As the largest organ of the human body, and our chief barrier against the external environment, the skin can be afflicted by a wide range of diseases. Dermatologists are experts in skin related disorders, and a day in the life of a dermatologist is often full of variety and surprises. Many may not be aware that dermatologists do not just treat medical problems in the skin, but also perform skin surgeries and aesthetic procedures.
Today, we follow Dr Koh Hong Yi, consultant dermatologist and Mohs micrographic surgeon at TSN Dermatology Skin Specialist Clinic through a typical work-day.
A typical work day can start very early for Dr Koh. Many people have the impression that dermatologists only treat patients in clinics, but they actually also see patients admitted to the hospital. Because his clinic starts at 8.30am, Dr Koh will need to visit his patients in the hospital ward before making his way to the clinic.
Figure 1: Cellulitis of the leg
Today, he has a patient who is admitted to the hospital for Cellulitis (Figure 1). Cellulitis is an acute condition caused by bacterial infection of the skin. The leg is the most common site of infection. Patients with cellulitis often present with fever and sudden painful swelling of the limb. The affected skin is usually red, swollen, and painful to touch, and patients will often find it difficult to walk. While mild cases of cellulitis can be treated in the clinic with oral antibiotics, more severe cases and patients with other health problems such as diabetes will need to be admitted for intravenous (injection) antibiotics and observation.
After checking that his patient’s cellulitis is responding to antibiotics, with fever starting to settle down, Dr Koh made his way to another ward to review another patient. This is a patient that another doctor had referred or asked Dr Koh to review for a skin problem which developed while the patient is admitted to the hospital. After interviewing the patient and performing a complete skin examination, Dr Koh determined that the patient likely has a Drug allergy reaction (Figure 2).
Figure 2: Drug allergy
Drug allergies are one of the most common problems that occur in patients who are admitted to the hospital. Patients often present with a sudden onset of red and itchy rashes on the body after receiving new medicines. A timely and accurate diagnosis is essential, because the causative medicine needs to be stopped immediately to prevent worsening of the allergic reaction. A comprehensive evaluation often takes time, as the doctor needs to examine the skin from head to toe to rule out life-threatening allergic reactions (also known as severe cutaneous adverse reactions or SCARs) and review all the medications the patient had taken in the past few months.
After a quick breakfast, Dr Koh is ready to start his clinic and see his first out-patient. Each consultation usually takes 10 to 15 minutes, and like a box of chocolates, the doctor never really knows the type of conditions he will see that day!
Singaporeans often experience a range of skin conditions due to the warm, humid climate, which can exacerbate issues like acne, eczema, and pigmentation. Whether it’s young adults struggling with acne or older individuals monitoring mole changes for skin cancer, skin health is a priority in this environment.
While patients often seek help for specific issues, their dermatologists also offer guidance on prevention and long-term management. This holistic approach helps patients not only to treat existing skin issues but also to enjoy healthier skin in the future.
Here’s a closer look at what dermatologists like Dr Koh handle on a typical day, and how clinics like TSN Dermatology support patients’ journey to better skin health.
1. Acne and acne scars
Figure 3: Acne and acne scars
Acne (Figure 3) is one of the most common skin complaints dermatologists handle, affecting teenagers and adults alike. Often triggered by hormonal changes, clogged pores, and bacterial activity, acne can present in different forms, from whiteheads and blackheads to more painful cystic acne. The frequent use of makeup, sweat, and oil buildup can also aggravate breakouts, especially in Singapore’s humid climate.
When treating severe acne, Dr Koh usually recommends a mix of topical treatments and oral medications. Topical creams with ingredients like benzoyl peroxide or tretinoin can reduce bacteria and unclog pores, while oral medications like antibiotics, hormone regulators, and isotretinoin address underlying factors. Dr Koh will also suggest lifestyle changes, such as managing stress, adjusting skincare routines, and dietary modifications such as taking less sugary foods.
For acne scars, which many find challenging to eliminate, Dr Koh may discuss advanced options like laser therapy, chemical peels, and microneedling. These treatments help resurface the skin, stimulate new collagen production, and reduce scar visibility. It’s a long-term approach, but with consistent care, patients can often see significant improvement.
2. Skin cancer and mole checks
With an abundance of UV exposure, skin cancer is a real concern in Singapore. Regular skin cancer screenings are vital, as early detection of skin cancer can save lives. Most dermatologists use a variety of methods to check moles and other skin irregularities, assessing characteristics like asymmetry, borders for irregularity, colour, diameter, and evolution, known as the ABCDE rule.
Figure 4: Appearance of an abnormal mole to the naked eye
Dr Koh routinely uses a dermatoscope (also known as dermoscope) to look closely at suspicious skin lumps (Figures 4 and 5). Dermatoscopy is a specialised skill mainly practised by dermatologists with experience managing skin cancers, and has been shown to increase the chance of picking up skin cancers such as basal cell carcinoma, squamous cell carcinoma, and melanoma early.
Figure 5: Same mole under dermatoscopy showing irregular and asymmetric borders
Most dermatologist clinics in Singapore emphasise follow-up appointments and sun safety practices for long-term skin health. Dermatologists advise regular mole checks at least once a year for those at risk and teach patients how to monitor their skin for changes. With early detection and preventive care, many skin cancers can be managed effectively, giving patients peace of mind.
3. Eczema
Eczema is a chronic condition that causes inflamed, itchy skin and is especially common in children. This skin disease can be triggered by several factors, including allergens, weather changes, irritants, and stress. In Singapore’s climate, eczema flare-ups can be hard to avoid, making day-to-day comfort a challenge.
Dr Koh often recommends a holistic, multi-step approach for managing eczema. A first consultation for eczema will include providing patients with information on what eczema is, the common triggers, and essential components of skin care to reduce eczema flares.
Moisturisers and medicated creams, both steroidal and non-steroidal, can help keep the skin hydrated and reduce inflammation. In more severe cases, phototherapy, biologics (targeted therapies) or oral immunosuppressants may be prescribed. Dr Koh will take time to discuss the benefits and downsides of each treatment option, so that patients can make an informed decision. He understands that expectations, concerns, and treatment goals will differ from patient to patient, so it is important that a physician and patient reach a shared consensus on the best treatment forward.
Besides medical treatment, Dr Koh will encourage patients to avoid known triggers, use mild skincare products, and maintain a stress-free environment. For long-term management, routine dermatology follow-ups help monitor the condition and adjust treatments as needed.
4. Dandruff (Seborrhoeic dermatitis)
Dandruff or seborrhoeic dermatitis is a frequent concern that, while harmless, can be frustrating due to the visible flakes and itchiness it causes. Seborrhoeic dermatitis is thought to arise due to overgrowth of the Malassezia fungus, which thrives on the oily skin of the head and neck. This triggers an immune response from the body, resulting in inflammation. Factors that trigger flares of seborrhoeic dermatitis include travel to different climes and stress. In severe cases, seborrhoeic dermatitis can cause red and flaky patches on the face, neck, and body.
Dermatologists treat dandruff with medicated shampoos, anti-fungal treatments, and creams such as mild corticosteroids or calcineurin inhibitors that help reduce the inflammation. These will reduce or eliminate the itch, flaking, and rash.
Persistent dandruff or seborrheic dermatitis often requires a dermatologist’s attention, especially if over-the-counter treatments aren’t effective.
5. Pigmentation and pigment disorders
Pigmentation issues, like melasma, lentigines, and post-inflammatory hyperpigmentation are common in Singapore due to our predominantly Asian population and sunny climate. These conditions cause dark patches on the skin and can severely impact one’s confidence and quality of life.
Figure 6: Hyperpigmentation on the cheeks
To treat hyperpigmentation (Figure 6), dermatologists use a combination of topical creams, laser therapy, chemical peels, and sun protection strategies. Topical creams may contain ingredients such as hydroquinone, Vitamin C, or retinoids to lighten dark patches gradually. For stubborn or deeper pigmentation, Q-switch lasers, such as the Nd-Yag, can be very helpful, though patients must be prepared that multiple sessions are required.
Education is also a big part of treatment – dermatologists stress the importance of sun protection and skincare routines to prevent future pigmentation issues.
Not a day passes for Dr Koh without some surgical procedure in the clinic. As a trained dermatologic surgeon and Mohs micrographic surgeon, Dr Koh gets referrals from colleagues and patients who look for him to remove lumps and bumps on the skin. What many patients may not realise is that many skin lumps can be removed in the clinic under local anaesthesia. There is often no need to be admitted to the hospital or go under general anaesthesia, which can increase the length of recovery and cost of the surgery.
Skin surgeries performed in the clinic for medical reasons often qualify for Medisave and Medishield under Day Surgery[1].
Some of the common procedures that can be performed in the clinic include:
Epidermal cysts (also known as secbaceous cysts) are common, benign growths that develop under the surface of the skin. They are small sacs that contain liquified skin material. Some also have a pore that opens to the surface resembling a blackhead. Sometimes liquid within can be expressed from the pore, though this is not recommended.
Cysts that are small and not causing any symptoms can sometimes be left alone without any treatment. Sometimes, epidermal cysts may become inflamed or infected. This results in the cyst swelling up and becoming very painful. In such situations, surgically removing the cyst will help to relieve the symptoms.
Figure 7: Minimal incision surgical technique
At TSN Dermatology Skin Specialist Clinic, we routinely employ the minimal incision surgical technique (Figure 7) for epidermal cyst removal. In this method, a surgical incision smaller than the size of the cyst is made on top of the cyst, which is then removed completely. Compared to traditional wide local excision, the minimal incision surgical technique has a faster healing time and leaves a smaller scar. This method is best employed when the epidermal cyst is not infected or inflamed.
If an epidermal cyst becomes inflamed or infected, sometimes it may be better to perform incision and drainage. In this technique, a cut is made on the surface of the cyst and the infected contents cleaned out. The wound is then packed with dressings and allowed to heal naturally. The patient will need to return regularly for wound review and change of dressing. In most cases, the wound is expected to heal within 2 months. Sometimes, during the review, if the wound is clean, there is an option for the wound to be stitched up. This helps to hasten the healing process.
Skin tags (also called acrochordons) are small polyps of skin that appear to hang off the skin surface. These growths are very common, and usually appear on the neck, armpits, and sometimes the groin. While skin tags are benign, patients often wish to have them removed as they appear unsightly, and sometimes catch on collars of clothes, causing irritation and bleeding.
Skin tags can be removed easily and quickly in the clinic. Preferred treatments include Electrocautery, carbon dioxide (CO2) laser, or cryotherapy. For laser or electrocautery, patients need to have anaesthetic cream (numbing cream) applied for 30 to 60 minutes before the procedure. The procedure is relatively painless, with most patients only experiencing none or minimal discomfort. In terms of down-time, the skin may be red for a few days. This is followed by small amounts of crusting which will resolve within 1 to 2 weeks. Patients need to practise good protection from sunlight to prevent hyperpigmentation after the procedure.
Dr Koh usually sees his last patient by 5pm. This is followed by administrative paperwork, where he will answer WhatsApp or email messages from his patients, and reply to doctor colleagues who have referred their patients to him.
Dr Koh will then pop by the hospital ward again to review his patients and make sure their conditions are stable, making changes to their treatments if necessary. Once that’s all done, it is home sweet home, to rest and re-charge for the following day!
Daily life for dermatologists involves treating a diverse array of skin conditions, from the common to the complex. Each patient requires a personalised approach, whether it’s acne, skin cancer monitoring, or managing chronic conditions like eczema. At TSN Dermatology, we are committed to delivering quality dermatology care, helping patients achieve healthier skin and greater confidence in their appearance.
Read about new advances in skin care.
