Nearly one in five Singaporeans have suffered from eczema at some point in their lives. In order to treat it successfully, it really helps to know a bit more about what causes eczema, beyond just having "sensitive skin".
Here are my top 10 tips from seeing eczema patients in clinic (they form a huge proportion of patients who visit the skin clinic).
1. What causes eczema?
The short answer: eczema is due to an overactive immune system that attacks important bits of your skin, leading to inflammation and rash.
Your skin loses its effectiveness as a barrier, resulting in water loss, dry skin, and that persistent itchy sensation.
2. Eczema can appear anywhere on your body.
Unfortunately, eczema isn't just confined to your limbs and body - it can pretty much affect any part of your body, including your face.
If you are unsure, have that rash checked out by your doctor! Sometimes a proper diagnosis is all it takes in order to properly treat eczema.
3. Singapore's humidity doesn't help matters.
Heat and humidity is one of the known triggers of eczema, with other common triggers including viral illness, stress, dry skin, and irritants (in soap products and other stuff you touch).
Take it from me - I had childhood eczema, which went away and only recurred when I came back to Singapore after 8 years abroad.
Try to avoid these triggers where you can, such as wearing gloves when washing the dishes.
4. Want to get rid of eczema? The key is moisturizers!
I always explain the importance of moisturisers to my patients using this example:
Think of your skin as a piece of clothing, preventing the nasty stuff outside from getting in, and useful stuff inside from getting out.
In an eczema flare, your skin becomes dry and leaky, like a piece of tattered clothing with many holes. As such, it can't retain any water, leading to a vicious cycle of dry skin, itch, more scratching, and more rash.
When you apply moisturizer, it adds an additional layer of protection to your "leaky skin" while giving it time to repair itself.
Even after the eczema has completely resolved, regular moisturizers are the key to prevent it from recurring.
How much moisturizer to put? My answer is that you can never apply too much. As a rule of thumb, I get patients to apply moisturizers within 30 minutes after they shower, 3-4 times a day.
QV cream, Aqueous cream, and Cetaphil are good brands of moisturizers that I recommend to patients because they don't have irritants in them.
Applying a lot of moisturizers every day can be cumbersome, in which case you may consider switching to an oilier moisturizer which stays on for longer (your doctor can advise you on which kind to use).
5. Topical steroid creams are very safe to use.
Singaporeans are extremely averse to taking any type of medication, especially if they contain the word "steroid".
Remember when I mentioned that eczema is caused by overactivity of the immune system? It just so happens that topical steroids are very effective at reducing both inflammation and rash.
Doctors prescribe different strengths of topical steroids to use on different parts of your body, depending on skin thickness.
For example, we always prescribe a much weaker steroid cream for face eczema, compared to other parts of your body, so there’s no need to be worried about skin thinning.
Don't be paranoid either about steroid cream being absorbed into your bloodstream (it doesn't happen).
6. Stop scratching.
Picking is not doing your damaged skin any favours. I know that during an itchy eczema flare, not scratching is easier said than done, especially while sleeping when it's common to scratch unconsciously.
Apart from regular application of moisturizers, there are a couple of other effective ways to help you stop the itching and scratching.
7. Oral medication is extremely helpful and effective in treating eczema.
For most people, oral medication for eczema comes in two forms: Anti-itch medication (antihistamines) and steroids (prednisolone).
Anti-histamines stop the itch. They are safe to take indefinitely as they do not have any side effects, and play a key part in breaking the itch/scratch/rash cycle.
Steroids work by temporarily suppressing your overactive immune system, and help to reduce both itch and rash.
They are safe to take for short durations as prescribed by your doctor, but can have severe side effects when taken over longer periods of time.
The worst thing you can do is doctor hop to get repeat oral steroid prescriptions as a "quick fix" - your body can become reliant on steroids over time if used incorrectly.
8. Eczema can cause nasty infections and require hospitalisation.
There aren’t too many skin disease that requires hospitalization, but in severe cases of eczema, the rash can affect over 90% of your body, resulting in severe infection and heat/water loss.
These patients need to be admitted to the hospital for life-saving treatment.
9. Diet does not cause eczema flares.
Many of my patients are convinced that diet can trigger a flare-up, and come into the clinic asking what foods they should avoid.
There is no scientific evidence that shows dietary restriction has any benefit in reducing or preventing flare-ups. However, I tend to advise patients to avoid any particular foods they know to trigger their eczema.
10. Unfortunately, eczema sticks with you for life (but we can prevent it from coming back).
I inevitably get asked by patients how to get rid of eczema permanently, to which I reply: If there were such a solution, I wouldn’t get any more eczema myself and would probably be a retired multimillionaire. The good news is that we can readily treat eczema when it appears, but sometimes despite our best efforts, there’s always a possibility that any of the triggers mentioned above may cause it to recur.
However, if you take proper care of your skin with regular application of moisturizers, there’s a high chance to minimize the recurrence of eczema.