This month, Kate’s figuring out creative ways to get those Zzz. For more Mom NeedyZz cartoon, see here.
Recently, I was asked about sagging breasts. As I read more about ‘sagging’, I realized that there are many myths surrounding sagging face. So as usual, I did some ‘Skin Investigation’ and here are 3 Sagging Face Myths.
Wait.. What causes Facial Sagging?
There are many factors and it makes sense that if we reduce the causes, we can limit facial sagging. Some factors like genetics and age are impossible to limit, graceful aging comes with sagging.
Genetics – There are certain genes that are studied to have an impact on how much the skin is affected by UV exposure.
Gravity – Can’t escape this one overtime.
Weakening skin structure – Key tissues that hold up our skin are collagen, elastin, fatty tissues and muscles. These reduce with age as the skin doesn’t renew itself as fast. Muscles that support our skin also gradually weakens, allowing fats to accumulate in areas that result in the appearance of sagging skin.
UV exposure – UV exposure damages collagen and elastin and it is a clear observation in studies involving twins where the twin who suntanned looked older. Collagen is a structural component of skin connective tissue. Elastin allows our skin to return to its original shape after stretching and contracting. Elastin also keeps skin smooth as the skin stretches with movements.
Sagging face looks sunken with less tissues around the cheekbones. A jowl means hanging skin around the neck/jaw. There are also marionette lines between the nose and corner of the mouth.
Myth #1 Exercising (Jumping, Running) causes your Face to Sag
Not true – The pounding motion does not have sufficient impact to damage collagen. What is more likely to fuel this myth is for people who exercise a lot outdoors, the UV rays damage the collagen AND if your exercise successful yielded rapid weight loss, your skin couldn’t shrink back and appear as sagging skin. Study had shown that moderate exercise had anti-aging benefits, however too intensive exercise may lead to oxidative stress that damages skin.
Myth #2 Sleeping on Tummy causes Facial Sagging
Not true since tummy sleep does not affect collagen but it affects wrinkles. The more the pillow pulls against your skin, and with age, your skin starts to wrinkle (study).
Myth #3 Facial Exercises work Your Face and reduce Sagging
Not true! Actually all that facial movements lead to wrinkles and possibly, unnatural ones where wrinkles wouldn’t have normally formed (review article showed no benefit).
Laser, ultrasound, radio-frequency, infrared treatments, skin lifting/ tightening and dermal fillers are some of the ways to fix sagging skin, but I won’t want to be so ‘unnatural’ in my aging. What’s your take?
For this 3-post series, we have Alana Mitchell, the founder of SkincarebyAlana.com. She’s the most suitable expert I know for this topic on makeup for sensitive skin, where we will be covering not just the basics of makeup, but very practical steps on applying and removing makeup and even how to mask the appearance of scars or pigmented skin.
More on Alana – Alana acquired her esthetician license from the State Board of Barber and Cosmetology of California, allowing her to practice skincare in the California state in her spa business. Alana has worked in the beauty industry for over 15 years, and teaches advanced education classes for esthetician students.
Eczema Skin
Eczema skin is quite difficult to manage when it comes to make-up; for one, the cause of the eczema could be irritant or contact dermatitis, whereby the eczema rash is triggered by contact with allergens. Secondly, the nature of eczema skin is dry and the skin barrier is defective. It requires applying emollient for moisturizing, protection from moisture (occlusion) loss and increase moisture absorption (humectant). Thirdly, eczema skin may have more scars/ blemishes or even lichenified/ thickened skin from prolonged scratching.
MarcieMom: Thank you Alana for helping us for the past two weeks on:
Today, we are focusing on eczema skin. Let’s tackle the above difficulties one by one and round-up with your makeup tips for eczema skin.
Eczema Skin and Makeup Ingredients
We mentioned in our previous posts that there are ingredients we can avoid for those with sensitive skin. What in your experience are the ingredients not to have for makeup on eczema skin type?
Alana: Amongst the most common are: alcohol, artificial fragrances, harsh sulfates (such as sodium lauryl sulfate), chemical preservatives, and chemical sunscreens (such as octinoxate and oxybenzone).
Moisturizer and Implications on Makeup
MarcieMom: Assuming that an eczema sufferer has very dry skin and needs frequent moisturizing – what is the practical way to go about this? (since it’s not practicable to constantly remove makeup and apply moisturizer, then apply makeup again)
Alana: That is super easy! Find a tinted moisturizer that you love! There are many brands that have tinted moisturizers that will not only deliver SPF protection, but will also provide vital hydration and beautiful coverage to your skin. Granted, the coverage on these products is typically rather light. But if you are doing what is right for your skin, and keeping it healthy, odds are you will only need a light coverage product. If you need heavier coverage, again, do some research. As long as your skin does not tend to get oily with reapplication, and as long as the product you are using is quality, reapplication should not be an issue at all.
MarcieMom: Is there makeup step to avoid for eczema skin? e.g. not to use mascara or adopt a simplified makeup routine
Alana: I wouldn’t say there is anything eczema skin needs to avoid. That is, of course, if you’ve found the right products for your skin type. As I’ve mentioned before, there are products out there for you! It is simply a matter of finding those products. Of course, if something in your makeup regimen is bothering you, or causing an eczema flare-up, discontinue use immediately!
Covering Scars, Pigmented Skin and Blemishes on Eczema Skin
Prolonged scratching of eczema skin can lead to scars, pigmented skin and thickened skin. It is important not to scratch eczema patch due to infection risk as well as scarring and discoloration.
MarcieMom: Alana, what are your makeup tips to cover these scars and blemishes on eczema skin? Are these concealers typically more irritating to skin than the usual foundation?
Alana: Much like foundation, there are many fabulous concealer options that not only mask but heal your skin. Do not, no matter how tempting, apply the first concealer you see in an effort to mask your eczema! This can lead to a negative reaction that will cause you even more problems. Take time to research brands that are especially good for sensitive, eczema prone skin, and take the time to patch test it before slathering it on the effected area. What many people don’t know is that irritated skin is often broken skin, and you do not want to be quick to slap a product on top of that. You will want a product that is specifically indicated to be able to be worn on irritated skin. Many of my eczema clients have had success using Lycogel’s Breathable Camouflage, which was designed specifically for users with rosacea (yes, even when it is in a reactive state).
Alana’s Makeup Removal tips for Eczema Skin
MarcieMom: Can you share your makeup removal tips for eczema skin? (with a view to minimize skin irritation and hydrate skin)
Alana: My makeup removal recommendation for eczema skin is honestly the same as it would be for eczema skin (and normal skin), just with different products! If you go beyond simply having sensitive skin, and have eczema prone skin as well, use products that are indicated to be good for super sensitive skin, and more importantly, for eczema skin as well. Just because a product does not indicate these things does not mean it cannot be used, but you should discuss it with your skin care professional before use. As I mentioned before, fewer and more natural ingredients are usually better. If you know your skin agrees with a certain oil (coconut oil is fantastic), you can use this to remove your eye and lip makeup before cleansing.
Thank you so much Alana for being with us for these past three weeks, it’s been such a pleasure and a great learning experience!
This month, Kate’s figuring out creative ways to get those Zzz. For more Mom NeedyZz cartoon, see here.
Last week, I’ve answered the question on Working Mom – Helping or Harming my Child by Working and while research seemed to give the thumbs up for working mom in terms of parenting, there’s still a lot of Ds over Chores.
Divide – How do you divide chores equitably between both parents?
Divided – Why is chores always a matter of stress and contention in dual-income families? (and a topic that keeps on coming up when mothers get together)
Dread – Ever heard of someone getting excited over chores?
Delegate – How do you delegate chores to kids?
Damn it, just get it over with! (week after week after week… is there chores in heaven?)
Chores is also something most commonly nagged about and I’ve got comments in my Am I Really Nagging? post whether I’m helping men to find excuse not to do chores, because I’ve said
#1 First ask yourself – Do you really want him to do it or is it easier if you just do it? Put aside equality of sexes and fairness, and consider seriously. If you can answer no and yes, just do it yourself. And read on.
I admit that I’m stumped when it comes to chores. I used to do chores grudgingly, resentfully because I think my spouse has to do the same thing that I do. But it gradually evolved to an appreciation that he does chores that I don’t do and there’s no need to calculate chores. Now, I’m at the stage of ‘Leave me alone to do my chores’ and ‘Can you do this other chore, please?’. It has been working peacefully for the past 2 years.
YET sometimes chores is a real chore. AND many working moms continue to do more chores. Let’s look at some of the studies:
OECD study showed that women spend more time on chores, read this Time article ‘ Closing the Chore Gap‘
Report that showed women spending 17.8 hours per week on chores and men spending 9.8 hours (for couples with kids below 18)
Interesting infographics on Cozi that showed women tended to perceive doing more chores
In Chore Wars: Working Mother Report – working moms still do more chores but millennial dads are doing more housework than their babyboomer dads
So chores are indeed tricky:
1st, it’s a dread
2nd, what chores need to be done is often perceived very differently by every family member
3rd, how much chores had actually been done by who is also perceived very differently
4th, is it right to ask another family member to do what you want done but not agreed by all needs to be done?
I’m stumped when it comes to chores. Every working mom would have found a way of dealing with it. I think that whatever don’t get you cursing under your breath, shouting at the top of your lungs, bottled with negativity is the right way – you don’t need to hear how other working moms manage chores (or their men!). One solution is being creative to keep chores to a minimal – a smaller house, outsourcing, rotating the chore duties and not being hung up on dirt. Some cartoons for you!
For this 3-post series, we have Alana Mitchell, the founder of SkincarebyAlana.com. She’s the most suitable expert I know for this topic on makeup for sensitive skin, where we will be covering not just the basics of makeup, but very practical steps on applying and removing makeup and even how to mask the appearance of scars or pigmented skin. See last week’s post on Skin Types and Makeup
More on Alana – Alana acquired her esthetician license from the State Board of Barber and Cosmetology of California, allowing her to practice skincare in the California state in her spa business. Alana has worked in the beauty industry for over 15 years, and teaches advanced education classes for esthetician students.
Sensitive Skin
There is no strict definition for sensitive skin but generally, it means being more prone to getting a hypersensitive reaction to ingredient/chemicals. You can find out which ingredient you’re sensitive to via a patch test and your patch test results can be entered into the CAMP (Contact Allergen Management Program) database in the US to obtain a list of products you can use.
Applying Makeup – Moisturizer and Foundation
MarcieMom: Alana, thanks for helping out this week with application and removal of makeup. We are getting into the specifics of makeup for those with sensitive skin this week.
Can you share with us how we can figure out our skin tone and choose the right foundation (color, texture)?
Alana: If I’m being totally honestly, there is a lot of guesswork that goes into finding your perfect shade. Foundation shades are typically crafted on the most common skin tones, and you will notice that there are usually only 10-20 shades in a typical range. Since everyone has their own unique skin tone, it is usually a matter of trying a shade that looks closest to yours. Another option is to buy one shade darker, and one shade lighter, so you can blend them to meet your exact skin tone.
For brands that label based on undertone, finding your exact shade might be much easier. The first step in figuring out your skin tone is knowing your skin’s undertone, which is a lot easier than many people might think! Simply look at the inside of your wrist and observe the color of your veins. If they appear to be blue, you are likely cool toned. If they appear to be green, you are likely a warm undertone. If you notice both blue and green, or something in between, you are likely a neutral undertone. Whichever tone you observe, you will want to lean towards that range (warm ranges are usually labeled with a W, cool with a C, and neutral with a N). After that, it is all a matter of finding the right shade. Just because it matches your undertone, does not mean it will be an exact match. It might still be too dark or too light – so trial and error will come into play yet again.
When in doubt, there are two things you can do: ask you local makeup artist or esthetician. They should be able to give you some recommendations, and might even be able to test products on you in an effort to find your exact match. When it comes to testing makeup, I am a huge advocate of doing so in a safe manner. If you head down to your local department store, see if they have small, sealed samples that you can test in-store or take home to test. If you feel comfortable allowing a makeup artist to test products on you in-store, make sure you understand the risks (those products are tested on many people, not just yourself) and watch them sanitize both the product and the makeup brush properly. I am not personally an advocate of using in-store testers, unless they are housed in an airless pump container, which most makeup products are not. But is very much a matter of personal preference.
MarcieMom: What about for those with sensitive skin? How can sensitive skin types choose the right foundation and what ingredients should sensitive skin types look for or avoid in foundation?
Alana: When it comes to sensitive skin, I always recommend seeking the advice of a dermatologist or medical esthetician. They are going to be able to give you the best recommendations for your skin type, because they have an understanding of the ingredients that go into skin care and makeup, and also have an understanding of sensitive skin in general.
As far as things to avoid: many sensitive skin types don’t do well with harsh chemicals, alcohol, artificial fragrances, and the like. However, each person is different, and an ingredient that does not irritate one sensitive skin user might irritate another. Brands like YoungBlood Cosmetics and Glo Minerals are fabulous options for sensitive skin users. YoungBlood Cosmetics, founded by Pauline Youngblood, delivers a range that can cover raw, inflamed or discolored skin while allowed it to breath and heal! So yes, most sensitive skin types can definitely use this ultra-gentle makeup range. Glo Minerals bills itself as being a “clinically advanced mineral makeup that covers, corrects, and protects”. They indicate on their site that they are suitable for “even the most sensitive skin,” and I have seen great success with sensitive skin clients using this brand.
MarcieMom: Moisturizing the skin and sun protection are important. How do these go with make-up? e.g. apply them all separately or it’s better to choose makeup that is both moisturizing and offers broad-spectrum UV protection?
Alana: While I am a firm believer in keeping moisturizing and makeup separate, you can definitely combine SPF protection with beautiful skin coverage. As I mentioned in my last post, I am a huge fan of tinted sunscreen. If dry skin is a concern for you, you can definitely reach for products that are more moisturizing.
There are many products that offer full coverage results with SPF foundation. I do urge users to be selective when it comes to picking out a brand and formulation, and to really consider if this option is best for them. Full coverage products are typically “heavier”, meaning most people will not want to reapply it throughout the day. Reapplying SPF every 2 hours (at least) is crucial for optimal sun protection, which is where product selection comes into play.
Lastly, powdered sunscreens make for a great and easy option! Though these are typically on the lighter side of the coverage spectrum, they do a great job of masking imperfections, while absorbing excess oil and mattifying the skin. I happen to be a huge fan of this method for touch-ups (after applying my tinted sunscreen in the AM).
Alana’s Makeup Removal tips for Sensitive Skin
MarcieMom: Alana, what would be your top makeup removal steps/ pointers for those with sensitive skin? (with a view to minimize skin irritation from the products, the beauty tools used e.g. brush and cross-irritation)
Alana: Makeup removal should always be a priority, but I personally like to keep it simple (and enjoyable) to make it feel less tedious at the end of a long day. First and foremost, be sure to remove any makeup around your eye area. There are many eye and lip makeup removers out there that are gentle enough for sensitive skin, and many that are actually indicated for sensitive skin. After you remove makeup in these areas, it’s time to cleanse your face. If you are not the proud owner of a skin cleansing device, make sure you cleanse twice a night to ensure you get any excess dirt, oil, and makeup off of your skin. That is about it! Of course, be sure to follow your cleansing up with your typical skin care routine.
Thank you so much for sharing the makeup basics for those with sensitive skin. It’d give those of us with sensitive skin so much more confidence when we approach makeup. Next week, we will focus on makeup for those with eczema, an area that many eczema sufferers struggle with.
This month, Kate’s figuring out creative ways to get those Zzz. For more Mom NeedyZz cartoon, see here.
Sometimes I feel that I spend too little time at home – I reach home at 9pm, my kid goes to bed at 11pm (sic, I know it’s late but I reach home at 9pm). That’s only 2 hours, of which I spend 30 mins to cook, 30 mins for must-do chores and 45 mins for dinner. (Anyone doing the math?).
So uhmm.. very strictly, quality time speaking, I only have bedtime routine from 11 pm to the time my kid falls asleep (which is 11.45pm to midnight, I know (double) sic). Bottomline – I’m a working mom who is not so much feeling guilty but worried if earning that 2nd income harm my kid.
Worried Working Mom
Totally understand! Your question applies so much to me, it’s spooky! Ok, we all love to be validated by hard evidence and there are quite a few studies that suggest, point toward, conclude that working moms are not harming, but helping our children. Studies have reported:
- Review article found that children whose mothers worked before age 3 didn’t have worse academic or behavior problems later in life than those with stay-at-home moms.
- Based on meta-analysis study, toddlers with working moms grew up to have fewer depression and anxiety issues and got better grades.
- Open-ended questionnaires study did not find that children wanted more time with their parents or thought that their parents were inadequate in their parenting.
- On the other hand, having resources (including money) and offering stability seem to correlate positively with a child’s academics. Childcare quality is critical to a child’s development, especially since working mom’s kid will spend longer hours at childcare. Quality childcare is associated with better academics and higher likelihood of college graduation.
- Based on review of surveys, there were observations that daughters of working moms had higher incomes (supervisory roles) while sons were more likely to spend more time at housework and childcare.
Sounds good right? I’m a working mom and when I first read the headlines, I was saying ‘Yes!’. But (there’s always a BUT) deep down, I know I don’t need studies on other families to tell me if I’m doing the right thing. You also don’t need me to tell you if you’re doing the right thing. Well, since you wrote in, you’d probably like some advice.. so here’s my Working Mom – Work or Stay at Home? thought process!
That’s what I believe – I don’t think it’s so much of an issue whether you’re a working mom or stay at home mom. I think (I can be wrong though!) that it’s THE ISSUE that got to be sorted out. So what’s the issue? Hmmm.. maybe
- You are impatient or get upset easily with your kids from work stress?
- You are not happy at work?
- You want to pursue an interest, a cause but that can’t be achieved while you’re holding a 9 to 5 job?
- You don’t parent when you should be parenting? (I’m all for chilling at parenting, but sometimes it needs warming up.)
- You find cracks in your marriage from how little time you spent with your spouse (and not with your kid)?
- You find yourselves hiding behind the excuse of ‘busy work’ to not do what you know it’s right?
If you often think about whether you ought to be a working mom, you ought to think why you’re thinking about it. And of all the studies in the world on what’s good for our child, no study can tell you what’s right for you. Only you know what’s right and being happy is a clue if something’s right.
Signing off with xoxo, #SkinishMom
For this 3-post series, we have Alana Mitchell, the founder of SkincarebyAlana.com. She’s the most suitable expert I know for this topic on makeup for sensitive skin, where we will be covering not just the basics of makeup, but very practical steps on applying and removing makeup and even how to mask the appearance of scars or pigmented skin.
More on Alana – Alana acquired her esthetician license from the State Board of Barber and Cosmetology of California, allowing her to practice skincare in the California state in her spa business. Alana has worked in the beauty industry for over 15 years, and teaches advanced education classes for esthetician students.
Skin Types and Makeup
If you check out product labels, you will generally find that they cater to (i) normal skin, (ii) dry skin, (iii) oily skin or (iv) sensitive skin. In this blog, we have always been focused on eczema skin that typically belongs to the dry skin type, sensitive skin (when we cover and irritants to avoid) and to some extent oily skin, when we discussed about acne.
MarcieMom: Alana, thank you so much for helping out with this series on makeup! I’m excited to learn more about it, especially when I’m clueless when it comes to makeup (I hardly use any!).
I read that the first step to figuring out what makeup and beauty products to use is to figure out your skin type. From WebMD, I noted that the different skin types are characterized by:
Normal Skin Type – (i) No or few imperfections, (ii) no severe sensitivity, (iii) barely visible pores and (iv) radiant complexion
Dry Skin Type – (i) Almost invisible pores, (ii) dull, rough complexion, (iii) red patches, (iv) less elasticity, (v) more visible lines and (vi) when exposed to drying factors, skin can crack, peel, or become itchy, irritated, or inflamed.
Oily Skin Type – (i) Enlarged pores, (ii) dull or shiny, thick complexion, (iii) blackheads, pimples, or other blemishes
Alana, most people may have difficulty figuring out their skin types or have a combination of skin types. Moreover, certain conditions such as skin disorders, smoking, medications, diet, stress, sun exposure, pollution, climate and existing beauty products may mask the real skin type. What is your advice on how we can figure out our skin type and how important is it to get the skin type right?
Alana: First, finding your right skin type is so important. Many people purchase products that aren’t necessarily right for their skin type, which can be either useless, or counterproductive in terms of achieving desired results. For instance: if someone with dry skin were to purchase a product specifically designed for oily skin, they are not likely to get the level of hydration they want (and more importantly, need). Figuring out your skin type is not always easy, which is where dermatologists and medical estheticians come into play! Going to one of these professionals may seem extreme, but it is the best first line of action in realizing your skin type and finding products that will work best for your skin type!
MarcieMom: I’m interested to find out what are the key differences in the formulation when a company label its product as suitable for (i) dry skin, (ii) oily skin and (iii) sensitive skin? Are there any regulations that govern when a company can label itself as such?
Alana: Key differences in these formulations typically address the markers of each skin type. For instance: dry skin formulas are typically more emollient. Many of these products use oils to nourish the skin, which is essential when you are dealing with any type of dryness or dehydration. In regards to makeup, dry skin users will want to lean more towards liquid formulations more than powder. I highly recommend looking into mineral makeup brands like YoungBlood Cosmetics, which use only the finest minerals while catering to even the most sensitive skin types.
Products designed for oily skin types are typically more mattifying. These formulas are often oil free, and lightweight, which helps to absorb excess oil and regulate oil production. Many people with oily skin will favor makeup that comes in powder form, but there are many fabulous mattifying liquid options that have recently hit the market as well.
Sensitive skin products are known as the more “gentle” formulas. These are typically (though not always) formulated with fewer harsh ingredients, and have been made with sensitive skin types in mind. It is important to note that just because a product is designed for sensitive skin, that does not mean your skin will take a liking to it! All skin is different, so even with sensitive or gentle products, you will still want to apply a patch test 24-48 in advance to using the product to ensure your skin will react well to it. I have not typically seen brands that put out a “sensitive” range for makeup. They are either friendly to sensitive skin as a whole, or they don’t formulate with sensitive skin in mind at all. Because of this, it is essential to look into the brands you are buying from, before you actually make your purchase. I have had wonderful experience with brands such as 100% Pure, Blinc Cosmetics, Glo Minerals, La Bella Donna, and again, YoungBlood Cosmetics.
There aren’t any firm regulations when it comes to labeling products for skin types. That being said, companies do have reputations to uphold, so it is important that they label their products for the right skin types accordingly. Your best bet is to ask your esthetician or dermatologist, and reading product reviews can also be very helpful as well!
MarcieMom: I’m the sort of gal whose makeup is just foundation and lipstick. Alana, what in your view, are the must-haves for makeup and are there certain types makeup (foundation, blusher, mascara, eyeliner) that certain skin types should not use or is it possible to find something for every skin type?
Alana: My three essentials are: mascara, tinted sunscreen, and lip gloss. Being a busy mom and business owner, I know all about getting ready on-the-go, and these three things are fantastic for making you look and feel confident in a pinch!
Makeup must-haves are always a personal thing, but if I could list one essential, it would be some form of tinted SPF. Tinted sunscreens are a great way to get coverage, protection, and hydration. If oily skin is more of a concern for you, you can also reach for a powdered sunscreen brush! These brushes are amazing, because they are so easy to keep in your purse, so easy to touch up, and will mop up oil without making your face look cakey or over-done.
The good news is: regardless of you skin type, there is bound to be an option out there for you. It is all a matter of research and recommendation. If you have had little to no luck, call an esthetician! My medical estheticians and I are available during business hours via phone, chat, and email to help shoppers in finding the perfect products for their skin type. It may sometimes be difficult, but I guarantee you it can be done.
Thank you so much for sharing your expertise on skin types and makeup with us. I think we all benefit from knowing more about skin types and understanding how that relates to selecting makeup. Next week, we will focus on sensitive skin, can’t wait!
Last 2 months were all about what happened to Kate when she didn’t get enough sleep. This month, she’s figuring out creative ways to get those Zzz. For more Mom NeedyZz cartoon, see here.
I want a surprise! A present! I’ve worked so hard (at work + at home), and we all know that eczema isn’t the easiest condition to manage. Can you make some suggestions on what presents my husband should get for me so that all dads reading your column will ‘GET IT’.. (got it?)
Surprise-Deprived Mom
You are so right! We love presents, especially for those of us whose love language is ‘Receiving Gifts’ (click here for your love language test from Dr Gary Chapman). Here are some suggestions, for men to get your spouse:
#1 Time off – Sometimes your wife may seem like she has it all under control and she may even appear not to trust you with eczema care. BUT she may have been wishing for you to step up and volunteer to spend some daddy-child bonding time so that she gets time-off. You never know if you don’t ask, and ask on the day you bring flowers home.
#2 Cheesecake and Coffee – If you don’t know the type she likes, buy a different one each time or even those where you can mix different flavors. Top this with time alone without kids/chores to do when she’s savoring them
#3 Beauty products – Sometimes it can get maddening when you’re applying all the moisturizers on your child but your own skin is dry. Getting beauty products for a mom of eczema child has a deeper meaning – you appreciate her efforts in your child’s skincare (please don’t get one with irritants on the list! Check this ingredients to avoid interview with dermatologist Dr Verallo-Rowell)
#4 Hotel staycation – Even with children along, this is a break from the daily routine. The important part? Be in-charge of packing and playing with your kids during the staycation!
#5 Love – Any small ways you show love is good, including doing your share of chores and not adding to the chore list, hugs and kisses, not snapping at her but showering praise instead. Comes from the heart, man.
Wishing my spouse is reading this too! xoxo, #SkinishMom
This is the final post of the 5-part series and today, I will try to apply all that we have learnt in the past 4 posts to eczema skin consultations. I have presented it in survey format for each step of teledermatology and look forward to hearing your experience!
Before the Teledermatology Process
Q1 Were you given a leaflet to explain teledermatology and what form of teledermatology is available to you?
Q2 Were you aware that you do not have to consent to teledermatology?
Q3 Were you told that if an in-person consultation is deemed required during the process, you will have access to the dermatologist?
Q4 Were you told if it is going to be stored and forward or live videoconferencing?
Q5 Were you told that your eczema is suitable or not suitable for teledermatology? For instance, full body eczema, or rashes in scalp, private parts or pigmented rash are difficult to capture fully in images. Or that your eczema is localised and can be clearly identified in image.
Q6 Were you told that teledermatology may not be as accurately diagnosed than face-to-face consultation?
Starting the Teledermatology Process
Q7 Were you told who is the dermatologist and his/her licensure and board certification?
Q8 Were you told what images of your eczema will be taken and how these will be stored and protected?
Q9 Were you given the instructions on how you can access your own patient record?
Q10 Did you feel that the referring physician is comprehensive in recording your medical history?
Q11 Were you asked these questions on your eczema?
- Previous treatment for eczema and response to medication
- Personal and family history of skin disease and atopy
- Known allergies
- Active problem list
- Body map is recommended to show the site of lesions and the extent of inflammation at each site
Q12 Did you feel you were treated with dignity during the photography session?
Q13 Were you told that you can have a companion during the consultation with the referring physician?
Skin Management Plan
Q14 Were you provided with a skin management plan? e.g. what medication, for how long/ which part of skin/ frequency/ how much to use
Q15 Was it made clear to you who is responsible for your care? e.g. to communicate with you and ensure that treatment is clearly communicated
Q16 Was there nursing staff to help you with skin care? e.g. guidance on how to moisture and wet wrap
Q17 Could your referring physician explain clearly which type of eczema you have, and the steps to reduce flare-ups e.g. allergy avoidance, active steps to reduce staph bacteria
Follow-up with Face-to-Face Skin Specialist Consultation
Q18 Did you have to wait longer than traditional referral to see the dermatologist who has provided the skin management plan?
Q19 Did you have to provide the same information again at the skin specialist clinic?
If you were referred for videoconferencing with the dermatologist,
Q20 Did the dermatologist have your information and referral form?
Q21 Was the videoconferencing set up in advance and smooth?
Q22 Were you told beforehand where you would need to uncover for the skin to be imaged?
Q23 Were all the persons in the room identified?
In instances where the set up or preparation for teledermatology is inadequate, the dermatologist may only confirm a diagnosis/ provide a treatment plan in-person. As such, it may end up being more time consuming to engage in teledermatolgy. What’s your experience? How many of the 23 questions were ‘checked’ for you?
For all other posts in this 5-part series, see
Is it possible to love when you’re tired? I’m too tired to think, feel or do anything, can I still actively love someone? Some days I ought to smile more, hug more or even really look at my loved ones more, but I’m too tired. Eczema parenting + full-time work.. love, it’s (almost) out of the window.
Tired Mom
Close that window.
Totally understand that it is difficult to love when you’re tired. I feel the same way too. Some days my eyes are only looking at the computer at work or looking at the floor, or the sink or the clothes hangers. But some days I think back of how doing something I know is good and loving will refresh me.
When I was living in Shanghai, I had to travel all the way from city area to the very west end of Shanghai for bible study. Almost every Friday, I felt like skipping bible study, especially while jostling in the cramped train (it’s so cramped that when the driver announced to get ready and move to the door for alighting at the next stop, he really meant it!). But every time at the end of the bible study, I felt refreshed and not tired – my husband felt the same. I kept this in my heart, knowing that if traveling so far, under such crowded (and often stale air) conditions, I could still feel refreshed, week after week for two years. Then, maybe I can love when I’m tired too.
Whoever are your loved ones are the people who God had put on earth for you to love, with the full knowledge that life on earth is no bed of roses. Love and your loved one was never meant to be a burden from the time of Adam and Eve (though that was the start of the ‘blame game’ among couples!). So how can a tired mom love? Especially if you have a child who needs extra care.
6 #SkinishMom Love-When-You-Are-Tired Tips
#1 Don’t blame or beat yourself up on bad days when you snapped or didn’t show TLC to your loved ones
#2 Don’t blame anyone, for anything
#3 If you are constantly too tired, then you should do something about it – ask for help, cut down on work that don’t matter
#4 Smile – Mother Teresa said
“Every time you smile at someone, it is an action of love,
a gift to that person, a beautiful thing.”
#5 Hug – it’s de-stressing, from Dr Mercola’s website
Hugs are one of the most succinct ways to encourage your body to release oxytocin, and the more oxytocin your pituitary gland releases, the better able you are to handle life’s stressors.
Oxytocin decreases the level of stress hormones (primarily cortisol) your body manufactures and lowers your blood pressure response to anxiety-producing events.
Oxytocin has also been found to reduce the cravings of drug and alcohol addiction, as well as for sweets. It even has a positive influence on inflammation and wound healing.
#6 Warm someone’s heart – When I’m tired, I’m bogged down by too many things to do. Usually none of these things satisfy my heart (it satisfied my brain though cos I’d have checked off my to-do list!). When you love, someone else who may be as tired as you has been loved. Knowing that you have done something to warm another heart will warm yours too.
I hoped this post has warmed your heart too, #SkinishMom
“Do not think that love in order to be genuine has to be extraordinary. What we need is to love without getting tired. Be faithful in small things because it is in them that your strength lies.”
Mother Teresa
Last 3 weeks we have covered 3 posts in this 5-part series on Teledermatology:
- Different Forms of Skin Consultation
- Skin Images and Patient Information
- Shortfalls in Teleconsultation
Teledermatology takes away the need to travel and meet in person with the skin specialist. This brings about numerous advantages such as:
Shorter wait time – Compared to traditional referrals, a referring physician that a patient sees (nearer and more accessible) can help to capture, store and transmit the patient information and skin images to a dermatologist. The access to a dermatologist is therefore faster.
Accessibility for patients who live in areas without dermatology care – Singapore is small but in many other countries, specialist dermatology department may only be available in certain areas and teledermatology is a way for patients living in more remote areas to have access to specialist care.
Familiarity – For skin issues that both the referring clinician and the dermatologist feel that it is appropriate for the dermatologist to prescribe a skin management plan and the referring clinician to administer and be responsible for the patient interaction and care, the patient will then be seeing the same doctor (referring clinician) who he/she has already established a relationship with.
Convenience – Potentially faster, cheaper and less stressful than to travel and visit another doctor.
More detailed record – As the process of teledermatology is reliant on the transmission of patient information, images and then the relay of the diagnosis and treatment plan, followed with the outcome of previous treatment, there is a well documented record of the patient information and the skin condition. This record may be more detailed in in-person consultation.
Reduction of waiting lists at dermatology clinics – As certain skin conditions do not warrant establishing a relationship with dermatologist but rather straightforward in the diagnosis and treatment, the waiting lists at dermatology clinics can be shortened.
However, it is NOT ALWAYS that these advantages can materialize and both the referring physician and dermatologist can take actions and have systems in place to ensure success in teledermatology:
At the Referring Physician
- Proper record of patient information, medical history and the history of the skin lesions
- Staff to take skin images that meet the guidelines of images in teledermatology – dermatology nurse trained to take high quality skin images
- Integrated system at the referring physician to incorporate teledermatology
- Proper planning of the consultation process at the referring physician to take the images required after the consultation
- Selection of patient – Patients who are resistance to teledermatology, for instance, elderly, shy or young patients, or with rash at private parts should not be pressured to consent to teledermatology
- Educational materials on the diagnosed skin condition to be available for the patient and the care team
At the Dermatologist
- Dermatologists who signed up for teledermatology should have the resources to promptly feedback on the information provided by the referring clinician
- Dermatologists should have resources for the referring clinician and his/her clinic on various skin conditions
- Close communication and record of patient care with a system to obtain feedback and address weakness in the process
- Patients should not have to furnish information all over again if referred for an in-person consultation at the skin specialist clinic, i.e. teledermatology should be integrated with the specialist clinic system
- Patients should have a shorter waiting time for in-person specialist skin consultation compared to traditional referral
- Patients should have easy access to dermatologist for face-to-face session
- Patients should be given clear skin management plan
If traveling to the dermatologist is not an issue to begin with and the mode of teledermatology is video conferencing, there may not be much cost/time-savings involved. On the other hand, it benefits certain situations such as elderly living in a home who may not have access to specialist care if not for teledermatology.
If you want to understand more of the quality standards in teledermatology, do read British Association of Dermatologists’ standards. Share in the comments if you have benefited from teledermatology and what advice you have for patients to get the most out of it, your sharing will help another!
Seriously sleep deprivation affects judgment and interestingly, studies showed that we judged poorly on the fact that we are sleep deprived! (ie we don’t even KNOW we need more sleep!) Next week, all the past two months of sleep deprivation is heading towards a breakdown. For more Mom NeedyZz cartoon, see here.
It was reported end June 2015 that an association (not causal link) was found between the consumption of citrus fruits (grapefruits and oranges) and skin cancer. Key points in these reports were:
- Increased risk of skin cancer melanoma with drinking orange juice and eating grape fruit
- Association, not causal
- Possible (in theory) that psoralens and furocoumarins in citrus fruits make the skin more photo-sensitive
- Association found from questionnaires filled by about 100,000 health professionals
#SkinishMom looked up Pubmed for more on citrus fruits and got into ‘Citrus Confusion’ – studies seemed in general to point to benefits from citrus fruits, including that of skin cancer protection. Below are the studies:
- Citrus peel use is associated with reduced risk of squamous cell carcinoma of the skin – showed that peel consumption, the major source of dietary d-limonene, is not uncommon and may have a potential protective effect in relation to skin squamous cell carcinoma
- Hesperetin induces melanin production in adult human epidermal melanocytes -Hesperidin, a flavonoid in citrus fruits, may protect from photodamage if its capacity to increase melanin production in human melanocyte cultures could be reproduced on human skin
- Topical hesperidin prevents glucocorticoid-induced abnormalities in epidermal barrier function in murine skin – Hesperidin can stimulate epidermal proliferation and differentiation, therefore protect against the side effects of topical glucocorticoids
- Protective effect of red orange extract supplementation against UV-induced skin damages: photoaging and solar lentigines – Red orange extract intake can strengthen physiological antioxidant skin defenses, protecting skin from the damaging processes involved in photo-aging and leading to an improvement in skin appearance and pigmentation
- Oral dose of citrus peel extracts promotes wound repair in diabetic rats – showed significant reduction in blood glucose and time to wound closure. Tissue growth and collagen synthesis were significantly higher
It is true though that psoralen (compound in citrus fruits) make the skin more photo-sensitive; there is a treatment for severe atopic dermatitis (eczema) in adults that prescribed psoralen to be taken 1.5 to 2 hours before phototherapy so that the skin will be more sensitive to the light (“PUVA“).
Taken together, #SkinishMom isn’t going to stop taking citrus fruits but always, sun protection please.
Last week we covered a critical part of the teledermatology process – getting quality patient information and skin images (for Store and Forward). This week we break down the various steps in teledermatology and explore why each step may not work as well as in-person consultation.
Face to face consultation remain the gold standard as there are many areas where teledermatology may fall short. The referring provider and the dermatologist must be familiar and trained to conduct teleconsultation to mitigate these shortfalls.
Step 1 – Understanding the Patient
In face to face consultation, non-verbal cues can be noted including signs of stress that may be important in measuring the quality of life and severity of skin condition e.g. eczema. In triage teledermatology, it is often limited to paper documentation or standard referral letter.
Mitigating factors – There should be a system in place at the referring physician clinic to understand the patient. For instance, comprehensive questionnaires, trained doctors and nurses to capture patient information and images and sufficient time to do so.
Step 2 – Skin Evaluation
In face to face consultation, the physician can use sense of touch and able to see ALL the skin areas. In teledermatology, it is limited to the skin area where the photograph has taken. There are certain skin areas where it is recommended to have an in-person consultation, such as:
- The whole body has skin problems, for instance, generalized eczema rather than localized. Physicians have to note to treat the patient as a whole, even when the information is centered on the lesions (a potential pitfall of teledermatolgoy is focusing only on the skin lesion).
- The skin conditions are on areas of skin with hair that cover up the skin rash, for instance, the scalp.
- The skin lesions if pigmented are harder to view as an image.
- Mucosal lesions and orifices, e.g. genital, present difficulty to take accurate image.
Mitigating factors – Skin images have to be taken from various angles, with mid close-up and macro close-up distance and skin lesions clearly marked. Therefore, the referring physician who takes the image or review the suitability of the image has to be trained. Special lighting or dermatoscopes may be required.
Step 3 – Administering the Treatment
It is more likely for the treatment to be carried out as prescribed if there is in-person interaction. Patients have an opportunity to ask their questions directly to the dermatologist and such interaction provide opportunity to optimize patient care.
Mitigating factors – If the treatment is to be handled by the referring physician, educational materials may need to be provided for both the referring physician and the patient. There ought to be close communication between the referring physician and the dermatologist so that the treatment and skin management plan for the patient is agreed and both physicians feel confident with the plan.
Step 4 – Responsibility for the Patient Care
It should be clear within the care team and clearly communicated who is responsible for the patient. In particular, in the quality standards by BAD, it is stated under ‘Patients with long-term skin conditions (eg eczema or psoriasis)’ that
Patients with chronic inflammatory skin disease should be managed through teledermatology only if the referring clinician has the facilities and clinical experience to provide on-going patient support and review based on the skin care management plan provided by the reporting skin specialist.
The rationale is that these skin conditions fluctuate significantly in severity and may require complex treatment plans for safe and effective long-term management. Patients (and parents/carer) should have access to suitable nursing expertise for treatment, counseling, education and advice. Another rationale is that these skin conditions may come with significant physical, social and psychological impairment and therefore the ability to provide on-going patient support is critical to patient care.
There is a reported loss of rapport with the patient through the teledermatology. As such for certain skin conditions that are chronic, fluctuating and require long-term care, teledermatology may not be suitable.
Next week, we will explore what are the advantages of teledermatology. Have you tried teledermatology? Did you feel at any time that your health and skin conditions are not fully understood? Was your referring physician convinced with the skin management plan and were you confident in following through with it?
Share in the comments, especially important as teledermatology is gaining in popularity and we want to do our little part to steer it in the right direction for skin/eczema patients!
Last week, Kate realized she put on weight (from lack of sleep!). And now this discovery of clothes no longer fitting.. what’s going to happen to her? For more Mom NeedyZz cartoons, see here.
There was a recent study published “Self-reported adverse tattoo reactions: a New York City Central Park study” where lead researcher Dr Marie Leger, Assistant Professor at NYU Lagone Medical Center, and her team surveyed about 300 people. It was noted that up to 6 percent suffered from rash, itch or swelling that lasted longer than 4 months. About 10 percent surveyed had short-term skin complications.
This again highlight that we ought to take tattooing seriously – it is not just ‘fashion’ because tattoo works by damaging skin barriers. Tattoo also cannot be ‘taken off’, as the process of doing so is a series of painful laser treatments to remove the skin layers that can take months.
As covered in this post, red ink results in the most allergic reactions. However, it is not clear what about the tattoo ink causes the reactions (dye, preservatives or brighteners). There is no easy way to know ahead if you will get a rash/ hypersensitive reaction because patch test may not be accurate since patch testing is meant to test for contact reactions (not when the chemicals are embedded into the skin layer). Tattoo presents a risk of skin rash or irritation/ swelling AND such skin reaction will change the way the tattoo looks! Wrinkled skin will also change the tattoo appearance.
Why Tattoo is Becoming Popular
Tattoos were once popular among sailors, bikers but for the past few years have been increasingly popular among celebrities. Today, ordinary folks in traditional occupations like teachers and government work also spot tattoos. For some, tattoo is about lending a voice to their life with tattoos that mean something to them. Other reasons include beauty, art, group affiliation, on impulse or addiction.
Step by Step Tattoo Safety Tips from #SkinishMom
#1 Is your skin generally hypersensitive? If yes, it’s best to skip it. As patch testing is not full-proof, there’s no absolute way to know you won’t get any skin reaction. Some reactions can appear months later and get only be rid of by removing the tattoo.
#2 Consider patch testing for the common chemicals used in a tattoo, such as mercury sulfide (cinnabar), ferric hydrate (sienna), sandalwood or brazilwood. Each ink has different components so you can decide on your colours and then patch test the ingredients. It is not a full-proof though.
#3 Check regulation monitoring tattoo establishment. Different country and state has different regulation, including inspection and equipment/supplies (contact with blood) handling procedures. You may even want to travel to a state that has stricter regulations.
#4 Go to regulated tattoo establishment.
#5 Get a tattoo you won’t regret! It is reported that more than 20% of adults regretted their tattoo choice… for instance, do you really want the name of an ex-girlfriend on your skin?
#6 Check the batch number of the pigment used. Also check if the brand of tattoo pigment is from more established companies, such as Millennium Colors Inc. Also make sure that sterilization is practiced.
#7 Protect your tattoo by keeping it clean and out of the sun. The better your skin heals, the better your tattoo will look.
Have you tattooed? and how did it work? Recommend your tattoo artist, brand or inks in the comments!