eczema treatment singapore

    Eczema Treatment In Singapore

    Are you experiencing red, dry and itchy skin?

    Control skin itchiness, sleep and flares with clinically proven therapies.

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    Eczema flare on flexures

    What is atopic eczema?

    Atopic eczema, also known as Atopic dermatitis, is a chronic inflammatory skin disorder marked by recurrent red and inflammed skin and intense ithciness, imparting a significant burden of disease on afflicted patients. Atopic eczema affects > 200 million individuals worldwide and follows a chronic relapsing course.The condition is most often found in children, with 90% experiencing an eruption by the age of 5.  However, ~25% of individuals with eczema have adult-onset disease.

    Our Approach

    Atopic eczema managment

    Atopic eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. It is a prevalent condition that can significantly impact the quality of life of those affected, ranging from infants to adults. The management of atopic eczema requires a comprehensive, patient-centered approach that addresses both the symptoms and the underlying causes to achieve optimal outcomes.

    What Causes Eczema?

    what-is-eczema
    Skin barrier defect due to Filaggrin gene mutation in eczema

    Although atopic eczema is a common condition, the underlying mechanism is complex and involves an interplay between genetics, immune system, skin barrier dysfunction and the environment. A mutation of the epidermal protein known as Filaggrin gene has been shown to be the strongest genetic factor in atopic eczema. However, not everyone with filaggrin gene mutation will develop eczema. Skin barrier dysfunction is also attributed to deficiency in ceramides and protease inhibitors in the skin. Intriguingly, studies have shown that individuals who migrate to a urban region from a rural one will increase their risk of atopic related diseases.

    How Is Atopic Eczema Diagnosed?

    Most cases of atopic eczema are diagnosed from the clinical history and clinical examination. Although common, there is no specific blood or imaging tests to diagnose the condition. 

    A diagnostic criteria by the UK Working Party states that a patient with Atopic Eczema must have a history of itchy skin with 3 or more of the following:

    • History of rash in the skin creases, including the cheeks of children less than 10 years of age
    • personal history of asthma, hay fever or history of atopic diseases in first degree relatives in children < 4 years old
    • Onset less than 2 years of age
    • Dry skin within the last year
    • Visible flexural eczema e.g. neck, front of elbow, back of knees, ankles.

    What are the symptoms of eczema?

    Atopic eczema affects different areas of the body and is associated with the development of eczematous lesions, which can display an age-related distribution. Bodily regions that are predominantly affected include the skin folds, the head, neck, face, wrists, and hands. Infants often present with acute lesions with some redness, scratch marks, vesicles (small fluid filled blisters) and weepy skin. As children grow, lesions become more poorly defined, dry, and exhibit paler redness. Adolescents and adults, on the other hand, can present with diffuse eczema and localized lesions usually manifesting in the eyelids, hands, and flexures; in adults, eczema can develop on the head, neck, shoulders, and scalp.

    What Conditions Are Associated With Atopic Eczema?

    Associated conditions with eczema
    • Atopic diseases are those where there is a heightened response of the immune system to allergens. Asthma, Allergic rhinitis (sensitive nose) and Allergic conjunctivitis (sensitive eyes) are examples of atopic conditions. There is a 60-70% chance of developing either asthma or allergic rhinitis if you have existing atopic eczema.
    • Food allergies are closely associated with atopic eczema, particularly in young children. The interplay between skin barrier dysfunction, immune system dysregulation, and genetic factors contributes to this relationship.
    • Sleep disturbance: Sleep disturbance is a common and significant issue for individuals with atopic eczema. The chronic itching, skin discomfort, and psychological stress associated with the condition can severely disrupt sleep, leading to a cascade of effects on physical and mental health. 
    • Depression: The relationship between atopic eczema and depression is complex and multifaceted. The chronic nature of eczema, its impact on appearance and daily life, and the psychosocial stress it generates all contribute to a higher risk of depression in affected individuals.

    What Can Trigger Eczema?

    Factors that may worsen eczema should be identified and minimised wherever possible. Different individuals may have different triggering factors, which may change seasonally, according to weather and geography. Common factors include stress, sweating, heat, dust mites and infections. External factors such as harsh soaps, detergents, latex and food allergens are possible factors.

    We offer comprehensive allergy testing via blood test to help identify possible allergens that may be impacting your quality of life.

    How Eczema Impacts Your life

    Among patients with Atopic eczema, itch is the most frequent symptom reported, but patients may also experience skin pain and difficulty sleeping. As a result, Atopic eczema can have a considerable impact on a patient’s quality of life, reducing work and school productivity, and increasing the financial burden of associated healthcare expenses. Studies have shown that those living with moderate to severe eczema may experience worse outcomes in quality of life compared to other chronic diseases. Moreover, it can adversely impact mental well-being, contributing to anxiety, depression and low self esteem.

    Eczema Treatment Singapore

    Eczema treatment options depends on the severity of your condition. For mild to moderate cases of Atopic Eczema, the focus is on repairing the skin barrier with regular moisturizers and topical steroids or topical calcineurin inhibitors to reduce inflammation and itchiness. For severe cases of Atopic eczema, treatment options include phototherapy, systemic therapy (e.g. ciclosporin, methotrexate) and biological therapy (e.g. Dupilumab).

    Barrier Repair & Moisturizers for Eczema

    Moisturizers are integral at reducing the transpeidermal water loss and reducing the skin barrier defect. Moisturizers are fundamental for eczema care and management. From studies, early use and regular use of moisturizers have been found to reduce eczema flares and incidences.

    There are 3 main classes of moisturizers. Emollient moisturizers act by softening the skin and covering the skin with a protective film. Humectant moisturizers retain moisture within the skin by pulling water to the upper layers of the skin. Lastly, occlusive moisturizers contain ingredients, typically lipid that protects the skin against too much transepidermal water loss.

    • Emollients e.g. Ceramide, Shea butter, Palmitoyl-ethanolamine
    • Humectants e.g. Glycerin, Urea, Hyaluronic acid
    • Occlusives e.g. Paraffin, Petrolatum, Olive oil, Coconut oil

    Advanced Topical Therapies for Eczema

    Current topical therapies for eczema (atopic dermatitis) are designed to reduce inflammation, restore the skin barrier, and alleviate itching. These treatments are categorized into different classes based on their mechanisms of action. Below are the most widely used and recent topical therapies for eczema:

    1. Topical Corticosteroids

    • Mechanism: Anti-inflammatory and immunosuppressive.
    • Examples: Hydrocortisone, betamethasone, mometasone, clobetasol.
    • Use: First-line treatment for acute eczema flare-ups and inflammation. Available in varying strengths (mild to potent) depending on the severity of the condition.
    • Considerations: Long-term use may lead to side effects such as skin thinning, striae, and reduced efficacy (tachyphylaxis).

    2. Topical Calcineurin Inhibitors (TCIs)

    • Mechanism: Immunomodulatory, blocking T-cell activation to reduce inflammation without thinning the skin.
    • Examples:
    • Use: Often used as an alternative to corticosteroids, especially for sensitive areas like the face, neck, and skin folds. Effective for long-term management.
    • Considerations: May cause initial burning or stinging, but long-term use is generally safe without skin thinning risks.

    3. Topical Phosphodiesterase-4 (PDE-4) Inhibitors

    • Mechanism: Inhibits PDE-4 enzyme to reduce cytokine release and inflammation in the skin.
    • Example:
      • Crisaborole (Eucrisa): FDA-approved for mild to moderate atopic dermatitis.
    • Use: Effective for reducing inflammation and itch, particularly in patients who prefer non-steroidal options or for long-term maintenance therapy. It is approved for use in infants from 3 months of age.
    • Considerations: Well-tolerated, with minimal side effects like mild burning at the application site.

    Biological Therapies for Eczema

    One of the most significant breakthroughs in the treatment of moderate to severe atopic eczema is the use of biologic drugs. Dupilumab, an IL-4 and IL-13 receptor antagonist, is the first biologic approved for atopic dermatitis. It targets specific immune pathways responsible for inflammation, providing substantial improvement in symptoms and quality of life for many patients. Other biologics targeting different pathways (such as IL-31 and IL-13 inhibitors) are currently in development and clinical trials, offering new hope for patients who do not respond to conventional treatments.

    Janus Kinase (JAK) Inhibitors

    Oral and topical JAK inhibitors represent another exciting advancement. These medications work by blocking key enzymes involved in the immune response that leads to eczema flare-ups. Approved drugs like upadacitinib and abrocitinib, as well as topical ruxolitinib, have shown efficacy in reducing inflammation, itch, and improving skin appearance. JAK inhibitors offer a promising alternative for patients with more severe disease who may have limited options.

    Frequently Asked Questions About Eczema

    Atopic eczema is considered a chronic inflammatory condition. Although there is no cure for eczema, effective treatments help to reduce symptom, improve sleep quality and overall quality of life.

    Wet wrap therapy is suitable for children with severe eczema to help restore the skin barrier and to reduce itchiness. A first moist layer of pyjamas or bandage is used followed by a second dry layer. When topical steroids are used, treatment is limited to once a day for up to a week.

    Non-soap cleansers that have neutral or low pH and are hypoallergenic are recommended. Avoid soaps associated with fragrances and with high pH levels.

    Although anti-histamines as monotherapy do not control the itchiness associated with eczema, they may play a role to improve sleep. However, they should be used cautiously in children due to the effects on cognition.

    Intermittent use of mild to moderate topical steroids for short duration is safe for pregnant women.

    Generally, for older children and adults, food allergens are quite unlikely to worsen atopic dermatitis. A food dairy and selected allergen testing may be beneficial in the proper context.

    Food allergy may be suspected in younger children, less than 3 years of age with widespread and stubborn eczema. Common allergens include cow’s milk, eggs, wheat, nuts and soy. An evaluation by an allergist may be necessary if dietary intervention is to be considered.

    Atopic Eczema Insights

    Effective management of atopic eczema requires a multifaceted approach that is tailored to the individual needs of each patient. By combining patient education, appropriate topical and systemic therapies, and psychosocial support, we can improve the quality of life for those living with this challenging condition. Continuous evaluation and adaptation of treatment plans will ensure that we provide the highest standard of care for our patients.

    Dr. Moses Ng

    Schedule a consultation for Eczema treatment in Singapore

    The treatment goals of eczema are to achieve remission/control of the disease, restore skin barrier and promote a positive change in your sleep, itch intensity and emotional well-being. The key to successful management is the prevention of ongoing symptoms and improving the quality of life of individuals with Atopic eczema.

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    References:
    1. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb. 70(2):338-51.
    2. Leung DY, Bieber T. Atopic dermatitis. Lancet. 2003 Jan 11. 361(9352):151-60.
    3. Sidbury R, Tom WL, Bergman JN, Cooper KD, Silverman RA, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014 Sep 25.
    4. Tay YK, Chan YC, Chandran NS, Ho MS, Koh MJ, Lim YL, Tang MB, Thirumoorthy T. Guidelines for the management of atopic dermatitis in Singapore. Ann Acad Med Singap. 2016 Oct 1;45(10):439-50.
    5. Luk D, Hon KL, Dizon MV, Leong KF, Tay YK, Koh MJ, Chandran NS, Wananukul S, Chatproedprai S, Luger T. Practical recommendations for the topical treatment of atopic dermatitis in South and East Asia. Dermatology and Therapy. 2021 Feb;11:275-91.

    ABOUT DR MOSES NG

    Dr Moses Ng dermatologist

    MBBS (London) with distinction
    Dip Practical Dermatology (Cardiff) with distinction
    Member of American Acne & Rosacea Society
    Fellow of American Society for Laser Medicine & Surgery

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    Dr. Moses Ng is a distinguished professional in the field of aesthetic medicine, renowned for his expertise in advanced cosmetic procedures. With over 15 years of experience, extensive training and a keen eye for detail, Dr. Ng specializes in a wide range of treatments, including injectables, laser therapies, and acne scar management.

    Dr. Moses Ng’s commitment to excellence and patient-centric approach have earned him a reputation as a trusted clinician in aesthetic medicine. His continuous pursuit of the latest advancements in the field ensures that his patients receive the highest standard of care and the most effective treatments available.

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