Does your child have frequent skin itchiness and redness?

Have you heard of atopic dermatitis or eczema?

Facts about atopic dermatitis

As a parent, your child's well-being is important. However, if your child(ren) often develop redness or itchy inflamed skin, he or she may be suffering from atopic dermatitis/ eczema.

Did you know that eczema can be inherited?

Don't fret. Dr Fiona Chang, from AsiaMedic CHI (Complete Healthcare International) clinic, will provide you with all the information you need to know about this condition.

What is atopic dermatitis?

You might know it as “dermatitis” or “eczema”. They are frequently used interchangeably.

It is a chronic inflammatory condition characterized by itch and often develops in early childhood.

The main symptoms of eczema are rash and itchy patches commonly on the elbows, hands, inside of the elbows and back of the knees but may also appear on any part of the body.

Why does my child develop atopic dermatitis?

The causes of atopic dermatitis are multi-factorial including but not limited to skin barrier abnormalities, dysregulated immune system, and altered skin resident flora.

Certain risk factors predispose a child to develop atopic dermatitis.

• Family history of atopy - which includes eczema, asthma or allergic rhinitis. If one of the parents has atopy, the child will have 2-4 times increased risk of developing atopic dermatitis. This risk increases to 3-5 times if both parents are atopic.
• Other genetic conditions that affect skin integrity- certain gene mutations, such as loss-of-function FLG mutations.

Is there a cure for atopic dermatitis?

There is currently no cure for atopic dermatitis, but many patients outgrow it.

In certain cases, the skin barrier matures and integrity improves with increasing age. The condition might then improve over time.

However, some patients might still suffer from atopic dermatitis that persists into adolescence and adulthood.

This is usually due to overactivation of the immune system after multiple episodes of flares. The skin may then be discoloured or thickened due to chronic inflammation.

Is it an allergy?

Allergy means overactivation of the immune system. Atopic dermatitis is more complicated than a merely overactive immunity.

It starts first with skin barrier abnormalities.

• The skin barrier refers to the outermost layer of the epidermis, which helps protect your skin from harsh elements and holds in moisture. If the skin barrier has been tampered with, for example due to dryness or a genetic problem, it creates an access for environmental irritants, allergens and microbes to enter freely.

Defective barrier allows external stimulants to enter and trigger immune response.

• This will cause itchiness and redness. Repeated stimulation will then over-activate the immune system, driving our body into hypersensitivity with worsening skin rash.

Should an allergy test be carried out?

Since allergy plays a role in certain groups of patients with atopic dermatitis, clinicians might offer skin or blood allergy tests.

These results will then be interpreted by the treating physician before a diagnosis of allergy is made.

Tips to manage atopic dermatitis

Management of atopic dermatitis includes:

1. Restoration of skin barrier
   • Avoid exacerbating factors, ie. Excessive bathing without subsequent moisturization, overheating of the skin, and exposure to solvents and detergents.
   • Hydration of the skin with moisturizer- frequent application of moisturizer throughout the day
2. Treatment of skin inflammation
   • Medications are usually required for mild to moderate atopic dermatitis.
   • First line treatment includes short term topical steroid cream and occasionally topical immunomodulating agent.
   • Oral immunomodulators are prescribed in more severe cases.
   • Oral antihistamine might be prescribed to manage itchiness.
3. Treatment for Secondary Skin Infection
   • Treatment with antibiotics or antiviral agents may be given by the treating physician.

Dr. Fiona Chang Resident Physician, MD (Taiwan), MRCP (Glasgow)

Dr Fiona is a GP at Complete Healthcare International (CHI). She obtained her medical degree from Chang Gung University, Taiwan in 2011 and subsequently completed her postgraduate training in Internal Medicine, Singapore. In 2015, Dr Chang attained the Membership of the Royal College of Physician (MRCP), Glasgow, United Kingdom and has since been practicing medicine in the Singapore restructured hospitals drawing, experience in renal medicine respiratory medicine cardiology and dermatology.

Dr Fiona is a bilingual who speaks English and Mandarin. She also converses in the Hokkien dialect.

If you have any questions or concerns regarding immunising your child, please consult your doctor for further advice. To get your child up to date with his or her immunisations in Singapore, contact us.