What Living In Singapore Does To Your Skin

Redness, dryness, itchy skin… Is it just a heat rash or something more serious? We speak to Dr Derrick Aw, Head and Senior Consultant, Division of Dermatology, National University Hospital, to find out more about four common skin conditions here.

Eczema

Eczema is a skin inflammation characterised by itchiness and bumps on the skin, and is an extremely common condition. So common, in fact, that according to Dr Aw, almost every other patient who comes for outpatient treatment in the University Dermatology Clinic has some form of eczema. Many patients have suffered from the condition since childhood (atopic eczema), but it can also be developed in some patients during adulthood. Sometimes, it comes about because the patient develops a reaction against substances (contact dermatitis). Examples of these include rubbing alcohol, bleach or detergents. Other times, it may be due to intrinsic factors (endogenous eczema), such as skin dryness as a result of ageing.

James Heilman, MD / CC BY-SA3.0

Atopic eczema has a genetic disposition and is frequently associated with the presence of other “allergic” conditions such as allergic rhinitis and allergic conjunctivitis. A prominent gene mutation has also been discovered present in many patients with atopic eczema, leading to the skin being unable to retain water, thus impairing its barrier function. Other forms of eczema arise from different triggers and causes. For instance, allergic contact dermatitis may come about as a result of an allergic reaction to a component in permanent hair dyes, while xerotic eczema arises due to the increasing dryness of the skin from ageing, or prolonged exposure to environments with very low humidity.

The cornerstone to eczema treatment and recovery, says Dr Aw, is to repair the defective skin barrier with regular moisturisation of the skin. It’s also important to avoid triggers that can further damage the skin barrier.These include: the use of harsh soaps, hot showers, or frequent contact with detergents. Inflammation can also be reduced with the use of anti-inflammatory topical medication, such as a topical steroid. However, these should be used under the guidance of a doctor or pharmacist to prevent the development of side effects from inappropriate or indiscriminate use.

Insect bites

Insect bites are a fairly common occurrence. Whole families have even had to seek treatment due to an infestation of bedbugs in their house.

According to Dr Aw, insect bites cause certain reactions due to the body’s inflammatory reaction to the foreign proteins encountered in bites or stings. “This reaction, in turn, causes blood vessels to open up, bringing in more blood to the skin’s surface. Blood vessel walls then become more permeable, allowing fluid to enter the tissues and cause swelling.

James Heilman, MD / CC BY-SA3.0

The production and release of chemical mediators from inflammatory cells can cause the sensation of itch, and also result in the blood vessel dilation and permeability,” says Dr Aw.

The good news, however, is that a topical steroid cream is usually sufficient in soothing and healing insect bites. Mild bites can go away with a hydrocortisone cream applied twice daily, while more persistent bites will probably need something more potent, such as mometasone cream. A few days of oral antihistamines can also be useful. These creams and antihistamines should and can be obtained from a pharmacist.

Heat rash

Unsurprisingly, heat rash is fairly common in this part of the world, although Dr Aw says that most patients don’t specifically see their dermatologist for this condition. Sometimes, the condition can progress to become a fungal infection.

Heat rash tends to occur in areas of the skin that have high moisture content, and higher local temperatures, such as the groin or armpit. In these areas, the local humidity builds up due to skin friction, or because the skin of each fold comes into direct contact with another fold, leading to an accumulation of perspiration. The combination of factors creates an inflammatory process in the skin, which manifests as an itch and redness. And because the environment is also fertile for the development of a fungal infection – usually yeast – this can complicate matters if the condition is left unmanaged.

Fortunately, heat rash can be easily prevented or managed. “Reduce friction and sweat accumulation by using a powder generously in the affected areas once or twice

daily,” advises Dr Aw. Being in an air-conditioned environment also helps as it has a lower humidity and temperature. If the inflammation is intolerable, apply a mild topical steroid – such as hydrocortisone cream – twice a day for a few days.

Rosacea

Characterised by redness and acne-like appearance, the occurrence of rosacea is less common here than in Western countries. However, Dr Aw has seen an increase in cases now – about two to five new cases each month. This can be attributed to easier access to medical care, as well as a greater awareness of the condition among his patients.

Rosacea is basically a heightened reactivity of the superficial blood vessels in your skin and is related to an underlying inflammatory process. Genetic and environmental factors probably play a role in the development of the condition too.

To reduce inflammation, Dr Aw recommends using certain prescription creams or gels, coupled with an oral antibiotic. To reduce the redness, patients can also try using a gel that temporarily constricts the blood vessels. As always, however, prevention is always better than cure. To prevent an ‘attack’ of flushing, avoid spicy foods, foods that contain caffeine, alcohol, overheated baths, and make sure that you’re well-protected from the sun.

The comments given by the doctor are for educational purposes and not a product recommendation.