Daily Archives: March 9, 2020

Five new Steam games you probably missed (March 9, 2020) – PC Gamer

Posted: March 9, 2020 at 1:46 pm

On an average day, about a dozen new games are released on Steam. And while we think that's a good thing, it can be understandably hard to keep up with. Potentially exciting gems are sure to be lost in the deluge of new things to play unless you sort through every single game that is released on Steam. So thats exactly what weve done.If nothing catches your fancy this week, we've gathered thebest PC gamesyou can play right now and a running list of thenew games of 2020.

Steam pageRelease: March 6Developer: Studio SeufzPrice: $14.99 | 12.99 | AU$21.50

How to describe The Longing? In this fascinating game you play as a Shade, instructed by a fallen, subterranean king to wake him after a long 400 day sleep. Keeping yourself occupied is the core of what you'll do in The Longing, whether that be via exploring, solving puzzles or, if you want, reading literature (the game draws from free eBook site Project Gutenberg, and offers the full text of Moby Dick, among many others). An in-game timer counts down 400 days in real time, and that counter continues even when the game is closed, so it's very possible to "play" The Longing and to wake the king without doing anything at all - but you'll have a long wait. Passing the time quicker is possible: "after all, time goes by faster if you learn to keep your mind occupied" reads the Steam description (I take this to mean: by actually playing the game). Honestly, this sounds like a true original.

Steam pageRelease: March 7Developer: MediatonicPrice: $14.99 | 11.99 | AU$21.50

Set in 1990s Los Angeles, Murder by Numbers is a visual novel with puzzle elements. It stars Honor Mizrahi and SCOUT - one is an actress, the other is an abandoned "reconnaissance robot". Together they must get to the bottom of a murder that Mizrahi has been implicated in - basically, her boss fired her and then... died. Very bad timing! You'll "Investigate a range of murders across TV studios, glitzy award shows, drag clubs" and more. Sounds brilliant, especially if you like the Phoenix Wright games but wish they were a little weirder.

Steam pageRelease: March 7Developer: Brave at NightPrice: $19.99 | 15.49 | AU$28.95

In Yes, Your Grace you're a king, and it's your job to make everyone happy. At least, it's your job to make the right people happy, and in this kingdom management sim you'll need to make some fairly morally perverse decisions in order to "keep the peace". Then there's the easy stuff: hiring generals, witches and hunters to "aid your efforts", going to war... things like that. Looks fun, especially if you're keen on stuff inspired by Slavic folklore. Lauren wrote about a Discord roleplay conducted in the game last week.

Steam pageRelease: March 4Developer: Game-LabsPrice: $39.99 | 33.99 | AU$56.95

Launched into Early Access last week, Ultimate Admiral: Age of Sail is the latest from a studio who has carved quite a niche in the Serious Boat Game market (see Naval Action), and also tactical games more generally (see Ultimate General: Civil War). You could almost call this latest game a combination of their earlier ones: it's got ship combat, yes, but it almost features "land and combined arms landing operations". The current Early Access version has English and US campaigns and a nice spread of battles across both, but expect a tonne more when it launches into 1.0, which will happen in about nine months.

Steam pageRelease: March 4Developer: Passtech GamesPrice: $14.99 | 12.99 | AU$21.95

Another Early Access game, this one's a roguelike dungeon crawler full of traps, treasure, and gratuitous amounts of blood. You'll find the usual array of contact and long range weapons (swords, bows, guns etc) with which to mow down "dozens of enemies". Honestly, this is the kind of game that doesn't sound that special on paper but if you see it in action (there's a trailer above) you'll probably be sold. The game is scheduled to launch into 1.0 by the end of the year.

These games were released between March 2 and 9 2020. Some online stores give us a small cut if you buy something through one of our links. Read ouraffiliate policyfor more info.

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Skater XL is a New Take on Skateboarding Games, Coming to PS4 – PlayStation.Blog

Posted: at 1:46 pm

Whats up, PlayStation fans! My names Dain and Im one of the creators of Skater XL, a new skateboarding game that were excited to announce will be coming soon to PS4.

Its been ten years since a new, authentic skateboarding game hit the market, and a lot has changed in that time. Skateboarding franchises were some of the most played and beloved video games of the 2000s many of us have fond memories of Friday nights chilling on the couch with a few buds passing the controller around playing EAs Skate or the original Tony Hawks Pro Skater series.

Fans of the genre have famously been clamoring for a new Skate and a revival of an old franchise, but the question weve been asking ourselves at Easy Day Studios is what would a skateboarding game designed from the ground up today look like? Weve spent the last few years looking to answer that question, designing and improving Skater XL through Early Access, and now moving towards the full launch of the complete 1.0 game.

The most important thing to understand about Skater XL is that its designed to be fun in the same way that skateboarding is fun. The core of the gameplay is designed more as an expressive and creative tool than a traditional video game with pre-set challenges to complete.

The game is unique in that it doesnt have any tricks programmed into it, only control of the movement through the thumbsticks. Each thumbstick is connected to the characters corresponding foot the right stick controls the right foot, the left stick controls the left foot.

This control scheme is consistent through all parts of the gameplay, making it easy to learn and rely on when inventing new tricks and movements. See below where the same movements have been made on the sticks in different modes of the gameplay. The front foot is pushed left and the back foot is pushed right, creating the same movement of the board in each situation.

There are a range of basic movements, with a ton of freedom in how they are performed. Skater XL uses physics controlled by the thumbsticks to drive all movement in the game, which is a big step away from traditional canned animation based systems. Precise movements made through the thumbsticks will make your tricks look and feel different each time, adding a level of expression, personalization, and style to the gameplay.

Below is an example of flipping the board while jumping to create tricks like kickflips and heelflips. How you flick the front foot creates different movement during the trick.

This same level of control is available in all types of tricks including jumps, flips, grinds, powerslides and manuals.

As your level of skill and creativity grows, you can combine and chain these tricks together in any way you like. For example, see here three different trick lines possible using just three basic tricks kickflip, powerslide and crooked grind.

There are so many ways to combine and style the same few tricks, and there are a lot of tricks possible in Skater XL!

The resulting gameplay is very much free-form, sandbox and creative in nature. Think of it more like a musical instrument than a conventional game.

The final piece of the puzzle is the environment. You can take this set of basic skills and tricks and re-invent the environment any way you like. Whether you push yourself, perfecting the subtle nuances of a highly technical trick, or just want to catch some air, our environments are yours to leave your mark on.

This creativity in reinventing real-world environments is a big part of skateboarding and the final release of Skater XL will contain several real-world locations based on iconic skate spots from California and the West Coast.

Here are a few more of the limitless tricks and combos possible in different areas of the levels:

At its core, Skater XL is about the journey of challenging yourself and expanding what you can do each time you play whether it be trying to perfect a line with a tough sequence of moves or a just chill and free-skate, doing what you feel like in the moment.

The freedom and depth in the controls is something we think that every skate game fan has been wanting since the birth of the genre. When we saw a Skater XL modding community spring up with more than 50,000 players and thousands of very positive reviews on Steam with some playing for more than a thousand hours, we felt humbled, but also that we were onto something.

Were constantly finding amazing new things that the community has created, including an onlinezines, video parts, fake skate brands and hundreds of mods. Its crazy and awesome.

Our work on the core game is just one part of a bigger ecosystem and our goal is for Skater XL to be the home for digital skateboarding. We cant wait to discover where the players, modders and content creators will go next, and are really excited to bring Skater XL to PS4 and PS4 Pro. I hope youll sign up for our email list as we have lots more to announce very soon.

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Coronavirus not expected to delay MLB season, cause games to be played without fans – MassLive.com

Posted: at 1:46 pm

Major League Baseball has given no indication that teams will need to delay the season or play games without fans present" due to the coronavirus crisis, according to a report from Evan Drellich and Ken Rosenthal of The Athletic. League commissioner Rob Manfred will address league owners on a conference call Monday.

As reported by ESPNs Jeff Passan, MLB sent a memo to teams earlier this week to prepare them for the possibility of alterations caused by the outbreak of coronavirus in the country. The league discouraged players from signing autographs for the remainder of spring training and suggested they pre-sign items and throw them to fans at games.

The league has not made any changes to its access policy, though the National Hockey League is reportedly considering the possibility of closing dressing rooms to media members and others in the near future. In baseball, media members have access to the clubhouse for an hour before regular season games and are allowed back 10 minutes after after the conclusion of games.

The MLB regular season starts March 26 with a full slate of 15 games. At least 500 people in the United States have contracted coronavirus, according to CNN, with 21 confirmed deaths so far.

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Celtics coach Brad Stevens one request if games have to be played with no fans due to coronavirus – ClutchPoints

Posted: at 1:46 pm

The NBA is still grappling with how best to handle the coronavirus, acknowledging the possibility of games being played without fans in the arena. If that does prove to be a reality, Boston Celtics head coach Brad Stevens hopes the league moves some of the game times up earlier in the day:

The league plans to host a conference call with team owners and doctors on Monday, according to ESPN NBA Insider Adrian Wojnarowski. They will also have until Tuesday to present their own plans for fighting the coronavirus:

The league wants teams to make sure each has a plan for scaled-down team traveling parties too, the memo said.

The NBA is also making it mandatory for teams to distribute hand-sanitizer to players and staff members.

The NBA has already instructed players to make changes in how they interact with fans advising no autographs or handshakes.

The spread of the illness is impacting how some players go about their business. Portland Trail Blazers guard C.J. McCollum made it clear he would not be signing autographs while also tweeting out multiple advisories.

Although some of the numbers are more estimates than concrete data, CBS Boston reported there are 28 cases of coronavirus in the state of Massachusetts.

Meanwhile, the Celtics have even more on their plate. Stevens team has been ravaged by injuries in recent weeks, with the likes of Kemba Walker, Jaylen Brown and Gordon Hayward all going down with separate maladies.

The Celtics enter Sundays contest against the Oklahoma City Thunder two games back of the Toronto Raptors for the second seed in the Eastern Conference.

Depending on how the league decides to tackle the coronavirus, Brad Stevens and the Celtics might have to make a late-season surge without the support of a raucous Boston crowd.

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The best gaming and media keyboards 2020 – Polygon

Posted: at 1:46 pm

It probably comes as no surprise that we at Polygon have strong opinions about the keyboards we use every day. It also may not shock you to learn that those strong opinions often vary wildly from person to person. Some of us prefer that our keys sound as clicky as possible, while others dream of typing silently. Many of us are dedicated to our personal curated aesthetics, with custom keycaps or all-pink accessories. Still others just want something functional and inconspicuous.

Product recommendations arent one-size-fits-all. What one person is looking for in a keyboard for their flight simulator cockpit might be totally wrong for someone who wants a new keyboard for playing Overwatch.

Consider the Polygon staff a small sample size of experts, here to recommend our favorite keyboards for each of our specific needs.

The Corsair K70 is pretty much my go-to recommendation for solid gaming keyboards. (While I havent yet tried the second-generation MK.2 model, Ive every confidence that its just as good or better than the original.)

The feature that I enjoy the most is the aluminum frame, which raises the keys up a fair bit and makes for easy cleaning underneath. Theres also a metal rocker for volume, a full slate of media keys, a big friendly mute button, and built-in dimmer switches so you dont have to futz with the software when it gets dark. Its also available in a full range of Cherry MX switches, including the smooth and quiet Cherry MX Silent switches, also known as the Pink switches. The software has also been very reliable over the years.

Charlie Hall

I have flirted with the idea of getting a tenkeyless (a keyboard without a numeric keypad) over the years, but Im just hooked on using that right hand number pad and word processing buttons that come with a full-size board. However, playing spacefaring games and flight simulators as much as I do, desktop real estate comes at a premium. Gotta make room for the stick and throttle, after all. Thats why I opted for the HyperX Alloy FPS RGB for my recent trip to the edge of the universe in Elite: Dangerous.

Its a full-size board, but with an extremely small footprint. The bezel is almost nonexistent. Its also got the same raised keys as the K70, and it weighs a ton so its not as likely to move around on you while in VR. Im not as big a fan of the software, unfortunately, which can be a bit inconsistent from version to version.

Charlie Hall

Akko and Ducky keyboards are perfect for people who want to cater something to their tastes.

They have keyboards in a wide variety of styles. You can get a small version with no number pad, a bigger board with a number pad, or an even smaller board with scrunched up arrow keys. Theres also a pretty nice variety of switches, so if you want a specific type of clicky sound or feel, Akko and Ducky probably have what you need.

I use the Akko 3087s 87-key in Sakura Pink, which is a collaboration between the two companies, but theres such a variety of boards, youre bound to find one that suits your fancy. Just dont blame me if you end up spending a lot of money on artisan keycaps.

Julia Lee

This keyboard is definitely a Gamer Girl accessory in the just make it pink! trend, but Im a gamer girl, gosh darn it, and I like this bright pink keyboard. (Literally all of my other gaming accessories are angular and black with some neon green accents, and theyre perfectly functional but theyre not very fun.)

I programmed this dream Razer BlackWidow Chroma keyboard with a variety of lighting effects. At rest, its light orange with a few select keys (WASD, volume up and down) highlighted in neon violet. When Im typing, the keys light up with a vibrant ocean blue, delayed so that they flare up and disappear as I type.

In addition to being and I cannot stress this enough extremely aesthetic, the keys are super responsive and satisfying to clack, and its got a built-in wrist rest that is comfortable and ergonomic. It has all of the comforts of a high-quality keyboard with none of the drabness.

Jenna Stoeber

I often stream video from my PC to my TV, but I got tired of having to walk over to my desk every time I wanted to use the mouse and keyboard. Plus Id have to crane my neck to see the cursor on the TV uncomfortable! Eventually I picked up Logitechs Bluetooth keyboard with a built-in trackpad that was specifically built for this exact purpose, complete with easy access media buttons.

While this cheap little guy would be a nightmare to use for gaming, its just right for browsing YouTube on my TV from my couch.

Emily Heller

I cant justify my fascination with mechanical keyboards in any practical way. They arent meaningfully better at typing than the alternatives. But they do look cool, and they do sound great, and I dont know, man, that just presses a little pleasure button in my brain and makes me marginally happy.

Its happening now, those marginal bursts of pleasure, one tap at a time, as I write this on my fairly new, fully beloved Keychron K2, about as simple and inexpensive as entry into the world of mechanical keyboards as you could reasonably expect for Windows PC or Mac.

Mechanical keyboards can be an expensive hobby, but the Keychron K2 will get you started at $79.99 (which is inexpensive, comparatively). Its an 84-key or tenkeyless design, which is a fancy way of saying that it doesnt have a (10-key) number pad (get it? tenkeyless!), which is important to me because I dont work at a bank anymore, so I dont need that, and Id rather have my mouse closer to my keyboard. It also has, as you can see, full-size arrow keys, which Im always a fan of, and function (or media) keys, too.

I have the brown switch version, which is totally a dorky mechanical keyboard thing. Kychron uses Gateron brand switches, and brown is clicky without being obnoxious and piercing. The word people tend to describe brown switches is tactile, which means you dont have to press too hard to type, and also its not so loud that itll hurt anyones ears. They should put me on marketing.

One last bit of warning, if youre thinking of dipping your feet into the world of mechanical keyboards: They can take some getting used to. You may spend a week (read: I did) or more (re)learning how to type accurately on them. It was worth it to me.

OK, I lied. Another bit of warning: Watch your wrists. If you like to type with your wrists on the desk, youll need to transition to floating wrists or buy some pads to lift your wrists up off of the table. Or buy a keyboard tray. Or adjust the height of your desk, if thats an option. Otherwise, the angle will wind up hurting your precious wrists. And that would be very bad. But also probably dont type with your wrists resting on anything.

Dave Tach

Getting into smaller mechanical keyboards is an exercise in delicately balancing performance, price, and compromises. There may not be a keyboard that will check off all the boxes you need, but the Anne Pro 2 is the one that has come closest to hitting the mark for me.

The Anne Pro 2 is a 60% keyboard so it cuts off the entire numpad, function row, other operation keys, and even removes the arrow keys which may be a dealbreaker for some. But each key on these smaller units can be remapped, have multiple functions, or even have different properties depending on how you press the keys.

Everything about the Anne Pro 2 can be tweaked to your preference with software, including a new update that adds a fun but unnecessary feature that lights up the keyboard to the beat of my music. Either way, I arrived at the altar of small keyboards first with a bit of fear, but Im a convert now. I can never go back to anything larger than a 60%, and Ive come to fully believe the adage that less is more.

If youre ordering the Anne Pro 2 on Amazon, youll have the option for three different key switches depending on your preference. If thats a choice that gives you some analysis paralysis, go for the Gateron browns, which are the perfect balance between the options. Also, its worth knowing that this keyboard works great as a wireless keyboard too, but it has problems with repeating keys. With the amount of typing I do all day, it can be pretty annoying, so for the time being I have it wired.

Jeff Ramos

If your keyboard doesnt have macro keys or if you need more of them, this three-by-three macro pad will do the trick. Its software stores the data in the hardware, which means you can set it up, plug it into other laptops and PCs, and itll remember what its supposed to do. You can customize the lighting, the commands, and all that good stuff. I have a key macroed just to type since I dont have a numpad anymore. Useful stuff!

Julia Lee

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College basketball rankings: Kansas extends winning streak to 16 games and remains No. 1 in the Top 25 And 1 – CBS Sports

Posted: at 1:46 pm

Selection Sunday is still a week away. A lot will happen between now and then. But, at this point, it's hard to envision a scenario where Kansas is anything other than the No. 1 overall seed in the NCAA Tournament.

"That's the best Kansas team I've seen," Texas Tech coach Chris Beard told reporters after the Jayhawks beat his Red Raiders, 66-62, on Saturday to secure the outright Big 12 title. "[Devon] Dotson [is] the best guard in college basketball, [Udoka Azubuike is] the best big in college basketball, [Marcus] Garrett is the best defender in college basketball, and their role players just don't make mistakes."

That's high praise.

And KU has the resume to back it up.

The Jayhawks are now 28-3 with 12 Quadrant 1 victories and zero losses outside of the first quadrant. Put simply, nobody can touch that body of work. So Kansas is No. 1 in Sunday morning's CBS Sports Top 25 And 1 daily college basketball rankings. And when you realize it's impossible for the Jayhawks to do much damage to their resume even with a loss in their first game of the Big 12 Tournament, it's a safe bet that KU will be the No. 1 overall seed on Selection Sunday and thus the favorite to win the 2020 NCAA Tournament.

IN: West VirginiaOUT: Penn State

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The PR Show: Can the Olympic Games deliver gold-medal value to sponsors? – PRWeek

Posted: at 1:46 pm

Team GB is on track to deliver its strongest commercial programme of any Olympic Games aside from London 2012.

The British Olympic Associations commercial director Tim Ellerton told PRWeeks podcast The PR Show that while the home London Games was an anomaly in terms of commercial interest, they had a similar interest in Tokyo: Maybe not in terms of revenue, but certainly in terms of the number of sponsors and brands involved.

Ellerton was one of four panelists in an Olympic Games special podcast alongside H+Ks new MD of sport Jamie Corr, M&C Saatchi sport and entertainment UK CEO Jamie-Wynne Morgan and The Playbooks head of sport, Nick Meakin.

He said Team GB is expected to take about 380 athletes to Tokyo, which is larger than the 366-strong Rio Olympics team that won 67 medals, including 27 gold.

The success of Team GB in 2016, backing up the performance of 2012 by coming second in the medal table, means that brands are interested in what we are about in terms of a team that really does bring the whole country together, Ellerton said.

Brands attraction to the Olympic Games is multifaceted. The recent success of Team GB is an obvious draw, as is the prestige of being associated with the Olympic Games movement.

Ellerton said brands are also attracted to seemingly endless supply of good stories behind athletes, which is something brands are aspiring too and where our conversations are developing more and more.

The Olympics is one of those few occasions in life that really does bring all countries together, Ellerton added.

Our country in particular has had quite a divisive time recently, which is why our campaign has all been around what we do to bring the country together and get behind the team.

M&C Saatchi Sports & Entertainment UK CEO Jamie Wynne-Morgan told The PR Show the Olympic Games consistently attracts a global TV audience of four billion people only second to the FIFA World Cup which from a sports sponsorship perspective, us huge.

Its such a unique event compared to other sports as it only happens every four years and the fact that the majority of athletes are still considered non-professional and have to train day in, day out for four years, he said.

The stories from the Olympics are unlike any other sport. Brands buy into the stories they can align themselves with; if they can find the right insight thats right for their brand and with the Olympics there will be so many its still a huge draw.

H+Ks new MD of sport Jamie Corr says the key for brands will be understanding what their space is and how they can use their partnerships to tell their stories.

The panel also discussed how brands are looking to capitalise on the Olympic campaigns (including a bedding brand and real estate sponsor), whether there are too many Olympic partners to get decent cut-through, and Rule 40, which protects Olympic partners and could prove a hurdle to other brands who sponsor athletes.

Later in the show, the panel moves on to Euro 2020 sponsorship and discusses what they think will happen in Manchester Citys bid to quash a two-year Champions League ban.

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Atopic dermatitis (eczema) – Symptoms and causes – Mayo Clinic

Posted: at 1:45 pm

Overview

Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It's common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever.

No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps, moisturize your skin regularly, and apply medicated creams or ointments.

Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.

See a doctor if you or your child:

Seek immediate medical attention for your child if the rash looks infected and he or she has a fever.

Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is related to a gene variation that affects the skin's ability to provide this protection. This allows your skin to be affected by environmental factors, irritants and allergens.

In some children, food allergies may play a role in causing eczema.

The primary risk factor for atopic dermatitis is having a personal or family history of eczema, allergies, hay fever or asthma.

Complications of atopic dermatitis (eczema) may include:

The following tips may help prevent bouts of dermatitis (flares) and minimize the drying effects of bathing:

Try to identify and avoid triggers that worsen the condition. Things that can worsen the skin reaction include sweat, stress, obesity, soaps, detergents, dust and pollen. Reduce your exposure to your triggers.

Infants and children may experience flares from eating certain foods, including eggs, milk, soy and wheat. Talk with your child's doctor about identifying potential food allergies.

Take a bleach bath. The American Academy of Dermatology recommends considering a bleach bath to help prevent flares. A diluted-bleach bath decreases bacteria on the skin and related infections. Add 1/2 cup (118 milliliters) of household bleach, not concentrated bleach, to a 40-gallon (151-liter) bathtub filled with warm water. Measures are for a U.S.-standard-sized tub filled to the overflow drainage holes.

Soak from the neck down or just the affected areas of skin for about 10 minutes. Do not submerge the head. Take a bleach bath no more than twice a week.

March 06, 2018

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Mum says son with eczema was able to have his first bubble bath thanks to new product – Manchester Evening News

Posted: at 1:45 pm

A mum says her little boy has been able to enjoy his first ever bubble bath thanks to a new product.

Annie Burton's two-year-old son George has eczema and she found even sensitive brands would cause a flare up.

But she says the new Once Upon a Foxx range has worked wonders and the youngster can now have a bath filled with bubbles.

Annie said: "After using the bubble bath for the first time I was anxious to see if he had any sort of reaction, I was amazed that there was no sign of any rash or redness.

He has now used it numerous times with no problems. I have one very happy excited child at bath time every night, the pictures speak for themselves."

The organic range has been launched by Alderley Edge-based mum-of-two Angela Foxx, who spent 18 months developing the items after her daughter Harper, now two, suffered with eczema and sensitive skin.

Nothing on the market was working so I set out to create an all organic product with only the best natural ingredients," said Angela, also mum to four-year-old Aston.

And Harper and George aren't the only children whose eczema has cleared since using the products.

Three-year-old Carter Fiorini suffered terribly on his arms and body and his mum Gemma shared photos showing before and after he started using the range.

She said: "Once Upon aFoxxproducts were life changing for us. We tried every product on the market and everything irritated his skin, even products that were supposed to be organic.

"Its so nice to have some beautiful smelling, foaming products rather than medicated fragrance free yucky ones."

The range includes a foaming shampoo, foaming body wash, bubble bath, body lotion and detangling spray and is made up of completely natural, organic ingredients.

The range, which launched in November, is available online and will soon be available in two big stores, but the details of those can't yet be revealed.

Have you found something that works particularly well for your child's eczema without using a prescribed cream or ointment? Let us know in the comments or on our Manchester Family Facebook page.

Get breaking news first on the free Manchester Evening News app - download it here for your Apple or Android device. You can also get a round-up of the biggest stories sent direct to your inbox every day with the MEN email newsletter - subscribe here . And you can follow us on Facebook here .

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View: Can daily application of an emollient from birth prevent the development of atopic eczema? – Hospital Healthcare Europe

Posted: at 1:45 pm

Rod Tucker BPharm PhD 5 March, 2020

But could regular emollient use from birth actually prevent the development of the condition?

Atopic eczema is a highly pruritic, inflammatory skin condition which affects 20% of children.1 The condition develops during infancy and classically leads to food allergies, asthma and allergic rhinitis in what has been termed the atopic march.2 A family history of atopic disease is an important risk factor for the development of atopic eczema. In addition, the presence of atopic eczema increases the risk of IgE-mediated food allergies and for example, infants with the condition are six times more likely to develop egg allergies.3 While the precise cause of eczema remains uncertain, the condition is characterised by a defective skin barrier and there is evidence that genetically determined loss-of-function mutations in the gene that codes for filaggrin, a protein that has an important role in skin barrier function, may contribute to eczema development during infancy.4 The presence of defective skin barrier serves as a possible entry route for allergens and this has been proposed as a possible route to sensitisation and the subsequent development of a peanut allergy.5

Emollients are the cornerstone of eczema management and are recommended for all patients with the condition.6 An emollient provides a water impermeable barrier over the surface of the skin which serves to both prevent water loss and ingression of potential allergens and irritants. Given this dual role, is it possible that treatment with emollients soon after birth could actually prevent the development of atopic eczema and the ensuing atopic march? This was the question posed in the barrier enhancement for eczema prevention (BEEP) study published in the Lancet.7 The study was based on the observations of a pilot study undertaken by the same group which found that the incidence of atopic eczema was lower (22% vs 43%) in 124 infants treated with the daily application of an emollient from birth.8 But this was not simply blue sky thinking: several lines of evidence had pointed to a role for emollients in preventing inflammation as well as work which illustrated how the barrier dysfunction in atopic eczema appeared to be a secondary phenomena to subclinical inflammation present in dry atopic skin.9

The BEEP study recruited 1394 high risk (that is, where at least one 1st degree relative had either eczema, allergic rhinitis or asthma) babies who were randomised to either once daily application of an emollient (Diprobase or Doublebase gel) to the whole body excluding the scalp or best practice skin-care advice (the control group). This latter group received advice to use mild cleansers and shampoos specifically formulated for infants but also to avoid soaps, bubble bath and baby wipes.

The primary outcome measure was a diagnosis of eczema at 2 years of age. The results showed no difference: eczema was present at 2 years of age in 23% of infants assigned to daily emollient use and 25% in the control group. There were also no significant differences in the incidence of food allergies or other allergic diseases and the authors were at a loss to explain their findings.

An alternative strategy to reducing food allergies is through early exposure to potentially allergenic foods in order to allow the development of tolerance and this was the subject of the preventing atopic dermatitis and allergies (PreventADALL) study which was also published in the same issue of the Lancet. In PreventADALL, Norwegian researchers explored the dual approach of daily emollient use and early introduction of potential allergic foodstuffs such as peanut butter, wheat porridge and eggs10 and the incidence of eczema was recorded after 12 months. The study had four arms: control (no advice); skin emollients; early feeding and finally combined emollient and early feeding. The incidence of eczema at 12 months was 8% (control group), 11% (emollient group), 9% (food group) and 5% (combined group) and these differences were not significant. In other words, neither a combination of daily emollient use and early introduction of potential allergenic foods reduced the development of atopic eczema at 12 months.

The results of both studies although disappointing, recognise the limited value of these primary prevention strategies. However, these results do not undermine the importance of regular emollient use in the management of established atopic eczema.

Whether changing the composition of an emollient makes any difference remains to be seen and is the subject of the on-going PEBBLES study.11

References

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View: Can daily application of an emollient from birth prevent the development of atopic eczema? - Hospital Healthcare Europe

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