Things You Should Know About Whiteheads & Blackheads – Beneath the Skin With Dr Benji

 

FEATURED EXPERT
DR BENJI TEOH TZE YUEN
Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.
WHITEHEADS & BLACKHEADS

Acne is a common skin disease that affects about 85% of adolescents at some time of their lives. The most common type of acne is acne vulgaris, which makes up 99% of acne cases and affects about 95% of boys and 83% of girls by the time they are 16.1,2

Blackheads and whiteheads are common characteristics of acne vulgaris.1

They are the result of the pores or hair follicles of the skin being blocked by dead skin and sebum (the oil produced by the skin).1,2

The primary lesion of acne is called a comedo.3 The plural form of comedo is comedones.
Whiteheads form when the comedones are closed and follicles are completely blocked.

Blackheads form when the comedones are open and the surface is dark black in colour due to oxidation of the lipid and melanin contents of the comedones.2,3

Acne vulgaris on its own is not associated with any mortality, but it can cause scars to form.3 These scars can cause psychosocial challenges such as depression, anxiety, and more.3

Common causes of acne vulgaris. Click on the image for a larger, clearer version.

HOW IS ACNE VULGARIS TREATED?

Be wary of treatment or management given by non-medical doctors when it comes to treating acne—there is a risk that these procedures may worsen the acne or cause scarring. Always consult a general practitioner or dermatologist first, so that you will receive evidence-based treatments and advice in line with the Malaysian clinical practice guidelines.

The following are the recommended treatment options for acne
vulgaris.

First line treatment
The first line treatment is the first recommended treatment for a certain disease.

When it comes to acne vulgaris, the first line treatment is pharmacological treatment, usually in the form of topical creams, gels, lotions, solutions, and other forms that can be applied onto the affected area of the skin.4

Medical topical treatments. These contain active ingredients such as benzoyl peroxide, retinoids, antibiotics, and others.4 They may be used on their own or, for moderate cases, in combination with other creams.4

Systemic treatments
Medications such as oral antibiotics as well as combined oral contraceptives may be prescribed by the doctor depending on the severity of the acne and other factors.5

Supplementary treatments
Physical treatments. Corticosteroid injection into the affected area of the skin may be helpful, either to complement existing therapy or to improve the appearance of skin after treatment.6

Chemical peels—in particular salicylic acid and glycolic acid peels—may be beneficial. However, they need to be carried out with care under the supervision of an experienced dermatologist.6

Energy-based devices. Laser treatment on the affected skin area may be beneficial when applied alongside other treatments.6

RETINOIDS ARE USEFUL IN TREATING ACNE VULGARIS.

‘Retinoid’ is an umbrella term for a family of chemical compounds that share structural and functional similarities with vitamin A.

They normalize shedding of the skin (desquamation) by reducing the proliferation of a common type of skin cells called keratinocytes as well as promoting the differentiation of these cells.4,6

Topical retinoids also block several important inflammatory pathways that are activated in acne: toll-like receptor, leukocyte migration, and AP-1 pathways. Blocking these pathways can reduce the release of inflammatory cytokines and nitric oxide as well as inhibit cellular inflammation.7

ADAPALENE IS A RETINOID APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA) FOR USE IN TREATING MILD TO MODERATE ACNE.

Adapalene is a third-generation retinoid. Compared to earlier generation retinoids, it interacts with the retinoid receptors of the skin in a different manner, so it causes less irritation compared to earlier generation retinoids while remaining just as effective.8

How effective is adapalene?

A meta-analysis of 5 large studies with 900 patients for over 12 weeks demonstrated that gel containing 0.1% adapalene is as effective as gel containing 0.025% tretinoin, another retinoid commonly used to treat acne (Cunliffe et al, 1998). After 12 weeks, both agents were equally effective but adapalene had a faster onset of action and less irritation.8

Another study (Cunliffe et al, 1997) compared 0.1% adapalene and 0.025% tretinoin on 323 patients for 3 months. They found that adapalene caused more decrease in total and noninflammatory lesions than tretinoin. However, there was no significant difference in terms of inflammatory lesions.9

Also, there is a study (Korkut and Piskin, 2005) that demonstrated how adapalane is more effective in treating non-inflammatory lesions compared to inflammatory lesions. The use of adapalene gel may yield results in as early as two weeks, but overall, it will take some time to see significant results.10

General adverse reactions

These include dryness, redness, irritation, and burning or stinging. These symptoms usually peak at the 2nd- to 4th-week mark before subsiding.11

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Things You Should Know About Melasma – Beneath the Skin With Dr Benji

FEATURED EXPERT
DR BENJI TEOH TZE YUEN
Consultant Dermatologist
Central Dermatology Specialist Clinic

For most skin conditions, there is always a treatment. Hence, there is no need to suffer in silence because you have a skin condition that makes you feel self conscious about your appearance. I have encountered patients that are distressed about whiteheads, blackheads, and melasma. If you have any of these skin conditions, please join me as I share with you some useful information about these conditions and available treatments.

MELASMA

Melasma is a common skin condition that causes brown patches and spots, usually on the face, which are darker than your natural skin tone.12,13

Melasma is not associated with any mortality but has significant psychosocial morbidity.12,14 It is shown in a systemic review and metaanalysis that prevalence of depression was as high 48.5% in Asia!14

WHAT HAPPENS TO YOUR SKIN WHEN YOU HAVE MELASMA?

Melasma is linked to an increase in the production of melanin, a skin pigment that gives the skin a darker tone.15

This increased production of melanin is linked the presence of ultraviolet (UV) light.15

However, the exact mechanism of how increased melanin production can lead to the development of melasma is still being researched upon.15

Common causes of melasma. Click on the image for a larger, clearer version.

SUN PROTECTION

Increased production of melanin is linked to the presence of UV light and UV light is a component of sunlight. Therefore, it is essential to reduce your skin exposure to sunlight.

Use a broad-spectrum sunscreen when you spend time under the sun. One study found that SPF 60 sunscreen is found to offer greater improvements than SPF 30 ones.16

THE US FOOD AND DRUG ADMINISTRATION (FDA) HAS APPROVED THE USE OF A TOPICAL TREATMENT FOR DARK SPOTS ASSOCIATED WITH MODERATE TO SEVERE MELASMA.

Such a topical cream includes the active ingredients fluocinolone acetonide, hydroquinone, and tretinoin.17

The cream works to disrupt pigment production in the skin and lighten the existing dark spots on the skin.18

It is considered a prescription medicine, available only with a doctor’s prescription, so you should consult a doctor to discuss whether this cream would be suitable to treat your melasma.

What’s in the cream?

Hydroquinone is considered the primary and most effective topical agent for blocking the enzyme tyrosinase, which is a very important enzyme in the pathway of melanin production.18

On top of that, it also is known to play a role in the degradation of melanin-producing cells (melanocytes) and melanin-storing cell structures called melanosomes.18

Tretinoin, a retinoid, works by motivating epidermal and dermal turnover, which may cause rapid loss of cell pigment. In addition, it inhibits tyrosinase, facilitates the penetration of hydroquinone, and neutralizes the stratum corneum thinning effects of corticosteroids.18

Fluocinolone acetonide is a moderate potent topical steroid used to reduce the irritation caused by both hydroquinone and tretinoin.

General adverse reactions

Some people may develop allergic reaction to one or more of the active ingredients. Both tretinoin and hydroquinone have been known to be cause irritation in some people. Some people may experience adverse reactions related to the general use of retinoids, which include redness, peeling, burning, dryness, or itching.

OTHER COMMON OPTIONS

Available over-the-counter creams to manage melasma commonly contain ingredients such as vitamin C, azelaic acid, kojic acid, salicylic acid, cysteamine, niacinamide, ascorbic acid, tranexamic acid, glutathione, and soybean extract.18

These ingredients help to reduce pigmentation by disrupting the pigment production process in the skin.18

These products, however, are categorised as cosmeceuticals and they may not work as well or as fast as a medical-grade treatment. The effectiveness of their use is still being researched upon, and they may also cause irritation to the skin of some people.

Chemical peel and laser treatments may also be useful for superficial melasma.12

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Human Clinical Trial Shows That Tocotrienol-Incorporated Oats Can Benefit People With Metabolic Syndrome (Mets)

This pioneering clinical trial, led by Dr Lee Lai Kuan from Universiti Sains Malaysia, involved 81 MetS patients that consumed two sachets (equivalent of 60 g) of Bioley Toco Oats daily for up to 12 weeks.

RESULTS
Improved Key MetS Parameters
√ 5.5% reduction in fasting blood sugar.
√ 4.3% reduction in diastolic blood pressure.
√ 23% increase in HDL (good) cholesterol.
√ 11.8% reduction in blood triglycerides.

Enhanced Antioxidant Levels
√ Significantly elevated total antioxidant capacity (TAC) and superoxide dismutase (SOD) levels.
√ Reduced protein carbonyl concentration, a marker of oxidative stress.

Anti-Inflammatory Effects
Lowered concentrations of multiple inflammatory biomarkers such as tumour necrosis factor-α (TNF-α), histidine-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and matrix metalloproteinase-3 (MMP-3). Tolerance Participants did not show any gastrointestinal side effects after prolonged consumption of Bioley Toco Oats.

Tolerance
Participants did not show any gastrointestinal side effects after prolonged consumption of Bioley Toco Oats.

CONCLUSION
The clinical trial findings demonstrate the potential of Bioley Toco Oats in improving metabolic parameters, enhancing antioxidant capacity, and reducing inflammation in individuals with metabolic syndrome.

IMPORTANT NOTE
This product is not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. A balanced diet and regular exercise are essential for good health. This product should not replace conventional treatments or consultations with qualified healthcare professionals for any medical condition.
Always seek proper medical advice for diagnosis and treatment.

 

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References:

1.    Tan, D. T., Khor, H. T., Low, W. H., Ali, A., & Gapor, A. (1991). Effect of a palm-oil-vitamin E concentrate on the serum and lipoprotein lipids in humans. The American journal of clinical nutrition, 53(4 Suppl), 1027S–1030S.
https://doi.org/10.1093/ajcn/53.4.1027S
2.    Ajuluchukwu, J. N., Okubadejo, N. U., Mabayoje, M., Ojini, F. I., Okwudiafor, R. N., Mbakwem, A. C., Fasanmade, O. A., & Oke, D. A. (2007). Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report. The Nigerian postgraduate medical journal, 14(1), 30–33.
https://pubmed.ncbi.nlm.nih.gov/17356586/
3.    Mottram, P., Shige, H., & Nestel, P. (1999). Vitamin E improves arterial compliance in middle-aged men and women. Atherosclerosis, 145(2), 399–404. https://doi.org/10.1016/s0021-9150(99)00073-8
4.    Khanna, S., Roy, S., Parinandi, N. L., Maurer, M., & Sen, C. K. (2006). Characterization of the potent neuroprotective properties of the natural vitamin E alpha-tocotrienol. Journal of neurochemistry, 98(5), 1474–1486.
https://doi.org/10.1111/j.1471-4159.2006.04000.x
5.    Mangialasche, F., Kivipelto, M., Mecocci, P., Rizzuto, D., Palmer, K., Winblad, B., & Fratiglioni, L. (2010). High plasma levels of vitamin E forms and reduced Alzheimer’s disease risk in advanced age. Journal of Alzheimer’s disease : JAD, 20(4), 1029–1037.
https://doi.org/10.3233/JAD-2010-091450

Healthcare Experts Unite to Combat Antimicrobial Resistance At Landmark Symposium

Left to right: Dr Mark Miller (Chief Medical Officer of bioMérieux), His Excellency Axel Cruau (Ambassador of France to Malaysia), YB Dato’ Lukanisman bin Awang Sauni (Deputy Minister of Health Malaysia) and En Mohd Hareeff Muhammed (CEO of Premier Integrated Labs and Chairman of Organising Committee of Center of Excellence) officiating the event.  

Kuala Lumpur, 23 November 2023 – Healthcare leaders and experts from public, private and global healthcare organisations came together yesterday for the landmark Antimicrobial Stewardship (AMS) Center of Excellence (COE) Day Symposium, jointly organised by bioMérieux, IHH Healthcare Malaysia, and Premier Integrated Labs. The symposium facilitated knowledge exchange and interconnectivity between AMS teams from different specialities, to address the threats of Antimicrobial Resistance (AMR). AMR is a major global health concern that hampers our ability to treat common infectious diseases, resulting in prolonged illness, higher healthcare costs, and increased mortality.

They shared insights into the challenges posed by AMR and the role of AMS as a solution. The symposium also highlighted the importance of diagnostics in AMR control, the link between antimicrobial resistance and judicious use of antibiotics, and initiatives in the public and private healthcare sector for controlling AMR.

Dr Mark Miller, Chief Medical Officer at bioMérieux and an expert on AMR and AMS, addressed how latest diagnostic tests can help physicians in adopting AMS principles while providing appropriate treatment for infectious diseases. Meanwhile, the National Institute of Health (NIH) presented their insights on national antimicrobial resistance data, which is integral in directing national efforts against this public health threat.

The symposium marked the first anniversary of the establishment of the AMS Center of Excellence (COE) partnership between bioMérieux, IHH Healthcare Malaysia and Premier Integrated Labs. The latter two healthcare providers join healthcare institutions in China and India to be designated as AMS COEs in Asia Pacific. Since its establishment, the Malaysia COE has marked several milestones in the fight against AMR. Notably, they have established an antibiotic resistance reporting framework, and organised nine AMS education programmes for front line healthcare professionals to advance their skills in AMS.

The presence of Deputy Minister of Health, YB Dato’ Lukanisman bin Awang Sauni, underscored the national importance of the symposium. YB Dato’ Lukanisman, in his speech said, “I am extremely pleased to see a partnership with the private sector committed to combating AMR. The effort to overcome this global threat requires collaboration from multiple different sectors. I would also like to congratulate bioMérieux, IHH Healthcare Malaysia and Premier Integrated Labs for being the first AMS COE in the region, and for organising a successful event today.”

Left to right: Dr. Rahela Ambaras Khan, Head of Pharmacotherapy Services, Pharmacy Department, Hospital Kuala Lumpur; Mr Tan Yew Aik, Head of Pharmacy Services IHH Healthcare Malaysia; En Mohd Hareeff Muhammed, CEO of Premier Integrated Labs and Chairman of Organising Committee of Center of Excellence; YB Dato’ Lukanisman bin Awang Sauni, Deputy Minister of Health Malaysia; His Excellency Axel Cruau, Ambassador of France to Malaysia; and Jacob Morton, AMS Global Programme Director bioMérieux at the symposium.

Mr Jean-François Naa, CEO of IHH Healthcare Malaysia, added, “At IHH Healthcare Malaysia, we are fully committed to combating AMR. It is integrated into our global sustainability goals, and we have set up an active AMS committee in Malaysia to strategically spearhead initiatives. In this battle against AMR, knowledge remains our strongest ally. The exchange of insights and experiences between global experts, local healthcare leaders and private healthcare providers is crucial, as we navigate these uncharted waters. Moving forward, it is crucial that we work together strategically to combat resistance, instead of in silos.”

The symposium was a significant step towards addressing the global health concern of AMR. It not only facilitated knowledge exchange and collaboration but also highlighted the importance of strategic partnerships in combating AMR

ABOUT ANTIMICROBIAL RESISTANCE 

Antimicrobial resistance (AMR) is a global health crisis caused by the natural mutation of bacteria, fungi, viruses, and parasites, leading to their resistance to antimicrobials. This means that standard antimicrobial treatments become ineffective, and infections persist, increasing the risk of severe consequences to the patient. AMR is directly responsible for 1.27 million deaths annually and is associated with 4.95 million deaths worldwide due to drug-resistant infections.

Combating AMR is critical to safeguard the efficacy of antibiotics for future generations. The appropriate use of diagnostics can guide responsible antimicrobial use, preserving their lifesaving potential.
ABOUT THE CENTER OF EXCELLENCE PARTNERSHIP

bioMérieux adopts a proactive, partnership-driven approach to combat AMR. Through diagnostic and data-driven solutions, bioMérieux strives to enhance AMS efforts. The AMS Centers of Excellence (COE) designation is awarded to leading hospitals globally that commit to best AMS practices. Currently, bioMérieux is partnered with thirteen sites across multiple continents. IHH Healthcare Malaysia and Premier Integrated Labs have achieved the distinction of becoming the first healthcare providers in ASEAN to be awarded the COE.

This partnership aims to promote data-driven best practices as well as to advance medical education in the field of AMS. It also focuses on generating real-world medical and economic data, emphasising the value of combining diagnostics, medical education, lab consultancy services, and information technology solutions. This partnership symbolises a significant step toward a world free from the threat of AMR.

By inspiring other health institutions, the COE can contribute to increasing the quality of care and improving the level of healthcare systems in Malaysia.

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A Breath of Fresh Hope For Women Against Lung Cancer

A panel discussion titled ‘A Breath of Fresh Hope’ was held on 7 December 2023. This was a collaboration between the pharmaceutical division of Roche (Malaysia) Sdn Bhd and the Lung Cancer Network Malaysia (LCNM).

This panel discussion highlighted the alarming prevalence of lung cancer in non-smoking Malaysian women, the related medical implications of this prevalence, and the social stigma surrounding this cancer.

“Over 2.2 million lung cancer cases were reported in 2020 globally, and more than 770,000 of them were in women. Lung cancer is the third top malignancies seen in the global female population, after breast and colorectal cancers,” said Ms Deepti Saraf.

SHIFTING PUBLIC PERCEPTION OF LUNG CANCER
FEATURED EXPERT
DR ANAND SACHITHANANDAN
Consultant Cardiothoracic Surgeon and Co-Founder of Lung Cancer Network
Malaysia

“The majority of lung cancer cases affect smokers. Having said that, we are now starting to see increasing numbers of cases of lung cancer in non-smokers, of whom women are overrepresented,” said Dr Anand.

Lung cancer does not affect smokers only; there are other risk factors that could put one could be at risk.

Dr Anand Sachithanadan revealed that fewer than 2% of Malaysian women smoke, but lung cancer is one of the main cancers that affect women in Malaysia.

Thus, contrary to popular perception, lung cancer does affect people that do not smoke, as outlined below.

Common lung cancer risk factors. Click on the image for a larger, clearer version.

BE AWARE OF THE SYMPTOMS OF LUNG CANCER—EVEN IF YOU DO NOT SMOKE
FEATURED EXPERT
DR JENNIFER LEONG
Consultant Clinical Oncologist
Sunway Medical Centre

Dr Jennifer Leong told us, “Many women harbour the preconceived notion that because they don’t smoke, they are not at risk of lung cancer. At times, even when displaying typical symptoms, they can easily miss out on these symptoms and do not get the required medical attention in the earlier stages of disease, affecting their chances at longer survival.”

“While I wouldn’t say that lung cancer is preventable, it’s very much a curable disease provided that you can detect it early on,” she added.

On the other hand, ignoring or overlooking the early symptoms of lung cancer would lead one to seek medical treatment only when the cancer has advanced to a late stage, during which the chances of a positive outcome are far more diminished.

Dr Anand concurred with Dr Jennifer’s statement. He stated: “Lung cancer care has been revolutionized in the last four or five years, leading to significantly better outcomes for our patients as well as overall survival. Despite all these tremendous promises, the fact remains most patients are still being diagnosed late in stage.”

Common symptoms of lung cancer. Click on the image for a larger, clearer version.

WOMEN SHOULD PRIORITISE THEIR OWN HEALTH AS WELL AS THAT OF THEIR LOVED ONES
FEATURED EXPERT
ASSOCIATE PROFESSOR DR CARYN CHAN MEI HSIEN
Consultant Health Psychologist
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

“Many women are expected to and are taught to prioritise the health of family, sometimes at the expense of their own health. Consequently, some women would ignore or dismiss their symptoms, or feel guilty when their medical treatments become a significant expense to the family,” said Associate Professor Dr Caryn Chan.

One unfortunate consequence of women putting the needs and well-being of others over their own is that they often neglect their own health.

Often, Associate Professor Dr Caryn Chan pointed out, they overlooked symptoms such as those of lung cancer, and seek medical attention only when their illness had deteriorated to an advanced stage.

This attitude on both the parts of women and society need to change. “Taking care of your health does not mean you are burdening the rest of the family,” Dr Caryn stated.

She also called for the family to come together to distribute caregiving and support responsibilities, typically delegated to a woman, across all capable family members. This way, a woman would have ample opportunity to also tend to her own needs and well-being.

BE MORE PROACTIVE IN DETECTING LUNG CANCER EARLY!
FEATURED EXPERT
MS. DEEPTI SARAF
General Manager
Roche Malaysia Sdn Bhd

“All of us have a part to play in raising awareness of lung cancer,” Ms Deepti Saraf reiterated while closing the panel discussion.

Be alert for symptoms.

If you, your loved ones, or your friends have symptoms, seek medical help.

If you are at high risk of lung cancer, consult your doctor.

The doctor can arrange for you to undergo regular screening to detect early the presence of cancer or other issues with your lungs.

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A Significant Milestone in Improving the Access of Malaysians to Comprehensive Genomic Profiling

Recently, Roche Pharmaceuticals and Roche Diagnostics cemented a partnership with Premier Integrated Labs with the signing of a memorandum of understanding (MOU). This MOU is effective from November 2023.

The objectives of this partnership include improving patient access to comprehensive genomic profiling or CGP as well as promoting greater awareness and understanding of CGP among Malaysians.

MS HENG CHAI YIN
General Manager
Roche Diagnostics (M) Sdn Bhd

“While awareness and understanding are crucial, our ultimate goal is to ensure that CGP is accessible to all patients in Malaysia. It is about providing every patient with the best possible chance for an accurate diagnosis and tailored treatment plan,” says Ms Heng Chai Yin, the General Manager of Roche Diagnostics Sdn Bhd.

WHAT IS COMPREHENSIVE GENOMIC PROFILING (CGP)?

With a single test, comprehensive genomic profiling (CGP) can analyse a broad panel of genes that is known to drive cancer growth. This type of testing produces comprehensive patient reports with broad and deep assessments of the possible underlying cancer drivers.1

HOW CGP PLAYS A KEY ROLE IN PRECISION MEDICINE

Precision medicine involves the use of personalized treatments for an individual with regards to a disease.2

Different people can respond differently to the same medication for the same disease, and there are many possible factors that are responsible for these differences.

Hence, a big part of precision medicine involves the identification of these differences through investigative methods such as in the image below.

Click on the image for a larger, clearer version. CGP falls under omics. Hence, it is one of the important procedures that provide healthcare professionals with the necessary data to design the best personalized treatments for their patients.
HOW CGP CAN IMPROVE THE PRECISION OF CANCER TREATMENT IN MALAYSIA
MS DEEPTI SARAF
General Manager
Roche (Malaysia) Sdn Bhd

According to Ms Deepti Saraf, CGP holds the key to unlocking the full potential of personalized medicine. It allows us to explore the genetic makeup of individuals, thereby enabling more precise and tailored treatment approaches.

Let’s look at lung cancer as an example.

How CGP could improve treatment for lung cancer and benefit both the patient and the oncologist. Click the image for a larger, clearer version.
CGP IS DIFFERENT FROM CONVENTIONAL GENOMIC TESTS

Ms Deepti Saraf points out that, unlike those genomic tests in the market that let you know about your genes and ancestry, CGP is more of a diagnostic tool that empowers doctors, especially oncologists, to create the most optimal personalized treatments for their patients based on available data.

EN HAREEFF MUHAMMED
Chief Executive Officer
Premier Integrated Labs

En Hareeff Muhammed brings up that, with the wealth of genomic data obtained through the use of CGP, databases can be created to analyse which treatments would work best for different groups of patients.

This goes back to Ms Deepti Saraf’s statement that CGP allows healthcare professionals to design the best personalized treatments for their patients. They can do this by using the information found in the database to help shape their decisions.

“It’s not just useful for the patients and saves time,” En Hareeff elaborates. “It also supports doctors in making better decisions.”

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References:

  1. Foundation Medicine. (n.d.). Why comprehensive genomic profiling? https://www.foundationmedicine.com/resource/why-comprehensive-genomic-profiling
  2. König, I. R., Fuchs, O., Hansen, G., von Mutius, E., & Kopp, M. V. (2017). What is precision
    medicine?. The European respiratory journal, 50(4), 1700391. https://doi.org/10.1183/13993003.00391-2017
  3. Omics-based clinical discovery: Science, technology, and applications. (2012, March 23). In C.M. Micheel, S.J. Nass, & G.S. Omenn (Eds), Evolution of translational omics: lessons learned and the path forward (p. 33). National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK202165/
  4. Tan, J., Hu, C., Deng, P., Wan, R., Cao, L., Li, M., Yang, H., Gu, Q., An, J., & Jiang, J. (2021). The predictive values of advanced non-small cell lung cancer patients harboring uncommon EGFR mutations-the mutation patterns, use of different generations of EGFR-TKIs, and concurrent genetic alterations. Frontiers in oncology, 11, 646577. https://doi.org/10.3389/fonc.2021.646577
  5. American Lung Association. (2022, November 17). EGFR and lung cancer. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lungcancer/symptoms-diagnosis/biomarker-testing/egfr

Don’t Let Glaucoma Rob You of Your Eyesight!

The eye is one of life’s treasures. It is our organ for vision.

The retina, located at the back of our eye, plays a key role in giving us our gift of sight. This is where information on shape, colour and pattern is picked up and carried to the brain via the optic nerve.

We must, therefore, be vigilant of eye conditions that may damage our optic nerve, impact our vision and eventually lead to sight loss. One such chronic condition is glaucoma.

WHAT IS GLAUCOMA?

Glaucoma occurs when the optic nerve connecting the eye to the brain is damaged. It often develops because of fluid building up in the in the front part of the eye, resulting in raised intraocular pressure (IOP).

While anyone can develop glaucoma, it is more common in people over 60 years old and can result in vision loss and eventual blindness, if not treated.

With no known cure for glaucoma, regular eye examinations are therefore, very important for early detection and proper treatment to slow or stop its progression.

WHAT ARE SOME SIGNS AND SYMPTOMS?

Symptoms can start so slowly that you may not even notice it.

Thus, it is good to promptly consult your ophthalmologist if you have any tell-tale signs.

These include loss of peripheral vision, having tunnel vision, a blurred or hazy vision, experience of halos or glare especially at night and having some eye pain and discomfort.

HOW TO TREAT GLAUCOMA?

The goal in glaucoma treatment is to control IOP, the main risk factor for the development and progression of glaucoma.

The first and most common treatment option is always noninvasive through medications or eye drops.

In Malaysia, a group of medicines called prostaglandin analogues (PGAs) are a common treatment choice because they are effective in lowering pressure in the eye and are easy to use with daily application.

However, it is reported that about 50% of users of PGA eye drops may experience visible changes that occur around the eye including the eyelids, known as prostaglandin-associated periorbitopathy syndrome (PAPS), after over one month.

Common signs of PAPS are sunken eyes or deepening of the upper eyelid sulcus (also known as DUES), excessive eyelash growth, droopy upper eyelid, darkening of skin around the eyes or eyelids, flattening of the lower eyelid bags and/or fat loss around the eye, and eyelids pressing firmly against the eye.

These can adversely affect the quality of life of glaucoma patients causing them to feel gloomy, avoid looking in the mirror, lack confidence to socialise, and interfere with their work.

Beyond these cosmetic changes, PAPS can also have negative impact on treatment outcomes, including unreliable eye pressure measurements and added difficulty and poor outcomes related to glaucoma surgery in the future.

Some patients are known to discontinue their treatment because of these side effects and this can hamper the overall management of their condition.

Nonetheless, the good news is that with advancements in ophthalmology, there are other class of medicines now available to fulfil the unmet needs among glaucoma patients. These newer options can help them be free from PAPS so they can continue treatment without compromising their quality of life.

BE PROACTIVE FOR BETTER VISION

Detect your condition early for better outcomes and consult your ophthalmologist to learn of a suitable eye drop for you.

Remember, regular and frequent eye examinations are essential to monitor the progression of glaucoma and to adjust treatment as needed.

Prevent the risk of vision loss and continue to enjoy the beautiful wonders of creation.