Eczema Treatment in Kota Kinabalu

Sep 10

8 min read

Updated: Sep 29

中文摘要在文末

Look, I'm going to be honest with you before we start anything else.

I have eczema.

Not the mild kind you get once and forget about. It started when I was in my twenties, on my fingers — dyshidrotic eczema, those tiny deep blisters along the sides of the fingers that itch in a way that's hard to explain to someone who's never had it. It's not a surface itch. It's underneath. And I remember driving in KL, stuck in traffic on the Federal Highway, scratching until it hurt, then biting my own fingers because scratching wasn't enough anymore. That's the part nobody talks about. You look completely normal. You're a functioning adult in a car. And you're quietly losing your mind over your own hands.

So when someone sits down in my clinic in Lintas Square and says "doctor, it's just a bit itchy," I already know. It's never just a bit itchy.

I'm telling you this because I want you to understand the perspective I'm writing from. I'm a GP with a strong interest in skin — not a dermatologist. But I've treated a lot of eczema, and I've also lived inside it. These days I flare maybe once every one to two years, and when I do, I know exactly what to do and it settles in a week. That didn't happen because I found a miracle cream. It happened because I finally understood the thing properly.

That's what I want to give you here.

What eczema actually is (and why it keeps coming back)

Eczema isn't a rash that you catch. It's not dirt, it's not "heaty", it's not something you did wrong.

Your skin has a barrier — think of it as a brick wall, where the skin cells are the bricks and the fats between them are the cement. In eczema, the cement is defective. It's genetic, mostly. So water escapes out, and irritants get in, and your immune system sits there permanently annoyed. Once it's annoyed, it itches. You scratch. Scratching damages the barrier more. More irritants get in. More itch.

That's the loop. And here's the thing — the loop is the disease. Not the redness. The redness is just what the loop looks like from outside.

Which is why "I put cream when it's red and stop when it's better" doesn't work. You're treating the redness. The loop is still running.

I say this to patients maybe ten times a day and I'll say it again here: eczema is managed, not cured. I know that's not what you want to hear. I didn't want to hear it either. But managed well, it becomes a non-event. Once every year or two. A week of proper treatment. Done. That is a completely different life from what most of my patients are living when they first walk in.

How I actually treat it

I'll be upfront about my style — I treat aggressively at the start, then taper down. Hit it hard, get the skin calm, then step down to maintenance. The exception is children, where I go much slower and gentler, and I'll write about that separately because it deserves its own post.

Roughly, this is how it goes.

If it's mild — a patch or two, not much sleep disturbance — a topical steroid for about a week is usually enough, plus a proper ceramide-based emollient that you keep using after the steroid stops. That last part is the whole game. The steroid puts out the fire. The emollient rebuilds the wall. People do the first and skip the second, then wonder why it's back in three weeks.

If it's moderate — widespread, disturbing your sleep, been going on for months — then it's a tapering steroid regime rather than a flat one-week course, plus switching your soap to a proper non-stripping cleanser, plus a bath oil, plus antihistamines at night so you actually sleep and stop scratching in your sleep. That combination is where most of my adult patients land.

If it's severe — raw, weeping, cracked, you haven't slept properly in weeks — then we go further. Wet wrap therapy, sometimes a short course of oral steroids to break the cycle. And if it's genuinely resistant to all of that, I'll refer you on for phototherapy or specialist input. I'd rather send you to the right person than keep you coming back to me out of pride.

Whatever tier you're in, my clinic will message you at around one week to ask how it's going. Not as a marketing thing. Because week one is when I find out whether my read on your skin was correct, and whether you're actually applying the cream the way I described, which — no offence — most people aren't. More on that in a moment.

About steroid creams, since you're already worried about them

You are. Everybody is. Someone on Facebook told you steroids thin your skin and damage your kidneys, and now you've got a tube at home you're too scared to use.

Here's the honest version. Topical steroids can cause skin thinning — if you use a potent one, on thin skin like the face, continuously, for months, unsupervised. That's a real thing and I've seen it. What causes it is unsupervised long-term use of the wrong potency in the wrong place.

What I've seen far more often is the opposite problem: someone with a legitimate flare using a steroid for two days, getting scared, stopping, flaring again, using it for two more days, stopping again. Months of that. The eczema never clears, the skin stays inflamed the whole time, and chronic inflammation does its own damage. The fear did more harm than the medicine would have.

Used properly — right potency for the right body part, for a defined period, with a plan to step down — steroids are safe and they work. That's the deal I make with patients. I'll explain exactly which one, where, how long, and when to stop.

And if you're still not comfortable, tell me. There are calcineurin inhibitors — tacrolimus, pimecrolimus — which aren't steroids at all and are especially useful on faces and for children. They're a genuine option, not a consolation prize.

If you don't want to use anything at all, I'll respect that too, but I'll be straight with you: moisturiser alone on moderate or severe eczema is not going to get you there. I'd rather tell you that honestly than send you home with something I know won't work just so you leave the room happy.

Sabah is its own problem

Living here changes the picture, and I think this gets underestimated.

Sweat and humidity are the number one trigger I see in KK. Sweat sitting on eczematous skin is intensely irritating, and here you sweat walking from the car park to the shop. It's not about being dirty. It's about salt and moisture sitting on a broken barrier all day.

Sea water — everyone assumes it's healing. For some people it genuinely helps, and for others it's a straight flare, especially if the skin is already cracked. You'll know which one you are after the first time.

Dust is the sneaky one. I had a patient with stubborn eczema on both ankles, and nothing else. Nothing on the arms, nothing anywhere else. That pattern didn't make sense to me. So we kept talking, and it turned out her office had started renovation works a couple of months before. Dust settling on the floor, all day, at ankle height. That was it. The treatment was straightforward once we knew — but the point is we would never have found it if I'd just written a prescription and moved on.

That's why my consultations are maybe ninety percent conversation and ten percent prescribing. The prescription is the easy part. Working out what your skin is reacting to in your actual life is the hard part, and it's the part that determines whether you're back in six weeks.

The mistakes I see most

I'll keep these short because I've got a whole post coming on this.

Chasing miracle creams from social media. There's an entire economy built on your desperation, and the products often contain unlabelled steroids anyway — just at unknown potency with no supervision.

Buying steroid cream over the counter and using whatever the pharmacy gave you, on any body part, indefinitely. Potency matters enormously. Face and groin are not the same as palms and soles.

Using it for one or two days and stopping the moment it looks better. This is probably the single biggest reason treatment "doesn't work".

Doctor shopping. Two weeks with me, no miracle, off to the next clinic, then the next. Eczema treatment needs a bit of runway. Jumping ship every fortnight guarantees you never get past the first step of anyone's plan.

Overwashing. Malaysians are clean people — sometimes too clean. Twice-daily long hot showers with strongly scented soap will strip whatever barrier you have left. My rule is clean enough, not too clean.

What about diet?

I get asked this constantly, and my answer disappoints people.

Treat the skin first. Sort out the diet second. If your barrier is broken and inflamed, no amount of dietary purity is going to fix it, and I've watched patients spend months on elimination diets with terrible skin the whole time.

That said — reducing sugar seems to help some people. If you've noticed a specific food reliably makes you itch, avoid it, you don't need my permission or a test. Probiotics, honestly, marginal at best. And please don't obsess over food diaries. The anxiety around it does more damage than most of the foods.

If you want to come and see me

I'm at Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. Walk-ins are fine, but an appointment is better because I don't like rushing skin consultations — they need talking time.

Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.

Bring whatever creams you've already tried, including the ones from the pharmacy and the ones from Shopee. I'm not going to judge you. It genuinely helps me to see what your skin has already been exposed to.

And if you've had this for years and you've given up — I understand that more than you'd think. But well-managed eczema is a very different thing from what you're living with now. It's worth one more try.

Steroid Creams, Children's Eczema