TCM Physician Lau Kiew Teck with Raffles Medical Group
Many parents have asked me “What about TCM?” while others have suggested that I explore TCM as an eczema treatment option for my child. I’ve looked into TCM briefly in this archive post, but felt I didn’t know enough to evaluate it. For this TCM Series, I’ve the privilege of interviewing TCM Physician Lau Kiew Teck of Raffles Medical Group, Raffles Chinese Medicine Clinic, whose special interests include respiratory conditions, dermatology, pediatrics, diabetes and digestive system disorders.
More on Physician Lau: Physician Liu Qiao De graduated from Singapore College of Traditional Chinese Medicine in 1977 and has been practising TCM since. In the early 90’s, Physician Liu pioneered a Quit Smoking programme using auricular acupuncture. Physician Liu’s special interests include treating skin problems such as eczema and psoriasis. In pediatrics, he specializes in treating asthmatic conditions.
Eczema – A Multi-Factorial Condition
Eczema is a condition which is contributed by multiple factors like genetics, over-active immune system, damaged skin barrier, allergy, environment and persistence of staph bacteria residing on eczema skin. It is also a chronic condition, meaning treatment options are meant to manage the eczema instead of curing it.
From what I’ve read on the web, eczema is due to weaknesses or imbalances in body organs, in particular, the spleen, the lungs and the stomach, which leads to skin with eczema rash. Thus, various TCM options, such as herbal medicine and acupuncture, are ways to detoxify and strengthen these organs, specifically to (1) clear heat, (2) remove dampness and (3) remove wind.
Marcie Mom: Physician Lau, is this also TCM’s stand on eczema – that it is multi-factorial and chronic? Kindly help us understand the factors (from TCM’s perspective) that contribute to eczema and whether TCM is a treatment option to manage or to cure eczema. Can the factors/ causes of eczema be reconciled between TCM and western medicine?
Physician Lau: Eczema is both multi-factorial and chronic condition that is contributed by genes, immune system, damaged skin, allergy and environment. TCM focuses on the holistic approach where a combination of treatment of acupuncture and herbs are used. Patients can choose to use either TCM or western medicine or both to treat eczema; we don’t enforce any specific arrangement.
Foods to Avoid for an Eczema Patient
I read from the web that food and beverage such as alcohol, coffee, sugar, spicy food and deep-fried food are to be avoided. Also for fruits deemed “heaty” such as durian, mango, longan and lychee. Foods that are “cooling” such as green beans are encouraged.
MarcieMom: Physician Lau, can you help to explain “heaty” versus “cooling” food? Most of us in Asia are familiar with the use of “heaty” and “cooling” but it’s seldom heard of by our readers in US, UK and Canada.
Physician Lau: Food only becomes heaty or cooling when your body reacts to the food. In general, the food in its nature is heaty or cooling based on its properties.
MarcieMom: Above foods such as alcohol and spicy food are top triggers of eczema, while sugar and deep-fried food are inflammatory (further explained in this post). Green bean is an anti-inflammation food, featured in this post. Anti-inflammatory foods include those that contain anti-oxidants, Vitamin C, carotenoids, flavonoids, quercetin and kaemferol that can reduce oxidation, fight free radicals and inflammation. Can I then understand the “heaty” food that TCM recommends to avoid as being inflammatory and those to have more as having anti-inflammatory compounds?
Physician Lau: Fried and spicy food and alcohol in general.
MarcieMom: Thanks Physician Lau for replying to these questions – TCM still seem to be a complicated topic to understand and hope to learn more in next week‘s interview.
This is a 4-week series focused on bacteria found on our skin, in particular Staphylococcus aureus, a bacterium that can lead to infection and complications in eczema patients. I’m honored to have Dr. Clay Cockerell, former clinical professor of dermatologyand pathology and the former director of the Division of Dermatopatholgy at University of Texas Southwestern Medical Center in Dallas, Texas, to help in this series.
Last week, Dr. Clay Cockerell gave us some basics about the type of bacteria found on our skin. This week, we will discuss Staphylococcus aureus (“Staph”) and other harmful bacteria.
Staphylococcus aureus worsens Eczema Skin
Staph aureus is not normally found on our skin, but in some people such as those who are colonized, it may be. When it is, it tends to involve areas that are warm and moist especially such as skin near mucous membranes such as the nose, mouth, genitals and anal area. It is found in about 25-30% of healthy adults who are known as carriers and generally does not cause an infection in those with otherwise healthy skin. It is a very resistant bacterium and it can survive in dry conditions such as on dry skin and with little oxygen.
Marcie Mom: Dr. Clay, I understand that Staph is a main factor causing skin inflammation in eczema skin.
Can you detail for us where Staph bacteria reside, how it penetrates and attacks the (i) skin and (ii) body of our child with eczema?
Dr. Clay: As noted in the first post of this series, Staph likes warm, moist, dark areas like the nose and groin, which are known as “reservoir” sites where it resides. In patients with eczema, it can affect any area of the skin that is compromised or affected with the dermatitis. Because the skin is compromised, it does not have a normal barrier, and the immune response is abnormal. The Staph grows in the skin and releases toxins that cause inflammation, which further worsens the eczema.
Staph bacteria likes warm, moist, dark areas like the nose and groin
It can begin growing in the skin and establish infection in the form of boils, cellulitis and folliculitis (“pus bumps”) in these individuals, as well. Rarely, it can actually enter the lymph and blood vessels and spread throughout the body, but it tends to remain localized at the site of entry.
Streptococcus Pyogenes Bacteria & Skin Infections
Marcie Mom: Another harmful one is the streptococcus pyogenes bacteria (“strep”), found in our throat and skin and in about 20% of healthy adults. Staph or strep bacteria can lead to skin infections such as folliculitis, furunculosis, impetigo, cellulitis, MRSA and Staphylococcal scalded skin syndrome (read more here). A skin culture can be performed which will diagnose which bacteria is present on the skin.
Marcie Mom: There are various symptoms of bacterial skin infection listed below, can you share with us the severity of the infection, e.g. when a parent ought to (i) seek a general practitioner’s consultation or (ii) rush to emergency?
Dr Clay’s Skin Infection Symptoms
Symptoms – itchy red rashes. This is the most common manifestation of eczema and may or may not be infected with bacteria. This can be treated at home using the prescribed treatment regimen.
Symptoms – skin turns painful, warm to touch/tenderness, swelling. This is a sign of a skin infection and needs to be seen by a doctor soon. If there is fever, this is something that a doctor should be notified about and an oral antibiotic should be started. It probably does not require a visit to an emergency room, but it should be called to the attention of a doctor who would evaluate the severity and might recommend that the patient be seen. These infections can arise at any time during the course of the disease.
Symptoms – infected area is filled with pus/blister/boil. As above, this is a sign of an infection and should be treated with an antibiotic. These are usually localized, but may require drainage. A caregiver should be notified who will prescribe a regimen such as applying warm compresses, topical antibiotics and possibly oral antibiotics. Generally, the patient should be seen soon and a culture performed. This is not usually an emergency, but if there is fever or redness that is spreading like above, it might require more urgent attention than a follow-up in a clinic.
Symptoms – lymph node on neck or armpit becomes protruding/ sore. This is also another sign of infection and would generally be treated like cellulitis. This is not usually an emergency, but would require antibiotics and culture.
Symptoms – fever/ chills, low blood pressure. This is a sign of a serious systemic infection, and the patient should be taken to an emergency room by an ambulance. This could be a manifestation of Toxic Shock Syndrome, which can be caused by some forms of Staph, or could possibly be necrotizing fasciitis, which might need emergency surgery.
MarcieMom: Thank you Dr Cockerell for helping us understand which symptoms we ought to be aware of. Next week, we will explore the treatment options and learn more about MRSA.
Too much TV is bad, but honestly, with air-con and a TV babysitter…?
This is the 67th 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.
The Invisible Factor affecting your Child’s Eczema Rash – Skin Bacteria
This is a 4-week series focused on bacteria found on our skin, in particular Staphylococcus aureus, a bacterium that can lead to infection and complications in eczema patients.I’m honored to have Dr. Clay Cockerell, former clinical professor of dermatology and patholgy and the former director of the Division of Dermatopatholgy at University of Texas Southwestern Medical Center in Dallas, Texas, to help in this series.
More on Dr. Cockerell – Dr. Clay Cockerell was the president of the American Academy of Dermatology in 2005. He is a renowned medical educator having overseen an educational program designed to train the next generation of dermatologists and dermatopathologists and the author of numerous papers and textbooks. He is a board-certified dermatologist and dermatopathologist licensed in many states throughout the U.S.His clinical expertise is in skin disorders and his passion has led him to co-found TopMD Skin Care, the company behind CLn® BodyWash.
Your Child has both Good and Bad Bacteria on Eczema Skin
Our skin is home to about 1 trillion microscopic organisms such as bacteria and fungi, and not all are bad – some are beneficial to us and some are harmless, but some are harmful like the Staphylococcus aureus bacterium (“Staph”) and Streptococcus pyogenes (“Strep”) that can cause skin infections. You can read more about the Human Microbiome Project of National Institutes of Health in this interview with Elizabeth Grice.
Marcie Mom: Dr. Clay, I read from this table that the bacteria commonly found on our skin are (1) Staphylococcus epidermidis, (2) Staphylococcus aureus, (3) Streptococcus pyogenes (4) Corynebacteria and (5) Mycobacteria.
Which bacteria are good for us (for instance, prevent colonization of harmful bacteria) and which bacteria are harmful?
Dr. Clay: Staphylococcus epidermidis is part of the normal bacterial flora that lives on our skin and is a beneficial bacterium. In fact, they serve in many ways to “police” the skin and prevent dangerous ones such as S. aureus and S. pyogenes from growing and “setting up shop”. These latter two may cause boils, folliculitis, cellulitis and erysipelas, all examples of skin infections.
Corynebacteria exist in several different species. C. acnes lives in hair follicles normally, but plays a role in the development of acne in acne-prone individuals. Other forms of Corynebacteria can also cause more serious infections such as C. minutissimum, which causes pitted keratolysis and juvenile plantar dermatosis, and C. diphtheria, which can cause cutaneous diphtheria, a rare form of cellulitis. There are also many different species of Mycobacteria, some of which are harmless and live in certain areas of the body such as the groin (M. smegmatis).
Others are harmful and can cause cutaneous tuberculosis and atypical mycobacterial infections such as Swimming Pool granuloma (M. marinum) and infections acquired from getting pedicures when exposed to infected water in nail salons (M. fortuitum).
Do We Need More Good Bacteria?
Most bacteria tend to reside in moist areas of skin, along skin folds. I read that diet, health, age and environment also affect the amount of bacteria on our skin. Let’s tackle the good bacteria on our skin first – is there anything that one can do (and should one try) to increase the amount of good bacteria on our skin?
Conversely, will frequent hand washing and use of sanitizers and anti-septic sprays remove good bacteria that our body needs?For a child whose immunity has yet to be fully developed, should he or she be washing hands more frequently or less than an adult?
Dr. Clay: The best way to increase the “good” bacteria is to have good hygiene, which prevents exposure to the “bad” bacteria (i.e., wash with a good soap and water and use hand sanitizers periodically). The good bacteria will naturally grow on your skin and live in harmony with our bodies naturally, as our body has certain factors, such as local immunity and chemicals on the skin surface, that create just the right environment.
Bacteria Population and Hand Washing
Bacteria multiply exponentially, so when its population is temporarily decreased, as after the use of hand cleanser, it re-grows quite quickly and returns to its normal concentration. The only way to truly “sterilize” so that the normal bacteria would not return would be to wash many, many times a day and even then, it is virtually impossible to get the skin totally sterile. In fact, individuals who do over-wash often cause significant skin irritation, which paradoxically can cause the “bad” bacteria to enter and colonize the skin and even cause an infection.
Staph Bacteria Colonizes Eczema Skin
There are individuals who have certain skin diseases that predispose them to become colonized with “bad” bacteria like Staph, especially those with atopic dermatitis, also known as eczema. These patients need to use more aggressive measures to get rid of these bacteria, as they can worsen the skin condition and lead to more serious infections. These patients often require systemic antibiotics or topical antibacterial agents including bleach, as administered in bleach baths, or bleach-containing body washes like the one I have been involved in developing, CLn® BodyWash, which can be used in a shower also.
Children don’t really need to wash their skin more than adults, as their immunity to bacteria develops very soon after birth. In fact, children’s skin can be more sensitive than adult skin, so care should be taken not to over wash with harsh soaps and detergents. Skin in elderly individuals also is less able to tolerate dryness, so the same caution should be taken by them, too.
Children and Elderly’s Skin should not be over-washed with harsh soaps
People who are Staph carriers (i.e. abnormally harbor Staph on their skin) are prone to developing boils and other infections and can spread the Staph to family members. They, too, should take measures to try to decrease the spread of Staph by using topical antibiotics and antiseptic washes.
MarcieMom: Thank you Dr Cockerell for the detailed explanation of the various bacteria on our skin. Next week, we will discuss specifically on staph bacteria.
This is the 66th 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
This is the 65th 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.
This was an original series combined to a post that focused on facial eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain the type of facial rashes, its treatment options and daily facial care. Dr Lynn is a consultant dermatologist who subspecializes in pediatric skin conditions, adult pigmentary conditions and laser dermatology.
Types of Facial Rashes
What are these Rashes on my face?
A rash on your face is possibly something you’d notice soon enough and start worrying about whether others would notice too. It can affect across all age groups, from infants to children to teenagers to adults, but are they all the same? And which age group or profile is more likely to suffer from one type of facial rash versus another type?
Below is a list of possible rashes on your face and with the help of Dr Lynn, a brief explanation of each and who is more likely to suffer from it.
Atopic Dermatitis
What it is: Inflammation of the skin, that is often associated with itchiness, redness, dryness and infection. It tends to occur together with rash elsewhere on the body.
What it looks like: Atopic dermatitis on the face typically presents as red patches on both cheeks associated with scaling. It can also affect the forehead and behind the ears. Darkening and skin folds can appear on the skin below the eyes as a result of constant rubbing. Infected eczema on the face can present as an oozing patch with crusting and scabbing.
Who gets these rashes: Infants with eczema commonly present with rash on their cheeks. Facial eczema occurs less commonly in older children and adults.
Facial eczema on baby’s cheeks (copyright picture)
Seborrhoeic Dermatitis
What it is: Seborrhoeic Dermatitis is a harmless scaling rash that can affect the face and scalp. It tends to occur in oily areas where there is a high concentration of sebaceous glands. It is believed to be an inflammatory reaction to a yeast called malassezia.
What it looks like: Seborrhoeic dermatitis presents as a slightly pinkish rash with white/yellow scales. It can affect the eyebrows, sides of the nose, inside and behind the ears, forehead and scalp. It can be aggravated by stress, illness and fatigue.
Who gets these rashes: Infants with seborrhoeic dermatitis presents with yellowish scales mainly on the scalp (also known as cradle cap). Adults can also get seborrhoeic dermatitis and commonly present with pinkish scaly rash on the face and white flakes on their scalp.
Infant with seborrhoeic dermatitis on scalp (picture credit from Dermnet NZ)
Adult with seborrhoeic dermatitis (picture credit: Dermnet NZ)
Irritant Contact Dermatitis in Babies
What it is: Irritant contact dermatitis occurs when external chemical or physical agents damage the skin. Common culprits include detergents, solvents, acids, water and friction. The severity of the rash depends on the amount and strength of the irritant, the length of exposure and the individual’s skin susceptibility. People with atopic eczema are more susceptible to irritant contact dermatitis.
What it looks like: Irritant contact dermatitis causes a well demarcated rash which is red and itchy and there can even be swelling and blisters. It can occur anyway in the body where the agent is in contact with the skin. In infants, the rash can occur around the mouth as a result of frequent contact with saliva.
Who gets these rashes: Anybody who gets in contact with an irritating agent can develop rashes. Patients who suffer from atopic eczema are more susceptible to irritant contact dermatitis as their skin’s protective barrier is damaged. People working in certain occupations like dishwashers, metal welders, hairdressers and cleaners are more prone to irritant contact dermatitis as they are often in contact with strong chemical agents. Infants who are teething can also be affected as their saliva is irritating to the skin.
Allergic Contact Dermatitis
What it is: Allergic contact dermatitis occurs because of an immune reaction to a substance which had been in contact with the skin and to which that particular individual is allergic to. Unlike irritant contact dermatitis, a small amount of the substance can lead to development of a rash. Allergic contact dermatitis does not occur in everyone in contact with the particular substance, it only affects people who are allergic to it i.e. those who develop an immune reaction to the substance. Irritant contact dermatitis, on the other hand, may affect anyone provided they have had enough contact with the irritant.
What it looks like: The rash caused by allergic contact dermatitis normally develops a few hours after being in contact with the substance. It is normally confined to the site where the skin had been in contact with the allergen though in severe cases, the rash can extend outside of this area and can even be generalized. The rash is red, itchy, swollen and blistered.
Allergic contact dermatitis on the face is often due to allergens found in skin care products or cosmetics. Other common sites are the ears and the neck secondary to nickel containing costume jewellery.
Who gets these rashes: Anyone can get allergic contact dermatitis as long as they are in contact with substances to which their body mounts an immune reaction to.
Rosacea
What it is: Rosacea is a skin condition that causes redness and acne-like zits on the central face. It can be transient, recurrent or permanent.
What it looks like: A patient with rosacea flushes or blushes easily especially in hot environment, when excited or after ingestion of alcohol. There is obvious redness of the face with prominent blood vessels. There can also be pimples on the face.
Who gets these rashes: Fair-skin females between the ages of 30-60 are more likely to suffer from rosacea.
Rosacea (picture credit Dermnet NZ)
Psoriasis
What it is: Psoriasis is a chronic non-contagious skin condition caused by rapid growth of the outer skin layer. It is one of the more common skin conditions seen in Singapore and genetics is believed to play a part.
What it looks like: Psoriasis usually presents with thick silvery flakes of scales on raised pinkish red skin with well-defined margins. Psoriasis can occur anywhere on the body including the face. On the head, it commonly affects the hairline, scalp, and behind the ears.
Who gets these rashes: People of any age can get psoriasis from infants to the elderly. It commonly starts in the 20-30 age group and the 50-60 age group.
Psoriasis (picture credit Dermnet NZ)
Facial Eczema Treatment
Treatment options for the face may differ slightly from the rest of the body due to the thinner skin and higher concentration of superficial blood vessels found in the face. Before Dr Lynn helps with the treatment specific for facial eczema, let’s run through good skin care routine that’s applicable for the whole body.
1. Moisturizing – Dry skin needs moisturizing and as there is a high concentration of sebaceous glands on the face, it will be good to choose a product that is non-comedogenic. A non-comedogenic product does not lead to the formation of whiteheads or blackheads. As always, choose one that does not contain an ingredient that you are allergic to and always choose one that has been clinically tested. Read this post for the top allergens and here for a better understanding of product label. For the face, you may also want to use a sunscreen that protects your face and not irritate it, read here for sunscreen selection.
2. Cleaning – As with the body, you will have to clean the face. Choose a facial cleanser that works for you, without abrasive materials. There’s no need to exfoliate your face more than how it is naturally exfoliating on its own. Moisturize after cleaning. Pat dry your face, do not rub and always avoid hot water.
3. Cold Presses – If you have an itchy rash on your face, you can apply a cooling pack on the area to reduce the itch. Dr Lynn advises not to use a hot pack as this may make the rash and itch worse. A cooling pack can be placed to temporarily reduce the itchiness on the face.
4. Avoiding Irritants and Allergens – Avoid harsh soap, common allergens which you are sensitive to.
Question: I have more than one type of eczema on my face! How do I treat both atopic dermatitis and seborrhoeic dermatitis? What if I have both irritant contact and atopic dermatitis?
Dr Lynn: It is not uncommon to see patients with eczema also having seborrhoeic dermatitis. These two conditions can be treated with similar creams. A thin layer of low-to mid potency steroid cream can be applied to the rash for a limited amount of time. Alternatively, a steroid-sparing cream like calcineurin-inhibitors (Tacrolimus or Pimicrolimus) can also be used. It is important to use moisturizer regularly together with the steroid cream/ Tacrolimus as it will help improve the barrier function of the skin. In order not to over-dry the skin, use a gentle soap and avoid facial scrubs.
Atopic dermatitis makes an individual more susceptible to irritant contact dermatitis. This is because people with atopic dermatitis have a suboptimal skin barrier which makes them more sensitive to chemical and physical agents. It is important to identify which substances/products are responsible for the irritant contact dermatitis. It is advisable to see your dermatologist. Avoidance of the irritant product and application of a suitable steroid cream and moisturizer are needed to treat both the irritant contact dermatitis and atopic dermatitis. Sometimes, if the dermatitis is severe, a course of oral steroids may be required.
Question: I’m told to use only mild steroids but the eczema on my face isn’t getting better! Are there other treatment options?
Dr Lynn: In general, only low to mid potency steroids should be used on the face for a limited amount of time (1-2 weeks). There are certain mid-potency steroids with minimum side effects that can be used on the face. I will advise starting with a mid-potency steroid cream if the eczema is persistent then tailing down to a low potency steroid once the rash is better. Another alternative is to use topical Calcineurin- Inhibitors like Tacrolimus and Pimicrolimus. This is a group of creams that have similar effect as steroids but without the steroidal side effects. They can be used for a longer period of time compared to steroid creams. It is important to see your dermatologist to decide on which cream is suitable for you. The regular use of a good moisturizer and gentle soap is also important.
Rashes on Eyelids
A particularly tricky part of the face are the eyelids because the eyelid skin is very thin and steroids can be absorbed more readily, leading to problems such as cataract and glaucoma. Dr Lynn’s advice on treatment options include:
1. Do consult a doctor if you have rashes around the eyelid. It is important to determine what is causing the rash. Common causes include eczema and contact dermatitis secondary to eye make-up.
Topical Steroid on Face – Precautions
In general, mild to mid potency steroids can be applied to the face. It should be applied twice a day and for not longer than 1-2 weeks. A mid potency steroid can be used initially then tailing down to a low potency steroid once the rash is better. Alternatively, a steroid-spring cream such as Tacrolimus or Pimicrolimus can used . In a minority of patients,Tacrolimus can cause a stinging sensation. At night, apply the cream just before you go to sleep. To prevent the steroid from dripping into the eyes, you can use a cream or ointment based steroid rather than a lotion based one which is more ‘watery’. Allow 20-30 minutes after application of the cream to the eyelids before doing activities that may cause sweating.
2. Clean the eyelid area, with lukewarm water, including cleaning the ‘mascara’ area of the eyelid. Avoid using water that is too hot. Use a gentle soap and do not rub this area excessively. Avoid using products with ingredients you’re allergic to. A patch test can be taken at the dermatologist, and ingredients that you’re tested sensitive to should be avoided for your face and eyelids as well.
3. Moisturize the eyelid, taking care again to use products that you are not allergic or sensitive to. If you feel that the moisturizing lotion you are using is too “watery“ and runs into your eyes, you can change the moisturizer to a cream or ointment form which is thicker.
4. For those who are using makeup, it is important to wash your brushes and change them regularly. Do not use make-up past their expiry dates as bacteria will accumulate in make-up which can irritate and infect your skin. Avoid mascara and choose products from large cosmetics and skincare companies that clinically test their products. Also avoid products that are shimmery or glitters as these contain metal particles, mica, which can irritate the skin.
A final note is to avoid rubbing the eyes, as this can lead to neurodermatitis, a thickening (lichenification) of the eyelids due to prolonged scratching. The appearance of the eyelids will be darker and in some instance, lead to skin folds on the eyelid.
Eczema Rash on Mouth and Lips
Apart from being prominent and noticeable as one will look inevitably look at someone’s mouth when he/she is talking, the lips is also an area that comes into contact with the food we eat, lip balm, lip stick and to some extent, toothpaste!
What sort of rash is common around the mouth? And is the same common on the lips? What is allergic contact cheilitis?
Dr Lynn: Some of the common rashes which can occur around the mouth include
Facial eczema. This happens in individuals with eczema and facial eczema is more common in infants.
Perioral dermatitis consists of groups of itchy or tender small red papules (bumps) which appear most often around the mouth. They spare the skin bordering the lips but develop on the sides of the chin, then spreading to include upper lip and cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky. Perioral dermatitis can be caused by the overuse of steroid creams, moisturizers, make-up and sunscreen. It is important to see your doctor as a course of oral antibiotics is needed.
Cheilitis is inflammation of the lips. It can cause deeps cracks at the sides of the lips which can be painful. There are many causes of cheilitis and they include: eczematous cheilitis, contact cheilitis (reaction to substances like make-up etc), medications and nutritional deficiencies. Allergic contact cheilitis is allergic contact dermatitis affecting the lips. It is an immune reaction of the body towards a substance to which the individual is allergic. Lip cosmetics, toothpaste, medication and dental materials are the most common cause of allergic contact cheilitis.
Identifying the Allergen/ Irritant: What can one try to isolate the product or food that is causing the rashes? For instance, should one note if a rash occurs after shaving, brushing teeth or ingesting certain food? What is the appropriate allergy testing?
Dr Lynn: The appropriate test is the patch test. A patch test is a method used to determine if a substance is responsible for causing an allergic inflammation of the skin. Diluted amounts of the substances are placed in contact with the skin on the back. If the individual is truly allergic to the substance, a local reaction will occur on the skin. Testing should include the standard series of test allergens as well as any other materials suggested by the history (like lip cosmetics, toothpaste). If you notice that a particular facial or dental product or food causes a rash around the lips consistently, do inform your doctor and include it into the patch test.
Food versus Contact Allergens: Is there a difference in the time lag between an allergic reaction triggered by contact, say with a musical instrument, or a cosmetic/skincare product versus food?
Dr Lynn: Allergic contact dermatitis triggered by contact with a musical instrument or cosmetic/skincare product is an itchy skin condition caused by an allergic reaction to a substance in the product. It arises some hours after contact with the responsible material, and settles down over some days provided the skin is no longer in contact with the skin. Contact dermatitis should be distinguished from contact urticaria, in which hives appears within minutes of exposure and fades away within minutes to hours.
Likewise, food allergy can present with immediate reactions occurring within minutes after ingestion like swelling of the lips, hives and in more severe cases, difficulty breathing. It can also present few hours later and can cause late reaction like eczematous rash.
Treatment: What is the treatment available for lips? Can steroid be applied?
Dr Lynn: If the lips are involved in contact dermatitis or eczema, a low potency steroid or a topical calcineurin-inhibitor like Pimecrolimus or Tacrolimus can be applied. As the skin on the lips is thinner and absorbs more cream compared to similar sized-skin on other areas on the body, only low potency steroid creams should be used for a limited amount of time.
Parents noting child is scratching (picture credit atopicskindisease.com) Chapter 5 of the habit reversal manual was the giveaway! Thanks DrB!
Last Saturday, the Eczema Support Group met for the 2nd sharing session and everyone had warmed up to each other and shared tips freely with one another!
For those who are new, I’m hosting monthly support group session held under the Eczema Support Group, for parents with children.
Once again, for those who missed the session or STILL waiting at the sidelines before taking the jump to meet up, below is a glimpse of how the sharing session went.
1. Cosy turnout – It could be exam month for kids, so we’d a smaller turnout compared to the first session, but it’s cozy and getting to feel like family!
2. Topic was distracting from scratching and everyone shared about their tricks but as we all know, it’s easier said than done.
3. A video was shown of the successful 2-week wet wrap program under National Institute of Allergy and Infectious Diseases (I’ve learnt of this as many moms in US shared that their child’s eczema became manageable after the program).
4. People brought food and everyone was happy! Thank you to everyone including NSC staff for making it so!
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Dr Mark Tang, one of our doctors on the Eczema Support Group’s advisory panel, came and interacted with our members. No medical question posed to him in this session.
This is the 64th 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.
Having to take leave on bad eczema days + not taking long trips! (who can bring so much moisturizer!!!)
This is the 63th 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.
With so much to carry (see last week’s cartoon), a backpack (heavy, bulging one) doesn’t do much for our fashion!
This is the 62th 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.
For those of you who are new to the Eczema Support Group’s sharing sessions, do check out this post and this post on how the first sharing session went!
I’m excited by the response and feedback received after the first meeting, and decided to be ambitious and hold 2 sessions concurrently – one for the parents and one for the kids! It wouldn’t be possible without the kind help of volunteer, Norah, a mom with eczema herself who is helping to facilitate the primary school children’s session. Here’s the session program!
Update Notice on 15 Oct: There will be no separate session for primary school age kids because less than 4 RSVP. Kids are still welcome to come, but will join parents in same session.
20 October 2012 (Saturday) – Venue, NSC Room 401, 10-11.30am
So, What’s the Program? Topic is “Distracting Tricks & Tips!”
1. 10-10.15am Introducing Ourselves – Feel free to bring your spouse, your helper and especially your primary school age child as there’s a special program for them this session!
2. 10.15-11.15am Parents will be in one room sharing all the tricks and tips we have to distract our child from scratching, while the primary school children will go to an adjacent room for their program, facilitated by Norah, a mom who has eczema and is passionate about learning about skin, allergies and eczema. My hubby will be present to entertain children of pre-school age with balloon sculpture, puzzles and coloring.
Kids’ Program – Mölnlycke Health Care representative, the company behind wet wrap Tubifast, will share a video teaching kids about wet-wrapping. This will be followed by a game and quiz that will center on moisturizing and distracting your child from scratching. As additional resources are required to hold the kids’ program, it will be cancelled if less than FOUR children from age 7-12 RSVP for the session by 12 October (Fri), so please if you’d like your child to meet other kids, you’ve to RSVP and bring him/her. Cancellation Notice, if any, will be updated in this post by Monday of the week of event.
Kids’ Program has been cancelled – update on 15 Oct.
Parents’ Program – Sharing about ways we distract our child from scratching and a chapter Working with younger children, from “Atopic Skin Disease – A Manual For Practitioners” will be made available to you. It’s copyright material which Dr Bridgett agreed for a hard copy of the relevant chapter be given to you! You can learn more about habit reversal through Dr Bridgett’s Combined Approach series on my blog.
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. Information on my blog is not pre-approved by NSC.
3. 11.15-11.30am Food – I’ll bring some and everyone feel free to bake or bring whatever you like yourself/ your kid to enjoy! Last session, everyone was happy eating cakes!
4. YOU MUST RSVP – Our medical social worker who is helping with the Eczema Support Group will be in-charge of confirming your attendance, which isn’t confirmed till she says so! If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids coming, so that I can get her to contact you. REMINDER – KIDS’ PROGRAM WILL BE CANCELLED IF INSUFFICIENT KIDS RSVP. Kids’ Program’s cancelled.
Look forward to seeing everyone!
Mei
p.s. It could be primary school exam time but we don’t have enough primary school age kids to run a separate program. Hope to see more of you next time!
Who’s with me that is better to stock up on color pencils, crayons, sticker book, color book, 123 book, ABC book, storybook THAN to deal with scratching!
This is the 61st 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.
This blog has covered lots on children with eczema, but as they grow older, eczema may present a different set of challenges and in a different form (for instance, due to puberty). MarcieMom is privileged to have Dr Lynn Chiam of Children & Adult Skin Hair Laser Clinic, a consultant dermatologist who subspecializes in paediatric skin conditions, adult pigmentary conditions and laser dermatology .
Puberty, Skin Changes and Eczema
As children move into pre-teen years and into puberty, what are some of the body changes that may trigger eczema?
Dr Lynn Chiam: As young children move into pre-teen and pubertal years, there are changes in the body’s hormonal profile and maturing of the sexual characteristics of the body. Sex steroids modulate skin thickness as well as immune function. It had been noted that under the age of 10, eczema occurs equally among boys and girls. However, from 10-18 years, eczema becomes more prevalent among girls. During adolescence, more girls develop eczema and more boys outgrow it. This suggests a role for gender-specific pubertal factors.
Are there certain parts of the body that are more prone to eczema at the onset of puberty? And is there any difference noted between eczema in a teenage boy versus a teenage girl?
As children mature, it has been noted that females with eczema had more problems with issues of clothes and shoes than boys. Significant itch and sleep disturbance affected both genders. The areas of the body affected by eczema remain similar between the two genders during puberty. More studies are needed evaluate the effects of hormonal changes on eczema.
In infants and toddlers (0-2 years), eczema tend to affect the face and scalp while in childhood (2-12 years), it affects the flexures (inner aspect of elbows, neck, back of knees), wrist and ankles. In adolescents, eczema tend to affect the eyelids, neck and flexures (inner aspect of elbows, back of knees).
Acne, Oily Skin & Warts
MarcieMom: Apart from eczema, other common skin problems in teens include acne, oily skin and warts. Can you briefly explain each of these conditions?
Also, can a teenager with eczema (i.e. dry skin) also suffer from acne or oily skin? And if yes, what’s your advice to managing two or more skin conditions?
Acne – Acne can occur in adolescents and adults. It usually starts during the teenage years and is thought to be related to hormonal changes during this period. Most people will suffer from some form of acne during their teenage years.
Acne can be divided into predominantly comedonal (whiteheads) or predominantly inflammatory with papules (zits) and pustules (zits filled with pus). Large and deep zits can result in permanent scarring.
Acne can be triggered by oily skin, oily face creams, smoking and stress. Mild acne can be treated with creams containing benzoyl peroxide, antibiotics and tretinoin. Moderate acne may require oral medications such as antibiotics and oral hormonal tablets. Severe acne can be treated with oral isotretinoin. Oral isotretinoin is usually well tolerated and can result in long term cure. However, it must not be taken in pregnancy.
Oily Skin in Teenagers
Oily skin – Oily skin (seborrhea) is a common cosmetic problem that occurs when oversized sebaceous glands produce excessive amounts of sebum. Sebum is the cause of oily skin and scalp. Increased facial sebum is also associated with the development of acne.
Sebaceous glands are microscopic glands in the skin that secrete sebum, which is made of fats, wax and the remains of dead fat-producing cells. Excessive sebum gives the appearance of shiny and greasy skin. In humans, they are found in greatest abundance on the face and scalp. Sebum is odourless but bacterial acting on it can produce odours.
Skin oiliness may vary according to age, gender, ethnicity and hot humid climate. During puberty, the activity of sebaceous glands increase because of heightened levels of the hormone known as androgens. In skin pores, sebum and keratin can create a “microcomedone” or “whitehead”.
A person with eczema can certainly suffer from acne as well as oily skin.
A person with eczema can certainly suffer from acne as well as oily skin. As he enters puberty, a teenager with eczema can develop oily skin on his face (where the sebaceous glands are concentrated) while other parts of the body (with less sebaceous glands) remain dry. The increase in facial sebum can trigger acne.
In a person with eczema and acne, it is important that if he applies steroid creams to his face for his eczema, he avoid applying them over the acne-prone areas. This is because steroid creams can make the acne worse. Alternatively, he can use creams like Tacrolimus or Pemecrolimus to control his eczema as they are non-steroidal in nature and do not aggravate acne.
He should also use anti-acne cream only to the areas with pimples and avoid the eczematous areas as some anti-acne cream can cause skin dryness. Wash the acne prone areas with anti- acne wash while using a gentle soap for the rest of the face. Clean away excess oil from the face whenever possible. Do consult a dermatologist for advice and treatment.
Warts and HPV
Warts – Warts are growths on your skin are caused by an infection with human papilloma virus, or HPV. Types of warts include:
Common warts, which often appear on your fingers, toes and on the knees.
Plantar warts, which show up on the soles of your feet.
Genital warts, which are a sexually transmitted disease.
Flat warts are skin- coloured and can appear in any area of the body.
Periungal warts prefer to grow at the sides or under the nails and can distort nail growth.
Warts are contagious and may spread from one area of the body to another or to others. There is no way to prevent warts.
In children, warts often go away on their own. In adults, they tend to stay. If they hurt or bother you or if they multiple, you can remove them.
There are many ways of treating warts. They include freezing it with liquid nitrogen, applying chemicals, electrosurgery (using heat to burn the warts away) and laser treatment.
Sweat & Sports on Eczema
Marcie Mom: Sweat can be a trigger for eczema and teenagers are at a very active stage of their life. If a child’s eczema is often triggered by sweat, would you advise parents to encourage their child to take up an indoor sport?
Are there certain sports that you think are better suited to eczema children? For instance, is swimming or squash or gymnastics more suitable than soccer or tennis?
Dr Lynn Chiam: Sweat and heat can be a trigger for eczema. However, it is best for a teenager with eczema to lead as normal a life as possible and participate in the sport he likes. Unless the eczema is very severe and difficult to control, I will not limit the choice of sports the teenager chooses. It is more important to know about good skin care and to apply creams correctly, which will help improve eczema, than to totally avoid certain sports.
If a teenager chooses to engage in a sport that’s outdoors and sweat a lot, what advice would you give him/her to manage the eczema?
Swimming for long periods during a bad flare of eczema is not advisable as the swimming pool water may cause more skin dryness.
I will advise that if you participate in a sport that will cause you to sweat a lot, to take a damp cloth to wipe away the sweat immediately after exercising followed by drying the skin with a dry cloth. If possible, take a shower using gentle soap shortly after the exercise and apply moisturizer immediately after bathing.
Cosmetics for Eczema
Teenagers may start to use (i) cosmetics, (ii) hair gel, (iii) anti-perspirant or (iv) wax arms/legs or shave. What would be your advice to a teen with eczema who wants to do the above (i) to (iv)?
Cosmetics contain fragrances and preservatives which may lead to allergic contact dermatitis (a rash due to allergy to the ingredients). A person with eczema has poor skin barrier function and may be more prone to skin irritation caused by cosmetics. If a teenager’s eczema flares with the use of cosmetics, it is important that she sees a dermatologist to do a patch test to check if she is allergic to the ingredients found in the cosmetics. If so, she will need to avoid that particular ingredient by reading the product labels of the cosmetics she uses. Always do a test spot by placing a small amount of the cosmetic on the inner aspect of the wrist. If there is no reaction after 1-2 days, then the cosmetic can be used on the face. Try to avoid using cosmetics over the areas affected by eczema. Cosmetics with a high water content are at a risk of being contaminated by bacteria and can pose a health risk to the user.
Try to avoid using cosmetics over the areas affected by eczema.
Hair Gel on Scalp Eczema
If a teenager’s eczema affects the scalp as well, it is advisable not to use hair gel when there is a flare of the eczema. If the scalp is not affected, it is recommended that a small amount of the hair gel is placed on a small area of the scalp first and to watch for any reaction. If there is no reaction after 1-2 days, then the hair gel can be used on the whole scalp. Always wash away the hair gel at the end of the day.
Anti-Perspirant and Allergic Contact Eczema
Anti- perspirant contains fragrances and preservatives can lead to allergic contact dermatitis. Again, do a test spot on the inner aspect of the wrist. Do not use the anti-perspirant if he develops any reaction.
Shaving and Micro-tears
Shaving and waxing of unwanted hairs can lead to micro-tears in the skin. Patients with eczema have an impaired skin barrier function and can easily get skin infection through these micro- tears. It is not advisable to shave or wax your hair if there is a flare of eczema. Laser hair removal, which does not cause micro-tears in the skin, is a more suitable way of removing unwanted hairs for patients with eczema.
No photos please! Only the dog can be photographed! Balloon Sculpture to occupy children during the sharing session
I had a wonderful time meeting up, learning and sharing with other parents of eczema children last Saturday, the very first of a monthly support group session held under the Eczema Support Group.
Everything shared was in confidence, so no specifics or pictures would be published (none taken in fact!) But for those who missed last Saturday’s sharing or waiting at the sidelines before taking the jump to meet up, below is a quick snapshot of how the sharing session went.
1. Good turnout – the meeting room was packed and thank you to my hubby for occupying the children with balloon sculpture & puzzles!
2. Topic was moisturizing and everyone shared readily about their moisturizing and eczema management experience.
3. Tubifast came to demonstrate how to wet wrap their bandage on various parts of the body, such as face and hand.
4. People brought food and everyone was happy, I hope! Because I know I’m happy and thrilled it went well, thank you to everyone including NSC staff for making it so!
– – – – –
Oh & before I forget, I asked Dr Mark Tang, one of our doctors on the Eczema Support Group’s advisory panel, questions I noted:
1. If steroid is put on the skin before moisturizer, will the steroid be diluted? Answer is putting steroid before or after is more of a personal preference and there is no clinical difference noted in either.
2. How frequent can a child with eczema go for swimming? About 15 minutes each time, 3 times per week.
3. Should rotating various moisturizing brands be practiced? No clinical basis for rotation.
4. Are natural or organic skincare products better? Natural/organic doesn’t mean no allergy reaction, best to look into ingredients.
This is the 60th 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.
OOPs #1 – There’s nothing to be happy about when you’ve eczema
OOPS #2 – I just found out that it is Eczema Week! I didn’t know and just assumed that everyone holds their eczema events this week around the world, just as I’m holding a sharing session this Sat! There’s still some time to RSVP if you like to come, RSVP by end of the day.
Three of my best allies on eczema online are collaborating in the NHS Online Skin Clinic where you are free to ask any skin condition and the doctor panel will answer. Here’s the link.
OOPS #3 – I’m not supporting parents on facebook yet (I know! I’m a resistant dinosaur-ess!) In fact, I need your help to share my content if you use facebook and you can share my latest, just brewed eczema newsletter too.
No prize for guessing which swaddled baby has eczema!
This is the 59th 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.
As you might have read, Eczema Support Group, Singapore, kicked off to a successful start with its inaugural event on 14th July 2012.
Thank you to the close to 100 attendants who filled up the feedback forms, from which we got a better understanding of the needs of our members & participants. The top three are (1) eczema information, (2) raising awareness and (3) sharing. As all of you know, I’ve been passionate about running support group sessions and will now do so under the Eczema Support Group.
Mark Your Calendars for Sharing with Parents with Eczema Children!
22 September 2012 (Saturday) – Venue: National Skin Centre (NSC) Room 401; Time: 10-11.30am
20 October 2012 (Saturday) – Venue, NSC Room 401, 10-11.30am (tentative, check back to confirm)
30 November 2012 (Friday) – Venue, NSC Room 401, 5.30-7.00pm (lunch at noon)
So, What are we Sharing?
Since this Eczema Suport Group is the first in Singapore and I assume, a sharing session like this is also the first! – we are all pioneers in this and so everyone got to bring a little patience with a big open heart.
We will be:
1. Introducing ourselves – a few words about your child’s eczema and better still, bring your child! (I would be bringing my toddler and hubby! I don’t have a helper/maid, but if you have, feel free to bring her along if she can help to take care of your child while you attempt a decent conversation!)
2. Topic of Sharing – Moisturizing! Do feel free to bring along your favorite moisturizing lotion/cream/ointment (if you’re like me, I’d suspect it’s already in your baby bag) and we can all share how we moisturize, when we moisturize & what we moisturize with. Mölnlycke Health Care representative, the company behind wet wrap Tubifast, will be on-hand to help out with your questions on wet-wrapping. There will be no doctor present, so don’t expect to be able to ‘Ask the Doc’. Information shared is not medical advice, please still see a doc. If you’re a product company checking this post, please don’t masquerade as a parent and attend the session to promote your product, you will be asked to leave.
3. Goodie bags – We have goodie bags with some sample-size creams from Ego, maker of QV as well as hard copies of my picture book ‘A to Z Animals are not Scratching!‘ for giveaway.
4. Food – I’ve a little budget, courtesy of National Skin Centre Health Endowment Fund to buy food. If you like to bring a cake you bake to share, do feel free. Or I heard this thing called cake-pop is really ‘in’ now, so anyone who like to make some and bring, we’d be more than happy!
5. Toys – I’d be bringing my toddler’s color pens, puzzles to occupy our kids. If you’ve a toy that you know would occupy your own kid, please please bring along.
6. Setting – It’s not cosy but we can make it so! It’s a meeting room 401, with a big table and chairs. There’s a sofa and a little (small area) where your kid can sit and play. Hmm.. if everyone bring your kid, there may be overcrowding, well, please wash their hands before coming and make sure they are not down with HFMD or flu.
7. YOU MUST RSVP – Our medical social worker who is helping with the Eczema Support Group will be in-charge of confirming your attendance, which isn’t confirmed till she says so! If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids coming, so that I can get her to contact you.
8. Ok, I’m long-winded, but so excited! Bring lots of patience please… for bearing with me and any hiccups that may happen on that day.
This is the 58th 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.
