Some Fast Facts About Eczema
According to the National Skin Centre (NSC), at least 1 out of 10 people (10%) in Singapore will be affected by eczema at some point in their life. Here are some facts you should know about the skin disease:
- It results in dry, inflamed and scaly skin
- It is one of the most commonly treated skin diseases at the NSC
- There is no proven cause of eczema, but research points to a combination of hereditary factors and external triggers
- The incidence of eczema in Singapore is among the highest in the world
- The condition is not contagious
- There is no cure, but the symptoms can be effectively managed
Eczema is also called atopic dermatitis, and is one of many types of dermatitis. The terms ‘eczema’ and ‘dermatitis’ are sometimes used interchangeably but both refer to the inflammation of the skin.
Although most often seen in children, the condition may persist into adolescence and adulthood. Some adults continue to have symptoms on and off for the rest of their life.
Eczema may result in reduced self-confidence, sleep disturbance, inability to concentrate at school or work, depression, as well as social isolation. It is important for you to seek treatment early to prevent the condition from worsening, especially if the chronic itch causes great physical discomfort and affects your quality of life.
Symptoms Of Eczema
The symptoms of eczema will look different for everyone as it is a highly individual condition that comes in many different forms. In mild cases, your skin could simply be dry, inflamed and itchy. But in more severe cases, your skin may experience oozing, crusting, or even bleeding.
Eczema patients will usually experience a period of time when their symptoms flare up, followed by a period of time when their symptoms abate due to medical treatment.
Children with eczema typically develop the condition before turning five. However, most of them will see their symptoms subside when they grow up. The symptoms in adults, children, and infants may be different.
Signs and symptoms of eczema in adults may include:
- Dry and sensitive skin
- Chronic itching that may intensify at night
- Red to brown patches, especially on your hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of your knees and elbows
- Small, raised bumps, which may leak fluid and form crusts when scratched
- Thickened, cracked, and scaly skin
For children aged two and above, the symptoms may include:
- Bumpy rashes
- Rashes accompanied by a discolouration
- Rashes that form behind the creases of elbows and knees
- Rashes that appear on the neck, wrists, ankles, and the creases between the buttocks and legs
- Lichenification (thickening of the skin)
For infants under the age of two, the symptoms may include:
- Rashes on the scalp and cheeks
- Rashes that bubble up before leaking fluid
- Rashes that can cause extreme itchiness and disturbed sleep
If you have suffered from eczema as a child but no longer experience the condition as an adult, you may still be prone to dry or sensitive skin that is easily irritated.
The physical appearance of your skin will depend on how much you scratch it and whether or not your skin is infected. Scratching the affected areas will only further irritate the skin, increase inflammation, and exacerbate the condition.
Types Of Eczema
There are seven different types of eczema:
- Atopic dermatitis
- Contact dermatitis
- Neurodermatitis
- Dyshidrotic eczema
- Nummular eczema
- Seborrheic dermatitis
- Stasis dermatitis
It is possible for you to have more than one type of eczema present on your body at the same time. Each form of eczema has its own separate set of triggers and requires different treatment methods. For this reason, it is crucial that you consult a dermatologist who specialises in treating these skin conditions.
What Causes Eczema
Doctors and healthcare practitioners do not know what the exact causes of eczema are. However, research strongly suggests that it is likely caused by a combination of things which may include:
- Genetics: Having relatives with eczema is a major risk factor.
- Autoimmune system problems: Your body’s reaction to triggers is what causes inflammation, and having an immune system that overreacts to irritants or allergens can cause eczema.
- Environment
- Lifestyle
- Stress
As eczema is not contagious, you cannot get it from, or give it to, another person by bodily contact.
Eczema Triggers And How To Avoid Them
In order to manage your eczema, it is helpful to have a good skincare routine best suited for keeping the condition under control. You should also identify and avoid certain trigger factors which cause flare-ups.
Food Allergens
An allergic reaction is an immune response to a specific substance you may be sensitive to.
Some patients with eczema have an accompanying food allergy which triggers their symptoms. While the skin condition is not caused by the allergic reaction itself, flare-ups will usually occur if patients eat certain foods. For example, foods such as simple sugars, refined carbohydrates, gluten, red meat, and dairy tend to cause bodily inflammation. These might cause your eczema to flare up.
You should speak with your dermatologist about allergy testing to detect the foods you may be allergic to. Alternatively, you may also consider an elimination diet by removing certain foods from your diet and reintroducing them after some time to identify which are responsible for worsening your symptoms. In future, this allows you to avoid them and minimise your likelihood of flare-ups.
Irritants
You may also experience eczema flare-ups due to certain irritants that serve as trigger factors. These may include:
- Friction between your skin and certain clothing fabrics
- Artificial fragrance, such as scented body products
- Cleaning products such as sprays, detergent or washing powder
These irritants can interfere with your skin barrier by removing natural oils and moisture. As a result, itching and scratching may ensue. For example, many people with eczema find that wool and synthetic materials trigger itching. Body products and cleaning products can also contain chemicals that cause skin dryness or irritation.
You may consider avoiding these irritants and opt for lifestyle alternatives where necessary. Clothing materials that are eczema-friendly such as cotton, bamboo, and silk are less harsh on the skin. Similarly, you should opt for hypoallergenic and scent and chemical-free body and cleaning products. Household alternatives such as white vinegar as a glass cleaner and baking soda as a kitchen cleaner are better alternatives as these agents do not contain any added chemicals.
Water
Another triggering factor for eczema is prolonged exposure to moisture. This is because water can dry out your skin, which results in persistent itching. Frequent showering, bathing, swimming, and washing of your hands can make eczema outbreaks more likely.
You should apply moisturiser to your skin after swimming or bathing, and shower with warm water to prevent excessive drying out of your skin.
Stress levels
Mental and emotional stress does not directly cause eczema but can stir up your symptoms. When your body is placed under stress, your adrenal glands secrete the hormone cortisol into your bloodstream. This hormone increases inflammation throughout your body as part of its ‘flight or fight” response, which can cause flare-ups.
To minimise stress levels, you should consider making time for rest and relaxation during the day. It also helps to engage in stress-relieving activities such as walking, reading, or meditating. If you are having trouble with depressive thoughts, you should seek help from a mental health professional.
Air temperature
Hot weather is known to irritate the skin, and is capable of worsening your itch. Heavy perspiration will also cause flare-ups in some cases. This is especially so in Singapore’s hot and humid weather, whereby excessive sweating can affect the skin’s barrier function.
You should try to keep your body temperature cool and limit sweating as much as possible. It is also good to stay hydrated and avoid being out in the hot sun.
On the other hand, cold weather can also cause your eczema to flare up. This is because cold air is usually accompanied by dry air which strips away your skin’s natural moisture. When you travel to cold countries, you may experience increased itching due to the dryness, which then leads to scratching and inflammation.
You should bring a skin moisturiser that helps to protect your skin. If you are residing in a cold country for an extended period of time, you may consider using a humidifier in your home to reduce the likelihood of skin dryness.
Hormonal changes
There is some evidence from medical research which suggests that sex hormones can influence the incidence of eczema.
The male hormone testosterone has a negative effect on your skin barrier function, making it more sensitive and vulnerable to drying out. Similarly, a drop in the female sex hormone estrogen right before a menstrual cycle can cause your skin to lose water, affecting its ability to maintain moisture. This leads to dryness and exacerbates your eczema symptoms.
It is not possible to avoid hormonal changes but you can mitigate the condition through the use of topical steroids. For females, you could also try marking out dates in your calendar when you’re likely to flare up such as during your period. If that is the case, you can take extra steps to avoid irritants that trigger your symptoms.
Microbes
Certain bacteria, viruses, and fungi are responsible for the outbreak of some types of infection in eczema. Some of them may include:
- Staphylococcus aureus: This bacteria is the leading cause of skin and soft tissue infections. Scratching your skin allows it to get into your skin’s deeper layers, causing infection.
- Malassezia: This kind of yeast infection can cause both dandruff and an itchy, flaky rash where your natural oils are present.
- Herpes: The herpes simplex virus can affect large areas of your skin, giving rise to a certain type of eczema known as eczema herpeticum.
To avoid the outbreak of eczema infection, you should observe proper hygiene habits and avoid scratching your skin as much as possible.
Exercise
Vigorous exercise or strenuous physical activity will lead to heavy sweating, which can exacerbate your eczema symptoms.
If you tend to have flare-ups after strenuous exercise, you should consider opting for less intense forms of activity or select a cooler time of the day to work out.
Eczema Treatments, What’s Your Best Option?
If you suffer from eczema, you know just how frustrating flare-ups can be. For most people, it can take some measure of trial-and-error to find the best way to reduce symptoms. Sometimes, little adjustments can help. Dermatologists recommend warm showers and over-the-counter moisturising products that hydrate the skin.
However, when these home remedies and self-care steps fail, you will need medical treatment. There are a range of medications which your dermatologist can prescribe to help alleviate your symptoms. These will also help your skin to heal and reduce discomfort.
Topical steroids
This form of treatment is most commonly prescribed as the main treatment for patients with eczema. Topical steroids will help to reduce skin inflammation and do not have any significant risks if used appropriately. The strength of the steroid cream will depend on your age, as well as the severity of your condition. However, some possible long-term side effects include thinning of the skin layer, easy bruising, and stretch marks
Steroid-free topical medications
Steroid-free topical medications have also been developed for use in the treatment of eczema. These new ointments, tacrolimus and pimecrolimus, are called TCI creams (topical calcineurin inhibitors) and treatment will depend on your suitability. Your dermatologist will assess your condition to determine if this treatment is appropriate for you.
Oral treatments
Oral medication for eczema is used in the form of antibiotics to counter skin infections. Additionally, antihistamines are prescribed to reduce flare-ups and prevent excessive scratching from the ensuing itch. But they are not recommended for daily use.
Other treatments
Wet-wrap therapy is another form of treatment to deal with severe eczema. This involves wrapping the affected area with wet bandages to re-introduce moisture into the skin layers and soothe your itch.
In some cases, your dermatologist may discuss the prospect of other treatment alternatives such as phototherapy, oral immunosuppressants and biologic injection treatment.
A Note From Dr Wong Soon Tee (Senior Consultant Dermatologist In Singapore)
If you are suffering from eczema, you’re not alone. Eczema is a very common skin condition that is treatable and can be kept under control.
Although eczema can be chronic and persistent throughout your life, early diagnosis and medical intervention will help to mitigate your symptoms effectively. It is important that you consult a dermatologist who is experienced in treating eczema in order to improve your quality of life.