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(Photo: Canva @Quality Stock Arts)

In Singapore, eczema affects approximately one in five children and one in 10 adults. Also known as atopic dermatitis, this chronic skin condition causes dry, red, and intensely itchy patches. While eczema can be distressing and disruptive to daily life, proper skincare and timely treatment can help manage it effectively.

What Is Eczema?

Eczema is a long-term inflammatory skin condition that commonly begins in childhood, though it can persist into or develop during adulthood. It results from a combination of genetic factors and an overactive immune response that weakens the skin's natural protective barrier.

The condition typically presents with dryness, redness, swelling, and persistent itching. Common areas affected include the face, neck, hands, feet, and skin folds such as the elbows and behind the knees. Importantly, eczema is not contagious, but it does require consistent management to prevent flares and complications such as skin infections.

Dr Choo Ying Ying, Associate Consultant and Family Medicine Physician at Sengkang Polyclinic, understands the frustration. "As both a healthcare professional and a parent to a child with eczema, I've witnessed how flare-ups can disrupt not just skin, but sleep, playtime, and the joy of everyday moments. It's not just the itch—it's the emotional weight that comes with it. I've also learned that with patience, timely treatment, and a proactive care plan, eczema can be brought under control. If you or your loved one is walking this journey, know that you're not alone. Eczema may demand daily care, but with the right strategies and support, you can take back control of your skin, your comfort and your confidence."

Understanding Causes and Common Triggers

People with atopic dermatitis have a compromised skin barrier and this makes their skin more vulnerable to irritants, allergens, and moisture loss. Several factors contribute to this condition:

• Family history of eczema, asthma, or allergic rhinitis
• Environmental triggers include dust mites, heat, humidity, sweat, harsh soaps, detergents, and prolonged water exposure
• Stress, hormonal changes, illness, and poor sleep

It is worthy to note that while food allergies can trigger eczema in young children, they are less commonly the main cause. Environmental factors typically play a more significant role.

Debunking Common Misconceptions

Despite eczema's prevalence, several misconceptions persist that can hinder proper management:

1. "Eczema is caused by dirty blood and can be cured.”

Reality: Eczema is not due to blood impurities. It is a chronic condition linked to genetics and immune function. While some children may outgrow it, there is no permanent cure, though it can be effectively managed.

2. “Eczema is due to eating the wrong foods.”

Reality: Food triggers are relatively uncommon, especially in adults. Avoiding certain foods without proper medical testing may lead to nutritional deficiencies, so it's important to consult a doctor or dietitian before making dietary changes.

3. “Eczema is contagious.”

Reality: Eczema is not an infection and cannot be transmitted between people.

4. “Poor hygiene causes eczema.”

Reality: Excessive washing or using harsh soaps can irritate sensitive skin. Instead, gentle cleansing and regular moisturising are essential.

5. “Steroid creams are harmful.”

Reality: Topical steroids are safe and effective for controlling eczema flares when used appropriately under medical supervision. Concerns about steroid toxicity or skin thinning usually stem from incorrect use, such as overuse or applying high-potency steroids for extended periods. Avoiding steroids completely may lead to poorly controlled eczema and increased infection risk.

Daily Skincare Tips

Daily skin care plays a crucial role in controlling eczema:

1.  Moisturising frequently is crucial. Apply fragrance-free emollients several times daily, especially after bathing, to maintain hydration and strengthen the skin barrier.
2. Choose gentle, soap-free, fragrance-free cleansers to avoid irritation.
3. Keep showers short and lukewarm, as hot water can dry out the skin. Limit baths to 5-10 minutes, then gently pat skin dry with a towel rather than rubbing. Apply moisturiser immediately while skin is still slightly damp.
4. Clothing choices matter too. Choose soft, cotton fabrics and avoid wool or rough materials that can irritate sensitive skin. In Singapore's humid climate, staying cool and avoid overheating and sweating are particularly important.
5. For those with recurrent skin infections, doctors may recommend antiseptic washes to reduce bacterial loads or consider staphylococcus decolonisation treatments.

Treatment Options

(Photo: Canva @antoninavlasova)

1.  Topical medications: Steroid creams are commonly used to reduce inflammation during flares, while calcineurin inhibitors (non-steroid creams) are suitable for sensitive areas or long-term use. Always follow medical advice regarding proper application.
2. Proactive therapy: Even after the skin appears healed, some doctors recommend continuing low-dose treatment on previously affected areas a few times a week to prevent recurrence.
3. Oral medications: Antihistamines may help relieve itching, especially at night. In severe cases, short-term oral steroids or other immune-suppressing medicines may be prescribed by a specialist.
4. Wet wrap therapy: This involves applying moisturiser or medicated cream followed by wrapping the skin in damp dressings. It can help reduce inflammation and discomfort during severe flares.
5. Phototherapy: For persistent or widespread eczema, ultraviolet (UV) light therapy may be offered in specialised centres.
6. Biologic therapy (Dupilumab injection): This injectable treatment targets specific pathways in the immune system and is used in patients with moderate to severe eczema not responding to conventional therapy.

Key Takeaways: How to Keep Eczema “CLEAR”

Remember that eczema is a chronic but manageable condition. While it cannot be cured, regular skincare and medical treatment enable most people to lead normal lives.

• Consistency is key: A daily routine of moisturising and gentle cleansing helps reduce flares.
• Learn your triggers: Identifying and avoiding environmental or lifestyle triggers can help you prevent flare-ups.
• Early treatment: Don’t wait for symptoms to worsen—treat at the first sign of a flare.
• Ask for help: For moderate to severe eczema, regular reviews with your GP or dermatologist ensure better long-term control.
• Remember, you are not alone! Many people have managed eczema successfully. With the right knowledge, proper self-care and support, you can too.

This article was contributed by Patient Education Workgroup, with inputs from Dr Choo Ying Ying, Associate Consultant, Sengkang Polyclinic. 

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Other references:

1. Health Hub: Eczema - https://www.healthhub.sg/a-z/diseases-and-conditions/eczema
2. Singapore General Hospital: The Itch that won’t stop- https://www.sgh.com.sg/news/singapore-health/the-itch-that-wont-stop
3. Patient Resource Sheet: https://www.kkh.com.sg/patient-care/areas-of-care/Documents/ChildLife-HealthResources/Medical_Kit_Resource_Sheet-Eczema.pdf