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Eczema Tips

National Eczema Association – Preschool for Eczema Child

Finding the right preschool for your eczema child can be a challenge – you wonder about whether the teachers have the time to ‘monitor’ and help to control your child’s scratching, and you worry about possible triggers at the preschool.

National Eczema Association – Eczema Warriors

For the past two blog posts, I have shared the articles that I wrote for National Eczema Association (US) about survival tips when caring for your eczema baby and another on getting through the darkest moments of parenting an eczema baby. These articles are part of the stories that were shared by eczema warriors from all over the world at NEA website.

Another article that I have shared on NEA is about finding the right preschool for your eczema child.

Mei MarcieMom EczemaBlues sharing on NEA on finding the right preschool for your eczema child
  1. Inform the school of your child’s eczema
  2. Visit the school before making a decision
  3. Ask about the class sizes—the smaller, the better
  4. Watch the teachers and students interact
  5. Ask about their experience with eczema kids
  6. Make sure the preschool is a NO BULLYING zone
  7. Volunteer to raise awareness around eczema
  8. Sign up for a trial run with the preschool

If your child has eczema, it is possible that they may be teased or feel embarrassed by the appearance of their skin. Preschools that take bullying seriously will be mindful about creating a respectful environment not just between the students and the teachers, but also among the children themselves.

I know that it is not easy to find a preschool that you can trust with your child. Sometimes it takes a leap of faith, but you can always exercise judgment and due diligence. Once you have committed to it, work with the preschool on the right environment instead of working against them through fault-finding. We know that it is not easy to care for a child with eczema, and it would be even harder for the preschool teachers who have many more children to take care.

If you are a parent of eczema child, please read the comments on our support group page where hundreds of parents have shared their greatest challenges and best parenting moments in caring for their child.

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Eczema Tips

National Eczema Association – 8 Survival Tips for Caring for Baby

It is difficult to care for an eczema baby, therefore when National Eczema Association asked me to share my journey, I gladly shared my 8 survival tips below.

National Eczema Association – Eczema Warriors

As I shared in the previous post on my first article with National Eczema Association, the NEA is doing a great job
giving eczema warriors all over the world a sense of solidarity – through the stories we hear each other share, of our struggles, how we figure out parts of the puzzle to improve our quality of life and inspire us to hold on to the hope of a better day tomorrow.

My eczema survival tips shared on NEA
My eczema survival tips shared on NEA, experience gained from caring for my daughter
  1. Feed smart
  2. Secure the baby’s hands
  3. Do less washing and cooking
  4. It’s partly in the mind
  5. Sleep cool, literally
  6. Don’t be afraid to start over
  7. Look at quality of life, not quality of skin
  8. Put the ‘care’ into skincare

If you are a parent of eczema child, please read the comments on our support group page where hundreds of parents have shared their greatest challenges and best parenting moments in caring for their child.

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Eczema Tips

Surfactant Skincare Series – Impact on Eczema Skin

This week, we’re looking at the research surrounding Surfactants on Atopic Dermatitis. First a recap of eczema skin and its ‘compromised’ characteristics that warrant special care during skin cleansing.

The defective skin barrier in atopic dermatitis makes it:

–    Increased skin permeability

–    Increased transepidermal water loss

–    Increased bacterial colonization

–    Reduced antimicrobial peptides (AMP) expression, possibly resulting in higher incidences of infection

–    Elevated skin pH

The above makes eczema skin more prone to irritants and more vulnerable to the ‘harsh’ effects of surfactants, discussed last week:

  • Alkalization –  Elevated skin pH has the impact of (i) reducing skin lipids (ii) allows for growth of harmful bacteria like staph bacteria and (iii) increases transepidermal water loss (TEWL)
  • Damage to Skin Lipids
  • Damage to Skin Cells
  • Toxic to Skin Cells
  • Irritation to Skin

Research on Surfactant Impacts on Eczema Skin

Much of the research focuses on certain surfactant ingredients, as below:

A defective skin barrier requires careful selection of cleansing product
A defective skin barrier requires careful selection of cleansing product

(I) Chlorhexidine Gluconate is the antiseptic for use on eczema skin as it causes the least atopic dermatitis skin lesions.

This is from a study examining the Effect of Hand Antiseptic Agents Benzalkonium Chloride, Povidone-Iodine, Ethanol, and Chlorhexidine Gluconate on Atopic Dermatitis in NC/Nga Mice. The four common antiseptic agents in hand sanitizers are:

Benzalkonium Chloride (BZK): A Cationic detergent with strong antiseptic activity, more gentle than that of ethanol-based BUT with reported contact dermatitis cases

Povidone-iodine (PVP-I) – Commonly use in mouthwash and in disinfection before surgery, low toxicity in humans BUT with reported contact dermatitis cases

Ethanol (Et-OH) – Broad antibacterial and antiviral spectrum BUT result in rough hands because of its strong defatting effect on the skin

Chlorhexidine gluconate (CHG)Broad antibacterial spectrum AND with low incidences of contact dermatitis

(II) Reduce the use of Sodium Lauryl Sulphate (SLS)

In a study involving twenty volunteers with atopic dermatitis, it was found that repeated exposure to sodium lauryl sulphate and sodium hydroxide lead to a more pronounced impairment of the skin barrier function and significant transepidermal water loss.

SLS is a known skin irritant that damages the lipid barrier, causing inflammation and detachment of the skin layers (denaturation discussed last week).

(III) Reduce Cocamidopropyl Betaine (CAPB)

In another study involving 1674 patients, atopic dermatitis was associated with contact hypersensitivity to cocamidopropyl betaine (CAPB), but not to cocamide diethanolamide DEA or amidoamine. CAPB is an amphoteric surfactant, that is considered milder than SLS and a very common surfactant in many products. However, CAPB is cytotoxic, i.e. toxic to skin cells.

(IV) The Use of Hydrophobically modified polymers (HMPs)

The recent studies on surfactants are in agreement that for patients with skin conditions, a gentle liquid cleanser containing HMPs are more appropriate. Addition of cationic polymers to skin cleansers can further protect the skin and improve moisturization. To further improve cleanser mildness, adding hydrophobically modified polymers (HMPs) to cleansers make it less irritating to the skin. This is due to the formation of larger micelle of the surfactant, i.e. the larger the less likely to penetrate and remove skin lipids.

Above is similar to the care to note when cleansing baby skin, as well as what to use/ avoid to limit the harmful effects of surfactants on skin discussed in the previous two weeks. For all the posts in this Surfactant Skincare Series, see:

  1. Surfactants and Functions
  2. Cleansing Baby Skin
  3. Impact on Skin

References

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Eczema Tips

Surfactant Skincare Series – Impact on Skin

This month, we’re looking at surfactants – the chemical agents in cleansing products. It is important because while surfactants play an important cleansing function, they also potentially cause skin irritation. Last two weeks, we have understood:

  1. Different groups of surfactants and their functions – Anionic, Cationic, Amphoteric and Non-ionic surfactants
  2. What to Look out for when Cleansing Baby Skin – Discussion on the use of liquid cleanser being preferable to water, and what to look out for in the choice of liquid cleanser

Today, we’re looking more in-depth into how surfactants interact with skin and the potential harm to our skin.

Surfactants, while cleanse and remove oil soluble dirt/sebum, also potentially damage skin cells and lipids
Surfactants, while cleanse and remove oil soluble dirt/sebum, also potentially damage skin cells and lipids

Alkalization – The traditional soap is alkaline in nature (pH of 9 and above) and the alkalinity will increase the skin pH (which is of pH 4.6 to 5.6). Modifying the skin pH to more alkaline than it is supposed to be has the impact of (i) reducing skin lipids, including ceramides (ii) allows for growth of harmful bacteria like staph bacteria that thrives in a more alkaline environment and (iii) increases transepidermal water loss (TEWL). Alkaline soap is able to dissolve both fat and water-soluble components of skin. Synthetic cleansers are of varying pH and able to modify the pH of the cleansing product.

Damage to Skin Lipids – Surfactants are able to clean dirt and sebum that are oil-soluble. However, this property also means that surfactants may inadvertently solubilize the skin natural lipid membranes (ceramides). Stronger anionic surfactants like Sodium Lauryl Sulphate (SLS) enhances penetration into the skin and able to affect the deeper skin cells (skin lipids).

Damage to Skin Cells – During washing, the surfactants interact with the skin cells and collagen fibers and cause temporarily swelling and hyper-hydration. Once the water evaporates, there is destruction of the skin protein structures (known as denaturation) and leads to skin dryness, roughness, tightness and scaling. This is an adverse effect of anionic surfactant.

Toxic to Skin Cells – Known as cytotoxicity, surfactants can permeate skin cells and cause irreparable alteration. Certain surfactants such as benzalkonium chloride and cocamidopropyl betaine (CAPB) are known to be more cytotoxic than SLS.  CAPB is an amphoteric surfactant, a group of surfactant less irritating than anionic surfactant (SLS belongs to anionic group) but nonetheless can be cytotoxic. CAPB is also associated with allergic contact dermatitis.

Irritation to Skin – This is related to the duration of exposure, frequency, concentration and individual skin type. SLS is a known irritant that can cause skin inflammation (irritant contact dermatitis) and when combined with triclosan (an antibacterial and antifungal agent in products), can stay on the skin for hours/days. Amphoteric and nonionic surfactants are considered to be less irritating to skin. (Note: Skin irritation and cytotoxity are different concepts.)

What to Note when Choosing Cleansing Products

Based on the above surfactant interaction with skin, it follows that we ought to choose:

  • Products close to the skin pH (even water is not, either neutral pH 7 or sometimes more alkali)
  • It follows then to avoid soaps, which by nature are alkaline
  • Avoid SLS, as it can penetrate, damage and irritant skin
  • Avoid CAPB as it is cytotoxic
  • Choose products with larger micelles as they do not penetrate the skin cells as much (product packaging may not indicate this information so it’s quite hard to know; look out for Polyethylene oxide (PEO)/ PEO Sorbitan Laurate which forms larger micelles in the surfactant or for the term Hydrophobically Modified Polymers (HMPs))
  • Choose cleansing products that are moisturizing and moisturize right after washing
  • Reduce washing for prolonged time and frequent washing
  • Avoid alcohols, gels and alphahydroxy acids that can cause stinging
  • Avoid perfume, benzoyl peroxide, preservatives, parabens, propylene glycol, lanolin, methylisothiazolinone and other top irritants in this post
  • Avoid ingredients ending with sulfates

It is not easy to find a cleanser without any of the above-mentioned ingredient. For those with sensitive skin, it may be better to not wash as often and take care to choose a hypoallergenic product. Try to read the ingredient label of your product and be sure that the first few ingredients are at least not those in this post.

References

Categories
Eczema Tips

Surfactant Skincare series – Cleansing Baby Skin

Last week, we briefly looked at the different types of surfactants and understand their functions. This week, we’re looking deeper into baby skin and the research around cleansing baby skin.

Baby Skin Structural Vulnerabilities

In the Skin Fact series, we’ve discussed much about baby skin structural differences. Below is a recap of certain baby skin characteristics that increase its vulnerability during skin cleansing:

Higher transepidermal water loss due to thinner stratum corneum – More vulnerable to water loss during bathing and skin barrier breakdown when there’s excessive friction (from over-washing or from rubbing skin when toweling dry).

High surface-area to volume ratio – along with a thinner stratum corneum and immature drug matebolism, make baby skin more vulnerable to harmful chemicals used during bathing

Less total lipids – make it vulnerable to further reduction of skin lipids lost during washing

Cleansing Baby Skin – Research on What’s Best

From a search on Pubmed for review articles on the research for baby skin cleansing, there’s actually not much research on it. From a 2009 European round table meeting, the consensus is:

Learning about cleansers for Baby Skin
Learning about cleansers for Baby Skin

  1. Liquid cleansers in bathing are beneficial over water alone – Water cannot remove dirt, oil that can only be removed by oil. Prolonged washing with water dries the skin and depending on the pH of the water itself, it may be more alkaline than the natural pH of the skin.
  2. Liquid cleanser are preferred, rather than soap which alters the skin pH and affect the skin lipids, increase skin drying and irritation – Learn more about soap and its impact on skin pH in the skin pH series. The pH of skin can affect its skin lipids, which (a lower skin lipids) in turn causes drying, itchiness and skin inflammation.
  3. Liquid cleanser should be mild, non-irritating, non-stinging (especially to the eyes as babies may not be able to blink fast enough) and non-pH altering, and contains moisturizing function

For cleansing of baby’s skin, I’ve found two other articles that offer recommendation on what’s best for baby skin.

Extracted from http://www.hindawi.com/journals/drp/2012/198789/tab2/ - Review article on The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier?
Extracted from http://www.hindawi.com/journals/drp/2012/198789/tab2/ – Review article on The Infant Skin Barrier: Can We Preserve, Protect, and Enhance the Barrier?

Apart from the three points above, additional points are:

4. Avoid Anionic Surfactants, these are those that cleanse very well but most irritating to skin, an easy way to identify them is to look out for those chemicals ending with Sulfates.

5. Choose those with large head groups and have the ability to form larger micelles. Surfactants organize into groups of molecules called micelles and generally the larger these micelles are, the less irritating the surfactant is. This is related to larger micelles being less able to penetrate the outer layer of skin (stratum corneum).

6. No preservatives is not best as bacterial growth can happen in such products

7. No scent does not mean no fragrance (potential irritant) is used, it can be one fragrance masking that of another.

Why Baby Skin needs Cleansing

Just like last week we asked the question ‘Why not just use water to clean?‘ (because 40% of dirt, oil can only be removed by oil), we also have to understand why baby skin needs cleansing. Baby skin has saliva, nasal secretions, urine, feces, germs and dirt which can potentially irritate the skin when left on the skin. It is also possible that both skin allergy and the body (ie food allergy) can develop from foods being left on the skin for too long. It is therefore important to clean baby skin. However, baby skin, given its structural vulnerabilities, should not be over-washed and to avoid using baby wipes on face or baby wipes that are non-hypoallergenic, especially those containing fragrance and MI.

Next week, I’d (make a brave) attempt to look into how surfactants affect skin and in particular, impact on eczema skin. It’s a very ‘chemical’ topic and not easy, so appreciate if there’s feedback to improve on the blog post, and share your best cleanser!

References

Categories
Eczema Tips

Surfactant Skincare series – Surfactants and Functions

Kicking off Wednesday posts in 2016, like to explore this group of ingredients which is present in all cleansers but also have the potential to irritate skin.

Surfactants are ingredients that are active on surfaces, mainly to lower the surface tension on the skin and remove dirt, sebum, oil from cosmetic products, microorganisms and exfoliated skin cells in an emulsified form to be washed off. The different type of surfactants affect their cleansing, foaming/ lathering, emulsifying, solubilizing abilities as well as its potential to irritate.

Why not just Water?

Before we go on, the simple question to ask is why not just use water to clean our skin. This is because water alone is not effective in removing dirt which can be removed only by oil. Hydrophilic dirt can be removed only by water, and fat-soluble lipophilic dirt only by oils.

Groups of Surfactants

Surfactants are divided into hydrophilic (water loving), hydrophobic (water repelling) and lipophilic (oil loving). Surfactants consist of a fat-soluble (lipophilic) part and a water-soluble (hydrophilic) part. The lipophilic part sticks to oil and dirt, and the hydrophilic part allows it to be washed away.

Surfactants - learning about this group of ingredients that can clean but also irritate eczema skin
Surfactants – learning about this group of ingredients that can clean but also irritate eczema skin

Surfactants perform different functions, namely:

  1. Cleansing
  2. Emulsification – arrange itself at interface between two immiscible liquids to create an emulsion
  3. Solubilization – blending oily solution into clear liquid
  4. Conditioning
  5. Wetting – increase contact between the product and dirt

Apart from functions, manufacturers also consider mildness, biodegradability, toxicity, moisturization, skin appearance and feel, smell (fragrance) and lubrication when formulating their products.

There are four major groups of surfactants, classified by their polar hydrophilic (water loving) head group:

  1. Anionic
  2. Cationic
  3. Amphoteric
  4. Non-Ionic

Anionic Surfactants – Negative charge

Give effective cleansing and foam, good wetting properties, excellent lather characteristics, but moderate disinfectant properties and also likely to irritate skin.

E.g. Carboxylic acids – Stearic acid for stick products like deodorants and antiperspirants; Sodium stearate for soap

Sulfates – give effective cleansing, foaming and cheap; common irritant, e.g. Sodium lauryl sulfate (SLS), an alkyl sulfate used in detergents; Sodium laureth sulfate (SLES), an alkyl ether sulfate used in shampoo

Sulfonic acid surfactants – more expensive than sulfates but less irritating, e.g. dioctyl sodium sulfosuccinate, alkyl benzene sulfonate

Taurates (derived from taurine), Isethionates, Olefin sulfonates, and Sulfosuccinates.

Phosphate esters – Alkyl aryl ether phosphates; alkyl ether phosphates

Cationic Surfactants – Positive charge

Effective for conditioning cosmetics, positive charge makes the surfactants electrostatically attracted to the negative (damaged) sites on hair and skin protein which makes them resist rinse-off. Difficult to ‘mix’ with Anionic Surfactants. Also irritate. May be used as antimicrobial preservatives due to ability to kill bacteria.

E.g. Amines

Alkylimidazolines

Alkoxylated Amines

Quaternized Ammonium Compounds (or Quats). e.g. Cetrimonium chloride and Stearalkonium Chloride

Amphoteric surfactants – both positive and negative charge (depending on environment)

Help improve foaming, conditioning and reduce irritation. Moderate antimicrobial activity. Used in mild cleansing products, but not effective cleansers and emulsifiers. Both Alkaline and Acid, help to adjust the pH of the water used in solution.

E.g. Sodium Lauriminodipropionate and Disodium Lauroamphodiacetate.

Cocamidopropyl betaine, cocoamphoacetate and cocoamphodiacetate

Non ionic Surfactants – No charge

Used in heavy thick creams, such as hand or body creams, as  emulsifiers, conditioning ingredients, and solubilizing agents.

Relatively low potential toxicity and they are considered the most gentle surfactants, but they are also the most expensive 

Able to solubilize fatty acids and cholesterol in skin, thus may remove skin lipids

E.g. Cocamide DEA (coconut diethanolamide), widely used in personal care products for its thickener property and foam booster

Fatty acid esters of fatty alcohols, sorbitan esters, sucrose and cholesterol derivatives used like emulsifiers

In the following Wednesdays of this month, we will explore the impact of surfactants on skin, baby and eczema skin and some of the research in this area. I’m learning much about this as I read as well and it’s not all so easy to understand! Any expert reading this who would like to help out are welcomed, do leave a comment if you have expertise in this area or there’s something to correct in my post (no offense will be taken!).

References

Categories
Eczema Tips

Top 5 Q&A from Living with Eczema: Mom Asks, Doc Answers

Most of you would know that I co-authored with Professor Hugo, NUH, a book ‘Living with Eczema: Mom Asks, Doc Answers‘ published last year. As an end of the year special, I picked five questions asked and Professor Hugo’s reply (almost half the book is Q&A, I picked these 5 based on being common questions parents of eczema children asked). The book is structured with information surrounding key topics like diagnosis, prevention, triggers, treatment including things that don’t work and future research, followed by Q&A. None of the questions I asked were ‘screened’ as we wanted to keep it as an authentic exchange between a mom and the doctor of her eczema child.

Top 5 Q&A Living with Eczema- Mom Asks, Doc Answers
Top 5 Q&A Living with Eczema- Mom Asks, Doc Answers

MarcieMom: The Hygiene Hypothesis has been interpreted by some to mean they should expose their infants to dirt, and possibly, avoid the use of anti-bacterial products. Is this recommended?

Infants with defective skin barrier or lower immunity would be even more susceptible to the penetration of irritants or allergens, or more susceptible to bacterial infection. So, should a mother take more hygiene precautions for her high-risk infant?

Professor Hugo: In theory this is correct, but the problem is that every baby is unique and needs a different degree of exposure of immune stimuli. This is very difficult to assess in a baby. However, in general, products that destroy the body’s own bacteria, such as antibiotics, should be avoided and only given if necessary (in case of a bacterial infection). There have been studies showing that early administration of antibiotics increases the risk for subsequent allergy, including eczema. Hygiene precautions taken by parents seem to have little impact on the development of eczema.

MarcieMom: While the skin prick test (SPT) is a faster, more reliable and cheaper option than the blood test, I have heard of parents avoiding it because the name “skin prick” test sounds traumatising for the child. What do you do in your practice to encourage fearful parents to let heir children take the SPT?

Professor Hugo: A good SPT, performed by an experienced person, should be painless. In our department we say that a SPT should be associated with no blood and no cry, even in infants.

MarcieMom: In your experience, how reliable are patients’ observations in relation to what is triggering his/her eczema?

Professor Hugo: Most parents fail to identify the triggers of their child’s eczema, or come up with lists that are non-reliable. Don’t forget that eczema is a chronic disease, needing a chronic or regular trigger. This is very diffi cult to identify, especially when a house dust mite allergy is involved, which can mimic multiple food allergies.

MarcieMom: How long should a patient use the prescribed corticosteroid before giving feedback to the physician of no noticeable improvement in the eczema?

Professor Hugo: Although corticosteroids are still the cornerstone treatment of eczema patches, they are only part of the holistic treatment of eczema. If all measures are taken appropriately, an effect of corticosteroids should be seen within one week. Most children can be treated with mild corticosteroids; only in severe eczema are more potent corticosteroids necessary.

MarcieMom: How do you build trust and relationship with your patient?

Professor Hugo: In a nutshell: be honest, don’t lie, and focus on limitations.

There are many more Q&A in the book and if you like to read it for free and you live in Singapore, it’s available in our national libraries island-wide. Wishing all families with eczema kids a happy new year and your encouragement keeps me going and faith that I’m storing treasures in heaven in this blog ministry. Just like the book, this blog is also dedicated to you.

We dedicate this book to
all children with eczema and
their families and hope that
this book will help all of them.

Prof Hugo and MarcieMom

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Doctor Q&A Eczema Tips

AAD A:Z Videos with Dr Lawrence F. Eichenfield – How to Treat Diaper Rash

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
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.

Categories
Doctor Q&A Eczema Tips

AAD A:Z Videos with Dr Lawrence F. Eichenfield – Eczema Bleach Bath

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
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.

Categories
Eczema Tips

Selection of Moisturizer (II) – Moisturizer and Ingredients

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, 2nd and 3rd generation moisturizers - Pros and Cons
1st, 2nd and 3rd generation moisturizers – Pros and Cons

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.)

Categories
Eczema Tips

Skin Expert Tips on Selection of Moisturizer

In June 2015, there was an eczema public forum held at the National Skin Centre Singapore and one of the talks wasMaking 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:

Selecting a right moisturizer can be tricky and confusing! Here are 10 selection tips, suited for those with eczema or sensitive skin
Selecting a right moisturizer can be tricky and confusing! Here are 10 selection tips, suited for those with eczema or sensitive skin

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

Categories
Eczema Tips

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

Eczema Triggers in School
Eczema Triggers in School

Eczema Skincare Tips in School
Eczema Skincare Tips in School

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.

Back to school tips for Eczema Children
Back to school tips for Eczema Children

Categories
Eczema Tips Guest Interview

Makeup for Sensitive Skin – Eczema Makeup Dos and Don’ts

For this 3-post series, we have Alana Mitchell, the founder of SkincarebyAlana.com. She’s the most suitable expert I know for this topic on makeup for sensitive skin, where we will be covering not just the basics of makeup, but very practical steps on applying and removing makeup and even how to mask the appearance of scars or pigmented skin. 

More on AlanaAlana acquired her esthetician license from the State Board of Barber and Cosmetology of California, allowing her to practice skincare in the California state in her spa business. Alana has worked in the beauty industry for over 15 years, and teaches advanced education classes for esthetician students.

Eczema Skin

Eczema Makeup - What You Have to Take Note Of!
Eczema Makeup – What You Have to Take Note Of!

Eczema skin is quite difficult to manage when it comes to make-up; for one, the cause of the eczema could be irritant or contact dermatitis, whereby the eczema rash is triggered by contact with allergens. Secondly, the nature of eczema skin is dry and the skin barrier is defective. It requires applying emollient for moisturizing, protection from moisture (occlusion) loss and increase moisture absorption (humectant). Thirdly, eczema skin may have more scars/ blemishes or even lichenified/ thickened skin from prolonged scratching.

MarcieMom: Thank you Alana for helping us for the past two weeks on:

Today, we are focusing on eczema skin. Let’s tackle the above difficulties one by one and round-up with your makeup tips for eczema skin.

Eczema Skin and Makeup Ingredients

We mentioned in our previous posts that there are ingredients we can avoid for those with sensitive skin. What in your experience are the ingredients not to have for makeup on eczema skin type? 

Alana: Amongst the most common are: alcohol, artificial fragrances, harsh sulfates (such as sodium lauryl sulfate), chemical preservatives, and chemical sunscreens (such as octinoxate and oxybenzone).

Ingredients to Avoid in Eczema Makeup
Ingredients to Avoid in Eczema Makeup

Moisturizer and Implications on Makeup

MarcieMom: Assuming that an eczema sufferer has very dry skin and needs frequent moisturizing – what is the practical way to go about this? (since it’s not practicable to constantly remove makeup and apply moisturizer, then apply makeup again)

Alana: That is super easy! Find a tinted moisturizer that you love! There are many brands that have tinted moisturizers that will not only deliver SPF protection, but will also provide vital hydration and beautiful coverage to your skin. Granted, the coverage on these products is typically rather light. But if you are doing what is right for your skin, and keeping it healthy, odds are you will only need a light coverage product. If you need heavier coverage, again, do some research. As long as your skin does not tend to get oily with reapplication, and as long as the product you are using is quality, reapplication should not be an issue at all.

MarcieMom: Is there makeup step to avoid for eczema skin? e.g. not to use mascara or adopt a simplified makeup routine

Alana: I wouldn’t say there is anything eczema skin needs to avoid. That is, of course, if you’ve found the right products for your skin type. As I’ve mentioned before, there are products out there for you! It is simply a matter of finding those products.  Of course, if something in your makeup regimen is bothering you, or causing an eczema flare-up, discontinue use immediately!

Covering Scars, Pigmented Skin and Blemishes on Eczema Skin

Prolonged scratching of eczema skin can lead to scars, pigmented skin and thickened skin. It is important not to scratch eczema patch due to infection risk as well as scarring and discoloration.

MarcieMom: Alana, what are your makeup tips to cover these scars and blemishes on eczema skin? Are these concealers typically more irritating to skin than the usual foundation? 

Alana: Much like foundation, there are many fabulous concealer options that not only mask but heal your skin. Do not, no matter how tempting, apply the first concealer you see in an effort to mask your eczema! This can lead to a negative reaction that will cause you even more problems. Take time to research brands that are especially good for sensitive, eczema prone skin, and take the time to patch test it before slathering it on the effected area. What many people don’t know is that irritated skin is often broken skin, and you do not want to be quick to slap a product on top of that. You will want a product that is specifically indicated to be able to be worn on irritated skin. Many of my eczema clients have had success using Lycogel’s Breathable Camouflage, which was designed specifically for users with rosacea (yes, even when it is in a reactive state).

Alana’s Makeup Removal tips for Eczema Skin

MarcieMom: Can you share your makeup removal tips for eczema skin? (with a view to minimize skin irritation and hydrate skin)

Makeup Removal tips for Eczema Skin
Makeup Removal tips for Eczema Skin

Alana: My makeup removal recommendation for eczema skin is honestly the same as it would be for eczema skin (and normal skin), just with different products! If you go beyond simply having sensitive skin, and have eczema prone skin as well, use products that are indicated to be good for super sensitive skin, and more importantly, for eczema skin as well. Just because a product does not indicate these things does not mean it cannot be used, but you should discuss it with your skin care professional before use. As I mentioned before, fewer and more natural ingredients are usually better. If you know your skin agrees with a certain oil (coconut oil is fantastic), you can use this to remove your eye and lip makeup before cleansing.

Thank you so much Alana for being with us for these past three weeks, it’s been such a pleasure and a great learning experience!

Categories
Eczema Tips Guest Interview

Makeup for Sensitive Skin – Applying and Removing Makeup

For this 3-post series, we have Alana Mitchell, the founder of SkincarebyAlana.com. She’s the most suitable expert I know for this topic on makeup for sensitive skin, where we will be covering not just the basics of makeup, but very practical steps on applying and removing makeup and even how to mask the appearance of scars or pigmented skin. See last week’s post on Skin Types and Makeup

More on AlanaAlana acquired her esthetician license from the State Board of Barber and Cosmetology of California, allowing her to practice skincare in the California state in her spa business. Alana has worked in the beauty industry for over 15 years, and teaches advanced education classes for esthetician students.

Sensitive Skin

There is no strict definition for sensitive skin but generally, it means being more prone to getting a hypersensitive reaction to ingredient/chemicals. You can find out which ingredient you’re sensitive to via a patch test and your patch test results can be entered into the CAMP (Contact Allergen Management Program) database in the US to obtain a list of products you can use.

Makeup and Removal for Sensitive Skin
Applying and Removal of Makeup for Sensitive Skin

Applying Makeup – Moisturizer and Foundation

MarcieMom: Alana, thanks for helping out this week with application and removal of makeup. We are getting into the specifics of makeup for those with sensitive skin this week.

Can you share with us how we can figure out our skin tone and choose the right foundation (color, texture)?

Alana: If I’m being totally honestly, there is a lot of guesswork that goes into finding your perfect shade. Foundation shades are typically crafted on the most common skin tones, and you will notice that there are usually only 10-20 shades in a typical range. Since everyone has their own unique skin tone, it is usually a matter of trying a shade that looks closest to yours. Another option is to buy one shade darker, and one shade lighter, so you can blend them to meet your exact skin tone.

For brands that label based on undertone, finding your exact shade might be much easier. The first step in figuring out your skin tone is knowing your skin’s undertone, which is a lot easier than many people might think! Simply look at the inside of your wrist and observe the color of your veins. If they appear to be blue, you are likely cool toned. If they appear to be green, you are likely a warm undertone. If you notice both blue and green, or something in between, you are likely a neutral undertone. Whichever tone you observe, you will want to lean towards that range (warm ranges are usually labeled with a W, cool with a C, and neutral with a N). After that, it is all a matter of finding the right shade. Just because it matches your undertone, does not mean it will be an exact match. It might still be too dark or too light – so trial and error will come into play yet again.

Figuring out Your Skin Tones for Foundation
How do you tell your Undertone?

When in doubt, there are two things you can do: ask you local makeup artist or esthetician. They should be able to give you some recommendations, and might even be able to test products on you in an effort to find your exact match. When it comes to testing makeup, I am a huge advocate of doing so in a safe manner. If you head down to your local department store, see if they have small, sealed samples that you can test in-store or take home to test. If you feel comfortable allowing a makeup artist to test products on you in-store, make sure you understand the risks (those products are tested on many people, not just yourself) and watch them sanitize both the product and the makeup brush properly. I am not personally an advocate of using in-store testers, unless they are housed in an airless pump container, which most makeup products are not. But is very much a matter of personal preference.

MarcieMom: What about for those with sensitive skin? How can sensitive skin types choose the right foundation and what ingredients should sensitive skin types look for or avoid in foundation?

Alana: When it comes to sensitive skin, I always recommend seeking the advice of a dermatologist or medical esthetician. They are going to be able to give you the best recommendations for your skin type, because they have an understanding of the ingredients that go into skin care and makeup, and also have an understanding of sensitive skin in general.

As far as things to avoid: many sensitive skin types don’t do well with harsh chemicals, alcohol, artificial fragrances, and the like. However, each person is different, and an ingredient that does not irritate one sensitive skin user might irritate another. Brands like YoungBlood Cosmetics and Glo Minerals are fabulous options for sensitive skin users. YoungBlood Cosmetics, founded by Pauline Youngblood, delivers a range that can cover raw, inflamed or discolored skin while allowed it to breath and heal! So yes, most sensitive skin types can definitely use this ultra-gentle makeup range. Glo Minerals bills itself as being a “clinically advanced mineral makeup that covers, corrects, and protects”. They indicate on their site that they are suitable for “even the most sensitive skin,” and I have seen great success with sensitive skin clients using this brand.

MarcieMom: Moisturizing the skin and sun protection are important. How do these go with make-up? e.g. apply them all separately or it’s better to choose makeup that is both moisturizing and offers broad-spectrum UV protection?

Alana: While I am a firm believer in keeping moisturizing and makeup separate, you can definitely combine SPF protection with beautiful skin coverage. As I mentioned in my last post, I am a huge fan of tinted sunscreen. If dry skin is a concern for you, you can definitely reach for products that are more moisturizing.

There are many products that offer full coverage results with SPF foundation. I do urge users to be selective when it comes to picking out a brand and formulation, and to really consider if this option is best for them. Full coverage products are typically “heavier”, meaning most people will not want to reapply it throughout the day. Reapplying SPF every 2 hours (at least) is crucial for optimal sun protection, which is where product selection comes into play.

Lastly, powdered sunscreens make for a great and easy option! Though these are typically on the lighter side of the coverage spectrum, they do a great job of masking imperfections, while absorbing excess oil and mattifying the skin. I happen to be a huge fan of this method for touch-ups (after applying my tinted sunscreen in the AM).

Alana’s Makeup Removal tips for Sensitive Skin

MarcieMom: Alana, what would be your top makeup removal steps/ pointers for those with sensitive skin? (with a view to minimize skin irritation from the products, the beauty tools used e.g. brush and cross-irritation)

Alana: Makeup removal should always be a priority, but I personally like to keep it simple (and enjoyable) to make it feel less tedious at the end of a long day. First and foremost, be sure to remove any makeup around your eye area. There are many eye and lip makeup removers out there that are gentle enough for sensitive skin, and many that are actually indicated for sensitive skin. After you remove makeup in these areas, it’s time to cleanse your face. If you are not the proud owner of a skin cleansing device, make sure you cleanse twice a night to ensure you get any excess dirt, oil, and makeup off of your skin. That is about it! Of course, be sure to follow your cleansing up with your typical skin care routine.

Makeup Removal Tips for Sensitive Skin
Makeup Removal Tips for Sensitive Skin

Thank you so much for sharing the makeup basics for those with sensitive skin. It’d give those of us with sensitive skin so much more confidence when we approach makeup. Next week, we will focus on makeup for those with eczema, an area that many eczema sufferers struggle with.

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Eczema Tips Guest Interview

Makeup for Sensitive Skin – Skin Types and Makeup

For this 3-post series, we have Alana Mitchell, the founder of SkincarebyAlana.com. She’s the most suitable expert I know for this topic on makeup for sensitive skin, where we will be covering not just the basics of makeup, but very practical steps on applying and removing makeup and even how to mask the appearance of scars or pigmented skin. 

More on AlanaAlana acquired her esthetician license from the State Board of Barber and Cosmetology of California, allowing her to practice skincare in the California state in her spa business. Alana has worked in the beauty industry for over 15 years, and teaches advanced education classes for esthetician students.

Skin Types and Makeup

Skin Types and Makeup with Alana Mitchell, the founder of SkincarebyAlana.com
Skin Types and Makeup with Alana Mitchell, the founder of SkincarebyAlana.com

If you check out product labels, you will generally find that they cater to (i) normal skin, (ii) dry skin, (iii) oily skin or (iv) sensitive skin. In this blog, we have always been focused on eczema skin that typically belongs to the dry skin type, sensitive skin (when we cover and irritants to avoid) and to some extent oily skin, when we discussed about acne

MarcieMom: Alana, thank you so much for helping out with this series on makeup! I’m excited to learn more about it, especially when I’m clueless when it comes to makeup (I hardly use any!).

I read that the first step to figuring out what makeup and beauty products to use is to figure out your skin type. From WebMD, I noted that the different skin types are characterized by:

Normal Skin Type – (i) No or few imperfections, (ii) no severe sensitivity, (iii) barely visible pores and (iv) radiant complexion

Dry Skin Type – (i) Almost invisible pores, (ii) dull, rough complexion, (iii) red patches, (iv) less elasticity, (v) more visible lines and (vi) when exposed to drying factors, skin can crack, peel, or become itchy, irritated, or inflamed.

Oily Skin Type – (i) Enlarged pores, (ii) dull or shiny, thick complexion, (iii) blackheads, pimples, or other blemishes

Alana, most people may have difficulty figuring out their skin types or have a combination of skin types. Moreover, certain conditions such as skin disorders, smoking, medications, diet, stress, sun exposure, pollution, climate and existing beauty products may mask the real skin type. What is your advice on how we can figure out our skin type and how important is it to get the skin type right?

Alana: First, finding your right skin type is so important. Many people purchase products that aren’t necessarily right for their skin type, which can be either useless, or counterproductive in terms of achieving desired results. For instance: if someone with dry skin were to purchase a product specifically designed for oily skin, they are not likely to get the level of hydration they want (and more importantly, need). Figuring out your skin type is not always easy, which is where dermatologists and medical estheticians come into play! Going to one of these professionals may seem extreme, but it is the best first line of action in realizing your skin type and finding products that will work best for your skin type!

It's important to figure out your skin type to get the right make-up
It’s important to figure out your skin type to get the right make-up

MarcieMom: I’m interested to find out what are the key differences in the formulation when a company label its product as suitable for (i) dry skin, (ii) oily skin and (iii) sensitive skin? Are there any regulations that govern when a company can label itself as such? 

Alana: Key differences in these formulations typically address the markers of each skin type. For instance: dry skin formulas are typically more emollient. Many of these products use oils to nourish the skin, which is essential when you are dealing with any type of dryness or dehydration. In regards to makeup, dry skin users will want to lean more towards liquid formulations more than powder. I highly recommend looking into mineral makeup brands like YoungBlood Cosmetics, which use only the finest minerals while catering to even the most sensitive skin types.

Products designed for oily skin types are typically more mattifying. These formulas are often oil free, and lightweight, which helps to absorb excess oil and regulate oil production. Many people with oily skin will favor makeup that comes in powder form, but there are many fabulous mattifying liquid options that have recently hit the market as well.

Sensitive skin products are known as the more “gentle” formulas. These are typically (though not always) formulated with fewer harsh ingredients, and have been made with sensitive skin types in mind. It is important to note that just because a product is designed for sensitive skin, that does not mean your skin will take a liking to it! All skin is different, so even with sensitive or gentle products, you will still want to apply a patch test 24-48 in advance to using the product to ensure your skin will react well to it. I have not typically seen brands that put out a “sensitive” range for makeup. They are either friendly to sensitive skin as a whole, or they don’t formulate with sensitive skin in mind at all. Because of this, it is essential to look into the brands you are buying from, before you actually make your purchase. I have had wonderful experience with brands such as 100% Pure, Blinc Cosmetics, Glo Minerals, La Bella Donna, and again, YoungBlood Cosmetics.

There aren’t any firm regulations when it comes to labeling products for skin types. That being said, companies do have reputations to uphold, so it is important that they label their products for the right skin types accordingly. Your best bet is to ask your esthetician or dermatologist, and reading product reviews can also be very helpful as well!

What to Note for Makeup when You have Dry, Oily or Sensitive Skin
What to Note for Makeup when You have Dry, Oily or Sensitive Skin

MarcieMom: I’m the sort of gal whose makeup is just foundation and lipstick. Alana, what in your view, are the must-haves for makeup and are there certain types makeup (foundation, blusher, mascara, eyeliner) that certain skin types should not use or is it possible to find something for every skin type?

Alana: My three essentials are: mascara, tinted sunscreen, and lip gloss. Being a busy mom and business owner, I know all about getting ready on-the-go, and these three things are fantastic for making you look and feel confident in a pinch!

Makeup must-haves are always a personal thing, but if I could list one essential, it would be some form of tinted SPF. Tinted sunscreens are a great way to get coverage, protection, and hydration. If oily skin is more of a concern for you, you can also reach for a powdered sunscreen brush! These brushes are amazing, because they are so easy to keep in your purse, so easy to touch up, and will mop up oil without making your face look cakey or over-done.

The good news is: regardless of you skin type, there is bound to be an option out there for you. It is all a matter of research and recommendation. If you have had little to no luck, call an esthetician! My medical estheticians and I are available during business hours via phone, chat, and email to help shoppers in finding the perfect products for their skin type. It may sometimes be difficult, but I guarantee you it can be done.

Thank you so much for sharing your expertise on skin types and makeup with us. I think we all benefit from knowing more about skin types and understanding how that relates to selecting makeup. Next week, we will focus on sensitive skin, can’t wait!

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Eczema Tips

Eczema ‘Cure’ Series – Does the type of Water Matter?

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

Water for Eczema Cure

The Water Not to Use – HOT

Hot water strips moisture from the skin and it is never recommended by dermatologists. It may feel good because the heat temporarily numbs the (itch) nerves and so a hot shower offer temporarily relief – avoid at all costs. Consider other bath options that are more beneficial for eczema, dry skin and relief such as a cool compress.

Does the Water Type Matter?

Drinking water – There was a study in 2005-2006 in the US that showed a possible link between the chemical dichlorophenol present in tap water and higher incidence of food allergy. If the food allergy manifest as skin rash, then it’s possible that changing the water we drink help our eczema. Apart from this one study, no other study was found in Pubmed. Apart from tap water, fruits and vegetables also contain this chemical, found in pesticides. (note: See Singapore PUB link on Singapore Drinking Water Quality, dichlorophenol is present)

Updated on 27 Oct 2016 – For those of you wondering about the benefits of alkaline water, interesting read on MedicalNewsToday – no benefit and even showed harm!

Bathing water – Too Alkaline – Tap water is alkaline with an average pH value of 8. As the skin pH is slightly acidic, washing with alkaline contribute to skin dryness. Thus, another reason to limit your shower time. Read more from dermatologist Dr Cheryl Lee on vinegar bath increases the acidity of the bath water.

Hard water vs soft water – Hard water is caused by limestone (calcium carbonate) dissolving in the water and it is the white deposit that is seen in kettles, bath tubs and steamer. Hard water has been associated with higher incidences of eczema and identified as environmental trigger. However, in a randomized-controlled trial, there was no significant difference in families whose eczema children use hard water versus soft water (via a water softener). However, many eczema sufferers personally feel better about using soft water, partly due to lower pH level and less detergent needed in soft water washing.

Spring water – A well-known spring water spa for eczema sufferers is La Roche-Pasay in France. It’s possible that a higher selenium content or the presence of a certain bacteria (Vitreoscilla filiformis) in spring water is beneficial for dry skin.

What Matters for Shower

The important thing is to moisturize immediately after a shower – this one step outweigh the type of water you use or even what you use to shower with (no soap). Immediately moisturizing traps moisture on the skin and limits the evaporation of moisture from the skin after bath. Leave some moisture on the skin, don’t rub very dry and trap some of that with an emollient cream/ointment right after bath.

For me, I don’t use any special water but always limit the time taken to shower. It’s usually quite fast like within 5 minutes, followed up moisturizing. What’s your experience on water you use at home? Do share in the comments! Also if you missed the rest of the Eczema ‘Cure’ Series, below are the links:

Diet

Home Remedies

Chemical-Free

Does How we Bath Matter

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Eczema Tips

Eczema ‘Cure’ Series – Do How We Bathe Matter?

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

There is a fair amount of suggestions by the dermatological community on how and what to bathe with to help eczema skin. Some eczema sufferers also shared on what they use, though in general, it is less often cited as a ‘cure’ compared to the first 3 series of this post on:

Personally, I alternate between an oatmeal-based bath, a chlorhexidine-based bath lotion and a hypoallergenic cleanser for my eczema child (Marcie, who’s 6 years old now!). I haven’t dared to try a bleach bath nor mixing vinegar though these two have also been recommended by dermatologists. Let’s explore the various baths for eczema sufferers!

Bath for Eczema Skin

Bath to Try #1 – Soaking

If you have a bath tub or your child still fit into one, soaking in a bath tub (not hot water, but use lukewarm or room temperature) for not more than 10 minutes can help the skin to absorb water. Especially for those of you who have to endure dry, winter months, possibly dissolve a thick emollient into the bath as well! Note: Don’t soak your head in the tub!

Bath to Try #2 – (Colloidal Oatmeal) Bath Oil

Bath oil – Try colloidal oatmeal bath or other bath oils but be sure they do not contain the key irritants such as fragrance. Oatmeal bath can relieve eczema itch. Bath oil tend to leave a film on the skin and possibly a quick rinse will suffice instead of trying to wash the ‘film’ away – I guess that’s a bit defeating the purpose of using a bath oil. Here’s a study on bath oil for infants.

Bath to Try #3 – Bleach Bath

The main purpose of bleach bath is to kill the staph bacteria that often colonizes eczema skin. I’ve the privilege of interviewing dermatologist Dr Cheryl Lee who is an early proponent of bleach bath (more here). Bleach bath is to be limited to no more than 3 times a week. A study on bleach bath here and updated research news on bleach bath here.

Bath to Try #4 – Chlorhexidine

I used to wipe my child’s skin with chlorhexidine when I noticed persistent itch or redness. Since I’ve been prescribed a chlorhexidine-based shower lotion, I’d use it say once a week especially as my child has quite a few ‘high bacterial’ habits! More on chlorhexidine and bleach bath from my interview with dermatologist Dr Clay Cockerell.

Bath to Try #5 – Vinegar Bath

If bleach sounds too aggressive/ chemical/ toxic to you, consider vinegar. I’ve had an informative interview with Dr Cheryl Lee where she shared how vinegar balances the skin pH level on top of killing the staph bacteria. Vinegar bath may be stinging for some eczema skin/wounds, check with your doctor first.

Other Baths

Some like to add magnesium flakes into bath, while others use salt.

Bath NOT to Take #1 – Hot

So many eczema sufferers SUFFER FROM ITCH and sometimes, uses hot water to numb the itch for a relief during shower. However, hot water strips moisture from skin, avoid at all costs.

Bath NOT to Take #2 – Soap

Soap is drying because it’s way too alkaline for our skin, more here on soap here. It often causes skin irritation too.

Bath NOT to Take #3 – Too Long

Too long a shower strips moisture from skin – it’s a bit mind boggling when you first heard of it, shouldn’t the longer you shower be more moisturizing? It’s not – think of it as a thunderstorm washing off the cement in the brick wall.

Bath NOT to Take #4 – Bubble Bath

Most of the bubble bath solutions contain irritants, avoid bubble bath for children with eczema.

Bath NOT to Take #5 – Exfoliating Bath

Our skin exfoliates on its own – using scrubs can further break down the skin barrier which is already ‘weak’ for eczema sufferers.

Bath NOT to Take #6 – Bath without Moisturizing After

Pat dry (not rub dry), moisturize within 3 minutes after shower. More in this video.

If bathing is so troublesome, why not forgo bathing? First of all, that’s downright unbearable, especially for us in hot weather cities (Singapore, Asia, Australia and parts of US too!). Secondly, bathing has a purpose to remove dirt, sweat and skin debris which can also be irritating if left to accumulate on the skin. Instead, you can try shortening the length of a shower or reducing the number of times you shower (in a day, not a week! – No way I can don’t shower everyday in Singapore!).

Do share your bathing tips in the comments, we love to hear more of what you’re doing!

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Eczema Tips

Eczema ‘Cure’ Series – Chemical-Free

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

There are some eczema sufferers that report an improvement in their eczema after ‘cleaning’ their homes of all chemicals (no pun intended!). Personally I don’t use much chemicals at home, for instance, my floor is cleaned with water and we don’t use anti-bacterial wash every time. It can be very difficult to adopt a zero-tolerance for chemical in your life, given how they are in a lot of products, even baby wipes! I do believe though that some individuals’ skin are more sensitive to chemicals than others and therefore for them, eliminating chemicals work well for their eczema. For the rest of us, perhaps a moderated approach to limit chemicals only in certain areas. These are my suggestions!

Chemical Alerts for Eczema

Chemical Alert #1 – Detergent

This is likely one area you have to be careful with because detergent residue can be irritating to child’s sensitive skin and it is also worn in close contact with the skin. Detergent residue can make up 2% of the weight of a clothing and it contains irritants such as

  • Sodium Lauryl Sulfate
  • Triclosan
  • Formaldehyde
  • Sodium Hydroxide
  • Linalool
  • Sodium Flouride

These chemicals are also present in fabric softener, bubble bath and baby wipes; read more in What and How Much Detergent to Use for a Child with Eczema

These chemicals irritant and can cause contact dermatitis. What I do is wash using a longer cycle and use a hypoallergenic detergent. It may also mean that the clothes don’t get cleaned as it would with stronger detergent but it beats having eczema. Be careful of new clothes too, wash them before wearing as they also contain chemicals (read this mom’s sharing on trying on new clothes for her eczema child).

Chemical Alert #2 – Anti-microbial Products

This is one of those oxymoron – we want to clean to be safe but the cleaning leads to more danger. Generally speaking, the concerns are:

  1. Increased use of antimicrobial products (ingredient triclosan and triclocarban) lead to prolonged contact through the use of everyday products like dish washing detergent, hand sanitizer, deodorant and soap. This overtime can lead to contact eczema where the skin starts to develop rash when in contact with these, for instance, occupations that involve frequent hand washing tend to get this.
  2. Exposure to the ingredients in anti-microbial products had been associated with wheezing and allergic rhinitis
  3. Avoid soap and surfactant that remove skin lipids, understand more from Dr Cheryl Lee in Moisturizer and Skincare Products
  4. Constantly using anti-microbial products to kill bacteria can actually lead to bacteria becoming resistant to cleaning, partly contributing to why hospitals have higher rate of staph bacteria infection although they clean the hospital often (see this study)
  5. Also the hygiene hypothesis, whereby the more ‘ bacteria cleaning’ we do, the less our body is capable of dealing with foreign matters thus sometimes going into an overdrive when exposed to something harmless

Chemical Alert #3 – Fragrance

Fragrance is undoubtedly the top irritant – avoid fragrance for the whole family with a baby with sensitive skin, as advised by dermatologist Dr Cheryl Lee MD in Eczema and Skin pH, point 7 on allergy avoidance. Other chemicals to avoid are nickel, formaldehyde releasing preservatives, propolis (in beeswax), neomycin and bacitracin. For alternative names to fragrance, see the compiled list from dermatologist Dr Verallo Rowell on Sensitive Skin Products – Top Irritants.

Other common irritants for children with eczema is listed in Contact Dermatitis for your Eczema Child and nickel is one that showed up in quite a few studies. Coins and jewelry of nickel has to be avoided for those sensitive to nickel.

Chemical Alert #4 – Hair Dyes and Tattoos

It would unlikely be affecting eczema children but teens and adults should take care of the potential dangerous effects from using hair dyes (with A-List Celebrity Hairstylist Kristan Serafino on alternative hairstyling tips) and tattoos.

Chemical Alert #5 – Chemical in the Air

Chemicals that we breathe in can also affect allergic condition, like asthma. Read how dermatologist Dr Cheryl Lee avoid VOC paint and redo her home carpeting. Avoid polyaromatic hydrocarbons as well.

Chemical Alert #6 – Baby Wipes

Baby wipes are a life-saver, especially when traveling. Be careful not to use it on the face though as the skin is thinner on the face and an ingredient in baby wipe methylchloroisothiazolinone or methylisothiazolinone has been linked to cause skin rash overtime.

On the point about the air, many food allergens can come into contact with our skin from the air. Especially if you or your child has egg allergy, it’d be best to dine in a restaurant with good air ventilation instead of hawker centre where the ‘egg’ content in the air is higher (something my co-author Prof Hugo Van Bever shared in our book launch). What other chemicals are you avoiding? Share in the comments!

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Eczema Tips

Eczema ‘Cure’ Series – Home Remedies

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

Many eczema sufferers are wary of chemical and steroids. I agree but am also wary of going into extremes of attributing everything bad to chemicals and steroids, especially given that eczema is a condition that comes about from many factors (so would focusing on just one aspect be over-simplification?). But I’m definitely supportive of home remedies that work – if they work without side effect!

Eczema home remedies

Home Remedy #1 – Moisturize

Moisturizing is one approach that most would agree is beneficial. It’s accepted that eczema patients (adults and children) have defective skin barrier and a moisturizer have various functions to

  • Protect skin from drying/ losing too much moisture
  • Protecting skin from irritants
  • Absorbing water into the skin
  • Filling up the ‘holes’ in the skin or restoring the skin lipids (that help keep the skin cells together and prevent infection, learn more from dermatologist Dr Cheryl Lee in this Over-Alkaline skincare interview)

See also the research on moisturizing where it had been shown to reduce steroid usage and preventive effect on babies with high risk

Watch the video on how to moisturize baby’s sensitive skin.

Home Remedy #2 – Don’t Moisturize (with Irritants)

There are also sharing by eczema sufferers that their eczema improved after STOPPING moisturizer use. My guess is that there could be ingredients in the moisturizers that they have been using that are triggering the eczema, a form of contact dermatitis. There is a test to determine which ingredient in skincare product that you could be sensitive to, known as patch test (interview with Laura Verallo Rowell, CEO of VMV Hypoallergenics).

There are indeed individuals whose skin are sensitive to many common ingredients and therefore, it would make sense for this selected group to stop moisturizer use. Not for general population with dry skin though.

To be safe, start off with a moisturizer that doesn’t contain the top irritants, compiled by dermatologist Dr Verallo Rowell with alternative names to these irritants.

Home Remedy #3 – Keep the Skin Moist

I wouldn’t really call it a ‘home remedy’ as clothing products that are able to trap moisture close to the skin and studied to improve eczema usually have invested money into the technology behind the clothing. One such technique is Wet Wrap which had been shown to help eczema and if you’d like to know more about what goes into the wrap and how to use it, read here. My national (Singapore) eczema support group also runs regular wet wrap session, do sign up at the top right box of my blog to be kept posted!

Home Remedy #4 – Ways to Kill Staph Bacteria

Staph bacteria is a common cause for eczema where increasing research showed that eczema skin is colonized by this bacteria which produces toxins that can worsen skin inflammation. There are ‘natural’ ways to kill the bacteria, for instance swimming or bleach bath or shower with a chlorhexidine-based bath wash.

If you don’t like the idea of bleach, read this interview with dermatologist Dr Cheryl Lee on vinegar spray.

Home Remedy #5 – Oils

Though no conclusive research, there are eczema patients whose skin improved after primrose and borage oil (see dermatologist Dr Cynthia Bailey’s comment in the post) and virgin coconut oil (see this very informative interview with dermatologist Dr Verallo Rowell on different types of coconut oil – make sure you get the right type!)

Home Remedy #6 – Anti-Inflammatory Natural Ingredients

There are also quite a few natural ingredients that have anti-inflammatory properties like honey, lavendar or able to protect skin like colloidal oat (interview with dermatologist Dr Claudia Aguirre).

Personally, I feel that the biggest home remedy is to avoid triggers. Logically it makes sense to identify these triggers because no treatment or remedy can be helpful if the skin is under constant ‘attack’. After which, I do believe in moisturizing and as for using natural ingredients, I’m all for it as long as it’s not something that irritate you (beware that natural does not equal no hypersensitive reaction) nor past expiry (as a home-made product may be less stable so the expiry date matters more).

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Eczema Tips

Eczema ‘Cure’ Series – Diet

If you’ve been following this blog, you’d know I don’t jump into eczema (miracle) cures. I still don’t.

But as I read journeys of how eczema sufferers are cured, I realized that there are common approaches they take. These may not be THE (or even an) eczema cure but I think there’re certain situations which they may help improve eczema. I hazard a guess and this series is more about a holistic approach to controlling eczema – I suppose you can call it a cure if one approach singularly works well for you!

Now, many eczema sufferers report curing their eczema from eliminating certain foods from their diet, typically these are (i) diary, (ii) wheat and (iii) sugar. Is there a basis for this? Think along with me!

Unusual suspects for Eczema cure

Suspect #1 – Allergy to Diary and Wheat Undetected

This is the most straightforward reason why cutting certain foods from diet heal your eczema – it’s possible that you have an allergy to certain foods but you’re not aware of it. The unawareness could be due to:

  1. You have not taken an allergy test, be it either skin prick test or blood IgE test. Watch the video on allergy testing and #SkinishMom column on why sometimes doctors don’t get you tested (other than the other obvious reason which is they don’t have the facility to test and don’t want to refer you to another doctor..)
  2. Foods like diary and wheat are so prevalent in our diet that you may not notice. Generally speaking the more common something is, the less likely that you can identify it on your own as the trigger for your eczema. That is why although house dust mite is a very common trigger, parents tend to not associate their child’s eczema flare up with it. For common allergens for children of different age, see here (extracted from Professor Hugo Van Bever’s article – Prof Hugo is my co-author for Living with Eczema Mom Asks, Doc Answers!)

Suspect #2 – Food Intolerance or Hypersensitivity not Easily Tested

While allergy testing (for increased blood IgE immunoglobulin) is straight forward, detecting food intolerance or hypersensitivity is a whole different ball game. Even allergist or your nutritionist can be floored by it. For instance, reaction to a food intolerance can be gradual, not necessarily in small amount (unlike allergy) and can be intolerant only when certain foods are in certain state (eg raw versus cooked). Learn more on the differences between allergy and food intolerance.

As such, it could well be that your intolerance reaction is in the form of skin rash but because it is delayed reaction, no doctor has told you that a certain food is the culprit. However, when it is removed from your diet, your skin condition improves.

Here’s an interesting research on how children have tummy ache but didn’t get diagnosed as related to food sensitivity.

Suspect #3 – Gluten Sensitivity comes in Many Forms

Similar to the above, gluten sensitivity can come in many forms – Celiac Disease, Non-Celiac Gluten Sensitivity or Wheat Allergy. While there are tests for celiac disease and wheat allergy, testing for non-celiac gluten sensitivity is not straightforward. This could be why many reported their eczema improving after cutting gluten yet they are not tested to be allergic to it.

There has been some (small scale, not conclusive) research suggesting that eczema sufferers tend to have gluten sensitivity which is why cutting gluten has worked for them.

Suspect #4 – Sugar Intolerance

For other eczema patients, cutting out sugar improves their eczema – a possible reason is that they have an intolerance to fructose or sucrose. This is due to the lack of digestive enzyme frutase and sucrase. However, tests for these are more expensive and being in many of processed foods and foods we eat, you may not think of testing for it.

Also cut the soda, read its harmful effects in this Soda and Child series.

Suspect #5 – Milk Intolerance

Similar to above, one could also be intolerant to milk from a lack of digestive enzyme lactase. It’s possible that the intolerance reaction gets triggered from different amounts and therefore, you may not know it’s from milk.

Read also alternative food sources from nutritionist Natalia Stasenko if your child is intolerant to milk.

Suspect #6 – Cutting out Inflammatory Foods

I’m personally very careful about NOT eating inflammatory foods and if your child with eczema is obese too, read tips from nutritionist Rania Batayneh on an anti-inflammatory diet.

The basic concept of inflammatory foods is that these foods promote the production of substances that put stress on our body, being increasingly recognized as the cause of many health conditions which are linked to prolonged inflammation (chronic inflammation). To understand this better, see interview with nutritionist Toby Amidor.

I’m not clear how inflammatory foods directly link with eczema but the general link is that eczema is skin inflammation (rash) and the overall reduction of inflammatory foods may have a greater impact on certain individuals than others (my own guess).

Suspect #7 – Eating Clean

This term ‘clean eating’ is quite ambiguous but generally taken to mean that we don’t eat processed foods, fried foods nor trans fat. There are also people that said once they cut out processed foods, cook and eat healthy, their eczema improved. I’m a big supporter of that, not so much for improving eczema but more for general health. In terms of research that supports doing so, there is a large scale association study that showed children who ate fast food more than 3 times/week are 30% more likely to have more severe allergic conditions. (side point – Prof Hywel Williams who led the study also wrote the foreword for my Living with Eczema book!)

Suspect #8 – Going Vegan

Some eczema sufferers choose to go vegan or cut down on meat. There is a basis for this as explained by dermatologist Dr Cheryl Lee in this post on Diet and Environment on Skin. Animal proteins and sugar are pro-inflammatory and give rise to excess free radicals that damage our body and our skin. My own guess is that some people get affected by animal protein more than others which is why going vegan works wonders for their skin!

Suspect #9 – Being Able to Take Action reduces Stress

This is my own guess – it is known that stress triggers eczema flare-ups (see dermatologist Dr Claudia Aguirre’s interview on Stressed Skin is Skin Deep) and most patients also feel helpless especially when there is no clear trigger or solution offered by their doctor. Being able to take proactive steps to eat healthy, cut sugar or figure out gluten-free recipes may reduce stress and inspire new interest in cooking. So the reduced stress possibly helps the eczema and for more on stress affecting acne, see dermatologist Dr Verallo-Rowell’s interview on Diet and Lifestyle.

Above is my thoughts on why eczema sufferers or parents of eczema children feel that changing diet ‘cured’ their eczema. Did diet change work for you? Share in the comments!

One reader, from Odylique Essential Care shared this post that they compiled from research papers and their infographic (Credit:www.odylique.com)

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