7 Different Types of Eczema

Eczema is an uncomfortable condition where parts of the skin become itchy, rough, inflamed, and in worst cases, ooze puss. Characterized by red patches and blisters, they are a great discomfort and are projected to plague a number of people in our population.

In this article, we will go over the various types of Eczema, their symptoms, and their causes in order to help you understand how to best prevent getting them. 

Different Types of Eczema

1. Stasis Dermatitis 

What is Stasis Dermatitis? 

Occurs usually in the lower leg, it is the formation of rough dry patches. It makes the leg feel heavy and inflamed. Stasis Dermatitis can also be known as Venous Dermatitis or Venous Eczema. 

What are the symptoms of Stasis Dermatitis? 

• Patches of skin colored yellow, red, or brown. 

• Bulging veins and swelling of the leg. 

• Itchiness and inflammation. 

• Sores that ooze. 

• Ulcers. 

What are the causes of Stasis Dermatitis? 

Usually found in individuals over 50 years of age or above, the condition is brought about by low circulation of blood to the leg. Usually due to high cholesterol or injury preventing proper blood flow. 

2. Nummular Eczema 

What is Nummular Eczema? 

Also known as Nummular Dermatitis or Discoid Eczema, these are characterized coin-shaped lesions that appear on the arm and legs that may or may not ooze puss or clear liquid. 

What are the symptoms of Nummular Eczema? 

• Circular lesions on the skin 

• Dry and itchy 

• Blisters that ooze liquid or puss 

What are the causes of Nummular Eczema?

There are no known definitive reasons why Nummular Eczema forms. It is thought that it is a congenital condition that forms when the individual is injured or experiences drastic changes in temperature. It may also be an allergic reaction to certain soaps or skin products. 

3. Neurodematitis 

What is Neurodematitis? 

Typically found on the neck, wrists, arms, legs and anal region, it is known for causing extreme itchiness that will worsen if scratched – creating an uncomfortable itch-scratch cycle. 

What are the symptoms of Neurodematitis? 

• Itchy Patches 

• Scaly textured skin 

• Patches that are rough and differently colored to the rest of the skin. 

What are the causes of Neurodematitis? 

A chronic skin condition, it is generally thought to form through bug bites or tight fitting clothes. There is, however, no objectively proven reason for their formation.

4. Hand Eczema 

What is Hand Eczema

Also known as hand dermatitis, it is blisters and red patches in the hands that are thought to be caused by allergic reaction or genetics. 

What are the symptoms of Hand Eczema? 

• Red Patches on the hands 

• Blistering 

• Dryness and flaking 

• Itchiness and pain 

What are the causes of Hand Eczema? 

Likely caused by allergic reaction to irritant substances. It is also known to come seasonally for those who possess it genetically. 

5. Dyshidrotic Eczema 

What is Dyshidrotic Eczema? 

Also known as Pompholyx, it is a form of dermatitis that forms on the tips of fingers, soles of feet, toes, and palms. Such a skin condition can sometimes be unresponsive to treatment and can cause much burden to both patient and doctor. 

What are the symptoms of Dyshidrotic Eczema? 

• Blistering and scaliness 

• Clear, white, or yellow colored patches 

• Itchy and may exude clear liquid 

What are the causes of Dyshidrotic Eczema? 

It may be caused by stress, pollen, excessive sweating, and/or an allergic reaction to nickel in jewelry or other metals. 

6. Contact Dermatitis 

What is Contact Dermatitis

It is the red and itchy patches of skin caused by direct contact to substances which one is allergic to.

What are the symptoms of Contact Dermatitis?

• Red rashes 

• Bumps caused by severe scratching 

• Itchiness 

• Tenderness, swelling, or burning sensation of the skin. 

What are the causes of Contact Dermatitis? 

The likely culprits are cosmetic products, soaps, and/or cleaning chemicals that cause irritation and allergic reactions.

7. Atopic Dermatitis 

What is Atopic Dermatitis? 

Long lasting and tends to flare up in periodic time frames, it is characterized by red itchy patches and may be accompanied by fever or asthma. There is no known cure. 

What are the symptoms of Atopic Dermatitis? 

• Dry Skin 

• Red Patches or Bumps 

• Itchiness and swelling 

• May be crusty and leak 

What are the causes of Atopic Dermatitis? 

Perhaps caused by an allergic reaction to certain foods, it is likely a genetic condition spurned by a lack of moisture on the skin thus making it more prone to irritants. 

We provide testing, treatment and management for Eczema and other skin conditions at our DTAP Clinic @Orchard.

Speak to our doctors today!

Vitiligo Self-Care & Vitiligo Prevention Tips

People with vitiligo can adopt certain measures in their daily lifestyle to help prevent their disease from getting worse.

Sun protection

Skin that has lost its colour tends to sunburn easily. Sunburn can worsen vitiligo. Getting a tan from sun exposure can also increase the contrast between white vitiligo and normal tanned skin, thereby making the vitiligo patches appear more obvious.

Recommended measures:

1. Use sunscreen everyday

  • choose sunscreen lotions that are water resistant, SPF greater than 30 and offer broad spectrum (UVA + UVB) protection. Remember to reapply every 2 hours, after spending time in water or when you sweat
  • apply sunscreen to all skin that is not covered by clothing 

2. Wear clothing that protects you from the sun

  • The ability of clothing to protect your skin against UV radiation from the sun can be measured as a UPF rating
  • Some clothing comes pre-treated with UV absorbers that gives them a high UPF rating.
  • In general, loose fitting, dark or brightly coloured clothing made of densely woven fabric of unbleached cotton, shiny polyester or satiny silk confers the greatest UV protection
  • You can also increase the UPF of your clothing by adding UV blocking additives to the wash cycle.

3. Stay in the shade when possible

4. Do not use tanning beds and sun lamps

Skin protection

Take precautions to minimise skin injury and irritation

A cut, graze, scratch or friction to skin may lead to new patches of vitiligo

Avoid exposure to chemicals

Compounds containing phenols, catechols and sulfhydryls present industrial chemicals, cleaning agents and some hair dyes are known to cause loss of skin colour 

Reduce mental stress

Psychological stress has been known to trigger vitiligo flare-ups perhaps through its effect on immune cells and nervous systems of the skin.

Hence maintaining good mental health is essential to controlling the disease.

Do not get a tattoo

Do not tattoo your skin other than for treatment purpose as the micro-injuries caused by tattoos can lead to new vitiligo patches

Psychological & Social Impact of Vitiligo

People with vitiligo often suffer from low self-esteem, depression and anxiety.  

The appearance of the disease often affects one’s self image, makes one feel self conscious, anxious and embarrassed. It is sometimes made worst by perceived discrimination from others.  Children are especially vulnerable to teasing and bullying from their peers.

The early treatment of vitiligo is always advised.

People with vitiligo are encouraged to learn more about their condition to improve their own understanding and control of the disease.

Talking and sharing experiences with other people in a similar situation via support groups can also be helpful. 

Counselling provided by a psychologist is another option that is especially useful for addressing issues with self image, depression and anxiety.

Everything You Need to Know About Molluscum Contagiosum

What is molluscum contagiosum?

Molluscum contagiosum is a fairly common skin infection or condition caused by a virus called Molluscum contagiosum, a type of poxvirus. It manifests as raised, pearly, flesh or skin coloured bumps which may sometimes have a central dimple (known as “central umbilication”).  

How does molluscum contagiosum spread?

Molluscum contagiosum is spread through skin contact with the virus. 
This can occur if you come into direct contact with someone else’s molluscum lesions, be it through sexual contact, or during contact sports like wrestling.

Unfortunately, the virus can survive on surfaces outside the body and can remain on infected surfaces like clothing, towels, gym equipment etc. Someone else who then comes into contact with these surfaces can get infected. 

In someone who is already infected, scratching or touching the lesions and then touching other parts of their body can result in the virus spreading. Shaving over infected skin can also spread the virus and worsen the infection. 

Once lesions resolve, an infected individual is no longer contagious. 

Who is affected by molluscum contagiosum?

Both children and adults alike can be infected by the virus. It is common amongst young children who may spread the virus through playing with each other. Lesions may occur anywhere – on the trunk, limbs, armpits, neck and possibly even face.

In adults, it is more commonly spread through sexual contact and may be considered an STD. The resultant lesions occur anywhere on the lower abdominal wall to the external genitalia and perineum. 

Individuals with weakened immune systems e.g. cancer patients or immunosuppressed patients, or individuals with skin conditions like eczema are at higher risk of being infected. 

What are the symptoms of molluscum contagiosum?

Molluscum contagiosum gives rise to shiny, pearly, skin coloured bumps which may range in number from few to many. These can occur anywhere on the body depending on where the virus inoculates the skin. These bumps are painless and can range in size from barely visible to several millimeters in size or larger. When lesions are larger, you may be able to notice a central dimple. 

In individuals with weakened immune system, lesions may be far more widespread e.g. >100 lesions.

Symptoms usually surface between 2 weeks to 2 months from initial infection, but can be delayed for up to half a year even. 

What are the complications of molluscum contagiosum?

Molluscum contagiosum is a benign and self-limiting condition. However, scratching lesions can result in scarring or secondary bacterial skin infections.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is diagnosed clinically i.e. by identification of the classic pearly skin bumps. If the lesions look atypical, a skin scraping of a bump may be useful – examination under a microscope will reveal “molluscum bodies” which confirms the diagnosis, but this is not routinely performed in most patients. 

How is molluscum contagiosum treated?

Treatment of molluscum contagiosum is not always necessary as the condition is self-limiting and lesions will eventually resolve by themselves without scarring. Most lesions will resolve within a year but can take longer than that. 
Treatment is recommended for:

  • Lesions around the genital or perianal region
  • If lesions are large 
  • In immunocompromised individuals with extensive lesions 

Various treatment methods available include:

  • Physical removal of lesions – with laser removal or cryotherapy (freezing with liquid nitrogen)
  • Topical creams or ointments e.g. podophyllotoxin application, imiquimod cream – but the efficacy of topical treatment may vary 
  • In immunocompromised individuals, usual treatment methods may fail and specific, special treatment (e.g. intralesional interferon) may be required 

How do I minimize my risk of getting molluscum contagiosum?

Good hygiene habits are crucial to minimize your risk of molluscum – regular hand washing, not sharing towels or sports equipment, wiping down equipment at the gym before usage, or covering equipment with your own towel rather than sitting or lying directly on it. Do not share razors or personal items. 

Avoid touching lesions if you are infected. Do not scratch, pick, or attempt to pop lesions. Shaving should also be avoided. Molluscum lesions should ideally be covered e.g. with a plaster to reduce the risk of transmission. 

Adults with lesions around their genital or perianal region should also avoid sexual contact until these have been treated. 

If you are concerned about any skin lumps or bumps and think you may have molluscum contagiosum, it is best to hold off attempting to treat it yourself (this may worsen the infection!) and see a doctor as soon as possible.

If you would like to find out more about molluscum contagiosum come down to any of our clinics for a consultation.

Common Causes of Penile Itching and Pubic Itching

A myriad of conditions can cause a man to have penile itching or pubic itching. The excruciating urge to scratch and relieve that itch at such an inconvenient part of the body can be a major source of embarrassment to some. When severe, it can result in extreme discomfort in the day, and disrupt one’s sleep at night.


Here are some of the causes of Penile Itching and Pubic Itching:


6 Common Causes of Penile Itch:


1. Balanitis

Balanitis is a common infection of the foreskin and head of the penis. It is caused by bacteria or fungus, or a combination of both.

Symptoms include redness, swelling, discomfort, penile itching, and sometimes pain when passing urine.
(See: Penile Infection, Infection of the Penis)

When fungal infection (candidiasis) is present, a whitish cottage cheese-like discharge can be found under the foreskin. Balanitis is often hygiene related, but can also be caused by STDs. It is more likely to occur in uncircumcised males.  Watch: What are the causes of Foreskin Infection (Balanitis)

2. Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus (HSV). Itching of the penis (penile itching) is usually the first symptom and can occur in other areas such as the scrotum, groin, buttocks and anus.

Shortly after, tiny clusters of fluid-filled blisters or ulcers can develop and these are usually painful. Other symptoms include painful urination, enlarged groin lymph nodes, fever and body aches. The virus can lie dormant in the body for years without causing any symptoms, therefore some people may not even be aware that they are infected.

Read: Genital Blister, Genital Ulcers & Genital Warts & Causes of Oral Herpes (Cold Sore)


3. Genital Warts

Genital warts are caused by the Human Papillomavirus (HPV), a sexually transmitted disease. They appear as flesh-coloured growths that can cluster and resemble a cauliflower. Most of the time they do not have any symptoms but can sometimes itch. Bleeding can also occur during sexual intercourse.

Read: Genital Warts Treatment


4. Contact Dermatitis

Contact dermatitis is a skin reaction to contact with an irritant. This can happen anywhere on the body, including the penis. When this happens, it is usually caused by latex condom usage. The skin of the penis can turn red and itchy.

Sometimes the skin can break causing serious discharge, and bacterial infection can occur. Mild cases can be treated with a corticosteroid cream. Non-latex condoms can be used if you have a latex allergy.


5. Urethritis

One of the causes of penile itching is Urethritis. Urethritis refers to inflammation of the urethra, the tube that carries urine from the bladder to outside the body. This condition most often causes pain or itching in the penis, which worsens when passing urine.

Other symptoms include urethral discharge, urinary frequency or urgency, difficulty urinating, and blood in the semen. Urethritis is most commonly caused by a bacterial infection and can be sexually transmitted. See other STD Symptoms 


6. Psoriasis

Psoriasis on elbows.

Genital psoriasis often occurs alongside psoriasis of the skin. Skin cells develop at an extremely fast rate, resulting in the accumulation of skin cells on the skin surface, building up into itchy, red plaques of scaly skin. See Psoriasis Treatment

5 Common Causes of Pubic Itch


1. Jock Itch

Also known as tinea cruris, jock itch is a fungal infection of the skin in the genital area, groin and buttocks. The rash is usually itchy, red, scaly and ring-shaped. It tends to occur in people who sweat a lot and/or are overweight.


2. Pubic Lice

More commonly known as crabs, these are tiny parasitic insects that attach to the hair and skin in the pubic region. Pubic lice can be easily spread via sexual contact or other forms of close contact, and can spread to other body areas with coarse hair such as beards, armpits and chest hair. It is also possible for pubic lice to spread by using an infected person’s clothes, towels, or bed.


3. Folliculitis

This is a condition in which hair follicles become inflamed and is usually caused by bacterial or fungal infection, or inflammation from ingrown hair. Initially, the affected hair follicles may have small red bumps or white-headed pimples, but can swell and become painful and subsequently develop into crusty sores.


4. Contact Dermatitis

As mentioned earlier, this condition can also occur in the pubic area.


5. Molluscum Contagiosum (mo-LUS-kum kun-tay-jee-OH-sum)

Molluscum Contagiousum is a benign viral infection of the skin and is caused by the molluscum contagiosum virus, resulting in painless, small, shiny pearl-shaped lesions. They can happen anywhere on the body as a result of contact, but when they occur in the genital area, it is usually as a result of sexual contact. They can appear alone or in clusters. They usually do not cause any symptoms, but can sometimes itch.

If you need to speak to our doctors, please visit our men’s clinics.  Alternatively, you can email us hello@dtapclinic.com.sg or call us for an appointment.
Take Care.

Other Read:


The Good Wrinkles, Bad Wrinkles and Ugly Wrinkles

We all have a love-hate relationship with wrinkles. OK, maybe more hate than love. This is why wrinkles treatment is one of the most requested treatments in cosmetic clinics. 
Why do wrinkles bother people so much? Firstly, wrinkles are perceived as a sign of getting older. In fact, wrinkles the earliest and most prominent sign of skin ageing. Secondly, it is almost impossible to hide wrinkles. Makeup? Sunglasses? Good luck with those. Lastly, they always start appearing in the most prominent areas – around the eyes and forehead.    

Are wrinkles all that bad?

I like to look at wrinkles from a different perspective, a little differently. I put them into 3 unique categories – the good, the bad and the ugly wrinkles.

Wrinkles – The Good, The Bad and The Ugly

Good Wrinkles?

“Good wrinkles? Are you sure they are good, doc?” This is a common reaction I get whenever I mention good wrinkles. But trust me, getting rid of good wrinkles may, in fact, make you look unnatural and less attractive. The best example of good wrinkles is what I call the gentleman’s wrinkles. Some wrinkles on the forehead and around the eyes are acceptable for men after 30 years old. These wrinkles make men look more attractive and distinguished. The only reason to treat these wrinkles with a small amount of botox regularly is to prevent them from becoming deep permanent wrinkles. Sometimes, simple treatment that improves skin hydration and quality can also prevent these wrinkles from worsening. 
What about ladies? Mild forehead wrinkles and crow’s feet look good in mature ladies. Overtreating these wrinkles often produce an unnatural and frozen look. It also removes natural facial expression which is often what makes ladies look attractive.

Now, what are bad wrinkles? 

Bad wrinkles are the wrinkles that have been around for so long that they become permanent deep lines. Imagine a piece of thin paper that has been folded repeatedly. The lines over the folded areas become static and permanent. Wrinkles that initially only appear when you frown or raise your eyebrows become permanent even at resting state.  
Examples of bad wrinkles are the frown and forehead wrinkles. Static frown wrinkles make you appear unapproachable and unhappy. Static forehead wrinkles make you appear older than your age.

How do you deal with bad wrinkles?

Start early! If you are genetically blessed with having wrinkles early in your age, you should really consider getting the preventive treatment done.


Botox (Botulinum toxin) treatment is a very useful treatment to delay this process. Botox relaxes the facial muscles that create wrinkles. It also helps tighten the skin around the treated area. Getting regular botox treatment done early can prevent or at least delay your wrinkles from getting worse as you age. 

Ultherapy and RadioFrequency tightening

You can also consider having skin tightening treatment such as Ultherapy and Radio Frequency treatment. Ultherapy uses high intensity focused ultrasound (HIFU) to stimulate collagen production. It can effectively tighten and lift facial skin and reduce wrinkles formation. It can be done once a year as a preventive treatment. In between Ultherapy treatments, RadioFrequency treatment is very useful to further enhance the collagen stimulation effect. 

Skin Treatment

Improving your skin quality will delay the formation of bad wrinkles. Skin treatments such as Hydrafacial, rejuvenation laser, intense pulsed light (IPL), Rejuran and skin boosters are some of the examples. Rejuvenation laser such as Clear and Brilliant helps improve skin texture. Rejuran and skin booster enhance skin hydration and collagen building. All these will help delay the skin ageing process and bad wrinkles formation.

Ugly wrinkles

Unfortunately, most people choose to ignore ugly wrinkles because they do not realize how much these wrinkles can affect their overall appearance. Examples of ugly wrinkles are under eye wrinkles, neck wrinkles and wrinkles at the back of the hands. Most people will often get their facial wrinkles treated to appear younger but fail to realize that they’re under eye wrinkles, hand and neck wrinkles will give away their real age.
Under eye-wrinkles are very common even in young people. They get worse with lifestyle factors such as chronic lack of sleep, unhealthy diet, stress and prolonged exposure to computer and mobile screen. By improving your lifestyle, these wrinkles often improve but may not be significant. It is then recommended to consider getting aesthetic treatment to further improve these wrinkles. Treatments such as lasers, fillers, skin booster and skin tightening treatment can help reduce these ugly wrinkles.
Hands and neck are often the most neglected parts. These lines can be improved with a fractional laser such as clear and brilliant or CO2 laser, skin tightening treatment such as Ultherapy, and hyaluronic acid injections such as Juvederm Volite skin booster and Rejuran. 
If this article has not given you any important clues about wrinkles management, I would like to emphasise on one take-home message: Start treatment early! 
If you wish to have any treatment done, it is very important to see a doctor for an assessment and advice before embarking on your aesthetic treatment journey.
The good, the bad and the ugly. Till next time. 
I hope this article gives you some useful tips on The Good, The Bad and The Ugly Wrinkles. You can visit www.saestheticsclinic.com for useful information on aesthetic treatment.
Also Read My other Guest Post on How to Look Young – By an Aesthetic Doctor
Take Care!

This article is written by our guest writer, Dr. Sii Sik Liong from S Aesthetics Clinic

S Aesthetics Clinic

9 Scotts Road
#07-07 Scotts Medical Centre (Pacific Plaza),
Singapore 228210
Telephone: +65 6235 0338
Email: hello@saestheticsclinic.com
On an unrelated note: pep hiv
Also on DTAP’s blog; rapid hiv test Singapore

How to Look Young – By an Aesthetic Doctor

People from different age group visit aesthetic doctors for advice and treatment. There is one universal request – I want to look younger.

Is it possible to look younger than your age?

The answer is yes, only if you work on it.

Here are some tips on how to maintain your youth:


Lifestyle is the most important of all. A healthy lifestyle is key to maintaining your youth.
You are what you eat. Skin health is affected by your daily food intake. A healthy diet keeps your skin healthy and youthful. Minimise intake of junk food, fatty and sugary food.
Smoking and excessive alcohol intake are detrimental to your skin health.
Excessive sun exposure (without proper sun protection) damages your skin and accelerates skin ageing.  
Lack of sleep and exercise make you age quicker. Exercise at least 3 times a week and have adequate rest and sleep.

Skin Care Routine

Invest in the 2 most important skin care essential – sunscreen and moisturizer.
Sunscreen protects your skin from harmful UV rays. UV rays damage your skin, induce skin pigmentation and make your skin age quicker.
Moisturizer improves and maintains skin hydration. It helps lock water in the skin, which is an essential nutrient for skin cells. A well-hydrated skin is healthier and more youthful.
Keep your face clean. Wash your face thoroughly twice a day. Remove your make-up properly after a long day. Make-up is notorious in clogging and damaging your skin. Do not sleep with your make-up on!

Aesthetic Treatment

If you are already living a healthy lifestyle and having a decent skin care routine, you can then explore aesthetic treatment to maintain your youth.
The treatment focus is on 2 aspects of ageing – skin quality and facial sagging.
Skin Quality
You have noticed by now that “skin” has been mentioned multiple times. This is because healthy and radiant skin defines a youthful look. By improving or at least maintaining your skin quality, you can look younger than your age. Non-invasive treatments are usually good enough to help maintain skin health.
Some examples are a good quality facial (such HydraFacial), medical light treatment (such as IPL), mild chemical peel and radiofrequency skin treatment.
If you are more adventurous, you can move on to slightly more intensive treatment such as Clear & Brilliant Skin Rejuvenation Laser and skin resurfacing laser which helps reduce pigmentation, improve skin texture and stimulate collagen regeneration. 
If you are not terrified by injections, go for more potent anti-ageing skin treatment such as Rejuran Healer and skin booster.
Rejuran Healer promotes collagen synthesis, skin healing and repair. It contains polynucleotides which have been proven to stimulate long-term skin regeneration from the inner skin layer. This gradually improves skin elasticity, skin health and restores skin damage caused by ageing and harmful UV rays. Skin booster contains hyaluronic acid which improves skin by hydrating the skin from within. This improves the general quality and health of the skin.


The hallmark of ageing is sagging – Saggy eyes, cheeks, jowls, jawline etc. If you wish to look younger, go for aesthetic treatment that helps to lift and tighten your face.
If you dislike needles on your face, you can start with Ultherapy and RadioFrequency lifting treatment. Ultherapy uses high intensity focused ultrasound (HIFU) to stimulate collagen production for face lifting and tightening without surgery. The end result is a firmer, more lifted and visibly tighter skin around the face and neck areas. The Ultherapy result is progressive and long term, therefore is a very good preventive treatment.
Those who wish to see more immediate lifting result can opt for filler and thread lift treatment. These treatments can provide immediate but temporary face lifting effect.   
Aesthetic treatment, if done by trained professionals, is safe and effective. Before you start getting any treatment done, it is important to see a doctor to get a proper assessment and advice.
I hope this article gives you some useful tips on how to look younger. You can visit www.saestheticsclinic.com for useful information on aesthetic treatment.
Take Care!

This article is written by our guest writter, Dr. Sii Sik Liong from S Aesthetics Clinic

S Aesthetics Clinic

9 Scotts Road
#07-07 Scotts Medical Centre (Pacific Plaza),
Singapore 228210
Telephone: +65 6235 0338
Email: hello@saestheticsclinic.com
On an unrelated note: pep hiv

Monkeypox – What You Need to Know

What is Monkeypox?

Monkeypox is a rare virus that is typically transmitted from animals to humans. Documented human infections occurred mostly in areas of Central and West Africa near rainforests. Human cases outside of Africa are extremely rare.
The Monkeypox virus is very similar to the human smallpox virus but causes less severe symptoms.

What are the Symptoms of Monkeypox?

The symptoms of Monkeypox usually begin 6-14 days (ranges between 5 up to 21 days) after infection by the virus.
Initial symptoms (first 5 days) include fever, headaches, muscle aches (myalgia), fatigue and swollen lymph nodes.

Within 1-3 days

Within 1-3 days of the onset of fever, a skin rash develops, usually starting from the face then spreading to the body.

Next 1.5 weeks or so

Over the course of the next 1.5 weeks or so, the rash develops from flat reddish bumps (maculopapular) to fluid filled tiny blisters (vesicles) which enlarge to become pustular, before eventually crusting and healing.
The rash can involve the palms and soles of the feet, oral mucosa and the eyes as well.
The total illness duration ranges between 2-3 weeks.

Image from CDC Public Health Image Library

Image from CDC Public Health Image Library

Is the Infection Serious?

Monkeypox is generally a self-limiting illness and symptoms fully resolve by themselves by 21 days.  Treatment for monkeypox is supportive until the illness runs its course.
However, serious complications such as pneumonia (lung infection) and encephalitis (brain inflammation) can occur.
The severity of symptoms may differ between patients and more serious illnesses have been seen in younger patients, with a mortality rate between 1-10%.

How is it spread?

Monkeypox is transmitted from animals to humans through bites, scratches, consumption of bushmeat, or through direct contact with the blood/fluid/bodies of infected animals.
Human-to-human transmission is possible through respiratory droplets or physical contact with body fluids/rash, or contaminated surfaces or materials.
The virus enters the body through the respiratory tract, mucous membranes, and broken skin.
Infected individuals are contagious from the onset of fever until their skin lesions have crusted over completely.

What is the Situation in Singapore?

On 8 May 2019, MOH confirmed the first case of imported Monkeypox infection in Singapore. The patient is a 38-year-old Nigerian male who may have contracted the virus in Nigeria through the consumption of bushmeat.
He arrived in Singapore on 28 April 2019 and subsequently developed a fever and rash on 30 April. He was hospitalised on 7 May and confirmed to have the infection and currently warded at the National Centre for Infectious Diseases (NCID). His condition is stable.
MOH is in the midst of contact tracing. Close contacts have been referred to the National Centre for Infectious Diseases (NCID) for further assessment and will be quarantined for 21 days. Low-risk contacts will be kept under surveillance to monitor their health status.

When Should I be Concerned about Monkeypox?

If you develop a fever and vesicular rash AND have travelled to West or Central Africa within the last 21 days OR have been in contact with an infected person within the last 21 days, there is a high suspicion of monkeypox and you should see a doctor immediately.
Otherwise, there is no need for unnecessary panic as all necessary steps to control the situation are already being taken.


• Maintain a high standard of personal hygiene, including frequent hand washing after going to the toilet, or when hands are soiled.
• Avoid direct contact with skin lesions of infected living or dead persons or animals, as well as objects that may have become contaminated with infectious fluids, such as soiled clothing or linens (e.g. bedding or towels) used by an infected person.
• Avoid contact with wild animals, and consumption of bushmeat.
• Returning travellers from areas affected by monkeypox should seek immediate medical attention if they develop any disease symptoms (e.g. sudden onset of high fever, swollen lymph nodes and rash) within three weeks of their return. They should inform their doctor of their recent travel history

Take Care!

Other Reads:

  1. What is Office Syndrome – Causes, Symptoms & Treatment
  2. What are the signs & symptoms of Nose Cancer
  3. Mycoplasma Genitalium (MG) – STD Screening, Testing & Treatment
  4. Chronic Pelvic Pain Syndrome Or Prostatitis
  5. 5 Ways to Fight Depression
  6. 8 Ways on How to Cope with Anxiety 
  7. 7 Common Causes of Knee Pain
  8. De Quervain’s Tenosynovitis – Causes, Symptoms Treatment 
  9. Plantar Fasciitis – Causes Symptom Treatment
  10. Shoulder Pain – Cause, Symptoms & Treatment 
  11. Trigger Finger – Cause, Symptoms & Treatment
  12. Tennis Elbow & Golfer’s Elbow – What You Need to Know 
  13. STD Symptoms in Women

Genital Blisters, Genital Warts and Genital Ulcers – Causes & Treatments

Genital blisters, genital warts, genital ulcers – more common than you think but invariably exceedingly distressing for the person suffering from them. Today we talk a little about the various causes for the above genital skin conditions.
Genital lumps, bumps and sores can be an alarming phenomenon for anyone. One day you notice a tiny little bump, or perhaps several bumps.
Now you’re not sure when they appeared – was your skin normal last week, or did you just never notice the bumps for a good duration? Or perhaps you notice what you thought was a little pimple or an ingrown hair follicle which happens from time to time because you shave. But now it’s burst, leaving a painful raw ulcer.

What are the Causes of Genital Blisters, Genital Warts and Genital Ulcers?

1) What are the Causes of Genital Blisters?

Genital blisters are small, fluid-filled bumps and can occur anywhere over the genital region.

a) Genital Herpes

One of the classic causes of genital blisters is genital Herpes, caused by the Herpes Simplex Virus.
Here’s a video about Herpes

Genital herpes has Several Stages:
Stage 1: Prodrome – the skin appears normal but you may feel an unusual sensation like a tingling or itching. This indicates that the virus is active and heralds an impending outbreak
Stage 2: Redness – you may notice some nonspecific red spots which may be uncomfortable or slightly painful.
Stage 3: Blisters – this is usually when people realise something is not right, Initially, these may resemble tiny pimples. They then grow in size and become fluid-filled and painful.
Stage 4: Ulcers – the blisters burst, leaving shallow, painful ulcers
Stage 5: Scabbing or crusting – a scab or crust forms over the ulcer, which eventually heals
Also, check out What is Oral Herpes & Cold Sore

b) Balanitis

In males, balanitis may sometimes present with tiny blisters. The term “balanitis” is a descriptive term which means inflammation of the head of the penis and foreskin. This usually manifests as skin redness, with some tiny blisters or whitish bumps, as well as possible itching/pain or discomfort.
There can be multiple causes of balanitis. The skin on the penis is no different from skin elsewhere on your body and redness, discomfort and irritation can be caused by many factors:

  • Infections such as fungal skin infections
  • Skin irritation caused by external factors like soaps (irritant or contact dermatitis)
  • Mechanical trauma in the form of excessive friction e.g. masturbation or sexual intercourse with insufficient lubrication
  • Poor hygiene
  • Sensitive skin e.g. in people prone to eczema or dry skin

Depending on the possible underlying trigger or cause, various topical creams may be useful. In some cases, skin swab tests or urine tests may be useful in checking for underlying infections.
Read more about What is a Penile Infection?

2) What are the Causes of Genital Warts?

a) Human Papilloma Virus

This is THE cause of genital warts. Genital warts are skin coloured, fleshy bumps which may occur singly or in clusters around the genital and anal region. They can range from tiny firm bumps to larger, irregular shaped bumps which are classically described as “cauliflower-like” in appearance.
The Human Papilloma Virus (HPV) is a sexually transmitted viral infection. There are many strains of HPV and they are transmitted through sexual contact. Some strains are responsible for genital warts, while other “high risk” strains can lead to an increased risk of cancers such as cervical, oral and anal cancers.
If you have warts, it effectively means you have been infected by at least one strain of HPV. If you are female and you are not already doing your regular PAP smear for cervical cancer, you should do a PAP smear with high risk HPV testing because an individual may have not just one but several strains of HPV. You can read more about PAP smears and cervical cancer screening.
There are various methods available for the treatment of genital warts, ranging from topical medications to freezing or cryosurgery electrosurgery. But one must be prepared that warts can unfortunately recur as the treatment for warts addresses the effects of a HPV infection but does not clear the virus from your body.
The best defence we have against genital warts is the HPV vaccine – Gardasil 9, which provides immunity against certain wart causing strains of HPV.

3) What are the Causes of Genital Ulcers?

When people think of genital ulcers, often the first few causes that spring to mind may be herpes or syphilis. However, genital ulcers can be due to other infections as well as rarer, non-infective causes such as autoimmune diseases.
This is why various tests are useful in differentiating the causes of genital ulcers. The treatment of choice varies drastically depending on what the underlying cause is.
Caused by Sexually transmitted infections (STIs)

  • Herpes Simplex Virus (Common)
  • Syphilis (Common)
  • Chancroid (Rare)
  • LGV (Rare)
  • Donovanosis (Rare)

Non-infective causes

  • Behcet’s (Autoimmune)
  • Crohn’s disease (Autoimmune)
  • Fixed drug eruption (rare causes)
  • Skin Cancer (rare causes)

a) Herpes Simplex Virus

(Painful shallow ulcers and blisters)

As mentioned earlier, both genital blisters and ulcers are different stages of a herpetic flare. A genital skin swab test for the presence of HSV DNA is helpful in confirming HSV as the cause of genital ulcers.

b) Syphilis

(Painless ulcers)

Syphilis can cause ulcers both during its primary and secondary stages.  A chancre, a painless round ulcer, occurs in primary syphilis, while in secondary syphilis, multiple painless ulcers may occur as well. One of the defining traits of a syphilitic ulcer is its painlessness.
These ulcers may be accompanied by other symptoms such as a rash elsewhere on the body.

C) Chancroid

(Multiple painful deep ulcers and swollen groin lymph nodes)

Chancroid is a painful ulcer which is frequently associated with enlarged and painful inguinal (groin) lymph nodes. These are located along your underwear line and may be felt as tender swollen lumps. There are usually several or multiple deep and painful ulcers.
This is caused by a bacterium called Hemophilus ducreyi, which is transmitted through sexual contact. Painful lymph nodes and negative test results for both Herpes and syphilis support this diagnosis. The good news is that antibiotic treatment can clear this up.

Lymphogranuloma venereum (LGV)

Small ulcer, swollen groin lymph nodes, possible rectal pain

Lymphogranuloma venereum (LGV) is an uncommon cause of genital ulcers. It is caused by the bacterium called Chlamydia trachomatis (serovars L1-3). This Chlamydia is different from the “subtype” of Chlamydia trachomat is that causes the common STD you are thinking about. A Rapid Chlamydia & Gonorrhoea PCR test will be about to detect the infection.
The ulcer it causes tends to be small and often goes unnoticed. The lymph node swelling is dramatic and painful and may even discharge pus.
If this was acquired through anal intercourse, inflammation of the anal and rectal canal (known as “proctitis”) can occur, causing rectal pain, bleeding and discharge and diarrhoea.


Shallow beefy looking ulcers

This is again a rare cause of genital ulcers in the developed world. It is caused by a bacterium called Klebsiella granulomatis and causes shallow ulcers which may bleed easily. This is usually diagnosed with a punch biopsy, which is when a sample of skin tissue is removed for evaluation in the lab.

Other rare causes:

Autoimmune or inflammatory causes, skin cancers, drug reactions

“Autoimmune” diseases occur when your body’s immune system has a tendency to attack itself and one of the many manifestations can be genital ulcers. These are rare and treatment is by a specialist doctor. These ulcers will go away only with good control of the underlying disease.
Sometimes, a bad reaction to a certain medication may cause a persistent, painful ulcer.
Very rarely, genital ulcers may be due to cancer.

All in All

The good news is that most of the above mentioned causes for genital blisters, warts and ulcers can be treated. But an even better step would be to protect yourself from even developing these – safe sexual practices (using barrier protection, doing your regular sexual health screening, and getting the HPV vaccine) are your best bet against these.
Take Care!

  1. HPV Infection & HPV Vaccination for Men who have sex with Men
  2. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  3. How Late Can a Period Be (Delayed Menstrual Cycle)
  4. What are the Causes of Abnormal Penile Discharge?
  5. STD Risk for Receptive Unprotected Anal Sex in Men
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know About Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related to Opportunistic Infections

Psoriasis: Inflammatory Skin Condition Series

Welcome, come to our first series of what you need to know about Inflammatory Skin Disease. In this series, we will write about Psoriasis.

What is Psoriasis?

Psoriasis is an inflammatory skin disease caused by an increased rate of skin cell turnover, resulting in thick scales appearing on the skin.
The skin usually becomes inflamed leaving a red hue. The affected skin results in being dry and unsightly.
Apart from its appearance, patients might experience itch as one of the most distressing symptoms.

Do You Have Psoriasis?

This condition usually presents with a rash that looks like salmon pink patches with silvery scales. It can appear anywhere on the scalp, body, back and limbs.
The scaly patches on the scalp are usually thicker and commonly it affects the elbows, the knees and the back.
This condition can affect the nails leading to a “pitting” appearance.
Patient with severe psoriasis might experience joint pain, swelling or tenderness.

Why Does Psoriasis Happen?

Studies show that patients with this condition can run in the family and it might be started by factors such as infection, or certain medications.
Studies have also shown that the imbalance in the immune system has a correlation with psoriasis.

What you shouldn’t do that might worsen Psoriasis?

Physical and emotional stress are well known to aggravate psoriasis.

Do try to lead a healthy lifestyle like eating healthily and exercising regularly. Exercise is strongly recommended as apart from keeping healthy it helps to alleviate stress. In addition, exercising outdoors with sun exposure will benefit your condition.
Throat infections or flu may also aggravate the disease as well thus it is important to strengthen your Immune system through a good balance diet.
Some medications may provoke the appearance of psoriasis.
Patients with falls causing skin injury might trigger a flare of psoriasis.
It is also important to use the medications as prescribed by your physician. It is also recommended to keep hydrated and employ the use of emollients to prevent your skin from drying out and itching.
Most importantly, do not scratch your skin as this may worsen your condition. There are anti-itch menthol cream or medications which might alleviate from the itch.

What are the Different Treatments for Psoriasis?

1) Topical medications
Most people with this condition have mild disease and get considerable relief with topical applications. These include topical steroids, coal tar and vitamin D cream.
However, your physician will advise you on the uses of the different medication.

2) Oral medications
If your condition is not responsive to the above medications, there are third line treatment such as oral medications.
Unfortunately, these drugs may suppress your immune system and cause severe side effects.
There are also risks involved and these include damage to the liver, kidney, causing you to have reduced red blood cells or even causing harm to your foetus if you are pregnant.

Is Psoriasis a Rare Skin Disease?

No, psoriasis is not an uncommon skin disease and it is not infectious. It cannot be passed on to other patients through contact.

Is there a cure for Psoriasis?

Unfortunately, there is no cure for psoriasis. However, most patients are able to achieve a good control over their condition and able to lead normal healthy life just like everyone else.

What else?

There are multiple studies that show that psoriasis has strong associations with other diseases. Obesity, Diabetes, Liver problems and high cholesterol are some of the examples.
Thus, apart from keeping psoriasis at bay, it is also extremely important to have your routine health check. Some blood tests that might be done include a check of your sugar and cholesterol levels.

If you wish to visit us for skin related concern, please visit us at our VITILIGO, PSORIASIS & SKIN CLINIC by DTAP at Scotts Medical Cente. We accept walk-ins and appointments.

Take Care!