What is urticaria?

Urticaria, clinically known as hives, is a condition where patients experience transient, itchy, red welts on the skin.

Types of urticaria include:

Type of urticaria	Characteristics and triggers of urticaria
Acute Urticaria	Short-term hives lasting less than six weeks, often triggered by allergies, infections, or stress.
Chronic Urticaria	Persistent hives that occur daily or almost daily for more than six weeks, often with an unknown cause.
Physical Urticaria	Hives caused by physical stimuli like cold, heat, pressure, or exercise.
Dermatographism	Skin hives that appear within minutes of scratching or rubbing the skin.
Delayed-Pressure Urticaria	Hives that form hours after sustained pressure on the skin.
Aquagenic Urticaria	Rare hives triggered by contact with water, for example, after bathing or sweating.
Drug-induced Urticaria	Hives caused by an allergic reaction to medication, appearing shortly after drug intake.
Contact Urticaria	Localised hives that appear immediately after the skin comes into contact with an allergen or irritant.
Idiopathic Urticaria	Chronic hives without an identifiable cause, characterised by spontaneous, recurring episodes.

What causes urticaria?

Hives or urticaria occur when histamine and other substances are released inside the body, which causes the skin to swell and form itchy patches or welts. Sometimes, these reactions are due to allergic responses to certain proteins called allergens, which, while harmless to many, can trigger symptoms like hives in sensitive individuals.

A significant proportion of chronic urticaria cases are thought to be autoimmune in nature. In these instances, the immune system produces antibodies against a special cell in the skin known as the mast cell, which then releases chemicals, such as histamine, that act on the skin to cause swelling, redness and itch.

Understanding the specific triggers can help those affected by urticaria avoid these factors and prevent the onset of hives. Common triggers of urticaria include:

• Food (common food allergens include eggs, shellfish, nuts, and milk)
• Medications (such as certain antibiotics, aspirin, and non-steroidal anti-inflammatory drugs)
• Insect stings or bites
• Environmental stimuli such as heat, cold, exercise, or pressure
• Pet dander
• Pollen
• Latex
• Plants
• Certain fabrics
• Bacterial or viral infections
• Tight-fitting clothes

What are the symptoms of urticaria?

Urticaria manifests as:

• Red, raised, itchy welts on the skin
• Transient itchy, red patches on the skin
• Burning or stinging sensation with very mild redness
• Intense itch
• Swelling

Who is at risk of urticaria?

Urticaria can affect anyone; nonetheless, certain individuals may have a higher propensity to develop hives due to specific risk factors, which include:

• Genetics: a family history of allergies or urticaria increases the risk of developing these conditions.
• Autoimmune diseases: patients with autoimmune conditions like lupus, diabetes, thyroid disorders, and rheumatoid arthritis may have a higher likelihood of experiencing chronic urticaria.
• Infections: bacterial or viral infections, e.g. COVID, can precipitate urticaria in some individuals.
• Physical stimuli: exposure to physical factors like cold or heat can trigger urticaria in sensitive people.
• Stress: elevated stress or anxiety levels can induce or exacerbate urticaria.
• Medications: certain drugs, including antibiotics and painkillers, can lead to the development of hives.

How is urticaria diagnosed?

Urticaria, or hives, is typically diagnosed by a dermatologist, involving several steps:

• Medical history and physical examination: your dermatologist will obtain a comprehensive medical history to understand your symptoms and exclude other potential conditions. This includes inquiries about your medications, diet, lifestyle habits, and the duration of your urticaria symptoms. A physical exam is also conducted to evaluate the extent of the hives and identify any other areas of concern.
• Laboratory tests: additional tests, such as testing for dermatographism, skin biopsies, allergy tests, and skin prick tests, may be necessary to confirm the diagnosis. Occasionally, chronic urticaria can be a marker of an underlying health issue, such as thyroid disease, blood disorders, autoimmune diseases, or some infections. Hence, our evaluation may include tests to rule out underlying conditions.

What are the treatment options for urticaria?

Despite thorough evaluations, a large number of chronic urticaria cases remain idiopathic, meaning no clear cause can be identified. In these instances, our focus shifts to managing symptoms and improving quality of life through a combination of lifestyle modifications and medication.

The treatment for urticaria varies based on the individual's medical history and symptom severity. Common treatment options include:

• Lifestyle changes and avoiding triggers: in cases of mild to moderate urticaria, avoiding known triggers and making lifestyle adjustments, such as discontinuing certain medications, wearing loose-fitting clothing, or protecting the skin from extreme temperatures, may be enough to manage the condition.
• Cool compresses: applying a cool compress or ice pack to the affected areas can momentarily alleviate the symptoms of hives.
• Antihistamines: these medications block the effects of histamine on the skin, relieving symptoms like itching and redness.
• Corticosteroids: oral or topical corticosteroids may be prescribed to reduce inflammation in more severe or persistent cases of hives.
• Omalizumab: this is a biologic subcutaneous injection that is highly efficacious for treating antihistamine-resistant urticaria or severe and persistent urticaria.

Frequently asked questions

How can I differentiate between urticaria and insect bites or other skin reactions?

Urticaria and insect bites look similar. However, urticaria lesions change rapidly, and individual spots usually last less than 24 hours, whereas insect bites and other reactions persist for days and evolve more slowly. Another clue to the diagnosis would be the distribution of the rashes. Urticaria can appear anywhere on the body and often in large areas, while insect bites are more localised and confined to specific exposure sites.

How effective are biologics in treating chronic urticaria?

Biologic therapies such as omalizumab are effective in treating chronic urticaria, especially for cases that have not responded well to traditional treatments such as antihistamines or corticosteroids.

The reduction in daily symptoms allows for a return to normal activities without the constant concern of a urticaria flare-up. Additionally, because omalizumab is specifically targeted, it tends to have fewer side effects than systemic corticosteroids or other traditional immunosuppressants. If you are struggling with chronic urticaria and traditional treatments have not been effective, consider scheduling a consultation to discuss whether biologics could be an appropriate option for you.

What causes urticaria to flare up?

Urticaria, or hives, can flare up due to various triggers, including allergic reactions to foods, medications, or insect stings, exposure to physical stimuli like heat or cold, infections, stress, and underlying health conditions. Identifying and avoiding personal triggers is key to managing flare-ups.

Is urticaria contagious?

Urticaria is not contagious and cannot be transmitted from one person to another. It is an immune response or reaction to certain external or internal factors within an individual's body.

Can urticaria lead to other health complications?

While urticaria itself is usually not serious, chronic or severe cases can sometimes be associated with other health issues, such as autoimmune disorders, underlying haematological abnormalities or thyroid problems.

What are skin infections?

Skin infections comprise a variety of conditions, such as warts, molluscum, herpes zoster, tinea (ringworm), fungal acne (pitysporum folliculitis), and tinea versicolor. These skin conditions can result from bacterial, viral, fungal, or parasitic infections, varying from mild to severe. If left untreated, these infections affect the skin’s barrier and may lead to discomfort, pain, and sometimes severe complications.

Frequently asked questions

How can I tell if my rash is a fungal infection or eczema?

Fungal infections often present with a rounded, active edge or border, which may have some scaling or pustules. It commonly occurs in the moist areas of the body, such as the armpits, groin or between the toes. On the other hand, eczema can be round in configuration but seldom presents with an active edge or border with central clearing, like in fungal infections. Eczema commonly affects the elbow creases, behind the knees or the face and neck and is often associated with a history of generally dry and sensitive skin.

A thorough examination by a dermatologist is crucial to accurately diagnosing your condition. To determine the exact cause of your rash, we might perform specific tests, such as skin scraping for fungal infections or a patch test for eczema.

How do I prevent skin infections in a tropical climate?

A few precautions can be taken, such as showering at least once daily with a gentle, non-irritating shower gel. This is especially important after activities that induce sweating.

Wearing “breathable”, loose-fitting clothing made of natural fibres like cotton also reduces the risk of trapped moisture that predisposes to bacterial and fungal overgrowth.

After exercise, avoid staying in damp clothing for prolonged periods, as this creates an ideal environment for microbial growth. This is especially important for swimwear and workout attire.

What should I do if over-the-counter treatments for fungal skin infections don't work?

It would be prudent to consult a dermatologist in this case. At Lumine Dermatology & Laser Clinic, we can ascertain the diagnosis and exclude other skin conditions that could mimic fungal infection. We can perform a skin scraping for fungal tests. Based on the diagnosis, prescription-strength antifungal medications may be recommended. These can include topical antifungals with higher potency than over-the-counter options or oral antifungal medications for more widespread or resistant infections.

How are skin infections transmitted?

Skin infections can be transmitted through direct or indirect contact. Direct contact includes skin-to-skin contact, such as when hugging and shaking hands. Indirect contact includes sharing razors and towels or touching surfaces an infected person has previously touched.

What is skin cancer?

Skin cancer arises from the uncontrolled proliferation of abnormal cells in the skin, the body's largest organ. The initiation of skin cancer occurs in the epidermis (outer layer of the skin) and involves three types of cells:

• Squamous cells: squamous cells are thin, flat cells forming the top layer of the epidermis.
• Basal cells: basal cells are round cells located beneath the squamous cells.
• Melanocytes: melanocytes are situated in the lower part of the epidermis. These cells produce melanin, the pigment that gives skin its colour.

The three main types of skin cancer are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma. BCC and SCC originate in the skin's basal and squamous layers. Melanoma, which is less common but more dangerous, starts in the melanocytes and is notorious for its ability to spread rapidly to other parts of the body and vital organs, significantly increasing the risk of mortality.

Precancerous conditions such as Actinic Keratosis and Bowen’s Disease may also progress to skin cancer if left untreated, which emphasises the importance of early detection and management.

At Lumine Dermatology & Laser Clinic, we offer a comprehensive and holistic treatment plan dedicated to prevention, early diagnosis, and looking at skin cancer.

What causes skin cancer?

Skin cancer originates from the abnormal growth of skin cells. Various factors contribute to this abnormality, with certain risk factors increasing susceptibility:

• UV rays: the primary culprit behind skin cancer is prolonged exposure to ultraviolet rays, whether from the sun or tanning beds. Inadequate protection, such as skipping sunscreen, significantly elevates this risk. Moreover, individuals with a history of blistering sunburns during childhood are particularly vulnerable.
• Immunity: a weakened immune system can make an individual more susceptible to skin cancer. This risk is compounded when combined with frequent exposure to sunlight.
• Age: while skin cancer can strike at any age, it is more common in older adults, particularly those over 50. However, this doesn't mean younger individuals are immune; everyone should take precautions.
• Skin types: people with lighter skin tones, freckles, or skin that burns or reddens easily are at a higher risk of developing skin cancer. This is particularly true for individuals with Fitzpatrick phototypes 1 and 2, which indicate lighter skin types and are more sensitive to UV damage.
• Genetics: if you have a family history of skin cancer, your risk of developing the disease is higher, underscoring the importance of regular skin checks.

How is skin cancer diagnosed?

Skin cancer is typically diagnosed by a dermatologist, a doctor specialising in skin conditions. In cases where skin cancer is confirmed, especially for melanoma, the dermatologist may collaborate with an oncologist to formulate a treatment strategy. The diagnostic process can vary based on the individual's symptoms and condition severity, but it generally includes:

• Clinical assessment: your dermatologist conducts a thorough examination, usually utilising a dermascope (dermatoscope) to visually inspect the skin for abnormalities or signs of cancer. 
• Medical history: your dermatologist will inquire about your detailed medical history, including any medications you are taking and if there is a family history of skin cancer.
• Skin biopsy: if there is suspicion of skin cancer or if you need to confirm the diagnosis, your dermatologist may perform a skin biopsy by taking a tissue sample from the affected area for laboratory analysis. For a concerning mole, the entire mole should be removed for histological confirmation.

Frequently asked questions

What are the early signs of skin cancer?

Early signs of skin cancer include new growths or moles on the skin, changes in the size, shape, or colour of existing moles, and skin lesions that feel sore,  itch, bleed, or do not heal. Monitoring these changes is crucial for early detection and treatment.

Can skin cancer be prevented?

While skin cancer cannot always be prevented, you can minimise your risk of developing it by avoiding exposure to UV radiation, wearing protective clothing, using sunscreen with an adequate SPF, avoiding tanning beds, and regularly checking the skin for any changes or new growths. For those with signs of photodamage or a history of multiple skin cancers, certain supplements can be prescribed to slow down these skin changes.

How often should I check my skin for signs of skin cancer?

It is recommended to perform a self-examination of your skin once a month to look for new growths or changes in existing moles. Additionally, annual skin checks by a dermatologist are advisable, especially for those with the following risk factors:

• Fair skin that burns rather than tans
• Family history or personal history of skin cancers
• History of extensive cumulative UV exposure or blistering sunburns in childhood
• Having more than 50 moles or having moles that are large, irregular in shape, or uneven in colour
• Organ transplant recipients or other individuals on chronic immunosuppressive treatments

What are nail problems?

Nail abnormalities can arise from various causes, leading to issues like yellowing, brittleness, black streaks, swelling, bleeding, and pain. Neglected nail problems can escalate into infections. Sometimes, they may signal an underlying health condition or skin issue.

Various nail problems can arise; these include but are not limited to:

What causes nail problems?

Nail problems can stem from numerous sources, including diseases (like lupus, eczema, psoriasis, diabetes, anaemia, thyroid disorders), nutrient deficiencies, ageing, environmental exposure, hormonal changes, improper nail care, manicures, infections, trauma, occupational hazards, hygiene practices, and certain medications. These factors can lead to various nail conditions, impacting their health and appearance.

How are nail problems diagnosed?

Our goal is to thoroughly understand your nail health and provide the most effective treatment plan.

• Medical history: your dermatologist will ask about your medical history, including symptoms, existing health conditions, family medical background, and medication history.
• Clinical examination: the nails and surrounding skin are thoroughly examined to assess their overall condition, including any visible abnormalities or signs of infection.
• Laboratory tests: in some instances, laboratory tests, such as fungal cultures and blood tests to check for nutritional deficiencies, may be required to confirm the diagnosis and identify underlying causes.
• Nail bed or nail matrix biopsy: in some cases, a biopsy of the nail apparatus may be required to establish the diagnosis.

What are the treatment options for nail problems?

We offer diverse treatment options at Lumine Dermatology & Laser Clinic. These include:

• Topical or intralesional steroid treatments: help reduce inflammation and enhance the appearance of the nails.
• Biologic treatments: for severe nail psoriasis, we offer biologic treatments, such as risankizumab, ixekizumab, and ustekinumab, which are known for their effectiveness in stubborn nail conditions.
• Oral antibiotics or antifungal medications: these targeted treatments for bacterial or fungal infections ensure that the root cause of nail problems is addressed.
• Surgical nail avulsion with or without matricectomy: for cases involving significant discomfort due to trauma or ingrown nails, surgical nail avulsion may be necessary. In certain conditions, matricectomy may also be performed to prevent nail regrowth.
• Chemical nail avulsion: our specialists are skilled in chemical nail avulsion techniques for treating persistently thickened and dystrophic nails.
• Lifestyle adjustments: we emphasise the importance of nail care and hygiene, advise on reducing nail polish and chemical exposure, and guide medication adjustments to promote optimal nail health.

Lumine Dermatology & Laser Clinic provides comprehensive and personalised care for all nail conditions.

Frequently asked questions

Can I prevent nail problems?

Yes, you can prevent nail problems by practising good nail hygiene, avoiding excessive exposure to water and chemicals, wearing proper footwear, and maintaining a balanced diet rich in essential nutrients.

Is it necessary to seek professional help for minor nail issues?

While minor nail issues may be resolved independently or with basic home care, it's advisable to consult a dermatologist for persistent or recurring problems, as they may indicate underlying issues that require medical attention.

Can nail problems affect people of all ages?

Yes, nail problems can affect individuals of all age groups, from children to older adults. While certain conditions, such as fungal infections or brittle nails, may be more prevalent in older individuals due to ageing or specific lifestyle habits, it's important to recognise that anyone, regardless of age, can experience nail issues. Our clinic is committed to diagnosing and treating nail conditions with personalised care for patients at every stage of life.

There are three stages of hidradenitis suppurativa:

• Stage 1: this is a mild disease characterised by isolated single or multiple abscesses. These abscesses typically do not cause scarring.
• Stage 2: moderate disease comprises recurrent abscesses with the formation of sinus tracts — narrow tunnels that form under the skin, connecting different abscesses. Scarring is present but limited compared to stage 3 hidradenitis suppurativa.
• Stage 3: advanced disease is characterised by the widespread involvement of interconnected sinus tracts and abscesses. Individuals with stage 3 hidradenitis suppurativa experience significant scarring, often leading to morbidity and debilitating complications.

What causes hidradenitis suppurative?

The exact cause of HS is not fully understood, but it is believed to involve a combination of factors, including:

• Blocked hair follicles: HS may start with blocked hair follicles, leading to inflammation and infection.
• Immune system dysfunction: evidence suggests that HS involves an abnormal immune response, where the body's immune system mistakenly attacks hair follicles and sweat glands, leading to inflammation and the formation of abscesses.
• Hormonal factors: hormonal changes, such as those occurring after childbirth or hormonal fluxes during periods, may trigger or worsen HS symptoms.

What are the symptoms of hidradenitis suppurativa?

Common symptoms of hidradenitis suppurativa include:

• Tender nodules: small, painful lumps that form under the skin.
• Painful abscesses: larger, deeply inflamed lesions that are often very painful.
• Malodorous discharge: when abscesses rupture, they can release a foul-smelling, purulent discharge.
• Sinus tracts: interconnected tunnels form under the skin over time, leading to further complications and scarring.

Commonly affected areas include:

• Armpits
• Groin folds
• Under the breasts (inframammary folds)
• Between the buttocks (natal cleft)
• Behind the ears
• Nape of the neck
• Waist, trunk, and other areas of the body (in advanced or stage 3 hidradenitis suppurativa)

Conditions associated with hidradenitis suppurativa: hidradenitis suppurativa is also associated with obesity, metabolic syndrome, and inflammatory bowel disease.

At Lumine Dermatology & Laser Clinic, we understand the physical and emotional impact hidradenitis suppurativa can have on our patients. We are dedicated to providing expert care, from accurate diagnosis to personalised treatment plans, including medical and surgical options to manage symptoms and improve quality of life. If you are experiencing symptoms of HS, we encourage you to reach out for a consultation so we can help you on your path to recovery.

Who is at risk of hidradenitis suppurativa?

The risk factors for hidradenitis suppurativa include:

• Genetics: 40% of those who suffer from hidradenitis suppurativa have a family member affected by the same condition.
• Medical conditions: individuals with certain medical conditions, such as diabetes, inflammatory bowel disease (IBD), arthritis, and metabolic syndrome, may be more likely to develop hidradenitis suppurativa.
• Hormonal: some individuals have perimenstrual flares of the condition with an improvement of symptoms during pregnancy.
• Smoking: smoking is significantly correlated with an elevated risk of hidradenitis suppurativa.
• Diet: high glycemic index foods and dairy products can exacerbate hidradenitis suppurativa.

How is hidradenitis suppurativa diagnosed?

It can be challenging to receive a correct diagnosis of hidradenitis suppurativa, especially in the early stages, as it is sometimes mistaken for folliculitis or recurrent furunculosis.

Hidradenitis suppurativa is a clinical diagnosis, and we typically look for characteristic lesions in the typical distribution of hidradenitis suppurativa. A history of recurrent and persistent lesions (at least two episodes in six months) is also helpful. Occasionally, we perform biopsies to exclude atypical infections that can mimic hidradenitis suppurativa.

It is best to consult with a dermatologist who can provide specialised treatment and a precise diagnosis of this condition based on the severity of symptoms, medical history, and a visual examination.

What are the treatment options for hidradenitis suppurativa?

Over the years, Dr Evelyn at Lumine Dermatology & Laser Clinic has helped many patients with hidradenitis suppurativa who have had the disease significantly affect all aspects of their lives.

At our clinic, we believe it does not have to be this way. However, early intervention is essential for hidradenitis suppurativa to minimise progressive scarring, which can affect treatment response. Managing hidradenitis suppurativa requires expertise and a multifaceted approach, often combining surgical and medical approaches with the occasional use of energy-based devices.

Medical approaches to treating hidradenitis suppurativa

• Topicals: we use topical antibiotics, antiseptics, steroids, saline compresses, and antiseptic washes to control the condition and alleviate symptoms.
• Oral antibiotics: we prescribe doxycycline, erythromycin, and clindamycin to combat infection and inflammation.
• Oral spironolactone (for females): oral spironolactone isan effective treatment for female patients, helping manage HS's hormone-related aspects.
• Oral immunosuppressants: oral immunosuppressants may be recommended for acute flares or long-term control of HS.
• Biologics: advanced treatments like adalimumab and ustekinumab are available to target inflammation at its source, offering relief for many patients.

Surgical approaches to treating hidradenitis suppurativa

• Incision and drainage: this procedure can alleviate discomfort significantly and provide immediate relief from acute abscesses.
• Deroofing: a targeted approach for persistent abscesses or nodules, offering considerable success in reducing symptoms.
• Excision of nodules and fibrous tracts: for severe cases, removing nodules and fibrous tracts can provide a lasting solution and significant relief.

Frequently asked questions

What triggers acne inversa or hidradenitis suppurativa (HS)?

Although the cause of hidradenitis suppurativa is not fully understood, it is believed to involve a combination of genetic, environmental, and hormonal factors. Factors such as obesity, smoking, and metabolic syndrome may be associated with an increased risk of developing this condition.

Does acne inversa or hidradenitis suppurativa (HS) go away on its own?

There is no cure for HS, but various treatment methods can manage this condition well. Your dermatologist can advise you further on managing this painful and chronic skin condition.

What happens if acne inversa or hidradenitis suppurativa (HS) is left untreated?

If left untreated, HS can lead to complications such as infections. With each flare-up, there will be more scarring, rendering some topical and oral treatments less effective and the condition more complicated to manage. Moreover, the psychological impact of living with a chronic, often painful skin condition can lead to depression, anxiety, and social isolation. It is best to seek treatment as early intervention is critical to managing and treating HS.

What are moles?

Moles appear primarily due to melanocyte clustering in specific areas rather than being evenly distributed across the skin. This clustering causes the characteristic darker spots known as moles.  While typically benign, moles might also occasionally indicate skin cancer.

Moles appear in various shapes and sizes. Some people have many moles on their bodies, while some only have a few. In most instances, moles can be left alone; some people choose to undergo mole removal due to cosmetic or health concerns.

Moles are not contagious; benign ones typically do not cause discomfort, such as pain, itch, or scabbing. They normally develop between the first thirty years of one’s life. If new moles develop in your 40s and 50s, it is advisable to see a dermatologist to check if the mole is benign.

Types and characteristics of moles

Moles, or nevi, are common skin growths that vary widely in appearance and significance. As your skin health partners, we're here to help you understand the different types of moles and their implications for your health.

Moles can be classified into:

Benign

Benign moles come in various forms. Understanding these types can help you monitor changes over time.

• Junctional moles: junctional moles are typically flat and darker in colour and are found where the epidermis meets the dermis.
• Intradermal moles: intradermal moles are mostly raised and flesh-coloured; these moles are situated within the dermis of the skin.
• Compound moles: compound moles exhibit features of both junctional and intradermal moles, often starting flat but becoming raised over time.

Changes in a mole's appearance can be a sign of development. Any mole that changes in appearance should be evaluated by a dermatologist to ensure it remains benign.

Atypical or dysplastic moles

Atypical moles, or dysplastic nevi, are characterised by their irregular appearance. They may be larger than ordinary moles and have uneven colours and borders. While not cancerous, their presence can indicate a higher risk of developing melanoma. Individuals with multiple dysplastic nevi should check their skin regularly with a dermatologist and perform regular skin self-assessments.

Malignant i.e  melanoma-in-situ, melanoma

Melanoma is a serious form of skin cancer that develops from melanocytes. It can appear anywhere, even in spots that don't get much sun exposure. Catching melanoma early is important because it can spread quickly. This is also the reason why we recommend regular skin check-ups.

Melanoma-in-situ refers to melanoma cells confined to the epidermis or top layer of the skin. While melanoma-in-situ is considered the earliest stage of melanoma and is highly curable with prompt intervention, it still requires vigilant monitoring and surgical removal.

What causes moles?

Key factors in mole development:

• Sun exposure: spending too much time in the sun without sufficient protection is known to be a factor in developing moles. Children who spend too much time in the sun may develop more moles as they age. Using sunscreen regularly, wearing protective clothing, and avoiding peak UV hours (10 am to 4 pm in Singapore when UV levels are highest) may prevent new moles from forming.
• Genetic predisposition: individuals with family members with multiple moles or of a lighter skin phototype are more prone to developing moles.
• Age: the majority of moles appear during childhood and adolescence, peaking in number by the age of 30. After that, the development of new moles tends to decrease. If new moles develop after this age, especially after your 40s, consult a dermatologist.
• Hormones: hormonal changes, such as those occurring during puberty and pregnancy, may contribute to the development of moles or changes in the appearance of existing moles.

While moles are generally harmless, knowing what causes them and when they might need professional attention is crucial for your skin health. Regular skin checks can help in the early detection of any issues, including skin cancer.

What do benign moles look like?

Benign moles are harmless and should not cause adverse side effects or symptoms. Changes in the appearance of moles or if they start bleeding or itching may indicate skin cancer.

In general, moles have the following appearances:

• Small bumps on the skin, which may be brown, tan, black, blue, red, or pink. Their texture may be smooth, wrinkled, flat, or raised.
• Moles may have hair growing from them and can grow anywhere on the body.
• Moles may fade with time or become darker due to hormonal changes.
• Moles often develop during the first thirty years of life.

What do cancerous moles look like?

A skin self-examination is a simple but effective detection strategy for skin cancers. Many new and recurrent melanomas can be detected by patients or their family members. When examining your moles at home, we recommend following the ABCDE guide to identify any suspicious changes that may require a closer look by a dermatologist.

One should look out for the ABCDEs of melanoma detection, encompassing:

• Asymmetry: if you draw a line through a mole and the two halves do not match, it may be a sign of malignant growth.
• Border irregularity: moles with irregular, notched, or scalloped borders are suspicious.
• Colour variation: a mole with multiple colours, especially shades of white, red, or blue, may be a warning sign.
• Diameter: moles larger than 6 mm should be examined, though melanomas can be smaller when first detected.
• Evolution: any change in the mole's size, shape, or colour or the development of new symptoms such as bleeding, itching, or crusting may warrant an evaluation.

Special care must be taken on often overlooked sites such as acral sites (especially finger webs and toe webs), scalp, retro auricular skin, natal cleft, back, and back of the legs.

If you experience pain or discomfort, develop new moles after age 30, or have concerns about any changes in your moles, make an appointment with a dermatologist for a consultation and skin cancer screening. They can assess the mole and suggest a course of treatment if necessary.

What are the risk factors for melanoma?

Dermatologists use the acronym HARMM to predict a patient’s risk of developing melanoma:

• History of previous melanoma
• Age 50 and above
• Regular dermatologist absent
• Mole changing
• Male gender

Patients with 4 or 5 of these risk factors were 4.4 times more likely than those with 0 or 1 of such risk factors to develop melanoma. Thus, meticulous monitoring of changes in existing moles and new lesions is crucial for such high-risk groups.

What is the role of skin cancer screenings in early detection?

At Lumine Dermatology & Laser Clinic, we understand the pivotal role that early detection plays in the successful treatment of skin cancer. Our dedicated skin screenings are designed to identify subtle yet critical changes in moles that may indicate malignancy or pre-malignancy, enabling timely intervention.

By opting for annual skin screenings, you are taking a proactive step towards safeguarding your skin health, ensuring any potential issues are identified and addressed as early as possible. We employ a meticulous approach to mole examination, which includes:

• Physical/visual examination: moles are assessed clinically and with dermatoscopy by a dermatologist, allowing us to meticulously evaluate their colour, size, shape, texture, and location.
• Skin biopsy: if further analysis is needed, a skin biopsy may be performed to determine whether a mole is benign or malignant. This process is part of our commitment to providing precise and thorough care.
• Photographic monitoring: at Lumine Dermatology & Laser Clinic, we emphasise the importance of tracking the evolution of your moles. We take detailed dermatoscopic and clinical photographs and serially monitor your moles over time to detect any changes promptly.

What are the treatment options for moles?

The treatment options for moles depend on various factors, including the type of mole, the size, and whether there is any suspicion of malignancy. Not all moles are the same. 

The first step in removing moles is to have a trained dermatologist examine the mole with a dermatoscope to determine whether it is benign or malignant. If the mole is suspicious of malignancy, an excisional biopsy with a 2 mm border may be performed, and the entire mole will be submitted for histological examination.

If we are confident we are dealing with a benign mole, here are some common treatment options for moles at Lumine Dermatology & Laser Clinic:

• Observation: most moles are harmless and do not need treatment. Your dermatologist may suggest monitoring them over time.
• Benign mole removal: moles may be removed for aesthetic or medical reasons. Mole removal can be conducted in various ways depending on the type and size of the mole. These include:
  • Laser mole removal (CO2, picosecond or long-pulsed alexandrite laser)
  • Shave biopsy
  • Excision biopsy
  • Or a combination of the above methods

Moles should never be removed by yourself or a friend/family member at home using natural remedies. This may cause problems and complications such as bleeding and infection. If you have a cosmetic concern about a mole and wish to have it removed, consult with a reputable dermatologist for treatment options.

Frequently asked questions

Are there any side effects to mole removal?

While generally safe, mole removal involves potential side effects, as with any medical procedure.

• Scarring: to minimise this, choosing the right procedure for the right type of mole and individual is important. If the cosmetic outcome will be inferior to having the mole there in the first place, it may not be worthwhile to embark on the mole removal journey (unless there is suspicion of malignancy).
• Infection: follow post-procedure instructions to minimise the risk of infection.
• Incomplete removal or recurrence: this is more common with shave excisions and laser mole removal. Sometimes, the benefit of complete mole removal must be balanced against the risks of scarring. In this case, more sessions may be required to achieve a good outcome.

To minimise the risks, it is essential to choose a qualified dermatologist or skin surgeon for mole removal. They can thoroughly evaluate and recommend the appropriate method based on your mole characteristics and skin type.

Are there any age restrictions for mole removal?

No, there are no age restrictions. We have the facilities and experience to perform mole removal for children. However, it is advisable to consult with your dermatologist, who will advise you on the level of urgency (or not) of removing a mole. It will also depend on your child's disposition and whether they can cooperate with medical procedures.

Does removing a mole leave a scar?

Yes, it can leave a scar. The size, location, and removal technique of the mole will also determine the scar's appearance.

What are the safest mole removal methods available in Singapore?

At Lumine Dermatology & Laser Clinic, we prioritise your safety and well-being. We offer various safe mole removal methods, including surgical excision (shave and excision biopsies), laser therapy (long pulsed 755nm laser, picosecond laser and CO2 laser), and a combination of treatment. During your consultation, we will assess your mole's characteristics and recommend the most suitable method.

How much does mole removal typically cost in Singapore?

The cost of mole removal in Singapore can vary depending on the size, location, number of moles removed, and the chosen removal method. Generally, prices range from SGD 250 to SGD 500 per mole. During your consultation, we'll provide a personalised quote based on your specific needs.

What factors should I consider before choosing a mole removal method in Singapore?

Before choosing a mole removal method, it's essential to consider factors such as the size, location, and type of mole, as well as your skin type, medical history, and expectations for mole removal. I have had patients remove specific moles on the face because it affects their self-esteem, the mole gets frequently inflamed due to location, or even some who believe a particular mole affects their job prospects or future. Our experienced dermatologist will carefully evaluate these factors during your consultation and recommend the safest and most effective removal method.

Can moles grow back after removal?

Moles can regrow after removal. A balance must be struck between the possibility of scarring and effective mole removal, and a mole removal process may involve a series of laser treatments instead of just one session. If a mole grows back, it is usually within the first six months.

Another possibility to consider is a biopsy if the mole keeps recurring, as one must always bear in mind the possibility of malignancy. However, our clinic will take great care to ensure thorough removal, minimising the chances of regrowth.

Is it necessary to get a biopsy after mole removal in Singapore?

Biopsy after mole removal is not always necessary, but it depends on several factors, including the mole's appearance and characteristics. In some cases, especially if the mole shows any suspicious features or if there's a concern about melanoma, it will be mandatory to examine the mole cells more closely under microscopy. Rest assured that we will discuss this option and ensure you're well-informed at every step.

What are scalp problems?

Scalp issues encompass a range of skin conditions that may result in itchiness, dandruff, or irritated skin. These conditions lead to discomfort and impact the look of hair. Whether your scalp is excessively oily, dry, or sensitive, these concerns affect your everyday ease and confidence.

Common scalp problems in Singapore include dandruff, oily scalp, and scalp folliculitis. Fortunately, most scalp issues can be effectively treated, restoring your mental well-being and self-assurance.

Concerned about scalp issues? Make an appointment with Lumine Dermatology & Laser Clinic today, and we can create a bespoke treatment plan for you.

Frequently asked questions

Why does scalp folliculitis keep coming back, and how can I prevent it?

Scalp folliculitis recurs due to excessive sweating, high humidity, and bacteria buildup on the scalp, often exacerbated by not rinsing hair thoroughly.

To prevent scalp folliculitis, it's crucial to maintain a regular hair-washing routine with a mild, antibacterial shampoo suited for frequent use in tropical climates. Choose lightweight, non-comedogenic hair products to avoid pore blockage. After physical activities, promptly rinse your scalp to remove excess sweat and oil.

Can using hair products cause dandruff or worsen scalp folliculitis?

Yes, certain hair products can trigger dandruff or exacerbate scalp folliculitis by irritating the scalp or clogging hair follicles. Hair products containing harsh chemicals (e.g., alcohols, sulfates, fragrances) may irritate sensitive skin, leading to flakiness resembling dandruff. Meanwhile, comedogenic oils applied too close to the scalp may occlude hair follicles, causing folliculitis.

In Singapore, prioritise products formulated for sensitive skin or specifically designed to treat dandruff and scalp conditions. If you suspect a product worsens your symptoms, consider eliminating it from your routine to observe any improvement.

How can I tell if my itchy scalp is due to dandruff or scalp folliculitis?

Dandruff and scalp folliculitis result in itchy scalps but have distinctive symptoms. Dandruff typically appears as flaky, white to yellowish scales on the scalp and hair accompanied by itching. A yeast-like fungus or dry skin mainly causes it.

Scalp folliculitis is identified by small, red, acne-like bumps or pustules at the hair follicles, which may be painful or itchy. In some cases, scalp folliculitis and dandruff can coexist together. For accurate diagnosis and treatment, consult a dermatologist in Singapore.

How often should I wash my hair if I have scalp folliculitis or dandruff, especially in humid Singapore?

The ideal hair washing frequency varies based on your scalp condition and hair type. For dandruff, daily or alternate-day washing with a gentle, anti-dandruff shampoo is beneficial to control yeast growth and minimise flakiness. For scalp folliculitis, frequent washing with a medicated or antibacterial shampoo, as prescribed by a dermatologist, helps eliminate infectious agents.

Singapore's high humidity necessitates regular washing to manage sweat and oil. Those with sensitive skin should opt for sulfate-free shampoos designed for daily use, being mindful of product buildup. Always follow a healthcare professional's advice to find the best routine for your scalp condition.

Hair problems can manifest in various forms, each presenting its unique challenges. The most common hair loss problems include androgenetic alopecia, alopecia areata, and telogen effluvium. Understanding these hair problems is crucial for developing effective treatments and management strategies to address individual needs and restore confidence and well-being.

Frequently asked questions

How effective are natural remedies for hair loss?

Natural remedies like coconut oil and aloe vera are loved for their soothing and moisturising properties. Coconut oil is rich in fatty acids that penetrate the hair shaft. However, if applied too close to the scalp, it may increase the growth of Malassezia furfur in a tropical climate such as Singapore, contributing to dandruff issues.

On the other hand, Aloe vera is known for its ability to soothe the scalp and provide a cooling effect, which can be refreshing in Singapore's heat. While these remedies are great for overall hair health and can help manage conditions like dryness and dandruff, it's important to note that their effectiveness in treating hair loss varies among individuals. If your hair loss is due to genetic factors, hormonal changes, or other medical conditions, these natural treatments might not address the root cause.

Does Singapore's water quality affect my hair?

Moving to a new environment can impact your hair, and the change in water quality compared to what your hair and scalp are accustomed to can sometimes lead to increased hair fall initially. The water in Singapore is treated and very clean, but like in many urban areas, it can contain minerals and chlorine at safe levels, which some individuals might find their hair sensitive to.

If you're experiencing this, consider using a filtered shower head to help remove any excess chlorine and minimise the hardness of the water. Additionally, using a gentle, hydrating shampoo and conditioner can help mitigate the effects of water quality on your hair. If the problem persists, consult a dermatologist in Singapore to explore other underlying causes and appropriate treatments.

Does the Asian diet affect my health?

Asian diets, typically rich in essential nutrients beneficial for hair growth, often include a variety of vegetables, fruits, lean proteins, and healthy fats from fish and nuts, which can provide a good foundation for healthy hair. However, hair loss can occur if vital nutrients like iron, vitamin D, certain B vitamins, zinc, and protein are deficient.

Regardless of the specific cuisine, ensuring a balanced diet that includes these nutrients is important. If you suspect your diet might be lacking, consider speaking to a nutritionist in Singapore who can provide guidance tailored to your needs and preferences. After consulting with a healthcare professional, incorporating multivitamins or specific supplements can help address deficiencies.

What is the expected timeline for hair loss treatment results?

The timeline for seeing results from hair loss treatments can vary widely depending on the type of treatment and the underlying cause of hair loss. Generally, patience is key, as hair growth takes time, and treatments can take several months to show visible improvements.

For topical and oral treatments like topical minoxidil, oral minoxidil, finasteride, and dutasteride, it might take at least 3 to 6 months of consistent use to notice a reduction in hair loss and start seeing new growth. The full potential of these medications may sometimes take a year to realise, and there may be a paradoxical hair-shedding phase when these medications are initiated.

Other supplements like proteoglycans typically minimise hair shedding within a few weeks of initiation, while topical scalp treatments in the form of growth factors and exosomes will depend on one’s response to these treatments. The time to notice results will vary from 2 to 6 months after initiation. Having realistic expectations and following your dermatologist's instructions closely is crucial.

What are epidermal cysts?

At Lumine Dermatology & Laser Clinic, we frequently address concerns related to epidermal cysts, commonly called sebaceous or epidermoid cysts. These benign skin growths develop under the skin. They grow gradually and are typically filled with a whitish, thick substance that may have an unpleasant odour. Although they can arise on any part of the body, they are more prevalent in areas prone to friction or pressure, such as the groin, underarms, and back.

In most cases, epidermal cysts are painless and do not cause health problems. Complications may occur when a cyst becomes swollen, red, or painful, particularly if it ruptures or becomes infected. If epidermal cysts are an aesthetic concern, rupture, and become inflamed or infected, they can be removed or drained by a dermatologist.

What causes epidermal cysts?

Our skin comprises three layers: the epidermis, dermis, and hypodermis. The epidermis is the outer layer of the skin; it acts as a protective barrier and is made up of skin cells that shed to be replaced by new skin cells.

Epidermal cysts develop due to a problem in the normal shedding of cells from the epidermis. In these cases, skin cells embed deeper into the inner layers of the skin, creating a pocket of epidermal cells within the skin. These pockets fill with skin secretions, notably keratin – a sturdy, whitish substance. When keratin becomes trapped, it forms the bulk of the cyst.

Epidermal cysts are commonly situated near hair follicle openings. They form when these openings become obstructed or inflamed, often due to harm inflicted on the hair follicles, such as scrapes or wounds.

What are the symptoms of epidermal cysts?

The symptoms of epidermal cysts vary depending on the severity. In general, the symptoms of epidermal cysts include:

• Small, round growth under the skin and is often more noticeable by touch than sight.
• Small blackhead with a small, palpable lump underneath that fluctuates in size and occasionally gets inflamed.
• Thick, white to yellow, cheesy material that discharges from the lump – this is keratin.
• Redness, swelling, or pain (signs that the cyst may be infected or ruptured). These symptoms prompt medical attention to prevent further complications.

Are epidermal cysts painful?

Epidermal cysts may not be painful, especially if they are small. However, if they become inflamed, they can cause significant swelling and discomfort. They may also rupture and get infected.

If you are in pain or discomfort due to an epidermal cyst,  do not squeeze the cyst on your own. It is important to seek medical attention. Consulting with a dermatologist can help accurately diagnose the issue and allow for appropriate treatment to alleviate your symptoms.

Who is at risk of epidermal cysts?

Epidermal cysts can affect individuals of any age, gender, or race. In Singapore, no specific group is at a higher risk of developing epidermal cysts. They often develop due to skin trauma or clogged hair follicles. In general, risk factors for epidermal cysts are:

• History of skin injuries: skin injury or trauma may cause epidermal cysts, which develop when there is an invagination of the outer layer of the skin (epidermis) into the deeper layers.
•  Family history/genetics: individuals with a genetic predisposition to developing epidermal cysts may be more prone to having them

How are epidermal cysts diagnosed?

Epidermal cysts are typically diagnosed by a dermatologist. The process usually includes the following:

• Clinical examination: your dermatologist will examine your epidermal cyst to determine the characteristics and symptoms, such as discharge and swelling.
• Skin biopsy: if the cyst has suspicious features, further tests, such as a biopsy, may be conducted to examine a sample of the cyst under a microscope.
• Imaging studies: in most cases, an examination or skin biopsy is sufficient to determine the characteristics of an epidermal cyst and provide a diagnosis. However, if the cyst diagnosis is uncertain, imaging tests such as ultrasound or magnetic resonance imaging (MRI) may be performed to examine the tissues on a deeper level.

What are the treatment options for epidermal cysts?

At Lumine Dermatology & Laser Clinic, the right treatment option for cysts involves considering various factors, including the cyst’s size, location, and history of previous inflammation or surgery. Equally important are your expectations regarding scarring, recovery time, and how treatment may impact your lifestyle.

We approach cyst removal via the following methods:

• Minimal incision technique: ideal for those seeking a less invasive option; this method involves a small incision to remove the cyst wall and its contents. This technique minimises scarring and reduces recovery time, although it may carry a slightly higher risk of recurrence than more invasive methods.
• Conventional elliptical excision: this method involves making an ellipse-shaped cut around the cyst's borders and then stitching up the wound in layers. The final result is a linear scar oriented along the skin’s natural tension lines.
• Incision and drainage: if the cyst is infected to the extent of forming an abscess, immediate relief can be provided through incision and drainage. This procedure allows pus to be drained, reducing discomfort quickly. The wound may be left open to heal naturally with regular dressing changes or closed with a secondary procedure once the infection has cleared.

Recognising that treatment does not end with surgery, Lumine Dermatology & Laser Clinic offers effective aftercare options. Our laser technologies, including the pulsed dye laser, picosecond lasers, and fractional carbon dioxide laser, are available to help remodel scars from the moment stitches are removed, ensuring the best possible cosmetic outcome.

Frequently asked questions

Can I remove an epidermal cyst myself?
It is not advisable to squeeze or pop an epidermal cyst at home, as it may become infected or lead to more complications, such as scarring. Consult a dermatologist to remove an epidermal cyst. At Lumine Dermatology & Laser Clinic, we are experienced and can provide you with the right advice and treatment.

How long does an epidermal cyst last?
Due to its structural nature within the skin, an epidermal cyst is unlikely to resolve independently or with topical medications. Surgical intervention is often the most direct approach to resolving these cysts.

Many find that epidermal cysts remain a small, manageable size for years, causing little to no discomfort.

However, it is not uncommon for these cysts to gradually increase in size. When situated in areas of the body such as the skin folds (prone to frictional forces) or pressure-dependent areas (buttocks, back), cysts have a higher chance of becoming inflamed or ruptured.

Are epidermal cysts hard or soft?
Epidermal cysts are typically firm lumps under the skin. When infected with pus accumulation, they will be tender to touch and feel slightly boggy with digital pressure. If a subcutaneous skin lump feels soft to the touch, it is more likely to be a lipoma. If it is bony and hard to touch, it is more likely to be an osteoma or bony origin.

Does epidermal cyst removal hurt?
Epidermal cyst removal is performed under local anaesthesia, which numbs the area around the cyst, making the procedure virtually painless. General anaesthesia is typically not required. This procedure is often done in a dermatology clinic without utilising an operation theatre.

Patients may feel slight pressure during the surgery but no significant pain. Post-procedure discomfort is minimal and usually does not require over-the-counter pain medication. Patient feedback consistently indicates that the procedure is far less daunting than anticipated, with minimal discomfort and quick recovery times.

What are the risks of epidermal cyst removal?

While epidermal cyst removal is generally safe, as with any surgical procedure, there are some associated risks. These include recurrence, infection, bleeding, and scarring. However, these risks are low, especially when the procedure is performed by skilled dermatologists using sterile techniques. At Lumine Dermatology & Laser Clinic, we provide detailed post-operative care instructions to minimise these risks and ensure a smooth recovery.

What is the recovery time for epidermal cyst removal?

Recovery time can vary depending on the size and location of the cyst but is typically brief if a minimal incision technique or elliptical excision is performed. Most patients can resume normal activities within a few days, and the incision site usually heals within a week. A discrete, waterproof dressing is often applied for 1-2 weeks after surgery. Avoiding strenuous activities for a short period post-surgery is recommended to aid healing.

What are the post-removal care instructions for an epidermal cyst?

Proper aftercare is crucial for a smooth recovery following epidermal cyst removal. Key steps include keeping the area clean and dry, applying the prescribed antibiotic ointment, and changing the bandage as directed. Patients should also avoid direct sunlight on the treated area and refrain from strenuous activities that could disrupt the healing process. Any signs of infection, such as increased redness, swelling, or pus, should prompt an immediate consultation with a dermatologist.

What is eczema?

Eczema, also referred to as dermatitis or atopic dermatitis, is a common skin condition affecting many Singaporeans. Here, we delve into the causes, symptoms, and effective strategies for living comfortably with eczema. Past studies have shown that close to 21.5% of Singapore's adolescents suffered from atopic dermatitis, and the prevalence was higher among the Chinese (21.6%). In another study, researchers surveyed 681 people and found that 21% of children and 11% of adults have eczema.

Eczema's impact goes beyond the skin, affecting overall well-being, sleep, and self-esteem. Our team at Lumine Dermatology & Laser Clinic is dedicated to offering comprehensive care, guiding you through understanding eczema, managing its symptoms, and making lifestyle adjustments to improve your quality of life.

There are seven types of eczema, each with its unique triggers and approach to treatment.

Type of eczema	Eczema characteristics
Atopic dermatitis	Atopic dermatitis is the most common form of eczema. It commonly affects the face in infancy and flexural areas in childhood and adolescence. Some adults with a history of atopic dermatitis in childhood will have eczema present more locally, such as the lips (cheilitis), eyelids, face, hands, or feet. Atopic dermatitis is sometimes seen as the first step in the "atopic march," potentially leading to other allergic conditions like asthma and allergic rhinitis.
Contact dermatitis	Contact dermatitis occurs when patients develop rashes at the exposure site upon contact with allergens. If you have persistent hand eczema, eyelid rashes, or dry and flaky lips, you should suspect contact dermatitis.   Common triggers include nickel, fragrances, hair dyes, and cosmetics.
Dyshidrotic eczema	Also known as pompholyx, dyshidrotic eczema manifests as itchy, bubble-like blisters on the hands and feet. This form of eczema tends to be particularly persistent and uncomfortable, sometimes accompanied by painful fissures in the skin.
Lichen Simplex Chronicus	Lichen Simplex Chronicus usually refers to a thick, itchy rash with exaggerated skin lines, often in response to chronic picking, rubbing, or scratching of the area.
Discoid eczema	Discoid eczema is a form of eczema that results in “coin-like” lesions around the body. Discoid eczema can be dry (dry, scaly, cracked plaques) or wet (oozy, crusted, secondarily infected plaques). Insect bites, stress, or even contact dermatitis to nickel are potential triggers for this eczema.
Seborrhoeic dermatitis	As the name suggests, seborrhoeic dermatitis is a form of eczema that affects areas with more oil production, such as the scalp, eyebrows, nasolabial folds, chest, and back.   The scales in seborrhoeic dermatitis often look a little yellowish and greasy.
Stasis dermatitis	Stasis dermatitis occurs due to circulation issues in the lower parts of the legs, more often on the medial aspects of the lower limbs rather than the lateral part.   If left untreated, stasis dermatitis can result in permanent changes in the appearance of one’s lower legs, known as lipodermatosclerosis. In lipodermatosclerosis, skin in the affected area is thickened and bound down, with limited mobility.

What are the symptoms of eczema?

Below are some key signs of eczema to watch for: 

• Itching: some individuals suffer from profound itchiness that disrupts sleep and unconsciously leads one to scratch to the extent of bleeding.
• Dry and scaly skin: individuals with eczema experience a higher rate of moisture loss (transepidermal water loss TEWL) in their skin, leading to dryness and scaling.
• Sensitive skin: the skin becomes irritated by harsh soaps and detergents, extreme temperatures, non-breathable fabrics, and sweat. There is also a higher prevalence of allergies to dust mites, pollen, and certain foods.
• Red, swollen and inflamed skin: with eczema, the skin is often swollen, red, scaly, and inflamed.
• Weeping skin: infected eczema can lead to “weeping” or oozing of clear or yellowish fluids, which may have a distinctive odour. This is a sign of bacterial infection and requires medical attention.

At Lumine Dermatology & Laser Clinic, we aim to alleviate symptoms and improve the quality of life for those with eczema. If you are experiencing any of the above symptoms, we encourage you to reach out for a consultation. Together, we can create a tailored approach to manage eczema right.

Is eczema painful?

Eczema can be painful, particularly when the areas affected become inflamed and infected. The pain associated with eczema is typically a result of intense scratching and skin-picking. However, patients tend not to be affected by the pain inflicted by this condition. This is because the pain tends to be comparatively “relieving” than the itch. As a result, one is prone to an itch-scratch-damage cycle.

In more serious cases, the pain can be associated with a skin infection known as eczema herpeticum. In this case, one needs to seek medical attention immediately so that the right antivirals can be prescribed.

What is the itch-scratch-damage cycle?

The itch-scratch-damage cycle is a fundamental concept that can often feel like a never-ending loop for those experiencing it. As a dermatologist, I frequently discuss this cycle with patients, aiming to show how it contributes to their discomfort and what steps we can take to break free from it.

The outer layer of the skin often acts as a protective wall against external irritants. Eczema acts like a breach in this wall, leading to dryness, cracking, and inflammation. This breach makes the skin vulnerable, leading to the first sign of trouble: itch.

Here's where the cycle begins: You feel an itch and instinctively scratch. While this might offer momentary relief, scratching worsens the skin's condition. It further damages the skin's barrier, making it even more susceptible to irritants and allergens, leading to more itching. Thus, the cycle continues, often leading to increased inflammation, infection, and intense itching.

Who is at risk of eczema?

Several factors increase an individual’s risk of developing eczema; these are:

• Genetics: if you have a family history of eczema, you might be more predisposed to developing it. The probability of developing eczema is 50% if a parent has been diagnosed with the condition (parental atopy). The genes involved in eczema include those that maintain the skin's structural integrity and moisture levels and those that code for major immune system elements.
• Environmental factors: environmental factors, such as exposure to harsh chemicals in some soaps and detergents, certain fabrics, sweat, and even weather changes, can significantly trigger or exacerbate eczema symptoms.
• Food allergies: in children with moderate to severe eczema, especially those under the age of 3, it may be worthwhile considering food allergy as a trigger. Common foods implicated in childhood eczema include milk, egg, wheat, soy, shrimp, and peanuts.
• House dust mite allergies: these allergies are prevalent in older children and adults. They could also trigger your eczema if you recently relocated from a temperate country to Singapore.
• Internal factors: emotional and physical stress or recovery after an infection can lead to dysregulation of the immune system, which can then cause eczema to flare up.

How is eczema diagnosed?

Identifying the type of eczema patients are dealing with is important to tailor a treatment to each patient accurately. The diagnostic process for eczema may involve the following:

• Comprehensive medical history: you will first be required to provide a comprehensive medical history to determine potential triggers. We delve into your family history, lifestyle, and the impact of eczema on your daily life and well-being. This will allow us to craft a treatment plan tailored just for you.
• Physical examination: the affected areas must be assessed to diagnose the type of eczema you have accurately. We pay special attention to areas that significantly impact your quality of life,  such as the scalp, hands, feet, and face, ensuring no detail is overlooked.
• Targeted allergy testing: if indicated, patch testing and blood tests help us pinpoint potential triggers to avoid.
• Biopsy for clarity: in cases where your condition presents a diagnostic challenge, we may recommend a skin biopsy.

If you suspect your child or yourself may be affected by eczema, contact us now for prompt clinical intervention. Early intervention prevents disease progression (eczema to food allergy and asthma).

What are the treatment options for eczema?

Eczema is a chronic and sometimes relapsing condition that can be effectively managed with the proper care. At Lumine Dermatology & Laser Clinic, we understand the complexities of eczema and are committed to providing personalised treatments that cater to our patients' unique needs.

Our clinic's dermatologist, Dr Evelyn brings extensive experience, offering holistic and innovative clinical treatments designed to alleviate symptoms and improve your skin's health.

Eczema treatment includes the following:

• Topicals: depending on severity, you may be prescribed topicals ranging from topical corticosteroids to non-steroidal creams such as pimecrolimus, tacrolimus, and crisaborole.
• Oral medications: treatment options range from traditional immunosuppressants such as cyclosporine and methotrexate, as well as the newer Janus Kinase (JAK) inhibitors such as baricitinib, abrocitinib, and upadacitinib.
• Antibiotics: where signs of infection are evident, you will be administered a course of antibiotics.
• Injections: injections such as subcutaneous dupilumab can be prescribed for patients with recurrent and persistent flare-ups. Dupilumab is a highly efficacious, FDA-approved treatment for eczema with a high safety margin. No blood tests are required, and side effects are minimal. Dupilumab can only be administered by dermatologists and is approved for use in atopic eczema from 6 months old and above.
• Wet wrap therapy: we provide guidance on wet wrap therapy, an effective method for enhancing the skin's barrier and moisture levels and offering relief from eczema discomfort.
• Skincare advice: our team will review your current skincare routine and discuss the impact of shower frequency, moisturiser use, and potential irritants. We will recommend products that support and strengthen your skin's barrier function.  
• Lifestyle choices: understanding that lifestyle factors can influence eczema, we offer advice on making adjustments that could reduce flare-ups and support your treatment journey.

Frequently asked questions

What is dupilumab, and how does it work?

At Lumine Dermatology & Laser Clinic, we are excited to offer dupilumab, a treatment for patients struggling with moderate to severe eczema (atopic dermatitis). This medication represents a significant leap forward in dermatology, offering new hope to those who have not found relief with traditional treatments.

Dupilumab operates by blocking the action of two key proteins, IL-4 and IL-13, that play a central role in the inflammatory process that drives eczema. By inhibiting these proteins, Dupilumab can effectively reduce the inflammatory response that leads to eczema symptoms. Dupilumab is administered by a dermatologist through a subcutaneous injection every two weeks. It can be administered in the clinic or at home. There is no need for blood tests, and Dupilumab has a good safety profile.

We are dedicated to exploring all avenues to improve skin health and enhance quality of life. If you are struggling with moderate to severe eczema and seeking alternatives to conventional treatments, dupilumab may offer the relief you have been searching for.

What are JAK inhibitors, and how do they work?

Oral JAK-inhibitors such as baricitinib (Olumiant), abrocitinib (Cibinqo), and upadacitinib (Rinvoq) work by blocking certain signalling pathways that affect the immune system and inflammatory process in eczema. JAK inhibitors can be administered orally, providing a significant advantage for those who prefer not to use injectables or are looking for an alternative to topical or oral steroids/immunosuppressants. These inhibitors lead to rapid improvement in eczema symptoms but come with some potential side effects. It is important to discuss this with a dermatologist well-versed with eczema treatment.

What causes eczema?

At its core, eczema results from a combination of genetics, immune system activation, and environmental factors. It is like a perfect storm where your skin's barrier, which usually protects you from the outside world, is compromised. This allows moisture to escape and irritants to enter more easily, leading to the symptoms many are familiar with.

Can I have more than one type of eczema?

You can have two or more types of eczema. This is also a form of disease progression common among patients with eczema. The best method to prevent this is to seek prompt intervention. Halting the progression of eczema at early stages will also ensure the condition is manageable and does not interfere with your quality of life.

How can I cure eczema permanently?

Many patients are hopeful of being permanently rid of eczema. Whilst scientifically, there is no cure for eczema, we firmly believe that treatments, lifestyle, and behavioural changes can effectively suppress flare-ups and lead to an unperturbed life. We understand the stress that conditions like eczema can inflict on you. However, eczema is not a life sentence, and there are a plethora of medications, e.g. dupilumab and JAK inhibitors, at our disposal to help you with your eczema.

Can diet and nutrition improve eczema?

There is some evidence that consuming omega 3 and 6 supplements can help fortify the skin barrier. Recurrently infected eczema can benefit from vitamin D supplementation. Consuming probiotics in pregnancy may potentially reduce the risk of eczema in children.

Is it possible to manage eczema without steroid creams?

This is possible with an arsenal of non-steroidal anti-inflammatory creams such as pimecrolimus, tacrolimus, and crisaborole. Good skin care, avoiding triggers, and applying non-steroidal anti-inflammatory agents can go a long way in managing eczema and minimising relapse.

What are benign skin growths?

Benign skin growths or lesions are typically harmless in Singapore and generally do not progress into malignant conditions such as skin cancer. These growths vary significantly in appearance. And are occasionally removed for diagnostic and cosmetic purposes.

Dr Evelyn at Lumine Dermatology & Laser Clinic offers tailored guidance or consultations regarding removing benign skin growths.

What do benign skin growths look like?

The appearance of benign skin growths varies widely depending on the type of growth. In some instances, benign skin growths do not cause noticeable symptoms and may only be discovered during a routine physical examination.

Type of benign skin growth	Appearance of benign skin growth	Causes of benign skin growths
Seborrhoeic keratosis	Seborrhoeic keratoses appear brown, black, or tan and may look waxy and slightly raised.   While they can appear anywhere on the body, they are commonly found on the face, neck, chest, and back.   In some cases, they may become itchy, irritated, and inflamed.	Seborrhoeic keratosis occurs due to an overgrowth of skin cells, also known as keratinocytes.   If you have multiple seborrhoeic keratosis, there may be a familial predisposition.
Skin tags	Skin tags are small, pedunculated, flesh-coloured skin appendages that may occasionally twist on themselves, turn black at the tip, and cause pain. They can also become inflamed from friction or trauma.	Skin tags tend to aggregate in the skin folds such as the armpits, thighs, eyelids, and neck. Skin tags can be hereditary or found more frequently in overweight individuals.
Sebaceous hyperplasias	Sebaceous hyperplasia are small, yellow, or flesh-coloured bumps on the skin's surface. They are usually dome-shaped with a central indentation and tend to develop on the face.	Sebaceous hyperplasia is caused by the enlargement of sebaceous (oil) glands and may be more common in those with acne.
Syringomas	Syringomas are small, firm, flesh-coloured or yellowish bumps.   They typically cluster around the eyes, especially on the lower eyelids, but may also occur on other parts of the face, neck, chest, or groin.	Syringomas are caused by the overgrowth of cells in the sweat glands (eccrine glands).
Dermatofibromas	Dermatofibromas are firm lumps usually found on the limbs. They are usually harmless and asymptomatic but can occasionally be painful, inflamed, or itchy.	Dermatofibromas are composed of collagen fibres and the cells that produce them, also known as fibroblasts.   They often occur in response to injury.
Lipomas	Lipomas are mobile, soft, rubbery lumps that are often better felt than seen.   Lipomas can become occasionally become painful.	Lipomas are a collection of fat cells often found in the skin's subcutaneous layer.   Occasionally, they may extend into the muscles underneath.   Some individuals with multiple lipomas have a genetic predisposition to developing them.
Cherry angiomas	Cherry angiomas are small, bright red or purple bumps on the skin. They are most frequently found on the trunk.   These typically appear in adulthood and increase in number with age.	The bright red appearance of cherry angiomas comes from the accumulation of small blood vessels underneath the skin.

What is the difference between benign skin growths and skin cancer?

The main difference between benign skin growths and skin cancer is that benign skin growths do not invade or spread to other tissues or organs. Skin cancer or malignant skin growths, on the other hand, tend to grow at a faster rate and invade underlying tissues with the propensity for spreading to different organs and lymph nodes (for specific subtypes of skin cancer).

However, these indicators alone cannot differentiate between benign skin growth and skin cancer. It is best to have it checked by a dermatologist who can perform skin biopsies or other tests to determine if the skin growth is benign or malignant.

Who is at risk of benign skin growth?

Benign skin growths are common and can develop in people of all ages and backgrounds. However, for some individuals, the risk may be higher. The following risk factors are associated with benign skin growths:

• Age: benign skin growths, such as sebaceous hyperplasia or skin tags, tend to develop as we age. They are more prevalent in middle-aged or older individuals.
• Genetics: having a family history of benign skin growths may increase the likelihood of developing similar growths.
• Hormones: some benign skin growths are influenced by hormonal changes. One example is cherry angioma, which grows in response to hormonal influences during pregnancy.
• Sun exposure: benign skin growths like seborrhoeic keratosis may develop more in sun-exposed areas, though this is debatable.
• Medical conditions: certain conditions, such as obesity or other metabolic disorders, have been associated with an increased risk of developing skin tags.
• Irritation, infection, or injury: some benign skin growths, such as skin tags, often occur due to irritation and friction in the skin. Dermatofibromas usually develop in response to trauma.

How are benign skin growths diagnosed?

The diagnosis of benign growths involves a combination of the following:

• Clinical examination: your dermatologist will physically examine the skin growth and assess its characteristics.
• Medical history assessment: your medical history will be analysed to identify possible causes of the benign skin growth. We will also try to understand how the skin growth affects you.
• Diagnostic tests: additional diagnostic tests, such as a skin biopsy, may be necessary to diagnose benign skin growths or distinguish them from malignant skin tumours. 

What are the treatment options for benign skin growths?

At Lumine Dermatology & Laser Clinic, we understand that each patient comes to us with unique concerns and goals. Whether a benign skin growth is causing discomfort or you seek treatment for cosmetic reasons, our team is here to offer a range of advanced treatment options tailored to your needs. Here's an overview of the treatments we provide for benign skin growth at Lumine Dermatology & Laser Clinic:

• Topical treatments: topical treatments often have limited efficacy in treating benign skin growths, though they may have a role to play in reducing inflammation and irritative symptoms associated with them.
• Snip or shave excision: this is a common method of removing benign skin growths, particularly large or inflamed ones, as a histological specimen can be obtained to rule out malignancy.
• Laser therapy: laser therapy (carbon dioxide laser, pulsed dye laser) is commonly used to treat certain skin lesions. It provides a precise and controlled method for removal without damaging the surrounding skin.

• Electrosurgery: this is a precise, minimally invasive procedure where heat is delivered through a small tip to vaporise tissue

Frequently asked questions

Is removing moles and skin tags painful?

The removal of moles and skin tags is typically performed under topical or local anaesthesia, making the procedure relatively painless. Patients might experience slight discomfort during the anaesthetic administration, but the removal should be painless. There is typically no need to take any over-the-counter pain relief post-procedure.

How effective is laser treatment for the removal of benign skin growths?

Laser treatment is a favoured method for removing benign skin growths due to its precision and ability to minimise damage to the surrounding skin, significantly reducing the risk of scarring. While laser treatment can offer excellent outcomes for many patients, it's important to consult a dermatologist to determine the most appropriate treatment plan.

How long does recovery take after the removal of benign skin growths?

Generally, most of our patients can return to their daily routine within a day, though the area we treated may need some time (ranging from a few days to two weeks) to heal completely. Following our aftercare instructions is essential, as they are tailored to help you recover as smoothly and swiftly as possible.

Can benign skin growths recur after removal?
Removal of benign skin growths may take more than one session. The efficacy of removing the growth must be balanced against the risk of causing scarring. Hence, more than one session may be required for deeper growths like syringomas and sebaceous hyperplasias.

While removing benign skin growths is generally permanent for the treated lesion, new growths can develop in other areas of the skin. The likelihood of recurrence depends on the individual’s skin type, genetics, and environmental factors.

When should you worry about skin growths?
Most skin growths are benign, meaning they are non-cancerous. They often do not require treatment unless they become inflamed, painful, itchy, or a cosmetic concern. However, it is always best to have a dermatologist check them if in doubt.

Do benign skin growths need to be removed?

Benign skin growths and tumours often do not need to be removed as they do not pose any significant health risks. However, if there are associated symptoms or cosmetic concerns, you can seek treatment for removal, as it can be done safely using minimally invasive techniques such as laser therapy.

What is the most common benign growth of the skin?
Seborrhoeic keratoses are believed to be among the most common benign growth or tumours of the skin.

What causes benign skin growths?
The exact cause of benign skin growths is often unknown, as they develop over time and with age. However, many benign skin growths are caused by years of exposure to the sun or develop in response to hormonal changes. Genetics may also play a role.