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How to apply creams

Creams should be applied just enough to cover the affected area. Generally, creams are applied twice daily and the best time is soon after a shower or bath. Use the one finger tip unit (FTU) to help you determine the amount of cream required.

one fingertip unit

Affected Body Area Quantity of Cream/Ointment to Use for Adults
Both sides of one hand One fingertip unit
One foot Two fingertip units
One arm Three fingertip units
One leg Six fingertip units
Chest and Abdomen Seven fingertip units
Back and Buttocks Seven fingertip units

 

For larger areas of involvement, use the following guide:

  • A single application to the whole body of an adult will require 30 to 40 g of product.
  • An area of one hand (palm and digits) will require 0.3 g per application.
  • No more than 45 g/week of potent or 100 g/week of a moderately potent topical steroid should be applied if systemic absorption is to be avoided.
  • In children, the amounts should be smaller.

What is psoriasis?

Psoriasis is a common skin condition that affects about 1%-2% of the world’s population. In Singapore, it appears to be more common among the Indians than the Chinese or Malays. It affects both sexes equally and can occur at any age, especially under the age of 35. The prevalence varies between countries and race.

How does psoriasis present?

Psoriasis often presents as well-defined salmon red plaques covered with silvery scales on the elbows, knees, shins and lower back. Many patients also have scalp involvement presenting as a bad dandruff. Sometimes, there may be joint pains or changes in the nails. Psoriasis tends to come and go with varying severity.

What do we know about psoriasis?

It appears that psoriasis occurs when the immune system sends out faulty signals that speed up the multiplication of skin cells, causing thickening of the affected skin. The pro-inflammatory signals also cause dilatation of the blood vessels in affected areas giving the red colour that we see.

Psoriasis is not contagious i.e. you cannot catch psoriasis by being near to someone with psoriasis.

It has been shown that psoriasis is associated with the metabolic syndrome including heart disease, hypertension, diabetes mellitus and gout.

What causes psoriasis?

It is believed that psoriasis is a genetic or hereditary disease although not everyone with psoriasis has a family history. How it is inherited is not clearly understood. In susceptible individuals, psoriasis appears after an outside event or trigger occurs, e.g. infection, injury to the skin, stressful event or certain medication

How is psoriasis treated?

Treatment depends on the type of psoriasis, age of the patient, the extent of the condition, whether the joints are involved and the preference of the patients. The following are the various methods of treatments.

  1. Creams – steroid, coal tar and vitamin D creams are commonly used.
  2. Phototherapy – narrow-band ultraviolet B light or PUVA (psoralen+ultraviolet A)
  3. Oral medications for more severe cases e.g. methotrexate, cyclosporine, acetretin.
  4. Biologics given by injections for patients with severe psoriasis where oral medications cannot be used for whatever reason.

What is atopic dermatitis (AD)?

AD is an allergic and inflammatory skin condition that results in eczema. It is characterized by intense itch, eczema in facial location in infants and in flexures in older children and adults. It tends to be recurrent or chronic relapsing.

What are the basic problems in atopic dermatitis?

In AD, the primary defect is the dysfunction of the skin barrier. This allows environmental inflammatory stimuli, allergens as well as bacteria to enter the skin and promoting inflammation which results in eczema. Stress can worsen the skin and cause itching. Scratching damages the skin further and allows more inflammatory stimuli to enter and worsen the eczema.

How to treat atopic dermatitis?

  1. Topical corticosteroids is the mainstay of treatment in AD. It helps to reduce the inflammation in the skin which in turn reduces the itch and thus reduce the trauma generated by scratching.
  2. Overuse of topical steroids may cause problems like thinning skin, stretch marks and systemic effects.
  3. Underuse of topical steroids or using topical steroids of inadequate strength delays or impede improvements with treatment. It is best to see a dermatologist who will advise on the best way to treat the condition.
  4. The use of mild soaps and moisturizes are important in helping repair the skin barrier thus breaking the cycle of inflammation and barrier damage.
  5. The best time to apply creams is immediately after shower or bath when the skin is moist.
  6. For recurrent eczema in special areas, cream which are calcineurin inhibitors can be used to prevent recurrences.
  7. Lack of adherence to treatment may explain the cycles of flaring of eczema.
  8. Regular treatments and follow ups with your doctor or dermatologist is the best way to work out the best outcome for your problem.

My son had white patches on his face. Does he have vitiligo?

Not all white patches are vitiligo. In children, eczema on the face can also cause a lightening of the skin colour. Bring him to a dermatologist for diagnosis and advice on skin care.

I have been itching here and there for several weeks. I have tried to change my soaps and clean my beddings but the condition has not improved? Do I need an allergy test?

First, you need to find out the cause of your itch. If necessary, you may need to change the things you use or your lifestyle. Not all itchy rashes are due to allergy. Allergy tests are only useful in special circumstances, and different allergy tests are suitable for certain conditions. Get your doctor’s advice on this.

My hair has been falling recently. What can I do?

Hair fall can be due to many reasons. It may be caused by a recent illness or after delivery of a baby, it may be related to the general health of the individual, or it may be familial in origin. Only by seeing the doctor can the doctor help to decipher the problem and advise on the appropriate treatment.

I am 30 years old and starting to get pimples. I did not have pimples when I was younger. What is the reason and what can I do about it?

Although it is more common for pimples to start at adolescence, pimples can occur in babies and may have a late onset in adult-onset acne. There are various reasons including hormonal change and the use of cosmetic products that may exacerbate the problem. Pimples can be treated at any age and the treatment depends on the severity and the lifestyle of the patient. Common treatments include the use of creams, lotions or gels, oral antibiotics, oral contraceptives or isotretinoin. A consult with the doctor will help to address your specific issues.

What is a chemical peel used for?

Chemical peels can be used to treat a variety of conditions, e.g.,

1. Acne, to reduce inflamed lesions, loosen and reduce white and black heads. It can be used to compliment the creams or tablets used to treat pimples.
2. Sun-damaged skin, to remove the sun-damaged outer layers, thus making the skin smoother.
3. Minimize wrinkles.
4. Pigmentation where the use of chemical peels enhances the lightening effects of lightening creams.

What is a chemical peel?

A chemical peel is the use of certain acids or chemicals to cause the peeling or exfoliation of old or damaged skin, thus allowing the new skin to grow or to rejuvenate. It may stimulate new collagen to form. This results in an improvement of the skin texture and skin tone resulting in a glow.

What is phototherapy?

Phototherapy is the use of light to treat diseases.

What is narrow-band UVB phototherapy?

Narrowband UVB phototherapy is the use of a specific wavelength (311 nm to 312 nm), in contrast to broad band UVB (290 nm to 320 nm), to treat certain skin diseases. Narrow band UVB has been shown to be more effective than broad band UVB in the outcome of the treatment with shorter and less exposure times.

What is narrow-band UVB used for?

Narrow band UVB is used to treat skin conditions like psoriasis, vitiligo, atopic eczema, pruritus, polymorphous light eruption, cutaneous cell lymphoma and lichen planus.

What does narrow-band UVB treatment involve?

The treatment involves standing in a specially designed light cabinet with tubes emitting UVB light. The patient is undressed and stands in the centre of the light box with his eyes and face protected. Light is emitted and the treatment last for a short time from seconds to minutes. Treatment is usually given at least three times a week at the beginning and for maintenance, the treatment frequency is reduced to once or twice a week. The amount of UVB delivered depends on the condition, the skin type of the patient, and other factors.

What are the side-effects of narrow-band UVB treatment?

Side effects are not frequent and tend not to be severe. There is a possibility of getting a burn, like a sunburn and the skin condition may sometimes get worse in the initial part of the treatment. Long term exposure can cause skin ageing and increase the risk of skin cancer just like prolonged exposure to sunlight.