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Best Dermatologist Anti-Aging Skincare Tips

September 28, 2022

Looking for anti-aging skincare tips by a dermatologist? The science behind anti-aging actually shows that well-aging is a more accurate term. Do aesthetic treatments truly lead to anti-aging? Singapore dermatologist Dr. Teo Wan Lin, published a key opinion piece in the International journal of Dermatology, “On Thoughts Emotions Facial Expressions and Aging”, with her research on the brain skin connection.

The journey of aging is a whole body experience and not isolated to external organs like the skin. Phenomena like inflammaging, cell senescence are key to understanding what happens in aging body cells. Way before we see physical changes in the skin for example, cell damage has been occurring for years. Is there a way for skin anti-aging by targeting these processes?

The following is an excerpt from Edible Beauty: Dermatologist Guide to An Anti-Aging Diet by dermatologist Dr. Teo Wan Lin. It delves into key scientific research that helps us understand the relevance of anti-aging skincare tips from the inside out – well aging. 

Edible Beauty: Dermatologist Guide to an Anti-Aging Diet

What Is The Skin Exposome Concept in Anti-Aging?

How Lifestyle Factors affect Skin Anti-Aging 

I’m sure you would have heard of how photodamage affects the aging processes of skin. What about other lifestyle factors? Being in a modern society that is fast-paced, leading a hectic lifestyle is something that all of us accept – we take it for granted that it is the way it should be. Nevertheless, being busy does not always correlate with being stressed. That, at the end of the day, is what we are concerned about when we talk about the skin aging exposome.

Lifestyle factors such as stress and lack of sleep, which leads to disruption of the circadian rhythm, can cause your body cells to enter into cell senescence much quicker than what it would have been without these factors. Environmental pollution has also been proven in studies to change the skin microbiome signature. This means that there is a difference in the type of bacteria and microorganism that lives on your skin, depending on what sort of pollutants you’re exposed to in your urban environment. 

Dermatologist Anti-aging Skincare Tip #1: Get enough sleep and also sleep at the right time! This means following sundown and sunrise patterns, which is how our bodies are coded to release hormones.

The Circadian Rhythm

One may say that having 8 hours of sleep is a luxury, but from a medical point of view, it is a necessity. Our body is designed to go through periods of activity and rest, and all that is pulsed according to the secretion of our endocrine hormones, and regulated by the hypothalamic-pituitary axis (HPA). Disruptions in the HPA axis have been shown to directly impact the process of inflammaging. The concept of inflammaging is first examined in our research of other organ cells, and it is described as a chronic or baseline degenerative state which promotes inflammation. 

Inflammaging & Cell Immunosenescence

Application of botanical-based cosmeceuticals helps in the rejuvenation of the skin as its antioxidant effects can counteract free radical formation. Free radical formation is the result of environmental assaults in addition to our inability to repair damaged DNA as we grow older. 

It is important to understand that nutraceuticals are based on sound science that addresses the heart of anti-aging – immunosenescence. The concept of senescence is best understood as a gradual falling asleep of your cells. Our body is able to maintain optimal functions with regard to the skin, which is often a marker of what is happening inside the body.

For example, it can be the function of the immune cells which are declining as you grow older. That is the reason for developing pigmentation, reduced skin immunity, and subsequently, the development of skin cancers which is directly proportional to advancing age. Nevertheless, beyond that, it is important that we also appreciate the cumulative systemic decline of our body functions and organs due to inflammaging, which will undoubtedly affect the health and consequently, the appearance of our skin. 

Dermatologist Anti-aging Skincare Tip #2 : Aging truly occurs from the inside out. The brain skin connection is a clear example of how stress and your mood directly affects your physical appearance.  Beyond that, lifestyle factors such as diet and exercise affect a process known as inflammaging.

Let’s Define Aging According to Science

What is cellular senescence? 

It is a complex stress response that leaves cells incapable of cell division. Senescent cells increase with age in the skin, and can alter tissue homeostasis and promote age-related diseases. The inability of senescent cells to regenerate can lead to impaired wound healing, causing prolonged or permanent tissue damage with age.

Is cellular senescence beneficial or detrimental for our skin? 

Cellular senescence can be both beneficial and detrimental during skin aging and wound healing, and contrasting cell autonomous and non-cell autonomous effects of senescent cells can depend on the physiological context. On the one hand, senescent cells can accelerate aging phenotypes through the loss of tissue homeostasis by promoting chronic inflammation, persistent degradation of the extracellular matrix, and stem cell exhaustion. On the other hand, senescent cells can also have essential roles during wound healing by limiting excessive proliferation and fibrosis and promoting the formation of granulation tissue.

What is the current evidence behind interventions for cellular senescence?

Injectables such as botox and fillers do not prevent cellular senescence. Toxins work via temporarily paralyzing or relaxing the facial musclesso that lines associated with facial expressions can be smoothed out with “disuse”. Fillers restore facial volume loss due to age-related subcutaneous fat atrophy. Most fillers are hyaluronic acid-based formulas that are completely reabsorbed into tissues after 6 months, necessitating a “refill”.

Lifestyle interventions described in this book such as the incorporation of a nutraceutical diet are evidence-based in targeting the cellular senescence pathway in the aging process. Not only does this improve the health of the skin, but of the entire body’s functions and leads to greater psychosocial wellness as well. 

Dermatologist Anti-aging Skincare Tip #3: Aesthetic treatments may be marketed as the holy grail of looking good. However the science of aging tells us otherwise. Aesthetic treatments can accompany a whole well aging lifestyle. Also understand how aesthetic treatments work so you can choose wisely. 

The Conundrum of Aesthetic Treatments in Anti-Aging

No, aesthetic treatments do not truly bring about ‘anti-aging’

In cosmetic dermatology, so much focus has been on aesthetic interventions like fillers, toxins, lasers and peels, all of which I also offer in my practice. But beyond that, I think it is very important to address the fact that to the trained eye, and to somebody who is in the medical field, there are two important aspects to consider when we are performing a cosmetic dermatology treatment. 

The first is that you are correcting what has already happened. For example, in the case of reversing wrinkles, you are injecting a toxin to relax the muscles, hence, you are not able to use the muscles for some time. Muscles will atrophy in the same way disuse of your body muscles will lead to it shrinking, which consequently, will translate out to smoothing out of forehead wrinkles. However, this does not address the root of the wrinkle formation itself – muscle overactivity that comes with advancing age, and the inability of the dermis to produce sufficient collagen and elastin to minimize the surface wrinkles.

We are always able to animate our faces from the time we are a child until we are old. The difference is, when we are children, we do not have wrinkles on our faces because we have a plump dermis. The structure of the skin helps to retain a certain smoothness and contour to hide the muscle activity. However, with age, you get thinning of the dermis and epidermis, and that is when you start to see superficial and deeper wrinkles. 

The second aspect of cosmetic dermatology interventions is that it is possible to see the effects of these external interventions. For example, it is not difficult for a trained eye to pick up if somebody has had fillers. Is it possible that fillers or toxins are injected in an almost imperceptible way? Yes, but a lot of what is being performed, especially in the field of aesthetic treatments, are performed by non-dermatologists. These treatments are typically interventions around the nose and lip area, and are meant to create a dramatic improvement or change the appearance of one’s skin. 

Further considerations in a post-COVID world

When the Moderna COVID-19 vaccine was rolled out in December 2020, it was reported to have caused swelling and inflammation in patients with cosmetic facial fillers. The FDA advisory committee reviewing the new Moderna vaccine stated this very specific side effect which has involved several trial participants who have had cosmetic facial fillers.

Aesthetic treatments like dermal fillers fall under the category of injectables and are used primarily for facial augmentation. Filling agents are meant to restore fullness in one’s appearance that could be lost over time with age as a result of subcutaneous fat atrophy, or a side effect of certain medications such as retroviral medications.

The ideal facial filler should have the following properties. First of all, it should have physiologic compatibility with your body – meaning that it readily incorporates itself with your tissues. It should be free of complications or side effects, and ideally, will not degrade with time. The commonest type of facial filler used in most cosmetic practices is hyaluronic acid-based. These fillers are fully reabsorbed into the tissues after 6 months and the cosmetic effects are lost. 

Fillers and vaccines

Some of the known side effects from using these facial fillers as injectables would be tenderness, bleeding, bruising. When lumps and nodules occur, this can be because of inappropriate injection techniques, or accumulation of the filler in a more superficial location than expected. Now, what is happening with the Moderna vaccine and this painful facial swelling that occurs where facial fillers have been previously injected, is best thought of as an allergic reaction, or an immunological reaction.

The process of injecting a vaccine essentially causes the immune system to be stimulated. That in turn results in the body recognizing that the facial filler is not a part of the body tissues, and the body starts to mount an immunological reaction against it.

Based on the cases that were reported to the FDA, the profile of these patients essentially had swelling and inflammation in the area that was administered the filler. A couple of the patients had the cheek filler 6 months prior to the vaccine, and one patient had lip filler done just 2 days after the vaccine. In all of these scenarios, the patients were treated with oral steroids and antihistamines, in which it was observed that their reaction resolved. 

Typically it is considered a medical event due to an immune system response to a perceived allergen. It is not likely that these individuals would have developed this response had they not been given the vaccine. The reason is that facial fillers are medically engineered to be biocompatible, but in the case where you’ve had a vaccine, your immune system will start to detect that these substances were injected, and are actually not part of your body tissues. 

Dermatologist Anti-aging Skincare Tip #4: Fillers are not for everyone. Aging is not a one-faceted process of loss of volume. Also consider that what your physician thinks you should improve on is not necessarily what you may think as well. You could very well have a different opinion a few months or few years later. The trend of dissolving fillers last year was an example of how an aesthetic treatment designed to deliver a certain “look” went out of trend. Do you want your face to be a victim of trends? 

Anti-Aging Cosmetic Dermatology

Dermatologist Anti-aging Skincare Tip #5: There are alternatives to well aging that can also be delivered via topical modalities. These can be complementary to a well aging routine. 

Alternatives to injectables to correct aged skin

The human facial structure is a composite of skin that is composed of: the epidermis, dermis subcutaneous fat, the SMAS layer and the muscle. Aging affects all these structures dynamically. Fillers only address one part of the aging equation – the  restoration of volume. In order to restore facial structure and facial sagging, consider other technologies such as radiofrequency and high intensity focused ultrasound (HIFU) which do not involve injection of other substances into your body tissues. A board-certified dermatologist or plastic surgeon will be able to advise you on these options.

Cosmeceutical Transdermal Delivery Patch
QRASER™ Cosmeceutical Transdermal Delivery Patch: Our unique Qraser™ polymer technology mimics the natural hydration and homeostasis (natural balance) of the skin barrier, known as the stratum corneum to enhance cosmeceutical absorption. Application of the  patch optimises the skin healing microenvironment to regulate healthy collagen production, reducing wrinkles. 

Other alternatives to injectables include advances in our understanding of textile cosmeceuticals in the form of polysaccharides, polymers and nanoparticle materials. These cosmeceuticals can create an optimal skin microenvironment that stimulates collagen production, improving the hydration of the stratum corneum that creates plumpness and firmness of the skin.

CollagenUP Facial Wand
The CollagenUp™ Facial Wand is the ultimate home-based skincare rejuvenation system. It includes Cleansing + Treatment + Toning + Radiofrequency + Red Photon + Blue Photon + EMS functions. 
Skin Healing Polysaccharide Facial Mask
The MoistureMax™ Skin Healing Polysaccharide Facial Mask has a unique porous structure that traps cosmeceutical active ingredients in mini-reservoirs within the mask, with enhanced delayed release of cosmeceuticals with minimal transepidermal water loss.

Dermatologist Anti-aging Skincare Tip #6 : Never trust another person’s version of how you should and can look better. Focus on skin health and research how a holistic lifestyle intervention can help reduce the impact of cell damage in aging. 

The Ethical Conundrum

Fundamentally, I think we do need to approach the ethical basis of such treatments. Not to say that it is wrong, but as dermatologists, we are first of all medical specialists in skin health. I feel that the public is ready to hear what we have to say about aging and skin health advocacy, and it is important for us to communicate the right kind of information about aging as well. In a post-COVID era, the fundamental concern should really shift to holistic interventions (proactively recommended by the physician) in anti-aging, beyond simply anti-aging skincare, that will also improve one’s overall health. 

I do have many patients in fact, who are on these treatments regularly. What I want to emphasize in this book is what I always tell my patients as well – you can perform all these interventions, but if you are not healthy, if you are not changing your lifestyle, none of these will be sustainable – and it is going to show. 

There is a visible outcome difference between an individual who does all these external treatments without lifestyle modifications, expecting a head to toe makeover with ‘zero effort’ vs an individual who is committed to leading a disciplined lifestyle. 

Dermatologist Anti-aging Skincare Tip #7: Beauty is not a commodity. However, choosing your health over all is a good way to distinguish between what works and what doesn’t in well aging. Start your well aging journey with what matters most. Your lifestyle. 

The Truth about Anti-Aging Skincare

The age-old adage of a healthy lifestyle is understated, likely because there are no marketing dollars attached to it, but the science today bears it out.

It’s been widely spoken about for a long time that we should all eat healthily and exercise. The public needs to understand that it is not just about looking trim and not being obese, but it’s really important for the health of our organs. Let’s not forget about our innate vanity – all of us want to look good, and we want to age gracefully. The key to understanding the aging process and what we can do from the perspective of skin aging, is to pay attention to where new anti-aging interventions in dermatology and healthcare will take us. 

Why your anti-aging diet is so much more relevant than supplements

@drteowanlin Your Beauty Lifestyle Guide: Inside the Edible Beauty Kitchen with Dr.TWL #healthydiet #antiaging #dermatologist ♬ original sound – Dr. Teo Wan Lin

While it is rare for individuals living in developed countries to have overt nutritional deficiencies, it is equally relevant for us to base our recommendations on current evidence from animal and clinical models in inflammaging. 

What the science tells us about anti-aging

Specific cell studies show that molecular pathways such as telomerase pathways and insulin growth factor signalling processes are involved in the inflammaging process.

Free radical generation is a result of environmental assaults, which can be in the form of UV radiation, environmental pollution, lack of sleep, psychological stress. All these will affect our body’s ability to repair DNA. In early stages, that will translate into signs of skin aging – increased pigmentation, wrinkles, loss of elasticity, radiance. In late stages, a condition known as chronic actinic dermatitis is diagnosed – an advanced form of photoaging which predisposes one to a higher risk of skin cancer. 

In this next chapter, I will go on to a specific, evidence-based nutraceutical diet for anti-aging holistically (beyond simply anti-aging skincare), the science behind the bioactive ingredients in the plant and fungi kingdom, and why I advocate dietary modification as opposed to taking oral supplements.

Anti Pollution Skincare: Useful Tips for Your Skincare Routine

August 19, 2022

Anti pollution skincare has been a popular buzzword in the skincare industry, but what does it really entail? As a result of exposure to urban pollution, double cleansing, on its own, is generally sufficient. Sonic cleansing takes it one step further to address pollution-induced microbiome imbalances. In this article, we share an excerpt from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre, on the topic of utilising sonic cleansing technology as anti pollution skincare.

Acne Care Bible, anti pollution skincare excerpy
Dr. Teo Wan Lin’s e-book Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention is available on Amazon.

There has been a study¹ done in polluted Chinese cities which demonstrates that the skin microbiome changes as a result of exposure to pollutants. Skin aging is also impacted by exposure to environmental pollutants.

Sonic cleansing as anti pollution skincare

Sonic cleansing technology is developed and applied to skincare devices, and can specifically aid in the treatment of acne and maskne because of its benefits in restoring microbiome balance. The use of sonic cleansing devices is also especially relevant when it comes to anti pollution skincare, as it helps to dislodge microparticulate PM 2.5 matter that settles on skin.

Studies that have been performed on the utility of sonic cleansing in acne show that there is a significant benefit in incorporating a well designed sonic cleansing device in your skincare regimen. This is as opposed to just using manual cleansing procedures, with or without skin cleansing products. The importance of understanding sonic cleansing is in the improved removal of particulate matter, which directly correlates to microbiome imbalances.

Sonic cleansing for anti pollution skincare
A minimalist ultrasonic sonic facial cleanser for anti pollution skincare recommended for use for all skin types, includes dry sensitive skin, combination and oily skin.

A well designed sonic cleansing device is able to address the removal of excess dirt, sebum and debris. It is also a safe and effective method to improve the skin microbiome for various dermatological conditions, improving transepidermal water loss and maintaining the skin barrier. The additional benefit of removing environmental pollutants as anti pollution skincare will also affect skin aging. 

Ideal sonic cleanser

The ideal sonic cleansing device can also support hydration and skin barrier function in skin models, which were tested for sebum oil and particulate pollution model after a real life scenario. Studies were consistently able to demonstrate a significant benefit compared to just manual cleansing alone on makeup removal models. For example, in a split-face study on 22 patients. There was great improvement on the side treated with a sonic brush in terms of appearance of fine lines, wrinkles, and increased absorption2.

In a study done by Caberlotto et al on skin models, it demonstrated that there was increased synthesis of proteins that support the skin structure when sonic technology was applied3 . How sonic cleansers work is that it essentially uses the skin’s elastic properties by applying an ideal amplitude and frequency to efficiently remove dirt and debris. Inflammatory skin conditions, including acne, perioral dermatitis and rosacea can benefit from the use of a sonic cleansing device.

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

Maintaining skin health with anti pollution skincare

Microbial imbalances cause not just skin infections but also pigmentation problems. Skin pigmentation is linked to melanocyte activity. Melanocytes are skin cells that produce melanin, a type of pigment in the skin. It has been shown that P. acnes is associated with a condition of hyperpigmentation known as progressive macular hypomelanosis. 

We know that it is important to maintain not just the healthy microbial load, but also a diversity of these germs in order for our skin to maintain health. This is a state we would consider as skin microbiome homeostasis. Topical skincare is the first line management of microbial dysbiosis. Importantly, cleansers that are pH balanced, close to that of the skin’s natural pH 5.5 is a good recommendation as the basis for any anti pollution skincare routine. Including probiotics, prebiotics and synbiotics in your diet is another way that can be used to treat and prevent dermatological diseases, such as eczema or acne.

It is important to understand that the skin is also influenced by your diet. Plant-based foods and supplements have been proven to be a form of prebiotic which can affect the skin bacteria balance. As a result, diet also constitutes an important element to the outcome of anti pollution skincare. In conclusion, this good microbiome is an area of emerging research. Ecobiology is an important perspective, to help dermatologists discover new treatment options to maintain a healthy skin microenvironment.

anti pollution skincare - eating balanced, plant-based meals

The importance of the skin microbiome

In a 2016 publication on cutaneous medicine and surgery, researchers found that the host immune system also affects the skin microbiota4. These skin microbiota, in turn, also affect the skin’s immune system. Individuals with immunodeficiency syndrome syndromes, which are inherited, have a different variety of skin microbiome. These individuals suffer from a type of dermatitis that resembles atopic dermatitis or eczema and have a greater risk of acquiring skin infections.

Additionally, there are certain interesting factors that are related to the skin microbiome such as body odor, which is affected by the presence of microorganisms on your skin. There is research showing that increased bacteria and reduced diversity of the bacteria on your skin is associated with increased attractiveness to mosquitoes. So, it potentially is a preventive measure for diseases that are mosquito borne, such as dengue fever.

The common skin disease that’s affected by the skin bacterial load is atopic dermatitis, which in the US for example, affects up to 15% of school-going children. We know that S. aureus colonization is a problem associated with atopic dermatitis. That is why bleach baths and oral antibiotics are recommended for effective treatment of atopic dermatitis.

Treating microbial imbalances in the skin

There is early evidence that ingested probiotics and prebiotics may offer benefits in preventing and reducing the severity of atopic dermatitis. Additionally, it’s important to note that low diversity in your gut bacteria in your early infancy is also associated with development of atopic dermatitis later on in life.

Furthermore, sonic cleansing is a form of therapy that has been incorporated into home use devices. This method of cleansing has been shown in a few clinical studies to improve the skin microbiome when used in conjunction with a gentle cleanser. It is also indicated for treatment of conditions such as acne. Additionally, it can also be applied appropriately to patients who have perioral dermatitis. Acne, in particular, is one condition that can be improved with sonic cleansing. Collectively, good cleansing methods are an integral part of any anti pollution skincare routine.

References:

[1] Kong, H. H., Oh, J., Deming, C., Conlan, S., Grice, E. A., Beatson, M. A., Nomicos, E., Polley, E. C., Komarow, H. D., NISC Comparative Sequence Program, Murray, P. R., Turner, M. L., & Segre, J. A. (2012). Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome research, 22(5), 850–859. https://doi.org/10.1101/gr.131029.111

[2] Wang, L., Xu, Y. N., Chu, C. C., Jing, Z., Chen, Y., Zhang, J., Pu, M., Mi, T., Du, Y., Liang, Z., Doraiswamy, C., Zeng, T., Wu, J., & Chen, L. (2021). Facial Skin Microbiota-Mediated Host Response to Pollution Stress Revealed by Microbiome Networks of Individual. mSystems, 6(4), e0031921. https://doi.org/10.1128/mSystems.00319-21

[3] Caberlotto, E., Ruiz, L., Miller, Z., Poletti, M., & Tadlock, L. (2017). Effects of a skin-massaging device on the ex-vivo expression of human dermis proteins and in-vivo facial wrinkles. PloS one, 12(3), e0172624. https://doi.org/10.1371/journal.pone.0172624

[4] Lynde, C. W., Andriessen, A., Bertucci, V., McCuaig, C., Skotnicki, S., Weinstein, M., … & Zip, C. (2016). The skin microbiome in atopic dermatitis and its relationship to emollients. Journal of cutaneous medicine and surgery, 20(1), 21-28.

How to Get Rid of Mask Acne? 3 Effective Dermatologist Tips

August 2, 2022

In this series in conjunction with the Dermatological Society of Singapore, dermatologist Dr. Teo Wan Lin shares her tips on treatment and prevention of mask acne, how to get rid of mask acne, including her recommendations for the best type of face mask for maskne.

Skin problems caused by friction

I want to touch on something known as frictional dermatitis right now. It will take us to important factors that influence whether or not you develop face mask skin problems related to the design of the face mask itself.

The constant contact of the face mask with various parts of our face especially when we’re wearing it throughout the day while going about our daily activities in indoor environments actually creates friction and for areas like the face where the skin is slightly thinner and more delicate, it can lead to dysfunction in the skin barrier. We spoke about dermatitis earlier but the very fact that we have to wear the face mask throughout the day creates a new issue and that’s not just relating to the microenvironment with the humidity, the bacteria but also mechanical forces of friction.

How to get rid of mask acne – Ideal face mask design

What type of face mask is best to get rid of mask acne?

That brings us to the topic of how our face mask design can influence the development of these various dermatological conditions. In the case of maskne and facial dermatitis/facial eczema, we would do well with a mask fabric that is breathable.

Traditionally we spoke about natural fibres such as cotton, linen and silk being the most beneficial for skin because of their ability to wick moisture away and while the surface of the skin does not really breathe as our respiratory system does, it is a good descriptor of what we hope can help to improve the local skin microenvironment in terms of allowing airflow and preventing humidity and moisture build up which can increase the growth of harmful bacteria and other germs like fungi.

How to get rid of mask acne - face mask design

However, the major problem with these natural fibres is that they are not waterproof and this is the very reason why when we talk about personal protective equipment, we’re not dealing with natural fibres but rather synthetic materials. Your N95 Mask, the surgical mask these are all synthetic and derivatives of fibres such as polyester.

The water resistance is a critical part of your mask design. We’re not wearing the face mask just to be compliant with local laws, we want it to reduce infectivity of the disease within the population and in the case of personal protective equipment, we actually hope that it can prevent infection risk especially with a highly transmissible virus such as COVID.

What type of fabric face mask should I choose?

How to get rid of mask acne or maskne? Reusable face masks made with biofunctional textiles. Essentially, biofunctional textiles are engineered materials that have beneficial properties for skin, specifically the skin microbiome. We know that there are naturally beneficial properties of a textile such as silk on skin because of its metallic content. For example, it contains copper.

The silk is produced by the silkworms as they spin the thread. What is being done in the field of biofunctional textiles is essentially incorporating these metallic nanoparticles, it could be copper, silver, zinc into synthetic materials so that while they retain the properties of being highly durable as well as being waterproof. Additionally, they also have these added bactericidal benefits. Bactericidal means that it kills bacteria on contact and that is something that has been proven with copper nanoparticles for example and silver.

how to get rid of mask acne - best reusable face mask
CUIONS Gold Anti-Maskne Face Mask infused with Copper Ions

Copper and silver have been used in the development of textiles as adjunct treatment for those with eczema for example, and it has been shown to be effective in terms of improving their quality of life as well as symptoms with use. It really helps by treating the skin microbiome so you may have heard of this term in the media.

The microbiome is truly an important area of dermatology research and treatments. It is no longer about us developing more powerful antibiotics to treat disorders such as acne or rosacea because we know that the inherent problem is that the bacteria develops resistance, and the root cause of these conditions isn’t really a pathogenic infection or bad infection. Instead, it is a problem with that being an imbalance of the good and bad bacteria. So biofunctional textiles hold promise in terms of treating this sort of microbiome imbalance.

How to get rid of mask acne

In this last part of my talk, we’re going to be discussing how you can manage mild symptoms of maskne, how to get rid of mask acne and hopefully even prevent it. First of all, the design of your face mask does make a difference. Many of us opt for reusable face masks because it’s just not eco-friendly or sustainable to be using disposable PPE although one must carefully consider the risks of infection and transmission given that we are seeing new variants of COVID as well as increasing knowledge about long COVID symptoms as well. However from the pure skin perspective, you can consider these factors.

First of all, one that can stay in place when you are speaking especially because we are wearing masks throughout the day in indoor environments is going to reduce friction on skin as opposed to an ill-fitting mask that you constantly have to touch and adjust and certainly that’s very bad from an infection control point of view as well.

The other factor that you should think about is the material of the face mask and it is firstly important to not wear cotton, linen or silk face mask because these frankly are not going to be as effective as one that is water resistant so synthetic material is actually preferable but then you have to consider the downside, which is everything we discussed earlier and this is why you may consider newer textiles such as biofunctional materials.

Solutions to get rid of Mask Acne

Finally, if you have the odd one or two pimples that come up say a certain target month for ladies that coincides with your period, you should use a good pimple cream. Avoid highly irritant pimple cream ingredients such as benzoyl peroxide, retinols are sometimes found in over the counter acne creams. These are very irritating for skin. So the key here is that we are managing a different type of acne, maskne because you are constantly wearing a face covering which means whatever you apply on your pimple is going to be absorbed much more.

how to get rid of mask acne - natural acne treatment
A pimple cream treatment delivered in the form of a face mask. The Berberine Acne Face Mask uses a reusable polysaccharide material as a cosmeceutical reservoir to deliver active ingredients to skin. Discover more about how berberine works here.

It is a phenomenon that occurs under occlusion which is when the skin is in a sense suffocated, that increases the irritant potential of benzoyl peroxide which itself can cause skin irritation signs such as redness, flaking. There are active ingredients without irritation that can be effective for the treatment of acne as well. So botanical ingredients that suppress inflammation, for example Berberine and Chlorella Vulgaris, these can be useful in the treatment of maskne.

How to get rid of mask acne – skincare for maskne

Another thing that you may have observed is your pimple cream can actually bleach your face mask. This may come as a surprise for many but the reason behind this is the benzoyl peroxide content that can bleach textiles. So I think it’s very important for all of us to appreciate the value of a good skincare regimen for acne sufferers, those who want to get rid of mask acne or even prevent maskne altogether. The basics of that would be an antibacterial face wash that’s also gentle on skin.

Natural antibacterial derivatives such as medical grade honey, even soya-based emulsifiers, these tend to be less harsh on skin than chemical antibacterial agents such as triclosan, which in the very long term also has some concerns with regards to whether there are potential side effects on the hormonal axis and we certainly don’t want to breed more drug resistance.

The second tenet of good acne skincare would be using an effective pimple cream which we spoke about earlier. Moisturizer is also important. If you suffer from oily skin, you may want to use a serum or a lotion which is lighter than a cream.

Best pimple cream for maskne - how to get rid of mask acne
The Blemish Spot Cream combines plant extracts such as Chlorella Vulgaris that reduce inflammation and swelling with antibacterial and oil control effects. Dermatologist recommended for maskne prevention and treatment. 

When should I see a dermatologist to get rid of mask acne?

If you have a pre-existing skin condition that has worsened after mask wearing then you should see a dermatologist because in many of these cases, whether it’s facial eczema, acne or rosacea, you do require treatment with prescription medication. If you have mild acne which is getting a little bit worse but still not severe enough that it is causing you emotional distress, you can try switching out your face mask, adding on an antibacterial cleanser, taking care of active pimples, not picking at them using a hydrocolloid patch can help.

If you have new onset, moderate to severe acne – so if you have anything more than five pimples a month, or to the extent that you feel emotionally disturbed by it, then you may want to seek medical attention earlier. Finally, it’s important to note that it is not recommended for lay persons to try to self diagnose their condition. If you have any doubt at all or if you have a previous history of a skin condition, then do visit a dermatologist so that you can get prompt and accurate diagnosis and start on effective treatment.

That wraps up my talk on maskne – what is it and how we can prevent it. I am really happy to be able to share these tips with you on world skin health day and thank you all for listening to my talk.

Dr. Teo shares on what causes maskne, where it develops as well as other face mask skin problems that may be mistaken for maskne in Part One of the transcript here.

What Causes Maskne & Face Mask Skin Problems? Complete Guide

July 29, 2022

Maskne is a term coined during the COVID-19 pandemic as a specific form of acne that occurs over the part of the face covered by the face mask. In conjunction with the Dermatological Society of Singapore, accredited dermatologist Dr. Teo Wan Lin answers commonly asked questions about maskne, or acne caused by wearing a face mask, for World Skin Health Day 2022. What causes maskne? How do I know if I have maskne? How to get rid of mask acne? Find out the answers to these essential questions about maskne and more in the transcript below.

Hello good morning, I’m Dr.Teo Wan Lin, a board-certified dermatologist practising at TWL Specialist Skin and Laser Centre. Today is World Skin Health Day and first of all, I would like to thank the organizing committee for inviting me to be part of this wonderful series of talks by my fellow colleagues on important dermatology related topics. I will be speaking on the topic of mask acne – what causes maskne and also how to treat it. I’m sure many of you have heard of maskne but here’s a little bit of background as to what exactly it is and how dermatologists approach it.

What causes maskne?

Well, this actually is not a novel condition. Rather, it is a form of occlusion acne or acne mechanica, which had previously been reported in individuals who had to wear for example – headgear, sporting helmets and also in healthcare workers who were used to working with infectious disease patients and needed to wear the N95 mask for long hours.

Essentially, what causes maskne is that it develops when there is a change in the local skin environment. We call that the microenvironment. The key here is that there is a good balance of bad bacteria as well as healthy bacteria that lives on everyone’s skin. When the skin microenvironment changes, it has the ability to affect the composition of good and bad bacteria. This is exactly what happens and is what causes maskne. The microbiome is disturbed and that’s when individuals who previously did not get acne may find that they start developing acne.

What is the difference between acne and maskne?

There are also those who already suffer from acne. It may be mild and they find that their acne gets much worse with the wearing of a face mask for long periods of time. So, what exactly is happening here? Essentially when you occlude the skin with a face mask for long periods of time, it increases the humidity and it allows accumulation of sweat and saliva for example when you’re speaking it inadvertently gets on to the face mask. That together with Singapore’s climate which is very hot and humid, all that creates the perfect microenvironment to breed bacteria.

Acne itself is directly linked to bacteria. You may have heard of P.acnes (Propionibacterium acnes) and that has been identified as the main bacteria that causes pimples in individuals who are genetically predisposed, being what causes maskne and acne for that matter. We’ve always spoken about acne being mainly a genetic condition driven by inflammation but we also know that the presence of this bacteria on the skin of acne sufferers actually is directly responsible for acne flare ups. In the case of what causes maskne, face mask occlusion directly impacts the rate of growth of these harmful microorganisms on skin.

How do I know if I have maskne?

What causes maskne and other face mask skin problems

Could the skin problems I’m seeing be due to skin sensitivity or any other form of skin condition? That’s a really critical question and it is important for you to note first of all, that many of these conditions can only be distinguished by an accredited dermatologist. However, these are some basic guidelines that may help you to figure out if you may have maskne, or it could be something else.

What causes maskne? Well, the definition of maskne is essentially the onset of acne pimples over the area occluded by the face mask within a period of four to six weeks after starting to wear a face mask. Essentially, this is based on the principle that acne doesn’t appear overnight. The process known as comedogenesis, comedone formation is actually the scientific way dermatologists explain how pimples occur. You may have heard of blackheads, whiteheads but before they appear on the surface of your skin, they are actually existing as microcomedones.

Microcomedones are at the bottom of the skin layer. When they arise to the surface, that’s when you develop a visible blackhead or whitehead. This is also when it can get infected with superficial skin bacteria and you can get red looking angry bumps known as papules. It can develop into a cyst which is often a larger bump that is painful, swollen and often requires treatment say with an injection by a dermatologist or it can also develop into a pustule where you see bits of pus at the surface of your skin.

Where does maskne develop?

The key here is that maskne doesn’t look at all different from regular acne apart from the fact that there is a history of mask wearing, and also the location where it develops. In this case we describe that as the O-Zone – the area conveniently attributed to the part of the face that is covered by a face mask. This is useful for dermatologists because traditionally we do describe the distribution of acne being slightly different in acne sufferers.

What causes maskne - Where do face mask skin problems develop?

For example, many of you may have heard of the T-zone which is the area over the forehead, to your nose and the chin area. That is the commonest area affected when it comes to physiologic acne, which is teenage acne basically. The U-Zone, the area around the jaw line has been associated more commonly with adult acne sufferers.

It’s also linked to the term hormonal acne but there isn’t really a big difference in terms of how and why these acne bumps form other than the fact that in hormonal acne there could be in certain cases, a condition known as polycystic ovarian syndrome. The short name for that is PCOS. It occurs in adult females who may also have irregular menstrual cycles and increased hair growth condition known as hirsutism as well as adult onset acne. Maskne in this sense can overlap with these different types of acne.

Other face mask skin problems that can be mistaken for maskne

Eczema

One of the face mask skin problems you may encounter is dermatitis, better known as eczema. Facial eczema is a condition where there is increased redness, flaking or they could even be skin swelling and some bumps occurring over the area that’s covered by the face mask. There are actually many factors that increase your chance of developing facial eczema when you wear a face mask and these would be the very fact that the face mask covers your mouth and your nose.

In this case, we want it to stop the respiratory droplets from excessively disseminating to your environment and hopefully that reduces the transmission rate. But the very fact that your salivary and nasal secretions get on your skin is not actually a natural or normal thing that happens all the time and this is why it causes problems. For example, the moisture alone from these secretions makes the microenvironment highly suitable for bacteria to thrive and contributes to what causes maskne.

In addition, the saliva contains digestive enzymes that’s meant to help us digest our food but when it is coming in contact with your skin and prior to the COVID 19 pandemic, we would see that most commonly in young children/toddlers who drool and that would lead to irritant contact dermatitis forming on the surface of the skin where it’s always in contact with saliva.

In an adult who has a family history or personal history of sensitive skin, allergic nose, sinus problems, they may have what we call atopy, which is a constellation of symptoms that increase your risk of developing skin conditions like eczema and that ultimately boils down to the skin barrier being deficient.

So you can imagine the process as when your saliva comes into contact with your skin, the salivary enzymes are actually partially digesting the superficial layer of skin cells. Over time with the increased accumulation of sweat, bacteria, humidity and occlusion, it does increase your risk of developing facial eczema or dermatitis that can appear specifically over the area covered by the mask.

Rosacea

Another one of the face mask skin problems you may face is a condition that can be worsened by mask wearing but is not itself maskne – rosacea. Rosacea is a condition where the skin’s blood vessels are hypersensitive and it expands excessively and persistently in response to heat, spicy foods, emotions and it can reach a state where even in the absence of these triggers, skin appears persistently red. There is a direct correlation with the symptoms of rosacea and mask wearing which leads to occlusion.

As we discussed earlier, occlusion itself creates a rather unnatural and we know is unhealthy skin microenvironment. There is research that explains to us how in conditions like rosacea, there could actually be a disturbance in the skin microbiome itself which is what causes maskne and other mask-related skin conditions. This is another reason why we may observe worsening of skin conditions that are not maskne over the area covered by the face mask.

Find out more on how to get rid of maskne in Part Two of this series.

Dermatologist’s 3 Best Makeup Tips for Acne Prone Skin

July 6, 2022

Good makeup habits are important for those experimenting with makeup. In this article, we break down essential makeup tips for acne prone skin, including excerpts from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Acne Care Bible
The Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention is available on Amazon Kindle and all major e-bookstores.

Based on Dr. Teo’s experience as a dermatologist, she advocates awareness of the following topics as part of her makeup tips. Learning about hygiene and care of makeup tools is important. With the availability of skincare knowledge on the internet, empower yourself with knowledge about makeup formulation is helpful. Above all, whether you are a parent of a teenager, a teenager or an adult with acne problems and wish to apply makeup safely and effectively, be sure to instil confidence and self-assurance while you have fun with makeup. Enjoy the journey, experimenting safely and learn to accept and be yourself. 

@drteowanlin #learningisfun #tiktokdoctor #doctorsoftiktok #dermatologist #tiktokdoc #acnetreatment #acnederm #acnefighter #makeuproutine #makeuptips ♬ Music In Your Heart (Instrumental) – BLVKSHP

Makeup Tips #1: Experimenting with makeup safely 

One of the most important makeup tips is that if you have sensitive skin and are prone to allergic skin reactions, you may wish to patch test all your skincare and makeup products before applying it on. This minimises the risk of moderate to severe allergic reactions. 

A patch test is a simple way of checking if your skin will react to new cosmetics or skincare products, and is a common way to test for allergies. It is important to patch test before you use a new product in order to avoid potential allergic reactions that can cause redness, swelling, irritation, or more.

How to patch test

Simply apply the product on your inner arm and leave it on for one to two hours to watch for any adverse effects such as redness, burning or stinging. If you are worried about delayed reactions, leave on for up to four hours or even overnight to watch for any allergic skin reactions. 

Positive patch test

If your patch test is positive, you may wish to visit an accredited dermatologist for a formal diagnosis of allergic contact dermatitis. Bring the packaging of your makeup along, as the dermatologist will need to review the ingredients that are most likely the cause of the allergic reaction. If deemed necessary, a comprehensive patch test will then be performed at the clinic. 

Negative patch test

If your patch test is negative, it is acceptable to apply the product directly on the area. A word of caution here, wash off products such as cleansers cannot be tested in this way as these products are leave-on formulations.  This means that even if you are not allergic to any of the ingredients in the cleanser, there is a chance that you will develop irritation from irritant contact dermatitis. Additionally, one may get a delayed reaction to the ingredients in skincare/makeup, even if one has tolerated it before. These reactions of course are much rarer. 

Certain individuals may find that products for sensitive areas such as the eyes and lips tend to have a higher risk of irritation. As part of eye makeup tips, it is important to do your brand research here. Brands that are often ophthalmologist tested would be preferred to those which are not for application around the eyes.

Makeup Tips #2: eyeliner/mascara

Mascara/eyeliner products should all be thrown away after three months of use. This is because of the nature of the product and the fact that it is applied over the sensitive eye area. Using mascara for longer than 3 months can breed bacteria and lead to eye infections. As part of general makeup tips, all liquid makeup products once opened should be discarded within a year, if it’s not fully used. In my experience, powder makeup can be safely used for up to 2 years.

Makeup Tips #3: Concealer for acne prone skin

Use a concealer where you need it – concealer is not meant to be applied over the entire face.

I clearly remember in my teenage years when I have had outbreaks of acne and was taken to a dermatologist by my mother. The dermatologist prescribed me an antibiotic – doxycycline. During that period of time, I was very conscious about the blemishes I had on my skin. I had a lot of makeup applied on me during photoshoots which I had no control over.

Besides, I was also increasingly conscious of the comments that were being passed by insensitive casting agents on my blemishes which in retrospect, were not at all severe. However, this is the harsh reality of a young adult who is working in this field. This surely is an experience that many teenagers can identify with. But especially so for social media influencers, models, actors or actresses who are under heightened scrutiny on the health of their skin. 

What I would say to myself back then is essentially that I didn’t need to feel bad about my skin, and that it was a perfectly natural part of my life that I had to go through. I would highlight that it was important that I had sought medical help. The antibiotics did clear up my skin and my back to normal for a long period of time, during which I was on topical retinoids for maintenance.

The great thing about topical retinoids is that it also helped to increase the radiance of my skin and I have continued to use that all the way to my late twenties. After which, I found that I have become sensitive to it and developed redness, flaking and eventually had to stop using it. What is the take-home makeup tips message here? 

If you have a skin problem, it is all right to conceal it. But do not pay too much attention to what insensitive individuals around you may be thinking or saying about your skin. However, it’s important to also get it medically treated because had I not had it treated, it may never have gone away, at least for a significant period of time. Or worse, I would be left with horrible scars which thankfully, I do not have today. My message to you is that you do not need to have scars from acne. 

The additional point I wish to make on makeup tips here is that the eyes are the windows to your soul. I remember this from one of the crash courses on casting etiquette that I was given by one of my bookers – clients do not want to see you with dramatic eye makeup but it’s good to curl your eyelashes and put on mascara. 

I remember my biggest struggle with makeup was with mascara. Singapore is extremely humid and very often by the time I reached a casting place, my under-eye area would be all dark from the humidity that caused the mascara to run and stain my skin. As I grew older, I learnt how to choose formulas which don’t run as much. I have to say since starting my medical career, I haven’t used mascara regularly for at least the last five years. As a doctor, working overnight in the hospital didn’t make mascara or any form of makeup very sustainable.

When I became a dermatologist and studied cosmetic formulations, I realised that removing mascara formulations is different from removing traditional makeup. Removing mascara requires solvents that are not just for dissolving pigments as in the case of concealers or foundation but also binders. For a mascara to hold in humid weather, it needs to have a certain level of waterproof coating.

@drteowanlin #acnetips #acneskincare #makeupacne #makeupcleaning #doublecleansing #dermatologist #tiktoksg #sgviral #learningisfun #docsoftiktok ♬ Piano sleep LoFi slow midnight(808930) – Gloveity

The ideal mascara will be one that doesn’t run and does its job in volumising and lengthening. It also has to be easy to remove with a gentle cleanser. Removal of mascara or even eyeliner is often a rather messy affair. On makeup tips for removals, I love milk emulsion type formulations for removing various types of makeup. I find these the most efficient and gentle for removing waterproof mascara and eyeliner. 

I remember using eye makeup remover pads and oil cleansers when I was younger to remove heavy eye makeup after fashion shows — both caused me to develop skin irritation. The skin irritation didn’t come from the mascara or the makeup but rather it came from the cleansing. The truth is if your makeup is difficult to remove, whatever cleanser you’re using – you either have to use a lot of it or it won’t come off at all. 

Eyelash Growth Enhancement Serum for Lash Makeup Tips

The EYELASH GROWTH ENHANCER is a dual oligopeptide serum that has been clinically proven to show 25% increase with thicker and longer eyelashes after 2 weeks of use & 66% increase in lash length and density in just 28 days.

As makeup tips for lashes, try not to wear mascaras so much, especially on a daily basis. You could opt for an eyelash growth enhancer which can naturally treat your eyelashes, making it stronger, healthier and more luscious. You can also opt for magnetic lashes rather than eyelash extensions which involve chemical glues that may damage your natural lashes.

A word of caution as additional eye makeup tips, excessive friction caused by over-cleansing the eye area. It will cause the delicate eye area to age faster simply because of the pressure of pulling, dragging and rubbing that is exerted over this area over a period of time. The best type of mascara and eye makeup remover would be an emulsion based oil soluble cleanser. These days I focus on eyelash care.

The glaucoma medication bimatoprost in the form of Latisse was released about a decade ago when it was known that it caused lash lengthening. However, the use of it was limited by hyperpigmentation side effects. I use and recommend an oligopeptide based lash formula now as an eyelash cosmeceutical to promote healthy lash growth.

How does a Sonic Facial Cleanser for Acne Work?

June 21, 2022

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

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

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

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

Acne microbiome

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

Sonic facial cleanser for acne

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

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

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

How does a sonic facial cleanser for acne work? 

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

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

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

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

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

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

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

Design of a sonic cleanser

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

Blade style sonic facial cleanser for acne

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

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

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

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

Acne Treatment for Teens: 3 Important FAQ

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

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

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

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

Mild acne treatment for teens

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

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

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

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

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

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

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

2. When should my teenager see a dermatologist? 

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

Red flags to watch out for:

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

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

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

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

Best Baby Moisturiser in Singapore: Dermatologist Guide 

May 18, 2022
best baby moisturiser

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

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

Baby moisturisers – can I use a regular moisturiser?

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

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

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

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What ingredients are in the best baby moisturiser formulations?

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

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

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

Components of the best baby skincare regimen – dermatologist recommended

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

Will my baby get eczema if I have eczema?

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

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

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

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

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

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

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

Best baby moisturiser application technique – dermatologist tip 

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

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

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

When should I start moisturising my baby? 

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

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

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

Other skincare ingredients in the best baby moisturisers

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

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

How does panthenol benefit the skin? 

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

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

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

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

Is panthenol safe for skin? 

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

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

Understanding common skin problems in babies 

Applying baby moisturiser for Insect bites?

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

Why does my newborn have acne? 

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

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

Common baby  skin problems – will baby moisturiser help?

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

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

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

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

Best Baby Skincare Tips Recommended by Dermatologists

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

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

May 7, 2022

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

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

What is in a commercial laundry detergent?

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

Powder detergent pros and cons

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

Liquid detergent benefits and disadvantages

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

Detergent pods: the best option?

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

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

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

What is the environmental impact of commercial laundry detergent use?

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

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

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

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

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

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

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

Advances in detergent formulations

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

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

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

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

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

How laundry detergent affects skin of newborn babies?

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

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

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

What is the best baby laundry detergent made of? 

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

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

Baby laundry detergents dermatologist recommended 

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

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

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

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

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

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

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

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

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

References

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

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

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

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

How common is eczema and what causes eczema flare ups?

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

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

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

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

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

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

Identifying risk factors for eczema, start using a moisturiser early

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

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

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

Healthy diet: natural way to support eczema treatment 

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

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

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

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

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

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

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

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

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

Best natural eczema cream / moisturiser therapy with wet wraps

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

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

Not all baby rashes is due to eczema 

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

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

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

Dangers of natural eczema cream or remedies

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

What you can do for mild eczema treatment without medications 

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

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

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

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

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

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

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

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

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