Combined Approach Series – Stress, Attitude and Habit Reversal

Parents see an acute flare that needs treatment

This is a 4 post series centered on ‘The Combined Approach’ that is explained in the ‘Atopic Skin Disease’, a manual for practitioners authored by Christopher Bridgett, Peter Noren and Richard Staughton (copy of book viewable by joining here). The Combined Approach uses habit reversal to stop habitual scratching in atopic eczema. Dr Christopher Bridgett has previously helped in Friday Doctor Q&A from November 2011 to February 2012 and MarcieMom has invited him to share more about the Combined Approach.

Three Levels of Treatment

In the manual ‘Atopic Skin Disease’, three levels of treatment are stated, namely:

1. Emollient Therapy

2. Steroid

3. Habit reversal

It is advised in your manual that steroid should not be used without follow-up moisturizer but moisturizer can be without steroid application. In the course of recovery, level 3 can be stopped first, followed by 2 and 1. We’ve covered the basics of all three levels in previous posts. There are some further dimensions in the management of eczema as follow:

1. StressStress is one of the possible triggers for eczema. Can you help a parent to identify when a child is stressed and how to see if the child is stressed because of the eczema or because of something else? How can a parent help a child to relax?

Dr Bridgett:

Stress can cause emotional upset – unhappiness and apprehensiveness for example in anyone, young or old. In a child this may include tearfulness, and avoidance behaviour, just as in an adult. Certainly having eczema itself is stressful, for both the child and the parents. Careful observation may clarify if something else is the source of stress: stress comes from common causes, even for the youngest child, and family upsets may be especially important to think about. If there are no other causes and the eczema is troublesome, then adequate treatment of the eczema will be stress relieving – for everyone.

Helping a child to relax usually involves simple acts – giving attention, and comfort, with suitable play, and amusing distraction. Reading a favourite story is a tried and tested bedtime means of inducing relaxation and sleep. But when a child is stressed, enabling relaxation is more difficult, especially if the causes of stress are not identified and dealt with.

2. Attitudes – Positive attitudes are suggested in your manual, such as ‘Manage, Don’t be Managed’ and to be careful so the doctor/nurse does not to ‘spread’ helplessness during a consultation. Should a patient comes across a doctor who is passive about managing the eczema, what can he/she do to change the doctor’s attitude? (Obviously, the other choice is simply switch doctor! But as a service to other patients, someone ought to say something!)

Dr Bridgett:

I find myself saying something about this all the time! Of course the responsibility for a successful visit to a doctor rests with all those involved. Each person should consider first what they themselves can do, rather than seeing any problem as caused by someone else. Some really useful ideas about this were covered when Jennifer talked to me: see http://atopicskindisease.com/articles/20111216 This might make a good topic for people reading this post to comment on here: I suggest your readers share their thoughts and experiences with you.

At some health centres and doctors surgeries there are patient discussion groups to allow people to share ideas on how things can be improved. Has anyone had experience of such a group? Does your doctor ever conduct a patient satisfaction survey?

Review of Habit Reversal

In The Combined Approach, follow-up visits include asking the patient or parent their (i) scratching frequency (ii) when there’s most scratching (iii) % of scratching from itch (iv) severity of eczema (v) % new eczema vs old and (vi) where most eczema. If a parent cannot find a doctor or convince their current doctor to implement the Combined Approach, can the parents implement this on their own without a doctor doing the follow-up (i.e. monitoring scratching on their own)?

Dr Bridgett:

The questions that you detail are in the first stages of The Combined Approach, during the first 4 to 6 weeks when habit reversal is important. The later part of the programme we call follow-up, and then vigilance for acute flare-up is the important emphasis, with early and energetic treatment with topical treatment being the order of the day. Habit reversal is not important long term. It is optimal topical treatment that is essential to maintain the progress that The Combined Approach achieves.

How to use The Combined Approach depends on the resources available. The clinic-based format is very effective, but if it is not feasible a self-help format is a good alternative, as discussed at http://atopicskindisease.com/categories/20110423_18 (joining is necessary to read this, but joining www.AtopicSkinDisease.com is still free!).

Hopefully blogs like this, and websites like www.AtopicSkinDisease.com will now gradually help everyone everywhere to discover how to treat atopic eczema successfully. There is no need now for anyone to necessarilyLive With Eczema: there is now a possibility to learn how to Live Without Eczema.

MarcieMom: Thank you Dr Christopher Bridgett for taking time to explain The Combined Approach. I’m certainly very glad to collaborate on this series with you. Should there be more questions from parents, I’d certainly invite you for another Friday Doctor Q&A!

Combined Approach Series – Eliminate Habitual Scratching

Combined Approach – Parents noting child is scratching

This is a 4 post series centered on ‘The Combined Approach’ that is explained in the ‘Atopic Skin Disease’, a manual for practitioners authored by Christopher Bridgett, Peter Noren and Richard Staughton (copy of book viewable by joining here). The Combined Approach uses habit reversal to stop habitual scratching in atopic eczema. Dr Christopher Bridgett has previously helped in Friday Doctor Q&A from November 2011 to February 2012 and MarcieMom has invited him to share more about the Combined Approach.

Development of a Nervous Habit

I read in your manual ‘Atopic Skin Disease’ of how a nervous habit develops, namely:

1. Normal initial specific response to an injury (or itch)

2. Increased frequency by positive reinforcement that leads to

3. Behavior (or scratching) becomes automatic

4. The habit generalizes to cause more situations precipitating the behavior

5. Decreased personal and social awareness

Also illustrated in your manual, another habit is introduced to reverse the scratching:

1. New habit is opposite to the old habit

2. Can be maintained for several minutes

3. Socially acceptable and compatible with normal activities

4. Strengthen muscles antagonistic to those of old habit

The techniques used in Noren and Melin, 1989 study mentioned in Atopic Skin Disease are:

1. Clenching fists and counting to 30 as an alternative to habit of scratching

2. Pinching the skin where it was itching as an alternative to itch-provoked scratching

Can you explain to our parents how to tell their child to clench fist and pinch skin? Is this something that can be understood by young children? And will pinching skin lead to the child using painful techniques to get rid of scratching? (I read in your manual not to say ‘Stop Scratching’, just as I’ve posted!)

Dr Bridgett:

The method of clenching a fist, then pinching the skin, is only suitable for older children, who are able to understand the instruction, and can accept responsibility for following the recommendations. The younger child requires a different approach which sees the parents as responsible for the treatment, with an adapted programme in between: see http://www.atopicskindisease.com/articles/20120115

So, no pinching small children please!

And yes – it is important to avoid saying “Stop Scratching” – you are quite right, of course!

Homework: Registering Scratching Frequency

In The Combined Approach, the first homework assignment to patients is to register the scratch frequency. This aids in the analysis of the scratching habit, following an ABC format of understanding the antecedents, behavior and consequences. Do you normally explain the ABC to patients before requesting them to register their scratching frequency? How can a parent help explain this to a young child? How can a parent help a child to count the scratching?

Dr Bridgett:

The explanation of the ABC normally comes after registration, as part of the instruction of how habit reversal works. See the patient handbook for Older Children: http://atopicskindisease.com/categories/20110503_1

The younger child has a different treatment programme, without any counting of scratching: for the younger child it is the parents who are responsible. They can achieve awareness of the childs behaviour without using a counter. See http://atopicskindisease.com/articles/Mark

MarcieMom: Thank you Dr Christopher Bridgett for explaining habit reversal that is part of The Combined Approach. In our next post, we will understand the three levels of treatment and conclude the series.

For previous posts in this series, see

Habit Reversal

Topical Treatment

Stress, Attitude and Habit Reversal

Combined Approach Series – Topical Treatment

This is a 4 post series centered on ‘The Combined Approach’ that is explained in the ‘Atopic Skin Disease’, a manual for practitioners authored by Christopher Bridgett, Peter Noren and Richard Staughton (copy of book viewable by joining here). The Combined Approach uses habit reversal to stop habitual scratching in atopic eczema. Dr Christopher Bridgett has previously helped in Friday Doctor Q&A from November 2011 to February 2012 and MarcieMom has invited him to share more about the Combined Approach.

Explaining Topical Treatment – Moisturizer

As we understand last week, The Combined Approach includes topical treatment using emollient and steroid. Moisturizing is a HUGE part of topical treatment, as emollients both lubricate and moisturize. Dr Bridgett’s advice on moisturizing is Thinly, Gently, Quickly and Often. There are a few other points mentioned in the ‘Atopic Skin Disease’:

  1. Thinnest possible application without ‘rubbing it in’
  2. More on exposed areas such as the head, neck and hands
  3. Pump dispensers preferable to open tubs due to bacteria infection
  4. Applying topical steroid first, then emollient over both the skin and the steroid
  5. Cream preferred over lotion

Can you explain why thinnest possible application is preferable for emollient? (I’d usually slather on my child as I find applying a thin layer leads to more rubbing to spread the emollient)

Also, can you explain why topical steroid first? (I’d written on this here and it does generate some discussion!)

Can you explain why cream is preferable over lotion?

Dr Bridgett:

Your three questions answered:

  • Thin applications of moisturizer allows heat to escape, but insulates against water loss.
  • If moisturizer is applied often enough, when the steroid is applied directly onto the eczema, it is applied to skin that has been recently moisturized. We get then the best results by putting moisturizer on over topical steroid, and moisturizing all the skin, not just that which has the eczema.
  • The thicker the moisturizer, the better the moisturizing effect. Also, often there are less additives in thicker moisturizers, as thicker moisturizers “keep” longer. There is less chance that a sensitivity reaction will occur with an ointment, compared with a cream. See http://atopicskindisease.com/articles/20110801

Explaining Topical Treatment – Steroid

It is stated in ‘Atopic Skin Disease’ manual that steroid cream work by inhibiting protein synthesis, secretion of products, cell division and migration of cells. The epidermis can benefit from reduced cell division, and the dermis from reduced cellular and lymphokine activity. Can you explain what this means, and why it is important to continue steroid treatment after epidermis healing (‘2-stage in steroid effect’)?

Dr Bridgett:

It seems the steroid anti-inflammatory effect is partly achieved by reducing over-activity in the skin, allowing natural healing then to lay down healthy skin again. By the time the seems good to look at, the healing is not complete through and through – there is more that is needed under the surface, so we recommend continuing with the topical steroid, beyond The Look Good Point: do not stop too soon. See http://atopicskindisease.com/articles/TT7

Many parents are very concerned with the skin-thinning side effects of steroid and also the ‘withdrawal’ symptoms once steroid treatment is discontinued. I read in your manual that side-effects are associated with inappropriate use of topical steroid and the risk is usually inadequate treatment (i.e. stopping steroid cream too early or using one of too low strength). How do you normally convince parents that steroid cream is safe? And what guidelines would you give them to gauge if the steroid cream of correct potency, frequency and amount is used?

Dr Bridgett:

Steroid side-effects come especially from using topical steroids long-term and in an unsupervised way. The method we use in The Combined Approach includes more supervision than is usually given, with a programme of several clinic visits, involving careful discussion of all anxieties and concerns. Using The Combined Approach, including therefore habit reversal, which allows natural healing alongside the good steroid effect. Then less topical steroid is used overall, for good effects, not side effects!

We offer information about the potency groups of the topical steroids, and how they are usually used. The thicker the skin, the stronger the topical steroid to be used. See http://atopicskindisease.com/categories/20110423_11

Each application of any cream needs to be sparingly applied – whether it is an emollient or a topical steroid: only a shine is required.

MarcieMom: Thank you Dr Christopher Bridgett for explaining the topical treatment that is part of The Combined Approach. In our next post, we will understand more on habit reversal techniques.

Combined Approach Series – Habit Reversal

 

Before The Combined Approach

This is a 4 post series centered on ‘The Combined Approach’ that is explained in the ‘Atopic Skin Disease’, a manual for practitioners authored by Christopher Bridgett, Peter Noren and Richard Staughton (copy of book viewable by joining here). The Combined Approach uses habit reversal to stop habitual scratching in atopic eczema. Dr Christopher Bridgett has previously helped in Friday Doctor Q&A from November 2011 to February 2012 and MarcieMom has invited him to share more about the Combined Approach. 

Why is it a Combined Approach?

The Combined Approach is about using conventional topical treatment (steroids and moisturizers) together with the elimination of self-damaging behavior using habit reversal techniques. ‘Atopic Skin Disease’ was published in 1996 as there was much success using The Combined Approach, which was reported at the European Congresses on Dermatology and Psychiatry in 1991 and 1995.

MarcieMom: Dr Bridgett, can you briefly explain the difference between The Combined Approach versus an eczema patient using his/her own ways to divert attention from scratching? Also, if an eczema patient or parent of eczema child comes to know of your approach, can he/she simply pass your manual to a dermatologist that he/she is seeing?

Dr BridgettThe Combined Approach is an exercise in behavioral medicine, and has two elements combined:

1. Optimized conventional treatment (emollients and topical steroids usually) : this is an important part of the approach, and cannot be overlooked!

2. Habit reversal: a formal behaviour modification technique: it requires, when offered to Adults and Older Children, first a period of registration using a hand tally counter – this is continued, as habit reversal is introduced. The inventiveness of the eczema patient is very useful in introducing new successful habit reversal behaviours, but some structure, discipline and supervision is linked to the success reported by many patients, and this requires reference to written material, and is often usefully supported by contact with others.

The manual is available for anyone to consult and follow if they wish, and both nurse practitioners and medical practitioners are successfully using The Combined Approach. An important alternative is to use the self help format set out in the book The Eczema Solution by Sue Armstrong-Brown.

When is Habit Reversal Most Effective?

The main idea is that scratching can often become a habit – that is, the adult or child with eczema then scratches not only because of itch. It is mentioned that adults with severe eczema can benefit most from The Combined Approach. Why is this so? Can you share with us pictures of before and after eczema and what was the habit that was eliminated that led to an improvement?

Dr Bridgett: Habit reversal is most effective

  • in combination with optimized conventional treatment, and
  • when there is evidence of chronic eczema – in adults or children – that is to say, the thickened skin called lichenification, which is due to regular rubbing and scratching that has become a habit, complicating atopic eczema. Any rubbing and scratching of the skin can become a habit, but each person can have their own particular problem. 

In the first pictures below the patient was habitually picking the skin of her forehead when watching TV, resulting in chronic eczema. When habit reversal was added to optimized topical treatment the skin healed very quickly.

Before and After The Combined Approach

In the next pictures, the patient had developed a habit of using the rivets on her jeans to scratch against:

Before The Combined Approach

Before The Combined Approach

After The Combined Approach

 

 

 

 

 

 

 

.

Not Neglecting Topical Treatment

I note that The Combined Approach does start with understanding and explaining the importance of topical treatment, as eliminating scratching is not a stand-alone treatment. Would explaining the structure of the skin and how a weak skin barrier is prone to water loss be important in the first visit? If yes, could you do a quick introduction for our parents to understand?

Dr Bridgett: Yes, The Combined Approach always covers the importance of skin as a barrier, and the importance of optimal topical treatment.

The skin has two layers, epidermis and dermis. The outer epidermis, which carefully replaces itself every four weeks, is important in preventing water getting out from inside, and irritation and infection getting in from outside.

Acute eczema involves inflammation of the epidermis. It’s structure then becomes weakened, allowing excessive water to escape. Extra moisturizers are then needed to stop excessive water loss, and anti-inflammatory topical steroids are also needed. And that’s not the whole story: the inflammation releases itchy substances that cause scratching – and this scratching stimulates over-activity of the epidermal cells. If the emollients and topical steroids are used correctly the situation quickly returns to normal. If not, the scratching continues, becomes a habit and the damaged and sensitive skin of chronic eczema is the result.

For more on skin structure, acute and chronic eczema see http://atopicskindisease.com/articles/FF3

MarcieMom: Thank you Dr Christopher Bridgett for giving us an understanding of the Combined Approach and showed us some of the successful cases. In our next post, we will understand more on the use of moisturizers and steroids as explained in the manual ‘Atopic Skin Disease’.

Silver Sense – Gorgeous Clothing That’s Kind to Skin

Silver Sense Clothing

MarcieMom saw on twitter that Silver Sense is active in eczema community and events and connected with Sarah Davies, co-founder of Silver Sense. Silver Sense is a company based in Nottinghamshire, UK, that creates children clothing made from a blend of natural cotton and silver fibres. Silver Sense’s clothing comes in a family of animals, and MarcieMom interviews Sarah to find out more about Albert the Whale, Gilbert the Gecko, Jeffrey the Monkey, Sidney the Spider, Jude the Crocodile, Olivia the Duckling and Erica the Elephant!

Marcie Mom: Thank you Sarah for taking time for this interview. I’d have to commend you that indeed the clothing looks gorgeous! I read from your site that Silver Sense is set up by your brother, Richard Lamb and you. While his work experience is in medical textiles, yours is in fashion design and product development. Both of you started Silver Sense because you were looking for a solution for your son Jonathan’s eczema. Could you share a little about your journey? For instance, how severe was Jonathan’s eczema? And for how long did you try other treatments before you decided to create Silver Sense? And what other skincare regimen and treatment (if any) do you use even after Jonathan is wearing Silver Sense?

Sarah: Jonathan’s eczema started at approximately 4 months old, to begin with it was quite mild so we tried to treat it solely with emollients which had been suggested by other Mums however we didn’t find anything that offered much improvement. We made changes to our daily routine such as stopping using fabric softeners and just bathing him in water. We found that some of the creams we tried actually made things worse as he had allergic reactions to some of the ingredients. His eczema wasn’t clearing and was in fact spreading to other areas so we made the first of our trips to the doctor.

Our doctor was very understanding and assured us it was ‘just’ baby eczema so armed with more creams and washes we tried again to treat it. Again, the washing cream made it worse and the prescription lotions did nothing, including the very mild steroid cream. By now the patches were infected and would bleed, Jonathan would also try to scratch them whenever he could. He had eczema on his tummy, tops of his arms, shoulders, back of his neck, cheeks and the backs of his knees, these patches were crusty and bleeding. It was very distressing for all of us. We went back to the Doctor and were given a stronger steroid cream which we could only use very sparingly and not on his face, it was horrible to see him scratch his cheek until it was bleeding and I couldn’t find anything to help improve this. The stronger steroid cream did offer some improvement but I hated using it on him and found that when I stopped the eczema just returned to how it was. It was at this stage when I learnt more about the healing properties of Silver and was desperate to find a long term solution that Silver Sense was born.

Jonathan now sleeps on Silver Sense bedding which has cleared up the patches on his cheek and neck. He also sleeps in our jammies and wears a vest every day. In conjunction with his Silver Sense clothing we moisturise him with Doublebase gel, use Oilatum bath additive and on any particularly dry patches we use Lucas Papaw Ointment. We find that we have no further patches on his torso, arms or face, everywhere that is in contact with the silver. He still gets eczema starting to appear on the backs of his knees towards the end of the day as they are not in contact with Silver in his other clothes however his sleepwear prevents scratching in the night and has dramatically improved his skin again by the morning.I do wonder how bad this would be without his Silver Sense clothing? Since using Silver Sense we have had no infected eczema patches.

Marcie Mom: Your range of clothing is very colourful and stylish, featuring babygrows, tops, bottoms, hats, bibs and blankets, all carefully designed to have the seams and labels on the outside. Do all these products have the same amount of silver fibres in the fabric? And of what percentage of the (end) fabric has the 99.9% pure silver sourced from medical textile company X-Static? Is there a minimum % of silver required in the fabric before its anti-microbial properties can be useful?

Sarah: All of our products are manufactured using fabrics that contain a minimum of 4% Pure Silver yarn; this percentage is a requirement to ensure that the products perform. All products are certified by X-Staticto ensure that they contain the correct amount of Pure Silver.

MarcieMom: It is mentioned in your site that silver has been ‘clinically proven to prevent inflammation by naturally calming itchiness..’. How does silver do that?

Sarah: Pure silver kills bugs by breaking down the DNA of bacteria, it is this bacteria that causes the inflammation, itchiness and infection in skin conditions. Bacteria cannot become resistant to the silver ions in our products so continual treatment is provided. The clinical studies that we refer to have been commissioned by X-Static and as such we use the amount of Silver as required by them, to meet their infection kill rates. Continued use will soothe, heal and protect delicate skin.

Marcie Mom: I did a quick search over the internet and saw a few companies that sell silver clothing– what advice would you give to parents who want to assess which clothing brand to choose? For instance, is there a certain type/ grade of silver or certain size of silver fibre to look out for? Or should parents look out for where the silver textile comes from and where the clothing is made? Or is there a certification body that can give product quality and safety assurance to parents?

Sarah: Firstly we would recommend that parents make sure that the clothing is using pure metal silver fibre instead of Nano silver which is a coating that can wash off and leech (leech is the transfer of particles from the material to the surrounding environment). We would recommend X-Static as it is accepted as being the market leader; it is not the cheapest yarn however it is the best in terms of performance and durability. We choose to make our products in the UK as it is where we are based and ensures we have complete control and visibility at all times of our production. Unfortunately there is no certification body however this is something we would welcome and actively be involved in.

MarcieMom: I read on your site that Silver Sense wants to be a truly British brand; you design the clothing, source the silver textile from X-Static (US?) and the fabric is then made in UK and clothing knitted locally in Nottinghamshire. I note with interest that as opposed to certain manufacturers who spray silver on the fabric, you knit it into the fabric. This translates into a more durable product where the silver won’t be washed away. Tell us, what is the product life of Silver Sense clothing and is there any trial conducted as to how many machine washes it can withstand? Also, if the silver can be washed away, is there a chance that over long-term use (say, a mom only uses Silver Sense for her newborn all the way till 5 year old) the child’s skin will be exposed to excessive silver that has leeched onto the skin? Is there any research done in this area? And what is the side effect (if any) on having silver on the skin all the time?

Sarah: We are the only childrenswear brand to knit pure metal silver fibre into our fabrics, when developing Silver Sense we researched many techniques of production and feel very strongly that this is the best and most effective way of adding silver to garments. X-Static have provided us with study data showing fabrics knitted with X-Static are capable of withstanding over 200 commercial laundry cycles without any performance reduction, it is accepted that industrial laundering is far more aggressive than domestic washing however we stress that customers must follow our product care guidelines which include no use of fabric softener and chlorine based bleaches. Without a doubt the pure silver in Silver Sense products will last the life of the garment and will not be washed away.Silver Sense garments will not leech. There are in excess of 300,000 US military personnel that wear X-Static base layer garments on a daily basis and there have been no known adverse side effects, in fact it is quite the opposite, soldiers report that skin conditions are improved in field conditions.

Marcie Mom: Thank you Sarah so much for your time and understanding where I come from when I asked these questions. My readers would know that while I don’t do any product review (nor subject Marcie to product testing), I am always open to knowing more products and asking questions that I think will help parents to assess better their options for their child with eczema. p.s. to readers of eczemablues.com, I didn’t receive any money from Silver Sense or Sarah for this interview and any advertising on eczemablues.com is donated to the eczema fund.

Do you dare to let your eczema child try a bleach bath?

A very cute winnie the pooh bathtub (from summerinfant.com)

Published in May 2009 Pediatrics Journal was the findings of a bleach bath study conducted on 31 children, aged 6 to 17 months, with moderate to severe eczema. The children had staph (see this post to learn about staph), which is a very resilient bacteria on the skin that can cause infection. Half the children were soaked 5 to 10 minutes in a bleach bath twice a week, while the other half in a placebo bath. The children who were soaked in the bleach bath showed decreased severity of eczema within 3 months. The diluted bleach bath act like a antiseptic, which can remove the bacteria. Before trying this on your own, do check with your baby’s doctor and also note the following:

1.      Dilute the bleach and don’t apply bleach directly onto skin. Bleach is an irritant to the skin, so do check with your doctor on the preparation of the bath. For the above study, it’s ¼ cup bleach diluted with 40 gallons of lukewarm water. The concentration of sodium hydrochlorite in the bleach should not be more than 6%.

2.      Rinse off the bleach, pat dry and moisturize generously within 3 minutes of the bath.

3.      The neck and head was not in the water for the study. It was published online though that the doctor of this study, Dr Amy Paller, suggested closing eyes and submerging head into the bath to clear the bacteria. I’m not sure about this as my baby Marcie keeps drinking her current oatmeal bath!

4.      A 14-day oral antibiotic was given at the same time during the study, and moisturizing too. This meant that bleach bath is not a standalone treatment (in fact, bleach can dry/irritate the skin, so do dilute and moisturize a lot).

5.      Bleach bath should not be used for cracked skin, and consult your doctor first (I know my baby’s doctor recommended swimming and chlorhexidine, which also serve to remove the staph bacteria).

My take is I don’t dare and won’t try bleach bath, since chlorhexidine (antiseptic) had worked for my baby. Swimming had also worked for her, even when we only brought her weekly (as opposed to her doctor’s advice to bring her 3 times/week). Do you dare to try the bleach bath on your child? If you have, do let us know how it went, thanks!

Alternative treatment – TCM for child eczema

TCM uses herbs, acupuncture and cream for treatment

You may have been asked by your friend to explore TCM (“Traditional Chinese Medicine”) treatment for your child and wonder if it is viable. I wondered the same and read whatever I could online on it. The information is sparse and prescriptions seem to differ based on the TCM doctor’s interpretation of your child’s condition after examining his skin, tongue, pulse and asking questions about his urine, stools, behavioural and sleep patterns. There is therefore no standard prescription and as a result, there is much less research on the effect of the treatment. Below are whatever I understood based on reading online.

TCM Treatment

The treatment is based on that the skin is affected by the ‘inside’ of the body and thus, herbs or acupuncture may be used to treat your child’s kidney, spleen or liver. The treatment is usually to remove toxins, phlegm, dampness and ‘heat’ in blood. Acupuncture for kids may use the Japanese system sho-ni-shin which does not involve puncturing the skin. Herbs, of up to 15 types, may be prescribed for you to boil and give your child. Cold compress using herbs, oatmeal bath, moisturizing herbal lotion may be prescribed too.

Versus Western Approach

There appears to be many similarities such as moisturizing, soaking in bath oil and control of allergic food. Diet control seems to be prescribed without conducting a skin prick test, and generally food such as cow’s milk, sugar, addictive, food colors and preservatives are to be avoided. I came across an article that suggested not having the child vaccinated as vaccination has toxin (I think vaccination is important and unless supported by strong medical evidence, we should not be excluding vaccination for our child).

So is TCM Safe?

I always think it is safer to consume something when the side effects are known then to consume something with no known side effects (since no one tested it)! The herbs that TCM prescribe may be anti-inflammatory, antihistaminic or immunosuppressant. The improved results may not take place at all or from 2 weeks to 8 months from what I’ve read on other parents’ forum posts or blog or research. The biggest question obviously is we know oral steroid works very fast but we know it is not for long-term use (in fact, my baby Marcie’s doctor said strictly once for Marcie), is it possible then for a TCM medicine to work equally fast and yet so safe that no side effect is known? So far, there are people online that sent their TCM medicine for lab analysis and found to contain steroids (equally, you will find others saying TCM doesn’t contain steroid), people who stopped the TCM medicine and the rashes came back or others who continue with steroid application while undergoing TCM treatment.

As mentioned earlier, the research is too little on TCM and for children, I personally won’t risk it, unless I have access to a lab and can test everything the TCM doctor gives my baby.

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

Citrus Fruits

“OH NO, could it be what I ate?” This was what went through my mind when I first read that pregnancy diet could increase the chance of my baby getting eczema (and my baby girl Marcie has eczema since two weeks old). I am not writing this post to put more guilt and blame into your life, but rather, if you’re considering a next child, it will be good to avoid some food or increase the intake of others. There is no conclusive evidence despite some scattered research reported on the web, so the overriding consideration is still to have a balanced diet (because a diet that is not balanced can lead to a whole host of other problems in the foetus and mothers who restrict their diet have resulted in smaller babies).

Here are some food to avoid:

1. Margarine; vegetable oil (too much will be too fat anyway)

2. Citrus fruit; celery (I ate lots of oranges during my pregnancy! Then again, my hubby has eczema so it’s more likely hereditary than diet)

3. Peanuts (Again, I ate peanut butter every morning! If your child has eczema or allergy, the advice is to delay giving peanuts till 3 years old)

4. No smoking or alcohol

Results of 2007 German study of 2,641 children is that food rich in n-6 polyunsaturated fatty acids and citrus fruits increase eczema in children up to 2 years old, whereas food rich in n-3 polyunsaturated fatty acids decrease chance of infant eczema. A later Japan study in 2010 shows that green and yellow vegetables, citrus fruit and beta-carotene reduces chance of infant eczema. (So citrus or no citrus?)

Here are some food to increase:

  1. Fish or fish oil
  2. Lactobacillus reuteri as oral probiotic supplement (my friend with eczema was prescribed this during pregnancy and both her girls turn out with no eczema)

Personally, I will eat more fish, take the probiotic supplement, not eat so many oranges nor peanut butter in my next pregnancy. I know how scary it is thinking our next child will also have eczema, fingers crossed..

Update: Almost 2 years later, we’ve decided not to have another child BUT more importantly, linking this article to a Q&A that I did with nutritionist Judy Converse on breast milk and pregnancy diet.

Update for a study in October 2014 that studied associations between maternal iron status in pregnancy and childhood wheeze and atopy. The results suggest that reduced maternal iron status during pregnancy is adversely associated with childhood wheeze, lung function and atopic sensitisation, justifying further studies on maternal Fe status and childhood asthma and atopic disease.

Update for a study in Nov-Dec 2014 that looked at all past studies Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches. Conclusion was did not find widespread or consistent links between mothers’ dietary intake and atopic outcomes in their children. However, maternal consumption of Mediterranean dietary patterns, diets rich in fruits and vegetables, fish, and vitamin D-containing foods were suggestive of benefit, requiring further evaluation.

Alternative treatment – Udder Cream as Moisturizer for Eczema

Udder Creams

Udders are mammary glands

Lately, I came across a recommendation by a mom that using udder cream has helped with her child’s eczema. Udders are mammary glands and the care and hygiene of the udders are important in milking. Udder creams are developed to soothe the chapped skin of the udder, prevent infection and irritation during milking. Somewhere along the line, the udder creams have been re-formulated to a less greasy form, and sold to adults and infant for eczema treatment, marketed with the following points:

  1. Natural skin care
  2. Skin repair properties
  3. Anti-inflammation
  4. Anti-fungal
  5. No paraffin oil

Over in forums, some moms have feedback it worked while a few others lamented that like other natural creams they have tried on their children, it irritated their skin. I haven’t tried it or on my child, but seems like most of these udder creams are not sold over the shelves but instead through stockists or online; like Moogoo and Dr Hess.

Alternative treatment – Does Manuka Honey help with eczema?

Manuka Honey

When my baby Marcie got hand-food-and- mouth disease, my brother introduced me to Manuka Honey as it supposedly can help to reduce the ulcers in the mouth. After doing a google search, I am surprised to find that there are many links relating to how manuka honey can help with eczema. Being curious, I did a little research and though the verdict is still not conclusive, Manuka Honey seems to be a fairly safe product with no known side effects.

What is Manuka Honey?

– Produced by bees that collect pollen from manuka bush native to New Zealand, proven to have anti-bacterial property above ordinary honey

– UMF stands for Unique Manuka Factors, where say a UMF 12 stands for 12% solution of antiseptic

How does it help with Eczema?

– Stops infection and reduces inflammation

Moisturize, soothe and repair dry, cracked and damaged skin

Other Benefits

Other benefits published in a 2006 article DailyMail.co.uk suggest ability to fight superbugs, bacteria that causes gum disease, soothes sore throat and helps with digestion

Word of Caution

– Got to find active manuka honey in cream form, rather than applying honey direct onto baby, o.w. so sticky (and yucky or yummy, depending on how you see it!)

– One teaspoon is recommended for adults, so not to be given in excess to children

– Not to be given to babies below one year old (some links recommend 2 year old)

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