Eczema Treatment Options By A Singapore Dermatologist

The precise cause of eczema remains unclear, yet it involves an exaggerated immune reaction in the skin. 

The severity of eczema varies, with milder cases displaying dry, itchy skin, and more severe instances leading to extensive inflammation and possible bleeding sores. A notable feature of eczema is the itch-scratch cycle, where itching exacerbates scratching, leading to increased skin irritation and exacerbation of the condition.

Overview Of Eczema Treatments In Singapore

Eczema has a wide range of treatments available, with more advancements on the horizon. There has been a surge in the development of new treatments for eczema, offering hope for improved management of this condition. 

The approach to eczema treatment varies depending on the type and severity of the condition. It typically involves a combination of lifestyle changes, over-the-counter (OTC) remedies, or prescription medications. Symptoms and responses to eczema treatment in Singapore can differ from person to person. Familiarize yourself with the available options and consult your dermatologist to tailor a treatment plan that suits your individual needs.

Over-the-counter (OTC) Remedies for Eczema

OTC eczema treatments encompass a range of topical and oral medications available without a prescription. These treatments aim to alleviate symptoms such as itchiness, redness, irritation, or rash. Certain OTC products can assist in preventing flare-ups and aid in sleep, especially when night-time itchiness is a concern. These products are available in both brand-name and generic forms.

Antihistamines and Pain Relievers

Atopic dermatitis, a common form of eczema, is often associated with allergies and asthma as part of the atopic triad. For individuals experiencing itch and inflammation due to allergies, healthcare providers might suggest antihistamines. Some antihistamines also have sedative properties to aid in sleep. Common OTC oral antihistamines include Diphenhydramine, Chlorpheniramine, Cetirizine, Loratadine, Fexofenadine, and Doxylamine.

OTC pain relievers like Acetaminophen, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), are also used to address symptoms like burning, pain, and inflammation associated with eczema.

Topical Hydrocortisone and Shampoos

Topical OTC hydrocortisone, a low-potency steroid, works by reducing irritation, itching, and inflammation. It is available in various forms, including ointments, creams, lotions, and gels, and is used for temporary relief from itching and rashes caused by most types of eczema.

Medicated OTC shampoos containing ingredients like ketoconazole, selenium sulfide, coal tar, and zinc pyrithione are beneficial for symptoms of seborrheic dermatitis on the scalp. These ingredients help lift the seborrheic dermatitis scale or provide anti-fungal treatment.

Considerations for OTC Products

Follow directions for OTC medicines carefully and consult your dermatologist before using them, particularly for individuals with specific medical conditions or those taking other medications. Special attention is required when administering these medicines to children, ensuring adherence to the recommended dosages and duration.

Prescription Topical Treatments

Topical JAK Inhibitors

The inflammation in atopic dermatitis (AD) is partly due to immune system messengers, cytokines, that operate through the JAK-STAT pathway. Topical JAK inhibitors target enzymes like JAK1 and JAK2, reducing inflammation, itch, and redness in the skin. Opzelura (ruxolitinib 1.5%) cream is an example, approved for short-term and non-continuous treatment of mild to moderate AD in non-immunocompromised patients 12 years and older.

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors (TCIs) suppress certain immune system cells, reducing symptoms like redness, itch, and inflammation. Tacrolimus ointment and pimecrolimus cream are TCIs approved for use in eczema, applicable to all affected skin areas, including delicate skin. They are suitable for extended use to control symptoms and reduce flares. Common side effects include a mild burning or stinging sensation upon application.

Topical PDE4 Inhibitors

Phosphodiesterase 4 (PDE4) inhibitors work by blocking the production of inflammatory cytokines. Crisaborole (Eucrisa®) is a PDE4 inhibitor approved for mild to moderate atopic dermatitis in adults and children as young as 3 months.

Topical Steroids

Topical corticosteroids are commonly prescribed for eczema to reduce inflammation and itching. These steroid creams for eczema range in potency and come in various forms like ointments, creams, lotions, and sprays. Care is necessary when applying steroids to areas like the face, genitals, and skin folds. Side effects can include skin thinning, stretch marks, and acne.

Prescription Injectable Biologics

Biologic drugs for treating eczema, known as biologics, are advanced therapies using human DNA to treat diseases at the immune system level. Administered subcutaneously or intravenously, biologics are genetically engineered medications derived from living tissues or cells.

How Biologics Work

Biologics target proteins called interleukins (ILs) produced by the immune system. In inflammatory diseases like atopic dermatitis, the immune system overreacts, leading to excessive IL release and chronic inflammation. By blocking specific ILs, biologics can reduce inflammation and alleviate symptoms of atopic dermatitis.

Examples of Biologics for Atopic Dermatitis

  • Dupixent® (dupilumab) is approved for adults and children aged 6 months and older with moderate to severe atopic dermatitis not responding to topical treatments.
  • Adbry (tralokinumab-ldrm) is suitable for adults with moderate to severe atopic dermatitis inadequately controlled with topical therapies.

Biologics are a significant advancement in eczema treatment, offering targeted relief for individuals with severe cases. However, it is essential to consult healthcare providers to understand their suitability and potential risks.

Prescription Oral Treatments

Oral treatments for eczema include a variety of medications that target the immune system’s role in the condition. These treatments are typically considered for moderate to severe atopic dermatitis.

Immunosuppressants

Immunosuppressants help control eczema symptoms by suppressing the overactive immune response. They are prescribed for moderate to severe atopic dermatitis and can help break the itch-scratch cycle, allowing the skin to heal and reducing infection risk. Common immunosuppressants include Azathioprine, Cyclosporine, Methotrexate, and Mycophenolate mofetil. These drugs are generally used for a limited period to bring eczema under control, followed by long-term management with topical treatments.

JAK Inhibitors

JAK inhibitors target the Janus Kinase-Signal transducer and activators of transcription (JAK-STAT) pathway involved in inflammatory responses. Oral JAK inhibitors like Cibinqo (abrocitinib) and Rinvoq (upadacitinib) selectively block JAK1, associated with inflammation and itch in atopic dermatitis. Approved for adults and adolescents with refractory moderate to severe atopic dermatitis, these medications are a newer addition to eczema treatment.

Traditional Systemic Medications

Traditional systemic medications used off-label for eczema include drugs initially developed for other conditions like organ transplant rejection or chemotherapy. They can be effective in reducing eczema symptoms but come with potential side effects that require careful monitoring.

Steroids

Steroid creams for eczema along with oral steroids such as prednisone are sometimes prescribed for severe eczema flare-ups. However, their long-term use is generally not recommended due to potential serious side effects, including increased infection risk, skin thinning, high blood pressure, and others. They are typically used as a short-term solution in acute cases.

Oral treatments for eczema offer various options for managing the condition, particularly in severe cases. However, they require careful consideration and regular monitoring by a dermatologist to ensure efficacy and safety.

Phototherapy for Eczema

Phototherapy, also known as light therapy, is a treatment option involving the use of ultraviolet (UV) light for various forms of eczema. It is particularly beneficial for widespread eczema or localized forms that have not responded well to topical treatments.

Types of Phototherapy

The most common type of phototherapy for eczema is narrowband ultraviolet B (NB-UVB) light. Other forms may include treatments using ultraviolet A (UVA) light, based on individual needs and healthcare provider recommendations.

Phototherapy Procedure

During treatment, patients apply a moisturizing oil to the skin and stand in a light-emitting cabinet, wearing protective goggles. The treatment is brief, often lasting just seconds to minutes, and targets either the entire body or specific areas. Improvement in eczema symptoms can typically be observed after one to two months of regular phototherapy sessions.

Potential Side Effects

While phototherapy is generally safe, some side effects can occur, such as:

  • Sunburn and skin tenderness, particularly after initial sessions.
  • Premature skin aging with prolonged use.
  • Rarely, nonmelanoma skin cancer and cataracts (from UVA treatment).

Phototherapy offers an alternative or supplementary treatment for eczema, particularly useful in cases where topical treatments are insufficient.