Dealing with Postpartum Hair Loss

You’re adjusting to life as a new mum. Everything seems to be going well when you begin to notice increased hair fall. It could be extra strands of hair on your pillow or more loose strands during washing, which could progress to hair falling out in clumps. You may change your shampoo or try various hair tonics, but you start to panic about going bald. Firstly, do not worry – the above scenario is very common. There are many possible causes of hair loss, also known as alopecia. In postpartum hair loss, we are dealing with a very specific type of alopecia known as telogen effluvium, and it is one of the most common conditions treated by dermatologists. For most people, five to 15 per cent of the hair on the scalp is in telogen phase, meaning in the hair growth cycle, these hairs are in resting phase (not growing or falling out; see sidebar for more information). Telogen effluvium is triggered when a physiologic or hormonal change causes a large number of hairs to enter telogen at one time. Shedding does not occur until the new anagen hairs begin to grow, which usually takes two to three months. The emerging hairs help to force the resting hairs out of the follicle, which is why most people notice a sudden increase in hair fall a few months after delivery, or after an acute illness. The good news is that the prognosis is excellent and in almost all cases, recovery occurs within six months. Often, no specific treatment is required. Supplements are occasionally prescribed and in some cases topical therapy as well, taking into account whether you are breastfeeding or not. We generally advise patients to use a gentle shampoo and minimise activities that might result in excessive hair loss, such as rough combing and brushing of the hair, or tying it into very tight braids or buns. It is uncommon for hair loss associated with pregnancy to persist unless there are other medical issues involved such as iron deficiency or thyroid disorders. You should seek medical advice if the hair loss persists beyond six months. Normal Growth Cycle Unlike some other animals that shed hair, human hair growth is asynchronous, which means that there are hairs in different stages of the growth cycle at any one time. Normal hair grows in cycles and goes through three stages:• Anagen: growing phase• Telogen: resting phase• Catagen: falling phase Therefore, the effect of normal or physiological hair fall is usually not too obvious because about 80 to 90 per cent of our scalp hairs are in the growing anagen phase at any given moment. Thus, it is normal for a person to lose as many as 50 to 100 strands of hair daily, and these usually show up on a comb, brush or on the bathroom floor, especially after washing your …

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Travel Skin Care

Travelling? Here’s what to pack to keep it healthy while on the go It’s that time again when Singaporeans jet off for their year-end holidays. When abroad, it is important to take care of your skin – especially if you have a pre-existing condition – to ensure that it does not flare up, and ruin your holiday. Sunscreen When you’re on holiday, the number of hours spent in the sun is generally far greater than what you’re used to, which makes you more susceptible to sunburn due to ultraviolet (UV) radiation. When at the beach or hiking in the mountains, remember to reapply sunscreen every three to four hours. If you’re on a winter holiday, it is equally important to use sunscreen. UV radiation is very intense in the mountains, as it is reflected off the snow and ice. Even on a cloudy day, UV radiation can damage your skin. Facial moisturiser Long flights can dry out facial skin. Signs of excessive facial dryness include flaking, especially on the sides of the nose and cheeks. If this is not addressed, your skin may turn patchy and red, and even start to itch. A facial moisturiser helps calm the skin and prevents eczema from developing. Facial moisturisers are usually not as rich as regular body moisturisers or lotion, and good ones are non-comedogenic, which means they will not clog pores. Use on a daily basis. Body and hand moisturisers This is especially important for winter holidays. Even people with relatively normal skin will experience dry skin in winter environments, and the effect is greater for someone who already has dry skin or eczema. Use body moisturisers daily, and it might be a good idea to pack a smaller tube of hand cream or lotion you can carry with you for frequent application. Gentle facial cleanser Avoid using regular soaps or harsh cleansers on the face, as these would exacerbate dry skin. Gentle “soapless” facial cleansers will clean the face and remove makeup without drying the skin. Lip balm Leaving your lips exposed to dry and cold conditions may lead to cheilitis (inflammation of the lips). The lips will feel dry and chapped, and small cuts or fissures can appear on the lips and corners of the mouth. This can be painful and may affect your eating. Using a lip balm throughout the day will help prevent this. Antibiotic ointment Keep this in your list of first aid items. A topical antibiotic ointment can be useful to treat cuts or abrasions, and prevent any infection. Insect repellent Insect repellents are useful to reduce the chance of catching mosquito-borne viruses, such as dengue and Zika. However, insect repellents will not protect you from all types of insects, so exercise caution and listen to advice from your tour guide or the locals. Topical medications Finally, if you have a chronic skin condition such as eczema or psoriasis, remember to pack your creams and …

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Keep your skin fresh and healthy in sunny Singapore

Taking care of your skin involves taking care of your overall health and not just relying on skin-directed treatments. In order to maintain youthful looking skin and a radiant complexion, here are some good habits that you can cultivate. Be sun smart This is the key in sunny Singapore. Ultraviolet (UV) radiation from the sun causes premature skin ageing, wrinkles and pigmentation. It breaks down collagen in our skin, which causes a loss of facial volume resulting in deep lines that physically age a person’s looks. UV radiation also increases the risk of certain skin cancers. Remember to use sunscreen – I recommend one with an SPF of 30. Your sunscreen should be applied over facial moisturiser. Not all sun exposure is bad. Sunlight is responsible for the production of vitamin D, which is important for maintaining good health. The intensity of sun exposure is especially high between 10am to 2pm, while early morning sun is much gentler. I recommend that my patients take a vitamin D supplement if they require it, rather than expose themselves to noon day sun.      2. Eat the right foods and supplements A well balanced diet is essential for healthy, fresh and radiant skin. Make sure you have a balanced diet with enough protein (from plant and animal sources), iron, zinc and omega-3 and -6 essential fatty acids. Oily fishes such as tuna, salmon and sardines, as well as flaxseed, are good sources of omega-3 fatty acids. Drink plenty of water as well. Incorporate some antioxidants in your diet. These are substances that mop up damaging free radicals, which cause skin damage and ageing. Vitamin E is a good antioxidant, as are substances such as beta-carotene (which the body converts to vitamin A), and other carotenoids such as lycopene. Green tea contains a powerful antioxidant known as polyphenol. Beta-carotenes are found in papayas, carrots, pumpkin and spinach. Tomatoes are a rich source of lycopene.      3. Treat your skin right Moisturise your skin regularly, particularly if you have very dry skin and underlying conditions such as eczema. Moisturisers are important because they keep the skin hydrated. Excessively dry skin is much more prone to irritation and inflammation, and this can result in itchy rashes. The skin can also develop a cracked appearance, especially on the legs. Moisturisers come in several formulations – gels, creams, lotions and ointments. Gels and lotions are more suitable for those with oilier skin, whereas creams and ointments are better for those with drier skin. One tip for people with dry skin on the face is to use a hydrating serum first, before applying a moisturising cream or lotion. This may help to lock in more moisture so that the facial skin does not develop flaking or scaly rashes. Do not use harsh soaps or very strong cleansers for showers. Also, try to avoid long showers, which tend to dry out the skin further. Finally, the key to healthy skin also means getting sufficient rest and avoiding bad habits such as smoking. Developing and maintaining good habits require discipline and some determination. Start these habits now and you will be rewarded with better looking skin in due …

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What stretch marks really are – and what you can do if you’re bothered by them

What are stretch marks? Stretch marks are fine lines on the body caused by sudden changes in growth or overstretching. These are caused by torn tissues under the skin and is a common condition in many people. Stretch marks do not cause significant medical problems but are often considered a cosmetic concern, especially in visible areas. Other names for stretch marks are striae distensae, striae atrophicans, striae rubra (which are red) and striae alba (white). Who gets stretch marks? Stretch marks affect women more than men. They usually occur in areas of the body that are prone to progressive and continuous stretching. Stretch marks are commonly found in: Pregnant women (abdomen and breast) Adolescents undergoing growth spurts (thighs, buttocks, breasts) Bodybuilders (shoulders) Obese or overweight people Stretch marks can also occur from prolonged use of oral or topical corticosteroids and from anabolic steroids. They are also a feature of a disease called Cushing’s syndrome, where increased activity in the adrenal cortex (excessive production of the steroid hormone cortisol) is implicated in their development. What do stretch marks look like? Stretch marks, when developing may occasionally be itchy. The area of the affected skin becomes pink, flattened and thin. Shortly after, striae rubra which consists of reddish or purplish lines develops, showing in directions perpendicular to the skin tension. These reddish or purplish lines lighten over time to become striae alba, which is flesh-coloured or whitish and is less conspicuous. Stretch marks are usually several centimetres long and about 1–10mm wide. Some of these stretch marks that are caused by usage of corticosteroid, or resulting from Cushing’s syndrome, are often larger and wider, and may involve other regions. What treatment is available? Stretch marks are usually thought of as only a cosmetic problem. However, they may be a cause of concern if a medical illness causes the striae (such as Cushing’s syndrome), or if the patient is on steroids. The following treatments may help: Moisturising oils Topical retinoid therapy Chemical peels Fractional Mixtopro CO2 laser (available in Thomson Well Women …

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The five most common postpartum skin woes and how to tackle them

Just as there are skin issues that arise during pregnancy, skin conditions can also develop after you give birth. Fortunately, they are largely treatable, so there is no need to fret – your postpartum skin and hair will bounce back in no time. We take a look at some of the most common conditions. Melasma Also known as “the mask of pregnancy”, this pigmentation condition is due to increased melanin production and is caused by a combination of genetic and hormonal factors, as well as sun exposure. It tends to affect Asian skin more, appearing as brownish patches over the cheeks, forehead, temples, nasal bridge, upper lips and jawline. It is best controlled by avoiding the sun and with regular use of sunscreen, lightening creams and topical agents, although it can persist in some cases. Other treatments include chemical peeling, intense pulsed light therapy and certain forms of laser therapy. Inform your doctor if you are breastfeeding – certain ingredients such as tretinoin and hydroquinone that can be found in some skincare products should be avoided by breastfeeding mums. Dermatitis/eczema Eczema or dermatitis is a relatively common yet noninfectious condition, so it will not spread to your baby. Often it is an aggravation of an underlying sensitive skin condition that has been present for some time. For new mothers, it can also develop as a result of excessive water contact due to frequent handwashing. Use moisturiser regularly to soothe inflamed and itchy skin. Topical steroid creams are prescribed to calm inflamed skin and are safe to use even when breastfeeding. Use a gentle soap substitute and continue to moisturise even after the skin rash has settled. Stretchmarks Affecting at least 90 percent of pregnant women, stretchmarks are a form of scarring that appear red when fresh, but most will fade to white after delivery. During pregnancy, intensive use of moisturisers may help the condition, and there are specially formulated stretchmark creams on the market that you can continue using after delivery. For more severe cases, dermatologists may prescribe tretinoin cream to use postpartum when you are not breastfeeding. Some skin-tightening laser treatments are safe options to remove stretchmarks even if you are breastfeeding, but these usually require multiple sessions. Telogen effluvium This condition results in hair fall that usually occurs about three months after delivery. Though increased hair fall can be distressing to new mothers, it is almost always a self-limiting condition, and you will usually recover within six months. If you notice increased hair fall, consult a doctor to exclude other causes of hair loss (such as low iron levels). Topical medications can be used if you are not breastfeeding. Acne Caused by an inflammation in the facial oil glands, acne may be aggravated by hormonal changes. Most of the time, acne clears within a few weeks or months, but medical treatment should be sought to prevent the risk of scarring. There are many topical agents that can be safely used even when breastfeeding. In more severe cases, oral medications such as antibiotics may be …

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Shedding light on skin cancer

What is skin cancer? Skin cancers are malignant tumours that arise from cells found in the skin tissue. There are different types of cells in the skin tissue and abnormal growths of these cells can give rise to different types of skin cancers. They are broadly divided into two groups – non-melanoma skin cancers, which are more common, and melanomas, which are more aggressive. What are the symptoms? The most common symptom is a skin growth, a lump or a bump that does not go away, and increases in size. These growths are almost always painless and may not be noticed for months, while some may develop ulcers. Another manifestation is a red, scaly patch that does not respond to various creams. Melanomas tend to appear as a dark pigmented area that may represent a mole that has changed, or arose spontaneously. What are the common types of skin cancer in Singapore? Based on statistics from the Singapore Cancer Registry (Trends in Cancer Incidence in Singapore 2010-2014), there are 1,719 and 1,381 cases of skin cancer in Singaporean men and women every year, respectively. The most common skin cancer is basal cell carcinoma, which is typically located on sun-exposed areas such as the head and neck region although they can also occur on covered areas such as the back. Is there a cure for it and what are the treatment types? Most skin cancer types can be cured by excision of the lesion with an adequate clear margin. Depending on the location and size of the lesion, more complex surgical procedures involving skin grafts may be needed sometimes. Certain types of skin cancers can also be treated using cryotherapy (freezing with liquid nitrogen), curettage and electosurgery, photodynamic therapy (which uses light and a photosensitising agent to kill cancer cells) and radiation therapy. How do I prevent skin cancer? Use adequate sun protection as ultraviolet radiation from the sun is the most important risk factor. Sunscreen, the use of hats and umbrellas and appropriate clothing for outdoor activities are essential. Skin self-examination and awareness can also aid in the early detection of skin cancers. People with badly sun-damaged skin should see a dermatologist for skin checks as some pre-cancerous lesions can be treated as a preventive measure. Get a broad spectrum sunscreen that protects against UVA and UVB. The SPF (sun protection factor) is a measure of its ability to protect against UVB. I recommend something with an SPF of 30 or above. Protection against UVA is provided by ingredients such as avobenzone, oxybenzone, ecamsule, titanium dioxide, and zinc oxide, so look out for …

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Laser hair removal

Laser hair removal is a common procedure performed by dermatologists. The technology utilises a light source of a specific wavelength that targets pigments within hair follicles. When the laser energy is absorbed by those pigments, heat is generated, which can destroy the hair follicle selectively without causing too much damage to the surrounding tissue. To reduce the risk of damaging the adjacent tissue and the surface of the skin (epidermis), current hair removal lasers incorporate an inbuilt cooling system that “precools” the epidermis before the laser beam is fired. This allows the use of higher fluences (energy levels) to reach the hair follicle, while simultaneously reducing pain and the risk of burns. What type of lasers are used during the procedure? At Thomson Specialist Skin Centre, we utilise the Gentlemax laser system, which incorporates the long pulsed Nd-Yag (1064nm) as well as the Alexandrite (755nm), ensuring coverage for all skin types. The use of an epidermal cooling system and suitable wavelengths reduce the risk of complications or burns from laser hair removal that are generally higher for darker skinned patients. If I go for laser hair removal, will I ever have to shave again? While laser hair removal can achieve long-term inhibition of hair growth after multiple sessions, it does not mean that the hair will never grow back. It does, however, reduce the need for constant shaving and waxing for a longer period. Take note that there may not be very noticeable improvement after a single session – there is a gradual reduction of hair density and thickness with each successive session, until hair growth is inhibited. In addition, laser hair removal does not work equally on all patients. Typically, patients with fair skin and dark hairs respond better to treatment. It also does not remove white hairs. What do I need to do prior to laser hair removal? Patients should not wax or pluck their hairs two weeks before undergoing laser hair removal. They should also avoid excessive sun exposure and tanning, as tanned skin may absorb the laser light, increasing the risk of burns. How many sessions would I need? The number of sessions required depends on the anatomical site. Use the following as a guide: 4–6 sessions for armpits, chin and face 4–6 sessions for the bikini area 6–8 sessions for lower legs 6–8 sessions for chest and back After the procedure, it is important to use sun protection in order to reduce the risk of post-laser hyperpigmentation. The treated areas may not be completely devoid of hair after each session, but any remaining strands of hair tend to be lighter in colour as well as finer in …

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Keep skin refreshed and supple with help from Restylane Skinboosters

Ageing is inevitable, and the older we get, the more the effects of gravity on our skin become apparent. Collagen levels are reduced and skin elasticity starts to deteriorate when we are in our 20s, although the effects are generally visible only several years later. Hyaluronic acid (HA) is a natural substance found in our body’s supporting tissues. It helps replenish moisture and maintains hydration within the skin. As we age, the volume of HA decreases. With this decline, the skin’s elasticity and ability to hold water also decrease, thereby resulting in the formation of more wrinkles and fine lines. Constant extensive exposure to ultraviolet (UV) rays, either from sunlight or tanning salons, as well as poor lifestyle habits such as smoking, quickens the depletion of dermal HA. To keep skin refreshed and supple, the use of sunblock and topical moisturisers is highly encouraged. Various anti-ageing creams and light- and laser-based therapies can also help to keep the skin looking youthful. Now, there is an additional treatment that can help in restoring hydrated and luminous skin. Here are the top four things to know about Restylane Skinboosters, the first FDA-approved HA product During the Restylane Skinboosters treatment, a gel-like substance (stabilised HA), which retains water and increases overall volume of hydration in the skin, is administered by micro-injections into the skin. The substance acts as a “dermal reservoir” that increases the skin’s capacity to hold a rich and long-lasting source of water under its surface. The therapy also stimulates dermal fibroblasts, which are cells that generate connective tissues to produce new collagen. This reduces roughness and enhances suppleness of the skin. Each treatment session lasts about 15 to 20 minutes, and although patients may experience some swelling and redness that typically subside in a few days, most people do not have any significant downtime. Depending on skin types, results may be visible after just one treatment, and can last as long as six months. For a start, three sessions of treatment are typically recommended. Restylane Skinboosters is recommended for women and men alike, as well as for all skin types. It is also not a solution confined to the face, and can be used for other exposed areas such as the neck, décolletage and …

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Adult Acne

Acne is not a problem faced only by teenagers. In fact, it is common among adults too, particularly women. Acne is caused by a combination of oil gland activity, obstruction of follicular openings and inflammation caused by the Propionibacterium acnes bacteria. Stress and hormones also come into play – women usually have acne breakouts around their menstrual cycles. Often a chronic condition, acne can ease up, only to flare up again. Adult acne can be distressing, even if there are only a few spots on the face. If you’ve been using an over-the-counter product for your acne for a month but there’s no sign of improvement, seek medical advice. Depending on the severity of the acne and your doctor’s assessment, there are four main treatment options available: Topicals The most common is vitamin A-derived retinoid. Topical products also include antibiotics such as clindamycin or erythromycin, and benzoyl peroxide – these are sometimes combined into one formulation. Oral antibiotics Common antibiotics include doxycycline, erythromycin and minocycline, which are useful in reducing inflammatory lesions (the ones with pus, or those that are large and tender). These should be taken for two to three months. Oral contraceptives For women on contraception who have acne, many combined oral contraceptive pills are useful, such as formulations containing both ethinylestradiol and cyproterone acetate. These tend to reduce acne flares that occur around menstruation and, to some extent, facial oiliness. Oral isotretinoin This is probably the most effective oral medication for severe acne. It controls oil production, reduces inflammation and prevents clogged skin pores. Isotretinoin should be used only under strict medical supervision. Women who take it should avoid getting pregnant, as the drug runs a high risk of causing birth defects. SMOOTH THOSE SCARS Superficial acne scars or pits can be treated with chemical peels and non-ablative laser therapy. The latter – done every four to six weeks for up to six sessions – remodels and plumps up the collagen below scars to reduce the appearance of the pits. For chemical peels, four to six sessions every other month are usually required. Deeper scars respond better to stronger laser treatments that penetrate deeper to remodel collagen and scar tissue. At least three to four sessions are recommended. Keloids are lumpy scars that tend to occur on the jawline, chest and shoulders of people predisposed to it. Injections are required in the lumpy areas to flatten and soften them. Post-inflammatory hyperpigmentation can develop, causing dark spots to appear. This can be treated with lightening creams, as well as chemical peels and some …

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Childhood Eczema

The term “eczema” is used interchangeably with “dermatitis” and means inflammation of the skin. Atopic eczema is one of the most common skin problems affecting children in Singapore.  It starts as an itchy red rash and upon scratching will result in broken skin. The rash may sometimes ooze fluid as well. Common areas affected include the neck, face, front of the elbows and back of the knees. In severe cases, the whole body can be affected. How did my child get eczema? Atopic eczema is not an infection. There are genetic factors involved (although a family history is not always present), and it is often associated with other sensitivity conditions affecting the lungs (asthma) and the nose (“hay fever”). Environmental factors can play a role as well, causing the skin to become very dry and making it less effective as a barrier to bacteria. Certain foods can aggravate atopic eczema, but most cases are not related to diet. You should speak to your child’s doctor if you are concerned about this. Eczema runs a chronic course. It can be stabilised with treatment but flare-ups can occur. Parents who are seeking a total cure may be disappointed when the dermatologist tells them there is no cure for eczema. There is reason to be hopeful because advances in medical research now provide effective treatments that can improve the condition and keep the child well. What are the treatment options? Eczema is specifically treated by anti-inflammatory steroid creams, which are applied once or twice a day before the application of moisturiser. Non-steroid creams are also available; these are called topical calcineurin inhibitor (TCI) creams and are usually used in children above the age of 2. Use mild nourishing soaps or synthetic soap substitutes. Moisturisers must be used daily to build good skin barrier and reduce the chance of developing eczema or flare-ups. Moisturisers also hydrate the skin and reduce itchiness. Anti-itch medication in the form of antihistamines may also be given. Occasionally, a course of antibiotics is required if there is any skin infection. What are steroid creams, and are there any side effects? A topical steroid of appropriate strength is prescribed depending on the location of the rashes and the child’s age. Steroid creams are classified into several grades of potency, and generally the least potent steroid will be selected to reduce the inflammation. Although there are potential side effects like thinning of the skin, these can be avoided with proper use of the creams under a doctor’s instructions. Many dermatologists use a “step down regime”. Initially, a stronger cream may be prescribed and when improvement occurs, the doctor will then reduce the strength of the …

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