Epidermolysis Bullosa

Oct 25 - 31st is epidermolysis bullosa awareness week.

Have you ever heard of epidermolysis bullosa?

Epidermolysis bullosa is a group of rare genetic disease where the skin and mucosa (mouth, stomach linings) are torn and develop blister with minimal friction. The mild ones only start to show up when the children learn to crawl or walk. The severe ones can be life threatening.

Children born with epidermolysis bullosa are also known as butterfly children because their skin is as fragile as butterfly skin. And they are often in pain from the raw wound.

The list of possible problems is long and include,
🩸 bleeding from the wound
🩸 constipation, avoiding bowel movement due to pain
🩸 painful and sensitive eyes, that may even leads to blindness
🩸 scarring on scalp, muscle, tendons that leads to hair loss, contracture and deformity affecting ability to walk and move
🩸 blisters in mouth that leads to difficulty in eating and malnutrition
🩸 infection
🩸 skin cancer

And not to mention poor quality of life with social isolation, school and work absentee. This is why they need our support.

You can reach out for EB community in Malaysia here.

Pimples at the wrong site or recurring bumps? You may have hidradenitis suppurativa

In the afternoon clinic today, two young men with recurring foul smelling pimples and bumps and even pus at their armpits for years came seeking  for help. One of them has complicated sinus tracts (tunnels under the skin), scars and keloids (painful or itchy overgrown scars).

Contrary to popular beliefs, this really has nothing to do with personal hygiene or food. This is hidradenitis suppurativa, some called it acne inversa, caused by abnormal skin near the hair follicles blocking the sweat and oil glands. A condition that is really not fun to have and they tends to go to skin folds such as the armpits, under breasts and groin.

Hidradenitis suppurativa usualy start after puberty and may worsen over time. For some it can be nothing more than "an occasional pimple at odd location", for others it can be painful, affecting daily activities, destroying one’s self esteem and social life. Very rarely, people with severe uncontrolled disease can develop skin cancer (squamous cell carcinoma) at the affected area.






Being overweight, having hormonal disorders, smoking, living in hot and humid environment are among key factors that can worsen hidradenitis suppurativa. Wearing tight fitting clothes of irritating materials and shaving can trigger a flare-up as well. Hidradenitis suppurativa often happen in the same family.

Seek medical help early if you have this condition. Early diagnosis and early treatment not only reduces bumps and pain but also keep complications such as sinus tracts and scarring at bay.

Common treatments (depending on severity and individual condition) include,

• Antiseptics
• Antibiotics
• Steroid injection into a painful breakout
• Hormone therapy
• Immunosuppresantrs
• Oral retinoids
• Radiation therapy
• Laser treatment to destroy hair follicles
• Biologic (injections of genetically engineered proteins to block the inflammatory response)

Surgery may be required, such as

• Incision and drainage of the most painful 1-2 lesions, mainly for short term relief, but often the symptom will return
• Deroofing, turning a repeatedly return lesion into a scar
• Excision, cutting out the affected area and closed by skin flap or skin graft

 
People with hidradenitis suppurativa may feel anxious or depressed. Patient support group is available in Malaysia. You can reach their Facebook page here.

"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).

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.


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Skin and Traveling

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