Moles

Besides a mole check, we offer removal of moles for cosmetic purposes. This includes surgical excision and CO2 laser ablation.

Hair Removal

Intense pulsed light permanent hair removal is available at Skin Physicians.

Skin Care

At Skin Physicians, we have specially formulated a range of products for your skin care needs. Besides basic skin care, special formulations take care of acne-prone skin, sensitive skin and pigmentation and effects of skin aging.

Vitiligo

1. What is vitiligo?

Vitiligo is an autoimmune disorder; it is a result of immune cells attacking the pigment cells (melanocytes) of the skin of the same individual. This results in the skin turning white due to the loss of pigment (melanin). Why this happens is genetically controlled. In an Individual with vitiligo, the pigment cells on their skin are genetically prone to external stress, including emotional stress and repeated trauma. When stressors arise, these pigment cells releases “alarm signals” that activates the immune system that results in the attack and disappearance of these pigment cells .

2. What concerns do vitiligo patients have ?

In Skin Physicians, we see around 100 vitiligo patients per month. Their main concerns include their physical appearance, especially when the white patches affect the exposed parts of their body like the face, hands, arms and legs. Being Asians with skin of colour, these white patches are a stark contrast to their normal skin colour. Patients are socially embarrassed with this presentation and many of them are depressed because of this. They can be embarrassed in performing tasks like a simple handshake, if vitiligo affects their hands. Many patients faced curious stares from passerby on the streets. They can also become very self-conscious of their appearance and become insecure. Sad to say children with vitiligo may be made fun of or taunted in schools. In certain Asian cultures, e.g. among Indians, it can be a taboo to have vitiligo. Affected patients (and their unaffected family members as well!) may face difficulty in finding a spouse and getting married.

3. At what age does vitiligo appear?

Vitiligo affects all age groups. 50% of vitiligo appears during childhood and 50% appears during adulthood

4. Is vitiligo hereditary?

Vitiligo is a genetic condition; it is hereditary. However the genetics is complex. In other words, whether the offsprings of an affected individual will present with vitiligo cannot be predicted with certainty. Someone may not see any signs of vitiligo even if their family has it, or it might skip a generation.

5. Can vitiligo cause an itch or rash?

It can. In early stages of vitiligo, the skin can be red (inflamed) and itchy before it loses its colour. As you may recall, the loss of pigment cells is due to “autoimmune destruction”. When the body’s immune cells attack the pigment cells of the skin, the skin may turn red and inflamed due to this attack.

6. Can those who have vitiligo go out in the sun, or is it advisable not to?

Vitiligo patients can go out in the sun but with caution. It depends on the duration of sun exposure and the extent of white patches in an affected individual. In vitiligo, the white patches have lost their pigment cells (melanocytes) and hence the loss of their protective pigment (melanin). Because of this, it makes the affected skin prone to sunburn. However if the sun exposure is short like simple walking from building to building, generally a sunblock is not required. However if the sun-exposure is prolonged, e.g. playing beach volleyball, cycling or hiking during the day, application of a sun-block is a must to prevent a sunburn.

7. What are the treatment options for vitiligo patients in Singapore?

Generally the approach to treating vitiligo is to:

• Stop its spread/ expansion (Induce Stability)
• Restore the Colour (Repigmentation)
• Camouflage

To stop the expansion and spread of vitiligo, medical treatment with oral steroids, steroid creams and topical immunomodulators can be used. Oral antioxidants have also been shown to be helpful. In situations where vitiligo is expanding or spreading rapidly, systemic immunosuppressant drugs are employed. Recently a new class of drugs called the Janus Kinase (JAK) Inhibitors have shown promising results in arresting the expansion of vitiligo and restoring skin colour. A topical form of JAK inhibitor will be available in Singapore later this year.

To restore skin colour, phototherapy is invariably required. Phototherapy involves the application of narrowband ultraviolet B (NBUVB) light twice to thrice weekly to the vitiligo patches. For patients with a few limited vitiligo patches, phototherapy can be administered using a handheld device (targeted phototherapy like the Excimer Light /Laser). However for patients with more extensive vitiligo, full body phototherapy will be required, and this involves stepping into a cabinet that contains full height NBUVB lamps. The restoration of skin colour takes time, and it usually takes 6 to 7 weeks of treatment to see results.

Patients with vitiligo on the exposed parts of the body (e.g. face or hands) can cover up the affected areas with a camouflage cream. Various cover-up creams are available commercially (many of which are water-resistant).

8. Cellular grafting as a treatment for vitiligo

For patients whose vitiligo is stable and who fail to respond adequately to the above treatments, surgical grafting can be considered. This involves transplanting the patient’s normal skin (i.e. tissue grafting) or skin cells (i.e. cellular grafting) onto the vitiligo areas to replenish the lost pigment cells.

For cellular grafting, the procedure is performed on an outpatient basis and takes about 3 to 4 hours to complete. Return of skin colour takes about 2 to 3 months to occur. This procedure is most effective for stable vitiligo, especially segmental vitiligo.

Non-cultured cellular grafting is an established and evidence-based transplant service offered by our centre for vitiligo treatment. Dr Goh Boon Kee first introduced cellular grafting as a clinical service in Singapore in 2006 and has since successfully transplanted more than 800 patients (Press Release 2006). He has also mentored and taught this procedure to the younger dermatologists in Singapore.

9. Advice for those suffering from vitiligo.

A) Not to be disheartened! The advances in dermatology have made vitiligo a treatable condition. With proper treatment, the skin colour can be restored. But you need patience for the skin colour to be gradually restored using the current medical treatments. Seek medical treatment!

B) Avoid physical trauma to the skin. Repeated knocks or cuts can result in vitiligo appearing on the injured areas.

C) Reduce emotional stress. Psychological stress can be a trigger for new patches of vitiligo appearing on the skin. So take things easy. Learn to relax. Physical Exercise (like jogging, swimming or practicing yoga) is a good way to relieve emotional stress. Think positive!

D) Eat healthily.
Many patients have avoided citrus fruits because “the internet” claims that it will worsen vitiligo; that is NOT true. In general , there is no food restriction in patients with vitiligo, but the advice is still a good balanced diet. Foods rich in antioxidants are beneficial to patients with vitiligo, so grab your fruits and vegetables!

Recommendations:

Vitiligo is a medical condition and not just a cosmetic concern. Vitiligo occurs because of an autoimmune cause.

Vitiligo is not an infectious disease; it is not contagious. You can safely shake the hands of an individual suffering from vitiligo.

Individuals with vitiligo need our support! They need our empathy. This condition is treatable. With medical treatments they can regain their skin colour, restore their self-confidence and assimilate fully into society.

Viral Warts

Warts are harmless growths on the skin caused by human papilloma viruses. They can affect any part of our skin and may appear as flat papules, “cauliflower”-like growths or indented lesions, like those on the soles which can be painful upon compression. At Skin Physicians, our treatment options for viral warts are comprehensive, including liquid nitrogen therapy, electrocautery, CO2 laser ablation and topical therapy.

Urticaria (Hives)

Urticaria, otherwise known as hives, is a common condition. It can be acute or chronic. Urticaria that lasts for more than six weeks is considered as chronic urticaria. Acute urticaria can be caused by viral infections, food allergy, drug allergy and so on. Chronic urticaria may be idiopathic or autoimmune in nature. It can also be caused by physical factors like pressure, sun and cold.

We have a special interest in urticaria. Investigations may be necessary following a detailed history and examination. The autologous serum skin test is available at our clinic and this is a screening test for autoimmune urticaria.

Skin Cancers

The incidence of skin cancers has been rising in recent years, possibly due to an increase in sun-seeking behaviour, depletion of the ozone layer, coupled with increasing life expectancy. The common types of skin cancers include basal cell carcinoma, squamous cell carcinoma and melanoma. Skin cancers can be detected early by proper skin examination. At Skin Physicians, we provide a comprehensive array of services that range from the detection of skin cancer (including full body mole check) to surgical removal of the lesions. For complex cases, we regularly partner with other specialists in Mount Elizabeth Medical Centre to provide multi-disciplinary care.

Skin Allergy

Skin allergy can present in various forms including skin swellings, hives, measles-like rash or blisters. Common triggers include drugs, chemicals, airborne agents, dyes and food. To establish if an agent is truly the cause of skin allergy, various tests can be performed after a careful and detailed clinical history. They include prick tests, patch tests and specific blood tests. Provocation tests can also be done, usually to rule out a non-offending agent.

Sexual Transmitted Diseases

We provide confidential and comprehensive investigations/treatment for sexually transmitted diseases.