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Medical Dermatology Conditions


What is Eczema?

Eczema comes from the Greek term meaning “to boil over”. Thus, eczema is the term for a group of chronic skin conditions causing the skin to become inflamed or irritated. Eczema is also sometimes referred to as “atopic dermatitis” as the word “atopic” is Greek for hereditary allergy and “dermatitis” comes from the Greek work for “skin”. People with atopic eczema have an increased chance of developing other atopic conditions, such as asthma and hay fever.

Eczema often affects infants and children, although some adults do develop eczema as well. At times, children who grow out of the disease often face it again in adulthood. Eczema ranges from mild (skin is dry, scaly, red and itchy) to more severe cases (weeping, crusting and bleeding). Eczema affects both genders, although some people are predisposed to inherit the disease if their parents have it as well.

Even though eczema and acne symptoms look similar, making it challenging to distinguish between them, they are two separate, unrelated skin conditions. Acne causes pimples to erupt. Conversely, eczema causes a discoloured or red, bumpy rash, which may resemble pimples. As such, acne treatments and eczema treatments are different and should not be used interchangeably. Consult a dermatologist in Singapore for the appropriate eczema treatments.

Hand dermatitis, Eczema on hand.
Eczema on neck of a woman

Causes of Eczema

The exact cause of Eczema is not yet known. However, people with atopic eczema tend to have a reduced layer of the lipid barrier of the skin. This caused an increase in water loss and a tendency towards dry skin. Furthermore, an overactive immune system can cause the release of chemicals under the skin surface to respond aggressively to the presence of irritants on the skin, causing skin inflammation. Scratching of the skin inflammation leads to a worsening of the condition as it could cause an infection on the skin. Eczema is also commonly found in families with a history of other allergies or asthma.

An eczema flare-up (occurrence of one or more symptoms of eczema) can occur when triggered by these common factors –

  • Changes in the climate
  • Pollution
  • Allergies to dust mite or pollen
  • Skin contact with coarse or synthetic material
  • Skin contact with harsh soaps or detergent
  • Allergy to animal dander (material shed from animal’s body such as fur and skin cells)
  • Sweating
  • Stress
  • Food allergies

It is important to note that eczema is not contagious. It is not spread by any form of contact.

Types and Symptoms of Eczema

The different types of eczema are classified as follows:

Type of EczemaSymptoms
Asteatotic eczemaFissures or grooves on skin which look pink and red. Tend to only affect the superficial layers of the skin. Occurs mostly in patients above 60 years of age although it can affect young adults as well.
Atopic DermatitisDry skin condition that can flare-up and become red, sore and itchy. Usually found in faces and often affects creases in the body such as the neck, back of knees, the inside of elbows and wrists.
Contact DermatitisContact with skin irritants causes mild dryness and skin redness and the appearance of skin burns. It can be painful, red, fluid-filled and ulcerated.
Dyshidrotic eczema (Pompholyx)Blisters develop on the soles of feet and/or the palms of hands. The blisters are usually itchy and may be filled with fluid. Often comes with subsequent peeling as the skin dries out – the skin can become red and dry with painful cracks (skin fissures). Usually a seasonal allergy and flare-ups often appear during spring.
Nummular eczema (Discoid eczema)The appearance is distinct with ‘coin shaped’ slightly bumpy “discs”, usually on the lower legs, trunk or forearms. Within a few days the patches begin to ooze, and can become very itchy, crusted and infected. Eventually, the surface becomes scaly, and the skin dry and flaky. Usually affects adults.
Seborrheic EczemaThe skin rash appears on areas with a lot of sebaceous glands, hence the name. It usually starts on the scalp as dandruff that can progress to redness, irritation and increased scaling. As the disease progresses, the scalp becomes inflamed, which may then spread onto the face and neck. This usually affects adults and infants.
Stasis EczemaThe appearance is of scaling, open sores or itchy, reddish skin. Other symptoms include calf pain and swollen legs. This skin condition is normally develops in people with poor blood circulation, most commonly in the lower limbs. Pregnant women and overweight adults have a higher chance of developing this skin disease.

Eczema Treatments in Singapore

As most forms of eczema are caused by skin inflammation, steroid creams are usually prescribed for eczema treatment as they are anti-inflammatory. Besides steroid creams, non-steroid creams are also available; these are called topical calcineurin inhibitor (TCI) creams and are usually prescribed to children above the age of 2. These creams are applied topically on the skin area where the rash forms and reduce inflammation while soothing the skin.

To cleanse the affected area and to remove whatever irritant is currently causing the irritation through contact, it is recommended that you use mild nourishing soaps or synthetic soap substitutes. Do not use harsh soaps, as these may cause further inflammation on sensitive skin.

Moisturisers must be used daily to build a protective skin barrier and reduce the chance of developing eczema. Moisturisers also hydrate the skin and reduce itch, so you wouldn’t be tempted to scratch the affected area. Anti-itch medication in the form of anti-histamines can also be given to reduce the itch. Occasionally, a course of antibiotics is required if there is any evidence of skin infection. These antibiotics are usually taken orally and you must complete the course for them to be effective and long-lasting.

In very severe or extensive cases of eczema, oral steroids may be given. Phototherapy (UV light) is another treatment option in Singapore for extensive eczema – should eczema cover a large surface of the skin such as the torso or limbs. In some cases, oral immunosuppressive therapy with drugs may have to be considered by the dermatologist. These eczema treatments are usually prescribed only in severe cases

Eczema is a chronic condition that can only be treated and not cured. Finding the right eczema treatment will depend on your age, medical condition, and the extent of your symptoms, among other things. A dermatologist will probably recommend a mix of remedies to achieve optimal results. Therefore, it is vital to work with a dermatologist to develop an effective eczema treatment plan to control the itch and rash.

The incidence of eczema in Singapore is one of the highest in the world. Why is this so? Perhaps this can be attributed to our nation’s hot and humid weather, resulting in excessive perspiration that can affect our skin’s barrier function. Other factors include overwashing with soaps, which can be detrimental to the skin barrier, and house dust mites (common triggers of eczema) that thrive in our hot, humid climate. A dermatologist can help develop an effective eczema treatment plan to help you manage your skin condition.

When you have eczema, specific cosmetic and skin care products can irritate your skin and trigger a flare-up. Be more careful when using products containing these ingredients:

  • Fragrances
  • Essential oils
  • Urea
  • Lanolin
  • Retinoids
  • Cocamidopropyl betaine
  • Propylene glycol
  • Ethanol

If you are unsure if a product is suitable for your skin, please consult your dermatologist before using it to prevent flare-ups. Your dermatologist can also help develop an effective eczema treatment plan to help you manage your skin condition.

Rest assured that eczema can be managed and won’t affect your lifestyle significantly. In fact, most eczema cases in Singapore are mild, with patients experiencing nothing more than small areas of dry skin that get itchy occasionally. However, there are severe cases of eczema that can be hard to ignore and can lead to regular skin infections if they are not treated properly. Therefore, it is essential for you to consult a dermatologist who can help develop an effective eczema treatment plan to help you manage your skin condition.

No, eczema and acne are two separate skin conditions with unrelated causes. The discoloured or red rash associated with eczema may be mistaken for pimples, but the two conditions are dissimilar. Each skin condition is treated with different medications, and you should not use your acne treatments and eczema treatments interchangeably.

Facial eczema requires careful treatment, as the skin on our face is more vulnerable to and easily irritated by the side effects of topical eczema treatment. Generally, facial eczema treatment aims to avoid further irritation caused by toiletries and cosmetics. Dermatologists may recommend switching to a more gentle skin cleansing regimen. They will also treat facial eczema with anti-inflammatory therapy, such as topical calcineurin inhibitors and topical steroids, and emollients.

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