With the proper use of steroids and moisturisers, sufferers can have a better quality of life. LEA WEE reports
Living with eczema can be a misery, so it is important to soothe the skin with the right treatments. Topical steroids reduce the redness and itch, while moisturisers speed up recovery by keeping the skin hydrated and protected against irritants such as dust, said Dr Derrick Aw, a senior consultant at the University Dermatology Clinic at the National University Hospital. Even after a flare-up has cleared, moisturisers should still be applied regularly as a preventive measure, he said.
Eczema is a common skin condition which is estimated to affect at least one in five under the age of 12 here. It is a sensitive skin reaction which can be triggered by stress, heat and dust. Sometimes, the triggers are not known. The condition tends to run in families. Unfortunately, some eczema sufferers and their family members wrongly believe moisturizers are not important, said Dr Tang, a senior consultant dermatologist at the National Skin Centre. But many overseas studies show that the frequent use of moisturisers can decrease the number of eczema flare-ups and the amount of steroids that needs to be used.
Another common misperception is that the use of steroids is dangerous because of their side effects, said Dr Tang. When used appropriately under a doctor’s supervision, steroid creams are effective and safe, he said. They help subside inflammation which causes the redness and itch, said Dr Aw. He said: “When the skin becomes better, one can apply steroids less frequently. This way, the side effects can be prevented and the itch can also be effectively controlled.”
Moisturisers and steroids can be formulated as lotions, creams or ointments. These havedifferent water and oil contents, with the oil content lowest in a lotion and highest in an ointment. Lotion is easily spread over large areas of the skin and is quickly absorbed. It is suitable for hairy areas such as the scalp, said Dr Aw. Creams and especially ointments tend to stay longer on the surface of the skin. Steroids in ointments are often prescribed for eczema on very dry and thickened skin, as they penetrate the skin more effectively, said Dr Aw. But as ointments are thick and greasy, they can be messy to use and difficult to apply over a large skin area, he said. The doctors had some tips on the use of moisturisers and steroid creams in eczema sufferers.
• That keeps the skin hydrated for at least eight to 12 hours. Children, especially, do not like to have substances applied frequently on their skin.
• That feels nice on the skin, so you would be motivated to apply it.
• That suits your skin type. For instance:
a) If you have very dry skin, use creams or ointments instead of lotions.
b) If you have very sensitive skin which turns red and itchy at the slightest irritation, avoid moisturisers with fragrances, strong antibacterial properties and exfoliating properties such as glycolic acids, which can irritate the skin further.
How to use:
• Use a moisturiser at least twice a day. The tendency is to apply it once only. The best times to apply a moisturiser are after a shower and before bedtime. Taking a shower tends to strip off moisture from the top layer of the skin, so it is important to moisturise afterwards to “lock in” moisture and replenish it. It is also good to apply a moisturiser before going to bed. At night, when the ambient humidity drops, the skin tends to lose water. You can also apply a hand cream after you wash your hands every time to counter the drying effects of washing.
• Apply the moisturiser all over the body. Doing so helps to protect the skin and prevents the eczema from developing elsewhere.
• Apply it generously. A common tendency is to apply the moisturiser too thinly. One fingertip unit of cream (a strip of cream which runs from the top crease of your third finger to the fingertip) should cover only the surface area of an entire hand. The skin should feel slick after an application.
• If the eczema is in an acute stage with lots of weeping and oozing, do not use a moisturiser, as it will not stay on the skin. Bring down the weepiness with wet compresses such as a diluted potassium permanganate solution, which has astringent properties and can dry up the wound quickly.
How to use:
• Apply the steroid cream after using a moisturiser. Hydrated skin can help in the absorption of steroids.
• Use the topical steroid as recommended by your doctor to prevent applying too much or too little of it. When the eczema improves, he will recommend you reduce its use for instance from twice a day to once daily. Overuse of steroid cream can lead to thinning skin (which may have a crinkled appearance and the underlying structures show through more clearly) and discoloration (usually a lighter colour).
• Depending on where the eczema is, the doctor would recommend different steroid formulations. For instance: a) If the red and itchy patches are on a hairy area such as the scalp or armpit, a steroid in lotion form would typically be recommended. Cream tends to stick to the hair, while on ointment may potentially clog hair follicles and cause them to become inflamed.
b) If the red and itchy patches are over thickened skin, a steroid in ointment form would typically be recommended.
• The very young and the very old tend to have thinner skin, so doctors will usually recommend a weaker steroid.
• Certain parts of the body, such as the eyelids and neck, have thinner skin than other parts, like the palms and soles. Doctors tend to use weaker steroids for areas with thinner skin.
NEW SUPPORT GROUP FOR SUFFERERS
Eczema is not contagious. Nor is it the result of something wrong that the patient did, such as using too much detergent or eating the wrong food. Detergent and food may trigger an allergic reaction but the nature of eczema is that it comes and goes, and it cannot always be attributed to a trigger, said the chairman of the newly set-up Eczema Support Group, who wants to be known only as Mei. The support group will be launched by the National Skin Centre on Saturday to dispel this and other myths about eczema and to provide moral and financial support for eczema sufferers.Mei, who has a daughter with eczema, said: “Eczema is becoming more common. It affects not just adults but also young children and the elderly.
A support group will allow eczema sufferers to foster a positive attitude towards managing their condition.” Among other things, the group hopes to offer support to teenagers who have problems adapting to their condition. Said Mei: “Eczema may appear on a teenager’s face and limbs. Appearance matters to teenagers. They may feel self-conscious about their eczema and have lowered self-esteem as a result. The eczema may also affect their ability to concentrate in school, take part in sports and interact with their peers.” The group also hopes to help needy families with their medication costs. Said Mei: “Eczema is a chronic condition and we recognise that treatment can be long-term and expensive. One of our key priorities is to identify patients from low-income families to see how we can help them tap into assistance schemes to cover some of the treatment costs.”
The support group hopes to attract as many eczema sufferers and their families as possible. Membership is free for now. The skin centre also has a support group for patients with psoriasis, another chronic skin condition.