Eczema is the most common skin condition in children we see in our clinic. The persistent itching can result in a disruption of daily activities, and understandably, can cause distress to both the child and the parent.
A dermatologist is a qualified skin specialist who has undergone board certification for diagnosis and treatment of all skin, hair and nail conditions. Pediatric dermatology is the diagnosis and management of common dermatological conditions that occur in childhood.
What are some of the common dermatological conditions that can affect children? In this article, we’re going to focus on the treatment and diagnosis of eczema in children by a pediatric dermatologist.
1. Know the Location and Type of Eczema
First of all, how does a pediatric dermatologist diagnose eczema? The clinical pattern of eczema, is as follows. The commonest type of eczema, is a “dry” type of eczema. It occurs generally over the flexures or the extensors of the elbows and the knees. It can also occur on areas which are a bit more sensitive to friction such as the neck and the back of the ears.
Some individuals may have a form of the disease that occurs around the mouth, known as perioral dermatitis. In children who suffer from facial eczema, it is important to rule out if there is an element of irritant contact dermatitis. Very young children who drool may develop facial eczema due to salivary enzymes that cause skin irritation on contact.
The ‘wet’ type of eczema is also known as exudative or discoid eczema. Discoid refers to “coin-like” referring to the round, well-demarcated lesions of discoid eczema. The diagnosis is sometimes confused with other types of skin diseases, such as skin infections i.e. impetigo is a secondary skin infection of the skin can occur together with eczema, causing pus and yellowish discharge. Discoid eczema is a wet type of eczema that is particularly stubborn and may need treatment with oral steroids together with potent topical steroids.
2. Understand Triggers for Eczema
During your consultation with your pediatric dermatologist, it is important to identify triggers for eczema flares. Some of the common triggers would include dust mite allergies, pet fur, carpets and environmental pollution. Stress can also affect eczema flare ups. A HEPA filter may help remove allergens. Stuffed animals can be washed at high heat, sunned or removed to reduce exposure to house dust mites, a known trigger for eczema.
3. Distinguishing Irritant Contact Dermatitis from Allergic Contact Dermatitis
There are two main types of dermatitis. The first is known as irritant contact dermatitis and the second type is allergic contact dermatitis. The two categories are different, because of the way the skin reacts to environmental exposures. In an individual with irritant contact dermatitis, it is a result of accumulated exposure to a substance that breaks down the skin barrier over time. In an individual with allergic contact dermatitis, the key difference is that it is not due to the accumulated damage on skin due to a caustic substance for example, in soaps, or disinfectants.
Rather because of the individual’s true innate allergy to the substance. This means it doesn’t matter if you’ve used the product once or if it’s your 100th time using it—you will still develop an allergic reaction. In fact each allergic contact dermatitis reaction may become more severe. Is it possible to develop allergic contact dermatitis even if you have previously tolerated the product? The answer is yes.
This is due to a process known as skin sensitization. Over time your body’s immune cells build up a memory to these substances that trigger off an allergic reaction in your skin. Common examples of allergic contact dermatitis would be that induced by metals in the environment. Nickel contact dermatitis is due to the presence of the environmental contaminant nickel, in a lot of metal alloys, for example in costume jewelry. Children can become sensitized to the presence of nickel, if they wear costume jewelry from an early age.
The types of irritant contact dermatitis that we encounter in a dermatologist practice are commonly due to cleansing agents, the use of harsh soaps in individuals who have to do a lot of wet work. Working in the kitchen or doing housework, such as laundry or dishwashing without gloves, predisposes to developing irritant contact dermatitis.
The location of the dermatitis will give us a clue as to the cause of it.
Sodium lauryl sulfate, or SLS for short, when it is present in high concentrations without moisturizers in the cleansing formulation, is a major risk factor for the development of irritant contact dermatitis. Irritant dermatitis can occur on the hand and body parts that come into contact with the irritating substance.
Atopic dermatitis is a type of genetically inherited eczema, these individuals have what we termed the atopic triad, which refers to allergic rhinitis, asthma and eczema. A positive family or personal history of any one of these three conditions is a risk factor for the disease. Individuals who have atopic eczema have a genetic predisposition to defective ceramide production, due to a genetic mutation in the gene known as filaggrin.
4. Pathogenesis of Eczema including bacterial infection
The pathogenesis of eczema is best understood via the brick and mortar module of the skin wall. The bricks represent the individual keratinocytes, which form the barrier against the external environment, and the mortar would be the “cement” that holds the keratinocytes together, providing an effective protective barrier against the environment. Now, this cement, is actually the ceramide that “glues” skin cells together in individuals with atopic eczema. The defect in ceramide production leads to a “leaky” wall, which means that if you are exposed to dust, pet fur or other environmental triggers, your skin is more likely to mount an immune reaction trying to fight off these external triggers.
This immune reaction then causes skin inflammation, which leads to the signs of eczema. Signs that your dermatologist would look out for would include symptoms such as flaking, skin swelling and redness. In discoid eczema, pus formation and skin infection, which manifests with yellow crusts.
The role of bacteria in atopic eczema
Bacteria is usually present in healthy forms on a normal person’s skin. In an individual with atopic eczema or other types of acquired forms of the disease such as irritant contact dermatitis, allergic contact dermatitis, there is a disruption in the skin microbiome.
Microbiome dysbiosis refers to a disruption in the healthy balance of the skin bacteria in eczema patients. What dermatologists know is that there is an increase in the bacteria known as Staphylococcus aureus, which is otherwise harmless on normal person’s skin. However, in diseased patients, this causes a superantigen effect, meaning that on its own, the bacteria drives inflammation.
For this reason, skin infection occurs together with eczema and must be treated with all antibiotics in acute flare-ups of the disease.
General measures that can prevent worsening of skin infection in an individual with dermatitis include gentle effective cleansers, such as the Miel Honey Cleanser with medical grade honey with natural anti-bacterial effects. This helps to restore the skin microbiome.
Patients can consider bleach baths, or in the local Singapore context, the dermatologist usually advises patients to go for a weekly swim, as the chlorine present in pool water can reset the skin bacteria.
The role of food allergy in eczema
Food allergy in adults is extremely uncommon, and especially so as a trigger for eczema. However, in a child under the age of four years old, there are cases where foods can trigger off eczema. In this case, your dermatologist will advise you to keep a food diary, which helps to record the intake of specific foods and find a pattern of what may be causing the disease.
True food allergy, presents with the following symptoms. Eye and lip swelling, difficulty breathing and diarrhea, which occurs within four hours of exposure to the suspected food. It is important to manage this with appropriate appropriate dermatological care.
Investigations for Suspected Food Allergy
Skin prick tests can be performed in suspected cases of food allergy.
Other types of tests that will be useful include the RAST test for food allergy to detect specific serum IgE concentrations. A food challenge, can also be performed to determine if an individual should have a specific allergy to food.
5. Management of Eczema
Your dermatologist will first establish a diagnosis based on the clinical features, the pattern of involvement and determine if there are any environmental factors that are constantly triggering off the eczema.
A strong family history is indicative of a genetic mutation. This means the condition is likely lifelong. However, most patients do not display signs or symptoms of eczema if the condition is well controlled and treated. This is especially true for children under the age of 12, it is very important to get the disease diagnosed and treated. This is because by the time they reach adolescence, oil production begins, they have a good chance of outgrowing their eczema.
Lifestyle Measures to Prevent Eczema
Additionally, lifestyle measures to reduce the environmental triggers can be helpful. The application of moisturizers is important – the gold standard of moisturizer therapy is known as Prescription Emollient Devices (PED). PEDs are not normal moisturizers. The Multi-CERAM cream is a type of PED, the best moisturiser effective for eczema treatment. It has been formulated with the optimal lipid ratio that replicates the natural lipid barrier of the healthy skin. The moisturiser also contains antioxidants anti inflammatory ingredients that help to reduce the inflammation in skin.
The Multi-CERAM moisturiser is formulated as a Prescription Emollient Device (PED), the gold standard in eczema management. Dermatologist formulated to treat eczema, dry sensitive skin and to prevent skin ageing. Botanically derived anti-oxidants to improve the appearance of cellulite. Suitable for face and body.
Steroid Therapy for Eczema
An important point to consider is the use of medications. It is very critical to understand that eczema must be treated with prescription creams i.e. topical steroid creams. These must be used under medical supervision.
Steroid Withdrawal and Steroid Phobia
The phenomenon of steroid withdrawal and steroid phobia are commonly reported in the internet because of a poor understanding of how topical steroids work. Using steroid creams without the supervision of an accredited dermatologist can be dangerous. Inappropriate use of steroid creams can cause skin thinning, ulcers, prolonged redness and broken blood vessels. It can cause tachyphylaxis, whereby the individual develops “resistance” to steroid treatment. This is dangerous because there are a limited number of steroid classes available.
Equally, having steroid phobia, where an individual suffering from the disease refuses treatment with medicated creams such as steroids, can be dangerous. It is important to know that there are steroid-sparing alternatives such as calcineurin inhibitors, tacrolimus (trade name Protopic) or pimecrolimus which do not have steroid thinning side effects but can be more costly. These treatments can also cause burning and irritation of the skin. Consult with your dermatologist to determine if this is the best treatment for your eczema.
Steroid phobia or steroid withdrawal in an individual with eczema can lead to extreme inflammation. Worst cases end up as generalized exfoliative dermatitis, a form of Erythroderma that is potentially life threatening. It is a form of skin failure, which can lead to loss of electrolytes, dysregulation of body temperatures and overall organ failure in extreme cases.
Proactive Management of Eczema
Your dermatologist will advise you how best to control your eczema using a prescribed prescription steroid cream. A common method for long term maintenance is known as proactive management. Proactive management of the disease involves a program whereby the dermatologist instructs you how to cut down the topical steroid strength and frequency of application, in order to prevent flare ups of your condition. Gold standard moisturiser therapy with PEDs, wet occlusion therapy with double pajamas and antihistamines are also essential for management of eczema.
Dr. Teo Wan Lin is an accredited adult and pediatric dermatologist in Singapore who specialises in the diagnosis and treatment of eczema, moles and birthmarks, allergies, and skin infections in children. She is also the founder of cosmeceutical skincare line Dr.TWL Dermaceuticals, which develops evidence-based cosmeceutical actives for the adjunct treatment of eczema. She is also the author of Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare.
Sensitive skin is typically characterized by dryness, flaking, sensations of stinging and itching associated with skin redness. It is actually a form of dermatitis otherwise known as eczema. I see a large number of patients who come in with complaints of persistent sensitive skin. What they often do not realise is that it is a form of eczema. Eczema can be caused by genetic factors and also external factors such as a change in environment and climate, presence of pollen, animal fur and dust. In this article, I shall share a few tips that I usually expound on with my patients and hopefully shed some light on this condition.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she tells us the science behind sensitive skin – a form of eczema.
What causes eczema?
Eczema is due to a defect in the skin barrier. The skin is best characterized by a brick and mortar model whereby the bricks of the skin cells are joined together by this cement which holds the skin cells together. People who have sensitive skin or eczema actually have defective ceramide which is the cement of the brick wall which is the skin. This is genetically determined and people who develop eczema in the later part of their lives can also have their condition triggered off by environmental factors such as differences in humidity from dry to humid weather and vice versa. The use of harsh cleansers can also cause eczema to develop over one’s lifetime.
Does ageing cause eczema?
With regards to the development of sensitive skin with age, the same concept of our body’s organ degenerating with age, our skin also degenerates. The main thing is the quality and quantity of ceramide which is produced throughout one’s lifetime decreases with age. On that note, skin can become more sensitive with age.
What should I look out for in sensitive skin products?
The ingredients that are essential for sensitive skin would be a moisturizer and a gentle cleanser. A gentle cleanser such as one that is formulated with minimal laureate sulfate content, which is the foaming component of a cleanser, would be beneficial for a patient who suffers from skin sensitivity. In addition, the use of a ceramide-containing moisturizer is essential. Traditional moisturizers contain humectants such as glycerine which trap water under the skin. Increasing research in dermatology shows that one should be replacing the defective and deficient ceramide content in the skin barrier by applying ceramide rich moisturizers. More information on using Dr.TWL’s Multi-CERAM Moisturizer for eczema treatment can be found here.
Dr.TWL Multi-CERAM Moisturizer is an ultra intensive skin moisturiser for total skin barrier repair with pharmaceutical grade ingredients. It contains phytoceramides which aids in skin barrier repair and multi-ceramide which aids in skin lipid restoration.
Dr.TWL Honey Cleanser is a blend of nature-derived emulsifiers. It is anti-flaking and supples skin. It is also recommended for all skin types as it is a gentle cleanser.
Where is ceramide from?
Sources of ceramide can be plant-derived, synthetic or from animals. Bovine ceramide is the typical source of ceramide used in moisturizers. Plant-derived ceramides which are phytoceramides is what I use in my practice. It contains these lipids which are extracted from plant seed oils.
Dr.TWL Radiance Fluide Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. It is specially formulated for a light-weight feel to impart a radiant glow without make-up. It also contains ceramide and grape seed oil, perfect for individuals with eczema and sensitive skin.
What ingredients should I avoid if I have sensitive skin?
The ingredients that one should avoid when you have sensitive skin will be things like astringents, so any alcohol-based gel, toners or lotions should be avoided because these tend to dry up the skin further. In addition, irritating ingredients such as alpha hydroxy acids and salicylic acids are commonly used for the treatment of acne as well as for skin exfoliation, these will definitely trigger off skin sensitivity.
Skin irritation? Breakouts? Allergies? Think it may be due to bad diet and unhealthy lifestyle? Or maybe because of your dirty beddings or perhaps pollution? All of that may be possible contributors to your unlikely skin concerns but have you ever wondered that maybe the problem could be in the makeup that you use?
Makeup is all fun and games until you learn about the risk it comes with using them. If using makeup products is part of your daily routine, then it is important to know about what you put on your skin! Did you know that the average woman ingests about 6 tons of lipstick in her lifetime? You may not notice because you don’t literally eat your lipstick, but every time lipstick gets unto your teeth, or whenever it transfers on to your food when you eat, the main thing is it’s now down your tummy! So before anything else, it’s now time to question on whether or not the products that you use are safe for you.
You may be reading the ingredient list of your makeup products but do you think that’s all it is? Some companies hide “certain substances” or mask it under deceptive titles. Others may have listed them, but what’s lacking is that there is not enough information on the potential harm it may cause for their consumers.
Certain ingredients used in the production of makeup and cosmetics can cause more harm than benefits and these can cause problems that may put your health at serious risk. Issues related to the use of products with these harmful ingredients may associate with skin allergies, cancer, weakened immunity, and more.
“For patients who suffer from sensitive skin and allergies, it’s often a vicious cycle with makeup products which are used for concealing the skin imperfections, and the same preservatives and ingredients in these products cause an exacerbation of the underlying skin condition,” says accredited dermatologist Dr. Teo Wan Lin.
How about for those without skin problems? Dr. Teo says, “Makeup is in direct contact with skin, and as skincare can deliver benefits to skin via topical absorption, makeup can also be used as a means to improve the health of the skin when it is incorporated with cosmeceutical active ingredients as an anti-ageing formula— while at the same time offering concealing of imperfections, which can improve individuals’ self-esteem. For products applied to mucosal areas such as the eyes and lips, it’s worthwhile to switch to pure mineral colorants in cosmeceutical bases because these are sensitive areas that are prone to irritation, and have thinner skin that will cause any harmful substances to be directly absorbed.”
We have listed down below the Top 5 harmful chemicals that are used in the production, preservation, and manufacturing of makeup products that you may be using everyday. Guess what, these ingredients don’t have to be present in your makeup— if you switch to mineral makeup for the eyes and lips!
This chemical is most commonly found in perfumes, colour cosmetics, nail polish, and hair care products. Phthalates are linked to endocrine disruption, developmental and reproductive toxicity, and cancer. Phthalates may be labeled as phthalate, DEP, DBP, DEHP and “fragrance”. Some companies intentionally exclude this on their ingredients list. Products that list “fragrance” on the label should be avoided to prevent possible exposure to phthalates.
Paraben…paraben… One of the most famous ingredients for makeup. Though you may not know much about this chemical, you’ve probably heard about this already because you may have previously encountered the term “paraben-free” on some beauty products and wonder what does it mean. Parabens are preservatives used in a wide variety of personal care products and foods to prevent the growth of microbes. Parabens are not water soluble and can penetrate the skin. As a result, repeated application of a product or multiple products containing parabens could mean almost continuous exposure. These endocrine-disrupting chemicals can be absorbed through skin, blood and the digestive system.
Effect of Paraben: causes endocrine dysfunction, interferes with male reproductive functions, and can lead to rapid skin ageing and DNA damage.
Paraben may be labeled as ethylparaben, butylparaben, methylparaben, propylparaben, isobutylparaben, isopropylparaben, and other ingredients ending in –paraben.
Lead has continuously been a very controversial component of lipstick. But did you know that it is often used in makeup foundation and whitening toothpaste as well? High levels of lead may pose a very serious risk on our health and studies have shown that there is no safe amount of lead exposure as though even at small amounts, lead can be very dangerous. Medical experts are clear that any level of lead exposure is unhealthy. The FDA or Food and Drug Administration has been determined to limit the usage of lead in lipstick and in a variety of other cosmetics. Read here.
Exposure to lead has been linked to a host of health concerns:
Neurotoxicity: It has been linked to learning, language and behavioral problems.
Reduced fertility in both men and women
Hormonal changes and menstrual irregularities
Delayed onset of puberty in girls and development of testes in boys.
Talc is used as an ingredient in face powders, blush, and eyeshadows. The incorporation of asbestos in talc is due to poor regulations involving cosmetic-grade talc, which is also known as talcum powder. Talc and asbestos are minerals that form together. That means talc mined for commercial uses can be contaminated with asbestos — a known cause of lung cancer and mesothelioma. Before purchasing any product that has talc, make sure it is labeled as asbestos-free. Health concerns of asbestos may include skin irritation, cancer, organ system toxicity.
Mainly used for preservation of our beauty products and personal care products such as moisturizer, lip products, hair products, makeup, sunscreen, antiperspirant/deodorant, fragrance, creams. Butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT) are chemicals are linked to several health concerns including endocrine disruption and organ-system toxicity.
Don’t get fooled by this because butylated compounds are also used as preservatives in food like meats, sausage, poultry, baked goods, beer, etc.
We have no control over the ingredients or manufacturing of the mass market makeup available in the market, but is that where custom blend mineral makeup can perhaps fill a need? “Custom blend mineral makeup has its advantages especially for eye and lip makeup because pure minerals are utilised. The eyelid and lip area are high-risk locations and naturally have thinner and more sensitive type of skin—known as mucosal skin. “ says Dr. Teo, who remarks that she has been seeing an increasing number of patients in her practice with eyelid and lip eczema, often triggered by makeup products such as mascara, eyelash extensions and lipsticks.
Especially if the sources are clearly labelled and audited, the risk of manufacturing contamination for sensitive products such as lipsticks and eye shadows, which is of the highest concerns to regulatory authorities like the FDA and HSA as well, due to the risk of ingestion and absorption, is eliminated. “When produced in smaller batches, custom blended mineral makeup is preservative free and avoids the problems of lead contamination in mass market manufacturing, which is important in lip products because of the lead content which is inevitably ingested.” Dr. Teo says.
How does one avoid getting these toxic chemicals incorporated into your daily routine? Also, isn’t it time that skincare is infused into makeup, since both are applied for long hours on the skin? Head over here to get your hands on cosmeceutical make-up.
Dr. TWL Dream Concealer™
100% Mineral Pigments Without Bulking Agents
FDA Eye/Lip Approved
LARECEA™ Extract [Regeneration]
PEACH Covers dark circles on light skin
ORANGECancels dark circles brown spots on medium to deep skin
PALE PURPLEConceal brown spots on light skin dullness
PURPLE Brightens/Neutralizes dull yellow on medium skin
PINKBrightens/Neutralizes dull yellow on light skin
BLUE Neutralizes sallowness & hyperpigmentation on fair skin
In patients with Eczema, there is an inherent defect of the epidermal barrier of the skin. When this barrier is compromised, bacteria and allergens are able to enter and thus there is an increased risk of secondary infections, which, in turn, can lead to aggravation of eczematous symptoms. It is believed that the best way to manage eczema is to repair the skin barrier or prevent its dysfunction, in which ceramide moisturisers play a critical role.
According to accredited dermatologistDr Teo Wan Lin who is an expert on sensitive skin and eczema, “I formulated the Dr Twl Dermaceuticals Multi-CERAM™ Moisturiserafter years of prescribing other brands of ceramide moisturisers which I found did not meet the underground clinical needs of patients, at a competitive price point. The high cost of manufacturing ceramide moisturisers lies in its reliance on synthetic sources of ceramide as well as bovine (cow derived) ceramide.”
“In the Dr Twl Dermaceuticals Multi-CERAM™ Moisturiser, which is very competitively priced with a high ceramide content, the novel focus and dermatological concept is on using multiple sources of ceramide for total skin lipid restoration, rather than just relying solely on the expensive synthetic and animal derived ceramide which results in low concentrations of ceramide being used in other ceramide moisturisers, or high price point which is prohibitive.
In the Multi-CERAM™ Moisturiser, phytoceramides are used — these are plant seed oil derived sources of ceramide that directly repair the skin barrier. This is in addition to containing plant anti-oxidants which incidentally combat cellulite, large amounts of glycerin which functions as a humectant, preventing trans-epidermal water loss, as well as Sodium Hyaluronate (Hyaluronic acid), a natural component of the skin, for dermal hydration,” Dr. Teo says.
What are Ceramides?
Ceramides are lipids that are naturally found in the intercellular “mortar” within the outer layer of s the statue corneum. They make up 40-50% of the lipid component of the lamellar lipids and are integral to the function of the epidermal barrier.
In patients with psoriasis, eczema and other dry skin conditions, reduced levels of Ceramides are observed.
The stratum corneum is comprised of corneocytes compressed within a lipid bilayer, which is made up of 40-45% Ceramides, 25% Cholesterol & 10-15% Free Fatty Acids. If incorporated in the wrong ratio, barrier repair may be impeded. These 3 major components of the stratum corneum bind the protein-rich corneocytes into a water impermeable protective barrier. A deficiency in Ceramides results in excessive transepidermal water loss, dry skin and increased permeability to environmental irritants, allergens and microorganisms. Thus, reduced levels of Ceramides is associated with dermatological disorders such as atopic dermatitis.
Studies show that if topical ceramides is applied in the correct ratio with cholesterol and free fatty acids, it can help to improve the epidermal barrier in people with Atopic Dermatitis (AD), thereby reinforcing barrier function. Therefore, ceramide moisturisers and cleansers have been proven to provide substantial relief from the symptoms of eczema.
Ceramide Dominant PED for Eczema
In order for ceramide-containing products to have a positive effect on the skin barrier function, ceramides should be present abundantly in an optimal ratio with other barrier repair ingredients. Our Multi-CERAM Moisturiser is uniquely formulated to ensure the delivery of an optimal ceramide, cholesterol and free fatty acid ratio. In fact, this moisturiser is formulated as a Prescription Emollient Device (PED), the gold standard in eczema management – Eichenfield et al. (2014) [on PubMed], and also the optimal moisturer for barrier protection against maskne – Teo (2020) [on PubMed].
By restoring healthy barrier function, the Dr. TWL Dermaceuticals Multi-CERAM Moisturiser helps to support ceramide synthesis and further augmenting skin barrier repair and skin health in general.
The Multi-CERAM™ Ceramide Moisturiser is uniquely formulated treat Eczema using:
Ceramide 1 (EOP) which is significantly deficient in eczema patients and Ceramide 3 (NP) which is linked to the transepidermal water loss experienced in eczema patients.
Phytoceramides which aids the repair of skin barrier
Sodium Hyaluronate for skin hydration
Ceramide complex (ceramides, cholesterol & FFA) which delivers ceramides topically in optimal ratios to aid in the reinforcement of the recovery of the skin barrier.
Management for patients with Eczema
A daily maintenance routine is vital. One of the main changes in eczema is a disruption and reduction in the layers of corneocytes in the stratum corneum. When the stratum corneum is well hydrated, it swells, allowing increased permeability of topical formulations. The key to managing eczema is through the regular use of a ceramide moisturiser with high ceramide content after showering or washing hands.
Successful management requires a holistic approach:
1. Avoid triggering factors 2. Maintain skin care through regular use of a moisturiser and a moisturising cleanser 3. Pharmacotherapy during acute exacerbations 4. Compliance of skin care products suggested by a dermatologist
In my previous articles, I have talked about cosmeceuticals and the importance of incorporating them in our daily routines. However, how do we enhance the skin absorption of these cosmeceuticals? Here I will be talking about the limitations of topical formulations and how we can overcome them to ultimately achieve the results that we desire.
The problem with topical formulations for your skin
The outermost layer of the skin, called the stratum corneum, acts as a natural barrier. It prevents foreign material from entering our system, shields us against environmental factors and prevents excessive water loss. The skin is a formidable barrier to the passage of substances into and out of the body, but it can be manipulated to allow it to become a viable pathway for drug administration.
Drug products applied to the skin’s surface penetrate the skin layers to a certain extent, where they can exert their effects. This is the case for topical formulations for treatment of skin disorders such as acne, dermatitis, and psoriasis. However, very few drugs are suitable for delivery by the topical route, as passive penetration through the skin is limited to very small molecules (<500Da), which are neutral and relatively lipophilic. Some considerations of dermatologists would be the vehicle of the topical, specifically if it is in a lotion, cream or ointment form, in increasing order of absorption and effectiveness. This however, is often limited by user preferences, with ointment formulas (more efficacious) deemed cosmetically less acceptable.
The skin is the largest organ of the human body, comprising 15% of body weight and therefore its use to deliver medicine to the body is not a new concept by any means. Advancements made by modern science are improving the skin’s potential as a route for drug administration. Dermatologists are at the forefront of research relating to transdermal drug delivery, given the unique accessibility of the largest organ of the body.
Owing to the drawbacks of topical formulations, transdermal patches have been developed to improve drug delivery through the skin and this is an area that my team has actively researched in the last year as an adjunct to our cosmeceutical formulations.
I have always been interested in finding new methods to allow my patients to achieve optimal results from our cosmeceuticals, thus in this article I shall share some tools which I employ in my clinical practice to achieve optimal absorption of cosmeceutical active ingredients.
Wet Wrap/Occlusion Skin Therapy & Facial Masks
A well known method employed by dermatologists to treat severe eczema known as wet wrap is actually a simple process involving applying a wet textile together with topical medications to skin, to increase absorption of skincare. An example of how and when wet wraps are used— during particularly intense eczema flares with severe itch or pain, wet wrap therapy rehydrates and enhances the absorption of topical medications applied on the skin. The fabric wraps are soaked in water and applied to the affected skin on the body. Wet wraps are best done after bathing, moisturising and applying topicals, then left overnight.
Wet wraps work via 3 different ways:
● Cooling — as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness
● Moisturising — cosmeceuticals covered over with wet bandages are deeply absorbed in to the skin to provide a longer-lasting moisturising effect
● Absorption — enhanced absorption of any topicals into both the superficial and deeper layers of skin where inflammation is present
Facial sheet masks work in a similar way, on the basis of occlusion. This means that when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. In my practice, whenever I want to increase absorption of cosmeceuticals and moisturisers that are dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.
I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture and clinically active ingredients to the skin—so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as evidence-based antioxidants for anti-ageing such as oligopeptides, vitamin C ( I use sodium ascorbyl phosphate which is a neutral, rather than acidic form of vitamin C, that has minimal skin irritation). Here’s a tip, use a cosmeceutical moisturiser like the Radiance Fluide™ and increase your skin’s absorption by applying it on damp skin, plus a soft wet cotton towel over it.
Performing a facial massage, such as with the aid of a facial roller before application of cosmeceuticals could increase the skincare absorption, leading to better effects of the anti- aging skincare. Local massage is an established treatment method of improving surgical scars, by stimulating blood flow and improving wound healing. A peer-reviewed study published in a medical journal Complementary Therapies in Medicine led by author Miyaji Akane at the Institute for Liberal Arts, Tokyo Institute of Technology (Tokyo Tech) and colleagues at Tokyo Healthcare University and the Research and Development Center, MTG Co. Ltd. in 2019 had examined the effects of using a facial roller on facial skin and blood flow. The study concluded that there was significantly increased vascular (blood vessel) dilation with use of the facial massage roller. This means that there will be increased absorption of any cosmeceuticals applied on the face following the massage.
My recommendation would be manual rather than electric facial rollers as the latter may cause excessive pressure and irritation (being automated) and is also dependent on user training as well as the manufacturer’s settings, with a potential risk of overheating of electric components. Manual facial massage is a self-regulated process as the user can immediately sense irritation and apply just the right amount of pressure.
Transdermal medications (usually in the form of a patch) are a little more modern and complex. Great strides in transdermal drug delivery have been made since the first transdermal drug was approved by the FDA in 1979.
Transdermal drugs bring medication through the skin, to the bloodstream. Once in the bloodstream, the ingredients circulate and take effect at a targeted location. Medication is delivered steadily and can be stopped simply by removing the patch. Since your body doesn’t have to digest the medicine through the stomach, a higher concentration reaches the bloodstream. The medication permeates the skin in a controlled fashion thus attaining more ready levels of the drug in the body.
The science behind polymers and transdermal drug delivery systems
Polymers are vital in a transdermal drug delivery system. Systems for transdermal delivery are assembled as a multilayered polymeric laminates consisting of a drug reservoir sandwiched in between 2 polymeric layers:
● An outer impervious backing — prevents the loss of drug
● An inner polymeric layer — functions as an adhesive and rate-controlling membrane There are 3 types of transdermal drug delivery systems:
● Reservoir systems
In this system, the drug reservoir is embedded between a backing layer and a rate-controlling membrane.
● Matrix Systems
In this system, the drug reservoir is either dispersed in an adhesive polymer or in a hydrophilic or lipophilic polymer matrix.
● Micro-reservoir Systems
This system is a combination of the above 2 systems. The drug reservoir is formed by suspending the drug in an aqueous solution and then dispersing the solution in a lipophilic polymer to form thousands of microscopic spheres of drug reservoirs.
Polymers used in transdermal delivery systems should have biocompatibility with the drug and other components of the system. They should also provide consistent, effective delivery of a drug throughout the product’s intended shelf life.
An example of a common polymer used are silicones, also known as polysiloxanes, made of many repeating units of siloxanes. Siloxanes are chains of alternating silicon and oxygen atoms that are often combined with carbon and/or hydrogen. Medical grade silicones are silicones that undergo specific testing for their biocompatibility and have been deemed appropriate to be used for medical applications. Topical silicone therapy is often used by plastic surgeons and dermatologists to treat and heal scars.
Key considerations of a polymer patch used for transdermal drug delivery would be —conformability of the material to be applied to irregular skin or scar surfaces, sensitive regions such as the face/eye area and the overall durability and biocompatibility of medical grade polymers.
The process of skin ageing relates to the ability of the body’s natural healing processes. The same cells which are activated during cell injury are the ones which lose function with ageing, and are responsible for loss of collagen, elastin and the overall loss of volume and elasticity of skin. Specifically, antiageing cosmeceuticals target and stimulate cells known as fibroblasts, which are best thought of as the “soldiers” of wound healing which produce collagen to seal up injured or damaged skin. Injury to the skin occurs over a gradual process in the case of ageing, due to the slowing of one’s biological clock and photodamage.
For the last year, my team and I worked with a material scientist to develop a transdermal delivery patch, the QRASER™ Transdermal absorption patch, launched in July 2019. This patch works via a matrix system of drug delivery. In this system, the drug reservoir is dispersed in an adhesive polymer matrix. The transdermal delivery patch uses a unique polymer technology that mimics the natural hydration and homeostasis of the skin barrier, to enhance cosmeceutical absorption. The focus is on improving absorption via optimisation of the skin healing microenvironment.
The result? Healthy collagen production thus reducing fine lines and wrinkles.
In conclusion, cosmeceuticals in the arena of dermatologist-led skincare research will be increasingly prominent in the next decade of “smart skincare”. This should be emphasised along with understanding of how these topicals work, the limitations of skincare absorption and potential technologies such as transdermal delivery patches which can optimise the anti-ageing benefits of cosmeceutical skincare.
Dr. Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, is one of Singapore’s prominent dermatologists specialising in medical and aesthetic dermatology. She is also the founder of Dr.TWL Dermaceuticals which specialised in cosmeceutical skincare. In July 2019, a material science arm Dr.TWL Biomaterials was launched focusing on novel biomaterials for skin and hair application. Click here for the links to our product and here to read more about Dr.TWL Dermaceuticals and here to read more about Dr.TWL Biomaterials.
TWL Specialist Skin and Laser Centre grants parties a limited license to use and/or republish this article on for any legitimate media purpose, provided that you:
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Nail abnormalities are often neglected. Patients tend to visit the dermatologist for skin-related concerns, such as acne or eczema. Yet, such diseases can be common and require diagnosis and management.
The nail (referring to the plate) is firmed rooted to the bed of our fingers or toes. They are made of modified keratin. It serves as a protective shield for our fingertips and toes. Nails on the fingers take approximately 5 to 6 months to grow out, while the toes require twice the duration. The slow growth rate and the difficulty of getting drugs to penetrate through the plates make it hard to treat the associated diseases.
Here, we share a few common diseases.
Onychomycosis is a type of yeast or mould infection. The infection causes a discolouration (white, yellow or brown). Other characteristics include thickening, splitting, roughening of the nail.
Common factors that place individuals at greater risk include humidity, heat, trauma and diabetes. Basketball players may be more predisposed due to the direct trauma of having their toes stepped on by other competitors.
Onychomycosis may also be a symptom of the following conditions: psoriasis, eczema, trauma or ageing.
Treatment for onychomycosis: Topical antifungal agents are less ineffective, due to its inability for deeper penetration into the bed of the toe or finger. Instead, oral terbinafine or itraconazole is often prescribed.
Does my nail have a bacterial infection?
When your nails suffer from bacterial infection, it is termed as paronychia. Paronychia can be acute or chronic. In acute paronychia, it is generally painful with pus present, caused by the bacteria Staphylococcus aureus. Repetitive minor trauma, picking and tearing can cause a tear in skin of the finger bed, allowing bacteria to invade.
In chronic paronychia, individuals in wet working conditions or cold environment are at greater risk. Compared to acute paronychia, chronic paronychia is generally less painful.
How to treat acute paronychia: Antibiotics and drainage of any pus if present.
How to treat chronic paronychia: Topical imidazoles are often prescribed. The patient should also avoid wet conditions, e.g. to use cotton-lined gloves when exposed to wet work. Manicuring or finger sucking should be avoided. Apply emollient creams regularly.
Ingrowns at the toes can be hard, swollen and painful. Trimming your nails too short, especially on the sides of your big toes, can cause an ingrown. Trimming the corners may encourage the plates to grow inwards, digging into your skin. Your skin then breaks due to the pressure, triggering an infection. Tight shoe wear or trauma can also cause ingrowns.
If excessive inflammation and swelling are present, patients are advised to visit a dermatologist for proper treatment. Oral antibiotics may be prescribed, and the dermatologist will assess if there is a need for surgical removal.
To prevent ingrowns, wear proper-fitting shoes that have adequate room for the toes. Wear socks too. Cut straight across instead of rounding the corners.
Tumours on nails can be benign or malignant. Warts are the most common type of benign tumour affecting them.
Dermatological diseases that can affect nail conditions
Psoriasis: Patients who suffer from psoriasis may notice that their nails are scaly or pitted, with debris collected under them. In severe cases, the plate crumples, along with thickening of the finger or toe bed.
Generally, the condition should improve with effective psoriasis management. There are no nail-specific treatments for patients with psoriasis.
Eczema: While eczema does not typically cause nail changes, certain patients may suffer from brittle nails. The plate may also be rippled and deformed, due to the body’s inflammatory process. Horizontal ridges can be seen across the nail, with thickening and sometimes discolouration.
Nail abnormalities can benefit from the application of moisturizers, especially for patients suffering from eczema. Use a dermatologist-formulated emollient such as Multi-CERAM™ Moisturizer, with phyto-ceramides for skin barrier repair and multi-ceramides for skin lipid restoration.
What happens to your skin when you drink too much?
To maintain the health of your skin, you may want to think twice before you reach for one too many drinks. Alcohol can be pretty harsh on the skin.
When broken down, alcohol produces molecules called aldehydes. Such molecules cause damage to the body’s cells by destroying their ability to function. When cells are damaged or die, our body produces new cells to replace them. However, a single exposure to alcohol can reduce the body’s ability to multiply cells.
Another effect of alcohol is the widening of small blood vessels in the skin. This allows more blood to flow closer to the skin’s surface, which produces the distinctive flush and feeling of warmth often associated with alcohol consumption. Over time, this can cause an unhealthy appearance including dullness, enlarged pores, sagging, discoloration and a lack of skin resilience. Such effects can last for days.
Excessive alcohol consumption can further limit the liver’s ability to remove toxins, which can also make you look older.
Alcohol interferes with the body’s ability to regulate water levels. Your brain produces a hormone called anti-diuretic hormone (ADH) that acts on our kidneys to control the amount of water secreted in your urine. When your body is dehydrated, your brain sends a signal to pump out ADH. ADH stops you from urinating as much, allowing you to retain your water levels.
Alcohol inhibits ADH levels. So even when you drink a lot of water alongside your alcoholic drinks, your body only hangs on to about a third of it while the rest goes out in your urine. In other words, alcohol increases urine volume and leaves your body dehydrated.
This dehydrating effect worsens skin elasticity, thickness and density. It also makes wrinkles and fine lines more noticeable.
Most itchy skin diseases are exacerbated by alcohol consumption. Alcohol causes eczema to be twice as common, likely due to its suppressive effects on the immune system.
Alcohol also makes psoriasis harder to treat. Psoriasis refers to the condition of red, itchy skin. While alcohol itself does not cause psoriasis, it increases the body’s susceptibility to infection and exacerbates the condition. Heavy drinkers are also more resistant to therapy.
Flushing is a common after-effect of drinking and tends to go away the next day. It is more prevalent in individuals who do not have an enzyme that breaks down aldehyde. (Alcohol is broken down via two general steps, first into aldehydes and then to acetate.) An accumulation of aldehydes causes flushing and rapid heart rates.
An impaired alcohol metabolism can also worsen rosacea, a common skin disease with a tendency to blush or flush more easily than others. It can further cause an increased incidence of telangiectasia or the appearance of spider veins at the surface of the skin.
However, excess ROS production can be harmful to the skin as it alters the body’s immune response, triggers inflammation and causes the body to attack itself. This can compromise the skin’s wound healing processes.
Consequently, alcohol can cause skin conditions such as eczema, psoriasis or, in some cases, acne to take much longer to heal than before.
Resveratrol in red wine
Resveratrol is an antioxidant often found in red wine. (Antioxidants work to fight against the oxidative stress that your skin cells encounter.) Resveratrol also has therapeutic benefits against various skin disorders and protects the skin against harmful UV rays. Given that UV radiation is a major cause of ageing, resveratrol is popular for its anti-ageing abilities.
However, there are other ways to get resveratrol that do not include the harmful effects of alcohol.
For a dermatologist-formulated anti-ageing serum, go for Elixir-V™ Total Recovery Serum. It contains a potent concoction of resveratrol, hyaluronic acid and oligopeptides that work together to give you the perfect V-face look.
Seek for professional help
If your skin condition worsens, schedule a visit with a dermatologist as soon as you can. The dermatologist can determine the best course of action and suitable treatment that would be effective for your condition and your lifestyle.
Anyone who has survived adolescence knows the feeling of seeing an ugly head of pus on the face and having the urge to press it out. Despite many commonly known warnings about the evils that befall those that pop pimples (the pimples will spread, grow infected and/or scar), few resist.
However, there are cases in which this behavior can become extreme. Such behavior becomes a condition called excoriation disorder (also known as dermatillomania, acne excoriée, neurotic excoriation, or psychogenic excoriation) when it is repetitive and intentionally self-harming.
Characteristics of excoriation disorder
Skin-picking is quite common and may occur at any age. It typically begins in adolescence as it coincides with the onset of puberty. Patients suffering from acne or eczema are more likely to pick their skin.
What distinguishes excoriation disorder from normal skin picking is that this behavior is self-injurious and involves repetitive scratching or picking at healthy skin, minor skin irregularities or general skin-picking automatically without realizing it. The behavior also results in tissue damage.
Sufferers of this disorder may skin-pick any area of the body and usually do so in multiple places. The most common areas are the face, followed by the hands, fingers, arms or legs. Acne, papules, scabs, scars, calluses and insect bites are also sometimes excoriation sites.
While potential skin-picking triggers may vary across individuals, common ones include emotions such as stress, anger, and anxiety. Skin-picking is often common during sedentary activities as well such as watching television and reading, boredom and feeling tired.
Excessive picking can result in tissue damage and lead to medical complications such as localized infections. Such behavior often begins with the onset of a dermatological condition like acne, and often worsens conditions by preventing wounds from healing properly.
Psychological aspect of the disorder
The behavior associated with skin picking shares similar symptoms with obsessive-compulsive disorder (OCD) and impulse control disorder. Features that resemble OCD include obsessions about an irregularity on the skin or preoccupation with having smooth skin and excoriating in response to the thoughts. Individuals who pick their skin may also experience mild to moderate levels of depression and/or anxiety.
Through the experience of picking, sufferers may feel tension prior to excoriating and relief or pleasure during or afterwards. However, any positive feelings are unfortunately transient and give way to the urge to pick again.
Individuals who skin pick rarely seek dermatological or psychiatric treatment for their condition; they are either embarrassed or believe that the condition is untreatable.
Instead, some patients may avoid social activities as it may expose their scars or injuries. Others resort to cosmetics, clothing and/or bandages to camouflage their scars.
However, there are other ways out. For excoriation disorder, both pharmacological and nonpharmacological treatments can help.
Cognitive-behavioral therapy and habit reversal therapy can be powerful interventions for excoriation disorder sufferers. Cognitive-behavioral therapy involves psychoeducation, cognitive restructuring and an emphasis on relapse prevention.
Habit reversal therapy involves self-monitoring and substituting skin-picking with an incompatible action. For examples, patients can be advised to clench their fists whenever they feel the urge to skin pick. Another example is to introduce a new behavioural sequence that ends with a harmless action: the hand approaches the face to pick the skin but then consciously deviates to a different location such as the ear.
Research on the use of medications for excoriation disorder is currently limited. Individuals who suffer from skin picking should receive a thorough physical examination before going on any medication.
Having said that, many individuals can benefit from drug interventions. Pharmacological agents used to treat excoriation disorder include:
Selective serotonin reuptake inhibitors
It is widely believed that imbalanced or low serotonin levels contribute to depression, anxiety disorders and some personality disorders. Better regulating serotonin is believed to help improve the brain function and thereby reduce the urge to skin-pick. Common drugs that increase levels of serotonin to the brain include clomipramine, fluoxetine and sertraline.
Like serotonin, people with low dopamine may exhibit more depression, anxiety, poor outlook, addiction and self-harming behavior. Opioid antagonists (naltrexone, nalmefene) increase the dopamine levels in our body and help diminish the urge to pick.
Examples include N-acetyl cysteine (NAC) and riluzole. Skin picking, along with other compulsive and habitual disorders, is said to arise from defective signalling of a substance called glutamate. With glutamatergic agents such as NAC, it helps to increase levels of glutamate in the brain, ensuring signalling functions normally again, reducing the urge to pick on skin.
When to visit a dermatologist
When picking on acne becomes serious, such as causing frequent infections or severe scarring, patients should seek help and visit a dermatologist. While skin picking is rather common, patients should take note if the intensity and frequency of such behaviour increases over time. Skin picking can inflict severe tissue damage, and may require a long period of time for scars to heal. A dermatologist will be able to provide professional treatment and advice before the condition worsens.
Eczema is one of the most common skin disorders in infants and children. Apart from dealing with the medical aspect of the disease, affected patients may experience significant psychosocial effects. As such, any eczema treatment needs to be comprehensively managed and best by an accredited dermatologist
Also termed as atopic dermatitis, it is very common in children but may occur at any age.
How does Eczema arise?
Atopic dermatitis or eczema is caused by a complex interaction of genetic and environmental factors including:
Most patients with eczema have a lower amount of filaggrin in the epidermal skin layer., due to mutations in the filaggrin gene. Filaggrin is a structural protein that plays a vital role in normal barrier structure and function. A lack of filaggrin contributes to the development of eczema in several ways.
Filaggrin breaks down into amino acids and protein derivative to form natural moisturizing factors (NMFs) in the outer skin layers. NMFs provide moisture retention, maintain the acidic pH and buffering capacity of the skin barrier and prevent an overgrowth of bacteria.
Inadequate filaggrin would mean a reduced ability to maintain hydration, which can cause xerosis (dry skin), pruritus (itching) and subsequently, eczema. A dysfunction in skin barrier may also allow entry of allergens, leading to an inflammatory response thus causing eczema.
Having an impaired barrier function also causes colonisation of a bacterium called Staphylococcus aureus. Scratching disrupts the skin barrier, thus also leads to the bacteria adhering to the outer skin layers.
The extent of bacterial colonization is associated with the severity of eczema.
Apart from genetic factors, defects in immune pathways are usually observed in patients with eczema. They tend to have high levels Th-2 cells, which contribute to a defective skin barrier. Th-2 cells play an important role in the immune system. A poor skin barrier may mean water is lost from the skin and also allows the penetration of irritants (soap, dirt, detergent) and allergens (pollens, microbes, dust-mites).
There is also an overproduction of cytokines in the body. Cytokines are cell signalling molecules that aid in cell to cell communication. It regulates the movement of cells towards sites of inflammation and infection.
The excessive release of cytokines initiates new responses that eventually leads to inflammation, causing the red, itchy and painful symptoms common in eczema.
Patients also have high levels of an antibody called immunoglobulin E (IgE), which puts them at disposition for hypersensitivity to environmental allergens. Hypersensitivity is when the immune system produces undesirable or detrimental reactions, such as attacking the body’s own cells or tissues instead of protecting them. With elevated IgE levels, it would mean exposure to a certain allergen can causes the immune system to attack the body’s own tissues and therefore skin inflammation that may be observed with eczema patients.
When it comes to eczema treatment, there are 3 main components that target a specific manifestation of the disease. As a chronic, relapsing condition that may flare up at variable intervals, a comprehensive home treatment plan is important for successful management.
Repair & Maintain Healthy Skin Barrier:
Lubrication of the skin is required to maintain skin hydration, commonly known as moisturisation. This helps to alleviate the discomfort that xerosis (dry skin) may bring about.
Patients with eczema should use moisturizers that are fragrance-free and least amount of preservatives, as these are potential irritants.
Topical corticosteroids are the most effective and common form of eczema treatment. Corticosteroids are drugs that mimic cortisol, a hormone found in the body. They work by diminishing inflammation, itching and bacteria colonisation.
This medication can be classified according to its potency, ranging from class VII (low potency) to class I (super potent). Great care must be taken to balance the potency of drug needed for results so as to minimise potential side effects.
Side effects include:
Atrophy (decrease in size or wasting away of a body part/tissue)
Adrenal suppression (body produces lower levels of cortisol)
For moderate to severe eczema conditions, wet wrap therapy can be used with topical steroids and dermatologist-approved moisturisers. After the medication is applied to the affected area, it is wrapped with a few layers of wet gauze, followed by dry gauze. Such therapy reduces itching and inflammation by preventing scratching and improves penetration of corticosteroids.
Topical inhibitors of calcineurin – protein phosphatase associated with activation of the immune system, are newer forms of eczema treatment, which are considered on areas unsuitable for topical steroids (e.g. eyelids) or if other eczema treatment options do not yield results. For example, Pimecrolimus cream and Tacrolimus ointment are calcineurin inhibitors that have demonstrated good efficacy for eczema treatments and do not cause side effects that corticosteroids bring, but have other considerations of use that should be managed with an accredited dermatologist.
Antihistamines are commonly used to treat itching. Even without a significant rash, itching can be present. Oral antihistamines help to reduce the sensation of itching, ideally to decrease scratching and trauma to the skin.
Antibiotic or antifungal medicines are used to treat the infected rash, to reduce the amount of bacterium Staphylococcus aureus. Topical mupirocin is often prescribed to prevent further infection.
Taking care of the skin
Avoid dry skin. Asian skin is more susceptible to being dry. Dry skin can cause itching and scratching. Tips to avoid dry skin:
Moisturize, especially after a bath as evaporation can cause excessive drying. A ceramide-based moisturizer that is suitable for sensitive skin and face could be Radiance Fluide™ Hydrating Emulsionwhich is also infused with skin rejuvenation properties. For intensive replenishment of ceramides (which are naturally found in healthy skin barrier but deficient in diseased skin), a dermatologist-tested moisturiser such as the Multi-CERAM may also be considered.
Bathe with lukewarm water for 10-15 minutes.
Use neutral or weakly acidic pH soap. Consider a mild cleanser that soothes the skin like Le Lait™ Milk Cleanser.
Avoid high ambient temperatures.
Avoid irritants that can cause or aggravate a rash, such as perfumes, scratchy clothing or bedding and sweating.
Formerly known as Besnier prurigo, Eczema — also known as atopic dermatitis — is the most common form of dermatitis. It is categorised as a chronic, itchy skin condition. Eczema is less common in adults and more commonly affects 15–20% of children. It is almost impossible to predict whether the condition of one’s eczema will improve by itself or not in an individual.
Sensitive skin is a condition that persists life-long. In a meta-analysis of over 110,000 subjects, it was found that children who developed atopic dermatitis before the age of 2 had a much lower risk of persistent disease than those who developed eczema later in childhood or during adolescence. 20% of children with eczema still had persistent disease 8 years later. Fewer than 5% had persistent disease 20 years later.
Genetics in Atopic Dermatitis
Since ‘atopic tendency’ such as eczema, asthma and hay fever can be passed down through the family, knowing one’s own family history of asthma, eczema or hay fever is very useful in diagnosing atopic dermatitis in infants. The complex interaction between genetic and environmental factors causes and triggers atopic dermatitis. Defects in skin barrier function make the skin more susceptible to irritation by contact irritants such as soap, the weather, temperature and non-specific triggers.
The appearance of eczema varies from person to person. In acute eczema flares, inflamed, red, sometimes blistered and weepy patches are common. In between such eczema flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas. The appearance and feel of eczema varies from one’s ethnic origin, age, types of creams applies, the presence of infection or an additional skin condition. However, there are some general patterns to where the eczema is found on the body according to the age of the affected person.
Atopic Dermatitis Changes with Age
Although eczema can manifest itself in older people for the first time, the onset of eczema is usually seen before a child turns two. It is widely distributed amongst infants less than one-year-old. It is unusual for an infant to be affected with atopic dermatitis before the age of four months. However, they may suffer from infantile seborrhoeic dermatitis or other rashes prior to this.
As infant’s tend to scratch at their itchy skin with their sharp baby nails, the appearance of eczema in infants tend to be usually scaly, dry, and red. The signs of eczema are physically first apparent on cheeks of infants. Due to the moisture retention of nappies, the appearance of eczema in the napkin area is frequently spared. However, just like other babies, if wet or soiled nappies are left on too long, they can develop irritant napkin dermatitis. Although, eczema is often worst between the ages of two and four it usually improves after four and it may clear altogether by the time one enters into teenhood.
As toddlers tend to scratch vigorously at their itchy skins, the appearance of their atopic dermatitis may look very raw and uncomfortable. As they start to move around, the dermatitis tends to become more thickened and localised. Body parts and areas such as the extensor aspects of joints, specifically the elbows, wrists, knees and ankles and even genitals are most commonly affected in this age group. This changes as the child grow older. The pattern frequently shifts from extensor aspects of the joints to the flexor surfaces of the same joints, such as creases. This is when the affected skin often becomes lichenified; thickened and dry from constant rubbing and scratching.
However, the extensor pattern of eczema persists into later childhood in some children. Older school-age children tend to develop a flexural pattern of eczema which commonly affects the elbow and knee creases and other susceptible areas such as the scalp, eyelids, earlobes, and neck. It is possible for school-age children to develop recurrent acute itchy blisters on their palms, fingers and sometimes on the feet, medically known as pompholyx or vesicular hand/foot atopic dermatitis
Many children in this age group tend to develop a ‘nummular’ pattern of atopic dermatitis. This refers to the appearance of small coin-like areas of eczema scattered over the body. Commonly mistaken for a fungal infection such as a ringworm, the appearance of these round patches of eczema are usually red, dry and itchy. Most of the eczema tends to improve during school years and it may completely clear up by the time they reach their teenage years. However it is important to note that the barrier function of the skin is never entirely normal.
The presence of atopic dermatitis in adults are varied in many ways. Despite having a possibility to have a diffused pattern of eczema, eczema in adults is usually more dry and lichenified compared to eczema in children. Eczema is adults are commonly persistent, localised, and possibly confined to the eyelids, nipples, flexure, and hands or all of these areas. Hand dermatitis in adult atopic tends to appear thickened, dry but may also be blistered at the same time. Infections such as staphylococcal infections are both recurrent and a prominent possibility. Occupational irritant contact dermatitis can trigger eczema. This most often affects hands that are regularly exposed to water, detergents and /or solvents.
As eczema can be triggered by physical, environmental and cosmetic factors, particular occupations such as hairdressing, farming, domestic duties, domestic and industrial cleaning and caregiving tend to expose the skin to various irritants and, sometimes, allergens, aggravating eczema. As it is easier to choose a more suitable occupation from the outset than to change it later, tt is wise to bear this in mind when considering career options. Having atopic dermatitis does not exclude contact allergic dermatitis (confirmed by patch tests in children and adults).
It could take many months to years to treat eczema and treatments plans often includes: – Intermittent topical steroids – Reduction of exposure to trigger factors – Ceramide based moisturisers (such as the Multi-CERAM which helps restore healthy skin barrier function) – In some cases, management may also include one of more of the following: – Antibiotics – Antihistamines – Crisabarole ointment – Phototherapy – Topical calcineurin inhibitors, such as pimecrolimus cream or tacrolimus ointment – Oral corticosteroids – Longstanding and severe eczema may be treated with an immunosuppressive agent. – Azathioprine – Ciclosporin – Methotrexate
Clinical trials of biologics such as Dupilumab are promising cures for eczema.