Dr Foo Seow Hoong is a consultant dermatologist with Gleneagles Hospital Medini Johor (GHMJ) in Iskandar Puteri. She has a wealth of experience in managing a variety of skin conditions on different skin types affecting both adult and paediatric patients. In addition, she has been trained to perform superficial skin surgery and aesthetic medicine as well.
Prior to joining Gleneagles Hospital Medini Johor, she worked as a consultant dermatologist in the National Health Service, United Kingdom. She completed her full dermatology training in the UK and achieved her Certificate of Completion of Training (CCT) Dermatology Specialist, MRCP(UK) (Dermatology) in 2016. She was subsequently invited to be a Fellow of the Royal College of Physicians of Edinburgh (FRCP) in November 2020 as an acknowledgement of her contributions to research in healthcare. This is widely considered to be the highest accolade for physicians.
Tell us more about yourself and what brought you here to GHMJ?
Having been in the UK for almost 2 decades, my husband and I felt it was the right time to return home to be closer to family. I was fortunate that Gleneagles Hospital Medini Johor reached out and offered me an opportunity to set up a dermatology service at their centre. I was particularly impressed with its world-class facilities, panel of esteemed consultants and Dr Kamal Amzan’s (CEO) vision for the hospital.
Prior to returning to Malaysia, I was a consultant dermatologist in the NHS, UK dealing with a variety of skin conditions. Having undergone the UK training system, I am experienced in managing general dermatology skin conditions such as acne, eczema, psoriasis, skin allergy and skin cancer, treating both adult and paediatric patients. I also perform procedures such as minor skin surgery, intralesional steroid injection, cryotherapy, patch testing, skin laser and cosmetics injections.
What are the services that you will be providing in GHMJ and what are the 2 most common skin conditions you have seen since starting in GHMJ?
I will be providing diagnoses and treatments for general dermatology, paediatric dermatology, skin cancers, cutaneous allergy, hair & nail disorders, vulva & genital dermatology and aesthetic dermatology. Simply put, if it’s anything to do with skin, I am the person you should be seeing.
I have been working at GHMJ since February 2022 and have noticed that the most common skin presentations are acne and eczema. This is not unusual as these are very common skin conditions.
What causes acne? Does diet play a role in acne?
Acne is very common. Some may say that it is a rite of passage – you go through puberty and you will likely have it. For most, it tends to go away from early to mid-twenties but for some, it can go on for a longer period. Acne can also develop for the first time in people in their late 20ties and beyond. Acne can range from a few spots on the face, neck, back and chest to a more severe problem that may cause scarring and reduce self-confidence.
Acne is likely caused by a combination of genetic, hormonal and lifestyle factors. Acne can run in families however, there are many people with acne who do not have affected people in their family.
Our sebaceous (oil-producing) glands are affected by our hormones. In people who have acne, the glands are particularly sensitive, even to normal blood levels of these hormones. This causes the glands to produce too much oil. At the same time, the lining of the pores (the small holes in the skin’s surface) becomes thickened and dead skin cells are not shed properly.
The acne bacteria (now known as Cutibacterium acnes) live on everyone’s skin, usually causing no problems. In those with acne, the build-up of oil creates an ideal environment for the bacteria to multiply. This is accompanied by inflammation which leads to the formation of red, swollen or pus-filled spots.
Research has shown that diet can influence acne. High glycaemic index (GI) diets (e.g. sugar and sugary foods, white bread, potatoes, white rice and etc.) have been shown to cause or aggravate acne. Research has also shown that switching to a low GI diet may help improve acne.
Does everyone with acne need to see a dermatologist?
Not all acne patients need to see a dermatologist. It is completely normal to have a spot or two when you are stressed or if you are a female, during your menstrual period. The aim of treatment is to not have big painful spots that can leave scars and post-inflammatory pigmentation (patches of darkened skin, remnants from active acne). If your spots are no longer controlled with topical treatment such as benzoyl peroxide, then it’s important to see a dermatologist who can examine your skin and come up with a seborrheic treatment plan to achieve your best skin health. The treatment that can be offered includes a combination of topical treatment, oral antibiotics, oral contraception, isotretinoin and laser treatment to tackle post-acne scarring.
What are your self-care advice for patients with acne?
My main take-home message is please don’t pick or squeeze your acne spots as this usually aggravates them and may cause scarring and infection. Prevention is always better than cure, treat your acne spots early and in the long run, it will be cheaper than trying to tackle the remnant acne scars.
Less is more, just keep your facial routine simple. Cleanse your skin and remove make-up with a gentle cleanser and water, or an oil-free soap substitute. Scrubbing too hard can irritate the skin and make your acne worse.
Think about the environmental factors in your life that may drive your acne flares. Your skin is related to your general health, so if you adopt good stress management techniques, have a good quality sleep routine and eat well, you can achieve optimum skin health.
Eczema is another form of common skin condition, but what causes it?
Eczema is basically inflammation of the skin. It is a complex skin condition, and several factors appear important for its development including patient susceptibility (endogenous) and environmental factors (exogenous).
Endogenous factors mean it runs in the family and if both parents have eczema, more likely their child will develop it too. Atopic eczema is linked with asthma and hayfever. These conditions are all linked to increased activity of the allergy reaction of the body’s immune system. So, if you have a family member who has either one of the three, there’s a higher chance that you will get eczema.
Also, in patients with eczema, they have weakened skin barriers due to alteration in the filaggrin gene. This makes the skin of patients affected by eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation.
Environmental (exogenous) factors that can cause eczema to flare include contact with soaps, detergents and any other chemicals applied to the skin, exposure to allergens, stress and infection with certain bacteria and viruses.
Therefore, it’s very important for eczema patients to use regular moisturiser to maintain their skin barrier. Food triggers of eczema are uncommon; patients and especially parents of children with eczema should always seek appropriate medical help before limiting diet in a growing child.
Can eczema be cured?
Eczema can’t be cured but there are many ways of controlling it and having good skin health. Most children affected by atopic eczema will see improvement as they get older although some will continue with flares from time to time.
Eczema patients can have a normal lifestyle – you can go swimming, have an inclusive healthy diet and have a completely normal life as long as you seek the right treatment for it.
Eczema usually presents as red, itchy patches. However, many other conditions can mimic eczema such as psoriasis, fungal infection, or seborrheic dermatitis, just to name a few. Therefore, it is very important to get the diagnosis correct by a dermatologist especially if your skin condition is not responding to treatment. I find it most satisfying when my patients with eczema achieve clear skin and good skin health with their personalised skin treatment. It is also fulfilling to see them live their best lives, no longer held back by their skin condition.
How do we keep eczema under control?
As eczema is a condition caused by a weakened skin barrier, moisturiser and emollient therapy is the key. The best moisturiser is the greasiest emollient you can tolerate as the greasier it is, the longer it will stay on your skin to protect your skin barrier.
Do not let your eczema get out of control. Always keep your active eczema treatment handy and use it as soon as your eczema flares. Using the fire analogy, when it’s small, it’s easier to put out, once it spreads, it would be quite hard to control!
Lastly, be aware of the environmental factors that may trigger your eczema. By avoiding these, you will be able to keep your eczema flares in check and achieve good skin health.