ACNE

Acne is very common and very treatable.
Let us show you how.

Among the most common skin problems we treat are breakouts, pimples and acne. Even though acne is very common in teenagers, do not be tempted to ignore it and think it is a normal part of growing up. It can sometimes lead to permanent acne scarring if the acne is severe and treatment is delayed. Acne can also have a significant impact on confidence and social wellbeing. While extremely common in teenagers, adult acne is also on the rise and can persist to the ages of 30s or 40s. As acne can leave permanent scars, it is very important to get effective treatment early and we are here to help.

There are many types of acne making an assessment by a trained dermatologist an important first step before appropriate treatment can be prescribed and tailored to your type of acne. There are also other skin conditions that can look remarkably like acne but will not respond to the usual acne medications. Your experienced dermatologist will assess your skin carefully before recommending any treatment.

TREAMENT & CARE FOR acne

The excellent news is we now have highly effective treatments for breakouts and acne. Our management strategies follow international guidelines:

• Mild acne - Special anti-inflammatory, anti-comedonal cleansers, prescription-only antibiotic and anti-inflammatory creams
• Moderate acne - Oral antibiotics, hormonal treatments in combination with prescription-only creams
• Severe acne - Vitamin A derivatives (Oratane) are highly effective for switching off severe acne. It can reduce the size of oil glands, oil production, skin cells clogging up pores and inflammation. Lower doses are used in our practice as it provides excellent results with minimal side effects. Your safety whilst taking these tablets will be ensured with close monitoring by your dermatologist. A course of treatment typically lasts 10–12 months, depending on severity. Large majority of patients who take it achieve excellent clearance of their acne, experiencing long-term remission of acne symptoms.

Lastly, if you have any remaining marks or scars left by previous acne, we can discuss laser treatments and injectables available to improve the appearance of your skin.

Lasers for acne scars

Acne scarring on the face can often be a source of embarrassment and dissatisfaction. Once active acne is controlled, you can embark on a course of acne scar laser treatments to improve the appearance of scars. We use top of the range lasers to effectively target acne scars including:

• Fractional CO2 Smartxide laser – to treat deeper scars that cause depressions and textural irregularities on the skin
• Picoway laser – to fade brown marks quickly; also treats mild to moderate scars
• Pulsed dye laser ( VBEAM) – to fade pink or red marks quickly, also improves textures

By utilising a variety of lasers to target different post acne scar issues, we always aim for minimal downtime with maximal effects. Stronger laser treatments may have downtime of around a week and you will be informed of these beforehand. Usually, a course of repeated treatments, at 4-6 weekly intervals, are required to resurface the skin and improve the appearance of acne scars.

It is important that you avoid a tan before or after your laser treatment to minimise the risk of post laser pigmentation. Before performing the treatment for you, your dermatologist will have an honest discussion with you about the predicted outcome, the estimated number of treatments required, and the possible downtime or complications. We are highly focused on the delivery of good outcomes with the lowest possible risk.

Scientific publications related to acne

Dr Ho has always had a deep interest in the treatment of acne post inflammatory hyperpigmentation and acne scarring, resulting in collaborative studies with eminent Hong Kong dermatologists and the publication of several articles in scientific journals.

• Chan NP, Ho SG, Yeung CK, Shek SY, Chan HH. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers Surg Med 2010 Nov; 42(9): 615-23
• Chan NP, Ho SG, Yeung CK, Shek SY, Chan HH. The use of non-ablative fractional resurfacing in Asian acne scar patients. Lasers Surg Med 2010 Dec; 42(10): 870-5
• Ho SG, Yeung CK, Chan NP, Shek SY, Kono T, Chan HH. A retrospective analysis of the management of acne post-inflammatory hyperpigmentation using topical treatment, laser treatment or combination topical and laser treatments in Oriental patients. Lasers in Surgery and Medicine 2011 Jan; 43(1): 1-7

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ALLERGIES

Allergies are common. It is a hypersensitive reaction to a substance, medicine, chemical or food, which triggers a range of symptoms including a skin rash, swelling, sneezing and asthma. Allergy testing help determine the substance or allergen that can provoke an allergic reaction in a particular individual.

Common allergens include medicines, chemicals, airborne substances and foods.

Your dermatologist will work with you to determine if there are potential allergens causing your symptoms and arrange for specific tests if appropriate. These may include a skin prick test, patch test or blood test (RAST test).

TREAMENT & CARE FOR ALLERGIES

If an allergy is determined, avoidance will be recommended. Other medications can also be advised to reduce any symptoms.

Corns and calluses

Corns and calluses are areas of thickening, most commonly found on pressure areas of the feet. They can sometimes cause significant pain, discomfort and even difficulty walking. Corns and calluses are caused by repeated friction or pressure to a specific area.

It is most important to have your corns carefully examined by a trained dermatologist as they can look remarkably like viral warts. Treatment of these two similar looking conditions is quite different. Your dermatologist will assess the affected areas with specialised magnifying devices and pare down the area for accurate diagnosis before suggesting the appropriate treatment.

TREAMENT & CARE FOR Corns and calluses

Important principals for the management of corn would include:

• Choosing comfortable, padded footwear
• Using protective cushions or insoles for added protection
• Soaking and paring down the thickened skin regularly
• Applying medicated ointments to help treat the thickened skin
• Sometimes referral to an orthopaedic surgeon or podiatrist may be necessary

If a wart is discovered, other treatments such a cryotherapy or CO2 laser will be discussed.

Dandruff

A dry and flaky scalp is often due to seborrheic dermatitis, more commonly known as dandruff. This is a chronic recurrent condition that can result in redness, itching and flaking of the scalp. It may also affect the ears, eyebrows and sides of the nose, causing redness and flaking.

The cause of seborrheic dermatitis is thought to be a combination of overproduction of skin oil and irritation from a yeast called Malassezia. Malassezia can be found on most people’s skin but people who suffer from seborrheic dermatitis are especially sensitive to it. Although this is not a condition that poses any health risk, it can be irritating and embarrassing for sufferers.

TREAMENT & CARE FOR Dandruff

• Anti-fungal shampoos - these can reduce the intensity and frequency of flares, reducing the flaking.
• Tar shampoos - these can be used to control itching, inflammation and flaking.
• Steroid scalp lotions - can be used in conjunction with shampoos to control the symptoms.
• Anti-fungal and mild steroid creams - these can be applied to the affected areas of the face and ears to control redness and flaking.

As seborrheic dermatitis is often a pesky recurrent problem, both an active and maintenance regime will be taught for optimal control.

Facial rashes

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Facial rashes are common and distressing, causing embarrassment as well as discomfort. Such rashes may present as red itchy rashes, dry scaly patches, blisters, bleeding or hives. They may affect a small area or be spread over the whole face. The possible causes of facial rashes range from mild to extremely serious. It is important to see a trained dermatologist so that a thorough history and examination can be taken to ascertain the cause of your facial rashes. Investigations such as blood tests and a skin biopsy may sometimes be required.

Possible causes include:

• Eczema or Allergies – The itchy red patches of eczema commonly affects the face of children. In adults, facial eczema may sometimes be due to irritation or allergies to skincare products used or hair dye.
• Seborrheic dermatitis – The red scaly patches on the eyebrows, sides of the nose, back of the ears, coupled with scaling of the scalp are the tell-tale signs of this pesky condition that comes and goes.
• Rosacea – Intermittent flushing, red, hot cheeks sometimes associated with red spots and broken facial veins, is characteristic of this condition.
• Lupus erythematosus – May appear as a “butterfly rash” on the cheeks of young women or patches on the face and body. Rashes are often worse after sun exposure. These rashes can sometimes affect other internal organs.

TREAMENT & CARE FOR Facial rashes

Your dermatologist can counsel you on the best treatment options after a diagnosis has been established. This may be in the form of creams or oral medicines.

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Fungal Infections

Fungal infections can infect the top layer of our skin, hair or nails. They are very common in our tropical climate, commonly affecting the feet, nails, groin and buttock areas. Different types of fungus may be responsible for different presentations and your dermatologist can perform some tests to confirm the diagnosis.

TREAMENT & CARE FOR Fungal Infections

• Topical anti-fungals - mild and small areas of fungal infections can be successfully treated using topical treatments.
• Oral anti-fungals - if the affected areas are large, severe, or non-responsive to topical treatments, oral tablets may be prescribed to eradicate the fungus.

It is also important to keep cool and dry to prevent recurrence of the infection.

Anti-itch tablets may help with any severe itching.

Hair Loss

We all experience some hair loss and it is normal to have 50-100 strands of hair fall a day. However if you see bald patches, severe hair thinning or a receding hairline, do see your dermatologist early. There are effective treatments available.

Androgenetic alopecia (male pattern hairloss or female pattern hairloss) is the most common type of hair loss. It is due to a combination of genetic or hormonal factors. This results in hair follicles become smaller, finer, and reduced in numbers. Male patients will notice gradual thinning at the top of the head and a receding frontal hairline. Women may notice widening of their hair parting or thinning at the crown.

Alopecia areata can result in round bald patches suddenly appearing on the scalp. The hair loss may even affect facial or body hair in severe cases eg loss of eyebrows, eyelashes and armpit hairs.

Factors that influence hair loss include genetic factors, stress, hormonal changes, poor nutrition, infections, certain medications or other medical conditions. Your dermatologist will perform a thorough history and examination, and do the necessary investigations to ascertain the cause.

TREAMENT & CARE FOR Hair Loss

• Topical treatments, such as minoxidil, may be applied to the scalp to increase hair growth.
• Steroids can be injected into affected areas of the scalp if appropriate.
• Oral tablets, can be prescribed to slow down the hair loss and increase hair growth.
• Contact sensitization therapy involves applying a substance onto the scalp to stimulate the immune system and can increase hair growth.
• Other treatments such as scalp microneedling, Regenera Activa, light therapy and hair transplantation can also be discussed.

Hand rashes

Hand rashes due to hand eczema is extremely common. Many people start with dry, inflamed, and chapped hands. Further irritation to the skin may occur due to over exposure to soaps, detergents, cleaning agents or chemicals. Some people have a greater tendency to develop hand rashes. They usually have a history of eczema, hay fever or asthma. Others develop hand rashes due to allergies to substances they come into contact with.

Your dermatologist will work with you to uncover and identify the possible causes of your hand rash.

TREAMENT & CARE FOR Hand rashes

• Hand protection - Protect your hands against soaps, cleansers and other chemicals by wearing gloves. Reduce the frequency of wet work and washing hands. Avoid hand washing dishes or clothes if possible.
• If the type of work you do is affecting your hands, talk to your employer about ways you can better protect your skin.
• Gentle cleansers and moisturisers - use regularly to improve skin barrier and prevent flares.
• Topical steroids, sometimes combined with antibiotics, can be used under medical supervision for treatment.
• In severe cases, oral antibiotics, oral steroids, phototherapy or oral anti- inflammatory medicines may be required.

Hand rashes can be stubborn to treat with intermittent flares. It is important to keep up with your medication. Stay in contact with your dermatologist and do not get discouraged.

Hyperhidrosis

Severe or excessive sweating is known as hyperhidrosis. This condition can leave affected areas constantly damp or wet, and can be a source of huge embarrassment to the sufferer. Many patients suffer in silence not knowing that effective treatments are available.

Hyperhidrosis is usually localized to areas with high concentration of sweat glands, commonly the armpits, palms, and soles. Sometimes, it may be generalized, affecting most of the body.

For most people, there may be a family history or they may have suffered from hyperhidrosis since childhood or adolesence. Rarely, it may be due to other underlying medical problems and will require further investigations.

TREAMENT & CARE FOR Hyperhidrosis

• Topical treatments - anti-perspirants containing aluminium salts can be applied overnight.
• Iontophoresis - Useful for hyperhidrosis of the palms and soles. Regular biweekly treatment using electric currents can help keep patients dry with minimal side effects.
• Oral treatment - prescribed oral medications can help reduce sweating from all parts of the body. This should be taken with medical supervision.
• Botox - little injections of Botox can be placed in the armpit areas for very effective control of underarm sweating. This is quick, effective and can often last for up to 6 months. Numbing cream is applied prior to these injections to make the procedure comfortable and tolerable.

Nail problems

Abnormal nails may be due to simple infections or trauma, or signal more serious underlying health problems. Do see your dermatologist for a successful diagnosis and treatment.
Nail abnormalities can present as:

• Changes in nail colour, shape or thickness
• Presence of pain, bleeding, discharge or swelling of surrounding skin
• Any lumps under or around the nail

The common causes of abnormal nails include fungal or bacterial infections, trauma or skin conditions such as eczema or psoriasis. Rarely it may be due to underlying cancer or other medical problems.

Appropriate tests will be arranged by your dermatologist to ascertain your diagnosis. A biopsy (sample) of the nail matrix and removal of abnormal nails for testing can also be performed if necessary.

TREAMENT & CARE FOR Nail problems

Depending on the cause, treatment options may include:

• Topical or oral antibiotics for bacterial infections
• Topical or oral anti-fungal medicines for fungal infections
• Treatments for any underlying skin disease
• Surgery and laser ablation for pincer or ingrown nails
• Advice on appropriate nail protection and care

Psoriasis

Psoriasis is a chronic skin condition that appears as red patches of inflamed skin with silvery white scales, often on the elbows, knees, scalp and face. It may also affect the nails and joints.

Both genetic and environmental factors play a role in the development of psoriasis. Triggers can include infections, stress, alcohol, smoking and certain medications.

Psoriasis is not contagious but it can be a source of discomfort and embarrassment for the sufferer.

TREAMENT & CARE FOR Psoriasis

• Topical treatment - topical steroids, coal tar and vitamin D based creams can be applied onto the skin and scalp to control mild to moderate psoriasis.
• Phototherapy - ultraviolet light can be used in different ways to treat psoriasis
• Oral treatment - immunosuppressive medicines can be considered for moderate to severe psoriasis.
• Injections - special injections known as biologics can block specific pathways involved in psoriasis and are increasingly being used and developed.

It is important to be aware that psoriasis can be associated with diabetes, hypertension, hyperlipidemia and obesity. Annual health checks are recommended for psoriasis patients.

Rosacea

Rosacea is a common chronic facial skin problem that many patients mistake for acne. It is more common in women than men, and more common in fairer skin types. Rosacea can show up as “spotty breakouts” on a background of facial redness and broken capillaries. Patients often complain of intermittent flushing and redness of their faces. This can be exacerbated by sun exposure, heat, spicy foods and alcohol.

TREAMENT & CARE FOR Rosacea

There is a wide range of effective treatments available:

• Topical creams can be used in mild cases.
• Oral medicines such as antibiotics or vitamin A based treatments can be added in more severe cases.
• Vascular lasers can also be used to reduce redness and treat broken capillaries.

In addition to the medicines prescribed, it is also important to avoid aggravating factors and adopt strict sun protection measures in our sunny climate.

Scars

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Scars can occur from many types of injury to the skin. Although nothing can restore the skin to its original perfection, there are many techniques available to soften the appearance of scarring. In addition, treatments can be given to reduce the itch, pain and tightness that can be associated with some scars.

TREAMENT & CARE FOR Scars

Your dermatologist will assess your scars to determine the appropriate treatment, which may include:

• Acne scars - injections, needling techniques or lasers may be used to improve acne scarring
• Keloid or hypertrophic scars - these disfiguring raised scars can be treated with steroid injections to soften and flatten. Picosecond or vascular lasers can be used during the same session to target the red/brown discolouration and soften further. In patients with earlobe keloids, CO2 laser and steroid injections can be used in combination to improve its appearance.
• Depressed scars - fractional laser resurfacing in combination with injectables can be used to improve the appearance of depressed scars
• Post surgical scars - early treatment of post surgical scars are now recommended, and these may include a combination of silicone gels, lasers and steroid injections.

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Skin Cancer Screening or Mole Check

Do not miss a skin cancer
Get worrying skin growths checked by a trained dermatologist

Skin cancer is the 6^th most common cancer in Singapore. Common skin cancers include the basal cell carcinoma and squamous cell carcinoma. Most of these cancers can be cured. The most dangerous skin cancer is the malignant melanoma, as this has the potential of spreading to nearby tissues and other parts of the body. This is easier to cure if it is discovered early before any spread occurs.

Risk factors for skin cancer include:

• Excessive sun exposure, especially in fair skin that burns easily
• History of sunburn
• History of previous skin cancer
• Family history of skin cancer
• Multiple abnormal moles
• Conditions or medicines that suppress the immune system
• Exposure to arsenic

If you have any changing moles or new skin lesions you are concerned about, do seek an early opinion from your trained dermatologist. Regular skin checks every 6 months are particularly important for individuals with risk factors for skin cancer, or who already had skin cancer.

Your dermatologist will perform a complete visual examination of all of your skin using specialised magnifying devices. As a dermatologist, she has been specifically trained to diagnose skin cancer by looking at them and taking a biopsy (sample) from any suspicious lesion. The removed tissue from any suspicious growth will be sent for analysis by a specially trained skin histopathologist to check for the presence of any cancer cells. The type of skin cancer, the thickness of the cancer and other characteristics of the skin cancer will be reported in the analysis if a skin cancer is diagnosed. Other tests such as lymph node biopsy, blood tests and imaging may be required.

Treatment for Skin Cancers

• Precancerous lesions such as solar keratoses can be treated with creams or cryotherapy (freezing treatment).
• Skin cancers are usually treated with surgery to remove the entire cancer, with adequate wide margins. Other treatment options can be discussed if surgery is not feasible.

We strongly advise all high-risk patients to come for regular skin cancer screening to detect any potential changes of skin cancer early. Early detection is key to having any cancer successfully treated and cured.

Experience

Dr Ho has spent many years practising Dermatology in London where she carried out numerous skin checks for skin cancer surveillance in Caucasians, and performed many surgeries for diagnostic and treatment purposes. As a Consultant Dermatological Surgeon at the National Skin Centre in Singapore, she has diagnosed and excised many skin cancers in the Asian population. She is well aware of how the same cancer (eg basal cell carcinoma) can look different in Caucasians and Asians, and easily missed by an untrained eye. Skin cancers can also be easily mistaken for normal moles or harmless age spots. The importance of sun protection, self-surveillance and full body skin checks by a trained dermatologist is key to early diagnosis and successful treatment.

Urticaria

Urticaria, commonly known as hives, appears as pink itchy bumps on the skin. The rash can appear anywhere, usually lasting a few hours before disappearing without leaving any marks. They can sometimes be associated with swelling of the eyelids and lips.

Common causes of hives include infections, medications or foods. Other triggers are heat, cold, pressure, exercise or stress.

Most urticarial episodes do not cause symptoms for more than a few weeks. However if it lasts for more than 6 weeks, blood tests are recommended to exclude any underlying medical causes.

TREAMENT & CARE FOR Urticaria

• Blood tests are performed to exclude any underlying causes or triggers
• Avoidance of known triggers can prevent the flare of urticaria.
• Anti-histamines are the mainstay of treatment in most cases of chronic urticaria.
• In severe cases, oral medicines or biologics such as omalizumab injections (Xolair) are also available for treatment.

Warts

Warts are small skin growths caused by the human papilloma virus (HPV), a virus that infects the top layer of skin. Small and usually painless, warts are commonly found on the hands and feet, but can occur elsewhere on the skin. Most warts are harmless, but may be unsightly, uncomfortable and can also be contagious. They are usually spread by contact, such as from one part of the body to another, through handshakes or handling of infected objects. Warts may take on different appearances and it is best to have suspected lesions diagnosed by a dermatologist.

Typically warts may go away on their own after months or years. Various over the counter medications can also be used. Most of these are a salicylic acid solution or a freezing spray. The spray is less effective than the freezing treatments done by dermatologists.

Do not treat warts on the face or genitalia yourself. These need to be treated by a dermatologist.

TREAMENT & CARE FOR Warts

For warts that do not respond to over-the-counter medications, dermatologists have much more effective treatments:

• Topical treatments - strong solutions or creams can be combined with freezing treatments for optimal response.
• Cryotherapy - freezing therapy that uses liquid nitrogen to destroy the warts
• Shave and electrocautery - warts that protrude from the surface of the skin can be shaved with a sharp razor, and the base burned with an electrical device.
• CO2 laser - Stubborn warts, especially those on the soles of feet or around fingers, toes and nails, can be lasered off using a CO2 laser.

When a speedy one off treatment is preferred, surgical methods such as shave excision or CO2 laser are recommended.
Unfortunately, regardless of the treatment method used, new warts may appear and old warts may recur. Do see your dermatologist for early treatment to avoid spread of the viral warts.

Vitiligo

Vitiligo is an autoimmune skin disorder which causes white patches to appear on the skin, and may even cause whitening of hair and eyelashes. Although it is not life threatening, it can cause significant distress from its disfiguring appearance. It may sometimes run in families, and may also be associated with other autoimmune disorders such as thyroid disease, alopecia areata or diabetes.

TREAMENT & CARE FOR Vitiligo

Prescription topical creams, light treatment as well as laser treatment are used for the treatment of vitiligo. Sometimes, combination therapy may be required.

Early treatment of vitiligo patches is more likely to result in re-pigmentation. Do consult your dermatologist for your management options.