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Pruritus is a medical term for ‘itch’. Itch is an uncomfortable sensation that provokes a person to scratch. When the itching lasts more than six weeks, it is termed chronic pruritus [1].
Although itching is not a life-threatening symptom, it can have a profound negative effect on a person’s social life. It can cause difficulty sleeping and an inability to concentrate on work/studies or daily routine. Chronic pruritus can cause emotional distress and is associated with mental health conditions such as anxiety and depression [2]. To make things worse, frequent scratching or rubbing of the affected skin area can lead to injury or impairment of skin tissues, resulting in infections and other health complications.
In this article, we explore these itchy symptoms and explain the possible underlying causes in simple layman's terms. The article strives to educate and empower patients to better understand these common symptoms and seek medical attention when symptoms persist.
Chronic pruritus is a common symptom that can affect anyone at any age or in any walk of life. Approximately 22% of people may experience chronic pruritus throughout their lifetime [3]. The condition is commonly seen in elderly people who are above the age of 65 [4]. In Singapore, nearly half of the elderly may experience chronic pruritus [5].
Though the sensation of ‘itch’ is a nuisance, it functions as a body’s self-protective mechanism. It is supposed to warn us against harmful external agents and protect our bodies. The itch sensation is comparable to other skin sensations such as touch, pain, etc.
Itch occurs when the itch-sensing nerve endings known as ‘pruriceptors’ on the skin are stimulated by heat, chemical, mechanical causes, infection, or even inflammation. Once the pruriceptors are activated, the ‘nerve signals’ will be delivered via the C-fibres that are present on the skin to the spinal cord and the brain. When we scratch or rub the affected area, the pain and touch receptors on the skin can also be activated. The concurrent pain and touch sensation can interfere with the itch sensation, resulting in temporary relief. However, the skin can be irritated or injured via scratching, eventually leading to a never-ending vicious itch-scratch cycle [6].
You should consider seeing a doctor for further checkups and treatment if your itch:
There are a few key questions that you may want to consider preparing yourself before seeing your doctor to evaluate chronic pruritus further; these are:
Chronic pruritus is a medical condition that can be tricky for patients and physicians to diagnose and manage.
We can split the causes of a persistent itch into broad categories, such as:
In a real-world circumstance, a person may have multiple factors that contribute to experiencing a persistent itch. Unfortunately, sometimes, it may be impossible to pinpoint a single cause of chronic pruritus.
Prolonged, unattended itch can lead to a vicious itch-scratch cycle. Out of itch desperation, one may even resort to repeated rubbing and washing to achieve temporary relief of the symptoms. Nonetheless, all these actions can lead to injury of the normal skin barrier, resulting in skin infection or even scarring of the affected area.
Chronic pruritus can be uncomfortable, affecting the quality of social life. It is known that a person with chronic pruritus is predisposed towards mental health disorders such as anxiety and depression.
Furthermore, chronic pruritus can be more than a skin-deep issue. It may suggest underlying medical conditions that, if left unattended, may result in potential long-term systemic complications.
It is useful to discuss your symptoms with your healthcare providers. Depending on individual circumstances, your doctor may offer tests such as the ones below to identify the possible trigger of your persistent itch symptoms.
Tests offered may include:
If there is an underlying condition that causes the recurring of itch, the underlying medical condition needs to be addressed.
Chronic pruritus can be relieved with:
You can discuss with your doctor to understand more about the management of chronic itch symptoms.
Erectile dysfunction (ED) is a medical condition when a man is unable to achieve or sustain an erection that is satisfactory for sexual intercourse. It is an alarming health condition that affects up to half of the men aged 30 and above in Singapore. It is slightly common in those with concurrent cardiovascular health risk factors.
Conventional treatment for erectile dysfunction involves lifestyle changes to improve underlying medical conditions and oral medication treatment with phosphodiesterase-5 inhibitors (PDE5i) such as sildenafil or tadalafil. In those who are unable to consume oral treatment or have poor improvement with oral treatment, more drastic and invasive options such as vacuum devices, injections, and penile prostheses may be considered. Patients with erectile dysfunction may also be susceptible to the exploitation of non-clinically proven medication or treatment options that are available in the market, leading to further waste of money with unsatisfactory outcomes.
Over the years, low-intensity shockwave therapy has slowly gained popularity among both patients and clinicians as one of the treatment options for ED. In this article, we want to understand and explore the efficacy and sustainability of this option in erectile dysfunction.
The effect of shockwave therapy relies on incorporating the theory of basic physics onto biologically targeted human tissue to achieve the desired outcome.
In physics, a shockwave is produced when:
As the name ‘shockwave’ suggests, the shock allows forward propagation of disturbance that moves faster than the speed of sound in the medium. The sudden delivery and discontinuity of the ‘disturbances’ in the medium allow shockwave to achieve an abrupt high-pressure level onto the targeted region. When the shockwave forces are applied to a localised area of the body, it leads to repeated and sudden sheer pressure, compression and expansion of the tissues.
In erectile dysfunction, the repetitive sheer pressure delivered by shockwave therapy stimulates the regrowth of blood vessels (neo-angiogenesis), improves micro-blood circulation, regenerates localised nerve (neurogenesis), activates progenitor cells to remodel, and restores erectile tissue from local inflammation and stress.
We now know that in most patients with erectile dysfunction, there is abnormal or reduced blood circulation through the erectile tissues. The idea of tissue regeneration with shockwave therapy changes the conventional treatment paradigm of erectile dysfunction.
Over the years, there have been increasingly promising clinical studies showing that shockwave therapy can be used beneficially and safely in ED. Shockwave therapy is also seen to work as an adjunct to improve patients' responses to oral medications such as PDE5i.
Currently, the EAU (European Association of Urology) recommends shockwave therapy as a first-line alternative treatment for patients who are unable to tolerate oral medications such as PDE5i. The Asia-Pacific Society for Sexual Medicine (APSSM) also recommends shockwave therapy to patients with mild or moderate vasculogenic (blood-circulatory related) ED who do not respond to oral medications.
Shockwave therapy is a convenient and relatively quick treatment therapy that can be offered in an outpatient setting. You are not required to fast for preparation prior to the procedure.
Your doctor will place a hand-held shockwave device onto your penis. The device will release gentle shock pulses to trigger the regeneration of the erectile tissues. There will be no needle involvement, and no anaesthesia is required. The entire procedure takes about 30 minutes. As there is generally no downtime, you are expected to be able to drive home, go to work, continue sports activities, and go about your usual everyday routine.
Patients with erectile dysfunction who:
If you are taking blood thinner medications such as anticoagulants or antiplatelets, you should inform your healthcare providers before treatment. Depending on your circumstances and health risks, your doctor can advise you further on the suitability of shockwave therapy.
Shockwave therapy is not a completely new medical technology and treatment option. In fact, this therapy has been available for over 40 years in the medical field. It is used to manage health conditions, including kidney stones, pelvic pain, and musculoskeletal injuries such as frozen shoulder and plantar fasciitis.
Sexually transmitted diseases (STDs) are an umbrella term for infections that can be acquired through sexual intercourse. Based on the local epidemiological studies in Singapore, STDs affected 201.6 per 100,000 of the population in 2017.
This leads us to the following questions:
We will explore the above points in this article.
STDs can have a detrimental effect on male hormones and can result in prostatitis and sexual dysfunction.
Testosterone is an essential male sex hormone that regulates the male libido, sperm production, general energy level, fat and muscle mass distribution, and red blood cell production. Testosterone hormone is produced mainly in the testicles, and the level can fluctuate. Common causes of reduction of testosterone hormone include ageing, diabetes, trauma, thyroid disease, hormonal disorders, tumour, and infection.
STD Infections can cause inflammation of the testicles (this is known as epididymitis), leading to impairment of the production of testosterone. Common STDs that are associated with low testosterone include HIV, chlamydia, gonorrhoea, and syphilis.
The prostate gland is a small chestnut organ located at the neck of the bladder, just in front of the rectum, and at the base of the urethra (the urinary tube that delivers urine). It is an important organ in the male reproductive system and aids in the production of semen to ensure the sperm is viable and able to move. Due to its location, the prostate gland can easily become infected by pathogens such as STDs.
Untreated STDs, such as HIV, gonorrhoea, and chlamydia, can infect the prostate, leading to prostatitis – inflammation of the prostate. When the prostate is inflamed, the surrounding blood circulation to the genitals can be compromised; there will be lesser blood flow to the penis which can result in difficulty in sustaining an erection.
Urethritis is a type of urinary tract infection that affects the urethra. The urethra is the opening tube that allows urine to flow from the bladder to the external body. Due to the proximity to the external environment, it is easily infected by STDs. Chlamydia and gonorrhoea remain two of the most common STDs associated with urethritis. However, there are other bacteria, such as syphilis, trichomonas, mycoplasma spp, ureaplasma spp, candida, etc that may contribute to urethritis symptoms.
Abnormal urinary symptoms such as painful urination, itching or burning sensation, and discharge over the urethral can occur in untreated urethritis. Untreated STD-related urethritis can be associated with the further spread of the disease to the surrounding reproductive organ, resulting in peri-pelvic infection or abscess, urinary tract scarring, inflammation of the testicles and prostate, etc. These can all lead to penile discomfort, pelvic pain, and inflammation and again affect a person’s sexual function.
Thankfully, most STDs that affect male sexual function are treatable with the correct diagnosis and medications.
STDs have been known to have a negative role in menstrual cycle and PMS.
Although STD infections do not affect the female hormonal axis, they can be associated with abnormal vaginal discharge and spotting symptoms. One may notice spotting from light to dark brown/red discharge when they are not having their usual period or after intercourse. Less commonly, STDs can be associated with irregular periods or missed periods, though other causes such as pregnancy, PCOS (polycystic ovarian syndrome), or thyroid disorder should be considered as possible differentials as well.
In chronic untreated STD infections, one may develop more severe complications such as inflammation and scarring of the pelvis and reproductive organs, including the uterus, fallopian tubes, and ovaries. In such instances, the ovulation or menstrual cycle can cease to function, leading to clinical presentation of irregular or missed periods.
Common bacterial STDs can be associated with abnormal menstrual cycle or vaginal symptoms. STDs bacteria including chlamydia, HPV, gonorrhoea, trichomonas, and mycoplasma genetalium, are common culprits. Unfortunately, as most symptoms of abnormal vaginal discharge or abnormal menstrual spotting tend to be mild, one may delay seeking medical treatment. If it is a case of an untreated STD, delaying treatment increases the risk of long-term complications such as pelvic inflammatory disease and can affect future fertility.
Studies have shown that there may be a link between untreated STDs and worsening premenstrual symptoms (PMS). Premenstrual symptoms such as headache, sadness, and longer period of cramps are exacerbated by untreated STDs (such as chlamydia, herpes, HPV) based on a clinical study in Oxford using a period-tracker app for smartphones.
The hypothesis suggests that with the associated inflammatory phase and falling of progesterone level prior to menses, STDs can worsen further this inflammation, hence, exacerbating PMS symptoms.
Aside from the physical complications from STDs, these infections are also associated with negative psychological impacts. The way general society stigmatizes STDs, a person’s upbringing and cultural background may affect a person’s mental outlook against STDs.
Emotional responses such as anger, depression, guilt, shame, and isolation can occur. This can be followed closely with reduced self-worth, low self-esteem, anxiety, and depression when one is dealing with STD conditions. Over time, constant mental stress against STDs can be associated with restlessness and reduced sexual desire or satisfaction.
One may be scared of contracting STDs to the extent of being unable to be aroused sexually. In males, psychogenic erectile dysfunction can occur out of fear of STDs. In females, one can experience sexual dysfunction symptoms such as vaginismus, reduced libido, painful intercourse, etc.
This will depend on the underlying cause of sexual dysfunction. If the root of the medical condition is due to underlying STD infections, treating or managing the underlying culprit STD infections is likely to improve a person’s overall sexual function. However, bear in mind that most cases of sexual dysfunction can be multi-factorial, and it may benefit to discuss your concerns with your doctor to address any other causes.
Based on the WHO diagnostic criteria, diabetes mellitus is defined as a fasting serum glucose level equal to or more than 7 mmol/L or 126 mg/dl. In diabetes, a person has chronically high sugar levels in the bloodstream due to a defect or reduced insulin production.
Diabetes is infamously associated with long-term health complications such as increased risk of heart attack, stroke, kidney disease, nerve complications, blindness, poor wound healing, various disabilities, and even death. According to the International Diabetes Federation, 1 in 10 people lives with diabetes worldwide. Based on the National Population Health Survey 2022 Singapore, the prevalence of diabetes (between the age group 18 to 75) in Singaporean is 8.5%.
In this article, we aim to discuss the correlation and overlapping symptoms of both medical conditions.
A person with diabetes tends to have a weaker general immune system, and this predisposes the person towards various forms of infections, including sexually transmitted diseases (STDs).
Interestingly, an untreated STD, just like any form of infection, may increase the blood sugar level in a diabetic person. This can create a vicious cycle for a diabetic patient with STDs- predisposition to high risks of infection and is more complicated to treat.
There is no direct causative effect between diabetes and STDs. Diabetes does not cause STDs, and vice versa. Both conditions are due to completely different underlying physiology. STDs are due to sex and infection. Diabetes is due to the ineffective breakdown of sugar by insulin in the body, leading to a long-term hyperglycaemic state in the circulation.
It is imperative to note that STDs, as the name has suggested, sexually transmitted diseases, are transmitted through sexual encounters. STDs occur due to exposure to unsafe unprotected oral, vaginal, or anal intercourse. A person with diabetes without a history of sexual encounters is, hence, unlikely to acquire an STD.
Nonetheless, people tend to be confused by both medical conditions, as their presentations are similar, and we strive to iron them out in simpler terms.
In both diabetes and STDs, a patient (both men and women) can present with itching over the genital region.
In diabetes, chronic high blood sugar and a low immune system cause a person to have a poorer skin barrier, which increases the risk of fungal and bacterial infection. Itching can be a symptom of a skin infection.
On the other hand, STDs such as Chlamydia, Gonorrhoea, Trichomoniasis, Mycoplasma Genitalium, HPV/warts, and Herpes Simplex Virus infection can present with itching over the genital region.
A rash over the genital region is always a concern of a possible STD. STDs such as herpes infection and HPV infection can present with a rash and are commonly mistaken as eczema or sensitive skin.
A rash over the lower pelvic, groin, or even anal region can also be non-STD related. In the case of diabetes, a combination of a weakened immune system and environmental factors such as increased sweating/ hygiene/ humidity of surroundings, one can present with a bacterial or fungal-related skin infection over the moist area below.
Furthermore, patients with diabetes may be more commonly seen with skin tags. Skin tags are small appendages, stalk-like skin bumps that can be confused with STD skin bumps such as HPV viral warts.
Abnormal vaginal discharge is characterised by unusual excessive volume (compared to baseline), colours such as yellow to green or greyish in appearance, and foul-smelling vaginal discharge. There can be occasional associated painful urinary symptoms, lower pelvic pain or, in more severe cases, even fever.
This abnormal symptom invariably always rings a red flag alarm on a possible underlying STD (as long as there is a sexual history involved). Bacterial STDs such as Chlamydia, Gonorrhoea, Trichomoniasis, Ureaplasma spp, Mycoplasma spp, etc, are common culprits that are involved in the abnormal symptoms.
Nonetheless, abnormal vaginal discharge can be seen more frequently in diabetic patients due to recurring fungal/yeast infections.
Urinary tract infection is frequently seen in a person with diabetes due to high blood sugar levels in the body. Confusingly, in bacterial STDs, one can present with similar symptoms such as urinary tract infection- painful urination, discharge from the urethral, burning sensation upon peeing, urinary urgency, etc.
In a person with a urinary tract infection that is not caused by an STD, the urinary tract is infected due to migration or contamination of the bacteria from the surrounding genital region. In the case of diabetes- it is due to an underlying poor immune system, poor skin integrity, and a higher risk of general infection.
In STDs, the causative bacteria, such as chlamydia and gonorrhoea, come from an external source- such as an infected sexual partner.
Pain during intercourse should not be ignored. Reversible and manageable causes such as STDs or diabetes should be addressed to avoid irrevocable complications such as chronic discomfort and infertility.
As diabetes can affect the blood vessels and nerve supplies of the body, in females, it can be associated with vaginal dryness due to reduced lubrication as a result of diabetic neuropathy. In diabetic males, the blood flow to the penis can be impaired, leading to sexual dysfunction. In both circumstances, sex can be painful and uncomfortable.
Painful sex can be an indicator of an untreated STD. Over time, an undiagnosed STD can cause chronic inflammation and scarring of the reproductive organs and chronic pain during intercourse. STDs are important to treat, not just to address sexual discomfort but, more importantly, to prevent the infection from causing scarring and eventual infertility.
High-risk pregnancies are commonly seen in a person with diabetes or untreated STDs.
In diabetes, the pregnant mother is at higher risk of miscarriage, pre-term labour, stillbirth, and serious birth defects in babies (congenital heart, brain, and spine defects).
Vertical transmission of STDs from mother to unborn foetus is possible. Infections such as HIV, hepatitis, syphilis, chlamydia and gonorrhoea can be passed on to the foetus during pregnancy. STDs in newborns can be associated with neurological defects, meningitis, blindness, deafness, chronic infection in the babies, failure to thrive, or even death. STDs are one of the preventable causes in newborns if screening and early treatment are offered to pregnant mothers.
1. Diabetes and STDs are two medical conditions of different entities and underlying causes.
2. A person can have both diabetes and STDs.
3. A person with underlying diabetes can be more susceptible to STDs.
4. Diabetes clinical presentation can be similar to STD symptoms, though the treatment for both are completely different.
5. As diabetes and STD presentations can be confusing, a review with your healthcare professional can be beneficial to diagnose the symptoms correctly.
6. Both diabetes and STDs can be screened accurately, and there are effective treatment options in managing both conditions to minimise long-term complications.
With the recent hype over skin food for luscious hair and longer, stronger nails, biotin is becoming a common supplement in our multivitamin drug cupboard. Have you ever wondered how safe biotin is and whether it has any long-term implications for our health?
In this article, we explore the role of biotin in the human body and the benefits and potential drawbacks of this supplement.
Biotin, also known as Vitamin B7, Vitamin H, and Coenzyme R, is a water-soluble protein that facilitates the production of energy for the body by acting as a catalyst in the metabolism of protein, carbohydrates, and fats.
It can be found in meat, salmon, eggs, innards such as liver, dairy products, cereal and grains, soy flour, fruits and vegetables such as bananas, carrots, cauliflower, etc. Biotin, when consumed, is absorbed in the small intestine and stored predominantly in the liver.
Currently, there are no blood tests that enable us to monitor the level of biotin in our body.
Biotin plays an essential role in the growth of skin, hair, and nails. Biotin deficiency is known to be associated with brittle nails, skin rash, or hair loss. Furthermore, low biotin can be associated with cardiovascular consequences such as high cholesterol and heart disease.
There are ongoing medical studies and research on the role and benefits of biotin in skin conditions such as seborrhoeic dermatitis, acne, or eczema and neurological conditions such as multiple sclerosis. However, there is insufficient clinical evidence to prove its efficacy in these conditions.
Patients who are on anti-convulsants (epilepsy medication) can be associated with lower biotin levels in their bodies.
Biotin deficiency is uncommon in healthy people with a regular, varied diet.
Biotin can be lower in chronic alcohol drinkers or pregnant or lactating mothers. Rarely, one can be genetically predisposed to biotin deficiency due to biotinidase enzyme deficiency (an enzyme that allows the release of free biotin in the body).
Biotin deficiency can be associated with hair loss, brittle nails, and skin rash, particularly over the mouth, eyes, nasal hole, and perianal region). In more severe cases, one can develop neurological symptoms such as seizures, numbness in the limbs, and psychiatric symptoms such as depression and hallucination.
Thankfully, no major side effects have been reported for overdosing on biotin. However, informing your healthcare provider before starting the supplement is still good practice.
As high biotin intake can lead to falsely high or low biochemistry laboratory test results, which can lead to misdiagnosis and mismanagement of a person’s health condition, it is always prudent to check with your doctor about your biotin dose.
There is slowly emerging medical evidence of biotin interference with laboratory test results. Most laboratory immunoassays (tests) use the biotin-streptavidin system to run samples, as this system allows high affinity and sensitivity (the ability of chemical proteins to bind together and pick up abnormalities). It is found that a high amount of biotin (>1mg/day) can cause false test readings.
Abnormal thyroid hormone blood tests and Vitamin D serum levels are found in patients who consume high biotin levels. There have been reports of false hyperthyroidism or inappropriate diagnosis and treatment of Grave’s disease in patients who are taking high-dose biotin (30-100 mg biotin/day). Aside from this, some reports reveal biotin can interfere with blood markers for heart failure (such as pro-BNP {brain natriuretic protein}), both female and male hormones, cortisol, parathyroid hormone readings, folate, vitamin B12, iron readings, etc.
The concern and danger here:
You are encouraged to inform your doctor on the supplement(s) that you are taking prior medical tests to ensure the tests is run and interpreted appropriately.
Thought for the day…
The interference of biotin with our daily biomarkers raises a few new questions to ponder:
A more pragmatic approach is to educate ourselves as both patients and consumers on the supplement that we are delving into. On the other hand, physicians have a role in screening patients' drug and supplement lists. Those who are on biotin should be counselled on the potential interference with laboratory results before blood testing.
1. Gifford JL, Sadrzadeh SMH, Naugler C. Biotin interference: Underrecognized patient safety risk in laboratory testing. Can Fam Physician. 2018 May;64(5):370.
2. Elston MS, Sehgal S, Du Toit S, Yarndley T, Conaglen JV. Factitious Graves’ disease due to biotin immunoassay interference—a case and review of the literature. J Clin Endocrinol Metab. 2016;101(9):3251–5.
3. Piketty ML, Polak M, Flechtner I, Gonzales-Briceño L, Souberbielle JC. False biochemical diagnosis of hyperthyroidism in streptavidin-biotin-based immunoassays: the problem of biotin intake and related interferences. Clin Chem Lab Med. 2017;55(6):780–8.
4. https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/#ref
There are two schools of thought on the management of molluscum contagiosum. Some physicians prefer conservative treatment, allowing the immune system to run its course and clear off the virus over time. On the other hand, one may opt for a more proactive approach to medically treating the infection.
In this article, we explore the reasons for considering treating molluscum contagiosum.
Molluscum contagiosum is a benign viral skin infection caused by the poxvirus [1]. The infection causes small, discrete, firm, white skin bumps known as Mollusca, with a classical characteristic of a dimple or pit in the centre. Molluscum lesions can occur on any part of the body, including the face, neck, body, arms, legs, or even the genital region.
Medical literature shows that 70% of molluscum contagiosum infections take months (up to 6-18 months) to resolve spontaneously [2]. However, in some patients, new molluscum lesions can continue to appear intermittently for 3-4 years. Less commonly, medical reports suggest the infection can even last up to 5 years.
One can acquire the viral infection through skin-to-skin contact, sexual contact, and fomite transfer through wet towels, pools, bathtubs, spa rooms, gym floor surfaces, etc [3]. Practising good hand hygiene is imperative in reducing the transfer of infection to self and others.
While molluscum contagiosum can be acquired through skin contact with contaminated surfaces/fomites, it is considered an STD when one contracts it from sexual partners. Typically, an STD-related molluscum contagiosum infection involves the genital areas or the oral region due to skin-to-skin transmission during physical intercourse [4].
If you are unsure whether your symptoms are due to molluscum contagiosum, you can contact your trusted physician for further evaluation. The lesions are characterised by round, discrete, waxy, pale dots with a central umbilication (indentation).
In cases where the diagnosis is unclear, your doctor may further evaluate the lesion with a dermatoscope or surgically remove a small skin sample (biopsy) to confirm the diagnosis.
The Mollusca that remains on the skin has a high risk of being passed on via skin-to-skin contact to people around us and self-inoculate to other parts of our body such as the hands, eyes, face, neck, and genital region.
As sexual activities involve physical intimacy and friction, the viral infection can easily be passed on between sexual couples. Untreated molluscum over the genital region increases a person’s risk of acquiring other types of STDs.
Incessant scratching can be a nuisance and an embarrassment in our daily life. The itch can even affect sleep and daily productivity. Although not life-threatening, molluscum can be uncomfortable and significantly reduce our well-being.
One of the common complications from persisting molluscum lesions is secondary bacterial infection. This is particularly important in patients with a compromised immune system [5], such as HIV patients. Concurrent bacterial and molluscum infections can further complicate health and hamper recovery. In these situations, it is imperative to get molluscum (the primary problem) treated.
This is particularly true in the case of inflammatory skin conditions such as eczema, where molluscum can cause a flare-up of existing eczema [6]. Persistent molluscum infection also makes the treatment of eczema more recalcitrant.
Although uncommon, when molluscum infection occurs in a pregnant woman, there is a possibility of vertical transmission of the disease from the mother via the uterus/birth canal to the baby.
Molluscum lesions covering the skin surface, particularly exposed areas such as the face, arms, legs, and hands, can be disfiguring and cause social embarrassment. Even having them over the genital regions can be socially awkward and embarrassing between couples.
Scratching, picking, and inappropriate scooping of the molluscum lesions can lead to scarring of the skin. Spontaneous scarring from molluscum infection is also possible due to chronic inflammation of the skin infection [7]. Skin scarring is irreversible.
It is medically indicated to consider treating molluscum contagiosum if:
Medical treatment of molluscum infection involves the following:
Effective physical removal treatments are offered safely in outpatient settings.
As molluscum contagiosum infection may continue to resurface due to underlying immune system inadequacy to combat the virus, physical removal treatment may be required in repeated sessions to eradicate the infection.
It is not advised to self-attempt to pick or remove the skin lesions as this can increase the risk of scarring and further self-inoculation of the virus to the surrounding skin.
When a person has genital molluscum contagiosum, this is an indication of an increased risk of other sexually transmissible infections. Other STD testing, including HIV testing, should be offered to prevent further complications develop from STDs and to protect loved ones from contracting STDs.
A person who has had molluscum contagiosum and has been treated before is not immunised or protected against future infections. Even with successful clearance of molluscum infection, you are still at risk of developing a new molluscum infection if exposed to a new source of the virus. There is currently no vaccination against molluscum contagiosum.
As long as you have the molluscum bumps, you can spread them to others.
If you are concerned about acquiring molluscum contagiosum infection or exposure to other forms of STDs, you are encouraged to reach out to your trusted physician and take proactive steps to protect yourself and the people around you.
The liver is an organ that never stops working, yet most of the time, we pay minimal attention and care to it. The liver plays numerous pivotal roles ranging from aiding digestion, protein and enzyme production, and detoxifying the body.
Even with a minor liver injury, insult, or stress, the liver continues to stay resilient and functions without symptoms. It is only when the liver is more than 2/3 damaged that symptoms start to show. Hence, taking care of the liver is paramount. In this article, we discuss a common reversible cause of liver damage—fatty liver disease.
The liver is located just below the lungs and over the right upper part of the abdomen –the region is also known as the right hypochondrium. It plays a vital role in:
Fatty liver disease, also known as steatosis of the liver, is a medical condition that occurs due to the accumulation of fat in the liver. There are two types of fatty liver disease, these are:
There is a strong association of NAFLD with metabolic conditions such as obesity, hypertension, diabetes, and dyslipidaemia. Some medical journals suggest fatty liver is the hepatic manifestation of metabolic syndrome.
Non-alcoholic fatty liver disease occurs in approximately 40% of Singaporeans and comprises four different stages, these are:
Patients with a fatty liver are usually asymptomatic. However, if you notice the following symptoms, it could be a sign that your fatty liver disease has progressed:
If you notice the above symptoms, make an appointment with your doctor immediately.
Non-alcoholic fatty liver disease is associated with the build-up of excess fats in the liver. This occurs when more calories are consumed than the body can use, the excess calories are converted to fats and stored in the liver. When the amount of fats in the liver is more than 5% of the liver’s weight, then fatty liver disease occurs.
There is also a strong association between non-alcoholic fatty liver disease and non-alcoholic steatohepatitis with metabolic syndrome.
This means that individuals are more predisposed to fatty liver disease if they have:
As most patients are asymptomatic, routine health screening or a medical checkup is encouraged to screen for metabolic syndrome and NAFLD. You are encouraged to discuss with your doctor on your possible risk factors and what can be done to reduce your risk of developing fatty liver disease.
Medical conditions that increase an individual’s risk for developing NAFLD include:
With the rise of metabolic syndrome, obesity, and diabetes, the cases of NAFLD are rising exponentially as well. Currently NAFLD is becoming the most common cause of liver disease in the world. A study conducted in 2022 found that the prevalence of NAFLD is estimated to be 32.4%, with numbers expected to grow.
In Singapore, the prevalence can be as high as 40%. Interestingly, not only can NAFLD be seen in obese people, but also in 20% of non-obese Asians.
As NAFLD can progress into irreversible complications such as cirrhosis (severe scarring of the liver), regular routine screening is important in the prevention of fatty liver disease.
Once an individual has developed liver cirrhosis, further complications may occur such as a buildup of abdominal fluid (ascites), oesophageal vein swelling and rupture (varices), liver encephalopathy (with change of mental state, confusion, drowsiness), increased risk of liver cancer (hepatocellular carcinoma), and end stage liver failure.
Hence, it is very important to detect and treat NAFLD when it is still in its early, reversible stages. Thankfully, the progression of the condition is generally slow, and most NAFLD patients are stable and can be managed in primary care. Do speak to your doctor to screen for NAFLD.
Fatty liver can go undiagnosed for years as it usually does not cause pain or other symptoms. One usually picks up fatty liver findings during routine blood tests.
If your results are concerning to your doctor, he/she may arrange an ultrasound of the liver. In severe cases, your doctor may refer you to a gastroenterologist who will then advise for a liver fibroscan or biopsy for further evaluation of the extent or severity of your fatty liver disease.
You should consider screening for fatty liver/NAFLD if you have any of the following conditions:
Your doctor will usually take your medical history and examine you physically— covering blood pressure, weight, height, waistline measurement, etc. Depending on how you fare, your cardiovascular organs and liver may also be screened.
Subsequently, blood tests which cover the general screening, and a liver function test are conducted to screen for metabolic syndrome and fatty liver disease. Depending on your individual risk factors, you may also be required to have imaging (e.g., ultrasound, CT scan, MRI) taken of your liver. You can discuss your concerns with your doctor regarding NAFLD and decide on any suitable tests for further evaluation.
NAFLD is a reversible condition if managed early, below are some steps you can take to reverse or prevent fatty liver disease.
Medications: medication may be prescribed for the concurrent management of diabetes, cholesterol, or blood pressure problems. Medications may also be prescribed to individuals with recalcitrant visceral fat/chronic elevated BMI in order to facilitate weight loss.
A major component of health screening involves cancer screening. Cancer remains a leading cause of morbidity and mortality in Singapore, accounting for 29.7% of deaths in 2015 according to the National Registry of Disease Office of Singapore.
The thought of screening for cancer can be distressing. One may even argue that by identifying cancer, it will be life-changing, life-defining, even death-sentenced without a cure to the problem. On the flipped side, even without curative treatment to the disease, early detection promises a better disease prognosis and a better quality of life with current modern medicine in comparison to cancer cases that are detected at late stages.
In certain cancers, early screening can in fact be life-saving. This is where health screening comes in place. Screening has been shown to be effective in early detection of colon cancer, breast cancers and cervical cancer. This article is written in the hope to give certain guidance and recommendation to people on choosing cancer screening packages.
You should consider if you are
You are recommended for a colonoscopy for everyone at the age of 50 and every 10 years thereafter. Your doctor may advise you for an earlier colonoscopy procedure if you have symptoms or family risk factors of colon cancer.
Colonoscopy, though not completely risk-free, is not overtly scary. Colonoscopy is a planned procedure arranged between you and your endoscopist. Prior to the procedure, you are advised to drink a medicine liquid 1 to 2 days prior procedure to clear out your bowels. You will be given sedation throughout the procedure to ease your discomfort. The procedure itself takes about 15 to 30 minutes, allowing your doctor to visualize your colon intestinal walls, and take sample biopsies or remove small polyps during the procedure.
You are recommended for a yearly mammogram at the age of 40 until the age of 50, then every 2 years repeating mammogram until the age of 69. Although Ultrasound breasts are not routinely performed, it may be recommended by your doctor if clinically indicated. In high risks individuals, your doctor may recommend you to do MRI breasts.
Many people find mammogram is a painful test. Mammogram though is not the most comfortable test, is useful in identifying cancerous areas of the breasts. Breast cancer is one of the cancers with a good survival rate if detect and managed early.
You are recommended cervical cancer screening from the age of 25 onwards if you have ever had sexual contact. You are recommended for pap smear test at least once every 3 years. You are also advised for HPV test every 5 years if you are sexually active and over the age of 30.
While pap smear and HPV tests can be uncomfortable, early treatment is curative. Early treatment of cervical cancer is particularly important to women during their reproduction years for future conceive and childbearing.
What cancer symptoms or warning signs I should be aware of?
While cancer is most often asymptomatic, you should speak to your doctor if you experience
Health screening is not completely without risks. False-positive results can cause anxiety and require further tests that involve further risks and cost. In false negative tests, it may give a person a false sense of security.
Speak to your doctor before deciding any tests for cancer screening- don’t leave cancer to chance.
Health screening allows screening for potential health conditions, striving at prevention and early management of asymptomatic health diseases, including Metabolic Syndrome.
Metabolic Syndrome also is known as Syndrome X, is made up of risk factors that if left unattended can potentially lead to chronic conditions such as cardiovascular diseases and cerebrovascular diseases. Metabolic Syndrome is a silent killer that is often not addressed until a major disastrous event such as a heart attack or stroke strikes with debilitating irreversible complications including death.
You have Metabolic Syndrome if you have 3 or more characteristics below:
As mentioned, it is an insidious condition that most people present without any symptoms. Some may show an obvious physical appearance of obesity with a large waistline and ‘pear-shaped’ body.
Metabolic Syndrome has 2 components- the fixed factors and flexible factors. The fixed factors are how we are genetically born and programmed with such as our race, age and family medical conditions that we are unable to change. Having said that, it is not all doomed, and we should not leave our health to fate. Flexible factors include one’s cholesterol, blood pressure, glucose level, body weight and personal lifestyle. We can make a major difference in the outcome by managing these flexible factors.
Health screening for Metabolic Syndrome involves screening for personal and family risks factors. This involves doctors review, both histories taking and physical examinations, batteries of blood tests investigations, blood pressure measurement, weight and height measurement, body fat percentage measurement and baseline ECG. In certain high-risk groups, your doctor may advise you further investigations or specialist input.
Screening for Metabolic Syndrome is aimed at managing the flexible factors of a person, reducing the chance of developing catastrophic conditions such as heart attack and stroke. By understanding one’s risks factors and health situation, your doctor can further advise you on both non-pharmacological (with lifestyle and dietary modification) and pharmacological (if required) changes.
Take charge of your health today, screen for Metabolic Syndrome!