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Brain aneurysms, also known as cerebral aneurysms, have been surfacing as new headlines following a recent young Malaysian artiste, Queenzy Cheng, who collapsed and succumbed at a work site due to a ruptured brain aneurysm.

Slightly closer to home and heart, within the same month, one of our blog authors' friends (also a young adult) collapsed from a similar medical condition and had a haemorrhagic stroke. The friend survived but with significant neurological complications and is currently undergoing intense rehabilitation in the hospital. 

ruptured brain aneurysm
Brain or cerebral aneurysms can rupture and cause catastrophic consequences.

A brain aneurysm is a medical condition that, in its wake, causes a catastrophic event to patients and their surrounding family and friends. Brain aneurysms tend to have a high mortality rate (approximately 50%), and even if an individual survives a rupture, they may have to live with profound long-term neurological disability.  This is a condition that nobody wishes to happen to themselves or their loved ones.

This article is written to serve as a general information guide to patients and families on brain aneurysms to promote awareness of this serious medical condition. 

If you have been having frequent headaches, it may be a sign of a brain aneurysm.

What is a brain aneurysm?

Aneurysm is a medical condition where there is a 'weakened point' [1] on the wall of a blood vessel. Over time, this weakened area may herniate or ‘bulge’ externally. An aneurysm can occur in any blood vessel – it can occur in the abdomen (abdominal aneurysm) and in the brain (brain aneurysm).

The thinning of the blood vessel wall can be due to a disease, trauma, injury, or a malformation at birth. If the aneurysm/thinning becomes significant, it runs a risk [2] of rupturing and bursting. If this occurs in the brain, the blood will spill over to the surrounding brain tissue, leading to brain inflammation, swelling, and irreversible brain tissue damage. A ruptured brain aneurysm can potentially lead to a disastrous event of a stroke, irreversible nerve paralysis, or even death.

blood vessel bulge
An aneurysm can occur in any blood vessel; in the case of a brain aneurysm, it occurs in the brain

What are the symptoms of a brain aneurysm?

A brain aneurysm that has ruptured can cause catastrophic symptoms [3] or even death. Patients with brain aneurysms are usually asymptomatic; however, when the aneurysm gets bigger, it may compress onto surrounding brain tissues or nerve cells, leading to neurological abnormal symptoms, such as:  

At the onset of a ruptured aneurysm, one may present with:

In the event of suspicion of a ruptured brain aneurysm, time is of the essence. Seek medical attention and go to the hospital immediately, as early neuro-surgical intervention can be life-saving. Delaying seeking medical assistance can result in death.

eye pain brain aneurysm
Pain in the eye area is a common symptom of a brain aneurysm.

What is the cause of a brain aneurysm?

In most patients, the cause of brain aneurysm remains unknown. 

However, one may be predisposed to brain aneurysm if there are hereditary [4] conditions such as connective tissue disease, blood vessel malformations, or polycystic kidney disease

Environmental factors such as head injury, uncontrolled high blood pressure, smoking, recreational drug usage, infection, or even high cholesterol leading to atherosclerosis can also put a person at risk of developing a brain aneurysm.

What happens if the brain aneurysm ruptures?

As the brain aneurysm extends over time, the arterial wall of the aneurysm can ‘thin out’ and may eventually rupture. Once the aneurysm is ruptured, the blood will spill into the brain space known as the subarachnoid region. This is an area that is usually filled with cerebrospinal fluid that cushions the brain. The bleeding blood causes inflammation and swelling over the surrounding brain tissue. Simultaneously, the brain region that is supposed to receive blood supply from the aneurysm is deprived of blood supply, leading to a stroke.

To make things worse, the massive outpour of blood from the aneurysm, brain inflammation and swelling will lead to fluid and pressure build-ups in the enclosed brain area. This can crush the brain tissue against the solid skull or force the brain to shift or herniate.

One can become terminally ill very quickly with confusion, coma, paralysis, stroke symptoms, or even death.

mri brain aneurysm
A brain MRI can help to identify if you are experiencing a brain aneurysm and is often life-saving.

The role of Diagnostic Imaging in screening for brain aneurysm

A Brain Magnetic Resonance Imaging (MRI) is safe, pain-free, and reliable to screen for brain aneurysm(s). It allows one to understand the brain structures, including the arteries and the veins in the brain. An MRI can visualise succinctly the size, location, character of the aneurysm (if any), and potential progression or effect from the aneurysm.

Sometimes, your doctor may recommend a brain MRI with contrast dye to facilitate the structure of the blood vessels in the brain. 

A brain MRI can serve as a way of detecting aneurysms in high-risk asymptomatic individuals or symptomatic patients. This may be beneficial in facilitating the physician (usually a neurologist or neurosurgical specialist) to decide the patient's future management. This includes monitoring the progression of the aneurysm closely or taking a proactive approach to surgically repairing the aneurysm. 

In the case of an acute rupture of a brain aneurysm, a computed tomography (CT) scan and brain MRI serves as a diagnostic life-saving imaging option to confirm the diagnosis, assess the extent and severity of the effect, thereafter allowing the physician to plan the immediate next best course of action for the patient.

What can I do if I have a brain aneurysm?

You are advised to follow up with your neurologist or neurosurgical specialist regularly to monitor the progression of the brain aneurysm.

In terms of lifestyle:

medial attention brain pain
Seeking medical attention when something feels amiss can save your life.

Health is our biggest wealth… Without health, nothing is important

If you have any modifiable risk factors above, you should speak to your doctor about lifestyle alternatives to lower your risk of developing a brain aneurysm. If you have concerns about family history and personal history of potential undiagnosed brain aneurysms, discuss with your doctor for appropriate medical screening tests and follow-up.


  1. Jersey AM, Foster DM. Cerebral Aneurysm. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507902/
  2. Ellegala, Dilantha B, MD; Day, Arthur L, MD.  Ruptured Cerebral Aneurysms. The New England Journal of Medicine; Boston Vol. 352, Iss. 2,  (Jan 13, 2005): 121-4.
  3. Novitzke J. The basics of brain aneurysms: a guide for patients. J Vasc Interv Neurol. 2008 Jul;1(3):89-90. PMID: 22518230; PMCID: PMC3317292.
  4. “Cerebral Aneurysms,” National Institute of Neurological Disorders and Stroke, 2024, https://www.ninds.nih.gov/health-information/disorders/cerebral-aneurysms.

Aches and pains remain one of the common reasons people visit the clinic. Both patients and doctors sometimes tend to brush the issues away and treat these symptoms with simple pain relievers before issuing medical certificates. But are we doing enough to address any possible underlying issues?

What is arthritis?

Arthritis is a broad term for inflammation in and around a joint. There are more than 100 different types of arthritis [1]. Generally, arthritis manifests with joint pain as the primary symptom, and you also experience the occasional joint stiffness and swelling.

The point is that sometimes, we overlook or dismiss persistent aches and pains as mere inconveniences. However, it is important to recognise that these symptoms may indicate underlying conditions such as arthritis, which may require more comprehensive evaluation and management.

Arthritis is characterised by inflammation in and around a joint.

What are the common symptoms of arthritis?

Symptoms of arthritis include: 

These symptoms can vary in how they appear. They may show up intermittently, meaning they come and go. Alternatively, they could be consistently present and remain the same over time. Sometimes, the symptoms may be progressive, meaning they worsen with time.

How common is arthritis in Singapore?

In Singapore, common musculoskeletal diseases affecting patients include rheumatoid arthritis, gout, and osteoarthritis.

According to the Global Burden of Diseases (GBD) 2019 study [2], musculoskeletal diseases rank among the top 5 broad causes of medical conditions leading to disability and overall health burden [3]. This means that these conditions significantly impact a person’s ability to function and contribute to the overall burden of healthcare.

Am I at risk of developing arthritis?

When it comes to arthritis risk factors, we can categorise them into two main groups: modifiable and non-modifiable factors.

Modifiable risk factors include:

smoking arthritis
Smoking increases the risk of arthritis.

Non-modifiable risk factors include:

What are the common types of arthritis?

While there are over 100 types of arthritis, we can broadly classify them into the following:

metabolic arthritis
Gout is a form of inflammatory arthritis often associated with metabolic syndrome, thus earning it the name of metabolic arthritis.

What are the differences between rheumatoid arthritis, gout, and osteoarthritis?

Rheumatoid arthritisGoutOsteoarthritis
Cause/type of arthritisAutoimmune disorder – the body’s immune cells attack their own bodyInflammatory – high purine diet and lifestyleMechanical – progressive wear and tear of joints
Joint locationSmall joints such as hands/feet are usually symmetrical in nature (though larger joints can be affected)Single joints such as big toe/feet/ankle/kneeLarge weight-bearing joints such as hip and knee
Pain onsetProgressive, though symptoms can be acute during a flare-upAcute, which intensifies progressivelyInsidious and progressive
Associated symptoms- Affected joints can be warm, tender to touch, and swollen-Lethargy-Weight loss-Fever-Affected joint is likely warm, tender to touch and swollen-Fever-Cracking of the joints-Worsening pain upon repeated use of the joint/end of the day
Other systemic symptoms-Chest pain-Shortness of breath-Reduced exercise tolerance-Red eyes-Rash-Hair loss-Blood in urine-Painful urination-Lower back pain associated with kidney stones-Possible associated chronic conditions such as hypertension/ hyperlipidaemia/ diabetes -Spine/back pain due to ageing/degenerative process-Associated raised BMI/obesity

When should I consider seeing my doctor, and what can my primary doctor do?

If you notice symptoms of arthritis, such as joint pain, swelling, and stiffness, you should speak to your primary care doctor. They will evaluate your symptoms based on your medical history and physical examinations of the joints. Your doctor may also recommend blood tests and X-rays to confirm the nature of your condition.

Determining the specific type of arthritis you have is crucial as it guides the choice of the most appropriate treatment plan. Early diagnosis and proper management can help you effectively address arthritis and improve your overall joint health and quality of life.

diagnosing arthritis
A doctor can help evaluate your symptoms and diagnose you accurately.

What should I expect when I see my doctor for arthritis?

The primary goal of seeking prompt medical attention when you experience symptoms of arthritis is to ensure you receive an accurate diagnosis and early treatment without further delay. This approach aims to effectively manage and alleviate your symptoms and prevent the condition from progressing.

The key objectives for arthritis treatment are to:

In cases of autoimmune arthritis, such as rheumatoid arthritis, your doctor may refer you to a rheumatologist or orthopaedic specialist for specialised care and management.

What happens if I don’t treat or diagnose arthritis?

When arthritis is left untreated, it has the potential to cause permanent and irreversible damage to your joints [15]. This can result in a loss of joint function, ultimately leading to difficulties in carrying out your daily activities and routines.

In certain forms of arthritis, particularly rheumatoid arthritis, the impact can extend beyond the joints, affecting other vital organs, including the heart, eyes, kidneys and lungs [16]. This highlights the importance of managing joint symptoms and addressing the underlying causes and potential complications associated with arthritis.

Is there a cure or treatment for arthritis?

There is no cure for arthritis; however, as previously mentioned, the primary goal in treating arthritis is to manage symptoms; this includes:

The specific treatment for arthritis depends on the type and underlying causes of the condition. While a primary care doctor can diagnose arthritis, there may be situations where collaborative care with specialists from various disciplines is necessary.

You may be offered medication based on the type of arthritis to control the symptoms. Additionally, your doctor will guide you on suitable regular physical exercises to keep your affected joints active and ensure your overall functionality is not compromised. In more severe cases, surgical options may be considered to manage the affected joint.

In conclusion

Listening to your body and recognising the symptoms it is signalling is the crucial initial step in addressing a potential arthritis condition. Taking the proactive step of getting checked and evaluated by your general practitioner is essential to addressing a brewing arthritis condition. So, don’t delay further; seek medical attention to start the journey toward diagnosis and appropriate treatment!


  1. Arthritis Foundation. (2023, September 25). How Arthritis Hurts. Retrieved from Arthritis Foundation: https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/sources-of-arthritis-pain
  2. Shiwen Liu, B. W. (2022). Global burden of musculoskeletal disorders and attributable factors in 204 countries and territories: a secondary analysis of the Global Burden of Disease 2019 study. BMJ Open, doi: 10.1136/bmjopen-2022-062183.
  3. Ministry of Health. (2020, December 30). Disease Burden. Retrieved from Ministry of Health Singapore: https://www.moh.gov.sg/resources-statistics/singapore-health-facts/disease-burden
  4. Kathleen Chang, S. M. (2014). Smoking and Rheumatoid Arthritis. International Journal of Molecular Sciences, doi: 10.3390/ijms151222279.
  5. Benjamin Raud, C. G.-A. (2020). Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Nature.
  6. Rees, M. (2022, May 27). What to know about post-traumatic arthritis. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/post-traumatic-arthritis
  7. Medline Plus. (2016, August 25). Infectious Arthritis. Retrieved from Medline Plus: https://medlineplus.gov/infectiousarthritis.html
  8. A. Shane Anderson, R. F. (2010). Why is Osteoarthritis an Age-Related Disease? Best Practice & Research: Clinical Rheumatology, doi: 10.1016/j.berh.2009.08.006.
  9. Vollenhoven, R. F. (2009). Sex differences in rheumatoid arthritis: more than meets the eye... BMC Medicine, doi: 10.1186/1741-7015-7-12.
  10. Júlia Kurkó, T. B. (2013). Genetics of Rheumatoid Arthritis — A Comprehensive Review. Clinical Reviews in Allergy & Immunology , doi: 10.1007/s12016-012-8346-7.
  11. Chang, X. (2021). Degenerative or Mechanical Arthritis. Journal of Arthritis.
  12. Rachel Nall, S. B. (2023, May 30). Autoimmune arthritis: Types, symptoms, and treatment. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/322975
  13. Arthritis Foundation Organisation. (2023, September 25). Infectious Arthritis. Retrieved from Infectious Arthritis- Arthritis Foundation: https://www.arthritis.org/diseases/infectious-arthritis
  14. Edward Roddy, M. D. (2010). Gout. Epidemiology of gout. Arthritis Research and Therapy, doi: 10.1186/ar3199.
  15. John P. Cunha, C. B. (2023). What Will Happen if Arthritis Is Left Untreated? Retrieved from eMedicine Health: https://www.emedicinehealth.com/ask_what_will_happen_if_arthritis_left_untreated/article_em.htm#doctor%E2%80%99s_response
  16. Rheumatology & Immunology, Singapore General Hospital; Department of Orthopaedic Surgery. (2021). Rheumatoid Arthritis. Retrieved from SingHealth: https://www.singhealth.com.sg/patient-care/conditions-treatments/rheumatoid-arthritis

What is pruritus ani?

Pruritus ani, also known as anal itching, is a medical condition where a person experiences itchiness around the anal region. You may notice that the itchiness worsens at night or when you are having a bowel movement [1]. 

There are two types of pruritus ani, these are:

While this condition does not threaten your internal health and body, it can affect you psychologically. This includes disrupting your sleep quality, affecting your mood, and even leading to embarrassment when symptoms occur in public.

itchy bottom
Itchy bottom, also known as pruritus ani, is characterised by itchiness around the anal region.

What are the causes of pruritus ani?

As previously mentioned, most cases of pruritus ani have no apparent cause. However, sometimes, it can be seen as an early warning sign of an underlying medical condition. Some possible causes of pruritus ani include:

Skin conditionsInfectionsStructural causesSystemic medical conditionsMiscellaneous (food and medication)
-Eczema-Contact dermatitis-Psoriasis-Seborrhoeic dermatitis-Fungal infection-Threadworms-STDS (herpes, scabies, warts, chlamydia)-Piles/haemorrhoids-Cyst-Fissure-Abscess-Tumour/growth-Thyroid disease-Diabetes-Iron deficiency anaemia-Liver disease-Colchicine-Peppermint oil-Antibiotics-Food such as milk, spices, chilli peppers 

What can exacerbate pruritus ani?

The symptoms of an itchy bottom can be exacerbated by: 

Stress can exacerbate the symptoms of an itchy bottom.

Is pruritus ani suggestive of having STDs?

While there can be various reasons for experiencing anal itching, it is essential to be aware that an untreated STD may potentially be a cause [2]. If the itch persists or becomes more severe and frequent, it is advisable to consult your doctor, especially if you have had a concerning exposure in the past.

It is important to know that STD-related pruritus ani is typically treatable, but diagnosis and prompt treatment by a healthcare professional is necessary.

What STDs are associated with pruritus ani?

If you are worried about contracting an STD and experiencing anal itching, you can discuss it with your doctor. Common STDs linked to anal itching are outlined below:

Bacterial STDsChlamydia, Gonorrhoea
Viral STDsWarts (HPV), Herpes Simplex Virus (HSV)
Mites STDsScabies, Pubic lice/crab

You should speak to your doctor if you notice persistent or worsening peri-anal itch. Consider undergoing STD screening and seek early medical treatment if you test positive.

What should I do if I experience anal itching or symptoms to suggest pruritus ani?

If you find that the itching in your anal area persists or worsens in terms of frequency and intensity, it is recommended that you seek medical advice. Since there can be multiple underlying causes for pruritus ani, it is crucial to have a thorough examination by a healthcare professional. This will help identify potential causes and ensure you receive appropriate treatment for your symptoms.

What should I expect when seeing my doctor for anal itching?

When you consult your doctor regarding anal itching, they will begin by taking your medical history and conducting a physical examination. During this examination, your doctor will carefully inspect the external skin around the anal area, checking for any lumps, bumps, or rashes. In some cases, your doctor may suggest an anoscopy procedure, which involves using a proctoscope to examine the anal canal for any abnormalities visually.

Depending on your specific concerns and medical history, you may be recommended additional tests, such as swabs or blood tests. These tests help further assess the situation and determine any underlying causes for your symptoms.

Anoscopes are used to examine the anal region to check for abnormalities visually.

Is anal itching or pruritus ani a sign of me being unhygienic?

Interestingly, while poor hygiene practices can contribute to skin problems and make you more susceptible to skin inflammation and itching, it is essential to note that perianal itching is typically not a result of inadequate cleanliness. In fact, individuals with pruritus ani often tend to be very concerned about hygiene and, as a result, may excessively and vigorously clean the affected area with soap and water. Paradoxically, this excessive cleaning can damage the skin’s protective barrier and lead to irritation, worsening the itching symptoms.

How can I treat anal itching?

If there is a specific underlying medical condition, your doctor may prescribe targeted treatments such as topical steroids, antifungal creams, deworming medications, or antibiotics to address the root problem. In cases involving structural issues such as haemorrhoids or anal fissures, your doctor will offer guidance on further treatments, which may include surgery.

However, pruritus ani may not have a clear cause in many instances. In such situations, you are advised to:

Excessive sweating and humidity can exacerbate symptoms of anal itching.

Will pruritus ani symptoms recur?

If the root medical problem is treated successfully, the itching symptoms can resolve independently. However, in cases where the cause of pruritus ani remains unknown, the itching can persist and become a chronic issue, which can be quite frustrating for you. In more chronic cases, your doctor may recommend consulting a dermatologist or a colorectal surgeon for further evaluation and management [3].

What symptoms are associated with pruritus ani that I should be worried about?

Symptoms or red flags that warrant you to seek medical attention immediately include:


Pruritus ani can be frustrating for you and your physician because identifying the root cause can be challenging. Discussing this with your physician may feel embarrassing and daunting, but it is crucial to do so, especially if there is a chance of treatable or reversible causes such as STDs. You can receive the most appropriate and effective treatment through a thorough examination and screening for potential infections and other factors. It is essential not to let embarrassment deter you from seeking the help you need.


  1. Seok-Gyu Song, S.-H. K. (2011). Pruritus Ani. Journal of the Korean Society of Coloproctology, 54-57.
  2. K Manavi, A. M. (2004). The prevalence of rectal chlamydial infection amongst men who have sex with men attending the genitourinary medicine clinic in Edinburgh. International Journal of STD and AIDS, 162-164.
  3. Matas Jakubauskas, A. D. (2023). Evaluation, management and future perspectives of anal pruritus: a narrative review. European Journal of Medical Research, doi: 10.1186/s40001-023-01018-5.

Topical Use of Steroid in Dermatological Condition: To Use or Not To Use?

Steroid medication is often labelled as a ‘bad’ medication with numerous side effects. Then why do doctors still prescribe this medication to patients?

In this article, we will clarify some pressing questions that the public may have regarding topical steroids. We also hope to encourage patients to consider the appropriate use of topical steroids in order to achieve treatment control of dermatological conditions.

What are topical steroids?

Topical steroids are steroid medications applied to the skin surfaces and are usually prescribed as a treatment for skin disorders. 

There are 3 main functions of topical steroid creams: 

Upon usage of the right type and amount of topical steroid, one may notice alleviation of skin symptoms such as itch or burning sensation.

Topical steroids
Topical steroids are applied on the skin where treatment is required.

What are the types of topical steroids?

You may notice that your doctor prescribes you various tubes of medication with various colour coding. In general, topical steroids are categorised based on their strength or potency and formulation. The higher the potency or strength of the topical steroid, the more effective it is to reduce inflammation.

Steroid potency

Topical steroids can be further subdivided depending on their formulation, this is also known as the ‘vehicle’ of the topical steroids. Different areas of the skin have different levels of thickness, as such, it is important to use the appropriate formulation to ensure sufficient penetration and absorption of the medication into the skin.

Vehicle/formulation of the steroidWhere is it suitable for
LotionAreas with more hair follicles – face, scalp
CreamMoist and weepy areas
OintmentDry and thick skin
Formulation of steroid
Different areas of the skin and dermatological issues require different types of steroid formulas.

Your doctor will guide you on which type of topical steroid is advisable based on your individual skin condition. Do speak to your doctor if you are unsure which type of topical steroids is suitable for you.

What are the side effects of topical steroids?

There are potential side effects to topical steroid application known as local or systemic side effects of steroids. Local side effects are defined as side effects that are localised on the affected skin area that was exposed to steroids. Systemic side effects, on the other hand, are side effects that affect a person’s overall body and internal organs.

Local side effectsSystemic side effects
Initial stinging/burning sensationSkin thinning/atrophyStretch marksBruisingThin blood vessels (telangiectasia)Hair growthWorsening of acne/rosacea/perioral dermatitisFluid retentionElevated blood pressureOsteoporosisCushing’s syndrome

What are topical steroid withdrawal (TSW) symptoms?

There are also multiple discussions on topical steroid withdrawal (TSW) [3], also known as red skin syndrome. These are a sub-section of patients who face extreme side effects when discontinuing the use of topical steroids. Some have even documented their journey of withdrawing from steroid treatment and their remorse for using them in the first place. So how can something so “bad” be a good idea to begin with?

TSW is a cluster of symptoms that occur when an individual develops a physical dependence on the topical steroid. This tends to occur in situations when a person has been using topical steroids for prolonged periods inappropriately, using moderate to high potency steroids, or excessive frequency usage of topical steroids. 

Rebounding or ‘withdrawal’ symptoms with worsening skin conditions such as itch and burning/stinging of the skin may occur upon discontinuation of topical steroids. TSW is a combination of topical steroid addiction, steroid eczema, and red skin syndrome. TSW commonly affects the face and genital region.

TSW remains a challenge for both physicians and patients to diagnose and manage. Currently, there is insufficient data to conclude the definitive cause of this condition. However recent research [4] has indicated that TSW is more commonly seen in adult women who apply mid- or high-potency topical corticosteroids to the face or genital region. Additionally, risks of side effects also occur with inappropriate use of topical steroids such as prolonged periods of topical steroid usage or exposure without tapering or periodic breaks [5].

What is the correct way of applying topical steroids?

You are advised to discuss with your doctor on the frequency and quantity of application of topical steroids that you are prescribed. We also suggest discussing plans on safely tapering off from topical steroid usage to avoid extreme TSW outcomes. 

As a rule of thumb, topical steroids are applied once or twice a day (maximum) in small amounts on the affected skin area or inflamed region. The quantity of topical steroids is measured by fingertip units (FTUs). One FTU of topical steroids is the amount squeezed out of a standard tube covering an adult’s fingertip (just like expressing toothpaste out of a tube). One FTU of medication is adequate to cover 2 flat surface areas of an adult’s palm.

Red skin syndrome
Have a tapering-off topical steroid plan with your doctor beforehand to avoid TSW.

What are the common mistakes and myths about using topical steroids?

Topical Steroids: To Use or Not To Use?

As with any medication prescribed, if a medication is administered for the right condition at the right dose, right method, and right frequency, the symptoms will resolve or improve. Every medication has potential side effects. It is pertinent that patients and practitioners take accountability and be proactive in dealing with the prescribed medication. If topical steroids are used judiciously, they are safe and effective in managing certain dermatological conditions

Frequently asked questions

Should I use topical steroids and moisturiser together?

Yes. Using both topical steroids and moisturiser allows for better absorption of the steroid medication and at the same time provides a good seal to the skin barrier with moisturiser to reduce further inflammation. Although there is no hard and fast rule, you can consider applying topical steroids to the affected area. After 15-30min, you can then apply a layer of moisturiser to the skin.

Is there a maximum duration to use topical steroids?

Generally, we suggest following your doctor’s guidance on the duration of topical steroid treatment as every patient’s condition may differ. Every case is subjective to the patient’s condition.

Typically you are advised for a short course (3 days to a week) of a suitable strength or strong topical steroid to manage your skin condition. Once the skin condition is under control, the topical steroid can be tapered to a weaker steroid. This approach involves the use of short bursts of high-strength topical steroids which is clinically proven to be an effective way of managing skin conditions.

In some patients who have recurring flare-ups of skin conditions upon withdrawal of topical steroids, short use of topical steroids (weekend therapy) to prevent flare-ups can be considered. In such a situation, your doctor may advise you to use the steroid cream over the frequent flare-up sites of the skin twice a week to prevent flares. 

Your doctor may want to understand the triggers of your skin condition and tailor your topical treatment regimen based on your triggers and symptoms. Speak to your doctor without further hesitation.


  1. Mayo Clinic (2022) Dermatitis, Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/dermatitis-eczema/symptoms-causes/syc-20352380#:~:text=Dermatitis%20is%20a%20general%20term,ooze%2C%20crust%20or%20flake%20off. (Accessed: 06 July 2023). 
  2. Whelan, C. (2021) Autoimmune hives: Causes, symptoms, treatments, and more, Healthline. Available at: https://www.healthline.com/health/skin/autoimmune-hives#causes (Accessed: 06 July 2023). 
  3. Hewett, L. (2022) TSW: What the eczema community needs to know, National Eczema Association. Available at: https://nationaleczema.org/blog/tsw-need-to-know/#:~:text=The%20potentially%20debilitating%20symptoms%20of,%2C%20fatigue%2C%20depression%20and%20disability. (Accessed: 06 July 2023). 
  4. Hajar, T. et al. (2015) A systematic review of topical corticosteroid withdrawal, Journal of the American Academy of Dermatology. Available at: https://www.jaad.org/article/s0190-9622(14)02209-9/fulltext (Accessed: 06 July 2023). 
  5. National Eczema Association (2021) Appropriate use of topical corticosteroids, National Eczema Association. Available at: https://nationaleczema.org/appropriate-use-of-topical-corticosteroids/ (Accessed: 06 July 2023). 
  6. S, D.A. (2017) Use of topical corticosteroids in dermatology: An evidence-based approach, Indian Journal of Dermatology. Available at: https://pubmed.ncbi.nlm.nih.gov/28584365/ (Accessed: 06 July 2023). 

Recently a patient walked into the clinic with a concern of acne on the shoulder that has remained unresolved over the course of several months. 

What comes to mind? 

He has a previous diagnosis of hypertriglyceridemia– elevated triglyceride levels in the flood. The rash that this patient mistook as acne is, in fact, eruptive xanthomas. Not all rashes are merely a skin condition. Rashes may be more than skin deep and suggestive of an underlying medical condition that has yet to be addressed. 

The objective of this article is to promote awareness on the possibility of a warning sign of systemic cardiovascular health issues. This is when a person is plagued with a seemingly benign dermatological rash.

Eruptive xanthoma is commonly confused as acne.

What are eruptive xanthomas?

Eruptive xanthomas are small (less than 1cm) yellow-hued papules with a reddish rim that can be seen over the shoulders, upper back, neck, abdomen, face, knees, and the buttock region. They can be slightly tender and/or itchy.

While uncommon, eruptive xanthoma can be noticeable if a person has it. Eruptive xanthomas can be seen in 8.5% of patients with severe hypertriglyceridaemia. The lesions are benign and can resolve over time with treatment and management of the triglyceride level. 

Why is it so important to pick up the findings of eruptive xanthomas?

As mentioned, it is associated with severe hypertriglyceridaemia which is a condition where a person’s blood has abnormally elevated or high concentrations of triglycerides (a type of fat). If this is left unattended, you can be at risk of cardiovascular complications such as a stroke, coronary heart disease, heart attack, or even pancreatitis

If you have an unexplained rash that is yellowish with a red rim and you are concerned that it could be a sign of eruptive xanthomas, do see a doctor to get yourself checked.

You could be at risk of cardiovascular complications with elevated levels of triglycerides.

What are triglycerides?

Triglycerides are lipids (fats) that can be found in your bloodstream. Triglycerides are made up of fatty acids (both saturated and unsaturated) and glycerol (a form of sugar).

They are produced from extra carbohydrate, alcohol, and glucose that we consume and are stored in the fat cells of our body. Our liver also naturally produces triglycerides. Triglycerides are used as a source of energy when required or when you are in between your meals. 

What is the difference between triglycerides and cholesterol?

Triglycerides are stored unused fat cells or calories. These provide your body with energy when required. Cholesterols, on the other hand, are proteins that help to synthesise cells and hormones. 

What is hypertriglyceridaemia?

Hypertriglyceridaemia is a common medical condition that is often encountered when a person performs a blood test for lipid screening as part of a cardiovascular risk workup. It is defined as an abnormal concentration of triglycerides in the blood. A normal triglyceride level is less than 150 mg/dl. 

According to the Ministry of Health (MOH), Singapore, Clinical Practice Guidelines for lipid, the definition of hypertriglyceridaemia is as below:

Who is at risk of developing hypertriglyceridaemia in Singapore?

There are several factors that may increase your risk of developing hypertriglyceridaemia, these are:

Upper abdominal pain could be a sign of hypertriglyceridaemia.

What are the symptoms of hypertriglyceridaemia?

Patients with elevated triglyceride are usually asymptomatic. However, they may have non-specific symptoms when the triglyceride level is greater than 1000 to 2000 mg/dl. 

Clinical symptoms include:

You are advised to seek medical attention if you develop any of the above symptoms to evaluate further any underlying medical conditions.

Xanthelasmas are a common symptom in individuals with elevated triglycerides or hypertriglyceridaemia.

What is the cause of hypertriglyceridaemia?

Hypertriglyceridaemia can be subcategorised into primary and secondary causes: 

You are advised to discuss with your doctor with regards to your family history and general lifestyle patterns. Your doctor will be able to identify any modifiable causes of hypertriglyceridaemia and work out a feasible health care plan to improve and monitor your triglyceride level, simply make an appointment with us. 

Should I be worried if my triglyceride levels are high?

When triglyceride levels are elevated, a person can be at risk of pancreatitis. The risk for pancreatitis is elevated when the triglyceride level is more than 1000 mg/dl.

As elevated triglyceride is often associated with other abnormal lipid readings such as low high-density lipoprotein (HDL), high low-density lipoprotein (LDL) hypertension, diabetes, obesity, and metabolic syndrome, it can hence also be associated with a higher risk of cardiovascular issues such as coronary heart disease and stroke accidents. 

How often should I screen for my triglyceride/lipid level?

If you are in adulthood, you may consider screening your cholesterol (including triglyceride levels) at least once every 2-3 years, as cholesterol levels tend to increase as we age. You are advised to speak to your health care provider, as you may be offered the tests more frequently depending on your previous results and underlying medical risk factors.

general health
Regular general health screenings can help identify underlying medical conditions.

What should I expect when I see my doctor to check my triglyceride/lipid levels?

Your doctor will obtain a medical and social history to understand your general health status and background lifestyle. Your doctor may also obtain a family history for cardiovascular risk factor assessment. A physical examination covering the cardiovascular system will be offered. Depending on your individual risk factors, your doctor may advise for blood tests to screen for cholesterol profile, diabetes screening, and other vital organs screening.

What are the treatments available for hypertriglyceridaemia?

The aim of treating hypertriglyceridaemia is to prevent and reduce risk of pancreatitis and cardiovascular disease. 

Your doctor will advise you on lifestyle modifications, such as:

If lifestyle changes are inadequate to control the triglyceride level, your doctor may prescribe you with oral medications to manage the levels. The risks and benefits of individual pharmacological options will be discussed prior to prescribing. Medication options include omega-3 fatty acids, fibrate, niacin, or statin

Take home message

While hypertriglyceridaemia is a medical condition that is generally asymptomatic, our body may signal us with vague symptoms such as rash or gastrointestinal symptoms to warn us of an underlying brewing medical condition. Take care of your cholesterol and triglyceride level with early screening and testing with us!


  1. Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ. 2007 Apr 10;176(8):1113-20. doi: 10.1503/cmaj.060963. PMID: 17420495; PMCID: PMC1839776.
  2. Eruptive xanthoma associated with hypertriglyeridaemia and diabetes. (n.d.). Retrieved from https://www1.racgp.org.au/ajgp/2023/june/eruptive-xanthoma-associated-with-hypertriglyerida#:~:text=Severe%20hypertriglyceridaemia%20is%20considered%20the,like%20lipoprotein%20lipase%20deficiency%2C%20familial 
  3. Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Triglycerides and Cardiovascular Outcomes-Can We REDUCE-IT ? Int J Angiol. 2020 Mar;29(1):2-11. doi: 10.1055/s-0040-1701639. Epub 2020 Feb 25. PMID: 32132810; PMCID: PMC7054063.
  4. Sandhu S, Al-Sarraf A, Taraboanta C, Frohlich J, Francis GA. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis 2011; 10:157
  5. Al Aboud AM, Shah SS, Al Aboud DM. Xanthelasma Palpebrarum. [Updated 2022 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531501/
  6. Krupa K, Fritz K, Parmar M. Omega-3 Fatty Acids. [Updated 2023 Jan 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564314/
  7. Singh G, Correa R. Fibrate Medications. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547756/
  8. Djadjo S, Bajaj T. Niacin. [Updated 2023 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
  9. Sizar O, Khare S, Jamil RT, et al. Statin Medications. [Updated 2023 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430940/ 

What is urethritis?

When the opening of the urinary system— the urethra, becomes inflamed, it is medically known as urethritis or an infection of the lower urinary tract [1]. This medical condition can be due to an infection, or other non-infectious related causes such as excessive physical pressure, exposure to irritants, and catheter insertion.

Hence, it is worth paying attention to your symptoms and addressing the underlying condition rather than fobbing the symptoms off as a general discomfort or aches and pains.

Urethritis occurs when the urethra becomes inflamed.

What are the signs and symptoms of urethritis?

While some patients may have no symptoms, some patients exhibit the following:

If you develop any unusual symptoms to suggest urethritis, speak to your doctor for further screening.

What are the possible causes of urethritis?

Common infectious causes of urethritis include [1]:

Unfortunately, up to 35% of urethritis has no reason found [4].

Your physician will obtain a medical history and assess your symptoms to discuss with you further on the possible causes and triggers of your urethritis symptoms.

Urethritis is commonly caused by sexually transmitted infections (STIs).

How common is infectious urethritis?

Infectious urethritis related to STIs is on a resurging trend over the years. Interestingly, in 2021, the CDC STD epidemiology report showed a significant rise in syphilis, gonorrhea, and chlamydia cases [5]. The reduction of chlamydial infection reports may be secondary to limited access to medical services during the COVID-19 pandemic and due to asymptomatic/minimal symptoms presentation.

Urethritis can occur in any person who is sexually active, though it is most common in the younger cohort between the ages of 20-24 [4].

What are the red flags of urethritis and when should I see my doctor for urethritis?

Although some patients may have no symptoms in urethritis, others may experience symptoms such as painful urination, increased urinary frequency, lower pelvic pain, lymph node swelling, or abnormal vaginal discharge/smell (in females). Please seek medical attention for further evaluation if you are experiencing any of these symptoms.

What should I expect when I see my doctor for urethritis?

Your doctor will take a medical history including your social/sexual history and examine you physically. Physical examination includes examination of the genital region for abnormal skin changes, discharge, and swelling (this includes your lymph nodes). 

Most patients with urethritis may not have any signs of infection. Depending on your individual risk factors and presentation, your doctor may offer you urine tests or swab tests to screen further for possible infectious causes of urethritis.

doctor appointment
Make an appointment to see your doctor if you suspect that you have urethritis.

What are the tests available for screening of urethritis?

As every patient may have a different cause of urethritis, it is worth discussing your symptoms and letting your doctor examine you further to determine the next course of testing for further evaluation of your condition.

What are the treatment options for urethritis?

Treatment of urethritis is dependent on the underlying cause. Commonly, if urethritis is associated with an underlying infection, your doctor may offer you antibiotics for further treatment of the condition. If there are concerns of an STI, your doctor may advise your sexual partners to be treated as well to avoid recurrence or reinfection.

Will I have recurring urethritis?

Thankfully, most patients recover well following antibiotics treatment for urethritis. While some may take time to recover, most patients’ symptoms resolve spontaneously over time after treatment.

Approximately 10-20% of patients may have persistent symptoms or recurring infection after treatment.

It is important for patients to be followed-up if their symptoms are non-resolving or persistent. Adherence to antibiotic treatment therapy is also important and a reassessment of reinfection by an untreated partner or new partners are important to anaylse treatment options.

In recurring urethritis patients, after ruling out infectious causes/treatment failure, one should consider non-infectious causes including trauma or anatomical abnormalities that have been discussed previously. You will have to work with your doctor for further evaluation of your symptoms.

urethritis treatment
Most patients recover after treatment of urethritis.

What should I do after treatment of urethritis to avoid recurrence?

To avoid recurrence of urethritis, you should:


  1. Young, A., Toncar, A., & Wray., A. A. (2022). Urethritis. Treasure Island (FL): StatPearls Publishing.
  2. Herchline, T. E. (n.d.). Urethritis. Infectious Disease and Antimicrobial Agents.
  3. Joseph U. Igietseme, Y. O. (2015). Molecular Medical Microbiology (Second Edition). Academic Press.
  4. Whitaker, D. L. (2022, October 3). Urethritis. Retrieved from Medscape: https://emedicine.medscape.com/article/438091-overview
  5.  CDC . (2023). U.S. STI Epidemic Showed No Signs of Slowing in 2021 – Cases Continued to Escalate. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchhstp/newsroom/2023/STD-Surveillance-Report-2021-media-statement.html

Ever wondered why there are days we vigorously scratch our rashes or our friends drop comments stating our skin rash resembles a map? Sometimes the mere action of picking up a pen can induce an itch, which then leads to swelling and redness.

This is known as hives. And it’s more common than you would think. Read on to find out more about this itchy situation.

Reaction of hives on the skin

What is hives/urticaria?

Hives, medically known as Urticaria, comes from the term Urtica Dioica, the stinging nettle plant abundantly found in Europe. Hives are your body’s response to irritation and come in the form of little marks on your skin similar to mosquito bites.

Hives are typically represented by an itchy wheal (swelling of the skin) surrounded by the occasional redness. The wheal tends to be slightly paler than your surrounding skin colour, is swollen, very itchy, and with lesions. Thankfully, these will usually resolve within or after 24 hours.

If you notice wheals or have any persistent itchy redness on your skin, consult your doctor for proper treatment and ways to reduce or manage possible symptoms of hives and rashes.

What causes hives/urticaria?

Hives occur when there is a sudden release of a chemical agent (such as histamine) into your skin.

Histamine is a substance that causes blood vessels to dilate and leak, leading to extra fluid accumulation in the tissue. If this has occurred, you may experience swelling, warmness and a slight itch on the affected region.

There are a risk factors that trigger histamine to be released, these are:

An allergic reaction to food can cause hives.

The cause of your hives may be different from someone else. Determining this will require a medical history and/or physical examination.

Visiting your doctor can help to determine what your skin is reacting to and if you have hives.

What triggers hives/urticaria?

In some cases, patients with hives may have no known direct or obvious trigger for their condition but can be easily identified for others.

Below is a table with common stimuli that can induce hives, and depending on the type of stimuli, the condition can be further sub categorised.

StimuliName of the hives / urticaria
Cold temperature (cold air or water)Cold urticaria
Hot temperature (hot air or water)Heat urticaria
Sweat from to exercising/heightened emotionsCholinergic urticaria
Pressure on the skin surface from heavy bags, seat belts, bra straps, or belt linesDelayed pressure urticaria
Tight clothing or scratching of the skinDermographism
Towel drying after a hot showerVibratory urticaria
Contact with waterAquagenic urticaria
Substance absorbed through the skin from contact with latex, saliva, flour, meat, fish, vegetables, caterpillar, or stinging nettleContact urticaria
Hives can cause the skin to become very itchy.

What are the signs and symptoms of hives/urticaria?

It is important to note that these symptoms can sometimes be an early sign of an allergic reaction, which can potentially be dangerous. Always seek medical attention if you suspect you are having an allergic reaction.

You can discuss any concerns with your doctor regarding symptoms of hives for further evaluation and treatment.

Types of hives/urticaria

Hives can be categorised according to the duration of each symptom:

Chronic urticaria can be further sub categorised into:

How common are hives/urticaria in Singapore?

Hives are a very common condition in Singapore, affecting 1 in every 5 Singaporeans (42%) at some point in their lives. Although hives are not a life-threatening condition, its wax and wane periods are enough to cause some discomfort and disruption in their daily lives.

Consider discussing any concerns with your doctor if you are experiencing any symptoms of hives.

Is hive/urticaria a serious condition?

Hives are not a self-limiting condition but avoiding proper treatment can lead to anaphylaxis — a life-threatening allergic reaction.

You are advised to monitor your symptoms and resolve them if they do not show any signs of improvement and progresses to spread all over your body and face. This could then lead to a slew of other reactions such as shortness of breath, wheezing, and feeling faint.

If you experience any of the above, please seek medical attention immediately.

Seek immediate medical attention if you are having an allergic reaction

Are hives/urticaria contagious?

Luckily, hives are not infectious, and you will not contract it from someone with hives — be it airborne or through direct contact.

Are hives/urticaria an allergy?

While hives are a subset of allergy, it can occur without the presence of an allergen. Triggers such as dust mites, mould, pet dander, pollen, chemicals, drugs, latex, and food allergens can trigger hives-like symptoms. This can be confusing for both patients and physicians to deduce underlying medical conditions.

You are advised to speak to your doctor for further evaluation of any hives or allergy symptoms.

Can I die from hives/urticaria?

The short answer is there is a low chance of you succumbing to hives.

However, hives can be an early sign of anaphylaxis, which is a severe allergic reaction that can be fatal.

Signs of anaphylaxis include:

Anaphylaxis is a treatable medical condition. If you show any signs of anaphylaxis, you should seek immediate medical attention.

Do hives/urticaria suggest underlying medical conditions?

Hives can be a sign of an underlying medical condition, these include:

It is advisable to speak to your doctor if you notice any signs of hives or if symptoms of hives persist and worsen over a long period of time for further evaluation and treatment.

When should I see my doctor for hives/urticaria?

In most cases, hives symptoms are temporary and can be resolved on their own.

However, it is always recommended to see your doctor if symptoms:

What do I expect when I see my doctor for hives / urticaria?

Hives are usually clinically diagnosed by your doctor by viewing your medical history for a better understanding of what could be triggering your hives. Depending on your individual conditions or if your doctor suspects an allergic reaction, you may be offered to do an allergy test followed by allergy treatment. Occasionally, your doctor may also require blood tests to be done to evaluate and rule out any underlying medical condition you may have that could trigger hives.

Find out the causes and triggers of your hives with a doctor

Is there any treatment for hives/urticaria?

Mild or transient hives may resolve their own without any medical treatment. However, if 

the itchiness is troubling you on a daily basis – be it pain or other symptoms – that leads to feeling unwell or a fever, you are advised to seek medical attention for hives treatment.

If you show any signs or symptoms of hives, your doctor will usually prescribe you with antihistamines to reduce symptoms. For severe cases, steroid medication, H2-antagonist Montelukast, or newer injectables such as biologics omalizumab may be prescribed instead.

During your consultation, your doctor will go through some triggers that could possibly be causing hives and ways to reduce the chances of a recurrence.

What are the possible complications of hives / urticaria?

Although hives are not a life-threatening condition on its own, one fourth of patients with hives can have coexisting angioedema.

Angioedema is a medical condition that causes swelling and fluid build-up in the deeper part of the skin. It mainly occurs over the softer, gravitational-dependent regions of the body such as the eyes, lips, genitals, hands, and feet.

More importantly, hives can also be an early sign of an allergic response known as anaphylaxis. If you ever experience lightheadedness, narrowing of your airways, wheezing, swelling of your eyes and lips, feeling unwell or abdominal pain, please call an emergency hotline and seek immediate medical attention as a severe allergic reaction can lead to death.

A long-term patient of mine recently visited the clinic with an urgent presentation of coca-cola-coloured urine. She also complained of lower back and thigh muscle aches. In view of the unique presentation, the patient herself collected her urine in a bottle and showed it to me. 

Clinically, aside from mild lethargy and muscle aches and pain, she was feeling well. She was concerned about urinary tract infections and kidney stones. What do you think is wrong?

Rhabdomyolysis urine
Dark-coloured urine is one of the symptoms of rhabdomyolysis.

The reasonable thought process would be:
“Is there something wrong with my urinary filtration system’’

 “Is there an issue with my kidney or the bladder?’’

‘’ Do I have a urinary infection or a kidney stone, or even cancer?”’

Upon further history exploration, she stated that she had recently bought a new spin bike to work out at home and was immediately suspected of rhabdomyolysis after this revelation. In recent years, with an increase in spin class popularity and exercise bike workouts, a correlative trend of exercise-induced rhabdomyolysis has been observed– a condition less commonly heard of but can occur to anyone. 

The mention of “spin class” or “spin cycling” is sufficient to alert any experienced doctor about the possibility of rhabdomyolysis. I’m happy to report that the patient recovered uneventfully over time following the prompt diagnosis and treatment. 

What is rhabdomyolysis?

Simply put, rhabdomyolysis is a medical condition in which the breakdown of muscle tissues leads to a spike of protein in the bloodstream, subsequently clogging up the tubes in the kidney and leading to kidney injury or acute kidney failure. 

Clinical explanation of rhabdomyolysis

When the breakdown of the skeletal muscle occurs,  increased protein myoglobulin and creatinine kinase(CK) substances in the bloodstream cause kidney injury or kidney failure. A sudden rise of excessive myoglobulin and creatinine kinase proteins in the bloodstream clogs up the intricate tubing system of the kidneys, leading to kidney injury or acute kidney failure. 

These proteins are usually filtered and excreted through the kidney system. However, with an influx of these particles in the bloodstream, one can develop complications such as acute kidney injury/failure, electrolyte imbalance, heart rhythm abnormalities, disseminated intravascular coagulation (DIC) and other severe life-threatening medical risks.

What is exercise-induced (exertional) rhabdomyolysis?

Exercise-induced rhabdomyolysis in Singapore happens to be a recurring theme amongst spin class goers.

Exercised-induced rhabdomyolysis happens when a person undergoes intense physical exercise leading to a sudden or excessive muscle contraction and breakdown of skeletal muscles. This breakdown subsequently releases skeletal muscle proteins Into the bloodstream. 

How common is exercise-induced rhabdomyolysis in Singapore? 

Exercise-induced rhabdomyolysis
Increased reports of rhabdomyolysis in Singapore following spin class popularity.

Exercise-induced rhabdomyolysis has been more commonly reported in the medical literature since 2004. In Singapore, following the increased popularity of spin cycling classes, more cases of exercise-induced rhabdomyolysis have been seen in the local hospital in recent years.

In 2020, 4 cases were noted locally, while the number of cases of exercise-induced rhabdomyolysis has increased to 10 cases in 2022. Some cases may even be missed as patients may be misdiagnosed as having urinary tract infections following the presentation of blood in the urine. If you suspect that you have developed rhabdomyolysis, please seek medical attention.

What are the signs and symptoms of rhabdomyolysis?

Symptoms to suggest a person has rhabdomyolysis include:

rhabdomyolysis symptoms
Rhabdomyolysis can cause symptoms such as dizziness, lethargy, heart palpitations, and confusion.

What causes rhabdomyolysis?

Rhabdomyolysis can be categorised into exertional (exercise-induced) or non-exertional.

Non-exertional related rhabdomyolysis can be due to:

What are the common medications that can cause rhabdomyolysis?

Do speak to your doctor before considering taking medication to understand the possible side effects and suitable doses of the medications.

Some of the common drugs that can cause rhabdomyolysis include :

What do I expect when I see my doctor for rhabdomyolysis?

Diagnosing rhabdomyolysis would involve a number of steps:

  1. Your doctor will usually go through your medical history, and conduct a physical examination.
  2. A blood test to screen for your kidney function and creatinine kinase (CK) will be ordered. 
  3. A urine test would also be suggested to rule out other potential urinary system causes.
  4. In acute or severe cases, your doctor may refer you to the hospital for further management of the condition.
doctor patient
Always be honest when sharing your medical history with your doctor to ensure an accurate diagnosis and effective treatment.

What are the treatment options for rhabdomyolysis?

Thankfully, most patients with rhabdomyolysis recover uneventfully. The treatment goal involves early fluid resuscitation to maintain normal kidney function or to aid kidney function recovery over time. 

Treatment advice(s) include:

When should I go to the hospital if I have rhabdomyolysis?

If you develop acute symptoms such as feeling generally unwell, muscle aches, lethargy, or acute findings of dark, red, or brownish urine, please seek medical attention. Hitherto, there are no studies that evaluate the safety and any subsequent complication in the management of rhabdomyolysis as an outpatient. It is worthwhile seeing your doctor to get yourself checked and evaluated for further health advice.

You may be required to stay overnight at the hospital for observation due to rhabdomyolysis.

How can I prevent rhabdomyolysis?

There are ways to avoid exposure to the risks of rhabdomyolysis.

These include: 

Frequently asked questions

Can I treat and manage rhabdomyolysis at home?

In mild cases, one may be able to recover from symptoms with increased fluid hydration, though there is a lack of medical guidelines on the safety and possible complications following the management of rhabdomyolysis at home. 

Given the severity and dangers of the condition, self-diagnosis and attempts at self-management for recovery is advised against. If you ever suspect you may be dealing with rhabdomyolysis, please visit your doctor as soon as possible. 

Will I die from rhabdomyolysis?

In severe cases, mortality (death) from rhabdomyolysis is predicted to be at 59%.  However, these are not all exercise-induced rhabdomyolysis. Nevertheless, a risk of mortality does exist. 

Will I recover from rhabdomyolysis?

With prompt diagnosis and treatment, most patients with rhabdomyolysis recover without complication. Hence, you are advised to seek medical attention if you encounter any symptoms to give yourself the highest chance of recovery. 

How fast can I return back to physical activities after rhabdomyolysis?

Your doctor will usually evaluate your individual risk and medical possibilities of delayed recovery before advising you when you can return to your physical activities. Generally, you are advised to return to gradual sports 1-2 months after recovery with adequate rest, fluid hydration, and close monitoring of urine and blood tests.

Do you have a persistent genital itch or discomfort that does not seem to be going away despite repeated visits to your doctor? Is your partner feeling itchy as well?

You may want to consider broadening your differentials to include parasites that may be thriving and crawling around your genital region. Pubic lice infestation affects between 2 to 10 percent of the human population with outbreaks from as far back as the 1970s.

In this article, we will dive into the unpleasantries of pubic lice. As scary as it sounds, pubic lice can be treated. Do read on.

pubic lice stage
Pubic lice can appear in 3 stages.

What are pubic lice?

Pubic lice, also known as “pubic crab”, are considered parasite infestations that can happen in your genital region.

Pubic lice can appear in 3 stages, these are:

How common is pubic lice in Singapore?

Regardless of your gender, ethnicity, race or socioeconomical standing, pubic lice infestation can affect anyone in Singapore.

Adult Singaporeans commonly infect one another with pubic lice through sexual contact, however, it can spread through close personal contact such as sharing clothing, towels, and linen from someone infected with pubic lice.
If there is pubic lice infestation on a child, especially if seen on their head or eye lashes, this can suggest the possibility of sexual abuse. Although, they could have simply contracted it by sharing clothing, bedding or towels with someone infected with pubic lice.

pubic crab
Pubic lice can be passed on by sharing clothing, bedding, and towels

Where can I find pubic lice?

Pubic lice can be found in your genital region. It is possible to pick out lice in areas of your body where coarse hair is present such as your armpit, beard, eyebrow, eye lashes, legs, or body. If you notice lice on your head, it is most likely due to head lice as opposed to pubic lice.

What are the risk factors of being infected by pubic lice?

Pubic lice are unable to fly or jump, but can climb from the hairs of one person to another. This increases the risk of being infected with pubic lice through the following factors:

What are the signs and symptoms of pubic lice?

Signs and symptoms to look out for if you suspect you have been infected by pubic lice include:

How are pubic lice diagnosed?

Pubic lice are diagnosed by physically pinpointing out louse or nits on the hair in the affected region — your pubic region or other parts of your body. Sometimes a magnifying glass or dermatoscope may be used for a better view of the lice or nits.

magnifying glass
A magnifying glass may be used for a better view of pubic lice.

What should I expect when visiting my doctor concerning pubic lice?

During your doctor’s visit, your doctor will inspect areas of your body with hair. These areas include your genital region, body, armpit, eye lashes, eyebrows, and even scalp to fully screen the possibility of nits and lice. A comb and magnifying glass may be used to facilitate the visualisation of the lice in these areas.

Are pubic lice a Sexually Transmitted Disease (STD)?

Although passed on in a similar manner (through close contact and sexual intercourse), pubic lice are not considered a Sexually Transmitted Disease, but rather, they are a Sexually Transmitted Infection (STI). 

When a visit to your doctor’s office concerns pubic lice, you will most likely be advised to get screened for other types of sexually transmitted diseases and/or genital infections depending on individual risk factors. Your sexual partner will most likely be advised to get the same screening to reduce these risks.

What is the treatment for pubic lice in Singapore?

Thankfully, there is a cure for pubic lice and you do not have to live with this infestation.

Medication in the form of lotions, creams, or shampoos containing malathion, permethrin, pyrethrins or piperonyl butoxide can be used to kill pubic lice. You will be advised to apply the medication on your whole body to fully treat the infestation. This will need to be left on for 24 hours before washing off. You are required to repeat this cycle for a whole week (7 days) to ensure all pubic lice and nits are killed.

For any lice or nits that have made it onto your eyebrows or eye lashes, you will be advised to apply petroleum ointment onto your eyelids for 10 days as an additional treatment.

It is important that your sexual partner(s) also receive treatment to reduce their risk of a cross-infection; even if they are asymptomatic.

All clothing, towels, and bedding should be washed if you have pubic lice infestation.

What should I do after pubic lice treatment?

  1. Wash all clothing, towels and bedding in hot water (> 50℃). These should then be dry cleaned and placed in plastic bags for at least 2 weeks to ensure all lice are dead.
  2. Mattresses should be vacuumed and cleaned to eliminate the presence of lice.
  3. Avoid sharing personal items including combs, razor blades, tweezers, clothing, bedding, or towels moving forward.
  4. If you had more than 1 sexual partner within the past month, they should be traced and informed for screening and treatment of pubic lice. Additionally, they can be screened for the possibility of other sexually transmitted infections.
  5. Avoid sexual contact with others until the end of your pubic lice treatment.
  6. Protect yourself against pubic lice by avoiding close or sexual contact with anyone you know that is infected with pubic lice until they have sought and completed the right treatment.

It is important to know that contraception methods such as barrier contraception are not effective at preventing pubic lice infections.

Can I contract pubic lice by sitting on dirty toilet seats or a couch?

Although it is possible for pubic lice to survive 1 to 2 days without human tissue cells, they generally do not fall off from their hosts unless the host themselves die.

Therefore, it is not possible to contract pubic lice from dirty toilet seats or a couch. This is because pubic lice rely on human tissue cells for survival and they will not be able to stay alive on other surfaces for long without live cells.

Pubic lice also do not posses the abilities to fly or jump, only climb from one person to another through close or sexual contact.