Do home remedies really work? Dermatologist busts common myths about eczema & effective therapies

Atopic dermatitis, more commonly known as eczema, is a common condition in Singapore that affects as many as 10 per cent of the population, according to local skin specialist, A/Prof Steven Thng.

The cause of eczema may be due to a combination of factors such as genetics, environmental triggers, poor skin barrier and skin inflammation.

Eczema and inflammation

A/Prof Thng busts myths surrounding eczema, including the causes and onset of the disease.

“It is the poor barrier that increases chances of inflammation in the skin that causes eczema. Sometimes, the inflammation in the skin may be so extensive that inflammatory markers can be even found in the blood,” he explained.

And while eczema is often thought of as a condition that occurs in childhood, some patients do get it in adulthood and even well into their 50s or 60s.

“You may have the genes but you might not have the disease until something triggers it,” said A/Prof Thng, sharing that adult-onset eczema usually develops due to the deterioration of the skin barrier caused by ageing.

When it comes to the often-asked question of whether certain foods may trigger eczema, A/Prof Thng admits that it’s a “difficult question” to answer.

“Some food[s], if you're allergic to it, can cause increased itch, and that can worsen eczema. But food generally doesn't cause eczema,” said A/Prof Thng.

He rubbished claims from some people who believe that avoiding particular foods would make the condition disappear.

“That’s wishful thinking and never happens most, or all of the time,” said A/Prof Thng.

Myths surrounding home remedies

Some of the worst cases of eczema that A/Prof Thng has seen are those where patients come in with red, inflamed skin affecting “80 per cent to 100 percent” of their entire body.

“They [patients’ skin] are oozy, they’re itchy and they [patients] are depressed,” said A/Prof Thng, signalling how a physical condition such as eczema can have far-reaching consequences that can affect one’s mental state.

We can imagine how coping with an uncontrollable itch, as well as having to deal with bleeding, broken skin can be distressing, to say the least. And there is no known cure for eczema currently.

It is unsurprising therefore that out of desperation, many eczema patients would turn to purportedly effective home remedies found online as a salve for their condition.

A search on the internet throws out many solutions to soothe eczema symptoms — from oatmeal baths and coconut oil to taking supplements such as evening primrose oil.

The remedies, however, often do not have sufficient scientific evidence to back their claims, according to A/Prof Thng who goes through some of the more common ones with us.

“There are some articles that say oatmeal is anti-inflammatory, but there are no good, proper studies to say that an oatmeal bath is very useful,” said A/Prof Thng.

A/Prof Thng also shared that some construe a bleach bath — where a small amount of bleach is added to water — to be useful due to their belief that “bacteria on the skin drives eczema”, but there is no good evidence that a “bleach bath” works either.

This is a misunderstanding as the disease is far more complex and may be caused by a myriad of factors.

As for the use of coconut oil, A/Prof Thng opines that it is simply a substitute for regular moisturiser.

Moisturisers are an important cornerstone of eczema treatment as it works to restore the skin barrier.

He explained: “Anything that restores the skin barrier, be it moisturisers or coconut oil or olive oil, is an important part of treatment for eczema. But you can’t say coconut oil works better [as] essentially, it’s just a moisturiser.”

However, A/Prof Thng’s stance is that he won’t stop anyone from trying out such home remedies for themselves, if they believe that it works.

“I will tell the patient that if you think it is useful for you, please carry on. But if you try it a few times and you think it’s not getting better, then stop it.”

A/Prof Thng expressed doubts, too, on the benefits of evening primrose oil supplements in the treatment of eczema.

“From a science perspective, [evening primrose oil] doesn’t build the skin barrier, it purports to be mildly anti-inflammatory by preventing pro-inflammatory cytokines in some studies but there is no good studies to prove it and so most dermatologists don’t believe in this supplement,” he stated.

It’s a different story for Vitamin D supplements however, as Vitamin D is closely related to the immune system. “Some people could be Vitamin D deficient so it could help in a subset of patients,” said A/Prof Thng.

Advancements in eczema research and treatment

In recent years however, there have been significant advancements made in the research and treatment of eczema.

A/Prof Thng shared how studies have found that the skin condition is largely driven by a particular subset of white blood cells in the body that are hyperactive and exacerbate the inflammation in the skin.

And when it comes to medical treatment for the skin condition, A/Prof Thng, who has over 20 years of experience in dermatology, explained that steroid creams are still the primary course of treatment for mild cases affecting a smaller surface area, while oral medication such as immunosuppressants may be prescribed to patients with more severe forms of eczema.

However, topical steroids don’t do anything to modify the disease itself, unlike some of the latest drugs in clinical development for eczema today.

Biologics, which are typically delivered through injections, are one of the newest ways to treat eczema, and is one area in which A/Prof Thng anticipates huge medical advancements in.

Such drugs are believed to be able to inhibit specific white blood cell activities and modify the elevated immune response which drives the condition. With more research, they can also be delivered in a more personalised way to each patient enabling precision medicine in the future.

A/Prof Thng shared: “We are now able to design drugs that target specifically the subset of white blood cells [that drive eczema] so that the rest of the white blood cells are not being affected. And because it's very targeted, it is very effective and it's got minimal side effects. So that's what biologics is – a very precise, targeted therapy.”

New treatments and clinical trials

The field of biologics is an exciting one paved with possibilities in the treatment of eczema, but for new medicines to be dispensed to patients quickly and effectively, investigating the drug in patients – a process called a clinical trial, is part and parcel of the process.

A/Prof Thng does a good job of dispelling the myths and concerns about clinical trials.

He shared how one question he’s often asked by clinical trial volunteers is whether they are simply test subjects for experimental drugs.

A/Prof Thng typically assures them that “by the time that [the drug] comes to clinical trial, all the safety data would have been done to ensure that the drug is safe enough [to be administered], otherwise the regulatory bodies would never approve the trial”.

He described to us how many rounds of tests are usually done on volunteers for clinical trials — whether for oral medication or injectables — to ensure that volunteers are deemed suitable for the treatment.

“There’s also sufficient testing to make sure all their liver systems and cardiovascular systems and all the other organ systems are not affected,” said A/Prof Thng in assuring volunteers’ concerns about safety.

Some drawbacks however, are that scientists may not have a longer-term view on potential side-effects as yet. “But we can rationalise, based on the drug’s mechanism of action, whether it will have any longer-term side effects.”

There may also be other side effects, such as drug allergies, which clinical trial investigators would look out for.

One obvious benefit of clinical trials however, is that for patients with severe cases of eczema, clinical trials provide them with a precious glimmer of hope, especially when all else has failed.

“When all the drugs they’ve tried haven’t worked, they have to look for a new available drug,” said A/Prof Thng, who also candidly shared that “few participate in clinical trials from an altruistic perspective”.

A/Prof Thng also brings to attention how clinical trials basically “offer patients a way to try new medicines which would otherwise not be available to them”.

One way where patients can access such trials is through their dermatologists in major hospitals or at skin centres, where there would be information on the latest clinical trial in eczema that they may be eligible for.

“With the Covid-19 pandemic, everybody knows that you need clinical trials before the vaccines come. So this idea of being in [a] current trial is no longer such a fearsome thing as in the past,” he added.

This is a sponsored article by ASLAN.

All images via ASLAN