Like many sufferers of atopic dermatitis or eczema, Singaporean actress Jae Liew had to endure years of physical discomfort and emotional trauma over her condition as a child, before learning to cope with it in adulthood.

Atopic dermatitis is the most common form of eczema. It causes the skin to become red, itchy, dry and cracked. In more serious cases there can also be oozing of pus from the open sores.

A study showed that over 20% of children aged 6-7 years are affected by atopic dermatitis in some countries like Ecuador, while in India the prevalence is less than 1%. A prevalence of over 15% was found in regions like Africa, Latin America, Europe and Oceania.

Everyone’s atopic dermatitis is different, but common triggers include stress, sweat, detergent, additives, flavourings, dust and pollen. Some foods can also trigger flares in infants and children.

Jae Liew, actress and ‘skin positive’ advocate, has suffered from atopic dermatitis since she was a child. In her primary school years, she endured regular flare-ups at the back of her knees, insides of her elbows, her neck and lips.

Specific triggers would cause her eczema to flare up, including heat and sweat, dust, furry objects and specific materials. She also has a strong genetic predisposition to the condition, as her entire family has been suffering from eczema in one form or another.

“As a child, the way we managed my condition was to remove all these triggers from the house. So I grew up without soft toys, I never wore materials like wool, and all dusty things were kept away. But it’s tough to avoid heat and sweat in our climate. Once my body got overheated and sweaty, my eczema would flare up,” says Jae.

Some mornings, Jae would wake up with her clothes stuck to her skin because of the oozing, and she would have to run her clothes under tap water to get the fabric ‘unstuck’.

“Quite often I would wake up to find that my bed sheets were stained with blood because I had been scratching in my sleep. It was really traumatic as a child to wake up to blood-stained sheets,” she recalls.

The itch-scratch cycle

For most people with eczema, the itching is usually the worst and most uncomfortable symptom. Scratching the itch is not only counterproductive for patients with eczema, but is bound to aggravate the condition.

In fact, a recent study on atopic dermatitis has shown that itching has significant adverse effects on patients’ quality of life, which can trigger depression, anxiety, sleeplessness and even suicidal thoughts.

According to the National Eczema Society (NES), the sensation of itch in eczema occurs when nerve-endings are stimulated by different factors such as external irritants, dry skin, eczema flares and so on. This causes the sensation of ‘itch’ which is transmitted to the brain, and then triggers the automatic response to scratch. This makes the itch-scratch cycle a vicious cycle for people with eczema.

However, telling someone with eczema not to scratch is easier said than done, particularly if you’re telling a child.

In its ‘Itching and Scratching Booklet’, the NES refers to this as a neurogenic itch, whereby the response to scratch can become an unconscious and conditioned response, or learnt human behaviour even in babies, making it difficult to control.

Treatment and management

While some children do outgrow atopic dermatitis, others are stuck with it for life. The condition can be complex to treat as it is usually caused by a combination of factors.

For most people, the condition is managed with a combination of minimising contact with triggers, breaking the itch-scratch cycle, and the use of prescribed medication or topical steroids.

Over the years, Jae has been prescribed various medications or treatments to manage her condition, including pinetarsol solution to shower with in place of soaps, creams containing urea and ceramides, and anti-histamines.

“Finally, when the flare-ups had gotten so bad that my skin was bleeding and it was affecting my day-to-day activities and sleep cycle, my doctor prescribed Elomet (a steroid cream). Out of all the treatments, Elomet is the only one that has brought any form of relief for me,” shares Jae.

Certain lifestyle and behavioural modifications have also helped her better manage her condition over the years.

In addition to avoiding her known triggers, she has developed a mechanism of swinging her arms back and forth whenever she feels an itch coming on, to distract herself – much to the amusement of her friends. She also keeps her nails very short all the time.

Jae ensures her skin is well moisturised, particularly after a shower, and tries to avoid the sun to prevent perspiring.

“I also try to manage my stress level by going for activities like yoga, and being sure to change out of my sweaty clothes after exercise as soon as possible,” she shares.

When she does feel an itch coming on, Jae often places an ice pack, wrapped in a tissue, against her skin to distract her from the urge to scratch.

Other useful tips that can help patients, even children, to prevent scratching include the ‘rubberband snapping’ method – the patient wears a rubberband on the wrist and twangs it against the skin whenever they feel an itch coming on; as well as wearing gloves or mitts while sleeping, and applying moisturiser to the itchy area. These work by taking the patient’s focus away from the itch and reducing their urge to scratch.

As a working actress, Jae is regularly exposed to cosmetics and skincare products that could contain potentially harmful ingredients to her skin. Instead of using these and risking a flare-up, she brings her own products to the set.

Better safe, than itchy
As a working actress, Jae is regularly exposed to cosmetics and skincare products that could contain potentially harmful ingredients to her skin. Instead of using these and risking a flare-up, she brings her own products to the set.

“I personally stick with products that I already know work for me. The temptation to try on new products can sometimes be very overwhelming, but I really feel there is no shame in sticking to what you already know works well on your skin.

“I also personally look out for the presence of certain essential oils and certain alcohols in the ingredients list because I know they cause my skin to flare up,” says Jae.

Rather than allowing the condition to affect her self-esteem, Jae has chosen to speak out about it on her social media platforms.

“There is so much misinformation out there about eczema, and I felt that I had to say something, because many others are probably going through the same situation. So I started by posting a selfie without any makeup or filter, and I received so many messages from my followers, both positive and negative. Many of my followers have also started to reach out to me to ask for advice for their situation,” says Jae, who continues to create awareness on atopic dermatitis through her platform.

While she does not dispense medical advice, she advises those who are suffering from atopic dermatitis or eczema to consult a doctor if the condition causes disruption to their daily lives or affects their sleep.