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Thank you for your part in our journey

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New Year's resolutions

Another year comes to an end and yet another one begins

I wish you and your family a year filled with good health and happiness. I completed 3 years of writing this blog in October last year and it has been an amazing experience for me. As always, I am reminded once again about how fortunate we are as a family in all that we have and how grateful I am for the love and support of my family and friends. We also remain grateful to the wonderful support shown by our doctors in being there for us every step of the way. So thank you all for simply being a part of our lives!

I feel honoured to be able to share with you our experiences in dealing with eczema and most importantly to be able to share with you our experiences of dealing with eczema with the help of Functional Medicine protocol. I  want to emphasize upon this last bit since most of you may not be aware that such an option/treatment exists. I have written about this in my earlier post- https://eczema-anindianperspective.com/2015/09/10/the-functional-medicine-and-gut-health-approach-to-managing-chronic-conditions-including-eczema/

We are now mostly familiar with the conventional medical treatments but have lost touch with many others some of which used to be a part of our own culture like ayurveda. In fact, Functional Medicine is similar to our ancient Ayurvedic tradition in many ways since it approaches the individual as a whole and does not just treat the symptoms. However, it differs in many ways since it incorporates the latest science and research, diagnostic testing, use of nutraceuticals amongst others.

Life is full of ups and downs; the trick is to enjoy the ups and have courage during the downs

Road to Eldorado

It has been a while since I have given an update on my daughter’s skin condition and treatment. Since I last wrote about the essential oils, there has been a lot of upheaval with regards to my daughter’s condition. Staph infection, caused by the bacteria Staphylococcus aureus is very common among those suffering from eczema. It is a very common bacteria residing on our skin and is invisible for all intents and purposes most of the times. But for those with eczema/sensitive skin it tends to create problems by causing infections. My daughter had recurring bouts of this infection starting in August last year. It notoriously difficult to get rid of once it gets entrenched. This led to a couple of rounds of antibiotics and oral steroids to control her skin condition which had deteriorated rapidly. These medications were  added on top of her immunosuppressive medication, Methotrexate, which also had to be increased to manager her eczema.

Thus, till about mid November last year, it was again a very trying time for us as a family. We had to deal with her eczema flare up which had actually became a constant feature since August and  it had also somewhat as a shock for us. This was because her eczema had been fairly under control for the past 10 months or so under the Functional Medicine treatment and her medication had been brought down gradually. As part of the treatment we got her Functional Medicine tests like Comprehensive Stool Analysis and Optimal Nutritional Evaluation done to determine her gut/microbiome health and her levels of vitamins, minerals, amino acids, antioxidants and other metabolic markers from the European Genova Diagnostics laboratories.

While the stool test did show some improvement from the earlier test done in January last year, the urine test was a bit of a disappointment but at the same time shed some light on her flare up. The urine metabolite test showed a huge amount of oxidative stress. Oxidative stress is akin to the process of combustion in our cells which use oxygen that we breathe in and food as fuel to provide our body with energy. However, in the process of creating energy, some byproducts in the form of extremely volatile free radicals are created which are usually neutralized by our body’s natural antioxidants. But when our body becomes overwhelmed by oxidative stress and/or there are not enough antioxidants to combat oxidative stress, problems occur. Infact this is the process of ageing that we all face over the course of our lives.

However, once we figured this out and boosted her supply of antioxidants with foods and supplements, her skin condition improved gradually. I increased her intake of natural antioxidants like strawberries, blueberries, blackberries, raspberries, spinach, Brussel sprouts, broccoli, beetroot and other colourful fruits and vegetables in various forms such as soups, smoothies, side and main dishes. Under the guidance of our Functional Medicine practitioner her intake of antioxidants like Vitamin A, C and D as supplements were also increased.

Other natural and traditional interventions

herbal medicine in capsules.

For the past year or so, I have been dabbling in and increasing my knowledge of traditional and natural interventions using local herbs and spices to manage eczema and other minor health issues. Over the past 6 months or so I had introduced a Curcumin supplement in a highly bio absorbable form. It is the main active ingredient in our local spice called turmeric used regularly in most of the Indian dishes, but for therapeutic needs one needs to consume much more than we can usually do from food alone. Curcumin is a super antioxidant and is highly anti-inflammatory at the same time. I use the Indian brand Cure Garden Daily Defense  and I increased the dosage to combat her oxidative stress.

The other supplement that I had added at the same time is a popular herb called Tulsi (or holy basil) from the brand Organic India Tulsi. Tulsi is a very important herb available locally and is used extensively in our Ayurvedic treatments. It is an adaptogenic herb and is thus very good for stress management, has antibacterial properties and increases the activity of antioxidant enzymes amongst a host of other benefits.

The other 2 local herbs that I introduced were neem from Himalaya Herbals (or Margosa) and Guduchi. Neem is again a common and popular local herb which is extremely beneficial for improving skin health and boosts immune and liver function. Guduchi is an adaptogenic herb, boosts the immune system and improves liver function amongst other things and is again beneficial for the skin. Then there are a few other herbs like berberine and burdock root that I use internally as well according to traditional Chinese medicine to enhance liver detoxification amongst other things. I intend to write about such herbal and natural interventions in a separate post later this year. I also intend to pursue a course in herbal treatments to take advantage of the vast natural resources that our country has in creating health and which we seem to have lost touch with.

Therapeutic grade essential oils continue to be the mainstay of our fight against staph infection. Lavender, tea tree, geranium and other essential oils from the brand Eden Garden are the ones that I use diluted with coconut oil as a carrier oil for applying locally. I have already written about this in greater details in my last blog post a while back – https://eczema-anindianperspective.com/2016/05/27/essential-oils-for-managing-eczema/.

Hopefully, once again over a period of time I will be able to phase out her medications with the help of her doctors. We have a long way to go yet and the road ahead may yet be a winding one but I know that we are pretty much prepared for our journey.

Reclaiming optimal health 

optimal wellness in wood type

You may be aware from my earlier posts that I am a certified Health Coach from the US based Dr Sears Wellness Institute. However, I have not mentioned earlier that I am currently pursuing a one year course with the Functional Medicine Coaching Academy (FMCA) which is offering this course in collaboration with the Institute of Functional Medicine (IFM). My daughter’s ongoing treatment is with the help of a UK based IFM certified practitioner, Pete Williams. My course is an exhaustive one and encompasses diverse topics like positive psychology, coaching process, motivational interviewing and functional nutrition, Functional Medicine structure and operating system like the GOTOIT, Timeline and Matrix; mind body techniques and various relevant systems and technologies.

fmca-coaching-center-ifm

As a part of my curriculum practicum I have already started counselling a few clients with various health issues on diet, lifestyle changes amongst others. I am really looking forward to completing this course and setting up a clinic in Mumbai. This clinic will be in conjunction with my daughter’s dermatologist and the coauthor of my book “ I have eczema…so what?”, Dr Amrita Talwar later this year. I hope to bring my personal experience of dealing with my daughter’s autoimmune condition with dietary, lifestyle and other changes to the table apart from all the knowledge that I would have gathered in my course as a certified Health Coach.

Alone we can do so little, together we can do so much

I always knew that it is difficult to tackle problems including health related alone, but I realised how critical a support system really is during our darkest days. Our support system of family, friends and health professionals acted as a kind of a well knit community and enabled us to pull through. It is time for me to give something back now using my experience and knowledge. I look forward to doing my bit in building a community focussed on creating optimal health at a time when chronic conditions are rising exponentially and conventional treatments are falling short . As Dr Mark Hyman (Chairman, IFM Board of Directors and Director of the Cleveland Clinic Center for Functional Medicine) has said “The power of community to create health is far greater than any physician, clinic or hospital”. I am excited and look forward to this new chapter in my life.

As a wise person had once said ” Optimal health is a journey taken one step, one habit, and one day at a time“.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Essential oils for managing eczema

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Eczema has been a great teacher. Over the past 8 or 9 years of dealing with my daughter’s eczema, I have learned many lessons though often reluctantly. Infact my whole family has. My daughter has learned what it means to be strong during very tough times and also how to deal with the many challenges she has faced in her young life. As a family we have learned the importance of showing our love for our daughter and being supportive; being there for her no matter what. Personally, eczema has taught me what patience is all about and that often there is a silver lining behind the grey cloud on the horizon. Of course, we have learned many other lessons as well, but these to my mind are the most important ones.

In the quest to learn more about this chronic condition which has been our constant companion for almost a decade now, I have learned a lot. I have been writing about it in my blog for almost three years now. I have written about the Functional Medicine treatment that my daughter is on currently. She is in fact responding very well to the treatment and we are in the process of lowering her immunossupressive medications.  But that topic is for my next blog post, today I am writing about another aspect of treating eczema.

Our experience with essential oils

I first came across essential oils in a meaningful and relevant manner in October last year. Before that mostly what I knew about essential oils were from my visits to the spa or salon and/or from fragranced beauty and other bath products. But even then I came to know much later that the fragrances in the usual beauty and bath products are actually artificial chemicals which try to imitate the natural fragrances of plants.

Last October, my daughter’s doctors were struggling to control her widespread staph infection due to the skin wounds from her constant scratching. Staph infection is a bacterial infection caused due to the presence of the bacteria Staphylococcus Aureus (or staph in short) which gets in through the cracks in the cuts and wounds on eczema prone skin. It is commonly present in those with healthy skins as well but is usually not able to create as many issues. The doctors had to give her two back to back week long dosages of antibiotics when the infection came back within 2 weeks of completing the first round of antibiotics. And even after that the infection was not completely under control and she was very itchy, inflamed and uncomfortable.

I was desperate enough to try bleach bath for her where I diluted household bleach with bath water and forced her to take a bath in it in an effort to get rid of the infection. It is a practice used to control severe staph infections in those with eczema. It was a a very painful time for her since the bleach bath used to sting her whole body. I felt like a really horrible person and mother for inflicting this kind of suffering on my daughter but my desperation forced me to try it out. Those were very trying times filled with pain and tears for all of us but thankfully they are behind us now. Now my daughter is able to enjoy both her bath and swimming lessons after many years. Essential oils came to our rescue and brought the infection under control and we have not looked back since.

 

(Further reading

https://nationaleczema.org/eczema/related-conditions/infections/staph/

https://www.sciencedaily.com/releases/2013/10/131030142414.htm)

Essential oils and Aromatherapy 

Aromatherapy

Unfortunately, in our zeal to embrace modern versions of medicine, quite a few of us have lost touch with other forms of treatment which can be equally effective. Luckily, I was thrust in the midst of the wonderful aromatic world of plant based therapy which have actually been used by man for millennia. But keep in mind that I am referring to the class of essential oils that are of therapeutic grade due to their 100% purity and which can be used for healing purposes. There are no bases, fillers or additives added. Most of the essential oils which are available in the market are not of therapeutic grade but are diluted and are good only for cosmetological needs and consumer products. I will be writing more about the brands and the companies that I use for managing eczema later in this post.

Essential oils are volatile liquids and are made mostly by a distillation process by extracting these from the leaves, flowers, seeds, roots and resins. The process of distillation separates the water and oil based compounds of the plant and makes the oil highly concentrated.  Infact it takes about 30 kgs of rose petals to make just about 15 ml of rose essential oil! This makes essential oils highly potent and effective for healing purposes. Essential oils have antibacterial, antifungal, antiseptic, antiparasitic, anti-inflammatory and highly therapeutic properties.  But like any other treatment, essential oils need to be treated with respect and with due knowledge of how to use them. Also, just like other treatments, aromatherapy works best in  combination with conventional treatments (if required for an existing condition), a good balanced and healthy diet, a daily stress management routine and regular excercise. 

(You can read more about them at

https://www.naha.org/explore-aromatherapy/about-aromatherapy/what-are-essential-oils

http://www.sciencedirect.com/science/article/pii/S2221169115001033)

All oils are not created equal

bunch of lavander

As I have mentioned earlier, there are different grades of essential oils. The ones I am referring to for managing eczema and other medical conditions are specifically therapeutic ones. The other ones might be much cheaper but will not have the healing properties that you need. In any case, since these oils are highly concentrated and very potent, only a few drops are needed at a time. They also have to be diluted at all times for topical applications even though there are a few exceptions.

The essential oils I use for managing staph infections and at the same time healing eczema prone skin are lavender, tea tree, geranium, clary sage, clove and oregano. I make a blend of oils by mixing 2 to 3 oils with a carrier oil (coconut oil) and use it to moisturise my daughter daily. Lavender and tea tree essential oils are the most important ones that I use every time while I add a third oil from the remaining list. Also keep in mind that clove and oregano are warming and highly potent oils and I use it mostly for fighting infections and not daily use. I do not use more than 5 to 6 drops of each in the blend and make up the rest with the remaining oils that I am using for that blend.

The dosage for the oils for a 3% topical (recommended) application is 30 drops of the essential oils (10 drops of each oil if using 3 essential oils) mixed with 30 ml of the carrier oil (coconut oil). In case of very young children and babies, you can start with a 1% 0r 2 % dilution which means about 5 to 6 drops of each oil ( or around 15 drops in all) mixed with 30 ml of the carrier oil. You also can use this concentration for maintenance  purposes once the skin infection has come under control.

A note of caution:  Avoid using essential oils on very young children (less than 2 years) and babies. If it is necessary to use for stubborn infection, use ones which are gentle on their delicate skin like lavender, tea tree and geranium and with maximum dilution. You can also buy a blend called Eczema Helper from the brand Plant Therapy made especially for children from 2 to 10 years of age. So far I have not been able to find any shopping site which ships this product to India apart from the Plant Therapy website itself and the link is given below-   

http://www.planttherapy.com/eczema-helper

The amounts of the essential oils should be increased or decreased in proportion to the carrier oil used. The blend should be kept in a glass bottle in a dark area well away from sunlight or any other source of light and heat. This blend can be applied whenever and wherever on the body moisturisation is required.

There are a few companies based in the US like Edens Garden, Plant Therapy, Young Living and Do Terra from where you can buy therapeutic grade essential oils . However, only Edens Garden Essential Oils and Plant Therapy Essential Oils are available as of now on Ebay India.  Sometimes, some of the other brands are available on Amazon India and Rediff shopping but are more expensive.  You can use the following link on Ebay India to buy the Edens Garden and Plant Therapy brand of essential oils–

Natural coconut oil
Also, equally important is the carrier oil used to dilute the essential oils. I have now been using cold pressed coconut oil to moisturise my daughter’s skin through all seasons successfully for more than a year now. Infact coconut oil itself has antimicrobial properties. I use the organic cold pressed coconut oil from Conscious Foods that is available at various retail stores including Godrej Nature’s basket, Foodhall (Mumbai) and online stores like Amazon India, naturalmantra.com, Foodesto.com and allthingsorganic.com amongst others. But you can use any cold pressed, unfragranced (preferably organic) coconut oil that is readily available in your area.

Stop and smell the roses

Essential oils have played a major role in managing my daughter’s skin infections and I am really happy to share it with you. I hope you find this article useful in incorporating essential oils into your eczema treatment routine.
A couple of other thoughts to leave you with.

Very often when we are pressed with stressful times in life, we forget that life is not just about tiding through tough times or “managing  situations”. It is also about enjoying time spent with family and friends, having fun, being creative and simply “doing nothing”. Infact in today’s world where we are hard pressed for time, “doing nothing” seems a sacrilege for most of us. The fact is, it is one of the most important gifts we can give ourselves. I have also had times when I felt that if I took some time out from managing my daughter’s eczema in some way or the other, I would not be a good parent. I did not feel “constructive” if I took out some time to take care of myself. But now I know that is simply not true! We all need a break from time to time to keep our sanity and remain productive.

I now use essential oils frequently for this purpose. Essential oils have an amazing array of benefits and uses. Diffusing a few drops of lavender (calming and sleep inducing) essential oils or other oils like ylang ylang, sandalwood, jasmine (to name a few) can calm you down.

As one wise person said, as you walk down the fairway of life, you must stop to smell the roses, for you get to play only one round. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A summary of some of the regular reatments for eczema

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Eczema - Printed Diagnosis on Blue Background and Medical Composition - Stethoscope, Pills and Syringe. Medical Concept. Blurred Image.

I have been writing about our experiences with eczema (or more specifically Atopic Dermatitis) for almost 2 years now. I have written about the various treatments we have tried in various posts but I realised that I have not really written in details and in a comprehensive manner about the first, second line and third line treatments that are usually used to treat eczema.

(Please note: I will refer to Atopic Dermatitis as eczema in my post from here on to simplify matters)

In this post I have written about the regular medical treatment that is used once the moisturisers alone are not able to control the inflammation. Moisturisers are an essential part of the treatment for eczema and works very well in mild forms but may not be sufficient to bring the eczema under control once the skin becomes red and inflamed in moderate to severe eczema. I have myself been confused at times with the myriad topical, steroidal and non steroidal creams that are prescribed by the doctors at various points in time. Then there are also the oral steroid medications and different immunosuppressants and phototherapy treatment that we have used to control flare ups. I believe it would help a lot of parents (and those adults suffering from eczema) if they had some idea about the basics of the different types of treatments and medications that they may be using on their child or even on themselves. It would definitely help in controlling and reducing the side effects that some of these strong medications can have on a person if not used properly.

Topical steroids

Steroid cream.

Topical corticosteroids are prescribed by the doctor/dermatologist when the skin becomes red and inflamed and the eczema does not clear up in spite of maintaining a healthy and regular bathing and moisturising routine. The topical corticosteroids range from very mild to very potent and you should be very careful in following the doctor’s instructions in using the same for your child both in terms of quantity and duration. This is especially true for young children and babies. In any case, the topical corticosteroids are prescribed only when the risks from eczema far outweigh the risks from the side effects of using these medicines. When a child suffering from eczema is unable to sleep at night due to incessant itching and thus starts affecting daily life at school and home, there is a risk of infection due to the cuts and inflamed skin, it is wise to use steroid creams/ointments as per the doctor’s advice till the time the rashes have gone.

Some important points to remember while using these medications-

  • One should start using the lowest potency steroid and only step up if required
  • Topical steroids are most effective if applied immediately after a bath but should only be applied on affected areas and not as a moisturiser
  • One should follow the doctor’s advice on the frequency of application (usually twice a day is more than enough on severely inflamed skin) and should start tapering off as instructed instead of stopping abruptly
  • Step up and the step down method (in terms of potency and frequency of steroid) needs to be maintained while using the topical steroids to keep the risks of side effects of these medications as low as possible
  • One should avoid using these medications on the face and other sensitive areas and this is all the more true for children who have very sensitive and delicate skin

Given below are the various common (but certainly not exhaustive) topical corticosteroid creams/ointments that are available in India (and ones I am most familiar with) and their potency

  • Low potency– Hydrocortisone creams (1%) are available as an OTC (over the counter) medicine in various forms like cream, ointment and lotions. This is the least potent amongst all the topical steroids but still should be used with caution especially for a child. This is especially true since this is easily available and one can unknowingly use this as a moisturiser without realising that it is still a steroid cream/ointment
  • Mild to mid potency– Steroidal creams/ointments like Desonide, Mometasone fuorate and Fluticasone propionate are available at the lower to mid end of the potency spectrum. These are brands like Desowen, Momate/Elocon and Flutivate brands in India for the respective steroidal creams/ointments respectively. The doctors will prescribe a particular steroidal cream based on the level of inflammation and rashes
  • Potent to highly potent– Steroidal creams like Betamethasone dipropionate and Halobetasol propionate are at the potent end of the corticosteroidal creams/ointment. In India we have brands like Fucibet (which also includes fucidic acid which is an antibacterial medication) and Halovate which include these steroids respectively.

You should also know there is an overlap in these topical medications since they are usually available in both cream and ointment forms and the potency for the same dosage will differ based on the form. The cream form has roughly half water and half oil, they spread easily, are well absorbed and usually wash off with water. Ointments on the other had are about 80% oil and 20% water and are thus “occlusive” which means they trap moisture and help in better absorption of the main component. Being occlusive, an ointment will allow the medication to get absorbed much more completely than a cream and hence are more potent at the same dosage as a cream.  

https://www.psoriasis.org/sublearn03_mild_potency

Application and side effects

Topical corticosteroids should be used in a step up manner in terms of increasing potency starting from a low potency and only moving up if required. Usually the doctor will prescribe the milder ones like desonide cream (brand name- Desowen) and only graduate to a stronger medication like Fucibet if required later on. Similarly, once the rashes have been brought under control, one should use the step down method both in terms of potency as well as frequency as per the doctor’s instructions.

As mentioned earlier, these medications should only be applied on affected areas and not as a  moisturiser. However, sometimes the rashes may be quite widespread all over the body. In that case, the doctor may prescribe a 1:4 ratio of a mild potency steroid like desowen to an emollient like cetraban which is then mixed thoroughly and applied all over the affected areas.

Side effects from these steroidal creams are varied and depends on the age of the person, the frequency of application, the potency of the drug amongst other factors. The thinning of the skin or skin atrophy is one such side effect which can take place if potent to highly potent steroidal creams are applied too frequently or without any break. However, one can avoid this and other side effects by following the doctor’s instructions for using this treatment and thus using this treatment as and when required, in the required quantity and for an appropriate duration. The other thing to keep in mind that in case of excessive scratching due constant itchiness in case of under medication, the skin tends to become thick and discoloured. Thus the treatment needs to be carried out in a timely manner under the supervision of a doctor and the instructions should be properly followed to minimise the side effects.

(Further reading-http://www.eczema.org/corticosteroids)

Calcineurin inhibitors

Another type of topical treatment available for eczema is the group of medications known as Calcineurin inhibitors. These are non-steroidal immunomodulators and are of 2 types- pimecrolimus 1% (Pacroma and Elidel) and tacrolimus 0.3% (Protopic). These topical medications work by suppressing the immune system and are usually prescribed to children over 2 years of age and adults and are recommended for use as a second line treatment for eczema.pacroma-cream

As with steroidal medications, these type of immunomodulators should also be applied only when prescribed by the doctor and for the recommended duration of time. Even though it does not have the side effects like thinning of the skin which is associated with steroidal treatments, one still has to be cautious while using these medications since they are relatively new medications and not much is known about their long term usage. There is a possible risk of skin cancer only in the long run after prolonged usage but it is still advisable to apply these creams at night to avoid sunlight exposure. These medications are also prescribed for eczema on the face (unlike topical steroids) and are prescribed for moderate to severe eczema only when the combination of topical steroids and emollients have not been successful.

(Further reading- http://www.ncbi.nlm.nih.gov/books/NBK45568/

http://www.ncbi.nlm.nih.gov/pubmed/14693489)

Phototherapy or Narrow band UVB

Another treatment that is prescribed once the topical treatments have not really worked for a person in controlling the eczema is phototherapy. It is used as a safer alternative to avoid using  the third line treatments of  the powerful immunosuppressive medications like azathioprine, methotrexate and cyclosporine.

In this treatment light or a particular narrow band of Ultraviolet rays are used to treat the eczema which is beneficial for skin diseases. It can be used both for localised as well as general areas of the skin covering the entire body. This treatment works effectively for some people but not for everyone and usually takes about 1 to 2 months to show the desire results. If this treatment is effective then it can effectively put the eczema in remission for a while at least. It may also minimise the usage of topical steroids and there its side effects.

Phototherapy is carried out in a special booth filled with UV rays for general treatment of eczema all over the body and hand-held devices for treatment of specific areas like hands, ankles etc. Nowadays, a high intensity phototherapy treatment is available in the form of a laser called Excimer. It is much more powerful than the regular phototherapy and emits Ultraviolet rays of a particular frequency which is used to treat different skin conditions like eczema, psoriasis etc. It is given in the form of a hand-held gadget and takes much less time than a regular phototherapy due to the high intensity of the rays and is more useful for treatment for localised areas of the body. However, one needs to be careful in protecting the eyes when undergoing this treatment. The risks associated with prolonged treatment are skin burns, increased ageing and increased risk of skin cancer. Like any other such treatment this has to be carried out under the supervision of a medical professional and all the instructions need to be followed carefully. (I have written about our experience with phototherapy in my blog post https://eczema-anindianperspective.com/2013/10/17/when-the-going-gets-tough-part-1/).

(This treatment is currently offered in the Comprehensive Skin Care Clinic run by senior pediatric dermatologist Dr Manish Shah in South Mumbai and the website is http://www.cscc.co.in/)

Oral Steroids

Steroids

The third line of treatment for eczema is the use of systemic medications like oral steroids. Prednisone is one of the most commonly used oral steroids given in cases of severe eczema where an immediate result is required and is given under strict supervision of the doctor. It is given as a daily dose starting with a high dosage and then is slowly tapered down once the eczema is under control. Oral steroids work by suppressing the immune system and helps in controlling the overactive immune system in the case of a person suffering from eczema. But this also makes it possible for the person to catch infections easily due to a weakened immune system and hence has to be monitored at all times. Also, in the case of a child, oral steroids may slow down growth and development and hence again one needs to be very careful.

There are other side effects as well which can be minimised by following instructions carefully and keeping a lookout for any symptoms which may arise on taking this medication. This is also done by carrying regular blood tests to determine adverse side effects if any. Due to the various side effects of this medication and its quick action, oral steroids are usually prescribed for short periods of time when results are needed fast. Bottomline, like any strong medications, one needs to take this under strict supervision and follow the doctor’s instructions about dosages  and how to start and stop taking this medication.

(Further reading: http://www.ncbi.nlm.nih.gov/books/NBK260241/)

Immunosuppressive medications

various tablets pills in bottle

The other third line of systemic treatments include the immunosuppressive medications like azathioprine, cyclosporine and methotrexate. These are all very powerful medications and are given only when all other options have failed to yield the desired results. All of these medications work by suppressing the immune system and hence bring the eczema under control. But once again, due to the various side effects these medications have to be given under strict supervision of the doctor prescribing this and by following all the instructions carefully. Since eczema is a chronic condition and these medications may be required to be given for long periods of time, regular testing is required to ensure that there are no side effects.

Azathioprine

Azathioprine works by tweaking the growth of certain white blood cells which contribute to the inflammation associated with eczema and thus suppresses the immune system. It takes a while longer to show results than cyclosporine and may not suitable for acute flare ups.The main side effect of azathioprine is bone marrow suppression and that is why a specific test is carried out before prescribing this medication which is called the TPMT enzyme test. This test determines the suitability of the person by determining the ease by which the person is able to break down azathioprine in the normal way. However regular testing would be required to keep a track of any adverse effect on the immune system. This medication is taken orally in the form of tablets and on a daily basis in the prescribed dosage.

We had a traumatic experience with this medication which was prescribed by a leading pediatric dermatologist in London for our then 7 year old daughter. In her case, even though she had a normal TPMT result, her body reacted disastrously to this medication and she suffered from bone marrow suppression and had to fight for her life. This was a one in a million kind of event and has never happened before to someone with normal TPMT levels. I have written about our experience in my post in 2013  and you can read about it at https://eczema-anindianperspective.com/2013/10/27/the-tough-get-going-part-2/.

Cyclosporine

Cyclosporine is another systemic immunosuppressant used to bring severe eczema under control and works by specifically blocking an important pathway in the immune system, and has different side effects than steroids. It is prescribed in low doses for eczema under strict supervision and once the eczema is under control, the medication is tapered off. One of the main risks associated with this medication is damage to the kidney especially with increased dosage and duration of medication and hence regular tests would be required to monitor the kidney activity. This medication has to be taken orally on a daily basis as per the prescribed dosage.

(I have written more about our experience of dealing with cyclosporine and azathioprine medications in my blog post where I have compared both at https://eczema-anindianperspective.com/2014/02/10/azathioprine-and-cyclopsorin-an-overview-of-two-immunosuppressive-medicines-used-to-control-my-daughters-eczema-from-a-parents-point-of-view/).

Methotrexate

Methotrexate is another systemic immunosuppressant which is used mainly in treatment for psoriasis and different types of arthritis. It is also given in low doses in cases of severe eczema and usually takes longer to work than cyclosporine. It has anti inflammatory properties and works by altering the body’s use of folic acid (a vitamin) which is needed for cell growth. Thus a folic acid supplement is a must on a daily basis for those taking this medication. This medication is taken once a week in the form of tablets. This dosage may also be split up into 2 doses taken within 24 hours to minimise any nausea that may occur. One of the main possible side effects of this medication is again adverse effects on the immune system especially on the white blood cells (which fight infection) and platelets (which help stop bleeding). Thus regular blood tests are required to keep a look out for any adverse side effects.

(Further reading- http://rheuminfo.com/medications/methotrexate/methotrexate-detailed-information)

Sometimes the hardest thing and the right thing are the same

Sometimes we don’t have a choice as far as giving strong medications to our child is concerned when the child is suffering from a severe chronic condition which adversely affects daily living. Of course we would prefer to find some alternative which is much safer and without any of the side effects that I have mentioned above. As of now we have not managed to bring our daughter’s eczema into remission and she needs constant medication in order to live a relatively normal life.

Things can also go horribly wrong like it did in our case in spite the very best of intentions. We have been very lucky and have learned to take this in our stride and be more vigilant in the future since our daughter still requires immunosuppressants to keep her severe eczema under control. This has not stopped us from looking for other options and neither should you. As one wise person had said, it does not matter how slowly you go as long as you do not stop.

Green power!! (greener alternatives for laundry and cleaning products especially for eczema and sensitive skin)

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I am publishing an updated my article on ecofriendly and natural alternatives for laundry and cleaning needs at home. It is a primer for those of you who are looking for eco friendly and natural alternatives for a cleaner and greener home.

Cleaning word cloud concept

I find that it is important for me to highlight the fact that there are harmless, natural, environment friendly laundry, dish washing, and cleaning alternatives which are available to us. In this particular post I have focused on the laundry and household cleaning agents that we use (In subsequent articles I would be focusing on the impact of our food habits and diet). While most of us do all that we can as far as moisturizers and bathing products are concerned for children who have eczema, some of us are not aware that the regular dish washing, cleaning and laundry products used in a household can also have a large and harmful effect on sensitive skin and allergy/eczema prone children (and adults). In India especially, eczema and other allergies are a recent phenomenon as compared to the West.

While I was happy using regular detergents and cleaning products for my household cleaning and laundry needs, I was particularly happy using highly fragrances and foaming cleaning/laundry detergents and thought that all products which were labelled as “child/baby friendly” and “gentle on the skin/clothes” actually were child friendly and gentle on the skin. But after a bit of research I was quite surprised to find that quite a few of the products that I had been using all my adult life were cumulatively doing more harm than good to my entire family and this was especially true for my daughter who has severe eczema. That is when I started looking for alternatives and was pleasantly surprised to find out that there are much better, natural, harmless and environment friendly options which might also be much more economical for regular use. Now, over the past couple of years in my quest to manage my daughter’s severe eczema, I have made a lot of changes in our lifestyle which includes skincare products, laundry products, dish washing products as well as other household cleaning products.

Natural Non-Toxic Cleaning Products

Since I am sharing my own personal experience in using these products, I have restricted this post to products which are available to Indian consumers only. Also, please note that I am going by the information provided by the manufacturers as far as the ingredients are concerned, certifications as mentioned and in some cases I have taken into account the product reviews by other users. 

 All that foams is not soap!

 Soaps and detergents are two different things but are often mistaken to be the same. While soaps are traditionally made from fats and oils and have been around for centuries, detergents are usually of synthetic origin and is a much more recent phenomenon. Detergents react less to minerals (found in hard water) than soap and hence is now the preferred choice for most.

soap-bubble-kidsstoppress

  • Sulphates are surfactants which are used in a wide range of products especially laundry and dishwashing detergents in order to reduce the surface tension of water thereby improving its ability to wet things and remove the dirt.
  • Other products where Sulphates are found are bathing products like shampoos, shower gels etc, toothpastes and even baby care products and it provides the “foam” that we are so used to.
  • Nowadays most of the skincare and laundry detergents usually contain the gentler Sodium Laureth Sulphate (SLES) plus a host of other chemical fragrances and preservatives and not the much harsher surfactant Sodium Lauryl Sulphate (SLS).
  • But even SLES is a chemical which is harmful for sensitive skin and it is just one of the many chemicals which are present in any cleaning/skincare/laundry products.
  • The other common chemicals are preservatives like Parabens (Methyl, propyl, isbotyl to name a few) and Methylisothiazolinone fragrances which are mostly made of synthetic chemicals and synthetic colours,  found in many baby and child care products.
  • Many organic and natural products have preservatives like Parabens and foaming agents like SLES unless stated otherwise. Hence it is imperative while buying any such product to check the ingredients listed carefully no matter what the label says in the front. The good thing is that there are detergents (laundry and cleaning purposes) which are available to us today which use natural ingredients and are also fragrance free.

Soapnuts- the underrated cleaning agent

 Soapnuts (or reetha as it is known in India) is actually not a nut but a dried berry or fruit which is highly effective in powder and liquid form and can be used to clean clothes, jewellery, dishes, hair and other household items. It is found mostly in India and Nepal and was used extensively in India to wash clothes and hair long before liquid detergents and shampoos took over.

 

Nutshells of soapnuts in a cotton bagThe saponin which is found in the fleshy part of the soapnut is a 100 % natural hypoallergenic surfactant which is believed to have antibacterial and antifungal properties as well.

  • Soapnuts can be used for cleaning pretty much anything and is the only cleaning product which is completely natural. Any other product which is labelled ‘natural’ will contain at least some chemicals like preservatives, fragrances amongst others.
  • The other important aspect of using soapnut is that it extremely convenient to use in washing machines (front and top loading) and dishwashers (in liquid form).
  • We use soapnuts regularly as the main cleaning agent for all our clothes and white vinegar and essential oils (lemon is my favourite) as a fabric conditioner and to remove grease and add natural fragrance to the laundry.

Other laundry products

 Apart from soapnuts products which are natural, biodegradable and convenient to use either by hand or in washing machines are as given below.

Power Laundry, Liquid Laundry and Bio Laundry Bar from the Rustic Art brand: The main ingredients in these products are soda ash, natural neem soap powder, glycerine (for liquid laundry), non edible oils (for soap bar) and natural lemon extract. I use these products for my bed linen, towels, soft furnishings and other heavy materials, delicate clothes and woollens (Liquid laundry) and I use the Laundry bar for the tough stains.

rustic_art_power_laundry-kidsstoppress

Bio-D from Dailydump.org: Bio-D is a bio detergent by dailydump.org (a brand of Bangalore-based PBK Waste Solutions Pvt Ltd) which is a biodegradable product made from palm oil. I have been using it as an alternative to the Bio Laundry bar from Rustic Art for the past year or so for the clothes which are handwashed.

Another product which is relatively new and is available in India is Kyra Natural Detergent Powder which is made of organic soapnuts. I plan to use this in the near future.

Home clean home

 There are various household non toxic and environment friendly cleaning products which are available to us. One can use basic kitchen items like white vinegar, baking soda and lemon to make cleaning products. I have used a combination of these from time to time to clean my kitchen pretty effectively. ONe of my favourite recipe for a multipurpose cleaner is as given below-

All-Purpose Cleaner recipe from goodgirlgonegreen.com

3 parts filtered water

1 part vinegar

1-2 tsp lemon juice

5-7 drops of lemon essential oil

Source:http://www.goodgirlgonegreen.com/7-diy-cleaning-recipes-using-vinegar/#sthash.dwxieNSg.dpuf

(You can check out more useful articles on homemade and non toxic cleaners from the following websites-

http://www.goodhousekeeping.com/home/cleaning/tips/a24885/make-at-home-cleaners/

http://www.thenewhomemaker.com/cleanorg/vinegar.html)

Natural cleaner. Vinegar, baking soda, salt, lemon

But for those who want a more convenient off the shelf option there are other products available as well in India. These products are made using natural ingredients like essential oils, plant extracts which are thus biodegradable, non toxic and eco friendly as well. I regularly use the products listed below for my cleaning purposes:

  • Just Mop Spray- Multipurpose Household Cleaner and Just Mop- Herbal Surface Cleaner from the brand Herbal Strategi
  • Floor and bathroom cleaners from the brand SOIL
  • Floor cleaner from the brand Safe O Shine

Harmless dish washing alternatives

Dish washing detergents also use foaming agents, synthetic fragrances and other chemicals to make them extremely effective in cleaning grease and dirt. But if you are really interested in making a change for greener alternatives, there are other options available.

One option is to make a dishwashing liquid from basic items like washing soda, citric acid and vinegar like the recipe mentioned below from the blog myhealthygreenfamily.com (source: myhealthygreenfamily.com/blog/wordpress/homemade-borax-free-dishwasher-detergent-with-secret-ingredient/) which also can be used in the dishwasher

1 cup washing soda (old recipe used  baking soda)

1/4 c. citric acid

1/4 c. coarse salt

10-15 drops of citrus essential oil (Optional.  Orange, grapefruit, or lemon essential oils have great cleaning as well as antibacterial properties.)

Distilled white vinegar (in the rinse aid compartment)

Mix first 3 ingredients well in an air tight container. Add essential oil.  Mix again.  Fill your rinse aid compartment with undiluted white distilled vinegar.

Use 1 tsp. detergent for average loads.
Use 1 tbsp. detergent for extra greasy, dirty loads

White distilled vinegar can be thus be used along with lemon essential oil as a rinse aid thus eliminating the need for any artificial rinse aid products.

Another option is to buy a scrub made of the combination of soapnuts, shikaki (dried fruits of the Acacia tree native to Asia) and lemon peel which is a completely natural, non toxic and ecofriendly option for dish-washing by hand like the one by dailydump.org.

Availability and delivery in India

I have been able to find out about all the products mentioned earlier through a lot of research on this topic over the past few years. I have also managed to source these products in a few cases through the manufacturer’s own websites but more often than not through the various websites advocating a green, eco friendly and healthier way of life. These are websites which list organic foods, clothing, personal care, cleaning and other products.

Some of my favourite websites (with quick delivery and good service) are as listed below ( in no particular order):

  • DailyDump.org : A comprehensive website which promotes green, eco friendly and sustainable lifestyle through composting and non toxic products for home and garden. This website has the Vanastree soapnut and shikaki scrub (manufactured by Dailydump) that I use for my dishwashing needs and the Bio- D biodegradable detergent for laundry purposes. They also have their own brand of soap-nuts (108 Soapy Nuts).
  • Naturalmantra, Greenngood and naturallyyours.in: These are comprehensive websites which list organic foods, supplements, natural home care, personal care products etc and is very convenient to buy laundry and household cleaning products from. I use all of these websites from time to time for my house cleaning, laundry and other household and organic grocery requirements.

I have compiled some of the easy and convenient ways in which you can use non toxic, natural alternatives for your household cleaning, laundry and dishwashing needs and their availability. I hope that this will encourage you to make your home a greener, eco friendly place for your family and friends.

Please feel free to get in touch with me for any queries or if you have any suggestions on this topic.

Products and resources which help to manage eczema

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I have been meaning to put up a post of the resources and products (mostly natural formulations) that have proved beneficial in some way or the other in the past few years while treating my daughter’s eczema. These products have been recommended by other parents based on their experiences while treating their child’s eczema. I would like to mention that while my daughter is still on immunosuppressive medication to control her very severe eczema, some of them might prove to be extremely beneficial for your child like it has for many other children.

This is obviously not an exhaustive list by any means and I have listed a few products that have come to my notice and a few other products which I use on my children.

Creams, moisturisers and salves

I have written earlier about moisturisers and creams but these products deserve a special mention. I have put down a few completely natural products which are not mainstream and are mostly formulated by parents of children with eczema after they tried out various mainstream creams and moisturisers but to no avail. Furthermore, all these products are free of steroids, Sulphates, parabens and other preservatives, artificial fragrances, petrochemicals and are made mostly from natural organic ingredients. These products have proven to be beneficial to many children and in some cases, parents have been able to substitute topical steroid creams and moisturisers with preservatives and other chemicals with these natural and organic products successfully.

However, for mild to moderate eczema, you must use the steroid creams and medicines prescribed by the doctor to calm an infection or bad flare up for your child. But in the long-term if you can use a combination of natural moisturizer and other lifestyle and dietary changes to keep eczema successfully under control, that is the best situation one should work towards. I am still trying to figure out what is best for my daughter and how to manage her eczema without using steroids, immunosuppressant and other such powerful medicines and through our own journey it will really make me happy if I can help some other children and their families to cope with eczema.

I have used the first 2 products and coconut oil on both my children. I have found the Purepotions cream to be very effective on extremely dry patches and the organic coconut oil is the main moisturiser for my daughter. Some of the other products have been recommended by other parents of children with eczema and/or adults with eczema who have found relief by using these products. I have also come across some of these products while continuing my search for products to help my daughter and others like her suffering from Atopic Dermatitis.  

However, you have to be careful before using the products for the first time on your child and should check the label to see if your child is allergic to any of the ingredients in any such products.

 

  • Purepotions Intensive moisturising ointment– This natural salve was formulated in UK by a mother, Natalie Balmond, when she took matters into her own to find an alternative natural solution to alleviate her daughter’s suffering due to bleeding sores covering 90% of her body. It has Beeswax which acts as a natural antibacterial barrier protecting the skin from external irritants and locking moisture in as well as Hemp  which is extremely rich in essential fatty acids which are often lacking in those with dry skin. One can find out more about this cream and order on their website (they deliver to India) – http://www.purepotions.biz/ and once can also purchase this ointment through other websites like http://www.everythingforeczema.com/skin-salvation.html.

 

 

  •  Chickweed and Calendula cream– The founder of the website, Ms Gail Palmer is another such mother whose daughter had eczema when she was small and she struggled to bring it under control. She developed this product made of chickweed and Calendula especially for chaffed, dry skin like in the case of eczema. Chickweed has been traditionally used by herbalists to help sooth itching, and Calendula to reduce inflammation. She has her own website and blog and one can buy this product on her website http://www.everythingforeczema.com/chickweed-and-calendula-cream.htm

 

 

 

Emily skin soothers

 

  • Baby and adult skin soother from the brand Emily Skin Soothers– Made by an acupuncturist for his daughter’s eczema, this balm contains only natural ingredients. It contains just three chinese herbs in a base of olive oil and beeswax. This product is available on the website http://www.eczemacompany.com/natural-eczema-cream/ and is shipped to India by this website.

 

 

 

  • Odylique Repair Lotion and Ultra Rich Balm by Essential Care– these and other skin care products have been formulated by Margaret and her family since 1980s. She was motivated by the lack of products suitable for her own and her family’s very sensitive and eczema-prone skin and she formulated skin care products based only on organic herbs, plant oils and natural active ingredients. The lotion and the balm are the 2 products made specifically for eczema prone skin and one can purchase their products from their website http://www.essential-care.co.uk/organic-skincare-for-problem-skin/organic-skincare-for-itchy-skin.html 

 

 

LJs natural

 

  • Organic Scratchy Balm and Organic Scratchy Bath/Body Oil by LJs Natural– These products were formulated by Lisa Johnson who had been suffering from severe eczema for a long time after a lot of research and experimentation. The combination of these products and complementary therapy including diet helped bring her eczema under control ever since. The balm is a blend of organic shea butter, avocado oil, evening primrose oil and may help provide relief from itching due to dry skin conditions in a completely natural way. The bath and body oil can be used on children since it is a blend of lavender and chamomile (which are great essential oils good for dry and damaged skin and are very relaxing if used before bed time). This product is now available for delivery to India after I contacted her last week. You can check out her website at http://www.lj-natural.com/my-story/.

 

Organic coconut oil

  • Coconut oil (Organic)– This moisturiser is something we have been using for quite a while now and it has proved to be very helpful especially during the times when my daughter’s skin is broken at places due to constant itching. It is an excellent emollient for not only coating the skin but penetrating it as well, unlike a mineral oil that only coats the skin. This is readily available in India from brands like Conscious Foods, Down to Earth, Kama etc.

 

 

Therapeutic clothing and products

There are some specialised types of products available to help patients suffering from eczema cope with the aches and pains and sleepless nights associated with this skin condition and have to be used in combination to the regular medications and mositurisers. Amongst these, the most obvious and natural ones which help in reducing skin aggravation is the use of completely natural laundry cleaners. I have touched upon this topic in my earlier post – “Eczema- a change in lifestyle”  particularly in relation to availability of these products in our country.

Today I am writing about other products which have been specially formulated to help in reducing itchiness, increasing the comfort level and which might help in reducing the intensity and frequency of flare ups in some people. I have used The Tubifast Garments on my daughter when she still had mild eczema and was advised wet wrapping treatment by her dermatologist. I have also used the Dermasilk full sleeves roll neck t shirt on her and it helped to some extent to reduce her itching at times. In particular, the Dermasilk Elite Girl Brief has proved to be beneficial to my daughter and she wears it to school everyday. It has helped reduce the itching in her groin area to a large extent.

Again, I have shortlisted most of these products based on the reviews and recommendations of other parents who have found these to be beneficial in some way or the other. There must be many more which have been developed  and the good thing is that there are a whole host of products developed specifically to minimise discomfort and itching associated with Atopic Dermatitis and thus improving the overall quality of life for an eczema patient.

 

Dermasilk

  • Dermasilk Therapeutic Clothing–  This is a line of clothing used in the treatment of various forms of dermatitis, eczema and allergic skin conditions and is made of a special, knitted medical grade silk (not regular silk material) by Espere Healthcare in the UK. One can read more about them on their website- http://www.dermasilk.co.uk/. They manufacture full sleeves roll neck T shirts, full length footless leggings, tubular sleeves (for elbows and knees) , underwear (for boys and girls), child gloves, short sleeves T shirt amongst others. I have used the long sleeves T shirt and full leggings for my daughter but intermittently due to various reasons and she was pretty comfortable wearing this at night. You can buy their products on the website- http://www.theallergyshop.com.au/dermasilk-kids/ since this website delivers to India.

 

Tubifast

 

  • Tubifast Garments by Monlycke Healthcare– Tubifast Garments are specifically made to manage eczema using the Wet Wrapping Technique also called Wet Dressing Technique. They are found in various forms for children- gloves, leggings, full sleeves vests in all sizes. Apart from these, Tubifast Patch Wrap,  is used to soothe and protect isolated patches of eczema, especially behind the knees or the elbow and comes in pairs. One can read more about them on their website- http://www.molnlycke.com/patient/en/Products/Wound-care-products/Tubifast-Garments/.  The garments can be ordered at the website- http://www.theallergyshop.com.au/dermasilk-kids/ and they deliver to India as well.

 

 

  • Scratch Me Nots– This is a website where once again a mother, Andrea, developed a product looking for a way to stop her daughter from scratching all the time due to her eczema and wanted to stop the itch- scratch cycle. She then eventually figured out how to bring her eczema under control once her daughter stopped scratching and thereafter they could sleep at nights and decrease the visits to the doctors and the medications. She has developed ScratchMeNot Flip Mittens, ScratchMeNot Flip Mitten Body, Bamboo Bubby Bag, ScratchMeNot Mitten Sleeves all designed for babies and children upto 6 years of age to stop their scratching especially at night. These products are made with an unique blend of bamboo viscose, organic cotton & lycra and one can buy their products on the website- http://www.eczemacompany.com/scratchmenot-flip-mitten-sleeve-formerly-classic/ or the company website- http://www.scratchmenot.com/view-all/.

Skintoskin

  • Skin to Skin biofunctional clothing – These products were developed by a dermatologist especially for babies, children and adults with atopic skin conditions like eczema. These are made from 70% pure cotton and 20% brown algae (seaweed) which has been bonded with silver particles giving the remaining 10%. According to the company, the seaweed extract has natural properties that soothes and protects against itchiness and the silver adds antiseptic properties, drastically reducing the growth of any potentially harmful bacteria on the skin.  The products available are boxer shorts for girls/boys, long sleeves and short sleeves Tshirts, socks and leggings. One can buy these products at  http://www.everythingforeczema.com/skin-to-skin.html (they deliver to India) and their website is http://uk.skintoskin.eu/ incase you need further information.

Diet and eczema

The other aspect of managing eczema that keeps coming up again and again from other parents who have successfully brought their child’s eczema under control and others who have been able to manage their own eczema is through their diet. This is something which my husband and I have been contemplating for some time for our daughter but have not been able to implement by ourselves. For a child, a well-balanced nutritional diet is critical for growth and well being and this is even more true when the child is on a restrictive diet due to eczema, allergies etc.

Fortunately, I came to know of a naturopath based in Mumbai recently and we have approached him to help us streamline Aiyana’s diet to help us to possibly decrease her dependency on medications which keeps her eczema under control currently. Even though no doctor will really recommend a change in the diet for eczema unless it directly affects a person due to his or her allergies, more and more people with severe eczema are going down this path especially when their dependency on powerful medicines with equally powerful side effects becomes too great. Hence the role of naturopaths, natural formulations and home remedies in chronic conditions like eczema.

But you must take the same precautions that you would take before giving any mainstream medicines to your child by finding out about the impact of dietary changes, side effects of any supplements given, regular monitoring required etc. Thus even in the case of managing your child’s eczema through changes in the diet and supplements, you should be clear about why you are eliminating some foods while keeping or even increasing others and not just follow all the recommendations blindly. For a child, a well-balanced diet is very important for growth and the dietary changes should take into account protein, calcium requirements of a growing child amongst other things.

Eczema-Diet-2nd-Ed-Front-Cover-192x300

On this front, after quite a bit of research on the resources available on diet and eczema, I have come across a book called “The Eczema Diet” by an Australian nutritionist Karen Fisher. Twelve years ago Karen’s daughter developed eczema soon after she was born. By the age of two, her daughter’s eczema had become so severe that Karen decided it was time to find her own solution.  Karen successfully controlled her daughter’s severe eczema by formulating a diet plan for her daughter. This book is based on a decade of extensive research of the causes of eczema by Karen Fischer.  It has helped a lot of people to bring their eczema under control and has also helped a lot of parents to manage their child’s eczema in a much more natural way.

I had ordered this book on http://www.theallergyshop.com.au/the-eczema-diet-by-karen-fischer/. This book has recently been delivered to me and I am still going through the same. So far I have read about how it works, the top eczema safe foods as well as the ones which trigger eczema.  In case you have already taken help of this book and tried this diet on yourself or your child, I would be really happy to hear from you.

 

I have tried to bring together in one place a variety of products (creams, moisturisers, clothing) which have helped many children and adults control their eczema and live a comfortable life. Eczema, while not usually life threatening in nature, can really hamper a family’s quality of life on a daily basis since lack of sleep, discomfort, itchiness, medications and their side effects take a toll on children with eczema and their parents alike.  However, there have been a number of parents who have found a way that has worked for their child to some extent or the other and all the trial and error they have gone through has been worth it in the end. While I am also one of those parents still struggling to bring my daughter’s eczema under control with minimal or no medication at all, I would like to live you with a thought that I often have to remind myself on those days when it all seems so difficult-

“In between goals is a thing called life, that has to be lived and enjoyed”- Sid Caesar 

 

 

 

Eczema- a change in lifestyle

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Many of you would have already read my last post recounting our nightmarish experience as parents where our daughter went through “severe neutropenia” as a result of “myelosuppression” (where her bone marrow had effectively shut down due to an immunosuppressant given to control her severe eczema). Yet, we have managed to pull through after a harrowing time earlier this year and since then things have come back to normal (well almost).I have mentioned briefly in my previous post about some of the measures I have taken at home and the changes in our lifestyle to ensure that no stone is unturned. I have been inspired by many parents who shared their experiences through their blogs, websites, forums, support groups and other social networks.

The first thing is that there might be no “one” particular thing or action that will help you to control your child’s eczema. It is usually a combination of things like regular moisturizing, topical application of steroidal creams, oral medications in severe cases and other such factors. But many parents have also been able to control their child’s eczema (or at least improve) through some lifestyle changes. I have done the same for my child and though in my daughter’s case her eczema is quite severe and is managed through medications, I never give up hope that these measures might be helping her in some way or the other. In any case, I am quite willing to make whatever changes that are required to be one step closer to help Aiyana lead a comfortable life and I am sure you will do the same for your child if required.

Some steps I have taken

1. I changed the laundry and dishwashing detergent for the entire household since that was the first thing most parents mentioned as a key trigger for flare up for eczema in many cases. Infact, last year, when Aiyana developed Erythroderma was the time when I changed the way we do our laundry. It was definitely difficult in the beginning to completely redo the way we do our laundry. I had to find out about product availability in India, their suitability to our climatic and water conditions and train my help to use these products. But through trial and error I have managed this effectively and for the past one year now I have completely eliminated synthetic detergents from my household and use only natural products to do the same.

I wanted to find a natural cleanser free of most chemicals (especially SLS and SLES) and came across our very own traditional “reetha” used by our previous generations for laundry as well as bathing purposes. Luckily for me, soap nut (or reetha as it is called in hindi) is produced primarily in India and Nepal. The fruit contains saponins which is a natural surfactants (foaming agent) and have been used for thousands of years in Asia for washing.

I thus started using soapnuts instead of regular and baby laundry detergent for all our clothes since no matter how “gentle” the detergent, they all contain “sulphates” as surfactants or foaming agents. Unlike other cleaning products which contain the harsher surfactant or foaming agent- Sodium Lauryl Sulphate (SLS), the laundry detergents usually contain the gentler version Sodium Lauryl Sulphate (SLES) and a host of other chemicals and preservatives.  I have written about this in details in my earlier post -“Bath time! (And skin care routine for eczema)“.

I buy a soapnut brand called 108 Soapnuts from a Bangalore based company called Daily Dump  through their website. There are also several other websites like  naturalmantra.com and greenngood.com amongst others which promote an eco-friendly and green way of life and stock this brand. As far as other household linen and delicate clothes are concerned I use various forms of a natural, SLS and SLES free laundry detergent made by a brand called “Rustic Art” . They have laundry powder products made of soda ash, lemon and neem extracts, bio degradable liquid laundry cleanser made of natural glycerin and bio degradable laundry bars made of non edible oils, lemon and neem.

(Source: http://solveeczema.org/; http://www.cleaninginstitute.org/clean_living/soaps__detergents.aspx)

Rustic Art laundry powder

2. I also changed my dishwashing detergent from the usual detergent based ones which contain sulphates and preservatives and  other chemicals. I started using a powder made of  shikakai, soapnut and dried lemon peels by the same brand Daily Dump and have been successfully using it to clean utensils by hand for more than a year. However, there are several other options to make one’s own dishwashing detergents by using natural ingredients like castile soap, vinegar, glycerin, borax (NOT boric acid), citric acid, baking soda, essential oils (for fragrance) amongst others. 

(There are quite a few blogs and websites dedicated to green living which have recipes to make on your own and a couple of examples are – http://www.rodalenews.com/homemade-dish-detergent and http://mymerrymessylife.com/2012/02/homemade-dishwashing-detergent-100-green-2.html).

 While I have not made dishwashing detergent at home yet, I have used an automatic dishwasher product free of phosphates, chlorine and other chemicals. It is a plant-based product which is fully biodegradable and is made by a company called Earth Friendly Products and is called Wave Auto Dishwasher Gel. I use it intermittently in my dishwasher as and when required (it is available on amazon websites in UK and US).

3. One of the other major trigger for eczema in children is dust mites which is a tiny insect found in every home. While it is not possible and practical to get rid of it completely one can reduce the incidence somewhat by following a few steps that I have followed

  • I have gotten rid of soft toys and soft furnishing from the children’s bedroom (one should remove carpets if any especially from the bedroom)
  • using “dust mite proof” hypoallergenic covers for the mattresses and the pillows; Portico has a range of such products available in India
  • I changed the heavy drapes that we used to have and started using light, cotton curtains which do not hold as much dust; also I change them every month
  • I also make sure to change and wash all our bed linen every week (ideally one should wash the bed linen in hot water at 50 degrees Celsius or more)
  • I have also purchased a steam cleaner ( Morphy Richards is available in India) and use it once a month on the mattresses and upholstery; it is more effective than a vacuum cleaner since the heat kills the dust mites without the use of chemicals
  • I am planning to test the bedrooms for dust mites using a test kit to figure out whether these measures are working or not using Ventia™ Rapid Test for Dust Mite Allergen; I will update you once I have done so

Ventia Allergen test

These are some of the steps that I follow diligently at home and now these changes in our lifestyle have become second nature to me and my family. I believe that even if these measures do not directly and measurably improve my daughter’s eczema (at least in the short run) they do not harm her either. They are changes that I am willing to make and so have a lot of other concerned parents whose children suffer from allergies, eczema, asthma and other related conditions.

It really helps to know what has worked for others and I keep myself updated about the way other parents try and make their homes and environment more green and healthy for their children and incorporate some of the measures from time to time. I hope that you might also find some of these useful and beneficial for your child in the long run as well.

If nothing else it will open up a whole new world of eco-friendly and green living for you and your family like it has for me!  

 Incase you have any suggestions or questions please do feel free to get in touch with me. 

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..the tough get going (Part 2)

 

Bath time! (And skin care routine for eczema)

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Skincare is an integral part of the treatment for eczema. Dryness of skin due to eczema occurs since the skin is unable to retain moisture. As far as my daughter is concerned, her skin care routine during bath and before sleeping at night usually takes up to an hour at times. I also moisturize her in between as many times as required depending on the weather and skin condition. She gets quite frustrated at times since it’s quite elaborate, but there is really no choice. For someone who such severely dry skin we have to take all precautions to prevent her skin from drying out.

Bath routine

The process that I follow is that of “moisturize and seal”. The skin is moistened during bath time and then followed immediately with sealing the moisture in. Also, I am very careful about the bath products that I use on her. I use only non scented, soap free cleansers on her skin . And if her skin has flared up a lot, I sometimes avoid applying anything on her skin at all apart from water or just sponge her gently. The bath is usually kept short to about 2-5 minutes to avoid further drying out of her skin. The steps that I take for her bath are as follows-

  • a short (2-5 min) bath that helps moisturize the skin
  • use some kind of emollient or bath oil/oatmeal powder in the water
  • use a soap free moisturizing cleanser on her
  • apply a thin layer of liquid paraffin to seal the moisturize (if required)
  • pat her skin dry (not rub)
  • apply moisturizer (ointment or cream depending on weather) as soon as possible before the skin becomes completely dry

Cleansing

Soap substitutes and bath emollients are very useful to clean and moisturize skin prone to eczema. I use bath emollients like Hydromol/ Oilatum bath emollient or oatmeal powder to add to her bath water to provide additional moisture to her skin.

Based mostly on the experiences of other parents across the world (through their blogs and other interactions over the years) I completely avoid bath and skincare products which have Sulphates in them and Sodium lauryl sulphate (SLS) in particular.  Some studies have shown that Sulphates and SLS in particular can damage the skin barrier in people with healthy skin as well. (Source: http://www.eczema.org/aqeous; http://www.ncbi.nlm.nih.gov/pubmed/14728695)

SLS is a synthetic detergent (cleaning agent) and surfactant (which means it makes bubbles). It is used in industrial products such as car wash soap, engine degreasers and floor cleaners. But it is also used in a wide range of personal care products such as soaps, shampoos and toothpastes to create lather.  While it is known to irritate skin when it comes into contact with products which have high doses of SLS, it can also damage skin of children with Atopic Dermatits. Usually, regular baby bath products contain Sodium Laureth Sulphate (SLES) which is gentler than SLS and is used to produce foam.

Last year when Aiyana’s skin condition was not improving at all was the time I decided to cut out this group altogether. I found options like Calfornia Baby products which are not only free of SLS and SLES but are also free of preservatives like Parabens. Instead they use coconut derived amino acids in their lotions which act as preservatives but are actually antioxidants; gluconolactone (corn) (and) sodium benzoate, an approved preservative for organic products in their shampoos and body washes. I am sure there are other such products which are equally gentle on the skin but as of now I am sticking to this range since I really do not want to take any chances with her skin care. It has proven to be gentle enough to be used even when her skin was not in a very good condition.

Oilatum Bath Additive Oil

Oilatum Bath Additive Oil

There are other less expensive options which I have used for Aiyana like Aveeno bath products (for e.g. Aveeno Skin Relief Body Wash); Oilatum bath emollient; Hydromol bath emollient and E45 cream and emollient. These have also worked well for her in the past and I still use a few of them (like Oilatum and E45) off and on both my children depending on their availability and skin condition. The paraffin based bath oils and creamy washes are good options in the summer months in a humid climate in our country. I have used the ointment form for cleansing (Epaderm and Hydromol ointments which are emollients and cleansers- all in one) a few times for my daughter when her skin had become extremely dry during the winter months. But I suppose for most children the bath oils and creamy washes should do the trick.

Products

  • Aveeno body wash is an oat based creamy wash;
  • Hydromol bath and shower emollient and Oilatum bath additive emollients are both liquid paraffin based bath oils (they also have cream based washes)
  • E45 has a cream wash and an emollient bath oil which work as a cleanser; Epaderm is in the form of a 3 in 1 emollient, bath additive and skin cleanser in ointment form
  • There are also other bath additives and creamy cleansers from Cetaphil, QV, Eucerin, Neosporin Ecema Essentials amongs others

    Epaderm 3 in 1 ointment

Availability

  • Aveeno products are usually available in Mumbai based stores like Just Moms (Breach Candy), Green Bell (Juhu), Amarsons. They can also be bought online from amazon.co.uk or amazom.com and a few sellers do ship them to India
  • Oilatum is readily available in most big chemist shops
  • Cetaphil, Eucerin and E45 are sometimes available in the same shops I have mentioned above
  • Hydromol and Epaderm is available in the UK and I buy online from amazon.co.uk or request my friends to get it for me
  • QV and other brands like Neosporin are available in the US and can be bought online through amazon.com but are not shipped by all sellers ( I am trying to figure out a way to get Neosporin Eczema Essentials Products for Aiyana since they are being recommended by quite a few parents)

E45 wash cream

Moisturizing routine

Emollients are found in various forms like creams, lotions and oils and are essentially used to moisturize dry skin.  I have already mentioned in details the moisturizing routine in my earlier post “Moisturizers and Eczema”. There are many products from brands like Exomega, Cetaphil, Avene, Hope’s Relief Cream. I have tried various products at different points in time depending on her skin condition and availability.

But the most important thing is to quickly seal in the moisture after bath while the skin is still moist after being patted dry.  Also, when the weather is hot and moist (mostly the case in Mumbai), I go lighter, meaning I use creams and lotions (if it’s very hot and humid lotions work well during the day); when it’s cool and dry I go heavier, meaning I use ointments or creams to provide better moisturization for my daughter.

I hope this article helps in giving you some basic pointers on the skin care routine that is so necessary for children (or even adults) with eczema to keep their skin healthy and their lives as normal and comfortable as possible. Please feel free to share your experiences and write to me with your questions if any! 

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Moisturizers and eczema

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Our long-term relationship with moisturizers

Moisturizing is a critical element in the treatment of eczema. They are found in the form creams, ointments and lotions.

Creams  contain a mixture of fat and water and feel light and cool to the skin. I have used them on my daughter during the hot summer months and during the day in the winter months.

Ointments are very thick and can be very greasy but they are very effective at holding water in the skin and hence are useful for very dry and thickened skin. I use these for Aiyana at night and as a soap substitute while bathing during the dry season.

Lotions contain more water and less fat than creams and can be used for moisturizing the skin in case of mild dryness.

All of the above may be suitable to be used at various points in time depending on whether a person’s eczema reacts to a specific ingredient or ingredients in an emollient, the humidity and the severity of eczema. Also for eczema (especially in case of children) such moisturizers necessarily have to be non cosmetic  and fragrance free since products containing alcohol, perfumes, lanolin, or preservatives tend to cause eczema breakouts.

Ever since we realised that Aiyana has eczema, I have been looking for the most suitable moisturizer for her. In this regard I have noticed that there is no one ideal moisturizer which has suited her at all times. I have changed her moisturizer brands over the years due to various reasons but I am always looking for a better one for her. I have used a type of cream on her earlier known as aqueous cream which is now believed to be more harmful than beneficial due to its sulphate content. In any case we noticed her skin did not get moisturized properly and I stopped using it more than a year back. (Source: http://www.eczema.org/aqueous)

Thus I have used quite a few products on my daughter, some of which are available in India and others are not. These have been recommended not only by her doctors but also by other parents across the world in their blogs and websites. Maybe you will find one here which will work better for your child as well.

HydromolOver the past few years I have used moisturizer brands like E45 cream, Exomega, Epaderm, Oilatum, Aveeno, Eucerin, California Baby, Mustela, Cetaphil, Burt’s Bees and Pure Potions at various points in  time. All these brands are not available here in India as of now. It can be very confusing to know which cream is suitable for your child and even I have learned through trial and error.

Although I have tried all the creams that I have mentioned, the ones which I found to have a creamier consistency ( these have seemed to work well with Aiyana) are the oat based ones like Aveeno and Exomega cream. I have used both of these interchangeably depending on their availability in Mumbai. But I had to shift from oat based moisturizers to others since she tested positive to the oat allergen last June in the IgE blood allergy test.

Another moisturizer which worked well for her last year is the ubiquitous coconut oil. In fact, when she had developed Erythroderma, we had used coconut oil (Parachute brand suited her better than the organic one) since her skin used to burn if we used any creams at all. It worked well as a moisturizer overall and seemed to really soothe her skin. But it was not as effective during the dry months. Also, Pure Potions amongst the ones I have mentioned has a “skin salvation” ointment which is a thick cream and supposed to have restorative properties and has helped Aiyana to some extent.

Currently I am using Hydromol cream on her(I switch to Hydromol ointment during the dry months) which seems to suit her skin and is effective in keeping her skin just moist. I had started using Hydromol Ointment on Aiyana in the dry months (December 2012 onwards) based on a UK-based doctor’s recommendation. I wanted to change her moisturizers to sulphate and paraben free creams (more on this in a separate post) and hence the change. And I have stuck to this brand ever since as it suits her skin. Amongst the other brands of creams, skincare and bath products (bath wash, shampoo, bath emollient) that have worked for her and have been highly recommended by other parents are the organic, sulphate and paraben free ones like California Baby (US), Burt’s Bees (US) and Pure Potions (UK). But these are on the expensive side as compared to the other brands and I have used these sparingly from time to time.

The other relatively less expensive mosisturizing bath products I have used in the past which I have found to be good for her are the fragrance free washes and shower/bath emollients from Aveeno, Oilatum and E45 out of which Oilatum is readily available in India. Currently I use California Baby bath products extensively for both my children since I have found them to be very gentle on their skin, especially for my daughter. ( I will elaborate on her skin care routine and her bath routine separately).  California Baby wash

Availability

  • Hydromol range is a UK based brand and is available online at amazon.co.UK through a seller-Mistry’s Pharmacy (all the sellers do not ship to India) as well as all the BOOTS pharmacies in UK.
  • Exomega range of products by Aderma, Cetaphil, Oilatum are available in big pharmacies in Mumbai like Rakhangi Medical( Worli), Asian Chemist (Bandra West) , Sterling Chemist (Pedder Road) amongst others as well as stores like Just Moms (Breach Candy), Green Bell (Juhu) and Amarsons.
  • Other brands like Mustela, Aveeno, Eucerin, California Baby, E45 and Burt’s Bees products are available in stores like Just Moms (in Breach Candy), Green Bell (Juhu) and to some extent Amarsons.
  • Pure Potions and Epaderm range are available on Amazon.co.uk as well as some other websites but may not be shipped to India.

I have tried to highlight as many options as possible keeping in mind different budgets. I have also compiled a list of the brands that we have used and their availability in Mumbai…I hope this helps incase you do decide to try any of these for your child. I would love to hear from you about what has worked for your child. Also, please feel free to ask me for any clarifications or any further information.