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Doctor Q&A Eczema Tips

AAD A:Z Videos with Dr Lawrence F. Eichenfield – How to Treat Diaper Rash

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

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

In the video, the key points covered are:

  • Always change the soiled diapers, even if it’s just wet
  • Gently cleanse the bump area, such as using moist cloth or alcohol-free and fragrance-free baby wipes
  • Use diaper cream that is zinc oxide based
  • Watch for signs of infection

MarcieMom: Thank you Dr Lawrence for helping parents to learn more about diaper rash this week (and on eczema bleach bath therapy last week). Although diaper rash is common, we still need to learn the proper care for diaper rash and when it is no longer a rash to be self-treated.

Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash
Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash

I understand that diaper rash is a layman’s term and the rash is most likely to be contact dermatitis, caused by close contact of the baby’s skin with the urine/stool that act as skin irritant.

MarcieMom: Is irritant contact dermatitis the most common form of diaper rash? What are other potential irritants apart from urine/stool? For instance, can the diaper itself irritate?

Dr Lawrence: It is true that irritant contact dermatitis is the most common form of diaper rash, with irritation from urine and stools being the most profound irritants. Occasionally children can get inflamed due to other factors, including allergy to diaper contents, though rare, infections such as yeast, which has occurred commonly after courses of oral antibiotics, and many other less common causes of irritation.

MarcieMom: We know that babies have underdeveloped sweat glands and thus occlusion and sweat can lead to heat rash/ miliaria.

MarcieMom: Is it possible that the diaper rash is a heat rash? What are the other possible diagnosis of diaper rash?

Dr Lawrence: It is uncommon for diaper rash to be “heat rash” as the anatomy of the diaper region is different. Aside irritant and occasionally allergic contact dermatitis, there is a broad set of causes of diaper rash which includes yeast infection, psoriasis, and in unusual cases, a broad set of more serious diseases. There are textbook chapters with long list of potential causes of diaper rash, though fortunately, these are uncommon.

MarcieMom: We saw in the video that cleaning the baby’s bum is part of caring for diaper rash. Many parents clean with baby wipes which may end up irritating the baby’s skin if the wipes contain methylchloroisothiazolinone (MI) or methylisothiazolinone. MI was named 2013 “Allergen of the Year” by the American Contact Dermatitis Society.

MarcieMom: What precautions should parents take when cleaning their baby’s bottom to ensure that the cleaning itself will not further irritate the skin? How can parents tell if it’s their cleaning that cause the rash instead of the contact with the soiled diaper?

Dr Lawrence: Parents may be less concerned now, as standard products have dropped MI or MCI from standard wipes. Parents don’t need to be concerned about potential allergy to their cleaning products if diaper rashes respond quickly to standard cleansing and moisturizing regimens, or even interventions with a few days of diaper cream and/or over-the-counter hydrocortisone. If rashes persist with the use of cleansing products and do not respond to standard treatment, then this may be a different story.

MarcieMom: It is recommended in the video to use a zinc-oxide based diaper cream. The diaper cream can act as a barrier that limits the contact of the urine/stools with the baby’s skin. Again, we want to avoid the situation where the cream itself becomes the source of irritant contact dermatitis or even allergic contact dermatitis (where the skin reacts to allergen in the cream).

MarcieMom: What are the ingredients to avoid when selecting a diaper cream? Apart from the obvious ingredients to avoid such as alcohol and fragrance, can ‘good’ ingredients like vitamin E also trigger a rash? Is it better to stick to a ‘basic’ diaper cream that is mainly zinc oxide, instead of a ‘fancy’ one with more ingredients?

Dr Lawrence: Diaper creams that are zinc-oxide based are a tried and true remedy. These produces a barrier layer that protects the skin and also aids in healing of mild irritation or inflammation. Most commercial products have been tested to be safe, with a tendency to be “bland”, meaning a minimal amount of additives being included in the preparations. Parents should be careful with some “organic-based products”, as these sometimes contain contact sensitizers, meaning chemicals that children can become allergic to.

Thank you Dr Lawrence for helping with the questions – we certainly are more informed about to care for our baby’s diaper rash and not aggravate it.

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Doctor Q&A Eczema Tips

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

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

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

In the video, the key points covered are:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Doctor Q&A

AAD A:Z Videos with Dr Daniela Kroshinsky – Cold Sores

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

The video covered today is “How to Treat Cold Sores”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.

MarcieMom: Thank you Dr Daniela for helping us with treatment of cold sores this week (and last week’s interview on pain management in shingles). For parents with eczema kids, we’re very vigilant about cold sores because of the risk of eczema herpeticum. We are looking forward to learn more about limiting the spread of cold sores at home and how to minimize the likelihood of eczema herpeticum.

Key points in the AAD Video

  • Half of population carry the cold sore herpes simplex virus (HSV)
  • Symptoms of cold sores – Burning, itching or tingling, small blisters on the lips or around the mouth which may merge, burst and crust over
  • Triggers of cold sores – stress, fatigue, flu/fever, sun exposure, hormonal changes, trauma (shaving cuts, cosmetic surgery)
  • Treatment – Apply topical anti-viral cream to slow the reproduction of the virus, cool the sores at home with a cool wet towel
  • Reduce pain by taking aspirin and ibuprofen
  • Avoid acidic fruits, such as tomatoes and citric fruits that can irritate the open skin
  • Anti-viral medication used within 72 hours of rash appearing may shorten the period of cold sores or be used for prevention for those with recurrent cold sores
  • Highly contagious – avoid kissing, sharing towel, cups, shavers, toothbrush or any other object that come into contact with the cold sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores

MarcieMom: Dr Daniela, cold sores are quite common but often, the people getting cold sores may not be aware of the severity of spreading to someone, for instance to a young child or to a person with severe eczema.

How contagious is cold sore? For instance, is my child safe as long as she doesn’t share anything with or touch the person with cold sore? Or is it super contagious? (The minute I see someone with cold sore, say in a train, I would leave the cabin. I imagine that he could have touched his cold sores, hold on to the train handle, and if I touch that or somewhere else in the train cabin that has contact with the cold sore, I would get it and possibly pass on to my child with eczema!) Is hand-washing sufficient to get rid of the cold sore virus? (Does anti-microbial product kill the virus or high temperature?)

Dr Daniela: The virus that causes cold sores spreads by direct contact so someone with a cold sore in the same cabin as a person with eczema would not pose a risk.  Spread through shared items depends on if and how much bister or wound fluid could be transmitted. Usually this is very unlikely to take place in public spaces.  In general, it’s a good idea not to touch strange fluids on trains! Handwashing and antimicrobial products would help to minimize this risk.

MarcieMom: I read on Mayo Clinic that the first-time getting the cold sore tend to be more serious that subsequent outbreaks; often, first-time cold sores may be accompanied by:

  • Fever
  • Painful eroded gums
  • Sore throat
  • Headache
  • Muscle aches
  • Swollen lymph nodes
  • Cold sores inside their mouths (for children under age 5)

Is each cold sore outbreak due to the same virus and therefore, there’s increased immunity with each outbreak? Will cold sores affect young children differently?

Dr Daniela: The first outbreak tends to be more severe with each subsequent outbreak being less involved.  Just like the varicella virus of chickenpox can lie dormant in a nerve root and then cause shingles, the cold sore virus, herpes simplex, can lie dormant and reactivate.  Children are less likely to be affected by cold sores but most people have been exposed to the virus by the time they reach adulthoods.

MarcieMom: For someone with severe eczema, the herpes simplex virus can infect compromised skin causing  eczema herpeticum. Dr Daniela, what are the factors that increase the likelihood of someone with eczema getting eczema herpeticum from cold sores? Is any child with eczema at higher risk or is he/she at higher risk only if the eczema is severe or generalized over the whole body?

Dr Daniela: Close contact with caregivers who are prone to cold sores can increase the risk of transmission of the virus.  Uncontrolled eczema leads to increased risk of open skin that could facilitate the virus spreading to the areas that are affected by eczema.  This can happen with any open area but would be more likely depending on how extensive the eczema is and as a result how much of the skin barrier has been compromised. 

MarcieMom: There are many parents whose eczema kids keep getting repeated episodes of eczema herpeticum. Apart from being on long-term anti-viral medication, are there other measures a child can take to reduce the likelihood of getting recurrent cold sores/eczema herpeticum?

Dr Daniella: Eczema herpeticum is the general term for when eczema is infected by herpes simplex virus, regardless of cause.  The best thing to do to minimize risk is to keep the eczema well-controlled and well-hydrated, minimizing dry or open patches that could allow the virus to enter more readily.

Thank you Dr Daniela for being so patient with these questions on cold sores and bearing with me (a paranoid mom!) and my questions on eczema herpeticum. We have learnt much from you and understand better the preventive measures to take to limit the spread of cold sores.

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Doctor Q&A

AAD A:Z Videos with Dr Daniela Kroshinsky – Shingles

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

The video covered today is “Shingles: Pain Management”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.  

MarcieMom: Dr Daniela, thank you for helping out in this AAD video series. Shingles affects about 1 in 5 people and more common in people over the age of 50. However, it’s possible to get it at any age though, as my daughter with eczema and chickenpox (at age 2) had shingles at the age of 4! We’d like in this interview to learn more about managing the pain and the rash associated with shingles and pointers for an eczema child/patient with shingles.

Key points in the AAD Video

    • Anyone can get shingles if they have the chicken pox virus (varicella zoster), either from having had chicken pox or from chicken pox vaccination
    • Shingles rash – More pain experienced than chickenpox, commonly in one region of the body and usually confined to one side of the body
    • Symptoms of Shingles – Area of skin that burns, tingles, itches or sensitive; begins as red spots that turn to raised areas and blisters in the same area. This is followed by crusting.
    • 2 to 3 weeks for the blisters to heal with reducing pain
    • If pain, itch, numbness or tingling develops, it can last months to years
    • Anti-viral medication used within 72 hours of rash appearing may shorten the course of the rash and lessen the pain. After 72 hours, anti-viral medication can still lessen the pain.
    • At home – Cool the rash, apply calamine lotion, do not peel, pick at or pop the blisters, cover the rash with loose, sterile bandage and wear loose-fitting, cotton clothing
  • Shingles is contagious – can spread in the form of chicken pox to someone who has not had chicken pox or to the fetus of a pregnant person.
Questions answered by Dr Daniela Kroshinsky on Shingles : Pain Management
Questions answered by Dr Daniela Kroshinsky on Shingles : Pain Management

MarcieMom: Shingles is caused by reactivation of an infection that is dormant in a nerve and the area of skin supplied by the nerve. Dr Daniela, can you explain which nerves get infected most often and is that why most people get the shingles rash on their torso? In the video, it is mentioned that some people get it on their face – does a person’s age and immune system affect which nerves will get infected? Once infected, can it spread from one part to another of the body?

Dr Daniela: In general, shingles will arise in the area of the body that had the greatest concentration of blisters at the time of the chicken pox but it varies widely.  Most chickenpox blisters arise on the torso.  Once someone is infected, they can spread the lesions to other parts of theirs skin through contact with the blister fluid which contains active virus.  In addition, people who have compromised immune systems may experience widening of the affected area beyond the initial skin patch fed by the nerve. This is called “disseminated zoster” and requires urgent attention and treatment.

Reducing Pain in Shingles

MarcieMom: We learnt in the video that anti-viral medication can help to reduce pain and pain relief measures at home can help. Why do certain people feel more pain than others? (Age, immune system, or existing medication they are on?) Are there any measures one can take to reduce the likelihood of prolonged pain, ie months after the rash has healed (Postherpetic neuralgia or PHN)?

Dr Daniela: There are many factors that can influence people’s perception of pain, many that we are still starting to understand.  Starting antiviral medication as soon as possible is the most helpful tool to help minimize the risk of pain.  If PAIN develops, seeking medical attention as soon as possible, including with a pain specialist if needed, can help to better manage these symptoms.

Lowering Likelihood of Shingles’ Complications

Apart from postherpetic neuralgia, there are other complications such as

    1. Skin infection, from bacteria/germs
    1. Shingles at the eye can cause eye inflammation
  1. Muscle weakness (palsy) due to shingles infection of the motor nerve

MarcieMom: Of particular interest is skin infection. What are the factors that will increase the chance of skin infection and what measures should one take to reduce the chances of skin infection?

Is someone with eczema skin that is already colonized with staphylococcus aureus bacteria more likely to suffer from skin infection? If yes, is it advisable to clean the shingles rash with chlorhexidine?

Dr Daniela: Picking or touching the lesions can introduce bacteria that could create bacterial infection of the shingles. Keeping the lesions clean and covered helps to minimize this.  With eczema in general, keeping eczema controlled and minimizing wounds helps to prevent secondary infection.  It is not necessary to clean shingles with a medicated soap.  Chlorhexidine can be irritating and can dry out skin, further exacerbating eczema and as such I would not recommend it be used for shingles.  Keeping the lesions covered and clean with gentle care is usually sufficient.

Managing Shingles for those with Active Eczema

For some eczema children and adults, they may be on various courses of corticosteroids or immunosuppressant, such as prednisolone, mycophenolate mofetil and cyclosporine. Will taking such medication increases the risk of getting shingles? 

Is it possible that shingle rash will appear over a patch of skin with eczema flare-up? If so, what topical medication should be applied? (still ok to apply topical corticosteroid over the eczema if shingles appear on the same patch?)

Dr Daniela: Immune-lowering medications can make it more likely that someone will have their shingles spread more widely so it is important to watch shingles as it develops to assess whether the eruption is spreading more widely, warranting more aggressive treatment. Once antiviral treatment has been started, topical steroids can be used cautiously to the eczema around the shingles lesions but it is important not to rub the viral lesions as it is possible to spread the viral particles and extend the infection.  Anti-itch medications like antihistamines can be very helpful to control the symptoms of itch that can accompany eczema.

Thank you Dr Daniela for helping us to understand how to manage shingles and offering clarity for those suffering with eczema who also get shingles.

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Doctor Q&A

AAD A:Z Videos with Dr Thomas Rohrer – How to Treat Sunburn

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

The video covered today is “How to Treat Sunburn”. For this video, I interviewed Dr. Thomas E. Rohrer, M.D., who is a dermatologic surgeon at SkinCare Physicians, and previously served as the Chief of Dermatologic Surgery at Boston University Medical Center and Boston Veterans Administration Hospital for eight years and as the Director of the Boston University Center for Cosmetic and Laser Surgery. Dr Rohrer is passionate about education and is the editor of six cosmetic and laser surgery textbooks and guest editor of numerous journals.

MarcieMom: Thank you Dr Rohrer for helping us with how to shave last week. This week, we are learning about how to treat sunburn and at the same time, learn about how sunburn affects eczema skin.

In the video, the key points on the treatment of sunburn were covered: (note: AAD has amended the video on Treatment of Sunburn but the contents in this blog post was still based on the previous video which is no longer available on Youtube. The video above features AAD’s updated video)

  1. Get out of the sun
  2. Take cool baths
  3. Pat dry, moisturize while there’s still a layer of water on the skin
  4. Choose creams with aloe vera
  5. Apply hydrocortisone cream to reduce inflammation but do not treat with benzocaine
  6. Take aspirin and ibuprofen
  7. Drink extra water as the sunburn draws water from the skin and rest of the body
  8. If there’re blisters from the sunburn, do not pop them but let them heal
  9. Watch for signs of infection

The way to shower and moisturize looks the same for both sunburned skin and eczema skin – not hot bath, not rubbing dry (but pat dry), trapping more moisture on the skin after shower and moisturizing right after.

In a previous interview with Dr Robin Schaffran, we learnt that ultraviolet light rays penetrate through the epidermis and dermis layers of the skin and damage the DNA in skin cells, collagen and elastin in the dermis.

How to treat sunburn AAD Video with Dr Thomas Rohrer
How to treat sunburn AAD Video with Dr Thomas Rohrer

MarcieMom: Dr Rohrer, what is it about the sunburned skin that makes it important to maximize the retention of skin moisture? What are the factors that affect the recovery of sunburned skin? (for instance, do certain conditions like eczema and psoriasis take longer to recover? Or whether skincare measures are taken after the sunburn?)

Dr Thomas: It is a good idea to try to maximize retention of skin moisture in everyone’s skin.  When the skin is burnt it becomes even more important as there is increased loss of water through the damaged skin. Similarly, with eczema or other conditions that result in dry scaling skin, the increased permeability of the skin makes it more important to keep the skin well moisturized. Keeping the skin moisturized will allow it to function more normally and recover more quickly.

In the video, it seemed that hydrocortisone is applied liberally on the sunburned skin to reduce inflammation. A few questions to provide some guidelines to patients who have access to mild hydrocortisone cream and want to self-treat at home.

Potency – What % of hydrocortisone should the lotion/cream be?

Frequency – How frequent (in a day) can it be applied onto sunburned skin?

Duration – What would be the duration and is there a decreasing frequency of application during this period?

Amount – How much of hydrocortisone can be applied? What is the sunburned skin covers a large skin area?

Dr Rohrer: Hydrocortisone can help reduce inflammation. On the face, no more than the over the counter 1% hydrocortisone should be used.  On other parts of the body a slightly stronger 2.5% formulation may be used.  It is best not to use either more than twice a day and only for a short period of time.  Most of the time only a couple of days are necessary before the burn feels much better.    

MarcieMom: Benzocaine is mentioned not to be used. However, I read on Mayoclinic that benzocaine is used for sunburn and on Pubmed that benzocaine is effective for treating the pain (but not the itch) on sunburned skin. What are the reasons why benzocaine should not be used for sunburn treatment?

Dr Rohrer: While benzocaine preparations do help reduce pain, many people are or become sensitive to it.  We frequently see allergic skin reactions to benzocaine and therefore do not recommend it for use with the majority of patients. 

MarcieMom: Lastly for those with eczema, sun exposure is not recommended during eczema flare-ups.

How does sun exposure affect eczema skin?

Dr Rohrer: Sun exposure and sunburn are not recommended for anyone.  While some people do find that mild sun exposure improves their eczema, it is not recommended as it adds to the cumulative radiation effect of the sun and can lead to skin cancers. 

Thank you Dr Thomas for helping us with treatment of sunburn and clarifying questions we have on self-treating at home. Sun protection is important (see AAD Video on How to Apply Sunscreen with Dr Sonia Badreshia-Bansal MD on this blog).

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Doctor Q&A

AAD A:Z Videos with Dr Thomas Rohrer – How to Shave

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

The video covered today is “How to Shave”. For this video, I interviewed Dr. Thomas E. Rohrer, M.D., who is a dermatologic surgeon at SkinCare Physicians, and previously served as the Chief of Dermatologic Surgery at Boston University Medical Center and Boston Veterans Administration Hospital for eight years and as the Director of the Boston University Center for Cosmetic and Laser Surgery. Dr Rohrer is passionate about education and is the editor of six cosmetic and laser surgery textbooks and guest editor of numerous journals.

MarcieMom: Dr Rohrer, thank you for helping out in this AAD video series. Shaving is something most men and women have to do regularly and it is not as simple as it looks – complications can arise from shaving and shaving can be complicated for those with existing skin conditions. We’d first cover how to shave safely and what those with eczema have to pay attention to when shaving.

Proper Way to Shave

In the video, the key steps in shaving are covered:

  1. Wet your skin and hair before shaving
  2. Apply shaving cream or gel
  3. Shave in the direction of hair growth
  4. Change blades after 5 to 7 shaves to minimize skin irritation
  5. Use shaver with sharp blades
  6. Not to try to shave off acne

I read that wetting the facial hair will allow it to absorb the moisture and a swollen hair is softer and easier to cut. It appears that warm water is best, either a few minutes from a moistened towel or after shower. I also come across that showering will open up the hair follicle and makes it easier to shave. The idea is that the easier it is to shave, the more likely a one-time pass is sufficient and thus, less likely to irritate the skin. Conversely, showering too long will cause the skin to wrinkle and harder to shave.

Questions answered by dermatologist Dr Thomas Rohrer on Shaving
Questions answered by dermatologist Dr Thomas Rohrer on Shaving, including that for eczema and sensitive skin

MarcieMom: Dr Rohrer, it seems to get quite ‘technical’ if one starts thinking about temperature and timing of wetting skin and hair before shaving. Can you explain

What happens to the skin, hair and hair follicles when they are wet

Why wet skin, hair and follicle makes shaving easier

Whether there is an optimal wetness and how important it is to get this right

Dr Rohrer: You are correct; when hair is wet, it absorbs a little water and becomes softer. This allows the razor to cut the hair more easily.  In general, things expand when they are warmed.  So using warm water will expand the hair, skin, and pores more than cold water. This allows more water to be absorbed into the skin and hair and makes the hair softer than if cold water was used. In addition, water in and of itself is a slight lubricant so it helps the razor glide over skin better than dry skin. It is difficult to wet the skin on the face, underarms, or legs too much.  These areas do not tend to get bloated like the fingers may after long water exposure.    

MarcieMom: Likewise for the application of shaving cream or gel, there appears to be ‘good practices’ such as leaving the shaving cream on the skin for 3 minutes, brushing the cream into the hair with a shaving brush to lift the hairs and to ensure that the hairs get coated with the cream.

Is a shaving cream necessary for all parts of the body or only facial hair for men? If lubricating is the main purpose of shaving cream, will showering with bath oil achieve the same purpose? Is there an issue of too much shaving cream?

Dr Rohrer: I don’t think one can use too much shaving cream.  The point of a shaving cream is to soften the skin and hair and act as a lubricant and barrier between the razor and the skin. If someone does not experience discomfort when using bath oils in the shower then that would be fine to use.  If they do have some irritation then they could add a shaving cream or gel.

Shaving for those with Sensitive Skin

Throughout the shaving process, there are quite a few steps that may lead to irritation for those with sensitive skin. For instance,

Shaving cream – using a shaving cream that contain irritants (for instance, fragrance and Triethanolamine) or having surfactants that are common allergens

Act of shaving – irritation from friction, damage to epidermis, or repeated shaving?

MarcieMom: Dr Rohrer, what should someone with sensitive skin take note of when shaving?

Dr Rohrer: Shaving foams out of a store bought can contain a great deal of alcohol and can dry the skin out.  If someone has sensitive skin it makes sense to use a shaving gel, cream, or soap. These products contain more glycerin than alcohol and do not dry the skin out.  It is also important to moisturize the skin right after shaving.  Men should use a moisturizer that contains sunscreen with an SPF of 15 or 30 in it.  This will give a good base coat on the face every morning.      

Shaving for those with Dry Skin and Eczema

One issue with dry shaving is that the razor may get clogged up with dead skin cells. A clogged razor doesn’t give a close shave and there is a risk of nicks. For those with dry skin or eczema, there may be more dead skin cells. Also shaving can cause micro-tears in the skin and eczema patients may get the micro-tears more easily or more prone to infection at the micro-tears.

MarcieMom: Dr Rohrer, should shaving over skin that has active eczema flare-up be avoided? What should an eczema sufferer take note of during shaving?

Dr Rohrer: If someone has eczema or any other skin condition, it should be treated and controlled medically.  There are great treatments for these diseases that can get them under control. The AAD is a wonderful resource for people to use to get more information about their particular condition. If there is a flare-up, then caution should be used when shaving over these areas. An electric razor is less likely to cut skin than a typical blade razor.  These devices can be used in areas that have been compromised by a dermatologic condition.  Moisturizing after shaving will also help.

Thank you Dr Thomas for helping us to understand shaving and how preparation is important. For those of us with eczema or sensitive skin, it is also most helpful to understand how shaving affects our skin.

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Youtube EczemaBlues Channel

(Video) Quick Guide on Allergy Test for Kids

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

Firstly, understand that eczema is also known as atopic dermatitis, inferring that there is an atopy ie hypersensitivity to allergen involved. However, not all eczema children will have an allergy, for instance, my child is tested negative to the common allergens.

For most parents then, it makes sense to find out the allergens involved in your child’s eczema, eliminate/avoid these triggers, so that your child’s skin can heal (versus constantly being provoked to skin inflammation). There are two common allergy tests,

1. Skin Prick Test – this is recommended as it is fast, accurate and low cost, it’s not scary and my daughter didn’t cry at all when she had it at 7 month old. Many parents are worried about how many allergens the child has to be pricked with, but this worry is undue as there are few common food, environment allergens that most kids react to and thus only these need to be tested. Read more on SPT here.

2. Blood IgE test – this is usually recommended for babies without clear patch of skin or unable to go without antihistamine (which is necessary to abstain for a week before the SPT). Read more on allergy test here.

The allergy test is done during consultation and parents should not be afraid to ask your doctor the next course of action and how you’d expect your child’s skin to be within the next few weeks of prescription and allergen avoidance. Don’t be shy!

Do watch the video for more details and as always, appreciate you sharing your experience. Also what other videos would you like to see, do leave me a comment!

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Eczema Tips Youtube EczemaBlues Channel

(Video) How to Moisturize Baby Sensitive Skin

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

Firstly, for babies with normal skin, it may not be that critical to moisturize (but good practice since baby’s skin is thinner and more susceptible to moisture loss). However, for babies with dry skin or eczema, moisturizing has been studied to reduce the need for topical medication and lessen the severity of eczema.

Many parents ask what is the best moisturizer to buy? In short, there isn’t a best one in terms of formulation but one that your child likes and within your budget to use generously. The functions of  moisturizer deal with maximizing moisture for the skin while acting as additional protective layer. Choosing a moisturizer that is without the top irritants is a wiser purchase than starting with the cheapest (and leading to irritated skin).

How to moisturize is also covered in the video, and the main thing to remember is always right after shower. For expert tips on reading skincare product label and moisturizing, click on the links.

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

Video Photo Credit: lupinoduck via Compfight cc

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Eczema Tips Youtube EczemaBlues Channel

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

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

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

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

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

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Youtube EczemaBlues Channel

(Video) Sun Protection for Kids – Sun Good or Bad?

This is the second of baby skincare series, which kickstart last week with Common Baby Rash.  I NEED YOUR SUPPORT, do subscribe to my EczemaBlues channel here. As I’m just starting out, and camera-shy, the video is my voice over slides that I prepared. Do share your comments pleeease on how I can improve them.

Now on sun protection, it is sadly not uncommon to see young babies being strolled into the hot sun and this is definitely NOT recommended as it is bad on so many levels, for the skin and also for the baby’s eyes which let in more harmful UV rays than adult’s.

To start with, the baby’s skin has less pigment cells and thus more vulnerable to the UV rays which penetrate and damage skin cells – resulting in sunburn and possibly, skin cancer over prolonged exposure. It is therefore important to take sun protection measures, and this ‘sunscreen’ tag link provides many expert tips on how to do so, including the choice of physical blockers for sunscreen and ingredients to avoid.

There is also much controversy on the benefit of sun for Vitamin D, BUT only 10-15 minutes is sufficient (the fairer the skin, the less time) and any longer sun exposure beyond that contributes to skin damage. Moreover, those with eczema flare-ups should avoid the sun as it can worsen the skin inflammation. Photo-therapy has to be prescribed (mainly for adults) and not the same as sun-tanning.

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

Video’s photo credit: photon bomb via Compfight cc

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Eczema Tips Youtube EczemaBlues Channel

(Video) Common Baby Rash – Ok or Not?

First of all, I’m starting to incorporate videos into my blog, so that parents who are busy or who likes to view videos on Youtube can access to the vast skincare, nutrition and parenting tips for eczema families! I NEED YOUR SUPPORT, do subscribe to my EczemaBlues channel here. As I’m just starting out, and camera-shy, the video is my voice over slides that I prepared. Do share your comments pleeease on how I can improve them.

So, this video is part of baby skincare series, where the first thing to do is to recognize if the baby rash is one of those common ones which you needn’t be worried about, or eczema (which you have to be). Common baby rash are:

Baby acne – due to hormones and will clear on its own

Milia – due to trapped skin and will disappear on its own

No specific treatment needed for above, only gently cleanse the baby’s skin.

Heat rash – due to clogged pores as baby’s sweat glands are underdeveloped and occlusion from thick clothes and blanket can trigger the heat rash. Choose light clothing and don’t over-wrap the baby! Baby’s skin is not able to regulate body temperature as well as adult’s.

The other common rash is cradle cap, where you can find more in link here.

Diaper rash is also another common rash, which is a form of irritant contact dermatitis. Air the baby’s bottom, gentle cleanse it and choose a non-fragrance barrier cream.

Eczema is one of the common  baby rash (affects 20% of children) which is NOT OK to leave untreated, particularly if your child’s eczema is more than mild. I made the mistake of not recognizing it, and on hindsight, I ought to have known as my baby was twitching and trying to rub her face on the pillow.

Do watch the video for more details and a transcript is also included (in case you want to tune out my voice!). This is my very first skincare video, appreciate your comment, good and bad! Thank you!

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Youtube EczemaBlues Channel

Healthcare and Patient Experience – #MedX hangout (video)

Gathering of Patients, Doctors, Educators and Tech in Stanford MedX Google Hangout - Privilege to be part of the panel
Gathering of Patients, Doctors, Educators and Tech in Stanford MedX Google Hangout – Privilege to be part of the panel (click on image to view video!)

It is truly humbling and a privilege to be part of healthcare initiatives, and in this Google Hangout with Stanford Medicine X, we discussed topics on:

Current challenges in healthcare facing the Asia region

Patient experience in Asia

Self-tracking of health by patients in Asia and whether it is helpful and how it can be used to facilitate discussion with physician

Movement towards participatory medicine, meaning the patients’ inputs, experience on what works or observations are considered by doctors

Interesting conversation as the panel of guests comes from different backgrounds, from patient caregiver (me, @MarcieMom), doctor who is active in supporting rare disease (@wmclaxton), experts in education (@Jmarooth) and devices to track health (@crayonlions). While the Google hangout was ongoing, a vibrant twitter conversation with #MedX was being moderated by @HugoOC with @DrStevenTucker joining in, and of course, thank you to @Afternoonnapper @StanfordMedX for organizing this and pouring energy into what they believe will improve healthcare.

MedX Singapore Panel

Inspired by the efforts of many in healthcare, I’ve created a playlist ‘Healthcare in Asia’ on at Youtube and will be adding more videos I find that would be relevant for us in this part of the world! Leave a comment if you’ve a recommendation for the playlist!

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Support Group

(Video) 2014 Eczema Lovexcitement

[youtube=http://youtu.be/0qOcRa9Zxes]

Hello Everyone!

Happy New Year, 2014! It is a joy to have walked through 3 solid years with you all, and in 2014, I’m making more videos – starting with this one! A video recapping the laughter (cartoons), the information (expert interviews) and the tears and joy (Friday eczema sharing from round the globe) – totaling a staggering 489 posts! Look forward to many more comments and connecting more with each and everyone of you. Take care, hugs!

Mei
p.s. this year, my book is going to be published, watch out for it – do subscribe to my newsletter at right side of blog to be kept updated of more news! (include giveaways too!)

Categories
Support Group

Video Invite to Christmas at Church

[youtube=http://youtu.be/5xwwx3MNcx8]

Here’s a video I made to invite those of you in Singapore to my church’s Christmas performance, hope that all the 10 tickets I have on hand can be given out. Will send by snail mail to you in Singapore, do RSVP asap, by Tuesday midnight latest in order for me to prepare the envelope and send the tickets first thing on Wed morning! Show’s this weekend!

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Doctor Q&A

Doctor Claudia Video – Why Stressed Skin is More Skin Deep

Dr. Claudia Aguirre is a neuroscientist, a TED speaker and creator of Ted Education lessons. She is passionate about skincare, psychodermatology and frequently lectures worldwide. Read more about her at doctorclaudia.com

Marcie Mom: Thank you Dr Claudia for taking time to answer questions on the video. In it, you shared that chronic stress is associated with many diseases including diabetes, cardiovascular diseases, autoimmune diseases and even cancer. Stress process begins in hypothalamus, that sends an initial signal to the pituitary gland, adrenal gland and triggers the release of adrenaline, noradrenaline and cortisol that travel through the body for a fight or flight response. Stress is also studied to be able to trigger neurogenic inflammation that can worsen eczema, psoriasis, premature aging, acne and rosacea.

Stress can dehydrate skin, leading to impaired skin barrier that makes the skin more vulnerable to allergens and irritants, and triggers eczema flares. Histamines released also contribute to the itch level experienced in the skin. Stress can also make the skin hypersensitive to allergens. Cortisol boosts oil production, leading to blocked pores and worsening acne.

Doctor Claudia shared that there is a new field Psychodermatology, which is the practice of treating skin disorders using both dermatological and psychiatric techniques. Treatments such as acupuncture, aromatherapy, breathing and massage techniques are also shared in the video.

Dr Claudia, can you share briefly with us how the brain ‘talks’ to the skin and how differently a stressed brain talks to the skin?

Dr Claudia: The brain and the skin share an embryonic origin and are constantly communicating with one another. Think about sensation – your skin, once stroked, sends signals to the brain and the brain determines whether it is being tickled, stroked, or punctured. Of course the picture is more complex than that, as it involves countless nerve fibers, relayed information in the spinal cord and signals from brain to skin. They communicate using electrical impulses and chemical signals for the most part. A stressed brain will send more stress signals, or hormones, throughout the body including the skin.

Dr Claudia Aguirre answers questions on Why Stressed Skin is more than Skin Deep video

MarcieMom: Eczema is a stressful condition to manage, and stress can also trigger eczema – a double whammy situation. For children with eczema, what do you think are some ways to break this vicious cycle?

Dr Claudia: The behavior should be modified to adapt to lifestyle changes early on. In children, this may be teaching them that they can keep their hands busy so they don’t idly scratch their skin. Teaching them to breathe deeply has also been shown to reduce anxiety and stress in children – some therapists put a ball or balloon on the belly of the child and make them move it while breathing deeply, lying on their back. This can help a child understand how to breathe from the belly, which can reduce stress. Maybe when they get particularly itchy, they can call out to mom or caretaker, who will apply a cool compress to relieve the itch without scratching the skin.

MarcieMom: You mentioned about touch being able to relieve stress. Do you think that a mother carrying or sleeping with an eczema baby can help relieve stress and offers the possibility to improve eczema?

Dr Claudia: Absolutely. Holding premature infants allows them to develop faster and carrying a baby or toddler is comforting in more ways than we know. Gently stroking them will also be soothing. As for co-sleeping, there are different viewpoints and it is up to the individual in the end. To relieve from dust mites, wash often with hypoallergenic detergent and vacuum frequently. Although they are a trigger, they are not the cause of eczema, so keeping the skin hydrated and lubricated will allow it to heal and prevent flare-ups.

Thanks Doctor Claudia, as always, very much appreciate your insights into skin.

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Doctor Q&A Eczema Tips

AAD Skincare Video Series: Sunscreen

Today’s video is “How to Apply Sunscreen – Protect your Skin against Skin Cancer and Premature Aging‘. For this video, I interviewed Dr. Sonia Badreshia-Bansal MD, who is the CEO and medical director of Elite MD. Dr Badreshia-Bansal is a board certified dermatologist trained at the prestigious Penn State, College of Medicine and the Milton S. Hershey Medical Center, where she served as Chief Resident.

Sunscreen Sun Protection Dr Sonia Bansal AAD video
  1. Face Washing 101
  2. How to Get the Most from Your Skincare Products
  3. Eczema Tips: How to Help your Child Feel Better
  4. How to Apply Sunscreen

MarcieMom: Thank you Dr Sonia for helping with this AAD Skincare series. No matter what the season is, sunscreen should be applied, even during winter.

For children with active eczema on the neck, forehead and face, is sunscreen recommended?

Dr Sonia: Sunscreen is recommended on all skin types daily in those  over the age of 6 months.

Application of Sunscreen on Eczema Skin

MarcieMom: What is the procedure for applying moisturizing and sunscreen for a child with eczema, going for a swim? What is the recommendation for after a swim? (considering preventing chlorine irritation, trapping moisture, yet wanting the benefits of chlorine to kill staph bacteria that frequently colonizes eczema skin)

Dr Sonia: A thick moisturizing cream should be used first, followed by sunscreen 30 min prior to going outside and swimming. After a swim, take a shower to get the chlorine which can further dry out the skin to produce eczema. Reapply thick moisturizer to lock in moisture.

Sunscreen for Child vs Adult

MarcieMom: What is the difference between a sunscreen for a child and that for an adult? Is it possible for a child to use an adult’s and for the adult to use the child’s?

Dr Sonia: Both can be used interchangeably. Look for a broad spectrum, SPF 30 sunscreen. I also recommend looking for zinc oxide or titanium dioxide, which will be less irritating than the chemical based sunscreens.

Sun Protection on Child’s Lips

MarcieMom: In the video it is also mentioned about protecting lips. Is that necessary for a child?

Dr Sonia: Lips may also sunburn. Preventing sunburns will prevent skin cancers, including the lip. All sun exposed areas should be protected, including lips.

MarcieMom: Thank you Dr Sonia for helping with my questions, and it has been an enriching month learning the AAD dermatology videos!

Categories
Doctor Q&A Eczema Tips

AAD Skincare Video Series: Eczema Tips

How to Help your Eczema Child feel Better with Dr Lawrence Eichenfield AAD

Today’s video is “Eczema Tips: How to Help your Child feel Better“. For this video, I’ve interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine.

  1. Face Washing 101
  2. How to Get the Most from Your Skincare Products
  3. Eczema Tips: How to Help your Child Feel Better
  4. How to Apply Sunscreen

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

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

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

Practical Way to Moisturize Eczema Child

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

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

Don’t get “hung up” on the perfect patting the perfect timing of application of moisturizers

Long-lasting vs Pore-clogging for Ointment?

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

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

Finding the Right Humidity for Eczema Skin

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

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

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

Categories
Doctor Q&A Eczema Tips

AAD Skincare Video Series: Skincare for Eczema

How to Get the Most from Skincare Products with Dr Joshua Zeichner AAD Video

Today’s video is “How to get the most from your Skincare Products“. For this video, I’ve interviewed Dr Joshua Zeichner, M.D., who is the Director of Cosmetic and Clinical Research in Dermatology, Mount Sinai Medical Center in New York and board-certified in Dermatology. He is Board Certified in Dermatology and considered one of the country’s key opinion leaders in treating acne and rosacea.

  1. Face Washing 101
  2. How to Get the Most from Your Skincare Products
  3. Eczema Tips: How to Help your Child Feel Better
  4. How to Apply Sunscreen

MarcieMom: Dr Zeichner, thank you for taking time to help with this AAD video series. 

Cross-Reactivity in Beauty & Skincare Products

For individuals with sensitive skin using multiple products, say facial cleanser, moisturizer and make-up, is there any guideline to ensure that there is no cross-reactive ingredient? e.g. choosing the same brand or ensuring that each does not have certain ingredient?

Dr Joshua: If you are sensitive to skin care products, your dermatologist can perform patch testing, an exam to determine what ingredients you may be allergic to.  You should avoid products with those particular ingredients.  Unfortunately, you cannot necessarily just stick to one brand because individual products do vary in their composition.  However, some brands in general do stick to being fragrance free, etc.

Medication or Moisturizer – Which to Apply First?

MarcieMom: It is recommended to wash the face first, followed by medication, then moisturizer or sunscreen, followed by make-up. What is the interval between applying moisturizer and sunscreen? Does the moisturizer have to dry before applying sunscreen? 

Dr Joshua: We do not have great data on this.  We do not really know if it is best to moisturize or medicate first.  In general, I recommend applying one product in a thin layer, allowing it to dry for about 60 seconds, then applying the next layer.  If you apply too much cream it may take longer to dry.

Does sunscreen have moisturizing effect and therefore, can skip applying moisturizer? 

Dr Joshua: Only if you are specifically using a facial moisturizer with sunscreen. Straight sunscreens for the beach are not designed to be moisturizers.

Common Irritants for Children Eczema Skin

MarcieMom: What are the ingredients that frequently irritate a child’s sensitive/eczema skin?

Dr Joshua: Usually fragrances and preservatives

MarcieMom: Thank you Dr Joshua for your reply, I’d be sure to remember applying moisturizer even when I’d be applying sunscreen for my child with eczema, and thankfully, we found skincare products that don’t irritate her eczema skin.

Categories
Doctor Q&A Eczema Tips

AAD Skincare Video Series: Face Washing

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

  1. Face Washing 101
  2. How to Get the Most from Your Skincare Products
  3. Eczema Tips: How to Help your Child Feel Better
  4. How to Apply Sunscreen

Today’s video is Face Washing 101 and I’ve interviewed Dr Jessica Krant MD MPH, who is a board-certified dermatologist, member of the American Academy of Dermatology, 2017 Castle Connolly Top Doctor, and founder of ArtofDermatology.com.

Face washing Dr Jessica Krant AAD video baby sensitive skin

MarcieMom: Thank you Dr Jessica for kickstarting this AAD video series! Today’s video sounds pretty basic, but I’ve some questions that still puzzle me, particular for those with sensitive skin. 

Face Washing for Toddlers

How should the face of a toddler be washed? Should the cleanser or bath oil for the body be used for the face? or is it not necessary to specifically wash the face except a quick rinse during shower?

Dr Jessica: Just like every adult has different skin, every toddler does too. Some might also be a little messier. It’s safe to wipe your toddler’s face clean with a towel soaked in warm water. Soap is really not needed, except on rare occasion, or if your own dermatologist has suggested something specific for certain medical conditions like seborrhea, eczema or baby acne. Cleansing bath oils or lotions that are soap-free are safe to use during bath time, as long as they are kept away from the baby’s eyes.

Face Washing for Child with Eczema

If the child has facial eczema, say weepy cheeks, how should the face be washed? Is that a sign of infection, and if so, what different measures ought to be taken?

Dr Jessica: Facial eczema with weepy cheeks can either be a sign of moderate to severe eczema with a broken down skin barrier but no infection, or a sign of skin infection in some cases. If unclear, it’s best to take the child to see a dermatologist so any risk of scarring is minimized, since babies and toddlers will definitely scratch itchy face skin and it’s hard to prevent that. No change should be made in the facial washing routine except to be extra gentle so as not to further irritate the rashy areas. Make sure any moisturizers aren’t stinging the skin and making it more itchy, and use ointment-based topical medicines rather than creams where possible.

Cleaning a Child’s Eyelids

In the video it is mentioned that the skin around the eyelid is delicate, and I would assume that for a child it is even more so. Would wiping with lukewarm soaked cotton pad be sufficient to clean the skin and remove the oil on the eyelid?

Dr Jessica: When necessary, wiping with warm water is a good way to clean a baby’s or toddler’s eyelids, but just make sure that any item used like a cotton pad, won’t come apart and leave small cotton fibers behind on the lids or lashes which could irritate the baby’s eyes.

It is recommended in the video to wash the face twice and after sweating. Is this recommendation the same for a child?

Dr Jessica: No, I think it would be best to wash a baby or toddler’s face as little as possible with anything other than warm water. A gentle soft cloth with warm water would be fine if there is any food or mucus at any time, but cleansing with anything else should be once per day or less often. And babies don’t really sweat, so there should be no extra cleaning unless there is actual dirt or mud present.

MarcieMom: Thank you so much Dr Jessica, indeed, I’ve to be careful of the cotton pads leaving residue on the eyes, particularly as my toddler tries to do it herself!

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Doctor Q&A

Doctor Claudia Video – Eczema: Scratching the Surface

Aging Skin Eczema Skin Videos of Dr Claudia Aguirre Neuroscientist

Dr. Claudia Aguirre is a neuroscientist, a TED speaker and creator of Ted Education lessons. She is passionate about skincare, psychodermatology and frequently lectures worldwide. Also check out last week’s video on Aging Skin.


This video showcasing Dr Claudia Aguirre was when she worked at Dermalogica

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.

Sweat and Eczema

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.

Aromatherapy, Stress and Eczema

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.

Water in Skincare Products to be Avoided?

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 for Eczema

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.

Vitamin D and Eczema

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”.

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!

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