What is Eczema in adults?
Eczema is a skin condition that causes the skin to become inflamed, itchy and red. There are several types of eczema, but the one that people most commonly refer to is atopic dermatitis. “Derm” refers to skin, while “itis” refers to inflammation. Essentially, dermatitis is an inflammation of the skin. Meanwhile, “atopic” refers to an allergy. The inflammatory response is caused by an irritant or an allergen from outside or inside the body, causing the symptoms of eczema.
Eczema is common in babies and children, but can happen to adults too. When atopic dermatitis happens after the age of 18 and you have never had it before, it is called adult-onset atopic dermatitis. In some cases, it is possible for atopic dermatitis to go away in children and then return again in adulthood as a milder version years later. It is also possible for atopic dermatitis to last from childhood all the way into adulthood.
What are the types of Eczema in adults and the common causes in Singapore?
There are different types of eczema, each with their own set of symptoms and root causes. They include:
This is the most common form of eczema that tends to start in childhood but can happen in adults too. It usually gets milder over time. Many people with atopic dermatitis also have asthma and hay fever. These three conditions are referred to medically as the “atopic triad”.
- Rashes in the creases of the elbows or knees
- Skin becoming lighter, darker or thicker in areas where the rash appears
- Small bumps that leak fluid when scratched
- Babies tend to have rashes on the scalp and cheeks
- Infection from scratching
Atopic dermatitis is due to a weakened skin barrier, which means the ability of the skin to protect you from irritants and allergens in the environment is reduced. Atopic dermatitis may be caused by a combination of the following factors:
- Dry skin
- Problems with the immune system
- Environmental triggers
As the name suggests, this type of dermatitis is due to contact with irritants or allergens. There are two types: allergic contact dermatitis with an allergic reaction by the immune system, or irritant contact dermatitis with irritated and damaged skin cells but no allergic reaction.
- Itchiness, redness and stinging
- Itchy bumps or hives
- Fluid-filled blisters that can ooze or become crusty
- Thickened and scaly skin
Contact dermatitis happens when you come into contact with something that irritates your skin or causes allergic reactions. The common triggers are:
- Irritant Contact Dermatitis - Detergents, bleach, poison ivy, tobacco smoke
- Allergic contact dermatitis - nickel, latex, fragrances, makeup
Hand and Feet Eczema Dyshidrotic Eczema
This type of eczema causes small blisters on the hands and feet, and is more common in women than in men.
- Fluid-filled blisters on the fingers, toes, palms, and soles of the feet
- Itchiness or pain from the blisters
- Scaling, cracking and flaking of the skin
- Damp hands and feet
- Exposure to substances like nickel, cobalt or chromium salt
This is a type of eczema that only affects your hands. It is common in people who work jobs where their hands frequently come into contact with irritants, such as hairdressing.
- Hands become red, itchy and dry
- Hands have cracks and blisters
Hand eczema is caused by frequent or long-term exposure to chemicals that can be irritating to your skin, which happens for those who work in these jobs:
- Laundry or dry cleaning
This is similar to atopic dermatitis.
- Thick scaly patches on
- Back of neck
- Soles of the feet
- Backs of hands
- Itchiness of the patches, especially when sleeping or relaxing
- Bleeding and infection of the patches when scratched
It usually happens in people who already have other types of eczema or psoriasis. The exact cause of neurodermatitis is unknown, but stress is thought to play a role.
“Nummular” refers to “coin” in Latin. Nummular eczema is characterised by round, coin-shaped spots that form on the skin.
- Round, coin-shaped spots
- Itchiness or scaling of the round spots
- Insect bite
- Allergic reaction to metals or chemicals
- Dry skin
- If you have other forms of eczema such as atopic dermatitis
This happens when fluid leaks from weakened veins into your skin, causing swelling, redness, itching and pain.
- Swelling of the lower legs
- Aching or heaviness of the legs
- Varicose veins – swollen, enlarged veins caused by faulty valves
- Dryness and itchiness of the skin above the varicose veins
- Open sores on lower legs and on the tops of your feet
Stasis dermatitis occurs in those who have blood flow problems. The valves in the veins help blood from the legs to return back to the heart. When they malfunction, blood pools in the legs and swelling occurs, leading to varicose veins.
What are the common symptoms of Eczema in Singapore?
Eczema presents itself differently for different people, so don’t be surprised if someone else’s symptoms aren’t the same as yours. Different types of eczema may also appear on different areas of the body at different times.
There may also be a range in the severity of the symptoms. Many people who have eczema experience itchiness that can range from mild to moderate or severe. It may be so unbearable that some people scratch to the point of bleeding, causing more inflammation and more rashes. This is known as the itch-scratch cycle that many with eczema experience.
Some of the common symptoms for eczema include:
- Dry, scaly skin
- Oozing and crusting
- Bumps on the skin
What are the usual risk factors or triggers for Eczema in Singapore?
There are some factors that make you more prone to eczema, such as:
- Having a family member with asthma, allergic rhinitis or eczema.
- Having a personal history of asthma or allergic rhinitis.
- Having very dry skin (icthyosis vulgaris)
- Living in a place with cold climate or very hot weather.
- Exposure to secondhand smoke, carpets/ soft toys, chemicals like laundry and dish soap, bubble bath
- Common infections like flu, skin infections and vaccinations can trigger eczema flares
- Emotional, work stress and bereavement
What are the treatment options for Eczema in Singapore?
There is no cure for eczema, but the symptoms can be managed with lifestyle habits, such as:
- Knowing your triggers and avoiding them
- Taking short baths with lukewarm water
- Using gentle cleansers and moisturizing regularly
- Watching out for signs of skin infection
- Dressing in soft and comfortable clothes
- Treating eczema early as the more severe it is, the more difficult it is to control
There are two broad categories of treatment for eczema:
- Moisturisers – for dryness and itching
- Anti-inflammatories – to reduce swelling, itching and redness
Both are available as creams and ointments that can be directly applied to the skin. There are also oral forms of anti-inflammatories.
Common treatments for atopic dermatitis include:
- Medications - These may be oral or topical, prescribed by doctors or obtained over-the-counter (OTC)
- Corticosteroid Creams: For itching and inflammation. Overuse or misuse of topical steroids can cause alot of damage to the skin. Thus, it must be used under the recommendation of a dermatologist.
- Corticosteroid Tablets: For short-term relief of itching and inflammation
- Topical Calcineurin Inhibitors: For suppression of inflammation
- Antihistamines: For severe itching
- Wet-Wrap Therapy - In this therapy, eczema symptoms are improved through increasing the moisture of your skin. After bathing and moisturising, wet strips of fabric or gauze are wrapped around the eczema-affected areas. This helps to keep the skin hydrated and improves the absorption of medicated creams and moisturisers. You may also wish to place a dry layer over the wet layer to prevent drying. The wrap may be left on for several hours or overnight. However, wet-wraps should not be used over corticosteroid creams unless the doctor advises it.
- Phototherapy - This is a form of ultraviolet (UV) light therapy. A doctor or dermatologist shines a UVB light on either the whole body or the affected areas of the body. This light will reduce itchiness and inflammation. It may also fight bacteria to prevent infection. However, it can cause redness, itchiness and flare of eczema especially in the initial stages. Hence, it should be used very cautiously.
- Immunosuppresants - Eczema is partly due to an overactive immune system. Thus, use of immunosuppressant does help to reduce the symptoms of eczema. However, immunosuppressants have side effects and it is important to monitor blood tests and be under close follow-up with a dermatologist.
- Biologics - Treatment of moderate-to-severe forms of AD is challenging, as topical corticosteroids are often insufficient to achieve disease control or inappropriate, and off-label use of immunosuppressants have significant side effects. Biologics are injections or tablets that target certain molecules in the immune system and thus help to reduce the inflammation in eczema.
Control of eczema is better and side effects is less compared to phototherapy and immunosuppressants. However, the cost of biologics is high and has to be discussed with patients.