Eczema, also known as atopic dermatitis, affects about 20% of Singaporeans. It is a condition that causes your skin to itch and redden. Because Singapore is a tropical country, Singaporeans are exposed to the sun which is one possible trigger for eczema to flare up. Although it can appear at any age, it is especially common in children. For now, there hasn’t been any cure for eczema and the condition will flare up periodically throughout your life.
In this article, I have answered a few questions that my patients have often asked about eczema. Read and be informed so that you too can take the proper steps in managing the condition.
What is eczema?
Healthy skin is able to act as a natural barrier that helps retain moisture and protects the skin from irritants such as allergens, bacteria and other microbes.
For patients with eczema, their skin loses the ability to retain moisture as well as protection from external environmental factors resulting in skin dryness and rash (inflammation).
Eczema is characterized by red, scaly lesions covering the skin. These lesions can be persistently itchy and can sometimes cause cracks in the skin making the affected area at risk for infection.
What causes eczema?
It has been widely believed that eczema is an autoimmune disease where a certain type of gene variation makes the immune system overactive which renders the skin unable to provide a natural barrier and protection.
Eczema can also be inherited or passed on down the family line so if you have a personal or family history of eczema, allergies and severe skin dryness, you may be at high risk of developing the condition.
In which parts of the body does eczema occur?
Unlike other skin conditions which are usually confined in specific parts of your body, eczema can occur on any part of your body. It most commonly appears on the face, back of the knees, hands, wrists and feet.
Eczema produces a rash which appears very dry, cracked or scaly. The rash is itchy and can be worse at night. Some small, raised bumps can also appear, which can leak fluid when scratched.
What are the triggers for eczema?
Typically, eczema is triggered by irritants, allergens and microbes. However, eczema can also be triggered by a lot of other factors that causes the skin to become dry. These factors include:
- Intense heat
- Humidity (very high or very low)
- High fever
- Certain chemicals
- Hormonal changes (especially in women)
Since Singapore is almost always basked in sunlight, heat and humidity is always part of a Singaporean’s daily life. This is also why a lot of patients have recurrent eczema outbreaks and flares triggered by intense heat. To help avoid the triggers, always make sure you have extra protection from the sun. Make sure also that you are careful with everything you touch or come in contact with because certain triggers like chemicals and irritants can be found anywhere in the environment.
How can eczema flare-ups be prevented?
Eczema can flare up when it is triggered by an external factor such as sweat and stress. Here are a few tips that you can follow to prevent these flare-ups from happening:
- Identify and avoid the triggers that can cause eczema flare-ups. As these flare-ups are usually caused by an external trigger, the best way to prevent it is by determining these triggers and avoiding them as much as possible. Whenever you have an eczema flare-up, list down all the possible triggers (check the previous section) that you experienced before it happened.
- Use moisturizers at least 2 times every day. Moisturizing creams and lotions are available in any pharmacy or grocery store and they go a long way in the prevention of eczema flare-ups. Dry skin is one of the possible triggers of eczema and it is important to keep your skin moisturized at all times. Always remember to moisturize your skin immediately after a bath.
- Avoid long baths or showers. Use warm water and reduce your bath time since baths can strip your skin of natural oils which keep your skin from getting dry. The less time you spend showering or bathing, the more of these natural oils your skin can retain after.
- Avoid harsh soaps. Instead use only gentle soaps, as antibacterial or deodorant soaps strip away more natural oils from your skin.
What are the available treatments for eczema?
1. Topical Steroid Creams
My patients always became wary when I tell them that steroid creams are used to treat eczema because of these two beliefs:
- Topical steroid creams can cause skin tightening
- Topical steroid creams are absorbed into the bloodstream
But I always tell them not to worry because topical steroid creams have been proven to be very effective in reducing scaling and lesions caused by eczema. These creams are also safe to use given that they were properly prescribed by your doctor.
I always make sure that the appropriate strength of steroid creams are given to the patient depending on the location of the treatment area and the thickness of the patient’s skin. Typically, if the treatment area is the face, weaker steroid creams are prescribed to treat eczema while stronger ones can be prescribed to other parts of the body.
The proper prescription is very important so the risk of skin tightening is prevented. Another thing that I assure my patients is that topical steroid creams are not absorbed into the bloodstream so there is really no need to worry.
2. Oral Medication
When topical steroid creams do not work, patients are prescribed oral medication to effectively treat eczema. Usually, oral medications include antihistamines, steroids and medications for infections.
- Antihistamines are mainly used as an anti-itch medication with no side-effects.
- Steroids work by temporarily suppressing your overactive immune system, and help to reduce both itch and rash.
- Antibiotics, antifungal and antiviral medications are prescribed to treat bacterial, fungal and viral infections, respectively if there are any.
These oral medications are only taken for a short duration, as prescribed by your doctor. Make sure you follow the prescribed oral medication regimen because if not properly followed and taken for a longer period, these may have severe side effects and can be very harmful for you.
Are there any ways to relieve eczema besides medication?
- Keep your skin moisturized. Dry skin will worsen your eczema, which is why moisturizing your skin is very important. Moisture will also help in reducing the itchiness and prevent more flaking from occurring. Moisturizing creams, ointments and lotions are available in your pharmacy and do not require a prescription.
- Avoid scratching the rash. When the rash gets very itchy, it can take a lot of self-control to avoid scratching it. One tip I give my patients is instead of scratching the rash, they can try pressing repeatedly on it. This technique relieves the itch but does less damage to your skin compared to scratching it. Another thing you can do is to cover the rash if you can’t stop scratching it. It can also help to trim your nails to lessen the damage that scratching does to your rash.
- Cover the rash with bandages. Covering the rash will not only prevent scratching, but also protect the skin from drying or infection. Remember to replace the bandage at least once per day.
- Use a humidifier in your home. Your skin can be sensitive to hot, dry indoor air and can intensify the itchy sensation. A humidifier adds moisture to the air and will help reduce the dryness.
- Avoid wearing clothes that are tight, rough or scratchy. You can reduce the irritation felt from eczema by wearing clothes that are smooth and comfortable. It is important also to wear the right clothes for the season, especially during hot weather which can worsen your condition.
- Avoid things that make you stressed or anxious. Eczema can be worsened by stress and anxiety, so it is important that you address them to also relieve the effects of eczema flare-ups.
Will avoiding certain types of food prevent eczema flare-ups?
It is true that there are some food that can trigger eczema. However these foods are specific to each person, and there is no definitive, comprehensive list of food that are known to trigger eczema for the whole population. Thus, the belief that a dietary restriction can prevent eczema flare-ups is just a myth. No scientific evidence has been found that supports this statement. Only the methods mentioned above for prevention
Will I need to be hospitalized if I have eczema?
Most skin conditions do not require hospitalization, however, eczema can become dangerous in some extremely severe cases. In these cases, the rash can appear on most of your body and can cause infection and/or loss of heat or moisture. In these extreme cases, hospitalization is needed as it can possibly threaten the life of the patient.
Is there an eczema treatment that can make it disappear completely?
My patients often asked me if there’s a way to cure eczema so that it doesn’t recur. Unfortunately, no cure has been found yet that will completely eliminate eczema. There are ways to treat it when it recurs but there is always a possibility that it recurs when you experience any of its triggers.
One of the best tips I can give when it comes to eczema problems is to always moisturize your skin. As long as you take the time to apply a moisturizer on your skin each day, there will be a small chance that your eczema will recur. Observe proper care and protection of your skin and eczema doesn’t have to be a big problem.