Melanin is the culprit behind the dark spots that give us an uneven complexion. It is a brown pigment found in the basal layer of the epidermis.
This pigment is synthesised by melanocytes. The process of melanin synthesis is termed melanogenesis. Melanocytes go through different stages of maturation, becoming more pigmented at each stage.
Certain stimulants trigger a gene to produce more of tyrosinase, a copper-containing enzyme that converts tyrosine into melanin. Stimulants that activate the melanocyte include hormones, inflammation (such as acne) and external environmental conditions (ultraviolet light that causes the production of free radicals).
One simple way to reduce melanin production is to use broad-spectrum sunscreens with zinc oxide, titanium dioxide or iron oxide. These substances help block UVA and UVB light, thus impeding the stimulation of melanocytes.
Pigmentary disordersfrom melanin
Common hyperpigmentation disorders that involve the darkening of an area of skin due to increased melanin include melasma, lentigo, and post-inflammatory hyperpigmentation.
Melasma is usually caused by chronic exposure to ultraviolet radiation or a spike in hormones due to pregnancy or the use of oral contraception. It can be found at the epidermis, dermal layer or mixed, depending on the location of the pigment.
A lentigo is a light or dark brown area of discoloration that can range from 1mm to 1cm across, and is caused by an increased number of melanocytes. Its outline is usually discrete, but can also be irregular. Simple lentigines arise mostly during childhood on areas not exposed to the sun. Solar (or senile) lentigines are found on the backs of hands or on the face, most commonly after middle age.
Post-inflammatory hyperpigmentation (PIH) is the skin’s response to inflammatory skin disorders. Common causes are acne and atopic dermatitis. PIH is caused by the overproduction of melanin caused by skin inflammation.
Treating hyperpigmentation from melanin
Hydroquinone: For 50 years, hydroquinone has been the gold standard treatment for hyperpigmentation. This compound inhibits tyrosinase activity, thus limiting the amount of melanin to be produced. It also alters melanosome formation, possibly degrading melanocytes.
However, prolonged use of topical hydroquinone has shown to have side effects such as ochronosis and permanent depigmentation. Ochronosis is a disorder with blue-black discoloration. As such, hydroquinone is banned in cosmetic formulations and only available through a prescription that should be carefully managed by an accredited dermatologist.
Retinoids are forms of vitamin A that can treat acne, photodamage and PIH. They have various pathways that lead to skin lightening effects, such as accelerating epidermal turnover, reducing pigment transfer and slowing the production of tyrosinase.
With common side effects being erythema, skin irritation, dryness and scaling, it is recommended to use a retinoid only under the supervision of an accredited dermatologist. Corticosteroids (steroid hormones) have anti-inflammatory abilities and are often prescribed along with retinoids to prevent excess irritation.
Arbutin is a botanically derived compound found in cranberries, blueberries, wheat and pears. Though arbutin is a derivative of hydroquinoine, it has shown to be a more controlled way of inhibiting the synthesis of melanin as it does not permanently destroy melanocytes.
Kojic acid is a naturally occurring fungal substance. Its skin-lightening ability works by inhibiting the activity of tyrosinase. However, frequent use can cause side effects of contact dermatitis or erythema (redness of the skin).
Azelaic acid is known to be effective for treating PIH and acne. Azelaic acid depigments the skin in several ways. It can inhibit tyrosinase or reduce levels of abnormal melanocytes. This means that azelaic acid does not influence normal skin pigmentation but only acts on the proliferation of unwanted melanocyte activity. Side effects are mild and only last for a short period of time. Irritation, burning sensation or mild erythema may emerge, taking 2 to 4 weeks to subside.
Niacinamide is a derivative of vitamin B3. It works by decreasing the transfer of melanosome to keratinocytes. Niacinamide is a stable ingredient as it is unaffected by light, moisture or acids. This ingredient is often incorporated into cosmeceuticals due to its safety profile.
Vitamin C or L-ascorbic acid is a naturally occurring antioxidant that helps with skin lightening. It prevents tyrosinase from converting tyrosine to melanin. Vitamin C is also favored for its anti-inflammatory and photoprotective properties. However, L-ascorbic acid is highly unstable and rapidly oxidized. It is not used in the treatment of PIH.
Stable forms of vitamin C include magnesium ascorbyl phosphate or sodium ascorbyl phosphate. For safe and effective results, consider a dermatologist-formulated serum VITA C GOLD™ Serum,a formulation tested for bio-activity in a laboratory.
As seen above, there are various treatment options to treat common hyperpigmentation disorders. Recognizing the underlying cause for pigmentation is critical for proper treatment and choosing the best-suited therapy. Visit an accredited dermatologist for effective and safe treatments catered to your condition.
People have been increasingly conscious about aging and the effects of aging on appearance. Skin aging will cause facial wrinkles and decreased collagen. Maintaining a youthful appearance seems to be the trend and many have resorted to skin treatments. There are many treatments like chemical peels, fractional laser and more but recently, ultrasound has been used in new treatments. HIFU and Ultherapy are examples of ultrasound treatments. It has been introduced as non-invasive and effective in having anti-aging effects on the skin.
What is High-Intensity Focused Ultrasound (HIFU) Sygmalift?
High-Intensity Focused Ultrasound also known as HIFU Sygmalift, is used for rejuvenation, lifting and tightening of the facial skin. Research has been done to demonstrate the efficacy of HIFU Sygmalift. It has been found that HIFU Sygmalift is a safe and effective method for facial skin tightening. It can be used not only to improve skin texture, but also contour the upper arms, knees and thighs. Besides facial skin, it can be used for other parts of your body.
How does HIFU Sygmalift work?
HIFU mainly causes cellular damage and reduces volume of the designated area by coagulation and generating instant microthermal lesions. This is done by using high frequency ultrasound waves targeted at the tissue area without causing any damage to the skin epidermis and surrounding tissues. The targeted skin tissues get heated up which causes cells to be activated, generating new collagen to produce a skin lifting and anti-aging effect.
What is Ultherapy?
Ultherapy is a new Food Drug Administration (FDA) approved treatment that tightens and lift facial skin. The treatment is mainly for the eyebrow, chin and neck area but can be used anywhere where the skin is lacking tightening. Follow up treatments are recommended once a year to maintain the effects. The procedure has been used as it is non invasive and hence does not require anesthetic or sedation.
However, it has been said to be painful and it would be better for some to use local anesthetic. It has been said to have no foreign substances or drastic changes but achieves to improve the health of the cells beneath your skin surface to result in a subtle, natural and healthy effect on the outside.
How does Ultherapy work?
Ultherapy is different from the common laser techniques that target the outer layer of the skin. It penetrates the surface and transmits energy to the deeper skin layers. This way, it causes damage to the collagen layers to stimulate more collagen production as the cells are tricked into repairing the collagen. It uses ultrasound technology which has been used in fat burning treatments. With collagen production, it produces skin tightening and anti aging effects.
How are HIFU Sygmalift and Ultherapy different?
HIFU Sygmalift and Ultherapy sound similar in terms of their methodology. Both use ultrasound treatment, a popular choice for non invasive and non-surgical face lifting and tightening treatments. Their main goal is to produce anti-aging effects, helping you to preserve your youthful look. However, there are still some small differences between the two which can impact your decision is choosing the most suitable treatment.
Extent of Pain
One of the main complaints about ultherapy treatment is that it is known to be painful and some people require local anesthetic. However, HIFU Sygmalift is mainly painless because it uses fractionated HIFU. Instead of traditional HIFU techniques which use one concentrated beam, HIFU Sygmalift breaks up the beam into fractions and penetrates the skin at precise extents. People who use HIFU Sygmalift may feel a small sense of tolerable pain but it is definitely less painful that Ultherapy.
Extent of Skin Penetration
HIFU Sygmalift targets the dermis and connective tissues to stimulate collagen production. Meanwhile, Ultherapy can penetrate deeper even into the muscle tissues, which is why some people feel pain. However, both result in skin tightening and lifting effects.
Post Treatment Maintenance
For Ultherapy, most people may see visible results even after the first or second session. To follow-up, they are recommended to go for treatments once a year to maximise the effects. On the other hand, HIFU Sygmalift is used once a month to maintain your skin. Patients of HIFU Sygmalift are recommended to use anti-aging products that contains peptides to complement the treatment, supporting a gentler type of treatment.
Both HIFU Sygmalift and Ultherapy use similar technology and methods with very subtle differences. However, these differences can make a big impact on your comfort with the treatments. Both methods are still safe, striving to produce anti-aging effects on your skin. With the similarities and differences explained, you can now make the best decision for yourself and choose the treatment that suits you the most.
The countless advertisements from skincare solution providers. They started with just the beauty parlours but now has spread to ‘medical spas’ with doctors purportedly offering solutions to bad skin. How could one even start to differentiate what works from what doesn’t? Afterall, it never comes cheap.. And what more, with every single beauty or “medi-spa”claiming the “skin-specialist title?’’
Well if you ever felt confused by the sheer multitude of “acne scar treatment’’ providers, and “skin specialists”, in all honesty, as a dermatologist, I don’t blame you. I’ve been equally baffled by the proliferation of “skin specialists’’ in Singapore, all promising to make you beautiful, either with customised serums, peels or lasers, and of course, at a price.
On this note, if you’ve already decided you want some help for your skin, my role here is to formulate a quick guide (albeit slightly unconventional compared to your magazine beauty writers) as to how one can make an informed decision as to who to go to for skin treatments, and what the treatments are all about!
In the spirit of providing honest, unbiased objective reviews and advice from an insider point of view, I seek to shed some light on a dermatologist’s perspective on acne scar treatment in this article, which is the same kind of advice I personally give to my patients, friends and relatives.
1. Educate yourself first – science of acne scars?
I’m going to make a rather unusual illustration here and allude to how I purchased my audiophile sound system when I wasn’t exactly an audiophile.
I’m not sure about you but one of the ways I make decisions on a lot of things I buy, is really first to find out all the information out there. I try to understand myself how the “science behind it works”. I’ll let you in on this little secret on how to win my consumer heart: I usually am most impressed by a vendor that best explains how best that product fulfils a need in my daily life, for example, and actually being able to try it myself, rather than attractive packaging or freebies.
Along the way I go through a bunch of reviews on what actual consumers have to say about the product. Needless to say, all these are often what we find on the Internet.
I don’t stop there, I research the brand thoroughly, from the origins, the certifications, and well, generally if I’m looking for an audiophile sound system, I don’t go to a general electronics store selling washing machines and furniture to boot, or necessarily to the most beautifully built soundbox out there. For months, I spoke first to all the audiophiles I knew, read reviews on geek websites and auditioned several stores, trained my ears and finally decided on my final buy.
Honestly, I am thankful for all that. I have had so many different speakers before but 1000 of those could not compare to the single, solid, smooth system I have now. It wasn’t exactly the cheapest, but it was worth every single cent. Point is, as consumers, we should look for true value and substance, not marketing and packaging. It’s never easy in today’s world, but one way easy way is to check out certifications and do brand research.
Now, if that didn’t put you to sleep yet, let me translate that into the world of acne scar treatment.
Now, there are 2 types of acne scars — Post-Inflammation Hyperpigmentation (PIH) and dermal acne scars (otherwise known as ice pick, rolling or box car-type scars). It’s probably useful to know these terms which your dermatologist would tell you about in the discussion of your scar treatment.
What I share with my patients is this : Imagine your skin as having 2 layers, and now it has certain defects which are visible. Like a piece of pottery, PIH occurs in the top layer like the cracked glaze, while dermal scars in the second layer are like huge dents in the pottery which occurred during the moulding process.
Now if you were tasked to restore this clayware to its ideal form, what would you do? It’s intuitive to think one could paint over the cracks, or sand it off till it’s smooth. For the dents, well, how about filling it in with a huge clunk of new clay, maybe with superglue and paint it over again and pray no one would have noticed it.
A master potter, on the other hand, would assess first the defects and the overall aesthetic of the object. He will then determine how to most efficiently restore it without it looking artificial or fake, without damaging more parts of the clayware, and essentially, simply make it what it should look like — more beautiful.
Most importantly, the master potter understands the characteristics of clay when it is dry or when it is wet, the tools he has and how to use them. This is because he’s had years of experience training in that at far more complex levels. He also knows what it takes to make the final product look good, without making a bigger mess in the process. He would also be honest enough to tell you upfront if some defects simply cannot be corrected in a single treatment.
3. Tools for acne scars – Ablative CO2 fractional lasers? Chemical peels? Carbon peels? Radiofrequency? Skinboosters?
All of the above are clinically proven to improve the appearance of acne scars. Now what that means is that a body of evidence exists behind this, with clinical studies that support the use of these methods, and that a good proportion of dermatologists agree with these safety and effectiveness of these studies before the machines are cleared by FDA for the treatment of acne scars.
There are recommendations for settings which are given by the manufacturers, but far from being a cut-and-dried formula, the best effects are realised with the correct choice of treatment, the correct combination, timing as well as personal experience/expertise with the use of these machines, tailored to the individual patient’s skin type and response. Otherwise, a robot could also treat your acne scars, better still, without human error (pun intended).
Did you know, for example, that the darker skinned you are, the more heat from the laser your skin absorbs, and hence the higher the risk of scarring from treatments itself? This applies to all Singaporeans out there, whether you are of Chinese, Indian or Malay or any other asian heritage, you have much higher amounts of melanin (pigment colour in your skin) than your counterparts in Europe or America (where most of these technologies were discovered and used). It is important for your doctor to carefully watch how your skin reacts to the laser, to achieve the desired endpoint (which shows the treatment has reached an effective level) without causing unwanted heat damage.
I personally use a combination of treatments- from ablative (CO2 laser, plasma nitrogen) to non-ablative (radiofrequency) fractional resurfacing for deeper scars and for a more dramatic effect, in combination with a well-timed chemical peel/microdermabrasion to prep the skin for best results. Pigment lasers work well for uneven skin tone. For a finishing touch, skinboosters work well to create a plump dewy skin texture.
On the topic of tools, not all laser machines are created equal, as those which are of more sophisticated engineering tend to be more precise, cause less potential side effects and downtime. For example, higher-end CO2 laser machines are different in terms of delivery of the shape of the pulse, the wave type and overall precision in delivering energy to the deeper layers of skin without burning the surface of skin. These also incorporate radiofrequency energy to enable higher energy delivery without increasing the risk of heat damage to the skin.
Superficial chemical peels are the commonest used type of peels. They comprise primarily of one of or a combination of these 3 — glycolic acids, salicylic and lactic acids. These can cause excessive irritation if the concentration or type of acid used is inappropriate and may lead to chemical burns, or if too mild, are simply not effective.
4. Maintenance – Proper skincare
So you finally restored that piece of beautiful pottery. Subject it to wear and tear, rough handling and you will be back to square 1. There is a true science behind evidence-based skincare. Go for reputable, dermatologist recommended brands formulated in laboratories rather than what your facial auntie recommends you or what the latest customised serum fad offers.
Obviously the scope of acne scar treatment is well beyond that of any article. What I’ve set out to do is to streamline the key factors, the “know-how” rather than the “what”, which I believe can help the lay person navigate a bit clearer on this cloudy path. There are way too many vendors selling their wares to acne-scar sufferers, adding more woe to their already battered self-esteem. Hope this helps!
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
Why do I get acne?
Acne occurs when the oil glands under the skin, known as sebaceous glands, become clogged with sebum, an oily substance. This process is known as inflammation, and it is often genetically determined. Hence, if you have a family history of acne, you are at high risk.
A normal amount of sebum usually keeps the skin healthy. Your oil glands become active once you reach adolescence due to hormones and this is when acne usually starts. When clogged, bacteria grow in the glands, and leads to bumps, swellings and visible blackheads and whiteheads on the skin’s surface.
Why do I tend to get acne on my chest, back and neck?
These areas have the highest numbers of oil glands and are acne-prone. Acne is not the only condition that can cause that. A fungal infection, known as pityosporum folliculitis, can also cause a similar condition. If you are developing bumps over these areas, it is important to see your dermatologist for diagnosis and treatment to prevent worsening and possible scarring.
As an adult, is it possible to still struggle with breakouts?
Acne can still affect adults. In fact, many adult females suffer from acne breakouts around the chin especially during certain times of their menstrual cycle. This should be differentiated from other conditions such as perioral dermatitis, which may look similar but is treated differently.
Is there a cure for acne, or do I just wait to outgrow it?
Acne can and should to be treated early to prevent worsening, secondary infections and scarring which may be permanent. It is definitely a fully treatable condition that no one should have to live with. Acne has an impact on one’s emotional well-being, and it is especially crucial during adolescent years and this should not be ignored. Severe forms of acne can result in bleeding, pus and more serious infections, a condition known as acne fulminans, which can result in complications.
What treatments are available for acne?
Under proper dermatologist care, acne can be fully treated with the correct medications, creams and light treatments. For patients who prefer not to be on oral medications, laser therapy is a safe and effective acne treatment method too. Ablative resurfacing can effectively reduce acne scarring. Blue light, a type of laser therapy is designed to treat acne when it is active. Blue light at high energy levels reduces the Propionibacterium acnes burden, leading to improvement of acne.
In addition to treatment, prevention against future acne breakouts are also crucial. Diet and proper skincare are also important factors in contributing to one’s acne condition. Therefore, holistic counselling with specific advice about how to manage your condition is important.