Eczema: A Singapore Dermatologist’s Guide

Eczema, or atopic dermatitis, is a chronic inflammatory skin condition, manifesting as itchy, dry, and red patches on the skin. Predominantly identified in childhood, eczema is noted in about 25% of children, often appearing before they reach 5 years of age. Although many children experience remission as they grow older, a small percentage of adults continue to show symptoms. Eczema is known for its itch-scratch cycle, leading to more skin damage. It presents differently in individuals, influenced by factors such as age, skin tone, and severity. In lighter skin, eczema may appear reddish or brown, while in darker skin, it might look dark brown, purple, or grey, posing diagnostic challenges. Post-eczema changes in skin color, such as hyperpigmentation or hypopigmentation, are also common.

Types of Eczema

Eczema manifests in various forms, each with distinct characteristics. The most common type is Atopic Dermatitis (AD), prevalent in childhood and often associated with other atopic conditions like asthma and hay fever. However, there are several other types:

Allergic Contact Dermatitis

A reaction to skin contact with a substance recognized as foreign by the immune system.

Dyshidrotic Eczema

Characterized by small blisters on the palms and soles, this form affects the skin on the hands and feet.

Neurodermatitis

This leads to scaly patches on the head, forearms, wrists, and lower legs, often triggered by a localized itch, such as an insect bite.

Discoid Eczema (Nummular Eczema)

Presents as circular patches of irritated skin that may be crusted, scaly, and itchy.

Stasis Dermatitis

Related to circulatory problems, this type affects the skin of the lower legs. Each type of eczema has unique triggers and symptoms, requiring a tailored approach to diagnosis and management. Understanding the specific type of eczema is crucial for effective treatment and care.

Symptoms Across Ages and Skin Tones

Infants

In babies under two years, eczema is often seen as rashes on the scalp and cheeks. These rashes might bubble up and leak fluid, causing extreme itchiness and potentially disturbing sleep.

Children

For children aged 2 to puberty, eczema typically appears behind the creases of elbows or knees, on the neck, wrists, ankles, or between the buttocks and legs. The rashes can be bumpy and may affect skin colour.

Adults

Adults with eczema usually experience more scaly rashes, often located in the creases of elbows, knees, or the nape of the neck. The skin in these areas may be very dry, itchy, and prone to infections.

Skin Tone Variations

Eczema in darker skin tones might present as grey or brown patches, leading to potential challenges in accurate diagnosis. Post-eczema changes like hyperpigmentation or hypopigmentation are also more prevalent in darker skin.

Causes and Risk Factors

Genetic Factors

Eczema’s development is often linked to genetics. A family history of eczema, asthma, or hay fever increases the likelihood of developing the condition.

Environmental Triggers

Various environmental elements can trigger eczema. These include irritants like soaps and detergents, allergens such as dust mites and pet dander, and extremes in temperature and humidity.

Diet and Lifestyle

Certain foods and stress are known to exacerbate eczema symptoms, although they are not direct causes of eczema. Lifestyle changes can sometimes help in managing the condition.

Skin Barrier Dysfunction

Issues with the skin’s barrier function, which retains moisture and protects against irritants, can make individuals more susceptible to eczema.

Hormonal Changes

Hormonal fluctuations, especially in females, can influence eczema symptoms, often seen during pregnancy and menstrual cycles.

Diagnosis of Eczema

Clinical Evaluation

Eczema is primarily diagnosed through clinical evaluation. A doctor assesses the skin and considers the patient’s medical history, including any family history of eczema or atopic conditions.

Allergy Testing

In cases where allergies are suspected to contribute to eczema, allergy testing may be conducted. This helps identify specific allergens that might trigger the condition.

Age Considerations in Diagnosis

The age of onset and the pattern of skin involvement often guide the diagnostic process, as eczema can present differently in infants, children, and adults.

Distinguishing from Other Skin Conditions

Differentiating eczema from similar skin conditions, such as psoriasis or contact dermatitis helps in effective management. This may involve a careful examination of the affected areas and a review of the individual’s overall health and environmental factors.

Treatment Approaches

Medications

Various medications are used in managing and treating eczema. These include:

Topical Treatments

• Topical corticosteroids to reduce inflammation and itching
• Topical calcineurin inhibitors for immune system suppression to decrease inflammation

Systemic Medications

• Oral corticosteroids or immunosuppressants for severe cases
• Antibiotics if a bacterial skin infection is present
• Antihistamines to reduce itching, particularly at night

Phototherapy

Exposure to ultraviolet light, known as phototherapy, can be effective for moderate eczema, helping to reduce symptoms and flare-ups.

Biologics

Biologics treatments for eczema like dupilumab (Dupixent) and tralokinumab-ldrm (Adbry) target specific proteins in the immune system to reduce inflammation and are used for moderate to severe eczema.

Emerging Treatments

Recent advancements include topical JAK inhibitors and PDE4 inhibitors, which have shown efficacy in treating atopic dermatitis.

Home Care and Management

Maintaining skin health through daily practices is vital for eczema management:

Skin Care Routine

• Regular moisturizing to retain skin moisture
• Using gentle, non-irritating soaps and cleansers

Lifestyle Adjustments

• Avoiding known irritants and allergens
• Wearing soft, breathable fabrics
• Managing stress through relaxation techniques

Environmental Considerations

• Using humidifiers in dry conditions
• Avoiding extreme temperatures that may trigger eczema flare-ups

Complications and Co-occurring Conditions

Eczema-Related Complications

Eczema can lead to several complications, including:

Skin Infections

Frequent scratching can break the skin, increasing the risk of bacterial, viral, or fungal infections.

Sleep Disturbances

The intense itchiness of eczema often disrupts sleep, leading to fatigue and impacting overall quality of life.

Co-occurring Atopic Conditions

Eczema often occurs alongside other atopic conditions, such as:

Asthma and Hay Fever

Many individuals with eczema also have asthma or hay fever, indicating a shared allergic background.

Food Allergies

Some individuals with eczema may also have food allergies, requiring dietary considerations and management.

Impact on Mental Health

The chronic nature of eczema and its visible symptoms can affect mental health, potentially leading to conditions like anxiety and depression.

Considerations for Skin Tone

In people with darker skin tones, eczema can lead to more pronounced hyperpigmentation or hypopigmentation, affecting the cosmetic appearance and possibly prolonging the psychological impact.

Preventing Flare-Ups

Regular Skin Care

Maintaining a consistent skin care routine is essential in preventing eczema flare-ups. This includes:

Moisturizing

Regularly applying moisturizers helps keep the skin hydrated and can prevent dryness and irritation.

Environmental Control

Managing the environment plays a crucial role in preventing flare-ups:

Humidity and Temperature

Using humidifiers and avoiding extreme temperatures can help maintain skin comfort.

Lifestyle Modifications

Lifestyle changes can significantly impact the frequency and severity of eczema flare-ups:

Stress Management

Stress is a commonly known eczema trigger, and managing it through relaxation techniques can be beneficial.

Clothing Choices

Opting for soft, breathable fabrics and avoiding irritants in clothing materials can help prevent skin irritation.

Dietary Considerations

While food is not a direct cause of eczema, some individuals may find certain foods exacerbate their symptoms. Identifying and avoiding these can be helpful.

When to Seek Professional Help

• Persistent, severe symptoms that disrupt daily activities
• Signs of skin infection, such as increased redness, warmth, or oozing
• Lack of improvement with over-the-counter treatments
• Frequent flare-ups affecting quality of life

Eczema management often requires a comprehensive approach, tailored to individual needs. Consulting a dermatologist can provide specialized care, ensuring effective treatment and long-term management of this chronic condition.