More AD patients are experiencing flares on their hands due to the frequent handwashing and sanitising necessitated by the current Covid-19 pandemic. — TNS
It's ironic that for a condition that requires lots of moisturising, bathing in the sea can actually make a person’s atopic dermatitis (AD) or eczema worse.
Says consultant dermatologist Dr Peter Ch’ng: “It’s a myth that sea water helps with AD.
“Many of my patients experience a flare of their AD after coming back from their beach holidays.
“This is because sea or salt water makes the skin dry.”
He adds: “Even water alone makes the skin dry because our skin is more acidic compared to water, which is more alkaline.
“That’s why I always advise my patients to use a moisturising cleanser, followed by moisturiser every time they wash their body.”
AD is a chronic inflammatory skin condition that usually starts in childhood – before the age of five in over 85% of cases, according to Dr Ch’ng.
It is characterised by rashes and constant, extreme itchiness, and is part of a family of allergic conditions that include allergic rhinitis and asthma.
Due to the visibility of the condition, as well as its effect on a person’s daily activities, AD has an impact that goes far beyond its symptoms.
Dr Ch’ng notes that the condition frequently restricts living a normal life, impacts mental health and leads to the development of other diseases.
Fortunately, there are many treatment options available for AD.
The problem is, however, that patients often do not follow their treatment regime properly.
“The Dermatological Society of Malaysia estimates that only 14.7% (about one in seven) of AD patients were adherent to treatment, while 58.7% of patients had steroid phobia.
“The combination of poor treatment adherence and the lack of novel treatment options play significant roles in the under-treatment of AD in Malaysia,” he says.
The treatment of AD requires both lifestyle modifications and the use of medicines such as topical or oral steroids, topical calcineurin inhibitors, phototherapy, oral or injectable immunosuppressants, antibiotics and biologics.
Dr Ch’ng shares his simplification of the treatment of AD into 5 “I”s:
AD is a genetic condition.
“This genetic condition makes the patient’s skin dry and it has to be replaced with a moisturising bath gel, followed by moisturiser,” says Dr Ch’ng.
“The moisturising bath gel and moisturiser should be free from preservatives and fragrance, which could worsen AD.”
He adds that the patient should continue to use moisturisers even if they are not experiencing a flare.
The driving force behind AD is inflammation.
He notes: “During an acute episode, it is like a war zone with a lot of inflammatory cells fighting at the surface of the skin, i.e. the epidermis.
“As a result, water is being produced and the patient can present with tiny blisters on the rash.
“For areas with thin skin, the blisters may rupture, leaving behind raw rashes.”
The key point is that moisturisers will not make an acute flare like this go away. Instead, the patient requires topical steroids.
“Topical steroids, when used appropriately and judiciously, will not harm the patient, whether in children or adults," he says, adding that only certain classes of topical steroids are used for children.
Another treatment option to help reduce the inflammation, which is steroid-free, is a topical calcineurin inhibitor.
Due to the frequent occur-ence of raw rashes, AD patients are prone to getting skin infections.
Dr Ch’ng says: “Whenever there is a crust over the raw rash, lesions that expand despite appropriate topical steroid treatment, or the patient is unwell, go see a doctor.
“The patient will need to be treated appropriately, according to the type of infection.”
He adds that while it is a myth that AD is contagious, such infections can indeed spread through contact with the affected skin.
One of the problems with AD is the “itch-scratch cycle” it perpetuates.
The itchiness causes the patient to scratch, which triggers more inflammation and itching, leading to more scratching and so on.
According to Dr Ch’ng, moisturisers play an important role in reducing the itch, as dry skin exacerbates the itchiness.
“Sometimes, patients will be given an antihistamine to partially reduce the itchiness.
“And we may also provide and educate the patient on a special kind of dressing known as a wet wrap,” he explains.
While trying to refrain from scratching may feel next to impossible, patients can at least keep their nails short, or wear mittens or gloves, to prevent further injury to the skin.
Food tends to often get the blame for causing or triggering AD.
Says Dr Ch’ng: “Although certain foods such as eggs, soy, milk, wheat, fish and shellfish may contribute to the worsening of AD in some patients, it is definitely not the only cause of the condition.
“It is important to note that just eliminating the particular food without managing the other “I”s above, will not help control AD.”
Other common triggers include dust mites and prolonged contact with sweat.
Another treatment option for patients with moderate to severe AD is biologic therapy.
Dr Ch’ng explains: “They target specific molecules – in this case, molecules known as interleukins – to interrupt the chain reaction that results in inflammation in AD.
“Clinical trials have shown promising results in reducing the severity of AD symptoms and improving quality of life.”
The good news is that while AD is not curable, over half of patients may grow out of it by the time they are teenagers, he says.
And while AD is much tougher on patients than most people understand, Dr Ch’ng urges them not to give up as timely and appropriate care can help improve their quality of life.
