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Dermatologist Answers 5 Common Questions on Skin Lightening

March 29, 2021

The term “skin lightening”, along with “whitening” and “fair” have often been marketed in products, particularly in Asia. Aside from being unhealthy and unsustainable, skin lightening treatments and procedures can often be dangerous. In this article, dermatologist answers 5 common questions on skin lightening, shedding light on dangerous practices, and giving tips on how to even skin tone instead of whiten it; including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Can you actually lighten your skin?

In the context of achieving a fairer skin tone, I think it is important to define if we are talking about eliminating uneven pigmentation, for example, or actually bleaching one’s skin to go to a lighter skin colour. The latter I do not recommend but in terms of making one’s skin tone more even and eliminating dark spots, there are various forms of pigmentations that you should know about including sun spots – otherwise known as solar lentigo, freckles, other medical conditions such as post inflammatory hyperpigmentation and melasma.

There are specific topical medications, lasers, as well as pills that one can use to treat these conditions. For the case of actually going to a completely lighter skin tone that is not natural for one’s genetically determined skin type, I do not recommend that and we can address that later in this chapter

What are the steps to take to achieve a fairer skin tone? Can we break it down into lifestyle, treatments and skincare?

To achieve a fairer skin tone, I will focus on how to enhance one’s skin health, so that you get less of the common hyperpigmentation conditions. We start off with genetics. Everyone is born with a certain skin type – we call that phototype. The dermatological grading of this is the Fitzpatrick phototype. For Asians, we tend to be between type III to type V. When it boils down to why people of a certain skin type, for example in phototype III, have varying amounts of skin fairness or pigmentation, it is said to be influenced by various factors.

Lifestyle certainly plays a role, as our skin contains melanin, a light-absorbing pigment molecule that also gives our skin its color. When we are exposed a lot to the sun, we activate the melanin-producing cells, melanocytes, that can cause one’s skin tone to get darker. The amount of exposure to sunlight is therefore one important factor.

Exposure to sunlight can slow down skin lightening of pigmentation

Other lifestyle habits like smoking, exposure to pollution and stress for example, can lead to a process known as free radical generation in our skin and this can increase one’s risk to hyperpigmentation or risk of existing areas of pigmentation to get even darker. Unhealthy lifestyle is definitely part of factors that cause our skin to be less radiant and can also cause the skin to appear as a dull complexion with uneven skin tone.

In terms of treatment, chemical peels and lasers help to stimulate one’s skin cells, restoring it to a normal cell cycle of a young person. Overall, this causes skin to look much more radiant with an even skin tone and a fairer complexion, whilst also reducing the amount of skin surface irregularities. The lasers work by causing the skin’s natural cells to eat up areas of pigmentation – this is beneficial for those hoping to achieve more even skin tone.

Certain skincare ingredients have shown effectiveness for even skin tone. For example, retinoids (which are prescription only), and oligopeptides which is what I incorporate in my skincare as it is non-irritating with potent anti-ageing properties and stimulate one’s immune cells to eat up pigmentation and has been proven to cause lighter skin tone.

Is it realistic to maintain a lighter skin tone than you’re naturally born with?

This is a very important question as it goes back to the premise of this series. Our skin tone is genetically determined and we refer to the Fitzpatrick phototype classification as mentioned above. It is unhealthy to want to bleach one’s skin and remove one’s natural melanin which is protective. There are ways to achieve that, but it is not practised in dermatologist’s offices because it is a dangerous method. The only indication for using bleaching creams will be to lighten small areas of hyperpigmentation such as sun spots or in cases of the medical condition – melasma.

To want to lighten one’s skin entirely, it is very dangerous because it can increase your risk of skin cancer as well as accelerate skin ageing. Such treatments are reserved for medical conditions such as vitiligo whereby one has lost significant amount of skin pigmentation through an autoimmune disease and is cosmetically disfiguring. In those cases, if the body surface area is involved very significantly, it can be an indication for the dermatologist to lighten the rest of the skin as well to help the overall cosmetic appearance.

What is the fastest way to lighten my skin tone naturally?

One’s skin tone often appears dark because of uneven pigmentation that has developed over the years with ageing and sun damage, as well as having dull skin. A quick in-office treatment will be a chemical peel performed by a dermatologist, using glycolic or lactic acids in combination with a laser treatment. In my clinic, we do both as part of a skin rejuvenating treatment on the same day. The results of this is usually apparent right after treatment, especially after applying the Amino Acid Masque which contains Vitamin C and various plant extracts that helps to shrink the pores and helps in brightening the skin tone.

To shed light on them, what are some controversial skin whitening and skin lightening methods?

More than controversial, some alternative skin lightening methods can be dangerous. In particular, do be wary of cosmetic products that promise exaggerated or miraculous results, as recommended by the Health Sciences Authority with some recent high profile cases of illegal cosmetics. Such products when purchased from unfamiliar sources may be prohibited, for example due to the dangerously high levels of mercury. This toxic heavy metal is in fact prohibited as an ingredient in skincare formulations as it can cause rash, skin discolouration and blotching. Chronic exposure to mercury may also cause damage to kidneys, digestive and nervous systems.

Another controversial method would be skin lightening creams containing ingredients such as hydroquinone and retinoids (tretinoin), which which can cause serious adverse reactions. While these substances may be commonly used in a dermatologist’s office as treatment for skin conditions, the potency requires it to be prescribed only by an accredited medical professional under strict medical supervision.

Other means of skin lightening such as intravenous glutathione treatments (injection) can be unsafe. Glutathione is an antioxidant naturally found in our cells and has skin-lightening abilities by converting melanin to a lighter color and cause reduction of melanin production as a whole. As with any treatments involving direct delivery to the bloodstream, additional caution should be exercised in consultation with an accredited medical professional. While glutathione has been proven safe for oral and topical treatments, we cannot say the same when it is injected into the bloodstream, given the inadequate safety data presently. Serious skin disorders, kidney dysfunction and thyroid function impairment have been reported in some cases.

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Skin lightening and even out skin tone with the Vita C serum

7 Face Mask Questions Answered by a Dermatologist

March 19, 2021

Want to add a face mask to your routine but don’t know which one or how? In this article we answer the 7 commonest questions on face masks, including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Do sheet masks work as well as traditional masks?

Sheet masks work on the basis of occlusion, meaning when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. The question of efficacy is not so much of whether it is a traditional mask (presumably referring to clay masks or gels applied onto skin as it is) or sheet mask, but really depends on what is the active ingredient contained in the mask. With precise active ingredients, the type of mask (sheet or gel for instance) becomes secondary in terms of efficacy, as in my practice for example, whenever I want to increase absorption of any topical that is dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.

Are overnight masks more effective?

It is too much to generalise to say that overnight masks are more effective because it really depends on the active ingredients. All sleeping mask formulas are the same as moisturisers, as these are leave-in rather than wash-off ingredients. They work by absorbing onto the skin to produce moisturising effects. In leaving a topical on the skin for more than 12 hours for example, it would be important to first ascertain suitability of the ingredients, preservative and vehicle, including concentrations and types, and all of the components being intended to be applied on the skin for an extended period and not as a wash off.

It is really a good marketing invention, because this encourages people to apply the proper amount of moisturiser, which is a really liberal amount, overnight, as during the day they may not be as inclined to because of whitish cream residue that may be seen under makeup. If the active ingredients contain irritating substances such as lactic, salicylic, glycol acids or retinols, one could actually develop skin irritation or skin allergies from masking over an extended period. Most topicals would be fully absorbed into the skin within a couple of hours, so it’s not necessary to leave something on overnight. It is more important to consider that a liberal amount of a good moisturiser is used during sleep, as that is when the skin repairs itself.

The Radiance Fluide contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. Specially formulated for a light-weight feel to impart a radiant glow without make-up.

Is it necessary to mask the skin? What are the benefits of masking?

I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture to the skin and include ingredients (wash-off) which cannot be incorporated into leave-on moisturisers. The benefits of masking is largely associated with increasing skin moisture, so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as potent antioxidants which can be plant derived.

face masks for skin
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Can you overdo masking? If yes, how do you know if you are overdoing it?

If you are using some form of cosmetic clay masks, I do not recommend doing so as these frequently contain astringents which excessively dries out the oil on one’s face using salicylic and lactic acids, typically marketed as products for acne prone skin. I do not recommend any of my acne patients to do that because when they are on medical treatment for acne, a common side effect is dry dehydrated skin. Conversely, one who is doing a home masking regimen that is marketed for reducing oily skin as well as acne, in place of seeking medical treatment for acne, it is possible that he or she ends up using masks containing salicylic and lactic acids (or clay derived products that dries out the skin) too often and may develop skin allergies or eczema. Overdoing masking in this case leads to skin that is dry, irritated, flaky and some people may develop more severe reactions. It is therefore important to get your skin condition properly diagnosed by an accredited dermatologist, rather than simply relying on DIY methods.

My preference for a wash-off face mask is a gel mask formula – Amino Acid 360° Masque. This enables a gentle, non-astringent effect, delivers vitamin C(for acne scars) and other antioxidants in a soothing gel that can be refrigerated to cool post-laser/chemical peel skin, and can also be tolerated by eczema/rosacea patients as well.

The AMINO ACID 360 MASQUE contains a potent concoction of skin brightening Vitamin C which soothes inflamed acne and lightens scars. LARECEA™ Extract with lifting amino acids penetrate the epidermis to stimulate collagen regeneration

Can you mask daily?

Yes definitely. When the mask contains cosmeceutical active ingredients clinically  proven to work on skin, these help to reverse the process of photoaging can have a skin brightening effect. As long as the mask delivers moisture and appropriate antioxidant ingredients instead of astringents (such as clay or charcoal) there is no limit to the number of times one can mask. Another tip I have for budget DIY masks?  Use your favourite ceramide-based moisturiser this way. For intensive treatment, apply a liberal amount of this moisturiser up to 3 times a day and on top of it use a soft damp cotton towel or the blank mask sheets (without essences) to increase absorption.

The MULTI-CERAM MOISTURISER 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.

Can you combine different masks at one time? Or use one after another? And if so, what are some good combinations to follow?

I would not recommend that because of the types of ingredients that may be present in masks that specifically target for example oily skin. In this case, some people may consider their T zone to be oilier and decide to use salicylic or lactic acid infused mask for those areas and a hydrating mask for other areas. In theory, this may seem like a good idea. However, from a dermatologist’s perspective, it is much more efficient in the treatment of oily skin, to apply chemical peel that contains a higher concentration of salicylic acid, lactic acid or glycolic acid as a procedure done at a dermatologist’s office and subsequently rinse it off, rather than having very low concentrations present in a leave-on mask, because the effects will most likely be not as good and over time, may cause skin irritation.

Are there certain masks better suited for certain skin types (eg: peel-off, clay, cream for dry skin, oily skin etc.)?

I typically do not recommend astringent masks (which may include those marketed as clay types or for oily skin) for any skin condition, even super oily skin, because these are not proven to help acne treatment. The face mask that I would recommend would be those for skin moisturisation.

How do you choose the right mask if you have a few different skin problems (eg: dull complexion, dehydrated skin, breakouts all at once) – which skin problem should you address first?

The key thing here is looking at the root of each of these conditions and treating them. For example, a dull complexion is actually related to the ageing process where the skin cells turnover at a slower rate than somebody who is more youthful. In terms of addressing this problem, I would recommend using cosmeceuticals which are applied on to the skin and absorbed, together with chemical peels as well as lasers if necessary as recommended by your dermatologist. Dehydrated skin is quite tricky, because if your skin is so dry that it starts flaking or becomes red, you may be suffering from a form of facial eczema and it is important to have it treated medically, understanding that this is not about face masking at all. In terms of breakouts, acne itself is considered a medical condition that can be treated. It is also not treatable by skincare or face masks on their own. If the acne is severe enough, one may require oral medications, or if it is hormonal, medications like oral contraceptive pills may help to control the underlying problem.

Must I follow strictly to the time stated on the instructions during mask applications? What can go wrong if the mask is applied for longer than required?

For sheet masks, when the mask has dried up due to the process of evaporation, there would really be no point in applying that to one’s skin as there will be no extra benefits. Also, if the active ingredients contain something which is meant to control oil production, it can cause the skin to be very irritated and dry with excessive application. In fact, it may cause problems as excessively long application could increase the likelihood of skin allergy towards such active ingredients.

With clay masks or other types of astringent masks for example, it can certainly cause the skin to develop facial eczema when applied for too long.

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Polysaccharide face masks

Our 360 Conscious Mask Bar subscription is a “Skin & Hair Gym” membership based on the principles of ethnobotany and clean cosmeceuticals. The Mask Bar is a gender neutral self-care concept centred on a universal compact Home Mask Bar System, with hyperpersonalised cosmeceutical essence vials delivered on a monthly subscription basis to your home. 

The Mask Bar subscriptions comes with 2x Polysaccharide masks per month, and 3x customized cosmeceutical essence vials, and a 4L Mask Bar. The energy-efficient 4L Mask Bar is designed to toggle between optimal preset temperatures of 8°Celsius for anti-inflammatory cold therapy and 55°Celsius for relaxing thermal therapy for scalp and hair treatment. 

The 360° Conscious Mask Bar also comes with private access to skin and haircare masterclasses by Dr. Teo Wan Lin. The dermatology masterclass series focuses on the science of skincare/haircare and the treatment of common dermatological conditions such as rosacea, acne and eczema. Class material includes video tutorials, transcripts and worksheets. A private access code will be sent to your inbox with the purchase of the Mask Bar System.

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How to Exfoliate the Face: Best Tips From a Dermatologist

March 11, 2021

Exfoliation, or the removal of dead skin cells from the outermost layer of the skin, is an important and necessary part of any skincare routine. However, if the word ‘exfoliation’ conjures up the action of scrubbing your face with harsh granules, you may be doing more harm to your skin than good. So what is the right exfoliation technique for your skin? In this article we will give you tips on how to exfoliate the face, including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.

Types of exfoliation

Exfoliation can happen in two forms: physical and chemical.

Physical exfoliation: Physical exfoliation relies on the rubbing of granules, particles or materials (cloths, sponges) over the face to remove dead skin cells by gentle mechanical force.

Do not use physical tools to exfoliate the face.

While this kind of exfoliation can leave you feeling refreshed, the technique can be too harsh for the skin, especially for individuals with acne-prone or sensitive skin. Physical exfoliation may even weaken the skin’s barrier function and leave your skin red or irritated.

This is a no-no for those with active acne, rosacea and eczema.

Chemical exfoliation: Chemical exfoliation relies on fruit enzymes and gentle acids to slough off dead skin. This mechanism is much more controlled, gentler than physical exfoliation and suitable for acne-prone and sensitive skin types (lactic acids, polyhydroxy acids, salicylic acids).

Chemical peels

Chemical peels should be performed at a dermatologist’s office under medical supervision. The active ingredient used is much more concentrated and effective, and hence has the potential to cause severe skin irritation. These peels have to be washed off right after the procedure, and otherwise have the potential to cause severe chemical burns. When used appropriately, chemical peels are a safe and effective way to remove dead skin cells and increase collagen production, inhibit pigmentation, reduce active seborrhoea and have an anti-ageing effect overall. With regular use, these treatments exfoliate the face and improve fine lines, wrinkles, skin discolouration and texture.

Exfoliate the skin: chemical peel

Glycolic, lactic or salicylic acid is commonly used. An accredited dermatologist is best able to identify the type of peel for your skin. Some

Individuals with active eczema or rosacea will not be suitable for chemical peels, hence it is important to get diagnosed and treated.

Types of exfoliating acids

The two most well-known type of exfoliating acids is alpha hydroxy acids (AHA) and beta hydroxy acids (BHA).

AHAs: Alpha hydroxy acids work by causing skin cells to detach from the outermost layer of skin, making them easier to slough off. Once the dead skin cells are removed, new cells can rise to the surface.

Common AHAs used as chemical exfoliants are lactic, glycolic and mandelic acid.

Glycolic acid: Glycolic acid is the strongest AHA as it has the smallest AHA molecule. As such, it is able to penetrate deeper into the skin and can exfoliate the face at lower concentrations compared to other acids. However, if you are just beginning to try out chemical exfoliants, a different acid should be considered

Lactic acid: Apart from exfoliating, lactic acid also moisturises. Individuals with dry skin can consider lactic acid for this dual function.

Mandelic acid: With a larger molecular structure, mandelic acid is not able to penetrate deeply into the skin. This makes it a gentle AHA and safe to use, especially for people with sensitive skin.

BHAs: Beta hydroxy acids (BHAs) differ from other AHAs as they are oil-soluble. This property allows them to penetrate deeper into our skin and pores.

BHAs exfoliate the face by softening the outermost layer of skin cells and dissolving unwanted skin debris. They also have anti-inflammatory and antibacterial properties, making them ideal for individuals with oily and acne-prone skin.

How to exfoliate the face: home-use chemical exfoliation

Online vendors are often providing home chemical peel kits which I would never recommend for the above reasons. Many doctor skincare products contain low doses of glycolic acids (AHAs) and lactic/salicylic acids but I have intentionally omitted these in my cosmeceutical formulations.

In my clinical practice, I have observed that the use of such clinical formulations over a period of time is one of the biggest risk factors do developing skin sensitivity, which really is a form of eczema known as irritant contact dermatitis. I would recommend using active ingredients such as a stabilised, pH neutral form of vitamin C (sodium ascorbyl phosphate as opposed to the acidic L-ascorbic acid) hyaluronic acid, phyto-antioxidant plant extracts such as Brassica oleracea (Larecea™) which have been proven to have robust anti-oxidant, UV-protective abilities without the risk of irritation.

The best at-home chemical peel equivalent

The effects of the SilkPeel Home Facial Peel System are that of microdermabrasion which has a similar effect to microscopic skin exfoliation. This is achieved in a clinical setting with chemical peel acids such as glycolic acid, salicylic acid and lactic acid. These, however, are legally used only by trained medical personnel, and should not be supplied to home users. This silk peel provides an at home chemical peel system that is both safe and effective. It has the additional benefit of delivering bioactive cosmeceuticals to the skin, with the use of the Amino Acid Masque for example.

Microdermabrasion

The key feature of our SilkPeel is the CUIONS microcrystalline head. The microcrystalline head effectively performs gentle microdermabrasion when used together with the Amino Acid Masque. This is a home-equivalent to in-clinic diamond microdermabrasion — the home facial kit version designed to be much less irritating to the skin while performing the function of microdermabrasion. We have engineered the copper ion head specifically to have a less abrasive structure than the traditional diamond heads, while retaining the microdermabrasion feature to gently exfoliate dead skin cells. It is suitable for sensitive skin, and can be done safely at home without medical supervision.

Benefits of exfoliation

We shed dead skin cells naturally as new skin cells slowly travel up from the deepest skin layers to the surface. On average, this process takes about 27 days.  As we age, this cell turnover process slows down.

When we exfoliate the face, we remove the build-up of dead skin cells. Regular exfoliation can reveal younger, brighter skin with an even tone.

Over-exfoliation

The benefits of chemical exfoliation may make it tempting to use AHAs and BHAs often. However, too much exfoliation can disrupt your skin barrier and cause the skin to become red and inflamed.

Discuss with your dermatologist how often you should get chemical peels.

Are you looking to exfoliate the face with a chemical peel procedure? TWL Specialist Skin and Laser Centre offers in-clinic photorejuvenation chemical peel procedures. Click button on bottom left to schedule an appointment with us.

The Best Maskne Treatment Explained by a Dermatologist

March 2, 2021

The COVID-19 pandemic has led to mandatory mask-wearing. Many mask-wearers have complained of “maskne” which refers to acne caused by wearing their masks for too long. What are the possible causes of this? Is it due to the material of the mask or accumulated sweat? In this article, I shall share my dermatological expertise on maskne, including common skin conditions that arise from a face mask and maskne treatment.

Masking Up: A Dermatologist's Guide to Maskne

Masking Up: A Dermatologist’s Guide to Maskne by Dr. Teo Wan Lin is written as a guide to the phenomenon, with skincare, makeup tips for the “new normal” of mask-wearing, as well as information on how to choose the right fabric mask. Sold on Amazon Kindle and Kinokuniya.

What is maskne? 

Maskne is a variant of acne mechanica or occlusion acne, which previously prior to the COVID-19, was most commonly seen in athletes who wear headgear (helmets, face guards), amongst medical staff (surgical mask, N95 mask in infectious disease settings), motorcyclists and construction workers who wear helmets. It is a disorder arising from the occlusion of hair follicles, directly related to mechanical stress (pressure, occlusion, friction) and microbiome dysbiosis (from the imbalance with heat, pH, moisture from biofluids including sweat). Both of these are affected by increased duration of mask-wear.

Besides mask acne, what other types of skin diseases can arise from prolonged mask wearing?

Several other skin diseases can be associated with prolonged mask-wearing, due to increased heat and moisture, and may also mimic symptoms of maskne. For example, eczema, rosacea and heat rash may manifest as red bumps and red patches which one may perceive as skin irritation. In my private dermatology practice, we do not do epidemiological studies regarding the number of cases, which should be assessed on a national level. Suffice to say, there has certainly been a very significant increase across the board in incidence of skin diseases associated with mask-wearing.

For those who wear their masks for prolonged periods of time, is there a possibility that the bacteria trapped inside the mask could cause skin infection or irritation?

Mask wearing creates an occlusive microenvironment and this changes the normal microbiome of healthy skin. The term microbiome refers to the balance of germs-bacteria, viruses, fungi, mites, that work with our body to keep it healthy. These germs have to be present for our immune system to work and self-regulate. It is formed at birth, changes as one age, varying in terms of each location i.e. the germs on our scalp are vastly different from that in our oral cavity, our nose, and the rest of the skin. Various dermatological conditions have now been shown to be linked to microbiome dysbiosis, which relates to an imbalance in the skin flora.

What are some of the severe forms of skin disease that could result from prolonged mask wearing?

There are other conditions apart from maskne that can arise from prolonged mask wearing. Individuals with preexisting conditions such as acne vulgaris, perioral dermatitis, eczema of the face and rosacea, may have their conditions aggravated and suffer serious flare ups. This is due to disruptions of the barrier function and microbiome of the skin as a result of prolonged mask wearing which impacts the skin microenvironment and involves also mechanical factors, such as textile-skin friction.

For example, the unique microenvironment created by a face mask causes exposure of the skin to biofluids such as the nasal and respiratory droplets which can alter the pH and microbiome of the skin. With this, individuals who are already prone to greasy skin and acne may find that their acne gets infected more seriously, leading to painful cysts and pustules. In another case, when one is speaking with the mask on, saliva inevitably gets onto the mask.

Saliva itself contains various digestive enzymes. Constant exposure to saliva may cause a form of facial eczema or dermatitis in individuals. In addition, constant contact with mask material also known as textile-skin friction, leads to frictional dermatitis, a form of eczema. It causes redness and results in post inflammatory hyperpigmentation.

For individuals with sensitive skin, what kind of mask material should they opt for, in order for better breathability?

Firstly, individuals with sensitive skin are actually atopic individuals with eczema. It is important to understand that these individuals perceive friction, as well as changes in skin temperatures and other sensations much more acutely. The ideal fabric mask is not just in the material but also in the design, as I have proposed in my white paper on maskne, the Diagnostic and Management Considerations of Maskne in the Era COVID-19, published in the Journal of American Academy of Dermatology1.

The ideal fabric mask design for maskne treatment should encompass details which have been published in the paper. This is a design that minimizes textile-skin friction, omits elastic ear straps which cause additional pressure over the back of the ears, and also allows adequate coverage with the use of a UPF protective biofunctional textile.

In terms of material, we know that natural fibres such as cotton has long been the material of choice for individuals with sensitive skin.

In my white paper, I covered a few key points about the material of face masks affecting the skin. Firstly, natural fibres like bamboo, cotton and silk can wick moisture away, keeping skin dry.  However, they retain fluids and become heavy. This is known as increased fluid saturation. This makes mask wear more uncomfortable. It can also create a sticky feeling. Natural fibres also disintegrate easily with wear, making it ineffective as a face covering to prevent fluid spread. On the other hand, synthetic materials that have been treated with biofunctional properties, examples are dri-fit, or what we incorporate in our biofunctional textiles can cool skin rapidly by enhanced evaporation. They are also water-resistant, minimising spread of contagious droplets.

Best maskne treatment and prevention: biofunctional textile mask design

The OSMIUM BLUE™ anti-aging fabric mask with nanoparticle technology is incorporated with CUIONS™ nanoparticles, which are rigorously lab tested for the active release of copper metallic ions clinically effective for anti-ageing by promoting collagen production and reducing skin pigmentation.

What are some of the additional skincare features that can be incorporated into a face mask?

In my paper on the ideal face mask design, I discussed the novel incorporation of ultra-violet protective factor, UPF into the mask material. This solves the problem of wearing sunscreen under the face mask which can increase comedogenicity -i.e. acne formation. To reduce heat retention and flare-ups of heat-related skin conditions such as miliaria rubra and facial hyperhidrosis, choose light or reflective colours.

Zincool mask for maskne treatment

The ZINCOOL™ zinc nanoparticle impregnated fabric is self-cleaning with whiter than white technology, and incorporates superior skin cooling, creating a highly breathable skin microenvironment, with super evaporation coefficient. It has anti-inflammatory, bactericidal and sebum control functions to treat maskne, and offers benefits for individuals who have facial eczema or are acne prone

In addition, these biofunctional textiles with metallic nanoparticles like copper and zinc have additional anti-oxidant and anti-ageing benefits. The CUIONS technology for biofunctional face masks by Dr. TWL Biomaterials includes copper oxide polyesters associated with reduced face wrinkles. While a lot of masks tout anti-bacterial benefits, these metallic ion textiles with copper, zinc and silver kill bacteria and are considered “bactericidal”. This reduces antibiotic resistance in acne treatment1 as well.

What are your recommendations for maskne treatment?

When it comes to maskne treatment, I would suggest to avoid conventional acne spot creams with synthetic active ingredients such as retinoids, benzoyl peroxide, sulfur, salicylic acid as these will cause increased skin irritation (irritant contact dermatitis) when applied under the occlusion of a face mask. Individuals who apply retinoids for night acne treatment may find that wearing a mask in the day increases the risk of retinoid dermatitis, a form of eczema that leads to redness and flaking on the skin.

Benzoyl peroxide is also known to bleach fabrics and may alter the structural integrity of the face mask, rendering it less effective for control of droplet spread. Anti-inflammatory acne spot creams are recommended for maskne treatment. Acne formulations with botanical actives such as Chlorella Vulgaris work by regulating sebum production, whilst natural moisturizing factors like amino acids fight inflammation and have additional moisturizing properties to protect the skin barrier. Special consideration for skincare as makskne treatment should include anti-bacterial gentle cleansers, moisturisers formulated as Prescription Emollient Devices (PEDs) that help maintain a healthy skin barrier/microbiome.

References:

  1. Teo WL. Diagnostic and Management Considerations for ‘Maskne’ in the Era of COVID-19 [published online ahead of print, 2020 Oct 1]. J Am Acad Dermatol. 2020;S0190-9622(20)32664-5. doi:10.1016/j.jaad.2020.09.063

Skin Cyst Removal, Signs and Causes

March 1, 2021

The two most common skin cysts are epidermoid cysts and sebaceous cysts. Typically harmless, cysts are bumps that show up under the skin. In this article, we will go through what exactly are epidermoid and sebaceous cysts, what are the causes, and treatment options for cyst removal by a dermatologist.

What are epidermoid cysts? 

A cyst is a benign (non cancerous), round, dome-shaped bump that contains fluid or other material. They can appear anywhere on the skin, but are most common on the face, neck, and trunk (e.g chest and shoulders). They are also common on the scrotum and vulva.  

Credit: DermNet NZ

What are sebaceous cysts?

Unlike epidermoid cysts which originate from the skin, true sebaceous cysts are rare and originate form the sebaceous glands.

Sebaceous cysts can be found over you entire body, except for the palms of your hands and the soles of your feet. When squeezed, a small dome shaped projection called a punctum will appear. Through that opening, the sebum may be squeezed out.

Signs of an epidermoid cysts include: 

  • A small blackhead on the opening of the cyst 
  • A thick, smelly yellow material that may drain from the cyst 
  • Often has a diameter of 1-3cm
epidermoid cyst removal

Credit: DermNet NZ

Rupture of the contents of the cyst can lead to swelling, redness, and tenderness. This can occur from bacterial infection such as Staph.A, E.Coli, or from trauma. 

Inflamed cyst: epidermoid cyst removal

Inflamed cyst
Credit: DermNet NZ

Other names for epidermoid cysts: 

  • Epidermal cysts 
  • Keratin cysts 
  • Sebaceous cysts (commonly mistakenly identified as these cysts do not involve sebaceous glands) 

What causes an epidermoid cyst? 

The epidermis – top layer of your skin – is made up of a thin, protective layer of cells that your body sheds continuously. Most epidermoid cysts form when these cells move into the deeper layers of your skin and multiply rather than shed. This causes a buildup of keratin in the skin, developing into cysts.

Sometimes, the epidermoid cysts can form due to irritation or trauma to the skin, or a portion of the hair follicle.  The epidermal cells are the walls of the cysts which secrete the protein keratin into the interior. The keratin is the thick, yellowish substance that sometimes drains from the cyst. 

What causes a sebaceous cyst?

Sebaceous cysts come from your sebaceous glands. Cysts can develop if the gland gets damaged, or the passage through which sebum leaves the skin is blocked. This usually occurs because of some sort of trauma in the area such as a scratch, surgical wound, or skin condition like acne.

Who gets epidermoid cysts?

Epidermoid cysts occur most commonly in adults, especially when young to middle aged. Additionally, they also occur twice as more frequently in men. Injuring the skin can also lead to development of epidermoid cysts.

Having certain rare genetic disorders may also increase the risk of developing epidermoid cysts:

  • Gardner syndrome
  • Basal cell naevus syndrome
  • Pachyonychia congenita type 2

Epidermoid cysts vs sebaceous cysts

Many refer to epidermoid cysts as sebaceous cysts, but they are different. True sebaceous cysts are much less common. Sebaceous cysts start in the sebaceous gland. This is an oil gland in the skin that secretes oil, or sebum that lubricates the skin and hair.  

What are the options for cyst removal? 

Most epidermal cysts are slow growing and painless, so they don’t usually need treatment. However, if the cyst grows rapidly, ruptures or becomes painful, bothers you for cosmetic reasons, or occurs in a spot that causes irritation, you can see a skin specialist to have perform an epidermoid cyst removal. 

Talk to your dermatologist about these options: 

  • Injection: this involves injecting the cyst with a steroid that reduces inflammation and swelling. 
  • Incision and drainage: Your dermatologist will make a small cut in the cyst, and gently squeeze out the contents. While this method is fairly quick and easy, cysts tend to recur after this treatment. 
  • Complete surgical excision: The most effective treatment for is a a complete epidermal cyst removal. Your doctor will remove the entire cyst with an intact cyst capsule. This is done through minor surgery in which you need to return to have stitches removed. 

Looking for cyst removal procedures in Singapore? Book a TeleConsultation with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.

Genital Warts Treatment, Symptoms, and Causes

February 17, 2021

Genital warts are warts that appear on the genital area. In this article, we go through the causes, symptoms, and common genital warts treatment.

What are genital warts?

Also known as anogenital warts, or condylomata acuminata, they usually appear as raised lesions that develop on the skin. They can be flesh-colored, light and pearly, or darker in color. The most common signs are small, scattered bumps, a cluster of bumps that resemble cauliflower, or growths in the genital area that can be raised or flat and smooth.

They are usually painless, but sometimes they can itch, burn or bleed. In men, these warts can be found on the scrotum, shaft of the penis, or even on the thigh. On women, they may be found on the vulva, in the vagina, and on the cervix. Oral sex can result in warts in or around the mouth, on the tongue and gums, in the mouth.

What are the causes of genital warts?

The warts are caused by some types of human papillomavirus (HPV). HPV is a common sexually transmitted infection that are highly contagious. Anyone who has sex can get HPV, and it is very common. At least half of people who have sex has had an HPV infection, and is most common before the age of 30.

However, not everyone who gets an HPV infection gets genital warts. Most never get these warts because their immune system can fight off the virus. Nonetheless, those with a weakened immune system may not be able to fight the virus, and can develop warts.

Genital warts spread from one individual to another through sex (vaginal, oral, anal), genital contact, or childbirth (mother to child).

Who is at risk of genital warts?

Individuals who have unprotected sex, have multiple partners, or who start having sex at a younger age are at increased risk of being infected with HPV and developing genital warts. It is most common in those under 30 years old.

Genital Warts Treatment

How dermatologists diagnose and treat genital warts?

While some genital warts can clear without treatment, removing the warts can lower the risk of virus spread, helps to relieve pain and itching, or can aid in easier cleaning.

If you want to treat your genital wart, it is best to see an accredited dermatologist. Do not buy an over-the-counter wart treatment that is sold without a prescription, these treat different types of warts.

Topical Genital Warts Treatment:

Often dermatologists will prescribe medications that you can apply yourself at home. These include Podofilox for external warts to stop them from growing, Imiquimod to boost the body’s immune system to fight against HPV or other prescription medicines.

Genital Warts Treatment Procedures:

A skin specialist may perform one of these procedures during a clinic visit:

  • Laser treatment (removing the warts with laser light)
  • Excision (cutting off the warts)
  • Cryosurgery (freezing off the warts with liquid nitrogen)

Liquid Nitrogen for Cryosurgery of Genital Warts
Cryosurgery uses liquid nitrogen at –196°C to freeze off warts

Treatment can remove the warts that is seen externally, but it may not fully get rid of the virus. If the virus remains, the wart can return. If you still have the virus, you can still spread it through sex. Wearing a condom can prevent the risk of spreading and catching the virus during sex.

Genital Warts Prevention

  • HPV Vaccine

There are 2 types of HPV vaccines available. One of them is “quadrivalent”, this means that it can protect against 4 types of HPV. This vaccine can protect against the HPV virus that causes genital warts. This vaccine requires 3 shots to be fully vaccinated. Get all three shots before you first sexual encounter for it to be the most effective.

  • Use a condom during sex

Wearing a condom during sex can help reduce the risk of getting genital warts. However, condoms do not cover all the skin in the genital area, hence it is not a full-proof way of protection.

  • Be candid and open with your sexual partners

Before having sexual activity with your partner for the first time, talk honestly about sexually transmitted infections (STI), and check whether or not you or your partner has had or has any STIs, including HPV.

Have a genital wart concern? Book a TeleConsultation, with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.

Copyright © 2021 TWL Specialist Skin & Laser Centre. All rights reserved.

4 Best Sensitive Skincare Tips – A Dermatologist’s Guide

February 16, 2021
Sensitive skin dermatologist shares sensitive skin tips

Dr. Teo Wan Lin is the host of a beauty podcast- Dermatologist Talks: Science of Beauty, which covers the latest in skincare active ingredients, dermatology news and beauty technology. Listen to her podcast here.

In this Conscious Beauty blog series which ties in with the launch of my podcast- Dermatologist Talks: Science of Beauty, I will be sharing about sensitive skincare tips in common dermatological conditions. 

This article will focus on a sensitive skin dermatologist’s view on skin reactivity and sensitivity, tips on managing skin sensitivity, as well as how to know if you have eczema. 

Reactive skin is characterized by marked sensitivity to physical (heat, cold, wind) or chemical (topically applied products) stimuli and by the impairment of the skin barrier’s ability to repair itself

A sensitive skincare routine is critical in the treatment of sensitive skin and eczema. I shall share about the types of moisturisers you should look out for and the active ingredients helpful in treating dermatitis.

What is dermatitis? Symptoms, Signs and Diagnosis

Dermatitis is equivalent to eczema. There are various subtypes of dermatitis that we see in dermatology.

The typical type of eczema that we see affecting children and adults is known as atopic dermatitis. This is a genetically inherited tendency to develop dry skin and sensitivity. It is due to a genetic defect that results in a filaggrin mutation. This produces deficient or insufficient amounts of the fatty lipid ceramide, which functions to moisturize the skin’s outer layer. Another type of dermatitis is known as seborrheic  dermatitis. The term seborrhea refers to oil production. 

To break it down, seborrheic dermatitis really refers to oily skin that is sensitive and is inflamed. So having both symptoms of dry and oily skin can be suggestive of the disease. Seborrheic dermatitis characteristically affects the eyebrow areas, around your nose (nasolabial) around the mouth. Individuals who suffer from mild to moderate separate dermatitis may find that they have increased flaking on the scalp. Symptoms of dandruff, scalp sensitivity, oiliness- especially if they don’t wash their hair daily is suggestive of seborrheic dermatitis. In severe cases, they may develop a condition known as sebopsoriasis, where they have larger areas or red flaky patches on the scalp. 

Another type of dermatitis known to dermatologists is known as perioral dermatitis. Perioral dermatitis is a condition that results in acne-like bumps, known as papules around the mouth area, hence the term perioral. It is associated with flaking dryness and red patches. It is sometimes misdiagnosed as hormonal acne. An accredited sensitive skin dermatologist can accurately diagnose if you have hormonal acne or perioral dermatitis, or sometimes, both. 

Risk Factors for Sensitive Skin

The risk factors for developing sensitive skin or eczema is as follows. If you have a personal history of allergic rhinitis, sinusitis, asthma, hay fever, then you’re at a higher risk of developing skin sensitivity or eczema. If anybody in your family has any of these conditions, you’re also considered at higher risk. 

What is the difference between sensitive skin and reactive skin?

Both terms sensitive and reactive skin are not used as scientific terms in dermatology. Rather, they have been coined to describe a pattern of skin behavior that laypersons can easily understand. For the purposes of this article, sensitive skin is best understood as synonymous with individuals with atopy- or tendency to develop allergies and eczema. This is directly related to barrier dysfunction of the skin. On the other hand, reactive skin refers to individuals whose skin symptoms develop in reaction to external triggers. 

Reactive skin can be understood as sensitivity to external stimuli. External triggers can be in the form of physical changes, such as temperature or pressure on the skin. It can be due to skincare or what is described as contactants. Reactive skin reacts to these triggers in the environment. This leads to inflammation in skin. Importantly, human beings are not meant to live in a controlled “bubble” and healthy skin can tolerate these changes.

When one develops sensitive skin, the impaired skin barrier function causes a skin reactivity because these allergens penetrate the skin. This triggers the immune system. 

The underlying cause of reactive skin can be due to multiple different dermatological diagnosis. Sensitive skin individuals generally have reactive skin, while only aminority of individuals with “reactive skin” actually do not have sensitive skin.

Specifically, individuals with conditions such as rosacea qualify as having reactive skin, as heat and sunlight triggers the condition. If you suffer from rosacea,  you may not have concomitant dry sensitive skin. However, there are patients who have both rosacea (a type of reactive skin condition) and eczema. In this case, both conditions have to be treated for the skin to look normal.

Another type of reactive skin condition in dermatology is a condition known as hives. Hives on the skin is also known as urticaria. Cholinergic urticaria is a type of heat rash that is triggered by raised temperatures. Aquagenic urticaria develops as skin rashes after contact with water.  If you get rashes after having air conditioning blown directly at you, you may have a form of physical urticaria. Developing rashes over where elastic waistbands and straps are is also a form of dermographism, or pressure urticaria. 

If you have urticaria and eczema together, you have both reactive and sensitive dry skin symptoms. However, you can also have hives and still have a normal skin barrier, which means your skin doesn’t feel dry. If you have both, treating the skin barrier with a “PED” moisturiser, such as the Multi-Ceram cream I formulated under Dr.TWL Dermaceuticals. It stands for “Prescription Emollient Device” which means it contains an optimal lipid (fat) ratio that balances the skin repair mechanism. It also has a steroid-like anti-inflammatory effect which helps reduce the dependence on steroid creams long term for eczema. 

Reactive skin conditions such as rosacea leads to skin inflammation that result in skin thickening. This is cosmetically disfiguring, causing enlarged pores and uneven skin texture.

Treatment of Sensitive Skin, Reactive Skin and Eczema

Sensitive Skincare Tip #1: Understand the skin barrier -protection matters

My first of the 4 sensitive skincare tips, is that if you have sensitive or reactive skin is to understand the concept of the skin barrier. In my previous article I spoke about the skin barrier- best visualized as a wall that protects the internal environment from the external environment. External triggers like pollutants, dust, pet fur present to the body’s immune system as allergens. These are common triggers for eczema. 

The skin barrier also degenerates with ageing and environmental exposures. If you are constantly doing wet work i.e. housework or working in an occupation which involves wet work. This increases your risk of eczema. 

Frequent contact with water, being in a damp environment increases trans-epidermal water loss. Trans-epidermal water loss due to evaporation from the skin surface can deplete the moisture levels of the skin. This makes it prone to skin irritation. 

Remember to wear appropriate protective gloves when in performing wet work. No matter how resilient your natural skin barrier is, it will suffer damage with accumulated exposure. If you are not wearing protective gloves, even detergents made for sensitive skin will still strip the skin barrier of moisture.

Sensitive Skin Dermatologist on How to prevent hand eczema

This is the way to wear your protective gear, a set of long gloves, preferably latex free. Individuals who have skin sensitivity may also have concomitant latex allergy. Wear long gloves that reach up to your elbows for complete hand protection. As a sensitive skincare tip, I recommend my patients to double glove. This means a set of cotton gloves on the inside, and the set of longer gloves on outside. This will reduce your exposure to the chemical detergents. 

Lathering agents i.e laureth sulfates weaken the skin barrier. When you are mopping the floor, with bleach or disinfectant, your feet comes into contact. Over time, this results in irritant contact dermatitis when the skin’s barrier function is damaged. High contact areas such as the hands and feet are often the first areas to develop skin sensitivity in individuals who do not have a genetic tendency to develop eczema so if you have developed this, then it’s possible that you actually acquired it true the exposure, with these substances.

Performing housework without protective gloves or boots exposure to detergents household cleanser cleaning agents can increase your risk of developing eczema. In this context, there are two main types of dermatitis. Acquired dermatitis can be in the form of allergic or irritant contact dermatitis. The other is atopic dermatitis, as discussed earlier. The difference between allergic and irritant contact dermatitis would be in the mechanism of reaction that occurs to cause skin hypersensitivity. 

If you are chronically exposed to harsh cleaning agents, you’re likely going to develop a form of irritant contact dermatitis. The strong chemicals in these cleansing agents, meant to dissolve tough stains- will break down the skin barrier over time. In addition, if you have atopy, certain ingredients such as fragrances, or preservatives may trigger an allergic reaction. 

Sensitive Skincare Tip #2: Opt for surgical steel jewelry 

Individuals who have metal allergies i.e. to costume jewelry, actually have a form of nickel hypersensitivity, and this itself is more prevalent in individuals who have atopic dermatitis. It is important to note that most people develop nickel sensitivity in the later part of their life. This is due to exposure to costume jewelry that causes sensitisation. 

The allergic reaction does not arise immediately.  It usually occurs after several exposures to the substance, causing the immune system to remember the allergen. Surgical steel jewelry is distinct from stainless steel jewelry (304) as it is labelled 316L with medical implant grade steel that is virtually free of environmental nickel contamination. 

Sensitive Skincare Tip #3 Get your sensitive/reactive skin condition properly diagnosed by an accredited dermatologist 

Reactive skin cannot just be treated with moisturizers as the underlying condition is medical in nature as opposed to just dry skin causing barrier dysfunction. For urticaria or hives, an effective oral anti-histamine regimen, coupled with avoidance of triggers is required.

Diagnosis must be made by an accredited dermatologist. You can check your doctor’s accreditation here. Aesthetic doctors are general practitioners and not considered skin specialists. Mistaking rosacea for eczema or sensitive skin will worsen the condition. Eczema treatment is usually with anti-inflammatory topical steroids. Steroid treatment used for eczema will cause worsening of rosacea. There is a special type of rosacea known as steroid-induced rosacea- causing skin thinning, prominent blood vessels, raised bumps (acne rosacea) and further flushing symptoms. 

Furthermore, it is critical to understand the underlying biological processes that cause reactive and sensitive skin. Sensitive skin is mainly due to loss of normal skin barrier function. Reactive skin is not strictly used as a medical term, although it is best interpreted by laypersons as skin that easily reacts to external changes i.e. environment. Skin sensitivity and reactivity  are common skin symptoms for facial eczema and rosacea.

Sensitive Skincare Tip #4 Manage Emotions and Mental Stress 

Managing your psychological state is very important. Reducing mental and emotional stress will prevent stress hormones that are released into your blood circulation. These stress hormones trigger inflammation and directly cause flare-ups of dermatological conditions such as acne, rosacea, eczema, psoriasis and even hair loss. Research shows consistently that psychological stress in laboratory mice worsens existing skin and hair diseases. It is also a risk factor for the development of new dermatological conditions.

One of the key indicators of stress is the emotion of being overwhelmed, feeling that one is unable to cope with the situation. Stress is subjective because what causes stress in an individual may not cause any stress in another. This has to do with mental resilience. Resilience cannot be acquired overnight or easily taught- as it has to be practised. Mental and emotional resilience is a character trait acquired through real-life experience in various difficult situations. 

Resilience can only be acquired in adversity- by conditioning your mind and emotions to respond in a positive manner in relation to the stressful situation. 

Brain training is another important way to harness this ability to overcome psychological stresses. The practice of mindfulness is a method that is evidence-based in cognitive behavioral science. A mindful attitude embraces the following: focusing on the moment, having a non-judgmental attitude, cultivating a “beginner” mindset. This helps the individual reduce perceived stress. Mindfulness activities include meditation, or activities that requires focus- engaging in craft or doing sports. My patients with long term skin conditions such as eczema, rosacea and even acne experience flare ups, whenever they feel stressed. Therefore, long term stress coping strategies form a critical part of medical treatment.

“Your healing journey towards beauty, begins with your consciousness of the inner world,” Dr. Teo Wan Lin.

Conscious Beauty 

Conscious Beauty by Dr.TWL Dermaceuticals stars model-actress Sara Malakul Lane, international burlesque performer Sukki Singapora and dermatologist at TWL Specialist Skin & Laser Centre Dr. Teo Wan Lin. Feminine beauty as a modern tale told by the girls themselves, through the lens of fashion model-turned photographer Sabrina Sikora.
E-book version only. 100% of proceeds received from CONSCIOUS BEAUTY will go to charitable causes supported by Dr.TWL Dermaceuticals – Action for AIDS Singapore and the United Nations World Food Programme. Available on Amazon Kindle, and the Dr. TWL Dermaceuticals website.

Dr. Teo Wan Lin is an accredited dermatologist practising at TWL Specialist Skin & Laser Centre. An expert in dermocosmetics for skin diseases, the skin microbiome and biofunctional textiles, her work has been published in top dermatology journals. Her additional research interest is in the brain-skin connection which emphasises psychological wellbeing in sufferers of chronic skin disorders. In her journey of helping dermatology patients for over a decade in practice, she strongly believes that true beauty has to begin from the inside rather than from the external.

Reactive Skin – Effective Treatments by Dermatologist

February 16, 2021
Reactive Skin

Reactive skin is a term that has been used to describe sensitivity to external stimuli. This external stimuli can be in the form of physical type of manifestations, such as changes in temperature heat, cold, or even the presence of wind on the skin, or it can be chemically induced wherever whereby the skin reacts to topically applied skincare and all these factors. Subsequently, lead to inflammation in the skin. The key here is most individuals are able to tolerate environmental changes. However, in a certain group of individuals who has sensitive skin, they actually have an impaired skin barrier function which means that these external stimuli tend to cause skin reactions.

Causes of Reactive Skin

Reactive skin can be due to multiple different dermatological diagnosis, whereas sensitive skin in general, is used to refer to individuals with a form of eczema. These individuals have dry skin and have inherited a deficient molecule that leads to barrier dysfunction. Reactive skin can be due to a condition known as hives, also known as urticaria. There is a Cholinergic type of urticaria which is a type of hives that reacts to heat. And also, even to water in a type of urticaria known as Aquagenic urticaria for individuals who develop hives in response to water. After being exposed to wind or air conditioning, they most likely have a form of physical urticaria.

If you’re familiar with images of individuals who seem to have writing on their skin. This is actually a phenomenon known as Dermatographia and is part of this constellation of diagnosis that fit under the reactive skin umbrella. Individuals with urticaria can have concomitant eczema sensitive dry skin. They could also have a normal skin barrier, and only react specifically to the stimuli. It is very common to have both diagnosis together.

In addition, one may also have a condition such as rosacea whereby the skin reacts to extremes of temperature, in particular heat, as well as UV radiation. This sort of reactivity actually causes long term skin damage because of persistent inflammation. The excess blood flow can cause skin thickening over a period of time, leading to the appearance of enlarged pores and irregular skin texture.

Reactive Skin vs Sensitive Skin

It is important to differentiate in an individual between reactive versus sensitive skin. For example, if you are just trying to treat reactive skin with moisturizers alone, you are very likely going to have a sub optimal result. In addition, another possible mistake is treating rosacea with the treatment meant for sensitive skin as a form of eczema, usually in the use of anti inflammatory topical steroids. The steroids itself is inappropriate treatment for rosacea. This can in fact lead to worsening of the rosacea because it can cause steroids induced rosacea flare ups.

Furthermore, it is critical to appreciate the underlying pathophysiological processes that cause reactive and sensitive skin. Sensitive skin itself may be synonymous with dermatitis or eczema, dry skin conditions, and is primarily due to barrier dysfunction. Reactive skin, on the other hand, is a lot more complex because, in and of itself, reactive skin is not used as a medical term. This includes also the term sensitive skin, as both of these terms were coined by laypersons to describe certain symptoms of the general population.

Role of Probiotics

Some advances in our understanding of skin sensitivity and reactivity have been in the form of topical probiotics, in particular, by bifidobacterium longum extract, which was proven in a clinical trial and published in the Journal of Experimental Dermatology, to improve sensitive skin. Specifically, the results of this study demonstrate that this bacterial extract has a beneficial effect on reactive skin, and that new approaches based on bacterial lysate could be developed for treatment and/or prevention of symptoms related to sensitive skin.

Let’s talk a little bit more about what probiotics. Probiotics can be in the form of fermented or non fermented food products. They are actually part of our intestinal microflora and have a beneficial outcome by exerting an anti-inflammatory biologic effect. This is the reason why doctors tend to prescribe them as a part of functional food diets. It is interesting that live probiotics, not just regulate the intestinal health, but can also have beneficial immunomodulatory effects on skin. This has been evidenced in a study, which has also showed that an ingested probiotic was able to reduce skin sensitivity in patients who have eczema.

Have a reactive skin concern? Book a TeleConsultation, with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.


Copyright © 2021 TWL Specialist Skin & Laser Centre. All rights reserved.

Dermatologist Recommended Skincare Tips

February 8, 2021
Dermatologist Recommended Skincare Tips

Do I need to see a dermatologist for my skin problem? How about dermatologist recommended products?

That is one of the commonest searched questions relating to visiting a dermatologist in Singapore.

What constitutes a ‘skin problem’? It is best defined in laypersons terms as a visible disorder of the skin that has affected your quality of life. Based on the symptoms of the disease, it’s important to consider that all almost all skin conditions start mild, and they progress over a period of time. Acute dermatological conditions such as rashes related to infections or hives tend to be related to an underlying systemic disorder such as a viral infection. A dermatologist is trained to distinguish between acute and chronic skin problems. He or she can also identify the underlying cause of the skin rashes, and recommend comprehensive care for your condition including the types of products that should be used.

Sudden Red Rashes due to Viral or Bacterial Exanthems 

Some helpful screening questions for acute rashes in dermatology would be the presence of fever, coryzal symptoms i.e. cough, runny nose, sore throat. A dermatologist can decide if it is related to the underlying infection or it’s a separate dermatological disorder. Rashes linked to underlying infections are known as exanthems and can be diagnosed with a full blood count, which can show a viral or bacterial infection. If it is due to an allergy, the eosinophils can be raised. 

Exanthems are treated symptomatically with a combination of topical steroids, antihistamines, moisturizers and gentle cleansers. 

Itchy Red Rashes on the Face and Body

However, one could also have concomitant skin reactivity or sensitivity, known as eczema. There are different forms of eczema under the term dermatitis. Seborrheic dermatitis, atopic dermatitis, perioral dermatitis are all forms of eczema. 

If you are struggling with acne that is persistent over a period of several months with more pimples and if you are already an adult struggling with this issue, then you should also visit dermatologists. This is especially so if over the counter medicated creams for acne such as those containing benzoyl peroxide salicylic acid are not working for you. It may be a sign that your acne requires specialist treatment.

In addition, acne causes scarring, that can cause psychosocial distress in the medium to long term. It is important to understand that acne, can cause psychological problems, so it is best to have it treated promptly to minimize further scarring. If you are suffering from eczema and have been using a gentle cleanser and a dermatologist recommended moisturizer for some time without improvement, you should see a dermatologist. This is also because the condition may progress, and you will likely need prescription topical steroids.

Is my skin condition due to my skincare products? Is it bad to use different face products?

Perioral dermatitis in particular looks like hormonal acne, and is sometimes misdiagnosed by non-specialists.  It presents as a cluster of red bumps around the mouth area, which may be itchy or painful. The condition can be caused by the use of many different types of products in individuals who like to experiment with skincare. Switching skincare very often, especially products which contain AHAs, BHAs like salicylic acid can be a risk for those predisposed to developing perioral dermatitis. Gentle dermatologist recommended cleansers are best, as opposed to cosmetic cleansers. For makeup removal, micellar water can cause more skin dryness than oil emulsion “milk cleansers” which are gentler on eczema-prone sensitive skin.

In perioral dermatitis, oil-based cleansers can trigger off flareups. Toothpaste can also aggravate the dermatitis. An SLS-free toothpaste, or a mint-free formula can be beneficial. Sunblocks and sunscreens are necessary in preventing sun-induced skin sensitivity. However,  certain formulas can trigger off perioral dermatitis. A dermatologist recommended sunblock such as the SunProtector which contains skin soothing anti-oxidant purslane extract (portulaca oleracea), with a combination of both physical block and chemical sunscreen is best for broad-spectrum UV protection in sensitive skin.

Certain brands of chemical sunscreen will irritate sensitive skin. However, pure physical sunblocks tend to leave a whitish cast and have poor cosmetic effect. At Dr. TWL Dermaceuticals, we formulate a sunscreen which is a combination of both physical and chemical block, which does not leave a whitish cast and is dermatologist recommended for rosacea, acne-prone, eczema type skin. 

Perioral dermatitis needs to be diagnosed and treated by a dermatologist

Treatment of perioral dermatitis is challenging and usually a course of oral antibiotics, together with topical treatment. It is important for an individual who’s suffering from this condition to visit an accredited dermatologist for accurate diagnosis and treatment. This condition traditionally does not respond well to topical cream management.  Skincare moisturizers can actually worsen perioral dermatitis. Traditional dermatologist recommended moisturizers may not work well in patients with perioral dermatitis.

Dermatologist Recommended Hyaluronic Acid

Occlusive ingredients such as mineral oil and paraffin in particular will trigger flare-ups and must be avoided. Preservative-free hyaluronic acid based moisturizers such as the 1% pure hyaluronic acid serum by Dr.TWL Dermaceuticals is prescribed in the clinic for skin conditions such as eczema, rosacea and acne may be better tolerated. It is multi-molecular weighted, which ensures optimal absorption of the serum. Common preservatives in skincare formulations can actually trigger perioral dermatitis, and are not dermatologist recommended.

5 Best Rosacea Skincare Tips – A Dermatologist’s Guide

January 25, 2021
Rosacea Skincare Tips, iintroducing Dermatologist Talks: Science of Beauty

Dr. Teo Wan Lin is the host of a beauty podcast- Dermatologist Talks: Science of Beauty, which covers the latest in skincare active ingredients, dermatology news and beauty technology. Listen to her podcast here.

In this Conscious Beauty blog series which ties in with the launch of my podcast- Dermatologist Talks: Science of Beauty- I will be sharing about skincare tips in common dermatological conditions.  Do you suffer from facial redness or flushing? Facial erythema can be caused by acne, rosacea, eczema and even autoimmune diseases like lupus. Most commonly, facial redness is due to rosacea. It is a disorder where the skin’s blood vessels are abnormally active leading to persistent skin inflammation. This article will focus on dermatologist rosacea skincare tips, medical therapies, as well as the role that a rosacea skincare routine has to play in treatment. 

Rosacea Symptoms, Signs and Diagnosis

Rosacea is a dermatological condition characterised by the tendency of one’s skin to become flushed or red. This can happen in the presence of certain triggers or when the disease is advanced, it may present as persistent redness. It is a condition affecting many in Singapore. It can also be fully treated by a dermatologist.

How does the skin look like? Firstly, there is persistent flushing, which presents as redness on the face.  In skin of color, the redness may not be obvious. However the individual over time develops skin textural changes, which can become disfiguring. Irregular skin texture, enlarged pores and eventual skin thickening are medium to long term complications of untreated rosacea.

In general, onset of the skin inflammation occurs when one is between 30 to 50 and tends to affect fair skinned individuals from a Celtic or Scandinavian ancestry. It is also seen commonly in Chinese people in Singapore. 

Rosacea is diagnosed visually, examining the skin around the nose and eyes, and from asking more questions. Before giving you a diagnosis, your dermatologist would have to rule out other medical conditions that can look like rosacea. Medical tests can help to rule out conditions like lupus and allergic skin reactions. 

  • Family history: It is more likely for you to get rosacea if you have a family member who also has rosacea. It is possible that people inherit the gene for rosacea. 
  • Immune system: Research has found that many people who have acne-like rosacea, or papulopustular rosacea, react to a bacterium called bacillus oleronius. This reaction causes their immune system to overreact. 
  • Intestinal bug: H Pylori is a bug that causes infections in the intestine. This bug is also common in those with rosacea. There is a hypothesis about the Helicobacter pylori bacteria colonizing the gut of rosacea patients, which explains why treatment with metronidazole can be effective in treatment.
  • Skin mite: Demodex is a mite that lives around the nose and cheek areas on the skin. This is where rosacea often appears. Studies have found that people with rosacea have large numbers of this mite on their skin. 
  • Processing of protein: The protein cathelicidin usually protects the skin from infection. How the body processes this protein may determine whether a person gets rosacea.

Topical treatment can include brimonidine, metronidazole and azelaic acid. However, these have irritating side effects.There is increasing evidence to support the use of cosmeceuticals, which do not have side effects, for the adjunct treatment of rosacea. At TWL Specialist Skin & Laser Centre, our dermatologist uses cosmeceuticals for the treatment of mild to moderate rosacea, in combination with  oral treatment where necessary. Anti-inflammatory oral antibiotics may be required for papulopustular subtypes i.e. tetracycline, erythromycin, to reduce skin inflammation. In severe papulopustular variants, isotretinoin may be required. Light therapies and lasers may be of value as adjunct treatments. 

Rosacea Skincare Tip #1 Respect the Skin Barrier When Cleansing and Moisturising 

We’re going to talk about the role of the skin barrier in rosacea. 

The skin barrier is best thought of as the physical “wall” that separates the external and our internal cell environment. An intact skin barrier protects from external allergens and environmental damage. An individual with rosacea may have associated eczema, making face redness worse. This can be pre-existing childhood eczema or due to external factors such as harsh drying skincare. 

When you suffer from a dermatological condition like rosacea, it is important to have it treated by an accredited skin specialist. Your rosacea skincare routine affects skin barrier function. When it is intact, there is less inflammation and facial redness will improve.

In your rosacea skincare routine, gentle cleansers are recommended. For foaming cleansers-these can be amino- acid based or formulated with lower SLS (sodium laureth sulfate) content. SLS- free cleansers usually contain alternatives like ammonium-laureth sulfate. Laureth sulfates can all strip the skin of moisture. SLS-alternative foaming cleansers can be natural emulsifiers, such as soy-based or honey. Medical-grade honey is purified and retains bioactive properties. It is a broad-spectrum anti-microbial. It inhibits bacteria, fungi and also moisturises the skin.

The function of gentle cleansers for rosacea can be two-fold. First by emulsifying the dirt, oil and grime in a lather which is then rinsed off. Second, the best cleanser leaves a beneficial residual effect on skin. It continues to act after the cleanser is washed off. This is possible with medical-grade honey cleansers that have a natural humectant property, trapping water under the skin’s surface. This reduces trans-epidermal water loss (TEWL).

If you wear makeup, double-cleansing is recommended. The type of cleanser to remove makeup has to effectively dissolve oil-soluble makeup pigments. An oil cleanser or a oil-in-water cleanser (usually formulated as a milk cleanser) will be gentler on your skin then a micellar formulation. 

Rosacea Cleansing Tips Explained by a Dermatologist

Gentle skincare is key. The goal of a rosacea skincare routine is to maintain integrity of skin barrier while avoiding agents that cause inflammation/flushing. Non-soap cleansers with synthetic detergents (pH 4.0-6.5) are better tolerated than traditional soaps (pH >6.5). Avoid harsh topicals such as toners, exfoliating agents and astringents. In erythematotelangiectatic rosacea and facial erythema (flushing), telangiectasia, eczema-like features such as skin sensitivity (burning or stinging sensation), dryness and scaling can be present. The redness can also affect other areas e.g. scalp, ears, neck and chest. 

Repair the skin barrier while undergoing rosacea treatment. Facial redness can be caused or worsened due to facial eczema. If you have itch, swelling and skin flaking, you may have dermatitis, which can co-exist with other dermatological conditions. 

The Best Type of Moisturiser for Sensitive Skin

Moisturisers in your rosacea skincare routine should target barrier repair. The best moisturiser for sensitive skin and rosacea is one with ceramides.  Ceramide-dominant moisturisers with an optimal lipid ratio help to replenish dehydrated skin. The gold standard moisturiser is formulated as a Prescription Emollient Device with additional anti-inflammatory ingredients. Hyaluronic acid and polyglutamic acid are additional hydrating molecules that do not leave a greasy feel in a tropical climate like Singapore. Polyglutamic acid is more effective than hyaluronic acid in attracting water molecules, but can be more expensive.

Rosacea Skincare Tip #2 Anti-Oxidants Target Inflammation

Inflammation occurs in rosacea. In papulopustular rosacea, inflammatory papules and pustules are present in addition to persistent face redness. Phymatous rosacea is a subtype of rosacea that shows thickened and coarse skin. Enlarged pores (dilated hair follicles on facial skin) may be a sign of rosacea, due to tissue overgrowth. Irregular skin texture can be due to nodules. These changes can get worse as one ages. Cosmeceutical skincare containing anti-oxidants fight inflammation in a healthy skincare regimen.

Importantly, skin inflammation in rosacea should be treated medically. This is because the end stage of persistent inflammation is a condition known as rhinophyma. Rhinophyma is disfiguring and surgical methods, including fractional CO2 laser resurfacing, may be required treatment when the disease is advanced.  

Dermocosmetics are the latest development in cosmetic dermatology. There is evidence supporting botanical anti-inflammatories in skincare formulations. 

As a rosacea skincare tip, active ingredients such as Gingko Biiloba, Camellia Sinensis, Aloe Vera, and Allantoin are beneficial in treatment. Gingko Biloba works for redness because of active terpenoids.  Gingko reduces blood vessel hyperactivity through its anti-inflammatory effect. Polyphenols are powerful antioxidants that fight free radicals. Green tea known as camellia sinensis is a source of polyphenols that are anti-inflammatory. It has been shown to reduce UVB-induced inflammation. Bioactives in aloe vera include aloin, aloe emodin, aletinic acid, choline and choline salicylate which are anti-inflammatory. It can also balance the skin microbiome.  Allantoin is a derivative of glyoxylic acid from the comfrey plant. It is a humectant and attracts moisture, restoring barrier function in patients with facial redness.

Common Misdiagnoses of Rosacea 

Acne rosacea is the commonest subtype seen in dermatologist offices. It commonly occurs over the nose, forehead, cheeks and chin. An accredited dermatologist will be able to correctly diagnose, based on clinical examination, as well as symptoms derived from history taking. It mimics acne and can be mistaken for pimples. It is also possible for early rosacea to be misdiagnosed as facial eczema coexisting with acne, because of the background redness. The papule-pustular variant can appear with acne-like bumps, cysts, or nodules.  The facial redness is due to visible blood vessels, also known as telangiectasia.

The flushing and skin swelling can look like sensitive skin or eczema.  It also mimics the enlarged pores of oily skin-types, when in fact the thickened skin is due to rosacea. Flaking, redness and red bumps around the mouth can be due to perioral dermatitis. It can affect the eyes, resulting in blepharitis, where one develops red and irritated eyes. This can be confused with findings of ocular rosacea- dryness, irritation and a foreign body sensation. Other dermatological conditions that can mimic rosacea include seborrheic dermatitis, lupus erythematosus, polycythaemia rubra vera and carcinoid syndrome which are less common. Steroid-induced acne may be a consideration if there is a history of using steroid creams on the face. 

Rosacea Skincare Tip #3 Sunprotection 

While it has multifactorial origins, lifestyle factors affect rosacea significantly. Sun exposure, consumption of alcohol, emotions, spicy foods, medications, menopausal hot flushes, exercise and stress can trigger flare ups. 

Sun protection is an essential component of a rosacea skincare routine. It is critical in treatment of all facial redness which is photosensitive. The cheeks are the most affected. As it is now covered by a face mask in a post-COVID19 world, sunblock may not be a practical measure of photoprotection. I have suggested in my research paper on maskne that UPF50+ biofunctional textiles be used as primary photoprotection with a face mask design. This means there is no need for reapplication.

However, as a rosace skincare tip, sunblock can also cause facial stinging in rosacea patients. A UPF50+ textile provides maximum broad spectrum UV-protection without any risk of skin irritation. For uncovered areas like the forehead, neck and upper chest, a broad-spectrum sunscreen is necessary. To prevent stinging, look for a sunscreen that is dermatologist-recommended. Also, UV-blocking ingredients such as titanium oxide and zinc oxide function as physical blockers are less sensitising. Look for additional protective ingredients such as dimethicone, cyclomethicone to prevent irritation from sunscreen ingredients.

Dermatologist’s Tip: Top Rosacea triggers

Various environmental or lifestyle factors can exacerbate rosacea. Heat, sunlight, stress, hot or cold weather, exercise, alcohol, spicy foods and certain skin care products. Emotions can also increase the frequency of disease flares. To reduce flushing after encounter with stimuli, applying cool compresses and transferring to cool environments may be helpful. Cold therapy can be harnessed for its anti-inflammatory effects. 

Rosacea Skincare Tip #4 Cosmetic camouflage 

The use of cosmetic products such as green colour correcting concealers can help. Cosmetic camouflage is a recognised intervention as part of rosacea treatment.  Green-tinted concealers or foundation helps to camouflage facial redness. This can be followed by a flesh-coloured facial foundation to achieve a natural look. I develop a line of color-correcting concealers in my skincare makeup line that helps with concealing.

Dermatologist’s Tip: Best Concealer for Rosacea? It’s Green 

Based on color science, green neutralises red, a color on the opposite end of the colour wheel. Cosmetic camouflage is an important part of rosacea treatment. It can alleviate psychosocial distress. Patients suffer significant embarrassment from episodes of facial redness. This perpetuates a cycle that makes the chronic condition more stressful. 

Rosacea Skincare Tip #5 A daily skincare ritual can help with your skin and also boost your mood 

Stress is a major trigger factor for rosacea. Some scientific ways to reduce psychological stress include cognitive reframing and mindfulness activities. Adopting a daily skincare ritual is beneficial mentally and physically for rosacea treatment. We have discussed the essential steps in a skincare regimen for sensitive, reactive skin. This maintains a healthy skin barrier, restores the skin microbiome and provides anti-oxidants to help protect. However, the additional value of a daily skincare ritual is that it improves psychological well being.

Self-care is a concept that allows the mind to re-charge together with the body. As a rosacea skincare tip, having a bed-time ritual for example, is healthy for sleep hygiene. Starting your work day with a ritual, can make you more productive. I created the 360 Conscious Mask Bar as a complete self-care concept with anti-inflammatory benefits for rosacea, sensitive/reactive skin patients. Cold therapy/ cryotherapy can be relaxing and soothing both physically and psychologically. 

Conscious Beauty 

Conscious Beauty by Dr.TWL Dermaceuticals stars model-actress Sara Malakul Lane, international burlesque performer Sukki Singapora and dermatologist at TWL Specialist Skin & Laser Centre Dr. Teo Wan Lin. Feminine beauty as a modern tale told by the girls themselves, through the lens of fashion model-turned photographer Sabrina Sikora.
E-book version only. 100% of proceeds received from CONSCIOUS BEAUTY will go to charitable causes supported by Dr.TWL Dermaceuticals – Action for AIDS Singapore and the United Nations World Food Programme. Available on Amazon Kindle, and the Dr. TWL Dermaceuticals website.

“Your healing journey towards beauty, begins with your consciousness of the inner world,” Dr. Teo Wan Lin

Dr. Teo Wan Lin is an accredited dermatologist practising at TWL Specialist Skin & Laser Centre. An expert in dermocosmetics for skin diseases, the skin microbiome and biofunctional textiles, her work has been published in top dermatology journals. Her additional research interest is in the brain-skin connection which emphasises psychological wellbeing in sufferers of chronic skin disorders. In her journey of helping dermatology patients for over a decade in practice, she strongly believes that true beauty has to begin from the inside rather than from the external.