By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Dr Lim Tzyy Huei interviewing a member of the public about skin concerns. Sensitive skin is a common concern affecting people of all ages. Symptoms such as dryness, redness, itching, burning and irritation can affect daily comfort and quality of life. As a dermatologist, I frequently encounter patients with sensitive skin, particularly those with eczema, rosacea and other inflammatory skin conditions. I recently had the opportunity to participate in Ceradan Malaysia's DR. Derm Tips educational video series, featuring conversations with members of the public about skin health and sensitive skin. Understanding Sensitive Skin and Skin Barrier Health Our skin has a natural protective barrier that helps retain moisture and protect against external irritants. When this barrier becomes compromised, the skin may become more prone to dryness, irritation and inflammation. Several factors can contribute to skin sensitivity, including: Excessive cleansing or harsh skincare products Over-exfoliation and inappropriate use of active skincare ingredients Environmental factors such as heat and sweating Underlying skin conditions such as eczema, rosacea or contact dermatitis A healthy skin barrier contains essential lipids, including ceramides, cholesterol and free fatty acids, which help maintain moisture and protect the skin. Gentle cleansing, regular moisturising and avoiding unnecessary skincare products are important steps in caring for sensitive skin. However, persistent redness, itching or recurrent irritation may indicate an underlying skin condition requiring dermatological assessment. Bringing Skin Health Education to a Wider Audience I am pleased that the educational video, published on Ceradan Malaysia's Instagram page (@ceradan311my), has reached over 1 million views. This encouraging milestone highlights the public's growing interest in understanding sensitive skin and maintaining healthy skin. As a dermatologist, I believe that public education should extend beyond the consultation room. Through educational collaborations and digital platforms, we can make reliable, evidence-based dermatological information more accessible to the wider community. I am grateful to Ceradan Malaysia for the opportunity to contribute to this educational initiative and hope to continue raising awareness about skin health. Watch the educational video on Instagram: https://www.instagram.com/p/DTH7u_fEhjk/ Final Thoughts Sensitive skin is not always simply a matter of choosing the right skincare product. Understanding the underlying cause, maintaining a healthy skin barrier and seeking appropriate medical advice when necessary are essential for long-term skin health. Through educational initiatives such as DR. Derm Tips, I hope to encourage greater public awareness and help more people make informed decisions about their skin. Dr Lim Tzyy Huei is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia, providing assessment and treatment for eczema, sensitive skin, rosacea, contact dermatitis and other dermatological conditions. Collaboration disclosure: This educational video was produced in collaboration with Ceradan Malaysia for public skin health awareness. No specific skincare product was recommended during the interview.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Hair thinning and a receding hairline are common concerns among men. Some experience these changes as early as their twenties, while others develop gradual hair loss later in life. The most common cause is male pattern hair loss, medically known as androgenetic alopecia. Although this condition is progressive, early diagnosis and appropriate treatment can help slow further hair loss, preserve existing hair and, in some cases, improve hair density. Successful treatment requires patience, consistency and realistic expectations. What Causes Male Pattern Hair Loss? Male pattern hair loss develops due to genetic predisposition and increased sensitivity of certain hair follicles to dihydrotestosterone (DHT), a hormone derived from testosterone. Over time, DHT causes susceptible hair follicles to gradually shrink, a process known as follicular miniaturisation. As a result, hair strands become progressively finer, shorter and less visible. Common signs include: Receding hairline, particularly around the temples Gradual thinning over the crown Reduced hair density on the top of the scalp Increasing visibility of the scalp Male pattern hair loss can be inherited from either side of the family. Related Reading: Female Pattern Hair Loss Hair thinning also affects women, although the pattern often differs. While men commonly experience a receding hairline and crown thinning, women typically notice a widening central hair parting and reduced hair density. For more information, read my related article: Female Pattern Hair Loss: Treatment Options, How to Apply Minoxidil and What to Expect. What Are the Treatment Options? Treatment depends on the severity of hair loss, age, medical history and individual preferences. The main goals are to slow further hair thinning, preserve existing hair and encourage regrowth where possible. 1. Topical Minoxidil – Stimulating Hair Growth Topical minoxidil is one of the most established treatments for male pattern hair loss. It is available as a solution or foam, with 5% minoxidil commonly recommended for men. Minoxidil helps prolong the hair growth phase and improve the thickness of miniaturised hair strands. Potential benefits include: Slowing further hair thinning Improving hair thickness and density Encouraging regrowth in partially miniaturised follicles Maintaining existing hair For men, 5% minoxidil solution is generally applied twice daily, unless otherwise advised by a dermatologist. How to Apply Topical Minoxidil Solution Correctly Proper application helps ensure the medication reaches the affected scalp rather than remaining on the hair strands. Step 1: Apply to a dry scalp Ensure the scalp is dry before application. Washing your hair before every application is unnecessary. Step 2: Part your hair Separate the hair to expose the thinning areas, particularly over the crown and top of the scalp. Step 3: Apply the recommended amount For most 5% minoxidil solutions, apply 1 mL per application, twice daily. Use the supplied dropper or spray applicator. The number of sprays required to deliver 1 mL varies between products. Step 4: Spread gently Apply the solution directly onto the affected scalp and spread gently using your fingertips. Avoid applying it mainly onto the hair strands. Vigorous massage is unnecessary. Step 5: Allow it to dry Leave the solution on the scalp and allow it to dry naturally. Avoid washing your hair or swimming for approximately four hours after application. Step 6: Wash your hands Wash your hands thoroughly after application to prevent accidental transfer to the face, eyes or other areas. Important reminders: Do not exceed the recommended amount, as applying more does not improve results. Avoid applying minoxidil to irritated, inflamed or broken scalp skin. Allow the solution to dry completely before going to bed. Keep minoxidil away from children and pets, particularly cats. Apply consistently for the best results. Some patients may experience scalp itching, dryness or irritation. Alternative formulations, such as minoxidil foam, may be better tolerated. 2. Oral Finasteride – Reducing DHT Finasteride is a prescription medication that reduces the conversion of testosterone into DHT. By lowering DHT levels, finasteride helps slow hair follicle miniaturisation, maintain existing hair and potentially improve hair density. The commonly prescribed dosage for male pattern hair loss is finasteride 1 mg once daily. Possible side effects include reduced libido, erectile or ejaculation difficulties and mood-related symptoms. These potential risks should be discussed with a doctor before starting treatment. Because finasteride and minoxidil work through different mechanisms, they may be prescribed together for suitable patients. 3. Other Treatment Options Depending on individual needs and response to treatment, a dermatologist may consider additional options. Low-Dose Oral Minoxidil Low-dose oral minoxidil may be considered when topical treatment is unsuitable, poorly tolerated or difficult to maintain. Its use for hair loss is off-label and requires medical supervision because of possible side effects, including excess body hair growth, ankle swelling, dizziness, palpitations and changes in blood pressure. Dutasteride Dutasteride reduces DHT levels more extensively than finasteride. It may be considered in selected patients, particularly those with an inadequate response to conventional treatment. Its use for hair loss is off-label in many countries. Platelet-Rich Plasma (PRP) Therapy PRP involves injecting concentrated platelets obtained from the patient's own blood into the scalp. Some patients may experience improvement in hair density, although results vary and repeated treatment sessions may be necessary. Low-Level Laser Therapy (LLLT) Specialised light-based devices, such as laser caps or combs, may provide modest improvements in hair density when used consistently. Hair Transplantation Hair transplantation may be suitable for selected patients with established hair loss and adequate donor hair. However, medical treatment may still be required to maintain the surrounding non-transplanted hair. How Long Does Hair Loss Treatment Take to Work? Hair regrowth is a gradual process. Most patients should not expect significant improvement within the first few weeks. Treatment duration What to expect First 1–2 months Temporary increased shedding may occur, particularly after starting minoxidil. 3–4 months Hair shedding may begin to stabilise, with early signs of regrowth in some patients. 6 months Improvements in hair thickness or density may become more noticeable. 6–12 months A more meaningful assessment of treatment effectiveness can be made. Beyond 12 months Continued treatment helps maintain the improvements achieved. These timelines are approximate. Treatment responses vary, and some patients may experience limited regrowth despite consistent use. Why Does Hair Shedding Sometimes Increase After Starting Minoxidil? Some patients notice increased hair shedding during the first few weeks after starting minoxidil. This happens because minoxidil influences the hair growth cycle, allowing older resting hairs to shed as follicles transition towards a new growth phase. Temporary early shedding does not necessarily mean the treatment is failing. It usually settles with continued treatment. However, excessive or persistent shedding should be assessed to exclude other causes of hair loss. Do I Need to Continue Treatment Long-Term? Male pattern hair loss is a chronic, progressive condition. Although treatments such as minoxidil and finasteride can help control hair loss, they do not permanently eliminate the underlying genetic and hormonal tendency. Therefore, long-term maintenance treatment is usually necessary. If treatment is discontinued, the improvements achieved may gradually be lost over the following months. It is also important to understand that successful treatment does not always mean restoring a completely full head of hair. For many patients, preventing further thinning and maintaining existing hair density are already meaningful treatment outcomes. Can Hair Grow Back Completely? The degree of regrowth depends on several factors: How early treatment is started Severity and duration of hair loss Degree of hair follicle miniaturisation Consistency of treatment Individual response to medication Hair follicles that are still producing fine, thin hairs generally have a better chance of responding than areas that have been completely bald for many years. This is why early treatment often provides better outcomes than waiting until significant hair loss has occurred. When Should You See a Dermatologist? Not all hair loss is caused by male pattern hair loss. Other conditions, including telogen effluvium, alopecia areata, scalp inflammation, nutritional deficiencies and scarring alopecia, can also cause thinning. A dermatologist can assess the pattern of hair loss, examine the scalp and hair follicles, and determine whether further investigations are necessary. Early assessment is particularly important if hair loss is sudden, patchy, rapidly progressive or associated with scalp symptoms. Final Thoughts Male pattern hair loss is common, but effective treatments are available to help slow its progression and maintain hair density. Topical minoxidil and oral finasteride remain important evidence-based treatments, while other options may be considered depending on individual circumstances. The key to successful treatment is to: Start treatment early Apply medication correctly and consistently Understand that temporary shedding may occur Allow at least 6–12 months to assess treatment response Continue long-term maintenance when treatment is beneficial With appropriate treatment and realistic expectations, many men can successfully manage hair loss and preserve their existing hair. If you are experiencing a receding hairline, thinning crown or progressive hair loss, a dermatology consultation can help identify the underlying cause and determine the most suitable treatment options. Disclaimer: This article is intended for general health education and does not replace individual medical consultation. Treatment suitability, benefits and potential side effects should be discussed with a qualified healthcare professional.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Hair thinning is a common concern among women and can affect confidence, self-esteem and emotional well-being. Some women notice a widening hair parting, a thinner ponytail or increased scalp visibility when looking in the mirror. One of the most common causes is female pattern hair loss (FPHL), also known as female androgenetic alopecia. Although female pattern hair loss is progressive, appropriate treatment can help slow further thinning, preserve existing hair and, in some women, improve hair density. However, hair regrowth takes time. Understanding the available treatments, correct application of minoxidil and realistic expectations is essential for successful long-term management. What Is Female Pattern Hair Loss? Female pattern hair loss is a progressive condition involving the gradual miniaturisation of hair follicles. Over time, affected follicles produce finer, shorter and thinner hair strands, resulting in reduced hair density. Unlike male pattern hair loss, which commonly presents with a receding hairline, women typically experience: Widening of the central hair parting Diffuse thinning over the top of the scalp Reduced hair volume and a thinner ponytail Increased scalp visibility, particularly under bright lighting The frontal hairline is often relatively preserved. Female pattern hair loss can begin in early adulthood but becomes increasingly common with age, particularly after menopause. Genetic factors play an important role. Hormonal influences may also contribute, although many affected women have normal circulating androgen levels. For more information about hair thinning in men, read my related article: Male Pattern Hair Loss: Treatment Options, Minoxidil Application and What to Expect. What Are the Treatment Options? Treatment depends on the severity of hair thinning, age, medical history, pregnancy plans and individual preferences. The main goals are to slow progression, preserve existing hair and encourage regrowth where possible. 1. Topical Minoxidil – First-Line Treatment Topical minoxidil is one of the most established, evidence-based treatments for female pattern hair loss. It helps prolong the hair growth phase, stimulate hair follicles and improve the thickness of miniaturised hairs. Common treatment regimens include: Minoxidil 2% solution: Commonly applied twice daily. Minoxidil 5% foam: Commonly applied once daily. Minoxidil 5% solution: May be prescribed once daily by a dermatologist, depending on individual suitability and product instructions. The once-daily 5% foam regimen is well established for women. Once-daily use of 5% solution may be an individualised regimen and can differ from the labelled dosing instructions of certain products. For some women, once-daily treatment is more convenient and easier to maintain over the long term. How to Apply Topical Minoxidil 5% Solution Once Daily If your dermatologist has prescribed minoxidil 5% solution once daily, correct application helps ensure that the medication reaches the scalp rather than remaining on the hair strands. Step 1: Apply to a dry scalp Ensure your scalp is completely dry before application. You do not need to wash your hair before every application. Step 2: Part your hair Use a comb or your fingers to expose the thinning areas, particularly along the central parting and top of the scalp. Step 3: Measure 1 mL of minoxidil solution The usual amount for an individually prescribed once-daily 5% solution regimen is 1 mL per application, unless your dermatologist advises otherwise. Use the supplied dropper or applicator to measure the correct amount. Step 4: Apply directly to the scalp Place small drops along the thinning areas, dividing your hair into several partings if necessary. Spread gently with your fingertips and avoid applying the solution mainly onto the hair strands. Step 5: Allow the solution to dry Let the medication dry naturally. Avoid washing your hair or swimming for approximately four hours after application. Many women prefer applying minoxidil in the evening. Allow it to dry completely before going to bed to minimise transfer onto pillows or facial skin. Step 6: Wash your hands Wash your hands thoroughly after application and avoid transferring the medication onto your forehead, cheeks or other facial areas. Important reminders: Apply only the prescribed amount. Using more will not accelerate hair growth. Avoid applying minoxidil to inflamed, irritated or broken scalp skin. Keep minoxidil away from children and pets, particularly cats, as exposure can be dangerous. Avoid minoxidil during pregnancy, when trying to conceive or while breastfeeding. Scalp itching, dryness or irritation may occur. An alternative formulation may be considered if necessary. 2. Low-Dose Oral Minoxidil Low-dose oral minoxidil may be considered for selected women who: Find topical application inconvenient Experience scalp irritation with topical minoxidil Have difficulty maintaining regular application Show an inadequate response to topical treatment Oral minoxidil is used off-label for hair loss and requires medical supervision. Possible side effects include unwanted facial or body hair growth, ankle swelling, dizziness, palpitations and changes in blood pressure. Rare but potentially serious cardiovascular adverse effects can occur. Appropriate patient selection and monitoring are therefore important. Oral minoxidil should also be avoided during pregnancy and breastfeeding. 3. Anti-Androgen Treatment Some women may benefit from medications that reduce the effects of androgens on susceptible hair follicles. Spironolactone Spironolactone may be considered for selected women, particularly those with associated acne, increased facial hair growth or other signs of androgen excess. It may help slow hair thinning and improve hair density. Possible side effects include menstrual irregularities, breast tenderness, dizziness and elevated potassium levels. Monitoring of blood pressure, kidney function and potassium may be necessary depending on individual risk factors. Spironolactone should generally be avoided during pregnancy. Finasteride or Dutasteride These medications reduce the formation of dihydrotestosterone (DHT), a hormone involved in hair follicle miniaturisation. They may be considered in selected women, particularly after menopause, although their use for female pattern hair loss is off-label in many countries. These medications are contraindicated during pregnancy because of the risk of fetal harm. Careful patient selection and effective contraception, where relevant, are essential. 4. Platelet-Rich Plasma (PRP) Treatment PRP involves collecting a small sample of the patient's blood, processing it to concentrate platelets and injecting the preparation into the scalp. Some studies suggest that PRP may improve hair density in selected patients. However, responses vary, treatment protocols are not standardised and repeated sessions may be required. PRP is generally considered an additional treatment rather than a replacement for established medical therapy. 5. Low-Level Laser Therapy (LLLT) Low-level laser therapy uses specialised light-based devices, such as laser caps or combs, to stimulate hair follicles. It may provide modest improvement in hair density for some patients when used consistently. Results vary, and ongoing treatment is generally required. 6. Hair Transplantation Hair transplantation may be suitable for selected women with established hair loss and adequate donor hair density. However, diffuse thinning may limit suitability in some patients. Medical treatment is often recommended to stabilise hair loss before considering surgical restoration. How Long Does Hair Loss Treatment Take to Work? Hair regrowth is a gradual process. Hair follicles need time to respond to treatment, and visible improvement usually takes several months. Treatment Duration What to Expect First 2–8 weeks Temporary increased shedding may occur after starting minoxidil Around 3 months Shedding may begin to stabilise; visible regrowth may still be limited 4–6 months Early improvement in hair thickness or density may become noticeable 6–12 months A more meaningful assessment of treatment effectiveness can be made Beyond 12 months Continued treatment helps maintain improvement and limit further progression These timelines are approximate, and individual responses vary. Why Am I Losing More Hair After Starting Minoxidil? Some women notice increased hair shedding during the first few weeks of minoxidil treatment. This occurs because minoxidil influences the hair growth cycle, allowing older resting hairs to shed as follicles enter a new growth phase. This temporary phenomenon is known as minoxidil-induced shedding. Although it can be worrying, it does not necessarily mean that treatment is worsening hair loss. In most cases, shedding gradually settles. However, persistent or excessive shedding should be assessed to exclude other contributing causes. Will My Hair Grow Back Completely? Treatment outcomes depend on several factors, including: Severity and duration of hair loss Degree of hair follicle miniaturisation Age and underlying medical conditions Consistency of treatment Individual treatment response Not every woman will achieve significant visible regrowth. For many patients, successful treatment means maintaining existing hair density and preventing further thinning. Others may notice improved hair thickness, reduced scalp visibility and increased overall hair volume. Starting treatment early generally offers a better opportunity to preserve existing hair. Do I Need to Continue Minoxidil Long Term? Female pattern hair loss is usually a chronic, progressive condition. Minoxidil helps manage hair loss but does not permanently reverse the underlying tendency towards follicle miniaturisation. Therefore, long-term treatment is generally necessary to maintain its benefits. If minoxidil is discontinued, hair that was maintained or regrown with treatment may gradually be lost over the following months. Regular follow-up helps assess treatment response and determine whether adjustments are needed. Are Hair Supplements Necessary? Not all hair thinning is caused by vitamin or mineral deficiencies. Supplements such as iron, vitamin D, zinc or biotin are not routinely necessary for every woman experiencing hair loss. They may be helpful when a relevant deficiency has been identified. Excessive supplementation can be unnecessary or potentially harmful. High-dose biotin may also interfere with certain laboratory blood tests. A balanced diet with adequate protein intake remains important for general hair health. When Should You See a Dermatologist? Hair thinning in women can have several causes, including: Female pattern hair loss Telogen effluvium, sometimes following illness, stress or childbirth Iron deficiency Thyroid disorders Alopecia areata Inflammatory or scarring scalp conditions Some women may have more than one contributing cause. A dermatologist can assess the scalp and perform trichoscopy to look for features such as hair follicle miniaturisation. Blood investigations may also be recommended when clinically indicated. Early assessment is particularly important if hair loss is sudden, rapidly progressive or associated with scalp pain, redness or scaling. Final Thoughts Female pattern hair loss is common and may gradually progress without treatment. Fortunately, several treatment options are available, including topical minoxidil, selected oral medications and additional procedures. Topical minoxidil remains an important first-line treatment, and a once-daily regimen may be suitable for some women under dermatological guidance. The key to successful treatment is to: Start treatment early Apply minoxidil correctly and consistently Understand that temporary initial shedding may occur Allow approximately 6–12 months to assess treatment response Continue long-term maintenance when treatment is beneficial Hair regrowth requires patience, but early diagnosis and consistent treatment can make a meaningful difference. If you are experiencing progressive hair thinning, a widening hair parting or reduced hair volume, a dermatology consultation can help identify the underlying cause and determine an appropriate treatment plan. Disclaimer: This article is intended for general educational purposes and does not replace individual medical advice. Treatment suitability, potential adverse effects and monitoring requirements should be discussed with a qualified healthcare professional.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Not every itchy rash is an allergy. Similar-looking skin conditions can have different causes and require different treatments. “Doctor, is this a skin allergy?” It is one of the most common questions I hear from patients with an itchy rash. Some notice red patches after using a new product. Others develop sudden hives or have a rash that improves with cream, only to return a few days later. Although these problems are often described as “skin allergy”, they can have very different causes. An itchy rash may be allergic, but it may also be eczema, irritation, urticaria or a fungal infection. Understanding the cause helps us choose the right treatment and avoid unnecessary testing or dietary restrictions. What Does “Skin Allergy” Actually Mean? A true allergy involves an immune reaction to a particular substance. On the skin, this may appear as an itchy, inflamed rash or as hives and swelling. However, itching and redness alone do not establish an allergy. The appearance, location and timing of the rash—and how long each individual lesion lasts—provide important clues. For example, dry patches that persist for days suggest a different problem from raised welts that disappear within hours. Contact Dermatitis: A Reaction to Something Touching the Skin Contact dermatitis commonly affects areas exposed to skincare products, jewellery, cleaning agents or substances encountered at work. There are two main types. Allergic contact dermatitis This is a delayed allergic reaction to a substance that comes into contact with the skin. Possible allergens include: Fragrances and certain preservatives. Hair-dye ingredients. Nickel in jewellery and accessories. Certain rubber chemicals. Ingredients in cosmetics or medicated creams. The affected skin may become itchy, swollen, scaly or blistered. A reaction can develop even after using the same product for years without previous problems. Irritant contact dermatitis This happens when an exposure damages the skin barrier, without a specific allergic reaction. Frequent handwashing, detergents, cleaning products and prolonged contact with water are common causes. Someone who regularly washes dishes, for example, may develop dry, cracked hands without being allergic to the washing-up liquid. Both types can occur together, so understanding the patient’s daily exposures is an important part of assessment. Eczema: A Recurring Inflammatory Skin Condition Atopic dermatitis, commonly called eczema, typically causes dry, itchy skin with recurring inflamed patches. It involves changes in the skin barrier and immune responses. Heat, sweating, friction and irritating products may aggravate symptoms, while scratching can further damage the skin. This creates a familiar cycle: Itching → Scratching → Skin damage → More inflammation and itching Some people with eczema also have asthma, allergic rhinitis or food allergies. However, eczema does not automatically mean that a particular food is responsible. Many patients need consistent skin care and appropriate anti-inflammatory treatment rather than an increasingly restrictive diet. Even after a flare settles, maintenance treatment may be needed to reduce recurrence. Does your face sting after washing or burn when you apply skincare? These symptoms do not necessarily mean an allergy. Read Sensitive Skin: Why Your Face Stings, Burns or Turns Red for more about common causes and practical skincare advice. Hives: Why an Itchy Rash May Come and Go Urticaria—also known as hives or gegata in Malay—causes raised, itchy welts that can appear suddenly and change shape or location. Each individual hive usually disappears within 24 hours, although new ones may develop elsewhere. Deeper swelling, called angioedema, can affect areas such as the eyelids or lips and may last longer. Hives are classified as: Acute urticaria: Episodes lasting less than six weeks. Chronic urticaria: Recurrent hives, angioedema or both continuing for six weeks or longer. Some episodes are triggered by food, medicines or infections. Others are brought on by physical factors such as pressure, cold or heat. In chronic spontaneous urticaria, there is no consistent external trigger. This explains why patients may continue having hives despite changing their diet, soap or washing detergent. Treatment commonly starts with a second-generation antihistamine. Persistent symptoms may require adjustments or additional treatment under medical supervision. Through my educational work and involvement in chronic urticaria research, I have seen how important it is to explain this distinction: recurrent hives do not necessarily mean repeated exposure to an unidentified allergen. Related reading: My First International Investigator Meeting in Singapore: Advancing Clinical Research in Chronic Urticaria. When Should Food Allergy Be Considered? Food allergy can cause hives, itching or swelling, sometimes alongside vomiting, breathing difficulty or other symptoms. A consistent pattern—such as symptoms developing soon after eating a particular food—makes an immediate food allergy more likely. By comparison, eczema that fluctuates over months or hives occurring almost daily without a clear relationship to meals needs a broader assessment. Food allergy testing should be guided by the history. A positive skin prick or specific IgE blood test may indicate sensitisation, but does not prove on its own that the food causes symptoms. Avoid removing multiple foods, particularly from a child’s diet, without medical advice. Suspected reactions should be assessed rather than tested by deliberately eating the food again at home. Could the Rash Be a Fungal Infection? Fungal infections can resemble eczema because both may cause itching, inflammation and scaling. Ringworm may form a gradually enlarging patch with a more prominent scaly edge, although its appearance varies. It does not always look like a clear ring. Steroid creams can temporarily reduce redness while masking or worsening the underlying fungal infection. A rash that repeatedly returns, changes appearance or spreads despite treatment should therefore be reassessed. A skin scraping may help confirm whether fungus is present. If it is, antifungal treatment is needed. Do You Need an Allergy Test? Not every itchy rash needs allergy testing. The first step is a careful history and skin examination. During a consultation, I may ask: When did the rash begin? How long does each patch or welt remain? Which areas are affected? Have you started any medicines or changed products? Is there a consistent trigger? What treatments have you tried, and what happened? Photographs are useful when the rash comes and goes. Bringing your medication list and relevant skincare products can also help. Depending on the suspected cause, investigations may include: Investigation What it helps assess Patch testing Delayed contact allergy to substances such as fragrances, preservatives, metals or hair-dye ingredients Skin prick or specific IgE blood testing Immediate allergy when suggested by the clinical history Skin scraping or fungal culture Suspected fungal infection Skin biopsy Selected unusual or persistent rashes when the diagnosis remains uncertain Patch testing and skin prick testing answer different questions. An allergy blood panel cannot replace patch testing when allergic contact dermatitis is suspected. There is no single test that identifies the cause of every rash. How Is Treatment Chosen? Treatment is tailored to the diagnosis, affected area and severity. For contact dermatitis, reducing irritant exposure or avoiding a confirmed allergen is central to preventing recurrence. For eczema, treatment usually combines moisturisers and gentle cleansing with appropriate anti-inflammatory medication. More severe disease may need specialist treatment. For urticaria, antihistamines are commonly the starting point, with further options for symptoms that remain uncontrolled. For fungal infection, an appropriate antifungal is required. The treatment plan should also explain how long to use each medicine, what improvement to expect and when to return for review. Repeatedly switching creams without reassessing the diagnosis can delay effective care. When Should You See a Doctor? Seek assessment if: The rash keeps returning or spreading. Treatment is not helping. You develop frequent hives or swelling. The skin becomes painful, cracked, weepy or wounded. Itching disrupts sleep, work or daily activities. A new rash develops after starting medication. You are unsure whether the problem is allergy, eczema or infection. Breathing difficulty, throat or tongue swelling, faintness or collapse require emergency medical attention. These may indicate anaphylaxis. A rapidly worsening rash with fever, blistering, peeling skin or sores affecting the mouth or eyes also needs urgent assessment. My Approach to Persistent Itchy Rashes At Dr Lim Skin Specialist Clinic, Pantai Hospital Batu Pahat, I see patients with a wide range of itchy and inflammatory skin conditions. I start by understanding how the rash behaves, reviewing possible exposures and examining the skin. Investigations are selected when they can help clarify the diagnosis or guide treatment. My aim is to give patients a clear explanation and a practical plan, including follow-up when needed to assess progress and adjust treatment. If your rash keeps returning, you do not have to keep guessing which product or food is responsible. Finding the cause can help you make more informed decisions and achieve better symptom control.

Understanding common causes and finding a skincare routine that works for you By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Facial redness, dryness and flaking do not always mean an allergy. Understanding the cause helps guide appropriate skincare and treatment. Does your face feel tight after washing? Does moisturiser sting, or does your skin turn red whenever you get hot? These are common concerns in my dermatology practice. Patients often describe: Dryness, tightness or stinging after cleansing. Redness, burning or itching after applying skincare products. Discomfort with sunlight, sweating or moving between outdoor heat and air-conditioned rooms. Irritation despite choosing products labelled “gentle” or “suitable for sensitive skin”. Little improvement despite repeatedly changing products. It is understandable to suspect an allergy. Some people start buying products marketed for allergy-prone skin or trying medicated creams themselves. However, sensitive skin is not necessarily an allergy. The symptoms may reflect irritation, a weakened skin barrier or an underlying condition such as eczema, rosacea or contact dermatitis. What Is Sensitive Skin? Sensitive skin describes skin that develops unpleasant sensations—such as stinging, burning, itching or tightness—in response to things that would not normally cause discomfort. Some people also have redness, dryness or flaking. Others experience considerable discomfort even though their skin looks normal. Appearance alone therefore does not tell the whole story. Changes in skin barrier function, heightened responses from sensory nerves and environmental exposures may all contribute. Sometimes, these symptoms are part of another skin condition. Why Has My Skin Become More Sensitive? 1. A weakened skin barrier The outermost layer of skin helps retain moisture and limit the entry of irritating substances. When this barrier is disrupted, skin becomes more prone to dryness and irritation. Common contributing factors include: Washing too often or using hot water. Harsh cleansers. Frequent scrubbing or exfoliation. Overusing acids, retinol or other irritating products. Repeated exposure to detergents. Inadequate moisturising. This can explain why a product you previously tolerated suddenly starts to sting. 2. Too many active ingredients Exfoliating acids, salicylic acid, retinol and some brightening ingredients can be useful when used appropriately. However, high concentrations, frequent application or layering several products can increase irritation. A longer skincare routine is not always a better one. When your skin is uncomfortable, simplifying the routine is often more helpful than adding another product. 3. Heat and environmental changes In Malaysia, sunlight, heat and sweating can aggravate skin discomfort. Spending long periods in air conditioning may also worsen dryness. For people with rosacea, heat and sun exposure are particularly common triggers for flushing, burning and stinging. 4. An underlying skin condition Persistent “sensitive skin” sometimes turns out to be a recognisable skin disorder. Condition Common features Eczema Dry, itchy, inflamed or flaky patches; more severe episodes may cause broken or weeping skin Rosacea Recurrent facial flushing, burning, visible blood vessels and sometimes inflamed bumps or pustules Irritant contact dermatitis Inflammation caused by exposure to irritating substances, including cleansers or skincare products Allergic contact dermatitis A delayed allergic reaction to particular ingredients, such as fragrances, preservatives or hair-dye chemicals These conditions can overlap, and their treatments differ. Establishing the diagnosis is important when symptoms persist. Sensitive Skin or an Allergy? “Sensitivity” describes how the skin feels or reacts. It does not necessarily involve an allergic immune response. For example: Tightness or stinging immediately after cleansing may suggest irritation. A persistent itchy rash developing hours to days after using a product may raise suspicion of allergic contact dermatitis. However, timing alone cannot reliably distinguish the two. The appearance of the rash, exposure history and, when appropriate, test results all need to be considered. If your main concern is recurrent itching, a body rash or hives, you may also find this article helpful: “Skin Allergy or Something Else? Understanding Your Itchy Rash.” Do I Need Allergy Testing? Not everyone with sensitive skin needs allergy testing. If allergic contact dermatitis from skincare products, cosmetics or hair dye is suspected, a dermatologist may recommend patch testing. Patch testing investigates delayed contact allergy. It serves a different purpose from skin prick testing or specific IgE blood tests. A routine allergy blood panel cannot replace patch testing and is usually not the first investigation for skin sensitivity. How to Care for Sensitive Skin Step 1: Simplify your routine If your skin is noticeably stinging, dry or inflamed, pause non-essential products that may be irritating it. These can include scrubs, exfoliating acids and retinol. For now, focus on three basics: Gentle cleansing → Moisturising → Sun protection Once your skin settles, introduce other products individually rather than changing your entire routine at once. Discuss any changes to prescribed treatments with your doctor. Step 2: Moisturise consistently Moisturisers help reduce water loss, relieve dryness and tightness, and support skin barrier recovery. Consider: Fragrance-free products with relatively simple formulations. Moisturisers containing ingredients such as ceramides or glycerin. A cream or emollient that suits your skin and does not cause persistent irritation. Applying moisturiser after gently patting your face dry, while the skin is still slightly damp, can be helpful. If this stings, try applying it once the skin is dry and review whether the product suits you. Price, brand name and a “sensitive skin” label cannot guarantee that a product will work for everyone. Step 3: Reduce irritation and protect against the sun Avoid hot water, vigorous rubbing, repeated cleansing and excessive exfoliation. Pat your face dry gently rather than rubbing it with a towel. During the day, use a broad-spectrum sunscreen you can tolerate, generally with SPF 30 or higher. Combine this with shade, a hat or an umbrella, and limit prolonged sun exposure. Try new products on a small area before using them more widely. This may help identify intolerance, but it does not replace formal allergy testing. Stop using a product if it causes persistent redness, swelling, burning or itching, and seek advice if symptoms continue. When Should You See a Dermatologist? Mild, short-lived discomfort may improve with changes to your routine. Arrange an assessment if you have: Repeated redness, stinging or itching. Symptoms that persist despite trying different products. Ongoing facial flushing, inflamed bumps or pustules. Significant flaking, cracks, broken skin or weeping. A suspected reaction to skincare, cosmetics or hair dye. Symptoms affecting sleep, work or daily life. Bring your current skincare products, medicated creams or ingredient lists to the appointment. These can help identify relevant exposures. Does Sensitive Skin Need Medication? Not always. For mild irritation, reducing triggers, cleansing gently and moisturising regularly may be enough. If eczema or contact dermatitis is present, a doctor may prescribe an appropriate topical anti-inflammatory treatment, taking into account the affected area and severity. Rosacea requires a different approach and may not improve with skincare products alone. Avoid prolonged, unsupervised use of steroid creams on the face. Topical corticosteroids can be effective for specific inflammatory conditions, but their strength, application site and duration should be guided by a doctor. Can Sensitive Skin Improve? The outlook depends on the cause. If symptoms result from over-cleansing or irritating products, adjusting the routine often allows the skin to recover gradually. If eczema, rosacea or another chronic condition is involved, ongoing management may be needed to keep symptoms under control. Give your skin time to respond. Repeatedly switching products because improvement is not immediate can make it harder to identify what helps. My Advice to Patients I often see patients who have tried numerous products for redness, itching or stinging without understanding why their skin remains uncomfortable. Some have irritation from an overly intensive skincare routine. Others have eczema, rosacea or contact dermatitis. Similar symptoms can have different explanations. I encourage patients to start by understanding the cause. A suitable routine, fewer irritating exposures and treatment for any underlying inflammation can help the skin become more comfortable and stable.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Back at Chinese High School, sharing practical acne care advice and answering students’ questions. It was a pleasure to return to Chinese High School, Batu Pahat, this time to speak to students about acne and skincare. As a former student, I enjoyed being back on campus. More importantly, it was an opportunity to discuss a condition I see regularly in practice—one that can affect teenagers’ confidence just as much as their skin. The talk covered why acne develops, which skincare habits help, and when it is worth seeking treatment. I also wanted to reassure students that acne is common, treatable and nothing to be embarrassed about. Why Acne Deserves Attention Acne is often dismissed as something teenagers simply have to grow out of. Yet persistent breakouts can affect how a young person feels about themselves, their friendships and everyday school life. In clinic, I meet teenagers who have spent months trying different products, often becoming frustrated when their skin does not improve. Some are already developing scars. Others have relatively few spots but feel deeply self-conscious about them. That is why I encourage students to seek advice when acne is troubling them. They do not need to wait until it becomes severe. What Our Research Taught Us My interest in this subject also comes from research I conducted with colleagues in Sarawak. Our paper, “Prevalence and Psychosocial Impact of Acne Vulgaris Among High School and University Students in Sarawak, Malaysia,” was published in the Medical Journal of Malaysia in July 2022. We studied 582 students aged 16–25 in Kuching and found that 75.8% had acne. Among those affected, 56% had not sought medical attention. The study also showed that even mild acne could have a substantial effect on quality of life. Those findings have stayed with me. They underline the importance of asking how acne is affecting someone, rather than judging its impact by appearance alone. They also make a strong case for school-based education. A straightforward conversation can help students recognise when they need support and understand that effective treatments are available. The Main Messages for Students During the session, I focused on a few practical points. Acne is not a sign of poor hygiene. Hormones, genetics, oil production, blocked follicles and inflammation all play a role. Washing harder or more often will not solve the problem. Be gentle with your skin. Harsh cleansers, scrubs and too many active ingredients can cause irritation. A simple routine with a gentle cleanser, suitable moisturiser and sunscreen is a sensible starting point. Try not to pick or squeeze. It can worsen inflammation and increase the risk of lasting marks and scars. Give treatment time. Frequently switching products makes it difficult to know what is helping. Consistent use and follow-up allow treatment to be assessed and adjusted properly. Get help if acne is persistent, painful, leaving scars or affecting your confidence. These are all valid reasons to speak to a doctor. Making Sense of Skincare Advice Teenagers have no shortage of skincare information. The challenge is deciding what to trust. A product recommended by a friend or promoted online may not suit their skin. Expensive products and complicated routines are not necessarily better, either. I wanted students to understand their skin, know when to seek help, and feel more at ease with the changes that come with adolescence. Good skin health education should give them practical knowledge without making them feel that every breakout is something to worry about. A School Visit I Was Glad to Make The questions and conversations with students were a valuable part of the visit. They offered a chance to address concerns directly and make the subject more approachable. With Chinese High School Principal 苏文忠. My thanks to the school for arranging this opportunity to share acne and skincare knowledge with the students. My thanks to Chinese High School, its teachers and students for welcoming me back. It was rewarding to contribute to the school community in a different capacity, years after being a student there myself. I hope the session helped students feel better informed about acne—and more confident about asking for help. Research reference： Lim TH ．Prevalence and psychosocial impact of acne vulgaris among high school and university students in Sarawak, Malaysia. Med J Malaysia. 2022;77(4):446–453.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Looking back on the American Academy of Dermatology (AAD) Annual Meeting 2025 in Orlando, USA, one of the highlights for me was attending a hands-on nail surgery workshop.' From left: Professor Bertrand Richert and Dr Aaron Russell. Learning from Experienced Faculty Professor Bertrand Richert is a Belgian dermatologist internationally recognised for his expertise in nail disorders and nail surgery. It was a valuable opportunity to learn from him alongside the other faculty, including Dr Aaron Russell, a dermatologist and dermatopathologist at Washington University in St. Louis. In small groups, we practised on fresh-frozen cadaveric hands under expert supervision. The faculty’s clear explanations and practical guidance made this an engaging experience, helping me better understand nail anatomy and refine surgical techniques. What Did the Workshop Cover? The workshop catered to participants ranging from beginners to experienced nail surgeons. Its practical training included: Partial and complete nail plate removal, also known as nail avulsion. Nail biopsy techniques, including punch, shave and longitudinal approaches. The teaching also covered patient assessment, surgical planning, equipment and suture selection, patient safety and relevant anatomy. Bringing Practical Insights Back to Batu Pahat This experience helped strengthen my skills in the diagnosis and surgical management of nail conditions. I am grateful to the teaching faculty for sharing their expertise, and for the practical insights I could bring back to my dermatology practice at Pantai Hospital Batu Pahat, Johor, Malaysia. Reference American Academy of Dermatology — AAD 2025 Hands-on: Nail Surgery workshop description

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Cryotherapy is a commonly used dermatological procedure that treats selected skin lesions through controlled freezing. It is usually performed in an outpatient clinic and often avoids the need for surgical excision or stitches. Liquid nitrogen cryotherapy can be used for viral warts, certain benign skin growths, and selected precancerous lesions. Although treatment usually takes only a few minutes, an accurate diagnosis, appropriate technique, and good aftercare are essential. This article explains how cryotherapy works, which conditions it can treat, and what patients can expect during recovery. What Is Cryotherapy? Cryotherapy, also called cryosurgery, destroys targeted tissue by exposing it to extremely low temperatures. In dermatology, the most commonly used freezing agent is liquid nitrogen, which has a temperature of approximately −196°C. Controlled freezing damages the cells within the lesion. As the area heals, the treated tissue may peel away or form a crust that gradually separates. The depth and duration of freezing are adjusted according to the diagnosis, thickness of the lesion, and treatment site. Which Skin Conditions Can Be Treated? Viral Warts Viral warts are caused by the human papillomavirus (HPV) and are among the most common reasons for cryotherapy. They include common warts on the hands and fingers, plantar warts on the soles, and periungual warts around the nails. Cryotherapy may also be considered for selected flat warts, although extra caution is needed on the face because of the risk of pigment changes. Warts often require several treatment sessions. Thick plantar warts can be particularly persistent, and carefully removing excess surface skin before freezing may help treatment reach the wart. Treatment around the nails requires care because damage to the nail matrix—the area responsible for nail growth—can cause lasting nail changes. Seborrhoeic Keratoses Seborrhoeic keratoses are benign growths that often have a waxy or “stuck-on” appearance. They become more common with age and may be brown, black, or skin-coloured. Treatment may be considered when they become irritated, itchy, or cosmetically bothersome. Cryotherapy is generally more suitable for thinner lesions; thicker growths may respond better to another procedure. A lesion with unusual pigmentation or an uncertain diagnosis should be assessed before removal. Skin Tags Skin tags are small, soft, benign growths commonly found on the neck, armpits, and skin folds. Cryotherapy is one option for selected skin tags. Depending on their size and location, snip excision or electrosurgery may offer a more suitable approach. Actinic Keratoses Actinic keratoses are rough, scaly lesions caused by cumulative sun exposure. They are considered precancerous because some can progress to squamous cell carcinoma. Cryotherapy can treat selected individual lesions. When there are numerous actinic keratoses or widespread sun damage, treatment of the wider affected area may be more appropriate. A lesion that is thickened, tender, rapidly growing, or otherwise suspicious may require biopsy before treatment. Other Selected Conditions Cryotherapy may also be used for molluscum contagiosum in selected patients. In specialist practice, it can occasionally treat carefully selected, biopsy-confirmed superficial skin cancers. Suitability depends on the diagnosis, location, and risk of recurrence. How Is Cryotherapy Performed? The dermatologist first examines the lesion and determines whether freezing is appropriate. Dermoscopy or a biopsy may be needed if the diagnosis is uncertain. Liquid nitrogen is then applied using a spray device, a cotton-tipped applicator, or a cryoprobe. The skin briefly turns white as it freezes, then thaws. Some lesions require more than one freeze–thaw cycle. Each application generally lasts seconds, and the overall procedure is usually completed within a few minutes. The treatment intensity is tailored to the lesion and nearby structures. Is Cryotherapy Painful? Patients commonly feel a cold, stinging, or burning sensation during treatment. Soreness or throbbing may continue afterwards, particularly on the fingertips, around the nails, or on the soles. Local anaesthesia is not routinely required for simple cryotherapy. However, comfort and treatment suitability should be considered individually, especially in children. What Happens After Treatment? The treated area may develop redness, swelling, tenderness, or a clear or blood-filled blister. A crust may form as the skin heals. Blistering is a possible treatment response, but it is not required for cryotherapy to work. Its presence or absence does not reliably indicate whether the lesion has cleared. Healing time varies with the site and depth of treatment. Small superficial areas may heal within one to two weeks, while deeper treatment sites and lesions on the lower legs can take considerably longer. Seek medical advice if there is increasing pain, spreading redness, pus, fever, or difficulty using the affected hand or foot. Caring for the Skin After Cryotherapy Follow the instructions provided by your treating clinician. General aftercare includes: Gently wash the area with water and a mild cleanser, then pat dry. Avoid scratching, picking, or pulling off the crust. Apply a thin layer of plain petroleum jelly if advised. Use a non-adherent dressing if the area is open or exposed to friction. Leave blisters intact unless your clinician advises otherwise. Protect healing skin from sun exposure. A large or painful blister may need assessment and, occasionally, drainage by a healthcare professional. Antibiotics are not routinely necessary after uncomplicated treatment. Possible Side Effects and Risks Cryotherapy can cause temporary pain, swelling, blistering, and crusting. Other possible effects include: Lighter or darker skin marks, which may persist; loss of pigment can sometimes be permanent. Scarring, particularly after deeper freezing. Infection. Temporary numbness or, rarely, lasting nerve damage. Nail changes when treatment affects the nail matrix. Incomplete clearance or recurrence. Pigment changes deserve particular consideration in darker skin tones and when treating visible areas such as the face. How Many Sessions Are Needed? Some benign lesions respond to one session, while warts often need repeated treatment. For suitable warts, sessions may be scheduled approximately two to four weeks apart, depending on healing, response, and tolerability. Persistent lesions should be reassessed rather than repeatedly frozen without reviewing the diagnosis and treatment plan. Plantar warts can be difficult to clear because of the thick skin and pressure on the soles. Other approaches, such as topical salicylic acid, may be used alone or alongside cryotherapy when appropriate. No treatment guarantees permanent clearance, and warts can recur. Is Cryotherapy Suitable for Everyone? Cryotherapy requires particular caution in people with poor circulation, reduced skin sensation, impaired wound healing, or conditions triggered by cold, such as cold urticaria or cryoglobulinaemia. The location also matters. Lesions near superficial nerves, nail structures, or other sensitive areas may require a different approach. Suspicious or undiagnosed lesions should be assessed before freezing. Cryotherapy destroys tissue and does not provide a specimen for laboratory examination. If melanoma or another skin cancer is suspected, appropriate diagnostic assessment and biopsy should take priority. Choosing the Most Appropriate Treatment Cryotherapy is one of several options for treating skin lesions. Alternatives include topical medication, curettage, electrosurgery, and surgical excision. The best choice depends on the diagnosis, lesion size and location, previous treatment response, healing risks, cosmetic considerations, and patient preferences. A quick procedure is useful only when it is appropriate for the condition being treated. Cryotherapy at Dr Lim Skin Specialist Clinic At Dr Lim Skin Specialist Clinic, Pantai Hospital Batu Pahat, Johor, patients with warts and other skin lesions can undergo dermatological assessment to determine whether cryotherapy or another treatment is suitable. My priority is to establish an accurate diagnosis, explain the available options, and help patients understand the expected recovery and possible risks. Cryotherapy remains a valuable treatment in everyday dermatology. With careful selection and appropriate aftercare, it can help manage a range of skin lesions while supporting safe healing. This article provides general educational information. Treatment suitability and recovery vary according to the individual condition and clinical assessment.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia With fellow investigators and research colleagues at the Hidradenitis Suppurativa Investigator Meeting in Tokyo, Japan. I had the privilege of attending an international investigator meeting in Tokyo, Japan, as a Principal Investigator for a clinical study on hidradenitis suppurativa (HS). This chronic inflammatory skin disease can cause considerable pain and have a profound impact on patients’ daily lives. It is an honour to contribute to research that seeks to expand our understanding of HS and explore potential new treatment options. The meeting brought together investigators and research professionals from different countries to review the study protocol, discuss patient safety, and coordinate the practical aspects of conducting an international multicentre clinical trial. Alongside the scientific discussions, the visit offered a welcome opportunity to reconnect with international colleagues and enjoy the warm hospitality of friends in Japan. Understanding Hidradenitis Suppurativa Hidradenitis suppurativa is a chronic inflammatory skin condition characterised by recurrent painful nodules, abscesses, draining tunnels, and scarring. It commonly affects the armpits, groin, buttocks, and areas beneath the breasts. HS is often under-recognised, and diagnosis may be delayed. Some patients experience years of recurrent painful swellings and drainage before their condition is correctly identified. Its effects extend beyond the skin. Pain, discharge, and recurrent inflammation can interfere with sleep, mobility, work, and everyday activities, while also affecting self-confidence and emotional well-being. Early recognition and appropriate management are important to control inflammation, limit further tissue damage, and improve quality of life. Why Clinical Research Matters Managing hidradenitis suppurativa can be challenging, particularly in patients with moderate to severe disease. Depending on the severity and individual needs, treatment may involve topical or systemic medications, biologic therapies, surgical procedures, and ongoing care to manage symptoms and flare-ups. Despite advances in treatment, some patients continue to experience persistent disease. Clinical research remains essential to address these unmet needs and evaluate potential new approaches. Clinical trials systematically assess the safety and effectiveness of investigational treatments. The evidence they generate helps determine whether these treatments may have a role in future clinical practice. As a Principal Investigator, my responsibilities include overseeing the study’s clinical conduct at the participating research site, prioritising patient safety, adhering to the approved protocol and ethical requirements, and ensuring the quality of clinical data. This role is both a professional responsibility and a meaningful opportunity to contribute to the evidence that shapes future patient care. Learning and Collaboration in Tokyo The investigator meeting provided a valuable setting to review the study objectives and protocol, discuss research methodology, and align approaches to clinical assessment and safety monitoring across participating centres. International multicentre trials depend on close collaboration between investigators, research teams, and study organisers. Consistent assessments and careful adherence to study procedures are essential to producing reliable, meaningful results. Meeting fellow investigators also offered an opportunity to exchange perspectives and learn from colleagues working in different clinical settings. These conversations reinforced the value of international collaboration in addressing the challenges of chronic inflammatory skin diseases. Reconnecting with International Colleagues Catching up in Tokyo with Professor Koremasa Hayama (left) and Dr Rosa from Spain (right). A particularly memorable part of the visit was the opportunity to catch up with Professor Koremasa Hayama from the Department of Dermatology, Nihon University, Japan, as well as Dr Rosa from Spain. I was grateful to Professor Hayama for his warm hospitality and for treating me to a wonderful Japanese dinner. Sharing local cuisine and catching up in a relaxed setting made the evening especially enjoyable. These personal connections are among the most rewarding aspects of international academic meetings. Relationships formed through dermatology can grow into lasting friendships, with opportunities to share experiences and support one another beyond the formal scientific programme. Bringing Research Perspectives into Clinical Practice Participating in clinical research deepens my appreciation of how potential treatments are developed and evaluated. It also reinforces principles that remain central to everyday dermatology practice: careful clinical assessment, patient safety, appropriate monitoring, and decisions guided by evidence. For patients living with hidradenitis suppurativa, continued research offers the possibility of better treatment options and more sustained disease control. Although not every investigational therapy will demonstrate sufficient benefit, well-conducted studies provide evidence that can guide future research and treatment decisions. As a dermatologist at Pantai Hospital Batu Pahat, I value the opportunity to connect clinical practice with research while continuing to learn from colleagues internationally. Looking Ahead The investigator meeting in Tokyo was a meaningful experience, combining scientific learning, international collaboration, and professional friendship. I am honoured to serve as a Principal Investigator in this hidradenitis suppurativa study and look forward to contributing to research that may improve the care and quality of life of people living with this challenging condition. My sincere thanks to the meeting organisers and fellow investigators, and to Professor Hayama for his generous hospitality during my visit to Japan.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia I was honoured to moderate the dermatology panel discussion at the GP Symposium organised by Pantai Hospital Batu Pahat, held at Katerina Hotel, Batu Pahat. Our session, “Beyond the Skin, Across the Ages: Multidisciplinary Care in Dermatology,” brought together specialists from paediatric dermatology, rheumatology and internal medicine to explore the importance of collaborative care across different age groups. From left: Dr. Reyhanah binti Mohd Rashid (Paediatric Dermatology), Dr. Lee Hwai Jien (Rheumatology) and Dr. Teo Kuo Zhau (Internal Medicine). It was a privilege to be joined by: Dr. Reyhanah binti Mohd Rashid, Paediatric Dermatologist, Hospital Sultan Ismail, Johor Bahru Dr. Lee Hwai Jien, Rheumatologist, Hospital Sultanah Nora Ismail, Batu Pahat Dr. Teo Kuo Zhau, Internal Medicine Specialist, Hospital Sultanah Nora Ismail, Batu Pahat Each panelist brought a valuable perspective to the discussion, helping us consider both the skin condition and the patient’s wider health needs. Three cases across different age groups Through three clinical cases, we explored some of the challenges encountered in dermatology: Recurrent paediatric eczema — managing eczema in children that repeatedly flares up or remains difficult to control despite treatment. Bullous pemphigoid in an elderly patient — diagnosing and treating this blistering skin condition, while considering the patient’s physical vulnerability, other medical conditions and the safety of treatment. Systemic lupus erythematosus (SLE) — understanding how skin changes may reflect a disease that also affects other organs, and how specialists from different disciplines work together to provide comprehensive care. For me, the session reinforced the importance of considering each patient’s age, underlying medical conditions and overall health alongside their skin disease. This is a perspective I aim to bring to my daily dermatology practice in Batu Pahat. My sincere thanks to the panelists for sharing their experience and insights, to everyone who joined the session, and to the organising team at Pantai Hospital Batu Pahat for bringing the event together. I am grateful for the opportunity to exchange ideas across specialties and reflect on how we can work together to improve patient care.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia With Dr Steven Chen (second from left, in the green shirt) and the Massachusetts General Hospital dermatology team Continuing to learn from experienced specialists is an important part of my development as a dermatologist. I was honoured to undertake a short-term dermatology observership at Massachusetts General Hospital (MGH) in Boston, USA, with Dr Steven Chen and his team. Learning with the dermatology team During my visit, I observed dermatology ward rounds and consultations at the Cutaneous Lymphoma Clinic. These experiences gave me valuable insights into the assessment, diagnosis and treatment of complex skin conditions and cutaneous lymphoma. The team’s clinical discussions also highlighted the importance of collaboration across specialties when caring for patients whose medical needs extend beyond the skin. With Dr Steven Chen beside the painting Ether Day, 1846, in MGH’s historic Ether Dome. Beyond the clinical experience, I was struck by MGH’s rich medical history. A particularly memorable moment was visiting the Ether Dome and seeing the renowned painting Ether Day, 1846. The painting commemorates the public demonstration of ether anaesthesia at MGH in 1846—an event that transformed surgery and helped lay the foundations of modern anaesthesia. Standing beside it offered a moment to reflect on how medical advances have changed patients’ lives. Although brief, this observership broadened my clinical perspective and reinforced the importance of considering each patient’s overall health alongside their skin condition. I look forward to applying these insights in my daily practice in Batu Pahat. My sincere thanks to Dr Steven Chen and the MGH dermatology team for their warm welcome, thoughtful guidance and generosity in sharing their knowledge. It was a privilege to learn in a hospital with such a remarkable history and an enduring commitment to advancing medicine. Further reading: The History of MGH: Ether & Ether Dome History

Kuching Borneo Dermatology Update 2026 brought together healthcare professionals from across Malaysia for three days of learning, sharing and collaboration at Imperial Hotel Kuching. From 31 July to 2 August 2026, dermatologists, doctors and allied health professionals from across Malaysia gathered at Imperial Hotel Kuching for the Kuching Borneo Dermatology Update (KBDU) 2026. Guided by the theme “Where Aesthetics Meets Dermatology,” the three-day meeting brought together medical dermatology, paediatric dermatology, immunodermatology and aesthetic practice through a combination of scientific lectures, practical workshops and public education. This year’s event welcomed 344 participants, comprising approximately 272 doctors and 72 allied health professionals, with the support of industry partners represented across 32 exhibition booths. Learning Through Practical Workshops KBDU 2026 began on 31 July with two pre-conference workshops designed to translate current knowledge into practical clinical skills. The Skin Booster and Neurotoxin Workshop covered treatment mechanisms, patient selection, clinical indications, delivery techniques and best practices. Participants also gained practical exposure through live demonstrations and hands-on sessions. Running alongside it was “Real-World Paediatric Dermatology: 20 Practical Cases That Change Practice.” Through interactive case discussions, participants explored common and challenging childhood skin conditions, including infections, birthmarks, inflammatory disorders, dermatological emergencies and unusual paediatric presentations. A Broad and Clinically Relevant Scientific Programme The main conference on 1 and 2 August featured a diverse programme spanning both medical and aesthetic dermatology. Topics included: Fungal and common skin infections Leprosy and sexually transmitted infections Eczema and skin-barrier disorders Nail diseases and nail psoriasis Psoriasis, including difficult-to-treat areas Hair loss and androgenetic alopecia Cutaneous drug reactions Cutaneous lupus, dermatomyositis, scleroderma and morphea Wound care Acne, pigmentation and acne scarring Facial anatomy, ageing and aesthetic procedures Complications and ethical considerations in cosmetic dermatology Throughout the conference, speakers combined current scientific evidence with practical approaches that doctors could apply in their everyday clinical practice. Public acne forum speakers and participants of the Skin Booster and Neurotoxin Workshop at KBDU 2026. My Contribution to KBDU 2026 It was an honour to serve as Vice Chairperson of KBDU 2026 and contribute to both its organisation and scientific programme. I presented: “Skin Barrier Dysfunction in Primary Care: From Pathophysiology to Practical Moisturization Strategies.” During this session, I discussed how disruption of the skin barrier contributes to dryness, inflammation and common conditions such as eczema. I also shared practical strategies for selecting and using moisturisers to support skin-barrier repair and improve patient care. I was also honoured to chair the Johnson & Johnson lunch symposium: “Reset Expectations in Difficult Areas: How Guselkumab Is Changing the Management of Hard-to-Treat Psoriasis,” presented by Dr Sean Yong Shin Shen. The session explored how advances in psoriasis treatment are helping clinicians achieve better outcomes in traditionally difficult-to-treat areas. Bringing Acne Education to the Public Another highlight of KBDU 2026 was the public forum: “Understanding Acne Beyond Skin Deep.” Together with Dr Teo Hock Gin, Dr Lee Sut Enn and Dr Ingrid Ting, we discussed acne from several important perspectives, including its causes, current treatment approaches, dietary and lifestyle misconceptions, and appropriate skincare. In my session, “What Is Acne?”, I explained that acne is a genuine inflammatory skin condition and not simply the result of poor hygiene. With suitable treatment and consistent skincare, acne can be controlled while reducing the risk of persistent pigmentation and permanent scarring. The public forum provided a valuable opportunity to make reliable dermatological information more accessible and to address common misconceptions surrounding acne. Supporting a More Sustainable Conference KBDU 2026 also introduced a sustainable hydration initiative to reduce the use of single-use plastic bottles. Water dispensers and reusable glasses were made available, while delegates were encouraged to bring their own bottles or tumblers. Although simple, this meaningful initiative demonstrated how medical conferences can support professional education while also promoting greater environmental responsibility. More Than a Dermatology Update KBDU 2026 was more than a scientific meeting. It was an opportunity to learn, exchange experiences, reconnect with colleagues and build new professional relationships. My sincere appreciation goes to our chairperson, organising committee, speakers, participants, industry partners and exhibitors. Their dedication and support made this event possible. For me, KBDU remains more than just a dermatology update—it is also a reunion of colleagues and friends who share the same commitment to advancing dermatological knowledge and patient care. The knowledge and perspectives gained from KBDU 2026 will continue to enrich my practice as a dermatologist at Dr Lim Tzyy Huei Skin Specialist Clinic, Pantai Hospital Batu Pahat, as I strive to provide informed and up-to-date dermatological care for my patients. I look forward to the next opportunity to learn, share and reconnect.