Mom E-votional : No Secret Formula

Eczema devotional Prayer FormulaIt’s strange why we seem to be obsessed with a secret formula for everything – Formula for success, formula for happiness, formula for weight loss and even formula for eczema cure! During Jesus’ time, his disciples wanted a formula for prayer.

Though Jesus did give his disciples a prayer to pray (Luke 11:2-4), there is really no secret formula. In fact, prayer is simply our conversation with God, and should not be a time to show-off or use empty words (as Jesus said in Matthew 6:5-8). There is no prayer specific for different occasions, it is a heartfelt request to a God who is love. Without any secret formula, God is available to all and in this tech age, the bible is free to be downloaded! It kinds of remind me to make this blog free for all too, there is no secret eczema knowledge I’m hoarding!

Bible verse:

Matthew 6:6 But when you pray, go into your room and shut the door and pray to your Father who is in secret. And your Father who sees in secret will reward you.

God, I am so glad that there is no secret formula to pray. I pray that you guide me in prayer and teach me to believe!

There is no secret to Jesus (best thing in life!)

Support Group – Eczema Stress and Skin

Stress Skin Eczema BluesStress triggers flare-ups for some patients with eczema, with many parents observing their schooling children having worsened eczema during exams.

Eczema, in itself being an itchy, chronic condition, also creates stress. Learn how to manage stress with psychologist Ms June Lim.

5 September (Friday) – Venue, National Skin Centre Singapore Room 401, 12pm to 1pm

Topic: Mental health and Eczema: Manage your Stress and help your Skin

The program will be sharing by Ms June Lim over lunch (provided). June is a psychologist at Tan Tock Seng Hospital and have been a visiting Psychologist at National Skin Centre for more than a year. 

This session is open to all who suffer from eczema, regardless of age. For those with children, you can bring them along but as I can’t make it for this session, do bring some ‘entertainment’ for your kids. Information on my blog is not pre-approved by NSC.

YOU MUST RSVP – It will then be possible for us to prepare lunch. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids.

Have fun for the session! More on stress’ impact on skin here (interview with Dr Claudia Aguirre) for your reading

Eczema Complications series – Erythroderma

Erythroderma Eczema Complications

Pictures taken from dermnetnz.org without specific permission granted, click on image for click to Dermnet NZ Erythroderma page

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Erythroderma and its Causes

Erythroderma refers to generalized redness of skin due to skin inflammation. It is a complication associated with severe eczema, psoriasis and other skin inflammatory diseases. It can also be caused by drug reaction or even without a known cause (idiopathic erythroderma). Other possible causes are:

  • Other forms of dermatitis, apart from eczema, such as contact dermatitis, stasis dermatitis (skin inflammation from blood pooling in leg veins, common for women above 50) and seborrheic dermatitis
  • Staphylococcal scalded skin syndrome, with fever, skin tenderness and irritability (staph bacteria infection causing blisters, aka scalded skin appearance, affecting kids below age 5)
  • Pityriasis rubra pilaris, appears as reddish-orange scaling patches, more common in adults
  • Pemphigus vulgaris and bullous pemphigiod, which refers to autoimmune blistering skin disease
  • Lymphoma of the cutaneous T-cells, also known as Sezary syndrome
  • Leukemia
  • Malignant rectum, lung, colon and fallopian tubes
  • Graft vs Host disease
  • HIV infection and other immune-deficiency conditions

The common drugs causing erythroderma in children are sulfonamides, antimalarials, penicillins, isoniazid, thioacetazone, streptomycin, nonsteroidal anti-inflammatory drugs (NSAIDS), topical tar, homeopathic and ayurvedic medicines. For general population, drugs such as allopurinol, arsenicals, aspirin, carbamazepine, captopril, gold, hydantoins, mercurials, penicillin, phenothiazines, phenylbutazone, quinacrine, sulfonamides, homeopathic and ayurvedic medication as well.

Symptoms of Erythroderma

The onset of erythroderma can be sudden and spread quickly. Apart from skin redness, it is often seen with:

  1. Skin exfoliation, also known as exfoliative dermatitis where about 90% of skin peel off in scales or layers
  2. Swelling (oedema)
  3. Oozing skin
  4. Itch
  5. Thickening of palms or soles or nails (even shedding nails)
  6. Erythroderma of the scalp may result in hair loss
  7. Erythoroderma of the eyelid may result in ectropian, which is rolling outwards of the inner eyelid (may also have conjunctivitis)
  8. Measle-like eruptions if due to drug reaction

Treatment of Erythroderma

The underlying cause has to be treated, with the following general treatment steps:

  • Wet wrap for skin moisture retention, with moisturizer and mild steroids
  • Maintain hydration, fluid and electrolyte balance
  • Antihistamines for itch
  • Stop unnecessary medication, in case erythroderma is drug-induced

Bacterial skin infection commonly accompanies erythroderma, and therefore antibiotics may be prescribed. Where fluids have to be given intravenously, hospitalization is required.

Complications of Erythroderma

Most important to watch out in erythroderma is compensating for the loss of skin’s ability to temperature control and maintain fluids. Complications include:

  • Pigment changes in skin to brown and white patch
  • Secondary infection with the oozing and crust
  • Swollen lymph nodes
  • Dehydration, from fluid loss through skin from higher metabolism
  • Heart failure from increased heart rate (usually in elderly)
  • Hypothermia, from abnormal temperature regulation, thus hydration and temperature control are important
  • Malnutrition, from protein loss and higher metabolism (to compensate for heat loss)

As I researched on erythroderma, I felt really sad for those suffering with it. As to why some people with inflammatory skin condition have an onset of erythroderma, it is not clear. I do hope though that keeping the underlying skin condition under control will forever keep erythroderma at bay. Anyone has experience with this?

Life of Eczema Girl – Who Sleep with Me?

Sleep_parenting

Back by popular demand, this month’s cartoon all on sleep, co-sleep, suffering sleep, sacrificial sleep, whatever you call it! This is the 57th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out hereIf you have a funny sleep story, drop me an email or a comment and I may just turn it into a cartoon!

Mom E-votional : Is Eczema an Handicap?

Eczema Devotional HandicapOne morning as I was jogging, I passed by in succession – a man with a very awkward limp, another man in a wheelchair and shortly after, someone who look like he has sprained his ankle. Ashamedly, my first thought was now I have to jog on the road instead of pedestrian path to avoid bumping into them and other people. Only the next thought was ‘Whoa, hang on. As unattractive and physically challenged they are, God loves them!’.

God’s love for the disabled is evident in Jesus’ ministry. There is a considerable amount of bible text in the gospel (John chapter 9) on Jesus healing the blind man (here is a commentary on Disability and the Sovereign Goodness of God) and many stories of Christians whose faith grew and mightily used by God to touch others. I then wonder if eczema is a handicap – in severe cases, it fit the definition of “restricting a person from participating in normal life“. Some children whose eczema are serious are not able to take part in sports, shower and sleep, I suppose that’s a real restriction. I pray that our children’s eczema will improve and not be so serious. But more so, I pray that our eczema experience can be used in some special way to help others – more love, resilience, empathy and whatever divine use it can be put to.

Bible verse:

John 9:1 As he (Jesus) passed by, he saw a man blind from birth.

God, eczema can be so severe that some days we feel it is a handicap. Heal our child’s eczema and use all of our life, even with the eczema

Jesus sees.

Come for 30 Aug Wet Wrap Workshop

Wet Wrap session with Singapore Eczema Support Group

Wet Wrap session for kids with Singapore Eczema Support Group

Reminder of next Saturday 30 Aug’s workshop at National Skin Centre, Singapore by Tubifast for the Eczema Support Group. This session will be focused on wet wrap for younger kids. Wet wrapping is a worthwhile technique to learn esp given repeated studies proving its effectiveness, read more here.

SESSION CANCELLED, RAIN CHECK TILL FOURTH  QUARTER THIS YEAR, CHECK BACK!

30 August (Saturday) – Venue, National Skin Centre Singapore Room 401, 9.30 am to 11 am

The program:

1. 9.30 am to 9.45 am Breakfast and Kids have balloon sculpture and jigsaw puzzles to keep them occupied

2. 9.45 am – 10.45 am Tubifast team demonstration, it’s much easier if you bring your child along for them to demo on him/her!

3. 10.45 – 11am Q&A time

Same note: No doctor present, so don’t expect to ‘Ask the Doc’. Information shared is not medical advice, please still see a doc. No selling anything or pretending to be a parent of eczema child and the session is for parents with eczema kids. Information on my blog is not pre-approved by NSC.

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

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

Eczema Complications series – Eye and Eyelid

Eczema eyelid complications eyeThis is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Eyelid Functions and Skin

The eyelid very often present a very tricky and difficult to treat skin area for eczema sufferers. Moreover, the constant rubbing and scratching of the eczema at the eyelid can also lead to complications. Before we go into the complications, let’s first understand the basics of eyelid functions and the skin at this delicate area.

Functions of the Eyelid

  1. Protection from injury
  2. Regulation of light
  3. Maintenance and distribution of tear film/ flow

Eyelid Skin

The skin of the eyelid is characterized by:

  1. Thinnest skin are of our body – total less than 1mm, with both the epidermis and dermis being the thinnest
  2. Smoother skin due to finer hairs
  3. Oilier skin due to more oil glands

Common Eyelid Conditions

Being thinner oilier skin and on the face predispose the eyelid to various health conditions, such as:

  1. Atopic dermatitis (eczema), more common from adolescent age (read more from dermatologist Dr Lynn Chiam)
  2. Contact dermatitis, due to contact with chemicals used on the face/eyes and hair
  3. Seborrheic dermatitis, typically on the eyelid and eyebrow (read here for more on seborrheic dermatitis)
  4. Blepharitis, also known as eyelid inflammation
  5. Conjunctivitis – this refers to inflammation of the eyelid lining, accompanied by itching and eye watering
  6. Ptosis, known as droopy eyelids from prolonged contact lens use or aging
  7. Dermatochalasis, baggy eyes from aging
  8. Ectropion, eyelids that roll outwards usually from ageing or sun-damaged facial skin
  9. Entropion, eyelids that roll inwards, may also be complication of blepharitis
  10. Malignant eyelid tumors
  11. Chalazion, eyelid cyst swelling from obstruction of the meibomian (tear) gland, may also be complication of blepharitis
  12. Hordeolum, also known as a stye, lump from infection of the meibomian gland, may also be complication of blepharitis

Eczema and Eyelid Complications

Apart from atopic, contact and seborrheic dermatitis of the eyelid, there are also complications from having eczema at the eyelid. Complications usually occur in patients with severe atopic dermatitis where repeated scratching and rubbing, inflammation and infection of the eyelid cause other conditions. Let’s take a closer look at some of these eczema eyelid complications:

Blepharitis

This refers to inflammation of the eyelid, being accompanied by redness, sore eyes, itch, flakiness, burning, swelling, eye watering and mucous discharge. The eyelid margin may appear crusty, waxy or greasy. Blepharitis can be due to many reasons, including allergy, irritation and bacteria infection that causes the eyelids to become itchy. Blepharitis is associated with eczema, rosacea and acne patients.

Relation of Blepharitis to eczema as follow:

a)     Staphylococcal blepharitis – patients with eczema have higher chance of staphylococcus bacteria colonization, leading to staph bacteria infection

b)    Seborrheic blepharitis – due to the malfunction of oil glands at the eyelid, affecting patients with seborrheic dermatitis. The excess oil production may be due to stress, hormonal changes or diet. A characteristic of seborrhea blepharitis is redness at the eyelid throughout the day and crusting at eyelid in the morning.

c)     Other eczema complications – Complications of eczema such as from herpes simplex or varicella zoster virus or molluscum contagiosum can also cause blepharitis.

Dennie-Morgan fold

This refers to a fold under the lower eyelid, typically due to excessive scratching/rubbing of the eye. The eyelid may also hyper-pigment or become red and swollen.

Allergic Contact Dermatitis

Ophthalmic corticosteroids may also product allergic contact dermatitis, due to allergy from certain ingredients of the corticosteroids.

Eyelid Erythema

This refers to redness of the eyelids and can be caused by eczema, contact dermatitis and blepharitis.

Cellulitis

This refers to bacterial infection of the eyelid and can also be caused by insect bite/ other skin injury. Preseptal cellulitis affects the eyelid and skin around the eye, but not the eye socket. Orbital Cellulitis is much more severe and affects the back of the eye, causing eye protrusion and double vision. The common bacteria causing cellulitis are Haemophilus influenzae, Staphylococcus and Streptococcus.

Neurodermatitis

Also known as lichen simplex chronicus, this refers to skin thickening, lichenification of the skin of the eyelid from habitual scratching.

Eczema and Eye Complications

There are also complications involving the eye, typically for prolonged eczema at the eyelid.

Keratoconus – This refers to the degeneration of cornea which pushes the eye outward, resulting in a cone shaped eyeball. There will be visual disturbance with this condition. This may be due to hard rubbing of the eye from the itch.

Scarring – This refers to scarring of the eye, mostly due to scratching or excessive rubbing.

Cataract – There is association between cataract and severe and chronic atopic dermatitis of more than 10 years, possibly due to overtime absorption of steroid cream applied on thin eyelid. One feature of cataracts associated with eczema is that the cataract affects both eyes.

Retinal detachment – This is very rare and associated with severe atopic dermatitis.

Complications from prescription creams seeping into the eyes, resulting in glaucoma

Certain eye-related conditions are not directly related to eczema, but related to allergy. For instance, conjunctival irritation

General Care for the Eyelid (Hygiene)

Top tips for general care of the eyelid:
1. Refrain from eye make-up
2. If wearing contact lens, always clean with disinfectant solution; in certain cases, refrain from using contact lens.
3. Apply warm (not hot) compress 4 times a day to clean and reduce discomfort (for blepharitis)
4. Clean eyelid with cotton swab with mild diluted baby shampoo/wash (read dermatologist Dr Jessica Krant’s tips for baby’s eyelid here)
5. Use artificial tears as blepharitis commonly occurs alongside dry eyes
6. An omega-3 supplement may be recommended to patients with blepharitis as small-scale study suggested anti-inflammatory effect of omega 3 benefit blepharitis patients. More on omega 3 and eczema here.

As you can see, there are quite a lot of health conditions affecting the eyelid and a few relating to eczema. Most of it has to do with bacteria and scratching, thus it is important to practice eyelid hygiene and treating conditions that create itch at the eye promptly.

note: if you’ve reached this far to the post, thank you! Took me a long time to do up a comprehensive post on eyelid complications from eczema and if you have any to share, kindly comment, will make my day!

Life of Eczema Girl – Sleep Rotation

Sleep, Co-sleeping in Marriage

Does Co-Sleeping change your Marriage *bedroom* dynamics?

Back by popular demand, this month’s cartoon all on sleep, co-sleep, suffering sleep, sacrificial sleep, whatever you call it! This is the 56th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out hereIf you have a funny sleep story, drop me an email or a comment and I may just turn it into a cartoon!

Mom E-votional : Inconveniences

Eczema Devotional InconvenienceIt is one of those irritating things – the new ATM pin for one of those fancy chip replacement card just didn’t work. I then had to waste an hour queuing and re-queuing to try different pins without pissing the people in the queue behind me. When all fails, I had to queue at another bank’s ATM. It then hit me that in life, we have many inconveniences – falling sick, home appliances failing or train breakdown during office commuting hours! But what of our children? I ask myself if I have ever viewed my daughter or her eczema as an inconvenience. 

The answer is probably yes. Sometimes I want to finish my chores, but have to stop to take care of my daughter. Some days I want a long shower, but I have to shower with my daughter to make sure that her fungal shampoo and chlorhexidine shower foam are used correctly. I then remember Jesus, how he never viewed the children as a nuisance, for instance when children were brought to him for prayers (Matthew Chapter 19:13-14). He also stopped or detoured in his journey to talk, heal and help others, for instance he healed a little girl (Mark 5:23). It then occurred to me that maybe life is made up of inconveniences! At least for parents of eczema children, with so much time spent on skincare, we might as well use this time as family time rather than view it as an inconvenient time! I pray that all of us have the wisdom to parent our children, despite the inconveniences from eczema.

Bible verse:

Mark 19:13-15 Then children were brought to him that he might lay his hands on them and pray. The disciples rebuked the people, but Jesus said, “Let the little children come to me and do not hinder them, for to such belongs the kingdom of heaven.”

God, help me to be a good mom even when it comes with inconveniences

Help to be a good daughter when when it becomes inconvenient

Help to be your good child despite the inconveniences

With God, there is no inconvenience

Eczema Complications series – Folliculitis

Folliculitis_Eczema

Taken from http://health.howstuffworks.com (no direct permission obtained for use, but duly credited)
Link of picture directed to HowStuffWorks website

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Bacterial Infection

Last week, we covered viral infections – eczema herpeticum previously covered in this blog (here and here) and molluscum contagiosum. This week, our focus is on bacterial infection. The most common bacteria that colonizes eczema skin is staphylococcus aureus bacteria, which is the cause of common children skin infections like impetigo and folliculitis. Apart from impetigo and folliculitis, S. aureus also causes other secondary infection with presence of pus, fever, swollen lymph nodes and in severe cases, staphylococcal scalded skin syndrome, where the lesions rupture to give scalded appearance (see this interview with Dr Clay Cockerell on symptoms of S.aureus infection).

Other bacterial infection include boils and ecthyma, also from S. aureus. The other common bacteria that causes infection is streptococcus pyogenes, which can cause cellulitis and erysipelas. Untreated bacterial infection can cause fatal systemic toxaemia or septicaemia, which is blood poisoning. If strep infection is a topic you’re interested, comment/email me and I may start a series on it!

Folliculitis

Folliculitis is an inflammation at the hair follicle that can be due to numerous causes – a common one being from staph bacteria. A word about staph bacteria is that even if it doesn’t trigger secondary infection, its presence impedes the recovery of eczema rash via (i) toxins (enterotoxin) from the bacteria that can trigger hypersensitivity and (ii) existing inflammation from bacteria makes it harder to treat the eczema (more on staph bacteria here).

So back to folliculitis – It appears as a small localized pus (on surface or deep) at the hair follicle, followed by red bump when the pus dried with surrounding inflamed skin that may itch. If the infection runs deep into the hair follicle, it can cause a boil which can be painful. The hair follicles on the chest, back, legs, face, neck, thighs and buttocks are more vulnerable to folliculitis. Folliculitis will not affect part of the body with no hair follicle such as the eye, mouth, palm and sole.

Multiple Causes of Folliculitis

Bacteria, from staphylococcus aureus is the most common cause.

Virus – Herpes simplex virus (that cause eczema herpeticum), herpes zoster (that cause shingles, read here of my daughter’s shingles experience) and molluscum contagiosum (covered last week) may also cause folliculitis.

Yeast – Folliculitis may also be from the yeast, Pityrosporum ovale (Malassezia) when it proliferates, usually on the trunk of young adults.

Fungi – Fungi such as tinea capitis (ringworm), Microsporum canis and Trichophyton tonsurans can cause folliculitis particularly on the scalp.

Parasite – Hair follicle mite (demodex) can affect the face or scalp of adults with compromised immune system or that of elderly. This is known as demodicosis. Scabies is another parasite that can trigger folliculitis.

Steroid – Systemically administered or topically applied steroids could result in facial folliculitis (perioral dermatitis) or steroid acne due to adverse reactions to long and significant doses of steroid.

Occlusion – Clothes with sweat, friction, thicker emollients, like paraffin-based ointment and adhesive plastic can break the skin and/or increase the penetration of bacteria into the hair follicle.

Chemicals – Some chemical like coal tar may cause irritant folliculitis.

Razor-burn folliculitis – This is due to frequent razor cuts creating opening on skin’s surface that allow bacteria to enter and cause inflammation at the hair follicle.  It is more common on women’s leg and men’s face and neck. Excessive close shaving creates trapped hair in the follicle, increasing inflammation.

Spa pool/ Hot tub folliculitis -  This is infection from inadequately chlorinated warm water, allowing the bacteria Pseudomonas aeruginosa to thrive. It is more common on the back and to prevent this, rinse/shower after a spa or hot tub.

Who is a Higher Risk of Folliculitis?

Skin conditions, such as acne, eczema and psoriasis patients

Diabetic patients

Obesity

Patients with lower immunity such as cancer, HIV, hepatitis or even chronic eczema patients who are on immunosuppressants may get eosinophilic folliculitis.

Occupations – Those that come into often contact with oil, tar or grease and sweat.

Warm and humid climate

Treatment of Folliculitis

The treatment will depend on the cause, as follow:

Bacteria – Antibacterial wash such as benzoyl peroxide, chlorhexidine or in certain case, antibiotics to kill the bacteria and clear the skin. There are increasing instances of methicillin-resistant Staph aureus bacteria, thus making it more difficult to treat such MRSA bacterial infection. Oral flucloxacillin is often prescribed and if there is penicillin resistance, erythromycin is prescribed. More on MRSA here.

Fungus and Yeast – Both fungus and yeast causing folliculitis can be treated using an antifungal shampoo or body wash such as ketoconazole (Nizoral shampoo) twice daily. Topical antifungal cream such as miconazole (Lotrimin) or terbinafine (Lamisil) and an antifungal medicine fluconazole (Diflucan) may be prescribed for more severe case.

Virus – Medication for virus, such as acyclovir for herpes simplex virus will help to resolve the folliculitis.

Razor folliculitis – Treatment includes antibacterial wash and topical antibiotics if not resolved on its own. Stopping to shave and using alternative hair removal techniques may help prevent future folliculitis from shaving repeatedly. Using a new razor and shaving in the direction of hair growth will help to prevent cuts. For men, antibacterial benzoyl peroxide shaving gel can be used. Permanent hair removal can also be attempted.

As the most likely factor is from bacterial infection, good hygiene measures such as hand-washing, not sharing towels/razors and showering after contact with likely bacteria surfaces helps prevent folliculitis. Not touching parts of body that have high staph bacteria such as the nose, armpit and perineum (area between anus and vulva/scrotum) can limit the spread of the bacteria to other parts of the body.

Folliculitis and Eczema

Children with eczema have a few factors to their disadvantage which make them more likely to get folliculitis. Of the causes of folliculitis, the one that most affect eczema patients is bacterial infection from staph bacteria.

  1. Eczema skin already have higher likelihood of bacterial colonization, of more than 50% chance.
  2. Most skin with staph bacteria won’t be harmed, however eczema skin is defective in its barrier protection, either from dry skin, ‘open’ skin from scratching and more permeable.
  3. Eczema patients are suspected to be less able to fight common bacteria, fungus, virus and yeast.
  4. The dry skin on eczema children is a more conducive environment for bacterial growth, compared to normal skin with natural oils.
  5. The toxin produced by Staph aureus bacteria worsens the eczema with triggering more hypersensitive reaction/inflammation.

It once again points to keeping bacteria count low, proper hygiene, keeping our children fresh and cool as preventive measures for our children. What is your experience? Do share in the comment!

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