Who feels it’s hard to find babysitting help for your baby with eczema? (Hands up!) 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,
Big hugs to you for your newborn and I know if your baby has developed eczema in the first month, you’d have barely recovered and adjusted to your new mom role. Being a new mom is difficult – our own body recovering (I had some problems recovering as my baby was above 90% in birthweight), adjusting to feeding baby every few hours and heck, even figuring out how to breastfeed (not all things come natural to all moms!). Before we even figured out and settled into a routine, we realized that our baby Marcie is definitely not sleeping like a baby. For some of us, our baby is also not feeding well (reflux seems to occur more often in eczema babies). We also found out that the rashes on our baby is not baby acne, heat rash but rash that itches so much that our baby doesn’t sleep nor rest well.
I shared about a particular incident when Marcie (two months old) was sitting quietly in her netted chair (over metal frame) while I was cooking. I was thinking it was an amazing evening that she didn’t need attention every 2-3 minutes and I could at least get some cooking done without the stress. When I looked at her after the cooking, I saw that she had blood all over her neck and the reason for her ‘peace’ was that she had the metal frame to rub against her neck (to ease the itch). Another incident was when I dozed off for five minutes when Marcie was napping and I opened my eyes to the sound of scratching to see that her hands have escaped from the swaddling and scratching till blood dripped from behind her ears to her face. I did feel guilty but I also know it’s impossible to not cook, not feed my baby, not pee, not brush my teeth and I’ve really done what I could do.
It was especially tough starting from about four months old, where Marcie was too big to be swaddled and it was getting so difficult to stop her from scratching. Sometimes her swaddle had to be modified to around her hands and it did look like we’re tying her up. Usually it’s only for no more than five minutes so that I can rush off to prepare milk or go to the loo. I remembered the part-time cleaner for our home seeing that Marcie was being restrained and looked horrified. No mom would want to do that but it’s impossible to be holding her hands every minute – most times, she’s already being carried or in a sling or within close reach to keep her from scratching.
Night time was tough – we co-slept so that we can hold her hands when she’s scratching. When even that become impossible, we’d all wake up, moisturize and freshen up, re-start the bedtime routine for another 2-3 hours of sleep. Life sometimes seem to be on hold when caring for an eczema baby, yet it doesn’t – there are still chores to be done, day job to go to and the stress can really get to first-time parents who already struggle with coping with parenthood.
Be united with your spouse, seek help and don’t blame each other. Many family members or friends won’t understand what you’re going through and some would have more than a few words of ‘wisdom’ (even when they are not familiar with what eczema is). Shut off those noise, concentrate on your family – that’s what got me through and faith. Having a bible study group to provide support and having a God I can turn to (even if it is just to vent and to cry out) helps. The first few months of caring for a newborn is never easy and if you’re a first-time parent, you’d be learning loads and figuring how to care for your newborn (differently!) from month to month. Caring for a newborn with eczema is so much more difficult, don’t give up hope and let negativity takes over your heart and your family.
1 Thessalonians 5:14
And we urge you, brothers, admonish the idle, encourage the fainthearted, help the weak, be patient with them all
MarcieMom’s note:
I’ve been working on this blog for five years, and what keeps me going is that Marcie’s eczema has a purpose and her recovering (now localized eczema with occasional flare-ups) is a blessing and that I can help share this blessing by keeping this blog going – encouraging parents all over the world who are at lost and feel alone in caring for their eczema baby.
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 Shave”. 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: Dr Rohrer, thank you for helping out in this AAD video series. Shaving is something most men and women have to do regularly and it is not as simple as it looks – complications can arise from shaving and shaving can be complicated for those with existing skin conditions. We’d first cover how to shave safely and what those with eczema have to pay attention to when shaving.
Proper Way to Shave
In the video, the key steps in shaving are covered:
- Wet your skin and hair before shaving
- Apply shaving cream or gel
- Shave in the direction of hair growth
- Change blades after 5 to 7 shaves to minimize skin irritation
- Use shaver with sharp blades
- Not to try to shave off acne
I read that wetting the facial hair will allow it to absorb the moisture and a swollen hair is softer and easier to cut. It appears that warm water is best, either a few minutes from a moistened towel or after shower. I also come across that showering will open up the hair follicle and makes it easier to shave. The idea is that the easier it is to shave, the more likely a one-time pass is sufficient and thus, less likely to irritate the skin. Conversely, showering too long will cause the skin to wrinkle and harder to shave.
MarcieMom: Dr Rohrer, it seems to get quite ‘technical’ if one starts thinking about temperature and timing of wetting skin and hair before shaving. Can you explain
What happens to the skin, hair and hair follicles when they are wet
Why wet skin, hair and follicle makes shaving easier
Whether there is an optimal wetness and how important it is to get this right
Dr Rohrer: You are correct; when hair is wet, it absorbs a little water and becomes softer. This allows the razor to cut the hair more easily. In general, things expand when they are warmed. So using warm water will expand the hair, skin, and pores more than cold water. This allows more water to be absorbed into the skin and hair and makes the hair softer than if cold water was used. In addition, water in and of itself is a slight lubricant so it helps the razor glide over skin better than dry skin. It is difficult to wet the skin on the face, underarms, or legs too much. These areas do not tend to get bloated like the fingers may after long water exposure.
MarcieMom: Likewise for the application of shaving cream or gel, there appears to be ‘good practices’ such as leaving the shaving cream on the skin for 3 minutes, brushing the cream into the hair with a shaving brush to lift the hairs and to ensure that the hairs get coated with the cream.
Is a shaving cream necessary for all parts of the body or only facial hair for men? If lubricating is the main purpose of shaving cream, will showering with bath oil achieve the same purpose? Is there an issue of too much shaving cream?
Dr Rohrer: I don’t think one can use too much shaving cream. The point of a shaving cream is to soften the skin and hair and act as a lubricant and barrier between the razor and the skin. If someone does not experience discomfort when using bath oils in the shower then that would be fine to use. If they do have some irritation then they could add a shaving cream or gel.
Shaving for those with Sensitive Skin
Throughout the shaving process, there are quite a few steps that may lead to irritation for those with sensitive skin. For instance,
Shaving cream – using a shaving cream that contain irritants (for instance, fragrance and Triethanolamine) or having surfactants that are common allergens
Act of shaving – irritation from friction, damage to epidermis, or repeated shaving?
MarcieMom: Dr Rohrer, what should someone with sensitive skin take note of when shaving?
Dr Rohrer: Shaving foams out of a store bought can contain a great deal of alcohol and can dry the skin out. If someone has sensitive skin it makes sense to use a shaving gel, cream, or soap. These products contain more glycerin than alcohol and do not dry the skin out. It is also important to moisturize the skin right after shaving. Men should use a moisturizer that contains sunscreen with an SPF of 15 or 30 in it. This will give a good base coat on the face every morning.
Shaving for those with Dry Skin and Eczema
One issue with dry shaving is that the razor may get clogged up with dead skin cells. A clogged razor doesn’t give a close shave and there is a risk of nicks. For those with dry skin or eczema, there may be more dead skin cells. Also shaving can cause micro-tears in the skin and eczema patients may get the micro-tears more easily or more prone to infection at the micro-tears.
MarcieMom: Dr Rohrer, should shaving over skin that has active eczema flare-up be avoided? What should an eczema sufferer take note of during shaving?
Dr Rohrer: If someone has eczema or any other skin condition, it should be treated and controlled medically. There are great treatments for these diseases that can get them under control. The AAD is a wonderful resource for people to use to get more information about their particular condition. If there is a flare-up, then caution should be used when shaving over these areas. An electric razor is less likely to cut skin than a typical blade razor. These devices can be used in areas that have been compromised by a dermatologic condition. Moisturizing after shaving will also help.
Thank you Dr Thomas for helping us to understand shaving and how preparation is important. For those of us with eczema or sensitive skin, it is also most helpful to understand how shaving affects our skin.
See last week’s cartoon on why Kate’s got so used to carrying her baby with eczema. For more Mom NeedyZz cartoon, see here.
Inspired by my back to school eczema tips, I wondered what letter a parent would write to inform the school of the child’s eczema and skincare.This is the final of a series of four #SkinishMom letters written to different schools (conjured up by my imagination and all schools are fictitious!).
Dear Principal,
I love fresh air and I know the school encourages your students to head outdoors and put in great effort in landscaping. The classrooms are not air-conditioned, allowing the children to appreciate the fresh air and be ‘closer’ to the greenery. I don’t use much air-conditioning at home too, given that it is a breeding ground for mold and bacteria as well as the much-feared ‘sick building syndrome’. It is also drying for the skin (an aspect that is bad for my child’s eczema) and potentially traps much dust.
But, in these hot summer months, my child with eczema literally can’t live without air-conditioning. His eczema is triggered by heat and sweat – the exact reason for why sweat irritates isn’t clear; it could be the minerals in the sweat, the crystallized sweat crystal or the changing skin pH. However, he really needs to be kept cool, I can offer the following solutions:
- I will get a portable air-conditioner for my child’s class (though I can’t possibly buy one for every class)
- Arrange for afternoon classes in an air-conditioned room like the computer room
- Seat my child under the fan where it is most cooling
- Allow him time to freshen up in between classes
I’m not a parent who sweat over the small stuff and this matter is certainly not small. I can have my child’s dermatologist write you a letter to justify the exceptions made for my child.
Thank you
#SkinishMom Disclaimer : A little tongue-in-cheek, don’t cut and paste and send to your child’s school!
Last week, we’ve covered the 10 Moisturizer Selection Tips. This week, (as promised!), I’ve compiled ingredient listing for common moisturizers found in pharmacy (in Singapore/Asia as some brands are marketed under different brand names in the US/UK).
There are broadly 3 generations of moisturizers:
1st generation moisturizers are occlusive – these act as a layer to prevent transepidermal water loss (TEWL). These ingredients are petrolatum, mineral oil, paraffin and triglycerides. Creams/ointments with higher concentration of these are sometimes termed ‘intensive’, ‘suitable for very dry skin’ as the ointment does not evaporate as quickly as lotion but it often leaves a stain on clothing or doesn’t feel as comfortable as lotion.
2nd generation moisturizers are humectant – these are sometimes referred to having natural moisturizing factors (NMFs) as they can pull moisture from the environment to the upper layer of skin (and also from inner layer of skin to the upper layer). These ingredients include glycerin, hyaluronic acid, sodium salt of pyrrolidone carboxylic acid, sorbitol, lecithin, panthenol, salicornia extract, amino acids and urea.
3rd generation moisturizers have skin repair properties – often a combination of both occlusive and humectant, these moisturizers include ingredients that help to repair the skin barrier, either by replacing lost skin components (ceramides and skin lipids) or reduce inflammation, itch and bacterial activity.
A moisturizer’s quality is also dependent on how well it delivers these properties (stability and structure) and what ingredients it does not have (which are allergens). Safety and product quality control are also important considerations.
Let’s zoom into the ingredient list of the below common moisturizers and see what we can understand they contain!
| Brands | Ingredients | Irritants | Free from Irritants/ pH |
| Aqueous cream
Functions: Occlusive Number of ingredients: 7 |
Liquid Paraffin 6% w/w, White Soft Paraffin 15% w/w, purified water, emulsifying wax (containing cetostearyl alcohol, sodium lauryl sulfate), chlorocresol 0.1% w/w | Sodium lauryl sulfate, Cetostearyl alcohol, Paraffin may irritate | Free from perfume, propylene glycol, lanolin, colorpH 6.5 to 7.5 |
| QV cream
Functions: Occlusive, Humectant Number of ingredients: 14 |
Aqua (Water), Paraffinum Liquidum, Glycerin, Petrolatum, Cetearyl Alcohol, Squalane, Dimethicone, Ceteth-20, Glyceryl Stearate SE, Stearic Acid, Laureth-3, Glyceryl Stearate, Methylparaben, Dichlorobenzyl Alcohol | Parabens, Dichlorobenzyl alcohol (preservatives that kill microbes so that product won’t spoil before expiry), Paraffin, petrolatum, Cetearyl alcohol may irritate | Free from perfume, propylene glycol, lanolin, color
pH 6 |
| QV Intensive Moisturiser
Functions: Occlusive, Humectant Number of ingredients: 7 Aquaphor Healing Ointment Functions: Occlusive, Humectant (bisabolol enhance healing) Number of ingredients: 7 |
QV Intensive Moisturizer
Light Liquid Paraffin (Paraffinum Liquidum), Petrolatum, Isopropyl Myristate, Polyethylene, Cetearyl Alcohol, Silica, Dimethicone Aquaphor Healing Ointment Petrolatum (41%), Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol |
Polyethylene, silica (mineral oil) may irritateLanolin | QV
Free from perfume, propylene glycol, lanolin, lanolin, paraben, colorpH not disclosed Aquaphor Free from perfume, propylene glycol, paraben, color pH not disclosed |
| Physiogel AI cream
Functions: Occlusive, humectant, repair Number of ingredients: 16 |
Aqua, Olea Europaea Fruit Oil, Glycerin, Pentylene Glycol, Olus Oil, Elaeis Guineensis Oil, Hydrogenated Lecithin, Squalane, Betaine, Palmitamide MEA (PEA), Sarcosine, Acetamide MEA, Hydroxyethylcellulose, Carbomer, Sodium Carbomer, Xanthan Gum | – | Free from perfume, propylene glycol, lanolin, paraben, colorpH not disclosed |
| Physiogel Daily Moisture Therapy Cream
Functions: Occlusive, humectant, repair Number of ingredients: 13
Cerave Moisturizing Cream Functions: Occlusive, humectant, repair Number of ingredients: 25 |
Physiogel
Aqua, Caprylic/Capric Triglyceride, Glycerin, Pentylene Glycol, Cocos Nucifera Oil, Hydrogenated Lecithin, Butyrospermum Parkii Butter, Hydroxyethylcellulose, Squalane, Carbomer, Xanthan Gum, Sodium Carbomer, Ceramide 3 Cerave Purified Water, Glycerin, Ceteareth-20 and Cetearyl Alcohol, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate, Cetearyl Alcohol, Cetyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Petrolatum, Dimethicone, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Disodium EDTA, Phenoxyethanol, Methylparaben, Propylparaben, Phytosphingosine, Carbomer, Xanthan Gum |
Cetearyl Alcohol, petrolatum, parabens | Physogel
Free from perfume, propylene glycol, lanolin, paraben, color pH not disclosed
Cerave Free from perfume, propylene glycol, lanolin, color pH not disclosed |
| Cetaphil moisturizing cream
Functions: Occlusive, humectant Number of ingredients: 20 |
Water, glycerin, petrolatum, dicaprylyl ether, dimethicone, glyceryl stearate, Cetearyl alcohol, prunus amygdalus dulcis (sweet almond) oil, PEG-30 stearate, tocopheryl acetate, acrylates/C10-30 alkyl acrylate crosspolymer, dimethiconol, benzyl alcohol, phenoxyethanol, methylparaben, propylparaben, glyceryl acrylate/acrylic acid copolymer, propylene glycol, disodium EDTA, sodium hydroxide | Parabens, propylene glycol, Benzyl alcohol is a natural grape preservative and scent, Petrolatum, cetearyl alcohol may irritate, Sodium hydroxide is to modulate pH of product and can be an irritant | Free from lanolin, colorpH not disclosed |
| Cetaphil intensive moisturizing cream
Functions: Occlusive, humectant, repair Shea butter is a plant lipid, Chlorhexidine to reduce bacteria Number of ingredients: 15
|
Water, glycerin, PEG-2 stearate, cetearyl alcohol, Butyrospermum parkii (shea butter), ethylhexyl methoxycinnamate, oleth-12, dimethicone, stearyl alcohol, glyceryl stearate, PEG-100 stearate, methylparaben, tocopherol, arginine PCA, chlorhexidine digluconate | Parabens, Cetearyl alcohol may irritate | Free from lanolin, propylene glycol, fragrancepH not disclosed |
| Cetaphil RestoraDerm Eczema Calming Body Lotion
Functions: Occlusive, humectant, repair Number of ingredients: 28 |
Water, Glycerin, Caprylic/Capric Triglyceride, Helianthus Annus (Sunflower) Seed Oil, Pentylene Glycol, Butyrospermum Parkii (Shea Butter), Sorbitol, Cyclopentasiloxane, Cetearyl Alcohol, Behenyl Alcohol, Glyceryl Stearate, Tocopheryl Acetate, Hydroxypalmitoyl Sphinganine, Niacinamide, Allantoin, Panthenol, Arginine, Disodium Ethylene Dicocamide PEG-15 Disulfate, Glyceryl Stearate Citrate, Sodium PCA, Ceteareth-20, Sodium Polyacrylate, Caprylyl Glycol, Citric Acid, Dimethiconol, Disodium EDTA, Sodium Hyaluronate, Cetyl Alcohol | Cetearyl alcohol may irritate | Free from perfume, lanolin, propylene glycol, paraben, colorpH not disclosed |
| Ezerra cream
Functions: Occlusive, humectant, repair (contain antihistamine for itch relief) Number of ingredients: 17 |
Water, Oleic/Linoleic Triglyceride, Saccharide Isomerate, Hydrogenated Polydecene, Pentaerythrityl Distearate, Glycerin, Cetearyl Alcohol, Dimethicone, Spent Grain Wax, Butyrospermum Parkii (Shea Butter) Extract, Argania Spinosa Kernel Oil, Phenoxyethanol, Sodium Stearyl Glutamate, Acrylates/ C10-C30 Alkyl Acrylate Crosspolymer, Ethylhexylglycerin, Octadecyl Di-t-butyl-4-hydroxyhydrocinnamate, Disodium EDTA | Cetearyl Alcohol may irritate | Free from perfume, lanolin, paraben, propylene glycol, colorpH not disclosed |
MarcieMom’s take:
On 1st generation moisturizer – The low cost emollient tend to perform mainly occlusive function, with ingredients such as petrolatum, paraffin and emulsifying agent to thicken the moisturizer. If you don’t have sensitive skin, or patch tested not to be affected by these ingredients, basic creams can help prevent moisture loss. However, if you have eczema skin, it is not suitable as these mosturizers tend to be more alkaline than our skin pH and the ingredients may irritate your skin. There is also no ingredient in these creams to help repair your skin barrier.
Pros: Low cost, perform basic occlusive function
Cons: Irritate sensitive skin, drying for skin for alkaline products, no skin barrier repair function
On 2nd generation moisturizer – If water is the first ingredient, it is likely that preservatives have to be used to keep the product from spoiling. Paraben is the ingredient that has received a lot of negative press due to its linkage with cancer. This is not proven but paraben is one of the more common irritants. Other names for parabens from (Derm Net NZ) are:
Methylparaben
Ethylparaben
Propylparaben
Butylparaben
Benzyl-parahydroxybenzoate (p-hydroxybenzoate)
Methyl-parahydroxybenzoate (p-hydroxybenzate)
Ethyl-parahydroxybenzoate (p-hydroxybenzoate)
Propyl-parahydroxybenzoate (p-hydroxybenzoate)
Butyl-parahydroxybenzoate (p-hydroxybenzoate)
Parahydroxybenzoate (p-hydroxybenzoate)
I like to look at the number of ingredients and the absence of common irritants when comparing second generation moisturizer. For the same price range, I’d prefer to choose one with fewer ingredients and less irritants to reduce likelihood of irritating my eczema child’s skin. Another way is to rotate your moisturizer (in the hope!) to reduce the duration which your skin is exposed to the irritant.
Pros: Hydrate skin, some brands are affordable
Cons: Granted for the price range, you may not get ingredients like ceramides, lipids that repair your skin. But don’t choose one with many ingredients or irritants.
On 3rd generation moisturizer – These more costly moisturizers are less likely to have irritants (still check though, don’t take for granted!) but whether it is worth the price is another matter. % of ingredients is not listed and the stability of how long the reparative function last is not known. Personally, I use these on weeks where my child’s skin tend to be persistently dry or itchy despite moisturizing regularly with 1st & 2nd generation moisturizer.
Pros: Repair skin
Cons: Cost prohibitive + paying so much means you want to be sure that ingredients are not common irritants
I have to admit that this post is a very amateur attempt to analyse skincare products. Many websites that specialize in skincare products do a much better job, such as Paula’s Choice and EWG’s Skin Deep. What I hope to have helped is a way for lay(mom and dad) to make sense of products’ ingredient list and choose a better product for your child. I’d be contacting the brands mentioned in this post and see if they have more to add on their products. (If you don’t see updates or comments in this post, it means the brands mentioned have not responded.)
This October, the Eczema Support Group will hold the first session, just for parents. We aim to bring parents who are facing similar issues together, to share about their experiences and learn effective coping methods.
Main focus : Emotional support and shared experiences among parents with eczema children
October 10, Saturday10am session will have a dermatologist to share with the parents and the support group sharing by parents will be facilitated by a medical social worker from National Skin Centre.
10 a.m. – Meet at Staff Lounge at National Skin Centre Level 4
1st Half till 10.45am – Dermatologist’s talk
2nd Half till 11.45am – Parents’ sharing
Light refreshments will be provided and for parents who bring their children, the children will have art activity in a separate room on the same floor.
Do RSVP (email [email protected]) so that we can prepare the refreshment and art materials. We love to hear from you and your response will help determine future support group’s session, see you!
Note: This session is open to eczema support group members (can sign up upon registration), past and present National Skin Centre’s patients
Who shares this experience? Fearing that our eczema babies will scratch, we ended up carrying them to sleep, nap, cook, work and what else? Share in the comments and it’d be put into a cartoon for other moms to lol 🙂 We all need some light-hearted moments… I know I do! For more Mom NeedyZz cartoon, see here.
Inspired by my back to school eczema tips, I wondered what letter a parent would write to inform the school of the child’s eczema and skincare.This is the third of a series of four #SkinishMom letters written to different schools (conjured up by my imagination and all schools are fictitious!).
Dear Teacher,
Thank you for guiding and helping my child in your class. I know that you have been tolerant of his scratching, due to eczema – it’s impossible to control the itch (in fact, scientists are just beginning to understand how the itch signals can be blocked). I know you have assigned my child to sit near the window, and that he cannot change his seat. There are however, a few problems with this ‘premier window seat’:
- It’s a ‘hot’ seat – Not as in my child gets called to answer questions but that it literally heats up by noon. Increased temperature and sweat causes my child to itch and eczema flare.
- It’s near to dust – The windows have dust in the ledge and that irritates my child’s skin. I’m not a fan of cleaning windows and certainly don’t expect the school to have window’s ledges cleaned.
- It’s near to the radiator – I would expect when winter comes and the radiator is on, the heat from it will certainly trigger eczema rash.
I’d be grateful if you can re-assign my child’s seat. I’m aware that teachers assign seats for a reason (or many reasons) and that your original arrangement certainly has its basis. Perhaps another factor to consider is it is distracting both for you, my child and the classmates sitting behind him to see him scratching non-stop.
Thank you
#SkinishMom Disclaimer : A little tongue-in-cheek, don’t cut and paste and send to your child’s school!
In June 2015, there was an eczema public forum held at the National Skin Centre Singapore and one of the talks was “Making the Right Choices for Your Skincare – Expert tips on Selection of the Right Moisturizer and Skincare Products” by A/P Professor Giam Yoke Chin. There was a segment of her talk where she shared about the evolution of moisturizer and what key ingredients are in them.
Seeing the high level of interest that the audience had in moisturizers, I’m inspired to write a post on the common moisturizers found in pharmacy (in Singapore/Asia as some brands are marketed under different brand names in the US/UK). So this 2-post series is mix of what I’ve learnt in Prof Giam’s talk and my own compilation of moisturizer’s ingredients; let me know (in the comments) what moisturiser has worked for you/ your child with eczema!
10 Moisturizer Selection Tips
We are blessed with many dermatologists and skincare experts sharing their views on moisturizer in this blog, here are the 10 Moisturizer’s Must Know I’ve learnt from them:
1. Labeling such as the term ‘natural‘, ‘hypoallergenic‘, ‘organic‘ (if no certification is mentioned), ‘dermatologist-tested’ (one dermatologist is also ‘dermatologist-tested’), ‘for sensitive skin’, ‘for baby skin’ are unregulated and up to the product company to define.
2. The fewer the ingredients, the less likelihood for hypersensitive skin reaction
3. The first ingredient has the highest content – typically, if it’s water, it means it’s lotion form. Having water in the ingredients will mean requiring preservatives to keep it from spoiling. A lotion/cream can deliver the ingredients to the skin faster as it’s easier to be absorbed vs ointment that’s longer lasting.
4. Use product within expiry date and period after opening date
5. Do not use moisturizer that is too expensive to use of sufficient amount for your skin (Eczema skin requires quite a lot of moisturizing!)
6. Avoid top irritants in a moisturizer such as perfume, fragrance, preservatives, parabens, propylene glycol, lanolin, colorant/dye, sodium lauryl sulphate
7. Moisturizers should hydrate your skin. if you’re not able to apply it frequently, you may want to opt for ointment (for longer lasting effect). If you can apply frequently (and depending on the weather/season), a lotion/cream may feel better on hot, humid days. Look out for ingredients such as cross-linked hyaluronic acid, sodium salt of pyrrolidone carboxylic acid, panthenol, salicornia extract, glycerin, amino acids and urea that can hydrate your skin. These are typically called natural moisturizing factors, referring to moisturizers with humectant property that attract water from environment to the skin.
8. If you can afford, use moisturizer that has the ability to repair the skin barrier. These ingredients that help restore the skin barrier, especially in increasing the ceramides, fatty acids and cholesterol in skin which is deficient for those with eczema.
9. Select products that are close to the skin pH which is slightly acidic from 4.6 to 5.6. The more alkaline a product, the more drying it is for the skin. It has been studied that the skin pH can affect enzyme balance on our skin and the more alkaline a product, the less enzymes are produced that are able to increase our skin’s ceramides and lipids. Reduced ceramides lead to our skin not being able to protect against skin inflammation and bacteria.
10. There are creams that have ingredients to reduce itch, inflammation and bacteria, for instance, antioxidants, oatmeal, acetyl-hexapeptide-15 and honey.
References:
Skin pH with Dr Cheryl Lee – Over Acidic or Over Alkaline
Skin pH with Dr Cheryl Lee – Eczema and Skin pH
Sensitive Skin Product series with Dr Verallo-Rowell and Laura Verallo Rowell Bertotto – How many ingredients
Sensitive Skin Product series with Dr Verallo-Rowell and Laura Verallo Rowell Bertotto – What ingredients to avoid
Sensitive Skin Product series with Dr Verallo-Rowell and Laura Verallo Rowell Bertotto – Understanding ingredients and patch test
Science of skincare products with Dr Elisabeth Briand – Eczema Supportive Care
Science of skincare products with Dr Elisabeth Briand – Stability
Science of skincare products with Dr Elisabeth Briand – Safety and Product Expiry Date
Reinforcing amount to moisturize eczema child with Dr Jeff Benabio
International Dermal Institute – Repairing Ingredients
Dermascope – Healthy skin starts with a healthy barrier
Tweet @MarcieMom your different ways of sleeping with your eczema baby and she will draw it in Kate’s life! For more Mom NeedyZz cartoon, see here.
Inspired by my back to school eczema tips, I wondered what letter a parent would write to inform the school of the child’s eczema and skincare.This is the second of a series of four #SkinishMom letters written to different schools (conjured up by my imagination and all schools are fictitious!).
Dear Principal,
I’m in full agreement with your uniform policy and having kids wear uniform give them a sense of identity with the school and eliminates issues with wearing home clothes such as differing fashion views on what’s ‘proper’ wear (and in this all-inclusive age, we almost fear saying someone else’s view is wrong!).
Sadly, my child cannot wear the uniform – not as it is. The current material has 60% polyester, with seams that are very rough and irritate her skin. We have tried, really tried very hard. The first day of wearing the uniform, her eczema flare-up all over her torso, especially the neck and skin areas in contact with the seams. On the second day, it just gets worse. If you’d be so kind to imagine and put yourself in her shoes, it’s like wearing a clothing that has many ants. These are shoes difficult to fit, and which principal can force the child under his care to wear an ant-filled clothing?
I can think of many ways to resolve this uniform problem:
- Allow me to custom-make a similar uniform without using the same material and have seams on the outside
- Allow my child to wear the t-shirt and shorts attire that is all cotton
- Allow my child to wear an inner garment for eczema children on no-exercise days and wear t-shirt and shorts on exercise days
- Allow my child to wear the t-shirt and shorts after lunch to reduce time with the uniform on
With all the alternatives, and none proposing to disregard your school’s uniform policy, surely there is some tolerance within your policy to allow for one of the above alternative? Also, deeply appreciate if you can put me in contact with the other parents – together we can negotiate with the uniform maker. Do you need a letter from the doctor explaining why the uniform as it is cannot be worn by my child?
Thank you
#SkinishMom Disclaimer : A little tongue-in-cheek, don’t cut and paste and send to your child’s school!
This is a 3-part series focused on hand eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain further the type of hand eczema, its cause, treatment options and daily hand care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology.
The first 2 part of the series are:
- Basics of hand rash and different types of hand eczema, its symptoms and triggers
- Treatment of Hand Eczema
Hand Eczema that Does Not Go Away
If the skin at the hand is too thick and hard, it will be more difficult for medication to penetrate deeply enough to improve the skin inflammation. This increases the likelihood of untreated and persistent hand eczema. Another reason why hand eczema does not go away could be the continued exposure to an irritant which has yet to be identified. Patch testing is then recommended.
MarcieMom: Dr Lynn, what are the ways to treat hand eczema when the skin has thickened?
Dr Lynn: For thickened skin, topical steroids of higher potency should be used. Ointment based steroids can be used instead of cream based steroids. Liberal and regular use of moisturizers should be emphasized. The use of wet wraps (occluding the creams with a wet glove) can also help to increase the penetration of the creams across the thickened skin.
Phototherpy (controlled use of UVA or UVB light) is sometimes used in this type of hand eczema.
MarcieMom: How often do you see in your practice that patients cannot recover due to continued exposure to allergens in their moisturizers or topical medication? When should one suspect that is the case and request for a patch test?
Dr Lynn: Allergy to topical medication and moisturizers are extremely rare. If patient had avoided all other possible irritants or allergens and have been compliant with medication and not getting better but worse, then the unlikely possibility of allergy to medication/ moisturizer can be considered and a patch test performed.
Daily Hand Care for Those with Sensitive Skin
Some skincare tips for those with hand eczema or sensitive skin are:
- Avoid frequent hand-washing or washing hands in hot water
- Moisturize after exposure to water
- Avoid irritants and triggers
MarcieMom: Dr Lynn, for those with hand eczema, should they be using an ointment instead of a lotion so that more of the moisturizer can be retained even with hand washing? Also, an ointment will be more protective against irritants.
Dr Lynn: Generally, ointment tend to be better absorbed and lock in the moisturizer for a longer period as compared to lotions. By repairing the skin barrier function faster than lotion, they tend to protect the skin and allow the skin to heal faster. They generally contain fewer preservatives and additives than creams.
MarcieMom: For occupations such as caterers, hair dressers, nurses and mechanics, will wearing gloves during their jobs help to reduce contact dermatitis? If yes, what type of gloves should they wear?
(I read some recommendations for vinyl gloves while others recommend cotton-lined gloves. Avoid latex gloves.) Are there any guidance on how long one should wear glove (since that trap sweat which is a possible irritant)?
Dr Lynn: Yes, wearing gloves is recommended for those in certain occupations where contact with certain irritants is repeated and prolonged. I will generally recommend cotton gloves as they generally do not cause irritation. However, if contact with water is necessary, use a water- proof gloves. If wearing latex gloves makes the rash worse, a patch test can be done to determine latex allergy.
Glove choice should be appropriate to the situation. Alternative to latex gloves include vinyl, nitrile and chloroprene. However, some of the chemicals used in the manufacture of non-latex gloves can also cause hypersensitivity.
I will advise patients to remove the gloves after about 20 minutes to allow sweat to evaporate. Dry the gloves inside out when not in use.
Thank you Dr Lynn for sharing with us skincare for hand eczema and understanding possible reasons why hand eczema is persistent. Hand eczema affects many adults and learning more about it help to manage the rash better.
Last updated on 17 November, 2024 12:12 pm
Kate’s running out of ideas for stealing more sleep. Any tips to share with her? (Comment if you do and I’d draw it into her life!) For more Mom NeedyZz cartoon, see here.
Inspired by my back to school eczema tips, I wondered what letter a parent would write to inform the school of the child’s eczema and skincare. Starting from this week, this is a series of four #SkinishMom letters written to different schools (conjured up by my imagination and all schools are fictitious!).
Dear Principal,
I love that my child gets to study in your school and I would love it better if you allow your teachers to help my child with her eczema. Eczema is a chronic skin condition, and it waxes and wanes. It is characterized by dry skin, severe itch and reddish rash. As a parent who doesn’t want to impose additional work on the school’s system, I would have done all that I can for my child’s eczema when she is not in school (so that there is less that your teachers need to do). But it’s not always possible, and it’s made impossible by your no-touch policy.
Imagine with me:
After exercise class – Sweat triggers her eczema flare-ups. At home, we would give her a shower and moisturize immediately after (the dermatologist’s rule is within 3 minutes). Yet the no-touch policy precludes your teachers from helping. We have taught our child to moisturize on her own, but can you help with moisturizing her back? If not, she will keep on scratching if her skin is dry. It seems akin to letting a child go hungry for hours (in this case itchy) when offering a snack that takes few minutes will help (in this case, literally seconds to moisturize).
Before heading outdoors – Child’s skin is thinner and more vulnerable to sunburn. Eczema and sunburn don’t go well and likely to worsen eczema flare-ups. Even without eczema, sun protection is essential to prevent skin cancer and sunburn. Sunburn in young children, with fever and blistering, requires immediate medical attention – surely, this is something to avoid. Or is the plan here to not apply sunscreen on a child, take her out for hours, get sunburn and call the parent to pick up the child to see a doctor all in the name of your no-touch policy?
I’m fully aware of the reasons behind the no-touch policy – touching a child may be viewed by some with suspicion and if reported, difficult to substantiate basis for the touch. I would like to make it simple by giving permission to your teachers or nurses to:
- Apply moisturizer for my child on her back after shower
- Apply moisturizer for my child on her torso, back, arms, hands and legs anytime
- Apply sunscreen at skin areas exposed to sun, and that includes face, neck, upper shoulders, hands, arms and legs anytime up to 30 minutes before heading outdoors
Thank you
#SkinishMom Disclaimer : A little tongue-in-cheek, don’t cut and paste and send to your child’s school!
This is a 3-part series focused on hand eczema, with the privilege of having Dr Lynn Chiam, of Children & Adult Skin Hair Laser Clinic, to help explain further the type of hand eczema, its cause, treatment options and daily hand care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology.
Last week, we covered the basics of hand rash and different types of hand eczema, its symptoms and triggers. This week, we will focus on treatment.
Common treatment for Hand Eczema
- Topical corticosteroids
- Topical calcineurin inhibitors e.g. tacrolimus and pimecrolimus
- Antihistamines
- Phototherapy
MarcieMom: Dr Lynn, a few questions on common treatment options for hand eczema:
- For topical corticosteroids, are there typical potencies or type of corticosteroids (such as anti-fungal/ anti-bacterial) that are commonly prescribed for hand eczema?
Dr Lynn: Topical steroids are the mainstay of treatment for hand eczema. Topical steroids reduce the redness and itch effectively by decreasing skin inflammation. Due to the thickness of the skin on the hands, higher potency steroid creams are usually used. When used for the correct duration and in the correct amount, side effects are very minimal. Steroid creams should only be used on the affected areas and are prescribed for twice a day use. When the condition has improved, lower potency creams can be used. Sometimes, decreasing the frequency of the creams is also practiced. Topical steroids should always be used together with moisturizers in the treatment of hand eczema.
In cases with secondary bacterial infection (especially in those with oozing and cracked skin), topical antibiotic creams can be used in conjunction with steroid creams.
- For topical calcineurin inhibitor, should sunscreen be used on sun-exposed part of the hand?
Dr Lynn: Topical calcineurin inhibitors (TCIs) are an alternative to steroid creams. As they have a slow onset of action, topical steroids are still used in the initially period. Topical calcineurin inhibitors are better used as maintenance agents. Side effects include a mild and temporary burning sensation. They are safe to use and in many studies over many years, they have not been associated with any major side effects or cancers.
Eczema guidelines propose that appropriate sun protection measures, such as minimisation of the time in the sun, use of sunscreen after applying TCI and covering the skin with appropriate clothing.
- Are there any precautions to take after applying the topical medication? e.g. not touch food, water?
Dr Lynn: I will normally advise my patients to allow about 15-30 minutes for the creams to be absorbed and to avoid washing hands during this period. Wearing a cloth glove can aid in the absorption and penetration of the creams and allows the person to do work without the creams getting in the way.
- Does avoidance of triggers play a larger role in management of hand eczema than medication? Is it likely that without exposure to triggers, skin inflammation at the hands will heal itself?
Dr Lynn: Although avoiding triggers does help significantly to prevent the eczema from progressing or being more severe, the use of anti-inflammatory agents like topical steroids and calcineurin inhibitors together with moisturizers are still essential to heal the skin.
MarcieMom: I read online of a new drug, oral alitretinoin, that has been reported to help with severe hand eczema. However, it has side effects such as headache, dry and flushing skin. It is also not recommended for pregnant women due to possibility of birth defect.
What is Alitretinoin (taken orally) and is it accepted among the dermatology community to prescribe it for severe hand eczema cases? When should a patient stop using it (ie when can one tell the side effects are too strong to justify taking the medication?)
Dr Lynn: Alitretinoin has been approved in certain countries for the treatment of severe hand eczema that has not responded to strong topical steroids. It belongs to a group of medicine known as retinoids. Currently, it is still not available in Singapore.
Certain blood tests need to be monitored while taking this medicine. Dryness, cracked lips, headache and hair loss may occur. If there is an increase in the liver enzymes and cholesterol levels, the dose of alitretinoin should be reduced/ stopped.
In view of the side effects to a fetus, women of child-bearing age should be properly counseled before starting the medicine and contraception advised.
Thank you Dr Lynn for explaining the treatment options for hand eczema. Next week we look forward to learning more about skincare and help for those whose hand eczema just won’t go away.
Last updated on 19 November, 2024 6:21 pm
This month, Kate’s figuring out creative ways to get those Zzz. For more Mom NeedyZz cartoon, see here.
Weight loss does lead to sagging skin – sad truth especially for those of us who have worked so hard to reduce weight. The reason was when we put on weight, our skin stretches to accommodate additional fat tissues but as this is lost, the skin doesn’t shrink back. This leads to sagging skin often seen after rapid weight loss.
The obvious way to reduce the effect that weight loss has on sagging skin is not to lose weight so rapidly. Here are 5 tips on limiting sagging skin as you try to lose weight.
Tip #1: Don’t Lose Weight Too Quickly
Losing weight too quickly, especially when combining crash diets with lots of exercise, can lead to a loss of both fats and muscles. The aim is to lose weight gradually (1 to 2 pounds per week), without losing muscles that support your skin.
Tip #2 Resistance Training
Mild to moderate intensity resistance training each week help to build muscle mass which “fill out” loose skin, reducing the appearance of sagging skin. The resistance training does not tighten your skin but shape your muscles and fill out your skin with increased muscle mass.
Tip #3 Don’t Suntan and Smoke
Both lead to oxidative stress, damage to collagen and elastin fibres and lead to sagging skin (plus UV exposure lead to skin cancer).
Tip #4 Eat Well
It is especially important to eat well when you’re exercising – we mentioned not taking a crash diet but we should also avoid diets that are highly inflammatory. In an interview with dermatologist Dr Cherly Lee, her advice was to reduce processed foods, animal proteins and sugars.
To build muscle, ensure adequate complex carbohydrates, proteins and sleep. Also include minerals and vitamins in your diet, along with essential fatty acids (EFA). In this WebMD article, nutrition and skin experts advised that EFA built cell membrane which not only acts as a skin barrier (to prevent irritants from penetrating and transepidermal water loss) but also as a pathway for nutrients and waste. Foods rich in omega-3 fatty acids also help to reduce inflammatory compounds, limiting skin damage from oxidative stress. Include also vitamins A, C and E which can increase collagen production and reduce UV damage to skin.
Tip #5 Drink Enough
We have investigated effect of water on skin and the conclusion was lack of water is bad for the skin but excess water does not benefit skin. Drinking enough is important when you’re exercising as water helps to carry nutrients, regulate temperature, improves your ability to work out and reduces heat cramps and heat stroke. However, drinking too much has drawn much concerns, due to abnormally low sodium (hyponatremia).
There are products that you can use or surgical and non-surgical treatments to counter sagging skin. Products containing retinols, vitamin C serus and alpha or beta hydroxy acids (AHAs or BHAs) are believed to increase collagen production, restore skin elasticity and renew skin. Be careful of overuse of retinols though, as it has been linked to skin irritation. Laser, ultrasound, radio-frequency, infrared, skin lifting/ tightening, dermal fillers and skin removal treatments are available to help sagging skin.
Off to do some squat press, planks and catch some zzz, #SkinishMom
3-part series on Hand Eczema with Dr Lynn Chiam
Dr Lynn Chiam
Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Children & Adult Skin Hair Laser Clinic, Singapore. Apart from paediatric dermatology, her other sub-specialty interests include adult pigmentary conditions and laser dermatology.
Is it really Hand Eczema?
Rashes on your hand may not be eczema although hand eczema/ hand dermatitis is the most common type of hand rash. Various other rashes can be:
Psoriasis
Psoriasis is a chronic skin condition characterized by clearly defined white, silvery or reddish thick patches. Apart from the palms, look for other typical signs of psoriasis such as scalp involvement and nail deformities.
Tinea Manuum
This refers to fungal infection of the hands which can look similar to hand eczema. Fungal infection needs to be excluded if only one hand is affected. A fungal scrape (skin test) will be positive in tinea manuum.
MarcieMom: Dr Lynn, how frequent are the above in causing hand rashes? Are there other common differential diagnosis from hand dermatitis?
Dr Lynn: Hand eczema has been identified as one of the most common frequent dermatological disorder encountered in clinical practice. It is caused by a combination of internal (genetics, individual predisposition) and external factors (exposure to irritants and allergens). It is estimated that about 10% of the general population suffer from hand eczema. It is reported to be more common in women and in certain occupations like hairdressers, healthcare workers and domestic workers.
Other conditions that can mimic hand eczema include psoriasis (which affects about 1% of the local population) and tinea manuum, a fungal infection of the hands which is uncommon.
Different types of Hand Eczema/ Dermatitis
Hand eczema results in inflammation of the skin which can present with dryness, scaling, redness, vesicles( bubbles), fissures, thickening, pain and itch. Even within hand eczema, there are various forms of dermatitis:
Irritant Contact Dermatitis
This is the most common form of dermatitis, caused by repeated exposure to irritants like water (from repeated hand washing), soaps, detergents, food products or chemicals frequently exposed to in a job, such as solvents, lubricants, oils and coolants. Friction and repetitive rubbing of the skin also increases the likelihood of irritant contact dermatitis. The rash is typically found on the knuckle surface of the hands. Avoidance of the irritant material can bring about a significant improvement.
Allergic Contact Dermatitis
Allergic contact dermatitis only happens to a small number of people who are sensitized to a certain material. This means that in the past, they may have been in contact with the offending material and even though on the first contact, there may have been only a little or mild reaction, the skin “remembers” the material as an allergen. On the repeated contact with the same material, a worse rash will result. Common allergens include nickel, fragrances, preservatives and rubber. A patch test can confirm the allergy.
Atopic Dermatitis
Patients who have atopic eczema when young are more likely to develop atopic dermatitis on the hands as an adult. Look for involvement of the other areas on the body.
Pompholyx
Pompholyx has a distinctive appearance of itchy small blisters on the palms of the hands. It is also more closely associated with excessive sweating and can be found on the soles and toes.
Nummular Hand Dermatitis
This shows up as circular areas of redness, scaling on the backs of the hands and can appear oozy.
Symptoms of Hand Eczema
Symptoms include redness (erythema), itch (pruritus), pain, dry, peeling/ flaking skin, blisters (vesicles) and cracks (fissures), weeping (exudation) and swelling (oedema).
MarcieMom: Dr Lynn, there are quite a few types of dermatitis – do they have similar symptoms or can it be difficult to diagnose which type of dermatitis one suffers from? Does age, gender or occupation affect which type of dermatitis one suffers from?
Dr Lynn:Yes, the different types of hand eczema can have similar symptoms. However, there are certain clues to look out for. From the history of the onset of the rash, contact with certain materials, improvement with avoidance, one may be able to distinguish between irritant and allergic contact dermatitis. A positive or family history of atopy (allergic tendencies) and involvement of the feet points to atopic hand eczema.
More women are affected by hand eczema than men. The prevalence of hand eczema is also higher in certain occupations like healthcare workers, hairdressers and domestic workers. This is due to prolonged and repeated contact with certain harsh materials resulting in irritant contact dermatitis. In irritant contact dermatitis, the knuckles, finger tips and web-spaces are commonly affected. Improvement is noted with avoidance of the material.
In allergic contact dermatitis, the rash may persist even with further avoidance of the allergen. Patch testing can help determine the allergen.
In adults with atopic eczema affecting the hands, other areas of the body can also be affected. In the acute stage, red spots, oozing and excoriations can be seen. In the later stages, the skin becomes dry, cracked and thick. Secondary infections can also set in.
Triggers of Hand Eczema
Triggers of hand eczema are typically water, sweat, soaps, detergents, food products, solvents, lubricants, oils and coolants.
MarcieMom: Dr Lynn, regardless of whether it is irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis, are the triggers similar? If yes, will avoiding these triggers be actions a hand eczema sufferer should take?
What are the factors that affect what form of dermatitis one get?
Dr Lynn: Yes, there are certain common triggers that will adversely affect the hands. Over-washing (even with just plain water), harsh soap, detergents and lubricants should generally be avoided by people with hand eczema. Wearing of gloves to reduce the contact of water and soaps with the skin is recommended if prolonged wet work is necessary.
Regular use of moisturizer can help prevent flares in people with hand eczema. Gentle soap in small amounts is recommended.
Keeping fingernails short prevent further damage of the skin while scratching. It is advisable to remove rings and bangles before hand-washing and wet work as they can trap moisturizer, dirt and bacteria.
MarcieMom: Thank you Dr Lynn for helping us to understand the different types of hand rash, hand eczema and its common triggers. Next week, we will look forward to learning about treatment of hand eczema.
Last updated on 17 November, 2024 10:24 am
Categories
Back to School Eczema Tips
For those in the US, it is almost back to school after the summer break. And those of us living in Singapore, Malaysia and tropical countries, it’s summer all year (and especially hot these days!). I’ve shared ‘Back to School” Eczema tips with my friend Alana Mitchell, at her Skincare by Alana blog, that covers:
- Eczema Prevention in School
- Eczema Skincare
Meanwhile, here are tips in table form, read the full post on Alana’s blog for further suggestions on prevention and skincare for eczema kids in school.
