A is for Atopic Dermatitis

Atopic Dermatitis or Atopic Eczema

An A that is as confused as our nomenclature

Well, the first step of recovery is acknowledging the problem. Borrowing from Alcoholics Anonymous, their 1st of the 12 steps is We admitted we were powerless over alcohol – that our lives had become unmanageable.

In our case, it is difficult to fully acknowledge the problem when we don’t know what the problem is. The irony is that there is difficulty defining the problem – in fact, the very term “atopic dermatitis” seems to be somewhat a matter of contention.

Mostly, we understand atopic dermatitis to refer to a chronic skin condition characterized by itch (pruritus), dry skin and inflammation, which waxes and wanes (with flare-ups). It is a multi-factorial condition, with causes and triggers linked to autoimmune and genetic factors, defective skin barrier, staph aureus bacteria colonization and hypersensitivity to allergens (including environmental ones like inhaled allergens, food allergens and contact allergens).

The difficulty is that there are many forms of dermatitis, and there are overlaps in symptoms and treatment. Broadly speaking, we want a way to differentiate whether we get the skin inflammation/ rashes because it is linked to immunoglobulin E (IgE) (antibodies produced by the immune system which defend the body but our immune system can wrongly recognize harmless substances as something to fight against, thus leading to allergic reaction). For instance, there are other forms of dermatitis where IgE is not involved, notably irritant contact dermatitis (where your skin develops rashes because it is in contact with a substance over a prolonged period).

There was an article published1 in European Journal of Allergy and Clinical Immunology in August 2016 which suggested the use of the term atopic dermatitis in literature, to differentiate from eczema which is commonly used to cover all forms of inflammatory rashes. Quoting from the article that reviews the existing literature:

Atopic dermatitis is the most commonly used term and appears to be increasing in popularity. Given that eczema is a nonspecific term that describes the morphological appearance of several forms of dermatitis, we strongly suggest the use of a more specific term, AD, in publications, healthcare clinician training, and patient education.

On the other hand, another article2 published in the Acta Dermatovenerol Croat highlighted that the Nomenclature Review Committee Of The World Allergy Organization recommended the term “eczema”. As extracted from World Allergy Organization website,

The umbrella term for a local inflammation of the skin should be dermatitis. What is generally known as “atopic eczema/dermatitis” is not one, single disease but rather an aggregation of several diseases with certain characteristics in common. A more appropriate term is eczema.

…eczema in a person of the atopic constitution, should be called atopic eczema.

The non-allergic variety can also be described by terms like irritant/toxic contact dermatitis.

I wonder why it seemed to be difficult to agree on whether it ought to be atopic dermatitis or atopic eczema, but inserting atopic does help to clarify that the skin condition should be rooted in IgE. Atopy as defined by the World Allergy Organization is:

Atopy is a personal and/or familial tendency, usually in childhood or adolescence, to become sensitized and produce IgE antibodies in response to ordinary exposure to allergens, usually proteins. As a consequence, such individuals can develop typical symptoms of asthma, rhinoconjunctivitis, or eczema. The terms ‘atopy’ and ‘atopic’ should be reserved to describe the genetic predisposition to become IgE-sensitized to allergens commonly occurring in the environment and to which everyone is exposed but to which the majority do not produce a prolonged IgE antibody response.

The “good news” is no matter what you call it, the way to treat it is the same – finding out the triggers, avoidance, moisturizing, steroidal and non-steroidal options, and lifestyle changes to reduce inflammation and staph bacteria colonization. The bad news is we will continue to wonder at the back of our mind whether we are contributing to misleading literature if we fail to clearly define what we’re writing about – well, at least for an eczema/ atopic dermatitis blogger like me, I certainly struggle. A cartoon for it:

Atopic dermatitis or man? Both are as confused!

Atopic dermatitis or man? Both are as confused!

References:

  1. Kantor R, Thyssen JP, Paller AS, Silverberg JI. Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of ‘atopic dermatitis’. Allergy 2016; 71: 1480–1485.

  2. Zbigniew Samochocki, Rożalski M, Rudnicka L, Atopic and Non-atopic Eczema. Acta Dermatovenerol Croat 2016 Jun;24(2):110-5.

Eczema Blues Google Collections

For the past 6 months, I’ve been receiving emails on where to find certain information and this prompted me to create Google Collections for your ease of reference, under my Google Plus Profile

A graphical way to search for eczema related posts on Eczema Blues

A graphical way to search for posts on Eczema Blues

You can continue to find information on this blog, using

  1. Search button on the right top
  2. Topics under menu bar drop-down list at Eczema Tips
  3. Interview series with Featured Guests
  4. Categories on right side column
  5. Tagged words on right side column

Hope that this eczema blog continues to be of help to you and make your life with eczema better!

Top 5 Q&A from Living with Eczema: Mom Asks, Doc Answers

Most of you would know that I co-authored with Professor Hugo, NUH, a book ‘Living with Eczema: Mom Asks, Doc Answers‘ published last year. As an end of the year special, I picked five questions asked and Professor Hugo’s reply (almost half the book is Q&A, I picked these 5 based on being common questions parents of eczema children asked). The book is structured with information surrounding key topics like diagnosis, prevention, triggers, treatment including things that don’t work and future research, followed by Q&A. None of the questions I asked were ‘screened’ as we wanted to keep it as an authentic exchange between a mom and the doctor of her eczema child.

Top 5 Q&A Living with Eczema- Mom Asks, Doc Answers

Top 5 Q&A Living with Eczema- Mom Asks, Doc Answers

MarcieMom: The Hygiene Hypothesis has been interpreted by some to mean they should expose their infants to dirt, and possibly, avoid the use of anti-bacterial products. Is this recommended?

Infants with defective skin barrier or lower immunity would be even more susceptible to the penetration of irritants or allergens, or more susceptible to bacterial infection. So, should a mother take more hygiene precautions for her high-risk infant?

Professor Hugo: In theory this is correct, but the problem is that every baby is unique and needs a different degree of exposure of immune stimuli. This is very difficult to assess in a baby. However, in general, products that destroy the body’s own bacteria, such as antibiotics, should be avoided and only given if necessary (in case of a bacterial infection). There have been studies showing that early administration of antibiotics
increases the risk for subsequent allergy, including eczema. Hygiene precautions taken by parents seem to have little impact on the development of eczema.

MarcieMom: While the skin prick test (SPT) is a faster, more reliable and cheaper option than the blood test, I have heard of parents avoiding it because the name “skin prick” test sounds traumatising for the child. What do you do in your practice to encourage fearful parents to let heir children take the SPT?

Professor Hugo: A good SPT, performed by an experienced person, should be painless. In our department we say that a SPT should be associated with no blood and no cry, even in infants.

MarcieMom: In your experience, how reliable are patients’ observations in relation to what is triggering his/her eczema?

Professor Hugo: Most parents fail to identify the triggers of their child’s eczema, or come up with lists that are non-reliable. Don’t forget that eczema is a chronic disease, needing a chronic or regular trigger. This is very diffi cult to identify, especially when a house dust mite allergy is involved, which can mimic multiple food allergies.

MarcieMom: How long should a patient use the prescribed corticosteroid before giving feedback to the physician of no noticeable improvement in the eczema?

Professor Hugo: Although corticosteroids are still the cornerstone treatment of eczema patches, they are only part of the holistic treatment of eczema. If all measures are taken appropriately, an effect of corticosteroids should be seen within one week. Most children can be treated with mild corticosteroids; only in severe eczema are more potent corticosteroids necessary.

MarcieMom: How do you build trust and relationship with your patient?

Professor Hugo: In a nutshell: be honest, don’t lie, and focus on limitations.

There are many more Q&A in the book and if you like to read it for free and you live in Singapore, it’s available in our national libraries island-wide. Wishing all families with eczema kids a happy new year and your encouragement keeps me going and faith that I’m storing treasures in heaven in this blog ministry. Just like the book, this blog is also dedicated to you.

We dedicate this book to
all children with eczema and
their families and hope that
this book will help all of them.

Prof Hugo and MarcieMom

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?

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?

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.

SOMEONE Manages Eczema Baby and Nut Allergic Child

Gail shares on managing eczema and allergy for her baby son and daughter, and oh, they look so lovely!

Gail shares on managing eczema and allergy for her baby and teenage daughter, and oh, they look so lovely!

This is a 2013 series focused on a personal journey with eczema while managing a certain aspect of life. Today, we have Gail, who shares about managing eczema for her baby and nut allergy for her older daughter. Gail has spent much time looking for products to help families with eczema, and has it all under one roof at her store, Everything for Eczema.

Marcie Mom: Hi Gail, it’s good to have you share in this series! Let’s start with you sharing a little of your older daughter’s nut allergy and the extent of care that is required.

Gail: Hi Mei.  My older daughter, Charlie, was diagnosed with a nut and seed allergy when she was 3 and she’s now 14.  The biggest challenges now that she is a teenager are that she hates carrying her epi-pens around with her as she feels they make her seem different to everyone else.  She will frequently take them out of her bag before she goes to school or out with friends.   Now that she eats out more without me, it’s also a worry as she is very self-conscious about asking whether there are nuts or seeds in a meal.

Marcie Mom: What about care for the younger baby? When did the eczema start and was the scratching intensive?

Gail: My younger daughter’s eczema started when she was just 6 weeks old.  Within a couple of months the whole of her body was covered in eczema and she often needed to have her legs and arms bandaged.  Tallulah was incredibly itchy and would scratch until she bled if left alone for more than a few seconds.  Bath times and nappy changing times were incredibly stressful as this was when she could get at her skin and scratch uncontrollably.

Marcie Mom: How did you manage bedtime for all of your children? What was the most difficult part?

Gail: Bedtime was one of the worst times of the day.  Tiredness would always make Tallulah extra itchy and she would need lots of attention.  This would have a knock on effect on Charlie who would start to feel left out.  It probably didn’t help that I was very sleep deprived too!

Marcie Mom: One final question – was there a turning point during this period which made it easier for your family to manage eczema and allergies for your children?

Gail: Establishing a good bedtime routine really helped.  When my little one was tucked up in bed I would then spend some quiet time with my older daughter so that she felt special too. Finally getting some sleep was a turning point for us all.  Suddenly you start to feel human again!

Marcie Mom: Thank you Gail for your sharing, it is truly not easy to manage all of it and we keep our fingers crossed that night time will get better for all families with eczema kids!

Rise and Shine Feature – Eczema Skin Function and Care

More eczema questions for Dr Lynn after the Rise and Shine Expo

More eczema questions for Dr Lynn after the Rise and Shine Expo

For the past 3 weeks, we have covered Dr Lynn Chiam’s talk ‘All about Children’s Skin’ at the Rise and Shine Expo, Singapore. Today, we are asking follow-up questions from her talk, specifically to help parents with eczema children.

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.

MarcieMom: Thanks Dr Lynn for spending some time here, and helping to address follow-up questions to your talk. You mentioned that the skin function includes protection against sun, and that baby’s skin offers less protection. How about skin of an eczema infant? And the skin of an eczema adult? Do they offer even less protection against the sun as the skin barrier of eczema patients are already defective?

Dr Lynn: Protection against the sun depends on the integrity of the skin as well as the amount of pigment cells in the skin. In general, a baby’s skin is less mature and contains less pigment cells compared to an adult and thus is more susceptible to the adverse effects of the sun. Darker- skinned individual tend to get less sun burn as compared to fair-skinned individuals.

In infants and adults with eczema, their skin barrier functions is defective and they can get broken skin as a result of scratching. This can make them more susceptible to sunlight and exposure to excessive amount of sunlight is known to trigger or aggravate the eczema.

MarcieMom: You also mentioned that the skin forms part of our body’s immune system. Is this due to the skin flora? Does the ‘porous’ eczema skin means that babies with eczema have a lower immunity and does this lower immunity translate to falling sick often? What is the implication for parents in caring for the general health of an eczema baby?

Dr Lynn: The skin contains cells which are involved in the reaction that our body mounts in response to an infection and inflammation. They are known as “B” cells and “T” cells. They can be thought of as “soldier cells” that defend our body when it is “attacked”. The skin flora on the other hand describes the bacteria, fungi and viruses that reside on our skin without causing any harm to our body. They are not part of the immune system.

The “porous” eczema skin allows bacteria and viruses to penetrate more easily and thus eczema patients are at a higher risk of getting skin infections. The skin of patients with eczema do have lower immunity to prevent skin infections but in general this not lead to overall decrease in their body’s  immunity. Children with eczema  do not fall sick more often as compared to their peers.

It is important for parents and health care providers to recognise eczema superimposed with skin infection as the skin infection has to be cleared for the eczema to heal well.

MarcieMom: Is wet wrap/dressing recommended for infants below 6 month old? Does the thinner skin of babies affect whether they ought to be wet wrapped?

Dr Lynn: As the skin of an infant below 6 months has a larger surface area: volume and is thinner as compared to adults, they tend to absorb a larger percentage of creams that is applied. Thus it may lead to side effects as a consequence of more creams that is absorbed via the skin into their system. Thus I will generally not advise wet wraps for infants unless the eczema is very severe and the creams used are very gentle.

MarcieMom: Similarly for steroid potency, is there a certain age by which the skin is thick enough to consider stronger potency steroid cream?

Dr Lynn: There are no guidelines for the potencies of steroids to be used according to age. In general, I will not use anything stronger than a mid-potency steroid in children less than 8 years old. The potency of the steroid used also depends on the thickness of the skin and the severity of the eczema. The neck, inner aspects of elbows, back of knees and wrist are generally considered to have thin skin and only low to mid-potency steroids should be used. Contrary to this, more potent steroids have to be used on the palms, soles and areas where the skin is thick as a result of the eczema.

For more severe eczema, a more potent steroid should be used to control the inflammation before tailing to a less potent one.

Thank you Dr Lynn for sharing your thoughts on the above questions, and thank you for the wealth of information you’ve provided in this blog.

For the 3 previous posts of this series, see

Children Skin Functions

Common Children Skin Conditions

Children Skin Conditions and FAQ

SOMEONE has Eczema and manages Cloth-Diapering

MieVee shared about her cloth diapering journey for her child with eczema

MieVee shared about her cloth diapering journey for her child with eczema

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have MieVee, whose 4.5 year-old child has eczema since 5 months old and shares how she manages her son’s sensitive skin around the diaper area. MieVee runs a successful site MummyReviews.com in Singapore and Malaysia.  

Marcie Mom: Hi MieVee, thanks for taking part in this blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema, when did he first have it and what was the most difficult part of managing his eczema?

MieVee: My eldest son, Vee, started developing a rash at his face during 5 months old. Despite him trying on various creams, the patch expanded to a large part of his face. It was very itchy and disrupted his sleep. Often, he’d rub his face against his pillow till it bled. The most difficult part was getting the rash and itch under control.

When he was about 14 months old, we discovered by chance that he had soy allergy. By eliminating soy from my diet (since I was breastfeeding him), the rash on his face subsided within 2 weeks and eventually disappeared.

However, the folds behind his knees are still prone to itchy rash, if he perspires.

Marcie Mom: I understand that you’d like to share on using cloth diapers for your son. When did you first start to use cloth diaper, and why?

MieVee: I started cloth diapering Vee from his newborn days. My main reasons are to use comfortable fabric against his skin, reduce trash and save money on diapering.

Marcie Mom: How difficult is it to cloth diaper for him, and do you apply any lotion?

MieVee: We use a variety of modern cloth diapers, so it has been very convenient. The easiest to use are pocket diapers with inserts and Velcro tabs. Even hubby could use these easily.

Vee was a high-needs fussy baby, especially during sleep. He didn’t like night-time diaper changes, would scream loudly and couldn’t get back to sleep easily. However, his diaper area would be prone to rashes if his regular diaper was left on for more than 5 hours.

Eventually, I found breathable night-time fleece cloth diapers that absorbed a lot through the night, while letting his skin breathe and remain rash-free. Since then, he slept much better at night.

In the day, he didn’t need diaper cream because we change his diaper every 2-3 hours. At night, because of the long hours, I apply a thin layer of non-zinc oxide diaper cream at his front diaper area. (To prevent the cloth diaper from repelling liquid, I place a disposable biodegradable liner on it.)

Marcie Mom: One final question – what is the best way to fold the cloth diaper?! I couldn’t get it right and gave up within a day!

MieVee: Most modern cloth diapers do not require any folding. Depending on the design, you may insert a rectangular absorbent fabric into a pocket or lay it on the diaper cover, put it on baby, then close it with Velcro tabs or snap buttons. Very easy!

There’re many cloth diaper reviews and tips on my blog to help new parents get started, so feel free to browse through them.

Marcie Mom: Thanks MieVee for sharing your journey on cloth diapering, and your tips!

AAD Skincare Video Series: Eczema Tips

Eczema Tips to Help your Child feel Better by American Academy of Dermatology

Eczema Tips to Help your Child feel Better by American Academy of Dermatology

I’m inspired by the efforts of like-minded individuals and organizations around the world to help eczema families via social media platforms. I came across American Academy of Dermatology (AAD) on Pinterest and they had pinned a Dermatology A: Z Video Series. I asked to feature their videos here, and their team of public relations is helpful and responsive, and made the special effort of introducing me to dermatologists who assisted with my questions and together, we made this series available to you.

Today’s video is “Eczema Tips: How to Help your Child feel Better“. For this video, I’ve interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatologyof 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.

MarcieMom: Thank you Dr Lawrence for taking time to help with this AAD skincare series, and in particular, with the eczema tips for children. It was mentioned that if the child’s eczema is infected, parents can discuss (twice weekly) bleach bath with the doctor.

What are the symptoms of an infected eczema? Is that the same as skin inflammation, which can occur at the underlying layers of skin and therefore not be visible? Would bleach bath be recommended for skin inflammation as well?  

Dr Lawrence: 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: It was mentioned to pat the skin partially dry after shower, before moisturizing. Many parents aren’t sure how to gauge partially dry – sometimes when there’s too much water on the skin after bath, the application of moisturizer seems to feel too ‘slippery’, versus sometimes it feels too much resistance to apply on already dried skin after shower. The guideline is to moisturize 3 minutes after shower. All these seem hard to implement ‘precisely’. What’s the practical way to moisturize?

Dr Lawrence: First of all, don’t get “hung up” on the perfect patting the perfect timing of application of moisturizers.  Pat off enough water so the skin seems dry enough to easily apply the moisturizer, and don’t worry if it’s 5 or ten or even 15 minutes after the bath or shower.

MarcieMom: I understand thick emollients are longer-lasting and suitable to trap more moisture after shower and also to last through the night. Is there a risk that too much application of thick emollients clog pores of children? Would rotating between liquids and creams help and also a little rubbing of skin during shower to make sure emollients don’t get ‘piled up’ on the skin?

Dr Lawrence: There’s lots of variability in skin types, degrees of skin dryness, and environmental/weather factors that influence how moisturizers feel on the skin and are perceived by the users/families.  Usually there aren’t problems with folliculitis or pore-clogging.  When the skin is more dry, gooier may be better.  If less so, less occlusive moisturizers are just fine.

MarcieMom:  On humidity levels, what is the recommended humidity level to not strip moisture from the skin but also not encourage the growth of dust mites and mold?

Dr Lawrence: There is no set “perfect humidity,” and the skin often does a good job of adapting to different humidities, though eczema skin may have more of a problem doing this.  Moderation is probably the mantra– extreme dryness or excessive humidification may create more troubles!

MarcieMom: Thank you Dr Lawrence, your advice is certainly useful and a relief for parents managing skincare for their eczema children that we don’t need to be too worried to ‘perfect’ it!

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