Eczema 'remedies': Helpful or harmful?

Eczema is a common chronic dry skin condition that causes the skin to be red, scaly and itchy.

In severe cases, the skin may even weep, blister or bleed.

Patients have to avoid allergens and irritants, as well as keep their skin from drying out by moisturing it regularly.

They may also use topical steroids to bring flare-ups under control, and antibiotics if there is evidence of infection.

As there is no cure, many patients may look for natural or alternative treatments to deal with their condition.

Some of them do sometimes work, though there is not enough evidence to prove their effectiveness in every case, said Dr Liew Hui Min, associate consultant, dermatology service, KK Women's and Children's Hospital.

She advises parents to seek professional advice from a dermatologist before the eczema affects the child's and the parents' lives, as every case is different.

Here is a look at some of the available as well as touted treatments for eczema:

WET WRAPS

This is a method of covering the skin with an outer dry layer and an inner wet layer over an emollient or topical steroid.

It aids skin barrier recovery, increases the efficacy of topical steroids when used at the same time and protects the skin from persistent scratching, said National Skin Centre consultant Madeline Ho.

For years, wraps have been used as a relatively safe and efficacious intervention if there is no overt infection but they should be used only under medical supervision, Dr Ho said.

For instance, the use of wet wraps should be limited to a short-term period to minimise potential adverse effects of the body absorbing too much steroid medication.

BLEACH BATHS

In the United States, there is a novel treatment of soaking in a diluted bleach bath, which is recommended for recurrent infected eczema, said Dr Liew.

"There is good evidence behind the use of soaking the patient in a bleach bath for five to 10 minutes, three times per week," she said. "Like antiseptic washes, the aim of using a diluted bleach bath is to reduce the amount of bacteria on the skin."

A bleach bath is where patients add a small amount of household bleach to a bathtub of water and lie in it.

However, a diluted bleach bath should be attempted only under medical supervision and advice, cautioned Dr Liew.

The public may not be aware of how much bleach to use or how often they can use a bleach bath to treat eczema, she said.

If used inappropriately, bleach can irritate the skin and aggravate the eczema. Dr Liew said they have yet to try the new treatment on their patients as they have noticed that the parents of their young patients are not comfortable with it.

COCONUT OIL

It is said to be a good treatment for eczema as it can soothe the itch and reduce the inflammation caused by the skin condition.

There is, however, no evidence to prove its effectiveness in treating eczema, said Dr Liew.

Still, coconut oil is very moisturising and, if parents think it helps their child, they can continue using it, she said.

VINEGAR BATHS

Adding vinegar to bathwater can supposedly offer eczema patients some relief, though it can also sting open wounds.

Dr Liew said there are no studies to prove these baths are effective in treating eczema. But it may provide relief to some and can be used.

SEA-SALT SPRAY OR BATH

Sea salt is rich in minerals, which can supposedly help with the redness, itchiness and dryness caused by eczema.

Again, there is no evidence to prove its effectiveness in treating eczema, said Dr Liew, and it would irritate broken skin.

PROBIOTICS

These naturally occurring microorganisms or "good" bacteria are said to be able to control allergic inflammation at an early age.

Dr Liew said there is little data on probiotics helping allergic diseases.

"There is no harm if parents would like their child to try this, but they should continue with the topical treatment and consume a balanced, healthy diet."

VITAMIN D

A deficiency in this vitamin could be associated with the prevalence of atopic eczema.

But more studies are required to determine if vitamin D supplementation helps eczema, said Dr Ho.

'NATURAL' HERBAL CREAMS

So-called natural products are often assumed to be safe to use, but some may cause harm.

The British Association of Dermatologists (BAD) said these herbal creams can cause irritation and allergic reactions and some "natural" creams have been shown to contain potent steroids.

EVENING PRIMROSE OIL

These supplement tablets have been touted as a treatment but research has not identified any consistent benefit, said BAD.

HOMEOPATHY

This involves a method of treating diseases using highly diluted portions of a particular toxin to cure the very same symptoms that it would cause in large doses.

BAD said that there is no evidence to suggest that it is helpful.

Dangers of buying topical steroids overseas

The controlled and supervised use of topical steroids is a very effective and safe treatment for eczema.

However, some patients would purchase strong topical steroids over the counter overseas, which can lead to uncontrolled and unsupervised use, said Dr Mark Koh, head of dermatology service at KK Women's and Children's Hospital.

He pointed out that some traditional medications contain steroids but may not have the appropriate labelling to indicate their content.

"Another group of patients may go doctor-hopping, requesting oral steroids whenever they get a flare of the eczema," he said.

"Repeated oral courses of steroids can lead to problems like poor growth, high blood pressure, diabetes, stretch marks and cataracts, among others."

On the other hand, there is a group of parents who have steroid phobia, where they exhibit an inappropriate amount of fear towards using topical corticosteroids in treating eczema, said Dr Koh.

For instance, they may worry that their child will need a stronger steroid cream after using a lower strength one for some time.

But that is because the skin naturally thickens as the child grows, said Dr Koh. A stronger cream is thus needed to penetrate the skin.

Chronic scratching from poorly controlled eczema can also lead to thickening of the skin, he said.

"When parents stop using topical steroids too early or too sparingly, the eczema is not optimally controlled, and it flares quickly when the child is again exposed to triggers like dust or stress."

Poorly controlled eczema can result in repeated hospital admissions, poor sleep, slow growth and worsening school performance for the affected child, he cautioned.

"Together with a daily skin moisturising regimen, topical steroids, when used in the right strength, amount and duration, is still the mainstay of eczema treatment." 

This article was first published on Oct 6, 2015.
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