Beat the itch: How advanced therapies are transforming eczema treatment
New approaches aim to provide longer-lasting relief and improve quality of life, says a dermatologist.
Persistent itching is a common and challenging symptom of eczema. Photos: Shutterstock
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As a student, Mr David Low* made every effort to take part in physical education lessons, but eczema flare-ups often kept him on the sidelines.
“I had to steer clear of ball sports when flare-ups on my palms and feet became too painful,” he recounted. Diagnosed in lower primary with eczema on his neck and behind his elbows and knees, the condition gradually spread to his extremities by the time he was in National Service (NS).
Also known as atopic dermatitis, eczema is an inflammatory skin condition that, in mild forms, presents as persistent itching or skin dryness, said Dr Mok Zhun Rui, a consultant dermatologist at The Dermatology Practice.
“More commonly, it is characterised by scaly patches and rashes,” he added. “When eczema is sub-optimally managed, skin infections may result.”
TRIGGERING THE ITCH
Dr Mok explained that patients with eczema usually have a family history of atopy – a predisposition to allergy-related conditions like asthma and allergic rhinitis1. Environmental factors such as allergens like pollen or dust mites, skin irritants from heavily perfumed soaps and detergents, and extreme climates or temperature fluctuations can also trigger eczema.
During his NS days, exposure to dust, heat and excessive perspiration aggravated Mr Low’s eczema, causing it to spread across at least 60 per cent of his body, including his face.
“I carried moisturiser wherever I went because of the unbearable dryness and itch,” he said. “I dreaded leaving the house as I had to apply thick layers of moisturiser that left me feeling uncomfortable.”
Later on, as an IT engineer in the finance industry, Mr Low found it challenging to concentrate at work whenever his eczema flared up. To manage his triggers, he limited strenuous activities, avoided extended sun exposure and refrained from alcohol as well as oily and spicy foods – sacrifices that made socialising with friends difficult. His nights were often restless due to the constant itching; the lack of sleep left him more susceptible to stress, which in turn led to more frequent flare-ups.
In individuals with eczema, the topmost layer of the skin barrier is compromised, making it less effective at keeping out harmful bacteria and substances. Dr Mok added that patients experience increased transepidermal water loss (water evaporation through the skin), leading to further dryness2 and flakiness. “This results in greater skin barrier dysfunction, increasing the risk of developing localised or systemic infections originating from the skin,” he said.
LONG-TERM ECZEMA CARE
Since eczema can range from mild to severe, Dr Mok advises patients to assess the extent and severity of their skin rashes before deciding whether to seek medical intervention. For dry, itchy skin that is non-inflamed and affects only small areas, over-the-counter moisturisers should suffice, he noted.
“If large areas of skin are affected or become acutely inflamed with symptoms such as oozing or crusting, you should seek medical attention. Furthermore, systemic symptoms like fever, chills and malaise are red flags that warrant urgent consultation,” said Dr Mok.
He explained that eczema treatment varies depending on factors such as the patient’s age, lifestyle, existing co-morbidities, current medications as well as the side effect profile of each medication.
Mr Low has undergone various treatments for his eczema, including topical and oral steroids. He was later prescribed immunosuppressants and then monoclonal antibody drugs (targeted therapies that block specific proteins in the immune system) before eventually transitioning to a Janus kinase (JAK) inhibitor, which he continues to take today. A JAK inhibitor is an oral tablet used to treat moderate-to-severe atopic dermatitis.
“It took about four to six weeks to see a noticeable improvement. I still need to moisturise twice daily, but my flare-ups, now reduced to once every two weeks, are less severe,” shared Mr Low.
According to Dr Mok, everyone responds differently to medication, so patients should discuss their treatment with their healthcare providers.
BREAKING THROUGH THE ECZEMA BARRIER
Beyond medication, managing eczema involves identifying and avoiding triggers, along with making lifestyle changes, such as avoiding hot showers and staying in a comfortably cool environment whenever possible.
“To reduce stress, patients are encouraged to engage in mindfulness activities,” said Dr Mok. “They should also pay attention to the itch-scratch cycle and the subconscious habit of scratching, as this can further damage the skin barrier.”
Mr Low remains diligent in his moisturising routine and maintains lifestyle habits aimed at preventing eczema flare-ups. “I feel that my eczema is much more manageable now,” he shared. “I can play sports, spend more time in the sun, travel, and most importantly, enjoy uninterrupted sleep.”
Assess your skin condition using the Dermatology Life Quality Index Assessment Tool and learn more about living with eczema.
*Names have been changed for privacy reasons.
This article is sponsored by Pfizer Singapore. The opinions expressed in this article are solely those of the expert(s), speaker(s) or participant(s) featured herein. This material is intended for educational and/or disease awareness purposes only and should not be used as a substitute for consulting a healthcare professional. For more information, speak to a healthcare professional. References are available upon request.
1Alford SH, Zoratti E, Peterson EL, et al. Parental history of atopic disease: disease pattern and risk of pediatric atopy in offspring. J Allergy Clin Immunol. 2004;114(5):1046-1050. doi:10.1016/j.jaci.2004.08.036.
2Umehara Y, Kiatsurayanon C, Trujillo-Paez JV, et al. Intractable Itch in Atopic Dermatitis: Causes and Treatments. Biomedicines. 2021;9(3):229. doi:10.3390/biomedicines9030229.
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