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Doctor Q&A

Rise and Shine Feature – Seminar with Dr Lynn Chiam on Children Skin Conditions

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.

Baby Sweaty Hands and Feet

Palmar Hyperhidrosis is the excessive and unpredictable sweating from hands, even when it is not hot or exercising.  This is due to overactive sweat glands. Primary hyperhidrosis refers to the excessive sweating from hands, feet and armpits and affect 2-3 percent of population with genes being a factor. Minimally invasive procedure can be carried out but for children, use of antiperspirant or prescriptions containing aluminium chloride.

Children Body Odour

Children may also experience body odour and it is the bacteria and not the sweat that creates the smell. Avoid tight clothing/foot wear and wash clothes thoroughly.

Children Hair Loss

Alopecia Atreata (Hair Loss) is a type of hair loss due to the immune system attacking the hair follicles (auto-immune condition). For most, the hair will grow back and if so, some opt not to treat the condition. Treatments can be topical corticosteroids, injections containing steroids or immunotherapy.

Sun and Baby Skin

The UV rays can cause sun burn, sun spots, wrinkles, enlargement of blood capillaries and even skin cancer. Particularly for children whose skin is thinner and less protected against UV rays, sun protection measures should always be taken. Avoid direct sunlight from 10am to 4pm, wear shades, hats and appropriate clothing. Also bear in mind that the sand and the sea can also reflect the rays, and thus sitting in a shaded area also requires sun protection.

Sunscreens are divided into chemical absorbers and physical reflectors; chemical absorbers absorbs the light and converts them into harmless rays but these are known to trigger more skin irritation than physical reflectors. Physical reflectors reflect the light off the skin. Be sure to put sufficient amount, one teaspoon on the face and to use one at least SPF30.

Stress and Baby Skin

Stress is also known to trigger skin conditions such as eczema and pimples/acne and therefore parents are encouraged to share stress relaxation techniques such as massage and breathing with their children.

Q&A with Dr Lynn Chiam

Dealing with Drool – Dr Lynn answered a question on dealing with the child’s drool and her tip is to use a wet cloth to dap away the saliva, followed by a dry cloth to dap dry and then moisturize immediately.

Air-conditioning – Children with eczema can sleep in air-conditioned room, bearing in mind that there is no ideal environment as too hot can also trigger eczema. A temperature of 24 to 25 deg C is comfortably cool.

Oil as Moisturizer – Dr Lynn pointed out that oil is not as easily absorbed onto the skin as moisturizer, and thus does less to improve the skin barrier function.

Water as Irritant – Dr Lynn explained that eczema skin is like a crumbling brick wall and prolonged washing can weaken the skin barrier function. Therefore good skincare includes a bathing routine that is not in hot water and not longer than ten minutes.

Steroid cream – Dr Lynn explained that steroid potencies range from 1 to 7, 1 being the strongest and 7 the weakest. There is also new generation topical corticosteroids that have less side effects.

Next week, I’m asking questions for eczema children in relation to what Dr Lynn had shared during the Rise and Shine seminar, and as always, grateful to her for reviewing the above.

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Doctor Q&A

Doctor Claudia Video – Why Stressed Skin is More Skin Deep

Dr. Claudia Aguirre is a neuroscientist, a TED speaker and creator of Ted Education lessons. She is passionate about skincare, psychodermatology and frequently lectures worldwide. Read more about her at doctorclaudia.com

Marcie Mom: Thank you Dr Claudia for taking time to answer questions on the video. In it, you shared that chronic stress is associated with many diseases including diabetes, cardiovascular diseases, autoimmune diseases and even cancer. Stress process begins in hypothalamus, that sends an initial signal to the pituitary gland, adrenal gland and triggers the release of adrenaline, noradrenaline and cortisol that travel through the body for a fight or flight response. Stress is also studied to be able to trigger neurogenic inflammation that can worsen eczema, psoriasis, premature aging, acne and rosacea.

Stress can dehydrate skin, leading to impaired skin barrier that makes the skin more vulnerable to allergens and irritants, and triggers eczema flares. Histamines released also contribute to the itch level experienced in the skin. Stress can also make the skin hypersensitive to allergens. Cortisol boosts oil production, leading to blocked pores and worsening acne.

Doctor Claudia shared that there is a new field Psychodermatology, which is the practice of treating skin disorders using both dermatological and psychiatric techniques. Treatments such as acupuncture, aromatherapy, breathing and massage techniques are also shared in the video.

Dr Claudia, can you share briefly with us how the brain ‘talks’ to the skin and how differently a stressed brain talks to the skin?

Dr Claudia: The brain and the skin share an embryonic origin and are constantly communicating with one another. Think about sensation – your skin, once stroked, sends signals to the brain and the brain determines whether it is being tickled, stroked, or punctured. Of course the picture is more complex than that, as it involves countless nerve fibers, relayed information in the spinal cord and signals from brain to skin. They communicate using electrical impulses and chemical signals for the most part. A stressed brain will send more stress signals, or hormones, throughout the body including the skin.

Dr Claudia Aguirre answers questions on Why Stressed Skin is more than Skin Deep video

MarcieMom: Eczema is a stressful condition to manage, and stress can also trigger eczema – a double whammy situation. For children with eczema, what do you think are some ways to break this vicious cycle?

Dr Claudia: The behavior should be modified to adapt to lifestyle changes early on. In children, this may be teaching them that they can keep their hands busy so they don’t idly scratch their skin. Teaching them to breathe deeply has also been shown to reduce anxiety and stress in children – some therapists put a ball or balloon on the belly of the child and make them move it while breathing deeply, lying on their back. This can help a child understand how to breathe from the belly, which can reduce stress. Maybe when they get particularly itchy, they can call out to mom or caretaker, who will apply a cool compress to relieve the itch without scratching the skin.

MarcieMom: You mentioned about touch being able to relieve stress. Do you think that a mother carrying or sleeping with an eczema baby can help relieve stress and offers the possibility to improve eczema?

Dr Claudia: Absolutely. Holding premature infants allows them to develop faster and carrying a baby or toddler is comforting in more ways than we know. Gently stroking them will also be soothing. As for co-sleeping, there are different viewpoints and it is up to the individual in the end. To relieve from dust mites, wash often with hypoallergenic detergent and vacuum frequently. Although they are a trigger, they are not the cause of eczema, so keeping the skin hydrated and lubricated will allow it to heal and prevent flare-ups.

Thanks Doctor Claudia, as always, very much appreciate your insights into skin.

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Doctor Q&A

Doctor Claudia Video – Eczema: Scratching the Surface

Aging Skin Eczema Skin Videos of Dr Claudia Aguirre Neuroscientist

Dr. Claudia Aguirre is a neuroscientist, a TED speaker and creator of Ted Education lessons. She is passionate about skincare, psychodermatology and frequently lectures worldwide. Also check out last week’s video on Aging Skin.


This video showcasing Dr Claudia Aguirre was when she worked at Dermalogica

Marcie Mom: In the video, Doctor Claudia explained atopic dermatitis and that elevated IgE (immunoglobulin E) triggered allergic response in certain people. There is no single cause of eczema identified, and no cure for the condition. It is instead a multi-factorial condition characterized by defective epidermal barrier that is more alkaline and has more enzyme activity that reduces the connectivity of the skin layers. Filaggrin is a protein that aids in the formation of skin layers (do watch the video to see the animated filaggrin) and converts to natural moisturizing factors. Dry skin lacks this normal functioning filaggrin gene, and has been linked to atopic diseases such as eczema, asthma and allergies.

Sweat and Eczema

Marcie Mom: Dr Claudia, in the video you mention that sweat is an irritant for many with eczema.

Can you explain how the chemicals in our sweat can cause the allergic reaction? Shouldn’t our skin be used to our sweat?

Dr Claudia: Well an irritant reaction is not the same as an allergic reaction. I explained that sweat can be irritating to eczema skin, as this epidermal barrier may not be fully functional. This is an interesting question though, as we are still understanding the chemical composition of sweat (be that eccrine or apocrine).

In general, sweat is composed of water, minerals (like sodium and magnesium), lactate, ammonia and various amino acids. It could be one of these compounds, the combination of them, the changing pH of the skin, or even the sweat’s water content that can cause the itching and stinging sensations to some people with Eczema.  Digging deeper, I found an interesting study that suggested the amino acid composition of sweat is similar to the composition of the protein profilaggrin (which is later converted to filaggrin). This is interesting because scientists can study filaggrin by using human sweat as a potential chemical model. In the end, sweat can make eczema skin uncomfortable, so I suggest bringing a cool damp towel to your workout, or maybe spritzing a hydrating spray, instead of rubbing or scratching this sensitive skin.

Aromatherapy, Stress and Eczema

MarcieMom: Stress is also a common trigger for eczema and suggestion such as aromatherapy is mentioned in the video. Out of curiosity, does the aroma work the same way as fragrance in skin care products, which is to be avoided? Or is there a specific type of aromatherapy for those with eczema?

Dr Claudia: No, aroma in skin care products varies widely. What you want to avoid are synthetic fragrances which can cause an irritant or allergenic reaction in the skin. Some people use perfume for years before they get a skin reaction. Aromatherapy typically employs essential oils, which are natural compounds. However these can be quite potent, so a trained professional with a background in aromatherapy should be consulted before any treatment. The act of breathing deeply alone can also reduce stress.

Water in Skincare Products to be Avoided?

MarcieMom: In the video, you also recommended water-free barrier repairing products and oatmeal compress. Is water to be avoided in skin care due to preservatives being required if there is a high water content or is it because the eczema skin ‘loses’ the more liquid product easily? As for oatmeal compress, do explain to us (I’m using oatmeal bath oil, but not sure how an oatmeal compress works).

Dr Claudia: Great question. I suppose it could be both. Paraben alternatives are preservatives that have a greater potential of being irritating than parabens. So ‘paraben-free’ formulations may actually be more irritating. The amount of water lost to a skin care product from the skin is most likely negligible, so I recommend anhydrous barrier-repairing products because they contain silicones to protect skin. Our skin has a lipid (oil) layer, so you want to replenish those oils to ensure a properly working barrier.

Colloidal oatmeal for Eczema

Colloidal oatmeal is a wonderful ingredient for eczema skin. There are many scientific studies on oats and dermatitis – and this should be your eczema skin’s best friend. Look for clinical colloidal oatmeal for best results. The compress is basically a wet wrap. This is used to lock in moisture and keep the actives on the skin. On wet skin, apply oat or other active ingredient, follow with a damp gauze and cover with dry wraps. This dry covering could be pajamas (good for kids), or other dry covering. Alternatively, a colloidal oatmeal masque is a really nice add-on to a skin treatment for hydrating and soothing skin.

Vitamin D and Eczema

Marcie Mom: Vitamin D has been mentioned much to boost immunity and for the skin.

How exactly can one with eczema get vitamin D, and what’s your recommended minutes of sun exposure for those with eczema?

Doctor Claudia: Everyone has different needs, so there is no single recommended amount of sun exposure. I advise those wanting to know to consult with a dermatologist trained in a bit of photobiology. Or you could ask a scientist (they are hard to find!). At a recent conference I met Prof. Brian Diffey, an expert in this field. In a recent paper, he concluded “Messages concerning sun exposure should remain focused on the detrimental effects of excessive sun exposure and should avoid giving specific advice on what might be ‘optimal’ sun exposure”.

Vitamin D is an essential hormone and we all need a good dose of it. So speak to a dietician or doctor to find which vitamin D supplements are good for you and be sun smart!

Marcie Mom: Thanks Doctor Claudia, your explanation is so helpful, as even though we can’t cure eczema – it doesn’t hurt to understand more of it in order to manage it confidently. I’m looking forward to more of your videos!

If you have something to share about the topics covered in this post, share in the comments or send this article to someone who has a similar experience. Your sharing will help others.

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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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Eczema Tips Guest Interview

Reducing Stress for Children

Reducing Stress for Eczema Children

Eczema families face higher stress due to the constant attention required to manage our child’s skin, including the itch and the scratching. Marcie Mom interviews Lori Lite, founder of Stress Free Kids®, who has a line of books and CDs to help children reduce stress, anxiety and anger.

Lori started her business when trying to settle her young son to sleep and reduce night terrors of her daughter. Her Indigo Dreams® audio book/CD series has been awarded the CNE Award of Excellence. Lori has been interviewed and/or featured in NY Times, MSNBC, ABC Radio, CBS News, USA Today, Web MD and Prevention Magazine. She is a certified children’s meditation facilitator and parenting stress expert and gained national attention when she appeared on Shark Tank.

What is Stress?

Stress is a reaction that affects our mind and/or body when we are confronted by a ‘stressor’ – something that angers, scares or worries us. For the child, stress can trigger or worsen the eczema – Dr Christopher Bridgett and Dr Claudia Aguirre shared about stress brain and skin connection.

Apart from impact on skin, stress can affect a child’s learning, sleep, emotions and ability to handle stressful situations. Not all stress is bad, as some normal stress encountered prior to a test may help the child to prepare for it. Unfortunately, with eczema, the stress can be chronic (just like eczema) as persistent eczema flares, scratching, lack of sleep and self-esteem can build up in a child.

How to Know if Your Child is Stressed?

MarcieMom: Lori, can you share with parents how we can identify that our child is stressed, in particular, for an infant or toddler? Can a new-born be stressed? (I’m thinking of all the writhing and fidgeting of my baby when her eczema already affected her at two weeks old!)

Lori:  Recognizing stress in new-borns and toddlers is difficult. As you noted, you felt your baby’s body language was telling you something was out of balance at only two weeks old. Babies that stiffen their bodies, arch their backs, grimace, and cry frequently can be exhibiting signs of stress. I always tell parents to trust their instincts. Parents, especially moms, know when something is wrong with their children. Keep an eye out for a change in your child’s behavior.  For example: clingy behavior is a sign of stress in toddlers. However, some toddlers are clingy. So if your child is usually not the clingy type and they are suddenly attached to your leg, then that would be a change in behavior.

Babies that stiffen their bodies, arch their backs, grimace, and cry frequently can be exhibiting signs of stress.

Some of the signs in children also include: no longer wanting to go to school, an increase in nightmares or night terrors, difficulty falling and staying asleep. Physical symptoms can present themselves as unexplained stomachaches, headaches, or other ailments. Sometimes the child will withdraw from friends and family members, or have frequent meltdowns, which is a common sign of stress for toddlers. It is important for moms or parents dealing with the additional challenges of eczema to be aware of and manage their own stress. Babies, children, and teens pick up on our stress. It is contagious and we must find healthy ways to manage stress and anxiety. We can set a great example to our family and send  a ripple of calm throughout the house.

Causes and How to Cope with Stress

In a survey of 1,206 young people, 44% are stressed over performance in school and 30% are stressed over family’s finances. In an article on StressFreeKids.com, it is mentioned by David Code, author of “Kids Pick Up on Everything” that “Parental stress can weaken the development of a child’s brain or immune system, increasing the risk of allergies, obesity, or mental disorders.”

In other words, “Stress is highly contagious between parent and child, even if the parent is unaware of his or her own anxiety.”

Children cope with the stress they face, usually by doing activities that relax them, such as exercise, music, TV or talking to a friend. As a parent, we can try to help our child cope in a healthy manner, ways that help their mind and body and won’t cause harm such as hitting themselves or others.

Reduce Stress Techniques for Kids

MarcieMom: Lori, your books and CDs focus on a few techniques, namely breathing, muscle relaxation, affirmative statements and visualization. For breathing, you mentioned

(i)         Have your child lie on their back and put their hand on their belly.

(ii)        Take a slow deep breath in through their nose and let it out through their mouth with a gentle ah-h-h-h-h-h-h sound. (They should feel their belly rise and fall).

(iii)       Breathe in slowly through their nose and out through their mouth like they are trying to move a feather up in the air.

(iv)       Breathe in slowly to the count 2, 3, 4 and out 2, 3, 4.

(v)        In 2, 3, 4 and out 2, 3, 4.

For breathing and muscle relaxation exercises, which age is appropriate to start?

Lori: It is never too soon for a child to reap the benefits of relaxation and meditation. There are reports that state that stress levels during pregnancy can affect an unborn child. I used deep breathing throughout my last pregnancy and I believe that because of this my newborn was easier to soothe when I focused on my breathing. In general the age of 4 is when a child can start to participate in relaxation exercises, but I have seen children as young as 18 months copy breathing and positive statements. Self-care, relaxation and stress management can begin at any age and should be part of daily living. When you feel stressed, tell your children that you are takeing a minute to focus on your breathing. Add visualizing breathing in happy, calm air…Throw an affirmation in like, “I am calm.” Children will copy what they see. Don’t be surprised if they climb up on you lap and breathe with you.

MarcieMom: You also recommended using affirmative statements, and also asking ‘What-If’ positive scenario questions. What age is suitable for this, and can you recommend a few ‘what-if’ questions and affirmative statements that parents with eczema children can use? (I was thinking ‘What if you don’t feel itchy?’ but then I’m WORRIED that will get the child to think about the itch!)

Lori: As soon as children start asking “what-if” and inserting their own fear-filled or negative outcomes, this is the time to implement repeating their “what-if” question and finishing with a positive outcome. For example, the child says, “What if my eczema gets worse?” and the parent says, “What if your eczema gets better?” Another example would be if the child asks, “What if the kids laugh at me?” In turn, the parent should suggest, “What if you find friends that accept you?”  Many children with eczema have food based allergies and might say, “What if I can’t eat anything yummy ever again?” We can empower children by answering, “What if we find new foods together that we can have a picnic with?”

The important aspect in affirmative statements is helping the child see a positive side, and have them focus on a positive outcome that rather than negative. You intuitively knew not to use the word itch in an effort to avoid bringing attention to it. We also want to avoid saying “not.”

MarcieMom: Thank you Lori so much for giving us a few techniques to relieve the daily stress. p.s. to readers of eczemablues.com, I did not receive any money from Lori or StressFreeKids for this interview

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Doctor Q&A Other treatments

Combined Approach Series – Stress, Attitude and Habit Reversal

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

Habitual Scratching and Eczema with Dr Christopher Bridgett

3 Levels of Eczema Treatment

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

1. Emollient Therapy

2. Steroid

3. Habit reversal

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

Stress for Eczema Child

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

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

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

How can a parent help a child to relax?

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

Positive Attitude

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

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

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

I find myself saying something about this all the time! Of course the responsibility for a successful visit to a doctor rests with all those involved. Each person should consider first what they themselves can do, rather than seeing any problem as caused by someone else. Some really useful ideas about this were covered when Jennifer talked to me: see http://atopicskindisease.com/articles/20111216 This might make a good topic for people reading this post to comment on here: I suggest your readers share their thoughts and experiences with you.

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

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

Review of Habit Reversal

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

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

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

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

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

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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
Guest Interview

What I’ve learnt from Dr Ava Shamban’s Channel – Protecting Skin

Dr AVA MD’s Channel

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.
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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!
Categories
Support Group

One more reason not to Stress your Child

Stress can be a trigger of eczema

Stress is one of the more common triggers of an eczema flare-up. Studies revealed that babies, young children and teenagers all suffer from stress, and usually go unnoticed by the parents.  Stress can come from many sources, such as separation from parents in preschool, academic pressure, peer pressure, knowledge of financial or work difficulties faced by parents, divorce, illness or death in the family and (depressing) world news.

Chronic stress, such as from divorce or death, affects the child more; and note this, stressed parents can pass on the stress to their children.

For an eczema child, stress may trigger a flare-up because

– Stress results in more hormones release, which in turn lead to over-production of cytokines that cause immune cells to release inflammatory substances which sensitive skin is allergic to.

– Stress suppresses the immune system, through the increased level of cortisol produced by the adrenal gland. The skin is less able to produce sufficient defense proteins, making it vulnerable.

–  Stress leads to lower skin cell growth and weakening of the fat/lipid skin barrier, resulting in drier skin. Dry skin is vulnerable to irritant.

Apart from triggering eczema, stress has other negative effects such as

– Impair the connection of brain circuits, resulting in smaller brain, slower learning and poorer memory

– Over-reactive to small problems, resulting in an inability to handle stress

So, how can you tell if your child is stressed?

– Behavioural/Emotional – acting out, refusing to go out, complaining, mood swings/outburst, withdrawn, too shy, fear of failure, worrying all the time, spent time alone, sucking thumb, twirling hair, biting nails, nightmares, clingy/fear being alone, anxiety, irritability, rocking, freezing up, obsessive about objects/food, constantly asking what’s next

– Physical – bed wetting, problem sleeping/eating, stomach ache, headache, regression in toileting, excessive crying, trembling, accident prone, over-react to sudden loud noise, sweaty palms

– Intellectual – Lack of concentration, inability to complete homework

And how do you help your stressed child?

– Establish a routine

– Ensure your child gets plenty of rest, and not ‘hurried’ to too many activities

– Give your child proper nutrition

– Spend time, listening and being there

– Exercise/ share activity with your child

– Encourage your child to keep a journal

2012 update: Read my interview with Stress Free Kids founder Lori Lite on how to reduce stress for kids; Lori has built a business helping kids to be stress free, inspired by her own journey with her children. She was a featured contestant on first season of Shark Tank.

2012 update: Read my interview with psychiatrist with interest in dermatology Dr Christopher Bridgett on his take on stress management for children.

2013 update: Read my interview with neuro-scientist & TEDx speaker Dr Claudia Aguirre on how the brain communicates with the skin.

Categories
Doctor Q&A

Friday Feature – Eczema Q&A with Dr. B

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

Q&A with Dr Christopher Bridgett on Childhood Eczema and Habitual Scratching

This was originally a series of Friday Q&As in 2012 which had since been combined into one informative post.

Bedtime Routine for Eczema Kids

Marcie Mom: I set up a bedtime routine of reading books, singing songs, turning off all the lights and playing baby christian songs. We also pray for good night’s sleep! How does routine help a child’s behaviour and how can it help the child’s eczema?

Dr B: Your routine enables learning the desired consequence – a good nights sleep – if all the pieces of the sequence follow each other frequently enough, including the consequence of falling asleep. It’s best to move on from reading, and singing songs, to turning off the lights and saying prayers only when the signs of sleep arriving soon are quite clear!

When you think the child will sleep OK without the routine, it may be tempting to make some short cuts. I suggest that this would be a mistake! If on the other hand, a child is especially fraught, and therefore wakeful, it is best to go slowly along the routine, reading more stories, singing more songs, before the lights are turned off, and good night kisses are given.

Routine usually enables most of us to cope with everyday life. Generally following an established and happy routine means less stress, and changes in routine are usually stressful. And less stress means calmer skin, and less scratching… sounds good for eczema, I think!

Stress Control for Eczema Family

MarcieMom: Parents taking care of eczema children experience high stress levels, apparently as high as parents taking care of children with kidney illness. I’ve also read that stress can be passed onto babies, is there a chance that the stress that parents of newborn feel may worsen the eczema of the baby?

Without making parents even more stressed (that they are passing on the stress!), are there any tips for them to manage their own stress or to prevent stressing their child inadvertently?

Dr B: The causation of atopic eczema is multifactorial – there is no one factor, there are many, and they can be divided up into those that we have to accept, and those that we can do something about. First we need to draw up the list that applies in a particular case – stress is usually there on the list, and stress is usually a factor we can do something about!

Stress and frustration directly affects the skin – the skin is very sensitive to our emotions, and we all tend to scratch more when stressed and frustrated, and scratching soon becomes habitual – which is the cause of chronic eczema. There is no doubt that stress can be part of family life; kids become how they are through their parents, don’t they?

Marcie Mom: Most parents of eczema children have no time for themselves, let alone exercise. Obviously, we know exercise is good for us but how does exercise affect our psychological well-bring?

Dr B: Great question! We seem to live in stressful times. Under stress the body releases hormones like adrenaline, that facilitate fighting, or fleeing! In modern times we can’t do either usually, so it’s important to have a regular physical outlet. A healthy mind in a healthy body.

Marcie Mom: Also, parents of eczema child tend to have less couple time and higher stress in marriage. What simple and practical advice would you give them?

Dr B: The first step is the one you have already taken: recognize the problem. Coping always begins with confronting reality. Next how it leaves you feeling needs expression – don’t bottle it up, let it out, talk about it, understand it and think it through.

Then consider getting and accepting help – problems shared are problems halved. Experiment with new ways of doing things. Don’t take the situation for granted – there is usually a way of changing arrangements for the better. 

Steroid Side Effects

Marcie Mom: Some child’s skin turn brown where it frequently itches, being scratched and steroid creams have been applied. Some parents think it’s the steroid cream that causes the change in skin colour but I’ve read that the brown patch is caused by cells in skin (‘melanocytes’) releasing extra pigments from scratching. Which is true? Particularly it’s important to dispel any misperception of steroid when the risk of under-treatment due to steroid phobia is real.

Dr BBoth are true!

In the first case, yes steroid creams will change the colour of skin – they very slowly reduce the pigmentation, lightening the colour of the skin. The anti-inflammatory effect of the steroid reduces the activity of all skin cells, including the pigment cells – the “melanocytes”.

In the second case, cellular activity in skin is stimulated by habitual scratching, and this affects all cells, including the pigment cells – the “melanocytes”. So habitual scratching causes the skin to thicken up – lichenification – and colour up – hyperpigmentation. Both are characteristic of chronic atopic eczema.

Cradle Cap

MarcieMom: Some eczema babies also get cradle cap, and the cradle cap shampoo has to be used to massage the scalp and wash off the cradle cap. What’s the difference between cradle cap shampoo and normal baby shampoo?

Dr B: Aha! I think I can answer this… Yes, they are different. Cradle cap is seborrheic dermatitis of the new born and infants – it is usually harmless, and can clear on its own, without any special treatment. The regular baby shampoo will help reduce the rash, but specially formulated cradle cap shampoo is stronger – it may have salicylic acid in it for example. If the special shampoo is used, please make sure it is suitable for the age of the child!

Marcie Mom: I’ve also read that brushing a newborn hair helps to keep cradle cap away. Is that true? What does brushing hair do to the scalp?

Dr B: Yes, brushing the hair helps tidy things up, until the cradle capclears. With cradle cap there is excess sebum being produced. Sebum is the natural oil of the skin. Sebum is good for the skin and hair, in moderation – for example, it gives insulation against water loss. When birds preen they are spreading oil over their feathers, and that is what brushing the hair does – see how it shines! 

Swimming for Eczema Children

Marcie Mom: Some parents are very skeptical of bring their eczema child to swimming but my baby’s doctor recommended it. Just 10-15 minutes 3 times a week and wash off pool water and moisturize immediately. Will that also be your recommendation? Swimming is so fun and I hate to see eczema children being kept off it!

Dr BSwimming is fun and good exercise – it also saves lives! So it’s good to say that swimming and atopic eczema usually go together just fine. The problem is caused by the water – it washes off a layer of the skin’s protection and leaves it very porous to water loss afterwards: a thin application of moisturizer before swimming protects against this. Make sure the application is thin though – no need to prepare for cross-channel swimming – see http://www.atopicskindisease.com/articles/TopTip1

Otherwise, the chemicals in the water of a swimming pool are disinfectants – chlorine, & bromine for example – they can be good for the skin, as their antibacterial effect is anti-inflammatory. However these additives can irritate too, so your procedure is a good one!

Moisturizing

MarcieMom: Moisturizing is important to maintain the skin barrier, particularly when eczema child has a weaker skin barrier that allows for more allergens to penetrate. The recommended guideline is about 500ml per week, that’s a lot and some children simply squirm when parents try to apply the moisturizer. What do you suggest parents can do to get their children to like being moisturized? Or even better, moisturize themselves!

Dr B: The use of a moisturizer – also called an emollient – is central to the care of atopic eczema.  The way it is used is very important – much more important than which one is used. Sometimes the better ones are the cheapest – and the best one is the one that is liked and used properly!

With children, as with adults, there are four key words to remember:

Thinly, Gently, Quickly and Often

and with the child it is very important to get it done quickly, and on afterwards to do something fun together, so that fun becomes the focus, not the moisturizing!

Getting the child to do their own moisturizing needs careful consideration: left to their own devices there is a good chance it will not get done properly – perhaps age and temperament come into it. 

Reactive Skin Reactive Mind?

Marcie Mom: It is mentioned in this article a comment by Sophie Worobec MD at University of Illinois that eczema children are “very bright” as the skin and the brain develop at the same time, so “very reactive skin and very reactive mind”. What do you think of this statement?

There seems to be an association between ADHD and eczema children. And have you seen more cases of ADHD for eczema patients?

Dr B: That there seems to be a close relationship between the skin and the mind is often referred to, and the development of the skin and the brain from the ectoderm of the early embryo is seen as relevant to this relationship – I sometimes say the brain can be called a specialized part of the skin!

But in reality the whole body is closely integrated. All the separate parts are interdependent through shared characteristics, and the overall function is enabled by circulating hormones and by the nervous system links between brain and body.

Both ADHD and atopic eczema are relatively common conditions. The recent reports of an association need to be treated with caution. I have no personal clinical experience of this reported association.

Tensed Baby

Marcie Mom: My baby has taken to tensing her stomach and legs in positions such as doing leg raisers or push-ups. My husband and I think it’s related to her being swaddled too much when young (we had to swaddle her due to scratching, sometimes looping a cloth around her limps cos the scratching was so bad). Do you think it is possible that she has learnt to use tensing to ease her itch and will this impact her psychologically? We certainly hope we haven’t made her gone bonkers!

Dr B: No, I do not think so! Probably what your baby is doing is “within normal limits” and is not due to swaddling, or to itching – and will have no psychological significance at all.

Marcie Mom: That’s comforting to know. Here’s another ‘crazy’ question from me. I frequently use finger food like biscuits (but only vitamin fortified, non-sugary, suitable for babies) to distract from my baby from scratching. My husband thinks I’m turning her into a glutton and soon she’ll have compulsive behaviour to keep eating. Is that true? 

Dr B: The importance of neutral/helpful alternative behaviours to scratching is fundamental to habit reversal – the new behaviour should not risk substituting a new problem for the old problem. I do not think what you describe is likely to lead to compulsive behaviour, but using eating as a habit reversal tactic does seem to encourage habitual snacking, and that may not be what you want to do?

Parental Guilt

Marcie Mom: Some parents have feedback that they feel guilty that they have either passed on the ‘bad gene’ or haven’t noticed their child scratching. What advice would you give to parents to cope with the guilt, which of course, isn’t justified!

Dr B: Both awareness of genetic inheritance, and coping with achild’s scratching are common human experiences and, as “facts of life”, need keeping in proportion. Some of us are more prone to self-blame than others. I think self-blame regarding genetic predisposition is quite unjustified. Failing to supervise a child’s scratching behaviour may be something to review. Sharing experiences in real time with others, and over the internet should be really helpful: great that you have this site!

Stop Scratching Eczema

Marcie Mom: Eczema babies seem to form a habit of scratching, mine even scratches my spouse or I when we’re beside her. How do you suggest parents can help to break the habit for your children (who can’t understand not to scratch nor appreciate the full negative effect of scratching)?

Dr B: Follow The Combined Approach to atopic eczema …. usehabit reversal behaviour modification to treat habitual scratching, together with optimal conventional treatment. To rescue a young child from chronic eczema please refer to Chapter 5 of our book“Atopic Skin Disease” – available to consult at www.atopicskindisease.com

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10 reasons why parents with eczema child have a tougher time

Stressed out Mom

How often do you feel like tearing your hair out? Pretty often for me, especially when Marcie was between one to ten months old. Her eczema was all over her body, scalp and face and she didn’t know how to distract herself from scatching.

Having been both a stay-at-home and a working mom, I fully understand the additional demands of taking care of children with eczema, whether or not you’re working. I didn’t have a helper or another adult to help out during the day. I was alone at home, trying my best to stay calm taking care of my baby and to be a good home maker. The stress level was sky high, knowing that any attention lapse could result in scars/broken skin on my baby.

If your spouse/ family member is taking care of a child with eczema, do emphatise with them as you can see below it’s a lot tougher to care for an eczema kid.

1.       Not even a minute’s break. A child with eczema will scratch when the skin is ‘triggered’, tired, sleepy, hungry or for no reason at all. Marcie scratches whenever she’s not occupied or when left alone. At one point, I couldn’t go to pee or poo or bathe until my hubby return from work.

2.       Fatigue from lack of sleep. A child with eczema tends to wake up in the middle of the night and scratch. I am still co-sleeping with Marcie so that I can hold her hands whenever she scratches. Lack of sleep leads to fatigue which also raises the stress level. Since Marcie was born, I haven’t slept throughout the night (but I’ve got used to it).

3.       No time to eat! If the restaurant is not cool enough or contains allergens that a child is sensitive too, the child will start scratching soon enough. I lost more weight than my weight gain during pregnancy plus, I’ve got into a habit of gobbling down my food as I know I only got a few minutes before Marcie starts to scratch.

4.       No time for exercise! It is extremely difficult to gather the energy to exercise when (and that is a BIG WHEN) there is a little free time. When I do have the chance to jog, the exercise routine only last for 2 weeks before my baby changes her routine. Most days, I choose to chill with my hubby ‘cos we have so little time to ourselves.

It’s no wonder why you or a parent with an eczema child is so high-strung. The basic needs of sleep, eat, exercise, pee & poo can’t even be met properly. There is this study that concludes the stress levels in mothers caring for young children with eczema are equivalent to those mothers of children with severe disabilities. Below are some other emotional issues that you or the parent may face.

5. Guilt. It is easy to feel guilty when you are the only care giver and your baby ends the day with blood. I remembered feeling guilty when I dozed off for a minute and heard my baby scratching her neck. I remembered checking on her when I finished cooking and saw that she woke from her nap and scratched till blood from her ears run down to her face. I remembered checking on her when she was in a baby chair and realized she scratched her neck against the metal frame till bleeding. I remembered questioning myself if it was right to tie her up for a few minutes when I prepared her milk. It took me some time but I know now that I’m the best mom for Marcie and there’s no reason for guilt.

6. Isolation. A stay-at-home mom has no one to share your day and you lost your work status. For parents with eczema kids, it is very difficult to share with people who have not gone through the same. Worse, you tend to get suggestions that somehow point to you ‘mis-caring’ for your child.

7. Anger and blame. Eczema is an immunology disorder and it is half the time inherited. It took quite a few months before I stopped accusing my hubby about him passing on his ‘bad gene’. It does no good and doesn’t help our relationship.

8. Almost no time with spouse. That’s a big issue when the child takes so much attention, from both parents. I have yet to learn to enjoy the moment with my hubby when our baby is with us.

9. More housework. If the trigger for your child’s eczema is dust mite dropping, then you may spend more time vacuuming the house, changing bed sheets and cleaning the toys. More housework again means less time with spouse (and seldom both agree on how much housework to do!)

10. Less money. Moisturisers, bath oils, steroid, specialist appointments all don’t come cheap. Financial burden may place additional stress on the couple relationship.

One thing I’m glad to report though, it is possible to manage all of these better overtime. One good that comes out of taking care of Marcie for the past 15 months is that I’m proud of myself, my hubby for managing it so well and is more confident of our ability to weather difficulties together…

& always believe that You are the Best Parent for your eczema child