Thursday, May 14, 2009

STI: Ask the experts

May 14, 2009

Ask the experts




Q: I am a woman in my late 20s and I have been suffering from acne and acne scars since my teens. My back and chest are in worse shape and I still have breakouts. Pimples keep popping up on my back and chest and leave blemishes.


I have consulted a dermatologist and have tried anti-acne products prescribed to me. I have also taken medicine such as Doxycycline but it had side effects. It made me nauseous.


Over the past five years, I have tried chemical peels, dermabrasion, laser treatment and over-the-counter whitening products with no results.


I have not been able to wear bare-backed tops because of the scars. I have also given up my favourite sport of swimming when I was in my teens because of this. I feel depressed and inferior.


How can I get rid of my acne and blemishes? I have heard that there is surgery available. How can this help and how much will it cost?


A: It appears that you have two problems; pimples are still popping up and the marks and scars left behind when they heal. Additionally, they are also causing social and psychological problems. You have already seen a dermatologist and have tried a variety of treatments to no avail.


Your priority should be to control the outbreaks so that you don't get new pimples, which are going to cause new marks and scars. After that, you need to look at ways to improve the marks and scars.


There are treatments that can help but you will need to consult a dermatologist. Some of the treatments you have heard or read about may not be suitable for your skin. You should consider consulting another dermatologist so that he can assess your skin and determine the most appropriate treatment for you.


Dr Lim Kah Beng is a consultant dermatologist at Gleneagles Hospital.





Q: I am 57 years old and my Prostate Specific Antigen reading has been increasing gradually over the last five years by about 1 a year. It is now at 11.3.


I have had two biopsies done and they were negative. Digital rectal examinations also turned up negative. How many biopsies must I have to rule out the possibility of prostate cancer? I am very reluctant to go for another one.


I wake up twice a night to urinate and the flow is weaker than before but this does not bother me. My children call me a health freak because I watch my diet carefully and exercise regularly. However, I am still worried about my condition.


A: Prostate Specific Antigen (PSA) is a protein produced by the prostate gland. The normal level is generally less than 4ug/L.


It can be elevated in cases of benign prostate enlargement, prostate infection or prostate cancer. In fact, one out of four men with elevated PSA is found to have prostate cancer.


To confirm if one has prostate cancer, one has to undergo a prostate biopsy. Other telltale signs of prostate cancer include slow and intermittent urinary flow, increased day and night frequency of urination and blood in the semen. Occasionally, the doctor may discover a hard nodule during a digital rectal examination.


The chance of finding cancer in a second biopsy ranges from 10 to 20 per cent and the chance of finding cancer in the third biopsy is only 5 to 10 per cent. The continual rise in PSA is worrisome and a repeat biopsy may be necessary.


Other investigations that may be helpful include the free PSA test and magnetic resonance imaging (MRI) of the prostate. The free PSA test (as opposed to the attached PSA test) helps to differentiate between benign and malignant conditions and determines the need for a repeat prostate biopsy.


Your urinary symptoms are probably due to the enlargement of the prostate and there are medications available to help you. However, do not ignore the rise in PSA and strongly consider a third biopsy.


Dr Fong Yan Kit is a urology specialist at Raffles Hospital.

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