Atopic eczema is an itchy inflammatory skin disease with strong association with genetics and triggered by environmental factors and is often neglected by parents in the early stages. It’s a slow insidious killer of family harmony: often scratching, irritable, hyperactive, poor sleep quality, parents often get agitated and helpless.

 

In an exclusive interview with Dr. Goh Chun Hwee on his journey of understanding eczema through his children’s eczema problems, he shared with us how he first struggled with his first-born’s eczema issue, trying out many methods to control the skin condition, but was far from smooth sailing in the beginning.

 

He then slowly began to understand deeper about eczema and with the new knowledge, he slowly captured the effective ways of controlling and later on, preventing flare ups of eczema in both his children, who are now happy school-goers.

 

”When I just started my career as a paediatrician, I thought I knew everything about eczema. I know the theory, pathophysiology and the treatment, what could actually go wrong? My overconfidence backfired. I went through a lot of hurdles managing my son’s eczema. It was definitely not a smooth sailing process,” he said.

“Eczema typically happens after 6-12 months old. If it happens before 6 months, which we call infantile eczema- it’s usually more severe.”

 

With his first born, eczema started to appear due to heat as his house was very hot and it was facing the sun. Just like every other concerned parent, Dr Goh was initially hesitant to control the eczema with topical steroids. Instead, he opted for various moisturizers to alleviate the eczema symptoms. However, it wasn’t as simple as that. He tried different types of moisturizers, but his efforts were to no avail. After trial and error, he realised that the concept of one-moisturizer-for-all doesn’t apply in eczema. Moisturizer comes in the form of lotion, cream, or ointment. One may be suitable to this patient but may not be suitable for another.

“With eczema in kids, you need to hit hard and fast. Control the eczema as soon as possible and don’t let it become chronic.”

 

He then started his child on the mildest form of steroid, but by this time, his baby’s eczema had already spread to his whole body. “It was like taking a pail of water to put out a forest fire, so of course it didn’t work,” he said. The strength of topical steroids depends on the severity, chronicity of the eczema, and the location. Areas with more severe eczema or thicker skin may require more potent topical steroids.

 

There’s a saying that goes- if you’re not a parent, you can never understand another parent’s feelings. In Dr Goh’s case, he said, “you can be a paediatrician, but without hands on experience, there’s no way you can give practical tips on how to treat children.”

“Eczema is like a house on fire. When the roof is on fire and you ignore it, the fire will continue to burn but eventually burnout, leaving behind the charred remains. You then need to fix it by building another roof. In chronic eczema, this cycle repeats ceaselessly and that is why the skin becomes thickened.” – Dr Goh.

 

Throughout his journey, Dr Goh learned valuable lessons about eczema and how to handle children’s eczema- “The pathophysiology of eczema is the same in adults and children. However, children are not a mini version of adults. Hence, the concept of treatment might not be the same” he said. His lessons, which he wants to share with all parents are these:

 

1. Genetic predisposition is inevitable – If you or your spouse has a history of eczema, chances of your children getting it is higher.
2. Heat, sweat, scratch are your worst enemy – Try avoiding these to prevent eczema from getting worse.
3. Understanding the disease is far more important than the medication itself – You may use the best medication, but if you don’t understand the disease, it will recur repetitively.
4. Every child responds differently to a moisturiser – One moisturiser may work on one child and not the other.
5. Don’t be afraid of steroids – If you know what you are doing, you will not go wrong. Topical steroid reduces the inflammation and hence control the eczema.
6. Treat eczema like how you would treat your own house – Be attentive and meticulously take care of it.
7. It’s far easier to put out a small fire rather than blazing one – Treat eczema as soon as the littlest symptoms are showing.
8. Children are not miniature adults – Treating a child with eczema is different than treating eczema in adults even despite having the same prescribed medication.
9. Eczema is expensive – But it’s costlier to have uncontrolled one.
10. The quiet ones are the most dangerous – Eczema is a silent killer and may progress unnoticed by anyone. By the time it becomes apparent, it’s already severe.

 

Dr. Goh Chun Hwee is a resident General Paediatrician at Pantai Hospital Ampang. If you’d like to know about eczema and how you can help treat and control your child’s eczema www.pantai.com.my/doctors/goh-chun-hwee is where you can request an appointment.

 

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PARENTHOOD’S TIPS FOR ECZEMA MANAGEMENT

As parents, daily management plays a crucial role in reducing and prolonging eczema flare-ups in our kids. Besides being mindful of certain triggers such as certain foods or environmental factors, it’s important to establish a consistent skincare routine.

 

Step 1: Gentle Cleanse

When it’s time for a bath, the choice of soap becomes crucial. Opt for mild, fragrance-free, and hypoallergenic soaps or cleansers to gently cleanse your child’s skin. The aim is to cleanse without removing the natural oils that maintain skin health.

 

Bepanthen SensiWash supports healthy skin microbiome and is anti-itch^1-3. It has a high concentration of humectant to preserve the skin’s barrier and natural pH while increasing skin hydration. Bepanthen SensiWash also contains an alpha-glucan oligosaccharide prebiotic that supports a healthy skin microbiome and is safe for babies above 1-month-old.

 

Step 2: Keep Skin Moisturised

Maintaining moisture is crucial for ensuring healthy skin. Following a bath, use a hypoallergenic, fragrance-free moisturiser to establish a protective barrier that retains skin hydration.

Bepanthen’s SensiDaily is a daily moisturiser that is formulated for eczema-prone skin and is clinically proven to keep eczema-prone skin flare-free for up to 3 months^4-15. With the Derma-Defence Formula it strengthens 3 skin barriers of eczema prone skin.

Derma-Defence Formula includes:

• Prebiotics- to support the balance and diversity of the skin microbiome.
• Vitamin B5, B3 and humectants- to protect and strengthen the skin barrier while maintaining physiological skin pH.

 

3: For Unexpected Itchy Moments

For unexpected flare-ups, use Bepanthen Itch Relief Cream, a steroid-free formula clinically proven to relieve itchiness within 30 minutes, with the same efficacy to 1% hydrocortisone* (a mild steroid medicine). What sets Bepanthen apart is its unique Lipid Lamellar Technology^TM, mirroring the skin’s natural lipids. These lipids form a protective layer, offering quick relief from itchiness while promoting the skin’s healing process. With physiologic humectants like glycerin and Provitamin B5 (Dexpanthenol), this cream ensures long-lasting hydration, assisting the skin in recovering from any damage.

 

 

 

Last but not least, remember to have a healthy lifestyle with a balanced diet, adequate sleep, and stress management, as these factors can influence eczema symptoms. By incorporating these practices into your daily routine, you can significantly contribute to minimising eczema flare-ups and providing your child with greater comfort.

 

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REFERENCES:
1. Bayer Consumer Care. An open, intra-individual, exploratory, blinded (de-branded product) in-home use test aimed to assess the skin tolerability, cosmetic acceptability and the skin microblome effect of a Bepanthen SensiControl Daily Gentle Body Wash in combination with Bepanthen Sens/Control Daily Moisturising Cream in children with a history of atopic dermatitis over a study period of 4 weeks. IMPACT Number 21762. February 2022.
2. Peltier E et al. J Cosmet Dermatol 2022;21:3859-66.
3. Bayer Consumer Care. An open, intra-individual, exploratory, blinded (de-branded product) in-home use test aimed to assess the skin tolerability, cosmetic acceptability and the skin microbiome effect of a Bepanthen* SensiControl Dally Gentle Body Wash In combination with Bepanthen* SensiControl Daily Moisturising Cream in children with a history of atopic dermatitis over a study period of 4 weeks. IMPACT Number 21762. February 2022.
4. Stettier H et al. J Dermatolog Treat 2017:28(8):774-9.
5. Bayer Consumer Care. Multicenter, two-phase exploratory clinical trial to examine efficacy and safety after open-label topical administration of a medical device (Bepanthen Itch Rellef Cream) for treatment of acute flare-ups followed by topical administration of a new cosmetic Bepanthen product or a cosmetic comparator in a parallel-group, randomized, investigator-blinded care phase for skin care in the remission phase in infants with mild atopic dermatitis. IMPACT Number 17534. January 2017.
6. Stettler H et al. J Dermatolog Treat 2017;28(2):173-80.
7. Bayer Consumer Care. Cosmetic test to Investigate the effects of a topical cosmetic formulation (Bepanthol” Pumpkin, 067-14P) on transepidermal water loss (TEWL), hydration of the stratum corneum, stratum corneum lipid content and lipid lamaellae structure in healthy adult subjects with dry skin. IMPACT Number 17953. May 2015.
8. Stettier H et al. J Dermatolog Treat 2017:28(3):251-7.
9. Bayer Consumer Care. Cosmetic Study to Investigate the Long-Lasting (Corneometry I) and the Long-Term (Corneometry II) Moisturization of a Cosmetic Topical Formulation (Bepanthol” 067-14P). IMPACT Number 17594. April 2015.
10. Kong HH et al. Genome Res 2012:22:850-9.
11. Branco CT and Guimarães JP. H&PC Today – Skin Care Supplement 2015;10:21-7.
12. Luger T et al. J Dermatologic Sci 2021;102:142-57.
13. Cho YS et al. J Clin Med 2022;11:3943.
14. National Institute of Standards and Technology. Shannon Diversity Index. Available from: https://www.itl.nist.gov/div898/software/dataplot/refman2/auxillar/shannon.htm. (Accessed August 2022),
15. Edslev SM et al. Acta Dermato-Venereol 2020;100:358-66.
*Based on clinical pilot trial done on previous formulation of Bepanthen Sensiderm.