Eczema myths debunked by doctors!
Health informationBy Keith 3 December 2021 Senior Project Editor
Eczema is one of the most common skin conditions in Hong Kong, with 30% children in Hong Kong suffering from it.In 2016, the Department of Health’s dermatology specialist outpatient clinics handled a total of 1,138 new cases of dermatitis and eczema. Eczema can cause significant disruption to patients’ lives and may also lead to considerable psychological stress.To alleviate the condition, many people try various treatments, including folk remedies. However, using the wrong method may, at best, prove ineffective and, at worst, cause the condition to worsen. So, which methods are most effective in relieving eczema? Why not listen to Dr Hu Zhenbin’s explanation!
Dr. Hu pointed out that from a Western medicine perspective, eczema is an inflammation. One of the causes of inflammation may be a deficiency of certain proteins in the body, leading to the skin's inability to retain moisture. If combined with external irritants, allergens, or environmental factors, the body's immune system may become imbalanced, triggering inflammation in the skin. When the skin is inflamed, its barrier is damaged, making it prone to moisture loss and dryness, or other inflammatory symptoms such as redness, swelling, or itching, and it may even ooze or bleed. Therefore, from a Western medicine perspective, moisturising is an important part of eczema care. It is necessary to frequently use large amounts of lotions or creams to keep the skin hydrated, which helps to control inflammation.
Using probiotics or coconut oil to treat eczema?
There are many popular claims that different products can treat eczema, such as taking probiotics or applying coconut oil. There are also folk remedies, such as bathing in brown sugar water or applying ginger to affected areas, based on the belief that patients have "damp toxin". However, Dr. Hu reminds us that these methods have no scientific basis and carry certain risks. Coconut oil may sometimes be used for moisturising, but it contains plant proteins, which can cause skin allergies and worsen affected areas in children after use, so parents need to be cautious. Other parents also use aromatherapy for healing, but these may worsen the affected areas, so extra attention is needed. Probiotics are relatively safer, but there are many types, and the dosage and age at which they are started need to be considered. Currently, there is still no robust scientific evidence to suggest that probiotics significantly help in controlling or preventing eczema, so Western medicine does not currently use probiotics as a treatment for eczema.
Is patting the skin to stop itching better than scratching?
When eczema flares up, children find the itching unbearable and will pat their skin to avoid scratching. Dr. Hu said that the most troublesome symptom of eczema is usually skin itching, and many patients naturally scratch or pat the affected area when they feel itchy. Generally speaking, gentle patting is preferable to scratching, as it can prevent skin from breaking and forming wounds, which could allow bacterial infections to take hold. In fact, eczema itching is similar to mosquito bites; even if you scratch until the skin breaks, it won't stop the itch. Therefore, if the affected area is itchy, we generally recommend using emollients. Dr. Hu reminds everyone that emollients come in different types; some are for general moisturising, while others are specifically designed to relieve eczema itching. If the itching is so severe that it prevents sleep, antihistamine medication can be used to reduce skin itching and discomfort.
Are there many side effects from using steroid creams?
In earlier times, when there were no better anti-inflammatory drugs or ointments available, and emollients with high moisturising content were also ineffective for patients with severe eczema, the only option was to use steroids. However, many parents are afraid of using steroid creams for their children due to their numerous side effects, which can even affect development. Dr. Wu points out that many parents become frightened as soon as they hear the word "steroids"; however, if the inflammation is very severe and affects a child's daily life or sleep quality, these impacts are actually more profound than the use of steroids.
Steroid creams are available in different strengths, allowing doctors or parents to choose accordingly based on the patient's condition. Unless a patient's eczema is very severe, for example, with inflammation over large areas of skin, and high-concentration eczema creams are used without proper management, it is not common for the use of steroid creams to affect development. Dr. Wu points out that steroids are generally considered an emergency treatment for eczema, to be used when an affected area deteriorates rapidly, and they show results in a short period. For children with very severe conditions, oral steroid medication may even be considered to control skin inflammation in a short time. Once the condition is under control, gentler treatments can be attempted to avoid long-term steroid use. If steroid medication is used for a short period at the dosage prescribed by a doctor, it is less likely to cause side effects that damage the skin barrier. However, if patients use steroids intermittently or long-term on their own, it may lead to poorer skin quality, thinning of the skin, and reduced skin immunity.
What is the most suitable eczema treatment for young children?
When choosing a suitable eczema treatment for young children, Dr. Wu recommends seeing a doctor as early as possible. First, the doctor will need to determine if it is indeed eczema, as it could be another skin condition, and the treatment or support methods would differ. If the doctor diagnoses eczema and it is more severe, it will be necessary to try and identify the triggers or allergens. For example, the doctor will inquire if the child's parents or siblings have eczema or other allergic conditions, including allergic rhinitis and asthma. It is also important to understand the child's dietary habits from infancy, such as whether they were breastfed or formula-fed, and at which stage of their diet the eczema began to appear. The aim is to understand the cause of the eczema in order to provide targeted treatment.
Moisturising is the most important aspect of managing eczema. If moisturising is done well, it can reduce the severity of affected areas and the frequency of relapses. In addition to moisturising, some children may need to use topical or oral medications, including creams to control inflammation. If the condition is more severe, steroid creams may be required, which are common treatments. On the other hand, if it is found that a child may be sensitive to certain substances, allergens should be avoided as much as possible in daily life, such as changing milk formula. If other family members have allergies, the allergens need to be identified, such as dust mites or dietary factors. Dr. Wu suggests that older children can undergo skin or blood allergy tests to understand if the child has more specific allergens, so that they can be treated accordingly and avoid these allergens in their daily lives.
Can non-steroidal drugs treat eczema?
Dr Wu pointed out that while steroid medications are indeed effective for eczema skin problems, non-steroid medications can also be used to control mild to moderate eczema. The non-steroid topical medications on the market are mainly divided into two types: topical calcineurin inhibitors and topical PDE4 enzyme inhibitors. Normally, the PDE4 enzyme in the human body can help the body regulate the inflammatory mechanism, but the PDE4 enzyme in the skin cells of eczema patients may be overactive, leading to skin inflammation. Scientific research has confirmed that PDE4 enzyme inhibitors can stop the overactivation of the PDE4 enzyme in skin cells, or thereby reduce eczema-related inflammatory symptoms such as redness, peeling, oozing, and itching. Therefore, non-steroid ointments can also relieve eczema and reduce the side effects of using steroids.
Compared to traditional steroid medications, PDE4 enzyme inhibitors do not contain steroids and can therefore be used long-term. They can also be used on thinner and more sensitive skin areas, such as the face and around the eyes.
Dr. Hu shared a case of a child with eczema. The child had eczema on their back and had been using steroid creams to control it. However, as soon as they stopped using the creams and only used moisturiser, the eczema would flare up and improve intermittently. During flare-ups, red rashes would appear (as shown in Figure 1).
Figure one
However, due to parental concerns about the potential side effects of long-term corticosteroid cream use, they subsequently switched to a PDE4 inhibitor.
Children using PDE4 enzyme inhibitors for three to four weeks showed significant improvement, with their skin returning to normal after about a month (as shown in Figure 2). They have now been using a moisturising lotion and PDE4 enzyme inhibitors for two to three months, and there have been no relapses.
Figure 2
Finally, Dr. Hu advised everyone to prevent eczema, stressing the importance of moisturising and avoiding allergens. If in doubt, it's best to consult a doctor first and not to try home remedies haphazardly.
The information was provided by Dr. Hu Zhenbin
