Other treatments

Eczema Research News – Does Homeopathy work?

Does Homeopathy Work for Eczema?
Does Homeopathy Work for Eczema?

This is part of a quarterly round-up of some of the recent eczema-related studies, so that we can be aware of possible treatments and their efficacy (and I can also keep myself updated with the latest eczema research!)

Today’s topic is on Homeopathy, does it Work? Firstly, I have to say I haven’t tried homeopathy on my child with eczema and secondly, there’s no blame or guilt meant to be placed on any parent for trying an alternative treatment. I’ve had quite a few moms who told me that they have tried or are trying homeopathy for their child, some remarked it seemed to work, or seemed to work for a while, or did not work. Similar to last week’s topic on antihistamine, let’s have a grasp on some basic information first before we look into the studies.

What is Homeopathy?

Homeopathy involves understanding a person’s health and history, including physical, emotional and psychological areas. A tailored treatment is recommended for each patient, and the substances provided in tablet form are usually highly diluted with the aim to trigger the body to heal itself naturally.

How does it Work for Eczema?

There are various ways to apply homeopathy, for instance choosing different substances to treat different appearance of eczema (ie. Blisters versus rashes). These can be applied topically in the form of creams or ointments, for instance that of calendula, sulphur, urtica urens and rhus toxicodendron. Recommendations on nutrition and lifestyle are also provided.

Are there any side effect of homeopathy?

There appears to be no known side effect, although the eczema may worsen if the conventional treatment is withdrawn in place of the homeopathic treatment.

What’s the studies on homeopathy’s impact on eczema?

Based on this study in January 2013, there is no significant difference between using homeopathic treatment versus conventional treatment, thus implying that the higher cost of homeopathy is unjustified. Similar conclusions in other studies at PubMed, here, here, here, here.

Have you tried homeopathy for your child? Is it effective? Do share in the comments, thank you!

Doctor Q&A Other treatments

TCM Series – Understanding Eczema from TCM’s Perspective

TCM Physician Lau Kiew Teck with Raffles Medical Group

For this TCM Series, I’ve the privilege of interviewing TCM Physician Lau Kiew Teck of Raffles Medical GroupRaffles Chinese Medicine Clinic, whose special interests include respiratory conditions, dermatology, pediatrics, diabetes and digestive system disorders.

Refer to the first part of this interview here and the second part here.

Understanding Herbal Bath & Cream

MarcieMom: I read that herbal bath and creams are also prescribed by TCM physicians. What are the ingredients of the herbal bath & cream? Given that there is so much transparency being pushed for in labeling ingredients of skin care products, are ingredients in TCM products fully labeled?

Physician Lau: In my practice at Raffles Hospital, our products are fully labeled and certified by Singapore Health Science Authority.

MarcieMom: Moisturizers, bath oil, bleach bath and steroid topical creams are treatment prescribed by western medicine. Is herbal cream, herbal bath similar? (as in have properties to repair the skin barrier, kill staph bacteria and reduce inflammation)

Physician Lau: As the properties are different between the western medicine and the herbal cream, we are unable to compare. The herbal bath definitely helps in reducing the inflammation thus creating an environment for the skin to recover. Repairing of skin largely depends on the individual body’s nature.

MarcieMom: Acupuncture is also a treatment option used for eczema; how does acupuncture treat eczema and is it recommended for children?

Physician Lau: As mentioned previously, TCM focuses on the holistic approach where a combination of treatment of acupuncture and herbs are used. For instance, if you are suffering from eczema due to weak digestive health, TCM, be it herbs or acupuncture or both, is administered to treat the indigestion problems and subsequently, through the holistic approach, it will speed up the recovery of eczema. I will not recommend acupuncture for children.

MarcieMom: Also, where are TCM medicine produced in? How can a patient check the harvesting of the herbs (whether using insecticide), the manufacturing facility (use of chemicals) and the packing facility?

Physician Lau: Patients can check the manufacturer’s label to see where the medicine is produced in. It is impossible to check on the harvesting of the herbs with the looks of it. Such assessments have to undergo testing.

Physician Lau: Based on the guidelines of Singapore Health Science Authority, all TCM products dispensed in Raffles Hospital are certified.

MarcieMom: Thank you Physician Lau for helping us understand a little more on TCM in the treatment for eczema for the past three weeks.

Doctor Q&A Other treatments

TCM Series – Understanding Eczema from TCM’s Perspective

TCM Physician Lau Kiew Teck with Raffles Medical Group

For this TCM Series, I’ve the privilege of interviewing TCM Physician Lau Kiew Teck of Raffles Medical GroupRaffles Chinese Medicine Clinic, whose special interests include respiratory conditions, dermatology, pediatrics, diabetes and digestive system disorders.

Refer to the first part of this interview here.

Herbal Medicine & its Compounds & Prescription

Herbs such as Flos Lonicerae (Jingyinhua), Herba menthae (Bohe), Cortex Moutan (danpi), Rhizoma Atractylodis (Cangzhu) and Cortex Phellodendri (hungbai) are herbs commonly prescribed by TCM physicians for eczema. They have anti-allergic, anti-inflammatory and reducing itchiness effects.

MarcieMom: Physician Lau, could you explain to us what compounds are made up in the herbs that you commonly prescribe to eczema children? (Compounds meaning containing which Vitamin or which carotenoid)

Physician Lau: These compounds are extensive and it is not possible to list them all down.

Marcie Mom: I searched for studies on TCM and effects on atopic dermatitis and it appear that studies which indicate positive results (meaning lower severity of eczema or less reliance on cortisteroids) have relatively small sample size (see here and here). In this review article, the authors from The Chinese University of Hong Kong, Pediatrics and Institute of Chinese Medicine departments, concluded that the “beneficial effects of Chinese medicine on children with atopic dermatitis have not been consistently demonstrated”. I would think this is due to limited studies, both in number of studies and the sample size of studies, which led to inconclusive results and the ambivalence of non-TCM practitioners to recommend their patients to explore TCM.

MarcieMom: Physician Lau, do you know of any conclusive large-scale study of TCM on eczema?

Physician Lau: Not that I know of.

I also read that the TCM prescription is individualized and not standardized across eczema patients. Why is it not possible to be standardized? Would prescribing the common herbs for eczema and in a standard dosage makes it easier for studies to be conducted and also for greater transparency in TCM medicine?

Physician Lau: Each patient requires different attention and treatment and TCM does that. It customizes the treatment for the patient so patient can recover speedily.

MarcieMom: Related to the above, the individualized treatment characteristic of TCM makes it scarier for parents, what if their TCM physician prescribes the wrong potency or frequency? I’m thinking about western steroid creams, a mom would easily google the strength of the steroid and know if it ought not be used daily. Can you advise (1) what questions a parents should ask their TCM physician about the medicines given to their child and (2) what are the common dosage and length of taking these meds?

Physician Lau: Each consultation differs from patient to patient so there is no common dosage or length of taking these medications. The most frequently asked question is “are they safe?” Yes, they are safe and there are no known side effects.

MarcieMom: I read quite a few studies preparing for this interview and found that all of them measure the toxicity level in kidney and liver (and most conclude no toxicity effect). Why is this mentioned in the studies of TCM? Is there a risk of toxicity because the compounds in the herbal medicine are too potent?

Physician Lau: In fact, all medications including western medicine measures the toxicity level in the kidney and liver as these are important and immediate organs that has reactions to the medicine. All medication concoctions follow this benchmark.

MarcieMom: Thank you Physician Lau for the reply. Next week, we’d explore herbal bath and cream treatment options.

Doctor Q&A Other treatments

Traditional Chinese Medicine (TCM) Series – Understanding Eczema from TCM’s Perspective

TCM Physician Lau Kiew Teck with Raffles Medical Group

Many parents have asked me “What about TCM?” while others have suggested that I explore TCM as an eczema treatment option for my child. I’ve looked into TCM briefly in this archive post, but felt I didn’t know enough to evaluate it. For this TCM Series, I’ve the privilege of interviewing TCM Physician Lau Kiew Teck of Raffles Medical Group, Raffles Chinese Medicine Clinic, whose special interests include respiratory conditions, dermatology, pediatrics, diabetes and digestive system disorders.

More on Physician Lau: Physician Liu Qiao De graduated from Singapore College of Traditional Chinese Medicine in 1977 and has been practising TCM since. In the early 90’s, Physician Liu pioneered a Quit Smoking programme using auricular acupuncture. Physician Liu’s special interests include treating skin problems such as eczema and psoriasis. In pediatrics, he specializes in treating asthmatic conditions.

Eczema – A Multi-Factorial Condition

Eczema is a condition which is contributed by multiple factors like genetics, over-active immune system, damaged skin barrier, allergy, environment and persistence of staph bacteria residing on eczema skin. It is also a chronic condition, meaning treatment options are meant to manage the eczema instead of curing it.

From what I’ve read on the web, eczema is due to weaknesses or imbalances in body organs, in particular, the spleen, the lungs and the stomach, which leads to skin with eczema rash. Thus, various TCM options, such as herbal medicine and acupuncture, are ways to detoxify and strengthen these organs, specifically to (1) clear heat, (2) remove dampness and (3) remove wind.

Marcie Mom: Physician Lau, is this also TCM’s stand on eczema – that it is multi-factorial and chronic? Kindly help us understand the factors (from TCM’s perspective) that contribute to eczema and whether TCM is a treatment option to manage or to cure eczema. Can the factors/ causes of eczema be reconciled between TCM and western medicine?

Physician Lau: Eczema is both multi-factorial and chronic condition that is contributed by genes, immune system, damaged skin, allergy and environment. TCM focuses on the holistic approach where a combination of treatment of acupuncture and herbs are used. Patients can choose to use either TCM or western medicine or both to treat eczema; we don’t enforce any specific arrangement.

Foods to Avoid for an Eczema Patient

I read from the web that food and beverage such as alcohol, coffee, sugar, spicy food and deep-fried food are to be avoided. Also for fruits deemed “heaty” such as durian, mango, longan and lychee. Foods that are “cooling” such as green beans are encouraged.

MarcieMom: Physician Lau, can you help to explain “heaty” versus “cooling” food? Most of us in Asia are familiar with the use of “heaty” and “cooling” but it’s seldom heard of by our readers in US, UK and Canada.

Physician Lau: Food only becomes heaty or cooling when your body reacts to the food. In general, the food in its nature is heaty or cooling based on its properties.

MarcieMom: Above foods such as alcohol and spicy food are top triggers of eczema, while sugar and deep-fried food are inflammatory (further explained in this post). Green bean is an anti-inflammation food, featured in this post. Anti-inflammatory foods include those that contain anti-oxidants, Vitamin C, carotenoids, flavonoids, quercetin and kaemferol that can reduce oxidation, fight free radicals and inflammation.  Can I then understand the “heaty” food that TCM recommends to avoid as being inflammatory and those to have more as having anti-inflammatory compounds? 

Physician Lau: Fried and spicy food and alcohol in general.

MarcieMom: Thanks Physician Lau for replying to these questions – TCM still seem to be a complicated topic to understand and hope to learn more in next week‘s interview.

Doctor Q&A Other treatments

Combined Approach Series – Stress, Attitude and Habit Reversal

Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at

Habitual Scratching and Eczema with Dr Christopher Bridgett

3 Levels of Eczema Treatment

In the manual ‘Atopic Skin Disease’, three levels of treatment are stated, namely:

1. Emollient Therapy

2. Steroid

3. Habit reversal

It is advised in your manual that steroid should not be used without follow-up moisturizer but moisturizer can be without steroid application. In the course of recovery, level 3 can be stopped first, followed by 2 and 1. We’ve covered the basics of all three levels in previous posts. There are some further dimensions in the management of eczema as follow:

Stress for Eczema Child

1. StressStress is one of the possible triggers for eczema.

Can you help a parent to identify when a child is stressed and how to see if the child is stressed because of the eczema or because of something else?

Stress can cause emotional upset – unhappiness and apprehensiveness for example – in anyone, young or old. In a child this may include tearfulness, and avoidance behaviour, just as in an adult. Certainly having eczema itself is stressful, for both the child and the parents. Careful observation may clarify if something else is the source of stress: stress comes from common causes, even for the youngest child, and family upsets may be especially important to think about. If there are no other causes and the eczema is troublesome, then adequate treatment of the eczema will be stress relieving – for everyone.

How can a parent help a child to relax?

Helping a child to relax usually involves simple acts – giving attention, and comfort, with suitable play, and amusing distraction. Reading a favourite story is a tried and tested bedtime means of inducing relaxation and sleep. But when a child is stressed, enabling relaxation is more difficult, especially if the causes of stress are not identified and dealt with.

Positive Attitude

2. Attitudes – Positive attitudes are suggested in your manual, such as ‘Manage, Don’t be Managed’ and to be careful so the doctor/nurse does not to ‘spread’ helplessness during a consultation.

Should a patient comes across a doctor who is passive about managing the eczema, what can he/she do to change the doctor’s attitude?

(Obviously, the other choice is simply switch doctor! But as a service to other patients, someone ought to say something!)

I find myself saying something about this all the time! Of course the responsibility for a successful visit to a doctor rests with all those involved. Each person should consider first what they themselves can do, rather than seeing any problem as caused by someone else. Some really useful ideas about this were covered when Jennifer talked to me: see This might make a good topic for people reading this post to comment on here: I suggest your readers share their thoughts and experiences with you.

At some health centres and doctors surgeries there are patient discussion groups to allow people to share ideas on how things can be improved. Has anyone had experience of such a group? Does your doctor ever conduct a patient satisfaction survey?

Each person should consider first what they themselves can do, rather than seeing any problem as caused by someone else. 

Review of Habit Reversal

In The Combined Approach, follow-up visits include asking the patient or parent their (i) scratching frequency (ii) when there’s most scratching (iii) % of scratching from itch (iv) severity of eczema (v) % new eczema vs old and (vi) where most eczema.

If a parent cannot find a doctor or convince their current doctor to implement the Combined Approach, can the parents implement this on their own without a doctor doing the follow-up (i.e. monitoring scratching on their own)?

The questions that you detail are in the first stages of The Combined Approach, during the first 4 to 6 weeks when habit reversal is important. The later part of the programme we call follow-up, and then vigilance for acute flare-up is the important emphasis, with early and energetic treatment with topical treatment being the order of the day. Habit reversal is not important long term. It is optimal topical treatment that is essential to maintain the progress that The Combined Approach achieves.

How to use The Combined Approach depends on the resources available. The clinic-based format is very effective, but if it is not feasible a self-help format is a good alternative, as discussed at

Hopefully blogs like this, and websites like will now gradually help everyone everywhere to discover how to treat atopic eczema successfully. There is no need now for anyone to necessarily Live With Eczema: there is now a possibility to learn how to Live Without Eczema.

Doctor Q&A Other treatments

Combined Approach Series – Eliminate Habitual Scratching

Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at

Habitual Scratching and Eczema with Dr Christopher Bridgett

Development of a Nervous Habit

I read in your manual ‘Atopic Skin Disease’ of how a nervous habit develops, namely:

1. Normal initial specific response to an injury (or itch)

2. Increased frequency by positive reinforcement that leads to

3. Behavior (or scratching) becomes automatic

4. The habit generalizes to cause more situations precipitating the behavior

5. Decreased personal and social awareness

Introduction of Replacement Habit

Also illustrated in your manual, another habit is introduced to reverse the scratching:

1. New habit is opposite to the old habit

2. Can be maintained for several minutes

3. Socially acceptable and compatible with normal activities

4. Strengthen muscles antagonistic to those of old habit

The techniques used in Noren and Melin, 1989 study mentioned in Atopic Skin Disease are:

1. Clenching fists and counting to 30 as an alternative to habit of scratching

2. Pinching the skin where it was itching as an alternative to itch-provoked scratching

Can you explain to our parents how to tell their child to clench fist and pinch skin? Is this something that can be understood by young children? And will pinching skin lead to the child using painful techniques to get rid of scratching? (I read in your manual not to say ‘Stop Scratching’, just as I’ve posted!)

The method of clenching a fist, then pinching the skin, is only suitable for older children, who are able to understand the instruction, and can accept responsibility for following the recommendations. The younger child requires a different approach which sees the parents as responsible for the treatment, with an adapted programme in between: see

So, no pinching small children please!

And yes – it is important to avoid saying “Stop Scratching” – you are quite right, of course!

Parents noting child is scratching
Parents noting child is scratching (picture credit

Register Scratching Frequency

In The Combined Approach, the first homework assignment to patients is to register the scratch frequency. This aids in the analysis of the scratching habit, following an ABC format of understanding the antecedents, behavior and consequences. Do you normally explain the ABC to patients before requesting them to register their scratching frequency? How can a parent help explain this to a young child? How can a parent help a child to count the scratching?

Dr Bridgett: The explanation of the ABC normally comes after registration, as part of the instruction of how habit reversal works. See the patient handbook for Older Children:

The younger child has a different treatment programme, without any counting of scratching: for the younger child it is the parents who are responsible. They can achieve awareness of the childs behaviour without using a counter.


MarcieMom: Thank you Dr Christopher Bridgett for explaining habit reversal that is part of The Combined Approach. In our next post, we will understand the three levels of treatment and conclude the series.

Doctor Q&A Other treatments

Combined Approach Series – Topical Treatment

Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at

Habitual Scratching and Eczema with Dr Christopher Bridgett

Explaining Topical Treatment – Moisturizer

The Combined Approach includes topical treatment using emollient and steroid. Moisturizing is a HUGE part of topical treatment, as emollients both lubricate and moisturize. Dr Bridgett’s advice on moisturizing is Thinly, Gently, Quickly and Often. There are a few other points mentioned in the ‘Atopic Skin Disease’:

  1. Thinnest possible application without ‘rubbing it in’
  2. More on exposed areas such as the head, neck and hands
  3. Pump dispensers preferable to open tubs due to bacteria infection
  4. Applying topical steroid first, then emollient over both the skin and the steroid
  5. Cream preferred over lotion

Can you explain why thinnest possible application is preferable for emollient?

(I’d usually slather on my child as I find applying a thin layer leads to more rubbing to spread the emollient)

Also, can you explain why topical steroid first?

(I’d written on this here and it does generate some discussion!)

Can you explain why cream is preferable over lotion?

Dr Bridgett: Your three questions answered:

  • Thin applications of moisturizer allows heat to escape, but insulates against water loss.
  • If moisturizer is applied often enough, when the steroid is applied directly onto the eczema, it is applied to skin that has been recently moisturized. We get then the best results by putting moisturizer on over topical steroid, and moisturizing all the skin, not just that which has the eczema.
  • The thicker the moisturizer, the better the moisturizing effect. Also, often there are less additives in thicker moisturizers, as thicker moisturizers “keep” longer. There is less chance that a sensitivity reaction will occur with an ointment, compared with a cream. See

Explaining Topical Treatment – Steroid

It is stated in ‘Atopic Skin Disease’ manual that steroid cream work by inhibiting protein synthesis, secretion of products, cell division and migration of cells. The epidermis can benefit from reduced cell division, and the dermis from reduced cellular and lymphokine activity. Can you explain what this means, and

why it is important to continue steroid treatment after epidermis healing (‘2-stage in steroid effect’)?

Dr Bridgett: It seems the steroid anti-inflammatory effect is partly achieved by reducing over-activity in the skin, allowing natural healing then to lay down healthy skin again. By the time the seems good to look at, the healing is not complete through and through – there is more that is needed under the surface, so we recommend continuing with the topical steroid, beyond The Look Good Point: do not stop too soon. See

Many parents are very concerned with the skin-thinning side effects of steroid and also the ‘withdrawal’ symptoms once steroid treatment is discontinued. I read in your manual that side-effects are associated with inappropriate use of topical steroid and the risk is usually inadequate treatment (i.e. stopping steroid cream too early or using one of too low strength).

How do you normally convince parents that steroid cream is safe? And what guidelines would you give them to gauge if the steroid cream of correct potency, frequency and amount is used?

Dr Bridgett: Steroid side-effects come especially from using topical steroids long-term and in an unsupervised way. The method we use in The Combined Approach includes more supervision than is usually given, with a programme of several clinic visits, involving careful discussion of all anxieties and concerns. Using The Combined Approach, including therefore habit reversal, which allows natural healing alongside the good steroid effect. Then less topical steroid is used overall, for good effects, not side effects!

We offer information about the potency groups of the topical steroids, and how they are usually used. The thicker the skin, the stronger the topical steroid to be used. See

Each application of any cream needs to be sparingly applied – whether it is an emollient or a topical steroid: only a shine is required.

MarcieMom: Thank you Dr Christopher Bridgett for explaining the topical treatment that is part of The Combined Approach. In our next post, we will understand more on habit reversal techniques.

Doctor Q&A Other treatments

Combined Approach Series – Habit Reversal

Dr. Christopher Bridgett is Hon. Clinical Senior Lecturer Imperial College at Chelsea & Westminster Hospital London. He is a psychiatrist with a special interest of using behavioural interventions to help people with atopic eczema, co-author of The Combined Approach at

Habitual Scratching and Eczema with Dr Christopher Bridgett

What is Combined Approach?

The Combined Approach is about using conventional topical treatment (steroids and moisturizers) together with the elimination of self-damaging behavior using habit reversal techniques. ‘Atopic Skin Disease’ was published in 1996 as there was much success using The Combined Approach, which was reported at the European Congresses on Dermatology and Psychiatry in 1991 and 1995.

Patient Improvised Distraction vs Combined Approach

MarcieMom: Dr Bridgett, can you briefly explain the difference between The Combined Approach versus an eczema patient using his/her own ways to divert attention from scratching?

Dr Bridgett: The Combined Approach is an exercise in behavioral medicine, and has two elements combined:

1. Optimized conventional treatment (emollients and topical steroids usually) : this is an important part of the approach, and cannot be overlooked!

2. Habit reversal: a formal behaviour modification technique: it requires, when offered to Adults and Older Children, first a period of registration using a hand tally counter – this is continued, as habit reversal is introduced. The inventiveness of the eczema patient is very useful in introducing new successful habit reversal behaviours, but some structure, discipline and supervision is linked to the success reported by many patients, and this requires reference to written material, and is often usefully supported by contact with others.

Also, if an eczema patient or parent of eczema child comes to know of your approach, can he/she simply pass your manual to a dermatologist that he/she is seeing?

The manual is available for anyone to consult and follow if they wish, and both nurse practitioners and medical practitioners are successfully using The Combined Approach. An important alternative is to use the self help format set out in the book The Eczema Solution by Sue Armstrong-Brown.

When is Habit Reversal Most Effective?

The main idea is that scratching can often become a habit – that is, the adult or child with eczema then scratches not only because of itch. It is mentioned that adults with severe eczema can benefit most from The Combined Approach. Why is this so?

Can you share with us pictures of before and after eczema and what was the habit that was eliminated that led to an improvement?

Dr Bridgett: Habit reversal is most effective

  • in combination with optimized conventional treatment, and
  • when there is evidence of chronic eczema – in adults or children – that is to say, the thickened skin called lichenification, which is due to regular rubbing and scratching that has become a habit, complicating atopic eczema. Any rubbing and scratching of the skin can become a habit, but each person can have their own particular problem. 

Habitual Picking during TV

In the first pictures below the patient was habitually picking the skin of her forehead when watching TV, resulting in chronic eczema. When habit reversal was added to optimized topical treatment the skin healed very quickly.

Before & After Pictures of Forehead, contributed by Dr B scratching habit associated with TV
Before & After Pics of Forehead, contributed by Dr B

In the next pictures, the patient had developed a habit of using the rivets on her jeans to scratch against:

Hand Eczema worsened by rubbing against jeans before habit reversal
Before The Combined Approach
Rubbing of hands against jeans rivets
Before The Combined Approach
After Hand Eczema
After The Combined Approach

Combined Habit Reversal with Topical Treatment

I note that The Combined Approach does start with understanding and explaining the importance of topical treatment, as eliminating scratching is not a stand-alone treatment. Would explaining the structure of the skin and how a weak skin barrier is prone to water loss be important in the first visit? If yes, could you do a quick introduction for our parents to understand?

Dr Bridgett: Yes, The Combined Approach always covers the importance of skin as a barrier, and the importance of optimal topical treatment.

The skin has two layers, epidermis and dermis. The outer epidermis, which carefully replaces itself every four weeks, is important in preventing water getting out from inside, and irritation and infection getting in from outside.

Acute eczema involves inflammation of the epidermis. It’s structure then becomes weakened, allowing excessive water to escape. Extra moisturizers are then needed to stop excessive water loss, and anti-inflammatory topical steroids are also needed. And that’s not the whole story: the inflammation releases itchy substances that cause scratching – and this scratching stimulates over-activity of the epidermal cells. If the emollients and topical steroids are used correctly the situation quickly returns to normal. If not, the scratching continues, becomes a habit and the damaged and sensitive skin of chronic eczema is the result.

For more on skin structure, acute and chronic eczema see

MarcieMom: Thank you Dr Christopher Bridgett for giving us an understanding of the Combined Approach and showed us some of the successful cases. In our next post, we will understand more on the use of moisturizers and steroids as explained in the manual ‘Atopic Skin Disease’.

Other treatments

Do you dare to let your eczema child try a bleach bath?

A very cute winnie the pooh bathtub (from

Published in May 2009 Pediatrics Journal was the findings of a bleach bath study conducted on 31 children, aged 6 to 17 months, with moderate to severe eczema. The children had staph (see this post to learn about staph), which is a very resilient bacteria on the skin that can cause infection. Half the children were soaked 5 to 10 minutes in a bleach bath twice a week, while the other half in a placebo bath. The children who were soaked in the bleach bath showed decreased severity of eczema within 3 months. The diluted bleach bath act like a antiseptic, which can remove the bacteria. Before trying this on your own, do check with your baby’s doctor and also note the following:

1.      Dilute the bleach and don’t apply bleach directly onto skin. Bleach is an irritant to the skin, so do check with your doctor on the preparation of the bath. For the above study, it’s ¼ cup bleach diluted with 40 gallons of lukewarm water. The concentration of sodium hydrochlorite in the bleach should not be more than 6%. Learn more about bleach bath and its effect on skin pH in interview with dermatologist Cheryl Lee MD

2.      Rinse off the bleach, pat dry and moisturize generously within 3 minutes of the bath.

3.      The neck and head was not in the water for the study. It was published online though that the doctor of this study, Dr Amy Paller, suggested closing eyes and submerging head into the bath to clear the bacteria. I’m not sure about this as my baby Marcie keeps drinking her current oatmeal bath!

4.      A 14-day oral antibiotic was given at the same time during the study, and moisturizing too. This meant that bleach bath is not a standalone treatment (in fact, bleach can dry/irritate the skin, so do dilute and moisturize a lot).

5.      Bleach bath should not be used for cracked skin, and consult your doctor first (I know my baby’s doctor recommended swimming and octenisan (2018 update: a more moisturizing antiseptic wash alternative chlorhexidine), which also serve to remove the staph bacteria).

2014 update: Read my interview with Dr Cheryl Lee on eczema skin and pH (including a Q&A on bleach bath)

2015 update: Read my interview with Dr Lawrence F Eichenfield (in collaboration with American Academy of Dermatology) on eczema bleach bath

My take is I don’t dare and won’t try bleach bath, since chlorhexidine (antiseptic) had worked for my baby. Swimming had also worked for her, even when we only brought her weekly (as opposed to her doctor’s advice to bring her 3 times/week). Do you dare to try the bleach bath on your child? If you have, do let us know how it went, thanks!

Other treatments

Alternative treatment – TCM for child eczema

TCM uses herbs, acupuncture and cream for treatment

You may have been asked by your friend to explore TCM (“Traditional Chinese Medicine”) treatment for your child and wonder if it is viable. I wondered the same and read whatever I could online on it. The information is sparse and prescriptions seem to differ based on the TCM doctor’s interpretation of your child’s condition after examining his skin, tongue, pulse and asking questions about his urine, stools, behavioural and sleep patterns. There is therefore no standard prescription and as a result, there is much less research on the effect of the treatment. Below are whatever I understood based on reading online.

TCM Treatment

The treatment is based on that the skin is affected by the ‘inside’ of the body and thus, herbs or acupuncture may be used to treat your child’s kidney, spleen or liver. The treatment is usually to remove toxins, phlegm, dampness and ‘heat’ in blood. Acupuncture for kids may use the Japanese system sho-ni-shin which does not involve puncturing the skin. Herbs, of up to 15 types, may be prescribed for you to boil and give your child. Cold compress using herbs, oatmeal bath, moisturizing herbal lotion may be prescribed too. Read more about TCM and eczema in this interview with TCM practitioner.

Versus Western Approach

There appears to be many similarities such as moisturizing, soaking in bath oil and control of allergic food. Diet control seems to be prescribed without conducting a skin prick test, and generally food such as cow’s milk, sugar, addictive, food colors and preservatives are to be avoided. I came across an article that suggested not having the child vaccinated as vaccination has toxin (I think vaccination is important and unless supported by strong medical evidence, we should not be excluding vaccination for our child).

So is TCM Safe?

I always think it is safer to consume something when the side effects are known then to consume something with no known side effects (since no one tested it)! The herbs that TCM prescribe may be anti-inflammatory, antihistaminic or immunosuppressant. The improved results may not take place at all or from 2 weeks to 8 months from what I’ve read on other parents’ forum posts or blog or research. The biggest question obviously is we know oral steroid works very fast but we know it is not for long-term use (in fact, my baby Marcie’s doctor said strictly once for Marcie), is it possible then for a TCM medicine to work equally fast and yet so safe that no side effect is known? So far, there are people online that sent their TCM medicine for lab analysis and found to contain steroids (equally, you will find others saying TCM doesn’t contain steroid), people who stopped the TCM medicine and the rashes came back or others who continue with steroid application while undergoing TCM treatment.

As mentioned earlier, the research is too little on TCM and for children, I personally won’t risk it, unless I have access to a lab and can test everything the TCM doctor gives my baby.

Other treatments

Is it what you ate? How Pregnancy diet affect eczema in baby

Citrus Fruits

“OH NO, could it be what I ate?” This was what went through my mind when I first read that pregnancy diet could increase the chance of my baby getting eczema (and my baby girl Marcie has eczema since two weeks old). I am not writing this post to put more guilt and blame into your life, but rather, if you’re considering a next child, it will be good to avoid some food or increase the intake of others. There is no conclusive evidence despite some scattered research reported on the web, so the overriding consideration is still to have a balanced diet (because a diet that is not balanced can lead to a whole host of other problems in the foetus and mothers who restrict their diet have resulted in smaller babies).

Here are some food to avoid:

1. Margarine; vegetable oil (too much will be too fat anyway)

2. Citrus fruit; celery (I ate lots of oranges during my pregnancy! Then again, my hubby has eczema so it’s more likely hereditary than diet)

3. Peanuts (Again, I ate peanut butter every morning! If your child has eczema or allergy, the advice is to delay giving peanuts till 3 years old)

4. No smoking or alcohol

Results of 2007 German study of 2,641 children is that food rich in n-6 polyunsaturated fatty acids and citrus fruits increase eczema in children up to 2 years old, whereas food rich in n-3 polyunsaturated fatty acids decrease chance of infant eczema. A later Japan study in 2010 shows that green and yellow vegetables, citrus fruit and beta-carotene reduces chance of infant eczema. (So citrus or no citrus?)

Here are some food to increase:

  1. Fish or fish oil
  2. Lactobacillus reuteri as oral probiotic supplement (my friend with eczema was prescribed this during pregnancy and both her girls turn out with no eczema)

Personally, I will eat more fish, take the probiotic supplement, not eat so many oranges nor peanut butter in my next pregnancy. I know how scary it is thinking our next child will also have eczema, fingers crossed..

Update: Almost 2 years later, we’ve decided not to have another child BUT more importantly, linking this article to a Q&A that I did with nutritionist Judy Converse on breast milk and pregnancy diet.

Update for a study in October 2014 that studied associations between maternal iron status in pregnancy and childhood wheeze and atopy. The results suggest that reduced maternal iron status during pregnancy is adversely associated with childhood wheeze, lung function and atopic sensitisation, justifying further studies on maternal Fe status and childhood asthma and atopic disease.

Update for a study in Nov-Dec 2014 that looked at all past studies Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches. Conclusion was did not find widespread or consistent links between mothers’ dietary intake and atopic outcomes in their children. However, maternal consumption of Mediterranean dietary patterns, diets rich in fruits and vegetables, fish, and vitamin D-containing foods were suggestive of benefit, requiring further evaluation.

Other treatments

Alternative treatment – Udder Cream as Moisturizer for Eczema

Udder Creams

Udders are mammary glands

Lately, I came across a recommendation by a mom that using udder cream has helped with her child’s eczema. Udders are mammary glands and the care and hygiene of the udders are important in milking. Udder creams are developed to soothe the chapped skin of the udder, prevent infection and irritation during milking. Somewhere along the line, the udder creams have been re-formulated to a less greasy form, and sold to adults and infant for eczema treatment, marketed with the following points:

  1. Natural skin care
  2. Skin repair properties
  3. Anti-inflammation
  4. Anti-fungal
  5. No paraffin oil

Over in forums, some moms have feedback it worked while a few others lamented that like other natural creams they have tried on their children, it irritated their skin. I haven’t tried it or on my child, but seems like most of these udder creams are not sold over the shelves but instead through stockists or online; read my interview with Moogoo founder.

Other treatments

Alternative treatment – Does Manuka Honey help with eczema?

Manuka Honey

When my baby Marcie got hand-food-and- mouth disease, my brother introduced me to Manuka Honey as it supposedly can help to reduce the ulcers in the mouth. After doing a google search, I am surprised to find that there are many links relating to how manuka honey can help with eczema. Being curious, I did a little research and though the verdict is still not conclusive, Manuka Honey seems to be a fairly safe product with no known side effects.

What is Manuka Honey?

– Produced by bees that collect pollen from manuka bush native to New Zealand, proven to have anti-bacterial property above ordinary honey

– UMF stands for Unique Manuka Factors, where say a UMF 12 stands for 12% solution of antiseptic

How does it help with Eczema?

– Stops infection and reduces inflammation

Moisturize, soothe and repair dry, cracked and damaged skin

Other Benefits

Other benefits published in a 2006 article suggest ability to fight superbugs, bacteria that causes gum disease, soothes sore throat and helps with digestion

Word of Caution

– Got to find active manuka honey in cream form, rather than applying honey direct onto baby, o.w. so sticky (and yucky or yummy, depending on how you see it!)

– One teaspoon is recommended for adults, so not to be given in excess to children

– Not to be given to babies below one year old (some links recommend 2 year old)

Update: View this post in 2014 with a compilation of studies on honey’s effect on eczema

Other treatments

Is partially hydrolysed milk worth the money?

Partial Hydrolysed Milk sold in Singapore

Partially hydrolyzed milk formula, such as Enfalac HA and NAN HA, was recommended to my baby girl Marcie when her eczema was diagnosed by the paediatrician at one month old. It was a nightmare getting her to drink the less tasty milk formula and each bottle feed dropped from 85ml to 20ml! It seemed to improve when we made the switch from NAN HA to Enfalac HA but you never know if it was due to the milk or that the reflux or gassiness got better.

The irony is that when I brought Marcie for a skin prick test when she was seven month old, she isn’t actually allergic to cow’s milk! The paediatrician had assumed that Marcie’s eczema was caused by food allergy, when it was intrinsic. So, I began to google whether HA milk was worth the money and whether I should let my next baby have hydrolyzed milk from the start.

So, here’s what I’ve found on this:

1. Partially hydrolyzed milk is non-hypoallergenic

This really confused me since the label clearly stated hypoallergenic. However, it seems like unlike extensively hydrolysed milk (which is not available in supermarket), only part of the cow’s milk protein is broken into smaller pieces.

2. Partially hydrolysed milk is proven to reduce risk of food allergy

So far research suggests that partially hydrolysed milk reduced the risk of food allergy, but it is not recommended for babies which has a firm food allergy. That is, if your child is already tested allergic to milk, giving partially hydrolysed milk can still give rise to allergic reaction.

3. Everyone says the best is breast milk

Naturally, it is cited on all labels that WHO recommends breast feeding for first six months. Problem is, parents like you and I, who are already stressed out with dealing with babies with eczema are unlikely to have the rest or the time to drink fluid or have proper nutrition, to produce enough breast milk! Easy to say, but we all know the effort required to produce breast milk.

I think, given that eczema is hereditary and to spare myself from the trauma of switching baby’s formula from a normal sweeter one to a partially hydrolysed one (should my next baby also has eczema), I would just start off him or her with HA milk.

Update: I’ve interviewed nutritionist Judy Converse on partially hydrolyzed milk about 2 years from this post (time flies!) and click here to read her explanation. Also check out this post in 2015 that compiled the significant studies on partially hydrolysed milk’s preventive effect for eczema high-risk infants.

Other treatments

Alternative treatment – Stemtech AFA, is it safe for your baby?

Recently, one mom recommended Stemtech AFA and out of curiosity, I decided to google and see what this product is. My personal view is to stick to moisturizing for eczema and consult a specialist for your child. Given that there is no cure nor quick fix for eczema, I will not give my child any oral medicine or in this case, dietary supplement, unless it is confirmed 100% safe by an independent doctor.

Here is the information on this dietary supplement, Stemtech AFA, obtained from its site:

– AFA is short for aquatic botanical Aphanizomenon Flos-Aquae, an extract of blue-green algae

– Support release of stem cells from bone marrow and increase the number of circulating stem cells (that will travel to areas of body most needed)

– Dietary supplement, not required to be approved by FDA

– Company is founded in 2005 by Christian Drapeau and its products sold through network marketing

There is no google search linking Stemtech AFA to treatment for eczema, but there is a post on a Dr Dale Peterson’s website who pointed out that there is potential toxicity and that bone marrow cells promote cancer growth and metastases (spread of cancer growth). Here are extracts of the post:

– Dr Milena Bruno, leading authority in blue-green algae, replied that a substance present in blue-green algae, Microcystin-LA, has several chronic consequences, they are clastogenic, strong tumor initiators and promoters, they are also endocrine disruptors, and  their effects are synergistic.

– Publication by Zhang, et. al. in the January 2007 issue of Environmental Toxicology which shows that microcystins not only accumulate in the liver and other tissues of adults, but are passed on to their offspring.

Dr Donald Orlic, whose work is cited by Christian Drapeau, replied that noone, to his knowledge, has ever suggested that there is benefit derived from a daily supplement of a bone marrow stem cell releasing product when administered to normal individuals.

There is an open lawsuit from a case of a girl who died from liver failure

– Various research cited by Dr Dale that bone marrow stem cells play a role in cancer growth

Above is what I googled and I don’t want to judge parents who opt for alternative treatments, knowing how stress we all are managing our children’s eczema. For me, I just stick to moisturizing and steroid use under doctor’s instruction.

2017 update: Stemtech International had filed for bankruptcy, read here