Mom NeedyZz Cartoon – Mom, Kid and Allergies

Mom NeedyZz Cartoon - Figuring out kids allergies
Guessing food allergies can get quite scary!

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.

Skin Fact – How Much We Sweat vs Infants

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
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:

  1. 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.
  2. 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.

In an interview with Dr Claudia Aguirre on Eczema – Scratching the Surface, she said:

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.

References

Eczema News – Hydrolyzed Milk Impact on Childhood Eczema

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
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.

  1. 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. For those interested in learning more about hydrolyzed formula, refer to FDA archived presentation.
  2. In 2013 (post), research’s recommendation was for high-risk infants who cannot be 100% breast-fed, partially hydrolyzed milk is recommended.
  3. 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
  4. In a paper published in Clinical and Translational Allergy, Partially hydrolysed, prebiotic supplemented whey formula for the prevention of allergic manifestations in high risk infants: a multicentre double-blind randomised controlled trial, it was found that there was no preventive effect to early feeding with a partially hydrolyzed formula with added prebiotics.
  5. In a paper published in the Expert Review of Clinical Immunology, The Role of Partially Hydrolyzed Whey Formula for the Prevention of Allergic Disease, authors warned that due to limitations on studies on partially hydrolyzed milk, the recommendation should still be ‘breast is best’.

On the question of costs,

In a paper published in the Annals of Nutrition and Metabolism, Cost-Effectiveness of Partially Hydrolyzed Whey Protein Formula in the Primary Prevention of Atopic Dermatitis in High-Risk Urban Infants in Southeast Asia, the finding was that overall costs (even after including the cost of milk formula) of taking partially hydrolyzed formula (as opposed to cow’s milk formula) for high-risk infants would be lower than the costs of managing eczema.

On the question of nutritional value,

Dr Sears (this blog has featured several of his and his sons’ talks, tweet chat and collaborated blog series), 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

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!

Mom NeedyZz Cartoon – Aeroplane Baby Food

Mom NeedyZz Cartoon Airplane Baby Feeding
Airplane food works?

Anyone tried this trick? For more Mom NeedyZz cartoon, see here.

Skin Facts – Water Loss from Children and Eczema Skin

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
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 corneum is 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.

What’s your take in this?

References

Eczema News – Do Elimination Diets Work?

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
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 that40% 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

  1. Nutritional deficiency – the paper mentioned that calcium, vitamin D and E were deficient.
  2. 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.

Learning Wet Wrap for Eczema Kids

Reminder of next Saturday’s hands-on wet wrap session for those with eczema kids in Singapore. Wet wrap is an accepted form of eczema therapeutics in children, that is worth learning as it has been studied to improve eczema. This Saturday’s eczema support group session at the National Skin Centre, Singapore will have

  • Presentation by Mölnlycke Health Care, the company with Tubifast wet wrap (read here to understand more on wet wrap)
  • Wet wrap demonstration – How to do a double-layer wrap, moist inner layer with a dry outer layer; dry wrap will also be explained
  • Wet wrap sizes and techniques – It can get quite difficult to wrap parts with bends or that slip off + what sizes are suitable for younger kids

Do RSVP for the session, details below:

Wet wrap - a proven therapy for eczema kids
Wet wrap – a proven therapy for eczema kids

28 November 2015 (Saturday) – Venue, National Skin Centre Singapore,

Level 4, Staff Lounge, 10 am to 11.30 am

The program:

1. 10.00 to 10.30 am Tubifast demonstration and presentation

2. 10.30 to 11.00 am Trying out wet wrap

3. 11.00 to 11.30 am Q&A and refreshments

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

One last thing, the session would be starting on-time and information on my blog is not pre-approved by NSC.

Look forward to your RSVP and meeting you!

Mom NeedyZz Cartoon – Mashing Baby Food

Mom NeedyZz Cartoon Baby Food Preparation
It sure feels like a ‘sweat’ shop for baby food preparation!

The difficult part of feeding is not just the feeding! For more Mom NeedyZz cartoon, see here.

Skin Facts – Sun Protection in Adult, Infant and Eczema Skin

We have started learning skin facts last week, specifically on the skin (surprise) isn’t the largest organ and that well, we don’t really know what’s in our dust. This week, we’re taking up a notch on going ‘intensive’ into the difference in the sun protection function of adult, child and eczema skin.

Normal Adult Skin

Sun Protective Function of our Skin
Sun Protective Function of our Skin and how it differs for Baby Skin and Eczema Skin

Adult skin has a fully developed sun protection function, in the form of pigment melanin which gives the skin its color. Therefore, the darker one’s complexion, the higher the sun protection. Melanocytes are the melanin-producing skin cells and it is the activity of the melanocytes, i.e. the amount of melanin produced, and not the number of melanocytes that determine the skin color.

When one is exposed to sun, more melanin is produced to help protect the skin against UV rays, thus giving a ‘tan’. Melanin can reduce the oxidative damage caused by UV rays but isn’t able to fully protect from the damaging effects of UV rays (see this news on potential harm of ‘sun-activated’ melanin to our skin).

Children Skin

An infant’s skin has not fully developed in many ways that make a baby more vulnerable to the damaging effects of UV rays – it has less pigment/ melanin, thinner skin/ stratum corneum and a higher surface area to body ratio.

Studies have also pointed to infants with exposure to UV rays will show skin pigmentation on exposed skin from as young as one year old (first summer). This was true even for infants who used sun protection when outdoors but not when in the car, in the shade or on a cloudy day. There are also studies showing that exposure to UV during childhood and adolescence can lead to skin cancer later in life.

Eczema Skin

There is no study that points to differences in melanocytes/ melanin due to eczema. However, the sun is known to both improve and aggravate eczema, for instance:

  • Some eczema sufferers report improved eczema during holiday when outdoors more often (no study confirmed why holiday seems to improve eczema).
  • Phototherapy is used as an eczema therapy for adults.
  • Active eczema flare-up should stay away from the sun as it can worsen eczema, and increase vulnerability to sun burn.
  • Certain skincare products increase sensitivity to sun, such as those containing ingredients alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), salicyclic acid, glycolic acids, Retin-A and hydrocortisone. Moisturized skin may get sun burn more easily, thus put on moisturizer and wait for 30 minutes before applying sunscreen.

Sun – We need it, but not too much of it.

Our skin play an important role in the synthesis of vitamin D, where vitamin D can increase the production of skin proteins (cathelicidin) and antimicrobial peptide (AMP) which protects against skin infection. However, just 15 minutes a day is enough and it’s referring to getting sun on the face and arms (i.e. no need to be in a bathing suit!). During summer, 2-3 direct sun exposures of 20 minutes per week is sufficient. Short frequent sun exposure is better than long exposure.

Rays from the Sun

There are 3 different rays from the sun:

  1. UVA – 320 to 400 nm : passed through the atmosphere
  2. UVB – 290 to 320 nm : passed through the atmosphere
  3. UVC – 100 to 290 nm : most dangerous, but filtered and do not pass through the atmosphere

UVA – UVA activates melanin already present in the upper skin cells but the tan is lost quickly. Penetrates deeper into the skin, damages the dermis (middle skin layer), accelerates aging, causes wrinkles, increases oxidation and suppresses cutaneous immune function.

UVB – UVB stimulates the production of new melanin, and a longer lasting tan. Also stimulates a thicker epidermis. Absorbs by the epidermis (top skin layer).

It’s not just the sun, it’s also the ozone.

We all know that the ozone layer is thinning and the thinner ozone has allowed more UVB rays to come through the atmosphere.

Sun protection

Sun protection has been covered in various interviews with dermatologists on this blog but the point to emphasize is that for babies, it is very important to avoid the sun and practice sun protection because:

  1. Thinner skin
  2. Less melanin-producing skin cells
  3. Larger surface area to body ratio
  4. Increased absorption of chemicals and vulnerability to irritants in sunscreen products make sun avoidance a wiser choice

Lips and eyes are also affected by UV rays, thus wearing a wide-brimmed hat and sunglasses are also part of sun protection.

More in interviews with dermatologists:

Sunscreen

It is recommended to use physical blockers/ inorganic filters such as zinc oxide (more UVA protection) and titanium dioxide (more UVB protection). As opposed to chemical absorbers, physical blockers do not penetrate more than two layers of stratum corneum and therefore less likely to induce skin irritation and sensitization. Moreover, infants tend to rub their eyes and may inadvertently rub the sunscreen into their eyes and won’t be able to ‘get rid’ of it as (i) their tear secretions and (ii) their blinking mechanism are not fully developed.

A note on SPF

SPF is the measure of ratio of UV rays before sunburn and SPF 30 means that the skin is able to take 30 times higher dose of UV rays before sunburn. The amount of sunscreen to apply is 2mg/cm2. Broad spectrum refers to additional UVA absorbers (avobenzone and octocrylene) being added to the physical blockers.

References

Eczema News – Childhood Eczema linked to Headaches

In a paper published August 2015 Journal of Allergy and Clinical Immunology, Dr Jonathan Silverberg studied an association between eczema and headaches. The cause of headaches could have come from (i) sleep disturbances or (ii) fatigue that eczema children suffer from.

Method of study: Analysis of data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children’s Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997-2013.

Childhood Eczema and Headaches
Childhood Eczema and Headaches

Results: From the analysis, eczema was associated with headaches in 14 of 19 studies. It was found that eczema children had a higher prevalence and likelihood of headaches. In particular, children with eczema that was associated with atopy, fatigue, excessive daytime sleepiness, insomnia, and only 0 to 3 nights of sufficient sleep had even higher odds of headache than eczema alone.

MarcieMom’s take – I couldn’t find other studies on Pubmed that examine this association but it wouldn’t come as a surprise that there is one; after all, how many of us adults don’t have a headache if we’re chronically deprived of sleep? A few other thoughts on sleep and headaches:

#1 Don’t mistake the headache for other illness

In adults, we may reach for the painkiller but this probably isn’t suitable for a child and can’t be taken long-term. Possibly explore antihistamines to see if it help with a better night sleep and of course, treating the eczema to reduce the itch.

#2 Sleep better

Easier said than done – it is still something that our family struggles with, though to a much lesser extent than when the eczema was severe. A few posts that may give you ideas on how to improve sleep at night:

I’ve recently found that dry wrap (as opposed to wet wrap which I have not tried) seemed to reduce the scratching at night. Singapore is pretty humid so instead of wet wrap, sometimes I put a layer of moisturizer (again) before sleep time, and put over a wrap bandage. Marcie’s skin usually appear better the next day and there’s less scratching on the wrapped spot at night. More on wet wrap in link.

Mom NeedyZz Cartoon – Candy Book

Mom NeedyZz cartoon Candy has its allure
Kids ‘obviously’ don’t just eat ANYthing.. only candy!

Anyone has similar experience? More kids’ eating adventures this month! For more Mom NeedyZz cartoon, see here.

Facts about Our Skin (vs Children vs Eczema Skin)

For these 8 weeks, we’re going ‘intensive’ into skin facts. Many articles have shared about adult skin facts, but in #SkinishMom style, we’re ‘digging’ deeper into children’s skin and eczema skin. (Note: all skin facts have published data for children and eczema skin)

Skin facts - Adult, Children and Eczema Skin
Some ‘Skin Investigation’ may turn up with unexpected facts!

Skin Fact #1 Skin is (NOT!) the largest organ in the body

Oops, doesn’t everyone say that skin is the largest organ? That’s why some ‘skin’ investigation is required for ‘skin journalism’. Located a letter to editor in the Journal of Investigative Dermatology that skin is not the largest organ in the body. The skin can be considered the largest BY WEIGHT for ‘medium-sized’ organs, excluding musculoskeletal system.

  • Skin (epidermis and dermis) weights 3.86kg, about 5.5% of a 70kg man
  • Subcutaneous tissue (layer of fats under the dermis layer) is not consider skin
  • Skin is not the largest organ by surface area, about 1.7 sqm but lung airway is 70sqm, and gastrointestinal tract is about 30-40sqm (note in the letter to editor, it’s stated as about football field, but in a paper that subsequently published in 2014 Scandinavian Journal of Gastroenterology, scientists measured the inner surface of gastrointestinal tract of a healthy average man; previous estimates of the gastrointestinal tract were made post-mortem where the tract has relaxed to a much longer length! ‘Interesting!’)

Skin Fact #2 Adult skin sheds about 17kg to 52kg over a lifetime

From research and as explained by Dr Claudia Aguirre on Quora (Dr Claudia is a featured guest of this blog), humans shed their entire outer layer of skin every 2-4 weeks at the rate of 0.001 — 0.003 ounces of skin flakes every hour. This worked out mathematically to be 17kg to 52kg (or 37 to 115 pounds) for someone who live up to over 70 years old (I’d suppose that the 0.001 to 0.003 ounces is for an average adult, thus strictly speaking, you can’t simply multiply by 70 due to (possibly?) less skin shed for a child (by weight, but given larger surface area to volume ratio, a child may shed ‘more’ skin).

Eczema skin – Eczema skin, characterized by dry skin, shed more skin (and add the scratching!). The outer skin layer (epidermis) has four layers of keratinocytes (skin cells). The keratinocytes at the basal layer continually grow and move upwards to the stratum corneum, changing from plump cells to dead, flattened cells that are shed. This takes about 28 days. I couldn’t find research on how much skin an eczema sufferer shed, but there’re two ‘opposite’ skin conditions worth mentioning:

Exfoliative Dermatitis – characterized by extensive red skin, followed by skin shedding (similar to life-threatening conditions covered in this blog: Stevens Johnson Syndrome and Erythroderma); the skin shedding is so extensive in these conditions that it affect the normal functioning of the body, in particular temperature regulation and moisture retention, requiring care in hospital.

Psoriasis – this condition is marked by only taking 3 to 4 days to mature and does not shed but the skin cells pile up on the skin surface, forming plaques and lesions.

Many eczema sufferers reported seeing massive skin shed on the bed and floor but I wonder why the skin cells shed appear so visible (as opposed to normal skin). Found an explanation that the cells on dry skin may stick together, thickening the stratum corneum and when they are shed, it is shed as visible sheets, aka scales.

Skin Fact #3 Dead skin cells comprised an UNKNOWN part of our dust at home

This is another ‘fact’ that could turn out to be a myth – most of the sites state that our dead skin made up anywhere from 50% to 90% of our dust at home. In a study by Layton and Beamer whose study was to find out how much of contaminated soil and outdoor pollutants would get into home dust, it was estimated that about 60% would come from outdoors. Dust is very complicated, with different home, season, surrounding and the type of dust in the air and on the floor being different. It cannot be simplified to state as most of the dust are dead skin cells.

What we have to know is dead skin cells are food for house dust mites and they literally sleep with us, in our bedsheet, pillow, pillow case and mattress. Read the following posts to understand more about dust mites:

There’s sooo much more skin facts to cover, I think we’re good for discovering these till end of the year!

References:

  1. Journal of Investigative Dermatology September 2013 ‘Letter to Editor’
  2. Scandinavian Journal of Gastroenterology June 2014 Surface area of the digestive tract – revisited.
  3. Clinical Pharmacist September 2010 Atopic eczema: Clinical features and diagnosis
  4. Healthline: Exfoliative dermatitis
  5. Dermal Institute: the Biology behind Eczema and Psoriasis
  6. PDR Health: Dry skin
  7. Environmental Science and Technology November 2009: Migration of Contaminated Soil and Airborne Particulates to Indoor Dust
  8. Time February 2010 What’s in Household Dust? Don’t Ask

AAD A:Z Videos with Dr Lawrence F. Eichenfield – How to Treat Diaper Rash

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “How to Treat Diaper Rash”. For this video, I interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine. Dr. Eichenfield’s clinical interests include atopic dermatitis, and serves on the editorial boards of several journals and periodicals, and is Co-Editor in Chief of Pediatric Dermatology.

In the video, the key points covered are:

  • Always change the soiled diapers, even if it’s just wet
  • Gently cleanse the bump area, such as using moist cloth or alcohol-free and fragrance-free baby wipes
  • Use diaper cream that is zinc oxide based
  • Watch for signs of infection

MarcieMom: Thank you Dr Lawrence for helping parents to learn more about diaper rash this week (and on eczema bleach bath therapy last week). Although diaper rash is common, we still need to learn the proper care for diaper rash and when it is no longer a rash to be self-treated.

Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash
Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash

I understand that diaper rash is a layman’s term and the rash is most likely to be contact dermatitis, caused by close contact of the baby’s skin with the urine/stool that act as skin irritant.

MarcieMom: Is irritant contact dermatitis the most common form of diaper rash? What are other potential irritants apart from urine/stool? For instance, can the diaper itself irritate?

Dr Lawrence: It is true that irritant contact dermatitis is the most common form of diaper rash, with irritation from urine and stools being the most profound irritants. Occasionally children can get inflamed due to other factors, including allergy to diaper contents, though rare, infections such as yeast, which has occurred commonly after courses of oral antibiotics, and many other less common causes of irritation.

MarcieMom: We know that babies have underdeveloped sweat glands and thus occlusion and sweat can lead to heat rash/ miliaria.

MarcieMom: Is it possible that the diaper rash is a heat rash? What are the other possible diagnosis of diaper rash?

Dr Lawrence: It is uncommon for diaper rash to be “heat rash” as the anatomy of the diaper region is different. Aside irritant and occasionally allergic contact dermatitis, there is a broad set of causes of diaper rash which includes yeast infection, psoriasis, and in unusual cases, a broad set of more serious diseases. There are textbook chapters with long list of potential causes of diaper rash, though fortunately, these are uncommon.

MarcieMom: We saw in the video that cleaning the baby’s bum is part of caring for diaper rash. Many parents clean with baby wipes which may end up irritating the baby’s skin if the wipes contain methylchloroisothiazolinone (MI) or methylisothiazolinone. MI was named 2013 “Allergen of the Year” by the American Contact Dermatitis Society.

MarcieMom: What precautions should parents take when cleaning their baby’s bottom to ensure that the cleaning itself will not further irritate the skin? How can parents tell if it’s their cleaning that cause the rash instead of the contact with the soiled diaper?

Dr Lawrence: Parents may be less concerned now, as standard products have dropped MI or MCI from standard wipes. Parents don’t need to be concerned about potential allergy to their cleaning products if diaper rashes respond quickly to standard cleansing and moisturizing regimens, or even interventions with a few days of diaper cream and/or over-the-counter hydrocortisone. If rashes persist with the use of cleansing products and do not respond to standard treatment, then this may be a different story.

MarcieMom: It is recommended in the video to use a zinc-oxide based diaper cream. The diaper cream can act as a barrier that limits the contact of the urine/stools with the baby’s skin. Again, we want to avoid the situation where the cream itself becomes the source of irritant contact dermatitis or even allergic contact dermatitis (where the skin reacts to allergen in the cream).

MarcieMom: What are the ingredients to avoid when selecting a diaper cream? Apart from the obvious ingredients to avoid such as alcohol and fragrance, can ‘good’ ingredients like vitamin E also trigger a rash? Is it better to stick to a ‘basic’ diaper cream that is mainly zinc oxide, instead of a ‘fancy’ one with more ingredients?

Dr Lawrence: Diaper creams that are zinc-oxide based are a tried and true remedy. These produces a barrier layer that protects the skin and also aids in healing of mild irritation or inflammation. Most commercial products have been tested to be safe, with a tendency to be “bland”, meaning a minimal amount of additives being included in the preparations. Parents should be careful with some “organic-based products”, as these sometimes contain contact sensitizers, meaning chemicals that children can become allergic to.

Thank you Dr Lawrence for helping with the questions – we certainly are more informed about to care for our baby’s diaper rash and not aggravate it.

Eczema Support Group – Wet Wrap Therapy

Wet wrap is an accepted form of eczema therapeutics in children, with numerous studies reporting improvement in eczema. Eczema Support Group under the National Skin Centre has organized a wet wrap demonstration and presentation, in collaboration with Tubifast, to explain what is wet wrap and the different techniques of wet wrap. The session will have

  • Presentation by Mölnlycke Health Care, the company with Tubifast wet wrap (read here to understand more on wet wrap)
  • Wet wrap demonstration – How to do a double-layer wrap, moist inner layer with a dry outer layer; dry wrap will also be explained
  • Wet wrap sizes and techniques – It can get quite difficult to wrap parts with bends or that slip off + what sizes are suitable for younger kids

Do RSVP for the session, details below:

Wet wrap - a proven therapy for eczema kids
Wet wrap – a proven therapy for eczema kids

28 November 2015 (Saturday) – Venue, National Skin Centre Singapore,

Level 4, Staff Lounge, 10 am to 11.30 am

The program:

1. 10.00 to 10.30 am Tubifast demonstration and presentation

2. 10.30 to 11.00 am Trying out wet wrap

3. 11.00 to 11.30 am Q&A and refreshments

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

One last thing, the session would be starting on-time and information on my blog is not pre-approved by NSC.

Look forward to your RSVP and meeting you!

Mom NeedyZz Cartoon – Teething Rings

Teething Ring Mom Cartoon
I’ve got a few in my fridge still, for keepsake! lol

Food, teething rings.. this is driving Mommy Kate nuts this month! For more Mom NeedyZz cartoon, see here.

Confessions of a Mom Caring for Eczema Kindergartener

Caring for any baby, your baby especially, is an unique experience. Mothers do have shared experience though, being mom and going through pregnancy, child birth and caring for a baby who goes through the development milestones. Mothers of eczema children have even more in common, as the struggles of caring for a baby who has rashes all over, experience constant discomfort and itch can only be understood by those who’ve been through them. This series by MarcieMom, are letters to you, with words of encouragement and sharing of her own parenting struggles.

Dear Daddy & Mommy,

It’s feels like our children have already grown so much! Marcie is starting grade school next year and these two years, she seems to be ‘shooting up’ – we went for a week holiday recently and everyday I marveled at her looking so big girl. When did my child grow so much? Sometimes I can be so focused on work, on this blog(!), on chores, on getting everything done that I missed looking at her. Have you looked at your child recently? These two years when her eczema has very much improved, I finally dared to kiss her more on her cheeks. One friend from Germany who visited did ask exactly that as he kissed his son so much all the time and noticed that we didn’t really kiss Marcie so much.

These two years have been so much better – evidence of which are the Nespresso machine I bought and the capsules that I’ve consumed, and the book that I co-authored and published. I’m quite scared about what Marcie starting grade school – will she get bullied? will she get laughed at as she has so many bad habits – scratching, biting fingers and peeling her skin. We never have to cut her fingernails for years and most times, I don’t even dare to look at her fingers (a task for my husband!). 

We got off co-sleeping but she still needed to be watched to remind her not to scratch at night. Given that her skin is a little tougher than baby years, we sometimes let her scratch a while to see if she would fall back asleep. It’s still frustrating to remind her not to scratch and the habitual scratching had led to some thickened skin on her feet. There’s less need to take leave to care for her as her eczema is so much more manageable and my parents are able to care for her even on our weekend marriage (church) camp.

How is your family life? Do you have a second baby? We made the decision to have an only child, partly as we didn’t feel that physically, emotionally and financially we could give a second child the same level of care – maybe we are wrong, we don’t know but I like being an ‘only mom’. I pray that if your second child won’t have eczema – some parents in the support group remarked that the second child’s eczema is worse while others say it’s less severe. We never know.. but consider taking probiotics prenatal and also in the early years, and fish oil too. 

Time seems to pass us by – and I wonder if I ought to have spent more time with Marcie, looked more at her, kissed her more and less at the rashes and the chores, and even this blog (takes lots of my free time to sustain this blog but it’s like a treasure that I store in heaven). I wonder how you feel about your parenting and how your marriage is holding up after years of caring for an eczema child. Has it got stronger or has it gotten so strained that you hardly can talk heart to heart as a couple? As I type this, Marcie is beside me and my husband in front of me, having just enjoyed a dinner at my parents’ home. We are all doing our own thing (evidently, since I’m typing this), have our own hopes and fears. Disappointment and discouragement. Today is Sunday (this post is scheduled to be published on Friday) and today’s sermon in church ended with an analogy of us building bricks and bricks of discouragement and disappointment and not seeing Jesus beyond the wall. It’s true on a certain level but I believe that the Jesus who is God and came down to live with us and die for us won’t be held back by a brick wall. I pray that the Holy Spirit in me (in all Christians) will dwell in me and show my how to lead my life – to be the mother I’m to be.

parenting eczema kindergartener

Isaiah 57:15

“I dwell in the high and holy place, and also with him who is of a contrite and lowly spirit, to revive the spirit of the lowly, and to revive the heart of the contrite.”

AAD A:Z Videos with Dr Lawrence F. Eichenfield – Eczema Bleach Bath

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “Eczema: Bleach Bath Therapy”. For this video, I interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine. Dr. Eichenfield’s clinical interests include atopic dermatitis, and serves on the editorial boards of several journals and periodicals, and is Co-Editor in Chief of Pediatric Dermatology.

In the video, the key points covered are:

  • Bleach bath is useful for children whose eczema is frequently infected.
  • Always ask the dermatologist before starting on bleach bath therapy.
  • Preparation of the diluted bleach bath – Half cup of bleach for a full tub of water or 1 teaspoon of bleach per gallon of water
  • Soak 5 to 10 minutes and to check with doctor on the frequency (per week) for the bath
Questions answered by Dr Lawrence Eichenfield on Eczema: Bleach Bath Therapy
Questions answered by Dr Lawrence Eichenfield on Eczema: Bleach Bath Therapy

MarcieMom: Dr Lawrence, thank you for helping out in this AAD video series once again. In our previous interview on Eczema Tips, I asked the question on what infected eczema looks like. Your reply was

Infected eczema can appear as unusual oozing or honey-colored crusting.  It can occasionally show as pus bumps, or as tender, red, warm skin.  Inflammation can also appear red, as well as “rashy” and scaly.  The bleach baths are usually recommended for children who have problems with skin infections, rather than just the inflammation seen with simple eczema flares.

MarcieMom: In another interview with Dr Clay Cockerell, readers of this blog learnt that there are both good and bad bacteria on the skin. The common ones are (1) Staphylococcus epidermidis, (2) Staphylococcus aureus, (3) Streptococcus pyogenes (4) Corynebacteria and (5) Mycobacteria. We also learn that

Bacteria multiply exponentially, so when its population is temporarily decreased, as after the use of hand cleanser, it re-grows quite quickly and returns to its normal concentration.

MarcieMom: We know that the main benefit of bleach bath is to reduce the harmful bacteria, in particular, staphylococcus aureus that often colonizes eczema skin and promotes skin inflammation.

MarcieMom: Will reducing staph bacteria via a bleach bath be only effective for a short time and the harmful bacteria quickly proliferate after the bath? 

Dr Lawrence: Bleach baths appear to decrease the quantity of bacteria on the skin, probably transiently. There have also been some studies to show that hypochlorous solution, the active ingredient in bleach bath, may have anti-inflammatory effect. We don’t really “wipe out” bacteria on the skin with bleach bath, but only tame it down for a period of time. However, they have been shown very useful as part of therapy in eczema that gets frequently infected

MarcieMom: It is mentioned in the video to consult the doctor before starting on bleach bath therapy. What are the factors that a doctor will consider when deciding whether bleach bath is a suitable (or not suitable) treatment for a child with eczema?

Dr Lawrence: When considering bleach bath, doctors will usually consider the overall degree of eczema, the tendency to have secondary infection, which can present as honey-colored crusting, as well as the age of the child. Bleach baths, while very useful, are usually therapy used in addition to regimens of moisturizing and topical anti-inflammatory therapies, as “add-on” for more difficult eczema to manage.

MarcieMom: In the video, we saw that household bleach is used for the bleach bath and we should check that there is no more than 6% sodium hypochlorite in the bleach. I realized that many household products (including bleach) do not label their contents (not mandatory requirement in every country) and that many bleach products have fragrance.

MarcieMom: What is your suggestion on how to get the right bleach product? In the event that parents can’t find a bleach product that is fragrance-free with clear labeling, what is the alternative product?

Dr Lawrence: You are correct to bring up the issue that there is variability in concentrations of bleach bath, as well as bleach not being available in all countries. Also, we have become aware that there are more concentrated forms of bleach being sold to decrease shelf space in grocery stores. Parents need to take a look at the percentage of sodium hydrochlorite, and if there are using a more concentrated version adjust the formula. There are commercial alternatives, including some readily available non-prescription products that have sodium hypochlorite solution as their active ingredient. For instance, CLn body wash, marketed by TopMD that offered this product through their website or Amazon.com. This product has had several studies that have shown benefits in pediatric atopic dermatitis.

MarcieMom: Staph bacteria is the cause of many other skin infections such as cellulitis, impetigo, folliculitis and staphylococcal scalded skin syndrome. Using bleach bath can be preventive, so that there is less likelihood of an infection. It is better than treating an infection using antibiotics that may lead to antibiotic resistance. However, a bleach bath can be drying for the skin since bleach has a pH level of 11 to 13, thus considerably alkaline. Alkaline products can also lead to reduction of ceramide-producing enzymes, decreased skin lipid production and dry skin.

MarcieMom: Is there a way to adjust the skin pH after the bleach bath? For instance, will rinsing off residual bleach bath water be useful or will it decrease the effects of the bleach bath?

Dr Lawrence: When using bleach bath, it is important to handle the skin as with regular baths, with use of emollients/moisturizers after bathing. Some experts will rinse off the residual bleach bath water, while others will leave it on the skin. In studies, it does not appear to make a significant difference, though experts do vary in their suggestions. Certainly application of moisturizers will help, and in any case, the application of moisturizers after bathing will help to improve the skin function, including recovering the pH to normal level.

Thank you Dr Lawrence for helping us to increase our understanding of the bleach bath and clarify questions and reservations we parents have.

Mom NeedyZz Cartoon – Eczema Food Journal Frustration

Eczema food journal rashes sleep pattern
It’s frustrating isn’t it? Journaling what eczema baby is eating can drive a mom nuts!

It’s never easy to figure out a pattern between food and rashes/ sleep. Literally drove me nuts. For more Mom NeedyZz cartoon, see here.

Confessions of a Mom Caring for Eczema Preschooler

Caring for any baby, your baby especially, is an unique experience. Mothers do have shared experience though, being mom and going through pregnancy, child birth and caring for a baby who goes through the development milestones. Mothers of eczema children have even more in common, as the struggles of caring for a baby who has rashes all over, experience constant discomfort and itch can only be understood by those who’ve been through them. This series by MarcieMom, are letters to you, with words of encouragement and sharing of her own parenting struggles.

Dear Daddy & Mommy,

I hope your family life has got easier as your child turned 2-3 years old – I remembered this was the time when we went to Singapore Botanical Gardens for the second time to watch a free outdoor concert. At the end of the concert we were thinking ‘Wow, did we just finish watching a concert without much scratching, had some fun on the grass and a decent picnic?’. This was especially poignant as two years ago we went for a similar event at the Botanical Gardens and had to run off the event, in anger and frustration, with our baby’s hands tied with the swaddle cloth due to the scratching and the blood.

Bedtime still comes with scratching for me, as I believe for many parents too. Idle hands, too dry air, or too warm, rising body temperature and for reasons no one knows, bedtime seems to be punctuated with scratching throughout the night. Having deal with eczema for 2+ years, most parents may have figured out a bedtime routine that seemed to be correlated with the least scratching. For us, it’s shower close to bedtime, air-conditioning, a little of bedtime reading and co-sleeping. I got so used to co-sleeping that I fall asleep pretty easily with an increasing weight on me. 

Daytime is much better now with so many activities to do. Be careful with playdough with sparkles or playing with bubbles, either make it quick and wash hands quickly after or wear gloves (we used the first method but parents have told me gloves worked). iPad sometimes save the day, but we try to limit that. Activities that are carried out in non-air conditioned room continue to be a problem, like gym in non-airconditioned area. Marcie scratched a little but I saw an older child with eczema who really couldn’t carry on with the class and just sat on the mat and scratched and scratched. Gym or teachers of classes are not equipped to manage eczema so don’t expect them to. We ended up choosing ballet as that is always air-conditioned and wearing light clothing!

I wonder how your child’s eczema is or whether other allergic conditions start to affect your child. I wonder if your child is attending a preschool that he/she is nicely settled in and the teachers have already known how to care for your child. Marcie enrolled in Columbia Academy and the teachers are very kind and understanding – reminding Marcie not to scratch and getting her to moisturize. As children these days seem to be so much more alert and active, I recommend choosing a preschool that has many activities rather than idle time – the activities (be it reading, writing, drawing, dance or music) really help to distract an eczema child from scratching. Also, I’m thankful that the teachers are strict and very mindful of teasing, calling names or bullying – which can happen to an eczema child.

Finding alternative caregiver is still difficult – my parents took care of Marcie after full day preschool but every time school’s off or Marcie is sick, we will still take leave. Most of our leave were spent caring for Marcie and a short holiday. Packing for holidays is almost like moving the whole house as I always pack for 2-3 change of clothes within a day! We were very thankful that we had very enjoyable family time during this period and pray that your family gets many lovely moments together, despite the eczema.

Parenting Eczema Preschooler

Matthew 7:7-11

“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you. For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened. Or which one of you, if his son asks him for bread, will give him a stone? Or if he asks for a fish, will give him a serpent? If you then, who are evil, know how to give good gifts to your children, how much more will your Father who is in heaven give good things to those who ask him”

AAD A:Z Videos with Dr Daniela Kroshinsky – Cold Sores

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “How to Treat Cold Sores”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.

MarcieMom: Thank you Dr Daniela for helping us with treatment of cold sores this week (and last week’s interview on pain management in shingles). For parents with eczema kids, we’re very vigilant about cold sores because of the risk of eczema herpeticum. We are looking forward to learn more about limiting the spread of cold sores at home and how to minimize the likelihood of eczema herpeticum.

Key points in the AAD Video

  • Half of population carry the cold sore herpes simplex virus (HSV)
  • Symptoms of cold sores – Burning, itching or tingling, small blisters on the lips or around the mouth which may merge, burst and crust over
  • Triggers of cold sores – stress, fatigue, flu/fever, sun exposure, hormonal changes, trauma (shaving cuts, cosmetic surgery)
  • Treatment – Apply topical anti-viral cream to slow the reproduction of the virus, cool the sores at home with a cool wet towel
  • Reduce pain by taking aspirin and ibuprofen
  • Avoid acidic fruits, such as tomatoes and citric fruits that can irritate the open skin
  • Anti-viral medication used within 72 hours of rash appearing may shorten the period of cold sores or be used for prevention for those with recurrent cold sores
  • Highly contagious – avoid kissing, sharing towel, cups, shavers, toothbrush or any other object that come into contact with the cold sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores

MarcieMom: Dr Daniela, cold sores are quite common but often, the people getting cold sores may not be aware of the severity of spreading to someone, for instance to a young child or to a person with severe eczema.

How contagious is cold sore? For instance, is my child safe as long as she doesn’t share anything with or touch the person with cold sore? Or is it super contagious? (The minute I see someone with cold sore, say in a train, I would leave the cabin. I imagine that he could have touched his cold sores, hold on to the train handle, and if I touch that or somewhere else in the train cabin that has contact with the cold sore, I would get it and possibly pass on to my child with eczema!) Is hand-washing sufficient to get rid of the cold sore virus? (Does anti-microbial product kill the virus or high temperature?)

Dr Daniela: The virus that causes cold sores spreads by direct contact so someone with a cold sore in the same cabin as a person with eczema would not pose a risk.  Spread through shared items depends on if and how much bister or wound fluid could be transmitted. Usually this is very unlikely to take place in public spaces.  In general, it’s a good idea not to touch strange fluids on trains! Handwashing and antimicrobial products would help to minimize this risk.

MarcieMom: I read on Mayo Clinic that the first-time getting the cold sore tend to be more serious that subsequent outbreaks; often, first-time cold sores may be accompanied by:

  • Fever
  • Painful eroded gums
  • Sore throat
  • Headache
  • Muscle aches
  • Swollen lymph nodes
  • Cold sores inside their mouths (for children under age 5)

Is each cold sore outbreak due to the same virus and therefore, there’s increased immunity with each outbreak? Will cold sores affect young children differently?

Dr Daniela: The first outbreak tends to be more severe with each subsequent outbreak being less involved.  Just like the varicella virus of chickenpox can lie dormant in a nerve root and then cause shingles, the cold sore virus, herpes simplex, can lie dormant and reactivate.  Children are less likely to be affected by cold sores but most people have been exposed to the virus by the time they reach adulthoods.

MarcieMom: For someone with severe eczema, the herpes simplex virus can infect compromised skin causing  eczema herpeticum. Dr Daniela, what are the factors that increase the likelihood of someone with eczema getting eczema herpeticum from cold sores? Is any child with eczema at higher risk or is he/she at higher risk only if the eczema is severe or generalized over the whole body?

Dr Daniela: Close contact with caregivers who are prone to cold sores can increase the risk of transmission of the virus.  Uncontrolled eczema leads to increased risk of open skin that could facilitate the virus spreading to the areas that are affected by eczema.  This can happen with any open area but would be more likely depending on how extensive the eczema is and as a result how much of the skin barrier has been compromised. 

MarcieMom: There are many parents whose eczema kids keep getting repeated episodes of eczema herpeticum. Apart from being on long-term anti-viral medication, are there other measures a child can take to reduce the likelihood of getting recurrent cold sores/eczema herpeticum?

Dr Daniella: Eczema herpeticum is the general term for when eczema is infected by herpes simplex virus, regardless of cause.  The best thing to do to minimize risk is to keep the eczema well-controlled and well-hydrated, minimizing dry or open patches that could allow the virus to enter more readily.

Thank you Dr Daniela for being so patient with these questions on cold sores and bearing with me (a paranoid mom!) and my questions on eczema herpeticum. We have learnt much from you and understand better the preventive measures to take to limit the spread of cold sores.