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Eczema Facts

Teledermatology – Skin Images and Patient Information

Last week, the basics of teledermatology was introduced – What Teledermatology is, its different forms and patient points when getting started on it. Today, we continue with the 2nd part of this 5-part series, focusing on a central part of the teledermatology process – Skin Images and Patient Information. Much of the guidelines are obtained from the British Association of Dermatologists’ Quality Standards for Teledermatology.

Information for Skin Patients

Before getting started on (and providing consent to) teledermatology, there are good practices on what Information You (as the skin patient) Ought To Be Provided With

  1. What the tele dermatology process involves and why it is helpful in your case
  2. Why there may be a difference in diagnostic accuracy from in-person consultation
  3. Process in place to have an in-person consultation should the need arise
  4. Who takes the images and what images are needed
  5. What information will be sent with the images
  6. How the images are transferred
  7. Information about the specialist to whom the images are sent to and what the specialist will do with the information
  8. What happens in response to the teledermtaology consultation
  9. How you can access your own information
  10. Where your skin images are stored, for how long and who have access
  11. The fact that you do not have to consent for teledermatology

Information from Skin Patients

Once you have consented to teledermatology, a critical part of the process is compiling complete and accurate Information on You and Your Skin Condition. Information that are expected to be collected, stored and transmitted (Store-and-Forward) are:

Personal Information on Patient 

  • Date of birth
  • Gender
  • Ethnic group
  • Address, contact number

Information on Patient’s Skin Condition

  • Date of onset and duration of skin lesions
  • Whether single or multiple skin lesions
  • Locations of the skin lesions
  • Changes in size, shape and colour
  • Any bleeding and/or ulceration
  • Symptoms that accompany the skin lesions

Information on Patient’s Medical History 

  • Any personal and/or family history of skin cancers
  • Other risk factors, e.g. excessive sun exposure, fair skin, large number of birth marks, currently on immunosuppressant medication
  • Other medical conditions
  • Repeat and recent medications

In particular, for those with inflammatory skin condition, e.g eczema, information from you that is required are:

  • 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

A note on Skin Images

Importance of Quality Skin Images and Patient Information for Teledermatology
Importance of Quality Skin Images and Patient Information for Teledermatology
  1. If the skin images are to be taken at the clinic of your referring physician, a few points that they ought to bear in mind are:
  2. Protecting your modesty – You have the right to have a chaperone or bring a companion
  3. Images should be a minimum of 2000×1500 pixels or 3 megapixels
  4. Images should be taken at least at two different angles, to compensate for loss of details from reflection
  5. Images should be mid-close up to identify where the lesion is and macro (close-up)
  6. The focusing distance should be at least 20cm for macro close-up.
  7. Image filenames should be clearly identified
  8. Skin lesions can be identified using sticky labels, surgical tape or washable markers.

In Store and Forward Teledermatology, capturing quality images, recording accurate and complete information is a critical success factor. If the dermatologist is comfortable with the quality of imaging and information, it is less likely that you will be called in for an in-person consultation.

What is your experience? Were you provided with adequate information BEFORE you consent to teledermatology and did you feel that your referring physician recorded all the requisite information? Share in the comments so we can benefit from your experience!

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Mom Sleep Cartoon

Mom NeedyZz Cartoon – Sleep Loss and Weight Gain

Don't ever think that sacrificing sleep for your family will help to lose weight! from Mom NeedyZz cartoon
Don’t ever think that sacrificing sleep for your family will help to lose weight!

Moms with eczema kids get less sleep simply cos our kids don’t sleep well. For tips on helping your child sleep better, see this post. Apart from the sake of our sanity, sleeping well has the benefit of avoiding weight gain (from the loss of sleep!). When you are awake, you may tend to reach for snacks. Came across a blog post on weight loss when sleeping here, and from WebMD,

The two hormones that are key in this process are ghrelin and leptin. “Ghrelin is the ‘go’ hormone that tells you when to eat, and when you are sleep-deprived, you have more ghrelin,” Breus says. “Leptin is the hormone that tells you to stop eating, and when you are sleep deprived, you have less leptin.”

More ghrelin plus less leptin equals weight gain.

“You are eating more, plus your metabolism is slower when you are sleep-deprived,” Breus says.

What’s your experience? Weight gain or loss while caring for your eczema child? Share in the comments! For more Mom NeedyZz cartoons, see here.

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Skin ish Mom Column

#SkinishMom investigates – Acne and Vitamin B12

A recent study by researchers at UCLA examined the link between Vitamin B12 and acne, as it had been suggested in numerous studies or published observations of vitamin B12-induced acne. It was observed in the small sample of 10 participants that after taking Vitamin B12, there were higher levels of the vitamin on the skin. This led to a skin bacterium Propionibacterium acnes to produce more porphyrins, a molecule that is pro-inflammatory. The researchers stressed that the take-away from their study was that skin bacteria is a critical part of understanding acne (and the take-away should not be to stop taking vitamin B).

Acne is linked to the increase of oil/sebum on the skin but the development of acne is not entirely lucid. In an interview MarcieMom had with dermatologist Dr Lynn Chiam, Dr Lynn shared her insight on acne and also tips for those suffering from both acne and eczema.

  1. Acne can be divided into whiteheads or predominantly inflammatory with papules (zits) and pustules (zits filled with pus)
  2. Large and deep zits can result in permanent scarring
  3. Acne usually starts during teen years
  4. Acne can be triggered by increased facial sebum, oily face creams, hormonal changes (pregnancy/ starting or stopping birth control pills/ menstruation), smoking, pollution and high humidity
  5. Mild acne can be treated with creams containing benzoyl peroxide, antibiotics and tretinoin
  6. Avoid applying steroid creams (for eczema) on acne as steroid creams can make the acne worse
  7. Anti-acne cream can cause skin dryness, so avoid applying over eczema skin

The key objectives of acne treatment is to heal the pimples, stop new ones and prevent scarring.

Tips for Caring for Acne Prone Skin
Tips for Caring for Acne Prone Skin

Tips for Acne-Prone Skincare

  • Clean away excess oil from the face and wash using gentle (non-soap) cleanser
  • Do not scrub the acne or squeeze, pinch, or pick the pimples as that increases the risk of scars or dark spots
  • Shave carefully – never dry shave or use a blunt blade
  • Stay out of the sun, if on topical medication
  • Choose oil free and noncomedogenic makeup

Do you have a special regime to care for your skin and any particular diet? Share with #SkinishMom in the comments!

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Eczema Facts

Teledermatology – Different Forms of Skin Consultations

With many people having access to cameras and internet, teledermatology is gaining popularity with the potential of getting a dermatologist’s consultation in a shorter time (compared to a long referral wait). This 5-part series explore the numerous aspects of teledermatology, much of the information is from dermatology associations like the American Telemedicine Association, American Academy of Dermatology, British Association of Dermatologists (BAD) and numerous published research/review papers.

What is Teledermatology?

Teledermatology is a skin consultation carried out remotely using telecommunications, it can take different forms such as:

Store and Forward – This refers to images being stored, sent to the dermatologist with patient information who will then revert with the consultation. Thus, it is not ‘real time’.

Real-time Interactive – This uses videoconferencing.

Direct-to-patient – Images are sent to the dermatologist and there is a live interaction.

Triage consultation – This involves two physicians, where one physician (referring physician) will send the patient information and images to the dermatologist and interact with the dermatologist. The patient interacts with the referring physician.

Store and Forward – When is it Used?

Store and forward is increasingly used, in various forms of skin consultations.

In direct-to-patient teldermatology, store and forward is between:

  • Patient and Dermatologist
  • Patient sends his medical history and images directly to dermatologist
  • Dermatologist provides care directly to patient

Store and forward can also be used in teletriage, whereby:

  • Referring physician interacts with patients, to obtain medical history and skin images
  • Referring provider sends the patient information to dermatologist
  • Dermatologist decides on next step – in-person consultation, tele consultation or no specialist consultation required
  • If it is to be via tele consultation, the dermatologist provides a consultative report back to the referring provider with a skin management plan
  • Referring physician is responsible to carry out the treatment recommendations

Some ‘Get Started’ Pointers for Patients:

Teledermatology Get Started Pointers for Skin Patients
Pointers for Patients considering Teledermatology

#1 Be clear about what you sign up for

As there are various forms teledermatology can take, make sure you find out which one your referring provider has in mind – will he remain as your primary care doctor or it is expected to eventually lead to a referral to see a dermatologist directly

#2 Licensure and board certification of dermatologists

In certain countries/states, there are regulations that mandate patients have a choice of dermatologist, access to where the dermatologist is licensed and what are his/her board certifications. Sometimes dermatologists can provide teledermatology only in states where he/she is licensed. Other states regulate that prescription can only be provided when there is a live interaction. Being licensed in a particular state may also mean being familiar with the health care infrastructure and the resources you (as the patient) have access to.

#3 Access to in-person followup

It would be ideal for you to have the option to access to the dermatologist in-person even if the teledermatology is currently not direct-to-patient form. Where the teledermatology is direct-to-patient, dermatologists are expected to have met you in person or to do so via a live video conferencing before prescribing medication.

#4 Expect your medical history to be stored and transmitted

As opposed to in-person consultation where images of your skin may not be taken, teledermatology relies on the storage of such images to be transmitted to a dermatologist. There are guidelines on collection of patient data and on privacy. Some data that are required to be collected are:

Medical history – for instance, history of eczema or atopic conditions in family

Medical records – past treatment given and current treatment will be documented electronically for all physicians in your care team to have access to. The patient’s existing primary care physician and dermatologist (if any) should be identified.

#5 Right doctor at right time and place

No matter what form of  teledermatology, it should be no less effective and efficient than a in-person referred consultation. The main advantage of teledermatology is the potential to receive a specialist consultation sooner and to have access to the right doctor. The teledermatology process should not end up being convoluted and time-consuming.

Have you tried teledermatology? Has it benefited you? Share in the comments so that the rest of us can benefit!

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Mom Sleep Cartoon

Mom NeedyZz Cartoon – Sleep Deprivation = Memory Loss

Mom NeedyZz Cartoon Sleep Deprivation Memory Loss

From WebMD, it’s stated that “In 2009, American and French researchers determined that brain events called “sharp wave ripples” are responsible for consolidating memory. The ripples also transfer learned information from the hippocampus to the neocortex of the brain, where long-term memories are stored.” Don’t forget that you haven’t had a good night’s sleep and go sleep now! For more of Mom NeedyZz cartoons > here!

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Skin ish Mom Column

#SkinishMom Investigates – Summer Foods and Skin

Summer Foods for Skin-  #SkinishMom.pngThere are quite a few articles out there on what summer foods you can eat in order for glowing skin and #SkinishMom decides to investigate! You can never take for granted that if a food is recommended on numerous health/ beauty websites, it means that it is the summer (super) food to eat for your skin – sometimes it’s just one website copying another. So #SkinishMom compiles the common summer foods and look at what they are recommended for (vitamins, antioxidants) and research Pubmed to see if there is a scientific basis for such recommendations.

For Water

This has been covered in this #SkinishMom column where it’s concluded (based on general dermatologists’ views online and research (or rather, lack of, since no one can earn money from researching water!) that being dehydrated is bad for the skin but excess water does not benefit the skin.

Foods to eat for water during summer is watermelon, cucumber, celery, cantaloupe, tomatoes and strawberries.

Vitamin C

Vitamin C is studied to varying extent (meaning: the trial is either small scale, or it may be at higher dosage than in a fruit or for application instead of oral or studied in mice) to:

  • Increase collagen production
  • Protect against damage from UVA and UVB rays
  • Helped skin healing, including pigmentation problems
  • Improve inflammatory skin condition (do you know mice are injected with a pro-inflammatory chemical to create inflammation, then administered an oral supplement to test the results, gasp!)

Summer fruits loaded with vitamin C are citrus fruits, oranges, grapefruits, lemons, limes and watermelon.

Antioxidants

Our skin, being the largest surface of our body, is subject to oxidative stress – from the sun, air pollutants, stress, alcohol and the foods we eat. Free radicals are formed during our body’s natural metabolism and oxidative stress but our skin have antioxidants to balance the free radicals. Intake of antioxidants have been studied to prevent carcinogenesis (formation of cancer cells) and protect cells from oxidative damage (e.g. limit the effects of sunburn). One study showed that sunburn to cells was decreased by antioxidant treatment via (i) protection from free radical and (ii) increasing epidermal thickness.

Foods with antioxidants that are popular during summer are blackberries, blueberries, raspberries and strawberries. Drink up green tea too!

Lycopene

This compound is studied to for collagen production and quite extensively known for its anti-cancer properties for melanoma (along with proanthocyanidins in grape seeds). Together with soy isoflavones, vitamin C, vitamin E, fish oil, lycopene has been studied to induce an improvement in the depth of facial wrinkles after long-term use.

Foods rich in lycopene are guava, water melon, papaya, grapefruit and cooked tomatoes.

Vitamin A

Retinoic acid is essential for skin and bone growth and in the studies, mostly linked with cell development and use in cancer treatment. Be careful about taking too much neonatal vitamin A supplement as it has been studied to be linked to atopy and wheezing in children.

Foods rich in vitamin A are carrots, sweet potatoes and pumpkins (but these are considered fall vegetables). The case for beta-carotene for skin isn’t so clear in studies though.

Vitamin E

Vitamin E protects skin membrane and guard against UV damage as it has UV absorptive properties.

Avocado, broccoli and tomatoes are foods rich in vitamin E.

Omega 3

Essential fatty acids are essential from the time of our development in our mother’s womb! It’s critical for brain development (our brains are actually quite full of fats!) and for our skin, omega 3 is able to regulate oil production, have antimicrobial and anti-inflammatory properties. Omega 3 is also studied to maintain our skin (stratum corneum permeability) barrier, inhibit pro inflammatory compounds and elevate our sunburn threshold and promote wound healing.

Experiment different recipes using avocado, chia seeds and salmon! 

Green tea polyphenols

Geen tea polyphenols (GTP) inhibits chemical carcinogen, induced by UV radiation. Green tea being calorie-free is a healthy drink to acquire a taste for.

So this summer, drink enough water and eat some of these summer foods to help protect your skin – sun protection is still a must though!

#SkinishMom

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News & Research

Eczema News – Child car seats – Home for House Dust Mites

House dust mites in child car seatsHouse dust mites is one of the most common allergen triggering eczema in older children. We often think of house dust mites residing on the bed sheets, pillows and mattresses. One often overlooked area is the child car seat. This team of researchers from Ireland studied the type and amount of allergens in the child car seats and (oops, add one more thing to your to-do chores) it turned out child car seats are quite loaded with dust mites and allergens. Here’s a quick look at the study.

Sample: Dust samples collected from 106 child car seats and driver seats

Results: 12 species of mites, of which nine are known to produce harmful allergens, were recorded from 212 dust samples. Over 80% of drivers’ seats and over 77% of child car seats had house dust mites and its allergens. Over 12% of driver seats and 15% of child car seats contained house dust mite levels sufficient to be risk factors for sensitization and allergic reactions. From the samples examined, the house dust mites were breeding (not dead).

What it means: For those with eczema, asthma and rhinitis, you’d have to add car seats to your list of items to clean. Especially if you spend long hours in the car, even more critical to vacuum your car seats regularly. Plus it is compulsory for your child to be in a child car seat for safety.

Why dust mites love car seats: The researchers pointed out that the materials of the car seats, being made of polyester and/or cotton, trap shed human skin and other organic matter (like food) that are the food sources of house dust mites.

Read also these posts for more on:

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Support Group

Eczema Support Group – Public Forum at NSC Singapore

Come this Saturday to the National Skin Centre Singapore for Public Forum on Eczema
Come this Saturday to the National Skin Centre Singapore for Public Forum on Eczema

This coming Saturday, National Skin Centre is holding an Eczema Support Group Forum on the Effective Management of Eczema. There will be 3 informative talks by dermatologists on the following topics:

A/Prof Mark Tang, Senior Consultant Dermatologist, will be sharing on new treatments for eczema

A/Prof Giam Yoke Chin, Senior Consultant Dermatologist, will be sharing her expert tips on the right selection of moisturiser and skincare products

Dr Eugene Tan, Associate Consultant Dermatologist, will share his insights on how to maximise treatment success and minimise risk

This forum is free for Eczema Support Group members, but S$5 for non-members. Do register early by calling 65-63508273. If you are interested in becoming a member and registering for the event, do leave a comment or email me at [email protected] and I’d get a NSC staff to contact you on membership and RSVP.

Mark your calendar for the event!
Date:   27 June 2015, Saturday
Time:   1.30pm to 4.30pm
(registration starts at 12:45pm. Event starts at 1:30pm sharp)
Venue: National Skin Centre, Level 5 Auditorium. 

See you!

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Mom Sleep Cartoon

Mom NeedyZz Cartoon – Lack of Sleep gives Dark Circles

Mom NeedyZz Cartoon Lack of Sleep Dark Circles

Chronic sleep loss leads to more stress hormone cortisol, which breaks down skin collagen, making your skin looks dull and dark circles under your eyes. Beauty sleep anyone? For more of Mom NeedyZz cartoons > here!

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Skin ish Mom Column

Ask #SkinishMom – Holiday is so not Relaxing!

#SkinishMom Parenting Skin Expert
Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

Hi #SkinishMom:

I’m so upset, holiday is supposed to be fun and relaxing right? But it never turned out that way. If we actually go for a holiday, I’d end up packing everyone’s bags, planning the itinerary, cleaning up the home and the dirty clothes. That’s still not the worse part. The worse is when we actually stay at home and entertain guests – gosh, my spouse and I would always end up quarreling and tension run sky-high. What’s up with hols, is it just me?

So-not-liking-holiday-Mom

It is so nooorrrrmal (yawn). It happens all the time – my theory?

Holidays Couple Quarrel

Theory of Failing Expectations

When we are up to our neck dealing with a regular workday, we don’t have time to quarrel. My guess is no one in the family has had the time to even look (like really look and appreciate the other person, as opposed to Yo, Where are my socks?) at each other, let alone talk. If you don’t have time to talk, you can’t quite quarrel.

But on a holiday, especially one where you stay at home – you’d have started a long weekend with the hope of getting your own stuff done (sorting photos, getting that manicure, baking a new recipe) but by the time you reach the middle of your break, you realized that it’s so not going to happen. Instead, you have to rush to the grocery store to get ready for the home party, clean up the house for the guests (and the thought of cleaning up after is already killing you), cook and then pretend to be the calm hostess while inside, you’re screaming everyone’s head off. Then the quarrel and tension come whenever it’s just you and your spouse – blaming about not doing fair share of work, mostly.

I came across other interesting theories too:

Narcissism of Small Differences (from the Atlantic)

This theory is from Sigmund Freud that small differences among people who are similar lead to them being hostile to each other. So family members who are similar tend to be hostile over a minor difference like which candidate to vote for!

Jealousy

Survey showed that jealousy is the common reason why most couples quarreled during vacation, because the men had wondering eyes for other women! Others were worried over everyday issues (finance) or wanted to be in control of what to do during the vacation.

Exhaustion

This is a given. Do not associate holidays with rest. Full-day, 24/7 care for your kids (school and alternative caregivers like your parents are having holidays, remember?) is bound to lead to exhaustion. No afternoon coffee breaks and gym workouts at lunch will upset you more than you think. Exhaustion is one of the key reasons why couples quarrel on holiday and when you think of it, it’s not just physical exhaustion. It’s mental as well – exerting mind control over your eczema child to pleeaaase moisturize and your hubby to just clean that up!

It’s the June/ summer holidays – be mindful of the above, lower your expectations on what can be accomplished during this ‘break’, do less and consider not meeting people who will set you off. No excuses for the men with lustful eyes for other ladies; if you happen to be with one during your vacation, dump him and your baggage be lighter!

Heading off for a coffee break and trying not to let all the bad long weekends and hols get to me,

#SkinishMom

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News & Research

Eczema News – Review of Clinical Trials for Eczema Therapeutics in Children

Recently, Hong Kong researchers published a review article ‘Eczema therapeutics in children: what do the clinical trials say?‘ in Hong Kong Medical Journal. Categorized by major treatment methods, previous clinical trials were examined for each individual treatment option. Below is my quick and dirty summary, for the full paper that is available for free, see here.

Clinical Trials Review on Eczema Treatment

#1 Emollient

There is no evidence to show that any emollient is superior to their counterparts, including a small trial that compared the results of using a (cheap) petroleum-based cream versus an (expensive) ceramide-based cream. >> Use a cream you can afford

Aqueous cream has been shown to cause skin irritation, thinning of the cornea stratum (ie skin layer), and increased transepidermal water loss following twice daily application for a few weeks. >> Avoid aqueous cream and sodium lauryl sulphate

There is a lack of evidence for other bathing practices like addition of emollients to bathing water, while use of emollients immediately after bathing as ‘soak and seal’ can help maintain hydration >> You were right about the ‘3 minutes, quickly moisturize after shower!

I hope I don't look like a crazy mom charging my eczema daughter to shower after swimming!
I hope I don’t look like a crazy mom charging my eczema daughter to shower after swimming!

Two studies showed that the use of emollients might prevent development of atopic dermtitis in high-risk patients >> Moisturize your next baby from young

#2 Topical Corticosteroids (TCS)

Guidelines on use of topical steroids – NICE guidelines for children recommend use of the
corresponding potency of TCS for severity of atopic eczema; mild potency for the face and neck and moderate potency only for short-term (3-5 days) use in severe flares; moderate or potent preparations for short periods only (7-14 days) for flares in vulnerable
sites such as axillae and groin.

Potent fluorinated corticosteroids should be avoided for infants and sensitive skin areas.

Systematic reviews of studies that compared the frequency of application of newer-generation moderately potent to very potent steroids identified no benefit in outcome for more frequent applications over once-daily application. >> Keep to once a day, no more than twice.

Topical corticosteroids are generally safe with few serious reported adverse effects. Risks of side-effects increase with higher potency, occlusion, thinner skin areas, severity of eczema, young age and longer duration of use. >> Be careful if your usage falls into these categories!

#3 Wet Wrap

All studies reported improvement in eczema scores, though the methods of wet wrap vary, for e.g., some used diluted steroid + moisturizer while another used chlorhexidine + moisturizer.

The most common reported adverse effects include discomfort, mostly due to chills, and
folliculitis more commonly caused by ointment.

#4 Topical immunomodulants

There is strong evidence that TCIs have a steroid-sparing effect and long-term use up to 12 months can prevent flares. Topical calcineurin inhibitors are particularly useful for sensitive sites including the face, neck, and skin flexures. It’s now studied that there is no statistically significant cancer risk.

#5 Proactive approach with topical anti-inflammatory therapy

The results suggested that for a patient with moderate-to-severe eczema and chronic relapsing lesions, maintenance treatment with topical anti-inflammatory therapy twice a week may be a better strategy to prevent eczema flares and topical corticosteroids more effective than topical calcineurin inhibitors. The rationale is that there is inflammation in the underneath layer of skin that is not visible, ie has not presented itself as rash.

#6 Antimicrobials and antiseptics

Bacteria count was reduced and there was significant improvement in mean eczema EASI (Eczema Area and Severity Index) for those using diluted bleach bath. >> I use chlorhexidine-wash for my daughter with eczema twice a week. More research news on bleach bath here.

#7 Antihistamines

There is no strong evidence that oral antihistamines are effective anti-pruritics. They are safe to use and their sedative effects, where present, may be useful to promote better sleep quality.

More treatment options that are less often prescribed are covered in the review article, like oral medication. Read up and let me know what you think!

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Mom Sleep Cartoon

Mom NeedyZz Cartoon – Depression and Sleep Deprivation

Mom NeedyZz Cartoon Sleep Deprivation Depression

Sleep deprivation is associated with depression – it’s not sure though which causes which, but they go hand in hand! Anyone feel emotional and depressed when lack of sleep? For more of Mom NeedyZz cartoons > here!

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Skin ish Mom Column

Ask #SkinishMom – Am I Really Nagging?

#SkinishMom Parenting Skin Expert
Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

To : The #SkinishMom

My husband kept saying that I’m nagging – nagging about my eczema child’s skincare (you know how we have to moisturize within 3 minutes after shower?), nagging about housework, nagging about doing things faster (we have loads of things to do, can’t possibly be doing slower right?). Am I really nagging? I thought I’m just talking – since when my words become ‘nags’?

Waiting-to-be-‘Naglightened’-Mom

11 eczema cartoon

I totally empathize. and mystified. Why do men keep saying that their wives are nagging, when we’re just talking? So I did a bit of digging to see if there’s any science I can find about nagging.

  • Nagging is defined as persistent and repeated requests that increases in frequency as the request is not fulfilled.
  • Nagging is a sign of love – we don’t nag at our boss, our co-workers, maybe not even our parents or kids, only at our spouse.
  • The nagger is usually the one who feel responsible about the subject – so, that’s why women nag about chores but not about soccer.
  • Nagging is a sign of not trusting that the requests will be met. It’s no surprise given that nagging turned the guy off and he intentionally didn’t want to do what you want him to do.

There is a lack of science in this area – I researched online and found a study that’s often misreported as men can be nagged to death. Actually, the conclusion was more like both men and women in demanding relationships were associated with increased death risk. This would not be surprising – chronic stress is reflected on our skin so it’s natural to assume it’d affect other parts of our body.

So bottom line, what’s a woman gonna do about her man, her supposed nagging and the negative spill-offs from being thought she’s nagging?

#SkinishMom anecdotes:

#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.

#2 Put aside negativity – you want to be appreciated for doing it all, not being hated for nagging you’ve done it all. Decide today to be a smart woman – smart in getting your man to love you, not hate you.

#3 Think of what your man wants – appreciation is my guess. Being made to feel like a man in the home, being admired by his spouse. Heck. I know you want the same from him. Men are dumb – give him what he wants first and the aha moment is more likely to hit him to do the same for you.

#4 Actually give your man what he wants – appreciation, in many forms (including but not limited to!) hugs, kisses, praise, touch, praise in front of your kid, sex, praise in front of his family, surprise gifts, praise in front of his friends/co-workers.

#5 If he hadn’t done something you want (not what you were nagging him about, something else- like a present, a cheesecake, a coffee machine, a iPadAir2), tell him POINT BLANK what you want.

#6 Be delighted by your man – he ‘surprises’ you with the thing you want, you’re ‘surprised’ and delighted. He’s delighted that you’re delighted not remembering it’s not a surprise (or not even crossing his mind that a non-surprise is an issue on the scale of ‘delightedness’).

#7 Witness positive change – 1. You didn’t nag (cos you did it all yourself), 2. You no longer see an annoyed look from him (cos there’s nothing he’s annoyed about), 3. He’s happy (cos you actually did something for him and appreciated him), 4. You’re happy cos finally, your husband is showing his love and appreciation.

Notice how easily the requests you were trying to get him to do fall out of the picture? Notice how kids don’t even come into the picture?

That’s the #SkinishMom way of handling nagging – if anyone has a better way, please do share! Since men are universally the same (o.w. why do books like Men are from Mars and Women are from Venus become best sellers if every man is different), do share with the rest of us women what had worked in your marriage!

Off to get a surprise gift for hubby,

#SkinishMom

Categories
News & Research

Eczema News – Second-hand Smoke and Eczema

Came across this 2015 research study on Environment Tobacco Smoke Exposure Affect Childhood Atopic Dermatitis Modified By TNF-α and TLR4 Polymorphisms in which the researchers studied:

  • 3,639 children aged 7 and 8 years old
  • Survey format – 2-year follow-up
  • Participants were followed up 2 years later with blood test

Results were that children with the gene variant (that encode immune proteins TNF-alpha and TLR-4) associated with inflammatory conditions such as asthma and Crohn’s disease were more likely to develop eczema if they had been exposed to smoke in the womb. Since we wouldn’t know whether there’s gene variant in a fetus, it’s best to quit smoking and have everyone around to quit if you’re planning to have a baby. More studies on Pubmed linking second-hand smoke and eczema:

Second hand smoke increases risk of eczema in fetus baby up to adolescents

Cigarette smoking on allergic conditions – Maternal smoking in the first year of the child’s life resulted in the children having an increased chance of wheezing, exercise-induced wheezing and asthma.

Foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema – Foetal exposure to maternal passive smoking was significantly associated with wheezing, allergic rhinitis and eczema.

Improvement of Atopic Dermatitis Severity after Reducing Indoor Air Pollutants – After the completion of the program that reduced the air pollutants in kindergarten, the prevalence of atopic dermatitis and the mean eczema area and severity index (EASI) were decreased, and the changes were both statistically significant.

Pre- and postnatal exposure to parental smoking and allergic disease through adolescence – Exposure to second hand smoke during infancy was associated with an overall elevated risk of asthma, rhinitis and eczema up to 16 years.

Updated in October 2015, new study on:

Parental smoking and development of allergic sensitization from birth to adolescence -Second hand tobacco smoke exposure in infancy appears to increase the risk of sensitization to food allergens up to age 16 years as well as eczema in combination with sensitization.

It is likely that not only tobacco smoke but also outdoor air pollutants like traffic exhaust can stimulate immune cells to respond. What is your experience? I was living in a scaffolded apartment for the first two trimesters – till today, I still wonder what the effect had been on my baby…


Categories
Support Group

Eczema Support Group – Skincare and Skin Aging

Eczema Support Group Lunch Skin Aging and Care
Friday lunch for Eczema Support Group with sharing by senior dermatology nurse Sister Wong at the National Skin Centre Singapore

Last Friday, the Eczema Support Group had an information packed sharing session by senior dermatology nurse Sister Wong who is deeply passionate about skincare.

For those who missed the session, we learnt a few key points:

1. Skin Aging Effects. These include:

  • Drier & itchy skin, due to loss of oil glands
  • More fragile & thinner
  • Bruise more easily, due to loss of skin cell support around blood vessel
  • Takes longer to heal
  • More loose skin, due to from loss of elastin/ collagen in skin (elasticity)

Aged skin shows up as forehead lines, fat loss in cheek, nasolabial folds, hollowing of mid face, vertical wrinkles, jaw contours and chin wrinkles.

2. Causes of Skin Aging – There’re both natural intrinsic aging and extrinsic aging factors, many of which we can take action to avoid:

  • Sun exposure – damages elastin fibre in skin
  • Squinting – sunglass to reduce squinting in sun
  • Repetitive facial movements
  • Smoking – more wrinkles, dull complexion
  • Overuse of soap
  • Bathing in hot water
  • Diet – not enough fruits & vegetables, too much sugar and refined carbohydrates
  • Alcohol – dehydrating

3. Sun Protection – Select a broad spectrum – both UVA and UVB protection, with at least SPF 30 for Singapore sun and choose one that is zinc oxide/ titanium dioxide based which less reported to irritate skin.

4. Moisturizing Skin – Select one that is

  • Affordable – Continual use is important
  • Not irritate skin
  • Without top irritants like fragrance, preservative, paraben, propylene glycol, color/dye
  • Fewer the ingredients, the less likelihood
  • Highest % ingredient is named first – Water
  • Product safety – Established company, trials, stability

5. How to Moisturize – Apart from the tips below, senior dermatology nurse shared about avoiding contact with flame after moisturizing as certain components of cream may be flammable.

  • Within 3 minutes after shower
  • Gently and generously
  • In direction of hair growth
  • Avoid contamination of tub – use spatula

6. How to Shower – Showering is a daily affair (and a must!) in hot weather Singapore and knowing the right way to shower will serve our skin well in the long-term.

  • No hot water – dries skin
  • No soap – alkaline, drying; use gentle cleanser (bath oil or colloidal oatmeal)
  • No long shower – no more than 10 mins – Drying for Skin
  • No scrubbing/exfoliation
  • No rubbing dry – pat dry instead

Thank you to all who attended and the National Skin Centre staff especially Sister Wong who has been fervently supportive of the group! Subscribe at the blog top right corner to stay tuned for more support group updates!

Categories
Mom Sleep Cartoon

Mom NeedyZz Cartoon – Lack of Sleep Makes You Stupid

Mom NeedyZz cartoon Sleep Deprivation Makes you Dumb

Lack of sleep impairs attention, concentration, reasoning and problem solving. For more of Mom NeedyZz cartoons > here!

Categories
Skin ish Mom Column

Ask #SkinishMom – Do I Need a Man?

#SkinishMom Parenting Skin Expert
Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

To: The #SkinishMom

You know.. I know you know… I’m a mom of eczema kid, I’m a daughter, I’m an employee, I’m a wife and each of these come with many duties. Some days I feel like I’m doing EVERYTHING – I mean I’ve even bought my in-laws their mother’s day and father’s day gifts (no one bought me anything), I do ALL the housework and I’ve to make my boss and spouse happy. On these ‘some days’, I’m thinking maybe I don’t need a man after all. Quit my job, live frugally just me and my kid. No man, ever. What do you think?

Mom at Cross-roads

I think… get a coffee. What you need (I know I did in the some days you mentioned) is coffee – along with it, the aroma, the caffeine, the frothy milk, the 20-minute break with a book or music. Alone… it’d make your mood ‘swell’. Did I mention that a 10-year study showed that women who drank two to three cups of caffeinated coffee a day were 15% less likely to develop depression.

On a more serious note – I get you. Taking care of an eczema child is not easy – the skincare, the struggles with your child (who sometimes stubbornly refuses to moisturize), the conflicts with other family members who don’t get the need for skincare. Plus, yeah.. women these days are doing housework + real work. Some days things are easier when you don’t go to work or you only have to clean up and cook for your child (as opposed to child + man).

A good moisturizer is one the eczema child uses!

But… I can never encourage you to D-I-V-O-R-C-E; Matthew 19:6

So they are no longer two but one flesh. What therefore God has joined together, let not man separate.

Plus the joy of a marriage takes time to build – the airy fairy, honeymoon period is so over but real love for a lifetime sets in, if both of you work at it. (At least I’m working on mine!). I do however think the solution may be in managing ‘me-time’, ‘man-time’, ‘work-time’ and ‘chore-time’:

1. Take care of your health – you don’t need permission from any man or any kid to take care of yourself. Exercise releases endorphins that trigger positive feelings (same as morphine!) and boost your bone + health.

2. Reduce time at work – if you’re not gunning to crack that glass ceiling, don’t stay back for the sake of staying back.

3. Take lunch break = ‘Me’ time. If you prefer to do it alone, do so. You’d be surprised – once your colleagues figure out that you have your own stuff to do at lunch, you won’t be missed anymore. Of course, if you are a people person and like hanging out with your colleagues, do so.

4. Take coffee break – a must

5. Increase time spent with your man at home – by reducing time on chores, even reducing time with your kid. When you’re old, sick or lonely, there’s only one guy who’s there for you – the one you took the time to know and to love.

Removing House Dust Mite even when there's no sensitization improves eczema

Try the above and don’t forget the coffee,

#SkinishMom

Categories
News & Research

Eczema News – High Blood Pressure Drug teamed with Corticosteroids

Hypertension drug with Steroid use reduces skin thinning

One of the key side effects of corticosteroid is skin thinning – this is also known as skin atrophy. Thinner skin has increased rate of transepidermal water loss (TEWL), more fragile and prone to irritation. The skin thinning is due to decreased rate of collagen and skin cell growth. The mechanism is from the activation of glucocoricoid and mineralocorticoid (MR) receptors in the epidermis by the corticosteroids.

Researchers in hypertension (high blood pressure) discovered that drugs for hypertension that contain spironolactone works as a MR antagonist by reducing the activation of the MR receptors. Based on a small randomized double-blind controlled trial of 23 individuals for 28 days, it was recorded that there was no skin thinning for those who applied spironolactone. Thus, it was an indication that corticosteroids could possibly be used without the worry of skin thinning effect if it’s applied together with the above hypertension drug. 

It is interesting to see if there’s medical advancement in this area – steroid side-effect is a concern of many parents and while generally safe to use, always bear in mind to use as indicated and check with your doctor

  • How much to use (finger tip unit)
  • How long to use (duration and frequency)
  • Where it can be used (especially for thinner areas of skin such as face and neck)
  • What appearance of rash you should see after application by week (1,2 and when to stop)
  • How it can be used – especially if you are also applying wet or dry wrap, you should not also be using corticosteroids as under occlusion, the side effects are more significant
Categories
Mom Sleep Cartoon

Mom NeedyZz Cartoon – Sleep Deprivation = ‘Accident’

Mom NeedyZz cartoon sleep deprivation accident

It’s no kidding – sleep deprivation is linked to road accidents, job injuries and who knows what will happen to a sleep-deprived mom alone at home? For more of Mom NeedyZz cartoons > here!

Categories
Skin ish Mom Column

Ask #SkinishMom – Do all Moms have Enough Breastmilk

#SkinishMom Parenting Skin Expert
Ask #SkinishMom any question – parenting, skin, eczema or plain venting!

To: The #SkinishMom

Seriously, I’m frustrated. I’m being told that it’s IMPOSSIBLE not to produce enough breast milk for my baby. Every mom has milk, and blah blah blah. But hello? What I’ve been struggling with for the past 3 weeks is not a dream, it’s a nightmare IRL.

Just-don’t-tell-me-I-have-enough-milk-Mom

Whoa! I hear you and I’m never ever gonna say that U Will Have Enough M-I-L-K. I absolutely certainly understand your frustration, and MarcieMom understands too. See her cartoons on breastmilk production.

Mom Needy Zz cartoon Lactation consultant breastfeeding

Seriously, I have nothing against the lactation consultant in the cartoon (why should I? It’s only a drawing.) But I do have everything against lactation consultants – gosh, I’m being totally undiplomatic but this is my column and I say it as I meant it. I’ve no idea why lactation consultants (or the few I know and heard of) seem to think all mothers will have enough breastmilk. The worse (and worst) part?

It is assumed that it is you (the mom who’s already struggling with caring for a newborn, lack of sleep, totally fatigue in a touchy state of relationships with every other adult human you’re stuck with) who have not done something right.

This is a sad truth – google ‘low breastmilk supply’, instead of getting articles that tell you there’s a medical basis for not producing enough breast milk, you get articles telling you you’ve done something wrong or not done something, that’s why YOU don’t have enough breast milk. Imagine if you google ‘low phone battery’, you’d get articles on what’s wrong with the battery, the technology behind the battery and that’s why it drains juice faster. We’re apparently less sympathetic when it comes to breasts. Low breast milk? It’s the mom, never the breasts.

Here are the common reasons about the mom (for low breast milk supply):

  • Not feeding immediately in hospital
  • Not feeding enough (variations of this is not feeding baby at each breast long enough, not feeding frequently enough, not pumping enough)
  • Not latching-on correctly
  • Being a wimp and offering formula milk instead of persisting without it
  • Not eating more, not drinking enough, not enough rest

I’m sure above is medically sound BUT what I understand you’re asking is there’s some reason why you’ve done the above and nothing is working. Maybe there are extenuating circumstances that force you to pump less frequently, how about ‘it’s been only 10ml for every 3 hours I pump my breasts, there’s still no improvement after 3 weeks and I’m already at the point when my breasts are already juiced dry’.

Mom NeedyZz Cartoon Breast Milk Storage Bias

So #SkinishMom investigates and finally, for once, I’ve uncovered some reasons that are linked to the breasts, not the mom.

  1. Milk not expressed within 6 hours of delivery – this one I totally agree. Right after delivery, for whatever reason, your baby may not be taking enough from your breast. The initial delay in stimulating the milk production may really make it much harder to get the milk flowing when you return home. Why didn’t anyone suggest expressing milk when you’re in the hospital? Oh wait, maybe the hospital doesn’t have a facility to store the milk. Next time, get a breast pump and mini fridge and plug into beside your bed.
  2. Hospital-grade pump. We’re talking about those that cost $500, electric and double-breast. Since breast milk production is so important and the delay caused by a lousy pump can have long and devastating impact, why didn’t hospitals at least lend moms the pump so that we can go and buy it before we get home?
  3. Not enough milk ducts, clogged nipples, hormones – It’s strange when I think of it. Because it’s assumed that you should have enough breast milk, no one actually diagnosed why you didn’t have enough breast milk. There could really be something wrong with the breasts or the hormones that stimulate the milk production.

Personally, in my totally bias opinion, I think that if there is a higher acceptance for moms who really don’t have enough breast milk, there will be solutions on how to help them. For instance,

  • Don’t expect latch-on; just pump and try your best but don’t drain yourself.
  • Let me see your breasts, it’s possible there’s something to be done about them rather than your fault.
  • Don’t worry about the low breast milk – you’re not less of a mom than the woman beside you with engorged breasts. Don’t worry about your baby taking formula milk – no one will know whether a breast fed baby or bottle fed baby will win the human race.

So there, I hear you, signing off with a cartoon from Mom NeedyZz series

#SkinishMom

Mom NeedZz Cartoon Breastfeeding Books