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CONTACT: +65 6355 0522

Stressing Out Can Aggravate Your Acne – Here’s How

October 22, 2018

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

 

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

 

Stress induces excessive oil production

 

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

 

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

 

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

 

Stress delays wound recovery

 

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

 

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

 

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

 

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

 

Stress promotes habits that aggravate acne

 

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

 

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

 

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

 

How to lessen the impact stress has on your skin?

 

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

 

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

 

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

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

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

What You Need to Know About Dry Skin

September 25, 2018

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

So what causes xerosis and how can it be managed?

What is dry skin?

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

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

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

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

What causes dry skin?

Dry skin arises largely due to abnormal epidermal differentiation.

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

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

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

How to replace skin’s water content

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

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

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

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

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

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

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

—–

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

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

Sleep Deprivation and The Skin

September 6, 2018

 

 

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

How lack of sleep impacts your skin

Dehydrates the skin

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

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

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

Reduces immune system function

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

Inflames the skin

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

Ages your skin

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

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

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

Regain your skin’s well-rested radiance

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

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


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

—–

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

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

 

 

 

 

 

Understanding Enlarged Pores & How to Treat Them

August 24, 2018

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

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

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

Excessive sebum production

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

Severe acne

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

Loss of skin elasticity

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

Hair thickness

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

Treatment options

Topical therapies

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

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

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

  • Niacinamideis another cosmetic ingredient that can reduce sebum production.

 

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

Oral therapy

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

Lasers and ultrasound devices

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

Hair removal

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

 

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

—–

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

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

What Is A Medifacial?

August 17, 2018

 

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

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

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

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

Microdermabrasion

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

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

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

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

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

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

Extraction

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

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

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

Application of potent serums

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

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

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

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

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

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

—–

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

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

 

 

 

 

 

 

 

 

 

 

 

 

A Dermatologist Explains Eczema & Its Treatment

August 4, 2018

 

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

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

How does atopic dermatitis arise?

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

  • Skin barrier dysfunction
  • Genetic predisposition
  • Immune dysfunction

The role of genetics in eczema

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

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

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

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

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

How immune dysfunction contributes to eczema

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

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

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

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

How to treat eczema?

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

Repair & Maintain Healthy Skin Barrier:

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

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

Reduce inflammation:

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

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

Side effects include:

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

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

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

Itch control:

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

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

Taking care of the skin 

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

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

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

—–

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

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

 

 

 

 

Everything You Need to Know About Melanin & Dark Spots

July 19, 2018

 

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

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

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

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

Pigmentary disorders

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

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

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

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

Treating hyperpigmentation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Understanding the layers of your skin

July 14, 2018


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

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

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

Our epidermis

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

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

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

The dermis

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

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

Caring for the skin we see

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

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

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

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

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

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

Caring for the skin beneath

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

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

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

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

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

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

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

 

 

A Dermatologist Explains the Skin Barrier and Hydration

June 22, 2018

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

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

The stratum corneum barrier

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

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

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

Skin Hydration

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

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

TEWL and Moisturizers

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

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

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

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

Glycerol

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

Hyaluronic acid

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

Conclusion

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

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

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

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

 

What causes our skin to age?

June 13, 2018

What causes our skin to age?

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

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

Extrinsic ageing

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

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

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

Photoageing

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

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

Antioxidant and skin ageing

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

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

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

Intrinsic ageing

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

Preventing the ageing process

To improve skin quality, there are various treatments available.

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

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

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

—–

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

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

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