Eczema

What is eczema?

Eczema, also referred to as dermatitis or atopic dermatitis, is a common skin condition affecting many Singaporeans. Here, we delve into the causes, symptoms, and effective strategies for living comfortably with eczema. Past studies have shown that close to 21.5% of Singapore's adolescents suffered from atopic dermatitis, and the prevalence was higher among the Chinese (21.6%). In another study, researchers surveyed 681 people and found that 21% of children and 11% of adults have eczema.

Eczema's impact goes beyond the skin, affecting overall well-being, sleep, and self-esteem. Our team at Lumine Dermatology & Laser Clinic is dedicated to offering comprehensive care, guiding you through understanding eczema, managing its symptoms, and making lifestyle adjustments to improve your quality of life.

There are seven types of eczema, each with its unique triggers and approach to treatment.

Type of eczema	Eczema characteristics
Atopic dermatitis	Atopic dermatitis is the most common form of eczema. It commonly affects the face in infancy and flexural areas in childhood and adolescence. Some adults with a history of atopic dermatitis in childhood will have eczema present more locally, such as the lips (cheilitis), eyelids, face, hands, or feet. Atopic dermatitis is sometimes seen as the first step in the "atopic march," potentially leading to other allergic conditions like asthma and allergic rhinitis.
Contact dermatitis	Contact dermatitis occurs when patients develop rashes at the exposure site upon contact with allergens. If you have persistent hand eczema, eyelid rashes, or dry and flaky lips, you should suspect contact dermatitis.   Common triggers include nickel, fragrances, hair dyes, and cosmetics.
Dyshidrotic eczema	Also known as pompholyx, dyshidrotic eczema manifests as itchy, bubble-like blisters on the hands and feet. This form of eczema tends to be particularly persistent and uncomfortable, sometimes accompanied by painful fissures in the skin.
Lichen Simplex Chronicus	Lichen Simplex Chronicus usually refers to a thick, itchy rash with exaggerated skin lines, often in response to chronic picking, rubbing, or scratching of the area.
Discoid eczema	Discoid eczema is a form of eczema that results in “coin-like” lesions around the body. Discoid eczema can be dry (dry, scaly, cracked plaques) or wet (oozy, crusted, secondarily infected plaques). Insect bites, stress, or even contact dermatitis to nickel are potential triggers for this eczema.
Seborrhoeic dermatitis	As the name suggests, seborrhoeic dermatitis is a form of eczema that affects areas with more oil production, such as the scalp, eyebrows, nasolabial folds, chest, and back.   The scales in seborrhoeic dermatitis often look a little yellowish and greasy.
Stasis dermatitis	Stasis dermatitis occurs due to circulation issues in the lower parts of the legs, more often on the medial aspects of the lower limbs rather than the lateral part.   If left untreated, stasis dermatitis can result in permanent changes in the appearance of one’s lower legs, known as lipodermatosclerosis. In lipodermatosclerosis, skin in the affected area is thickened and bound down, with limited mobility.

What are the symptoms of eczema?

Below are some key signs of eczema to watch for: 

• Itching: some individuals suffer from profound itchiness that disrupts sleep and unconsciously leads one to scratch to the extent of bleeding.
• Dry and scaly skin: individuals with eczema experience a higher rate of moisture loss (transepidermal water loss TEWL) in their skin, leading to dryness and scaling.
• Sensitive skin: the skin becomes irritated by harsh soaps and detergents, extreme temperatures, non-breathable fabrics, and sweat. There is also a higher prevalence of allergies to dust mites, pollen, and certain foods.
• Red, swollen and inflamed skin: with eczema, the skin is often swollen, red, scaly, and inflamed.
• Weeping skin: infected eczema can lead to “weeping” or oozing of clear or yellowish fluids, which may have a distinctive odour. This is a sign of bacterial infection and requires medical attention.

At Lumine Dermatology & Laser Clinic, we aim to alleviate symptoms and improve the quality of life for those with eczema. If you are experiencing any of the above symptoms, we encourage you to reach out for a consultation. Together, we can create a tailored approach to manage eczema right.

Is eczema painful?

Eczema can be painful, particularly when the areas affected become inflamed and infected. The pain associated with eczema is typically a result of intense scratching and skin-picking. However, patients tend not to be affected by the pain inflicted by this condition. This is because the pain tends to be comparatively “relieving” than the itch. As a result, one is prone to an itch-scratch-damage cycle.

In more serious cases, the pain can be associated with a skin infection known as eczema herpeticum. In this case, one needs to seek medical attention immediately so that the right antivirals can be prescribed.

What is the itch-scratch-damage cycle?

The itch-scratch-damage cycle is a fundamental concept that can often feel like a never-ending loop for those experiencing it. As a dermatologist, I frequently discuss this cycle with patients, aiming to show how it contributes to their discomfort and what steps we can take to break free from it.

The outer layer of the skin often acts as a protective wall against external irritants. Eczema acts like a breach in this wall, leading to dryness, cracking, and inflammation. This breach makes the skin vulnerable, leading to the first sign of trouble: itch.

Here's where the cycle begins: You feel an itch and instinctively scratch. While this might offer momentary relief, scratching worsens the skin's condition. It further damages the skin's barrier, making it even more susceptible to irritants and allergens, leading to more itching. Thus, the cycle continues, often leading to increased inflammation, infection, and intense itching.

Who is at risk of eczema?

Several factors increase an individual’s risk of developing eczema; these are:

• Genetics: if you have a family history of eczema, you might be more predisposed to developing it. The probability of developing eczema is 50% if a parent has been diagnosed with the condition (parental atopy). The genes involved in eczema include those that maintain the skin's structural integrity and moisture levels and those that code for major immune system elements.
• Environmental factors: environmental factors, such as exposure to harsh chemicals in some soaps and detergents, certain fabrics, sweat, and even weather changes, can significantly trigger or exacerbate eczema symptoms.
• Food allergies: in children with moderate to severe eczema, especially those under the age of 3, it may be worthwhile considering food allergy as a trigger. Common foods implicated in childhood eczema include milk, egg, wheat, soy, shrimp, and peanuts.
• House dust mite allergies: these allergies are prevalent in older children and adults. They could also trigger your eczema if you recently relocated from a temperate country to Singapore.
• Internal factors: emotional and physical stress or recovery after an infection can lead to dysregulation of the immune system, which can then cause eczema to flare up.

How is eczema diagnosed?

Identifying the type of eczema patients are dealing with is important to tailor a treatment to each patient accurately. The diagnostic process for eczema may involve the following:

• Comprehensive medical history: you will first be required to provide a comprehensive medical history to determine potential triggers. We delve into your family history, lifestyle, and the impact of eczema on your daily life and well-being. This will allow us to craft a treatment plan tailored just for you.
• Physical examination: the affected areas must be assessed to diagnose the type of eczema you have accurately. We pay special attention to areas that significantly impact your quality of life,  such as the scalp, hands, feet, and face, ensuring no detail is overlooked.
• Targeted allergy testing: if indicated, patch testing and blood tests help us pinpoint potential triggers to avoid.
• Biopsy for clarity: in cases where your condition presents a diagnostic challenge, we may recommend a skin biopsy.

If you suspect your child or yourself may be affected by eczema, contact us now for prompt clinical intervention. Early intervention prevents disease progression (eczema to food allergy and asthma).

What are the treatment options for eczema?

Eczema is a chronic and sometimes relapsing condition that can be effectively managed with the proper care. At Lumine Dermatology & Laser Clinic, we understand the complexities of eczema and are committed to providing personalised treatments that cater to our patients' unique needs.

Our clinic's dermatologist, Dr Evelyn brings extensive experience, offering holistic and innovative clinical treatments designed to alleviate symptoms and improve your skin's health.

Eczema treatment includes the following:

• Topicals: depending on severity, you may be prescribed topicals ranging from topical corticosteroids to non-steroidal creams such as pimecrolimus, tacrolimus, and crisaborole.
• Oral medications: treatment options range from traditional immunosuppressants such as cyclosporine and methotrexate, as well as the newer Janus Kinase (JAK) inhibitors such as baricitinib, abrocitinib, and upadacitinib.
• Antibiotics: where signs of infection are evident, you will be administered a course of antibiotics.
• Injections: injections such as subcutaneous dupilumab can be prescribed for patients with recurrent and persistent flare-ups. Dupilumab is a highly efficacious, FDA-approved treatment for eczema with a high safety margin. No blood tests are required, and side effects are minimal. Dupilumab can only be administered by dermatologists and is approved for use in atopic eczema from 6 months old and above.
• Wet wrap therapy: we provide guidance on wet wrap therapy, an effective method for enhancing the skin's barrier and moisture levels and offering relief from eczema discomfort.
• Skincare advice: our team will review your current skincare routine and discuss the impact of shower frequency, moisturiser use, and potential irritants. We will recommend products that support and strengthen your skin's barrier function.  
• Lifestyle choices: understanding that lifestyle factors can influence eczema, we offer advice on making adjustments that could reduce flare-ups and support your treatment journey.

Frequently asked questions

What is dupilumab, and how does it work?

At Lumine Dermatology & Laser Clinic, we are excited to offer dupilumab, a treatment for patients struggling with moderate to severe eczema (atopic dermatitis). This medication represents a significant leap forward in dermatology, offering new hope to those who have not found relief with traditional treatments.

Dupilumab operates by blocking the action of two key proteins, IL-4 and IL-13, that play a central role in the inflammatory process that drives eczema. By inhibiting these proteins, Dupilumab can effectively reduce the inflammatory response that leads to eczema symptoms. Dupilumab is administered by a dermatologist through a subcutaneous injection every two weeks. It can be administered in the clinic or at home. There is no need for blood tests, and Dupilumab has a good safety profile.

We are dedicated to exploring all avenues to improve skin health and enhance quality of life. If you are struggling with moderate to severe eczema and seeking alternatives to conventional treatments, dupilumab may offer the relief you have been searching for.

What are JAK inhibitors, and how do they work?

Oral JAK-inhibitors such as baricitinib (Olumiant), abrocitinib (Cibinqo), and upadacitinib (Rinvoq) work by blocking certain signalling pathways that affect the immune system and inflammatory process in eczema. JAK inhibitors can be administered orally, providing a significant advantage for those who prefer not to use injectables or are looking for an alternative to topical or oral steroids/immunosuppressants. These inhibitors lead to rapid improvement in eczema symptoms but come with some potential side effects. It is important to discuss this with a dermatologist well-versed with eczema treatment.

What causes eczema?

At its core, eczema results from a combination of genetics, immune system activation, and environmental factors. It is like a perfect storm where your skin's barrier, which usually protects you from the outside world, is compromised. This allows moisture to escape and irritants to enter more easily, leading to the symptoms many are familiar with.

Can I have more than one type of eczema?

You can have two or more types of eczema. This is also a form of disease progression common among patients with eczema. The best method to prevent this is to seek prompt intervention. Halting the progression of eczema at early stages will also ensure the condition is manageable and does not interfere with your quality of life.

How can I cure eczema permanently?

Many patients are hopeful of being permanently rid of eczema. Whilst scientifically, there is no cure for eczema, we firmly believe that treatments, lifestyle, and behavioural changes can effectively suppress flare-ups and lead to an unperturbed life. We understand the stress that conditions like eczema can inflict on you. However, eczema is not a life sentence, and there are a plethora of medications, e.g. dupilumab and JAK inhibitors, at our disposal to help you with your eczema.

Can diet and nutrition improve eczema?

There is some evidence that consuming omega 3 and 6 supplements can help fortify the skin barrier. Recurrently infected eczema can benefit from vitamin D supplementation. Consuming probiotics in pregnancy may potentially reduce the risk of eczema in children.

Is it possible to manage eczema without steroid creams?

This is possible with an arsenal of non-steroidal anti-inflammatory creams such as pimecrolimus, tacrolimus, and crisaborole. Good skin care, avoiding triggers, and applying non-steroidal anti-inflammatory agents can go a long way in managing eczema and minimising relapse.