Category: Eczema Facts

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Eczema Facts

Eczema Complications series – Eye and Eyelid

Eczema eyelid complications eyeThis is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Eyelid Functions and Skin

The eyelid very often present a very tricky and difficult to treat skin area for eczema sufferers. Moreover, the constant rubbing and scratching of the eczema at the eyelid can also lead to complications. Before we go into the complications, let’s first understand the basics of eyelid functions and the skin at this delicate area.

Functions of the Eyelid

  1. Protection from injury
  2. Regulation of light
  3. Maintenance and distribution of tear film/ flow

Eyelid Skin

The skin of the eyelid is characterized by:

  1. Thinnest skin are of our body – total less than 1mm, with both the epidermis and dermis being the thinnest
  2. Smoother skin due to finer hairs
  3. Oilier skin due to more oil glands

Common Eyelid Conditions

Being thinner oilier skin and on the face predispose the eyelid to various health conditions, such as:

  1. Atopic dermatitis (eczema), more common from adolescent age (read more from dermatologist Dr Lynn Chiam)
  2. Contact dermatitis, due to contact with chemicals used on the face/eyes and hair
  3. Seborrheic dermatitis, typically on the eyelid and eyebrow (read here for more on seborrheic dermatitis)
  4. Blepharitis, also known as eyelid inflammation
  5. Conjunctivitis – this refers to inflammation of the eyelid lining, accompanied by itching and eye watering
  6. Ptosis, known as droopy eyelids from prolonged contact lens use or aging
  7. Dermatochalasis, baggy eyes from aging
  8. Ectropion, eyelids that roll outwards usually from ageing or sun-damaged facial skin
  9. Entropion, eyelids that roll inwards, may also be complication of blepharitis
  10. Malignant eyelid tumors
  11. Chalazion, eyelid cyst swelling from obstruction of the meibomian (tear) gland, may also be complication of blepharitis
  12. Hordeolum, also known as a stye, lump from infection of the meibomian gland, may also be complication of blepharitis

Eczema and Eyelid Complications

Apart from atopic, contact and seborrheic dermatitis of the eyelid, there are also complications from having eczema at the eyelid. Complications usually occur in patients with severe atopic dermatitis where repeated scratching and rubbing, inflammation and infection of the eyelid cause other conditions. Let’s take a closer look at some of these eczema eyelid complications:

Blepharitis

This refers to inflammation of the eyelid, being accompanied by redness, sore eyes, itch, flakiness, burning, swelling, eye watering and mucous discharge. The eyelid margin may appear crusty, waxy or greasy. Blepharitis can be due to many reasons, including allergy, irritation and bacteria infection that causes the eyelids to become itchy. Blepharitis is associated with eczema, rosacea and acne patients.

Relation of Blepharitis to eczema as follow:

a)     Staphylococcal blepharitis – patients with eczema have higher chance of staphylococcus bacteria colonization, leading to staph bacteria infection

b)    Seborrheic blepharitis – due to the malfunction of oil glands at the eyelid, affecting patients with seborrheic dermatitis. The excess oil production may be due to stress, hormonal changes or diet. A characteristic of seborrhea blepharitis is redness at the eyelid throughout the day and crusting at eyelid in the morning.

c)     Other eczema complications – Complications of eczema such as from herpes simplex or varicella zoster virus or molluscum contagiosum can also cause blepharitis.

Dennie-Morgan fold

This refers to a fold under the lower eyelid, typically due to excessive scratching/rubbing of the eye. The eyelid may also hyper-pigment or become red and swollen.

Allergic Contact Dermatitis

Ophthalmic corticosteroids may also product allergic contact dermatitis, due to allergy from certain ingredients of the corticosteroids.

Eyelid Erythema

This refers to redness of the eyelids and can be caused by eczema, contact dermatitis and blepharitis.

Cellulitis

This refers to bacterial infection of the eyelid and can also be caused by insect bite/ other skin injury. Preseptal cellulitis affects the eyelid and skin around the eye, but not the eye socket. Orbital Cellulitis is much more severe and affects the back of the eye, causing eye protrusion and double vision. The common bacteria causing cellulitis are Haemophilus influenzae, Staphylococcus and Streptococcus.

Neurodermatitis

Also known as lichen simplex chronicus, this refers to skin thickening, lichenification of the skin of the eyelid from habitual scratching.

Eczema and Eye Complications

There are also complications involving the eye, typically for prolonged eczema at the eyelid.

Keratoconus – This refers to the degeneration of cornea which pushes the eye outward, resulting in a cone shaped eyeball. There will be visual disturbance with this condition. This may be due to hard rubbing of the eye from the itch.

Scarring – This refers to scarring of the eye, mostly due to scratching or excessive rubbing.

Cataract – There is association between cataract and severe and chronic atopic dermatitis of more than 10 years, possibly due to overtime absorption of steroid cream applied on thin eyelid. One feature of cataracts associated with eczema is that the cataract affects both eyes.

Retinal detachment – This is very rare and associated with severe atopic dermatitis.

Complications from prescription creams seeping into the eyes, resulting in glaucoma

Certain eye-related conditions are not directly related to eczema, but related to allergy. For instance, conjunctival irritation

General Care for the Eyelid (Hygiene)

Top tips for general care of the eyelid:
1. Refrain from eye make-up
2. If wearing contact lens, always clean with disinfectant solution; in certain cases, refrain from using contact lens.
3. Apply warm (not hot) compress 4 times a day to clean and reduce discomfort (for blepharitis)
4. Clean eyelid with cotton swab with mild diluted baby shampoo/wash (read dermatologist Dr Jessica Krant’s tips for baby’s eyelid here)
5. Use artificial tears as blepharitis commonly occurs alongside dry eyes
6. An omega-3 supplement may be recommended to patients with blepharitis as small-scale study suggested anti-inflammatory effect of omega 3 benefit blepharitis patients. More on omega 3 and eczema here.

As you can see, there are quite a lot of health conditions affecting the eyelid and a few relating to eczema. Most of it has to do with bacteria and scratching, thus it is important to practice eyelid hygiene and treating conditions that create itch at the eye promptly.

note: if you’ve reached this far to the post, thank you! Took me a long time to do up a comprehensive post on eyelid complications from eczema and if you have any to share, kindly comment, will make my day!

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Eczema Facts

Eczema Complications series – Folliculitis

Folliculitis_Eczema
Taken from http://health.howstuffworks.com (no direct permission obtained for use, but duly credited)
Link of picture directed to HowStuffWorks website

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Bacterial Infection

Last week, we covered viral infections – eczema herpeticum previously covered in this blog (here and here) and molluscum contagiosum. This week, our focus is on bacterial infection. The most common bacteria that colonizes eczema skin is staphylococcus aureus bacteria, which is the cause of common children skin infections like impetigo and folliculitis. Apart from impetigo and folliculitis, S. aureus also causes other secondary infection with presence of pus, fever, swollen lymph nodes and in severe cases, staphylococcal scalded skin syndrome, where the lesions rupture to give scalded appearance (see this interview with Dr Clay Cockerell on symptoms of S.aureus infection).

Other bacterial infection include boils and ecthyma, also from S. aureus. The other common bacteria that causes infection is streptococcus pyogenes, which can cause cellulitis and erysipelas. Untreated bacterial infection can cause fatal systemic toxaemia or septicaemia, which is blood poisoning. If strep infection is a topic you’re interested, comment/email me and I may start a series on it!

Folliculitis

Folliculitis is an inflammation at the hair follicle that can be due to numerous causes – a common one being from staph bacteria. A word about staph bacteria is that even if it doesn’t trigger secondary infection, its presence impedes the recovery of eczema rash via (i) toxins (enterotoxin) from the bacteria that can trigger hypersensitivity and (ii) existing inflammation from bacteria makes it harder to treat the eczema (more on staph bacteria here).

So back to folliculitis – It appears as a small localized pus (on surface or deep) at the hair follicle, followed by red bump when the pus dried with surrounding inflamed skin that may itch. If the infection runs deep into the hair follicle, it can cause a boil which can be painful. The hair follicles on the chest, back, legs, face, neck, thighs and buttocks are more vulnerable to folliculitis. Folliculitis will not affect part of the body with no hair follicle such as the eye, mouth, palm and sole.

Multiple Causes of Folliculitis

Bacteria, from staphylococcus aureus is the most common cause.

Virus – Herpes simplex virus (that cause eczema herpeticum), herpes zoster (that cause shingles, read here of my daughter’s shingles experience) and molluscum contagiosum (covered last week) may also cause folliculitis.

Yeast – Folliculitis may also be from the yeast, Pityrosporum ovale (Malassezia) when it proliferates, usually on the trunk of young adults.

Fungi – Fungi such as tinea capitis (ringworm), Microsporum canis and Trichophyton tonsurans can cause folliculitis particularly on the scalp.

Parasite – Hair follicle mite (demodex) can affect the face or scalp of adults with compromised immune system or that of elderly. This is known as demodicosis. Scabies is another parasite that can trigger folliculitis.

Steroid – Systemically administered or topically applied steroids could result in facial folliculitis (perioral dermatitis) or steroid acne due to adverse reactions to long and significant doses of steroid.

Occlusion – Clothes with sweat, friction, thicker emollients, like paraffin-based ointment and adhesive plastic can break the skin and/or increase the penetration of bacteria into the hair follicle.

Chemicals – Some chemical like coal tar may cause irritant folliculitis.

Razor-burn folliculitis – This is due to frequent razor cuts creating opening on skin’s surface that allow bacteria to enter and cause inflammation at the hair follicle.  It is more common on women’s leg and men’s face and neck. Excessive close shaving creates trapped hair in the follicle, increasing inflammation.

Spa pool/ Hot tub folliculitis –  This is infection from inadequately chlorinated warm water, allowing the bacteria Pseudomonas aeruginosa to thrive. It is more common on the back and to prevent this, rinse/shower after a spa or hot tub.

Who is a Higher Risk of Folliculitis?

Skin conditions, such as acne, eczema and psoriasis patients

Diabetic patients

Obesity

Patients with lower immunity such as cancer, HIV, hepatitis or even chronic eczema patients who are on immunosuppressants may get eosinophilic folliculitis.

Occupations – Those that come into often contact with oil, tar or grease and sweat.

Warm and humid climate

Treatment of Folliculitis

The treatment will depend on the cause, as follow:

Bacteria – Antibacterial wash such as benzoyl peroxide, chlorhexidine or in certain case, antibiotics to kill the bacteria and clear the skin. There are increasing instances of methicillin-resistant Staph aureus bacteria, thus making it more difficult to treat such MRSA bacterial infection. Oral flucloxacillin is often prescribed and if there is penicillin resistance, erythromycin is prescribed. More on MRSA here.

Fungus and Yeast – Both fungus and yeast causing folliculitis can be treated using an antifungal shampoo or body wash such as ketoconazole (Nizoral shampoo) twice daily. Topical antifungal cream such as miconazole (Lotrimin) or terbinafine (Lamisil) and an antifungal medicine fluconazole (Diflucan) may be prescribed for more severe case.

Virus – Medication for virus, such as acyclovir for herpes simplex virus will help to resolve the folliculitis.

Razor folliculitis – Treatment includes antibacterial wash and topical antibiotics if not resolved on its own. Stopping to shave and using alternative hair removal techniques may help prevent future folliculitis from shaving repeatedly. Using a new razor and shaving in the direction of hair growth will help to prevent cuts. For men, antibacterial benzoyl peroxide shaving gel can be used. Permanent hair removal can also be attempted.

As the most likely factor is from bacterial infection, good hygiene measures such as hand-washing, not sharing towels/razors and showering after contact with likely bacteria surfaces helps prevent folliculitis. Not touching parts of body that have high staph bacteria such as the nose, armpit and perineum (area between anus and vulva/scrotum) can limit the spread of the bacteria to other parts of the body.

Folliculitis and Eczema

Children with eczema have a few factors to their disadvantage which make them more likely to get folliculitis. Of the causes of folliculitis, the one that most affect eczema patients is bacterial infection from staph bacteria.

  1. Eczema skin already have higher likelihood of bacterial colonization, of more than 50% chance.
  2. Most skin with staph bacteria won’t be harmed, however eczema skin is defective in its barrier protection, either from dry skin, ‘open’ skin from scratching and more permeable.
  3. Eczema patients are suspected to be less able to fight common bacteria, fungus, virus and yeast.
  4. The dry skin on eczema children is a more conducive environment for bacterial growth, compared to normal skin with natural oils.
  5. The toxin produced by Staph aureus bacteria worsens the eczema with triggering more hypersensitive reaction/inflammation.

It once again points to keeping bacteria count low, proper hygiene, keeping our children fresh and cool as preventive measures for our children. What is your experience? Do share in the comment!

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Eczema Facts

Eczema Complications series – Molluscum Contagiosum

molluscum contagiosum eczema
Taken from cdc.gov (no direct permission obtained for use, but duly credited)
Link of picture directed to CDC website

This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!

Molluscum Contagiosum (Virus)

Apart from molluscum contagiosum, the other common viral infection is eczema herpeticum. This eczema complications series will not include herpeticum because it has been covered in April 2012 post: Eczema Herpeticum – What is it and is it Dangerous? Eczema herpeticum is caused by the herpes simplex virus and eczema children’s skin (being defective) is more vulnerable to the penetration of the virus.

The other common viral infection in children is molluscum contagiosum, caused by the molluscum contagiosum virus, a family of the pox virus. It appears in clusters of small bumps (papules) in places such as armpit, face, neck, abdomen, groin, joints which are warm and moist. The papules may be pink, white or brown but often with a center hole and waxy/shiny look. The papules will later turn inflamed, crusted or into scabs. The extent of the molluscum varies – from mild with a few papules in most healthy children to extensive and last longer for children with eczema (study here) or low immunity (for instance, larger and more papules in HIV patients). In healthy children, the virus will stay on the skin and not circulate in the body therefore the virus leave the body with full resolution of the papules.

Spreading of Molluscum Contagiosum

Molluscum Contagiosum is spread by skin contact, for instance, taking shower or swim together (not clear whether the water spread the virus or contact with towels, surfaces at pool spread the virus). It can also be spread via bedding, toys, towels and clothes. In adults, it can be spread by sexual intercourse. Children (age 1-4, some reports show up to 12) living in tropical climate (warm, humid, crowded) have a higher risk of molluscum contatgiosum. The incubation period ranges from weeks to months. The recovery period on its own can take from 6 months to few years. It follows that if you are infected, to limit sharing of towels, toys and touching surfaces (bandaged the papules).

Treatment of Molluscum Contagiosum

Treatment can be hastened by pinching/ squeezing the molluscum lesions to express the soft white core. This is best done a few lesions at a time for children as it can be painful. The base is then treated with silver nitrate or mild sclerosing agent. Various medical treatment may include electrocautery, cryotherapy (freezing), curettage (cutting), laser, cantharidine, imiquimod cream or wart cream containing salicylic acid. There is no drug/ vaccine that kill the virus. Consultation for treatment should be about 3-4 weeks apart as certain molluscum may have been in incubation stage.

Although both the molluscum contagiosum and small pox are pox virus, they are distinctively different to our immune system and thus a smallpox vaccination does not prevent molluscum contagiosum.

Relationship with Eczema

It is almost like a double-whammy – children with eczema with defective skin barrier are more susceptible to molluscum contagiosum and after getting molluscum contagiosum, the eczema worsened PLUS the molluscum at the eczema area healed slower. Furthermore, molluscum contagiosum is likely to be more extensive in eczema children due to the scratching of the papules, followed by touching the rest of the body. There is also linkage between molluscum contagiosum and long-term use of glucocorticoids which are steroids such as prednisone, dexamethasone and hydrocortisone. Use of non-steroid cream such as topical immune-modulators (tacrolimus and pimecrolimus) have also been associated with molluscum contagiosum (here).

My take – a lot of the complications are possibly going to be linked to scratching, where infection and bacteria/virus spread from one part to another. Therefore, it always make sense to treat eczema and take steps to improve the skin barrier.

Have your child had molluscum contagiosum before? Share your experience and it may help another family, thanks!

 

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Eczema Complications – Impetigo for Eczema Child

Picture taken from bupa.co.uk Impetigo infection around the mouth a 7-year old girl.
Picture taken from bupa.co.uk
Impetigo infection around the mouth a 7-year old girl.

Impetigo is a common bacterial infection for children ages 2 to 5, and more likely for a child with pre-existing skin condition such as eczema. Today’s article aims to find out more about impetigo, its signs (how to recognize it early), its treatment, prevention and the correlation between impetigo and eczema/atopic dermatitis.

What is Impetigo?

Impetigo is a skin infection that is caused by bacteria (i) Staphylococcus aureus or (ii) Streptococcus pyogenes (same as that causing strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) also causes impetigo. Impetigo is contagious and affect preschoolers most often.

Should impetigo appear as large blisters, it is known as bullous impetigo or non-bullous impetigo if they are crusted. Non-bullous impetigo is more common, often starting out as tiny blisters, then bursting to become wet patches of reddened weeping skin. It then form a yellowish crust. 

Signs of Impetigo

Blisters or sores on the face (nose, mouth), neck, hands, forearms and diaper area – these areas are within easy ‘scratching’ reach and often carries more bacteria from contact with surfaces with bacteria. The blisters burst and form a yellowish crust. Impetigo can also present as folliculitis, whereby the hair follicles also blister and burst to become wet patches. Impetigo may also be itchy and be painful if it occurs around lymph nodes. In a study, the areas most commonly infected by impetigo are the head and neck (65.4%), followed by 19.6% on an upper extremity and by 7.5% each on the trunk and a lower extremity.

Treatment of Impetigo

For localized, yet to spread impetigo, antibiotic ointment can help (mupirocin (Bactroban) or fusidic acid) . For more widespread impetigo, oral antibiotic is prescribed for a faster recovery (few days versus few weeks) and control of the blisters. The area has to be washed and covered up to prevent scratching and spreading the bacteria to other parts of the body. Generally, after 48 hours of antibiotic treatment, the child may be cleared to return to preschool.

Prevention of Impetigo

As impetigo is caused by bacteria, good hygiene such as hand-washing, not touching other surfaces, biting fingers, scratching can help prevent it. For children with eczema, it is good to bring them for swimming, consider cleaning with chlorhexidine or bleach bath in order to keep the bacteria count low and minimize the chance of skin infection. As there is staph bacteria present in the nose, children should refrain from ‘digging’ nose and touching the rest of the body. Fingernails should be kept short and ensure no sharing of towels, bed linen or clothing with other family members. 

Impetigo and Eczema

Impetigo is more likely to affect children with already a weakened skin barrier, either generalized as in eczema or localised as in insect bites, cuts or rashes from contact allergens. As it is spread by contact with the bacteria, it most often affects children who scratch, thus often affecting eczema kids. For children in hot and humid climate/ during summer, the likelihood of impetigo infections is higher (higher chance of insect bites, scratching). Eczema skin is more often colonized with staph bacteria and for those with history of eczema herpeticum, the impetigo infection may be via MRSA bacteria.

All in, impetigo is a condition that parents with eczema kids should definitely be aware of. Especially if your child, like mine, live in hot, humid climate, goes to preschool and scratches/bites and simply can’t follow good hygiene! (did I hear a ‘bummer’ from one of you?)

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Soda and Child series : Impact on Eczema, Allergy

Soda Eczema Allergy

For the past two weeks (here and here), we have explored the Top 10 Bads of Soda for our children. Today, we’d be going into whether soda leads to allergic conditions.

There is actually very little written on this, and I’ve scoured both the web and Pubmed. Thus far, the biggest culprit ingredient linked to eczema, asthma and allergies is Sodium benzoate. This has been covered last week where sodium benzoate is a preservative found in soft drinks, and linked to allergy and behavourial issues.

I only found one study on Pubmed, where 62 children from age 12 months to 13 years were observed for whether restriction in their diet led to an improvement in eczema. Among the restricted foods, soda (11.9%) was the highest, followed in decreasing order by food additives (9.2%), walnut (7.0%), peanut (7.0%), and other nuts (5.9%). When foods were grouped, the crustacean group was the most frequently restricted group, followed by processed foods, nuts, milk & dairy products, and meats.

The observation from the study was that atopic dermatitis/eczema improved for those children which had restricted 1 to 3 food groups, and those that avoided more than 3 groups didn’t showed significant improvement. There may therefore be some impact on restricting foods, but it is not clear nor a causal link directly established through this study.

There are many websites though, through personal testimonies, where various individuals found that removing sugar, caffeine, preservatives and artificial sweeteners from their diets helped. In this case, as there is little nutritional benefit of such ingredients for our children, restricting these ingredients from their diet should be a plus (if not for eczema, for healthy living!).

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Eczema Facts

Soda and Child series : Top 10 Bads of Soda

soda and child health effects
Soda is really bad, opt for plain water for our children!

Last week, we started the Soda and Child series and today, we would continue exploring the other ingredients of soda.

#3 Phosphoric Acid – Phosphorous deplete calcium in the body which is essential for the child’s growth, putting teenage girls at risk of osteoporosis. There are some studies that show that drinking soda is related to drinking less of milk, but this is not very significant.

#4 Acids –The acids in soda contribute to an unnatural acid environment within the stomach and can lead to inflammation of the stomach and duodenal lining. The acids also erode the enamel on the teeth and thus up the risk for tooth decay (plus sugar also cause cavities)

#5 Caffeine –Some soda contains caffeine which stimulates adrenal glands. Colas, diet colas and many soda contain caffeine. Energy drinks which are getting more popular among children and teens also contain caffeine. Drinking too much caffeine, as adults can attest to, make us tremble, lose sleep, stomach upset, increased blood pressure and irregular heartbeat.

#6 Sodium benzoate or potassium benzoate –these are preservatives present in diet sodas which have been linked with allergic conditions and possible irritant to the skin, eyes and mucous membranes. Studies on rats indicate increase in anxiety and motor impairment after benzoate consumption.

#7 Aspartame – Used in diet soda as a sugar substitute, there are many studies linking aspartame to brain tumors, birth defects, diabetes, emotional disorders and epilepsy (from Mercola site). Interestingly, Dr Mercola pointed out that “when aspartame is stored for long periods of time or kept in warm areas it changes to methanol, an alcohol that converts to formaldehyde and formic acid, which are known carcinogens”.

#8 More on Artificial Sweetener – Below is an interesting extract from a post written by Mark Hyman, MD at Huff Post:

Artificial sweeteners are hundreds to thousands of times sweeter than regular sugar, activating our genetically-programmed preference for sweet taste more than any other substance.

They trick your metabolism into thinking sugar is on its way. This causes your body to pump out insulin, the fat storage hormone, which lays down more belly fat.

It also confuses and slows your metabolism down, so you burn fewer calories every day.

It makes you hungrier and crave even more sugar and starchy carbs like bread and pasta.

In animal studies, the rats that consumed artificial sweeteners ate more, their metabolism slowed, and they put on 14 percent more body fat in just two weeks — even eating fewer calories.

In population studies, there was a 200 percent increased risk of obesity in diet soda drinkers.

#9 MSG Monosodium Glutamate – MSG is found within the citric acid and has been linked to brain diseases like Alzheimer’s,learning disorders and psychiatric conditions.

#10 Diuretics –Sodas are diuretics which is dehydrating and affects digestion.

These top 10 Bads of Soda, even though studies may not have been conclusive causal links, are enough to stop me, my child and my family from consuming. Is there any impact on allergic conditions? Find out next week.

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Soda and Child series : Impact on Kids Health

Soda Children Health

For the past few years, there is much awareness on the ‘danger’of soda –even celebrities are more mindful of endorsing soda brands (google Beyonce, Scarlett Johansson and Taylor Swift)! Sugar, which is a key ingredient in soda drinks, is inflammatory and well-known nutritionists like Rania Betayneh and Toby Amidor had offered tips on inflammation in this blog.

Every time I see someone close to me buying a sugared drink (or for that matter, when I buy a sugared drink myself!), I always joke about ‘Here’s the inflammatory drink!’. Lately an acquaintance who loves soda had recently been diagnosed with a terminal chronic condition which led me to start looking at soda again. If it’s REALLY (Truly Bluely as my 5-year old daughter would say) BAD for health, we as parents would not want our child to consume soda. So, let’s review the effects on general health in this 3-week soda and our kid series, with the last post with a focused on possible effect on allergic conditions.

Top 10 ‘Bads’ of Soda

#1 Sugar – Sugar is empty calories and linked to obesity, which in turn is linked to a whole host of chronic diseases. It is also linked to increased risk of pre-diabetes (something to watch out for even for adults), metabolic disorders and heart disease which have symptoms like big waistline, high blood pressure and low HDL/good cholesterol.

More recently, sweetened drink has been linked to behavioral issues in children, with issues like aggression, depression and attention difficulties. As to which ingredient causes it, it is not clear but caffeine, acids, HFCS and sugar had been hypothesized to be behind the behavioral issues.

But can all the health problems be blamed on sugar?

The case made by soft drink companies/associations is that soft drinks should not be picked on for the rise in obesity and it is true to some extent – the additional 100-200 calories from a can of soda may not contribute to material weight gain, what is contributing is that because it doesn’t make your child feel full, thus there is a tendency to not reduce overall calories intake. The additional (empty) calories from soda can become truly weight-gaining unless one makes a conscious effort to exercise.

#2 High Frutose Corn Syrup –The HFCS in soda doesn’t make the child full and thus, misled the child to consume more of the drink. This has been covered in Dr Sears L.E.A.N series here, with the Dr Sears LEAN team’s tip below:

Drinking soda should be discouraged. Many juice drinks and all sodas are high in calories, provide no nutrients, and are usually sweetened with high fructose corn syrup (HFCS), which you should always avoid. Click here to learn more about why you should avoid HFCS: http://www.drsearslean.com/2011/10/the-high-fructose-corn-syrup-debate/

Next week, we will be going through the other ingredients in soda drinks and learn the other possible effects on health of our children!

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Contact Dermatitis – Can a Child have Eczema and this?

Double whammy? Contact dermatitis in atopic dermatitis child
Double whammy? Contact dermatitis in atopic dermatitis child

Can my Child have both Atopic and Contact Dermatitis?

Contact dermatitis is more common in adults, but it is possible that a patient with atopic dermatitis also have contact dermatitis. The logic is that eczema skin barrier is defective, thus more vulnerable to hypersensitive reaction to chemicals. The chemicals which I’ve found from recent years’ studies which affect eczema patients (not necessarily children) more than non-eczema patients are

Surfactants cocamidopropyl betaine (CAPB), from AAD study. Also quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol (from another AAD study)

How does dermatologist treat Contact Dermatitis?

The treatment is similar to atopic dermatitis, so in a sense it may not be as critical if the two cannot be differentiated. The difference is that without avoiding the substance that is causing the hypersensitive reaction, it is then not possible to keep it from causing the rash. Moisturizing, medicated cream, compresses to relieve itch and soothe skin, and antihistamines for reduced scratching at night may be prescribed.

In finding out which are the irritants involved in contact dermatitis, a patch test can be carried out (read more here). Patch test involves placing the suspected irritants/chemicals (note: there is a ‘science’ as to how much to put and how to prepare the liquid, don’t try to do this yourself) on paper tape on your child’s back or arm. The tape will be left on for about 48 hours and observation be noted by the dermatologist.

Is my child more likely to have contact dermatitis as an adult?

I haven’t come across such study, but it makes sense to figure out the irritants early and to avoid them. Also to treat the eczema promptly and take measure to protect the child’s skin barrier so that it is more robust against irritants when the child is older. (At the same time, I’m thinking she has got to fend for herself when old, I’m not going to say ‘Stop Scratching’ till I’m 60 year old!)

What are the preventive measures for contact dermatitis?

Avoidance is key, especially once you or your child has undergone patch testing and knows which substance triggers the hypersensitive reaction. There are common chemicals that are present in contact dermatitis in children (US), and these are nickel, neomycin, cobalt, fragrance, Myroxylon pereirae, gold, formaldehyde, lanolin/wool alcohols, thimerosal, and potassium dichromate. Also for those without any allergy, but has eczema (known as ‘intrinsic eczema’), this study suggest the possibility of nickel and cobalt allergy.

This study provides a percentage of common allergens for eczema children, nickel (16.3%), cobalt (6.9%), Kathon CG (5.4%), potassium dichromate (5.1%), fragrance mix (4.3%), and neomycin (4.3%).

The above chemical names may be too difficult to remember, so below is a compilation of where they may be commonly present in:

Soaps and detergents

Saliva

Urine (common cause of diaper rash)

Baby lotions, avoid perfume/fragrance products, preservatives

Latex, e.g. rubber products

We’ve covered the basics and the conclusion may be to be aware of contact dermatitis and promptly remove the suspected irritants. When the child is older, say 5 year old, bring him/her to a patch test.

Read last week: Contact Dermatitis, does your Eczema Child have it?

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Eczema Facts

Contact Dermatitis – does your Eczema Child have it?

The things that can be irritant! Eczema child and contact dermatitis
The things that can be irritant!

So far we have not gone ‘technical’ in this blog to differentiate between atopic dermatitis and contact dermatitis, simply because when we talk about eczema, we are referring to atopic dermatitis. So what’s the difference between the two? And more importantly, are our eczema children also suffering from contact dermatitis? Is the treatment the same? And are they more likely to have contact dermatitis when older?

Phew, this already sounds like a stressful topic (everything is stressful the minute I think about anything from primary school/ grade school onwards!) These topics will be broken into two manageable reading posts, with a focus to share about the research on relationship between atopic and contact dermatitis (at least what I can find from past 3 years!)

What is Contact Dermatitis?

To complicate matters, there are two types of contact dermatitis – allergic and irritant. Allergic contact dermatitis involves the immune system by which a hypersensitive reaction (rash) results from a previous contact with the allergen. Irritant contact dermatitis, on the other hand, does not involve the immune system being sensitized to the irritant. It is a delayed hypersensitive reaction due to prolonged exposure to the irritant.

How is it different from Atopic Dermatitis?

Irritant contact dermatitis is different from atopic dermatitis in that usually more than a minuscule amount of the irritant is required to generate the hypersensitive reaction, whereas in atopic dermatitis, a very small amount can cause a severe flare-up. The mechanism of which the rashes appear differ – contact dermatitis is known as type IV delayed hypersensitivity reaction which does not involve the (IgE) immune system whereas atopic dermatitis is type 1 IgE-mediated reaction.

Which one is my Child suffering from?

This can be difficult to figure out because the symptoms of eczema and contact dermatitis are similar, such as red rashes, blisters, thickening of skin (lichenification), scaly skin and itch.

Atopic dermatitis (eczema) is more common in children, however when the child does not respond to treatment, it may be worthwhile exploring if he/she is having rashes from the chemicals the skin comes into contact with. The relationship and prevalence of the two is still not super clear, as it may be due to the much higher amount of lotions and medication used on the eczema child’s skin. This study suggest that there is increasing prevalence of contact dermatitis in children, whereas previously thought to be uncommon. Patients with atopic dermatitis are more likely to be sensitive to quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol in this study.

Check back next week on Wednesday to learn of the treatment and prevention of contact dermatitis in children.

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Eczema Facts

Eczema Medication Series – Prednisolone

Marcie says 'Prednisolone worked for me!' MarcieMom says THANK YOU GOD
Marcie says ‘Prednisolone worked for me!’ MarcieMom says THANK YOU GOD

This is a series on some of the medication that I’ve collated from parents who shared in forums. For this week on Prednisolone, my baby with eczema had been prescribed a one-time 3 week reducing dosage course at about 7 month old, and it had cleared her eczema which then became manageable after the course. I know of many other young children, who did not respond well after the course, and some who did – please freely share your experience in the comments, your sharing can help encourage and comfort another parent.

What is Prednisolone?

Prednisolone is a type of corticosteroid which is prescribed to control inflammatory and allergic conditions like eczema, severe psoriasis and severe seborrheic dermatitis, colitis, asthma and rheumatoid arthritis. It works by stopping the release of chemicals that cause inflammation. Prednisolone is also used to treat blood cancer and lymphoma, to reduce the destruction of platelets by the body’s immune system.

It is usually an oral prescription (for my girl, it was solution) that must be complied strictly. Self-altering the dosage is not acceptable as the dosage is decided by a skilled physician, taking into account a combination of factors such as the skin condition and weight. If you are in a highly stressed season in life, do let your doctor know as that is a factor for deciding on the dosage.

From personal experience, the skin of the baby changes during the course – it may get better than worse, for my child, better again. Terminating halfway on your own, due to fear of oral steroid or deterioration of eczema, will make it more difficult for the doctor to make an assessment of how the course worked (or not).

Monitoring

Monitor your child’s growth and if concerned, discuss with the doctor. Steroid course may slow a child’s growth if used over long period or cause thinning of bones (osteoporosis), as it impairs calcium absorption and new bone formation. Look out also for signs of vision changes.

Warning

There are interactions with other medications so it’s best to let your doctor know of medication, vitamins and supplements that you or your baby/child is taking. Taking steroid over a long period can lower the body’s immunity. Avoid contact with people who are ill (esp. with chicken pox, measles or shingles), and also those who have taken a recent live vaccine (also check with the doctor before your child gets vaccinated). Wash hands also to prevent infection.

Side Effects

Watch for side effects, one of which is adrenal issue whose symptoms are fainting, irregular heartbeat, thirst, irritability or unusual fatigue. Click here for a list of common to less seen symptoms.

There is no particular diet to follow (except avoid liquorice), unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a study of 21 patients, only 1 achieved stable remission of eczema versus a higher rate (6 out of 17) for those prescribed cyclosporine. I find it strange though that I couldn’t find more study on Pubmed for prednisolone than for other medications in this series, which are licensed for use later. I’m glad that oral steroid course worked for my child, and love to know how it worked out for you.

For previous posts in this series, see

Cyclosporine

Methotrexate

Cellcept

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Eczema Facts

Eczema Medication Series – Cellcept

cellcept eczemaThis is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Cellcept?

Cellcept is the product name for mycophenolate mofetil, which is an immunosuppressant. Similar to cyclosporine, it is prescribed to lower the risk of organ (kidney, heart or liver) transplant rejection via lowering the activity of the immune system.  It is also prescribed for Crohn’s disease. It may also be prescribed for those with severe eczema who has not been responded to conventional treatments over prolonged periods.

It can be taken orally or by intravenous infusion, and patient needs to follow the prescription carefully, including how many hours to take it before food. The capsule or tablet should be swallowed whole, not crushed or chewed and thus ask for a suspension if you have problems swallowing whole. For the medication in this series that work on the immune system, altering the dosage of the same drug can be used to treat different conditions. Thus, it is important to follow the dosage and frequency designed by your doctor and not to self-adjust through your own observation of the skin’s condition. Doing so not only risks side effects, it also makes it difficult for your doctor to prescribe a follow-up treatment.

Monitoring

Certain tests may be requested by your doctor to assess the side effects of Cellcept, such as blood tests (blood count and chemistry panel), particularly to monitor the blood count of white blood cells, red blood cells and platelets.

Warning

There are medications that can reduce the amount of the active ingredient of Cellcept in the bloodstream, thus making it less effective. Some of these are antacids, colestyiramne, iron tablets, ciclosporin and rifampicin. It’s best to let your doctor know of medication, vitamins and supplements that you are taking.

There is associated risk of   lymphoma and skin cancer, so sun protection measures are important. Also take good care of your gums and visit dentist regularly as swollen gums is a possible side effect. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent live vaccine (also check with the doctor before getting vaccinated) as Cellcept is an immunosuppressant. Wash your hands also to prevent infection.

Side Effects

Watch for side effects, and let your doctor know; some of the side effects are:

Constipation, stomach upset, gas, chills, fever, rash, swelling, headache, vomiting, diarrhea, nausea, loss of appetite, hair loss,  swollen gums, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, muscle cramps, water retention and increased heartbeat.

Symptoms of flu such as sore throat, fever, night sweats, or painful urination, vision changes, reddened skin that cannot heal or sore may indicate infection that warrant seeing your doctor.  Stomach or intestinal bleeding is also a side effect, and signs to look out for are stomach pain, blood in your stool, or dark, sticky stools. There are also reports of risk of brain infection (progressive multifocal  leukoencephalopathy) whose symptoms include visual loss, seizures, movement and speech difficulties, weakness, confusion and headaches. Do call your doctor immediately.

Refer here for a list of more to less common side effects.

There is no particular diet to follow, unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a few studies online, and the various conclusions are:

  1. In a retrospective case series of 14 children with severe eczema, 1 failed to respond to treatment while others improved significantly.
  2. In a study of 16 patients over 34 weeks, 1 had pancreatic cancer and the rest had improved significantly.
  3. In a retrospective study of 20 patients, 17 improved over 4 weeks of the course, but 7 patients developed various infections.
  4. In a study of 12 patients with paediatric severe eczema at the University of North Carolina at Chapel Hill pediatric dermatology clinic, 8 out of 12 reported significant improvement.
  5. In this study of 10 adult patients, mycophenolate mofetil is found to be effective in reducing the severity of eczema after 12 weeks.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances that had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!

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Eczema Facts

Eczema Medication Series – Methotrexate

Sharing your experience can Help

This is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Methotrexate?
Methotrexate is an antimetabolite which slows down the metabolism of new cells (for instance prescribed to reduce growth of cancer cells). It works via inhibiting dihydrofolate reductase (DHFRase), an enzyme involved in the synthesis of DNA, RNA. It may be prescribed for advanced stages of cancer, severe active rheumatoid arthritis and certain types of cancers. It is also used to treat skin conditions – severe psoriasis, whereby methotrexate decreases the formation of skin cells to prevent the formation of scales. It may also be prescribed for those with severe eczema whose treatment using cyclosporine or corticosteroids are discontinued, as methotrexate has anti-inflammatory properties. Methotrexate also lowers the activity of the immune system.

It can be taken orally or by injection, and patient needs to follow the prescription carefully, especially the dosage or frequency (may be weekly for treatment of skin condition). The dosage prescribed will be determined by the doctor, usually for skin-related, it will be a low dosage, and dosage may vary during the course. It is important to follow-through with the prescription, and not terminate it once you self-assessed your condition has improved.

Monitoring
Certain tests may be requested by your doctor, to assess the side effects of methotrexate, such as blood and liver tests.

Warning
Check with your doctor how much fluid you need to be taking during the course as drinking more water can help to reduce toxicity in kidneys. If you are on non-steroidal anti-inflammatory medication such as aspirin, ibuprofen, choline magnesium or magnesium salicylate, do check with the doctor the safety of these medications as they can increase the level of methotrexate in the blood. Also check on medication such as acitretin, azathioprine, isotretinoin, sulfasalazine or tretinoin that may increase concentration of methotrexate in the blood or increase toxicity for certain body organs – liver, kidney and bone marrow (better to tell the doctor of drugs, medicines, supplements and vitamins you are taking). There is associated risk with liver damage, so do check on alcohol consumption.

There may also be sensitivity to light, so take sun protection measures and avoid sunlight. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent nasal flu vaccine or who has chickenpox (also check with the doctor before getting vaccinated) as methotrexate has mild immune suppressive effect. Also check on what sports you can engage in, to prevent cuts or injury. Wash your hands also to prevent infection.

Side Effects
Watch for side effects, and let your doctor know; some of the side effects are:
Chills, fever, rash, peeling skin, headache, mouth sores, vomiting, diarrhea, nausea, loss of appetite, hair loss, swollen gums, red eyes, sore throat, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, seizures, fainting, difficulty with body movements, vision changes and painful urination.
Symptoms such as diarrhea, black, tarry or bloody stools or bloody vomits may be related to damage to the lining of intestine due to Methotrexate. Do call your doctor immediately. Also, if you had stomach ulcers or previous medical conditions related to intestines, do inform your doctor.
Refer here for which side effects are more common, and which are less.

Diet
Folic acid may be prescribed as a supplement during the course, but this depends on your doctor as studies are not definitive in this area. Folic acid may in some ways reduce the effectiveness of methotrexate, thus may be prescribed on days when patient need not take methotrexate.

Most Importantly, Does it Work?
I’ve found a few studies online, and the various conclusions are:
1. In this study of 60 patients, methotrexate found to improve mild to moderate eczema
2. In a study of 42 patients, both methotrexate and azathioprine showed clinical improvement in eczema for adult patients in the short term.
3. In a study of 25 patients with paediatric discoid eczema, about 19 children showed improvement after 10.5 months.
4. In this study of 20 patients, methotrexate found to be effective, but there were also patients who dropped out from the study due to side effects.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances, which had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!

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Eczema Facts

Eczema Medication Series – Cyclosporine

Cyclosporine EczemaThis is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Cyclosporine?

Cyclosporine is an immunosuppressant, and slows down the immune system (thus frequently prescribe to prevent organ rejection after a transplant). It is registered in certain countries to treat skin conditions – psoriasis and atopic dermatitis (eczema). It may be prescribed for those with severe eczema that has not responded to other treatments for prolonged period. Cyclosporine works by reducing inflammation on the skin, through its effect on immune cells (lymphocytes). It is taken orally, and patient needs to follow the prescription carefully and take the medication at same time. The dosage prescribed will be determined by the doctor, usually for skin-related, it will be a low dosage, and dosage may vary during the course. It is important to follow-through with the prescription, and not terminate it once you self-assessed your condition has improved.

Monitoring

Certain tests may be requested by your doctor, to assess the side effects of cyclosporine, such as blood pressure test, blood and urine tests (to monitor creatinine levels) and tests to monitor potassium, blood count, fasting lipid, uric acid and liver function.

Warning

Care ought to be taken to ensure that the prescription of Cyclosporine is the right one, as it can be in different form – original vs modified. Different form of cyclosporine is to be mixed with different liquids, so do check with your doctor too. Also check with your doctor on what other medication to avoid, especially those that affect the immune system, such as azathioprine, methotrexate and tacrolimus. There is associated risk with high blood pressure, kidney damage, lymph and skin cancer, so do check with the doctor if your child should take additional sun protection measures, and for adults, avoid phototherapy during the medication. Do not drive as side effect of cyclosporine is dizziness. Avoid contact with people who are ill, and also those who have taken a recent nasal flu vaccine (also check with the doctor before you/ your child get vaccinated).

Side Effects

Watch for side effects, and let your doctor know; some of the side effects are:

Headache, vomiting, diarrhea, nausea, increased hair growth on face or body,  swollen gums, acne, trembling, flushing, cramps, joint pains, pin and needle sensation, flu, sore throat, facial pain and increased blood pressure .

The serious side effects to call your doctor immediately are bleeding, bruising, paleness, yellowing of skin or eyes, seizures, fainting, difficulty with body movements, swelling and vision changes, painful urination.

Refer here which side effects are more common, and which are less.

Diet

Grapefruit and juice is to be avoided as it can increase the amount of cyclosporine in your blood stream. Foods such as bananas, prunes that are high in potassium are to be limited as cyclosporine can also increase the amount of potassium in the bloodstream. Check also if you need to take magnesium supplement, as cyclosporine may reduce the level of magnesium in the blood.

Most Importantly, Does it Work?

I’ve found a few studies online, and the various conclusions are:

  1. Studied to offer relief for those with severe eczema, but the effect is not long-lasting, similar conclusion in this study.
  2. Review article of 15 studies found cyclosporine to be effective for 6-8 weeks.
  3. One study that tracked up to 1 year continued to show eczema in remission, but this study was without control group.
  4. In a study involving 40 children, cyclosporine found to be effective and well-tolerated. In this study involving 35 children, cyclosporine found to be more effective for those whose eczema are triggered by skin infection (than those triggered by others)

A point to note is above studies were small sample sizes, possibly due to cyclosporine prescribed only for severe instances. Do share your experience in the comments!

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Eczema Facts

Protopic – Is a Non-Steroid Cream Better for your Child?

Picture from protopic-la.com

This is a post that I wanted to write for some time because I’ve been reading parents’ differing views on whether Protopic has worked for their child. I did a quick internet search on forums, and 10 out of 14 parents said it worked, 3 mentioned it gave a stinging sensation and 1 believed it led to herpes virus. Of course, my limited browsing of forum posts is not a scientific study but it certainly has piqued my interest to find out more about Protopic (something I didn’t research earlier because a mom with eczema child is busy! and also Marcie doesn’t use nor has been prescribed Protopic).

So What’s Protopic and what does it do?

According to its website, Protopic is a topical calcineurin inhibitor (TCI) that is available upon prescription. Calcineurin activates the T-cells of the immune system, which when over-produced attacks the skin leading to inflammation (read more in this post). Protopic, whose drug name is tacrolimus, belongs to a class of drugs known as calcineurin inhibitors and works to decrease the effects of, or suppresses, the immune system. Tacrolimus is also known as FK-506 or fujimycin and typically prescribed to reduce the likelihood of new organs being rejected in a transplant operation. Tacrolimus was discovered in 1984 from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis. Protopic is a product of Japanese pharmaceutical company, Astellas Pharma, and its ingredients are tacrolimus, mineral oil, paraffin, propylene carbonate, white petrolatum and white wax.

Who can and How to use Protopic?

It is recommended for moderate to severe eczema and to be prescribed by doctors, who are to prescribe it only when topical corticosteroids are not effective. It is only to be used for short periods, generally not more than 6 weeks. It comes in two strengths, 0.1% and 0.03% but for children (at least 2 years of age), only the 0.03% is recommended. The application of Protopic ought to be thin and improvement (if any) is usually seen in two weeks.

Protopic is not to be used with wet wraps, lest there’s over-absorption into the body. Protopic should also not be used on eczema that is infected as there’s no study relating to its safety in infected eczema. Going outdoors in the sun and tanning beds are also to be avoided because of shorter time to tumor formation when applying Protopic, as disclosed on their website. Hands ought to be washed after applying Protopic. The long-term use of Protopic has not been studied and thus, its application as a maintenance topical treatment to prevent flare-ups need to be advised by doctors. It is also not recommended for nursing moms or moms who are trying to be pregnant.

Pros and Cons of Protopic

Various studies have been conducted on Protopic, and it appears to be more effective than low-potency steroid creams. The other advantages over steroid creams is that it doesn’t cause skin thinning and therefore can be used on parts of other where skin is generally thinner, such as the face, eyelids and neck. However, as it suppresses the immune system, there’s increased risk of viral infection, in particular from herpes/ eczema herpeticum/ chickenpox/ shingles virus. Skin burning and itching sensations are the most common side effects (usually in its initial use) of using Protopic. It is also possible to be allergic to tacrolimus or other ingredients in Protopic, such as mineral oil and paraffin. Furthermore, a number of cases of cancer of skin or of lymphocytes cells have been reported, resulting in FDA issuing a black box cancer warning (read more on webmd post). Protopic may also interact with certain medications, including some antibiotics such as azithromycin which is commonly prescribed to children. You can read the product leaflet here.

Update in Feb 2015 – 10 year follow-up study on children who use pimecrolimus showed no significant cancer risk.

MarcieMom’s Take?

Marcie hasn’t been prescribed Protopic but from various talks that I’ve attended, it appears that though calcineurin inhibitors are mentioned, it’s always fairly down in the list of treatment options. One thing I feel is clear is that I wouldn’t opt to use Protopic just because I’m worried about the side effects of steroids as a drug that works on the immune system would surely has its own sets of side effects.

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Eczema Facts

Eczema Herpeticum – What is it and is it dangerous?

Eczema herpeticum
Eczema Herpeticum (extract from www.eczemaguide.com)
Eczema Herpeticum (extract from www.eczemaguide.com)

Eczema herpeticum – this is a term that I keep hearing of moms in forums sharing that their children have repeated eczema herpeticum during the year and also of delayed diagnosis where it’s not identified as herpeticum promptly.

If you search eczema herpeticum’s definition – you’ll see it’s often stated as a rare life-threatening complications that results from infections caused by herpes simplex virus type 1 or 2. The virus enters the child’s body through the defective skin (common in eczema children) and attacks multiple organs, including eyes, brain, lung and liver. However, judging from moms’ feedback, it isn’t that rare, so let’s learn more about it!

Is Eczema Herpeticum Dangerous?

Before we get to that, let’s look at how one gets it. Usually the child comes into contact or catches the virus from someone with cold sores. Cold sores is not dangerous and usually it causes blisters around the mouth and is accompanied with fever or flu-like symptoms. Cold sores is most contagious when there are blisters, but can also spread when there’s no blister as the herpes simplex virus can lie dormant in one’s body. The virus can be spread by kissing, sharing utensils, lip balm or generally, coming into contact with the mucus of the infected person.

Now, here’s the DANGER part – for a child with eczema, the herpes simplex virus can enter the skin and sets off a chain of infections, including large scale bacterial skin infection. The symptoms are:

1. 5-12 days after exposure – Rashes with blisters at eczema lesions/skin patches

2. Spreading of the blisters with yellow pus, accompanied with flu, fever and body aches

3. Blisters start to get painful with bleeding, scabbing

4. Widespread at body parts, usually neck, head, upper body with swollen lymph nodes

If left to run its course, the infections may take over body organs, including the eyes. Should the eczema on your child looks different than normal, and starts to blister with pus, it’s recommended to go to the hospital for a prompt diagnosis and treatment.

Diagnosing and Treating Eczema Herpeticum

Diagnosis can be quickly conducted by antibody staining of the pus filled vesticles or a viral culture test. Sometimes, it may be mistaken as small pox or chicken pox, but in any case, an anti-viral drug such as acyclovir or valaciclovir can be administered. For skin with bacterial infections caused by staph, antibiotics is also given to reduce the secondary infection risk.

Be prompt in going to hospital as research shows that the delay in one day increases hospital stay by 11% and one-third of the patients have staph infections, while 3.9% has blood infected and 3.8% needs to stay in intensive care.

As for why moms are sharing that their children gets repeated attacks, it’s because the virus stays in the child’s body and sometimes when there’s a trigger such as fever/flu or stress, it can set off the virus. Some children need to be on daily anti-viral drug which so far, seems to be minimal long-term negative effect as the drug attacks the virus but not the child.

Learn more about eczema and infection from National Eczema Society here.

Update on research in September 2015, Journal of Allergy and Clinical Immunology – Certain genetic variants in a gene (iFNGR1) have been studied to increase susceptibility of atopic dermatitis patients to eczema herpeticum.

Update on May 2017 article on Eczema Herpeticum written by MedicalNewsToday.com

A note on Marcie’s experience: When she got chickenpox, she didn’t get the anti-viral drug because her skin wasn’t so bad. When she got Hand-Foot-Mouth-Disease the second time, she was given anti-bacterial antibiotics because her skin looked red and infected.

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Last updated on 19 December, 2024 1:21 pm
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Eczema Facts

Should you be Worried about House Dust Mite (HDM) for your Eczema Child?

House dust mite as an eczema trigger household allergen
House Dust Mite (picture from dust-mite.net)
House Dust Mite (picture from dust-mite.net)

House dust mites are tiny insects, about 0.03mm long, look scary under a microscope but too small to be seen by us. They are definitely in our homes as house dust mites, or HDM, love room temperature (18 deg C to 26 deg C/65 to 80 deg F), humid (above 55%) homes where there are plenty of shed human skin for food. HDM feed on our dead skin, fingernails, hair, animal fur, bacteria, fungi and pollen. In your home, they are likely to be on the bed, mattress, carpets, upholstered furniture and curtains. There is no way to have zero dust mite in your home, but you can reduce their quantity by making the environment less favorable for them. It takes a lot of effort to keep the dust mites away, so we should understand a little bit more before killing ourselves with the cleaning.

How does house dust mite affect your eczema child?

First things first, get your child tested. A skin prick test will show if your child is allergic to the droppings of the house dust mite. It’s the protein in the droppings that is the allergen, and not every eczema child will be allergic to HDM (my baby Marcie isn’t) though patients with eczema could be more susceptible to dust mite allergy (taken from “Specific profiles of house dust mite sensitization in children with asthma and in children with eczema” article in Pediatric Allergy and Immunology 2010). It was also written in the same article that those with eczema by 3 months old is more likely to be sensitized to aeroallergen by 5 years old. Also, the more severe the eczema, the greater the sensitization to HDM. In the article, it is noted that the major HDM allergen for eczema patients is Der p1 of D.pteronyssinus, which is a large particle that don’t stay airborne but quickly land on surface, including on the skin. For eczema children with defective skin barrier, the allergen can penetrate the skin more easily to trigger itchiness.

How to reduce house dust mite?

If your child is tested allergic or get asthma attack from inhaling the HDM allergen, then there’s little choice but to get rid of as much dust (and the dust mite dropping trapped in the dust) as possible. Here’re a few ways to keep the dust mites away:

1.      Remove carpets, thick curtains, thick mattress, upholstered furniture (think plastic, wood, leather, vinyl).

2.      Get dust mite proof covers for the pillows and mattresses.

3.      Wash bed sheet, pillow cases weekly at temperature of above 60 deg C (you can see my washing machine here, I steam wash everything).

4.      Wipe your home with wet cloth, instead of dry dusting from one area to the air (finally, there’s some support for what I love to do, using a wet kitchen towel to clean everything).

5.      If vacuuming, get a vacuum cleaner with a good filter that does not release small particle in the exhaust; I borrow my friend’s $3000 vacuum cleaner twice a year to vacuum mattress; but if your child has asthma, then the mattress needs to be vacuum weekly. (Dust mite can burrow deep into the mattress and will be hard to vacuum away if the mattress is thick.)

6.      Ventilate room; this will reduce stale humid air trapped in the room, and let the sun in (think less cosy for the dust mite).

7.      No soft toys; if your child absolutely can’t do without them, try freezing the soft toys in plastic bag for 24 hours in the freezer to kill the dust mite, followed by washing away the dead mites and droppings in the washing machine.

8.      Reduce humidity, but too dry environment is bad for eczema, read this post on humidifier and air-con.

9.      Reduce ornaments, dried flowers, books, textured wallpapers; the less surface for dust to land on, the better.

Save your money on these:

1.      Don’t buy mite killing sprays which may be an irritant; likewise, for ionizers.

2.      Don’t buy air filters because the air filter may stir up air, making it longer for the dust to settle (which increases risk for asthma children as the HDM allergen stays airborne). Or air filter may end up filtering only the air near to the filter.

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Last updated on 19 December, 2024 11:59 am
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Eczema Facts

4-part series on What Causes Your Child’s Eczema – Staph

Eczema on baby neck and relationship with staph bacteria colonization
Eczema on neck - Bacteria colonization?
Eczema on neck – Bacteria colonization?

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

What is Staph?

Staph is short for staphylococcus aureus, a very resilient bacteria found on the skin that can cause infection if it penetrates the skin. More than 90% of the people with eczema has staph versus less than 10% of people without eczema. Read more about staph bacteria on eczema skin in this interview with Dr Clay Cockerell, former president of American Academy of Dermatology.

One more reason not to scratch

Scratching gives a feel-good feeling to your child as written in this post, but it’s really bad. Scratching damages the skin barrier and makes it very easy for staph to penetrate. As written in the article “Features of childhood atopic dermatitis”, staph increases IgE production, activate native T-cells by its superantigens and damage skin by its proteases.

IgE are antibodies that catalyzed the protective cells of the immune system to lock on to the antigen, see this post on immune system). Superantigens are toxins released by staph, that causes skin inflammation. Staph also results in less protein that is used to fight infection.

How do you know if your child has Staph?

Children with eczema are prone to staph bacteria, so chances are very likely there is staph on the skin but it may or may not be visible in the form of skin inflammation. If there is honey-colored crusts, pus-filled blisters, red scaly patches, swelling that is warm to the touch or fever, it’s likely that staph has already caused skin infection.

So, how to get rid of the Staph bacteria?

Marcie’s doctor Prof Hugo Van Bever recommended using chlorhexidine before applying steroid cream for Marcie. I told him during the consultation that I only use chlorhexidine (antiseptic solution) when Marcie’s rashes is persistent and red (like in the picture). However, he said that the bacteria is not visible to human eye thus it’s a good practice to clean the skin before applying steroid.

I also read that some paediatrician recommended diluted bleach bath as the bleach can remove the bacteria from the skin. Prof Hugo recommended swimming for Marcie. The idea is that people with eczema typically suffers from bacteria colonization, so remove the bacteria first and if need be, apply steroid which is more effective without the bacteria (of course, moisturizing is a must).

For previous posts in this series, see

Defective Skin Barrier

Allergy

Auto-Immunity

Update 2018: New antiseptic wash products such as Octenisan are now in the market, providing a more moisturizing wash option compared to chlorhexidine gluconate (which is drying).

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Last updated on 19 December, 2024 1:29 pm
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Eczema Facts

4-part series on What Causes Your Child’s Eczema – Auto-Immunity

Auto-immune disease eczema
How the Immune System works
How the Immune System works

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

Attacking the Organ to Protect

Another possible cause of eczema is that the immune system has wrongly identified the organ it is meant to protect as an enemy to attack. Here are the basic steps on how the immune system works:

1st: The foreign substance (antigen) that invades the body is detected by a group of cells known as the B lymphocytes. B cells are specialized proteins that lock onto the antigen (but cannot destroy them).

2nd: The B cells continue to exist in the body, which helps to prevent the body from being invaded by the same antigen.

3rd: T lymphocytes are also produced to destroy the antigen, that have been locked by the B cells.

Higher level of antibodies have been found where the eczema is more severe. It is possible that scratching aggravates the immune response by stimulating a greater release of proteins (specifically the IL-21 protein that regulates the T cells) which scientists have found to be present in inflamed skin. Thus, scientists are exploring whether by manipulating the IL-21 protein, the amount of T cells can be regulated so that the immune system will not attack the skin incorrectly (click here to read more).

But why is the immune system not working as it should?

There is no answer yet, though the hygiene hypothesis is that our environment being too cleaned now (with everyone using anti-bacterial wipes and cleaning much more with chemicals) has deprived our immune system of the chance to practice working on the antigens, leading it to work on harmless substance. However, if your child is already known to be allergic to say dust mites, then the accepted action is to minimize the dust mites rather than purposely not cleaning your home.

Update on 10 Dec 2016: Came across this study by the bioengineering team at Imperial College:

The team’s model showed that repeated flare-ups of AD trigger an immune system overreaction in the body, and when triggered this can’t be reversed. This creates a cycle where the threshold for triggering further AD outbreaks becomes lower, the flare-ups are more severe, and the condition progresses to becoming long-term. Severe flare-ups happen as a result of the complex interactions between the body’s immune system, the skin’s protective barrier, and environmental factors such as stress.

The press release of the study by Imperial College here.

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Last updated on 17 December, 2024 5:52 pm
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Eczema Facts

4-part series on What Causes Your Child’s Eczema – Allergy

Allergy and atopic dermatitis relationship in childhood eczema
Role of allergens according to age and severity of AD (taken from Table 3 of article “Features of childhood atopic dermatitus”
Role of allergens according to age and severity of AD (taken from Table 3 of article “Features of childhood atopic dermatitus”

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and hopefully digested the information accurately for you to read.

Does Allergy Cause Eczema?

The answer is we don’t know. If you refer to the first part of this series, allergy is hypothesized to be caused by eczema (rather than causing eczema). What has been observed is that the more severe eczema is, the higher the chances of allergies (as shown in table above). Allergies can be to food (which in the article “Features of childhood atopic dermatitis” summarized that it can be from direct eating/drinking, breast milk, placenta, inhaling and even kissing!), to house dust mites, dander and a whole lot of others (I’ve freaked myself out when researching what my baby girl Marcie could be allergic to).

Marcie’s Allergy

As it turned out, Marcie is not allergic to anything! She had a skin prick test done, something which I always recommend other parents to do because it takes a lot of guess work out. True that skin prick test is not 100% fail-proof, but it’s better than going mad worrying about everything cos if you google, you will most surely find something written or a post by someone that their child is allergic to something.

Here are some previous posts on skin prick test and eczema triggers that may interest you:

Taking the fear out of skin prick test

What triggers itch?

If your child has eczema, can you have a pet dog?

Is partially hydrolysed milk worth the money?

What and how much Detergent to Use?

Is it what you ate? How pregnancy diet affect eczema in baby

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Last updated on 19 December, 2024 10:33 am
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Eczema Facts

4-part series on What Causes Your Child’s Eczema – Defective Skin Barrier

Impact of detective skin barrier on eczema skin causes
Restoring Defective Skin Barrier (taken from nationaleczema.org, article by Peter Elias M.D.)
Restoring Defective Skin Barrier (taken from nationaleczema.org, article by Peter Elias M.D.)

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

Why does my baby get eczema?

I’ve asked the same question countless times and I know it’s something to do with the genes (if you read my family tree post here); but exactly what causes eczema? Medical professionals are still trying to find the answer as finding the right answer can help them to find the right way to prevent/treat eczema. Apparently, it has all along been thought that eczema has something to do with a hyperactive immune system, which being too sensitive has wrongly thought that matters not harmful to the skin/body are harmful. Now, there’s a new outside-in hypothesis that it is the defective skin barrier that leads to more irritant and allergen penetrating the skin, inducing the immune system to increase production of IgE (that work as antibody). Too much IgE will lead to skin inflammation, asthma, hayfever and food allergy.

But why is the skin barrier defective?

This is caused by a few types of proteins, the most commonly cited one being the 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. The FLG does not explain all cases, because there are people without defective FLG but still has eczema and people with eczema, but no defective FLG. (Thus, it’s currently accepted as a few possible factors such as the gene, environment, allergy reacting together, in some way that we don’t know yet)

The Implication

In the table above, there are some current ways to restore our baby’s skin barrier mainly by moisturizing, FROM DAY ONE. This is because if the outside-in hypothesis is true, then the stronger the skin barrier, the less chances of allergen/irritant penetrating the body to cause the body to react hypersensitively. There is a chance then for us to stop the allergic march in our children, where eczema is replaced by asthma and rhinitis. Humidifier also helps to ensure that the environment is not too dry for the skin, especially during winter or if your air-con is on.

If you are interested in reading the research paper details, click here. To learn more about skin pH, read this very informative interview with dermatologist Dr Cheryl Lee where we break down for you the what is the normal skin pH, eczema skin pH (more alkaline), why it is important to get our skin to be slightly acidic and how much harm alkaline skincare products can do to our skin.

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Last updated on 18 December, 2024 11:16 pm