Living with Eczema: From a Doctor Who Has It
Updated: Sep 29
中文摘要在文末
I don't usually write about myself. But this one only works if I do.
I've had eczema since my twenties. Dyshidrotic eczema, on my fingers — the kind that comes up as tiny deep blisters along the sides of the fingers, under skin that's too thick for them to break through easily. If you've had it, you already know the specific quality of that itch. If you haven't, it's hard to describe. It isn't on the surface. It's underneath, somewhere you can't reach, and no amount of scratching gets to it because the thing that itches is a millimetre below where your nails can go.
Which is why I used to bite my fingers.
I was working in KL then. And the memory that's stayed with me is being stuck in traffic — Federal Highway, evening, not moving — scratching my fingers against the steering wheel, and when that wasn't enough, bringing my hand up to my mouth and biting the sides of my fingers. Hard. Repeatedly. Because pain was at least a different sensation from the itch, and I would have taken almost any sensation over that one.
Nobody in the surrounding cars had any idea. That's the thing about hand eczema. You look completely normal. You're a young doctor in a car in traffic like everyone else. And you're privately unravelling over your own hands.
The parts nobody warns you about
The itch is the headline, but it's not what wore me down.
The sleep. Or the lack of it. I'd wake up having scratched in my sleep, which is a strange thing to be angry about — you can't even blame yourself properly, you were unconscious. Then a day of work on four hours of broken sleep, and everything is worse when you're tired, including your skin.
The hands being visible. Fingers are on display constantly. Handing something to a patient. Shaking hands. Holding a pen. Cracked, peeling, occasionally weeping fingers are not something you can put a long sleeve over. I got quite good at holding things a particular way.
The small humiliations. Hand sanitiser on cracked fingers is genuinely one of the more painful things I've experienced, and in a clinical job you're using it constantly. Squeezing a lime. Detergent. Anything acidic. A colleague asking, kindly, "eh, your hand okay ah?" and having to say yes.
The way it distorts your thinking. This is the part I most want other patients to hear. When something itches badly for months, it stops being a skin problem and starts being a mood problem. You get irritable. You get demoralised. You start to feel faintly ridiculous for being so affected by something so minor-sounding. "It's just eczema" is a sentence that has been said to a lot of people who were quietly suffering.
So when a patient sits in front of me and gets a bit emotional about their skin, I don't find that excessive. I find it completely reasonable.
The mistakes I made, as a doctor who should have known
Here's the embarrassing part. I made most of the same mistakes I now see in my patients. Having a medical degree did not protect me at all.
I under-treated. Used a cream for a few days, it improved, stopped. Flared again. Repeated that cycle for a genuinely long time before I sat down and thought about what I was actually doing.
I used the wrong potency for the site. Finger and palm skin is thick. Something perfectly adequate for the average forearm does very little there, and I spent a while concluding that treatment "didn't really work for me" when the honest problem was that I wasn't applying enough of something strong enough for long enough.
I didn't moisturise properly. I'd apply something thin, occasionally, mostly when things were bad. On the good days I did nothing, because the skin looked fine — which is exactly the moment the barrier work should be happening.
And I ignored triggers I could have identified in an afternoon. Constant hand-washing at work. Sanitiser. Not drying between the fingers. Not wearing gloves for washing up at home, because that felt fussy.
So when I say I'm not judging your Shopee cream, I mean it. My version of the same failure just had better vocabulary.
What actually changed
There wasn't a single moment. But roughly, three things.
I started treating flares properly and completely. When it comes up now, I use the right potency for hands, enough of it, for a proper duration — not two days, and not stopping the instant it looks better. It settles in about a week. Reliably.
I moisturise on the good days. This is the boring one and it's the one that made the biggest difference to the frequency of flares. Not the severity — the frequency. Emollient on the hands as a permanent habit, especially after washing them, especially at night.
I dealt with the triggers I'd been dismissing as too trivial to matter. Gloves for washing up. Drying properly between the fingers. Being sensible about sanitiser where I could. Individually, each of these felt too small to bother with. Collectively, they were most of the problem.
That's it. There was no miracle product. I want to be very clear about that, because if there had been one, I'd tell you what it was.
Where I am now
I flare roughly once every one to two years.
When it happens, I recognise it early — usually a couple of days of that particular deep itch before anything is visible — and I treat it immediately and properly, and it's gone within about a week. It's now an inconvenience. It's not a feature of my life.
The gap between "flares constantly, sleeps badly, bites his own fingers in traffic" and "occasionally has a mildly annoying week" is enormous. And nothing about my underlying condition changed. I still have exactly the same defective barrier and the same genetics I had at twenty-eight. What changed was entirely what I do about it.
That's the whole reason I write these posts, and the reason my consultations are mostly talking rather than prescribing. Roughly ninety percent of a skin consultation with me is education and ten percent is the prescription, and people are sometimes surprised by that. But the prescription is the easy part. Any doctor can write it. What determines whether you're still struggling in two years is whether you actually understand the disease — and if you do, you'll make better decisions in a hundred small moments I'll never be present for.
If you've given up
Some of you have been at this for years. You've tried things, they've failed, you've been told it's just eczema, and at some point you decided this is simply how your skin is.
I'd gently push back on that.
There's a difference between eczema that can't be cured — true, it can't — and eczema that can't be controlled, which is much rarer than the number of people living with uncontrolled eczema would suggest. In my experience most people who've "tried everything" have actually tried many things partially: right medication wrong duration, right idea wrong potency, correct plan abandoned at week two, good treatment undermined by a trigger nobody ever asked about.
That's not a failure of effort. It's usually a failure of somebody sitting down with you and going through it properly.
If you want that conversation, come and have it. I'm at Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments are better than walk-ins, because these consultations need time and I don't like rushing them.
Bring everything you've tried. And bring the frustration too — I'd rather hear it than have you sit there politely while I explain things you already know.
I do understand this one from both sides of the desk. That doesn't make me a better doctor than anyone else. But it does mean that when you tell me it's driving you mad, I'm not being polite when I say I know.
简要说明
我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan（皮肤与暗疮）。我是对皮肤有专长的普通科医生，不是皮肤专科医生。
这篇是我自己的故事。
我二十多岁开始有湿疹——手指的汗疱疹（dyshidrotic eczema），手指侧边长小水泡，痒在皮肤底下，抓不到。以前在吉隆坡工作时，塞车时会一边开车一边抓，抓不够就咬自己的手指，因为痛至少是另一种感觉。
最难受的不只是痒： 睡不好、手指外露没得遮、洗手液碰到裂口非常痛，还有情绪上的消耗——痒久了会变得烦躁、沮丧，还觉得自己「不过是湿疹」而不好意思说出口。所以病人在我面前情绪激动时，我一点都不觉得夸张。
我自己也犯过同样的错：擦几天就停、用的强度不适合手掌（手掌皮肤厚）、好的时候不涂保湿、忽略明明可以处理的诱因（洗碗不戴手套、指缝没擦干）。有医学学位并没有让我幸免。
后来改变的三件事：
发作时完整地治疗——用对强度、用足量、做完疗程，大约一周就好。
好的时候也涂保湿。这一点最影响发作的「频率」。
处理那些看似微不足道的诱因——洗碗戴手套、指缝擦干。单独看都很小，加起来却是问题的大部分。
现在我大约一两年才发作一次，而且一周内就能控制住。我的体质完全没变，变的只是我怎么处理它。没有神药。如果有，我一定会告诉你。
如果你已经放弃了：湿疹无法根治是事实，但「无法控制」比大家以为的罕见得多。多数「什么都试过」的人，其实是每样都试了一半——药对但疗程不足、方向对但强度不对、计划好但两星期就放弃、或者从来没有人问过你的诱因。
Klinik Dr Tan (Skin & Acne)，Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu。WhatsApp：017-234 7328。建议预约，因为这样的问诊需要时间。请把试过的药膏都带来。
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