Today we feature an interview with Mei, also known as @MarcieMom. Mei started blogging about eczema and helping eczema families in her unique way since 2011, a year after her daughter Marcie was diagnosed with eczema. She co-authored Living with Eczema: Mom Asks, Doc Answers and illustrated the book cover and another children’s book A to Z Animals are not Scratching!. Mei chairs a national eczema support group in Singapore and donated to set up a fund for eczema patients requiring financial assistance. She has helped many parents through her blog EczemaBlues.
In our previous post, we reviewed her book Living with Eczema: Mom Asks, Doc Answers. MarcieMom has also been a past contributor to DermBytes, blogging about her experience as mom to an eczema child and sharing her top tips for taking care of eczema.
Q: What was your inspiration behind writing the book?
I was invited by my daughter Marcie’s doctor, Professor Hugo van Bever, to co-author the book. It was an excellent opportunity to share what I know about eczema and ask all the questions a Mom would have, thus the unique idea behind the book Living with Eczema: Mom Asks, Doc Answers! From the onset, we wanted this book to be practical for parents and practitioners; it’s also 100% authentic – I asked the questions and Prof Hugo answered, we didn’t screen out each other’s questions or answers!
Q: How did you decide which topics to cover?
We group the topics from first giving a background to eczema, with the majority of the chapters centered on practical aspects like diagnosis, skincare and treatment, followed by future research. It is intended to be comprehensive but not too complicated. For the questions, it’s from my own experience blogging, replying to comment, moderating eczema forums and also, an extra pair of eyes from the lovely Amanda of Nottingham Support Group for Carers of Children with Eczema.
Q: How was the partnership in working with Professor Hugo? Did working closely with a healthcare provider lead to any new insights?
Professor Hugo was most gracious – we had an equal partnership in all aspects, from the title, to chapters, to splitting the writing work (he covering the more technical and I writing the more practical), to doing what each is good at (he had the overall responsibility of ensuring medical accuracy while I did the administrative part).
Professor Hugo has a very straight forward approach to his patients – be honest and listen. I remembered that I did not feel rushed at all during the consultation sessions my daughter had with him. Similarly, I didn’t feel rushed or ‘clerical’or ‘subordinate’in my collaboration with him and he respected my views on the book.
Q: Did you learn any new things while working on the book?
I did learn quite a few technical parts of the skin but then I quickly forgot them!
Q: Can you share some feedback you have received from other eczema caregivers?
Our book is recently launched so much of what other eczema caregivers said were ‘where to buy the book?’! Bloggers we sent the book to appreciate the practical and comprehensive aspects of the book.
Q: This is now your second book! (The first being a children’s book that is distributed to eczema support groups.) Any additional future writing plans?
Yes! I have a quarter-baked novella on being a mom with eczema kid, purely fictional (ahem!) but I haven’t got the inspiration to proceed till the end yet. It’s intended to be romance novel though, but since, I’ve fallen in love with thriller instead but it’s so much more difficult to write a thriller!
Authors: Dr. Hugo Van Bever, MarcieMom
“Living with Eczema: Mom Asks, Doc Answers!” by Dr. Hugo Van Bever and MarcieMom is a unique book which systematically tackles must-know information about eczema. Each chapter includes an introduction to the topic followed by a question and answer discussion between MarcieMom and Dr. Hugo Van Bever. MarcieMom’s questions cover the frequently asked questions that eczema patients and parents have and Dr. Hugo Van Bever provides answers.
This book is a helpful supplement for any eczema patient or parent. Health care providers are often limited in the amount of time they have to teach and counsel during a clinic visit so this book can help fill in the gaps. Furthermore, Dr. Van Bever cites studies and evidence (or lack thereof) in his answers, helping dispel myths and promote evidence-based practices. This is no small thing as plenty of non-evidence based practices abound in the care of atopic dermatitis. In other words, Dr. Van Bever helps the reader understand what works and what does not. He also tackles frequently confusing topics such as the utility of allergy testing in eczema. This book is also helpful for patients and parents who feel alone in their disease. MarcieMom is frank and open about her experience in taking care of Marcie’s eczema. I found “Living with Eczema: Mom Asks, Doc Answers!” to be a good blend of background information, up-to-date science, and practical advice and would recommend this book to any eczema patient or parent.
The dry air is setting in and your skin is drying out! Here are some top tips for keeping your skin hydrated.
1. Use a humidifier. Re-create a more moist environment by infusing some water into the air. Make sure to choose a humidifier that can capably humidify the size of your room. For safety, choose a cool mist humidifier for your child’s room.
2. Moisturize, moisturize, moisturize. Increase your frequency of moisturization. Moisturizers increase the water content in your skin and can prevent the water content from evaporating off your skin. Find one that is fragrance-free and hypoallergenic. Hydrolatum, which is often behind the pharmacists’ counter, is one simple cost-effective moisturizing cream.
3. Keep sample sized/travel sized moisturizers at your desk, by your sink, and in your purse. If you have it around, you’re more likely to use it.
4. Avoid harsh soaps. Sure, that Irish Spring has a scent that will wake you up, but it will also strip your skin of its oils. Find a gentler soap such as one that is infused with emollients.
5. Use lukewarm water and not hot water. Although that hot water feels great when you are itchy or have a rash such as eczema, your skin is left in even worse shape than before! Turn down the dial on the heat and also limit the amount of time you spend washing. And remember to moisturize (#3) after your shower.
The world of health care can be a complex and confusing world to navigate. Add in the mix of different insurance plans which can regulate your path to your doctor, and that makes it all the more confusing. For instance, your insurance plan may make you see your primary care physician or pediatrician before you can see a specialist such as a dermatologist or allergist.
So for eczema, what type of doctor should you see?
The answer to who you should see for eczema may depend on whether you are asking for yourself (if you are an adult) or for your child.
For children, common physicians who treat eczema include dermatologists, allergists/immunologists, and pediatricians.
Dermatologists are doctors that specialize in the skin, hair and nails. Eczema is one type of skin condition that treat these disorders. Dermatologists complete extra training in their specialty. Pediatric dermatologists further specialize in skin, hair and nail diseases of kids. You may see some physicians advertise themselves as being board-certified. This means that they passed certain training requirements and passed the board exam for that specific area. Thus, you may see someone advertised as a board-certified dermatologist or a board-certified pediatric dermatologist.
Allergists/immunologists first train in internal medicine or family medicine or pediatrics and then further specialize in allergy/immunology. Because eczema does have an immunologic basis, this is a condition that allergists and immunologists also treat. Additionally, if food allergy or other environmental allergy is suspected, this may be further reason to refer to an allergist.
Pediatricians focus on the health and diseases involving kids. Since eczema is a common condition affecting kids, many pediatricians are well versed in this condition. However, some pediatricians may have limited training in the skin. In this case, you may want to seek further care from either a dermatologist or allergist.
Primary care physicians (PCPs) are for adults what pediatricians for kids. If PCPs are not able to manage the eczema, you will most likely be referred to a dermatologist. Referral to an allergist is less common for the adult population with eczema. That may be because environmental triggers play a smaller role in adult eczema as compared to childhood eczema.
Regardless of who you see, the important thing is that your physician is well-versed in treating eczema.
Just as important is the relationship that you have with your physician. Eczema can be a very frustrating condition so it’s important that you have a good teammate to face eczema head on!
For an interesting paper on physician referral patterns and treatment patterns for eczema, see this paper.
As part of Eczema Awareness Month, we will feature Eczema Champions — individuals who are helping lead the fight against eczema. In this interview, we learn more about Dr. Peter Lio.
Dr. Peter Lio is the co-founder and co-director of the Chicago Integrative Eczema Center. He is also Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University, Feinberg School of Medicine, and former faculty member of Harvard Medical School. Dr. Lio is a graduate of Harvard Medical School and completed his residency through the Harvard dermatology residency program. He is also trained in acupuncture and has interests in alternative medicine. He is a member of the National Eczema Association scientific advisory board.
How did you become interested in eczema? Were there specific experiences that drew you towards this disease?
In medical school, I was very interested in neurology since my background was in neuroscience as an undergraduate. One of the tough things about neurology was that there were not always good treatments for many of diseases, and that was frustrating and sad. Dermatology really captivated me because you could directly treat the skin in so many ways: from topical creams, to oral medications, to lasers and light! I think I am drawn to eczema because it is a tricky problem and one that causes a great deal of suffering, but one that has many potential treatments that can help patients get better. It’s exciting to be a part of something that we don’t understand fully yet, but that we continue to close in on. One of the things that really made me think in eczema was the fact that there were so many strong opinions about what worked and what didn’t. So many voices, but yet still no easy cure. I wanted to delve more deeply into this to better understand it, and my journey has taken more than a decade, including a year of acupuncture training. Excitingly, the journey continues, because although I know so much more than when I started, I still do not have all the answers…
Were you also always interested in acupuncture and alternative medicine? What led you to pursue these interests?
My mother had a powerful effect on me here: she had many “home remedies” and was interested in folk treatments for many diseases. She had come from a big family (11 children!) and there was a lot of local wisdom. As I learned things in medical school, I remained interested in this other type of medicine, and was sort of surprised that much of it was not discussed. Most of my teachers were thoughtful about other approaches to health, but there wasn’t much that was really taught then. However, I think I am living at the right time: shortly after, the alternative medicine explosion seemed to start, and there was more interest than ever before! Lots of doors began to open for me, including a life-changing experience with Kiiko Matsumoto and David Euler in the course called “Structural Acupuncture for Physicians” offered at Harvard Medical School. As I learned more about Traditional Chinese Medicine and Acupuncture, I was also voraciously reading about naturopathy, different types of herbal treatments, homeopathy, and other forms of alternative medicine. Moreover, patients who were interested in this were increasingly being referred to me; I can honestly say that I’ve learned more from patients than from books about alternative medicine!
You are unique in that you are well-versed in both traditional and alternative medicine. At times, people present traditional Western medicine and alternative medicine as being mutually exclusive. How do you see the relationship between traditional Western medicine and alternative medicine? Have there been instances where the two have been difficult to reconcile?
For me, it’s important to keep an open mind for both systems. I try to take the “best” from both worlds and really try to use the idea of “Integrative Dermatology” to bring it all together to optimize health. I do have patients who don’t want any “conventional” medicine, but I am usually able to show that much of what we call “conventional” is actually very close to nature; it’s a misconception (by doctors as well as patients!) that there is a hard line between these two worlds. For example, there is an FDA-approved prescription medication cream for genital warts that is entirely based on green tea! It’s one of the first botanicals ever approved by the FDA, but it clearly lives in both worlds. Other medications, such as azelaic acid, also are very close to nature; this is derived from buckwheat and is produced naturally by the commensal yeasts that live on our skin. Most of the time, I am trying to use as many gentle and supportive treatments as possible, in order to minimize or totally avoid the so-called “big guns”; however, for more serious conditions, I do find that powerful medications can make an incredible difference, and–when used properly–can do so safely. That is why I think I am firmly planted in the world of “Integrative Medicine”.
What is your treatment approach for eczema? Do you pursue both traditional and alternative medicines both at the same time? Do you let your patients help guide you?
My general approach is to first do the following: identify and avoid any and all triggers, strengthen the skin barrier with natural agents and moisturizers, work on re-balancing the skin and gut bacteria by decreasing staphylococcus and adding probiotics, and finding ways to decrease itch and inflammation naturally. Once these are optimized, some patients do not need anything else! Those are awesome success stories, but, unfortunately are relatively few given the more complicated cases that are referred to me. However, we try to do this first for pretty much all cases. If this is not enough, we have a “phase 2” on the Eczema Action Plan for patients that generally involves a prescription anti-inflammatory, usually a topical corticosteroid or calcineurin inhibitor to be used for up to 2 weeks per month maximum. In this way, we aim for good effect with absolutely minimal risk of side effects. I have most of my more severe cases come in frequently, both to check the skin and monitor for any signs of side effects, but also because it is very difficult to do these plans day in and day out, and so there is an element of support and cheerleading that goes on in a visit that is difficult to explain but seems very important. Should that fail, we then usually discuss wet-wrap therapy or the healing power of phototherapy (Narrow band UVB light treatments) next. Beyond that, we can discuss powerful systemic treatments such as cyclosporine, mycophenolate, and azathioprine; fortunately, those are necessary only for a small portion of patients.
Can you tell us more about the Chicago Integrative Eczema Center?
The Chicago Integrative Eczema Center is a resource for patients and families with atopic dermatitis seeking a more holistic approach to care. We emphasize integrating natural therapies, Traditional Chinese Medicine, and Acupuncture/Acupressure in addition to trusted conventional medical treatments. There are 4 components: education, with the website which has lots of neat resources including videos, and the Center meetings once every other month on a Saturday AM which have specialized education content and awesome guest speakers; the support group (sponsored by the National Eczema Association) which is incredible for patients and families; patient care with me and with Dr. Ryan Lombardo, a Traditional Chinese Medicine doctor; and then research that will hopefully allow us to continue to answer more questions and get to the bottom of this disease. It’s been a very exciting few years as we’ve grown, and patients have come from incredible distances to attend the meetings. We do, however, constantly struggle with how we can do things better and serve our patients and their families better.
What led you to co-found the Chicago Integrative Eczema Center?
One of the frustrating things was that all day long I would go from room to room to see patients with eczema and there would be a common refrain: “I feel alone in this.” And it was ironic because each patient felt alone, but I was seeing this entire community of patients–they just didn’t know each other! At the same time, there is so much information to go over with eczema–it’s not just applying one cream and being done! Safety issues, moisturizing tips, bacterial infections: there is just really too much for a single visit. Additionally, concerns about medications also take a long time since there are usually specific questions that patients would like to ask. What has been incredible about the Center is that it provides an opportunity with time and space to deal with these issues, which has been a true game-changer.
Eczema centers are more popular in Europe but are few and far between in the United States. Could your integrative eczema center succeed in the rest of the US?
This is a very good point. In Europe there are similar centers that are sometimes called “Atopy Schools”. They are very rare in the US, in part because insurance does not pay for the services at all. Accordingly, all the educational and support resources of our Center are free for patients, which has been wonderful, but we wish even more patients and families would attend and we continue to try to get the word out!
What advances are you most excited about in the field of eczema? How should resources be prioritized in the fight against eczema?
There are some really exciting new ideas in eczema. Most exciting, perhaps, is the concept that “leaky skin” may be the real driving force for many of our most severe patients. This is a developing story, but it could mean that–for some at least–simply protecting the skin barrier could actually prevent eczema and possibly even food allergies! So much time, money, and energy is devoted to calming the eczema once it has started, it is intoxicating to think that the whole thing could be prevented… I’ve written a bit more about this idea here: http://chicagoeczema.com/resource/leaky-gut-or-leaky-skin/
The Third annual Itching for a Cure walk is coming up in just two days! It will be held this Sunday at the UCLA campus. It is the only walk dedicated towards raising funds for eczema. That’s pretty special considering eczema may affect more than 30 million Americans.
Here are the details:
WHEN: Sunday, October 5
WHERE: Dickson Court South, UCLA
405 Hilgard Avenue, Los Angeles, CA 90095
You can still register to walk by clicking here.
If you’re not located near the LA area, you can still contribute to the fight against eczema by clicking here.
Get those running/walking shoes ready!
October is heralded by crisp cool air, changing color of leaves, trips to the apple orchard and cider donuts. For many people, along with this change of seasons comes a spike in eczema flares. Thus, October is also Eczema Awareness Month.
This month, we will bring you an array of articles on eczema ranging from basic information about this condition to interviews with champions in the fight against eczema and review of products that can help eczema.
Take a look at your local supermarket/pharmacy’s skin care section and you can easily get overwhelmed by the different moisturizer options. There are many different brands, and formulations. Creams, lotions, and ointments, oh my!
So what are some guidelines to follow when choosing a moisturizer for eczema?
Your moisturizer should be hypoallergenic. The last thing you want is for your moisturizer to give you an allergic reaction on your skin.
- Your moisturizer should be fragrance-free. Fragrances are a leading cause of skin contact allergies.
- Look for creams or ointments. Your moisturizer should not be thin and watery. It should be thick. Why? because then it can seal and lock in your skin’s moisture. If your moisturizer is thin and watery, the water will evaporate off, leaving little protectant on your skin. Ointments are great, but some people don’t like the oily feel.
Here are some of my favorite moisturizers (and no! I have no conflicts of interest and am not paid by these companies!):
- Vanicream moisturizing cream – This one is hypoallergenic and fragrance free and comes in a big tub.
- Cerave moisturizing cream – This cream includes ingredients such as ceramides and hyaluronic acid which help protect the skin and seal in moisture.
- Aveeno eczema therapy – The moisturizing cream contains colloidal oatmeal. It is not as thick as the above creams, but many patients have found this to be a very pleasant cream
- Vaniply ointment – I like how this one comes in a travel size which I can stick in my purse to moisturize my hands or lips on the go.
- Aveeno healing ointment or Aquaphor healing ointment – I’ve also found this very handy for the hands or lips on the go.
- Neutrogena Norwegian formula hand cream – This is slightly less greasy than other ointment but thicker than a cream. It also comes in a size that is easy to throw in my purse or keep at the desk. I frequently use this after washing my hands or when I don’t have a separate chap stick around.
- Plain old Vaseline petroleum jelly – Inexpensive and a great sealant! The skin will feel a little greasy afterwards, but it’s supposed to!
What are some of your favorite moisturizers?
Want to learn about the proper way to apply moisturizer? The answer is HERE.
Continuing on the theme of frequent handwashing, we will cover how to use liquid bandage (aka liquid bandaid) over those very pesky fissures and cracks which really likethe fingertips and can result from frequent water contact such as from handwashing. Prevention is key, but if you’ve already developed those cracks, you’re probably looking for something to ease the pain. Liquid bandage is an over the counter product sold at your local pharmacy or supermarket. It’s essentially a super-glue to seal up your cracks.
How do you use liquid bandage?
– First, clean the affected cut/fissure/crack
– Try to press the two sides of normal skin together if possible
– Apply a small amount over the area and let it dry
– You can apply extra coatings for extra sealage
How do you remove liquid bandage?
There are a few different ways. Check the box of your product. For some, you can apply a fresh coating and simply wipe the whole amount off. Otherwise, nail polish remover and oils can also remove the product. You can also just let it fall off on its own.
One frequent complaint I’ve heard from patients is that liquid bandage HURTS and STINGS especially for larger cracks! That’s because it may contain alcohols which really burn on open skin. Once the product dries, it shouldn’t burn. Several physicians have also recommended using superglue in place of liquid bandage but check with your doctor first.
Also, if liquid bandage doesn’t work for you, you can also try vaseline (petrolatum jelly) or petrolatum jelly based ointments.
What is your favorite remedy for cracked and fissured hands and fingers?
The combination of dry weather and frequent handwashing or hand sanitizing can really wreak havoc on your skin. For those of us in the healthcare profession, we’re cleansing our hands before and after seeing each patient in order to prevent the spread of germs from one patient to the next. For those of us who do chores like dishwashing, laundry, cooking, and for those parents who are taking care of kids and pets, we have even more reason to be handwashing.
So what do you do about the dry, irritated, red, cracked skin that can result?
1) If you don’t need to be cleansing your hands, then don’t. This sounds silly, but excess water exposure will dry your skin out. While it’s important to maintain good hand hygiene, if you don’t have a need to be washing your hands, then don’t.
2) Use lukewarm water instead of steaming hot water. A pet peeve of mine are those automatic faucets which pipe out steaming hot water and there’s no way to change the temperature.
3) Pat dry instead of rubbing your skin dry. You needn’t scrub away your skin after handwashing.
4) Follow up your handwashing with a moisturizer. Being a dermatologist, I have little sample-sized hand moisturizers at my desk that I use after washing my hands and whenevermy hands feel dry. (Remember that episode of Grey’s Anatomy where they showed all the dermatologists moisturizing? Well, that’s not all that we do…!)
5) If you suspect you could be having an allergic or irritant reaction to your hand sanitizer, try a hypoallergenic one such as this one from VMV Hypoallergenics. They added moisturizer to their hand sanitizer!
6) Wear gloves if you can to protect your skin while doing chores. I like the really inexpensive clear plastic food handler’s gloves to lightweight chores.
What tips do you have for preventing dry irritated skin on your hands?