DERMA DIGEST | ISSUE 22 FEB 2021 – MAY 2021 DERMA DIGEST | ISSUE 22 FEB 2021 – MAY 2021

NATIONAL SKIN CENTRE1 Mandalay Road Singapore 308205

Website : www.nsc.com.sgFacebook: NationalSkinCentre

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Editorial Team:Dr Heng Jun Khee, Ms Richelle Gan, Ms Shyamala Naguleswaran,Mr Cephas Low

Advisors: Prof Tan Suat Hoon & Mrs Tang Lee Foon

Tel : 6350 6666Fax: 6258 2475

Tel : 6350 6680

Content can be quoted or reproduced with permission of National Skin Centre (S) Pte Ltd.

Dr Koh Yun PeiEffective from 1 February 2021

Dr Leong Wai Mun SeanEffective from 1 February 2021

Dr Etienne Wang Cho EeEffective from 1 July 2021

Dr Tan Chee HianEffective from 1 February 2021

Dr Chong Yi Rui TriciaEffective from 1 February 2021

Dr Heng Yee KiatEffective from 1 March 2021

Dr Eugene Tan Sern TingEffective from 1 July 2021

Dr Lim Hua Liang Joel Effective from 1 February 2021

Senior Consultants

Consultants

Associate Consultants

NSC’s Derma Digest is going digital to conserve the environment! We will still be providing dermatology news but we be phasing out our printed copies. If you wish to receive online copies of NSC’s dermatology related news, please email us at pr@nsc.com.sg to be added to our mailing list.

Congratulations to the following medical staff on their promotion or appointment!

Derma Digest Goes Green

COVID-19 Surveillance Testing for Staff at NSC & DSCTo ensure the safety of all our staff, a one-time surveillance testing was conducted at National Skin Centre (NSC) and Department of Sexually Transmitted Infections (DSC) from 11 to 25 May 2021 and 18 to 20 May 2021, respectively. A total of 430 staff (351 from NSC and 35 from DSC) and 44 Non-NSC staff (partners/vendors) underwent the COVID-19 PCR swab test.

The combined efforts of the Infection Control Committee as well as Nursing, Clinic Operations (Reception and Rostering), Laboratory, Medical Affairs and Support Services departments, resulted in a seamless and efficient surveillance testing.

Staff (left) undergoing the swab test conducted by Ms Kong Kim Yoke, Nurse Clinician

to manage her wounds herself. Our nurses help to treat her wounds.

Today, her condition is better and she is able to sleep comfortably without pain and discomfort. Through the SALVE programme, patients-in-need such as Mdm Kan are provided financial assistance and supported with clinical care in treating their skin conditions.

Help for Patients with Severe Skin Conditions

Learn more about Mdm Kan’s journey and how she has benefitted from the NSC HF by scanning the QR Code on the left to watch a short video.

The Skin Aid for the Vulnerable and Elderly (SALVE) programme, supported through the National Skin Centre Health Fund (NSCHF), targets frequent admitters to the dermatology wards at acute hospitals. Patients with chronic relapsing skin diseases are supported with regular application of topical medications, to reduce the incidence of preventable re-admissions into acute care hospitals.

Mdm Kan FJ is 73 years old and lives alone as her husband is staying at a nursing home. She is blind in one eye and can barely see with the other.

She has pemphigus, an immune-mediated condition that causes blisters to form on her skin, leaving behind raw sores that heal slowly if not treated. Being visually impaired, she is not able

Give a gift, take that step to partner us to help Mdm Kan and others like her.To donate, please scan the QR code on the right.

Staff (left) undergoing the swab test conducted by Ms Winnie Quek, Senior Staff Nurse

Staff (left), waiting for her swab test to be conducted by Ms Winnie Quek, Senior Staff Nurse

Mr Andy Tan, Transport Technician (Medical Affairs) transporting the test specimens to Tan Tock Seng Hospital

DERMA DIGEST | ISSUE 22 FEB 2021 – MAY 2021 DERMA DIGEST | ISSUE 22 FEB 2021 – MAY 2021

Applying sunscreen and sunblock provides sun protection to our skin, but do you know that what we eat may help to minimise sun damage to our skin too?

Prolonged and repeated exposure to sunlight without protection causes both immediate and long term harmful effects to the skin. Ultraviolet (UV) radiation can cause sunburn, dark spots formation, premature skin ageing and skin cancer.

Orally consumed substances, either as food supplements, concentrates or purified extracts, may bear the potential to increase protection against the harmful effects of UV radiation, visible light and infrared radiation. They appear to display antioxidant activities, reduce inflammation and cell death, and may modify the response of the immune system.

Adding Sun-Protection Food to Your Diet

CarotenoidsCarotenoids that are commonly found in a food diet include beta-carotene, lycopene and lutein. Studies have revealed that carotenoids display antioxidant properties by suppressing harmful UVA and UVB mediated reactive oxygen species formation.

NicotinamideNicotinamide, a form of Vitamin B3, is essential for the production of Adenosine Triphosphate (ATP), which stores energy and drives many processes in cells.

Nicotinamide appears to prevent UV-induced depletion of ATP in cells, enhance UV-induced DNA repair, regulate inflammatory mediators in human skin cells, and prevent skin cancer in animal studies. In human studies, oral nicotinamide administration could reduce the number of actinic keratosis.

Vitamin C and EUV light decreases Vitamin C content of the skin, an effect that is dependent on the intensity and duration of UV exposure. The addition of Vitamin C to skin cell cultures showed a reduction in UV-related DNA damage, inflammation and cell death.

The primary sun-protection effect of vitamin E is attributed to its role as a fat-soluble antioxidant. Multiple studies have found that oral supplementation with a combination of Vitamin C and E effectively

Here is a list of oral vitamins and dietary products that may have beneficial sun-protection properties:

1

42

3 5

increases minimal erythema dose (a measure of UV sun-protection) and decreases erythema-induced blood flow to damaged areas of the skin. These studies concludedthat interactions between the two antioxidants, Vitamin C and E, may be necessary to achieve UV protection by dietary means.

PolyphenolsPolyphenols are a large family of naturally occurring plant products and are widely distributed in plant foods such as fruits, vegetables, nuts, bark and seeds. Experimental and epidemiologic studies have suggested that polyphenols can modify the response of the immune system, help with DNA repair, exhibit antioxidant and anti-inflammatory effects. They are a promising group of compounds that can be exploited as sun-protection agents. Pigmented polyphenols absorb UV radiation, which facilitates sunscreen function.

Green TeaFour major polyphenols in green tea include epicatechin, epicatechin-3-gallate, epigallocatechinand epigallocatechin-3-gallate (EGCG), the most potent antioxidant. There have been extensive vexperimental studies of the properties of green tea, including antioxidant and anti-inflammatory activities, prevention of DNA damage, regulation of immune response and reduction of premature skin ageing. A study showed that EGCG or drinking green tea protects against UV and visible light-induced DNA damage.

Image: Freepik.com

The National Skin Centre Update in Dermatology & Venereology 2021 will be held as a virtual conference and will take place from 7 to 9 October 2021. The meeting will bring together the NSC faculty and our partners in clinical care and research who will share their experiences and updates on advances in dermatology care, practice and research. To find out more, visit: https://www.nsc.com.sg/Patient-Guide/Events/Pages/nscupdate2021.aspx

Register before 31 August 2021 to enjoy the Early Bird registration fees!

7 TO 9 OCTOBER 2021SINGAPORE

National Skin Centre will be hosting the Asian Society of Dermatopathology (ASD) 3rd Annual Meeting on 8 and 9 October 2021 as a virtual conference. The faculty consists of a line up of world renowned international speakers and faculty experts throughout Asia. They will impart their wealth of experience to all and the case presentations will feature interesting and unique cases that reflect the range of dermatopathology practices in Asia.

To learn more about and register for the Asian Society of Dermatopathology 3rd Annual Meeting, visit: https://www.nsc.com.sg/Patient-Guide/Events/Pages/ASD2021.aspx

As a registrant to the ASD Annual Meeting, you will enjoy preferential rates for the National Skin Centre (NSC) Update in Dermatology & Venereology 2021 (Virtual), which is held concurrently.

Improved ‘Magic Mouthwash’ Formula

Certain groups of patients, including patients with immunobullous diseases such as pemphigus vulgaris, inflammatory diseases such as oral lichen planus, or patients with cancer receiving chemotherapy, suffer from multiple painful mouth ulcers that greatly reduce the quality of life. As mouth ulcers can be a recurrent manifestation in these conditions, there is a need to manage them to reduce the pain, inflammation and opportunistic infections of the lesions in the mouth.

The ‘Hydrocortisone, Nystatin, Diphenhydramine, Tetracycline’ (HNDT) medicated mouthwash was introduced in 2015 and prescribed to patients with pemphigus vulgaris to ease their discomfort. This mouthwash helps to reduce inflammation, numb the pain and prevent opportunistic infections in the oral cavity.

Due to the HNDT medicated mouthwash’s short shelf life of two weeks after compounding, the pharmacy at NSC was unable to prepare buffer stock for immediate fill of prescriptions, resulting in patients needing to come back another day to collect. In addition, many freshly compounded preparations remained uncollected by patients, resulting in wastage of the pharmacy technician’s time, effort and raw materials used.

Between 2017 and 2018, NSC pharmacy collaborated with the National University of Singapore (NUS) Pharmacy school to look into the stability and antimicrobial activities of this mouthwash as an undergraduate final year project. Ms. Winnie Choo, Senior Pharmacist, who was part of the team and one of the lead initiators of this project, worked alongside professors and undergraduate students to improve the shelf life of the mouthwash.

The reformulation explorations to improve the shelf life resulted in replacement of tetracycline by the more stable doxycycline. Winnie added a further element by converting the preparation into a self-reconstitution kit, for flexibility to be prepared at home by patients only when they need to use it. This saved

Ms Winnie Choo, senior pharmacist, compounding the ‘Magic Mouthwash’

them travel time and costs to return regularly to NSC to collect freshly prepared mouthwash. Not stopping there, Winnie next addressed the suspending agent in the formula. The original formula used ‘Simple Syrup’, as the suspending agent to thicken the mouthwash’s consistency, and to mask the taste of the active ingredients. However, due to the syrup’s high sugar content, this was not ideal for patients’ dental health if they needed to use this mouthwash for the long term. Winnie sourced for a sugar-free orange flavoured oral suspending agent, which was compatible with the active ingredients, and introduced this in early 2020 in the improved version of the formula. The success of reformulating and improving the now renamed HND Dox (depicting doxycycline) medicated mouthwash has spurred Winnie on. She diligently continues to monitor any unmet medical needs that can be addressed within her capabilities. Winnie expresses, “I am appreciative of our doctors who reach out to let me know actual unmet needs on the ground, and look to work together to find solutions. I think actual care innovation can be materialised with continuing efforts of collaboration across professions”.

Hydrocortisone, Nystatin, Diphenhydramine, Doxycycline (HND Dox) medicated mouthwash also known as ‘Magic Mouthwash’

Oral Lichen Planus

Oral ulcers from Pemphigus Vulgaris