What is Hives Rash | Urticaria?

Urticaria, clinically known as hives rash, 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 Rash?

Hives rash 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 Hives Rash | 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 (Hives Rash) diagnosed?

Urticaria, or hives rash, 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 Hives Rash?

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, clindamycin and/or rifampicin to combat infection and inflammation.
• Oral spironolactone (for females): oral spironolactone is an 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, secukinumab 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 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 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 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.