Meet Prof Hugo and I for our Book Launch

Book launch eczema

I would love the chance to meet you all who have been reading my blog – it feels like we have journeyed together via this blog, whether you have commented or emailed me or stayed ‘silent’ – I know you are there!

Come join Prof Hugo van Bever and I for our ‘Living with Eczema : Mom Asks, Doc Answers’ book launch, which is on

8 November 2014, Saturday, 2 to 4 pm at Jurong Regional Library

The event is free – Prof Hugo and I will each be speaking, followed by a half hour Q&A where you can ask all the questions you like! Registration is required at golibrary.nlb.gov.sg

Do come and join us, Prof Hugo will be giving his Doc’s Tips while I’d be sharing my Mom’s Views, look forward to seeing you!

Eczema News – Nipple Eczema – Oh My!

EczemaBlues Nipple Eczema

There’s a recent study on Nipple Eczema: An Indicative Manifestation on Atopic Dermatitis published in July 2014’s American Journal of Dermatopathology. The study of 43 individuals with nipple eczema, part of whom had eczema history and the others without eczema, showed no definite difference between the patterns of their nipple skin inflammation. It prompted me though to read further on nipple eczema, after all, it’s an issue close to women, plus breastfeeding mothers.

Nipple Eczema – is it Eczema?

Nipple eczema is often confused with Paget’s disease because of similar symptoms. Paget’s disease is a rare type of cancer at the nipple-areola complex (1-4% of female breast cancer). The confusion is that both have the appearance of eczema rash, possibly accompanied by itch, pain, tenderness, scales, cracks, oozing, nipple discharge/bleeding, redness and erosion.   However, one distinguishing feature is that Paget’s disease affect the nipple first whereas nipple eczema affects the surrounding skin, i.e. the areola. It is also more likely to be unilateral than bilateral.

Nipple eczema can occur for both men and women, not limited to women who are breastfeeding/ pregnant.

Types of Nipple Eczema

Allergic contact dermatitis – If triggered by skincare product used on body, appearance of the rash would be on both breasts. A case study was reported in Indian Journal of Dermatology where topical application of ingredients like propylene glycol, chlorocresols and parabens trigger nipple eczema (though only on one breast).

Another study in June 2014 noted allergic contact to CI+Me-isothiazolinone, a chemical found in detergents, preservatives and fabric softeners. Thus possibly traces of CI+Me-isothiazolinone in undergarments triggered the eczema at the breasts.

Other possible chemicals that trigger nipple eczema could be protein allergens (food) from the baby’s mouth.

Atopic dermatitis (AD) – Due to the weaker eczema skin barrier and increased likelihood of sensitization to products, the risk of nipple eczema appears to increase with age for AD patients.

Irritant contact dermatitis – Chemicals, product ingredients and friction can irritate. Clothing may irritate or friction from exercise or from exercise bra/ disposable breast pad/ poor-designed nursing bra. There may be both irritant/allergic contact dermatitis to creams used on nipple during pregnancy/breastfeeding. Soaps, detergents, fragrance and bleach are possible irritants.

Yeast infection – This is more likely for women with history of yeast vaginitis or from babies who have thrush (i.e. yeast infection with white spots on baby’s tongue or mouth). The yeast infection will affect skin at the base of the nipple, with appearance of fine cracks. Yeast infection is reportedly more common after antibiotic use.

Bacterial infection – Eczema skin is prone to be colonized by staphylococcus aureus bacteria and the breast/nipple skin is not spared. Skin damage can lead to increased susceptibility for bacteria infection and the damage may come from scratching (on an AD patient) or certain activities during breastfeeding, such as use of uncomfortable breast pump, over-washing and cleaning of the nipple area which dries and damages the skin.

Diagnosis

Diagnosis is not easy as the symptoms look similar. Typically, ruling out Paget’s disease (esp if nipple eczema is only on one breast) is a priority. After which, patch testing can be taken to analyze which possible chemicals the patient has come into contact with that may possibly have triggered the rash.

What if Breastfeeding?

Nipple eczema can bring about soreness, pain and burning sensation, and prematurely terminate lactation and breastfeeding. Women who have eczema or sensitive skin may be more prone to nipple eczema. The breasts can be washed with lukewarm water and moisturized. Check with your doctor before applying cream on the breast/nipple to ensure safety for the baby. If prescribed cream, ask for clear instruction on wiping it off before breastfeeding. The liquid to wipe off the cream can be milk expressed from breast.

Anyone has experience on nipple eczema? Do comment and share. Breastfeeding does not come easy for many mothers (ME included!) and I can’t imagine piling on an itchy, painful nipple on top of the struggles. Do share and encourage another if you can!

Eczema Camp for Primary and Secondary School Kids

Eczema Camp Singapore

Come join as a family on 28 November 2014 – a camp for your eczema kids!

It’s amazing how much kids can bond in a camp and your child with eczema may love the chance to make friends, especially one who would understand what having eczema feels like. So come register before 21 November 2014 for the camp on:

NSC-KKH Eczema Camp (supported by NSC HEF)

Event Date: 28 November 2014 (Friday)

Time: 9.00am – 4.00pm

Venue: SAFRA Yishun Country Club

Eligibility: Open to all NSC Eczema Support Group members (primary and secondary school students) – You can always sign up to be a group member at the same time you RSVP!

Registration Fees: $10.00 per pax (including activities, transport and lunch). Registrations are confirmed upon receipt of payment, please call 6350 8560 or email [email protected]

There will also be an educational talk on “Management strategies in atopic dermatitis”, to reinforce the principles of eczema management and parents can ask your questions to clarify any doubt with the dermatologist speaker. The camp activities are fun and safe, your child can discover his/her inner adventurous self!

Eczema Camp Program SIngapore

Mom E-votional : The Best Life Insurance

Healthy Living Eczema Blues Infographics

I look at this data, (that I read in Dr David Katz’ Disease Proof) and wondered

Isn’t Healthy Living the BEST INSURANCE?

We all worry about whether we have the right insurance, adequate insurance coverage, read the fine print correctly (and probably shorten a few years figuring it all out, if ever we can!). Yet, the best insurance is to lead healthy life and this is compiled by CDC to be Diet, Exercise and No Smoking – with taking care of these 3, there’s statistics showing 80% reduction in death from disease!

I know I’ve been a little obsessed with health for the past few weeks, but it’s ever so important that I really need to share it. Likewise, the message of salvation is something so important, it has to be shared. It’s not 80% but 100% – Believe in God and that Jesus died for your sins, it’s the way to heaven.

Bible verse:

Romans 10:9 If you declare with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you will be saved.

God, there are many messages, tasks, to-do lists, goals, targets that are important but nothing beat THE MESSAGE of salvation, a gift you offered. Open our mind and heart to truth, sometimes it’s so simple that we’re too proud to believe.

Choose your Life on Earth and in Heaven.

Eczema News – Tattoo and Eczema – is it worth the Skin?

Tattoo EczemaBlues Skin

Tattoo has been rising in popularity – from TV shows, to ordinary persons in the gym! You see them (almost) everywhere and it’s no longer the ‘hip’ or ‘happening’ guys and gals who tattoo. How does tattoo affect your skin barrier? Will tattooing lead to skin rash/eczema and can eczema sufferers have tattoo? This is a NEW topic we’re exploring and one that although not applicable to kids, we never know how popular tattoo will be and how (young or) old it will be considered norm/OK/cool to have a tattoo!

Tattoo and Skin Barrier

Tattoo works by damaging the skin barrier.

The (permanent) kind of tattoo involves depositing the tattoo pigment via needle into the dermis. The dermis is NOT the top skin layer, but instead the second layer, i.e. the needle penetrates the epidermis, the dermal-epidermal junction, into the dermis. Wound and trauma is caused to the skin barrier.

The wound needs to heal – the better it heals, the better the tattoo and overall surrounding skin will look. The body generates an immune response to defend against the pigment and in the process, lock the pigment permanently.

Tattoo for Eczema Sufferers

In certain states (in US), the law prohibit operators tattooing on the affected skin lesions for eczema and psoriasis patients. There are instances of discoloration of the tattoo and thus the patient/customer has to moderate his expectations and the tattoo artist has to be told about the skin condition.

Apart from the tattoo not appearing as it would on normal skin, there is also a risk of eczema flare-up (not limited to the tattoo-ed skin). The healing process may take longer or be more painful for those with pre-existing skin conditions.

Tattoo Complications

Even if you have normal skin, there are still various skin complications that come with tattooing:

Allergic/ Irritant contact dermatitis – The skin can be sensitive to the tattoo pigment used.

According to American Academy of Dermatology, the type of ink had evolved from metal sales, lead, cobalt and carbon to organic azo dye with plastic-based pigment (which are also used in industrial printing, textile and car). While Patch Testing is recommended where the pigment is first ‘patched’ on the skin and left for 48-72 hours to observe any reaction, organic dyes which are insoluble may not trigger a hypersensitive reaction. Thus, one may falsely assume his/her skin will not react to the dye, but when the dye is impregnated into the skin barrier, a hypersensitive reaction occurs.

The symptoms of allergic skin reaction are itch, rash, scaly, flaky or bumpy. If scratched, it is also prone to skin infection. Sometimes, these symptoms are not immediate but may take months/years to surface as the body gradually develop a delayed hypersensitivity response to it or when it comes into contact with cross reactants (e.g. thimerasol). The level of itch and discomfort is significant – in a study of 40 patients, it was shown to be comparable to that faced by patients with psoriasis and eczema. Granuloma (small, red raised bumps) can significantly alter the aesthetics of the tattoo.

What’s in the Ink?

Of the pigments, the red pigment seems to trigger the most hypersensitive reaction due to the content mercury sulfide (cinnabar). Other components of the red pigment are ferric hydrate (sienna), sandalwood or brazilwood. All other colors are also able to trigger hypersensitive skin reaction.

  • Black pigment uses carbon (india ink), iron oxide and logwood.
  • Blue pigment is colbalt aluminate.
  • Brown pigment is ferric oxide.
  • Green pigment is chromic oxide, lead chromate and phthalocyanine dye.
  • Purple pigment is manganese and aluminum.
  • Yellow pigment is cadmium sulfide.
  • White pigment is titanium oxide and zinc oxide.
  • Fluorescent inks contain fluoroscene.

There is no regulation on the ink used – but to keep track of any news on faulty ‘product’, copy down the company, brand, color and batch number of pigment used. For a more detailed explanation of which pigment may trigger which skin reaction, see Dr Audrey Kunin’s post on DermaDoctor

Photo-allergic dermatitis – This refers to skin inflammation (swelling) after pigment’s exposure to light. The colors most associated with this sort of photo-sensitivity are red, brown and yellow.

Skin infections – Various skin infection can be due to either the ink or the tools used. The potential types of skin infections are:

Bacterial infection – Sterilization of equipment and use of quality pigment reduces the likelihood of bacterial infection

Hepatitis B and C – Sterilization + immunization against Hep B for both the one getting the tattoo and the tattoo artist

Tuberculosis, Myco bacteria, Syphilis, HIV, Malaria

Lichenoid – A delayed hypersensitive response, mainly from mercury in red pigment that led to papules or plaques forming (lichen planus reaction).

Pseudolymphoma – Common with red pigment, where delayed hypersensitive reaction result in red nodules/plaques.

Sarcoidal (Köbner) Granuloma – These are itchy and (swollen) bumps that appear underneath the skin and thus modify the look of the tattoo, a form of autoimmune disorder.

Keloid – Large, raised scars that alter the appearance of the skin/tattoo.

MRI sensitivity – Certain pigment in eyeliner tattoo ink can trigger hypersensitive skin reaction should the person undergo a MRI scan.

Tattoo Safety

Tattooing being increasingly popular also leads to more artists operating from their home. Beware though as home artists may not follow the requirements expected of a licensed artist (on sanitary, request for client’s information, recording of pigment used, wound care, needle disposal). Do not be afraid to play safe – as seen above, the complications can be severe.

Ask to see sterile packaging in original form, INSIST on sterilization, if you have a skin condition, let both your dermatologist and the artist know. As mentioned before, ask for the batch number of the ink used on you. Explore the use of safer chemicals or colors and consider patch testing before tattooing.

Do not tattoo over a mole because the change in appearance of moles is a key ‘warning’ sign of skin cancer.

Is Temporary Tattoo then Safer?

No, for henna dye that contains paraphenylenediamine (PPD), it can cause severe allergic reaction. It is also known as black henna, which is pure henna mixed with PPD.

What Research Says

I looked up Pubmed for possible research but most reported isolated or very small scale studies, mostly on what has been covered above. Of emphasis is that patch testing turned up negative for people who eventually had a positive hypersensitive reaction to red pigment, thus patch testing doesn’t fully cover ‘better be safe, then sorry’. The safest is not to even tattoo.

Source: AAD

Mom E-votional (Infographic) : Healthy Life Expectancy

Life Expectancy Eczema Blues

Quality of life matters – we want to live longer, but not in sickness (or itchiness for that matter!)

I read about HALE – Healthy Life Expectancy in Dr David Katz’ book Disease Proof and it’s a simple truth presented – we are living longer, but sicker. Above is the HALE of United States, but you can always access this page on World Health Organization to find out the life expectancy of your country. For instance, in Singapore:

From 1990 to 2012, men are living longer from 73 to 80 and women from 78 to 85 (we Singaporeans live longer than our friends in US). Of these years, men spend 6 years in sickness and women spend 8 years in sickness.

Quality of life matters.

Eczema, itch takes a little of that away, chronic diseases take a lot more of life away. Our health care system is built on treating sickness but we ought to take preventive steps instead. Last week devotional brings the importance of diet, this week, look at your loved ones and yourself, and be determined to live good, long lives, not sick ones.

Deuteronomy 5:33

You shall walk in all the way that the Lord your God has commanded you, that you may live, and that it may go well with you, and that you may live long in the land that you shall possess.

God, you desire for us to live long and well. Help us in our busyness to treasure our body and care for it, amen!

Live Long, Healthy Life

Eczema News – Honey and Eczema : Is it Effective?

Honey Eczema Manuka Honey had been covered briefly in this blog 3 years ago when my child had Hand-Foot-Mouth-Disease. It is sometimes applied on the skin for its anti-inflammatory and skin repair properties. Is it effective as a moisturizer or as a topical treatment for eczema? Today’s eczema news look into the recent studies on honey’s impact on atopic dermatitis.

What Honey are we talking?
Ηoney is made up of sugars (mainly fructose), water, vitamins (B complex and C) and minerals (calcium, copper, magnesium, iron, phosphorus, potassium, selenium, chromium and zinc). It also contains amino acids, antibiotic-rich inhibine, proteins, enzymes and antioxidants (flavonoids).

According to WebMD, honey is tested in the lab (not on humans) to fight bacteria (including staph bacteria common on eczema skin) and food-borne pathogens like E.coli and salmonella. However, as you’d see below, controlled trials on honey and eczema are very few and efficacy not proven. Notwithstanding, honey is often used for infected wound healing.

Raw or unprocessed honey is not to be taken orally for infants for risk of botulism as their immune system has not yet fully developed to withstand the botulism bacteria.

Clinical trials/Studies on Honey
I found the below studies on PubMed:

1. Randomized controlled trial in New Zealand on Kanuka Honey – The control is aqueous cream, with 15 adults participating who were all non-allergic to honey, with eczema lesions and not using corticosteroids or antibiotics. There is no evidence of efficacy over aqueous cream, which represent a negative control as it is not recommended as eczema treatment.

2. Partially controlled study on honey mixture – this mixture contained honey, olive oil and beeswax with varying proportion of corticosteroid ointment vs Vaseline in control group. 8 out of 10 patients (out of 21) patients showed improvement after 2 weeks. However, due to the honey being mixed with other ingredients, it did not present a solid case for use of honey.

I read in this article for the choice of the honey mixture, namely:
Honey for its anti-inflammatory and antibacterial properties that help to decrease pain and the appearance of scars, faster wound healing. Manuka honey is reported to have the highest bacterial compound methylglyoxal to fight bacteria.

Olive oil for its anti-inflammatory and antibacterial properties

Beeswax for its anti-inflammatory properties
Olive oil and Honey – Contain flavonoids that inhibit allergic reactions

Have you bought any skincare products with honey? How did it work out on eczema skin? Do share in the comment!

(Video) Family Mealtime should look like this!

For parents of picky eaters, the last date to sign up for the Picky Toddler Solution is on 16 October. Dietitian moms behind this course has prized it to be cheaper than private sessions with pediatric dietitian.

For parents of picky eaters, the last date to sign up for the Picky Toddler Solution is on 16 October. Dietitian moms behind this course has priced it to be cheaper than private sessions with pediatric dietitian.

This is the last of the short video series by two Mom Dietitians, previous videos were on Magic Phrase to end feeding battles and Mom’s Role in Feeding Kids. Today, it’s another short video on what Happy and Healthy Family Mealtimes should be. Dietitian Natalia Stasenko, RD is no stranger to this blog as she had provided valuable information on a Toddler Nutrition series covering

How Much to Eat
What to Eat
What Not to Eat

In this video (click link here then input your email to view the 2nd and 3rd video), the following tips are shared:

  1. Picky eating typically starts at around 2 year old.
  2. Either of the extreme approaches are wrong, either (i) Give up serving healthy selection  of food (Mom’s Job!) and cater to what the child wants and when he/she wants it! OR (ii) Controlling and turn meal time to be a battle session.
  3. A Happy and Healthy Mealtime should incorporate selection of foods, including healthy options and what your child normally likes to eat. The whole family sits together and each pick their own foods from the serving.
  4. It is not advisable to have a separate meal time for the child = Sending message that he/she is not expected to eat what the family eats.
  5. Inculcate a positive attitude to eating, valuing family meal time and trusting the child to feed himself/herself (the child’s job!

P.S. I’VE SIGNED UP AS AFFILIATE FOR THIS PICKY EATER CLASS, BUT MORE SO AS I’VE WORKED WITH NATALIA BEFORE AND SHE’S VERY PASSIONATE ABOUT KIDS NUTRITION.

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