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Period Acne: How Sex Hormones Impact Your Skin

September 14, 2021

Three hormones impact your skin during your monthly cycle: estrogen, progesterone and testosterone. These hormones fluctuate through the menstrual cycle, being responsible for the changes in your skin. They also cause period acne by increasing skin inflammation, oil production as well as increased bacterial growth, particularly C. acnes. These hormonal fluctuations just before your period may also be responsible for other period symptoms such as moodiness, sore breasts and premenstrual syndrome (PMS). In addition, PMS is associated with increased stress levels, which may also worsen acne.

1. Estrogen

Estrogen is the main hormone in the first half of your monthly cycle, which increases collagen production and skin thickness. This influences your skin’s structural integrity, moisture retention and barrier function. It also stimulates the hair follicles in the scalp and have antioxidant properties, protecting against stress and inflammation. At high levels of estrogen, it helps to hydrate your skin, making it look wrinkle-free as well as suppress levels of sebum production and gland activation.

2. Progesterone

Progesterone is another important sex hormone involved in your menstrual cycle. It helps keep the other hormone levels in check as well as reduces cortisol and other stress hormones. This promotes healthy sleep, which is vital for skin health.

3. Testosterone

Testosterone belongs to a class of male hormones, androgens. However, women also require a small amount of testosterone for growth, maintenance and repair of a woman’s reproductive tissues, bone mass and behaviour.  In women, it is produced in smaller quantities in the ovaries and released into the bloodstream. When there are more androgens binding to the receptors on the sebaceous glands, more sebum is produced. The sebum can combine with dead skin cells from within the pore, causing a blockage. This blockage traps all the excess sebum being produced and can trigger period acne. Additionally, these sebum-filled pores provide an ideal environment for C. acnes to proliferate and cause inflammatory period acne.

Sweat and menstrual cycle phases

The body’s ability to sweat changes throughout the cycle as well. Studies have shown that women in their second half of the cycle, also known as the luteal phase, have an increase in sweat production when exposed to warmer temperatures. This is as compared to when they were in the first half of their menstrual cycle, also known as the follicular phase. Increase in sweating is not just limited to the face, but across the whole body.

The menstrual cycle usually lasts for 28 days:

Days 1–7: Menstruation, the “Reset” of the Cycle

Cycle day 1 is the first day of the period. This is characterized with having low levels of the three major hormones, estrogen, progesterone and testosterone, affecting mood and metabolism. In particular, the low levels of estrogen leads to less stimulation of collagen, elastin and hyaluronic acid, hence the skin looks duller. Estrogen and testosterone levels gradually increase by cycle day 3. During the period itself, the condition of the skin generally improves. 

As skin barrier function and hydration are low during the menstrual phase, skincare should focus on increasing the skin’s water content. During this phase, one can use a moisturizer rich in phytoestrogens, which are plant-based estrogens. These natural moisturising factors safely and effectively imitate estrogen’s effect on skin, improving the skin’s elasticity, clarity and luminosity. It is also recommended to drink more water as the skin requires water to maintain its elasticity. Excess caffeine should be avoid, as it can dehydrate the body and cause skin dullness. One should also avoid sugar and simple carbohydrates during this period as it can cause the skin to become even more susceptible to blemishes and period acne.

period acne
The Blemish Spot Cream is a power packed dermatologist pimple cream formulated using bioactive plant extracts to quickly reduce and inhibit spot inflammation.

Days 8–15: “The Venus Week”

The week following your period, estrogen and testosterone both climb towards a peak just before ovulation. The increase in levels of estrogen and progesterone, accompanied with an increase in dopamine and endorphins, stimulates one’s mood and metabolism. The skin has a glowing effect.

During this week, less is more in terms of makeup, one should let their naturally enhanced skin shine through. It is recommended to keep sugar and carbohydrate intake to a minimum to keep your skin glowing. Maintaining a good skin care routine will also help to prolong your skin’s best condition. 

Days 16–28: Progesterone Dominance, the “Minerva Phase”

Just after ovulation, estrogen and testosterone decreases as progesterone levels increases. This encourages rest and eating, even though you may not be pregnant. As progesterone rises, it causes slower metabolism, resulting in more bloating and a tendency to gain weight.

Significantly for the skin, this rise in progesterone level stimulates sebum production. As the cycle progresses, even progesterone in addition to the other 2 hormones, begins to fall. This further affects one’s mood in response to the decrease in levels of the 3 main hormones. Shortly before menstruation begins, both oestrogen and progesterone are at their lowest levels and at this point testosterone is actually at a higher level than the female hormones. Consequently, there is an increase in sebum production.

During this phase, the best way to tackle a sluggish mood and sluggish metabolism is exercise and meditation. It is vital to take extra care to prevent skin problems in the week leading up to your period, where you’re likely to experience breakouts and skin dullness.

How to deal with period acne

In conclusion, by understanding the hormonal shifts behind each phase, one can anticipate and adjust to optimize her mood, energy levels and skin condition to avoid period acne, despite the intense hormonal changes. Other ways you can deal with period acne breakouts include avoiding irritating products, such as greasy sunscreens, cosmetics, oils, and concealers as well as limiting your exposure to UV rays by staying out of the sun when possible.

It is also recommended to wash your face after activities that cause you to sweat and only use acne products as directed according to your dermatologist. Applying too much product will irritate and dry out your skin which may worsen your period acne. For additional tips, click here to read more about a natural acne treatment.

Use the Miel Honey™ Cleanser for thorough cleansing of skin. It contains botanical emulsifiers leaving a clean yet moisturised feel. This cleanser also includes Arnica Montana Extract which stabilizes skin and reduces flaking.

7 Common Sunscreen Mistakes & How to Treat Sunburn

September 6, 2021

Sunscreen is the most important skin care product you can use to protect your skin from the sun. A good sunscreen with potent UVA and UVB blocking can keep you from getting sunburnt. It also minimizes the development of wrinkles and other signs of aging, and can reduce your risk of skin cancer, according to the U.S. Food and Drug Administration (FDA). In this article, we will discuss some common sunscreen mistakes and how you can effectively treat sunburns.

Sunscreens in skin cancer prevention

Skin cancer is the most common cancer in the United States, affecting one in five Americans in their lifetime. Yet most cases of skin cancer can be prevented by protecting your skin from the sun’s harmful ultraviolet rays. In animal studies, a sunscreen of SPF 12 was shown to protect against epidermal cell damage while a sunscreen of SPF 15, when applied to mouse skin was found to nearly abolish UVR-induced mutations in the p53 tumor suppressor gene.

The best way to prevent skin cancer is sun avoidance. Where that is not possible, once can practise seeking shade, wearing protective clothing, and applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. However, in a recent survey, the American Academy of Dermatology (AAD) found that not everyone is applying their sunscreen correctly, making several common sunscreen mistakes. This leaves people vulnerable to dangerous ultraviolet radiation from the sun and susceptible to skin cancer.

Common Sunscreen Mistakes

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 this sunscreen are potent antioxidants which actively fight free radicals generated by blue light as well as airborne pollutants – for comprehensive protection.

Common Sunscreen Mistakes 

Ignoring the label

There are a variety of sunscreens on the market with a myriad of labels offering little explanations, which no doubt contributes to the common sunscreen mistakes made by people. However, to effectively protect one from the sun, it is recommended by the AAD to wear sunscreens that are broad-spectrum, water-resistant and have an SPF of 30 or higher. Sunscreens that are “water resistant” are often misconceived to be very long lasting, but it may actually provide protection for only 40 minutes in water according to FDA definitions. Hence, to be as safe as possible when in the sun, use a lot of sunscreen and reapply it frequently.

Using too little and waiting too long to reapply

Amongst common sunscreen mistakes, the most frequently made mistake is probably that most people apply less than the recommended amount of sunscreen. One should apply sunscreen generously and cover all skin that isn’t covered by clothing. In fact, in order to achieve the SPF rating labeled on the bottled, one needs to apply 2mg per square centimetre of skin according to SPF definitions. This works out approximately to be a quarter to half a teaspoon to cover the entire face. In addition, one should apply sunscreen 15 minutes before going outdoors, and reapply at least every 2 hours and even more often if you are swimming or sweating. 

Applying only in sunny weather 

The sun emits harmful UV rays all year long, however the AAD found that only about 20% of Americans use sunscreen on cloudy days, where up to 80% of UV rays can penetrate your skin. To protect your skin and reduce skin cancer risk, apply sunscreen every time you head outside, even on cloudy days.

Using an old bottle

The FDA requires sunscreen to last three years. After that, it may not provide the amount of protection listed on the bottle. Check the expiration date before applying, and if there is no expiry date indicated on the bottle, assume it expires three years from the date of purchase. Throw out your sunscreen if it’s expired or if you are unsure how long you’ve had it, as applying expired sunscreen does not help protect your skin from the sun.

Relying solely on sunscreen

Since no sunscreen can block 100% of the sun’s UV rays, it’s also important to seek shade and wear sun-protective clothing with an ultraviolet protection factor label, including a lightweight, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses with UV protection for eye protection. 

Missing Important Areas

It’s important to apply sunscreen to all areas that will be exposed to the sun, and there are a few spots people tend to miss as part of the most common sunscreen mistakes. A study published in April 2019 in the journal PLoS One found that nearly 20 percent of participants did not apply sunscreen to their eyelids, with the skin on the eyelid having the highest incidence of skin cancer per unit area. Lips are another often-missed area that’s susceptible to damage as they do not contain a lot of melanin, which is a protective pigment. The Skin Cancer Foundation recommends one to wear a lip balm or lipstick with SPF 15 or higher. 

Your skin can burn if it receives too much exposure from the sun’s ultraviolet rays. Although it may seem like a temporary condition, sunburn can cause long-lasting damage to the skin, which may increase one’s risk of getting skin cancer. Hence, to help heal and soothe stinging skin, it is important to begin treating sunburn as soon as you notice it.

Taking Care of Sunburn

Use a moisturizer that contains ceramides to help repair sunburnt skin

While your skin is still wet after showering, apply a moisturizer cream or lotion to help seal in moisture. Ceramides are important components of a good moisturiser as they mimic natural lipids that help to repair and restore the skin barrier. Over the next few days at least following sun damage, apply moisturizer frequently to the affected area. This will help keep the skin hydrated and expedite repair of the skin barrier. 

Skin repair cream

The Multi-CERAM™ Moisturiser is an ultra intensive skin moisturiser for total skin barrier repair with pharmaceutical grade ingredients. It is dermatologist-formulated to treat eczema, dry sensitive skin and to prevent skin aging.

Drink more water

A sunburn draws fluid to the skin’s surface and away from the rest of the body, hence drinking more water when you are sunburnt helps prevent dehydration. It is vital to rehydrate by drinking extra liquids, including water and sports drinks that help to replenish electrolytes. 

Take extra care to protect sunburnt skin while it heals

Wear clothing that covers your skin while outdoors and stay out of the sun entirely until the sunburn heals. Loose, soft, breathable and tightly-woven fabrics are recommended to protect the affected area. UPF or Ultraviolet Protection Factor where available is the gold standard for sun protective clothing. However, in the absence of that, it is sufficient to identify tightly-woven fabrics by holding the fabric up to a bright light and seeing that the fabric does not allow any light to pass through. 

And there you have it, a whole list of common sunscreen mistakes and sunburn tips which we have now clarified and hopefully helpful to you!

References:

Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. J Am Acad Dermatol. 2017;76(3S1):S100-S109. doi:10.1016/j.jaad.2016.09.038

Back Acne: Causes, Prevention And Treatment

August 28, 2021

Acne is a common skin disease in adolescents and young adults, occurring mainly in areas rich in sebaceous glands such as the scalp, face, chest and back. It originates from enhanced sebum production, which leads to comedones and secondary inflammation of the hair follicles in sebaceous areas. 

Skin on the back is as prone to acne as skin on the face. The occurrence of back acne, coined as bacne, has been significantly associated with insecurities of appearance for both men and women. Patients who are 20 years and above are significantly more likely to suffer from appearance-related distress compared to 16 -19 year-old patients. In this article, learn more about the causes, prevention and treatment options for back acne.

Causes of Back Acne

Fluctuations of sex hormones is a main contributing factor to bacne. Stress, illness, travel, disturbed sleep pattern, menstruation cycles and puberty can all alter the hormonal cycle and lead to breakouts. Specifically, the production of testosterone in both men and women, enlarges oil glands and causes them to produce an excess of oil. At the same time, dead skin cells that are not shed properly clog up the follicles. The combination of these processes leads to a build-up of oil and results in whiteheads and blackheads. Additionally, Cutibacterium acnes is present on everyone’s skin and it does not cause any problems for many. However, the buildup of oil on the skin of people prone to acne creates an optimal environment for the bacteria to multiply. This can lead to inflammation and the formation of blemishes, pimples and cysts. Back acne is actually a subset of acne vulgaris and you’ll most likely find that the individual has acne on their face too. 

Learn more on the causes of back acne, as well as treatment and prevention methods in our podcast, Dermatologist Talks: Science of Beauty by accredited dermatologist, Dr. Teo Wan Lin.

When Back Acne is not just Acne 

A form of back acne is actually a fungal infection, termed as fungal acne, Malassezia folliculitis, also known as pityrosporum folliculitis. It is an infection of the hair follicle caused by Malassezia yeasts. This yeast overgrows in a humid, tropical, summer-like climate, being very common in Singapore. It is also common in individuals who tend to produce more oil. We can characterize it by multiple small bumps on the surface of the skin that actually look very similar to each other, and they may actually be itchy. This is different from traditional acne bumps. 

Risk Factors Of Back Acne 

First of all, it’s important to note that bacne in most cases is a combination and not just one of the two conditions. The reason is really because if you are acne prone, you already produce more oil than your peers. This puts you at a higher risk of the yeast colonizing your skin, which causes pityrosporum folliculitis. Genetic susceptibility is one key factor, which determines the content of the sebum the individual produces and consequently, affecting the microbiome of the skin. So this explains why certain individuals never develope acne despite having exposure to the same environmental triggers as another person.

Triggers that can cause Back Acne 

Living in a humid, tropical climate, or individuals who get flare ups during the summer season is one key trigger. This is because when the weather is hot, individuals sweat more, changing the local skin microbiome. The fungal organisms, malassezia furfur, as well as bacteria that causes acne, known as C acnes, then proliferates. This will then increase your chances of developing bacne.

The local factors that’s caused by textile skin interactions are also relevant in this context. For example, if an individual exercises a lot and stay sweaty throughout the day without changing out of the wet clothing, this causes an accumulation of sweat mixture with dirt, grime and bacteria. All that will cause secondary infections in individuals who suffer from bacne. In particular, if one wears tight-fitting clothing especially from nonbreathable, synthetic or elastic material, this can occlude the surface of your skin and can cause your symptoms to get worse. 

Preventing Back Acne 

It is recommended to shower after sweating, avoid products that irritate your skin, avoid scrubbing the affected areas, not pick at spots as this may lead to them spreading and scarring. It is best to stay out of the sun and avoiding tanning beds because damaged skin is more prone to acne. 

Breathable textiles with dry-fit textile technology usually help to actively cool the skin and not get saturated with sweat during intense exercise. These are recommended for sportswear to prevent backne. Traditionally, we consider cotton, linen and silk to be breathable textiles that help to regulate the skin microenvironment. However, the downside is that a lot of these materials when saturated with sweat such as in the case of sportswear, actually become very heavy. 

Biofunctional Textile for Preventing and Treating Back Acne 

In my practice, we are using a biofunctional textile – a kimono to be worn at night. The Anti-Ageing Kimono in CUIONS™ Gold features a nanoparticle integrated biofunctional textile woven into a luxurious garment with minimal seams for ultimate skin comfort. The garments targets the skin microbiome and helps to treat body acne and eczema through its bactericidal properties. It also creates a breathable skin microclimate by reducing the humidity around the skin, hence resulting in a healthier skin microbiome.Wearing the correct skin friendly fabrics will prevent recurrence of body acne and is an important part of treatment. 

back acne

The unisex Anti-Aging Kimono in CUIONS™ Gold features a nanoparticle integrated biofunctional textile¹ woven into a luxurious garment with minimal seams for ultimate skin comfort and breathability.

The evolution of biofunctional textiles is also relevant in the treatment of disorders such as bacne, where there’s a large body surface area affected unlike individuals who only have acne on the face. When cream application may be difficult, it stands to be a promising mode of therapy. Topical antibiotics for the treatment of acne has been around for decades, but long term use is quite tricky because of the emergence of drug resistance. Biofunctional textiles essentially function as topical antibiotics but without the risk of bacterial resistance. 

Design and Cut of Clothing

Additionally, the importance of clothing doesn’t just stop at the material, but also the design and the cut. The design should allow for adequate airflow and comfortable movement. For the junction between the skin and the garment, it’s important to reduce the chances of occlusion related dermatosis. 

Treating Back Acne 

Firstly, one can use an antibacterial body wash such as the Miel Honey™ Cleanser, a medical grade antibacterial, anti-fungal honey cleanser which naturally emulsifies and leaves a humectant layer on the skin. A prescription retinoid is also helpful in the adjunct treatment of bacne. It can help reduce the appearance of blackheads and whiteheads, which subsequently become inflamed when infected. 

TheMiel Honey™ Cleanser is dermatologist-designed for thorough cleansing of skin with botanical emulsifiers leaving a clean yet moisturised feel. It contains Arnica Montana Extract that stabilizes skin and reduces flaking.

Natural Back Acne Treatment

Some of the topical medications besides retinoids that can be helpful in the treatment of bacne are in the realm of botanicals. Berberine, a derivative from Eastern medicine is an active ingredient which successfully suppress various acne pathways, including inflammation, scar formation, antioxidant properties, and also has minimal to zero irritation potential.

References:

Schaunig C, Kopera D. Silk textile with antimicrobial AEM5772/5 (Dermasilk): a pilot study with positive influence on acne vulgaris on the back. Int J Dermatol. 2017;56(5):589-591. doi:10.1111/ijd.13541
Hassan J, Grogan S, Clark-Carter D, Richards H, Yates V. The individual health burden of acne. J Health Psychol. 2009;14(8):1105-1118. doi:10.1177/1359105309342470

Singapore Dermatologist: A Comprehensive Guide

August 24, 2021

Looking for a Singapore Dermatologist? Let’s understand a little bit about dermatology. Dermatology is a specialised branch of medicine. The specialty covers specific conditions that encompass the skin, hair and nails, and is considered traditionally a branch of Internal Medicine. Dermatology also entails surgery because of skin cancers as well as superficial lumps and bumps. Superficial skin lesions can be either benign or malignant. These often require removal by surgery. Surgical excision is required, for example, for pre-malignant or cancerous lesions.

A qualified dermatologist is trained extensively in Singapore. A Singapore dermatologist has undergone at least eight to 10 years of postgraduate training before becoming board certified. This starts with five years of medical school, where basic medical and surgical knowledge is tested. After one year of housemanship, applicants to dermatology can then start to apply for the dermatology residency program, which is part of Internal Medicine. In this process, they go into postgraduate studies involving both medical and surgical aspects of dermatology. Pathology is an important field in dermatology training. Dermatologist are trained to identify historic pathology. This refers to cell and tissue appearances of skin diseases that is important in diagnosis.

In the last five to eight years, especially in Singapore, there has been a proliferation of skincare doctors, skincare experts, and aesthetic doctors who claim to be practising some form of dermatology. An internet search of the term “Singapore Dermatologist” throws up multitudes of results and listings that hardly brings clarity to what it actually means. What does being a Singapore Dermatologist truly entail? In the following, we seek to shed some light to the term.

Checking the Accreditation of a Singapore Dermatologist

According to the Ministry of Health (MoH) Singapore guidelines, only accredited dermatologist are qualified to be considered specialists in the field of skin, hair and nails. The correct practice of dermatology would be required in order to qualify an individual as a trained Singapore dermatologist. This includes having to learn to diagnose and treat over 3,000 known diseases of the skin, hair and nails, and also cosmetic concerns. The proliferation of skincare experts and skincare doctors, who go by many of these names including aesthetic doctors, is deeply worrying. This is because many of them actually even mislead the public in terms of their qualifications.

A diploma in dermatology does not qualify an individual to be a dermatologist. Neither does showing up in a “Singapore Dermatologist” internet search guarantee that one is a dermatologist. It is important for the public to first check the doctor’s qualification which can be conveniently accessed at the MoH website.

They should also raise to the Dermatological Society of Singapore if they encounter any physician who intentionally misleads them to believe that they are dermatologists. You may refer to the Dermatological Society of Singapore’s website for their ongoing public education campaign on who is a skin doctor. There is a QR code at the website, which you can scan to help you identify if the said doctor is indeed a dermatologist that they claim to be.

Medical Treatment by Singapore Dermatologist

It is very important to understand that the skin is an organ to be respected as much as the heart, the lungs and the liver. The skin is in fact, the largest organ of the body. Besides that, the conditions that affect individuals across the different age groups are also unique. A Singapore Dermatologist is uniquely trained in paediatric, adult and geriatric dermatology. They care for people across the age groups.

Examples of paediatric dermatology cases would be birthmarks. Birthmarks are not just a cosmetic concern, as certain types of birthmarks known as haemangiomas can also be function threatening. An example would be ahaemangiomas growth that threatens the child’s eyesight.

In an adult or even in a younger person, it is not uncommon to diagnose skin cancers. The most dangerous type of skin cancer we are aware of is a melanoma, and melanomas are deadly if left unchecked. However, if diagnosed and treated with excision early, and with chemotherapy if required, it is treatable.

Singapore Dermatologist Eczema Treatment

Common conditions such as eczema, may be overlooked or disregarded by many as a minor skin concern. What a Singapore dermatologist knows and is empowered to do is to alleviate the immense suffering associated with intense itching. This severely troubles school going children when they are trying to pay attention in class. At home, it is even more unbearable, as it can disrupt sleep. This is a vicious cycle. As the child without appropriate dermatological intervention and treatment by a dermatologist will find it hard to pay attention during the time in school.

An interesting aspect of dermatology and what highlights the importance of the work of a Singapore dermatologist, is that many severe internal organ failures. This includes liver failure and kidney failure, for example, which can manifest with skin symptoms.

Pruritis is an example of such a dermatological condition. It is a generic term to describe excessive itch occurring all over the body with minimal skin signs. By skin signs, dermatologist, refer to the presence of redness, flaking and scratch marks. When these signs are missing, and the individual complaints of itch, then it is a cause for further investigation. Many times, dermatologists are the first to pick up severe internal organ diseases such as liver cancers and pancreatic cancers because of this.

Hair Loss Treatment by Singapore Dermatologist

Dermatologists, are also very important physicians, when it comes to treatment of scalp issues and hair loss. Hair loss is a troubling condition that can disturb one’s self esteem. In Singapore, dermatologists are the only accredited specialists to treat scalp and hair problems. Many members of the public believe that going to a trichologist is the answer for their scalp problems. However, this is not the case. Trichologists are not medical doctors, and definitely not all medical doctors who offer to treat hair loss are dermatologists.

Why is it important to have your hair loss treated by an accredited Singapore dermatologist? There are many causes of hair loss. Alopecia Areata is an example of such a condition that can progress rapidly, and has more severe, underlying causes, such as an autoimmune disease. It is important for dermatologists, to identify and treat causes of hair fall early in order to prevent long term disfigurement. This is also to pick up any underlying disease. For example, Alopecia Areata can be associated with thyroid dysfunction.

What is a Board Certified Dermatologist?

As you would have seen by now, the work of a Singapore dermatologist involves extensive training and accreditation. However, with the advent of social media, there has been an influx of these skincare and haircare experts. Some of whom have a medical degree, many of whom do not. It is important in terms of public perception that the skin and the hair has to be respected as important organs that needs to be treated by an accredited specialist.

Let us now discuss a little more about board certification. Fundamentally, it is not right to call yourself a dermatologist if you are not. At least in Singapore, the US, Europe, and Australia, we know that there are medical boards which provide board certification. This means that the health authorities are regulating the use of this term. Consequently, the board certification that a dermatologist receives is important because it is a sign of standardised international training relevant in the treatment and care of dermatological conditions.

How can you tell if your dermatologist is board certified? In the US, the letters FAAD appear as a qualification after the name of the doctor. This stands for Fellow of the American Academy of Dermatology. In Singapore, look up for the term FAMS, which is referring to Fellow of the Academy of Medicine Singapore, with the note the term dermatology after that. You can generally check on a dermatologist’s website, if they are board certified.

However, it has caught our attention that many aesthetic doctors have been misleading, in terms of their representation of themselves using the word dermatology throughout their bio, without stating that they are a dermatologist. Many of them are also touted as skincare specialists, but there is no regulation on such a term.

In fact, aesthetic doctors are general practitioners who should, according to the Ministry of Health – Singapore Medical Council guidelines, state themselves as general practitioners. Aesthetic medicine itself is not an accredited specialty. Again, we refer you to the Dermatological Society of Singapore’s website to check how to determine if your doctor is indeed a board certified dermatologist.

Why should you choose a board certified dermatologist in Singapore?

First of all, the skin itself is a complex organ that links to many internal diseases. Even for conditions such as acne, eczema, these are optimally treated by an accredited skin specialist with many years of experience, training and expertise.

In addition, If you suffer from hair fall, it is important to get the attention of a dermatologist as soon as you notice it. This is because hair does take time to grow back. A Singapore dermatologist is well positioned to advise on the evidence based treatments available, and also to work out for any underlying causes of hair fall which can be life threatening. By life threatening, we refer to internal diseases such as thyroid function problems. Thyrotoxicosis is an extreme state of high thyroid levels that can present with hair loss, and can also cause lethal heart rhythm problems.

Besides, for individuals who think that they only have pigmentation problems and visit an aesthetic doctor, many of these fail to realise that pigmentation can sometimes be skin cancers. A common example is lentigo maligna. Lentigo maligna is an extremely dangerous, aggressive form of melanoma that can appear on the face looking like a sunspot or a freckle. It is something well studied by dermatologists. An important step in management is to do a punch biopsy and have the results read by a dermatopathologist.

If you are struggling with your skincare routine, it can be confusing. In terms of information out there and who to listen to, there seems to be many experts. It is important to understand that beautiful looking skin is actually healthy skin. A Singapore dermatologist is best poised to advise you on the availability of treatment and maintenance options in a skincare routine that will help you achieve healthy and hence beautiful looking skin.

The Importance Of Treating Acne Early – How To Prevent Acne Breakouts

August 14, 2021

For most individuals, acne is just part and parcel of growing up. Almost everyone has experienced a skin breakout at some point in their lives. In recent years, acne treatments have become more effective, with benefits of treating acne early instead of letting it run its course, becoming more prominent. Acne as a whole is harmless, however, it can have physical and emotional impacts, and in some cases, be disfiguring. In this article, we will discuss how to prevent acne breakouts and why it is important to do so.

What is acne?

Acne is a chronic, inflammatory skin condition that can cause blackheads, whiteheads, pimples, acne cysts or nodules especially on the face, shoulders and back.  Acne forms when pores in your skin become blocked by oil, dead skin cells, bacteria, and other environmental debris. 

Is it better to treat acne or leave it alone?

While acne will eventually resolve by its own, it is recommended to treat acne for these reasons:

Reduce scars

All types of acne from blackheads to deep, painful nodules can cause scarring, which may be permanent. By treating acne early before it worsens, it helps prevent acne scars. While severe acne is most likely to leave scars, mild acne can scar when picked. Treating at the first sign of acne may also prevent one from developing a habit of picking at their acne and risk developing acne scars.

Stop lingering spots from developing when acne clears

Individuals with medium-to-darkly pigmented skin may see a dark spot appear when an acne pimple, cyst, or nodule clears, whereas individuals with light-coloured skin may see a red spot where acne once was. This is known as post-inflammatory hyperpigmentation, which can linger for months. 

Prevent mild acne from becoming severe

Left untreated, acne can worsen. What starts out as a few pimples can progress to widespread blackheads, whiteheads, and deep, painful pimples. Hence, by starting acne treatment early, it decreases the likelihood that one needs stronger acne medicine if acne becomes severe. These medicines have more possible side effects and require close monitoring by a dermatologist. 

Sidestep emotional distress

Studies have shown that many suffer with self-esteem issues after developing acne while many research studies have also shown that people who have severe acne tend to have higher rates of depression and anxiety than do people without acne. Other studies show that treating acne can alleviate these feelings.

How to prevent acne breakouts

Cleansing

Gentle cleansers with antibacterial active ingredients for maintenance of a healthy skin microbiome.

The Miel Honey™ Cleanser allows thorough cleansing of skin with botanical emulsifiers leaving a clean yet moisturised feel. It contains Arnica Montana Extract which stabilizes skin and reduces flaking.

Leave‐on skincare

Avoid alcohol, salicylic acid, alpha‐hydroxy acids, and retinols in leave‐on acne skincare formulations because of increased risk of irritant contact dermatitis under prolonged occlusion.

Moisturizers

Serum, mist, lotion, and cream‐based vehicles are preferred over ointments. Moisturizers are essential in the maintenance of a healthy skin barrier function and reduce disruption of the skin microbiome, besides acting as a shield against external triggers. Humectants and “Prescription Emollient Devices (PEDs) should be the standard of care for moisturizers. Examples of PEDs include optimal ceramide/lipid mixtures with anti‐inflammatory ingredients such as glycyrrhetinic acid while examples of humectants that reduce transepidermal water loss without any irritation when worn under occlusion are natural moisturizing factors, sodium hyaluronate, and polyglutamic acid. 

The Multi-CERAM™ Moisturiser is dermatologist-formulated to treat eczema, dry sensitive skin and to prevent skin ageing. It is formulated as a Prescription Emollient Device (PED), the gold standard in eczema management, and also the optimal moisturiser for barrier protection against maskne.

Topical acne treatments

Chemical active ingredients, such as benzoyl peroxide, salicylic acid, sulfur, alpha‐hydroxy acids, and retinoids, have a higher risk of inducing irritant contact dermatitis under occlusive face mask wear. Evidence‐based botanical active ingredients, which work via anti‐inflammatory effects, regulation of sebum production, and broad‐spectrum antimicrobial activity, are recommended for maskne treatment. Zinc oxide formulations have broad antimicrobial properties effective for prevention and treatment of acne, and are stable in powder formulations.

Hydrogel carrier formulations of retinoid or antibiotic combination topicals can minimize local irritation by ensuring better drug tolerance and efficacy in addition to providing an optimal wound healing environment. It may also provide effective barrier protection to reduce skin–textile friction and secondary bacterial infection.

Sunscreen

Current recommendations of broad‐spectrum SPF 50+ topical sunscreen and its 3–4 hourly reapplication rate are impractical under long periods of face mask wear especially outdoors. Ultraviolet protective (UPF) 50+ fabrics used for mask wear should be the principal intervention for broad‐spectrum sun protection for the lower half of the face during the COVID‐19 pandemic, to improve patient compliance to photoprotection and incentivize mask‐wearing, also eliminating periodic reapplication of sunscreens.

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.

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, reduce 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 CUIONS™ Copper Silk Face Mask contains copper nanoparticle impregnated fabric in 2 layers for enhanced filtration. It is rigorously lab tested for the active release of copper ions that are biocidal.

References:

Teo WL. The “Maskne” microbiome – pathophysiology and therapeutics. Int J Dermatol. 2021;60(7):799-809. doi:10.1111/ijd.15425

American Academy of Dermatology. “Acne comes of age earlier.” News release issued August 2, 2013. Last accessed April 28, 2017.

American Academy of Dermatology. “Acne by the numbers.” In: Burden of Skin Disease. Last accessed April 28, 2017.

Sunscreen for Face – How Much to Use According to a Dermatologist

August 7, 2021

Sunscreen is one of the most important ways to protect your skin’s appearance at any health and age. When used regularly, sunscreen for face and body helps to prevent sunburn, skin cancer, and premature signs of aging. In this article, accredited dermatologist Dr. Teo Wan Lin answers commonly asked questions about sunscreen.

Fact or fiction: should we be using a two-finger length of sunscreen for our face and body? How much sunscreen should I use on my face and body?

The two-finger length is a somewhat arbitrary method of determining the amount of sunscreen that we need. This measurement was proposed in a letter written to the British Medical Journal in 2002, which simply highlights a broad rule of thumb about how we are likely under-applying the amount of sunscreen that we need. In fact, most people only end up applying maybe 25-50% of what’s usually required.

Taking into consideration the recommendation of 2mg per sq cm of skin, in practice, this means using at least a teaspoon worth of sunscreen to cover the face. Studies indicate that most people use too little sunscreen, meaning most are getting sun protection levels much less than the product-stated SPF. Factoring in activities such as swimming or exercising further reduces the amount of sun protection left on the skin. When outdoors, the recommendation is to reapply sunscreen approximately every two hours, or after swimming or sweating.

It is important to be a little bit more conservative in terms of estimating the amount of sunscreen that we are applying. Also, remember not to just rely on sunscreen alone. Rather, sun avoidance measures are probably a much more integral part of sun protection as well. In particular, avoid the sun from 10am to 4pm in an equatorial climate.

Is this the same amount for different types and textures of sunscreen such as cream, gel, lotion and milk?

It is very relevant to talk about the different textures available. The reason is because, first of all, it can affect the subjective perception by the user of how cosmetically acceptable a product is. This may subconsciously influence the amount that they end up applying. For example, in humid climates like in Singapore, we find that we tend to underapply cream or oily versions of sunscreens because it gives the sensation that you’re already applying much more than what you should. In fact, under laboratory settings, to achieve the SPF reflected on the bottle, we should use approximately 2 milligrams per square centimeter of skin. These types of formulations are actually the most effective and the most common.

The thing with gels and lotions is that sometimes it does lower the efficacy of a sunscreen itself. Because, the certain components that protect against UVA, for example, the chemical sunscreens, are only stable in an oil formula. So when it is in a gel or lotion formula, these can eventually contribute to a lower overall SPF value.

Oil in water sunscreens

The exact change in efficacy really depends on the individual formulation, such as the proportion of oil and water components. Oil-in-water and water-in-oil systems are the most commonly available sunscreens and for good reason. They are easy to apply and the oil provides UV absorption. The rule of thumb in applying sunblock is still to stick to the SPF rating which is fixed based on a 2 mg per square centimeter skin application.

The SPF provides a predetermined rating of the amount of sun protection given for the universally fixed amount of application on skin (at 2mg per sq cm). It is independent from the type of formulation, be it gel or lotion etc, which inherently affects the amount of protection given, but not the amount applied. That is fixed on a specific SPF rating. Do note that current FDA regulations on testing and standardization do not pertain to spray sunscreens. The FDA continues to evaluate these products to ensure safety and effectiveness.

What exactly is SPF?

SPF is a measure of how much UV radiation from the sun is required to produce sunburn on skin that is protected by sunscreen. Hence, as the SPF value of the sunscreen increases, there is a proportionate increase in protection against sunburn. The SPF allows the consumer to compare the level of sunburn protection provided by different sunscreens. In dermatology practices, we recommend SPF 30 minimum because of practical issues surrounding reapplication. 

Learn more about choosing the ideal sunscreen in our podcast, Dermatologist Talks: Science of Beauty.

Does a high SPF mean I can apply less sunscreen?

Many people believe that wearing a SPF 15 sunscreen allows an individual to stay in the sun 15 times longer without getting sunburnt. This is a very simplistic way of thinking about sunscreens and SPF factor. It is also rather inaccurate. Because, SPF is directly related to the amount of solar exposure that you’re trying to protect your skin from. While it is true that the total amount of solar exposure energy is also related to the duration of solar exposure, there are other factors that influence the amount of solar energy reaching your skin and causing ultraviolet induced damage. For example, the intensity of solar exposure.

The most important thing is that at the end of the day, the American Academy of Dermatology still recommends using sunscreen for face and body in conjunction with sun avoidance measures. Sun avoidance measures are particularly important in a year round tropical climate like equatorial Singapore. From the time of 10am-4pm when the sun is most intense, that’s traditionally what’s recommended in temperate climates. In Singapore’s context, we should be avoiding the sun from 9am all the way to 5pm.

What is the recommended SPF we should wear on a daily basis? How often should it be re-applied for effective protection?

Yes, definitely for daily wear. We live in a year-round tropical climate with high amounts of UV exposure, even indoors, because of windows that do not have UV filters. Dermatologists recommend a minimum of SPF 30. Taking into consideration that the cosmetic preferences of individuals, for example, depending on the texture of the sunscreen, may result in decreased application. For example, if the sunscreen feels uncomfortable or greasy, which are factors that need to be considered.

In general, an SPF 30 blocks 97 percent of the sun’s UVB rays. A higher SPF blocks slightly more of the UVB rays. However, no sunscreen can block 100% of it, so there is little use going for excessively high SPF ratings. In my practice, I typically prescribe an SPF 50. For example, the SunProtector, which uses a lightweight invisible formulation suitable for humid climates.

Best sunscreen for face: Sunprotector

The SunProtector is exquisitely formulated for humid climates. It is a broad-spectrum sunscreen that also regenerates and soothes sensitive skin. Designed with unique pigments blended to be almost invisible under make-up.

It is also critical to note that a higher SPF lasts the same amount of time as a lower SPF. A high SPF does not allow you to spend additional time outdoors without reapplication. Sunscreen for face and body should be reapplied approximately every two hours when outdoors, even on cloudy days. Furhtermore, after swimming or sweating, as may be instructed on the bottle. In addition, as discussed earlier, one should practise avoiding the sun from 10am to 4pm (in equatorial climates) as much as possible by planning their outdoor activities around it.

Shoul I use a makeup sponge to apply sunscreen? Does it help to apply more evenly?

I don’t recommend this method of dabbing sunscreen onto the sponge. The sponge will definitely lower the efficacy of the sunscreen for face. By virtue of the fact that it is absorbent and is meant for application of makeup. It may even give the false impression – because the sponge gives ‘even coverage’ – that a sufficient amount of sunscreen has been applied. The key thing is the thickness of sunscreen that protects your skin.

I’ve heard that we should apply sunscreen in the direction of the hair’s growth in over to prevent clogging of the pores, is this true?

Unfortunately, this is completely a myth. In terms of skin clogging, the best medical term to describe this would be comedogenicity. Comedogenicity has to do with a few factors. First of all, if the formula itself is heavily oil-based. However, there are oil-based products that are not comedogenic. In fact, it is rare to find a truly comedogenic product both in makeup and skincare in this day and age. Maybe in the early 90s, but rarely in this age. Because of the extensive knowledge of cosmetics and skincare we have now.

The key thing here is also the microenvironment of the skin. For example, if you are wearing sunscreen for face under a face mask, the occlusive nature of the face mask can increase the comedogenicity of the product, even if it’s not comedogenic on its own. 

Applying it in a different direction is not a science-based approach. Comedones also do not actually form on the surface of the skin. Instead, they start with an inflammatory process in the deeper layers of the skin – starting as microcomedones before they surface to the top of the skin.

Should I apply more sunscreen for areas on the face with pigmentation or dark spots?

There is no objective scientific evidence that suggests this. Rather, we know that even areas which do not have pigmentation are prone to developing pigmentation. It’s important to note that way before we see pigmentation developing, it’s actually been developing under the skin over many years. My suggestion is to apply as much as you can, and follow the rule that more is always safer when it comes to sunscreen for face. Especially for skin of color, it’s important to look for formulations that do not leave a white cast on your skin.

Is there an ideal method as to how to apply sunscreen on the face and body?

Studies using fluorescence with sunscreens have documented “missing areas” after self-application of sunscreen which is an important consideration when sunscreen fails to protect against sunburn. Techniques of sunscreen application were also tested, and it was found that rubbing instead of gentle application decreased the SPF up to 20%. The latter is therefore recommended to minimise the loss of efficacy during application.

A novel technique for sunscreen application

Notably, a 2014 study described a sunscreen application technique to protect more efficiently against UV radiation. This technique is a systematized method dividing the body and face into different segments so as not to forget any “zones”, which differs from conventional methods. It consisted of three steps.

Namely, step 1 involves the dose of sunscreen (visualization of “teaspoons” to reach the correct amount for each “zone”). Step 2 involves the application itself (applying the total dose on several uniformly spaced spots for each “zone”). Finally, step 3 involves the spread during application (with gentle circular moves for an even application for each “zone”). This sunscreen application technique has been developed for different preparations such as creams, lotions, and sprays. The study showed that it enabled sunscreen to be much more evenly applied.

Furthermore, the skin surface area covered by sunscreen was significantly improved. This method, which has been approved by the French Association of Photodermatology, may provide a useful framework to educate individuals on the proper way of applying sunscreen to improve skin protection from UV rays.

References:

Jeanmougin M, Bouloc A, Schmutz JL. A new sunscreen application technique to protect more efficiently from ultraviolet radiation. Photodermatol Photoimmunol Photomed. 2014;30(6):323-331. doi:10.1111/phpp.12138

Pregnancy-Safe Skincare: Ingredients to Use and Those to Avoid

July 27, 2021

During pregnancy, women commonly experience many physiological changes, including changes in hormone levels, such as increases in androgen levels. This may result in acne development or worsening of acne, as well as an increase in hair growth. The safety of common skincare agents used for acne as well as bleaching creams and hair removal products for pregnant women are often undermined, even though most skincare products are safe and not expected to cause malformations or adverse effects on the developing foetus. In this article, learn how women can still look and feel their best with a pregnancy-safe skincare routine, without putting their developing foetus at risk. 

How does the skin change during pregnancy?

During pregnancy, a change in hormonal levels and blood flow can cause changes in the skin. Firstly, there may be an increase in pigmentation – dark patches developing on facial skin, a condition known as chloasma. To prevent worsening, avoid sun exposure as the rays can cause more dark spots to form. Many women tend to become more acne-prone during pregnancy as well. Lastly, stretch marks are also common during the second and third trimesters. 

Are topical antibacterials safe?

Topical antibacterials such as clindamycin and erythromycin are used either by itself or as adjunct topical treatments for acne. A study showed that clindamycin resulted in no increased risk of malformations among 647 women with use in the first, second or third trimester of pregnancy. Furthermore, consuming erythromycin during pregnancy has not been associated with causing abnormal birth defects in several thousand women. 

Skincare ingredients to avoid 

Topical Retinoids 

The amount of drug absorbed from the skin after applying retinoids is very low, however, there have been 4 published case reports of birth defects in the literature associated with topical tretinoin use. How harmful the use of retinoids is during pregnancy is unclear as 2 prospective studies that examined use during the first trimester of pregnancy with 96 and 106 women did not find an increased risk of major malformations. However, until data on larger groups of subjects are collected, it is recommended that women should switch to other safer alternatives other than retinoid-based products. One of the most safe and effective is glycolic acid,  in addition to topical benzoyl peroxide and topical salicylic acid.

Skin whitening agent – Hydroquinone

Clinically, hydroquinone is used as a topical depigmenting agent for skin conditions such as melasma, and cosmetically, it is used as a skin-whitening agent. Research has shown that an estimated 35% to 45% is systemically absorbed following topical use in humans. Based on current available evidence, topical use of hydroquinone during pregnancy is not associated with increased risk of major malformations or other adverse effects for the foetus. However, due to fairly substantial absorption compared with other skincare products, it is recommended to be used sparingly or switch to other safer alternatives. Studies show that alpha hydroxy acids, such as citric and lactic acids, are effective in treating hyperpigmentation, and they are generally safe to use in pregnancy. 

Learn more about why the skin whitening agent, hydroquinone, should be avoided in our podcast, Dermatologist Talks: Science of Beauty Ep 36, by accredited dermatologist Dr. Teo Wan Lin.

A note about organic skincare products 

According to Dr. Teo Wan Lin, in her book Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare: “most people think organic skincare is either eco-friendly, natural or vegan. Here’s the catch, they can and cannot be. Organically farmed produce can be friendlier on the environment in general, as less pesticide use means less harmful release of chemicals to the environment which accumulates as waste and potentially harms wildlife. However, these can also come at a greater cost, and by no means does that translate into any real benefits when incorporated into skincare which is not consumed but applied.

In fact, organic skincare often boasts essential oils which can cause both allergic (in susceptible individuals) and irritant contact dermatitis (due to the concentration of most essential oils, it is not medically advisable to apply any type of essential oil directly to skin as it can result in a chemical burning type of reaction).

Brands touting “organic skincare”, especially when home-made, lack the stringent quality controls present in a laboratory setting, which is required for the formulation of dermatologist-grade cosmeceutical skincare. One real danger of certain types of “organic skincare”’ is that they are not regulated for safety, in terms of bacterial contamination. Preservatives such as parabens have gotten some bad press in recent years but the overall consensus in the dermatological community and by the FDA is that they are still regarded as safe and necessary to reduce bacterial growth in applied creams. The lack of “preservatives” is again a questionable label because this means that something else should be added to the product to increase the shelf-life of such a product which is meant for public sale.”

Pregnancy-safe skincare ingredients 

Sunscreen

Many use sunscreens to protect their skin from the sun’s harmful UV rays. Research conducted shows that sunscreens have very limited systemic absorption. Additionally, sunscreens have been used in pregnant women to treat or prevent melasma, and there have been no adverse events reported. One can consider mineral-based sunscreens, which include zinc oxide and titanium dioxide, that protect the skin by forcing the UV rays to bounce off of the skin entirely. 

The SunProtector™ is formulated with physical blockers like titanium dioxide and zinc oxide that effectively blocks blue light emitted by indoor devices. It is a pregnancy-safe skincare product that contains 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.

Glycolic acid 

The first pregnancy-safe skincare ingredient is Glycolic acid is an alpha hydroxy acid that can be found in many skincare products. There have not been any studies analysing the use of glycolic acid in pregnant women, however, application of topical glycolic acid during pregnancy is safe as only a small amount is expected to be absorbed systemically, hence it will unlikely cause harm to the foetus. 

Phytoceramide-rich moisturizers

The nextpregnancy-safe skincare ingredient is the inclusion of shea butter, which acts as a phytoceramide. It is a plant-derived, ceramide-like molecule that helps to maintain a healthy protective skin barrier in the skin. There are new sources of ceramides such as phytoceramides (ceramide-like molecules derived from plant seed oils).

The Radiancé Fluide™ Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. A pregnancy-safe skincare product that is specially formulated for a light-weight feel to impart a radiant glow without make-up.

Botanical ingredients 

Functional dermatology refers to the use of pharmaceutically active, botanical ingredients. A lot of drugs are actually derived from plants – it applies these principles to formulas. This includes natural ingredients specifically tailored to individual patient concerns like pigmentation, oily/acne prone skin and eczema. As scientific knowledge of dermatology advances, so will the discovery of the immense potential of botanical and plant extracts in both skin and hair cosmeceuticals. Furthermore, botanical cosmeceutical extracts do not involve the synthetic ingredients that often have an environmental impact in the manufacturing process.

These ingredients would also be safe for pregnant women, who wish to continue their anti-ageing skincare throughout pregnancy. This narrowed down the choice of ingredients to plant-derived actives which had also demonstrated efficacy in the laboratory testing phase.

Salicylic acid 

Many cosmetic and skincare products contain the ingredient salicylic acid and the amount of systemic absorption varies. Many published studies show that there is no increase in the baseline risk of adverse events, such as major malformations, preterm birth, or low birth weight in women who have taken low-dose acetylsalicylic acid during pregnancy. Additionally, since only a small proportion of salicylic acid will be absorbed through the skin, it is highly unlikely to cause harm to a developing baby, hence can be considered as another pregnancy-safe skincare ingredient.

References:

Bozzo P, Chua-Gocheco A, Einarson A. Safety of skin care products during pregnancy. Can Fam Physician. 2011;57(6):665-667.

Stretch Marks: Common Causes, How They Form & How To Treat Them

July 24, 2021

Stretch marks are common and can affect both men and women, however they are more frequent among women and usually occur at one’s thighs, buttock, lower back, chest, upper arm and knee. Although they rarely cause medical problems, stretch marks are considered a major aesthetic concern and may be distressing to some individuals. In this article, we will discuss the causes of stretch marks, how they form, and the treatment options available.

What exactly is a stretch mark?

A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin that supports our skin, to rupture. As the skin heals, stretch marks may appear. When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on one’s skin colour. Early stretch marks may feel slightly raised and can be itchy while over time, the colour fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you can feel a slight depression.

Causes of stretch marks

Stretch marks occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include hormonal imbalance, 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 marks.

Stretch marks can form via three main mechanisms:

Genetic predisposition

No specific gene has been identified as the cause of marks developing on the skin. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions, suggesting 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, hence less collagen and elastin fibres are produced and the skin is less flexible and resilient to withstand stretching, causing marks to form. This effect is similar to that caused by corticosteroids, which explains why chronic use of the drug is 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 stretch to accommodate when growth is slow. However, with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming marks.

Who is more prone to stretch marks?

One who is undergoing puberty and has growth spurts, pregnant women, one who undergoes rapid weight loss or gain or is weight training and experiencing rapid muscle growth. Those who apply a corticosteroid to their skin for a long time can also cause stretch marks. Individuals who have Cushing’s disease or Marfan syndrome may also see stretch marks.

It is important to have your stretch marks reviewed by your dermatologist, as there are a few medical conditions which may mimic these marks. Like any scar, stretch marks are permanent, but treatment helps to make them less noticeable. Consulting an accredited dermatologist would help you in seeking an effective treatment. In addition, there are also specific treatments which should only be performed by a qualified dermatologist to reduce the appearance of these marks.

How to treat stretch marks

Topical treatments only have mild effects in reducing the appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach. It is recommended to use products on early stretch marks as in general, early stretch marks respond better to treatment than the older lesions. 

Tretinoin

Tretinoin is a retinoid, helping to boost fibroblast production, which are molecules responsible for the structural support in our cells and synthesize collagen, hence helping to make early stretch marks less noticeable. In one study, people who applied this prescription cream every night for 24 weeks had less noticeable stretch marks while those who didn’t apply the cream saw their early stretch marks grow. 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. Researchers have found that products containing centella may help prevent stretch marks. 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.

stretch marks

The Elixir-V™ Total Recovery Serum contains intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.

Moisturizers

A randomized, double-blind, placebo-controlled study in pregnant women showed that the severity of stretch marks can be reduced by topical application of moisturisers. Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide, helps stimulate collagen synthesis, tighten and lift stretch marks. The Radiance Emulsion formula is recommended for use with Qraser Custom Cut Mask, uniquely engineered with several properties which are beneficial for creating a healthy skin microenvironment, and helping the balance of growth factors that stimulate collagen production. 

The Radiance Fluide™ Hydrating Emulsion 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.

Procedures that dermatologists perform: 

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, 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. In a study conducted, microdermabrasion was found to be as effective as the daily application of topical 0.05% tretinoin cream in the reduction in the severity of early stretch marks.

Learn more about microdermabrasion in our podcast, Dermatologist Talks: Science of Beauty Ep 43, where accredited dermatologist Dr. Teo Wan Lin discusses the benefits of microdermabrasion, as well as how it works.

Light therapy

Different types of light treatment are also 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. The treatment of stretch marks using the laser showed clinical improvement, with the laser inducing the formation of collagen. There are rarely complications, and the cooling of the stretch marks before and immediately after the use of the laser further helps to protect the skin. 

References:

Wollina U, Goldman A. Management of stretch marks (with a focus on striae rubrae). J Cutan Aesthet Surg. 2017;10(3):124-129. doi:10.4103/JCAS.JCAS_118_17

Pre-Wedding Skincare: Tips For Your Wedding Beauty Regimen

July 8, 2021

Everyone wishes for bright, glowing skin on their wedding day. Preparing one’s skin can require lots of planning and care beforehand to achieve the perfect, radiant look when the big day arrives. How can you ensure that you have the ideal wedding skincare regimen for your skin? In this article, we will discuss some tips on how to get your skin in wedding-ready shape, as well as certain do’s and don’ts before your wedding in order to achieve that bridal glow.

In addition to a wedding checklist, starting or changing your skincare routine is a great way to practice self-care and de-stress before the big day. Plus, everyone wants glowing skin when all eyes are on them walking down the aisle.

When should the bride-to-be start preparing for a pre-wedding skincare regime?

When it comes to wedding beauty, women tend to get more hardworking with their regular masking and night-time skincare routine. Changing your skincare routine two or three months before your big day can give you ample time for your skin to reach its optimal condition. The skin’s natural renewal cycle is about 28 days for a middle aged adult which slows as we grow older, so this is the minimum time new skin takes to form at the deepest layer and emerge at the surface of the skin. When you start on a dermocosmetic skincare regimen, we expect 1-3 cycles of skin renewal before you see the results.

What are some wedding skincare tips or pre-wedding beauty regimen that you recommend?

Important lifestyle factors that will enhance absorption and effectiveness of your skincare would be an exercise regimen (High-Intensity Interval Type workouts are best for stimulating collagen production), a superfood-based diet with antioxidants, and 8-hour sleep timed according to our body’s natural circadian rhythm. Also, avoid alcohol and definitely don’t smoke!

Learn more about superfoods that are good for your skin in our podcast, Dermatologist Talks: Science of Beauty

You’ve probably encountered many bride-to-be’s in your practice, as seeing a dermatologist are on many bride’s beauty checklists before the big day. Skin-perfecting treatment options are seemingly endless and appear to be trending nowadays – and are also thought to give you an instant beauty boost.

What is the biggest misconception about a pre-wedding skincare routine?  

Skin-wise, many brides think they can fix everything in 3 months. Many come to me with long-standing untreated adult hormonal acne, rosacea, perioral dermatitis, facial eczema and think that everything can be fully treated before the wedding. What they fail to consider is that these conditions usually develop in genetically-prone individuals, and need to be controlled with medications and not facials. 

A dermocosmetic skincare regimen can help improve scars, texture and appearance significantly in 3 months, but the underlying disease must still be treated with medications. Medications take a minimum of 1 month to work, and there is a chance that we may need to switch medications if it does not work well for them. Additionally, the stress from wedding preparations will also impact the skin, making treatments may be less effective, so all these have to be considered. 

My advice? Don’t plan to treat your skin 1 month before the wedding. If you have an active skin disease, do not simply go for facials or aesthetic treatments but visit an accredited dermatologist 6 months before your wedding date to have ample time to get your skin condition under control.

Yes that’s true! Those suffering from skin diseases ought to consult a dermatologist as their conditions might worsen if they apply skincare or do treatments which cause further irritation. It can take up to months for a new skincare regimen to work, so we should give ourselves ample time to try out dermatologist-recommended products.

If you really want to get your skin in top form before the big day, don’t wait to see a dermatologist. In the meantime, here are some do’s and dont’s in terms of your pre-wedding skincare routine: 

Do: Protect your skin. Be diligent with applying sunscreens, seeking shade and using UPF protective fabrics to avoid harmful exposure from the sun. 

Do: Prevent body acne. If you’re planning on wearing a strapless or backless dress, you’d want to be especially mindful of back or chest acne. Use an antibacterial gentle cleanser. My patients use a medical grade antibacterial honey cleanser that emulsifies and also leaves a humectant layer on skin. A prescription retinoid is also helpful in the adjunct treatment of bacne  – it can help reduce the appearance of blackheads and whiteheads.

Don’t: Rely completely on makeup. Makeup may have varying results on camera, so it’s probably unwise to count on that to capture your best on the wedding day. Instead, stick to implementing a good skincare routine. The V-Face Bundle is great for hydrating, lifting and tightening of your face for the sculptured V-face look, and is perfect for pampering the facial skin before your big day.

The V-Face Bundle is specially put together to get the perfect v-face look. It features the Amino Acid 360° Masque for brightening and lifting, the Elixir-V™ Toal Recovery Serum which contains a nourishing concentrate of deep hydrating, lifting and tightening peptides, the Elixir-V™ Eyes for reduced wrinkles and dark circles, as well as the Jade Roller Rose Quartz for use with cosmeceuticals to increase serum absorption.

Are there any aesthetic treatments that you recommend as part of a pre-wedding skincare regimen? 

Chemical peels performed in a dermatology clinic can help to reduce the appearance of sun spots, fine lines, wrinkles, enlarged pores and acne scars. This helps to improve the appearance of the skin by gently stimulating the top layer of the skin cells through applying a solution made of fruit-derived acids. The acids we alternate in our clinic includes glycolic acid, lactic and salicylic acid. This treatment can stimulate the skin to regenerate, revealing improved skin texture and brighter-looking skin.

While booking a chemical peel right now may not be the safest option due to the pandemic, a skincare device that stimulates the effects of a chemical peel is recommended. 

silkpeel microdermabrasion

The effects of the The effects of the SilkPeel Home Medi-Facial Kit are that of microdermabrasion which has a similar effect to microscopic skin exfoliation. This is achieved in a clinical setting with chemical peel acids. This silk peel provides a home-based facial peel system that is both safe and effective, and has the additional benefit of delivering bioactive cosmeceuticals to the skin.

How Does Your Sleeping Habits Cause Sleep Wrinkles?

June 30, 2021

Sleep wrinkles can develop in response to pressure asserted when one’s face is pressed against a sleep surface. Wrinkles are generally considered to be caused by facial expressions. While facial expressions are behind most significant wrinkle patterns, not all wrinkles on the face are caused by contraction of facial muscles. One’s sleeping position is actually one of the main causes, more specifically sleep wrinkles. Just like how sleeping positions can cause sleep wrinkles, a lack of sleep can also lead to wrinkles and contribute to overall facial ageing. In this article, we will discuss how one’s sleep routine can result in sleep wrinkles, and what you can do about them.

What is pillow face? 

Pillow face refers to the creases and folds from your sleep positions at night. Sleep lines can form when people sleep on their stomach or side, with the face squished into the pillow. Over time, the repetitive pressure and friction results in ironing the wrinkles in the facial skin. As we age, these sleep lines can become permanent due to volume loss and a reduction in skin elasticity.

The sleep regeneration process 

While the lack of sleep causes wrinkles, ample sleep prevents further wrinkle formation. The skin produces new collagen when one sleeps, hence the skin is plumper and less likely to wrinkle. A recent clinical trial commissioned by Estée Lauder and conducted by physician-scientists concluded that women who slept only 5 hours per night for one month had double the amount of wrinkles and spots compared to those who slept at least 7 hours. 

Follow these tips to help prevent and get rid of sleep wrinkles:

Choosing your sleep position

By sleeping on the side or stomach, your face is pressed into your pillow, causing your skin to fold up and form vertical wrinkles. These wrinkles eventually become etched on the skin’s surface and can become permanent with time and repetition. Sleep wrinkles are caused by the repeatedly pulling, stretching and pushing the skin on the face with changes in sleep position. These forces become significant when we consider the amount of time spent in sleep and sleep position. 

Your pillowcase matters 

The CUIONS™ Anti-Ageing Beauty Copper Pillowcase contains advanced copper ion technology. It is antibacterial, suitable for acne patients as well as clinically proven to reduce facial wrinkles. An average person will spend 229,961 hours in their lifetime sleeping. This is given that an average person sleeps 8 hours every night. The right bedding can either provide comfort or cause discomfort, impacting your sleep quality. Dermatologists advise that the material in contact with your skin, especially your pillowcase, should also be non-irritating and breathable.

The CUIONS™ nanoparticle fabric was evaluated in the form of a pillowcase in a landmark study done in 2012. The study was by a group of Korean dermatologists that demonstrated there are statistically significant results between the groups of patients sleeping on the pillowcases containing copper-impregnated fibers, as compared to the control pillowcases. Paying attention to the fabrics that your skin comes in contact with for such long periods of the night is an important factor. However, many people often overlook this in their bedtime routine. Switching up your bedding may just be the step you need to get better sleep.

The CUIONS™ Anti-Aging Beauty Copper Pillowcase is clinically proven to reduce facial wrinkles and also has anti-bacterial properties.

Wear a sleep mask 

A sleep mask serves as a protective layer between you and your pillow, hence you’re less likely to wake up with sheet lines and therefore less likely to suffer collagen breakdown.

Wearing a copper eye mask further helps in reduction in wrinkles, fine lines and improvement of the overall appearance. While sleeping, copper ions are absorbed through the skin, stabilizing and stimulating the formation of extracellular matrix proteins, such as collagen, fibronectin and integrin. Copper ions facilitate efficient collagen and elastin cross-linking. Superoxide dismutase enzyme, which is copper-dependent, helps to protect against free radicals in the skin, preventing premature ageing. Hence, copper ions help prevent wrinkles from forming as well as improve the appearance of the skin.

The CUIONS™ Anti-Aging Sleeping Eye Mask can also be used in conjunction with the CutisCool™ Biological Gel Pack, which can help to achieve anti-puffiness, anti-fatigue and reduce as well as improve dark eye circles. CutisCool™ Gel is sealed in a leak-proof packaging to form a cooling mixture but without the discomfort of ice.

The CUIONS™ Anti-Aging Sleeping Eye Mask includes advanced copper ion technology, clinically proven to reduce wrinkles, improve the undereye skin health, eye bags and puffiness when used with the CutisCool™ Biological Gel Pack.

Anti-wrinkle patches

These are medical grade polymer patches that mimic the skin barrier and erase wrinkles, unique in the Singapore market. QRASER™ patches contain oligopeptides to further tighten and lift the dermis, recreating the optimal environment for your skin to start stimulating more collagen formation from the inside, providing a natural facelift non surgically. There is also one special cut out for the neck area available for maximum lifting and targets wrinkles on the neck.

anti wrinkle

The Qraser™ Cosmeceutical Transdermal Delivery Patch is dermatologist-desgined for eye bags, undereye wrinkles and loose skin. The unique Qraser™ anti-wrinkle polymer technology mimics the natural hydration and homeostasis (natural balance) of the skin barrier, known as the stratum corneum to enhance cosmeceutical absorption. 

References:

Kotlus BS. Effect of Sleep Position on Perceived Facial Aging. Dermatologic surgery. 2013;39:1360-1362.

Poljsak B, Godic A, Lampe T, Dahmane R. The influence of the sleeping on the formation of facial wrinkles. Journal of cosmetic and laser therapy. 2012;14:133-138.

Anson G, Kane MA, Lambros V. Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep. Aesthet Surg J. 2016;36(8):931-940. doi:10.1093/asj/sjw074