SINGAPORE — I still remember the look of confusion in the eyes of my four-year-old nephew one Saturday evening last year, whose innocent mind was likely wondering why his uncle’s face looked a little bit different than it normally did. 

I sat uncomfortably at the restaurant table, fully aware that he was scanning the colony of peeling, red, coin-shaped nodes that lined up across my forehead, over my eyelids and under my lips.

The bumps had spread mercilessly along my back, my arms and my legs as well, and it was hard to convince myself that I didn’t look like a freak. It was even harder to convince myself that others didn’t view me the same way.

In my mounting social anxiety, I had to excuse myself and head to a nearby washroom to breathe and cool down. I felt ashamed, exasperated and angry at why my body was behaving this way out of the blue. 

Later that month, a dermatologist told me that what I experienced was a flare-up of nummular dermatitis, or discoid eczema — a condition that causes skin to become itchy, swollen and cracked in circular or oval patches.

The damning reality of this prickly condition was having to wear long sleeves to hide my condition on hot and humid days, spending sleepless nights scratching myself awake, and dealing with the stress of a friend or a colleague pointing out my reddened skin.

After months of a consistent skincare routine and several rounds of pricey dermatological treatments, my condition gradually improved.

However, the scars and the few patches of eczema that remain on my body serve as a niggling reminder that a flare-up may just be around the corner. 

It’s a prospect that scares me to hell and back — more sleepless nights, more social anxiety and more money that I cannot afford to spend. 

I decided to speak to experts in dermatology and psychology to find out how I can better manage my condition and deal with these feelings of anxiety as an adult who has never had to deal with eczema.

ECZEMA AFFECTS 1 IN 10 ADULTS IN SINGAPORE

The first thing that surprised me was how prevalent eczema was in Singapore and around the world. 

Dr Lynn Chiam, a dermatologist at the Children and Adult Skin Hair Laser Clinic, said that the condition affects about 20 per cent of children and 10 per cent of adults in Singapore.

The latest statistics from the Global Report on Atopic Dermatitis 2022 showed that the percentage figures are the same for both age groups worldwide. 

In addition to the physical symptoms of eczema, a 2019 study conducted in France by skincare brand La Roche-Posay highlighted its psychological consequences — it found that more than 60 per cent of children with eczema reported having a lack of concentration in class due to constant itching.

This frustrating inability to focus is something I understand all too well.

My productivity and quality of work took a heavy toll during my flare-up, because my attention would inadvertently be directed to finding some sort of relief to the nagging itch.

Knowing that I was not going through this alone brought me some comfort, but I also wanted to know how I can go about managing my condition. 

Associate Professor Mark Koh, a dermatologist from the KK Women’s and Children’s Hospital, said that our genes determine the structural integrity of our skin barrier as well as our immune response to the external environment. 

He said that eczema patients may experience an over-reactive or hyper-sensitive immune response of the skin to environmental triggers such as stress, lack of sleep, heat, perspiration, dusty environments, dust mites, pets, insect bites and smoking.

Changing one’s lifestyle to minimise the exposure to such triggers can help with keeping eczema under control, Assoc Prof Koh added.

As for the itchiness eczema patients face, he said that constant scratching may expose parts of the skin to cells that can trigger an inflammatory response, which could result in a more widespread and persistent condition. 

Therefore, minimising the itch-scratch cycle is important to reduce the severity of eczema. 

Yet, some of these lifestyle changes are not easy to make.

Turning on the air-conditioning to combat the heat on this island, for example, can make your skin dry and aggravate the condition.

Often, the intense itch prevents one from falling asleep at night, which in turn causes the eczema to worsen, leading to more stress and a vicious circle of mental and physical fatigue. 

Dr Tham Siew Nee, a senior dermatologist at the TSN Dermatology Skin Specialist Clinic, said that to tackle this problem, using cold compresses or creams with menthol or calamine that give a cool feeling can help to provide relief.

Both Dr Tham and Assoc Prof Koh also said that taking oral antihistamines with sedating effects may be useful to help patients sleep better at night. 

Assoc Prof Koh suggested adopting a “comprehensive, holistic approach” to managing eczema, adding that the most effective therapies are directed at the underlying pathophysiology, the wide range of symptoms and the patient’s mental health.

ADDRESSING THE SOURCE OF STRESS

Ms Stephanie Tak, a counsellor with the psychological consultancy Mind What Matters, echoed Assoc Prof Koh’s remarks. 

She said that it takes people time and effort to adapt to and gain acceptance of a newly diagnosed medical condition.

Coping with eczema means not only managing the symptoms as prescribed by the dermatologist, but also taking the time to manage the stress or anxiety that may have been part of the equation in triggering the eczema in the first place.

“Taking care of our mental well-being can look differently for different people. It might involve addressing the source of stress, finding a coping mechanism that can serve as a temporary distraction, and also finding ways to relax the body and mind,” she added.

Hearing this, I thought about how I used to include an app-based guided meditation as part of my morning routine when my eczema was at its worst, which helped me to clear my mind, calm my nerves and reflect on the things for which I was grateful.

I decided to resume this routine, which helped to pull me out of the pits and fits of self-absorbed pity, thanks to Ms Tak’s reminder. 

Nevertheless, my body image issues remain to this day, and I staunchly refuse to wear sleeveless shirts outside the house and rebuke instantly any suggestion of heading to the beach or for a swim, so that I may hide my scars.

To this, Ms Tak said that in many cases, the fear of drawing unwanted attention or fear of judgement from others is unrealistic.

For example, one may have thoughts assuming what another person may think or say when they see the flaky red skin, but these are often “thinking errors” — a product of our own overthinking.

She also recommended that I overcome these hurdles by placing myself in the situations I have been actively avoiding, so that I can be proven wrong of these “inaccurate assumptions”. 

The journey to acceptance involves giving ourselves opportunities to face our fears, she said.

‘I AM MORE THAN MY ECZEMA’

I am acutely aware that while there are practical ways for me to keep eczema at bay, I have to accept that some things are ultimately beyond my control.

And the best way to accept it — and gain some semblance of inner peace — is to be more comfortable with who I am and how I look. That starts with facing my fears, as Ms Tak suggested. 

Although I agree with her reasons, it is still going to be difficult for me to step out of my own bubble of shame and confront my body image issues head-on.

It’s a step that I have yet to take. But I know if I am to believe that I am more than my eczema, I have to act like it.

My plan is to start with the small things and use the courage and momentum to eventually get where I know I need to be.

I guess I’ll start by heading down to the coffee shop in a singlet.