Monday, November 30, 2015   

Beyond the surface

Apple Lam

Tuesday, August 27, 2013


Models who grace magazine covers with that clear, smooth skin on their faces and limbs represent an impossible ideal for most people. And the bar is raised even further for those with eczema and acne.

Atopic dermatitis is a type of eczema where the skin becomes dry and inflamed and causes intense itching. Once you scratch the skin, it becomes red and starts swelling, crusting, scaling and developing cracks. Eczema is usually found on the insides of elbows, the backs of knees and the face, and typically affects children under seven.

Acne - usually found on the face, a clearly visible part of the body, the chest and the back - also socially affects teenagers who are in the process of developing their self-image and self- confidence.

In 2011, Italian pharmaceutical giant Menarini Asia-Pacific commissioned the Atopic Dermatitis Quality of Life Study, which surveyed 1,028 mothers of children aged one to 16 years old who had moderate to severe atopic dermatitis. About 750 had children who were at least four years old.

Apart from causing physical discomfort, atopic dermatitis also makes the social lives of kids especially difficult. For example, 63 percent of mothers whose children were at least four years old reported that their kids avoided swimming or other sports for "very much" or "quite a lot" of the week in which they were surveyed.

Around 45 percent said that atopic dermatitis had a large impact on their children's friendships.

The pharmaceutical company conducted a separate online survey in India, Malaysia, the Philippines and Singapore from October to December 2012, during which 1,020 acne patients aged 18 to 35 were polled. The study found that 66 percent of respondents felt embarrassed and self-conscious about their acne and 37 percent said they only felt comfortable hanging out with close friends.

Acne is typically caused by a build- up of oil beneath the skin. Whiteheads and blackheads that appear on the skin are non-inflammatory.

The acne becomes inflamed when the bacteria that usually live in the skin feed on the excess oil, resulting in red and swollen pimples.

Ellis Hon Kam-lun, professor of pediatrics at the Chinese University of Hong Kong, said that in addition to doctors choosing the appropriate treatments and giving the right advice, the key to effectively treating eczema is educating parents to follow through with prescribed treatments.

For example, a pediatrician may recommend a moisturizer for a child with atopic dermatitis - a treatment recommended for mild, moderate and severe atopic eczema by the National Institute of Health and Care Excellence in the UK.

"But parents don't use it as they think it's too greasy. So we really have to spend time educating them how to choose one ideal emollient and to use it consistently," said Hon, who is also a pediatrician.

Another problem is the phobia about steroids. Parents opt for Chinese herbal medicine for their children rather than putting them on steroids. But there have been cases where Chinese medicine practitioners who are not reputable have given children herbal remedies that also contain steroids.

Hon described one of his patients, a boy who developed Cushing syndrome, a condition where the face becomes swollen and round due to prolonged exposure to potent steroids. "Chinese medicine is a very strong branch of science. But many people abuse it in the name of Chinese medicine."

As for acne, the idea that it is caused by lack of cleanliness is a misconception, said Giuseppe Micali, head of the department of dermatology at the University of Catania, Italy.

"Many teenagers wash their face three to five times a day and use aggressive and strong cleansers to remove oil," he said. "In the beginning, the cleansers dry out the skin. Then the skin reacts and produces more sebum, making the skin oilier. This increases the chances of a pathogenic bacteria skin infection."

Micali, who has been a dermatologist for 30 years, added: "If you compulsively wash your face, you make the acne worse."

The ideal cleanser should not clog pores, produce acne, irritate or cause an allergic reaction, so consumers should look for the following labels: "non- comedogenic," "non-acnegenic," "non- irritating" and "non-allergenic."

The Global Alliance to Improve Outcomes in Acne Group, an international group of acne experts, recommends antibiotics only for those who have inflammatory acne.

Micali said using antibiotics to treat mild acne is a common mistake made by dermatologists worldwide. And since there are no precise guidelines on how to treat post-acne scarring, people should manage their condition well.

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