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Support Group

Eczema Blues Google Collections

For the past 6 months, I’ve been receiving emails on where to find certain information and this prompted me to create Google Collections for your ease of reference, under my Google Plus Profile

A graphical way to search for eczema related posts on Eczema Blues
A graphical way to search for posts on Eczema Blues

You can continue to find information on this blog, using

  1. Search button on the right top
  2. Topics under menu bar drop-down list at Eczema Tips
  3. Interview series with Featured Guests
  4. Categories on right side column
  5. Tagged words on right side column

Hope that this eczema blog continues to be of help to you and make your life with eczema better!

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

Categories
News & Research

Eczema News – Use of Bath Oil Reduce Xerosis and Eczema

Last week, we looked at the study on detergent and this week, we’re focusing on bathing (video on Baby Bath Basics). We know that soaps are to be avoided as it is drying to the skin and adjusts the skin pH to more alkaline than it should be. You also know that I use bath oil for my daughter Marcie, including a cartoon below on care after the bath!

But does bath oil really help dry skin (xerosis) and eczema? This study in Norway examines that, let’s take a look at it!

Bath Oil for Eczema Child
We use bath oil, instead of soap for shower; A few times, we slipped cos the floor is really bath oily!

Study title: Can Early Skin Care Normalise Dry Skin and possibly Prevent Atopic Eczema? A pilot study in young infants

Study objective: Assess if xerosis, and possibly eczema, could be reduced at six months of age by early introduction of frequent oil baths/facial fat cream in infants with dry skin.

Study method: 56 six-week-old infants with xerosis (dry skin), but not eczema, are separated into 2 groups – one using bath oil frequently (up to 7xs/week) and moisturizer on face, while not the other (sparse use). The skin outcome is measured at 6-month old.

What’s Bath Oil to do with Baby Skincare?

The observation is that for babies with eczema, the onset of their eczema (45% of eczema kids have eczema in first 6 months of age) is characterised by altered skin barrier, increased water loss and defective lipid layer. Bath oil retains the moisture on skin. Moisturizers and bath oil are often part of eczema skincare but can it have preventive effect? 

Bath Oil Preventive on Xerosis and Eczema

A note on Xerosis (dry skin)

The study aims to investigate if frequent use of bath oil and moisturizer can reduce dry skin. Dry skin is an indication of defective skin barrier, being unable to retain moisture and have low skin lipids. The defectiveness of skin barrier is in-part genetic, linked to filaggrin gene, but also have an environmental element to it. In the study, the researchers put it succinctly as

Xerosis (dry skin) is a common feature of AE.. The abnormalities found in the stratum corneum involve increased water loss through the skin and reduction in total skin surface lipid. Normal desquamation of the stratum corneum depends on pH dependent proteases with normal function at low pH. Elevated pH of the stratum corneum increases serine protease activity, with secondary generation of inflammatory cytokines and reduced activity of lipid-processing enzymes, resulting in a defective lipid layer.

A Western lifestyle with excessive use of soap and water and skin care products may change the pH of the skin surface in addition to changing the hydration of the skin, thereby influencing the barrier function of the skin.

Skin pH is one of the many factors leading to defective skin. Do read Dr Cheryl Eberting’s series on skin pH. In the post I did with Professor Hugo in 2011, it is mentioned that the lack of filaggrin gene also increases the skin pH and leads to increased skin inflammation. (fyi: elevated skin pH, increasing skin pH = more alkaline than the skin should be, one of the reason why soap is never recommended for dry skin as it’s alkaline – we want the skin to be slightly acidic).

Conclusion: The intervention group had more often normal skin (75%) at six months than the observation group (37.5%), and less often probable atopic eczema. No adverse reactions were reported.

My take: I do use oatmeal-based bath oil on alternate day. Now that my child is at preschooler age, we no longer soak her in the bath tub but just apply and rinse like normal bath lotion.

What’s your take? Do you have a few seconds to drop a comment and share?

Categories
Eczema Facts

Contact Dermatitis – Can a Child have Eczema and this?

Double whammy? Contact dermatitis in atopic dermatitis child
Double whammy? Contact dermatitis in atopic dermatitis child

Can my Child have both Atopic and Contact Dermatitis?

Contact dermatitis is more common in adults, but it is possible that a patient with atopic dermatitis also have contact dermatitis. The logic is that eczema skin barrier is defective, thus more vulnerable to hypersensitive reaction to chemicals. The chemicals which I’ve found from recent years’ studies which affect eczema patients (not necessarily children) more than non-eczema patients are

Surfactants cocamidopropyl betaine (CAPB), from AAD study. Also quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol (from another AAD study)

How does dermatologist treat Contact Dermatitis?

The treatment is similar to atopic dermatitis, so in a sense it may not be as critical if the two cannot be differentiated. The difference is that without avoiding the substance that is causing the hypersensitive reaction, it is then not possible to keep it from causing the rash. Moisturizing, medicated cream, compresses to relieve itch and soothe skin, and antihistamines for reduced scratching at night may be prescribed.

In finding out which are the irritants involved in contact dermatitis, a patch test can be carried out (read more here). Patch test involves placing the suspected irritants/chemicals (note: there is a ‘science’ as to how much to put and how to prepare the liquid, don’t try to do this yourself) on paper tape on your child’s back or arm. The tape will be left on for about 48 hours and observation be noted by the dermatologist.

Is my child more likely to have contact dermatitis as an adult?

I haven’t come across such study, but it makes sense to figure out the irritants early and to avoid them. Also to treat the eczema promptly and take measure to protect the child’s skin barrier so that it is more robust against irritants when the child is older. (At the same time, I’m thinking she has got to fend for herself when old, I’m not going to say ‘Stop Scratching’ till I’m 60 year old!)

What are the preventive measures for contact dermatitis?

Avoidance is key, especially once you or your child has undergone patch testing and knows which substance triggers the hypersensitive reaction. There are common chemicals that are present in contact dermatitis in children (US), and these are nickel, neomycin, cobalt, fragrance, Myroxylon pereirae, gold, formaldehyde, lanolin/wool alcohols, thimerosal, and potassium dichromate. Also for those without any allergy, but has eczema (known as ‘intrinsic eczema’), this study suggest the possibility of nickel and cobalt allergy.

This study provides a percentage of common allergens for eczema children, nickel (16.3%), cobalt (6.9%), Kathon CG (5.4%), potassium dichromate (5.1%), fragrance mix (4.3%), and neomycin (4.3%).

The above chemical names may be too difficult to remember, so below is a compilation of where they may be commonly present in:

Soaps and detergents

Saliva

Urine (common cause of diaper rash)

Baby lotions, avoid perfume/fragrance products, preservatives

Latex, e.g. rubber products

We’ve covered the basics and the conclusion may be to be aware of contact dermatitis and promptly remove the suspected irritants. When the child is older, say 5 year old, bring him/her to a patch test.

Read last week: Contact Dermatitis, does your Eczema Child have it?

Categories
Eczema Facts

Contact Dermatitis – does your Eczema Child have it?

The things that can be irritant! Eczema child and contact dermatitis
The things that can be irritant!

So far we have not gone ‘technical’ in this blog to differentiate between atopic dermatitis and contact dermatitis, simply because when we talk about eczema, we are referring to atopic dermatitis. So what’s the difference between the two? And more importantly, are our eczema children also suffering from contact dermatitis? Is the treatment the same? And are they more likely to have contact dermatitis when older?

Phew, this already sounds like a stressful topic (everything is stressful the minute I think about anything from primary school/ grade school onwards!) These topics will be broken into two manageable reading posts, with a focus to share about the research on relationship between atopic and contact dermatitis (at least what I can find from past 3 years!)

What is Contact Dermatitis?

To complicate matters, there are two types of contact dermatitis – allergic and irritant. Allergic contact dermatitis involves the immune system by which a hypersensitive reaction (rash) results from a previous contact with the allergen. Irritant contact dermatitis, on the other hand, does not involve the immune system being sensitized to the irritant. It is a delayed hypersensitive reaction due to prolonged exposure to the irritant.

How is it different from Atopic Dermatitis?

Irritant contact dermatitis is different from atopic dermatitis in that usually more than a minuscule amount of the irritant is required to generate the hypersensitive reaction, whereas in atopic dermatitis, a very small amount can cause a severe flare-up. The mechanism of which the rashes appear differ – contact dermatitis is known as type IV delayed hypersensitivity reaction which does not involve the (IgE) immune system whereas atopic dermatitis is type 1 IgE-mediated reaction.

Which one is my Child suffering from?

This can be difficult to figure out because the symptoms of eczema and contact dermatitis are similar, such as red rashes, blisters, thickening of skin (lichenification), scaly skin and itch.

Atopic dermatitis (eczema) is more common in children, however when the child does not respond to treatment, it may be worthwhile exploring if he/she is having rashes from the chemicals the skin comes into contact with. The relationship and prevalence of the two is still not super clear, as it may be due to the much higher amount of lotions and medication used on the eczema child’s skin. This study suggest that there is increasing prevalence of contact dermatitis in children, whereas previously thought to be uncommon. Patients with atopic dermatitis are more likely to be sensitive to quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol in this study.

Check back next week on Wednesday to learn of the treatment and prevention of contact dermatitis in children.

Categories
Living with Eczema

SOMEONE Manages Eczema Baby and Nut Allergic Child

Gail shares on managing eczema and allergy for her baby son and daughter, and oh, they look so lovely!
Gail shares on managing eczema and allergy for her baby and teenage daughter, and oh, they look so lovely!

This is a series focused on a personal journey with eczema while managing a certain aspect of life. Today, we have Gail, who shares about managing eczema for her baby and nut allergy for her older daughter. Gail has spent much time looking for products to help families with eczema, and has it all under one roof at her store, Everything for Eczema.

Marcie Mom: Hi Gail, it’s good to have you share in this series! Let’s start with you sharing a little of your older daughter’s nut allergy and the extent of care that is required.

Gail: Hi Mei.  My older daughter, Charlie, was diagnosed with a nut and seed allergy when she was 3 and she’s now 14.  The biggest challenges now that she is a teenager are that she hates carrying her epi-pens around with her as she feels they make her seem different to everyone else.  She will frequently take them out of her bag before she goes to school or out with friends.   Now that she eats out more without me, it’s also a worry as she is very self-conscious about asking whether there are nuts or seeds in a meal.

Marcie Mom: What about care for the younger baby? When did the eczema start and was the scratching intensive?

Gail: My younger daughter’s eczema started when she was just 6 weeks old.  Within a couple of months the whole of her body was covered in eczema and she often needed to have her legs and arms bandaged.  Tallulah was incredibly itchy and would scratch until she bled if left alone for more than a few seconds.  Bath times and nappy changing times were incredibly stressful as this was when she could get at her skin and scratch uncontrollably.

Marcie Mom: How did you manage bedtime for all of your children? What was the most difficult part?

Gail: Bedtime was one of the worst times of the day.  Tiredness would always make Tallulah extra itchy and she would need lots of attention.  This would have a knock on effect on Charlie who would start to feel left out.  It probably didn’t help that I was very sleep deprived too!

Marcie Mom: One final question – was there a turning point during this period which made it easier for your family to manage eczema and allergies for your children?

Gail: Establishing a good bedtime routine really helped.  When my little one was tucked up in bed I would then spend some quiet time with my older daughter so that she felt special too. Finally getting some sleep was a turning point for us all.  Suddenly you start to feel human again!

Marcie Mom: Thank you Gail for your sharing, it is truly not easy to manage all of it and we keep our fingers crossed that night time will get better for all families with eczema kids!

Categories
Doctor Q&A

Rise and Shine Feature – Eczema Skin Function and Care

Dr Lynn Chiam Dermatologist Children Skin Conditions Eczema

Dr Lynn Chiam shared during the Rise and Shine Expo on ‘All about Children’s Skin’. She consults at Children & Adult Skin Hair Laser Clinic and subspecializes in pediatric skin conditions. She was formerly the head of pediatric dermatology at National Skin Centre, Singapore. She has also shared her expertise on Teen Eczema, Hand Eczema and Facial Eczema.

Eczema Baby Skin

MarcieMom: Thanks Dr Lynn for spending some time here, and helping to address follow-up questions to your talk. You mentioned that the skin function includes protection against sun, and that baby’s skin offers less protection. How about skin of an eczema infant? And the skin of an eczema adult? Do they offer even less protection against the sun as the skin barrier of eczema patients are already defective?

Dr Lynn: Protection against the sun depends on the integrity of the skin as well as the amount of pigment cells in the skin. In general, a baby’s skin is less mature and contains less pigment cells compared to an adult and thus is more susceptible to the adverse effects of the sun. Darker- skinned individual tend to get less sun burn as compared to fair-skinned individuals.

In infants and adults with eczema, their skin barrier functions is defective and they can get broken skin as a result of scratching. This can make them more susceptible to sunlight and exposure to excessive amount of sunlight is known to trigger or aggravate the eczema.

Eczema Baby Skin is more susceptible to sunlight and exposure to excessive amount of sunlight is known to trigger or aggravate the eczema.

Eczema Baby Skin Infections

MarcieMom: You also mentioned that the skin forms part of our body’s immune system. Is this due to the skin flora? Does the ‘porous’ eczema skin means that babies with eczema have a lower immunity and does this lower immunity translate to falling sick often? What is the implication for parents in caring for the general health of an eczema baby?

Dr Lynn: The skin contains cells which are involved in the reaction that our body mounts in response to an infection and inflammation. They are known as “B” cells and “T” cells. They can be thought of as “soldier cells” that defend our body when it is “attacked”. The skin flora on the other hand describes the bacteria, fungi and viruses that reside on our skin without causing any harm to our body. They are not part of the immune system.

The “porous” eczema skin allows bacteria and viruses to penetrate more easily and thus eczema patients are at a higher risk of getting skin infections. The skin of patients with eczema do have lower immunity to prevent skin infections but in general this not lead to overall decrease in their body’s  immunity. Children with eczema  do not fall sick more often as compared to their peers.

It is important for parents and health care providers to recognise eczema superimposed with skin infection as the skin infection has to be cleared for the eczema to heal well.

Wet Wrapping for Eczema Baby

MarcieMom: Is wet wrap/dressing recommended for infants below 6 month old? Does the thinner skin of babies affect whether they ought to be wet wrapped?

Dr Lynn: As the skin of an infant below 6 months has a larger surface area: volume and is thinner as compared to adults, they tend to absorb a larger percentage of creams that is applied. Thus it may lead to side effects as a consequence of more creams that is absorbed via the skin into their system. Thus I will generally not advise wet wraps for infants unless the eczema is very severe and the creams used are very gentle.

Wet wrap is not advisable for infants unless the eczema is very severe and the creams used are very gentle

Topical Steroid Potency for Baby

MarcieMom: Similarly for steroid potency, is there a certain age by which the skin is thick enough to consider stronger potency steroid cream?

Dr Lynn: There are no guidelines for the potencies of steroids to be used according to age. In general, I will not use anything stronger than a mid-potency steroid in children less than 8 years old. The potency of the steroid used also depends on the thickness of the skin and the severity of the eczema. The neck, inner aspects of elbows, back of knees and wrist are generally considered to have thin skin and only low to mid-potency steroids should be used. Contrary to this, more potent steroids have to be used on the palms, soles and areas where the skin is thick as a result of the eczema.

For more severe eczema, a more potent steroid should be used to control the inflammation before tailing to a less potent one.

Thank you Dr Lynn for sharing your thoughts on the above questions, and thank you for the wealth of information you’ve provided in this blog.

Categories
Living with Eczema

SOMEONE has Eczema and manages Cloth-Diapering

MieVee shared about her cloth diapering journey for her child with eczema
MieVee shared about her cloth diapering journey for her child with eczema

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have MieVee, whose 4.5 year-old child has eczema since 5 months old and shares how she manages her son’s sensitive skin around the diaper area. MieVee runs a successful site MummyReviews.com in Singapore and Malaysia.  

Marcie Mom: Hi MieVee, thanks for taking part in this blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema, when did he first have it and what was the most difficult part of managing his eczema?

MieVee: My eldest son, Vee, started developing a rash at his face during 5 months old. Despite him trying on various creams, the patch expanded to a large part of his face. It was very itchy and disrupted his sleep. Often, he’d rub his face against his pillow till it bled. The most difficult part was getting the rash and itch under control.

When he was about 14 months old, we discovered by chance that he had soy allergy. By eliminating soy from my diet (since I was breastfeeding him), the rash on his face subsided within 2 weeks and eventually disappeared.

However, the folds behind his knees are still prone to itchy rash, if he perspires.

Marcie Mom: I understand that you’d like to share on using cloth diapers for your son. When did you first start to use cloth diaper, and why?

MieVee: I started cloth diapering Vee from his newborn days. My main reasons are to use comfortable fabric against his skin, reduce trash and save money on diapering.

Marcie Mom: How difficult is it to cloth diaper for him, and do you apply any lotion?

MieVee: We use a variety of modern cloth diapers, so it has been very convenient. The easiest to use are pocket diapers with inserts and Velcro tabs. Even hubby could use these easily.

Vee was a high-needs fussy baby, especially during sleep. He didn’t like night-time diaper changes, would scream loudly and couldn’t get back to sleep easily. However, his diaper area would be prone to rashes if his regular diaper was left on for more than 5 hours.

Eventually, I found breathable night-time fleece cloth diapers that absorbed a lot through the night, while letting his skin breathe and remain rash-free. Since then, he slept much better at night.

In the day, he didn’t need diaper cream because we change his diaper every 2-3 hours. At night, because of the long hours, I apply a thin layer of non-zinc oxide diaper cream at his front diaper area. (To prevent the cloth diaper from repelling liquid, I place a disposable biodegradable liner on it.)

Marcie Mom: One final question – what is the best way to fold the cloth diaper?! I couldn’t get it right and gave up within a day!

MieVee: Most modern cloth diapers do not require any folding. Depending on the design, you may insert a rectangular absorbent fabric into a pocket or lay it on the diaper cover, put it on baby, then close it with Velcro tabs or snap buttons. Very easy!

There’re many cloth diaper reviews and tips on my blog to help new parents get started, so feel free to browse through them.

Marcie Mom: Thanks MieVee for sharing your journey on cloth diapering, and your tips!

Categories
Doctor Q&A Youtube EczemaBlues Channel

AAD Skincare Video Series: Eczema Tips

How to Help your Eczema Child feel Better with Dr Lawrence Eichenfield AAD

Today’s video is “Eczema Tips: How to Help your Child feel Better“. For this video, I’ve 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.

  1. Face Washing 101
  2. How to Get the Most from Your Skincare Products
  3. Eczema Tips: How to Help your Child Feel Better
  4. How to Apply Sunscreen

MarcieMom: Thank you Dr Lawrence for taking time to help with this AAD skincare series, and in particular, with the eczema tips for children. It was mentioned that if the child’s eczema is infected, parents can discuss (twice weekly) bleach bath with the doctor.

What are the symptoms of an infected eczema? Is that the same as skin inflammation, which can occur at the underlying layers of skin and therefore not be visible? Would bleach bath be recommended for skin inflammation as well?  

Dr Lawrence: 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.

Practical Way to Moisturize Eczema Child

MarcieMom: It was mentioned to pat the skin partially dry after shower, before moisturizing. Many parents aren’t sure how to gauge partially dry – sometimes when there’s too much water on the skin after bath, the application of moisturizer seems to feel too ‘slippery’, versus sometimes it feels too much resistance to apply on already dried skin after shower. The guideline is to moisturize 3 minutes after shower. All these seem hard to implement ‘precisely’. What’s the practical way to moisturize?

Dr Lawrence: First of all, don’t get “hung up” on the perfect patting the perfect timing of application of moisturizers.  Pat off enough water so the skin seems dry enough to easily apply the moisturizer, and don’t worry if it’s 5 or ten or even 15 minutes after the bath or shower.

Don’t get “hung up” on the perfect patting the perfect timing of application of moisturizers

Long-lasting vs Pore-clogging for Ointment?

MarcieMom: I understand thick emollients are longer-lasting and suitable to trap more moisture after shower and also to last through the night. Is there a risk that too much application of thick emollients clog pores of children? Would rotating between liquids and creams help and also a little rubbing of skin during shower to make sure emollients don’t get ‘piled up’ on the skin?

Dr Lawrence: There’s lots of variability in skin types, degrees of skin dryness, and environmental/weather factors that influence how moisturizers feel on the skin and are perceived by the users/families.  Usually there aren’t problems with folliculitis or pore-clogging.  When the skin is more dry, gooier may be better.  If less so, less occlusive moisturizers are just fine.

Finding the Right Humidity for Eczema Skin

MarcieMom:  On humidity levels, what is the recommended humidity level to not strip moisture from the skin but also not encourage the growth of dust mites and mold?

Dr Lawrence: There is no set “perfect humidity,” and the skin often does a good job of adapting to different humidities, though eczema skin may have more of a problem doing this.  Moderation is probably the mantra– extreme dryness or excessive humidification may create more troubles!

MarcieMom: Thank you Dr Lawrence, your advice is certainly useful and a relief for parents managing skincare for their eczema children that we don’t need to be too worried to ‘perfect’ it!

Categories
Doctor Q&A

Skin Health Series – Functions of Skin – Dry, Hot/Cold and Collagen

This is the second of a much-awaited series, where I get to work with Dr Verallo-Rowell again (we last worked on Sensitive Skin Product Series in 2012). Dr Verallo-Rowell is a dermatologist, dermatopathologist and dermatology/laser surgeon, founder of VMV Hypoallergenics, and is also an author, esteemed researcher and speaker. 

Skin Health Connection Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics

Understanding Skin & Health – Functions of Skin

The skin has a few important functions, (i) it protects the body from foreign particle, bacteria and it prevents moisture loss, (ii) the skin regulates body temperature, and (iii) the skin gives us a sense of touch.   We understand that in atopic dermatitis, the immune cells in the skin mistook a (harmless) allergen to be harmful, resulting in skin inflammation.

Dry Skin – Eczema or Health Condition?

MarcieMom: Does dry skin indicate possibility of eczema and other skin or health issues?

Will a person’s diet, lifestyle, smoking, drinking (caffeine or alcohol) affects the dryness of skin?

Dr Verallo-Rowell: People with the inherited form of eczema called atopic dermatitis almost always have dry skin but not all people with dry skin have skin or other health issues. Some people just have Congenital Dry Skin while others have Acquired Dry Skin from environmental agents such as too much hot water and strong detergents use; friction from clothing; frequent air travel, pollution, exposure to chemicals at work or play, or frequently staying in highly air-conditioned rooms.

Impact on Diet and Smoking on Skin

Yes definitely – the diet is very important because what we eat forms the structure of our cells, in particular the lipid bi-layer of our cells where a balance of saturated and unsaturated oils, short and long chain fatty acids, omega 3 and omega 6 oils or transfats can contribute to inflammation at the molecular level to eventually manifest itself as skin dryness. Smoking is a strong oxidizing agent. Many studies have now shown it to therefore show much faster aging changes including dryness, wrinkles, toughening of the texture of skin. Too much alcohol affects the liver and caffeine dehydrates.

Smoking is a strong oxidizing agent

Skin being Hot and Cold to Touch

An infected skin patch feels warm to touch. Are there health conditions that affect how cold or hot our skin feels or cause a change in how cold or hot an object feels to us?

Dr Verallo-Rowell: Our skin when compared with skin of others in the same room or under the same environmental circumstances may feel hotter to touch when: febrile from any cause usually infections; in hyperthyroid persons; in rosacea ; when perspiring heavily. The opposite – feel colder to touch may occur in anemic, cachectic, hypothyroid people, or very sedentary people or anyone with lowered metabolism.

A change in how cold or hot an object feels to a person is affected primarily by the condition of the peripheral nerves. One sees this in Hansen’s disease, diabetic neuropathy, metal poisoning, and any other form of neuropathy affecting the peripheral nerves.

Collagen – Consume or Apply on Skin?

MarcieMom: The dermis contains collagen fibers that maintain the elasticity of the skin. In the subcutis, there are fat cells, nerve cells and blood vessels. There are many products that are marketed as containing collagen, be it to be consumed or applied on skin.

How does the collagen from a drink find itself to the skin? And how does the collagen on a skincare product ‘dig’ itself to the collagen fibers of skin? Will it bind with the existing collagen fibers? Are they even the same collagen?

Dr Verallo-Rowell: Collagen are coarser fibers in the dermis that give skin its bulk or structure. Elasticity of the skin is given to it by the elastic fibers. The ingredients in the above products are soluble forms of collagen meant to add bulk, or elastin, meant to give elasticity.  These ingredients are usually from animal or plant proteins with similar bulk forming effects though more likely just texturizing or moisturizing effects. They are extracts that blend into the formulation and not the collagen fibers or fibrils themselves.  Many years ago collagen from cows (called Xyderm or Xyplast) were popular fillers that were what we used to inject into the skin. The molecules of collagen are too large to penetrate the skin and its barriers by topical application.

MarcieMom: Thank you Dr Verallo-Rowell, it is a reminder for me to eat healthily and also understand how our skin interacts with the environment!

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Living with Eczema

SOMEONE Manages Son’s Eczema during Summer

Christy on Eczema BluesThis is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Christy, who shares how she manages her son’s eczema which flares up during summer. Christy blogs at UpliftingFamilies and is passionate about helping families with their parenting struggles.

Marcie Mom: Hi Christy, thanks so much for taking part in my Friday blog series ‘Someone has Eczema’! Let’s start with you sharing a little of your son’s eczema history, when did he get eczema and what triggers a flare-up?

Christy: When my son was around two years old, I noticed one day that the back of his knees were red.  I took him to the doctor because I didn’t know what was going on.  The doctor said it was eczema and gave us some medicine to treat it.  It seems as if summer heat, increased sweating, and swimming pools (chlorine) causes him to get a flare up.  The best treatment we used was a thin layer of cortisone and then cover it with moisturizing lotion, or a prescription steroid cream.

Marcie Mom: Share with us how his skin changes as he grows older – did it improve? 

Christy: The doctor said most people typically outgrow it; however, my son is 12 years old and still gets flare ups in the summer time.  I feel if he would pre-treat his skin every day that it would greatly improve his skin but he is a typical boy and forgets.

Marcie Mom: How does summer affect his eczema and does the family need to accommodate to his condition during summer?

Christy: My son doesn’t really seem too bothered by his flare ups.  Occasionally, they will start bleeding.  I just have to remind him to use his eczema cream on his arms and legs.  We haven’t ever skipped an outing or anything due to his eczema but he does have to carry his prescription cream with him. 

Marcie Mom: One final question – I read from your blog that each of your 3 children has some special needs. Did managing eczema for your son make it harder to manage the other two children?

Christy: His eczema hasn’t made it harder to manage with my other two kids.  He was the youngest when he was first diagnosed and I would make a habit to put cream on his legs twice a day, usually during a diaper change.  Now that he is older, I just have to remind him to put on his eczema cream. 

Marcie Mom: Thanks Christy for taking time to share your personal story and it is good to know that eczema can be managed well!

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Living with Eczema

SOMEONE has Thyroid Cancer and Manages Eczema

Gibz shares her experience managing eczema, result of her thyroid treatment
Gibz shares her experience managing eczema, result of her thyroid treatment

This is a series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Gibz, to share how she manages her eczema, a side effect of the treatment for her thyroid cancer. Gibz is a lovely young lady, and works full-time and blogs to share and encourage others.

Marcie Mom: Hi Gibz, thank you so much for for taking part in my blog series ‘Someone has Eczema’ and I’m so glad to have jumped into your twitter chat and got to know you. Before that, I had no idea that eczema is a side effect from thyroid treatment. Do share with us your medical conditions, and in particular, when skin rashes first appear?

Gibz: I had thyroid cancer so I have to take thyroxine daily to stop me becoming hypothyroid. I’m also hypoparathyroid which means I can’t manage my blood calcium levels; this was a complication of the cancer treatment. Skin rashes first appeared after I had my thyroid removed and started my thyroxine and calcium pills.

Marcie Mom: How did your skin react during the treatment? Do certain drugs trigger a rash and is that a side effect you knew before it happened?

Gibz: My skin became really dry during certain points in the treatment, but I didn’t pay much attention to it. As time went on my skin got worse and I started getting rashes. Skin rashes appear when my thyroxine dose is changed, whenever you go on a new dose your body needs around 8 weeks to adjust, and in that time everything goes a bit crazy! I knew dry skin was a side effect but I didn’t realise eczema could be triggered by it.

Marcie Mom: You have reached out to others via your blog, and I saw that your best friend is also a cancer survivor. Is skin rash common in cancer treatment?

Gibz: I don’t think she’s had any problems; it’s not something we’ve talked about! That depends on the treatment you have, with some treatments it’s probably very common, I don’t think it’s common during thyroid cancer treatment but I could be wrong.

Marcie Mom: One final question – what advice would you give to another who suffers eczema as a result of treatment or another medical condition?

Gibz: Talk to your doctor about it, chances are you shouldn’t be getting that kind of reaction and they might be able to give you different tablets or a new dose that will suit your body better. If they can’t do that they should be able to help you control your eczema.

Marcie Mom: Thanks Gibz for taking time to share your journey with us, I really enjoy connecting with you and it added another dimension to my understanding of eczema.

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Living with Eczema

SOMEONE has Eczema and manages Occupation as Massage Therapist

Massage Therapist - Paola Bassanese
Massage Therapist – Paola Bassanese

This is a new series focused on personal journey with eczema while managing a certain aspect of life. Today, we have Paola Bassanese, who has had eczema since her childhood years and whose work as a massage therapist requires frequent hand-washing. Paola is the founder of Energya, an award-winning massage therapy practice based in Central London.

Marcie Mom: Hi Paola, thanks for taking part in my new blog series ‘Someone has Eczema’ and for returning to my blog (the first interview with you was on massage for eczema). Let’s start with you sharing the severity of your eczema, whether it particularly affects your hands and what would trigger your eczema flares?

Paola: Hi Mei, thank you for giving me the opportunity to share my experience. My eczema is somewhat stress related and can also be triggered by external factors like contact with irritating substances, cold weather and wrong food choices. My eczema is often contact dermatisis and it appears solely on my hands causing cracking in the skin and bleeding.

The random fashion of my eczema flare ups make it difficult to prevent the reoccurence of eczema so my key strategy is to keep stress at bay. This is particularly important because if I am stressed and get eczema I can’t work and being self-employed I need to stay healthy to be able to treat my clients and to run  my business.

My worst eczema flare ups were when I worked in offices and my hands were bleeding and painful when I tried to type or move my fingers. In my first year as a massage therapist when I set up my practice after leaving a well paid office job my stress levels were very high and I had to manage my condition while trying to gain clients. Saying it was a difficult time is an understatement!

Marcie Mom: I haven’t had many massages before, and I think even for those who do, we may not be aware of the chemicals that we come into contact with, and therefore, a massage therapist would also be in contact with. Can you share some of these chemicals in the more common types of massages and whether they cause eczema rashes for you?

Paola: Chemicals don’t tend to be used in the massage industry in general and scent-free natural oils are often used. During the consultation form with a new client the therapist asks if there’s any allergies and will act accordingly. However, in salon and spas offering for example manicures and pedicures therapists are in daily contact with chemicals.

Aromatherapy oils (which I don’t use because of my eczema) can irritate the skin even if they are organic. These oils contain natural chemicals so when they come into contact with the skin they can cause reactions even after years of safe use.

Marcie Mom: Definitely there’s a lot of hand-washing and sanitizing involved in your work, how has it affected you?

Paola: I have become more aware of the types of soaps and detergents I use. I have to wash my hands constantly between clients and I only use mild soaps that don’t strip the skin from its own protection barrier. I then moisturise with creams I have tested that don’t give me an allergic or comedogenic reaction; however every so often I need to change the cream I use as over time I become either over-sensitive or it stops being effective.

Marcie Mom: One final question – you made amazing progress, and was awarded by the Chamber of Commerce for running your business in UK and raising the profile of your Italy hometown, Trieste. You must have known from the onset of your massage therapist career that hand-washing would be an issue, yet you persisted and even set up your own practice and won numerous awards. How did you manage this part of your job, and what advice would you give to others who have eczema and want to pursue an occupation they love (say massage therapist, nursing, dentist) that requires hand-washing?

Paola: Thank you Mei for the compliment. Well, looking back at my life I would say that my worst cases of eczema happened when I felt extremely stressed and did not have control over my work environment. So in that sense it doesn’t matter what job I was doing or what country I was in: it was all to do with mental attitude. Yes, of course contact with allergens and chemicals triggered some reactions but I was at my worst when I felt that my life was going nowhere and I needed more positive challenges and projects.

I would advise anyone who suffers from eczema and chooses a profession that requires frequent hand-washing to look at all these factors:

– Nutrition. Do you have any food allergies or sensitivities? Can you make some changes to your diet to reduce the intake of inflammatory foods?

– Stress. How stressed are you and what can you do to reduce your stress levels? Take time for yoruself and practice forms of relaxation like yoga and meditation

– Products. Do your research and look for cleaning products that are tested against allergies and apply barrier cream when you can.

Marcie Mom: Thanks Paola for taking time to share your journey with us, managing eczema and an occupation that has frequent hand-washing, and going on to be so successful in massage therapy is indeed inspiring!

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News & Research

Does Fast Food Cause Eczema?

And you'll run faster as you choose healthier options!
And you’ll run faster as you choose healthier options!

The short answer is we don’t know, but get your kids away from fast food.

Apart from the risk of obesity, a recent study of more than 500,000 children in over 50 countries showed a linkage between fast food and chronic illnesses, namely severe asthma, hay fever and eczema. For kids who eat fast food 3 times or more a week, there’s a 30 percent increased risk in severity of the above conditions.  There’s no causal relationship, but signal a link between fast food and eczema. This study was widely reported because it covered a large number of participants and across countries, however, there are limitations which NHS (UK) pointed out. Professor Hywel Williams, one of the co-authors of the study, mentioned in an NIH interview that three or more weekly servings of fruit reduced the severity of symptoms in 11 percent among teens and 14 percent among children. Fast foods is defined as burgers, while eczema is an itchy rash in the past 12 months with symptoms defined as severe if sleep disturbance was reported at least once per week.

I also come across other interesting reports relating to trans fat (abundant in fast food) and coke, and eczema.

Dr David L Katz replied to a Q&A on Oprah.com to reduce intake of saturated or trans fat, as well as foods related to inflammation. He also suggested increasing omega-3s that can help increase anti-inflammatory hormones in the body. He pointed out flaxseed oil, which I’ve been giving my toddler Marcie. For those of us who are celebrating Chinese New Year, you’d be aware (and beware) as many of these commercial cookies have been prepared with partially hydrogenated vegetable oil and one piece of bak-kwa is 300 calories!

Dr Jeff Benabio in his video said that people severely allergic to formaldehyde can also be allergic to diet soda, as diet soda contained aspartame which after ingestion, created formaldehyde. Specifically, aspartame is hydrolysed to methanol, which is metabolized to formaldehyde then to formate.

For readers of this blog, you’d know I’ve been blogging about eating anti-inflammation food and staying away from inflammatory sugar and trans fat, in the link below:

Interview series with nutritionist Julie Daniluk on various anti-inflammatory foods, such as shiitake mushroom.

Interview series with Dr Sears L.E.A.N. on boosting immune system of children, via consuming more fruits and vegetables.

Interview series with nutritionist Toby Amidor on eczema kids’ nutrition & inflammatory foods.

So, in conclusion, there’s no doubt that fast food, which are high in trans fat and mostly fried, are to be avoided. I’ve been cooking healthy food for my family daily, and you’d be amazed at how fast you can whip out a meal once you’re used to it, faster than fast food!

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Doctor Q&A

Friday Dr Q&A with Dr Liew – Managing Allergy & Eczema at Childcare

Dr Liew is a pediatrician who practices at the SBCC Baby & Child Clinic, Gleneagles Hospital Singapore and is also a visiting consultant to KK Hospital. He subspecialises in allergy, immunology and rheumatology. He was also awarded several research grants to pursue clinical research in paediatric anaphylaxis, drug allergy, primary immunodeficiencies and Kawasaki disease.

Managing Allergy for Eczema Kids Dr Liew Woei Kang

This was an original four posts of Friday Q&A, combined into one more informative post. MarcieMom contacted Dr Liew on setting up an eczema fund in Singapore and subsequently collaborated on this Q&A.

Childcare for Allergy Kids

MarcieMom: Suppose a child who has an allergy has to have alternative care-giver, say at child care centre.

What would you recommend a parent to share with the childcare?

Dr Liew: Your allergist should be able to advice what the caregivers be taught. Written action plans for eczema are useful for daily skin care instructions, whilst food allergy/anaphylaxis action plans provide information on treatment in emergencies. There is continued public education regarding allergic conditions via hospitals and societies like AAA.

Food Allergy in Childcare

How should a parent besides obviously telling the teachers/ care-givers of the allergy, help to make it easier for the school to prevent contact with the food? 

For instance, is there a need to warrant 0% contact, for instance, the whole school shouldn’t even bring the food in?

Dr Liew: After a diagnosis of food allergy, it would be important to relay the importance of food avoidance and emergency care plans with the care-givers. Written food allergy/anaphylaxis plans are useful. The degree of strict avoidance varies accordingly to the food allergen and severity of allergic reaction. It would be better to discuss specific advice with your allergist.

Non-Food Allergens

What are the common non-food allergens?

And if it’s dust mite, how can a parent tell the school to keep the dust mite level low since house dust mite is something that can’t be totally eliminated? And if it’s dog droppings allergy, should a parent not even sign up a child care centre where teachers or even classmates have dogs at home? For common skin allergen like soaps and detergents, should a parent go as far as to monitor what detergent the child care centre or caregiver is using? (And the bigger question is – how can a child care centre with 70+ kids cope with so ‘many requests’ of a parent?)

Dr Liew: The most common environmental allergen is house dust mites in Singapore. House dust mite avoidance measures are useful to reduce the levels of protein, but results variable. I would not recommend schools to implement house dust mite avoidance measures as they are time-consuming and difficult to implement in the long term. Dog sensitisation is usually to the hair epithelia, rather than poo, and is not common in Singapore. Irritants like harsh soaps and detergents should be avoided in children with eczema and dry skin. It may be helpful to provide the school with your child’s soap substitute and moisturisers, and get the teachers assistance for application.

Allergic Reactions in Kids

How can a parent recognize an allergic reaction and more importantly, which are the symptoms that are signs of serious reaction such as anaphylaxis?

Mild to moderate allergic reaction include:

• Swelling of lips, face, eyes

• Hives or welts

• Tingling mouth

• Abdominal pain, vomiting

Antihistamines usually suffice.

Severe allergic reaction (anaphylaxis) include:

• Difficult/noisy breathing

• Swelling of tongue

• Swelling/tightness in throat

• Difficulty talking and/or hoarse voice

• Wheeze or persistent cough

• Persistent dizziness or collapse

• Pale and floppy (young children)

Epi-pens at Childcare

When should a parent prepare an epi-pen and how can the parent teach the child and the alternative care-giver on when an epi-pen is to be used?

Epipen should be administered for severe reactions. A written anaphylaxis plan should be provided with pictorial reminders on how to administer an epipen.

Outdoor Allergens

What are some common outdoor allergens in Singapore?

For instance, to certain type of trees or to certain pollen? Pollen counts are usually higher in the morning and on a warm, windy day versus just after a rain. Many places in Singapore are air-conditioned, is this better or worse off for a child with dust mite, pollen or certain allergy?

Dr Liew: Outdoor aeroallergens include tree pollen (Oil palm tree pollen is commonest), grass pollen are common in temperate countries with seasons, but is uncommon in Singapore. Air-conditioning is better tolerated for eczema patients but can worsen an allergic rhinitis. The impact on specific allergens are not great except moulds, as they may grow in poorly maintained air-conditioning units.

Air-conditioning is better tolerated for eczema patients but can worsen an allergic rhinitis.

Mold & Indoor Allergens

MarcieMom: Mold is another allergen and lots seem to be growing in my home!

If a child is allergic to mold, what steps should a parent take?

Also, for allergies like cockroach droppings, does it mean that the parent must diligently hunt for all droppings in corners of the home and remove them?

Dr Liew: Steps to reduce mould in the environment include a well-ventilated room, and if air-conditioning is used, frequent maintenance of the AC unit. Pest control measures are best for cockcroach sensitisation, as cockroaches often “roam” around and leave traces of protein.

Vaccines and Allergy

MarcieMom: On vaccines, there is so much discussion out there where even doctors are coming out to say that vaccines are unnecessary and pharmaceutical companies are coming up with more and more vaccines that are unnecessary and even harmful for our children. Some parents may be opting their child out of vaccines due to egg protein included in some of the vaccines.

What’s your recommendation on this and when should a parent seriously questions a vaccine before letting his/her child have it?

Dr Liew: Vaccines are the one of the proven public health measures to reduce mortality from infectious diseases. Vaccines are produced for significant infectious diseases. There is no link between vaccination and allergies. Traces of egg proteins can be found in influenza vaccines and specialised vaccines like yellow fever. Egg allergic patients should discuss the risk benefit ratios of receiving these vaccines. MMR vaccines are safe for egg allergic patients.

Antibiotics

MarcieMom: On antibiotics, I’ve read online that antibiotics are mostly unnecessary since they are only effective against bacteria yet it is so common for general practitioners to prescribe antibiotics! (in fact, I always have to refuse the prescription because it’s just a common flu!) Antibiotics are also known to cause allergic reaction, what would be your recommendation?

Dr Liew: Antibiotics should only be prescribed for bacterial infections.

Cross-Reactions

MarcieMom: On cross-reaction, it’s commonly heard of when a child is allergic to birch pollen, he/she is also allergic to apple. Or a child who is allergic to latex is also allergic to kiwi.

Can such allergy be identified by allergy tests?

Also, what are some of the common allergies that you can point our parents to, so that they are aware if their child is allergic to one thing, they should probably avoid something else.

Dr Liew: Cross-reactive allergens occur due to the similarity of one protein to another, usually within the same botany taxonomy. They can be easily tested by skin prick test or blood IgE testing. A good example would be most cow’s milk allergic patients are allergic to goat’s milk as there is an approximately 95% similarity between the two.

MarcieMom: Thank you Dr Liew, it’s such a great pleasure to have you explaining all these allergy questions that many parents have, we are all so grateful!

Categories
Eczema Tips

Should you and your child take Probiotics?

Probiotics tablet and milk

Though the answer is still uncertain, it’s leaning towards a Yes for pregnant woman to take probiotics Lactobacillus rhamnosus (LGG) in her third trimester. 1st things first, probiotics are live lactic acid bacteria that has been purported to help with food digestion, production of vitamins, prevention of infection and regulation of immune system. Probiotics is commonly used to treat digestive issues as they can withstand the stomach and bile acids, colonize the digestive tract and balance the good/bad bacteria. Some probiotics strain helps to reduce diarrhea and bloating in children treated with antibiotics. There are many different strains of probiotics and over 200 probiotics products, with different strain and dosage.

So what’s this LGG and is it proven?

LGG, is one of the most researched strain and used to strengthen the gut by defending against unwanted bacteria and virus. Increasingly, there’s research supporting the use of LGG for treatment of eczema and clinical studies have been conducted. You can refer to this article for a summary of the studies, but in a nutshell, not all the studies conclude eczema prevention and reduction in eczema severity but 2 out of the 3 studies on LGG showed reduced incidence of eczema in children by age 2. The mothers (in one study, only allergy-prone moms) started taking the probiotics in the last 5 weeks of pregnancy and during breast-feeding for 3-6 months after birth. Sometimes the child is also given the probiotics and generally, the incidence of eczema is reduced by half. There’s less support that probiotics can reduce asthma or allergy, and in one of the study, there’s actually higher incidence of wheezing after taking probiotics.

How to take these probiotics?

Your genealogist must be consulted as there’re so many types of probiotics and the dosage varies. Dosage is counted in CFU, which stands for colony forming units. I’ve read that to be effective, the CFU need to be in billions. You can also ask your genealogist of his/her knowledge of the research studies on the probiotics that you’re being prescribed. Also, some advised against giving the probotics supplement directly to infant, especially those below 1 month old (I’ve found a product online that gives probiotics to children above 4 years old in the form of chewable tablet, not available in Singapore). So do check with your doctor before taking these probiotics.

Would I take LGG in my next pregnancy?

If you read this post, you’d know I haven’t decided if I want to have a second child! So far, I’ve known of a friend who has eczema who took LGG prescribed by her genealogist in both pregnancies and so far, both her girls aged 3 and 5 have no eczema. So, I think I will give probiotics a shot if my genealogist is supportive of it. But, I’d still be keeping my fingers crossed because I’m not the one with eczema (my hubby is). Anyone has any experience on taking LGG? Do comment and let the rest of us know!

Categories
Doctor Q&A Eczema Tips

Sensitive Skin Product Series – How to Manage the Diaper Area?

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?
Grandma Minnie's Oil's Well Nurturing Do-It-Oil (picture from vmvhypoallergenics.com)
Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil (picture from vmvhypoallergenics.com)

Marcie Mom: I note with interest that your product Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil can prevent diaper rash.

What is the ingredient that prevents this rash and how it is different from the off-the-shelf diaper rash cream?

Dr. Verallo-Rowell: The USDA- certified Organic Virgin Coconut Oil and Monolaurin

Both ingredients – no reported allergies, irritations from either one.

1. Virgin coconut oil prevents the diaper rash by its giving an additional barrier film of protection on top of the skin to help protect the skin from irritating chemicals: urine, feces, sweat, preservatives, possibly antiseptics that may be used by manufacturers of diapers. Paper / tissue products are often preserved, some even with formaldehyde or formaldehyde-like chemicals. In addition, virgin coconut oil under the influence of natural skin bacteria that contain lipases (the same lipase enzymes that break down the sebum/fats produced by our skin glands to produce fatty acids that give the skin is acidity or acid mantle – an innate antiseptic function from the skin) – produce monoglycerides of its lauric, capric and caprylic fatty acids.  These are well studied to have broad-spectrum antiseptic properties.

2. The purified monolaurin produced in the laboratory of Dr. John Kabara wrote and worked on this ingredient since the 1960s… is added for additional protection of the skin.

Laura: Most diaper rash creams primarily contain just zinc oxide and petroleum jelly.

One dermatological (prescriptive) diaper rash ointment contains an antifungal drug (many diaper rashes are actually a fungal condition) and cannot be obtained without a prescription (it also costs around US$300).

We mimic both the effects of the above in Oil’s Well in that the Virgin Coconut Oil provides a bit of the barrier function of zinc oxide and petroleum jelly, and the monolaurin provides an antiseptic, antibiotic and antifungal action.  Note that monolaurin is also present in breast milk as another innate or natural antibiotic provided by nature from breastfeeding infants.

Prevent Diaper Rash

Marcie Mom: For prevention of diaper rash, your recommendation is to apply where the skin comes into contact with wetness. However, for eczema rash, I read that it’s least likely to be where the skin is wet.

Dr. Verallo-Rowell: Need to know the context of this statement because wetting the skin in those with eczema does make the skin more moisturized (water is the best moisturizer) but that wetness must not be chronic to macerate it such as in the diaper and around the mouth areas from saliva, mucus, sweat, food, etc.

Diaper Rash vs Eczema

Marcie Mom: My baby often gets rashes and scratches around the diaper waist band and the upper thigh joint areas. How can a parent differentiate between diaper rash and eczema rash? And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse?

Dr. Verallo-Rowell: Yes. Can be from pressure (a form of dermographism) or actual irritation (rarely at that age, allergy), by the chemicals in the elastic material of the waist and thigh band or even the chemicals in laundry soap.

How can a parent differentiate between diaper rash and eczema rash?  By the presence of the rash in other areas more commonly involved by atopic eczema rash in babies: outer areas of the upper and lower extremities, the face.

And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse? Yes if the moisturizer has ingredients that are irritating to the skin usually by virtue of its scent, preservatives, antibiotics, dyes, non-medical grade lanolin, etc. Note that vitamin E and tea tree oil, propolis, and some other natural ingredients are top allergens in the allergens list.

Marcie Mom: A BIG THANK YOU to Dr. Verallo-Rowell and Laura for helping us in this series on sensitive skin products. We’ve learnt SO much from you and SO much more confident on how to choose and manage the sensitive skin of our children.

Categories
Doctor Q&A Eczema Tips

Sensitive Skin Product Series – How to Use on Sensitive Skin?

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?
Sensitive skin of child includes the eyelid eczema
Sensitive skin of child includes the eyelid

Sensitive Skin Parts of Eczema Skin Child

In our previous interviews, we have learnt what to look out for in the product packaging, including understanding the list of ingredients. In this interview, we wish to focus on the use of sensitive skin products on the parts of the child which are more delicate.

Marcie Mom: Thanks Laura for taking time to help us learn more about managing the delicate parts of our child’s skin. First, let’s all be on the same page relating to what defines delicate skin?

Is it where the skin is thinner, like eyelid, face, neck, underarm and groin area?

Dr. Verallo-Rowell: Yes, where the skin is thinner: eyelids, neck, groin because of the easier absorption of chemicals. Plus, often wet areas such as cheeks, around the mouth from milk and food, neck and maybe the chest, and of course the diaper areas where maceration and heat “thins” the skin. Also from trauma and sweating of physical activities in school and at play with the use of play devices or clothing and shoe wear — hence the need sometimes for milder laundry soaps.

PLUS the following conditions:

–  Those diagnosed with an atopic problem: asthma, hay fever, and of course atopic dermatitis/ including a family history especially when (+) in both sides of the family. To treat and to prevent barrier loss because barrier dysfunction is a basic problem in those with atopic skin.

–  Those with medical conditions that make them “sensitive” Example: being off and on antibiotics a lot which disturbs the balance of naturally opposing bacteria and fungi in skin and the natural, healthy dominance of one over the other; those on maintenance drugs which make them prone to drug allergies or even photosensitivity; those who are obese and prone to sweatiness (or who are otherwise prone to sweatiness).

Washed-off Product Use

Marcie Mom: I also read that rinsing the product immediately is stated in many of your products’ instruction. For eczema children, they may need to soak in bath oil (my baby soaks in colloidal oatmeal bath oil).

How long would you advise parents to let their child soak?

Dr. Verallo-Rowell: I generally like colloidal oatmeal bath oil but am careful to read the ingredients list for any additional ingredients as listed above and elsewhere. For the more sensitive I prefer the pure virgin coconut oil in water for 5 to 15-minute soaks.

Marcie Mom: And can they do so if they have a rash at the groin area?

Dr. Verallo-Rowell: Yes with the virgin coconut oil. I have seen extremely irritated skin, however, where even water makes them sting. In these cases, I prescribe the total removal of all products with just a bit of the VCO applied very lightly and gingerly, section by section — which I’ve found to be soothing until the oil can be applied all over. Once less sensitive, soaking in it can be done.

Laura: In case you’re reading instructions of “rinse immediately” for things like shampoo…this is important for ALL wash-off products. Wash-off products contain ingredients that are, as the name implies, meant to be washed off (such as surfactants or soaping/bubbling ingredients). Their action is cleansing, and they are not meant to stay on the skin for more than a few seconds at a time in the shower or bath. But oils and moisturizers? Or oils in a soak? These are usually fine to “marinate” in for a while 🙂 Again, with the caveats above of hypoallergenicity.

Shampoo & Shower Tips

Marcie Mom: When I’m showering my 2 year old, I apply shampoo on her hair and bath oil on her tummy, back and legs. For her face, neck, underarm and groin, I don’t apply any bath oil on them but just rinse with water (I assume some of the bath oil would inadvertently flow to these areas when I’m rinsing). Is this the correct technique and clean enough?

Dr. Verallo-Rowell: Wise and smart. Another technique I use is the pure VCO as the cleansing oil on any irritated/irritable/potentially irritable skin.  It’s all in one: functions as a mild cleanser, barrier and for healing.

Marcie Mom: Lastly, the eyelid. Eyelid eczema is not uncommon for children and furthermore, children tend to scratch their eyes when sleepy or tired. I normally wipe my baby’s eyes with cotton pad soaked in slightly warm cooled boiled water followed by a thin layer of moisturizer.

What would be your advice on treating rash on the child’s eyelid? Is there any ingredient that is a no-no for the eyelid?

Dr. Verallo-Rowell: Wet with a little water the way you do it above, then apply the VCO alone or with pure plain petroleum jelly to lock in the water.  The oils “melt” in a few minutes. Gently pat into the skin and if necessary (not usual) wipe off any excess to avoid their getting into the eye.

Laura: A nice alternative to the plain petroleum jelly can be our popular Big, Brave Boo-Boo Balm, which is petroleum jelly but with the coconut-derived monolaurin.

Marcie Mom: Thanks so much again, it sure gives me some peace on what I can do for the sensitive part of my baby’s skin.

Categories
Guest Interview

Dr SEARS L.E.A.N. Series: Raising Healthy Kids

This original 9-part series published every fortnight has been condensed to one longer informative post. This series examine the DrSearsLEAN (Lifestyle-Exercise-Attitude-Nutrition) tips and privileged to have DrSears’ team to help with the tips for parents with eczema children.

Healthy Kid’s Diet

Tip #1: Pick Your Salad

It is a fun way to learn about fruits and vegetables in a farm, by picking them and making your own salad. Most of the farms listed on pickyourown.org are in the US, but you can also find vegetable farms in Singapore! Parents of eczema children may think that their child is allergic or hypersensitive to certain foods, particularly when there’s an eczema flare after consumption of a new food. But is the food really a trigger?

How do Parents know if it’s the Food that’s Triggering an Itch?

There are certain foods that are more common in triggering an allergic reaction, but food in itself is not a common eczema trigger. The nature of eczema is that it comes and goes and it’s best to have the suspected food be confirmed in a skin prick test or if need to, an oral food challenge before excluding it. Should food be a trigger, usually it’s a few food rather than many foods. Even food that shows up positive in a skin prick test may not trigger itch and thus need not be excluded from your child’s diet.

You may start suspecting a food allergy when:

1.             Your child shows immediate rashes or swelling around the mouth (oral allergy syndrome). This is less common in young children but some foods such as banana, kiwi, avocado, and potato have triggered such reactions. Other reactions could be itchy bumps or abdominal pain, vomiting, itchy eyes, sneezing or wheezing.

2.             Your child shows delayed reactions, more than 24 hours, after consuming the food. However, such foods are harder to detect through skin prick test or by observation as abdominal pain, itchiness or diarrhea could also be due to other reasons.

For a start, you can keep a food diary for your child, logging everything he/she eats for 4 to 6 weeks. I actually recorded from my baby’s first bite all the way to 9 month old but there’s no discernible pattern because my baby turned out to be not allergic to anything! I was a paranoid mom for so long until the negative results from the skin prick test, which is why I recommend it to every parent to save themselves the agony of second-guessing.

DrSearsLEAN’s recommendation

Eczema is a condition caused by two factors: first, a genetic tendency toward dry, irritated skin; and second, skin allergies to a variety of irritants and foods. The cause is mainly genetic – an inborn tendency toward dry skin and allergies. There is no way to change this genetics. The important issue is not what causes eczema in the first place, but what allergies and skin irritants is your child exposed to that is triggering the flare-ups.

If your child has any food allergies, then they will play a major role in causing eczema. The problem is, you may not know if your child has any food allergies, and if he does, which foods is he allergic to? Thankfully, there are six common foods that make up nearly 90% of possible allergic foods. These are milk, egg, soy, peanuts, fish and wheat.

What Foods for Eczema Child?

Before we discuss the common food allergens that may trigger your child’s eczema, let’s have some fun looking at DrSearsLEAN  – Traffic Light Eating for healthy diet:

GREEN Light foods are “Go” foods. They are all high in nutrients and are all fruits & vegetables.

Yellow Light foods are “Slowdown” foods. These are foods that are ok to eat every day, but you need to use portion control. Examples of yellow light foods include whole grain bread, pasta, eggs, lean meat, fish, and olive oil.

Red Light foods are “Stop and Think!” about making a better choice. These are foods that are highly processed and contain high amounts of sugar and trans-fat. Red Light foods are foods such as cookies, candies, fast food, doughnuts, etc.

What are the Common Food Allergens?

Food is not a common eczema trigger, but certain foods that children are more commonly allergic to include cow’s milk, eggs, soya, wheat, fish, nuts and gluten (this is different from celiac disease). Cow’s milk should not be excluded unless it’s proven intolerant or to trigger a reaction. Salicylates, usually present in concentrated juice/sauce, unripe fruits and areas around the skin, can also trigger itchiness and redness. Salicylates increase the release of histamine but cooking the food can reduce the chance of allergy.

Should Elimination Diets be carried out?

Food should not be excluded until proven allergic to. A dietiian should always be consulted and advice followed. Parents need to be educated in nutrition and be able to read food labels. A restricted diet, usually consisting of meat, vegetables, fruits, water and rice milk, should not be continued if there is no improvement after 6 weeks. There are cases when food removed from a diet added back later in childhood causes a more severe allergic reaction than before.

DrSearsLEAN’s recommendation

As mentioned last week, there are six common foods (milk, egg, soy, peanuts, fish and wheat) that make up nearly 90% of possible allergic foods. Eliminate all 6 foods for 2 to 3 weeks. If you see dramatic improvement, then re-introduce each food one at a time to determine which is causing the allergy. It is important to note that fruits and vegetables are not common allergens and are very important in boosting your child’s immune system and the phytonutrients and antioxidants they contain are powerful anti-inflammatories. Try incorporating fruits and vegetables into every meal – even breakfast!

Healthy Kid’s Lifestyle

Tip #2: Make a Rule – Less TV, More Exercise!

Make a rule’ – which is no TV or video games on weekdays or before 30 minutes of play outside. Ideally, instead of watching TV, children can spend time exercising and do a range of activities from inviting their friends over to play to playing sports as a family. TV (and IPad) is becoming a ‘baby-sitter’, offering some relief for parents to finish up the chores or tidy the house (my own favorite phrase is ‘Order Has Been Restored!’). I have to confess that I let my baby watch TV since 3 month old, but only baby sign language dvd which has distracted her from scratching. As parents of eczema child would appreciate, it’s immensely stressful and difficult to keep the child from scratching and if TV can help, is that ok?

TV and Eczema and ADHD

The American Academy of Pediatrics recommends no TV for children below two years old. A study by Dr. Dimitri Christakis, Director of Child Health Institute at Children’s Hospital and Regional Medical Center (Seattle, Washington) showed that for every hour of TV watched, the toddler has a 10% higher chance of developing attention problems by age 7. The study is not without its limitations, which include data collected based on parents’ recollection, no data on content of TV programs and attention problems do not necessarily equal ADHD (‘Attention Deficit Hyperactivity Disorder’). Another study done by Carl Landhuis of University of Otago in Dunedin similarly concluded that children aged 5 to 7 who watched more than two hours of TV are more likely to develop symptoms of ADHD. Common reasons why TV is not good for children are that the fast-paced screens are not natural and replaces other activities like reading that require attention development. The noise of the TV also interferes with the brain’s ‘inner speech’, especially if TV is left on all the time when no one’s watching.

The bad news for parents with eczema children is that study has suggested an association between eczema and ADHD in children. 5.2% of 1,436 children with eczema also have ADHD versus 3.4% of children without eczema. Also the younger the child has eczema, the increased likelihood of ADHD. Thus, it would appear that even though TV may help distract a child from scratching, it is even more critical not to let eczema children watch TV given the higher correlation with ADHD.

DrSearsLEAN’s recommendation

Television plays a big role in childhood obesity because watching TV is a non-active activity that often leads to boredom (believe it or not!) and a tendency to over consume junky foods. Be a role model for your children and don’t eat while watching TV. Encourage them to participate in another activity such as reading or imaginative play. Your children will imitate your actions so always remember that how much time you spend watching TV and what other behaviors you practice while watching TV is a choice. Taking the time to invest in your child by playing with them is always a worthwhile investment for both your and their health!

Tip #3: ‘Set an Example’ – It’s easier to Exercise as a family

Exercise as a family such as ‘develop a routine’, ‘play sports together as a family’ and ‘have each person pick a different family exercise or activity to learn together’. It’s even more important to encourage each family member to keep fit because obesity is contagious! As written in the ‘The New England Journal of Medicine recently published a study that showed that if one spouse is obese, the other is 37 percent more likely to become obese, too’. For families with children with eczema, it is even more important because there appears to be a link between obesity and eczema.

Obesity is Contagious

Obesity and Eczema

In a study conducted by Dr. Jonathan Silverberg, dermatologist at St Luke’s Roosevelt Hospital (New York), there’s increased risk of developing severe eczema for children who are obese. Particularly, for children who became obese between age 2 to 5, the risk is three times higher than non-obese children. A later study focusing on adults gave similar results but the good thing is in both studies, eczema symptoms improved when weight is reduced.

Another study in Sweden also showed that hand eczema co-relates with individuals who are obese, have higher stress and smokes. The reason for obesity affecting eczema could be due to obesity resulting in inflammation in fat tissue, which overtime, can affect the skin.

DrSearsLEAN’s recommendation

Moving around and being active is one habit kids can learn easily, especially if their parents set a good example. Rather than thinking of movement as “exercise”, think of it as “play”! Running, hopping, skipping, jumping, riding a bike, etc, – These are all things kids (and parent) naturally enjoy. Movement does far more than just help control obesity. Moving more improves mood, helps you to feel better, improves sleep, helps digestion, encourages self-confidence, and more! Take some time to play with your child everyday. It will benefit both of you immensely!

Tip #4: ‘Reduce Stress in Your Life’ – Laugh More and Be Grateful

Leading a healthier and happier life comes from having the right attitude to life, and that includes taking steps to reduce stress, increase laughter and be grateful. There are many practical tips to follow but as parents of eczema children, it may be hard to do so; for instance, it’s hard to think positively when the eczema flares yet again for no reason. Or it can be difficult to enjoy a dvd when your child keeps scratching during the movie. Worse, repeated failed attempts to keep the eczema under control could demoralize the parent so much that it’s hard to appreciate the good even in our spouse, not to mention someone we don’t like.  The stress that families with eczema faces is considerable and a study has shown that stress levels in mothers caring for young children with eczema are equivalent to those mothers of children with severe disabilities.

Stress Triggers Eczema

While it may be more difficult to keep the stress level low in families with eczema children, it is important to do so should stress be one of the triggers of the eczema. As stated in Adnan Nasir’s book Eczema Free for Life, stress is the number three trigger and can worsen eczema by:

(i)         Stimulating hormones to be released which result in an increase in inflammatory substances the skin is allergic to

(ii)        Suppressing the immune system which results in a decrease in defense proteins to protect the skin

(iii)       Weakening the lipid skin barrier which results in dry skin that is vulnerable to irritants

Museums, Factory Tours, Animal Farms but Swimming?

Swimming is a fun activity such as having fun with balls and slides in water parks or leisure pools.  But many parents are worried about bringing their child with eczema to the pool, fearing that the chlorine in the swimming pool water may worsen the eczema. On the contrary, my baby’s doctor actually advised swimming three times a week but not more than 10 minutes each time. Be sure to shower them immediately and apply generous amount of moisturizer.

According to a factsheet from the National Eczema Society, chlorine is generally the least likely to cause skin irritation. In another of their fact sheet, it is suggested that re-creating chlorinated swimming pool with a bleach bath can have positive anti-septic effects on the skin. In particular, eczema skin is susceptible to colonization of staphylococcus aureus bacteria that can cause infection if it penetrates the skin. More than 90% of the people with eczema have staph versus less than 10% of people without eczema. Swimming is therefore a fun way to reduce this bacteria and applying steroid will then be more effective.

DrSearsLEAN’s recommendation

Chlorine and other chemicals in water can sometimes be the cause of skin irritation and contribute to eczema in a small percentage of kids. Always bathe your child in clean fresh water after swimming and avoid using regular soap. Most regular soap, whether liquid or bar soap can cause dryness. A natural soap mixed with moisturizing lotion and free of perfumes will enhance skin moisture. These can be found in any drugstore or supermarket. Also avoid scented lotions and use PABA-free suntan lotion to protect their skin. Be sure to use a generous amount of moisturizer after bathing your child.The lotion helps seal in all the moisture gained from the bath to help control your child’s eczema.

Overall, swimming is a fun way to get your kids moving more! Plus, they are learning a life-long tool. It’s much easier to learn to swim when your child is young. Getting them used to the water helps them overcome fears and could be a life-saving tool  someday!

Indoors Fun versus Sweating it Outdoors

There are many fun activities to do indoors and some are ‘put together a PLAY basket’ and ‘get a pedometer’. One of the tips is ‘plan your family vacation around an outdoor activity’, such as camping which is an opportunity to get away from technology and instead, do some biking and hiking. However, outdoor exercise inadvertently comes with sun and sweat. Heat and perspiration is the number one trigger for eczema and is also the only trigger I’ve identified for my baby. The combination of heat and perspiration may set off a ‘heat rash’ as an eczema child’s skin is more vulnerable to chemicals in sweat which may irritate the skin.

Sunlight – To Block or Not?

According to a factsheet from the National Eczema Society, sun exposure is drying to the skin and may aggravate eczema for some people. Ron Sweren, M.D., a dermatologist and director of the photo-medicine unit at Johns Hopkins also said that sunlight can serve as a trigger that worsens eczema. To prevent sunburn, sunscreen lotion is a must but again, you can read here that some of the ingredients may also irritate your child’s skin. Moreover, according to Sewon Kang, M.D., director of department of dermatology at John Hopkins, increased sweating will lead to more showers taken, which again could worsen the eczema. In less common cases, there may be sunlight allergy or photosensitive eczema which further restricts exposure to sun.


However, there are also cases of eczema that improve with sunlight exposure and there’s a treatment known as phototherapy that exposes the skin to UVA1 rays that can soothe the skin without causing sunburn. Moreover, vitamin D that comes from sunlight has been shown to increase the production of skin proteins (cathelicidin) which protects against skin infection.

Dr Sears L.E.A.N.’s recommendation

Eczema results from the combination of a genetic tendency toward dry, sensitive skin and a susceptibility to allergies. Although most children aren’t bothered by the day-to-day wear and tear of soaps, dirt, sweat, heat, clothing, and everything else we come into contact with, the skin of a child with eczema is hypersensitive to everyday life. It is important for you to monitor your child and identify the main trigger for developing eczema flare-ups. For some it could be heat and sweat, others are triggered by what they eat (or what mom eats if they are breastfeeding), grass, dirt, or chemicals in the environment around them. Although there is nothing you can do to change your child’s genetic susceptibility to dry, sensitive skin, there are many steps you can take to improve skin health, reduce exposure to irritants, track own allergic triggers, and minimize the impact the eczema has on your child’s day-to-day life

Healthy Kid’s Nutrition

Boosting our immune system is important, particularly for both parents and children with eczema because the lack of sleep can lower our immunity. As recommended on DrSearsLean.com, we should choose healthy food that contain the following eight immune system boosters, namely vitamin C, vitamin E, carotenoids, bioflavonoids, zinc, garlic, selenium and omega-3 fatty acids. Out of these eight immunity boosters, parents may find that zinc and essential fatty acids are often recommended for children with eczema.

Tip #5: Get Healthy Eating Food, not Supplement

There’s some research that points to zinc and omega-3 fatty acids can help to reduce skin rashes in adults and also that eczema children appear to be deficient in essential fatty acids which results in a lower production of anti-inflammatory prostaglandins that can help fight skin infection. However, research is not conclusive as clinical trials have also been conducted with no significant impact on eczema. Parents should incorporate the immune system booster food into the child’s diet rather than in supplement as excessive intake of say, zinc can inhibit immune function. The RNI (reference nutrient intake) for zinc is 4mg per day for a six month-old and 5mg for a toddler. Zinc-rich foods include beans, chickpeas, beef, turkey and spinach while omega-3 rich foods are salmon, tuna and sardines.


DrSearsLEAN’s recommendation

To improve your child’s skin from the inside out, add these nutrients to his or her diet:

  • Fruits and vegetables can help improve allergic and inflammatory diseases like eczema. If you have a picky eater who avoids fruits and veggies, you may consider giving them a whole food supplement to help boost their immune system.
  • An omega-3 supplement provides beneficial fats to help the skin stay healthy. Good sources of Omega-3s are avocados, salmon, tuna, flax seeds, pumpkin seeds.
  • Probiotics taken in liquid, powder, or pill form can help decrease food allergies.

Choosing A Healthy Drink for Kids

Parents beware that not all drinks packaged for children and have ‘vitamins’ listed on the packaging are healthy. As stated on DrSearsLean.com, drinks with the main ingredient ‘high fructose corn syrup’ may result in overeating because it does not trigger a hormone, leptin, that creates fullness. Moreover, children who drink more than 12 ounces per day of concentrated juice are more likely to be overweight. For eczema children, it’s also best to avoid sugary drinks which contain caffeine (may trigger eczema), increase tooth decay while artificially flavored drinks have been linked to ADHD. For a healthy choice, plain water with lots of fruits and vegetables is best

Does Softening Water Help?

Water makes up 60% of our body and is useful for flushing out waste and toxins. There are some observations that eczema is more prevalent in areas where water is hard as the higher calcium and magnesium content may be a skin irritant. However, from a clinical trial conducted by Professor Hywel Williams and Dr Kim Thomas of the Centre of Evidence Based Dermatology at University of Nottingham, there is no impact of using softened water on eczema. However for parents who have found water softeners to improve their children’s eczema, they certainly can continue to do so. Skincare routine like moisturizing, showering without using harsh soap and appropriate treatment is still required.

DrSearsLEAN’s recommendation

Water is an essential nutrient. Water is to our body what oil is to a car; we can’t function without it. Like growing plants, growing kids need lots of water. Our bodies are 50 to 70 percent water, and much of that water has to be replaced every day. Water helps prevent constipation, eliminate toxins from the body, hydrate the brain, and keeps breathing passages moist and clear of mucus. As a general rule, children need around one ounce of fluid per pound of body weight per day. The majority of your fluids should be from plain water, but a small amount of fluids can also be from milk or 100% fruit juice. Drinking soda should be discouraged. Many juice drinks and all sodas are high in calories, provide no nutrients, and are usually sweetened with high fructose corn syrup (HFCS), which you should always avoid.

MarcieMom: Thank you Dr. Sears for being with us throughout the whole series. I’ve been so glad and delighted to hear your advice which definitely gives me the confidence to raise a healthy child, despite her eczema.

Categories
Doctor Q&A

Sensitive Skin Product Series – Understanding Suitable for Eczema Children

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?

What does Suitable for Baby mean?

MarcieMom: Suitable for Eczema Child/Infant – These are the most important keywords for a parent looking for sensitive skin products for his/her child with eczema – how much surer can it be when the product is labelled (and often prominently so) that it can be used for infant with eczema!

Can you explain to us what ‘suitable for use for infant’ and ‘suitable for eczema’ really mean? Also, is there a regulatory body that governs the use of such terms on product packaging?

Laura: Again, great question, and not as confusing as it may seem with some simple guidelines (but yes, still not regulated terms so there is definitely self-education needed).

Suitable for infants: Here is the premise we at VMV operate on. Baby skin is formed and functioning from a very young age (neonatal and even younger — in utero by the end of the 1st trimester). But during the first few months of life, immunological functions are still undeveloped. For example, atopic dermatitis (an allergic disease that needs immune-forming cells to make IgE immunoglobulin) is not often seen until after the 3rd month of life. Because infant skin is newer to the world, building up its defenses, and as the surface area of skin is greater in babies (they absorb anything topically applied more than adults), baby skin care should be very safe yet still protect against micro-organisms. This, at VMV, has meant products with as few or ZERO of all known allergens (plus other things that are NOT allergens but known to have irritant responses and other safety issues, like SLS and phthalates)

PLUS the inclusion of a very safe antibacterial-antiviral-antifungal-anti-inflammatory in all formulations. We also use coconut oil and its derivatives a lot because many have been found to actually be present in mother’s milk, studied extensively, peer-reviewed and published multiple times.

Baby Skincare hould be very safe yet still protect against micro-organisms

What does Suitable for Eczema mean?

Suitable for Eczema has similar requirements. Eczema is actually atopic dermatitis. I left the more detailed definition to my mother, Dr. Verallo-Rowell, as this is her forte and I believe you and your readers would appreciate a doctor’s definition:

Dr. Verallo-Rowell: Eczema is actually a more generalized term for any skin eruption characterized by edema within the epidermis and dermis clinically seen as tiny itchy bubbles that ooze and become little bubbles or vesicles, even blisters. Then, exposed to the air, they dry up and become crusts. With chronicity this wet phase may not be as obvious, and becomes replaced more by dry, thickened, very itchy patches and plaques. Atopic dermatitis is the prototype example of this process but it may be seen in other conditions such as allergic and irritant contact or photocontact dermatitis, eczematous drug eruption and secondary reactions to a primary diagnosis.

Laura: Because “eczema” is actually a very general term, a specific diagnosis can be a powerful tool towards consistent and sustained management. A specific diagnosis usually also comes with an identification of the possible triggers for an individual’s flare-ups. Because babies cannot yet be patch tested, however, the alternative is frequent and controlled observation of what seems to cause eruptions (this is also why it is so important to use few products…so it’s easier to observe what the trigger/s might be) and strict prevention.

For the many conditions that can fall under the mantle “eczema”, they all benefit from the same ultra-über safety that we would do for baby products, i.e. ZERO of all known allergens, etc. plus the inclusion of a very safe antibacterial-antiviral-antifungal in all formulations. Why? With eczema, when the skin develops fissures or cracks, this becomes welcoming to opportunistic microorganisms to enter the skin, which can lead to or exacerbate itching and further dryness…which can lead to more cracks (which can lead to more infection) and more scratching (which can spread infection)…more risk of microorganisms, etc. in a vicious cycle. This is why we put the skin-safe but powerful antibacterial-antiviral-antifungal-anti-inflammatory (monolaurin) in all these products.

Marcie Mom: Thanks Dr. Verallo-Rowell and Laura, I think we’ve covered the more common terms which parents of eczema children look out for in labels and discussed whether they are truly meaningful and beneficial. Look forward to learning more from you in our next blog interview.

2015 update: Skin facts series that cover more on baby skin –

Baby skin’s increased transepidermal water loss

Baby skin’s increased chemical penetration

Baby skin’s reduced lipids

2018 update: The above terms continue to be unregulated; read FDA current regulatory guidelines, and you can do your part! If you have a rash reaction to the products, you can report to FDA here. Complaints made to the product companies need not be reported to the FDA by the product company – in an August 2017 study by Dr Steve Xu (a featured guest on this blog’s series on contact dermatitis in children) Adverse Reported to the US Food and Drug Administration for Cosmetics and Personal Care Products:

It was noted that in 2014, the FDA sent letters to manufacturers Chaz Dean and Guthy Renker LLC in response to 127 consumer complaints of hair and scalp problems related to the WEN by Chaz Dean Cleansing Conditioners. Only then did the FDA discover that the manufacturers had already received 21,000 consumer complaints of scalp irritation and alopecia. (Italic text from northwestern.edu)

As cosmetics products (including shampoo and moisturizers) do not require any regulatory pre-approval, it is super important for consumers to take action to alert FDA on any adverse reaction. Apart from WEN shampoo above, another recent instance whereby consumers’ complaints to FDA and Better Business Bureau have raised awareness of possible adverse reactions is Monat shampoo, read here. Read also EWG article on myths of cosmetics safety