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

Fighting back and chest acne

December 10, 2018

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

What causes truncal acne?

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

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

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

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

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

How can I treat truncal acne?

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

Topical treatments

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

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

Oral antibiotics

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

Hormonal therapies

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

Oral isotretinoin

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

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

Cleansing

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

Cosmeceuticals

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

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

—–

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

To book an appointment with Dr Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

 

Does Makeup Cause Acne?

November 27, 2018

 

Does makeup cause acne? The straightforward answer is no. However, certain ingredients in cosmetics can aggravate acne. We explain how and which products to avoid below.

How do cosmetics aggravate acne?

The two major causes of acne are genetics and a bacterium called Proprionibacterium acnes (P. acnes). Neither of these originate from makeup.

However, several substances in your makeup can be comedogenic or acnegenic, both of which can cause skin irritations that aggravate the acne condition.

Comedogenic products

Comedogenic substances cause comedones.

Comedones are small bumps that arise when pores get blocked by excessive sebum and dead skin debris. Closed comedones, or whiteheads, have a cover of skin cells that prevent oxidation. Open comedones, or blackheads, are exposed to the environment which causes the sebum to oxidate and turn black.

Comedogenic products trigger a disorder in the cells lining the pores.  The normal process of cells shedding is interrupted by an excess of keratin. This causes dead skin cells and sebum to stick together and cause blockage.

Acnegenic products

Acnegenic products cause inflammation of hair follicles which leads to the formation of papules or pustules. Papules are small reddish raised bumps on the skin. They are often painful and hard when you touch them. Pustules are swollen and resemble blisters with a yellowish pus.

How to choose the right cosmetic product?

When choosing your cosmetic products, look for non-acnegenic and non-comedogenic labels. The former is less common than the latter.

The absence of a label does not mean a product is acnegenic or comedogenic though so look next to the ingredients.

Potentially comedogenic substances include cocoa butter, corn oil, lanolin, oleic acid, olive oil, paraffin, peanut oil, safflower oil, sesame oil, sodium lauryl sulfate, stearic acid and stearyl alcohol. Potentially acnegenic substances include fragrances, harsh chemicals and alcohols.

However, this list should also not be blindly followed. In any cosmetic formulation, it is likely that the substance that may be comedogenic or acnegenic in raw form is present in much lesser concentrations. Certain individuals are also more prone to comedone formation than others so some users can use a moisturizer formulated with cocoa butter without difficulty while others cannot.

As a result, the only way to know for certain if a cosmetic product is going to irritate your skin is to try it and observe what happens. If a breakout is due to cosmetics, it typically occurs 48 hours after application. Such breakouts usually disappear quickly after application is discontinued.  In comparison, the development of acne takes about 2 to 4 weeks.

If breakouts continue even after discontinuing a product’s use, switch to dermatologist-recommended products or visit a dermatologist.

Are your makeup brushes clean?

If you find you’re having consistent reactions to cosmetics, the culprit may be your dirty makeup brushes. These applicators can provide the perfect environment for bacteria to thrive and cause an infection called gram-negative folliculitis. Gram-negative folliculitis causes pustules.

To avoid this, clean your makeup applicators weekly to remove bacteria, dead skin cells and sebum. Also, do not share your makeup brushes.

Keep your face clean and clear

To minimize breakouts and skin irritations, put greater care into removing makeup thoroughly. Use a gentle cleanser, preferably one that is formulated for acne-prone skin like Miel Honey™ CleanserA skincare regime for acne-prone skin should also include antioxidants, such as VITA C GOLD™ Serum Antioxidants help to reduce oxidation of sebum, thus reducing the inflammation that can lead to acne.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

Are Wait Times Necessary in My Skincare Routine?

November 21, 2018

Are you wondering if it is necessary to incorporate a ‘wait time’ between each step of your skincare regime? Read on as we ask a dermatologist, Dr Teo Wan Lin, to find out.

1. Do you agree with the ‘waiting time’ skincare routine method? If so, why? If no, why?

From a dermatologist’s perspective, a skincare routine does not need ‘waiting time’. How well a product is absorbed by the skin depends on the active ingredient and the formulation of the product. It has to be cosmetically acceptable; asking someone to apply a heavy ointment in a humid climate like Singapore is unacceptable.

The ease of absorption is often perceived by users as how quickly the product disappears into the skin. However, this is not an accurate indicator of how well the product is functioning or if it is better absorbed than others.

There is a certain logic to layering your products. For ease of application, I recommend applying the lightest product, such as your serums, followed by lotion and lastly your cream or oilment.

In theory, so long as the product is applied onto the skin, the active ingredient will be absorbed by the skin. Yet, the perception of ease of absorption is subjective, simply because in a humid climate, users may not feel heavier creams are being absorbed even when it is already having an effect on your skin.

It is more important to consider the active ingredient of the product and how comfortable it goes to the skin rather than the waiting time.

2. There are clearly several steps to this ‘waiting time’ skincare routine method that is recommended, but is it even possible for our skin to absorb so much product? How much product are we able to absorb? Does it differ from person to person?  

In my line of cosmeceuticals, we also advocate layering. Certain active ingredients are better delivered in a serum rather than lotion/cream as it is more effective. As long as one is applying products that are accurately formulated with evidence-based science such as in a dermatologist tested line, the active ingredients will be delivered to the skin and the user can enjoy its therapeutic benefit.

Instead of relying on ‘waiting time’, users can focus on how to enhance absorption of their product. A tip I tell my patients often is to apply skincare right after a shower, when the skin is slightly damp as it helps to enhance the skin’s ability to absorb the product.

Also, rather than considering the amount of product our skin is able to absorb, the more relevant question is to consider the environmental humidity and the formulation of product (cream/serum/ointment). The absorption of product is subjective on the environmental humidity.

Someone who applies an ointment will receive the therapeutic benefit of the medication but will not feel the product is being absorbed due to the greasy layer that is left on the skin. Consider again someone who applies a serum that contains nothing but the simplest of moisturizers, say glycerin. The user will feel this serum is very well-absorbed by the skin simply because it evaporates into the air.

3. What are the key steps/products/and or habits one should have to maintain a good complexion?

I always advocate proper skin cleansing. Most women do wear makeup. Yet, many makeup removers contain harsh astringents that can disrupt the skin barrier. Leaving behind makeup residue is also not desirable as it can cause bacteria and grime to build up, especially in our humid climate. For this reason, I always advocate the double cleansing method, such as with the Milk Cleanser and Honey Cleanser, for a thorough cleanse.

The second thing I would advocate is the use of cosmeceutical serums. The two must-have serums are Hyaluronic Acid serum and a stabilised Vitamin C serum. Hyaluronic acid helps the skin to retain moisture whilst Vitamin C is an essential antioxidant that helps to fight free radical damage.

One should also never forget sun protection. Your sunscreen should have UVA/B filters, an SPF of 30 to 50, and broad-spectrum protection. Above all that, a good sunscreen should contain antioxidants too. Another key thing is the amount of sunscreen applied, as people often apply too little sunblock needed. Reapplication every 3 to 4 hours is also advocated, especially when one is outdoors.

4. Do you feel that there are any skincare hacks out there that actually work?

Skincare ‘hacks’ can be dangerous as the skin is our largest organ and should be respected. There are no shortcuts to maintaining the health of your skin. When you visit a dermatologist, we often share with you the use of cosmeceuticals and retinoids for anti-ageing. Cosmetic procedures such as lasers are also available to help reverse effects of skin ageing.

A tip that everyone can abide by is to have a good diet rich in antioxidants, adopt a healthy lifestyle that has a sufficient amount of physical activity and to get adequate sleep every night.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Is It Bad to Pick on Your Acne?

November 4, 2018

Anyone who has survived adolescence knows the feeling of seeing an ugly head of pus on the face and having the urge to press it out. Despite many commonly known warnings about the evils that befall those that pop pimples (the pimples will spread, grow infected and/or scar), few resist.

However, there are cases in which this behavior can become extreme. Such behavior becomes a condition called excoriation disorder (also known as dermatillomania, acne excoriée, neurotic excoriation, or psychogenic excoriation) when it is repetitive and intentionally self-harming.

Characteristics of excoriation disorder

Skin-picking is quite common and may occur at any age. It typically begins in adolescence as it coincides with the onset of puberty. Patients suffering from acne or eczema are more likely to pick their skin.

What distinguishes excoriation disorder from normal skin picking is that this behavior is self-injurious and involves repetitive scratching or picking at healthy skin, minor skin irregularities or general skin-picking automatically without realizing it. The behavior also results in tissue damage.

Sufferers of this disorder may skin-pick any area of the body and usually do so in multiple places. The most common areas are the face, followed by the hands, fingers, arms or legs. Acne, papules, scabs, scars, calluses and insect bites are also sometimes excoriation sites.

While potential skin-picking triggers may vary across individuals, common ones include emotions such as stress, anger, and anxiety. Skin-picking is often common during sedentary activities as well such as watching television and reading, boredom and feeling tired.

Excessive picking can result in tissue damage and lead to medical complications such as localized infections. Such behavior often begins with the onset of a dermatological condition like acne, and often worsens conditions by preventing wounds from healing properly.

Psychological aspect of the disorder

The behavior associated with skin picking shares similar symptoms with obsessive-compulsive disorder (OCD) and impulse control disorder. Features that resemble OCD include obsessions about an irregularity on the skin or preoccupation with having smooth skin and excoriating in response to the thoughts. Individuals who pick their skin may also experience mild to moderate levels of depression and/or anxiety.

Through the experience of picking, sufferers may feel tension prior to excoriating and relief or pleasure during or afterwards. However, any positive feelings are unfortunately transient and give way to the urge to pick again.

Treatment

Individuals who skin pick rarely seek dermatological or psychiatric treatment for their condition; they are either embarrassed or believe that the condition is untreatable.

Instead, some patients may avoid social activities as it may expose their scars or injuries. Others resort to cosmetics, clothing and/or bandages to camouflage their scars.

However, there are other ways out. For excoriation disorder, both pharmacological and nonpharmacological treatments can help.

Behavioural interventions

Cognitive-behavioral therapy and habit reversal therapy can be powerful interventions for excoriation disorder sufferers. Cognitive-behavioral therapy involves psychoeducation, cognitive restructuring and an emphasis on relapse prevention.

Habit reversal therapy involves self-monitoring and substituting skin-picking with an incompatible action. For examples, patients can be advised to clench their fists whenever they feel the urge to skin pick. Another example is to introduce a new behavioural sequence that ends with a harmless action: the hand approaches the face to pick the skin but then consciously deviates to a different location such as the ear.

Pharmacotherapy treatments

Research on the use of medications for excoriation disorder is currently limited. Individuals who suffer from skin picking should receive a thorough physical examination before going on any medication.

Having said that, many individuals can benefit from drug interventions. Pharmacological agents used to treat excoriation disorder include:

Selective serotonin reuptake inhibitors

It is widely believed that imbalanced or low serotonin levels contribute to depression, anxiety disorders and some personality disorders. Better regulating serotonin is believed to help improve the brain function and thereby reduce the urge to skin-pick. Common drugs that increase levels of serotonin to the brain include clomipramine, fluoxetine and sertraline.

Opioid antagonists

Like serotonin, people with low dopamine may exhibit more depression, anxiety, poor outlook, addiction and self-harming behavior. Opioid antagonists (naltrexone, nalmefene) increase the dopamine levels in our body and help diminish the urge to pick.

Glutamatergic agents

Examples include N-acetyl cysteine (NAC) and riluzole. Skin picking, along with other compulsive and habitual disorders, is said to arise from defective signalling of a substance called glutamate. With glutamatergic agents such as NAC, it helps to increase levels of glutamate in the brain, ensuring signalling functions normally again, reducing the urge to pick on skin.

When to visit a dermatologist

When picking on acne becomes serious, such as causing frequent infections or severe scarring, patients should seek help and visit a dermatologist. While skin picking is rather common, patients should take note if the intensity and frequency of such behaviour increases over time. Skin picking can inflict severe tissue damage, and may require a long period of time for scars to heal. A dermatologist will be able to provide professional treatment and advice before the condition worsens.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

Stressing Out Can Aggravate Your Acne – Here’s How

October 22, 2018

Any acne google search will reveal links between acne breakouts and a variety of factors including cosmetics, spicy food, sunlight, chocolate, and even sweat. However, one less tangible factor that is often included but rarely explained is stress.

Stress is truly a significant factor in acne. While it is unlikely to cause acne alone, it can trigger flares and aggravate the condition by causing excessive oil production and delaying the wound recovery time of acne.

Stress induces excessive oil production

During periods of high stress, the hypothalamic-pituitary-adrenal (HPA) axis is activated and produces hormones. The HPA axis is the interaction between our body’s central nervous system (brain) and the endocrine system (hormonal-related).

The HPA releases androgens and corticotropin-releasing hormones (CRHs) in response to stress. CRHs bind to the receptors on our oil glands and accelerate lipid synthesis. CRHs also activates the testosterone in our body, which further enhances lipid production.

When the body experiences stress, neuropeptides are also released. Neuropeptides are small proteins found in the brain that are engaged in the functions of signalling and communication. Neuropeptides can also influence hormones. In particular, a neuropeptide called Substance P can stimulate the growth in the number and size of oil glands, which contributes to acne.

Stress delays wound recovery

Individuals with high levels of perceived psychological stress have shown significantly delayed recovery rates of the skin barrier. In other words, stress slows down the body’s ability to heal wounds, which can be a factor in slowing the repair of acne injuries.

Stress also triggers the increased level of the hormones glucocorticoids and catecholamines, which can adversely influence the healing process.

Glucocorticoids reduce the number of cytokines at the site of injury. Cytokines are essential in the early stage of wound healing as they protect against infection and prepare the injured site for repair by sending signals for phagocytes. Phagocytes kill and digest unwanted microorganisms. The later stages of wound repair are thus delayed with lower level of cytokines, meaning more time is required for acne to heal.

Further, catecholamines regulate a range of immune functions such as cell proliferation, production of cytokines (essential in wound-healing process) and antibodies. Elevated catecholamine levels during times of stress can inhibit the production of cytokines or suppress the body’s natural immune response to attacks.

Stress promotes habits that aggravate acne

The stresses of daily life may encourage individuals to pick at or scratch their skin. Such habits cause further inflammation, scarring and hyperpigmentation.

Stressed individuals are also more likely to have unhealthy habits, such as poor sleep patterns, imbalanced nutrition, and excessive consumption of alcohol. Stressed-out individuals can, at times, overeat in the face of chronic stress or increase their intake of calorie-rich food to calm the nerves. Comfort foods such as ice cream or cake can help to tone down the body’s stress responses but trigger acne or inflammation.

Finally, stress can cause people to neglect good self-care, including maintaining a usual skincare routine.

How to lessen the impact stress has on your skin?

Physical exercise can alleviate stress and regulate the production of stress-related hormones. Patients suffering from acne may be tempted to steer from exercise due to the discomfort from sweat, but exercising can provide important benefits to your skin. Just shower immediately after exercising and use a gentle moisturizer to keep your skin hydrated.

Experiment with other stress-reduction techniques as well such as meditation, yoga or reading a good book. If a stressful event is around the corner, be sure to get sufficient sleep and consume proper meals to eliminate other potential triggers that can aggravate your acne.

In addition to managing your stress-levels, consider visiting a dermatologist. Acne is treatable with the help of an accredited dermatologist, so it is worthwhile to seek professional advice.

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

—–
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

What You Need to Know About Dry Skin

September 25, 2018

Dry skin (medically known as xerosis) usually appears rough, scaly and even itchy. Xerosis can be caused by factors ranging from cold weather to frequent showering, and is also a common symptom of several chronic skin diseases. While xerosis is not a critical condition, it can cause significant discomfort, affect one’s appearance, and accelerate skin’s aging.

So what causes xerosis and how can it be managed?

What is dry skin?

In normal skin, lipids and natural moisturizing factors (NMFs) are needed to maintain barrier function and optimal skin hydration. NMFs attract water molecules while lipids controls the amount of skin that evaporates from the skin surface.

NMFs keep the skin hydrated by binding to water and holding onto it, preventing excessive water loss as the skin cells have sufficient hydration to remain turgid. An effective skin barrier keeps the skin’s water content at a healthy level of 15 to 20 per cent.

Dry or dehydrated skin has reduced NMF levels which compromises the skin’s ability to retain water. As a result, moisture is lost much faster than replenished. When the skin’s water content falls below 10 percent, visible scales form and the skin starts to have a rough dry appearance. Individuals with dry skin can also often notice cracks or experience flaking.

The precise organisation of lipids are important as it determines the amount of water that can be trapped in the skin. In healthy skin, sufficient lipids are present to keep Transepidermal Water Loss (TEWL) values low, as less water is lost to the surroundings.

What causes dry skin?

Dry skin arises largely due to abnormal epidermal differentiation.

The epidermis is produced by cells that divide and proliferate in the deeper skin layers before travelling towards the skin surface. At the surface, skin cells mature, flatten and die. These dead skin cells are sealed together with fatty lipids to form a continuous skin barrier. This process is termed epidermal differentiation.

A disruption in the skin barrier can cause epidermal differentiation to become abnormal and the skin barrier function to become damaged. This disruption can happen for a variety of reasons:

  • Genetics: Dry skin is a major manifestation of several skin diseases such as atopic dermatitis (eczema) or psoriasis (itch) which has a genetic component.
  • Aging: In aging skin, a marked decline in lipid and water content ultimately impairs skin barrier function. A decline in filaggrin, a protein that produces NMFs, is also observed as we age, leading to diminished NMF levels
  • Low humidity: Low humidity causes less amino acids and filaggrin to be produced in the stratum corneum, as they require optimal humidity to function well. As a result, NMF levels are lower.
  • For example cold dry weather often causes ‘winter itch’ where skin is rough, red and irritated. Winter xerosis is aggravated by the presence of hot, dry air from modern central heating, causing impaired desquamation and scaling. You may also experience dry skin in hot weather if most of your time is spend in air-conditioned surroundings.
  • Sun exposure: Ultraviolet (UV) radiation from the sun can also affect normal epidermal proliferation by compromising the skin barrier’s function and resulting in greater water loss to the environment.
  • Frequent bathing: Such habits, especially with hot water, can further irritate the skin and damage the skin barrier function. Hot water should be avoided, and a shorter bath duration is recommended.
  • Other environmental factors: Chemical agents such as soaps, lotions, perfumes or detergents can also contribute to xerosis.

How to replace skin’s water content

We often see buzz about the importance of hydrating our skin, but how exactly do we ensure our skin is hydrated enough?

Currently, the best approach to treating dry skin is to restore normal abnormal epidermal differentiation by using ingredients that can easily penetrate the skin and prompt it to produce healthy levels of lipids again. Effective ingredients are lipids, humectants and antipruritic agents:

Other types of lipids that are not found naturally in our body can also be beneficial by serving as an occlusive layer, such as petrolatum. They prevent water loss to the surroundings by trapping it. A common example of petrolatum is Vaseline.

Humectants, such as glycerol, lactic acid, hyaluronic acid and urea, attract and retain water in the skin. Glycerol or urea can improve skin elasticity and barrier function, and compensate for the lower levels of NMF in dry skin. Hyaluronic acid is a humectant capable of holding up to 1000 times their own weight in water, locking in moisture for the skin.

Antipruritic agents block histamine release to interfere with the itch sensation and break the itch-scratch cycle.

An ideal ingredient should prompt the skin to restore epidermal differentiation, reduce excessive water loss and itching. Multi-CERAM Moisturizer is dermatologist-formulated to treat eczema and dry skin with pharmaceutical grade ingredients. An ultra-intensive formulation, this moisturizer relies on ceramides, plant seed oils, sodium hyaluronate and glycerin to repair the skin barrier and restore skin moisture.

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

—–

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

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Sleep Deprivation and The Skin

September 6, 2018

 

Have you ever woken up groggy from less than six hours sleep and felt your skin is looking unwell? Ever wonder why?

How lack of sleep impacts your skin

Dehydrates the skin

The skin barrier works as a shield against environmental threats and prevents excessive water loss. When you don’t get enough sleep, your skin barrier can weaken and your levels of transepidermal water loss (TEWL) can be higher. TEWL is the amount of water lost to external environments via evaporation. Increased water loss dries out our skin, which can cause skin scaling and increased desquamation or the shedding of the skin’s outermost cells.

Imagining your skin cells as bricks and the lipids/fats in between as mortar, dehydrated skin has a more ‘disorganised’ brick and mortar structure; this causes more light to bounce off the surface. In comparison, hydrated skin has an ‘organised’ structure, allowing more light to penetrate the skin and giving off a translucent appearance.

Your pores can also appear larger with lack of sleep. While you will not have an increased number of pores if you sleep less, increased skin scaling causes a coarser skin texture and can make pores appear enlarged.

Reduces immune system function

Sleep also plays a role in restoring the body’s immune system function. Any change in the immune response may affect collagen production and lead to impaired skin integrity.

Inflames the skin

Sleep deprivation also triggers increased levels of inflammatory cytokines, which in turn modify the structures of collagen molecules. Collagen gives the skin its elasticity and flexibility. Assembling into a dense network of fibres, collagen holds the dermis layer together and protects the skin from external sources such as bacterial agents or ultraviolet radiation. Lower collagen levels manifest as thinner and wrinkled skin.

Ages your skin

Poor sleepers may experience uneven pigmentation, fine wrinkling, skin laxity, loss of facial fat and benign skin growths.

Chronic poor quality of sleep is also associated with accelerated intrinsic ageing. Intrinsic ageing results from factors inherent in chronological ageing such as metabolic oxidative stress.

Stress is also a likely factor inherent in the lack of sleep. In response to stress, your brain releases an excess of stress hormones called glucocorticoids. This hormone causes negative effects on nearly all body tissues and accelerates the aging process. Glucocorticoids also inhibit lipid production, which eventually weakens skin integrity.

Regain your skin’s well-rested radiance

If you covet a seemingly translucent, pore-less look, it’s no surprise that we suggest you catch up on your sleep.

However, while you’re trying to change your sleep habits, providing rich hydration to your skin can also help compensate for some of your sleep loss. Apart from a moisturizer, a good boost of hydration also can come from an effective hyaluronic acid serum.


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

—–

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

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

 

 

 

Understanding Enlarged Pores & How to Treat Them

August 24, 2018

Enlarged facial pores are a cosmetic concern that plague individuals with oily skin types. Even though this condition besets a majority of individuals, especially those who live in humid climates, treatment options for large pores are elusive or unreliable.

Large pores may not be health-threatening or a disease symptom, but they can be the reason why we refuse to get up close with a mirror. A skin pore usually refers to an enlarged opening of pilosebaceous follicles. The pilosebaceous unit has the hair follicle, the sebaceous (oil) gland and skin muscles.

The mechanism by which visible facial pores occur remains unclear, but three possible causes have emerged: loss of skin elasticity, hair follicle size and excessive sebum production. Other potential factors that can influence this skin condition include genetics, chronic photodamageacne and vitamin A deficiency.

Excessive sebum production

Oily skin results from excess production of sebum by the oil glands, which fills the follicles and leaks onto the skin surface. During the menstrual cycle, sebum production levels are higher. Pore size is also larger during the ovulation phase. A surge of three hormones during the ovulation phase triggers the oil glands – luteinizing hormone, follicle-stimulating hormone and progesterone.

Severe acne

Previous cases of inflamed acne can destroy hair structures and leave them susceptible to influence by androgenic stimulation. Androgen is a hormone that exerts a major effect on sebocyte (cells found in oil glands) proliferation and sebum secretion. This means acne inflammation may cause you to be more prone to androgen activity, bringing about change in follicle volume and size.

Loss of skin elasticity

A main feature of skin’s ageing process is the loss of elasticity. Our skin’s collagen and elastin framework that supports skin resilience become less efficient due to ageing and chronic photodamage. A protein, crucial for elastic fiber assembly, called microfibril-associated glycoprotein-1 is also produced less over time. Without it, tissues around follicles provide less structural support and there is a loss of thickness in the skin dermal layer. Such changes lead to skin fragility, sagging and enlarged pores.

Hair thickness

The volume of our pores is dependent on the size of the hair follicle. There are dermal papilla cells in our hair follicles that contain androgen receptors. Our pore size is affected by the androgen activity in hair follicles.

Treatment options

Topical therapies

  • Topical retinoids are often considered as first-line therapies to reverse collagen and elastin-associated changes caused by aging and photodamage. Retinoids are vitamin A derivatives and were previously used as anti-ageing therapies before the efficacy for improving the appearance of facial pores were discovered.

Commonly used retinoids are tretinoin, isotretinoin and tazarotene for skin rejuvenation, regulating sebum production, and the reduction of wrinkles and large facial pores. Isotretinoin is the most potent inhibitor of sebum production.

Patients are advised to consult their dermatologist before any use of retinoids as side effects – such as inflammation, burning, redness or dry skin – are common.

  • Niacinamideis another cosmetic ingredient that can reduce sebum production.

 

  • Chemical peelscan also help rejuvenate the skin and improve the appearance of large pores. At the epidermal or dermal level, the application of acids induces the temporary breakdown and regeneration of healthier cells. Glycolic acid, lactic acid and salicylic acid are commonly used for chemical peels.

Oral therapy

Common oral therapies targeted at enlarged pores are anti-androgens, such as oral contraceptives, spironolactone and cyproterone acetate. They modulate sebum levels by blocking androgen action.

Lasers and ultrasound devices

Advanced devices have been developed to deliver targeted thermal or ultrasound energy to the skin. Such therapies work by remodelling the collagen fibers near our pores for increased skin elasticity and decreased sebum production. Non-ablative lasers helps with facial pore minimalisation and improved appearance of photoaged skin.

Hair removal

Pore volume may decrease with hair removal, especially so if patients have thick and dark facial hair. Laser or intense pulsed light sources can create photothermal destruction of the hair follicles to minimise appearance of large pores.

 

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

—–

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

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

What Is A Medifacial?

August 17, 2018

 

Spa facials are now commonplace, offered everywhere from shopping malls to neighbourhood estates. While these may help you unwind,  conventional spa facials may not be able to deliver effective results to your skin, and they may even cause more harm than good.

This is because facials at conventional spas or beauty salons are unsupervised by a doctor and may cause irritation and skin sensitivity. Often they include forceful extraction of pimples, blackheads and whiteheads that not only inflame the skin and cause pain but also increase the chances of secondary infections and deep scarring. Some of our patients have even contracted viral warts from contaminated instruments used for pimple extraction.

Enter the Medifacial. Short for medical facial, it is a procedure performed at a licensed medical establishment with non-invasive dermatological procedures. It causes neither pain or scarring, and uses pharmaceutical grade solutions and serums. A form of microdermabrasion very gently exfoliates dead skin cells, and a specialized vacuum handpiece extracts blackheads and whiteheads. The procedure both removes impurities and intensely hydrates with potent serums, including antioxidants and hydroxy acids, that soothe and rejuvenate the skin.

Medifacials can be tailored to the address a patient’s individual skin concerns including:

Microdermabrasion

Microdermabrasion is a safe and painless resurfacing procedure that results in decreased levels of melanin and increased collagen density. Not to be confused with dermabrasion, it targets the epidermis – the outer skin layer – instead of the dermis which is the deeper skin layer.

In conventional dermabrasion, a handpiece sprays inert crystals onto the face – such as aluminium oxide, magnesium oxide or sodium chloride or other abrasive substances – and vacuums them off.

In a medifacial, the microdermabrasion process uses a specialized vacuum handpiece embedded with an abrasion tip that is designed to rotate and gently exfoliate the skin while concurrently applying a soothing solution. The vacuum pressure and speed is adjusted to each patient’s sensitivity and tolerance to maintain as comfortable a procedure as possible.

The mechanism of abrasion and suction gently exfoliates the outer skin layers to remove dead skin cells. With a superficial depth of skin removal, microdermabrasion helps improve the conditions of skin surface such as scarring or photodamaged skin.

By producing controlled superficial trauma, the procedure also promotes facial rejuvenation. Repetitive injury to the epidermis can cause gradual improvement as it stimulates collagen production and fibroblast proliferation. (Fibroblast are cells found in connective tissues that produce collagen and other fibres.) This allows new collagen deposition in the dermis layer.

Mild erythema (redness) may occur at the end of a microdermabrasion treatment but will subside within hours. Microdermabrasion should not be confused with dermabrasion.

Extraction

If you have self-extracted comedones at home, you will likely be aware of the excessive scarring and breakouts that often follow. It is likely that the right pressure or angle is not applied during home extractions, disrupting the integrity of follicles and causing inflammation. Not using medically sterilised equipment can also lead to infections, exacerbating the condition.

In a dermatologist’s office, extraction is safely and easily performed and rarely leaves residual scarring. An accredited dermatologist can first assess between comedones that are suitable for extraction versus those that are not. After prepping the skin with alcohol, a tiny prick incision is made with a surgical blade to lightly pierce the epidermis. Light or medium pressure is applied directly on top of the comedo until all of the contents are removed. The treatment may cause minor discomfort but also help achieve an almost instant improvement in skin appearance.

In a medifacial, the microdermasion and vacuum processes, together with specialized and hydrating solutions, “loosen” and extract blackheads, whiteheads, excess sebum, keratin and other impurities. The specialized medifacial handpiece creates a strong vacuum with precision control that targets comedones from enlarged pores and removes the associated waste from the epidermis. It avoids collateral damage to the surrounding tissue and is completely painless.

Application of potent serums

In a medifacial, topical application of various serums and solutions is carried out continuously using the specialized treatment handpiece. The serums contain a potent mix of sodium hyaluronate, antioxidants and hydroxy acids that are applied at different stages of treatment to achieve a variety of effects such as skin hydration, lightening of pigmentation and softening of the skin for exfoliation and extraction.

Antioxidants are substances that protect our body and skin from oxidative damage. With their highly protective and rejuvenating properties, they are a mainstay in skincare formulations and key ingredients in a medifacial treatment. Antioxidants used include vitamin E, vitamin C, and rosa damascena (or rose water) that have brightening effects to help skin achieve a radiant glow.

Larecea Extract™ is a dermatologist-formulated combination of bioactive antioxidants derived from brassica olereacea (cruciferous family plants)  and potent regenerative amino acids. It is a trademarked ingredient in the Dr.TWL Dermaceuticals’ cosmeceutical line.

Hydroxy acids help remove the top layer (epidermis) of dead skin cells. They do this by dissolving the ‘cement’ between skin cells, revealing smoother and firmer skin. Hydroxy acids used in a medifacial treatment include salicylic acid and lactic acids. Lactic

So the next time you step out of a facial salon with unsatisfying results, do consider a medifacial instead. Conducted under the supervision of an accredited dermatologist, a medifacial clears up the skin and helps restore its brightness through microdermabrasion, extractions, and an infusion of potent nutrient serums that hydrate and rejuvenate. It also has zero downtime, and only requires liberal sunscreen application to protect against ultraviolet radiation afterwards.

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

—–

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

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

 

 

 

 

 

 

 

 

 

 

A Dermatologist Explains Eczema & Its Treatment

August 4, 2018

 

Eczema is one of the most common skin disorders in infants and children. Apart from dealing with the medical aspect of the disease, affected patients may experience significant psychosocial effects.

Also termed as atopic dermatitis, it is very common in children but may occur at any age.

How does atopic dermatitis arise?

Atopic dermatitis is caused by a complex interaction of genetic and environmental factors including:

  • Skin barrier dysfunction
  • Genetic predisposition
  • Immune dysfunction

The role of genetics in eczema

Most patients with eczema have a lower amount of filaggrin in the epidermal skin layer., due to mutations in the filaggrin gene. Filaggrin is a structural protein that plays a vital role in normal barrier structure and function. A lack of filaggrin contributes to the development of eczema in several ways.

Filaggrin breaks down into amino acids and protein derivative to form natural moisturizing factors (NMFs) in the outer skin layers. NMFs provide moisture retention, maintain the acidic pH and buffering capacity of the skin barrier and prevent an overgrowth of bacteria.

Inadequate filaggrin would mean a reduced ability to maintain hydration, which can cause xerosis (dry skin), pruritus (itching) and subsequently, eczema. A dysfunction in skin barrier may also allow entry of allergens, leading to an inflammatory response thus causing eczema.

Having an impaired barrier function also causes colonisation of a bacterium called Staphylococcus aureus. Scratching disrupts the skin barrier, thus also leads to the bacteria adhering to the outer skin layers.

The extent of bacterial colonization is associated with the severity of eczema.

How immune dysfunction contributes to eczema

Apart from genetic factors, defects in immune pathways are usually observed in patients with eczema. They tend to have high levels Th-2 cells, which contribute to a defective skin barrier. Th-2 cells play an important role in the immune system. A poor skin barrier may mean water is lost from the skin and also allows the penetration of irritants (soap, dirt, detergent) and allergens (pollens, microbes, dust-mites).

There is also an overproduction of cytokines in the body. Cytokines are cell signalling molecules that aid in cell to cell communication. It regulates the movement of cells towards sites of inflammation and infection.

The excessive release of cytokines initiates new responses that eventually leads to inflammation, causing the red, itchy and painful symptoms common in eczema.

Patients also have high levels of an antibody called immunoglobulin E (IgE), which puts them at disposition for hypersensitivity to environmental allergens. Hypersensitivity is when the immune system produces undesirable or detrimental reactions, such as attacking the body’s own cells or tissues instead of protecting them. With elevated IgE levels, it would mean exposure to a certain allergen can causes the immune system to attack the body’s own tissues and therefore skin inflammation that may be observed with eczema patients.

How to treat eczema?

When it comes to treatment, there are 3 main components that target a specific manifestation of the disease. As a chronic, relapsing condition that may flare up at variable intervals, a comprehensive home treatment plan is important for successful management.

Repair & Maintain Healthy Skin Barrier:

Lubrication of the skin is required to maintain skin hydration, commonly known as moisturisation. This helps to alleviate the discomfort that xerosis (dry skin) may bring about.

Patients with eczema should use moisturizers that are fragrance-free and least amount of preservatives, as these are potential irritants.

Reduce inflammation:

Topical corticosteroids are the most effective and common treatment. Corticosteroids are drugs that mimic cortisol, a hormone found in the body. They work by diminishing inflammation, itching and bacteria colonisation.

This medication can be classified according to its potency, ranging from class VII (low potency) to class I (super potent). Great care must be taken to balance the potency of drug needed for results so as to minimise potential side effects.

Side effects include:

  • Atrophy (decrease in size or wasting away of a body part/tissue)
  • Striae (stretch marks)
  • Acne
  • Telangiectasisa (small dilated blood vessels)
  • Secondary infections
  • Adrenal suppression (body produces lower levels of cortisol)

For moderate to severe eczema conditions, wet wrap therapy can be used with topical steroids and dermatologist-approved moisturisers. After the medication is applied to the affected area, it is wrapped with a few layers of wet gauze, followed by dry gauze. Such therapy reduces itching and inflammation by preventing scratching and improves penetration of corticosteroids.

Topical inhibitors of calcineurin – protein phosphatase associated with activation of the immune system, are newer forms of treatment, which are considered on areas unsuitable for topical steroids (e.g. eyelids) or if other treatment options do not yield results. For example, Pimecrolimus cream and Tacrolimus ointment are calcineurin inhibitors that have demonstrated good efficacy for eczema treatments and do not cause side effects that corticosteroids bring, but have other considerations of use that should be managed with an accredited dermatologist.

Itch control:

Antihistamines are commonly used to treat itching. Even without a significant rash, itching can be present. Oral antihistamines help to reduce the sensation of itching, ideally to decrease scratching and trauma to the skin.

Antibiotic or antifungal medicines are used to treat the infected rash, to reduce the amount of bacterium Staphylococcus aureus. Topical mupirocin is often prescribed to prevent further infection.

Taking care of the skin 

Avoid dry skin. Asian skin is more susceptible to being dry. Dry skin can cause itching and scratching. Tips to avoid dry skin:

Avoid irritants that can cause or aggravate a rash, such as perfumes, scratchy clothing or bedding and sweating.

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

—–

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

To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

 

 

error: Copyright © 2017 twlskin.com. All rights reserved.