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Effective Hair Loss Treatments? A Dermatologist’s View

October 10, 2017

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Hair loss at any age affects one’s self confidence and esteem. It may also lead to depression and anxiety, conditions that affect work productivity and fitness. Unfortunately, way too many hair loss sufferers go an entire merry-go-round of trichologists, medi-spas, scalp treatments by aestheticians, hair salons before deciding to see a dermatologist, by which time a lot of their hair (and money) has already been lost. In this article, I start by tackling the commonest misconceptions of hair loss, what causes hair loss and finally, any treatments that are effective for hair loss.

If you are an expatriate that’s recently found yourself losing hair after moving to a new city, you are not alone. I have met many patients who are convinced that since moving to hot and humid Singapore they have started losing their crowning glory. Some attribute this to work stress, or the stress of relocation overall. Many report similar experiences from online forums and friends who have developed hair fall since moving to Singapore, with all sorts of speculations including water supply issues. So if you’ve moved to a new city recently, started experiencing hair fall, fret not because I hope to debunk some myths from a dermatologist viewpoint on hair loss happening to many mid-life career professionals.

1. Commonest Misconceptions of Hair Loss

It’s not in the water, the wrong shampoo or hair care 

Hair loss is not linked to using an inappropriate shampoo. Using organic or baby shampoos doesn’t help hair loss problems either. How shampoos work is by means of lathering agents, like sodium or ammonium-laureth sulfate which grab dirt, grime, bacteria and oil from scalp and hair. and the foam is then rinsed off with water. The so-called degreasing shampoos are those that contain higher amounts of Sodium Laureth Sulfate (SLS). Water, as long as it is potable, should not affect the condition of your scalp or hair. Unsanitary water not complying with WHO guidelines could be teeming with bacteria which is a different case.

Chemical hair treatments causes hair loss by breakage only, not from the roots 

Bleaching, perming, rebonding and dyeing hair all count as chemical treatments that alter the structure and the bonds of the hair to change its appearance. Essentially, these chemical processes damage the hair shaft, leading to parts of the hair shaft being broken off and causing hair loss by breakage. If you have bleached or permed hair, you should adopt grooming practices such as a wide-toothed comb and soft bristled brush using gentle detangling motions rather than harsh combing which can result in even more breakage.

2. Hair loss problems are best treated by an accredited dermatologist

A google search on “hair loss treatment” throws up myriad trichology, herbal aesthetic and medi-spa centres offering solutions to treat all scalp and hair problems. As a patient once remarked “ I wish I had known to see a dermatologist earlier for my hair loss.” Before I go on, lets first qualify what counts as hair loss. Anything between 60–100 strands of hair a day falls within the normal range but if you are used to losing say 30–50 strands usually and suddenly notice an increase in hair fall, that’s something to be alert to. Some symptoms: more hair in the drain, floor, on combs and the pillowcase. Ladies may notice having a wider parting and a thinner ponytail. Do you have a family member suffering from hair loss? Be alert to early symptoms of hair loss and seek a dermatologist’s advice for prompt diagnosis, treatment and prevention.

3. It’s not always the stress. Some other causes of hair loss 

In my practice, some of my hair loss patients come to me with their own lists of diagnoses of medical conditions that lead to hair loss, usually from a medical website that isn’t written for the layperson. Some research on forums and beauty websites which may boast causes and cures of hair loss which is simply unscientific.

If you’ve just had a stressful period such as relocation or adjusting to a new job, you may be experiencing telogen effluvium, which is when scalp hair is pushed to the end of the growth cycle and falls out, typically 3 months after the stressful event. Illnesses such as high fever, viral infections and crash dieting can cause telogen effluvium.

Male and Female Pattern Hair loss is one of the commonest causes of genetic hair loss, due to the hormone testosterone, and is also known as androgenetic alopecia. This is likely if you have a family member with hair loss, especially at an early age.

Alopecia areata is an autoimmune condition, the cause of it is unknown although there is some evidence that it is influenced by one’s genetics as well. This is a non-scarring type of hair loss that results in multiple patches of hair loss, and can be effectively treated with steroid injections and oral medications.

Bacterial infections of the scalp, such as scalp folliculitis, more severe forms known as dissecting cellulitis and folliculitis decalvans cause scarring hair loss if left untreated.

Excessively tight hairstyles on the hair such as corn-braiding and tight pony-tails can cause a form of hair loss known as traction alopecia.

Some medications can also cause hair loss, for example, anti-cancer drugs and anticoagulants can cause hair loss.

4. Do you have other scalp symptoms?

Do you have itch, redness or pain on your scalp? An undiagnosed inflammatory scalp disease such as seborrheic dermatitis, scalp eczema or psoriasis can be responsible.

Seborrheic dermatitis is caused by a yeast known as malessezia furfur in an individual with excess production of oil and can be worse in tropical and humid climates such as Singapore. Malessezia under normal conditions does not cause disease of the skin or scalp. Under humid environments, it can cause moderate to severe scalp inflammation and flaking and when it is severe, even hair loss. If you have tried over the counter anti-dandruff shampoos and are not better, promptly seek the care of an accredited dermatologist rather than self medicate or DIY.

Scalp eczema, an excessively dry scalp/skin condition is another cause of scalp inflammation. If one has a family history of psoriasis, scalp psoriasis can also cause scaling on the scalp similar to dandruff.

If you had contact with a cat or dog with ringworm -infection, have your scalp and skin checked by a dermatologist. Animals carry a type of fungal infection known as dermatophyte infections which are contagious. This type of scalp inflammation is commoner in children and presents as a red, scaly and itchy patch with hair loss.

Hair loss can occur due to one or more of these factors. Dermatologists evaluate by taking a thorough history, a physical examination and may recommend laboratory tests and microscopic tests before diagnosis. They also are trained to distinguish between scarring alopecia, a permanent type of hair loss, and may also offer a scalp biopsy, for a microscopic samples of the scalp.

5. Risks of not getting prompt medical treatment 

I had a patient who had spent over two decades on numerous hair and scalp treatments promising to treat hair loss until a colleague recommended her to see a dermatologist instead. By the time she had come to see me, she had lost about 50% of her natural hair ( she was only in her mid-thirties).

A lot of people are not even aware that dermatologists are the specialists in treating scalp and hair problems, including hair loss. In the case of the patient above, while her hair loss did get better, she turned out to be having a combination of telogen effluvium, scalp inflammation from seborrheic dermatitis as well as underlying genetic hair loss, known as female pattern hair loss. Her treatment was gradual, as over such a long period of time her hair follicles had undergone miniaturisation, meaning that she had an advanced stage of hair loss. Compared to if she had sought appropriate medical treatment, which could mean overall a slower, or less optimised outcome with treatment.

6. What treatments are available?

When it comes to hair regrowth treatments, it is important to follow evidence-based methods of encouraging hair growth. Light treatments, such as red light and yellow light, used in combination with active ingredients such as minoxidil and copper peptides, have evidence that supports hair re-growth. However, the more important issue is not to dismiss hair loss as a cosmetic concern as severe underlying medical conditions like lupus( an autoimmune disease), chronic illnesses, thyroid disease, anemia are causes of hair loss and needs to be medically treated. A trained dermatologist differentiates both non-scarring and scarring alopecia, the latter is irreversible hair loss that can be promptly diagnosed and requires medical treatment.

7.What is the outcome like?

Most cases of hair loss are age-related and due to androgenetic alopecia ( influenced by the hormone testosterone). Such cases have a strong genetic component and early detection, prevention measures can help retard hair loss. Discuss with your dermatologist what options are available, especially if you are aware of a strong family history of hair loss at an early age.

Mild scalp inflammation caused by scalp folliculitis, psoriasis, eczema and seborrheic dermatitis do not cause hair loss. However, if uncontrolled, it can force the hair growth cycle into telogen effluvium which is the cause of hair loss that occurs after a major illness. These conditions are all fully treatable with medications and should be diagnosed promptly to prevent worsening which may eventually lead to hair loss. For other causes of hair loss such as alopecia areata, an autoimmune disorder affecting the immune system whereby hair follicles are destroyed, it appears as round patches of hair loss and can be treated in early stages effectively with steroid injections. Left ignored, such may progress and require oral steroids for control. Some causes of hair loss result in scarring, whereby the hair follicle is destroyed and may not regrow. Such cases when treated early have better prognosis and outcome. Examples include folliculitis decalvans, which is a severe form of type of scalp folliculitis, leading to constant inflammation and infection. Tinea capitis is a contagious fungal scalp infection generally affecting younger children that can lead to scarring hair loss if untreated.

If you have an underlying more serious health problem such as hyper or hypothyroidism, an autoimmune disorder or anemia, hair loss may sometimes be the first presenting symptom. Your dermatologist will evaluate if a blood test is necessary to detect such conditions.

© 2017. Dr. Teo Wan Lin. All rights reserved.

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

A Dermatologist’s Best Guide to Hair Loss Treatments for Your Sensitive Scalp

October 5, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

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In the third installment of my series on dealing with hair loss in Singapore as a dermatologist, I’m going to discuss dandruff and scalp sensitivity. This is one of the commonest scalp complaints that my patients have in conjunction with hair loss symptoms and leaves many of them wondering if it is the cause of their hair loss problem.

1. What is dandruff and what causes it?

Flaking on the scalp and white scales found on one’s clothes are one of the first symptoms of dandruff, which is lay speak for any form of scalp inflammation that causes the cell turnover rate on the scalp to increase abnormally. There are several medical conditions that can result in this, the commonest being the following: scalp psoriasis, seborrheic dermatitis and scalp eczema.

2. Do I have a sensitive scalp or is it a symptom of another condition?

Do you have itch, redness or pain on your scalp? You may have an undiagnosed inflammatory scalp disease. Scalp “sensitivity” without any underlying scalp condition is a very rare condition attributed to abnormal nerve sensations known as scalp dysaesthesia.

It is far more common to have an underlying cause such as seborrheic dermatitis, which is due to proliferation of a yeast known as malessezia furfur in an individual with excess production of oil. It is also commoner in tropical and humid climates such as Singapore, as it encourages this yeast to grow. Otherwise, malessezia is an inhabitant of one’s skin and scalp. Under normal conditions, it does not cause any issues, however under humid and sweaty environments, this yeast can proliferate to cause scalp inflammation and flaking. If you have scalp flaking which does not respond to over the counter anti-dandruff shampoos, which usually contain zinc pyrithone which is anti-fungal, promptly seek the care of an accredited dermatologist rather than self medicate or DIY.

Other causes of scalp inflammation would be scalp eczema, which is due to an excessively dry scalp/skin condition, scalp psoriasis, which may be the case especially if one has a family history of psoriasis or rashes on one’s body. If you have been in contact with a ringworm infected cat or dog, also do have your scalp and skin checked by a dermatologist as these infections are contagious and could also cause a form of scalp inflammation presenting as a red, scaly and itchy patch with hair loss.

3. Is my sensitive scalp causing hair loss?

Most cases of scalp inflammation due to eczema, seborrheic dermatitis, scalp folliculitis or psoriasis should not cause hair loss. However severe inflammation can push the hair growth cycle into a stage of telogen effluvium which is when hair reaches the end of its cycle and falls out, similar to hair loss that occurs after a major illness or post-pregnancy. In addition, if one picks and peels off crusted areas over the scalp this can also cause damage to the hair root and lead to hair loss. There are other causes of hair loss such as alopecia areata, which is an autoimmune disorder causing one’s immune system to attack hair follicles, leading to hair loss. This usually has no symptoms other than the appearance of round patches of hair loss over one’s scalp. Scarring causes of hair loss include folliculitis decalvans, which is the end-stage of a type of scalp folliculitis, whereby the hair follicles themselves are constantly inflammed and infected. Children may be more susceptible to tinea capitis, which is a fungal scalp infection that can lead to scarring hair loss if untreated.

© 2017 Dr. Teo Wan Lin. All rights reserved. 

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Top 3 Tips on Hair Loss Treatments Reviewed by a Dermatologist

October 4, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

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One of my patients who came to my clinic for hair loss treatment once remarked that “Why is it that everyone thinks of seeing hair loss treatment centres, hair spas and their hair salons offering anti-hair loss treatments before consulting a dermatologist for their hair and scalp problems?” Hence in part 2 of my article, I will be using this as a case-study in point in my discussion on hair loss.

However, before that, I would like to qualify what exactly counts as hair loss. It’s normal to lose about 60–100 strands of hair a day, however, anything more than what you are used to losing should be monitored carefully. Here are some symptoms: more hair in your shower drain, on the floor, your combs and pillow, having a wider parting and thinner ponytail for girls. If you have a family member with hair loss, also be alert to early symptoms of hair loss.

1. Who do you see for hair loss and scalp problems?

My patient spoke from experience, having gone a merry-go-round with numerous hair and scalp treatments promising to treat hair loss for over two decades, emerged none-the-better nor wiser until a good friend of hers recommended her to see a dermatologist instead. She had, at that time already resigned to her fate of having a troubled scalp and also lost 40 to 50% of her natural hair at the age of 35, blaming it on bad genetics and oily scalp.

She wasn’t even aware that dermatologists are the specialists in treating scalp and hair problems, including hair loss. Do a google search of “hair loss treatments Singapore” and one is instantly inundated with a multitude of trichologist, herbal remedies, anti-hair loss treatment centres, salon listings, aesthetic centres run by general practitioners and with that a few listings of dermatologists which seems buried under all the other ads. So, if you have a true hair loss problem, stop self-medicating or visiting spas or salons and instead find an accredited dermatologist here.

2.What causes hair loss?

In my dermatological practice, almost all patients suffering from hair loss had also done their due research online about possible causes of hair loss before seeing me. The real problem though, medical websites are not written for the layperson and the lists of diagnoses of conditions that lead to hair loss simply leave the hair loss sufferer worried and fearful. Those that do their research on forums and beauty websites are none the wiser, as they suggest many non-evidenced backed methods of hair growth or causes of hair loss which is simply unscientific and wrong information. There are many different causes of hair loss, which can occur at the same time or individually, and dermatologists need to conduct a thorough history taking, medical evaluation/examination and may recommend some blood tests and microscopic tests before diagnosing the cause of hair loss. For some rare causes of hair loss, especially of what is termed scarring alopecia, a scalp biopsy, which is where samples of the scalp are taken for microscopic examination may be required.

3. Can hair loss be treated?

The good news is, my patient’s hair loss did get better, she turned out to be suffering from a combination of telogen effluvium, scalp inflammation from seborrheic dermatitis as well as underlying genetic hair loss, known as female pattern hair loss. The bad news? Her treatment took a while, while her hair loss was controlled, a lot of her hair follicles had become miniaturised (think the shiny glossy scalp that you’ve seen in older men with androgenetic alopecia, which is hair loss influenced by genetics and the male hormone testosterone). What this means is that it is a more advanced stage of hair loss which could mean a slower or less optimised outcome with treatment. The take home point is, while there are multiple evidence-based methods of encouraging hair growth (for cosmetic reasons in age or genetics influenced hair loss i.e. androgenetic alopecia) such as light treatments, in combination with active ingredients such as minoxidil and more recently, copper peptides which I prescribe in my practice. The real issue is that more severe underlying medical conditions like lupus (an autoimmune disease), chronic undiagnosed illnesses, thyroid disease, anemia — these have serious underlying health implications which need to be treated on top of the hair loss problem. In addition, a trained dermatologist can pick up causes of both non-scarring and scarring alopecia, the latter is irreversible hair loss that can be promptly diagnosed and requires medical treatment.

© 2017 Dr. Teo Wan Lin. All rights reserved. 

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Singapore Dermatologist Demystifies Hair Loss Treatments

October 3, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

In my practice, I have seen many men and women who are beset with hair loss, which can occur at any age and is extremely distressing. It is unfortunate that many go the route of medi-spas and scalp treatments by aestheticians before deciding to see a dermatologist, by which time a lot of their hair has already been lost.

I’ve also seen so many expatriates who are convinced that only since moving to hot and humid( and stressful) Singapore they have started developing scalp problems and hair loss. Also with stories that their friends have developed the same issues since moving to Singapore, leading some to even conclude that the water supply must be the cause. So if you’ve moved to Singapore recently, started having hair fall and feeling panicky, fret not because I’m about to share some top dermatologist tips (the first of a series) on hair loss happening on this sunny island. Ever since the media brouhaha about certain hair loss treatment centres’ tactics on selling beleaguered customers their “anti- hair loss” packages, I’ve been wanting to share my dermatologist expertise on this troubling topic, hoping it will help many out there who are searching for an answer to their hair loss woes. So I’ve decided to pen down some the top tips dermatologists offer to hair loss patients in a series, starting with the first.

1. Hair loss is not caused by a wrong shampoo, hair care products or even water supplies

Hair loss is not caused by using the wrong kind of shampoo. Period. The science of all shampoos is that it contains lathering agents, like sodium or ammonium-laureth sulfate based detergents, in varying proportions, to grab dirt, grime, bacteria and oil from the surface of the scalp and hair and the foam is then rinsed off with water. The ones which promise to degrease and deep-cleanse are simply those that contain higher proportions of Sodium Laureth Sulfate (SLS). Put simply, all shampoos perform a similar function and the main difference would really be how well they cleanse the scalp without drying out hair ends.

It is a total myth that what’s in your water (assuming we are speaking about potable water in the first place) can affect the condition of your scalp. Unsanitary water would be teeming with bacteria so using that on any part of one’s body can indeed increase chances of infections but that’s never the case in Singapore. Hence there’s no possibility that the water you are using to shower is causing your hair loss and there’s also no need to spend extra money on specially treated water for showering!

2. Chemical hair treatments like rebonding, perming and bleaching can cause hair loss, but a specific kind

It’s a question that almost every patient with hair loss asks me, “ Is my hair loss caused by bleaching my hair last year?” The truth is bleaching is detrimental for the hair shaft( which is made from keratin, a dead material) but unless one has an allergic reaction ( i.e. allergic or irritant contact dermatitis ) due to the bleaching agent that occurs on the scalp( which is the “living component” where the hair follicles are), bleaching itself should not cause hair to fall out from the roots, which is true hair loss. What bleaching and other chemical treatments i.e.perming, rebonding, hair dyes, actually does is to alter the structure and the bonds of the hair via chemical reactions so that it’s appearance is changed. Essentially, these chemical processes damage the hair shaft, leading to parts of the hair shaft being broken off and causing hair loss by breakage. If you have bleached or permed hair, you should adopt grooming practices such as a wide-toothed comb and soft bristled brush using gentle detangling motions rather than harsh combing which can result in even more breakage.

3. Certain hairstyles can trigger and worsen hair loss

Do you always tie your hair in a tight bun or pony tail? If you find your hairline receding or are experiencing tightness or even a headache around your hairline at the end of the day, beware. Dermatologists counsel that wearing such hairstyles persistently can cause a form of hair loss known as traction alopecia, whereby continued pulling and pressure over the hair roots causes the hair follicles to weaken, miniaturise and if over an extremely long period of time, even die. If you are having hair loss concerns, use a scrunchie or a hair tie that does not rip at the hair or tie it overly tightly. You may want to keep a shorter hairstyle while your hair loss concern is addressed by your dermatologist.

© 2017 Dr. Teo Wan Lin. All rights reserved.

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

Top Hair Loss Tips & Treatment by a Singapore Dermatologist – Hairy Issue(s)

January 1, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

 

Am I losing hair?

Do you notice more hair than usual in your drain, on the floor, combs and on your pillow? Do you find your hair parting wider and ponytail less thick? Do you have family members with hair loss?

I have a greasy scalp and dandruff, does this cause hair loss?

Seborrheic dermatitis is the medical term for dandruff and it is caused by the overgrowth of yeast on the scalp, worsened by a humid climate and scalp oiliness. While this does not directly cause hair loss, it can drive inflammation in the scalp which can lead to hair loss if it is not controlled.

What to do?

If you have such symptoms which do not improve with an over the counter anti-dandruff shampoo, promptly seek the care of a dermatologist who will evaluate the cause of the flaking and prescribe medicated lotions and shampoos which will stop the inflammation. For hair loss, certain hair lotions and laser devices can be used to encourage hair regrowth.

Is my scalp sensitive?    

Patients with sensitive scalp are likely to feel itch, pain or stinging over their scalp and may also experience symptoms of scalp flaking, pimples and hair loss.

I have sensitive and oily scalp, can I go for herbal scalp treatments which claim to unclog my pores?

Increased scalp sensitivity is due to underlying inflammation which is always related to a medical diagnosis that must be addressed by a dermatologist, who would treat the condition with appropriate prescribed medicated shampoos and anti-inflammatory scalp lotions, and monitor for clinical improvement.

Any other forms of “scalp treatments” for hair loss or scalp greasiness/dandruff by non-dermatologists and herbal preparations are not evidence-based and often contain harsh irritant substances that cause scalp eczema. There is no such thing as scalp “pores” being clogged up. Patients who experience recurrent scalp pimples have a condition known as scalp folliculitis, which must be controlled with oral antibiotics.

© 2017 Dr Teo Wan Lin. All rights reserved.

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Meet with Dr. Teo Wan Lin, accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to treat any hair conditions you may have.

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here