Most of you would know that I co-authored with Professor Hugo, NUH, a book ‘Living with Eczema: Mom Asks, Doc Answers‘ published last year. As an end of the year special, I picked five questions asked and Professor Hugo’s reply (almost half the book is Q&A, I picked these 5 based on being common questions parents of eczema children asked). The book is structured with information surrounding key topics like diagnosis, prevention, triggers, treatment including things that don’t work and future research, followed by Q&A. None of the questions I asked were ‘screened’ as we wanted to keep it as an authentic exchange between a mom and the doctor of her eczema child.
Top 5 Q&A Living with Eczema- Mom Asks, Doc Answers
MarcieMom: The Hygiene Hypothesis has been interpreted by some to mean they should expose their infants to dirt, and possibly, avoid the use of anti-bacterial products. Is this recommended?
Infants with defective skin barrier or lower immunity would be even more susceptible to the penetration of irritants or allergens, or more susceptible to bacterial infection. So, should a mother take more hygiene precautions for her high-risk infant?
Professor Hugo: In theory this is correct, but the problem is that every baby is unique and needs a different degree of exposure of immune stimuli. This is very difficult to assess in a baby. However, in general, products that destroy the body’s own bacteria, such as antibiotics, should be avoided and only given if necessary (in case of a bacterial infection). There have been studies showing that early administration of antibiotics increases the risk for subsequent allergy, including eczema. Hygiene precautions taken by parents seem to have little impact on the development of eczema.
MarcieMom: While the skin prick test (SPT) is a faster, more reliable and cheaper option than the blood test, I have heard of parents avoiding it because the name “skin prick” test sounds traumatising for the child. What do you do in your practice to encourage fearful parents to let heir children take the SPT?
Professor Hugo: A good SPT, performed by an experienced person, should be painless. In our department we say that a SPT should be associated with no blood and no cry, even in infants.
MarcieMom: In your experience, how reliable are patients’ observations in relation to what is triggering his/her eczema?
Professor Hugo: Most parents fail to identify the triggers of their child’s eczema, or come up with lists that are non-reliable. Don’t forget that eczema is a chronic disease, needing a chronic or regular trigger. This is very diffi cult to identify, especially when a house dust mite allergy is involved, which can mimic multiple food allergies.
Professor Hugo: Although corticosteroids are still the cornerstone treatment of eczema patches, they are only part of the holistic treatmentof eczema. If all measures are taken appropriately, an effect of corticosteroids should be seen within one week. Most children can be treated with mild corticosteroids; only in severe eczema are more potent corticosteroids necessary.
MarcieMom: How do you build trust and relationship with your patient?
Professor Hugo: In a nutshell: be honest, don’t lie, and focus on limitations.
There are many more Q&A in the book and if you like to read it for free and you live in Singapore, it’s available in our national libraries island-wide. Wishing all families with eczema kids a happy new year and your encouragement keeps me going and faith that I’m storing treasures in heaven in this blog ministry. Just like the book, this blog is also dedicated to you.
We dedicate this book to
all children with eczema and
their families and hope that
this book will help all of them.
Don't let these 10 Top Christmas Allergy Suspects spoil your season fun!
It’s end of the year, it’s Christmas time and there are actually quite a few things about Christmas that can really spoil the season fun. Apart from visiting others’ homes (pet, mold, dust mites), eating foods that you don’t normally eat (or never eaten before), there’s the Christmas tree that can cause quite a few allergic symptoms.
This Christmas special looks at some of these ‘Christmas Allergy Suspects‘:
Don’t let these 10 Top Christmas Allergy Suspects spoil your season fun!
Christmas allergy suspect #1: Christmas tree
Allergic contact dermatitis – reaction to colophony, also known as rosin, is the sap or sticky substance that comes from pine and spruce trees.
Allergic rhinitis – reaction to alternaria mould
Main trees are scotch pine (allergic conditions likely due to mold Penicillium spinulosum), followed by spruce tree (due to mold Epicoccum and Alternaria). Hose down the tree outdoors and handle with gloves to reduce the mold spores.
Even artificial christmas trees can cause a reaction as they have been stored and accumulated dust mites and molds in the basement.
Christmas allergy suspect #2: Poinsettia
Cross-reactivity with latex allergy observed in a case study
Christmas allergy suspect #3: Christmas cactus
Contact urticaria and rhinoconjunctivitis (of workers at a cactus nursery)
Christmas allergy suspect #4: Christmas candy
Asthma (of a candy maker) after exposure to pectin, a compound in Christmas candy
Christmas allergy suspect #5: Food, Cocktails
Common allergens are milk, eggs, soy, fish, shellfish, peanuts, tree nuts and wheat. Ask before you eat or inform the host. If you’re hosting, take care to avoid these allergens or avoid them in some of the dishes and not re-use the utensils without washing.
Allergens in cocktails include sulfites in wine, maraschino cherries, and tree nuts in beer.
Christmas allergy suspect #6: Pets
If you’re allergic to pet dander, it’d be best to check out if the home you’re visiting has pets. The concentration of pet dander allergens are usually higher during Christmas, due to more time spent indoors.
Christmas allergy suspect #7: Dust mite
Though dust mites are present all year round, it is worse during the holidays as we spent more time in our bed with the cold weather.
Christmas suspect #8: Artificial snow or Frosting
Asthma can be triggered when spraying artificial snow or any chemical spray (say on frosted window) can irritate the eyes, nose, lungs and skin.
Christmas suspect #9: Stress
Stress is a known trigger for eczema and asthma – go easy on shopping and visiting schedules.
Christmas suspect #10: Candles, air fresheners, potpourri
It may add an extra touch to your home for the holiday season but these give off compounds that irritate the nose and throat.
Enjoy Christmas, and remember it is the time for celebrating Christ’s birth and his love for us.
For unto you is born this day in the city of David a Savior, who is Christ the Lord.
This is the last of Skin Facts series and as we come to a close in 2015 and usher in 2016, one Skin Fact to look at is how our skin renew itself. The dermatological terms are ‘epidermal cell proliferation‘ which takes into account the turnover of cells and there are differences between normal adult, baby and eczema skin. Here’s a look at Skin Renewal Facts!
Basics of Skin Renewal
Skin Renewal in Baby and Eczema Skin
The skin regenerate itself every 27 to 39 days, meaning that the cells from the lower layer of the epidermis (outer layer) move up to the surface and differentiate. The epithelial cells are called keratinocytes and they have different structures within the different layers of the epidermis (from the deeper basal layer, to spinous, granular to the corny layer at the surface). The top layer is also known as the stratum corneum, for which we have looked into the transepidermal water loss through stratum corneum.
This skin renewal is not related to wrinkles as wrinkles are primarily due to the loss of collagen, which is in the dermis (middle layer) of skin. Baby skin feels ‘softer’ and more elastic likely due to shorter collagen fibres.
Baby Skin – Cell Turnover Rate
Microscopic examination of baby skin showed that baby stratum corneum is 30% thinner than adult skin, and that baby epidermis is 20–30% thinner than adult skin. The cell size at the corny layer of the baby skin is smaller, which implies that the baby’s cell turnover rate is higher. This correlates with better wound healing in infant skincompared to adult skin. Epidermal cell proliferation rate decreases with age.
Eczema Skin – Defective Protein
As cells proliferate, there are proteins that are expressed by the skin cells. Studies have been made on various proteins and one of the most distinguishing (lack of) proteins is that of filaggrin (FLG), which serves to produce and protect the skin barrier. In people with eczema, there is lower level of FLG, resulting in flatter skin surface cells, disrupted protective fatty layer, reducing the moisturizing function of the skin and increasing water loss from the skin. Reduced FLG also increases the skin pH and leads to increased skin inflammation. It is possible that for eczema skin, the defective protein expression makes it unable to proliferate but instead ‘terminate’ at the basal layer. This has the effect of weakening the skin structure.
Around end November 2014, I ran a blog series on Children Food Sensitivities, explaining there are various types of gluten-related food sensitivities, namely:
Various types of gluten-related conditions
Celiac disease – Immune system attacks the villi in the esophagus when exposed to gluten protein gliadin, found in wheat, barley, rye, and sometimes oats. This lead to intestinal inflammation, flattening of the villi and long-term damage to the small intestine.
Non-Celiac Gluten Sensitivity (NCGS) – Diagnosis is not straightforward with no proven medical test. It is typically diagnosed after elimination of other similar conditions (for instance, wheat allergy, Irritable Bowel Syndrome) and after observation and further consultations.
Wheat Allergy – Involves an immune Ig-E mediated reaction to the wheat protein, can be diagnosed via allergy test.
It was debatable in 2014 then as to whether non-celiac gluten sensitivity (NCGS) even exists as (i) it is difficult to diagnose NCGS, and (ii) some studies concluded that it is actually sensitivity to FODMAPs rather than NCGS. (Gluten-containing grains are high in FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols) which are sugars/ carbohydrates that tend to be poorly digested, e.g. frutose.
Almost a year later in 2015, we want to examine (i) whether non-celiac gluten sensitivity (NCGS) is a clinical entity (ie we are sure there’s such a medical condition) and (ii) its impact on eczema or skin rash.
Methods: 17 patients affected by NCG, median age 36, 76% females, with itchy rash similar to eczema, psoriasis or dermatitis herpetiformis; wheat allergy and celiac disease tests were carried out to confirm that these 17 patients were not suffering from these.
Finding: Skin improvement noted after a month of gluten-free diet
In this paper, non-celiac gluten sensitivity is stated as a clinical syndrome characterized by both intestinal and extraintestinal symptoms, which are responsive to gluten (wheat) withdrawal from the diet.
Its estimated prevalence is 3% to 5% and a syndrome from multiple factors.
From this paper, a diagnosis pathway was suggested to determine if one suffers from NCGS. The blind gluten challenge remains a ‘gold standard’ for diagnosis; if going on a strict gluten free diet, it is maintained for at least 3 weeks to observe if symptoms improve.
NCGS Diagnosis; copyright of World Journal of Gastroenterology, June 2015; 21(23); 7110-7119; Figure 1
It seemed from recent studies that NCGS remained a syndrome without an easy way of diagnosis. The latest study that noted an association between gluten and skin rash would likely be considered as being on a small scale. However, the possibility of skin rash linked to gluten cannot be dismissed and more collaboration between dermatologist and gastroenterologist would increasingly be seen as more patients suspect gluten as a source of their skin problems.
Update on 17 October 2016 – A new study showed the possible group of proteins found in wheat – amylase-trypsin inhibitors (ATIs) – to trigger an immune response in the gut that can spread to other tissues in the body. From MedicalNewsToday
ATIs only make up a small amount of wheat proteins – around 4 percent – yet the immune response they induce significantly affects the lymph nodes, kidneys, spleen, and brain in some people, causing inflammation. ATIs have also been suggested to exacerbate rheumatoid arthritis, multiple sclerosis (MS), asthma, lupus, and nonalcoholic fatty liver disease, as well as inflammatory bowel disease.
What’s your experience with gluten? Do you think your child has gluten sensitivity? Share in the comments and we can all learn from it!
It’s tough when there’s so much information as well, is our formula milk safe or not?
The ‘screen’ is from Dr Mercola’s website and I don’t think it’s untrue as another dermatologist has mentioned the inflammatory effects glycation has on our body. The question should be what is the best alternative if I can’t breastfeed, instead of breastmilk vs formula milk (‘breast milk is best’ remains the recommendation). I remembered researching ingredients of formula milk and almost gone crazy. In a way, I’m glad the formula milk is over and we moved on to drinking fresh milk. For more Mom NeedyZz cartoon, see here.
This is the 6th post exploring ‘Skin Facts’ and today’s focus is on the lipids/ fats in our skin. There is distinct difference between the skin lipids of normal adult skin, baby skin and eczema skin. Let’s explore skin lipids!
Types of Skin Lipids
Skin Facts – Lipids in Baby and Eczema Skin, and its functions
There are lipids from both sebaceous and keratinocyte/ epidermis:
Sebaceous – from sebaceous glands and coats the skin surface, mainly triglycerides, wax esters and squalene, fatty acids and smaller amounts of cholesterol, cholesterol esters and diglycerides
Epidermal – found between the epidermal skin cells, mix of ceramides, free fatty acids and cholesterol
Lipids from Sebaceous Glands – Sebum
The concentration of sebum is higher at the forehead, face, scalp, upper chest and back and lower on the hands and feet and none on the palms and soles.
Function of Sebum
Deliver antioxidants to the surface of the skin in the form of vitamin E
Increased protection via increasing impermeability of skin
Maintenance of skin moisture content
Eczema and Lipids
Atopic dermatitis is associated with reduced epidermal lipids in all three categories – reduced ceramides, cholesterol and free fatty acids
The lack of lipids lead to a weak ‘brick and mortar’ structure where the lipids are akin to the mortar that keep the skin cells (bricks) together. This weakened skin barrier is associated with increased transepidermal water loss and increased skin permeability
The subcutaneous fat in baby skin is rich in the saturated oils – palmitic and esteric acid, with the following characteristics:
Higher melting point temperatures – freeze more easily (such as eating ice or popsicle for hours!), thus avoid extreme temperature for babies
Saturated vs Higher unsaturated oleic acid and linoleic acid in adults
Infant skin contains less total lipids compared to adults
Malnutrition is linked with changes in surface lipids, where an alteration in skin lipids has been observed due to essential fatty acid deficiency
With a lower lipid skin content, it is important not to excessively wash baby skin and further remove the skin lipids.
Other posts on EczemaBlues.com on skin lipids are:
Eczema News – ‘Lipid fingerprint’ Treatment Approach : Where the Oregon State University is developing a system to identify the missing lipids in an individual skin, thus the possibility of getting moisturizer to replenish the specific deficient lipid.
Last week, we learnt much about LAB Fermented Extract (Biogenics 16) and its effects on a child’s intestinal health, as well as the dosage and safety of Biogenics 16. This 2nd part of the series will focus on clinical studies on LAB Fermented Extract’s effect on skin and eczema, specifically examining the two published studies conducted by Japan researchers. It is seen in various studies the preventive effect of probiotics on onset of eczema and today’s sponsored post focus will be on lactic acid bacteria (LAB) fermented extract and its efficacy on skin.
As always, I appreciate that the marketing team at Lifestream Group has gone the extra mile to provide the case studies below and also to have the manufacturer and its team of medical professionals answer questions on Biogenics 16.
The study of the effect of LAB Fermented Extract on atopic dermatitis was conducted by Dr Shigehiro Tsuchiya of Tsuchiya Hospital, Japan.
Patients: 2 children (boys), age 7 and 9
Skin condition: Reactive skin conditions characterized by generalized rashes with itch; treatment received had included oral and topic administration of 10cc per day of LAB Fermented Extract.
Duration of study: 2 months
Finding: Rashes improved gradually over two months and no longer visible, with decreasing IgE levels. No relapse of rash was seen within the next 12 months.
MarcieMom: I understand that the study was a case study, instead of a double-blind placebo controlled study. Whenever it comes to atopic dermatitis, it is difficult to control all variables due to eczema being a multi-factorial condition. To give some background to readers, many of whom are parents of eczema children, is there information on:
(a) How long did the two boys have eczema and did they have any confirmed allergies?
Both boys have been identified with eczema years prior to the study.
(b) Did the two boys continue with their corticosteroid topical or oral application during the two months of taking LAB?
They did not continue with any oral forms of medication, except for a topical corticosteroid during the test period. The test results were measured according to IgE level which has more relevance to consumption of LAB Fermented Extract. Test results indicate a significant improvement after using LAB Fermented Extract.
Image from the study provided by Lifestream Group
(c) Were there any other eczema therapeutics that were given to the two boys during the two months? (for instance, bleach bath therapy, wet wrap therapy)
No other eczema therapeutics was given to the 2 boys during the test period of 2 months. Results observed were based on the beneficial effects of LAB Fermented Extract (Biogenics 16).
MarcieMom: More research is showing the link between our gut flora and our skin flora. Similar to the intestinal gut, our skin has both good and bad bacteria. In an interview with former president of American Academy of Dermatology, readers have learnt that our skin has beneficial bacteria, e.g. staphylococcus epidermidis and bad bacteria such as S. aureus and S. pyogenes. Of interest to eczema sufferers is staphylococcus aureus which frequently colonizes eczema skin, making it difficult for eczema to recover while increasing skin inflammation.
I’d like to understand the mechanism of how LAB Fermented Extract improves eczema, does it
(a) Impact the skin flora by encouraging growth of beneficial bacteria on the skin, or
There have been studies showing the effectiveness of topical probiotics in inhibiting the growth of bad bacteria, virus and yeast in skin. In the study by Dr Shigehiro Tsuchiya of Tsuchiya Hospital, Japan, it is reflected that oral and topical application of Biogenics 16 is effective in improving the condition of atopic dermatitis in the 2 subjects. Since LAB Fermented Extract does not contain live bacteria, the risk of allergies or rejection by skin flora can be further minimized. However, further research is still being carried out at this point on the exact benefits in topical application of Biogenics 16.
(b) Impact the skin health by encouraging growth of beneficial bacteria in the intestine or other mechanism?
A healthy intestine with balanced gut flora is important to keep the skin healthy and for overall well-being. Unhealthy intestine dominated with bad bacteria may be one of the causes of poor skin condition which may be due to the following possibilities:
1. Unbalanced gut flora increases intestinal permeability, leading to a condition known as “leaky gut syndrome”. This means that bad bacteria, toxins, undigested foods and other foreign substances gets leaked out into the bloodstream, contributing to systemic inflammation which may lead to poor skin condition.
2. The damage to the mucosa triggers an inflammatory reaction from the immune system. The continuous cycle of inflammation worsens the state of the gut, leading to poor skin health.
Different from probiotics or prebiotics, LAB Fermented Extract does not contain live bacteria, but instead is a high strength extract resulted from the co-culture of 16 unique strains of Lactic Acid Bacteria extracted using a unique, patented extraction process. It encourages the proliferation of our intestine’s own good bacteria, while suppressing bad bacteria. When the condition of intestinal permeability is improved, skin condition will also be improved, as less foreign substances can reach the bloodstream. This will reduce skin inflammation as well as lower the level of IgE, which can be identified from the clinical study by Dr Shigehiro Tsuchiya in the chart in fig.1
Image provided by Lifestream Group
By supporting the improvement of our intestinal health with LAB Fermented Extract, much of the mentioned symptoms, including skin condition may then be improved.
The next skin-related study was on Effects on Female Beauty, by Dr Shintaro Hashimoto, Daimyo-cho Skin Clinic, Japan.
Subjects: 75 female, age 30 to 70 (average age of 35)
Duration of study: 30 days
Finding: Improvement in skin texture, skin moisture retention, reduction in acne and skin breakout, improvement in skin elasticity; This was seen that sulcus, or grooves in the skin, straightened and the skin became smoother.
MarcieMom: This is an interesting study and possibly have implications for people with defective skin barrier. Often, the skin barrier is considered defective for eczema children because it is dry (inability to retain moisture and short of skin lipids) and porous (vulnerable to irritant penetration). An improvement in skin texture and moisture retention is therefore helpful and since LAB Fermented Extract is safe for infants, theoretically, parents have another ‘tool’ to use to prevent the onset of eczema. (The studied ‘tool’ is via moisturizing from 3 weeks old for high-risk infants.)
Moreover, we have seen research whereby sensitization to food comes from outside-in, i.e. via the skin. It is therefore of great comfort to parents to ‘arrest’ the allergic march by strengthening the child’s skin barrier from young.
Again, can you explain
(a) the mechanism of how a healthy gut affect the skin barrier?
Our intestine is the largest immune organ in our body. Many of the skin issues occurring maybe caused due to a lowered immunity. Therefore by improving our intestinal health through proliferation of our good bacteria and suppressing the bad ones, we will be able to effectively improve our immunity, in turn relieving skin symptoms.
(b) the layer of skin cells (epidermis, dermis) that improved with LAB Fermented Extract?
Results of the study is based on a questionnaires answered by the subjects on their skin condition. Other skin texture improvement in this study is being observed and analyzed on the epidermis of the skin. Improvement in epidermis often is reflected when there is improvement in the base layer and dermis of the skin.
(c) whether the improvement in the skin cells is permanent or is it one whereby LAB Fermented Extract has to be taken regularly to maintain the improved skin barrier?
Our body is constantly under attack from harsh environments, processed foods, stressful lifestyles and also ever changing virus strains. All these contribute to a lowered immunity, which also affects other parts of our body including skin condition. By ensuring that our intestine has sufficient support in maintain a good colony of good bacteria and suppressing bad bacteria, it will lower chances of skin issues, helping us maintain not use good quality skin, but optimal health.
Biogenics 16 is also recognized by more than 850 clinics in Japan, many of which is skin related.
Get additional $5 of website price when you purchase Biogenics 16 at www.lifestreamgroup.com. Simply quote coupon code MEI5OFF upon check out to get the discount.
Promotion valid from 3-31 Dec 2015
Terms & conditions apply
Lifestream manages LABO NutritionTM under which Biogenics 16 is distributed. Parents can understand from this sponsored post how taking LAB supplement can affect the skin and potentially, improve eczema.
We can’t live without water and it is an area which many parents suspect may have something to do with the eczema. Water that we drink or bathe in has been covered in this post, but today’s post is focused on Water Hardness and reviewing the research in this area.
Finding: Exposure to hard water and infant swimming interact with atopic status increased the prevalence of childhood eczema. A breaching of the epidermal barrier by detergents or salts in hard water and by chlorine-based oxidants in swimming pool water might explain these interactions.
Finding: Water hardness in the area where 6-7 year-old schoolchildren live has some relevance to the development of eczema.
It seemed that although water hardness is believed by parents to have an impact on eczema, this is not seen in research, the most definite trial is that in Feb 2011 which was a randomised controlled trial as opposed to analysis of data.
On the study noted that swimming worsened eczema but swimming is useful for killing of staph bacteria (and a fun and fit way as opposed to bleach bath). Some advice by doctors who have addressed the topic of swimming on this blog:
It’s good to say that swimming and atopic eczema usually go together just fine. The problem is caused by the water – it washes off a layer of the skin’s protection and leaves it very porous to water loss afterwards: a thin application of moisturizer before swimming protects against this.
Otherwise, the chemicals in the water of a swimming pool are disinfectants – chlorine, & bromine for example – they can be good for the skin, as their antibacterial effect is anti-inflammatory. However these additives can irritate too.
Swimming for long periods during a bad flare of eczema is not advisable as the swimming pool water may cause more skin dryness.
What’s your experience with hard water or did you purchase any of the water treatment kit for your home? Share in the comments so that other parents can learn from your experience!
Many chemicals come into contact with our skin, some intentional and others inadvertently. How much chemicals penetrate our skin?What about that of a baby or those who have defective skin barrier like eczema sufferers? This 5th post of Skin Facts series explores the chemicals our skin comes into contact with.
Our Skin Structure – How do Chemicals Penetrate?
Chemicals definitely penetrate certain layers of our skin, otherwise, the skincare industry will collapse if all skincare products just stay on the skin surface and no product can claim to improve your skin! Chemicals penetrate different layers of skin barrier (that’s part of the ‘price’ we pay for a skincare product where technology is involved to enhance penetration).
Here are 3 Ways Chemicals Penetrate our Skin:
Penetration/ Transcellular absorption – via the stratum corneum through the corneocytes (flattened cells that made up the horny layer); Stratum corneum contains about 40% protein (primarily keratin), 15% to 20% lipids and 40% water.
Intercellular absorption (main route) – Chemical is transferred around the corneocytes in the lipid-richextracellular regions; Lipids present in the intercellular spaces of the stratum corneum are by weight: 45–50% ceramides, 25% cholesterol, 15% long-chain free fatty acids and 5% other lipids, the most important being cholesterol sulfate, cholesterol esters, and glucosylceramides.
Michaels et al. (1975) is the one who came up with the ‘brick and mortar‘ analogy describing corneocytes filled with lipids. Dermatologists explain eczema skin has the wall without strong mortar holding the bricks.
Appendageal absorption – Chemical bypasses the corneocytes, entering the shunts provided by the hair follicles, sweat glands, and sebaceous glands
Baby Skin – More Chemical Penetration?
Chemical Penetration in Our Skin and Our Children
The baby skin is not fully developed, where Infant stratum corneum was found to be 30% thinner and infant epidermis 20% thinner than in adults. More chemicals penetrate due to this and there’s higher risk associated with this penetration due to:
High surface-area to volume ratio
Higher metabolic rate, higher respiratory volume
Immature drug metabolism, drug carriage and detoxification systems
Decreased subcutaneous fat stores that (i) increase absorptive area and (ii) decrease the volume of distribution of the chemical
Higher chances of injured skin (for instance, from adhesive tapes) increase skin permeability
Vulnerable to endocrine disrupters
Eczema Skin – How Defective Skin Barrier Affect Chemical Penetration
Eczema skin is defective which allows more chemicals to penetrate and be absorbed with possible effects of:
Enhanced absorption of a specific chemical
Entrance of larger molecules such as proteins and nanoparticles
Facilitate entrance of chemicals into and through the skin
The Care in Chemicals
With increased chemical penetration, it follows then that we ought to be extra careful of what goes onto baby skin as well as eczema skin (and baby’s eczema skin!). It is impossible (and not necessary) to aim for zero chemical contact, instead know which types of products not to use and what skincare/ cosmetics ingredients to avoid:
Soap – Avoid as it is drying (due to alkalinity) and harsh for skin; alternative: use a gentle cleanser/ bath oil/ oatmeal bath
Anti-microbial wash – Avoid; read this post to learn more about effects of anti-microbial wash and its ingredients that irritate skin
Shampoo – Choose one without key irritants (see below)
Antiperspirant – Safe to use, can opt for an aluminium and paraben free one (see WebMD article)
Skincare moisturizer – Choose one without key irritants (see below)
Detergent and detergent residue on clothes – Use a hypoallergenic one and turn on a longer cycle (see this post)
Toothpaste – Safe to use, just don’t overuse
Baby wipe – Choose one without Methylisothiazolin (MI) and fragrance free (see this post)
Bubble bath – Avoid as the average bubble bath is irritating to skin
Cosmetics – Throw away expired cosmetics
Instead of trying to eliminate all chemicals, it’d be more practicable to avoid ingredients that are known irritants or suspected to cause harm:
AVOID #1 Perfume
Fragrance, phthalate esters, synthetic musk compound, Benzyl alcohol, scent, aroma, Abietic acid, alcohol, Abitol (see this post on various names of perfumes)
“The average fragrance product tested contained 14 secret chemicals not listed on the label,” reports EWG, which analyzed the Campaign’s data. “Among them are chemicals associated with hormone disruption and allergic reactions, and many substances that have not been assessed for safety in personal care products.” EWG adds that some of the undisclosed ingredients are chemicals “with troubling hazardous properties or with a propensity to accumulate in human tissues.” Examples include diethyl phthalate, a chemical found in 97 percent of Americans and linked to sperm damage in human epidemiological studies, and musk ketone, which concentrates in human fat tissue and breast milk. Fragrance secrecy is legal due to a giant loophole in the Federal Fair Packaging and Labeling Act of 1973, which requires companies to list cosmetics ingredients on the product labels but explicitly exempts fragrance.”
I find it interesting because if you look at your perfume, even the most expensive ones, you would find many of them are irritants and definitely hard to pronounce! There are also ingredients that are ‘hidden’ behind proprietary names given by the brand.
Consequence: Irritate, allergenic, allergic rhinitis, chronic sinus, asthma, accumulate in the environment, the body and the breast milk, disrupt the endocrine system (Endocrine system is a network of glands that produce and release hormones).
1,2 Propanediol, 1,2-dihydroxypropane, methyl glycol, trimethyl glycol (Ethylene Glycol is more toxic than propylene glycol)
Found in: Skincare products, shampoo
Consequence: Known irritant for babies, infants and those with sensitive skin conditions such as eczema, or those with prolonged dermal contact e.g. during treatment of burns
Found in: Shampoos, conditioner, bath additives, toothpaste, baby wipes
Consequence: Irritant and drying to skin, corrodes hair follicle and impedes hair growth
Here’s what I learned from dermatologist Dr Cheryl Lee on surfactants used in our product (see post):
Surfactants are designed to remove dirt and oils from the skin, but the problem is that they can also remove the lipids from the skin as well. This leads to disruption in the skin barrier and exacerbates all the skin barrier problems in atopic dermatitis…Of note, a recent study by Belsito et. al., showed that the surfactant cocamidopropyl betaine (CAPB) is more likely to cause allergic contact dermatitis in people with atopic dermatitis than in those who do not have atopic dermatitis.
Some of the above chemicals are UV-filters such as oxybenzone that are excreted in the urine after application to the skin. Sun protection is a must, choose a physical blocker type and learn more in Skin Fact – Sun Protection in Adult, Infant and Eczema Skin
Consequence: Biochemical or cellular level changes, disrupts the endocrine system, accumulates in breast milk and in the environment, photo allergic reaction (PABA)
Others to Avoid
Triclosan – Present in shampoos, bath cleansers, toothpast and baby wipes, can cause allergies and bacterial resistance (see this eczema news on household products’ exposure)
It is studied that twice daily moisturization with a hypoallergenic (meaning no fragrances, no essential oils, no plant extracts, no formaldehyde-releasing preservatives, no lanolin, no neomycin, no bacitracin, no methylchloroisothiazolinone) moisturizer in high-risk newborn babies lead to an approximately 50% reduction in rates of new onset atopic dermatitis.
We have also looked at infants being more susceptible to sunburn. This, on surface, seems to suggest that putting on moisturizing and sunburn is good for the babies but there’s a major caveat that you should not be putting on harmful chemicals since so much more chemicals penetrates infant skin (and possibly even more for infants with defective skin). Use good quality moisturizer, tested safe for babies and without the key irritants AND avoid sun (rather than ‘suntan’ a baby with sunscreen as we’ve seen sunscreen contains quite a fair bit of irritants!).
Intestinal health has gained importance in recent years due to studies that showed the link between intestinal health and numerous other health conditions, (beyond gastrointestinal conditions) even to skin and allergic conditions. It is known that not all probiotic strains are effective and also not all probiotic supplements are of high density and quality to have an effect on intestinal balance.
Today’s sponsored post is on LAB Fermented Extract, known as Biogenics 16 in Singapore. Questions are answered by the manufacturer and its team of medical professionals, an aspect which I appreciate as it showed the level of commitment and transparency. The key features of Biogenics16 and its impact on a child’s health are the focus of this 2-part blog series.
Feature #1 High Strength with 16 Unique Strains of LAB
LAB fermented extract is neither prebiotics or probiotics, but an extract of secretions and bacteria body substance of lactic acid bacteria from 16 high strength bacteria strains through a patented extraction technology. The 16 bacteria strains include L. acidophilus, L. brevis, L. casei, L. curvatus, L. fermentum, L. plantarum, L. rhamnosus and L. salivarius.
It was observed by the late Dr Kazuyoshi Masagaki that ingested probiotic supplements do not survive well in body temperature and the acidic stomach environment, thus expelled as the body may not recognize it as its own. Instead lactic acid bacteria (LAB) fermented extract helps the body proliferate and grow its own good bacteria. At the same time, it also strengthens the immune cells, 70% of the body’s immunity cells are found along the intestinal walls.
MarcieMom: I read your report that about 95% of probiotics ingested get destroyed by stomach acid and most probiotics degenerate at temperature more than 25 degrees C. It is indeed worrying as probiotics products are not cheap and if most of them get destroyed, it appears then it is of limited efficacy. On the other hand, Biogeneics 16 uses an organic, non-GMO soya bean broth as a culture medium, to cultivate and extract the friendly strains with patent technology to encourage the body to grow its own friendly bacteria while diminishing the bad bacteria.
Like to clarify:
a. When we talk about probiotics, we usually talk about the strains to be at least in billions of colony forming units (CFU). What is the equivalent unit of measure for Biogenics 16?
Biogenics 16 does not contain live bacteria. It is instead an extract of Secretions and Bacteria Body Substance of 16 strains of lactic acid bacteria that are clinically proven to increase natural growth of body’s own friendly bacteria effectively for better health.Thus, it is unnecessary to measure the forming units of bacteria.
b. If LAB’s Fermented Extract is able to encourage the growth of good bacteria, why is it recommended to be taken daily? i.e. should it be taken more initially and when the gut is able to produce the good bacteria on its own, the dosage can then be reduced?
Factors such as poor diet, stress, pollutants, prescription of drugs and antibiotics deplete the amount of good bacteria in our body while contributing to the proliferation of bad bacteria. The imbalance of intestinal flora may lead to many health problems especially constipation, indigestion and undischarged toxic waste accumulate and may leak back into the body. Thus, it is important to take LAB’s Fermented Extract daily so as to ensure the balance of good bacteria while continuing to inhibit the on-going growth of bad bacteria, in order to achieve optimum gastrointestinal health.
Feature #2 High Resilience and Higher Performance
LAB Fermented Extract had been tested in clinical studies to improve
Intestinal health – 1. The level of bad enzymes/ carcinogens decreased during the time of administering LAB; 2. The intestines appeared cleaner after taking LAB for 4 weeks to 2 months
Immunity – where a higher amount of bad bacteria led to increase in intestinal toxins in the intestine, bloodstream which can affect nutrient absorption and oxygen circulation
Bowel irregularity
Rash and skin texture – will be covered in part 2 of this series
Oral health
MarcieMom: Children suffer from a range of gastrointestinal conditions, such as indigestion, constipation and diarrhea. At the same time, parents want to feed their children healthy but if the healthy food is not absorbed due to gut imbalance, it seems pointless to have good nutrition. I’m interested in how LAB Fermented Extract helps in nutrition and immunity:
a. We won’t know if a child is absorbing nutrients properly – do you have pointers where a parent can use to ‘gauge’ if the child has enough good bacteria?
A healthy child with enough good bacteria does not fall sick as easily, has lots of energy, clear skin, bright eyes and a good appetite. His weight will also be within healthy range.
In contrast, one with an unhealthy intestine tract has low immunity, bowel irregularities (constipation/diarrhea), is more lethargic and easily succumbs to allergies and infections. These symptoms can be indicators that your child does not have enough good bacteria in their intestine.
b. How does having good bacteria in the gut translate to high nutrient absorption and immunity? And which of the 16 strains help with this?
The small intestine is the place where nutrients are being absorbed in the body. If there are insufficient good bacteria in the intestines, the ecology of the good and bad bacteria gets upset. With insufficient good bacteria to digest food, bad bacteria take over and undigested food that is not discharged regularly from the bowels will clog up the gut. Undischarged wastes create toxins and cause the body and its vital organs to work harder and this creates stress on the body. Nutrients absorption is naturally compromised.
LAB Fermented Extract in Biogenics 16 is produced from the co-culture of specially selected 16 strains of LAB. When consumed, Biogenics 16 works in three ways, namely:
Creating a conducive gastro intestinal environment to encourage the natural proliferation of the body’s own bacteria, which is the best fit for the individual as compared to foreign ingested probiotics.
Suppressing bad bacteria. As the good bacteria flourish in the environment facilitated by LAB Fermented Extract, the bad bacteria colony shrinks and its reproduction is inhibited.
Strengthening the immune system and Peyer’s Patch (an immune sensor of intestine) to activate immunity cells. (70% of entire body’s immune cells – Gut-associated lymphoid tissue (GALT) are located in intestine).
Feature #3 Premium Quality and High Potency
The fermentation and maturation of Biogenics16 is maintained at a fixed temperature and humidity for a period of 1 year. The patented technology helps to deliver high quality and consistent active ingredients. The dosage is half a sachet for children two years and above, and 1 ml drop for children below two years old. Biogenics 16 is lactose-free and gluten free.
MarcieMom: On the dosage for children, I’m curious to find out if (a) taking a full sachet will have side effects or will it be ‘wasted’?, (b) the effect of taking LAB Fermented Extract on alternative day as opposed to daily?, (c) what if the child is already taking fermented drinks like Yakult and Vitagen or already taking probiotics supplement?
a) Biogenics 16 LAB Fermented Extract does not contain any live bacteria, sugar, additives, pesticides, colouring or flavouring, making it absolutely safe for children consumption.
b) Observing your child’s stool is a good way to gauge if he/she is actually taking enough. Yellowish brown and odorless stool would indicate that your child is having good intestinal health, while dark brown with foul odor would mean otherwise. Through this observation, you will be able to better decide how much LAB Fermented Extract your child actually requires.
c) According to Dr Hiromi Shinya, a pioneer of modern colonoscopic techniques and author of many bestselling books in Asia, taking fermented drink that contains non-resident (ie. Not the body’s own) bacteria are not fully effective in increasing the beneficial bacteria living in the intestine. This is because the live bacteria in fermented drink are not heat stable and as much as 95% of the bacteria are dead even before consuming. Thereafter, the remaining bacteria are easily destroyed when passing through our acidic stomach environment, or excreted in the stool if the body recognizes it as a foreign bacteria. Aside from that, fermented milk products may also contain high amounts of sugar, which is unhealthy for the child’s diet.
Biogenics 16 is 100% resistant to heat and stomach acids. It encourages the growth of our body’s friendly bacteria while inhibiting the growth of bad bacteria, while strengthening the immune cells.
Feature #4 High Safety Assurance and Patented Extraction Technology
Biogenics 16 is safe for all ages, including infants and elderly and in full compliance with the Japan Health Authority. There is no added sugar, preservatives, pesticides, artificial coloring and flavoring.
Feature #5 Proven Results, Trusted Choice
Biogenics 16 is an established product, researched for 100 years and backed by clinical trials.
MarcieMom: How long from the time it is manufactured can Biogenics 16 be safe to consume (product expiry)? And is there a certain period after which the product will degenerate?
The shelf life of Biogenics 16 is 3 years from the date of manufacturing. Made from high potency with controlled fermentation process and patented extraction technology in Japan, Biogenics 16 provides LAB Fermented Extract that is highly stable and provides the same effectiveness and benefits for consumption by the date of expiry.
Get additional $5 of website price when you purchase Biogenics 16 at www.lifestreamgroup.com. Simply quote coupon code MEI5OFF upon check out to get the discount.
Promotion valid from 3-31 Dec 2015
Terms & conditions apply
Lifestream manages LABO NutritionTM under which Biogenics 16 is distributed. It is very useful information for parents and certainly help parents to be more aware of the child’s intestinal health and also in assessing products for it. Next week’s sponsored post will help readers of this blog understand how LAB Fermented Extract affects skin and improves eczema.
At end September 2015, it was announced on various medical new sites that Oregon State University’s researchers have developed a new approach to treat eczema that is
Personalized; and based on
Individual lipid deficiencies (akin to lipid fingerprint)
The new system patented (yet to be developed) requires testing of skin and lipid samples (from sticking and pulling off a piece of tape on/from the skin), using a mass spectrometry. The testing is non-invasive and suitable for infants and elderly as well.
Target Lipid Deficiency for Eczema Treatment
It is established that eczema skin is often lacking in lipids, the reason why many moisturizers have active ingredients to restore the skin lipid levels such as ceramides, cholesterol and free fatty acids. However, there are many types of skin lipids and researchers at OSU believe that choosing the skincare and therapeutic product that specifically target one’s deficient lipids will help eczema sufferers.
Hopefully when developed, the ‘lipid fingerprint’ system will address:
Steroid usage which has side effects with long-term use
‘One size fits all’ method of moisturizer selection
Reduce costs associated with doctor consultation and that of using the ‘wrong’ products – when the deficient lipids can be identified, it can then be known which lipid composition is missing, i.e. those that serve protective or barrier or antimicrobial function.
Associate Professor Arup Indra explained in an interview that “Lipids in our skin help retain moisture, they act like a blanket that protects against irritation and infection, You could think of skin cells as the bricks of a wall, but lipids are the mortar that prevent things from getting through the cracks. When they are deficient, problems can develop.”
Previous research by A/P Indra and other researchers has identified a protein (Ctip2) that is critical for forming and maintaining the skin barrier in mice, and for skin lipid metabolism. Mice that had Ctip2 removed had dry and scaly skin, and developed skin lesions. The removal of Ctip2 also led to increased inflammation, with presence of high levels of inflammatory proteins, enlarged lymph nodes and spleen in the mice. Without Ctip2, TSLP (another protein that has been known to activate other cells to be pro-inflammatory, linked to eczema and asthma) also became 1000-fold higher in the mice.
It is interesting research by the College of Pharmacy at OSU and my personal thought is that even if targeting deficient lipids alone may not ‘cure’ eczema for everyone, it will definitely help to reduce the cost of buying moisturizers that are not the ‘right lipid fit’. Keeping fingers crossed that R&D in atopic dermatitis will have breakthrough in the next few years to provide relief for all eczema sufferers.
Mommy Kate is on the brink of going nuts! It happened to me too, trying to figure out whether there is ONE food safe in this world for my baby – my tip, take an allergy test! For more Mom NeedyZz cartoon, see here.
We have been learning about skin facts and last week, we learnt about insensible perspiration – which is transepidermal water loss that we cannot control. This week we are learning about sweating, sweat glands and how sweat affects eczema skin. First, the basics:
Why, How Much, Where and What of Sweating
Sweat – Why, How much, where and what
WHY – Sweating is a way to cool the body temperature whereby sweat glands in the skin are activated and release sweat. The evaporation of the sweat cools the body and those leftover sweat (on a humid day) leaves you soaked. See #SkinishMom post on sweaty occasions.
HOW MUCH – We sweat different amounts on different occasions; for an hour of exercise, one can sweat from 0.8 to 1.4 liters. Excessive sweating is ‘defined’ in terms of the sweating deteriorating the quality of life, a condition known as hyperhidrosis.
WHERE – This gets interesting as emotional sweating when you’re angry or anxious activate the sweat glands on the palms, soles and underarms! Sweating after eating spicy foods (gustatory sweating) are on the lips and forehead.
WHAT – Sweat is made up of water, ammonia, urea, minerals (like sodium and magnesium), trace metals, lactate and various salts and amino acids. The exact composition of sweat varies depending on diet, genetics and activity level.
Sweat Glands in Adults and Children
Sweat comes from two types of glands:
Eccrine glands – All over the body in the dermis (layer after the outer epidermis of skin), there are over 2 million eccrine glands. The sweat exit via a pore. The sweat from eccrine glands has no smell of its own but the smell comes from bacteria on our skin feeding on the oils in the sweat.
Apocrine sweat glands – At armpits and private parts, and the sweat exit via a hair follicle. Upon puberty, the glands make a thick, oily fluid which has a smell.
Women – More sweat glands then men, but less active
Babies – Babies are born with sweat glands but they are not activated, only the ones on the foreheads are! After the forehead, the sweat glands on the trunk, arms and legs are activated. In this Common Summer Skin Rash series – Heat Rash, dermatologist Dr Robin Schaffran explained heat rash, medically known as miliaria:
Miliaria occurs under conditions of high heat and humidity that lead to excessive sweating. Occlusion of the skin from too much clothing or blankets can aggravate the pooling of sweat on the skin surface leading to over-hydration of the skin. In susceptible persons such as infants who have immature sweat glands, this often leads to transient blockage of the sweat ducts. Therefore, as more sweat is produced, there becomes and inability to secrete the sweat because of the blockage.
Sweat and Eczema
Sweat is known to cause irritant reaction for those with eczema. However, what in the sweat irritates is not known. In the Skin pH series – Moisturizer and Skincare Products interview with dermatologist Dr Cheryl Lee:
As for sweat, the biggest problem is the irritancy of the sweat itself. The salts from sweat can crystalize and act as an irritant to the skin. If you can see that your baby’s sweat has dried and has a salty residue, then I would recommend rinsing it off with plain water (no soap) to prevent it from becoming an irritant.
It could be one of these compounds, the combination of them, the changing pH of the skin, or even the sweat’s water content that can cause the itching and stinging sensations to some people with eczema.
Eczema may also occur in those suffering from ichthyosis, a condition that has excessive skin scales, clogging sweat glands and preventing sweating normally. Pompholyx is another condition that some eczema sufferers also have, with a distinctive appearance of itchy small blisters on the palms of the hands. It is also more closely associated with excessive sweating and can be found on the soles and toes.
What milk to give a baby with eczema or a baby who is at high risk of eczema is ONE question that all parents ask – there are various options when it comes to milk:
(i) Breast milk – Recognized as the milk for babies up to six months of age, due to the natural protective benefits of breast milk and its ease of digestion, coupled with no artificially added sugar, salt and fats
(ii) Cow’s milk – An alternative to breast milk or supplement for breast milk; however, cow’s milk protein is the most common food allergen in young children (where the protein size is 10kD and more to act as an allergen)
(iii) Partially hydrolyzed milk – Commercially available, whereby the milk protein is broken down to protein size of less than 5kD; however, there is no strict definition of what qualifies as partially hydrolyzed formula and some partially hydrolyzed milk formula have about 20% of the peptides exceeding 6kD (kD is a measurement of its molecular weight)
(iv) Extensively hydrolyzed milk – Not commercially available in some countries, on prescription, whereby the milk protein is extensively broken down to protein size of less than 3kD.
(v) Other non cow’s milk formula, excluding goat’s milk as the goat milk protein is similar to that of cow’s milk
The Key Question is whether partially hydrolyzed milk protein is effective in preventing eczema. This is often examined alongside the questions of (i) whether it is cost effective to be put on hydrolyzed formula and (ii) inferior nutritional value of hydrolyzed formula.
Limited evidence (there’s still some evidence) of protective effect of partialy hydrolyzed formula for high risk babies
Let’s examine the research on whether partially hydrolyzed milk protein is effective in eczema prevention.
I have briefly looked into this in 2011 (post) and the research then showed that partially hydrolyzed milk is recommended for high-risk babies but not if there is a proven milk allergy.
In 2013 (post), research’s recommendation was for high-risk infants who cannot be 100% breast-fed, partially hydrolyzed milk is recommended.
Other more recent research: Allergic manifestation 15 years after early intervention with hydrolyzed formulas – the GINI Study where it is concluded that eczema is reduced in children who took partially and extensively hydrolyzed formula, with lower prevalence up to adolescents (11 to 15 year old). The GINI Study is German Infant Nutritional Intervention program study of birth cohorts, with many other interesting allergic conditions’ studies here
Dr Sears’ view is that unless recommended by doctor, parents should not opt for hydrolyzed milk on their own due to
High content of sweeteners to make hydrolyzed formula palatable
Artificially carbohydrates in the form of corn syrup, sucrose, corn starch or tapioca
High salt content
Artificially added fats
Also check out an extensive interview with registered dietitian on different types of milk for babies with eczema, allergies and reflux. It seems though that partially hydrolyzed milk formula is in practice recommended by doctors due to cow’s milk being the most common food allergen in infants. Research wise, there has yet to be a conclusion due to difficulty of conducting unbiased studies with sufficient (mother and baby) participants. What’s your experience in this? Do share in the comments!
This is the third week of ‘Skin Facts’ and last week, we’ve looked into the sun protection function of children vs adult skin, and how the sun affects eczema skin. Today, we’re looking into another critical function of skin and one that is very relevant for eczema skin – our skin’s moisture retention property. One can also view it as how much moisture is lost from our skin, known as Transepidermal Water Loss (TEWL). TEWL is studied by dermatologists, as excessive TEWL points to a defective skin barrier, and in severe cases, affect the ability of the body to function. Let’s go “water deep” into this skin function!
Water and our Body
Water makes up a large point of our body weight, here are some interesting facts about the water in our body from water.USGS.gov (the US Geological Survey website):
Water content in our Body
Lungs 83%
Muscle 79%
Kidneys 79%
Brain 73%
Heart 73%
Liver 71%
Skin 64%
Bones 31%
Percentage of Body Weight that is Water
Fetus 94%
Infant at birth 78%
One-year old 65%
Female 55% (due to higher fat content)
Male 60%
Elderly 50%
Functions of Water in our Body
Forms the building material of cell
Regulates body temperature by sweating and respiration
Transport via the bloodstream
Flushes waste via urination
Absorbs shock for brain and spinal cord, also lubricates joints
Forms saliva
Moisture Loss and Retention from Children, Normal and Eczema Skin
Water Loss from our Skin
Our skin allows water to be lost through it, as part of insensible perspiration (or transepidermal diffusion) and sweating. Insensible refers to us not being aware of it (another insensible loss of water is from respiration). Sweating helps regulate our body temperature, via cooling of the skin. However, sufficient intake of water is required in order for sweating to not dehydrate the body and continue to be effective in cooling our body temperature.
Much of the water is lost through the stratum corneum, the upper most layer of the epidermis made up of a dead cell layer. A defective stratum corneum layer will allow excessive epidermal water loss and potentially, increase risk of irritant and allergen sensitivity. Water loss from evaporation from our skin is about 400ml daily in an adult. For research news on how the skin can be a channel for allergy, see Food Sensitization from Eczema.
Transepidermal Water Loss (TEWL) from Children Skin TEWL from baby skin is higher than normal adult skin, due to their thinner stratum corneum. For premature infants less than 30 weeks, there are also fewer layers of stratum corneum resulting in increase fluid and heat loss. Interestingly, infant skin is found to have higher water content and able to absorb more water but lose excess water faster than adult skin.TEWL was also strongly predictive of AD at 12 months (study here). The natural moisturizing factor (protein breakdown products such as small amino acids, urea, pyrrolidone carboxylic acid, ornithine, citrulline, urocanic acid) in infant is also lower than an adult.
How this Impact Parents Caring for Baby Skin Protection of the stratum corneumis important, and this can be via:
Reduced bathing – Washing baby skin with a washcloth during the first 4 weeks of life is associated with increased TEWL and decreased stratum corneum hydration compared with simply soaking in water. The recommendation is to use a mild liquid cleanser with water (less drying than water alone), and that bathing should be brief (10 minutes or less) and no more than every other day with spot cleaning in between.
Good bathing regimen – Includes not using hot water, not scrubbing the skin dry (but pat dry), keeping it short to 10 minutes, not using soap and moisturizing right after (see video)
Good skincare regimen – Moisturizing protects the skin barrier (see video). It is important to note that given the thinner stratum corneum of infants, their higher surface area to body ratio, infants are more vulnerable to toxicity of products. Therefore, be sure you understand the product label (there’s a comprehensive Sensitive Skin Products blog series to help you with that).
Transepidermal Water Loss (TEWL) from Eczema Skin
TEWL is studied to be higher in eczema skin and also dry skin (without eczema). The water content of stratum corneum is also lower in adults with eczema than normal skin. It is also studied at the natural moisturizing factor of eczema skin is defective, lacking in proteins that are able to play a role in the skin’s humectant property – the ability to pull moisture from the environment and retain this water (which is why 2nd generation moisturizers incorporated humectant property, learn more here).
Drinking Water and Skin
A myth. Dehydration will affect skin but drinking excess water will not lead to ‘glowing’ skin. Drinking enough water will also not prevent skin aging or wrinkles as these are related to genetics, sun and oxidative stress brought on by pollutants. Read this #SkinishMom Investigation! – Drinking water for dry skin
To round-up, we learnt that water is integral to our body and to our skin. We have insensible water loss and a thinner stratum corneum in baby skin and a defective stratum corneum in eczema skin both results in increased transepidermal water loss (TEWL). This knowledge should encourage (not discourage!) us to be more committed to a good bath and skincare routine.
Elimination diets are often tried out at home to see if the child’s eczema improved after eliminating certain foods. The common food allergens for young children are eggs, cow’s milk, soy and wheat and in certain cases, parents may
(Scenario 1) eliminate such foods when tested positive in allergy tests, or
(Scenario 2) eliminate such foods even when allergy tests didn’t return positive (for many reasons such as suspecting it’s food intolerance which doesn’t show in allergy test or not trusting that the tests are accurate), or
(Scenario 3) eliminate such foods without testing for allergies, either because doctors didn’t recommend allergy testing or such facility is not easily available where the family lives.
The question then is whether Scenario 2 and 3 are valid for parents trying out elimination diets for their child. A paper published in July 2015, in the College of Family Physicians of Canada sought to study the papers that have been published on elimination diets, specifically with regard to eliminating eggs and cow’s milk.
Insufficient evidence to support elimination diets
Result of study: There is insufficient evidence about the benefit of eliminating cow’s milk in unselected patients with atopic dermatitis (AD). Some evidence suggests that egg elimination might benefit those children with AD who are suspected of being allergic to eggs and who are sensitized to eggs.
MarcieMom’s digest on the paper:
#1 Go for allergy testing
I’m a supporter of allergy testing, simply because given that tests are fairly accurate and you can always take a few tests at different development stages of the child to corroborate what he is allergic (or not allergic to), I feel that taking allergy test beats the worry that comes with second-guessing.
#2 Outside-in versus Inside-out
It has been covered in this blog before on the possibility (and doctors are accepting that possibility with more research) that food sensitization can come from outside-in: meaning it is the defective skin barrier that allows food allergens in the air (on the skin) to result in the body being sensitized to the food allergen. It reinforces the importance of protecting the child’s skin barrier with good skincare routine, even from birth for infants at high risk.
#3 Observations can be misleading
Elimination diets rely on observing if there’s any change in the skin/ increase in rashes after consumption of food. However, this can be misleading because (i) allergic reactions may not show up immediately and (ii) prevailing allergens such as to house dust mite can ‘confuse’ the observations because it triggers eczema flares from time to time.
#4 Lesser case for elimination diet
It is mentioned in the paper that “40% to 90% of infants with moderate to severe AD are food sensitized based on positive results of skin-prick tests to 1 or more food allergens” but “only 35% to 40% of food-sensitized children with AD have clinical signs and symptoms of food allergy according to multiple double-blind, placebo-controlled food challenge studies“. This means that it is more likely that a child will be tested positive to a food that he can actually consume and not trigger a food allergic reaction. As such, it seems to not justify eliminating a food when it is not even tested positive in the first place.
#5 Studies where elimination diets improve eczema
There were two studies mentioned in the paper that reported an improvement in eczema after elimination diet, (i) was eliminating eggs for infants who are sensitized to eggs, and (i) was using hydrolyzed milk.
#6 Elimination diet risks
The risks of elimination diets are
Nutritional deficiency – the paper mentioned that calcium, vitamin D and E were deficient.
Turning intolerance due to elimination – the paper mentioned that early low-dose cutaneous exposure to food allergens leads to allergic sensitization, whereas early oral consumption of food proteins induces immune tolerance. This means that taking a food, suspecting it is an allergen for the child and eliminating it, make it more likely to have a food allergy as opposed to not eliminating that food.
The above is why the medical community generally only recommend elimination diets when tested positive, and after reviewing various test results and understanding the roles that other allergens play. When evaluating all the double-blind placebo-controlled food challenges, only about 6% of the children with eczema had a reaction to the suspected food allergen. It is therefore, more likely than not, that the eczema rash is not due to the suspected food.
What’s your experience in elimination diet? Has it improved your child’s eczema? Do share in the comments especially when many parents are interested in how other eczema families cope with diet.
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