Quick Fix for Acne

I've picked a pimple and it became red and swollen. I have an event coming up in 3 days. How do I speed up the healing process?

Are there quick fix for acne? 

The answer is yes. But we will need to assess the condition of the "red and swollen" acne to see if which fix is for you.

If the acne was "properly picked", the picking itself should have shortened this particular acne's "lifespan". You can hasten the recovery further by applying a non-comedogenic moisturiser.

By "properly picked", I mean it should be picked hygienically and completely without any residue or pus being left behind.

If the acne was not "properly picked", and has "swollen" and might even appear to be forming up a cyst, then you might need intralesional steroids (which means injecting low concentration of steroids directly to the cyst itself) to reduce the redness and the swelling quickly.

If the acne was not ready to be picked, light and laser treatment could be helpful to hasten its maturity so that it can heal faster.

If in doubt, it is always good to pay a visit to your nearest dermatology facility. If that is not possible before your event, a professional concealer could do the trick! ;P

Hair Thinning? Could it be androgenetic alopecia?

Losing hair and it seems to run in the family? It could be androgenetic alopecia.

What is this?

This is a type of hair loss that is genetically determined.

The basic

Hair are produced from the hair follicles. And it has a few phases.
Anagen: growth phase
Catagen: involution phase
Telogen: resting phase

What happens in androgenetic alopecia is that there is
1. Increased hair shedding
2. Miniaturisation of hair (thick large pigmented terminal hair --> thinner and shorter indeterminate hairs --> short and non-pigmented vellus hair)

Generally people with this condition tends to have gradual hair loss.
For men,  it usually start with recession of frontal hair lone and gradual thinning at the sides.
For women, it usually start over the crown. Luckily usually there isn't an area of marked baldness.

Why should you see a doctor?

There are many other causes of hair loss. Some people have temporary hair thinning due to stress, drugs or nutritional deficiency. Diffuse alopecia areata may look like androgenetic alopecia too.

Again, I must stress that effective treatment comes after an accurate diagnosis. What works for others who stand out to be the testimonials of certain products may not be what works for you. An accurate diagnosis to begin with will save you a lot of unnecessary money spent.

Investigations and treatment of androgenetic alopecia is not that cheap, but how many times we have encounter patients who have spent up to 5 figures buying packages of hair growth treatment at "hair specialist" saloon or spa trying to "treat Demodex infection that eats up the hair" or "clear the clogged hair follicles" etc.?

While majority of people with this condition can be otherwise quite normal, some people may have abnormal thyroid function, sex hormone etc. Others can have hair thinning as part of polycyctic ovarian syndrome where they might have acne, irregular menses, excessive body hair or even difficulty to get pregnant.

What are the treatments for me?

The treatment for androgenetic alopecia needs to be individualised. But before we talk about treatment, you must understand that the main aim of treatment is to slow or stop the progression of hair loss. While some people can get their hair regrowth, some may not. And it is difficult to predict who may response and who may not.

Main treatments available includes:
1. Topical solutions e.g. minoxidil
2. Oral tablets e.g. finasteride (for men only), spironolactone etc.
3. Low level laser therapy
4. Platelet rich plasma
5. Hair filler
6. Hair transplant

The list above is definitely not exhaustive. And don't forget cosmetic dermatology with hair thickening, hair camouflage, hair prosthesis and wigs.

At the moment,  hair implants are NOT recommended because these synthetic fiber implants are not only expensive, they are also dangerous and leading to a whole lots of complications.

Eczema and Career

I have eczema since young. Will it affect my career choice?

Unfortunately yes.

Certain jobs can be problematic for people with more than just mild eczema, especially if you will be in contact with irritants that may make your eczema flare-up more frequent. These include nursing, cleaning, catering, hairdressing etc.

But if you really love a job, think about measures that you can take to protect your skin. Proper use of personal protective gear may help.

Sunscreen for Indoor

My melasma is getting worse although I hardly go outdoor. Should I use sunscreen indoor?

Yes you should!

Why?

Ultraviolet rays can get to you even if you just stay indoors.

Do not underestimate the amount of ultraviolet rays that pass through the windows or glass door. clear glass allows 75% of UVA rays through. Even if there is tinting, up to 50% of the UVA rays may still pass through.

Travelling in a car? The  ultraviolet rays may pass through the car windows. 

Indoor lighting particularly fluorescent lighting, especially if the distance from the skin is close. This means desk lamps, bed lamps and overhead lamps are not a good idea for those with melasma and photosensitivity.

Other sources include TV monitors, computer monitors, tablets etc. Luckily nowadays, most traditional monitors have been replaced by LCD display which do not emit UV rays. They still do emit high energy visible lights though.


What you can do?

Add acrylic or plastic diffusers to indoor lights.
Choose incandescent bulbs or LEDs rather than fluorescent lights .
Choose a broad spectrum sunscreen and use it even indoor.


You might be interested to read:
Choosing The Best Sunscreen - Beyond UVR protection 
How much sunscreen is 2mg/cm2
Sunscreen and Moisturiser

"Dress code" for eczema

I have severe eczema and I tend to scratch a lot. I find it embarassing to go out to meet people with all the rashes and scratch marks on my skin, in particularly on my legs. What should I wear?

Many people with eczema has similar struggle. While we do not want you to fight with your wardrobe and to limit your style of fashion, but choosing the right clothing can help you feel comfortable and make peace with your skin.

The softer the cloth, the gentler it is to your skin.

Cotton clothes is usually gentle and comfortable to the skin.

As a general rule, avoid wool, synthetic fabrics and lace especially if it is irritating to your skin.

Functional textiles

There are some studies on the use of functional textiles. These include the use of silk, antimicrobial silk and silver impregnated fabrics. The support is weak but at least there is no hazard to try (no hazard to your skin, but may be hazardous to your wallet, haha).

Sunscreen and Moisturiser

Should I apply moisturiser before or after the sunscreen?

 

One of the frequently asked questions!

Save those bucks on day time moisturiser for a better sunscreen because you don't need another moisturiser to go with the sunscreen.

Using an extra moisturiser may reduce the actual amount of sunscreen applied on the face. And that means you are even farther away from the magical 2mg/cm2 figure to reach the labelled SPF value on the sunscreen bottle.

Tips:

1. If you feel your skin is too dry and need extra moisture, choose a thicker cream base sunscreen. If you feel your skin is often greasy and oily, choose a gel, fluid or lotion base sunscreen. Better still, choose one with diamethicone, so that it is occlusive with that extra protection effect, yet not leaving the greasy feeling.
2. Apply sunscreen half hour before leaving the house and reapply every 2 hours particularly if you go under the sun.
3. Don't leave out the back of the neck! Other commonly miss area include the ears and the toes.

Enjoy slapping your sunscreen away!

You might be interested in:

Choosing the best sunscreen

How much sunscreen is 2mg/cm2 

Sunscreen for Indoor

Bed bugs

I'm traveling soon. During my last trip to Italy, I came back with very itchy bumps which I was told could be due to bed bugs. What can I do to avoid getting bed bugs again?

Bed bugs is on the rise. More and more local and international travelers came back with bed bugs. Bed bugs usually gives rise to itchy red bumps on exposed part of the body. They do not transmit serious illness but can be a great nuisance.

Why is bed bugs on the rise? 

The biggest reason is probably because more and more people are traveling. These bugs are often found in hotels, hostels, apartments. They can hide in small crevices of luggage from one place to another. As they are small, they can conveniently hide on clothing, furniture and even on your pets. A lot of pesticides for example DDT has been banned for environmental issue. And the natural predators of bed bugs such as cockroaches are being hunted down. Other predators of bed bugs include spiders and ants.

How do I know it is bed bugs and not something else?

If there are new itchy bumps on the exposed part of the body, especially when you have slept on a used bed the night before, then most likely you are getting bed bugs.

You might want to look at the seams of the mattresses for blood stains, rusty spots of bed bug excrement, egg shells, or you might even find a bug or two, which is usually visible with naked eyes as they are about 5mm in size. Bed bugs give a musty odor. Do not forget to check the phone directories, carpets and your luggage too.

How to reduce the risk of bed bugs when travelling?

• Avoid sleeping on used bed, especially if it has a musty odor
• Keep the luggage zipped up even within hotel room
• Store the luggage high
• Store the luggage in the bathroom if possible (it is not easy for bed bugs to climb up the slippery porcelain)
• Wash all your clothes upon getting home, even if you have not worn some of them

Click here for a slideshow on bed bugs.


You might be interested in
Skin and Traveling

Itchy Food (Pseudo-food allergy)

I have eczema. Every time I take seafood, my skin itches. What are the food that I should avoid?

I have wrote on Food and Eczema earlier. Diet restriction is only recommended for people with proven food allergy. But a lot of people with negative skin prick test and negative serum IgE to food allergen still complain of itch when they take certain food.

Yes, certain food does make you feel more itchy even though you do not really have food allergy! Why? 

These are food that contains high level of histamine. While most people are happily eating away, some people has lower enzymes (s.g. diamine oxidase) to degrade histamine content in food and may experience "pseudoallergy". Itch and hives are among the common symptom, others may experience facial flushing, angioedema (eye and lips swelling), eczema and even flare up of acne, rosacea and psoriasis. Some people may experience diarrhoea, headache, runny nose and asthma. Just to name a few.

Food with high histamine-releasing capacities include

• Alcohol
• Canned food
• Shellfish
• Smoked meat
• Sausage 
• Certain fishes such as tuna and mackerel
• Beans
• Nuts
• Chocolates
• Vinegar

Food that may not contain high histamine level but trigger the body to release histamines include

• Citrus fruits
• Strawberries
• Tomatoes
• Papaya
• Wheat germ
• Nuts
• Chocolates
• Liquorice
• Certain fish 
• Shellfish
• Pork
• Egg white
• Certain additives and spices

Food that reduces diamine oxidase enzymes include alcohol, energy drink, black tea and green tea.

Should eczema patient takes low histamine diet?

Some patients with severe eczema find taking low histamine diet helpful, in particularly during flare ups. Generally diet restriction is not recommended for people living with eczema, unless there is real intolerance.


You may be interested to read:
Food and eczema

Choosing A Topical Steroids

Which topical steroids is the right one for me?

I have previously blogged about Steroid Fear and The do's and don't of using topical steroids in eczema. Before I start on how to choose the right topical steroids, I cannot stress enough that the success of using topical steroids starts from an accurate diagnosis, which means using it in the indicated and right situation.

Common conditions treatable with topical steroids include eczema, psoriasis and lichen planus.

There are many topical steroids in the market. They vary in potencies and preparations. Some even comes in combination with antifungals and antibiotics. Generally combinations of topical steroids and antifungals is not recommended as it may lead to persistent fungal infection.

Preparations (vehicles)

Steroids comes in various preparations, generally the ""heavier" the preparation, the "stronger" the strength of the same steroids it carries. One example is that 1% hydrocortisone ointment is stronger than 1% hydrocortisone cream.

Ointment provides occlusion and enhanced absorption of the steroid that it carries. However, some patients may not like the greasy feeling it leaves on the skin. You may want to avoid using it on skin folds and hairy areas. Best timing to use it will be right after a shower or bath.

Creams is good to hydrate the skin and patients love it because they get absorbed after a while. However, creams do not provide occlusives effect. They often contain preservatives and some people can have allergic contact dermatitis to creams.

Lotions are even less greasy than creams. Lotions contain alcohol. Lotions are good for hairy skin because they can penetrate through the hair easily and do not leave much residue on the hair.

Gels are jelly-like. They are good for acne-prone skin. Typically gels dry up very quickly so even if you apply it on hairy area, it does not give matting of hairs.

Other preparations of medications include foams, mousses, shampoos and powder.

Strength of steroids (potency)

In laboratory, the strength of steroids is assessed based on how much it causes blanching (due to constriction of blood vessels) in normal and healthy people. This does not always translate to how strong a particular steroids' anti-inflammatory effects on a patient. However, generally the strength of clobetasol propionate is higher than betamethasone dipropionate than betamethasone valerate than hydrocortisone.

Lower potency steroids are safer for using in large surface area, longer term, thinner skin area and in children.

Superpotent steroids should not be used on face and under occlusion, unless for a very short duration.

Superpotent steroids such as clobetasol propionate are typically not recommended for continuous use longer than 3 weeks, other steroids are typically not recommended for continuous use longer than 3 months.

Summary

Things to consider when choosing the most suitable topical steroids of the right strength and right preparation include:

1. The diagnosis
2. Condition of the skin intended to apply (acne prone? very dry?)
3. Site intended to apply (thin skin area? skin folds? hairy area?)
4. Surface area intended to apply
5. Duration intended to use
6. Age (children? elderly?)
7. Pregnancy
8. Allergy (contact dermatitis to preservatives?)
9. Personal preference

You might be interested to read about:
Steroid fear 
Do's and Don'ts of Using Topical Steroids
Bathing in Eczema
Food and Eczema
Color cosmetics and Eczema
Acne and Eczema

Facial Eczema

I have eczema since childhood. I believed I have my eczema inherited from my father. My eczema has been mild all these while until my pregnancy when it suddenly become very severe. I am now 5 months post delivery but my eczema is getting worse each day. It is all over my face and I feel very miserable and depressed.

I have visited numerous doctors and tried numerous creams, steroids and non-steroids, but each time, it came back after a few days. None of the medicine heals. I expressed my frustration on facebook, and after recommendations from another mother, I seek treatment at a traditional chinese medicine centre from Taipei. I was given a soap, a spray and some creams. It helps a bit but still comes back. I was told I can't take medicine because I am still breastfeeding.

I lose my temper easily and totally lost my confident to get out of the house. What can I do?

Hugs. You are not alone. Eczema can be very frustrating. Especially when it involves the face of a young mother.

The Basics

Eczema is a group of inflammatory problem involving skin that is usually itchy. There are many types of eczema.

The one that you seems to have from your description maybe:

• Atopic eczema: typically starts young, with personal or family history of atopy, associated with defect in skin barrier and immune dysfunction
• Contact dermatitis: typically persistent and relapsing, particularly if the culprit allergens or irritants is not identified, and appropriate skin care is not in place

A little detective work

Could this be the culprit?

• Nickel and chromium, not necessarily from costume jewelleries, don't forget the mobile phones (Not common, but people can be allergic to silicone cover of the phone as well)
• Preservatives and fragrance in cleansing agent including shampoo, cleanser, mouth wash.
• Skin care products
• Cosmetics 

Important points:

A product that has been used for several years may not necessarily be safe because:

• We are not born with allergy, allergy develops over time.
• The manufacturers can change their formulas to include different ingredient and may not states it clearly.

Don't forget indirect applications can come from the touch of your own hand.

How to get better? 

Management plan of eczema needs to be personalised. Things that need to take into considerations include the stage and severity of your condition.

If your skin is weeping and oozy, you may need temporary usage of astringents, baths or even draining of water blisters. Viral and bacterial infections, if present, must be treated.

Generally, steroids and non-steroidal products help to reduce inflammation, itch and all the suffering that you are having right now.

Moisturised your skin as often as you can. Choose a hypoallergenic moisturiser. Choose an occlussive moisturiser that coats and protects your skin, preventing transepidermal water loss. Choose a therapeutic moisturiser that will help to restore the defective skin barrier.

Avoiding the culprit should get you better within a week or two although it might take months to clear up completely. If you are really not sure which is the culprit, patch testing may help.

You might be interested to read about:
Food and Eczema
Color cosmetics and Eczema
Steroid fear 
Do's and Don'ts of Using Topical Steroids
Bathing in Eczema
Acne and Eczema

Skin and Traveling

I came back from a trip lately and had very bad skin eruption which has never happened to me before. I believe the drastic change of weather is the cause. Is that true that weather affects our skin?

Yes. It is true.

Dry weather

Skin is the most superficial organ and hence it is one organ that is most exposed to the external environment and most susceptible to the change in weather.

We, Malaysian are used to hot and humid weather. If you travel to temperate countries during winter, dry skin and cracked lips are among the most common skin problems. People with eczema may suffer a severe flare if they don't moisturise their skin diligently enough.

Heat trapping clothing?

Traveling in winter, most people will wear heat trapping clothes. Wearing tight fitting or heat trapping clothing can lead to folliculitis due to irritated hair follicles.

Soaking comfortably in hot water bath?

A contaminated bathtub, or even whirlpool, swimming pool and water slides can give one pseudomonas folliculitis. There is even reports of infection from contaminated diving suits.

Sun exposure

Many people gets sunburn while traveling. We hide in shades and in air-conditioned room back in our hometown. When we go traveling, we go outdoor much more frequently. During winter in particular, we love to stand under direct sunlight, not to forget that beautiful snow reflects ultraviolet rays to our faces that are often not covered by the winter coat. The results? The flare-ups of acne, rosacea, eczema, psoriasis, blistering diseases and lupus erythematosus (For people with all this conditions).

More exposure to ultraviolet rays also means higher skin cancer rate apart from lower the immunity and higher chance of cataracts.

Others

Apart from the change of weather, don't forget that stress, diet etc. can affect our skin. Not all trips are nice and relaxing. If you are under stress, acne, rosacea and psoriasis can crop up. If you take a lot of comfort food with high glycemic index during the trip, acne can crop up; or spicy food, and rosacea can crop up.

Do you share blankets, pillow cases or even towels and clothing while traveling? Many skin infections can spread via contacts.

Last but not least, don't forget that bed mites, ticks and scabies can be rampant in certain accommodation with suboptimal hygiene.

I love good skin but I love traveling too. What can I do to avoid skin problem?

• Sun protection - hats, scarfs, sunglasses, sunscreen, shades
• Stay moisturised and hydrated
• Stay warm
• Keep to your usual skin care routine
• Avoid sharing of personal items
• Steer away from contaminated / parasites infested places as far as possible

Acne or Eczema

My face itch with many small red bumps. Is this acne or eczema?

Acne is not typically described to be itchy. In many textbooks, itch is not mentioned as a symptom of acne at all. Having said that, a few studies have shown that 50-70% of people with acne do complain of facial itchiness, in particularly when they sweat, or in heat, or under dry air or when they feel stressful.

Eczema is usually itchy. One senior consultant dermatologist that I know loves to say, "If it ain't itchy, it is not eczema". Is there any new skin care, paper masks, makeup and any other items that you have recently use on your face prior to the onset of the problem? Or did you just have a facial treatment lately? Having said that, all that itch may not be eczema too.

Other possible "itchy red bumps" that may appear on face include rosacea, seborrheic eczema, bacterial folliculitis, pseudofolliculitis barbae, miliaria, perioral dermatitis etc.

Do me a favour. If you can't figure it out it's acne or eczema in the next one to two weeks, and if it's not going away, please consult your nearest dermatologist.

Can a person with HIV get babies?

Ok, this is totally unrelated to skin, but guess I can put this under health. This morning as I was going out with my family to our favourite Bak Kut Teh place for breakfast, I received a call from my university friend who is an opthalmologist asking about this:"If a person with HIV on HAART (medicines for HIV) is getting married, can he gets babies?"

Obviously the best person to discuss his family plan would be his infectious disease physician with whom he is following up. I might not be up to date but I did a little search on BHIVA & CDC before getting the answer as follows.

If the male partner is HIV positive:

• Wait till the viral load is less than 50 for at least 6 months
• Make sure there are no other infections
• Unprotected sexual intercourse only at the fertile time of the woman's cycle
• Consider assisted conception with sperm washing or donor sperm if your risk of tramitting HIV is high (ask your ID physician) 
• Consider pre-exposure prophylaxis treatment (ask your ID physician)

If the female partner is HIV positive:

• Wait till the viral load is less than 50
• Make sure there are no other infections
• Take folic acid at least 3 months before planning for pregnancy, in particular if you are on antibiotics such as bactrim (co-trimoxazole)
• Both natural delivery and Caesarean section are possible options if your viral load is less than 50
• Intravenous infusion of HIV medicine may be given if your waters have broken or if your viral load is high

The baby will be given HIV medicine for at least 4 weeks and tested for HIV. Breastfeeding is not encouraged especially if in countries where formula milk is easily accessible.

Good to know: 
Take the HIV medications diligently, don't ever miss a dose, if the viral load is low, the risk of transmitting HIV from male partner to female partner is almost zero, and the risk of transmitting HIV from mother to newborn is less than 1%. :)

New Miracle Cream, should I try it?

My friend bought acne products online. There's a number of consumers' testimonials and looks very convincing. I'm tempted looking at the pre- and post-treatment results. Should I try it or should I not?

Photo from sciencebasedmedicine.org

I can't advise you if the particular product is good or otherwise but maybe I can give you a few guides on choosing the products. There are a lot of online or over-the-counter or direct selling products with testimonials and claims from consumers. Some people practically swear by it, claiming the extreme effectiveness without the side effects of "standard treatment".

A few points to ponder:

I am sure you know that most skin diseases progress and change and heal with time. Be it acne or eczema or psoriasis, there are good times and bad times. Even if you do not treat it, it may gets better on its own. And of course, it may worsens too. The reason we are treating it is to make it recovers faster, lessens the itch and the pain, lessens the marks and the scars.

Plain vehicles aka. plain creams without active ingredients can heal. We know that skin conditions like acne and eczema do improve with moisturiser. Yes, it does. There are many therapeutic moisturisers, marketed in particularly for eczema, with proper well designed scientific studies such as randomised controlled trials to prove its efficacy. These are really awesome, especially for young babies and adults who are steroid phobic. If you noticed, most of the time if not all, they are comparing with 1% hydrocortisone (aka one of the weakest topical steroids). This means that the claims they can made is that they are effective, but the effects is not inferior but also not better than the weakest steroids.

There is something called placebo effect. A person's condition can improve because he or she is very confident and expecting the recovery. Likewise, he or she is more likely to experience side effects from the treatment if he or she is expecting it. (But unlike alternative or integrative medicine practitioners, we the doctors still need to tell you the possible side effects of every drugs prescribed, don't we?)

Before forking out your cash, some reality check: 
Is the active ingredients listed?
Is the potential side effects listed?

Remember that something with literally no side effect at all, is likely to be just a vehicle (aka. plain moisturiser, even that could have irritations sometimes).

If you are keen to try, perhaps you can do a little scientific study at home. Most skin conditions affect both side of your face / body with similar severity. You can do a split face trial. Use the new product on one side of the face and standard treatment on the other side and compare. Scientifically, a new medication should be compared to the standard treatment for its efficacy before it is launched.

Good luck!



You might be interested to read:
Moisturiser for acne
Steroid fear

Moisturiser for oily skin? Yay or Nay?

I have oily skin with frequent acne breakout. Do I still need moisturiser?

Many people with acne reported that their facial skin is "oily", "greasy", "clogged up", "an additional layer on skin" because of the extra sebum production.

But the answer is yes. You still need moisturiser.

Why?

In acne, your skin barrier is actually impaired. The four main features in acne are

• Increased sebum production (more "oil")
• Follicular keratinisation (plugging of pores)
• Propionibacterium acnes (a type of bacteria) proliferation
• Inflammation

That extra sebum does not contribute much to skin barrier but can be used by the bacteria called Propionibacterium acnes to grow and break the balance of the many other natural organisms on the skin (more than 500 species live on our skin, if they live in harmony, they should not be causing any trouble) and leading to inflammation. An inflamed skin is a skin that is in a mess. Moisturising it helps to reduce inflammation, to restore the harmony and the balance of our skin.

Many medications that are used to treat acne, ranging from antimicrobials to retinoids, can cause dry skin. Moisturising the skin helps to reduce irritation and itch and makes you feel more comfortable.

Tips on choosing the right moisturiser.

1. Pick one that says non-comedogenic
2. Pick one that says hypoallergenic or for sensitive skin
3. Pick therapeutic moisturiser that helps to restore skin barrier
4. Look at the ingredient, I personally loves one that contains dimethicone because it is an occlusive that helps to retain moisture and yet doesn't give that greasy feeling while gives that little extra protection to the skin
5. Try it on, it should feels soothing

Oily skin? Don't worry. Happy moisturising it away!


You might be interested in:
Acne myths 
Skin oils for acne skin

Why is my fungal infection keeps coming back to bug me?

My fungal infection keeps coming back despite treatment. What else can I do?

Tinea cruris is a superficial fungal infection known for its recurring nature. Moist skin is very prone to re-infection.

Here is what you can do:

1. Keep the crural folds dry after bathing by using a separate towels
2. Avoid tight fitting garments that will trap your sweats
3. Bring extra garments out, especially if you know you may sweat soon
4. Do not share personal garments and towels with others
5. Lose weight to reduce apposition of skin folds
6. If you nails, hands and feet or any part of the body has fungal infection, get them treated at the same time

Contact Dermatitis to Color Cosmetics

This morning, my 21-month-old daughter did this to my eye palette. (She loves to play with whatever on my vanity table.) I thought maybe it's time I should write something about cosmetics. Thanks for the reminder, little girl.

Not too long ago, a friend of mine told me his wife cannot put on purple color eye shadow.

"Anything to do with purplish hue will make her itch and red and swollen."

Yes, this is a form of allergy.

Color cosmetics can cause various skin reactions. These include:

• Contact urticaria - wheals and hives, itchy or burning, often resolve within 24 hours
• Contact dermatitis - dry, itchy and scaly rashes, may form blisters and become oozy and weepy, lasted for days
• Photocontact dermatitis - similar to contact dermatitis, but form because the ingredient interacts with sunlight
• Anaphylaxis - eye and lips swelling, difficulty to breathe, death has been reported in association with black dye
• Others: acne, pigment and skin color changes

Common allergens found in eye shadow include:

• Nickels (often found on eyelash curler, and some make up brushes as well)
• Cobalts
• Fragrance
• Preservatives
• Carmine (red, violet, margenta shades)
• Dyes
• Formaldehyde
• Lanolin

No, I'm not saying you should not make up. I do regularly apply make up myself. But if you are atopy (having conditions such as eczema, asthma, allergic rhinitis) and are prone to skin reactions, be in the knows and this is what you may want to do:

1. Read the list of ingredients before buying a product.
2. Do a mini test, try the product on the inner aspect of your elbow or wrist a few times before buying it. (That is what testers are for!)
3. Choose hypoallergic, fragrance free and non-comedogenic ones, even though it doesn't guarantee no skin reaction.
4. Perhaps pick product with less complicated ingredient.

 Finally, enjoy your color cosmetics!

How much sunscreen is 2mg/cm2?

How much sunscreen should I apply?

In previous article on Choosing The Best Sunscreen, we have mentioned that the SPF value stated on the sunscreen is actually based on the application as thick as 2mg/cm.

Ever wonder how much is 2mg/cm2?

I do. Let me measure my own face with a curve ruler. From forehead till chin 20cm, from ear to ear 26cm.

This is going to be a very rough figure. Although I'm a Virgo, I'm not very good at maths after leaving my mathematics class for years.

Surface area of a rectangle is Height x Width, then 20 x 26 = 520cm2.

If my face is a perfect oval, then the surface area will be 3.14 x 10 x 13 = 408.2cm2

I'm not good at maths, but the surface area of my face would be probably between 408 to 520cm given that he shape is between oval and rectangle?

To apply 2mg/cm2 to the face means I will need roughly 1040mg to cover the whole face = slightly more than 1g.

Say my 1 FTU = 0.4g, I need around 2.5 FTU of sunscreen to cover my whole face, not to mention neck and other areas.

To use this much of sunscreen, I probably have to apply layer by layer, let one layer dry and put on another layer. Else, I will look fairer than Geisha. Haha.

The other way of looking at whether I'm using enough sunscreen or not will be this: A 50g sunscreen will only be enough to be use for 50 times for me. Say that I apply twice a day, a 50g sunscreen will be used up in less than a month's time if I'm using according to the recommendation of 2cm/cm2!

This is exactly why we should buy the best sunscreen, the highest SPF, not just more than SPF35, because nobody use that much of sunscreen, and since we are under-applying, that little extra SPF protection, does make a difference.

How much steroids should I use?

I was instructed to apply the steroids "thinly" over the affected area of the skin. How thin is "thin"?

Why just a thin layer?
No, not because your doctor is fear of side effects of topical steroids, he or she should not be. A thin layer  is needed because a thicker layer does not equate an enhanced penetration or a better effect. (But not too thin as well, or there will be inadequate effect.)

How thin is thin? 
A thin layer is probably between 0.01 to 0.1mm. But it is impossible to measure that. So we usually use fingertip unit (FTU) as measurement instead.

If you squeeze the cream or ointment out from a tube with 5mm nozzle, and let it covers the tip until the first crease of on your index finger, that is 1 FTU.

1 FTU is roughly 0.5g for an average man, 0.4g for a woman, and even lesser for children.

And how much does 1 FTU covers?

One hand (front and back) or two palms.

Having said that, don't worry if you need to use slightly more or less. This is just a rough guide. As long as you keep the steroids on the affected / thick and rough skin area, you should be fine.

Skin Oils for Acne Skin?

I have acne. Can I use skin oils as my facial moisturisers?

We all know oily skin are acne-prone skin. Common sense tells us that people with acne prone skin should avoid oily greasy product that can clog your pores and make your acne worse.
But a lot of people say otherwise, so is skin oil really okay for acne-prone skin?

After some search, this is what I get:

1. People don't get oily skin everywhere. A lot of people has what we called "combination skin" where one part of the skin maybe oily and another part maybe dry. It is definitely okay to use it on your dry skin area.

2. Oils have many grades. Some experts* say certain cosmetic grade mineral oils may not clog the pores.

What's my take?

Avoid it if you are not sure.

Still very keen to give it a try? Try it on a small part of your skin instead of the whole face, and share with us what happens next.


*picture is for illustration purpose only.

Do's and Don'ts of Using Topical Steroids In Eczema

Do's

1. Use steroids on affected area (Touch and feel your skin with your fingers if you are not sure, affected skin areas are rough, bumpy and thick with different texture compare to unaffected area.)
2. Apply adequate amount of steroids.
3. Apply steroids onto dry area.
4. Use steroids once to twice a day or whenever necessary.
5. Smooth the steroids in the direction of hair growth, especially if the area is hairy and you are using a greasy ointment.
6. Leave 30 minutes in between applying another topical preparations onto the same area of the skin.

Don'ts

1. Do not use steroids in ointment form onto wet and weepy area (more often than not, wet and weepy areas are infected).
2. Do not use strong steroids on thin skin area such as genitals and face particularly around the eyes, unless instructed by your doctor. (ask your doctor how long you can use it on your face)
3. Do not use strong steroids under occlusion (under dressings, tight clothing, folded skin area such as in the buttock folds), unless instructed by your doctor. (Occlusion increases absorption)
4. Do not use steroids to raw skin area.
5. Do not apply occlusive ointment (such as mineral oils, paraffin, petrolatum) prior to steroids.
6. Do not use steroids (and any other medicines) after expiry date.
7. Do not share steroids (and any other medicines) with your family or friends.

Steroid Fear

"Four out of five people are afraid of using corticosteroids in eczema..." --news from last week.

Definitely true in my practice.

Steroids generally have bad reputation. And perhaps western medicines have a bad reputation of dishing out steroids to patients so a lot of them turns to traditional medicines or alternative medicines, which are unfortunately sometimes being adulterated with steroids.There are reports of parents, in fear of using steroids for their children, turn to alternative medicines with potent steroids, click here for one of the report from Hong Kong.

Is Steroids Bad?

Yes and no. It depends on how it is being used.

If eczema is fire, then topical steroids (be it gel, lotion, cream or ointment) is water. Yes, and we are saying that 4 out of 5 people, in fear of drowning, many avoid water or use minimal amount of water to pour on the fire that is burning them down.

Common sense tells us that you can pour water onto the fire as long as it is still burning. Using the correct formulation and strength onto the appropriate area based on appropriate indications under proper supervision should keep you safe.

There are alternative of extinguishing fire without using water, and yes, there are alternative of non-steroidal preparation too. But I must say that most of the time, topical steroids are often powerful and yet cheaper.

Read about the Do's and Don't of Using Topical Steroids in Eczema here and how much steroids to use here.