In Singapore alone, about 21 per cent of children live with eczema. Atopic dermatitis in particular, is the most common form of the condition in kids. As it is the most common skin disorder in our country, it has also affected the lives of many young patients, parents and caregivers.
In fact, recent studies have found that at least one in every 10 adults and two in every 10 children in Singapore suffer from atopic dermatitis. The National Skin Centre even reports around 15,000 cases annually. Meanwhile, the paediatric dermatology service at KK Women's and Children's Hospital (KKH) sees at least 10 to 20 new AD cases a day.
With World Atopic Dermatitis Day taking place this week, theAsianparent reached out to Dr Mark Koh from KKH to talk us through atopic dermatitis in kids. The associate professor also shared advice on how parents can help their children suffering from such conditions.
What Is Atopic Dermatitis?
As per Dr Koh, atopic dermatitis is a chronic, recurrent inflammatory skin disease caused by a defective skin barrier as well as an overactive immune system.
"Atopic dermatitis’ systemic nature means that it seriously impacts patients’ lives beyond their skin. It almost always restricts life, impacts mental health and leads to the development of other diseases," he tells theAsianparent.
Dr Koh adds, "What we need to remember is that AD is not just a skin disease. It often leads to anxiety, depression and the development of other chronic conditions."
For individuals living with atopic dermatitis, it is important to be reminded of the following:
- An accurate diagnosis is essential.
- Do not give up. When atopic dermatitis patients receive timely and appropriate care, quality of life can be improved.
Atopic Dermatitis In Kids: Symptoms You Should Know
According to Dr Koh, the symptoms can appear on the skin as the following:
- Itchy
- Red
- Scaly rash
"Children may often become irritable and uncomfortable because of their AD and have trouble sleeping, especially if the rash spreads," adds the associate professor.
Meanwhile, moderate to severe atopic dermatitis usually have the following symptoms:
- Thick rashes often covering a large extent of the skin
- Intense, persistent itching
- Skin dryness, cracking, redness, crusting and oozing
There are also some cases wherein children may develop:
- Fever from secondary skin infection
- Itchy skin that can be painful or become oozy and wet due to chronic scratching
According to Dr Koh, the presentation of atopic dermatitis varies between infants, children, adolescents and adults.
- Infants: atopic dermatitis affects the scalp and face
- Children and adolescents: atopic dermatitis in kids often affects the flexural areas
- Adults: the condition could affect the face, hands and feet
"If you have had AD for years, patches of your skin may be thick, leathery, and darker (or lighter) than the surrounding skin. Years of scratching causes this. The thickened skin can itch all the time," says Dr Koh.
He adds, "Adults and children with AD have an increased risk of developing coexisting type 2 inflammatory diseases, including asthma and hay fever."
While there is no specific test for the diagnosis of atopic dermatitis, most specialists would examine the skin and ask questions about symptoms as well as the child's past health. They will also be asked about other family members who might have the condition.
How Atopic Dermatitis In Kids Affects Their Lives And That Of Their Parents
Dr Koh tells us the impact of atopic dermatitis in kids and parents is "multidimensional and can be enormous, regardless of the severity of physical symptoms."
To elaborate more on how this skin disorder affects the lives of patients and their families, Dr Koh breaks it down to physical, psychosocial as well as how it impacts caregivers.
Physical
"The impact on patients begins with the physical discomfort and limitations. The most common complaint is itch, which is more pronounced in the night, leading to constant scratching, tearing of the skin and sleeplessness," explains the doctor.
He makes sure to add, "There are cases where atopic dermatitis leads to severe disabilities, where patients experience shivering and oozing sores. They need to be hospitalised and treated with intravenous therapy because of serious infection."
Psychosocial
"In paediatric groups, parental anxiety and concerns are significant and acting quick is essential. As eczema is associated with allergies, some parents may restrict their child’s diet excessively, with detrimental impact on their physical and emotional wellbeing. Some become depressed, on top of being malnourished," says Dr Koh.
He adds that almost all children with atopic dermatitis are affected by nighttime itch, which can often result in sleepless nights. Because of this, the way they function at school is compromised and causes the child large amounts of stress.
Atopic dermatitis has a very severe impact on the psyche, mainly on adolescents and youths (e.g. teenage girls with visible eczema on their face).
Dr Koh tells us, "Some patients with atopic dermatitis choose not to go out, thereby affecting their social life. While very young children are not bothered by their looks, the older ones and adult patients are, as atopic dermatitis is a highly visible condition.
"It affects their self-esteem and self-worth. In extreme cases, they may become suicidal," he adds.
It is also noted how children with eczema may get laughed at, bullied and isolated at school since their peers "do not understand that their condition is not contagious." Atopic dermatitis in kids can also strain family relationships as they struggle to deal with the condition.
Impact on Caregivers
"The burden of atopic dermatitis on caregivers is enormous," says Dr Koh. This is because managing and caring for the atopic dermatitis patient requires a lot of time.
There are even some parents who are greatly affected and blame themselves for the condition. But what they don't understand is that stress can be a trigger for atopic dermatitis and this would only lead to loading more stress on themselves and the child.
Treatment For Atopic Dermatitis In Kids
According to Dr Koh, the treatment for atopic dermatitis in both adults and kids are generally similar. But can be personalised by the specialists depending on the severity of the condition.
Moisturisers And Medicated Topicals
The treatment of atopic dermatitis will need lifestyle modifications for the patients. It will also require the use of moisturisers and medicated topicals. This includes topical steroids and topical calcineurin inhibitors.
Long-term Disease Management
"Without an appropriate long-term option for AD symptoms, many patients continue dealing with uncontrolled symptoms, which can cause pain and misery across certain facets of a patient’s life," Dr Koh tells theAsianparent.
He also says, "At the end of the day, adopting a comprehensive, holistic approach to disease management can help address the multifaceted impact of AD on children."
Biologics Treatment
Biologics is a new-age treatment available in both public and private clinics in Singapore. It is also a great alternative for treating atopic dermatitis in kids as it has been proven to improve the quality of life of moderate to severe young patients.
Tips On How Parents Can Take Care Of Their Children With Atopic Dermatitis
When asked about how parents and caregivers can better take care of children with atopic dermatitis, Dr Koh recommended the following treatment:
1. Frequent, daily application of moisturisers
The use of topical steroids or topical calcineurin inhibitors should be applied once signs of atopic dermatitis appear. Signs to look out for are the following:
- Redness
- Bumpiness
- Itch
Dr Koh recommends application should continue until the skin is flat as well as no longer red and itchy. Stopping the application too early will only lead to easy flaring of the disease once exposed to triggers.
As some patients and caregivers wait to apply creams even when the condition is present, Dr Koh advises they should be applied as soon as the first signs appear.
2. Be positive and supportive
"Caregivers should remain positive and supportive of the patient despite how challenging it may be," he says.
3. Seek help from a specialist if needed
If parents and caregivers think their children are suffering from more severe atopic dermatitis, it is important that they seek help from a specialist as soon as possible.
Instead of self-medicating or using methods such as extreme dietary restrictions, it is better to so seek specialist help for your child.
While many people do want to find a cure for atopic dermatitis, Dr Koh adds how there is, unfortunately, no cure for the condition. This is because it is a genetically determined condition.
"However, with good treatment, the condition can be controlled, and the patient can lead a normal life," he tells us.
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