Happy New Year and look forward to this year’s first session on the topic of Skincare for Kids.
Skincare for young children is important as they are able to understand skincare, and have to take care of their own skin for those who are schooling. Young children may also resist moisturizing and parents have to teach children how to moisturize and understand its benefits. Children who are in primary school also have to be aware some of the school activities that may trigger their eczema flare-ups and learn the basics of managing their eczema in school.
The speaker for this session is dermatology nurse Sister Wong, who is the Senior Nurse Educator at National Skin Center and trained in Dermatology and STI (Sexually Transmitted Infections) Nursing in UK. She had spent many years in the inpatient nursing care in CDC and currently based in outpatient services in National Skin Centre. She is also in charge of training programmes for the nurses in Dermatology.
Block your Friday lunch, on
22 January 2016 (Friday) – Venue, NSC Room 401, 12.15 noon to 1.15pm
Do note though that this is not a consultation session. For those bringing your child, there will be balloons for sculpturing, puzzles and coloring to occupy your children.
You must RSVP so that we can order lunch and arrange the layout for the seats. If you’re coming, please email [email protected] your name, mobile and email, number of adults & kids coming.
One last thing, the session would be starting on-time and information on my blog is not pre-approved by NSC.
Personally I find it difficult to think and plan when at home, as the demands of the home/ child seem endless and even if I’ve planned, my plans are hard to carry out unless in the middle of the night (like now, 1am, preparing this post, asking myself ‘why do I keep doing this?’ and replying to myself ‘Just keep doing what God has blessed you with’). Follow Kate’s cartoon here.
Kicking off Wednesday posts in 2016, like to explore this group of ingredients which is present in all cleansers but also have the potential to irritate skin.
Surfactants are ingredients that are active on surfaces, mainly to lower the surface tension on the skin and remove dirt, sebum, oil from cosmetic products, microorganisms and exfoliated skin cells in an emulsified form to be washed off. The different type of surfactants affect their cleansing, foaming/ lathering, emulsifying, solubilizing abilities as well as its potential to irritate.
Why not just Water?
Before we go on, the simple question to ask is why not just use water to clean our skin. This is because water alone is not effective in removing dirt which can be removed only by oil. Hydrophilic dirt can be removed only by water, and fat-soluble lipophilic dirt only by oils.
Groups of Surfactants
Surfactants are divided into hydrophilic (water loving), hydrophobic (water repelling) and lipophilic (oil loving). Surfactants consist of a fat-soluble (lipophilic) part and a water-soluble (hydrophilic) part. The lipophilic part sticks to oil and dirt, and the hydrophilic part allows it to be washed away.
Surfactants perform different functions, namely:
Emulsification – arrange itself at interface between two immiscible liquids to create an emulsion
Solubilization – blending oily solution into clear liquid
Wetting – increase contact between the product and dirt
Apart from functions, manufacturers also consider mildness, biodegradability, toxicity, moisturization, skin appearance and feel, smell (fragrance) and lubrication when formulating their products.
There are four major groups of surfactants, classified by their polar hydrophilic (water loving) head group:
Anionic Surfactants – Negative charge
Give effective cleansing and foam, good wetting properties, excellent lather characteristics, but moderate disinfectant properties and also likely to irritate skin.
E.g. Carboxylic acids – Stearic acid for stick products like deodorants and antiperspirants; Sodium stearate for soap
Sulfates – give effective cleansing, foaming and cheap; common irritant, e.g. Sodium lauryl sulfate (SLS), an alkyl sulfate used in detergents; Sodium laureth sulfate (SLES), an alkyl ether sulfate used in shampoo
Sulfonic acid surfactants – more expensive than sulfates but less irritating, e.g. dioctyl sodium sulfosuccinate, alkyl benzene sulfonate
Taurates (derived from taurine), Isethionates, Olefin sulfonates, and Sulfosuccinates.
Effective for conditioning cosmetics,positive charge makes the surfactants electrostatically attracted to the negative (damaged) sites on hair and skin protein which makes them resist rinse-off. Difficult to ‘mix’ with Anionic Surfactants. Also irritate. May be used as antimicrobial preservatives due to ability to kill bacteria.
Quaternized Ammonium Compounds (or Quats). e.g. Cetrimonium chloride and Stearalkonium Chloride
Amphoteric surfactants – both positive and negative charge (depending on environment)
Help improve foaming, conditioning and reduce irritation. Moderate antimicrobial activity. Used in mild cleansing products, but not effective cleansers and emulsifiers. Both Alkaline and Acid, help to adjust the pH of the water used in solution.
E.g. Sodium Lauriminodipropionate and Disodium Lauroamphodiacetate.
Cocamidopropyl betaine, cocoamphoacetate and cocoamphodiacetate
Non ionic Surfactants – No charge
Used in heavy thick creams, such as hand or body creams, as emulsifiers, conditioning ingredients, and solubilizing agents.
Relatively low potential toxicity and they are considered the most gentle surfactants, but they are also the most expensive
Able to solubilize fatty acids and cholesterol in skin, thus may remove skin lipids
E.g. Cocamide DEA (coconut diethanolamide), widely used in personal care products for its thickener property and foam booster
Fatty acid esters of fatty alcohols, sorbitan esters, sucrose and cholesterol derivatives used like emulsifiers
In the following Wednesdays of this month, we will explore the impact of surfactants on skin, baby and eczema skin and some of the research in this area. I’m learning much about this as I read as well and it’s not all so easy to understand! Any expert reading this who would like to help out are welcomed, do leave a comment if you have expertise in this area or there’s something to correct in my post (no offense will be taken!).
This year we’re continuing with the characters from last year’s Mom NeedyZz cartoon but focusing on Kate charting her life. A little like what I always feel in the beginning of the year. I pray that all mothers have a little ‘me’ time to think through their life, but yes, we’d always still be a mommy.
Happy New Year to everyone! I pray that this blog will be a blessing to you in 2016 and I’m inspired to create activities for eczema children to learn about their skin and eczema. This is the first one that I’ve created, so give me feedback and thank you for letting EczemaBlues be a part of your life!
3. Act of applying lotion or cream on your skin
6. What shower (temperature) should I NOT take because it dries my skin?
7. Should you moisturize daily or weekly?
8. Name of cream I should apply when I go into the sun
10. Name of the thick cream you apply, the thicker the cream, the longer it last
11. What is a function of our skin – against chemicals and harmful substances (start with P)
12. What should you NOT do when wiping yourself dry with a towel? (Clue: opposite of pat dry)
13. Will scratching damage our skin?
1. Name of liquid I produce that sometimes make me feel itchy
2. What part of me should I keep it trimmed and short to limit skin damage if I scratch?
4. The time frame when you should moisturize after shower
5. Name of the watery liquid you apply on your skin
8. Are long or short showers better for me?
9. What is the body organ that covers our body?
11. What ingredient should I avoid? (Clue: Smells nice!)
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.
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.
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‘:
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: Artifical 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
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:
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.
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!
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
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.
(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
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.
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?
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).
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.
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
Rash and skin texture – will be covered in part 2 of this series
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.