Eczema (Symptoms, Causes & Treatment)
I am not a doctor. I am not a TCM practitioner. The information provided purely to better understand Eczema, what are the symptoms, causes and treatments available for eczema sufferers.
These are not medical advice. Information provided are with the hope of help eczema sufferers, their family and love ones around them have a better understanding of what is Eczema.
This is a blog post on my understanding of Eczema and information are will be updated as I learn more and have a better sense of how the diseases comes about, what are the treatments available and whether there could be a cure for suffers..
“When a thing is understood, the cure is half accomplished – Anne Shannon Monroe”.
What is Eczema
Eczema (pronounced: EK-zeh-ma) a.k.a. dermatitis is a condition where patches of skin become inflamed, itchy, red, cracked, and rough coupled with blister development. Living with eczema can be an ongoing challenge.
The word “eczema” is derived from a Greek word meaning “to boil over,” which is a good description for the red, inflamed, itchy patches that occur during flare-ups.
Eczema can range from mild, moderate, to severe.
Severe eczema and psoriasis often result in reduced self-esteem, sleep disturbance, loss of concentration at school or work, social withdrawal, depression, increased leave from school or work. Caregivers may also be faced with fatigue looking after the needs of sufferers as well.
Is Eczema Contagious?
Eczema isn’t contagious. Even if you have an active rash, you can’t pass the condition on to someone else. If you think you’ve gotten eczema from someone else, you likely have another skin condition.
Types of Dermatitis (aka Eczema)
Further adding to the confusion, many sources use the term eczema interchangeably for the most common type: atopic dermatitis.
Causes of Eczema?
There are many types of eczema.
Many of them have different causes, some of which still aren’t fully understood.
Atopic dermatitis is one of the most common types. It’s often genetic and tends to start showing up during childhood. This genetic link might make it seem like eczema is contagious, as multiple members of the same family may have it.
Allergic eczema is a form of eczema that occurs in response to contact with an allergen. An allergen is any substance to which a person may be allergic. It is commonly called contact dermatitis. People with this type of eczema develop rashes after exposure to certain allergens, such as pet dander, pollen, mold, foods, certain fabrics, such as wool.
Contact dermatitis is another common form of eczema. It tends to affect people with sensitive skin. Flare-ups happen when you come into contact with an irritant. These irritants vary from person to person, but can include fragrances, dyes, nickel and other metals, synthetic fabrics and cigarette smoke.
Nummular eczema (aka nummular dermatitis) looks different than other types of eczema with its round or coin-shaped lesions. Nummular (pronounced as numb-mu-LUR) eczema, also known as discoid eczema and nummular dermatitis, is a common type of eczema that can occur at any age. It looks very different than the usual eczema and can be much more difficult to treat. People with nummular eczema develop coin-shaped spots on their skin, which may be very itchy. It is thought to be “triggered” by things like insect bites, reactions to skin inflammation, or dry skin in the winter.
Seborrheic dermatitis is considered a chronic form of eczema, seborrheic dermatitis (seb-uh-REE-ick dur-muh-TIE-tis) appears on the body where there are a lot of oil-producing (sebaceous) glands like the upper back, nose and scalp. The exact cause of seborrheic dermatitis is unknown, although genes and hormones play a role. Microorganisms such as yeast, that live on the skin naturally can also contribute to seborrheic dermatitis. Unlike many other forms of eczema, seborrheic dermatitis is not the result of an allergy. People of any age can develop seborrheic dermatitis including infants (known as “cradle cap”). It is slightly more common in men than women.
Stasis dermatitis is also called gravitational dermatitis, venous eczema and venous stasis dermatitis. It happens when there is a problem with blood flow in the veins and pressure develops (usually in the lower legs). This pressure can cause fluid to leak out of the veins and into the skin, resulting in stasis dermatitis.
Impact of Eczema
According to Dr Lynn Chiam, a dermatologist at Mount Elizabeth Novena Hospital, research has shown that skin diseases can impact a person’s quality of life more significantly than other medical conditions, as it is visible to other people.
Once considered a childhood disease, eczema is now one of the most prevalent skin conditions in adults with an estimate one in ten adults in Singapore suffer from atopic dermatitis.
In up to a quarter of the cases, the adults have a moderate-to-severe form of the condition, which severely impacts their quality of life. Studies have shown that people with moderate to severe atopic eczema experience impaired quality of life, including disrupted sleep, as well as increased anxiety and depression. Missed work days are common during flare-ups.es.
Eczema is now the top skin condition seen at National Skin Centre with > 18,000 case seen (2017) and demand for help with skin issues on the rise in Singapore.
Due to Singapore’s hot and humid weather which lead to excessive perspiration which can affect the skin’s barrier function, incidence of eczema in Singapore is one of the highest in the world.
Although doctors have gained more knowledge about eczema (aka dermatitis) over the years, this complex skin disorder is still not fully understood till now.
Symptoms of Eczema
Atopic dermatitis (aka eczema or AD) signs and symptoms vary widely from person to person. Symptoms could include:
- Dry skin
- Itching, which may be severe, especially at night
- Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp
- Small, raised bumps, which may leak fluid and crust over when scratched
- Thickened, cracked, scaly skin
- Raw, sensitive, swollen skin from scratching
Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.
Treatments / Cure for Eczema
There is currently no cure for eczema at the moment.
The aim is for disease control, said Assoc Prof Mark Tang, senior consultant and director of research at the National Skin Centre (NSC).
Severe eczema is challenging to treat, but the good news is that with proper care and education, most patients can control their condition.
Treatments for eczema commonly includes moisturizers and prescription cream (topical steroids or non-steroid creams) aiming to control symptoms by reducing inflammation and relieving itching.
Moisturizers (aka Emollients)
A good skincare routine is required for eczema patients, with the main aim of strengthening the skin’s defective barrier.
Evidence indicates that moisturizing agents (emollients) may reduce eczema severity and lead to fewer flares and an emollients with an oil–based formulations appear to be better and water–based formulations are not recommended for children.
With proper moisturizing routine, a quality moisturizer aka emollient may reduce the number of flares in people with dermatitis when coupled with the following steps.
- Frequent and regular moisturizing
- Avoiding long and hot showers, keeping bathing time to about 10 minutes
- Dabbing dry the skin after a shower, instead of rubbing it dry
- Using mild cleansers and avoiding harsh soaps and products containing fragrances
- Reducing harmful bacteria on skin via gentle antiseptic agents for those with frequent skin infections
Products that contain dyes, perfumes, or peanuts should not be used.
Topical steroids are potent medicines that have been prescribed for your current skin condition only. Do not give to other people or use for other problems as they may worsen the problems.
Topical steroids are applied to the skin to treat many types of skin problems, including itch, redness and swelling associated with allergies, eczema, contact dermatitis and psoriasis. It is also used for other conditions as determined by your doctor.
Topical steroids are available as creams, ointments and lotions. Before applying this medicine, you need to clear the skin, then apply a thin layer to completely cover the affected area and rub it gently in a circular motion until the medicine disappears. Do not apply too much.
Do not bandage or cover after applying the medicine unless directed by the doctor.
Occlusive dressing (airtight covering) may increase both the amount of the steroids absorbed through the skin, as well as increase the risk of side effects.
Apply it twice a day, unless otherwise directed by your doctor. More frequent applications are usually not helpful.
If you have forgotten a dose, apply as soon as you remember. If it is almost time for your next application, skip the missed dose. Do not apply more of it to make up for the missed dose.
When you overuse the topical steroids or if you are on long-term treatment, you may experience thinning of the skin, stretch marks, increased hair growth, easy bruising, reddish stretch marks and / or acne.
While steroid creams have a remarkable skin-penetrating ability, flooding the bloodstream and killing the cells that provide immunity against pathogens, it may only be covering up the problem rather than solving the root of the issue.
Non-steroid Anti-inflammatory Drug (NSAID Cream)
Non-steroid Anti-inflammatory Drugs or NSAID are drugs which is available for purchase over the counter (OTC) without a need for doctor prescription.
TCI is used to treat eczema (atopic dermatitis) by suppressing the symptoms (itching, redness and inflammation) which are a reaction caused by the body’s immune system. It weakens the skin’s defense (immune) system, thereby decreasing the allergic reaction and relieving the eczema.
It is normally used in children above 2 years old. However, your doctor may prescribe the use of TCI in certain situations in children less than 2 years of age.
Generally used as a short-term or long-term periodic treatment. It is often used when other types of treatment are either not working or when you cannot tolerate other types of treatment.
While NSAID are seen as a milder option for controlling symptoms of eczema and a non-steroid alternative, commonly used TCI like Tacrolimus and pimecrolimus were suspected of carrying a cancer risk, though the matter is still a subject of controversy.
You should use TCI only on areas of your skin that has eczema.
Dry your skin completely before applying TCI.
Apply a thin layer of TCI and rub it in well to cover the affected areas. The dose of TCI will be different for different patients. Follow your doctor’s orders or the directions on the label.
If you are a caregiver applying TCI on a patient, or if you are a patient who is not treating your hands, wash your hands with soap and water after applying TCI. This should remove any TCI left on the hands. If you are using moisturizers, apply them after the TCI.
Do not cover the skin being treated with bandages, dressings or wraps. You can wear normal clothing.
Do not bathe, shower or swim right after applying this medicine. This could wash off the TCI.
Do not use this medicine in the eyes or on the inside of your nose or mouth.
If you feel that the medicine is not working well, do not apply more than the prescribed dose. Consult your doctor.
If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next application, skip the missed application and go back to your regular usage schedule.
Increasingly, dermatologists are recommending pro-active therapy where treatment is administered even after the rash has subsided. This is done in order to decrease the residual inflammation in the skin which is not visible (not red) and to maintain the duration of rash-free periods.
The common oral medications to treat eczema are over-the- counter antihistamines which reduce the amount of histamines, thereby reducing itch. However, these may not be effective for all patients.
Wet wrap therapy involves applying the required steroid cream and/or moisturiser and then wrapping the skin with a layer of open-weave tubular dressing which is moist (either with cool, room temperature or lukewarm water, depending on the patient’s preference). In this way, the rash resolves faster and itch is greatly reduced.
Photo-therapy is the exposure of the affected skin to specific light bands of ultraviolet B and/or ultraviolet A light. It is mostly used for adults with care on the amount of exposure to minimise potential UV damage to the skin.
The Health Sciences Authority recently approved a biologic treatment called Dupilumab for atopic dermatitis. Given as an injection, it is the first-of-its-kind treatment that has been approved for adult patients in Singapore with inadequately controlled moderate to severe atopic dermatitis.
Manufactured by American Drug Maker, Regeneron Pharmaceuticals, Dupilumab (sold under the trade name Dupixent) is a human monoclonal antibody designed to target key pathways of the immune system believed to drive the persistent inflammation in atopic dermatitis.
Biologics have been used to treat certain cancers, autoimmune conditions and psoriasis, another type of inflammatory skin disease.
Dr Yew Yik Weng, consultant at the National Skin Centre and adjunct lecturer at Lee Kong Chian School of Medicine, said: “When used together with emollients (moisturisers) and topical steroids, about 70 per cent of patients can achieve 75 per cent improvement in their atopic dermatitis condition at four months.”
While the new drug sounds promising for sufferers, it doesn’t come cheap. The twice-per-month injections will cost patients a whopping $37,000 USD a year.
The average cost for a biologic treatment is around SGD $2,500 a month in Singapore, but this varies among different healthcare institutions.
As for those who cannot afford Dupilumab, Dr Yew said: “Biologics is just one of the anti-inflammatory treatment options for eczema. There are other anti-inflammatory options that may also help patients.
“More importantly, patients should not neglect the three pillars of eczema treatment, namely, to repair and moisturise, to control the itch, and to avoid triggers.”
Home Routine for Eczema
The following tips may help prevent bouts of dermatitis (flares) and minimize the drying effects of bathing:
- Moisturize your skin at least twice a day. Creams, ointments and lotions seal in moisture. Choose a product or products that work well for you.
- Try to identify and avoid triggers that worsen the condition. Things that can worsen the skin reaction include sweat, stress, obesity, harsh cleanser, detergents, dust and pollen. Reduce your exposure to your triggers
- Try to identify food allergies. Infants and children may experience flares from eating certain foods, including eggs, milk, soy and wheat. Talk with your child’s doctor about identifying potential food allergies.
- Take shorter baths or showers. Limit your baths and showers to 10 to 15 minutes. And use warm, rather than hot, water.
- Use only gentle soaps. Choose mild soaps. Deodorant soaps and antibacterial soaps can remove more natural oils and dry your skin.
- Dry yourself carefully. After bathing gently pat your skin dry with a soft towel and apply moisturizer while your skin is still damp.
Natural Remedies for Eczema
Many people with eczema use products and practices that are outside Western, or conventional, medicine to help manage their symptoms.
If you use these natural therapies with doctor-prescribed medications, you are using a “complementary” method to manage your eczema. If you are using natural therapies in place of conventional medicine, you are using an “alternative” method.
The following complementary and alternative therapies have been studied and found to benefit certain symptoms of eczema in adults. Check with your health care provider if you are interested in trying alternative therapies on your child’s or your own eczema condition.
I’ll attempt to update this blog post with more information on non-steroid and natural remedies for eczema as I understand more.
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