Review: ScratchMeNot Flip Mitten Sleeves

The ScratchMeNot Flip Mitten Sleeves are a unique way of protecting little ones’ nails and fingers from damaging their own skin, hair and nails.  An alternative to traditional mittens, they are worn like a shawl over the child’s normal clothing.  The ends can flip open or closed.  When closed, the exterior of the mitten is silk.  When open, the exterior of the mitten is cotton.  The shawl part of the sleeve is a blend of organic bamboo viscose, organic cotton and lycra.  They are available for babies and children ranging from 3 months to 6 years old.

These sleeves are useful for babies and children who scratch themselves, especially those with eczema or atopic dermatitis, or other skin issues.  They are also useful for children who pull out hair or have a habit of nail biting.  The ScratchMeNot Flip Mitten Sleeves were designed by  eczema mom Andrea Thomas and it shows.

I really like these sleeves and here’s why:

– The external silk mittens are gentle on skin. I have yet to find baby and kid mittens that are made of silk.  The traditional mittens and flip sleeves attached to onesies are cotton.  Silk is much smoother and decreases the amount of damage rubbing can do to the skin.  Even rubbing with cotton can lead to thickening (what we call “lichenification” in dermatology) which can worsen the skin condition and itch.

– These sleeves stay on.  The mitten portion is attached to the shawl portion.  Babies and kids are really good at getting traditional mittens off.  These stay on.

– They are easy to flip open and closed.  This is important because you aren’t going to just flip them closed and leave your child that way all day.  There are often predictable times when your child will scratch skin, pull hair or bite nails — e.g. when she/he is tired or fussy, during diaper changes, at night when her/his inhibition is decreased, etc.  In anticipation of these times, you can close the mittens.  The rest of the time, you can keep the mittens open.  This may also decrease your anxiety over whether you child won’t have enough open mitten time to learn how to use her/his fingers and hands.

– They are easy to get on and off.  The shawl part is a mix of bamboo viscose, cotton and lycra.  It has just enough stretch so that you can put it on easily, but not so loose that your child can work her/his way out of it.

– They are relatively affordable.  There are so many products that target parents of eczema babies and kids.  Some of them are very costly.  These are relatively affordable and there are often deals through the ScratchMeNot website or The Eczema Company.

As a dermatologist and eczema mom myself, I give these ScratchMeNot Flip Mitten Sleeves 5 stars.

DermBytes readers get 10% off at the ScratchMeNot website with the code: Dermbytes.

What is Neurofibromatosis?

Neurofibromas in neurofibromatosis often appear during puberty or adulthood.
Neurofibromas in neurofibromatosis often appear during puberty or adulthood.

In dermatology, we have many conditions that are caused by defects in a specific gene. In the case of Neurofibromatosis 1 (we’ll go over other Neurofibromatoses later), the defect is in Neurofibromin.  The transmission is autosomal dominant, meaning that to have the condition, you only need one of the mutated genes to be passed on from either mom or dad.

Neurofibromatosis 1 (aka Von Recklinghausen disease) is a syndrome, meaning, several different findings are seen.

These include:

cafe au lait macules which are flat tan spots of the skin and show up either at birth or early in childhood. The number and size of these spots can increase with time. The criteria for diagnosis includes having 6 or more of these spots and sets 5 mm as the minimum size in a kid, or 15 mm in those who are past puberty.

– clumps of pigment causing growths in the eyes called Lisch nodules or iris hamartomas which usually show up during childhood.

– freckling of the armpits – aka axillary freckling or Crowe’s sign. This shows up in later childhood.  Freckling can also occur in the groin area (inguinal freckling).

– soft fleshy growths on the body called neurofibromas which show up during puberty or adulthood.

– growths in the eye nerves called optic glioma(s). These growth can affect vision, potentially leading to vision loss.

– plexiform neurofibromas which are not the standard neurofibroma. These are more complex, often deeper in the skin and larger.  These have a chance of turning into a type of cancer called a malignant peripheral nerve sheath tumor.

– bone abnormalities including the bones around the eye and of the bones of the extremities..

There are other findings which may be seen as well, such as high blood pressure.

Infantile hemangiomas grow early!

Courtesy of wikipedia user Zeimusu

In the August 2012 issue of Pediatrics, authors from the Mayo Clinic and UCSF described the growth patter of infants’ hemangiomas using photos that parents were asked to take.  Hemangiomas are the most common “tumor” in infancy. Now, often when people hear the word “tumor” they think of cancer, and malignancy. But by tumor, we simply mean an abnormal growth of a specific type of body tissue. In this case, the hemangioma is an abnormal growth of vessels.  Some people have also referred to this as a “strawberry hemangioma” (thus the front page photo) as the color and growth may be reminiscent of a strawberry.

These hemangiomas are common and are estimated to affect ~4% of Caucasian infants.  Our teaching from textbooks has said that these hemangiomas tend to have a rapid growth phase during the first 6 months or so.  However, previous studies haven’t really characterized how these hemangiomas grow during this early period.  That is what these authors sought to do.

They found that the most rapid growth occured between weeks 5.5-7.5 of age.  That means this growth happens early!  It raises the question of whether we should think about sending these babies for evaluation much earlier, before this rapid growth occurs.  Then, treatment could be started early.

Reference: Tollefson MM, Frieden IJ. Early Growth of Infantile Hemangiomas: What Parents’ Photographs Tell Us. Pediatrics. 130(2). Aug 2012.

Wet wraps for atopic dermatitis at the Mayo Clinic

In a follow-up post to September’s post on wet wraps, I thought we would review one of the articles from the Mayo Clinic on the use of wet wraps in pediatric patients with bad atopic dermatitis.

The Mayo Clinic has had a tradition of using wet wrap therapy for a multitude of skin conditions including atopic dermatitis.  In their paper in the July 2012 issue of the Journal of the American Academy of Dermatology (JAAD), the authors reviewed their medical charts as it pertained to the use of wet wrap therapy with steroids over a period of 30 years and in examining 218 patients.  Pediatric patients with severe atopic dermatitis were admitted to the Mayo Clinic where they received wet wrap therapy.  Patient were treated with topical steroids and moisturizer which were covered with wet wraps (with either water or vinegar soaks) which were then covered with dry wrappings and a warm blanket.  They had these applied 5-8 times a day, and had dressings removed every 3 hours for dressing changes (and so that the child could walk around, urinate, etc).  A number of these patients also did get oral antibiotics for skin infection over the eczema.  The authors found that many of their patients had good results. For instance, 45% were deemed to have 75-100% improvement.

This study highlights that wet wraps with topical steroids is an important potential therapy to consider. While there are limitations to the study design, it is worth educating patients, their families, and other providers about this therapy.

Wet Wraps for Eczema

Continuing on the theme of eczema after the wonderful guest post by Marcie’s Mom, I thought we could talk about wet wraps in more detail.

Wet wraps have been shown in research studies to be quite effective in helping to treat and prevent eczema and is a remedy that can be easily done at home.  And it’s not expensive!  So what does it entail?

1) The skin must be moistened and hydrated. And by moistened, I mean in a bathtub ideally.  After stepping out of the bath (or shower if you don’t have a tub), pat the skin dry. Avoid rubbing.

2) Apply a thick moisturizer or topical medications as instructed by your physician.

3) Prepare a set of damp cotton pajamas by soaking it in a tub of lukewarm water and then wringing dry.  If you want to get fancy, you can buy special pajamas or wraps for this purpose.  Put on the pair of pajamas — it may be more comfortable to have the seams facing outward.

4) You can wear a set of dry pajamas on top.

Some people like having waterproof bedding just in case there is some dampness that seeps through.

Do babies get acne?

Image courtesy of Sage Ross.

The answer is yes! Babies get acne too! “Neonatal acne” or “neonatal cephalic pustulosis” is a common condition that crops up in the first few weeks or month of your baby’s life as little pimples of the forehead, cheeks and chin.

What causes baby acne? We don’t know exactly what causes this condition, but it may be related to exposure to maternal hormones when the baby is in the womb.

So what do you do about baby acne? Baby acne is not harmful so you can leave it alone. This condition usually goes away in weeks, if not months. In the meantime, continue gentle skin care for your baby. Since rashes can be difficult to distinguish to an untrained eye, mention any concerning features to your pediatrician or dermatologist.

Rashy as a baby’s bottom?

Changing diapers immediately as they become wet can help prevent diaper rashes.

The saying goes, “smooth as a baby’s bottom…” but what if your baby’s bottom is rashy and not smooth? It could be irritant diaper dermatitis (dermatitis = fancy word for rash).

Diaper rashes are very common. Why? Because babies are in diapers and they pee and poop and all that wetness and material gets smushed next to the skin. That irritates the skin, causing it to become red, scaly and sometimes peel off.

So what can you do to prevent irritant diaper dermatitis?
– Prevention is key. Keep the buttocks dry — as soon as the diaper gets wet, change it! The longer the urine or stool sits longer the skin, the more irritated the skin becomes.
– After cleansing, you can air drying the area.
– Apply a barrier cream. Barrier creams containing zinc are helpful and there are many brands available. It protects the skin from outside irritants, serving as a protective layer. You can also try an emollient such as plain old vaseline or Aquaphor healing ointment.
– Don’t go nuts with wipes. Being overly aggressive can actually damage the skin. Try using a squirt bottle to rinse off stool. Or just use your hands and water.
– Avoid wipes or soaps that have allergens (e.g. fragrances, etc).

If the diaper rash doesn’t go away, talk to your pediatrician or dermatologist. It may be time to make sure there isn’t extra bacteria or yeast hanging around or another more serious cause for a rash in the diaper area.

Kids are beautiful. Just the way they are.

As a parent, how do you deal with a cosmetic but non-medical issue in your child?

I’ve been thinking about this issue a little more after seeing several kids this week with vitiligo (a skin condition where white patches appear on the skin) and hemangiomas (usually strawberry colored growths of blood vessels which usually do not cause medical issues).

For kids who are old enough to read reactions to the cosmetic issue or disfigurement, it’s important that we reinforce that our kids are beautiful the way they are — treatment or no treatment. The decision to treat these spots is made out of love and for a desire for the best possible outcome, but an obsession with the skin abnormality can cause kids to feel stigmatized even in their own home.

One of the doctors in our clinic has a nice way of putting it. “Tigers and leopards have spots. Your kid is allowed to have spots too.”