I came across an article ‘The Most Practical (and Realistic) Parenting Advice you will Ever Read’, it’s kind of funny, offering tips such as:
It’s ok if you miss a day of bathing your kids
You aren’t the first to give in to tantrum
You don’t have to do homework
Sometimes feeling hurried and harassed is part of being a parent
To me, I try my best – go home early, spend time with kid on activity and reading with them. We discover authors that are funny with bright illustration, such as Mo Williems, Jan Thomas and Allen Plenderleith. Do I laugh with my daughter when reading? Yes. But hey, some nights I can’t wait to get it over and grab some zzz myself! Esp. given how late her bedtime is, how much scratching and crazy ‘eczema’ habits she picked up over the short (or excruciating long!) 5 years of her life, I really just want to sleep and not parent!
God is also a parent, father to Jesus and Christians. I don’t think God does ‘realistic parenting’ as in he doesn’t have enough energy to parent us. But I think he’s realistic in another sense, that he knows us so well and understands when we fall short.
Bible verse:
Matthew 6:26 Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they?
Father in heaven, you know us and how we parent. Yet being so aware of our shortfall, you love us. Help us to parent our children with the same love and give us wisdom to juggle so many aspects of life – work, children, chores, aged parents and eczema too!
We are the best parents for our children, that’s real!
This is a 2-part series on a workshop that I’ve attended at Singapore Rise and Shine Expo, by Dr Peter Sears, ‘Raising smart and ALSO well-behaved child – Is it true that we shouldn’t spare the rod and spoil the child?’ Last week was on parenting styles, and Dr. Peter Sears is board-certified by The American Academy of Family Practitioners.
Balance in Parenting
Dr Peter Sears shared that balance is a key aspect in parenting and a few areas which tend to be off-balance are:
Father/Child relationship – For some families, the father may not be as involved as the mother, particularly in the early years. Dr Sears encouraged dad’s early involvement, instead of waiting till the child is preschooler age. This is especially so as trust between parent and child is built from young.
Mom Helicopter Parenting – This refers to the mother monitoring the relationship and ‘hovering’ the interaction between the father and child. Doing so risk the child growing up thinking that dad is ‘secondary’ to mom and mom is the real authority figure in the family.
Mother Burnout – Many scenarios exist that increase the likelihood of mother burnout and the two common ones are dads’ inadequate involvement and moms controlling every situation (even when the dad wants to be involved!). If there is conflict in parenting styles between mom and dad, Dr Peter Sears cautioned that disagreement should not be in front of the child as that would confuse the child.
Couple disagreement should not be in front of the child as that would confuse the child
Emotional Balance – As a baby can pick up facial cues and mirror feelings, parents should adopt a calm and firm presence/face when disciplining. The baby’s brain has ‘mirror neurons’ and thus anxiety can be picked up.
Conveying Limits – Parents often say ‘No’ or ‘Stop’ to the child, but negative language does not help the child to focus on what should be done (instead, what should not be done). Dr Peter Sears shared a parenting moment from his dad (Dr Bill Sears) who instead of saying ‘No’ to his daughter for speaking rudely to his wife, told her that ‘I will not tolerate such behavior to the woman who I love’. This enables the child to connect the impact of her action. In general, instead of saying no, direct the child on what should be done.
I will not tolerate such behavior to the woman who I love
The mother’s brain changes to cater to nurturing babies, and attachment parenting and breastfeeding help boost hormones that facilitate caregiving – amygdala, cingulate, prolactin and oxytocin. Mothers who practice attachment parenting are better to trusting themselves on the needs of the child.
(ii) Child’s Brain
Attachment parented infants have higher growth hormones and brain enzymes, and more likely for the neurons to make the right brain connections. The child grows up with an inner control mechanism, knowing what should be done and able to think through consequences. Conversely, for a baby who is left to cry it out, their cortisol is off balance (too high and too low) with prolonged high stress hormones that slow growth and depress immunity.
On the other hand, detached parenting set up ‘undiscipline’, leading to a fearful, fussy and clingy baby who may be shy or exhibit stranger anxiety. Other characteristics of a child with detached parents are not able to share or play with peers, blank unhappy stares and possibly become a bully due to lacking an inner control mechanism.
Dr Sears also shared briefly on the importance of nutrition, more from last year Dr Bill Sears’ talk here.
MarcieMom’s questions to Dr Sears
On Diet – What foods would you recommend for a baby with eczema, and would it be different for a toddler or a preteen?
Dr Peter Sears: Eczema often has an association with underlying food or environmental allergies. For children with moderate to severe eczema, we usually recommend having allergy testing done by a licensed allergist (if this is financially feasible). Identifying underlying allergies can help control eczema.
In addition, I often recommend that my patients with eczema take a daily Omega-3 DHA/EPA fish oil supplement as well as daily Probiotic supplement. Omega-3 fish oil has been shown to be beneficial for skin health and various types of eczema/ dermatitis due to it’s anti-inflammatory properties. Probiotics have been suggested to be beneficial as well.
On Colic – Is reflux something more commonly seen in children with eczema? If so, why? What formula would you recommend for eczema babies?
Dr Peter Sears: There has been an association between eczema and acid reflux. Theories on this suggest that this may be related to milk or dairy sensitivity or dairy allergy. Children with milk sensitivity/allergy may be more likely to exhibit symptoms of acid reflux and skin manifestations of eczema.
Parents should always consult with their doctor before switching formulas. Of course, we always recommend breastfeeding whenever possible. Hypoallergenic formulas may be beneficial for infants with dairy sensitivity and/or eczema.
On Parenting – Eczema families are more stressed, more chores to do (if there’s house dust mite allergy) and may even be more stretched financially as emollients, doctor consultations or having to have one parent stay home results in a loss of income. What do parents have to watch out for in their parenting to ensure that eczema doesn’t come in the way of them raising a happy and successful child?
Dr Peter Sears: This is a difficult question because every household and family dynamic will be different. To generalize, we would say that it is very important that there is a strong family support system and that both mother and father (as well as other capable family members) be as involved as possible in day to day care of this condition. This goes back to my talk about balance in the home with childcare.
Thank you to Dr Peter Sears for going through what he had shared in the Rise and Shine Expo workshop and also giving useful tips for eczema families. For those unsure about parenting styles, check out last week Dr Sears’ talk here.
I’m not sure still on whether we are meant to just eat vege!
This month I’m plagued by a curiosity of the child’s mind (esp. an eczema child!) when learning about creation. If you have a funny Sunday school experience, drop me an email or a comment and I may just turn it into a cartoon! This is the 59th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here.
Some days I feel suffocated – yes, like there’s no air to breathe. In a crowded train, there’s lack of fresh air coupled with many people coughing at close distance. Outside if there’s haze or pollutants, I wonder if I’m doing more harm to my body jogging (and breathing the exhaust fumes).
In fact, how we breathe can affect our health too. Slow, rhythmic and deep breathing (involving the diaphragm) is best for adequate oxygen and maintaining the right level of carbon dioxide. Apparently, we have gotten too stressed to breathe properly, resulting in much shorter breaths! For those with allergic rhinitis, air pollutants, house dust mites, pollen and pet dander in the air can also cause a flare-up. In short, how we breathe and the air we breathe do matter.
God is no stranger to air and breath. He created the atmosphere. He breathed life into Adam, the first man (Genesis 2:7). Jesus, after his resurrection, breathed the Holy Spirit on his disciples (John 20:21). I pray that we parents can breathe deep, relaxing breaths when caring for our eczema children, and with each breath, it’s literally life!
Bible verse:
Genesis 2:7 then the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature
God, we want to breathe each breath right. Breathing happiness, joy, love and not anxiety, stress and frustration. Help us and our children in each breath we take.
This is a 2-part series on a workshop that I’ve attended at Singapore Rise and Shine Expo, by Dr Peter Sears, ‘Raising smart and ALSO well-behaved child – Is it true that we shouldn’t spare the rod and spoil the child?’ Last year, I attended his father, Dr Bill Sears, at the same expo on raising healthy child and attachment parenting.
Dr. Peter Sears is board-certified by The American Academy of Family Practitioners. His primary passion in medicine is to promote well-being and health through the practice of preventive medicine at all ages along with using traditional and complementary treatments for curing of disease. More on Dr Peter Sears
Which Parenting Style Works Best?
Dr Peter Sears started the talk reminding parents that no one technique will work for every child, but instead he believes that forming a trusting bond with the child is the foundation for parenting. Dr Sears (family) believe in attachment parenting, which is being responsive and close to the baby especially in the first six months of birth. It is the natural way to parent because it is nurturing the baby according to the mother’s instinct.
With attachment parenting as the foundation to build trust between parent and child, Dr Sears observed in their family practice that it will lead to the following desirable C Outcomes in kids:
Caring kids
Compassionate
Communicative
Connected
Comfortable with intimacy
Confident kids
Confident parents
Dr Sears’ Pros and Cons in Parenting Styles
Authoritarian Style – This parenting style tends towards a command and control approach with a focus on wrong-doing and punishment. Spanking is often part of this parenting style. The positives of this style is that it is very clear to the child that the parent is in-charge and the child needs to obey. The parent being in-charge is important as a growing child needs guidance, direction and security.
The negative of this style is the potential pitfall of taking love from the parent-child relationship and inadequate positive reinforcements for the child. There is also a danger of the child engaging in the desired behavior out of fear, instead of out of respect. Moreover, the desired behavior does not come from self (child) who is able to think through the consequences and exercise inner control.
Permissive Style – This parenting style is characterized with warmth and affection, but with few or unclear limits. While it is good that there is much positive reinforcement given to the child, the negative is that the child takes control.
Authoritative Style – A more balanced parenting approach is to combine the positives of the above two styles, which gives the child love and warmth with structure. While this parenting style allows the child to thrive the best, it also requires more dedication, responsibility and creativity from parents. (It takes MORE work!) An authoritative parenting style fosters competence and mature moral judgment in the child, lowering the risk for problem behavior.
Is Spanking OK?
Dr Peter Sears explained that cultural and society settings affect whether spanking is involved in parenting. For instance, many European countries, Canada and New Zealand have legislation prohibiting spanking. This comes from studies that spanking has adverse effects that are associated with anti-social behavior, decreased rate of school performance and more behavioral and mental issues (for instance, depression and bi-polar).
Spanking may also send the wrong message that physical force is the way to resolve conflicts or issues.
It is also very easy for parents to cross the line as physical force may be used when parents are stressed or a stronger force may hurt the child.
Dr Peter Sears provided alternatives to spanking, such as time-outs and explaining the consequences of misbehavior. Parents can engage in re-wind/ replay scenarios with the child to guide the child towards right behavior.
There is much balance required in parenting and next week, we will be sharing various aspects from Dr Peter Sears. Gratitude to Dr Peter Sears for taking time to review this blog post.
Ever wonder what our kid thinks about when they learn about creation?
This month I’m suddenly plagued by a curiosity of the child’s mind (esp. an eczema child!) when learning about creation. What do you think are their thoughts esp. as they may just be scratching during Sunday school! This is the 58th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. If you have a funny Sunday school experience, drop me an email or a comment and I may just turn it into a cartoon!
It’s strange why we seem to be obsessed with a secret formula for everything – Formula for success, formula for happiness, formula for weight loss and even formula for eczema cure! During Jesus’ time, his disciples wanted a formula for prayer.
Though Jesus did give his disciples a prayer to pray (Luke 11:2-4), there is really no secret formula. In fact, prayer is simply our conversation with God, and should not be a time to show-off or use empty words (as Jesus said in Matthew 6:5-8). There is no prayer specific for different occasions, it is a heartfelt request to a God who is love. Without any secret formula, God is available to all and in this tech age, the bible is free to be downloaded! It kinds of remind me to make this blog free for all too, there is no secret eczema knowledge I’m hoarding!
Bible verse:
Matthew 6:6 But when you pray, go into your room and shut the door and pray to your Father who is in secret. And your Father who sees in secret will reward you.
God, I am so glad that there is no secret formula to pray. I pray that you guide me in prayer and teach me to believe!
Stress triggers flare-ups for some patients with eczema, with many parents observing their schooling children having worsened eczema during exams.
Eczema, in itself being an itchy, chronic condition, also creates stress. Learn how to manage stress with psychologist Ms June Lim.
5 September (Friday) – Venue, National Skin Centre Singapore Room 401, 12pm to 1pm
Topic: Mental health and Eczema: Manage your Stress and help your Skin
The program will be sharing by Ms June Lim over lunch (provided). June is a psychologist at Tan Tock Seng Hospital and have been a visiting Psychologist at National Skin Centre for more than a year.
This session is open to all who suffer from eczema, regardless of age. For those with children, you can bring them along but as I can’t make it for this session, do bring some ‘entertainment’ for your kids. Information on my blog is not pre-approved by NSC.
YOU MUST RSVP – It will then be possible for us to prepare lunch. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids.
Have fun for the session! More on stress’ impact on skin here (interview with Dr Claudia Aguirre) for your reading
Pictures taken from dermnetnz.org without specific permission granted, click on image for click to Dermnet NZ Erythroderma page
This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!
Erythroderma and its Causes
Erythroderma refers to generalized redness of skin due to skin inflammation. It is a complication associated with severe eczema, psoriasis and other skin inflammatory diseases. It can also be caused by drug reaction or even without a known cause(idiopathic erythroderma). Other possible causes are:
Other forms of dermatitis, apart from eczema, such as contact dermatitis, stasis dermatitis (skin inflammation from blood pooling in leg veins, common for women above 50) and seborrheic dermatitis
Staphylococcal scalded skin syndrome, with fever, skin tenderness and irritability (staph bacteria infection causing blisters, aka scalded skin appearance, affecting kids below age 5)
Pityriasis rubra pilaris, appears as reddish-orange scaling patches, more common in adults
Pemphigus vulgaris and bullous pemphigiod, which refers to autoimmune blistering skin disease
Lymphoma of the cutaneous T-cells, also known as Sezary syndrome
Leukemia
Malignant rectum, lung, colon and fallopian tubes
Graft vs Host disease
HIV infection and other immune-deficiency conditions
The common drugs causing erythroderma in children are sulfonamides, antimalarials, penicillins, isoniazid, thioacetazone, streptomycin, nonsteroidal anti-inflammatory drugs (NSAIDS), topical tar, homeopathic and ayurvedic medicines. For general population, drugs such as allopurinol, arsenicals, aspirin, carbamazepine, captopril, gold, hydantoins, mercurials, penicillin, phenothiazines, phenylbutazone, quinacrine, sulfonamides, homeopathic and ayurvedic medication as well.
Symptoms of Erythroderma
The onset of erythroderma can be sudden and spread quickly. Apart from skin redness, it is often seen with:
Skin exfoliation, also known as exfoliative dermatitis where about 90% of skin peel off in scales or layers
Swelling (oedema)
Oozing skin
Itch
Thickening of palms or soles or nails (even shedding nails)
Erythroderma of the scalp may result in hair loss
Erythoroderma of the eyelid may result in ectropian, which is rolling outwards of the inner eyelid (may also have conjunctivitis)
Measle-like eruptions if due to drug reaction
Treatment of Erythroderma
The underlying cause has to be treated, with the following general treatment steps:
Wet wrap for skin moisture retention, with moisturizer and mild steroids
Maintain hydration, fluid and electrolyte balance
Antihistamines for itch
Stop unnecessary medication, in case erythroderma is drug-induced
Bacterial skin infection commonly accompanies erythroderma, and therefore antibiotics may be prescribed. Where fluids have to be given intravenously, hospitalization is required.
Complications of Erythroderma
Most important to watch out in erythroderma is compensating for the loss of skin’s ability to temperature control and maintain fluids. Complications include:
Pigment changes in skin to brown and white patch
Secondary infection with the oozing and crust
Swollen lymph nodes
Dehydration, from fluid loss through skin from higher metabolism
Heart failure from increased heart rate (usually in elderly)
Hypothermia, from abnormal temperature regulation, thus hydration and temperature control are important
Malnutrition, from protein loss and higher metabolism (to compensate for heat loss)
As I researched on erythroderma, I felt really sad for those suffering with it. As to why some people with inflammatory skin condition have an onset of erythroderma, it is not clear. I do hope though that keeping the underlying skin condition under control will forever keep erythroderma at bay. Anyone has experience with this?
Back by popular demand, this month’s cartoon all on sleep, co-sleep, suffering sleep, sacrificial sleep, whatever you call it! This is the 57th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. If you have a funny sleep story, drop me an email or a comment and I may just turn it into a cartoon!
One morning as I was jogging, I passed by in succession – a man with a very awkward limp, another man in a wheelchair and shortly after, someone who look like he has sprained his ankle. Ashamedly, my first thought was now I have to jog on the road instead of pedestrian path to avoid bumping into them and other people. Only the next thought was ‘Whoa, hang on. As unattractive and physically challenged they are, God loves them!’.
God’s love for the disabled is evident in Jesus’ ministry. There is a considerable amount of bible text in the gospel (John chapter 9) on Jesus healing the blind man (here is a commentary on Disability and the Sovereign Goodness of God) and many stories of Christians whose faith grew and mightily used by God to touch others. I then wonder if eczema is a handicap – in severe cases, it fit the definition of “restricting a person from participating in normal life“. Some children whose eczema are serious are not able to take part in sports, shower and sleep, I suppose that’s a real restriction. I pray that our children’s eczema will improve and not be so serious. But more so, I pray that our eczema experience can be used in some special way to help others – more love, resilience, empathy and whatever divine use it can be put to.
Bible verse:
John 9:1 As he (Jesus) passed by, he saw a man blind from birth.
God, eczema can be so severe that some days we feel it is a handicap. Heal our child’s eczema and use all of our life, even with the eczema
Wet Wrap session for kids with Singapore Eczema Support Group
Reminder of next Saturday 30 Aug’s workshop at National Skin Centre, Singapore by Tubifast for the Eczema Support Group. This session will be focused on wet wrap for younger kids. Wet wrapping is a worthwhile technique to learn esp given repeated studies proving its effectiveness, read more here.
SESSION CANCELLED, RAIN CHECK TILL FOURTH QUARTER THIS YEAR, CHECK BACK!
30 August (Saturday) – Venue, National Skin Centre Singapore Room 401, 9.30 am to 11 am
The program:
1. 9.30 am to 9.45 am Breakfast and Kids have balloon sculpture and jigsaw puzzles to keep them occupied
2. 9.45 am – 10.45 am Tubifast team demonstration, it’s much easier if you bring your child along for them to demo on him/her!
3. 10.45 – 11am Q&A time
Same note: No doctor present, so don’t expect to ‘Ask the Doc’. Information shared is not medical advice, please still see a doc. No selling anything or pretending to be a parent of eczema child and the session is for parents with eczema kids. Information on my blog is not pre-approved by NSC.
4. YOU MUST RSVP – It will then be possible for us to prepare breakfast and for the Tubifast team to prepare the relevant product. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids (and age, so the right size wrap can be prepared for presentation) coming.
One last thing, the session would be ending on-time, so please don’t come late and expect it to drag, it won’t – simply cos I have to run! Look forward to seeing you! Mei
This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!
Eyelid Functions and Skin
The eyelid very often present a very tricky and difficult to treat skin area for eczema sufferers. Moreover, the constant rubbing and scratching of the eczema at the eyelid can also lead to complications. Before we go into the complications, let’s first understand the basics of eyelid functions and the skin at this delicate area.
Functions of the Eyelid
Protection from injury
Regulation of light
Maintenance and distribution of tear film/ flow
Eyelid Skin
The skin of the eyelid is characterized by:
Thinnest skin are of our body – total less than 1mm, with both the epidermis and dermis being the thinnest
Smoother skin due to finer hairs
Oilier skin due to more oil glands
Common Eyelid Conditions
Being thinner oilier skin and on the face predispose the eyelid to various health conditions, such as:
Atopic dermatitis (eczema), more common from adolescent age (read more from dermatologist Dr Lynn Chiam)
Contact dermatitis, due to contact with chemicals used on the face/eyes and hair
Seborrheic dermatitis, typically on the eyelid and eyebrow (read here for more on seborrheic dermatitis)
Blepharitis, also known as eyelid inflammation
Conjunctivitis – this refers to inflammation of the eyelid lining, accompanied by itching and eye watering
Ptosis, known as droopy eyelids from prolonged contact lens use or aging
Dermatochalasis, baggy eyes from aging
Ectropion, eyelids that roll outwards usually from ageing or sun-damaged facial skin
Entropion, eyelids that roll inwards, may also be complication of blepharitis
Malignant eyelid tumors
Chalazion, eyelid cyst swelling from obstruction of the meibomian (tear) gland, may also be complication of blepharitis
Hordeolum, also known as a stye, lump from infection of the meibomian gland, may also be complication of blepharitis
Eczema and Eyelid Complications
Apart from atopic, contact and seborrheic dermatitis of the eyelid, there are also complications from having eczema at the eyelid. Complications usually occur in patients with severe atopic dermatitis where repeated scratching and rubbing, inflammation and infection of the eyelid cause other conditions. Let’s take a closer look at some of these eczema eyelid complications:
Blepharitis
This refers to inflammation of the eyelid, being accompanied by redness, sore eyes, itch, flakiness, burning, swelling, eye watering and mucous discharge. The eyelid margin may appear crusty, waxy or greasy. Blepharitis can be due to many reasons, including allergy, irritation and bacteria infection that causes the eyelids to become itchy. Blepharitis is associated with eczema, rosacea and acne patients.
Relation of Blepharitis to eczema as follow:
a) Staphylococcal blepharitis – patients with eczema have higher chance of staphylococcus bacteria colonization, leading to staph bacteria infection
b) Seborrheic blepharitis – due to the malfunction of oil glands at the eyelid, affecting patients with seborrheic dermatitis. The excess oil production may be due to stress, hormonal changes or diet. A characteristic of seborrhea blepharitis is redness at the eyelid throughout the day and crusting at eyelid in the morning.
c) Other eczema complications – Complications of eczema such as from herpes simplex or varicella zoster virus or molluscum contagiosum can also cause blepharitis.
Dennie-Morgan fold
This refers to a fold under the lower eyelid, typically due to excessive scratching/rubbing of the eye. The eyelid may also hyper-pigment or become red and swollen.
Allergic Contact Dermatitis
Ophthalmic corticosteroids may also product allergic contact dermatitis, due to allergy from certain ingredients of the corticosteroids.
Eyelid Erythema
This refers to redness of the eyelids and can be caused by eczema, contact dermatitis and blepharitis.
Cellulitis
This refers to bacterial infection of the eyelid and can also be caused by insect bite/ other skin injury. Preseptal cellulitis affects the eyelid and skin around the eye, but not the eye socket. Orbital Cellulitis is much more severe and affects the back of the eye, causing eye protrusion and double vision. The common bacteria causing cellulitis are Haemophilus influenzae, Staphylococcus and Streptococcus.
Neurodermatitis
Also known as lichen simplex chronicus, this refers to skin thickening, lichenification of the skin of the eyelid from habitual scratching.
Eczema and Eye Complications
There are also complications involving the eye, typically for prolonged eczema at the eyelid.
Keratoconus – This refers to the degeneration of cornea which pushes the eye outward, resulting in a cone shaped eyeball. There will be visual disturbance with this condition. This may be due to hard rubbing of the eye from the itch.
Scarring – This refers to scarring of the eye, mostly due to scratching or excessive rubbing.
Cataract – There is association between cataract and severe and chronic atopic dermatitis of more than 10 years, possibly due to overtime absorption of steroid cream applied on thin eyelid. One feature of cataracts associated with eczema is that the cataract affects both eyes.
Retinal detachment – This is very rare and associated with severe atopic dermatitis.
Complications from prescription creams seeping into the eyes, resulting in glaucoma
Certain eye-related conditions are not directly related to eczema, but related to allergy. For instance, conjunctival irritation
General Care for the Eyelid (Hygiene)
Top tips for general care of the eyelid:
1. Refrain from eye make-up
2. If wearing contact lens, always clean with disinfectant solution; in certain cases, refrain from using contact lens.
3. Apply warm (not hot) compress 4 times a day to clean and reduce discomfort (for blepharitis)
4. Clean eyelid with cotton swab with mild diluted baby shampoo/wash (read dermatologist Dr Jessica Krant’s tips for baby’s eyelid here)
5. Use artificial tears as blepharitis commonly occurs alongside dry eyes
6. An omega-3 supplement may be recommended to patients with blepharitis as small-scale study suggested anti-inflammatory effect of omega 3 benefit blepharitis patients. More on omega 3 and eczema here.
As you can see, there are quite a lot of health conditions affecting the eyelid and a few relating to eczema. Most of it has to do with bacteria and scratching, thus it is important to practice eyelid hygiene and treating conditions that create itch at the eye promptly.
note: if you’ve reached this far to the post, thank you! Took me a long time to do up a comprehensive post on eyelid complications from eczema and if you have any to share, kindly comment, will make my day!
Does Co-Sleeping change your Marriage *bedroom* dynamics?
Back by popular demand, this month’s cartoon all on sleep, co-sleep, suffering sleep, sacrificial sleep, whatever you call it! This is the 56th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. If you have a funny sleep story, drop me an email or a comment and I may just turn it into a cartoon!
It is one of those irritating things – the new ATM pin for one of those fancy chip replacement card just didn’t work. I then had to waste an hour queuing and re-queuing to try different pins without pissing the people in the queue behind me. When all fails, I had to queue at another bank’s ATM. It then hit me that in life, we have many inconveniences – falling sick, home appliances failing or train breakdown during office commuting hours! But what of our children? I ask myself if I have ever viewed my daughter or her eczema as an inconvenience.
The answer is probably yes. Sometimes I want to finish my chores, but have to stop to take care of my daughter. Some days I want a long shower, but I have to shower with my daughter to make sure that her anti-fungal shampoo and anti-bacterial body wash are used correctly. I then remember Jesus, how he never viewed the children as a nuisance, for instance when children were brought to him for prayers (Matthew Chapter 19:13-14). He also stopped or detoured in his journey to talk, heal and help others, for instance he healed a little girl (Mark 5:23). It then occurred to me that maybe life is made up of inconveniences! At least for parents of eczema children, with so much time spent on skincare, we might as well use this time as family time rather than view it as an inconvenient time! I pray that all of us have the wisdom to parent our children, despite the inconveniences from eczema.
Bible verse:
Mark 19:13-15 Then children were brought to him that he might lay his hands on them and pray. The disciples rebuked the people, but Jesus said, “Let the little children come to me and do not hinder them, for to such belongs the kingdom of heaven.”
God, help me to be a good mom even when it comes with inconveniences
Help to be a good daughter when when it becomes inconvenient
Help to be your good child despite the inconveniences
Taken from http://health.howstuffworks.com (no direct permission obtained for use, but duly credited) Link of picture directed to HowStuffWorks website
This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!
Bacterial Infection
Last week, we covered viral infections – eczema herpeticum previously covered in this blog (here and here) and molluscum contagiosum. This week, our focus is on bacterial infection. The most common bacteria that colonizes eczema skin is staphylococcus aureus bacteria, which is the cause of common children skin infections like impetigo and folliculitis. Apart from impetigo and folliculitis, S. aureus also causes other secondary infection with presence of pus, fever, swollen lymph nodes and in severe cases, staphylococcal scalded skin syndrome, where the lesions rupture to give scalded appearance (see this interview with Dr Clay Cockerell on symptoms of S.aureus infection).
Other bacterial infection include boils and ecthyma, also from S. aureus. The other common bacteria that causes infection is streptococcus pyogenes, which can cause cellulitis and erysipelas. Untreated bacterial infection can cause fatal systemic toxaemia or septicaemia, which is blood poisoning. If strep infection is a topic you’re interested, comment/email me and I may start a series on it!
Folliculitis
Folliculitis is an inflammation at the hair follicle that can be due to numerous causes – a common one being from staph bacteria. A word about staph bacteria is that even if it doesn’t trigger secondary infection, its presence impedes the recovery of eczema rash via (i) toxins (enterotoxin) from the bacteria that can trigger hypersensitivity and (ii) existing inflammation from bacteria makes it harder to treat the eczema (more on staph bacteria here).
So back to folliculitis – It appears as a small localized pus (on surface or deep) at the hair follicle, followed by red bump when the pus dried with surrounding inflamed skin that may itch. If the infection runs deep into the hair follicle, it can cause a boil which can be painful. The hair follicles on the chest, back, legs, face, neck, thighs and buttocks are more vulnerable to folliculitis. Folliculitis will not affect part of the body with no hair follicle such as the eye, mouth, palm and sole.
Multiple Causes of Folliculitis
Bacteria, from staphylococcus aureus is the most common cause.
Virus – Herpes simplex virus (that cause eczema herpeticum), herpes zoster (that cause shingles, read here of my daughter’s shingles experience) and molluscum contagiosum (covered last week) may also cause folliculitis.
Yeast – Folliculitis may also be from the yeast, Pityrosporum ovale (Malassezia) when it proliferates, usually on the trunk of young adults.
Fungi – Fungi such as tinea capitis (ringworm), Microsporum canis and Trichophyton tonsurans can cause folliculitis particularly on the scalp.
Parasite – Hair follicle mite (demodex) can affect the face or scalp of adults with compromised immune system or that of elderly. This is known as demodicosis. Scabies is another parasite that can trigger folliculitis.
Steroid – Systemically administered or topically applied steroids could result in facial folliculitis (perioral dermatitis) or steroid acne due to adverse reactions to long and significant doses of steroid.
Occlusion – Clothes with sweat, friction, thicker emollients, like paraffin-based ointment and adhesive plastic can break the skin and/or increase the penetration of bacteria into the hair follicle.
Chemicals – Some chemical like coal tar may cause irritant folliculitis.
Razor-burn folliculitis – This is due to frequent razor cuts creating opening on skin’s surface that allow bacteria to enter and cause inflammation at the hair follicle. It is more common on women’s leg and men’s face and neck. Excessive close shaving creates trapped hair in the follicle, increasing inflammation.
Spa pool/ Hot tub folliculitis – This is infection from inadequately chlorinated warm water, allowing the bacteria Pseudomonas aeruginosa to thrive. It is more common on the back and to prevent this, rinse/shower after a spa or hot tub.
Who is a Higher Risk of Folliculitis?
Skin conditions, such as acne, eczema and psoriasis patients
Diabetic patients
Obesity
Patients with lower immunity such as cancer, HIV, hepatitis or even chronic eczema patients who are on immunosuppressants may get eosinophilic folliculitis.
Occupations – Those that come into often contact with oil, tar or grease and sweat.
Warm and humid climate
Treatment of Folliculitis
The treatment will depend on the cause, as follow:
Bacteria – Antibacterial wash such as benzoyl peroxide, chlorhexidine or in certain case, antibiotics to kill the bacteria and clear the skin. There are increasing instances of methicillin-resistant Staph aureus bacteria, thus making it more difficult to treat such MRSA bacterial infection. Oral flucloxacillin is often prescribed and if there is penicillin resistance, erythromycin is prescribed. More on MRSA here.
Fungus and Yeast – Both fungus and yeast causing folliculitis can be treated using an antifungal shampoo or body wash such as ketoconazole (Nizoral shampoo) twice daily. Topical antifungal cream such as miconazole (Lotrimin) or terbinafine (Lamisil) and an antifungal medicine fluconazole (Diflucan) may be prescribed for more severe case.
Virus – Medication for virus, such as acyclovir for herpes simplex virus will help to resolve the folliculitis.
Razor folliculitis – Treatment includes antibacterial wash and topical antibiotics if not resolved on its own. Stopping to shave and using alternative hair removal techniques may help prevent future folliculitis from shaving repeatedly. Using a new razor and shaving in the direction of hair growth will help to prevent cuts. For men, antibacterial benzoyl peroxide shaving gel can be used. Permanent hair removal can also be attempted.
As the most likely factor is from bacterial infection, good hygiene measures such as hand-washing, not sharing towels/razors and showering after contact with likely bacteria surfaces helps prevent folliculitis. Not touching parts of body that have high staph bacteria such as the nose, armpit and perineum (area between anus and vulva/scrotum) can limit the spread of the bacteria to other parts of the body.
Folliculitis and Eczema
Children with eczema have a few factors to their disadvantage which make them more likely to get folliculitis. Of the causes of folliculitis, the one that most affect eczema patients is bacterial infection from staph bacteria.
Eczema skin already have higher likelihood of bacterial colonization, of more than 50% chance.
Most skin with staph bacteria won’t be harmed, however eczema skin is defective in its barrier protection, either from dry skin, ‘open’ skin from scratching and more permeable.
Eczema patients are suspected to be less able to fight common bacteria, fungus, virus and yeast.
The dry skin on eczema children is a more conducive environment for bacterial growth, compared to normal skin with natural oils.
The toxin produced by Staph aureus bacteria worsens the eczema with triggering more hypersensitive reaction/inflammation.
It once again points to keeping bacteria count low, proper hygiene, keeping our children fresh and cool as preventive measures for our children. What is your experience? Do share in the comment!
Wet Wrap session for kids with Singapore Eczema Support Group
Back by popular demand is another session on wet wrap, focusing on wet wrap for kids, including the younger ones. Another study had been released recently in July on the efficacy of wet wrap, citing a 71% reduction in symptoms out of the 72 children who took part in the study. Healthy skin is maintained one month after returning home with reduced reliance on medication. So the more reason to learn some wet wrap techniques!
30 August (Saturday) – Venue, National Skin Centre Singapore Room 401, 9.30 am to 11 am
The program:
1. 9.30 am to 9.45 am Introducing Ourselves over BREAKFAST – A warm-up for everyone, and food to get everyone awake. Feel free to bring your child, we have puzzles, coloring, balloon sculpture to keep your little ones occupied.
2. 9.45 am – 10.45 am Tubifast team will share on wet wraps for kids. They will give a presentation and have products available for you to see. From past sessions’ experience, it is not as easy to visualize your child and how to wrap, so you may just want to bring him/her along!
3. 10.45 – 11am Q&A time, so be prepared with your question!
Same note: No doctor present, so don’t expect to ‘Ask the Doc’. Information shared is not medical advice, please still see a doc. No selling anything or pretending to be a parent of eczema child and the session is for parents with eczema kids. Information on my blog is not pre-approved by NSC.
4. YOU MUST RSVP – It will then be possible for us to prepare breakfast and for the Tubifast team to prepare the relevant product. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids (and age, so the right size wrap can be prepared for presentation) coming.
One last thing, the session would be ending on-time, so please don’t come late and expect it to drag, it won’t – simply cos I have to run! Look forward to seeing you! Mei
Back by popular demand, this month’s cartoon all on sleep, co-sleep, suffering sleep, sacrificial sleep, whatever you call it! This is the 55th of my 2nd cartoon series, ‘LIFE OF AN ECZEMA GIRL’. For more cartoon in this series, check out here. If you have a funny sleep story, drop me an email or a comment and I may just turn it into a cartoon!
In life, there are certain moments when we Reset. For me, these are times when my daily routine is different, for instance, taking a long-haul flight where your morning and evening swap. Or being down with flu and having to rest at home. Typically, for these down times, I ask myself these few questions:
Is all that I’m doing (the busyness, even fully justifiable and worthwhile activities) RIGHT?
Do I need to change, add, reduce, refocus what I’ve been doing?
Am I loving God, my family and my friends enough?
Taking care of an eczema child makes these questions even trickier. For one, we may be spending disproportionately amount of time doing any or all of the following:
Monitoring + Saying + Shouting Stop Scratching
Moisturizing
Caring for Eczema Flare-ups
These are certainly things we have to do, but I think it’s not so much of the time and work involved but also the stress it creates. It may also prevent parents from evaluating their own life, their parenting and how they want family time to be different. Sadly, after spending so much time on skincare of eczema child + the stress that comes with it, parents are hardly in a ‘sane’ state of mind to reset. I pray that all parents get our down time and ‘me’ time to steer our life in the right direction.
Bible verse:
Psalm 25:5 Lead me in your truth and teach me, for you are the God of my salvation; for you I wait all the day long
God, every day our life as parent is very busy. Caring for eczema child comes with stress and lack of sleep. Help us to quieten our mind and lead us to grow and thrive in our life on earth.
Taken from cdc.gov (no direct permission obtained for use, but duly credited) Link of picture directed to CDC website
This is a 4-topic series focused on complications from eczema and mainly inspired because my daughter recently had impetigo. Moreover, the potential complications from bacterial, viral and fungal infection are not very often emphasized yet a child with eczema is often vulnerable to infections. So let’s explore!
Molluscum Contagiosum (Virus)
Apart from molluscum contagiosum, the other common viral infection is eczema herpeticum. This eczema complications series will not include herpeticum because it has been covered in April 2012 post: Eczema Herpeticum – What is it and is it Dangerous? Eczema herpeticum is caused by the herpes simplex virus and eczema children’s skin (being defective) is more vulnerable to the penetration of the virus.
The other common viral infection in children is molluscum contagiosum, caused by the molluscum contagiosum virus, a family of the pox virus. It appears in clusters of small bumps (papules) in places such as armpit, face, neck, abdomen, groin, joints which are warm and moist. The papules may be pink, white or brown but often with a center hole and waxy/shiny look. The papules will later turn inflamed, crusted or into scabs. The extent of the molluscum varies – from mild with a few papules in most healthy children to extensive and last longer for children with eczema (study here) or low immunity (for instance, larger and more papules in HIV patients). In healthy children, the virus will stay on the skin and not circulate in the body therefore the virus leave the body with full resolution of the papules.
Spreading of Molluscum Contagiosum
Molluscum Contagiosum is spread by skin contact, for instance, taking shower or swim together (not clear whether the water spread the virus or contact with towels, surfaces at pool spread the virus). It can also be spread via bedding, toys, towels and clothes. In adults, it can be spread by sexual intercourse. Children (age 1-4, some reports show up to 12) living in tropical climate (warm, humid, crowded) have a higher risk of molluscum contatgiosum. The incubation period ranges from weeks to months. The recovery period on its own can take from 6 months to few years. It follows that if you are infected, to limit sharing of towels, toys and touching surfaces (bandaged the papules).
Treatment of Molluscum Contagiosum
Treatment can be hastened by pinching/ squeezing the molluscum lesions to express the soft white core. This is best done a few lesions at a time for children as it can be painful. The base is then treated with silver nitrate or mild sclerosing agent. Various medical treatment may include electrocautery, cryotherapy (freezing), curettage (cutting), laser, cantharidine, imiquimod cream or wart cream containing salicylic acid. There is no drug/ vaccine that kill the virus. Consultation for treatment should be about 3-4 weeks apart as certain molluscum may have been in incubation stage.
Although both the molluscum contagiosum and small pox are pox virus, they are distinctively different to our immune system and thus a smallpox vaccination does not prevent molluscum contagiosum.
Relationship with Eczema
It is almost like a double-whammy – children with eczema with defective skin barrier are more susceptible to molluscum contagiosum and after getting molluscum contagiosum, the eczema worsened PLUS the molluscum at the eczema area healed slower. Furthermore, molluscum contagiosum is likely to be more extensive in eczema children due to the scratching of the papules, followed by touching the rest of the body. There is also linkage between molluscum contagiosum and long-term use of glucocorticoids which are steroids such as prednisone, dexamethasone and hydrocortisone. Use of non-steroid cream such as topical immune-modulators (tacrolimus and pimecrolimus) have also been associated with molluscum contagiosum (here).
My take – a lot of the complications are possibly going to be linked to scratching, where infection and bacteria/virus spread from one part to another. Therefore, it always make sense to treat eczema and take steps to improve the skin barrier.
Have your child had molluscum contagiosum before? Share your experience and it may help another family, thanks!
