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What to Do with Unsightly
Skin Problems?

They say that beauty is only skin deep. However, not everyone is blessed with perfect skin. So then, what are the avenues available for people with less-than-perfect skin? Changi General Hospital organised
a public forum on this immensely popular topic on 15 Nov 2003 at the CGH Auditorium.

Unsightly Bumps - Acne
Dr Colin Kwok
Consultant Dermatologist

Acne is a bane of many teenagers and adults alike. Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. However, the disease is not restricted to any age group; adults in their 20s - even into their 40s - can get acne. While not a life threatening condition, acne can be upsetting and disfiguring.

The goal of acne therapy is to get rid of existing lesions and prevent the formation of new ones. Most treatments resolve existing acne lesions and, with continuous use, discourage new ones from forming.

According to Consultant Dermatologist Dr Colin Kwok, the treatment of Acne depends on the severity of the acne.

Mild Acne can be treated with topical antiseptics, antibiotics or retinoids, e.g. Benzoyl peroxide, Erythomycin, Retin A.

Moderate Acne can be treated with oral antibiotics, e.g. Tetracycline or hormonal therapy.

Severe Acne is usually treated with an oral medication called Isotretinoin (Accutane) or Kenacort injections that work to reduce the swelling and redness that are features of severe acne.

Severe acne can lead to serious and permanent scarring. Even less severe cases can lead to scarring. Acne scarring ranges from pitted, uneven scars also known as 'ice-pick' scars to raised lumpy scars such as keloids.

Scars cannot be completely erased. However, they can be treated to look less obvious. Treatment of acne scars includes, Kenacort injections for severe scars, punch excision for deep, ice-pick scars, chemical pills or lasers.

Skin pigmentary problems is another common skin problem afflicting people today.

Skin colour begins down in the deepest level of your epidermis, where special cells called "melanocytes" live. Melanocytes make a dark chemical called "melanin".

Ethnic, developmental, hereditary, hormonal, physiological and pathological factors also determine a person's skin colour.

Café-au-lait spots, Nevus of Ota and Nevus of Hori are some common skin pigmentation problems.

Café-au-lait spots are characterised by brown oval lesions. These flat birthmarks with distinct edges are a bit darker than the surrounding skin. In light-skinned individuals, they are the colour of coffee with lots of cream. In those with darker skin, they can be the colour of a rich, full-bodied, black coffee. The spots can increase in size, number, and darkness throughout childhood.

Nevus of Ota is characterised by a greyish-blue discolouration to the face, as well as in and around the eyes. It is more common in females and is caused by an increased number of pigment cells.

Nevus of Hori is characterised by a greyish-blue discolouration on both cheeks. It is more predominant is women in their 40s and 50s.

Unsightly Spots - Freckles and Age Spots
Dr Tay Yong Kwang
Head and Senior Consultant Dermatologist

According to Senior Consultant Dermatologist, Dr Tay Yong Kwang, all of these pigment problems can be treated with a pigment laser. Pain is minimal as an anaesthetic cream is applied for one to two hours prior to the procedure.

Dr Tay also advised patients to avoid sunlight after the procedure and to use sunscreen daily.

Dilated blood vessels causes the "red face" effect. Some of the causes of dilated blood vessels are ethnicity, sun damage, misuse of steroid cream or a condition called Rosecea.

Try to avoid things that make your face red or flushed such as spicy food, hot drinks, caffeine and alcohol. Limit your exposure to sunlight or use sunscreen of Sun Protection Factor (SPF) 15 or higher.

 

Unsightly Lines - Wrinkles and Vessels
Dr Khoo Boo Peng
Consultant Dermatologist

Consultant Dermatologist Dr Khoo Boo Peng warned against self treatment and treatment by unqualified persons.

"Stop using any steroid creams that might be recommended by a friend. See your skin specialist for treatment."

Special gels and creams will be needed to treat the redness. These can be supplemented with oral antibiotics.

Laser treatment is recommended for more severe cases. Lasers have been used successfully in many types of treatments. Laser treatments performed properly, by a trained physician, are safe and effective. There are many benefits to laser surgery including little if any pain, no needles for most patients, less bruising and swelling and once removed, lesions do not return.

Leg veins is another common problem. Leg veins usually refers to one of two common circulation problems, spider veins and varicose veins.

Spider veins are small, enlarged superficial blood vessels that appear red or blue and commonly occur on the legs or at other places such as the face.

Large veins need to be treated first. Vein stripping is the treatment for removal for large veins. Ambulatory phlebectomy micro-extraction is a procedure which allows for the removal of large surface varicosities through very small incisions that need no stitches.

Sclerotherapy is usually used to remove medium to small sized veins. Sclerotherapy is a technique that involves the use of a very fine needle to inject a solution (sclerosant) directly into the veins. The solution causes the lining of the vein to swell, eventually sealing off the blood vessel and preventing blood flow.

Laser therapy can also be used to remove medium to small sized veins, such as facial veins.

We begin to age from the moment that we are born, thus wrinkles are inescapable. However, wrinkles can be minimised. The overall management of wrinkles can be summarised as:

Rejuvenate
The use of topical agents such as suncreens, retinoids, hydroxy acids, anti-oxidants and bleaching agents.

Resurfacing
The use of chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers.

Replacement
Injections of natural fat or synthetic material under the skin to smoothen the wrinkles.

Relaxation
Botox injections to relax the facial muscles that cause wrinkles, thus leaving the overlying skin smooth and unwrinkled.

Redraping
Plastic surgery that involves a face-lift, brow lift, eyelid surgey, etc.

There are however new ways to treat wrinkles today. Among them are the uses of Argireline anti-wrinkle cream, mini facelift procedures that are done under local anaesthesia, laser resurfacing and non-ablative laser.

Fat: Here Today, Gone Tomorrow
Dr Eileen Tan
Consultant Dermatologist

Fat is like that stubborn stain on your shirt or tie. No matter how hard you wash, a little bit of the stain will always remain. Thus, some would think that plastic surgery especially Liposuction, would be a quick way to get rid of fat.

According to Consultant Dermatologist, Dr Eileen Tan, "Liposuction is not used for weight loss. Rather it is used for the localised removal of diet and exercise resistant fat."

Liposuction is a procedure synonymous with plastic surgery. Liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, or totally by local anaesthesia.

Tumescent liposuction is a popular liposuction technique. Tumescent liposuction refers to a technique that uses large volumes of very dilute local anaesthesia that is injected into the fat causing the targeted areas to become tumescent, or swollen and firm. Dr Tan adds that this technique causes minimal bleeding, thus patients recovery very quickly after the procedure.

As with any type of surgery, there is always a risk of complication. These include pain, swelling and numbness. Other more serious complications such as lidocaine toxicity, infection, haemorrhage and Deep Vein Thrombosis are rare.

The amount of fat removed during each procedure is probably between 3 to 5 litres. However, if larger amounts of fat need to be removed, it is safer to divide liposuction into separate surgical procedures.

Fat can also be used in certain procedures. Fat transfer is the process of transferring fat from one area of the body to another in the same individual. This fat may be used to fill undesirable depressions and furrows such as those between the nose and corners of the mouth and to enhance the contour of the lips. It is also used to replace fat lost from the face during the aging process.

Despite all the possible skin treatments that are available, Dr Tay Yong Kwang, Head of Dermatology Service, reminded that the aim of these treatments is improvement, not perfection.

"Beauty is an elusive goal, aim for improvement for perfection is never wholly obtainable," said Dr Tay.