Wednesday, 6 December 2017

Protect your baby even before you get pregnant

Retinoids is a wonderful medicine that helps to treat acne, rosacea, folliculitis, psoriasis and many skin conditions. It can even smoothen skin tone and stimulate collagen production. But do not use retinoids especially the oral form (e.g. Roaccutane) during pregnancy or breastfeeding. In fact, you must be more than 100% sure you are not pregnant before starting it, and if you are sexually active, use at least two forms of birth control e.g. birth control pill + condoms.

Being a parent is a serious responsibility. With oral retinoids, it is almost a sure thing that the innocent baby will end up with birth defects.

You are on oral retinoids and planning to get married? Afraid not. Just inform your dermatologist so that we can help with your family and skin care planning by changing your medications to other safer options. 

Different oral retinoids stay in the body for different duration. Usually you will be told to stop your isotretinoin for at least a month (or until next menstrual cycle), but with acitretin, it is probably best to plan for pregnancy after 3 years of stopping it! For this reason, we seldom start young ladies on childbearing age on acitretin unless we have no other option.

Some medications may even pass to the future baby from the father. One of the example is methotrexate. The whole process of spermatogenesis in human takes about 74 days, and if you count in the transport in the ductal system, it can take about 3 months. Hence, it is best to wait for at least 3 months after the father has stopped methotrexate before making baby!

For all future mothers, here’s other medicines and things you need to stop. This list is not complete and some medications can not be stopped just like that, your baby need healthy mother to take good care of him/her too, so please check with your doctor before planning for your family!
⛔️immunosuppresants and chemotherapies
⛔️some blood thinners e.g warfarin
⛔️cholesterol medicines
⛔️some seizure medicines
⛔️some antihypertensives
⛔️some antidepressants and mood stabiliser
⛔️some antifungals
⛔️some antibiotics

And don’t forget to start taking folic acid!

Friday, 10 November 2017


My friend has keloids on her chest. Cryotherapy, laser or plastic surgery?

Keloids happen when your skin doesn’t realise it has healed and continues to grow much larger than the original wound, often to the extent that it is painful. Once started, it can continue to grow for months and even years.

Cryotherapy may help small keloids. My first line treatment of choice is intralesional corticosteroid injections because it is cost effective in softens/ shrinks the scar and reduces the pain. Patient often feel much better after the very first injection. I usually encourage patient to use silicone sheets and do scar massages at home. If the location allows, wearing pressure garment is a great adjunct.

Ablative and non-ablative lasers can help to reduce the height and redness.

Surgical removal (especially on the chest) has nearly 100% recurrence rate and is only used in combination with other treatment modalities.

My scar did not heal well

My first surgical scar healed well but the second surgical scar doesn’t. Why?

Many factors could affect scar formation.
1. The site of less tension (less tightness) tends to heal better e.g. inner arm vs. shoulder
2. The site of better blood supply heals better, e.g. face vs. feet
3. The doctor’s skill
4. Patient factors, e.g smoking, diabetes, genetics
5. Timing of stitch removal, hygiene, absence of infection and good wound care etc.

How do minimise scar after surgery / injury?
1. Keep the area dry especially the first few days.
2. Keep the area clean.
3. Allow the wound to "breathe".
4. Consider silicone adhesive dressing.
5. Minimise movement of the area (avoid pulling or tugging on the wound)
6. If there is risk of infection, consider the use of antiseptics. Consult your doctor if there is a need for antibiotics if the wound is weepy, changing colour or foul smelling.
7. If it forms a scab, do not pick on it, allow the scab to fall off naturally.
8. Sun protection
9. Moisturiser --- but not on raw wound

Hair care tips for swimmers

I’m a professional swimmer and have very dry skin. I suspect it’s all those chlorine in the pool that has damaged my skin (and hair). I don’t want to quit swimming. What can I do?

1. Stay hydrated and drink regularly before, during and after your swim.
2. Wear silicone swim cap to protect your hair.
3. Apply occlusive moisturiser to seal your skin off chlorinated pool water before a dip.
4. Apply double layer of sunscreen and reapply every hour if you are swimming under direct sunlight.
5. Take a lukewarm shower after the swim and use a gentle cleanser. Don’t forget to use conditioner for your hair after shampooing.
6. Moisturise your skin immediately and generously after the shower.

Tuesday, 31 October 2017

Whitening laser and gutatte pigmentation

Happy Halloween!
Did you get scare by this pale face of mine? Hahaha.

But white or fair skin has been recognised as beauty in Asian for years. Top sales of skin care products in Asian? I would imagine it to be one of those whitening products rather than sunscreen.

Is whitening laser safe?

When you mentioned "whitening laser", I assume you are referring to Q-switched Nd-Yag 1064nm laser.

Q-switched Nd-Yag has become very popular nowadays because it offers to treat many pigmentation problem and rejuvenation by stimulation of collagen production at the same time. 1064nm has been said to be the most suitable whitening wavelength for Asian skin as the risk of postinflammatory hyperpigmentation is small. Nowadays, you get to do it everywhere, in beauty saloon, in medispa, in general clinics. And it is often marketed as "lunch time laser" as it usually give very short down time (some redness is what you may get) especially when administered in low fluence using large spot size, or what is also known as toning laser.

As this "whitening and rejuvenation laser" getting more common, some people found instead of getting a homogenous white and fair skin, they get white spots. Some people get this even after just 4-5 times of laser, not necessarily after years of repetitive treatment. (Not all Q-switched Ng-Yag lasers are the same, even if they are of the same 1064nm wavelengths) The "solution"? Some people end up going for more and more whitening laser! Instead of monthly, some started to do it every 2 weeks, and every week, and every other days, and even everyday! (This happened especially for those who bought "packages of laser" to save cost or perhaps some centres who offered free rescue treatments.) The consequences, from one white spots to multiple white spots to lacey and mottled appearance.

We do not know why this happened. Perhaps the cumulative laser has destroyed the melanocytes (pigment producing cells) in the skin. What is horrible with this condition caused by "whitening laser" compared to other types of laser such as CO2 resurfacing laser and ruby laser is that this mottled or guttate pigmentation is very difficult to treat. Doctors have tried using topical whitening cream, steroids, calcineurin inhibitors and phototherapy with narrow band ultrabiolet B and various other modalities but many remained the same after years and probably going to be permanent!

No, I'm not saying Q-switched Nd-Yag laser is all evil and no good. Neither did I say you should not do it at all. It has helped many with pigmentation problems if done in a careful way.

I'm asking you to be just a little more careful. And I am definitely against buying or selling large packages of laser treatments as marketing strategies. Please do go to a good doctor who know what exactly he or she is doing. Go to a doctor who will be honest with you what are the pros and cons and what to expect. Very few treatments under the sun is without a single risk since even doing nothing and just staying under the sun is with skin cancer risk as well. As long as you know what to expect, when to put a stop to it, what remedial measures to be taken, you should be fine, most if not all the time.

If you have bought packages of "whitening laser", (yes, you may be heading for problem) and do not want to "waste" it. What I can advise you to do is that do not do it too frequently and closely monitor your face. If you notice white spots starting to appear, stop the laser treatment. do not go for further laser treatment even if you still have another 5 or 10 more treatments to go.  (What? You still have 20 over sessions? What a big "packages"! You must be kidding me!) Use sunscreen diligently and keep your fingers crossed, perhaps it is not permanent yet.

Read some cases from Singapore here.

Saturday, 28 October 2017

Skin Care Routine for Dull and Uneven Skin Tone

My skin is dull and I have uneven skin tone. What can I do about it?

Pigment problem is so common, which is why foundation, concealer, BB cream and CC cream are essential items in most ladies' makeup bag.

Try out this simple yet effective skin care routine to help brighten up your skin and smooth-en your skin tone.

1. Gentle cleanser
2. Antioxidant + sunscreen

Re-apply sunscreen 2 hourly throughout the day. (Yes, I know it isn't easy, but good skin doesn't come the easy way for most people after 30 years old.)

1. Makeup remover / gentle cleanser
2. Retinoids or retinol
3. Moisturiser

A few reminders:
  1. Prescribed topical retinoids (common acne medication) is more effective but may cause irritation (dry, red and even skin peeling for some). Start with a pea size and observe your skin reaction for a week or even two before increasing the amount.
  2. If you have sensitive skin and are trying out new skin care products, start one by one, a week or two apart, just in case you develop any skin reaction, it's easier to identify the culprit.
  3. If "water" is your usual "morning cleanser" and you have no skin problem, go ahead, it makes your routine even simpler. Personally I do not use cleanser except makeup remover and I strongly feel cleanser isn't for everyone, especially if your skin is not too oily. But please do remove your makeup completely.

Thursday, 19 October 2017

How to keep your skin hydrated?

Malaysia is a humid country, yet we keep on seeing people, with underlying skin problem or without, coming with dry and even cracked skin.

Here's a few tips on how to keep your skin hydrated.
  1. Drink water, whenever you feel thirsty. Sounds dumb but how many of us forget to listen to our body cues when er are too engrossed in our work? We lose water in our sweats, urine, bowel movements and even while we breathe. A standard recommendation is to drink 6-8 glasses a day but really there is no "standard" for everyone because we are all different. Exactly how much water one needs depends on many factors from how much you exercise to your metabolic rate to how dry the environment is. Drinking too much water to the extent of water toxicity can lead to confusion and even coma and death. (But who on the earth in their right minds would drink so much water!?)
  2. Talk short cold or lukewarm water shower rather than long hot baths (if you have eczema, keep the shower shorter than 5 minutes).
  3. Use gentle cleanser instead of soap bar or antiseptic shower gel.
  4. Apply generous amount of moisturiser immediately after baths (well not exactly immediate, within 3 minutes or when your skin is still damp).
  5. Use paper mask. Paper mask is a great and yet economical invention of facial skin care. If not properly use, it may over hydrate the skin around the eyes making you look puffy though.
  6. Use fabric gloves and socks after putting on moisturiser if you have dry hands or feet. This is a form of occlusion which will help your skin absorbs the moisturiser better, keep the moisture longer besides keeping your bed sheet and blanket clean.
  7. Avoid direct sunlight, smoking, sauna.
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