Allergic Contact Dermatitis in Children (I) – Q&A with Dr Steve Xu

Eczema is a skin condition with many parts to the puzzle – it is linked to hereditary skin condition, allergens (food, inhaled, contact and airborne), environmental factors (heat, humidity), bacteria colonization on skin (and how gut microbiome may affect allergic conditions), lifestyle factors (stress, hormonal change) and also suspected to be linked with diet/ water. Very often we may think of what we have eaten, rather than what we have applied on our skin. A moisturizer or topical prescription tend not to fall under our usual ‘list of suspects’ when we try to figure out what’s triggering the eczema.

This 2-part blog series aim to bring greater awareness of contact allergens, and how some of these may be the ingredients in your skincare products. Especially for pediatric patients, we have to be even more careful because:

  1. Babies’ skin barrier is thinner than that of an adult- making it extra vulnerable to chemical irritants (also greater transepidermal water loss and therefore, moisturizing is important)
  2. Increasing research showing that a strong skin barrier has protective effect against eczema, and reduce likelihood of food sensitization
  3. Babies have a larger surface area to volume ratio, therefore potentially the risk associated with chemical absorption is higher
Contact allergens is of particular importance to pediatric patients

Contact allergens is of particular importance to pediatric patients

I’m privileged to have dermatologist Steve Xu, MD MSc to help with this series. Dr Steve is currently a 2nd year dermatology resident at McGaw Medical Center of Northwestern University. He earned his MD from Harvard as a Soros Fellow, and a Masters in Health Policy and Finance from The London School of Economics as a Marshall Scholar. He completed a BS in bioengineering at Rice University. For his academic interests, Steve is focused on consumer education and the intersection between health policy and clinical medicine. His publications have appeared in The New England Journal of Medicine, and PLOS Medicine garnering broad press attention from sources such as CNN, The Washington Post, and The Los Angeles Times. Dr Steve has created a web resource for patients with eczema and contact dermatitis at itchyrash.org. See also Dr Steve’s publications at the end of this post.

Dermatologist Dr Steve Xu MD

Dr Steve Xu MD, MSc

Allergic Contact Dermatitis – What is it?

MarcieMom: Contact dermatitis refer to skin rash that is triggered by contact with an allergen/ irritant. If the immune response is that related to IgE, it would be allergic contact dermatitis; conversely, if the response is due to overtime exposure to the irritant (leading the skin to develop delayed-type hypersensitivity), it is irritant contact dermatitis. 

The thing is a child can have all the different types of dermatitis – atopic, allergic contact and irritant contact.

MarcieMom: Dr Steve, thank you for joining me for this series. The different terms can get very confusing for parents of eczema children. How would you explain the different types of dermatitis to a patient?

Dr Steve Xu:  Right now even within the scientific community, there’s a big debate on what exactly we should call ‘eczema’. At our institution (Northwestern University), this is how we break it down.

The term ‘eczema’ itself actually describes how a certain rash looks.  Atopic dermatitis, allergic contact dermatitis, and irritant contact dermatitis all can cause an ‘eczema’ rash that looks exactly the same. Eczema used as a standalone term isn’t really specific.

For classic childhood ‘eczema’, we refer to this as atopic dermatitis. Allergic and irritant contact dermatitis is defined as a condition where an external agent leads to an eczematous rash. We define the difference between allergic and contact dermatitis here. Basically, an allergic contact dermatitis is defined by an immune-mediated response to an external agent applied to the skin. These reactions typically require only a very small amount of the agent to lead to a rash. Irritant contact dermatitis is not immune related but leads to an indistinguishable eczematous reaction. Typically, more of an external agent must be applied to cause a rash in irritant contact dermatitis.

MarcieMom: In practical terms, is diagnosing the type of dermatitis important? Or knowing the triggers are adequate for management of eczema?

Dr Steve Xu: Yes, definitely. An irritant contact dermatitis usually requires more of the external agent to cause a rash. This is practically important because if you only have an irritant contact dermatitis you may be able to tolerate products that are wash off or rinse off. If you have an allergic contact dermatitis, then we recommend avoidance altogether. Even a little exposure can cause a miserable rash.

Prevalence of Allergic Contact Dermatitis

There is increasing evidence that allergic contact dermatitis is underreported in children and while traditionally thought as unlikely for children, contact dermatitis is becoming more common.

MarcieMom: In the article1, the top ten pediatric allergens found in personal hygiene products are listed (with the first as having most percentage of children being hypersensitive to it):

  1. Neomycin – topical antibiotic, another contact allergen is over-the-counter antibiotic Bacitracin
  2. Balsam of Peru – also known as Myroxylon pereirae, chemically related to fragrance and thus used to screen for fragrance allergy
  3. Fragrance mix – Of the flowering plants, the Comositae family is the most likely to cause skin sensitization, such as chamomile, dandelion and ragweed; also cross-reactive with propolis (beeswax)
  4. Benzalkonium chloride – ammonium compound used as preservative, including in disinfecting wipes and eye drops
  5. Lanolin – natural oil from sebum of wool-bearing animals
  6. Cocamidopropyl betaine (CAPB) – used as a surfactant
  7. Formaldehyde – preservative, also associated with quaternium 15, imidazolindinyl urea (most common), diazolidinyl urea, bronopol, dimethyl-dimethyl hydantoin (this can get very tricky to memorize, readers can refer to this table created by dermapathologist in a previous interview)
  8. Methylchlorsothiazolinone (MCI)/ Methylisothiazolinone (MI) – likely to be in bubble baths, soaps, cosmetic products, and baby wipes
  9. Propylene glycol – previously common in moisturizers (but many brands stopped including propylene glycol: it has humectant properties and also an emulsifier) and topical steroids
  10. Corticosteroids – when using steroid creams, we have to be aware of its potency, but we may now have to know its likelihood of being contact allergen (we will discuss this next week)
Top 10 Pediatric Contact Allergens in Personal Hygiene Products

Top 10 Pediatric Contact Allergens in Personal Hygiene Products

Other than the above 10, the other well-known contact allergens are cetylstearyl alcohol, sodium lauryl sulphate, pehnoxyethanol, parabens, TEA (triethanolamine) and vitamin E.

Nickel and cobalt are also common contact allergens but less likely that children will come into contact with them.

MarcieMom: It is interesting to note that the above can be found in personal care products, even in those marketed for children. I’m wondering if there is an increase in sensitization in personal hygiene/ skincare products? If so, why? (for instance, is it the increased use of products? Or increased awareness/ patch testing/ consultation)

Dr Steve Xu: The prevalence of contact dermatitis has remained stable overall but certain chemicals are representing a larger share of problems. This is related to industry trends. For example, as formaldehyde was phased out over the past 20 years in personal care products, we’ve seen a growing use of methylisothiazolinone as a preservative. It’s unsurprising that methylisothiazolinone contact allergy is rising rapidly.

Pediatric dermatologists have really worked hard to raise awareness among pediatricians and allergists about contact dermatitis in kids with atopic dermatitis. More than half of kids with atopic dermatitis will have a relevant positive patch test. In general, we’re arguing that kids with atopic dermatitis should be patch tested more and tested for food allergies less

Parents need to know that just because a product is labeled “For babies” or “Safe for kids”, it doesn’t mean it’s any different than what products are sold for adults. These are just marketing claims. Statements like “sensitive skin safe” ororganicalso aren’t regulated. Even carefully reading the labels may not be completely fool-proof. Often times, manufacturers do not have to be specific about which fragrance they are using (different fragrances can cause contact dermatitis).

MarcieMom: Practically, this feels like being caught between a rock and a hard place. The baby’s skin loses more moisture, has less lipids and for babies with dry skin, even more so we have to moisturize. Now, we know the common contact allergens to avoid and of course, should take the effort to read the product label and make sure we’re not putting something on our babies with these allergens. YET, the more we put something on our babies, the more likely the skin can become sensitized to it overtime! (for instance, lanolin, CAPB weren’t previously contact allergens)

MarcieMom: Is there a strategy to moisturizing to reduce likelihood of contact dermatitis? For instance, rotating skincare products which one expert has previously mentioned.

Dr Steve Xu: We often have patients come into our clinic with classic allergic contact dermatitis and exclaim: “I haven’t changed my products in years!”. In truth, this is exactly how a contact allergy develops. It’s true that small, continued exposures over time train your immune system to develop an allergy.

Interview with dermatologist Dr Steve Xu, MD

Interview with dermatologist Dr Steve Xu, MD

With that being said and to the best of my knowledge, there are no well-designed clinical studies showing that rotating skincare products reduces the risk of future allergic contact dermatitis. I’m hesitant to recommend this strategy.

Here’s some practical advice to perhaps help answer this question. Let’s say you have a child with atopic dermatitis and it’s fairly well controlled. Over the course of a period of time, let’s say the atopic dermatitis has taken a turn for the worst and is not getting better with optimal therapy. Or, let’s say that that the atopic dermatitis is appearing in areas it never has before (e.g. belly button, waistband, wrist). Then, this is a time to consider whether there is a simultaneous allergic or irritant contact dermatitis. Patch testing would be recommended.

If there is a relevant positive patch test, than this is the time to follow a safe list. Severely limiting what skincare products or household products can be used in the absence of a patch-test proven allergen may be overkill.

MarcieMom: Thank you Dr Steve for helping us to understand more about contact dermatitis; for me, I’ve learnt that there is practical benefit of knowing the type of dermatitis one is suffering from, and being mindful of the possible development of contact dermatitis for an eczema child. Look forward to next week where we will discuss more about skincare product, prevalence of contact dermatitis in kids and corticosteroids.

References:

  1. Hannah Hill, Alina Goldenberg, Linda Golkar, Kristyn Beck, Judith Williams & Sharon E. Jacob (2016): Pre-Emptive Avoidance Strategy (P.E.A.S.) – addressing allergic contact dermatitis in pediatric populations, Expert Review of Clinical Immunology, DOI: 10.1586/1744666X.2016.1142373

For some of Dr Steve’s publications, see below:

  1. Xu S, Walter JR and Bhatia A. Online Reported User Satisfaction with Laser and Light Treatments: Need for Caution. Dermatologic Surgery. Published online September 9th, 2016. DOI: 10.1097/DSS.0000000000000862.
  2. Xu S, Kwa M, Agarwal A, Rademaker A, and Kundu RV. Sunscreen Product Performance and Other Determinants of Consumer Preference. JAMA Dermatology. 2016. 152(8):920-927.
  3. Walter JR and Xu S. Therapeutic Transdermal Drug Innovation from 2000-2014: Current Status and Future Outlook. 2015. Drug Discovery Today. 2015. 20(11):1293-1299.
  4. Walter JR and Xu S. Topical Drug Innovation from 2000 through 2014. JAMA Dermatology. 2015. 151(7):792-794.
  5. Xu S, Heller M, Wu PA and Nambudiri VE. Chemical Burn Caused by Topical Application of Garlic Under Occlusion. Dermatology Online Journal. 2014. 20(1). URL: https://escholarship.org/uc/item/88v527wg.

Science of Skincare Products – Eczema Supportive Care

Elisabeth Briand Interview on Science of Skincare ProductsThis is a 4-part series focused on understanding the science behind skincare products so that parents of eczema children and eczema sufferers can better understand what goes into the bottle. For this series, I have Dr. Elisabeth Briand, R&D manager at Skintifique. Elisabeth holds an Engineering Master’s degree in food industry and a PhD in chemistry. Before working for Skintifique, she had 10 years experience in academic research as a physico-chemist, in France at Paris VI and Paris XI faculty of Pharmacy and in Sweden, at Chalmers University of Technology. In this interview, Dr. Elisabeth is helping us to understand the science of laboratory-tested skincare products.

MarcieMom: Thank you Elisabeth for joining me again for this last part of our skincare products. Ive covered in this blog that moisturizer has preventive effect on eczema and for those with eczema, moisturizing frequently is able to reduce the use of corticosteroid cream. What I would like to focus in this interview is whether the type of cream, how we apply and when we apply will make a difference in the functions of the moisturizer.

MarcieMom: We are aware that the more liquid a moisturizer is, the shorter time it will last but it is more comfortable to apply than an ointment (which has little to no water content), especially in hot and humid weather like Singapore or during summer. Does the nature of whether it is lotion, cream or ointment affects the efficacy of the skincare product? For instance, does being lotion meant it is more easily absorbed and being ointment meant it will be longer-lasting?

Dr Elisabeth: Many kinds of products are indeed available to help and promote skin health. The same principles as those described earlier work for all of them: products with few ingredients and safe ones will be better for sensitive and fragile skins.

Various kinds of products will, as you said, give different kind of feel and the aim may (or may not) be different as well. The purpose of the two products is different, while ointment is often used to bring a lot of fatty acids the skin and add an occlusive layer to reduce the TEWL (Transepidermal Water Loss or water that is lost through the skin), cream is more used to bring water to the epidermis, as well as other hydrophilic compounds that could be of interest. Creams bring also hydrophobic compounds (fatty acids, hydrophobic active ingredients, …) but to a lesser extent.

The long-term efficiency of a product will depend on how it is structured and how quickly the compounds are delivered to the skin and absorbed. For ointment, they generally have an occlusive layer that will remains on top of the skin, which is the purpose of these ingredients so that it can prevent water to evaporate from skin. So the feel it gives and that specific function will last for a rather long time. On the contrary, water and active compounds are delivered quickly and evaporate or absorbed quickly by skin. As a consequence, the moisturizing feel disappears rather quickly

One of the achievements that may be reached by using innovative structure is to make cream that have a feel comparable to a classical cream, but will display a long-lasting delivery of the active ingredients, and then combined some of the advantages from an ointment (long-lasting relief and effect) and from a classical cream (pleasant feel, bringing water to the skin).

Skincare Moisturizer as Eczema Support

MarcieMom: The other bigquestion that all parents have is each skincare company claims that their product is able to hydrate, build the skin structure better. These typically belong to the group of moisturizers that contain ceramides or have the ability to restore the skin lipids. In your view Elisabeth, is there certain characteristic (such as ingredients or process) that will differentiate a category of moisturizer as being better at restoring skin functions than others?

Dr Elisabeth: Efficiency is claimed by all companies, of course, because all products will bring the element that will help skin moisturizing, at least in the short term. It is clear however that some products will be more efficient than others; just like some products will have better feel than others etc. As mentioned in our previous discussion, this is why scientific innovation and knowhow comes into play: in our view, they are the key to make better, more efficient and safer products

Ceramides are indeed one of the components that enter in the composition of skin membranes and seems to play a role in its restoration. There are however several types of ceramides and all of them do not seem to display the same efficiency according to various recent publications. What will help skin to be restored is to protect it from threats, and nourish it with proper ingredients. A general appellation of Natural Moisturizing Factor has been created to describe these ingredients that can play a positive role in skin restoration. Ceramides are only one of them. For example, vegetal oils are mainly made of fatty acids that interact with skin cell membrane and help it to be “nourished”. Some of these oils also have additional compounds that will play a positive role. Glycerin, urea, aminoacids, cholesterol, and many other ingredients can play a role in restoring skin functions. What is important is to determine which ingredients will be helpful in a specific situation, and how you can maximize the efficiency of this ingredient in the molecular structure that you create inside the product.

MarcieMom: Readers of this blog are familiar with basic skincare, such as moisturizing right after shower and making sure to moisturize enough. Either due to cost or belief of effectiveness of certain way of moisturizing, some parents may

  • apply brand A moisturizer in the day, and brand B at night; or
  • apply brand A on certain days of the week and brand B on others (or alternate by weeks);
  • apply brand A (a lotion) and brand B (an ointment) over it.

In your view, which is the skincare moisturizing method that make sense? For instance, with constraints that many families have, such as budget and time to moisturize (e.g. child in school or simply to reduce the number of times moisturizing is needed).

Dr ElisabethA daily moisturizing routine is indeed driven by various factors, lifestyle included. A product can be efficient, but if it is a hassle to use it, it won’t be used properly and will become inefficient. I would say there is no “you have to” routine, just find one that is working for you. If you keep in mind the principles I already described: using efficient products with few and safe ingredients, you can find what works the best for you. And it may be completely different from what works for another person. And it can be the same product or products for a very long period of time. Regularly changing skincare products from time to time can be a good idea when you are using products that contain a lot of ingredients. or that contain an ingredient you are slightly sensitized to. So you will give a rest to your skin that would otherwise be exposed to some ingredients that could become unhealthy with time and regular use.

MarcieMom: Many eczema sufferers feel that rotating the emollient seems to make it more effective than always using the same emollient. Is there some basis for that?

Dr ElisabethThe efficiency of a product is determined by its ability to bring what is needed by the skin to be protected to help restore its functions. Rotating products can be a way to bring various efficient ingredients that are not found in only one products. But as I just mentioned before, there can be other reasons that can make an emollient less efficient, so you have to switch from it for a while. Some ingredients can lead to some sensitization of the skin. Not strong enough to give a rash, but strong enough to lead to some irritation if used over long periods of time, that would explain why a product would become less efficient. Reducing the number of ingredients can decrease this risk and in that case, your emollient will work for a longer time.

Thank you Elisabeth of being ever so patient in this series of interviews on skincare products, tackling specifically the science behind it. It is truly enlightening and practical!

For all interviews under this Science of Skincare Products series:

Science in the Bottle

Safety and Product Expiry Date

Stability

p.s. Declaration of no self-interest – is that what it’s called? lol Just want to let you know that Dr Elisabeth left a comment on my blog and I felt she was very helpful. When I realized her area of expertise, I suggested that we collaborate on a ‘science-y’ series as I’ve always been intrigued by it. No money has changed hands, only time invested to bring this series to you all!

Doctor Claudia Video – Eczema: Scratching the Surface

Doctor Claudia Aguirre's Video on Eczema: Scratching the Surface

Doctor Claudia Aguirre’s Video on Eczema: Scratching the Surface

Dr. Claudia Aguirre is a neuro-scientist and a skin industry expert at The International Dermal Institute and Dermalogica. She is passionate about skincare, frequently lectures worldwide, and is an editorial contributor to global trade and consumer media. You can find her at twitter.com/doctorclaudia.

Marcie Mom: In the video, Doctor Claudia explained atopic dermatitis and that elevated IgE (immunoglobulin E) triggered allergic response in certain people. There is no single cause of eczema identified, and no cure for the condition. It is instead a multi-factorial condition characterized by defective epidermal barrier that is more alkaline and has more enzyme activity that reduces the connectivity of the skin layers. Filaggrin is a protein that aids in the formation of skin layers (do watch the video to see the animated filaggrin) and converts to natural moisturizing factors. Dry skin lacks this normal functioning filaggrin gene, and has been linked to atopic diseases such as eczema, asthma and allergies.

Marcie Mom: Dr Claudia, in the video you mention that sweat is an irritant for many with eczema. Can you explain how the chemicals in our sweat can cause the allergic reaction? Shouldn’t our skin be used to our sweat?

Dr Claudia: Well an irritant reaction is not the same as an allergic reaction. I explained that sweat can be irritating to eczema skin, as this epidermal barrier may not be fully functional. This is an interesting question though, as we are still understanding the chemical composition of sweat (be that eccrine or apocrine). In general, sweat is composed of water, minerals (like sodium and magnesium), lactate, ammonia and various amino acids. It could be one of these compounds, the combination of them, the changing pH of the skin, or even the sweat’s water content that can cause the itching and stinging sensations to some people with Eczema.  Digging deeper, I found an interesting study that suggested the amino acid composition of sweat is similar to the composition of the protein profilaggrin (which is later converted to filaggrin). This is interesting because scientists can study filaggrin by using human sweat as a potential chemical model. In the end, sweat can make eczema skin uncomfortable, so I suggest bringing a cool damp towel to your workout, or maybe spritzing a hydrating spray, instead of rubbing or scratching this sensitive skin.

MarcieMom: Stress is also a common trigger for eczema and suggestion such as aromatherapy is mentioned in the video. Out of curiosity, does the aroma work the same way as fragrance in skin care products, which is to be avoided? Or is there a specific type of aromatherapy for those with eczema?

Dr Claudia: No, aroma in skin care products varies widely. What you want to avoid are synthetic fragrances which can cause an irritant or allergenic reaction in the skin. Some people use perfume for years before they get a skin reaction. Aromatherapy typically employs essential oils, which are natural compounds. However these can be quite potent, so a trained professional with a background in aromatherapy should be consulted before any treatment. The act of breathing deeply alone can also reduce stress. To find out more ways of reducing stress check out the latest webisode: http://youtu.be/EAcFAUd9-6Q

MarcieMom: In the video, you also recommended water-free barrier repairing products and oatmeal compress. Is water to be avoided in skin care due to preservatives being required if there is a high water content or is it because the eczema skin ‘loses’ the more liquid product easily? As for oatmeal compress, do explain to us (I’m using oatmeal bath oil, but not sure how an oatmeal compress works).

Dr Claudia: Great question. I suppose it could be both. Paraben alternatives are preservatives that have a greater potential of being irritating than parabens. So ‘paraben-free’ formulations may actually be more irritating. The amount of water lost to a skin care product from the skin is most likely negligible, so I recommend anhydrous barrier-repairing products because they contain silicones to protect skin. Our skin has a lipid (oil) layer, so you want to replenish those oils to ensure a properly working barrier. Colloidal oatmeal is a wonderful ingredient for eczema skin. There are many scientific studies on oats and dermatitis – and this should be your eczema skin’s best friend. Look for clinical colloidal oatmeal for best results. The compress is basically a wet wrap. This is used to lock in moisture and keep the actives on the skin. On wet skin, apply oat or other active ingredient, follow with a damp gauze and cover with dry wraps. This dry covering could be pajamas (good for kids), or other dry covering. Alternatively, a colloidal oatmeal masque is a really nice add-on to a skin treatment for hydrating and soothing skin.

Marcie Mom: Vitamin D has been mentioned much to boost immunity and for the skin. How exactly can one with eczema get vitamin D, and what’s your recommended minutes of sun exposure for those with eczema?

Doctor Claudia: Everyone has different needs, so there is no single recommended amount of sun exposure. I advise those wanting to know to consult with a dermatologist trained in a bit of photobiology. Or you could ask a scientist (they are hard to find!). At a recent conference I met Prof. Brian Diffey, an expert in this field. In a recent paper, he concluded “Messages concerning sun exposure should remain focused on the detrimental effects of excessive sun exposure and should avoid giving specific advice on what might be ‘optimal’ sun exposure. http://www.medscape.com/viewarticle/722853

Vitamin D is an essential hormone and we all need a good dose of it. So speak to a dietician or doctor to find which vitamin D supplements are good for you and be sun smart!

Marcie Mom: Thanks Doctor Claudia, your explanation is so helpful, as even though we can’t cure eczema – it doesn’t hurt to understand more of it in order to manage it confidently. I’m looking forward to more of your videos!

MooGoo… Learning about a Natural Skin Care brand (Part 2 of 2)

Interview with MooGoo Skincare (picture credit moogoo.com.au)

This is the second segment of the interview with Craig Jones, founder of MooGoo. MooGoo is an Australian company that makes a range of skincare products, founded by adapting the ‘diary’ version of udder cream for a family member. Refer to the first segment of interview here.

Marcie Mom: I noted also on your website that ‘MooGoo creams have been independently tested to ensure they remain pure and uncontaminated for at least two years, when stored below 30 Degrees Celsius. This is a called a “Challenge Test. It is not a compulsory test in Australia.’ Could you give further details as to who conducted this test, how the test is conducted and what is your definition of ‘pure’ and ‘uncontaminated’?

Preservatives is one area of our formulation that we are very proud. A product that is often used on broken skin, or babies, needs to be properly preserved so it is sterile. Everyone would be aware of ingredients like Parabens, Benzoates, Formaldehyde Donors and other ingredients often used to keep skin care products sterile. It doesn’t take too much research to see that if we had the choice, we probably wouldn’t put these chemicals on our skin. (It is also interesting to see how often they aren’t on the list of ingredients published on websites, but are on the label of products). These ingredients are used as they are inexpensive ways of preserving a cream.

Obviously most natural companies want to avoid being seen in the company of these type of ingredients. The temptation can be to try and cut corners in preserving a cream and use fairly ineffective preservatives like Grapefruit Seed Extract. Not all companies do this at all, but it can be a temptation, especially as nobody checks for preservative efficacy in Australia.

We accidentally discovered a new way of preserving our creams based on Hops. I stumbled across i when talking to a food ingredient supplier who used it for Apple Juice. We tried it in the creams and after a bit of tinkering (at first some people found it changed the smell of the cream so we had to cut the percentage down) we now use that as a total edible preservative.

We have our creams tested by Conmac labs. The BP Preservative Efficacy Test is a program of deliberately contaminating the cream sample with a range of bacteria and mould, and then tracking the growth of the bacteria and mould over a 30 day period. To pass, the preservation system must kill all the bacteria and mould. I have included a sample report so you can see.

Because we have so many infants using our products, and because we are using a novel edible preservation system, we make sure our products pass this test.

Marcie Mom: You have some products suited for eczema and one of them is the ‘Eczema and Psoriasis Balm’. It is AUD18.50 for 120g which translates to about SGD24. I would say the price is about mid-range. Aloe vera, matricaria chamomilla extract, centella asiatica and sage oil are listed as active ingredients (and very good that you list amount of mg of ingredient per gram, which in aggregate is 30.5mg/g). Why did you choose these ingredients and what research can you point us to that concludes these ingredients applied on skin are beneficial for eczema? Also, are these ingredients listed as allergens by any national dermatitis group, e.g. NACDG?

Craig Jones: This is a complicated question. Before we created the Eczema Balm, a lot of people were already using our Udder Cream for skin problems. In fact, the Udder Cream was first made for my mother who had psoriasis. At that time I had no intention of starting a skin care company, and if that cream hadn’t worked as well as it did, I am sure I would still be enjoying my previous profession of being a pilot and MooGoo would have gone no further than our kitchen and my mother’s skin.

The original Udder Cream we made  probably worked quite well due to the oils such as Sweet Almond Oil that we used, combined with the Aloe and Allantoin. I am the first to admit it is not a “miracle” formula. I think the reason it helped so many people is that they had been using poorer quality creams (often sorbolene type creams) for years and so when they switched to a repair moisturiser of better quality, some found a huge improvement. But it was probably the choice of oils, the fact it didn’t contain some certain preservatives that helped the most.

However, to register a product for Eczema with the Therapeutic Goods Administration, we needed to add some approved “Actives”. So we looked for those with the best evidence we could find as natural anti-inflammatories and wound healing, and added those. But I don’t think it is just the actives that help. I personally think the natural oils and Allantoin also assist.

Incidentally, over the last 4 years i have kept researching lots of different natural actives. In a few months we are releasing a second Eczema Balm. On paper it should work even better. We are keeping the original as it is so popular and still a very good product. However it doesn’t work for everybody, and so this is another option. It was also the result of my personal belief that the combination of ingredients should result in the best possible natural anti-inflammatory cream it is possible to make. So we will see how it goes.

As for allergies, even the best ingredients can have people that are allergic to them. As you know, we compare it to food. People can be allergic to nuts or dairy or shellfish. However, for the vast majority of the population, these foods are very healthy. Nobody is allergic to Cola. This doesn’t make Cola a superior food to shellfish.

It is the same in skin care. Typical examples of allergies can be to Aloe Vera and Vitamin E. For most people however, these are excellent ingredients for the skin. It would be detrimental to most people if they were taken out because a very small number of people have allergies.

We do however avoid Essential Oils as much as possible due to allergies. We used to use them in a lot of our products, including the Milk Shampoo, Wash and Conditioner. People would sometimes react to these. So we instead worked with a company that specialized in phthalate free fragrant oils that didn’t cause allergic reactions and now use these. The number of people with reactions in the products without essential oils is almost nil.

Anti-ageing products though do have more potential for allergies with some people if they are genuinely effective. This is because genuine anti-ageing actives need to penetrate and work with the skin metabolism, so they need to be reasonably concentrated and fairly bio-active. So they are more powerful. An inert ingredient or an ingredient that was in the product at a tiny concentration would not be an allergy risk for anyone, but nor would it do what people hoped.

So what we do it put the best ingredients in the product we can at the concentration we think we need, and then encourage everyone to patch test all natural products before use.  This is much better for most people we think than not using any ingredient that may end up causing an allergy. Paraffin and Water (Sorbolene) may not cause many allergies, but it won’t do a lot of good either.

Marcie Mom: Thanks Craig for being open and sharing insights to your products and the decisions behind them. p.s. to readers of eczemablues.com, I didn’t receive any money from MooGoo for this interview.

MooGoo… Learning about a Natural Skin Care brand (Part 1 of 2)

Interview with MooGoo Skincare (picture credit Moogoo.com.au)

MarcieMom heard from a mom in Malaysia of how well received MooGoo is among moms with eczema children. MooGoo is an Australian company that makes a range of skincare products, founded by adapting the ‘diary’ version of udder cream for a family member. As you know, while MarcieMom doesn’t do product review (no, Marcie is not available for testing), she is open to writing and introducing and more importantly, finding out more in-depth about eczema products so that parents reading this blog can have more information. Thus, MarcieMom looked up Moogoo.com.au and asked Craig Jones, founder of MooGoo for an interview to find out more about their products targeted at eczema children and infants.

Marcie Mom: Thank you Craig for taking time for this interview. I haven’t used MooGoo but like to ask questions that another ‘self-educated!’ mom with eczema child would likely ask reading your website. I’m very pleased to see that you do highlight on your website that natural doesn’t mean not allergenic and you encourage testing on a small skin patch before using. Now, we know there is no certification for natural and ingredients extracted from nature will need to be processed to fit into the packaging and be of a form that can be used. For instance, olive oil needs to be preserved and the preservatives can irritate. Is there a certification for organic in Australia and if there is, do you think it’d be more objective to brand MooGoo as such? And if not, how do you think you can help explain to your customers how to assess the extent of ‘natural-ness’ of MooGoo or another brand?

Craig Jones: Very good question. In fact, a pure oil like Olive Oil doesn’t need a preservative. When we buy Olive Oil, or Sweet Almond Oil or any other natural ingredient, it is already pure. A preservative is only needed when an oil is mixed with water as bacteria and mould need water. (That is why, if you ever see on a website an ingredient list that contains water, but they don’t show a preservative, you know there is something missing from the preservative list.) If an ingredient came blended with a preservative, this should be put on the finished label of the product.

There are lots of organic certification system in Australia. For food, organic certification can be important for many people. For skin care, because the ingredients we buy are already pure and cosmetic grade, I know it doesn’t really make any difference. They do not come contaminated with pesticides or preservative.

It would certainly help from a marketing perspective to have “organic” splashed across the label. It would also be a simple process for us to become “Organic” certified. I think all of our products would already qualify. All we have to do is to pay the license fee to whichever certification body we chose and a bit more record keeping concerning ingredient supply chain. But I personally feel “organic” in skin care is more of a marketing tool than anything else and I would feel insincere using it. That is why we choose not to. Perhaps we should.

Marcie Mom: Your website gives a very homely and cosy feel and I noticed that a message that seems to be emphasized is to not use products containing mineral oil or paraffin oil. From what I know, though these oils do get mention as being potential irritants, they are not the top allergens and not cancer causing when applied to the skin as moisturizer. Why have MooGoo chosen to emphasize on paraffin and mineral oil? (Also, the links you’ve shared under ‘Why We Don’t Use Paraffin Oil in Skincare’ are either broken or not directly applicable to moisturizer context.)

Craig Jones: Although everyone has different preferences and some people may choose paraffin oil, I think mostly it sneaks into products because it is poorly understood exactly what it is. I personally think Paraffin Oil is a very poor quality oil to be used in skin care and would not use a product with Paraffin on my skin. Nor would I put it in a product that we make.  Labelled as “soft white paraffin oil/mineral oil/baby oil/paraffin liquidatum” it doesn’t sound particularly offensive. Bu people probably don’t comprehend that this is a flammable petroleum oil that in its raw form, they probably wouldn’t put on their skin.  Properly refined petroleum oil for skin care does have the carcinogenic hydrocarbons removed, that is true. However, in the need to keep the price down (paraffin oil is usually used in cheaper products) I wonder sometimes if there might be a temptation for companies to use cheaper grades of paraffin. Also, the study below here has always concerned me. It has shows tumour growth in UV treated mice that have first had paraffin based moisturisers applied, as compared to no tumour growth in the control cream which was non-paraffin based. It doesn’t prove that paraffin oil can cause tumour growth in humans exposed to UV, but it would concern me. (Study here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630214/?tool=pubmed)

Here is story about a study done on paraffin oils and childhood eczema using a paraffin based cream where is generally made eczema worse for kids. (http://www.sciencedaily.com/releases/2010/10/101018074536.htm)

So for the video ( I will have to look for the broken links) we didn’t make any claims that paraffin is a cancer risk as is claimed by a few other websites. All we wanted to do was show people exactly what it was. Paraffin is the base oil for so many pharmacy products because it is so cheap. We get a feedback all the time comparing the price of our products to something like Sorbolene. So we need to explain that although both may look the same, they aren’t the same.

Marcie Mom: I also see that you have a MooGoo Nappy Balm and that they are first tried and tested on your own babies, and friends, staff and even facebook customers! Good to know but I’d like to ask if you send or intend to send your product for clinical trials for independent reporting. I also noted that there are quite a number of oils that you use, can you share a little more about which oil needs to be preserved and processed to the form of a balm and how MooGoo has ensured that you keep the end product safe for use in babies? Do you manufacture all your products in-house?

Craig Jones: All the products we make for ourselves first. The Nappy Balm will soon be registered as a medical device in Australia which includes the evidence for ingredient efficacy.

For the oils we simply chose a list of soothing edible oils. Although people with nut allergies are generally not allergic to nut oils (because the allergy causing protein is removed) we chose to not use Nut Oils in this case so that new mothers weren’t concerned.

This is not a miracle product either. The main thing is that we use edible oils so that the product can be ingested. Most commercial nappy balms are paraffin based. Paraffin Oil can be fatal for children if ingested. It simply works as an edible barrier balm that is also anti-bacterial. A very simple product.

Marcie Mom: Thanks Craig for taking time for an interview with me. I know there’s so much more you’ve to share that can help parents assess the products they’re using. So, I’ll be running the 2nd segment of your interview in two weeks’ time, on 24th July (p.s. to readers of eczemablues.com, I didn’t receive any money from MooGoo for this interview).

Sensitive Skin Product Series – How many ingredients?

When More is not Merrier!

This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Marcie Mom met Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity. VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. In this interview, Laura answers Marcie Mom’s questions on understanding how many ingredients a product should have.

Marcie Mom: Given that a child with very sensitive skin/eczema can be allergic to many ingredients, it makes sense that the fewer ingredients, the less likelihood of triggering an allergic reaction. Is there an average number of ingredients a moisturizer is likely to have?

Laura: There is no one average to give because different formulations necessitate different quantities of various things like emulsifiers, stabilizers and so on. For example, a shampoo might normally need to have a longer ingredients list than, say, a lipstick, because the shampoo contains so much water and needs more preservation, whereas a lipstick or concealer is mostly wax and therefore needs less preservation. A good bet is to compare similar products, e.g. two toothpastes. If toothpaste A has 10 ingredients and toothpaste B has 25, then A is probably the safer bet. Of course, toothpaste A could have allergens and toothpaste B could have no allergens…

In a nutshell: hypoallergenicity is a highly complex concept with many, many moving parts and it would be unreasonable to expect any mother or any consumer to master (or even familiarize herself with) all of these myriad issues. As we are mostly “lay” moms who want to care for children with very sensitive skin, it’s not a matter of mastering this complexity or of finding one magic bullet. It’s a matter of choosing products with as many of the good-practices as possible. If I were to summarize the safest best practices into a simple checklist, this would be it:

1)             Look for zero or as few allergens as possible. Your best bets for this are a) a patch test when your child is old enough and b) a VH-Rating.

2)              Avoid the most consistent top allergens: paraben, fragrance, masking fragrance, dyes, “coca”-surfactants

3)            Choose shorter ingredient lists (but check them against #2 above).

4)             Try to opt for brands with real clinical legitimacy. Published studies in well-known medical journals and presented studies in the large medical conventions are a good bet. At least you’ll know that their claims are backed by research that has objectively been considered scientifically valid enough for presentation and publication…so you might at least feel more comfortable trusting their claims.

Marcie Mom: Great checklist! I’m so happy that we’ve understood lots and understand so much better when we read the product label. Our next interview will move on to practical application of the moisturizers!

Sensitive Skin Product Series – Understanding Coconut Oil

 

Table to explain processing of coconut types and of other oils (provided by Dr Verallo-Rowell)

This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Marcie Mom met Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity. VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. In this interview, Dr. Verallo-Rowell and Laura answer Marcie Mom’s questions on coconut oil.

Marcie Mom: I read with interest that your products contain USDA-certified organic virgin coconut oil and monolaurin (derived from coconut oil) that is a substitute for paraben. Do all products containing coconut oil have the same antibacterial, antiviral and disinfectant properties that your product have? Could the ‘wrong’ coconut oil actually be an allergen?

Laura: There are currently no reports of reactions to coconut oil but yes, there are different types of coconut oils. Ours is USDA-certified organic because the entire farm is organic…no fertilizers, nothing…and because the method of extracting the oil is organic…nothing is added; we use first and cold-pressed oil…not even heat is used and no chemicals. Some other coconuts are grown on non-organic farms or the oils/other extracts are processed using other chemicals that could be allergenic. Others still are sold with additives like preservatives or flavor or stabilizers or fragrance. Those would definitely increase the likelihood of a reaction.

Virgin coconut oil is well studied to have anti-viral properties and has even shown some success in managing herpetic flareups that are resistant to valacyclovir. Virgin coconut oil should have these properties, but we can only vouch for the one we produce because we control it from seed to bottle, and it is the oil with which all our clinical studies were done.

Monolaurin has a slew of studies as well proving its similarity in efficacy to several broad-spectrum antibiotics, antivirals, disinfectants (even 70% isopropyl alcohol) and antifungals, but without the side effects like increased tolerance to treatment or dryness. I should also point out that our proprietary preservative system that replaces parabens is not just monolaurin…it’s a delicate balance between this and several other ingredients…it’s a big headache, if I’m to be frank 🙂 But such is our mandate 🙂

Dr. Verallo-Rowell: Yes. No matter how processed, the composition of all fatty acids in the oil removed from the coconut meat is about the same: myristic (15%), lauric acid (46-50%), Capric (6-8%), Caprylic ( 6%). These are all medium chain and saturated.

Could the ‘wrong’ coconut oil actually be an allergen? Yes, because of processing. RBD (primarily a cooking and/or industrial oil) vs. virgin coconut oil. See table above that explains processing of coconut types and of other oils.

Marcie Mom: Thanks! Coconut oil is increasing popular as an ingredient and your information on it is precious to parents when evaluating what product to buy. We’ll learn more about cross-reaction in our next interview.

 

Sensitive Skin Product Series – What Ingredient to Avoid

List of Ingredients that Could Irritate

This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Marcie Mom met Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity. VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. In this interview, Dr. Verallo-Rowell and Laura answer Marcie Mom’s questions on which ingredients to possibly avoid.

Marcie Mom: For a parent on a tight budget (also considering long term and frequent use of moisturizers), should he/she start the child on the cheapest lotion/cream available? If not, is there certain baseline to start with, for instance, it must state ‘suitable for infant with eczema’ or not contain ‘perfume’?

Dr. Verallo-Rowell: The answer is no. Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients versus, for example, pharmaceutical-grade or higher-quality or purer ingredients, which are frequently more expensive. Some cheaper products are dyed with relatively cheap ingredients to add attractiveness in children’s eyes. Cheap or expensive, preservation is also problem, as are added antibiotics. All these are allergens and break down the skin’s natural barrier.

Make function be the basis for your choice. Remember that in different forms of eczemas you pay attention to the skin’s outermost barrier layer: genetic innate barrier dysfunction initiates atopic; allergic or irritant reaction breaks down the barrier in contact; food around the mouth area can physically act on the barrier, and secondarily, bacteria cross damaged barrier in all types of eczemas.

Hence to keep the barrier as intact as possible: Place the least irritating, partially occluding product you can find without any of the above: scents, preservatives, antibiotics, dyes. Mineral oil and pertroleum jelly are long time favorites of us dermatologists. They are cheap and excellent barriers, but they are petrochemical derived. Consider non-preserved, non-adulterated oils. For this my favorite is virgin coconut oil because it needs no preservation and is broken down by lipases of friendly skin bacteria into monoglycerides with antiseptic properties. I have a published paper on VCO vs. Olive oil in Atopic Dermatitis that includes comparison on Staph. Aureus action by both oils.

MarcieMom: Can you list for us some common irritants and list them on a scale of 1-10 (1 being the most likely to cause allergy)? It’ll also be great if you can let us know if there are other common names for these irritants.

1.     Perfume/ Fragrance

Benzyl alcohol (Phenylmethanol / Phenylcarbinol) Natural grape aromatic preserves & scents in “fragrance-free products”
Carvone (d-carvone, d-1-Methyl-4-isopropenyl-6-cyclohexen-2-one Essential oils from dill, caraway seeds, spearmint, orange peel
Cananga odorata(Ylang ylang, Cananga distillates) from the flower
Cinnamic aldehyde (Cinnamaldehyde) from bark camphor, cassia cinnamon trees
Colophonium Rosin (Abietic acid, alcohol, Abitol) A resin from pine trees
Extracts of common plants of the (Astraceae/ Compositae family: yarrow, mountain arnica, German chamomile,  feverfew,  tansy) Botanical additives

2.     Preservatives

Bacitracin  (An Antibiotic )
p-Chloro-M-Xylenol (Chlroxylenol, PCMX)
Clioquinol
Formaldehyde (Formalin, Methaldehyde, Methanal)
Diazolidinyl urea (Germall II) and 

Imidazolidinyl urea (Germal 115, Eukyl K 200)

Dimethylol dihydroxy ethyleneurea (DMDHEU)
DMDM Hydantoin (Glydant)
Quarternium 15 (Dowicil 200)
Methyldibromo glutaronitrile + 2 phenoxyethanol (Eukyl K 400)
Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI Eukyl K100, Kathon CG)

3.     Parabens – Methyl, Ethyl , Propyl, Butyl Paraben.  Please also above in Preservatives

4.     Propylene Glycol – 1,2 Propanediol

5.     Lanolin – Lanolin alcohol, Wool Alcohol

6.     Colorant/Dye

Disperse blue 124/106  Mix (Thiazol-azoyl-p-phenylene diamine derivative dyes)
p-Phenylenediamine

7.     Conventional emulsifiers

Stearamidopropyl dimethylamine  (Amidoamine)
Dimethylaminopropylamine (DMAPA)
Cocamide DEA (Coconut Diethanolamide)
Cocamidopropyl betaine
Oleamidopropyl dimethylamine
Decyl glucoside  from glucose (corn starch) & decanol fatty acid from coconut
Ethylenediamine dihydrochloride (Chlorethamine)

8.     Mineral oils – actually quite skin safe. A favorite among dermatologists.

9.     Paraffin – same as mineral oil.

10.  Sodium Lauryl Sulphate – An Irritant especially when present in higher concentrations. Not too common as an Allergen.

Marcie Mom: Thanks Dr. Verallo-Rowell and Laura. It’s great to finally have a sense of the list of ingredients to avoid and in priority, so that parents can check if the product they buy are at least free of the allergens on the top of the list!

Sensitive Skin Product Series – Understanding Irritant-Free

Allergens to Avoid

This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Marcie Mom met Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity. VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. In this interview, Laura answers Marcie Mom’s questions on understanding ingredients that may be potential irritants.

‘Perfume Free’, ‘Propylene Glycol Free’, ‘Paraben Free’, ‘Lanolin Free’, ‘Preservatives Free’, ‘Colorant Free’ – So Many ‘Frees’! Is this too much or too little?
In this post, I’ve consolidated a list of irritants to avoid which include the above and also sodium lauryl sulphate, mineral oils, conventional emulsifiers and paraffin. I’ve also realized that it’s difficult to find a product that excludes all potential irritants so for this interview, we catch up with Laura to understand which are the more allergenic ingredients and how to assess what our child can use.

Marcie Mom: I understand that VMV recommends its customers to perform a patch test, i.e. applying on a small area and observe for few hours to up to 72 hours before gradually increasing usage. Can a child also take a patch test?

Laura: Wow you do your research 🙂 Ok, for ANY cosmetic, doing a provisional patch test before purchasing and/or sampling is always a good idea prior to making a purchase.

The best tool is really a proper patch test done by your dermatologist, but this cannot be done on children. If you have a child with very sensitive skin, allergies and/or eczema, etc., however, as soon as he is old enough to get a full patch test, he should. This is really the best way to determine what, in particular he needs to avoid. And if you’re sensitive, as allergies are often hereditary, your own patch test results may give you a possible idea of what your child might be allergic to as well (this is not a sure thing, however; your child would still benefit from his/her own patch test at the appropriate age).

Making Sense of Irritant-Free

Marcie Mom: Should parents use a product that markets ‘XXX-Free’?

Laura: Yes, a good guide is to look out for what irritant the product is free of. The big problem, however, is that a lot of marketing-speak says “free this” and “free that”, and, unless you’ve really done your homework and have a deep understanding of ingredients and allergens, you may not be able to accurately judge if the ingredient that is absent is even harmful. What I’m trying to say is that “XXX-FREE!” is a powerful marketing phrase on its own, whether or not it has objective merit (e.g. whether or not a product is better for not having a particular ingredient in it).

SLS

Lots of shampoos now, for example, are touting “SLS-free” heavily. The thing is there are two ingredients with these initials: Sodium LauRYL Sulfate and Sodium LaurETH Sulfate. While the former is a well-known irritant, the latter is actually rather harmless, particularly in lower concentrations. So if a product says SLS-Free, you’d need to check which of the two is absent. And, neither is on the allergen lists (again, these lists are compiled from patch tests done on over 20,000 people). Much of the hooplah surrounding SLS/SLES has to do with their environmental impact — which is a valid concern but may not be as relevant as for skin safety.

‘Cancer-Causing’

One more thing to consider. When you read a lot of the posts about “causes cancer”, it’s natural to worry. These claims are serious and you don’t want to take them lightly. However, it is important to remember that many (but not all) of these reports are skewed to be sensational — they may not be balanced. For example, much of the evidence of the carcinogenicity of certain ingredients is determined in laboratory experiments with animals fed the ingredient in very high doses (sometimes the equivalent of the animal’s body weight and the equivalent of a lifetime of consumption at these doses). Many of the same ingredients used in cosmetics are used in minuscule amounts and in molecular sizes that are too large to penetrate to the dermis, much less get to the bloodstream. An example would be parabens: we stopped using them because they are allergens, not because of the cancer panic, because there simply is not enough to go on. More information in this article.

Mineral Oil

Mineral oil is another great example: NOT an allergen. Ask any dermatologist and they’ll tell you mineral oil is a go-to, reliable hydrator even for extremely sensitive skin (there are some reports of comedogenicity but it is otherwise a go-to moisturizer) and for extremely sensitive areas (even the genitalia). Again, most of the concern with this (as well as petroleum jelly, another big dermatologist favorite) is environmental. And again this is a valid argument for the planet, but strictly speaking for skin safety, these ingredients are not allergens and are relied upon regularly by dermatologists for very dry, sensitive skin conditions.

Hypoallergenic

“Hypoallergenic” is not regulated. Many ingredients touted for sensitive skin are actually highly allergenic. Some natural and/or organic ingredients are allergens, too. Yes, definitely, “fragrance-free” is key…but then again, are you confident that you know all the chemical names of all products that are fragrances and masking fragrances or that cross react with/are related to them (e.g. cinnamic alcohol)?

The best guide is really allergen-free. But you have to make sure that the “allergens” to which the brand is referring are those that are proven allergens. The NACDG and ESSCA patch test on over 20,000 people in multiple countries to compile their lists of allergens, and crucially, they update these lists every few years. These lists are, therefore, statistically relevant, consistently updated, and put together by two of the most respected groups of doctors in the world who concentrate on allergens and contact dermatitis — and they are regularly published in peer-reviewed medical journals. This allergen list is what the VH-Rating System uses and, considering we’ve had less than 0.1% reported reactions in 30 years, it’s quite reliable.

Marcie Mom: Thanks! It’s great to understand a little more about some of the ingredients, so that parents can assess if they truly need a product that excludes them. For the next interview, we’ll continue to learn more about choosing products for sensitive skin.

Sensitive Skin Product Series – Understanding Ingredients

Allergens to Avoid

This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Marcie Mom met Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity. VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. In this interview, Laura answers Marcie Mom’s questions on understanding the ingredient label.

Product Label – Deciphering the Ingredients

Marcie Mom: Laura, thanks again for continuing to help us make sense of the ingredient label.

Many ingredients sound similar though not identical. Is there some broad classification of ingredients and how to identify what type of ingredient a certain name suggests? Is there a glossary/definition page that you can refer us to?

For instance, do ‘glycerin’, ‘capric triglyceride’, ‘palm glycerides’, ‘caprylyl glycol’, ‘glyceryl stearate SE’, ‘glyceryl laurate’, ‘glycol distearate’, ‘butylene glycol’, ‘glycerylcocoate’ belong to the same classification? And what are they?

Laura: Unfortunately, unless you’re a chemist or decide to devote yourself to the pharmacological sciences, this is almost impossible to master for most consumers. Yes, there are some roots to words that imply certain things. “GLY”, for example, implies a fat; “OSE” implies a sugar. But all the other roots in each word also mean different things and can signify huge differences.

Cocamidoproplyl Betaine

For example: cocamidoproplyl betaine is a surfactant and an allergen. Coconut oil (cocas nucifera) is an oil and is not an allergen. Both have “coca” imbedded in the name. In the former, it is not the coconut element that is the allergen but the substances used to process the coconut extracts (the “amines”) that make the ingredient allergenic.

Butylene Glycol

Another example: butylene glycol (not an allergen) and propylene glycol (allergen)…both have “glycol”, but the former is a humectant and antioxidant (also not an allergen) while the latter is a formaldehyde-releasing preservative and an allergen.

SLS

Yet another: both Sodium LauRYL Sulfate and Sodium LaurETH Sulfate share lots of elements in their nomenclature. But SLS (the former) is far more irritating than the latter (the latter is actually quite safe). I suppose you could try to memorize RYL as “avoid” and ETH as “better”, but again, this does require some effort.

In addition to understanding (and memorizing!) all the possible combinations of different chemical roots, one would also need to memorize which are on the current allergen lists. As the current lists now specify 76 common allergens (and the lists change every so often), mastering the complexity of cosmetic ingredients is really more of a full-time job than something that most consumers can do, even as a hobby. There aren’t even a lot of dermatologists who are extremely familiar with all these ingredients, the allergens, possible cross reactants, etc. Those that specialize in contact dermatitis would have very in-depth knowledge, and this knowledge takes lots of sustained reading and learning. Considering that only a subset of dermatologists who devote themselves to this study would have this knowledge, you can imagine how difficult it would be for a regular consumer.

This complexity is in part why our founding physician created the VH-Number Rating System. If a patient got a patch test, great: at least she’d know what to avoid. But even then, some chemical names are listed in different ways…or there may be cross reactants that aren’t immediately obvious. With a VH-Number, consumers can immediately see if (and how many) known allergens are included, and the allergen is highlighted in the ingredients list for easy identification. 

Marcie Mom: Thanks so much Laura; looks like it’s best to stick to a trusted company for choosing products for our children as you’ve illustrated, it’s near impossible for a mom (plus a stressed one!) to master the ingredients and allergens.

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