Categories
News & Research

MRSA Decolonization Hospital – Eczema implications

MRSA soap study in hospitals plublished eczema A quick post on the latest study published in the above New England Journal of Medicine on the effectiveness of chlorhexidine soap on the decolonization of MRSA in hospitals.

1. Investigating if targeted decolonization or universal decolonization are more effective in hospitals.

Why hospitals? Hospitals is one of the common areas where staph bacteria S. aureus strive, due to it being a confined area with patients with infection. Read Dr Clay’s Q&A #2 to avoid hospitals if your child has eczema.

What’s the big deal of MRSA decolonization? 

MRSA is a big deal, because it is a particular strain of staph bacteria that is resistant to commonly prescribed antibiotics such as methicillin, floxacillin, lactamase-resistant pencillin and amoxicillin. This puts the patient at a high risk of complications from MRSA infection that cannot be promptly treated. Read this post to understand MRSA. It is a big deal for eczema patients because staph bacteria colonization is common on eczema skin, and thus poses the risk of MRSA infection.

2. Conclusion

The study from 3 hospitals (including 74 ICUs and 74,256 patients) showed that universal decolonization is more effective than targeted. Which means – eliminate the need to screen patients for MRSA, but instead have all ICU patients use chlorhexidine soap and mupirocin ointment. What’s chlorhexidine? A chemical that can kill stap bacteria – implications for eczema?

3. Implications for Eczema?

I think it reinforces the active washing with chlorhexidine reduces bacteria infection. I always wipe my child’s eczema skin with chlorhexidine, to remove staph. Staph promotes skin inflammation, read more here, and here on how resistant Staph is.

Categories
Living with Eczema

Someone Manages Differing Eczema Views

Deborah Wyatt, founder of TalkHealth which includes a Talk Eczema forum
Deborah Wyatt, founder of TalkHealth which includes a Talk Eczema forum

This is a series focused on personal journey with eczema while managing a certain aspect of life.
Today, we have Deborah Wyatt, whose daughter’s eczema inspired her to start TalkHealth, an online
community including that of eczema. Deborah will share on her experience managing differing views on
eczema, since the founding of TalkEczema in 2000.

Marcie Mom: Hi Deborah, thanks for taking part in my Friday blog series ‘Someone has Eczema’! Let’s
start with you sharing your personal experience when your daughter had
eczema?

Deborah: My daughter was confirmed as suffering with eczema after falling ill with a virus when she was only 5 months old. The virus and/or the medication seemed to be the trigger.

Living with a child with eczema was all-consuming. For around 5 years it totally took over and dominated our lives. I really didn’t enjoy the first 5 years of my daughter’s life, and to be honest it’s just a horrible memory peppered with sleepless nights, sore and bleeding skin and sheer exhaustion.

Nobody can ever appreciate what it is like to live with a child with a skin condition like eczema.

Like many people affected by eczema, we tried every possible combination of products and treatments in order to try to contain the symptoms. My quest was to make my daughter’s skin as comfortable as possible. Friends and family were very supportive but it was the eczema community I developed online that really threw me a lifeline.

I’m grateful that today, aged 14, my daughter is more or less eczema free. She still has patches of localized eczema which we treat with emollients and suffers with hayfever, food allergies and asthma. But the difference now she is older is that we are very much in control of it.

Marcie Mom: I know from my experience moderating at your forum, and also running support group and this blog, that parents will believe most strongly in what works for them. Some may have been endorsed in studies and internationally, while others not. From your experience, what is the best approach to ensure that everyone (we’re talking eczema sufferers of all ages, experiences, living in different countries, climates and under different health systems) shares amicably on what works?

Deborah: The talkeczema forum, like many other patient forums, is a great place to meet like- minded people and to share experiences of different products and treatments. However, I would always say that if anyone is in any doubt about any treatments they read about, they should talk to their GP or healthcare professional in order to obtain a balanced view. It’s always better to work in partnership with your healthcare professional in order to achieve the best outcomes.

Marcie Mom: There will be at some point where medical opinion is warranted, especially when there are studies but not widely endorsed. How do you tackle such views?

Deborah: It’s always wise to talk openly and honestly with your healthcare professional in order for them to help you make the right treatment choices. Sites like talkeczema are a great place to gather both evidence-based and anecdotal information and advice and by talking your findings, thoughts and views through with your healthcare professional, they can help you to make the right choices for you and your child.

Marcie Mom: One final question – how much would you rank the importance of support in an online community to your own life?

Deborah: I think you can’t put a price on the level of support and help that can be gained in an online community forum. One of the hardest things about living with a chronic health condition like eczema is the emotional turmoil it brings. Talking things through with other people who really understand what you are going through is very uplifting and powerful. It makes you realize you aren’t alone and there are others out there who can offer that vital emotional support.

Marcie Mom: Thanks Deborah for taking time to share your view on managing views! As our world gets increasingly connected, it is good to bear in mind your pointers!

Categories
Guest Interview

Improving our Homes for Eczema Children – Minimizing Indoor Allergens (House Dust Mites, Mold, Cockroach)

Celia Imrey is an architect and co-founder of SpaceKit; she graduated from Yale University (Masters of Architecture) and Brown University (Bachelor of Art and Semiotics, Magna Cum Laude). She is an Associate at the American Institute of Architects and is a LEED (Leadership in Energy and Environmental Design Accredited Professional) Accredited Professional. She has taught architecture and art courses at Yale, Brown, Columbia/Barnard and NYU.

This was originally a two-part series combined into one informative post.

For parents with eczema children, it is very likely you’ve ‘scanned’ your homes looking for possible triggers of eczema flare-ups (I know I did!). Whilst most of us think about our bed sheets, our laundry and carpets, we may not think about the layout and materials of our homes.

MarcieMom: Hi Celia, it’s so good to have you share with us on improving our homes. It’s also the first time I’ve an architect as featured guest, so I’m excited for the fresh perspective your interview will give to readers of this blog.

Common Indoor Allergens

The common indoor allergens are dust mites, mold, pet dander and cockroaches (droppings). We will consider how we can improve our home environment to minimize indoor allergen. Let’s start with the dreaded, all pervasive dust mites!

Dust Mites – Eczema Trigger for Children

Dust mite is a very common trigger of eczema for children, and more of it can be read in this post. They thrive in room temperature, humid environment and feeds on our dead skin. There are different allergens within the dust mite dropping, and they vary in particle size which renders some airborne while others tend to stay on surfaces. It may trigger different allergic conditions and symptoms for different ones in your family, depending in part, whether their airways or their skin is sensitized to the allergen.

Measures to reduce house dust mites are listed here, and they include removing carpets and stuff toys, washing in above 60 degC water and getting dust mite covers.

MarcieMom: Let’s suppose we are not changing where we live, but able to change our room layout and materials we use (ie major renovation):

Reducing Dust Mite through Home Design

Do the materials which we use for our floor, and for our walls, make a difference?

For instance, will certain wall materials or paint or finishing increase the surfaces for dust mites to live while others make it more difficult for them to thrive?

Celia: At Space Kit, we recommend using natural materials where possible, especially for carpets. Dust mites take refuge in carpets but can’t live on hard surfaces like wood floors or plastic. Wherever you have carpets or rugs, use wool. The natural lanolin in wool repels dust mites.  Paint does not affect dust mites that we know.

The natural lanolin in wool repels dust mites. 

How Home Design Affect Humidity & Dust Mite Growth

Is there a way to manage the humidity of our home?

Both in the overall sense, meaning to reduce trapping moisture in our home; and also particular to the child’s bedroom, should it be say further away from the bathroom or have windows positioned a certain area (or if windows can’t be moved, for the bed to be positioned differently)?

Celia: Proper natural and mechanical ventilation are essential for healthy living, especially in bathrooms, kitchens and laundry areas. A well designed home takes air circulation (and thus temperature and humidity) into account; there is directionality to air circulation, and Mechanical Spaces (where air handling equipment are) are designed in relation to the spaces they serve in order to maximize air circulation and minimize dead air pockets. Humid conditions can be countered using air conditioning and ensuring that windows are fully sealed when closed. Furniture placement near humid areas will encourage mites.

Humid conditions can be countered using air conditioning and ensuring that windows are fully sealed when closed.

Designing a Home to be Cool without Drying Child’s Skin

MarcieMom: For a child with eczema, like mine, needs to be kept cool and so sleeps in air-conditioned room. As the air-con dries the air, I actually have a humidifier on. The risk of a humidifier is of course it promotes the growth of dust mites and mold.

Do you have a solution to keeping the room cool, without making it dry or too moist?

Celia: You could cool the air before having your child sleep in the room. This will minimize the amount of time the child sleeps in dry air.  You could use the smaller, directional humidifiers to provide humid air only to the pillow area and then remove and treat the linens each day. It’s a lot of changing sheets but very hot water kills mites immediately, so regular laundering should be part of your solution if you use a humidifier.

Sunlight and Ventilation in Child’s Room Design

MarcieMom: Sunning and ventilation helps to remove dust mites.

What factors should we consider so that our bedroom can have sufficient sunlight and ventilation?

Celia: We love sunning and ventilation at Space Kit too! Light materials and paint colors help bounce light around. For bedrooms, use window treatment that provides sufficient privacy when open.  If you like sleeping in a dark space but have a privacy issue, you will need two kinds of window treatment, one for darkening the room and one for providing privacy while letting light (and some air) in.  Quality window treatment that is easy to use is critical.  You need to be able to operate it or pull back the curtains with a simple hook or tie.  Ease of use encourages you to use your windows to live in a healthier manner.

Mold, Another Common Eczema Trigger

Mold is another common indoor allergen and more of it can be read from CDC. Like house dust mite, they thrive in room temperature and humid environment. Their feeds include materials like wood, leather, dead skin and cotton and wool fibres. Mold spores are airborne and trigger symptoms and conditions such as watery eyes, sore throat, respiratory issues, nasal congestion, eczema and even asthma. Minimizing mold growth can be via control of temperature, control of humidity and reducing their food.

Choice of Home Materials on Mold

MarcieMom: As I’m preparing for this, I’m surprised to learn that many building materials are food sources for mold, including wallpaper glue, greases, paper, textiles and wood. 

Do you have suggested common materials to use for our walls and floors, and in our bathroom, so that there is less food for the mold?

Celia: Solutions that resist mold are a fundamental part of Space Kit’s designs. There are many design considerations to make with regard to moisture. Good designs don’t leak, cause condensation, or trap moisture. Some options include using good quality door seals and gaskets for shower doors. Usage of moisture and mold resistant backer boards and vapour barriers.

Are there other areas in our home that traps moisture easily and what can we do about them (both during renovation and on maintenance basis)? 

I’ve read that certain paints, leaks, damp basements, poor drainage or plumping traps moisture, and also condensation on cool surfaces can increase mold.

Celia: Basically mold feeds on untreated, natural surfaces. Space Kit promotes the use of natural materials, like stone, ceramics, plaster and wood and we advocate finishing them properly. For example, wood is a beautiful home material, especially for floors, but it needs to be finished properly, so use varnishes, stains, paints, and fill all the cracks. In using any natural material, make sure all the surfaces are coated and maintained.  Wool carpets are dyed and the dye is bound with a sealer. If you keep carpets clean and off any floors that have moisture issues like concrete floors in a basement, they should not feed mold. Space Kit’s window treatments use materials that hinder mold, like synthetic materials. For bathrooms, we recommend tiling the full walls.

Note: be vigilant about spotting mold: undersides of tables, on ceilings, etc. and treat immediately before it spreads.

What about the selection of cabinets, walls, wall coverings, bookshelves and also the positioning of furniture? Do these affect mold growth?

Celia: None of these affect mold growth if there if proper air circulation.

Bathroom Design on Mold Growth

MarcieMom: My guess on the common area in our homes where mold thrive is the bathroom where it is often damp. 

What are your recommendations to minimize mold in bathroom?

Celia: Our designs are intended to minimize moisture retention, for example, we like glass shower doors (with systematic wipe-down after showering) instead of curtains. Proper ventilation for bathrooms and dryers is critical.

Cockroach – The Yucky Eczema Trigger

Cockroach, more precisely the allergens found in their droppings, saliva and bodies, is another common indoor allergen. From the AAFA website, it is mentioned that When one roach is seen in the basement or kitchen, it is safe to assume that at least 800 roaches are hidden under the kitchen sink, in closets and the like’.

Cockroaches thrive in warm and humid environment, and they feed on our food (thrash, scraps, starch) and water. The particle sizes of cockroach allergen are large and tend to settle on surfaces. They not only worsen allergic conditions, but carry bacteria.  Symptoms or conditions of allergy to cockroach may be itchy eyes, itchy skin, eczema rashes, nasal congestion, asthma and allergic rhinitis. Minimizing the growth of cockroach can be done by observing hygiene and minimizing their food source, water and shelter.

Prevalence of Cockroach Allergen in Dust

In a study published in the New England Journal of Medicine, of the children in the study, “36.8 percent were allergic to cockroach allergen, 34.9 percent to dust-mite allergen, and 22.7 percent to cat allergen. Among the children’s bedrooms, 50.2 percent had high levels of cockroach allergen in dust, 9.7 percent had high levels of dust-mite allergen, and 12.6 percent had high levels of cat allergen”.

I understand that cockroaches hide outside the home, what are the possible areas in our home to ‘seal off’ cockroaches?

Celia: Sealing the hole around the steam pipe and sealing the hole around all plumbing and electrical pipes. Also, you can utilize drain covers to prevent critters from entering up into your home through showers and sinks.

MarcieMom: Chemicals may trigger irritation either in airway or skin for young children. It is best, therefore, to use cockroach trap. This may sound strange, but is there a need to plan ahead where cockroach traps should be placed?

Celia: If proper preventive measures are appropriately taken such as sealing of holes and cracks, then there is no need to plan for precautions.

Safe Chemicals at Home for Children

MarcieMom: While we’re on the topic of chemicals, which are the materials you would commonly recommend that are safe for young children, and for how long would ‘airing’ be required before the family moves into the home?

Celia: Materials with zero or low VOC content are recommended for children and adults. It is best to move in after all the fumes from the paint have disappeared (i.e. that are no off gassing smells) and the home is dust free.

MarcieMom: Thank you so much Celia for helping us improve our homes and minimize the indoor allergens, right from the renovation stage!

Categories
Support Group

Parenting Eczema Child – I feel incompetent

This image says it all.. just suddenly feel this way, I’m doing a fab job with controlling the eczema, but what about the heart, mind and soul?

Parenting Eczema Child

Categories
101 things that Mothers with Eczema Child do Differently

95 of the 101 things that Moms with Eczema Child do Differently – Kid has Grown with Different Distraction Device

Match this with the 94th Cartoon!
Match this with the 94th Cartoon!

This is the 95th of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

Categories
Living with Eczema

SOMEONE Managed Allergic March for Son with Eczema

Sarah, with her 3 children, shares on managing allergic march
Sarah, with her 3 children, shares on managing allergic march

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Sarah Chapman, whose third son has eczema since three-month old. Today, she shares how she managed her son’s Allergic March. Sarah is a volunteer with AllergyUK and had shared her allergy knowledge nationwide.

Marcie Mom: Hi Sarah thanks so much for taking part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your family’s eczema and allergy history, and when did eczema or allergy start and what’s the severity?

Sarah: I had eczema soon after birth, and throughout my childhood. I still get it every now and then. My maternal grandfather had it all his life. I can remember him scratching! My mother and her brothers had eczema as well. There is also a lot of asthma in my family and nickel allergies.

My husband has asthma with links to environmental allergies.

Marcie Mom: I understand that your son, now 17 year old, experienced the Allergic March, progressing from eczema to allergies.  What was his condition from birth to a young child?

Sarah: Our 3rd son had eczema day 10 after birth, and as time went by he had a poor sleep pattern (by that I mean an  inability to sleep for longer than 2 separate hours a night, and 20 min cat naps a day) He also had very slow and poor weight gain, even though breastfeeding was going well. These are the early signs of food allergy in a breast fed infant before three months old.

As he grew his eczema was very hard to control, his daily treatment was 5- 8 all body emollients and twice daily low dose steroid cream. Just before we were about to start wet wrapping treatment we discovered that he had an egg allergy and then peanut at 13 months old. I had also started to suspect that environmental allergies, like pollen, dog and cat were a problem.  At 18 months old immunologist confirmed allergies to, dust mite, cat, dog, tree pollen, hay fever, egg, tree nut, peanut.

As we paid a great deal to lessen dust mite exposure and pollen in our home, and controlled diet and his skin improved. When I stopped breastfeeding him, his skin got instantly better, but he began to catch every infection going, and skin became infected and so on.

Treatment added to original eczema plan, change of emollients, eye drops, nasal sprays, antihistamine during hay fever and tree pollen season.   Age 2 epi pens, and emergency plan for anaphylaxis.

Like many allergic children he physically shows signs of being an allergic child. He has a ‘captains salute’ a small dry crease on top of nose from rhinitis, from using hand to push up nose from constant nose drip. He is a mouth breather child, again a sign of poorly controlled rhinitis.

He has dark rings, and an extra dry crease under his eyes. He also has derma- graphism (am not sure about the spelling of that btw!) which means that if he is slightly scratched a wheal will form within minutes. He also snored as a child which isn’t normal and is a sign of rhinitis.

Rhinitis has a major impact on sleep quality, and babies and young children require sleep to grow. Concentration at school when you have a totally blocked nose 24/7 is very difficult and so has impact on education.

Marcie Mom: How did the eczema progress when he started elementary school?

Sarah: As he neared 5 his eczema improved, this is typical of an allergic march child, and at the same time his rhinitis and environmental allergies were making more of an impact. We had discovered more food allergies to add to list.  Eczema treatment 3 full body emollient a day, and no steroid cream required. Except after food reaction in which eczema would appear as hives and other IgE response symptoms disappeared.

Age 5   allergies, Dust mite, Tree Pollen, hay fever, dog , cat , egg, peanut, legumes, tree nut, kiwi fruit.

Age 7   Dog allergy considered life threatening, change to emergency treatment plan, oral steroids and asthma inhaler (has asthma response during allergic reaction, but not asthmatic) yeast extract new food allergy.

Food challenge in allergy clinic confirmed outgrown cooked egg allergy = increase in  food  choice with higher calories.(still underweight.)

Age 10 Outgrown raw egg allergy in food challenge. Dog allergy lessened and quality of life improved, for instance sleep overs with friends who have dog, controlled with antihistamine.

Eczema,dry skin only.

Marcie Mom: What was his condition as a preteen and teenager? Did puberty change his condition? And how is your son now, as a young adult?

Sarah: By 12 redeveloped raw egg allergy, and by 13 possibly cooked egg, now at 17 prefers to avoid himself.  Food allergies: Egg, Peanut, some Legumes, Brazil nut, Yeast Extract, Kiwi Fruit, Hay Fever, Mold, Tree Pollen, Dust Mite.

Skin very dry, but otherwise OK!

We have used epi pen 3 times so far, but despite this is gaining confidence in his ability to buy food independently and going out with his friends.

Marcie Mom: Thanks Sarah for taking time to share your son’s allergic march, it is useful for parents to know but hopefully, won’t go through the full allergic march!

Categories
Eczema Facts

Eczema Medication Series – Prednisolone

Marcie says 'Prednisolone worked for me!' MarcieMom says THANK YOU GOD
Marcie says ‘Prednisolone worked for me!’ MarcieMom says THANK YOU GOD

This is a series on some of the medication that I’ve collated from parents who shared in forums. For this week on Prednisolone, my baby with eczema had been prescribed a one-time 3 week reducing dosage course at about 7 month old, and it had cleared her eczema which then became manageable after the course. I know of many other young children, who did not respond well after the course, and some who did – please freely share your experience in the comments, your sharing can help encourage and comfort another parent.

What is Prednisolone?

Prednisolone is a type of corticosteroid which is prescribed to control inflammatory and allergic conditions like eczema, severe psoriasis and severe seborrheic dermatitis, colitis, asthma and rheumatoid arthritis. It works by stopping the release of chemicals that cause inflammation. Prednisolone is also used to treat blood cancer and lymphoma, to reduce the destruction of platelets by the body’s immune system.

It is usually an oral prescription (for my girl, it was solution) that must be complied strictly. Self-altering the dosage is not acceptable as the dosage is decided by a skilled physician, taking into account a combination of factors such as the skin condition and weight. If you are in a highly stressed season in life, do let your doctor know as that is a factor for deciding on the dosage.

From personal experience, the skin of the baby changes during the course – it may get better than worse, for my child, better again. Terminating halfway on your own, due to fear of oral steroid or deterioration of eczema, will make it more difficult for the doctor to make an assessment of how the course worked (or not).

Monitoring

Monitor your child’s growth and if concerned, discuss with the doctor. Steroid course may slow a child’s growth if used over long period or cause thinning of bones (osteoporosis), as it impairs calcium absorption and new bone formation. Look out also for signs of vision changes.

Warning

There are interactions with other medications so it’s best to let your doctor know of medication, vitamins and supplements that you or your baby/child is taking. Taking steroid over a long period can lower the body’s immunity. Avoid contact with people who are ill (esp. with chicken pox, measles or shingles), and also those who have taken a recent live vaccine (also check with the doctor before your child gets vaccinated). Wash hands also to prevent infection.

Side Effects

Watch for side effects, one of which is adrenal issue whose symptoms are fainting, irregular heartbeat, thirst, irritability or unusual fatigue. Click here for a list of common to less seen symptoms.

There is no particular diet to follow (except avoid liquorice), unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a study of 21 patients, only 1 achieved stable remission of eczema versus a higher rate (6 out of 17) for those prescribed cyclosporine. I find it strange though that I couldn’t find more study on Pubmed for prednisolone than for other medications in this series, which are licensed for use later. I’m glad that oral steroid course worked for my child, and love to know how it worked out for you.

For previous posts in this series, see

Cyclosporine

Methotrexate

Cellcept

Categories
Doctor Q&A Support Group

Sharing Treatment for Eczema Children

Eczema Treatment for Children Dr Lynn Chiam dermatologist Singapore
Elomet ointment

Last Friday’s eczema support group session with Dr Lynn Chiam was a fruitful one – the topic was Treatment for Kids’ Eczema and we had pizza and chicken wings for lunch at the National Skin Centre Singapore!
Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Children & Adult Skin Hair Laser Clinic, Singapore.

Eczema Tips for Children

1. Moisturizing within 3 Minutes After Shower

This is inline with Dr Jennifer Shu’s tip here, so it appears that it’s an international recommended practice. Dr Lynn shared that should it be difficult to do so, or if skin is still dry, wet wrap can be implemented. For practical purpose, should the child not be able to tolerate wet wrap overnight, instead implement at least an hour, 5 times a week. Even a dry wrap will retain moisturizer better for the skin.

2. Removing House Dust Mite (if it is an allergen for your child)

Dust mite can be killed either by extreme cold or heat – so wash bedsheet in at least 60 deg C water (read this post) and for stuff toys, freezing them may help decrease the amount of dust mite as they are affected by extremes of temperature. Dr Lynn recommended sunning mattresses and changing mattress once per year, i.e. don’t get a thick and very expensive one. Remove carpets.

3. Use of Topical Steroid – Don’t be Steroid-Phobia

I shared that there is a lot of fear out there among parents on using even the mildest steroid cream, and I’ve heard of increasing number of children hospitalized for infections due to fear of using steroid. Read more here on ‘Is Steroid Cream Safe?’. Dr Lynn explained 4 side effects of topical steroid (i) skin thinning (ii) easy bruising, (iii) fragile blood vessels and (iv) excessive hair growth. However, these can be avoided if patients ensure they use (1) the right steroid (2) at the right part of skin and (3) for the right amount of time. 

Topical Corticosteroid Withdrawal Children

Read this interview with Professor Hugo where we go through the review paper conducted by National Eczema Association on Topical Corticosteroid Withdrawal

For anyone who emailed me (and we’re talking many!) who ask if steroid cream is safe because they’ve read about the side effects (which further reinforces FEAR spread like FIRE), you know my reply is the side effects of MISUSE should not be confused with Right Use. There are also many who have an agenda for propagating fear – to sell a steroid-alternative. Again, there is no need to use one and not the other. You can use steroid safely to treat flare-ups and skin inflammation, while at the same time, moisturize, wet wrap, have healthy diet, healthy lifestyle, distract your child, protect their skin, covering their fingers..


Side effects of MISUSE should not be confused with Right Use

Dr Lynn shared that steroid treatment should be used pro-actively, to treat skin inflammation even after the rash disappear, and this is also consistent with what Dr Bridgett shared in this post. Protopic can be used for maintenance, and I’ve clarified with Dr Lynn that the stinging sensation that some experienced with Protopic will not be manifest as rashes. For more on Protopic, see here.

4. On Oral Steroid

This is usually a treatment for severe active cases, not lightly prescribed due to its side effects of osteoporosis, stunting growth and increased vulnerability to infection. Tomorrow’s post is on prednisolone, and you can also refer to previous post on cyclosporine.

5. This is my afterthought – Don’t Jump from Fear to Fire

I’ve shared earlier that Fears spreads like Fire, and I like to remind parents not to jump from fear into fire – for instance:

Is someone telling you not to use steroid but something natural? If so, do ask them and search Pubmed for studies. I’m not against natural and I’m not against any parent wanting to try something natural. Do check 1. It’s safe to consume/apply, 2. Keep up the standard treatment.

Is someone telling you that a steroid cream is not working and that the flare is caused by it? Think back – did your child have rashes before the steroid? and Dr Lynn shared that each steroid cream has its own molecular structure, suited for different purpose. You may wish to work with your doctor on another cream.

Is someone telling you their skin recovers after doing a,b,c and d? Ask them, did they do a,b,c and d while applying the steroid?

Is your doctor (I really hope not) telling you that established clinically trialed cream is no good and their own concoction is better? I do not know if it is/not, how would anyone know if it’s kept a secret, even without a medical name. If it doesn’t work for your child, it’d be impossible for the next doctor to understand what your child has been prescribed and how the skin reacted.

This is a very long summary of the discussion. But as you can see, I’m really AGAINST people who spread fear of steroid – again, I’m not saying steroid is the only way, I’m saying it has its place and fear shouldn’t be propagated for personal means.

Categories
101 things that Mothers with Eczema Child do Differently

94 of the 101 things that Moms with Eczema Child do Differently – Kid has Grown, Seat has Changed, but…

Still Scratching!
Still Scratching!

This is the 94th of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

Categories
Living with Eczema

SOMEONE Managed Diet for Child with Eczema

Judy Converse, nutritionist and a registered dietitian, shares about managing diet for her son.
Judy Converse, nutritionist and a registered dietitian, shares about managing diet for her son.

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Judy Converse, founder of Nutrition Care for Children LLC, whose son showed signs of eczema in his first two months. Today, she shares how she managed her son’s diet. Judy is a licensed nutritionist and a registered dietitian for more than 20 years, and had shared on Eczema Kids Nutrition here.

Marcie Mom: Hi Judy, thanks so much for returning to take part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema history – when did eczema start and what’s the severity?

Judy: My son’s rashes became visible just after birth. It was confusing – he was breast fed; I had received no medications or interventions during delivery. There seemed to be nothing, as far as I knew, that he could have reacted to. Within the next few weeks, it was bad enough that he might bleed from scratching at it, unless we covered his hands for sleep. I know this is controversial, but we came to strongly suspect this was part of an adverse reaction to his newborn dose of hepatitis B vaccine, which had been given without our knowledge.

Marcie Mom: I understand that you got into your current field to understand more about helping your son.

Share with us: What perplexed you so much when you were managing his diet that spurred you to be a nutritionist and dietitian?

Judy: I became a dietitian years before my son was born, and had already worked in this field. But I had not been involved with pediatric nutrition up to that point, other than some work in the WIC program in my training. My son’s circumstances are what triggered me into this niche. What perplexed me – or I should say – stunned me – was that even though he was having rashes and many other concerning symptoms, we were repeatedly told it was “normal”. He had projectile vomiting, terrible hard screaming (one nurse said to me “he’s too young to have colic” when he was just a few days old and screaming until he was blue), seizure like events, and runny liquid stools – at 8 or 12 months old, he would have 10 liquid runny mucousy stools a day, that ran up to his neck and down his legs. Even my father, then about 70 years old, brought it up to me. Five kids plus three other grandkids and he’d never seen poop like that. But the doctors insisted it was normal. It isn’t normal. It’s clearly a sign of a problem with digestion, absorption, inflammation or all three.

My son was born full term weighing 7 lbs 8 oz, but slid down the growth chart so that by age 2 months, he was hovering at the 5th percentile. This was the wrong direction. Obviously, his digestion was not working normally. But I could not get any of my son’s pediatric providers to see that. I found this quite disturbing, to see that a baby’s nutrition, growth, feeding and eliminating were not a priority to them.  My training had given me thorough evidence based information about how crucial these are for normal brain development and learning. It was a shocker to me that no one was concerned. No one seemed to realize this can impact a baby’s brain.

Marcie Mom: Was it easy to figure out his allergies or did the allergy testing not corroborate with your observations?

Judy: Though I had excellent training in my undergrad and graduate nutrition studies, allergies in infants was new territory for me. I had no guidance from my son’s health care providers. I reached out to La Leche League, which I knew about because one of my graduate advisors had been involved with them. They gave me helpful information about breastfeeding an allergic baby. This was in 1996-1997. No internet to speak of. I opened my text books and dove into learning as much as I could. I requested allergy testing when my son was 8 months old. This is young for this testing, but he had dramatic allergic responses to several foods he had never eaten. The doctor apologized, saying my son would probably have asthma and eczema for the rest of his life. Neither came true – I was determined to redirect that.

I later learned that these reactions were only part of the story. These were IgE allergy reactions. When my son was about two years old, we checked IgG food sensitivity reactions. There were several reactions there as well. They didn’t correspond to the IgE. It filled out the rest of the story, and confirmed he had other foods we had to prioritize. This is something I have seen often in my practice since. There is plenty of debate about IgG food allergy testing, especially in children as young as 2 years old. But once we mapped both the IgG and IgE reactions, we could make a more effective plan. My son was eczema free and has been his whole life since. His stools and growth normalized. He was happier. Over the years, he has had a few asthma episodes. Every time we are offered an inhaler, he seems to use it once or twice, then it sits in a drawer and expires before he needs it again.

Marcie Mom: One final question – now that your son is an adult, did that shared experience managing his diet give him fond memories of your care and love for him?

Judy: My son is in high school – not always the moment when parents feel appreciated by their kids! But he understands all the effort made on his behalf. We as a family have learned to enjoy many foods that we never would have discovered if it weren’t for his needs. He is sort of a foodie. He loves good food, is interested in cooking, and has an adventurous palate, because at a very young age, we had to have other options for him. He has taught me a lot.

Marcie Mom: Thanks Judy for taking time to share your journey on managing your son’s diet – am sure many moms like me are inspired to study to help our children!

Categories
Eczema Facts

Eczema Medication Series – Cellcept

cellcept eczemaThis is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Cellcept?

Cellcept is the product name for mycophenolate mofetil, which is an immunosuppressant. Similar to cyclosporine, it is prescribed to lower the risk of organ (kidney, heart or liver) transplant rejection via lowering the activity of the immune system.  It is also prescribed for Crohn’s disease. It may also be prescribed for those with severe eczema who has not been responded to conventional treatments over prolonged periods.

It can be taken orally or by intravenous infusion, and patient needs to follow the prescription carefully, including how many hours to take it before food. The capsule or tablet should be swallowed whole, not crushed or chewed and thus ask for a suspension if you have problems swallowing whole. For the medication in this series that work on the immune system, altering the dosage of the same drug can be used to treat different conditions. Thus, it is important to follow the dosage and frequency designed by your doctor and not to self-adjust through your own observation of the skin’s condition. Doing so not only risks side effects, it also makes it difficult for your doctor to prescribe a follow-up treatment.

Monitoring

Certain tests may be requested by your doctor to assess the side effects of Cellcept, such as blood tests (blood count and chemistry panel), particularly to monitor the blood count of white blood cells, red blood cells and platelets.

Warning

There are medications that can reduce the amount of the active ingredient of Cellcept in the bloodstream, thus making it less effective. Some of these are antacids, colestyiramne, iron tablets, ciclosporin and rifampicin. It’s best to let your doctor know of medication, vitamins and supplements that you are taking.

There is associated risk of   lymphoma and skin cancer, so sun protection measures are important. Also take good care of your gums and visit dentist regularly as swollen gums is a possible side effect. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent live vaccine (also check with the doctor before getting vaccinated) as Cellcept is an immunosuppressant. Wash your hands also to prevent infection.

Side Effects

Watch for side effects, and let your doctor know; some of the side effects are:

Constipation, stomach upset, gas, chills, fever, rash, swelling, headache, vomiting, diarrhea, nausea, loss of appetite, hair loss,  swollen gums, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, muscle cramps, water retention and increased heartbeat.

Symptoms of flu such as sore throat, fever, night sweats, or painful urination, vision changes, reddened skin that cannot heal or sore may indicate infection that warrant seeing your doctor.  Stomach or intestinal bleeding is also a side effect, and signs to look out for are stomach pain, blood in your stool, or dark, sticky stools. There are also reports of risk of brain infection (progressive multifocal  leukoencephalopathy) whose symptoms include visual loss, seizures, movement and speech difficulties, weakness, confusion and headaches. Do call your doctor immediately.

Refer here for a list of more to less common side effects.

There is no particular diet to follow, unless directed by your doctor.

Most Importantly, Does it Work?

I’ve found a few studies online, and the various conclusions are:

  1. In a retrospective case series of 14 children with severe eczema, 1 failed to respond to treatment while others improved significantly.
  2. In a study of 16 patients over 34 weeks, 1 had pancreatic cancer and the rest had improved significantly.
  3. In a retrospective study of 20 patients, 17 improved over 4 weeks of the course, but 7 patients developed various infections.
  4. In a study of 12 patients with paediatric severe eczema at the University of North Carolina at Chapel Hill pediatric dermatology clinic, 8 out of 12 reported significant improvement.
  5. In this study of 10 adult patients, mycophenolate mofetil is found to be effective in reducing the severity of eczema after 12 weeks.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances that had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!

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101 things that Mothers with Eczema Child do Differently

93 of the 101 things that Moms with Eczema Child do Differently – Kid has Grown and Still No Sleep

93 eczema cartoon

This is the 93rd of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

Categories
Living with Eczema

Someone with Eczema Baby Managed Returning to Work

Kelly shares on how she managed returning to work!
Kelly shares on how she managed returning to work!

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Kelly who will be sharing on returning to work, at about the time when her son with eczema was six-month old. Kelly is the founder of Bamboo Bubby, and is a return guest of my blog, see here for her interview on the bamboo bubby sleeping bags.

Marcie Mom: Hi Kelly, thanks for taking part in my new blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema, when did he started to have eczema and how was it at 6-month old and now?

Kelly: Thanks for the opportunity to share my experiences Mei! My son was around 6 months old when we finally found a doctor who put the word eczema to his dry, red and irritated skin and who referred us to a specialist eczema clinic. It wasn’t however something that just started overnight. I remember starting to search pharmacy shelves when he was two weeks old looking for a cream that would take away some of the dryness and irritation. We had also need numerous doctors over this time too who were quite blasé about it and would tell us to just use sorbolene (which made it worse!). I think we tried every other cream known to man in that time too as well as trying every type of formula in the hope of finding one that he would drink, because we thought he was just a ‘difficult drinker’ who fought every single feed, often pushing his bottles out of our hands so hard they’d fly across the room!

It wasn’t until our eczema clinic appointment and after a round of allergy tests showed up an intolerance to cow milk protein, that the link between his milk refusal and his eczema became clear for us. We then went through a process of trying soy formula (this was the worst his skin had ever been), then a couple of prescription ones (which he outright refused) before we tried a goats milk one as a last resort and the change was instant from the first bottle. For the first time in his short little life, he drank a whole bottle instead of us forcing 10mls at a time into him. So we just kept giving him this and after a month or so his skin improved A LOT! We were of course also layering moisturizers on him after every nappy change as the eczema was all over his body, but especially bad on his cheeks, stomach, back and legs.

Now, at 3 years old, he still gets eczema flareups, but we know what to do to control and manage it now. Flareups are now usually caused by sickness, fatigue or seasonal allergies.

Marcie Mom: What were your son’s triggers and were they easy for you to communicate to your caregiver?

Kelly: I think we were very lucky that we discovered his trigger not long after I returned to work and he started at our local childcare centre. They were fantastic about accommodating to his needs and being in the baby room, we took all his milk bottles each day anyway. Our Child Care Centre though is required to have policies and procedures in place to meet local and other legislative requirements, meaning they have a Healthy Eating Policy plus several around medication management. So, once we had a written management plan from the doctor that stated his trigger and that he needed moisturizers applied in a certain way after every nappy change it was a very easy process to communicate his needs. They have a very organized system of keeping track of all the babies various different needs and they did a really wonderful job of ensuring he was looked after in this regard.

Marcie Mom: What was the eczema skin care routine you were using, and was it difficult to get the caregiver to understand and be committed to the same routine?

Kelly: Of course there is probably no one else in the world who would do for your child exactly the same as you would yourself, because that’s what we do as parents for our children, often going above and beyond to feel we’ve done everything and the best possible job! However for us, obtaining the GP Management Plan really was the key to ensure the centre provided as close to what we were doing as possible with the regular application of various moisturizers and to make sure his trigger food was avoided.

The aspect I found the most difficult to deal with though, was the sleep routine (or lack of) that our baby desperately needed, yet due to the eczema and milk intolerance we’d never had a chance to establish at home before then throwing child care into the mix! It was around this time that I made my first sleeping bag for him, which helped the caregivers to know that he wouldn’t be damaging his skin while sleeping.

Marcie Mom: One final question – every mom needs to let go, at some point, of our newborn and especially difficult if the child requires special care. Was there a moment that tugged, pulled or pierced your heart when returning to work?

Kelly: I think there was more than a single moment! For me the hardest part was actually knowing in my heart that returning to work was not the best thing for our family, but that it was unfortunately a financial necessity.

I honestly never contemplated just how difficult it is to manage a condition like eczema on top of my own post-natally triggered condition AND return to work with the stress that this brings too, however I believe that having to ‘do it all’ has strengthened who we are as people and what we now know we can cope with. When I look back over the past three years, I’m now grateful for it all. I’ve learnt a lot about juggling of work, baby, household and about the importance of focusing only on doing what is important and necessary – everything else can wait and does get there eventually – it just takes longer than it used to.

Marcie Mom: Thanks Kelly for sharing your journey on returning to work, we all go through it at different degree and different stages in our life, HUGS!

Categories
Eczema Facts

Eczema Medication Series – Methotrexate

Sharing your experience can Help

This is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Methotrexate?
Methotrexate is an antimetabolite which slows down the metabolism of new cells (for instance prescribed to reduce growth of cancer cells). It works via inhibiting dihydrofolate reductase (DHFRase), an enzyme involved in the synthesis of DNA, RNA. It may be prescribed for advanced stages of cancer, severe active rheumatoid arthritis and certain types of cancers. It is also used to treat skin conditions – severe psoriasis, whereby methotrexate decreases the formation of skin cells to prevent the formation of scales. It may also be prescribed for those with severe eczema whose treatment using cyclosporine or corticosteroids are discontinued, as methotrexate has anti-inflammatory properties. Methotrexate also lowers the activity of the immune system.

It can be taken orally or by injection, and patient needs to follow the prescription carefully, especially the dosage or frequency (may be weekly for treatment of skin condition). The dosage prescribed will be determined by the doctor, usually for skin-related, it will be a low dosage, and dosage may vary during the course. It is important to follow-through with the prescription, and not terminate it once you self-assessed your condition has improved.

Monitoring
Certain tests may be requested by your doctor, to assess the side effects of methotrexate, such as blood and liver tests.

Warning
Check with your doctor how much fluid you need to be taking during the course as drinking more water can help to reduce toxicity in kidneys. If you are on non-steroidal anti-inflammatory medication such as aspirin, ibuprofen, choline magnesium or magnesium salicylate, do check with the doctor the safety of these medications as they can increase the level of methotrexate in the blood. Also check on medication such as acitretin, azathioprine, isotretinoin, sulfasalazine or tretinoin that may increase concentration of methotrexate in the blood or increase toxicity for certain body organs – liver, kidney and bone marrow (better to tell the doctor of drugs, medicines, supplements and vitamins you are taking). There is associated risk with liver damage, so do check on alcohol consumption.

There may also be sensitivity to light, so take sun protection measures and avoid sunlight. Do not drive as a possible side effect is dizziness. Avoid contact with people who are ill, and also those who have taken a recent nasal flu vaccine or who has chickenpox (also check with the doctor before getting vaccinated) as methotrexate has mild immune suppressive effect. Also check on what sports you can engage in, to prevent cuts or injury. Wash your hands also to prevent infection.

Side Effects
Watch for side effects, and let your doctor know; some of the side effects are:
Chills, fever, rash, peeling skin, headache, mouth sores, vomiting, diarrhea, nausea, loss of appetite, hair loss, swollen gums, red eyes, sore throat, bleeding, bruising, paleness, difficulty breathing, excessive fatigue, yellowing of skin or eyes, seizures, fainting, difficulty with body movements, vision changes and painful urination.
Symptoms such as diarrhea, black, tarry or bloody stools or bloody vomits may be related to damage to the lining of intestine due to Methotrexate. Do call your doctor immediately. Also, if you had stomach ulcers or previous medical conditions related to intestines, do inform your doctor.
Refer here for which side effects are more common, and which are less.

Diet
Folic acid may be prescribed as a supplement during the course, but this depends on your doctor as studies are not definitive in this area. Folic acid may in some ways reduce the effectiveness of methotrexate, thus may be prescribed on days when patient need not take methotrexate.

Most Importantly, Does it Work?
I’ve found a few studies online, and the various conclusions are:
1. In this study of 60 patients, methotrexate found to improve mild to moderate eczema
2. In a study of 42 patients, both methotrexate and azathioprine showed clinical improvement in eczema for adult patients in the short term.
3. In a study of 25 patients with paediatric discoid eczema, about 19 children showed improvement after 10.5 months.
4. In this study of 20 patients, methotrexate found to be effective, but there were also patients who dropped out from the study due to side effects.

A point to note is above studies were small sample sizes (and I’ve found a few others of even smaller sizes), possibly due to methotrexate prescribed only for severe instances, which had not responded to corticosteroids or cyclosporine. Do share your experience in the comments!

Categories
101 things that Mothers with Eczema Child do Differently

92 of the 101 things that Moms with Eczema Child do Differently – Kid has Grown but Still the Same

From fetus to bed, still scratching!
From fetus to bed, still scratching!

This is the 92nd of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.

Categories
Living with Eczema

SOMEONE manages Child’s Clothing – Eczema Trigger

Tiffany shares on clothing choice and care for her child
Tiffany shares on clothing choice and care for her child

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Tiffany to share how she manages her daughter’s eczema whenever she tries on new clothing. Tiffany is a mom of two and very active in social media, see her interesting Pinterest board here.

Marcie Mom: Hi TIffany, thanks for taking part in my new blog series ‘Someone has Eczema’! And I’m so excited about your aspect of life – trying new clothes, dressing our girls up! How did you discover that trying out new clothing is a trigger for your daughter? Is that the main trigger for her eczema?
Tiffany: When we try on new clothes, she breaks out into a rash on her face almost all the time! I think there is something in new fabrics that triggers the eczema. However, if I wash it first and then put it on her, there is no reaction.

Marcie Mom: Is your daughter’s eczema triggered by clothes that have yet to be washed (new clothes in store) or by certain materials used in the fabric?
Tiffany: I’ve been getting a mix but mostly 100% cotton clothing. I think it’s unwashed clothing that triggers it.

Marcie Mom: What care do you take to wash the new clothes? And did you get certain type of detergent or washing machine? Or have to sun it or not put it through the dryer?
Tiffany: I wash it with “unscented” detergent. I put it thru the washing machine and dryer. I have changed our family’s detergent all to the “unscented”

Marcie Mom: One final question – have you ever been tempted to just buy without letting your daughter try the clothes or request for hand-me-down to get around this trigger?
Tiffany: Yes, I have to buy without having her try it on but I would buy one in say a size 3T and then see if she fits after I’ve washed it. Then if she does, I can continue to buy without her trying on but I have to stick with the same brand.

Marcie Mom: Thanks Tiffany for your sharing! It’s very encouraging to see how everyone of us overcome eczema in our daily life, and nothing should stop us from our shopping lol!

Categories
News & Research

Oral evening primrose oil and borage oil Ineffective for Eczema


This is a quick update on the study just published on evening primrose oil and borage oil. A quick summary of the study:

Study Objective: To assess the effects of oral evening primrose oil or borage oil for treating the symptoms of atopic eczema.

Scale: This is a review article, meaning it reviewed studies done by others according to certain criteria and methodologies. There are 27 studies, 1596 participants (up to August 2012) and 19 studies covered evening primrose oil and 8 covered borage oil.

Results: For oral evening primrose oil and borage oil, there was no significant improvement over placebos used in trial. There were also “fairly common, mild, transient adverse effects, which are mainly gastrointestinal”.
It was mentioned that there was a warning in a case report that if evening primrose oil was to be taken for a prolonged period of time (more than one year), there is a “potential risk of inflammation, thrombosis, and immunosuppression”. No long-term effects included in the studies.

Do refer to my Eczema and Diet post if interested to find out effect on certain supplements on eczema.

Categories
Eczema Facts

Eczema Medication Series – Cyclosporine

Cyclosporine EczemaThis is a series on some of the medication that I’ve collated from parents who shared in forums. My baby with eczema hadn’t been prescribed these, but my usual investigative self got interested after reading mixed feedback on these medicines. Do share in the comments your child’s experience, and the effect on his/her eczema.

What is Cyclosporine?

Cyclosporine is an immunosuppressant, and slows down the immune system (thus frequently prescribe to prevent organ rejection after a transplant). It is registered in certain countries to treat skin conditions – psoriasis and atopic dermatitis (eczema). It may be prescribed for those with severe eczema that has not responded to other treatments for prolonged period. Cyclosporine works by reducing inflammation on the skin, through its effect on immune cells (lymphocytes). It is taken orally, and patient needs to follow the prescription carefully and take the medication at same time. The dosage prescribed will be determined by the doctor, usually for skin-related, it will be a low dosage, and dosage may vary during the course. It is important to follow-through with the prescription, and not terminate it once you self-assessed your condition has improved.

Monitoring

Certain tests may be requested by your doctor, to assess the side effects of cyclosporine, such as blood pressure test, blood and urine tests (to monitor creatinine levels) and tests to monitor potassium, blood count, fasting lipid, uric acid and liver function.

Warning

Care ought to be taken to ensure that the prescription of Cyclosporine is the right one, as it can be in different form – original vs modified. Different form of cyclosporine is to be mixed with different liquids, so do check with your doctor too. Also check with your doctor on what other medication to avoid, especially those that affect the immune system, such as azathioprine, methotrexate and tacrolimus. There is associated risk with high blood pressure, kidney damage, lymph and skin cancer, so do check with the doctor if your child should take additional sun protection measures, and for adults, avoid phototherapy during the medication. Do not drive as side effect of cyclosporine is dizziness. Avoid contact with people who are ill, and also those who have taken a recent nasal flu vaccine (also check with the doctor before you/ your child get vaccinated).

Side Effects

Watch for side effects, and let your doctor know; some of the side effects are:

Headache, vomiting, diarrhea, nausea, increased hair growth on face or body,  swollen gums, acne, trembling, flushing, cramps, joint pains, pin and needle sensation, flu, sore throat, facial pain and increased blood pressure .

The serious side effects to call your doctor immediately are bleeding, bruising, paleness, yellowing of skin or eyes, seizures, fainting, difficulty with body movements, swelling and vision changes, painful urination.

Refer here which side effects are more common, and which are less.

Diet

Grapefruit and juice is to be avoided as it can increase the amount of cyclosporine in your blood stream. Foods such as bananas, prunes that are high in potassium are to be limited as cyclosporine can also increase the amount of potassium in the bloodstream. Check also if you need to take magnesium supplement, as cyclosporine may reduce the level of magnesium in the blood.

Most Importantly, Does it Work?

I’ve found a few studies online, and the various conclusions are:

  1. Studied to offer relief for those with severe eczema, but the effect is not long-lasting, similar conclusion in this study.
  2. Review article of 15 studies found cyclosporine to be effective for 6-8 weeks.
  3. One study that tracked up to 1 year continued to show eczema in remission, but this study was without control group.
  4. In a study involving 40 children, cyclosporine found to be effective and well-tolerated. In this study involving 35 children, cyclosporine found to be more effective for those whose eczema are triggered by skin infection (than those triggered by others)

A point to note is above studies were small sample sizes, possibly due to cyclosporine prescribed only for severe instances. Do share your experience in the comments!

Categories
Support Group

Eczema Support Group for Children – 6th Sharing on Wet Wraps

Tubifast Wet Wrap EczemaBlues

On 27 April (last Saturday), the Eczema Support Group for Parents with Eczema Children held its 6th sharing session and it’s safe to say everyone had a good discussion!

It was a wet wrap demonstration by Tubifast, with a product manager from Mölnlycke Health Care Limited. The key sharing were:

1. Different color-coded are of different sizes, the most common ones are green and blue sold in Guardian pharmacies, the larger ones in Singapore at Paragon, Novena, Woodlands, Jurong, Parkway Parade, Yishun and Bkt Batok. Mt E, KKH (not OTC, ask to be redirected to another dept but need not be consulted there), polyclinic pharmacies also carry, and the full range is available in NSC. (I’m writing this because I receive requests from moms all the time on where to buy, and many go to their nearest Guardian and can’t find them)

2. Wet wrap will require 2 layer, inner moist, outer dry. if you’re buying garments, that would mean buying 2 boxes, or some prefer to use a dry pajama for the outer layer. You can also choose to dry wrap, moisturize and wear the garment as it’s harder to scratch with the fitting garments/wrap. Some kids prefer cool water, while some prefer lukewarm for inner layer, as long as it’s not hot (strips moisture!)

3. Wet wrap can be hand washed, air dry (not in direct sun) and reused as long as it’s still elastic. You can refer to this post for more tips on wear and tear.

4. Size – Always cut a longer strip than the area to be wet wrapped, and there will be some fraying, fold the frayed ends in; and don’t keep trying to cut the frays away. For the face, as it’s irregular shaped, cut even longer than the length of the face. The maximum size for garments is 14 year old.Materials for garments and bandage are slightly different – for garment, it is elastane, nylon and viscose and for wrap, viscose, elastane and polyamide. Gloves are available, even for infants – they make look too small, but they are stretchable.

5. Tie it up – Try tying knots to secure one part of the wrap to the next, perineal dressing, picture above. Basically cut a hole in one part of wrap, say body, and cut another on the hips, cut a thin strip and loop that strip through these two holes.

MarcieMom’s Sleeping Tips

I’ve shared the importance of sleep to a child’s healthy weight gain and behaviour/learning. Also, shared tips to better sleep, such as bathing closer to bedtime, moisturizing, keeping room cool and not too dry and following through with a sleep routine.

The next session will be a first, where a doctor will sit in and help answer questions on a topic – it will be on a friday lunch, and I’d be releasing details soon so everyone can block out lunch on that day! (food provided)

Thank you to the nurse, and medical social worker for sitting through this with me, and being such good encouragers! And of course, I appreciate everyone’s participation, we had many light moments despite the stress of being parents to eczema kids!

Categories
101 things that Mothers with Eczema Child do Differently

91 of the 101 things that Moms with Eczema Child do Differently – Coupleless Conversation

So much for baby finally falling asleep!
So much for baby finally falling asleep!

This is the 91st of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.