What is
Eczema / Dermatitis?
Atopic Eczema is a chronic, inflammatory skin disease characterised by a highly itchy rash especially at the elbow and area behind the knee (popliteal fossae). It affects 1 out of 10 persons (10%) at some time in their life. It can be present in all age groups. It typically comprises variable combinations of redness, blistering, scaling, excoriation, crusting, fissuring and thickened skin (lichenification).
The rashes may be so itchy that they interfere with sleep. With scratching, it leads to bleeding, excoriation and infections. 70% of cases first appear during the first 5 years of life. The skin will appear:
- Red, inflamed, covering most of the body, including elbows, knees, nape, neck, ankles, behind the ear where ear lobe joins the cheek, eyelids.
- Dry and sensitive skin
- Weeping, oozing or crusting blisters.
- Thickened, discoloured, scaly, bumpy patches of skin.
Eczema is believed to be triggered by
- Food (egg, dairy products, nuts, wheat, gluten, shell fish)
- Allergens (pollen, house dust mites)
- Irritants (soaps, detergents, solvents, antiseptics)
- Extreme hot and cold. High or low humidity.
- Stress
Treatments
Treatment of Eczema
There is no specific cure for eczema. Aim of treatment is to relieve symptoms and prevent flare-ups. It can be treated with:
- Avoidance of triggering factors and irritants.
- Moisturisers and Emollients. Frequent and generous applications especially when the skin is dry.
- Topical Steroid Cream. They have anti-inflammatory properties that help to reduce itchiness and skin inflammation. Long-term usage is not advisable.
- Oral Antihistamine to reduce the itch.
- Protopic Ointment or Elidel Cream which suppress skin immune system. It is useful for long-term maintenance therapy to replace Steroid Cream.
Treatment of Thickened Lichenified Eczema
Topical cream is generally not effective in the treatment of lichenified eczema. It can be very frustrating for patient to live with ugly and thickened scar. It can be treated with good result by using laser. In general, it requires about 3 to 10 sessions depending on the severity of the lesions.
Case Study 1
A 47-year old housewife developed thickened, ugly, fissured, painful scars on her right palm due to frequent hand-washing during the Covid-19 pandemic. She did not respond to topical cream and oral medication. Her scar improved after 2 months of treatment with laser.
Disclaimer: This is not a claim or guarantee of treatment. Result from treatment will vary between patients.
Case Study 2
A 42-year old lady with thickened, ugly, itchy scar on her left foot and toes. Scar improved after 4 treatment sessions with laser.
Disclaimer: This is not a claim or guarantee of treatment. Result from treatment will vary between patients.
Case Study 3
This man had chronic eczema with thickened skin, itchy scars on his fingers. His scar improved after 3 treatment sessions with laser.
Disclaimer: This is not a claim or guarantee of treatment. Result from treatment will vary between patients.
Case Study 4
This 26-year old man has severe eczema with ugly scars, dried skin, scratch marks and broken skin all over his body and face. He tried phototherapy but failed. He was put on immunosuppressant, Cyclosporine and Methotrexate for 1 year. He improved but it recurred 6 months after he stopped the medicines. He was on injectable steroid for 5 years and his pain and itchiness were much more intense and unbearable when the effect of the steroid worn off. Initially each steroid injection lasted him 3-6 months. It shortened to 2 weeks when I saw him. He was steroid dependent for 5 years and was covering up his body to avoid embarrassment. He was not able to work or socialise with friends. He had unbearable pain everytime his body touched water during bathing.
I treated him for 2 months. His eczema improved and his itchiness is better by 70% according to him. With extreme heat and sweating, his eczema will still recurred. He is cheerful, able to work and socialise. He is not dependent on steroid injection now.
Disclaimer: This is not a claim or guarantee of treatment. Result from treatment will vary between patients.
