38 IRRAWADDY ROAD #07-28
MOUNT ELIZABETH NOVENA SPECIALIST CENTRE
CONTACT: +65 6355 0522

Do you have cystic acne?

March 19, 2019

While acne is a common skin disease, it is often difficult to treat severe acne, like the nodulocystic form. Also known as cystic acne or nodular acne, such severe forms can cause significant damage to the skin and affect one’s self-esteem.

Is my acne mild or severe?

If you find that you have only one or two pimples appearing at a certain time of the month, it is considered physiological acne and it is mild. The occasional outbreak you experience is often resolved on its own.

However, if the original blackhead or whitehead becomes badly infected by surface bacteria that it triggers the skin’s inflammatory response, a cyst wall may form around the original site of inflammation.

How do I know if I have cystic acne?

Cystic acne, or nodular acne, are larger and more severe than the typical pimple. These nodules feel like stubborn, firm bumps under the skin and can last for months. You can get them on the face, neck, back, chests or shoulders.

What causes cystic acne?

Cystic acne develops from milder forms of acne. Oil and dead skin skins that clog the oil gland also traps bacteria within, causing inflammation. You may also be genetically disposed to developing cystic acne, if your parents had severe nodules, you are more likely to get it.

Hormones are also another major cause for cystic acne, which may explain why they can develop during puberty. Hormonal changes that take place during pregnancy can also trigger cystic acne.

What happens when your cystic acne is not treated?

Treatment of cystic acne can be challenging as topical treatment is usually less effective. If left untreated, your cystic acne may become a permanent scar. This can be painful, red and get secondarily infected over time. If the condition worsens, an abscess will develop, that is a collection of pus under the skin.

Do not squeeze or pick the pimple, as it introduces more bacteria to an already infected cyst. Extraction of the cyst with sharp objects by non-medical professionals should also be avoided, as they are not safe and sterilized in a medical environment. Doing so only introduces potential for bacteria to affect you, even if you are not acne prone. For example, we have been referred patients who had what started as an ordinary pimple, infected by a rare infection known as atypical mycobacteria. The bacteria originated from tap water with use of an unsterilized instrument by a facialist, leading to granulomatous infection of the skin and led to a sequence of biopsies as well as several months of oral antibiotics for treatment.

How should you treat cystic acne?

When you develop a single bump that becomes large and painful, it is a sign that your acne may be severe. If the acne does not disappear after a maximum of 2 months, it is unlikely that it is just normal physiological acne. This warrants medical treatment before the cystic acne worsens. Over-the-counter acne treatments are less effective against cystic acne and it is best to visit an accredited dermatologist as soon as possible.

Under the care of a dermatologist for assessment, one would expect an injection of triamcinolone, a steroid that can reduce swelling and inflammation, leading to the resolution of the cyst wall.

Another common therapy is oral isotretinoin, known for its efficacy for cystic acne. Severe acne tends to be unresponsive to drugs such as oral tetracycline or topical adapalene/benzoyl peroxide. It helps to fight acne by reducing the size and activity of your oil glands and reducing acne-causing bacteria.  However, isotretinoin also has side effects, limiting its usefulness for certain patients. Side effects include liver damage, depression, behavioural change and risk of causing serious birth defects. Isotretinoin can also make your skin feel very dry. Your eyes will also feel drier than normal.

Cosmeceuticals should also be used in tandem with oral medications. Use moisturizers regularly, such as Multi-CERAM™ Moisturizer for a healthy and hydrated skin barrier. Vitamin C serums have anti-acne abilities and help to accelerate healing scars. An anti-bacterial cleanser is also essential to allow a thorough cleanse, consider a gentle cleanser such as Miel Honey™ Cleanser.

To treat scars, chemical peels and laser resurfacing can be considered.

Visit a dermatologist to get a professional diagnosis, who will be able to pick the best form of treatment to suit the severity of your acne and reduce scarring.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
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 guide on milia treatment

February 25, 2019

 

They may be small, but we definitely do not want these small, pesky bumps around. Milia, sometimes called ‘milk spot’ or ‘oilseed, are tiny white bumps that are benign, but hard to remove. You may have attempted to squeeze it out, given that milia can be cosmetically unappealing, but that would only worsen it.

If you are hoping to know the causes of those tiny bumps under your eyes, and how to get rid of it, read on.

Understanding what is milia – the white bumps under your eyes

Milia are keratin-filled bumps of 1-3 mm in diameter, arising from the outermost layer of the skin. Keratin is a structural protein that makes up your hair, nails and skin.

They are classified into primary and secondary milia.

What causes milia?

Primary milia is the most common, occurring spontaneously without a known stimulus. Secondary milia is induced by various stimuli, typically when the skin undergoes some form of trauma. This could be dermabrasion, physical trauma e.g. x-rays, inflammatory skin diseases e.g. acne or use of topical or systemic drugs.

Primary milia are connected to the sheath of our hair follicles, near our oil glands. Secondary milia connect to our sweat glands, rarely to hair follicles or the outermost skin layer. Milia are formed when there is an obstruction of the hair follicles or sweat glands.

Primary milia

Such form of milia is common in newborns, typically found on the face or scalp. They tend to disappear within weeks. In adults, benign primary milia occur spontaneously, often randomly distributed across cheeks and eyelids, and sometimes at the genitalia. While milia found on newborns go away in time, milia that develop later in life tend to persist.

Rarer forms of milia include milia en plaque, where multiple keratin-filled bumps are found in a cluster. It occurs without any apparent trigger and can arise spontaneously on healthy skin of predisposed individuals. Affected areas are often reddish, found under the eyes, on the ears, head or neck.

Multiple eruptive milia have a wider distribution than simple primary milia. It may be spontaneous or an inherited genetic condition. The bumps can be found distributed over the face, neck, upper chest, back and arms. It often numbers in the hundreds and can develop over a period of weeks to months.

Secondary milia

Secondary milia occur anywhere following traumatic stimuli after the skin is damaged in some way. Medications that may trigger secondary milia include topical steroids, penicillamine, benoxaprofen and cyclosporine. Other conditions can include contact dermatitis, skin grafts, second-degree burns and radiotherapy. In children, superficial abrasions can also lead to secondary milia.

Treating milia: can it be done at home or by a dermatologist?

Milia is benign and does not have any symptoms, thus treatments are only necessary if requested by the patient. However, all treatments must be recommended by your dermatologist.

  • Evacuation: For individual milium, the most effective way is to nick it with a scalpel blade, followed by applying pressure with a blunt edge. It is important to only have it done at a dermatologist’s office, as it may result in scarring when done without professional expertise. Any puncture of the skin may also cause infection.
  • Laser therapy: CO2 laser ablation can treat individual or multiple milia with minimal complications or recurrences
  • Oral prescription: Tretinoin or minocycline is often prescribed.
  • Microdermabrasion: A skin-resurfacing procedure to help gently sand the outer skin layer, causing cell turnover. Skin that grows back is smoother.
  • Electrolysis: Current is applied through a tiny needle on the milium, piercing through the keratin-filled bump. The contents of the milium are then soften, thus easy to remove.

Patients should not attempt milia extraction at home on themselves. While milia alone do not have any side effects, improper technique can cause skin trauma, leading to scarring or injury. If you would like to remove milia professionally, consult an accredited dermatologist.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
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.

 

 

 

How to reduce stretch marks

February 24, 2019

 

Stretch marks are extremely common. Yet, those squiggly lines on your skin are never welcomed. While such forms of dermal scarring are not medically dangerous, it can be aesthetically unpleasant to patients, causing distress.

Common occurrence of stretch marks includes the thigh, buttock, lower back, chest, upper arm and knee. Striae rubrae and striae albae are the two recognizable forms of stretch marks. Striae rubrae are flesh-toned scars, often accompanied by redness and ruptured capillaries that cause a subtle violet appearance. They then progress to striae albae – silvery, wrinkled scars that are hypopigmented (lighter than your usual skin colour).  

What causes stretch marks

Stretch marks, or striae distensae, occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include endocrine imbalance (a type of hormone), extended periods of mechanical stretch or any structural changes to the skin can lead to stretch marks. Chronic use of oral or topical corticosteroids can also contribute to the development of stretch marks.

Stretch marks are formed via three main mechanisms:

  1. Genetic predisposition
  2. Hormonal disorders
  3. Mechanical disorders/stretching of the skin

Genetic predisposition

No specific gene has been isolated as the cause of stretch marks developing. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions. This suggests genetic predisposition, that certain individuals may have a greater tendency of developing stretch marks based on their genes.

Hormones

A hormonal imbalance can contribute to the development of stretch marks. A hormone called adrenocorticotrophic causes an increased rate of protein breakdown. In turn, this leads to less collagen and elastin fibres being produced. With less collagen and elastin, the skin is less flexible and resilient to withstand stretching, causing stretch marks.

This effect is similar to that caused by corticosteroids, which explains why patients on long-term use of the drug are more prone to developing stretch marks.

Mechanical stretch

Rapid expansion or contraction of the skin causes it to stretch beyond its usual elastic ability. Fibres in the middle skin layer (dermis) stretch to accommodate when growth is slow. But with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming stretch marks.

In pregnancy, stretch marks frequently appear in the third trimester.

How to treat stretch marks

Topicals:               

Topical treatments only have mild effects in reducing appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach.

  • Tretinoin: Boost fibroblast production. Fibroblasts are molecules responsible for the structural support in our cells and synthesize collagen. Best for striae rubrae (for newly developed stretch marks), poor for striae albae (stretch marks that have been around for some time).
  • It is not recommended to use tretinoin during pregnancy as it carries a risk of birth defects
  • Phytochemicals: Plant extracts such as Centella Asiatica can boost the cells that produce elastic fibers and collagen. Resveratrol, naturally occurring in grapes and berries, can also boost skin elasticity. Elixir-V™ Total Recovery Serum contains a potent combination of phytochemicals, including resveratrol, to help fight ageing effects
  • Moisturizers: They can be applied as an adjuvant to treat stretch marks. Look out for moisturizers with active ingredients such as niacinamide. Apart from its brightening abilities, niacinamide stimulates collagen synthesis. You may consider Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide.

While ingredients such as cocoa butter or olive oil are commonly marketed as effective in reducing stretch marks, it has not been scientifically proven to show results.

Chemical peels: They help to induce the production of collagen and improve the appearance of stretch marks. Salicylic acid, lactic acid and glycolic acid are most commonly used.

Microdermabrasion: In this process, physical agents such as aluminium oxide is used for skin resurfacing. A targeted injury is caused to trigger collagen production and to deposit elastin. Topical therapies are also more effective after microdermabrasion, as your active ingredients can better penetrate the dermis layer.

Light therapy: Different types of light treatment are available to stimulate collagen production in the dermis layer. Examples include infrared light devices, intense pulsed light (IPL) and ultraviolet light.

Ablative lasers: Such lasers are effective in reducing scars as they create a deliberate wound to induce healing of the skin.

Stretch marks are not medically dangerous, but if you are seeking for an effective treatment, it is best to consult an accredited dermatologist for best results.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

—–

Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

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.

 

Tips for a proper shave

January 27, 2019

 

Shaving-related irritation is one of the most popular cosmetic complaints among men. While it can affect any part of the face, the neck area is particularly sensitive to shaving nicks and redness.

If you are looking to keep your shave smooth and irritation-free, stick around as we share a few useful tips below.

Shaving and your skin

Shaving close to the skin without causing trauma is challenging. Also, shaving can compromise your skin barrier. Specifically, our skin has a layer of lipids that works to retain moisture and regulate the entry of any chemicals. When we shave, this lipid layer is compromised, especially if alcohol-containing aftershaves are used. When the lipid layer is damaged, the skin becomes extremely vulnerable to external stimuli. Moisture is easily lost to the surroundings and foreign chemicals can enter the skin easily. The skin can be more irritable at this stage.

Shaving may also be a physical stimulus for the receptors in our skin. While the sensory receptors in the skin are meant to perceive pain, they also react to more innocent environmental stimulus like a razor. Upon shaving, the skin releases mediators that cause a flare response, which leads to redness or a burning sensation.

Ingrown hairs

When shaved, the hair is left with a sharp tip. Ingrown hairs happen when the tip grows out of the follicle, curves downwards and re-enters the skin. Alternatively, it can grow inwards and penetrate the deeper skin layers.

Your body recognizes the hair’s reentry as a foreign object and triggers an inflammatory reaction that causes redness and itchiness. The follicles can resemble a pimple filled with pus.

To avoid this, do not stretch the skin while you shave as it causes newly cut hair to retract underneath the skin.

Razor burns

Razor burns occur when there is skin inflammation. Symptoms include burning, itching, stinging and redness. In mild cases, the discomfort can last for a few hours and resemble a rash or scratch. If the condition worsens, you may notice bumps that resemble pimples.

Tips for a smooth shave

  • Dry beard hair is stiffer more resistant to applied forces, which means stiffer hair requires greater force when shaving. To soften the beard hairs, first, wash your face with warm water and a gentle antibacterial cleanser like Miel Honey™ Cleanser. The cleanser is formulated with natural honey and Arnica Montana that reduces the risk of infection. The motion of washing your face also releases embedded hairs.
  • Shave with the grain, i.e. in the direction of hair growth, to reduce razor burn.
  • Use a sharp and clean razor blade with every shave. Dull blades require more pressure and unclean blades can introduce bacteria and trigger inflammation. 
  • If ingrown hairs are a significant issue, switch to electrical razors that reduce the closeness of the shave. Maintain beard hair at length of 0.5 to 1 mm to prevent hair from penetrating the skin.
  • Use a moisturizer after your shave to decrease irritation and rehydrate the skin. An emulsion-based, lightweight moisturizer like Radiance Fluide™ Hydrating Emulsion is recommended.

If you experience persistent shaving-related irritation, it is best to visit an accredited dermatologist. A thorough consultation can identify any underlying condition and provide advice on suitable treatment options.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

—–

Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

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 Guide to Exfoliation

January 20, 2019

Exfoliation, or the removal of dead skin cells from the outermost layer of the skin, is an important and necessary part of any skincare routine. However, if the word ‘exfoliation’ conjures up the action of scrubbing your face with harsh granules, you may be doing more harm to your skin than good.

So what is the right exfoliation technique for your skin?

Benefits of exfoliation

We shed dead skin cells naturally as new skin cells slowly travel up from the deepest skin layers to the surface. On average, this process takes about 27 days.  As we age, this cell turnover process slows down.

When we exfoliate, we remove the build-up of dead skin cells. Regular exfoliation can reveal younger, brighter skin with an even tone. 

Types of exfoliation

Exfoliation can happen in two forms: physical and chemical.

  • Physical exfoliation: Physical exfoliation relies on the rubbing of tiny granules or particles over the face to remove dead skin cells by physical force.

While this kind of exfoliation can leave you feeling refreshed, the technique can be too harsh for the skin, especially for individuals with acne-prone or sensitive skin. Physical exfoliation may even weaken the skin’s barrier function and leave your skin red or irritated.

For those of you without sensitive or acne-prone skin, physical exfoliation can still be an option. However, make sure to look out for exfoliating agents that are not too large.

  • Chemical exfoliation: Chemical exfoliation relies on fruit enzymes and gentle acids to slough off dead skin. This mechanism is much gentler than physical exfoliation and more suitable for acne-prone and sensitive skin types.

Types of acids

The two most well-known type of exfoliating acids is alpha hydroxy acids (AHA) and beta hydroxy acids (BHA).

AHAs: Alpha hydroxy acids work by causing skin cells to detach from the outermost layer of skin, making them easier to slough off. Once the dead skin cells are removed, new cells can rise to the surface.

Common AHAs used as chemical exfoliants are lactic, glycolic and mandelic acid.

Glycolic acid: Glycolic acid is the strongest AHA as it has the smallest AHA molecule. As such, it is able to penetrate deeper into the skin and can exfoliate at lower concentrations compared to other acids. However, if you are just beginning to try out chemical exfoliants, a different acid should be considered.

Lactic acid: Apart from exfoliating, lactic acid also moisturizes. Individuals with dry skin can consider lactic acid for this dual function.

Mandelic acid: With a larger molecular structure, mandelic acid is not able to penetrate deeply into the skin. This makes it a gentle AHA and safe to use, especially for people with sensitive skin.

BHAs: Beta hydroxyl acids (BHAs) differ from other AHAs as they are oil-soluble. This property allows them to penetrate deeper into our skin and pores.

BHAs exfoliate by softening the outermost layer of skin cells and dissolving unwanted skin debris. They also have anti-inflammatory and antibacterial properties, making them ideal for individuals with oily and acne-prone skin.

Chemical peels

Chemical peels are often done at a dermatologist’s office where the chemical agent used can be much more concentrated. Glycolic, lactic or salicylic acid is commonly used. A certified dermatologist is best able to identify the type of peel for your skin.

With regular use, these treatments exfoliate the surface skin and improve fine lines, wrinkles, skin discolouration and texture.

Chemical exfoliation at home

Most patients prefer to do chemical exfoliation on their own. However, this can cause skin sensitivity and redness for certain individuals over time without proper medical supervision.

As a result, Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, recommends using active ingredients such as stabilised vitamin C (sodium ascorbyl phosphate), hyaluronic acid, phyto plant extracts or LARECEA™ extract. These ingredients are proven to deliver health to your skin without the sensitivity that AHA or BHA might cause when used without medical supervision.

Over-exfoliation

The benefits of chemical exfoliation may make it tempting to use AHAs and BHAs often. However, too much exfoliation can disrupt your skin barrier and cause the skin to become red and inflamed.

If you are a beginner to AHA and BHA, start slow. If you do not have sensitive skin, exfoliate every other day. Those with sensitive skin should stick to exfoliating once a week. Discuss with your dermatologist how often you should get chemical peels.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

—–

Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

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.

 

 

How does your skin react to alcohol?

January 19, 2019

 

What happens to your skin when you drink too much?

To maintain the health of your skin, you may want to think twice before you reach for one too many drinks. Alcohol can be pretty harsh on the skin.

Here’s why.

Premature ageing

When broken down, alcohol produces molecules called aldehydes. Such molecules cause damage to the body’s cells by destroying their ability to function. When cells are damaged or die, our body produces new cells to replace them. However, a single exposure to alcohol can reduce the body’s ability to multiply cells.

Another effect of alcohol is the widening of small blood vessels in the skin. This allows more blood to flow closer to the skin’s surface, which produces the distinctive flush and feeling of warmth often associated with alcohol consumption. Over time, this can cause an unhealthy appearance including dullness, enlarged pores, sagging, discoloration and a lack of skin resilience. Such effects can last for days.

Excessive alcohol consumption can further limit the liver’s ability to remove toxins, which can also make you look older.

Dehydration

Alcohol interferes with the body’s ability to regulate water levels. Your brain produces a hormone called anti-diuretic hormone (ADH) that acts on our kidneys to control the amount of water secreted in your urine. When your body is dehydrated, your brain sends a signal to pump out ADH. ADH stops you from urinating as much, allowing you to retain your water levels.

Alcohol inhibits ADH levels. So even when you drink a lot of water alongside your alcoholic drinks, your body only hangs on to about a third of it while the rest goes out in your urine. In other words, alcohol increases urine volume and leaves your body dehydrated.

This dehydrating effect worsens skin elasticity, thickness and density. It also makes wrinkles and fine lines more noticeable. 

Itchy skin

Most itchy skin diseases are exacerbated by alcohol consumption. Alcohol causes eczema to be twice as common, likely due to its suppressive effects on the immune system.

Alcohol also makes psoriasis harder to treat. Psoriasis refers to the condition of red, itchy skin. While alcohol itself does not cause psoriasis, it increases the body’s susceptibility to infection and exacerbates the condition. Heavy drinkers are also more resistant to therapy.

Flushing and Rosacea

Flushing is a common after-effect of drinking and tends to go away the next day. It is more prevalent in individuals who do not have an enzyme that breaks down aldehyde. (Alcohol is broken down via two general steps, first into aldehydes and then to acetate.) An accumulation of aldehydes causes flushing and rapid heart rates.

An impaired alcohol metabolism can also worsen rosacea, a common skin disease with a tendency to blush or flush more easily than others. It can further cause an increased incidence of telangiectasia or the appearance of spider veins at the surface of the skin. 

Inflammation

When alcohol is broken down in the body, reactive oxygen species (ROS) is released as a by-product. ROS are important signalling molecules in the body.

However, excess ROS production can be harmful to the skin as it alters the body’s immune response, triggers inflammation and causes the body to attack itself. This can compromise the skin’s wound healing processes.

Consequently, alcohol can cause skin conditions such as eczema, psoriasis or, in some cases, acne to take much longer to heal than before.

Resveratrol in red wine

Resveratrol is an antioxidant often found in red wine. (Antioxidants work to fight against the oxidative stress that your skin cells encounter.) Resveratrol also has therapeutic benefits against various skin disorders and protects the skin against harmful UV rays. Given that UV radiation is a major cause of ageing, resveratrol is popular for its anti-ageing abilities.

However, there are other ways to get resveratrol that do not include the harmful effects of alcohol.

For a dermatologist-formulated anti-ageing serum, go for Elixir-V™ Total Recovery Serum. It contains a potent concoction of resveratrol, hyaluronic acid and oligopeptides that work together to give you the perfect V-face look.

Seek for help

If your skin condition worsens, schedule a visit with a dermatologist as soon as you can. The dermatologist can determine the best course of action and suitable treatment that would be effective for your condition and your lifestyle.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

—–

Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

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.

 

 

 

 

 

Tackling oily skin

January 1, 2019

Are you tired of your skin getting greasy midday? Oily skin is a common cosmetic problem that gives the appearance of shiny skin. While there is no way to prevent it, there are certain techniques that can help fight it.

What causes oily skin?

We begin by understanding the oil, or sebaceous, glands on our face. These glands release a complex mixture of lipids (fats) onto the skin surface called sebum. Oil glands are highly concentrated on the face, upper chest, back and behind the ear. An excessive volume of oil glands is the main cause of oily skin.

Androgens

Our oil glands are stimulated by a hormone called androgen to produce sebum at puberty and beyond. The enzyme that catalyses androgen to its most active form is also found in higher concentrations in oil glands as compared to other skin parts.

At various life stages, your body experiences changes in androgen levels. This explains why you do not have oily skin all your life. Oil glands are present at birth but sebum production remains low until puberty when it increases exponentially. Sebum secretions are typically the highest among 15-35-year-olds and decline gradually afterwards. They stop after menopause for women, and for men in their sixties or seventies.

At any age, men are more likely to suffer from oily skin than women. This is because men have higher sebum production levels mostly due to testosterone secretions.

Diet

A diet rich in carbohydrates and a high glycemic index is associated with high insulin levels. Example of high glycemic load foods is sugary foods, white rice, white bread, and potatoes. Low glycemic load foods include fruits, legumes, soy products and porridge.

Insulin stimulates oil glands to produce more lipids. Switch to a low glycemic-load diet for an improvement in insulin level, which can, in turn, keep your oily skin in check.

Insulin levels typically peak during late puberty and gradually decline in the 30s, which explains why some of us develop oily skin at school.

Genetic disposition

Various genes control the activity of our oil glands. In most individuals, an overexpression of a gene called Smad7 leads to an increase in lipid synthesis. This means an individual with oily skin will not be able to eliminate the condition. However, with proper long-term cosmeceutical skincare, it is possible to have less oily skin.

Other factors

Temperature: Sebum production varies directly with temperature; an increase in 1°C leads to a 10% increase in sebum excretion rate. Unsurprisingly, summer is the season when our oil glands produce the most sebum. Hot, humid climates also cause skin to be oilier.

Cleansing habits: Using a harsh cleanser or over-washing to remove excess sebum can strip skin completely dry, leading to reactive seborrhea. This is a condition where the excessive skin drying is read by the body as a signal to produce more oil.

Treating oily skin

Retinoids: This vitamin A derivative helps reduce the growth of sebum-producing cells, decreases the size of oil glands and suppresses sebum production.

Hyaluronic acid: This moisture-binding ingredient delivers hydration to your skin and restores moisture balance. Ensuring your skin has sufficient moisture helps prevents your skin from producing excessive sebum. Hyaluronic acid also plumps up your skin for an even complexion.

Cleanser: Use a gentle cleanser, ideally an anti-bacterial one like Miel Honey Cleanser. Dermatologist-formulated for all skin types, even oily or acne-prone skin, this cleanser is effective in removing grime, oil, bacteria and other environmental pollutants without stripping the skin’s essential lipids off. With honey as a natural humectant, it also traps moisture under the skin while you cleanse.

Moisturizer: Individuals with oily skin may think their skin does not lack hydration. However, just because your skin has a lot of oil does not mean it has sufficient hydration. UV rays, environmental pollutants or harsh products can disrupt the skin barrier, affecting its ability to retain water. As a result, moisturizing regularly is an essential step.

If you have oily skin, look for a lightweight moisturizer. Radiance Fluide™ Hydrating Emulsion is an oil-in-water emulsion formulated for Singapore’s humid climate. An oil-in-water formula means small droplets of oil are dispersed in a larger volume of water. This gives a lighter texture compared to water-in-oil formulas where small droplets of water are dispersed in a larger volume of oil.

Oral isotretinoin

An oral retinoid has the greatest results in suppressing sebum production, often a 60 to 90% reduction. A significant consideration before starting on oral isotretinoin is teratogenicity though (ability to affect fetal development and cause birth defects at the time of conception or during pregnancy).

Oral retinoids are only available on prescription due to their side effects. For cautious management, always consult a dermatologist first.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
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.

Brightening dark spots

December 25, 2018

Struggling with dark spots? To treat them, you first have to know the kind of pigmentation you have.

Melasma

Melasma is characterized by irregular brown patches on the skin and can typically be found on the forehead, upper lip, nose and the chin. Melasma is the result of an overproduction of melanin (the pigment that gives colour to our skin, hair and eyes).

Excessive sun exposure is one of the greatest contributors to melasma as melanin-producing cells are easily stimulated by UVA and UVB rays. Pregnancy, hormone treatments and genetic predisposition are other causes.

Postinflammatory hyperpigmentation (PIH)

PIH is the result of your skin’s melanin-inducing response to inflammation or injury, and appears at the injured site as a dark brown macule or patch. Such markings usually fade within a few months with appropriate treatment. However, the brown spots may darken or spread if not addressed. Sun exposure may also worsen PIH.

 Skin conditions that can cause the above inflammation include acne vulgaris, atopic dermatitis (eczema) and psoriasis (red, flaky skin patches).

Freckles

Freckles, also known as ephelides, are harmless small pigmented spots that are frequently found on the face, arms, neck and chest. Freckles are brown due to a diffusion of melanin into skin cells.

In winter, the activity of melanin-producing cells slows down. When exposed to UV radiation in sunlight, melanin-producing cells pick-up. As a result, freckles fade slight in the winter and darken in summer. Often, freckles partially disappear with age.

Genetics contribute to the formation of freckles. They are frequently observed in fair-skinned individuals, especially those with red hair.

Solar lentigo

Solar lentigines are harmless patches of darkened skin that are generally larger than freckles and have well-defined edges. They are caused by an accumulation of sun damage that leads to an increase in the number of melanin-producing cells and subsequent accumulation of melanin.

Solar lentigines are also associated with increased age. While freckles generally disappear over time, untreated solar lentigines are likely to persist indefinitely.

Treatments

For all dark spots, start by avoiding the sun and applying a sufficient amount of sunscreen every two hours. Use a lightweight sunscreen like Dr. TWL’s SunProtector™, which is dermatologist-formulated for the humid climate.

For melasma, consider a combination of topical therapies (outlined below) and chemical peels. Lasers should be considered last.

For PIH, first treat and prevent the skin condition triggering the inflammation. Then use topical treatments followed by chemical peels and lastly, laser and light treatments.

For freckles, use topical or laser/light therapies.

For solar lentigines, use ablative therapy with cryotherapy. Subsequent treatment options include topical agents and laser therapy.

Bleaching agents

 Bleaching agents are often used to inhibit melanin synthesis. The most commonly prescribed ones are hydroquinone, azelaic acid and kojic acid.

Hydroquinone inhibits the production of melanin by binding to tyrosinase, the enzyme responsible for the first step in melanin production.

Azelaic acid acts on abnormal melanin-producing cells but leaves the healthy ones untouched, ensuring optimal melanin levels.

Kojic acid binds to copper, which is required by melanin-producing cells.

Retinoids

Topical retinoids are often used in combination with bleaching agents. Retinoids target pigmentation issues by inducing the death of melanin-producing cells, accelerating turnover of new skin cells and inhibiting the enzyme tyrosinase.

Chemical peels

Chemical peels refer to the process of applying acids to the skin to destroy the outer skin layers. They accelerate the process of exfoliation by sloughing off dead layers of older skin and promoting smoother layers of new skin.

Superficial and medium depth peels are effective in treating pigmentation concerns. These peels differ in the depth of skin resurfaced. Superficial peels target only the surface skin layer while medium peels target the next layer.

To successfully achieve significant depigmentation, a patient needs to undergo at least 3 to 4 repeated peels. Common acids employed are glycolic acid, salicylic acid and lactic acid.

Laser and light treatments

Lasers are notably successful with solar lentigines, but less so with melasma and PIH. Such treatments damage the skin to stimulate growth of new skin cells.

To treat solar lentigo and freckles, use IPL, Q-switched lasers and fractional lasers.

To treat melasma and PIH (and only after topical therapy and chemical peels), try fractional radiofrequency, Q-switched or picosecond lasers, high-fluence/high-density non-ablative lasers, pulsed dye lasers, IPL, microneedling, and spot liquid nitrogen treatment.

If you are considering laser or light treatment, be sure to first consult an accredited dermatologist to recommend suitable treatments for the skin condition you are experiencing.

Cosmeceuticals

Patients who are not ready to commit to laser treatments can consider cosmeceuticals. These are cosmetic products with bioactive ingredients that are scientifically proven to deliver results to the skin. Active ingredients that fight dark spots include vitamin C and niacinamide. As a powerful antioxidant, Vita C GOLD™ Serum can help fade dark spots on your face and neutralise some of the free radicals that damage your skin. Niacinamide, found in Radiance Fluide™ Hydrating Emulsion, helps to brighten skin by reducing the amount of melanin.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
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.

Understanding Fillers

December 18, 2018

 

Dermal fillers are minimally invasive mainstay cosmetic treatments used to help return the appearance of volume and youth to ageing skin. Volume deficiency, scars, wrinkles, lip augmentation (plumping), facial sculpting and contouring are common facial concerns targeted by dermal fillers.

This guide will tell you everything you need to know about them: how they work, the choices of products on the market, and their possible side effects on your body and skin.

What are dermal fillers?

Before starting on dermal fillers, we need a brief understanding of how the face changes as we age. Over time, the thickness and elasticity of our skin decreases, and our faces loses fat. Soft tissues sag, facial muscles weaken, and the outermost layer of skin wrinkles.

Enter fillers. Dermal fillers help restore lost volume to your face and add lift.

Types of dermal fillers

The classifications of dermal fillers vary according to their properties. Fillers are categorized based on their biodegradability, how long it takes before the filling substance is absorbed by the body, and the duration of a treatment’s effect.

Early attempts to use fillers for facial rejuvenation relied on dermal fat or collagen fillers. However, the effectiveness of fat as a filling agent was risky as a number of variables were involved. These included the method and type of fat harvested, both of which could cause inconsistent absorption rates by the body. There could also be significant side effects including prolonged swelling, internal bruising and cause infections. Bovine (cattle) collagen, the first collage filler used, also had limited success due to its short duration of effect (3-4 months) and potential risk of allergic reaction.

Human-based collagen has since been developed but demand for collagen remains low compared to more effective filling agents.

Biodegradable fillers

These are fillers that provide temporary or semi-permanent effects as they gradually degrade and get absorbed by the body. Common biodegradable fillers are collagen, hyaluronic acid, calcium hydroxyapatite and poly-L-lactic acid.

Hyaluronic acid

Naturally present in our skin and connective tissues, hyaluronic acid is a key structural component that stabilizes cellular structures and binds collagen and elastic fibers. Hyaluronic acid remains as the most widely used dermal filler due to its ease of use, safety and minimal side effects.

When hyaluronic acid is injected into the skin, it combines with the natural hyaluronic acid found in our body. Due to its hygroscopic nature (ability to absorb water from surroundings), hyaluronic acid binds to water quickly, creating volume that lasts for 6 to 12 months before degrading into the body. It also induces new collagen formation, a desirable quality as our bodies gradually stop producing collagen in our late twenties.

Poly-L-lactic acid (PLLA)

A synthetic, biodegradable polymer of the alpha-hydroxyl-acid family (natural acids found in food), poly-L-lactic acid (PLLA) is another common filling agent. Its safe profile enables PLLA to be actively used in other medical applications such as in dissolvable stiches or soft tissue implants.

PLLA triggers mild inflammation to promote the formation of collagen and tissue fibers. The accumulation of collagen creates volume at the site of injection. Over time, PLLA breaks down into lactic acid and is metabolized to carbon dioxide or incorporated into glucose molecules.

Calcium hydroxylapatite (CaHA)

CaHA is a synthetic compound with a chemical structure that resembles a component found in our bones and teeth. Treatment with CaHA is safe and will not cause allergic reactions. When injected into skin tissues, our body gradually absorbs CaHA, inducing new collagen to be produced. Such an effect typically lasts about 15 months or longer.

CaHA breaks down into calcium and phosphate ions before finally being excreted by the body.

Nonbiodegradable fillers

Silicone

Injecting silicone into the face adds volume directly and immediately and also triggers collagen production that adds to the effect. Silicone is favoured for its stable chemical structure, ease of use, low cost, and long-lasting effects. As a non-biodegradable filler, silicone stays in your body once it is injected.

However, the use of silicon in cosmetic treatments is controversial due to its potential to cause long-term complications such as abnormal swelling, blindness or nerve damage. Issues can also arise from poor injection technique, the amount of silicone used and differences in silicone grades. For these reasons, it is strongly recommended you get your fillers done only by a trained dermatologist.

Warnings and alternatives

Administered professionally and with the proper technique and expertise, a dermal filler comes with minimal side effects. However, with many different rejuvenation treatments available, it’s important you consult a trusted dermatologist for a professional assessment before commencing treatment.

For those who prefer plumping effects without an injection, go for Dr TWL’s Hyaluronic Acid serum. As a skincare ingredient, hyaluronic acid draws moisture from its surroundings and keeps the skin well-hydrated; it is able to hold over 1,000 times its own weight in water. This gives a desirable plumping effect and improves fine lines and wrinkles without the needles.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
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.

Fighting back and chest acne

December 10, 2018

When it comes to acne, most of us tend to think of facial acne – the most visible form of acne vulgaris. Back and chest acne, or truncal acne, is often overlooked even though more than half of people with facial acne can also have truncal acne. Further, acne on any part of the body can impact one’s self-esteem, body image or self-confidence.

What causes truncal acne?

Truncal acne develops in a similar way to facial acne. Major causes of acne include excess sebum secretion, abnormal desquamation (shedding) of skin cells, the presence of the bacteria Propionibacterium acnes (P.acnes), and inflammation. These elements can be found as much on the back and chest as on the face.

Genetics is also a crucial component. Your genetic disposition can influence the formation of comedones or the way your body responds to the P. acnes on your skin.

Acne forms when abnormal desquamation of epithelial cells causes sebum and keratin to accumulate and block hair follicles. This creates comedones – either open blackheads or closed whiteheads.

An increased production of sebum also creates an ideal environment for P.acnes to thrive, especially during puberty when oil glands are excited by hormones called androgens. The activated oil glands produce inflammatory factors, such as cytokines, that increase the skin’s inflammatory response.

Your back, shoulders and chest are also more prone to acne mechanica, meaning acne caused by the pressure, occlusion, friction or heat of clothing or physical activity. Sports equipment, such as shoulder pads and tight straps, can further exacerbate acne. Sweaty clothing traps sweat, oils and substances that support the growth of  P. acnes. As a result, be sure to change out of sweaty clothing after a workout or seek shade when the sun is at its strongest.

How can I treat truncal acne?

First-line therapy for truncal acne should always be a combination of a topical and antimicrobial treatment to reduce the risk of bacteria resistance. Treatment lengths should also be kept as short as possible – to a three to four month course – and cautiously managed by an accredited dermatologist.

Topical treatments

  • Benzoyl peroxide: Decreases inflammation and abnormal desquamation. It also contains anti-microbial properties that kill bacteria, but can bleach clothing and bedding. As such, it may be less desirable for treatment of truncal acne
  • Retinoids: Reduce comedonal formation, expel mature comedones and exert anti-inflammatory effects.
  • Antibiotics e.g. erythromycin, clindamycin: Reduce the proliferation of P.acnes but are not recommended to be used as the only form of treatment due to the risk that bacteria will grow resistant to the effects of medication.
  • Azelaic acid: A newer form of treatment that has three pharmacological effects: anti-inflammatory, antimicrobial, and stabilizing on abnormal desquamation. Above all, azelaic acid also fades post-acne marks by inhibiting the release of tyrosinanse, an enzyme that controls the production of melanin.

While skin on the body can withstand acne medication that may be too irritating on facial skin, they can be harder to apply on the back. Also, skin on the body is thicker than the face and may respond more slowly to treatment.

Oral antibiotics

Antibiotics work to limit the proliferation of P.acnes, which makes them useful in treating moderate to severe acne.

Hormonal therapies

Oral contraceptives work to reduce androgen levels, which in turn decreases sebum production. Oral contraceptives are effective against inflammatory acne in females. Patients who do not mind being on contraceptives can consider this treatment.

Oral isotretinoin

Isotretinoin is a form of oral retinoid that is effective against severe. It helps to decrease sebum production, bacterial proliferation, inflammation and abnormal rate of skin cells shedding.

However, isotretinoin can have severe side effects.  It can disturb the development of a fetus and cause birth defects if the mother is taking it at the time of conception or during pregnancy.  Other potential side effects include mood changes, liver damage, or fluctuations in lipid levels. As a result, this medication should be cautiously managed by a dermatologist.

Cleansing

Proper cleansing should also follow alongside other treatment therapies. Dr. TWL’s Miel Honey™ Cleanser is a dermatologist-formulated cleanser ideal for acne-prone skin and uses medical grade honey as an anti-bacterial and anti-inflammatory agent. A gentle cleanser that lathers up from botanical emulsifiers, the foam produced is generous and refreshing on the skin.

Cosmeceuticals

Truncal acne patients can also consider cosmeceuticals as part of their treatment. Cosmeceuticals are cosmetic products that contain active ingredients that deliver medical benefits to the skin. Vitamin C, in particular, works as an antioxidant that helps clear the skin of inflammation. Another botanical to consider is Arnica Montana flower extract, which is especially beneficial for acne-prone skin as it stabilises inflammation and reduces skin flaking.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

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.

 

 

 

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