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.
Marcie Mom: Given that a child with very sensitive skin/eczema can be allergic to many ingredients, it makes sense that the fewer ingredients, the less likelihood of triggering an allergic reaction.
Is there an average number of ingredients a moisturizer is likely to have?
Laura: There is no one average to give because different formulations necessitate different quantities of various things like emulsifiers, stabilizers and so on. For example, a shampoo might normally need to have a longer ingredients list than, say, a lipstick, because the shampoo contains so much water and needs more preservation, whereas a lipstick or concealer is mostly wax and therefore needs less preservation. A good bet is to compare similar products, e.g. two toothpastes. If toothpaste A has 10 ingredients and toothpaste B has 25, then A is probably the safer bet. Of course, toothpaste A could have allergens and toothpaste B could have no allergens…
In a nutshell: hypoallergenicity is a highly complex concept with many, many moving parts and it would be unreasonable to expect any mother or any consumer to master (or even familiarize herself with) all of these myriad issues. As we are mostly “lay” moms who want to care for children with very sensitive skin, it’s not a matter of mastering this complexity or of finding one magic bullet. It’s a matter of choosing products with as many of the good-practices as possible. If I were to summarize the safest best practices into a simple checklist, this would be it:
1) Look for zero or as few allergens as possible. Your best bets for this are a) a patch test when your child is old enough and b) a VH-Rating.
2) Avoid the most consistent top allergens: paraben, fragrance, masking fragrance, dyes, “coca”-surfactants
3) Choose shorter ingredient lists (but check them against #2 above).
4) Try to opt for brands with real clinical legitimacy. Published studies in well-known medical journals and presented studies in the large medical conventions are a good bet. At least you’ll know that their claims are backed by research that has objectively been considered scientifically valid enough for presentation and publication…so you might at least feel more comfortable trusting their claims.
Marcie Mom: Great checklist! I’m so happy that we’ve understood lots and understand so much better when we read the product label.
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.
Keeping to a company that you can trust can help minimize cross-reactivity (picture from vmvhypoallergenics.com)
Cross-Reaction of Skincare Ingredients
Marcie Mom: I read that there is a possibility of cross reaction between different companies’ products. My baby uses two brands and so far, all seems well.
Is there a way for a parent to compare the ingredients and assess if there’s a high likelihood of cross reaction?
Laura: I think our previous interviews would lead to this answer being “yes it’s possible but only if you really want a chemistry degree and a specialization in contact dermatitis” 🙂 Comparing ingredients may not be enough…it would be impossible, for example, to be sure that the product of company A was mixed in a container used only for fragrance-free products; company B’s formula may be mixed in containers shared with other formulations that DO contain fragrance.
Cross reactants also require some knowledge of chemistry. You’d need to know that beeswax and propolis are related. Cocamide-DEA and Coca-betaine are coconut-derived allergens but are allergens not because of the coconut but because of the chemicals used in the processing.
Let’s tackle the logic first. When a reaction occurs, a contact dermatologist will ask you for a history that will include “what are you using”?
The more products you list, the harder it is to determine what the culprit is that is actually causing the reaction.
We’ve heard dermatologists share stories of patients being convinced their reaction was due to a new product they just tried, because they’d been using all their other products for years without a problem…but after getting a patch test, discovering that the patient was actually allergic to ingredients in all the OLD products, with the NEW product being the safest for the patient! More products means more factors to consider when trying to identify the culprit/s responsible for the reaction.
The other concern is a corporate one. If a customer came to VMV and asked if they could use one of our products with one from another company, it would be irresponsible for us to guess at an answer. We do not outsource any of our R&D, research, clinical studies or manufacturing, so we can answer for our products and processes. We know where we source our ingredients and their quality. Many raw materials are actually combinations of ingredients and we are highly specific about the breakdown of our raw materials (a kojic acid can have traces of parabens, for example, so we won’t use it). We know how our plant is cleaned and which raw materials are stored near each other. We know which products we can mix in shared containers. We know what tests we do. But we simply have no way of knowing any of the above for any other company. It would be unfair of us to guess and we truly would have no way of knowing if any of our products might cross react with theirs.
On the other hand, if you email us regarding a concern, our team is trained to help you based on their knowledge of skin, allergens and our products. It would be unreasonable to expect them to have the same training for other companies’ products (and if one of our employees came from another company, they might even be legally constrained against sharing or utilizing any of that knowledge when they work for us).
One Brand vs Many
Sticking to one brand (ours or someone else’s) at least gives you the advantage of having a customer support option that is familiar with all the products you are using. Also, if the brand does not outsource its manufacturing, it should have a better knowledge of all its ingredients and practices, and could possibly help you better. Sticking to one brand increases the likelihood that ingredients are sourced from similar suppliers with similar quality, etc. And, again, in the case of a reaction, sticking to fewer products lessens the factors to filter out when trying to determine the cause.
Marcie Mom: Thank you again for providing valuable insight into cross-reactivity, thus helping parents make a decision if we choose to buy from more than one company.
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.
Table to explain processing of coconut types and of other oils (provided by Dr Verallo-Rowell)
Certified Organic VCO
Marcie Mom: I read with interest that your products contain USDA-certified organic virgin coconut oil and monolaurin (derived from coconut oil) that is a substitute for paraben.
Do all products containing coconut oil have the same antibacterial, antiviral and disinfectant properties that your product have? Could the ‘wrong’ coconut oil actually be an allergen?
Laura: There are currently no reports of reactions to coconut oil but yes, there are different types of coconut oils. Ours is USDA-certified organic because the entire farm is organic…no fertilizers, nothing…and because the method of extracting the oil is organic…nothing is added; we use first and cold-pressed oil…not even heat is used and no chemicals. Some other coconuts are grown on non-organic farms or the oils/other extracts are processed using other chemicals that could be allergenic. Others still are sold with additives like preservatives or flavor or stabilizers or fragrance. Those would definitely increase the likelihood of a reaction.
Virgin coconut oil is well studied to have anti-viral properties and has even shown some success in managing herpetic flareups that are resistant to valacyclovir. Virgin coconut oil should have these properties, but we can only vouch for the one we produce because we control it from seed to bottle, and it is the oil with which all our clinical studies were done.
Monolaurin has a slew of studies as well proving its similarity in efficacy to several broad-spectrum antibiotics, antivirals, disinfectants (even 70% isopropyl alcohol) and antifungals, but without the side effects like increased tolerance to treatment or dryness. I should also point out that our proprietary preservative system that replaces parabens is not just monolaurin…it’s a delicate balance between this and several other ingredients…it’s a big headache, if I’m to be frank 🙂 But such is our mandate 🙂
Dr. Verallo-Rowell: Yes. No matter how processed, the composition of all fatty acids in the oil removed from the coconut meat is about the same: myristic (15%), lauric acid (46-50%), Capric (6-8%), Caprylic ( 6%). These are all medium chain and saturated.
Could the ‘wrong’ coconut oil actually be an allergen? Yes, because of processing. RBD (primarily a cooking and/or industrial oil) vs. virgin coconut oil.
See table above that explains processing of coconut types and of other oils.
Marcie Mom: Thanks! Coconut oil is increasing popular as an ingredient and your information on it is precious to parents when evaluating what product to buy.
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.
Marcie Mom: For a parent on a tight budget (also considering long term and frequent use of moisturizers), should he/she start the child on the cheapest lotion/cream available? If not, is there certain baseline to start with, for instance, it must state ‘suitable for infant with eczema’ or not contain ‘perfume’?
Dr. Verallo-Rowell: The answer is no. Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients versus, for example, pharmaceutical-grade or higher-quality or purer ingredients, which are frequently more expensive. Some cheaper products are dyed with relatively cheap ingredients to add attractiveness in children’s eyes. Cheap or expensive, preservation is also problem, as are added antibiotics. All these are allergens and break down the skin’s natural barrier.
Many cheap products are strongly/nicely scented to cover up for the natural scent of less-pure cosmetic ingredients
Make function be the basis for your choice. Remember that in different forms of eczemas you pay attention to the skin’s outermost barrier layer: genetic innate barrier dysfunction initiates atopic; allergic or irritant reaction breaks down the barrier in contact; food around the mouth area can physically act on the barrier, and secondarily, bacteria cross damaged barrier in all types of eczemas. Hence to keep the barrier as intact as possible:
Place the least irritating, partially occluding product you can find without any of the above: scents, preservatives, antibiotics, dyes.
Mineral oil and pertroleum jelly are long time favorites of us dermatologists. They are cheap and excellent barriers, but they are petrochemical derived. Consider non-preserved, non-adulterated oils. For this my favorite is virgin coconut oil because it needs no preservation and is broken down by lipases of friendly skin bacteria into monoglycerides with antiseptic properties. I have a published paper on VCO vs. Olive oil in Atopic Dermatitis that includes comparison on Staph. Aureus action by both oils.
Can you list for us some common irritants and list them on a scale of 1-10 (1 being the most likely to cause allergy)?
It’ll also be great if you can let us know if there are other common names for these irritants.
Perfume, Fragrance
Benzyl alcohol (Phenylmethanol / Phenylcarbinol), also named as Natural grape aromatic preserves & scents in “fragrance-free products”
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.
‘Perfume Free’, ‘Propylene Glycol Free’, ‘Paraben Free’, ‘Lanolin Free’, ‘Preservatives Free’, ‘Colorant Free’ – So Many ‘Frees’! Is this too much or too little?
In this post, I’ve consolidated a list of irritants to avoid which include the above and also sodium lauryl sulphate, mineral oils, conventional emulsifiers and paraffin. I’ve also realized that it’s difficult to find a product that excludes all potential irritants so for this interview, we catch up with Laura to understand which are the more allergenic ingredients and how to assess what our child can use.
Marcie Mom: I understand that VMV recommends its customers to perform a patch test, i.e. applying on a small area and observe for few hours to up to 72 hours before gradually increasing usage. Can a child also take a patch test?
Laura: Wow you do your research 🙂 Ok, for ANY cosmetic, doing a provisional patch test before purchasing and/or sampling is always a good idea prior to making a purchase.
Patch Testing
The best tool is really a proper patch test done by your dermatologist, but this cannot be done on children. If you have a child with very sensitive skin, allergies and/or eczema, etc., however, as soon as he is old enough to get a full patch test, he should. This is really the best way to determine what, in particular he needs to avoid. And if you’re sensitive, as allergies are often hereditary, your own patch test results may give you a possible idea of what your child might be allergic to as well (this is not a sure thing, however; your child would still benefit from his/her own patch test at the appropriate age).
Making Sense of Irritant-Free
Marcie Mom: Should parents use a product that markets ‘XXX-Free’?
Laura: Yes, a good guide is to look out for what irritant the product is free of. The big problem, however, is that a lot of marketing-speak says “free this” and “free that”, and, unless you’ve really done your homework and have a deep understanding of ingredients and allergens, you may not be able to accurately judge if the ingredient that is absent is even harmful. What I’m trying to say is that “XXX-FREE!” is a powerful marketing phrase on its own, whether or not it has objective merit (e.g. whether or not a product is better for not having a particular ingredient in it).
SLS – FREE
Lots of shampoos now, for example, are touting “SLS-free” heavily. The thing is there are two ingredients with these initials: Sodium LauRYL Sulfate and Sodium LaurETH Sulfate. While the former is a well-known irritant, the latter is actually rather harmless, particularly in lower concentrations. So if a product says SLS-Free, you’d need to check which of the two is absent. And, neither is on the allergen lists (again, these lists are compiled from patch tests done on over 20,000 people). Much of the hooplah surrounding SLS/SLES has to do with their environmental impact — which is a valid concern but may not be as relevant as for skin safety.
‘Cancer-Causing’
One more thing to consider. When you read a lot of the posts about “causes cancer”, it’s natural to worry. These claims are serious and you don’t want to take them lightly. However, it is important to remember that many (but not all) of these reports are skewed to be sensational — they may not be balanced. For example, much of the evidence of the carcinogenicity of certain ingredients is determined in laboratory experiments with animals fed the ingredient in very high doses (sometimes the equivalent of the animal’s body weight and the equivalent of a lifetime of consumption at these doses). Many of the same ingredients used in cosmetics are used in minuscule amounts and in molecular sizes that are too large to penetrate to the dermis, much less get to the bloodstream. An example would be parabens: we stopped using them because they are allergens, not because of the cancer panic, because there simply is not enough to go on.
Mineral Oil
Mineral oil is another great example: NOT an allergen. Ask any dermatologist and they’ll tell you mineral oil is a go-to, reliable hydrator even for extremely sensitive skin (there are some reports of comedogenicity but it is otherwise a go-to moisturizer) and for extremely sensitive areas (even the genitalia). Again, most of the concern with this (as well as petroleum jelly, another big dermatologist favorite) is environmental. And again this is a valid argument for the planet, but strictly speaking for skin safety, these ingredients are not allergens and are relied upon regularly by dermatologists for very dry, sensitive skin conditions.
Hypoallergenic
“Hypoallergenic” is not regulated. Many ingredients touted for sensitive skin are actually highly allergenic. Some natural and/or organic ingredients are allergens, too. Yes, definitely, “fragrance-free” is key…but then again, are you confident that you know all the chemical names of all products that are fragrances and masking fragrances or that cross react with/are related to them (e.g. cinnamic alcohol)?
The best guide is really allergen-free. But you have to make sure that the “allergens” to which the brand is referring are those that are proven allergens. The NACDG and ESSCA patch test on over 20,000 people in multiple countries to compile their lists of allergens, and crucially, they update these lists every few years. These lists are, therefore, statistically relevant, consistently updated, and put together by two of the most respected groups of doctors in the world who concentrate on allergens and contact dermatitis — and they are regularly published in peer-reviewed medical journals. This allergen list is what the VH-Rating System uses and, considering we’ve had less than 0.1% reported reactions in 30 years, it’s quite reliable.
Marcie Mom: Thanks! It’s great to understand a little more about some of the ingredients, so that parents can assess if they truly need a product that excludes them. For the next interview, we’ll continue to learn more about choosing products for sensitive skin.
2015 update: Selection of moisturizer – try to see how to put a few basic principles of moisturizer selection in practice
2016 update: Surfactant skincare series that covers ingredients that have been studied to irritate eczema skin, such as CAPB
2018 update: The current list of prohibited ingredients by FDA are 1,4-dioxane, and 10 other ingredients: Bithionol, Chlorofluorocarbon propellants, Chloroform, Halogenated salicylanilides (di-, tri-, metabromsalan and tetrachlorosalicylanilide), Hexachlorophene (HCP concentration in a cosmetic may not exceed 0.1 percent, and it may not be used in cosmetics that are applied to mucous membranes, such as the lips), mercury compounds, methylene chloride, prohibited cattle materials, Vinyl chloride and Zirconium-containing complexes.
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.
Marcie Mom: Laura, thanks again for continuing to help us make sense of the ingredient label.
Many ingredients sound similar though not identical.
Is there some broad classification of ingredients and how to identify what type of ingredient a certain name suggests? Is there a glossary/definition page that you can refer us to?
For instance, do ‘glycerin’, ‘capric triglyceride’, ‘palm glycerides’, ‘caprylyl glycol’, ‘glyceryl stearate SE’, ‘glyceryl laurate’, ‘glycol distearate’, ‘butylene glycol’, ‘glycerylcocoate’ belong to the same classification? And what are they?
Laura: Unfortunately, unless you’re a chemist or decide to devote yourself to the pharmacological sciences, this is almost impossible to master for most consumers. Yes, there are some roots to words that imply certain things. “GLY”, for example, implies a fat; “OSE” implies a sugar. But all the other roots in each word also mean different things and can signify huge differences.
For example: cocamidopropyl betaine (CAPB) is a surfactant and an allergen. Coconut oil (cocas nucifera) is an oil and is not an allergen. Both have “coca” imbedded in the name. In the former, it is not the coconut element that is the allergen but the substances used to process the coconut extracts (the “amines”) that make the ingredient allergenic.
Butylene Glycol
Another example: butylene glycol (not an allergen) and propylene glycol (allergen)…both have “glycol”, but the former is a humectant and antioxidant (also not an allergen) while the latter is a formaldehyde-releasing preservative and an allergen.
SLS – Lauryl or Laureth?
Yet another: both Sodium LauRYL Sulfate and Sodium LaurETH Sulfate share lots of elements in their nomenclature. But SLS (the former) is far more irritating than the latter (the latter is actually quite safe). I suppose you could try to memorize RYL as “avoid” and ETH as “better”, but again, this does require some effort.
In addition to understanding (and memorizing!) all the possible combinations of different chemical roots, one would also need to memorize which are on the current allergen lists. As the current lists now specify 76 common allergens (and the lists change every so often), mastering the complexity of cosmetic ingredients is really more of a full-time job than something that most consumers can do, even as a hobby. There aren’t even a lot of dermatologists who are extremely familiar with all these ingredients, the allergens, possible cross reactants, etc. Those that specialize in contact dermatitis would have very in-depth knowledge, and this knowledge takes lots of sustained reading and learning. Considering that only a subset of dermatologists who devote themselves to this study would have this knowledge, you can imagine how difficult it would be for a regular consumer.
This complexity is in part why our founding physician created the VH-Number Rating System. If a patient got a patch test, great: at least she’d know what to avoid. But even then, some chemical names are listed in different ways…or there may be cross reactants that aren’t immediately obvious. With a VH-Number, consumers can immediately see if (and how many) known allergens are included, and the allergen is highlighted in the ingredients list for easy identification.
Marcie Mom: Thanks so much Laura; looks like it’s best to stick to a trusted company for choosing products for our children as you’ve illustrated, it’s near impossible for a mom (plus a stressed one!) to master the ingredients and allergens.
2015 update: Selection of moisturizer – try to see how to put a few basic principles of moisturizer selection in practice
2016 update: Surfactant skincare series that covers ingredients that have been studied to irritate eczema skin, such as CAPB
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.
Product Label – Deciphering the Skincare Ingredients
I’ve written in this post on how difficult it has been comparing the ingredients across products and make some sense of what they mean. For one, not all products list all their ingredients and even when they do, different companies seem to be giving the same ingredient different names (because they all sound so similar yet not identical!)
Marcie Mom: Laura, thanks again for continuing to help us understand the product label. This interview will focus on getting a broad understanding of labeling ingredients.
i. Is the ‘Ingredient’ list on product packaging Compulsory and Regulated?Does the Ingredient List cover all ingredients? Or can companies pick and choose what they like to reveal?
Laura: In many countries, yes, it is compulsory to list all ingredients, following a specified format, and using only the INCI (International Nomenclature of Cosmetic Ingredients) names of ingredients. A few countries do not require that ingredients be listed, in full or in part, and/or do not have requirements regarding the names used or formatting.
ii. Why is there no percentage (%) beside each ingredient? That way parents can compare and choose the product with the least % of allergen. Also, I read that certain allergen will not trigger a reaction because its concentration is too low in moisturizers but I also read that some products use an exceptionally high concentration of certain irritants.
How can consumer find out the concentration of allergen/irritant in a product?
Laura: This is quite a complex question…love it! 🙂
First, % are not included mostly because of proprietary concerns. A company does not want its exact formulation copied by anyone else.
Second, if a product is a DRUG (prescription or over-the-counter), it does, actually, have to disclose the % of the active ingredient.
Third, an easy way to get an idea of how much of an ingredient is in the formulation is to look at WHERE it is on the ingredients list. Most regulatory bodies require that ingredients be listed from MOST to LEAST.
Fourth: the % of an irritant or allergen is relevant mostly if someone only has irritant reactions to it. Irritant reactions do have a relationship to concentration of ingredient, frequency of exposure, time on skin, etc. For example, you could be using an allergen most of your life and not really react to it or just have mild irritant reactions like dryness. But if you are ALLERGIC to a substance or develop an allergy to it, any % of it for any amount of time on the skin will cause a reaction. Again, this is why a patch test is so important.
Look at WHERE it is on the ingredients list. Most regulatory bodies require that ingredients be listed from MOST to LEAST.
iii. Can you explain a little more on patch test?
Patch-Testing a Skincare Product before Use
A patch test is a painless procedure where ingredients/substances are put on your back in small dollops and kept on for a few days, with readings by your doctor at intervals like 48 and 72 hours. It can be a little costly upfront, but the amount of time, money and discomfort/skin trauma it can save you (versus random trial and error) over time makes up for that hundredfold. It tells you EXACTLY which ingredients you, in particular, need to avoid.
So, for example, you may need to avoid certain dyes in clothing, certain laundry soaps, and certain metals in your cell phone, etc. but may actually be ok using such natural ingredients as tea tree oil…this helps guide you far more specifically. And if you happen to be in the USA and your dermatologist is a member of the American Contact Dermatitis Society, your patch test results can be entered into the CAMP (Contact Allergen Management Program) database…so that instead of just a list of ingredients to avoid, you get a list of brands and product names that you can use.
Not to over-emphasize a point but this is also why the VH-Rating System is so handy. If you have not yet had a patch test, choosing the highest VH-Rating (showing that zero allergens are included in the formulation) can already significantly improve your chances of non-reaction. If you HAVE had a patch test, if an allergen is included in a product, the VH-Rating will alert you to the presence of which allergen in particular is included (for example Vitamin E). If your patch test shows you’re allergic to parabens and not vitamin E, then you probably can still use the product.
Marcie Mom: Thanks so much Laura for your help in helping us understand the big picture on ingredient labeling. In our next interview, we will learn in greater detail about reading ingredients on the label.
2018 update: Check out SkinSAFE app (developed by Mayo Clinic and licensed to Her Inc.) where you can either have your Personal Allergen Code (for US patients) or you select allergens that you want to exclude from products or use their 11 allergens to exclude from products, namely preservatives, fragrance, parabens, lanolin, coconut, topical antibiotic, MCI/MI, nickel, gluten, soy and propylene glycol.
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.
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 –
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
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.
Terms on Product Label – What They Really Mean and Do They Mean Well?
Marcie Mom: Today’s learning more about terms like ‘organic’, ‘non-comedogenic’ and ‘pH-balanced’
Organic – This is a term that always baffles me and reading the amount of debate online as to what is organic is even more confusing!
Can you explain to us whether the use of ‘organic’ term is regulated?
Laura: Regulation is much clearer for “organic” which requires certification by certain bodies that have earned the right to certify organicity (certain companies authorized by the US Department of Agriculture, for instance). For example, the virgin coconut oil we use is USDA-certified — a seal that has very strict requirements, that necessitates an inspector to travel to our farm and inspect it in person (including how we extract the oil) and a seal which we have to renew (to “re-earn”) regularly.
With the proper certification, “organic” is arguably far more reliable than “natural”.
Non-Comedogenic
Marcie Mom: Non-comedogenic – I noticed that your products are listed as ‘non-comedogenic’ and ‘non-drying’. Can you explain to us what this mean and also what pH-balanced means?
Laura:Non-comedogenic means will not clog pores…and this is important for compliance. If a product will not cause reactions or offers a very effective clinical therapy…but then causes acne…then people are less likely to use it or may have just created more problems to deal with.
Non-drying is related to allergenicity. Many people who experience dry skin do not realize that they may already be experiencing a mild allergic or irritant reaction. We use this term to alert people to this fact. As well, some non-pore-clogging products achieve pore-friendliness via the inclusion of ingredients that do dry out the skin.
Important note: Many skin conditions, including psoriasis, eczema, acne and aging, are caused by, worsened by, or related to inflammation. The more a product can help reduce inflammation or if it can contain an anti-inflammatory, the better for most skin concerns. Also, the less inflammation to have to fight, the stronger the skin is and the better able to, on its own, ward off infection, reactions and other problems.
pH-Balanced
pH-balanced is an interesting term because it could mean completely neutral, which may or may not be ideal for a formulation. The skin’s natural pH is actually slightly more acidic (5.5-6.5) than neutral (which is 7). Bar soaps, because of the way they are made, intrinsically tend to have a more basic or higher pH (some going as high as 8 or 9). This can, on its own, be quite denaturing and very drying to skin. Most of our products for very dry, sensitive skin skew towards the skin’s natural pH as much as possible, or slightly lower…we try to avoid the high range as much as possible.
Marcie Mom: Thanks! So, we’ve covered the more common terms in labels and discussed whether they are truly meaningful. In the next interview, we’ll understand more about the term most parents with eczema children look for, i.e. “suitable for eczema/ infant”.
2018 update: Read FDA’s article on regulation of “organic”, which is under US Department of Agriculture (USDA)
2014 update: Read my interview with dermatologist Dr Cheryl Lee on eczema skin and pH
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.
Terms on Product Label – What They Really Mean and Do They Mean Well?
MarcieMom: Let’s continue to understand what ‘Natural’ means!
Natural – I don’t use products labelled ‘natural’ for my baby because my husband who has eczema always find that natural products sting his skin. I understand that natural ingredients do not necessarily mean not allergenic and can’t understand why there seems to be so much ‘hype’ around being natural.
Can you explain when/why natural becomes popular and is there a valid reason for selecting natural products?
Is there regulation governing the use of this term and what percentage of the total ingredients must be natural before a product can label itself as such?
Laura: Great question and let’s break it down one by one 🙂
Natural seems to have grown in popularity due to two main reasons, both of which are good in and of themselves and should lead to more good:
1) A growing desire among more and more people to have safer products in their lives. This can arguably be attributed to the internet’s ability to make so much more information available so quickly to more people, as well as that people seem to have become far more aware of what they put in and on their bodies than ever before. With obesity now an epidemic in some countries, we’ve also begun to take a closer look at the quality of foods we’re imbibing. One of the biggest concerns has been the amount of processed foods that we consume, for example, and therefore the drive to go back to less processed foods, more locally available, etc. This desire for safety seems to be driving the desire for “natural”.
2) Another big driver for “natural” is the desire to be more environmentally responsible. Thankfully, we are learning as a species (albeit slowly) that this is one planet and it needs a lot of help!
These two main drivers, I would argue, are what are behind the “hype” of natural.
Regulating ‘Natural’ in Skincare
There is, however, a lot of confusion surrounding the term “natural.” First off, you’re right, it’s not yet regulated. Almost anything natural has to be processed in some way to be able to be used, so regulation eventually needs to be standardized to settle on what amount and what type of processing is allowed. There are certain brands that are spearheading this much-needed regulation, but for now, it’s still pretty ambiguous.
What’s Natural?
Another thing that seems to trip people up is the perceived line between “natural” and “chemical”. Everything in nature (see the periodic table of elements) is expressed in a chemical signature (water is hydrogen + oxygen; vitamin E is tocopheryl acetate…both of which sound “chemical”). This is further complicated by some semantics. In sunscreens, “chemical” ingredients are actually correctly called “organic”; and “physical” ingredients are correctly termed “inorganic”. Definitely confusing 🙂
Does Natural = Hypoallergenic?
As you pointed out, many, many, many natural ingredients are highly allergenic. The extremes would be bee stings, shellfish and peanuts…which, no matter how natural and organic, can be extremely allergenic or even deadly for those allergic to them. Pollen, dander, mangoes and strawberries are highly allergenic, too. Tea tree oil is on the allergen list, as are Ylang Ylang, Lavandula Angustifolia Oil (Lavender Oil), and most fragrances — no matter how fresh-from-the-earth-and-farmed-by-your-own-hands they are.
We try to use natural/organic ingredients as much as possible — because we do want to use less processed ingredients and would like to be more responsible to the planet. But at VMV our mandate is very strictly hypoallergenicity and clinical efficacy. So those are our primary filters. If a natural/organic ingredient meets these criteria (such as virgin coconut oil and green tea, which are both extremely well studied, with lots of published research, and not on allergen lists), then we will use them.
MarcieMom: What are some natural ingredients that are considered hypoallergenic? Also, which natural ingredient tends to trigger allergies but yet commonly marketed as good for skin?
Laura:Some natural ingredients considered allergenic are listed above, many of which are commonly marketed as good for the skin. HOWEVER, please remember that we are all individuals. MANY people can use ingredients that are allergens! Repeated exposure to them over time can lead to skin sensitivity and other problems later on (like darkening, etc.) but still, there is a large proportion of the population that can tolerate these allergens. Therefore, brands that market these ingredients as good for the skin may not be misrepresenting anything. Vitamin E, for example, is a WONDERFUL antioxidant. It is on the latest allergen lists, which is why we’ve reformulated many products to remove it. But it has ample evidence to support that it does, in fact, have many properties that are great for skin.
Coconut oil, its monoglyceride derivative, coconut water, green tea, rice phytic acid are virtually non-allergenic. Note that olive oil often needs to be preserved because it is a mono-unsaturated oil (C18:1) versus coconut oil, mostly C8, C10, C12 and all with saturated carbon bonds. Therefore, coconut oil does not need to be preserved. The gallates preservative of olive oil have been reported to be allergens. Most other oils bought from the shelf are long chain polyunsaturated oils and often are also preserved or contain trans fats from partial hydrogenation and are no longer “natural”.
Marcie Mom: Thanks! Today, we’ve learnt lots on ‘Natural’ and we’ll be learning more about ‘Organic’, another very common term in product label.
2018 update: FTC (Federal Trade Commission) monitors marketing terms on product and has updated on their website in 2016 that as of that time, there were 4 proposed settlements and administrative issued complaint to challenge the allegedly deceptive use of those phrases in ads for skincare products, shampoos and styling products, and sunscreens.
From what I can see, the FTC was able to take actions because those products were labeled 100% natural. What about “natural” without the “100%/All”? No regulation or action can be taken. For instance, one of the four products mentioned in FTC site was beyond coastal sunscreen, which continued to be labeled “natural” – there are natural ingredients in it, but also “non-natural” ones:
The positive thing though is that none of the above ingredients (though I’m not sure why so many ingredients are necessary) are on the 86 contact allergens established in humans as compiled by the European Commission – Scientific Committee on Consumer Safety.
Been watching Dr Ava Shamban’s Channel – a series of youtube videos relating to skincare. Dr. Ava Shamban–a renowned board-certified dermatologist licensed to practice medicine in California, New York and Hawaii–graduated magna cum laude from Harvard University before receiving her medical degree from Case Western Reserve Medical School. In addition to serving as Assistant Clinical Professor of Dermatology at the UCLA-Geffen School of Medicine, she is recognized as the “Extreme Makeover” dermatologist and the resident expert on the Emmy winning daytime talk show, “The Doctors.” Dr. Shamban is also author of the new book, Heal Your Skin: The Breakthrough Plan for Renewal (Wiley)
Dr. Ava on How Exercise Benefits Skin
Exercise can increase circulation, thereby increasing nutrients to the skin and reducing toxins. Cortisol, produced by adrenal gland, will also be reduced (cortisol lowers immune system). Any exercise that can be carried out on daily/ every other day basis is good!
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Dr Ava on How to Avoid Stress that Causes Acne
Stress can manifest both internally and externally, on the skin. Stress, increases cortisol, which is viewed as a male-like hormone (androgen) and increases acne. To de-stress, relax and nap. A combination of rest and exercise is always beneficial.
See also my post here on stress on children with eczema.
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Dr Ava on How to Buy Quality Skincare at the Drugstore
The skincare products suited for you may not necessarily be the most expensive; label-reading is important (which is why I’ve started the Sensitive Skin Products series with VMVHypoallergenics). Make sure that the active ingredient is in the first five ingredients and the product is fragrance-free. In Dr Ava’s words ‘If you want to use perfume, use perfume; but not on your face’.
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Dr Ava on How to Choose the Right Sunscreen and SPF?
Choose a high SPF especially at least SPF50 on higher altitude. Choose one that is not too oily or greasy and comfortable to use (with make-up). If doing sports, need a water-proof or resistant one. Sunscreen on the face is formulated differently with that on the body.
Sun-protection is discussed and Dr Ava’s recommendation is to have a high SPF sunscreen, wide-brimmed hat and wear sun-protective clothing (there’s even for babies with SPF 50 rating). Choose physical sunscreen that’s safer for children (you can see this post for more info). For face, a non-comedogenic lotion with SPF can also be used. There’re also certain foods that can help increase SPF, mainly red/purple fruits such as pomegranate, carrots, watermelons, blueberry and raspberry!
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.
This is a 13-part series focused on understanding and using products for sensitive skin, an important topic given the generous amount of moisturizers that go onto the skin of a child with eczema. Dr. Vermén created the VH Rating System which is the only validated hypoallergenic rating system in the world and is used across all the products at VMV. With a shared interest to help those with sensitive skin, Laura, Dr Vermén and I collaborated to bring you this series:
Testing Hypoallergenic (picture from vmvhypoallergenics.com)
In this interview, Laura answers Marcie Mom’s questions on understanding the product label.
Terms on Product Label – What They Really Mean and Do They Mean Well?
Common terms that the average consumer may look out for will be ‘hypoallergenic’, ‘natural’ and ‘100% organic’. Hypoallergenic refers to less likely to cause allergies while the definition of ‘natural’ and ‘organic’ is vague.
Marcie Mom: Laura, thanks for helping to answer these questions that confuse me and so many parents looking for a suitable moisturizer for their eczema child. Let’s tackle them one by one.
What’s Hypoallergenic?
MarcieMom: I am looking at my baby’s moisturizers and one brand says hypoallergenic while the other does not. I read that at VMV, you rate a product using the VH Rating System that grades a product safety based on how many allergens it does not contain (i.e. higher score means less allergens). However, I don’t see such rating system in other brands.
How do I then know how hypoallergenic it is? Or in other words, is there a regulatory body that ensures the product meet at least some criteria before it can be labeled as ‘hypoallergenic’?
And, is some country stricter in the use of the term?
Laura: Actually, the “hypoallergenic” claim is one of the biggest problems with cosmetics — different FDAs regulate the term differently and some don’t at all. Even when there are regulations, these are minimal or are poorly defined. This applies to the United States as well where a judicial ruling in the 1970s for the FDA to regulate the term was overturned by the Court of Appeals.
As a result of this decision many U.S. manufacturers can label and advertise their cosmetics as “hypoallergenic” without being required to provide supporting evidence. Consequently, neither consumers nor doctors have much assurance that such claims are valid. One recent ruling by the US-FDA requires that ingredients used in cosmetics be listed in the product label — which is definitely an improvement but unless one is extremely familiar with ingredient names, it may not be of much help regarding the hypoallergenic claim.
This lack of definite regulatory criteria for the “hypoallergenic” label is a problem for those who really need hypoallergenicity or who want skin-safer care.
Dermatologists tend to not respect the claim and consumers, as you mention in your blog, are at a loss about how to interpret it.
VH-Number Rating System
It’s precisely because of this lack of regulation that our founder, a dermatologist-dermatopathologist who specializes in several diseases like chronic and recurring contact dermatitis and atopic dermatoses, created the VH-Number Rating System. She wanted an objective way to prove hypoallergenicity — one whose criteria are clear, reliable, repeatable, easy for the consumer to follow, and whose basis is respectably peer-reviewed and published.
The VH-Number Rating System is based on a list of allergens. This list is collated from the assessment by independent groups from Europe, the United States, Canada and other countries of contact dermatitis experts who regularly do patch tests and publish the ranking of these allergens. Altogether, these doctors now test over 20,000 people yearly. Because the patch tests are done on so many people across many countries, and are updated every few years, this list is the most reliable reference for the top allergens that produce allergic reactions in people.
In our products, we use this list to know what to OMIT from our formulations. And the VH-Rating System is the only system to show how many of these allergens are NOT in a product. It works a little like an SPF in that it’s a simple numerical guide as to the hypoallergenicity of a product. As with an SPF, the higher the VH Number the better (the more allergens are omitted).
This VH system was recently published in Dermatitis, the journal of the American Contact Dermatitis Society and a leading publication on contact and atopic dermatitis. The article states that the VH-Number Rating System is “shown to objectively validate the hypoallergenic cosmetics claim”. So finally, yes, there is a way to objectively measure a product’s hypoallergenicity.
When Skincare Products are Not Rated
If a brand does not use the VH-Rating System (it is proprietary to VMV), you have to be a bit of a contact derm AND chemistry expert. Why?
First, you have to have access to or memorize the list of allergens. Right now, there are 76 allergens…quite a lot to memorize. As well, the list changes every few years, so you’d have to keep up-to-date…not easy if you’re not a dermatologist who specializes in this.
As well, you’d need to know your chemistry well enough to be able to recognize the different names that ingredients can sometimes have. For example:
1. Fragrances are always top allergens…but you may not know that cinnamic alcohol is actually a type of fragrance.
2. “Preservative-free” product may be using fragrances to preserve the product but unless you recognize the chemical or “INCI” (International Nomenclature of Cosmetic Ingredients) name, you may not realize it.
3. Cross-Interaction – You may also not know which ingredients cross react with each other. For example, beeswax is an allergen…but propolis is related to it.
4. Similar Names – More mind-boggling examples are things like SLS and SLES. Neither are on the allergen lists. Both have had some irritations reported (not so much allergic reactions) but far more with SLS and in both cases, reactions seem highly concentration-related. BUT both ingredients actually have the initials SLS…you would have to know that SLS is Sodium LauRYL Sulfate (to avoid) and SLES is Sodium LaurETH Sulfate (relatively ok).
Marcie Mom: Thanks! I’ve certainly learnt lots about what’s hypoallergenic and look forward to learning about the other common terms used in product label!
2018 update: The ruling to regulate “hypoallergenics” is still not successful, read FDA article here – they even termed it an “ill-fated” regulation! Read a compilation of all the labeling claims at FDA’s site to understand what each skincare product labeling term (does not) mean!
Frequent scratching or rubbing of eyes can be due to itchiness caused by eye allergy or infection; but for a child with eczema, it is possible that he or she has eczema on the eyelid. Though eyelid eczema is more common in adults wearing cosmetics, children can also suffer from dry, sensitive and itchy eyelid. The skin around the eye is thin and sensitive, and also vulnerable to irritants and allergens just as other parts of the body of an eczema child. My baby Marcie sometimes scratches her eyes, and the eyelids look red, dry and sometimes a little swollen.
Here’s a little bit more of how you can identify eyelid eczema in your child:
– Eyelid is itchy, looks inflamed or scaly.
– Eyelid is red or swollen.
– If scratching is vigorous and prolonged, it may cause a change in the appearance of the eyelid, e.g. extra fold of skin under the eye or darker eyelid.
– Extreme rubbing can even lead to deformed cornea (keratoconus)
I haven’t asked for any medical advice regarding eyelid eczema, but I usually wipe Marcie’s eyelid with cooled boiled water on cotton pad. If her eyelid looks oily (at the place where mascara is applied, not that I apply eye makeup on her), I will use slightly warm cooled boiled water that can remove the oil better. I will then sparingly apply Physiogel AI cream on her eyelids, and usually, she stopped scratching after a few days since her eyelid eczema is not severe. Do do see a specialist and seek appropriate treatment as you can read below, it’s a little trickier to treat the eyelid eczema.
– Certain irritant/allergen in moisturizers may worsen the eyelid eczema, see this post and the comment section for some of these irritants.
– Eyelid can be moisturized, but avoid doing it too generously that it flows into the eye and irritate the eye.
– Check with the doctor if the steroid lotion/cream that you have can be applied on the eyelid. There’s some research that shows increased risk of cataract and glaucoma with steroid use. (Also read that the risk of cataract is higher for people with severe eczema for more than ten years…but let’s not scare ourselves too much now and just focus on managing our children’s eczema for now)
– As the eyelid is already thinner than other skin, and extensive steroid use causes skin thinning, do consult your baby’s doctor on the frequency you can apply the steroid. (note: don’t get put off steroid use, as there’s research that there’s no long term adverse effect if used as doctor prescribed)
– For cleaning the eyelid (if need to), ask your baby’s doctor first if you want to use eye lid cleanser as most of these are for adults only.
Update: Since this post, I have interviewed several dermatologists on eyelid eczema and how to clean and treat it, here are the posts:
Jennifer Roberge, who has a child with eczema, shares why she decided to set up an online store EczemaCompany.com. Her online store offering products for children with eczema has recently launched, with products such as clothing from Kumfy Cotton and ScratchMeNot, creams, soaps and bath oils.
Marcie Mom: Jennifer, it’s so good to see an entrepreneur mom, particularly when the business will help children with eczema. What gave you the idea to start EczemaCompany.com?
Jennifer: My son Tristan was diagnosed with eczema at three months old and it was progressively getting worse over the years (he’s now three years old). I was desperate to find anything and everything that would help to relieve his suffering, calm the itchiness, or prevent the horrible scratching that would keep our whole family up at night. We spent a lot of money and searched companies all over the world to discover the best natural products for him. It was very costly and time consuming finding the right products from so many different sources, so my idea was to gather our favorites and make them available in one online store for other families like us.
Marcie Mom: How do you think your products can help other parents with eczema children? Have they worked for your child?
Jennifer: I have chosen the products you’ll see on the website because either we use them on our son or we know other parents who have used them, both with great results. My son does not take a nap or night’s sleep without wearing his ScratchMeNot mittens and Kumfy Cotton clothing (tops with mittens and pants with feet) because without them he would scratch himself horribly. All our creams, oils, and soaps are wonderful products with all natural ingredients that are gentle on delicate irritated skin, but not all of them will work for every child. Therefore, we offer a variety of products so parents can find something that will help their child with their particular case of eczema.
Marcie Mom: How do you find the time to parent two children and run the online store?
Jennifer: Multi-tasking, isn’t that what moms do best?! I’m sure all the mompreneurs will say the same. It’s also finding the right balance of time management and structure. I have the passion to help families living with the daily challenges of eczema, so that’s a big motivator for me. We do plan to keep to our regular family time though – dinner together, weekends biking or going to the park. Family is incredibly important, so our time together will remain a priority in our lives.
Marcie Mom: Thanks Jennifer, all the best for your online store.
p.s. To readers of eczemablues.com, I did not receive any money from Jennifer or EczemaCompany.com for this interview.
One thing that my husband and I can’t quite agree on is how much to moisturize – I like to slather huge amounts (think pressing the bottle pump vigorously, and just applying VERY liberally) while my husband prefers to pump with measured control as he feels that too much moisturizer get wasted on the clothing and when my baby hides under the blanket to escape from us). So how much is enough? And when to moisturize?
Let’s first establish that moisturizing is a must; it’s the one advice that I had from Marcie’s doctor Prof Hugo Van Bever, and in his words “You Can’t Moisturize Enough”. In a later follow-up consultation even after Marcie’s eczema is under control, his advice is still to continue moisturizing.Moisturizing helps to restore the skin barrier which is typically broken/thin in eczema skin, and that allows irritants and allergens to penetrate the skin. Moisturizer helps to trap water (after a bath) and also retain moisture in the skin. As you can see in the chart, people who moisturize more had to pay less visits to the doctor. I also read that the more moisturizer one uses, the less severe the eczema is.
So, how much to Moisturize? From what I’ve read is 400-500 grams per week, that’s one bottle of QV 500ml lotion or 2 bottles of Physiogel lotion, which is also the amount that I’ve been applying for Marcie. If you read my budgeting post, you will know how much it cost.
Steroid first or Moisturizer first? That’s another item that my hubby and I can’t agree on, but I think he’s right. Steroid first, then moisturizer.
When to Moisturize? Immediately after shower, and roughly at every diaper change/ 2-3 times per day. Moisturize even when the eczema is under control and for whole body, not just the rash area.
What Moisturizer to choose? I’ve tried to decipher the ingredients with not much success, but have posted here on what to generally look out for.I’ve later read that silicone is to protect the skin, butylene to re-hydrate and prolipids to restore. I know that propylene glycol and sodium lauryl sulfate may irritate the skin. You can also refer to this link for more on the ingredients (I didn’t summarize them ‘cos I’d tried for 2 days to compare ingredients across brands and they just don’t label them the same way…)Whatever it is, don’t give up on moisturizing! Anyone has any brands that worked for your child? Do post in the comments, thanks!
Update on:
How Much to Moisturize – read this Q&A with dermatologist Dr Jeff Benabio here
On Steroid or Moisturizer first – read this Q&A with Dr Bridgett here
On which ingredients to avoid in skincare production – read this Q&A with Dr Verallo-Rowell here
S$30+ for air-con servicing (S$100/time and servicing every 3 months)
S$30+ for doctor’s consultation and prescription (S$100-S$200/time and appointment every 6 months)
S$253 increase in monthly budget!
This is the fourth of my “101 Things that Moms with Eczema Child Do Differently“, a tongue-in-cheek look at the many unique situations that we face. For more cartoons, click here to view.
Marcie had her half-yearly check-up last Saturday at NUH’s children clinic and we are happy that her skin is considered good enough not to use steroid. Instead, we ought to follow the 3 tips from her doctor, Prof Hugo (in picture):
1. Moisturize, especially after Marcie has got in touch with water (after a bath or swimming)
2. Use chlorhexidine before applying steroid cream to clean away the bacteria so that the steroid cream will be more effective
Update 2018: Instead of chlorhexidine gluconate wash, Octenisan is recommended instead as it is less drying. Do not use an antiseptic body wash daily as both the good and bad skin bacteria are washed off. Also, the antiseptic body wash lotion has to be left on the skin for at least a minute before rinsing off to give sufficient time for the antiseptic to work.
Lately, I came across a recommendation by a mom that using udder cream has helped with her child’s eczema. Udders are mammary glands and the care and hygiene of the udders are important in milking. Udder creams are developed to soothe the chapped skin of the udder, prevent infection and irritation during milking. Somewhere along the line, the udder creams have been re-formulated to a less greasy form, and sold to adults and infant for eczema treatment, marketed with the following points:
Natural skin care
Skin repair properties
Anti-inflammation
Anti-fungal
No paraffin oil
Over in forums, some moms have feedback it worked while a few others lamented that like other natural creams they have tried on their children, it irritated their skin. I haven’t tried it or on my child, but seems like most of these udder creams are not sold over the shelves but instead through stockists or online; read my interview with Moogoo founder.
Navigating through all the moisturizers out there to find the right one for your baby can be a nightmare.
My baby Marcie has tried various lotions and creams (I remembered when the household budget burst due to many trial and error purchases and our cabinets stacked full of different moisturizers) and finally settled on using Physiogel AI cream, Physiogel body lotion and QV body lotion. As you are figuring out which moisturizer to use, it is important to remember the one advice that I had from Marcie’s doctor, “You Can’t Moisturize too Much”.
The Undecipherable Information out there on Moisturizer
Whether over the internet or on product labels, I have this conclusion after trying to no avail to sum up the pros and cons of different moisturizers – We, as parents and layman, can’t figure out from reading the information available. I have tried at least 3 times to make sense of all the information out there, including comparing all the ingredients, and given up (all three times). I can only let you know that Physiogel and QV work for Marcie which are also recommended by Marcie’s doctor (I didn’t accept any advertising fees from these two brands and neither do I see these brands sold at the clinic that Marcie’s doctor works in).
What Moisturizers worked for Marcie’s Eczema
Physiogel AI cream works quite well but due to its high cost, S$35 for 50ml, I only use it on her face and after swimming. Physiogel AI cream is able to neutralize free radicals which when produced in excess, damages skin cells. Physiogel body lotion also works for Marcie but also due to its cost, I use when her rashes are affecting her badly (on top of using mild steroid). On a daily basis, liberal amounts of QV body lotion is slathered on Marcie and her infant care teachers have also been reassured not to worry about slathering too much.
What has not worked for Marcie’s Eczema
Aqueous cream which contains emulsifying ointment, paraffin and preservatives – I tried this as it was recommended by a friend’s dermatologist but it hasn’t worked for Marcie. She scratched the area and was crying with frustration the two nights we applied for her. Also read that some doctors say this cream will cause thinning of skin over long period of use.
California Baby – no improvement and my hubby who has eczema felt that it stung on his eczema skin
Gaia Natural Baby – no improvement and too expensive to use liberally
Both the organic cream, California Baby and Gaia Natural Baby, are gifts from friends. Read that organic does not necessarily mean non – allergenic as some people can still be allergic to the organic ingredients. Also the use of the word ‘organic’ is not regulated.
Calamine lotion – not suitable as told by a doctor whose kids have allergies. I think it’s because one of the key ingredient, zinc oxide, absorbs moisture and that’s why it doesn’t help to moisturize the skin but helps to dry up weeping wounds.
Prickly heat powder– not suitable as told by same doctor above. My own guess is that it doesn’t have any moisturizing function.
Some common items to look out for in labels
Hypoallergenic – means less chance of developing allergy
Suitable for eczema baby or child
Free of fragrance and perfumes
Free from dyes, colors, conventional emulsifiers, preservatives, mineral oils, paraffin
In general, lotions are more easily absorbed but not as long-lasting as creams. For me, I prefer lotion as Marcie is too fidgety for me to have the time to get the cream from the tub (and ensuring no contamination) and apply over her body.
Do persevere in moisturizing as dry skin leads to itching and do so liberally all day and immediately after your baby’s shower.
Update: Almost a year after writing this post, I’ve interviewed a dermatologist Dr Verallo-Rowell for a 13-part Sensitive Skin Product Series, and in this post, she provides the list of ingredients and their different names to avoid.
That’s the advice that I received during the first specialist consultation for my baby’s eczema in 2010, and I’m still sticking to it after ten years.
What should I do? What moisturizer to use?
I suppose we all started our journey of parenting eczema kids asking these questions. And the advice from my daughter’s doctor (Prof Hugo, who later co-authored with me Living with Eczema: Mom Asks, Doc Answers) is ‘Moisturize, Moisturize, Moisturize’. Followed by, ‘You Can’t Moisturize too Much’.
Our Selection of Moisturizers
So, what moisturizer to use?
I did ask this question, and Prof Hugo’s answer was the one that your child likes, and you can afford to use it generously.
And, my child does have preferences. Here’s the timeline of the moisturizers which we have tried, and honestly, we haven’t tried that many because we are the if it ain’t broke, don’t fix it kind of person.
Frequent, almost daily use. From 2010 to date. The main plus point is its price point! I don’t think it’s the best moisturizer in terms of ingredients but it does its work of keeping moisture in and skin hydrated. For the past ten years, we have used it for at least 5 years and there was once when it didn’t seem to work as rashes appeared and skin seemed dry. We then switched to a more expensive cream like Physiogel but has since re-incorporated QV cream back into our staple of creams. We do not use QV lotion though as its effect is not long lasting enough for our dry skin > Read full review
Soon after, at the advice of a GP (who still is our GP!), we tried Physiogel AI. It contains ingredients that can replenish skin lipids, therefore, more effective in hydrating dry skin. The only negative about it is its price. At $35 for 100ml, it may not be a cream which you can generously use twice a day for your whole body. I think we use it more frequently when our daughter was a baby, since her surface area was smaller then! However, we use Physiogel AI lotion daily – typically as a first layer over dry skin, and then ‘seal’ with a thicker less expensive cream > Read full review
QV lotion
physiogel ai lotion
physiogel cream
Since Physiogel AI worked well but was too costly for frequent use, we tried ‘downgrading’ to Physiogel cream. It still contains lipids such as triglyceride, and long lasting enough. We used this for quite a few years, in particular, when using the cheaper QV cream alone didn’t work so well after continued use > Read full review
california baby eczema cream
Given all the marketing on organic and natural product, we tried California Baby. It didn’t seem to be long lasting and felt a little itchy after use. We stopped just after using once and threw the bottle away. Some of the reviews on Amazon were positive, while others feedback caused rashes.
Burt’s Bees moisturizing cream
We tried another natural cream that was a gift from friends. It could be that the product was expiring, and therefore had bacteria growth (or she was sensitive to one of the natural ingredients), my daughter’s skin looked more inflamed and itchy after a single use on her leg. As with California Baby, we threw it away. Some of the Amazon reviews also mentioned skin irritation.
Curel japan intensive moisture
I was actually asked to review this cream when it was first launched in Singapore. However, I was kind of averse to doing product review and declined. Subsequently, free samples of it was given out during an eczema patient session and I tried it out on my daughter. It was very smooth and creamy feel, but given the cost of $24 for 120ml, we decided to continue using cheaper alternatives that also worked.
bioderma atoderm pp baume
My daughter had fungal infection, and around the same time, the eczema rashes started to flare up, with thickened skin and dark scabs. We decided to re-visit a dermatologist (something that we hadn’t required since 1-year old!). The dermatologist recommended Bioderma, the dermatologist’s range. While that worked well, it was not available at regular pharmacy and we tried the Atoderm normal range which also worked.
However, half a year later (at around the start of fourth grade), my daughter’s skin started to rash. It could be that her classroom was at the top floor and sun-facing. In any case, we stopped Bioderma for a while to switch back to Physiogel AI, and currently re-incorporated Bioderma Creme to our staple of creams > Read full review
aveeno eczema therapy
We decided to try out Aveeno because its sunscreen is value-for-money and really sun protective. Personally, Aveeno’s eczema therapy moisturising cream feels very moisturizing. However, my daughter doesn’t like it as it feels greasy to her. > Read full review
The above completes our ten-year experimentation and use of moisturizers. There are some others like Ceradan and probiotic skincare lotion which are not available outside of Asia. There are a lot of posts that cover moisturizers – key ones are:
If I had known that my baby has high eczema risk, I would have moisturized from birth (why didn’t anyone tell me?) Another interesting insight from dermatologist is that it’s the sweat residue that tend to trigger eczema flare-up, so wipe sweat off before it crystallized.
You know what will be really useful? For you to share your moisturizer journey in the comments or in the forum post that I’ve created for this. Another parent reading this can be spared from trying a cream that didn’t work.
