Eczema

What is Eczema?

Eczema is a common inflammation condition of the skin. Although eczema can occur any time in one’s life, it typically starts presenting when one is a child.

You may have come across medical terms such as ‘atopic eczema’ or ‘atopic dermatitis’.

‘Atopy’ is a term to describe an umbrella of hypersensitive allergic medical conditions such as allergy rhinitis, hay fever, food allergy, asthma and eczema.

‘Eczema’ is a Greek word that means ‘boils’ and is used to describe rash that is red, dry, itchy that sometimes weeps, blisters or scales, crusts or thickens.

What causes Eczema?

  • Genetics
    Atopic eczema tends to run in the families. The alteration of the gene maintaining a good skin barrier is believed to be the key factor in development of eczema.
  • Impaired skin barrier
    It is believed that people with eczema has skin barrier impairment, predisposing them to triggers in the environment, eventually leading to an inflammatory, allergic, and itchy skin response. Environmental triggers include chemicals such as wash/detergents/soaps, and exposure to infection, allergens, bacteria and etc.

What are the symptoms and presentations of Eczema?

Patients with eczema experience symptoms such as

  • Itch
  • Red, dry skin
  • Scratch marks with bleeding over affected skin area
  • Moist and weepy over active eczema skin
  • Small water blisters over the hands and feet
  • Thickened and uneven skin tone over affected skin areas

Who is at risk of Eczema in Singapore?

In Singapore, Eczema is one of the commonest inflammatory skin condition affecting one in five children and one in 10 adults. Atopic eczema affects both male and female equally.

How is Atopic Eczema Diagnosed?

Eczema is recognized by doctors or other trained health professionals during physical examination. Blood tests and skin tests are usually not required. Your doctor may offer swab test to look for any concurrent infections on the skin. In individual cases that the doctor is concern of allergens, allergy tests such as RAST test, skin prick test or patch test may be offered.

How is Eczema treated in Singapore?

Most atopic eczema cases can be treated with moisturizers, medicated creams and ointments. The mainstay of treatment is regular use of moisturizer and washing with a moisturiser (rather than soap) to restore and maintain the skin barrier of affected people, so that the skin works as an effective barrier against external environment.

Your doctor may recommend you steroid creams or ointments to reduce the redness and itching of atopic eczema when the rashes are active. The creams and ointment comes in different doses and strengths, and your doctor will advise you on which to use, where and how long to use. Despite many negative connotations with steroid creams, when using appropriately, they are safe and effective for eczema rashes.

Antibiotics and use of antiseptic may be required on skin areas that are suggestive of infected. Antihistamine tablets are helpful in certain patients to calm the itch symptoms, and helps one to have a good night sleep

You are advised to avoid natural herbal creams as they can cause irritation and allergic reaction.

In more severe cases, your doctor may recommend you for other alternative treatment with the guidance of dermatologist specialist such as:

  • UV light treatment
  • Oral steroid
  • Oral medications that reduce your immune system such as azathioprine, ciclosporin, methotrexate, mycophenolate mofetil
  • Injection medication such as Biologics, Dupilumab
Presenting SymptomsEczemaPsoriasis
ItchMore intenseLess severe
AppearanceDry, Rough, Small blisters, Papules, CrustingWhite thick scales
Location of rashSkin folds and flexures
Can occur over the neck, eyelid, face, wrist, hands and feet
Skin extensors of limbs
Affects the scalp, buttock, umbilicus, lower back, abdomen and ear
Patient DemographicsChildhood and AdulthoodGenerally occurs in adults

FAQS

Common environmental triggers include heat, humidity, dust mites allergies. Harsh irritants such as detergent, wash, soap, water are common causes of Eczema flare up as well.

Your doctor will obtain a medical history to understand any childhood or current symptoms of atopy. Lifestyle, dietary intake, topical histories may also be obtained by your doctor to understand any possible triggers. Your doctor will examine your rashes and general skin condition before give you further individual skin care advice and medication.

Unfortunately, there remains no cure for eczema. However, there are various options to control the symptoms. Most children with atopic eczema will have 60% improvement of atopic eczema when they progress into adolescence years.

You are encouraged to:

  • Daily moisturize your skin, at least 2-3 times a day with non-fragrant moisturizer that you can tolerate. Smooth it on your skin following the direction of your hair growth
  • Wash with moisturizer. Avoid soap, bubble baths, shower gels, detergents
  • Wear non-powdered, non-rubbery gloves when you need to deal with irritants such as doing house work
  • Rinse off the chlorinated water after swimming and apply plenty of moisturizer
  • Avoid cotton wooly cloths
  • Double rinse/wash clothing to remove detergent residues
  • Avoid scratching
  • Avoid pets
  • Avoid heat and dusty places
  • Avoid people with active cold sore, as this can runs a risk of a sever generalized cold sore infection in people with eczema

No, eczema is not contagious and you will not acquire eczema by touching another person’s eczema rash. However, having family members with eczema increase your risk of developing eczema in view of genetic atopy predisposition. Speak to your doctor to find out more about the risks factors of developing eczema.

Allergic triggers do play a role in exacerbating eczema, though this is usually a consequence of abnormal skin barrier rather than a main original cause of eczema. Identifying avoidable allergic factors can improve the control of eczema.

Food Allergy:
The prevalence of food allergy is higher in children when compared to adults with Eczema.
Food allergy tests can be performed via skin prick test and RAST test.

Dust mite allergies:
Due to the high density of population in Singapore, dust mite allergies are common.
Finding out allergy to dust mites and tweaking daily lifestyle may improve the symptoms of Eczema. Dust mite allergies can be tested via skin prick test and RAST test.

Pollen allergies:
While pollen allergies are commonly associated with hay fever, it can be a trigger to eczematous flare ups, especially the exposed area such as the face/neck/limbs. Testing for pollen allergies can be performed via skin prick test and RAST test.

Animal/Pet dander allergies:
Exposure to furry pets typically cause an atopic person to experience with runny nose, or watery eyes, following with a delayed reaction of eczema flare. Animal dander allergies can be done via skin prick test and RAST test.

Contact Allergies:
Common contactant such as nickel, belt, jewelries, fragrance, chemical cosmetics, hair dye, tattoo, rubber, plastics can cause a type of Eczema known as allergic contact dermatitis. The presentation of eczema is localized to the area of contact with the allergen. You can consider a patch test to screen for contact allergies.

You are advised to discuss your Eczema symptoms and possible triggers with your doctor during consultation. Your doctor will recommend allergy tests that are suitable to aid your control of Eczema.

In severe recalcitrant eczema, your doctor may advise you to omit common food allergens such as nuts, seafood, cow’s milk, wheat, gluten and egg. It is good practice to write a food diary to monitor for any possible food allergens as every patient may have different triggers.

It is prudent to ensure while practicing diet elimination, basic essential nutrients that the body requires are replenished via other food substance or supplement.

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