It is stressful when your children are with eczema. Sleepless nights, daily routine of applying topical treatment and the anxiety that your kids are look at or bullied in school. I can relate and emphatise with all of you. I have seen kids as young as 7 days old with bad eczema, it is heartbreaking and wish that I have a magic wand to help anxious parents.
Eczema is a dry skin condition, where moisture on the top layer of the skin are lost leading to dry and irritated skin that are prone to infection. The first line of treatment are emollients that include moisturisers (cream and ointment), bath oil and soap substitute. There are loads of moisturisers available i.e cetraben cream, diprobase, hydromol, epaderm, E45, doublebase, hydrous cream and etc. The best moisturisers for each individual are the one that the patient likes thus enabling good concordance.
School age kids are able to choose and try different moisturisers. Health practitioners in the UK usually give small samples of moisturisers to try and then prescribe it for them. Try to avoid using soap or bubble bath, these are alkaline base and aggravates your kids dry skin but instead use soap substitute. Most moisturising creams can be use as soap substitute, it does not ladder and your kids may not like it initially but soon they will get use to it.
If your kids like having a bath, adding bath oil will help. If your child eczema is weepy most likely it is infected then a bath oil with added antiseptic is beneficial. Once infection subsided, just use the normal bath oil. Now if your child's skin are red, itchy and inflame (bumpy)then topical steroid is needed. Topical steroids have four strenght; mild, moderate, potent and super potent.
Children with bad eczema use moderate steroids for few days (3-7 days) then reduce it to mild strenght. Depending on patient's age and the site, your child might have to use different strenght. Face, the thinnest skin, a mild steroids are commonly use. Hydrocotisone oint/cream is an example and Eumovate on the trunk and limbs as a moderate strenght.
Potent steroids are rarely use and it is usually prescribe by your dermatologist for few days to control the flared eczema. Once the eczema subsided, you can use the mild steroids or just use moisturiser. Eczema flare is on and off, what is important is that you know what to do if there is a flare of eczema. The following tips might be helpful:
1. Establish a routine with your child, bathing and showering, make it enjoyable for them. Explain the reason why a bath oil has to be added, then add some toys in the bath to motivate them. It is difficult initially but the buttom line is establish a routine.
2. Pat the skin dry and avoid rubbing towel on their skin. It will stimulate scratch-itch cycle. Once they start scratching it is difficult to stop.
3. Apply the moisturiser all over, it will trap the moisture in, thus reducing ithing and soreness. Apply the cream/Oint in down ward stroke to avoid folliculitis and clogging the hair follicles causing the patient to itch.
4. After 30 minutes to one hour apply the topical steroids as prescribed.
5. Using a cotton vest and leggings is helpful.
6. Your kids nails should be always short. Preventing skin damage when they scratch.
7. If kids always scratch, use cotton mittens on their hands
8. Let the kids participate in the application of cream if possible
9. Have enough supply of moisturiser. Place a tub in the living area, bath room, and bed room. Accessibility to these cream will increase compliance and your kid will apply the cream once their skin itch.
10. Have a mild, and moderate potent steroids at home. Use the moderate potent steroid for few days then reduce to mild strenght. If eczema is controlled, use only emollients. Then repeat the cycle if eczema flares. It is ok to use topical steroids as long as have a rest period in between, not to use it continously.
11. Avoid wool clothing, vacuum the room if carpeted, wash stuff toys if not place in a plastic bag and keep inside the freezer over night to kill the houst dust mites.
12. Join the national eczema society in your locality, this will give you the chance to meet mum with eczema kids. Sharing experiences can be helpful.
Saturday, March 13, 2010
Sunday, February 14, 2010
Skin Surgery Wound
Skin cancer cases are on the rise, this could be attributed to increase drive of the government in educating people with regards to awareness of early detection and treatment of skin cancer. Surgical removal of the suspected skin lesions are far the best treatment options. Specimen is send for histology, giving proper orientation to the whole lesion under the microscope and it removes the cancerous cells with adequate margin (including margin of healthy skin).
The following are practical advise to look after your wound:
- Keep the area dry after 24-48 hours, then you can have a shower but avoid soaking your wound not unless it healed.
-It is best to keep the wound without a dressing after 48 hours not unless you are intructed to do so. Surgical wound is a clean wound and exposing to the air can promote wound healing.
-Apply vaseline ointment 2x a day on the area , moist environment promotes wound healing. Remember to wash your hand before applying the ointment.
- If bleeding continues, apply a pressure on the area for 10-15 minutes. Place your hand and apply a gentle pressure, this helps to stop the bleeding. If persistent, see your health practitioner.
- avoid strenous exercise, heavy lifting, bending, flexing near the area, these can cause the wound to open.
-Take paracetamol for pain but avoid aspirin and brufen. These meds can aggravate bleeding because it reduce the blood to clot.
- If soreness persist, the areas are red and the wound secretes yellow to greenish exudates then most likely it is infected. See your health practitioner to treat it with antibiotics.
-See your nurse for removal of stitches as instructed.
The following are practical advise to look after your wound:
- Keep the area dry after 24-48 hours, then you can have a shower but avoid soaking your wound not unless it healed.
-It is best to keep the wound without a dressing after 48 hours not unless you are intructed to do so. Surgical wound is a clean wound and exposing to the air can promote wound healing.
-Apply vaseline ointment 2x a day on the area , moist environment promotes wound healing. Remember to wash your hand before applying the ointment.
- If bleeding continues, apply a pressure on the area for 10-15 minutes. Place your hand and apply a gentle pressure, this helps to stop the bleeding. If persistent, see your health practitioner.
- avoid strenous exercise, heavy lifting, bending, flexing near the area, these can cause the wound to open.
-Take paracetamol for pain but avoid aspirin and brufen. These meds can aggravate bleeding because it reduce the blood to clot.
- If soreness persist, the areas are red and the wound secretes yellow to greenish exudates then most likely it is infected. See your health practitioner to treat it with antibiotics.
-See your nurse for removal of stitches as instructed.
Sunday, February 07, 2010
Hair loss
Hair is one of the appendages of the skin. Healthy looking hair symbolises beauty and good health. There are a lot of my readers, perhaps at somepoint experience if not, have seen a friend with hair loss problem. Hair loss can be attributed to decrease growth of hair, increase shedding/falling, breakage of hair, and conversion of thick terminal hair to thin vellus hair.
Hair growth have cycles, starts from the growing phase----middle phase--- then the falling out phase. Each strand of hair grows 1cm per month, after 3-4 months, the resting phase or the falling out phase takes place and new hair grows to replace it. It is normal to have 50 or more hair to fall everyday, although excessive falling may occur as well.
What causes hair loss/ thinning?
1. Drug or medicines can cause hair loss. Blood thinners (Anticoagulants), drugs for gout, high blood pressure or heart problems meds, birth control pills, excessive Vit A, and anti-depresants. Replacing the drugs help to regain hair growth.
2. Children with fungal infections on the scalp may temporarily loss hair- treating the infection will alleviate hair loss.
3. Underlying illness like lupus, or diabetes
4. Thyroid gland- over active and under active thyroid glands can cause hair loss.
5. Hormonal inbalances- Androgen (male hormones), estrogen (female hormones). Correcting the hormone inbalance may stop your hair loss.
6. Stress from illness like fever, operation, wieght loss, after child birth can temporarily cause hair loss.
7. Iron deficiency.
8. Seborrheic dermatitis (dandruff), atopic dermatitis- can cause temporary hair loss.
9. Injury to the scalp may lead to scarring alopecia.
10. Genetic or most likely tendency to baldness due to genes inherited from your ancestors.
11. Age - 50 year old or above may icrease thinning of hair.
12. Trauma- includes tight curlers, certain hairstyles cause traction alopecia, hair dryer (broken hair shafts), perming solution/ bleach, and brushing too often.
Trichotillomania- is a disorder where there is repetitive pulling, plucking and breaking of one's hair. This type of individual needs mental hygiene (more appropriate words use now a days) assessment and help. At times, this is one way of seeking attention. Please consult your health practitioner.
Treatment is geared towards finding the cause of hair loss. Some individual may need to have diagnostic biopsy done- a portion of skin taken and examine under the microscope. although there is an over the counter remedy called Minoxidil (Rogaine) that can be used, it may take up to 6 months before result can be seen. Once treatment is discontinued, hair loss re-starts. If your hair loss causes anxiety and depression, please see your health practitioner for advice.
References:
1. Dermnetnz.org
2. Family Doctors.org
3. Bad.org.uk
Hair growth have cycles, starts from the growing phase----middle phase--- then the falling out phase. Each strand of hair grows 1cm per month, after 3-4 months, the resting phase or the falling out phase takes place and new hair grows to replace it. It is normal to have 50 or more hair to fall everyday, although excessive falling may occur as well.
What causes hair loss/ thinning?
1. Drug or medicines can cause hair loss. Blood thinners (Anticoagulants), drugs for gout, high blood pressure or heart problems meds, birth control pills, excessive Vit A, and anti-depresants. Replacing the drugs help to regain hair growth.
2. Children with fungal infections on the scalp may temporarily loss hair- treating the infection will alleviate hair loss.
3. Underlying illness like lupus, or diabetes
4. Thyroid gland- over active and under active thyroid glands can cause hair loss.
5. Hormonal inbalances- Androgen (male hormones), estrogen (female hormones). Correcting the hormone inbalance may stop your hair loss.
6. Stress from illness like fever, operation, wieght loss, after child birth can temporarily cause hair loss.
7. Iron deficiency.
8. Seborrheic dermatitis (dandruff), atopic dermatitis- can cause temporary hair loss.
9. Injury to the scalp may lead to scarring alopecia.
10. Genetic or most likely tendency to baldness due to genes inherited from your ancestors.
11. Age - 50 year old or above may icrease thinning of hair.
12. Trauma- includes tight curlers, certain hairstyles cause traction alopecia, hair dryer (broken hair shafts), perming solution/ bleach, and brushing too often.
Trichotillomania- is a disorder where there is repetitive pulling, plucking and breaking of one's hair. This type of individual needs mental hygiene (more appropriate words use now a days) assessment and help. At times, this is one way of seeking attention. Please consult your health practitioner.
Treatment is geared towards finding the cause of hair loss. Some individual may need to have diagnostic biopsy done- a portion of skin taken and examine under the microscope. although there is an over the counter remedy called Minoxidil (Rogaine) that can be used, it may take up to 6 months before result can be seen. Once treatment is discontinued, hair loss re-starts. If your hair loss causes anxiety and depression, please see your health practitioner for advice.
References:
1. Dermnetnz.org
2. Family Doctors.org
3. Bad.org.uk
Friday, February 05, 2010
Men's Vanity?
For the past months, I have been writing about skin diseases. I guess for a change, it is somewhat nice to debate about men being metrosexual. Is there such thing as vanity for men? I know there are some guys who are conscious about their looks and the way women appreciate their physical beauty not necessarily the masculinity.
Recently you have seen an increase marketing of men's product ranging from moisturisers to anti-ageing serum. The last one that I have seen today in the magazine, anti-ageing serum (50ml) for almost £500. That is totally rubbish, a waste of money. Famous brand advertise product with all these natural ingredients, which a normal homo-sapien eats and now produce it to be applied as night cream to reduce ageing. I'm not convince at all, a simple moisturiser that cost £1 will do the same tricks.
Men normally sweat a lot compare to women, this produces a natural sebum (oil) that helps to maintain a moist skin. Although, bacteria (normal flora) may thrive on these sebum and leads to chemical breakdown producing an end product that may not be pleasant to smell. Not to worry though, this smell signifies manliness and suppose to attract the opposite sex. Ha ha ha, it sounds weird, but in a modern world it is in fact unhygienic. Yes for the animal kingdom, it does the trick to attract mating.
Simple essentials are fine after all, men need good grooming and improve their confidence. Don't over do it and to my female readers, guide your husband or boyfriend.
Recently you have seen an increase marketing of men's product ranging from moisturisers to anti-ageing serum. The last one that I have seen today in the magazine, anti-ageing serum (50ml) for almost £500. That is totally rubbish, a waste of money. Famous brand advertise product with all these natural ingredients, which a normal homo-sapien eats and now produce it to be applied as night cream to reduce ageing. I'm not convince at all, a simple moisturiser that cost £1 will do the same tricks.
Men normally sweat a lot compare to women, this produces a natural sebum (oil) that helps to maintain a moist skin. Although, bacteria (normal flora) may thrive on these sebum and leads to chemical breakdown producing an end product that may not be pleasant to smell. Not to worry though, this smell signifies manliness and suppose to attract the opposite sex. Ha ha ha, it sounds weird, but in a modern world it is in fact unhygienic. Yes for the animal kingdom, it does the trick to attract mating.
Simple essentials are fine after all, men need good grooming and improve their confidence. Don't over do it and to my female readers, guide your husband or boyfriend.
Tuesday, February 02, 2010
Latex allergy
A friend has requested, for me to write about latex allergy. Natural latex rubber is a milky fluid obtained from the rubber tree (Havea Brasilieasis)mostly grown in South East Asia including the philippines. It is use in large number of products including glue, foam, gloves, catheters, condoms, balloons, toys, erasers, sports equipment, clothing, elastic bands, medical and dental equipment. Tell your health practitioner if you have latex allergy especially if you are recieving treatment from them, most hospital equipments are with latex component.
There are two types of allergy related to natural rubber latex, one is cause by natural latex proteins and the other is the chemicals use to convert it to the useable items. An example of these chemicals include thiurams, dithiocarbonates, mercaptobenzothiozoles(MBT). Allergic reactions to natural latex proteins are potentially life threatening, this is type I allergy (contact urticaria). Immediate symptoms includes urticaria (hives) at the site of contact with latex (hands-gloves, genital-condom), hayfever type symptoms, bronchial constriction(asthma) and breathing problems may occur. if your airway(breathing) is affected, this is an emergency situation and call for help as soon as possible. This reaction is manifested between 5-15 minutes after contact with latex product, or delayed for several hours. Symptoms can continue after latex contact had stopped.
Allergy to the chemical components of NRL is a type IV allergy (contact allergy) that is delayed type of reactions, 6-48 hours after exposure. It can cause a rash, itching and at times blisters. Contact allergy is not sensitivity to latex protein but rather to chemicals used in the manufacture of latex product. History taking and clinical examination can help with diagnosing latex allergy. There are some test that are use to help in confirming the diagnosis.
Patch test is use for contact dermatitis where a series of batteries (chemicals) are place in an alluminum chambers and applied on the person's back and left for 48 hours. Afterwards initial reading is done and repeated after 48 hours. Results are interpreted if the person is allergic or not to the test done.
Prick Test is done for person that are suspected to be allergic to the latex protein. The solution is prick into the intradermal part of the skin and the result is interpreted after 15-30 minutes. Radioallergosorbent test (RAST) is a blood test to determine if the person is allergic to certain substances, it is not as accurate as the skin test but it needs to be correlated with the clinical symptoms.
If you are allergic to latex, then it needs to be avoided. Check the day to day products you use and warn your employer about your latex allergy. Topical steroids are used for contact allergy and contact urticaria with airway obstruction is treated as an emergency situation. Mild to moderate urticaria is treated with antihistamine. Please see your health practitioner if you suspect that you are allergic to latex.
There are two types of allergy related to natural rubber latex, one is cause by natural latex proteins and the other is the chemicals use to convert it to the useable items. An example of these chemicals include thiurams, dithiocarbonates, mercaptobenzothiozoles(MBT). Allergic reactions to natural latex proteins are potentially life threatening, this is type I allergy (contact urticaria). Immediate symptoms includes urticaria (hives) at the site of contact with latex (hands-gloves, genital-condom), hayfever type symptoms, bronchial constriction(asthma) and breathing problems may occur. if your airway(breathing) is affected, this is an emergency situation and call for help as soon as possible. This reaction is manifested between 5-15 minutes after contact with latex product, or delayed for several hours. Symptoms can continue after latex contact had stopped.
Allergy to the chemical components of NRL is a type IV allergy (contact allergy) that is delayed type of reactions, 6-48 hours after exposure. It can cause a rash, itching and at times blisters. Contact allergy is not sensitivity to latex protein but rather to chemicals used in the manufacture of latex product. History taking and clinical examination can help with diagnosing latex allergy. There are some test that are use to help in confirming the diagnosis.
Patch test is use for contact dermatitis where a series of batteries (chemicals) are place in an alluminum chambers and applied on the person's back and left for 48 hours. Afterwards initial reading is done and repeated after 48 hours. Results are interpreted if the person is allergic or not to the test done.
Prick Test is done for person that are suspected to be allergic to the latex protein. The solution is prick into the intradermal part of the skin and the result is interpreted after 15-30 minutes. Radioallergosorbent test (RAST) is a blood test to determine if the person is allergic to certain substances, it is not as accurate as the skin test but it needs to be correlated with the clinical symptoms.
If you are allergic to latex, then it needs to be avoided. Check the day to day products you use and warn your employer about your latex allergy. Topical steroids are used for contact allergy and contact urticaria with airway obstruction is treated as an emergency situation. Mild to moderate urticaria is treated with antihistamine. Please see your health practitioner if you suspect that you are allergic to latex.
Monday, February 01, 2010
Headlice
There are a lot of school kids that are infected with headlice. This may sound simple infestation but if not treated properly, it can infect others including the family members. Headlice is common, it is a small parasitic insect that thrive only on human scalp. If someone is infected with headlice, it does not mean lack of hygiene, as a matter of fact it affects any socio-economic group wether rich or poor . It is more common in girls than boys.
The lice produce 6 eggs a day, cement thier eggs (nits) near to the scalp and hatch between 7-10 days. By ten days the remnants of hatch eggs are far from the scalp and can be visibly seen, if hair shafts are parted. They can live upto 40 days, lay more than 100 eggs, bites and feed on human blood. The saliva and faecal matter of the lice can irritate the scalp causing itchiness. The individual scratch the scalp, causing soreness with open wound. This leads to secondary bacterial infection (Impetigo).
The headlice are acquired by direct contact (head to head), when kids are playing. It takes 30 seconds to tranfer to the other scalp of an individual. The headlice are also acquired indirectly through shared hats, combs, and pillows. Confirmation of headlice is through direct examination of the scalp with good lighting, sometimes a magnifier can help.
It can be cured with the use of pediculicides, although resistance to this treatment has been documented. Physical methods is also useful, removing the lice and their eggs through repeated combing. It is easier if the hair is wet and use a fine toothed comb. The common pediculicides are MALATHION, SYNTHETIC PYRETHROIDS and CARBARYL. Follow the instruction as directed by your health practitioners, usually treatment are left for 12 hours before being washed off. To completely irradicate the headlice and nits, it requires 2 applications 7 days apart.
Your local pharmacist can be consulted for resistance cases in your locality and different pediculicide is usually recommended. Some health practitioners rotate the different treatment to prevent resistance to them. There are reported cases where kerosene is use to treat headlice, it is not recommended since it is a hazardous and higly flammable. The skin on the scalp can absorb the chemicals causing neurological problems. It is advisable to consult your health practitioner for best treatment.
The lice produce 6 eggs a day, cement thier eggs (nits) near to the scalp and hatch between 7-10 days. By ten days the remnants of hatch eggs are far from the scalp and can be visibly seen, if hair shafts are parted. They can live upto 40 days, lay more than 100 eggs, bites and feed on human blood. The saliva and faecal matter of the lice can irritate the scalp causing itchiness. The individual scratch the scalp, causing soreness with open wound. This leads to secondary bacterial infection (Impetigo).
The headlice are acquired by direct contact (head to head), when kids are playing. It takes 30 seconds to tranfer to the other scalp of an individual. The headlice are also acquired indirectly through shared hats, combs, and pillows. Confirmation of headlice is through direct examination of the scalp with good lighting, sometimes a magnifier can help.
It can be cured with the use of pediculicides, although resistance to this treatment has been documented. Physical methods is also useful, removing the lice and their eggs through repeated combing. It is easier if the hair is wet and use a fine toothed comb. The common pediculicides are MALATHION, SYNTHETIC PYRETHROIDS and CARBARYL. Follow the instruction as directed by your health practitioners, usually treatment are left for 12 hours before being washed off. To completely irradicate the headlice and nits, it requires 2 applications 7 days apart.
Your local pharmacist can be consulted for resistance cases in your locality and different pediculicide is usually recommended. Some health practitioners rotate the different treatment to prevent resistance to them. There are reported cases where kerosene is use to treat headlice, it is not recommended since it is a hazardous and higly flammable. The skin on the scalp can absorb the chemicals causing neurological problems. It is advisable to consult your health practitioner for best treatment.
Sunday, January 17, 2010
Scalp psoriasis
It is a scaly condition on the scalp, silvery thick plaques and hairlines are also affected with erythematous skin and scale of dead skin. People with scalp psoriasis may have psoriasis elsewhere or it just affect their scalp. An individual may suffer from mild to severe symptoms, treatment will depend on the severity of your scalp psoriasis.
Coal tar shampoo preparations are use for mild symptoms, where there is mild scaliness and with mild redness. T gel shampoo, capasal and polytar shampoo are available over the counter. Steroid scalp preparations are helpful for moderate to severe symptoms but these topical solutions should be prescribe by your health practitioners. It is mostly alcohol base and can sting your scalp. Concordance will be an issue because some people may not like it.
Coal tar compound preparations are also use for moderate to severe scalp psoriasis. It contains salicylic acid that help to lift the thick scales and coconut oil to moisturise your scalp. These need to be applied and left on your scalp for at least one hour then to wash it afterwards. Scalp psoriasis can be difficult to treat and requires perseverance. If you have any queries about your topical treatment please email me on nurseyourskin@yahoo.com.
Coal tar shampoo preparations are use for mild symptoms, where there is mild scaliness and with mild redness. T gel shampoo, capasal and polytar shampoo are available over the counter. Steroid scalp preparations are helpful for moderate to severe symptoms but these topical solutions should be prescribe by your health practitioners. It is mostly alcohol base and can sting your scalp. Concordance will be an issue because some people may not like it.
Coal tar compound preparations are also use for moderate to severe scalp psoriasis. It contains salicylic acid that help to lift the thick scales and coconut oil to moisturise your scalp. These need to be applied and left on your scalp for at least one hour then to wash it afterwards. Scalp psoriasis can be difficult to treat and requires perseverance. If you have any queries about your topical treatment please email me on nurseyourskin@yahoo.com.
Friday, January 15, 2010
Chicken skin, what is it?
A friend is asking about a rough papules on his upper arms and according to him, it is like a chicken skin. This is known as "Keratosis Pilaris", the word keratosis means (excess keratin) and pilaris (hair). The horny, tough outer layer of the skin accumulates on the hair follicles rather than desquamating thus a raise papules are noted similar to a "goose bumps". This is a harmless skin condition that does not cause any problems but it can look unsightly and make the person concious when expose to the public.
This is hereditary and runs among family members, it is common among obese individual and people with dry skin condition like eczema and icthyosis (excess dry skin). The papules are prominent on winter and less on summer months. Unfortunately there is no treatment to cure this skin condition but certain creams may help to alleviate it. It may subside during adult years although it can persist but usually uncommon among elderly.
Since it is an accumulation of keratin (dead skin), applying daily moisturisers help. Try using moisturiser containing urea,lactic acid or with mild salicylic acid preparation. Salicylic acid is keratolytic, it helps to desquamate or lift the dead skin. 2% salicylic acid in white soft paraffin are commonly use. Eucerin moisturisers contain lactic acid or urea that are readily avialable over the counter also helps. Apply these preparations at least 2x a day in a downward stroke to prevent folliculitis.
Try using mild soap or if not use soap substitute instead. Soap is alkaline based and can aggravate skin dryness. Avoid hot bath but instead use tepid warm water and exfoliating your skin can help as well.
This is hereditary and runs among family members, it is common among obese individual and people with dry skin condition like eczema and icthyosis (excess dry skin). The papules are prominent on winter and less on summer months. Unfortunately there is no treatment to cure this skin condition but certain creams may help to alleviate it. It may subside during adult years although it can persist but usually uncommon among elderly.
Since it is an accumulation of keratin (dead skin), applying daily moisturisers help. Try using moisturiser containing urea,lactic acid or with mild salicylic acid preparation. Salicylic acid is keratolytic, it helps to desquamate or lift the dead skin. 2% salicylic acid in white soft paraffin are commonly use. Eucerin moisturisers contain lactic acid or urea that are readily avialable over the counter also helps. Apply these preparations at least 2x a day in a downward stroke to prevent folliculitis.
Try using mild soap or if not use soap substitute instead. Soap is alkaline based and can aggravate skin dryness. Avoid hot bath but instead use tepid warm water and exfoliating your skin can help as well.
Wednesday, January 13, 2010
Phototherapy: What to expect.
Hello everyone! This article is dedicated to a mom who kindly send me a message asking about phototherapy in relation to her child's eczema. Light treatment has been used since ancient time in treating some skin condition, this has been documented in egyptian history. The common skin conditions that are treated with phototherapy includes psoriasis, eczema, vitiligo, PLE (polymorphic light eruption), urticaria and etc. There are two types of light that are being used, Narrowband UVB and PUVA. Narrowband light tends to penetrate on the epidermis of the skin while Psoralen UVA tends to penetrate differ into the dermis by using psoralen. Psoralen can be given by tablets, bathsoaks and gel.
Your health practitioner usually will decide what is the best light treatment for your skin condition. In the UK, some phototherapy department use MED (Minimal erythema dose) for narrow band and MPD (Minimal phototoxic dose) for PUVA. What they do, is to use an equipment to test the amount of light that is safe to use on the small portion of your skin. Once that is determine, they can safely administer the first dose and also gives them the basis of incremental dose for the next appointment. Now, not all phototherapy department have these facilities. The next option is to base the dose on patient's skin type. The health practitioner will base it on your skin color and your skin response to sunlight whether it burns or tan.
Before starting the treatment your phototherapist (usually nurses) will counsel you about phototherapy. They will explain to you about the use of goggles to protect your eyes while inside the photo cabinet or if your eyelids need to be treated then your eyes need to be closed. For PUVA patient taking oral psoralen, the need to use dark glasses up to 12 hours after treatment including inside your house. Since psoralen can make your skin sensitive to light, it does affect your eyes as well. This prevents cataract as potential side effects of exposing to light.
The male individual needs to protect their private parts from light, the areas are prone to skin cancer. They can wear dark colored socks (to cover the area), underwear, or jock strap. The need to apply moisturiser at least an hour before treatment and just right after phototherapy is essential. Light treatment can make your skin drier and can cause erythema, moisturisers alleviates it. You have to inform the phototherapist if you are taking any medicines or any new medication being prescribed for you or bought any over the counter. Some medicine can make you sensitive to light, this may cause burning or blisters if not noted.
Avoid using perfume, deodorant or any scented oils on your skin before your light treatment, this chemical may interact with light causing burning on your skin. Use same hair style for the whole therapy so as not to treat the unexposed area and never cut your hair too short while having phototherapy. The unexposed areas will be exposed causing burning or erythema on the areas. Attend your appointment regularly to maximise the benefits of light treatment. Remember not to touch any plants/flowers, do gardening, eat celery, figs, parsnip,limes at least 2 hours before your phototherapy. These can contain photosensitisers that can make your skin sensitive to light thus causing burning or erythema. Never to drink alcohol before your light treatment.
The light therapy can tan your skin, some individual may find it satisfactory for them. In relation to eczema, the light treatment have immuno-suppressive action thus reducing redness and itching. Your health practitioner is the best person to ask with regards to your treatment. This blog is to augment the information given and does not replace the proper consultation with them.
Your health practitioner usually will decide what is the best light treatment for your skin condition. In the UK, some phototherapy department use MED (Minimal erythema dose) for narrow band and MPD (Minimal phototoxic dose) for PUVA. What they do, is to use an equipment to test the amount of light that is safe to use on the small portion of your skin. Once that is determine, they can safely administer the first dose and also gives them the basis of incremental dose for the next appointment. Now, not all phototherapy department have these facilities. The next option is to base the dose on patient's skin type. The health practitioner will base it on your skin color and your skin response to sunlight whether it burns or tan.
Before starting the treatment your phototherapist (usually nurses) will counsel you about phototherapy. They will explain to you about the use of goggles to protect your eyes while inside the photo cabinet or if your eyelids need to be treated then your eyes need to be closed. For PUVA patient taking oral psoralen, the need to use dark glasses up to 12 hours after treatment including inside your house. Since psoralen can make your skin sensitive to light, it does affect your eyes as well. This prevents cataract as potential side effects of exposing to light.
The male individual needs to protect their private parts from light, the areas are prone to skin cancer. They can wear dark colored socks (to cover the area), underwear, or jock strap. The need to apply moisturiser at least an hour before treatment and just right after phototherapy is essential. Light treatment can make your skin drier and can cause erythema, moisturisers alleviates it. You have to inform the phototherapist if you are taking any medicines or any new medication being prescribed for you or bought any over the counter. Some medicine can make you sensitive to light, this may cause burning or blisters if not noted.
Avoid using perfume, deodorant or any scented oils on your skin before your light treatment, this chemical may interact with light causing burning on your skin. Use same hair style for the whole therapy so as not to treat the unexposed area and never cut your hair too short while having phototherapy. The unexposed areas will be exposed causing burning or erythema on the areas. Attend your appointment regularly to maximise the benefits of light treatment. Remember not to touch any plants/flowers, do gardening, eat celery, figs, parsnip,limes at least 2 hours before your phototherapy. These can contain photosensitisers that can make your skin sensitive to light thus causing burning or erythema. Never to drink alcohol before your light treatment.
The light therapy can tan your skin, some individual may find it satisfactory for them. In relation to eczema, the light treatment have immuno-suppressive action thus reducing redness and itching. Your health practitioner is the best person to ask with regards to your treatment. This blog is to augment the information given and does not replace the proper consultation with them.
Tuesday, January 05, 2010
Tips for adult with eczema
This article is dedicated to my Chinese friend. He was diagnosed with eczema for the last 6 years or so. Here are some tips that may help to alleviate your eczema......
1. Avoid using soap- eczema is a dry skin condition, the protective barrier (top most) skin is hindered due to unknown reason thus your skin is prone to irritation, infection and loss of fluids(dry skin). Soap is alkaline based and makes your skin more drier and more irritated. Try to use soap substitute, all non-scented emollients can be used. Double base have a shower cream, try it out.
2. If you are having a bath then, use bath oil. Loads of brand in the market (oilatum, cetraben, etc). Avoid using bath oil with antiseptic (oilatum plus) not unless your eczema is infected, to prevent resistance.
3. Use tepid warm water. Very warm water can trigger your eczema to itch inducing itch-scratch cycle.
4. Pat your skin dry instead of rubbing your skin with the towel. This triggers the itching inducing itch-scratch cycle.
5. Apply your moisturiser (emollient) after a bath/shower.- Use a downward stroke to prevent clogging your hair follicles that may cause folliculitis. It also traps heat triggering you to itch (application must not be thick).
6. Use your topical steroids only if your skin is red (inflammed), itchy and your emollient is not alleviating it. If your eczema is bad, use them ones or twice daily. Then reduce them to ones or alternate days if your eczema subsided. Gradually reduce them then stop. Eczema is on and off; stress, weather and irritants can trigger your eczema. Re-start your steroid if your eczema is bad otherwise continue with your daily moisturiser.
7. List down the trigger factors that can aggravate your eczema. Wool clothing, cats/dogs, house dust mites, heaters at home, plants,harsh chemicals/perfume/aftershave, etc. Avoid the trigger factors- vacuum your room regularly, change bed sheet weekly, use heating to the minimum, use gloves when handling harsh chemicals, use cotton clothing.
8. Avoid scratching if possible- If you start scratching, it will lead to itch-scratch cycle, never ending until you hack your skin (bleeding). Use your moisturiser instead or have a warm bath with bath oil.
9 Trim your finger nail short- to avoid trauma in case, you scratch unconciously at night.
10. Apply emolients to your skin before bed time- it helps with itching at night.
11. Drink at least 8 glasses of fluids daily (1.5 to 2.0 liters of fluids).
12. Try to avoid people with herpes simplex infection (cold sore) it can cause eczema herpeticum (severe complication of eczema)-weepy, punch out lesion with high grade temperature.
13. If your eczema is weepy- it is infected, see your health practitioner to prescribe antibiotics.
14. Learn to relax- reduce your stress and learn to smile.
These tips may help, otherwise see me for free consultation...
1. Avoid using soap- eczema is a dry skin condition, the protective barrier (top most) skin is hindered due to unknown reason thus your skin is prone to irritation, infection and loss of fluids(dry skin). Soap is alkaline based and makes your skin more drier and more irritated. Try to use soap substitute, all non-scented emollients can be used. Double base have a shower cream, try it out.
2. If you are having a bath then, use bath oil. Loads of brand in the market (oilatum, cetraben, etc). Avoid using bath oil with antiseptic (oilatum plus) not unless your eczema is infected, to prevent resistance.
3. Use tepid warm water. Very warm water can trigger your eczema to itch inducing itch-scratch cycle.
4. Pat your skin dry instead of rubbing your skin with the towel. This triggers the itching inducing itch-scratch cycle.
5. Apply your moisturiser (emollient) after a bath/shower.- Use a downward stroke to prevent clogging your hair follicles that may cause folliculitis. It also traps heat triggering you to itch (application must not be thick).
6. Use your topical steroids only if your skin is red (inflammed), itchy and your emollient is not alleviating it. If your eczema is bad, use them ones or twice daily. Then reduce them to ones or alternate days if your eczema subsided. Gradually reduce them then stop. Eczema is on and off; stress, weather and irritants can trigger your eczema. Re-start your steroid if your eczema is bad otherwise continue with your daily moisturiser.
7. List down the trigger factors that can aggravate your eczema. Wool clothing, cats/dogs, house dust mites, heaters at home, plants,harsh chemicals/perfume/aftershave, etc. Avoid the trigger factors- vacuum your room regularly, change bed sheet weekly, use heating to the minimum, use gloves when handling harsh chemicals, use cotton clothing.
8. Avoid scratching if possible- If you start scratching, it will lead to itch-scratch cycle, never ending until you hack your skin (bleeding). Use your moisturiser instead or have a warm bath with bath oil.
9 Trim your finger nail short- to avoid trauma in case, you scratch unconciously at night.
10. Apply emolients to your skin before bed time- it helps with itching at night.
11. Drink at least 8 glasses of fluids daily (1.5 to 2.0 liters of fluids).
12. Try to avoid people with herpes simplex infection (cold sore) it can cause eczema herpeticum (severe complication of eczema)-weepy, punch out lesion with high grade temperature.
13. If your eczema is weepy- it is infected, see your health practitioner to prescribe antibiotics.
14. Learn to relax- reduce your stress and learn to smile.
These tips may help, otherwise see me for free consultation...
Sunday, January 03, 2010
Why teenagers are prone to acne and the common over the counter treatment.
Acne vulgaris is common among teenagers and young adolescents due to surge of hormonal changes in their body. Hormones (circulating androgen) can make the sebaceous (oil) gland sensitive to it, leading to over production and secretion of sebum (oil). Propionibacterium acnes, a normal flora of the pilosebaceous ductcan aggravate the situation by proliferating well due to the presence of excessive sebum making a good medium for them to thrive. The bacteria diffuse into the dermis (second layer of skin) causing inflammation and possible infection, visibly seen as pustule (pus forming lesion). The follicles are enlarge due to increase accumulation of dead keratinocytes partially blocking the duct forming open comedones (blackheads) and closed comedones (whiteheads).
The aim of the treatment is to unblock the pores, prevent formation of new lesions and treat infection. There are factors that need to be considered in choosing for the right treatment. It should be convinient to use, with fewer side effects and effective. Over the counter products are available to treat mild to moderate acne. Product containing Benzoyl peroxide are in a form of cream, gel and lotion preparation. This comes in different concentrations ranging from 2.5% to 10 % and has antibacterial and anticomedonal properties. Try to use the lowest concentration as this can cause irritation (redness) and skin peeling. Reducing the dose of treatment can also minimise the side effects. Wash your hands after treatment and avoid getting in contact with clothes because it can cause bleaching.
Retinoic acid is another form of treatment that helps to loosen and reduce the retention of keratinocytes within the duct thus preventing the formation of comedones. This treatment can cause mild skin irritation and avoiding exposure to sunlight helps. Using the preparation only at night is also beneficial. Product containing Azelaic acid is also use, it has an antibacterial and anticomedonal properties. Like the above treatment, this can also cause skin irritation and reducing it to once a day application helps in minimising the side effects. Topical antibiotics can be used for mild to moderate acnes especially if it is not responding well with benzoyl peroxides. Sometimes alternating between the two treatment can be effective and prevents resistance to propionibacterium acnes. Combined topical preparations are also available and you can seek the advise of your local pharmacies.
Topical treatment should be tried for at least 3 months to get good results and topical antibiotic should be used alternately to prevent resistance to the bacteria. Ask your health professional for advise if symptoms persist and systemic treatment might be needed. Avoid using oily/greasy cosmetic product to your face or near it, it can aggravates your acne formation.
Friday, January 01, 2010
Is it beneficial to use an ointment instead of cream or lotion?
Ointment is a preparation that is oil base and it stays on your skin longer. It is free of preservative thus minimising contact allergy. This is beneficial for people with dry skin but it is not cosmetically acceptible. Individuals complain of being too greasy and slimey thus reducing non concordance with the prescribed treatment. This preparation can be used at night, most people are happy to use them before bed time.
Cream is water based and preservatives are added to prevent the growth of bacteria. These preservatives can cause contact allergy to people who are sensitive to them. You need to apply the cream more often if it is an emollient, because it tends to dry quickly. Individuals with busy schedule may be put off with multiple application of emollients. Lotion can be beneficial in a hairy areas like scalp.
In my clinical practice, I give a small samples of moisturiser to my clients to try. If the individual likes the moisturiser prescribed, then concordance will be high. The most important thing is for you to apply your topical treatment regularly whether it is a cream or an ointment. It is pointless to prescribe an ointment when you are not going to apply it.
Cream is water based and preservatives are added to prevent the growth of bacteria. These preservatives can cause contact allergy to people who are sensitive to them. You need to apply the cream more often if it is an emollient, because it tends to dry quickly. Individuals with busy schedule may be put off with multiple application of emollients. Lotion can be beneficial in a hairy areas like scalp.
In my clinical practice, I give a small samples of moisturiser to my clients to try. If the individual likes the moisturiser prescribed, then concordance will be high. The most important thing is for you to apply your topical treatment regularly whether it is a cream or an ointment. It is pointless to prescribe an ointment when you are not going to apply it.
Hand Dermatitis/ Eczema: Is it irritant or contact dermatitis?
I'm sure there are a lot of my readers who know someone with hand dermatitis. The question is, is it contact or just irritant dermatitis? How do you distinguish them?. Irritant hand dermatitis (eczema) is predispose by frequent hand washing. Most common among health professionals, hair dressers and people that works in the catering business. The natural protective barrier of the skin is strip off due to frequent washing leading to dry and irritated skin. It is advisable to avoid soap but instead use your non scented emollient as soap substitute. Use gloves when handling harsh chemical or washing dishes but bear in mind try to use non latex gloves.
Contact hand eczema is cause by being allergic to the things that your hand is in contact with. This could be cause by latex allergy, or component of your cream. Cream as an emollient is water base and contains preservatives. These preservatives can cause allegic reaction leading to contact dermatitis. Most dermatology department offers patch testing, where a series of battery are use to test if you are allergic to certain chemicals. Face and hand series includes different chemicals that are commonly use on these areas, it could be an active ingredient use in most cosmetics, soap, its preservatives and others.
If after patch testing you are positive to certain things, then you need to avoid them. Otherwise your hand eczema will flare again. For irritant hand eczema, try to use regular moisturiser after washing your hands, avoid any harsh chemicals and strong substances from perfumes/aftershaves. Speak to your health practitioners if patch testing will be beneficial for you. They can assess you clinically, if they suspect contact allergy then patch testing is needed. When your hand dermatitis is bad, your doctor will prescribe topical steroids to control the symptoms. Use it only when your hand eczema is red, itchy and the moisturiser does not control it. Seek medical advise if your eczema is not controlled with the prescribe treatment. I will keep my article short but informative. Avoiding medical terminolgy if possible but instead use common words. Happy new year..
Contact hand eczema is cause by being allergic to the things that your hand is in contact with. This could be cause by latex allergy, or component of your cream. Cream as an emollient is water base and contains preservatives. These preservatives can cause allegic reaction leading to contact dermatitis. Most dermatology department offers patch testing, where a series of battery are use to test if you are allergic to certain chemicals. Face and hand series includes different chemicals that are commonly use on these areas, it could be an active ingredient use in most cosmetics, soap, its preservatives and others.
If after patch testing you are positive to certain things, then you need to avoid them. Otherwise your hand eczema will flare again. For irritant hand eczema, try to use regular moisturiser after washing your hands, avoid any harsh chemicals and strong substances from perfumes/aftershaves. Speak to your health practitioners if patch testing will be beneficial for you. They can assess you clinically, if they suspect contact allergy then patch testing is needed. When your hand dermatitis is bad, your doctor will prescribe topical steroids to control the symptoms. Use it only when your hand eczema is red, itchy and the moisturiser does not control it. Seek medical advise if your eczema is not controlled with the prescribe treatment. I will keep my article short but informative. Avoiding medical terminolgy if possible but instead use common words. Happy new year..
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