Hand Eczema with Dr Lynn Chiam – Skincare

This is a 3-part series focused on hand eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain further the type of hand eczema, its cause, treatment options and daily hand care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

The first 2 part of the series are:

  1. Basics of hand rash and different types of hand eczema, its symptoms and triggers
  2. Treatment of Hand Eczema
Hand Eczema - Skincare for the Sensitive Hand with dermatologist Dr Lynn Chiam

Hand Eczema – Skincare for the Sensitive Hand with dermatologist Dr Lynn Chiam

Hand Eczema that Does Not Go Away

If the skin at the hand is too thick and hard, it will be more difficult for medication to penetrate deeply enough to improve the skin inflammation. This increases the likelihood of untreated and persistent hand eczema. Another reason why hand eczema does not go away could be the continued exposure to an irritant which has yet to be identified. Patch testing is then recommended.

MarcieMom: Dr Lynn, what are the ways to treat hand eczema when the skin has thickened?

Dr Lynn: For thickened skin, topical steroids of higher potency should be used. Ointment based steroids can be used instead of cream based steroids. Liberal and regular use of moisturizers should be emphasized. The use of wet wraps (occluding the creams with a wet glove) can also help to increase the penetration of the creams across the thickened skin.

Phototherpy (controlled use of UVA or UVB light) is sometimes used in this type of hand eczema.

MarcieMom: How often do you see in your practice that patients cannot recover due to continued exposure to allergens in their moisturizers or topical medication? When should one suspect that is the case and request for a patch test?

Dr Lynn: Allergy to topical medication and moisturizers are extremely rare. If patient had avoided all other possible irritants or allergens and have been compliant with medication and not getting better but worse, then the unlikely possibility of allergy to medication/ moisturizer can be considered and a patch test performed.

Daily Hand Care for Those with Sensitive Skin

Some skincare tips for those with hand eczema or sensitive skin are:

  • Avoid frequent hand-washing or washing hands in hot water
  • Moisturize after exposure to water
  • Avoid irritants and triggers

MarcieMom: Dr Lynn, for those with hand eczema, should they be using an ointment instead of a lotion so that more of the moisturizer can be retained even with hand washing? Also, an ointment will be more protective against irritants.

Dr Lynn: Generally, ointment tend to be better absorbed and lock in the moisturizer for a longer period as compared to lotions. By repairing the skin barrier function faster than lotion, they tend to protect the skin and allow the skin to heal faster. They generally contain fewer preservatives and additives than creams.

MarcieMom: For occupations such as caterers, hair dressers, nurses and mechanics, will wearing gloves during their jobs help to reduce contact dermatitis? If yes, what type of gloves should they wear?

(I read some recommendations for vinyl gloves while others recommend cotton-lined gloves. Avoid latex gloves.) Are there any guidance on how long one should wear glove (since that trap sweat which is a possible irritant)?

Dr Lynn: Yes, wearing gloves is recommended for those in certain occupations where contact with certain irritants is repeated and prolonged. I will generally recommend cotton gloves as they generally do not cause irritation. However, if contact with water is necessary, use a water- proof gloves. If wearing latex gloves makes the rash worse, a patch test can be done to determine latex allergy.

Glove choice should be appropriate to the situation. Alternative to latex gloves include vinyl, nitrile and chloroprene. However, some of the chemicals used in the manufacture of non-latex gloves can also cause hypersensitivity.

I will advise patients to remove the gloves after about 20 minutes to allow sweat to evaporate. Dry the gloves inside out when not in use.

Thank you Dr Lynn for sharing with us skincare for hand eczema and understanding possible reasons why hand eczema is persistent. Hand eczema affects many adults and learning more about it help to manage the rash better.

Hand Eczema with Dr Lynn Chiam – Treatment

This is a 3-part series focused on hand eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain further the type of hand eczema, its cause, treatment options and daily hand care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

Last week, we covered the basics of hand rash and different types of hand eczema, its symptoms and triggers. This week, we will focus on treatment.

Common treatment for Hand Eczema

  1. Topical corticosteroids
  2. Topical calcineurin inhibitors e.g. tacrolimus and pimecrolimus
  3. Antihistamines
  4. Phototherapy
Treatment for Hand Eczema with dermatologist Dr Lynn Chiam

Treatment for Hand Eczema with dermatologist Dr Lynn Chiam

MarcieMom: Dr Lynn, a few questions on common treatment options for hand eczema:

  • For topical corticosteroids, are there typical potencies or type of corticosteroids (such as anti-fungal/ anti-bacterial) that are commonly prescribed for hand eczema?

Dr Lynn: Topical steroids are the mainstay of treatment for hand eczema. Topical steroids reduce the redness and itch effectively by decreasing skin inflammation. Due to the thickness of the skin on the hands, higher potency steroid creams are usually used. When used for the correct duration and in the correct amount, side effects are very minimal. Steroid creams should only be used on the affected areas and are prescribed for twice a day use. When the condition has improved, lower potency creams can be used. Sometimes, decreasing the frequency of the creams is also practiced. Topical steroids should always be used together with moisturizers in the treatment of hand eczema.

In cases with secondary bacterial infection (especially in those with oozing and cracked skin), topical antibiotic creams can be used in conjunction with steroid creams.

  • For topical calcineurin inhibitor, should sunscreen be used on sun-exposed part of the hand?

Dr Lynn: Topical calcineurin inhibitors (TCIs) are an alternative to steroid creams. As they have a slow onset of action, topical steroids are still used in the initially period. Topical calcineurin inhibitors are better used as maintenance agents. Side effects include a mild and temporary burning sensation. They are safe to use and in many studies over many years, they have not been associated with any major side effects or cancers.

Eczema guidelines propose that appropriate sun protection measures, such as minimisation of the time in the sun, use of sunscreen after applying TCI and covering the skin with appropriate clothing.

  • Are there any precautions to take after applying the topical medication? E.g. not touch food, water?

Dr Lynn: I will normally advise my patients to allow about 15-30 minutes for the creams to be absorbed and to avoid washing hands during this period. Wearing a cloth glove can aid in the absorption and penetration of the creams and allows the person to do work without the creams getting in the way.

  • Does avoidance of triggers play a larger role in management of hand eczema than medication? Is it likely that without exposure to triggers, skin inflammation at the hands will heal itself?

Dr Lynn: Although avoiding triggers does help significantly to prevent the eczema from progressing or being more severe, the use of anti-inflammatory agents like topical steroids and calcineurin inhibitors together with moisturizers are still essential to heal the skin.

MarcieMom: I read online of a new drug, oral alitretinoin, that has been reported to help with severe hand eczema. However, it has side effects such as headache, dry and flushing skin. It is also not recommended for pregnant women due to possibility of birth defect.

What is Alitretinoin (taken orally) and is it accepted among the dermatology community to prescribe it for severe hand eczema cases? When should a patient stop using it (ie when can one tell the side effects are too strong to justify taking the medication?)

Dr Lynn: Alitretinoin has been approved in certain countries for the treatment of severe hand eczema that has not responded to strong topical steroids. It belongs to a group of medicine known as retinoids. Currently, it is still not available in Singapore.

Certain blood tests need to be monitored while taking this medicine. Dryness, cracked lips, headache and hair loss may occur. If there is an increase in the liver enzymes and cholesterol levels, the dose of alitretinoin should be reduced/ stopped.

In view of the side effects to a fetus, women of child-bearing age should be properly counseled before starting the medicine and contraception advised.

Thank you Dr Lynn for explaining the treatment options for hand eczema. Next week we look forward to learning more about skincare and help for those whose hand eczema just won’t go away.

Hand Eczema with Dr Lynn Chiam – Types, Symptoms, Triggers

This is a 3-part series focused on hand eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain further the type of hand eczema, its cause, treatment options and daily hand care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

Is it really Hand Eczema?

Rashes on your hand may not be eczema although hand eczema/ hand dermatitis is the most common type of hand rash. Various other rashes can be:

Psoriasis

Psoriasis is a chronic skin condition characterized by clearly defined white, silvery or reddish thick patches. Apart from the palms, look for other typical signs of psoriasis such as scalp involvement and nail deformities.

Tinea Manuum

This refers to fungal infection of the hands which can look similar to hand eczema. Fungal infection needs to be excluded if only 1 hand is affected. A fungal scrape (skin test) will be positive in tinea manuum.

MarcieMom: Dr Lynn, how frequent are the above in causing hand rashes? Are there other common differential diagnosis from hand dermatitis?

Dr Lynn: Hand eczema has been identified as one of the most common frequent dermatological disorder encountered in clinical practice. It is caused by a combination of internal (genetics, individual predisposition) and external factors (exposure to irritants and allergens). It is estimated that about 10% of the general population suffer from hand eczema. It is reported to be more common in women and in certain occupations like hairdressers, healthcare workers and domestic workers.

Other conditions that can mimic hand eczema include psoriasis (which affects about 1% of the local population) and tinea manuum, a fungal infection of the hands which is uncommon.

Different Types of Hand Eczema/ Dermatitis

Hand eczema results in inflammation of the skin which can present with dryness, scaling, redness, vesicles( bubbles), fissures, thickening, pain and itch. Even within hand eczema, there are various forms of dermatitis:

Hand Eczema - Types, symptoms and triggers with dermatologist Dr Lynn Chiam

Hand Eczema – Types, symptoms and triggers with dermatologist Dr Lynn Chiam

Irritant Contact Dermatitis

This is the most common form of dermatitis, caused by repeated exposure to irritants like water (from repeated hand washing), soaps, detergents, food products or chemicals frequently exposed to in a job, such as solvents, lubricants, oils and coolants. Friction and repetitive rubbing of the skin also increases the likelihood of irritant contact dermatitis. The rash is typically found on the knuckle surface of the hands. Avoidance of the irritant material can bring about a significant improvement.

Allergic Contact Dermatitis

Allergic contact dermatitis only happens to a small number of people who are sensitized to a certain material. This means that in the past, they may have been in contact with the offending material and even though on the first contact, there may have been only a little or mild reaction, the skin “remembers” the material as an allergen. On the repeated contact with the same material, a worse rash will result. Common allergens include nickel, fragrances, preservatives and rubber. A patch test can confirm the allergy.

Atopic Dermatitis

Patients who have atopic eczema when young are more likely to develop atopic dermatitis on the hands as an adult. Look for involvement of the other areas on the body.

Pompholyx

Pompholyx has a distinctive appearance of itchy small blisters on the palms of the hands. It is also more closely associated with excessive sweating and can be found on the soles and toes.

Nummular Hand Dermatitis

This shows up as circular areas of redness, scaling on the backs of the hands and can appear oozy.

Symptoms of Hand Eczema

Symptoms include redness (erythema), itch (pruritus), pain, dry, peeling/ flaking skin, blisters (vesicles) and cracks (fissures), weeping (exudation) and swelling (oedema).

MarcieMom: Dr Lynn, there are quite a few types of dermatitis – do they have similar symptoms or can it be difficult to diagnose which type of dermatitis one suffers from? Does age, gender or occupation affect which type of dermatitis one suffers from?

Dr Lynn: Yes, the different types of hand eczema can have similar symptoms. However, there are certain clues to look out for. From the history of the onset of the rash, contact with certain materials, improvement with avoidance, one may be able to distinguish between irritant and allergic contact dermatitis. A positive or family history of atopy (allergic tendencies) and involvement of the feet points to atopic hand eczema.

More women are affected by hand eczema than men. The prevalence of hand eczema is also higher in certain occupations like healthcare workers, hairdressers and domestic workers. This is due to prolonged and repeated contact with certain harsh materials resulting in irritant contact dermatitis. In irritant contact dermatitis, the knuckles, finger tips and web-spaces are commonly affected. Improvement is noted with avoidance of the material.

In allergic contact dermatitis, the rash may persist even with further avoidance of the allergen. Patch testing can help determine the allergen.

In adults with atopic eczema affecting the hands, other areas of the body can also be affected. In the acute stage, red spots, oozing and excoriations can be seen. In the later stages, the skin becomes dry, cracked and thick. Secondary infections can also set in.

Triggers of Hand Eczema

Triggers of hand eczema are typically water, sweat, soaps, detergents, food products, solvents, lubricants, oils and coolants.

MarcieMom: Dr Lynn, regardless of whether it is irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis, are the triggers similar? If yes, will avoiding these triggers be actions a hand eczema sufferer should take?

What are the factors that affect what form of dermatitis one get?

Dr Lynn: Yes, there are certain common triggers that will adversely affect the hands. Over-washing (even with just plain water), harsh soap, detergents and lubricants should generally be avoided by people with hand eczema. Wearing of gloves to reduce the contact of water and soaps with the skin is recommended if prolonged wet work is necessary.

Regular use of moisturizer can help prevent flares in people with hand eczema. Gentle soap in small amounts is recommended.

Keeping fingernails short prevent further damage of the skin while scratching. It is advisable to remove rings and bangles before hand-washing and wet work as they can trap moisturizer, dirt and bacteria.

Thank you Dr Lynn for helping us to understand the different types of hand rash, hand eczema and its common triggers. Next week, we will look forward to learning about treatment of hand eczema.

Science of Skincare Products – Eczema Supportive Care

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me again for this last part of our skincare products. Ive covered in this blog that moisturizer has preventive effect on eczema and for those with eczema, moisturizing frequently is able to reduce the use of corticosteroid cream. What I would like to focus in this interview is whether the type of cream, how we apply and when we apply will make a difference in the functions of the moisturizer.

MarcieMom: We are aware that the more liquid a moisturizer is, the shorter time it will last but it is more comfortable to apply than an ointment (which has little to no water content), especially in hot and humid weather like Singapore or during summer. Does the nature of whether it is lotion, cream or ointment affects the efficacy of the skincare product? For instance, does being lotion meant it is more easily absorbed and being ointment meant it will be longer-lasting?

Dr Elisabeth: Many kinds of products are indeed available to help and promote skin health. The same principles as those described earlier work for all of them: products with few ingredients and safe ones will be better for sensitive and fragile skins.

Various kinds of products will, as you said, give different kind of feel and the aim may (or may not) be different as well. The purpose of the two products is different, while ointment is often used to bring a lot of fatty acids the skin and add an occlusive layer to reduce the TEWL (Transepidermal Water Loss or water that is lost through the skin), cream is more used to bring water to the epidermis, as well as other hydrophilic compounds that could be of interest. Creams bring also hydrophobic compounds (fatty acids, hydrophobic active ingredients, …) but to a lesser extent.

The long-term efficiency of a product will depend on how it is structured and how quickly the compounds are delivered to the skin and absorbed. For ointment, they generally have an occlusive layer that will remains on top of the skin, which is the purpose of these ingredients so that it can prevent water to evaporate from skin. So the feel it gives and that specific function will last for a rather long time. On the contrary, water and active compounds are delivered quickly and evaporate or absorbed quickly by skin. As a consequence, the moisturizing feel disappears rather quickly

One of the achievements that may be reached by using innovative structure is to make cream that have a feel comparable to a classical cream, but will display a long-lasting delivery of the active ingredients, and then combined some of the advantages from an ointment (long-lasting relief and effect) and from a classical cream (pleasant feel, bringing water to the skin).

Skincare Moisturizer as Eczema Support

MarcieMom: The other bigquestion that all parents have is each skincare company claims that their product is able to hydrate, build the skin structure better. These typically belong to the group of moisturizers that contain ceramides or have the ability to restore the skin lipids. In your view Elisabeth, is there certain characteristic (such as ingredients or process) that will differentiate a category of moisturizer as being better at restoring skin functions than others?

Dr Elisabeth: Efficiency is claimed by all companies, of course, because all products will bring the element that will help skin moisturizing, at least in the short term. It is clear however that some products will be more efficient than others; just like some products will have better feel than others etc. As mentioned in our previous discussion, this is why scientific innovation and knowhow comes into play: in our view, they are the key to make better, more efficient and safer products

Ceramides are indeed one of the components that enter in the composition of skin membranes and seems to play a role in its restoration. There are however several types of ceramides and all of them do not seem to display the same efficiency according to various recent publications. What will help skin to be restored is to protect it from threats, and nourish it with proper ingredients. A general appellation of Natural Moisturizing Factor has been created to describe these ingredients that can play a positive role in skin restoration. Ceramides are only one of them. For example, vegetal oils are mainly made of fatty acids that interact with skin cell membrane and help it to be “nourished”. Some of these oils also have additional compounds that will play a positive role. Glycerin, urea, aminoacids, cholesterol, and many other ingredients can play a role in restoring skin functions. What is important is to determine which ingredients will be helpful in a specific situation, and how you can maximize the efficiency of this ingredient in the molecular structure that you create inside the product.

MarcieMom: Readers of this blog are familiar with basic skincare, such as moisturizing right after shower and making sure to moisturize enough. Either due to cost or belief of effectiveness of certain way of moisturizing, some parents may

  • apply brand A moisturizer in the day, and brand B at night; or
  • apply brand A on certain days of the week and brand B on others (or alternate by weeks);
  • apply brand A (a lotion) and brand B (an ointment) over it.

In your view, which is the skincare moisturizing method that make sense? For instance, with constraints that many families have, such as budget and time to moisturize (e.g. child in school or simply to reduce the number of times moisturizing is needed).

Dr ElisabethA daily moisturizing routine is indeed driven by various factors, lifestyle included. A product can be efficient, but if it is a hassle to use it, it won’t be used properly and will become inefficient. I would say there is no “you have to” routine, just find one that is working for you. If you keep in mind the principles I already described: using efficient products with few and safe ingredients, you can find what works the best for you. And it may be completely different from what works for another person. And it can be the same product or products for a very long period of time. Regularly changing skincare products from time to time can be a good idea when you are using products that contain a lot of ingredients. or that contain an ingredient you are slightly sensitized to. So you will give a rest to your skin that would otherwise be exposed to some ingredients that could become unhealthy with time and regular use.

MarcieMom: Many eczema sufferers feel that rotating the emollient seems to make it more effective than always using the same emollient. Is there some basis for that?

Dr ElisabethThe efficiency of a product is determined by its ability to bring what is needed by the skin to be protected to help restore its functions. Rotating products can be a way to bring various efficient ingredients that are not found in only one products. But as I just mentioned before, there can be other reasons that can make an emollient less efficient, so you have to switch from it for a while. Some ingredients can lead to some sensitization of the skin. Not strong enough to give a rash, but strong enough to lead to some irritation if used over long periods of time, that would explain why a product would become less efficient. Reducing the number of ingredients can decrease this risk and in that case, your emollient will work for a longer time.

Thank you Elisabeth of being ever so patient in this series of interviews on skincare products, tackling specifically the science behind it. It is truly enlightening and practical!

For all interviews under this Science of Skincare Products series:

Science in the Bottle

Safety and Product Expiry Date

Stability

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Science of Skincare Products – Stability

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for sharing with us your knowledge on skincare products. So far, we have covered the basics of the ‘science’ in skincare formulation and safety, expiration of skincare products. Today we are learning about the concept of stability in a skincare product.

Is it possible that a moisturizer has not spoilt but is no longer effective? Is technology required to hold the ingredientstogether to be stable?

Stability in Skincare Product ingredients

Dr ElisabethGenerally yes. The best skincare products can be quite sophisticated, “high tech” products, so if the structures that hold the different ingredients are degraded, then there can be a significant loss of efficiency. To make a parallel, if you stomp onto your mobile phone and it is crushed, you will still have all the components of the phone, but the structure will be destroyed and the phone may not work any more! Using industrial processes enable to make structures that will increase the stability of a product. You will not be able to achieve these structures with a bowl and a mixer. A lot of scientific and industrial knowledge is necessary to make products that will last for a long period of time.

At Skintifique, we have developed products that have very novel internal structures, which is what give them distinctive properties, be it for moisturizing the skin, protecting it from common allergens and irritants such as Nickel and other metals, or providing long lasting moisturizing and soothing.

MarcieMom: Any tips for parents to make sure that they are buying a product that is safe and stable and not using one which has stopped being so?

Dr ElisabethChoosing a product that is safe and efficient is a major concern for parents and people with sensitive skins. The first tip I would recommend is to choose skincare with the least number of ingredients. No ingredient is completely safe for everyone, and by reducing the number of ingredients you are exposed to, you minimize the probability your skin will react to one of the constituents. So in that case, fewer means safer. Of course, the better known the ingredients, the safer the products: a skincare product that would only contain 8 ingredients but 3 of which no one has ever heard of, or used in a skincare, would not necessarily be the safest choice…

I would recommend buying skincare from a brand you trust and that must fulfill stringent regulation. It can be established brands but also new ones (and as a representative of a new brand, I can only emphasize that some new brands can be even safer and better than established ones!), a keypoint is : do I trust this brand or do I have reasons to? Of course, one sometimes needs to try new products, if only to get better benefits than with current products, so then another keypoint is: can I make a test, eg buying initially 1 tube, or getting a sample etc. Some tips can help to reassure about the professionalism of a company: is there an easy way to contact them, are there some credential that tell you who is behind, are they prone to answer your question to one of their products, are their products manufactured in reliable places

Use products that have been designed for sensitive skins or children. They have been assessed by independent experts in toxicology with more stringent criteria, especially in the EU.

Since 2013, there is a new regulation (european cosmetic regulations) that have clarified what is necessary for a product, and fair labeling is a major part of it. Evidence has to be provided before a product can be labeled as suitable for children and sensitive skin. An independent toxicologist expert is mandated to consider all the evidences claimed for a product. What is not done yet is a previous approval of cosmetic product before it is commercialized, but you have to give all these information as soon as a state authority requests it. So if you are a serious skincare company, you have all the tests done, certificates needed and so on in a « cosmetic file » that is ready to be consulted by state authority. There can always be untrusted company that are selling  products with not all the tests made but if it is discovered, consequences can serious…
What is not described in the regulation is the exact method and tests you have to performed to build your evidence, but some consensual recommendations are coming out from bench of experts in toxicologist. As an example, one of these recommendations is to use much more stringent safe limit for a product destined for a child. To illustrate it, this is roughly how is estimated the toxicology profile of a cosmetic product for an adult and a child:
To determine if a product is safe for an adult and how much of this product, at the maximum, it is advised to applied on skin, you determine the exact concentration of each ingredient, and how much of each of these compound is applied on the skin. You have toxicological profile for each ingredient allowed in cosmetics, with the maximale dose at which it is not toxic. The limit of exposure for each of the component of the cream is determined, and the maximum amount of a skincare that can be applied daily is determined by the ingredient with the lower dose of exposure allowed.
To determine if a product is safe for a child, you make the same analysis, but with more stringent criteria. For exemple, the maximale dose of each ingredient allowed per day is divided by a factor of 2.3 and since you have to take into account the various mass of people (generally a factor 12 between a child and an adult), the overall factor of safety is about 27 compare to a product designed for an adult.

As long as it is within the expiry date or period after opening (PAO), and unopened, it should be safe, but as soon as the product has changed in color, odor, aspect, throw it away.

Thank you Elisabeth – now we all know what to look out for especially when most of us have so many creams and lotions at home for our eczema child and after keeping for some time, we struggle whether to throw it out or still use it.

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Science of Skincare Products – Safety and Product Expiry Date

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me again for this series. Im looking forward to this interview as its focused on safety and stability. Quite a few times I look at a product and wonder what will happen after the expiry date, and if it will spoil without visible change.

MarcieMom: Lets first discuss expiry date. How is this expiry date determined? Is there a real need for an expiry date, as in will certain ingredients really spoil?

Dr Elisabeth: Every product sold in established market must pass mandatory regulatory requirements that are essentially designed to ensure safety of the products for consumers. Expiry date of a product is one of the aspects that is often covered by regulatory requirements. I will talk here more about products produced or sold in European Union, which is one of the most stringent worldwide. It means the product must pass several tests that prove it will not spoil during that period of time.

To ensure the safety of a product, you can strictly follow the regulations that are mandatory, or you can also add extra care to that aspect. Regulation is the minimum required, and you can always do better by putting yourself higher internal requirements.

In products produced and/or sold in E.U., you can have two mentions of expiry, one is an actual expiry date, and the second one is Period After Opening or PAO.

If a product has passed tests that will prove it is stable for at least 36 months, expiry date is optional, but you have to indicate how long this product can be used safely after it has been opened. 

Period after opening symbol skincare

Period-After-Opening Symbol

Some other products will display an expiry date. There are multiple reasons to indicate an expiry date. It can be because

  1. the products did not pass the test for a period corresponding to three year/ 36 months,  
  2. it has not been tested for this long period of time or
  3. it has passed the test for that period of time, but for various reasons, it has been decided to shorten its shelf life.

In the last case, the reason behind is often to ensure a maximum of safety. The tests that mimic product aging are well known and well controlled but are still tests. Real life can be quite different than what has been modelized in a lab, and adding an expiry date is a way to ensure a maximum safety for customers.

Using a product for a longer period that is indicated may not be necessarily harmful, and the product can still be good, but you are on your own. There is no data to support the fact that it is safe or not…

Safety and Expiry Date in Skincare Product

MarcieMom: I suspect that an organic skincare lotion I bought may have got bacteria because after a few weeks of using, my daughter developed impetigo (or of course, the impetigo could simply be a complication from eczema and the scratching everywhere). What are the factors that increase the chance a skincare product will spoil? Is it the type of ingredients, where they are made and flown to, or what temperature they are kept in?

Dr Elisabeth: A serious skincare company will take great care of offering products with the best quality, to avoid risk of products spoiling.

The first factor that will induce spoiling of the product is the quality of raw ingredients used in the product and the quality of the manufacturing process. Having strict controls over these factors will help to avoid problems of contamination and oxidation, which are the most frequent causes of product degradation.

The quality of raw ingredients is obviously essential, as any contaminant present in the ingredients with contaminate the final products. Another source of contamination can be the material that is used to manufacture or package the product. Finally, the last main source of contamination is humans that work on the preparation of the cream. They must take great care of personal hygiene before working (washing hands, using single-use gloves, round cap and masks) and only do so under the highest safety and quality standards. The preservatives used in the skincare provide a good reassurance and generally protect the products reasonable well, but reducing the amount of microbiological contamination from the start, ie from the moment the ingredients are sourced and they are manufactured, is the best way to avoid spoiling later on. In E.U., manufacturers of skincare have to follow “good manufacturing practices” regulation, and at Skintifique, for instance, we have applied extremely strict criteria when choosing our suppliers of raw materials and our industrial partners, precisely so as to have the highest assurance on the quality and safety of our products

Stability tests are made to ensure a safe use of the product, but as I said earlier, these tests are designed to mimic quite standard situations. Real life conditions can be harder than what has been modelized. For example, sunscreen creams that have been forgotten in the car on a back sit, and stayed for a long time in a very warm environment, under the sun, have experience several cycles of heat/cooling, which is one of the harder conditions a skincare product can experience. These conditions exceed what have been tested in a lab, and the product can go bad earlier than what is said on the packaging. To ensure that a product will not spoil, you should keep them away from heat and UV. Putting them in a fridge can help keeping them, but may induce a change in the structure of the product (its texture won’t be the same).

MarcieMom: Thank you Elisabeth for sharing about safety and expiry dates of skincare products – next time when I’m offered the chance to visit a skincare company’s plant, I shall look out for these areas! Next week, we will touch on the stability of a product. Can’t wait to learn more!

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Science of Skincare Products – Science in the Bottle

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me for this series. I’m really excited about it because most parents (me included) wonder the differences between skincare products and whether it’s better to get one from a company with the ‘science’ background (or home-made is better).

Let’s start with what’s in the bottle – the ingredients. From a previous interview series, we have learned a few general principles relating to skincare products, to choose those

  1. Without the common irritants, such as fragrance, preservatives, parabens, propylene glycol, lanolin and dye
  2. With as few ingredients as possible, to reduce the likelihood of sensitivity to ingredients
  3. Whether labeled as natural or organic, the overriding factor is whether these ingredients lead to hypersensitive reaction for our skin

Science in skincare product bottle

MarcieMom: How is the selection process of ingredients determined? For instance, is there always a need for a ‘base’ for a skincare product and then add on active ingredients? Do these ingredients have to work together?

Dr Elisabeth: The choice of ingredients is indeed key to develop a skincare product. Some ingredients will be chosen for their activity, some others for making a support for these active ingredients. Ideally, a very strict and rigorous selection process should be carried out. Each company has its own priority for this; for instance, some will prioritize on ingredients they believe give a distinctive feel (texture, fragrance) when applying a product, some others will focus their research on how improving the efficiency of a product by using one specific ingredient. At Skintifique, we focused on a new innovative approach: using both a minimum number of ingredients and very safe ingredients. Making a product safe, efficient and pleasant to use within these constraints require a lot of skills and knowledge in various fields (physic-chemistry, formulation, microbiology and pharmacology).

One way to make a skincare product is to add a set of ingredients with a specific function (eg moisturizing, or protecting the skin from specific allergens or irritants) to a “base” that has a well-known profile of safety, texture and efficiency. In that case, the base will bring the safety and the basic functions a moisturizer must have (generally, humectant, emollient and occlusive function, it sustains stability and safety tests) and the added specific ingredients will bring the specific features of a product (soothing, …).

At Skintifique, we have focused our work on how developing new materials that will enable the use of very few ingredients while maximizing their effects. It means developing products with a new approach, based on how molecules can interact with each other. That’s why the composition of our products may seem very simple, but the products are actually based on very sophisticated science, both in the base(s) that we use, in the functions we add to them and in the ability to mix these functions into the base.

MarcieMom: There are various functions of an emollient/moisturizer.

  1. Occlusive, as protection for the skin
  2. Humectant, the ability to draw water from the environment into the skin
  3. Moisturize, smooth the skin and fill in cracks

MarcieMom: I noted that your product has patent technology. Does a patent technology that enable the functions of the moisturizer to be better than non-patent technology? In other words, what is it about being developed in a lab that makes the skincare product more effective than just the sum of ingredients?

Dr Elisabeth: A lab facility is required when you want to make innovative products.

Developing a skincare product can be done rather easily if you are looking for a product with basic moisturizing functions or just a feel good benefit. There is a long history in the process of making a cream and the principles that drive the stability and the efficiency of classical moisturizer are rather well known.

If you want to add extra features to a product, for example a release in time of active ingredients, a longer stability, or something revolutionary such as having a activity that reflects the needs of the skin (eg the cream is more active when the skin needs it), while using a very low number of ingredients, then you have to think differently of how it is traditionally made. It requires a lot of research. This is the type of products we strive to do at Skintifique and that is why we protect, with patents and otherwise, the technologies that are used in our products. To achieve the development of our products, we have to make numerous tests and iterations that are possible only in a lab. We needed specific equipment to process and also analyze the various formulations.

It is a little bit like in cooking. Using eggs, flour, milk and sugar, you can make simple cakes (which will not harm you if you eat them, but which will not provide anything special in terms of taste and feeling), or you can also achieve a new culinary chef d’oeuvre, if you put a lot of knowledge, expertise and skills only a chef can bring in making it.

MarcieMom: Can you briefly describe the key processes to make a skincare product from sourcing to making the final cream/lotion. How is it different for a company like Skintifique versus say, a company that does not have the laboratory or facilities?

Dr Elisabeth: The general process to make a skincare product is simple at high level: decision on what the properties of the skincare should be and how to make it (e.g. a highly moisturizing product with few ingredients for people with sensitive skin vs a skin tanning product for fun), then identify, or invention of, the best technologies to do the product, including choice of raw ingredients that must fulfill strict criteria in terms of safety and purity, then a lot of trials in the lab and with real life volunteers, then industrial production, quality check and then, commercialization. For serious skincare companies, quality is a major priority and a lot of quality-check procedures are made all through the process (raw ingredients, industrial process, finished products…)

Making innovative products requires a lot of research and development work, and the results will condition the industrial process. For instance, using only a few ingredients to make a product like our Hydrating Gel requires modifying a lot the various steps needed to process a product. That is why a strong effort is made both on the invention work in the lab and on industrial scale-up phases. For more classical cream, this scale-up process is less critical.

MarcieMom: Thank you Elisabeth for helping us in this post – it is enlightening as we now understand the key components of a skincare product and how having technology and laboratory affects the final product. I look forward to next week’s interview where we learn more about the safety and stability of a product.

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Feeding Kids Healthy series – Eating a Balanced Diet

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (currently about 11% in Singapore), parents also have to be mindful of overeating AND eating the wrong types of foods.

Anna Jacob Abbott Interview with EczemaBluesFor this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Last week, we covered what and how much a child should eat. This week, we will focus on how we can get the child to eat a healthy and balanced diet. We have Anna Jacob, Director of Nutrition from Abbott. More on Ms Anna here.

MarcieMom: Thank you Anna for helping us figure out how we can actually get our kids to eat the healthy meal we’ve prepared. We assume that parents have the knowledge to serve a healthy meal of half plate fruits and vegetables (the more colour, the better), a quarter of protein and a quarter of whole grains. Let’s overcome the potential obstacles in each food group!

For fruits, the common ones in Singapore are apples, oranges, pears, grapes, strawberries and mangoes. Within these fruits, we have red, orange, green, purple and yellow! Would you reckon it is more attractive to kids to be served a variety of colours within a meal or rotating each fruit? What is the serving size in each case? Must they be organic?

Anna Jacob: Fruits are rich in many vitamins, some minerals and dietary fibre. Brightly colored fruits also have many natural plant compounds that are now known to be beneficial to health. For example, beta-carotene in yellow-orange fruits supports healthy skin and anthocyanins in red fruit may benefit heart health.

There are basically five colored types of fruit:

  • Green:  Green apples, pears, kiwi, honeydew
  • White: Bananas, lychees, longans, mangosteens
  • Yellow and Orange: Oranges, papaya, cantaloupe, mango
  • Red: Cherries, watermelon, red apples
  • Blue and Purple: Blueberries, purple grapes

Parents can add color to their children’s meals with a variety of fruits, making recipes more attractive and nutritious.  However, we do not have to serve up all the colored fruits on one plate all the time. Incorporating them through different meals and snacks will help your child appreciate and eat them too.

Dietary guidelines from around the world recommend that fruit should be part of a child’s diet – starting with just half a serving after 6 months and progressing to 2 servings by 7 years.  Examples of a serving of fruit, as defined by Singapore’s Health Promotion Board, is 1 medium banana, 1 medium apple, pear or orange, 1 wedge of watermelon, papaya or melon or 10 grapes or longans.

Fruits in Singapore are safe and rinsing the fruit in clean running water before cutting and eating it is sufficient. Therefore, it is not necessary for parents to buy only organic fruit for their children. But for those who want it and can afford it, organic fruit – free of synthetic fertilizers and pesticides – may provide peace of mind.

MarcieMom: For vegetables, the leafy green ones, cruciferous (broccoli, cauliflower and Brussel sprouts) are packed with nutrients. What is the best method of preparation that retains the nutrients yet appealing to kids? Do you recommend hiding vegetables?

Anna Jacob: Indeed, green leafy vegetables are rich in many nutrients including iron, vitamin C, folate, calcium and fibre.  However, many vitamins are sensitive to light and exposure to air. In addition, the water soluble vitamins and many minerals are soluble in water.

Vegetables retain their nutrients best when they are eaten fresh and not processed. To preserve the nutrients in fresh vegetables, prepare them just before eating; do not soak or cook them in water for too long, prepare just before eating, cut into larger pieces and do not overcook vegetables.

Cooking destroys some nutrients, especially the fragile, water soluble ones.  However, many children eat more vegetables when they are served up cooked. Of the many cooking methods commonly used to prepare vegetables, microwaving and steaming conserve nutrients best.  On the other hand, some nutrients in vegetables are better absorbed when prepared with some fat.  For example, tomatoes cooked in oil make lycopene (the natural red pigment) more available to the body. Cooking also makes many otherwise inedible vegetables suitable for a child’s diet – think potatoes, yam, beets and more.

So, use several cooking methods to prepare vegetables to increase your child’s exposure to a variety.  Aim to provide ½ serving of vegetables a day to a child over 6 months and, gradually progress this to 2 servings by the time he / she enters school.  A serving is defined as ¾ of a 250-ml mug of cooked or non-leafy vegetable, 150 g of raw leafy vegetables and 100 g of non-leafy vegetable.

Ideally, children should accept all food including vegetables. However, some reject vegetables due to color, taste, texture. Some scientists also suggest that a few kids are ‘super-tasters’ and may be more sensitive to the bitter notes of leafy green and cruciferous (broccoli, cauliflower and Brussel sprouts) vegetables – causing rejection of these nutrient-dense foods.

Patience is the key when you want to inculcate healthy habits – offer the same vegetable over and over again, without forcing, so that the vegetable becomes familiar. Model eating the same food item at family meal times and, vary the presentation, cooking method and flavoring.  If and when all these suggestions for introducing vegetable fail or take time to achieve, parents may have to be creative and incorporate vegetables in foods. So, ‘hiding’ vegetables is a last resort and not the best option.  But, it is still a valid option and, so, do not feel guilty if you are doing it. Just keep working on all the suggestions listed above, and, soon over time, you will succeed – at least to some degree.

MarcieMom: For grains, whole grains like whole wheat, brown rice, quinoa are better than white rice. As there is less natural sugar in these than white rice, how should they be prepared to be appealing?

Anna Jacob: Natural grain foods – whole grain and polished – do not contain natural or added sugars. All carbohydrates in grain foods, after digestion are absorbed into the blood stream as simple sugars. This is unavoidable as it is the way the body handles carbohydrates. Sugars and starches are not all bad – they do help provide energy to keep children active. In the right proportion, they ensure that children get the energy they need to grow and be active. One advantage of whole grains is that it has more fibre, vitamins, minerals and natural plant components than refined grains. So, definitely, whole grains are more nutritious and therefore, the healthier choice. Here are some tips on how to cook them:

  • Brown rice can be steamed or boiled. However, you need to adjust cooking time and added water volume to achieve a soft and edible grain suitable for your child’s eating ability.
  • Whole wheat grains can be boiled to prepare porridge or milled to make whole meal flour. The flour is versatile and you can make a variety of breads and biscuits with it.
  • Quinoa, usually prepared by the absorption method, requires two-times the volume of water as quinoa and cooks in 10 – 15 minutes.

As these are staple foods and, we eat a good portion of them at each meal, so, it is best to prepare them simply with less fat, salt or sugar. They can be eaten with vegetables and lean proteins as side dishes.  In addition, for variety, you can toss whole grains with fresh or cooked vegetables, nuts, lean meat and some natural seasonings to prepare delicious one-dish meals or snacks.

MarcieMom: Apart from the food preparation, can you share your top 5 tips for getting children to experiment different foods and eat the foods served to them? What are the top 3 pitfalls to avoid when getting a child to eat his/her meal?

Anna Jacob: 5 tips to get children to experiment eating different foods 

5 Tips to Get your kid to experiment

  1. Involve your child in food preparation. From gardening to shopping and cooking, involving your child will help him/her learn about food, become familiar with it and, even develop a sense of pride and ownership. Time spent together over these activities will offer you many opportunities to teach your child about the nutrient-goodness of food as well.
  2. Eat with your child. Children learn about nutrition best by modeling healthy eating behaviors. As you eat a wide variety of food, your child will learn to do so too. You can use these special moments to teach table manners and to bond.
  3. Offer healthy foods. As a parent, you need to ensure age-appropriate and healthy foods are available at regular meal and snack times. However, you need to allow your child to select the portion he wants to eat. Encourage independent eating too. Over time, your child will develop a healthy attitude towards food and eating.
  4. Be creative but do not become a short-order cook. Offer your child a variety of food items, cooked in various styles. You can do this by becoming a creative cook or introducing your child to various food choices out of home. But, once the menu is set, and the food is on the table, do not entertain preparation of special dishes for your child.
  5. Allow your child to occasionally eat with peers. Kids also learn fast by watching their friends. Eating a meal or two with peers helps your child pick up skills he never had.

3 pitfalls to avoid when getting a child to eat his/her meal

  1. Do not abdicate responsibility for your child’s nutrition. Many working parents do not have the luxury to be at home with their child at every meal time. But, set the menu. Know what is served and what is eaten. Talk to your child’s caregivers and, tell them what you would like your child to eat so that they can work with you to ensure good nutrition.
  2. Do not force feed. While you decide when, where and what your child eats, please give your little one the right to select how much he wants to eat. Force feeding is counterproductive as it stresses the caregiver and, scares the child or causes defiance.
  3. Do not distract your child while eating. It is another common practice to let children watch television or play computer games during meals while the caregiver feeds the child. This feeding style does not develop a child’s self-feeding ability – to know and appreciate what is served and learn to be conscious of how much he is eating.

While you should encourage healthy and appropriate eating, this takes time and much effort, you should track growth with your child’s physician at regular visits; and, in the interim you may provide a complete and balanced supplement to fill nutrient gaps, if any – to achieve optimal growth during the critical periods of life.

Thank you so much to Anna Jacob for sharing these tips. Even for families who are already eating healthy, it is a good reminder to keep up the effort, try new foods and enjoy a healthy life!

Pediasure Giveaway

There is also a giveaway sponsored by Abbott and do visit their free Pediasure-Nutritrac tool.

PediaSure goodie bag

The goodie bag contains:

  • 1 x PediaSure purple tote bag
  • 1 x Food cutter set
  • 1 x Lunch box
  • 1 x PediaSure RTD Chocolate flavor
  • 1 x PediaSure RTD Vanilla flavor
  • 1 x $3 PediaSure voucher
  • 1 x $5 PediaSure voucher

Giveaway rules:

Comment in this post or email [email protected] your reply to “How do you get your child to eat more vegetables?” by 27 February 2015

3 winners will be selected, with each receiving the goodie bag above.

If you’re selected as a winner, you have to provide your Singapore address for the goodie bag to be sent to you.

Have fun with the giveaway! You can include pictures of a healthy meal with veges too!

Feeding Kids Healthy series – What and How Much is Right?

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (currently about 11% in Singapore), parents also have to be mindful of overeating AND eating the wrong types of foods.

Dr Chu pediatrician Singapore Interview on EczemaBluesFor this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Today, we have Dr Chu Hui Ping, Paediatrician from Raffles Children’s Centre with a clinical interest in pediatric gastroenterology. More on her profile here.

So let’s start with understanding how much a child should eat!

MarcieMom: Thank you Dr Chu for helping us in this series to clarify for parents how to feed our children. Firstly, in Singapore, we are familiar with the growth charts included in our child’s health booklet. Parents can work out the weight and height percentile of their child against the right chart for their age and gender.

Should growth charts be used as a gauge of how much to feed a child? For instance, being above 95% percentile for weight means that the child should cut back and below 5% means parents should feed more?

Dr Chu: It’s probably not that simple and straight-forward just to use the growth percentile to decide on how much the child should be eating. Generally we don’t only look at the percentile for weight; we also consider the height percentile, i.e. whether the child is proportionate for weight and height, as well as the growth of the child over the last few months or a year.

Some children are genetically bigger in size, for instance they are already born bigger and have always been growing along the 95th percentile for their weight and height. So it will not be appropriate to put these kids on a diet. It is more important to ensure that children who are at above 95th percentile and who are at less than 5th percentile for weight are being assessed by their doctors or paediatricians to exclude any medical conditions which make them gain or lose weight respectively. Even if there aren’t any underlying medical conditions, it is also essential to review the various components of their diets and ensure that the diet is well-balanced and consists of the essential nutrients rather than just cutting down or feeding more.

MarcieMom: Growth charts don’t take into account the fats a child has (since obesity is defined as excess fats) nor do growth charts take into account physical activity levels. How should parent figure out if their child should be eating more or less based on the amount of exercise they have?

Dr Chu: The child should be able to regulate his intake of food depending on the amount of exercise he has. Generally if the child is active, i.e. participates in active play or exercise for 60 minutes in a day, he will feel hungry and ask for food if his current diet is insufficient to meet his activity level. It is more common for parents to give too much food in proportion to the amount of exercise that the child has, resulting in the child being overweight due to the excess unutilized calories. If the parent feels that the child is not eating sufficient for the amount of physical activity he has, he can increase the proportion of complex carbohydrates or whole grains which can help to release energy in a slow manner, as well as proteins in the form of lean meat for muscle growth.

MarcieMom: How much to eat is only one part of the equation. What about the type of foods? While we know that excess sugar, trans-fat and processed foods are bad for health, what can parents do to ensure that their child have an optimal diet? Do share your top 5 tips on eating healthy for the child (and family)!

Dr Chu: My 5 tips for healthy eating for anyone, child or adult, are as follows:

Kids Healthy Diet

  1. Eat fresh –try to avoid processed foods and to prepare your meals using fresh ingredients.
  2. Ensure that half of your meal should be consisting of vegetables and fruits.
  3. Choose wholesome foods such as brown rice and wholemeal bread.
  4. Reduce unhealthy fats/oils by cooking in a more healthy manner – steaming, boiling, stewing etc.
  5. Drink water for hydration instead of sweetened juices and soft drinks.

MarcieMom: In Singapore, there are many food courts and coffee shops but these usually don’t meet the healthy plate guideline of half a plate of fruits and vegetables. Which 5 common dishes found in coffee shops would you recommend and which 5 dishes would you discourage for children?

Dr Chu: Choosing health food options in food courts and coffee shops may be tough but not impossible. I would recommend these food choices:

  1. Rice with mixed dishes (choosing at least 1 vegetable and 1 lean meat)
  2. Fish soup with additional vegetables, soup noodles with additional vegetables
  3. Grilled fish or chicken with salad and mashed potato (instead of French fries)
  4. Freshly cut fruit platter

I would discourage these food options for children:

  1. Chicken rice (because too oily and little vegetables)
  2. Char kway teow (because too oily and too much salt)
  3. Fried economic beehoon with luncheon meat (because too oily and lots of MSG in the processed meat)
  4. Laksa (because high saturated fats from the coconut milk)
  5. Black fried carrot cake (because too much salt and sugar from the black sauce used)

Thank you Dr Chu for enlightening us on the types of foods beneficial for our child’s growth. Next week, we will check back on how to actually get our child to eat them!

Pediasure Giveaway

There is also a giveaway sponsored by Abbott and do visit their free Pediasure-Nutritrac tool.

PediaSure goodie bag

The goodie bag contains:

  • 1 x PediaSure purple tote bag
  • 1 x Food cutter set
  • 1 x Lunch box
  • 1 x PediaSure RTD Chocolate flavor
  • 1 x PediaSure RTD Vanilla flavor
  • 1 x $3 PediaSure voucher
  • 1 x $5 PediaSure voucher

Giveaway rules:

Comment in this post or email [email protected] your reply to “How do you get your child to eat more vegetables?” by 27 February 2015

3 winners will be selected, with each receiving the goodie bag above.

If you’re selected as a winner, you have to provide your Singapore address for the goodie bag to be sent to you.

Have fun with the giveaway! You can include pictures of a healthy meal with veges too!

Skin pH with Cheryl Lee Eberting, M.D.– Eczema and Skin pH

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

Skin pH interview with skin barrier expert, Cheryl Lee Eberting, M.D.of CherylLeeMD.com

This is the 5th and last post of Skin pH series: Read the 1st post on Understanding Skin pH and its Impact here, 2nd post on Overly Acidic and Alkaline Skin here, 3rd post on Diet, Environment on Skin here and 4th post on Moisturizing and Skincare Products’ impact on Skin and Skin pH here.

We are privileged to have Board Certified Dermatologist Cheryl Lee Eberting, M.D. again for this 5-week skin pH series. Read more on Dr Cheryl Lee here. Dr. Eberting invented the TrueLipids skin barrier optimization and repair technology; a technology that helps the skin to repair itself by recreating its own natural environment.  Dr. Eberting’s expertise in treating eczema  has led people to come from all over the world to seek her care and to the development of a dedicated eczema care clinic online.

MarcieMom: Thank you Dr Cheryl Lee for being with us for the past 4 weeks and today, we focus on eczema skin – a topic which parents/readers of this blog would most certainly be keen to find out!

Eczema and Skin pH

MarcieMom: I read that alkaline pH is associated with skin dryness. Since eczema is characterized by skin dryness, does this mean all eczema skin is too alkaline? Came across a study that even the uninvolved skin of eczema adults have higher alkaline pH than those without eczema. It was stated as 6.13±0.52 on the eczema lesions, 5.80±0.41 on perilesional skin and 5.54±0.49 on uninvolved skin. In the control group, the mean pH of the skin surface was 5.24±0.40.

Dr Cheryl: Yes.  If you have dry skin, eczema, a rash, or an infection on your skin, then the pH is too high.  In atopic dermatitis, there are 7 major problems that lead to the abnormal skin barrier and they are all interrelated with each other.  The problems are as follows:

  1. Skin lipid deficiencies (phytosphingosine, phytosphingosine-containing ceramides like Ceramide 3, cholesterol esters, and very long chain fatty acids have been shown to be particularly deficient in atopic skin, dry skin and aged skin).
  2. Excessive loss of water due to skin lipid deficiencies. (white petrolatum in the gold standard water loss inhibitor.  Paraffin is likely even more effective than petrolatum however.  Certain lipids have also been shown to be very good at inhibiting water loss.  The lipid isostearyl isostearate is one of the most effective lipids as preventing water loss from the skin.
  3. Abnormal pH (partly caused by the lipid deficiencies above, but also then CAUSES a lipid deficiency because the enzymes that make epidermal lipids only work within the optimal skin pH range)
  4. Susceptibility to infection (caused by the lipid deficiencies—some of these lipids are anti-staphylococcal—and caused by the overly alkaline pH).
  5. Inflammation (cause by lipid deficiencies that cause desiccation and entrance of allergens and infection into the lower levels of the epidermis which then leads to infection.)
  6. Allergy (atopic skin is susceptible to allergic contact dermatitis to certain chemicals at higher rates than non-atopic skin.  This is also a result of all of the above problems.)
  7. Abnormal calcium gradients.  (The epidermis has calcium gradients that lead to lipid production and to normal cell cycling.  In atopic dermatitis, these gradients are disrupted and contribute to lower levels of lipid production and dysfunctional cell cycling.)

These 7 problems are present in the entire skin barrier of an atopic and this is why is it so very important to focus on skin barrier optimization that addresses all 7 of these problems simultaneously.

MarcieMom: What skincare measures (if any) should parents of eczema children take to help the child’s skin to reduce its alkalinity?

Eczema and Skin pH - Steps to take

 

Dr Cheryl Lee:

1. Bleach Baths Really Work:

As I discussed in this post, I think bleach baths work as part of the eczema skin care regimen, but they also alkalinize the skin a little bit too.  The target concentration of a bleach bath is .005% hypochlorite ion.  Because there are different sizes of bathtubs around the world, it is difficult to just tell you how much bleach to put it.  In the United States, we have a standard-sized tub that most people have in their homes. (And we have ridiculously large tubs too).  For the regular-sized American tub, I recommend 1/8 cup if the tub is 1/4 full, or 1/4 cup is the tub is 1/2 full or 3/8cup is the tup is 3/4 full.  For very mild cases of eczema, bleach baths may not be needed, but if there is any crusting or scabbing, try taking the bath three times a week.  The more severe it is, the more frequently you should take a bleach bath.

Special Trick for Babies with eczema:  If your child will not stay in the bathtub long enough to have an effective bleach bath (about 20 minutes), then try using a large tupperware/plastic container INSIDE your shower for your child to play in.  I recently discovered this on my own children and now I can’t get them to STOP taking a bath (which is bad for eczema too;  too many baths can dry out the skin and make it worse).

Of note, we have always thought that the bleach bath is working because it is killing the Staph. aureus on the skin.  Well, recent studies showed that it is not only the killing of the Staph, but it is also due to the low level oxidation exposure.  When the skin is exposed to very low levels of oxidation, the skin then turns on anti-inflammatory and reparative pathways.  This is totally counter-intuitive, but is very, very interesting and makes me thing that our creator really knew what he was doing!

2. pH-Adjustment After Bathing and After Bleach Baths OR If you Don’t Have Access to Bleach:

After taking a bleach bath, use a pH-protecting gel with vinegar in it or use a vinegar spray diluted with one part vinegar and six parts water to all affected areas.  (white vinegar or apple cider is best—no rice or balsamic vinegar).  This should then be covered with a pH-optimized moisturizer (pH 4.6 to 5.6….a little more acidic may be beneficial, but more alkaline is bad).

Of note, I had a patient come to see me all the way from Cambodia.  When she went home to Cambodia, she was unable to find bleach anywhere.  If this is the case, I have seen similar benefits from vinegar baths (it takes A LOT of vinegar–around 6 cups to a half-full regular American-sized tub).  Or, you can do the vinegar spray or pH-protecting vinegar gel if you cannot take a bath.

3. Moisturize the Skin Barrier AT LEAST Two Times a Day With Skin Barrier Optimizing Moisturizers, But Four Times Works Better and Faster:

I think it is very important to moisturize atopic skin at least twice a day WHEN IT IS NORMAL LOOKING.  When it is broken out AT ALL, I always advise that my patients use their eczema products (we use the TrueLipids Eczema Experts 1% Hydrocortisone Cream followed by the TrueLipids Relieve & Protect Ointment) up to four times a day UNTIL the skin is normal looking.  Once the skin LOOKS and FEELS normal, then my patients switch to the TrueLipids Ceramide+ Cream followed by the ointment twice a day for maintenance.  It is very important to treat ALL affected areas and not just the areas that are scabby looking.  What I mean by this is that even the areas of the body like the stomach and back that may look a lot better that the worst areas on the arms and legs, must also be treated until they ARE normal; normal looking and normal feeling.

The skin on the trunk often has what we call folliculocentric atopic dermatitis where each little hair follicle is more accentuated and is a little bit lighter in color than the skin around it.  This is active disease and needs to be treated just as much as the scabby, inflamed areas do.  The skin on the trunk usually heals much more quickly than does the skin on the arms and legs and, as it heals and goes to normal, the hydrocortisone can be replaced with the Ceramide+ Cream.

4. The Maintenance Moisturization Phase is Just as important as Treatment Phase:

I cannot stress the importance of maintenance moisturization.  Plan on at least twice daily moisturization for the rest of your life.  You must avoid all common allergens in your skin care products too.  There are certain allergenic chemicals that are known to be more common in people who have atopic dermatitis and you should at the very least avoid them.  I will write more about this in a later post.  By optimizing the skin barrier, you can prevent it from breaking down into eczema and can probably also control other allergic diseases like asthma and hay fever too.

5. Wet Wrap Therapy if Your Eczema is Severe:

If your eczema is very, very severe, you will need to do wet wrap therapy where you take your bleach bath, then do your pH adjustment and then wrap the skin in WHITE COTTON (not wrinkle-free type fabric because is often has formaldehyde in it) pajamas or bandages every day.  I have even had a few patients who have needed to do wet wraps during the day too.  Don’t use ACE wraps or anything that has latex or spandex in it as this can be allergenic for atopic skin too.  Once the wraps or pajamas are on, spray them down with water and cover with a layer of dry clothing and go to bed.

6. Break Through Low Dose Steroid Maintenance in Severe Cases:

For more severe cases, once the skin is completely back to normal, I recommend using the TrueLipids 1% hydrocortisone cream twice as part of your maintenance routine.  Studies have shown that low levels of hydrocortisone like this can keep one in remission and prolong time between relapse. Studies have also shown this benefit from treatment a few times a week with Elidel or Protopic, but I do not prefer them as I don’t find them to be very effective, they are very expensive and they are not the safest drugs in the world. (That being said, if you are allergic to glucocorticoids, then Elidel and Protopic can be a lifesaver.)

Also very important is that of glucocorticoid allergy.  Studies have shown that between 24 and 90% of children with atopic dermatitis who are patch tested are allergic to at least one glucocorticoid.  If your child is one who seems to either not get better with hydrocortisone or who gets a little better but then seems to get worse, he/she may be allergic to it.  It is always a good idea in this case to get your child patch tested to see what they are allergic too and to learn what classes of gluccocorticoids that your child can use.

7. Allergen Avoidance and Patch Testing if Needed:

I cannot stress enough how important it is so avoid allergens in your skin care products, soaps, detergents AND in the products that family members are using.  Find a dermatologist who is experienced in patch testing (not prick testing) for allergic contact dermatitis (ACD).  ACD is an allergy to a chemical that is coming in contact with the skin.  For example, fragrance allergy is one of the most common allergens in atopic dermatitis.  If daddy is wearing cologne and baby touches his shirt, this can equal a month of eczema flare for baby.

The whole family needs to avoid the allergen triggers.  In addition to fragrance (which cross reacts with essential oils and many plant extracts), common allergens in atopic dermatitis include nickel, formaldehyde releasing preservatives, propolis (in beeswax), neomycin, bacitracin and more.

Thank you Dr Cheryl Lee for going through with us the factors that affect skin pH with practical steps on what parents can do. It will definitely help parents to be committed to these measures with the right understanding of why to take them. Thank you once again!

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