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Best Stay-Home Skincare Tips: How Working From Home Affects your Skin

June 17, 2021

The COVID-19 pandemic has impacted many aspects of our life, from mask wearing giving rise to maskne, and other skin conditions; to even the effects of lifestyle changes on our skin. One might think that being home all the time would be a godsend for the skin — if only. From stress-induced inflammation to exposure to long periods of blue light from devices, there are a number of ways that our changed lifestyles factors can affect the skin. In this article, Dr. Teo Wan Lin shares how lifestyle changes can affect your skin and also share some beneficial stay-home skincare tips while you’re working from home.

How has working from home changed our skin? What are some of your best stay-home skincare tips?

Impact of lifestyle changes on the skin

If you have an underlying skin issue, it’s not going to go away just from staying at home. Healthy and troubled skin are rarely purely due to environmental or lifestyle factors such as staying at home or going out. Instead, it is more determined by an individual’s genetic makeup. The cause of eczema and acne, which are the commonest skin problems experienced by people in Singapore, are genetically influenced. Hence, whether or not an individual goes out doesn’t make a difference. One thing that can definitely make all skin conditions worse is stress. So if staying at home makes you more or less stressed, it will have the appropriate effects on the skin. Changes in our daily routines and lifestyle – especially major ones such as the circuit breaker – can lead to body stress even when we can’t feel it.

Additionally, changes in sleep pattern i.e. lack of sleep or even change in hours, can disrupt the body’s natural circadian rhythm, which will ultimately affect skin health.

Now that we’ve got more time to ourselves in the morning, it seems like the best time to start building our own multi-step skincare routine, adding in all the steps we didn’t think we had time for before. What are your thoughts on that?  

It’s important to pay attention to what is essential, efficient, and sustainable in our skincare routines, rather than focusing on the time spent on them. This is because once life slowly starts to return to normal and picks up pace, we may not have the time to maintain complex, lengthy routines — and that’s to the detriment of our skin. 

That’s true, we might have time to keep it up now, but once life slowly starts to return to normal and picks up pace, we may not have the time to maintain complex, lengthy routines — and that’s to the detriment of our skin.

Well since we’re indoors more, under air conditioning and sweating less- and there are days where I don’t even leave the house – does that mean we can skip out on cleansing?

The indoor environment is not necessarily better than the outdoors, as there are still chemicals such as benzenes and formaldehyde emitted from furniture and paintwork. These could act as pollutants and cause free radical damage to our skin. To combat this, it is recommended to use a micellar formula or an oil-based emulsion to dissolve oil-soluble pigments from makeup, and then double-cleanse with an antibacterial cleanser thereafter. This second stage of cleansing would really benefit acne-prone skin if done correctly.

Furthermore, unless you have specific UV filters applied to your windows, you can still be susceptible to sun damage from the light that comes in. Day curtains are also by no means acceptable in terms of replacing sunscreen. For one essential stay-home skincare tip, it is recommended to continue to wear sunscreen even when you’re indoors as it is still possible to be exposed to harmful UVA and UVB rays indoors.

The SunProtector is formulated with physical blockers like titanium dioxide and zinc oxide that effectively blocks blue light emitted by indoor devices. Portulaca Oleracea (Purslane) and Oligopeptides in our SunProtector are potent antioxidants which actively fight free radicals generated by blue light as well as airborne pollutants – for comprehensive protection.

Yes, this just be a rule of thumb that applies even when you’re staying home: don’t forget your sunscreen. Apart from that, it goes without saying that we should be mindful of what we eat while we’re working from home. It’s much easier to sit in front of your laptop with a bag of chips when we’re sitting at home.

What are the effects of our diet on our skin? 

While you’re at home more often, be mindful not to over-snack as this can increase the risk of inflammatory skin conditions such as adult acne. Avoid diets high in trans fat like deep fried foods, dairy products, and sugary foods as they are pro-inflammatory, which can exacerbate your underlying acne problems.

Additionally, it is important to note that majority of patients with skin problems who start on medical treatments would improve, as long as they comply with the treatments. However, the rate of recovery as well as the sustainability of positive effects is significantly better in the group where they are conscientious with their diet.

We also briefly touched upon the impact of increased mask-wearing on the skin. By now, I think we all know about maskne – which is a type of occlusion acne which before the pandemic, was usually seen on athletes who had to wear helmets or facial gear.

Can you tell us about the types of skin condition we might see that arise due to more frequent mask wearing? How can we prevent these mask-related flare ups? 

Increased mask-wearing can have several impacts on the skin. Maskne, a type of occlusion acne, is commonly found on athletes who wear helmets or facial gearwhich before the pandemic. There are different types of skin conditions that may arise due to more frequent mask wearing, so how can we prevent these mask-related flare ups? 

Impact of mask wearing on the skin

I published the first international research paper on maskne in October 2020 in the Journal of the American Academy of Dermatology1 which describes the phenomenon of an “O-zone” pattern of acne occurring where the mask occludes the skin and changes microbiome (bacteria) balance and can trigger acne. Besides acne, there are other facial rashes that can occur such as allergic reactions to the fabric dyes, eczema (from textile-skin friction), and worsening of pre-existing facial rashes covered by the face mask such as perioral dermatitis, rosacea and heat rash. I also discussed in my latest research paper how design elements2 that we incorporated into our biofunctional textile mask design help to both protect against the spread of COVID and the skin at the same time. 

One way to mitigate this is to have a breathable barrier between the mask and your skin, such as a mask slip. My team has created a mask slip, where you can put in your surgical mask. This allows the mask to be reused and it wicks sweat away. The material used is hypoallergenic and the mask slip can help reduce the risk of developing occlusion acne.

The reusable, washable Lyosilk Mask Slip is designed and created by the Dr.TWL Biomaterials Team to help protect and prolong the lifespan of your surgical mask. It provides a cooling, sweat-wicking, breathable layer against skin to prevent skin irritation due to prolonged surgical mask wear.

Anti-Aging Diet: Can Your Diet Make You Look Younger?

June 9, 2021

The old adage ‘you are what you eat’ has never been so true when it comes to skincare. Research has proven that an imbalanced balanced diet and bad eating habits are important factors in skin aging. In this article, we will explore the science behind an anti-aging diet, and the antioxidant-rich superfoods that play a part in your skin’s health.

Our skin is the largest organ in our body, and the primary line of defence that protects the body from external aggressors. Skin aging is a complex process, and can be categorized by chronological aging, and photo-aging, which can be affected by both internal and external factors. As the main way for our body to get the energy and nutrients it needs for function, people have gradually realized our diet’s importance to the skin. 

Skin Aging

UV exposure induces oxidative stress in the skin, which eventually, leads to skin inflammation. When the degree of inflammation exceeds the defenses of the body’s immune system to clear up, immune cells such as macrophages begin secreting pro-inflammatory factors and free radicals, accelerating skin inflammation and injury. This process is known as inflammaging.

The Dr.TWL SunProtector is formulated with physical blockers like titanium dioxide and zinc oxide that effectively blocks UV radiation. Portulaca Oleracea (Purslane) and Oligopeptides in our SunProtector are potent antioxidants which actively fight free radicals generated by UV exposure as well as airborne pollutants – for comprehensive protection.

DNA damage to the skin is manifested as photo-aging in the form of wrinkles, loss of elasticity, irregular texture, hyperpigmentation. These are a result of oxidative stress that cannot be repaired at the same rate as a younger person’s skin. Superfoods with a high antioxidant concentration can actually help to boost these processes of DNA repair and combat the results of free radical generation.

“Sunscreen itself performs a fundamental role of protecting your skin from damaging ultraviolet radiation. Both UVA and UVB have been implicated in photoaging. As well as in carcinogenesis, which is a process of skin cancer formation. Simply put, when we have ultraviolet radiation exposure, as we grow older, our skin becomes less and less able to handle the oxidative stress and the ensuing free radical generation. All of which permit DNA damage to occur at the cellular level,” accredited dermatologist Dr. Teo Wan Lin. Listen to our podcast Dermatologist Talks: Science of Beauty Ep 34 where Dr. Teo discusses more about photoaging and sun protection.

Anti-aging diet: What are superfoods?

Skin health is influenced by your genetics, your lifestyle, which incorporates your diet, as well as factors such as how frequently you exercise and the type of exercise. These factors influence skin health, which in turn affects skin aging. Additionally, skincare which includes topicals being applied to the skin, plays a role in skin aging as well. These are more precisely termed as dermocosmetics or cosmeceuticals, which have pharmaceutically active properties in over the counter cosmetics.

Superfoods, with the exception of fish, are mostly plant-based foods that are nutritionally dense and confer many benefits to your overall health, and in this case, the skin. We are well aware that proper nutrition is critical for the healthy functioning of the body systems. We also know that as our body ages, every single organ ages in tandem with our biological clock as a result of both genetic as well as environmental factors.

The free radical theory of aging states that organisms age because cells accumulate free radical damage over time. A free radical is an atom that is unstable because it has only one unpaired electron in its shell rather than two. They can interact with DNA, proteins and fatty acids in the body, causing breaks in the DNA chain, protein-protein linking and oxidative damage. Oxidative stress, therefore, eventually leads to aging, so foods that contain antioxidants have been a key topic of research. Here are some of the natural antioxidants and their effect in alleviating skin aging. 

Which is better for my skin, eating superfoods or using skincare products?  

In relation to an anti-aging diet, it is crucial to note that the use of skin products has one very specific advantage, it is directly applied to the skin. Because the stratum corneum is designed in a way that is able to absorb what’s applied to it, we expect that if you’re using pharmaceutically active ingredients, cell changes can be positively manipulated to benefit your skin health and reduce oxidative stress. Skincare on its own is a critical part of the maintenance of the skin barrier, which is the way your body protects itself from the external allergens from any adverse environmental exposures. If that barrier is depleted, then we certainly expect that your skin will malfunction.

The short answer to this complex question is you cannot have healthy skin with a poor diet when you’re older. Unless you’ve won the genetic lottery and there are definitely individuals who eat junk food and yet still have very good skin. However, their overall health will suffer. If your health is poor, your skin will also age as you grow older. Therefore, the bottom line is that eating superfoods is more effective in the long run.

What consists of an anti-aging diet?

There are certain combinations of superfoods for the best results. For example, the well-known rainbow diet, which includes lots of different colours in your diet. It stems from the presence of carotenoids and anthocyanins in colored fruits and vegetables.

anti-aging diet: rainbow diet

There has yet to be a study that talks about the proportion of all these superfoods in a diet. However, what studies have actually shown is that when they incorporated a nutraceutical dietary intervention in an aging population, there were significant overall psychological and physical benefits. It suffices to say that everything in the plant and the mushroom kingdom has antioxidants and is suitable for an anti-aging diet.

Many of these, such as broccoli, cabbage, kale have been classified as superfoods because of the dense nutritional content per gram of the food that’s being served, as well as unique actives that are present in these vegetables that help to fight oxidative stress. In particular, we know that studies have been done on broccoli and the cruciferous vegetables of the Brassica family that show that it actually has cancer-fighting properties. This can therefore help in your anti-aging diet.

What are the best superfoods for my skin?

It’s good to focus on the different colours of foods. There are the brightly colored carotenoid-rich fruits and vegetables in orange, red and yellow. As well as anthocyanin-rich blue, purple produce such as blueberries and beetroot. Soya, in particular, is a phytoestrogen, having a positive benefit on your skin. There have been studies done in Japan on the benefits of consuming soy products such as miso or soy beans, when it comes to anti-aging.

How long does it take to see the results of a superfood-rich anti-aging diet?

Studies have to be done for a dermatologist to categorically state that there is a specific time period after which we expect to see results, and these are not available at the moment. It’s also very difficult to conduct such a study because of many confounding factors, such as there not being a standardised ‘superfoods diet’. 

Instead, the importance of nutraceuticals in your diet should be highlighted, as they affect your body systemically. Nutraceutical intervention can be a potential active therapy to address the lifestyle component of the skin exposome concept, which explains the skin aging process.

On the other hand, skincare products are a lot more measurable in terms of what we expect to see. For example, in my clinic and my skincare arm Dr.TWL Dermaceuticals, we use retinoid-like peptides. However, they do not contain retinoid or retinol side effects such as irritation. Usually, within two to three weeks of using the topicals, the individual will have a subjective improvement in skin hydration, elasticity, and radiance. Additionally, there have been studies showing cells in a lab environment as well as in clinical studies, where results are actually measurable as well.

Grow your own food

Understanding the benefits of an antioxidant-rich, anti-aging diet, how do you go about incorporating more of these superfoods into your diet? According to research conducted by University of Florida Institute of Food and Agricultural Sciences in 2016, gardening and growing your own food helps people develop a lasting habit of eating enough fruits and vegetables.

Furthermore, you get to decide what kinds of fertilizers and pesticides come into contact with your food. Commercial produce breeders often develop new varieties based on high yields and fast growth. In this process, there might be a compromise of nutrients and flavor. In your own garden, you can pick the variety that’s important to you, and be able to have the farm-to-table experience right at home. 

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Living in an urban area like Singapore, having a garden may not be a viable option. Instead, opt for urban farming with the easy-to-assemble SOLAR-ALGA Organic Urban Tower Farm. The first certified organic system, It is a compact hydroponic and aeroponic system that grows 45 different plants in just 0.14sqm of space.

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Complimentary with the SOLAR-ALGA, grow your own fruits and vegetable seedlings such as spinach, cucumber and cauliflower in the Mira-Sponge seedling Nursery. Get a head start on growing your own food for an anti-aging diet with the MiraFoam tray, providing the perfect micro environment for seedling germination and growth.

Keloid Treatment, Symptoms, and Causes

June 1, 2021

A keloid is a smooth, raised scar that is generally larger than the original injury and darker than the surrounding skin. An estimated 10% of people will experience keloid scarring. Due to their raised appearance, they are some of the most conspicuous types of scars, which might pose a challenge to minimize. In this article, we will discuss keloid treatment options, what they usually look like, as well as their causes.

What is a keloid?

Keloids form when there is an overgrowth of fibrous tissue (scar tissue) on the skin, presenting itself as a raised scar. When the skin tissue is damaged, scar tissue will develop above the wound to repair the injury. 

What do keloids look like? How do I know if I have a keloid? 

keloid treatment

Credit: American Academy of Dermatology Association

Keloids may vary in shapes and sizes. If it’s on the earlobe, it mostly presents itself as a round, solid mass. When it develops on the shoulders or chest area, the keloid is likely to be spread out across the skin. To identify a keloid, they usually feel painful or itchy and begin as a pink, red or purple scar raised above your skin. In some cases, if this scar covers a large area on the body, it may decrease an individual’s mobility at that certain body part.

Once you see a keloid, it tends to grow slowly. Most continue to spread for weeks and months. They can become increasingly irritated, itchy or painful when rubbed against your clothes. Additionally, keloids may become darker with time – the border is usually darker than the center.

How do people get keloids? 

Keloids are classified as a type of tumor, but not malignant. Surprisingly, they can develop from the most common types of skin injuries such as acne scars, burns, chicken pox scars, piercings, vaccinations as well as surgical incision areas. Keloid scarring can also stem from genetic factors, which means a child has a higher risk of getting it if either parents have them. They are also more likely to develop on people of darker skin colours as compared to those with lighter skin tones. Therefore, researchers believe that this scarring may be linked to a gene related to dark skin pigment. 

Keloids on a man’s chest. These keloids appeared slowly after severe acne cleared.
Credit: American Academy of Dermatology Association

Keloids vs Hypertrophic scars

It is not uncommon that some people confuse keloids with hypertrophic scars. Unlike keloids, hypertrophic scars are smaller and flatter, and the colours can range from pink to brown. They can also fade or go away over time, but keloids are not able to. Causes of hypertrophic scars are similar to keloids, such as piercings. Initially, they can be itchy and painful but symptoms will alleviate as the skin heals. 

Do keloids go away? What are the keloid treatment options available?

Unfortunately, keloids are considered quite difficult to get rid of and even if they are treated, there are chances of them resurfacing again. However, the success of keloid treatment can vary, and it is advisable to seek a dermatologist to help develop a treatment plan to best suit the removal of keloid scarring. 

Steroid Injection or Cream

These are also known as intralesional injections, which involves injecting steroids directly into the scar tissue in order to reduce its size. This keloid treatment method is one of the more common approaches, however, it is important to note that 50-80% of keloids reform after this treatment. Steroid creams are also an alternative. According to studies, there is a 9-50% chance of the scar resurfacing. 

Cryotherapy

Cryotherapy, also known as cryoablation, refers to the use of extreme cold to freeze and remove abnormal tissues. This treatment method involves freezing off a keloid scar, and is generally more successful for smaller scars.

Surgery and Radiotherapy

Surgery is usually the last resort for keloids treatment, mainly because it may cause a larger scar to develop. Radiotherapy can aid in decreasing the size of the scar and also produces much better results if it occurs after surgery. 

SRT-100TM

This keloid treatment is non-abrasive and is a type of superficial radiation therapy and is significantly effective in getting rid of keloid scarring, with a success rate over 90%. Performing surgery will still lead to keloids growing back eventually but with the SRT-100TM, there is a less than 10% chance of the regrowth. The mechanism behind this is that keloid cells are destroyed, which allows low chances of resurfacing. Due to its high success rate, it has been described as The Keloid Cure and is also approved by the FDA. 

Prevention of Keloids 

Prevention methods include avoiding piercings, cosmetic surgeries and tattoos and adopting proper wound care habits. Practice proper wound care by washing the injured skin area immediately using soap and clean water, followed by using a sterile gauze to cover up and bandage the affected area. Do visit an accredited dermatologist, for advice on your keloid scarring. 

Have a keloid concern? Book a TeleConsultation, with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.

Copyright © 2021 TWL Specialist Skin & Laser Centre. All rights reserved.

6 Best Maskne Tips: Prevention and Treatment

May 22, 2021

Find out the best maskne tips for prevention and treatment. Mask acne or ‘maskne’ for short is a new term coined during the 2020 COVID-19 pandemic. It refers to acne that has developed around the areas of skin-mask contact. This affects areas such as the cheeks, the area around the mouth, around the nose, and the jawline – known as the O-zone pattern1. Maskne is a disorder of follicular occlusion, and is directly related to mechanical stress from pressure, occlusion and friction of face mask wear, and microbiome dysbiosis from heat, change in pH and moisture from biofluids.

Method 1: Use gentle cleansers

Cleansers with active antibacterial ingredients is important to maintain a healthy skin microbiome and prevent bacterial growth. Ingredients such as benzoyl peroxide and salicylic acid have been proven to aid in maskne treatment which are often found in gentle cleansers.

One of the more effective maskne tips is to use medical grade honey, an ingredient used in cleansers which has natural emulsifying, antibacterial, anti-fungal properties for effective cleansing. Natural honey is also a humectant, trapping a layer of moisture for protection after cleansing and is suitable for those with sensitive skin.

Maskne tips: Use a gentle cleanser

Medical grade honey is used in the Miel Honey Cleanser which has natural emulsifying, antibacterial, anti-fungal properties for gentle and effective cleansing in eczema-prone individuals. Natural honey is also a humectant, trapping a layer of moisture for protection after cleansing.

Method 2: Use skin barrier-repairing moisturizers 

Moisturizers containing humectants and “Prescription Emollient Devices”(PEDs), are ideal for acne prevention. Ingredients to look out for in a moisturizer should include humectants like glycerin, amino acids, natural moisturizing factors, sodium hyaluronate, and polyglutamic acid which draw moisture from the environment to the upper layer of the skin, helping to reduce transepidermal water loss. However, common humectants such as lactic acid and urea should be avoided. When these are worn under occlusion, they interact with sweat and moisture to alter skin PH, causing irritant contact dermatitis. Examples of PEDs include optimal ceramide/lipid mixtures with anti‐inflammatory ingredients such as glycyrrhetinic acid.

Another one of our maskne tips is to look out for humectants and emollients instead of occlusives (petroleum jelly, mineral oil-based liquid paraffin). This applies to both dry and combination/oily skin. The occlusive effect of the face mask in combination with a humid climate can lead to worsening of facial eczema and trigger occlusion acne.

Method 3: Avoid leave on skincare with irritating ingredients under your mask

More maskne tips include avoiding ingredients such as alcohol, salicylic acid, alpha‐hydroxy acids, tea tree oil, benzoyl peroxide and retinols when looking for leave-on acne skincare formulations. These increase risk of irritant contact dermatitis – an allergy caused by active ingredients in acne spot creams. Wearing a face mask creates a moist, occlusive effect that increases the absorption of these astringent (skin-drying) ingredients, leading to a heightened risk of skin irritation.

Additionally, benzoyl peroxide can cause bleaching of the mask and may alter the structural integrity of the face mask – rendering it less effective for controlling droplet spread.  

Method 4: Use over the counter acne creams

Acne formulations that contain plant-derived anti-inflammatory active ingredients are recommended for use under a face mask.These have anti-inflammatory effects and are usually better tolerated, with minimal risk of irritant contact dermatitis that can be caused by harsh astringent ingredients. 

Look out for ingredients like Chlorella Vulgaris that works by regulating sebum production and inhibiting spot inflammation. Berberine is a botanical active that has been proven to be bactericidal, have oil control and anti-inflammatory functions, which can help in the prevention and treatment of maskne. Additionally, zinc oxide formulations have proven to be effective in treatment of acne. Its antimicrobial properties are recommended in maskne prevention. It is also well established in inhibiting bacterial growth and also controls oil gland activity without causing skin irritation especially after prolonged face mask wear. 

The custom compounded Prescriptive Skin – Acne Treatment contains organic berberine extract that helps to target mechanisms in acne formation. It helps to block sebum production, is anti-inflammatory and bactericidal. Treating acne scarring and erythema, it also helps to inhibit melanin formation and combat oxidative stress

Hydrocolloid acne patches are also helpful in the treatment of maskne as they can help to prevent touching or picking that can lead to scarring or infections. They also create an optimal microenvironment for faster and better healing, and help to increase absorption of active ingredients in pimple creams.  

Method 5: Use a breathable fabric face mask

Textile-skin friction and the occlusive skin environment resulting from face mask wear is a trigger to several dermatological conditions such as acne mechanica, frictional dermatitis, and postinflammatory hyperpigmentation.  Biofunctional face masks are an option for face masks which have higher evaporation rates, reduces the sensation of stickiness, and overall provide more breathability.

A breathable fabric mask can help to wick moisture away and keep the skin dry, maintaining an optimal skin microbiome that can help to treat and prevent maskne. Furthermore, biofunctional textiles such as copper, zinc and silver impregnated fabrics are bactericidal, and can be used to treat skin infections or diseases triggered off by bacteria including acne and maskne. The goal of a reusable face mask is to contain respiratory droplets and prevent it from spreading to the environment. 

The CUIONS Anti Aging + Anti Maskne mask is clinically proven to be more hygienic than the standard fabric mask. It has anti-odor properties with the copper ions killing bacteria/fungi/microbes that come into contact with the mask. This is particularly suited for comfortable wear against your skin over prolonged periods.

Method 6: Keep your face mask clean

Another tip is to wash your reusable face mask regularly. Washing at high temperatures can help to destroy both odour and disease. If daily washing of fabric masks isn’t possible, applying a hot iron (356–428 Fahrenheit at standard settings) on both sides of the fabric is sufficient to kill respiratory viruses, including the COVID‐19 virus. 

When removing the mask to eat, drink or exercise, it is best to loop it under the jawline to reduce environmental contamination. This also minimises the risks of mask dislocation and need for constant adjustment. Follow our maskne tips to prevent acne breakouts.

References: 

Teo W. L. (2021). Diagnostic and management considerations for “maskne” in the era of COVID-19. Journal of the American Academy of Dermatology, 84(2), 520–521. https://doi.org/10.1016/j.jaad.2020.09.063

Teo WL. The “Maskne” microbiome – pathophysiology and therapeutics [published online ahead of print, 2021 Feb 12]. Int J Dermatol. 2021;10.1111/ijd.15425. doi:10.1111/ijd.15425

All You Need to Know About Fractional CO2 Laser for Acne Scars

May 21, 2021

Acne can form on your face when skin pores get clogged. Apart from making one feel insecure, acne can also be painful and leave stubborn scars and redness behind during the healing process. In this article, we will discuss the causes of acne scars and all you need to know about fractional CO2 laser for acne scars treatment.

What causes acne and how do acne scars form? 

Acne is a common disease that prevails in 90% of adolescents, and has the ability to persist to adulthood with psychological and social implications. Acne typically appears when hair follicle openings become blocked by over-secretion of oil and dead skin or bacteria accumulation in the pores. Acne scars, on the other hand, result from the inflammation of acne blemishes. In some cases, the contents of the blemishes spill into surrounding tissue that may cause deeper scars. They take on 2 main forms, either the scar develops when there is a loss of tissue, or when it is raised above the skin surface. They include:

Atrophic Scars

Located at areas with thicker skin, usually on the lower cheeks and jaw. Atrophic scars are further classified into ice pick, rolling and boxcar type. Ice pick indents are observed to have narrow and deep scars. Rolling scars are wider and can reach to the subcutaneous adipose (fat) tissue. Lastly, boxcar types have visible vertical edges which are wider than ice picks.

Visual representation of the different types of acne scars. Read more about the different types of acne scars here

Hypertrophic Scars

These lesions of scar tissue that rise off the surface of the skin are caused when collagen in that region is overproduced. They are usually located on the chest, shoulders and jawlines. Additionally, they tend to be itchy or painful. 

CO2 Laser for acne scars 

Laser treatments aim to minimize the scar appearance from acne outbreaks. It focuses light on the skin surface to disrupt the scar tissue while also encouraging new, healthy skin cells to grow and replace the scar tissue. One such type is the fractional carbon dioxide laser method. 

What does fractional CO2 laser do?

The CO2 laser is a non-invasive skin treatment that uses a laser made of CO2 to remove the outer layers of damaged skin and hence, acne scars. This particular laser system is the gold standard in acne scar treatment whereby it obtains better results with minimal thermal damage to the skin and also keeps the epidermis intact. Benefits of this method compared to other lasers include less tissue damage and edema, as well as faster recovery. 

How is the CO2 laser procedure done? 

The CO2 laser for acne scars is an ablative procedure, meaning it operates by breaking up the skin. The laser with a wavelength of 10,600nm penetrates deep into the skin. The epidermis (thin outer layer of the skin) is removed and dermis (underlying skin) is heated. This will then stimulate the body’s natural healing process and boost collagen fibre production, which ultimately results in the replacement of old, damaged cells. After the epidermis regrows, the treated skin will appear clearer, smoother and tighter. 

Who should avoid CO2 laser for acne scars? 

Generally, it is advisable for patients suffering from extensive breakouts, open wounds or facial infections to avoid the fractional CO2 laser for acne scars. It’s also worth noting complication preventions throughout the treatment process. Patients prone to poor wound healing or hypertrophic scarring should avoid aggressive skin resurfacing. 

How long does CO2 laser resurfacing take to heal? Is there any downtime? 

The period of recovery heavily depends on the severity of the condition, but the use of fractional technology has enabled healthy tissues to produce cells and proteins that will quickly aid in skin healing. Therefore, patients only have to undergo shorter recovery periods that last around 5 to 7 days. 

Is the CO2 laser for acne scars painful? 

The treatment is usually done with anesthesia so as to minimise any occurrences of discomfort. Most patients describe it as only a prickling sensation. The different types include topical anesthesia and numbing cream. Otherwise, painkillers and anti-itching medications may also be administered. 

How many CO2 laser treatments are needed?

The number of treatments for CO2 laser for acne scars mainly depends on the severity of the condition and the extent of the acne scars. Typically, patients undergo 1 to 3 sessions on average, which can be carried out at 4 to 6 weekly intervals.

Side effects of CO2 laser for acne scars

Since the fractional CO2 laser procedure encompasses heat, patients may experience redness or swelling in the treated area. In rare cases, studies show that the adverse side effects of laser methods include bacterial, fungal or herpetic infections, which are short-term. Long-term side effects may consist of prolonged erythema, post-inflammatory hyperpigmentation particularly in skin of color.

Adjunct Treatment for Acne Scars 

While the fractional CO2 laser is a first-line treatment for acne scarring, the potential for side effects from long-term, continuous treatment is an issue. Research has found that additive or adjunct treatments such as those with cosmeceuticals and radiofrequency, can be effective in the treatment of acne scars.

Cosmeceuticals that include the botanical ingredient Centella Asiatica can be beneficial when it comes to anti scarring. This phytochemical has anti-inflammatory and wound healing properties for cysts, scars, and sensitive skin. Centella asiatica contains compounds like asiaticoside for increasing strength of the new skin at the wound, and madecassoside for collagen formation and anti-inflammation, especially helpful for treating acne scars.

Cosmeceuticals for adjunct treatment wiith CO2 laser for acne scars

THE ELIXIR-V™ TOTAL RECOVERY SERUM formulated with Centella Asiatica for scar healing, is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.

In one study Mu et al highlighted that combining radiofrequency energy with fractional CO2 has the effect of a temperature increase in the dermis, the deeper layer of the skin. This temperature increase produces a firming and compacting effect in the skin. One 10 patient study found that this method of radiofrequency and fractional CO2 combination showed more improvement and faster healing with fewer side effects of pigmentary changes in the treatment group.

Radiofrequency alone has shown efficacy in acne scar treatment. The mechanism of action of thiis technique also complements that of laser resurfacing in fractional CO2 lasers.

The CollagenUp Facial Wand is an FDA approved home radiofrequency device which increases absorption and helps in skin cleansing and moisturizing in addition to photofacial light functions. Use this radiofrequency device at home in conjunction with CO2 laser for better results in your acne scar treatment routine.

Dr. Teo Wan Lin is an accredited dermatologist in Singapore who specialises in the diagnosis and treatment of acne, acne scars and other skin diseases. She is also the founder of cosmeceutical skincare line Dr.TWL Dermaceuticals, which develops evidence-based cosmeceutical actives for the adjunct treatment of eczema. She is also the author of Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare.

Book an appointment for a specialist skin consultation.

References

Petrov A, Pljakovska V. Fractional Carbon Dioxide Laser in Treatment of Acne Scars. Open access Macedonian journal of medical sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884248/. Published March 15, 2016. Accessed May 20, 2021. 

Mu YZ, Jiang L, Yang H. The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars. Dermatol Ther. 2019;32(6):e13084. doi:10.1111/dth.13084

Dermatologist Tips on How to Protect Your Skin From Blue Light

May 14, 2021

We know that long term exposure to blue light from digital devices can cause eye strain, hence, the advent of blue light filtering glasses. However can blue light, or visible light, damage the skin as well? In this article we will explain what visible light is, the effects of blue light on skin, and dermatologist tips on how to protect your skin from visible light damage.

What is visible light? 

Visible light (VL) is radiation encountered at the earth’s surface with wavelengths of  400-700 nm. It can be seen by the human eye as it emits light from electronic devices such as computers, cell phones, television screens. Blue light is the part of the visible light spectrum that contains the highest energy. 

How is it different from UV rays? 

UVA and UVB light from the sun fall under the category of invisible light, as we cannot see these rays. However, they are present during daylight hours and can have many effects on the skin. UVB light from the sun has a shorter wavlength, and is associated with causes sunburn, while UVA light causes deeper damage like reduction of production of collagen and oxidative stress. 

What are the sources of visible light? 

The primary source of VL comes from the sun. Other than that, artificial sources of VL is from our electronic devices, lightbulbs and lasers. The natural source of VL from the sun is especially important for other organisms to survive. Living organisms including bacteria, fungi, animals, and plants use blue light to adapt to changing ambient light, blue light is used for photosynthesis. Ocean organisms depend on VL to obtain sunlight. Red light is able to penetrate through depths of 2m and blue light able to reach up to 200-300m.

What does red and blue light therapy do to your skin?

Visible light can be beneficial for our skin when used in therapeutic, controlled settings such as adjunct treatment for dermatological conditions. However, it can also be detrimental to the skin if exposed to high intensities of it from the sun. 

Blue light has anti-inflammatory and antiproliferative properties. The use of therapeutic visible light to treat dermatological conditions include blue light for psoriasis, atopic dermatitis or eczema, rosacea, acne and others. On the other hand, red light is used in dermatology for skin resurfacing and rejuvenation. Furthermore, alopecia, acne, skin fibroblasts modulation, and pre-cancerous and cancerous skin lesions can be treated by red light. The combination of red and blue light also cures seborrheic dermatitis, pityriasis versicolor, and acne.

Is blue light bad for your skin?

Recently, scientists have recognised the role of VL in the production of pigment in the skin. Pigmentary disorders such as melasma and post-inflammatory hyperpigmentation (PIH) disproportionately affect individuals with Fitzpatrick skin types (FST) III to VI. 

Some studies have shown that exposure to high intensity blue light from the sun can cause more hyperpigmentation in darker skinned individuals, compared to when exposed to UV irradiation. However, there is a lack of evidence about the role of VL from artificial sources in pigmentation production. Because, the LED light used in studies was much higher in intensity as compared to the LED devices used in daily life.   

“Blue light is a very popular topic because we are exposed to a lot of devices in our homes that emit blue light. For example our mobile phones, iPads, our computer screens; especially now so with more people working from home. The key premise of this question is that there was a study done a few years ago by dermatologists that demonstrated amongst individuals with existing pigmentation problems.

Exposure to high doses of blue light, the kind of blue light that is present in solar radiation, is much more intense than the blue light coming from your devices. Therefore, with these individuals that already had pigmentation, exposure to high doses of blue light from the sun was observed to make their pigmentation worse. Putting this into context, it’s much more important to preach avoidance of UV exposure as well as sun protection. This is because the sun is the biggest producer of blue light”, accredited dermatologist Dr. Teo Wan Lin.

What ingredients protect against blue light?

According to Dr. Teo, how to protect your skin against blue light is to keep in mind that “if you do already have pigmentation, please be more conscious to reduce the amount of screen time you have. Secondly, you may want to actively incorporate serums that contain potent antioxidants. This refers to cosmeceuticals that have been proven in clinical settings to reduce the process of free radical damage caused by environmental stresses. For example, I’m referring to active ingredients such as Centella Asiatica, resveratrol, vitamin C – and many other botanical extracts that have proven benefits of antioxidant properties.”

Photoprotection is currently the number one recommendation for prevention of the effect of blue light on skin. Seeking shade, using photoprotective outer-wear such as UPF50+ materials, and daily use of a broad spectrum sunscreen with SPF >30 is recommended. Known VL blockers include physical filter iron oxide which can be found at various concentrations in sunscreens.

Individuals have to take note that skin protected by sunscreen with higher concentrations of titanium, zinc, and iron compounds can offer better protection to VL. Sunscreen containing high amounts of iron oxide was found to be highly effective in reducing hyperpigmentation. Since sunscreens do not label the iron oxide percentage, one must ensure the sunscreen to go on white as a sign if it protects against VL. 

Protect your skin from blue light with the Sunprotector

The SunProtector which is what we use in our dermatologist practice, is a broad-spectrum sunscreen that contains both the ceramide, the UVA blocking component, as well as physical blockers such as titanium oxide and zinc oxide. It is also includes Portulaca oleracea extract also known as purslane as well as oligopeptides, both of which are well-established in scientific literature to block melanin production due to its antioxidants abilities. 

With regards to a specific anti-blue light product, look for a physical sunscreen. I always recommend broad-spectrum sunscreens that contain UVA and UVB protection – and this usually involves the use of both chemical sunscreens as well as physical sunscreens such as zinc oxide, titanium dioxide. If your sunscreen has both zinc oxide and titanium dioxide These would be effective in blocking high-energy blue light that is radiated from your devices.

Skincare Slugging: The Beauty Trend Used for Eczema Treatment

May 5, 2021

Slugging involves sealing your skin with Vaseline, petrolatum, or white soft paraffin. In this article we will explain everything you need to know about skincare slugging, it’s benefits and when you should use this method. Including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre. 

What is skincare slugging? 

Slugging is a term coined by K beauty and recently popularized on the social media platform Tiktok. This skincare trend refers to the process of sealing your skin with an occlusive agent – Vaseline, white soft paraffin, or petrolatum. It is touted to keep your skin moisturized and prevent transepidermal water loss. 

While this technique has been recently popularized again, dermatologists have been recommending this as the last step in the treatment of severe eczema, sealing in moisturizer and helping to trap in moisture. However, this is not commonly recommended for the facial skin, especially in humid climates like Singapore. Because, the face is usually greasier due to the distribution of oil glands. Applying an occlusive substance like Vaseline if you produce quite a bit of oil or if you have acne, is not a good idea.

The science behind slugging 

Petrolatum, the ingredient found in Vaseline, Aquaphor and other topical creams, acts as an occlusive and a skin protectant – which means it prevents transepidermal water loss or evaporation of moisture from the skin. 

“The trend of skincare slugging is essentially borne out of moisturising in layers. For example, what dermatologists usually recommend for individuals who suffer from severe body eczema is applying first a ceramide dominant moisturiser, one that is formulated correctly with the lipid ratio, then as a final layer, petroleum jelly. This is to increase the occlusive effect on the skin’s microenvironment and this can actually help to maintain moisture in the topmost layer of the skin.

Use a ceramide based moisturizer before skincare slugging

The Multi-CERAM Cream is a new generation “Smart Moisturiser” formulated as a Prescription Emollient Device. It is formulated with an optimal skin lipid mixture, containing a mixture of plant-derived phytoceramides and synthetic ceramide. Antioxidants that fight skin inflammation are incorporated for optimal treatment of eczema.

However, slugging should be applied with other moisturizers for the best effects. The use of ceramides in moisturisers is crucial in preventing and repairing skin barrier dysfunction. When paired with the process of slugging, it can help to increase absorption of the moisturizer and speed up healing of the skin barrier,” accredited dermatologist, Dr. Teo Wan Lin.  

Eczema and dry skin 

Eczema is primarily due to a defect in the skin barrier and quite frequently presents as itchy and dry skin. The condition is genetically determined and can be made worse by skin irritants, allergies, environment and stress. In my practice, only ceramide-based moisturisers which focus on restoring the skin barrier are prescribed. Ceramides are lipids that occur naturally on the epidermis and are integral to locking in moisture to the skin and regulating healthy skin barrier function. 

In layman terms, you may think of the skin as a protective brick wall, and ceramide being the cement that holds the bricks together and prevents water from seeping through, in order to perform an effective barrier function. Intensive moisturising with ceramide is often recommended through the course of an eczema treatment so as to restore healthy barrier function to the skin. In cases of more severe eczema, wet-wrap therapy, which enhances absorption of topical medications by the skin, may be employed over the topicals and moisturiser applied on to the skin as part of treatment. 

Slugging is often recommended as the last step in order to seal in ceramide-based moisturizers for increased absorption and enhanced healing. 

Is Vaseline safe to use on skin? 

Mineral oils in petroleum jelly or Vaseline are completely safe for skin. As long as it’s approved for cosmetic use, the origins of this mineral oil component is not going to cause any damage to your skin. In fact it’s an effective skin smoothener and can help to prevent water loss to the environment. 

Is slugging for everyone? 

If you do have oily acne prone skin or active acne we don’t recommend applying a petroleum jelly on your skin. Using occlusives on an acne-prone individual can cause a form of occlusion-type comedogenic acne. Instead, opt for a moisturiser that is either cream, serum or lotion based to hydrate and protect the skin barrier.

In humid, tropical climates like Singapore, skincare slugging can increase the occlusiveness of any product that is applied to the skin. This holds truer still with the wearing of the face mask. Sealing on a layer of Vaseline will increase the comedogenicity of any moisturiser that is potentially applied on your face when it’s applied under occlusion. 

Additionally, while it does act as a barrier to trap in moisture from leaving the skin, if applied on unwashed skin, it can also trap in any bad bacteria, dirt and grime – leading to breakouts. 

How to do skincare slugging the right way? 

  1. Apply a ceramide-based moisturizer on dry, flaky, eczema-prone skin on the body. 
  2. Seal the products in with a thick layer of white soft paraffin, Vaseline, or a petrolatum based ointment. 

How Menopause Affects Your Skin

April 24, 2021

Menopause officially begins one year after your last period, and can bring many changes to a woman’s body – especially to the skin. In this article, we explore how menopause affects the skin, traditional estrogen treatment, and promising cosmeceuticals in preventing and treating signs of aging in menopause skin.

How does menopause affect the skin?

Estradiol levels, one of the three major estrogen hormones secreted by the body, declines to nearly zero after menopause. This estrogen-deficient condition can lead to a dramatic reduction in overall skin health and appearance, due to the negative impact on dermal cellular and homeostatic mechanisms. These changes appear in the form of loss of collagen, loss of elasticity, increased MMP (enzymes that break down collagen) activity, which result in dryness, wrinkles, impaired wound healing, decreased antioxidant activity. These changes may affect self-esteem, psychological health, and increased physical perception of aging. 

Traditional estrogen treatment 

Since the 1940s, estrogen hormone preparations have been a popular treatment for menopausal women to treat symptoms such as hot flush (sudden feeling of heat, mostly over the face, neck and chest). This Menopausal Hormone Treatment (MHT) was later changed to include the addition of progestin to avoid the development of health conditions such as endometrial hyperplasia, and cancer.  

There have been few studies that measure the effects of normal dosage of MHT on skin health, with most studies on the effects of estrogen on skin health dating from the time estrogenic dosage of MHT was as much as 10x the amount in present day treatment. Furthermore, in most of the research, there has been large and usually unmeasured and uncontrolled effects of exposure to smoking, environmental aggressors, race, and aging.

Hence, while traditional treatments such as local hormone treatment have generally been regarded as effective in reversing skin aging in estrogen-deficient or menopausal skin, the uncertainty of the long term side effects has led to the development of newer therapeutic agents in the form of botanicals . 

Cosmeceuticals to treat estrogen-deficient, menopausal skin

Cosmeceuticals represent the blending of cosmetics and pharmaceuticals. One of the greatest sources of new cosmeceutical ingredients are from plants. Plants are rich in antioxidants as they must survive constant UV exposure. Botanicals are also considered safe as they meet the FDA’s criteria of substances that are safe to use in topical over-the-counter formulations. 

Resveratrol

Resveratrol, a compound derived from grape, has been well researched for its anti-aging properties, and can be beneficial in the treatment of estrogen-deficient, menopausal skin in post-menopausal women. Recent studies reports that resveratrol has anti-inflammatory properties that protect against UV radiation from the sun, and oxidative stress. It also helps to stimulate production of collagen in fibroblasts, and inhibition of melanogenesis – helping to prevent the formation of pigmentation and dark spots. 

treat menopause skin with Elixir V Total Recovery Serum

The Elixir V Serum is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides. It contains Larecea™ our trademarked extract of Brassica oleracea (a botanical extract from cruciferous family plants) and a super-power Japanese Knotweed plant extract which is a source of trans-resveratrol, a potent anti-oxidant that enhances cellular regeneration at night, without the irritation effects of traditional retinoids.

Phytoestrogens & Isoflavones

Selective estrogen receptor modulators (SERMs) are examples of possible therapeutic agents that can send estrogen’s important skin health signals in place of decreased estrogen levels. Recent research has found that phytoestrogens (plant-derived compounds) that contain SERMs can play a major role in treatment for aging and estrogen-deficient skin. 

Mineral Booster for menopause skin

The Mineral Booster is a dual function refreshing mist to increase absorption of skincare at night, for a perfect look with make-up & during touch-ups in the day. It contains skin-calming & repairing active ingredients, including precious rice bran extract, licorice extract, and Glycine Max Soybean Extract – that is a rich source of phytoestrogens and isoflavones. Suspended in a purified deep sea water mist harvested 600m below sea level using sophisticated technology. Perfect for tropical and humid climates.

Many studies have examined phytoestrogens which act as SERMs and help to send estrogen’s signals in place of decreased levels of estrogen. Isoflavone is a phenolic compound classified as an phytoestrogen. Isoflavones are found in high quantities in soybeans and other legumes. Phytoestrogens have been found to act as an anti-aging ingredient, resulting in increased production of collagen and hyaluronic acid in the skin.

They are also potent antioxidants, with anti-inflammatory properties. Studies conducted in 30 post-menopausal women found that treatment with isoflavone-rich, concentrated soy extract caused significant increase in skin thickness and number of collagen and elastin fibres. Additionally, creams and lotions containing phytoestrogens and isoflavones in a 12-24 week study showed improvement in skin dryness, thickness, facial wrinkles, increased hyaluronic acid, and type I and III collagen production. In these studies, no significant adverse effects after topical application of these cosmeceuticals. 

Novel botanical compounds 

In a study conducted by Lephart and Naftolin, two plant-derived compounds have been shown to improve the condition of the skin, especially in estrogen-deficient, menopausal skin. 4’acetoxy resveratrol (4AR) and equol are 2 novel botanical compounds that were associated with improvements in 8 skin parameters in a cohort of post-menopausal women. 

The results show that for skin firmness around the eyes, Equol was associated with a 78% improvement, while 4AR associated with 68% improvement from baseline. For skin smoothness, equol was associated with 63% and 71% improvement for 4AR, while rates of frown lines and wrinkles were 72% for equol, and 77% for 4AR. Even skin tone improved 70% for equol and 83% for 4AR. Radiance and brightness rates were similar (73% for equol, 72% for 4AR), while rates of pore size (52% vs 63%), skin spots and discoloration (56% vs 73%), and hydration showed slight favoring of 4AR with equol at 71% and 4AR at 72%.

Overall, the percentage improvements were very similar for the 2 botanical compounds. This indicates that topical application of plant compounds with SERMs can play a major role as cosmeceuticals in the skin care industry, showing significant improvement in estrogen-deficient skin. 

References: 

Lephart, E.D., Naftolin, F. Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatol Ther (Heidelb) (2020). https://doi.org/10.1007/s13555-020-00468-7

Desmawati, D., & Sulastri, D. (2019). Phytoestrogens and Their Health Effect. Open access Macedonian journal of medical sciences7(3), 495–499. https://doi.org/10.3889/oamjms.2019.044

Dermatologist Answers 5 Common Questions on Skin Lightening

March 29, 2021

The term “skin lightening”, along with “whitening” and “fair” have often been marketed in products, particularly in Asia. Aside from being unhealthy and unsustainable, skin lightening treatments and procedures can often be dangerous. In this article, dermatologist answers 5 common questions on skin lightening, shedding light on dangerous practices, and giving tips on how to even skin tone instead of whiten it; including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Can you actually lighten your skin?

In the context of achieving a fairer skin tone, I think it is important to define if we are talking about eliminating uneven pigmentation, for example, or actually bleaching one’s skin to go to a lighter skin colour. The latter I do not recommend but in terms of making one’s skin tone more even and eliminating dark spots, there are various forms of pigmentations that you should know about including sun spots – otherwise known as solar lentigo, freckles, other medical conditions such as post inflammatory hyperpigmentation and melasma.

There are specific topical medications, lasers, as well as pills that one can use to treat these conditions. For the case of actually going to a completely lighter skin tone that is not natural for one’s genetically determined skin type, I do not recommend that and we can address that later in this chapter

What are the steps to take to achieve a fairer skin tone? Can we break it down into lifestyle, treatments and skincare?

To achieve a fairer skin tone, I will focus on how to enhance one’s skin health, so that you get less of the common hyperpigmentation conditions. We start off with genetics. Everyone is born with a certain skin type – we call that phototype. The dermatological grading of this is the Fitzpatrick phototype. For Asians, we tend to be between type III to type V. When it boils down to why people of a certain skin type, for example in phototype III, have varying amounts of skin fairness or pigmentation, it is said to be influenced by various factors.

Lifestyle certainly plays a role, as our skin contains melanin, a light-absorbing pigment molecule that also gives our skin its color. When we are exposed a lot to the sun, we activate the melanin-producing cells, melanocytes, that can cause one’s skin tone to get darker. The amount of exposure to sunlight is therefore one important factor.

Exposure to sunlight can slow down skin lightening of pigmentation

Other lifestyle habits like smoking, exposure to pollution and stress for example, can lead to a process known as free radical generation in our skin and this can increase one’s risk to hyperpigmentation or risk of existing areas of pigmentation to get even darker. Unhealthy lifestyle is definitely part of factors that cause our skin to be less radiant and can also cause the skin to appear as a dull complexion with uneven skin tone.

In terms of treatment, chemical peels and lasers help to stimulate one’s skin cells, restoring it to a normal cell cycle of a young person. Overall, this causes skin to look much more radiant with an even skin tone and a fairer complexion, whilst also reducing the amount of skin surface irregularities. The lasers work by causing the skin’s natural cells to eat up areas of pigmentation – this is beneficial for those hoping to achieve more even skin tone.

Certain skincare ingredients have shown effectiveness for even skin tone. For example, retinoids (which are prescription only), and oligopeptides which is what I incorporate in my skincare as it is non-irritating with potent anti-ageing properties and stimulate one’s immune cells to eat up pigmentation and has been proven to cause lighter skin tone.

Is it realistic to maintain a lighter skin tone than you’re naturally born with?

This is a very important question as it goes back to the premise of this series. Our skin tone is genetically determined and we refer to the Fitzpatrick phototype classification as mentioned above. It is unhealthy to want to bleach one’s skin and remove one’s natural melanin which is protective. There are ways to achieve that, but it is not practised in dermatologist’s offices because it is a dangerous method. The only indication for using bleaching creams will be to lighten small areas of hyperpigmentation such as sun spots or in cases of the medical condition – melasma.

To want to lighten one’s skin entirely, it is very dangerous because it can increase your risk of skin cancer as well as accelerate skin ageing. Such treatments are reserved for medical conditions such as vitiligo whereby one has lost significant amount of skin pigmentation through an autoimmune disease and is cosmetically disfiguring. In those cases, if the body surface area is involved very significantly, it can be an indication for the dermatologist to lighten the rest of the skin as well to help the overall cosmetic appearance.

What is the fastest way to lighten my skin tone naturally?

One’s skin tone often appears dark because of uneven pigmentation that has developed over the years with ageing and sun damage, as well as having dull skin. A quick in-office treatment will be a chemical peel performed by a dermatologist, using glycolic or lactic acids in combination with a laser treatment. In my clinic, we do both as part of a skin rejuvenating treatment on the same day. The results of this is usually apparent right after treatment, especially after applying the Amino Acid Masque which contains Vitamin C and various plant extracts that helps to shrink the pores and helps in brightening the skin tone.

To shed light on them, what are some controversial skin whitening and skin lightening methods?

More than controversial, some alternative skin lightening methods can be dangerous. In particular, do be wary of cosmetic products that promise exaggerated or miraculous results, as recommended by the Health Sciences Authority with some recent high profile cases of illegal cosmetics. Such products when purchased from unfamiliar sources may be prohibited, for example due to the dangerously high levels of mercury. This toxic heavy metal is in fact prohibited as an ingredient in skincare formulations as it can cause rash, skin discolouration and blotching. Chronic exposure to mercury may also cause damage to kidneys, digestive and nervous systems.

Another controversial method would be skin lightening creams containing ingredients such as hydroquinone and retinoids (tretinoin), which which can cause serious adverse reactions. While these substances may be commonly used in a dermatologist’s office as treatment for skin conditions, the potency requires it to be prescribed only by an accredited medical professional under strict medical supervision.

Other means of skin lightening such as intravenous glutathione treatments (injection) can be unsafe. Glutathione is an antioxidant naturally found in our cells and has skin-lightening abilities by converting melanin to a lighter color and cause reduction of melanin production as a whole. As with any treatments involving direct delivery to the bloodstream, additional caution should be exercised in consultation with an accredited medical professional. While glutathione has been proven safe for oral and topical treatments, we cannot say the same when it is injected into the bloodstream, given the inadequate safety data presently. Serious skin disorders, kidney dysfunction and thyroid function impairment have been reported in some cases.

SHOP THE STORY

Skin lightening and even out skin tone with the Vita C serum

7 Face Mask Questions Answered by a Dermatologist

March 19, 2021

Want to add a face mask to your routine but don’t know which one or how? In this article we answer the 7 commonest questions on face masks, including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Do sheet masks work as well as traditional masks?

Sheet masks work on the basis of occlusion, meaning when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. The question of efficacy is not so much of whether it is a traditional mask (presumably referring to clay masks or gels applied onto skin as it is) or sheet mask, but really depends on what is the active ingredient contained in the mask. With precise active ingredients, the type of mask (sheet or gel for instance) becomes secondary in terms of efficacy, as in my practice for example, whenever I want to increase absorption of any topical that is dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.

Are overnight masks more effective?

It is too much to generalise to say that overnight masks are more effective because it really depends on the active ingredients. All sleeping mask formulas are the same as moisturisers, as these are leave-in rather than wash-off ingredients. They work by absorbing onto the skin to produce moisturising effects. In leaving a topical on the skin for more than 12 hours for example, it would be important to first ascertain suitability of the ingredients, preservative and vehicle, including concentrations and types, and all of the components being intended to be applied on the skin for an extended period and not as a wash off.

It is really a good marketing invention, because this encourages people to apply the proper amount of moisturiser, which is a really liberal amount, overnight, as during the day they may not be as inclined to because of whitish cream residue that may be seen under makeup. If the active ingredients contain irritating substances such as lactic, salicylic, glycol acids or retinols, one could actually develop skin irritation or skin allergies from masking over an extended period. Most topicals would be fully absorbed into the skin within a couple of hours, so it’s not necessary to leave something on overnight. It is more important to consider that a liberal amount of a good moisturiser is used during sleep, as that is when the skin repairs itself.

The Radiance Fluide contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. Specially formulated for a light-weight feel to impart a radiant glow without make-up.

Is it necessary to mask the skin? What are the benefits of masking?

I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture to the skin and include ingredients (wash-off) which cannot be incorporated into leave-on moisturisers. The benefits of masking is largely associated with increasing skin moisture, so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as potent antioxidants which can be plant derived.

face masks for skin
The 360 Conscious Mask Bar subscription is a gender neutral self-care concept centred on a universal compact Home Mask Bar System, with hyperpersonalised cosmeceutical essence vials delivered on a monthly subscription basis to your home. 

Can you overdo masking? If yes, how do you know if you are overdoing it?

If you are using some form of cosmetic clay masks, I do not recommend doing so as these frequently contain astringents which excessively dries out the oil on one’s face using salicylic and lactic acids, typically marketed as products for acne prone skin. I do not recommend any of my acne patients to do that because when they are on medical treatment for acne, a common side effect is dry dehydrated skin. Conversely, one who is doing a home masking regimen that is marketed for reducing oily skin as well as acne, in place of seeking medical treatment for acne, it is possible that he or she ends up using masks containing salicylic and lactic acids (or clay derived products that dries out the skin) too often and may develop skin allergies or eczema. Overdoing masking in this case leads to skin that is dry, irritated, flaky and some people may develop more severe reactions. It is therefore important to get your skin condition properly diagnosed by an accredited dermatologist, rather than simply relying on DIY methods.

My preference for a wash-off face mask is a gel mask formula – Amino Acid 360° Masque. This enables a gentle, non-astringent effect, delivers vitamin C(for acne scars) and other antioxidants in a soothing gel that can be refrigerated to cool post-laser/chemical peel skin, and can also be tolerated by eczema/rosacea patients as well.

The AMINO ACID 360 MASQUE contains a potent concoction of skin brightening Vitamin C which soothes inflamed acne and lightens scars. LARECEA™ Extract with lifting amino acids penetrate the epidermis to stimulate collagen regeneration

Can you mask daily?

Yes definitely. When the mask contains cosmeceutical active ingredients clinically  proven to work on skin, these help to reverse the process of photoaging can have a skin brightening effect. As long as the mask delivers moisture and appropriate antioxidant ingredients instead of astringents (such as clay or charcoal) there is no limit to the number of times one can mask. Another tip I have for budget DIY masks?  Use your favourite ceramide-based moisturiser this way. For intensive treatment, apply a liberal amount of this moisturiser up to 3 times a day and on top of it use a soft damp cotton towel or the blank mask sheets (without essences) to increase absorption.

The MULTI-CERAM MOISTURISER is formulated with an optimal skin lipid mixture, containing a mixture of plant-derived phytoceramides and synthetic ceramide. Antioxidants that fight skin inflammation are incorporated for optimal treatment of eczema.

Can you combine different masks at one time? Or use one after another? And if so, what are some good combinations to follow?

I would not recommend that because of the types of ingredients that may be present in masks that specifically target for example oily skin. In this case, some people may consider their T zone to be oilier and decide to use salicylic or lactic acid infused mask for those areas and a hydrating mask for other areas. In theory, this may seem like a good idea. However, from a dermatologist’s perspective, it is much more efficient in the treatment of oily skin, to apply chemical peel that contains a higher concentration of salicylic acid, lactic acid or glycolic acid as a procedure done at a dermatologist’s office and subsequently rinse it off, rather than having very low concentrations present in a leave-on mask, because the effects will most likely be not as good and over time, may cause skin irritation.

Are there certain masks better suited for certain skin types (eg: peel-off, clay, cream for dry skin, oily skin etc.)?

I typically do not recommend astringent masks (which may include those marketed as clay types or for oily skin) for any skin condition, even super oily skin, because these are not proven to help acne treatment. The face mask that I would recommend would be those for skin moisturisation.

How do you choose the right mask if you have a few different skin problems (eg: dull complexion, dehydrated skin, breakouts all at once) – which skin problem should you address first?

The key thing here is looking at the root of each of these conditions and treating them. For example, a dull complexion is actually related to the ageing process where the skin cells turnover at a slower rate than somebody who is more youthful. In terms of addressing this problem, I would recommend using cosmeceuticals which are applied on to the skin and absorbed, together with chemical peels as well as lasers if necessary as recommended by your dermatologist. Dehydrated skin is quite tricky, because if your skin is so dry that it starts flaking or becomes red, you may be suffering from a form of facial eczema and it is important to have it treated medically, understanding that this is not about face masking at all. In terms of breakouts, acne itself is considered a medical condition that can be treated. It is also not treatable by skincare or face masks on their own. If the acne is severe enough, one may require oral medications, or if it is hormonal, medications like oral contraceptive pills may help to control the underlying problem.

Must I follow strictly to the time stated on the instructions during mask applications? What can go wrong if the mask is applied for longer than required?

For sheet masks, when the mask has dried up due to the process of evaporation, there would really be no point in applying that to one’s skin as there will be no extra benefits. Also, if the active ingredients contain something which is meant to control oil production, it can cause the skin to be very irritated and dry with excessive application. In fact, it may cause problems as excessively long application could increase the likelihood of skin allergy towards such active ingredients.

With clay masks or other types of astringent masks for example, it can certainly cause the skin to develop facial eczema when applied for too long.

The 360 Conscious Mask Bar

Polysaccharide face masks

Our 360 Conscious Mask Bar subscription is a “Skin & Hair Gym” membership based on the principles of ethnobotany and clean cosmeceuticals. The Mask Bar is a gender neutral self-care concept centred on a universal compact Home Mask Bar System, with hyperpersonalised cosmeceutical essence vials delivered on a monthly subscription basis to your home. 

The Mask Bar subscriptions comes with 2x Polysaccharide masks per month, and 3x customized cosmeceutical essence vials, and a 4L Mask Bar. The energy-efficient 4L Mask Bar is designed to toggle between optimal preset temperatures of 8°Celsius for anti-inflammatory cold therapy and 55°Celsius for relaxing thermal therapy for scalp and hair treatment. 

The 360° Conscious Mask Bar also comes with private access to skin and haircare masterclasses by Dr. Teo Wan Lin. The dermatology masterclass series focuses on the science of skincare/haircare and the treatment of common dermatological conditions such as rosacea, acne and eczema. Class material includes video tutorials, transcripts and worksheets. A private access code will be sent to your inbox with the purchase of the Mask Bar System.

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