What is the ideal skincare regimen if you suffer from eczema? Are eczema creams the answer? Eczema itself can be regarded as a disorder of the genetics, the immune system, the microbiome as well as barrier function of skin. According to accredited Singapore dermatologist Dr. Teo Wan Lin, “Our understanding of eczema has shifted from an allergy, immune system mediated sort of skin condition to one that is predominantly barrier dysfunction related. There is an increasing emphasis on the effects of a healthy skin microbiome.” In this article, we offer some top tips to get your eczema under control in eczema treatment, with the right eczema creams first.
The Role of Eczema Creams in Treatment
This educational video covers the important steps in a skincare routine designed for dry, sensitive, and eczema prone skin types.
There are three important long term goals: maintain effectiveness and safe use of prescription eczema creams, repair the damaged skin barrier and prevent skin infection.
If your eczema is moderate to severe, you may require prescription medications. Common prescription medications include topical steroids or calcineurin inhibitors. These are immune suppressants that help to modulate the immune system. It is important to highlight that it may not just be a condition that requires intermittent treatment. Rather, it could be one that is chronic, which means that long term planning together with the use of eczema creams to prevent flare ups is essential.
Cleansing in Eczema Treatment
The first important aspect in eczema treatment is cleansing. Cleansing is the process by which the skin can restore its natural microbiome by removing excess dirt, grime, dead skin and unhealthy pathogens. Pathogens could include bacteria, viruses and fungi on the surface of skin. In eczema patients, it is very important because eczema is believed to be driven by a super antigen effect. The super antigen effect is due to the overgrowth of a type of bacteria known as Staphylococcus Aureus (S. Aureus). S. Aureus lives on the skin of healthy individuals but tends to overgrow in individuals who suffer from eczema. It is important to understand that in individuals who suffer from eczema, S. Aureus colonisation becomes a harmful event that can cause your immune system to go into overdrive. Consequently, this leads to infections such as impetigo as well as driving the base inflammation process in eczema.
A gentle cleanser is equally important. The cleanser has to trap moisture under the layer of the skin without drying the skin out as it cleanses. This is the importance of using a cleanser with humectant properties. The Honey Cleanser is an example of a face and body cleanser that is gentle and effective on eczema skin. This is due to its unique formulation containing natural medical grade honey. Honey in turn helps to trap a layer of moisture under the surface of the skin and to prevent water loss to the environment.
Skin Microbiome in Eczema Treatment
The second aspect of eczema treatment has to do with stabilising the skin microbiome. One should focus on the latest available technologies to maintain a healthy skin microbiome especially in eczema prone patients. It is of interest that biofunctional textiles have shown great promise in eczema treatment. Such textiles refer to those impregnated with zinc oxide, silver and copper nanoparticles. The use of these textiles have demonstrated reduction in eczema flareups. This is presumably because of the ability of the textiles to suppress bacteria and fungal growth which are eczema triggers.
Overall, the use of biofunctional textiles on eczema patients has been examined notably in clinical studies. Subjects wear the textiles throughout the night in these studies which conclude the textiles to be efficacious. This is partially because it reduces the chance of developing itch which can disturb sleep. The textile also functions as a topical antibiotic reducing any risk of eczema secondary infections. The skin of eczema patients is more prone to developing infections as a result of the skin barrier dysfunction.
Another good tip is to go for swims. In western countries, dermatologists often recommend bleach baths. In Singapore, dermatologists generally advise patients to go for a swim. This is because the chlorine actually performs a function of helping to eliminate excess unhealthy growth of Staphylococcus aureus.
Moisturisers in Eczema Treatment
The third cornerstone of eczema treatment would be the application of moisturisers.
It is important to highlight that for eczema therapy, not all moisturisers are equal. We have all heard about ceramide containing moisturisers which are supposed to help mimic the skin barrier. These can be effective in terms of replacing what is naturally deficient in eczema prone skin. The filaggrin gene is actually deficient in producing a certain type of protein in skin, for patients who suffer from a genetic form of eczema. This can lead to skin barrier dysfunction which can develop first in childhood and progress to adulthood as well. Patients may also develop eczema because of external causes, as in the case of contact dermatitis. This could either be due to an allergy or irritation from repeated exposure to harsh astringents or chemical disinfectants, which is another reason why one can have skin barrier dysfunction.
Technique of Applying Moisturising Eczema Creams
The gold standard of eczema therapy now is actually moisturising eczema creams known as a prescription emollient device (PED). A PED type moisturiser contains not just a correct balance of lipids that mimic to the natural composition of your skin lipids. It also contains additional anti inflammatory ingredients that work as steroid sparing alternatives to help to reduce the chances of flare up of eczema. It is critical to understand that the eczema patient often feels burdened by application of moisturisers. Therefore, it is truly important to highlight that it is not just the type of moisturiser but also the technique of moisturiser application that matters.
According to Dr. Teo Wan Lin, the correct amount of moisturiser to apply for an individual who suffers from eczema is actually a thick layer. The thick layer should still be a visible layer on your skin five minutes after you apply. This is because it is the amount that it takes in order to replenish the natural skin barrier. Notably, this is different from say applying topical steroids or medications prescribed by a dermatologist where we advise applying a thin layer.
Frequency of Applying Moisturising Eczema Creams
The frequency of application is also very important. It is clearly not convenient to be applying moisturisers all the time. This is especially so if one has to undergo the minimum frequency of application of three times a day for mild cases of eczema over the entire body. In particular, the area that is prone to eczema is critical.
The frequency or application should go up to five or even ten times for individuals who are suffering from moderate to severe eczema. This has to be done with the type of moisturiser that is formulated as a PED, so as to have the highest chance of coming off medicated steroids. Also, this is a form of steroid sparing treatment. Such treatments are very important because as effective as topical steroids are, there is a phenomenon known as tachyphylaxis. This is where the individual develops resistance to the topical steroids because of improper or prolonged exposure to the medications.
Dermatologist Treatment for Eczema
Dr.TWL Dermaceuticals is a dermatologist formulated range of skincare and haircare products for sensitive skin users. The range suited for eczema care includes the antibacterial Honey Cleanser to maintain a healthy skin microbiome, the Multi-CERAM Eczema Cream which is a gold standard prescription emollient device, and the Mineral Booster which has super potent polyglutamic acid. Polyglutamic acid has five times the water retaining capacity of hyaluronic acid to hydrate skin deeply and intensely. If you suffer from eczema and would like to book a visit with an accredited dermatologist, you may contact Dr. Teo Wan Lin (of TWL Specialist Skin & Laser Centre), who offers teleconsultations for diagnosis and treatment of eczema internationally. Click on the booking link below to make an appointment directly online.