Protect your baby even before you get pregnant

Retinoids is a wonderful medicine that helps to treat acne, rosacea, folliculitis, psoriasis and many skin conditions. It can even smoothen skin tone and stimulate collagen production. But do not use retinoids especially the oral form (e.g. Roaccutane) during pregnancy or breastfeeding. In fact, you must be more than 100% sure you are not pregnant before starting it, and if you are sexually active, use at least two forms of birth control e.g. birth control pill + condoms.

Being a parent is a serious responsibility. With oral retinoids, it is almost a sure thing that the innocent baby will end up with birth defects.
 
You are on oral retinoids and planning to get married? Afraid not. Just inform your dermatologist so that we can help with your family and skin care planning by changing your medications to other safer options. 

Different oral retinoids stay in the body for different duration. Usually you will be told to stop your isotretinoin for at least a month (or until next menstrual cycle), but with acitretin, it is probably best to plan for pregnancy after 3 years of stopping it! For this reason, we seldom start young ladies on childbearing age on acitretin unless we have no other option.

Some medications may even pass to the future baby from the father. One of the example is methotrexate. The whole process of spermatogenesis in human takes about 74 days, and if you count in the transport in the ductal system, it can take about 3 months. Hence, it is best to wait for at least 3 months after the father has stopped methotrexate before making baby!

For all future mothers, here’s other medicines and things you need to stop. This list is not complete and some medications can not be stopped just like that, your baby need healthy mother to take good care of him/her too, so please check with your doctor before planning for your family!
 
⛔️painkillers
⛔️immunosuppresants and chemotherapies
⛔️some blood thinners e.g warfarin
⛔️cholesterol medicines
⛔️some seizure medicines
⛔️some antihypertensives
⛔️some antidepressants and mood stabiliser
⛔️some antifungals
⛔️some antibiotics
⛔️alcohol
⛔️caffeine
⛔️⛔️smoking

And don’t forget to start taking folic acid!

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%. :)

My doctor(s) can't seem to help me. What should I do?

I have a serious skin problem. I have a red swelling on my cheek which started as a "pimple" but gradually getting larger. I had taken a few courses of antibiotics in the past one year, including a 6 months course of erythromycin from my family doctor. He took a small skin sample from my cheek prior to the long course of antibiotics but the report wasn't conclusive. Then I was given oral steroids which seems to get the swelling slightly smaller but it never goes away. I trusted my family doctor as my family has been under his care for years. But he can't seem to solve my problem. What should I do?

Here's what I think you should consider.

1. What is the diagnosis? Sounds like no definite diagnosis has been made so far. Effective treatments often comes from an accurate diagnosis. (Yes, I say "often", some people treat by hunches, and it works, sometimes. But the basic of medicine should be diagnosis first before treatment.)

2. How was the skin sample taken? Was it taken at the right place? Was it deep enough? Is the cut big enough for the laboratory to examine? What laboratory tests have been done? A histopathological examination? Any extra stain needed? What about culture for fungus and bacteria and other not so common bacteria?

3. Perhaps you might want to politely ask your family doctor if he thinks any other doctors or nearby dermatologists may help you with your problem? Most if not all good doctors do not mind writing you a letter, giving out your previous investigation and biopsy records. If a particular doctor is very defensive about you going for a second opinion, it may be, well, a warning sign perhaps.

4. Consider going to dermatologists in bigger or more well known medical centres because they may be more experienced in managing not-so-common skin problems.