Eczema (dermatitis) is one of the most common skin problems in Singapore. It usually presents as intensely itchy, red, flaky skin. When eczema flares, patients may notice the rash become weepy and crusted. Gradually, the skin may become dry, scaly and thickened. Skin eczema is also prone to secondary infection by bacteria or viruses

1. Atopic dermatitis: This is a very common form of eczema, affecting around 20% of children in Singapore. Many patients present at a young age with an itchy rash on the neck and folds of the limbs. Atopic dermatitis is frequently associated with other “allergic” conditions such as asthma, allergic rhinitis (sinusitis) or allergic conjunctivitis. Atopic dermatitis has a genetic basis - patients may have family members with eczema or associated conditions. In severe cases, children may suffer from lack of sleep due to itch, poor concentration in school and low self-esteem.
2. Seborrhoeic dermatitis: This condition usually causes red, flaky rash on the scalp, face and ears. In severe cases, it can also affect the chest, armpits and groin. Seborrhoeic dermatitis occurs in both infants and adults. The cause is suspected to be related to a fungus called Malassezia that normally resides on our skin.
3. Nummular (discoid) eczema: This form of eczema frequently occurs in young people, typically appearing as round, disc-shaped patches on the limbs and sometimes the trunk. The rash is usually very itchy. It can sometimes be oozing and crusted, or dry and scaly.
4. Dyshidrotic eczema (Pompholyx): The main features are itchy small blisters on the palms, soles, and sides of fingers and toes.
5. Contact dermatitis: This usually arises from the skin being in contact with an allergen or irritant. A comprehensive clinical evaluation by a doctor is required to identify the substance that is causing the eczema. Patch testing (see Allergy) may be helpful.
6. Asteatotic eczema: This condition arises from dryness of the skin, and is more often seen in older people and on the legs and flanks of the trunk. Travelling to cool, dry countries can also trigger asteatotic eczema.
7. Stasis dermatitis: This form of eczema is associated with incompetency of the veins in the legs and varicose veins. It can present as dry or weepy, scaly red patches on the legs. Stasis dermatitis often results in brown pigmentation on the legs.

Most forms of eczema are diagnosed clinically by a specialist and do not require any tests. Some tests we offer include:

1. Patch test: This is useful to diagnose contact dermatitis and look for potential allergens that may be triggering or making eczema worse.
2. Blood test: This is sometimes ordered to look for possible food or environmental allergens.
3. Skin microscopy: In this test, some scales (flakes) of dead skin are scrapped off the rash and examined under a microscope to look for fungal infection or infestation by mites such as scabies.
4. Skin biopsy: This test involves cutting a small piece of skin for examination under the microscope. This can help confirm the diagnosis of eczema, and exclude other conditions that may mimic eczema.

Management of eczema requires a multi-pronged approach. Our doctors will usually take time to discuss the options with the patient, and reach a mutually acceptable form of treatment. Treatments that we offer include:

1. Education: This forms the foundation for treating a chronic disease like eczema. Our specialists will share with patients the importance of skincare, the use of moisturizers, avoidance of triggers (e.g. dust mites) and how to manage eczema flares in Singapore’s hot and humid climate.
2. Topical therapy: Topical treatment includes both steroid and non-steroid creams, ointments and lotions. These can be combined with wet wrap or “double pyjama” therapy.
3. Phototherapy: This treatment harnesses the effect of ultraviolet radiation to reduce inflammation on the skin, making it particularly beneficial for managing Atopic dermatitis. At TSN Dermatology, we have a full-body narrowband UVB (NBUVB) cabin that is suitable for patients with extensive eczema.
4. Oral medications: The options encompass both steroid and non-steroid medications such as cyclosporine, methotrexate, mycophenolate mofetil and the latest “small molecules” or JAK-inhibitors, which have been approved to treat atopic dermatitis since 2022.
5. Biologics: Biologics are targeted therapies that are often highly effective in treating certain diseases. Dupilumab (Dupixent) is currently the only biologic licensed to treat atopic dermatitis in Singapore. It has been shown to be highly effective and safe to use in most patients, including children. Specialists at TSN Dermatology have extensive experience with using biologics and will be able to share with you if this is a suitable option for you.