The skin is the largest organ of the body. Our skin plays an important role as it not only regulates and retains moisture, but also functions as a protective barrier against ultraviolet radiation (UV), and other external substances, whether mechanical, physical injury, chemical or microbial substances. 

Our skin barrier can be compromised by a mixture of genetic and environmental factors - be it irritants, allergen exposure, or even stress, in combination with a hyperactive immune system.

Eczema is a chronic skin disease that can occur in both children and adults. 

Learning about what causes eczema and understanding what makes it flare and/or worse is the key to effective treatment.

6 Tips to prevent recurring eczema

Cornerstones in the management of eczema centre on the practise of good diligent skin care which involves tactics like:

1. Avoiding known triggers

2. Avoidance of scratching and injuring the skin and understanding the itch scratch cycle

3. Avoiding possible irritants to the skin, such as harsh soaps and chemicals, sweat etc

4. Using gentle cleansers or non-soap based shower gel/body wash

5. Regular application of moisturisers to the skin everyday

6. Consider using wet wraps or double pyjamas to hydrate the skin and help keep cool

Treatment for eczema

Treatment options for atopic eczema (the most common form of eczema) include:

• Medicated creams and/or ointments: steroidal and non-steroidal

• Oral antihistamines (for itch)

• Conventional phototherapy (narrowband- UV therapy)

• Oral immunosuppressants

• Biologics (Dupilumab which is administered as a subcutaneous injection)

In this Q&A, don't miss the chance to ask skin specialist, Dr Laura Hui, what to do to effectively stop the eczema itch from recurring.

About Dr Laura Hui

Dr Laura Hui is a consultant from the Department of Dermatology at Singapore General Hospital. She graduated from Imperial College London in 2012 and completed her specialist training in Dermatology in Singapore. 

Dr Hui has years of experience in managing patients with eczema and has a great passion to improve the quality of life in all her patients.

Questions and answers on treating and managing eczema

1. Question by Fitim

Dear Dr Hui,

To be well protected from Atopic Dermatitis during Summer days or in general, is it preferred to wear a Hat and which Creams to put in the morning or evening? Thanks in advance.

Answer by Dr Laura Hui

Sun exposure is known to result in pigmentation, wrinkles and increase the risk of skin cancer. Notwithstanding, hot, humid weather and sweat can also cause flares of eczema.  Long term exposure to harsh ultraviolet rays can compromise the skin barrier and we recommend

• Regular application of a broad spectrum sunscreen daily (at least SPF 50), and to re-apply every 2-4hours

• Avoid direct exposure to sunlight, especially during peak hours e.g. 10am-4pm

• Protect your skin with clothing e.g long sleeves and wide brimmed hats/caps

For patients with eczema, moisturizers should be continuously applied throughout the day to the whole body, focusing on drier areas, and at least every morning and evening. Medicated creams, typically topical steroids are applied twice a day to affected skin only.

2. Question by Angie

Dear Dr Hui,

These are few question I like to ask on eczema.

a) Can eczema affect any part of the body?

b) What are the best treatments for eczema?

c) Are there any natural remedies for managing eczema?

d) How do I prevent eczema flare-ups?

e) Can diet affect eczema?

f) How does stress impact eczema symptoms?

g) What skincare products should I avoid if I have eczema?

h) How do I know if my eczema is affected?

i) Does weather change affect eczema?

j) Does eczema come out by patches and like dot dot popping out but the dots cannot be seen but can feel is rough and popping out.

k) Can I use make-up if I got eczema? Like what type face powder I can use?

Answer by Dr Laura Hui

a) Can eczema affect any part of the body? Yes

b) What are the best treatments for eczema?
Good skincare practises are corner stone for the management of eczema. The list of available treatments and skin care practises were as previously provided – in my writeup.

c) Are there any natural remedies for managing eczema? No robust scientific evidence currently with regards to natural remedies for managing eczema

d) How do I prevent eczema flare-ups? Refer (b) and (16) for the known triggers

e) Can diet affect eczema? No robust scientific evidence currently with regards to dietary intake and flares of eczema

f) How does stress impact eczema symptoms? Emotional stress is a common trigger for eczema, although the exact pathophysiology remains unknown. We provide a counselling service at SGH with a trained psychologist to address this

g) What skincare products should I avoid if I have eczema?
This is a general approach, and not meant to be instructive or exhaustive. Every individual is different, choose what works best for you.

Avoid

• Heavily fragranced and “perfumed” products

• Products with high contents of alcohol /ethanol – this can be drying for your skin

• Products that are visually coloured with synthetic chemical colorants and dyes – this can potentially irritate sensitive skin

• Essential oils – even those with “natural substances” such as tea tree oil, can irritate the skin or be an allergen in patients with eczema

• Products with retinoids and/or retinol – they have good anti-aging properties but are potentially irritating for patients with eczema

• Propylene glycol and Urea – these are humectants that can help to hydrate the skin, but in patients with eczema, this can potentially cause irritation

h) How do I know if my eczema is affected?
Signs and symptoms of flares of eczema can include

• dry, cracked, itchy and red skin

• can be oozy and warm if secondarily infected

• severe itch that can even affect your work and sleep

i) Does weather change affect eczema? – refer to (13)

j) Does eczema come out by patches and like dot dot popping out but the dots cannot be seen but can feel is rough and popping out.

Eczema is characterised by dry, scaly flaky skin and is a skin condition affecting the outer layer of the skin. You might be describing a skin condition called keratosis pilaris that is characterised by follicular pinpoint like papules that is commonly seen in patients with atopic eczema.

k) Can I use make-up if I got eczema? Like what type face powder I can use?
If you have eczema affecting the face, we would recommend simplifying your facial regimen and avoiding and limiting the amount of facial products applied as this can cause more irritation to the face. Every patient is unique, and what works for one patient might cause irritation for another. Simple rules include to avoid heavily fragranced products and choose makeup products that are less drying, i.e. choose cream or lotion based formulations over gel based ones.

The photograph you provided appears to be urticaria or hives, kindly seek a  consult from a dermatologist for more advice.

3. Question by Andrea

Dear Dr,

Can I know what are the known triggers for eczema? Is consuming certain types of food like shellfish, seafood, one of the triggers? Thanks.

Answer by Dr Laura Hui

We recommend mild, non alkaline soap, as these are gentle on the skin. Besides gentle cleansers, always limit the duration of showers to less than 10minutes and avoid using hot water as well as excessive frequent showers, as all these will strip the skin of moisture and make it more dry and scaly.

Yes, eczema can affect any part of the body.

There is no robust scientific evidence at present linking food intake with eczema.

Medicated creams available for eczema include

• Topical steroid creams

• Topical non steroidals  – commonly calcineurin inhibitors , these include protopic ointment, elidel and newer creams such as crisaborole (which is a phosphodiesterase inhibitor)

• Combination creams consisting of topical steroids with antibiotics, e.g. fucicort

Known triggers for eczema include (but are not exhaustive)

• Dry skin – when your skin becomes flaky and dry, it can be easily inflamed, resulting in a flare of eczema

• Irritants – ubiquitous household products such as soap, detergent, shampoo, fragranced products and even “natural substances” such as citrus juices can cause your skin to itch, and become inflamed and dry

• Infection – infections of the skin, either by bacteria (e.g. overgrowth of Staph bacteria) or viruses (such as herpes simplex) can cause a flare of eczema

• Stress – emotional stress is a commonly reported trigger of eczema

• Extremes of temperature – changes in the season, such as extreme heat or cold can also trigger flares of eczema

• Allergens – exposure to allergens, if one is allergic to them can also cause eczema. Commonly reported allergens include substances like metal – nickel, preservatives and certain products in fragrances

4. Question by Magdalene

Dear Dr Laura Hui

I started to have itchiness on my wrists several months ago. I had consulted a TCM physician and advised that the cause of it is due to (1) my body heatiness and (2) sensitive skin. After taking the medicine, the itchiness has reduced and I have recovered.

However, the itchiness on my wrists is back. 

Noted to avoid known triggers but how to identify the triggers? So far, I don't know the triggers.

Can you elaborate what you mean by "the itch scratch cycle". Understand the itch scratch cycle? how?

What is the purpose of regular application of moisturisers to the skin every day? apply moisturiser even if there is no itchiness?

What should I do to effectively stop the eczema itch from recurring?

Appreciate your advice on the above. Thank you.

Answer by Dr Laura Hui

Known triggers for eczema include (but are not exhaustive)

• Dry skin – when your skin becomes flaky and dry, it can be easily inflamed, resulting in a flare of eczema

• Irritants – ubiquitous household products such as soap, detergent, shampoo, fragranced products and even “natural substances” such as citrus juices can cause your skin to itch, and become inflamed and dry

• Infection – infections of the skin, either by bacteria (e.g. overgrowth of Staph bacteria) or viruses (such as herpes simplex) can cause a flare of eczema

• Stress – emotional stress is a commonly reported trigger of eczema

• Extremes of temperature – changes in the season, such as extreme heat or cold can also trigger flares of eczema

• Allergens – exposure to allergens, if one is allergic to them can also cause eczema. Commonly reported allergens include substances like metal – nickel, preservatives and certain products in fragrances
  

Avoid these if possible to minimise the risk of eczema flares and thus itch.

For most patients, itch is the most unbearable symptom of eczema and this can often be the most difficult to treat. It is important to understand the itch scratch cycle, as this will help you to prevent scratching and thus prevent more damage to the skin.

When patients scratch, it causes more inflammation and it is scratching of the skin that damages the skin, not the itch. When the skin itches, the response is to scratch and this can evolve to become an unconscious, conditioned response, which perpetuates more skin damage and eczema. I.e. to reiterate, the itch causes the scratch, and the scratch causes more inflammation with more rash/eczema. A lot of patients will tell us that intense scratching relieves the itch and is “pleasurable”, but this will only result in skin damage, pain, skin thickening, scarring and worsening of their eczema.

Consider small habits like

• Trimming your nails short, avoid jagged edges

• Wearing cotton gloves or mittens at night to reduce the damage of scratching on the skin

• Distract yourself from the itch with activities

• Try to substitute some other action for scratching. Some patients find it useful to press a nail onto the skin or pinch the skin in lieu of scratching. Methods such as counting to 10 or clenching fists also work

• Keep bedrooms cool and well ventilated

• Regardless, continue to practise good skin care such as regular moisturisers, keep cool, consider cool compresses, oral antihistamines if necessary

The usage of moisturisers regularly is paramount to the maintenance of skin hydration and the skin barrier in patients with eczema. Patients with eczema have dry skin prone to inflammation and moisturisers help to keep the skin well hydrated and to reduce possible irritation from any environmental allergens or irritants.

Consult your dermatologist regularly also to ensure that your eczema is adequately treated and that the prescribed topical and/or systemic treatment is appropriate for you at that time. We also provide a psychologist service at our specialist eczema clinics at SGH.

5. Question by Wendy

Dear Hi Dr Hui,

I realised my eczema was triggered by shower gels/shampoos containing:

• Myristic acid & Lauric acid,

• Salicylic acid & salicylates,

• Sodium C14-16 Olefin Sulfonate

With a lot of new formulations in the market (eg. Disodium Laureth Sulfosuccinate, Sodium Cocoyl Isethionate), even in dermatological skincare, are there any test(s) that can help to pinpoint which other cleansing chemicals could be possible triggers for me?

Are there any oral probiotic strain(s) that could help with eczema? Thank you for your advice.

Answer by Dr Laura Hui

We offer a patch test service at SGH that can help in identifying any possible allergens in causing allergic contact dermatitis. This test will involve coming in to the hospital three times in a week with possible allergens applied to your back. Kindly schedule a consult with our dermatologists for more advice.

To date, there is still limited scientific evidence regarding oral probotic strains for the treatment of eczema.

6. Question by Eric

Dear Doctor,

I do have bad itch and eczema … doctor says it is due to my asthma- at times I take my inhaler - I don’t feel itchy at night.

Could it be my high blood medication? Ehh I don’t think so too. It comes and goes - I use moisturiser and cream from Polyclinic but at night at times only very itchy can’t sleep.

My sister-in-law says i have ring worm but i think its eczema been so many years 😭 Need your advice, thanks.

Answer by Dr Laura Hui

Known triggers for eczema include (but are not exhaustive)

• Dry skin – when your skin becomes flaky and dry, it can be easily inflamed, resulting in a flare of eczema

• Irritants – ubiquitous household products such as soap, detergent, shampoo, fragranced products and even “natural substances” such as citrus juices can cause your skin to itch, and become inflamed and dry

• Infection – infections of the skin, either by bacteria (e.g. overgrowth of Staph bacteria) or viruses (such as herpes simplex) can cause a flare of eczema

• Stress – emotional stress is a commonly reported trigger of eczema

• Extremes of temperature – changes in the season, such as extreme heat or cold can also trigger flares of eczema

• Allergens – exposure to allergens, if one is allergic to them can also cause eczema. Commonly reported allergens include substances like metal – nickel, preservatives and certain products in fragrances
  

7. Question by Chee Khuen

Dear Dr Laura Hui,

Please explain what is meant by using wet wraps or double pyjamas to keep skin cool to manage eczema. Please explain “wet wraps”. Does ‘double pyjamas’ means wearing 2 pyjamas at the same time as it is likely to make me feel warmer rather than cool.

Please also explain ‘known triggers’ as I really do not know what causes eczema to trigger. If I know, I can try to avoid them. Thank you for your advice.

Answer by Dr Laura Hui

Dear Chee Khuen,

Dermatologists tend to use wet wraps or double pyjamas interchangeably. Wet wrap and/or double pyjamas therapy is a good option for patients with bad eczema flares and can help alleviate the itch and pain.  

They involve wearing 2 layers – an inner layer that is damp and an outer layer that is dry. Commonly, for the wet layer, one can use pyjamas for larger areas of skin, while for more limited and targeted/smaller areas, patients can opt to use socks, gloves, gauze or cotton dressings instead, e.g tubifast, which are reusable, washable dressings.

Wet wraps or double pyjamas are best done in the evening before going to bed. This therapy can help rehydrate and calm the skin, and also help topical medications to work better.

Step-by-step instructions are as below.

1. Shower with a gentle, mild,  non-fragranced and non-alkaline soap. Do not scrub the skin.

2. Rinse off and pat the skin lightly with a towel. Leave skin slightly damp.

3. Liberally apply moisturizer your body.

4. Wait a few minutes for the moisturiser to absorb into the skin, then apply prescription topical medication(s) as directed to affected areas of the skin. (Note: Use topical medication(s) as directed by your doctor; talk to your doctor about which topical medications are safe to use with wet wraps.)

5. Apply wet wraps or wear double pyjamas 
   Wet wraps: 
   a) Moisten the cotton dressing e.g tubifast or gauze in warm water so that it is slightly damp but not dripping wet.
   b) Wrap or wear the moist dressing around the area affected with eczema, e.g. arms or legs or hands/feet 
   c) Wear or wrap a dry dressing over the wet one. 
   
   Double pyjamas: 
   a) Moisten the inner pyjamas layer in warm water so it is slightly damp but not dripping wet.
   b) Wear the damp pyjamas. (if it is too wet, wring it till it is slightly damp)
   c) Wear an outer layer of dry pyjamas

6. Leave wet wraps or double pyjamas on for two-six hours as tolerated or overnight

7. Remove pyjamas and/or wet wraps.

Known triggers for eczema include (but are not exhaustive)

• Dry skin – when your skin becomes flaky and dry, it can be easily inflamed, resulting in a flare of eczema

• Irritants – ubiquitous household products such as soap, detergent, shampoo, fragranced products and even “natural substances” such as citrus juices can cause your skin to itch, and become inflamed and dry

• Infection – infections of the skin, either by bacteria (e.g. overgrowth of Staph bacteria) or viruses (such as herpes simplex) can cause a flare of eczema

• Stress – emotional stress is a commonly reported trigger of eczema

• Extremes of temperature – changes in the season, such as extreme heat or cold can also trigger flares of eczema

• Allergens – exposure to allergens, if one is allergic to them can also cause eczema. Commonly reported allergens include substances like metal – nickel, preservatives and certain products in fragrances
  

8. Question by Patma

Hi Dr,

Do weather conditions play a part in triggering eczema?

My granddaughter is only 2yrs old but her arms and back has small rashes.

We saw a specialist but he said it will not go away. We are applying eucerin omega cream.

Answer by Dr Laura Hui

Yes, changes in weather conditions certainly play a role in causing eczema flares. 

Climate factors such as extreme heat, hot humid weather and cold and dry weather, all can cause the skin to be dry, itchy and inflamed. 

Living in cold places as well as humid and hot environments, all can contribute to and eczema flare in a genetically susceptible individual who is predisposed to atopic eczema.

9. Question by Siew Fen

Hi Dr Hui,

Is there any body soap that can help prevent the recurring of eczema?

Can eczema affect the private area?

Is there any type of food to avoid?

Is there any type of food that can reduce the severity of the condition?

What are the medication available at the pharmacy - Medicated creams and/or ointments: steroidal and non-steroidal?

What are some types of known triggers?

Thank you for your advice.

Answer by Dr Laura Hui

Dear Siew Fen,

We recommend mild, non alkaline soap, as these are gentle on the skin. Besides gentle cleansers, always limit the duration of showers to less than 10minutes and avoid using hot water as well as excessive frequent showers, as all these will strip the skin of moisture and make it more dry and scaly.

Yes, eczema can affect any part of the body.

There is no robust scientific evidence at present linking food intake with eczema.

Medicated creams available for eczema include

• Topical steroid creams

• Topical non steroidals  – commonly calcineurin inhibitors , these include protopic ointment, elidel and newer creams such as crisaborole (which is a phosphodiesterase inhibitor)

• Combination creams consisting of topical steroids with antibiotics, e.g. fucicort

Known triggers for eczema include (but are not exhaustive)

• Dry skin – when your skin becomes flaky and dry, it can be easily inflamed, resulting in a flare of eczema

• Irritants – ubiquitous household products such as soap, detergent, shampoo, fragranced products and even “natural substances” such as citrus juices can cause your skin to itch, and become inflamed and dry

• Infection – infections of the skin, either by bacteria (e.g. overgrowth of Staph bacteria) or viruses (such as herpes simplex) can cause a flare of eczema

• Stress – emotional stress is a commonly reported trigger of eczema

• Extremes of temperature – changes in the season, such as extreme heat or cold can also trigger flares of eczema

• Allergens – exposure to allergens, if one is allergic to them can also cause eczema. Commonly reported allergens include substances like metal – nickel, preservatives and certain products in fragrances

10. Question by Evelyn

Hi Dr,

Both my sons have eczema triggered from their pinky finger & on bad days spread to the upper side of palm. What are the best ways to avoid it from recurring?

Answer by Dr Laura Hui

Dear Evelyn, good skin care and hand protection is of paramount here. 

Do ensure that they avoid contact with any possible chemicals that can irritate the skin, this includes detergent, soaps as well as even sweat. 

Always wear proper gloves to protect their hands when washing utensils, clothes/laundry or when doing cleaning or gardening. 

Avoid excessive hand washing as this will damage the skin barrier. If hand washing is required, try to use a mild and non-alkaline soap and always follow up with a generous amount of hand moisturiser after. 

A good hand care routine at night, such as applying a layer of moisturiser then to put on cotton gloves, will allow their hands to be well hydrated overnight. 

During eczema flares, also make sure that topical steroids are applied till resolution of the eczema.

11. Question by Alice

Dear Doctor,

My eczema outbreaks have become worse and more frequent as I age.

a) Is it true that aging will cause eczema outbreaks more frequently?

b) Besides applying cream and taking medication, is there any medication to cure eczema entirely or no?

Await your advice. Thank you.

Answer by Dr Laura Hui

Dear Alice,

With age, our skin undergoes functional and structural changes that can compromise our skin barrier. 

Together with other factors such as immune dysregulation and skin dysbiosis; coupled with a decrease in hydration, oil and skin structural proteins, this results in a weakened skin barrier that can lead to more dry, scaly skin, inflammation and thus eczema outbreaks.

Unfortunately, there is no cure for eczema at the moment, but it is a very common skin condition both in the young and elderly that can be managed with good skin care practises and medications.

Ref: H24