When it comes to acne, most of us tend to think of facial acne – the most visible form of acne vulgaris. Back and chest acne, or truncal acne, is often overlooked even though more than half of people with facial acne can also have truncal acne. Further, acne on any part of the body can impact one’s self-esteem, body image or self-confidence.
What causes truncal acne?
Truncal acne develops in a similar way to facial acne. Major causes of acne include excess sebum secretion, abnormal desquamation (shedding) of skin cells, the presence of the bacteria Propionibacterium acnes (P.acnes), and inflammation. These elements can be found as much on the back and chest as on the face.
Genetics is also a crucial component. Your genetic disposition can influence the formation of comedones or the way your body responds to the P. acnes on your skin.
Acne forms when abnormal desquamation of epithelial cells causes sebum and keratin to accumulate and block hair follicles. This creates comedones – either open blackheads or closed whiteheads.
An increased production of sebum also creates an ideal environment for P.acnes to thrive, especially during puberty when oil glands are excited by hormones called androgens. The activated oil glands produce inflammatory factors, such as cytokines, that increase the skin’s inflammatory response.
Your back, shoulders and chest are also more prone to acne mechanica, meaning acne caused by the pressure, occlusion, friction or heat of clothing or physical activity. Sports equipment, such as shoulder pads and tight straps, can further exacerbate acne. Sweaty clothing traps sweat, oils and substances that support the growth of P. acnes. As a result, be sure to change out of sweaty clothing after a workout or seek shade when the sun is at its strongest.
How can I treat truncal acne?
First-line therapy for truncal acne should always be a combination of a topical and antimicrobial treatment to reduce the risk of bacteria resistance. Treatment lengths should also be kept as short as possible – to a three to four month course – and cautiously managed by an accredited dermatologist.
Topical treatments
- Benzoyl peroxide: Decreases inflammation and abnormal desquamation. It also contains anti-microbial properties that kill bacteria, but can bleach clothing and bedding. As such, it may be less desirable for treatment of truncal acne
- Retinoids: Reduce comedonal formation, expel mature comedones and exert anti-inflammatory effects.
- Antibiotics e.g. erythromycin, clindamycin: Reduce the proliferation of P.acnes but are not recommended to be used as the only form of treatment due to the risk that bacteria will grow resistant to the effects of medication.
- Azelaic acid: A newer form of treatment that has three pharmacological effects: anti-inflammatory, antimicrobial, and stabilizing on abnormal desquamation. Above all, azelaic acid also fades post-acne marks by inhibiting the release of tyrosinanse, an enzyme that controls the production of melanin.
While skin on the body can withstand acne medication that may be too irritating on facial skin, they can be harder to apply on the back. Also, skin on the body is thicker than the face and may respond more slowly to treatment.
Oral antibiotics
Antibiotics work to limit the proliferation of P.acnes, which makes them useful in treating moderate to severe acne.
Hormonal therapies
Oral contraceptives work to reduce androgen levels, which in turn decreases sebum production. Oral contraceptives are effective against inflammatory acne in females. Patients who do not mind being on contraceptives can consider this treatment.
Oral isotretinoin
Isotretinoin is a form of oral retinoid that is effective against severe. It helps to decrease sebum production, bacterial proliferation, inflammation and abnormal rate of skin cells shedding.
However, isotretinoin can have severe side effects. It can disturb the development of a fetus and cause birth defects if the mother is taking it at the time of conception or during pregnancy. Other potential side effects include mood changes, liver damage, or fluctuations in lipid levels. As a result, this medication should be cautiously managed by a dermatologist.
Cleansing
Proper cleansing should also follow alongside other treatment therapies. Dr. TWL’s Miel Honey™ Cleanser is a dermatologist-formulated cleanser ideal for acne-prone skin and uses medical grade honey as an anti-bacterial and anti-inflammatory agent. A gentle cleanser that lathers up from botanical emulsifiers, the foam produced is generous and refreshing on the skin.
Cosmeceuticals
Truncal acne patients can also consider cosmeceuticals as part of their treatment. Cosmeceuticals are cosmetic products that contain active ingredients that deliver medical benefits to the skin. Vitamin C, in particular, works as an antioxidant that helps clear the skin of inflammation. Another botanical to consider is Arnica Montana flower extract, which is especially beneficial for acne-prone skin as it stabilises inflammation and reduces skin flaking.
© 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.
Any acne google search will reveal links between acne breakouts and a variety of factors including cosmetics, spicy food, sunlight, chocolate, and even sweat. However, one less tangible factor that is often included but rarely explained is stress.
Stress is truly a significant factor in acne. While it is unlikely to cause acne alone, it can trigger flares and aggravate the condition by causing excessive oil production and delaying the wound recovery time of acne.
Stress induces excessive oil production
During periods of high stress, the hypothalamic-pituitary-adrenal (HPA) axis is activated and produces hormones. The HPA axis is the interaction between our body’s central nervous system (brain) and the endocrine system (hormonal-related).
The HPA releases androgens and corticotropin-releasing hormones (CRHs) in response to stress. CRHs bind to the receptors on our oil glands and accelerate lipid synthesis. CRHs also activates the testosterone in our body, which further enhances lipid production.
When the body experiences stress, neuropeptides are also released. Neuropeptides are small proteins found in the brain that are engaged in the functions of signalling and communication. Neuropeptides can also influence hormones. In particular, a neuropeptide called Substance P can stimulate the growth in the number and size of oil glands, which contributes to acne.
Stress delays wound recovery
Individuals with high levels of perceived psychological stress have shown significantly delayed recovery rates of the skin barrier. In other words, stress slows down the body’s ability to heal wounds, which can be a factor in slowing the repair of acne injuries.
Stress also triggers the increased level of the hormones glucocorticoids and catecholamines, which can adversely influence the healing process.
Glucocorticoids reduce the number of cytokines at the site of injury. Cytokines are essential in the early stage of wound healing as they protect against infection and prepare the injured site for repair by sending signals for phagocytes. Phagocytes kill and digest unwanted microorganisms. The later stages of wound repair are thus delayed with lower level of cytokines, meaning more time is required for acne to heal.
Further, catecholamines regulate a range of immune functions such as cell proliferation, production of cytokines (essential in wound-healing process) and antibodies. Elevated catecholamine levels during times of stress can inhibit the production of cytokines or suppress the body’s natural immune response to attacks.
Stress promotes habits that aggravate acne
The stresses of daily life may encourage individuals to pick at or scratch their skin. Such habits cause further inflammation, scarring and hyperpigmentation.
Stressed individuals are also more likely to have unhealthy habits, such as poor sleep patterns, imbalanced nutrition, and excessive consumption of alcohol. Stressed-out individuals can, at times, overeat in the face of chronic stress or increase their intake of calorie-rich food to calm the nerves. Comfort foods such as ice cream or cake can help to tone down the body’s stress responses but trigger acne or inflammation.
Finally, stress can cause people to neglect good self-care, including maintaining a usual skincare routine.
How to lessen the impact stress has on your skin?
Physical exercise can alleviate stress and regulate the production of stress-related hormones. Patients suffering from acne may be tempted to steer from exercise due to the discomfort from sweat, but exercising can provide important benefits to your skin. Just shower immediately after exercising and use a gentle moisturizer to keep your skin hydrated.
Experiment with other stress-reduction techniques as well such as meditation, yoga or reading a good book. If a stressful event is around the corner, be sure to get sufficient sleep and consume proper meals to eliminate other potential triggers that can aggravate your acne.
In addition to managing your stress-levels, consider visiting a dermatologist. Acne is treatable with the help of an accredited dermatologist, so it is worthwhile to seek professional advice.
© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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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.
Spa facials are now commonplace, offered everywhere from shopping malls to neighbourhood estates. While these may help you unwind, conventional spa facials may not be able to deliver effective results to your skin, and they may even cause more harm than good.
This is because facials at conventional spas or beauty salons are unsupervised by a doctor and may cause irritation and skin sensitivity. Often they include forceful extraction of pimples, blackheads and whiteheads that not only inflame the skin and cause pain but also increase the chances of secondary infections and deep scarring. Some of our patients have even contracted viral warts from contaminated instruments used for pimple extraction.
Enter the Medifacial. Short for medical facial, it is a procedure performed at a licensed medical establishment with non-invasive dermatological procedures. It causes neither pain or scarring, and uses pharmaceutical grade solutions and serums. A form of microdermabrasion very gently exfoliates dead skin cells, and a specialized vacuum handpiece extracts blackheads and whiteheads. The procedure both removes impurities and intensely hydrates with potent serums, including antioxidants and hydroxy acids, that soothe and rejuvenate the skin.
Medifacials can be tailored to the address a patient’s individual skin concerns including:
Microdermabrasion
Microdermabrasion is a safe and painless resurfacing procedure that results in decreased levels of melanin and increased collagen density. Not to be confused with dermabrasion, it targets the epidermis – the outer skin layer – instead of the dermis which is the deeper skin layer.
In conventional dermabrasion, a handpiece sprays inert crystals onto the face – such as aluminium oxide, magnesium oxide or sodium chloride or other abrasive substances – and vacuums them off.
In a medifacial, the microdermabrasion process uses a specialized vacuum handpiece embedded with an abrasion tip that is designed to rotate and gently exfoliate the skin while concurrently applying a soothing solution. The vacuum pressure and speed is adjusted to each patient’s sensitivity and tolerance to maintain as comfortable a procedure as possible.
The mechanism of abrasion and suction gently exfoliates the outer skin layers to remove dead skin cells. With a superficial depth of skin removal, microdermabrasion helps improve the conditions of skin surface such as scarring or photodamaged skin.
By producing controlled superficial trauma, the procedure also promotes facial rejuvenation. Repetitive injury to the epidermis can cause gradual improvement as it stimulates collagen production and fibroblast proliferation. (Fibroblast are cells found in connective tissues that produce collagen and other fibres.) This allows new collagen deposition in the dermis layer.
Mild erythema (redness) may occur at the end of a microdermabrasion treatment but will subside within hours. Microdermabrasion should not be confused with dermabrasion.
Extraction
If you have self-extracted comedones at home, you will likely be aware of the excessive scarring and breakouts that often follow. It is likely that the right pressure or angle is not applied during home extractions, disrupting the integrity of follicles and causing inflammation. Not using medically sterilised equipment can also lead to infections, exacerbating the condition.
In a dermatologist’s office, extraction is safely and easily performed and rarely leaves residual scarring. An accredited dermatologist can first assess between comedones that are suitable for extraction versus those that are not. After prepping the skin with alcohol, a tiny prick incision is made with a surgical blade to lightly pierce the epidermis. Light or medium pressure is applied directly on top of the comedo until all of the contents are removed. The treatment may cause minor discomfort but also help achieve an almost instant improvement in skin appearance.
In a medifacial, the microdermasion and vacuum processes, together with specialized and hydrating solutions, “loosen” and extract blackheads, whiteheads, excess sebum, keratin and other impurities. The specialized medifacial handpiece creates a strong vacuum with precision control that targets comedones from enlarged pores and removes the associated waste from the epidermis. It avoids collateral damage to the surrounding tissue and is completely painless.
Application of potent serums
In a medifacial, topical application of various serums and solutions is carried out continuously using the specialized treatment handpiece. The serums contain a potent mix of sodium hyaluronate, antioxidants and hydroxy acids that are applied at different stages of treatment to achieve a variety of effects such as skin hydration, lightening of pigmentation and softening of the skin for exfoliation and extraction.
Antioxidants are substances that protect our body and skin from oxidative damage. With their highly protective and rejuvenating properties, they are a mainstay in skincare formulations and key ingredients in a medifacial treatment. Antioxidants used include vitamin E, vitamin C, and rosa damascena (or rose water) that have brightening effects to help skin achieve a radiant glow.
Larecea Extract™ is a dermatologist-formulated combination of bioactive antioxidants derived from brassica olereacea (cruciferous family plants) and potent regenerative amino acids. It is a trademarked ingredient in the Dr.TWL Dermaceuticals’ cosmeceutical line.
Hydroxy acids help remove the top layer (epidermis) of dead skin cells. They do this by dissolving the ‘cement’ between skin cells, revealing smoother and firmer skin. Hydroxy acids used in a medifacial treatment include salicylic acid and lactic acids. Lactic
So the next time you step out of a facial salon with unsatisfying results, do consider a medifacial instead. Conducted under the supervision of an accredited dermatologist, a medifacial clears up the skin and helps restore its brightness through microdermabrasion, extractions, and an infusion of potent nutrient serums that hydrate and rejuvenate. It also has zero downtime, and only requires liberal sunscreen application to protect against ultraviolet radiation afterwards.
© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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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.
Suffering from acne? Also known as acne vulgaris, patients who suffer from this inflammatory disease typically develop it in adolescence.
Does my diet cause the acne?
The answer is not straightforward, because acne itself is multifactorial in origin, with genetics, inflammation, hormone related oil production in a complex interplay. However, a quick answer would be yes, diet does appear increasingly to influence the severity of acne and treatment outcome to a certain extent.
Acne vulgaris is often touted to be the epidemic disease of civilization, typically in first-world countries. Caused by an unhealthy diet fueled by modernization, it affects the sebaceous follicles of adolescents and adults. Today, a typical diet is characterized by high glycemic index foods, insulinotropic milk proteins and saturated fats.
So, does a Western diet trigger acne?
To convince you, populations that are exposed to diets with low glycemic load and no milk/dairy consumption are acne-free, such as the Inuit, Ache hunters of Paraguay, rural areas of Brazil. Prevalence of acne increased as Okinawa islanders and the Chinese switch from traditional diets to Westernized food.
How do hyperglycemic carbohydrates cause acne?
High glycemic index foods are those that are extremely high in glucose. The glycemic index works by measuring the impact that your food has on your blood sugar level. High glycemic index foods cause your blood sugar to rise faster.
Eating lots of food like white bread and cereal can also cause the elevation of hormones, leading to increased sebum production. The high glycemic load changes the composition of sebum fatty acids, causing proinflammatory and comedogenic responses. A diet-induced change in sebum composition can trigger acne inflammation and drive the process of comedogenesis, also known as the formation of blackheads.
Can saturated fats lead to my acne problems?
The major culprit is a saturated fatty acid called palmitate, and it consists of 32% milk triglycerides. Palmitate triggers the abnormal proliferation of keratinocytes, a cell that produces keratin, resulting in micro-comedones. The continuous sebum accumulation, enlargement of follicle and build-up of keratin within the micro-comedones causes the formation of comedones.
Trans-fats, produced industrially that structurally resemble palmitate, are in the fast food that we eat. With the replacement of natural solid fats and liquid oils with hydrogenated fats in fast food, fried food and baked goods, it has led to unhealthy diets that contribute to acne. Such a diet contributes to inflammatory responses of our sebaceous glands and hair follicles.
Does milk cause acne too?
The link between milk consumption and acne is not a breakthrough, adolescent acne is closely associated with their diets being rich in milk, cheese, yogurt, cakes and low in fish, fruits and vegetables. Milk contributes to increased insulin levels which prevent that production of an important protein FoxO1. The deficiency of this protein has been linked to major factors of development of acne.
Milk intake can also influence comedogenesis as it contains androgens, a type of hormone, steroids and other components that can affect the sebaceous gland and hair follicle. Such molecules survive processing, and for instance, in cheese, fermentation leads to more testosterone being produced from the precursors in milk.
Milk facilitates the pathway of sebaceous lipogenesis and sebocyte proliferation. Excessive intake of milk protein also explains the onset and aggravation of acne.
How can I adjust my diet to be less acne-prone?
You may opt for a palaeolithic diet – no hyperglycemic carbohydrates, no milk and dairy products. Fish consumption has shown to have anti-acne effect, as the fatty acids from the fish can reduce inflammation.
Resveratrol, a compound found in the skin of grapes, has shown to inhibit the growth of P.acnes, a bacteria that facilitates ace development in optimal environments.
Though multifaceted, dietary factors can worsen breakouts in acne-prone individuals. For a clearer skin, a good tip is to bear in mind what you consume, have a healthy balanced diet and lifestyle. However, if you have a persistent flare of acne for anything more than several months, medicated treatments such as oral antibiotics and topical retinoids may be necessary. So do visit a dermatologist early to prevent complications such as secondary skin infections i.e. gram-negative folliculitis, or severe acne scarring.
© 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.
What is acne?
Acne vulgaris is an epidermis inflammatory disease of the human sebaceous follicle and is a common dermatologic condition. Typically beginning in adolescence, it may persist into adulthood when left untreated.
How is acne developed?
The development of acne is not fully clarified, but it is agreed upon that the causes are multifactorial. A major cause of acne is related to a bacterium called Proprionibacterium acnes (P. acnes).
As a bacterium that grows deep inside of pores, P. acnes feeds on the sebum produced by sebaceous glands surrounding the base of the hair shaft. P. acnes grows best in an environment with accumulated sebum. P. acnes uses sebum as an energy source, causing the breakdown of sebum by the bacterium to produce byproducts that are inflammatory.
According to Dr.Teo Wan Lin, a dermatologist at TWL Specialist Skin and Laser Centre, she says: “To combat this inflammation, your body releases destructive enzymes to fight the infection. This immune response can cause damage to surrounding skin cells and is responsible for symptoms observed in acne as it permanently damages the skin and leads to acne scars.”
What are the causes that trigger acne?
One major cause is our genetic predisposition. Other factors that aggravate acne include:
- Oil-based cosmetics and facial massage
- Medicates that promote acne development e.g. steroids, lithium and iodides
- Food with a high glycemic number e.g. dairy products, candy
- Severe anxiety or anger may aggravate acne as it can stimulate stress hormones
Where does acne occur?
Acne occurs most prominently at skin sites with high density of sebaceous glands e.g. the face, back and chest.
Are there different types of acne?
Generally, acne can be divided into comedones, cystic acne. Comedones are hair follicles that are formed by the blockage of pores with sebum, debris and dirt, causing the pore to become infected.
Open comedones are blackheads, caused by an overproduction and buildup of oil that is oxidized, thus explaining its blackish appearance. Closed comedones are whiteheads, where the follicle is blocked completely. As the opening to the skin is obstructed, the rupturing of closed comedones can lead to skin inflammation.
Cystic acne is angry, red bumps filled with bacteria and pus. Caused by inflammation, it can start off as comedones that were left untreated, leading to an excessive growth of P. acne.
How can I treat acne?
Current treatments include topical formulations in the forms of creams, gels, lotions such as antibiotics, antibacterial agents and retinoids. Yet, patients need to be cautious of such treatments as it can lead to dryness, peeling or erythema. Different forms of acne would require alternative treatment techniques.
To treat open comedones, a mixture of carbon laser peels and chemical peels can be considered. For closed comedones, be sure not to pick those whiteheads as it exposes the skin to bacteria.
If you suffer from cystic acne, oral medication is likely to be given to shrink oil glands or prescription creams that contain tretinoin.
The use of lasers to treat acne is also increasingly popular due to minimal complications involved to allow benefits of treating acne scarring. The lasers will target the colonization of P. acne and high levels of sebum production on the face, chest and back.
If you may find it confusing to face acne alone, talk to a dermatologist. It is also important to visit your dermatologist before the acne gets severe and prevent scarring.
© 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.
What are cosmeceuticals?
Cosmeceuticals refer to skincare that has been developed from the combination of cosmetics and pharmaceuticals. They have medical or drug-like benefits, such as improving appearance through its ability to affect the structure and function of the skin and are recognised by dermatologists.
As these types of skincare contain bioactive ingredients, which means it has been laboratory tested and formulated, they ensure effective and proper penetration of skincare onto the skin. Cosmeceuticals differ from normal moisturisers or typical cosmetic formula as they contain anti-ageing, anti-wrinkle, sun-protective, anti-acne and anti-oxidant ingredients that have indeed been backed by dermatological research.
Who are cosmeceuticals for?
Cosmeceuticals are for everyone. They are commonly recommended by dermatologists as a complementary treatment for those who are undergoing cosmetic dermatology treatments such as lasers, fillers and botox for anti-ageing. It is also recommended as a form of skincare when treating skin conditions like acne. In addition, they serve as a cost effective option for patients to maintain the beneficial effects of such cosmetic treatments at the comfort of their homes and regular users of cosmeceuticals to maintain their youth and improve the appearance of their skin.
How to find the right type cosmeceuticals for you?
As cosmeceuticals are not regulated by the FDA or Health Sciences Authority in Singapore, as a quick rule of thumb, a product recommended by a dermatologist (check your doctor’s accreditation) would be safe bet. The skincare and aesthetics market today is flooded with cosmetic companies and even ‘doctor-designed’ skincare products by aesthetic doctors (who are not dermatologists) to add on to the public’s confusion of who’s the real skin expert.
One would be wise to do thorough brand research, look for the labels ‘dermatologist-tested’, ‘dermatologist formulated/recommended’ or just consult a dermatologist before you buy. As a cosmeceutical product, it should also ideally be formulated in a laboratory rather than in a cosmetic factory. It should also have the approval of a dermatologist. The reason these factors are important are because, one has to bear in mind that even when a correct active ingredient is present, it may lack effectiveness because of an inappropriate drug delivery system, compound instability, poor penetration, inadequate dosing or the ingredient itself may lack good clinical studies to back it up.
© 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.
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.
By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
“Pock-marks, enlarged pores, uneven skin, congested skin …” Ever been told that by your friendly beauty advisors at the cosmetic counters pushing their magical products or by your facial auntie? Those pimply bumps that last for months, are they just scars that don’t go away? Or am I still having an acne problem in my 20s and 30s?
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
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.
Yes, research on the science of acne scar treatment all you want, but if you are like most people who want the very best results for their acne scar treatment, go to a dermatologist. Check on the qualifications of your doctor on the Singapore Medical Council website (https://prs.moh.gov.sg/prs/internet/profSearch/main.action?hpe=SMC) because they are the ones who know intimately the science and physiology of skin, and most importantly, have the experience and the know-how to avoid and manage complications which may arise from treatment.
2. Assessment
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, and 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, he understands the characteristics of clay when it is dry or when it is wet, the tools he has and how to use them, 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 — 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.
Conclusion
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!
© 2017 Dr. Teo Wan Lin. All rights reserved.
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Dr. Teo Wan Lin is a leading dermatologist in Singapore and also the Medical Director of TWL Specialist Skin & Laser Centre.
To book an appointment with Dr. Teo for Acne Scar Treatment, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
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. Specifically, blue light, a type of laser therapy is designed to treat acne when it is active, and another therapy, ablative resurfacing can cure the scarring after it subsides.
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.
© 2017 Dr Teo Wan Lin. All rights reserved.
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Meet with Dr. Teo Wan Lin, accredited dermatologist at TWL Specialist Skin & Laser Centre for a thorough consultation and a full skin examination to control your acne condition over the long run.
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.
