Reducing that bruise

I want to go for filler injections. My doctor told me one of the potential side effects is that I could have bruises under my eyes. I know this should be temporary but I'm very worried as I usually bruise quite badly and easily with minor fall. Is there any way to reduce the chance of me bruising?

From a simple needle prick to procedures like filler, or even major surgery, every procedure that manipulate your skin potentially causes bleeding and bruising.

Here's how you can do to reduce the chance or the severity of bleeding and bruises.
✅ Avoid aspirin, NSAIDS (a type of painkillers), vitamin C & E, fish oil a week before
✅ Stop alcohol and garlic 2 days before
✅ Avoid excessive exercise immediately before and 2 days after
✅ Avoid flight 1-2 days if possible (change of cabin pressure)
❓Pineapples contains bromelain and may help to reduce bruising

Videos for Eczema Children

Acne in mature skin

I am in my late 40's. And I still get acne. Why?

Contrary to popular belief, acne isn't just a problem of the teenagers. Young babies can get acne (known as infantile acne, often temporary). Most people do not get severe acne after menopause but yes, you may still get acne at a mature age.

The reason you get acne is probably not much of a difference to that of the teenagers. But there may be other things that you would want to consider if you have never had acne and suddenly suffering from severe breakout at this point of time.

1. Did you recently change your skin care products? Some people changed their skin care products to those "designed for mature skin" which are usually more greasy and may block the pores.
2.  Did you recently change your skin care routine? Did you just started on a face scrubs? Or tried a new facial treatment?
3. Did you recently go travelling?
4. A recent change of job?
5. Could it be something else rather than a true acne? Some skin diseases may mimick acne, and these include acne rosacea, sebaceous hyperplasia, milia and bacteria folliculitis.

Consult a dermatologist if you are not sure.

Healing Eczema Without Steroids

Recently, one of my patient with very severe eczema on methotrexate asked: "Can I heal my eczema without any steroids?"

Yes, you can.

Just like how your chickenpox can heal without antiviral, your runny nose can heal without any antihistamines, your sore throats can heal without any antibiotics, some women can even deliver at home, your eczema can heal without any steroids.

"Steroids is not a cure for eczema, they said," she told me. She was invited to join a support group for "healing eczema without steroids". And she has came across many natural healing advocates who strongly urge everyone to avoid steroids.

And I do not beg to differ.

What I want you to know is that "dermatologists readily dish out steroids" to help you getting over the most difficult time, and we have absolutely no intention not to harm you. In case some may have forgotten, our oath says "First do no harm" and our motto is "To cure sometimes, to relieve often, to comfort always".

I am not against natural path. But if you want to go absolutely steroids free, these are what I would suggest,

1. Avoid all irritants and your known allergens
2. Keep your bathing brief (<5 minutes) and not too frequent, using slight lukewarm water
3. Use gentle cleanser instead of soap (no natural handmade soap please and no bubble bath)
4. Always keep your skin moist, frequent re-application of moisturiser is the key
5. Seal in the moisture with occlusives (parrafin, vaseline ointment, dimethicone if you hate that greasy feeling)
6. If you feel really itchy, replace that scratch with applying cold pack or cold cream (no need to buy any particular brand of cold cream, just keep your hypoallergic moisturiser in the fridge)
7. Use immunomodulators such as topical tacrolimus, pimecrolimus
8. Ask your doctor about phototherapy (controlled light treatment) to see if you are a good candidate
9. If you are going for alternative medicine, please go for facilities with proper registration and certification (although I have no idea how to check that these are in place), and do ask them if their treatments may have any potential short term or long term side effects (Perhaps they might not actively discuss with you if you don't ask? Well, the reason I said this is because I have a teenage boy with eczema who came to me after 2 years of herbal remedies which was initially very effective and now he is suffering from stunted growth and a few other problems)

Whatever your choice is, take good care of your skin and get better soon!

Sunburn remedy

I came home from an outing with friends and found myself sunburnt despite using sunscreen! What should I do now?

No sunscreen offer 100% protection, which is why they are now known as sunscreen rather than sunblock.

Sunburn should be treated as soon as possible. Here's what you should do:

1. Seek shade immediately, if you are still outdoor.
2. Cool down with a shower or baths.
3. Apply a generous layer of moisturiser over the sunburnt area.
4. Apply mild topical corticosteroids to reduce the redness and swelling.
5. Drink a lot of water to prevent dehydration.

If you have a blister at the sunburnt area, do not de-roof it. De-roofing and leaving raw skin exposed poses a risk of secondary bacterial infection and slows down healing.

If there is a large area of blisters, or you are starting to feel feverish or chills, you should seek medical consultation immediately.

Practise strict sun protection until the burned area completely heal.

Preparing your own saline solution

What it is for?

To wash the raw wound / blistering area, or you can even use it to bathe if there is any condition causing extensive skin loss.

Why using a saline solution?

It is isotonic. That means it will not draw water in or out of your raw wound hence there will be less pain.

It cleans and wound and reduces the risk of secondary bacterial infection.

How to prepare it?

Simply add 9g of salt to a litre of water. Viola!

If you have just a small wound, buy those bottled sterile saline bottle that are readily available in most pharmacies. Yes, those that are used to wash contact lenses one will do.

Expired sunscreen

I just noticed my sunscreen has expired 6 months ago. It wasn't cheap and I don't feel like wasting it. Can I still use it?

While a sunscreen may not necessary go bad immediately after the expiry date, the expiry date stated is actually the duration that the product remained effective and safe based on the manufacturer's test.

Physical agents such as zinc oxide and titanium dioxide usually lasts longer than chemical agents.

If it doesn't "smell bad", it could very well still be safe to be used despite a reduced effect of protection. A reduced effect means even if you are applying adequate amount, it may not reached the labelled SPF. Most sunscreen in the market comes in a bottle of 30-50ml. If you apply it generously on all the exposed part of the body, you would have finished the bottle in no time. ;P

Since there is no way to be sure of the efficacy and safety after the expiry date and if you ask for my advice, I would have to tell you to throw it out.

Stitch Removal

Someone asks,
"Can I remove my stitches myself at home?"
"What if I can't make it on the appointment date given for stitch removal?"

I personally would advice against attempting to remove the stitches at home if you are not a trained healthcare personnel.

Why?

There's a few things that your doctor need to assess when he or she removes your stitches. For one, he or she needs to check if your wound has healed nicely and it's ready for the stitches to be removed. If the stitches are removed too early, you may risk having the wound gaps and you may need re-suturing. If the stitches are removed too late, more often than not the suture materials maybe buried under the skin making it difficult to remove and at higher risk of scarring.

Also, he or she needs to check if there is any sign of infection. If there is any early sign of infection, it should be treated early.

When should a stitch be removed?

When a stitch needs to be removed depends on a few factors.

First, the location of the wound, generally the wound of the face heals faster and will be removed soonest compare to other parts of the body, for example legs.

Second, the types of sutures used. Some sutures are absorbable and does not require opening of stitches.

Third, the tension of the stitches on the skin.

Other factors include age, smoking, underlying skin disease, previously irradiated skin, general health, infection etc.

Generally the doctor who stitched it will be the best person to advice you when is the best time to remove it.

Can't make it for the appointment to remove the stitch?

If possible, always tell your doctor before he or she make that stitch so that he or she can plan something else for you. Intradermal or subcuticular stitching with absorbable sutures will be fine to leave in.

Is there any nearby healthcare facility, a family doctor clinic for example, to help you removing it?

If you are confident enough and really want to remove it yourself, ask your doctor if he or she could provide you with the material and teach you how. ;)