When an aesthetic clinic refers you:
eczema, psoriasis, suspicious lesions and conditions that belong with a specialist

What does an aesthetic clinic not treat?

An aesthetic practice treats the appearance of healthy skin: pigment, scars, laxity, volume, texture, unwanted hair and fat. It is licensed, equipped and staffed for that. A dermatology specialist diagnoses and manages diseases of the skin, hair and nails, with access to biopsy, patch testing, phototherapy, systemic and biologic drugs and the monitoring they require. The two overlap at the edges, which is why the first visit here includes an examination and not just a discussion of what you would like changed. When the examination finds disease, the honest answer is a referral, and this page explains what triggers one.

Eczema and psoriasis: why an aesthetic clinic sends you on rather than treating around

Eczema is common in Singapore; the Ministry of Health's HealthHub notes that about a fifth of school children have it, and a proportion carry it into adult life. It is not one disease. Atopic eczema, contact dermatitis from a product or a metal, seborrhoeic dermatitis of the face and scalp, and hand eczema from wet work each have a different trigger and a different plan, and telling them apart is a dermatology task that sometimes needs patch testing. An aesthetic clinic that applies a peel, a laser or a skin booster to eczematous skin does not treat the eczema; it adds a wound to inflamed skin, and the flare that follows is predictable. The right sequence is control first, with the GP or dermatologist, and then any cosmetic work on skin that is quiet.

Psoriasis is a systemic immune disease that happens to show on the skin. It carries associations with joint disease, cardiovascular risk and metabolic syndrome that need screening, and its treatment ladder runs from topical steroids and vitamin D analogues through phototherapy to methotrexate and biologic injections, all of which are prescribed and monitored by a specialist. It also has a specific relevance for aesthetic procedures: in active psoriasis, injury to the skin can provoke a new plaque at the site of injury, a phenomenon dermatologists call Koebnerisation. That is why microneedling, laser resurfacing and even repeated injections are kept off psoriasis-prone skin during active disease, and why a history of psoriasis is asked about before any procedure here, even when the skin looks clear.

What Dr Sin Yong does when he finds either is straightforward. He tells you what he thinks it is and why it is not a cosmetic problem, writes to your GP or to a dermatologist with the findings, and sets out what aesthetic work can reasonably wait for and what can continue on unaffected skin. If you already have a dermatologist, the letter goes to them, so that nothing done here cuts across their plan.

“If I cannot name what is on your skin, I have no business putting a laser on it. A referral letter is a treatment decision, not a failure to make one.”

Dr Sin YongOn referral

Suspicious moles and lesions: why a cosmetic laser is the wrong first step

Mole, sun spot and skin tag removal are among the commonest requests at an aesthetic clinic, and the examination before them is the point at which skin cancers are picked up. Dr Sin Yong looks at every lesion he is asked to remove with a dermatoscope. Anything that is asymmetric, has an irregular or blurred border, shows more than one colour, is larger than about 6 mm, or has changed, itched, bled or failed to heal, the ABCDE features described in the melanoma literature, is not treated. Nor is a pearly, slowly enlarging bump with fine vessels, a scaly patch that keeps returning, or a sore that does not close, because those are the patterns of basal and squamous cell carcinoma, which are more common in Singapore than melanoma.

The reason is not caution for its own sake. A laser or a shave on a melanoma destroys the tissue a pathologist needs to stage it, and can leave the deeper part behind. A suspicious lesion needs excision with a margin and histology, which is a dermatology or plastic surgery job, and it needs it promptly. The referral letter says what was seen, where, and what the dermatoscope showed, and the patient is asked to tell the clinic the outcome. Lesions that are clearly benign are removed here as described on mole removal, skin tag removal and age warts, and that page explains what 'clearly benign' means.

Signs that get a referral rather than a removal

• A new mole after 40, or a mole that looks different from all the others.
• Change in size, shape or colour over time; itching, bleeding or crusting.
• A pearly or translucent bump, a scaly red patch that persists, or a non-healing sore, especially on sun-exposed skin.
• A dark streak under a nail, or a dark patch on a palm, sole or mucosal surface, where melanoma in Asian skin is more often found.

How referral to a dermatologist works in Singapore

Singapore has public and private routes to a dermatologist, and the cost and waiting time differ, so the letter from this clinic is written to fit the route you choose.

The subsidised public route

The National Skin Centre, part of NHG Health, is the national specialist centre for skin disease. Subsidised appointments there are for Singapore citizens and PRs referred from a polyclinic, a CHAS clinic or a subsidised clinic of a public hospital, and the first appointment is made by the referring institution. A letter from this clinic can be taken to your polyclinic doctor, who makes the referral; the subsidy covers medical care, not cosmetic procedures. Dermatology clinics at the public hospitals work on the same basis.

The private route

A private dermatologist, or a non-subsidised appointment at the National Skin Centre or a public hospital, can be booked directly with a referral letter from any doctor, including this clinic, and usually sooner. Many patients with employer insurance use this route. For a suspicious lesion, speed matters more than route, and Dr Sin Yong will say so.

What the letter contains

• What was seen on examination, including dermatoscopic findings for a lesion.
• What was not done and why.
• Your relevant history: medicines, allergies, previous aesthetic treatments and products used.
• The question for the specialist, so that the appointment starts at the right point.

Doctors referring patients the other way, to this clinic, for scars, filler problems or hair loss, will find the criteria on the page for referring doctors; skin disease found during those assessments is returned to dermatology in the same way.

What can still be done safely around eczema, psoriasis and other skin conditions

A referral is not a refusal of aesthetic care. Most people with eczema or psoriasis have long periods of quiet skin and areas that are never affected, and aesthetic work is planned around the disease rather than cancelled by it. The principles Dr Sin Yong follows are these.

• Disease controlled first. Procedures wait for a flare to settle, and the dermatologist's plan is not interrupted to fit a treatment date.
• Affected skin is left alone. Laser, microneedling, peels and injections stay off active eczema and psoriasis plaques, and off psoriasis-prone sites such as elbows, knees and scalp margins even when they look clear.
• Barrier before procedure. On eczema-prone skin, a bland routine is established before any laser or peel, and the settings are gentler than for the same concern on robust skin.
• Medicines are declared. Oral steroids, methotrexate, ciclosporin and biologics affect healing and infection risk; recent isotretinoin changes what resurfacing is reasonable; both are asked about at every visit.
• Lesions are diagnosed, then removed. Nothing is lasered until it has a name.
• The two doctors talk. Where you have a dermatologist, treatment here is copied to them, and theirs is noted here.

Conditions this clinic does assess and treat, with the medical boundary stated on each page, include rosacea, perioral dermatitis, keloids, milia and dark underarms, each with its own page explaining where the medical boundary sits and when a specialist is involved. The full list of skin concerns assessed here is on the conditions index.