As I’m coming out of this recent flare, I was fortunate to visit Ben Lee, a naturopathic doctor in Singapore who specialises in eczema/TSW (and has been through it himself).
I found him on Instagram through the TSW community and was impressed by the useful information on his page.
I could tell he knew our community well when I sat down in his office and when I scratched he pointed behind me and said, “Is the fan okay? Should I turn the fan off?”
Even though I could barely feel it, he is accustomed to how sensitive some of us are.
My goal visiting Ben was to generate ideas around the root cause of my flares and what solutions he has seen work in his practice.
We achieved all that and more – he is knowledgeable and shared much valuable information with me that I will now incorporate into my daily life.
Here’s a summary of what we discussed – hopefully, it’s of help to you as well.
The first thing was going through my history and a gallery of photos I have documenting my flares. I went back all the way to 2019 and shared details of my first and subsequent flares, the results from changing environments etc.
I could see the wheels turning in his head as he examined the photos and he would say – that one looks fungal, that one looks bacterial, that looks like staph, etc etc.
I also sent him copies of my bloodwork etc so he knew my allergies.
He asked a lot of questions like, do your eyelids get itchy often, are your stools watery, do you itch when you exercise etc and tried to piece everything together.
Firstly he explained the flares on my face and the flares on my body are different.
The flares on my body seem staph-related, while the flares on my face/scalp look yeast-related.
This makes sense – they look quite different. On my body the flare is bumpy – he said this is symptomatic of folliculitis, caused by staph. On my face it is fungal and likely caused by Malassezia yeast – something I am highly allergic to according to my bloodwork.
However, the root cause of these things being able to happen is the dryness of my skin. This causes the skin to break and lets the staph/fungi inside, which causes the irritation.
If the skin barrier is strong, this won’t happen.
So the main goal was to stop my skin being so dry.
Instead of just telling me to “use a moisturizer” which is what every other doctor in my life has done, we went a layer deeper and he explained why my skin is dry:
The skin needs multiple things to stay hydrated. Omega 3, but also Omega 6 and Omega 9, as well as ceramides, zinc, Vitamin A, Vitamin C and amino acids (protein).
More importantly, the dosage needs to be correct.
Dry skin needs at least 1200mg of omega 3 EPA daily. I told him I was taking fish oil, but when we looked at the dosage, I was only getting about 300mg of EPA. That meant instead of taking 2 capsules a day, I should have been taking 8!
You also want to be getting 300mg per day of omega 6 GLA.
He said the best ways to get these fats are fish oil, evening primrose oil and hempseed oil (Evening Primrose oil being the best choice).
Another useful tidbit was that we tend to concentrate on saturated fats, but the skin actually requires unsaturated fats more.
Saturated fats are things like butter and coconut oil. Unsaturated fats are things like extra virgin olive oil, fish, flax, chia, walnuts, hempseed and evening primrose.
With the above changes, I should expect to see the hydration of my skin improve a lot.
Next we talked about yeast and staph.
In my allergy test I had a reaction to Malassezia, which is a type of yeast naturally found on the face. The flaring areas on my face were consistent with fungi-related flares.
He said using a ketoconazole shampoo can help with the scalp.
As for the face, he said mixing vinegar with water at a ratio of 1:100 and spraying this on your body and face 2-3 times per day has had excellent results for many of his patients.
The reason is this raises the acidity of the skin layer – if there is an overgrowth of staph the skin is too alkaline. When the skin is acidic, fungi and staph can’t survive.
Finally, he said if there are obvious breakages in the skin infected with staph, you can treat it with an antibacterial ointment like Bactroban.
When asked about moisturizer, he said he personally uses the Cerave brand, however, for someone like me with a staph/yeast issue, topical moisturizers are not going to be useful and will likely make flares worse.
He said it’s preferable that we moisturize from the inside, using the protocol he described earlier (omega 3’s etc).
He was also extremely helpful in asking which brands of supplements I’ve been using and then looked them up so he could dose me properly. He also has a huge dispensary and says he’s happy to dispense anything you need but does not sell it aggressively at all.
In the end, his recommendations were:
Omega 3:
- EPA at least 1,200mg daily. (Nordic Naturals Ultimate Omega 60s, 2 softgels 2x daily).
- Drizzle 1 teaspoon of flaxseed oil on all your meals
- 1 handful of walnuts 3-4 times per week
Omega 6:
- Evening Primrose Oil – GLA at least 300mg daily (Source Naturals Evening Primrose Oil 1350mg, 3 softgels daily)
Zinc:
- Zinc Citrate 25mg – 1 capsule daily
Vitamin A
- One palm-sized serving of red/orange foods daily (pumpkin, papaya, sweet potato, carrots)
- Grass fed beef liver – 2 tablespoons weekly
Topicals:
- 1ml of white vinegar into 100ml water, spray on skin twice daily
- Nizoral shampoo for scalp
Ceramides:
- L-histidine supplement (however this is not too important and is optional).
This should keep staph from over-colonizing the skin, while supporting the skin to be more moisturized naturally so it can keep irritants out and give the skin the nutrients it needs to stay strong and repaired.
Since I am quite far along in my TSW journey, and the redness and oozing stage has largely gone, his advice might be quite different to what he would offer to you or anyone else. Overall I thought it was an extremely valuable session, probably the most valuable I’ve had from a medical professional regarding skin and TSW. If you can’t get to Singapore, he also does many online consults which might be an option if you’re interested.
The cost was $220 SGD (about $150 USD) for a 75 minute session.
Wishing you all healing!