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MOUNT ELIZABETH NOVENA SPECIALIST CENTRE
CONTACT: +65 6355 0522

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.

 

 

 

 

Everything You Need to Know About Melanin & Dark Spots

July 19, 2018

 

Melanin is the culprit behind the dark spots that give us an uneven complexion. It is a brown pigment found in the basal layer of the epidermis.

This pigment is synthesised by melanocytes. The process of melanin synthesis is termed melanogenesis. Melanocytes go through different stages of maturation, becoming more pigmented at each stage.

Certain stimulants trigger a gene to produce more of tyrosinase, a copper-containing enzyme that converts tyrosine into melanin. Stimulants that activate the melanocyte include hormones, inflammation (such as acne) and external environmental conditions (ultraviolet light that causes the production of free radicals).

One simple way to reduce melanin production is to use broad-spectrum sunscreens with zinc oxide, titanium dioxide or iron oxide. These substances help block UVA and UVB light, thus impeding the stimulation of melanocytes.

Pigmentary disorders

Common hyperpigmentation disorders that involve the darkening of an area of skin due to increased melanin include melasma, lentigo, and post-inflammatory hyperpigmentation.

Melasma is usually caused by chronic exposure to ultraviolet radiation or a spike in hormones due to pregnancy or the use of oral contraception. It can be found at the epidermisdermal layer or mixed, depending on the location of the pigment.

A lentigo is a light or dark brown area of discoloration that can range from 1mm to 1cm across, and is caused by an increased number of melanocytes. Its outline is usually discrete, but can also be irregular. Simple lentigines arise mostly during childhood on areas not exposed to the sun. Solar (or senile) lentigines are found on the backs of hands or on the face, most commonly after middle age.

Post-inflammatory hyperpigmentation (PIH) is the skin’s response to inflammatory skin disorders. Common causes are acne and atopic dermatitis. PIH is caused by the overproduction of melanin caused by skin inflammation.

Treating hyperpigmentation

Hydroquinone: For 50 years, hydroquinone has been the gold standard treatment for hyperpigmentation. This compound inhibits tyrosinase activity, thus limiting the amount of melanin to be produced. It also alters melanosome formation, possibly degrading melanocytes.

However, prolonged use of topical hydroquinone has shown to have side effects such as ochronosis and permanent depigmentation. Ochronosis is a disorder with blue-black discoloration. As such, hydroquinone is banned in cosmetic formulations and only available through a prescription that should be carefully managed by an accredited dermatologist.

Retinoids are forms of vitamin A that can treat acnephotodamage and PIH. They have various pathways that lead to skin lightening effects, such as accelerating epidermal turnover, reducing pigment transfer and slowing the production of tyrosinase.

With common side effects being erythema, skin irritation, dryness and scaling, it is recommended to use a retinoid only under the supervision of an accredited dermatologist. Corticosteroids (steroid hormones) have anti-inflammatory abilities and are often prescribed along with retinoids to prevent excess irritation.

Arbutin is a botanically derived compound found in cranberries, blueberries, wheat and pears. Though arbutin is a derivative of hydroquinoine, it has shown to be a more controlled way of inhibiting the synthesis of melanin as it does not permanently destroy melanocytes.

Kojic acid is a naturally occurring fungal substance. Its skin-lightening ability works by inhibiting the activity of tyrosinase. However, frequent use can cause side effects of contact dermatitis or erythema (redness of the skin).

Azelaic acid is known to be effective for treating PIH and acne. Azelaic acid depigments the skin in several ways. It can inhibit tyrosinase or reduce levels of abnormal melanocytes. This means that azelaic acid does not influence normal skin pigmentation but only acts on the proliferation of unwanted melanocyte activity.  Side effects are mild and only last for a short period of time. Irritation, burning sensation or mild erythema may emerge, taking 2 to 4 weeks to subside.

Niacinamide is a derivative of vitamin B3. It works by decreasing the transfer of melanosome to keratinocytes. Niacinamide is a stable ingredient as it is unaffected by light, moisture or acids. This ingredient is often incorporated into cosmeceuticals due to its safety profile.

Vitamin C or L-ascorbic acid is a naturally occurring antioxidant that helps with skin lightening. It prevents tyrosinase from converting tyrosine to melanin. Vitamin C is also favored for its anti-inflammatory and photoprotective properties. However, L-ascorbic acid is highly unstable and rapidly oxidized. It is not used in the treatment of PIH.

Stable forms of vitamin C include magnesium ascorbyl phosphate or sodium ascorbyl phosphate. For safe and effective results, consider a dermatologist-formulated serum VITA C GOLD™ Serum,a formulation tested for bio-activity in a laboratory.

As seen above, there are various treatment options to treat common hyperpigmentation disorders. Recognizing the underlying cause for pigmentation is critical for proper treatment and choosing the best-suited therapy. Visit an accredited dermatologist for effective and safe treatments catered to your condition.

© 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 the layers of your skin

July 14, 2018


Our skin is the largest organ in the body, and the most visible. Yet, few of us really understand how it works. When searching the internet for causes and treatments of our skin conditions, for example, we often come across terms like ‘epidermis’ and ‘dermis’ that are literally Greek and hard to understand.

As a result, it’s difficult to know exactly how to care for our skin. As our outer layer endures harsh external conditions such as environmental pollutants, UV rays, pressure, temperature, and others, how can we best protect and keep it in good health?

To answer this question, we need to start with a skin 101 primer.

Our epidermis

The outermost layer of the skin is known as the epidermis. It consists of four layers of closely packed cells. Skin cells found in these layers are called keratinocytes. They manufacture and store keratin which is the protein that makes up the main structure of our hair, skin and nails.

From deep to superficial, the four skin layers in the epidermis are stratum basale (deepest), stratum spinosum, stratum granulosum and stratum corneum (outermost).

In the epidermis of certain body parts with thicker skin, such as palms, soles and digits, there is an additional layer of cells called stratum lucidum. It is found wedged between the stratum corneum and the stratum granulosum.

The dermis

The dermis refers to the inner layer of skin found between the epidermis and subcutaneous (=under the skin) fat. The dermis layers are made of connective tissues, linked by interwoven fibres of collagen and elastin, packed in bundles.

Collagen takes up 70% of the weight of the dermis. Collagen fibers provides the skin with structural support and tensile strength. Collagen proteins also bind to water, keeping the skin well hydrated. Accounting for 2% of the weight of the dermis, elastin fibers allow movement and are responsible for the elasticity of the skin.

Caring for the skin we see

In the outermost layer, known as the stratum corneum, the keratinocytes are actually dead cells pushed up from deeper layers. As these cells travel to the surface, they undergo keratinization, the process whereby the contents of the cell develop tough keratin proteins. Other components such as cholesterol, ceramides and free fatty acids in the stratum corneum also work together to give a toughness to the skin that can withstand all sorts of chemical and mechanical insults.

In this way, the stratum corneum becomes a barrier that prevents dehydration of underlying tissues and serves as a mechanical protection for the more delicate layers below. It is also the layer most crucial in maintaining the skin’s moisture.

The stratum corneum layer is usually replaced with cell division and renewal in a cycle of 4 weeks.

Ageing and exposure to ultraviolet radiation can stress the skin, leading to poor skin barrier function and an increase in water loss. The barrier function can also be affected by other factors such as a deficiency in fatty acids and lipids, detergents (usually from harsh cleansers) or dehydration.

Caring for your skin then should involve a regimen of protecting it from the sun with UV protection, using cleaners and other products that do not dehydrate the skin, and maintaining the moisture in the skin through moisturizers. Cleansers, in particular, can contain harsh surfactants that emulsify to remove grease and dirt but can irritate the skin. Use a gentle cleanser with a natural emulsifier instead. For example, Dr TWL’s  Miel Honey™ Cleanser uses medical-grade honey as a natural emulsifier, leaving the skin both clean and gently moisturized.

Many cosmetic treatments work by causing a change in the epidermal layer, thereby encouraging it to renew itself faster. Procedures targeting the epidermis include some forms of chemical peelslasers, intense pulse light (IPL), microneedling or topical drugs.

Caring for the skin beneath

The dermis, the layer beneath the epidermis, gets thinner and loses its elasticity over time.

Various cosmetic treatments available often aim to restore the amount of collagen lost during the ageing process, such as medium and deep chemical peels, microneedling, microfocused ultrasound and ablative lasers. Fillers can also restore the volume of collagen in the dermis layer, correcting fine lines and wrinkles.

Lasers, IPL or resurfacing treatments can differ according to the skin layer that it targets – the epidermis or dermis layer. Non-ablative treatments focus on the dermis while leaving the epidermis intact. Ablative lasers treat both dermis and epidermis layers.

Chemical peels can reach different levels of the skin depending on the frequency, the peeling substance (typically an acid), the concentration of the substance, and skin condition of the patient. In a controlled manner, skin cells are destroyed in a chemical peel to stimulate regeneration of a smoother epidermis and new collagen in the dermis.

© 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 the Skin Barrier and Hydration

June 22, 2018

Any detailed research you may have done about the skin would have returned you with the term ‘skin barrier’, or in scientific terms the ‘stratum corneum barrier’. You may be aware of how important the skin barrier’s function can affect the condition of the skin, but how exactly does the skin barrier work?

Skin hydration and the stratum corneum barrier has been active areas of study for many years. Yet, consumers are only beginning to get their interest piqued about the skin barrier, largely due to many marketing techniques. Before you commit to any product or treatment that promises to ‘repair’ the skin barrier, have a read on what these terms and processes mean.

The stratum corneum barrier

The skin barrier prevents foreign material from entering the human body. But it does more than just that. It also prevents water loss and serves as a shield against environmental factors. The barrier works to maintain the body’s homeostasis (or stable equilibrium) level. The loss of water from the body through evaporation from the surface of the skin is common, thus a need to keep our corneocytes hydrated.

Corneocytes are the cells found in the stratum cornum layer, that is the outermost layer of the epidermis. These cells are formed through cornification, where the skin cells develop tough protective layers or structures, creating a physical barrier for the skin. When deprived of water, dry skin may be more prone to crack open at stress.

The environment’s humidity also affects the corneocytes. As the level of humidity can vary, corneocytes get their source of hydration from the body, in order to maintain equilibrium with the environment. This may explain why our skin feels drier in winter. The skin battles harsh winds, depleting the skin’s moisture layers.

Skin Hydration

Skin hydration is an important factor when considering how to attain healthy skin. We look at the stratum corneum’s water content when analyzing skin hydration, with healthy skin containing more than 10 per cent water.

A mixture of water-soluble compounds called natural moisturizing factor (NMF) have been found to affect water content levels. The arrangement of lipids (fats) in the stratum corneum is also important, as it serves as an effective barrier to the passage of water through the layer. A poor arrangement can lead to transepidermal water loss (TEWL). TEWL is essentially when water diffuses and evaporates from the skin surface. Even though this is a natural process, excess TEWL is undesirable as it can lead to many unwanted skin conditions.

TEWL and Moisturizers

TEWL has been one of the most commonly used methods in the skin care industry to measure skin hydration as it directly correlates with skin barrier dysfunction. Healthy skin would score a low TEWL value as it would mean less water loss.

In the same vein, most moisturizers are put to the test by using TEWL values. A good moisturizer should help decrease TEWL. Moisturizers have remained as a ‘staple’ in basic skincare. Yet, not many may fully understand its function, thus some are unable to choose a suitable moisturizer for their skin needs. An effective moisturizer should protect the skin by stimulating and augmenting its natural barrier function, whilst catering to the skin’s requirement for moisture. Environmental attacks on the skin are also shielded with a proper moisturizer which can slow down skin ageing.

What happens if the water content of the stratum cornum falls below a desirable level? Normal desquamation is not able to take place, that is the shedding of the outermost skin layer. With insufficient hydration, skin cells will adhere to one another and accumulate on the surface layer. Visible changes associated with this phenomenon include dryness, roughness, scaling and flaking.

Certain cosmetic ingredients have become a cult favourite in recent years by targeting the stratum cornum water content, such as glycerol (also known as glycerin) and hyaluronic acid.

Glycerol

This ingredient exists in the stratum cornum as a natural endogenous humectant. It has shown that changes in the stratum cornum’s water content correlate with the glycerol content in the layer. Such results have driven the development of glycerol-containing moisturizers. Check the ingredient list of your moisturizer, this star ingredient should appear in any effective moisturizer.

Hyaluronic acid

Though it is known as a major component of the dermis (deeper layer of the skin), hyaluronic acid is also found present in the outermost layer. It plays an important role in regulating the skin barrier function and hydration. Although the skin care industry may recognize hyaluronic acid as a powerful humectant (attracts water to hydrate the skin), this molecule also participates in cellular functions. Hyaluronic acid influences cell-cell interactions that lead to normal structure of the skin barrier.

Conclusion

Though the mechanisms for skin hydration remain complex, a simple understanding about the skin structure and function is crucial when looking for an appropriate product or treatment. With these complex terms tackled, you are now one step closer to understanding your skin and its needs. If your current skincare routine does not yield desired results, you can consider cosmeceuticals as the alternative. A combination of ‘cosmetics’ and ‘pharmaceuticals’, cosmeceuticals are products with bioactive ingredients that can bring pharmaceutical effects to the skin barrier and health.

© 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 causes our skin to age?

June 13, 2018

What causes our skin to age?

We know that ageing is a natural process that cannot be changed. Fine lines, wrinkles, sagging and dark spots are some changes in the skin as we grow older. While some of these changes are unavoidable, certain signs of ageing are actually caused by sun damage and can be avoided. Some knowledge of the mechanism of the human ageing process can allow you to be more adept at ways to slow down such effects.

The process of skin aging can be classified into 2 groups: extrinsic ageing and intrinsic ageing. The two processes are biologically different.

Extrinsic ageing

This factor includes physical, chemical or environmental factors that the skin is exposed to. A major contributor to extrinsic ageing is UV radiation. Cumulative exposure to the sun in an individual’s lifetime can add up to cause significant damage to the skin.

Other external factors are cigarette smoking, air pollution, and exposure to cold, heat, dust and smog. Our lifestyle choices can also take a toll on our skin e.g. exercise, sleeping habits, diet or stress. Varying circumstances through all these factors can cause oxidative stress. This leads to some extent of dysfunction across our cells, mitochondria, DNA and could manifest as inflammation, cellular membrane damage or even immune dysfunction for instance.

UVA and UVB radiation causes photoageing. As UVA can penetrate deeper into the skin (greater penetration depth) and generate unwanted radicals, it is said to be more responsible for photoageing. UVB rays are mostly absorbed by the outer skin layers and causes DNA damage within the outer skin cells.

Photoageing

Photoageing is a slow process resulting from chronic exposure to UV radiation. Skin type and accumulative lifetime exposure to the sun can determine the degree of photoageing. When UV light penetrates the skin, cells produce melanin to form as a protective barrier (this is also how a tan is developed!). The melanin pigment helps to reflect some of the rays. The rest of the radiation that is not reflected will be absorbed by the skin cells. This can damage the cells that function to develop tissue fibers for the skin’s structure.

In photoaged skin, the epidermis (outermost skin layer) becomes more fragile and less elastic. There is greater damage of elastic tissue and a decrease in cellularity. It can cause elastosis, where there is an overgrowth of elastic fibers. Rough spots called actinic keratoses can also be caused by excessive UV exposure, which can be precancerous skin lesions.

Antioxidant and skin ageing

UV radiation causes oxidative damage. This means it produces excessive free radicals within the skin cells. Free radicals are formed when atoms or molecules loose electrons. They are generated by our own bodies during normal metabolic process, but external sources such as from UV radiation may cause excessive amounts. Excessive free radicals can lead to human skin disorders and premature skin ageing for example. Exposure to air pollutants can also trigger the release of free radicals.

The human skin has antioxidant enzymes to help protect against free radicals, such as superoxide dismutase (SOD) and glutathione (GSH) biosynthesizing enzymes. Other antioxidant molecules you may be familiar with are vitamins A, C and E. Antioxidants protect cells by interacting with the free radicals and neutralizing them by “donating” electrons to prevent unwanted damage.

You can think of the antioxidants as the ‘good’ molecules in your fight against ageing. However, these antioxidants reduce in number over time, thus a weaker ability to combat against free radicals and against ageing. With weaker defence against free radicals, the skin begins to show signs of photoageing.

Intrinsic ageing

Intrinsic ageing can also be understood as genetically programmed ageing. Structural proteins such as collagen and elastin, a major component of the dermis, and organelles such as mitochondria are produced less over the course of time. DNA functions and repair abilities decline with time. Thinning and loss of the skin’s elasticity happens as visible manifestations of these changes. Chronologic ageing can also be caused by hormonal changes.

Preventing the ageing process

To improve skin quality, there are various treatments available.

  • Sunscreens have been long perceived as a vital prevention measure to reduce UV damage. Look for a dermatologist tested sunscreen with minimum SPF30. Apply and reapply religiously (every 3 hours for optimal protection).
  • Retinoids have shown to reverse sun damage and can improve the skin’s extracellular matrix (which provides structural and biochemical support to cells).
  • Cosmeceuticals may serve as a ready consistent supply of antioxidants
  • Dermal fillers can restore volume loss and remove skin wrinkles
  • Chemical peels use acids to regenerate and improve the appearance of aged skin

On your own, certain lifestyle habits can be changed to slow down the process of skin ageing. Adequate exercise and sleep are vital in general regulation of bodily functions which combat aging. Quitting smoking can cut out exposure to unwanted chemicals and pollutants. A diet rich in antioxidants can also be helpful. Keep hydrated and cleanse your skin regularly to remove dirt and pollutants / chemicals (which may cause oxidative stress) from the skin.

© 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 Rosacea and How to Treat It

June 11, 2018

 

If you experience persistent redness on your face, you may be suffering from rosacea. It is a common inflammatory skin condition that impacts a large portion of the fair-skinned population. Rosacea is more prevalent in women between 30 and 50 years of age, but there can be manifestations of the condition across all age groups.

Although it may be more common in people with fair skin, blue eyes and Celtic ascendance, rosacea is not uncommon in Asian populations. The itchy, stinging skin condition is often mistaken for eczema, leading to non-precise treatments that may exacerbate the condition.

Constant facial redness is the most common sign of rosacea and resembles a frequent flush or sunburn that does not go away. Such redness may be accompanied by a tingling heat or warmth that comes and goes.

 

Types of Rosacea

Rosacea can be classified into 4 clinical subtypes: erthematotelangiectatic, papulopustular, phymatous and ocular. Most subtypes have characteristics of flushing and telangiectasia, where small blood vessels are prominent and visible. Patients are often diagnosed with more than one rosacea subtype and experience increased sensitivity of the facial skin such as burning, stinging or itchy sensations.

Erythematotelangiectatic rosacea is characterised by redness and flushing in the centre of the face, with telangiectasia present in most patients. The skin may be very sensitive and swollen.Telangiectasias are visible small, broken or widened blood vessels. Erythematotelangiectatic rosacea is the most common subtype and has a tendency to flush or blush more easily than other people.

Papulopustular rosacea is marked by bumps and pimples that result from chronic inflammation. Redness is also visible in this subtype, while telangiectasias may not be as evident here. This subtype may have acne-like breakouts and oily skin, but it must be differentiated from acne as the treatment required differs.

Phymatous rosacea is uncommon in women and develops over years. Marked by thickened skin and irregular skin surface, it has a bumpy texture. This subtype is rare, as the patient often has symptoms of another rosacea subtype first. The skin may thicken on the nose, chin, forehead, cheeks and ears, and pores appear large.

Patients with ocular rosacea may feel a burning sting around the eyes and experience crusty discharge on the lashes or eyelids. For this subtype, rosacea is affecting mostly the eye. The eyes may be more sensitive to light. Eyelids can be swollen and styes can be frequent. Patients having this condition may also have a watery or bloodshot appearance and may not have their vision as well as before.

 

What causes rosacea?

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she said:  “There is an underlying genetic predisposition for patients with rosacea, individuals with a family history of rosacea are more likely to develop the condition. While studies on the cause of rosacea remain unclear, it is proposed that underlying features are inflammation and vascular reactivity, leading to erythema (redness) and presence of papules and pustules.”

Certain triggers can stimulate an immune response, such as alcohol consumption, spices, hormones, stress, UV radiation, microbes, extreme weathers, humidity and certain cosmetics.

In the pathogenesis of rosacea, it is proposed that a microbial organism called Demodex Folliculoru incites a flare by triggering an immune response in patients with rosacea. In simpler terms, patients with rosacea do not react well to certain triggers as they incite an exaggerated immune response. The immune system then releases an overproduction of factors, leading to inflammation and vascular dilation.

 

Treating rosacea

Treatment begins with a proper diagnosis, including identifying the subtype. Most therapies focus on suppressing the symptoms and targeting inflammation.

Lifestyle interventions include using high-factor sunscreens, patient education, dietary changes and avoiding irritants and triggers. Photoprotection has always been an important step, but for patients with rosacea, it becomes even more crucial as photoprotection may prevent a flare triggered by sun exposure.

A gentle skin care regimen is recommended to maintain skin hydration and barrier function. As the psychosocial impact of rosacea can greatly influence individuals, whilst cover-up or colour-correcting powders can also be recommended to mitigate the effect.

Topical treatment options to inhibit the inflammatory pathways that are involved in rosacea include azelaic acid, erythromycin and metronidazole. Depending on the severity of the condition and the patient’s skin sensitivity, the medium of the topicals may be lotion, cream, gel or foam.

Short-term oral antibacterials such as tetracyclines and macrolides may also be prescribed when topical therapies fail to control the disease. For persistent cases of rosacea, oral isotretinoin may also be required. Laser, light-based therapies and surgical interventions are also treatment options for certain patients.

 

Conclusion

Rosacea is a serious medical condition that is often underdiagnosed and undertreated, even though this condition potentially has a great psychosocial impact on the affected individual. As the common initial symptoms are often mistaken for something else,such as sunburn, rosacea may go undiagnosed for most patients.

A proper diagnosis along with precise treatments can significantly improve the patient’s quality of life. If symptoms of rosacea appear, it is recommended to consult an accredited dermatologist for advice and proper management, to prevent the condition from getting worse.

© 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 Guide to Alpha Hydroxyl Acid (AHA) Facial Treatments

May 31, 2018

 

Alpha Hydroxyl Acid (AHA) Facial Treatments

Alpha hydroxy acids (AHA) are naturally-occurring compounds possessing unparalleled benefits to the skin and extensively used in a dermatologist’s office. Most AHAs are non-toxic and are often present in food and fruits, thus also known as fruit acids.

The types of AHA used commonly for cosmetic purposes are glycolic acid and lactic acid. Glycolic acid, found in sugar cane, has the smallest molecule of all the AHAs and is the most widely used acid in skincare. Lactic acid is present in sour milk and tomato juice and can be found in our bodies as a byproduct of metabolic processes.

Certain types of AHA have lipophilic (ability to dissolve in lipids/fats) side groups in its chemical structure such as mandelic acid and benzylic acid. Such acids are more soluble in lipids over the conventional water-soluble AHAs, thus are often used for oily and acne-prone skin.

Uses as a peeling agent

AHAs are commonly used in peeling procedures as a short intense exposure to the acid produces benefits to the skin. A chemical peel is the application of one or more chemical exfoliating agents to the skin, and by exerting a controlled epidermal injury, it allows regeneration of new epidermal and dermal tissue. Such treatments are often used to treat skin disorders and conditions for aesthetic improvement.

Using controlled higher concentrations of AHAs, application to the skin for short times can achieve substantial desquamation (skin peeling). This renewal of skin cells is useful in anti-ageing, reducing hyperpigmentation and improving radiance. It is important to have a chemical peel conducted by an accredited dermatologist, to prevent uneven peeling and dermal wounding.

In contrast to other peeling agents, such as phenol or salicylic acid, most of the AHAs are nutritive and physiologic.

Pre-peeling preparation

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, to prepare the skin for a regeneration phase, pre-treatment is necessary. The cosmetic conditions most suitable for a chemical peel would be features of photo ageing, such as solar lentigines, sallowed complexions, rough and textured skin, fine lines or wrinkles, acne scarring or hyperpigmentation. Whilst most skin types can opt for an AHA chemical peel, it is imperative to first seek assessment by an accredited dermatologist who will cater the peel, such as the acid type, strength, frequency and duration, for variability of individual skin conditions. Performed properly by a trained dermatologist, risk of scarring from a chemical peel is drastically reduced. The level of expertise in administering peels ensures a good outcome.

Prior to the actual application of the chemical peel substance, the skin will need to be thoroughly cleansed to remove oil and debris before being rinsed and dried.

Treatment with Chemical Peel

The peeling agent (AHAs) will be applied on the skin using an applicator or a brush. The duration of allowing the peeling agent to be in contact with the skin varies according to the skin’s conditions as assessed by the dermatologist. With superficial peels, some sensation of heat and stinging may be experienced, before the peeling agent is neutralized (where applicable) and thoroughly cleansed off after the duration of contact recommended by the dermatologist. The chemical peel treatment is completed at our clinic with application of a hydrating Amino Acid Masque to soothe and calm the skin post-peel. Additional post peel care requires the use of sunscreens and other photoprotective agents, due to sun sensitivity post-treatment. It should be noted that regular application of sunscreen is advocated as it can reduce sun damage and aggravating of skin conditions.

How does a chemical peel work?

For superficial peels, the acid causes breakdown and decreases cohesiveness of corneocytes, that are found at the outermost part of the epidermis. Desquamation occurs, allowing renewal from lower epidermal layers. By weakening and ‘ungluing’ the cells in the inner stratum layer, it leads to uniform exfoliation of the outermost stratum layers.

With a low PH, most acid peels need to be properly neutralized to prevent acidification of the skin. To avoid burning, AHA peels are neutralized with basic salts such as sodium bicarbonate or sodium hydroxide.

A chemical peel does not compromise the barrier structure or integrity of the skin, as the mechanism of action of AHAs on the skin is a more targeted action for epidermal skin renewal.

Conclusion

As a treatment that improves skin texture and counters the effects of ageing, chemical peels continue to be relied on for various skin conditions. It is also safe for the skin and human health in general, as extensively tried and tested by dermatologist’s. A range of AHA formulations and concentrations are available for the dermatologist to administer therapy according to the patient’s requirements.

Speak to your dermatologist today for a tailored experience.

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

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

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

 

Why See a Dermatologist?

May 29, 2018

 

What is a dermatologist?

A dermatologist (skin specialist) is a qualified medical specialist who has obtained qualifications to specialise in the diagnosis, treatment and prevention of skin, nail and hair diseases. Dermatologists are trained in cosmetic skin problems and aesthetic procedures. Only doctors listed as dermatologists by the Ministry of Health are recognised dermatologists. Cosmetic lasers, treatments, botulinum toxin and filler injections were developed by dermatologists. Aesthetic doctors are not skin specialists, they are family practitioners(GPs) who need to be accredited by the Dermatological Society of Singapore to carry out these procedures. Having a diploma in dermatology (Dip Derm) or a diploma in family practice dermatology (Dip FP Dermatology) does not qualify a doctor to be a dermatologist.

— Dermatological Society of Singapore

In this article, we break down some common FAQ, tips that have helped our patients and media friends navigate their way in their skincare journey with us. We hope it can help you to make the right decision about the health of your skin.  Find an accredited dermatologist here.

 

  1.       What can a dermatologist tell you that an “aesthetic doctor” can’t about your skin?

There are a few layers to answering this question actually. Firstly, there is actually no such thing as an aesthetic doctor, either a dermatologist, plastic surgeon or a general practitioner as aesthetic medicine is not considered a medical speciality.

The public should refer to the Singapore Medical Council guidelines with regards to the “aesthetic doctor” label, which actually is not an approved qualification or title, as the practice of “aesthetic medicine” is actually the realm of specialist dermatologists and plastic surgeons. Procedures such as chemical peels and lasers, botulinum toxin and fillers re developed and used by dermatologists, but are increasingly practised by non-dermatologists such as general practitioners (GP, family practice doctors). Having a diploma in dermatology (Dip Derm) or a diploma in family practice dermatology (Dip FP Dermatology) does not qualify a doctor to be a dermatologist. In Singapore, GPs require additional Certifications of Competency (COC) to carry out such treatments in Singapore, which is administered by the Dermatological Society of Singapore.(Source: Dermatological Society of Singapore)

So the real question should be.. what a GP who offers treatment for dermatological conditions can’t tell you, compared to a dermatologist.

A dermatologist (skin specialist) is a qualified medical specialist who, through additional years of special training, has obtained qualifications to specialise in the diagnosis, treatment and prevention of skin, nail and hair diseases affecting persons of all ages. Dermatologists are also trained in cosmetic skin problems and aesthetic procedures. In Singapore, to qualify as a dermatologist, a doctor needs to obtain a post-graduate degree in general internal medicine or paediatrics which may take up to 5 years before acceptance into a full-time dermatology training programme in a recognised dermatological institute lasting 3 years. At the end of this training, the Ministry of Health certifies the doctor as a dermatologist. Only doctors listed as dermatologists by the Ministry of Health are recognised dermatologists.

Dermatologists are experts in the treatment of skin conditions such as acne, eczema, psoriasis, skin infections, skin allergy, skin cancers and hair loss. Dermatologists also treat all kinds of cosmetic problems of the skin and provide advice on skin health. Special treatments such as surgery for skin cancers and pre-cancerous skin conditions, the use of ultraviolet light therapy, laser therapy, intense pulsed light (IPL), radio-frequency therapy, botulinum toxin and filler injections and hair transplantations are also carried out by dermatologists. In fact, many cosmetic lasers and treatments were initially developed by dermatologists.

At the end of the day, be it in skin or other specialities, the public should just be discerning as to the qualifications of the doctor, and what a medical specialist accredited by the Ministry of Health is trained to do for specialised conditions, as long as they are not misled to believe that they are seeing a skin or an aesthetic specialist when they are seeing a general practitioner.

 

  1.   “Aesthetic Doctors (General practitioners) and Dermatologists – Are treatments offered the same?

The practice of medicine is really as much an art as well as a science, meaning that while many general practitioners would say they have experience treating say dermatological conditions in the family practice setting, there is a real difference in training, knowledge and experience of a dermatologist. A specialist dermatologist takes additional years (at least 5 years) and goes through specialist accreditation managing complex medical and cosmetic dermatology conditions as well as complications associated with treatment. Certainly, for straightforward cases of any medical condition, family practice doctors are able to treat but would not be able to distinguish or diagnose conditions as accurately as a specialist dermatologist.

 

  1. Tell me about an example where it mattered to see a qualified dermatologist

         A case study in point: Adult Patient with pimples

If you are an adult and still struggle with pimples, then be warned your case would not be as simple as the on-off breakouts that teenagers have, which is physiological acne. Both would respond to some degree to conventional acne medication such as topical and oral antibiotics but would have a limited effectiveness if the true underlying cause is not considered. There may be a much more serious underlying medical condition, for example.

When acne persists into adulthood, dermatologists are trained to consider and work with specialist gynaecologists to diagnose and rule out secondary factors such as Polycystic Ovarian Syndrome, which is associated with irregularities of the menstrual cycle, excess facial hair growth, weight gain as well as acne, which is actually treated most effectively with a hormonal contraceptive pill. Dermatologists would also perform adjunctive treatments like chemical peels for a quick response, to remove existing blackheads (open comedones)  and whiteheads( closed comedones) and reduce the appearance of scars. While one may wonder if the beautician or aesthetic doctor could perform the same peel, be warned that if you struggle with sensitive dry yet acne prone skin, your condition could get much worse when it is not managed by an accredited dermatologist. The choice and duration of the chemical peel (concentration, composition and source) are operator dependent.

In addition, your dermatologist may suggest that chemical peels may not be suitable for you at all if you have underlying facial eczema, and may treat your eczema at the same time as acne. Anecdotally, I have had experience with patients who attended my clinic and were purportedly recommended with “oxygen facials” by “aesthetic doctors” for their sensitive skin for years. They actually were diagnosed with facial eczema, which is a medical condition managed by dermatologists. There is no evidence for using oxygen facials or any type of “facials” to treat facial eczema and in fact, could worsen the condition. If left untreated, it could spread and lead to severe infections and scarring.

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

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

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

 

A Dermatologist’s Guide to Dermarolling

April 28, 2018

 

Derma rolling, also known as microneedling, has become popular in treating acne scars and it can be used safely in a dermatologist’s clinic by an accredited dermatologist, as a simple office-based procedure.

It is a minimally invasive procedure that uses fine needles to puncture the epidermis to create micro wounds that stimulate the release of growth factors and induce collagen production. The procedure is painful and a prescription numbing cream is used to numb the skin before the treatment. Overall, the epidermis remains relatively intact and doesn’t seem to have many side effects when performed by a trained professional and with sterilised equipment. To this date, the procedure seems to be generally safe and low-cost method of improving acne scars, however, there are insufficient studies as yet to support the use of microneedling for various conditions as an evidence-based method. Microneedling can also be used for enhanced delivery of applied medications, “transdermal delivery” of cosmeceuticals such as vitamin C and vitamin A derivatives (retinoids) but this is best used with caution. In my personal experience, it can cause irritation and there is no conclusive evidence to suggest that it is superior to an optimised topically applied cosmeceutical alone. It has also been used for the treatment of hair loss, with steroids delivered for conditions such as alopecia areata, although it is not preferred over conventional methods of steroid injections for this autoimmune condition.

It lasts 10 to 20 minutes and informed consent is obtained about the expected outcomes, delayed response, and need for multiple sessions. Dermatologists also prepare the skin preoperatively for at least a month with vitamin A and C formulations twice a day to optimise results, such as enhancing dermal collagen formation.

There has been a proliferation of ‘home-care dermarollers’, which are of shorter needle length less than 0.15 mm for improvement of skin texture such as pore size, fine lines, sebum production and delivery of anti-ageing products. Some have also been developed for coverage of larger surface areas such as legs and buttocks for stretch marks and cellulite. In my view, there is insufficient data supporting the safety and effectiveness of home care dermarollers and is not recommended. For conditions such as acne scars, it is far more effective to recommend ablative fractional resurfacing.

On a related note, dermarollers carry risks which may be far more pronounced in the at-home group such as the following:

Infection. Medical microneedles are currently made of medical-grade stainless steel presterilized by gamma irradiation and are for single use only. Home dermarollers are usually made of smaller shorter needles, for multiple uses (other than washing in hot water, but this does NOT eliminate all viruses and bacteria, including a type of tap-water tuberculosis bacteria known as atypical mycobacteria). It is hard to predict how deep a home user may end up traumatising their skin, whereas when it is performed by an accredited dermatologist, sterility of the instrument as well as proper technique is applied.

Dermarollers should NOT be used in patients with anyone with these following problems i.e. active acne, skin infection such as Herpes labialis or warts, chronic skin diseases such as eczema and psoriasis. Those with blood clotting abnormalities, or on anticoagulant therapy, chemo/radiotherapy are at high risk of bleeding and suffering rare infections using non-medical dermarollers.

Patients with keloidal tendency should also not use dermarollers.

Dermarolling may seem like a ‘less invasive’, easier or more novel option to traditional ways of treating acne scars, but it is definitely less effective than laser therapies. However, it has been used mainly in medical studies as a combination treatment with surgical/laser therapies to enhance results. It is also popular in darker skin types, as these patients can have a higher risk of developing hyperpigmentation as a side effect to ablative laser treatments, whereas microneedling does not seem to carry the same risk in such groups.

Dermarolling is only recommended when performed by an accredited dermatologist.  Even then, common side effects are redness and irritation (which usually subside within a few hours) and patients are often informed of the risks of scarring:  post-inflammatory hyperpigmentation, worsening of acne and reactivation of herpes, systemic hypersensitivity, allergic granulomatous reactions (such as sarcoidosis) and local infections following the use of a nonsterile instrument, such as home-use dermarollers. In addition, there have been reports of allergies to materials used in the needles. Improper technique, such as when performed by a non-medical professional, can result in worsened acne scars, and injury.

There is not yet clear data available to substantiate the length of time which effects of dermarolling could last. Also, depending on the severity of the condition and what dermarolling is used for, it is important to note that severe conditions such as ice pick or box car acne scars or photoaging will not have dramatic improvement effects from dermarolling alone, but will benefit from a combination of laser/injectables/cosmeceuticals with or without dermarolling. Skin healing goes through different phases and occurs differently at different ages, with individual genetic differences, which will all play a factor in determining how long and how dramatic the benefits of dermarolling and treatments in general will present.

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

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

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

A Dermatologist’s Guide to Enlarged Pores, Oily Skin and Acne in Singapore

April 13, 2018

 

One’s skin type is largely determined by the genetics of an individual.

The production of oil itself is genetically determined – if one has a family history of having oily skin, it is very likely that one would develop it as well, as this is directly linked to the production of androgens such as the male hormone testosterone at the onset of puberty which affects both males and females. Based on the proportion of patients at the clinic, there is a significant population of people with oily skin types in Singapore. This is because of overactivity of the sebaceous glands which are concentrated over the forehead nose and the chin area, but can also occur on any part of the face, as well as including the chest and back which are also the areas more acne-prone. Although further research needs to be done to prove the common belief that a humid climate like Singapore results in oily skin, what we do know is that climate changes can have an adverse impact on skin that is already diseased such as with underlying acne, facial eczema or rosacea which are the common skin conditions I see in my practice.

Problems associated with oily skin?

Acne is a major issue faced by those with oily skin. The cause of acne itself is multifactorial, involving primarily genetics which causes inflammation exacerbated by the production of oil often driven by hormonal factors, leading to the formation of whiteheads and blackheads. One of the ways of treating acne would include reducing oil production by the means of an oral medication known as isotretinoin or by physical methods, such as chemical peel microdermabrasion as well as laser treatments that will shrink the oil glands. To add clarity, while almost all acne prone patients have oily skin, this is not to say that having oily skin one definitely would suffer from acne.

Oily skin and ageing

One popular belief is that individuals with oily skin do not age as quickly. A desirable side-effect of oily skin perhaps? Or perhaps not.

Skin aging is due to a complex interplay of factors, with the key determining factor being a balance between one’s biology, influenced by genetics (have a look at how your parents are aging), as well as environmental aging, due to the exposure to ultraviolet rays, air pollutants, cigarette smoke as well as a stressful lifestyle. The key thing to note is that unhealthy skin ages poorly and much worse than healthy skin. In patients with facial eczema, for example, with dry dehydrated skin known as asteatosis, they are inherently unable to produce a fatty lipid known as ceramide, which helps to repair and restore the skin barrier. Without this, the skin is unable to protect itself from external allergens or changes in the environment and this can accelerate aging. Dehydrated skin has an unhealthy epidermis and dermis. As a result, this can accelerate aging in the form of wrinkles as well as the loss of volume.

If one has oily skin, the production of oil can form a barrier between the skin and the environment and this is a sort of protection which reduces the formation of fine lines and wrinkles or what cause free radical formation. Nevertheless, if one has an underlying skin condition such as scarred skin due to previous cystic acne, it doesn’t matter that your skin is oily, one would expect skin aging to progress faster than in a normal individual.

There is a study which shows that people with oily skin tend to look younger than their counterparts and this is well-proven in clinical practice. However, I would say that striving to have oily skin is actually not desirable, especially in a very humid climate like Singapore, as a shiny complexion could be quite embarrassing. Long-term overproduction of oil due to overactivity of the sebaceous glands can also lead to irregular skin texture and enlarged pores.

It is best to strive for healthy radiant skin that is well moisturized but not oily. There is a difference between moisturizer and oil, as I have seen many patients with nodular cystic acne and oily skin who also suffer from facial eczema which is dry dehydrated skin. Well moisturized skin is smooth and radiant, and looks healthy – a key component of the skin’s moisture is from molecules such as ceramide and hyaluronic acid which is an abundant water molecule in the second layer skin known as the dermis.

It is a myth that people with oily skin don’t really need moisturizer. In fact, you could have a lot of oil on your face and still have dehydrated skin that’s lacking in the key moisture molecules. Our patients who are on treatment for acne still use a good cosmeceutical moisturizer to lighten their scars, as well as Vitamin C and Hyaluronic acid serum that can restore the correct moisture balance in their skin to prevent excessive oil production known as reactive seborrhea. Reactive seborrhea occurs when one strips skin excessively of its natural oils causing the skin to produce even more oil.

Can someone with oily skin change to having normal skin with diligent skincare alone?

The amount of oil produced by an individual is genetically determined and influenced by the secretion of one’s hormones. It is however possible with proper long term cosmeceutical skincare, that one’s skin becomes adjusted in terms of restoring the normal moisture level.


Using improper skin care such as harsh oily-skin cleansers may strip skin completely dry and this leads to a vicious cycle known as reactive seborrhea.

The key ingredient involved in restoring skin moisture and not oil, is firstly a pure concentrated form of topical hyaluronic acid in our skin care. According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre,  “We use a 1% concentrated hyaluronic acid serum freshly-compounded for optimum absorption in a pharmaceutical setting. This is easily a hundred to a thousand times higher than the concentration available in cosmetic skin preparations boasting the same ingredients. Regular use of topical hyaluronic acid has the effect of visually filling and plumping up the dermis (the second layer of skin which tends to sag with dehydration and aging), leading to a poreless, even complexion”

In terms of cleansing, I would recommend using an antibacterial foaming cleanser. The honey cleanser is formulated to remove grime, oil, bacteria and other surface pollutants that tend to settle on the skin at the end of the day. The nature of oily skin is that it tends to be a breeding ground for bacteria as well as a certain type of yeast known as malassezia which thrives in a humid climate like Singapore. This is a non-chemical form of an antibacterial and antiseptic wash, using natural medical grade honey which helps in reducing the amount of grease on one’s face. As honey is a natural humectant, it traps moisture under the skin while cleansing. It thus helps to moisturize the skin and regulates the balance of the oils as well as health of the skin.

For a targeted approach, treating oily skin – medically known as Hyperseborrhea, a visit to a dermatologist is recommended. This would typically involve counselling on the use of appropriate cosmeceuticals as well as a retinoid which can regulate oil production. Our patients would also undergo chemical peels (glycolic, lactic and salicylic acid peels) in combination with laser treatments that can help to shrink the oil glands and reduce oil production. From then on, once the amount of oil production is reduced, it is easier to maintain with topicals alone.

A skincare regime for oily skin

There is a recipe for healthy skin in the same way one is careful to have a healthy diet and lifestyle to prevent illness, rather than change one’s diet only after one gets sick. Whether or not you have dry, oily or combination skin, there is really skincare that is suited for you and the answer lies in dermatologist-tested cosmeceutical skincare. Cosmeceuticals are researched to include potent bioactive ingredients formulated to prevent the onset of aging, as well as to deliver nutrients to your skin.

Such a skincare regimen, is likened to a healthy diet that will prevent skin problems from developing later. If you have an underlying skin condition, cosmeceutical skincare can
also reduce the severity of acne and facial eczema. So it is indeed true, at least for cosmeceutical skincare, that there is a one-size-fits-all for all types of skin, as a recommendation for the basic healthy diet of skin.

The key conundrum in skincare that has been plaguing dermatologists in the last 50 years was really that the dermatologist-tested skincare (which is compatible with aging problem skin types) we advocated for our patients did not provide additional cosmeceutical benefits. These women then went looking for over-the-counter cosmetics skincare which promised them anti-aging, but clearly not without the irritation and side effects. Then the dermatological community turned its attention to clinically proven anti-oxidants in skincare and showed that cosmeceuticals were valid and important in the treatment of aging skin to restore skin health. The advent of cosmeceuticals promises the same level of non-irritating gentle skin cleansing and moisturizing, with all the power molecules antioxidants which can lighten scars, brighten your complexion and retard aging. What’s there not to love?

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

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

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

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