Skin Deep Series (Part 1): Dealing with Eczema
Friday, July 17th, 2020, 6:00:00 PM
Ask Dr Colin Theng about:
Some questions you can ask me are:
- Can I treat eczema without topical steroids?
- What skin diseases and infections can atopic eczema mimic?
Dr Colin Theng, with over 20 years of experience, is regularly invited to speak at various conferences such as the World Congress of Dermatology and the Asian Dermatology Congress. He was especially interested in areas such as eczema and psoriasis and has served numerous advisory boards. Dr Theng has had extensive experience in both medical dermatology and laser surgery and upon years of practising, he has garner comprehensive experience in handling both Asian and Caucasian skin types. Dr Theng is currently serving as the President of the Psoriasis Association of Singapore and is a Councillor with International Psoriasis Council. He is also serving as a Treasurer at Dermatological Society of Singapore. His teaching achievements include the Dean’s Award for Teaching Excellence.
Generally, I do not advise you to cut out the blister, but you can prick the blister. Because sometimes the blister is so tense that when you press on it, it gets very painful, so what you can consider doing is take a sterile needle and just poke it to let the fluid come out, but do not remove the whole blister. Otherwise, the skin underneath is going to be very raw and painful, so the skin can act as a protection for the raw areas underneath it but you can consider pricking to release the fluid so the blister is not so tense and painful.
Yes, definitely. Even during the SARS time, we actually saw it already and now we are seeing a lot of people getting hand eczema. Hand eczema is due to contact with soaps and irritants and even all these sanitisers. Frequent hand washing leads to eczema. it’s a very slow process. Initially when you wash nothing happens, the more you wash the barrier gets weaker and weaker because of the soap and irritants until one day your barrier just breaks down and you develop eczema.
I think it is possible. There is a type of eczema that is called oestrogen or progesterone dermatitis. So, these are eczema or dermatitis that is related to levels of hormones in the body. For some people, during the time of their menstrual cycle, they can get premenstrual exacerbation because they have this. But it is quite rare and not common. But we do know that it is a recognised entity either oestrogen or progesterone dermatitis and that may be reasons why those eczemas can flare during the menstrual cycle.
The injection in dupixent is usually given as 2 weekly injections. So, it is given as a subcutaneous injection, at the start usually, there is a loading dose of two injections and subsequent every 2 weeks it's given. In terms of the clinical trials, we do see a group of patients maybe 30-40% who are very fast respondents. The moment you inject, in 1-2 weeks the itch is completely gone and within a month you see the skin settling very well. Usually, by 3 months we know whether or not the drug is working well for you and if your skin has done well, we will know you are a good respondent.
When we talk about contact dermatitis, there are two types of contact dermatitis. One is an irritant contact dermatitis, the other is allergic contact dermatitis. Irritant contact dermatitis happens when you come into contact with something irritating. For example, if all of us touch some dilute acid, it is going to irritate our skin, so that is a contact allergy because we come into contact with the acid which irritates our skin. Then we have allergic contact dermatitis, where the substance you apply on the skin sensitises the skin and causes you to mount an immune response.
Sometimes you can get a form of eczema on the hand. When you have these blisters or rashes on the hands, there is a type of eczema called dyshidrotic eczema, which affects the hands and feet, presenting with bubbles on the hands. Sometimes it can be mild, so a few tiny bubbles. In some cases I’ve seen, the bubbles merge and become this very big blister and they can be very uncomfortable and painful for the individual. So, I believe it has to do with the severity and you can consult a doctor who can prescribe topical medications to try and control them.
I think that topical steroid withdrawal is something to empathise about, because that is probably a thing that makes people more fearful, thinking that I am going to be applying something that I am going to be addicted to and never get off.
If the patient has mild eczema, the most important thing I would tell patients is to use gentle cleansers and moisturizers. I think that is very simple and safe. The other important thing is to avoid scratching, I know it sounds like a very simple thing to say, but it is extremely important, because the more you scratch the worse it gets, and it is called the “itch-scratch cycle”. The more you scratch, the itchier the skin gets and the more you scratch, and if you can stop scratching, a lot of cases it will get better without any topical steroids. So, that is something important.
Eczema can come back when you stop it. We define rebound as being worse than the original condition. I do see the rashes coming back when they discontinue for some patients, but I don’t often see a rebound for Protopic. But for some people, they may feel a burning sensation as a side effect and that is expected for the Protopic. Occasionally I do see some people whose faces get a little bit red and they can't tolerate it and usually, I won’t continue them on the medication, but most people who get the burning for a few days and then they get used to it and tolerate it.
There have been various studies going on to see whether eczema can be prevented right from childhood. There have been initial studies that suggest that using gentle cleansers and moisturisers when young, even before the onset of eczema, can help to improve eczema by maintaining and improving the skin barrier. So, there are some studies that show initial data that seems to suggest that can prevent the onset of eczema. Some studies have also shown that breastfeeding can help to prevent the development of eczema in people more prone to developing eczema.