Reminder of next Saturday’s hands-on wet wrap session for those with eczema kids in Singapore. Wet wrap is an accepted form of eczema therapeutics in children, that is worth learning as it has been studied to improve eczema. This Saturday’s eczema support group session at the National Skin Centre, Singapore will have
Presentation by Mölnlycke Health Care, the company with Tubifast wet wrap (read here to understand more on wet wrap)
Wet wrap demonstration – How to do a double-layer wrap, moist inner layer with a dry outer layer; dry wrap will also be explained
Wet wrap sizes and techniques – It can get quite difficult to wrap parts with bends or that slip off + what sizes are suitable for younger kids
Do RSVP for the session, details below:
Wet wrap – a proven therapy for eczema kids
28 November 2015 (Saturday) – Venue, National Skin Centre Singapore,
Level 4, Staff Lounge, 10 am to 11.30 am
The program:
1. 10.00 to 10.30 am Tubifast demonstration and presentation
2. 10.30 to 11.00 am Trying out wet wrap
3. 11.00 to 11.30 am Q&A and refreshments
4. YOU MUST RSVP – It will then be possible for us to prepare breakfast and for the Tubifast team to prepare the relevant product. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids (and age, so the right size wrap can be prepared for presentation) coming.
One last thing, the session would be starting on-time and information on my blog is not pre-approved by NSC.
We have started learning skin facts last week, specifically on the skin (surprise) isn’t the largest organ and that well, we don’t really know what’s in our dust. This week, we’re taking up a notch on going ‘intensive’ into the difference in the sun protection function of adult, child and eczema skin.
Normal Adult Skin
Sun Protective Function of our Skin and how it differs for Baby Skin and Eczema Skin
Adult skin has a fully developed sun protection function, in the form of pigment melanin which gives the skin its color. Therefore, the darker one’s complexion, the higher the sun protection. Melanocytes are the melanin-producing skin cells and it is the activity of the melanocytes, i.e. the amount of melanin produced, and not the number of melanocytes that determine the skin color.
When one is exposed to sun, more melanin is produced to help protect the skin against UV rays, thus giving a ‘tan’. Melanin can reduce the oxidative damage caused by UV rays but isn’t able to fully protect from the damaging effects of UV rays (see this news on potential harm of ‘sun-activated’ melanin to our skin).
Children Skin
An infant’s skin has not fully developed in many ways that make a baby more vulnerable to the damaging effects of UV rays – it has less pigment/ melanin, thinner skin/ stratum corneum and a higher surface area to body ratio.
Studies have also pointed to infants with exposure to UV rays will show skin pigmentation on exposed skin from as young as one year old (first summer). This was true even for infants who used sun protection when outdoors but not when in the car, in the shade or on a cloudy day. There are also studies showing that exposure to UV during childhood and adolescence can lead to skin cancer later in life.
Eczema Skin
There is no study that points to differences in melanocytes/ melanin due to eczema. However, the sun is known to both improve and aggravate eczema, for instance:
Some eczema sufferers report improved eczema during holiday when outdoors more often (no study confirmed why holiday seems to improve eczema).
Phototherapy is used as an eczema therapy for adults.
Active eczema flare-up should stay away from the sun as it can worsen eczema, and increase vulnerability to sun burn.
Certain skincare products increase sensitivity to sun, such as those containing ingredients alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), salicyclic acid, glycolic acids, Retin-A and hydrocortisone. Moisturized skin may get sun burn more easily, thus put on moisturizer and wait for 30 minutes before applying sunscreen.
Sun – We need it, but not too much of it.
Our skin play an important role in the synthesis of vitamin D, where vitamin D can increase the production of skin proteins (cathelicidin) and antimicrobial peptide (AMP) which protects against skin infection. However, just 15 minutes a day is enough and it’s referring to getting sun on the face and arms (i.e. no need to be in a bathing suit!). During summer, 2-3 direct sun exposures of 20 minutes per week is sufficient. Short frequent sun exposure is better than long exposure.
Rays from the Sun
There are 3 different rays from the sun:
UVA – 320 to 400 nm : passed through the atmosphere
UVB – 290 to 320 nm : passed through the atmosphere
UVC – 100 to 290 nm : most dangerous, but filtered and do not pass through the atmosphere
UVA – UVA activates melanin already present in the upper skin cells but the tan is lost quickly. Penetrates deeper into the skin, damages the dermis (middle skin layer), accelerates aging, causes wrinkles, increases oxidation and suppresses cutaneous immune function.
UVB – UVB stimulates the production of new melanin, and a longer lasting tan. Also stimulates a thicker epidermis. Absorbs by the epidermis (top skin layer).
It’s not just the sun, it’s also the ozone.
We all know that the ozone layer is thinning and the thinner ozone has allowed more UVB rays to come through the atmosphere.
Sun protection
Sun protection has been covered in various interviews with dermatologists on this blog but the point to emphasize is that for babies, it is very important to avoid the sun and practice sun protection because:
Thinner skin
Less melanin-producing skin cells
Larger surface area to body ratio
Increased absorption of chemicals and vulnerability to irritants in sunscreen products make sun avoidance a wiser choice
Lips and eyes are also affected by UV rays, thus wearing a wide-brimmed hat and sunglasses are also part of sun protection.
It is recommended to use physical blockers/ inorganic filters such as zinc oxide (more UVA protection) and titanium dioxide (more UVB protection). As opposed to chemical absorbers, physical blockers do not penetrate more than two layers of stratum corneum and therefore less likely to induce skin irritation and sensitization. Moreover, infants tend to rub their eyes and may inadvertently rub the sunscreen into their eyes and won’t be able to ‘get rid’ of it as (i) their tear secretions and (ii) their blinking mechanism are not fully developed.
A note on SPF
SPF is the measure of ratio of UV rays before sunburn and SPF 30 means that the skin is able to take 30 times higher dose of UV rays before sunburn. The amount of sunscreen to apply is 2mg/cm2. Broad spectrum refers to additional UVA absorbers (avobenzone and octocrylene) being added to the physical blockers.
In a paper published August 2015 Journal of Allergy and Clinical Immunology, Dr Jonathan Silverberg studied an association between eczema and headaches. The cause of headaches could have come from (i) sleep disturbances or (ii) fatigue that eczema children suffer from.
Method of study: Analysis of data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children’s Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997-2013.
Childhood Eczema and Headaches
Results: From the analysis, eczema was associated with headaches in 14 of 19 studies. It was found that eczema children had a higher prevalence and likelihood of headaches. In particular, children with eczema that was associated with atopy, fatigue, excessive daytime sleepiness, insomnia, and only 0 to 3 nights of sufficient sleep had even higher odds of headache than eczema alone.
MarcieMom’s take – I couldn’t find other studies on Pubmed that examine this association but it wouldn’t come as a surprise that there is one; after all, how many of us adults don’t have a headache if we’re chronically deprived of sleep? A few other thoughts on sleep and headaches:
#1 Don’t mistake the headache for other illness
In adults, we may reach for the painkiller but this probably isn’t suitable for a child and can’t be taken long-term. Possibly explore antihistamines to see if it help with a better night sleep and of course, treating the eczema to reduce the itch.
#2 Sleep better
Easier said than done – it is still something that our family struggles with, though to a much lesser extent than when the eczema was severe. A few posts that may give you ideas on how to improve sleep at night:
I’ve recently found that dry wrap (as opposed to wet wrap which I have not tried) seemed to reduce the scratching at night. Singapore is pretty humid so instead of wet wrap, sometimes I put a layer of moisturizer (again) before sleep time, and put over a wrap bandage. Marcie’s skin usually appear better the next day and there’s less scratching on the wrapped spot at night. More on wet wrap in this interview with Tubifast.
For these 8 weeks, we’re going ‘intensive’ into skin facts. Many articles have shared about adult skin facts, but in #SkinishMom style, we’re ‘digging’ deeper into children’s skin and eczema skin. (Note: all skin facts have published data for children and eczema skin)
Some ‘Skin Investigation’ may turn up with unexpected facts!
Skin Fact #1 Skin is (NOT!) the largest organ in the body
Oops, doesn’t everyone say that skin is the largest organ? That’s why some ‘skin’ investigation is required for ‘skin journalism’. Located a letter to editor in the Journal of Investigative Dermatology that skin is not the largest organ in the body. The skin can be considered the largest BY WEIGHT for ‘medium-sized’ organs, excluding musculoskeletal system.
Skin (epidermis and dermis) weights 3.86kg, about 5.5% of a 70kg man
Subcutaneous tissue (layer of fats under the dermis layer) is not consider skin
Skin is not the largest organ by surface area, about 1.7 sqm but lung airway is 70sqm, and gastrointestinal tract is about 30-40sqm (note in the letter to editor, it’s stated as about football field, but in a paper that subsequently published in 2014 Scandinavian Journal of Gastroenterology, scientists measured the inner surface of gastrointestinal tract of a healthy average man; previous estimates of the gastrointestinal tract were made post-mortem where the tract has relaxed to a much longer length! ‘Interesting!’)
Skin Fact #2 Adult skin sheds about 17kg to 52kg over a lifetime
From research and as explained by Dr Claudia Aguirre on Quora (Dr Claudia is a featured guest of this blog), humans shed their entire outer layer of skin every 2-4 weeks at the rate of 0.001 — 0.003 ounces of skin flakes every hour. This worked out mathematically to be 17kg to 52kg (or 37 to 115 pounds) for someone who live up to over 70 years old (I’d suppose that the 0.001 to 0.003 ounces is for an average adult, thus strictly speaking, you can’t simply multiply by 70 due to (possibly?) less skin shed for a child (by weight, but given larger surface area to volume ratio, a child may shed ‘more’ skin).
Eczema skin – Eczema skin, characterized by dry skin, shed more skin (and add the scratching!). The outer skin layer (epidermis) has four layers of keratinocytes (skin cells). The keratinocytes at the basal layer continually grow and move upwards to the stratum corneum, changing from plump cells to dead, flattened cells that are shed. This takes about 28 days. I couldn’t find research on how much skin an eczema sufferer shed, but there’re two ‘opposite’ skin conditions worth mentioning:
Exfoliative Dermatitis – characterized by extensive red skin, followed by skin shedding (similar to life-threatening conditions covered in this blog: Stevens Johnson Syndrome and Erythroderma); the skin shedding is so extensive in these conditions that it affect the normal functioning of the body, in particular temperature regulation and moisture retention, requiring care in hospital.
Psoriasis – this condition is marked by only taking 3 to 4 days to mature and does not shed but the skin cells pile up on the skin surface, forming plaques and lesions.
Many eczema sufferers reported seeing massive skin shed on the bed and floor but I wonder why the skin cells shed appear so visible (as opposed to normal skin). Found an explanation that the cells on dry skin may stick together, thickening the stratum corneum and when they are shed, it is shed as visible sheets, aka scales.
Skin Fact #3 Dead skin cells comprised an UNKNOWN part of our dust at home
This is another ‘fact’ that could turn out to be a myth – most of the sites state that our dead skin made up anywhere from 50% to 90% of our dust at home. In a study by Layton and Beamer whose study was to find out how much of contaminated soil and outdoor pollutants would get into home dust, it was estimated that about 60% would come from outdoors. Dust is very complicated, with different home, season, surrounding and the type of dust in the air and on the floor being different. It cannot be simplified to state as most of the dust are dead skin cells.
What we have to know is dead skin cells are food for house dust mites and they literally sleep with us, in our bedsheet, pillow, pillow case and mattress. Read the following posts to understand more about dust mites:
In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!
The video covered today is “How to Treat Diaper Rash”. For this video, I interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine. Dr. Eichenfield’s clinical interests include atopic dermatitis, and serves on the editorial boards of several journals and periodicals, and is Co-Editor in Chief of Pediatric Dermatology.
In the video, the key points covered are:
Always change the soiled diapers, even if it’s just wet
Gently cleanse the bump area, such as using moist cloth or alcohol-free and fragrance-free baby wipes
Use diaper cream that is zinc oxide based
Watch for signs of infection
MarcieMom: Thank you Dr Lawrence for helping parents to learn more about diaper rash this week (and on eczema bleach bath therapy last week). Although diaper rash is common, we still need to learn the proper care for diaper rash and when it is no longer a rash to be self-treated.
Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash
I understand that diaper rash is a layman’s term and the rash is most likely to be contact dermatitis, caused by close contact of the baby’s skin with the urine/stool that act as skin irritant.
MarcieMom: Is irritant contact dermatitis the most common form of diaper rash? What are other potential irritants apart from urine/stool? For instance, can the diaper itself irritate?
Dr Lawrence: It is true that irritant contact dermatitis is the most common form of diaper rash, with irritation from urine and stools being the most profound irritants. Occasionally children can get inflamed due to other factors, including allergy to diaper contents, though rare, infections such as yeast, which has occurred commonly after courses of oral antibiotics, and many other less common causes of irritation.
MarcieMom: We know that babies have underdeveloped sweat glands and thus occlusion and sweat can lead to heat rash/ miliaria.
MarcieMom: Is it possible that the diaper rash is a heat rash? What are the other possible diagnosis of diaper rash?
Dr Lawrence: It is uncommon for diaper rash to be “heat rash” as the anatomy of the diaper region is different. Aside irritant and occasionally allergic contact dermatitis, there is a broad set of causes of diaper rash which includes yeast infection, psoriasis, and in unusual cases, a broad set of more serious diseases. There are textbook chapters with long list of potential causes of diaper rash, though fortunately, these are uncommon.
MarcieMom: We saw in the video that cleaning the baby’s bum is part of caring for diaper rash. Many parents clean with baby wipes which may end up irritating the baby’s skin if the wipes contain methylchloroisothiazolinone (MI) or methylisothiazolinone. MI was named 2013 “Allergen of the Year” by the American Contact Dermatitis Society.
MarcieMom: What precautions should parents take when cleaning their baby’s bottom to ensure that the cleaning itself will not further irritate the skin? How can parents tell if it’s their cleaning that cause the rash instead of the contact with the soiled diaper?
Dr Lawrence: Parents may be less concerned now, as standard products have dropped MI or MCI from standard wipes. Parents don’t need to be concerned about potential allergy to their cleaning products if diaper rashes respond quickly to standard cleansing and moisturizing regimens, or even interventions with a few days of diaper cream and/or over-the-counter hydrocortisone. If rashes persist with the use of cleansing products and do not respond to standard treatment, then this may be a different story.
MarcieMom: It is recommended in the video to use a zinc-oxide based diaper cream. The diaper cream can act as a barrier that limits the contact of the urine/stools with the baby’s skin. Again, we want to avoid the situation where the cream itself becomes the source of irritant contact dermatitis or even allergic contact dermatitis (where the skin reacts to allergen in the cream).
MarcieMom: What are the ingredients to avoid when selecting a diaper cream? Apart from the obvious ingredients to avoid such as alcohol and fragrance, can ‘good’ ingredients like vitamin E also trigger a rash? Is it better to stick to a ‘basic’ diaper cream that is mainly zinc oxide, instead of a ‘fancy’ one with more ingredients?
Dr Lawrence: Diaper creams that are zinc-oxide based are a tried and true remedy. These produces a barrier layer that protects the skin and also aids in healing of mild irritation or inflammation. Most commercial products have been tested to be safe, with a tendency to be “bland”, meaning a minimal amount of additives being included in the preparations. Parents should be careful with some “organic-based products”, as these sometimes contain contact sensitizers, meaning chemicals that children can become allergic to.
Thank you Dr Lawrence for helping with the questions – we certainly are more informed about to care for our baby’s diaper rash and not aggravate it.
Wet wrap is an accepted form of eczema therapeutics in children, with numerous studies reporting improvement in eczema. Eczema Support Group under the National Skin Centre has organized a wet wrap demonstration and presentation, in collaboration with Tubifast, to explain what is wet wrap and the different techniques of wet wrap. The session will have
Presentation by Mölnlycke Health Care, the company with Tubifast wet wrap (read here to understand more on wet wrap)
Wet wrap demonstration – How to do a double-layer wrap, moist inner layer with a dry outer layer; dry wrap will also be explained
Wet wrap sizes and techniques – It can get quite difficult to wrap parts with bends or that slip off + what sizes are suitable for younger kids
Do RSVP for the session, details below:
Wet wrap – a proven therapy for eczema kids
28 November 2015 (Saturday) – Venue, National Skin Centre Singapore,
Level 4, Staff Lounge, 10 am to 11.30 am
The program:
1. 10.00 to 10.30 am Tubifast demonstration and presentation
2. 10.30 to 11.00 am Trying out wet wrap
3. 11.00 to 11.30 am Q&A and refreshments
4. YOU MUST RSVP – It will then be possible for us to prepare breakfast and for the Tubifast team to prepare the relevant product. If you’re coming, please email me ([email protected]) your name, mobile and email, number of adults & kids (and age, so the right size wrap can be prepared for presentation) coming.
One last thing, the session would be starting on-time and information on my blog is not pre-approved by NSC.
Caring for any baby, your baby especially, is an unique experience. Mothers do have shared experience though, being mom and going through pregnancy, child birth and caring for a baby who goes through the development milestones. Mothers of eczema children have even more in common, as the struggles of caring for a baby who has rashes all over, experience constant discomfort and itch can only be understood by those who’ve been through them. This series by MarcieMom, are letters to you, with words of encouragement and sharing of her own parenting struggles.
Dear Daddy & Mommy,
It’s feels like our children have already grown so much! Marcie is starting grade school next year and these two years, she seems to be ‘shooting up’ – we went for a week holiday recently and everyday I marveled at her looking so big girl. When did my child grow so much? Sometimes I can be so focused on work, on this blog(!), on chores, on getting everything done that I missed looking at her. Have you looked at your child recently? These two years when her eczema has very much improved, I finally dared to kiss her more on her cheeks. One friend from Germany who visited did ask exactly that as he kissed his son so much all the time and noticed that we didn’t really kiss Marcie so much.
These two years have been so much better – evidence of which are the Nespresso machine I bought and the capsules that I’ve consumed, and the book that I co-authored and published. I’m quite scared about what Marcie starting grade school – will she get bullied? will she get laughed at as she has so many bad habits – scratching, biting fingers and peeling her skin. We never have to cut her fingernails for years and most times, I don’t even dare to look at her fingers (a task for my husband!).
We got off co-sleeping but she still needed to be watched to remind her not to scratch at night. Given that her skin is a little tougher than baby years, we sometimes let her scratch a while to see if she would fall back asleep. It’s still frustrating to remind her not to scratch and the habitual scratching had led to some thickened skin on her feet. There’s less need to take leave to care for her as her eczema is so much more manageable and my parents are able to care for her even on our weekend marriage (church) camp.
How is your family life? Do you have a second baby? We made the decision to have an only child, partly as we didn’t feel that physically, emotionally and financially we could give a second child the same level of care – maybe we are wrong, we don’t know but I like being an ‘only mom’. I pray that if your second child won’t have eczema – some parents in the support group remarked that the second child’s eczema is worse while others say it’s less severe. We never know.. but consider taking probiotics prenatal and also in the early years, and fish oil too.
Time seems to pass us by – and I wonder if I ought to have spent more time with Marcie, looked more at her, kissed her more and less at the rashes and the chores, and even this blog (takes lots of my free time to sustain this blog but it’s like a treasure that I store in heaven). I wonder how you feel about your parenting and how your marriage is holding up after years of caring for an eczema child. Has it got stronger or has it gotten so strained that you hardly can talk heart to heart as a couple? As I type this, Marcie is beside me and my husband in front of me, having just enjoyed a dinner at my parents’ home. We are all doing our own thing (evidently, since I’m typing this), have our own hopes and fears. Disappointment and discouragement. Today is Sunday (this post is scheduled to be published on Friday) and today’s sermon in church ended with an analogy of us building bricks and bricks of discouragement and disappointment and not seeing Jesus beyond the wall. It’s true on a certain level but I believe that the Jesus who is God and came down to live with us and die for us won’t be held back by a brick wall. I pray that the Holy Spirit in me (in all Christians) will dwell in me and show my how to lead my life – to be the mother I’m to be.
Isaiah 57:15
“I dwell in the high and holy place, and also with him who is of a contrite and lowly spirit, to revive the spirit of the lowly, and to revive the heart of the contrite.”
In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!
The video covered today is “Eczema: Bleach Bath Therapy”. For this video, I interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine. Dr. Eichenfield’s clinical interests include atopic dermatitis, and serves on the editorial boards of several journals and periodicals, and is Co-Editor in Chief of Pediatric Dermatology.
In the video, the key points covered are:
Bleach bath is useful for children whose eczema is frequently infected.
Always ask the dermatologist before starting on bleach bath therapy.
Preparation of the diluted bleach bath – Half cup of bleach for a full tub of water or 1 teaspoon of bleach per gallon of water
Soak 5 to 10 minutes and to check with doctor on the frequency (per week) for the bath
Questions answered by Dr Lawrence Eichenfield on Eczema: Bleach Bath Therapy
MarcieMom: Dr Lawrence, thank you for helping out in this AAD video series once again. In our previous interview on Eczema Tips, I asked the question on what infected eczema looks like. Your reply was
Infected eczema can appear as unusual oozing or honey-colored crusting.It can occasionally show as pus bumps, or as tender, red, warm skin.Inflammation can also appear red, as well as “rashy” and scaly.The bleach baths are usually recommended for children who have problems with skin infections, rather than just the inflammation seen with simple eczema flares.
MarcieMom: In another interview with Dr Clay Cockerell, readers of this blog learnt that there are both good and bad bacteria on the skin. The common ones are (1) Staphylococcus epidermidis, (2) Staphylococcus aureus, (3) Streptococcus pyogenes (4) Corynebacteria and (5) Mycobacteria. We also learn that
Bacteria multiply exponentially, so when its population is temporarily decreased, as after the use of hand cleanser, it re-grows quite quickly and returns to its normal concentration.
MarcieMom: We know that the main benefit of bleach bath is to reduce the harmful bacteria, in particular, staphylococcus aureus that often colonizes eczema skin and promotes skin inflammation.
MarcieMom: Will reducing staph bacteria via a bleach bath be only effective for a short time and the harmful bacteria quickly proliferate after the bath?
Dr Lawrence: Bleach baths appear to decrease the quantity of bacteria on the skin, probably transiently. There have also been some studies to show that hypochlorous solution, the active ingredient in bleach bath, may have anti-inflammatory effect. We don’t really “wipe out” bacteria on the skin with bleach bath, but only tame it down for a period of time. However, they have been shown very useful as part of therapy in eczema that gets frequently infected.
MarcieMom: It is mentioned in the video to consult the doctor before starting on bleach bath therapy. What are the factors that a doctor will consider when deciding whether bleach bath is a suitable (or not suitable) treatment for a child with eczema?
Dr Lawrence: When considering bleach bath, doctors will usually consider the overall degree of eczema, the tendency to have secondary infection, which can present as honey-colored crusting, as well as the age of the child. Bleach baths, while very useful, are usually therapy used in addition to regimens of moisturizing and topical anti-inflammatory therapies, as “add-on” for more difficult eczema to manage.
MarcieMom: In the video, we saw that household bleach is used for the bleach bath and we should check that there is no more than 6% sodium hypochlorite in the bleach. I realized that many household products (including bleach) do not label their contents (not mandatory requirement in every country) and that many bleach products have fragrance.
MarcieMom: What is your suggestion on how to get the right bleach product? In the event that parents can’t find a bleach product that is fragrance-free with clear labeling, what is the alternative product?
Dr Lawrence: You are correct to bring up the issue that there is variability in concentrations of bleach bath, as well as bleach not being available in all countries. Also, we have become aware that there are more concentrated forms of bleach being sold to decrease shelf space in grocery stores. Parents need to take a look at the percentage of sodium hydrochlorite, and if there are using a more concentrated version adjust the formula. There are commercial alternatives, including some readily available non-prescription products that have sodium hypochlorite solution as their active ingredient. For instance, CLn body wash, marketed by TopMD that offered this product through their website or Amazon.com. This product has had several studies that have shown benefits in pediatric atopic dermatitis.
MarcieMom: Staph bacteria is the cause of many other skin infections such as cellulitis, impetigo, folliculitis and staphylococcal scalded skin syndrome. Using bleach bath can be preventive, so that there is less likelihood of an infection. It is better than treating an infection using antibiotics that may lead to antibiotic resistance. However, a bleach bath can be drying for the skin since bleach has a pH level of 11 to 13, thus considerably alkaline. Alkaline products can also lead to reduction of ceramide-producing enzymes, decreased skin lipid production and dry skin.
MarcieMom: Is there a way to adjust the skin pH after the bleach bath? For instance, will rinsing off residual bleach bath water be useful or will it decrease the effects of the bleach bath?
Dr Lawrence: When using bleach bath, it is important to handle the skin as with regular baths, with use of emollients/moisturizers after bathing. Some experts will rinse off the residual bleach bath water, while others will leave it on the skin. In studies, it does not appear to make a significant difference, though experts do vary in their suggestions. Certainly application of moisturizers will help, and in any case, the application of moisturizers after bathing will help to improve the skin function, including recovering the pH to normal level.
Thank you Dr Lawrence for helping us to increase our understanding of the bleach bath and clarify questions and reservations we parents have.
Caring for any baby, your baby especially, is an unique experience. Mothers do have shared experience though, being mom and going through pregnancy, child birth and caring for a baby who goes through the development milestones. Mothers of eczema children have even more in common, as the struggles of caring for a baby who has rashes all over, experience constant discomfort and itch can only be understood by those who’ve been through them. This series by MarcieMom, are letters to you, with words of encouragement and sharing of her own parenting struggles.
Dear Daddy & Mommy,
I hope your family life has got easier as your child turned 2-3 years old – I remembered this was the time when we went to Singapore Botanical Gardens for the second time to watch a free outdoor concert. At the end of the concert we were thinking ‘Wow, did we just finish watching a concert without much scratching, had some fun on the grass and a decent picnic?’. This was especially poignant as two years ago we went for a similar event at the Botanical Gardens and had to run off the event, in anger and frustration, with our baby’s hands tied with the swaddle cloth due to the scratching and the blood.
Bedtime still comes with scratching for me, as I believe for many parents too. Idle hands, too dry air, or too warm, rising body temperature and for reasons no one knows, bedtime seems to be punctuated with scratching throughout the night. Having deal with eczema for 2+ years, most parents may have figured out a bedtime routine that seemed to be correlated with the least scratching. For us, it’s shower close to bedtime, air-conditioning, a little of bedtime reading and co-sleeping. I got so used to co-sleeping that I fall asleep pretty easily with an increasing weight on me.
Daytime is much better now with so many activities to do. Be careful with playdough with sparkles or playing with bubbles, either make it quick and wash hands quickly after or wear gloves (we used the first method but parents have told me gloves worked). iPad sometimes save the day, but we try to limit that. Activities that are carried out in non-air conditioned room continue to be a problem, like gym in non-airconditioned area. Marcie scratched a little but I saw an older child with eczema who really couldn’t carry on with the class and just sat on the mat and scratched and scratched. Gym or teachers of classes are not equipped to manage eczema so don’t expect them to. We ended up choosing ballet as that is always air-conditioned and wearing light clothing!
I wonder how your child’s eczema is or whether other allergic conditions start to affect your child. I wonder if your child is attending a preschool that he/she is nicely settled in and the teachers have already known how to care for your child. Marcie enrolled in Columbia Academy and the teachers are very kind and understanding – reminding Marcie not to scratch and getting her to moisturize. As children these days seem to be so much more alert and active, I recommend choosing a preschool that has many activities rather than idle time – the activities (be it reading, writing, drawing, dance or music) really help to distract an eczema child from scratching. Also, I’m thankful that the teachers are strict and very mindful of teasing, calling names or bullying – which can happen to an eczema child.
Finding alternative caregiver is still difficult – my parents took care of Marcie after full day preschool but every time school’s off or Marcie is sick, we will still take leave. Most of our leave were spent caring for Marcie and a short holiday. Packing for holidays is almost like moving the whole house as I always pack for 2-3 change of clothes within a day! We were very thankful that we had very enjoyable family time during this period and pray that your family gets many lovely moments together, despite the eczema.
Matthew 7:7-11
“Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you. For everyone who asks receives, and the one who seeks finds, and to the one who knocks it will be opened. Or which one of you, if his son asks him for bread, will give him a stone? Or if he asks for a fish, will give him a serpent? If you then, who are evil, know how to give good gifts to your children, how much more will your Father who is in heaven give good things to those who ask him”
In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!
The video covered today is “How to Treat Cold Sores”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.
MarcieMom: Thank you Dr Daniela for helping us with treatment of cold sores this week (and last week’s interview on pain management in shingles). For parents with eczema kids, we’re very vigilant about cold sores because of the risk of eczema herpeticum. We are looking forward to learn more about limiting the spread of cold sores at home and how to minimize the likelihood of eczema herpeticum.
Symptoms of cold sores – Burning, itching or tingling, small blisters on the lips or around the mouth which may merge, burst and crust over
Triggers of cold sores – stress, fatigue, flu/fever, sun exposure, hormonal changes, trauma (shaving cuts, cosmetic surgery)
Treatment – Apply topical anti-viral cream to slow the reproduction of the virus, cool the sores at home with a cool wet towel
Reduce pain by taking aspirin and ibuprofen
Avoid acidic fruits, such as tomatoes and citric fruits that can irritate the open skin
Anti-viral medication used within 72 hours of rash appearing may shorten the period of cold sores or be used for prevention for those with recurrent cold sores
Highly contagious – avoid kissing, sharing towel, cups, shavers, toothbrush or any other object that come into contact with the cold sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores
MarcieMom: Dr Daniela, cold sores are quite common but often, the people getting cold sores may not be aware of the severity of spreading to someone, for instance to a young child or to a person with severe eczema.
How contagious is cold sore? For instance, is my child safe as long as she doesn’t share anything with or touch the person with cold sore? Or is it super contagious? (The minute I see someone with cold sore, say in a train, I would leave the cabin. I imagine that he could have touched his cold sores, hold on to the train handle, and if I touch that or somewhere else in the train cabin that has contact with the cold sore, I would get it and possibly pass on to my child with eczema!) Is hand-washing sufficient to get rid of the cold sore virus? (Does anti-microbial product kill the virus or high temperature?)
Dr Daniela: The virus that causes cold sores spreads by direct contact so someone with a cold sore in the same cabin as a person with eczema would not pose a risk.Spread through shared items depends on if and how much bister or wound fluid could be transmitted. Usually this is very unlikely to take place in public spaces.In general, it’s a good idea not to touch strange fluids on trains! Handwashing and antimicrobial products would help to minimize this risk.
MarcieMom: I read on Mayo Clinic that the first-time getting the cold sore tend to be more serious that subsequent outbreaks; often, first-time cold sores may be accompanied by:
Fever
Painful eroded gums
Sore throat
Headache
Muscle aches
Swollen lymph nodes
Cold sores inside their mouths (for children under age 5)
Is each cold sore outbreak due to the same virus and therefore, there’s increased immunity with each outbreak? Will cold sores affect young children differently?
Dr Daniela: The first outbreak tends to be more severe with each subsequent outbreak being less involved.Just like the varicella virus of chickenpox can lie dormant in a nerve root and then cause shingles, the cold sore virus, herpes simplex, can lie dormant and reactivate.Children are less likely to be affected by cold sores but most people have been exposed to the virus by the time they reach adulthoods.
MarcieMom: For someone with severe eczema, the herpes simplex virus can infect compromised skin causingeczema herpeticum. Dr Daniela, what are the factors that increase the likelihood of someone with eczema getting eczema herpeticum from cold sores? Is any child with eczema at higher risk or is he/she at higher risk only if the eczema is severe or generalized over the whole body?
Dr Daniela: Close contact with caregivers who are prone to cold sores can increase the risk of transmission of the virus.Uncontrolled eczema leads to increased risk of open skin that could facilitate the virus spreading to the areas that are affected by eczema.This can happen with any open area but would be more likely depending on how extensive the eczema is and as a result how much of the skin barrier has been compromised.
MarcieMom: There are many parents whose eczema kids keep getting repeated episodes of eczema herpeticum. Apart from being on long-term anti-viral medication, are there other measures a child can take to reduce the likelihood of getting recurrent cold sores/eczema herpeticum?
Dr Daniella: Eczema herpeticum is the general term for when eczema is infected by herpes simplex virus, regardless of cause.The best thing to do to minimize risk is to keep the eczema well-controlled and well-hydrated, minimizing dry or open patches that could allow the virus to enter more readily.
Thank you Dr Daniela for being so patient with these questions on cold sores and bearing with me (a paranoid mom!) and my questions on eczema herpeticum. We have learnt much from you and understand better the preventive measures to take to limit the spread of cold sores.
When it’s daytime, the scratching is still there. Anything to not scratch?
Who can blame Mommy Kate? Eating book is not the best diet for a baby but sometimes, it beats the damage tht scratching can do. For #SkinishMom A to Z Eczema Scratching Distraction tips, see here. For more Mom NeedyZz cartoon, see here.
Caring for any baby, your baby especially, is an unique experience. Mothers do have shared experience though, being mom and going through pregnancy, child birth and caring for a baby who goes through the development milestones. Mothers of eczema children have even more in common, as the struggles of caring for a baby who has rashes all over, experience constant discomfort and itch can only be understood by those who’ve been through them. This series by MarcieMom, are letters to you, with words of encouragement and sharing of her own parenting struggles.
Dear Daddy & Mommy,
Congrats on your baby taking the first toddler step and it’s a joy, eczema or not! Being able to hold on to something and move about can be a great distraction from scratching. I remembered life got better for us when Marcie could explore her world more independently – there’re so many more activities she can do and many of them distracted her from scratching. By one year old, I seemed to have perfected parenting by distraction – it even distracted all the tantrums from the supposed ‘terrible two’ year! (Serious – there was no ‘terrible two’ for us at all, we really distracted every tantrum as that usually comes after the scratching, and we were so efficient at distracting Marcie from the first instance she scratched). Books, toys, teething rings, coloring, fresh change of clothes were things we lug around everywhere. We figured a little of backache would be much better than dealing with the damage from scratching (and ‘spoiling’ the day).
Marcie turning one year old was also the time when I rejoined the work force and enrolled her in an infant care. Many parents ask me if there is a preschool I would recommend and how receptive schools are to caring for eczema children. Well, I would say instead of the school brand, you really need to be comfortable with the caregivers and the teachers. Marcie was enrolled in PCF infant care and one of the caregiver was a Christian lady who really loved Marcie. I remembered her calling me almost breaking down into tears as she reported that Marcie had been ‘tensing up’ for close to two hours (Marcie had a habit then of tensing up in a plank position, something she came up with on her own which we guessed was to stop herself from scratching – she had solid stomach muscles, no kidding). They took very good care of her, moisturizing her diligently and feeding her with the food that we prepared and also gradually introducing her to new foods.
But I know for many parents out there, the toddler years can continue to be difficult – some had to deal with terrible two and also the scratching that got even worse. If you haven’t found a doctor that you can trust or treatment hasn’t worked out, this may be a time of despair as you start wondering if the eczema will ever be outgrown and whether it can learn to other allergic conditions. Some of you would have to deal with preschools that don’t understand eczema or if your child has food allergies, preschools that don’t accept them. I remembered reading a research paper that said the best time to enroll in a preschool is from 9 to 15 months where the child is able to adapt to the increased bacteria and germs better than when younger or when older. Research is one thing though, finding a preschool that you are comfortable with may be another matter.
I pray that wherever you are, there will be caring teachers and caregivers who can take over part of the day/ full day care for your eczema toddler. I pray that you have understanding colleagues and bosses who accommodate if you have to take leave to care for your eczema child. I pray that your child will not fall sick too often and when he/she does, the scratching won’t be intensive (fever tends to trigger eczema flare-ups). I pray for joy and peace to be in your home. I would love to pray specifically for you, leave me a comment on your prayer requests.
Romans 15:13
May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope
In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!
The video covered today is “Shingles: Pain Management”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.
MarcieMom: Dr Daniela, thank you for helping out in this AAD video series. Shingles affects about 1 in 5 people and more common in people over the age of 50. However, it’s possible to get it at any age though, as my daughter with eczema and chickenpox (at age 2) had shingles at the age of 4! We’d like in this interview to learn more about managing the pain and the rash associated with shingles and pointers for an eczema child/patient with shingles.
Anyone can get shingles if they have the chicken pox virus (varicella zoster), either from having had chicken pox or from chicken pox vaccination
Shingles rash – More pain experienced than chickenpox, commonly in one region of the body and usually confined to one side of the body
Symptoms of Shingles – Area of skin that burns, tingles, itches or sensitive; begins as red spots that turn to raised areas and blisters in the same area. This is followed by crusting.
2 to 3 weeks for the blisters to heal with reducing pain
If pain, itch, numbness or tingling develops, it can last months to years
Anti-viral medication used within 72 hours of rash appearing may shorten the course of the rash and lessen the pain. After 72 hours, anti-viral medication can still lessen the pain.
At home – Cool the rash, apply calamine lotion, do not peel, pick at or pop the blisters, cover the rash with loose, sterile bandage and wear loose-fitting, cotton clothing
Shingles is contagious – can spread in the form of chicken pox to someone who has not had chicken pox or to the fetus of a pregnant person.
Questions answered by Dr Daniela Kroshinsky on Shingles : Pain Management
MarcieMom: Shingles is caused by reactivation of an infection that is dormant in a nerve and the area of skin supplied by the nerve. Dr Daniela, can you explain which nerves get infected most often and is that why most people get the shingles rash on their torso? In the video, it is mentioned that some people get it on their face – does a person’s age and immune system affect which nerves will get infected?Once infected, can it spread from one part to another of the body?
Dr Daniela: In general, shingles will arise in the area of the body that had the greatest concentration of blisters at the time of the chicken pox but it varies widely.Most chickenpox blisters arise on the torso.Once someone is infected, they can spread the lesions to other parts of theirs skin through contact with the blister fluid which contains active virus.In addition, people who have compromised immune systems may experience widening of the affected area beyond the initial skin patch fed by the nerve. This is called “disseminated zoster” and requires urgent attention and treatment.
Reducing Pain in Shingles
MarcieMom: We learnt in the video that anti-viral medication can help to reduce pain and pain relief measures at home can help. Why do certain people feel more pain than others? (Age, immune system, or existing medication they are on?) Are there any measures one can take to reduce the likelihood of prolonged pain, ie months after the rash has healed (Postherpetic neuralgia or PHN)?
Dr Daniela: There are many factorsthat can influence people’s perception of pain, many that we are still starting to understand.Starting antiviral medication as soon as possible is the most helpful tool to help minimize the risk of pain.If PAIN develops, seeking medical attention as soon as possible, including with a pain specialist if needed, can help to better manage these symptoms.
Lowering Likelihood of Shingles’ Complications
Apart from postherpetic neuralgia, there are other complications such as
Skin infection, from bacteria/germs
Shingles at the eye can cause eye inflammation
Muscle weakness (palsy) due to shingles infection of the motor nerve
MarcieMom: Of particular interest is skin infection. What are the factors that will increase the chance of skin infection and what measures should one take to reduce the chances of skin infection?
Is someone with eczema skin that is already colonized with staphylococcus aureus bacteria more likely to suffer from skin infection? If yes, is it advisable to clean the shingles rash with chlorhexidine?
Dr Daniela: Picking or touching the lesions can introduce bacteria that could create bacterial infection of the shingles. Keeping the lesions clean and covered helps to minimize this.With eczema in general, keeping eczema controlled and minimizing wounds helps to prevent secondary infection.It is not necessary to clean shingles with a medicated soap.Chlorhexidine can be irritating and can dry out skin, further exacerbating eczema and as such I would not recommend it be used for shingles.Keeping the lesions covered and clean with gentle care is usually sufficient.
Managing Shingles for those with Active Eczema
For some eczema children and adults, they may be on various courses of corticosteroids or immunosuppressant, such as prednisolone, mycophenolate mofetil and cyclosporine. Will taking such medication increases the risk of getting shingles?
Is it possible that shingle rash will appear over a patch of skin with eczema flare-up? If so, what topical medication should be applied? (still ok to apply topical corticosteroid over the eczema if shingles appear on the same patch?)
Dr Daniela: Immune-lowering medications can make it more likely that someone will have their shingles spread more widely so it is important to watch shingles as it develops to assess whether the eruption is spreading more widely, warranting more aggressive treatment. Once antiviral treatment has been started, topical steroids can be used cautiously to the eczema around the shingles lesions but it is important not to rub the viral lesions as it is possible to spread the viral particles and extend the infection.Anti-itch medications like antihistamines can be very helpful to control the symptoms of itch that can accompany eczema.
Thank you Dr Daniela for helping us to understand how to manage shingles and offering clarity for those suffering with eczema who also get shingles.
If only sleep comes so easily at night… for eczema baby
It’s strange isn’t it? Eczema baby doesn’t sleep well at night and sometimes fall asleep easily in the day. But yet no matter how tired they are (or how well rested or how anything!), sleep doesn’t come easy when it’s bedtime at night. For more Mom NeedyZz cartoon, see here.
Caring for any baby, your baby especially, is an unique experience. Mothers do have shared experience though, being mom and going through pregnancy, child birth and caring for a baby who goes through the development milestones. Mothers of eczema children have even more in common, as the struggles of caring for a baby who has rashes all over, experience constant discomfort and itch can only be understood by those who’ve been through them. This series by MarcieMom, are letters to you, with words of encouragement and sharing of her own parenting struggles.
Dear Daddy & Mommy,
Hopefully the past half year hasn’t been so rough and you’ve ‘enjoyed’ baby milestones like the baby sitting up, crawling and soon, learning to swallow! Thinking back of parenting Marcie from 6-12 months old, I recalled that starting solids was a time that drove me paranoid. Some of you who have been following my blog know that I’m supportive of allergy test as I believe that it can really help to pinpoint what to avoid. More importantly, what we DON’T HAVE TO AVOID. Without allergy testing, I even thought at one point that Marcie was allergic to the high chair as that was made of latex! Especially at a time of starting solids, it can be very frustrating to write in a food journal and try to observe when the rashes appear when there is no discernible pattern.
It was when Marcie was 7 months old that we brought her to the skin prick test – it’s not scary at all! For Marcie, likely the itch was normally so bad that the prick didn’t seem to bother her. She merely winced when her skin was pricked but otherwise, was not distressed by the test. It turned out that she was not allergic and it gave us a peace of mind as to what she can eat – finally, we can feed her without trying to link the foods she’s taking to the rashes. Moving to solids then became easier than feeding milk – something we struggled so much with in the first six months due to reflux.
This period I felt was a tough time as the baby really starts to have strength to scratch and can be quite hard to put back to sleep at night. Half a year of sleepless nights can also ‘break’ someone and the thought that it’s never getting better but worse is terrifying and trying. It is also the time when the mom gets back to work from her maternity leave and not finding someone to take care of an eczema baby can make getting back to work difficult.
I’m glad that I stayed at home for my baby’s first year. I could take care of her the way I like – feeding (she’s a good eater now, used to foods of many textures and fruits and vegetables, i.e. not the traditional asian porridge with fish diet), co-sleeping and caring for her skin. The baby’s skin has not yet matured and research has pointed to that a defective skin barrier can sensitize a baby to allergens where contact to allergens via skin lead to food allergy. Although it was difficult, I felt that being one on one with my baby helped with her skin and her development. There were fun moments when we learnt sign language to distract her from scratching and sing songs together. Even with eczema, I felt that I had a pleasant time with her especially when it’s leisure time when I don’t have to feed, cook or do chores.
At about 7+ months old when Marcie started on her one-time oral steroid course (prednisolone), I really cried anguish tears. Her eczema improved during the first few days of the reducing dosage course but came back after a week into the course when the dosage was reduced. I was so scared and wanted to stop the course but continued. I’m grateful that her eczema was under control after the two weeks’ course when towards the end of the course, the eczema improved again and was limited to certain areas. It was a scary time especially when you know the same medicine at higher dosage is for treating cancer and the wrong dosage can have serious side effects. To this day, I know that it is a blessing that Marcie recovered after the course as many other children whose eczema worsened – we don’t know how the body will react after the course and knowing that we’ve been blessed keeps my work for this blog going.
If you are seeing a doctor, make sure that you see one who you can trust. Eczema is a chronic condition and seeing a doctor who you don’t trust and don’t have time to answer your questions or dismiss your worries can be the catalyst for much negativity – blame between the parents, fear motivating you to try an alternative treatment and distrust of doctors.
Psalm 9:9-10
The Lord is a stronghold for the oppressed, a stronghold in times of trouble. And those who know your name put their trust in you, for you, O Lord, have not forsaken those who seek you
In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!
The video covered today is “How to Treat Sunburn”. For this video, I interviewed Dr. Thomas E. Rohrer, M.D., who is a dermatologic surgeon at SkinCare Physicians, and previously served as the Chief of Dermatologic Surgery at Boston University Medical Center and Boston Veterans Administration Hospital for eight years and as the Director of the Boston University Center for Cosmetic and Laser Surgery. Dr Rohrer is passionate about education and is the editor of six cosmetic and laser surgery textbooks and guest editor of numerous journals.
MarcieMom: Thank you Dr Rohrer for helping us with how to shave last week. This week, we are learning about how to treat sunburn and at the same time, learn about how sunburn affects eczema skin.
In the video, the key points on the treatment of sunburn were covered: (note: AAD has amended the video on Treatment of Sunburn but the contents in this blog post was still based on the previous video which is no longer available on Youtube. The video above features AAD’s updated video)
Get out of the sun
Take cool baths
Pat dry, moisturize while there’s still a layer of water on the skin
Choose creams with aloe vera
Apply hydrocortisone cream to reduce inflammation but do not treat with benzocaine
Take aspirin and ibuprofen
Drink extra water as the sunburn draws water from the skin and rest of the body
If there’re blisters from the sunburn, do not pop them but let them heal
Watch for signs of infection
The way to shower and moisturize looks the same for both sunburned skin and eczema skin – not hot bath, not rubbing dry (but pat dry), trapping more moisture on the skin after shower and moisturizing right after.
In a previous interview with Dr Robin Schaffran, we learnt that ultraviolet light rays penetrate through the epidermis and dermis layers of the skin and damage the DNA in skin cells, collagen and elastin in the dermis.
How to treat sunburn AAD Video with Dr Thomas Rohrer
MarcieMom: Dr Rohrer, what is it about the sunburned skin that makes it important to maximize the retention of skin moisture? What are the factors that affect the recovery of sunburned skin? (for instance, do certain conditions like eczema and psoriasis take longer to recover? Or whether skincare measures are taken after the sunburn?)
Dr Thomas: It is a good idea to try to maximize retention of skin moisture in everyone’s skin.When the skin is burnt it becomes even more important as there is increased loss of water through the damaged skin. Similarly, with eczema or other conditions that result in dry scaling skin, the increased permeability of the skin makes it more important to keep the skin well moisturized. Keeping the skin moisturized will allow it to function more normally and recover more quickly.
In the video, it seemed that hydrocortisone is applied liberally on the sunburned skin to reduce inflammation. A few questions to provide some guidelines to patients who have access to mild hydrocortisone cream and want to self-treat at home.
Potency – What % of hydrocortisone should the lotion/cream be?
Frequency – How frequent (in a day) can it be applied onto sunburned skin?
Duration – What would be the duration and is there a decreasing frequency of application during this period?
Amount – How much of hydrocortisone can be applied? What is the sunburned skin covers a large skin area?
Dr Rohrer: Hydrocortisone can help reduce inflammation. On the face, no more than the over the counter 1% hydrocortisone should be used.On other parts of the body a slightly stronger 2.5% formulation may be used.It is best not to use either more than twice a day and only for a short period of time.Most of the time only a couple of days are necessary before the burn feels much better.
MarcieMom: Benzocaine is mentioned not to be used. However, I read on Mayoclinic that benzocaine is used for sunburn and on Pubmed that benzocaine is effective for treating the pain (but not the itch) on sunburned skin. What are the reasons why benzocaine should not be used for sunburn treatment?
Dr Rohrer: While benzocaine preparations do help reduce pain, many people are or become sensitive to it.We frequently see allergic skin reactions to benzocaine and therefore do not recommend it for use with the majority of patients.
MarcieMom: Lastly for those with eczema, sun exposure is not recommended during eczema flare-ups.
How does sun exposure affect eczema skin?
Dr Rohrer: Sun exposure and sunburn are not recommended for anyone.While some people do find that mild sun exposure improves their eczema, it is not recommended as it adds to the cumulative radiation effect of the sun and can lead to skin cancers.
Thank you Dr Thomas for helping us with treatment of sunburn and clarifying questions we have on self-treating at home. Sun protection is important (see AAD Video on How to Apply Sunscreen with Dr Sonia Badreshia-Bansal MD on this blog).
