What is eczema?

Eczema, or atopic dermatitis, is a skin condition that causes itchy, dry, scaly patches on the skin.  Sometimes atopic dermatitis can cause small bumps on the skin that leak fluid, or thickened and cracked dry skin, or brown patches on the skin. The skin symptoms can come and go. Sometimes the skin can   get so inflamed that an infection can develop on top.

Atopic dermatitis is more commonly seen in babies and children, but adults can also develop it.

We don’t know the exact cause of atopic dermatitis but we know there are several factors that contribute to getting it.  Genetics is one of these factors.  Atopic dermatitis tends to run in families.  We also know that there is a protein (filaggrin) on the top layer of the skin, the epidermis, that doesn’t work right in some people with atopic dermatitis.

Children with atopic dermatitis are much more likely to develop food allergies.  Children with atopic dermatitis are more likely to develop asthma and allergic rhinitis later in childhood.  This is called the “Allergic March”.  It starts as atopic dermatitis in infancy and then “marches on” to cause allergic rhinitis in childhood and young adulthood, and then even later can lead to asthma.

What can you do at home to help atopic dermatitis?

  1. Eliminate things that worsen it. If there are infections on the skin like Staphylococcus aureus and herpes simples, these must be treated completely. Stress and anxiety can worsen atopic dermatitis, so stress relieving exercises can help calm the skin. Using antihistamines regularly can help control the itching and lessen the amount of trauma to the skin from scratching. If ingestion of foods or inhalation of environmental allergies (this is rare) are thought to be contributing to the atopic dermatitis, these can be avoided. Make sure there is no allergic contact dermatitis (like a nickel allergy) that is worsening the atopic dermatitis.
  2. Moisturize, Moisturize, Moisturize! Since a breakdown in the skins natural barrier is a main problem in atopic dermatitis, it is important to keep the skin moist. Creams and ointments are better than lotions for this purpose. Moisturizers that contain the ingredient ceramide are especially beneficial in helping rebuild the skin barrier. Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with atopic dermatitis are thick creams (such as EucerinCetaphil, and Nutraderm) or ointments (such as petroleum jellyAquaphor, and Vaseline), which contain little to no water. Emollients are best applied immediately after bathing when the skin is well hydrated
  3. Take a bleach bath 1-2 times a week. A diluted bleach bath decreases bacteria on the skin and can help infections of the skin. Add ½ cup of household bleach (not concentrated bleach) to a 40 gallon bathtub of warm water. Soak from the neck down for about 10 minutes. Do not put your head in this water.
  4. Use gentle soaps.  Choose a non-soap cleanser because they are usually free of sodium lauryl sulfate. This chemical creates soap’s foaming action and can irritate skin. Examples of non-soap cleansers include Dove® Sensitive Skin Unscented Beauty Bar,  Aquaphor®Gentle Wash,  AVEENO® Advanced Care Wash, Basis® Sensitive Skin Bar,  CeraVe™ Hydrating Cleanser, and Cetaphil® Gentle Cleansing Bar.
  5. Dry your skin gently. When drying off, pat (don’t rub) your skin dry with a soft towel and immediately apply moisturizer.
  6. If all else fails, visit a Board-Certified Allergist/Immunologist to help manage symptoms.

Portion Distortion

You’ve been eating salads and cutting your portion sizes, but can’t lose weight. Why??

One reason might be portion distortion.

I encourage everyone trying to lose weight to visit the National Heart, Lung and Blood Institute’s page on Portion Distortion.

The pictures are shocking. Here are some examples from their site:

When we go to restaurants, the grocery store, or are inundated with commercials and recipes on TV and online, our idea of what a normal serving size is becomes distorted. We forget what is NORMAL!

How to beat portion distortion? 

Change your plate size to a 9 inch plate. The average size of a dinner plate in the 1950s was 9 inches across. By the 1980’s it had grown to 11 inches and today the average dinner plate is a  13 inches in diameter. Bigger, Bigger, more calories slip right in!

When you go to restaurants ask for a smaller extra plate, or if you get a 13 inch plate, eat only half of what is on the plate. Even if it is a salad. Take the rest home as a second meal and save some money. Or-split the plate with a friend.

 Just serve yourself only what you need.  Don’t fill that plate up with the intention of eating till you’re full.  If you are still hungry, drink water and wait 15 minutes before getting up to get seconds. This allows your stomach time to give your brain the “I’m not hungry anymore” signal. Know the difference between “not being hungry” and “being full.”

Use common objects to remember portion sizes. Retrain your eye to know what the proper size of common foods are. For example a bagel should be the size of a hockey puck. A cup of cereal is about the size of your fist.  You can print out this useful card to take with you when you go out.



Now that you’ve learned about what to eat, what not to eat, and how much to eat, it’s time to exercise and burn calories.  Read our next article on customizing an exercise program for yourself.

Trying to Lose Weight?

If you’re trying to lose weight it easy to be confused by all the different advice that out there.

The weight loss industry is very profitable. Many people claim to be experts in weight loss and give out bad weight loss advice.  And on top of that, the news on TV constantly reports studies on the health benefits of different foods and diets without giving information on study limitations and reliability!

You don’t need to wade through all that garbage of information. Decades of research have shown over and over again several common themes in what kind of diet helps with weight loss.

Remember those old fruit and fiber cereal commercials from the 1990s? Yup, it’s still true!  Fruit and Fiber are beneficial to health.

FRUITS and VEGETABLES:  We know that an increased intake of fruits and vegetables is linked to a lower risk of premature death and they decrease your risk for having heart attack and stroke too.

FIBER:  Eating a diet that is high in fiber can also decrease your risk for having a heart attack, colon cancer and overall your risk for death.  Eating fiber also protects against type 2 diabetes.  Good fiber sources are found in that she bowls, fruits and especially legumes.  Women should consume 25 g of fiber per day and mentioned consume 38 g of fiber per day.

CARBOHYDRATES  (GRAINS and SUGARS): More recently the fat has been to go gluten-free or to cut out sugar completely.  Gr are necessary for good health you should choose whole-grain foods like 100% whole-wheat bread, steel cut oats, and wild rice or brown rice.  Avoid refined grains like white bread and white rice. Don’t be fooled.  Just because the color of the food is brown doesn’t mean it has whole grain in it.  Don’t be fooled by advertising terms like “all natural.” It’s important to read the label carefully as many products will be labeled as “made from whole-wheat” but it actually has very little whole wheat in the product. It can be very deceiving. Click here to Learn to read labels.

RED MEAT:  It is well-established now for many years that regularly eating red meat, particularly processed meats like pepperoni and salami can increase your risk of cancer, heart disease and diabetes.  Try to limit your intake of red meat to high-quality, lean meats only once or twice a month.

FATS: The first thing to know about fats is that there are healthy fats and unhealthy fats.  When it comes to fats, the type of fat you consume is more important than the amount of fat that you consume.

Trans-fats appear on food labels as “partially hydrogenated oils “.  These kinds of fats or solid at room temperature and are found in margarine and commercial baked goods.  They’re also used in frying vats and fast food restaurants. These fats are well known to contribute to heart disease and diabetes and are the worst kind of fat.  They also create inflammation. Avoid these as much as possible.  Even tiny amounts of these fats can increase heart disease by 23%!  Read labels carefully and don’t be tricked into eating trans-fats. To learn how, click here.

Saturated fats such as those found in cheese, butter, and red meat.  Most Americans get a lot of this type of fat through fast food, cookies, meat (burgers, sausage, bacon and beef), milk/butter/dairy, and pizza and cheese. Typically saturated fats have been thought to be unhealthy..  Saturated fats do raise cholesterol levels but is it unclear if this translates into increasing heart disease. So they are unhealthy but we just don’t know how unhealthy. The lesson here is to decrease your saturated fats and do your best to replace them with polyunsaturated fats or monounsaturated fats.

Monounsaturated fats are usually thought to be healthy. Look for them in olives, peanuts, canola oils, nuts, pumpkin and sesame seeds and avocados.  We have seen that diets including monounsaturated fats can reduce the risk of stroke, heart attack and death by about 30%.  If you have diabetes, changing from a polyunsaturated to a monounsaturated diet can reduce insulin resistance.  Click here for a list of foods containing monounsaturated fats.

Polyunsaturated fats are the healthiest and are found in fish, walnuts, flax seeds, sunflower/corn/flaxseed/soybean oils.  Omega-3 fats are important to know about because the human body cannot make this type of fat. Omega-3 gats lower the risk of premature death.  Here are more foods that contain polyunsaturated fats.


Now that we have some information on what you should and should not eat, the next thing to discuss is how much to eat.  


For those who want to delve into the data, good scientific articles to review include the following:

Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, Willett WC, Rimm EB, Hu FB. N Engl J Med. 2017 Jul 13;377(2):143-153. doi: 10.1056/NEJMoa1613502. PMID: 28700845

Mensink, R.P., et al., Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr, 2003. 77(5): p. 1146-55.

Appel, L.J., et al., Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA, 2005. 294(19): p. 2455-64.

What causes itchy hives?

What causes those itchy hives and what can be done about them?

Hives are those awful, itchy red raised welts on your skin. They are caused when mast cells in your skin are triggered to release histamine.

Mast cells release histamine, a chemical that causes itching, redness and swelling.

There are two types of hives, short-term hives (acute urticaria) and  long-term hives (chronic urticaria). If you have had hives for less than 6 weeks, you probably have acute urticaria.

Acute urticaria can be triggered by things such as eating a certain food or drug, insect bites, and infections.

Urticaria can be associated with more serious symptoms such as angioedema (swelling of the lips, eyelids, tongue or other part of the body),  nausea, vomiting, abdominal cramping, light headedness,  wheezing or shortness of breath. These serious symptoms can be signs of anaphylaxis, a life-threatening allergic reaction that required immediate medical attention. If you are experiencing serious symptoms with your hives, seek immediate medical attention by calling 911.

While swelling and hives can be signs of anaphylaxis, it is more likely that your hives are caused by something else. As long as you don’t have any of the other symptoms of anaphylaxis, you can probably wait until you can get a doctor’s appointment to fin out the cause.

If you have had hives for more than 6 weeks, you probably have chronic urticaria.  Chronic urticaria can be caused by an autoimmune condition, thyroid problems or cancer.  Or, it could be due to a  physical urticaria, a non-allergic trigger. Examples of physical urticaria include developing hives after scratching or rubbing, tight clothes, sweating or being too hot or too cold, swelling from vibration, and in some cases, exposure to sun or water.

Hives are  usually treated with antihistamines such as Benadryl, Claritin, Zyrtec, Allegra and Xyzal. If antihistamines don’t work, your physician may recommend a few days of corticosteroids. For severe or difficult to treat hives, some patients may require Xolair injections or immune modulators such as cyclosporine.

Hives, also called urticaria, are itchy, raised, red spots on the skin. They may be caused by allergic or non-allergic triggers.


Prepare for this year’s flu season!

The flu is serious!!!

We tend to think of the flu as something like a cold or stomach bug, however, it is a serious disease. Every year, hundreds of thousands of people are hospitalized and tens of thousands of people die from the flu and related complications. Even relatively healthy people can become seriously ill and because the virus is airborne, (spread through air) healthy habits, such as washing hands frequently, are not enough. A yearly flu shot is a good way to reduce your risk of getting sick; you need a new shot every year because the most common strains of flu change every flu season. Each year’s vaccine is tailored to include the strains predicted to be the most common during the upcoming flu season.

The flu vaccine is safe and effective!

While it is true the flu vaccine cannot completely eliminate your risk of getting the flu, it can reduce your risk by 50-60%. Additionally, the flu vaccine cannot give you the flu because the virus present in your flu vaccine is inactivated, meaning it is not infectious. The most common side effects of the vaccine are tenderness, swelling or redness at the site of the shot. A low-grade fever and muscle aches are also possible side effects.

There is an option for those who dislike needles!

An intradermal flu vaccine is available, which is administered into the skin as opposed to a traditional vaccine which is injected into muscle. Because it is administered at a different site, the intradermal vaccine has a smaller needle!

Different vaccines are recommended for those over the age of 65!

As we age, our immune systems can weaken, which means that a threat must be stronger in order for the body to recognize and fight it. Because the goal of a vaccine is to produce an immune response to help protect against future exposure to a virus, there are two different flu vaccines for those over the age of 65. The first is a high dose vaccine, which is four times stronger than a normal flu vaccine. Another option is a flu vaccine with adjuvant, an adjuvant is substance added to vaccine to produce a stronger immune response.

You can help keep babies and seriously ill people safe!!!

Did you know that refusing to vaccinate yourself puts others at risk? This is because of something called “herd immunity.” Basically, when a high enough number of people have immunity to a disease, either from previous infection or vaccination, everyone will be safe because there is a low chance of the disease spreading. This means that people who cannot be vaccinated, like babies and those with serious medical conditions, will be safe. So go ahead and get a flu shot, you’ll be someone’s hero!

What’s new this flu season? 

A few things are new this season:

  • The recommendation to not use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season.
  • Flu vaccines have been updated to better match circulating viruses (the influenza A(H1N1) component was updated).
  • Pregnant women may receive any licensed, recommended, and age-appropriate flu vaccine.
  • Two new quadrivalent (four-component) flu vaccines have been licensed: one inactivated influenza vaccine (“Afluria Quadrivalent” IIV) and one recombinant influenza vaccine (“Flublok Qudrivalent” RIV).
  • The age recommendation for “Flulaval Quadrivalent” has been changed from 3 years old and older to 6 months and older to be consistent with FDA-approved labeling.
  • The trivalent formulation of Afluria is recommended for people 5 years and older (from 9 years and older) in order to match the Food and Drug Administration package insert.

Please visit the CDC’s website for more information about the flu vaccine.


Walk with Dr. Julie Patel and the ARSH Team!

Bring your family and friends!

Please join us at the park (Terry Hershey Park or Arthur Stoney Park) every 2nd Saturday of the month at 10 am for Walk with a Doc.

We all know that brisk walking can help us lose weight. But did you know that walking also:

♥ lowers your blood sugar levels and your overall risk for diabetes?

♥ can help delay the onset of varicose veins and spider veins?

♥ can protect the joints, especially the knees and hips, from osteoarthritis (wear and tear arthritis from aging)?

♥ can boost immune function?


Walk With a Doc is a non-profit organization that encourages healthy physical activity in people of all ages, and seeks to reverse the consequences of a sedentary lifestyle in order to improve the health and well-being of the country.



The next date will be November 11, 2017 at Terry Hershey Park.  The October 14, 2017  at Terry Hershey Park  has been cancelled. Please park at the Memorial Drive Parking Lot. We will meet in front of the Gazebos at 10 am. We will be wearing Walk With a Doc T-shirts. For park maps and other information please visit: http://www.energycorridor.org/site/page/trails-and-parks