Eczema Treatment in Singapore

Moisturisers and barrier repair for eczema

Every treatment plan begins with a moisturiser applied correctly, meaning a sufficiently thick product applied to damp skin at least twice daily over the whole affected area rather than only the itching patch. Regular application restores the lipid layer of the skin and reduces the water lost through it. A Cochrane review of 77 trials found that regular emollient use roughly halves the number of flares and reduces the quantity of anti-inflammatory cream required [1]. The product is matched to the patient’s skin and to Singapore’s climate, because heavy ointments suited to cooler European climates are frequently abandoned here within a week.

Non-steroidal eczema creams, tacrolimus and pimecrolimus

Non-steroidal prescription creams are the core of my eczema treatment for the face, eyelids, neck and skin folds, and for children, where long courses of steroid cream cause skin thinning. Topical calcineurin inhibitors such as tacrolimus and pimecrolimus block the activation of the immune cells that drive inflammation in the skin, and because they do not suppress collagen production, they do not thin the skin. A one-year randomised trial comparing tacrolimus ointment with a steroid regimen in adults with moderate to severe eczema found tacrolimus at least as effective, with more patients clear of eczema at the end of the year [5]. Applied twice weekly to the areas that usually flare, an approach known as proactive treatment, these creams can substantially reduce the number of flares [6].

Topical steroid creams for eczema, and how to use them correctly

Steroid creams remain appropriate as a short, decisive course for thick eczema on the body or limbs. The errors I correct most often are a cream too weak for the site, a course too short to clear the flare, and continuous use on the face over several months. Steroids thin the skin by suppressing collagen production, a risk that rises with the strength of the cream, the length of use and the thinness of the skin treated. A correctly chosen steroid used for two weeks therefore causes less harm than a weak one used inadequately for a year.

Narrowband UVB phototherapy for eczema in Singapore

For eczema that covers a large area or recurs despite good topical treatment, narrowband ultraviolet B (UVB) phototherapy is the next step. The 311 nm wavelength suppresses the overactive immune cells in the skin and reduces bacterial colonisation, with less risk of burning than broadband ultraviolet light. A course consists of two to three sessions a week for eight to twelve weeks, each session lasting a few minutes. In a randomised trial in adults with moderate to severe atopic dermatitis, narrowband UVB produced better results than broadband UVB [7]. A narrowband UVB unit is available in my clinic, so no hospital referral is required. Sessions start from S$200 before GST.

Pulsed dye laser for chronic eczema patches

Thickened, red, long-standing patches of eczema that no longer respond to creams sometimes respond to low-energy pulsed dye laser. The laser light is absorbed by haemoglobin in the small dilated blood vessels supplying the inflamed skin, which reduces the redness and the inflammation those vessels sustain. The evidence consists of a pilot study rather than a large trial, so I use pulsed dye laser for localised areas only [8], as an addition to the treatment plan rather than a replacement for it.

LDM ultrasound treatment for eczema

LDM applies high-frequency ultrasound to the skin to calm inflammation and support recovery of the skin barrier. I use it as an adjunct for patients seeking an option between topical treatment and phototherapy, and for maintenance. The treatment is comfortable and involves no downtime.

Oral medicines for severe eczema flares

A short course of an oral antihistamine can improve sleep when itching is severe, although a Cochrane review found that antihistamines alone do not treat the eczema itself [9]. Antibiotics are added only when the skin is infected. Oral steroids are reserved for a severe flare and prescribed for days rather than weeks, because eczema commonly rebounds when they are stopped.

Biologics and JAK inhibitors for eczema, referral to a dermatologist

I do not prescribe oral Janus kinase (JAK) inhibitors or biologic injections such as dupilumab. Patients whose eczema is severe enough to require them are referred to a dermatologist, and I continue their skin care between specialist reviews.

Heat and sweat trigger eczema in the skin folds and on the neck, because sweat left on the skin irritates an already damaged barrier. Air-conditioning lowers humidity and dries the skin, which triggers eczema on the shins and forearms, and most office workers in Singapore move between the two environments several times a day. The measures I recommend to every patient are rinsing sweat off with plain water rather than soap, applying moisturiser within three minutes of showering, keeping showers short and warm rather than hot, and wearing cotton or moisture-wicking fabric against the skin. Dust mites thrive in Singapore’s humidity, and allergen-proof covers on mattresses and pillows can measurably reduce flares in patients sensitised to them.

Atopic dermatitis is the common, hereditary form of eczema that starts in childhood and follows a pattern of flares and remissions. I have written about it in detail in the atopic dermatitis guide. Contact dermatitis is eczema caused by a substance touching the skin, and is the type that patch testing identifies. Discoid or nummular eczema appears as coin-shaped patches on the limbs and usually responds to an adequate course of treatment.

Seborrhoeic dermatitis affects the scalp, eyebrows and sides of the nose and is treated differently, with antifungal and anti-inflammatory creams. Hand eczema, and dyshidrotic eczema, which forms small itchy blisters on the palms, fingers and soles, are often related to work exposures such as frequent hand washing and prolonged glove use. Psoriasis is frequently mistaken for eczema, and the distinction matters because the treatments differ. The differences are set out in psoriasis versus eczema.