Tag Archive: acne scars

Brightening dark spots

December 25, 2018

Struggling with dark spots? To treat them, you first have to know the kind of pigmentation you have.

Melasma

Melasma is characterized by irregular brown patches on the skin and can typically be found on the forehead, upper lip, nose and the chin. Melasma is the result of an overproduction of melanin (the pigment that gives colour to our skin, hair and eyes).

Excessive sun exposure is one of the greatest contributors to melasma as melanin-producing cells are easily stimulated by UVA and UVB rays. Pregnancy, hormone treatments and genetic predisposition are other causes.

Postinflammatory hyperpigmentation (PIH)

PIH is the result of your skin’s melanin-inducing response to inflammation or injury, and appears at the injured site as a dark brown macule or patch. Such markings usually fade within a few months with appropriate treatment. However, the brown spots may darken or spread if not addressed. Sun exposure may also worsen PIH.

 Skin conditions that can cause the above inflammation include acne vulgaris, atopic dermatitis (eczema) and psoriasis (red, flaky skin patches).

Freckles

Freckles, also known as ephelides, are harmless small pigmented spots that are frequently found on the face, arms, neck and chest. Freckles are brown due to a diffusion of melanin into skin cells.

In winter, the activity of melanin-producing cells slows down. When exposed to UV radiation in sunlight, melanin-producing cells pick-up. As a result, freckles fade slight in the winter and darken in summer. Often, freckles partially disappear with age.

Genetics contribute to the formation of freckles. They are frequently observed in fair-skinned individuals, especially those with red hair.

Solar lentigo

Solar lentigines are harmless patches of darkened skin that are generally larger than freckles and have well-defined edges. They are caused by an accumulation of sun damage that leads to an increase in the number of melanin-producing cells and subsequent accumulation of melanin.

Solar lentigines are also associated with increased age. While freckles generally disappear over time, untreated solar lentigines are likely to persist indefinitely.

Treatments

For all dark spots, start by avoiding the sun and applying a sufficient amount of sunscreen every two hours. Use a lightweight sunscreen like Dr. TWL’s SunProtector™, which is dermatologist-formulated for the humid climate.

For melasma, consider a combination of topical therapies (outlined below) and chemical peels. Lasers should be considered last.

For PIH, first treat and prevent the skin condition triggering the inflammation. Then use topical treatments followed by chemical peels and lastly, laser and light treatments.

For freckles, use topical or laser/light therapies.

For solar lentigines, use ablative therapy with cryotherapy. Subsequent treatment options include topical agents and laser therapy.

Bleaching agents

 Bleaching agents are often used to inhibit melanin synthesis. The most commonly prescribed ones are hydroquinone, azelaic acid and kojic acid.

Hydroquinone inhibits the production of melanin by binding to tyrosinase, the enzyme responsible for the first step in melanin production.

Azelaic acid acts on abnormal melanin-producing cells but leaves the healthy ones untouched, ensuring optimal melanin levels.

Kojic acid binds to copper, which is required by melanin-producing cells.

Retinoids

Topical retinoids are often used in combination with bleaching agents. Retinoids target pigmentation issues by inducing the death of melanin-producing cells, accelerating turnover of new skin cells and inhibiting the enzyme tyrosinase.

Chemical peels

Chemical peels refer to the process of applying acids to the skin to destroy the outer skin layers. They accelerate the process of exfoliation by sloughing off dead layers of older skin and promoting smoother layers of new skin.

Superficial and medium depth peels are effective in treating pigmentation concerns. These peels differ in the depth of skin resurfaced. Superficial peels target only the surface skin layer while medium peels target the next layer.

To successfully achieve significant depigmentation, a patient needs to undergo at least 3 to 4 repeated peels. Common acids employed are glycolic acid, salicylic acid and lactic acid.

Laser and light treatments

Lasers are notably successful with solar lentigines, but less so with melasma and PIH. Such treatments damage the skin to stimulate growth of new skin cells.

To treat solar lentigo and freckles, use IPL, Q-switched lasers and fractional lasers.

To treat melasma and PIH (and only after topical therapy and chemical peels), try fractional radiofrequency, Q-switched or picosecond lasers, high-fluence/high-density non-ablative lasers, pulsed dye lasers, IPL, microneedling, and spot liquid nitrogen treatment.

If you are considering laser or light treatment, be sure to first consult an accredited dermatologist to recommend suitable treatments for the skin condition you are experiencing.

Cosmeceuticals

Patients who are not ready to commit to laser treatments can consider cosmeceuticals. These are cosmetic products with bioactive ingredients that are scientifically proven to deliver results to the skin. Active ingredients that fight dark spots include vitamin C and niacinamide. As a powerful antioxidant, Vita C GOLD™ Serum can help fade dark spots on your face and neutralise some of the free radicals that damage your skin. Niacinamide, found in Radiance Fluide™ Hydrating Emulsion, helps to brighten skin by reducing the amount of melanin.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

Everything You Need to Know About Melanin & Dark Spots

July 19, 2018

 

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

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

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

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

Pigmentary disorders

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

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

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

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

Treating hyperpigmentation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Dermatologist’s Guide to Dermarolling

April 28, 2018

 

Derma rolling, also known as microneedling, has become popular in treating acne scars and it can be used safely in a dermatologist’s clinic by an accredited dermatologist, as a simple office-based procedure.

It is a minimally invasive procedure that uses fine needles to puncture the epidermis to create micro wounds that stimulate the release of growth factors and induce collagen production. The procedure is painful and a prescription numbing cream is used to numb the skin before the treatment. Overall, the epidermis remains relatively intact and doesn’t seem to have many side effects when performed by a trained professional and with sterilised equipment. To this date, the procedure seems to be generally safe and low-cost method of improving acne scars, however, there are insufficient studies as yet to support the use of microneedling for various conditions as an evidence-based method. Microneedling can also be used for enhanced delivery of applied medications, “transdermal delivery” of cosmeceuticals such as vitamin C and vitamin A derivatives (retinoids) but this is best used with caution. In my personal experience, it can cause irritation and there is no conclusive evidence to suggest that it is superior to an optimised topically applied cosmeceutical alone. It has also been used for the treatment of hair loss, with steroids delivered for conditions such as alopecia areata, although it is not preferred over conventional methods of steroid injections for this autoimmune condition.

It lasts 10 to 20 minutes and informed consent is obtained about the expected outcomes, delayed response, and need for multiple sessions. Dermatologists also prepare the skin preoperatively for at least a month with vitamin A and C formulations twice a day to optimise results, such as enhancing dermal collagen formation.

There has been a proliferation of ‘home-care dermarollers’, which are of shorter needle length less than 0.15 mm for improvement of skin texture such as pore size, fine lines, sebum production and delivery of anti-ageing products. Some have also been developed for coverage of larger surface areas such as legs and buttocks for stretch marks and cellulite. In my view, there is insufficient data supporting the safety and effectiveness of home care dermarollers and is not recommended. For conditions such as acne scars, it is far more effective to recommend ablative fractional resurfacing.

On a related note, dermarollers carry risks which may be far more pronounced in the at-home group such as the following:

Infection. Medical microneedles are currently made of medical-grade stainless steel presterilized by gamma irradiation and are for single use only. Home dermarollers are usually made of smaller shorter needles, for multiple uses (other than washing in hot water, but this does NOT eliminate all viruses and bacteria, including a type of tap-water tuberculosis bacteria known as atypical mycobacteria). It is hard to predict how deep a home user may end up traumatising their skin, whereas when it is performed by an accredited dermatologist, sterility of the instrument as well as proper technique is applied.

Dermarollers should NOT be used in patients with anyone with these following problems i.e. active acne, skin infection such as Herpes labialis or warts, chronic skin diseases such as eczema and psoriasis. Those with blood clotting abnormalities, or on anticoagulant therapy, chemo/radiotherapy are at high risk of bleeding and suffering rare infections using non-medical dermarollers.

Patients with keloidal tendency should also not use dermarollers.

Dermarolling may seem like a ‘less invasive’, easier or more novel option to traditional ways of treating acne scars, but it is definitely less effective than laser therapies. However, it has been used mainly in medical studies as a combination treatment with surgical/laser therapies to enhance results. It is also popular in darker skin types, as these patients can have a higher risk of developing hyperpigmentation as a side effect to ablative laser treatments, whereas microneedling does not seem to carry the same risk in such groups.

Dermarolling is only recommended when performed by an accredited dermatologist.  Even then, common side effects are redness and irritation (which usually subside within a few hours) and patients are often informed of the risks of scarring:  post-inflammatory hyperpigmentation, worsening of acne and reactivation of herpes, systemic hypersensitivity, allergic granulomatous reactions (such as sarcoidosis) and local infections following the use of a nonsterile instrument, such as home-use dermarollers. In addition, there have been reports of allergies to materials used in the needles. Improper technique, such as when performed by a non-medical professional, can result in worsened acne scars, and injury.

There is not yet clear data available to substantiate the length of time which effects of dermarolling could last. Also, depending on the severity of the condition and what dermarolling is used for, it is important to note that severe conditions such as ice pick or box car acne scars or photoaging will not have dramatic improvement effects from dermarolling alone, but will benefit from a combination of laser/injectables/cosmeceuticals with or without dermarolling. Skin healing goes through different phases and occurs differently at different ages, with individual genetic differences, which will all play a factor in determining how long and how dramatic the benefits of dermarolling and treatments in general will present.

© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.

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

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

Explaining Laser Therapy by a Dermatologist

October 7, 2017

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What is Laser Therapy

Laser Therapy is the use of different invisible wavelengths of light to stimulate distinct layers of skin in order to rejuvenate and anti-age skin. Pigmented lesions can also be effectively removed with specific lasers that cause crusting and stimulate pigment cells (known as melanocytes) to disseminate.

Who is Laser Therapy for?

Laser Therapy is indicated for the following skin concerns.

 

What should I know about Laser Therapy?

Non ablative lasers differ from regular forms of laser therapy. Instead of heating and removing the top skin tissue, non-ablative or non-wounding lasers work beneath the surface skin layer. They aim to improve skin texture and tone and minimize fine lines present with minimal side effects and recovery down time. Primarily used to treat facial skin rejuvenation and acne scars, according to a patient’s skin type and condition, non ablative laser therapies computer-control the parameters of light energy delivered from light-based devices.

© 2017 twlskin.com. All rights reserved.

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

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

All you need to know about Acne Scar Treatment

October 3, 2017

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What is Acne Scar Treatment?

Acne Scar Treatment is a series of refined dermatological techniques which are performed on a patient to improve the appearance of his/her skin and to boost his/her self-esteem.

Who is Acne Scar Treatment for?

Acne Scar Treatment is for those with deep permanent scars such as pitting or crater-like scars caused by severe acne.

What are the types of Acne Scar Treatment available?

Based on the nature of the scarring by acne, the patient’s medical history, the dermatologist will choose a technique or combination of treatment that is most suitable for the patient. The below-mentioned techniques and procedures are commonly used to in improving acne scarring.

  • Laser Therapy: By delivering short pulses of the laser beam, dermatologist are able to smoothen, sculpt and normalize the appearance of acne scars. The non ablative and ultrapulse carbon dioxide lasers are commonly used for treating acne scars.
  • Chemical Peel: By applying a chemical solution to the skin, mild scarring and comedogenic acne can be treated. It also improves your skin tone and reduce pore size.
  • Excision and Punch Replacement Graft: By surgically removing a depressed acne scar and replacing it with a patch of skin from elsewhere on the patient’s body, excision and punch replacement graft can improve acne scarring.
  • Soft tissue fillers: By injecting a small quantity of hyaluronic filler or a patient’s own fat, taken from another part of the body, below the surface of the acne scarred skin, these soft tissue fillers are able to elevate depressed scars.

 

© 2017 twlskin.com. All rights reserved.

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

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