What Is Eczema (Atopic Dermatitis)?
Eczema, or atopic dermatitis, is a chronic inflammatory skin condition characterised by intensely itchy, dry, red, and weeping skin. It affects approximately 20% of children and 3–5% of adults in Singapore — higher rates than many Western countries, likely driven by our hot, humid climate and high dust mite prevalence.
Eczema is part of the "atopic triad" — many patients also have asthma and/or allergic rhinitis. It is not contagious and is caused by a combination of genetic predisposition (impaired skin barrier function) and immune dysregulation.
Diagnosis and Severity Classification
Dermatologists classify eczema by severity using the EASI (Eczema Area and Severity Index) or IGA (Investigator's Global Assessment) scales:
| Severity | Characteristics | Treatment Approach |
|---|---|---|
| Mild | Limited area, mild redness/itch, controlled with emollients + occasional topical steroid | Topical steroids, emollients |
| Moderate | More widespread, frequent flares, affects quality of life | Topical steroids/immunomodulators, phototherapy |
| Severe | Extensive, constant itch, sleep disruption, secondary infections | Systemic agents: cyclosporine, methotrexate, dupilumab |
Treatment Options
Topical Treatments (First Line)
- Emollients (moisturisers): The foundation of eczema care — restore the skin barrier. Apply 2–3x/day and within 3 minutes of bathing (wet wrap technique). Choose fragrance-free, hypoallergenic formulations.
- Topical corticosteroids: Anti-inflammatory; range from mild (hydrocortisone 1%) to very potent (clobetasol). Use the correct potency for the correct site — face and flexures need mild steroids; thicker skin can tolerate moderate-potent.
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus): Non-steroid alternatives; good for face and sensitive areas; avoid long-term steroid side effects.
- Crisaborole (Eucrisa): PDE4 inhibitor for mild-moderate eczema; newer non-steroid option.
- Topical JAK inhibitors (ruxolitinib — Opzelura): Newest topical option for mild-moderate eczema with rapid itch relief.
Systemic Treatments (Moderate to Severe)
| Treatment | Details | Estimated Cost (SGD) |
|---|---|---|
| Phototherapy (NB-UVB) | 2–3x/week; 20–40 sessions/course | $150–$300/session (private) |
| Cyclosporine (oral) | Fast-acting immunosuppressant; 3–6 month courses; kidney monitoring required | $100–$200/month (Rx) |
| Methotrexate (oral/injection) | Slower onset; useful for long-term control; liver monitoring | $50–$150/month (Rx) |
| Dupilumab (Dupixent — biologic injection) | IL-4/IL-13 blocker; transformative results in moderate-severe AD; injected every 2 weeks | $1,000–$2,000/month (private) |
| JAK inhibitors (baricitinib, upadacitinib) | Oral pills; rapid itch relief; latest systemic option | $1,500–$2,500/month (private) |
See our researched shortlist: subspecialty focus, credentials and clinic websites, checked against public records.
View the shortlist →Common triggers include dust mites (extremely prevalent in humid Singapore), pet dander, certain foods (dairy, eggs, nuts in children), sweat, heat, synthetic fabrics, stress, and harsh soaps or detergents. Singapore's climate — hot and humid — makes sweat-triggered flares particularly common.
Eczema (atopic dermatitis) is a chronic relapsing condition — there is currently no permanent cure, but it is very manageable. Many children improve significantly by adulthood. Adults can achieve long periods of remission with proper maintenance therapy. New biologics like dupilumab (Dupixent) offer excellent control for moderate-to-severe cases.
Dermatology consultations cost $80–$200+. Prescription topical steroids and emollients add $50–$150/month. For moderate-to-severe eczema, phototherapy (narrowband UVB) at private clinics costs $150–$300/session; dupilumab injections cost $1,000–$2,000/month but may be partially subsidised at public hospitals. CHAS patients can access subsidised GP treatment.
Both are chronic inflammatory skin conditions, but they differ in appearance and mechanism. Eczema (atopic dermatitis) is usually itchy, appears in skin creases (inner elbows, behind knees), and is associated with allergy. Psoriasis appears as thick, silvery-scaled plaques typically on elbows, knees, and scalp, and is driven by an immune response rather than allergy. A dermatologist can diagnose the difference on examination.
Medisave cannot be used for outpatient eczema consultations or medications. However, if eczema is severe enough to require hospitalisation (rare), Medisave applies. For subsidised outpatient treatment, CHAS cardholders receive subsidies at polyclinics and GP clinics. Patients on dupilumab at restructured hospitals may benefit from government subsidies.