Skin Conditions and Eczema

The term “Eczema” refer to the group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is known as atopic dermatitis, or atopic eczema.

An estimated 10% to 20% of infants and about 3% of adults and children in the U.S are afflicted with eczema. Infants that develop eczema usually outgrow the condition by ten years of age. However, some individuals continue to be symptomatic throughout life.


Symptoms

Eczema causes itch that might be experienced globally all over the body.

Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brownish in colour. Among darker-skinned people, eczema can affect pigmentation, making the affected areas lighter or darker.

In infants, the itchy rash can produce an oozing, crusting condition that often erupts on the face and scalp, though eczematous patches may appear anywhere.


Causes

Causes of eczema are unknown, but it's believed to be an overreaction of the immune system to an irritant.

Families and bloodlines that are genetically prone to allergies have a predisposition to develop eczema.

In some patients, eczema arises only on exposure to the irritative substance. These can include household products like soaps and detergents, animal dander, and other common industrial products.

Stress has been implicated in making existing eczema worse.


Diagnosis

Diagnosis is clinical and made by the bedside. There are no specific tests for “eczema” though tests for substance allergies are available.


Treatment

Treatment aims to control the symptoms of itching and prevent infections. Moisturizing creams and lotions are recommended and these should be applied after bathing while the skin is still damp. Cold compresses can also be used to relieve itching.

Medicinal products like hydrocortisone 15 creams and other prescription creams available from your doctor can help control the inflammation. If an infection sets in, your doctor might prescribe antibiotics.

For further symptom control, antihistamines are sometimes prescribed. Other more advanced forms of treatment include phototherapy with UV radiation and use of cyclosporin for very severe cases.


Prevention

The following will help prevent outbreaks of eczema:

• Frequent Moisturization of skin.
• Avoidance of sudden temperature and humidity change.
• Avoidance of sweating or overheating.
• Reduction of stress.
• Avoidance of scratchy materials such as wool.
• Avoidance of harsh soaps, detergents, and solvents.
• Avoidance of any known foods that cause outbreaks.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What is Thalassaemia

Thalassaemia is an inherited blood disorder caused by a genetic defect. The condition causes the body to produce abnormal haemoglobin in red blood cells, which in turn causes anaemia.

Haemoglobin within red blood cells is important because it is the primary molecule that carries oxygen around the body. Hence, the lack of functional haemoglobin causes a malfunction in oxygen carrying capability.


Types of Thalassaemia

There are two types of thalassaemia: Alpha thalassaemia and Beta thalassaemia.

Patients with Alpha thalassaemia carrying one faulty gene will experience no observable effect. Patients with two faulty genes experience mild anaemia. Patients with three faulty genes will result in chronic anaemia requiring regular blood transfusions. Four faulty genes are incompatible with life.

Patients with Beta thalassaemia can be divided into several forms. Beta thalassaemia major,  also called BTM, requires regular blood transfusions and is the most serious. Beta thalassaemia intermedia, also known as BTI or non-transfusion dependent thalassaemia or NTDT, is a milder form of the condition and the severity differs between individuals, from mild anaemia to the need for regular blood transfusions.

Carriers of either Alpha or Beta Thalassaemia genes may not know their carrier status and can only confirm it by blood testing.  Knowing one’s carrier status is important for people planning to have children, as thalassaemia is an inheritable disease.

People of Mediterranean, Middle Eastern, African or Asian descent are more likely to be carriers. Thalassaemia is common in these regions because it helps to protect the carriers against malaria.


Causes of Thalassaemia

Thalassaemia is a genetic disease and cannot be transmitted from one person to another.


Treatment for Thalassaemia

The most common treatment for beta thalassaemia major (BTM) is to have regular blood transfusions every four-to-six weeks to reinfuse functional haemoglobin in the body. This treatment can raise iron levels in the body to dangerous levels, risking heart, liver and hormone problems. Chelation may be performed to reduce iron levels in such situations. .

Bone marrow transplants may cure thalassaemia in young individuals below the age of sixteen but potential cases should be considered individually.

Stem cells in umbilical cord blood transfusion have also been used for thalassaemia treatment.

For Beta thalassaemia intermediate (BTI) patients, treatment will depends on the severity of a person's symptoms. This can range from folate supplements to blood transfusions.

People with BTM are recommended to have a diet high in calcium and vitamin D and to take regular weight-bearing exercise to help strengthen their bones.


Complications of Thalassaemia

• Hypersplenism 
• Delayed puberty 
• Stunted growth
• Irregular heart rhythms 
• Hepatitis, Hepatic Cirrhosis
• Osteoporosis

Thalassaemia Myths

It is important to know the truth about thalassaemia and not to succumb to many myths surrounding the disease. Here are a few samples of misleading information.

Asymptomatic parents will not pass the disease to their children.
Myth: Faulty genes can be transmitted vertically from parent to child.

If only one parent is a carrier, the child will not inherit the genetic disorder.
Myth: As long as one parent is a carrier, every child has a chance of inheriting the genetic disorder and can only be confirmed with blood evaluation

Routine blood tests during a person's lifetime would have demonstrated carrier status.
Myth: Only specific blood tests for thalassaemia detect carrier status.

If a baby is a carrier, he or she will get ill later in life.
Myth: Carriers do not develop full blown thalassaemia but will have a chance of passing the faulty gene to subsequent generations. .

If both parents are carriers, the 25% chance of a child having the disorder would mean one out of four babies will be ill.
Myth: Every pregnancy should be considered as an independent event for statistical evaluation. Hence every baby born has a 1 in 4 chance of inheriting the disease.

Thalassemia will not occur in the Caucasian population.
Myth: While thalassemia occurs more frequently in certain ethnic groups, it has also been found in caucasians. .

It is imperative that I keep my carrier status a secret.
Myth: Blood relatives often carry similar genes. Hence sharing one’s carrier status can increase awareness and understanding amongst the community.

My child is only a carrier so I will not discuss it with him.
Myth: It is important to inform a child of his/her carrier status because the faulty gene can be transmitted to future generations.

Only women need screening tests.
Myth: Both sexes need to be tested as a combination of genes is inherited by a child.

Marrying someone from a different ethnic background avoids children being affected.
Myth: Parents of any background have the potential to pass on carrier status or thalassaemia

Being a carrier protects against malaria.
Partly true: Thalassaemia carriers have a certain degree of protection against malaria.

Thalassaemia can be caught from blood transfusions.
Myth: Thalassaemia is a genetic disorder. It is not transmitted through blood transfusions.

Thalassaemia needs to be treated with iron supplements.
Myth: Use of supplements should be done under medical advice.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Type 2 Diabetes And Managing It

Diabetes is a life-long disease that affects the way your body handles glucose in your blood.


Causes

Insulin, a hormone produced by the pancreas, facilitates the movement of glucose absorbed from food in blood into cells.

Patients with Type II diabetes have insulin resistance and the normal metabolism involving insulin becomes disrupted. .

In the initial phase, the pancreas will compensate by making more insulin to maintain normal metabolism but eventually, due to inadequate compensation, sugar will build up in the blood.

Causes of type 2 diabetes include:

• Genes. Certain individuals have a genetic predisposition to develop type 2 diabetes
• Obesity. Obesity causes insulin resistance.
• Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.
• Hepatic Causes. Liver abnormalities can cause abnormally high blood sugars
• Abnormal beta cells. Abnormal pancreatic beta cells (the cells that produce insulin) can cause Diabetes Type II

Risk Factors and Prevention

• Age: 45 or older
• Family members with Diabetes
• Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American are all predisposed to develop Diabetes Type 2
• Heart and blood vessel disease
• High blood pressure, even if it's treated and under control
• Low HDL ("good") cholesterol
• High triglycerides
• Being overweight or obese
• Gestational Pregnancy
• Polycystic ovary syndrome (PCOS)
• Depression
• A sedentary lifestyle
• Smoking
• Stress
• Insufficient or excessive amounts of sleep

What Can You Do?

• Lose weight. 7% to 10% of weight loss can cut your risk of type 2 diabetes by half.
• Exercise. Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.
• Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.
• Quit smoking.

Symptoms

• Excessive thirst
• Excessive amounts of urine
• Blurry vision
• Increased irritability
• Tingling or numbness in your hands or feet
• Feeling tired all the time
• Poor wound healing
• Recurrent yeast infections

Getting a Diagnosis

Blood tests can be performed to determine diabetic statuses.

A1C: This gives an indication of the sugar control over the last 3 months from the point of blood evaluation.

Fasting plasma glucose: This gives a direct measure of the blood glucose level at the point of blood evaluation. .

Oral glucose tolerance test (OGTT): This evaluates how your body handles excessive sugar.


Long-Term Effects

Over time, high blood sugar can damage and cause problems with your:

• Heart and blood vessels
• Kidneys
• Eyes
• Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
• Wound healing
• Pregnancy

The best way to avoid these complications is to manage your diabetes well.

• Take your diabetes medications or insulin on time.
• Check your blood glucose.
• Eat right, and don't skip meals.
• See your doctor regularly to check for early signs of trouble.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What is Roseola

Roseola, a common infection affecting children less than 2 years of age, is a mild infection characterised by fever, rash, and generalized irritability in infants.

Two common strains of herpes virus cause roseola. Duration of disease can last beyond a week in some cases.

Roseola typically isn't serious. However, in some cases, uncontrolled high fevers can result in complications.

Treatment of roseola includes bed rest, fluids and anti-pyretic medications.


Symptoms

Roseola can be dormant in the child up to a week or 10 days. Once the disease erupts, the symptoms include:

• Fever. Roseola typically starts with a sudden, high fever greater than 39.4 C. Other symptoms experienced include a sore throat, runny nose or cough. Swollen lymph nodes can also occur. The fever usually lasts 3-5 days. 
• Rash. Once the fever subsides, a rash typically appears — but not always. The rash consists of many small pink spots or patches, are generally flat, and usually has a global distribution all over the body. The rash, which isn't itchy or uncomfortable, can last from several hours to several days before fading.

Other signs and symptoms of roseola may include:

• Irritability in infants and children
• Mild diarrhea
• Decreased appetite
• Swollen eyelids

When To See A Doctor

Seek immediate medical care if the child has a seizure due to uncontrolled fevers.


Call your child's doctor if:

• The fever is uncontrolled. 
• The illness is prolonged and unresolving after a week

Call your doctor

If immunocompromised, contact your doctor. Monitoring for a possible infection will be necessary.


Causes

The most common cause of roseola is the human herpes virus 6, and in rare cases, herpes 7.

It is spread via respiratory secretions or saliva. Hence children in close contact with other children become infected easily.

Roseola is contagious even if no rash is present. Hence the disease can spread insidiously.


Risk Factors

Older infants are at greatest risk of acquiring roseola because their immune system is still developing. Newborn babies receive antibodies from their mothers that protect them in the first 6 months of life. Hence, the most common age of infection is between 6 to 15 months.


Complications

1.  Seizures in children

Uncontrolled fevers can result in seizures in children. This often presents as a brief loss of consciousness, jerking of limbs, and or temporary loss of bladder or bowel control.

Although frightening, febrile seizures in otherwise healthy children are generally short-lived and are rarely harmful. However, seek medical care if unsure.


Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.

2.  Concerns for immunocompromised individuals
Immunocompromised individuals, for example, those who have recently received a bone marrow or organ transplant, may contract roseola as a new infection or due to reactivation of the dormant virus in their body.

These patients may experience potentially serious complications from the infection, such as
pneumonia or encephalitis.


Preparing For Your Appointment

Prior to seeing the doctor, encourage your child to rest and drink lots of fluids.


Tests and Diagnosis

Diagnosis is usually clinical though a blood test can be done to check for antibodies.


Treatments and Drugs

Most children spontaneously recover within a week of the onset of the fever.

Medications to control fever can be used for symptom control.


Prevention

Avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever subsides.

Most patients are immune by the time they are of schooling age. However, basic hand washing is recommended to prevent the spread of the disease.

Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. Infected adults however can pass the disease to children.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.