Sunday, May 31, 2009

STI: A lifelong itch

May 28, 2009


A lifelong itch

Architect Tan Boon Soo tells POON CHIAN HUI how eczema affects her mood as well as her social and work life


Never tell Ms Tan Boon Soo 'to itch is human, to scratch is divine'.


The architect and interior designer, 39, learnt about four years ago that she has eczema although she has had the condition for longer than that.


'It was discovered by accident,' she said. 'I went to a doctor for an allergy and he said that the red patches on my skin were actually caused by eczema.'


That was when she realised that her lifelong struggle with skin problems - that had spanned more than 20 years - could well be linked to eczema.


Eczema is a persistent inflammation of the skin's outer layer. It usually appears during childhood and can be a lifelong problem. Affected areas are often itchy and appear as tiny scales that are red and shiny.


Sure enough, Ms Tan, who is single, has had such patches since her teenage years, especially on her face, although she previously thought they were due to acne.


'My face was always as red as a baboon's backside, especially around the nose,' she said. 'Rudolph the red-nosed reindeer was my nickname.'


There is more. A few years ago, her right leg turned a frightening shade of dark brown when she scratched it.


'It felt very itchy and I was so frustrated - I just kept scratching and scratching,' said MsTan. 'I was very scared when I saw that my leg had turned almost black,' she said. 'I thought I was disfigured. I didn't know what to do besides wearing long skirts every day.' Fortunately, the discolouration faded after one month.


Her skin is so sensitive that even a few drops of dirty water can cause her eczema to flare up.


'Once, I was in a public toilet when someone at the sink accidentally splashed dirty water on me,' recalled Ms Tan. 'Moments later, my skin started to itch.'


Even so, she did not know that she was suffering from eczema. This is because she is allergic to numerous foods and her skin would erupt in unsightly hives and rashes at times. The mix of skin inflammation clouded the appearance of eczema.


It was uncovered only when she visited the doctor for an allergy.


Ms Tan was given a steroid-based cream, which she applies once a day. She felt 'very excited' when the redness cleared up for the first time, she said.


She also uses a mild facial wash, moisturiser and sunscreen daily to prevent her rashes from worsening.


However, she has not been cured of eczema. The cream only keeps the condition under control. She still experiences itchy patches occasionally, and these annoying episodes cause a significant amount of frustration in her.


There is the constant dread of not knowing when her skin will start itching again.


'I'm always worried that I won't look good on certain days, especially when I have to meet people for business or attend an event,' she said, adding that her mood dampens considerably if her eczema flares up.


'I won't feel like meeting people, so I'll just go home,' she said.


At work, she uses lots of make-up to cover the rashes when they occur.


'I'm used to it now, so I don't feel particularly distressed.'


Instead, she views her chronic skin problem with light-hearted pragmatism.


'There's no point in getting upset,' she said cheerfully. 'When I was a teenager, I did feel a little resentful but, after a while, I didn't think about it any more.'




Eczema refers to a category of persistent skin inflammation that is characterised by red, itchy patches.


The root cause of this condition is an over-reactive immune system, said Dr Cheong Wai Kwong, a consultant dermatologist at the Specialist Skin Clinic.


'Eczema is unlike fungal infections as it is not contagious and neither is it caused by external factors,' he said.


Instead, it is in the genes - some people are genetically predisposed to developing eczema. Most will also first experience eczema as a child.


The most common form of eczema in children is atopic dermatitis, which affects the skin at the joints. For adults, itchy patches tend to appear on the palms and soles, said Dr Cheong.


The condition is further classified into mild, moderate or severe cases.


Most people have moderate eczema, where they experience patches of itchy skin. In severe cases, the skin can be scaly, red, raw and 'weepy' from fluid discharge.


'However, the skin is raw mostly because of scratching, as severe eczema is extremely itchy,' said DrCheong. 'Sometimes, the raw skin may lead to bacterial infection.'


Typically, eczema can be worsened by exposure to specific environmental factors like dust, heat and sunlight, although this differs from person to person. Sweat is also a common aggravating factor.


Hence, eczema sufferers in Singapore may fare worse in general due to the tropical climate here.


A study done in 2000 showed that about 20 per cent of Singaporean children aged between seven and 17 had eczema, said Dr Cheong.


'This condition is often frustrating for sufferers and their families because it is chronic - there is no cure for the problem,' he said.


Instead, treatment for eczema involves recognising the factors that aggravate the condition and avoiding these triggers. Topical products and medication are also used to control the inflammation.


This includes moisturisers to counteract the dryness, cortisone tablets and steroid-based creams to reduce inflammation. However, the downside is that steroid creams may thin the skin.


The good news is, there is now a new branch of treatment that includes non-steroid creams and oral medication, said Dr Cheong.


Ultraviolet radiation therapy may be used for patients with severe eczema to reduce the degree of weeping wounds. Other medications that may be prescribed are antihistamine tablets for severe itching and antibiotics for infections.


All in all, eczema can be managed despite its chronic nature.


What may be more distressing are the social and psychological consequences that sufferers face.


Said Dr Cheong: 'There is a limit to the activities that they can participate in, like sports and other outdoor activities. For those who get better, they may experience much anxiety and uncertainty, as they don't know when the eczema will flare up again.'


A study showed that about 20% of Singaporean children aged between seven and 17 had eczema

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