Atopic Dermatitis

Atopic Dermatitis (AD) or Eczema is a very common, recurrent itchy skin condition in children. It affects 1 in 5 children.
The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and allergic rhinitis. These conditions are all linked by an increased activity of the allergy reaction of the body’s immune system. So many patients with AD have a personal or family history of other atopic conditions like asthma, allergic rhinitis or allergic conjunctivitis.
Many genes involved in formation of the skin barrier and the skin’s immune system play a role in the development of AD. Many patients with AD have dry skin which is easily irritated.

What are the common causes of Atopic Dermatitis in Singapore?

Atopic Dermatitis is a complex condition that is due to an interplay of genetic, environmental and skin barrier defects. Patients typically have altered skin barrier, and increased inflammatory and allergy responses. Environmental factors like chemicals, infections, pollens, dust can trigger the inflammatory and allergy response and cause eczema.
An alteration in a gene that is important for maintaining a healthy skin barrier has been closely linked to the development of eczema. This makes the skin of patients affected by eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation. Atopic dermatitis cannot be caught from somebody else – it is not infectious.

How does AD present?

AD commonly starts in infancy but some patients may present in childhood or later.

  • In infants and babies, AD usually affects the scalp and face. In more severe cases, it can spread to the body and limbs.
  • In children and adolescents, AD commonly affects the skin folds (neck, elbows, back of the knees)
  • Other common appearances of atopic eczema include coin-sized areas of inflammation on the limbs (a discoid pattern), and numerous small bumps that coincide with the hair follicles (a follicular pattern).


  • Red, scaly rash
  • Severe itch causing sleep disturbance, irritability and tiredness
  • Blisters, small water bubbles
  • Weepy, moist skin with bleeding due to repeated scratching
  • Skin can become thicker and darker with chronic rash

What makes Atopic Dermatitis flare up?

  • Changes in climate
  • Dusty environment
  • Heat, sweat
  • Smoking
  • Strong soaps, detergents, bubble baths
  • Pets, carpets, stuff toys
  • Infections - any infections like common flu, covid-19 or skin infections can cause AD flares.
  • Insect/ mosquito bites - repeated scratching can trigger a AD flare
  • Vaccinations
  • Stress - any physical or mental stress can trigger AD.
  • Scratching - scratching itself can cause skin infections due to multiple germs in our fingernails and trigger AD.
  • The role of food allergy in triggering AD is controversial. If there is a strong suspicion then appropriate food allergy testing should be done prior to avoidance/ elimination of the food.

Treatment method for Atopic Dermatitis in Singapore

  1. Identify and reduce triggers
    -- Avoid dusty environments, stuff toys, carpets. Wash bed linens in hot water once a week
    -- Family members should avoid smoking
    -- Avoid strong soaps, chemical, bubble baths
    -- Avoid sweating where possible or take measures to cool the skin quickly. Consider stopping physical exercise during severe flares
    -- Minimise scratching, cut and file fingernails regularly
  2. Basic skin care
    -- Short baths in lukewarm water are recommended. Avoid hot showers or long baths. Pat dry, do not rub after bath.
    -- Soap substitute is recommended. Sometimes, gentle antiseptic wash maybe prescribed for patients with repeated skin infections
    -- Moisturize regularly, at least 3-4 times per day with a fragrance free moisturizer. Apply the moisturizer liberally on all skin surfaces and not just over the rash. The doctor will recommend which moisturizer is suitable for your child.
  3. Specific Treatment
    Anti-inflammatory creams
    • Anti-inflammatory creams such as steroids and calcineurin inhibitors are the main treatment of active AD.
    • The strength of the cream, frequency of use, duration of use will depend on the age of the child, location and severity of the eczema.
    • These creams should be used on red, itchy and bumpy areas (active AD). Once the rash improves, decrease the frequency of application. Stop once the redness/ itchiness resolves and skin is flat.
    • Prolonged use of potent/ super potent topical steroids can lead to side effects like skin thinning, easy bruising, stretch marks (striae) and increased hair growth. If these are present, pls stop the cream and contact your doctor.

      Oral and topical antibiotics or antivirals are used for skin infections with eczema. Oral anti-histamines are used as adjunct treatment in eczema to relieve the itch and sleep better at night.

      If the topical anti-inflammatory creams are not able to control AD effectively, it is necessary to discuss other options like immunosuppressants and biologics with your doctor. These medications are more potent and better able to control eczema but can potentially cause more side effects and are more expensive. (See Biologics in Eczema under treatment)


Depending on the scar type, extent and location, treatment options need to be tailored and discussed. Common type of scars include-


These raised scars are common and usually symptomatic (itch, pain), and can occur following skin surgery, acne, or skin injury. The scars are red inflammed and thick, and can be treated with regular intralesional steroid injections to flatten and soften the scars. Vascular lasers can be used to reduce the redness of the scar.


Treatment can be tailored to the type of acne scars and extent of scarring, Fractionated laser resurfacing is commonly used for the most common form of pitted and depressed acne scars on the face.


Early treatment of post-surgery scars is recommended using a combination of advanced scar gels and early steroid injections to prevent the formation of unsightly keloid scars.



Dr Uma Alagappan is a MOH accredited consultant dermatologist in private with more than 15 years experience as a medical doctor. She sub-specialises in paediatric dermatology, women’s dermatology and general dermatology. Dr Uma’s interests include chronic eczema, food allergy and immunodermatology. She is also well versed with the use of lasers for treating paediatric and adult patients.
Dr Uma completed her dermatology training in Changi General Hospital and National Skin Centre in 2015. She joined KKH Dermatology Service to subspecialize in paediatric dermatology in 2017. She was awarded the Ministry of Health Manpower Development Plan Award in 2019 to pursue paediatric immunodermatology and allergo-dermatology in the renowned Boston Children’s Hospital, Massachusetts, USA. Upon her return, she spearheaded a number of clinics at KKH including the food allergy eczema clinic for the paediatric eczema patients, immunodermatology clinics and the psychology eczema multi-disciplinary clinics.
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290 Orchard Road 09-01/02 Paragon Medical Centre, Singapore 238859

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