孫女從嬰兒時期就有異位性皮膚炎,心疼他因為癢而抓出許多血絲與常常皮膚紅腫。身為婦產科醫師的我,對這個疾病不甚了解,但最近開始閱讀這個疾病的相關知識,想與大家分享。
近二十年來,台灣的異位性皮膚炎的盛行率增加將近一倍, 有些研究顯示都市化和空氣污染會增加風險,也有些研究說媽媽在懷孕期間多吃魚會降低風險。
百分之八十的異位性皮膚炎始於5歲以下,而約有一半以上得異位性皮膚炎的小朋友,長大會”自己好” 但詳細原因不明,或許和早期疾病的控制有關。
異位性皮膚炎是一種皮膚的過敏反應,許多病人因爲皮膚天然保濕因子 (filaggrin) 不足的體質,造成過敏原更容易通過乾燥龜裂的皮膚,而誘發過敏反應,所以除了擦藥與(嚴重時)吃藥,保濕乳液對於預防復發非常重要,近幾年有些免疫阻斷劑的上市,讓對付嚴重異位性皮膚炎的 ”藥品軍火庫“ 又增加一些生力軍。
有家族病史的小朋友更容易得到異位性皮膚炎,代表基因也有關聯。約有60-70% 的異位性皮膚炎的病患,會有 Filaggrin 基因上的某些位點的突變 ,目前已知有數十個 Filaggrin 基因位點的突變,有趣的是,亞洲人與歐洲人突變的位點不盡相同。而台灣本土人口 Filaggrin 基因位點的突變,仍尚未被發表。
目前各國的皮膚科醫學會,都同意早期治療,藉以降低復發的強度與頻率,所以小朋友的皮膚如果常常乾紅癢,應該及早就醫診斷與治療。至於有家族病史但沒有發病的小朋友,是否該做Flaggrin基因檢測,而提早擦保濕乳液 ,是一個值得討論的題目。
#異位性皮膚炎
#保濕因子
#提早擦乳液
參考文獻
Chu C-Y et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis. Dermatologica Sinica. 2015 Dec 1;33(4):220–30.
Romieu I, Torrent M, Garcia-Esteban R, Ferrer C, Ribas-Fitó N, Antó JM, et al. Maternal fish intake during pregnancy and atopy and asthma in infancy. Clin Exp Allergy. 2007 Apr;37(4):518–25.
Irvine AD, McLean WHI, Leung DYM. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med. 2011 Oct 6;365(14):1315–27.
Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. ANM. 2015;66(Suppl. 1):8–16.
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My granddaughter suffers from atopic dermatitis (AD) at a young age. The constant scratching causes little spots of bleeding and roughening of her baby skin. There doesn’t seem to be a cure for this condition. Even though I am an O&G specialist by trade, I have decided to read a little bit more on this topic and share them with you.
The prevalence of AD has doubled in Taiwan in the last 20 years. Some research shows industrialisation and air pollution may be risk factors whilst fish intake during pregnancy reduces infant risks of AD.
Eighty percent of AD starts below the age of 5. And about half of the children tend to “grow out of” AD. It may be mutli-factorial but the immune tolerance may be related to early control of AD.
Atopic dermatitis is a hypersensitivity reaction of the skin, many patients are found to have defects in their skin Filaggrin, which is a naturally-occurring skin moisturiser. Therefore skin emollient is an important treatment for the prevention of AD flares. Apart from the existing immunosuppression treatments (such as topical corticosteroids and calcineurin inhibitors), there are now biological agents available for the treatment of severe AD. The therapeutic armamentarium against AD is slowly increasing as we understand more about the disease.
Many variants of mutation at the Filaggrin gene have been found in up to 70% of patients with AD. There are currently 50-60 disease-causing variants known. Interestingly, mutations found in the European population seem to be different from those found in the Asian population. The mutations specific to the Taiwanese population are yet to be found.
The consensus amongst international experts seems to agree that early treatment of AD reduces recurrence and severities. However, it would be interesting to know the utility of early moisturizer application in those testing positive for Filaggrin gene but without AD.
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Asher learns to ride a bike!
This is the 4yo who still whines when he goes to school and clings onto me, is learning to write his Chinese name, can barely read a few words, cries easily and is still like a baby in many ways even though we tell him he is a big boy now already. So he definitely surprised me that morning.
Remember how the kids and I lugged our new bicycle from Decathlon onto the train all the way home? Yup, it was all worthwhile because guess what, this boy learnt to cycle in just 30min! He was a little apprehensive at the start because he couldn't control the handlebar and there were the inevitable mistakes where he rammed into the wall, knocked over a bench and fell into a bush. Yup, not everything was captured on camera (thanks to the little sister for helping us to take these clips!) but you do know that behind every success lies hardwork, effort and persistence. So glad that he managed to persevere, pick himself up and be strong enough to keep trying.
Check out his big smiles at the end and how he kept asking to go again and again! I cherish these moments so much and it's funny but I'm always the one teaching the kids to cycle and I have to say this was the shortest record time ever among the three. He learnt to turn in our second session and now he just needs to learn to start pedalling - that will be tricky because the bike is a little too tall for him and he needs to lean over to one side to reach the ground.
For those who were asking for tips, I would say start the kid on a balance bike first (it helps them greatly to balance and steer), find a large, empty area to practise, wear protection gear (at least a helmet and knee pads) to reduce the child's fear of falling, teach them to use the brakes, be patient in supporting and encourage them to keep trying! Some of my favourite phrases are "You can do it!", "I'm here with you", "Control the bike, not let it control you", "Balance, balance, look in front", and "You did awesome!"
P.S. Sharing the only photo we took together that day - Meimei asked us to for keepsake - that shows the unglam me with sweaty armpits. Hahaha. Still, I wouldn't trade that moment for anything.
#ahappymum
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Happy holidays! Sharing this again in case you’re looking for something to do with your little this week! ❤️
Enjoy!
Whether it's the school holidays or not, if you're looking for a fun day out with your toddler, here's the ultimate list I compiled over Ella Grace's 3 week break! 😂😅
Everyday, I would look through the list then narrow it down to one or two choices for Ella Grace to pick from (freedom within boundaries, mamas!) and off we would go!
The list is categorized by area and includes at least one activity and one restaurant. Depending on how she was feeling that day, traffic, dinner plans, etc we would either nap-on-the-go in her stroller (and mama got a quiet coffee!) then continue or we would head home.
Change it up, make it your own, invite a friend, be flexible, but most importantly, enjoy your time together and I'd love to see what adventures you guys get up to! <3
---
KL SCHOOL HOLIDAYS (TODDLER EDITION!):
***
BANDAR UTAMA
1 Utama
Watch people "fly" at the AirRider, have a little splash at the fountain below, stop for a little play and pouch at SquEEEze Me Baby and slurp down some noodles at Go Noodle.
****
BANGSAR
Join a class or open swim time at Aquabubs Swim School(heated salt pool w child-friendly facilities and play area) then stop by La Juiceria Superfoods Signature for fresh organic yumminess and Floristika on the way home for a bundle of happy and a horticulture lesson.
Bangsar Village
Walk over to I Love Snackfood and Nala Designs to explore, have a play and meal at Marmalade, check out Janie & Joe and the awesome dot-to-dot markers and train sets at Kiddos' Gear before finishing off w a sweet "guilt-free" treat at Kind Kones!
BSC
Stop for chicken rice or fish noodles at House + Co before having a little play at Jungle Gym, a little read at Times , a little exploring at Mothercare Malaysia, a little oohing and ahhing at MoMa Lifestyle and top it off with a babycino Jason's Foodhall and a balloon from Chilli's while you wait for your car!
The Hive- Bulk Foods
Spend a day talking to your little one about sustainability and conservation at this cute little zero-waste store in Bangsar. They have workshops for adults and little ones and also a little play corner if they get restless halfway through your browsing. Such a beautiful way to teach teeny tiny about reducing and reusing from helping to bring your own containers to filling them up with your sundries to picking out stainless steel straws for friends and bamboo toothbrushes for the family. The only bad part is when your child announces to the entire universe that "MAMA HAS A BIG ONE TOO!!" while pointing to the Freedom Cups.
***
DAMANSARA UTAMA
The Starling
Spend a day at Kiddomo Universe or catch a kid-friendly movie (with a playground in the cinema!) at MBO Cinemas. Stop for a steaming yummy bowl of pho at Pho Vietz or walk outside for a super yummy nasi lemak and fried chicken at Village Park.
***
DAMANSARA JAYA
Atria Shopping Gallery
Spend a day at Jungle Gym (Tuesday mornings are the best day to go!), eat lunch at Antipodean Cafe (they have a mini play area), get a massage at Healing Touch while teeny tiny naps or you can even drop them off at Playroom Malaysia. If you feel like blowing a few dollars on arcade fun, there is a Molly Fantasy on the third floor too! Ella Grace loves going to the Naughty Nuri's for dinner as there's always some sort of dancing performance to wiggle to!
***
DESA PARK CITY
Plaza Arkadia
Depending on where you park, check out Noriter or Kinderia for a little play, awesome books at The Story Book, a balloon at Brrrloon, the most amazing toy store and lifestyle mash up at Carousel and Kaleidoscope, splash around in their splash fountain, swing on their tree house and stop for some chicken tandoori pizza at Nutz and Bolts or a nyonya meal at Aunty Lee's.
If you're at Waterfront instead, check out the fishes in the lake, the amazing walking trail at the park with lots of pets to say hi to along the way, playground to explore and then stop for a meal at the new Kenny Hills Bakers!
***
KAMPUNG PENCHALA
Either on the way somewhere or as an activity by itself, stop by Restoran Sambal Hijau for an incredible array of authentic Malay food - Ella Grace's visit isn't complete unless she says hi to the cats, chickens, and checks out the banana leaf trees and gardens!
Bonus joy for mama, you can get your car washed and vacuumed while you have lunch!
***
KOTA DAMANSARA
IPC Shopping Centre
Join a cooking class at Young Chefs Academy Malaysia, have a little play at Bucket B Cafe, enjoy some udon or sushi at Ben's Independent Grocers and end your day with a sweet treat at Inside Scoop or Magnum!
Alternatively, you could also walk over to IKEA and have a play at the playground in The Curve, ride a train, and have lunch at Macha & Co. There is also a KidZania Kuala Lumpur nearby for older kids!
***
KUALA LUMPUR
Suria KLCC
Take the train to KLCC and visit Aquaria or Petrosains - The Discovery Centre, browse the books at Books Kinokuniya Malaysia and eat a lunch of local favorites at JP Teres in Grand Hyatt Kuala Lumpur
**If your little one can hold out, there is a beautiful musical fountain light show that comes on at 8pm/9pm/9:45pm
Pavillion / Lot 10
Take the train to Bukit Bintang and enjoy breakfast at Shook! in Starhill before checking out Toybox in Isetan a super fun interactive play area for little ones that is only available periodically. Take a little walk over to Pavilion (stop by to watch the Turkish ice cream show otw) and check out the play area inside Parkson for a little bit more running around before settling down for some La Boca (Ella Grace really likes their tender beef cheeks and we like their soft tacos!) or ramen at Ippudo
KL Bird Park
Spend the day at the bird park checking out free flying birds at the aviary, the bird show and depending on what time you get out, you can either grab lunch at the beautiful Peter Hoe at The Row or check out the new kid's high tea set at The Majestic Hotel.
***
MID VALLEY CITY
The Gardens Mall
Have lunch at Benbino (The BIG Group) where there are ball pits, balloon rooms, tunnels, slides or spend a few hours at the new Jurassica on the third floor. They have an awesome play gym Ella Grace loves, along with some live reptile feedings. The dinosaur part is glow-in-the-dark and moves and roars...very cool if your little one is into dinosaurs but might be a little scary if not! They also have a rock climbing wall and flying fox in there. You can stop by Borders for a little coffee and warm milk, some books before nap time or for a little rest then head over to Fresco for delicious Mexican w churros for dessert!
***On Saturdays, our favorite SUPA DUPA Circus balloon team makes a special appearance in Benbino from 3-5pm!
***
MONT KIARA
1 Mont Kiara
Check out the newly renovated Noriter 1Mont Kiara KL (it's now completely built out of foam lego blocks!) before having lunch at Kodawari Menya where the udon is good but the service is even greater! We also love getting a guilt-free treat and stopping for a little coloring at Kind Kones before leaving!
Acoris
We love going to Ra-Ft Cafe' / Bistro for breakfast and then stopping at the Playground The Cafe after for dessert and play!
Publika
We love going to the The Little Owl, Korean Cafe, a beautiful enclosed play area with simple homecooked Korean food, good coffee and attached toilet (so great when you're newly potty trained). We usually stop by the sereni & shentel store to have a little look before picking up groceries at the Ben's Independent Grocer downstairs. Ella Grace also religiously checks the Inside Scoop case to see if the Unicorn flavor is in stock!
***
SRI HARTAMAS
Join a Toddler Sensory class at Baby Sensory Sri Hartamas, grab lunch at Mei by Fat Spoon explore a little at The Batik Boutique then stop by the firestation on the way home to check out the fire trucks and vehicles, training tower and equipment!
***
SUNWAY
Sunway Lagoon, Malaysia
Spend a day at the waterpark, tour the mini zoo, or build sandcastles on the beach. Make it a mini-staycation and rent a room at the nearby hotels for a little rest and check out the DreamWorks Kungfu Panda Village for a little meal fun. I was pleasantly surprised how much we loved Sunway Lagoon (even though she couldn't sit on any of the rides!) and have been back 3 times now! Get the season pass upgrade!
***
SENTUL
Teach your little about refugees and take them for a giant croissant or delicious soft-baked chocolate chip cookie at Project B and get to know your waiter! Check out The Kuala Lumpur Performing Arts Centre (klpac) to see if they have any shows for children (we caught the ballet that day!!) or you can also check out the nice open space outdoors with the giant fishes in the lake!
***
TAMAN TUN DR ISMAIL
Taman Rekreasi Lembah Kiara TTDI
Hidden inside the neighborhood is a beautiful park that you can bring your bicycle/scooters to, blow bubbles, have a little playground fun as well as watch people exercise in various forms from zumba to taichi to calisthenics! There is also some amount of wildlife like monkeys, iguanas, monitor lizards, water spiders etc as well as turtles and fishes in the lake. We usually stop by Aunty Manju's on the way home for the world's most delicious appom or even a rootbeer float at A&W!
***On Sunday evenings, there is a really cool night market that you can get groceries, meat, fish, fruit, etc as well as all kinds of yummy dinner offerings like J's favorite satay and my favorite sup ayam!
***
RAWANG
Mari House
A new discovery thanks to the #LOccitaneCares program, this lovely little edu-retreat out of the city is a super fun day out for little ones from catching fishes in the streams, checking out tadpoles, learning how to grow organic vegetables using compost and other green techniques, cooking "farm-to-table" to just getting to run around in nature! Come armed in some serious mosquito repellent and on the third Saturday of the month, they have a market and picnic with workshops for the whole family!
***
ETC
Look up the IBU Family Resource Group KL playgroup schedule for the week and see which one you might like to join. If at the IBU House, we like stopping at Aunty Nat's for some delicious Nyonya food after!
Go to the morning market in your neighborhood and stop for some roti after before getting the team at Playgroup_nestkl to come over for an afternoon of messy play that includes customized sensory stations, music, storytelling, and fun!
Set up playdates in your house and just let the kids entertain each other. I can't tell you how many times that even when we had grand plans to meet at all of the above, there were also some seriously lazy days where we just hung out at home and the kids made up their own games and stories and we ate delivery!
The key to it all is just doing what works for your family and your lifestyle. You know your child best and what they can handle, even the most "boring" days in your head are the most magical days to them if only because they got mama all day all to themselves.
***
Racheal Kwacz is a child & family development specialist by trade but her most favorite job in the entire world is being mama to the most curious, fiercely independent, joyful little THREE-year-old foodie who she hones most of her parenting workshops with. Follow their adventures on FB and Instagram (@rachealkwacz)!
www.instagram.com/rachealkwacz
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