All You Need To Know About Eczema In Children And Adults

In this article, we talked to a dermatologist in Singapore about the topic of eczema, a common disease many people suffer silently from. We summarize some information on Eczema that everyone should have.

Eczema is also known as dermatitis and can affect a variety of people, including both adults and children. Generally, people with eczema causes dry, scaly, and itchy skin to various degrees depending on the person and the symptoms. The inflamed area often looks red and can be rather uncomfortable.

According to the National Skin Center, one in every ten adults in Singapore have eczema.

There are multiple types of eczema caused by various issues. Contact dermatitis is caused by allergens,  which can be a variety of different external triggers. Endogenous dermatitis is caused by issues within the body. One common form of endogenous dermatitis is atopic dermatitis.

Contact Dermatitis 

Contact dermatitis is caused by an irritant either ingested or that touched the skin. The exposes to these triggers causes a release of inflammatory chemicals which can cause eczema.

Some common causes of contact dermatitis are perfume, chemicals in skincare and makeup products, jewellery (especially gold or nickel), and/or latex gloves.

The most common type of contact dermatitis is irritant contact dermatitis. This generally happens when the skin comes in contact with a toxic substance such as bleach, pepper spray, battery acid, or kerosene. There are also less toxic substances that sometimes cause a reaction, even simply soap or water.

Atopic Dermatitis 

Atopic Dermatitis is most commonly found on babies and has the same common symptoms as adult dermatitis (such as red, itchy, and inflamed skin). It is also often found in the flexural areas (ex: neck,  elbows, behind the knees, etc.) in children. In severe cases, it can spread past that and affect the quality of life for the child. When this is around for a long period of time, it can cause thick skin from scratching and rubbing.

Eczema affects one in five children in Singapore, and 60% of those are affected within the first year of their life. “Atopic” means an inherent sensitivity to a variety of environmental factors. It is common for these children to have other sensitivities as well, such as asthma or rhinitis.

What Is The Underlying Cause of Eczema?  

Researchers say there is no one known cause of eczema, but say that most likely there are both environmental and genetic factors at play in the same person at the same time. It is often seen with an overactive immune system.

Some research has found that patients with dermatitis have a gene mutation that lowers the production of filaggrin. Filaggrin creates a barrier on the outer layer of the skin that protects it from irritants, adds moisture, and protects from infections and bacteria. This means people with dermatitis have inflamed and infection-prone skin.

Investigations for Eczema 

No lab tests can prove eczema. Generally, it is diagnosed by examining both skin and medical history. There are tests done to see if there are other related conditions around, however:

Blood Tests 

A small sample of your blood is taken to check for an immune reaction shown by high levels of eosinophil cells. They also may check for an IgE antibody. This can help find food and environmental allergies.

Patch Testing 

This is when small patches are put on the skin, generally for 24 hours, to see if eczema gets worse. This shows what may be a trigger for the person, and once avoided, eczema can improve. They often test for common allergens, such as rubber, fragrances, metals, and other issues.

Skin Prick Test 

Skin Prick Tests require that no antihistamines be taken for at least a week prior to get the full effect of the reaction. In the Skin Prick Test, a small amount of allergen is applied to the skin with a small, disposable plastic device. The skin is then watched for the next twenty minutes in order to see if there is any redness or inflammation.

Skin Biopsy 

In Skin Biopsys, a small piece of skin is removed from the face (after numbing) to make sure there are no other skin conditions that mimic eczema.

Treatment Available for Eczema 

Atopic Dermatitis can be persistent and chronic. By intervening early, you or your loved one’s symptoms can be alleviated and your or their overall quality of life can be improved. The first step is going to a dermatologist who is knowledgeable and experienced when it comes to both diagnosing and treating eczema.

There are a number of different treatments for eczema. The most common are topical management. This can be done with moisturizers, steroid creams, non-steroid creams, and wet-wrapping. Wet-wrapping is when the affected area is wrapped with wet bandages for rehydrating and soothing purposes. This is generally suggested for severe dermatitis. The best management for an eczema flare is figured out with a dermatologist or dermatology trained nurse, in conjunction with you.

For very severe cases, in-patient treatment may be recommended. Generally, then several treatments will be done at once. In addition to wet treatments, counselling, and/or therapy is often recommended. When your condition is stabilized, you will be sent home.

If the severity is worse or not improving, especially if topical treatments aren’t helping, your doctor may suggest other treatments, such as phototherapy, immunosuppressants used orally, and biologic injection treatment.

General Advice: 

1. Avoid stuffed toys, pets, and carpets to lower the number of dust mites in the home.
2. Avoid bubble baths and strong soaps.
3. Take a ten-minute shower or bathe daily with lukewarm water.
4. We recommend a soap substitute.
5. Avoid excessive sweating and extreme temperatures, especially during flare-ups.
6. Minimize scratching. Cutting fingernails can help.
7. Moisturize two to three times a day with a fragrance-free moisturizer.

Topical Steroids 

1. The strength of asteroid will depend on age and location.
2. Use as directed, often twice daily.
3. Stop steroids when the skin is flat and no longer itchy.
4. Prolonged use of steroids can have side effects.

Wet-Wrap Therapy 

1. This is wet-wraps put over an ointment.
2. Your doctor will show you how this is done.
3. This helps the ointments get into the skin and prevents scratching.

Oral Treatments 

1. Oral Anti-Histamines can be suggested, and often help with sleep, but are not for long-term use.
2. Oral Antibiotics are used in the event of an infection.
3. Oral Steroids or Immunosuppressants help with severe flare-ups