Stop that itch!
Acute eczema is characterised by sudden onset of redness, itching and blistering. It usually resolves within a few weeks of proper treatment. Chronic eczema is longstanding and patients may suffer from recurrent episodes of dry, scaly and itchy skin. With scratching, the skin can be thickened and discoloured over time.
In Singapore, eczema is estimated to affect 20% of children and 11% of adults. In children and young adults, eczema typically appears on creases of the elbows and knees and spreads to other areas when it becomes severe. Patients usually have a family history of eczema, allergic rhinitis or asthma. In older individuals, eczema is usually caused by dry skin. Sometimes, poor blood circulation in the legs can lead to eczema of the lower legs and ankles.
The incidence of eczema in Singapore is increasing and one theory is that it may be attributed to changes in modern living conditions. The "hygiene hypothesis" suggests that our immune system is not being exposed to the same variety of microorganisms as it was in the past, causing it to overreact to harmless substances such as dust mites or pollen. Another possibility is with better healthcare, more people with mild eczema are coming forward to seek treatment, while in the past they might have just ignored it.
According to Dr Cao Taige, Associate Consultant, Department of Dermatology from SKH, moderate to severe eczema can be managed by the dermatologists who could assess the condition and prescribe from the many options of creams, phototherapy, as well as oral medications.
Dr Cao added that there have also been several new treatments, giving hope to patients with severe eczema. These new medications target specific proteins that are involved in the inflammation that cause eczema. Dupilumab is a fortnightly injection while baricitinib, abrocitinib and upadacitinib (also known as JAK inhibitors) are oral medications that are taken daily. These medications are costly and needed to be taken for the long term.
FACT: One main misconception is that steroid cream causes skin thinning and should therefore be avoided. Although there are cases where the skin becomes thin and bruises easily from the improper use of steroid, these cases are usually the result of long-term self-medication of strong steroid creams. To avoid such side effects, doctors will usually assess the condition based on its severity and the body area involved in order to decide the proper strength and duration of treatment. On the other hand, inadequately-treated eczema may lead to thickened skin which can be more resistant to treatment.
FACT: As topical creams are applied to the skin and little gets absorbed into the bloodstream, their potential side-effects are primarily limited to the skin.
FACT: Using the correct strength of steroids for a sufficient amount of time is crucial in treating eczema. If flare-ups are recurring and higher strengths are needed, it is best to consult a dermatologist to rule out any other underlying conditions and provide other treatment options, such as phototherapy, oral medications or injections.
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