Eczema is a common skin condition that affects millions worldwide, but severe eczema can be particularly debilitating. It goes beyond mild irritation, causing intense discomfort, skin damage, and emotional distress. Understanding its symptoms, recognition, and treatment options is crucial for effective management. If you’re struggling with severe eczema, consulting an eczema specialist or a Gleneagles dermatologist in Singapore can help you find relief.

 

What does severe eczema look like?

 

Severe eczema presents with more intense symptoms and extensive rashes compared to mild cases. Common signs include:

• Persistent itching: Uncontrollable itching that can lead to skin damage.
• Red, inflamed skin: Widespread redness and swelling.
• Cracked and bleeding skin: Excessive dryness can cause painful cracks and bleeding.
• Thickened skin: Long-term scratching leads to skin thickening (lichenification).
• Oozing or weeping lesions: Fluid-filled blisters that break and ooze fluid.
• Sleep disruptions: Intense itching can interfere with sleep quality.

As the natural barrier function of the skin deteriorates, the risk of bacterial and viral skin infections increases significantly.

 

Recognising severe eczema

 

There is no single blood test or diagnostic procedure to determine eczema severity. Instead, assessment relies on a detailed evaluation of symptoms, considering their intensity, the extent of the affected body surface area, and the frequency of flare-ups. Patients may report daily discomfort and a reduction in quality of life, underscoring the need for timely medical intervention when symptoms worsen¹.

 

Severity scoring systems: SCORAD and EASI

 

Dermatologists use standardised scoring systems to assess eczema severity, guiding treatment decisions.

 

1. SCORAD (SCORing Atopic Dermatitis)

 

SCORAD² is a widely used tool that evaluates eczema severity based on three key factors:

• Extent of skin involvement – Percentage of body surface affected.
• Intensity of symptoms – Measures redness, swelling, oozing, scratch marks, skin thickening, and dryness.
• Subjective symptoms – Includes patient-reported itching and sleep disturbances.

SCORAD provides a numerical score that helps dermatologists determine the severity of eczema and track treatment effectiveness

 

2. EASI (Eczema Area and Severity Index)

 

EASI³ is another objective scoring system that assesses eczema severity based on:

• Affected body regions – Head/neck, trunk, upper limbs, and lower limbs.
• Severity of symptoms – Evaluates redness, thickness, scratching, and lichenification.
• Percentage of skin involvement – Determines the extent of affected areas.

EASI scores help dermatologists quantify eczema severity and tailor treatment plans accordingly.

 

Erythroderma and generalised exfoliative dermatitis

 

In extreme cases, eczema can progress to erythroderma, also known as generalised exfoliative dermatitis. This condition involves widespread redness and scaling of the skin, affecting 80% or more of the body’s surface. It can be triggered by severe eczema, psoriasis, drug reactions, or other severe skin diseases.

 

Symptoms of erythroderma

 

• Extensive redness: The skin appears intensely inflamed and warm to the touch.
• Severe scaling: Peeling or shedding of skin in large sheets.
• Intolerable itching: Persistent discomfort leading to scratching and skin damage.
• Swollen lymph nodes: Indicating systemic involvement.
• Temperature regulation issues: The body struggles to maintain a normal temperature. Patients may feel cold and shiver.
• Fluid and protein loss: Can lead to dehydration and metabolic imbalances.

 

Treatment for erythroderma

 

Managing erythroderma requires urgent medical attention, often in a hospital setting. Treatment may include:

• Intravenous fluids: To restore hydration and electrolyte balance.
• Systemic corticosteroids: To control inflammation.
• Antibiotics: If secondary infections occur.
• Emollients and wet dressings: To soothe and protect the skin.
• Avoiding triggering medications: If drug-induced erythroderma is suspected.

 

Treatment options for severe eczema

 

1. Medical treatment

 

Seeking professional care from an eczema specialist is essential for managing severe eczema. Common treatments include:

• Topical corticosteroids: Reduce inflammation and itching.
• Calcineurin inhibitors and PDE4 inhibitors: Non-steroidal creams that help control flare-ups.
• Antihistamines: Help manage itching and allergic reactions.
• Antibiotics: Used if eczema becomes infected.

 

2. Lifestyle and home remedies

 

In addition to medical treatments, lifestyle changes, like good skin care, can help manage severe eczema:

• Moisturising regularly: Hydrating the skin prevents dryness and irritation.
• Avoiding triggers: Identifying allergens and irritants can reduce flare-ups.
• Using gentle skincare products: Fragrance-free and hypoallergenic products are preferred.
• Managing stress: Stress can worsen eczema symptoms.

 

3. Advanced therapies

 

For severe cases, dermatologists may recommend:

• Phototherapy: Ultraviolet light therapy to reduce inflammation.
• Wet wrap therapy: Applying moist bandages to soothe the skin.
• Systemic corticosteroids or other immunomodulating therapies: Helps to suppress and calm the overly active immune system and decrease inflammation. JAK inhibitors – currently the most advanced and arguably most effective treatment for severe eczema – belong in this category.
• Biologic therapies: Advanced injectable treatments (eg. Dupilumab) targeting specific immune pathways leading to effective control of eczema with relatively fewer side effects.

 

Finding the right specialist in Singapore

 

If you’re dealing with severe eczema, consulting a dermatologist in Singapore is crucial for effective treatment. Specialists can provide personalised care plans, ensuring long-term relief and improved skin health. TSN Dermatology offers specialised treatments to help manage eczema effectively. Schedule a consultation today and take the first step towards healthier skin.

 

References

 

What is Moderate to Severe Eczema? (2022, December 12). Allergy & Asthma Network. https://allergyasthmanetwork.org/what-is-eczema/moderate-to-severe-eczema/

Oakley A. SCORAD. https://dermnetnz.org/topics/scorad

Oakley A. EASI Score. https://dermnetnz.org/topics/easi-score