On 19^th October 2024, Dr Koh was invited by DKSH and Fullerton Health to address the latter’s panel of GPs on two important topics frequently encountered in family practice. The event was held at the luxurious Sheraton Towers hotel along Scotts Road.

Dr Koh began with a discussion on a Non-Steroidal Approach to Eczema Management. Atopic dermatitis remains one of the most common skin disorders in Singapore, with family physicians managing the majority of cases.

Patients are increasingly aware and concerned about the overuse of topical steroids and conditions such as topical steroid withdrawal (TSW), steroid addiction, and steroid dependency. Terms like ‘topical steroid damaged face (TSDF)’ and ‘red skin syndrome’ often circulate on social media and patient forums.

Dr Koh shared that while topical steroids remain a key component in eczema management and are safe when used appropriately, doctors need to understand and acknowledge patients’ fears about topical steroids and offer non-steroidal options. Topical tacrolimus and pimecrolimus have been around for many years and are beneficial for mild to moderate eczema. A new non-steroidal topical medication, Crisaborole 2%, was recently approved for the management of mild eczema and is a welcome addition to the non-steroidal armamentarium.

Non-steroidal topical medications can effectively treat eczema flare-ups and, in a “pro-active” approach, prevent future flare-ups. Research shows that daily application of Crisaborole 2%, along with twice weekly applications of pimecrolimus 1% or tacrolimus 0.03% or 0.1%, significantly reduce the number of eczema flare-ups and extend the intervals between them.

Safety remains a priority, particularly among parents of children with eczema. To address this, Dr Koh produced some reassuring data showing that real world use of topical non-steroidal medications are generally well-tolerated, with few additional adverse effects compared to placebos. While irritation is a side effect often seen in this class of medications, it is typically mild and transient. Dr Koh Hong Yi also offered practical tips on how these can be mitigated, including cooling the cream in the fridge before applying it to the skin.

Dr Koh also covered the hot topic of food allergies in patients with eczema, noting recent findings that suggest eczema precedes food allergies and that uncontrolled eczema may contribute to the development of food allergies in young children. This underlines the importance of keeping eczema under control, even in the youngest patients.

Following a brief intermission, Dr Koh returned to the stage to deliver his next lecture on Skin Cancer Management in Singapore. As a trained Mohs micrographic surgeon, Dr Koh receives many referrals for the treatment of skin cancers. Basal cell carcinoma, squamous cell carcinoma, and melanoma are the three most common skin cancers in Singapore. Although skin cancers are more frequent in those over 60, younger individuals are not spared; Dr Koh shared a case of his patient who developed basal cell cancer in his 30s!

Prevention is better than cure, and ultraviolet radiation is the main cause of skin cancers. Dr Koh emphasised the importance of sun protection, including the use of broad-spectrum, high-SPF sunscreens, UV-protective clothing, and staying indoors during the afternoon. Emerging research also suggests that regular intake of nicotinamide (vitamin B3) may reduce the risk of skin cancer in high-risk individuals. An interesting observation made by researchers in Singapore even pointed to lower rates of skin cancer in regular coffee drinkers!

When skin cancer does occur, patients need to be aware of the range of therapeutic options available to them. Surgery remains the first line of treatment. While conventional wide margin excision still plays a role, patients should be informed about Mohs micrographic surgery, which offers a higher cure rate and a smaller wound. Mohs micrographic surgery uses a layer-by-layer approach to remove the cancer cells from the body, ensuring that none are left behind while minimising the amount of normal skin tissue that needs to be sacrificed. It is well tolerated and has been performed even in patients in their 90s!

Apart from surgery, there are also many non-surgical or minor surgical options available, such as curettage and cautery, cryotherapy, and imiquimod cream. Dr Koh noted the importance of  skin cancer surgeons being aware of both surgical and non-surgical options to cater to each patient’s unique needs and preferences.

The event concluded with a lively Question & Answer session, where Dr Koh Hong Yi engaged his fellow GP colleagues before tucking in to a sumptuous lunch.

If you wish to learn more about the topics above, please contact TSN Dermatology Skin Specialist Clinic at 64766821 (telephone), 88311384 (WhatsApp), or skinhealthspore@gmail.com (email).