Hydroxychloroquine ( Plaquenil® ) is a medication prescribed to treat some skin conditions including cutaneous lupus erythematosus, dermatomyositis and other light sensitive skin diseases. As long term use is associated with the risk of retinal damage, patients who are started on hydroxychloroquine must undergo baseline eye examination by ophthalmogists at Tan Tock Seng Hospital (TTSH).

NSC has recently introduced a basic eye screening service by trained nurses for patients starting Hydroxychloroquine. Senior Staff Nurse Priscilla Tan, who has an advanced Diploma in Ophthalmology, is in charge of providing in-house training for this service, which entails 6-monthly checks over a 5 year period for visual acuity, screening for maculopathy using the red-on-black Amsler chart and color vision screening. Patients with abnormalities detected during basic eye screening will be referred back to the ophthalmologist.

Basic Eye Screening Service Available For Immuno-Dermatology PatientsCindy Choi, Nurse Clinician

Our nurses at basic eye screening training.

The Director and Management of National Skin Centre wish all Muslim Readers

Selamat Hari Raya Puasa

As part of NSC’s 25th Anniversary celebrations, the Singapore Anti-Narcotics Association (SANA) has been adopted as our beneficiary in a charity fund raising project to help ex-offenders in need of tattoo removal, to facilitate their integration back into society.

Gaining employment for ex-offenders is essential in the process of social integration. However, many find difficulty in securing a job due to the visible tattoos on their bodies. Moreover, they face financial difficulties in affording laser tattoo removal treatments at standard rates. NSC will lend a helping hand by subsidsing the fees for tattoo removal and organising a 3km walk around Gardens by the Bay to raise awareness. All proceeds will go to SANA-NSC Laser Tattoo Removal Programme for ex-offenders. For registration and donations, email joelteo@nsc.gov.sg or call 6350 8244.

Date : 23 August 2014Venue : Garden by the Bay (Silver leaf garden)Registration Fees: Adult - $10, Student - $5, Child below 5yrs - FREE

Skin Facts

Education / Training

What is urticaria?

Urticaria is a common skin condition. It is also known as hives. The most common form is called ‘ordinary urticaria’ and it is divided into the ‘acute’ and ‘chronic’ types. Acute urticaria usually lasts from a few days up to six weeks. Chronic urticaria, by definition, lasts for more than six weeks. Physical urticaria and urticarial vasculitis are less common forms of urticaria.

How is urticaria diagnosed?

The diagnosis of urticaria can usually be made from the history and appearance, or description, of the hives. In the majority of people no cause can be found. Your doctor may ask you questions to try to identify one.

In acute urticaria, investigation is usually not necessary. Occasionally, if an allergic reaction is suspected, a specific blood test for allergic sensitization (RAST), or a skin prick test may be performed. Chronic urticaria is rarely caused by allergy; so routine allergy tests are not necessary. A blood test may be necessary to ensure that there is no underlying medical condition such as thyroid disease or infection. In a small percentage of people, foods, colouring agents or preservatives appear to worsen the urticaria. A food diary may be kept and the suspected substances can be omitted from the diet to see if the condition improves. These substances can later be reintroduced to see if it aggravates the urticaria. When physical urticaria is suspected, a physical challenge test may be performed.

What causes urticaria?

The cause of acute urticaria is frequently not found. Known triggers include:1. Allergies a. Food such as nuts, strawberries, citrus fruits, egg, food additives, shellfish. It can occur even if you have eaten it many times before without any problem. b. Insect bites and stings c. Medicines like penicillin, aspirin, and painkillers.2. Viral infections3. Contact e.g. chemicals, latex, cosmetics, plants, etc.

Like acute urticaria, there is usually no readily identifiable cause for chronic urticaria. It has been found that some cases of chronic urticaria may be autoimmune in nature. These patients have immune cells targeting the mast cells leading to the release of histamine. Physical urticaria is an interesting subtype ofurticaria. It is caused by a physical stimulus on the skin. Examples of physical stimuli are physical pressure on the skin, exercise, cold temperature, and sunlight.

Urticaria

Health Manpower Development Plan (HMDP) Report Dr Chuah Sai Yee, Associate Consultant

I recently completed my six-month HMDP training in Pigmentary, Hair and Nail Disorders at the Department of Dermatology, Hôpital l’Archet 2, Nice, France (from 17 October 2013 to 16 April 2014) under the supervision of Professor Jean-Philippe Lacour (Head of Department). Hôpital l’Archet 2 is part of Centre Hospitalier Universitaire de Nice (University Hospital of Nice) where the largest dermatology unit is located. It is a busy unit dealing with general dermatology and subspecialties such as pigmentary disorders, paediatric dermatology, skin cancers, hair disorders, psoriasis, dermatosurgery, genitourinary medicine. It also has a modern laser centre and a robust research centre.

I had the opportunity to spend time in all these clinics, particularly the pigmentary disorders clinic and laser centre unit under Professor Thierry Passeron where I gained experience and wider exposure in the management of various pigmentary disorders. I also joined Professor Philippe Bahadoran, who has a special interest in the non-invasive imaging of the skin using the reflectance confocal microscopy (RCM). RCM is a relatively novel technique, which allows non-invasive imaging of the epidermis and the upper dermis at a near-histological resolu¬tion, for the evaluation of pigmentary conditions, melanocytic lesions, and several inflammatory and neoplastic skin conditions. This may constitute an excellent alternative to invasive biopsy collection in the diagnosis of several skin disorders and would definitely be a useful tool to study hyperpigmentary disorders without the need for biopsies.

I hope to apply this knowledge gained in my clinical practice and start using the new RCM machine to study patients with pigmentary disorders. This will help us to better understand the condition in order to better manage affected patients.

Dr Chuah’s supervisor, Professor Jean-Philippe Lacour, Head of Department of Dermatology,

University Hospital of Nice (right).

Education / Training

Staff News

MOH HMDP Visiting Expert: Prof Detlef ZilikensAudrey Wong, Corporate Communications Executive

Prof Detlef Zilikens (in black blazer) with our doctors.

A/Prof Steven Thng Awarded Healthcare Humanity Award 2014Audrey Wong, Corporate Communications Executive

Prof Detlef Zilikens, Chairman of the Department of Dermatology in the University of Lübeck, Germany, visited NSC from 7 to 14 May 2014. He is an expert in autoimmune blistering diseases. His research lies in the development of diagnostic assays of serum antibodies in autoimmune blistering diseases, pathogenesis and management of autoimmune blistering diseases and other autoimmune connective tissue diseases.

Throughout his stay, he gave several lectures ranging from the pathogenesis of Pemphigus diseases, dermatitis herpetiformis to lupus erythematosus and dermatomyositis. Our doctors who attended his lectures found them very enriching. Prof Zilikens was also “impressed by the well structured residency programme.” He even thought that it “would be good to use the lunch time for structured learning back in Germany but it would be difficult as residents are busy in the ward providing both in-patient and out-patient care, resulting in very little time.”

NSC 25th Anniversary CelebrationAudrey Wong, Corporate Communications Executive

NSC celebrated its 25th Anniversary with fun and games on 17 April 2014. Games such as Charades, Bingo and Speedy Texting to test texting skills on mobile phones were held during lunch break. Staff were also encouraged to participate in a creative paper plate craft competition to post their well wishes on the “NSC Anniversary Wall” in the staff lounge.

In the evening, more games followed - an entertaining Don’t Forget The Lyrics and an exciting cup stacking race. Anticipation was in the air as the 25th Anniversary cake was presented to staff and the birthday song was sung. The celebrations ended perfectly as staff enjoyed a BBQ dinner in a casual setting in the outdoor garden.

CME Calendar

Seminar for Fees

GPs

GPs

$450*/ $500

$450*/ $500

Date

16 Aug, Sat

4 Oct, Sat

Title

Certificate of Competence: Chemical Peels

Certificate of Competence: Laser Hair Removal

*Early bird rate of $450 applies to registration made at least one month before the workshop.

For enquiries on our seminars and public forums, please call the Training Department at Tel: 63508477.You may also register online at www.nsc.com.sg

A/Prof Steven Thng was among the 76 recipients who received the 2014 Healthcare Humanity Award which recognises the efforts by healthcare staff across Singapore. The ceremony took place on 14 May 2014 at the Biopolis with President Tony Tan Keng Yam as the Guest of Honour.

A/Prof Thng volunteered his time on mission trips and joined other missionaries in a roving tuberculosis clinic to help the needy at several third world countries in Asia. His longest mission trip was to East Timor for six months in 1999 to 2000 to set up

an emergency centre in support of peacekeeping troops. He also set up the Melanocyte Culture Laboratory at the NSC to conduct research for a better treatment for Vitiligo. Due to lack of skin samples, he volunteered his skin cells for testing and the pigment clinic at NSC now offers comprehensive treatment for Vitiligo patients. A/Prof Thng said “I am humbled to receive the healthcare humanity award. I will continue to work with one purpose in mind, to improve the health of my patients and to bring them the best care possible for their conditions." Congratulations A/Prof Thng!

Staff News

This is an in-house publication for staff information only. Contents can be quoted or reproduced with permission of National Skin Centre (S) Pte Ltd.Designed and Printed by : Art N Craft Printing Pte Ltd

National Skin Centre 1 Mandalay Road Singapore 308205 Website: www.nsc.com.sgwww.facebook.com/NationalSkinCentre

APPOINTMENT Tel: 6350 6666 Fax: 6258 2475 RECORDED GENERAL INFORMATION Tel: 6350 6680For NSC Internet Appointment Booking, please login to www.nsc.com.sg

Editorial: Ms Audrey Wong Advisors: Clinical A/Prof Tan Suat Hoon, Mrs Tang Lee Foon

NSC Dinner & Dance 2014 – The OscarsAudrey Wong, Corporate Communications Executive

NSC Dinner & Dance was a night of glamour as staff were decked out in their best attire, staying true to the theme of The Oscars on 7 June 2014 at Marina Bay Sands. Pre- dinner entertainment was presented by our band of talented singing doctors. The night progressed to a new high as our Director, A/Prof Tan Suat Hoon wowed the audience with her opening song Over The Rainbow to welcome our Guest of Honour, Dr Muhammad Faishal Ibrahim, Parliamentary Secretary for Ministry of Health and Ministry of Transport.

A slideshow showcasing milestones over the past 25 years was dedicated to all staff to thank them for their contributions. Highlights of the night included several song and dance numbers by our very own staff members, taking “The Best Selfie” and inaugural awards such as Most Beautiful Heart and Most Diligent Staff being presented to Senior Staff Nurse Priscilla Tan and Mr Thomas Quek, Senior HR Executive, respectively. The Distinguished Friend of NSC Award was presented to Mrs Deby Sarojiuy Pala Krishnan, Chairman of NSC’s Medifund Committee since March 2011. Other awardees of the night are listed below. Congratulations to all!

Awardees

Dr Ng See Ket, Senior Consultant

Dr Mark Tang, Senior Consultant

Dr Emily Gan, Senior Resident

Dr Julia Lim

Dr Aaron Tan, Senior Resident, Mr Mohd Adnan Bin Mahmud, Nurse ClinicianMs Norlaila Bte Kamarudin, Assistant Nurse ClinicianMs Brenda Lim, Head of NursingMs Susila Theve, Senior Clinic Executive AssistantMs Ramasamy Retinam Anjalai, Patient Service Associate

Awards

Dean’s Award

NSC Best Teacher Award 2013

NSC Teaching Excellence Award for Senior Residents 2013 Yong Loo Lin Graduate School-National Skin Centre GraduateDiploma in Family Practice Dermatology Book Prize

Ego-National Skin Centre Dermatology Fellowship Awards

Bioderma-National Skin Centre Dermatology Fellowship Award

NSC Retirement Award 2014