Eczema News #Christmas Special – Top 10 Allergy Suspects

It’s end of the year, it’s Christmas time and there are actually quite a few things about Christmas that can really spoil the season fun. Apart from visiting others’ homes (pet, mold, dust mites), eating foods that you don’t normally eat (or never eaten before), there’s the Christmas tree that can cause quite a few allergic symptoms.

This Christmas special looks at some of these ‘Christmas Allergy Suspects‘:

10 Top Christmas Allergy Suspects

Don’t let these 10 Top Christmas Allergy Suspects spoil your season fun!

Christmas allergy suspect #1: Christmas tree

Allergic contact dermatitis – reaction to colophony, also known as rosin, is the sap or sticky substance that comes from pine and spruce trees.

Allergic rhinitis – reaction to alternaria mould

Main trees are scotch pine (allergic conditions likely due to mold Penicillium spinulosum), followed by spruce tree (due to mold Epicoccum and Alternaria). Hose down the tree outdoors and handle with gloves to reduce the mold spores.

Even artificial christmas trees can cause a reaction as they have been stored and accumulated dust mites and molds in the basement.

Christmas allergy suspect #2: Poinsettia

Cross-reactivity with latex allergy observed in a case study

Christmas allergy suspect #3: Christmas cactus

Contact urticaria and rhinoconjunctivitis (of workers at a cactus nursery)

Christmas allergy suspect #4: Christmas candy

Asthma (of a candy maker) after exposure to pectin, a compound in Christmas candy

Christmas allergy suspect #5: Food, Cocktails

Common allergens are milk, eggs, soy, fish, shellfish, peanuts, tree nuts and wheat. Ask before you eat or inform the host. If you’re hosting, take care to avoid these allergens or avoid them in some of the dishes and not re-use the utensils without washing.

Allergens in cocktails include sulfites in wine, maraschino cherries, and tree nuts in beer.

Christmas allergy suspect #6: Pets

If you’re allergic to pet dander, it’d be best to check out if the home you’re visiting has pets. The concentration of pet dander allergens are usually higher during Christmas, due to more time spent indoors.

Christmas allergy suspect #7: Dust mite

Though dust mites are present all year round, it is worse during the holidays as we spent more time in our bed with the cold weather.

Christmas suspect #8: Artifical snow or Frosting

Asthma can be triggered when spraying artificial snow or any chemical spray (say on frosted window) can irritate the eyes, nose, lungs and skin.

Christmas suspect #9: Stress

Stress is a known trigger for eczema and asthma – go easy on shopping and visiting schedules.

Christmas suspect #10: Candles, air fresheners, potpourri

It may add an extra touch to your home for the holiday season but these give off compounds that irritate the nose and throat.

Enjoy Christmas, and remember it is the time for celebrating Christ’s birth and his love for us.

 For unto you is born this day in the city of David a Savior, who is Christ the Lord.

Luke 2:11

References:

  1. The sweet christmas rash
  2. No poinsettia this christmas
  3. Immediate allergic and nonallergic reactions to Christmas and Easter cacti.
  4. Christmas Tree Allergy: Mould and Pollen Studies

Skin Facts – Skin Renewal in Babies and Eczema Skin

This is the last of Skin Facts series and as we come to a close in 2015 and usher in 2016, one Skin Fact to look at is how our skin renew itself. The dermatological terms are ‘epidermal cell proliferation‘ which takes into account the turnover of cells and there are differences between normal adult, baby and eczema skin. Here’s a look at Skin Renewal Facts!

Basics of Skin Renewal

Skin Renewal in Baby and Eczema Skin

Skin Renewal in Baby and Eczema Skin

The skin regenerate itself every 27 to 39 days, meaning that the cells from the lower layer of the epidermis (outer layer) move up to the surface and differentiate. The epithelial cells are called keratinocytes and they have different structures within the different layers of the epidermis (from the deeper basal layer, to spinous, granular to the corny layer at the surface). The top layer is also known as the stratum corneum, for which we have looked into the transepidermal water loss through stratum corneum.

This skin renewal is not related to wrinkles as wrinkles are primarily due to the loss of collagen, which is in the dermis (middle layer) of skin. Baby skin feels ‘softer’ and more elastic likely due to shorter collagen fibres.

Baby Skin – Cell Turnover Rate

Microscopic examination of baby skin showed that baby stratum corneum is 30% thinner than adult skin, and that baby epidermis is 20–30% thinner than adult skin. The cell size at the corny layer of the baby skin is smaller, which implies that the baby’s cell turnover rate is higher. This correlates with better wound healing in infant skin compared to adult skin. Epidermal cell proliferation rate decreases with age.

Eczema Skin – Defective Protein

As cells proliferate, there are proteins that are expressed by the skin cells. Studies have been made on various proteins and one of the most distinguishing (lack of) proteins is that of filaggrin (FLG), which serves to produce and protect the skin barrier. In people with eczema, there is lower level of FLG, resulting in flatter skin surface cells, disrupted protective fatty layer, reducing the moisturizing function of the skin and increasing water loss from the skin. Reduced FLG also increases the skin pH and leads to increased skin inflammation. It is possible that for eczema skin, the defective protein expression makes it unable to proliferate but instead ‘terminate’ at the basal layer. This has the effect of weakening the skin structure.

Here’s a recap of all the Skin Facts posts:

Facts about our Skin versus Baby and Eczema Skin

Sun protection in adults, infants and Eczema Skin

Water loss from Children and Eczema Skin

How much we sweat versus infants

Chemicals Penetrate via Baby Skin

Lipids in Baby and Eczema Skin

References

Cosmetics & Toiletries – Baby Skin vs. Adult Skin Structure, Function and Composition

Medscape – On the Role of the Epidermal Differentiation Complex in Ichthyosis Vulgaris, Atopic Dermatitis and Psoriasis

Eczema News – Non-Celiac Gluten Sensitivity

Around end November 2014, I ran a blog series on Children Food Sensitivities, explaining there are various types of gluten-related food sensitivities, namely:

GLUTEN SENSITIVITY

Various types of gluten-related conditions

Celiac disease – Immune system attacks the villi in the esophagus when exposed to gluten protein gliadin, found in wheat, barley, rye, and sometimes oats. This lead to intestinal inflammation, flattening of the villi and long-term damage to the small intestine.

Non-Celiac Gluten Sensitivity (NCGS) – Diagnosis is not straightforward with no proven medical test. It is typically diagnosed after elimination of other similar conditions (for instance, wheat allergy, Irritable Bowel Syndrome) and after observation and further consultations.

Wheat Allergy – Involves an immune Ig-E mediated reaction to the wheat protein, can be diagnosed via allergy test.

It was debatable in 2014 then as to whether non-celiac gluten sensitivity (NCGS) even exists as (i) it is difficult to diagnose NCGS, and (ii) some studies concluded that it is actually sensitivity to FODMAPs rather than NCGS. (Gluten-containing grains are high in FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols) which are sugars/ carbohydrates that tend to be poorly digested, e.g. frutose.

Almost a year later in 2015, we want to examine (i) whether non-celiac gluten sensitivity (NCGS) is a clinical entity (ie we are sure there’s such a medical condition) and (ii) its impact on eczema or skin rash.

September 2015 Study – Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features

Methods: 17 patients affected by NCG, median age 36, 76% females, with itchy rash similar to  eczema, psoriasis or dermatitis herpetiformis; wheat allergy and celiac disease tests were carried out to confirm that these 17 patients were not suffering from these.

Finding: Skin improvement noted after a month of gluten-free diet

July 2015 Paper – Non-celiac gluten sensitivity: Time for sifting the grain

In this paper, non-celiac gluten sensitivity is stated as a clinical syndrome characterized by both intestinal and extraintestinal symptoms, which are responsive to gluten (wheat) withdrawal from the diet.

Its estimated prevalence is 3% to 5% and a syndrome from multiple factors.

July 2015 Case study – Gluten Psychosis: Confirmation of a New Clinical Entity

In this case study, a 14-year old girl recovered from psychotic symptoms, after eliminating gluten. Other conditions linked to NCGS included:

  • Gastrointestinal symptoms: Abdominal pain, bloating, diarrhea or constipation
  • Systemic manifestations: “Foggy mind”, depression, headache, fatigue, and leg or arm numbness
  • Neuro-psychiatric disorders: Autism, schizophrenia and depression

June 2015 Study – Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity

From this paper, a diagnosis pathway was suggested to determine if one suffers from NCGS. The blind gluten challenge remains a ‘gold standard’ for diagnosis; if going on a strict gluten free diet, it is maintained for at least 3 weeks to observe if symptoms improve.

Non-Celiac Gluten Sensitivity Diagnosis

NCGS Diagnosis; copyright of World Journal of Gastroenterology, June 2015; 21(23); 7110-7119; Figure 1

June 2015 Study – Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria; The criteria is similar to above, with varying guidelines on the duration of gluten free and introduction of gluten diet.

Various research had linked NCGS to female gender and adult age.

It seemed from recent studies that NCGS remained a syndrome without an easy way of diagnosis. The latest study that noted an association between gluten and skin rash would likely be considered as being on a small scale. However, the possibility of skin rash linked to gluten cannot be dismissed and more collaboration between dermatologist and gastroenterologist would increasingly be seen as more patients suspect gluten as a source of their skin problems.

Update on 17 October 2016 – A new study showed the possible group of proteins found in wheat – amylase-trypsin inhibitors (ATIs) – to trigger an immune response in the gut that can spread to other tissues in the body. From MedicalNewsToday

ATIs only make up a small amount of wheat proteins – around 4 percent – yet the immune response they induce significantly affects the lymph nodes, kidneys, spleen, and brain in some people, causing inflammation. ATIs have also been suggested to exacerbate rheumatoid arthritis, multiple sclerosis (MS), asthma, lupus, and nonalcoholic fatty liver disease, as well as inflammatory bowel disease.

What’s your experience with gluten? Do you think your child has gluten sensitivity? Share in the comments and we can all learn from it!

Skin Facts – Lipids in Baby and Eczema Skin

This is the 6th post exploring ‘Skin Facts’ and today’s focus is on the lipids/ fats in our skin. There is distinct difference between the skin lipids of normal adult skin, baby skin and eczema skin. Let’s explore skin lipids!

Types of Skin Lipids

Skin Facts - Lipids in Baby and Eczema Skin

Skin Facts – Lipids in Baby and Eczema Skin, and its functions

There are lipids from both sebaceous and keratinocyte/ epidermis:

  • Sebaceous – from sebaceous glands and coats the skin surface, mainly triglycerides, wax esters and squalene, fatty acids and smaller amounts of cholesterol, cholesterol esters and diglycerides
  • Epidermal – found between the epidermal skin cells, mix of ceramides, free fatty acids and cholesterol

Lipids from Sebaceous Glands – Sebum

The concentration of sebum is higher at the forehead, face, scalp, upper chest and back and lower on the hands and feet and none on the palms and soles.

Function of Sebum

  • Deliver antioxidants to the surface of the skin in the form of vitamin E
  • Antibacterial protection
  • Antimycotic protection (fungi)
  • Reduces water loss from skin surface

Unfortunately, sebum is also associated with

  • Body odor
  • Acne

Functions of Epidermal Lipids

  • Hydration of the stratum corneum
  • Antibacterial protection
    Antimycotic protection (fungi)
  • Increased protection via increasing impermeability of skin
  • Maintenance of skin moisture content

Eczema and Lipids

Atopic dermatitis is associated with reduced epidermal lipids in all three categories – reduced ceramides, cholesterol and free fatty acids

The lack of lipids lead to a weak ‘brick and mortar’ structure where the lipids are akin to the mortar that keep the skin cells (bricks) together. This weakened skin barrier is associated with increased transepidermal water loss and increased skin permeability

See

Lipids in Baby Skin

The subcutaneous fat in baby skin is rich in the saturated oils – palmitic and esteric acid, with the following characteristics:

  • Higher melting point temperatures – freeze more easily (such as eating ice or popsicle for hours!), thus avoid extreme temperature for babies
  • Saturated vs Higher unsaturated oleic acid and linoleic acid in adults

Infant skin contains less total lipids compared to adults

Malnutrition is linked with changes in surface lipids, where an alteration in skin lipids has been observed due to essential fatty acid deficiency

With a lower lipid skin content, it is important not to excessively wash baby skin and further remove the skin lipids.

Other posts on EczemaBlues.com on skin lipids are:

Eczema News – ‘Lipid fingerprint’ Treatment Approach : Where the Oregon State University is developing a system to identify the missing lipids in an individual skin, thus the possibility of getting moisturizer to replenish the specific deficient lipid.

References

Eczema News – Does Water Hardness affect Childhood Eczema

We can’t live without water and it is an area which many parents suspect may have something to do with the eczema. Water that we drink or bathe in has been covered in this post, but today’s post is focused on Water Hardness and reviewing the research in this area.

Water Hardness and Eczema

Water Hardness and Eczema

October 2015 Study on Water hardness and eczema at 1 and 4 year of age in the INMA birth cohort (INMA refers to Infancia y Medio Ambiente, a birth cohort study in Spain; see INMA website for many interesting research on environmental factors during pregnancy and early life)

Finding: No association between eczema and water hardness at home or bathing exposure during the first four years of life

July 2012 Study on Interactions between domestic water hardness, infant swimming and atopy in the development of childhood eczema

Finding: Exposure to hard water and infant swimming interact with atopic status increased the prevalence of childhood eczema. A breaching of the epidermal barrier by detergents or salts in hard water and by chlorine-based oxidants in swimming pool water might explain these interactions.

February 2011 Study on A randomised controlled trial of ion-exchange water softeners for the treatment of eczema in children (SWET Trial) (full report)

Finding: Water softeners provided no additional benefit to usual care in this study population.

July 2007 Study on Domestic water hardness and prevalence of atopic eczema in Castellon (Spain) school children

Finding: Water hardness in the area where 6-7 year-old schoolchildren live has some relevance to the development of eczema.

It seemed that although water hardness is believed by parents to have an impact on eczema, this is not seen in research, the most definite trial is that in Feb 2011 which was a randomised controlled trial as opposed to analysis of data.

On the study noted that swimming worsened eczema but swimming is useful for killing of staph bacteria (and a fun and fit way as opposed to bleach bath). Some advice by doctors who have addressed the topic of swimming on this blog:

Dr Christopher Bridgett on swimming Q&A

It’s good to say that swimming and atopic eczema usually go together just fine. The problem is caused by the water – it washes off a layer of the skin’s protection and leaves it very porous to water loss afterwards: a thin application of moisturizer before swimming protects against this.

Otherwise, the chemicals in the water of a swimming pool are disinfectants – chlorine, & bromine for example – they can be good for the skin, as their antibacterial effect is anti-inflammatory. However these additives can irritate too.

Dr Lynn Chiam in interview on teen eczema and sports

Swimming for long periods during a bad flare of eczema is not advisable as the swimming pool water may cause more skin dryness.

What’s your experience with hard water or did you purchase any of the water treatment kit for your home? Share in the comments so that other parents can learn from your experience!

Skin Facts – Chemicals Penetrate via Baby Skin

Many chemicals come into contact with our skin, some intentional and others inadvertently. How much chemicals penetrate our skin? What about that of a baby or those who have defective skin barrier like eczema sufferers? This 5th post of Skin Facts series explores the chemicals our skin comes into contact with.

Our Skin Structure – How do Chemicals Penetrate?

Chemicals definitely penetrate certain layers of our skin, otherwise, the skincare industry will collapse if all skincare products just stay on the skin surface and no product can claim to improve your skin! Chemicals penetrate different layers of skin barrier (that’s part of the ‘price’ we pay for a skincare product where technology is involved to enhance penetration).

Here are 3 Ways Chemicals Penetrate our Skin:

Penetration/ Transcellular absorption – via the stratum corneum through the corneocytes (flattened cells that made up the horny layer); Stratum corneum contains about 40% protein (primarily keratin), 15% to 20% lipids and 40% water.

Intercellular absorption (main route) – Chemical is transferred around the corneocytes in the lipid-rich extracellular regions; Lipids present in the intercellular spaces of the stratum corneum are by weight: 45–50% ceramides, 25% cholesterol, 15% long-chain free fatty acids and 5% other lipids, the most important being cholesterol sulfate, cholesterol esters, and glucosylceramides.

Michaels et al. (1975) is the one who came up with the ‘brick and mortar‘ analogy describing corneocytes filled with lipids. Dermatologists explain eczema skin has the wall without strong mortar holding the bricks.

Appendageal absorption – Chemical bypasses the corneocytes, entering the shunts provided by the hair follicles, sweat glands, and sebaceous glands

Baby Skin – More Chemical Penetration?

Chemical Penetration in Our Skin and Our Children

Chemical Penetration in Our Skin and Our Children

The baby skin is not fully developed, where Infant stratum corneum was found to be 30% thinner and infant epidermis 20% thinner than in adults. More chemicals penetrate due to this and there’s higher risk associated with this penetration due to:

  • High surface-area to volume ratio
  • Higher metabolic rate, higher respiratory volume
  • Immature drug metabolism, drug carriage and detoxification systems
  • Decreased subcutaneous fat stores that (i) increase absorptive area and (ii) decrease the volume of distribution of the chemical
  • Higher chances of injured skin (for instance, from adhesive tapes) increase skin permeability
  • Vulnerable to endocrine disrupters

Eczema Skin – How Defective Skin Barrier Affect Chemical Penetration

Eczema skin is defective which allows more chemicals to penetrate and be absorbed with possible effects of:

  • Enhanced absorption of a specific chemical
  • Entrance of larger molecules such as proteins and nanoparticles
  • Facilitate entrance of chemicals into and through the skin

The Care in Chemicals

With increased chemical penetration, it follows then that we ought to be extra careful of what goes onto baby skin as well as eczema skin (and baby’s eczema skin!). It is impossible (and not necessary) to aim for zero chemical contact, instead know which types of products not to use and what skincare/ cosmetics ingredients to avoid:

  1. Soap – Avoid as it is drying (due to alkalinity) and harsh for skin; alternative: use a gentle cleanser/ bath oil/ oatmeal bath
  2. Anti-microbial wash – Avoid; read this post to learn more about effects of anti-microbial wash and its ingredients that irritate skin
  3. Shampoo – Choose one without key irritants (see below)
  4. Antiperspirant – Safe to use, can opt for an aluminium and paraben free one (see WebMD article)
  5. Skincare moisturizer – Choose one without key irritants (see below)
  6. Detergent and detergent residue on clothes – Use a hypoallergenic one and turn on a longer cycle (see this post)
  7. Toothpaste – Safe to use, just don’t overuse
  8. Baby wipe – Choose one without Methylisothiazolin (MI) and fragrance free (see this post)
  9. Bubble bath – Avoid as the average bubble bath is irritating to skin
  10. Cosmetics – Throw away expired cosmetics

Instead of trying to eliminate all chemicals, it’d be more practicable to avoid ingredients that are known irritants or suspected to cause harm:

AVOID #1 Perfume

Fragrance, phthalate esters, synthetic musk compound, Benzyl alcohol, scent, aroma, Abietic acid, alcohol, Abitol (see this post on various names of perfumes)

Found in: Perfume, shampoos, cleansers, lotions, creams, oils, sunscreens, toothpaste, baby wipes

It is stated in this article on Scientific American – Scent of Danger: Are There Toxic Ingredients in Perfumes and Colognes?

“The average fragrance product tested contained 14 secret chemicals not listed on the label,” reports EWG, which analyzed the Campaign’s data. “Among them are chemicals associated with hormone disruption and allergic reactions, and many substances that have not been assessed for safety in personal care products.” EWG adds that some of the undisclosed ingredients are chemicals “with troubling hazardous properties or with a propensity to accumulate in human tissues.” Examples include diethyl phthalate, a chemical found in 97 percent of Americans and linked to sperm damage in human epidemiological studies, and musk ketone, which concentrates in human fat tissue and breast milk. Fragrance secrecy is legal due to a giant loophole in the Federal Fair Packaging and Labeling Act of 1973, which requires companies to list cosmetics ingredients on the product labels but explicitly exempts fragrance.”

I find it interesting because if you look at your perfume, even the most expensive ones, you would find many of them are irritants and definitely hard to pronounce! There are also ingredients that are ‘hidden’ behind proprietary names given by the brand.

Consequence: Irritate, allergenic, allergic rhinitis, chronic sinus, asthma, accumulate in the environment, the body and the breast milk, disrupt the endocrine system (Endocrine system is a network of glands that produce and release hormones).

AVOID #2 Preservatives

  • Parabens – Methylparaben, Butylparaben, Propylparaben, Ethylparaben
  • Phenoxyethanol
  • Formaldehydes and formaldehyde releasers – Formalin, Methaldehyde, Methanal, Quaternium-15, 1,4-dioxane, DMDM hydantoin, Diazolidinyl urea, Imidazolidinyl urea, Methylchloroisothiazolinone/ Methylisothiazolinone

Found in: Shampoos, bath additives, lotions, creams, oils, sunscreens, toothpaste, baby wipes

Consequence: Irritate, allergenic, carcinogenic (formaldehyde via nasal pathway), endocrine disruptors (paraben)

AVOID #3 Propylene Glycol

1,2 Propanediol, 1,2-dihydroxypropane, methyl glycol, trimethyl glycol (Ethylene Glycol is more toxic than propylene glycol)

Found in: Skincare products, shampoo

Consequence: Known irritant for babies, infants and those with sensitive skin conditions such as eczema, or those with prolonged dermal contact e.g. during treatment of burns

AVOID #4 Sodium Lauryl Sulphate

Sodium Lauryl Sulfate (SLS, Sodium dodecyl sulfate; Sulphuric acid, monododecyl ester, sodium salt; Sodium salt sulphuric acid; Monododecyl ester sodium salt sulphuric acid), Ammonium lauryl sulfate (ALS), Sodium Laureth Sulfate (SLES)

Found in: Shampoos, conditioner, bath additives, toothpaste, baby wipes

Consequence: Irritant and drying to skin, corrodes hair follicle and impedes hair growth

Here’s what I learned from dermatologist Dr Cheryl Lee on surfactants used in our product (see post):

Surfactants are designed to remove dirt and oils from the skin, but the problem is that they can also remove the lipids from the skin as well. This leads to disruption in the skin barrier and exacerbates all the skin barrier problems in atopic dermatitis…Of note, a recent study by Belsito et. al., showed that the surfactant cocamidopropyl betaine (CAPB) is more likely to cause allergic contact dermatitis in people with atopic dermatitis than in those who do not have atopic dermatitis.

AVOID #5 Sunscreen with these chemicals

Benzophenone-3 (oxybenzone), 3-Benzylidene camphor (3 BC), 4-Methylbenzylidene camphor (4-MBC), Octyl methoxycinnamate (OMC, Ethylhexylmethoxycinnamate, Octinoxate), Octyl-Dimethyl- para-Aminobenzoic-Acid PABA (OD-PABA), Nano titanium dioxide, nano zinc oxide, nano silver

Some of the above chemicals are UV-filters such as oxybenzone that are excreted in the urine after application to the skin. Sun protection is a must, choose a physical blocker type and learn more in Skin Fact – Sun Protection in Adult, Infant and Eczema Skin

Consequence: Biochemical or cellular level changes, disrupts the endocrine system, accumulates in breast milk and in the environment, photo allergic reaction (PABA)

Others to Avoid

Triclosan – Present in shampoos, bath cleansers, toothpast and baby wipes, can cause allergies and bacterial resistance (see this eczema news on household products’ exposure)

Detergent – Contains irritants ethylene oxide, 1,4 Dioxane (by-product of sodium lauryl sulphate, sodium myreth sulfate, sodium oleth sulfate, sodium laureth sulfate, ceteareth-20, PEG-100 stearate, polyethylene, polyethylene glycol, polyoxyethylene, oxynol)

A note on Babies with Eczema or Dry Skin

It is studied that twice daily moisturization with a hypoallergenic (meaning no fragrances, no essential oils, no plant extracts, no formaldehyde-releasing preservatives, no lanolin, no neomycin, no bacitracin, no methylchloroisothiazolinone) moisturizer in high-risk newborn babies lead to an approximately 50% reduction in rates of new onset atopic dermatitis.

We have also looked at infants being more susceptible to sunburn. This, on surface, seems to suggest that putting on moisturizing and sunburn is good for the babies but there’s a major caveat that you should not be putting on harmful chemicals since so much more chemicals penetrates infant skin (and possibly even more for infants with defective skin). Use good quality moisturizer, tested safe for babies and without the key irritants AND avoid sun (rather than ‘suntan’ a baby with sunscreen as we’ve seen sunscreen contains quite a fair bit of irritants!).

References

Eczema News – ‘Lipid fingerprint’ Treatment Approach

At end September 2015, it was announced on various medical new sites that Oregon State University’s researchers have developed a new approach to treat eczema that is

  • Personalized; and based on
  • Individual lipid deficiencies (akin to lipid fingerprint)

The new system patented (yet to be developed) requires testing of skin and lipid samples (from sticking and pulling off a piece of tape on/from the skin), using a mass spectrometry. The testing is non-invasive and suitable for infants and elderly as well.

Target Lipid Deficiency for Eczema Treatment

Target Lipid Deficiency for Eczema Treatment

It is established that eczema skin is often lacking in lipids, the reason why many moisturizers have active ingredients to restore the skin lipid levels such as ceramides, cholesterol and free fatty acids. However, there are many types of skin lipids and researchers at OSU believe that choosing the skincare and therapeutic product that specifically target one’s deficient lipids will help eczema sufferers.

Hopefully when developed, the ‘lipid fingerprint’ system will address:

  • Steroid usage which has side effects with long-term use
  • ‘One size fits all’ method of moisturizer selection
  • Reduce costs associated with doctor consultation and that of using the ‘wrong’ products – when the deficient lipids can be identified, it can then be known which lipid composition is missing, i.e. those that serve protective or barrier or antimicrobial function.

Associate Professor Arup Indra explained in an interview that “Lipids in our skin help retain moisture, they act like a blanket that protects against irritation and infection, You could think of skin cells as the bricks of a wall, but lipids are the mortar that prevent things from getting through the cracks. When they are deficient, problems can develop.”

Previous research by A/P Indra and other researchers has identified a protein (Ctip2) that is critical for forming and maintaining the skin barrier in mice, and for skin lipid metabolism. Mice that had Ctip2 removed had dry and scaly skin, and developed skin lesions. The removal of Ctip2 also led to increased inflammation, with presence of high levels of inflammatory proteins, enlarged lymph nodes and spleen in the mice. Without Ctip2, TSLP (another protein that has been known to activate other cells to be pro-inflammatory, linked to eczema and asthma) also became 1000-fold higher in the mice.

It is interesting research by the College of Pharmacy at OSU and my personal thought is that even if targeting deficient lipids alone may not ‘cure’ eczema for everyone, it will definitely help to reduce the cost of buying moisturizers that are not the ‘right lipid fit’. Keeping fingers crossed that R&D in atopic dermatitis will have breakthrough in the next few years to provide relief for all eczema sufferers.

Skin Fact – How Much We Sweat vs Infants

We have been learning about skin facts and last week, we learnt about insensible perspiration – which is transepidermal water loss that we cannot control. This week we are learning about sweating, sweat glands and how sweat affects eczema skin. First, the basics:

Why, How Much, Where and What of Sweating

Sweat - Why, How much, where and what

Sweat – Why, How much, where and what

WHY – Sweating is a way to cool the body temperature whereby sweat glands in the skin are activated and release sweat. The evaporation of the sweat cools the body and those leftover sweat (on a humid day) leaves you soaked. See #SkinishMom post on sweaty occasions.

HOW MUCH – We sweat different amounts on different occasions; for an hour of exercise, one can sweat from 0.8 to 1.4 liters. Excessive sweating is ‘defined’ in terms of the sweating deteriorating the quality of life, a condition known as hyperhidrosis.

WHERE – This gets interesting as emotional sweating when you’re angry or anxious activate the sweat glands on the palms, soles and underarms! Sweating after eating spicy foods (gustatory sweating) are on the lips and forehead.

WHAT – Sweat is made up of water, ammonia, urea, minerals (like sodium and magnesium), trace metals, lactate and various salts and amino acids. The exact composition of sweat varies depending on diet, genetics and activity level.

Sweat Glands in Adults and Children

Sweat comes from two types of glands:

  1. Eccrine glands – All over the body in the dermis (layer after the outer epidermis of skin), there are over 2 million eccrine glands. The sweat exit via a pore. The sweat from eccrine glands has no smell of its own but the smell comes from bacteria on our skin feeding on the oils in the sweat.
  2. Apocrine sweat glands – At armpits and private parts, and the sweat exit via a hair follicle. Upon puberty, the glands make a thick, oily fluid which has a smell.

Women – More sweat glands then men, but less active

Babies – Babies are born with sweat glands but they are not activated, only the ones on the foreheads are! After the forehead, the sweat glands on the trunk, arms and legs are activated. In this Common Summer Skin Rash series – Heat Rash, dermatologist Dr Robin Schaffran explained heat rash, medically known as miliaria:

Miliaria occurs under conditions of high heat and humidity that lead to excessive sweating. Occlusion of the skin from too much clothing or blankets can aggravate the pooling of sweat on the skin surface leading to over-hydration of the skin. In susceptible persons such as infants who have immature sweat glands, this often leads to transient blockage of the sweat ducts. Therefore, as more sweat is produced, there becomes and inability to secrete the sweat because of the blockage.

Sweat and Eczema

Sweat is known to cause irritant reaction for those with eczema. However, what in the sweat irritates is not known. In the Skin pH series – Moisturizer and Skincare Products interview with dermatologist Dr Cheryl Lee:

As for sweat, the biggest problem is the irritancy of the sweat itself. The salts from sweat can crystalize and act as an irritant to the skin. If you can see that your baby’s sweat has dried and has a salty residue, then I would recommend rinsing it off with plain water (no soap) to prevent it from becoming an irritant.

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

It could be one of these compounds, the combination of them, the changing pH of the skin, or even the sweat’s water content that can cause the itching and stinging sensations to some people with eczema.

Eczema may also occur in those suffering from ichthyosis, a condition that has excessive skin scales, clogging sweat glands and preventing sweating normally. Pompholyx is another condition that some eczema sufferers also have, with a distinctive appearance of itchy small blisters on the palms of the hands. It is also more closely associated with excessive sweating and can be found on the soles and toes.

References

Eczema News – Hydrolyzed Milk Impact on Childhood Eczema

What milk to give a baby with eczema or a baby who is at high risk of eczema is ONE question that all parents ask – there are various options when it comes to milk:

(i) Breast milk – Recognized as the milk for babies up to six months of age, due to the natural protective benefits of breast milk and its ease of digestion, coupled with no artificially added sugar, salt and fats

(ii) Cow’s milk – An alternative to breast milk or supplement for breast milk; however, cow’s milk protein is the most common food allergen in young children (where the protein size is 10kD and more to act as an allergen)

(iii) Partially hydrolyzed milk – Commercially available, whereby the milk protein is broken down to protein size of less than 5kD; however, there is no strict definition of what qualifies as partially hydrolyzed formula and some partially hydrolyzed milk formula have about 20% of the peptides exceeding 6kD (kD is a measurement of its molecular weight)

(iv) Extensively hydrolyzed milk – Not commercially available in some countries, on prescription, whereby the milk protein is extensively broken down to protein size of less than 3kD.

(v) Other non cow’s milk formula, excluding goat’s milk as the goat milk protein is similar to that of cow’s milk

The Key Question is whether partially hydrolyzed milk protein is effective in preventing eczema. This is often examined alongside the questions of (i) whether it is cost effective to be put on hydrolyzed formula and (ii) inferior nutritional value of hydrolyzed formula.

Limited evidence (there's still some evidence) of protective effect of partialy hydrolyzed formula for high risk babies

Limited evidence (there’s still some evidence) of protective effect of partialy hydrolyzed formula for high risk babies

Let’s examine the research on whether partially hydrolyzed milk protein is effective in eczema prevention.

  1. I have briefly looked into this in 2011 (post) and the research then showed that partially hydrolyzed milk is recommended for high-risk babies but not if there is a proven milk allergy. For those interested in learning more about hydrolyzed formula, refer to FDA archived presentation.
  2. In 2013 (post), research’s recommendation was for high-risk infants who cannot be 100% breast-fed, partially hydrolyzed milk is recommended.
  3. Other more recent research: Allergic manifestation 15 years after early intervention with hydrolyzed formulas – the GINI Study where it is concluded that eczema is reduced in children who took partially and extensively hydrolyzed formula, with lower prevalence up to adolescents (11 to 15 year old).  The GINI Study is German Infant Nutritional Intervention program study of birth cohorts, with many other interesting allergic conditions’ studies here
  4. In a paper published in Clinical and Translational Allergy, Partially hydrolysed, prebiotic supplemented whey formula for the prevention of allergic manifestations in high risk infants: a multicentre double-blind randomised controlled trial, it was found that there was no preventive effect to early feeding with a partially hydrolyzed formula with added prebiotics.
  5. In a paper published in the Expert Review of Clinical Immunology, The Role of Partially Hydrolyzed Whey Formula for the Prevention of Allergic Disease, authors warned that due to limitations on studies on partially hydrolyzed milk, the recommendation should still be ‘breast is best’.

On the question of costs,

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

On the question of nutritional value,

Dr Sears (this blog has featured several of his and his sons’ talks, tweet chat and collaborated blog series), Dr Sears’ view is that unless recommended by doctor, parents should not opt for hydrolyzed milk on their own due to

  • High content of sweeteners to make hydrolyzed formula palatable
  • Artificially carbohydrates in the form of corn syrup, sucrose, corn starch or tapioca
  • High salt content
  • Artificially added fats

It seems though that partially hydrolyzed milk formula is in practice recommended by doctors due to cow’s milk being the most common food allergen in infants. Research wise, there has yet to be a conclusion due to difficulty of conducting unbiased studies with sufficient (mother and baby) participants. What’s your experience in this? Do share in the comments!

Skin Facts – Water Loss from Children and Eczema Skin

This is the third week of ‘Skin Facts’ and last week, we’ve looked into the sun protection function of children vs adult skin, and how the sun affects eczema skin. Today, we’re looking into another critical function of skin and one that is very relevant for eczema skin – our skin’s moisture retention property. One can also view it as how much moisture is lost from our skin, known as Transepidermal Water Loss (TEWL). TEWL is studied by dermatologists, as excessive TEWL points to a defective skin barrier, and in severe cases, affect the ability of the body to function. Let’s go “water deep” into this skin function!

Water and our Body
Water makes up a large point of our body weight, here are some interesting facts about the water in our body from water.USGS.gov (the US Geological Survey website):

Water content in our Body

  • Lungs 83%
  • Muscle 79%
  • Kidneys 79%
  • Brain 73%
  • Heart 73%
  • Liver 71%
  • Skin 64%
  • Bones 31%

Percentage of Body Weight that is Water

  • Fetus 94%
  • Infant at birth 78%
  • One-year old 65%
  • Female 55% (due to higher fat content)
  • Male 60%
  • Elderly 50%

Functions of Water in our Body

  • Forms the building material of cell
  • Regulates body temperature by sweating and respiration
  • Transport via the bloodstream
  • Flushes waste via urination
  • Absorbs shock for brain and spinal cord, also lubricates joints
  • Forms saliva
Moisture Loss and Retention from Children, Normal and Eczema Skin

Moisture Loss and Retention from Children, Normal and Eczema Skin

Water Loss from our Skin
Our skin allows water to be lost through it, as part of insensible perspiration (or transepidermal diffusion) and sweating. Insensible refers to us not being aware of it (another insensible loss of water is from respiration). Sweating helps regulate our body temperature, via cooling of the skin. However, sufficient intake of water is required in order for sweating to not dehydrate the body and continue to be effective in cooling our body temperature.

Much of the water is lost through the stratum corneum, the upper most layer of the epidermis made up of a dead cell layer. A defective stratum corneum layer will allow excessive epidermal water loss and potentially, increase risk of irritant and allergen sensitivity. Water loss from evaporation from our skin is about 400ml daily in an adult. For research news on how the skin can be a channel for allergy, see Food Sensitization from Eczema.

Transepidermal Water Loss (TEWL) from Children Skin
TEWL from baby skin is higher than normal adult skin, due to their thinner stratum corneum. For premature infants less than 30 weeks, there are also fewer layers of stratum corneum resulting in increase fluid and heat loss. Interestingly, infant skin is found to have higher water content and able to absorb more water but lose excess water faster than adult skin. TEWL was also strongly predictive of AD at 12 months (study here). The natural moisturizing factor (protein breakdown products such as small amino acids, urea, pyrrolidone carboxylic acid, ornithine, citrulline, urocanic acid) in infant is also lower than an adult.

How this Impact Parents Caring for Baby Skin
Protection of the stratum corneum is important, and this can be via:

Reduced bathing – Washing baby skin with a washcloth during the first 4 weeks of life is associated with increased TEWL and decreased stratum corneum hydration compared with simply soaking in water. The recommendation is to use a mild liquid cleanser with water (less drying than water alone), and that bathing should be brief (10 minutes or less) and no more than every other day with spot cleaning in between.

Good bathing regimen – Includes not using hot water, not scrubbing the skin dry (but pat dry), keeping it short to 10 minutes, not using soap and moisturizing right after (see video)

Good skincare regimen – Moisturizing protects the skin barrier (see video). It is important to note that given the thinner stratum corneum of infants, their higher surface area to body ratio, infants are more vulnerable to toxicity of products. Therefore, be sure you understand the product label (there’s a comprehensive Sensitive Skin Products blog series to help you with that).

Transepidermal Water Loss (TEWL) from Eczema Skin

TEWL is studied to be higher in eczema skin and also dry skin (without eczema). The water content of stratum corneum is also lower in adults with eczema than normal skin. It is also studied at the natural moisturizing factor of eczema skin is defective, lacking in proteins that are able to play a role in the skin’s humectant property – the ability to pull moisture from the environment and retain this water (which is why 2nd generation moisturizers incorporated humectant property, learn more here).

Drinking Water and Skin
A myth. Dehydration will affect skin but drinking excess water will not lead to ‘glowing’ skin. Drinking enough water will also not prevent skin aging or wrinkles as these are related to genetics, sun and oxidative stress brought on by pollutants. Read this #SkinishMom Investigation! – Drinking water for dry skin

To round-up, we learnt that water is integral to our body and to our skin. We have insensible water loss and a thinner stratum corneum in baby skin and a defective stratum corneum in eczema skin both results in increased transepidermal water loss (TEWL). This knowledge should encourage (not discourage!) us to be more committed to a good bath and skincare routine.

What’s your take in this?

References

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