Thursday, 17 August 2017

Bed bugs

I'm traveling soon. During my last trip to Italy, I came back with very itchy bumps which I was told could be due to bed bugs. What can I do to avoid getting bed bugs again?


Bed bugs is on the rise. More and more local and international travelers came back with bed bugs. Bed bugs usually gives rise to itchy red bumps on exposed part of the body. They do not transmit serious illness but can be a great nuisance.

Why is bed bugs on the rise? 

The biggest reason is probably because more and more people are traveling. These bugs are often found in hotels, hostels, apartments. They can hide in small crevices of luggage from one place to another. As they are small, they can conveniently hide on clothing, furniture and even on your pets. A lot of pesticides for example DDT has been banned for environmental issue. And the natural predators of bed bugs such as cockroaches are being hunted down. Other predators of bed bugs include spiders and ants.

How do I know it is bed bugs and not something else?

If there are new itchy bumps on the exposed part of the body, especially when you have slept on a used bed the night before, then most likely you are getting bed bugs.

You might want to look at the seams of the mattresses for blood stains, rusty spots of bed bug excrement, egg shells, or you might even find a bug or two, which is usually visible with naked eyes as they are about 5mm in size. Bed bugs give a musty odor. Do not forget to check the phone directories, carpets and your luggage too.

How to reduce the risk of bed bugs when travelling?
  • Avoid sleeping on used bed, especially if it has a musty odor
  • Keep the luggage zipped up even within hotel room
  • Store the luggage high
  • Store the luggage in the bathroom if possible (it is not easy for bed bugs to climb up the slippery porcelain)
  • Wash all your clothes upon getting home, even if you have not worn some of them
Click here for a slideshow on bed bugs.


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Skin and Traveling

Itchy Food (Pseudo-food allergy)

I have eczema. Every time I take seafood, my skin itches. What are the food that I should avoid?

I have wrote on Food and Eczema earlier. Diet restriction is only recommended for people with proven food allergy. But a lot of people with negative skin prick test and negative serum IgE to food allergen still complain of itch when they take certain food.

Yes, certain food does make you feel more itchy even though you do not really have food allergy! Why? 

These are food that contains high level of histamine. While most people are happily eating away, some people has lower enzymes (s.g. diamine oxidase) to degrade histamine content in food and may experience "pseudoallergy". Itch and hives are among the common symptom, others may experience facial flushing, angioedema (eye and lips swelling), eczema and even flare up of acne, rosacea and psoriasis. Some people may experience diarrhoea, headache, runny nose and asthma. Just to name a few.

Food with high histamine-releasing capacities include
  • Alcohol
  • Canned food
  • Shellfish
  • Smoked meat
  • Sausage 
  • Certain fishes such as tuna and mackerel
  • Beans
  • Nuts
  • Chocolates
  • Vinegar

Food that may not contain high histamine level but trigger the body to release histamines include
  • Citrus fruits
  • Strawberries
  • Tomatoes
  • Papaya
  • Wheat germ
  • Nuts
  • Chocolates
  • Liquorice
  • Certain fish 
  • Shellfish
  • Pork
  • Egg white
  • Certain additives and spices

Food that reduces diamine oxidase enzymes include alcohol, energy drink, black tea and green tea.

Should eczema patient takes low histamine diet?

Some patients with severe eczema find taking low histamine diet helpful, in particularly during flare ups. Generally diet restriction is not recommended for people living with eczema, unless there is real intolerance.


You may be interested to read:
Food and eczema

Wednesday, 16 August 2017

Choosing A Topical Steroids

Which topical steroids is the right one for me?

I have previously blogged about Steroid Fear and The do's and don't of using topical steroids in eczema. Before I start on how to choose the right topical steroids, I cannot stress enough that the success of using topical steroids starts from an accurate diagnosis, which means using it in the indicated and right situation.

Common conditions treatable with topical steroids include eczema, psoriasis and lichen planus.

There are many topical steroids in the market. They vary in potencies and preparations. Some even comes in combination with antifungals and antibiotics. Generally combinations of topical steroids and antifungals is not recommended as it may lead to persistent fungal infection.

Preparations (vehicles)

Steroids comes in various preparations, generally the ""heavier" the preparation, the "stronger" the strength of the same steroids it carries. One example is that 1% hydrocortisone ointment is stronger than 1% hydrocortisone cream.

Ointment provides occlusion and enhanced absorption of the steroid that it carries. However, some patients may not like the greasy feeling it leaves on the skin. You may want to avoid using it on skin folds and hairy areas. Best timing to use it will be right after a shower or bath.

Creams is good to hydrate the skin and patients love it because they get absorbed after a while. However, creams do not provide occlusives effect. They often contain preservatives and some people can have allergic contact dermatitis to creams.

Lotions are even less greasy than creams. Lotions contain alcohol. Lotions are good for hairy skin because they can penetrate through the hair easily and do not leave much residue on the hair.

Gels are jelly-like. They are good for acne-prone skin. Typically gels dry up very quickly so even if you apply it on hairy area, it does not give matting of hairs.

Other preparations of medications include foams, mousses, shampoos and powder.

Strength of steroids (potency)

In laboratory, the strength of steroids is assessed based on how much it causes blanching (due to constriction of blood vessels) in normal and healthy people. This does not always translate to how strong a particular steroids' anti-inflammatory effects on a patient. However, generally the strength of clobetasol propionate is higher than betamethasone dipropionate than betamethasone valerate than hydrocortisone.

Lower potency steroids are safer for using in large surface area, longer term, thinner skin area and in children.

Superpotent steroids should not be used on face and under occlusion, unless for a very short duration.

Superpotent steroids such as clobetasol propionate are typically not recommended for continuous use longer than 3 weeks, other steroids are typically not recommended for continuous use longer than 3 months.

Summary

Things to consider when choosing the most suitable topical steroids of the right strength and right preparation include:

  1. The diagnosis
  2. Condition of the skin intended to apply (acne prone? very dry?)
  3. Site intended to apply (thin skin area? skin folds? hairy area?)
  4. Surface area intended to apply
  5. Duration intended to use
  6. Age (children? elderly?)
  7. Pregnancy
  8. Allergy (contact dermatitis to preservatives?)
  9. Personal preference



You might be interested to read about:
Steroid fear 
Do's and Don'ts of Using Topical Steroids
Bathing in Eczema
Food and Eczema
Color cosmetics and Eczema
Acne and Eczema

Tuesday, 15 August 2017

Facial Eczema

I have eczema since childhood. I believed I have my eczema inherited from my father. My eczema has been mild all these while until my pregnancy when it suddenly become very severe. I am now 5 months post delivery but my eczema is getting worse each day. It is all over my face and I feel very miserable and depressed.

I have visited numerous doctors and tried numerous creams, steroids and non-steroids, but each time, it came back after a few days. None of the medicine heals. I expressed my frustration on facebook, and after recommendations from another mother, I seek treatment at a traditional chinese medicine centre from Taipei. I was given a soap, a spray and some creams. It helps a bit but still comes back. I was told I can't take medicine because I am still breastfeeding.

I lose my temper easily and totally lost my confident to get out of the house. What can I do?

Hugs. You are not alone. Eczema can be very frustrating. Especially when it involves the face of a young mother.

The Basics

Eczema is a group of inflammatory problem involving skin that is usually itchy. There are many types of eczema.

The one that you seems to have from your description maybe:
  • Atopic eczema: typically starts young, with personal or family history of atopy, associated with defect in skin barrier and immune dysfunction
  • Contact dermatitis: typically persistent and relapsing, particularly if the culprit allergens or irritants is not identified, and appropriate skin care is not in place
A little detective work

Could this be the culprit?
  • Nickel and chromium, not necessarily from costume jewelleries, don't forget the mobile phones (Not common, but people can be allergic to silicone cover of the phone as well)
  • Preservatives and fragrance in cleansing agent including shampoo, cleanser, mouth wash.
  • Skin care products
  • Cosmetics 

Important points:

A product that has been used for several years may not necessarily be safe because:
  • We are not born with allergy, allergy develops over time.
  • The manufacturers can change their formulas to include different ingredient and may not states it clearly.
Don't forget indirect applications can come from the touch of your own hand.

How to get better? 

Management plan of eczema needs to be personalised. Things that need to take into considerations include the stage and severity of your condition.

If your skin is weeping and oozy, you may need temporary usage of astringents, baths or even draining of water blisters. Viral and bacterial infections, if present, must be treated.

Generally, steroids and non-steroidal products help to reduce inflammation, itch and all the suffering that you are having right now.

Moisturised your skin as often as you can. Choose a hypoallergenic moisturiser. Choose an occlussive moisturiser that coats and protects your skin, preventing transepidermal water loss. Choose a therapeutic moisturiser that will help to restore the defective skin barrier.

Avoiding the culprit should get you better within a week or two although it might take months to clear up completely. If you are really not sure which is the culprit, patch testing may help.

You might be interested to read about:
Food and Eczema
Color cosmetics and Eczema
Steroid fear 
Do's and Don'ts of Using Topical Steroids
Bathing in Eczema
Acne and Eczema

Skin and Traveling


I came back from a trip lately and had very bad skin eruption which has never happened to me before. I believe the drastic change of weather is the cause. Is that true that weather affects our skin?


Yes. It is true.

Dry weather

Skin is the most superficial organ and hence it is one organ that is most exposed to the external environment and most susceptible to the change in weather.

We, Malaysian are used to hot and humid weather. If you travel to temperate countries during winter, dry skin and cracked lips are among the most common skin problems. People with eczema may suffer a severe flare if they don't moisturise their skin diligently enough.

Heat trapping clothing?

Traveling in winter, most people will wear heat trapping clothes. Wearing tight fitting or heat trapping clothing can lead to folliculitis due to irritated hair follicles.

Soaking comfortably in hot water bath?

A contaminated bathtub, or even whirlpool, swimming pool and water slides can give one pseudomonas folliculitis. There is even reports of infection from contaminated diving suits.

Sun exposure

Many people gets sunburn while traveling. We hide in shades and in air-conditioned room back in our hometown. When we go traveling, we go outdoor much more frequently. During winter in particular, we love to stand under direct sunlight, not to forget that beautiful snow reflects ultraviolet rays to our faces that are often not covered by the winter coat. The results? The flare-ups of acne, rosacea, eczema, psoriasis, blistering diseases and lupus erythematosus (For people with all this conditions).

More exposure to ultraviolet rays also means higher skin cancer rate apart from lower the immunity and higher chance of cataracts.

Others

Apart from the change of weather, don't forget that stress, diet etc. can affect our skin. Not all trips are nice and relaxing. If you are under stress, acne, rosacea and psoriasis can crop up. If you take a lot of comfort food with high glycemic index during the trip, acne can crop up; or spicy food, and rosacea can crop up.

Do you share blankets, pillow cases or even towels and clothing while traveling? Many skin infections can spread via contacts.

Last but not least, don't forget that bed mites, ticks and scabies can be rampant in certain accommodation with suboptimal hygiene.

I love good skin but I love traveling too. What can I do to avoid skin problem?
  • Sun protection - hats, scarfs, sunglasses, sunscreen, shades
  • Stay moisturised and hydrated
  • Stay warm
  • Keep to your usual skin care routine
  • Avoid sharing of personal items
  • Steer away from contaminated / parasites infested places as far as possible



Monday, 14 August 2017

Acne or Eczema

My face itch with many small red bumps. Is this acne or eczema?



Acne is not typically described to be itchy. In many textbooks, itch is not mentioned as a symptom of acne at all. Having said that, a few studies have shown that 50-70% of people with acne do complain of facial itchiness, in particularly when they sweat, or in heat, or under dry air or when they feel stressful.

Eczema is usually itchy. One senior consultant dermatologist that I know loves to say, "If it ain't itchy, it is not eczema". Is there any new skin care, paper masks, makeup and any other items that you have recently use on your face prior to the onset of the problem? Or did you just have a facial treatment lately? Having said that, all that itch may not be eczema too.

Other possible "itchy red bumps" that may appear on face include rosacea, seborrheic eczema, bacterial folliculitis, pseudofolliculitis barbae, miliaria, perioral dermatitis etc.

Do me a favour. If you can't figure it out it's acne or eczema in the next one to two weeks, and if it's not going away, please consult your nearest dermatologist.

Sunday, 13 August 2017

Can a person with HIV get babies?

Ok, this is totally unrelated to skin, but guess I can put this under health. This morning as I was going out with my family to our favourite Bak Kut Teh place for breakfast, I received a call from my university friend who is an opthalmologist asking about this:"If a person with HIV on HAART (medicines for HIV) is getting married, can he gets babies?"

Obviously the best person to discuss his family plan would be his infectious disease physician with whom he is following up. I might not be up to date but I did a little search on BHIVA & CDC before getting the answer as follows.

If the male partner is HIV positive:
  • Wait till the viral load is less than 50 for at least 6 months
  • Make sure there are no other infections
  • Unprotected sexual intercourse only at the fertile time of the woman's cycle
  • Consider assisted conception with sperm washing or donor sperm if your risk of tramitting HIV is high (ask your ID physician) 
  • Consider pre-exposure prophylaxis treatment (ask your ID physician)
If the female partner is HIV positive:
  • Wait till the viral load is less than 50
  • Make sure there are no other infections
  • Take folic acid at least 3 months before planning for pregnancy, in particular if you are on antibiotics such as bactrim (co-trimoxazole)
  • Both natural delivery and Caesarean section are possible options if your viral load is less than 50
  • Intravenous infusion of HIV medicine may be given if your waters have broken or if your viral load is high
The baby will be given HIV medicine for at least 4 weeks and tested for HIV. Breastfeeding is not encouraged especially if in countries where formula milk is easily accessible.

Good to know: 
Take the HIV medications diligently, don't ever miss a dose, if the viral load is low, the risk of transmitting HIV from male partner to female partner is almost zero, and the risk of transmitting HIV from mother to newborn is less than 1%. :)
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Bed bugs

I'm traveling soon. During my last trip to Italy, I came back with very itchy bumps which I was told could be due to bed bugs. What can...