Crossword for Eczema Kids – I Can Shower!

Teach your child some best shower practices to protect their dry/ eczema skin

Teach your child some best shower practices to protect their dry/ eczema skin

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1. Should I pat myself completely dry after shower?

3. What temperature water should I not use during shower?

6. How many minutes after shower should I moisturize? (Ideally: It’s immediate, but dermatologist’s rule is (how many) minutes)

8. What item should I not use on my skin to wash myself? 11. How many minutes should I shower? Too long shower dries the skin!

12. Meaning: Not harsh. Be sure not to use harsh cleanser for your shower!

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2. What plant can be made into a bath oil for your skin?

4. How often do I shower in a day?

5. What I use to clean my hair

7. Showering too many times is _ _ _ _ _ _ to the skin

9. The gentle action that you can take dry the skin after shower, using a towel

10. What can I use on my skin during shower to make it smoother? Bath _ _ _

You also have the option of downloading the pdf and if you need help with the answers, click here.

Learning to shower right is very important, think of many times you shower in a year! If you like the pdf version, click here and here for the answers!

More on showering in the following posts:

  1. Q&A with Dr Jennifer Shu – Bathing for Eczema Babies
  2. How to Shower your Eczema Child
  3. Video: How to Shower Eczema Baby
  4. Eczema Cure series: Do Baths Matter
  5. Eczema News – Use of Bath Oil for Eczema

AAD A:Z Videos with Dr Lawrence F. Eichenfield – Eczema Bleach Bath

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “Eczema: Bleach Bath Therapy”. For this video, I interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine. Dr. Eichenfield’s clinical interests include atopic dermatitis, and serves on the editorial boards of several journals and periodicals, and is Co-Editor in Chief of Pediatric Dermatology.

In the video, the key points covered are:

  • Bleach bath is useful for children whose eczema is frequently infected.
  • Always ask the dermatologist before starting on bleach bath therapy.
  • Preparation of the diluted bleach bath – Half cup of bleach for a full tub of water or 1 teaspoon of bleach per gallon of water
  • Soak 5 to 10 minutes and to check with doctor on the frequency (per week) for the bath
Questions answered by Dr Lawrence Eichenfield on Eczema: Bleach Bath Therapy

Questions answered by Dr Lawrence Eichenfield on Eczema: Bleach Bath Therapy

MarcieMom: Dr Lawrence, thank you for helping out in this AAD video series once again. In our previous interview on Eczema Tips, I asked the question on what infected eczema looks like. Your reply was

Infected eczema can appear as unusual oozing or honey-colored crusting.  It can occasionally show as pus bumps, or as tender, red, warm skin.  Inflammation can also appear red, as well as “rashy” and scaly.  The bleach baths are usually recommended for children who have problems with skin infections, rather than just the inflammation seen with simple eczema flares.

MarcieMom: In another interview with Dr Clay Cockerell, readers of this blog learnt that there are both good and bad bacteria on the skin. The common ones are (1) Staphylococcus epidermidis, (2) Staphylococcus aureus, (3) Streptococcus pyogenes (4) Corynebacteria and (5) Mycobacteria. We also learn that

Bacteria multiply exponentially, so when its population is temporarily decreased, as after the use of hand cleanser, it re-grows quite quickly and returns to its normal concentration.

MarcieMom: We know that the main benefit of bleach bath is to reduce the harmful bacteria, in particular, staphylococcus aureus that often colonizes eczema skin and promotes skin inflammation.

MarcieMom: Will reducing staph bacteria via a bleach bath be only effective for a short time and the harmful bacteria quickly proliferate after the bath? 

Dr Lawrence: Bleach baths appear to decrease the quantity of bacteria on the skin, probably transiently. There have also been some studies to show that hypochlorous solution, the active ingredient in bleach bath, may have anti-inflammatory effect. We don’t really “wipe out” bacteria on the skin with bleach bath, but only tame it down for a period of time. However, they have been shown very useful as part of therapy in eczema that gets frequently infected

MarcieMom: It is mentioned in the video to consult the doctor before starting on bleach bath therapy. What are the factors that a doctor will consider when deciding whether bleach bath is a suitable (or not suitable) treatment for a child with eczema?

Dr Lawrence: When considering bleach bath, doctors will usually consider the overall degree of eczema, the tendency to have secondary infection, which can present as honey-colored crusting, as well as the age of the child. Bleach baths, while very useful, are usually therapy used in addition to regimens of moisturizing and topical anti-inflammatory therapies, as “add-on” for more difficult eczema to manage.

MarcieMom: In the video, we saw that household bleach is used for the bleach bath and we should check that there is no more than 6% sodium hypochlorite in the bleach. I realized that many household products (including bleach) do not label their contents (not mandatory requirement in every country) and that many bleach products have fragrance.

MarcieMom: What is your suggestion on how to get the right bleach product? In the event that parents can’t find a bleach product that is fragrance-free with clear labeling, what is the alternative product?

Dr Lawrence: You are correct to bring up the issue that there is variability in concentrations of bleach bath, as well as bleach not being available in all countries. Also, we have become aware that there are more concentrated forms of bleach being sold to decrease shelf space in grocery stores. Parents need to take a look at the percentage of sodium hydrochlorite, and if there are using a more concentrated version adjust the formula. There are commercial alternatives, including some readily available non-prescription products that have sodium hypochlorite solution as their active ingredient. For instance, CLn body wash, marketed by TopMD that offered this product through their website or Amazon.com. This product has had several studies that have shown benefits in pediatric atopic dermatitis.

MarcieMom: Staph bacteria is the cause of many other skin infections such as cellulitis, impetigo, folliculitis and staphylococcal scalded skin syndrome. Using bleach bath can be preventive, so that there is less likelihood of an infection. It is better than treating an infection using antibiotics that may lead to antibiotic resistance. However, a bleach bath can be drying for the skin since bleach has a pH level of 11 to 13, thus considerably alkaline. Alkaline products can also lead to reduction of ceramide-producing enzymes, decreased skin lipid production and dry skin.

MarcieMom: Is there a way to adjust the skin pH after the bleach bath? For instance, will rinsing off residual bleach bath water be useful or will it decrease the effects of the bleach bath?

Dr Lawrence: When using bleach bath, it is important to handle the skin as with regular baths, with use of emollients/moisturizers after bathing. Some experts will rinse off the residual bleach bath water, while others will leave it on the skin. In studies, it does not appear to make a significant difference, though experts do vary in their suggestions. Certainly application of moisturizers will help, and in any case, the application of moisturizers after bathing will help to improve the skin function, including recovering the pH to normal level.

Thank you Dr Lawrence for helping us to increase our understanding of the bleach bath and clarify questions and reservations we parents have.

Eczema ‘Cure’ Series – Do How We Bathe Matter?

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

There is a fair amount of suggestions by the dermatological community on how and what to bathe with to help eczema skin. Some eczema sufferers also shared on what they use, though in general, it is less often cited as a ‘cure’ compared to the first 3 series of this post on:

Personally, I alternate between an oatmeal-based bath, a chlorhexidine-based bath lotion and a hypoallergenic cleanser for my eczema child (Marcie, who’s 6 years old now!). I haven’t dared to try a bleach bath nor mixing vinegar though these two have also been recommended by dermatologists. Let’s explore the various baths for eczema sufferers!

Bath for Eczema Skin

Bath to Try #1 – Soaking

If you have a bath tub or your child still fit into one, soaking in a bath tub (not hot water, but use lukewarm or room temperature) for not more than 10 minutes can help the skin to absorb water. Especially for those of you who have to endure dry, winter months, possibly dissolve a thick emollient into the bath as well! Note: Don’t soak your head in the tub!

Bath to Try #2 – (Colloidal Oatmeal) Bath Oil

Bath oil – Try colloidal oatmeal bath or other bath oils but be sure they do not contain the key irritants such as fragrance. Oatmeal bath can relieve eczema itch. Bath oil tend to leave a film on the skin and possibly a quick rinse will suffice instead of trying to wash the ‘film’ away – I guess that’s a bit defeating the purpose of using a bath oil. Here’s a study on bath oil for infants.

Bath to Try #3 – Bleach Bath

The main purpose of bleach bath is to kill the staph bacteria that often colonizes eczema skin. I’ve the privilege of interviewing dermatologist Dr Cheryl Lee who is an early proponent of bleach bath (more here). Bleach bath is to be limited to no more than 3 times a week. A study on bleach bath here and updated research news on bleach bath here.

Bath to Try #4 – Chlorhexidine

I used to wipe my child’s skin with chlorhexidine when I noticed persistent itch or redness. Since I’ve been prescribed a chlorhexidine-based shower lotion, I’d use it say once a week especially as my child has quite a few ‘high bacterial’ habits! More on chlorhexidine and bleach bath from my interview with dermatologist Dr Clay Cockerell.

Bath to Try #5 – Vinegar Bath

If bleach sounds too aggressive/ chemical/ toxic to you, consider vinegar. I’ve had an informative interview with Dr Cheryl Lee where she shared how vinegar balances the skin pH level on top of killing the staph bacteria. Vinegar bath may be stinging for some eczema skin/wounds, check with your doctor first.

Other Baths

Some like to add magnesium flakes into bath, while others use salt.

Bath NOT to Take #1 – Hot

So many eczema sufferers SUFFER FROM ITCH and sometimes, uses hot water to numb the itch for a relief during shower. However, hot water strips moisture from skin, avoid at all costs.

Bath NOT to Take #2 – Soap

Soap is drying because it’s way too alkaline for our skin, more here on soap here. It often causes skin irritation too.

Bath NOT to Take #3 – Too Long

Too long a shower strips moisture from skin – it’s a bit mind boggling when you first heard of it, shouldn’t the longer you shower be more moisturizing? It’s not – think of it as a thunderstorm washing off the cement in the brick wall.

Bath NOT to Take #4 – Bubble Bath

Most of the bubble bath solutions contain irritants, avoid bubble bath for children with eczema.

Bath NOT to Take #5 – Exfoliating Bath

Our skin exfoliates on its own – using scrubs can further break down the skin barrier which is already ‘weak’ for eczema sufferers.

Bath NOT to Take #6 – Bath without Moisturizing After

Pat dry (not rub dry), moisturize within 3 minutes after shower. More in this video.

If bathing is so troublesome, why not forgo bathing? First of all, that’s downright unbearable, especially for us in hot weather cities (Singapore, Asia, Australia and parts of US too!). Secondly, bathing has a purpose to remove dirt, sweat and skin debris which can also be irritating if left to accumulate on the skin. Instead, you can try shortening the length of a shower or reducing the number of times you shower (in a day, not a week! – No way I can don’t shower everyday in Singapore!).

Do share your bathing tips in the comments, we love to hear more of what you’re doing!

Eczema News – Use of Bath Oil Reduce Xerosis and Eczema

Last week, we looked at the study on detergent and this week, we’re focusing on bathing (video on Baby Bath Basics). We know that soaps are to be avoided as it is drying to the skin and adjusts the skin pH to more alkaline than it should be. You also know that I use bath oil for my daughter Marcie, including a cartoon below on care after the bath!

But does bath oil really help dry skin (xerosis) and eczema? This study in Norway examines that, let’s take a look at it!

Bath Oil for Eczema Child

We use bath oil, instead of soap for shower; A few times, we slipped cos the floor is really bath oily!

Study title: Can Early Skin Care Normalise Dry Skin and possibly Prevent Atopic Eczema? A pilot study in young infants

Study objective: Assess if xerosis, and possibly eczema, could be reduced at six months of age by early introduction of frequent oil baths/facial fat cream in infants with dry skin.

Study method: 56 six-week-old infants with xerosis (dry skin), but not eczema, are separated into 2 groups – one using bath oil frequently (up to 7xs/week) and moisturizer on face, while not the other (sparse use). The skin outcome is measured at 6-month old.

What’s Bath Oil to do with Baby Skincare?

The observation is that for babies with eczema, the onset of their eczema (45% of eczema kids have eczema in first 6 months of age) is characterised by altered skin barrier, increased water loss and defective lipid layer. Bath oil retains the moisture on skin. Moisturizers and bath oil are often part of eczema skincare but can it have preventive effect? 

Bath Oil Preventive on Xerosis and Eczema

A note on Xerosis (dry skin)

The study aims to investigate if frequent use of bath oil and moisturizer can reduce dry skin. Dry skin is an indication of defective skin barrier, being unable to retain moisture and have low skin lipids. The defectiveness of skin barrier is in-part genetic, linked to filaggrin gene, but also have an environmental element to it. In the study, the researchers put it succinctly as

Xerosis (dry skin) is a common feature of AE.. The abnormalities found in the stratum corneum involve increased water loss through the skin and reduction in total skin surface lipid. Normal desquamation of the stratum corneum depends on pH dependent proteases with normal function at low pH. Elevated pH of the stratum corneum increases serine protease activity, with secondary generation of inflammatory cytokines and reduced activity of lipid-processing enzymes, resulting in a defective lipid layer.

A Western lifestyle with excessive use of soap and water and skin care products may change the pH of the skin surface in addition to changing the hydration of the skin, thereby influencing the barrier function of the skin.

Skin pH is one of the many factors leading to defective skin. Do read Dr Cheryl Eberting’s series on skin pH. In the post I did with Professor Hugo in 2011, it is mentioned that the lack of filaggrin gene also increases the skin pH and leads to increased skin inflammation. (fyi: elevated skin pH, increasing skin pH = more alkaline than the skin should be, one of the reason why soap is never recommended for dry skin as it’s alkaline – we want the skin to be slightly acidic).

Conclusion: The intervention group had more often normal skin (75%) at six months than the observation group (37.5%), and less often probable atopic eczema. No adverse reactions were reported.

My take: I do use oatmeal-based bath oil on alternate day. Now that my child is at preschooler age, we no longer soak her in the bath tub but just apply and rinse like normal bath lotion.

What’s your take? Do you have a few seconds to drop a comment and share?

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

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

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

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

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

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

Eczema and Skin pH

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

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

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

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

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

Eczema and Skin pH - Steps to take

 

Dr Cheryl Lee:

1. Bleach Baths Really Work:

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

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

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

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

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

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

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

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

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

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

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

5. Wet Wrap Therapy if Your Eczema is Severe:

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

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

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

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

7. Allergen Avoidance and Patch Testing if Needed:

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

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

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

(Video) How to Shower Eczema Baby – More or Less?

This is the third of baby skincare series, focusing on shower. The previous two videos were on Common Baby Rash and Sun Protection for Kids. I NEED YOUR SUPPORT, do subscribe to my EczemaBlues channel here. As I’m just starting out, and camera-shy, the video is my voice over slides that I prepared. Do share your comments pleeease on how I can improve them.

Now on how to shower your baby, the foremost is to recognize that your baby’s skin is different from adult skin – it is thinner and more susceptible to loss of natural oil and moisture. Also, babies (despite all their poop and pee) are not ‘dirty’ and showering can be limited to once in 1-2 days, depending on the weather, humidity and sweat.

Showering is drying to the skin, as it is akin to washing off the protective layers of skin cells and therefore, long and hot shower is to be avoided. For babies with eczema, it is MOST important to moisturize right after shower. As to what shower to use, it can be non-fragrance bath oil, colloidal oatmeal bath and for babies who are bathed in a tub, it’s good practice to shower the hair after bathing the baby so that he/she won’t be soaking in used shampoo. For more expert tips on how to bathe your baby, check out the tag link ‘bath’.

Do watch the video for more details and as always, appreciate you sharing your experience, thank you!

Eczema Research News – Reduce Staph Bacteria?

Reducing Staph Bacteria helps Eczema Child

Reducing Staph Bacteria helps Eczema Child (picture from summerinfant.com)

This is part of a quarterly round-up of some of the recent eczema-related studies, so that we can be aware of possible treatments and their efficacy (and I can also keep myself updated with the latest eczema research!)

Today’s topic is on Staph Bacteria, should we Reduce it? Staph, short for Staphylococcus aureus, is a bacteria that is frequently found on the skin of eczema patients. I have wrote about staph bacteria from as early as 2011, covering topics from:

What Causes Your Child’s Eczema – Staph (series from review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora)

Staph Bacteria series with Dr Clay Cockerell

MRSA (Methicillin-Resistant Staph Aureus) decolonisation

At the same time, I have been encouraging parents to bring their children for swimming or to clean the child’s eczema skin with chlorhexidine, with the intention of reducing the staph bacteria which promote skin inflammation via the provocation of mast skin cells. My purpose today is to update on the literature behind staph bacteria, in the hope of knowing if we ought to be more vigilant at reducing the staph bacteria on our child’s skin.

What is Staph Bacteria?

Staph is short for staphylococcus aureus, a very resilient bacteria found on the skin that can survive in dry condition and on dry skin with little oxygen.  It tends to involve areas that are warm and moist especially such as skin near mucous membranes such as the nose, mouth, genitals and anal area. It is found in about 25-30% of healthy adults who are known as carriers and generally does not cause an infection in those with otherwise healthy skin. However, in almost 90% of eczema patients, staph bacteria colonizes their skin.

What harm does Staph cause?

According to this paper, the staph bacteria “causes immune-system cells in the skin to react in a way that produces eczema-like rashes. The release of the molecule, called delta toxin, by staph bacteria caused immune-related mast cells in the skin to release tiny granules that cause inflammation”. Read also this study by Dr Herbert Allen, MD.

How to reduce Staph bacteria on our child’s skin?

Swimming, bleach bath, chlorhexidine

What’s the studies on treatment involving the active reduction of staph bacteria?

We are interested in this, obviously, it is important to know if the measures that we are taking in the care of our child’s eczema skin is effective. Based on the studies I looked up on PubMed from 2013 onward:

Bleach bath is effective in eczema treatment, via reduction of staph bacteria (here)

Confirmation that children with eczema have staph bacteria colonization on their skin (here), likewise for adults (here, in particular it was hypothesized that staph bacteria colonization may have facilitated the penetration of allergens into the skin, triggering rash)

Update for August 2015 study which contrary to previous studies, showed that a four-week, twice-weekly regime of bleach baths is no more effective than water in a double-blinded, placebo-controlled cross-over trial.

Staph bacteria associated with higher severity of eczema (here)

A number of studies mentioned the concern over MRSA, and that prescription such as fusidic acid may lead to the bacteria being resistant to treatment (here).

Have you tried any of the staph bacteria reduction tips for your child? Is it effective? Do share in the comments, thank you!

Rise and Shine Feature – Seminar with Dr Lynn Chiam on Skin Functions

Rise and Shine Expo Seminar with Dr Lynn Chiam, on Children's Skin

Rise and Shine Expo Seminar with Dr Lynn Chiam, on Children’s Skin

From 27 to 29 September 2013, Rise and Shine Expo, an informative expo to raise happy and healthy children was held in Singapore. There were more than 100 seminars, workshops and trial classes held and one of the seminars by dermatologist Dr Lynn Chiam was on ‘All about Children’s Skin’, a topic I’m very passionate about.

Dr Lynn Chiam of Children & Adult Skin Hair Laser Clinic is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. She was formerly the head of paediatric dermatology at National Skin Centre, Singapore before leaving for private practice. She has vast experience in childhood atopic dermatitis and childhood birthmarks. She has previously shared her expertise in this blog on Teen Eczema and Facial Eczema.

Dr Lynn’s Seminar at Rise and Shine Expo

The seminar was held at the stage area in Hall 401, Suntec City Convention Centre at 4.30pm, Saturday 28 September. The parents who turned up were very keen to understand more about children’s skin, as most of their children had either eczema or other skin conditions.

Skin Functions

Dr Lynn shared on the various functions of skin, that is more than a covering but also

  • Acts as a barrier to prevent the penetration of irritants, toxins and harmful organisms

  • Prevents moisture loss

  • Shields the body from harmful UV light

  • Forms part of our immune system

  • Regulates temperature and part of our body’s sensory mechanism (touch)

Function of skin for a baby

The baby’s skin is different from that of adult, being (i) thinner, (ii) less hair, (iii) less oil and (iv) less pigmentation. It is also less equipped to handle temperature changes, sunlight and prevention of moisture loss, and is more vulnerable to toxin, blistering and erosions. A new born baby’s skin is covered by vernix caseosa, a creamy white substance that helps the newborn adjust from being in a womb to outside when delivered. It is lubricating and has anti-bacterial function.

Skin Changes for a Baby

The baby’s skin will undergo changes, gradually getting thicker with less permeability and with more mature sweat and sebaceous glands. There is then less heat and moisture loss.

Care of Baby’s Skin

The newborn baby’s skin does not require much washing, bathing once daily or once in two days is sufficient. Hot water should not be used and avoid showering more than 10 minutes, always taking care to pat dry instead of aggressively rubbing dry. As baby’s skin is more susceptible to sunburn, sun protection with at least SPF 30 and also wearing protective clothing, hats and not going out from 10am to 4pm in direct sunlight is important. Topical creams or lotions can be used in infants but parents must be careful to examine ingredients to ensure no toxicity or irritants.

The most common skin irritation by baby is diaper rash, which is a form of irritant contact dermatitis, triggered by faeces (watery stools) and urine. The diaper results in a significant amount of time for which the urine is in contact with the skin, taking into account all the time a newborn spent lying or sitting down. The skin ought to be gently cleansed and lubricants applied.

Next week, I will be posting on the next segment of Dr Lynn’s talk on common skin conditions and grateful to Dr Lynn Chiam for reviewing the above on her talk at Rise and Shine Expo.

SOMEONE manages Bathing and After-Bath Skin Care

Read on Julie sharing how she manages bathing and after-bath skin care

Read on Julie sharing how she manages bathing and after-bath skin care

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Julie C., a married mom, who has had eczema since she was 5 years old and shares how she manages her baths and after-bath skin care. Marcie Mom: Hi Julie, thanks for agreeing to be part of this series! You were sharing with me that your eczema may not be apparent to many, had it been more severe in your childhood?

Julie: Yes, as a child I had very visible eczema patches on my face, arms, and legs. Not only was the eczema painful but the other kids teased me about it. My parents tried to help, but none of the remedies recommended by our doctors worked. Unfortunately, it continued into my teenage years and made it difficult to date. Today, I get lots of compliments about how beautiful my skin is.

Marcie Mom: Were there any difficulties you had managing your bath and the after-bath skin care? And how have you finally figured out a routine that works for your skin?

Julie: Yes, there were. Many soaps and shower gels would burn. Many lotions would burn and make things worse – especially on my face.

For bathing, I use a mild soap which is safe for the face too. If I am having a flare up, plain warm water works best for me until the flare up passes. Sometimes when I feel a flare up coming on, I am able to use a liquid antihistamine to stop it.

As an adult, I’ve come to realize my eczema definitely has environmental triggers; however, for me, stress is big a trigger too. To manage stress, I exercise, eat well, and get enough sleep.

Just by doing a little observation and research, I learned what my environmental eczema triggers are, how to avoid them, and what to do if I accidentally come in contact with them.

One big environmental trigger is clothing. People with eczema may want to avoid red clothing. The red dyes seem to be a trigger. Also, be careful about what you wash your clothes with. Your laundry detergent doesn’t ever completely rinse out of your clothing and it could be contributing to your flare ups. The same thing applies to liquid fabric softeners.

Certain foods can lead to flare ups too. For example, there is a certain brand of spaghetti sauce which causes flare ups for me and my niece.

Marcie Mom: What about cosmetics? Any allergies to any cosmetics and what do you do to minimize any potential eczema flares, especially on the face?

Julie: I don’t have a need for foundation, but I do wear lipstick and it can be hit and miss. Most of the pricier brands seems to be safe; however, I once got an eczema break out on my lips from a specific shade in a brand I frequently use!

Marcie Mom: One final question – do you have a favorite facial mask for your face?

Julie: My facial regimen is surprisingly simple.

No facial masks at this point. For washing I use: a mild soap, sometimes I only wash my face with plain warm water, and sometimes I use a rice scrub for sensitive skin to exfoliate. (Warning: Never exfoliate when you’re in the middle of a flare up!) I always use my hands to wash my face – never a cloth or a sponge. I do not dry my face either. After cleansing, while my face is still wet / damp, I apply a very mild moisturizing lotion or a dot of petroleum jelly.

Marcie Mom: Thanks Julie for taking time to share this with me, and many other ladies out there will surely be able to identify with your routine!

Dermatology addressed at Rise and Shine and Carnival GIVE-AWAY

I’m one of the partner bloggers for Singapore’s Rise and Shine Expo, and the neat part of this expo is that they also address dermatology (read one of the founder’s eczema journey here).

Their expert panel includes dermatologist, Dr Audrey Tan, who has answered two dermatology questions on their site here. Below is an extract, do read Dr Audrey’s full reply:

What are the side effect of applying steroids on a baby less than 2 years old and what are other effective cures other than steroids?

Dr Audrey Tan: It is safe to use a topical steroid on your son’s skin as long as the steroid is of the potency appropriate for the degree of skin inflammation, and it is applied only on affected skin…

What kind of baby products should I use on my baby who has mild eczema problem? Are there any special ingredient I should look out for or avoid when buying products? Can my baby continue with swimming since swimming will dry out the skin?

Dr Audrey Tan: Applying a moisturizer is an important part of the daily skin care routine for your baby with mild eczema…

Rise and Shine is also holding a carnival on 3rd March 2013, Sunday, 8.30am to 12.30 pm, at The Lawn @ Marina Bay. Dr Amy Khor is the guest of honor, and there’s goodie bags, fun activities and talks relevant for kids, see below poster on how to register!

AND the FIRST TWO PEOPLE (in Singapore with valid email address) to COMMENT in this post will receive TWO Adult tickets FREE for the Carnival. The early bird ticket is worth S$8 each. Giveaway ends at 3pm this Thursday 28 Feb 2013.

Rise and Shine Carnival

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