Many Singaporeans suffer from itchy skin, often due to various common skin conditions, such as eczema (atopic dermatitis), psoriasis, or hives (urticaria), impacting their day-to-day quality of life. While scratching would provide some form of relief, doing it continuously will only worsen the skin condition, leading to bleeding and sleepless nights. The skin condition is also further aggravated by the country’s hot and humid weather.
In fact, one in 10 adult Singaporeans suffer from atopic dermatitis, which causes itchy, dry and cracked skin.
While there are many products in the market that promise to relieve itch, there was an unmet clinical need of relieving and reducing the itchiness effectively. This led to the creation of the Suu Balm, a renowned breakthrough brand, innovated by Dr Tey Hong Liang, a dermatologist at the National Skin Centre (NSC) and founder of The Itch Clinic.
From one solution to a whole variety of selections under body care, facial care, scalp care and one that caters to children.
CHI catches up with Dr Tey and Dr John O’Shea, co-founder of Good Pharma Dermatology (GPD) to learn more about the story behind the innovation of the Suu Balm range of products.
Sense of Relief
When Dr Tey first started The Itch Clinic, the patients that he saw suffered from immense and frequent itches, but there was nothing that they could apply on themselves to relieve the itch. The impact that their skin conditions had on their lives resulted in distress, so much so that up to 20 percent of them were suicidal.
“When I started developing itches myself, I felt that I could now understand from a patient’s perspective. Previously, I was always listening and trying to understand patients, but by experiencing it myself and trying all the different solutions in the market, I found that they do not effectively reduce the itch,” shared Dr Tey.
This predicament led to the creation of a solution that required finding an active ingredient that relieves the itch, while addressing the underlying cause of it to prevent the recurrence, with continuous application of the solution. “So it's a two-pronged approach, addressing the symptoms, addressing the cause and then after that, it perpetuates itself,” he added. The unmet clinical needs to be addressed are:
- The right amount of menthol required to relieve itch, as too much of it would result in contact dermatitis and too little would be ineffective.
- The cream should be safe for those with sensitive skin conditions, as many itch relieving solutions contain ingredients that can cause contact dermatitis, and is a particular concern especially to those suffering from conditions such as eczema.
- The solution should also improve skin barriers, other than relieving the itch.
- Have a moisturising effect without the stickiness upon application
Game Changing Formula
Dr Tey spent years searching for the right formula that would fulfil the requirements of the solution needed to effectively provide relief to his patients. After numerous tests and formulations, he discovered the one combination that truly worked wonders – a natural ingredient – menthol, which when combined in the right amount with a deeply nourishing moisturiser would provide instant itch relief and with daily use, help heal the skin over time. With the help of the pharmacy at the National Skin Centre, they formulated a prototype cream and tested with the patients at his clinic.
When news of its positive results and effectiveness soon got around, other doctors started to use the solution in their clinics and skin centre. With high demand among the doctors, it was obvious that the product could benefit many more people, without having to consult a doctor each time in order to get the solution. This was when Dr Tey and his team reached out to find a partner whom they could collaborate with to further develop the product into something that would be suitable for the public.
Dr John O’Shea and Jason Humphries, co-founders of Good Pharma Dermatology, came onboard the journey to take the solution to the next step. In partnership with NSC, they took it upon themselves to create the brand, Suu Balm, that would become synonymous with fast effective itch relief.
Since the formulation of the first solution, the collaborating partners have gone on to work together on research as well. GPD would share the feedback received from customers, and discuss on ways to meet the suggestions made by the users.
For example, when developing the facial cream, a common question was whether they could use it on their face. Dr O’Shea said, “That let us and Dr Tey confirm that it would be a bit of an issue as the original menthol in our first product would not be ideal for use around the eyes, so we needed to find another solution.”
Together, they chose the ingredients, and Dr Tey would vet these ingredients meticulously. GPD would develop the formulation and help test them, while Dr Tey tests them with samples and prototypes at the National Skin Centre. There were also external tests that were done on the products such as residues, hypoallergenic testing, and looking for potential irritancy. The list of ingredients were kept as short as possible, to minimise any problems that might arise.
A study was conducted at the National Skin Centre to evaluate its safety and efficacy. The study demonstrated a 56 percent reduction in itch for people with reported eczema. Further studies have shown that over 90 percent of people start to get relief from itch within minutes of applying the product.
It took the team almost 2 years to develop the first Suu Balm product, and it took another 3 years before the next Suu Balm product was launched.
The products were registered as cosmetics, and as the team explored breaking Suu Balm into the different territories, they have had to meet the various requirements meted out by the different national authorities. Further clinical studies have been done (or are in planning) in the Philippines and Taiwan to evaluate the products in different patient populations.
While the market demand for an itch relief solution was immense - considering everyone suffers from a bout of skin related irritation at some point - sales were quite low in the beginning. But even then, Dr Tey was steadfast in his belief that the value brought by the Suu Balm would bring customers to make their purchase.
“If one has a product of value, people will recommend to others and word will spread. I think the biggest issue was really getting the buy-in from public healthcare institutions,” reflects Dr Tey. “It was something new. As far as we know, no one had actually tried to commercialise a product from a public healthcare institution.”
He urged for the change in mindset, to view this as a way to create further value for the patients and for the community, rather than holding on with the idea that public healthcare institutions should not co-develop products with pharmaceutical companies. “Suu Balm serves as an example, so that other things could go forth. Without this experience, we couldn't have come up with subsequent products.”
The team still faced quite a bit of problem with that mindset and experienced a lot of resistance. However, there was still hope that people were changing, and as more and more examples come about, and more institutions do it, then this obstacle will soon cease to exist.
“We could probably be here the whole day if I went through all our challenges,” joked Dr O’Shea. “We faced challenges largely because in neither Jason Humphries (co-founder of GDP) nor my background, would you find experience in launching a consumer healthcare product.”
All of the challenges in marketing that the duo faced were due to not knowing what was needed. They overcame most of their problems by leveraging on their past experiences, particularly for Jason as he had a lot of experience that was relevant and then our consulting background, for example, what they used to do for other people, where they analyse the problems and try to come up with solutions for them.
“When things don't seem to be going right, or when we've got a challenge, we go out and try and talk to people. We do our desk research and analyse our situation, then try to come up with potential solutions to that,” said Dr O’Shea.
Into the Unknown
In a recent example, due to the COVID-19 crisis, they only had 2 days to bring their products in from their manufacturing facility in Malaysia, just before the closing of borders and lockdown in Malaysia took effect. No one knew how long the borders would be closed, and without the possibility of drawing products from the factory, there was concern on whether there would be enough stocks to market. “It was a brand new experience for us, but thankfully, the flow of goods between Singapore and Malaysia continued shortly after. Fortunately, there were also buffer stocks at the Singapore warehouse to ensure that pharmacy shelves are well stocked up,” said Dr O’Shea.
The team also faced problems shipping the products to further markets like the Philippines, Taiwan, UK, Ireland and Thailand, as shipping to these locations were done only a few times a year. But thankfully, by the time the products needed to be shipped out in August, regulations for shipping of products to these countries were eased.
Aspire to Innovate
Dr Tey said that clinicians were in the best position to understand the issues faced by the patients, and that it was important to take the initiative to innovate and come up with ways to solve these issues.
There was that mindset that “innovation is for innovators, and that clinician just want to see their patients.” Dr Tey said that from the get-go, doctors and clinicians have been solving their patients’ problem and by thinking of ways to innovate the way we treat the problems, patients would fare better, and the clinic would do better too.
“You are actually improving your clinical practice. I think we have to see it that way, right from the start. We spend after office hours working on solutions, but subsequently as you get better, you can actually apply for time, for grants to fund your project. You get more resources, more muscles, more connection, more help, then you can do bigger and better things,” encouraged Dr Tey.
“I think we have heard from many people that you always go and look for your niche. I always say, go find your own Calcutta, like what Mother Theresa said, you really have to find somewhere that has an unmet need,” urged Dr Tey to all aspiring innovators. “The best person to think of a solution is actually the one who accumulates all the complaints and problems shared by the patients.”
He advises for potential innovators to identify the problem, and then take a step back to think beyond the routine algorithm of what would be usually prescribed.
Then, think of how the situation can be further improved and resolved. Sometimes, taking a step back and stripping away the conventional perspective will give a clearer picture on how to approach the situation.
From that start point, identify the need, and think of different varying solutions instead of conventional ones. Innovators should also engage and collaborate with technology providers, and marry the problem with the technology to come up with the solution.
When taking a solution out to market, Dr Tey likens it to an orchestra, where the innovator acts as a conductor standing in the middle to make sure that the players managing the science, the marketing, the commercialisation and regulatory processes are all in synch, like one big musical movement, and know exactly how and when to deliver the solution to the patients. And that would be the end point.
Although now fairly well known in Asia and the West, the Suu Balm team continue to work tirelessly to introduce more solutions for the community. Eight solutions are currently in the making, and 2 to 3 products were expected for launch over the few years. But, with ingredient companies and researchers coming up with new ingredients and ideas, the team would be on their toes to constantly update their existing products and continuously improve their offerings.
The brand distribution’s most recent expansion was to Hong Kong in October last year, and next on the list would be Indonesia, which they hope to market to later this year.
“Indonesians have been very entrepreneurial and resourceful people. In fact, Suu Balm has been on sale via Tokopedia, one of their e-commerce platform,” said Dr O’Shea.
The successful collaboration between Dr Tey from the NSC, and Dr O’Shea and Mr Humphries have led to the global community benefiting from a solution that not only soothes the itch, but adds on to the quality of life by eliminating this ailment.
So next time you want to scratch that itch, think about how a certain soothing solution was innovated simply by having that determination to eliminate a problem!
*The innovation was made possible with facilitation from NHG’s Centre for Medical Technologies & Innovations (CMTi).
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