What is eczema?

“Don’t scratch!”

This is perhaps one of the most frequently uttered advice to sufferers of eczema – a chronic and stubborn inflammatory skin condition otherwise known as atopic dermatitis.

In fact, eczema currently plagues every 1 in 10 adults in Singapore, and is currently the most commonly seen skin condition at the National Skin Centre.
Affecting both children and adults, it is not unusual to notice a friend, family member, or even strangers on the street suffering from eczema.

So, what exactly is eczema, and can it be cured? Here’s everything you need to know about the prevalence of eczema in Singapore, as well as the plethora of treatment options available.

Eczema Singapore

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Itchy and dry skin are the most obvious signs of eczema. It is normal to see patches on the skin undergoing flare-ups (red and itchy, small fluid-filled sacs on the skin), and areas of skin which have already become lichenified (thick and leathery) due to continuous scratching.

The clinical presentation of eczema differs from person to person, and is largely dependent on individual factors such as age, disease activity and severity. Here are some pictures that serve to illustrate this:

0-2 years old

2-16 years old

Adults

 
While the characteristics and symptoms of eczema observed in each age group is slightly different, the most common signs are:

  • Dry skin
  • Itching (especially at night)
  • Raw or inflamed skin from scratching
  • Thick, scaly, or flaking skin
  • Small, raised, and often reddish bumps.
  • Reddish, brownish, or even greyish patches of skin (particularly on the areas surrounding the joints, such as the inside of the elbows and back of the knees)
     
  • Living with eczema can often lead to intense scratching that can bleed and lead to infections and scarring – causing patients to suffer from a loss of self-esteem that can greatly lower their quality of life.

    There are many different types of eczema – which is why it is important to consult an experienced doctor in order to obtain the right diagnosis. At The Clifford Clinic, our doctors are passionate and dedicated to help patients improve their symptoms and enhance their quality of life – starting with the proper diagnosis and treatment recommendations.

    When patients come to our clinic, we typically diagnose them via a simple process that consists of discussing their full medical history, screening the appearance and distribution of skin lesions, and maybe even performing a biopsy.

What causes eczema?

While there is still no single cause that can be directly tied to eczema, it is currently thought that a bad hand of genes is largely responsible for its development.

The patient’s genetics induces a hyperactive immune system that affects the skin’s barrier function, causing sufferers of eczema to have extra sensitive skin.

Usually, individuals with eczema have a family history of the skin disease.

Other external factors such as pollution, allergens (e.g. house dust mites), certain types of food, stress, and even hot weather are important triggers to take note of.

It doesn’t help that Singapore’s hot and humid weather can act as a aggravating factor for causing eczema flare-ups – which makes it even more pertinent to see a dermatologist as soon as you can, ruling out any other medical conditions and starting treatment immediately.

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The clinical course of eczema and its complications

Eczema is a chronic condition which is met with periods of flares and remission.

As a result of the skin lesions, victims of eczema tend to get skin infections fairly easily.

Due to this, people suffering from eczema in Singapore need to consult and seek help from a doctor as soon as they start to notice symptoms.

Treatment options:

While there is currently no cure for eczema, it is still possible for the skin condition to be controlled.

There are 3 important aspects of eczema treatment as follows:

  • Moisturise the skin

Patients with eczema have a damaged skin barrier, which reduces the ability of skin to retain moisture. And when the skin is dry, it becomes itchy.

Hence, keeping the skin hydrated is an integral part in the treatment of eczema –moisturisers do that by working to protect the outermost barrier of the skin.

Other noteworthy pointers include having shorter baths (5-10 minutes) in order to prevent stripping the body of too much moisture, and using mild or soap-free body washes for the same reason. Also, the best time to apply your moisturize is immediately after you hop out of the shower.

  • Control the itch

Should the skin still continue to itch despite keeping it hydrated, treatment options include taking oral medications such as antihistamines – which are essentially anti-allergic drugs meant to reduce and put an end to the itch.

Wet wrap therapy is another intensive moisturizing solution that can be done to help resolve the rash and reduce the itch when it becomes unbearable.

In the case that the itch is so bad that it disturbs the sleep of the patient at night, sedating antihistamines can also be given.

  • Avoid triggers

One of the best ways to control eczema is to avoid a flare-up by identifying the “triggers” and avoiding them. But this too, takes time to figure out.

Overtime, patients with eczema are typically aware of their “triggers”. Some common ones include the heat, cold, dust mites, emotional stress, or exposure to certain types of detergents.

Being mindful of one’s triggers is a critical step in treating eczema, and purposefully avoiding them is crucial in reducing the likelihood of a flare-up.

What happens during an eczema flare-up?

During an eczema flare-up, your doctor may prescribe topical corticosteroids to help reduce the inflammation (redness and itching). Unfortunately, steroidal creams often have harmful side effects – such as the thinning of skin overtime. As such, it is important that patients strictly adhere to the type, dosage, and duration of corticosteroid used as advised by a medical doctor.

Latest treatment options

With newer technological advancements, there are now more potent and effective types of treatment available for those suffering from eczema in Singapore.

For example, adult patients can undergo phototherapy, or take oral cyclosporine if  results with the aforementioned treatments are not satisfactory.

As new research and studies continue to find a possible cure for patients, here are 2 of the latest treatment options available in the market:

  • Dupilumab (Dupixent)

Approved by the Health Sciences Authority (HSA) for treating severe eczema in Singapore, Dupixent is a biologic treatment that is administered through an injection under the skin.

Essentially a human antibody, the treatment works to neutralise harmful bacteria, virus and fungi – targeting specific aspects of the immune system which are causing the inflammation. This in turn helps to reduce the symptoms faced in eczema by healing the skin from within.

Clinical trials have revealed that more than half of patients using Dupixent have reported a vast improvement in their symptoms – with a 75% reduction after 16 weeks.

While there is no hard and fast rule on the recommended duration patients should be on Dupixent – experts generally recommend a minimum of 4 months.

Clinical trials have revealed that more than half of patients using Dupixent have reported a vast improvement in their symptoms – with a 75% reduction after 16 weeks.

While there is no hard and fast rule on the recommended duration patients should be on Dupixent – experts generally recommend a minimum of 4 months.

However, not everything is a bed of roses. Dupixent does have certain drawbacks as well. Firstly, it is extremely costly – the average cost of receiving Dupixent treatment can easily add up to around $2,500 each month.

Additionally, there are some side effects of the treatment, such as the reactivation of the herpes virus and conjunctivitis. Although these side effects do not occur very often, it is still good to be aware of them.

  • Microbiome cream

There exists “good” and “bad” bacteria – both Yakult and Vitagen being classic examples of ingesting beneficial bacteria into the body.

Although it may first come across as counterintuitive, applying or consuming good bacteria actually makes it more difficult for harmful ones to colonise the body – and is the main concept behind microbiome creams for the skin.

Microbiome creams are perfect for replenishing the good bacteria on the skin, especially since treatment options like antibiotics aren’t able to distinguish between good and bad – thus killing both types of bacteria in the process.

  • Baricitinib

Similar to Dupulimab, this drug is meant to tame the overactive immune system present in patients with eczema. While it is classically used in the treatment of rheumatoid arthritis to ease joint pain and swelling, it is currently being further explored in terms of its usage in the treatment of eczema.

By preventing inflammation of the immune system, patients with eczema can potentially achieve clear skin and see significant improvement in their disease activity.

As it is still undergoing phase three of its trials, it has not been approved for commercial usage yet. However, it is definitely a potential treatment option to look forward to.

In conclusion, eczema can be a debilitating disease for its sufferers. While it is a disease which cannot be cured, providing temporary relief for itching and redness through moisturisers and avoiding triggers are good enough for now.

Having said this, a multi-pronged approach still needs to be adopted. At The Clifford Clinic, we have come up with a comprehensive solution for eczema sufferers – complete with biologics like Dupixent and a mix of oral and topical medications, we also offer laser treatments that can help rejuvenate your skin after an eczema flare-up.

When combined with a radical lifestyle change, healthy habits, and a good skincare routine – we can hopefully offer new hope for patients to tackle that itch for good!