Support Group

One more reason not to Stress your Child

Stress can be a trigger of eczema

Stress is one of the more common triggers of an eczema flare-up. Studies revealed that babies, young children and teenagers all suffer from stress, and usually go unnoticed by the parents.  Stress can come from many sources, such as separation from parents in preschool, academic pressure, peer pressure, knowledge of financial or work difficulties faced by parents, divorce, illness or death in the family and (depressing) world news.

Chronic stress, such as from divorce or death, affects the child more; and note this, stressed parents can pass on the stress to their children.

For an eczema child, stress may trigger a flare-up because

– Stress results in more hormones release, which in turn lead to over-production of cytokines that cause immune cells to release inflammatory substances which sensitive skin is allergic to.

– Stress suppresses the immune system, through the increased level of cortisol produced by the adrenal gland. The skin is less able to produce sufficient defense proteins, making it vulnerable.

–  Stress leads to lower skin cell growth and weakening of the fat/lipid skin barrier, resulting in drier skin. Dry skin is vulnerable to irritant.

Apart from triggering eczema, stress has other negative effects such as

– Impair the connection of brain circuits, resulting in smaller brain, slower learning and poorer memory

– Over-reactive to small problems, resulting in an inability to handle stress

So, how can you tell if your child is stressed?

– Behavioural/Emotional – acting out, refusing to go out, complaining, mood swings/outburst, withdrawn, too shy, fear of failure, worrying all the time, spent time alone, sucking thumb, twirling hair, biting nails, nightmares, clingy/fear being alone, anxiety, irritability, rocking, freezing up, obsessive about objects/food, constantly asking what’s next

– Physical – bed wetting, problem sleeping/eating, stomach ache, headache, regression in toileting, excessive crying, trembling, accident prone, over-react to sudden loud noise, sweaty palms

– Intellectual – Lack of concentration, inability to complete homework

And how do you help your stressed child?

– Establish a routine

– Ensure your child gets plenty of rest, and not ‘hurried’ to too many activities

– Give your child proper nutrition

– Spend time, listening and being there

– Exercise/ share activity with your child

– Encourage your child to keep a journal

2012 update: Read my interview with Stress Free Kids founder Lori Lite on how to reduce stress for kids; Lori has built a business helping kids to be stress free, inspired by her own journey with her children. She was a featured contestant on first season of Shark Tank.

2012 update: Read my interview with psychiatrist with interest in dermatology Dr Christopher Bridgett on his take on stress management for children.

2013 update: Read my interview with neuro-scientist & TEDx speaker Dr Claudia Aguirre on how the brain communicates with the skin.

Support Group

Is it OK to have Only One Child?

My hubby, Marcie & Me

I’ve struggled with this issue and like to end 2011 with a ‘preliminary’ conclusion. So, as I always do, I research. And based on recent studies, there is no evidence supporting that the only child will fare worse than children with siblings, in fact fare better in areas of achievement and intelligence. Here’s my pros and cons list.

Since, we’re already on the topic of social development; this research shows that eczema child has more behavioral problems (23% vs 5%), shows signs of fearfulness to strangers (40% vs 10%), more dependent on parents (50% vs 10%) and have sleep difficulty (this, we all know, see this post). 25% of eczema children aged 2-13 years old, 39% aged 14-17 years old and 28% aged above 18 years old are teased or bulled due to eczema. Issues usually arise if the eczema is severe, such as bandages are required or the rash looks quite bad that other children avoid the eczema child. The good news is that behavior issues are temporary, usually cease when the eczema got better. Moms of eczema children, although much more stressed, are more empathetic to their children which help to reduce behavioral issues.

And yes, back to my preliminary conclusion – I think I will have only one child, Marcie. I’m not crazy about kids, and the only reason I’d have another child is for fear of Marcie being lonely and orphaned. I’ll make more effort to foster friendships for her and be happy that we can look forward to a close relationship, early retirement and better quality of life (phew! no struggling with incessant scratching for 2nd child)

Eczema Tips

Block Sun, Irritate Skin of Eczema Child?

Wearing a Hat also blocks the Sun (and also my hubby)

That’s something that parents seem to be very worried about and have reason to be as sunscreen lotion does contain several ingredients that are potential irritants. My baby Marcie uses Cetaphil and so far, it has worked well. But I have to confess that apart from applying before swimming, I don’t use the sunblock lotion since her eczema is triggered by heat so we’re seldom in the sun. Still, I did some research online and summarized for those of you who are looking into sunscreen lotion.

What’s UVA, UVB and SPF?

UVA rays can penetrate the skin and causes skin damage and aging; UVB, on the other hand, can cause sunburn. The lower the SPF number, the less protection against the UVB rays. Children should use at least SPF30 (SPF 30-59 is considered high) due to their delicate skin. SPF 30 means about 97% of the UVB rays are blocked. For babies, SPF 40 and above is recommended, though babies below six months should not even be in direct sun.

How to Protect from the Sun?

Apart from applying sunblock, your child can also wear a hat, thin but tightly woven white cotton, sunglass and use his/her favourite umbrella! Avoid going out from 11am to 4pm, where the rays are strongest.

What Sunscreen Lotion to get?

Sunscreen lotion are generally divided into two types – those that are chemical absorbers and those that are physical reflectors. Chemical absorbers penetrate the skin more and are more likely to irritate than physical reflectors, which reflect the UV rays from the skin. Physical reflectors are usually titanium dioxide/zinc dioxide based and the drawback is that they leave a white sheen on the skin (nano particles technology can reduce this white sheen but reported to increase risk of cancer; in particular, avoid spray-on and stick to cream/lotion).

Also, stick to what you’d normally look out for in moisturizers fragrance-free, preservative-free, lanolin-free, propylene glycol-free, PABA-free (para-aminobenzoic acid not only stains clothing but requires an alcohol vehicle to work), suitable for sensitive skin, hypo-allergenic, avoid ingredients like methyldibromoglutaronitrile, quaternium 15, benzophenones, oxybenzone, octinoxate, dibenzoylmethanes, mexoryl, retinylpalmitate, salicylates, octocrylene and cinnamates (I’m not sure if you can find one sunscreen lotion without any of these ingredients; the ones I listed first are what seem to be the more allergic ones).

How to apply Sunscreen Lotion?

First, test on a small part of the body, preferably inside of the arm. Wait for 24 hours to watch for any allergic reaction.

2013 update: Read my interview with Sonia Badreshia-Bansal MD (in collaboration with American Academy of Dermatology) on sunscreen.

2013 update: Read my interview with Dr Robin Schaffran on sunburn in this common summer skin rashes for kids series.

2014 update: Watch (or listen) to my Youtube slideshow on sun protection for kids.

2015 update: Read my interview with Dr Thomas Rohrer (in collaboration with American Academy of Dermatology) on how to treat sunburn.

2015 update: Skin (fun) facts! What’s the difference between normal, eczema and baby skin with regard to sun protection, find out here.

If no issue with the lotion, apply moisturizer as per normal for your eczema child. 30 minutes later, apply sunscreen lotion. 20 minutes later, can go into the sun. Subsequently, apply every 2 hours particularly if contact with water or the child perspires a lot (even if the lotion says it’s water-proof). Apply even if in water as the cooling effect of water does not mean no sunburn. Lastly, make sure the sunscreen lotion hasn’t expired!

Eczema Tips

Does Your Child Keep Scratching his Eyes?

Eczema on your child’s eyelid 

Frequent scratching or rubbing of eyes can be due to itchiness caused by eye allergy or infection; but for a child with eczema, it is possible that he or she has eczema on the eyelid. Though eyelid eczema is more common in adults wearing cosmetics, children can also suffer from dry, sensitive and itchy eyelid. The skin around the eye is thin and sensitive, and also vulnerable to irritants and allergens just as other parts of the body of an eczema child. My baby Marcie sometimes scratches her eyes, and the eyelids look red, dry and sometimes a little swollen.

Here’s a little bit more of how you can identify eyelid eczema in your child:
– Eyelid is itchy, looks inflamed or scaly.

– Eyelid is red or swollen.

– If scratching is vigorous and prolonged, it may cause a change in the appearance of the eyelid, e.g. extra fold of skin under the eye or darker eyelid.

– Extreme rubbing can even lead to deformed cornea (keratoconus)

I haven’t asked for any medical advice regarding eyelid eczema, but I usually wipe Marcie’s eyelid with cooled boiled water on cotton pad. If her eyelid looks oily (at the place where mascara is applied, not that I apply eye makeup on her), I will use slightly warm cooled boiled water that can remove the oil better. I will then sparingly apply Physiogel AI cream on her eyelids, and usually, she stopped scratching after a few days since her eyelid eczema is not severe. Do do see a specialist and seek appropriate treatment as you can read below, it’s a little trickier to treat the eyelid eczema.

–          Certain irritant/allergen in moisturizers may worsen the eyelid eczema, see this post and the comment section for some of these irritants.

–          Eyelid can be moisturized, but avoid doing it too generously that it flows into the eye and irritate the eye.

–          Check with the doctor if the steroid lotion/cream that you have can be applied on the eyelid. There’s some research that shows increased risk of cataract and glaucoma with steroid use. (Also read that the risk of cataract is higher for people with severe eczema for more than ten years…but let’s not scare ourselves too much now and just focus on managing our children’s eczema for now)

–          As the eyelid is already thinner than other skin, and extensive steroid use causes skin thinning, do consult your baby’s doctor on the frequency you can apply the steroid. (note: don’t get put off steroid use, as there’s research that there’s no long term adverse effect if used as doctor prescribed)

–          For cleaning the eyelid (if need to), ask your baby’s doctor first if you want to use eye lid cleanser as most of these are for adults only.

Update: Since this post, I have interviewed several dermatologists on eyelid eczema and how to clean and treat it, here are the posts:

Rashes on eyelids with Dr Lynn Chiam

Face cleansing with Dr Jessica Krant

How to use skincare products on sensitive skin with Dr Verallo Rowell

Eczema Tips

Distracting Little Fingers of Children

Is she signing “Eat” or sucking her fingers?

Are you running out of ideas to distract your child with eczema from scratching? Marcie (in photo) knows about 200 signs from Amercian Sign Language (ASL) and sometimes when she wants to scratch, I’d quickly distract her by asking her how to sign certain animals, like “Mouse”, “Monkey” or “Bird”. Most of the time, it works as Marcie would respond by doing the sign and soon forgot about scratching.

Here’s Marcie’s Signing Story:

At about 3 month old, when we decided she could watch TV and hence, should watch programs suited for her, we went to the library and borrowed a few children DVDs. She’s really taken to Signing Time and watching the DVD already distracted her from scratching.

By about 6 month old, she already started signing back. Her first signs were “More”, “Milk” and she loved signing “Cat”, “Dog” and “Bird”.

By about 15 month old, she actually knew more signs than my husband and I! We left her to watch the DVD on her own, while we quickly did household chores and given her good memory, she actually learnt more than us.

Now, at almost 2 year old, Marcie knows almost 200 signs (she could know more, cos I only counted those I learnt with her). Marcie is scratching less and likes dancing now, so although she’s signing less, signing has helped us for almost a year with distracting her from scratching.

So, are there other benefits to Signing? Marcie’s “True/False/Not Sure” response.

Yes,  you won’t find helping eczema children as a benefit listed but there are many other listed benefits:

1. Able to communicate with caregiver, thus reducing frustration/tantrums (from your baby, not you!) – True. Marcie, despite her eczema, did not show sign of frustration of not being able to communicate with us.

2. Improve motor skills – Not sure. Being an eczema baby from 2 weeks old, Marcie has better finger dexterity than other babies her age. Before others discover their fingers, Marcie was already scratching! Baby’s finger muscles develop earlier than speech muscles, so they can sign before they can talk.

3. Understand English earlier and Increase Vocabulary – True. Marcie knows 200 words already, and she knows her A to Z at about 14 month old. By knowing, I meant she can sign and she can pinpoint the alphabet if I ask her which is “M”. Also, I read that alphabet like C and Z may confuse a child, and knowing that they have different sign allow the baby to know they are different alphabet. Also alphabet like W may mislead the child to thinking it’s three alphabets. Also, teaching a child using a multi-sensory approach can help him/her remember better. Read interview with MySmartHands founder on benefits of baby sign language.

4. Deeper bonding with parents, higher trust level- Unsure. I co-sleep with Marcie and was stay at home mom for 11 months, without hiring a maid/au pair. So, I can’t tell if she’s bonded with me because of the signing or not.

5. Helps talking, does not delay speech – Unsure. Marcie, at almost 2 year old, hasn’t talked much though she sings to herself, dances and tries to say certain words.

6. Stimulates intellectual development – Unsure. Research conducted showed higher IQ of signing babies (114) compared to non-signing babies (102). I think Marcie is already smart, so I can’t tell this one (lol, I know I’m one of those moms who think her baby is smarter than others).

7. Boost self-esteem and confidence – Unsure. Marcie is quite shy around strangers, say in sunday school.

8. Learn a recognized 2nd language, rather than make-up signs – Yes. I’m intending when Marcie is older to sign up to volunteer with the deaf association. You need to go through their sign language course but I’m sure we’ll pick up quickly given the head start.

All in all, I love signing with Marcie and I love seeing her stop her scratching and sign in response to my request for “What’s the Sign for Eat?”

Guest Interview Support Group

Building a Vibrant Support Group in Today’s Society

Amanda Roberts, the lady twittering for @EczemaSupport

@MarcieMom met Amanda Roberts, the lady who listens and writes to close to 3,000 followers over Twitter for the Nottingham Support Group for Carers of Children with Eczema (NSGCCE) under the name @EczemaSupport. As MarcieMom has just started the support group for parents, and seeing that @EczemaSupport is so effective in engaging its followers, MarcieMom invited Amanda for a blog interview, so that both support group organizers and members can learn how to partner and build their support groups.

Marcie Mom: Hi Amanda, thank you for taking time to answer my questions. First, tell us a little more about yourself and how you got into twittering for NSGCCE in 2009?

Amanda: Our group, Nottingham Support Groups for Carers of Children with Eczema, was started nearly twenty years ago.  It is a joint initiative between carers of children and health care professionals.  These healthcare professionals have so much knowledge and experience, and have made an impact on eczema services locally and nationally.  Everyone involved works on a voluntary basis. This is lucky because it means we have never had to raise funds from commercial sources, so our information is demonstrably uninfluenced by corporate concerns.

I am just a parent of two boys with eczema.  There is, as you might expect, a family history of atopy – I have eczema, so does my mother: we have asthma, hay fever and anaphylaxis to contend with too.

The group used to meet face to face every other month and we had carers attend from all over the region.  But we knew there was a big need further afield which the meetings were not addressing.  We developed our website and started to move toward providing support and information through web based applications.  Twitter is so appropriate for reaching out to those within the Twitter community who are managing eczema within their family.  It allows us to share and to learn.  Fabulous.

Marcie Mom: In today’s society where nuclear and double-income families are the norm, parents usually find it difficult to find time to meet other parents. Personally, I feel that it’s even more difficult to find secondary caregivers for eczema children because they require more care and attention. Do you think this is a factor that contributes to support groups being difficult to take off?

Amanda: That is a good point.  It has to be a factor.  Meeting a need for eczema support in a time and a location convenient for the carer is one of the advantages we have found with moving to Twitter.

Marcie Mom: Do you think parents prefer to participate in private group mails where only other members of the same support group can view or do you think they prefer public forums?

Amanda: Parents and carers will have different feelings about this, and it will depend in part on what they want to discuss.  There has to be a place for both scenarios. It is not necessary for a support group to provide both but if a person responds in a private group setting, they should be able to trust that their response will not be broadcast outside the group.

Marcie Mom: What advice would you give to someone like me who is trying to grow a support group?

Amanda: Growing a support group takes time and dedication; ideally you need a team to share the burden.  Your situation will be different to ours, but we have been really lucky to have a group of people who have put long hours on an ongoing basis, into a variety of tasks and the group has grown and adapted to things.

Marcie Mom: From your experience, what do you think a support group member can do to contribute to the support group he/she is in?

Amanda: Support group members contribute by just being part of the group.  Everyone is different, with different experiences and family needs.  Sharing and learning from everyone else’s experiences has to be the value of support groups.  Some may have skills they wish to contribute (which is great but not something that should be expected).

Marcie Mom: Here’s the last question that I’m very passionate about. I organize face-to-face meetings and usually at affordable places near to public train stations because I want families that can’t afford cars to also be part of the group. It’s the same reason why I print the calendars to be distributed free in hospitals – Lower income parents may not have the time/resource to connect online. What do you think support group organizers can do to reach out to this group?

Amanda: Undoubtedly hard to reach groups will need support.  Personally I am very wary of solutions being imposed from outside, however.  It is important that we are alert to opportunities to help, support and facilitate such solutions – but the start has to come from within.

Marcie Mom: Thanks Amanda for this interview and supporting me with encouragements over twitter.

Doctor Q&A

Friday Feature – Eczema Q&A with Dr. B

Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at

Q&A with Dr Christopher Bridgett on Childhood Eczema and Habitual Scratching

This was originally a series of Friday Q&As in 2012 which had since been combined into one informative post.

Bedtime Routine for Eczema Kids

Marcie Mom: I set up a bedtime routine of reading books, singing songs, turning off all the lights and playing baby christian songs. We also pray for good night’s sleep! How does routine help a child’s behaviour and how can it help the child’s eczema?

Dr B: Your routine enables learning the desired consequence – a good nights sleep – if all the pieces of the sequence follow each other frequently enough, including the consequence of falling asleep. It’s best to move on from reading, and singing songs, to turning off the lights and saying prayers only when the signs of sleep arriving soon are quite clear!

When you think the child will sleep OK without the routine, it may be tempting to make some short cuts. I suggest that this would be a mistake! If on the other hand, a child is especially fraught, and therefore wakeful, it is best to go slowly along the routine, reading more stories, singing more songs, before the lights are turned off, and good night kisses are given.

Routine usually enables most of us to cope with everyday life. Generally following an established and happy routine means less stress, and changes in routine are usually stressful. And less stress means calmer skin, and less scratching… sounds good for eczema, I think!

Stress Control for Eczema Family

MarcieMom: Parents taking care of eczema children experience high stress levels, apparently as high as parents taking care of children with kidney illness. I’ve also read that stress can be passed onto babies, is there a chance that the stress that parents of newborn feel may worsen the eczema of the baby?

Without making parents even more stressed (that they are passing on the stress!), are there any tips for them to manage their own stress or to prevent stressing their child inadvertently?

Dr B: The causation of atopic eczema is multifactorial – there is no one factor, there are many, and they can be divided up into those that we have to accept, and those that we can do something about. First we need to draw up the list that applies in a particular case – stress is usually there on the list, and stress is usually a factor we can do something about!

Stress and frustration directly affects the skin – the skin is very sensitive to our emotions, and we all tend to scratch more when stressed and frustrated, and scratching soon becomes habitual – which is the cause of chronic eczema. There is no doubt that stress can be part of family life; kids become how they are through their parents, don’t they?

Marcie Mom: Most parents of eczema children have no time for themselves, let alone exercise. Obviously, we know exercise is good for us but how does exercise affect our psychological well-bring?

Dr B: Great question! We seem to live in stressful times. Under stress the body releases hormones like adrenaline, that facilitate fighting, or fleeing! In modern times we can’t do either usually, so it’s important to have a regular physical outlet. A healthy mind in a healthy body.

Marcie Mom: Also, parents of eczema child tend to have less couple time and higher stress in marriage. What simple and practical advice would you give them?

Dr B: The first step is the one you have already taken: recognize the problem. Coping always begins with confronting reality. Next how it leaves you feeling needs expression – don’t bottle it up, let it out, talk about it, understand it and think it through.

Then consider getting and accepting help – problems shared are problems halved. Experiment with new ways of doing things. Don’t take the situation for granted – there is usually a way of changing arrangements for the better. 

Steroid Side Effects

Marcie Mom: Some child’s skin turn brown where it frequently itches, being scratched and steroid creams have been applied. Some parents think it’s the steroid cream that causes the change in skin colour but I’ve read that the brown patch is caused by cells in skin (‘melanocytes’) releasing extra pigments from scratching. Which is true? Particularly it’s important to dispel any misperception of steroid when the risk of under-treatment due to steroid phobia is real.

Dr BBoth are true!

In the first case, yes steroid creams will change the colour of skin – they very slowly reduce the pigmentation, lightening the colour of the skin. The anti-inflammatory effect of the steroid reduces the activity of all skin cells, including the pigment cells – the “melanocytes”.

In the second case, cellular activity in skin is stimulated by habitual scratching, and this affects all cells, including the pigment cells – the “melanocytes”. So habitual scratching causes the skin to thicken up – lichenification – and colour up – hyperpigmentation. Both are characteristic of chronic atopic eczema.

Cradle Cap

MarcieMom: Some eczema babies also get cradle cap, and the cradle cap shampoo has to be used to massage the scalp and wash off the cradle cap. What’s the difference between cradle cap shampoo and normal baby shampoo?

Dr B: Aha! I think I can answer this… Yes, they are different. Cradle cap is seborrheic dermatitis of the new born and infants – it is usually harmless, and can clear on its own, without any special treatment. The regular baby shampoo will help reduce the rash, but specially formulated cradle cap shampoo is stronger – it may have salicylic acid in it for example. If the special shampoo is used, please make sure it is suitable for the age of the child!

Marcie Mom: I’ve also read that brushing a newborn hair helps to keep cradle cap away. Is that true? What does brushing hair do to the scalp?

Dr B: Yes, brushing the hair helps tidy things up, until the cradle capclears. With cradle cap there is excess sebum being produced. Sebum is the natural oil of the skin. Sebum is good for the skin and hair, in moderation – for example, it gives insulation against water loss. When birds preen they are spreading oil over their feathers, and that is what brushing the hair does – see how it shines! 

Swimming for Eczema Children

Marcie Mom: Some parents are very skeptical of bring their eczema child to swimming but my baby’s doctor recommended it. Just 10-15 minutes 3 times a week and wash off pool water and moisturize immediately. Will that also be your recommendation? Swimming is so fun and I hate to see eczema children being kept off it!

Dr BSwimming is fun and good exercise – it also saves lives! So it’s good to say that swimming and atopic eczema usually go together just fine. The problem is caused by the water – it washes off a layer of the skin’s protection and leaves it very porous to water loss afterwards: a thin application of moisturizer before swimming protects against this. Make sure the application is thin though – no need to prepare for cross-channel swimming – see

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


MarcieMom: Moisturizing is important to maintain the skin barrier, particularly when eczema child has a weaker skin barrier that allows for more allergens to penetrate. The recommended guideline is about 500ml per week, that’s a lot and some children simply squirm when parents try to apply the moisturizer. What do you suggest parents can do to get their children to like being moisturized? Or even better, moisturize themselves!

Dr B: The use of a moisturizer – also called an emollient – is central to the care of atopic eczema.  The way it is used is very important – much more important than which one is used. Sometimes the better ones are the cheapest – and the best one is the one that is liked and used properly!

With children, as with adults, there are four key words to remember:

Thinly, Gently, Quickly and Often

and with the child it is very important to get it done quickly, and on afterwards to do something fun together, so that fun becomes the focus, not the moisturizing!

Getting the child to do their own moisturizing needs careful consideration: left to their own devices there is a good chance it will not get done properly – perhaps age and temperament come into it. 

Reactive Skin Reactive Mind?

Marcie Mom: It is mentioned in this article a comment by Sophie Worobec MD at University of Illinois that eczema children are “very bright” as the skin and the brain develop at the same time, so “very reactive skin and very reactive mind”. What do you think of this statement?

There seems to be an association between ADHD and eczema children. And have you seen more cases of ADHD for eczema patients?

Dr B: That there seems to be a close relationship between the skin and the mind is often referred to, and the development of the skin and the brain from the ectoderm of the early embryo is seen as relevant to this relationship – I sometimes say the brain can be called a specialized part of the skin!

But in reality the whole body is closely integrated. All the separate parts are interdependent through shared characteristics, and the overall function is enabled by circulating hormones and by the nervous system links between brain and body.

Both ADHD and atopic eczema are relatively common conditions. The recent reports of an association need to be treated with caution. I have no personal clinical experience of this reported association.

Tensed Baby

Marcie Mom: My baby has taken to tensing her stomach and legs in positions such as doing leg raisers or push-ups. My husband and I think it’s related to her being swaddled too much when young (we had to swaddle her due to scratching, sometimes looping a cloth around her limps cos the scratching was so bad). Do you think it is possible that she has learnt to use tensing to ease her itch and will this impact her psychologically? We certainly hope we haven’t made her gone bonkers!

Dr B: No, I do not think so! Probably what your baby is doing is “within normal limits” and is not due to swaddling, or to itching – and will have no psychological significance at all.

Marcie Mom: That’s comforting to know. Here’s another ‘crazy’ question from me. I frequently use finger food like biscuits (but only vitamin fortified, non-sugary, suitable for babies) to distract from my baby from scratching. My husband thinks I’m turning her into a glutton and soon she’ll have compulsive behaviour to keep eating. Is that true? 

Dr B: The importance of neutral/helpful alternative behaviours to scratching is fundamental to habit reversal – the new behaviour should not risk substituting a new problem for the old problem. I do not think what you describe is likely to lead to compulsive behaviour, but using eating as a habit reversal tactic does seem to encourage habitual snacking, and that may not be what you want to do?

Parental Guilt

Marcie Mom: Some parents have feedback that they feel guilty that they have either passed on the ‘bad gene’ or haven’t noticed their child scratching. What advice would you give to parents to cope with the guilt, which of course, isn’t justified!

Dr B: Both awareness of genetic inheritance, and coping with achild’s scratching are common human experiences and, as “facts of life”, need keeping in proportion. Some of us are more prone to self-blame than others. I think self-blame regarding genetic predisposition is quite unjustified. Failing to supervise a child’s scratching behaviour may be something to review. Sharing experiences in real time with others, and over the internet should be really helpful: great that you have this site!

Stop Scratching Eczema

Marcie Mom: Eczema babies seem to form a habit of scratching, mine even scratches my spouse or I when we’re beside her. How do you suggest parents can help to break the habit for your children (who can’t understand not to scratch nor appreciate the full negative effect of scratching)?

Dr B: Follow The Combined Approach to atopic eczema …. usehabit reversal behaviour modification to treat habitual scratching, together with optimal conventional treatment. To rescue a young child from chronic eczema please refer to Chapter 5 of our book“Atopic Skin Disease” – available to consult at

Eczema Tips

Recommend Your Baby’s Eczema Doctor (Singapore)

Prof Hugo with Marcie

Many moms have asked who to recommend for their baby’s doctor – whoever we decide on, I feel that the doctor must be specialist in children and have the best interest of the child. It is also very important that we, as parents, be confident and partner with our child’s doctor. This is particularly the case if you’re prescribed oral steroid, you have to trust your doctor and follow through, giving up halfway makes it more difficult to decide on the next treatment step.

So, here’s the list of doctors who see eczema children, take the poll at the end or add in your own in the comments.

1. Prof Hugo Van Bever – My baby’s doctor, Head and Senior Consultant, Division of Paediatric Allergy, Immunology & Rheumatology, at NUH. (Please see below, Dr Lynette Shek is the current Head and Senior Consultant of the department.) He’s from Belgium 🙂 During his consultation, I find that he takes time to understand and form a proper diagnosis; I never told him this, but I was really afraid of bringing my baby to a hospital to get a skin prick test. Borrowed his book ‘Allergic Diseases in Children‘ from the Singapore’s library and felt more assured when I read that he cares deeply for his chronically ill patients.

2015 update: I’ve co-authored “Living with Eczema: Mom Asks, Doc Answers!” book with Prof Hugo. Prof Hugo is also an author of a fiction trilogy, how cool is that!

2. Dr Lee Bee Wah – Consultant Paediatrician and Clinical Paediatric Immunologist/Allergist, The Child and Allergy Clinic, Mount Elizabeth Medical Centre. She’s recommended by my general practitioner whose children have allergies and see Dr Lee. I’m not sure about charges though, my GP told me charges depends on duration of consultation.

3. Dr Liew Woei Kang – Paediatrician, Special Interest in Allergy & Immunology, SBCC Baby & Child Clinic. We’ve met and he’s active in driving initiatives related to allergy children. He also consults in several of Singapore’s hospital with children clinics. Dr Liew is the past president of Asthma Allergy Association in Singapore.

2012 update: We also collaborated to set up Singapore Eczema Fund.

Hospitals with Children Clinic

4. KK Women’s and Children Hospital – They have an allergy specialty that manages eczema, food allergy and intolerance. Adj Assoc Prof Mark Koh is the head of pediatric dermatology. A/Prof Anne Goh Eng Neo is the Head & Senior Consultant. Also have another specialty in rheumatology & immunology, A/Prof Thaschawee (Tash) Arkachaisri is the Head & Senior Consultant.

You can read the notes that I took from an eczema forum with A/P Mark Koh as one of the speakers here.

5. National Skin Centre – They have a Paediatric Dermatology Clinic, and some of the doctors listed here also do visit consultation there.

I facilitate quarterly eczema support group sessions at the NSC, please contact me if you’d like to be on the mailing list.

6. Raffles Children Centre, Raffles Hospital – They have a paediatric medicine specialty, with atopy (allergic conditions) and dermatology sub-specialties.

7. Mt Alvernia Hospital – They have different children clinics within the same hospital, do check first the doctor’s specialty before making appointment. Kinder Clinic is one of the clinics with a branch in Mt Alvernia; they have an paediatric allergy, immunology and rheumatology specialty. Here’s a list of their doctors, with doctors listed for specialties in pediatric allergy, immunology and dermatology should you want to make an appointment.

8. Gleneagles Hospital – Likewise, double-check doctor’s specialty.

9. Polyclinics in Singapore – I think they have doctors who treat eczema, though not specializing in children. For those who don’t mind a longer waiting time, you can go to polyclinic first and get a referral to NUH. As far as I know, the difference between going to NUH straight, or getting a referral, is the latter may be a longer waiting time. The last time I attended an eczema support group session at NUH, I was told that subsidized patients will also have the same doctor to follow-up on their condition. The other doctor, A/Prof Lynette Shek, same dept as Prof Hugo, also has many positive feedback from moms in forums (and she is the current Head  and Senior Consultant, Division of Paediatric Allergy, Immunology & Rheumatology, NUH)

A final reminder

Generally, I recommend parents with severe eczema child to see specialists and not just pediatricians or general practitioners. This is particularly so as skin prick/blood test is administered in hospitals. Do note that Changi Hospital, Tan Tock Seng and Singapore General Hospital do not have a children clinics. If your favorite doctor has been left out, do leave their names in the comments!

2017 update: Apart from eczema, Marcie has had various conditions over the years that affect the skin such as shingles, chickenpox, HFMD, impetigo and the latest in 2017 was ringworm (and allergy to ringworm that resulted in rashes all over her body). I realized from the recent experience that a dedicated general practitioner (who is experienced, and actively studies information such as Dermnetnz, can accurately diagnose and formulate the right treatment as well.

2018 update: All links updated

Support Group

Do Low Income Eczema Children Suffer More?

Prevalence of Eczema in Singapore SchoolchildrenWe all know the cost that goes into managing our children’s eczema, it’s not only expensive, it is also stressful for the parents. Have you wondered how much worse off you would cope if you can’t afford moisturizers, can’t afford specialist treatment, can’t afford bath oils and have to take two jobs to make ends meet? This has been a burden in my heart ever since my baby has eczema, I’m thinking “How do low income eczema children cope? Do they end up overusing steroid cream? Do they even seek a treatment or even know that their children are suffering from eczema?”

In a study conducted as part of Phase 1 of the International Study of Asthma and Allergies in Childhood (ISAAC), it is observed that “children in lower socioeconomic groups tended to have more severe atopic disease”. Phase 1 was conducted in 1994, so $1k is considered as low income, and children in this income group experienced the highest incidence of persistent rash without clearing. (I wish I could find Phase 3 study online but I couldn’t get any information except that eczema increased from 1994 to 2001). In a study conducted in US, it was also noted a higher prevalence of eczema for low-income individuals, coupled with a low rate of physician diagnosis.

I am working with a non-profit in Singapore to set up an eczema fund to pay for the cost of moisturizers for low income eczema children. Will update everyone when the fund is ready, target sometime early 2012; if you are interested in contributing (even your two cents) to the fund, do email me, thanks!

January 2012 update: Singapore eczema fund set up here

Side note: Although there are many moisturizers that are super expensive, as they contain ceramides, lipids, anti-inflammatory properties, there are also basic ones that trap and retain moisture. Refer to this post series on moisturizer selection, and the most important choice for moisturizer (other than one which does not irritate your skin) is one that you can use comfortably (in the context of being affordable and feels comfortable on your child’s skin)

Eczema Facts

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

House Dust Mite (picture from

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

How does house dust mite affect your eczema child?

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

How to reduce house dust mite?

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

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

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

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

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

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

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

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

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

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

Save your money on these:

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

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

Eczema Tips Guest Interview

Educating Babies using Sign Language at My Smart Hands

Laura Berg, founder of My Smart Hands

Marcie Mom at catches up with Laura Berg, the founder of My Smart Hands, an international company of about 200 instructors that educates young minds using sign language. Marcie Mom interviews Laura because signing has occupied Marcie’s fingers and distracted her from scratching her eczema rash. To let readers of learn more about signing, Laura will share about the benefits of signing and addresses some of the common misperceptions of teaching sign language to your child.

Marcie Mom: Hi Laura, from 2005 when you started designing My Smart Hands’ curriculum to now, what are the top three positive changes you’ve noticed in the children who learnt sign language?
Laura: The top three positive changes would be:

1. Signing reduces frustration. Many children want to desperately communicate with us and they can’t do so easily because their language skills aren’t quite there yet. Signing can bridge the gap until language develops which hugely reduces the child’s frustration level.

2. We are finding that signing enhances language. It doesn’t make children talk sooner but it does build their language skills. There is a difference between speech and language. Children can use language (signing) without speech and therefore exercise that portion of their brain. If a child is a late talker, his/her vocabulary will be much larger if they’ve used sign language before they are able to talk.

3. It builds confidence. A child who is easily understood by the adults around them experiences less frustration and displays more confidence. These children don’t have to worry about not being understood. It boosts their self-esteem as they are able to engage more with the adults in their lives.

Marcie Mom: Many parents are worried that learning sign language will delay the development of speech. Have you seen that happening or is there any negative impact on the child’s behaviour?
Laura: This is a common concern that parents have. Mind you, I am hearing this concern less and less. The longer the idea of signing with babies have been around, the longer there is proof that this is a complete myth. Some people think children will be lazy and just want to sign. I, personally, have never seen a lazy child when it comes to talking. They want to talk, they babble all the time! As soon as they are able to do so they will.

To elaborate on my point above, there is a difference between speech and language. A child can still have language without the ability to speak or form words. I often use the example of two children and both of them don’t talk until they are two years old. You’ve signed with child A but not with child B. Child A is able to communicate and engage with his parents. His parents know that this child understands them so they give him more complicated language to use (through the use of sign). Child B on the other hand is left with choices, does she want an apple or an orange for a snack? Whereas child A might be asked, “what would you like for a snack”. This question alone allows for more though process to take place and more consideration of what the child wants. By the time these children turn two, child A will have a much larger vocabulary than child B because he was able to use language all that time.
So no, signing definitely does not delay speech. It definitely helps language skills 🙂

Marcie Mom: It’s probably not common for parents to come up to you and say that signing has helped to distract their child from scratching the eczema rash. Has there been any other instance you’ve come across that signing has helped to distract the child in a positive way, say from throwing tantrums?
Laura: Yes definitely! It’s a great way to easily communicate with the child in a discrete and even distracting way. When my daughter was younger she would throw a fit every time I told her ‘no’ but she’d be completely fine if I signed ‘no’ to her. I’m not sure why that is but I know it worked for her and definitely reduced the number of fits she threw. A mom who took one of my classes reported that when her daughter would throw a temper tantrum she would start to sing and sign the Itsy Bitsy Spider song. She would try to just sing it and the child would completely ignore her. When she put the actions to the song the movement would catch her daughter’s eye and snap her out of the temper tantrum she was throwing.

Marcie Mom: What advice will you give parents who are keen to explore learning sign language with their child? And how best can parents approach it?
Laura: The main thing I would tell parents is to not be intimidated! You can easily learn the signs that you teach your child as you go. Simply look up one sign and start with that. I recommend starting with the sign ‘milk’. Once you become comfortable with that sign then look up another one and teach your child. It’s very simple, don’t be intimidated!

I recommend parents start with 1-5 signs in the beginning. This way you won’t feel too overwhelmed. The most important thing is to be consistent with your signing. It is more important to sign the word every time you say it than to introduce tons of signs throughout the day. Even if you sign one thing until your child signs back you will find that very useful. Once your child realizes that a sign means something then you will find that he or she will pick more signs up faster.

And most importantly, don’t give up. If you are consistent your child will pick signing up. Each child picks it up at different stages. The benefits will definitely come. Enjoy and have fun!!

Marcie Mom: Thanks Laura!
p.s. To readers of, I asked Laura for the interview because signing has helped Marcie with her eczema. I did not receive any money from Laura or My Smart Hands for this interview.

Support Group

Will daycare help protect your eczema child from allergy and asthma?

Allergic March – Starting with Eczema

I believe all parents with eczema children struggled with sending their children to daycare. I know I did, when I sent my baby girl Marcie to daycare when she’s 11 months old. Apart from worrying that daycare teachers can’t take care of her, given the constant scratching and attention required, I also worry that she will fall sick more often, resulting in asthma. Are these worries valid?

There is no conclusive research on daycare’s protection against nor causing allergy and asthma. As far as I gather, various studies’ conclusion are mixed as below:

1. A German study reviewed 3,097 children from birth to 6 years old and noted that children who attended daycare in the first two years also had more chances of eczema. This was from tracking children in East versus West Germany, as 52% of children attended daycare in the East versus only 6% in the West.

2. Another study showed that children who attended daycare early (between 6 to 12 months) had lower allergy antibodies, meaning less likely to develop food or nasal allergy. However, there was a higher incidence of respiratory tract infection, i.e. more wheezing.

3. Another study showed that children who attended daycare early were 75% less likely to develop asthma by 5 years old. However, if daycare was started after the child turned 2 years old, there were 3 times more allergy problems.

4. Another study showed that by 8 years old, daycare or no daycare had no impact on allergy/asthma.

How do we decide on daycare’s impact on allergic march when we still don’t know the cause? Based on the 4-part series, you’ll see that there is no one clear cause of eczema. If it’s the skin barrier, then you may decide to take care of your child yourself to make 100% sure that her skin is protected by moisturizing. If it’s the immune system, you may hope that sending your child to daycare will strengthen her immunity (though as you see above, there’s no conclusion). Moreover, eczema is a skin condition with multiple factors influencing the outcome, so it is hard to isolate a single cause to focus on.

So what do you base the daycare decision on? Personally, I don’t base it on impact on allergy/asthma. I base it on other factors, like whether she’s taken care of at the daycare, whether they pay attention to moisturizing and disinfecting her skin, whether I want or need to go back to work. The allergic march, which is the progression from eczema, to allergy and asthma, is also dependent on the severity of eczema (the more severe, the more likely to have allergy/asthma) and the whether the child has both eczema and allergy (then more likely to have asthma).

I know.. tough letting someone else take care of our eczema children, wondering if she scratches more, stresses more (which trigger more scratching) because someone else is taking care of them.

Support Group

Weaning off Eczema Baby from Co-Sleeping

Baby Marcie thought the cot is a fun place to walk around -> Baby Marcie found out that she’s staying in the cot for the night

 2 hours later, at 1 a.m.

My hubby was comforting Marcie, while I pretended to be dead -> Finally, out of exhaustion, everyone’s asleep

Hi! Last night was such a major milestone that I had to update you all; my baby Marcie spent the first night sleeping by herself in her cot! If you’ve seen my previous posts (here and here), you’d know that I’ve been co-sleeping with my baby. But for the past month, I’ve had a bad cough and Marcie sleeping on me made it worse. Last night, we cleared the clutter in her cot, vacuumed her mattress and resolved to regain our bodies (and sanity) at night.

Other treatments

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

A very cute winnie the pooh bathtub (from

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%. Learn more about bleach bath and its effect on skin pH in interview with dermatologist Cheryl Lee MD

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 octenisan (2018 update: a more moisturizing antiseptic wash alternative chlorhexidine), which also serve to remove the staph bacteria).

2014 update: Read my interview with Dr Cheryl Lee on eczema skin and pH (including a Q&A on bleach bath)

2015 update: Read my interview with Dr Lawrence F Eichenfield (in collaboration with American Academy of Dermatology) on eczema bleach bath

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!

Eczema Facts

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

Eczema on neck – Bacteria colonization?

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

What is Staph?

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

One more reason not to scratch

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

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

How do you know if your child has Staph?

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

So, how to get rid of the Staph bacteria?

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

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

For previous posts in this series, see

Defective Skin Barrier



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

Eczema Facts

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

How the Immune System works

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

Attacking the Organ to Protect

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

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

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

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

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

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

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

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

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

The press release of the study by Imperial College here.

Eczema Facts

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

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

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

Does Allergy Cause Eczema?

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

Marcie’s Allergy

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

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

Taking the fear out of skin prick test

What triggers itch?

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

Is partially hydrolysed milk worth the money?

What and how much Detergent to Use?

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

Eczema Facts

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

Restoring Defective Skin Barrier (taken from, article by Peter Elias M.D.)

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

Why does my baby get eczema?

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

But why is the skin barrier defective?

This is caused by a few types of proteins, the most commonly cited one being the filaggrin (FLG), which serves to produce and protect the skin barrier. In people with eczema, there is lower level of FLG, resulting in flatter skin surface cells, disrupted protective fatty layer, reducing the moisturizing function of the skin and increasing water loss from the skin. Reduced FLG also increases the skin pH and leads to increased skin inflammation. The FLG does not explain all cases, because there are people without defective FLG but still has eczema and people with eczema, but no defective FLG. (Thus, it’s currently accepted as a few possible factors such as the gene, environment, allergy reacting together, in some way that we don’t know yet)

The Implication

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

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

Guest Interview

Mom with Eczema Child sets up Online Store, The Eczema Company

Jennifer and her children

Jennifer Roberge, who has a child with eczema, shares why she decided to set up an online store Her online store offering products for children with eczema has recently launched, with products such as clothing from Kumfy Cotton and ScratchMeNot, creams, soaps and bath oils.

Marcie Mom: Jennifer, it’s so good to see an entrepreneur mom, particularly when the business will help children with eczema. What gave you the idea to start

Jennifer: My son Tristan was diagnosed with eczema at three months old and it was progressively getting worse over the years (he’s now three years old). I was desperate to find anything and everything that would help to relieve his suffering, calm the itchiness, or prevent the horrible scratching that would keep our whole family up at night. We spent a lot of money and searched companies all over the world to discover the best natural products for him. It was very costly and time consuming finding the right products from so many different sources, so my idea was to gather our favorites and make them available in one online store for other families like us.

Marcie Mom: How do you think your products can help other parents with eczema children? Have they worked for your child?

Jennifer: I have chosen the products you’ll see on the website because either we use them on our son or we know other parents who have used them, both with great results. My son does not take a nap or night’s sleep without wearing his ScratchMeNot mittens and Kumfy Cotton clothing (tops with mittens and pants with feet) because without them he would scratch himself horribly.  All our creams, oils, and soaps are wonderful products with all natural ingredients that are gentle on delicate irritated skin, but not all of them will work for every child. Therefore, we offer a variety of products so parents can find something that will help their child with their particular case of eczema.

Marcie Mom: How do you find the time to parent two children and run the online store?

Jennifer: Multi-tasking, isn’t that what moms do best?! I’m sure all the mompreneurs will say the same. It’s also finding the right balance of time management and structure. I have the passion to help families living with the daily challenges of eczema, so that’s a big motivator for me.  We do plan to keep to our regular family time though – dinner together, weekends biking or going to the park. Family is incredibly important, so our time together will remain a priority in our lives.

Marcie Mom: Thanks Jennifer, all the best for your online store.
p.s. To readers of, I did not receive any money from Jennifer or for this interview.

Eczema Tips

What and how much detergent to use when you have a child with Eczema?

My washing machine

When you are a first-time mom, you get lots of advice; if you are a first-time mom of an eczema child, you get even more advice on everything from everyone, and sometimes they get contentious. Detergent is one of the issues where opinions differ – some say no detergent, some say little detergent, some say organic detergent and most of the time, it brings about frustration. So what is right?

Unfortunately, yet again, there is no clear cut answer. Detergents are everywhere, from laundry, to residue on our clothes (supposedly up to 2% of the fabric weight), towels, dishes, food containers, bedding, bathroom, floor, furniture, hair, skin (ours that come into contact with our children) and lint. There are parents who believe in cutting out all sources of detergent but given the prevalence of detergent even in dust, it is difficult to cut everything.

Below are some of what I’ve found out, from various research papers and online.

1. Increase in eczema is linked to increased usage of soap and detergent personal wash products in children (taken from review article Features of childhood atopic dermatitus by Hugo Van Bever and Genevieve Illanora, who in turn quoted Dr Michael Cork’s 2002 article)

Dr Michael Cork’s article in Dermatology in Practice published that eczema in british children increased from 3% in 1950s to more than 20%; during this time, the sales of detergent increased from 76m pounds in 1981 to 453m pounds in 2001. There is also an increase in central heating, carpeting, double glazing/wall insulation that promotes the environment for dust mite to thrive.

2. Is detergent bad?

Apparently, yes. Detergent strips the protective fats of our skin barrier, making it easier for irritant and allergen to penetrate. Eczema skin is dry, and thus more suspectible to cracks in the skin, making it even more vulnerable. The ingredients which are bad in detergent include sodium lauryl sulfate, triclosan, formaldehyde, sodium hydroxide, linalool and sodium flouride. These chemicals are not only used in detergent (including some hypoallergenic detergent), but also fabric softener, bubble bath, insect repellent, air freshener, toothpaste, bleach, liquid soap and baby wipes!

(A Sweden study showed that 5–7% of 3,000 eczema patients patch tested positive to linalool, which is found in 60-80% of perfumed hygiene products and detergent liquid. Linalool is a fragrance ingredient found naturally in lavender and mint, and when oxidised, can cause contact allergy).

3. So what to use and how to use?

Mild, fragrance-free, dye-free, lubricant-free, phosphate-free, brightener-free products suited for sensitive skin. (many webpages recommend puraderm). Recommended to use liquid detergent, instead of solid and to use 1/8 to 1/2 of the recommended dosage (supposedly washing machines are more water-efficient now while detergents have gone more concentrated). Using more detergent than necessary does not make your clothes cleaner but instead creates a build-up of residue which you can tell if your clothes get stiff when dried.

4. So how far should you go in cutting down detergent?

Personally, I used as little detergent as I can pour out and I invested in a washing machine with allergy care function which supposedly washes away chemicals, which I think it does as each cycle is 2 hours! I clean my floor with water only and that’s about all the measures I take. I find cutting all traces of detergent to be too exhausting and so far it hasn’t seem necessary from observing my baby’s skin reaction. What’s your take on this? Do drop me a comment!