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Navigating Eczema with Dr Ker Khor Jia

Consultant Dermatologist and Managing Director of Dermatology & Co
MBBS, MRCP (UK), FAMS (Dermatology)

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Navigating eczema through life is tricky, we know – it never hurts to find out more info that could lead to a more comfortable existence! Learn more from Dr Ker about eczema and its common misconceptions, as well as how to treat it with lifestyle changes involving diet, exercise, and self-caring rituals.

Results may vary.

Eczema, also known as atopic dermatitis, is a sensitive skin condition. People with eczema will find that their skin is red, itchy, rough, dry or cracked.

Eczema can affect children, teenagers and adults. Most of the time, it can start from a young age, but it is also found in adults.

Generally, eczema affects the face and joints, such as where the arm bends, the back of knees and neck where sweat gets trapped.

For babies, when they drool, the saliva on their chin and cheeks can also irritate their skin.

For adults, eczema can occur anywhere on the body and spread or get worse if it’s not treated correctly.

Yes. For example, excessive rubbing or scratching due to itching may break the skin and lead to a bacterial infection on top of eczema.

Hives is also a sensitive skin condition but it is a different condition. Hives appear as bumps on the skin that look like large mosquito bites, and they are very itchy. It may be triggered by something you ate or applied. They appear very suddenly and subside within 24 hours, with no lingering aftereffects. Once hives subside, your skin looks normal again. An anti-histamine can help, but if you experience any swelling around the eyes or difficulty breathing, you should see a doctor immediately.

A fungal rash is more often related to hygiene, and more common on areas such as the soles of the feet or in between the toes. A common cause may be long hours of wearing shoes or socks that are damp from sweat, or not washing and drying in between the toes after bathing. However, sometimes it can be difficult to distinguish a fungal rash from eczema, as both can be red and itchy with peeling skin, and both can co-exist. To confirm which, a scraping of the skin can be sent for testing so that proper treatment can be prescribed.

Eczema can be triggered by sweat, personal care products with fragrance and preservatives, dust and stress, among others.

Avoiding triggers can help. Here are some suggestions:

  • After exercising, wipe off sweat with a damp towel; focus on joint folds such arm joints, the back of knees and neck.
  • Change out of your damp, sweaty clothes as soon as possible.
  • Minimise use of wet wipes that contain fragrance and preservatives as these can irritate the skin.
  • Take steps to avoid dusty places and minimise house dust mite exposure. You can wash your bedsheets in machine warm water cycle weekly, sun them to dry. Buy hypoallergenic anti-dust mite mattresses and pillows. Minimise soft toys on the bed and carpets in the bedroom as these trap house dust mites.
  • Keep a food diary to see if your skin gets irritated after eating certain foods so that you will know what to avoid in the future.
  • Learn to manage stress. This is important not just for adults but also for children, who experience more flare-ups during examination time.
  • I can’t exercise because sweat aggravates my skin
    You can exercise in environments that are more cooling and/or carry a towel to wipe away sweat. It’s important to maintain an active and healthy lifestyle.
  • I can’t go swimming if I have a skin condition.
    Eczema is not contagious. However, chlorine in the pool water can dry out the skin. To prevent this, stand under the shower immediately after you step out of the pool, then have a proper bathe with a gentle cleanser and apply moisturiser all over. To help your moisturiser absorb more quickly into your skin, apply it immediately after you towel dry, while your skin is still slightly damp.
  • Steroid creams cause staining or discolouration on my skin.
    The brown marks left behind after a flare-up is actually unrelated to the cream. Instead, it is part of the skin’s natural healing process, which includes depositing more colour or pigment in the deeper layers of the skin. This becomes visible once the redness wears off, and it is more obvious in areas that are exposed to the sun. You can help to minimise this darkening by limiting sun exposure on the affected areas, and continue using moisturisers that contain ceramide, to help repair the skin and keep it healthy. This in turn will help to reduce the appearance of the darker skin, but it will take time and depends on your activities and sun exposure.

Many people choose their toiletries because they like how it smells. However, fragrances can irritate sensitive skin, so it’s best to choose one that is fragrance-free. If your skin is very dry, a soap substitute that does not contain sodium lauryl sulfate (SLS) is more gentle and less drying. Lastly, after towelling dry, apply a fragrance-free moisturiser while your skin is still slightly damp – this will allow the moisturiser to be absorbed more easily. You should also try to choose a moisturiser that contains a protein called ceramides, which are proven to help repair your skin from within. For people with sensitive skin, avoid using abrasive scrubs and loofahs etc as they may lead to greater skin irritation.

Ceramides are a protein that is naturally present in the skin, in a very specific ratio. In people with eczema, there is an imbalance which contributes to making your skin feel dry, itchy and irritated. This is why moisturisers containing ceramides are more effective for people with eczema, especially those that are formulated using the same ratio that is naturally found in healthy skin.

It is best to apply a ceramide-containing moisturiser all over. To understand why, imagine your skin structure like a brick wall, and your skin cells are the individual bricks, stacked up in layers. The cement that is holding all the skin cells together contains ceramide. If you have eczema, your skin has problems producing that ‘cement’, leaving gaps in the ‘brick wall’. This means that moisture can easily escape through the gaps and irritants can enter.

When you use a moisturiser that contains ceramides, you are helping to replace and restore the ceramides in your skin. This means the ‘wall’ and your skin becomes more resilient and is better able to resist irritants. This is why you should apply a ceramide-containing moisturiser all over, even when there is no visible dryness.

General advice would be:

  • use gentle or soap-free products
  • avoid irritants such as products with fragrance, prolonged exposure to sweat, chlorine and dust
  • apply ceramide-containing moisturiser after every bath, from top to toe

I must also stress that it’s very important to get diagnosed by a medical practitioner such as a general practitioner or dermatologist. This is because some allergic reactions or skin infections may resemble eczema.

In addition, many people prefer to try home remedies, and for some this may help. However, in some instances, the eczema can worsen and require more potent medications to repair the damage. So, I would always recommend that you see a general practitioner or dermatologist for diagnosis and advice.

Firstly, please do not ignore signs of eczema or any form of skin irritation that persists or gets worse over time. As mentioned above, you should speak to your baby’s doctor for a proper diagnosis and recommended treatment as self-diagnosis or self-medication, especially for babies, could make it worse and make it more difficult to treat.

Secondly, remember to moisturise from tip to toe, including the face. This is because eczema-prone skin has insufficient ceramides to maintain a good skin barrier. So, even if there is no visible sign of irritation, any part of the skin could potentially flare up. By moisturising all over, you help to replenish ceramides in the skin, and over time this will help to make the skin barrier more resilient against irritation.

Thirdly, with proper care, 50-70% of children with eczema will outgrow it in their teens. This is more likely if their eczema has been well managed since childhood to minimise flare-ups, so take hope that using soap- and fragrance-free products together with a ceramide-rich moisturiser improves the odds that your child will outgrow eczema.

img-Dr-Ker-Khor-Jia
Consultant Dermatologist and Managing Director of Dermatology & Co
MBBS, MRCP (UK), FAMS (Dermatology)
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