By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Acne, commonly known as pimples, is one of the most common skin conditions affecting teenagers and adults. For some people, pimples appear occasionally and settle on their own. Others may experience persistent breakouts, inflamed pimples, dark marks or scarring. Having acne does not mean someone has poor hygiene or has done something wrong with their skincare. It is a common skin condition influenced by hormones, oil production, genetics and inflammation. While not everyone with acne requires medical treatment, understanding why it develops, what treatments are available and when professional assessment may be helpful allows individuals to make informed decisions about their skin. The aim of acne care is not necessarily to achieve perfectly clear skin, but to manage inflammation, prevent complications when appropriate and support healthy skin over time. What Causes Acne? Acne develops when hair follicles become blocked by excess oil (sebum) and dead skin cells. Four main processes contribute to acne formation: Excess oil production: Hormonal changes stimulate the sebaceous glands to produce more oil. Clogged pores: Dead skin cells accumulate inside hair follicles, forming blackheads and whiteheads. Bacterial activity: Cutibacterium acnes, a bacterium naturally present on the skin, can contribute to inflammation within blocked follicles. Inflammation: This causes red pimples, pus-filled lesions and sometimes deeper, painful nodules. Acne commonly affects the face, chest, shoulders and back. Importantly, acne is not simply caused by dirty skin. Excessive washing and harsh skincare products may actually irritate the skin and worsen inflammation. Why Does Acne Keep Coming Back? Acne often follows a recurring pattern, particularly during adolescence and early adulthood. Even after successful treatment, new pimples may appear because the underlying factors contributing to acne are still present. Common contributing factors include: Hormonal changes: Puberty, menstrual cycles and hormonal fluctuations in adulthood can stimulate oil production. Genetics: Individuals with a family history of acne may have a greater tendency to develop persistent breakouts. Skincare products: Certain oily or pore-clogging cosmetics may contribute to acne in susceptible individuals. Stress and lifestyle: Emotional stress and inadequate sleep may aggravate acne in some people. Diet: High-glycaemic foods and certain dairy products may worsen acne in susceptible individuals, although the relationship varies. Stopping treatment too early: Discontinuing medication before adequate control is achieved may allow new pimples to develop. Acne recurrence does not necessarily mean that previous treatment has failed. Some patients benefit from maintenance treatment, while others may need only occasional treatment when breakouts occur. What Are the Different Types of Acne? Acne can present in several forms: Comedonal Acne Blackheads and whiteheads caused by clogged pores, usually with minimal inflammation. Inflammatory Acne Red bumps and pus-filled pimples, commonly affecting the face, chest and back. Nodular or Cystic Acne Deeper, painful inflammatory lesions that may persist longer and carry a greater risk of permanent scarring. Some individuals have a combination of these types. A few occasional pimples may be manageable with simple skincare, while persistent inflammatory acne or painful nodules may benefit from medical treatment. Could It Be Something Other Than Acne? Not every pimple-like eruption is necessarily acne. Other skin conditions, such as rosacea, folliculitis and perioral dermatitis, can sometimes cause similar-looking bumps but may require different treatments. For example, rosacea often causes facial redness, flushing and sensitive skin, while folliculitis may produce small, similar-looking bumps that are sometimes itchy. Unlike typical acne, these conditions usually do not produce blackheads or whiteheads. If acne-like bumps persist despite treatment, particularly when accompanied by itching, burning or facial flushing, a dermatological assessment may help clarify the diagnosis. For more information, read my related article: Not All Pimples Are Acne: 5 Skin Conditions Commonly Mistaken for Acne. What Are the Treatment Options for Acne? Treatment depends on the type and severity of acne, skin tolerance, previous treatment response and risk of scarring. 1. Topical Treatments (Creams and Gels) Topical medications are commonly used for mild to moderate acne and may also be prescribed alongside oral treatment. Common options include: Benzoyl peroxide: Reduces acne-associated bacteria and inflammation. Adapalene or tretinoin: Topical retinoids that help prevent clogged pores and new acne formation. Azelaic acid: Helps improve inflammatory acne and post-inflammatory pigmentation. Topical antibiotics, such as clindamycin: Generally combined with benzoyl peroxide to reduce antibiotic resistance. Topical anti-androgen treatment, such as clascoterone 1% cream (Winlevi), offers another treatment approach by targeting androgen receptors in the skin. I also discussed this treatment and the importance of maintaining the skin barrier during acne treatment at a recent GP educational session in Batu Pahat. Read more: Beyond the Surface: Balancing Sebum and Reinforcing the Skin Barrier. These treatments require several weeks of consistent use before meaningful improvement becomes noticeable. Temporary dryness, peeling or irritation may occur initially. Using a suitable moisturiser and adjusting application frequency under medical guidance can improve tolerance. Topical retinoids should be avoided during pregnancy and when planning pregnancy. 2. Oral Antibiotics For moderate to severe inflammatory acne, oral antibiotics such as doxycycline may be prescribed. They help reduce inflammation and acne-associated bacterial activity. Oral antibiotics are generally used for a limited duration and combined with appropriate topical treatment, usually including benzoyl peroxide. Prolonged or unnecessary antibiotic use should be avoided because it increases the risk of antibiotic resistance. 3. Hormonal Treatment For selected female patients, particularly those experiencing persistent adult acne or menstrual-related breakouts, hormonal treatment may be considered. Options include certain combined oral contraceptive pills or spironolactone. These treatments are not suitable for everyone and require individual medical assessment, particularly regarding pregnancy and other contraindications. 4. Oral Isotretinoin Oral isotretinoin is one of the most effective treatments for severe, scarring or treatment-resistant acne. It works by significantly reducing oil production, improving follicular blockage and reducing inflammation. Isotretinoin may be considered for : Severe nodular or cystic acne Acne causing permanent scarring Persistent acne that has not responded adequately to conventional treatment Acne causing substantial personal distress A typical treatment course often lasts approximately 4–6 months, although some patients require longer treatment depending on the prescribed regimen and response. Common side effects include dry lips, dry skin and dry eyes. Blood tests and medical monitoring may be required. Isotretinoin must not be used during pregnancy because it can cause severe birth defects. Strict pregnancy-prevention precautions are essential for patients who can become pregnant. Many patients experience prolonged improvement after completing treatment, although acne may occasionally recur. Not everyone with acne needs isotretinoin. Treatment should be based on clinical indications, expected benefits, possible risks and individual circumstances. 5. Additional Dermatological Procedures Depending on the type and severity of acne, additional treatments may include: Intralesional corticosteroid injections for selected large, painful inflammatory nodules. Comedone extraction for appropriate blackheads and whiteheads. Chemical peels as an adjunctive treatment in selected patients. These procedures complement, rather than replace, appropriate medical acne treatment. How Long Does Acne Treatment Take to Work? Acne treatment requires patience, as improvement usually occurs gradually. Treatment period What patients may expect First 2–4 weeks Early improvement may begin; some treatments can initially cause dryness or irritation 6–8 weeks New pimples and inflammation may become less frequent 8–12 weeks More noticeable improvement, allowing treatment response to be assessed 3–6 months Further improvement with continued appropriate treatment These timelines are approximate and depend on acne severity, treatment type and individual response. Changing skincare products too frequently or stopping prescribed medication prematurely may interfere with progress. What About Acne Marks and Scars ? After active acne settles, some people notice residual red marks, dark pigmentation or permanent scarring. These are different conditions and do not always require treatment. Post-inflammatory hyperpigmentation (PIH): Brown or dark marks remaining after acne inflammation. They may gradually fade over several months. Post-inflammatory erythema (PIE): Red or pink marks caused by residual vascular changes following inflammation. Atrophic acne scars: Permanent depressions in the skin, including ice-pick, boxcar and rolling scars. Treatments for established acne scars may include microneedling, subcision, chemical reconstruction techniques or laser-based procedures, depending on the scar type. However, not everyone with acne marks or scars needs procedural treatment. For individuals with active inflammatory acne, early treatment may help reduce the risk of further scarring. How Should You Care for Acne-Prone Skin? A simple and consistent skincare routine is often more helpful than using multiple products. Morning Routine Wash your face with a gentle cleanser. Apply prescribed acne medication if instructed. Use a lightweight, non-comedogenic moisturiser. Apply broad-spectrum sunscreen with SPF 30 or above. Evening Routine Cleanse gently to remove sunscreen, makeup and excess oil. Apply prescribed acne treatment according to instructions. Use a suitable moisturiser to reduce dryness and irritation. Avoid squeezing pimples, harsh facial scrubs, excessive exfoliation and frequently changing treatment products. Some acne medications, particularly topical retinoids and benzoyl peroxide, may initially cause dryness or irritation. For more information on protecting sensitive skin and improving treatment tolerance, read my related article: Sensitive Skin: Why Your Face Stings, Burns or Turns Red. Can Acne Be Permanently Cured? Acne often improves with age, although some individuals continue to experience breakouts into adulthood. Many patients achieve good control with appropriate treatment. However, recurrence remains possible because hormonal, genetic and inflammatory factors may continue to influence acne development. Some individuals benefit from maintenance treatment, such as topical retinoids or benzoyl peroxide, while others may not need ongoing medication once their acne has settled. Patients who complete oral isotretinoin may experience prolonged remission, although relapse can occasionally occur. The goal is to manage acne according to individual needs, rather than expecting everyone to achieve permanently flawless skin. When Should You See a Dermatologist? Not everyone with acne needs specialist treatment. However, dermatological assessment may be helpful if: Acne persists despite appropriate over-the-counter treatment. Pimples are deep, painful or frequently inflamed. Acne is causing persistent marks or permanent scarring. Breakouts repeatedly return despite treatment. You are considering oral medication such as isotretinoin. You would like to understand the available treatment options. Early assessment is particularly useful for patients developing painful nodules, cysts or signs of permanent scarring. Understanding Acne Without Unnecessary Pressure Acne is particularly common during adolescence, and understanding the condition can help young people make informed decisions about their skin. During an acne education session at Chinese High School, Batu Pahat, I shared information about acne, common misconceptions and available treatment options, together with insights from our previously published acne research. The purpose of acne education is not to encourage everyone to pursue perfectly clear skin, but to help people understand their condition and recognise when treatment may be beneficial. Read more: Back to School: Talking Acne at My Alma Mater in Batu Pahat. Understanding Acne and Making Informed Treatment Choices Acne is a common skin condition, and having pimples does not mean that someone has unhealthy skin or poor hygiene. For some individuals, occasional breakouts may require little more than gentle skincare. Others may benefit from treatment, particularly when acne becomes persistent, painful or begins to cause scarring. Understanding the available treatments, their benefits and limitations allows individuals to make decisions that suit their own needs. Healthy skin does not have to mean perfectly clear skin. The aim of acne care is to understand your skin, manage problems when necessary and make informed choices without unnecessary pressure to achieve perfection. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical interests include acne, rosacea, eczema, psoriasis, hair disorders and other medical dermatological conditions. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment suitability depends on individual circumstances.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Small red bumps, white spots or pimple-like eruptions on the face and body are often described as acne. However, not every skin bump is actually acne. Some people spend weeks or months using acne creams, facial cleansers or other skincare products, only to find that their skin does not improve. In certain cases, the products may even cause more irritation. One possible explanation is that the skin condition may not be acne in the first place. Several skin conditions, including rosacea, folliculitis and perioral dermatitis, can resemble acne but have different causes and may require different treatment approaches. Understanding these differences can help you recognise when your skin may need a closer assessment, without assuming that every bump or imperfection requires treatment. How Can You Recognise Typical Acne? Before looking at conditions that resemble acne, it helps to understand how acne usually appears. Acne develops when hair follicles become clogged with excess oil and dead skin cells, leading to inflammation. Common features include: Blackheads: Open clogged pores that appear dark. Whiteheads: Small, closed clogged pores. Inflammatory pimples: Red bumps or pus-filled spots. Nodules: Deeper, painful inflammatory lumps. Acne commonly affects the face, chest, shoulders and back. One useful clue is the presence of comedones, the medical term for blackheads and whiteheads. These are characteristic of acne but are usually absent in several conditions that resemble it. However, not every person with acne has obvious blackheads or whiteheads, and some individuals may have more than one skin condition at the same time. For a detailed explanation of acne causes, available treatments and expected improvement, read my related article: Acne (Pimples): Causes, Treatment Options, Why It Keeps Coming Back and What to Expect 1. Rosacea: When Facial Redness Looks Like Acne Rosacea is a chronic inflammatory skin condition that commonly affects the cheeks, nose, forehead and chin. Some patients develop small red bumps or pustules that resemble inflammatory acne. However, rosacea often has additional features that help distinguish it from typical acne. Common clues Persistent facial redness Frequent flushing, especially after heat or sun exposure Burning, stinging or sensitive skin Small red bumps or pustules Visible tiny blood vessels on the cheeks or nose Usually no blackheads or whiteheads Some individuals also experience eye irritation or dryness. Why does the distinction matter? Certain conventional acne treatments, particularly strong exfoliating products or irritating topical medications, may worsen redness and sensitivity in rosacea-prone skin. Rosacea treatment may involve specific anti-inflammatory creams, oral medication or vascular treatments, depending on the symptoms. If your skin frequently becomes red, hot or sensitive, particularly when exposed to sunlight or heat, the condition may not be ordinary acne. For more information, read: Rosacea (Facial Redness): Causes, Treatment Options and How to Prevent Flare-Ups 2. Folliculitis: When Inflamed Hair Follicles Resemble Pimples Folliculitis refers to inflammation of the hair follicles. It can cause small red bumps or pustules that look similar to acne, particularly on the forehead, chest, shoulders and back. Unlike typical acne, folliculitis often produces bumps that look relatively similar in size and appearance. Common clues Small red bumps or pustules centred around hair follicles Bumps that appear relatively uniform in size Itching or tenderness in some cases Involvement of the chest, back, scalp or other hair-bearing areas Usually no blackheads or whiteheads Folliculitis has several possible causes, including bacterial infection, yeast-related inflammation and irritation from friction or shaving. What about fungal acne? One particular condition is Malassezia folliculitis, sometimes called fungal acne. Despite its popular name, it is not true acne. Malassezia folliculitis often produces multiple small, similar-looking bumps that may be quite itchy, especially on the chest, upper back, shoulders or forehead. It may be aggravated by heat, sweating and occlusive conditions. Why does the distinction matter? Bacterial folliculitis and Malassezia folliculitis may require different treatments. For example, yeast-related folliculitis may respond to antifungal medication rather than conventional acne treatment. Prolonged or unnecessary antibiotic use may also contribute to difficulties in managing certain forms of folliculitis. If your so-called acne consists mainly of itchy, similar-looking bumps that repeatedly return despite treatment, folliculitis may be worth considering. For further information, read: Folliculitis (Inflamed Hair Follicles): Causes, Treatment and Recurrence 3. Perioral Dermatitis: Small Bumps Around the Mouth Perioral dermatitis, also called periorificial dermatitis, is an inflammatory skin condition that often causes small red bumps around the mouth. It can also affect the areas around the nose and eyes. Because the bumps sometimes resemble tiny pimples, the condition may initially be mistaken for acne. Common clues Small red or skin-coloured bumps around the mouth Occasional tiny pustules Dryness, flaking, burning or irritation Sometimes involvement around the nose or eyes Usually no blackheads or whiteheads A characteristic feature is that the skin immediately next to the lips may remain relatively unaffected. What can contribute to perioral dermatitis? The exact cause is not always clear. However, topical corticosteroid creams applied to the face can trigger or aggravate the condition in some individuals. Certain skincare products, cosmetics and other irritants may also contribute. Why does the distinction matter? Perioral dermatitis may require a different treatment approach from acne. Repeated use of steroid creams can temporarily reduce redness but may eventually worsen the eruption or contribute to recurrence. Management may involve simplifying skincare, reviewing potential triggers and using appropriate prescribed medication. If small bumps repeatedly appear around your mouth, particularly with dryness or burning, it may be helpful to have the condition assessed before continuing acne treatment. 4. Milia: Tiny White Bumps That Are Not Whiteheads Milia are small, firm, keratin-filled cysts that develop just beneath the surface of the skin. They often appear as tiny white or yellowish bumps, particularly around the eyes, cheeks and forehead. Because of their colour and size, milia are sometimes mistaken for acne whiteheads. Common clues Tiny, firm white or yellowish bumps Usually no redness or inflammation Commonly found around the eyes and cheeks Do not behave like ordinary pimples May remain unchanged for months Unlike acne whiteheads, milia are not simply clogged pores containing excess oil. Do milia need treatment? Not necessarily. Milia are benign and may resolve naturally, particularly in babies. In adults, some may persist and can be removed by a trained professional if treatment is desired. Trying to squeeze or extract them at home can cause unnecessary skin injury, especially around the delicate eye area. If a small white bump remains unchanged despite acne treatment, it may be milia rather than a whitehead. 5. Keratosis Pilaris: Rough Bumps Sometimes Mistaken for Acne Keratosis pilaris is a common, harmless skin condition caused by keratin accumulating around hair follicle openings. It is sometimes described as chicken skin because the skin feels rough, with many tiny bumps. It commonly affects the upper arms and thighs, although it can also involve the cheeks, particularly in children. Common clues Multiple tiny, rough bumps Skin that feels dry or similar to sandpaper Commonly affects the upper arms, thighs or cheeks Usually little or no pus formation May be more noticeable when the skin is dry Some bumps may appear reddish, particularly in individuals with lighter skin tones. Does keratosis pilaris require treatment? Usually not. Keratosis pilaris is harmless and often becomes less noticeable with age. Regular moisturising may help improve dryness and roughness. Selected patients may benefit from creams containing ingredients such as urea, lactic acid or other keratolytic agents, although these can irritate sensitive skin. There is no need to treat keratosis pilaris simply because the skin does not feel completely smooth. How Can You Tell the Difference? Although these conditions may look similar, certain features can provide useful clues. Skin condition Common appearance Helpful distinguishing clue Acne Blackheads, whiteheads, red pimples and sometimes nodules Comedones are characteristic Rosacea Facial redness with small red bumps or pustules Flushing, burning and sensitive skin Folliculitis Small bumps or pustules around hair follicles Often similar-looking lesions; may itch Perioral dermatitis Small inflammatory bumps around the mouth, nose or eyes Periorificial distribution with dryness or irritation Milia Tiny, firm white or yellowish bumps Usually non-inflamed and persistent Keratosis pilaris Multiple small, rough follicular bumps Dry, sandpaper-like skin, often on arms or thighs These features are only general guides. A photograph or a single symptom is not always enough to distinguish these conditions reliably. Some patients may also have more than one condition simultaneously. Why Do Acne Treatments Sometimes Make Things Worse? When skin bumps are mistaken for acne, people may repeatedly try stronger acne products or increase how frequently they use them. However, different skin conditions do not necessarily respond to the same ingredients. For example: Rosacea-prone skin may become more irritated by strong exfoliating acids or poorly tolerated retinoids. Malassezia folliculitis may not respond to conventional antibacterial acne treatments. Perioral dermatitis may be aggravated by inappropriate use of facial steroid creams or irritating skincare products. Milia and keratosis pilaris may not respond to standard acne medication because their underlying causes are different. It is also important to remember that dryness or mild irritation during acne treatment does not automatically mean the diagnosis is wrong. Some effective acne medications can initially cause temporary dryness, peeling or stinging. The important consideration is whether the diagnosis fits the symptoms, whether treatment is being used appropriately and whether the skin is responding as expected. When Should You Consider a Dermatological Assessment? Not every skin bump needs medical treatment. However, an assessment may be useful if: Your presumed acne is not improving despite appropriate treatment. The bumps are particularly itchy or all look very similar. Facial redness, flushing or burning is more prominent than pimples. Small bumps remain concentrated around the mouth, nose or eyes. You develop deep, painful lesions or permanent scarring. Your skin repeatedly becomes irritated by acne products. You are unsure which skin condition you have or whether treatment is necessary. Depending on the findings, a dermatologist may recommend a different treatment approach or further investigations, such as skin scraping when a fungal cause is suspected. The purpose is to identify the condition accurately and avoid unnecessary or unsuitable treatment. Understanding Your Skin Before Choosing Treatment Not every red bump, white spot or rough patch on the skin is acne. Rosacea, folliculitis, perioral dermatitis, milia and keratosis pilaris are examples of conditions that may resemble pimples but have different causes and treatment approaches. Recognising these differences can help explain why a particular skincare product or acne treatment may not be working as expected. At the same time, not every bump needs to be removed or treated. Some skin changes are harmless, while others may benefit from medical attention when they cause discomfort, persistent inflammation or complications. Understanding your skin is more important than trying to make every bump disappear. The aim is to recognise when treatment may be helpful and make informed choices without unnecessary pressure to achieve perfect skin. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and management of acne, rosacea, folliculitis, eczema and other inflammatory skin conditions affecting the face and body. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Skin conditions with similar appearances may require different diagnoses and treatments.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Excessively sweaty palms and feet can be uncomfortable and embarrassing, even when the weather is not particularly hot. Some people notice their hands becoming wet while writing, using a mobile phone or shaking hands. Others experience persistently damp feet, making it uncomfortable to wear shoes and socks throughout the day. These symptoms may be caused by palmar and plantar hyperhidrosis, a condition characterised by excessive sweating of the hands and feet. Although sweating is a normal process that helps regulate body temperature, excessive sweating can interfere with daily activities, work, school and social interactions. Fortunately, several treatment options are available to help control sweating and improve quality of life. What Is Palmar and Plantar Hyperhidrosis? Hyperhidrosis is a medical condition in which the body produces more sweat than is necessary for normal temperature regulation. It can affect different areas of the body, particularly: Palmar hyperhidrosis: Excessive sweating of the palms. Plantar hyperhidrosis: Excessive sweating of the soles. Axillary hyperhidrosis: Excessive sweating of the underarms. Some patients experience sweating in only one area, while others have both sweaty palms and feet. Symptoms often begin during childhood or adolescence and may continue into adulthood. What Causes Excessive Sweating of the Palms and Feet? The most common cause is primary focal hyperhidrosis, a condition in which the nerves responsible for stimulating sweat glands become overactive. The sweat glands themselves are usually normal, but they receive excessive signals to produce sweat. Primary hyperhidrosis often affects both sides of the body and may run in families. Sweating typically occurs during waking hours and becomes less noticeable or stops during sleep. What Can Make Sweating Worse? Common aggravating factors include: Hot and humid weather Emotional stress or anxiety Physical activity Wearing enclosed shoes for prolonged periods Certain foods or beverages In Malaysia's hot and humid climate, excessive sweating may become particularly troublesome. However, hyperhidrosis is not simply caused by hot weather, anxiety or poor hygiene. Occasionally, excessive sweating may be associated with an underlying medical condition, such as thyroid disorders, diabetes or certain medications. This is known as secondary hyperhidrosis. Sudden onset, generalised sweating or excessive night sweating may require further medical assessment. How Does Hyperhidrosis Affect Daily Life? Although hyperhidrosis is not usually dangerous, it can significantly affect comfort, confidence and daily activities. People with sweaty palms may have difficulty holding a pen, handling paper, using touchscreen devices or shaking hands. Those with excessive foot sweating may experience damp socks, unpleasant odour, skin irritation or recurrent fungal infections. Prolonged moisture can also cause the skin to become soft and macerated, increasing the risk of certain skin infections. Some patients feel embarrassed during social interactions or become anxious about situations involving hand contact. Hyperhidrosis is a genuine medical condition, not simply a cosmetic concern. What Are the Treatment Options for Sweaty Palms and Feet? Treatment depends on the severity of sweating, the areas affected, previous treatment response and individual preferences. The aim is to reduce sweating to a manageable level while minimising discomfort and treatment-related side effects. 1. Medical Antiperspirants Antiperspirants containing aluminium chloride are commonly used as an initial treatment. They work by temporarily reducing sweat output through the sweat ducts. These products are generally applied to completely dry skin before bedtime and washed off the following morning, according to the prescribed instructions. Once sweating improves, application frequency may be gradually reduced to a maintenance schedule. However, some patients experience irritation, dryness or burning sensations, particularly with stronger preparations. Antiperspirants may be useful for mild to moderate sweating, although some patients with severe palmar or plantar hyperhidrosis may require additional treatment. 2. Iontophoresis: A Non-Invasive Treatment for Sweaty Palms and Feet Iontophoresis is one of the established non-invasive treatments for palmar and plantar hyperhidrosis. During treatment, the hands or feet are placed in shallow trays containing tap water while a controlled, low-level electrical current passes through the water. This helps temporarily reduce sweat production in the treated areas. The procedure does not involve injections or surgery. How Often Is Iontophoresis Required? A typical treatment programme may involve: Approximately 15–30 minutes per session Several treatment sessions per week initially Gradual reduction in sweating after repeated sessions Maintenance treatment once adequate control is achieved Many patients begin noticing improvement after approximately 5–10 sessions, although some require additional treatments. Once sweating is controlled, maintenance sessions may be required weekly or every one to two weeks, depending on the response and treatment device. Is Iontophoresis Painful? Most patients tolerate iontophoresis well. Some may experience mild tingling, dryness or temporary skin irritation during or after treatment. The electrical current should be adjusted according to comfort and the device's recommended treatment protocol. Iontophoresis may not be suitable for certain patients, including those with implanted electronic devices, some metal implants or during pregnancy. Medical assessment is recommended before starting treatment. Does Iontophoresis Permanently Stop Sweating? No. Iontophoresis helps control sweating rather than permanently stopping sweat production. Once treatment is discontinued, sweating may gradually return. Regular maintenance sessions are usually necessary to sustain the improvement. 3. Botulinum Toxin Injections Botulinum toxin injections can temporarily block the nerve signals that stimulate sweat production. They may be considered for patients with significant hyperhidrosis who do not respond adequately to medical antiperspirants or iontophoresis. Sweating often improves within approximately 1–2 weeks after treatment. The effect is temporary and typically lasts several months, after which repeat injections may be required. However, injections into the palms and soles can be painful, and suitable pain-control measures may be needed. Temporary weakness of the hand muscles may occasionally occur following treatment of the palms. 4. Oral Medications For patients with severe sweating or hyperhidrosis affecting multiple body areas, oral medications may occasionally be considered. Examples include: Oxybutynin Glycopyrrolate (Glycopyrronium) These medications reduce the activity of sweat glands throughout the body. However, possible side effects include: Dry mouth Constipation Blurred vision Difficulty passing urine Reduced ability to tolerate hot weather Because these medications affect sweating throughout the body, careful patient selection and medical supervision are important. This is particularly relevant in Malaysia, where reduced sweating may increase the risk of overheating during hot weather or strenuous exercise. 5. Surgical Treatment For selected patients with severe palmar hyperhidrosis who have not responded to other treatments, endoscopic thoracic sympathectomy (ETS) may occasionally be considered. This procedure interrupts certain nerve pathways responsible for excessive sweating. Although it can provide substantial improvement in palmar sweating, surgery carries important risks. One of the most significant is compensatory sweating, in which excessive sweating develops in other areas of the body, such as the back, chest or abdomen. Compensatory sweating can be persistent and, in some patients, more troublesome than the original condition. For this reason, ETS is generally reserved for carefully selected patients after detailed counselling. ETS is not recommended as a treatment for isolated plantar hyperhidrosis. Which Treatment Is Best for Sweaty Palms and Feet? There is no single treatment that works best for everyone. Treatment Expected benefit Main limitations Aluminium chloride May help mild to moderate sweating Skin irritation; regular application needed Iontophoresis Established non-invasive treatment for palms and soles Requires repeated sessions and maintenance Botulinum toxin Significant temporary reduction in sweating Painful injections; repeat treatment needed Oral medication May reduce sweating across multiple areas Systemic side effects Surgery (ETS) Potential long-term improvement in selected severe palmar cases Invasive; risk of compensatory sweating For many patients with palmar or plantar hyperhidrosis, iontophoresis is a useful treatment option because it is non-invasive and can provide meaningful sweat reduction without systemic medication. However, the most appropriate treatment depends on symptom severity, treatment response, medical history and patient preference. Can Hyperhidrosis Be Permanently Cured ? Primary hyperhidrosis is usually a chronic condition, and symptoms may persist for many years. Most non-surgical treatments control excessive sweating rather than permanently cure the condition. For example, iontophoresis can significantly reduce sweating, but symptoms may gradually return if maintenance treatment is stopped. Similarly, botulinum toxin injections provide temporary improvement and may need to be repeated. The goal is not necessarily to eliminate sweating completely, because sweating is an important natural function of the body. Instead, the aim is to achieve comfortable, manageable sweating that no longer interferes significantly with daily life. How Can You Reduce Excessive Sweating in Daily Life ? Alongside medical treatment, several practical measures may help improve comfort. For excessive foot sweating: Wear breathable, well-fitting shoes. Choose moisture-absorbing or moisture-wicking socks. Change socks when they become damp. Allow shoes to dry thoroughly between uses. Keep the feet clean and dry to reduce skin maceration. Seek treatment for associated fungal infections or other skin problems. For sweaty palms, keeping a small towel available and identifying personal triggers may help manage daily activities. Avoid harsh or irritating products that may worsen skin dryness or discomfort. These measures can improve comfort but are often insufficient on their own for moderate to severe hyperhidrosis. When Should You See a Dermatologist? Consider a dermatological consultation if : Your palms or soles sweat excessively even when you are resting. Sweating interferes with writing, school, work or social activities. Your feet remain persistently damp despite regular hygiene. Medical antiperspirants have not provided adequate improvement. You are interested in iontophoresis or other medical treatments. Excessive sweating is causing embarrassment or affecting your confidence. If sweating begins suddenly, affects the entire body, occurs during sleep or is associated with symptoms such as fever or unexplained weight loss, further medical assessment may be required to identify an underlying cause. Managing Excessive Sweating in the Long Term Palmar and plantar hyperhidrosis are common conditions that can significantly affect comfort, confidence and quality of life. Although excessive sweating may not always be permanently curable, effective treatments are available. Medical antiperspirants, iontophoresis, botulinum toxin injections and selected oral medications can help reduce sweating. For patients with severe palmar hyperhidrosis, surgery may occasionally be considered after careful assessment. With an appropriate treatment plan and regular maintenance where necessary, many patients can achieve better sweating control and greater comfort in their daily activities. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and management of excessive sweating (hyperhidrosis), eczema, fungal skin infections and other medical dermatological conditions. Patients experiencing persistent excessive sweating of the palms or soles may arrange a dermatological consultation to discuss suitable treatment options. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment suitability and availability depend on individual circumstances.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Facial redness, frequent flushing and sensitive skin are common concerns, especially among people whose skin becomes easily irritated by sunlight, heat or skincare products. Some people also develop small red bumps or pus-filled spots that resemble acne, making it difficult to understand why their skin keeps reacting. These symptoms may be caused by rosacea, a chronic inflammatory skin condition that mainly affects the central part of the face. Although rosacea can be persistent and prone to flare-ups, appropriate treatment, gentle skincare and identification of personal triggers can help control symptoms and improve skin comfort. What Is Rosacea? Rosacea is a chronic inflammatory skin condition that commonly affects the cheeks, nose, forehead and chin. Typical features include: Persistent facial redness Frequent flushing, particularly after heat exposure Burning, stinging or unusually sensitive skin Small red bumps and pus-filled spots Visible tiny blood vessels on the face Dryness and skin irritation Some patients mainly experience redness and flushing, while others develop inflammatory bumps resembling acne. Rosacea can also affect the eyes, causing dryness, irritation, redness or a gritty sensation. Importantly, rosacea is not contagious and is not caused by poor hygiene. What Causes Rosacea? The exact cause of rosacea is not fully understood. It is believed to involve several factors, including an overactive inflammatory response, changes in how facial blood vessels react, genetic susceptibility and increased skin sensitivity. Microscopic organisms called Demodex mites, which naturally live on human skin, may also contribute to inflammation in some patients. However, rosacea is not simply an infection caused by these mites. Why Does Rosacea Keep Coming Back? Rosacea often follows a pattern of improvement and recurrence. Even after successful treatment, symptoms may return when the skin is exposed to certain triggers. Common aggravating factors include: 1. Sunlight and Heat Sun exposure, hot weather and prolonged outdoor activities may trigger facial flushing and worsen redness. This is particularly relevant in Malaysia's hot and humid climate. 2. Hot Environments and Sweating Hot showers, saunas, vigorous exercise and poorly ventilated environments can trigger flare-ups in some individuals. 3. Spicy Food and Hot Beverages Spicy meals, hot drinks and certain foods may cause facial flushing. However, food-related triggers vary between individuals, and unnecessary dietary restrictions are not recommended. 4. Alcohol Alcohol may trigger flushing in some people, but it is not the underlying cause of rosacea. 5. Emotional Stress Stress and strong emotions may contribute to flushing and worsening skin inflammation. 6. Irritating Skincare Products Harsh cleansers, facial scrubs, exfoliating acids and excessive use of active skincare ingredients may aggravate sensitive skin. Not everyone has the same triggers. Identifying your own aggravating factors is more useful than trying to avoid every possible trigger. Is Rosacea the Same as Acne? Rosacea and acne can look similar, but they are different skin conditions. Both may cause red bumps and pus-filled spots on the face. However, acne commonly involves blackheads, whiteheads and clogged pores, whereas rosacea is more often associated with facial redness, flushing, burning and sensitive skin. Typical rosacea does not produce comedones (blackheads and whiteheads), although some patients may have both conditions. This distinction is important because certain conventional acne treatments may irritate rosacea-prone skin. What Are the Treatment Options for Rosacea? Treatment depends on the main symptoms, their severity and individual skin sensitivity. Some treatments are more effective for inflammatory bumps, while others target persistent redness or visible blood vessels. 1. Topical Medication For mild to moderate rosacea, commonly prescribed topical treatments include: Metronidazole: Helps reduce inflammatory bumps and associated inflammation. Azelaic acid: Helps improve inflammatory lesions and redness, although mild stinging or irritation may occur initially. Ivermectin cream: Helps control inflammatory bumps, particularly in papulopustular rosacea. These medications generally require several weeks of consistent use before noticeable improvement. They are more effective for inflammatory bumps than for persistent visible blood vessels. 2. Oral Medication For moderate to severe rosacea, particularly when numerous inflammatory bumps or pustules are present, oral medication may be required. Doxycycline is commonly prescribed because of its anti-inflammatory effects. Treatment often lasts approximately 6–12 weeks, depending on severity and response. Low-dose anti-inflammatory doxycycline formulations may also be suitable for selected patients. For severe or difficult-to-control rosacea, low-dose oral isotretinoin may occasionally be considered under dermatologist supervision. 3. Treatment for Persistent Facial Redness Some patients experience mainly persistent redness and flushing without significant inflammatory bumps. In selected cases, topical medications such as brimonidine or oxymetazoline may temporarily reduce facial redness by narrowing superficial blood vessels. However, these medications do not permanently eliminate rosacea. Some individuals may experience irritation or worsening redness. Visible dilated blood vessels and persistent redness may also improve with vascular laser or intense pulsed light (IPL) treatment. Treatment suitability depends on the type of redness, skin type and availability of appropriate facilities. 4. Treatment for Sensitive or Burning Skin Many patients with rosacea experience burning, stinging or difficulty tolerating skincare products. In these cases, protecting the skin barrier is an important part of management. A gentle skincare routine using suitable cleansers, moisturisers and sunscreen can help reduce irritation and improve tolerance to prescribed treatment. How Should You Care for Rosacea-Prone Skin? For sensitive, rosacea-prone skin, a simple skincare routine is often better than using multiple active products. Morning Routine Gently cleanse the face using a mild, fragrance-free cleanser. Apply prescribed topical medication if instructed. Use a suitable moisturiser to support the skin barrier. Apply broad-spectrum sunscreen, preferably SPF 50, before outdoor activities. Evening Routine Cleanse gently without scrubbing. Apply prescribed treatment as directed. Use a gentle moisturiser to reduce dryness and irritation. Skincare Products to Use With Caution If your skin is easily irritated, consider limiting: Harsh facial scrubs or excessive exfoliation Strong exfoliating acids or frequent chemical peels Alcohol-based toners Fragranced skincare products Frequent use of retinoids without medical guidance Very hot water when washing the face Not all active skincare ingredients need to be avoided permanently. The most suitable routine depends on your skin condition and individual tolerance. Can Cold Compresses Help Rosacea? A cool compress may temporarily relieve facial flushing, warmth and burning sensations. Use a clean, soft cloth soaked in cool water and gently place it over the affected area for approximately 5–10 minutes. Avoid applying ice directly to the skin, as extreme cold may irritate sensitive skin or worsen symptoms in some individuals. Cold compresses can provide temporary comfort but do not replace medical treatment when inflammation is present. How Long Does Rosacea Treatment Take to Work ? Improvement is usually gradual, and the response depends on the symptoms being treated. Treatment period What patients may expect First 2–4 weeks Early reduction in inflammatory bumps or irritation may begin 6–8 weeks More noticeable improvement in inflammatory lesions 8–12 weeks Further improvement and reassessment of treatment response Long-term Maintenance skincare or medication may be needed to reduce recurrence These are approximate timelines rather than guaranteed results. Persistent redness and visible blood vessels may respond less well to anti-inflammatory creams and sometimes require different treatments. Can Rosacea Be Permanently Cured ? Rosacea is generally a chronic skin condition, meaning symptoms may recur even after successful treatment. However, many patients can achieve good control and experience long periods with minimal flare-ups. Some may benefit from maintenance topical medication, while others can manage their symptoms through gentle skincare and avoidance of personal triggers once inflammation has settled. The goal is to keep inflammation, redness and discomfort under control while maintaining comfortable, healthy skin. When Should You See a Dermatologist? Consider dermatological assessment if : Facial redness persists or repeatedly returns. Your skin frequently burns or stings. Acne treatments repeatedly worsen facial redness. You develop persistent red bumps or pustules. Your skin becomes increasingly sensitive to skincare products. You experience eye irritation, dryness or recurrent eyelid inflammation. Rosacea affects your confidence or daily activities. If you experience eye pain, significant light sensitivity, blurred vision or reduced vision, seek prompt medical or ophthalmological assessment. Other skin conditions, including acne, seborrhoeic dermatitis, contact dermatitis and cutaneous lupus, may sometimes resemble rosacea. An accurate diagnosis helps ensure the most appropriate treatment is selected. Managing Rosacea in the Long Term Rosacea is a common chronic skin condition that can cause persistent facial redness, flushing, inflammatory bumps and increased skin sensitivity. Although symptoms may return from time to time, they can often be controlled with appropriate medication, gentle skincare and identification of individual triggers. Treatment should be tailored to the main symptoms, as inflammatory bumps, persistent redness and sensitive skin may respond to different approaches. With appropriate treatment and a consistent skincare routine, many patients can reduce flare-ups and maintain good long-term skin comfort. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and management of rosacea, acne, eczema, sensitive skin and other inflammatory skin conditions. For patients experiencing persistent facial redness, burning, sensitive skin or recurrent acne-like eruptions, dermatological assessment may help confirm the diagnosis and guide appropriate treatment. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment suitability and availability may vary between patients.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Dry, peeling or cracked skin on a child's feet is a common concern among parents. Sometimes, the soles appear red and shiny, with painful cracks developing around the toes or front part of the feet. These symptoms are often mistaken for fungal infection, eczema or poor foot hygiene. However, one possible cause is juvenile plantar dermatosis (JPD), a recurring skin condition that mainly affects school-aged children. Although the condition is harmless and not contagious, painful cracks may interfere with walking, running and sports activities. Understanding the contributing factors and adopting appropriate foot care can help improve symptoms and reduce repeated flare-ups. What Is Juvenile Plantar Dermatosis? Juvenile plantar dermatosis is a skin condition characterised by dryness, redness, peeling and cracking of the weight-bearing areas of the feet. It most commonly affects children between 3 and 14 years old, particularly those of primary school age. The condition usually affects both feet, especially: The soles of the big toes and other toes The balls of the feet The front part of the soles Occasionally, the heels Affected skin often appears red, smooth and unusually shiny, sometimes accompanied by painful cracks known as fissures. An important clinical feature is that the spaces between the toes are usually unaffected. This can help distinguish JPD from certain fungal infections. What Causes Juvenile Plantar Dermatosis? The exact cause is not fully understood, but the condition is thought to result from a combination of friction, sweating and skin barrier damage. 1. Friction From Walking and Running Repeated friction between the feet, socks and shoes can damage the skin's protective barrier. Children are often physically active, and prolonged walking, running or sports activities may worsen peeling and cracking. 2. Sweating and Repeated Drying When feet sweat inside enclosed shoes, the skin becomes moist. As the moisture evaporates, the skin may become excessively dry. Repeated cycles of sweating and drying can weaken the skin barrier, contributing to redness, peeling and painful cracks. 3. Tight or Poorly Ventilated Footwear Shoes made from poorly breathable materials can trap heat and moisture. This is particularly relevant in Malaysia, where children may wear enclosed school shoes for several hours each day. Poorly fitting shoes may also increase friction, especially around the toes and front part of the soles. Choosing well-fitting, breathable shoes and regularly changing damp socks may help reduce irritation. 4. Sensitive or Eczema-Prone Skin Some children with JPD also have a history of eczema, asthma or allergic rhinitis. Their skin may be more sensitive and prone to dryness or irritation. However, not every child with juvenile plantar dermatosis has eczema or allergies. Why Does the Condition Keep Coming Back? Juvenile plantar dermatosis often follows a recurring pattern. The skin may improve with moisturisers and appropriate care, only to become dry and cracked again after several weeks. This happens because contributing factors such as friction, sweating and prolonged wearing of enclosed shoes may still be present. For example, some children improve during school holidays when they spend less time wearing enclosed shoes, but develop another flare after returning to school. Recurrence does not necessarily mean treatment has failed. The main goal is to repair the skin barrier, reduce repeated irritation and prevent painful cracks while the condition gradually improves with age. Is Juvenile Plantar Dermatosis a Fungal Infection? No. Juvenile plantar dermatosis is not caused by a fungus and is not contagious. However, fungal infections such as tinea pedis, commonly known as athlete's foot or 香港脚, can sometimes cause similar peeling and scaling. One useful difference is that JPD usually affects the weight-bearing areas of the soles while sparing the spaces between the toes. Other conditions that may resemble JPD include: Atopic eczema Allergic contact dermatitis caused by footwear Psoriasis Keratolysis exfoliativa, which causes superficial skin peeling If the diagnosis is uncertain, a dermatologist may recommend skin scraping to exclude fungal infection or patch testing when footwear allergy is suspected. What Are the Treatment Options ? Treatment focuses on protecting the skin barrier, reducing friction and managing painful cracks. 1. Regular Moisturiser Application Moisturisers are one of the most important parts of managing JPD. Thick moisturising creams or ointments containing petrolatum, ceramides or other barrier-repairing ingredients can help reduce dryness and protect the skin. Moisturiser is particularly useful: After bathing After removing shoes and socks Before bedtime Whenever the skin becomes excessively dry Petroleum jelly can be especially helpful for very dry or cracked skin. Urea-containing creams may also help soften thickened, dry skin, although they can sting when applied to open cracks. 2. Suitable Footwear and Socks Reducing friction and prolonged moisture is an essential part of treatment. Parents can help by choosing well-fitting, breathable shoes and avoiding tight or poorly ventilated footwear. Cotton or other absorbent socks may help manage sweat. Socks should be changed when they become damp, especially after sports or prolonged physical activity. Allowing the feet to air when practical and safe may also help. 3. Topical Anti-inflammatory Treatment For children with significant redness, itching or inflammation, a dermatologist may occasionally prescribe a short course of topical corticosteroid. However, topical steroids are not always necessary and may offer limited additional benefit when friction and skin barrier damage are the main problems. Regular moisturising and footwear modification remain the foundation of treatment. 4. Caring for Painful Cracks Deep cracks, also known as fissures, can be painful, particularly during walking or running. Applying petroleum jelly regularly and protecting suitable cracks with a clean, non-irritating dressing may help healing. Avoid picking or peeling loose skin, and consider temporarily reducing activities that place excessive pressure on painful areas. Persistent or deep fissures may require medical assessment and additional wound care. How Long Does Juvenile Plantar Dermatosis Take to Improve ? Redness and dryness may begin to improve over several weeks with consistent skincare and reduced friction. However, painful cracks may take longer to heal, particularly if the child continues to experience repeated friction or sweating. Flare-ups may recur throughout childhood. The encouraging news is that juvenile plantar dermatosis often improves naturally as children approach puberty or adolescence. Many children eventually outgrow the condition, although some may experience symptoms for longer. How Can Parents Prevent Repeated Flare-Ups ? A simple daily foot-care routine can help reduce irritation and maintain skin comfort. Before school Ensure shoes fit properly. Choose clean, dry and absorbent socks. Apply moisturiser if the skin is dry, allowing it to absorb before putting on socks. After school Remove shoes and socks. Gently clean and dry the feet if needed. Allow the feet to air. Apply moisturiser to dry areas. Before bedtime Apply a generous layer of moisturising cream or petroleum jelly. Pay particular attention to dry areas and existing cracks. Protect painful fissures with an appropriate dressing when necessary. Consistency is often more helpful than repeatedly changing creams or using multiple products. When Should You See a Dermatologist ? Consider dermatological assessment if: The feet remain persistently red, dry or cracked. Painful fissures interfere with walking or sports. The condition frequently recurs despite regular skincare. Antifungal treatment has not improved the rash. The diagnosis remains uncertain. Increasing redness, swelling, discharge or other signs of infection develop. An accurate diagnosis can help distinguish JPD from fungal infection, eczema or footwear allergy and avoid unnecessary treatment. Helping Your Child Manage Juvenile Plantar Dermatosis Juvenile plantar dermatosis is a common, non-contagious condition that causes dry, shiny, peeling and sometimes cracked skin on children's feet. Although it may resemble eczema or fungal infection, it is mainly associated with friction, sweating and disruption of the skin barrier. Regular moisturising, suitable footwear, reducing friction and protecting painful cracks are the most important management measures. While recurrence is common during childhood, many children gradually improve as they grow older. With consistent skincare and appropriate preventive measures, most children can remain comfortable and continue their usual daily activities. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and management of eczema, juvenile plantar dermatosis, fungal skin infections, psoriasis and other inflammatory skin conditions affecting children and adults. For children experiencing persistent peeling, dryness, redness or painful cracks on their feet, dermatological assessment may help confirm the diagnosis and guide appropriate management. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Vitiligo is a skin condition that causes white patches to develop on different parts of the body, commonly affecting the face, hands, arms and legs. For some people, the patches remain unchanged for many years. Others may notice new patches developing or existing ones gradually spreading. Although vitiligo is not contagious or life-threatening, its visible appearance can sometimes affect self-confidence and emotional well-being. Treatment is available to help control disease progression and restore some of the lost skin colour. However, improvement takes time, and results vary between individuals. Understanding the condition, available treatments and realistic expectations can help patients make informed decisions about their care. What Is Vitiligo? Vitiligo occurs when pigment-producing cells in the skin, called melanocytes, are damaged or destroyed. These cells produce melanin, the pigment responsible for natural skin colour. When melanocytes are lost, affected areas become lighter or completely white. Vitiligo can affect almost any part of the body, including: Face, particularly around the eyes and mouth Hands and fingers Arms and legs Feet Genital areas Scalp and hair Some patients develop only a few small patches, while others experience more widespread involvement. What Causes Vitiligo? Vitiligo is primarily an autoimmune skin condition, meaning the immune system mistakenly attacks the body's own pigment-producing cells. Several factors may contribute to its development. 1. Genetic predisposition Having a family member with vitiligo may increase the likelihood of developing the condition, although many patients have no family history. 2. Autoimmune activity Vitiligo can occur alongside other autoimmune conditions, particularly autoimmune thyroid disease. 3. Skin injury or repeated friction In some patients, scratching, rubbing, pressure or skin injury may trigger new white patches. This is known as the Koebner phenomenon. 4. Environmental factors Sunburn and certain chemical exposures may contribute to the development or worsening of vitiligo in susceptible individuals. Importantly, vitiligo is not caused by poor hygiene and cannot spread from one person to another. Will Vitiligo Continue to Spread? The progression of vitiligo varies between individuals. Some patients have a few patches that remain stable for years, while others develop new patches or experience periods of more rapid spreading. The condition may also become stable for a period before becoming active again. Early assessment is useful, particularly when new patches are appearing, as treatment may help stabilise active disease and improve the opportunity for repigmentation. What Are the Treatment Options for Vitiligo? Vitiligo treatment generally has two main goals: Control disease activity to reduce the development of new white patches. Encourage repigmentation to restore some or most of the natural skin colour. The most suitable treatment depends on the location, extent, duration and activity of vitiligo. 1. Topical Corticosteroids Topical corticosteroids may be prescribed for localised vitiligo, particularly on the body and limbs. They help reduce the immune activity responsible for damaging pigment-producing cells. However, prolonged or inappropriate use may cause skin thinning and other side effects. Treatment should therefore follow a dermatologist's instructions. 2. Topical Tacrolimus Tacrolimus ointment is commonly used for vitiligo affecting the face, eyelids and other sensitive areas. Unlike topical corticosteroids, tacrolimus does not cause skin thinning. It works by regulating local immune activity and may gradually encourage pigmentation to return. Treatment generally needs to be continued for several months before the response can be properly assessed. 3. Topical Ruxolitinib Cream Ruxolitinib is a newer topical treatment belonging to a group of medications called Janus kinase (JAK) inhibitors. It targets inflammatory pathways involved in the autoimmune process of vitiligo. Ruxolitinib cream has been approved in certain countries for eligible patients aged 12 years and above with non-segmental vitiligo. It may improve repigmentation, particularly on the face, although several months of consistent treatment are usually required. Availability, suitability and regulatory approval vary between countries. 4. Narrowband UVB Phototherapy Narrowband ultraviolet B (NB-UVB) phototherapy is an established treatment for vitiligo, particularly when larger areas of the body are affected. It uses carefully controlled ultraviolet light to help regulate immune activity and stimulate repigmentation. Treatment commonly requires two to three sessions per week over several months, and some patients may need six to twelve months of treatment. Phototherapy may be used alone or combined with selected topical medications. 5. Oral Medication for Rapidly Spreading Vitiligo For patients whose vitiligo is spreading rapidly, a dermatologist may consider a short course of systemic treatment, such as carefully supervised oral corticosteroids. The main purpose is to stabilise the condition and reduce further pigment loss, rather than directly restore skin colour. These medications are not routinely required for stable vitiligo and must be used cautiously because of potential side effects. 6. Surgical Treatment For selected patients with localised, stable vitiligo that has not responded adequately to other treatments, surgical procedures may be considered. These include skin grafting and melanocyte transplantation. Such treatments are generally reserved for carefully selected cases in which the disease has remained stable for a sufficient period. How Long Does It Take for Skin Colour to Return? Vitiligo treatment requires patience. Repigmentation is usually gradual, and visible improvement may not occur during the first few weeks. The following provides a general guide to what patients may expect. Treatment duration Possible improvement First 1–2 months Often little visible change 3–6 months Early pigmentation may begin returning in responsive areas 6–12 months More noticeable improvement may develop with continued treatment Beyond 12 months Further repigmentation may occur, depending on treatment response These are approximate time frames, not guaranteed outcomes. Some patients notice small brown spots appearing within the white patches. These spots may gradually enlarge and merge as pigmentation returns. The location of vitiligo also influences treatment response. The face and neck generally respond better, while the fingers, hands, feet and areas with white hair are often more difficult to repigment. Even with appropriate treatment, complete restoration of natural skin colour may not be possible in every case. Can Vitiligo Be Completely Cured ? There is currently no treatment that guarantees a permanent cure for vitiligo. However, available treatments can help many patients achieve meaningful repigmentation and reduce disease progression. Some patients regain substantial skin pigmentation, while others experience partial improvement. Importantly, not every patient needs active treatment. If the condition is stable and does not cause significant concern, choosing not to pursue repigmentation treatment is also reasonable. Treatment decisions should consider the patient's preferences, disease activity and expected benefits. Can Vitiligo Return After Successful Treatment? Yes. Vitiligo may recur even after successful repigmentation. This is because treatment can restore pigmentation without permanently eliminating the underlying autoimmune tendency. New white patches may develop, or previously treated areas may gradually lose pigmentation again. For selected patients, maintenance treatment, such as intermittent topical tacrolimus, may help reduce the risk of recurrence. Regular follow-up allows treatment to be adjusted if new patches appear or the disease becomes active again. How Can Patients Manage Vitiligo Better ? Alongside medical treatment, several practical measures can help protect the skin and support overall well-being. Protect the skin from sunburn. Use broad-spectrum sunscreen, preferably SPF 50+, particularly on exposed white patches that lack protective melanin. Avoid unnecessary skin injury. Repeated scratching, rubbing or trauma may trigger new patches in susceptible individuals. Follow the prescribed treatment plan. Repigmentation takes time, and consistency is important. Consider cosmetic camouflage. Camouflage products may help make white patches less noticeable for patients who prefer this option. Monitor for new patches. Photographs taken over time may help track disease progression and treatment response. Look after emotional well-being. Vitiligo can affect confidence and quality of life, and support is available when needed. There is currently no convincing evidence that a particular diet or supplement can reliably cure vitiligo. Patients should be cautious about products promising rapid or permanent restoration of skin colour. When Should You See a Dermatologist? Consider dermatological assessment if: New white patches appear on the skin. Existing patches are spreading rapidly. White patches develop on the face or other visible areas. You are uncertain whether the patches are caused by vitiligo. You would like to discuss treatment options and expected outcomes. The condition is affecting your confidence or emotional well-being. Not all white patches are caused by vitiligo. Conditions such as pityriasis alba, certain fungal infections and post-inflammatory hypopigmentation may look similar. A dermatologist can assess the skin and may use a Wood's lamp examination to help confirm the diagnosis. Assessment for associated autoimmune conditions, particularly thyroid disease, may also be appropriate in selected patients. Living With Vitiligo Vitiligo is a long-term skin condition, but its course varies considerably between individuals. Some people develop only a few stable patches, while others may experience spreading or recurrence. Although a permanent cure cannot be guaranteed, treatments such as topical corticosteroids, tacrolimus, ruxolitinib cream and phototherapy offer opportunities to stabilise the condition and restore pigmentation. Early assessment, appropriate treatment and realistic expectations are important for achieving meaningful improvement. Most importantly, vitiligo is not contagious, and patients should not feel pressured to undergo treatment solely because their skin looks different. For those who wish to pursue treatment, an individualised approach can help identify the most suitable options based on their condition and personal preferences. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and treatment of vitiligo, pigmentation disorders, eczema, psoriasis and other inflammatory skin conditions. Patients with vitiligo or unexplained white patches may benefit from dermatological assessment to confirm the diagnosis and discuss appropriate management options. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment suitability, medication availability and regulatory approval may vary between patients and countries.

Many skin rashes look very similar at first glance. Redness, itchiness, dry skin, scaling, and irritation are common symptoms in both eczema and fungal infections. This similarity often leads to confusion about the actual cause of the rash. People frequently try different creams without success, only to find out later that their condition was misdiagnosed. Many patients become understandably confused when a rash keeps recurring despite trying different creams. Some rashes may temporarily improve before flaring again later, making it difficult to know whether the problem is eczema, fungal infection, or irritation from previous treatments. Eczema and fungal infections can sometimes appear surprisingly similar, especially during early or recurring flare-ups. Why Eczema and Fungal Infections Look Similar Both eczema and fungal infections can cause: Redness Itching Dry or flaky skin Irritation Recurring rashes In daily practice, some patients may initially assume a rash is eczema and continue applying steroid creams repeatedly. The redness may improve temporarily, but the rash later spreads, becomes more sensitive, or develops a clearer border over time. In some cases, the underlying problem may actually be fungal infection instead of eczema alone. Related article: Are Steroid Creams Always Harmful? What Is Eczema? Eczema, also known as atopic dermatitis, is an inflammatory skin condition caused by a weakened skin barrier and increased skin sensitivity. It is not contagious and often runs in families with a history of allergies or asthma. Common features of eczema include: Dry and sensitive skin Itching that worsens with scratching Recurring flare-ups Thickened skin from chronic rubbing or scratching Irritation triggered by heat, sweat, stress, or certain skincare products Eczema often appears in specific areas such as: Inner elbows Behind the knees Neck Eyelids Hands Sometimes the face In hot and humid climates like Malaysia, sweating and friction can make eczema symptoms worse. For example, a person who sweats heavily during the day may notice their eczema flares up more in the evening. Related article: Why Eczema Keeps Coming Back and How to Manage It Better? What Is a Fungal Skin Infection? Fungal skin infections happen when fungi grow on the skin surface. These infections are contagious and can spread through direct contact or by sharing personal items like towels or clothing. Common types of fungal infections include: Tinea corporis (ringworm): Circular, red, scaly patches with clearer centers Tinea pedis (athlete’s foot): Scaling and cracking between the toes Tinea cruris (jock itch): Red, itchy rash in the groin area Fungal infections often cause: Redness with a defined edge Itching that can be intense Scaling or peeling skin Sometimes small blisters or pustules around the rash Unlike eczema, fungal infections usually have a more distinct border and may spread outward in a ring-like pattern. They also tend to worsen with steroid creams, which can suppress the immune response and allow fungi to grow more. For more information about fungal skin infections, including treatment options, why they keep recurring and how to prevent reinfection, read my related article: Tinea (Fungal Skin Infection): Causes, Treatment and How to Prevent Recurrence Key Differences Between Eczema and Fungal Infection Feature Eczema Fungal Infection Cause Inflammation related to skin barrier dysfunction Fungal organisms growing on the skin Contagious? No Yes Appearance Dry, red, flaky or thickened skin Red, scaly rash with clearer borders or ring-like pattern Itching Often severe and worsens with scratching Usually itchy, sometimes with burning sensation Response to Steroid Creams Usually improves May temporarily improve before worsening later Common Areas Inner elbows, behind knees, neck, face, hands Feet, groin, body folds, scalp In reality, some skin conditions may overlap or appear less typical after repeated self-treatment, especially when multiple creams have already been used. When to See a Doctor If you have a rash that does not improve with over-the-counter creams or keeps coming back, it is important to get a proper diagnosis. A dermatologist can examine the rash, sometimes take skin scrapings for lab tests, and recommend the right treatment. For example, if a rash improves briefly with steroid cream but then worsens, it could be a fungal infection masked by the steroid. Appropriate antifungal treatment may help improve the infection once the correct diagnosis is identified. Treatment Approaches Eczema treatment usually focuses on reducing inflammation, protecting the skin barrier, and minimising triggers such as heat, sweat, or irritation. Fungal infections, on the other hand, require antifungal treatment and may worsen if treated incorrectly with repeated steroid-containing creams. Because the treatments can differ significantly, persistent or recurring rashes may occasionally benefit from reassessment rather than repeatedly changing creams independently. Practical Skin Care Considerations Some practical measures may also help reduce irritation and recurrent flare-ups over time: reducing prolonged moisture and friction on the skin, cleansing gently after excessive sweating, using suitable moisturisers to support the skin barrier, and avoiding repeated self-treatment with multiple creams without understanding the underlying condition involved. If a rash continues to recur despite treatment, reassessment may sometimes be more helpful than simply changing products repeatedly. Why Some Rashes Require Reassessment However, eczema, fungal infection, dermatitis, and steroid-modified rashes can sometimes look surprisingly similar, especially after multiple creams have already been used. Because of this, persistent or recurring rashes may occasionally benefit from reassessment rather than repeatedly changing creams independently. With the correct diagnosis, suitable treatment approach, and proper skin care, many skin conditions can usually be managed more comfortably over time. Related article: Why Skin Conditions Can Behave Differently in Malaysia’s Hot and Humid Climate

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Fungal skin infections are common, particularly in hot and humid countries like Malaysia. They often cause itchy, red or scaly rashes on the body, groin, feet and other areas of the skin. Although most fungal infections respond well to treatment, some patients experience repeated episodes even after using antifungal creams or oral medications. There are several possible reasons, including incomplete treatment, excessive sweating, reinfection, inappropriate steroid use and occasionally antifungal resistance. Understanding these factors is important because successful treatment involves not only clearing the infection but also reducing the risk of it returning. What Is Tinea? Tinea, also known as dermatophytosis or ringworm, is a fungal infection affecting the skin, scalp or nails. Despite the name ringworm, it is caused by fungi, not worms. Common types include: Tinea corporis: Fungal infection of the body, arms or legs. Tinea cruris: Fungal infection of the groin and inner thighs, also called jock itch. Tinea pedis: Fungal infection of the feet, commonly known as athlete's foot. Tinea faciei: Fungal infection affecting the face. Tinea capitis: Fungal infection of the scalp. Tinea unguium: Fungal infection affecting the nails. Tinea commonly causes itchy, red or scaly patches, sometimes with a ring-shaped appearance and a more prominent border. However, not all fungal infections have the typical ring-shaped appearance, particularly if the rash has been modified by previous treatment. Why Does Tinea Keep Coming Back? 1. Incomplete Antifungal Treatment One common reason for persistent fungal infection is stopping treatment too early. Although itching and redness may improve within a few days, the fungus may not have been completely eliminated. Stopping medication prematurely can allow the infection to persist or become noticeable again. Completing the prescribed antifungal treatment is important, even when the rash appears to have improved earlier. 2. Excessive Sweating and Humid Weather Fungi grow particularly well in warm, moist environments. Malaysia's tropical climate, together with frequent sweating, can increase the risk of fungal infections, especially around the groin, feet and skin folds. Tight clothing, damp underwear and inadequate drying after bathing may further contribute. Keeping the skin dry, wearing breathable clothing and changing out of sweaty clothes promptly can help reduce recurrence. 3. Reinfection From Other Parts of the Body Sometimes, a fungal infection keeps returning because another area of the body remains infected. For example, patients with recurrent groin fungal infections may also have athlete's foot or fungal nail infections. The fungus can spread from the feet to the groin through contaminated hands, towels or clothing. Treating the groin alone may not be enough if the infection elsewhere remains untreated. Checking the feet and toenails is therefore important in patients with recurrent fungal infections. 4. Repeated Exposure and Reinfection Fungal infections can spread through direct skin contact or contaminated personal items. Possible sources of reinfection include shared towels, clothing, footwear, infected household members and pets. Even after successful treatment, a new fungal infection may develop following repeated exposure. Avoiding shared personal items and identifying possible sources of infection can help reduce recurrence. 5. Inappropriate Use of Steroid Creams Steroid creams may temporarily reduce redness and itching but can worsen an underlying fungal infection when used inappropriately. They may also change the appearance of the rash, making it more difficult to recognise. This is known as tinea incognito, or steroid-modified fungal infection. Repeatedly applying steroid creams or steroid-antifungal combination products without confirming the diagnosis may delay appropriate treatment. 6. Underlying Medical Conditions Certain conditions can increase susceptibility to persistent or recurrent fungal infections, including: Diabetes mellitus Excessive sweating Obesity and deep skin folds Reduced immune function Use of immunosuppressive medications Managing these contributing factors may help improve treatment outcomes and reduce recurrence. 7. Antifungal Resistance Some dermatophyte infections have become more difficult to treat because of resistance to commonly used antifungal medications. One example is Trichophyton indotineae, which has been associated with extensive, persistent and sometimes terbinafine-resistant fungal infections. However, not every recurrent fungal infection is caused by antifungal resistance. Incomplete treatment, reinfection or an incorrect diagnosis are often more important considerations. If a fungal infection does not improve despite appropriate treatment, further testing may be needed before changing the medication. Is Every Recurrent Itchy Rash a Fungal Infection? Not necessarily. Several skin conditions, including eczema, contact dermatitis, psoriasis and inflammatory intertrigo, can resemble tinea. For example, a persistent groin rash may be caused by friction and inflammation rather than a fungal infection. Repeated antifungal treatment may not help if the underlying problem is not fungal. For a more detailed explanation, read my related article: Eczema or Fungal Infection: How to Tell the Difference. When the diagnosis is uncertain, a dermatologist may recommend skin scraping for microscopic examination or fungal culture. Confirming the diagnosis is especially important when a rash persists despite several courses of treatment. What Are the Treatment Options for Tinea? Treatment depends on the affected area, severity and previous treatment response. 1. Topical Antifungal Treatment For localised fungal infections, antifungal creams are usually the first-line treatment. Common options include: Terbinafine Clotrimazole Ketoconazole Treatment generally lasts approximately 1–4 weeks, depending on the medication and affected area. The medication should be applied as directed, usually covering the affected skin and a small margin of surrounding skin. Completing the prescribed treatment course is important, even if symptoms improve earlier. 2. Oral Antifungal Treatment For extensive, persistent or difficult-to-treat fungal infections, oral antifungal medication may be required. Common options include: Terbinafine Itraconazole Fluconazole in selected cases The choice and treatment duration depend on the type of infection, previous treatment response and individual medical circumstances. Oral antifungal medications may require assessment of liver function, drug interactions and other safety considerations. Fungal infections involving the scalp or nails usually require different treatment approaches and often longer treatment courses. Not every patient with recurrent tinea requires oral antifungal medication. Confirming the diagnosis and identifying the reasons for recurrence are equally important. How Can You Prevent Fungal Infections From Coming Back? Several practical measures can help reduce the risk of recurrence: Complete the prescribed treatment. Do not stop medication prematurely when the rash improves. Keep the skin clean and dry. Pay particular attention to the groin, feet and skin folds. Change sweaty clothing promptly. Avoid wearing damp underwear, socks or exercise clothing for prolonged periods. Wear loose, breathable clothing. This helps reduce heat, friction and trapped moisture. Avoid sharing personal items. Do not share towels, footwear or clothing, especially with someone who has an active infection. Check for fungal infections elsewhere. Untreated athlete's foot or fungal nail infections may contribute to reinfection. Avoid inappropriate steroid use. Do not repeatedly apply steroid creams to undiagnosed rashes. Manage contributing health conditions. Excessive sweating and poorly controlled diabetes may increase recurrence risk. If the infection continues to return despite these measures, further assessment may be necessary. When Should You See a Dermatologist? Consider dermatological assessment if: The fungal infection repeatedly returns despite treatment. The rash spreads or becomes more extensive. Several antifungal treatments have failed. The diagnosis remains uncertain. The infection involves the scalp, nails or multiple body areas. You have diabetes or a weakened immune system. Depending on the clinical findings, further investigations such as fungal microscopy or culture may help confirm the diagnosis and guide treatment. Can Tinea Be Cured Permanently? Most uncomplicated tinea infections can be successfully treated with appropriate antifungal medication. However, successful treatment does not provide lifelong immunity. A new infection may develop following repeated exposure, especially when contributing factors such as excessive sweating or untreated fungal infections elsewhere remain. For patients with recurrent infections, the goal is not simply to clear the current rash but also to identify and address the reasons it keeps returning. Managing Recurrent Fungal Infections Fungal skin infections are generally treatable, but recurrence may occur when contributing factors remain unaddressed. Incomplete treatment, excessive sweating, reinfection, inappropriate steroid use and occasionally antifungal resistance may all play a role. Importantly, not every recurrent itchy rash is caused by a fungal infection. Accurate diagnosis, appropriate antifungal treatment and practical preventive measures are essential for achieving better long-term outcomes. For patients whose rashes continue to return despite treatment, dermatological assessment may help identify the underlying cause and guide further management. About the Author Dr Lim Tzyy Huei is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and treatment of fungal skin infections, eczema, psoriasis, acne and other inflammatory skin conditions. Patients experiencing persistent or recurrent fungal skin infections may benefit from dermatological assessment to confirm the diagnosis and discuss appropriate treatment options. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment suitability and medication requirements vary between patients.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia With fellow investigators and research colleagues at the Remibrutinib Investigator Meeting in Singapore, May 2023. In May 2023, I had the privilege of attending my first international investigator meeting in Singapore as a Principal Investigator (PI) for a clinical study evaluating remibrutinib in chronic spontaneous urticaria. This was an important milestone in my dermatology career, offering an opportunity to contribute to international clinical research and learn alongside fellow investigators and research professionals from different countries. The meeting covered the scientific background of the investigational treatment, study procedures, and the shared responsibility of conducting research with careful attention to patient safety and data quality. Understanding Chronic Urticaria Chronic urticaria, commonly known as chronic hives or gegata in Malay, is characterised by recurrent itchy wheals, angioedema, or both, lasting more than six weeks. Individual wheals typically disappear within 24 hours, but new lesions may develop unpredictably. For patients, this recurring cycle can disrupt sleep, interfere with daily activities, and affect emotional well-being. In chronic spontaneous urticaria (CSU), symptoms occur without a definite external trigger. Some patients remain symptomatic despite antihistamine treatment, highlighting the need to investigate additional approaches to disease control. Exploring a New Treatment Approach: Remibrutinib At the time of the meeting, remibrutinib was being investigated as a potential oral treatment for chronic spontaneous urticaria. Remibrutinib is a Bruton’s tyrosine kinase (BTK) inhibitor. It targets signalling pathways involved in immune-cell activation and the release of mediators that contribute to urticaria symptoms, offering a different approach from antihistamines. The meeting provided an opportunity to understand the scientific rationale behind this approach, review the study protocol, and discuss how treatment efficacy and safety would be assessed. It reinforced an essential principle of clinical research: potential benefits must be evaluated through carefully designed studies and reliable evidence. My Responsibilities as a Principal Investigator Serving as a Principal Investigator was both an honour and a significant responsibility. At the participating research site, the role involves overseeing study conduct, protecting participants’ safety and rights, ensuring appropriate informed consent, and maintaining accurate clinical records. It also requires adherence to the approved protocol, ethical requirements, and Good Clinical Practice (GCP) standards. The investigator meeting helped deepen my understanding of these responsibilities and the coordination required between investigators, research teams, and study organisers. Behind every clinical trial are patients who place their trust in the research team. Respecting that trust is central to responsible research. Learning Through International Collaboration One of the most rewarding aspects of the meeting was connecting with colleagues from different countries and healthcare settings. Exchanging experiences offered valuable perspectives on the challenges of managing chronic urticaria. These discussions also highlighted the importance of consistent clinical assessments and close collaboration across participating centres. Although our healthcare systems and clinical experiences differed, we shared a common goal: generating meaningful evidence that could help improve patient care. A Meaningful Milestone in My Dermatology Career Looking back, my first international investigator meeting in Singapore remains a memorable part of my professional journey. Beyond the scientific learning, it strengthened my appreciation of the relationship between research and everyday clinical practice. Progress depends on understanding disease mechanisms, asking relevant questions, and carefully evaluating potential treatments. I am grateful for the opportunity to contribute as a Principal Investigator and to learn from an international research community committed to improving care for people living with chronic urticaria. This experience continues to shape my commitment to ongoing learning, responsible research, and evidence-based dermatology. Understanding Chronic Spontaneous Urticaria: A Patient's Guide Beyond clinical research, helping patients understand and manage chronic urticaria remains an important part of my dermatology practice. For patients who experience recurrent hives, I have also written a patient education article explaining why chronic spontaneous urticaria keeps coming back, common aggravating factors, available treatments including antihistamines and omalizumab, and what to expect from long-term management. Read more: Chronic Urticaria (Hives): Why It Keeps Coming Back

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Do you frequently experience itchy, raised red patches on your skin that appear suddenly, disappear within hours, and then return again? Some patients develop these rashes almost every day. Others may experience swelling around the eyelids, lips or face. Despite avoiding certain foods, changing skincare products or taking allergy medications, the symptoms may continue for weeks or months. This condition may be Chronic Spontaneous Urticaria (CSU), commonly known as chronic hives. CSU can be frustrating because the symptoms often appear without an obvious trigger. However, with proper diagnosis and a structured treatment plan, most patients can achieve meaningful symptom control. What Is Chronic Spontaneous Urticaria? Urticaria, commonly known as hives, causes itchy, raised swellings on the skin called wheals. These wheals may vary in size and shape. They can appear anywhere on the body, disappear and then develop in another location. In typical urticaria, an individual wheal usually disappears within 24 hours without leaving a scar or permanent mark. Urticaria is classified according to its duration: Acute urticaria: Symptoms lasting up to six weeks. Chronic urticaria: Recurrent symptoms lasting more than six weeks. Chronic spontaneous urticaria refers to recurrent hives, swelling or both that develop without a consistent, identifiable external trigger. Some patients also develop angioedema, which causes deeper swelling, commonly around the lips, eyelids, hands or feet. Although CSU is usually not life-threatening, persistent itching, visible skin changes and unpredictable flare-ups can significantly affect sleep, daily activities and emotional well-being. What Causes Chronic Spontaneous Urticaria? One of the most common questions patients ask is: "Doctor, what am I allergic to? Why do I keep getting hives?" Interestingly, CSU is usually not caused by a conventional food allergy. The condition involves abnormal activation of certain immune cells in the skin, particularly mast cells. When mast cells are activated, they release histamine and other inflammatory substances, causing itching, redness, wheals and sometimes swelling. In some patients, autoimmune mechanisms play an important role. The immune system may produce antibodies that contribute to mast cell activation. However, the exact underlying mechanism may not always be identifiable. This explains why patients can experience repeated episodes of hives even when they have not eaten anything unusual or changed their daily routine. What Can Trigger or Worsen CSU? Although CSU occurs spontaneously, certain factors may aggravate existing symptoms. Common contributing factors include: 1. Emotional Stress Stress does not necessarily cause CSU, but it can worsen itching and increase the frequency or intensity of flare-ups. Some patients notice worsening symptoms during periods of emotional stress, poor sleep or physical exhaustion. 2. Infections Viral infections and other illnesses may temporarily aggravate urticaria. However, this does not mean that every patient with CSU has an underlying infection requiring treatment. 3. Heat and Sweating Hot weather, hot showers and excessive sweating can worsen symptoms in some patients. This may be particularly relevant in Malaysia's hot and humid climate. 4. Certain Medications Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, may worsen urticaria in susceptible individuals. Patients should inform their doctor if they notice worsening symptoms after taking particular medications. Do not discontinue prescribed medication without medical advice. 5. Alcohol and Other Individual Aggravating Factors Alcohol, pressure from tight clothing and other individual factors may aggravate symptoms in some patients. However, not everyone with CSU has the same triggers. The aim is to identify genuine aggravating factors rather than unnecessarily avoiding large groups of foods or activities. Is Chronic Spontaneous Urticaria a Food Allergy? This is a common misunderstanding. Unlike immediate food allergies, which typically cause symptoms shortly after exposure to a specific food, CSU often occurs independently of food intake. Many patients undergo extensive food allergy testing or start restrictive diets, hoping to find a particular food responsible for their symptoms. However, routine food allergy testing is usually not necessary unless the patient's history suggests a reproducible allergic reaction. Unnecessary food restriction may cause additional stress and nutritional imbalance without improving the condition. If a specific food consistently causes symptoms shortly after ingestion, further assessment may be appropriate. Do I Need Allergy Tests or Blood Tests? The diagnosis of CSU is primarily based on a detailed medical history and examination. Your dermatologist may ask about: How long the hives have been occurring Whether individual wheals disappear within 24 hours The frequency and severity of symptoms Associated swelling of the lips or eyelids Possible medication-related triggers Other symptoms or underlying medical conditions Selected blood tests may be recommended, including a full blood count and inflammatory markers. In specialist care, thyroid autoantibodies and total IgE may sometimes provide additional information about the underlying disease mechanisms and likely treatment response. However, a normal total IgE level does not exclude CSU, and an elevated IgE level does not automatically mean that food allergy is responsible. Extensive investigations are generally unnecessary unless the history or examination suggests another condition. What Are the Treatment Options for CSU? Treatment aims to reduce itching, prevent new wheals and swelling, improve sleep and quality of life, and achieve good long-term disease control. Treatment is usually introduced in a stepwise manner depending on symptom severity and response. 1. Second-Generation Antihistamines Modern, second-generation antihistamines are generally the first-line treatment for CSU. Common examples include: Fexofenadine Bilastine Cetirizine Levocetirizine Desloratadine Rupatadine These medications block the effects of histamine and help reduce itching and wheal formation. Unlike older antihistamines, many second-generation antihistamines are less likely to cause significant drowsiness. For patients with frequent symptoms, regular daily treatment is often more effective than taking medication only when itching becomes severe. What if the usual antihistamine dose does not work? Some patients require higher doses to achieve adequate symptom control. Under medical supervision, the dose of a second-generation antihistamine may be increased up to four times the standard dose in selected patients. This is a recognised guideline-supported approach, although higher-than-licensed dosing is generally off-label. Patients should not increase their medication dosage without discussing it with their treating doctor. 2. Omalizumab (Xolair) – Targeted Biologic Treatment For patients whose CSU remains uncontrolled despite appropriately increased antihistamine treatment, omalizumab may be recommended. Omalizumab is a targeted biologic medication that binds to immunoglobulin E (IgE), helping reduce mast cell activation. It is administered by subcutaneous injection, commonly at four-week intervals. What can patients expect? Many patients experience a significant reduction in itching, hives and swelling. Some patients improve within the first few weeks, while others require several months before the full benefit becomes apparent. Treatment response varies between individuals, and complete clearance cannot be guaranteed. Omalizumab is generally well tolerated, but allergic reactions, including rare anaphylaxis, are possible. Appropriate medical supervision is important. Omalizumab helps control disease activity but does not necessarily permanently cure CSU. Symptoms may recur after treatment is discontinued, and some patients may require a longer treatment period. 3. Dupilumab (Dupixent) – Another Biologic Treatment Option Dupilumab is a biologic medication that targets inflammatory pathways involving interleukin-4 and interleukin-13. It is already used in several inflammatory conditions, including atopic dermatitis. Clinical studies have demonstrated that dupilumab can also improve symptoms in selected patients with inadequately controlled CSU. It may be considered in appropriate patients depending on previous treatment response, other associated medical conditions and local regulatory approval. Dupilumab is given by subcutaneous injection. As with other systemic treatments, the choice of medication should be individualised. 4. Remibrutinib – An Oral Targeted Treatment Remibrutinib is a newer oral medication that inhibits Bruton's tyrosine kinase (BTK), a signalling enzyme involved in mast cell activation. By interrupting this pathway, remibrutinib can reduce the release of inflammatory mediators responsible for hives and itching. Unlike biologic injections, remibrutinib is taken orally. Clinical trials have demonstrated meaningful improvements in itching and urticaria activity in selected patients with CSU. Its use depends on local regulatory approval, availability, patient suitability and specialist assessment. 5. Ciclosporin – For Selected Difficult-to-Control Cases Ciclosporin is an immunosuppressive medication that may be considered in selected patients with severe CSU who remain inadequately controlled despite other treatments. It can be effective but requires careful monitoring because of potential adverse effects, including increased blood pressure, kidney impairment and medication interactions. It is generally reserved for patients requiring specialist-directed treatment. 6. What About Oral Steroids? Oral corticosteroids may temporarily reduce severe urticaria symptoms. However, long-term oral steroid treatment is not recommended for CSU because of potential complications such as weight gain, raised blood sugar, hypertension, osteoporosis and increased susceptibility to infections. A very short course may occasionally be considered for a severe flare, but steroids should not become the main long-term treatment strategy. How Long Does CSU Last? The duration of CSU varies considerably between individuals. Some patients improve and enter remission within months, while others may experience recurrent symptoms for several years. CSU often follows an unpredictable course, with periods of improvement and occasional flare-ups. It is important to understand that persistent urticaria does not necessarily indicate a dangerous underlying disease. With appropriate treatment, many patients can maintain normal daily activities despite having chronic urticaria. Can CSU Be Cured Permanently? There is currently no treatment that can guarantee a permanent cure for every patient. However, CSU can enter spontaneous remission, meaning the hives eventually stop occurring without the need for continued medication. The role of treatment is to keep symptoms controlled while the disease remains active. Some patients can gradually reduce or discontinue medication after achieving sustained symptom control. Others may require longer-term maintenance treatment. The decision to reduce treatment should be made together with the treating dermatologist. Why Do My Hives Return When I Stop Taking Antihistamines? This is another common concern. Antihistamines control the effects of histamine, but they do not necessarily eliminate the underlying tendency for mast cell activation. Therefore, symptoms may return when medication is stopped while the disease remains active. This does not mean that your body has become addicted to antihistamines. It usually indicates that the underlying urticaria has not yet entered remission. Patients with frequent recurrence may benefit from regular treatment followed by a gradual, supervised step-down approach once stable control has been achieved. What Can I Do to Reduce CSU Flare-Ups? Although CSU cannot always be prevented, some practical measures may help minimise aggravating factors. 1. Take medication consistently Follow the prescribed antihistamine schedule rather than repeatedly stopping and restarting treatment without medical advice. 2. Avoid known aggravating medications If you notice worsening symptoms after certain painkillers or other medications, discuss this with your doctor. 3. Minimise excessive heat exposure Choose comfortable clothing and avoid very hot showers if heat aggravates your hives. 4. Maintain regular sleep and stress management Stress reduction and adequate sleep may improve overall well-being and help minimise symptom aggravation. 5. Avoid unnecessary food restrictions Do not eliminate multiple food groups unless there is a clear, reproducible relationship or medical advice to do so. 6. Keep a symptom diary Recording the frequency of hives, associated swelling, medication use and possible aggravating factors can help assess disease control. When Should You See a Dermatologist? Consider specialist assessment if: Hives persist or recur for more than six weeks Symptoms interfere with sleep, work or daily activities Regular antihistamines provide inadequate relief You experience recurrent swelling of the lips or eyelids You need frequent courses of oral steroids The diagnosis remains uncertain Seek emergency medical attention if hives or swelling are accompanied by difficulty breathing, throat or tongue swelling, dizziness, fainting or signs of a severe allergic reaction. If individual skin lesions remain in the same location for more than 24 hours, are painful rather than itchy, or leave bruising, further assessment may be necessary to exclude other conditions such as urticarial vasculitis. Final Thoughts Chronic spontaneous urticaria can be distressing, particularly when itchy rashes continue to appear without an obvious explanation. However, CSU is not usually caused by a conventional food allergy, and extensive dietary restrictions or repeated allergy testing may not provide the answer. The most important approach is to confirm the diagnosis, identify relevant aggravating factors and establish a structured treatment plan. Modern antihistamines remain the first-line treatment, while targeted therapies such as omalizumab and newer treatment options offer additional possibilities for patients with difficult-to-control disease. Although CSU may persist for months or years, good symptom control is achievable for many patients, and spontaneous remission can occur over time. About the Author Dr Lim Tzyy Huei is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the assessment and management of chronic urticaria, eczema, psoriasis, acne, allergic and inflammatory skin conditions. Patients with persistent or recurrent hives may benefit from dermatological assessment to confirm the diagnosis and discuss appropriate treatment options. Disclaimer: This article provides general educational information and does not replace individual medical consultation. Treatment suitability, medication availability and regulatory approval may vary.

By Dr Lim Tzyy Huei ( 林子辉医生 ) Consultant Dermatologist | Pantai Hospital Batu Pahat, Johor, Malaysia Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that causes itching, redness, dryness and sometimes painful cracks or wounds. For many patients, eczema can be controlled with moisturisers and prescribed creams. However, others continue to experience frequent flare-ups, severe itching or widespread inflammation despite appropriate treatment. What treatment options are available when steroid creams are not enough? Are biologic injections or newer oral medications suitable for severe eczema? Eczema treatment has advanced considerably in recent years. Today, several treatment options are available, ranging from topical medications to targeted therapies that control specific inflammatory pathways. Understanding these options can help patients make informed decisions and develop realistic expectations about long-term eczema management. 1. Understanding Eczema Treatment Eczema develops through a combination of a weakened skin barrier and an overactive inflammatory response. Heat, sweating, harsh soaps, fragrances, dry skin and other individual triggers can aggravate inflammation and cause flare-ups. Treatment generally focuses on three important goals: Controlling inflammation and relieving itching. Repairing and maintaining the skin barrier. Preventing frequent flare-ups and improving quality of life. The treatment approach depends on eczema severity, the areas affected, previous treatment response and individual medical needs. For a more detailed explanation of common triggers, read my related article: Why Eczema Keeps Coming Back and How to Manage It Better. 2. First-Line Treatment: Steroid Creams and Moisturisers For most patients with mild-to-moderate eczema, topical treatment is the first step. Topical Corticosteroids (Steroid Creams) Topical corticosteroids help reduce inflammation, redness and itching during active eczema flare-ups. When used correctly, they are generally safe and effective. During an active flare-up: Apply the prescribed steroid cream to inflamed areas, usually once daily or as directed. Use an adequate amount to cover the affected skin. Continue until inflammation has settled, often within several days to 1–2 weeks, although some flare-ups require longer treatment. Avoid using potent steroid creams on the face, eyelids, groin or skin folds unless specifically advised by your dermatologist. Different areas of the body may require different steroid strengths. What Happens After Eczema Improves? Once the inflammation has settled, treatment may be reduced, stopped or changed to a milder anti-inflammatory medication. For patients with frequently recurring eczema, a proactive maintenance strategy may be recommended. This involves applying a prescribed anti-inflammatory cream twice weekly to previously affected areas, even when the skin appears clear. Such maintenance treatment can help reduce future flare-ups. Not every topical steroid requires gradual tapering. The appropriate treatment duration and maintenance plan should be individualised. Moisturisers: The Foundation of Eczema Care Even when eczema appears clear, the skin barrier may remain vulnerable to dryness and irritation. Regular moisturising is therefore essential. Recommended measures include: Apply moisturiser at least twice daily. Moisturise immediately after bathing. Choose fragrance-free creams or ointments. Apply moisturiser to the whole body, not only areas affected by eczema. Continue daily moisturising even when eczema is well controlled. Steroid creams control inflammation, while moisturisers help maintain the skin barrier. Both are important for long-term eczema control. For patients concerned about topical steroid safety, you may also read: Are Steroid Creams Always Harmful? 3. Are There Non-Steroid Creams for Eczema? Yes. Some patients may benefit from non-steroidal anti-inflammatory creams, particularly when eczema affects sensitive areas or requires longer-term maintenance. Examples include: Tacrolimus Ointment Tacrolimus is a topical calcineurin inhibitor that helps control skin inflammation without causing steroid-related skin thinning. It may be particularly useful for eczema affecting the face, eyelids, neck and skin folds. Pimecrolimus Cream Pimecrolimus is another non-steroidal anti-inflammatory medication that may be suitable for selected patients with mild-to-moderate eczema, especially in sensitive areas. Both medications may initially cause temporary burning or stinging, which often improves with continued use. These treatments can also be used intermittently for maintenance in suitable patients. The choice between steroid and non-steroid creams depends on eczema severity, location, age and treatment response. 4. What If Eczema Remains Severe Despite Cream Treatment? Some patients continue to experience: Severe or persistent itching. Widespread eczema. Frequent flare-ups despite appropriate topical treatment. Sleep disturbance. Painful cracks or repeated skin infections. Significant effects on work, daily activities or quality of life. In these situations, systemic treatment may be considered. Systemic treatments act on inflammatory pathways throughout the body rather than treating only individual patches of eczema. Several options are available. Conventional Oral Medications Methotrexate Methotrexate is an immunomodulating medication usually taken once weekly. It helps reduce excessive immune activity and may be considered for patients with persistent moderate-to-severe eczema. Improvement develops gradually, often over 4–12 weeks. Regular blood monitoring is required because methotrexate may affect the liver, blood counts and other organs. It must not be used during pregnancy. Cyclosporin Cyclosporin is a relatively fast-acting immunosuppressant. Some patients with severe eczema may experience improvement within 1–2 weeks. It may be particularly useful when relatively rapid control of severe inflammation is required. However, cyclosporin requires regular monitoring of blood pressure and kidney function and is often used for shorter-term disease control. 5. Biologic Injections for Moderate-to-Severe Eczema Biologic therapies are newer treatments that target specific immune pathways responsible for eczema inflammation. Unlike conventional immunosuppressants, they act more selectively on particular inflammatory signals. Two important options include: Dupilumab (Dupixent) Dupilumab blocks signalling from interleukin-4 (IL-4) and interleukin-13 (IL-13), which are important inflammatory pathways in atopic dermatitis. It is usually administered by subcutaneous injection every two weeks in adults, following an initial loading dose. Some patients notice improvement in itching within the first few weeks, while more substantial skin improvement may develop over several months. Dupilumab may be suitable for longer-term control of moderate-to-severe eczema. Lebrikizumab Lebrikizumab specifically targets IL-13, an important inflammatory signal involved in eczema. Treatment initially involves subcutaneous injections every two weeks. After an adequate response, some patients may continue with injections every four weeks for maintenance. Like dupilumab, it can help reduce itching, inflammation and eczema severity. Are Biologic Treatments Safe? Biologic treatments are generally well tolerated in appropriately selected patients. Possible side effects include: Injection-site reactions. Eye irritation or conjunctivitis. Other treatment-specific adverse effects. Patients should discuss their medical history and possible side effects with their dermatologist before starting treatment. Biologics may provide sustained control, but continued treatment is often necessary to maintain improvement. 6. Oral JAK Inhibitors: Targeted Treatment for Eczema Janus kinase (JAK) inhibitors are targeted oral medications that block inflammatory signals involved in eczema. One of their important advantages is the potential for relatively rapid improvement in itching. Examples include: Upadacitinib (Rinvoq) A selective JAK1 inhibitor. Some patients experience noticeable itch relief within the first few days of treatment. Baricitinib (Olumiant) A JAK1/JAK2 inhibitor that can help reduce itching and inflammation in suitable patients. Abrocitinib (Cibinqo) A selective JAK1 inhibitor that may also provide relatively rapid improvement in itching and eczema severity.These medications are generally taken once daily. What Are the Risks of JAK Inhibitors? Although JAK inhibitors can be highly effective, they require careful patient selection. Potential risks include: Serious infections, including shingles. Changes in blood counts, liver enzymes or cholesterol. Blood clots. Cardiovascular complications and other serious adverse events in susceptible patients. Screening for infections, including tuberculosis and hepatitis where appropriate, and regular blood monitoring are generally required. Age, smoking history, cardiovascular risk factors, previous blood clots and other medical conditions are important when considering these medications. Not every patient needs to try conventional oral immunosuppressants before being considered for biologics or JAK inhibitors. Treatment choice should follow individual clinical assessment, medication indications and safety considerations. 7. How Long Does Eczema Treatment Take to Work? Different treatments work at different speeds. Treatment General expectation Topical steroid creams Improvement often begins within several days Tacrolimus / Pimecrolimus Improvement generally develops over days to weeks Methotrexate Often takes 4–12 weeks Cyclosporin Some patients improve within 1–2 weeks Dupilumab / Lebrikizumab Itch may improve within weeks; skin improvement develops over subsequent weeks to months Oral JAK inhibitors Itch improvement may begin within days in some patients These timelines are general estimates. Individual responses vary depending on eczema severity, treatment adherence and other factors. Not every patient will achieve completely clear skin, but meaningful reductions in itching, inflammation, sleep disturbance and flare-up frequency are important treatment outcomes. 8. Can Eczema Treatment Be Reduced or Stopped? Eczema is a chronic condition, and recurrence is possible even after successful treatment. For patients with mild eczema, topical anti-inflammatory medication may be reduced or stopped once the flare-up has settled, while regular moisturising continues. Patients with frequently recurring eczema may benefit from intermittent maintenance treatment. For those receiving biologics, JAK inhibitors or conventional systemic medications, treatment duration depends on disease control, safety and individual response. Stopping systemic treatment may lead to recurrence in some patients. Therefore, treatment should not be discontinued or adjusted without discussing a suitable plan with the treating dermatologist. The aim of long-term eczema management is to maintain good disease control using the safest effective treatment strategy. 9. When Should You See a Dermatologist? Consider consulting a dermatologist if: Eczema remains uncontrolled despite prescribed creams and moisturisers. Itching significantly affects sleep or daily activities. Large areas of the body are affected. Flare-ups occur frequently or require repeated courses of potent steroid creams. Painful cracks, wounds or recurrent skin infections develop. You wish to understand whether biologic injections or oral targeted treatments may be suitable. A dermatologist can assess eczema severity, review previous treatment responses and recommend an appropriate long-term management plan. Conclusion: Choosing the Right Eczema Treatment Eczema treatment is not limited to steroid creams. For many patients, regular moisturising and appropriate topical anti-inflammatory treatment are sufficient to maintain good control. For others with moderate-to-severe or frequently recurring eczema, additional options such as methotrexate, cyclosporin, biologic injections or oral JAK inhibitors may provide significant improvement. Each treatment has different benefits, expected response times and safety considerations. The most appropriate treatment depends on the patient's eczema severity, age, medical history, previous treatment response and individual needs. Successful eczema treatment is not simply about clearing the rash temporarily. It is about achieving sustained control, reducing itching and flare-ups, and improving quality of life. Related Reading For patients who would like to understand more about eczema and its long-term management: Why Eczema Keeps Coming Back and How to Manage It Better — Common triggers, skin barrier dysfunction and prevention of recurrence. Eczema Treatment Explained: Answers to Common Questions and Concerns — Why treatments sometimes change, concerns about stronger creams and the importance of follow-up. Are Steroid Creams Always Harmful? — Understanding topical steroid safety and common misconceptions. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the diagnosis and treatment of eczema, psoriasis, acne, skin allergies and other inflammatory skin conditions. He provides individualised treatment plans ranging from topical medication and skin care counselling to conventional systemic therapies, biologic injections and targeted oral treatments for patients with moderate-to-severe eczema. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment availability, approved indications and suitability may vary. Medication benefits, risks and monitoring requirements should be discussed with a qualified healthcare professional.

By Dr Lim Tzyy Huei (林子辉医生) Consultant Dermatologist | Pantai Hospital Batu Pahat, Johor, Malaysia Do you frequently develop painful lumps, boils or abscesses around your armpits, groin, buttocks or inner thighs? If these painful swellings repeatedly return to the same areas, you may have a chronic inflammatory skin condition called Hidradenitis Suppurativa (HS). HS is often mistaken for ordinary boils or bacterial infections. However, it is a long-term inflammatory condition involving hair follicles and surrounding skin. Early diagnosis and appropriate treatment can help reduce flare-ups, pain and permanent scarring. Living with Hidradenitis Suppurativa Living with HS can be physically and emotionally challenging. Recurrent painful lumps, discomfort and scarring may affect daily activities, sleep, confidence and social interactions. For some patients, even after the skin has improved, the worry of another painful flare-up can remain. If you are living with HS, remember that you are not alone. With appropriate treatment and ongoing care, many patients can achieve better disease control and regain confidence in their daily lives. 1. What Causes Hidradenitis Suppurativa? HS develops when hair follicles become blocked and inflamed, leading to painful lumps, abscesses and sometimes tunnels beneath the skin. Common contributing factors include: Genetic predisposition: HS may run in families. Smoking: Associated with HS and may worsen disease activity. Excess body weight: Skin friction and sweating may aggravate symptoms. Hormonal influences: Some patients experience flare-ups around menstruation. Heat, sweating and friction: These may worsen irritation in affected areas. Importantly, HS is not caused by poor hygiene and is not contagious. 2. What Are the Symptoms of HS? Common symptoms include: Recurrent painful lumps or boils. Swellings that discharge pus or blood. Repeated inflammation in the armpits, groin, buttocks or inner thighs. Persistent wounds or tunnels beneath the skin. Scarring after repeated episodes. Without appropriate treatment, some patients may develop extensive scarring and chronic draining wounds. 3. What Are the Treatment Options? Treatment depends on the severity, frequency of flare-ups and extent of skin involvement. Mild HS Topical antibiotics such as clindamycin. Antiseptic washes when appropriate. Treatment for individual painful inflamed lumps. Measures to minimise friction and irritation. Moderate HS Oral antibiotics such as doxycycline. Combination antibiotic treatments when indicated. Hormonal treatment for selected patients. Procedures for persistent or recurrent lesions. Moderate-to-Severe HS Patients with frequent painful abscesses, draining tunnels or significant scarring may require more advanced treatment. Options include: Biologic injections: Such as adalimumab, secukinumab or bimekizumab, which target specific inflammatory pathways. Surgical procedures: Deroofing or excision of persistent tunnels and recurrent lesions. Combination treatment: Medication and procedures may be used together for better disease control. Treatment is individualised, and not every patient requires biologic injections or surgery. 4. How to Reduce HS Flare-Ups Although HS cannot always be permanently cured, good daily care can help reduce irritation and support treatment. Recommended measures include: Wear loose, breathable clothing to reduce friction. Avoid squeezing or picking painful lumps. Keep affected areas clean and gently dry. Stop smoking if applicable. Maintain a healthy weight where appropriate. Avoid close shaving or hair-removal methods that irritate affected skin. Seek early treatment when new painful lumps develop. For painful flare-ups, a warm compress may provide temporary relief. Lifestyle measures are helpful, but medical treatment is often necessary to control the underlying inflammation. 5. Can Hidradenitis Suppurativa Come Back? Yes. HS is a chronic inflammatory condition that may recur even after successful treatment. Some patients experience occasional mild flare-ups, while others develop frequent painful lumps, persistent wounds or scarring. Although existing treatments can help control inflammation and reduce flare-ups, managing HS can sometimes be challenging, particularly in patients with moderate-to-severe disease. Fortunately, advances in dermatology research have led to the development of newer treatments, including biologic therapies that target specific inflammatory pathways. Ongoing Research and New Treatment Developments As our understanding of HS continues to improve, international clinical studies are exploring additional treatment options to achieve better and longer-lasting disease control. As part of my involvement in dermatology research, I attended an international Hidradenitis Suppurativa Investigator Meeting in Tokyo, Japan, serving as a Principal Investigator in a multicentre clinical study. The meeting brought together dermatology investigators from different countries to discuss ongoing clinical research, patient safety and potential new treatment approaches for HS. These research efforts are important because HS can significantly affect patients' physical comfort, emotional well-being and quality of life. For patients living with recurrent HS, continued medical advances offer hope for more effective long-term treatment options. You can read more about my involvement in HS research here: Advancing Dermatology Research: Hidradenitis Suppurativa Investigator Meeting in Tokyo, Japan 6. When Should You See a Dermatologist? Consider consulting a dermatologist if: Painful boils repeatedly appear in the same areas. Swellings frequently discharge pus. Scars or persistent wounds develop. Repeated antibiotic treatments provide only temporary relief. Symptoms affect walking, sitting, sleep or daily activities. Early diagnosis and appropriate treatment may help prevent disease progression and permanent scarring. Conclusion: Living Better with HS Hidradenitis suppurativa is more than just recurrent boils. It is a chronic inflammatory skin condition that can affect both physical comfort and emotional well-being. Although HS may recur, advances in treatment and ongoing clinical research continue to improve the options available to patients. With appropriate medication, lifestyle measures and regular follow-up, many patients can achieve better disease control, fewer flare-ups and improved quality of life. Early diagnosis, individualised treatment and long-term care are key to managing HS effectively. About the Author Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. His clinical practice includes the management of eczema, psoriasis, hidradenitis suppurativa, acne and other inflammatory skin conditions. He is also involved in international dermatology clinical research, including studies exploring potential treatment options for hidradenitis suppurativa. This article is intended for general patient education and does not replace individual medical consultation.