Common Acquired Facial Pigmentation

Freckles

Freckles are small flat brown marks arising on the face and other sun exposed areas. They are most often seen in fair skinned people, but they are an inherited characteristic that sometimes affects darker skin types as well. As the person ages this type of freckle generally become more noticeable. It can be lightened by avoiding sun exposure and with the regular use of sunblocks and whitening creams. They can be safely removed by intense pulsed light therapy (IPL) or pigment laser therapy.

Lentigines

Larger flat brown spots on the face and hands arising in middle age also result from sun damage exposure. Commonly known as age spots or liver spots, the correct term for a single lesion is solar lentigo (plural lentigines).

Lentigines are due to localised proliferation of melanocytes. It is important to distinguish the harmless solar lentigo which does not turn cancerous from an early malignant melanoma (skin cancer). Similarly, they can be lightened by avoiding sun exposure and with the regular use of sunblocks and whitening creams. They can also be safely removed by intense pulsed light
therapy (IPL) or pigment laser therapy.

Seborrhoeic keratoses

Seborrhoeic keratoses are superficial skin overgrowth which are brown and slightly raised. They are due to aging and sun exposure. They can be seen on the face as well as the sun exposed areas as the limbs. They do not transform to skin cancer. Treatment includes liquid nitrogen and laser therapy.

Skin Tags

Skin tags are skin-coloured or brown growths which commonly occur on the neck, underarms and face. They are harmless and do not transform into skin cancer. They can be easily removed by snip-excision, electrocautery and laser therapy.

Moles

Moles are due to abnormal collections of pigment cell (melanocytes) in the skin. They occur in childhood, adolescents and early adulthood. Most moles are dark and pigmented. Moles are small, flat and pigmented when they appear but with aging, they become raised, dome-shaped and often appear lighter.

Moles that develop irregular borders, bleeding or sudden increase in size are a cause for concern and a dermatologist should be consulted early. Small flat moles can be treated with laser whilst bigger ones should be exised.

Viral Warts

Warts are growths on your skin caused by an infection with human papilloma virus, or HPV. 

Types of warts include:

• Common warts, which often appear on your fingers, toes and on the knees Plantar warts, which show up on the soles of your feet
• Genital warts, which are a sexually transmitted disease
• Flat warts are skin-coloured and can appear in any area of the body
• Periungual warts prefer to grow at the sides or under the nails and can distort nail growth

Warts are contagious and may spread from one area of the body to another or to others. There is no way to prevent warts.

Treatment

Adult Hair Loss

The medical term for hair loss is alopecia. Alopecia may be localised or diffuse.

Patients may notice hair shedding, poor hair quality, hair thinning or bald areas. There may be associated scalp disease or scarring.

Male and Female Pattern Hair Loss

What is male pattern hair loss (androgenetic alopecia)?

What treatments are available for male pattern hair loss?

• Minoxidil solution
• Finasteride tablets (type II 5-alpha reductase inhibitor)
• Hair stimulating laser comb/ band
• Topical stem cells and hair growth serums
• Oral hair growth supplements

What is female pattern hair loss?

What treatments are available for female pattern hair loss?

Other causes of hair loss are associated with poor quality hair include iron deficiency, deficiency of thyroid hormone and systemic diseases such as systemic lupus erythematosus, syphilis and severe illness result in patchy hair thinning and bald patches.

Diphencyprone (DCP) Treatment for Alopecia Areata

How does DCP work?

DCP works by inducing contact dermatitis. The body’s immune system is stimulated causing inflammation on the surface of the skin. By diverting the white blood cells away from the hair bulb, the hairs can re-grow. DCP does not work in every patient, but reports suggest that up to 50% of people who use it will obtain significant re-growth of their hair.

What would you expect if your doctor put you on DCP?

First Visit
DCP treatment usually involves making you allergic to this chemical by “sensitizing” you to the chemical DCP, as on a patch on your scalp. This chemical is painted on a small patch on your scalp and left on for 24 hours.

After 24-hours, you should remove the patch by wiping the chemical with a tissue before washing the area in the shower. An itchy area or even blister will develop in 3 to 5 days where the DCP is applied. This itchy area will fade in 2-3 weeks.

Second visit (2 weeks after sensitization)

You need to see the doctor 2 weeks after the “sensitization” period. Your doctor will examine you and decide if DCP will work for you. If you have strong reaction to DCP (you developed an itch or blister 3-5 days after “sensitization”), this means that you have been successfully sensitized to DCP.

The patch test usually involves applying various concentrations of the DCP on your left arm, and left there for 24 hours. Similarly, after 24 hours, you are required to wipe away the chemical and wash the area in the shower. Three days after the patch test, you are required to come back to NSC, for a review to determine the best dose for treatment of your condition.

Subsequent visits
(usually applied weekly)

DCP is usually applied once a week. DCP comes in many concentrations (0.0001%, 0.001%, 0.01%, 0.05%, 0.1%, 0.5%, 1% etc) and your doctor will choose the best concentration to start treating you with. ln treatment room, your nurse will apply DCP to all areas of the scalp that are bald. After 24 hours, you will be required to wash off all the remaining chemical from your scalp.

Once you have been sensitized to the DCP, you will get a rash wherever it touches you. So you must be careful when you wash away the remaining chemical to make sure that it does not come into contact with other parts of your body.

What can you expect after each treatment?

One to two days after your treatment, you may experience itching, burning, blistering on the scalp and may even look like a mild sunburn. Different people react differently and some people will only have a mild redness and slight itch, whilst others may get a very severe itch and even few blisters. A satisfactory reaction is for the DCP to cause mild redness and itch which lasts for 24-48 hours.

The redness and itch is then allowed to subside, and the DCP is applied each week. DCP will be continued until the bald area has completely re-grown. This will usually take several months. If you get a strong reaction, do tell your staff nurse and no treatment will be done until your reaction settles. Some patients will develop painful swellings (lymph nodes) at the back of your neck and are distressed. It is generally benign. Please see your doctor.

Medical Reviews

Your doctor will review you one month after starting treatment. He will adjust the concentration of DCP applied according to your response to the previous concentration. You will continue for at least 6 months of treatment before we consider the treatment to be unsuccessful and recommend stopping.

When the treatment was deemed successful and you have achieved complete re-growth, your doctor will either reduce the frequency and put on a maintenance regime or stop the treatment completely.

Side Effects

Treatment with DCP is usually safe and any side effects are usually due to hypersenstivity to the chemical. You can develop redness, blisters itch and white patches. If you are extremely sensitive to the chemical you might even develop rashes on other parts of the body, not exposed to the chemical. If this happens, and it is extensive and severe, you are required to stop the treatment and to consult us immediately.

At all times when on treatment, YOU MUST NOT BE PREGNANT OR BREASTFEEDING. Should you be pregnant while on treatment, you must let your doctor know immediately, as DCP is not recommended in pregnancy.

SkinCancers

Skin cancer is the 6th most common form of cancer in the Singapore.

The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

• Spend a lot of time in the sun or have been sunburned
• Have light-colored skin, hair and eyes
• Have a family member with skin cancer
• Are over age 50

The majority of skin cancer can be prevented by careful sun protection from an early age, and detected early by regular self skin examination.

Current treatments for primary skin cancer include:

• Excision surgery
• Curettage and diathermy/cautery
• Electrosurgery
• Cryotherapy
• Fluorouracil cream
• Imiquimod cream
• Photodynamic therapy
• Radiotherapy