Adolescents are in their teens and naturally pay special attention to their appearance. However, contracting eczema can lead not only to itching and discomfort but also to difficulties in their personal and social lives, affecting their confidence. The medical community has not yet found a cure for eczema that works in a short period of time, and eczema sufferers are often plagued by recurring flare-ups that cannot be "permanently resolved." Paediatrician Dr. Woo Chun-bun uses examples of young eczema patients to encourage sufferers, especially when eczema is in its early stages, to focus on moisturisation and daily care. Even if the condition worsens, it is still important to accept treatment positively and proactively, as there are many treatment options available that can help reduce the frequency of eczema flare-ups and control the condition.
The prevalence of eczema among adolescents in Hong Kong is approximately 4%; there are many factors that can trigger flare-ups or cause the condition to worsen
The global average prevalence of infantile and childhood eczema ranges from 3% to 20%.1One in 5 infants and young children will have eczema that continues into adolescence or even adulthood2. Dr Hu cited a study indicating that the prevalence of eczema among 13- to 14-year-olds in Hong Kong is approximately 4%3although the figures are lower than those in some other European countries4However, for chronic diseases, approximately 4 out of 100 people have eczema, which is also a proportion worth noting.
The causes of eczema are numerous, with the primary factor being innate constitution, including parental genes. Most eczema patients experience symptoms in infancy or early childhood, with some cases persisting into adolescence or even adulthood without full remission. Acquired factors, on the other hand, contribute to the recurrence or worsening of eczema, including:3:
- Food allergy
- External environmental factors such as dust mites
- Animal hairs or excrement
- Emotional stress
- Bacterial infections such as Staphylococcus aureus
Escalate treatment based on eczema severity
Once eczema appears, it progresses through different stages, from dry, itchy skin to constant scratching leading to skin damage, and even oozing and bacterial infections. The condition can evolve from its initial onset to becoming more severe, and appropriate treatment and care are essential, addressing the specific symptoms.
LEVEL 1: Dealing with Eczema - Basic Moisturisers are Essential
One of the main causes of eczema is a lack of certain proteins in the skin, which impairs its moisture-locking function. Therefore, eczema sufferers, whether they are experiencing a flare-up or not, should maintain good daily moisturisation and regularly apply a suitable emollient to reduce symptoms such as itching, redness, and swelling.
Level 2: Early stage eczema - Control the condition as soon as possible
Dr. Hu admitted that eczema is a chronic disease with a chance of recurring. Even if the allergen is found, it may still improve and worsen intermittently. Therefore, even with initial eczema, it is important to "control" it: "In addition to frequent application of moisturiser, you can also use topical treatments such as topical steroids or topical calcineurin inhibitors (TCIs) prescribed by your doctor to control the condition and prevent the eczema from worsening."
LEVEL 3: Eczema worsening. Prescribed oral antibiotics for faster treatment.
If eczema worsens, and even develops bacterial infections such as Staphylococcus aureus, topical ointments alone may not be sufficient. Doctors might prescribe oral antibiotics to reduce Staphylococcus aureus levels, which will help speed up eczema recovery.
LEVEL 4: SEVERE ECZEMA: DESENSITISATION OR BIOLOGICAL THERAPY
If eczema becomes more severe or recurs frequently, even affecting a patient's sleep and daily life, they can actively consider other treatment methods. Dr. Wu suggests: "Patients can undergo an IgE allergy blood test to identify their allergens, and then decide to proceed with..."Desensitisation therapy; Novel injectable biologic medications can also be considered, which help to alleviate severe eczema problems.
Dr. Hu shared two adolescent cases to encourage eczema patients to actively and patiently accept treatment, as the condition can always be controlled.
Case Study 1: Young Girl Identifies Allergen; Targeted Treatment Restores Her Vivacity
A pair of sisters, aged 7 and 8, are seeking medical attention as their parents are concerned about the elder sister's eczema. "Nearly 70-80% of the elder sister's skin is affected by eczema symptoms. She frequently scratches until her skin breaks and weeps, which is quite severe," said Dr. Hu. He explained that after conducting an IgE allergy blood test which identified dust mites as the allergen, they prescribed both topical steroid creams and desensitisation therapy. After one month, the eczema had improved by nearly half.
After the elder sister showed improvement, her younger sister, who also suffered from eczema, sought medical attention. Both underwent desensitisation therapy. Six months later, the sleep quality and mood of both sisters improved. What reassured their parents the most was seeing their well-behaved and lively personalities return.
Case 2: Teenager with eczema loses confidence due to visible symptoms; injection therapy improves mood and social life.
Another 14-year-old boy, who has had eczema since childhood, found that although his symptoms were not severe, the affected areas were on his face and hands, which are exposed parts of the body. This caused him considerable emotional distress as he entered puberty. Fearing that sweating would worsen his eczema, he gave up playing sports and exercising with his peers, which severely impacted his self-confidence and social life.
Despite IgE allergy blood tests failing to identify the allergen, a treatment plan involving biological agents was suggested. "After the third injection, the boy's eczema had significantly improved, with his sleep and social issues also being easily resolved, making him happy." The patient has now completed the 16-week course of treatment with satisfactory results.
Maintain a positive mindset and seek medical attention early.
Dr. Wu encouraged eczema patients that although eczema is difficult to "cure completely," patients, especially adolescents entering puberty, should maintain a positive mindset and refrain from trying folk remedies or untried treatments circulating online or elsewhere. If eczema relapses or worsens, seek medical attention as soon as possible to reduce the frequency, duration, and severity of eczema flare-ups.
Doctor's Tips: Eczema Care for Adolescents
- Wear cotton, quick-dry clothing:Even though Hong Kong has entered autumn, the weather remains hot. It is recommended that patients wear breathable, sweat-absorbent clothing to prevent excessive sweating from triggering eczema.
- Summer moisturiserLotionand in winter, use a moisturising creamCream）：Keeping skin well-moisturised helps to reduce skin inflammation and effectively lowers the frequency and severity of eczema flare-ups. Patients can choose different moisturisers according to the season and climate, which will help relieve eczema symptoms.
- Wet compress first aidIf eczema suddenly worsens, you can try a wet wrap method for "first aid" before using prescription steroids. This method is suitable for the body, hands and feet. It is recommended that patients apply moisturiser to the affected area after bathing, then wrap it in wet gauze, followed by cling film, and finally wear tight sleeves or the like overnight to allow the affected area to absorb the moisturiser as much as possible. The condition should significantly improve after one to two nights of wet wrapping.
References
Silverberg JJ, et al. Ann Allergy Asthma Immunol. 2021; 126:417-28
2. Hadi HA, et al. Life. 2021; 11:936
3. Leung TNH, et al. HK J Paediatr. (New Series) 2021; 26:42-57
4. Kowalska-Olędzka E, Czarnecka M & Baran A. J Drug Assess. 2019; 8:126–8
