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How does a Sonic Facial Cleanser for Acne Work?

June 21, 2022

Regular and proper cleansing is a key step in acne treatment, and can make a difference to your skin microbiome. In this article, we walk through how a sonic facial cleanser for acne works, including excerpts from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Acne care bible: How does sonic facial cleanser for acne treatment work?
Dr. Teo Wan Lin’s e-book Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention is available on Amazon.

The skin is the largest organ of the body which also happens to be colonized by a lot of germs. Germs are also known as microorganisms. The community of germs present on our skin affects our immune system and is important for healthy functioning of the skin. The microbiome of skin is created right after birth. The oil glands that develop as we enter adulthood can influence the type of microbiome which is genetically influenced. The concept of ecobiology is based on this principle. Your skin is an ever changing ecosystem that interacts with your environment. It also constantly engages in cell talk—within the cells itself, between the different types of cells, and also the external environment.

Microbiome dysbiosis refers to an imbalance due to changes in the abundance and diversity of microorganisms that are present on the surface of skin. This can be related to disturbances in the skin barrier function due to medications applied, environmental changes and poor skin care habits.

Acne microbiome

Acne is the most prominent dermatological condition that is directly influenced by microbiome dysbiosis. The Cutibacterium acnes phylotype of bacteria is predominantly found in acne patients. We attribute one of the causes of acne to the relatively poor diversity of the germs present on the surface of acne prone individuals. This has been postulated to trigger skin inflammation.

Sonic facial cleanser for acne

The skin microbiome essentially describes the host of good and bad bacteria, fungi that inhabit the surface of the skin. When there is an imbalance in this delicate ecosystem, skin conditions can develop. It is critical to understand that healthy functioning of the skin as a barrier against the external environment also includes its ability to protect from infections.

Skin infections play a role in many dermatological conditions. In acne vulgaris, that can be a secondary bacterial infection known as gram negative folliculitis, which results in pustules as well as acne flare ups. This is where addressing the skin microbiome, especially using technologies such as sonic cleansing to enhance traditional double cleansing techniques can be helpful. In fact, this has been demonstrated in clinical studies involving sonic facial cleansers, as it helps to stabilize the skin microbiome.

Sonic cleansing is a form of therapy that has been incorporated into home facial devices. This method of cleansing has been shown in a few clinical studies to improve the skin microbiome when used in conjunction with a gentle cleanser. It is also indicated for treatment of conditions such as acne. Additionally, it can also be applied appropriately to patients who have perioral dermatitis. Acne, in particular, is one condition that can be improved with sonic cleansing.

How does a sonic facial cleanser for acne work? 

Sonic technology essentially uses ultrasonic waves – in this case, from a range of 5,000 to 24,000 pulsations per second to dislodge any debris as well as particulate matter on the surface of the skin, which is invisible to the naked eye. Why is this relevant? Double cleansing, which is the standard of cleansing especially if you wear waterproof sunscreen and makeup, does not completely remove your skin of particulate matter.

In fact, the effect of residual particulate matter, PM 2.5 has been increasingly implicated in scientific studies that focus on the aging skin exposome. These particulate matter can cause oxidative stress, and eventually DNA cell damage. This is the primary cause of aging skin in older individuals, because one can no longer keep up with the rate of DNA repair. 

Blade Style Sonic Facial Cleanser
A minimalist ultrasonic sonic facial cleanser for acne recommended for use for all skin types, includes dry sensitive skin, combination and oily skin.

Eventually, skin aging can manifest in terms of fine lines, wrinkles, textural changes such as the loss of skin elasticity, as well as enlarged pores. In terms of keeping a healthy moisturized skin barrier, sonic cleansing can help by stabilizing the microbiome. 

In eczema, there is actually an imbalance in the good and bad bacteria present on skin. Staphylococcus aureus, which is usually present on normal healthy skin suddenly triggers off an immune stimulated response that we call the superantigen effect, eventually leading to eczema flare ups. This is how sonic cleansing can help individuals with facial eczema as well. Individuals with eczema are advised to use the blade-style sonic facial cleansers, as the brush head/silicone bristle models can irritate the skin. 

Skin aging itself is understood to be a complex process that involves both your biological processes, lifestyle factors such as your dietary and exercise needs, and also application of antioxidant skincare. 

Traditionally, brush cleansers were used as a prototype for sonic facial cleansers. However, there are some key problems with this. The brushes made of synthetic plastic tend to accumulate bacteria and other microscopic particles – especially in the humid and hot environment in bathrooms. This has led to the evolution of different types of sonic cleansing devices which include silicone brush heads, as well as blade style Sonic cleansers which were the prototype for the Korean medi-facials. This is the same design that we adopted for our mass-produced sonic cleansing device that simulates the Korean medi facial experience.

Design of a sonic cleanser

When choosing a sonic facial cleanser for acne, it is important to consider the design as well as if it is suitable for an individual with sensitive skin. 

Blade style sonic facial cleanser for acne

Sometimes called a face scrubber, this design was modeled after the original Korean sonic facial cleanser and popularized by Korean medi-facials. This is the commonest style we use in dermatology and aesthetic clinics for medi-facials because it allows the user to have 100% control. The key here is also to appreciate that there is minimal skin abrasion for individuals who suffer from very sensitive skin. While silicone and brush cleansers may be adapted for sensitive skin, there is still a certain amount of friction that cannot be avoided.

With the Blade Style Sonic Cleanser, the benefit is that the natural curve of the device is designed such that there is no frictional contact with skin and it can effectively perform the function of sonic cleansing without aggravating any sort of skin sensitivity. This is achieved via the proprietary angle built into the curvature of the stainless steel blade. By minimizing friction on the skin, devices like the Blade Style Sonic Facial Cleanser for acne is ideal in terms of design for sensitive skin users who desire mechanical exfoliation that does not irritate. 

Blade Style Sonic Facial Cleanser 2
The Blade Style Sonic Cleanser is modeled after the original korean sonic cleanser used in dermatology clinics. Dermatologist-recommended facial cleansing device for all skin types. Dual function sonic cleansing and antioxidant infusion treatment with single mode.

The Blade Style Sonic Facial Cleanser for acne is critically designed to withstand the humid environments of bathrooms as well as tropical climates like in Singapore, where we are based in. It is also a highly hygienic material that resists the growth of bacteria to a much larger extent than silicone or brush-style sonic cleansing heads.

Acne Treatment for Teens: 3 Important FAQ

May 27, 2022
acne care bible
Dr. Teo Wan Lin’s e-book Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention is available on Amazon.

While acne can occur at any age, teens and young adults are more likely to get acne breakouts. Read on to find out 3 commonly asked questions about dermatologist recommended acne treatment for teens from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

1. What kind of acne treatment for teens do dermatologists recommend?

Dermatologists usually start with acne treatment for teens that has less toxicity, require less monitoring, and are more convenient and sustainable. If your acne is deemed to be a little bit more severe, we move on to the more potent medications which are nevertheless still very safe when prescribed by an accredited dermatologist and monitored. There is no type of acne in the world that cannot be fully treated

Mild acne treatment for teens

If your teen’s acne is mild, you can use over-the-counter formulations which are readily available in your pharmacy. Some of these will contain ingredients such as benzoyl peroxide, salicylic acid, sulphur and tea tree oil. These have been safely and widely used in the community for decades. I personally no longer recommend any of these because I find that while it may work in very mild cases by drying out the oil and the pimple itself, for a lot of cases it causes irritation- a condition known as irritant contact dermatitis. This is because of the astringent nature of these formulations. Furthermore, acne is not just an oily skin condition, inflammation also plays a huge part. 

Singapore Dermatologist Dr. Teo Wan Lin has formulated an over-the-counter blemish spot cream suitable as acne treatment for teens. It contains an algae extract chlorella vulgaris which actively targets sebum activity, contains natural moisturising factors as well as plant antioxidants to fight inflammation.

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

For acne face washes, antibacterial effects can be achieved with natural or chemical based ingredients. Chemical-based acne face washes are more common, but they are not the preferred choice. These are often based on triclosan which can be controversial because of its long-term hormonal effects, but nevertheless effective. Instead, you can use natural agents which have antibacterial properties such as our medical-grade honey cleanser. As acne treatment for teens, these will give excellent effects in controlling mild acne. 

Honey Cleanser for Acne Treatment
The Miel Honey Cleanser is formulated with medical grade honey which effectively cleanses while trapping a layer of moisture on your skin. This maintains healthy balance of moisture, and helps both dry and oily skin types, making it an effective acne treatment for teens.

However, if you find that your child has persistent acne or has any of the indicators for having to see a dermatologist, do not delay because the emotional impact of acne is cumulative. This is because the period of one’s teenage years is considered a milestone and a formative period whereby their attitudes, beliefs, and emotions are just being solidified. Both in a good and bad way, it can be liable to influences.

Acne itself does cause a certain adjustment disorder in terms of how it impacts one’s self-esteem and psychosocial function so prolonging any period of adjustment disorder or any perceived suffering by the teenager will not have beneficial results. These are the same individuals that do not get proper medical acne treatment for teens, who are left with this sense of helplessness, frustration and acne scarring and distress when it persists all the way till adulthood when it is untreated. 

2. When should my teenager see a dermatologist? 

Firstly, whatever the severity of acne, if your child is feeling emotionally disturbed by his or her acne, please see a dermatologist. Different individuals have different thresholds for the tolerance of acne bumps and it is not our place to decide if his or her condition can be left alone.

Red flags to watch out for:

  1.  Increased moodiness, sensitivity to comments or irritability, change in one’s appetite and sleep patterns.
  1. Persistent acne problems for more than six weeks
    Doctors usually use acute or chronic to categorize disease conditions. An acute condition would resolve in maximum a month but most of the time within two to three weeks. Something that persists beyond 6 weeks falls into the chronic categories. In the case of acne, it indicates a persistent problem.
  1. The presence of scars
    Having one or two pimples every month is no cause for alarm and it’s perfectly fine to self-medicate with over the counter medications. However, if you notice your acne starts to scar then it could be an indication that the acne is much more inflammatory. It’s important to keep it under control before more dramatic skin damage occurs.
  1. Having acne cysts
    If your child has mainly a few whiteheads or blackheads or acne bumps known as papules, it is generally going to be milder than cystic acne. Cystic acne is a big, red, painful hard bump which is buried under your skin. They do not have an opening to the surface of your skin and it can result in significant swelling. Rarely it can turn into a collection of pus which is known as an abscess. This is due to the body building a wall around the area of inflammation to isolate the acne cyst from its surroundings.
  1. If you have a strong family history of acne
    If anyone in your immediate family has been on accutane or isotretinoin before, this is an indicator that a strong genetic trait for acne exists. If this is so, your child should be treated by a dermatologist as early as possible.

3. How does a dermatologist decide if my child needs prescription medication as acne treatment for teens?

  1. Lesion count
    An individual with less than 5 lesions will be in the category of mild acne. Anything more than 5 to 20 would be moderate, and anything more than 20 would be moderate to severe acne. Cases of moderate to moderate to severe acne all require oral medications as an effective acne treatment for teens. Earlier cases of moderate acne may do well with just physical therapy such as blue light or chemical peels alone. 
  1. Type of acne that is present
    If the individual has primarily comedonal acne, it would fall under the category of mild to moderate acne. If an individual has pustules, which is indicative of secondary bacterial infection, it will be considered to be in moderate category. If there a big red painful cysts for secondary infection it would be under the category of cystic acne and that itself would be under the severe category.
  1. Presence of scars
    In an individual with just a few papules but with significant scarring due to acne excoriee especially in young girls, the disease process is immediately moderate to severe. This is because of the secondary skin damage that is occurring. If there is presence of deep dermal scars then it also would be in the severe category because it means that the individual is very prone to developing deeper inflammation that causes the dermal scarring to occur. 
  1. History of failed treatments
    If the individual had been on medication before either by another dermatologist or general practitioner and after stopping the medicine the acne came back very quickly, it would also be in the moderate category. These individuals in the moderate and moderate to severe categories all require pharmacotherapy. However, in some individuals who choose not to take oral medications, blue light treatment which is a half an hour treatment that is performed ideally 2 times a week up to a month, is considered a curative procedure for acne because it helps to kill the causative organism Propionibacterium acne.  

If your teenager suffers from moderate or severe acne, you may wish to book in for a teleconsultation with our dermatologist. Click here to find out more and book an appointment with us.

Best Baby Moisturiser in Singapore: Dermatologist Guide 

May 18, 2022
best baby moisturiser

“The best baby moisturiser is one that replaces deficient ceramides and soothes newborn’s skin.” Singapore dermatologist Dr. Teo Wan Lin and chief scientific officer of Dr.TWL Dermaceuticals. 

If you are reading this while searching for the best baby moisturiser on the market- first understand how newborn skin is different.  In this interview with dermatologist Dr. Teo Wan Lin, she explains the structure of baby skin. Baby skin is different from that of a toddler, an older child and adults. 

Baby moisturisers – can I use a regular moisturiser?

Using your favourite drugstore moisturiser on baby? Check these first. Baby’s skin is permeable, so many cosmetic additives and preservatives are unsafe.

The product should be labelled dermatologist-recommended. The best baby moisturisers have no fragrance. We generally do not recommend using regular moisturisers for baby’s sensitive skin. Brands that work with dermatologists are a safer bet. These brands are readily available at drugstores. However, there is a difference in effectiveness between different brands. It depends on the active ingredients used.

Generally, the best baby moisturisers tend to be more expensive because of higher concentrations of ceramide. A “safe” baby moisturiser can be as common as white soft paraffin, also known as Vaseline. However, safe doesn’t mean effective at all. Essentially, Vaseline does function as a moisturiser, by preventing water loss to the environment. It stops trans epidermal water loss. This is only one part of moisturiser therapy. 

@drteowanlin #dermatologist #tiktokdoctor #learningisfun #babymoisturizer #moisturiser #babyskincare #babyskin ♬ A warm piano instrumental ballad(808701) – NOPPO MUSIC

What ingredients are in the best baby moisturiser formulations?

Ceramides (synthetic, plant derived preferred over animal sources), humectants (hyaluronic acid, glycerin), occlusives (mineral oil). These are common ingredients in dermatologist recommended moisturisers including baby moisturisers.  Mineral oil is not bad for skin when correctly formulated it enhances moisture retention. This means less trans epidermal water loss to the environment. 

Baby skincare is designed for the unique structure of baby’s delicate skin 

The implications for baby skincare are clear based on the structural differences. The design of baby skincare products has to be as mild as possible. In terms of cleansing, we are considering how surfactants interact with skin tissues. Harsh cleansers can lead to a disruption in the delicate skin barrier of infants. This potentially allows for easy penetration of environmental allergens and skin infections. In addition, it is extremely vulnerable to friction and occlusion, especially in the diaper area. This is the reason why we recommend barrier creams, both to treat and to prevent skin irritation. When formulating skincare products for babies, it has to be carefully considered to balance these needs.

Components of the best baby skincare regimen – dermatologist recommended

Babies definitely need skincare. In fact, the needs of baby skincare are different from that of adults. Baby skin has primarily one deficiency: an incompletely developed skin barrier. Cleansing is very important because it helps to maintain a healthy balance of good and bad bacteria. This ensures that the microbiome is resilient. Eventually, when the baby grows to be an older child, the same healthy microbiome can help to protect against a variety of skin infections. 

Will my baby get eczema if I have eczema?

Baby skincare is critical if there is a family history of eczema. This is primarily due to a deficiency in the gene filaggrin. This gene is responsible for manufacturing ceramide, an important fatty lipid that joins the skin cells together, much like how cement joins the bricks of a wall together. As a result, if cleansing is too harsh, for example, using surfactants that strip the skin dry of its natural moisturizing oils, it will be damaging to delicate baby skin.

Best baby moisturiser
Ceramide functions as the “cement” that holds “bricks” of the skin wall together and a deficiency can cause a breach in the protective barrier of the skin, leading to symptoms of skin sensitivity.
  • Look for mild skincare products for your baby’s skin
  • Baby skincare is critical, especially if there is a family history of eczema 

How to know what moisturizer is the best for your baby?

An important step in baby skincare is the application of a ceramide dominant moisturizer. There are many different types of moisturizers marketed for babies. Look at the ingredient list. It is important that it contains a variety of ceramides. For example in the Multi-CERAM Moisturiser, phytoceramides in the form of shea butter form the base of the moisturizing ingredients, together with other humectants that trap water under the skin. Your dermatologist will be able to recommend the best moisturizer for your baby.

Best baby moisturiser
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.

For cleansers, choose those which have been approved for dry, sensitive skin and recommended by dermatologists. We formulate a medical grade honey cleanser that uses honey as a natural lathering agent that also has antimicrobial properties. It also moisturizes the skin while cleansing at the same time. It is important to highlight that you do not need to use a lot of cleansing foam in order to get the job done. In the case of the honey cleanser, a pea sized amount is more than enough. Focus on areas that are soiled and rinse off thoroughly with cool water.

Honey Cleanser for Babies
Honey Cleanser provides thorough cleansing of skin with botanical emulsifiers leaving a clean yet moisturised feel. Arnica Montana Extract stabilizes skin and reduces flaking.

Best baby moisturiser application technique – dermatologist tip 

There is a form of therapy known as wet wrap therapy that is advocated for infants and children with very dry skin. Wet wrap therapy essentially means your skin has to be damp as you apply your creams, including any medications if prescribed by a dermatologist. This is usually achieved by wearing a damp layer of clothing for at least 30 minutes.

Another helpful tip is to always keep your baby wipes, detergent, and alcohol free. My preference is for reusable wipes that do not contain any other detergents or surfactants. The micellar baby wipes can be used with the mineral booster formulated with purified deep seawater for a quick cleanse on the spot if your baby soils themselves. The Mineral Booster contains polyglutamic acid, which is a relative of hyaluronic acid. Hyaluronic Acid is more well known, but polyglutamic acid is actually far more effective. 

The Dr.TWL baby wipe is an earth-friendly reusable baby wipe incorporated with micellar textile technology. This water-activated cleansing wipe uses the ultra-soft and fine textile fibres to attract dirt particles, without the use of harsh cleansing agents.

When should I start moisturising my baby? 

Start moisturizing your baby from day one. A good moisturizer formulated as a prescription emollient device can help to build your baby’s skin resilience and protect it from infections and future dry skin problems. If you notice your baby’s skin is irritated, first check the location. If it is at the diaper area, it is important to air the area and try to do open cradle nursing as opposed to keeping the diaper on for prolonged periods of time. Using natural materials such as linen and cotton is also more beneficial.

Usage of a barrier cream is not just for treatment, but also for prevention. A good moisturizer can function as an effective barrier cream in most cases. One that contains zinc oxide can have additional benefits in terms of controlling bad bacteria and moisture if that is the cause of irritation. 

  • Look for a ceramide-based moisturiser for your baby’s skin for treatment and prevention
  • Choose a dermatologist-recommended cleanser for dry, sensitive skin for your baby’s skincare
  • Sunscreen is as important for infants and children as they are for adults 

Other skincare ingredients in the best baby moisturisers

Panthenol is a popular skincare ingredient found in many skin and hair products, touted for its moisturizing abilities. It has the unique ability to function as both a humectant to draw water, binding it to the skin, as well as an emollient to prevent transepidermal water loss, trapping water to smooth and hydrate the skin. Hydrated skin helps to improve the overall appearance as well as plumpness and elasticity of the skin. 

Panthenol is the provitamin precursor that the body uses to convert to vitamin B, also known as pantothenic acid. It is an ingredient that has been increasingly incorporated in makeup, haircare products as well as skincare products for its ability to give the skin its dewiness, as well as impart shine to hair. On ingredient labels, it is also known as provitamin B5, butanamide and d-pantothenyl alcohol. 

How does panthenol benefit the skin? 

Acting as a humectant, it is able to bind to water molecules, holding them in the skin. This makes this ingredient suitable for skin that has to endure harsher climates, exposure to air conditioning or heaters, as it is able to compensate for and prevent the transepidermal water loss that occurs. Transepidermal water loss is the loss of water from our skin to the environment.

Not only does it retain moisture in the skin, but it also acts as an emollient that helps to stimulate cells that promote skin barrier function, maintaining a healthy skin barrier. The skin barrier is the outermost layer of the skin that plays an important role in protecting from environmental stressors, irritation, and inflammation. Benefits of a strong skin barrier include being able to lock in moisture and keep it from escaping. 

As the same cells responsible for skin barrier function are also important for wound healing, panthenol may help to protect the skin while it is healing. 

Studies also suggest that panthenol was able to help reduce UV-induced redness and irritation through its anti-inflammatory effect. Furthermore, it could also help relieve itching associated with eczema or dermatitis.

Is panthenol safe for skin? 

Panthenol is considered safe for its intended uses. It is generally well-tolerated by most skin types, rarely causing irritation or sensitivity. However, with any ingredient, an allergy is always possible, even though the chances are low. Therefore, it is always beneficial to perform a patch test before using any new ingredient or skincare and makeup product. 

  • Panthenol is a skincare ingredient that acts as a humectant and an emollient, helping to draw water to the skin and prevent transepidermal water loss

Understanding common skin problems in babies 

Applying baby moisturiser for Insect bites?

Watch out for bites on a baby as well. If you are bringing your baby outdoors, be sure to use a mosquito patch or a baby safe insect repellent. Bug bites, besides being a possible carrier disease, can trigger allergic reactions in infants. This can result in a widespread type of rash starting from a single insect bite. In these cases, it is best to seek a consultation with an accredited dermatologist as baby moisturiser therapy alone may not be enough.

Why does my newborn have acne? 

My newborn has acne, should I still apply baby moisturiser? 

 Neonatal acne is a form of acne that is due to the transfer of hormones from the mother to the baby. This is usually self-limiting, which means it will resolve on its own. You may consult with your dermatologist if it persists or gets worse. Moisturiser therapy is still recommended, provided it is a non-occlusive formula like the Multi-CERAM moisturiser. Baby’s skin is delicate and susceptible to infections. Applying a well formulated baby moisturiser can prevent skin infections.

Common baby  skin problems – will baby moisturiser help?

 Of all the skin conditions that can occur in a newborn infant, one of the most dangerous which must not be ignored is an exanthem. It is important to distinguish exanthem from just dry skin or eczema. An exanthem can be the marker of a serious infection going on in a young child. It is best to visit an accredited dermatologist or your pediatrician if you suspect that there is a new rash. 

Viral Exanthem in Babies
Viral Exanthem in babies (Source: DermNet)

My baby has scalp flaking, should I apply baby moisturiser on the scalp?

A baby’s scalp is also particularly prone to flaking, also known as cradle cap. This is a form of yeast overgrowth, known medically as seborrheic dermatitis. Using olive oil to remove the crust, as well as maintaining good hygiene is the first step to stabilizing the oils and balance of drums on your baby’s skull. Removing the crust should be done gently as the crust can sometimes be very thick and adhere to the scalp. Your dermatologist may find it appropriate to prescribe a prescription shampoo if required. Applying moisturiser on baby’s  scalp is not always helpful or necessary. Use as directed by your dermatologist.

Best Baby Skincare Tips Recommended by Dermatologists

  • Use a baby-safe insect repellent when going outdoors 
  • Visit a dermatologist if you notice neonatal acne
  • Use olive oil to gently remove crust on the scalp from cradle cap

Baby Laundry Detergent for Sensitive Skin: Dermatologist Advice on Infant Skincare

May 7, 2022

Are baby laundry detergents necessary? What type of laundry detergent should I use for baby’s clothes? Is a specially formulated baby laundry detergent recommended? If these are your questions, read these dermatologist tips on how laundry detergents matter. 

Dermatologist's Baby Skincare Guide
This series on caring for your baby’s skin is  by dermatologist at TWL Specialist Skin & Laser Centre, Dr. Teo Wan Lin. Her e-book, Dermatologist’s Baby Skincare Guide is available for free for a limited time on the Dr.TWL Pharmacy e-shop and on Amazon Kindle.

What is in a commercial laundry detergent?

What type of detergent should I use? Liquid, powder, detergent pods or detergent strips? 

Powder detergent pros and cons

It may feel like it does not matter what type of detergent you use. After all, laundry detergents are just detergents right? Well, according to Dr. Teo, no. Powders are probably the worst to have around if you have sensitive airways and allergies. The fine particles containing concentrated detergent can be hazardous if inhaled. Most individuals with sensitivities, eczema, allergic rhinitis and asthma react badly to exposure. If you have children and pets, these can accidentally be ingested and are highly toxic. It is difficult to control the spread of these particles when scooping out the detergent.

Liquid detergent benefits and disadvantages

Liquid detergent is safer in this regard. However, it is very heavy, less efficient in terms of storage space and can still be spilled accidentally. The packaging waste is also significant. These are stored in plastic bottles which contributes to landfill plastic waste. Definitely not an eco-friendly option.

Detergent pods: the best option?

Detergent pods are gaining in popularity. Laundry detergent pods are compact packets of powder or liquid detergent compressed and coated with a dissolvable plastic. It definitely overcomes the issues mentioned above with powder and liquid detergents. It seems like an environmentally friendly option, with minimal packaging. Most of all,  it is convenient, no measuring or scooping detergent. Simply toss in the laundry detergent pod and press start. 

However, Dr Teo cautions that the ingredients in these detergent pods have not changed. They may claim to contain more eco friendly ingredients, but always be suspicious if there is a strong fragrance. Based on current laws, detergent makers are not required to register their product with the authorities. Unlike cosmetics, detergent ingredients are not regulated. Manufacturers then will choose the strongest chemical agents, such as industrial strength solvents to achieve high efficiency cleansing. Synthetic fragrances are added to achieve fragranced linen. After all fresh smelling, clean and bright laundry is the goal right?

Again, this is based on our current assumption that all these residues are completely washed out. However, chemical engineers agree that the process of laundry, will not achieve this. As these particles are very small, it will be trapped in the weave of fabrics even in a regular laundry cycle.

What is the environmental impact of commercial laundry detergent use?

It is also shortsighted to imagine that the runoff into our sewage pipes will be contained somewhere without release into the environment. Eventually it will all make it back to the environment where it will harm our food sources. Therefore there is a standard that measures how readily biodegradable a chemical is, to measure its impact on the environment. The OECD 310D guideline for testing of chemicals determines how eco-friendly a chemical is. Almost all commercially available traditional detergents will not meet this standard. 

What is the impact of laundry detergent chemicals on our health and skin?

The current impact is unknown. However, if we apply the same rules of cosmetic ingredient analysis, then laundry detergent formulations are worrying. These mostly all demonstrate carcinogenicity and toxicity (in high doses) when assessed by MSDS data. MSDS refers to Materials and Safety Data Sheet, the industry standard for occupational skin health.

Contact dermatitis is a dermatological condition related to irritation caused by direct contact with a chemical agent. It can be irritant contact dermatitis, which is due to the irritation potential of the ingredient causing a mild chemical burn. Imagine irritant contact dermatitis as a condition where the chemical dissolves away the top layer of protection of your skin.

Allergic contact dermatitis is another type of allergic reaction. This has nothing to do with the irritation potential where it simply produces a caustic reaction. Rather, it depends on the individual. If the individual is sensitive to the ingredient, it will trigger off a series of allergic reactions. This is mediated by the immune system. It could be due to previous exposure, where it didn’t cause a reaction. Such an exposure works by stimulating the immune memory. The second exposure to the allergen then causes a full blown allergic reaction.

Why should I care that my laundry detergent is gentle on my skin? Isn’t it washed out by the washing machine at the end of the cycle?

Contact dermatitis to detergents? An urban myth? This was stated in a commentary in the Journal of the American Academy of Dermatology in 2003 [1]. However, more research in the recent decade has demonstrated that textiles do carry residues that can trigger off immunological memory and lead to potential allergic reactions [2, 3]. 

Advances in detergent formulations

Organic, green, plant-based laundry detergents are some of the eco friendly options marketed. Notably, enzyme based formulations are marketed as the better ways to clean a fabric. Safer for skin, and better for the environment. Is that so? According to Heidi Bai and colleagues in the peer reviewed dermatology journal – Dermatitis in 2020, contact allergens in top selling textile care products are prevalent [3]. 

According to Singapore dermatologist Dr. Teo Wan Lin, this paper stated some alarming findings. Laundry detergents labelled as baby safe, gentle, contained common allergens. Such as methylisothiazolinone, the most prevalent contact allergen found in personal care products. The difficulty for dermatologists in distinguishing mild detergents in commercial detergents is this. There is no ingredient list for many, other than detergents  marketed as being dye or fragrance free. However, this does not change the fact that these contain the top allergens found that cause skin allergies. 

How about enzyme based cleaning products? Are these safer and gentler on skin?

Also, there is evidence that transcutaneous sensitisation occurs through skin. This means that exposure to these enzyme proteins create an immune memory. Household cleaning products that contain these proteins are the main cause of exposure. The skin immune system is linked to the overall body immune system.  

“The skin plays a role in the development of IgE mediated allergies. To date the current opinion is that enzyme proteins should not cause allergic contact dermatitis. However, dermatologists should be concerned about whether topical exposure to enzymes used widely in consumer cleaning products could result in allergic sensitisation. This is an area that requires further research,” comments Dr Teo, based on the latest research on textile dermatitis. 

How laundry detergent affects skin of newborn babies?

Newborn skin is much more sensitive than that of an older child or an adult. Regular liquid detergents in theory can be used for baby laundry. However, there is a concern about harsh chemicals used in commercial laundry detergents. These detergents are tested by makers to to tough on stains, the standard that measures effectiveness of the detergent. Consumers want their clothes looking bright and clean, laundry smelling fresh.

Thus optical brighteners and other chemical additives, including fragrances are added in these formulas. Theoretically, these should be washed out by the washing machine. However, these additives undoubtedly leave a residue on fabrics. This is even after washing it thoroughly in a washing machine. Especially for fragrances as it is desired to freshen the laundry.

For this reason, many experts including dermatologists recommend using a very gentle detergent for laundering baby’s clothes. That reason is because the fragrances and chemical residues can penetrate the delicate skin barrier. The best baby laundry detergents are often made of surfactants which are gentler in nature but nevertheless can still get rid of stains. For cloth diapers as well, it is important to use one that can effectively freshen up the fabric. A baby laundry detergent safe for newborns is dye free, fragrance free. Preferably one that is specially formulated for newborns is unlikely to irritate baby’s skin.

What is the best baby laundry detergent made of? 

The Dr.TWL Pharmacy laundry detergent sheet specially formulated for babies and those with sensitive skin as well as eczema. It is a revolutionary laundry detergent sheet based on all natural surfactant known as soapwort. It is derived from the plant soapwort. The baby laundry detergent sheet is a detergent that is not just ecologically friendly, but gentle on baby’s skin. It comes packed in a 100% biodegradable kraft paper packet with zero plastic packaging. The benefit of laundry detergent sheets over traditional laundry detergent is there is no more measuring. No risk of accidental spills. Simply tear along the dotted line and toss in a full load of laundry.

Baby Laundry Detergent for Sensitive Skin
Baby Laundry Detergent Sheets – Dermatologist-recommended for baby’s clothes. Suitable for whole family laundry care for eczema, sensitive skin patients. Uses natural coconut and plant extract Soapwort as effective, skin-friendly detergent. 

Baby laundry detergents dermatologist recommended 

Baby laundry detergents should not contain additives that can potentially penetrate the skin barrier. In fact, it’s not just dyes and fragrances. Many other additives such as industrial solvents, optical brighteners leave a microscopic residue in fabrics after being washed. As newborn’s skin barrier is not fully developed, there is a risk that it can inadvertently penetrate the skin barrier. Besides, a newborn’s skin is more sensitive to harsh surfactants present in regular detergents. If there is a family history of eczema, definitely avoid using regular detergents for baby’s laundry.

Baby Laundry Detergent for Sensitive Skin
Each Hypoallergenic Laundry Detergent Strip encapsulates dermatologist-approved potent plant-based ingredients for effective cleansing that is effective on fabrics and gentle on skin.

I suffer from sensitive skin. Should I switch out my laundry detergent? 

Dermatology research suggests that textile related contact dermatitis can cause skin allergies. Chemical residues on textiles due to laundry agents is an overlooked cause of worsening eczema too. Eczema and sensitive skin is treated with both medical and lifestyle interventions. Medical treatment includes dermatologist recommended ceramide dominant moisturisers and topical steroids for more severe cases. Lifestyle interventions include omitting all possible contactants. Such as strong lathering soaps and detergents. Commercial laundry detergents  that contain common contact allergens have been reported as a trigger for contact dermatitis in susceptible individuals. 

Ingredient analysis of the Hypoallergenic Baby Laundry Detergent by Dr.TWL Pharmacy 

Baby Laundry Detergent for Sensitive Skin
The Baby Laundry Detergent Sheets are Hypoallergenic, Dermatologist-tested and approved.

The list of ingredients in a specially formulated baby laundry detergent strips by Dr.TWL Pharmacy are as below. Here’s how to check the safety and data of all ingredients of your household cleaning agents. Key in the ingredient at the Environmental Working Group (EWG) Ingredient Database. Hazard ratings within the EWG Database are shown as low, moderate, or high concern categories, with numeric rankings spanning those categories that range from 1 (low concern) to 10 (high concern).

Source of undermentioned Ingredient Hazard Rating Excerpt: EWG Skin Deep® Database

Baby Laundry Detergent: Sodium C14-16 Olefin Sulfonate
Sodium C14-16 Olefin Sulfonate: An ultra gentle surfactant derived from coconuts. A natural lathering agent.
Baby Laundry Detergent: Poly Vinyl Alcohol
Polyvinyl Alcohol: A waterproof coating safe for the environment that protects your hands from the detergent.
Baby Laundry Detergent: Cocamidopropyl Betaine
Cocamiddopropyl Betaine: A creamy thickening agent from coconuts that is used in personal care products including shampoos. Produces a rich creamy lather. Gentle on hands and skin.
Baby Laundry Detergent: Glycerin
Glycerin: A moisturising ingredient that traps moisture under the skin.
Baby Laundry Detergent: Saponins
Soap Nut Extract (Saponins): A novel 100% plant derived soap agent, from the plant soap wort. Thoroughly removes stains and dirt, gentle on skin and fabrics. Perfect for babies and those with sensitive skin.
Baby Laundry Detergent: Chamomile Essential Oil
Chamomile Essential Oil: A skin-calming non-irritating essential oil derived from chamomile flowers for refreshing fabrics, allergen-free .

References

  1. Rockoff AS. Detergent allergies: an urban legend. J Am Acad Dermatol. 2003 Jul;49(1):161. doi: 10.1067/mjd.2003.189. PMID: 12833037.
  2. Cotton CH, Duah CG, Matiz C. Allergic Contact Dermatitis Due to Methylisothiazolinone in a Young Girl’s Laundry Detergent. Pediatr Dermatol. 2017 Jul;34(4):486-487. doi: 10.1111/pde.13122. Epub 2017 May 19. PMID: 28523864.
  3. Bai H, Tam I, Yu J. Contact Allergens in Top-Selling Textile-care Products. Dermatitis. 2020 Jan/Feb;31(1):53-58. doi: 10.1097/DER.0000000000000566. PMID: 31905182.

Best Natural Eczema Cream for Babies: Myths, Facts & Dermatologist Treatment

April 25, 2022
Baby Skincare Book on Natural Eczema Cream
Dr. Teo Wan Lin’s free e-book Dermatologist’s Guide to Baby Skincare is available on Amazon.

If you are searching for the best natural eczema cream for babies, chances are you may have heard some bad things about traditional eczema treatment. If you are based in Singapore, the hot weather does trigger off eczema flare ups in both babies and adults. In this article Singapore dermatologist, Dr. Teo Wan Lin, shares her top tips on eczema management. She includes important scientific facts about natural eczema cream or remedies, which is important if you wish to get facts right.

How common is eczema and what causes eczema flare ups?

Eczema is common in Singapore as it is worldwide. However, Singapore’s hot and humid climate modifies the skin microenvironment. For many with dry sensitive skin issues, humidity can improve the skin condition. Conversely, a dry temperate climate can trigger off their skin flare ups. Increased water loss through the skin occurs in dry climates. This is known as trans epidermal water loss. Singapore is a very humid country. Those who suffer from eczema benefit from increased environmental humidity. 

Effect of air conditioning on eczema. Keep cool but avoid using air conditioners. 

In Singapore’s hot weather, many individuals end up being in air-conditioned environments for prolonged periods. Air conditioning increases the rate of water loss through the epidermis. This is especially if there is no humidifier in the environment. 

Avoiding triggers is part of natural eczema treatment that does not involve drugs

The causes or triggers of eczema are mainly environmental. Food allergy is rare and tends to affect only children below the age of four. Even then, accompanying symptoms such as diarrhoea, swelling of the throat, and the airways must accompany the symptoms in order for it to be considered a true allergy. Most eczema cases are actually triggered off by environmental changes. A reduction in humidity, for example prolonged exposure to an air conditioned environment, increases water loss. Use of harsh soaps which strip the skin of its natural protective oils, bacterial infections for example due to poor hygiene can also trigger off flare ups.

The commonest trigger is actually dust in the environment. Literally all eczema patients have dust mite allergy and routine testing is not carried out by dermatologists. Methods of dust mite reduction include getting rid of carpets, stuffed toys and awareness of the certain types of animal fur that can trigger off a flare up. Using a HEPA filter can also reduce the amount of airborne particulate allergens in the environment. Sweat triggers off eczema flare ups. So one should avoid heat and high temperatures. While humidity is beneficial, increased environmental temperature causes more  sweating. For eczema sufferers, sweat actually contains urea, lactate that worsens the eczema flare ups. 

Identifying risk factors for eczema, start using a moisturiser early

Lifestyle does affect eczema, Inadequate sleep, disturbed sleep patterns, a poor diet, stress; these are all factors that can directly trigger off eczema flare ups because it is controlled by the immune system. 

On top of that, we know that eczema itself is predominantly a genetic condition so if there is a family history of sensitive skin, allergic rhinitis, asthma, one can be at a higher risk of acquiring eczema, also known as atopic dermatitis. Eczema does not just occur in individuals who are genetically predisposed. With age, the functions of the skin can also deteriorate and constant exposure to certain soaps, as well as environmental contractions can reduce the integrity of the skin barrier.

Always use a good ceramide dominant moisturiser. Ceramides are the fatty lipids that cement the cells of your skin. This reduces the chance that environmental allergens can penetrate the skin and trigger off a flare up. When this barrier is deficient, that’s when you can develop eczema. If your symptoms do not disappear after using a moisturiser, you should see a board certified dermatologist.

Healthy diet: natural way to support eczema treatment 

Fatty fish, plant oils, evening primrose are rich in omega 3 fatty acids and can support a healthy skin barrier. For those under the age of 4, there could be  possible food allergies. Parents will need to discuss with dermatologist case by case. If the body is unhealthy, the skin as an organ will be affected. Hence, a healthy diet is recommended. 

Natural Eczema Treatment by a Healthy Diet
Dr. Teo Wan Lin is the author of Edible Beauty, a complete dermatologist guide to foods beneficial for skin.

Why is there a concern about medical treatment for eczema? What is a natural eczema cream?

Many people have heard misleading information on the internet about steroid withdrawal syndrome. Most of the time, these cases are not managed by dermatologists and have a poor outcome. Topical anti-inflammatory agents are not just steroid creams. There are non-steroidal creams known as calcineurin inhibitors. There are also those with natural functional ingredients derived from plant extracts. These are anti inflammatory and can be incorporated in moisturiser creams for eczema patients. 

It is important to know how eczema is treated by dermatologists.  Board certified skin doctors follow a treatment protocol, based on evidence-based medicine. They first assess the severity of the eczema, starting with topical medications such as topical steroids or other immunomodulators. These can be steroid-sparing alternatives. The emphasis on a natural eczema cream is not scientific.

The definition of a natural eczema cream itself is arbitrary. Most people think it must be from a plant or a food. However, such ingredients may not only be toxic, but also not effective eczema treatment. For example, most essential oils used for aromatherapy or naturopathic purposes are caustic to the skin. Eczema patients must avoid all of it.

A common additive peppermint essential oil is an example. While it can provide a minty, cooling sensation to relieve itch. Peppermint essential oil can worsen eczema. Rather, dermatologists recommend using menthol extract in small concentrations. This can be extracted and formulated as part of eczema skincare. The above is an example of how a natural eczema cream can actually worsen eczema. 

Instead of searching for a natural eczema cream for babies, you should look for one which is dermatologist formulated. It will be effective and safe on baby’s skin.

Using the best baby moisturiser is one part of treatment. Dermatologists emphasise that how often and how you apply moisturisers is equally important. 

Best natural eczema cream / moisturiser therapy with wet wraps

Wet wrap therapy is the gold standard with an aggressive regimen of skin barrier repair with a good ceramide-based moisturiser. There are ways to increase absorption of the creams. One of the commonest methods is using wet wrap therapy. This is when the skin increases its ability to absorb what is applied on the surface when a layer of damp material such as cotton, is placed on top of the skin. The technique is commonly recommended in paediatric eczema. In addition, the method does not require any medications and relies on a good moisturiser to achieve the desired effects.

Not all rash is eczema. If you are searching for a natural eczema cream or remedy online, chances are you have noticed a rash on your baby. The top tip from our dermatologist is – be wary that it may not be eczema. Consequently, it is not relevant to be searching for a natural eczema cream or for eczema treatments for that matter.

Not all baby rashes is due to eczema 

The lay person may find it difficult to differentiate between eczema and other types of rashes. They are not expected to self-diagnose. When in doubt, they should always consult an accredited dermatologist. However, here are some tips which can help you navigate your symptoms better.

If you have a sudden onset rash that spreads from the body to the rest of your limbs, this should not be regarded as eczema. It could be a viral related rash known as a viral exanthem and it is dangerous for a parent to assume that that is eczema if it is happening to their child. This is because viral exanthems are associated with underlying infections and it is important to seek medical attention for these infections.

Eczema tends to be chronic. It can start early on in the child’s life and usually affects the elbows and the knees, thinner areas of the skin around the neck and parts of the face. These areas can be very itchy. Parents may notice a child or infant rubbing themselves on surfaces to relieve themselves of the itch. Overtime, this can develop to areas of thickened skin from being red and flaky, to being thick and rough. This is a process known as lichenification. The important thing to do is regardless of whether you have been diagnosed with eczema before, is to use a good ceramide-based moisturiser. 

Dangers of natural eczema cream or remedies

I would not recommend natural eczema cream or herbal remedies that are being marketed for eczema. These often contain essential oils which are in fact irritating to dry sensitive skin when used in inappropriate concentrations and also lanolin-based moisturisers which, first of all is very animal-unfriendly and also can contain residues which are irritating to eczema prone skin. Using apple cider vinegar, any food or plant product raw are commonly purported natural eczema creams. There are myriad of home concoctions available online for treating itch or alleviating dryness. Be warned that these naturally eczema creams can potentially lead to serious harm.

What you can do for mild eczema treatment without medications 

If you have mild symptoms, you can use this method first. Relieve itch by applying your moisturiser cold. The lower temperature helps to cool skin. The cooling sensation distracts your itch receptors and this can reduce the discomfort. Also, instead of scratching, you can pat your skin or tap it. Scratching destroys the protective layer formed by your skin cells and can set the stage for worsening infections. 

Steroid phobia: sometimes it is necessary to use steroids for eczema. 

Dermatology is the practice of evidence-based medicine for the treatment of skin conditions. Eczema is not just a dry skin condition that the lay person can self-medicate and treat using natural eczema creams, hoping it will go away. It is important to correct this perspective because eczema always starts off being mild and it does get very severe. The most severe form of eczema is known as erythroderma, also known as the red man syndrome and these cases do not happen overnight.

Mild to moderate eczema must be treated aggressively with a combination of appropriate ceramide dominant moisturizers, wet wrap therapy with topical immunomodulators which include topical steroids. However, these must be closely monitored when prescribed by a dermatologist because there is always a risk of inappropriate use leading to side effects such as skin thinning and a phenomenon known as tachyphylaxis where the medicines actually stop working. Dermatologists are well-versed in the management of eczema with topical steroids. 

Steroid phobia is a term coined by dermatologists to describe the harmful effects of misinformation about topical steroids. This is what causes parents to avoid medical treatment altogether. As a result, there is a very poor outcome and will require stronger medications to bring the eczema under control. 

Rather, it is a balance we strike. At our clinic, we focus on a proactive treatment approach that emphasises using techniques of application, as well as biomaterial applications. This enhances the effects of moisturiser therapy. We also focus on plant extracts which have proven anti-inflammatory properties. These extracts, consequently, constitute some basis of a natural eczema cream that is commonly referred to. They can help to wean patients off topical steroids faster. Ultimately, if you are under the care of a dermatologist, he or she maintains responsibility for effective and safe eczema treatment. 

Best natural eczema cream: what ingredients should you look out for in an eczema product?

There is a concept known as the prescription emollient device coined by Lawrence Eichenfield, a paediatric dermatologist. A prescription emollient device is the best type of moisturiser for dry skin types, especially those who are prone to eczema. Essentially, there is a dominant ceramide component which can be animal-derived or as is our brand’s preference, plant-derived from seed oils known as phytoceramides. This is probably as close as we can get to a true natural eczema cream. Together with anti-inflammatory botanicals, the cream performs a steroid-sparing role in a sense that it does reduce reliance on topical steroids which is the ultimate goal of treatment.

Vitamin D and Acne: Dermatologist’s Complete Guide

April 21, 2022

Vitamin D and acne, is there a link? In this series of Dermatology Lectures, Singapore dermatologist Dr. Teo Wan Lin goes through the scientific literature to help you understand skin science plainly. Follow her on her Instagram @drteowanlin and on Tik Tok where she regularly gives masterclasses on skin and hair health. 

Science of Beauty
Dr. Teo Wan Lin is a board certified Singapore dermatologist and host of beauty podcast Dermatologist Talks: Science of Beauty. She has collaborated with brands such as L’Oréal Paris, Skinceuticals, Laneige, Eucerin to create scientific educational material on her beauty podcast.

Dermatology Lectures by Singapore Dermatologist Dr.TWL 

Dermatology Made Simple!

Point Summary:

The following is a discussion on the effects between vitamin D and acne. This is an emerging topic, what dermatologists know is still fairly limited. However, it is helpful to go through existing studies which offer some information on the subject.

Dermatology Lectures - Vitamin D and Acne

Vitamin D and Acne: Korean authors published a study in the Annals of Dermatology 2016. They found that Vitamin D reduced oil production. Vitamin D also reduced acne inflammation. 

In the study [1], scientists determined the effects of vitamin D on the sebocytes which produce oil. Acne patients have increased oil production. Propionebacterium acnes, the bacteria in acne, stimulates sebum production. 

The study found Vitamin D blocked both inflammation and oil production. Specific markers known as interleukins as well. P. Acnes stimulates inflammatory acne. So the study concluded Vitamin D can block this inflammation and help acne. 

How does vitamin D affect sebum production? There are many other studies which link vitamin D and acne.  

Other studies also report Vitamin D’s ability to block the growth of sebocytes, responsible for oil gland activity in acne patients. Vitamin D decreases the production of inflammatory markers from these oil gland producing cells. This reduces inflammatory acne.  Many previous studies corroborate that vitamin D reduced activity of oil glands. The mechanism by which this occurs is confirmed by this study.  When sebocytes are incubated with vitamin D, vitamin D actually inhibits inflammation. This is important because inflammation is the main pathway in acne, which is mostly genetically determined. Vitamin D deficiency however looks like it affects the development of acne. On the basis of these findings, the authors recommend the use of vitamin D for inflammatory acne.

Why should we study the association of Vitamin D and acne? What do we know so far?

In vitro studies [2], conducted in the laboratory setting with cells, demonstrate vitamin D’s role in acne development. Vitamin D receptors are present in human oil glands known as sebocytes. Dermatologists also discovered that vitamin D affects oil and inflammation processes in skin.

However, our knowledge is not well established in terms of clinical studies. So this was considered the landmark paper that helped to correlate these two factors. 

Background about Vitamin D. What is Vitamin D and how does Vitamin D and acne link together? 

Vitamin D is an essential micronutrient for our immune system. It helps the immune function of  skin too. Vitamin D deficiency is implicated in skin diseases such as eczema (atopic dermatitis) as well as psoriasis. Acne is one of the commonest skin problems worldwide seen by dermatologists. 

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Micronutrients are essential to healthy organ functioning.

Acne is considered an inflammatory disease. So far, there are some associations of the levels of vitamin D and acne. Korean and American dermatologists published a study [2], a randomized control trial in 2016. They found that vitamin D deficiency was detected in up to 48.8% of patients with acne but only 22.5% of the healthy control group. 

A randomized control trial is considered the gold standard of study design. This is part of how we evaluate scientific hypothesis. 

Vitamin D and Acne: Does vitamin D reduce sebum production? Can vitamin D deficiency cause acne? Vitamin D deficiency associated with acne severity

Severity of acne is associated with vitamin D deficiency. This means, the higher the levels of vitamin D in the blood serum, the less severe the acne was. The 2016 study authors concluded that vitamin D deficiency was more frequent in patients who have acne. Also, serum vitamin D levels were inversely correlated with how severe the acne is. Particularly, in patients with more severe inflammatory cystic lesions. 

The background to this study is essentially the hypothesis that links vitamin D to our immune system. Dermatologists already know vitamin D mediates skin diseases such as eczema, psoriasis, autoimmune diseases, alopecia and vitiligo. 

More recently in 2021, authors Ming Wang published a systematic review [3] in the Journal of Cosmetic Dermatology.

Also known as a meta analysis, it is a complete study of the available scientific literature on how vitamin D status and vitamin D supplementation affects acne patients. The results showed that overall, in acne patients, there is a lower level of measurable serum vitamin D levels. Several other studies [3, 4, 5, 6] correlate the deficiency of vitamin D and acne severity.

Vitamin D and Acne: Does Vitamin D help hormonal acne?

This topic is not adequately researched. Vitamin D deficiency in the above study [7] is associated with adverse fertility outcomes including PCOS and hypogonadism. However, the evidence is insufficient to establish causality. High-quality RCTs are needed to further evaluate the effects of vitamin D supplementation in PCOS women as well as on androgen levels in men. It is a possible hypothesis that as Vitamin D does affect hormone regulation, it can also affect development of hormonal acne. 

Vitamin D and Acne: Can vitamin D help with acne? 

It is important to note that topically applied vitamin D is not expected to work. Vitamin D has a high molecular weight. This means it does not penetrate easily via topical agents. Oil gland cells known as sebocytes are involved in acne. Sebocytes are considered by scientists and dermatologists as vitamin D responsive cells. This is the main reason dermatologists consider if vitamin D supplements can be part of effective therapy for acne.

There is emerging evidence about a possibly therapeutic option of vitamin D supplementation for acne patients. Another important randomized control trials that we want to talk about was published in the Journal of Dermatological Treatments [4]. Author Amal stated that acne patients more commonly have vitamin D deficiency, compared to healthy individuals. This is a similar result found by the first study authors. Overall, these support the association of vitamin d and acne, that levels of vitamin D and acne severity are inversely correlated. 

Is sunlight really bad for your skin and health? The key is balance.

The role that Vitamin D plays in the development of skin disease is fairly well known to dermatologists. However, dermatologists are not entirely sure how vitamin D and acne link together. Acne is considered a rather complex condition primarily genetic. This means it occurs in genetically predisposed individuals. Other factors such as the immune system regulation also affects acne development. The immune system is different between individuals.

Lifestyle affecting Vitamin D levels in the skin is an established concept. Our lifestyles of advocating sun avoidance as the primary means of photoprotection can have an impact on our immune system and our health.

All vertebrates need vitamin D to maintain and develop a healthy skeleton. The skin actually manufactures vitamin D. The skin is able to make the biologically active vitamin D metabolite. This is very important to regulate growth and differentiation. of cells. Phototherapy with UVB is used for the treatment of inflammatory skin conditions such as psoriasis. In psoriasis, skin cells proliferate excessively. This is how UVB suppresses inflammation. 

We should tread a very, tread the line very carefully when talking about sun exposure and vitamin D levels. For skin cancer prevention, dermatologists will always recommend sun avoidance, together with adequate sun protection. Sun protection can be in the form of sunscreen and photo protective clothing. This reduces skin cancer risk.

Vitamin D and Skin Health

In a study published in 2007 by a dermatologist from Germany in Experimental Dermatology, the author suggests vitamin D analogues as skin therapy.

The biological effects of vitamin D analogues can prevent cancer and also treat inflammatory skin diseases. He suggested for the dermatological recommendations on sun protection campaigns for skin cancer prevention to be re-evaluated. 

This is to prevent widespread population vitamin D deficiency. 

Perhaps the key is to consider Vitamin D supplementation.

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Mushrooms are a source of Vitamin D in diet. Especially if they are exposed to sunlight when growing.

The overactive oil gland is the underlying cause of excess oil production in acne patients. This information about vitamin D and acne means that it is potentially a target for biologically active vitamin D analogues. Pharmacological analogues, also known as supplements, can be helpful if true. The studies show that vitamin D can directly affect the oil glands and also the immune system, hence establishing the clear link between vitamin D and acne.

How is vitamin D made in our skin?

Vitamin D analogues, offered as supplements, help to protect against ultraviolet radiation. UV rays cause apoptosis, a type of cell death. Failure of cell death of cancerous cells cause skin cancer formation.

Vitamin D supplements can protect against infection. Skin infections, particularly by regulating the local skin immune system. The problem with vitamin D deficiency is actually greater than what we know it to be. The skin is very relevant because it is the main organ  where vitamin D is made. Excessive sun protection does increase the risk of vitamin D deficiency. Older scientific papers in 2007 evaluated transplant patients who were required to avoid UV exposure in an extreme sense for skin cancer prevention. They all had  serious vitamin D deficiency. 

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Learn about how diet can affect your skin in this series of Edible Beauty Masterclasses by Dr. Teo Wan Lin.

How much vitamin D is necessary to protect against cancer and other diseases?

The overall consensus is that 1000 units needed to have a protective effect. Dermatologists will not have to worry excessively in a patient with adequate vitamin D supplementation. However, one needs to be aware that strict sun avoidance measures can lead to a serious health risk of vitamin D deficiency. Vitamin D supplementation will increasingly feature in scientific publications about dermatological conditions. Before that, we should have an adequate understanding of how vitamin D works in our and throughout the whole body.

Disclaimer: This series on Dermatology Lectures offers the author’s personal perspective on scientific literature and should not be regarded as medical advice. 

References:

  1. Lee WJ, Kim MJ, Ryu HS, et al. Effect of Vitamin D on the Expression of Inflammatory Biomarkers in Cultured Sebocytes Treated with Propionibacterium acnes or Ultraviolet B Irradiation. Ann Dermatol. 2016;28(5):665-669. doi:10.5021/ad.2016.28.5.665
  2. Lim SK, Ha JM, Lee YH, Lee Y, Seo YJ, Kim CD, Lee JH, Im M. Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial. PLoS One. 2016 Aug 25;11(8):e0161162. doi: 10.1371/journal.pone.0161162. PMID: 27560161; PMCID: PMC4999291.
  3. Wang M, Zhou Y, Yan Y. Vitamin D status and efficacy of vitamin D supplementation in acne patients: A systematic review and meta-analysis. J Cosmet Dermatol. 2021 Dec;20(12):3802-3807. doi: 10.1111/jocd.14057. Epub 2021 Apr 15. PMID: 33690970.
  4. Ahmed Mohamed A, Salah Ahmed EM, Abdel-Aziz RTA, Eldeeb Abdallah HH, El-Hanafi H, Hussein G, Abbassi MM, El Borolossy R. The impact of active vitamin D administration on the clinical outcomes of acne vulgaris. J Dermatolog Treat. 2021 Nov;32(7):756-761. doi: 10.1080/09546634.2019.1708852. Epub 2020 Jan 3. Erratum in: J Dermatolog Treat. 2020 Jan 21;:1. PMID: 31868550.
  5. Alhetheli G, Elneam AIA, Alsenaid A, Al-Dhubaibi M. Vitamin D Levels in Patients with and without Acne and Its Relation to Acne Severity: A Case-Control Study. Clin Cosmet Investig Dermatol. 2020 Oct 7;13:759-765. doi: 10.2147/CCID.S271500. Erratum in: Clin Cosmet Investig Dermatol. 2020 Nov 02;13:815. PMID: 33116739; PMCID: PMC7549021.
  6. Kemeriz F, Tuncer SÇ, Acar EM, Tuğrul B. Evaluation of 25-hydroxy vitamin D levels and disease severity in patients with acne vulgaris. Dermatol Ther. 2020 May;33(3):e13393. doi: 10.1111/dth.13393. Epub 2020 May 6. PMID: 32268447.
  7. Trummer C, Pilz S, Schwetz V, Obermayer-Pietsch B, Lerchbaum E. Vitamin D, PCOS and androgens in men: a systematic review. Endocr Connect. 2018;7(3):R95-R113. doi:10.1530/EC-18-0009.

Acne Excoriee: Best Tips on How to Avoid Squeezing Pimples

February 17, 2022

Acne Excoriee, or excoriated acne, is a result of acne lesions being compulsively picked at and scratched, resulting in red marks and scars. In this article, we will cover what exactly acne excoriee is, what causes it, as well as reflections from an acne dermatologist on how skin affects one’s psychology and why it is so important that we impart correct beliefs in one’s childhood/teenage years. Including an excerpt from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Acne Care Bible - Find out the causes and treatment of teenage acne
The Acne Care Bible is written for sufferers of adult acne, teenagers, as well as parents of teenagers who may want to equip themselves with knowledge on how to prepare their children for the start of puberty. 

What is Acne Excoriee?

It is a condition that predominantly affects young teenage girls who may have the condition persist to adulthood. It is characterized by areas of raw broken skin present over the face together with acne lesions. The characteristic is that these have a circular, what we termed as an “excoriated” appearance which is consistent with picking and peeling of the skin. 

As we know, acne itself is associated with significant psychosocial disturbances. The period of one’s teenage years is already fraught with emotional ups and downs associated with both physiological changes as well as the complex interplay of social factors that occur in a teenager’s life. The teenage years are also the beginning of when one starts to develop sexual awareness. This is a critical factor influencing one’s self-esteem as the teenager often becomes self-conscious about his/her perceived attractiveness. 

Acne undoubtedly can leave one’s self-esteem scarred primarily because of cosmetic disfigurement. Acne bumps are visible on one’s face, are often painful and can lead to discomfort. It is my observation that individuals with acne tend to develop a self-perpetuating cycle of feeling upset about the pimples, expressing the frustration through destructive habits such as squeezing pimples and picking them which then leads to secondary bacterial infections. This then becomes an ongoing acne problem that never seems to fully go away. I shall share in the following segment how I treat my patients with this condition.

How to identify acne excoriee? 

Whether you are a parent of a teenager or a teenager yourself, this age group of young adults is critical in the diagnosis of acne excoriee. In fact, in French, this is known as “acne excoriee des jeunes filles”, literally translating to “acne excoriee of young girls”. I have never diagnosed a male patient with this condition so it does seem to pre-select the female gender. I have also seen adult female patients with this condition but the key thing to note is that all their acne excoriee problems started when they were teenagers. The clinical appearance of acne excoriee is characteristic to the trained eye. 

@drteowanlin New book launch @amazon @drtwlderma #acnecare #healthy #skincare #pimpletreatment #fyp #foryou #foryourpagechallenge ♬ Say So (Instrumental Version) [Originally Performed by Doja Cat] – Elliot Van Coup

Appearance of skin lesions

These are some signs dermatologists look out for when diagnosing acne excoriee. Excoriated papules appear as areas of broken skin which are often circular. These are the result of digging, picking and peeling the areas where the blemishes are. The second feature will be that of hyperpigmentation. When these picked areas heal, they often lead to dark marks. These marks are first red then brown before turning into a dark brown or even grayish in individuals of color. The third feature would be the presence of other types of acne. Acne excoriee is never a standalone condition. It always occurs together with a true underlying condition such as comedonal or cystic acne. 

Psychological impact of acne excoriee

All dermatologists recognize the importance of the mind and its influence on the skin and vice-versa. Acne excoriee is a classic example of how skin conditions can greatly affect one’s psychology. 

When I interview patients with acne excoriee, their responses are similar. The patient often feels extremely ashamed, they feel “dirty” because their skin has these spots that never seem to go away. It is a very difficult emotional experience for these individuals who are constantly suffering from a sense of shame due to not having “clean skin”. As a result of this negative psychology, many of the patients end up trying to “clean” their skin by digging and picking. However, a lot of them are “unconscious” that their behaviour leads to scarring and pigmentation which they experience and often justify it as necessary because they keep getting new zits they need to “pop”. 

The self-perpetuating cycle of acne excoriee

Next, I shall move on to the actual cognitive-physiological process of when the individual with acne excoriee starts to pick their skin. The individual first observes a pimple on the surface of the skin which may or may not appear to have a visible tract to the surface. If they view it as a superficial pimple where there is a whitehead or a blackhead that could potentially be squeezed out, they start extracting the cyst and squeezing pimples. What’s usually going on in their thought processes at this stage is usually this: if I squeeze the contents of the pimple out it will flatten and disappear. 

acne excoriee cycle

This is not an entirely irrational thought, for it is typically backed by previous experiences whereby the acne bump did resolve upon its contents being extruded. This likely formed a positive reinforcement cognitive loop whereby the mind and intuition associates the act with a positive outcome. There is almost a “gratification” that occurs if and when any pus or material is expressed, causing the individual to blindly disregard the scarring that occurs as a result of squeezing pimples. On the other hand, should the pimple be a “blind” pimple, and nothing comes out after repeatedly squeezing pimples, the individual then develops deep frustration and a sense of shame, leading to depressive feelings. 

Brain-skin connection

However, there is a definite psychological bias here which also forms the basis of many obsessive compulsive disorders (OCD). The act which is a “compulsion” is meant to relieve the individual’s “obsession” with their pimple. What it fails to establish is the objective awareness that squeezing pimples has more often than not causes worsened acne cysts and scars. In my experience, where there is an attempt by a physician (i.e. myself) to highlight this, the patient will then deny that there is any link between their actions and the resultant condition, and then justify their behaviour with “but then the pimple will never go away if I don’t squeeze it.”

However, in acne excoriee, there is usually no link to any true psychiatric condition, nor is there any other evidence of OCD features found in the individual suffering from acne excoriee. Occasionally, where there are concomitant symptoms of depression or anxiety, appropriate referrals for psychiatric co management are made.

Acne excoriee can also occur when individuals use instruments to extract their acne as well. The appearance of all these lesions is classical and using an instrument to extract acne is by no means recommended by dermatologists nor does it lead to a favorable outcome. It is also not recommended to go for a facial treatment whereby a therapist extracts it for you.

The reason being whatever instrument that is being used to extrude the debris and pus contained within the acne bump is usually going to introduce more infection with superficial skin bacteria. It will then worsen inflammation which is the primary cause of acne itself. If the pimple appears to be blind and deep-seated within the skin, the individual will panic further because they feel the immense need to squeeze it out before the pimple stays permanent. 

“If I don’t squeeze it out, it will leave a mark and it will never go away.” The perpetual repeating of such a thought process causes a habit to form. As you know, our minds and our movements are connected by way of neurons in the brain as well as certain chemicals that are associated with our emotions. Patients with acne excoriee feel a sense of relief from their emotional discomfort when squeezing pimples and picking their skin.

acne excoriee and the brain skin connection

The pathophysiology of acne and how acne excoriee develops is a true complication that needs to be addressed separately

Acne itself is predominantly genetic. The genetics of an individual leads to inflammation. Combined with hormonally influenced oil production which occurs when one enters into puberty, the presence of bacteria on the surface of one’s skin forms the perfect environment for acne bumps to develop. Acne excoriee is best viewed as an abnormal response by the individual to the development of physiological acne. Many teenagers go through puberty years with minimal damage to skin, experiencing acne bumps here and there, but it is never severe enough to cause acne excoriee.

Acne excoriee occurs in individuals with physiological acne as well. Most of these patients do not have severe cystic acne, rather they have mild to moderate acne but they have a heightened sense of how their appearance may affect the perception of others around them. This escalates into anxiety and a need to remove facial blemishes from one’s skin via various methods. Part of this could be due to peer/media influence as well, or an underlying body dysmorphic condition. 

When one sees extraction such as needle decompression being advertised, some may assume that physical extraction is needed to treat their acne and start to afflict these traumatic methods by themselves. However, it is very important to note that all these therapies are done in a medical setting, with sterile instruments and with careful patient selection. However, there are a lot of therapists who do advocate extraction contrary to what dermatologists advise, thus we do not blame the individual for believing that this is a viable method of acne treatment. Once the habit is formed, the individual develops a sense of satisfaction, even catharsis from squeezing pimples or excoriating their acne bumps. 

Teenage Acne 101: Complete Guide on How Puberty Affects Skin & Hair

February 6, 2022

Many teens or pre-teens start getting acne during puberty. In this article, we explain teenage acne forms, and how puberty affects the skin and hair, including excerpts from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Acne Care Bible - Find out the causes and treatment of teenage acne
The Acne Care Bible is written for sufferers of adult acne, teenagers, as well as parents of teenagers who may want to equip themselves with knowledge on how to prepare their children for the start of puberty. 

We will start from a medical perspective, explaining the changes that occur physiologically that result in the external body changes observed in teenagers as they transition to adulthood. Thereafter, we will cover the specific skin and hair changes caused by puberty, like teenage acne.

Firstly, when does puberty occur? 

Between the ages of 10 to 14, both boys and girls start to secrete sex hormones. 

What happens to the body during puberty?

Puberty is marked by the secretion of sex hormones. For boys, they start to produce the male hormone testosterone whilst for girls, they start to produce both estrogen (which is the feminine hormone) as well as testosterone. In boys, they will observe that their voice may change, as well as growing a more toned and muscular physique, along with genital enlargement. All these are the effects of testosterone. 

Girls will experience breast and nipple enlargement in the early stages of puberty. The onset of puberty in girls is marked by the start of their period or the menstruation cycle. 

The influence of sex hormones on skin

Puberty is determined by the onset of the secretion of sex hormones, the timing of which varies slightly between individuals and may occur in stages over a period of several years. Where the skin is concerned, we shall now zoom in specifically on the influence of sex hormones on overall skin texture, appearance and function.

Did you know that testosterone is responsible for the production of oil? This is the cause of teens developing greasier skin and teenage acne as a result. Sex hormones are chemicals which trigger off the activity of oil glands, which are also known as the sebaceous glands because they produce sebum. Estrogens in females specifically help the skin to attain a smooth and soft appearance. This explains why women, in general, have smoother and softer skin than men.

influence of hormones on teenage acne

The same process occurs on one’s scalp as well. The scalp, face, chest and back form an area termed as the “seborrheic areas”, which really refer to areas that produce more oil. During this time, teenagers and young adults may also observe the development of teenage acne or acne-like rashes over the chest and back area. This can be due to acne itself and/or a type of skin rash induced by a fungus.

Colloquially termed as fungal acne, it is a misnomer because this is not true acne. Rather, it is inflammation of the follicles caused by a yeast known as Malessezia Furfur, a condition known as Pityosporum folliculitis. Both are related to the overproduction of oil, increased sweating such as during sports, and is especially common in individuals living in humid climates.

Effects of puberty on skin

If you are experiencing any of these symptoms, know that this is part of adolescence. A lot of hormones are being released into your body during puberty. These actively act on areas such as your scalp, your hair, and skin during your transformation to adulthood. 

What’s happening to my skin? 

1. Greasier skin that cause teenage acne

Have you noticed your skin becoming greasier over your forehead, nose, and chin? Don’t be alarmed! This is a common phenomenon known as T-Zone oiliness. The oil glands are concentrated over these areas. Oil glands are also known as sebaceous glands which are associated with hair follicles. Every area of your body has hair follicles other than your palms and your soles. Seborrheic areas are areas where the hair follicles are associated with oil glands. These would be the T-Zone of the face, the scalp, The central ‘V’ of the chest as well as on the back. 

Teenage acne appear on the forehead and T-zone

2. Enlarged pores with blackheads and whiteheads

What you may see as black dots appearing over your nose and chin are actually not “dirt” that you should try to pick and squeeze out, but rather blackheads or open comedones, which are a form of teenage acne. If you observe an increase in the size of the pores of your skin, this is related to the increased activity of the sebaceous glands, which are responsible for producing oil.

What’s happening to my hair? Teenage Acne on the Scalp?
Changes in hair and scalp

If you’ve noticed your scalp getting greasier recently and even experience pimples on the scalp, do not worry, this is part of puberty and teenage acne. The oil glands that are active on your skin are also active on the scalp. They form a primary role of providing lubrication to the hair shaft to facilitate development of thicker, denser luscious hair.

Causes of greasy scalp and dry hair

The hair is made up of three distinct components. You have the roots of the head where the hair is embedded in your scalp; this is where it is associated with the sebaceous glands that produce oil (sebum). The second part of your hair you should know about is the hair shaft. The hair shaft is composed of dead material, this is known as keratin. The part that is “alive” is the follicle growing on your scalp.

Finally, your hair ends. You may have heard about split ends. It is due to damage at the end of the hair shaft, often caused by grooming practices. It is possible to have both greasy scalp and dry hair ends if you are using the wrong types of shampoo. Certain commercial shampoos for dry hair ends are not suitable for individuals with greasy scalps, whilst others cater for oily scalps contain high amounts of drying ingredients (known as astringents) which can cause the hair shaft to be excessively dry. 

Do I have dandruff? What is dandruff?

The teenage years are when one starts to observe changes in the scalp such as scalp flaking. Otherwise known as dandruff, but more accurately, as seborrheic dermatitis in medical terms. Many adult patients recall having their first episodes of having dandruff in teenage years. Dandruff is a layperson term for a medical condition known as seborrheic dermatitis. The term “seborrheic” derives from the root word sebum, referring to oil production. By now you would be familiar with the term seborrhea. Hence it is a condition related to an oily scalp. 

Deep Cleanse Shampoo to treat teenage acne and dandruff
The Copper Peptide Deep Cleanse Shampoo is a degreasing shampoo that contains amino acid surfactant for a gentle cleansing action on sensitive scalps, as well as Zinc Pyrithione to treat dandruff, ideal for teens with oilier scalps.

What causes dandruff to form? 

Seborrheic dermatitis is caused by a yeast that grows on everyone’s scalp and skin. That’s right, so even in healthy, young, and old individuals, the yeast is a healthy commensal. The name of this disease is Malassezia furfur. It tends to overgrow in individuals who produce more oil than others and in warm humid climates like Singapore and the tropics. Combined with sweat, this is the optimal environment for the overgrowth of this yeast. Overgrowth of the yeast then leads to inflammation of the skin as well as the scalp.

On the skin, this may appear as whitehead-like bumps that people often mistake for teenage acne. In reality, it is actually fungal acne and is found commonly over the hairline and the jawline. When over the scalp, it develops into dandruff. Specifically, people who suffer from seborrheic dermatitis may also complain of scalp sensitivity as well as discomfort. If you find that your scalp is feeling greasy at the end of every day or when you wake up in the morning, then very likely you produce more oil than normal. 

Are there any individuals who enter into puberty and do not have these symptoms? 

Yes. However, most individuals will observe these changes in their skin including the scalp as they become teenagers, and experience teenage acne. However, the key feature here would be genetics. So if any of your parents had suffered from oily scalp, oily skin and teenage acne when they were teenagers, you will likely have the same symptoms. 

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Personalised Skincare for Acne & Sensitive Skin: Dermatologist Perspective

January 19, 2022
Science of Beauty
Dr. Teo Wan Lin hosts a fortnightly beauty podcast Dermatologist Talks: Science of Beauty. She is also the founder of Dr.TWL Dermaceuticals, a cosmeceutical research and development company. She has collaborated with skincare brands such as DIOR, Clinique, L’Oréal Paris, Amorepacific, Skinceuticals, Eucerin and Amorepacific to create skincare education content relevant for the public. Follow her on Instagram @drteowanlin.

This article is an interview with accredited Singapore dermatologist Dr. Teo Wan Lin, skin specialist at TWL Specialist Skin & Laser Centre on the topic of personalised skincare for acne and sensitive skin in Singapore. Is personalised skincare merely a successful marketing strategy? Or are there true benefits to having a personalised skincare line? 

Dr. Teo shares why she founded the Custom Mask Bar at Dr.TWL Pharmacy in 2019, the pioneering the development of personalised skincare masks in Singapore. She dissects the science behind using traditional herbal ingredients for dermatological conditions. Read on to learn about her thoughts on the benefits and limitations of personalised skincare in Singapore. We also ask her about her forecast for upcoming skincare trends dominating 2022. She answers these questions and more. 

Personalised cosmetics in Singapore tend to be more expensive than the mass produced counterparts, is there a reason why?

I think what consumers are paying for would essentially be for 

  1. Labor cost of small scale compounding 
  2. Sourcing of “rare” active ingredients with pharmaceutically active properties incorporated in these topicals
  3. Research & Development in the entire concept, including testing and research

Right now in my practice, we are fortunate to have an onsite pharmacy with trained staff that are able to compound these select functional active ingredients in  over the counter prescriptions, in different concentrations, adjusting to the needs of our patients.

Personalised skincare has been marketed for problem skin such as acne and sensitive skin. Is this a benefit of personalised skincare or is this pure marketing hype?

Individuals with acne and sensitive skin often turn to a myriad of over the counter skincare hoping to solve their skin problems. Very often, such DIY methods do not solve their skin sensitivity. In fact, they may observe their sensitive skin getting worse. I emphasise always that acne and sensitive skin while commonly self diagnosed by laypersons, are medical conditions. Depending on severity of the pimples and/or dermatitis, prescription medications may be required. However, skincare is very relevant to all dermatologic conditions. This is because active ingredients applied to skin can either soothe or irritate it.

If you suffer from irritated skin, you may experience redness, stinging and flaking easily. It is also possible to have both acne, oily skin and dry irritated skin at the same time. This happens when the skin barrier function is disrupted. How personalised skincare can help acne and sensitive skin sufferers is via restoration of the skin barrier. This means it contains skincare active ingredients that heal dry irritated skin to reduce symptoms of redness and flaking. This is why dermatologists emphasise topical skincare regimens for all dermatologic conditions. Consequently, personalised skincare is beneficial if it specially emphasises ingredients designed for sensitive skin.

From a skin specialist’s perspective, all dermatologist-recommended skincare should be suitable for sensitive skin. This is a concept we term as skin tolerability. This means that the effective skincare ingredient can be used on both oily, acne prone as well as dry, sensitive skin types. From the layperson’s perspective, it is helpful for mass market skincare to indicate via a personalised skincare option, for those with troubled skin. 

How relevant is personalised skincare for acne as opposed to mass produced pimple creams?  

What is fairly new in the western approach to acne pharmacological treatment, is the increasing awareness that traditional herbal remedies may actually be worth studying. This is due to the potent botanical extracts found in natural plants which have potent effects on skin cells. An example of the personalised skincare for acne prescriptive we developed is the berberine acne cream.

Our bulk production item under the cosmeceutical arm is the Blemish Spot Cream which contains chlorella vulgaris and anti-inflammatory Argan oil. It is used in place of traditional topical acne treatments such as benzoyl peroxide, topical clindamycin gel. Both of these I have phased out in the last 5 years simply because they are not effective and/or cause skin irritation.

Skin irritation is even more relevant now because of maskne. This is because mask-wearing creates a unique microenvironment that increases the occlusive potential of skincare ingredients. Furthermore, what this means is you can get irritated skin more easily. Redness and flaking results. These symptoms do not help acne and prolonged use of such skincare ingredients can cause irritant contact dermatitis.

Our personalised acne cream contains berberine active for acne treatment. The berberine prescriptive for acne is essentially a Traditional Chinese Medicine herb that has shown promise in terms of acne treatment published in recent peer-reviewed dermatology research

As a result, the ingredient should not be dismissed as mere herbal remedies, which unfortunately many have been inclined to do so. Rather in science, we are trained to establish facts only after observation and repeated testing. This means that you have to keep an open mind, even in dermatology research. The rarity of this active ingredient also means it is not cost-effective for us to produce it in bulk. Often, this because we cannot procure enough of the raw material.

Unlike synthetic chemical counterparts, these are natural plant extracts that have to be grown, harvested and processed. Also, compounding for berberine in our lab is in different percentages. Starting at 10% increasing to 20% and then 25%. It is more cost effective for the us to custom compound it, in turn we pass on the savings to consumers.

Personalised skincare for acne and sensitive skin has elevated the place of botanical remedies in the realm of evidence-based medicine. Dermatologists are now paying attention to the herbal active ingredients popularised by personalised skincare brands and performing more research. 

Are there benefits in personalised acne treatments compared to mass produced pimple creams?

In terms of botanicals being qualified for medical treatment is good news. Because off the low/minimal level of skin irritation, botanical cosmeceuticals are not regulated prescription-only drugs. The added benefit is that the concentrations and combinations can be titrated without the requirement for another new product being launched. From a cosmetic manufacturing perspective, this simply adds to more packaging waste and environmental footprint.

On the other hand, our research and development is focussed instead on developing the best carriers and creams suitable for personalised titrations. Berberine has been incorporated into the Custom Mask Bar as an adjunct antibiotic-free treatment option for acne sufferers. This has been trialled in my practice prior to its mass market launch. It has holistic benefits as a topical treatment for acne, simply by virtue of its rich phytochemical makeup. As a result, the custom compounded topical has anti-inflammatory properties, on top of improving post-inflammatory hyperperpigmentation. 

Personalised skincare in a dermatology clinic seems intuitive. However, how and why did you decide to take it to the masses via your online skincare pharmacy space at Dr.TWL Pharmacy?

We have utilised this personalised skincare treatment method as a way to educate the masses on common skin conditions such as acne and eczema. 

The Custom Mask Bar via the virtual pharmacy arm launched in 2019. It is the unique intersection of over the counter active ingredients with actual bioactive, pharmaceutical properties for the adjunct treatment of actual dermatological conditions. Along with the current trend of personalised skincare, consumers understand more about botanical ingredients and how they work. Bringing this to the masses was partly an educational effort, as well as allowing first-time consumers of personalised skincare to safely and effectively incorporate these into their skincare regimen.

Personalised Skincare Acne Prescriptive
Customised skincare as opposed to mass produced for treatment of common dermatological conditions like acne and eczema makes sense because of the manpower and the sourcing of rare  active ingredients involved. At Dr.TWL Pharmacy, a common vehicle is developed for our personalised formulations. This vehicle is rich in skin repairing oligopeptides and also is an effective carrier to ensure proper absorption. 

Best Home Facial Devices: Dermatologist’s Complete Guide

January 13, 2022
Science of Beauty
Dr. Teo Wan Lin dermatologist at TWL Specialist Skin & Laser Centre, is also the host of beauty podcast Dermatologist Talks: Science of Beauty. The beauty podcast has collaborated with brands such as L’Oréal Paris, Philosophy, Eucerin and LANEIGE (Amorepacific) to create educational content relevant to skincare and dermatology.

Are you looking for the best home facial device to augment your skincare regimen in 2022? The good news is, in this article we discuss with our founder, accredited Singapore dermatologist Dr. Teo Wan Lin, on her top tips about what to look out for. Dr. Teo, who is also the chief scientific officer of Dr.TWL Dermaceuticals, is involved in the selection of technologies for the Dermatologist Tools Suite

Importantly, we want to find out what we should be looking out for in terms of choosing the ideal home facial skincare device for our needs. We start first with the type of technology that is useful in a home facial device. Clinic technologies such as lasers are not safe nor effective when used as a home device. So what kind of home devices should we be looking out for? Dr. Teo explains the importance of technologies relevant in the home facial care device industry. She also shares on the target audience and also how it can specifically target specific skin concerns. Read on to find out more.

Are home facial devices necessary for our skincare regimen in 2022? How do we know if it is the best home facial device for our needs?

Home facial device technologies have dominated the beauty consumer market in the last 2 years. Not surprisingly, many of these have been adapted from in-clinic treatments. The COVID-19 pandemic has also increased the demand for at-home DIY services. So yes, home facial devices are considered helpful in our skincare regimen. It helps to increase absorption of active ingredients in our skincare products. There is also an impact on skin ageing. For example, radiofrequency and microcurrent stimulate collagen production. Sonic cleansing actually helps with thorough cleansing and this improves the skin microbiome.

Should we include a sonic cleansing device?

Sonic Cleanser Home Facial Device Features
Are you looking for the best home facial device to incorporate into your skincare regimen for 2022? Read our dermatologist guide to discover what important features you should be looking out for.

Sonic cleansing is actually the use of ultrasonic pulsations to remove some very fine particulate matter. These are  known as PM 2.5 pollutants which remain on the skin even after double cleansing. This is very relevant because of emerging research in dermatology shows that it is involved in photo aging. Exposure to pollutants such as PM 2.5 particulate matter increases oxidative stress on skin.

Thorough cleansing with double cleansing is the traditional standard. Using an oil based cleanser to dissolve oil soluble pigments such as makeup pigments, followed by a foaming cleanser that does not strip skin dry. This is typically what is recommended by dermatologists and beauty experts. The advent of sonic cleansing means that it is ideal to incorporate sonic cleansing into a comprehensive cleansing regimen. Cleansing must be emphasized as the primary step to achieve a healthy canvas. This is the clean skin on which you can apply antioxidants serums to enable optimal skincare absorption 

How should we choose the best type of sonic cleanser for our skincare needs?

Sonic cleansing devices can be further classified into the design types. When choosing the best home facial device for your skincare needs, you should consider the design of the product. For the category of sonic cleansers, there are a few designs to consider. The brush type of sonic cleansers is the prototype developed by Clarisonic which is now defunct. The silicone brush head sonic cleansing devices are currently popular. There are also the blade style sonic cleansers which are modelled after the original facial scrubbers developed in Korea for dermatology clinics. 

There are pros and cons for each of these designs. For the silicone brush head models, these have largely superseded the now defunct brush head model. The reason is because these silicone bristles are environmentally more friendly. It is durable and also tends to trap less bacteria, which is a problem with the traditional brush head sonic cleansers. The blade style sonic cleanser also known as a facial scrubber is actually my preferred type of sonic cleanser. It is what we use in the clinic as a cleansing prep before medi-facials. This is because it generates the highest numbers of pulsations in a concentrated surface area, at 24,000 pulsations per second based on our prototype model. 

What are the specific features of the facial scrubber model which make it an ideal home facial device?

It is modeled after the original Korean medifacial facial scrubber style sonic cleanser. 5,000 to 8,000 pulsations is the industry standard for silicone brush head type sonic cleansers. The benefit of the blade style sonic cleanser is also that it has a dual function of being able to use the same sonic technology to nebulise antioxidants. Applying your serums and enhancing the absorption is a bonus. How this technology works is also that it increases the surface area of the droplets for the skin to absorb it. 

The value of sonic cleansing has also been described in dermatology literature. It has the ability to improve the microbiome of skin which is the balance of good and bad bacteria. This directly impacts conditions such as acne, facial eczema, seborrheic dermatitis and even rosacea. Sonic cleansing as it exfoliates the top most layer of skin cells, can also deliver benefits of skin brightening.

What is the best home facial device for anti-aging?

Microcurrent Home Facial Device Features
If you have heard of microcurrent facials being the favourite of celebrity aestheticians, this dermatologist guide to choosing the best home facial device will help you find a device with the best features.

The second important home facial device technology that you should be aware of is microcurrent. Microcurrent facials have been popularised by celebrity aestheticians and also aesthetic spas. It is indeed a valid technology that can be incorporated into your home facial devices because it is safe and also effective. The scientific premise of the best microcurrent home facial devices is built on studies. 

Microcurrent is low level electrical current. It can actually stimulate wound healing by increasing collagen production in diabetic wounds. This, when applied to a home facial device for anti aging, means that you can target loss of collagen. Loss of collagen  is part of the photo-aging process. In the consideration of the best home facial device based on microcurrent technology to choose, one should consider the warranty period as well as durability. 

This is because in order for microcurrent to be effective, the contact spheres have to be first of all, well maintained and clean. For this, it has to be well designed.

What are the key features we should look out for when choosing a home facial device?

Ideally, the best home facial device should deliver the equivalent of an in-clinic facial over at least a year. This is in order for you to have maximum value for your skin investment. Looking at warranty periods and durability is crucial for if you are looking to find the best home facial device for your skin needs. This brings you the most value as a consumer.  

Instant Beauty Features
Instant beauty is a trending topic in 2022. While instant immediately sounds gimmicky, many of the best home facial devices available rely on existing technology that is designed to give instantaneous results. This does not mean you don’t use it regularly though. You should incorporate this as part of your daily skincare regimen for maximum medium to long term benefits.

For this reason, cheap imitation models or those which are battery operated are out of the equation. Look for USB rechargeable for the best home facial device to suit your needs. These, when they are well made, have a warranty period of at least six months. If you were to do the math, you’ll find that it is actually a very worthwhile investment. 

A microcurrent facial with an aesthetician will set your back at least $100 to $200. A well made microcurrent device from a reputable brand with warranty is priced at usually $400 upwards. If you perform a microcurrent facial for yourself daily as part of your self care regimen. You easily spend only $1 or less over the period of a year which should be the warranty period. 

For other electrical devices, it is not as critical in terms of built and durability. However for microcurrent devices in particular, because you are relying on the ability of the device to transmit the low level microcurrent, it is important. You should be looking for one that is from a reliable, reputable brand.

What are the benefits of microcurrent for your skin?

A sturdy built microcurrent device can also be thought of as extremely beneficial for transdermal delivery. 

Transdermal delivery is essentially the increase in the absorption of skincare active ingredients through the skin barrier. It can help skincare active ingredients penetrate the topmost layer of skin, the stratum corneum. Microcurrent therapy can increase a beneficial phenomenon known as electroporation, which increases the absorption of skincare active ingredients. In a sense, because microcurrent directly increases cell ATP, it is not uncommon for individuals to report instant tightening and brightening effects. Much like lasers and HIFU (High Intensity Focussed Ultrasound), except that it is in a home facial device. 

Microcurrent also stimulates cell energy. If you’ve heard of ATP in your science lessons. It stands for adenosine triphosphate. Adenosine triphosphate is a marker of how much energy there is in your skin cells. When searching for the best home facial device, technologies that stimulate cell energy often have a good result. Cell energy determines how well your skin can repair itself after damage.

A lot, if not all of skin aging is due to the inability of skin to repair oxidative stress. For this reason, microcurrent therapy when incorporated into your daily skincare regimen can increase the skin radiance and elasticity. This is especially so when paired with a suitable skincare product that contains antioxidants. Vitamin C for example has a good brightening effect.

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