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.