eczema  has led people to come from all over the world to seek her care and to the development of a dedicated eczema care clinic online.

MarcieMom: Thank you Dr Cheryl Lee for helping us understand skin pH – what happens in an ideal skin pH 4.6 to 5.6 environment and what goes wrong when it’s too alkaline or acidic. Today we put these knowledge to use on how we can have the right diet and environment for our skin pH!

Diet and Skin pH

There’s quite a lot of websites proposing that we eat more alkaline foods such as fruits and vegetables of pH 8 to 10 and less acidic foods of pH 3-4 such as soda and sugar drinks.

MarcieMom: How does what we eat affect our skin’s pH? Do you in your practice recommend diet for eczema kids based on food pH level, or should it be based on anti-inflammatory properties, or whether it had been studied to improve eczema (e.g. omega 3)?

Diet Environment on Skin pH

Dr Cheryl Lee: I don’t recommend diets based on the pH of foods, but rather, I recommend diets that are as close to the way they come out of the ground as possible and I certainly do recommend against the ingestion of any processed foods, drinks and candies.  The body has robust pH buffering capacities that can help to keep the body at an optimal pH.  More important are the effects of oxidation in our diets.  I like to explain it this way; our bodies come with a certain amount of “anti-oxidant juice”.  When we eat processed foods, animal proteins and sugars, our anti-oxidant capacious are called upon and utilized.  When we eat too much of these foods, we exceed the body’s ability to replace the anti-oxidant juice and then the body becomes damaged by the free-radicals and excess sugars that are generated when we over eat or when we eat unhealthy foods.

I think the most important dietary approach we should all take is to limit the ingestion of animal proteins as much as possible.  Animal proteins have been demonstrated to increase rates of carbamylation.  Carbamylation is a metabolic phenomena that happens when we ingest animal proteins. The breakdown products of animal proteins as well urea (this is why I also advise against the use of urea on the skin) in a pro-inflammatory environment that promotes high blood pressure, autoimmune disease, diabetes, heart disease, cancer and more.  Interestingly, a recent study even showed that in people who have an infection of the gut with the H. pylori bacteria are unable to adequately detoxify the heterocyclic amines that are generated when meat is cooked.  The H. pylori infection make the gut unable to detoxify these chemicals and these chemicals lead to gastric cancer.

Excess sugar also leads to something called glycation.  Glycation is what happens with excess glucose and glucose metabolic products permanently bind to fat, proteins and even nucleic acids (in our DNA).  The combination of the excess glucose and the proteins and fats are called advanced glycation endproducs (AGEs) and they are what ‘gunk up the system’ and lead to many pro-inflammatory pathways.

I think it is very important to eat lots of fruits, nuts and vegetables and to limit the intake of sugar and animal protein. Vitamins B1, B3, B6, B12, C and others can be helpful in promoting better food metabolism and in limiting the effects of poor diet.

Environment and Skin pH

Smoking, pollution, water and sun also affects the skin pH.

MarcieMom: Dr Cheryl, can you share with us the main environmental contributors and whether it makes our kids’ skin more alkaline or more acidic? What if there are certain factors that can’t be limited, for instance, the water available.

Dr Cheryl: Lets start with water.  The pH of your particular water supply can be quite variable and can be very alkaline.  I think this might be part of the problem in atopic dermatitis and may be part of the puzzle that is missing.  We (dermatologists) are having our patients take dilute bleach baths that are adding (though ever so slightly) to the alkalinity of the water and the skin.  We do know that the benefits of bleach baths are irrefutable and substantial though.  I have started advising the use of a vinegar-based gel to my patients after their baths.  They apply this gel to all areas that are affected by eczema and then apply their moisturizers or other topical medications right on top.This seems to be very helpful. This pH gel is something that I have filed a patent for and will be on the market next spring.

Another option is to use a vinegar spray.  For this I advise that you mix one part white vinegar (not rice vinegar, not balsamic vinegar) from grain (make sure it is not from wheat if you are allergic to wheat) or apple cider vinegar (preferred) with six parts of water and put it in a spray bottle and spray it on the areas of eczema.  Follow this with your regular moisturizers or medication.  I have also had some of my patients use vinegar baths rather than bleach baths and they too have benefited greatly.

I also want to mention the effects of air quality on eczema and our overall health.  Studies have shown that INDOOR air pollution can have a major detrimental effect on our health and leads to increased rates of asthma and related conditions and to the overall burden of disease.  Chemicals like polyaromatic hydrocarbons (from paints, glues, solvents, cleansers) can increase the rates of many health problems.

I always am sure to use VOC free paint in my home.  If I paint my furniture, I will leave it outside or in the garage for several weeks before I bring it inside.  If you can smell it, then you shouldn’t have it in your house.  When I redid the carpet in my home, I researched every little facet of carpet chemistry and found that an all-wool carpet is probably the safest carpet to have for this same reason.  The newer ‘no-stain’ carpets are bathed in a chemicals that is then baked on to make the carpets resistant to staining.  These chemicals have been shown to be very detrimental to our health as well.

A few more things I do in my home to help the air quality is to be sure to vent the air when I cook (smoke from cooked food is particularly pro-inflammatory and carcinogenic).  I avoid the use of cleaning chemicals in my house too.  I usually will use plain old fragrance-free soap and water, or vinegar, or a little bleach (when someone has the stomach flu) and that is it.  I intentionally avoid the use of antibacterial soaps and household cleaners as they are unnecessary, toxic and actually induce bacterial resistance in our homes and our bodies.

In addition to indoor air pollution, outdoor particulate air pollution is even pro-inflammatory and has been documented to contribute to 22% of the global burden of disease that can be attributable to one’s environmental factors.  A study just came out recently that even correlated exposure to polyaromatic hydrocarbons in air pollution to the rates of Attention Deficit & Hyperactivity Disorder (ADHD).  Numerous studies have also correlated ADHD to eczema and I believe there has got to be an environmental correlation to the increased rates of eczema too.  For years we dermatologists have been schooled on “the hygiene hypothesis” of eczema due to lower rates of eczema detected in children who grew up in rural areas as compared to those who grew up in urban settings.  The thought has been that a rural lifestyle exposes one to more bacterial and parasitic antigens earlier in life and that this was to be somewhat protective.  I believe the hygiene hypothesis is actually the complete opposite and that is should be called something more like the “lack of environmental hygiene hypothesis” as the effects of pollution in our food, air, and water is clearly and irrefutably a contributing factor to countless health problems and most likely to eczema as well.  This concept is very well established from a scientific standpoint, but is lacking in public education.  It is my hope that people with come to understand the role of toxins in their environment and that they may take actions to limit them.

Thank you Dr Cheryl for sharing with us what you practice in your home too! Next week we will continue with understanding what products we can use to get our child’s pH right!

Mom E-votional : F-words

Depression Eczema EmotionsIt’s coming to the end of the year – some years I end the year being pleased with my life progress, some years I end it being depressed. If your child’s eczema is severe and you have tried everything you can, but nothing works, every attempt yields no improvement and soon, trying something new leads to fear of shattered hope.

Life can be difficult.

In developed countries, we mostly live without the fear of war at our doorstep, without the fear of not having food on the table the next day, without the fear of persecution for our faith. Yet, we sometimes live in another kind of fear. Have I wasted my life if I’m not successful? Have I lost the talent that I had not discovered (the number of reality shows sometimes get to us rather than inspire us!)? Am I grooming my child for failure in my parenting? It’s ok to be a failure today but have I turned into a loser?

I comfort myself with this bible verse, Deuteronomy 31:6

Be strong and courageous. Do not be afraid or terrified because of them, for the LORD your God goes with you; he will never leave you nor forsake you.

God, give us parents strength – strength in our hearts and mind to keep on parenting, keep on doing what we do, wisdom to do the right things in our life and for our child and the love to carry it out with joy.

Banish the F-Words, have no Fear

Skin pH with Cheryl Lee Eberting, M.D.– Over Acidic or Over Alkaline

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

This is the 2nd post of Skin pH series: Read the 1st post on Understanding Skin pH and its Impact here.

We are privileged to have Board Certified Dermatologist Cheryl Lee Eberting, M.D. again for this 5-week skin pH series. Read more on Dr Cheryl Lee here. Dr. Eberting invented the TrueLipids skin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.  Dr. Eberting’s expertise in treating eczema  has led people to come from all over the world to seek her care and to the development of a dedicated eczema care clinic online.

MarcieMom: Thank you Dr Cheryl Lee for helping us understand skin pH – we learnt last week from you that skin pH impacts lipid-producing enzymes and skin bacteria. Today, we aim to understand what would happen in an overly acidic or alkaline skin!

MarcieMom: I read that the acid mantle is beneficial to skin due to (i) reduction of moisture evaporation from stratum corneum (upper skin layer) and (ii) discourage bacteria and fungi growth. Conversely, a more alkaline skin pH is prone to dryness and encourages growth of pathogens (from M.symphodialis) that promote skin inflammation. Moreover, skin pH affects Sphingosine production (a skin lipid) that in turn, also impacts skin flora.

This is all quite confusing!

Can you explain if our skin can be over-acidic or over-alkaline? And if yes, how does it impact our skin structure?

When Skin is over Acidic or Alkaline

Dr Cheryl Lee: Our skin can be overly acidic, or it can be in the optimal range of 4.6 to 5.6, or it can be overly alkaline.  When there is any sort of epidermal disruption such as seen in eczema, a rash, an infection, inflammation, or when the skin comes in contact with soap, bleach or even tap water, then the pH of the skin becomes overly alkaline. This is when pH of the skin exceeds the optimal lipid-producing range of 4.6 to 5.6 and the ceramide-producing enzymes slow down or stop producing ceramides.  With decreased skin lipid production, the skin loses water more rapidly and becomes dried out and more itchy….then we start to scratch and bacteria are introduced which then leads to an elevated pH and inflammation.  This leads to an ever more elevated pH and more inflammation and the rash that we call atopic dermatitis.  Again, you can start to understand that the Itch Scratch cycle is more than just itching and scratching.

Ceramides are only one of the lipid species in the epidermis, but are very important in preserving the antimicrobial functions of the skin as well as preventing loss of water from the skin.  Fatty acids are also an important group of lipids that are involved in contributing to the natural acidity of the skin barrier and to the skin’s ability to discourage growth of unfriendly bacteria.

Studies have shown that “hyper acidification” of the skin barrier (down to 3.5ish) with polyhydroxy acids (gluconolactone and lactobionic acids) may actually be beneficial and may hasten skin barrier optimization.   Interestingly, another acid, 18-B glycyrrhetinic acid, can also help to optimize the skin pH, and importantly, it has also been shown to be effective at controlling Malassezia species from overgrowing on the skin. These three acids are the acids that I prefer to use on the skin for these reasons. We do know that hyper acidification with other acids such as citric and lactic acids can be more irritating to the skin barrier due to their propensity to turn into a salt once applied to the skin. If the skin barrier is really excessively acidic (i.e. a pH less than 3.5), it can be physically destructive to skin tissue (a chemical peel) and will break it down. I think it is best to stay as close to 4.6 and 5.6 range, however, it may also be beneficial to be slightly more acidic than this.

Effects of OFF-Balanced pH Skin

MarcieMom: I see on beauty sites quite a few skin conditions being attributed to over-acidic or over-alkaline skin. For instance, alkaline skin is associated with:

  • Dryness—not enough lipids are being produced.
  • Increased sensitivity
  • More prone to sun damage
  • Eczema
  • Acne
  • Wrinkles (sagging skin from deterioration of collagen cells)

Acidic skin is associated with:

  • Skin redness
  • Skin inflammation
  • Painful to touch
  • Pimples

Is the above correct? Moreover, we know that skin conditions are often multi-factorial, so is it over-simplistic to attribute the skin’s pH to a skin condition?  

Dr Cheryl: Overly alkaline skin is indeed associated with dryness, increased sensitivity, being more prone to sun damage, eczema and acne.  Overly acidic skin doesn’t usually happen unless an acid is applied to the skin to change the pH as is the case when we do a chemical peel on the face and indeed, a chemical peel will make your skin more sensitive to the touch, more red, inflamed and painful, but these symptoms are usually short-lived and will resolve once the skin has repaired itself from the chemical peel.

Interestingly, we do know that ceramide production is pH-dependent and we do know that ceramides are involved in controlling matrix metalloproteinase (MMP) production.  The MMPs in the skin are involved in regulating and controlling inflammatory responses after sun exposure and can lead to the breakdown of collagen and elastin.  For this reason, ceramides are important after sun exposure, and the pH is important for ceramide production.  Also very important is the role of the pH in eczema prone skin where there is a disrupted skin barrier which results in a rash, and there is infection/colonization from Staph. aureus.

Thank you Dr Cheryl for being ever so patient in enlightening us about the skin pH. Next week, we will focus more on our diet and skin pH, something practical that parents can work on for their eczema kids. All dads and moms, check back next Wednesday!

Mom E-votional : (All out of) Eczema Love

Love for Child with Eczema

Does a Mom’s (and Dad’s) Love ever run out?

As I think about this, I’ve got Air Supply’s song ‘All out of love’ stuck in my head! I wonder though, does love ever run out? Can we love till we stopped loving? or even start hating? What is love?

I’m the first to confess that I’m bad at it. Unconditional love? I think of many times when I supposedly do an act of love but expect something (appreciation, more love?). I think of even more times when an act of love easily turns into an occasion for resentment. Does having a child with eczema or another health condition requires the parents to have more love? Sometimes love is as elusive as a bubble – it’s tangible yet the second you hold on to it, it burst. Anyone with me?

One person who is definitely not with me is Jesus. He knows how to love. His love for us led him to the cross. He sees our heart (all that terrible thoughts sometimes!) and yet still chooses to die for us. (Even when I may run away from myself!)

Bible verse:

1 John 3:16-18 : This is how we know what love is: Jesus Christ laid down his life for us. And we ought to lay down our lives for our brothers and sisters. If anyone has material possessions and sees a brother or sister in need but has no pity on them, how can the love of God be in that person? Dear children, let us not love with words or speech but with actions and in truth.

Help me to love! Love my spouse, my child, my parents, my friends, my neighbour, myself and my God.. love is so difficult, enlighten me in this journey to love!

Love never runs out.

Skin pH with Cheryl Lee Eberting, M.D.– Skin pH and Eczema Impact

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Parents are always looking at getting the right product for their children with eczema – many of these are marketed as pH-balanced and it can be confusing whether alkaline, acidic or neutral is good.

We are privileged to have Cheryl Lee Eberting, M.D. to help answer our questions in this 5-week skin pH series. Cheryl Lee Eberting, M.D. is a Board Certified Dermatologist and a past clinical research fellow of the National Institutes of Health. She is a member of the American Contact Dermatitis Society and and has a deep interest in chemical allergies, toxicities, and the role of the skin barrier in atopic dermatitis. She has recently published regarding skin barrier repair in atopic dermatitis, irritant and allergic contact dermatitis.  Dr. Eberting invented the TrueLipids skin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.  Dr. Eberting’s expertise in treating eczema  has led people to come from all over the world to seek her care and to the development of a dedicated eczema care clinic online.

MarcieMom: Thank you Dr Cheryl Lee for joining us today. Skin pH is an intriguing subject with many angles to explore so let’s jump right in!

What is Skin pH?

pH stands for the potential of hydrogen, which is a measurement of the hydrogen ion concentration. pH scale ranges from 1 (most acidic) to 14 (most alkaline) with 7 representing neutral. The skin pH comes from the ‘acid mantle’, which is an emulsion of secretions from sebaceous (oil) and sweat glands and decomposed corneocytes (upper skin layer cells).

MarcieMom: Dr Cheryl Lee, this acid mantle on the surface of the skin is what gives the skin its pH level. However, the optimal pH of the skin barrier seems to change with more studies being conducted. I understand that the ideal pH of the skin barrier is thought to be 5.5, but it is now accepted as being more acidic from 4.5 to 5.0.

Skin pH eczema

Is there a recognized ideal/natural state skin pH agreed by dermatologist worldwide?  

Dr Cheryl Lee: You are right about the great variation in the ideal skin pH in the medical literature.  When you read the skin pH literature, there seems to be a range of between 4.6 to 5.6 depending on the study and where on the body the pH was tested. Dermatologists do agree that the skin should have an acidic pH somewhere in this range.  When our skin comes in contact with alkaline substances such as soap or even tap water, the optimal pH is exceeded.  Tap water has been shown to alkalinize the pH of the skin for six hours. This means that the natural buffering systems in the skin barrier take up to six hours to buffer the skin barrier back into the optimal acidic range when the skin comes in contact with tap water. Soap and bleach are even more alkaline than tap water and obviously have an even more dramatic effect on alkalinizing the skin barrier.

Why is More Acidic Skin pH the ‘Ideal’?

Dr Cheryl Lee: The epidermis is composed of the epidermal lipid barrier which contains many lipids (fats) that serve to keep the skin water proof, infection-proof, chemical and allergen proof and much more.  These epidermal lipids are composed of four main classes including Ceramides (47%), cholesterol (24%), fatty acids (11%), and cholesterol esters (18%).  The ceramide fraction is a very important part of the lipid bilayer that lines the corneocytes in the epidermis.  We know that ceramides are important for preventing water loss, infection, irritation and in helping to regulate the pH as well.  The main enzymes that make ceramides are called B-Glucocerebrosidase and acid sphingomyelinase.  Both of these enzymes have an optimal pH in which they can do their work and produce ceramides. If the pH of the skin exceeds about 5.7, then there are other enzymes(serine proteases) that become activated in the skin and will literally chop up and metabolize the ceramide-producing enzymes rendering the skin unable to make skin barrier lipids and to repair itself. As the skin barrier lipids can no longer be replenished, then the skin barrier begins to break down. Thus, we learn how ceramide production can come to a halt and affect the integrity of the skin barrier when the pH of the skin is too alkaline.

Another important facet of the optimal pH of the skin is the role it plays in the skin’s microbiome    The term microbiome describes all of the good and bad bacteria that live on our skin.  An acidic pH discourages the growth of bad bacteria and encourages the growth of good bacteria.  Staph. aureus for example, prefers a more alkaline environment and does not like to grow in the normally acidic environment of the healthy skin barrier.  Good bacteria like Staph. epidermis prefer the acidic environment and do not thrive in an alkaline environment.  As you may know, people who have atopic dermatitis are particularly susceptible to the overgrowth of Staph. aureus.  This has a lot to do with the overly alkaline environment of the skin barrier AS WELL AS the particular lipid deficiencies that are present in atopic dermatitis.

SKIN BARRIER LIPIDS ARE NATURALLY ANTI-STAPHYLOCOCAL.

The skin barrier in atopic dermatitis has been shown to have particular lipid deficiencies. For example, there are well-documented deficiencies in phystosphingosine, phystosphingosine-containing ceramides like Ceramide 3, in cholesterol esters (NOT CHOLESTEROL) and in Very Long Chain Fatty Acids. Phytosphingosine for example, has been shown to have anti-staphylococcal and anti-candidal effects and has been shown to be deficient in aged, dry and eczema-prone skin. Phytosphingosine deficiency leads to the phytosphingosine-containing ceramide deficiency. These ceramides are produced by the pH dependent enzymes and are not produced at appropriate levels in atopic skin.  This contributes to the colonization/infection by Staph. aureus and becomes part of the wicked cycle that we all know in atopic dermatitis.  You can see, this is a very interconnected cycle of lipid deficiency, alkaline pH, infection….repeat.  We can attempt to break the cycle by addressing all of these things simultaneously.

Thank you Dr Cheryl Lee in explaining the importance of skin pH; next week, we will learn more about what happens in off-optimal pH skin.

Mom E-votional : Bottle Up Marriage

Marriage Tip Feelings Bottled UpI imagine in every marriage, there’s work to do. After all, as the saying goes, you won’t know how unloving you are till you live with someone. Even more in a marriage with eczema kids, these ‘negative’ feelings may easily escalate.

God cares about our marriage and there are many verses on how married couples should love each other. My favourite is the one below, and it’s so hard to live it up!

Bible verse:

Ephesians 4:2-3  “Be completely humble and gentle; Be patient, bearing with one another in love. Make every effort to keep the unity of the spirit through the bond of peace.”

Father, help us in our marriage. It’s so so difficult – sometimes I don’t have time to love my spouse! (maybe I don’t have time to love even myself!!). Help me to love for love unites!

Don’t Bottle Up the Bad, Choose Love

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