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The following article is by Lea Wee published in Mind Your Body of the Straits Times dated 13 January 2011, Thursday
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By Lea Wee
Cases of children with eczema - a skin condition resulting in dry, red and itchy patches - are on the rise. But health experts cannot explain why.
Madam Diana Ng has tried everything to help her five-year-old son deal with a rash that keeps popping up all over his body, including his scalp.
Each month, the assistant director of a marketing communications department spends up to $400 on medication and moisturisers to soothe the angry rashes.
Recently, she borrowed an electrolyte machine which converts tap water into alkaline water for drinking. Reason: Another mother had told her that drinking alkaline water improved her children's health. If it helps to improve her son's eczema, Madam Ng plans to fork out $1,600 for a machine too.
Then there was laundry detergent additive she spent $130 on, because it claims to kill dust mites. Next on her shopping list is an air filter which will cost her about $700.
The itching is so bad that her son gets only 21/2 hours of sleep every night. He scratches his sores till they bleed.
Madam Ng does not like applying steroid creams on her son's rashes. These creams are prescribed by doctors to reduce the redness and itching. When used over long periods, they cause thinning of the skin and can slow down a child's physical growth.
Cases of children with eczema are on the rise here. At least one in five under the age of 12 is affected, a study published by National University Hospital (NUH) in 2003 showed.
In 2006, a report in the medical journal Lancet noted that cases of eczema among six- and seven-year-olds in Singapore rose from 2.8 per cent to 8.9 per cent in seven years.
In contrast, asthma cases in the same group fell from 15.7 per cent to 10.2 per cent.
Children with eczema have sensitive skin which reacts to triggers in the environment. Dry, red and itchy patches erupt, typically at the wrists, the backs of knees and the insides of elbows. Babies have flare-ups around their cheeks and mouths.
Associate consultant Lynn Chiam from the National Skin Centre said the increase is a worldwide phenomenon, especially in urban areas.
One hypothesis is that city kids are under-exposed to bugs and mites from young, so their immune systems cannot handle the triggers. However, this does not explain why asthma cases, which has the same triggers, has gone down in the same period.
Evidence has emerged in recent years to pinpoint a strong genetic cause for eczema. The gene, which produces the protein filaggrin to protect the skin, has been found to be defective in those with eczema.
A genetic predisposition is then triggered by environmental factors, the most common of which are house dust mites, said Dr Chiam.
Other triggers are heat, sweat, stress, food and dust, for instance, from nearby construction or renovation works.
With 150 children - or three out of four - showing up at the National Skin Centre each month with eczema, a workflow plan for doctors and a dedicated team of nurses to counsel patients and their families was put in place.
At NUH, there are nurses assigned to look after these children and their families.
Two out of every five children seen at the hospital's allergy clinic have eczema, said Professor Hugo Van Bever from the NUH University Children's Medical Institute.
General practitioner John Chiam, who is in private practice and has an interest in dermatology, sees one new case of childhood eczema every week, compared to one every fortnight five years ago.
It is not always possible to pinpoint the triggers but the good news is, three out of four children will outgrow the condition.
Dr John Chiam said the most effective way to battle eczema in children is to guide parents on the use of soap substitutes, moisturisers and medication such as steroids. Some soaps strip the skin of its natural protection so parents should avoid using them.
New-generation steroids have fewer side effects such as skin thinning. But Dr John Chiam warned that all steriods, when used long enough and in the wrong way, can cause side effects. This is why steroid creams should be applied in thin layers and children should stop using them once their eczema clears.
There are also non-steroidal creams available and they are safe and effective.
A few studies suggest that probiotics supplements may be beneficial, but other studies, including one done at NUH, have shown no such beneficial effect.
Madam Ng wanted to give probiotics to her son too. 'But the doctor said probiotics works only if my son starts taking it before he turns two," she said.
1 in 5 kids under the age of 12 has eczema
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