As it’s the largest organ in the body, the health aspects of skin should not be overlooked, writes Aznim Ruhana Md Yusup
THE first time Lynn had an eczema episode on her ankles was 12 years ago. It was red, dry and itchy. The doctor prescribed a medicated cream and the eczema disappeared.
But the condition flared up again recently, this time between the index and middle fingers on her left hand. She tried a number of creams prescribed by the family doctor and even used virgin coconut oil but the inflammation didn’t subside.
Eczema is a common itchy skin disease that typically manifests itself in red, inflamed skin which may lead to weeping (oozing of liquid) or crusting (formation of a hard outer layer on the skin surface).
There are several types of eczema, with patients from all age groups. “Atopic aczema is more of a childhood condition,” says Hospital Kuala Lumpur dermatologist Dr Leong Kin Fon.
Speaking at the launch of Eucerin’s Soothing Cream for dry and irritable skin, Dr Leong says approximately one in five primary schoolchildren have atopic eczema, and it’s more prevalent in urban areas.
Atopic eczema tends to appear when a baby is a few months old, and is a multi-factorial disease. Genetics play a role, as do environmental factors like extreme weather, harsh cleansers or stress.
While atopic eczema cannot be cured, the flare-ups can be managed through a combination of medication and lifestyle changes.
Most children outgrow the condition as they get older.
“Dandruff is also a type of eczema called seborrhoeic eczema,” he says. The condition is related to the excessive secretion of sebum, making the scalp oily and very flaky.
Other types of eczema include discoid eczema that is characterised by coin-shaped lesions and varicose eczema, which is associated with poor venous blood circulation.
CONTACT ECZEMA
This is directly related to materials that our body comes in contact with.
“If I put a bit of detergent on your skin, and then I put a plaster over it, by tomorrow it will become eczematous. This is what we call irritant contact eczema. Eczema caused by harsh cleansers is curable. Stop using the irritant and apply a bit of serum or moisturiser, and it should be cured,” says Dr Leong.
“Then there’s allergic contact eczema. You wear fragrance or a watch or jewellery made of nickel and there is nothing wrong for a year or two, but after a few years it starts to become a problem.”
This type of eczema takes time to stimulate the immune system. It is only after a certain period of time that the body reacts to the allergen.
Given that it has been developing over time, it will take a while for the skin to go back to its non-eczematous form. So avoid contact with the allergen and use a moisturiser designed for eczema.
Dr Leong’s mother suffered from eczema on her hands from all the washing up she did while taking care of her young family.
“She still suffered from it for several years after my five siblings and I had left home for university. But now, she has fully recovered because she doesn’t need to do a lot of housework anymore,” he adds.
PSORIASIS PATCH
If atopic eczema generally manifests in babies and young children, psoriasis is more of an adult condition, affecting one to two per cent of the population. It appears as scaly red or pink patches on skin and is usually itchy.
Like atopic eczema, it is a multifactorial condition. Genetics play a role but the environmental factors for psoriasis are not as clear.
Depending on the patient, a psoriasis flare-up may be caused by infection but it can also be due to food or medication.
There is no cure for psoriasis, but it can controlled with a combination of treatments including moisturiser, steroid cream and medication. Ultraviolet photo therapy may also be prescribed. The latest in psoriasis treatment is biologics which comes in the form of an injection.
“Biologics is very expensive,” says Dr Leong. “The cost may be up to RM50,000 a year. But you probably only need an injection once a month and there’s no need to apply cream. It’s not a cure but it does makes your life easier.”
Due to causes not entirely understood, psoriasis sometimes disappears after a few flare-ups. Some patients say it is due to food manipulation but Dr Leong is wary of such claims.
“Changing your diet will perhaps work for one or two out of 100 psoriasis patients. It doesn’t work for everyone. As a community doctor, I can’t use that finding to manage other patients,” he says.
The biggest challenge in treating patients with psoriasis or eczema is ensuring their mental well-being. Both diseases manifest very clearly, and can lead to self-esteem issues or stigmatisation based on the unfounded fear that the conditions are infectious.
“The first thing I do is to touch their skin to show that it is not contagious. Skin is the largest organ in our body and it’s the first layer of the human body that we interact with. So that has significant psycho-social impact on patients.”
NO MAGIC CREAM
A more common type of skin disease is acne. It afflicts about 90 per cent of the population, the only difference being the severity. It tends to go away with age, but that’s not good enough for a self-conscious teenager.
“A youngster, after using acne cream for seven days, may become impatient. He or she wants the acne to disappear overnight even though treatment takes six weeks to become effective. If I don’t explain the treatment properly, they may stop treatment and use other creams instead,” says Dr Leong.
“Patients look for a magic cream but there’s no such thing. You can control acne or perhaps reduce its severity, but there’s no cream to make it go away completely.”
While acne is not infectious, one may catch a fungal or bacterial infection.
Fungal infection is usually related to obesity or diabetes. Dr Leong explains: “A taxi driver sits in his vehicle all day and sweat accumulates at folded areas (e.g. the abdomen). Sweat and friction will destroy the superficial layer of the skin after a year or two. This is a good medium for the fungus to grow on.”
Bacterial infection is more serious. It’s more common in children as their immune system is less mature. There is also a high chance of it attacking the elderly as the immune system gets weaker with age but healthy people between 5 and 60 can usually fend it off. The infection itself appears very weepy or watery with blisters and pus.
Other skin diseases include pigment problems like vitiligo where the skin loses colour, leading to patches of lighter skin. Michael Jackson was a vitiligo sufferer. America’s Next Top Model contestant Chantelle Brown-Young also has the condition.
TREATMENT PRESCRIPTION
It may be tricky for general practitioners to recognise the different types of skin diseases. Skin diseases tend to look alike, and explaining the outward aspect of a certain condition can be misleading.
“You need at least four or five years of treating skin problems everyday then you start to become more confident in differentiating the various types of eczema,” says Dr Leong.
This lack of proficiency leads to frustration in patients, who feel like they are being put under a trial-and-error method, with different creams being prescribed after each visit.
“If you find you’re not getting better after two or three visits, then it’s best to ask for a dermatologist. If it can be managed then stay with the primary care doctors. Out of 100 patients, maybe only five require referral to a dermatologist,” he adds.