CONVERSATIONS WITH… A Skin Specialist

Our expert details the most common skin problem among Singaporeans and the best skincare product for you.

If you think that an aesthetics doctor is a dermatologist, you’re wrong.

While such procedures are certainly a routine part of a skin doctor’s duties, these experts deal with many medical conditions, including skin cancer, explains Dr Tan Hiok Hee, a senior consultant dermatologist at Thomson Specialist Skin Centre.

Dr Tan, 53, who previously headed various clinics at the National Skin Centre, notes that some people believe that skin conditions are “trivial” and are only of cosmetic concern.

Skin conditions can be devastating to a patient’s psyche and social function,” he points out. “They can also have potential serious complications if untreated. For example, psoriasis can be associated with joint disorders as well as the metabolic syndrome, putting the patient at higher risk of heart attacks or diabetes.”

A fellow at the Academy of Medicine of Singapore, as well as the Royal College of Physicians in Edinburgh and London, Dr Tan recounts how he “stumbled” on this medical speciality. “I had actually requested a posting in dermatology, so that I could brush up on my knowledge in skin diseases for the internal medicine exams. However, I ended up enjoying the posting so much that I made the decision to pursue it as a career.”

”Many people think that skin conditions are trivial and are only of cosmetic concern. Skin conditions can be devastating to a patient’s psyche and social function. They can also have potential serious complications if untreated.”

Elaborating, he says he picked this branch of medicine because he finds dermatology “challenging”. Having treated at least 50,000 patients in his 21 years in this field, he explains, “Dermatologists need to be good with their eyes as well as their hands, and it is a unique blend of medicine and surgery.”

Married to a family physician and a father of two sons, aged 19 and 21, the Liverpool Football Club fan enjoys reading and taking walks in his free time.

Incidentally, you’d be surprised to find out what his go-to skincare product is. It isn’t an oil-free toner or a hydrating moisturiser, it’s something with at least SPF 30. Indeed, Dr Tan’s advice to all his patients is “use a sunblock”.  

Read on to learn about common skin issues Singaporeans face and why this skin specialist believes sunscreen is key in preventing skin problems.


What’s a typical day like for you, Dr Tan?

I like to get an early start, so I’m in the clinic by 7.30 am looking through lab results, doing correspondence and answering e-mails. Clinic sessions start at 8am and usually end by 5pm. The type of cases I see each day can be varied. Besides consultations, I also do procedures such as skin surgery, laser therapy or cryotherapy (using liquid nitrogen).

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As a skin specialist, what are your areas of interest?

I was trained in the sub-specialties of cutaneous [skin] infections as well as sexually transmitted infections. In addition, I have interests in the management of severe acne and eczema.

What common skin issues do Singaporeans face?

Eczema, psoriasis, acne, pigmentary disorders, skin infections, skin tumours and growths (whether benign or cancerous), and hair loss.

Is eczema on the rise in Singapore?

Eczema is the most common skin disorder that we see. Previous local studies in Singapore show a prevalence of eczema in 20.8 per cent of school children and teenagers aged 7 to 16 years old (2002, Tay et al). The increase in numbers may be due to a combination of factors:

  • Increased patient awareness, thus more people are seeking medical attention.
  • More frequent travel. As the skin is exposed to a variety of extreme weather conditions, it may unmask an underlying eczema. For example, some people might develop an itchy rash from the cold weather.
  • Singapore’s hot and humid weather might also lead to excessive perspiration and over-washing, both of which can disrupt our skin barrier.
 

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Are pregnant women more prone to skin problems? 

Yes, there is a group of pregnancy-related skin conditions that may occur during this period. Some women may also see an increase in pigmentation and melasma. Certain skin conditions such as eczema can also worsen during pregnancy.

What’s your advice to a mum-to-be who has skin problems or allergies and hopes to lower her child’s risk of acquiring the same skin disorder?

Seek professional advice, speak to a dermatologist and manage your own skin condition well. I would advise breastfeeding for at least 6 months if possible.

Any way to prevent your child from developing skin conditions you or your spouse have?

Certain skin conditions are caused by genetics and it is impossible to block out the risks of developing those conditions, but regular moisturising, reduction of exposure to house dust mites, and avoiding known triggers such as harsh soaps and over washing may help.  

”When babies have eczema, it is not due to a hygiene problem. Thus frequent washing or using a strong antiseptic soap is not the answer and could make things worse.”

What should new parents look out for when it comes to newborn’s skin?

Look out for any red and rough patches that might be itchy or suspected to be early eczema. Areas that are red and tender may also signify an infection.

What mistakes do new parents usually make that may not help but worsen baby’s skin condition?

When babies have eczema, it is not due to a hygiene problem. Thus frequent washing or using a strong antiseptic soap is not the answer and could make things worse.

What are common baby or toddler skin issues?

Toddler have many common skin issues, which fortunately are only temporary and quite harmless, like cradle cap, diaper rash, milia on the face or even neonatal acne and heat rash. There are other issues as well such as birthmarks, vascular abnormalities and eczema in infancy.

What’s the best way to keep your child’s skin soft, smooth and problem free?

Moisturise regularly, change baby’s diapers frequently and avoid sunburns when the child starts swimming lessons and activities outdoors.

 

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With Singapore getting hotter and hotter, should parents always use sunscreen/sunblock when they let their kids play outside?

Bad sunburns in childhood can lead to an increased risk of skin cancers in adult years, so always try to prevent this. Use a sunblock that is appropriate for children. I recommend something with an SPF of 30. There are also sunblocks with a paediatric formulation for ages 1 and above. Don’t forget the role of clothing and even hats in reducing the risk of sunburns. The sun is also at its most intense at between noon and 3pm in most areas, so avoid this timing if you have to play outdoors.

What is your most memorable your patient encounter?

I have a few. One of them involves a patient with Down syndrome and eczema that I have seen for years. It was gratifying to see his condition improve over the years, and this patient has grown up to become a nice young man and is able to do a part-time job. Credit to his mother for all her support over the years.

The other case was a teen with very severe nodulocystic acne [a severe form of inflammatory acne]. It was so bad that that he started to skip school and became a social recluse. He was even starting to get depressed. With the use of appropriate medications, cooperation from the patient and support from his parents, I could see the transformation over eight to 10 months. He became a totally different person once his acne had been treated.

Do you have a favourite or most useful skincare product?

Sunblock.

“Bad sunburns in childhood can lead to an increased risk of skin cancers in adult years, so always try to prevent this. Use a sunblock that is appropriate for children. I recommend something with an SPF of 30.”

What do you like most about your job?

In most cases, I am able to help patients alleviate their symptoms and complaints. Although many skin diseases are chronic, many things can be done to mitigate the condition. I am most satisfied when a patient comes in with something that has been troubling them for a long time because it was not correctly diagnosed, and I am able to use my training to help them and give them a solution to their problems.

On the flipside, what is your job’s biggest challenge?

Patients can be frustrated by the chronicity of certain skin conditions. Some conditions can be very severe and difficult to treat. The most difficult part is to convince the patient that occasional flares or relapses do not signify that the treatment is ineffective.

Any pet peeves about your patients?

Patients who are impolite to my staff.

What is one thing you would like to say to all your patients?

Use a sunblock. If you notice any unusual moles, lumps or bumps, please get them checked.

Please fill in the blanks:

If I weren’t a dermatologist, I would be a… Gastroenterologist.

The three words best that best describe me… Soft-spoken, meticulous, caring.

The last country that I visited was… Australia.

My favourite movie is… It’s a tie between The Godfather Part II and The Dark Knight Rises

My go-to hawker food is… Char kway teow with lots of chilli.

A superpower I would love to have is…. The ability to fly.

Photos: Dr Tan Hiok Hee

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