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Eczema: Are We More Prone To It As We Get Older?

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Eczema: Are We More Prone To It As We Get Older?

Summary:

  • Eczema can significantly disrupt daily life, especially in Singapore’s hot, humid climate, with triggers like sweat, dust, and pet dander causing flare-ups that can lead to hospitalisation and social withdrawal.
  • The condition is common among the elderly due to dry skin, environmental factors, and reactions to products, with itchiness being one of the most debilitating symptoms and a major impact on mental and emotional well-being.
  • Effective management focuses on moisturising, gentle skincare, avoiding irritants, using anti-inflammatory treatments when needed, and maintaining a balanced diet – while recognising that systemic steroids are not a long-term solution.
Imagine living in a hot and humid country like Singapore and having to wear long-sleeved clothes year-round. This is a reality for Constance Ong, who has a chronic skin condition known as eczema.
Having eczema has changed the way I dress. I cover up completely now, to protect my skin,
the 60-year-old reveals.

"It has also affected my lifestyle. I no longer exercise as perspiration makes me itch."

"When I have a really bad flare-up, I try not to meet people I don't know well. I also keep myself to one room in the house to avoid pet dander and keep it really clean."

Constance says she “always had” eczema. They appear as little patches on her neck, elbows, and behind her knees. However, it got worse two or three years ago. She had a particularly bad breakout last year and had to be hospitalised. She was given an intravenous anti-viral treatment for a week and it cleared up very well.
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When she stopped topical steroids treatment however, she had a rebound.
I was on holiday in Japan at that time. My legs swelled two-and-a-half times and my skin was constantly seeping,
Constance recalls.

"I came back to Singapore immediately and was hospitalised for five days for monitoring."

Constance tries her best to avoid allergens and to manage her symptoms “because medicine is for life”. The two most triggering things for her are dust and pet dander. She has pets – three dogs. But if her dogs are clean, she is okay.
Eczema in Singapore
Dr. Evelyn Tay, founder and consultant dermatologist at Lumine Dermatology & Laser Clinic, describes eczema as a condition characterised by itchy, sensitive, and dry skin.
Underlying this is often inflammation in the skin due to a weakened skin barrier, predominantly due to the reduced ability of the skin to retain moisture,
she says.
Eczema: Are We More Prone To It As We Get Older? - Associate Professor Lee Haur Yueh
Dr. Evelyn Tay
Credit: Lumine Dermatology & Laser Clinic.
Dr Tay adds that there is a high prevalence of eczema in tropical Singapore, and increasingly so over the years.
The hot and humid weather in Singapore induces perspiration and some individuals with eczema are sensitive to certain components of sweat, which can then irritate the skin,
she explains.

"Tropical weather also favours the growth of house dust mites, which is a common trigger for atopic eczema in our local population."

Associate Professor Lee Haur Yueh, senior consultant, department of dermatology at Singapore General Hospital, reveals that although eczema commonly affects the young, people of various ages can have it. And, although eczema often starts in childhood, it can improve and recover, only to reappear in the later stages of life.
Our skin gets drier with age. The use of certain products such as hair dyes, fragrances, and scented personal care products can bring on contact dermatitis, which is a form of eczema that is related to an allergic reaction to things that are applied,
he adds.
Assoc Prof Lee shares that eczema was the most common skin condition affecting the elderly from 2004-2018 – based on a cohort study done from patients attending the National Skin Centre.
Meanwhile, Dr Tay adds that a questionnaire-based survey in a primary care setting in Singapore found that 81.6% of elderly had dry skin, and the chance of having dry skin increased by 13.5% with each additional year of age.
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Treating eczema
Itchiness is often the most important symptom to address for someone with eczema as it can have a severe impact on their lives, says Dr Tay. An itch can often lead to disrupted sleep and excessive scratching, which may result in broken skin or bruising, especially in the elderly whose skin is more fragile. This can then lead to secondary infections in the skin.
The impact of eczema on one’s mental health also cannot be underestimated. Uncontrolled eczema can impact one’s self esteem and social life, leading to social withdrawal or depression,
she adds.

"Some individuals may conclude that the eczema is solely due to the consumption of certain foods, leading to the adoption of restrictive diets that may impact overall nutrition."

Treating eczema is down to using moisturisers and non-soap cleansers, says Assoc Prof Lee. This helps to increase moisture and repair the skin’s barrier function.
Eczema: Are We More Prone To It As We Get Older? - Associate Professor Lee Haur Yueh
Associate Professor Lee Haur Yueh
Credit: Singapore General Hospital
In areas that are inflamed, topical corticosteroid creams or other anti-inflammatory creams may be helpful,
he adds.

"In severe cases, phototherapy, oral tablets that help to modulate the immune system, or injections known as biologics may be helpful. Systemic steroids should not be used to treat eczema in the long run."

It is, therefore, important to adopt good skincare habits as we get older. Dr Tay suggests selecting a fragrance-free, hypoallergenic, pH neutral wash for bathing, as well as avoiding harsh soaps or scrubs to maintain the skin barrier.
If the skin is itchy, avoid using hot water or caustic substances on the inflamed skin, which may temporarily alleviate the itch but lead to further aggravation of the inflamed and dry skin shortly after,
she advises.
A diet rich in omega 3 fatty acids is also recommended, which improves cardiovascular health and may also help with skin health. Having a healthy balanced diet, which incorporates foods with antioxidant and anti-inflammatory properties, can also help reduce inflammation in the skin.
Finally, when travelling overseas, recognise that the skin may react differently,
she adds.

"For those with sensitive skin, bring travel-sized portions of gentle cleansers and moisturisers with a thicker consistency than what you're used to in Singapore. This is to compensate for the increased water loss from the skin when the humidity and temperature drops."

As someone who has lived with eczema for many years, Constance knows a lot about other people’s opinions on her condition. And she shares that what irritates her most is people telling her “don’t scratch”.
Eczema can be really itchy and irritating. I know that they mean well, but when people say that, it adds to the annoyance,
she explains.

"Also, sometimes when we pick off skin, there may be remnants left behind…but people should know that it’s not contagious."

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