Quick Guide to Causes of Eczema: Is it Genetic?

Types of Eczema

Eczema is distinguished according to various subtypes. Discoid, dry and exudative eczema, pompholyx and papular eczema are common examples of the types of eczema affecting both children and adults. Eczema is also known as dermatitis. The disease can be classified according to the underlying causes of eczema. 

Acquired, External Causes of Eczema

Causes of eczema from acquired sources are due to external environmental factors. For example, dry weather or low temperatures can cause the skin barrier function to worsen, such as in temperate, winter climates. In addition, using excessively astringent products, such as those containing high levels of lauryl sulfates, or other types of detergents can strip your skin barrier and cause it to become dry. This is what we call exogenous eczema, or acquired eczema. 

Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre says “some individuals actually develop acquired eczema after allergic reactions. For example, nickel sensitization can occur throughout one’s lifetime due to exposure to costume jewelry, even if they do not have a history of nickel allergy. Most individuals develop nickel allergy in their mid life owing to chronic exposure of nickel present in costume jewelry.

This occurs most frequently in earrings as well as what is worn on the body including metal belts. That itself can constitute important causes of eczema, with a type known as allergic contact dermatitis. This is why we recommend wearing specifically medical grade surgical steel, 316L grade rather than just stainless steel, jewelry, as this eliminates the risk of nickel sensitization”.

External factors which are causes of eczema can also include cleansing methods. “Excessive handwashing, for example causes irritant contact dermatitis, a type of eczema that is caused by excessive irritation off the skin barrier causing it to lose its natural moisturizing properties as a result as increased water loss due to the environment, a phenomenon known as transepidermal water loss.”

Is My Eczema Genetic? 

According to accredited Singapore dermatologist Dr. Teo Wan Lin, “Dermatologists generally regard eczema-prone individuals as having a certain genetic tendency to develop skin barrier dysfunction. In fact, there is a very specific sign that dermatologists look out for to determine if the causes of eczema are indeed genetic. Genetic testing is usually not performed outside of clinical studies for the treatment and diagnosis of eczema. The important sign of a genetic cause of eczema is known as Ichthyosis Vulgaris.”

Ichthyosis Vulgaris is a genetic type of eczema that one can detect from  early childhood. It is a form of eczema or atopic dermatitis that presents itself as fish-scale like skin, commonly found over the front part of the lower legs. 

If you have noticed that on your skin, you are at high risk of developing moderate to severe eczema. Another form of eczema, known as asteatotic eczema or “eczema cracquele” can look similar, and both reflect moderate to severe disease which requires treatment by a dermatologist. 

Ichthyosis Vulgaris is a genetic condition caused by a deficiency in a gene known as filaggrin, which results in faulty production of ceramide. Ceramide is a fat molecule that joins skin cells together. It is essential for healthy skin barrier functioning. The stratum corneum is best envisioned as a brick and mortar model, where the skin consists of skin cells joined together by mortar. 

Why ceramide-containing moisturisers are important for eczema treatment 

Ceramide is produced by the body to protect itself against the external environment. This can be due to triggers such as pollen, dust, environmental pollutants.  It can also be caused by contact with harsh soaps or astringents.  The latter is part of common causes of eczema that results in irritant contact dermatitis.

How to know if you are prone to genetic causes of eczema

If you have a history of sensitive nose or airways which are respectively known as allergic rhinitis and asthma, then you may be at risk of developing atopic dermatitis.

This is a form of eczema that presents as a dry itchy skin condition affecting any part of the body. However, they can localise to areas prone to friction, such as the neck (collar area), underarms, elbows and knees, as well as under the breast in women. For these types of eczema, switching to a friction-free garment can help, on top of medical therapy that includes Ceramide-dominant moisturisers and prescription steroids. Prescription creams will be discussed with your dermatologist and adjusted according to the dose, strength and frequency of application. 

What if I have the dry skin symptoms?

The form of eczema known as Ichthyosis Vulgaris is significant because it is considered a marker for more severe eczema. If you have observed your skin having these symptoms from childhood, it’s very likely you have inherited it as a form of genetic dry skin.

 “Ichthyosis Vulgaris is transmitted through generations. Have a look if your parents or siblings also have the same fish-scale like skin on their legs. While one may not always develop itchy, dry skin symptoms in childhood,  with age, eczema symptoms may start manifesting,” says Dr. Teo.

Treatment of Genetic Eczema in Singapore 

Now what to do if you have Ichthyosis Vulgaris?

Firstly, if you currently do not have symptoms, it is wise to invest in a moisturizer that is formulated as a prescription emollient device (PED). 

“The PED type of moisturiser is actually the gold standard for eczema moisturizer therapy currently. It contains the ideal lipid ratio that mimics the skin’s natural composition of ceramides. Such a moisturiser formula also contains potent antioxidants that are formulated to reduce reliance on topical steroids. This is because it helps to reduce skin inflammation. Usually when the barrier is deficient, external allergens can trigger off an inflammatory cycle and this is when the skin starts getting red, itchy and may even develop pus and infection,” says Singapore dermatologist Dr. Teo Wan Lin. 

Dermatologist Recommended Eczema Moisturisers

An example of an excellent ceramide-dominant PED formula moisturiser is the Multi-CERAM cream by Dr.TWL Dermaceuticals, formulated for treatment and prevention of eczema. For those with genetic causes of eczema, this moisturiser is both comfortable, safe and effective to treat and prevent flare-ups. Use of this moisturiser can also improve the appearance of skin, especially if you don’t suffer from other symptoms such as flaking, redness or itching, this moisturiser alone is sufficient.

The moisturiser has been formulated to mimic the skin’s natural barrier and also be fully absorbed without leaving a sticky feeling on skin. In addition, it can also help to reduce skin inflammation and treat the underlying causes of eczema because it contains potent botanicals that have additional anti-inflammatory properties. 

Sudden appearance of Eczema on legs

Now if you have suddenly developed Ichthyosis Vulgaris as an adult, it is important that you visit an accredited dermatologist. The reason is because, in a small subset of cases that develop in adulthood is actually related to underlying malignancies, which can be dangerous if left undetected. This form of Ichthyosis Vulgarisis known as secondary Ichthyosis Vulgaris. 

Dr. Teo Wan Lin has authored a book, Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare, which provides comprehensive tips on skincare for eczema and dry skin sufferers. 

You may consult Dr Teo Wan Lin, accredited dermatologist of TWL Specialist Skin & Laser Center in Singapore where telemedicine consultations are offered for conditions such as acne, eczema , as well as other forms of facial skin conditions and body rashes. For more skincare tips, you may listen to her podcast Dermatologist Talks: Science of Beauty.