This 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, adult pigmentary conditions and laser dermatology .
Puberty, Skin Changes and Eczema
As children move into pre-teen years and into puberty, what are some of the body changes that may trigger eczema?
Dr Lynn Chiam: As young children move into pre-teen and pubertal years, there are changes in the body’s hormonal profile and maturing of the sexual characteristics of the body. Sex steroids modulate skin thickness as well as immune function. It had been noted that under the age of 10, eczema occurs equally among boys and girls. However, from 10-18 years, eczema becomes more prevalent among girls. During adolescence, more girls develop eczema and more boys outgrow it. This suggests a role for gender-specific pubertal factors.
Are there certain parts of the body that are more prone to eczema at the onset of puberty? And is there any difference noted between eczema in a teenage boy versus a teenage girl?
As children mature, it has been noted that females with eczema had more problems with issues of clothes and shoes than boys. Significant itch and sleep disturbance affected both genders. The areas of the body affected by eczema remain similar between the two genders during puberty. More studies are needed evaluate the effects of hormonal changes on eczema.
In infants and toddlers (0-2 years), eczema tend to affect the face and scalp while in childhood (2-12 years), it affects the flexures (inner aspect of elbows, neck, back of knees), wrist and ankles. In adolescents, eczema tend to affect the eyelids, neck and flexures (inner aspect of elbows, back of knees).
Acne, Oily Skin & Warts
MarcieMom: 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?
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 in Teenagers
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.
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.
Warts and HPV
Warts – Warts 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.
Sweat & Sports on Eczema
Marcie Mom: Sweat can be a trigger for eczema and teenagers are at a very active stage of their life. If a child’s eczema is often triggered by sweat, would you advise parents to encourage their child to take up an indoor sport?
Are there certain sports that you think are better suited to eczema children? For instance, is swimming or squash or gymnastics more suitable than soccer or tennis?
Dr Lynn Chiam: Sweat and heat can be a trigger for eczema. However, it is best for a teenager with eczema to lead as normal a life as possible and participate in the sport he likes. Unless the eczema is very severe and difficult to control, I will not limit the choice of sports the teenager chooses. It is more important to know about good skin care and to apply creams correctly, which will help improve eczema, than to totally avoid certain sports.
If a teenager chooses to engage in a sport that’s outdoors and sweat a lot, what advice would you give him/her to manage the eczema?
Swimming for long periods during a bad flare of eczema is not advisable as the swimming pool water may cause more skin dryness.
I will advise that if you participate in a sport that will cause you to sweat a lot, to take a damp cloth to wipe away the sweat immediately after exercising followed by drying the skin with a dry cloth. If possible, take a shower using gentle soap shortly after the exercise and apply moisturizer immediately after bathing.
Cosmetics for Eczema
Teenagers may start to use (i) cosmetics, (ii) hair gel, (iii) anti-perspirant or (iv) wax arms/legs or shave. What would be your advice to a teen with eczema who wants to do the above (i) to (iv)?
Cosmetics contain fragrances and preservatives which may lead to allergic contact dermatitis (a rash due to allergy to the ingredients). A person with eczema has poor skin barrier function and may be more prone to skin irritation caused by cosmetics. If a teenager’s eczema flares with the use of cosmetics, it is important that she sees a dermatologist to do a patch test to check if she is allergic to the ingredients found in the cosmetics. If so, she will need to avoid that particular ingredient by reading the product labels of the cosmetics she uses. Always do a test spot by placing a small amount of the cosmetic on the inner aspect of the wrist. If there is no reaction after 1-2 days, then the cosmetic can be used on the face. Try to avoid using cosmetics over the areas affected by eczema. Cosmetics with a high water content are at a risk of being contaminated by bacteria and can pose a health risk to the user.
Try to avoid using cosmetics over the areas affected by eczema.
Hair Gel on Scalp Eczema
If a teenager’s eczema affects the scalp as well, it is advisable not to use hair gel when there is a flare of the eczema. If the scalp is not affected, it is recommended that a small amount of the hair gel is placed on a small area of the scalp first and to watch for any reaction. If there is no reaction after 1-2 days, then the hair gel can be used on the whole scalp. Always wash away the hair gel at the end of the day.
Anti-Perspirant and Allergic Contact Eczema
Anti- perspirant contains fragrances and preservatives can lead to allergic contact dermatitis. Again, do a test spot on the inner aspect of the wrist. Do not use the anti-perspirant if he develops any reaction.
Shaving and Micro-tears
Shaving and waxing of unwanted hairs can lead to micro-tears in the skin. Patients with eczema have an impaired skin barrier function and can easily get skin infection through these micro- tears. It is not advisable to shave or wax your hair if there is a flare of eczema. Laser hair removal, which does not cause micro-tears in the skin, is a more suitable way of removing unwanted hairs for patients with eczema.