Get expert tips from Associate Professor Giam Yoke Chin on coping with eczema at home
Understanding the environment first
The Asian Parent: Should eczema- children with moderately eczema spend less time outdoors when the weather is hot?
Associate Professor Giam Yoke Chin: Yes, especially in Singapore where humidity level ranges from 60 to 80% tends to aggravate eczema making children uncomfortable to be outdoors.
TAP: Will perspiration make eczema conditions worse?
AP Giam: Yes, sweating is a common aggravating factor in atopic eczema conditions. The flexures are often irritated by sweat and itch.
Hygiene and skincare selection
TAP: Should children with eczema shower more often?
AP Giam: It is recommended that bathing or showering be limited to twice a day. It also depends on the soap that is used for showering. Soaps with high pH can trigger proteases, an enzyme that breaks down the skin and cause eczema. Excess showering with hot water is not recommended.
TAP: What makes an ideal cleanser for children with eczema?
AP Giam: An ideal cleanser, is one that does not contain high levels of detergent (like lauryl sulphate), does not contain high amounts of antiseptics (like chlorhexidine, iodine) and include moisturising agents like glycerin.
Wearing the right clothes
TAP: Are there recommended types of fabrics that should be worn by children with eczema? Will wearing the correct fabric reduce future flare-ups?
AP Giam: Most of the time, it is preferred that thin cool cotton fabric clothes be worn by children with eczema. Some of the other fabrics to avoid are wool and nylon. Try not to layer too many pieces of clothing. In hot weather, for a child with bad eczema, often cotton singlet and bottoms are adequate.
TAP: Is it true or a folk-lore that “dirtiness” in children is the cause of the eczema?
AP Giam: “Dirtiness” needs to be defined— is it from dust (house dust mite) or bacteria? In those children, from the age of three, both bacteria, especially the Staphylococcus, and the house dust mites can irritate and sensitise the skin and cause inflammation that can lead to eczema. On the other hand, there is a theory, called the “hygiene theory”, which says that children, living in rural areas and exposed to dirtiness suffer less from eczema. Those residing in urban areas, kept away from dirt, have a higher tendency to develop eczema. This theory is not proven.
Repair the barrier, stop the dryness and itch
TAP: How can we go about keeping skin moisturised while repairing a damaged skin barrier?
AP Giam: We hope to tackle two things when it comes to eczema. The immediate tactic is to treat the inflammation. The second and more crucial method in preventing eczema is to repair the damaged skin by producing a well-hydrated intact skin barrier. This action prevents relapses of eczema and if this is kept up, children who reach a certain age have been found to grow out of the condition.
TAP: What makes an ideal moisturizer for children with eczema?
AP Giam: An ideal moisturiser is one that contains the active ingredients to repair the skin. Some of these ingredients attract water, which is retained in the cell to hydrate the cell. We also need to look out for ingredients that form a cementing function to keep the skin cells attached to each other. Some examples are glycerin, natural moisturising factor, lipids and ceramides. There are many new agents added in moisturisers that help to treat the inflammation and itch of eczema. One example of such an agent is N-Palmitoylethanolamide (PEA), an antioxidant proven to relieve itch and redness.
TAP: Is it true that eczema, or dry, itchy skin is often due to a damaged skin barrier. Why is it so?
AP Giam: Researchers have discovered that filaggrin is an important gene and if defective, the skin won’t be able to produce barrier cells to protect itself, resulting in skin with cracks that allow moisture to escape, and hence dry skin. Dry and damaged skin not only causes itch but it can allow infective agents and allergens to enter the skin and cause eczema. As such, when applying moisturiser, it has to be done regularly in order to repair the skin barrier, and it has to be applied even to normal areas of the body, as the gene defect can be found in these areas too. A good moisturiser should contain lipids that have similar structures to lipids in the skin—they help to repair dry and damaged skin and give long lasting benefits.
AP Giam Yoke Chin is an Associate Professor and clinical teacher at the National University of Singapore (NUS). She is a senior consultant, specialising in paediatric dermatology, at National Skin Care Centre and a visiting consultant to the paediatric clinic at National University Health Services, Children Medical Institute. In 2009, AP Giam was awarded the National Day Award for Medical Administration. AP Giam received her education in the United Kingdom and America.
This series has been brought to you by Physiogel® and theAsianparent.
*The comments given by the doctor is for educational purposes and not a product recommendation. Readers should consult their doctor if they have further enquiries.
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[SG/PSG/0005k/13 CERTIFIED 08/04/13]
