MUCH like her name, Cahaya Umairah Airidz has a smile that lights up a room.
The 8-year-old is the picture of health, dressed in a bright yellow skirt and white shirt, with a matching yellow headband on her long hair.
It's hard to imagine that just over a year ago, this smiling, confident child was in extreme discomfort due to severe eczema, a condition that affected her confidence, impacted her school life and even her ability to do the things that other children take for granted, like playing sports or being out in the sun.
Cahaya was first diagnosed with eczema when she was 4 years old and her life took a challenging turn.
Sleep and schooling were both affected whenever her eczema flared up. She would scratch even in her sleep, leaving her skin bleeding.
"In a week, she could only manage to go to school for one or two days and it was heartbreaking to see her cry in discomfort," says her mother, Azidah Khanib.
But since she started on biologics, a therapy targeted at the specific part of the immune system that is responsible for the inflammatory response in eczema, her condition has improved significantly, so much so that Cahaya is now exploring new ground as a child model.
Azidah says Cahaya needs to get the injectable treatment once a month and, at the same time, they carefully monitor her bathing routine to ensure she only uses products which are safe for her skin and don't trigger any reaction.
In school, she has finally been able to participate in sports. It's a huge step forward for the little girl who missed out on many childhood activities due to her condition.
The one thing she can't do is to consume too many sweets as that definitely triggers her eczema, adds Azidah.
Like Cahaya, university student Mirzan Shafeeq Mohammad Shazli has also been managing eczema since childhood.
The 19-year-old stays clear of scented or perfumed skincare and personal care products, and has to keep his skin well moisturised at all times. He's also on regular medication to manage his eczema.
When he was 12, he experienced a particularly bad episode when his skin turned very red and last year, during a trip to Port Dickson, he experienced a severe flare-up, resulting in his legs being covered with lesions and had to be admitted to the hospital.
But since eczema is present in his mother's side of the family and one of his siblings also has the condition, Mirzan has been educated since young about managing the condition.
Stress and extreme temperatures are triggers, he explains.
"Most of my friends understand and are supportive of my condition. They don't treat me differently."
While eczema is a challenging skin condition, it is possible to manage it and cope with daily life if one adheres to medical advice and avoids triggers, he adds.
UNDERSTANDING ECZEMA
WHILE there are many types of eczema, the most common is atopic eczema and it has a multi-factorial cause, says Kuala Lumpur Hospital consultant dermatologist Dr Moonyza Akmal Ahmad Kamil.
Being in a sweaty environment or experiencing stress can cause eczema to flare up, she adds, and the common affected areas are usually the folds of the skin, like the back of the neck or behind the knee.
A flare-up means skin is inflamed, with redness, scaliness and dryness.
While Malaysia is yet to have an eczema registry which would provide more data on the prevalence of the condition in the country, Dr Moonyza says at HKL, for every four new referrals to the dermatology department, one is an eczema case and generally, 25 per cent of referrals fall under the category of eczema.
"Eczema, if not properly managed, can significantly impact quality of life and day-to-day routine," she explains.
While there is a genetic link to the condition, it's not necessarily true that only those with a family history would develop eczema. There are eczema patients without a family history of the condition.
However, if there is a history of atopic diseases in the family, such as parents with bronchial asthma or allergic rhinitis, the child would have a higher risk.
Environmental factors also play a role and include things like dust and sweat, and reactions to chemicals in personal care products.
In general, the first step in treatment is "avoidance", says Dr Moonyza. This means one needs to determine one's triggers and avoid them.
Patients also need to keep their skin hydrated or moisturised at all times so bathing practices are a crucial second step in eczema management.
"Generally, we advise them to shower twice a day only and use products which have an appropriate pH level, not too acidic or too alkaline, and moisturise while the skin is still damp."
Unlike most people, those with eczema have skin that can't "hold" water, hence moisturisation is important.
They also need to be diligent in applying topical treatments which help reduce inflammation.
Dr Moonyza says some patients would be on conventional medication, while others may opt for the newer line of treatments such as injectables.
For very severe, whole body eczema or "recalcitrant eczema" which doesn't respond to medication, patients may be recommended phototherapy, where they are placed in a cabin with ultraviolet light.
Dr Moonyza says the time spent in the cabin would differ according to the dosage prescribed to the individual patient and patients may need between 20-30 sessions.
Treatment options for eczema need to be personalised, she adds, as some treatment options or medications may suit certain patients but not others. Finding out what works for a particular patient is important.
"Total cure is difficult, but with the newer approaches in treatment, we are seeing fewer hospital admissions due to eczema. The hope is that their condition can go into remission and stay in remission."