By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia Eczema can be frustrating because the skin may improve for a period of time, only to flare up again later. Many patients eventually ask: “Why does my eczema keep recurring?” or “Will eczema ever completely go away?” Understanding why eczema behaves this way may help reduce flare-ups and improve long-term skin control over time. What Is Eczema and Why Does It Flare Up? Eczema is a broad term for inflammatory skin conditions. Atopic dermatitis is one of the most common forms. In atopic dermatitis, the skin barrier becomes weaker and more sensitive. This barrier normally protects the skin from irritants and helps retain moisture. When it is impaired, the skin: Loses moisture easily Becomes dry and itchy Reacts more readily to triggers such as heat, sweat and irritants The immune system also contributes to skin inflammation. Even after a visible rash improves, the skin may remain prone to further flare-ups. Different Types of Eczema and Related Skin Conditions Eczema does not always look the same. Its appearance can vary depending on the type of eczema, the area affected and the patient's age. Some common presentations include: Pompholyx (Dyshidrotic Eczema) — This can cause intensely itchy, small, fluid-filled blisters on the palms, soles or sides of the fingers and toes. Read more in Pompholyx on the Feet: Why Do Small Itchy Blisters Keep Coming Back? Atopic Cheilitis (Lip Eczema) — Persistent dryness, peeling, irritation and cracking of the lips may be caused by lip eczema. Contact allergies and irritants can also contribute. Learn more in Atopic Cheilitis: Why Are My Lips Always Dry, Cracked and Itchy? Childhood Eczema — Babies and children commonly develop dry, itchy and inflamed skin, although the affected areas may change with age. Read Eczema in Babies and Children: Causes, Treatment and Will They Outgrow It? Juvenile Plantar Dermatosis (Dry, Peeling Feet in Children) — An eczema-like condition causing dry, shiny, peeling skin and painful cracks on children's soles, often associated with friction and sweating. Read more in Juvenile Plantar Dermatosis: Causes, Treatment and Prevention. Although these conditions may look different, accurate diagnosis, appropriate treatment and good skin care are important for controlling symptoms. Why Does Eczema Keep Coming Back? 1. The Skin Barrier Is Still Healing Even when visible redness and inflammation fade, the skin barrier may not have fully recovered. The skin can remain vulnerable to: Sweating Friction from clothing or scratching Dry or cold weather Harsh soaps and detergents Regular moisturising helps support the skin barrier and reduce dryness, irritation and repeated flare-ups. 2. Heat, Sweat and Malaysia's Humid Climate In Malaysia's hot and humid climate, sweating is a common trigger for eczema flare-ups. Outdoor activities, prolonged sweating and poorly ventilated clothing can contribute to itching and discomfort. Sudden temperature changes between outdoor heat and air-conditioned environments may also aggravate sensitive skin in some people. These environmental factors can influence several skin conditions, not just eczema. Related reading: Why Skin Conditions Can Behave Differently in Malaysia's Hot and Humid Climate. 3. Continuous Exposure to Daily Triggers Eczema can be aggravated by everyday factors, including: Harsh soaps, detergents or fragranced products Rough fabrics and friction Stress and inadequate sleep Excessive sweating Certain contact allergens or environmental exposures in susceptible individuals Not every eczema flare-up is caused by an allergy. Identifying consistent individual triggers is generally more useful than avoiding numerous products or foods unnecessarily. If your rash repeatedly returns despite treatment, it may be helpful to understand whether the problem is eczema, irritation or another skin condition. Read Skin Allergy or Something Else? Understanding Your Itchy Rash to learn why different itchy rashes may require different approaches. How to Manage Recurrent Eczema Effectively Maintain a Consistent Skincare Routine Use gentle, fragrance-free cleansers. Apply moisturiser regularly, including after bathing. Choose suitable moisturising creams or ointments for dry skin. Avoid prolonged exposure to very hot water. Consistent skin care remains important even during periods when eczema appears well controlled. Protect Your Skin from Environmental Factors Wear loose, breathable clothing. Change damp clothing after excessive sweating. Avoid prolonged exposure to conditions that aggravate your skin. Use gentle cleansing methods after activities that cause heavy sweating. Recognise Personal Triggers Pay attention to factors that repeatedly worsen your eczema. For example, some patients notice flare-ups after using certain skincare products, detergents or occupational materials. When allergic contact dermatitis is suspected, a dermatologist may recommend patch testing. However, allergy tests are not routinely necessary for every patient with eczema. Use Medications as Directed Topical corticosteroids and other prescribed anti-inflammatory treatments help control inflammation during eczema flare-ups. Some patients worry about steroid side effects, while others stop treatment as soon as the redness improves. When the correct medication strength, application site and treatment duration are followed, topical corticosteroids are generally effective and safe. For a detailed explanation, read Are Steroid Creams Always Harmful?. Eczema treatment may also change over time depending on disease severity, the affected body areas and the response to previous medication. For answers to common concerns about changing creams, maintenance treatment and follow-up care, read Eczema Treatment Explained: Answers to Common Questions and Concerns. When to Seek Professional Help If eczema repeatedly returns despite appropriate skincare and treatment, or if it affects sleep and quality of life, a dermatological assessment may be helpful. Depending on severity, treatment options may include: Prescription topical anti-inflammatory medications Non-steroid topical treatments Phototherapy Systemic medications Targeted therapies, including biologic injections or JAK inhibitors for suitable patients Not everyone with eczema requires advanced treatment. However, patients with persistent moderate-to-severe disease may benefit from specialist assessment and a more individualised treatment plan. Related reading: Eczema (Atopic Dermatitis): Treatment Options from Steroid Creams to Biologics and JAK Inhibitors. What If the Rash Is Not Actually Eczema? Persistent redness, scaling and itching do not always mean eczema is returning. Fungal skin infections and other inflammatory conditions can sometimes resemble eczema, but their treatments differ. For example, applying steroid creams alone to an untreated fungal infection may temporarily reduce inflammation while allowing the infection to persist or worsen. If the diagnosis remains uncertain, read Eczema or Fungal Infection? How to Tell the Difference. Accurate diagnosis is particularly important when a rash repeatedly fails to improve despite treatment. Final Thoughts Eczema is often a long-term condition that follows a pattern of improvement and flare-ups. The goal is not simply to clear the visible rash temporarily, but to strengthen the skin barrier, control inflammation, identify relevant triggers and reduce future flare-ups. Different forms of eczema may require different treatment approaches. Whether the problem involves recurrent body eczema, itchy blisters on the feet, persistent lip irritation or childhood eczema, an accurate diagnosis and suitable management plan are important. With consistent skin care, appropriate treatment and regular follow-up when needed, many patients can achieve good long-term control. Dr Lim Tzyy Huei is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia. Medical Disclaimer: This article is intended for general patient education and does not replace individual medical consultation, diagnosis or treatment advice.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Have you ever noticed tiny, itchy, water-filled blisters appearing on the soles of your feet or around your toes? Sometimes, these blisters disappear after a few weeks, leaving behind dry, peeling or cracked skin. However, the same problem may return repeatedly, especially during hot weather or when your feet sweat excessively. This condition may be pompholyx, also known as dyshidrotic eczema or vesicular foot eczema. In Malaysia, patients may describe it as “water blisters on the feet,” “itchy foot blisters,” or “kaki naik gelembung air dan gatal.” Although pompholyx is not contagious, it can be uncomfortable and frustrating when flare-ups keep recurring. What Is Pompholyx? Pompholyx is a type of eczema that causes small, fluid-filled blisters on the skin. It commonly affects: The soles of the feet The sides and undersides of the toes The arches of the feet Sometimes, the palms and fingers as well The blisters are usually small and deeply seated within the skin. They may appear in clusters and cause intense itching or a burning sensation. After several days or weeks, the blisters gradually dry up, leaving the skin peeling, rough or cracked. In more severe cases, larger blisters and painful skin fissures may develop, making walking uncomfortable. Importantly, pompholyx is a form of eczema, not a fungal infection, and it cannot spread from one person to another. What Causes Pompholyx on the Feet? The exact cause is not fully understood. Pompholyx involves inflammation of the skin and may be influenced by several contributing factors. 1. Excessive Sweating and Hot Weather Heat and sweating are common triggers. In Malaysia’s hot and humid climate, wearing enclosed shoes for prolonged periods may increase sweating and irritation. Some patients notice that their blisters become worse after a long day of wearing shoes or during particularly hot weather. However, pompholyx is not simply caused by blocked sweat glands. 2. Skin Irritation Repeated exposure to moisture, soap, detergents or other irritating substances may damage the skin barrier. This makes the skin more vulnerable to inflammation and eczema flare-ups. 3. Contact Allergies Certain materials used in footwear may trigger allergic contact dermatitis, which can resemble or aggravate foot eczema. Possible allergens include: Rubber chemicals Shoe adhesives Leather treatment chemicals Certain dyes and metals If the rash repeatedly develops after wearing particular shoes, further evaluation may be helpful. 4. Stress Emotional stress may contribute to eczema flare-ups in some individuals. Although stress is not the only cause, it may make existing symptoms more difficult to control. 5. Fungal Infection A fungal infection of the feet, commonly called athlete’s foot or kaki berkulat, may sometimes be associated with a blistering eczema-like reaction. This is particularly important when blisters keep recurring despite treatment. Identifying and treating an underlying fungal infection may help improve the condition. Is Pompholyx the Same as Athlete’s Foot? No. Although both conditions can cause itching, blisters and peeling skin, they require different treatments. Pompholyx (Eczema) Athlete’s Foot (Fungal Infection) Inflammatory skin condition Caused by fungal infection Small, deeply seated itchy blisters Scaling, peeling, itching or sometimes blisters Often affects both feet May affect one or both feet May flare with heat, sweating or irritation Favoured by warm, moist environments Treated mainly with anti-inflammatory medication Requires antifungal treatment Not contagious Can spread through infected skin or contaminated surfaces These features can overlap, and appearance alone may not reliably distinguish the two conditions. In uncertain cases, a dermatologist may perform a skin scraping for fungal examination. This distinction is important because using steroid creams alone on an untreated fungal infection may temporarily reduce redness while allowing the infection to persist or worsen. How Is Pompholyx Treated ? Treatment depends on the severity of the eczema, the extent of blistering and how frequently it recurs. 1. Topical Steroid Creams Topical corticosteroids are commonly used to reduce inflammation, itching and blister formation. Because the skin on the soles is relatively thick, stronger prescription steroid preparations may sometimes be necessary for a short period. Once the inflammation improves, treatment is usually reduced or stopped according to the dermatologist’s instructions. Prolonged unsupervised use of potent steroid creams should be avoided. If you're concerned about steroid creams, you can read my article Are Steroid Creams Always Harmful?, which explains the benefits, precautions and risks of inappropriate use. 2. Moisturisers and Skin Barrier Repair Regular moisturising is an important part of treatment, even when the blisters have disappeared. A fragrance-free moisturising cream or ointment can help: Reduce dryness and peeling Improve the skin barrier Reduce painful cracking Support recovery after a flare-up Apply moisturiser after bathing and whenever the skin feels dry. If the skin is actively weeping or very moist, your dermatologist may recommend a different preparation until the blisters settle. 3. Cool Compresses During an acute flare, a cool, damp compress may help soothe itching and discomfort. Avoid applying ice directly to the skin or soaking the feet for prolonged periods, as this may worsen irritation. 4. Treat Excessive Sweating For patients whose eczema is aggravated by excessive foot sweating, controlling moisture may be beneficial. Depending on the situation, treatment may include prescription antiperspirants or other treatments for excessive sweating. These are considered individually, especially when excessive sweating is a persistent contributing factor. 5. Treatment for Recurrent or Severe Pompholyx Some patients experience frequent flare-ups despite appropriate topical treatment and skin care. In selected cases, a dermatologist may consider : Topical calcineurin inhibitors, such as tacrolimus Phototherapy Short-term systemic treatment for severe flares Other systemic anti-inflammatory treatments for difficult-to-control disease These options are not required for most patients and should be tailored to the diagnosis, severity and treatment response. Why Does Pompholyx Keep Coming Back? Pompholyx can be a recurrent skin condition. Even after the blisters have completely disappeared, the skin may remain sensitive to certain triggers. Common reasons for recurrence include ongoing exposure to heat and sweating, prolonged use of enclosed footwear, repeated skin irritation, contact allergies or an underlying fungal infection. Some patients may also have an underlying tendency to develop eczema. Recurrence does not necessarily mean that the previous treatment was ineffective. It may simply mean that the inflammation has settled while the skin remains susceptible to further flare-ups. Long-term management therefore focuses not only on treating active blisters but also on identifying and reducing contributing factors. How Can You Reduce Future Flare-Ups? Several simple foot-care measures may help. Keep your feet cool and comfortable. Choose breathable footwear whenever practical and avoid prolonged use of tight, poorly ventilated shoes. Change socks when they become damp. Moisture-wicking socks may help reduce prolonged exposure to sweat. Wash your feet gently. Use mild, fragrance-free cleansers and avoid excessive scrubbing or harsh antiseptic washes. Dry your feet carefully. Pay particular attention to the areas between the toes, where trapped moisture can encourage fungal infection. Moisturise regularly. Apply a suitable moisturiser to dry or eczema-prone areas, especially after bathing. Avoid scratching or deliberately bursting blisters. This may damage the skin and increase the risk of secondary bacterial infection. Review possible footwear allergies. If flare-ups are consistently associated with particular shoes, assessment for contact allergy may be useful. How Long Does Pompholyx Take to Heal? A typical flare may last approximately two to four weeks, although the duration varies. With appropriate treatment, itching and inflammation may begin to improve earlier. However, the peeling and dryness that follow the blistering stage may take additional time to settle. Some patients experience only occasional episodes, while others develop recurrent flare-ups over many months or years. The aim of treatment is to relieve symptoms, help the skin heal and reduce the frequency and severity of future episodes. When Should You See a Dermatologist? You should seek medical assessment if : Blisters repeatedly appear on your feet Itching interferes with sleep or daily activities The skin becomes painful, cracked or difficult to walk on The rash does not improve with initial treatment You are unsure whether the condition is eczema or fungal infection There is increasing redness, warmth, swelling, pus or fever Depending on the examination findings, a dermatologist may recommend fungal testing, patch testing for contact allergies or occasionally a skin biopsy if the diagnosis remains uncertain. Final Thoughts Pompholyx on the feet can be uncomfortable, especially when itchy blisters repeatedly develop and leave the skin dry, peeling or cracked. Although the condition may recur, most patients can achieve good symptom control with appropriate treatment and regular skin care. The key is to confirm the diagnosis, distinguish eczema from fungal infection, treat active inflammation and identify possible contributing factors. If you experience recurrent itchy blisters or peeling skin on your feet, an accurate dermatological assessment can help determine the most suitable treatment. Dr Lim Tzyy Huei is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia, providing assessment and treatment for eczema, fungal skin infections and other conditions affecting the skin, hair and nails. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation, diagnosis or treatment advice. Itchy blisters and peeling skin on the feet may have different causes, including eczema and fungal infections. An accurate diagnosis is important, as treatment options may vary depending on the underlying condition and individual circumstances.

By Dr Lim Tzyy Huei (林子辉医生) | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Childhood eczema, medically known as atopic dermatitis, is one of the most common skin conditions affecting babies and children. In Malaysia, eczema is sometimes called ekzema or ruam ekzema in Malay, and 湿疹 in Chinese. Many parents become worried when their child’s skin is constantly dry, red and itchy, especially when the eczema keeps returning despite using different creams. Some children scratch until their skin bleeds, while others struggle to sleep because of persistent itching. The good news is that childhood eczema can usually be controlled with proper skincare and appropriate treatment, allowing children to sleep comfortably and enjoy their daily activities. 1. What Causes Eczema in Children? Eczema develops because of a combination of: A weakened skin barrier that allows moisture to escape easily An overactive immune response causing skin inflammation Genetic factors, particularly in families with eczema, asthma or allergic rhinitis Environmental factors that irritate sensitive skin Children with eczema have skin that is more easily irritated and becomes dry and inflamed. Importantly, eczema is not contagious. Your child cannot spread eczema to other children through touching, playing or sharing toys. Eczema is also not caused by poor hygiene. 2. What Does Childhood Eczema Look Like? The appearance and location of eczema may change as children grow. Babies and Infants Eczema commonly affects: Cheeks and forehead Scalp Arms and legs Trunk The skin may appear red, rough, dry or occasionally weepy. Toddlers and Older Children Eczema often affects: Behind the knees Inside the elbows Wrists and ankles Neck Hands and fingers Repeated scratching can cause the skin to become thickened, darker or rougher over time. In children with darker skin tones, eczema may appear brown, purple or grey rather than bright red. 3. Why Does My Child’s Eczema Keep Coming Back? This is one of the most common questions parents ask. Eczema is a chronic inflammatory skin condition. Even when the visible rash improves, the skin barrier may remain sensitive and prone to inflammation. Common factors that can worsen eczema include: Hot weather and excessive sweating Dry skin Harsh soaps or fragranced skincare products Frequent washing without moisturising Rough fabrics and friction Certain environmental allergens Skin infections Scratching and irritation In Malaysia’s hot and humid climate, sweating and overheating are particularly common problems. Not every flare-up is caused by food allergy. Rather than trying to avoid every possible trigger, it is usually more helpful to identify factors that consistently worsen your child’s skin while maintaining a regular skincare routine. Eczema often follows a cycle of flare-ups and improvement. Even when the visible rash has settled, the skin barrier may remain sensitive, making repeated flare-ups possible. To understand why eczema keeps returning and how to achieve better long-term control, you can read my related article: Why Does Eczema Keep Coming Back? Understanding Flare-Ups and How to Manage Them. 4. Is Childhood Eczema Caused by Food Allergy? Many parents suspect that foods such as eggs, milk, seafood or peanuts are responsible for their child’s eczema. Although some children with eczema also have food allergies, most eczema flare-ups are not directly caused by food. Unnecessary food restrictions may affect a child’s nutrition and growth. Food allergy assessment may be appropriate when: A child develops hives, facial swelling or vomiting shortly after eating a particular food Eczema remains moderate to severe despite appropriate treatment, especially in young children There is a convincing history suggesting a specific food allergy Parents should not remove major food groups from their child’s diet without medical advice. Routine food allergy testing is not necessary for every child with eczema. 5. How Should I Care for My Child’s Eczema at Home? Good daily skincare is the foundation of eczema treatment. Use Moisturiser Regularly Apply a fragrance-free moisturiser at least twice daily, even when the skin looks normal. Thick creams or ointments are generally more effective for very dry skin than light lotions. Moisturiser helps: Repair and protect the skin barrier Reduce dryness and itching Prevent skin cracking Reduce the frequency of eczema flare-ups Bathing and Cleansing Use lukewarm rather than hot water. Keep baths or showers short and comfortable. Choose gentle, fragrance-free cleansers. Avoid harsh soaps, bubble baths and vigorous scrubbing. Apply moisturiser soon after bathing. Clothing and Environment Choose soft, comfortable clothing, preferably cotton. Avoid overheating, especially during sleep, and change sweaty clothing when necessary. Keeping fingernails short can also reduce skin damage caused by scratching. 6. Are Steroid Creams Safe for Babies and Children? Many parents are understandably concerned about using steroid creams on their child’s skin. Topical corticosteroids are commonly prescribed to reduce the inflammation responsible for redness, itching and eczema flare-ups. When the correct strength is used on the appropriate body area for the recommended duration, topical steroid creams are generally safe and effective. Different areas of the body may require different strengths. For example: The face and skin folds usually require milder treatment. Arms, legs and other body areas may require different strengths depending on eczema severity. Thickened eczema may need stronger treatment under medical supervision. Side effects such as skin thinning are mainly associated with inappropriate or prolonged use, especially of stronger steroid preparations. Avoiding necessary treatment can also allow eczema to worsen, causing persistent scratching, broken skin and infection. Parents should follow their doctor’s instructions rather than repeatedly stopping treatment too early or using stronger creams without supervision. Further Reading: Are Steroid Creams Always Harmful? Many parents worry about using steroid creams on their baby's or child's skin, particularly when eczema keeps coming back. When used correctly, topical steroid creams are generally safe and effective. Choosing the appropriate strength, applying them to the correct areas and following the recommended treatment duration are important for safe treatment. For a better understanding of how steroid creams work, their possible side effects and how to use them safely, read my related article: Are Steroid Creams Always Harmful? 7. Why Does Eczema Return After Stopping Steroid Cream? Sometimes eczema improves quickly with treatment but returns shortly after the cream is stopped. This does not necessarily mean that the skin has become dependent on steroids. More commonly, it happens because: The underlying tendency towards inflammation remains The skin barrier has not fully recovered Treatment was stopped before the flare settled Triggering factors are still present The eczema requires a longer-term maintenance plan For children who experience frequent flare-ups, a dermatologist may recommend proactive maintenance treatment, such as applying a prescribed anti-inflammatory cream twice weekly to areas that repeatedly develop eczema. This approach can help reduce future flare-ups while limiting repeated courses of treatment. 8. What If Moisturisers and Steroid Creams Are Not Enough? Some children continue to experience frequent or severe eczema despite appropriate skincare. Depending on the child’s age, eczema severity and previous treatment response, additional options may include: Non-Steroid Anti-Inflammatory Creams Medications such as tacrolimus or pimecrolimus may be considered for selected children, particularly when eczema frequently affects sensitive areas such as the face or skin folds. Wet Wrap Therapy This may help children with severe itching or widespread eczema during difficult flare-ups. It should be performed under appropriate medical guidance, particularly when medicated creams are used. Advanced Treatment for Severe Eczema Children with persistent moderate-to-severe eczema may require specialist treatment, including newer targeted therapies such as dupilumab or other age-appropriate medicines. The choice depends on the child’s age, severity, medical history, treatment availability and individual needs. Not every child with eczema requires advanced treatment. However, children with severe eczema should not have to continue suffering when effective treatment options are available. 9. Can Eczema Become Infected? Yes. Repeated scratching can damage the skin barrier and allow bacteria or viruses to cause infection. Warning signs include: Increasing pain or tenderness Yellow crusting or pus Rapidly worsening redness or swelling Fever or a child becoming unwell Sudden clusters of painful blisters or punched-out sores Painful, rapidly spreading blisters or erosions, particularly with fever, may indicate a serious viral infection known as eczema herpeticum, which requires urgent medical assessment. Not every weeping eczema rash requires antibiotics. The treatment depends on whether an infection is actually present. 10. Will My Child Eventually Outgrow Eczema? Many children experience significant improvement as they grow older. Some may have very little eczema by their school years, while others continue to experience occasional flare-ups during adolescence or adulthood. It is difficult to predict exactly when eczema will improve. Children with more severe or persistent eczema, or those with associated allergic conditions, may have a greater chance of ongoing symptoms. However, even when eczema does not completely disappear, it can often be managed successfully. The aim of treatment is to keep the skin comfortable, reduce itching, improve sleep and minimise the impact of eczema on everyday life. 11. When Should My Child See a Dermatologist? Consider specialist assessment if: Eczema keeps returning despite regular moisturising and appropriate treatment Your child scratches until the skin bleeds Itching frequently interrupts sleep Eczema affects large areas of the body The rash frequently becomes infected Eczema affects the child’s confidence, mood or school activities You are worried about long-term steroid use The diagnosis is uncertain A dermatologist can assess the severity of eczema, review the current skincare routine and develop a treatment plan suitable for the child’s age and needs. Living With Childhood Eczema: A Message to Parents Caring for a child with eczema can be exhausting. Repeated flare-ups, sleepless nights, frequent moisturising and concerns about medication can place significant stress on the whole family. Parents sometimes feel frustrated when the rash improves and then returns again. It is important to understand that eczema is not caused by poor parenting or inadequate cleanliness. The goal is not to achieve perfect skin every day, but to keep your child comfortable, sleeping well and able to enjoy childhood without constant itching. With proper education, regular skincare and appropriate medical treatment, most children can achieve good eczema control. Consult a Dermatologist in Batu Pahat If your baby or child has persistent eczema, frequent flare-ups or troublesome itching, an assessment by a dermatologist can help identify the underlying problems and guide suitable treatment. Dr Lim Tzyy Huei (林子辉医生) Consultant DermatologistPantai Hospital Batu Pahat, Johor Children with eczema can be assessed and managed with an individualised treatment plan based on their age, skin condition and eczema severity. Medical Disclaimer: This article is intended for general patient education and does not replace individual medical assessment or treatment advice.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Have you noticed small red bumps or pus-filled spots appearing on your chest, back, scalp, buttocks or thighs? These bumps may look similar to acne. Sometimes, they are itchy, painful or tender to touch. They may improve temporarily with treatment, only to return again after a few weeks. This could be folliculitis, a common skin condition involving inflammation of the hair follicles. Although many cases are mild and settle with appropriate care, some patients experience persistent or recurrent folliculitis. Understanding the underlying cause is important because not all folliculitis is caused by bacteria, and different types require different treatments. What Is Folliculitis? Folliculitis occurs when hair follicles become inflamed due to infection, irritation or other contributing factors. Hair follicles are tiny structures in the skin from which hair grows. When they become inflamed, small red bumps or pus-filled lesions may develop around the affected follicles. Common symptoms include: Small red bumps or white-headed pustules Itchiness, discomfort or tenderness Clusters of acne-like spots Occasional pain or swelling Recurrent outbreaks in the same areas Folliculitis can develop almost anywhere hair grows, but commonly affects the scalp, face, beard area, chest, back, buttocks, thighs and groin. What Causes Folliculitis? There are several types of folliculitis, and identifying the correct cause helps guide treatment. 1. Bacterial Folliculitis Bacterial folliculitis is commonly caused by Staphylococcus aureus, a bacterium that can normally be present on the skin or inside the nose. When bacteria enter or multiply around damaged hair follicles, inflammation and infection may develop. Patients may notice small red bumps with pus-filled centres, sometimes accompanied by tenderness. Contributing factors include excessive sweating, friction from tight clothing, shaving, skin irritation and underlying skin conditions such as eczema. 2. Fungal Folliculitis (Malassezia Folliculitis) Malassezia folliculitis, previously known as Pityrosporum folliculitis, is caused by an overgrowth of Malassezia, a yeast that naturally lives on human skin. It commonly affects the: Chest Upper back Shoulders Upper arms Occasionally the face and forehead Unlike typical acne, Malassezia folliculitis often produces small, similar-looking, itchy bumps, usually without blackheads or whiteheads (comedones). It may become more noticeable in hot and humid weather, particularly when sweating is excessive. Prolonged antibiotic use and certain medications that suppress the immune system can also increase susceptibility. Importantly, Malassezia folliculitis does not usually respond to antibacterial treatments, because the underlying cause is yeast rather than bacteria. 3. Folliculitis Due to Friction, Shaving or Irritation Not all folliculitis is caused by infection. Repeated friction, shaving, waxing, plucking and tight clothing may irritate or damage hair follicles. This is particularly common around the beard, neck, thighs, buttocks and groin. Ingrown hairs following shaving can also produce inflamed bumps that resemble folliculitis. This is often referred to as pseudofolliculitis. Reducing mechanical irritation and modifying hair-removal practices are important parts of treatment. Folliculitis or Acne: How Can You Tell the Difference? Folliculitis is frequently mistaken for acne because both can cause red bumps and pustules. However, there are some differences. Acne commonly produces blackheads, whiteheads, inflammatory pimples and sometimes deeper nodules. It frequently affects the face, chest and back. Folliculitis usually develops around individual hair follicles. The lesions may look relatively uniform and can be associated with itchiness or tenderness. Malassezia folliculitis, in particular, often causes itchy, similar-sized bumps without comedones. Some patients may have both acne and folliculitis at the same time. A dermatologist can help distinguish these conditions, particularly when conventional acne treatment has not been effective. Why Does Folliculitis Keep Coming Back? One of the most common concerns among patients is: “My folliculitis improves after medication, but why does it keep recurring?” There are several possible explanations. 1. Heat, Sweating and Humidity Hot and humid environments may encourage sweating, skin maceration and follicular irritation. This is especially relevant in Malaysia, where prolonged exposure to heat and humidity is common. Wearing tight or poorly ventilated clothing may further aggravate the condition. 2. Friction and Repeated Skin Irritation Frequent shaving, tight trousers, sportswear and prolonged friction can repeatedly irritate hair follicles. Even after the inflammation improves, the same triggers may cause another outbreak. 3. Persistent Bacterial Colonisation Some individuals repeatedly carry Staphylococcus aureus on their skin or inside their nose. In selected patients with recurrent bacterial folliculitis, bacterial swabs and further assessment may be necessary. 4. Incorrect Diagnosis or Treatment Not every acne-like eruption is bacterial folliculitis. For example, Malassezia folliculitis may persist despite repeated courses of antibiotics. In some cases, prolonged antibiotic exposure can even contribute to yeast-associated folliculitis. This is why persistent or recurrent lesions should be reassessed rather than repeatedly treated with the same medication. 5. Underlying Medical Conditions or Medications Patients with diabetes, weakened immunity or certain underlying skin conditions may be more susceptible to recurrent infections. Some medications, including corticosteroids and immunosuppressive treatments, may also contribute to follicular eruptions or increase the risk of infection. What Are the Treatment Options for Folliculitis? Treatment depends on the underlying cause, severity, extent of involvement and frequency of recurrence. 1. Antiseptic Cleansers For selected patients with bacterial folliculitis, antiseptic washes may help reduce the number of bacteria on the skin. Commonly used options include chlorhexidine-based cleansers or benzoyl peroxide washes. However, excessive cleansing may cause dryness and irritation, particularly in patients with sensitive or eczema-prone skin. 2. Topical Antibiotics For localised bacterial folliculitis, a dermatologist may prescribe topical antibiotics such as: Fusidic acid Mupirocin Clindamycin in selected circumstances These medications are generally used for short courses when indicated. Repeated or prolonged antibiotic use without proper assessment should be avoided because of the risk of antibiotic resistance. 3. Oral Antibiotics For more extensive, deeper or persistent bacterial infections, oral antibiotics may sometimes be required. The choice of antibiotic depends on the suspected bacteria, clinical severity and, when appropriate, bacterial culture results. Not every patient with folliculitis requires oral antibiotics. 4. Antifungal Treatment For Malassezia folliculitis, antifungal treatment is usually more appropriate. Depending on severity, options may include: Ketoconazole shampoo or topical preparations Selenium sulfide preparations Other topical antifungal treatments Oral antifungal medications for selected extensive or persistent cases Some patients may benefit from intermittent antifungal maintenance treatment, particularly if they experience frequent recurrence. Oral antifungal medication should only be used under medical supervision because of possible drug interactions and adverse effects. 5. Management of Deep Folliculitis or Boils Occasionally, follicular inflammation progresses into a deeper infection, producing a painful, swollen lump or boil. Larger abscesses may require drainage rather than topical treatment alone. Patients should avoid squeezing or attempting to drain these lesions at home because this may worsen inflammation or spread infection. How Long Does Folliculitis Take to Heal ? The recovery period varies depending on the cause and severity. Mild superficial folliculitis may settle spontaneously within several days. With appropriate treatment, many bacterial cases improve within approximately one to two weeks. Malassezia folliculitis may require several weeks of antifungal treatment, particularly when the affected area is extensive. Deeper infections may take longer to recover. After the active inflammation settles, some patients may notice lingering red or brown marks, known as post-inflammatory erythema or hyperpigmentation. These marks are not necessarily signs of ongoing infection and may take weeks to months to fade. How Can You Prevent Folliculitis From Recurring? Although recurrence cannot always be completely prevented, several practical measures may help reduce the frequency of outbreaks. 1. Reduce excessive sweating and prolonged moisture Shower after heavy sweating or exercise, and change out of damp clothing promptly. 2. Choose loose, breathable clothing Avoid prolonged friction from tight trousers, sportswear or poorly ventilated fabrics. 3. Practise gentle skin cleansing Use a mild cleanser regularly. Avoid excessive scrubbing, which may further irritate the follicles. 4. Modify shaving habits Avoid shaving over actively inflamed skin. When shaving is necessary, use a clean, sharp razor, shave in the direction of hair growth and avoid repeated passes over the same area. 5. Avoid squeezing or scratching the lesions Picking at folliculitis can worsen inflammation, introduce additional infection and increase the risk of pigmentation or scarring. 6. Choose suitable skincare products If your skin is prone to follicular blockage, consider lightweight, non-comedogenic products rather than heavy, greasy preparations. 7. Follow the prescribed treatment plan Complete treatment as advised and avoid repeatedly using leftover antibiotics or antifungal medication without reassessment. For patients with frequent recurrence, a dermatologist may recommend a maintenance strategy tailored to the underlying cause. When Should You See a Dermatologist? Consider seeking dermatological assessment if: Folliculitis keeps recurring despite treatment The lesions become increasingly painful or widespread There are recurrent boils or pus-filled swellings The condition does not improve with appropriate initial treatment Scarring, pigmentation or hair loss develops The diagnosis remains uncertain Seek prompt medical attention if redness spreads rapidly, there is fever, significant pain or swelling, or if you are immunocompromised. In persistent cases, investigations such as bacterial swabs, fungal examination or occasionally a skin biopsy may be considered. Some conditions, including acne, hidradenitis suppurativa and certain inflammatory skin disorders, can resemble folliculitis and may require a different treatment approach. Can Folliculitis Be Cured Permanently? Many cases of folliculitis resolve completely with appropriate treatment and avoidance of contributing factors. However, recurrence is possible, especially when there is ongoing sweating, friction, repeated shaving, bacterial colonisation or a tendency towards Malassezia overgrowth. For patients with recurrent folliculitis, the goal is not simply to clear the current outbreak, but also to identify the underlying cause and reduce future episodes. Repeated folliculitis does not necessarily mean that stronger antibiotics are needed. Sometimes, the most important step is reviewing the diagnosis and choosing a more targeted treatment. Final Thoughts Folliculitis is a common skin condition that may resemble acne but can develop for several different reasons. While bacterial folliculitis may respond to antiseptic measures or antibiotics, Malassezia folliculitis requires antifungal treatment. Irritation-related folliculitis may improve by reducing shaving, friction and other triggers. Understanding the cause is essential, particularly for patients who experience repeated outbreaks. With appropriate diagnosis, targeted treatment and practical preventive measures, most patients can achieve better long-term control. 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 acne, folliculitis, fungal skin infections, eczema, psoriasis and other inflammatory skin conditions. For patients experiencing persistent or recurrent folliculitis, dermatological assessment may help identify the underlying cause and guide appropriate treatment. This article is intended for general patient education and does not replace an individual medical consultation.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia On 12 July 2025, I had the pleasure of delivering a lunch talk titled “Management of Atopic Dermatitis in Primary Care” at City Rise Hotel, Miri, Sarawak. Sponsored by Medcin Pharma (Vanicream), the session brought together primary care doctors to discuss practical approaches to recognising and managing atopic dermatitis, commonly known as eczema. Having previously served in Sarawak, I particularly valued the opportunity to return, reconnect with colleagues and exchange clinical experiences. Managing Eczema Beyond the Flare Atopic dermatitis is a chronic, relapsing inflammatory skin condition affecting children and adults. Persistent itching, recurrent inflammation and disrupted sleep can place a considerable burden on patients and their families. Primary care doctors play an important role in recognising eczema, initiating treatment and helping patients understand its recurring nature. During the talk, we explored how to develop practical treatment plans that address both active flares and ongoing care. Key topics included: Accurate diagnosis: Recognising eczema and distinguishing it from other skin conditions. Individual triggers: Identifying irritants and environmental factors that may aggravate symptoms. Skin barrier care: Supporting regular moisturisation, gentle cleansing and suitable skincare. Appropriate treatment: Selecting topical corticosteroids and steroid-sparing treatments according to the affected area and clinical needs. Patient education: Explaining correct application, addressing treatment concerns and setting realistic expectations. Specialist referral: Recognising when persistent, severe or diagnostically uncertain disease requires further assessment. Skin Barrier Care as a Foundation A central message was that eczema management involves more than reducing visible inflammation. Regular moisturisation and gentle skincare support the skin barrier and remain important even when eczema improves. Patients also need clear guidance on how these measures fit alongside their prescribed anti-inflammatory treatment. Choosing products that suit the individual’s skin, keeping routines manageable and explaining the purpose of each treatment can help patients follow their care plan more consistently. A Meaningful Return to Sarawak Returning to Sarawak to share dermatology knowledge was a meaningful experience. It brought back memories of my time working there and offered an opportunity to reconnect with the healthcare community. The discussion and Q&A allowed us to explore everyday challenges, including recurrent flares, concerns about topical treatments and difficulties maintaining regular skincare. These exchanges are a valuable part of continuing medical education. They help connect specialist knowledge with the practical realities of primary care and encourage closer collaboration in supporting patients. Continuing Dermatology Education As a dermatologist at Pantai Hospital Batu Pahat, Johor, I value opportunities to share clinical knowledge and learn from colleagues working in different settings. My sincere thanks to Medcin Pharma for sponsoring the session and to the participating doctors for their engagement and thoughtful questions. I hope the sharing provided useful approaches to eczema care—from early recognition and appropriate treatment to patient education and a sustainable long-term plan.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia The shingles rash has healed, the blisters have disappeared, but the pain is still there. Why? This is a common concern among patients recovering from shingles, also known as herpes zoster, kayap (Malay), or 生蛇 (Chinese). Some patients experience persistent burning, stabbing, or electric shock-like pain even after their skin looks completely normal. This condition is known as postherpetic neuralgia (PHN), a form of nerve pain that can last for months or occasionally years after shingles. The good news is that many patients gradually improve, and treatments are available to help control the discomfort. 1. What Is Postherpetic Neuralgia? Postherpetic neuralgia is persistent nerve pain following a shingles infection. Shingles occurs when the chickenpox virus, known as the varicella-zoster virus, becomes active again within the nerves. During the infection, the virus causes inflammation and injury to the affected nerves. Even after the skin lesions have healed, these nerves may continue sending abnormal pain signals to the brain. This explains why some patients still experience pain despite having no visible rash. Medically, postherpetic neuralgia is commonly defined as pain persisting for more than 90 days after the shingles rash began. Pain occurring earlier during recovery may be described as acute or subacute zoster-associated neuralgia. Postherpetic neuralgia is a complication of shingles, but not everyone who develops shingles will experience persistent nerve pain. If you would like to understand more about why shingles occurs, its early symptoms, antiviral treatment, recovery time and prevention, you can read my related article: Shingles (Herpes Zoster): Why Does It Happen, How Is It Treated, and Will the Pain Go Away? 2. What Does Postherpetic Neuralgia Feel Like? The pain can vary considerably between patients. Common descriptions include: Burning or hot sensations beneath the skin Sharp, stabbing, or shooting pain Electric shock-like sensations Persistent aching or throbbing Tingling or numbness Extreme sensitivity to light touch Pain when clothing or bedsheets touch the skin Some patients experience constant discomfort, while others have intermittent episodes of severe pain. The affected area usually corresponds to the location of the previous shingles rash. For example, a patient who had shingles over one side of the chest may continue to experience burning or shooting pain in the same area. 3. Why Does the Skin Hurt Even After the Rash Has Healed? This happens because shingles affects not only the skin but also the underlying sensory nerves. During the infection, the virus can damage or irritate these nerves, making them unusually sensitive. As a result, normal sensations such as gentle touch, clothing friction, or temperature changes may be interpreted as pain. This abnormal sensitivity is called allodynia. For some patients, even a soft shirt touching the affected area may feel extremely uncomfortable. Importantly, persistent nerve pain does not necessarily mean that the shingles virus is still actively multiplying. 4. Who Is More Likely to Develop Postherpetic Neuralgia? Not everyone who develops shingles will experience prolonged nerve pain. The risk is higher in: Adults aged 50 years and above, especially the elderly Patients who experience severe pain during shingles Individuals with extensive blistering eruptions Patients with weakened immune systems People with certain chronic medical conditions The likelihood of persistent nerve pain generally increases with age. However, younger adults can occasionally develop postherpetic neuralgia as well. 5. How Long Does Postherpetic Neuralgia Last? This is one of the most frequently asked questions. Unfortunately, there is no fixed recovery period. Some patients experience gradual improvement within a few months, while others may continue having symptoms for a year or longer. Recovery depends on several factors, including age, severity of nerve involvement, and individual response to treatment. For many patients, the pain gradually becomes less intense and less frequent. Persistent nerve pain does not automatically mean permanent nerve damage or lifelong pain. Nevertheless, some individuals may experience prolonged symptoms requiring ongoing management. 6. What Treatments Are Available? Unlike ordinary muscle or joint pain, postherpetic neuralgia involves abnormal nerve signalling. Therefore, common painkillers such as paracetamol may not provide sufficient relief. Treatment usually focuses on medications specifically designed to manage nerve-related pain. A. Gabapentin and Pregabalin Gabapentin and pregabalin are commonly prescribed medications for postherpetic neuralgia. They help reduce abnormal nerve signalling and may improve: Burning or shooting pain Electric shock-like sensations Skin hypersensitivity Sleep disturbance caused by nerve pain These medications are usually started at a low dose and adjusted gradually according to treatment response. They may take several days or weeks to provide meaningful relief. Possible side effects include dizziness, drowsiness, and unsteadiness. Dose adjustment is particularly important in older patients and those with impaired kidney function. B. Certain Antidepressant Medications Some medications originally developed for depression, such as amitriptyline or nortriptyline, can also help relieve nerve pain. They work by modifying how pain signals are processed within the nervous system. These medications may be prescribed at lower doses than those typically used to treat depression. They are not suitable for everyone, particularly certain older patients or individuals with specific heart conditions or other contraindications. C. Topical Treatments For patients with pain affecting a limited area, topical treatments may be useful. Options include: Lidocaine patches or preparations Capsaicin-based treatments under appropriate medical supervision These treatments act locally and may be considered when oral medications are poorly tolerated or insufficient. They should only be used as directed, particularly when the skin is sensitive or fragile. D. Specialist Pain Management For patients with severe or persistent symptoms despite medication, referral to a pain specialist may be considered. Depending on the individual situation, additional treatment options may include selected nerve blocks or other specialist pain-management procedures. Not every patient requires these treatments. 7. What Can You Do at Home to Reduce the Pain? Alongside prescribed treatment, simple adjustments may help reduce discomfort. Wear loose, soft cotton clothing to minimise friction. Avoid scratching or rubbing the painful area. Use a cool compress if it provides relief. Maintain regular sleep habits. Keep a record of pain severity and treatment response. Take prescribed medication consistently and avoid stopping it abruptly without medical advice. Cold compresses may help some patients but worsen discomfort in others, particularly those with temperature sensitivity. The aim is to identify measures that improve comfort without further irritating the nerves. 8. Can Antiviral Medication Treat Postherpetic Neuralgia? Antiviral medications such as acyclovir and valacyclovir are important during an active shingles infection. They work by reducing viral replication. However, once the shingles rash has healed and established postherpetic neuralgia develops, antiviral medications generally do not relieve the persistent nerve pain. At this stage, treatment focuses on controlling abnormal nerve signalling rather than treating an active viral infection. This is why medications such as gabapentin or pregabalin may be prescribed instead. 9. Can Postherpetic Neuralgia Be Prevented? The most effective preventive strategy is reducing the risk of shingles itself. Shingles vaccination can significantly reduce the likelihood of developing shingles and its complications, including postherpetic neuralgia. The recombinant shingles vaccine, Shingrix, is available in Malaysia for adults aged 50 years and above, as well as certain younger adults with increased risk. For patients who develop shingles, antiviral treatment should ideally begin within 72 hours after the rash appears. Early antiviral therapy can improve the course of acute shingles, although it does not reliably eliminate the risk of subsequent postherpetic neuralgia. 10. Frequently Asked Questions Is postherpetic neuralgia contagious? No. Postherpetic neuralgia is nerve pain following shingles, not an active contagious infection. Does persistent pain mean the shingles virus is still active? Not necessarily. The pain usually results from nerve injury or altered nerve signalling after the infection. Can postherpetic neuralgia occur without visible skin changes? Yes. The skin may appear completely healed while the underlying nerves remain sensitive. Which is better for nerve pain: gabapentin or pregabalin? Both medications can be effective. The choice depends on pain severity, other medical conditions, kidney function, potential side effects, and individual treatment response. Neither medication is universally better for every patient. Will I need nerve pain medication for the rest of my life? Not necessarily. Many patients gradually improve, allowing medication to be reduced or discontinued under medical supervision. When should I see a doctor? Medical assessment is recommended if nerve pain persists, becomes more severe, affects sleep, or interferes with daily activities. New weakness, visual symptoms, severe headache, or new blistering eruptions require prompt reassessment. Final Thoughts Postherpetic neuralgia can be frustrating because the skin may look completely normal while the pain continues. For some patients, even simple activities such as wearing clothes, sleeping, or moving comfortably can become difficult. Fortunately, many patients experience gradual improvement, and appropriate treatment can help reduce discomfort and improve quality of life. You do not have to wait for the nerve pain to become unbearable before seeking treatment. 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 shingles, postherpetic neuralgia, and other skin-related conditions. Medical Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Treatment suitability, medication choice, and recovery may vary depending on each patient's medical condition and individual needs. Please consult a qualified healthcare professional for appropriate assessment and treatment.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Shingles, medically known as herpes zoster, is a painful skin condition caused by the reactivation of the chickenpox virus. In Malaysia, it is commonly called kayap in Malay or 生蛇 in Chinese. Many patients first notice a burning, tingling, or painful sensation on one side of their body. A few days later, clusters of small fluid-filled blisters may appear. Although the skin rash usually heals within a few weeks, some patients continue to experience nerve pain long after the blisters have disappeared. Understanding the early symptoms and seeking timely treatment can help reduce the severity of shingles and its complications. 1. What Causes Shingles? Shingles is caused by the varicella-zoster virus, the same virus responsible for chickenpox. After recovering from chickenpox, the virus does not completely disappear from the body. Instead, it remains inactive within the nerve cells. Years or even decades later, the virus may reactivate, causing shingles. Shingles is more common in: Adults aged 50 years and above People with weakened immune systems Patients receiving chemotherapy or immunosuppressive medication Individuals with certain chronic medical conditions However, shingles can also occur in younger, otherwise healthy adults. Although some patients associate an episode with stress or tiredness, shingles is caused by viral reactivation rather than stress alone. 2. What Are the Early Symptoms of Shingles? The earliest symptoms may develop several days before the rash appears. Patients may experience: Burning or tingling sensations Sharp, stabbing, or shooting pain Itching or unusual skin sensitivity Pain even when clothing lightly touches the skin Once the rash appears, it typically develops into clusters of small fluid-filled blisters. Shingles commonly affects the chest, back, abdomen, or face. The rash usually follows the distribution of a nerve and appears on one side of the body, often without crossing the midline. Sometimes, the pain may be mistaken for muscular pain or other medical conditions before the skin changes become visible. 3. Why Is Early Treatment Important? Antiviral treatment works best when started within the first 72 hours after the rash appears. Commonly prescribed antiviral medications include: Acyclovir Valacyclovir Famciclovir These medications help reduce viral activity, shorten the duration of the illness, and lessen the severity of acute symptoms. Patients should still seek medical assessment even if more than 72 hours have passed, particularly when new blisters are appearing, the rash involves the face or eye, or the immune system is weakened. Early treatment is important, but it cannot guarantee that long-term nerve pain will be prevented. 4. How Long Does Shingles Take to Heal? The recovery process varies between individuals. First few days: Burning, tingling, or pain may occur before the rash. Days 1–5 of the rash: Red patches and fluid-filled blisters develop. Around days 7–10: Blisters begin drying and forming crusts. Weeks 2–4: The rash gradually heals. After healing: Some patients experience persistent nerve pain or skin discolouration. The skin may remain darker or lighter after the rash heals, particularly in individuals prone to post-inflammatory pigmentation. 5. Why Does the Pain Continue After Shingles Has Healed? One of the most troublesome complications of shingles is postherpetic neuralgia (PHN). This refers to nerve pain that persists for at least three months after the shingles rash develops. Patients may describe: Burning or shooting pain Electric shock-like sensations Persistent tingling Pain when clothing touches the skin Sleep disturbance caused by discomfort The risk increases with age, particularly among older adults and those who experience severe shingles. For some individuals, the discomfort resolves gradually. In others, it may continue for months or occasionally longer. How Is Postherpetic Neuralgia Treated? Depending on the severity of symptoms, treatment may include: Gabapentin Pregabalin Certain antidepressant medications used specifically for nerve pain Topical lidocaine preparations for suitable patients These medications aim to reduce nerve-related pain and improve sleep and daily functioning. Treatment must be individualised, as some medications can cause dizziness or drowsiness. Dosage adjustments may also be necessary in patients with impaired kidney function. For some patients, nerve pain may continue long after the shingles rash has healed. This condition, known as postherpetic neuralgia (PHN), can affect sleep, daily activities and quality of life. To learn more about why nerve pain persists and the available treatment options, read my related article: Postherpetic Neuralgia: Why Does Nerve Pain Continue After Shingles and How Is It Treated? 6. Can Shingles Spread to Other People? Shingles itself is not passed directly from one person to another. However, someone who has never had chickenpox or received the chickenpox vaccine may develop chickenpox after exposure to the virus from shingles blisters. Until all lesions have dried and crusted, patients should: Keep the affected rash covered where possible. Avoid scratching or touching the blisters. Wash their hands regularly. Avoid direct contact with susceptible pregnant women, newborn babies, and individuals with weakened immune systems. Shingles is generally no longer contagious once all blisters have crusted. 7. When Should You Seek Urgent Medical Attention? Although most uncomplicated cases can be managed with oral antiviral medication, certain situations require urgent assessment. These include: Shingles affecting the forehead, eyelid, or near the eye Eye redness, eye pain, or blurred vision Facial weakness, hearing changes, or severe ear pain Extensive or rapidly spreading blisters Severe headache, confusion, or neurological symptoms Shingles occurring in patients with significantly weakened immune systems Shingles involving the eye can cause serious complications, including permanent visual impairment, if not treated promptly. 8. Can Shingles Come Back? Yes. Although many patients experience shingles only once, the virus remains within the body and can reactivate again. Repeat episodes are more likely in older individuals and those with weakened immune systems. If a patient experiences repeated episodes of a blistering rash, further assessment may be necessary to confirm the diagnosis and exclude other conditions, such as herpes simplex infection. 9. Can Shingles Be Prevented? Vaccination can significantly reduce the risk of developing shingles and its complications. The recombinant shingles vaccine, Shingrix, is available in Malaysia for adults aged 50 years and above, as well as adults aged 18 years and above who are at increased risk of shingles. It is usually administered as two doses, commonly separated by 2–6 months. Different intervals may be recommended for certain immunocompromised individuals. Even individuals who have experienced shingles previously may benefit from vaccination after recovering from the acute episode. Vaccination does not treat an active shingles infection, but it helps reduce the likelihood of future episodes and long-term nerve pain. 10. Frequently Asked Questions Is shingles caused by eating certain foods? No. Shingles is caused by reactivation of the chickenpox virus. There is no convincing evidence that particular foods trigger the infection. Can I shower if I have shingles? Yes. Gentle washing is generally safe. Avoid vigorous scrubbing and keep the affected skin clean and dry afterward. Can I apply steroid cream to shingles? Steroid creams are not the primary treatment for shingles and should not replace antiviral medication. Use them only when specifically advised by a doctor. Does every patient need medication for nerve pain? No. Many patients improve as the rash heals. Additional treatment may be considered when pain persists or interferes with sleep and everyday activities. Can younger adults develop shingles? Yes. Although shingles becomes more common with increasing age, younger adults can also develop the condition. Final Thoughts Shingles is more than just a blistering skin rash. For some patients, the nerve pain can be more troublesome than the skin lesions themselves. Recognising the early symptoms and receiving appropriate antiviral treatment can help shorten the illness and relieve acute symptoms. If you develop a painful blistering rash, particularly on one side of the body or face, seek medical assessment as early as possible. 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 shingles, persistent nerve-related discomfort and other blistering skin conditions. Medical Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Diagnosis, treatment suitability and recovery may vary according to each patient's condition. Please consult a qualified healthcare professional for appropriate assessment and treatment.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Dry or cracked lips are common, especially during hot weather, air-conditioned environments or periods of frequent lip licking. However, if your lips remain dry, itchy, red or painful despite repeatedly applying lip balm, you may have a condition called atopic cheilitis, also known as lip eczema. Atopic cheilitis is a form of eczema affecting the lips. It can occur in children and adults, particularly those with sensitive skin or a history of eczema (atopic dermatitis). Although it is not contagious, the condition can be uncomfortable, affect eating and speaking, and keep coming back if the underlying inflammation and triggers are not properly addressed. What Is Atopic Cheilitis? Atopic cheilitis is inflammation of the lips associated with an eczema-prone skin barrier. Normally, the skin barrier helps retain moisture and protects against external irritants. In people with atopic eczema, this barrier is less effective, making the lips more vulnerable to dryness, irritation and inflammation. Atopic cheilitis may affect the upper lip, lower lip or both. Sometimes, the surrounding skin also becomes inflamed. It is important to understand that not all persistent dry lips are caused by atopic cheilitis. Irritant contact cheilitis and allergic contact cheilitis can look very similar, and more than one condition may occur together. What Are the Symptoms? Common symptoms include: Persistent dryness or chapped lips Redness and inflammation Peeling or flaking skin Itching or burning sensation Cracks or painful fissures Tightness when smiling or opening the mouth Occasional mild swelling Darkening of the lips after repeated inflammation In more severe cases, painful cracks may develop, making eating, drinking or speaking uncomfortable. The symptoms may improve temporarily with lip balm but return repeatedly. What Causes Atopic Cheilitis? Atopic cheilitis is associated with a weakened skin barrier and an underlying tendency towards eczema. Several factors can aggravate the condition. 1. Frequent Lip Licking When the lips feel dry, many people instinctively lick them. Although saliva provides temporary moisture, repeated wetting and drying can further damage the skin barrier. This creates a cycle: Dry lips → Lip licking → Increased irritation → More dryness → Repeated lip licking. This is particularly common among children. 2. Lip Balm, Lipstick and Cosmetic Products Some lip products contain ingredients that may irritate sensitive lips or cause allergic reactions. Potential triggers include: Fragrances Flavourings Menthol Peppermint Cinnamon Certain preservatives Ingredients in lipsticks and lip cosmetics Interestingly, repeatedly applying different lip balms may sometimes make the condition worse rather than better. 3. Toothpaste and Mouthwash Certain toothpaste or mouthwash ingredients may irritate the lips or trigger contact allergy. Examples include flavourings such as mint or cinnamon and some other ingredients in oral-care products. If lip eczema persists despite treatment, these products may need to be reviewed. 4. Environmental Factors Common aggravating factors include: Dry air-conditioned environments Wind Cold or dry weather Repeated wiping of the mouth Excessive saliva contact Although Malaysia has a humid climate, prolonged exposure to air conditioning and frequent lip irritation may still worsen symptoms. 5. Underlying Atopic Eczema People with eczema affecting the face, hands or other parts of the body may also develop lip eczema. However, lip eczema can sometimes occur without obvious eczema elsewhere. Is Atopic Cheilitis the Same as Lip Allergy? Not necessarily. There are several causes of eczematous inflammation affecting the lips. Condition Main Cause Atopic cheilitis Eczema-prone skin barrier and inflammation Irritant contact cheilitis Repeated irritation from saliva, products or environmental factors Allergic contact cheilitis Allergy to ingredients in products touching the lips Angular cheilitis Inflammation mainly at the mouth corners, sometimes associated with Candida or bacterial infection These conditions may look similar and can occasionally coexist. For example, someone with underlying atopic cheilitis may also develop an allergic reaction to a lip balm. Therefore, identifying the correct cause is important, especially when symptoms keep recurring. How Is Atopic Cheilitis Treated? Treatment aims to reduce inflammation, repair the lip barrier and prevent repeated flare-ups. 1. Use a Simple, Fragrance-Free Lip Moisturiser Regular moisturising is one of the most important steps. Plain petroleum jelly is often a suitable choice because it contains very few ingredients and helps reduce moisture loss. Apply it several times daily, particularly: After washing your face After eating Before bedtime Whenever the lips feel dry Avoid frequently changing between multiple lip products. A simple formulation is often better tolerated than heavily flavoured or fragranced products. 2. Avoid Lip Licking and Picking Try to avoid licking, biting, rubbing or peeling the lips. These habits can prolong inflammation and delay healing. For children, parents can gently encourage regular moisturising rather than repeated lip licking. 3. Short-Course Anti-Inflammatory Treatment When the lips are significantly inflamed, moisturiser alone may not be sufficient. A dermatologist may prescribe a short course of a suitable low-potency topical corticosteroid to control the inflammation. Because the lips have delicate skin, stronger steroid preparations or prolonged unsupervised use should be avoided. 4. Steroid-Sparing Treatments For patients with recurrent or persistent lip eczema, topical calcineurin inhibitors such as tacrolimus or pimecrolimus may sometimes be prescribed. These medications help reduce inflammation without the skin-thinning effects associated with prolonged topical corticosteroid use. Temporary stinging or burning may occur when treatment is first started. The choice of treatment depends on the patient's age, severity, diagnosis and clinical assessment. 5. Identify and Avoid Triggers If the lips repeatedly become inflamed after using certain products, it may be necessary to stop them temporarily and review their ingredients. Common products worth reviewing include: Lip balm Lipstick Lip gloss Toothpaste Mouthwash Facial skincare products Avoiding the relevant trigger is essential for long-term improvement. When Is Patch Testing Necessary? Patch testing may be recommended when: Lip eczema keeps recurring Symptoms do not improve despite appropriate treatment A contact allergy is suspected Symptoms worsen after applying certain lip products There is persistent inflammation without a clear cause Patch testing helps identify delayed allergic reactions to substances such as fragrances, preservatives, flavourings and cosmetic ingredients. It is different from a skin-prick test used to investigate certain immediate allergic reactions. Not everyone with atopic cheilitis requires patch testing, but it can be particularly useful in persistent or treatment-resistant cases. Why Does Lip Eczema Keep Coming Back? Lip eczema may recur because the skin barrier remains sensitive even after the visible inflammation has improved. Common reasons include: Continued lip licking or biting Repeated exposure to irritating products An unidentified contact allergy Stopping moisturising too early Incomplete control of inflammation Underlying eczema-prone skin Repeated flare-ups of lip eczema do not necessarily mean that previous treatment has failed. A weakened skin barrier, ongoing irritation and inconsistent moisturising may all contribute to recurrence. To understand why eczema tends to return and how to achieve better long-term control, you can read my related article: Why Does Eczema Keep Coming Back? Understanding Flare-Ups and How to Manage Them. How Long Does It Take to Recover? Mild cases may start improving within several days after appropriate treatment and avoidance of triggers. More persistent cases may take a few weeks, especially when inflammation has been present for a long time. The recovery period varies depending on the severity and underlying cause. Even after the lips have improved, regular moisturising and trigger avoidance may be necessary to prevent recurrence. Can Atopic Cheilitis Cause Dark Lips? Yes. Repeated inflammation may sometimes lead to post-inflammatory hyperpigmentation, particularly in individuals with darker skin tones. The lips may appear brownish or darker after the redness and dryness have subsided. This pigmentation often improves gradually once the inflammation is controlled, although recovery can take time. It is important to avoid harsh scrubs, exfoliating acids or unprescribed lightening products on inflamed lips, as these may worsen irritation. When Should You See a Dermatologist? Consider consulting a dermatologist if: Your lips remain dry or cracked despite regular moisturising You experience repeated episodes of lip eczema The lips become painful, swollen or severely inflamed There is persistent pigmentation or an unusual change in appearance You suspect an allergy to toothpaste, cosmetics or lip products Treatment from the pharmacy has not helped A persistent, localised, thickened, bleeding or non-healing lip lesion should also be examined to exclude other conditions, including sun-related lip damage. A dermatologist can assess whether the problem is due to atopic eczema, contact irritation, allergy, infection or another lip disorder. Frequently Asked Questions 1. Is atopic cheilitis contagious? No. Atopic cheilitis is an inflammatory skin condition and cannot spread from one person to another. 2. Can children develop lip eczema? Yes. Children with eczema-prone skin may develop dry, itchy or cracked lips. Frequent lip licking can also contribute to irritation. 3. Can I use Vaseline for lip eczema? Plain petroleum jelly is often helpful for protecting the lip barrier and reducing dryness. However, inflamed lips may also require prescription treatment. 4. Is lip eczema caused by a vitamin deficiency? Atopic cheilitis itself is not usually caused by vitamin deficiency. However, certain nutritional deficiencies, particularly iron or some B vitamins, can contribute to other forms of cheilitis. 5. Can lip eczema be cured permanently? Atopic cheilitis can often be controlled effectively, but recurrence is possible because of the underlying eczema tendency or repeated exposure to triggers. Identifying the cause and maintaining good lip care can significantly reduce flare-ups. Final Thoughts Persistent dry and cracked lips are not always simply due to a lack of moisture. In some patients, the underlying problem is eczema-related inflammation, contact irritation or an allergic reaction to products used every day. The key to managing atopic cheilitis is not just applying more lip balm, but identifying the cause, controlling inflammation and protecting the lip barrier. With appropriate treatment and a consistent lip-care routine, most patients can achieve significant improvement and better long-term control. 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 eczema, contact dermatitis, skin allergies and other inflammatory skin conditions. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation. Diagnosis, treatment suitability and recovery may vary depending on each patient's condition. If you experience persistent or worsening lip symptoms, please consult a qualified healthcare professional for proper assessment and treatment.

By Dr Lim Tzyy Huei Consultant Dermatologist | Pantai Hospital Batu Pahat, Johor, Malaysia Have you noticed a rough, hard skin growth on the sole of your foot or around your toes? Does it sometimes cause pain when walking, standing or wearing shoes? This could be a viral wart, a common skin infection caused by the human papillomavirus (HPV). Warts that develop on the soles of the feet are called plantar warts. They may also appear on the tips or sides of the toes, between the toes or around the toenails. Although viral warts are usually benign, they can cause discomfort, gradually enlarge, spread to surrounding skin or persist for months or even years. Several treatments are available, but some patients require multiple sessions before the warts can be successfully cleared. Understanding the treatment options, recovery process and risk of recurrence can help patients develop realistic expectations. 1. What Are Viral Warts on the Feet and Toes? Viral warts develop when certain types of HPV infect the outer layer of the skin. The virus can enter through tiny cuts or cracks, causing skin cells to multiply and form rough, thickened growths. Common locations include: Heels and balls of the feet. Tips and undersides of the toes. Sides of the toes and spaces between them. Skin surrounding the toenails. Because the soles of the feet bear body weight, pressure may push plantar warts inward, making them painful when walking. Some patients develop clusters of small warts that merge together, forming what is known as a mosaic wart. 2. How Can You Tell a Viral Wart from a Corn? Plantar warts are frequently mistaken for corns or calluses. Common features of viral warts include: Rough, thickened skin. Tiny black or red dots within the lesion, representing small blood vessels. Interruption of normal skin lines. Pain when walking, standing or squeezing the lesion from the sides. A single wart or multiple nearby lesions. Corns and calluses, on the other hand, usually develop from repeated pressure or friction rather than a viral infection. Because these conditions can sometimes look very similar, a dermatologist may use clinical examination and dermoscopy to help distinguish them. If a growth has an unusual appearance, repeatedly bleeds, changes over time or fails to improve with treatment, a skin biopsy may occasionally be necessary to exclude other conditions. 3. Why Do Some People Develop Plantar Warts More Easily? Not everyone exposed to HPV will develop viral warts. Certain factors may increase the likelihood of infection or spread. 1. Walking barefoot in damp public areas Examples include public bathrooms, swimming pool changing rooms and shared showers. 2. Excessive foot sweating or prolonged moisture Moist skin may become more vulnerable to friction and minor damage, allowing the virus to enter. 3. Small cuts or cracks in the skin Skin fissures, abrasions and scratching may provide entry points for HPV. 4. Weakened immune system Patients with reduced immune function or those taking immunosuppressive medications may develop more numerous, persistent or difficult-to-treat warts. 5. Picking, cutting or scratching existing warts This can damage surrounding skin and spread the virus to nearby areas. 6. Sharing personal items Items such as towels, socks, shoes, nail clippers and foot files may contribute to transmission. Tight footwear does not directly cause viral warts, but repeated friction and pressure can make existing plantar warts more painful. 4. Do Plantar Warts Always Need Treatment? Not every viral wart requires immediate treatment. Some warts may disappear naturally as the immune system gradually clears the infection. However, this process can take several months or even years. Treatment is generally considered when: Walking, standing or wearing shoes becomes painful. The wart gradually increases in size. The infection spreads to nearby skin or other toes. Multiple warts develop. Home treatment does not provide sufficient improvement. The lesion interferes with sports or daily activities. The most appropriate treatment depends on the wart's size, number, location, thickness and the patient's overall health. 5. What Are the Treatment Options for Warts on the Feet and Toes? 1. Salicylic Acid Treatment Salicylic acid is one of the commonly used first-line treatments for viral warts. It works by gradually softening and removing the thickened outer skin, helping reduce the wart tissue. Treatment usually requires regular home application for approximately 6–12 weeks or longer. During treatment, the skin may become white, softened, flaky or mildly irritated. For thicker warts, gentle removal of softened dead skin may sometimes be recommended. However, patients should avoid cutting or digging into the wart with blades or scissors. Salicylic acid should be applied carefully to avoid irritating the surrounding healthy skin. Patients with diabetes, poor circulation or reduced sensation in their feet should not use strong wart-removing preparations without medical advice. 2. Liquid Nitrogen Cryotherapy Cryotherapy is a commonly performed dermatological procedure for treating viral warts. It uses extremely cold liquid nitrogen to freeze and destroy affected skin tissue. For thick plantar warts, the dermatologist may first gently pare down the thickened dead skin before applying liquid nitrogen. Following treatment, patients may experience: Temporary stinging or burning. Local redness and swelling. Clear blisters or blood blisters. Crusting and peeling. Gradual skin healing. The treated skin generally heals within 1–2 weeks, although deeper freezing may require longer recovery. Blister formation is a recognised response after cryotherapy and does not necessarily indicate infection. Most plantar warts require repeated treatment sessions, commonly spaced approximately 2–4 weeks apart, depending on healing and clinical response. Larger, thicker or longstanding warts may require a longer treatment course. 3. Electrosurgery and Curettage Electrosurgery uses electrical energy to destroy wart tissue, while curettage involves removing the lesion with a specialised instrument. These procedures are usually performed under local anaesthesia and may be considered for selected stubborn warts. Although the visible wart may be removed during one procedure, the treatment creates a wound and carries risks of pain, bleeding, infection and scarring. Because the soles of the feet are weight-bearing areas, scarring may sometimes cause prolonged discomfort when walking. Therefore, these procedures are not suitable for every patient. 4. Surgical Excision Surgical removal may occasionally be considered for selected persistent warts or skin growths where the diagnosis remains uncertain. However, surgery is generally not a first-line treatment for plantar warts. The soles and toes are frequently exposed to pressure, and surgical wounds may interfere with walking and require several weeks to heal. Potential risks include bleeding, infection, scarring and recurrence. 5. Other Treatments for Stubborn Warts For viral warts that remain persistent despite repeated treatment, a dermatologist may consider additional options, including: Laser treatment. Intralesional immunotherapy. Intralesional bleomycin injections. Selected topical medications, such as 5-fluorouracil. Other specialist treatments for resistant warts. Each treatment has different indications, expected benefits and potential side effects. The most suitable option depends on the individual patient. 6. How Long Does Wart Treatment Take? Viral wart treatment is often a gradual process. Complete clearance cannot always be achieved in a single session. Treatment Expected treatment or recovery time Salicylic acid Daily application for approximately 6–12 weeks or longer Liquid nitrogen cryotherapy Usually repeated every 2–4 weeks; several sessions may be required Electrosurgery or curettage Visible wart may be removed in one session; wound healing usually takes several weeks Surgical excision Recovery generally takes several weeks Other treatments for stubborn warts Varies according to the treatment and severity Smaller, recently developed warts may respond more easily than large lesions that have been present for years. Plantar warts located on weight-bearing areas can also be more difficult to treat because of thickened skin, pressure and friction. Even when the skin surface appears healed, follow-up may be necessary to check for any remaining wart tissue. 7. Why Do Viral Warts Come Back After Treatment? Recurrence is a common concern among patients undergoing wart treatment. Even when a wart appears to have disappeared, it may return. Possible reasons include: 1. Remaining HPV-infected skin cells Treatment may remove the visible wart while a small number of infected cells remain. 2. Incomplete clearance Larger, thicker or longstanding warts may require repeated treatment before they are fully cleared. 3. Nearby infection that was not initially visible Small infected areas may not be noticeable during the first treatment but become apparent later. 4. New exposure to HPV Contact with infected skin, contaminated objects or surfaces may result in another infection. 5. Reduced immune response Some patients have difficulty clearing HPV effectively, making their warts more persistent or prone to recurrence. Importantly, recurrence does not necessarily mean that the previous treatment was unsuccessful or performed incorrectly. The likelihood of recurrence varies with the characteristics of the wart, immune status, treatment method and other individual factors. There is no single recurrence percentage that applies to every patient. 8. How Can You Reduce the Risk of Wart Recurrence? Although recurrence cannot always be prevented, proper foot care can help reduce transmission and reinfection. 1. Keep your feet clean and dry Dry carefully between the toes after washing, change socks regularly and choose breathable footwear. 2. Avoid walking barefoot in damp public places Wear slippers in public bathrooms, swimming pool changing rooms and shared showers. 3. Avoid picking, cutting or digging into warts Do not attempt to remove warts using blades or scissors, as this may injure the skin and spread the virus. 4. Do not share personal items Avoid sharing towels, socks, shoes, nail clippers and foot files. 5. Reduce footwear friction and pressure Choose properly fitting shoes with sufficient space for the toes. Pressure-relieving pads may help reduce discomfort when walking, although they do not eliminate the viral infection. 6. Complete the recommended treatment course Do not assume a wart has completely cleared simply because its surface has become flatter or smaller. 9. How Should You Care for Your Skin After Cryotherapy? Proper aftercare supports healing and helps reduce the risk of infection and other complications. During the First 1–2 Days The treated area may feel sore, red, swollen or mildly burning. Some patients develop a blister within 24–48 hours. This is generally a recognised response to cryotherapy. Keep the area clean and minimise unnecessary friction or pressure. What If a Blister Develops? Cryotherapy blisters may contain clear fluid or blood. If the blister is small and only mildly uncomfortable, it is usually best to leave it intact rather than puncturing it yourself. If the blister becomes large, significantly painful or interferes with walking, contact your treating doctor for assessment. What If the Blister Bursts? Gently clean the area with water and mild soap. Do not forcibly remove the overlying blister skin. Cover the wound with a non-adherent dressing. Replace the dressing whenever it becomes wet or dirty. Avoid applying salicylic acid or other irritating wart treatments directly onto the open wound until it has healed. Can You Walk After Cryotherapy? Most patients can continue light daily activities according to their level of discomfort. However, treatment over the heel, ball of the foot or weight-bearing parts of the toes may make walking painful. Temporarily reduce prolonged walking, running and high-impact activities, and wear comfortable shoes. When Should You Seek Medical Attention? Contact your doctor if you experience: Increasing or severe pain. Spreading redness or swelling. Pus or an unpleasant smell from the wound. Fever. Persistent bleeding. A wound that does not heal as expected. These symptoms may indicate infection or another complication requiring assessment. 10. Can Viral Warts Spread to Family Members or Other Toes? Yes. HPV can spread through direct skin contact or contact with contaminated objects and surfaces. Repeated scratching, cutting or picking at warts may also spread the virus to other areas of your own feet. To reduce transmission: Avoid sharing towels, socks, shoes and foot-care tools. Wear slippers in communal wet areas. Wash your hands after touching or treating a wart. Avoid unnecessary picking or scratching. However, not everyone living with someone who has viral warts will become infected. Individual immune responses and skin condition also influence the risk. 11. When Should You See a Dermatologist? Consider consulting a dermatologist if: A wart causes pain when walking or wearing shoes. The lesion continues to enlarge or spread. Multiple warts develop. Home treatment does not help. Warts repeatedly return despite treatment. You are unsure whether the growth is a wart, corn or another skin condition. The lesion repeatedly bleeds, changes colour or has an unusual appearance. Patients with diabetes, poor circulation, reduced foot sensation or weakened immune function should be particularly cautious about using strong over-the-counter wart-removing products or attempting self-removal. Not every thickened growth on the sole is a viral wart. An accurate diagnosis is the first step towards choosing appropriate treatment. Conclusion: Treating Plantar Warts Requires Patience Viral warts on the soles and toes are common skin infections caused by HPV. Although some may disappear naturally, others can persist, gradually enlarge, interfere with walking or spread to nearby skin. Available treatments include salicylic acid, liquid nitrogen cryotherapy, electrosurgery, curettage and other specialist options for stubborn warts. However, treatment often takes several weeks to months, and complete clearance cannot be guaranteed after a single session. Early diagnosis, appropriate treatment, completing the recommended treatment course and practising good foot hygiene are important parts of managing viral warts. Plantar Wart and Toe Wart Assessment in Batu Pahat If you have a persistent thickened skin growth on your sole or toes, experience pain when walking, or notice that warts keep returning despite treatment, a dermatology consultation may help identify the cause and appropriate treatment. Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia, provides assessment and treatment for viral warts, plantar warts, toe warts and other skin growths. Treatment is individualised according to the location, size, symptoms and medical history of each patient. Disclaimer: This article is intended for general medical education and does not replace individual medical diagnosis, treatment or wound-care advice.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Do you have recurring red, thick, scaly patches on your skin that never seem to disappear completely? Does your scalp keep flaking despite using anti-dandruff shampoo? These could be signs of psoriasis, a chronic inflammatory skin condition that can affect the scalp, elbows, knees, body, nails and sometimes the joints. Psoriasis is sometimes described as penyakit kulit bersisik in Malay or 银屑病 (牛皮癣) in Chinese. Although psoriasis can be persistent and frustrating, it is important to understand that psoriasis is not contagious, is not caused by poor hygiene, and can often be controlled effectively with appropriate treatment. What Is Psoriasis? Psoriasis is a long-term inflammatory condition in which the immune system becomes overactive, causing skin cells to multiply more rapidly than normal. As a result, skin cells accumulate on the surface, forming thickened, inflamed and scaly patches. Common symptoms include: Red, pink, brown or darker patches of thickened skin, often covered with silvery-white scales Persistent flaking or scaling of the scalp Itching, irritation or a burning sensation Dry, cracked skin that may occasionally bleed Nail changes such as small pits, thickening or separation from the nail bed Psoriasis can develop at any age, and its severity varies considerably between individuals. Some people have only a few small patches, while others experience widespread skin involvement. Which Areas Can Psoriasis Affect? Psoriasis can appear on different parts of the body. Type of psoriasis Common features Plaque psoriasis Thick, well-defined scaly patches, commonly on the elbows, knees and body Scalp psoriasis Persistent scalp flaking, thick scales and itching Inverse psoriasis Smooth, inflamed patches in skin folds such as the groin, armpits or beneath the breasts Guttate psoriasis Multiple small, drop-like scaly spots, sometimes following a throat infection Nail psoriasis Nail pitting, thickening, discoloration or separation Pustular psoriasis Pus-filled bumps caused by inflammation rather than ordinary bacterial infection Some severe forms, including widespread pustular psoriasis and erythrodermic psoriasis, require urgent medical assessment. What Causes Psoriasis? Psoriasis develops through a combination of genetic predisposition and immune system dysregulation. It is not caused by a fungal infection or poor personal hygiene. Although psoriasis can run in families, many patients have no known family history. Certain factors may trigger psoriasis or worsen existing symptoms. Common psoriasis triggers 1. Emotional stress Stress may contribute to flare-ups and sometimes makes existing psoriasis more difficult to control. 2. Skin injury or irritation Scratching, cuts, friction, sunburn or repeated trauma may cause new psoriasis patches to appear. This is known as the Koebner phenomenon. 3. Infections Some infections, particularly streptococcal throat infections, can trigger certain types of psoriasis. 4. Smoking and excessive alcohol consumption These may worsen psoriasis and affect overall health. 5. Certain medications Some medicines, including lithium and selected beta-blockers, may aggravate psoriasis in susceptible individuals. Changes to prescribed medications should always be discussed with a doctor. 6. Obesity and metabolic health Excess body weight is associated with more severe psoriasis in some patients and may reduce treatment response. However, triggers vary between individuals, and not every flare-up has an identifiable cause. What Are the Treatment Options for Psoriasis? Treatment depends on the severity of psoriasis, the affected body areas, its impact on daily activities and whether joint involvement is present. The aim is to reduce inflammation, clear or improve skin lesions, relieve itching and maintain good long-term disease control. 1. Topical Treatments (Creams and Ointments) For mild or localised psoriasis, topical treatment is often sufficient. Topical corticosteroids Steroid creams or lotions help reduce inflammation, redness, thickening and itching. Different strengths may be prescribed depending on the affected area. Stronger preparations may be required for thick plaques on the elbows or knees, while delicate areas such as the face and skin folds require more cautious treatment. Vitamin D analogues Medications such as calcipotriol help regulate excessive skin cell production. They may be used alone or combined with topical corticosteroids. Other topical treatments Selected patients may benefit from salicylic acid, coal tar preparations or non-steroidal anti-inflammatory creams. Moisturisers are also important for reducing dryness and scaling. Important: Psoriasis treatment should not be stopped or changed abruptly without understanding the maintenance plan. Some patients benefit from intermittent treatment to previously affected areas after improvement. 2. Phototherapy (Medical Light Treatment) Narrowband ultraviolet B (NB-UVB) phototherapy may be considered for patients with more widespread psoriasis or those who do not respond adequately to topical treatment. It uses controlled ultraviolet light to reduce skin inflammation. Treatment usually requires repeated sessions over several weeks. Phototherapy should be performed under appropriate medical supervision. It is different from using tanning beds or attempting to treat psoriasis through excessive sun exposure. 3. Oral Medications Patients with moderate to severe psoriasis, extensive lesions or significant impairment of daily activities may require systemic medication. Common options include: Methotrexate Methotrexate helps suppress excessive immune activity and is commonly used for moderate to severe psoriasis. It is generally taken once weekly and requires regular blood monitoring, particularly for liver function and blood cell counts. Cyclosporine Cyclosporine is a relatively fast-acting medication that may be useful when rapid control is required. It requires monitoring of blood pressure and kidney function and is generally used for a limited period. Acitretin Acitretin is an oral retinoid that can be useful for selected types of psoriasis, including thick or pustular disease. It requires monitoring and has important pregnancy-related restrictions. Other oral targeted treatments, such as apremilast or deucravacitinib, may be considered depending on the patient’s suitability, clinical circumstances and local availability. 4. Biologic Injections Biologic therapies have significantly improved the treatment of moderate to severe psoriasis. These medications target specific inflammatory pathways involved in psoriasis, allowing more selective control of the disease. Examples include: Biologic group Examples TNF-alpha inhibitors Adalimumab, infliximab IL-12/23 inhibitor Ustekinumab IL-17 inhibitors Secukinumab, ixekizumab IL-23 inhibitors Guselkumab, risankizumab Biologic injections can achieve substantial skin clearance in many patients, including those with psoriasis that has not responded adequately to conventional treatment. Some patients achieve almost completely clear skin. However, not every treatment works equally well for everyone. Before starting biologic therapy, patients generally require assessment for infections such as tuberculosis and hepatitis, along with other relevant medical conditions. The selection of treatment depends on several factors, including psoriasis severity, joint symptoms, other medical conditions, medication safety, patient preference and affordability. How Long Does Psoriasis Treatment Take to Work? Improvement is usually gradual, although the response varies depending on the treatment used. Treatment General expectation Topical treatment Early improvement often within 2–4 weeks Phototherapy Gradual improvement over several weeks Methotrexate Improvement may become noticeable after 4–8 weeks Cyclosporine Often improves within a few weeks Biologic injections Some improve within the first few weeks, with fuller responses often assessed after 3–4 months These are general estimates rather than guaranteed timelines. Some patients may need longer treatment or adjustments before satisfactory control is achieved. Can Psoriasis Be Cured Permanently? Currently, there is no permanent cure for psoriasis. However, many patients can achieve excellent long-term control, and some can remain almost completely free of visible skin lesions with appropriate treatment. Psoriasis tends to follow a relapsing and remitting course. This means symptoms may improve or disappear for a period of time before returning. Recurrence does not necessarily mean treatment has failed. The frequency and severity of flare-ups vary between patients. Some require only intermittent topical treatment, while others benefit from ongoing systemic or biologic treatment. How Can I Reduce Psoriasis Flare-Ups? Although not every flare-up can be prevented, several measures may help maintain healthier skin and improve long-term disease control. 1. Moisturise regularly Apply a fragrance-free moisturiser at least once or twice daily, especially after bathing. 2. Avoid scratching or picking scales Repeated injury can worsen inflammation and sometimes trigger new lesions. 3. Use gentle skin care products Avoid harsh soaps, aggressive scrubbing and unnecessary irritating products. 4. Manage stress and maintain adequate sleep Stress management may help some patients reduce flare-ups and improve their quality of life. 5. Maintain a healthy body weight Weight management, regular physical activity and a balanced diet are beneficial for overall health and may improve psoriasis outcomes. 6. Avoid smoking and limit alcohol intake These are particularly important because psoriasis is associated with other long-term health conditions. 7. Follow the prescribed treatment and maintenance plan Continuing appropriate treatment and attending scheduled reviews may help maintain disease control. There is no single diet proven to cure psoriasis. Patients generally do not need to avoid entire food groups unless there is a separate medical reason. Can Psoriasis Affect the Joints? Yes. Some people with psoriasis develop psoriatic arthritis, an inflammatory condition affecting the joints, tendons or spine. Warning signs include: Persistent joint pain or swelling Morning joint stiffness Swollen fingers or toes Heel pain Persistent inflammatory back pain Early recognition and treatment are important because untreated psoriatic arthritis may lead to permanent joint damage. Patients with psoriasis should inform their doctor if these symptoms develop, even if their skin condition is relatively mild. Is Psoriasis Associated With Other Health Conditions? Psoriasis is more than a skin condition. People with psoriasis, particularly those with more severe disease, may have an increased risk of certain associated conditions, including: Obesity and metabolic syndrome Diabetes High blood pressure and cardiovascular disease Fatty liver disease Anxiety and depression Psoriatic arthritis This does not mean every patient will develop these conditions. However, appropriate health screening and management of cardiovascular risk factors are important parts of long-term care. When Should You See a Dermatologist? Consider seeking dermatological assessment if: Your scaly skin patches persist or keep recurring. Your scalp does not improve with ordinary anti-dandruff treatment. Your psoriasis affects the face, hands, feet, nails or genital area. Your skin condition interferes with sleep, work or daily activities. You develop joint pain, stiffness or swelling. Your psoriasis remains poorly controlled despite treatment. Sudden widespread skin redness, extensive pustules, fever or feeling very unwell requires urgent medical assessment. Living With Psoriasis Living with psoriasis can sometimes be physically uncomfortable and emotionally exhausting. Visible patches, persistent scaling and repeated flare-ups may affect confidence, social activities, sleep and quality of life. It is important to remember that psoriasis is not caused by being unclean, and it cannot be passed to others through touching, sharing meals or ordinary daily contact. With an accurate diagnosis, suitable treatment and consistent long-term care, many people with psoriasis can maintain good skin control and continue their usual activities comfortably. Final Thoughts Psoriasis is a chronic inflammatory condition, but it does not have to remain uncontrolled. Modern treatment options range from medicated creams and phototherapy to oral medications and targeted biologic injections. The most suitable approach depends not only on the amount of skin involved, but also on the affected areas, associated symptoms and how much psoriasis affects your daily life. Early assessment and an individualised treatment plan can help improve symptoms, reduce flare-ups and maintain better long-term control. Dermatology Consultation in Batu Pahat If you are experiencing persistent scaly patches, recurrent scalp psoriasis, nail changes or psoriasis that is difficult to control, a dermatological assessment can help confirm the diagnosis and guide appropriate treatment. Dr Lim Tzyy Huei Consultant Dermatologist Pantai Hospital Batu Pahat, Johor, Malaysia This article is intended for general patient education and does not replace an individual medical consultation.

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia Do you experience intense itching, especially at night? Have you noticed small itchy bumps on your fingers, wrists, waist or other parts of your body? Perhaps other family members have also started scratching. These could be signs of scabies, a contagious skin condition commonly known as kudis buta in Malay and 疥疮 in Chinese. Scabies can cause persistent itching, disturbed sleep and considerable discomfort. It is sometimes mistaken for eczema, an allergic reaction or insect bites. Although scabies is treatable, successful management involves more than applying an anti-itch cream. Correct medication application, treating close contacts at the same time and following simple household precautions are important to prevent the infestation from spreading or returning. What Is Scabies? Scabies is a skin infestation caused by a microscopic mite called Sarcoptes scabiei var. hominis. These tiny mites burrow into the outer layer of the skin, where they live and lay eggs. The body's immune reaction to the mites and their waste products causes an itchy, inflammatory skin rash. Scabies is not caused by poor hygiene. Anyone can develop scabies, regardless of age, cleanliness or living conditions. What Are the Common Symptoms of Scabies? The most characteristic symptom is intense itching that becomes worse at night. Other common features include: Small red or skin-coloured itchy bumps Persistent scratching and disturbed sleep Tiny, curved or wavy lines on the skin, known as burrows Scratch marks, crusting or small wounds Eczema-like patches caused by repeated scratching Which Parts of the Body Are Commonly Affected? Scabies frequently affects: Between the fingers Wrists and hands Armpits Waist and abdomen Buttocks and groin Genital area Skin around the nipples In babies and young children, scabies may also affect the scalp, face, palms and soles. Not everyone develops visible burrows. Some patients only have scattered itchy bumps or eczema-like patches, making the condition more difficult to recognise. How Does Scabies Spread ? Scabies spreads mainly through prolonged, direct skin-to-skin contact with someone who has the infestation. Common situations include: Living in the same household Sharing a bed Close physical or intimate contact Providing personal care to an affected person Living in crowded environments, such as dormitories or care facilities Transmission through shared clothing, towels or bedding is less common in ordinary scabies, but it can occur. Scabies does not usually spread through brief contact, such as a quick handshake. Can Someone Spread Scabies Without Having Symptoms? Yes. When someone develops scabies for the first time, itching may take approximately 4–8 weeks to appear. During this period, the person may already be able to transmit the mites to others. For someone who has previously had scabies, symptoms may develop much faster following reinfestation. This is one reason why treating only the family member who is currently itchy may not be enough. How Is Scabies Diagnosed ? A dermatologist can often diagnose scabies by assessing : The pattern and severity of itching The distribution of the rash The presence of characteristic burrows or skin changes Whether other household members or close contacts have similar symptoms In selected cases, dermoscopy or skin scraping may help identify mites, eggs or mite waste products. However, a negative skin scraping does not completely rule out scabies. Because scabies can resemble eczema, insect bites and other itchy skin conditions, an accurate diagnosis is important, particularly when symptoms persist despite treatment. What Are the Treatment Options for Scabies? The main goals of treatment are to eliminate the mites, relieve symptoms and prevent transmission or reinfestation. 1. Permethrin 5% Cream Permethrin 5% cream is commonly recommended as a first-line treatment for ordinary scabies. It works by killing the scabies mites. Correct application is essential because applying the cream only to visible rashes may leave mites in other areas of the skin. How to Apply Permethrin Correctly Apply the cream to clean, dry and cool skin, usually at night. For most adults, apply it thoroughly over the entire body from the neck down, including areas without visible rashes. Pay particular attention to the spaces between fingers and toes, under the fingernails, wrists, genital area, buttocks and soles. Leave the cream on for approximately 8–12 hours, or according to your doctor's instructions, before washing it off. If you wash your hands during the treatment period, reapply the cream to your hands. Repeat the application approximately 7 days later, as instructed. For infants, young children and certain older or immunocompromised patients, treatment may also need to include the scalp, neck and face, while avoiding the eyes and mouth. The exact treatment area and application instructions should follow medical advice. Important: Do not apply permethrin only to the itchy areas. Mites may be present even where the skin looks normal. 2. Oral Ivermectin Oral ivermectin is another treatment option that may be considered in selected patients, particularly when topical treatment is difficult, impractical or has not been successful. It may also form part of the treatment for more severe forms of scabies. For ordinary scabies, treatment generally involves two weight-based doses, approximately 7–14 days apart. Ivermectin is not suitable for everyone. Its use during pregnancy and in children weighing less than 15 kg requires particular caution because safety information is limited. The choice between topical and oral treatment should be based on the patient's age, weight, medical condition, treatment history and other relevant factors. 3. Treatment for Persistent Itching Even after the mites have been eliminated, the skin may remain itchy because the immune system continues reacting to the infestation. Depending on the skin condition, your dermatologist may recommend: Moisturisers to reduce dryness and improve skin comfort Topical corticosteroids to relieve residual inflammation or eczema Antihistamines for symptomatic relief in selected patients Additional treatment if a secondary bacterial infection develops These treatments help relieve itching and inflammation, but they do not replace medication that kills the scabies mites. Why Must Family Members and Close Contacts Be Treated Together? This is one of the most important steps in preventing scabies from returning. Household members, sexual partners and other close contacts generally need treatment at the same time, even if they have no itching or visible rash. For example, one family member may complete treatment successfully but become reinfested through contact with another family member who was not treated. Because symptoms can take several weeks to appear, waiting until everyone starts itching may allow the infestation to continue spreading. Simultaneous treatment helps break this cycle. How Should You Clean Your Home During Scabies Treatment? Scabies mites generally survive for only about 2–3 days away from human skin. For ordinary scabies, extensive household disinfection is usually unnecessary. However, several practical precautions can help prevent reinfestation. What Should You Do on Treatment Day? Wash recently used bedsheets, pillowcases, towels and clothing, particularly items used during the previous three days. Use hot water and a hot dryer when the fabric allows. Place items that cannot be washed into a sealed plastic bag for several days to one week. Change into clean clothing and use clean bedding after treatment. Avoid sharing towels, clothing and bedding during the treatment period. Avoid close skin-to-skin contact until the initial treatment has been completed, and follow any additional advice about resuming close contact. There is usually no need to spray insecticides throughout the house, discard mattresses or throw away furniture. For crusted scabies, which is a more contagious form of the condition, more intensive household and infection-control measures may be required. Why Am I Still Itchy After Scabies Treatment? One of the most common questions patients ask is: “Doctor, I have already applied the scabies cream. Why am I still itching?” Persistent itching does not always mean that scabies treatment has failed. After the mites are killed, the immune system may continue reacting to mite remnants and their waste products. This is known as post-scabetic itch. Itching may continue for several weeks, even after successful treatment. Some patients also develop post-scabetic eczema or persistent itchy nodules, which may require additional anti-inflammatory treatment. How Can You Tell Whether Scabies Is Improving? Signs suggesting recovery Signs that may require reassessment Itching gradually becomes less intense Itching continues to worsen No new burrows appear New burrows or characteristic bumps appear Existing rashes slowly improve New rashes develop in typical scabies locations Household members are improving Other close contacts continue developing symptoms These signs are helpful but are not always definitive. If itching persists beyond 2–4 weeks, becomes worse or is accompanied by new characteristic lesions, reassessment may be necessary. Avoid repeatedly applying scabies medication without medical advice, as excessive treatment can irritate the skin and worsen itching. Why Does Scabies Keep Coming Back? Repeated episodes of scabies can be frustrating, especially when several household members are affected. However, recurrence is often caused by reinfestation or incomplete treatment, rather than the medication no longer working. Common reasons include: 1. Family Members Were Not Treated Together An untreated family member or close contact may continue carrying mites and transmit them back to someone who has completed treatment. 2. The Cream Was Not Applied Properly Applying permethrin only to itchy areas or missing places such as finger spaces, under the nails, genital area or soles may allow mites to survive. 3. The Second Treatment Was Missed A repeat application is commonly recommended to improve the likelihood of successful treatment. Skipping the scheduled second treatment may reduce treatment effectiveness. 4. Re-exposure to Someone With Scabies Continued close contact with an untreated person can lead to reinfestation, even when the original treatment was performed correctly. 5. Post-Scabetic Itching Was Mistaken for Active Scabies Itching may remain for several weeks after successful treatment. This does not necessarily mean that mites are still present. 6. The Original Diagnosis Was Incorrect Other skin conditions, including eczema, contact dermatitis and insect-bite reactions, can resemble scabies. If the rash persists despite correctly completed treatment, a dermatologist can reassess the diagnosis and decide whether further medication is necessary. Can Scabies Cause Complications? Repeated scratching can damage the skin barrier, creating small wounds and increasing the risk of secondary bacterial infection. Possible signs include: Increasing redness or swelling Painful or tender skin Pus formation Yellowish crusting A less common but more serious form, known as crusted scabies, may cause thick, crusted or scaly skin containing very large numbers of mites. Crusted scabies is highly contagious and requires prompt medical assessment, often with a combination of treatments. When Should You See a Dermatologist? A dermatological assessment may be helpful if: You experience persistent itching, particularly at night. Several family members develop similar itchy rashes. Symptoms do not improve after completing treatment. New itchy bumps or burrows continue appearing. You develop painful, crusted or infected skin. You are unsure whether the rash is scabies, eczema or another skin condition. Early diagnosis and appropriate treatment can help relieve symptoms, reduce unnecessary medication use and prevent transmission to others. Final Thoughts: Treating Scabies and Preventing Recurrence Scabies is a common and treatable skin condition, but the itching can be very uncomfortable, especially when it affects sleep or spreads among household members. Successful treatment involves more than treating the visible rash. Applying medication correctly, treating close contacts at the same time and following appropriate household precautions are essential to prevent reinfestation. It is also important to remember that itching may continue for several weeks after successful treatment. This does not automatically mean scabies is still active. With correct treatment and appropriate follow-up, most patients recover successfully. Dr Lim Tzyy Huei（林子辉医生） is a Consultant Dermatologist practising at Pantai Hospital Batu Pahat, Johor, Malaysia. Dermatology consultations are available for scabies, persistent itching, eczema, skin infections and other inflammatory skin conditions. Disclaimer: This article is intended for general patient education and does not replace individual medical consultation, diagnosis or treatment advice. Treatment suitability and application instructions may vary according to age, pregnancy status, medical conditions and clinical findings.

By Dr Lim Tzyy Huei, Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia I had the pleasure of speaking to fellow general practitioners at Fika Café, Batu Pahat, during an educational session sponsored by Hyphens Pharma. My talk, “Beyond the Surface: Balancing Sebum and Reinforcing the Skin Barrier,” explored how sebum production contributes to acne and why skin barrier care deserves attention throughout treatment. The discussion also covered Winlevi (clascoterone 1% cream) and its role as a topical anti-androgen treatment. Understanding Sebum’s Role in Acne Acne develops through several interacting processes, including excess sebum production, blocked follicles, Cutibacterium acnes and inflammation. Understanding these mechanisms helps guide treatment according to each patient’s presentation and needs. One focus of the session was the influence of androgens on sebaceous gland activity. This pathway provides the basis for topical anti-androgen treatment, adding another approach to the management of acne. For patients who would like to understand more about why acne develops, available treatments and expected improvement, I have discussed these topics in my related article: Acne (Pimples): Causes, Treatment Options, Why It Keeps Coming Back and What to Expect. Winlevi: A Different Approach to Topical Treatment Winlevi (clascoterone 1% cream) is a topical androgen receptor inhibitor used to treat acne vulgaris. It targets androgen receptors in the skin, offering a different mechanism of action from established treatments such as topical retinoids and benzoyl peroxide. During the session, we discussed where this option may fit within an individualised treatment plan, taking into account acne severity, skin tolerability and other treatments being used. Introducing a treatment also requires clear patient counselling. Explaining how to use the medication, setting realistic expectations and reviewing progress are essential parts of ongoing care. Supporting the Skin Barrier During Acne Treatment Treatment tolerability was another central theme. Dryness, redness, peeling and irritation can make it difficult for patients to follow an acne treatment regimen consistently. Gentle cleansing, suitable moisturisers and sun protection can help support the skin during treatment. These measures deserve a place in the treatment plan from the outset, with adjustments when irritation develops. In everyday practice, effective acne care involves both controlling the disease and helping patients maintain a routine they can follow comfortably over time. For further patient-friendly advice on managing skin sensitivity, irritation and appropriate skincare, read my related article: Sensitive Skin: Why Your Face Stings, Burns or Turns Red. Sharing Practical Insights with GP Colleagues Acne is frequently encountered in primary care, and this session offered an opportunity to discuss both evolving treatment options and familiar challenges in daily practice. The connection between sebum regulation, treatment tolerability and skin barrier care provided a useful focus for the discussion. My thanks to Hyphens Pharma for sponsoring the session and to the GP colleagues who joined us at Fika Café. I valued the opportunity to share dermatology insights with fellow doctors in Batu Pahat, particularly on how to make acne treatment effective and manageable for patients.