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Posted: 15 Jun 2013 04:46 PM PDT

Eczema not only affects your skin, but also all other aspects of your life.

MOMMY, please help me stop the itch!" pleaded the four-year-old in between tears.

It was 3am when Rachel (not her real name) was awakened by her daughter's cries from the next bed. Struggling to keep her eyes open, she staggered out of bed to find the little girl scratching herself bloody in tears.

Her heart aching, she grabbed a tube of moisturiser nearby and gently applied it onto her daughter's skin to soothe it and reduce the chronic itchiness.

The weather was hot, but Rachel restrained herself from turning on the air-conditioner as it would dry the air and aggravate her daughter's skin condition.

Both mother and daughter woke up tired and poorly rested the following morning as a result of their interrupted sleep.

As she applied more moisturiser on her daughter after her shower, Rachel noted with relief that last night's scratches left minimal red and brown spots.

There was a time when the scratch marks were so bad, her little girl was ostracised by her friends. They were afraid to sit near her because she kept scratching herself.

Such is the life of a parent caring for children with atopic dermatitis, a condition more commonly known as eczema.

Anyone who has encountered eczema can tell you this: the impact of eczema is more than skin-deep.

As singer LeAnn Rimes aptly put it: "Eczema scarred my life, inside out. I wouldn't even wish it on my enemy."

Eczema explained

'Atopic' is a word suggesting hereditary elements to certain types of hypersensitivity, while 'dermatitis' simply means an inflammation of the skin.

It is the most common skin disease around the world, comprising 15-25% of all skin problems.

In atopic dermatitis, the skin rashes can be caused by either external factors or internal triggers.

According to Hospital Kuala Lumpur Institute of Paediatrics dermatologist Dr Leong Kin Fon, it is important to first identify the kind of eczema the child has.

In children with endogenous (or genetic) eczema, the skin barrier is dysfunctional due to a defective gene that codes the skin proteins. These children need to focus more on skincare strategies, such as using specially-formulated cleansers and moisturisers.

For others, their eczema is related to an immune disorder, where a trigger sets off an alert in the brain and causes skin inflammation.

Common symptoms include dry and red skin, scaling, extreme itchiness and inflammation.

Scratching worsens the condition by aggravating the inflammation on the upper layer of the skin.

However, most patients find the itch to be intolerable, which results in a vicious cycle of itch-and-scratch, and ends up with bleeding and pain.

The problem usually begins before the age of five. According to University of Texas-Houston Medical School professor of dermatology and paediatrics Dr Adelaide Ann Hebert, this chronic skin condition usually starts with red, itchy patches on the face, but moves to the front of elbows and back of the knees as the child grows.

In 30% of cases, the condition persists into adulthood.

Family history is believed to play a role, especially in families with asthma and hay fever. However, Prof Hebert points out that eczema has multi-factorial causes, including environment, weather conditions and living standards.

Developed countries with high standards of living are found to have a higher prevalence, for example, Japan, where up to 30% of the paediatric population is believed to suffer from eczema.

This is attributed to the Hygiene Hypothesis, where researchers believe living environments that are too clean and sterile deprive the body of beneficial bacteria that are essential for daily living.

This results in the body creating a hypersensitive reaction to common everyday triggers, such as heat, sweat and dust.

Dr Leong thinks there may be truth to this hypothesis, as 2001 statistics show that 12.6% of Malaysian primary school pupils have eczema, compared to 22% of Singaporeans – our highly industrialised neighbour with more stringent hygiene practices.

With Malaysians and Singapo-reans sharing similar genetic heritages, the significantly higher levels of eczema down south are evidence that lineage is not a key factor in eczema prevalence.

Dr Leong also shares his experience in rural Sabah, where his young eczema patients only require simple treatments, compared to patients in the city who usually require stronger remedies.

He adds that eczema sometimes goes into remission as a child grows and his immune system matures. However, those with a family history of eczema are more likely to relapse in adulthood.

Staying moisturised

As eczema has no cure, the main goals of treatment are to relieve discomfort by reducing the itch and increasing the number of flare-free days for the patient.

Indeed, an Eczema Patient Impact Survey suggests that Rachel is just one of the 62% of caregivers who are constantly worried about their child's next flare-up.

Both Dr Leong and Prof Hebert agree that a paradigm shift is needed in the treatment of eczema.

Traditionally, treatment has focused solely on treating flare-ups when they occur, with clinicians prescribing short-term doses of topical steroids and advising the use of moisturisers to keep the skin moist.

"When there is an eczema flare-up, we have to prescribe steroids to manage and calm the skin back into remission (when the red patches and sores subside), which is not advisable for long-term usage due to its accompanying side-effects," says Dr Leong.

He stresses the importance of acting proactively to ensure that the skin remains moisturised, even when the patient's eczema is under control.

As Prof Hebert explains: "A damaged eczematous skin is like having your skin covered in polka dot holes.

"Precious water from your skin is lost through these tiny polka dot holes, making your skin dry and itchy when pathogens (allergens) enter the skin via the broken skin barrier."

The application of emollients or moisturisers will seal these "polka dot holes", and provide a barrier to protect the child's skin from water loss and further damage, whilst keeping the skin supple.

"It is crucial that parents choose a moisturiser with the right formulation, and most importantly, is effective to help treat the child's condition, and prevent the skin from entering the infamous scratch-itch cycle," she states.

As an eczema patient herself, Prof Hebert uses Atopiclair, a non-steroidal moisturiser. She says: "Essentially, patients can expect a dramatic reduction in flare-ups, whilst reducing the need for topical steroids in 91% of patients, according to a paediatric clinical study."

Numerous clinical trials comparing both the traditional reactive and proactive approaches have shown that the proactive approach is better in managing eczema. In one such study, patients were 7.7 times less likely to experience a flare-up with the proactive approach.

Education is key

Patients also need to be educated on eczema and its causative effects, so as to better manage their daily habits that may trigger or aggravate the condition.

"When we give this education, it empowers the parents to really take hold of the disease, and once they know what to do, they would know when to do it – this would be through night and day in their child's life," says Dr Leong.

Most parents who have children with eczema tend to be very conscious about food as they try to identify and eliminate foods that trigger an eczema attack.

In Prof Hebert's experience however, parents are frequently unable to correctly identify the trigger for their child's eczema, especially with the amount of processed foods we consume.

Also, removing food triggers is only effective in the early years for the 10% of atopic eczema patients in whom food is a trigger.

This is because the body's immune system and skin remains dynamic throughout one's lifetime, hence, one builds up tolerance as they grow, says Dr Leong.

He stresses that there is no one-size-fits-all management method for eczema, as the patient's condition may change with age and their environment.

Physicians today use a combination of inside-out and outside-in therapies, where dietary control and effective moisturising are both used to achieve the best results in disease control.

Inside-out therapies refer to finding out the triggers that cause a flare-up and making dietary changes to reduce the incidence, while outside-in involves treating the condition from the outside (on the skin surface) using topical products and strategies.

For Rachel, her daughter's condition improved after she stopped using harsh soap in the shower, switching instead to gentle and specially formulated cleansers and moisturizers without fragrance, preservatives or strong sanitisers.

Prof Hebert shares that baths should be limited to about 10 minutes to prevent loss of lipids in the skin.

Emollient creams should also be applied immediately following a bath, to trap water in the skin, as bathing without moisturizing can be drying to the skin.

Working together

Ideally, parents, physicians and the child should sit down together to discuss the therapies they prefer, as it involves their daily regimen.

Prof Hebert says that parents should be given specific guidelines to help them while allowing them to explore what method suits them and their child best.

Patients and parents also need to know how to use topical corticosteroid creams and ointments carefully, as excessive and prolonged usage can result in thinning of the skin.

This includes using only a thin layer once a day, and no longer than two to four weeks of continuous application.

Patients also need to be careful to avoid using potent topical steroids on the face, as the skin there is thinner and more likely to absorb higher amounts of the cream.

Once the inflammation subsides, patients should switch strategies and embark on proactive management with moisturisers that have anti-inflammatory and anti-itch properties to further suppress the "invisible inflammation", which remains within the skin.

Prof Hebert stresses that parents or patients cannot expect to find an immediate solution by making a one-time trip to a clinic.

Patients often have to try several treatments to determine which one works.

Sometimes, they even have to rotate different regimens to prevent drug tolerance that may develop when using the same treatment over a prolonged period.

Both Prof Hebert and Dr Leong agree that a common problem is that most parents and patients get impatient when they do not see fast results on anti-inflammation drugs or antibiotics, so they take a shortcut by purchasing a steroid cream or an intramuscular injection at the pharmacy for immediate relief. Some even resort to alternative therapies such as homeopathy.

While they may gain immediate relief, Dr Leong warns that they will miss out on learning more about their disease progression, and how they can better manage their next flare-up, manage itchiness, taper down the inflammation, how to reduce colonization of bacteria, and how to reduce the impact of different kinds of moisturising cleansers.

The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. The views and opinions expressed in this column are solely that of the author's. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Start them young

Posted: 15 Jun 2013 04:56 PM PDT

Parents need to tackle the issue of lifestyle diseases from young to minimise the risk of children growing up to become unhealthy adults.

CONTRARY to what many people believe, non-communicable diseases (NCDs) or chronic lifestyle diseases do not just affect adults.

Children are just as vulnerable, and the sad truth is that the actual risk of developing these diseases starts early in childhood, and continues well into adulthood and old age.

The unhealthy lifestyle choices made by many Malaysians is fuelling the rise of a major risk factor for NCDs in children – childhood obesity.

Data collected in 2011 National Health and Morbidity Survey showed that almost 500,000 children in Malaysia are obese. Childhood obesity is also more likely to continue into adulthood.

If nothing is done, not only will your health be at risk, but your child's future health and well-being will also be in jeopardy.

Unhealthy choices

Zee Ying: "I'll meet you at the mamak after tuition classes, ok? Please order one mee goreng and a teh-o-ais limau for me."

Rina: "Ok. Where will you be going after that?"

Zee Ying: "I'm going home to play some video games on my computer."

It is not uncommon to overhear such a conversation in the course of a typical day in Malaysia. It has become a habit to have a quick bite at the mamak stall/restaurant or a fast food outlet, before heading home to play video games, and have dinner before going off to bed.

The unhealthy lifestyle choices and decisions that your child makes can have a negative impact on his future health.

As parents, you should lead by example. Show your child that he should lead an active lifestyle and eat healthily.

Leading inactive lifestyles and indulging in unhealthy foods, coupled with bad eating habits (eg overeating at buffets, and eating/drinking too much sweet foods or drinks), are directly linked to the rising NCD statistics that are plaguing our nation.

Factors such as age, gender, race and genetics are beyond our control. The controllable factors that can affect your child's chances of developing NCDs are eating habits and an inactive lifestyle.

Eating right

Healthy eating is all about getting the right "mix" of nutrition. A simplified method of doing it right is to follow the acronym BMV – eat balanced meals, in moderate amounts, and with a variety of food types.

Whether at home or on the go, eating healthily is a lifestyle choice.

The healthiness of a meal really depends on the ingredients, how it's prepared, and the portions served/eaten.

Being healthy doesn't mean giving up delicious foods. There are several cooking methods, which are healthy and also produce delicious meals. These include steaming, stir-frying, braising, grilling, roasting, and baking.

Instead of using lots of salt, sugar or butter to enhance flavour, you can use a variety of herbs, spices and low-fat condiments instead.

But in the end, it doesn't matter whether your child has home-cooked meals or eats out a lot, as the same general rules for eating should apply. Here are the key points to help your child form good eating habits:

● Practice portion control

Be sure to keep your child's meal portions small in order to ensure that he does not overeat. However, let him ask for more if he needs it.

● Tame your child's craving for sweets

Limit your child's access to sweets; eating too much sugary confections is bad for his teeth and his health, as they have high levels of sugar and calories.

● Limit snacking

Snacking between meals should be controlled; if you do provide your child with snacks, make sure they are healthy snacks (eg egg or tuna sandwiches, slices of fruits, steamed pau etc).

On top of that, make sure your child does not snack two hours before meals or he may "spoil" his appetite.

● Teach your child to eat at regular times

● Encourage your child to eat his meals at fixed and regular times throughout the day.

Meanwhile, avoid the following:

● Deep fried foods, processed meats (nuggets, sausages, bacon etc.), saturated fats (ghee, butter, full cream cheese) and high fat foods (cakes, pastries, pies).

● Extra salt, seasoning, and sauces (tomato, chilli, soy) or heavy salad dressings.

● Calorie-dense foods and foods with high sugar content (eg cakes, desserts, kuih-muih).

● Eating lots of western (fried/roasted chicken, pizzas, burgers) and local "fast foods" (roti canai, mee mamak, fried noodles, curry noodles).

● Eating all the gravy and/or soup that comes with your meal when you eat out.

● Late night meals or snacks (after 10pm).

These rules can also be applied to yourself; do bear in mind that your child constantly watches what you do and will emulate your actions.

Make it a point not to eat just for the sake of eating. Every little bit adds up. Even a "little" snack goes a long way towards increasing your food intake versus the actual amount of energy you spend.

Your eating habits will become your child's eating habits as well, so be sure to lead by example!

Staying active

Keeping your child physically active helps improves his cardiovascular fitness, strength and flexibility, burns up excess calories to keep him in the pink of health, and generally helps him feel, think and learn better.

Insufficient physical activity on the other hand, can lead to NCDs.

Although it may be difficult to set aside time for your child to be physically active between school, tuition classes and bedtime, bear in mind that your child just needs about an hour of this every day.

Get your child to participate in activities that will increase his flexibility, strength and muscle endurance every day if possible, but at least as often as five to six times a week.

You may consider getting your child involved in sports like football, basketball, or badminton. However, on their own, these sports may not be enough, especially if they are only played once or twice a week.

In order to reach the recommended activity level of 60 minutes a day, you will need to encourage your child to become more physically active in other ways. Here are some ideas:

● Incorporate physical activity into their daily routine.

Get your child to help you with household chores such as sweeping, mopping, vacuuming or washing dishes. This is not only great for increasing his physical activity level, but is also good for his development.

During outings, park farther away and count with your children the number of steps from the car to your destination.

● Allow enough time for free play.

Kids can burn more calories and have more fun when left to their own devices.

● Keep a variety of games and sports equipment on hand.

This does not have to be expensive – an assortment of balls, skipping ropes and hula-hoops can keep your child busy for hours.

● Be active together.

This is an excellent way to spend quality time together and serves the secondary purpose of getting both you and your child moving.

You could make it a habit to have a daily after-dinner walk to keep your whole family active, or try a game of "hide and seek", toss ball or dance to music, to keep things fun and active.

Don't neglect to take advantage of playgrounds, parks, football fields and public swimming pools. Make family fitness outings part of your regular routine.

● Less sedentary activities.

Impose a time limit of not more than two hours a day for activities such as watching TV, going online, and playing video games.

Help show your kids that exercise is important by regularly exercising yourself. Keep up your daily exercise routine and your child will most likely follow suit.

A good foundation

Start laying the foundation for your child's future health as early as possible. Chronic lifestyle diseases have their roots deep in our society today, and affect both adults and children.

Children who are overweight or obese are likely to grow to become overweight or obese adults. This increases their risk of developing heart disease and diabetes (which has been recorded in children as young as seven years of age).

They may also have decreased insulin resistance, gastro-oesophageal reflux disease (GERD), impaired glucose tolerance, joint and musculoskeletal problems, sleep apnoea, and breathing difficulties, like asthma.

The early years are the best time to mould good eating habits and an active lifestyle. Help your child develop healthy eating habits. Get him to become more physically active.

The benefits of living a healthy lifestyle mean a lower chance of NCDs in your child's future.

Dr Tee E Siong is the president of the Nutrition Society of Malaysia, and both Prof Norimah A. Karim and Prof Poh Bee Koon are nutritionists. This article is a courtesy of Malaysian Paediatric Association's Positive Parenting Programme. The opinions expressed in the article are the views of the authors. For more information, please visit www.mypositiveparenting.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Our ‘gutsy’ digestive system

Posted: 15 Jun 2013 05:00 PM PDT

The body's gastrointestinal system does far more than just digest our food.

GUTS do indeed, represent more than sheer ninja bravery or your intuitive feelings. The gut's digestive system, sometimes dubbed "the second brain", is a network of more than 100 million neurons that runs the length of your gastrointestinal tract (that is a whopping 5 metres or more!).

Your gut health is extremely crucial to your overall wellbeing, as it is your guts or digestive system that ensures your body is appropriately nourished.

It converts food into energy, absorbs essential nutrients and vitamins, and even does 'guard' duty by fighting off bacteria to keep you healthy and strong.

When the process works as it should, you're happily oblivious.

However, should your gut fail to work properly, many other things in your life can follow suit. For instance:

● A negative impact on one's quality of life (ranging from a restraint on work and activity, and increased financial burden),

● Increased chances of getting cancer, and

● Subsequent increased risk of mortality.

Hello, friendly bacteria!

Your gut is also home to trillions of bacteria known as gut microflora.

It is also home to 70-80% of your body's immune system, so reseeding your gut with healthy (or friendly) bacteria such as Lactobacillus spp. is important for the prevention of virtually all sorts of disease, from normal coughs and colds to cancer.

The "friendly or good" bacteria support your health in several ways:

● Help digest food and absorb nutrients.

● Produce folic acid and vitamin B12 for healthy blood cells.

● Stimulate production of immune cells on the intestinal walls.

● Activate white blood cells that kill bad bacteria.

Caring for your gut

In order to build a healthy digestive system and to be healthy for life, you need to start giving your digestive health the special attention it deserves.

Here are some ways to ensure that your digestive health isn't over-strained:

● Stay hydrated

Make sure you get enough water every day; there is nothing better you can do for your body than to drink sufficient water.

Having sufficient water ensures that your body can eliminate waste efficiently, and also helps prevent constipation.

Fluids found in drinks like water and juices, and also those found in foods, will contribute towards your daily water intake.

● Eat right

Be sure to eat a healthy and nutritious diet.

One of the things you need to take note of is consuming more fibre.

You should also make sure that you take the time to eat properly.

If you frequently suffer from indigestion, bloating, heartburn, and other digestive health issues, consider eating smaller and more frequent meals.

This prevents your digestive system from being overburdened and helps shrink your stomach capacity, making you less likely to overeat.

● Stay physically active

Exercise may help with many minor digestive problems, ranging from bloating to constipation. Just getting your body to be physically active assists your body's digestive system to function more efficiently.

Exercise also induces endorphins, which are great to combat stress, and more importantly, keep you happy!

● Eat probiotic-rich foods

Probiotics are living microorganisms that are often added to yoghurt or yoghurt drinks. Research has proven their efficacy in helping with diarrhoea, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD).

In fact, probiotics are so crucial to your health that researchers have compared them to "a newly recognized organ". Here are some things you should avoid:

● Smoking

Each time you light up, you are sowing the seeds of chaos in your digestive system in many ways.

The valves at the end of your oesophagus can be weakened, leading to acid reflux and heartburn.

It also increases your risk of developing various gastrointestinal cancers.

On top of that, smokers also face the threat of developing peptic ulcers and Crohn's disease.

● Drinking alcohol

Avoid alcohol, especially if you have digestive problems. This is because alcohol will interfere with your stomach's overall functions, like its acid secretion, muscles, and nutrient absorption properties.

Drinking too much alcohol will aggravate your heartburn or diarrhoea, and it may even cause liver problems and oesophageal cancer.

● Eating quickly or gulping food

Keep air out of your stomach by not swallowing it in the first place.

Take your time and eat slowly, being careful not to gulp your food or drinks. Chew each bite thoroughly.

Avoid gum and hard candy if they cause you to swallow air.

● Eating fatty foods in excess

High-fat foods take longer to digest, and since they "sit" in your stomach longer, they also cause your stomach to produce more acid. This, in turn, may irritate your digestive system.

Fatty and greasy foods also lead to a lazy, relaxed lower oesophageal sphincter, which means that you will not only have to deal with a bloated stomach, but there is also a high possibility that the contents will make their way back up your throat.

Avoid complications

The consequences of a malfunctioning digestive system can be extensive and severe, as a weakened immune system means vulnerability to infections and diseases.

This highlights the importance of taking proactive steps to ensure your digestive system receives the care it merits.

In order to avoid these potential health problems, make sure you start caring for your digestive health.

Just start by following the tips outlined above for better health in the long run.

Don't put it off, start caring for your digestive health today.

Datuk Dr Muhammad Radzi Abu Hassan is a consultant gastroenterologist of Digestive Health Advisory Board. The author is not associated with and does not endorse any brands or products. For a free digestive health info guide or more information, please contact 03-56211408. For more information, e-mail starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Kredit: www.thestar.com.my

Ahad, 16 Jun 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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