Anyone’s husband like to Do things to help? Share your funnies with me!
For all cartoons in this series, see Mom Sleep Cartoon.
I imagine in every marriage, there’s work to do. After all, as the saying goes, you won’t know how unloving you are till you live with someone. Even more in a marriage with eczema kids, these ‘negative’ feelings may easily escalate.
God cares about our marriage and there are many verses on how married couples should love each other. My favourite is the one below, and it’s so hard to live it up!
Bible verse:
Ephesians 4:2-3 “Be completely humble and gentle; Be patient, bearing with one another in love. Make every effort to keep the unity of the spirit through the bond of peace.”
Father, help us in our marriage. It’s so so difficult – sometimes I don’t have time to love my spouse! (maybe I don’t have time to love even myself). Help me to love.
Don’t Bottle Up the Bad, Choose Love
Last updated on 15 November, 2024 5:49 pm
There’s so much about gluten-free these days – it’s an industry in itself and marketing ‘Gluten-Free’ is seen in menus and food packaging. We hear of sports celebrities performing better after cutting gluten and we hear of celebrity moms choosing gluten-free diets for their children. But what is gluten and what happens when you eat it? As the 4th part of this series, today’s post explores the different types of gluten sensitivities.
TOP 5 Facts You Need to Know to Differentiate Your “Gluten Sensitivity Type”!
Gluten refers to the proteins found in wheat, barley, rye and triticale (a cross between wheat and rye). Gluten gives elasticity/stickiness to the dough.
GLUTEN SENSITIVITY TYPE #1 – CELIAC DISEASE (CD)
CD Fact #1: Involves immune system, BUT not IgE-mediated reaction to the gluten.
CD Fact #2: Immune system attacks the villi in the esophagus when exposed to gluten protein gliadin, found in wheat, barley, rye, and sometimes oats. This lead to intestinal inflammation, flattening of the villi and long-term damage to the small intestine. Associated with high intestinal permeability whereby bacteria, antigens and undigested food ‘leaked’ through the gastrointestinal barrier.
CD Fact #3: Symptoms include diarrhea, abdominal bloating/pain/cramps, bone/joint pain, bruises, constipation, depression, failure to thrive for children, mouth sores, infertility/miscarriage, malnutrition, weight loss, chronic fatigue, anemia, blood or fats in stool, nausea, joint pain, tingling on hands/feet, Dermatitis Herpetiformis or no symptom. Related to malabsorption of nutrients due to the intestinal villi being compromised.
CD Fact #4: Diagnosis is straightforward with tests to detect AGA (Antigliadin) and EmA (Andomysium Antibodies). Cutting gluten before testing will affect results. Small intestinal biopsy is an accurate test for celiac disease.
CD Fact #5: Treatment is strict avoidance of gluten in order for the villi to heal. Note that oats can be tainted with gluten and some common medications, vitamin supplements and cosmetic products also contain gluten. Untreated gluten has been linked to intestinal cancer, liver disease, small bowel ulcers and other inflammation-related diseases of the digestive tract, heart, joint and even brain.
GLUTEN SENSITIVITY TYPE #2 – NON-CELIAC GLUTEN SENSITIVITY (NCGS) or GLUTEN INTOLERANCE
NCGS Fact #1: Does not involve immune system and is not celiac disease. However, patients clearly experience discomfort and symptoms after ingesting gluten.
NCGS Fact #2: No intestinal inflammation and not associated with high intestinal permeability, unlike celiac disease.
NCGS Fact #3: Symptoms are gastrointestinal symptoms like abdominal bloating, diarrhea, gas, cramps, headaches and fatigue.
NCGS Fact #4: Diagnosis is not straightforward with no proven medical test. It is typically diagnosed after elimination of other similar conditions (for instance, wheat allergy, Irritable Bowel Syndrome) and after observation and further consultations.
NCGS Fact #5: Treatment is avoidance of gluten ONLY after confirmation of this course of action by doctors. Doctors will eliminate the possibility of celiac disease, wheat allergy or other diseases before advising on treatment for NCGS.
GLUTEN SENSITIVITY TYPE #3 – WHEAT ALLERGY (WA)
WA Fact #1 : Involves an immune Ig-E mediated reaction to the wheat protein
WA Fact #2: The increase in IgE antibodies trigger chemical release that lead to allergic reactions, that can either be manifested via the skin, respiratory or gastrointestinal systems and other behavioral issues.
WA Fact #3: Wheat is one of the common food allergens in children and symptoms include eczema, rhinitis, asthma, urticaria, conjunctivitis, abdominal pain, diarrhea and angiodema. These symptoms could be immediate (swelling or hives) or be delayed, including low weight gain in children. There’s also exercise-induced anaphylaxis to wheat.
WA Fact #4 Diagnosis is via allergy testing.
WA Fact #5: Treatment is avoidance of wheat. There is no need to avoid barley and rye which contains gluten but not wheat.
There is recently studied that people with non-celia gluten sensitivity may actually not be sensitive to gluten, but instead to FODMAPs. FODMAPs stand for fermentable oligo-, di-, and mono-saccharides and polyols, which are sugars, carbohydrates that tend to be poorly digested, e.g. frutose. It could be that gluten-containing grains are high in FODMAPs and thus avoiding gluten makes one who is sensitive to FODMAPs feel better. (see this study conducted as double-blind cross-over trial).
Update on 17 October 2016 – A new study showed the possible group of proteins found in wheat – amylase-trypsin inhibitors (ATIs) – to trigger an immune response in the gut that can spread to other tissues in the body. From MedicalNewsToday
ATIs only make up a small amount of wheat proteins – around 4 percent – yet the immune response they induce significantly affects the lymph nodes, kidneys, spleen, and brain in some people, causing inflammation. ATIs have also been suggested to exacerbate rheumatoid arthritis, multiple sclerosis (MS), asthma, lupus, and nonalcoholic fatty liver disease, as well as inflammatory bowel disease.
Hope this 4-part series clarify! it did for me and I have a clearer picture and better appreciation of the complexities involved in understanding and diagnosing one’s gluten-related (or suspected!) condition.
For other posts in this series, do check out
Allergic, Intolerant or Hyper?
Top 10 Kids’ Food Sensitivities Myths
Sources:
Send me your funnies (ideas) of baby’s kicking! For all cartoons in this series, see Mom Sleep Cartoon.
Each child has his/her own gift – there are 8 multiple intelligences from this interview with Dr Thomas Armstrong and it’s amazing how each of us learn and can be ‘gifted’ in different way! I wonder too if having eczema helps or impedes our child in the way they learn and see the world – many children with eczema develop interpersonal and intrapersonal skills, to make friends and to explain the skin condition. What about your child?
The bible asks us to use our gifts too and I pray all the time that whatever I’m doing at this blog is using some of that gifts and helping someone!
Bible verse:
1 Peter 4:10 As each has received a gift, use it to serve one another, as good stewards of God’s varied grace:
God, help us and our children to discover our gifts and use it purposefully in this life! It would be such a waste if we never discover and use that something special we’re gifted with!
Your Child has a Gift
Last updated on 16 November, 2024 12:47 am
A reminder for signing up for eczema kids’ camp on 28 Nov (Friday)! Fun programmes are lined up with dermatologist’s talk.
Registration Fees: $10.00 per pax (including activities, transport and lunch). Registrations are confirmed upon receipt of payment, please call 6350 8560 or email [email protected] – it’s a wonderful opportunity for your primary school kids and pre-teens to make friends, who can support them in their eczema journey!
This blog has always been focused on eczema, rather than allergy. However, I came across a very good book by Dr Wayne Shreffler and Dr Qian Yuan on ‘Understanding your food allergies and intolerances‘ and found that it clarified many food allergy concepts. Thus, this 4-part series is to share that knowledge with you!
For the past 2 weeks, we’ve covered
This week, I’m doing something totally unscientific – I’m compiling all statistics I find online on outgrowing allergies to lay out in a graphical representation of WHAT AGE will a CHILD (likely!) OUTGROW FOOD ALLERGY! It’s definitely not scientific because each study/report has a different focus but just to save time for you (paranoid moms and dads who would try to do the same), I figure I might as well make an attempt!
While reading up on outgrowing food allergies, I’ve found some interesting food allergy facts!
Fact #1 Shellfish allergy onset later in life (6 years and older) and usually lifelong. Same for fish allergy.
Fact #2 Shellfish allergy IS NOT THE SAME as fish allergy.
Fact #3: Shrimp, lobsters and crabs are more allergic than mollusks such as scallops, oysters, clams and mussels.
Fact #4: Allergy to one type of (fin)fish does not mean allergic to another BUT study in 2004’s Journal of Allergy and Clinical Immunology found that 30% of children and approximately 66% of adults reacted to multiple types of fin fish.
Fact #5: More women than men are allergic to fish (0.6% vs. 0.2%).
Fact #6: Egg allergy is most closely associated with eczema, among the other food allergens. (Does not mean that egg allergy is most likely the trigger for your child’s eczema, as house dust mite is the more likely suspect for older children)
Fact #7: You can be allergic to either egg white or yolk or both but avoid the whole egg as it’s not possible to ensure clean separation.
Fact #8: Eggs and Milk cooked under intense heat (say baking cakes) seem to be more well-tolerated but don’t experiment without doctor’s advice (study here).
Fact #9: Soy allergy tend to be mild
Fact #10: Highly refined soybean oil (not cold pressed, expeller pressed, or extruded oil) and soy lecithin is usually tolerated by people with soy allergy.
Fact #11: Food allergies developed from young (except peanuts, tree nuts, shellfish and fish) are more likely to be outgrown versus food allergies developed as a teenager or adult, which tend to be lifelong.
Fact #12: 26.6% of children outgrew their allergies by age 5.4.
Fact #13: The more severe the allergic reaction, the less likely to be outgrown.
Fact #14: Mean age of tolerance for egg allergy was age of 7.2; Milk 6 years; Tree Nut 9.6; Shellfish 11.6; Soy 7; Fin fish 9.3; Peanuts 8.4
Fact #15: Boys are more likely to outgrow allergies than girls.
When researching for this post, I actually found quite a number of websites carrying misinformation or unclear information where it’s either proven wrong in later studies (for instance, to delay introduction of foods) or information relating to intolerance being grouped as food allergy information (such as only larger amounts of food trigger a reaction).
Another ‘sad’ news is that there is a study that children can develop a second (different) reaction to foods that they have outgrown. This is a study on Eosinophilic Esophagitis or EoE where it was found that 17 out of 1,025 patients in the study had initially outgrown IgE-mediated reaction to the foods but now suffer from EoE reaction (see AllergicLiving.com for their interview with the researchers of the study). EoE is an inflammation at the esophagus due to increase of eosinophil cells, leading to narrowing of the esophagus.
Hope whatever age your child is, your family is managing the food allergies well. Share your outgrowing age below!
Sources:
- ACAAI
- RaiseHealthyEaters (post by Dr Joneja)
- FARE
- Mayo Clinic
- Medscape
- Studies (egg) here and here
To figure out if this psychiatrist has the right insight, see last week’s cartoon.
It’s almost impossible to give something our undivided attention these days – our many commitments, responsibilities, roles and our devices seem to pull us in all direction. What about undivided love? Sometimes I find it a mystery for those who have more than one child, is it possible to give undivided love to both? Even between an eczema child and a spouse, can love be undivided?
Yet, as a Christian, I am to love God wholeheartedly. I find it hard as well – in theory, loving God will translate to loving everyone, one another. IRL (in real life), I’m not sure how it works – for me, I have lists of to-dos which I strike off to make sure I’ve somehow loved everyone I care about in my life, but that’s an effort in itself!
Bible verse:
Jeremiah 29: 13 You will seek me and find me, when you seek me with all your heart.
Lord, help me to be wholehearted in loving the people around me.
How do I love everyone I care about? How do I love without selfishness?
How do I love without resentment and balancing scales?
Help us parents of eczema kids to love, it’s So Important to get this right in life!
Love Wholeheartedly
Last updated on 15 November, 2024 9:46 pm
This blog has always been focused on eczema, rather than allergy. However, I came across a very good book by Dr Wayne Shreffler and Dr Qian Yuan on ‘Understanding your food allergies and intolerances‘ and found that it clarified many food allergy concepts. Thus, this 4-part series is to share that knowledge with you!
Last week, we clarified Food Allergy vs Food Intolerance which gave an overview of the differences between the two. Today we can put this to test by tackling these Kids’ Food Sensitivity Myths!
Myth #1: This Food Doesn’t Agree with Me, I’m Allergic to It!
This actually reminds me of my hubby (lol), most times we don’t agree (that is when we actually talk!) but no, I’m not allergic to him (hopefully he thinks the same!). As explained in last week’s post, food sensitivity can be either in the form of allergy or intolerance. Some doctors also allow for a 3rd category of food sensitivity, when they can’t classify it as either an allergic reaction or find the chemical the body is intolerant to.
However, these days, there’s almost a ‘cool’ factor to say you’re allergic to something. So while it is possible that more people think or say they have an allergy than they really have, food intolerance/sensitivity may also be underestimated as they are hard to diagnose. Do note too that adults can also have an onset of allergy at an older age, esp for certain allergy like shellfish.
Myth #2: Food intolerances can be tested using IgG antibodies test
There are many IgG tests available online and generally the medical community is against this test for identifying food sensitivity. The main reason is that elevated IgE implies an exposure to the food rather than an allergy to the food. Also while 80% of the foods are the common suspects in allergy, IgG test may test hundreds of foods and with false positives, lead to harmful elimination diet.
Myth #3: You are either Allergic or Intolerant
For some individuals the same foods can trigger both food allergy and intolerance. For instance, there can be an allergy to the milk protein while also lacking lactase digestive enzyme to break down lactose. This is why it is important to consult a specialist as it is not easy to figure it out on your own.
Myth #4: You can eat JUST A LITTLE of the sensitive food
This falls back to last week’s explanation of food allergy and intolerance. For severe food allergy, smelling the food can trigger a reaction, and it can be fatal one like anaphylactic reaction (that’s why there is so much debate about peanuts on plane!). However, for food intolerance, some people can eat certain amounts or in certain forms, e.g. food cooked with milk (I tried this fish recipe before, tasted horrible!) may give a different reaction to drinking milk.
Myth #5: I feel Bloated, I’m Allergic!
Bloating is more closely related to food intolerance but eating gassy foods cause bloating too. Pregnant women suffer more from bloating and constipation due to pregnancy hormones leading to relaxation of gastrointestinal wall muscles, thus foods stay in the tract longer.
Myth #6: I didn’t eat the food, how can I be allergic to it?
Food sensitization is when the body first comes into contact with the food protein and the body then ‘tag’ it as an enemy. The next time even small amounts of the food (in some cases, touched or smelled) can trigger an allergic reaction. So smelling peanuts on plane, touching or shaking hands with another child with peanut butter trace on hands can lead to an allergic reaction.
Myth #7: Delaying food introduction to a child can prevent the food allergy
Based on updated studies, the recommendation to delay introduction of common food allergens (usually peanuts, tree nuts, shellfish) is now revoked. The studies were contradictory – some showed late introduction helped as the child’s immune system is stronger while others showed early introduction helped as the child builds an immunity to it earlier. Thus the current recommendation is Just Eat (Whatever) a Balanced Diet. An update on a study on early introduction of eggs done in August 2015 showed that the elevated immune responses to egg were established prior to egg ingestion at 4 months and were not affected by whether eggs were introduced early.
Myth #8: Allergy testing is 100% accurate
Allergy testing (skin prick and IgE) is fairly accurate but not 100%. The only gold standard in food allergy testing is the oral food challenge. However due to the difficulty of conducting the oral food challenge (involves hospital stay), doctors form a diagnosis based on corroborated ‘evidence’, for instance the test results, parents’ observations and doctor’s knowledge of food allergens, family history.
Myth #9: Organic Foods are Safer
Organic foods (only the properly certified ones) may be safer in terms of free from pesticides but not safer in terms of allergic reaction to the food protein. Organic or not, the food protein is still present. For some people, peeling the fruit’s skin or cooking in a different way may help.
Myth #10: Allergy test can tell how Allergic you are
Allergy testing only tells you if you have an allergy, but it cannot predict the severity of the reaction. For instance, (see this previous post), the size of the wheal from skin prick test does not correlate with the reaction you will have.
Categories
Living with Eczema Book Launch
It was very nice meeting many moms at last Saturday’s Living with Eczema book launch. Both Professor Hugo and I shared, and in case you’re worried you missed something important from Prof Hugo’s talk, here are the salient points!
1. As the child ages, the type of eczema may change (for instance, from atopic dermatitis to contact dermatitis – saliva, ingredients in skincare products) and the triggers change too (an older child is more likely to be allergic to house dust mites).
2. Avoid antibiotic cream as it is more likely to destroy weaker strains of bacteria but stronger strains prevails (oral antibiotic is also not advised)
3. Psoriasis n pigmentation are possible to be present at birth, but not eczema (thus indicating that an environmental element is present in this skin condition) > further reinforced by studies that show moisturizing a newborn baby at high risk of eczema reduces risk of AD by 50%
4. Reduce contact with allergens in the air, including eggs which are present in food court and non-circulating air. Egg protein is airborne, small and light – can even be in our dust and our mattress.
5. Recommendation to adopt an outdoor lifestyle to reduce contact with indoor allergen.
6. Untreated eczema can lead to infection, particularly with scratching. Infected eczema after healing leads to dark scars which are permanent. Scratch lesions which persist will also reduce pigment cells, thus leading to skin discoloration. (See also eczema complications series, where many complications arise due to scratching/infection).
7. Eczema has a genetic component – 25% if both parents don’t have eczema, 60% if mom has eczema, 50% if dad has eczema.
8. In terms of food allergens in Singapore, egg is the most common, followed by milk, soy and wheat.
There is much more that is shared in the book Living with Eczema: Mom Asks, Doc Answers, watch this video to see what it covers. Furthermore, from now till 8 May 2015, Prof Hugo and I will answer any question you have from reading the book on GooglePlus, read here to find out how!
Do let me know if you have any funny story on how your pregnancy! For all the cartoon in this series, look up this ‘Mom Sleep Cartoon‘ Category.
We all know today’s dinner scene may look very different from the pre-tablet and smartphone age – recently, I was at breakfast with my family and niece and we each had a device. I immediately thought of all the parenting advice that I am to practice – remove electronic device, build conversation and open our world to each other during meals (vs closed up and only pals with Angry Birds, crushing candy).
But then I thought – hey, it’s also a way of connecting. It is possible that conversations can be built around how to crush candy, your best score, highest level and longest time to break one level. Why not? If it’s something that at that point works to draw people closer, it’s more than justified.
Jesus was unconventional in drawing people together – he talked to a samaritan woman at the well (John 4) and ate with tax collectors in their home (Mark 2:13). Talking about eczema draws parents of eczema kids closer too – hopefully, this blog helped in that conversation! I do pray that we all have time to enjoy our meal, with friends and family (despite it being so stressful with the eczema!).
Bible verse:
Mark 2:16 : When the teachers of the law who were Pharisees saw him eating with the sinners and tax collectors, they asked his disciples: “Why does he eat with tax collectors and sinners?”
God, we thank you that you are a God who loves people, dine with us and meet us at the most unlikely place but just when we need it.
Love the People at Your Table
This blog has always been focused on eczema, rather than allergy. However, I came across a very good book by Dr Wayne Shreffler and Dr Qian Yuan on ‘Understanding your food allergies and intolerances‘ and found that it clarified many food allergy concepts. Thus, this 4-part series is to share that knowledge with you!
Each week is a different concept de-mystified, so let’s get started!
Kids Food Sensitivities – What is Sensitivity?
What does it mean to be sensitive to a food? In layman’s term, it could mean a range of symptoms from headaches to tummy upset, but medically, it covers two main terms:
Food Allergy and Food Intolerance – both have similar symptoms but the cause and treatment is different, which is why it is important to differentiate the two.
| Food Allergy | Food Intolerance |
| Direct immune system’s response to food protein | Not a direct immune response but different causes (not all known), e.g. lack of specific enzymes to digest the food (not necessarily a protein) |
| Cause is the reaction to food protein, can be tested with fair accuracy with allergy tests | Cause is not always known and not easy to test a food intolerance |
| Symptoms can be immediate (few hours) or delayed, and include
Itch, hives, breathing difficulty (including anaphylaxis), eczema, runny nose, coughing, vomiting, diarrhea, abdominal pain, swallowing difficulty, chronic chest pain, heart burn, constipation, weight loss, swelling of facial features Symptoms can affect the skin, intestines, respiratory tract and cause behavior change |
Symptoms may take place gradually – nausea, stomach pain, gas (bloating)/cramps/bleeding, vomiting, diarrhea, heartburn, headache or migraine
Symptoms typically affect intestines. |
| Happens every time | May not happen for the tolerated amount or in certain forms; the more you take, the more severe the symptoms and symptoms may differ in each incident |
| Small amount triggers | Certain amounts may be tolerated (trial and error process to figure out) |
| Common food allergens: Milk, soy, egg, wheat, peanuts, tree nuts, fish and shellfish | Common food intolerances: Frutose, Sucrose, Lactose, MSG (monosodium glutamate), sulfite, tyramine, histamine |
| Except for peanuts, tree nuts, fish/shellfish that are harder to outgrow, other food allergens tend to be outgrown at older age | May actually onset at older age |
| Genetics play a role | Genetics play a role |
As seen above, there are distinct differences between food allergy and food intolerance although the symptoms of both are similar. However, to be concerned that there is indeed a food sensitivity issue, there has to be a reproducible reaction with the food – i.e. not referring to a one-time stomach upset after eating prawns in the past year (that might be food poisoning!).
The diagnosis of food intolerance is generally difficult, except for lack of digestive enzymes lactase, frutase and sucrase. The lack of the digestive enzymes result in lactose, fructose and sucrose not being broken down and result in pain, bloating, spasm and diarrhea. Even stress or anxiety associated with a certain food can cause an intolerance.On the other hand, symptoms such as swelling are closely associated with allergic reaction.
The diagnosis of immediate food allergy is more straight forward than delayed food allergy, with allergy testing and blood test to detect elevated levels if immunoglobulin E (IgE). The common food allergens differ in different country (taken from allergyuk.org)
- Worldwide – milk, egg
- USA, UK, Australia – peanut and tree nuts
- France – mustard seed
- Italy, Spain – peach, apple, shellfish
- Israel – sesame
- Spain, Japan – fish
- Japan – buckwheat
- Singapore – birds’ nest, shellfish
For those in Singapore, it is interesting that fish isn’t on our list of common food allergens possibly due to it being so much part of our diet. Birds’ nest on the other hand is given as ‘tonic’ to children early and may actually trigger an allergy!
Treatment wise – for both food allergy and food intolerance, avoidance is key. For food allergy, children can undergo another allergy test to see if they have ‘outgrown’ it. For food intolerance which usually does not result in fatal reaction, small amounts of food can be re-introduced in different forms to see which form/amount can be tolerated. There is no cure for allergy or intolerance; however, for certain food intolerance, enzyme supplements can be taken beforehand to digest the food to be ingested e.g. lactose.
Here’s a graphic for recap!
Do let me know if you have any funny story on how your family suffers at sleeptime, for all the cartoon in this series, look up this ‘Mom Sleep Cartoon‘ Category.
Some of us resign to our genes – eczema gene, allergy gene, diabetes gene, heart disease gene.. but we needn’t do that yet. In the study of epigenetics, it is found that our ‘bad’ gene will not express itself (ie you get the disease) if we have healthy diet, exercise, don’t smoke.. in fact, even for those who already have diabetes, a 7% weight loss can lead to 58% reduction of subsequent diabetes (learnt from Dr David Katz’ book Disease Proof).
Likewise, even if you have committed sin or feel too old, you’re never too old to be a child of God. It’s never too late to be a Christian, not until your very last breath!
Bible verse:
1 Timothy 2:3-4: God our Savior, who wants all people to be saved and to come to a knowledge of the truth
God, we thank you it’s never too late or too sick to believe in You! Let a seed be planted in all who read this!
Never too Late for Jesus
Last updated on 14 November, 2024 3:44 pm
I would love the chance to meet you all who have been reading my blog – it feels like we have journeyed together via this blog, whether you have commented or emailed me or stayed ‘silent’ – I know you are there!
Come join Prof Hugo van Bever and I for our ‘Living with Eczema : Mom Asks, Doc Answers’ book launch, which is on
8 November 2014, Saturday, 2 to 4 pm at Jurong Regional Library
The event is free – Prof Hugo and I will each be speaking, followed by a half hour Q&A where you can ask all the questions you like! Registration is required at golibrary.nlb.gov.sg
Do come and join us, Prof Hugo will be giving his Doc’s Tips while I’d be sharing my Mom’s Views, look forward to seeing you!
There’s a recent study on Nipple Eczema: An Indicative Manifestation on Atopic Dermatitis published in July 2014’s American Journal of Dermatopathology. The study of 43 individuals with nipple eczema, part of whom had eczema history and the others without eczema, showed no definite difference between the patterns of their nipple skin inflammation. It prompted me though to read further on nipple eczema, after all, it’s an issue close to women, plus breastfeeding mothers.
Nipple Eczema – is it Eczema?
Nipple eczema is often confused with Paget’s disease because of similar symptoms. Paget’s disease is a rare type of cancer at the nipple-areola complex (1-4% of female breast cancer). The confusion is that both have the appearance of eczema rash, possibly accompanied by itch, pain, tenderness, scales, cracks, oozing, nipple discharge/bleeding, redness and erosion. However, one distinguishing feature is that Paget’s disease affect the nipple first whereas nipple eczema affects the surrounding skin, i.e. the areola. It is also more likely to be unilateral than bilateral.
Nipple eczema can occur for both men and women, not limited to women who are breastfeeding/ pregnant.
Types of Nipple Eczema
Allergic contact dermatitis – If triggered by skincare product used on body, appearance of the rash would be on both breasts. A case study was reported in Indian Journal of Dermatology where topical application of ingredients like propylene glycol, chlorocresols and parabens trigger nipple eczema (though only on one breast).
Another study in June 2014 noted allergic contact to CI+Me-isothiazolinone, a chemical found in detergents, preservatives and fabric softeners. Thus possibly traces of CI+Me-isothiazolinone in undergarments triggered the eczema at the breasts.
Other possible chemicals that trigger nipple eczema could be protein allergens (food) from the baby’s mouth.
Atopic dermatitis (AD) – Due to the weaker eczema skin barrier and increased likelihood of sensitization to products, the risk of nipple eczema appears to increase with age for AD patients.
Irritant contact dermatitis – Chemicals, product ingredients and friction can irritate. Clothing may irritate or friction from exercise or from exercise bra/ disposable breast pad/ poor-designed nursing bra. There may be both irritant/allergic contact dermatitis to creams used on nipple during pregnancy/breastfeeding. Soaps, detergents, fragrance and bleach are possible irritants.
Yeast infection – This is more likely for women with history of yeast vaginitis or from babies who have thrush (i.e. yeast infection with white spots on baby’s tongue or mouth). The yeast infection will affect skin at the base of the nipple, with appearance of fine cracks. Yeast infection is reportedly more common after antibiotic use.
Bacterial infection – Eczema skin is prone to be colonized by staphylococcus aureus bacteria and the breast/nipple skin is not spared. Skin damage can lead to increased susceptibility for bacteria infection and the damage may come from scratching (on an AD patient) or certain activities during breastfeeding, such as use of uncomfortable breast pump, over-washing and cleaning of the nipple area which dries and damages the skin.
Diagnosis
Diagnosis is not easy as the symptoms look similar. Typically, ruling out Paget’s disease (esp if nipple eczema is only on one breast) is a priority. After which, patch testing can be taken to analyze which possible chemicals the patient has come into contact with that may possibly have triggered the rash.
What if Breastfeeding?
Nipple eczema can bring about soreness, pain and burning sensation, and prematurely terminate lactation and breastfeeding. Women who have eczema or sensitive skin may be more prone to nipple eczema. The breasts can be washed with lukewarm water and moisturized. Check with your doctor before applying cream on the breast/nipple to ensure safety for the baby. If prescribed cream, ask for clear instruction on wiping it off before breastfeeding. The liquid to wipe off the cream can be milk expressed from breast.
Anyone has experience on nipple eczema? Do comment and share. Breastfeeding does not come easy for many mothers (ME included!) and I can’t imagine piling on an itchy, painful nipple on top of the struggles. Do share and encourage another if you can!
Last updated on 21 November, 2024 8:05 am
It’s amazing how much kids can bond in a camp and your child with eczema may love the chance to make friends, especially one who would understand what having eczema feels like. So come register before 21 November 2014 for the camp on:
NSC-KKH Eczema Camp (supported by NSC HEF)
Event Date: 28 November 2014 (Friday)
Time: 9.00am – 4.00pm
Venue: SAFRA Yishun Country Club
Eligibility: Open to all NSC Eczema Support Group members (primary and secondary school students) – You can always sign up to be a group member at the same time you RSVP!
Registration Fees: $10.00 per pax (including activities, transport and lunch). Registrations are confirmed upon receipt of payment, please call 6350 8560 or email [email protected]
There will also be an educational talk on “Management strategies in atopic dermatitis”, to reinforce the principles of eczema management and parents can ask your questions to clarify any doubt with the dermatologist speaker. The camp activities are fun and safe, your child can discover his/her inner adventurous self!
Can you believe it?
There’s a reason why this couple, Mark and Kate, stays as a couple. See last week’s cartoon for the hint!