Toddler Eczema

What started out as a suspect fungal infection on the toe, turns out to an outbreak of eczema over the whole body, appearing on the neck, back of the knees, wrists, between fingers and toes.

My 3 year old daughter had an early stage onset of the most common eczema Atopic dermatitis. The actual cause of her eczema remains a mystery. There were 3 theories. 

1. Dry skin

Since she started Nursery 2, she took her own bath and she loved using lots of body wash which perhaps have made her skin dry. And she took 2 baths a day (once in school, once at home), Besides over-showering, we slept in ac room and did not apply sufficient moisturizer has made her skin dry. 

2. Triggers

With the skin’s natural barrier weakened, it was susceptible to irritants and allergens. Heat, soap, dust were all possible triggers.

3. Food Allergy (least likely)

My daughter used to have allergies to eggs and we thought it could be either eggs or other food allergens which we have not discovered.

We visited polyclinic at first when it started from the toe (middle image, as above) and was given hydrocortisone (1%). But it didn't work. It became drier and my daughter scratches it a lot, making it swell. Soon, the rashes spread to some parts of the body beyond just the toes. At that time, I applied lots of moisturizers (including aloe vera), hoping to relieve her itch. Aloe Vera was effective to soothe the skin for a while but required constant application as my daughter started scratching again soon after.

As it didn't work, I thought I should go to a clinic that specializes in skin and I brought her to Niks Maple clinic at Vision (Jurong East). I have visited them before for my acne and it helped. We saw Dr Ong and was pointed out that it was eczema and that I wasn't doing enough in moisturizing my daughter. The consultation alone was about $25 but the cost of the medicine and products were expensive and I spent about $150+ in a single visit. The medicine/products given were as follow:

• Nizoral for her toes
• Fucicort for her rashes
• Anti-Itch Oatmeal Moisturizing Cream 150ml
• Aroma Shower & Bath Oil 750ml

As Fucicort had steroid, I was a little hesitant to apply for her. But the rashes still got worse, partially because my daughter scratches a lot and the skin became dryer despite moisturizing with the Anti-Itch Oatmeal Moisturizing Cream.

Just a week after CNY, her skin still doesn't improve. Rashes started to turn darker and patchy. There are more areas on her body and neck with rough skin. There were red spots forming sparsely over the sides of her body, thighs, arms and the face near the neck. We decided to visit a specialist, knowing that it will cost us a bomb to see them. 

First I called NUH on 31 Jan 2020 and was told that the nearest appointment I could get to see a paediatric dermatologist is in July (6 months gap???!!!) as the schedule was very packed. I asked the nurse over the phone if there was any way to expedite as the skin condition can get really bad even in a few weeks. I was advised to go to A&E if I think is urgent. My goodness... My husband was pretty mad as he said he could easily find a specialist in Korea and spend a lot less. He was surprised at the inefficiency of our public health system. 

Hence, I decided to call a specialist clinic despite knowing it will be relatively expensive. I have called about 3 clinics but most of them are not available on the day itself and will have to schedule one week later, except Chiang Children's Allergy and Asthma Clinic. We heading to Chiang Children's Allergy and Asthma Clinic which was at Mount Elizabeth. The clinic opens at 2pm and waited for my appointment time at 2.30pm. The consult with Dr Dr Chiang Wen Chin was about 10 mins. First she briefly looked at my daughter's skin condition. As my daughter could not sit still, she called in her nurse so that she could ask me questions without my daughter interrupting the conversation. She clearly stated that to "treat" eczema, there is a lot of "homework" for the parents to bring back moisture to the skin. There was a whole basket of creams and medication that I would need to apply at different stages. After the consultation, the nurse demonstrated to me which medication to use for which skin condition. When they mention that I should use moisturizer generously, I wasn't expecting such a huge layer of moisturizer (see image 6). My daughter wasn't very pleased to wear the wet wrap but she obediently followed instructions and sat there quietly as she was given video to watch.

Step 1: Bath Oil
Step 2: Medication
Step 3: Moisturizer
Step 4: Wet Wrap
Step 5: Antibiotics (not required unless no recovery after 2 weeks)

I recalled bringing my daughter to a paediatrician in Korea and I only spend $5 for consultation and around $10 for medication. I saw a skin specialist for my sudden skin allergy when I visited Korea, I only spend $20 (foreigner rate, without subsidy). Seeing a specialist in Korea is even cheaper than visiting a GP in Singapore. 

Review some of the skincare products from The Ordinary

Recently, I passed by a pop-up store by Hust.sg at Raffles Exchange and chanced upon the brand The Ordinary. What caught my attention was the chemical names as I researched on the latest anti-ageing ingredients when I took a specialist diploma course in cosmetic science at Singapore Polytechnic a few years ago. But nothing beats trying the serums and testing the efficacy of them.

Before I decided on getting the above 4 products, I knew that I wanted to reduce the look of acne scars on my face but without being overly abrasive, and I wanted to reduce the uneven tone or brighten my skin so that my face will look rejuvenated. I read some reviews from other bloggers, such as

• The Best Products From The Ordinary to Stock Up On, Stat by Byrdie 
• Reviewed: The Best (and Worst) Skincare Products from The Ordinary by TheSkincareEdit
• We Tried Every Product From The Ordinary — Here's What We Thought by Refinery29

The top 4 products which I have chosen are as below. Surprisingly, there aren't that expensive.

1) Ascorbic Acid 8% + Alpha Arbutin 2% (costs SGD 19.50)

• Targets hyperpigmentation, dark spots, uneven tone, signs of age
• A unique combination of two powerful brightening ingredients
• Alpha arbutin is a derivative of hydroquinone and inhibits melanin production

2) Alpha Lipoic Acid 5% (costs SGD 12)

• Targets lackluster skin, signs of age
• A concentrated serum to brighten and to target signs of age
• An enzyme with strong antioxidant activity, sensitive skin will probably find this too harsh.
• Meant to be applied only two or three times a week, at night, so could be a good alternative to daily vitamin C

3) Lactic Acid 10% + HA (costs SGD 12)

• Targets uneven tone, textural irregularities, fine lines
• A high-strength superficial peeling formulation
• Make your skin more sensitive to the sun and could be irritating

My Review: Despite the high concentration of lactic acid, there was no burning sensation. Yet the slight tingling sensation makes you feel that the serum is taking its effect. The smell is distinct but reasonably acceptable. I used it for almost 4 days per week and I could see a remarkable pinkish glow on my skin, seemingly taking its effect as a superficial peeling serum. I made sure I apply moisturizer at night and it seems like the skin absorbs the moisturizer even better. I used to have lots of acne during my 20s, but now at mid-30s, I have mainly scars which I hope to reduce the uneven tone. Well, I don't expect a miracle change but I think over time the overall skin tone will improve with the mild chemical exfoliation. For the low price, I will definitely consider continuing to use it long-term.

Scars from previous acne

Read more from other users: SkincareByMoonlight,  WardropeOxygen, ViewsInPixels, NessiesBeautyBlog,

4) Ascorbyl Glucoside Solution 12% (costs SGD 18)

• Targets dullness, uneven tone, signs of age
• A brightening serum with stabilized Vitamin C derivative
• Ascorbyl glucoside is not as powerful as the gold standard, L-ascorbic acid. It's effective for evening out skin tone, but probably won't help much with collagen synthesis.
• Suit any skin type, especially acne-prone skin

PUPPP rash of pregnancy - What worked for me

Now in the 30th week of my second pregnancy, I am suffering a super terrible itch named PUPPP (pruritic urticarial papules and plaques of pregnancy), also known as polymorphic eruption of pregnancy (PEP). There are big patches of red skin all over my stomach and breast, which get really itchy when rubbed against clothing, triggering my unconscious scratching. Scratching momentarily satisfied my itch, but resulted in more itch, more redness and purplish "bruise". 

Stage 1: Early onset of PUPPP

There are smaller pink spots all over the stomach, of which some of them congregate together. During this stage, the itch is already immense. Not knowing what it could be, most mothers will be like me, I subconsciously scratched it frequently. During this "inflammation" stage, the papules and plaques are pretty distinct. As the skin is inflammed and more sensitive, I used purely aloe vera gel.

Day 3 of PUPPP

Stage 2: The spread of PUPPP

Even with minimal, light and indirect scratching, the pink spots will continue to spread in greater area. By day 5, my entire stomach is almost completely red. Even with light scratching, the skin was easily "bruised" under the surface and the patch will look a purplish-blue instead of red. That area will feel slight pain compared to the other areas of redness.

Day 5 of PUPPP

It is important not to scratch or trigger the skin further. I will recommend against any of these when you have PUPPP. You also will not want to introduce open wounds that increase risk of infection.

1) Do not use shower head.

The water blasting from the tiny nozzles hits on your skin, aggrevating it further. You may feel good during a shower bath as it reduces the itch, but unconsciously, the spots are aggrevated and begin to spread to greater area. Use a

tap or water scoop instead.

2) Do not use hot water to bath.

Similar to use of shower head, hot water provides you only with temporary relief of itch but it actually stimulates the nerves and "dries" your skin. Cold or room temperature water provides greater relief and the itch is reduced more after the bath

3) Do not rub your skin too hard while bathing

The last thing your skin wants is further stimulant. Besides using milder soap, only gently clean your skin without scrubbing.

During this stage, I have also experimented with a few external remedies:
1) Aveeno Daily Emollient Cream (Triple oat complex + ceramides)
I used this straight after bath, applying on the left side of my stomach. It provides about 3-4 hours of itch relief and I apply more whenever the itch is back.

2) 99% Aloe Vera gel
I also used this straight after bath, applying on the right side of my stomach. It also provides about 3-4 hours of itch relief. It seems like the rash spread less compared to the left side of my stomach which I used Aveeno (oat/ceramide based cream).

3) Suu balm dual rapid itch cream (menthol + ceramides)
My friend introduced this cream to me as it was effective for her. I like the menthol which provides a cooling relief but the itch relief only lasts about 2 hours. Perhaps it is lighter compared to Aveeno. This cream is formulated by National Skin Centre Singapore, especially people with dry and eczema skin. While mentol's cooling effect cacels out itch, but products higher than 1-3% concentration irritates the skin. Suu balm cream has 3%. Hence I avoid putting it direct on skin. I will always apply aloe vera first and let it dry before applying Suu balm on specific spots. As the cooling sensation makes me comfortable, I have bought the other range of products such as Suu balm wash and lotion.

Day 7 of PUPPP

Surprisingly, the itch reduced on day 6 night. Either I made a conscious effort not to scratch and the itch reduced, or because the itch was more manageable and I scratched less. And because of that, the redness did not spread further to other areas. The redness has also started to become paler. I also noticed papules and plaques are significantly less. Some little areas seem a little flaky, hence I apply generously more aloe vera on those areas. Whenever it feels a litle itch and bathing in cold bath, the other difference I made during day 5-6 was the following:

In terms of fluid intake:
1) Drank more water and green tea throughout the day
2) Drank lemon water in the morning (for detoxing)
3) Avoided my usual intake of milk or sweet drinks like bubble tea

In terms of food intake:
1) Had more vegetables (e.g. spinach) and fruits (e.g. apple, dragon fruit, grapes)
2) Avoided chicken and pork, but had salmon fish instead.

Day 14

Although I have less itch and no more pinkish rashes, the dark marks from the past rash seem to take many days to fade away. Meanwhile, I have started to use my stretch mark creams again and no adverse reaction. Hope it gets back to usual soon.

9 Months after last dose of Accutane

I officially ended my Accutane dose on end Feb. As I was planning for baby and to be sure that I do not cause any side effects to my little one, I avoid any unprotected intercourse until after end March. Meanwhile, I was tracking my period cycle. It used to be 28-days cycle but towards the last 2 months of dose, it was +/- 3 days from the usual cycle and the month right after my last dose, it was 36-days cycle. Not too sure if it is because the body or hormone level is adjusting back, or it could be purely influenced by emotion and sub-conscious stress on baby planning. In April, my husband and I made our first attempt and to our pleasant surprise, we succeeded.

Now I am already on my 3^rd trimester (31 Weeks Pregnancy). So far, it was a rather smooth journey for me. No issue with baby’s growth, no vomiting, not much nauseous feeling, no particular food craving or abhorrence. I eat as per normal, drink cold drinks whenever I feel like. I still go for my occasional walks. I do not fully abstain from foods which in Chinese terms “cold food” which apparently are not good for baby such as Chin Chow, Pineapple, Watermelon, soda drink, etc. In terms of nutrition, I was well-conditioned as I was on this  NiPPeR study which involves researchers in the United Kingdom (Southampton), Singapore and New Zealand (Auckland) from the EpiGen Global Research Consortium who are trialling the use of a combination of nutrients and probiotics before and during pregnancy to improve the health of mothers and their babies.

Not sure if it is due to pregnancy or due to long-lasting effect of Accutane, I stopped having acne. My skin has improved and recovered. I barely have any acne. Maybe one or two during first trimester which matured and dried up really fast. I didn’t have to do anything or apply any acne cream or sorts. My facial cleansing and maintenance routine became very simple. Just a simple make-up remover, facial wash (Vitamin A cleanser from Niks Maple Clinic) and facial moisturizer (Skin Repair Cream from Niks Maple Clinic). For the facial moisturizer, I have tried also Intensive Barrier Repair Cream from Niks Maple Clinic which is half the price of the Skin Repair Cream, but I feel Skin Repair Cream is much better. Not only is it more effective in protecting my skin and the texture is better, my makeup also stays better on the skin without turning cakey at the end of the day. 

Final 8th month in Accutane

It has been a long while... The journey has been really long and it does interfere with my plans to have babies. One problem with Accutane is that pregnancy is strictly "prohibited" as it will cause birth  defects that include flipper limbed babies, microcephalous (small heads), tiny o missing ears, tiny eyes, blind, heart defects, delft palate, retardation, vascular malformations, kidney problems. It is also recommended that no trying of pregnancy within the 9th month. Hence careful birth control is required and that adds stress whenever my husband and I gets intimate.

My 8th month will end by end Feb. I kind of fast forwarded the journey by myself. I was told to take 30mg each day, but I took 40mg instead. I read that it is the cumulative dosage that is important and the recommendation of minimum cumulative dose is 120mg/kg to 150mg/kg. Considering that my weight is 52kg --> lower dosage is 54 * 120 mg = 6480 mg. Assuming that I take 30mg each day, I will need about 7-8 months. If i increase the daily dosage, I could potentially reduce the period. However, it is not recommended to increase the daily dosage to too high a concentration. Your body may not be able to take on the side effects. My major side effects are dry lips and elevated cholesterol. Luckily my cholesterol is still within a reasonable level even though it is on he unhealthy high range. My cholesterol used to be on the normal range. Hence, I will say please take with precaution and carefully monitor your health condition.

6 months to Accutane

It has been 6th months in Accutane. Acne has reduced lots since the 4th month, but the whole course of Accutane is 8 months. Now that my skin has completely cleared, I am very tempted to stop the course as I am planning for a baby next year. However, I am not sure what the chances of reoccurance if I stop the course prematurely.

Accutane Journey (End of Month 4)

I just finished 4 months of accutane. Feeling great and more confident. I can now go out with minimum or no makeup foundation :)

Accutane Journey (Week 4)

On 2 Aug (Day 22), it was the start of week 4th. There seemed to have some improvements. Bumps were less prominent, no new acne formed. Both lips and skin was drier but well moisturized with lip balm and moisturizer. I made sure i drink a glass of water when i wakes up and right before i sleep.

On 7 Aug (Day 27), it is almost end of 1 month. Let me show you a snapshot of the days.... apologies of the bad photography.

Roaccutane (Week 1-4) Right Cheek

Roaccutane (Week 1-4) Left Cheek

You must be wondering how I can even go out with this. I used concealer to cover but of cos the bumps cannot be covered easily. Although day 27 looks red, the bumps were smaller can easily concealed. As of today, besides some minor backaches, I do not have much other symptoms of side effects.

1 week - whiteheads surface within 2-3 days, 5x size of pimple bumps, lips dry; Side Effects: lips dry
2 weeks - whiteheads start to burst, some new pimples along the sides of the chin; Side Effects: lips dry, some minor backache

3-4 weeks - pimples and pores shrunk in size, pimple bumps reduced from 26-28 to 5-6, redness remains; Side Effects: lips dry, some minor backache

Accutane Journey (Week 3)

On 27 July 2015 (Day 16, third week), the bumps are still there. I still have about 20 pimples. Some bumps have subsided after I squeezed out the whiteheads. To be honest, it is hard not to accidentally pop the whiteheads as they are protruding. I noted some blood in the nostrils when i blow my nose. This is prob because the skin has become thinner. My lips are still fine as i put a generous layer of lipbalm. I am using Vasline's lip therapy (100% petrolatum) 

Day 17, more cystic acne formed. I wonder if it is because my mensus was coming. The skin has also become dry and flaky, making the skin harder to heal when it was pricked. As much as I would encourage you not to prick it, i understand how much u want to squeeze the pus out to reduce the bumps. I wasn't able to control myself hence i would expect a delay in recovery as the cystic acne of one spot may have spread to other parts of the skin when I pricked before it was "ripe". Darn... 

Accutane Journey (Week 2)

Day 8, the 23 active spots remain red and active. I started to have itchy scalp. I read some blog reviews that accutane makes scar easier, slows down healing process, red marks will take a few months to fade. I will try to observe the cycle of pimples with and without picking. I quote other bloggers' observations as below:

"If you don't pick-
1 day: Ahh huge whitehead of pus
2 day: Dark brown whitehead of pus
3 day: Where the *@#&*# did it go?!
--
If you do-
1 day: Ahh pop huge whitehead of pus
2 day: Ahh huge redmark of pus 

4 day: Another pimple grows elsewhere

4 month: Ahh huge redmark of pus"

In terms of emotions, I do not feel much difference other than being more anti-social. I chose to go for lunches on my own and when I am eating, I tried to motivate myself by reading other people's accutance progress through the website www.acne.org. It helped that many reviewers advised not to give up.