Have you been experiencing more breakouts during the COVID-19 pandemic? In this interview transcription, Dr. Teo Wan Lin talks about Maskne skincare, common skin issues, and self-care tips in the COVID-19 era.
Dr. Teo Wan Lin, a #HerWorldTribe member and a key opinion leader in the field of cosmeceuticals (including the realm of maskne skincare), was invited as a guest dermatologist for Clinique’s #EvenBetterTomorrow campaign on HerWorld Singapore’s IG Live.
Dr. Teo shared over a lunchtime conversation with editor Ng Yi Lian her latest book launch on haircare – The Haircare Bible: Dermatologist’s Tips for Haircare and Hair Loss, now available islandwide in major bookstores. Viewers also got a sneak preview of her book Masking Up: A Dermatologist’s Guide to Maskne, slated for fourth and on Amazon Kindle
Covered in this transcription of the interview are some of the questions asked about common and maskne skincare problems women have during this pandemic, also featuring a Q&A session with the Instagram live participants, and Dr. Teo’s vision for an even better tomorrow. Topics includ common skin concerns women have during this Covid-19 period, pigmentation and acne skin concerns especially in tropical Singapore, how to treat them, and her plans for an even better tomorrow. She also shares some best tips for scalp hygiene and hair care in warm and humid Singapore.
I just wanted to ask you a few questions about maskne skincare, I think we all have some burning questions you can help us answer. Just like plenty of women have faced during this pandemic, I’ve experienced more breakouts on my chin, and my scalp seems a little oilier, can you tell me why?
That’s a great question that I’m sure lots of people have too. First of all, breaking out over the mouth area covered by the face mask is something that we’ve observed in more and more people over the last couple of months. I’m sure all of us have heard of ‘Maskne’ and even ‘Maskne Skincare’. I just wanted to share a little bit of a scientific, medical perspective on this issue amidst all the beauty buzzwords and information overload.
It’s not a brand new condition, it’s actually a variant of a well established form or acne called acne mechanica. Acne mechanica is due to local factors such as friction, pressure, as well as the microenvironment of the skin being affected by humidity and increase in skin temperature. All these will influence little subtleties in the skin such as pH, and the microbiome balance – which refers to the bacteria and organisms that live on your skin. So it is not a surprise to us that this new lifestyle intervention of wearing a face mask – which is mandatory in many countries – has led to an increase in acne mechanica.
Now, for the second question about the cause of scalp oiliness. It is very common in tropical countries like Singapore for young adults who do produce a bit more oil, to develop a more greasy scalp because of the condition Seborrheic Dermatitis. As you know, once we hit puberty, because of the influence of hormones, our body starts producing oil. This oil, together with ambience factors of increased heat and temperature in an outdoor environment, can breed the overgrowth of a certain type of yeast known as malassezia.
Malassezia can cause Seborrheic Dermatitis, which is what you just described: oily scalp, a bit of scalp discomfort, and sometimes people even develop dandruff. Seborrheic dermatitis is also worsened by stress, as acne is, so it is not surprising that in 2020, where so many things have changed for all of us, that we see an increase in these concerns.
Can it be fixed?
Absolutely. As a dermatologist, the important thing I always highlight to my patients is that we have to first understand the disease process, then we can suggest therapies that directly address it. Once you have the correct diagnosis, there are specific medical treatments we can recommend that are effective for these conditions.
Great, I also want to find out a little more about your business during this period. How was Circuit Breaker for you personally and professionally?
Well I think it was probably a lot better for us than alot of others. The reason is because I had already implemented teledermatology at the end of last year for my overseas patients, as it was something that we felt was a real need for international patients who couldn’t get their medication or get their regular consultations at a specialist hospital.
We’ve been doing that for medical dermatology specifically, so the transition for us was not so abrupt, except that we had many more patients that qualified for teledermatology from February onwards. As you know, Circuit Breaker started in April, so we already had 6-7 weeks of prep before we decided to convert 95% of all our patients to teledermatology.
Let me share a little bit about teledermatology with you, because it could sound a little bit foreign. It’s not something that’s brand new. Telemedicine is an established field within medicine, and dermatology, being a visual specialty, is very suited for virtual consultation. It is still considered a legal consult, so the way we design the protocols do abide by medical legal standards. We require the clarity of the photos to be of a certain standard, and my nurse is in fact a lot busier, because they have to do a lot of video explanations.
The unfortunate thing of course, is the loss of the human touch and interaction, but we do try to make up for it in terms of the time we spend, and also through the fact that my practice has always been based on educating the patient about disease processes and empowering them to be able to handle their skin and scalp conditions. So at the end of the day, it’s been difficult for a lot of people, but it’s something that we’ve all grown used to.
You had the foresight to launch teledermatology last year, even before COVID happened. How have your recent experiences mold the way you view life and work?
I would say that the most important lesson that all of us should take home from COVID is humility. I think for too long, we have all been very self-centered as a modern society. We’ve forgotten that we are part of a very large ecosystem, which is nature itself. For me, I’ve always been very into botanicals and nature. My personal hobby is gardening, and I have been growing edibles for the past 5-8 years.
So the humbling experience that all of us have gone through because of COVID – where there was some uncertainty even about food supply, the mad rush at the grocery stores etc, has helped to mold a perspective that as humans we’re not alone in this world. We have to bear in mind that whatever actions we make, especially when it’s impacting the environment, the animals or even their habitats, there will be some sort of consequence that we have to suffer. I think this is the most humbling lesson.
Adding on, food sustainability, for one, is something I have also been working on. My new project that we have been researching over the last 8 months or so, is born out of my interest in sustainable vertical gardens, and is a solar-powered home vertical hydroponic system, so look forward to that in the future. But at the end of the day, I feel that the biggest take home from this entire 2020 COVID experience is that we have to understand we’re part of a larger ecosystem and we’re not just manipulating the other species, so we can’t take these things for granted.
I absolutely agree. Besides what we have addressed about common skin concerns, what are some of the must-have ingredients in our maskne skincare, and also that will help to take care of, brighten, and even out skin tone?
That’s a great question. Before I answer that, I want to set the background right for the scientific approach of aging. You have to understand that the skin is an organ, just like your lungs, your liver. The great thing about topical application with serums, creams, emulsions is that it’s able to access the skin directly.
So as long as you’re able to address the process of cell senescence, which is responsible for the process of aging, you can expect some sort of efficacy of the product. In terms of addressing age related or environmental related consequences, such as what you mentioned – lack of radiance, uneven skin tone, irregular pores – these are what we label as the negative signs of skin aging.
Now on a more specific note, I want to talk about the importance of the use of botanicals. On the topic of plants, the amazing thing is that Earth has provided us with all these little miracles in the life of a plant. In dermatology, we are familiar with the concept of antioxidants – that can be categorized into compounds such as polyphenols – which I want to break down for our listeners today.
If you understand how skin dullness is caused by free radical damage, then you’d understand how antioxidants combat free radical damage. Polyphenols present in extract in Green Tea Camellia Sinensis, Resveratrol extracted from grapes; these have potent free radical scavenging properties, which is exactly what will target the cell mechanisms responsible for deterioration in your skin’s appearance.
Another category of ingredients I’m sure you’ve heard of is Vitamin C, which is an established antioxidant. In conditions like Maskne, Vitamin C plays a role in improving the condition of your skin via two ways. The first is in controlling the acne itself. The very fact that it is an antioxidant molecule means that it makes it slightly more difficult for the bacteria responsible for acne to cause inflammation. Secondly, we know that Vitamin C reduces scarring because it lightens the amount of pigmentation through melanin inhibition.
To summarize, the two important functions a good ingredient should have when it is formulated in maskne skincare and skincare in general is: cell protective effects and photoprotection (protection from environmental and sun damage). Botanical extracts have this amazing property of fulfilling both antioxidant, cytoprotective and photoprotective effects on skin.
What are the effective ingredients in the Even Better Clinical serum that you would say embody some of what you mentioned earlier, that we should be looking out for?
Before I answer your question, here’s a tip on how to read the ingredients on your product, be it maskne skincare or any skincare in general. It is an FDA and HSA requirement that all skincare products sold have a full ingredient list. The top-most ingredient is what is present in the highest percentage, going in descending order to the bottom. This is how you can roughly figure out how much of each ingredient is present in your product.
After examining the Even Better Clinical Serum, I’ve noted that the great thing about the formulation is the combination of botanical extracts that this product has demonstrated. The presence of not just Camellia Sinensis polyphenols, as we discussed earlier, but in combination with other nature-derived extracts, is what is great about this formulation. For example, this product contains rice bran extract, which is a potent anthocyanin, meaning it works directly on the cell mechanisms to reverse environment-related aging processes. When used regularly, it will help to improve radiance of the skin, as well as skin quality.
Another thing I wanted to highlight is that just because it is a serum meant for skin lightening, it doesn’t mean that it completely ignores the concept of the skin barrier. A good antioxidant serum will have moisture stabilizing properties.
In this case, the Even Better Clinical Serum contains Sodium Hyaluronic, Squalane and Glycerin – which are all important humectants that help to trap moisture under the skin. In order for us to have healthy, radiant skin, we have to address both the antioxidant properties of a cosmeceutical product, as well as the barrier restorative properties. This is so that you don’t just have radiant skin, but healthy skin that is resilient against environmental stressors.
That’s good to know, because often we buy our skincare and products in general but we don’t know exactly what to look out for.
Yes, and it’s difficult for anyone to navigate, simply because of the abundance of information on the internet, especially with the amount of advertising that’s going on. At the end of the day, I think we should be moving towards the direction of promoting skin health because it helps the self-esteem of every individual, rather than pointing out the negative effects of aging, or trying to attain something that is not part of skin health.
As a practice, I think it’s important for us to center on the individual as a whole; and as a dermatologist, I play the important role of explaining the process of skin health and treatment goals in this very confusing world of beauty.
Speaking of that, can you explain more on how “dermatologist-tested” products differ from other products or maskne skincare in the market? Is it really suitable for people with sensitive skin, or is it suitable for everybody?
Firstly, I want to highlight that this term “dermatologist-tested” isn’t regulated, so you’ll probably find that the majority of products sold in supermarkets, pharmacies, malls have this label on it. Since this term isn’t regulated, it’s important to understand the brand history and the brand ethos before you trust it. If it’s been “dermatologically-tested” it doesn’t necessarily mean it’s been developed in conjunction with a dermatologist in a clinical setting, nor does it mean they worked with a dermatologist to assess the efficacy or allergenicity of the product.
Clinique is one of the exceptions to this, as they have worked with dermatologists to develop their products. The brand is also well-known for keeping their product formulations allergy-free, so in my opinion is much more valuable than a “dermatologist-tested” label. There has been lots of information and different labels thrown around callously in the beauty world, and I think it’s educational for us to share this with our viewers.
Are sun spots and discoloration relevant concerns now that people are wearing less makeup, or tend to wear less sun protection and products with SPF while at home?
While this may seem like a simple yes or no question, it’s not so straightforward. I’ve seen both men and women who come into my practice and are bothered by these visible imperfections on the skin. While it may not be so severe to me, it is very obvious to them, so it really is a reflection of how they themselves have suffered with this perceived imperfection over a period of time.
Answering your question, I didn’t find that there were less people bothered by it throughout this period, but there’s always been individuals who may not have very severe pigmentation that are more bothered by it, and certain individuals who might not care about it at all.
Going into the science behind pigmentation, we know that we’re born with a natural skin phototype, and it’s not healthy for us to be chasing after this ideal of lightening our skin or changing our skin tone. But the presence of increased pigmentation over specific areas, such as sunspots as you mentioned, is a diagnosis known as solar lentigo that is related to age, sun-damage and genetics. Specific treatments for solar lentigo would include using topical ingredients that inhibit melanin synthesis, and enhance the cell synergistic effects of your skin’s chemical mediators that help to remove the pigmentation.
For deeper pigmentation conditions like Melasma, it’s not related to staying at home or being outdoors. Instead, Melasma is a chronic, long-standing process which takes several years to develop. Hormonal imbalances can also influence the development of Melasma.
I just wanted to address some of the questions we have from the Instagram live participants, are there any superfoods that you would recommend that are beneficial for our skin or as part of maskne skincare?
I feel that skin health is a manifestation of our general health. We all know the old saying ‘we are what we eat’ – our diet plays an important role in the health of our skin. From a scientific point of view, there have been many studies related to effects of a high saturated fat diet, high sugar diet, consumption of dairy products, as well as chocolate that can worsen the symptoms of acne.
But for skin health specifically, it is true that when we are consuming a healthy diet, consisting of superfoods like those in the category of Brassica Oleracea such as kale, broccoli, cauliflower, it has the ability to inhibit growth of cancerous cells. From day one, our bodies are constantly fighting off the proliferation of these cancerous cells. When we go past the age of 25, about the time when our skin shows signs of aging, we are also trying to address the question of cell senescence, or the cell aging pathway.
Beetroot, for example, is one of my favorite foods, and also one of the superfoods favored by athletes. It’s been proven to increase your body’s ability to take up oxygen, and increase your stamina and performance too. So I have been trying to incorporate Beetroot creatively in all my meals, and also have moved to a predominantly plant-based diet from the start of COVID.
Building on that, as a medical doctor, it was very scary to see COVID’s spread, because we’ve never seen any microorganism or any infectious disease of this nature. It’s potentially life threatening and fatal, but at the same time, spreads asymptomatically in otherwise healthy individuals. The origin of this virus, from the data, is from the animal kingdom.
It’s not normal in any sense for these viruses to cross over to us in such a way and cause a pandemic. This clearly has to do with the fact that we are encroaching into another species’ habitat and farming them in ways that are unethical, that is causing all these mutant pandemic strains to arise. So as a personal decision, I decided to stop eating animals, so that it’s much less likely for us to get another pandemic.
Furthermore, it is increasingly being recognised by science that it is possible for us to have a complete, holistic diet from a plant-based diet. However, I do still eat a lot of fish, which is full of what we call ‘good unsaturated fats’ that can help with skin health, and the process of anti-aging, as well as brain health. But I do think that it is important for us to appreciate that our diet is very significant in not only nutrition, and will affect our skin as well.
Two last skincare questions, from comments from viewers during the LIVE session…
“How different is the skin on our body with skin on our face?”
“I have chronic arm acne, would you recommend using the same products as what I use on my face?”
If you have acne-like lesions on your body, it does not always mean that it is acne. But let me get into the difference between the skin on your face and your body. The key thing here is the production of oil. The face is what we call a seborrheic area. Our palms and soles, for example, are completely devoid of oil glands.
Depending on genetics, certain individuals may have more oil production on the centre of the chest, as well as the back, which can be a manifestation of acne. But when you have acne-like lesions on the upper arm, it’s not so typical for it to be true Acne Vulgaris, which is what we’ve been talking about so far.
Acne Vulgaris is influenced by genetics, hormone production, increase in oil production, as well as bacteria. Acne-like lesions on your arm, however, can be characteristics of a condition known as Keratosis pilaris (KP), which is actually a form of eczema. Individuals with KP may have some pigmentation, and have tiny bumps, which can also be inflamed because of infection, making it look like acne. But the distribution in this case is in non-seborrheic or less-seborrheic areas, like on the upper arms or thighs.
It’s also relevant for us to touch on other mimics of acne. Many people who suffer from acne on the chest or the back may have a concurrent condition known as Pityrosporum folliculitis – or as you’ve probably heard, fungal acne. As a dermatologist practicing in the tropics like Singapore, a lot of individuals with chest and back acne, actually have concurring Pityrosporum folliculitis.
Pityrosporum folliculitis is caused by a yeast, a fungal organism that overgrows in hot, humid climates and areas that produce more oil. Treatment for this condition has to address the yeast overgrowth, typically with an antifungal shampoo and cream, in conjunction with anti-inflammatory acne treatment if there is acne as well.
You’ve clearly kept yourself very busy this year despite Covid. While you’ve talked about transitioning to a plant-based diet, can you tell us more about what you have done to ensure an #EvenBetter you?
I love the perspective of this campaign, because self-improvement is essentially my life ethos. Those who know me, know that I’m always keen to learn new things, and like to adopt holistic integrated measures for health in general. I have always been an avid athlete, and love sports in general. Aside from that, I think it’s important for every individual to understand that our life really depends on the decisions we take. We can talk about our mental, physical, and emotional health, but you should understand that they are never independent of each other.
With this, when you address your physical health, in this case, the health of our skin, you mustn’t neglect the emotional and psychological effects too. It’s very difficult for many to grasp the fact that we’re no longer able to socialize as freely as we did before. But I think it’s been a very good healing process for all of us. The way I view COVID is that we’ve all been traumatized by this major catastrophe, so the initial reaction is shock and confusion, then you start to grieve, and then, finally, accept.
The long term life lessons that I would like to share is that essentially, you have to look within yourself for your sense of identity, and that includes being very comfortable and assured in your life goals, and not be easily swayed by the things that are happening around us. If you are able to find an inner sense of identity, it will help you to cope with things around you.
That’s always been my way of dealing with various stresses I come across in life, because it’s not possible to live in a world that’s trouble free – even on the best days, there are hiccups. It’s not that you’re waiting for everything to go awry from the way you’ve planned it, rather, it’s the assurance that you are equipped to handle things that arrive unexpectedly on your lap.
Watch the full IG LIVE of the session here.
Copyright © 2020 Dr. Teo Wan Lin.