Are you looking for a Dermatologist in Singapore to treat your eczema?
Our founder is Singaporean dermatologist Dr. Teo Wan Lin of TWL Specialist Skin & Laser Centre, a Ministry of Health accredited Dermatology Practice in Singapore. In this article, we would like to share Dr. Teo’s eczema tips as a dermatologist.
By Dr. Teo Wan Lin
Dermatologist
MB.BS, MRCS(Ed),
FAMS(Dermatology)
TWL Specialist Skin & Laser Centre
Do you struggle with sensitive red skin? Have your GP diagnosed you with eczema previously? Are you on topical steroids on and off? Does your eczema flare up often? My advice to you is do see a dermatologist early.
Why you should see a dermatologist early
This is why: 40% of all my patients are on followup for skin sensitivity issues, eczema, also known as dermatitis. Of these 40%, at least three quarters of them are patients who had at some point of time seen a non-dermatologist for their condition. These found their condition increasingly difficult to control over the months or years. Thereafter they presented to a dermatologist.
This category of patients are challenging cases for management. Why? They have lost a “window of opportunity”. Early treatment of eczema by a dermatologist brings down inflammation. It is important to also treat secondary infection early. The strategy is proactive management. This reduces the risks of flare up due to triggers, such as pollen, dust mites, weather changes. Eczema patients must be careful about using inappropriate cleansers that are too strong for their skin.
Eczema is Genetic
Although dermatologists emphasise that eczema is a genetic disease, medications and diligence, with proper management advised by a dermatologist, can successfully treat eczema. An individual who develops eczema either in early childhood or later on as an adult is likely to have a genetic tendency to eczema. This refers to a deficiency in the Filaggrin gene, which is in charge of coding for the production of ceramide, best thought of as the “cement” that joins the skin cell “bricks” together. The key to successful treatment of eczema is threefold
- Timely Resolution of Acute Inflammation and Infection
- Repair of the Skin Barrier with Ceramide Based Moisturisers and Humectants
- Suppression of Flareups with Proactive Management of Eczema.
Let me expound on the topic of moisturising in this segment. This is because it is a crucial step that one can do for prevention, especially if one already has a known personal or family history of eczema.
Moisturisers
As a dermatologist, I am interested in topicals which mimic closely the components and concentration of those components naturally found in healthy skin barrier such as ceramides, that are also validated in a clinical setting. For the ease of understanding, we may think of Ceramides as cement joining the bricks of a wall together in order to form an effective protective barrier. In my practice, I frequently focus on restoring healthy skin barrier function to diseased skin and to achieve that, such skin barrier repair topicals, which also have a “moisturising” function, are critically important. From this perspective, there is no such thing as too much moisturiser.
For those who are of the “anti-moisturiser” camp— this simply does not make physiological sense. Even in individuals with oily skin, it can be dehydrated and irritated, as they lack in ceramide production.
However, the type of moisturiser does matter greatly. Humectants, occlusive ingredients (such as paraffin) can all count as ingredients for a moisturiser as they prevent TEWL (Trans-Epidermal Water Loss). However, occlusive ingredients would not be suitable in an acne-prone individual as this can cause a form of occlusion- type comedogenic acne. My case for moisturiser for all skin types would be a ceramide based moisturiser.
Eczema without Moisturiser
For patients with eczema, skin function deteriorates continually. This is because the skin is unable to produce sufficient amounts of the components that constitute healthy skin barrier function. This results in aggravated transepidermal water loss and susceptibility to environmental triggers.
Skin with lowered barrier functions is more susceptible to infections, irritating chemicals (e.g. sodium laureth sulphate found in almost all lathering detergents and facial wash), mechanical stress (shearing forces such as carrying heavy weights or physical activities). This results in a vicious cycle whereby sensitive skin becomes less and less capable of producing the quantity and quality of components required in maintaining a healthy skin barrier.
The Correct Definition of Moisturisers
Let us re-define moisturisers to mean topicals that closely mimic components in a healthy skin barrier. Such moisturisers have been clinically tested by dermatologists to restore barrier function.
A good example to highlight this point would be the following – my eczema or sensitive-skin patients do not respond to drug-store moisturisers, and consistently get worse whenever they make the switch out of costly ceramide-based barrier repair creams. The cost issue is largely due to the raw material – bovine or synthetic ceramide component of such moisturisers. In my clinic, we formulate a cost-effective moisturiser, Multi-CERAM™, by combining bovine ceramide and plant-seed oil derived phytoceramides.
Important Points to Check In Your Moisturiser
Bioactive Ingredients Such As Hyaluronic Acid and Ceramide
To sum up, it is important to use moisturisers that contain bioactive ingredients mimicking the components of healthy skin barrier. These include humectants like hyaluronic acid that attracts water molecules to the skin and ceramide-type lipids that control transepidermal water loss.
Order Presented in Ingredient List
Looking down the order of ingredients in the list presented is also important. The ingredient with the highest percentage is right on top. Following which, the concentration of each ingredient decreases with a descending order of mention in the ingredient list. The least moisturising and least effective creams/lotions are those which have the highest concentration of water or plain silicones. This is because while they give the instant feel of moisture, it quickly disappears and does not repair the skin barrier.
One of the more recent “fads” I had heard about is that for those who unquestioningly use moisturiser, one is causing our skin to develop a “dependence”. Let me clarify this. What these folks are saying is not evidence-based in the current state of the art. Their comments could perhaps be loosely tied to prior studies that evaluate behavior of the skin barrier to be partially compromised after exposure to some form of moisturisers.
However, these prior studies did not have the benefit of being more knowledgeable in the skin barrier in dermatological research as we are today, with which, dermatologists in fact advocate barrier repair in the form of ceramide-containing moisturisers for example. This is increasingly supported by clinical studies indicating notable and sustainable improvements in skin barrier function after treatment with moisturising topicals containing specific ingredients like ceramides that mimic skin barrier components and at suitable concentrations clinically validated by dermatologists.
Key Takeaway Points on Moisturisers
In short, I do not think that using a moisturiser that is dermatologist approved to contain ingredients that mimic healthy skin barrier components causes dependence, in the same way that a healthy diet supplementing nutrients to the body does not cause dependence.