Hot weather causes rise in heat injury cases, worsens skin conditions

As the mercury spikes, with record temperatures hitting 37 deg C in mid-May, hospitals and clinics here are seeing more patients with heat injuries and heat rashes or flare-ups of pre-existing skin conditions.

From about zero to two cases of heat injury a week between January and April, the number has increased slightly since May to four cases a week at hospitals under the National University Health System (NUHS) – which includes the National University Hospital (NUH), Ng Teng Fong General Hospital (NTFGH) and Alexandra Hospital.

Khoo Teck Puat Hospital (KTPH) has seen a 1½ times increase in heat injuries since April. In particular, the hospital saw cases of heat exhaustion jump to five in May, from one case in April.

Heat injuries can range in severity – from heat cramps, which are painful muscle spasms due to the dilution of electrolytes in the body caused by heat exposure, to heat exhaustion, where a patient is still alert but experiences body aches, dizziness and a fast heart rate due to heat exposure and dehydration.

The most dangerous and severe heat injury is heat stroke, where patients are confused, have a high body temperature of more than 40 deg C, and are at risk of multi-organ failure.

Dr Ong Pei Yuin, a consultant at NUH’s department of emergency medicine, said the spike in the number of cases corresponds with the higher temperatures that Singapore has been experiencing.

Most of the cases at the NUHS cluster were minor, and patients were discharged after treatment, said Dr Ong, adding that none of the cases in the past month were admitted.

Dr Kanak Naidu, a senior consultant at KTPH’s acute and emergency care department, said that people who work outdoors or engage in outdoor activities are more prone to getting heat injuries.

But heat injuries can also happen to those staying indoors – especially the elderly – if there is no proper ventilation or other means of air movement such as fans or air-conditioners.

Dr Rachel Lim, clinical lead for the preventive care workgroup at SingHealth Polyclinics, said young children and the elderly are usually more susceptible to having heat-related health conditions.

“Young children have a greater exposed body area than the overall volume of body fluid compared with adults, resulting in greater heat absorption. The elderly, on the other hand, have a reduced ability to remove heat from their body. Always remind the elderly and young children to hydrate themselves as they may sometimes be unaware that their bodies require replacement of fluids,” she said.

Other individuals at higher risk of heat-related health issues include pregnant women and those who are obese, in poorer physical condition, or have chronic medical conditions such as diabetes and cardiovascular diseases, she added.

Patients have also been turning up at general practitioner clinics to seek relief for heat-induced ailments.

Dr Vincent Han from A Medical Clinic said that he has seen up to a 30 per cent increase in mild cases involving headaches, heat rashes and heat cramps.

He also had two cases where the patients were close to heat exhaustion – they were exercising during a hot period, like midday, and had transient fainting episodes lasting one to two seconds. However, they were able to recover quickly after resting and hydrating themselves.

“People should not try to exercise to the same threshold like they did in the earlier part of the year when the weather was cooler. They should try to acclimatise themselves to the hot weather, and this conditioning will take one or two weeks,” added Dr Han.

Doctors say that to deal with the spike in temperatures, it is important for those who exercise to hydrate themselves often, drinking a bottle of fluid for each hour outdoors.

People should also avoid intense outdoor activities between 10am and 4pm, as the weather is at its hottest during this period, They should also wear lightweight, loose-fitting and light-coloured clothing that allows for better air circulation and reflects sunlight.

In terms of diet, opt for light, easily digestible meals that are rich in water content, such as fruits, vegetables, salads and chilled soups. Avoid heavy, greasy or spicy foods, which can increase body heat.

The heat has also worsened skin conditions, according to some hospitals and clinics.

Dr Tan Ki Wei, chief and senior consultant at Changi General Hospital’s department of dermatology, said there has been an estimated 10 per cent to 20 per cent increase in cases in the past month of patients’ eczema worsening as a result of the heat and excessive sweating.

The National Skin Centre (NSC) has seen a rise in the number of patients with a flare-up of their pre-existing skin conditions, particularly eczema. NSC did not provide a figure for this.

GP clinics Life Family Clinic and Yang and Yap Clinic told The Sunday Times that they have seen over the past month increases of 20 per cent and 15 per cent, respectively, in patients seeking help for heat rashes and worsening of their eczema conditions.

Dr Su Pei Qi, a consultant at NSC, said eczema patients present with dry, irritated skin and often experience a worsening of their itch.

Ms Josephine Lee, an educator, 35 has suffered from eczema since her primary school days. The hot weather has made her skin more irritable and itchy, affecting her mood and ability to sleep at night.

She also had to change her lifestyle in recent weeks to manage her skin condition. “I cannot go to the gym or to the swimming pool, which I used to do about three times a week. I stay in air-conditioned places more often and use more moisturiser to soothe my skin,” she said.

Patients with psoriasis may also complain of increased itchiness, while those with acne may experience a worsening of their pimples as increased sweat and oil can lead to clogged pores and may precipitate acne breakouts.

To minimise skin irritation, doctors advise the use of a mild cleanser to wash the skin and to take lukewarm or cool showers rather than hot showers. They say moisturising regularly with a fragrance-free moisturiser is important. Switching to a light or oil-free moisturiser might also be more comfortable, especially if a person is sweating more than usual.

People with acne-prone skin are advised to use “non-comedogenic” or “oil-free” skincare products.

They should also cleanse the face twice daily, as the warm weather and humidity tend to increase the build-up of oil on the skin.

There may be some temporary respite from the scorching heat in the second half of May, as the weatherman is expecting above average rainfall during this period.

But temperatures could keep rising when the El Nino weather phenomenon, which is set to bring hotter and drier conditions to South-east Asia, lands in the later half of the year.