Lady in Red: the clothes issue

First off, allow me to apologize for the large space in between posts. Life sometimes gets in the way and I haven't been posting as often as I would like to.

So. Today I wanna talk clothes.
You may want to be dressed in red or whatever color you choose, but without actually being the Lady in red - literally. (Or gentleman in red.)
This may sound silly to some of you and completely obvious to others, but here goes.

My biggest piece of advice about clothes is:

WEAR 100% COTTON.

I mean it. Seriously. When things start going haywire, do NOT wear synthetic fabrics. Polyester, Lycra, Rayon and the sort are totally out of the question. Fleece? Nuh-uh. That's just a fancy name for polyester, which is actually plastic. Wool? Don't even think about it. Personally, I wouldn't go with linen either.
Cotton simply lets your skin breathe. Other fabrics might feel nicer at first, but put them on a vulnerable skin area and you've just created a potential flare-up.

Now, you don't have to take my word on this one, but I know what works for me. I recommend you try for yourself and see if it doesn't make a difference. I'm not saying wearing cotton will solve your problems; I'm just saying that NOT wearing cotton will make them worse.

Potential pitfalls:

• No label on the clothes. You're looking through old articles of clothing and you've cut the labels off. Or else, you're in a store or flea-market with no labels.
• "But this one is 30/50/80/92% cotton". Well, OK, this is a very personal thing. Maybe a certain percentage works for you and that is fine. What I've personally found is that 8% Lycra can turn a totally breathing shirt into a stretchy one. Sketchy, I say. The very reason designers use 8% Lycra in shirts (to make them look and feel like they're not cotton) is the same reason you don't want them.
• The label says one thing but your skin says another. I know it sounds far-fetched, but I've found certain labels that simply lie outright about the content of their items. Also, some clothing items have insides and outside that are different, etc.
  

The solution? Learn the feel of a cotton shirt. Try your hand at touch tests and test yourself in stores that do have labels. By now I can usually recognize what's cotton and what's not just by touching it. Stick to the 100%, unless your skin signals otherwise. Once you gain confidence in your ability to sense cotton, use the touch-test to guide you. Is this or that fabric kind to your itchy skin? If it is, by all means go for it. Just make sure you follow up on your decision later to see if the skin is suffering from it.

And this goes for everything you are wearing.
Pants? Definitely. Jeans may be mostly cotton but might still itch because of the texture. Other pants might be better, or worse, depending on the material. Go with a combination of labels and intuition, then pay attention to signals from your skin.
Sweaters? Oh yeah. Nowadays it's totally possible to find 100% cotton sweaters. If you wear shirts under the sweaters, you may feel comfortable wearing other material on top. Just make sure the areas that contact the sweater (hands, neck) aren't suffering because of it.
Underwear? Socks? You betcha. Of course, this depends on where your itchiness and rashes are focused. You may not need to worry about these articles. Again, listen to the signals you're getting from your skin and pay attention to what it's telling you.
Winter wear, e.g. scarves, mittens, hats...? Umm. These are harder to find in cotton, and as above, you might not need them to be cotton. If you're really far gone, and itching everywhere, make an effort to find these at least in partial cotton (anything above 50% is better than nothing).
Summer wear, e.g. tank tops and shorts, bathing suits? Go with the exposure level that works for you, but try to stick to cotton in the summer especially: you're skin will need to breathe. As for bathing suits, obviously those don't come in cotton. There's a limit to how much you can do, I guess.
At work? On a date? Why not? There are plenty of cool, savvy and even formal clothes nowadays that are cotton. You just have to keep your eyes peeled for them.
Sportswear? For sure. You want to be super-comfy, not super-itchy, for your workout, right?
Housewear? Yes, yes, yes. If your work (or your fashion sense) demands you wear things that simply cannot be replaced with cotton, at the very least do yourself a favor and change into sweatpants and sweatshirts when you come home.

Now, ladies, the next one is truly for you. (Guys, you can skip ahead...)
Bras, my dears, a very problematic article of clothing. You will rarely find a really 100% cotton bra. You've gotta go with your instincts here, too, because the labels will often lie. A label may say 100% cotton when actually the shell is cotton but the interior is totally synthetic. The straps can be another problem if they're synthetic, as can the connector between the two cups.
My take on this? Play around with 80% cotton (or more) sports bras. Focus on the feeling of the interior. Hanes has some pretty good stuff that's mostly cotton. So do Victoria's Secret, and their padded kind is actually better than any other bra I own. (I stock up every time I'm in the states). One last trick: Wear your bra inside out. Yep, girls, I mean it. Most bras (except the sports bras) feel gentler on the outside than the inside.

A final word to the wise.
Depending on how good or bad your atopic situation is, you may want to forgo non-cotton cloths entirely. I say, refresh your wardrobe with some cotton clothes and see how it works for you. If cotton fulfills your day-to-day needs, great. If not, try to combine as many cotton articles as you can as often a possible (e.g. a cotton shirt underneath more formal wear, or cotton tights underneath a pair of jeans). You may end up looking a bit bulky, but if it helps your skin, that
may be a small price to pay.
The best advice I can give here (apart from "wear 100% cotton", heh) is to say once again: go with your instincts and you skin's signals to figure out what works for you. Good luck!

News Flash: Warning Signs

Edit (6.4.08): just for clarification, these are warning signs of when your atopic is getting bad or worse. They are meant for people already diagnosed with atopic, not for the diagnosis. Only a doctor can diagnose you correctly (and even they can be wrong).

I had missed the signs. Some of them I chose to ignore, or repressed the fact they existed. Some of them I saw, but did not recognize them for the huge, flashing red bulbs that they should have been. Finally, some warning signs were written in a language I had never heard of and therefore I walked right by them.

So, know your warning signs.

1. You are scratching nonstop.
• Recognition: I know, nonstop is very subjective. Still, try to be honest with yourself. When was the last time you sat still for an hour without scratching? Can you even do that? Or are you truly the itchy and scratchy show?
• e.g. in my friend's wedding, same day as my birthday, there is a photo of me in which I am "hugging myself" - in other words I couldn't stop scratching my upper arms. And I was posing for this photo.
• You may not be that far gone, but if you are scratching a lot more than your usual self, make note of this.
  
• Result #1: The restless feeling of scratching alone can drive you nuts. Seriously. Self-image problems may also arise (can anyone say teenagers?).
  
• Result #2: If you have atopic, you'll probably hate hearing this (I certainly do), but scratching really does aggravates the situation. as I understand it, scratching causes more Mast cells to release the histamines that are causing the allergy in the first place.
• that doesn't mean I can tell you how to stop, or that people should in fact tell you to stop - sorry, that's a separate post. But it's definitely a warning sign.
  
2. You can't sleep because you're so itchy.
• Recognition: One or even a few sleepless nights are not a major indication, although you should take notice. If there's a pattern of recurring sleepless nights, beware. Sleepless nights can be either that you can't fall asleep, or you wake up in the middle of the night and can't fall back asleep.
• Result: short and long-term lack of sleep can (obviously) have a harmful effect on your entire well-being and health. It has a systemic effect, especially when it recurs frequently. You literally "need your beauty sleep".
  
3. Your skin is infected.
• See post about infections.
  
• Recognition: infections may have a few forms:
• folliculitis: acne-like pimples wherever your hair grows. This alone may have nothing to do with atopic, but if it's in combination with rashes and itching of the same areas, that is a surefire sign.
  
• secondary inflammation: bacteria may develop in the place your itching has left open wounds. Fluids exuding from the wound, or a honey-colored crust, are some indications of this. (termed secondary inflammation IIRC)
  
• Result: This is more important than you may realize. I certainly didn't. When your skin is infected, it is not able to function as your body's barrier from the world. You become much more sensitive to outside effects such as other diseases. Skin infections can and should be treated.
  
• Also, there is a claim that when your skin is infected, it itches more; I can certainly attest to that personally.
4. Erythroderma: cuts, scratches and rashes are spread over more than 80% of your body.
• Recognition: if the atopic is contained in certain areas, that's bad enough, but if it's all over your body, that is a sure sign that something is very wrong.
• Result: see number 1: you can't stop scratching. This is a vicious cycle that must be broken.
5. Flaky, scaly, peeling skin.
• Recognition: do you leave a trail of white powder behind you? Is your skin falling apart in certain places? If the skin is peeling off or flaking off, this is not good. The more intense the flaking, the worse.
• Result: your skin cannot heal, because it is involved in a continuous effort to grow back. The epidermis turns so thin that it breaks more easily, so scratching has an even more adverse effect.
  

If one or more of these signs are happening to you, run - don't walk - to your doctor. And remember, your physician is absolutely not enough for this. Go straight to the experts. It's worth your time and money to find a good doctor. Again, it's possible a combination of dermatologists and allergists will be needed.

Infectious Infections

Now here's a topic I've been itching to write (no pun intended) ever since I got into the hospital. Remember those warning signs I said I had missed along the road? Those huge blinking lights I just didn't see? Well, infections were by far the most flashy of them. (The sleepless nights were all the dark spots between blinks, evidently, but that's a story for a different post.) And the effect they can have on your skin, and your entire body, can be devastating.

Now, I knew about one kind of infections - the folliculitis infections. You know, those acne-like pimples that give such a satisfying pop. You (OK, I) just love to hate them. Turns out, that for atopic patients they are often caused by a bacteria fondly known as Staph. No, not the cute sister from Full House; it's short for staphylococcus aureus. Now, nearly everybody has these nice little bacteria. The skin has an innate defense mechanism against them, and they just don't bother most people. Except atopic patients. First of all, they evidently have more of it (see paper 1 below). For reasons I won't get into here*, atopic patients then react worse to this bacteria. Then, as I understand it, they often develop an allergy to the bacteria, which causes worse itching (surprise surprise). But the thing is, I didn't have folliculitis before the hospitalization, so I thought I was home free in that domain.

But I had no idea this was only one of the infection types possible. When I was hospitalized, in fact, my skin was harboring three different types of bacteria. Not in the skin follicles, but all around. Especially in the cuts and open wounds. A couple more types and they could've started a party! What party-poopers those doctors were, gosh, I tell you.

Now, these infected/inflamed areas were recognizable by the fluids they were exuding out of the cuts (lesions?) and the yellowish crust they kept developing. This website lists another sign I saw but didn't recognize: my lymph nodes were swollen. It also mentions fatigue, which is a funny one, since I wasn't sleeping at all, so how could I not be tired? [By the way, that same page lists several other potential complications of atopic - worth a read for those of us who think we know all there is to know about atopic.]

These infections can and should be treated. The accepted treatment is usually oral antibiotics, although a cream that combines antibiotics and cortisones can be applied locally.

Now, the infections should go away when the antibiotics has run its course, but they might come back. That's what mine did. About month after I left the hospital I was already full of infections. This time Staph had much less open wounds to go for, so it came out as the folliculitis, my friend from days of yore, and the itching followed close behind. I took another course of antibiotics. Staph went away, but came back even faster this time around; within three days I was noticeably infected. So now, I'm taking them for the third time, and agreed with the doctor to keep taking it in a lower dose as a prophylactic.

A final note - due to a super cool explanation*, the immuno-suppressants I'm taking should not be worsening these infections. In fact, once they are in full operation, I shouldn't be so susceptible to Staph.

Some extra bibliography:
* Prof B told me the article he is co-authoring about this topic hasn't been published yet; once it is, I'll post a link.
1. Abeck, Mempel (1998) . Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications. (abstract)
2. Ihsan Edan Al-saimary, Sundis S. Bakr, Khalil E. Al-Hamdi: Staphylococcus Aureus As A Causative Agent Of Atopic Dermatitis/ Eczema Syndrome (ADES ) And Its Theraputic Implications. (full paper)

An antihistamine druggie

Please remember that I am not a health professional of any kind. My notes represent my own experience and reactions to the drugs in the past and present. Your reactions may be different.

Oh, and I am not paid by anyone to say either good or bad things about the drugs.

Aerius (Desloratadine) - evidently this is America's Clarinex. I use it, it seems to do the job, although for me the restriction of one a day means I have to take another antihistamine to finish the job.

Histazine or Zyllergy (cetirizine dihydrocholride) - sold in Israel, apparently not in the states. It does not seem to be exactly the same as zyrtec (cetirizine hydrocholride, just one, not di) nor xyzal (levocetirizine dihydrochloride). Whatever. Works fine enough for me.

Profiten or Zaditen (ketotifen) - now that I look it up, it says that it is mostly used for asthma prevention. So maybe you (and I) shouldn't be using it for atopic dermatitis. Dunno. I took it twice daily as part of my switching scheme and it seemed to work OK at the time. But I'll try to pay more attention if I ever take it again.

Mizollen (Mizolastine) - the pages I read claim it has less sedative effects, but as I never suffer from sedation from the regular antihistamines, I failed to appreciate the gesture. In fact it gave me gases and caused my mouth to taste weird. If I recall correctly, this seemed to be caused by the inactive ingredient that had something to do with lactose (although I am not lactose intolerant as far as I know). Stopped once I switched to a different drug. Oh, seems to be European only - couldn't find it in the states.

The real sedative antihistamines:

Phenergan (promethazine), as stated in the previous post, is an antihistamine that causes some sedation/calming. The sedation part is supposed to calm down the itchy and scratchy show. For me it just sent me on a wild ride of dizziness, nausea, and major major headaches (caused, as far as I could tell, by extremely high hearing sensitivity. Think Clark Kent in Smallville when he first discovers superhearing).

Otarex (Hydroxyzine hydrochloride) (Atarax in the states) - it is considered as the same family of drugs as phenergan.It's supposed to relieve that itchiness that drives you bananas. Well, it did. It also, in both distant and recent past attempts, gave me those same severe headaches, as well as memory lapses. It affected my ability to think clearly, and caused extreme drowsiness. For me at least it was NOT worth it.

The Headaches with a capital H lasted for a few weeks after stopping to take Otarex (and I only took it for a week). But after I stopped Phenergan they stopped within a day or two.

The other allergy

In trying to get rid of the many side effects I had been suffering due to the massive infusion of drugs that I was on, Dr. R in my first checkup recommended stopping to take Phenergan. This drug is an antihistamine that also induces calm and so is expected to ease itchiness. By this point I was sleeping fine at nights

Dr. R was right in a sense. My nasty side effects all but went away. The massive headaches due to noise sensitivity completely disappeared and the worst of the nuasea, dizziness etc. was gone with the wind.

However Dr. R (dermatologist) dismissed my question about replacing the phenergan with another antihistamine. After all, I was getting aerius, wasn't I? That should be enough, said the doctor.

Enough for the itching, maybe. But within two days, I was sniffling and sneezing, my nose was running a marathon, and I was coughing up mucus like it was fifth grade and I was in a spitting contest. In other words, my allergic rhinitis had reared its ugly head, with a little bit of asthmatic mucus as a side dish. After all, before changing to otarex (later switched to phenergan) I was balanced on a two-antihistamines-a-day diet. So backing down to one was definitely not good.

The good news? Once I put the histazine back on, the runny nose ran in to hide and it's back to normal. Or as normal as it gets around here, anyway.

So there's my reverse warning from the last post. Your dermtologist may discount your other allergies. You have been warned.

Drug info in the following post.

The right doctors: worth more than their weight in gold

Dr. G told me he was the wrong doctor, but I didn't really listen. He's an allergist, and in fact the only doctor I was seeing regularly. He told me I needed a dermatologist. I found one but was inconsistent in my visits. In fact I found three or four dermatologists and did not persist in more than two or three visits to each. And then I went to a different allergist, because Dr. G wasn't doing anything about my atopic (he kept telling me I needed to see a dermatologist!)

Boy, was I wrong.

With atopic dermatitis, you've got two major factors at play. You've got your allergies, and they play a major part. But you can't just bank on the allergies. As Dr. H (dermatologist) once told me - but it didn't sink in - even if I were in a bubble, ate just lettuce and drank just water, I'd still have atopic dermatitis. In other words, allergies are a contributing factor - possibly a critical one - but not the sole cause. And when push comes to shove, and treating the allergies fails to solve the problem, you need a dermatologist.

I found this out the hard way. By the time I saw a dermatologist, it was in the hospital. Learn from my mistakes. Don't wait.

P.S. The reverse is also true. Don't put all your trust in a dermatologist without ever seeing an allergist; allergies may have a major effect on your atopic.

Crème de la Crème

One thing that did not come as a surprise to me at the hospital was the insistence on moisturizing. I had been taking baths and putting creams on my skin for ages. However, the precise nature of these was slightly different than I was used to, especially regarding the creams.

The treatment began with very cortisone-heavy creams. However, as the days passed and my skin cleared up, these were gradually decreased - lower dosages, smaller areas, etc. The main treatment, they explained, will be the immuno-suppressants... and that I gotta keep up the moisture.

So, which creams? Up until now I had been using Vanicream for years. In the hospital they used Eucerin, but not the store-brand one. They mix it up with... olive oil. Precise measurements to follow soon. They recommended I keep using it, and I intend to for now. It leaves the skin feeling quite smooth.

Oh, one more thing. They recommend keeping the creams refrigerated. The idea, as I understand it, is that when you put on the cold cream it has a further soothing effect. Just don't keep it too cold.

And how should you spread the cream? With the palms of your hands, not your fingers. From top to bottom, in the direction of the hair growth, to avoid folliculitis (inflammation of the hair roots).

Baths will come in a separate post.

Edit: with cortisones you're supposed to spread a thin layer, but with the moisturizers, don't be stingy. Other than cost, there's practically no reason not to apply liberally. Just don't forget to use the fragrance-free, paraben-free, everything-free version.

Things that were, and things yet to come

Phew. I haven't been very active lately, but there were some good reasons for that. So, I am going to tell you a little bit about what has been going on. I'm also going to mention a lot of things that will receive my fullest attention in separate posts. I want to do this right, so I will devote a post to any topic that seems relevant and not go into too many details here. So to avoid repeating myself a lot, I'll write "TBE" - to be explained - wherever I want to write more later. [Edit (6.4.08): these TBE's are now links to the relevant posts, wherever I actually wrote them.]

Around the last time I posted, my situation was already pretty severe, and it was getting worse by the day. I somehow managed to function although I was barely sleeping at nights, scratching constantly and so on.
My situation can be likened to the proverbial boiling frog. For nearly two years my situation was going from bad to worse, with only temporary remissions brought upon by use of cortisones in different formats. I will write a separate post about all the warning signs I missed, should have seen, or didn't know existed... TBE#1. But for now suffice it to say that by the beginning of August, I was near the boiling point.
In hindsight, my situation was actually dangerous (TBE [6.4.08 - due to infections and sleepless nights]). To make a long story short, I came to an appointment with an allergist. As I was waiting for him to show up, the nurses told me in no uncertain terms that they think I should go to the emergency room - a statement which managed to dull the surprise when the allergist took one look at me and said I needed hospitalization. Most importantly he said this should be seeing a dermatologist - that he as an allergist couldn't do enough for me (TBE).
So the very next morning I showed up in the Rambam hospital in Haifa, which evidently hosts one of Israel's best skin departments (if not the best one). I came to the upstairs clinic first, and met with the department head. He was also very clear on the fact that I needed to be hospitalized, and so I was admitted to the hospital.
I spent the following ten days there, and received all-around treatment that has turned my skin upside down, inside-out and altogether amazingly healthy. To me the best part of this was that I received no systemic cortisones but rather a combination of other treatments (TBE), the most important of which being an immuno-suppressive (TBE). Within two days of being there my skin was nearly entirely cleared up. I was still itching, though, and not sleeping at nights; this improved later on (TBE). Finally I was discharged home, and I will continue some of the treatments at home while others are over (TBE...).

With so many things yet to be explained, I want to wrap up this post now with a note of cautious optimism. Right now, my skin is in a wonderful condition, and I intend to do everything in my power to help it stay this way. To this end, and also to help other people be healthier, I plan to post a series of short posts on specific topics that I encountered immediately before and during the hospitalization. I hope that I can follow through with these ambitions.

Refreshing treatments

So as of yesterday I started refreshing my day-to-day treatments. In fact, when it comes to antihistamines for atopic, doctors recommend you change your medication every so often as it stops being effective. Something about the receptors becoming blocked. Later you can switch back - the block isn't permanent. I forgot about this trick for a while there, but around March I went to an allergist/immunologist that reminded me of this, Dr. BZ. So I switched from Aerius(mornings) and Zyllergy(nights) to Profiten twice daily.

[Side note: some people get drowsy or sleepy from the antihistamines. Not me. Doesn't do a thing. Or like my mom would tell the doctors when I was a kid: "I wish it made her sleep".]

Seeing as my atopic's been getting worse lately, my mom reminded me of the switching scheme again just the other day. So now I'm back to the old regime: Aerius mornings, Zyllergy (aka Histazine) nights.

Plus, my boyfriend (smart guy) reminded me of a more natural tack that I had taken in the past and we agreed helped - Evening Primrose Oil. This natural dietary supplement is supposed to make your skin healthier and more moist. And indeed, I must say that last year when I stopped taking it I felt a marked decrease in the skin moisture, so I went back to it. For some odd reason I stopped taking it again later in the year and forgot about it completely. Well, now I'm back on it.

All this, by the way, is in addition to:

• the homeopathic remedy that I've been taking for the past half year;
• the moisturizing creams I use constantly; and
• the oil and/or oat baths I take twice a day.

Sometimes it's hard to know what helps and what harms. But I do my best to figure that out as best I can.

Edit (29.9.07) : looking up drugs for this post, it turns out that Dr. BZ was pretty far off the mark in the actual recommendation. Profiten is more of an asthma prevention drug than a generic antihistamine. So even if it's a good idea to switch, don't be so sure that profiten is the drug of choice for atopic dermatitis.

Put on a Happy Face

Hi there. As I said above, this blog will be devoted to my self-research, recommendations, insights and plain rambling about atopic dermatitis. Also known as skin asthma. If you're here you probably know what it is so I'm not going to bother too much with that. Welcome here.

I have it, and have had it since I was 8 months old. I'm now 23 years old which gives me over 22 years of experience to share, not to mention any number of doctor's recommendations that I've heard and unconventional treatments as well. As of right now my atopic is pretty darn severe. This comes and goes in waves of a few years at a time.

So I will begin with a funny insight I had the other day. I woke up after a good night's sleep (a rare occurence for me these days) but due to some renovation noise on the floor above me, my good mood soon turned annoyed. Took my bath and started putting creams on (more about all that later) and was really upset and itchy. This surprised me because, as I said, I woke up with a smile on my face after my first 8+ hour sleep, possibly in weeks. Yet twenty minutes later I was grumpy and as far from smiling as night from day. And then it hit me. I was down and couldn't bring myself to smile, for a very simple reason. My face was so dry that it actually hurt my muscles to smile. I immediately applied my favorite moisturizer to my face and, surprise! The smile came back. It was like magic. Try it the next time you're grumpy for no apparent reason.

By the way, I believe this realization took part in place due to the difficulties I was having in the previous evening's sports class - I attend a muscle-training/toning class. Usually I enjoy the class but that evening I was so dry that it was literally painful to stretch and work the muscles. The next mroning I recognized that very same feeling when I tried to smile. So take this for all muscles, not just your facial ones. Exercising can lift your mood as well as smiling, but if you have atopic, make sure your muscles are getting a reasonably moist skin to work with. Otherwise you will just be in pain.

Introduction to "A Topic: Dermatitis"

Hi, my name is Shiri and this blog is about atopic dermatitis.

A few clarifications and disclaimers before I start. First and foremost, I am not, I repeat, not, medical personnel of any kind. I am a young woman who was diagnosed with atopic dermatitis at eight months I've lived with it nearly all my life, on and off. Any and all recommendations in this blog are my own personal opinion. They may be based in whole or in part on many doctor's recommendations, or other people's recommendations, but eventually synthesized in my own mind and doled out however I see fit.

In fact, I recommend to take everything anyone tells you about atopic, including myself, with a massive grain of salt. Atopic is one of the least understood conditions - certainly for a condition/disease so widespread, one could expect more research and comprehension of the problem but this is not the case. What's more, atopic often varies widely among individuals or even among the same person in different periods. It is extremely important that each and every atopic patient tailor the treatment(s) to his or her own special needs. Trial and error with careful tracking of results is the best way to go. Always be careful when starting a new treatment of any kind. Be aware of the consequences and any new reactions that may stem from it.

One more thing, I live in Israel, not that it's of great relevance but has some bearing on weather-oriented recommendations, so keep that in mind.

It is my intention here in this blog to raise awareness to atopic and provide people diagnosed with atopic (or their parents) with some basic tools to handle it. Atopic Dermatitis is a difficult disease to handle, one that is not well understood neither by doctors nor by society. While asthma is nowadays considered common and no one would be surprised if a kid pulls out an inhaler in the middle of nowhere, the alternative of that same child scratching is often misconstrued, ridiculed or just evokes confusion. Meanwhile the doctors (especially pediatricians who are not dermatologists) react in various ways, often contradicting ones. Recommendations are unclear, and day-to-day recommendations are confused with actual treatment. Prognosis is always foggy and usually completely unreliable.

I want to clear away some of that fog. But again, I implore you not to trust me. Try things for yourself. I'm here to offer you the options and to share my experiences with them. I also wish you the best of luck and invite you to share your experiences with me. I'd love to hear from you.

Thanks,
-Shiri