Eczema ‘Cure’ Series – Diet

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

Now, many eczema sufferers report curing their eczema from eliminating certain foods from their diet, typically these are (i) diary, (ii) wheat and (iii) sugar. Is there a basis for this? Think along with me!

Unusual suspects for Eczema cure

Suspect #1 – Allergy to Diary and Wheat Undetected

This is the most straightforward reason why cutting certain foods from diet heal your eczema – it’s possible that you have an allergy to certain foods but you’re not aware of it. The unawareness could be due to:

  1. You have not taken an allergy test, be it either skin prick test or blood IgE test. Watch the video on allergy testing and #SkinishMom column on why sometimes doctors don’t get you tested (other than the other obvious reason which is they don’t have the facility to test and don’t want to refer you to another doctor..)
  2. Foods like diary and wheat are so prevalent in our diet that you may not notice. Generally speaking the more common something is, the less likely that you can identify it on your own as the trigger for your eczema. That is why although house dust mite is a very common trigger, parents tend to not associate their child’s eczema flare up with it. For common allergens for children of different age, see here (extracted from Professor Hugo Van Bever’s article – Prof Hugo is my co-author for Living with Eczema Mom Asks, Doc Answers!)

Suspect #2 – Food Intolerance or Hypersensitivity not Easily Tested

While allergy testing (for increased blood IgE immunoglobulin) is straight forward, detecting food intolerance or hypersensitivity is a whole different ball game. Even allergist or your nutritionist can be floored by it. For instance, reaction to a food intolerance can be gradual, not necessarily in small amount (unlike allergy) and can be intolerant only when certain foods are in certain state (eg raw versus cooked). Learn more on the differences between allergy and food intolerance.

As such, it could well be that your intolerance reaction is in the form of skin rash but because it is delayed reaction, no doctor has told you that a certain food is the culprit. However, when it is removed from your diet, your skin condition improves.

Here’s an interesting research on how children have tummy ache but didn’t get diagnosed as related to food sensitivity.

Suspect #3 – Gluten Sensitivity comes in Many Forms

Similar to the above, gluten sensitivity can come in many forms – Celiac Disease, Non-Celiac Gluten Sensitivity or Wheat Allergy. While there are tests for celiac disease and wheat allergy, testing for non-celiac gluten sensitivity is not straightforward. This could be why many reported their eczema improving after cutting gluten yet they are not tested to be allergic to it.

There has been some (small scale, not conclusive) research suggesting that eczema sufferers tend to have gluten sensitivity which is why cutting gluten has worked for them.

Suspect #4 – Sugar Intolerance

For other eczema patients, cutting out sugar improves their eczema – a possible reason is that they have an intolerance to fructose or sucrose. This is due to the lack of digestive enzyme frutase and sucrase. However, tests for these are more expensive and being in many of processed foods and foods we eat, you may not think of testing for it.

Also cut the soda, read its harmful effects in this Soda and Child series.

Suspect #5 – Milk Intolerance

Similar to above, one could also be intolerant to milk from a lack of digestive enzyme lactase. It’s possible that the intolerance reaction gets triggered from different amounts and therefore, you may not know it’s from milk.

Read also alternative food sources from nutritionist Natalia Stasenko if your child is intolerant to milk.

Suspect #6 – Cutting out Inflammatory Foods

I’m personally very careful about NOT eating inflammatory foods and if your child with eczema is obese too, read tips from nutritionist Rania Batayneh on an anti-inflammatory diet.

The basic concept of inflammatory foods is that these foods promote the production of substances that put stress on our body, being increasingly recognized as the cause of many health conditions which are linked to prolonged inflammation (chronic inflammation). To understand this better, see interview with nutritionist Toby Amidor.

I’m not clear how inflammatory foods directly link with eczema but the general link is that eczema is skin inflammation (rash) and the overall reduction of inflammatory foods may have a greater impact on certain individuals than others (my own guess).

Suspect #7 – Eating Clean

This term ‘clean eating’ is quite ambiguous but generally taken to mean that we don’t eat processed foods, fried foods nor trans fat. There are also people that said once they cut out processed foods, cook and eat healthy, their eczema improved. I’m a big supporter of that, not so much for improving eczema but more for general health. In terms of research that supports doing so, there is a large scale association study that showed children who ate fast food more than 3 times/week are 30% more likely to have more severe allergic conditions. (side point – Prof Hywel Williams who led the study also wrote the foreword for my Living with Eczema book!)

Suspect #8 – Going Vegan

Some eczema sufferers choose to go vegan or cut down on meat. There is a basis for this as explained by dermatologist Dr Cheryl Lee in this post on Diet and Environment on Skin. Animal proteins and sugar are pro-inflammatory and give rise to excess free radicals that damage our body and our skin. My own guess is that some people get affected by animal protein more than others which is why going vegan works wonders for their skin!

Suspect #9 – Being Able to Take Action reduces Stress

This is my own guess – it is known that stress triggers eczema flare-ups (see dermatologist Dr Claudia Aguirre’s interview on Stressed Skin is Skin Deep) and most patients also feel helpless especially when there is no clear trigger or solution offered by their doctor. Being able to take proactive steps to eat healthy, cut sugar or figure out gluten-free recipes may reduce stress and inspire new interest in cooking. So the reduced stress possibly helps the eczema and for more on stress affecting acne, see dermatologist Dr Verallo-Rowell’s interview on Diet and Lifestyle.

Above is my thoughts on why eczema sufferers or parents of eczema children feel that changing diet ‘cured’ their eczema. Did diet change work for you? Share in the comments!

Eczema Support Group – Wet Wrap Session

Wet Wrap session with Singapore Eczema Support Group

Last Saturday 28 March, the Eczema Support Group kickstart the year with a wet wrap session and I learnt something new every time!

The wet wrap demonstration was by Mölnlycke Health Care Limited, whose Tubifast product is used globally. A few tips about using wet wrap:

1. It can be dry or wet. Dry wrap is having a single layer of the bandage tubing over skin that has bee moisturized. Wet wrap is having an inner layer soaked in water, over moisturized skin and an outer layer over that inner layer. This applies for garments as well.

2. Different color-coded are of different sizes, the most common ones are green and blue sold in Guardian pharmacies, the smaller sized ones and garments are available in hospitals or the National Skin Centre.

3. Wet wrap can be hand washed, air dry (not in direct sun) and reused as long as it’s still elastic. You can refer to this post for more tips on wear and tear.

4. Size – Always cut a longer strip than the area to be wet wrapped, and there will be some fraying, fold the frayed ends in; and don’t keep trying to cut the frays away. Gloves are available, even for infants – they make look too small, but they are stretchable.

5. Materials – for garment, it is elastane, nylon and viscose and for wrap, viscose, elastane and polyamide. For those with latex allergy, no worries because no latex is used in the product nor the packaging.

6. Tie it up – Try tying knots to secure one part of the wrap to the next, perineal dressing, picture above. Basically cut a hole in one part of wrap, say body, and cut another on the hips, cut a thin strip and loop that strip through these two holes.

Thank you to all who attended and the National Skin Centre staff – subscribe at the blog top right corner to stay tuned for updates!

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

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