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A former nursing student in Hong Kong killed her parents before taking her own life on June 17, leaving behind a suicide note that indicated she was tormented by her eczema.

Pang Ching-yu, 23, had previously posted in online forums about her skin condition and the side effects she suffered from taking steroids to treat it. She also blamed her parents for her eczema.

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“People with eczema giving birth to kids are worse than poor people giving birth to kids,” one post read. “If you’re poor, you can rely on your own hard work. With eczema, sorry, you have to suffer (your whole life) with no change.”

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In another post, she said having it meant “there’s nothing you can do except to wait and die,” and that her “social life (was) all gone.”

Hong Kong police said that a suicide note found in Ching-yu’s bedroom made reference to her chronic skin condition.

Eczema Canada describes the condition as a recurring, long-term inflammation of the skin for which there is no cure. Although eczema is a broad term that encompasses many different conditions, of which atopic dermatitis is one, the two terms are used interchangeably since atopic dermatitis is the most common of the group.

There’s a counterintuitive aspect to eczema that makes it especially problematic and which experts define as the “itch that rashes” as opposed to a rash that causes itchiness, because the itch starts well before the rash appears. Symptoms can range from mild dry, hot and itchy patches to severe cases where the skin becomes broken, raw and bleeding.

Eczema usually appears within the first six months of birth, and can continue into adolescence and adulthood. It is estimated that up to 17 per cent of Canadians will suffer from eczema or atopic dermatitis at some point in their lives.

While Ching-yu seemingly lay the bulk of the blame for her skin condition on hereditary factors, not all people with eczema or atopic dermatitis have a family history of it.

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“There is a strong genetic component to atopic dermatitis,” Dr. Aaron Drucker, a dermatologist and researcher at Women’s College Hospital and the University of Toronto, tells Global News. “Many patients have a family history of atopic dermatitis or related conditions such as asthma or hayfever. However, some patients have no family history of those conditions.”

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While eczema is largely viewed as dermatological condition, there is evidence that links it to some mental health disorders, although this is by no means an indication that it’s a given among sufferers.

Drucker says eczema is associated with increased rates of a number of conditions, including depression, anxiety and ADHD. In addition, the Eczema Society of Canada points out that its inflamed and raw appearance may lead to feelings of embarrassment, social withdrawl and low self-esteem, which can negatively impact mood and quality of life. Sleep disruption is also very common.

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In a 2014 study published in the Journal of Investigative Dermatology, researchers from Oslo University Hospital and Institute of Clinical Medicine found a link between teens with eczema and suicidal ideation. Of the 3,775 18- and 19-year-olds studied, 15.5 per cent of the eczema sufferers among them reported suicidal thoughts compared to 9.1 per cent of teens who didn’t have eczema.

In a subgroup analysis, suicidal thoughts were reported among 23.8 per cent of those who suffered from eczema and itch. The study concluded that eczema was associated with suicidal thoughts and mental health problems, however it was not linked to social problems.

In another study from 2017 out of the University of Copenhagen, researchers concluded that although eczema is associated with depression, anxiety and suicidal ideation, it did not show any increase in psychiatric consultations, hospitalization or suicide.

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Drucker is quick to point out that this is a field that requires a lot more research before drawing any definitive conclusions. With funding from the National Eczema Association and the Eczema Society of Canada, he has launched the first North American studies on suicide risk in atopic dermatitis patients.

“In one study, having atopic dermatitis was associated with twice the risk of suicide relative to the general population,” he said. This isn’t entirely surprising, considering the National Eczema Association estimates that more than 30 per cent of atopic dermatitis patients have a diagnosis of depression or anxiety.

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However, Drucker said, “in a second study, there was no association [with suicide risk].”

He is currently examining this question among people in Ontario.