Your skin turns dry and red. But what makes eczema more unbearable than other skin diseases is that intense and severe itch. Scratching brings about relief but it doesn’t last for long. Skin becomes broken and infection sets in. You know it will be another sleepless night.
One common form of eczema is atopic dermatitis. While 80% of cases are mild, the condition can persist from early infancy right through to adulthood. A chronic inflammatory disease, it causes a rash on the skin so patients experience intense itch. As it requires patients to avoid trigger causes such as sports, it can impact quality of life considerably.
We find out from Dr Mark Tang, senior consultant dermatologist, The Skin Specialists and Laser Clinic, why city dwellers – like us here in Singapore! – are more prone to this type of eczema.
1 in 10 adults in Singapore have atopic dermatitis. Our rates are now similar to that of major cities in US, Europe and Japan. Atopic dermatitis, which affects males and females equally, is more common in first-world countries. It is thought that modern living is too “clean” and early environmental exposures paradoxically leads to abnormal immune responses that trigger the condition.
Eczema is not always genetic. Eczema comes about from the interaction between our immune response genes and our skin barrier. Some patients inherited skin that over-reacts to environmental factors such as heat, dust and sweat, causing skin to turn red, dry and itchy. Up to 30% of patients with eczema have a missing or malfunctioning filaggrin gene. Filaggrin is a protein that helps to hold skin cells together and protect the skin barrier against moisture loss and inflammation due to environmental irritants.
Eczema can also be caused by environmental triggers – like other chronic diseases. Heat, sweat and dust are the common ones. Other culprits include soap, detergent, fragrance and (over-washing with) plain water, all of which exacerbate skin barrier damage.
Eczema can be managed with lifestyle changes. It is important to ensure that triggers are not present in clothing, skincare and makeup products, and sports activities. Try to develop behaviour techniques to, for example, distract yourself from scratching when the skin starts to feel itchy. Some patients apply moisturiser to soothe the itch – find one with ingredients such as humectants such as glycerine and urea to draw and lock in moisture; emollients such as paraffin or oils to reduce water loss; and lipids such as ceramides to repair the skin lipid barrier. Since our skin has an acidic pH, consider a formula with pH5.5 or below in order to maintain the stability of the skin barrier.
Steroids, which are prescribed to some patients, can cause side effects with overuse. With topical steroids, skin can start to thin and become easily bruised. With oral steroids, meanwhile, side effects can range from cataract to diabetes and osteoporosis. Among the latest steroid-free therapy options is dupilumab, which targets they key proteins that contribute to inflammation that brings about eczema and has proven in clinical trials as effective and safe for the treatment of moderate to severe atopic dermatitis.
Eczema can go into remission with time. While the exact reasons why and how this happens is still being researched but it is believed that early intervention to strengthen the skin barrier and immune system can help improve outcomes over the long term.