Teen Eczema Q&A with Dr Lynn Chiam – Acne & Oily Skin & Warts

Dr Lynn Chiam, a consultant dermatologist who subspecializes in paediatric skin conditions

his blog has covered lots on children with eczema, but as they grow older, eczema may present a different set of challenges and in a different form (for instance, due to puberty). MarcieMom is privileged to have Dr Lynn Chiam of Children & Adult Skin Hair Laser Clinic, a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Dr Chiam is a mum to three young children and is expecting her 4th child at the end of the year.

More on Dr Lynn Chiam – Dr Lynn was formerly the head of paediatric dermatology at National Skin Centre, Singapore before leaving for private practice. She has vast experience in childhood atopic dermatitis and childhood birthmarks. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. She has published numerous articles and has contributed articles to various magazines and newspapers. She helped set up the Eczema Support Group for both children and adults and is currently the Medical Advisor to the group.

Marcie Mom: Apart from eczema, other common skin problems in teens include acne, oily skin and warts. Can you briefly explain each of these conditions? Also, can a teenager with eczema (i.e. dry skin) also suffer from acne or oily skin? And if yes, what’s your advice to managing two or more skin conditions?

Dr Lynn Chiam:

Acne - Acne can occur in adolescents and adults. It usually starts during the teenage years and is thought to be related to hormonal changes during this period. Most people will suffer from some form of acne during their teenage years.

Acne can be divided into predominantly comedonal (whiteheads) or predominantly inflammatory with papules (zits) and pustules (zits filled with pus). Large and deep zits can result in permanent scarring.

Acne can be triggered by oily skin, oily face creams, smoking and stress. Mild acne can be treated with creams containing benzoyl peroxide, antibiotics and tretinoin. Moderate acne may require oral medications such as antibiotics and oral hormonal tablets. Severe acne can be treated with oral isotretinoin. Oral isotretinoin is usually well tolerated and can result in long term cure. However, it must not be taken in pregnancy.

Oily skin – Oily skin (seborrhea) is a common cosmetic problem that occurs when oversized sebaceous glands produce excessive amounts of sebum. Sebum is the cause of oily skin and scalp. Increased facial sebum is also associated with the development of acne.

Sebaceous glands are microscopic glands in the skin that secrete sebum, which is made of fats, wax and the remains of dead fat-producing cells. Excessive sebum gives the appearance of shiny and greasy skin. In humans, they are found in greatest abundance on the face and scalp. Sebum is odourless but bacterial acting on it can produce odours.

Skin oiliness may vary according to age, gender, ethnicity and hot humid climate. During puberty, the activity of sebaceous glands increase because of heightened levels of the hormone known as androgens. In skin pores, sebum and keratin can create a “microcomedone” or “whitehead”.

A person with eczema can certainly suffer from acne as well as oily skin. As he enters puberty, a teenager with eczema can develop oily skin on his face (where the sebaceous glands are concentrated) while other parts of the body (with less sebaceous glands) remain dry. The increase in facial sebum can trigger acne.

In a person with eczema and acne, it is important that if he applies steroid creams to his face for his eczema, he avoid applying them over the acne-prone areas. This is because steroid creams can make the acne worse. Alternatively, he can use creams like Tacrolimus or Pemecrolimus to control his eczema as they are non-steroidal in nature and do not aggravate acne.

He should also use anti-acne cream only to the areas with pimples and avoid the eczematous areas as some anti-acne cream can cause skin dryness. Wash the acne prone areas with anti- acne wash while using a gentle soap for the rest of the face. Clean away excess oil from the face whenever possible. Do consult a dermatologist for advice and treatment.

WartsWarts are growths on your skin are caused by an infection with human papilloma virus, or HPV. Types of warts include:

  • Common warts, which often appear on your fingers, toes and on the knees.
  • Plantar warts, which show up on the soles of your feet.
  • Genital warts, which are a sexually transmitted disease.
  • Flat warts are skin- coloured and can appear in any area of the body.
  • Periungal warts prefer to grow at the sides or under the nails and can distort nail growth.

Warts are contagious and may spread from one area of the body to another or to others. There is no way to prevent warts.

In children, warts often go away on their own. In adults, they tend to stay. If they hurt or bother you or if they multiple, you can remove them.

There are many ways of treating warts. They include freezing it with liquid nitrogen, applying chemicals, electrosurgery (using heat to burn the warts away) and laser treatment.

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