Eczema is the most common chronic skin condition.Eczema, also knownas dermatitis, is a chronic skin disorder that causes the skin to become inflamed or irritated. The symptoms include dryness, redness and intense itchy rashes on the skin. These rashes commonly occur on the face, knees, hands or feet. It may also affect other areas as well.Eczema can adversely affect one’s quality of life if it is not well controlled.
Eczema in Singapore is one of the highest in Asia.
Causes of Eczema
Many factors are involved in eczema. There is a strong link with genetics, as it is more likely for a child to have eczema if one or both of his parents suffer from it. In patients with eczema, it is not uncommon to have family members with allergic rhinitis and asthma. People with eczema have a defective skin barrier, whereby the skin is more prone to the penetration of irritants and allergens and loss of skin moisture.
Apart from genes, the surrounding environment also plays an important role.
- Environmental irritants and allergens
The most common allergen in Singapore is the house dust mite. Other common environmental triggers for eczema include heat, humidity and sweat. Irritants such as prolonged contact with harsh soaps, detergents and water can also cause a flare-up of eczema.
- Endogenous factors
Internal factors such as stress, fever, hormonal changes or lack of sleep can also trigger eczema flare-ups.
- Abnormal bacteria skin colonisation
There is increasing recognition of the role of skin bacteria in eczema. For instance, it was noted that the surface skin environment of eczema patients is different and more easily colonised by harmful bacteria, particularly staphylococcus aureus (S. aureus). The presence of S. aureus bacteria promotes further skin
Inflammationand reduces the efficacy of topical treatment.
Common Misconceptions about Eczema in Singapore
1) Eczema is due to impurity of the blood and can definitely be cured
Eczema is a chronic skin condition associated with a defective skin barrier. Eczema is not related to deficiencies in the blood and while most patients will outgrow their eczema, there is no one treatment that can ‘cure’ eczema.
2) Eczema is caused by food
While a food allergy can trigger eczema, it is much less common than believed. Very often, patients or parents think it is food-related because it is more ‘observable’ compared to environmental allergens. In older children, house dust mite is a more likely trigger for eczema.
3) Eczema is contagious
Eczema is due to the patient’s skin barrier and its reaction with the environment and immune system. However, as the eczema rash may look red and progressive, some people may think it is contagious. This is definitely not the case!
4) Eczema is due to a lack of hygiene
Again, due to the appearance of the rash, some people think that eczema is a result of inadequate washing. Eczema is not related to cleanliness and conversely, frequent use of soaps and detergents might even contribute to the increasing prevalence of eczema. Moreover, over-cleaning dries the skin, which aggravates eczema.
A good skincare routine is required for eczema patients, with the main aim of strengthening the skin’s defective barrier. These include:
1) Frequent and regular moisturising
2) Avoiding long and hot showers, keeping bathing time to about 10 minutes
3) Dabbing dry the skin after a shower, instead of rubbing it dry
4) Using mild cleansers and avoiding harsh soaps and products containing fragrances
5) Reducing harmful bacteria on skin via gentle antiseptic agents for those with frequent skin infections
While moisturising is a must for dry eczema skin, treatment is required during eczema flare-ups. Failure to treat the skin inflammation promptly can lead to worsening of the inflammation, skin infection and scarring. Eczema treatment for patients depends on the severity of the condition, the areas of the body affected, the patient’s age and general health.
The more common eczema treatment options are:
1) Prescription creams
Prescription creams are generally categorised into topical steroids or non-steroidal creams like topical calcineurin inhibitors. Topical steroids work to reduce localised skin inflammation and have to be applied according with your doctor’s instructions.
2) Pro-active therapy
Increasingly, dermatologists are recommending pro-active therapy where treatment is administered even after the rash has subsided. This is done in order to decrease the residual inflammation in the skin which is not visible (not red) and to maintain the duration of rash-free periods.
3) Oral medications
The common oral medications are over-the-counter antihistamines which reduce the amount of histamines, thereby reducing itch. However, these may not be effective for all patients.
4) Wet wrap-therapy
Wet wrap therapy involves applying the required steroid cream and/or moisturiser and then wrapping the skin with a layer of open-weave tubular dressing which is moist (either with cool, room temperature or lukewarm water, depending on the patient’s preference). In this way, the rash resolves faster and itch is greatly reduced.
Photo-therapy is the exposure of the affected skin to specific light bands of ultraviolet B and/or ultraviolet A light. It is mostly used for adults with care on the amount of exposure to minimise potential UV damage to the skin.