01 Nov 2011
By Rachel Chan
Since she was a child, 15-year old Catherine* has suffered from an itchy skin disorder which leaves her with red, scaly skin. The itching can be severe, especially at night, and after scratching, the skin becomes swollen, raw and sensitive. The angry red patches often appear on the hands and feet, and at the bends of the limbs.
Catherine has atopic dermatitis or atopic eczema, a skin condition which affects nearly 21 per cent or one in five people in Singapore.
“Atopic dermatitis is a relatively common disease and it is recognised by a characteristic pattern,” said Dr Pang Shiu Ming, Director and Senior Consultant, Dermatology Unit, Singapore General Hospital (SGH).
A form of skin inflammation, eczema is broadly applied to a range of persistent skin conditions that include symptoms of dryness and a recurring skin rash. Excessive bathing, harsh soaps and sweating can trigger off an eczema attack. Eczema can be controlled by medications and moisturisers.
Typically, more than half of the patients who suffer from atopic dermatitis develop it before they turn two years old. However, the condition can affect people of all ages. For many, the condition clears upon reaching adulthood, while for others, the condition flares up occasionally sometimes for years. People with eczema also usually have other allergic conditions like asthma, allergic rhinitis or hay fever.
Some think eczema may be due to an overly hygienic environment, said Dr Pang. “If you are in a very hygienic environment, you may not be exposed to many kinds of bacteria, which increases your likelihood of having eczema,” Dr Pang said. In people with eczema, their immune system tends to react more easily to a wider range of harmless influences, such as dust mite and animal fur.
People who have been exposed to all kinds of bacteria at an early age tend not to react as easily as people who have not had this exposure, usually people living in a super-clean environment. “In countries where hygiene levels are low, people are likely to have been infected by many kinds of bacteria from a very young age. As a result, the skin develops its own protection against atopic dermatitis,” Dr Pang added.
“In more urban environments where hygiene standards are much better, children don’t have exposure to all these bacteria and are therefore more likely to develop eczema.”
Recent studies, said Dr Koh Hong Yi, Registrar, Department of Dermatology, SGH, suggest that the majority of patients who suffer from eczema have a protein mutation in their skin called filaggrin which results in the weakening of the skin’s natural protective barrier. They also tend to have reduced levels of fats in their skin, causing their skin to be drier than normal.
“Another difference in the skin of eczema sufferers is the higher number of bacteria living on their skin. All of us have bacteria on our skin but we also have this chemical known as anti-microbial which protects us from this bacteria. On the skin of patients with atopic dermatitis, the level of this protective anti-microbials is much lower, which allows more bacteria to stay on the surface of the skin,” Dr Koh said.
People who suffer from severe eczema are sometimes prescribed a drug to suppress their overactive immune system, said Dr Pang. When the condition improves, topical steroids are then used to control the areas of the skin with lingering eczema.
For milder cases of eczema, antihistamines are given to control itching, while steroid creams of different strengths as well as non-steroidal creams calm the skin when eczema flares up. Other treatments can also include light therapy (phototherapy), which exposes the skin to various wavelengths of light for different periods.
Using a fragrance-free moisturiser or skin cream is also important as dry skin can exacerbate the condition. For this reason, people who suffer from eczema have to avoid soaps, fragrances and harsh detergents.
Eczema sufferers are also encouraged to do light exercise such as swimming after their condition stabilises. However, sporting activities which cause heavy sweating should be avoided in order not to aggravate the eczema.
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