Monday, July 16, 2007

Asian Americans and Eczema


My son, Penguin, has been scratching himself since his third or fourth week of life. Medically, he has been diagnosed with eczema like many Asian American children and especially Pilipino kids according to this study. It is not extreme but annoying, and we feel for him when he scratches off the top layer of his skin like its a lottery quick pick or scratches as if he has fleas. I think we've put an industrial sized vat of Aquaphor and Eucerin on him by now.

At the risk of exposing my complete medical ignorance to the doctors on this blog, the conspiracy theorist in me believes his condition (the fact more Pilipinos like his uncle get eczema) raises the larger issue of differentiated health care based on race. For geneticists, race is more than skin deep (although unclear as to how much and what.) Life expectancy and mortality rates still have significant differences according to race, and I don't think it is simply based on socioeconomic differences (although gender is a bigger factor.) When I did large scale opinion studies on issues that were related to race, we would have to significantly oversample for each racial demographic to have a valid statistically significant sample of particular races. The results of medical studies are assumed generalizable to all populations, but is that always the case, have they oversampled for different races or other subpopulations? Personally, I've been amazed to know of middle class and affluent African Americans dying of seemingly "natural causes" at a relatively young age, and I'm not talking about sickle cell anemia. What medical work is being done on race-specific ailments or effects of medication?

17 comments:

angie said...

i, too, wonder about medical studies that are applied to a general public: a few years ago there was big move amongst medical care providers* to recommend their older patients take a "baby" (80mg) aspirin a day to reduce the risk of heart attack. it was revealed that these studies had been done on ALL MALES (up to that point) - BUT the advice was being given to EVERYONE. makes you think, huh?


*my ex-husband and many of our friends are HCPs.

mamazilla said...

on a related note, i always wonder about caucasian physicians v. asian physicians. being american born and born with a disability, my physicians have always been caucasian. but now that i'm an adult and a mother, i wonder sometimes if i should seek out an asian primary care physician for myself (filipina) or an asian pediatrician for my children (mixed). i just wonder if an asian physician would have another perspective on illnesses and being an asian patient.

currently, we see two pediatricians for my children. our first ped is caucasian and really knowledgeable, very patient/understanding and has a wonderful relationship with the kids. but, her office is far from our current home.

we found a filipina ped closer to home and the few times we've seen her, she's very nice and also very knowledgeable as well. she reminds me a lot of my mom. sometimes so much so in that when i've brought one of the kids in a panic about some random symptom. sometimes, she just looks at me like i'm nuts and a little high strung.

good luck on the eczema front... we're right there with you with the vats of aquaphor and eucerin. i recently read somewhere that eczema has been linked to asthma - i'm so worried!

la dra said...

Still, we need to remember that the box that a person checks (or that someone else checks for them!) on a survey is hardly a scientific category that can be viewed as valid. These boxes are highly subjective, varying from country to country and some people may choose to identify differently in different situations.

Obviously, diseases do run in families but a lot of families are probably as mixed up as mine so the family histories of genetic diseases are also mixed up. So, genetic counseling is done on a family by family basis.

Lastly, I think a lot of medicine is based on generalizations but you do get to know your community and patients eventually over time. And hopefully you can apply those generalizations in a more thoughtful and informed way.

And just a thought: maybe Pilipino skin gets too dry in America's climate. Maybe you should find more humidity? hehe-- just joking!

SoulSnax said...

Mr. Maestro, we're going through the same exact thing with our baby right now. And I wish I had some answers for you. However, in my wife's extensive internet research on the topic, one little nugget stood out for me: the possibility that salt water, or ocean water could be a remedy. I have a memory of a time about ten years ago, when I had pretty bad acne, the combination of seawater and sand, and sun made it all go away. I think it could be the same thing with excema. I've had some pretty bad cases of it myself, and I'm dying to find out if seawater helps. And if you think about it, it could be that we are like fish out of water... we Filipinos evolved (if you believe in evolution) from people who lived in and around the sea. And this has nothing to do with the fact that I am a Pisces!

thisislarry said...

soulsnax, a timely comment.

we're leaving for a beach vacation tomorrow :)

Princess Pony has had pretty bad eczema, since birth. A few years ago we spent a week in Maui and her eczema almost magically receded. Lets see if the beach will do it again this time.

The latest technique we've been using to keep the eczema in check is to give here a 15 minute bath EVERY DAY! and then while she's still moist, slather on the Aquaphor, or Cetpahil Creme (and it must be the creme, lotions are too wimpy).

Our allergist said that in order to have a chance at beating the eczema, we had to get it way way under control, which we really hadn't, always kindof hoping she would grow out of it on her own.

Good luck Mr Maestro, Soulsnax, and fellow Parents of Eczema! -L

Natasha said...

Two of my kids (both multiracial, but not Asian) had eczema, and only a couple things worked--I'll give you my tips :)

Bath 1x a week, not more. Put oil in the bath (apricot, almond, jojoba) and rinse hair with clear water at the end so it's not too oily. The oil baths changed my infant son's life.

For my youngest (Black/White) child, out of desperation I made my own cream (organic bees wax, coconut oil, olive oil) in a thick texture--think carmex. Every time I changed her diaper, I put some on her face. It seemed like one of the thousand mysterious chemicals in all the recommended creams was really aggravating her skin, so I went super-basic with ingredients I trusted. Voila--within days the rash was gone, and within weeks her patchy skin was finally returning to its beautiful brown.

I'm still looking for a pediatrician that can care for everyone in my mixed crew (Native American, African American, European American).

Best wishes,
Natasha

Darryl said...

Aveeno through and through...

I have it..my wife no.

Baby ,yes but on the backsides of

the arms above the elbows only.

Funny, no?

SoulSnax said...

Oh, one other thing that has worked like a charm is Oilatum Bath Formula. My wife picked it up when she was in the UK, and we have only a few capfuls left. If anyone out there happens to know where to get it in the USA, lemme know.

Trixie said...

My sister has eczema too. By the time we were teenagers we had moved to a beach town and it got better. The bad thing was that she was fair skinned and out in the sun a lot. As an adult she still has to work to manage it especially now that's in central TX. Sun damaged caused other problems for her skin too. She has used so many products - all at one time or another. But I believe she will be dealing with this in various degrees all her life. It's not as bad as when she was young/pre-teen but it's not going away forever either. I can remember 1000s of tubes of cream/lotion/etc laying all around our shared bedroom. So rest assured that Eczema can be a problem for all skin types and that even Caucasian doctors with Caucasian patients don't have a 100% certain cure that works for everyone.

S Nguyen said...

I don't know if this works in severe cases, but dabbing breastmilk (especially the cream) on it also seems to work. Something about the antibacterial/antimicrobial properties? Who knows, but it's free if mama and baby are nursing.

= )

Dexter said...

My son is Filipino/White and he had TERRIBLE eczema a newborn. It would be on his face primarily, but would also get trouble spots on his legs, elbows and chest. We tried the usual suspects; Aquaphor, petroleum jelly, Elidel (with prescription)...even a Filipino wives tale remedy courtesy of my mom: always bathe him with guava leaves. Although the symptoms would be alleviated, he would still get it. Now that he's over a year old now, the eczema has lightened up significantly.

One thing that I have noticed is to not only keep the skin moisturized, but also to have him drink lots of water. Since he's been drinking water, it seems to keep his skin clear.

maryschoi said...

hi, as a person working in public health, i feel compelled to say that there are tons and tons of research studie sthat study health disparities between white and non white groups, mostly black/af-american groups. there isn't too much on the asian american group because, well, there aren't that many of us in the us (i think we're like 4%) and it's hard to recruit asian participants. that said, at my work, we are currently trying to get a grant to recruit more asian americans in a large study of people with mild or moderate kidney disease.. we'll seee if the NIH goes for that one. =)

Richard Shen said...

Both my children had eczema. My solution was two fold. Drink more water. The Chinese believe the Eczema is the way "poison" is passed out if too much are in the body. To increase water intake will help pass the waste through urine, and not through the skin.

The other, which was more server with my son, who turn out to be allergic to lactose based formula. Once we switched him to soy based formula, the eczema, along with gas and discomfort went away.

He is now 6, and can drink milk without any problems. It seems he was reacting to the formula when he was younger.

Nanda said...

And yet still looks so beautiful!
Aahh! I want one!

Ben said...

hang in there. my daughter has it, too. it's gotten better, though, and we hope she outgrows it as she gets older.

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SoulSnax said...

Hey guys, i was going through old RiceDaddies posts, and I feel I should share something that our allergist recommended. It has made all the difference:

We used to bathe our kids in a tub full of water and let them soak in there for a bit with the thought that we were helping to moisturize their skin. Afterward we would seal it all in with Aquaphor.

Turns out, tap water in general is not optimal for our skin. Chlorinated tap water is even worse, not to mention swimming pool water. So that explains the tendency of our kids to get eczema mostly on their thighs and knees, because that's what was soaking up the most tap water.

Our allergist recommended either a shower or a very quick bath, followed by aquaphor. We followed that recommendation, and never bothered to fill those prescriptions for steroid creams and anti-itch creams that the allergist wrote up. It's been a couple of months and no eczema at all!