Eczema, or known medically as dermatitis, is a chronic skin disorder that causes the skin to become inflamed or irritated. The symptoms include dryness, redness and intense itchy rashes on the skin. These rashes commonly occur on the face, knees, hands or feet. It may also affect other areas as well.

Dr Wang Yi Shi, Consultant from the Department of Dermatology at Changi General Hospital and Dr Shah Mitesh, Deputy Director at SingHealth Polyclinics, give detailed answers to your questions.

Question by gssnss

Dear Dr Wang,

I used to swim during my younger days in the afternoons and after a while I noticed that I've this dry rough skin on my back and after I've stopped swimming for years it has become darkened slightly raised patches. It is not itchcy but just unsightly can't wear low backed dresses and it does not spread. Just wondering how to get rid of them ?

Zer

Answered by Dr. Wang Yi Shi Consultant Department of Dermatology Changi General Hospital

If it is just dry, rough skin, applying a moisturizing cream twice daily over the affected area should be helpful.

However, it is difficult to ascertain from your description exactly what skin condition you have on your back. May I suggest you consult a dermatologist if things do not improve after using a moisturizer for 6-8 weeks. There may be other products that can be used to improve the appearance of the back.

Question by conniehing

Dear Doctors

I am not sure if these conditions are Eczema? there are rashes, skin peeling, itchness over some body area, affected area are on and off on my neck, shouldle, never being cure since one and half year ago...pls advise me what should i do totally cure it.

CCS

Answered by Dr. Wang Yi Shi Consultant Department of Dermatology Changi General Hospital

It sounds like you have eczema. This is usually treated with topical steroids and emollients. However, there are other skin conditions which can cause itching and peeling of the skin such as psoriasis and fungal skin infections. May I suggest you consult a dermatologist for advice. It is important for someone experienced to make an accurate diagnosis of your skin problem, so as to recommend the appropriate treatment.

Question by yuckyyucks

Apart from Emollients, moisturisers, type of clothes, steriodal oral med, injections, creams, autoimmune pills and anti histamine pills

Is there any new help to ease the discomfort of chronic ezcema sufferers?

Thanks,
Doris

Answered by Dr. Wang Yi Shi Consultant Department of Dermatology Changi General Hospital

Topical steroids and moisturizers are the mainstay of treatment for eczema. For very severe acute flares, short courses of oral steroids are useful. For people who have chronic, persistent, extensive eczema, the following treatments are sometimes used: phototherapy, immune-suppressing medications such as azathioprine and cyclosporine.

Sometimes, the eczema may be complicated by secondary bacterial and viral infections. These need to be treated with antibiotics and/ or antiviral medications accordingly.

A new group of non-steroidal creams for eczema was introduced a few years ago. They are called topical calcineurin inhibitors. (eg topical tacrolimus/ pimecrolimus).

However, they are not more effective than steroid creams but can be useful for treatment of eczema over areas of thin skin such around the eyes, where long term topical steroid use is not recommended because of the risk of side effects.

Question by lydia

Dear Drs,

I hope you would be able to help out with my enquiries.

1. For eczema patients, when they exercise, the perspiration would trigger the skin to be itchy. Hence, in your opinion, do you think it is wise to exercise regularly? After exercising, should they use warm or cold water to shower so as not to aggravate the skin condition?
2. ​​On top of the above, I also had some marks on my bottom (resembes pimples in red and brown). The doctor had prescribed me with creams - Betamethasone and Aqueous Cream for my eczema. However, it doesn't improve as much. In fact, this is worsened everytime when I undergo monthly period due to the padding that irritates my skin further. Are there any ways which I could do to improve the situation?

Thank you so much.

Answered by Dr. Wang Yi Shi Consultant Department of Dermatology Changi General Hospital

1. It is wise to exercise regularly. Not all eczema sufferers experience worsening of the eczema when they exercise. However, if you find that your eczema tends to get worse when you get hot and sweaty, you can consider swimming as an alternative form of exercise. It is not good to use water that is too hot to bathe. Luke warm or cold water is fine.
2. You may have folliculitis over the buttocks. If the condition is very mild, an antibacterial cleanser and topical acne medications can help, but you need to avoid using benzoyl peroxide containing products on the buttocks as it can bleach your underwear. If the folliculitis is severe, a course of oral antibiotics is sometimes useful.

Question by leejoslyn

I am suffering from face aczeme for more than one month and can not recover after 3 times of doctor visits . I had stop all the cleansers and cosmetics products except Cetaphil lotion and cleanser still the same. What should I do next , should I seek TCM advice like Yu Ren Sheng or apply other creams ? My colleague recommend Astellas , Protopic ointment 0.03% ( tacrolimus ointment ) but my doctor said better dont use as my face will get worst. I have the same situation lasr March and it recover after 5 days .

I dont know why this time it take me 6 weeks and still the same .

Pls help to advice .thanks

Answered by Dr. Wang Yi Shi Consultant Department of Dermatology Changi General Hospital

Facial eczema can sometimes be difficult to treat and slow to resolve. Other skin problems can also mimick facial eczema eg contact dermatitis, rosacea, psoriasis, and tinea, so I strongly suggest that you consult a dermatologist.

It is important for an experienced doctor to see you and make an accurate diagnosis of your rash so as to recommend appropriate treatments and /or tests if deemed necessary.

Question by cynthiat

I have a daughter in her teens, she has a history of encezmia but it was mild for a nbr of year.

recently begining of this year, it started to act up alot. she was going thru some hard times and even now. the itch became more severe and the hot weather and environment shere she is staying at, aggrevated the skin condition.

the itch and scars are hideous, around the whole entire neck, arms , armpits, behindthe knees, back and buttocks, lower limbs, feet....sigh...

she has seen a shenton medical GP and they gave her a kind of steroid cream. I bought her the EGO GV skip repair lotion to use after applying the doc cream

I need advice on:

1. how to take care of the condition? how to main it?
2. what shud she do initial to calm the skin down?
3. what next step shud she do?
4. what sort of cream/lotion to use from now onwards?
5. can she still spray perfume? can she still use the olay body bath?

Answered by Dr. Wang Yi Shi Consultant Department of Dermatology Changi General Hospital

A few steps can be taken

1. try to be in a cool environment since the heat seems to make her eczema worse. Consider installing an airconditioner if this is not already installed.
2. She should use a moisturizer 3-4 times a day and use a gentle skin cleanser. I would recommend brands like QV, Cetaphil, Physiogel
3. It sounds like her eczema is quite bad. This itself is probably causing her significant stress. There are many different treatments available for eczema but the treatment needs to be tailored to every individual patient.

Topical steroids and moisturizers are the mainstay of treatment for eczema. For very severe acute flares, short courses of oral steroids are useful.

For people who have chronic, persistent, extensive eczema, the following treatments are sometimes used: phototherapy, immune-suppressing medications such as azathioprine and cyclosporine.

Sometimes, the eczema may be complicated by secondary bacterial and viral infections. These need to be treated with antibiotics and/ or antiviral medications accordingly.

I would strongly recommend that she consults a dermatologist. After seeing her, the dermatologist can then treat her eczema according to the severity and location of the rashes.

As for perfume, I would suggest she avoids spraying it directly on her skin if she has bad eczema. However, spraying it onto her clothing should be fine.

I would suggest that she uses the body wash I recommended above rather than Olay body bath.

Question by gfnlcl

My eczema gets worse this two years. There is a big patch on my leg below the knee that become inflamed and irritated. As the medicine cause drowsiness, I did not consume it in the day but only at night. I also have small patches on my hands. Currently, I’m applying Betasonee Cream and Dermasone Cream. There is not much improvement. Is there any treatment to speed up the healing? How can it be prevent? Is there any medicine to treat old scar?

Answered by Dr. Shah Mitesh Deputy Director Family Medicine SingHealth Polyclinics

It is important to comply with treatment.

Your physician usually helps you by prescribing external remedies (corticosteroid creams are most effective). Use sparingly. Apply a thin layer of cream on the rash with your fingers. Rub onto the skin till it disappears. Apply at least twice a day, preferably after showering.

Do not use strong steroid creams for long periods as over-use will harm the skin. Use weak steroid creams when your eczema is mild.

Oral medication (sedatives, antihistamines and sometimes, antibiotics by mouth) to control the itching and baths with diluted potassium permanganate are helpful. Corticosteroids taken by mouth or given by injections should be avoided if possible. However, when all other measures have failed, your physician may prescribe systemic corticosteroids for short periods.

Question by thl22

I had eczema since young. One patch on a toe never completely go away even though it does improve when I use the cream my doctor prescribed. I also have bubbles eczema on my fingers and toes, which flares up on and off.

The last few years, there have been periods when I experienced eczema on other areas of my body. What can be the cause and what can I do to prevent/reduce the occurrence?

Answered by Dr. Shah Mitesh Deputy Director Family Medicine SingHealth Polyclinics

Recurrence is common. To reduce recurrences, you need to relieve itching. This can be done by eliminating the aggravating factors, such as:

• Rapid changes of temperatures, strenuous exercise and hot weather
• Rough, scratchy, tight & woolen clothing
• Frequent use of soaps, bubble bath, hot water and other cleansing procedures that tend to remove natural oil from skin
• Emotional upsets

Wear light, smooth, soft, non-binding clothing. Do not increase the skin’s dryness by prolonged or frequent hot baths, or showers and soap.

Use mild soaps or ‘soap-free” soaps or emulsifying ointment. Bathe or shower with lukewarm (not hot) water.

When necessary, sponge gently under the arms, in the groins and in other areas where cleansing is imperative.

At other times, cleanse the entire skin with non-greasy lotion. Avoid sudden changes of temperature for instance, coming to air-conditioned rooms from the hot outdoors. Try not to rub or scratch. When the itching is severe, try to relieve it by dabbing or applying cloths soaked in iced water.

Question by iceysim

I have Eczema problem since young, after consulting with the specialist in SAF's Military Medicine Institute. They told me its part of my gene and can’t be cure; the only way is to prevent it by applying moisturizer on the affected area.

However, whenever after I apply on these areas. It tends to sweat intensely causing me to itch even more than before. What are some other methods which I could use to prevent? Furthermore does eating habit plays a part in Eczema?

Answered by Dr. Shah Mitesh Deputy Director Family Medicine SingHealth Polyclinics

The exact cause of atopic eczema is unknown. It may be hereditary. The patient or some family members may have other hypersensitive conditions like asthma or hay fever.

Atopic eczema is sometimes associated with food allergies, but is not common. The elimination of certain foods may be of help to some people.

Although certain foods will sometimes provoke attacks, elimination of foods rarely brings about a lasting improvement or cure. Nevertheless, when all else fails, avoidance of common offending foods such as cow’s milk and eggs may be tried for a few weeks.

Types of eczema

• Atopic Dermatitis – it is possible​​ to develop atopic eczema at any age but it is most commonly found in babies and young children. Atopic eczema is thought to run in families and it is part of a group of atopic conditions, which include eczema, asthma and hay fever.
• Seborrhoeic Eczema – there are two types of this condition: one is most commonly seen in babies; the second is fairly common in younger adults. Areas affected tend to be the oily parts of the body, such as the scalp, face, groin and chest. Seborrhoeic eczema is not normally itchy. (mentioned in Q5)
• Discoid Eczema – this condition is usually confined to the arms and legs. It consists of scaly, itchy, coin-shaped patches that can blister and weep. (mentioned in Q4)
• Varicose Eczema – this is a condition of the legs, commonly found in the elderly and people with varicose veins.
• Contact Dermatitis​ – there are two types – irritant and allergic. Irritant is caused by exposure to substances such as soaps, detergents, engine oils, hair dyes and bleaches. Allergy is caused by specific sensitivity to a material such as nickel, chrome or rubber.

Emollients are basically simple moisturizers used to combat the dryness of eczema and to protect the skin from further water loss. There is a wide range of products of this kind and it may take you some time to find the one that is suitable for your skin.

Question by capirexx

Hi, I had eczema about 10 years ago on my face. After I applied the prescribed cream that the doctor gave me, my condition improved but what is left on my face now are those 'white heads', sitting on where the eczema was. Sometimes when the eczema 'flares' up, I don't know whether I should apply those medicated cream again or should I just leave it alone? Thanks!

Answered by Dr. Shah Mitesh Deputy Director Family Medicine SingHealth Polyclinics

Dermatitis or eczema is an itchy, dry hypersensitive skin disorder affecting many people. It is common in children but can occur at any age. It is not infectious or contagious.

The rash may appear red, wet and weepy or dry, thickened and scaly. Scratching often aggravates the rash. The skin thickens and becomes darker. It is a chronic condition. It can affect any part of the body, particularly the elbow bends, back of the knees and the neck.

Eczema tends to be recurrent. Periods of “flares” and remissions are common. Treatment with topical steroid creams and attention to skin care is important during the “flares”. No treatment is needed when the rash is quiescent. Post-inflammatory hypo-pigmentation is common; the skin pigment may return after weeks to months.

Question by Barbara Chng

Dear Doctor

The back of my neck i.e. towards the right and left sides itches. The ear opening of both ears also itch and flaky. I apply Olivin Fragrant Olive Oil for my ears and Physiogel Cream for my neck. When I tried using QV Cream on my neck, the neck bcomes more itchy. Am I having eczema? What should I do to stop the itchiness?

Thank you.

Yours faithfully
Barbara Chng

Answered by Dr. Shah Mitesh Deputy Director Family Medicine SingHealth Polyclinics

Dermatitis or eczema is an itchy, dry hypersensitive skin disorder affecting many people. It is common in children but can occur at any age. It is not infectious or contagious. The rash may appear red, wet and weepy or dry, thickened and scaly. Scratching often aggravates the rash. The skin thickens and becomes darker. It is a chronic condition. It can affect any part of the body, particularly the elbow bends, back of the knees and the neck.

This can be done by eliminating the aggravating factors, such as:

• Rapid changes of temperatures, strenuous exercise and hot weatherc
• Rough, scratchy, tight & woolen clothing
• Frequent use of soaps, bubble bath, hot water and other cleansing procedures that tend to remove natural oil from skin
• Emotional upsets

Wear light, smooth, soft, non-binding clothing. Do not increase the skin’s dryness by prolonged or frequent hot baths, or showers and soap.

Use mild soaps or ‘soap-free” soaps or emulsifying ointment. Bathe or shower with lukewarm (not hot) water. When necessary, sponge gently under the arms, in the groins and in other areas where cleansing is imperative. At other times, cleanse the entire skin with non-greasy lotion. Avoid sudden changes of temperature for instance, coming to air-conditioned rooms from the hot outdoors.

Try not to rub or scratch. When the itching is severe, try to relieve it by dabbing or applying cloths soaked in iced water.

Ref: U11