It’s hotter than ever in sunny Singapore, South and Southeast Asia going through a record-smashing heatwave. For some of us, hotter days just mean more trips to the beach or swimming pool. But for one in ten Singaporeans with the skin condition eczema, hotter weather can cause more skin itching, more inflammation and even bleeding skin.
Sun exposure and humidity are top triggers for eczema problems in Singapore because the hot weather causes more sweating and prickly heat. In turn, these can lead to uncontrolled scratching and skin damage.
Eczema, or atopic dermatitis, is a chronic skin inflammation that’s caused by a combination of factors, including genetics, a defective skin barrier, the immune system, and environmental factors – such as heat, pollution or stress.
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Atopic dermatitis can occur at any age, but it often appears in early childhood. In Singapore, about one in five children and one in 10 adults suffer from eczema or atopic dermatitis, the most common form of eczema. It can be passed from parent to child, so a child is more likely to develop the condition if one or both parents have it, or if a family member has either allergic rhinitis or asthma.
Eczema is classed as mild, moderate or severe depending on how much of the skin is affected, and how red, thick and itchy the skin becomes.
Dermatologist Dr Lynn Teo explains, “Patients with moderate to severe forms can experience severe itching, pain, bleeding, and weeping of the lesions. This can affect their sleep and their ability to participate in work and leisure activities and lead to anxiety and depression.”
The good news is that some 80 per cent of children with atopic dermatitis grow out of it by eight years old – it’s because the skin’s barrier function naturally improves with time. But kids with severe symptoms may not be so lucky. They may face a lifetime of very sensitive skin.
It really helps to identify and avoid potential triggers, and manage symptoms. But how? Let’s speak to Dr Lynn Teo, Consultant Dermatologist, The Dermatology Practice. Since we live in Singapore, let’s also get input from physicians at Oriental Remedies Group, which uses Traditional Chinese Medicine (TCM) methods.
All races can suffer from eczema, but it’s more common in Asians than Caucasians. One study in 2003 investigated school children from 36 schools in Singapore. Atopic dermatitis was more common among the Chinese children (21.6 per cent) and Malays (19.8 per cent) compared to Indians (16 per cent) and others (14 per cent). Most of the children had mild to moderate forms of the disease, rather than moderate to severe.
When it comes to what causes eczema, the TCM point of view is quite complementary to the Western view. TCM physicians hold that eczema is caused by weak Lung Qi and external pathogens that cause Heat Dampness. The Lung Qi functions similarly to our immune system, so weak Lung Qi makes us more sensitive to allergens like dust and pollen.
TCM holds that Heat Dampness is caused by overconsumption of greasy or spicy foods, excessive drinking, and living in hot and humid climates – like Singapore.
“High temperatures cause blood vessels to dilate, triggering inflammation of the skin and itching,’ explains Dr Teo. “Heat also makes us sweat, which leaves a residue on the skin, which increases fluid loss and dries out the skin. The sodium in sweat can also sting, and make skin itchy.”
To make matters worse, people with atopic dermatitis have special sweat. “Atopic dermatitis patients produce sweat with reduced natural moisturising factors, which can dry the skin. Their sweat also contains less antimicrobial peptides and antibodies which can increase the skin’s susceptibility to infections.”
Other triggers include detergents, stress, sweat, allergens such as dust or pollutants and clothing that is rough or made from synthetic materials. Smoking and a diet high in fat and sugar, and having hypertension or diabetes can also increase the risk of developing moderate to severe atopic dermatitis.
According to the TCM physician, “Hot and humid weather causes accumulation of heat dampness in the body, which naturally worsens eczema. In addition, patients suffering from eczema have weakened skin barriers, which makes them more sensitive to skin damage from UV rays. Hot and humid weather can also cause more sweating, which increases skin irritation and inflammation.”
Dr Teo starts with common-sense advice. “Reduce or avoid sweating by staying indoors and out of the sun. If you do not use air-conditioning, turn on your fan to help circulate the air around the skin. It’s best to wear soft and breathable clothing in natural fibers, to help keep the skin cool.”
The TCM physicians have some advice about using a fan to stay cool.”It is not advisable to have the fan blowing directly at you, because it can potentially worsen eczema. Instead, put the fan on oscillating mode and wear thin, long-sleeved clothing to avoid direct wind contact.
“Patients should also try to drink more water which can help with reducing body temperature and expelling toxins, and avoid spicy or oily foods to reduce heat dampness in the body.”
It sounds strange, but water can actually dry out your skin by removing the top layer of natural body oils.
“Long hot showers are the worst for eczema-prone skin, as the hot water increases dryness and itching, “ explains Dr Teo. Instead, she recommends short daily showers using cool or tepid water and an emollient shower gel.
“Use non-irritating cleansers and shampoos, apply topical corticosteroid creams immediately after showering to lock in moisture then gently pat your skin dry – do not rub or scrub the skin.” And always moisturise, moisturise, moisturise.
TCM experts are also against hot showers. “Cold water may provide temporary relief but they weaken lung qi and immunity, which is the root cause of eczema. For eczema patients, lukewarm showers help to minimize skin irritation and discomfort.”
Look for non-soap cleansers with low or neutral pH that are labeled hypoallergenic and fragrance-free. Examples of non-soap cleansers are glycerin, lauryl glucoside, and tocopherol-based gels.
Look for fragrance-free shampoos with a short list of ingredients. “Avoid shampoos that contain sodium lauryl sulfate, a detergent that’s known to irritate the skin. Or look for medical-grade shampoos.”
Before you try a new product, you’re wise to do a “patch test” on your skin – place a small amount of product on the skin for about 48 to 72 hours, then check for any itch or reaction
Don’t make the mistake of assuming that an organic product is always your best choice. “Certain ingredients which are in ‘natural’ or ‘organic’ products can cause allergies or cause irritation,” explains Dr Teo.
TCM physicians at Oriental Remedies Group say their patients are “Keen to try TCM as it is a sustainable method to manage their eczema without steroids. In most eczema cases, we do not advocate using western medicine and TCM treatments at the same time. But patients who suffer from other complications arising from eczema –- for example a fungal infection or a bacterial infection due to scratching – may need to take western medication at the same time.”
Dr Lynn Teo gives her advice for adults and children; “Short-term topical creams are sufficient for mild eczema. For moderate to severe eczema, the key is preventing flareups and allowing the skin to heal. This is where a systemic treatment is often used for a minimum of six months to a year.”
In the past steroid creams were the only option for eczema, but nowadays patients can use non-steroid creams that help the immune system in the skin work better by ‘ turning down” some proteins and “turning up” other ones.
Dr Teo is excited about a new kind of oral medication called Janus kinase inhibitors or (JAK) inhibitors. “They impede specific immune enzymes that promote inflammation. The medications in this class show encouraging results in human trials, providing rapid relief for redness and itching, so patients experience less discomfort, pain, and distress.”
In one study involving patients aged 18 to 75 years, 43.8 per cent of patients achieved clear or almost clear skin when treated with a JAK inhibitor drug. Over 60 per cent of the patients said their skin was much less itchy.
Above all, she stresses the importance of seeing a doctor, instead of trying to muddle through by yourself. “Eczema or atopic dermatitis can look different in different individuals. And it’s possible to confuse eczema with other skin conditions such as psoriasis or contact dermatitis (shown above). This is why it is important to consult with a skin specialist for an accurate diagnosis.”
From a TCM point of view, holistic is the way to treat eczema. “Most TCM herbs are prescribed as powders which can be dissolved in hot water. Herbal soaks and itch relief creams are also effective in alleviating eczema symptoms. These soaks and creams usually contain dampness-expelling herbs.
“We also believe in also improving the patient’s gut health, because the gut is closely linked to the immune system and skin and an imbalance in the gut microbiome will affect the skin. So we may give them diet recommendations and synbiotic supplements to restore gut health.”
This article was originally published on July 4, 2022, and updated on 23 April, 2023.
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