Living with eczema

SINGAPORE — For more than 30 years, living with severe eczema made life “a living hell” for 34-year-old civil servant Justin Lee.

The chronic inflammatory skin disease leaves Mr Lee’s skin red, inflamed and itchy. On bad days, his skin may even crack and bleed.

“Imagine being constantly itchy and in pain. The intense itch affects my sleep, too. I used to get by on just two to three hours of sleep, which reduced my ability to concentrate in school and at work,” said Mr Lee, who also has to deal with constant stares from people who think that his skin condition is contagious.

About one in 10 adults in Singapore suffers from atopic eczema, said Associate Professor Mark Tang, senior consultant and director of research at the National Skin Centre (NSC).

Eczema is the top skin condition seen at NSC, which attends to 15,000 of such cases every year.

Skin experts TODAY spoke to said the number of people getting this skin condition has increased over the years. One of the main culprits is urbanisation, said Assoc Prof Tang, who is also the head of the Eczema Clinic at NSC.

Environmental changes such as pollution, stress, smoking and poor diet might have contributed to the increase, said dermatologist Dr Eileen Tan, who has a practice at Mount Elizabeth Hospital and Mount Elizabeth Novena Hospital.

CONTROLLING ECZEMA

There is currently no cure for eczema. The aim is for disease control, said Assoc Prof Tang.

“Severe eczema is challenging to treat, but the good news is that with proper care and education, most patients can control their condition. It is important to work with your doctor to optimise the control and outcome,” said Assoc Prof Tang.

Most treatment routines involve the regular use of emollients or moisturisers. They play an important role in repairing the skin barrier in a person with eczema, said Assoc Prof Tang.

Also important is avoiding eczema triggers, added Dr Tan. They may include changes in temperature, chemical irritants (such as pesticides, perfumes and harsh soaps), allergens (house dust mites and animal dander) and stress.

In addition, medications help patients cope with symptoms that can cause considerable distress to the patient, said Dr Tan. She said that studies in Asia, North America and Europe have linked a lower quality of life, depression, anxiety and stress to eczema.

To keep from scratching himself excessively, Mr Lee applies topical medication and moisturisers on his skin several times each day, even during work breaks.

Even so, whenever his condition flares every other month — triggered by factors such as hot weather, dust or stress — he cannot help but scratch at the extremely itchy rashes until they bleed.

“Unfortunately, the scratching only leads to a vicious cycle of more inflammation and itchiness,” he said.

When that happens, Mr Lee would visit a skin specialist who might prescribe steroid creams and pills. To control bad flare-ups, injections would be required. He spends an average of S$200 to S$300 per visit, depending on the medications prescribed.

However, while Mr Lee gets temporary relief from the medications, they do not prevent symptoms from recurring.

Over the years, he has also spent a few thousand dollars on alternative remedies such as acupuncture and traditional Chinese medicine, but those do not work on him.

CURRENT AND

NEW TREATMENTS

According to Assoc Prof Tang, the skin disease is caused by a combination of factors: A defective skin barrier and an overactive skin immune system.

“Hence, for patients with severe eczema, anti-inflammatory medications such as steroid and steroid-free (calcineurin inhibitor) creams are used to dampen the immune activation,” said Assoc Prof Tang.

When applied on affected skin, calcineurin inhibitors work by blocking cells in the immune system that can cause inflammation.

However, these treatments may not be sufficient for some patients. In such instances, the doctor might offer options, including ultra-violet light phototherapy, said Assoc Prof Tang.

Occasionally, patients may also require antibiotics to treat skin infections, which are common in eczema patients with cracked skin or wounds.

New smart drugs called biologics could soon offer hope for patients such as Mr Lee, who struggle to control their severe symptoms.

The NSC is currently part of a global multi-centre Phase 3 study to evaluate the use of an experimental biologic drug for moderate to severe eczema.

“These are smart drugs that target specific pathways or molecules that cause the disease, somewhat like hitting hard where it matters most,” said Assoc Prof Tang.

Biologics have been used to treat psoriasis, another inflammatory skin disease, as well as certain cancers and autoimmune diseases, said Assoc Prof Tang. There is currently no approved biologic medication for eczema.

The experimental biologic drug is expected to be submitted for US Food and Drug Administration approval end 2016, said Assoc Prof Tang.

OVERCOMING THE STIGMA

Mr Lee’s skin condition used to take a toll on his self-esteem, but he is now learning to live life positively while he bides his time for newer treatment options.

“The flare-ups cause a lot of stress, frustration and embarrassment, but what hit me the hardest was the issue of low self-esteem. People sometimes think my condition is contagious and are afraid to interact with me.

“I’ve learnt to overcome this and be confident of who I am, so that I do not end up being depressed and a social recluse,” he said.