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


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!).


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!

News & Research

Eczema News – Antimicrobial Household Products’ Exposure and Allergy

Kicking off 2015 with eczema research news update – The year often starts with some ‘spring cleaning’, so this study published in November 2014 is timely for those of us who are taking out the household cleaning chemicals – will it increase the likelihood of allergy and eczema in your child? Here’s a summary of the study, full study available for free here.

Detergent and Allergy Rhinitis


Study title: Association between exposure to antimicrobial household products and allergic symptoms

Study objective: Investigate antimicrobial household product exposure and allergic symptoms in Korean children > 25,805 questionnaires completed. The age of the children were mostly from 3-8 years old, with about 15% at 0-2 year old.

Study method: An antimicrobial exposure (AE) score was derived and used to measure associations with allergic symptoms.

What are Antimicrobial Products?

They are products that contain antimicrobial agents that kill microorganisms or inhibit the organisms’ growth. Typical ingredient is triclosan and triclocarban. Antimicrobial products used in household are toothpaste, soap, hand sanitizer, dishwashing detergent, fungicide, laundry detergent, deodorant, aerosol cleaners, wet wipe and pesticide.  Toothpaste, soap, hand sanitizer, dishwashing detergent and wet wipe were the most widely and frequently used.

Potentially Harmful Ingredients 


Chloroxylenol, also known as p-chloroxylenol, is an active preservative agent

Tetrasodium ethylenediaminetetraacetate (EDTA)


Conclusion: Subjects with a high AE score (fourth quartile) were more likely to have symptoms of wheezing and allergic rhinitis (but not eczema).

Use of antimicrobial products related to wheezing and rhinitis.
Use of antimicrobial products related to wheezing and rhinitis.
Table taken from study, Nov 2014 Association between exposure to antimicrobial household products and allergic symptoms.

My take: I’m not very obsessed with eliminating all chemicals used at home but instead, I almost never use detergent on cleaning floor and my laundry cycle is 2 hours (more here). Floors cleaned using water, or with soap, is reported to be as clean as if using antimicrobial product.

Living with Eczema

SOMEONE manages Child’s Clothing – Eczema Trigger

Tiffany shares on clothing choice and care for her child
Tiffany shares on clothing choice and care for her child

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Tiffany to share how she manages her daughter’s eczema whenever she tries on new clothing. Tiffany is a mom of two and very active in social media, see her interesting Pinterest board here.

Marcie Mom: Hi TIffany, thanks for taking part in my new blog series ‘Someone has Eczema’! And I’m so excited about your aspect of life – trying new clothes, dressing our girls up! How did you discover that trying out new clothing is a trigger for your daughter? Is that the main trigger for her eczema?
Tiffany: When we try on new clothes, she breaks out into a rash on her face almost all the time! I think there is something in new fabrics that triggers the eczema. However, if I wash it first and then put it on her, there is no reaction.

Marcie Mom: Is your daughter’s eczema triggered by clothes that have yet to be washed (new clothes in store) or by certain materials used in the fabric?
Tiffany: I’ve been getting a mix but mostly 100% cotton clothing. I think it’s unwashed clothing that triggers it.

Marcie Mom: What care do you take to wash the new clothes? And did you get certain type of detergent or washing machine? Or have to sun it or not put it through the dryer?
Tiffany: I wash it with “unscented” detergent. I put it thru the washing machine and dryer. I have changed our family’s detergent all to the “unscented”

Marcie Mom: One final question – have you ever been tempted to just buy without letting your daughter try the clothes or request for hand-me-down to get around this trigger?
Tiffany: Yes, I have to buy without having her try it on but I would buy one in say a size 3T and then see if she fits after I’ve washed it. Then if she does, I can continue to buy without her trying on but I have to stick with the same brand.

Marcie Mom: Thanks Tiffany for your sharing! It’s very encouraging to see how everyone of us overcome eczema in our daily life, and nothing should stop us from our shopping lol!

Doctor Q&A

Staph Bacteria Series with Dr. Clay Cockerell: Bacteria on Your Skin

The Invisible Factor affecting your Child’s Eczema Rash – Skin Bacteria

Dr. Clay Cockerell on Staph Bacteria on Child's Skin - Board-certified Dermatologist and Dermatopathologist

This is a 4-week series focused on bacteria found on our skin, in particular Staphylococcus aureus, a bacterium that can lead to infection and complications in eczema patients. I’m honored to have Dr. Clay Cockerell, former clinical professor of dermatology and patholgy and the former director of the Division of Dermatopatholgy at University of Texas Southwestern Medical Center in Dallas, Texas, to help in this series.

More on Dr. Cockerell – Dr. Clay Cockerell was the president of the American Academy of Dermatology in 2005. He is a renowned medical educator having overseen an educational program designed to train the next generation of dermatologists and dermatopathologists and the author of numerous papers and textbooks. He is a board-certified dermatologist and dermatopathologist licensed in many states throughout the U.S.His clinical expertise is in skin disorders and his passion has led him to co-found TopMD Skin Care, the company behind CLn® BodyWash.

Your Child has both Good and Bad Bacteria on Eczema Skin

Our skin is home to about 1 trillion microscopic organisms such as bacteria and fungi, and not all are bad – some are beneficial to us and some are harmless, but some are harmful like the Staphylococcus aureus bacterium (“Staph”) and Streptococcus pyogenes (“Strep”) that can cause skin infections. You can read more about the Human Microbiome Project of National Institutes of Health in this interview with Elizabeth Grice.

Marcie Mom: Dr. Clay, I read from this table that the bacteria commonly found on our skin are (1) Staphylococcus epidermidis, (2) Staphylococcus aureus, (3) Streptococcus pyogenes (4) Corynebacteria and (5) Mycobacteria.

Which bacteria are good for us (for instance, prevent colonization of harmful bacteria) and which bacteria are harmful?

Dr. Clay: Staphylococcus epidermidis is part of the normal bacterial flora that lives on our skin and is a beneficial bacterium. In fact, they serve in many ways to “police” the skin and prevent dangerous ones such as S. aureus and S. pyogenes from growing and “setting up shop”. These latter two may cause boils, folliculitis, cellulitis and erysipelas, all examples of skin infections.

Corynebacteria exist in several different species. C. acnes lives in hair follicles normally, but plays a role in the development of acne in acne-prone individuals. Other forms of Corynebacteria can also cause more serious infections such as C. minutissimum, which causes pitted keratolysis and juvenile plantar dermatosis, and C. diphtheria, which can cause cutaneous diphtheria, a rare form of cellulitis. There are also many different species of Mycobacteria, some of which are harmless and live in certain areas of the body such as the groin (M. smegmatis).

Others are harmful and can cause cutaneous tuberculosis and atypical mycobacterial infections such as Swimming Pool granuloma (M. marinum) and infections acquired from getting pedicures when exposed to infected water in nail salons (M. fortuitum).

Do We Need More Good Bacteria?

Most bacteria tend to reside in moist areas of skin, along skin folds. I read that diet, health, age and environment also affect the amount of bacteria on our skin. Let’s tackle the good bacteria on our skin first – is there anything that one can do (and should one try) to increase the amount of good bacteria on our skin?

Conversely, will frequent hand washing and use of sanitizers and anti-septic sprays remove good bacteria that our body needs? For a child whose immunity has yet to be fully developed, should he or she be washing hands more frequently or less than an adult?

Dr. Clay: The best way to increase the “good” bacteria is to have good hygiene, which prevents exposure to the “bad” bacteria (i.e., wash with a good soap and water and use hand sanitizers periodically). The good bacteria will naturally grow on your skin and live in harmony with our bodies naturally, as our body has certain factors, such as local immunity and chemicals on the skin surface, that create just the right environment. 

Bacteria Population and Hand Washing

Bacteria multiply exponentially, so when its population is temporarily decreased, as after the use of hand cleanser, it re-grows quite quickly and returns to its normal concentration. The only way to truly “sterilize” so that the normal bacteria would not return would be to wash many, many times a day and even then, it is virtually impossible to get the skin totally sterile. In fact, individuals who do over-wash often cause significant skin irritation, which paradoxically can cause the “bad” bacteria to enter and colonize the skin and even cause an infection.

Staph Bacteria Colonizes Eczema Skin

There are individuals who have certain skin diseases that predispose them to become colonized with “bad” bacteria like Staph, especially those with atopic dermatitis, also known as eczema. These patients need to use more aggressive measures to get rid of these bacteria, as they can worsen the skin condition and lead to more serious infections. These patients often require systemic antibiotics or topical antibacterial agents including bleach, as administered in bleach baths, or bleach-containing body washes like the one I have been involved in developing, CLn® BodyWash, which can be used in a shower also.

Children don’t really need to wash their skin more than adults, as their immunity to bacteria develops very soon after birth. In fact, children’s skin can be more sensitive than adult skin, so care should be taken not to over wash with harsh soaps and detergents. Skin in elderly individuals also is less able to tolerate dryness, so the same caution should be taken by them, too.

Children and Elderly’s Skin should not be over-washed with harsh soaps

People who are Staph carriers (i.e. abnormally harbor Staph on their skin) are prone to developing boils and other infections and can spread the Staph to family members.  They, too, should take measures to try to decrease the spread of Staph by using topical antibiotics and antiseptic washes.

MarcieMom: Thank you Dr Cockerell for the detailed explanation of the various bacteria on our skin. Next week, we will discuss specifically on staph bacteria.

Eczema Tips

What and how much detergent to use when you have a child with Eczema?

My washing machine

When you are a first-time mom, you get lots of advice; if you are a first-time mom of an eczema child, you get even more advice on everything from everyone, and sometimes they get contentious. Detergent is one of the issues where opinions differ – some say no detergent, some say little detergent, some say organic detergent and most of the time, it brings about frustration. So what is right?

Unfortunately, yet again, there is no clear cut answer. Detergents are everywhere, from laundry, to residue on our clothes (supposedly up to 2% of the fabric weight), towels, dishes, food containers, bedding, bathroom, floor, furniture, hair, skin (ours that come into contact with our children) and lint. There are parents who believe in cutting out all sources of detergent but given the prevalence of detergent even in dust, it is difficult to cut everything.

Below are some of what I’ve found out, from various research papers and online.

1. Increase in eczema is linked to increased usage of soap and detergent personal wash products in children (taken from review article Features of childhood atopic dermatitus by Hugo Van Bever and Genevieve Illanora, who in turn quoted Dr Michael Cork’s 2002 article)

Dr Michael Cork’s article in Dermatology in Practice published that eczema in british children increased from 3% in 1950s to more than 20%; during this time, the sales of detergent increased from 76m pounds in 1981 to 453m pounds in 2001. There is also an increase in central heating, carpeting, double glazing/wall insulation that promotes the environment for dust mite to thrive.

2. Is detergent bad?

Apparently, yes. Detergent strips the protective fats of our skin barrier, making it easier for irritant and allergen to penetrate. Eczema skin is dry, and thus more suspectible to cracks in the skin, making it even more vulnerable. The ingredients which are bad in detergent include sodium lauryl sulfate, triclosan, formaldehyde, sodium hydroxide, linalool and sodium flouride. These chemicals are not only used in detergent (including some hypoallergenic detergent), but also fabric softener, bubble bath, insect repellent, air freshener, toothpaste, bleach, liquid soap and baby wipes!

(A Sweden study showed that 5–7% of 3,000 eczema patients patch tested positive to linalool, which is found in 60-80% of perfumed hygiene products and detergent liquid. Linalool is a fragrance ingredient found naturally in lavender and mint, and when oxidised, can cause contact allergy).

3. So what to use and how to use?

Mild, fragrance-free, dye-free, lubricant-free, phosphate-free, brightener-free products suited for sensitive skin. (many webpages recommend puraderm). Recommended to use liquid detergent, instead of solid and to use 1/8 to 1/2 of the recommended dosage (supposedly washing machines are more water-efficient now while detergents have gone more concentrated). Using more detergent than necessary does not make your clothes cleaner but instead creates a build-up of residue which you can tell if your clothes get stiff when dried.

4. So how far should you go in cutting down detergent?

Personally, I used as little detergent as I can pour out and I invested in a washing machine with allergy care function which supposedly washes away chemicals, which I think it does as each cycle is 2 hours! I clean my floor with water only and that’s about all the measures I take. I find cutting all traces of detergent to be too exhausting and so far it hasn’t seem necessary from observing my baby’s skin reaction. What’s your take on this? Do drop me a comment!

101 things that Mothers with Eczema Child do Differently

7 of the 101 things that Moms with Eczema Child do Differently – Detergent Decision

Detergent Decisions

I remembered that detergent was one area which I received lots of ‘advice’ on, especially when Marcie’s skin was very bad about 7 months old. It’s frustrating, and that’s one of the reason I’ve set up the support group because only parents with eczema children go through all the other stuff that comes with eczema flares.

This is the seventh of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.