The hidden price of childhood eczema

SINGAPORE — In less than two years, five-year-old Jenelle Tin’s battle with eczema has cost her parents about S$8,000.

To keep her itchy skin condition under control, they spend about S$200 every month on special moisturisers, body washes and shampoos.

Then, there are the numerous visits to the doctor, as well as medication Jenelle requires during flare-ups. Typically triggered by heat and humidity, the flare-ups leave her with inflamed, red, itchy and cracked skin, and sleepless nights of non-stop scratching, said her father, 46-year-old engineer Tin Cheong Eng.

They occur about three times a year, and each episode lasts about a month.

“Besides the usual maintenance and flare-up expenses, we also have to factor in time and transportation costs as Jenelle’s skincare products are only available at one hospital pharmacy,” said Mr Tin, who has three other children aged two to 10 years old. Only Jenelle suffers from eczema.

The Tins’ situation is not unique, as an increasing number of children in Singapore grapple with eczema, or atopic dermatitis.

More than just a distressing chronic condition that affects quality of life, a new study has found that eczema is also financially draining.

In developed Asia Pacific countries, including Singapore, the cost of managing an infant with eczema may range from US$1,000 to US$6,000 (about S$1,350 to S$8,100) each year.

The study, which was published in the Annals of Nutrition and Metabolism last year, looked at direct medical costs as well as indirect expenses from missed time at work and transportation.

Eczema affects about one in five schoolgoing children here, a figure that has risen significantly in the last few decades, according to the study’s co-author, Adjunct Professor Lee Bee Wah from the department of paediatrics at National University of Singapore’s Yong Loo Lin School of Medicine.

Previous studies showed that the figure was under 10 per cent two decades ago, she said.

At KK Women’s and Children’s Hospital (KKH), the number of new eczema cases seen at its Dermatology Service has almost tripled in the last two years.

From five to eight new cases each day in 2014, it now sees 15 to 20 new cases daily.

Presently, it is not clear why some children develop eczema.

However, what is known is that the condition tends to run in the family, with maternal allergy history being the strongest risk factor, said Adjunct Prof Lee.

Changes in the environment, lifestyle and diet, early exposure to antibiotics and more babies being delivered via Caesarean section — which can cause them to miss out on good gut bacteria that has been linked to allergies — may also play a part in today’s “allergy epidemic”, she added.

MANAGING A CHRONIC ITCH

There is currently no cure for eczema, but maintenance treatments of daily moisturising can keep it under control.

The mainstay of eczema treatment focuses on improving the skin barrier function, which is impaired in eczema sufferers due to a deficient gene known as the filaggrin gene, said Dr Lynn Chiam from Children and Adult Skin, Hair and Laser Clinic at Mt Elizabeth Novena Specialist Medical Centre.

According to her, a deficiency in filaggrin leads to a decreased production of natural moisturising substances in the skin.

“The skin is unable to maintain hydration and becomes dry and scaly. Once the skin barrier is damaged, external irritants and allergens can easily penetrate it, leading to red, inflamed and itchy skin,” she added.

In severe cases, the child experiences itchy, red, crusty and flaky skin which may hurt or become oozy and wet due to chronic scratching, said Dr Mark Koh, head and consultant at KKH’s Dermatology Service.

Steroid creams are typically prescribed during periods of intense inflammation. Very severe eczema may be treated with strong medications that suppress the patient’s immune system, and this would require close monitoring as they can have side effects on blood counts, the liver and the kidneys, said Dr Koh.

For parents and caregivers, managing a child’s chronic rash can be hard work. “Cost is just one aspect of the disease; psychologically, it is also tough on everyone especially when her non-stop scratching keeps us up at night,” said Mr Tin.

Dr Koh said a common challenge caregivers face is adhering to the child’s topical medication regimen, which may involve applying different creams to various body areas several times a day.

But good management of eczema would mean fewer clinic visits, hospital admissions and less need for stronger medication, thus bringing down costs and improving the child’s quality of life.

A CHILD-FRIENDLY APP TO TRACK ECZEMA

To help parents better manage their child’s skin condition, a child-friendly mobile application, iControl Eczema, was recently launched in Singapore.

Co-developed by KKH, Nanyang Polytechnic and Hyphens Pharma, the app allows parents to track their child’s eczema on a daily basis and share the progress with their doctor in between clinic visits.

It also has a reminder function that can be programmed to remind patients to complete their daily topical medication routine. It can be downloaded for free on the Apple and Android platforms.

The doctors said that at present, there are a lot of misinformation and folk remedies, which can be dangerous. Dr Chiam said there is currently no valid scientific evidence to show that alternative treatments such as aromatherapy, Neem shampoos, water purifiers and steam cleaners improve eczema.

“We have seen some parents who spend significant amounts of money on alternative treatments that are not proven or may even cause detrimental effects. Understanding the factors causing eczema can lead to improved understanding of disease management and better outcomes,” said Dr Koh.

Fortunately, Dr Chiam said the majority of children will outgrow the condition during their teenage years.

Mr Tin hopes this will be the case for his daughter but, in the meantime, Jenelle adheres to a strict routine of moisturising four times daily to keep her skin hydrated and prevent flare-ups. Her teachers were also taught to help her apply the moisturiser in school.

“Her condition is (under) better control now, but we never know when it will flare (up) again. Although caring for a child with eczema can sometimes be frustrating, parents and caregivers have to remain positive and supportive,” said Mr Tin.