It is important to maintain a healthy barrier between your skin and the mask to minimize the chance of skin irritation. In this chapter on maskne skincare, we will touch on the fundamentals of the skin microbiome – the balance of good and bad bacteria and yeasts on one’s skin, and the importance of skin care to maintain the microbiome balance.
Maskne skincare recommendations for mask-wearing
The wearing of an occlusive face mask has implications for the absorption of skincare applied. A moist and humid environment increases the absorption of any topical applied to the skin, which in the case of acne treatments, can increase the irritation potential of the active ingredient(s)
When mixed with sweat, certain active ingredients may also be biochemically altered and cause dermatitis (eczema). Sunscreens commonly cause irritation in individuals with eczema, and wearing a chemical sunscreen (as opposed to a physical sunscreen) under occlusion and sweat will increase the chance of developing sensitivity to the sunscreen.
Choice of Cleanser
A gentle emulsifying cleanser is important for thorough cleansing. For individuals who wear makeup, double cleansing is recommended to remove residual sweat, grime, oil, and make-up build-up. For non-acne prone individuals who wish to prevent maskne, it may be time to get started on a gentle cleanser with antibacterial properties.
My personal maskne skincare recommendation is the cleanser from my cosmeceutical line formulated with medical-grade honey. Medical grade purified honey functions as a broad-spectrum antimicrobial with natural emulsifying properties.
Medical grade honey is used in the Miel Honey Cleanser which has natural emulsifying, antibacterial, anti-fungal properties for gentle and effective cleansing in eczema-prone individuals. Natural honey is also a humectant, trapping a layer of moisture for protection after cleansing.
Choice of Acne Cream
When it comes to maskne skincare, avoid acne spot creams with synthetic active ingredients such as retinoids, benzoxyl peroxide, aulfur, salicylic acid as these will cause increased skin irritation (irritant contact dermatitis) when applied under the occlusion of a face mask. Individuals who apply retinoids for night acne treatment may find that wearing a mask in the day increases the risk of retinoid dermatitis, a form of eczema that leads to redness and flaking on the skin.
There are many different formulations of acne creams. The ones that we are familiar with would be benzoyl peroxide, salicylic acid and even sulphur or tea tree oil base formulas. These have largely fallen out of favor in dermatologists in the last 2 years primarily because of irritation potential.
Benzoyl peroxide is also known to bleach fabrics and may alter the structural integrity of the face mask, rendering it less effective for control of droplet spread. Anti-inflammatory acne spot creams are recommended. Acne formulations with botanical actives such as Chlorella Vulgaris work by regulating sebum production, whilst natural moisturizing factors like amino acids fight inflammation and have additional moisturizing properties to protect the skin barrier.
The Blemish Spot Cream is formulated with an algae extract, Chlorella Vulgaris, that reduces the activity of oil glands and has anti-inflammatory properties. Natural Moisturising Factors (NMF) in the form of amino acids help to reduce scarring and promote wound healing of the pimple.
In the ideal maskne skincare routine, hydrocolloid acne patches can be helpful because of the following reasons: 1. Prevents touching or picking which can lead to infection and scarring 2. Creates a moist microenvironment for faster and better healing 3. Increases absorption of active ingredients in pimple cream (non-irritating anti-inflammatory formulas recommended; avoid those with salicylic acid or retinols if you have sensitive skin) 4. Absorbs fluid to aid in quick resolution of acne papule/cyst
Hydrocolloid patches can sometimes contain active ingredients i.e. salicylic acid and benzoyl peroxide, hyaluronic acid and niacinamide, although it can certainly be used on its own with benefits as above. Overall, it helps acne papules heal faster by reducing inflammation.
Use of powder formulations to control excess oil and moisture
Mineral zinc oxide has anti-microbial and oil regulating properties. I currently recommend a loose powder formula for my acne-prone patients, as part of treatment for their oily skin. The benefits of using a zinc oxide powder formula for individuals suffering from maskne are as follows: control of bacteria as zinc oxide is antimicrobial, control of sebum regulation and absorption of excess moisture in those who suffer from hyperhidrosis (excess sweating). In addition, zinc oxide is an inert ingredient which means it is not affected by changes in pH or sweat.
For dry skin: Use protective emollient creams that contain barrier repairing ceramides and humectants such as polyglutamic acid, hyaluronic acid and natural moisturizing factors like amino acids. Avoid urea or lactate based humectants as this will likely cause skin irritation when mixed with sweat on the skin. Avoid occlusives such as white soft paraffin as this may increase the incidence of acne mechanica
The Multi-CERAM Cream is a new generation “Smart Moisturiser” formulated as a Prescription Emollient Device. It is formulated with an optimal skin lipid mixture, containing a mixture of plant-derived phytoceramides and synthetic ceramide. Antioxidants that fight skin inflammation are incorporated for optimal treatment of eczema.
For combination/oily skin: Use serums and emulsions/lotions rather than cream formulas. Cosmeceutical formulations containing plant anti-oxidants like Portulaca Oleracea, Centella Asiatica, Brassica Oleracea are anti-inflammatory and can be helpful in maintaining healthy skin function.
The Radiancé Fluide™ Hydrating Emulsion contains amino acids, oligopeptides and niacinamide for regeneration and skin brightening, specially formulated for a lightweight feel to impart a radiant glow.
The Elixir-V™ Total Recovery Serum is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.
Predominant outdoor mask wear in warm, humid climates
A maskne skincare tip would be to use serum or lotion vehicles instead of cream formulas. Choose humectants and emollients instead of occlusives (petroleum jelly, mineral oil-based liquid paraffin). This applies to both dry and combination/oily skin. The occlusive effect of the face mask in combination with a humid climate can lead to worsening of facial eczema and trigger occlusion acne
The Mineral Booster™ is power-packed with amino acids for repair, potent plant root extracts for UV-protection and polyglutamic acid for superior moisture retention.
When it comes to sunscreen as part of the ideal maskne skincare routine, the following issues are of concern here:
1. The oil solvent in sunscreen formulations can be comedogenic and can trigger off flare-ups of conditions such as perioral dermatitis. 2. The chemical sunscreen components (azobenzenes, cinnamates) can cause irritant contact dermatitis, which can be worsened by the occlusive effect of a face mask as well as by sweat accumulation on the skin. 3.The waterproof formula is necessary due to moisture and sweat build up under the face mask and will require frequent reapplication. 4. Reapplication of sunscreen under the face mask throughout the day may not be practical.
When one develops irritation after applying sunscreen, it is often due to chemical sunscreen components mixing with sweat. Some individuals feel stinging whenever they wear sunscreen, and it is usually not because they are allergic to sunscreen itself but it’s simply because the chemical block components can be altered via exposure to UV-light and when mixed with sweat (ammonia content).
The Sun Protector is exquisitely formulated for humid climates. It is a broad-spectrum sunscreen that also regenerates and soothes sensitive skin.
The relevance of UV-protection is not to be undermined. For normally healthy individuals, it is an important step to the prevention of photo-aging and skin cancers. For photosensitive individuals i.e. on acne treatment (retinoids/oral tetracycline), rosacea, lupus, post-laser, it is a key part of dermatological treatment. Sunscreen requirements should include broad-spectrum protection minimum SPF 30+, although the standard in dermatology practices are SPF 50+. Physical sunscreens are preferred over chemical sunscreens due to the inert formula of physical blockers, being less likely to trigger dermatitis.
Fabrics with ultraviolet-protective function (UPF
One part of maskne skincare, is the type of face mask chosen. All fabrics confer some level of protection from ultraviolet light, although for a garment to qualify as ultraviolet protective, there are key requirements, based on the current European guidelines. The design of the garment has to cover a maximal body surface area. Following which, the UPF-rating of the material itself depends on scientific measurements such as fiber chemistry, porosity, concentration, fluorescent whitening agents, UV-absorbers, and other finishing chemicals. While natural fibres such as cotton, silk and linen are breathable, they often confer very minimal to no UV protection. All approved UV-protective garments are synthetic in nature.
Currently, I recommend UV-protective fabrics for fabric masks, as a practical solution for sun protection during the pandemic. UPF 50+ qualifies for excellent protection according to the Skin Cancer Foundation Seal of Recommendation guidelines. A UPF 50 fabric blocks 98 percent of the sun’s rays and allows two percent (1/50th) to penetrate, thus reducing your exposure risk to UVA and UVB radiation, which causes photoaging, pigmentation and skin cancers.
Implications for individuals with skin pigmentation concerns
Given that it is highly recommended to wear a face mask during the COVID pandemic, it may be a turning point in dermatological care for the treatment of pigmentary disorders. Dermatologists are always looking at the topic of sun protection with great interest because firstly, it is the biggest contributor, other than our own genetics, to skin cancer. Secondly, it is the most significant external factor affecting aging, pigmentation disorders such as melasma and solar lentigines (sun spots). Sun protection advice for individuals suffering from facial pigmentation has been traditionally centered on the use of broad-brimmed hats, broad-spectrum sunscreens with minimum SPF 30.
With current recommendations to wear face masks, it is timely to revisit the topic of UV-protective clothing. In countries where there is a culture of sunbathing, there are higher rates of skin cancer, especially in individuals who are of a lighter skin phototype/have light-colored eyes i.e. blue or green eyes. The benefits of UV protective clothing is as such – offers gold standard protection with UPF 50+, not affected by factors such as reapplication (of sunscreen) or water-resistance. Fabrics are conferred with ultra-violet protection properties by way of specific material treatments, and are also required to meet the basic requirements of maximal skin coverage.
In August 2020, Dr. Teo Wan Lin, author of Skincare Bible – Dermatologist’s Tips on Cosmeceutical Skincare, was invited as a guest dermatologist for Clozette’sInstagram live session on the topic of maskne. A prominent researcher in the area of cosmeceutical skincare, Dr. Teo answered questions about acne care, hydrocolloid patches, maskne, and imparted useful tips for skincare routines. Read on to find out more about what Dr. Teo shared with editor Becks Ko and beauty KOL Khaw Xin Lin.
When it comes to choosing skin care products to tackle maskne, should we choose natural ingredients or “chemical” ingredients?
Dr. Teo emphasized that one should focus on whether the ingredient itself is evidence-based. “Some examples of naturally-derived ingredients that are beneficial come in the form of potent plant-based antioxidants, while chemical ingredients that are beneficial include salicylic acid, benzoyl peroxide, retinol, and retinoids. While these are synthetic structures, they have also been proven in our studies to have specific benefits for the skin.”
Botanical ingredients are anti-inflammatory
Dr. Teo highlighted a few specific botanical ingredients that can address inflammation. “Centella Asiatica (CICA), also known as the Indian pennywort, has been well-established to be a potent antioxidant. Centella Asiatica reduces inflammation and promotes good healing of scars. Ingredients like those derived from avocado oil are rich in polyphenols and fatty acids. Oleic acid – can also help in inflammation as well as the healing of acne scars. Salicylic acid which was first derived from the bark of willow trees, is a chemical compound that can have good effects in terms of reducing oiliness of skin.”
What is the ideal cleanser?
On the topic of cleansers, Dr. Teo pointed out that the ideal cleanser is one that can effectively remove the oil, dirt, and grime, while at the same time, functions as a humectant. This means that it preserves a layer of moisture on the surface of your skin to minimize water loss to the environment — a phenomenon known as transepidermal water loss. “In individuals who have skin conditions such as acne, eczema, there is an imbalance in this bacterial count, and cleansing then particularly becomes an important part of the skincare routine. If the cleanser is too harsh on the skin, you’re going to aggravate these conditions because it dries the skin barrier out.
On the other hand, it has to effectively remove all these particles that are a breeding ground for bacteria.” She further elaborates, “If you find that your cleanser is making you feel that your skin is squeaky clean and a little bit tight after rinsing it off, this is a sign that it is far too drying and it may not even address your concern of having greasy skin. Such a phenomenon will actually lead to excess oil production as a compensatory response.”
Sulfate-based vs amino acid surfactants
“The science behind a cleanser is really that of surfactants, which are basically the key ingredients involved in the cleansing work.” In traditional sulfate-based cleansing surfactant systems, there is a very high pH environment. Over time, it increases the abrasiveness and dehydration of the skin’s barrier. All of which increase the skin’s susceptibility to infections and dryness.
How to use an acne spot cream?
If you are wondering what skincare routine one should adopt for acne-prone skin, Dr. Teo underlined the steps to take. “First, cleanse with a good cleanser that doesn’t dehydrate the skin. Now, the second part, moisturizing. If you suffer from acne or maskne, it’s good to have on hand an acne spot cream that works for you. If you tend to be acne-prone over the entire chin or the cheek area, on regular days, I would apply a thin layer of the acne cream over the entire acne-prone part of your face.
And when you have a pimple, depending on the recommended dosage of the product, to apply it at the earliest sign of the pimple developing. Finally, use sunscreen. Whenever you heal from a pimple, post-inflammation hyperpigmentation (PIH) is a concern, and wearing sunscreen can help to inhibit excess melanin production caused by inflammation, reducing scarring.”
Should people with acne-prone or oily skin type skip moisturizers? What type of moisturizers to use for oily skin?
On the importance of moisturizing, Dr. Teo brought attention to how skipping moisturizers even if you have oily skin is a myth. “The reason is that even when your skin is greasy, it may lack the lipid barrier that protects your skin from the environment. This is a common phenomenon in individuals who find that they have both oily and dehydrated skin.
If you have oily skin and you decide to skip a moisturizer and use a very harsh, astringent cleanser and toner, you may actually have you have a paradoxical phenomenon called reactive seborrhea. That’s when overproduction of oil occurs because the oil glands attempt to compensate. This is definitely not ideal when you are trying to control oily skin.” If you tend to have oily skin, avoid heavy cream formulas and opt for serums and emulsions in the daytime, especially in a humid climate like Singapore.
A dermatologist’s approach to treating acne or maskne – separating myths from facts
Preventing acne from reappearing on the same spot
“If you have acne that keeps appearing over a certain spot, you could actually have something a little deeper known as an acne cyst.” An acne cyst is essentially a collection of pus, dead skin material that is segregated by a cyst wall. While it may reduce when it’s less inflamed, the cyst wall persists.
If you’re having a recurrent, painful, deep acne bump that lasts for anything longer than 2 weeks, then the suspicion of having an acne cyst is more likely. On another note, Dr. Teo elaborates, “if you tend to get acne over a certain area such as your chin or your cheeks, then using the right products can help prevent the formation of microcomedones, to prevent appearance of acne.”
Letting our acne “breathe”
“This is quite a paradox because, on one hand, we know that occlusion acne can occur with comedogenic substances and more recently, maskne, which is acne mechanica due to occlusion of the face mask on skin. On the other hand, a moist environment is optimal for the healing of inflammation.”
“If you do not have inflamed acne, then it is important for your skin to have some breathability in terms of moisture-wicking because this breeds bacteria and can cause flare-ups in acne. However, if you do have inflamed acne, then using the right acne care product can help the acne to heal faster. The effects of such products can be enhanced by creating a moist, wound-healing environment such as using a hydrocolloid acne patch.
Should we pop our acne?
“Popping a pimple is always a bad idea because it can get more inflamed and you may introduce more bacteria. If you notice your acne is coming to a head and there’s pus at the surface, after a warm shower, you can use a damp cotton pad to gently compress the area and the pus should come out naturally. However, if you’re not able to do so, definitely don’t proceed to squeeze it.”
Best fabric to prevent maskne?
On the point of choosing the best fabric to prevent maskne, Dr. Teo suggested opting for functional textiles. “None of the natural materials are waterproof. However, if you’re talking about skincare, typically natural fibers tend to allow more breathability in layman’s terms.
What I am recommending my patients right now is the concept of functional textiles. So the usage of synthetic fibers, in this case, would be ideal because it’s waterproof, but it has to be treated so that it’s skin-friendly. There are several physical factors that can alter the breathability of synthetic textiles, such as incorporating certain metallic ions like silver, copper, and zinc which can confer antibacterial properties that can reduce the occurrence of maskne.”
For many people, blackheads, whiteheads and pimples are a normal part of puberty. However, for some, acne can be a stubborn problem that occurs well beyond their teenage years. This is known as Hormonal Acne. Hormonal acne are characterized by painful and unpleasant pimples. It most commonly appears in adult women ages 20 to 40. In this article, I will be sharing about the science behind hormonal acne and the recommended treatment option.
Hormonal acne is characterised by flare ups during specific periods in the menstrual cycle. Individuals with hormonal acne often present with large painful cysts around the chin and jawline area. Mild hormonal acne is often a normal physiological occurence. However, more severe forms may be directly related to an underlying gynecological problem known as polycystic ovarian syndrome (PCOS). In Polycystic Ovarian Syndrome. Other symptoms may include irregular menstrual cycles, excessive facial hair growth, weight gain in addition to adult acne.
2. Who suffers from hormonal acne?
Sufferers of hormonal acne tend to be adult females who find that the acne persists beyond puberty. In my knowledge, there has not been any clinical epidemiological study performed by dermatologists on the incidences of hormonal acne. However, in my practice, out of 10 adult women that I see, a good 60 or 70% would report an influence of their menstrual cycle on their acne.
3. When should I see a dermatologist for my hormonal acne?
Finally, at the earliest onset of a flare up consisting of more than 5 pimples a month should warrant a visit to a dermatologist. This is especially if one does not have a history of having acne. The earlier the start of treatment, the lower the chances of morbidity from scarring. Acne has severe psychosocial effects as well. Dermatologists recommend that acne treatment should be commenced earliest as persistent acne flare ups cause emotional distress.
4. What is the best treatment option for hormonal acne?
The best treatment option for hormonal acne is to first visit an accredited dermatologist. A clinical evaluation will be conducted to inspect for any other clinical signs suggestive of a more severe underlying gynecological issue such as PCOS. Early detection and concurrent treatment of the underlying PCOS is key to effective control of hormonal acne.
The attending dermatologist will subsequently determine the acne treatment regime based on the appearance of the acne itself, rather than on the fact that it is hormonal acne. If it is predominantly nodules and cysts, treatment will likely be escalated to an oral medication isotretinoin (also known as Oratane or Accutane).
However, most hormonal acne patients have moderate severity, comedonal type acne with occasional painful cysts. These individuals start treatment with an oral contraceptive pill that has cyproterone acetate in addition to the estrogen component. Cyproterone acetate has been proven to block the male hormone testosterone. This is helpful in treating hormonal flare ups of acne. This may also be administered with oral antibiotics which can help reduce inflammation in cases of moderate-severe acne.
Hormonal acne, like other forms of acne, is always treated with topical anti-inflammatory creams in addition to oral medications. An antibacterial cleanser is essential. I have moved away from prescribing chemical antibacterial agents like triclosan to natural derivatives. My patients use a Honey Cleanser Formula made with medical grade honey. Medical grade honey is naturally anti-bacterial and anti-fungal.
Individuals who suffer from extensive comedonal acne around the hairline may actually have concomitant fungal acne- a condition known as Pityosporum Folliculitis. Acne-prone individuals tend to have excess sebum (oil) production, and this also predisposes to increased fungal growth. Malessezia, which is the yeast organism responsible for fungal acne, overgrows in individuals with excess sebum production. This is worsened by humid weather.
Physical therapies such as blue light and lasers help hormonal acne. Blue light helps to suppress the acne bacteria, propionebacterium acnes which is responsible for acne flare-ups.
Lasers such as the carbon laser are semi-ablative, meaning they do not directly traumatise the surface of the skin but still help to resurface gently. These can also help to control sebum production by directly shrinking oil glands. The results are cumulative, meaning that the more sessions undergone, the greater the effects of sebum reduction.
In terms of answering your question as to the best treatment option for hormonal acne, it is important to highlight that acne is a medical condition rather than a cosmetic one. It is caused by a myriad of factors working together. Firstly, our personal genetics, the second being inflammation which is influenced by genetics as well.
Hormonal fluctuations in females during the menstrual cycle indicates that certain individuals are more sensitive to circulating amounts of testosterone than others. Hormones trigger off increased oil production- which aggravates acne inflammation. Bacteria also play a role in acne. Individuals with acne have higher counts of propionebacterium acnes. Diet plays a role as well, with dairy products and foods high in saturated fat causing flare-ups of acne.
With this, one can then medically target several of these processes in the treatment of hormonal acne. There is no one single method. It has to be addressed holistically. If you have primarily hormonal acne that is caused by PCOS, taking an oral contraceptive pill and treating the underlying hormonal issue would help to resolve the skin problem. However, 80-90% of the adult females I see have a combination of factors causing their acne. We have to approach the treatment holistically, addressing all these processes.
5. How can I prevent hormonal acne?
Truth is, many individuals are predisposed to developing adult acne because of their genetics. Singapore’s humid climate is not helpful for acne sufferers, as the moist environment encourages growth of bacteria. Secondary skin infections like gram-negative folliculitis cause pustules and inflammation.
From what I observe, most adult acne patients start treatment too late. Prevention is always key. If you have greasy skin or are prone to hormonal flares of acne, a good skincare routine is helpful. For removing all the dirt, grime and makeup, I advocate double-cleansing. This helps overall to reduce the bacteria load your skin. Cleansing encourages a good balance of good bacteria, eliminating bad bacteria on one’s skin.
Individuals who have hormonal acne tend to get gram-negative folliculitis, a secondary bacterial infection caused by bad bacteria on the skin. Using a well formulated anti-acne pimple cream is also important. This helps to treat inflammed papules and can prevent progression to acne cysts. I have moved away from prescribing topical antibiotics (which lead to bacterial resistance with time) to botanical derived anti-inflammatory active ingredients such as Chlorella Vulgaris, an algae extract which directly blocks sebum production. Natural moisturising factors such as amino acids also helps to reduce inflammation.
The use of antioxidants serums such as vitamin C reduce bacterial counts and can improve acne as well as acne scars. I regularly prescribe hyaluronic acid serum which helps to regulate oil production. An underrated active ingredient is polyglutamic acid, an active ingredient which can hold 4-5 times more moisture than hyaluronic acid itself. The Mineral Booster which I formulated for problem-skin has predominant polyglutamic acid content and is very effective for moisturising throughout the day, over/under makeup. It is an excellent humectant with additional natural moisturising factors which enhances the skin’s natural repair barrier without a heavy cream formula which can increase facial oiliness.
“How do we avoid acne breakouts?” As dermatologists in Singapore, this is the commonest question we get asked. Certainly not a surprise, considering over 90% of the world population is affected by acne at one point or another in their life. Yes, acne is not a problem unique only to Singapore, which has a constantly hot and humid climate that some may try attribute their less-than-ideal complexion to.
Whilst the climate could play a role in proliferation of the P. acnes bacterium responsible for acne breakouts, the underlying cause of it is actually multi-factorial and intertwined with one’s genetics. Given the pervasiveness of acne, there are naturally burning questions surrounding what we can do to get rid of pimples that have popped up and how do we prevent them from reoccurring, which we discuss below.
Pimples that have come to the surface have two possible outcomes. One outcome would be the pimples going away, so the pus and all the debris get extruded out within two to three days. The pimple flattens out and leaves a mark and eventually it fades. The other possible outcome, which is undesirable, would be having the pimple grow bigger and bigger. This becomes cystic acne and may feel as being very deep under the skin. The pimple may also become part of broader acne breakouts, with multiple cysts and may even be painful. It is therefore a no brainer that we want to prevent the second outcome.
The crux here is to understand that having just 1 or 2 pimples a month is classified as physiological acne. This can actually be very well managed with over the counter topical acne creams. However, if you have anything more than five pimples a month, there is a need for prescription medications. Be it in the form of creams or oral medications, because otherwise, you will likely end up in an inefficient cycle, find that the problem keeps recurring and never goes away.
If you have anything more than 5 pimples in a month, it means that under your skin, you have at least 20 pimples gradually rising to the surface. These embedded pimples take turns to come out. That is why some people struggle with having acne which never seems to go away. The pimples do not appear overnight, contrary to popular belief. Micro-comedones, which are little bumps under your skin, rise to the surface of skin through the process of inflammation. These could take 1 to 2 weeks to appear. In the interim, over the counter (OTC) acne medications may be useful in resolving some bumps, especially where there are fewer bumps.
There are plenty of OTC active ingredients we know traditionally for treating acne. These include benzoyl peroxide, salicylic acid, and some people use sulphur based solutions. However, in my opinion, these only work for very mild acne. I personally do not prescribe any of these in my practice anymore, because they cause irritation and very often the side effects outweigh the benefits. Furthermore, you can get a lot of sensitivity, redness, burning and stinging sensations.
If you have more than 5 pimples a month or experience acne breakouts, you have at least moderate to severe acne. This warrants a visit to your dermatologist for comprehensive management of your acne condition. The following are some tips which I would dispense to those having mild acne breakouts, and also applicable as adjuncts during acne treatment and maintenance thereafter.
1. Use anti-inflammatory creams on acne breakouts
In place of the traditional acne treatment ingredients, I am now proposing anti-inflammatory pimple creams that are composed of bioactive viable botanical ingredients. One such cream is the Blemish Spot Cream, which I have formulated using an algae extract and amino acids. This is instead of the traditional harsh chemical ingredients which work by drying out the skin.
With studies in more recent years, we understand more about acne being an inflammatory condition, which is genetically determined. Accordingly, we work towards reducing inflammations. Therefore, certain amino acids like serine and methionine, that help to repair wounds and reduce inflammations, would be effective. If you think of your pimple as an injury to the skin, which it really is, you want the skin to heal faster. By the same principles, the raw materials supporting wound healing, i.e. amino acids, have the effect helping the pimple to resolve.
In addition, lipid extracts from the algae chlorella vulgaris is also a critical anti-inflammatory constituent. A 2015 study showed that these extracts have tremendous efficacy in inhibiting human inflammatory mediators, with nearly 80% inhibition in some permutations, thereby reducing the pathogencity of P. acnes in causing acne breakouts.
Another key ingredient in the Blemish Spot Cream cream tackles oil production. Oil production significantly worsens acne, causing it to become more inflamed. The abundance of oil also becomes a perfect breeding ground for bacteria, to even cause secondary bacterial infections. In this light, we use extracts from the Argania spinosa tree, colloquially known as argan oil, to reduce oil gland activity. Apart from regulating oil production, sterolins (a form of plant fats) in argan oil also has a potent anti-inflammatory effect from dampening overactive antibody immune responses.
Botanical-based anti-inflammatory creams have in fact increasingly taken the place of prescription antibiotic ointments in our practice. You may have heard of clindamycin, clindoxyl and erythromycin gels which are topical antibiotics that kill surface bacteria. The antibiotic gels, however, have demonstrated limited success in suppressing acne inflammation. Furthermore, I think it is important to highlight that these lose efficacy after a maximum of 3 months. This is because the body gradually develops resistance against topical antibiotics and should be closely managed by your dermatologist.
A more sustainable second category of prescription medication would be retinoid creams. Retinoids belong to the vitamin A group of topicals. Different trade names exist, although by and large the mechanism of action is similar. Essentially, retinoids such as tretinoin work by treating the microcomedones under the surface of the skin.
They accelerate the rate of cellular turnover of the skin, thereby bringing up to the surface microcomedonic bumps in the first one to two months of treatment. This is before they start to suppressing the growth of such microcomedones. However, these are not without side effects, such as redness and irritation which may occur during the course of treatment and needs to be monitored by your dermatologist.
For those with mild acne, the potent anti-inflammatory properties of the Blemish Spot Cream will be handy in resolving acne breakouts. This is especially when the pimples are not yet fully inflamed and in clinical practice for such cases, has demonstrated particularly quick spot resolution of comedones. For those undergoing acne treatments or maintenance post treatment, the Blemish Spot Cream may also be used for prevention of acne breakouts around acne-prone areas.
2. Use an anti-bacterial cleanser
I think for acne it is very important that you use an anti-bacterial cleanser. For the ladies, double cleansing works in this method – oil soluble pigments such as those from makeup, especially eyeliner, mascara, eye shadows pigments, need to be dissolved in either a micellar formulation or a oil based emulsion. The oil-in-water emulsion forms a milky formula which is what I usually recommend to my patients because this is much gentler on skin.
The second stage of cleansing is where acne-prone skin would benefit from if done correctly. An anti-bacterial face wash in the past to us meant using a chemical such as triclosan. Triclosan, while effective in preventing acne breakouts, has had some controversy in its use. Although not definite yet, it has some reported effects on the human hormonal system and that is why I have also stopped prescribing that. Instead, we use a medical grade honey cleanser which helps to emulsify the grim, dirt, and it forms a foam which is not based off a very strong lathering agent like the laureth sulphates.
We are using the natural emulsifying lathering properties of honey and the same would go with a product such as soya. The great things about these natural emulsifiers is that they form a layer of what we call a humectant after you wash it off. This is so that while your skin feels clean after a wash, it is not dehydrated. The humectant layer in fact stays on the rest of the day and helps to form a healthy skin barrier between your skin and the environment to help prevent the onset of acne breakouts.
3. Healthy diets go a long way to prevent acne breakouts
The other aspect that should not be neglected would be your diet. I find that if you have problem skin and we start you on treatment, almost everybody will get well as long as they comply with treatment. However, the rate of recovery as well as the sustainability of the positive effects of treatment is significantly better in the group where they are conscientious with their diet.
We now know that diets high in trans fat, i.e. deep fried foods, dairy products, sugary foods, are pro-inflammatory which means that it can exacerbate your underlying acne conditions to cause acne breakouts. I tell my patients to stay away from that and also take an anti-oxidant rich diet. It is very hard to imagine that we are not what we eat. The same goes for skin, an organ that needs to be respected along with whatever nutrition that goes to your skin, which occurs via 2 ways.
Firstly, nutrition to the skin is topically applied and to me that is the most significant such as in the form of antioxidant cosmeceuticals. The second means, by consumption, is for the healthy functioning of all your tissues. This is for it to fight the daily assaults of free radical formation from environmental pollution, uv exposure, biological ageing. It is critical that have your supply of anti-oxidants in diet and all these do not have to be found in supplements which may be controversial, in terms of the amounts that have to be ingested in a sustainable manner.
We should perhaps instead look towards a healthy natural anti-oxidant rich diet. Do include lots of blueberries and even olive oil. Olive oil in our diet has been proven both by cardiologists as well as within the dermatology research community to have positive anti-ageing effects on the heart as well as on the skin. These factors do add up eventually for healthy skin that is free of acne breakouts.
Acne in teenagers and adults is a troubling condition, affecting one’s self-esteem and confidence levels. In my clinical practice as a dermatologist, acne vulgaris, colloquially known also as pimples, forms at least 50% of the daily load of patients I see. There are many aspects to be addressed within the dermatology consultation.
This varies from the cause of pimples, to questions about effective acne treatments, DIY formulas, over the counter acne creams and prescription medications. I have sought to share as many of these treatment pearls in the following article as comprehensively as possible, and hope it can help shed some light on the best acne treatments available.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She is the founder of Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Dr. TWL Pharmacy is the only full fledged online specialist dermatologist compounding pharmacy in Singapore and is jointly headed by a trained pharmaceutical engineer for strict quality controls.
Why do pimples form and what exactly is happening to your skin when a pimple forms
Pimples is the colloquial term for Acne Vulgaris. This refers to an inflammatory condition of the skin that presents with blackheads and whiteheads, otherwise known as closed comedones and open comedones respectively, inflamed papules as well as acne cysts. The cause of Acne Vulgaris is multifactorial.
First of all, it is determined by one’s genetics. Individuals with a family history of acne tend to have a higher chance of developing acne. This is brought on by the onset of puberty which leads to the secretion of the male hormone, testosterone. Testosterone, in turn triggers oil production in both men and women. That being said, sebum, the oily substance secreted by your sebaceous glands, is essential for the entire process of acne formation.
The third thing that occurs due to one’s genetics, is the process of inflammation itself which leads to comedone formation. All pimples whether whiteheads or blackheads arise first as microcomedones under the surface of the skin.
When they reach the surface of the skin, they become visible. The process that drives this is a mix of genetics, the presence of sebum as well as some form of dysregulation of the process of follicular keratinisation i.e. the way your skin retains dead skin cells around your skin pores.
Aside from genetics, there is also the involvement of a bacterium known as Propionibacterium acnes – a heavy commencer in individuals who suffer from acne. Finally, a lot of acne flare-ups can be due to the secondary bacterial infection of existing acne bumps known as gram-negative folliculitis. This tends to present with pus-filled papules and tend to have a yellowish tip.
I have observed that I always get acne in the same spot
While I do hear this coming from my patients quite often, i.e. “I always get this one pimple now and then on my cheek, chin, forehead…”, there is no scientific answer to this. From my personal experience, this could be due to one of the following. Firstly, if you tend to pick at your pimples, there is a condition known as acné excoriée. The entire name of this condition in french is acné excoriée des jeunes filles meaning acne excoriée of young girls.
There is an element of this compulsive picking of acne and this is the main reason why I find my patients having acne at the same spot. They constantly pick at it so even when it is healing, it does not get the chance to heal and picking introduces secondary bacterial infection.
The second reason why is because you are suffering from some form of acne that is related to occlusion. Some people wear helmets or face masks. If acne develops around that area, it is a type of acne known as occlusion acne. It could also be due to the application of comedogenic, hair waxes etc.
The third thing, if you are talking specifically about acne on the chin, you have to consider perhaps it is not acne at all. There is a condition known as perioral dermatitis. Perioral dermatitis looks very similar to acne and if you are seeing a non-specialist, it is very easy to be confused. This is because the bumps look very similar to acne, except that it is a mixture of eczema and inflammation, acne bumps, or it could even be acne rosacea.
All about Acne Creams
When you apply a pimple-clearing product to your pimple, what happens to the spot? What are some of the ingredients that you’d want to look out for in a pimple product, and what should you avoid? Are pimple drying lotions ok for the skin and how do they work?
If you find yourself searching online for answers to these questions, you are not alone. These are some frequently asked questions by sufferers of acne and I shall seek to clarify them here. There are a few categories of pimple-clearing creams. The first being the good old-fashioned creams that simply dry out the skin and reduce sebum production.
Pimple Drying Medications
This category would include topicals that contain the following active ingredients: benzoyl peroxide, salicylic acid, calamine lotion, sulfur-containing lotions. In some mild cases these creams may lead to an improvement in acne itself.
Pimple Creams Containing Antibiotics
The second category of acne treatment creams would be those containing antibiotics. The commonest antibiotic-acne gels would be those which contain clindamycin or erythromycin as an active ingredient.
These work on the premise that a lot of cystic acne is caused by secondary bacterial inflammation. As with all topically applied antibiotics especially in a chronic skin condition like acne which is not primarily due to skin infection, there is a huge problem with using topical antibiotics.
Topical antibiotics work well in a short-term simply because the skin has never been exposed to it. But very quickly the body learns to identify the antibiotic and develops resistance.
This is particularly concerning because the resistance doesn’t just take place in the skin level. Exposure of the topical antibiotics on the skin level leads to resistance systemically as well. For example, it could lead to antibiotic resistance when one is older.
The main thing about antibiotics is that it is a mere short-term fix and does not work after some time. There are other combinations of antibiotic gels, such as clindamycin combined with benzoyl peroxide which is the active ingredient present in the OXY pimple cream. The benzoyl peroxide component has been proven to reduce the emergence of bacterial resistance.
Prevention Creams – Retinoids for Acne Treatment of Whiteheads and Blackheads
The third category of pimple creams which I consider more preventive rather than treatment sort of cream is the retinoid category. These are the vitamin A derivative creams. We have heard of creams like tretinoin and adapalene which may have differing trade names. Both these creams are Vitamin A derivatives and they work via preventing microcomedone formation.
However, when you apply these creams, you should not apply it to inflamed active pimples as this can worsen the inflammation process. Rather they should be used in conjunction with active acne treatments prescribed by a dermatologist which is proportionate to the severity of your acne as preventive treatment. When you start applying a retinoid cream for example, you only get to see the result 2-3 weeks later.
A Dermatologist’s Recommendation of the Ideal Pimple Cream – New Generation Anti-Inflammatory, Anti-Sebum Pimple Creams
The fourth category of acne treatment creams is actually what I actively advocate now and which we have formulated in a highly effective Blemish Spot Cream under Dr.TWL Dermaceuticals. It is targeted at reducing inflammation itself. I am very convinced that botanicals have a prominent role to play in cosmeceuticals.
Cosmeceuticals are no longer just confined to the realm of having anti-ageing properties but are also adjuncts for the treatment of many medical skin conditions. I have used botanicals extracts successfully in the treatment of rosacea for example.
For acne, I incorporate an algae extract from chlorella vulgaris which actively reduces the oil gland activity. This is combined with amino acids such as methionine and serine that help to heal the skin when you apply it. The main thing is that when you try to dry up an active pimple, very often you get more inflammation as you are burning the skin around it.
What you need to do is to try to get the pimple to heal as quickly as possible. This is so that you minimise the risk of scarring. At the same time, this also treats the underlying problem of acne pimples which keep forming.
Are there different pimple creams best suited for the different types of acne (eg blackheads whiteheads, red swollen pimples)?
For tretinoin and adapalene which are the two main available form of vitamin A creams, these should not be used for red, painful, swollen acne treatment. They are best suited for comedonal acne which would be your blackheads and your whiteheads. For drying pimple creams, like benzoyl peroxide, salicylic acid, calamine lotion, I don’t recommend applying these to areas that have broken skin.
If you apply these to broken skin, the irritation and drying potential is just going to be multiplied. Potentially, you are going to end up with something that looks like a chemical burn. That is something much redder with a lot of peeling flaking and bad scarring.
Instead, I would recommend using an anti-inflammatory product with botanical-based extract that doesn’t contain anything irritating like salicylic acid. For example, the one we use is based on an algae. There is no issue applying this over areas with broken skin, although it also really depends on the formulation itself.
In addition, for a correctly labelled and medicated acne cream, i.e. not just a cosmetic product, there would be very clear indications of use available.
Does my skin ever get used to pimple-clearing products – is that why my pimple never seems to heal?
If you are using a medication like clindamycin and erythromycin, then yes because you develop real bacterial resistance which stops the medication from working. If you are using something which is drying such as the first category I spoke about earlier, or something anti-inflammatory, there is no evidence that your skin can actually develop a form of resistance to that. It is simply that the severity of acne has progressed or in the first place it wasn’t sufficient acne treatment.
Adult Acne Treatment
For patients with mild acne, they will have approximately 3-5 pimples every month and they tend to be of the teenager age group. Once you are past your teenage years, from the age of 21 onwards, it is a different ballgame of what dermatologists term as adult acne. If you still suffer from acne then, meaning having an average of more than 5 pimples every month after the age of 18, it is at the minimum, a case of moderate acne.
Moderate severity acne means that while you don’t have severe scarring or cystic acne, it is still very persistent and would need to be treated medically by an accredited dermatologist. In my clinical experience, moderate acne does not respond well to topicals only regimens. Topicals are only useful as an adjunct in the treatment of moderate acne.
On the other hand, using appropriate cleansers and pimple-clearing gels works well and is sufficient for mild acne. It may be a selection bias by default, given that attendances at a dermatologist practice would be moderate cases.
This is because the mild cases perhaps get treated at the GP level before they do get to us. Moderate cases of adult acne would need more treatment than just topicals. According to international dermatology guidelines, there are two options for the treatment of adult cystic acne.
Oral Acne Treatments
Firstly, the oral pathway for which I must emphasise that there are many oral medications that are safe and effective that have been widely prescribed by dermatologists internationally for decades. Examples of commonly prescribed medications include low dose oral antibiotics like doxycycline, erythromycin. These function primarily as anti-inflammatory medications to prevent comedone formation.
Minocycline is less frequently used these few years as it has been linked to a few rare cases of hypersensitivity syndrome, on top of potentially causing blue-grey skin discolouration.
Erythromycin in particular is safe for pregnant and lactating individuals. Oral contraceptive pills such as Diane-35 and Estelle-35 contains estrogen as well as cyproterone, which blocks androgen (testosterone activity). Androgens are male hormones that trigger off oil production, exacerbating adult hormonal acne.
Women with a history of irregular menstrual periods with cystic acne may have undiagnosed polycystic ovarian syndrome (PCOS). Such individuals will benefit from joint management of a dermatologist and a gynaecologist. Treatment of PCOS is with hormonal therapy, which will benefit adult acne treatment as well as preventing infertility.
Non-Oral Acne Treatments and Physical Therapies
Secondly, we have the non-oral pathway for acne treatment which involves physical therapies that have to be administered in a clinic setting. For example the usage of LED wavelengths, blue-light, two times a week for one month.
Blue light is therapeutic for treating acne that is especially worsened by the bacteria Propionebacterium Acnes. This has been proven to be effective in a regimen of twice weekly 30 minutes duration for a one month regimen.
Chemical Peels and Lasers for Acne Treatment – Can they be used independently?
Use of chemical peels and specific lasers like the carbon laser helps to shrink the oil glands of someone with active acne, especially in individuals that may not want to go on oral medications.
I always recommend those with persistent moderate acne to go for a short course of a safe antibiotic such as erythromycin or doxycycline in conjunction with any of these physical therapies. This is the most cost-effective option that targets inflammation that goes on in acne rather than blindly treating it from the surface.
For severe acne, you may suffer from deep painful cysts which often involve pus and bleeding and there will be a lot of scarring. The treatment for this is very straightforward, our first line is always this medication called isotretinoin.
The medication is also known as accutane or oratane which are brand names of the forms of isotretinoin available. Isotretinoin is an extremely effective oral medication which works essentially by shrinking your oil glands.
Without oil, your skin simply doesn’t produce acne. However, isotretinoin use does come with drawbacks like increased sun sensitivity, dryness of the lips and eyes. One also has to monitor your liver function and cholesterol levels whilst on isotretinoin.
A lot of patients in my practice have asked me to gauge the number of days to determine if an acne product works and my answer is simply this.
The Wound Healing Process of a Pimple’s Life Cycle
When a pimple forms it is best viewed as an injury caused by inflammation to the skin. You may go by the principles of wound-healing, especially when it only involves the top two layers of the skin (the epidermis and dermis).
Within the first 2-3 days of a cyst, there should be signs of pus draining. Should there be blood coming out of it, soon one should observe the redness and swelling resolving as well.
Acne That Does Not Heal
Acne may progressively accumulate and get larger instead of reducing in size. For example, the acne may get more painful, accumulate more pus and blood that doesn’t seem to be draining. When this occurs, one has to consider that there is an underlying cyst forming.
What is An Acne Cyst?
The formation of an acne cyst involves the collection of haemoserous material – blood, sebum, dead skin, keratin and debris. These substances subsequently get “cordoned off” by the body with a wall around it. This is part of the immune system’s response to inflammation. Acne cysts do not respond well to any topical treatment.
Proper Treatment of An Acne Cyst
Acne treatment of cysts involves a combination of the following. Firstly, an injection known as an intralesional steroid injection helps to reduce inflammation locally. It is injected right into the centre of the nodule and within 3 days, swelling will reduce the underlying swelling.
It is very important for the injection to be administered. This is because untreated acne cysts can lead to more severe problems like facial abscesses with drainage of pus.
Furthermore, it can spread to other parts of your face which is rare but has been documented. Concurrently, large painful acne cysts should be treated with an oral antibiotic such as amoxicillin, sufficient to treat the secondary bacterial infection that causes this reaction.
In the light of the Covid lockdown, our clinic is open to TeleDermatology services for acne treatment. This includes complimentary doorstep courier of prescription, contactless delivery within 3 working days. Same day delivery can also be arranged.
If you suffer from mild to moderate acne, you may try these over the counter cosmeceuticals proven for acne treatment.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She is the founder of Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Dr. TWL Pharmacy is the only full fledged online specialist dermatologist compounding pharmacy in Singapore and is jointly headed by a trained pharmaceutical engineer for strict quality controls. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she talks about chemical peels, are they necessary and are there any alternatives for those who wish to do it at home?
What is a chemical peel?
A chemical peel is the application of a high yet safe concentration of a certain acid on the skin. Superficial peels involve the use of acids such as salicylic acid and glycolic acid. They induce epidermal injury and the induced exfoliation is followed by dermal and epidermal regeneration from adjacent epithelium and skin adnexa, which results in improved surface texture and appearance of the skin. Superficial peels are most commonly used for mild skin disorders such as dyschromia, acne, postinflammatory hyperpigmentation, melasma, and actinic keratosis.
What are the benefits of a chemical peel?
Chemical peels exfoliate the dead outer layer of your skin and are mainly used to treat:
Acne (i.e Blackheads, whiteheads & pimples)
Chemical peels reduce inflamed lesions, loosen and reduce open and closed comedones (colloquially known as blackheads and whiteheads respectively). Chemical peels also lighten mild acne and facial scars from past blemishes. It can be used to compliment topical or oral medication to treat pimples and control acne breakouts.
Reduce fine lines under eyes, around the mouth and on the forehead.
Lighten mild acne and facial scars.
Reduce age spots, freckles, and dark patches (melasma) due to pregnancy or taking birth control pills.
Remove the sun-damaged outer layers, leaving you with smoother skin.
Chemical peels also increase the absorption of skincare products into the skin because the removal of the topmost layer of skin ensures that there are no dead cells impeding the penetration of products.
SA has anti-inflammatory, antimicrobial and depigmenting properties. It is safe in skin of all Fitzpatrick phototypes. Because of SA’s lipophilic and comedolytic effects, it is particularly effective for comedonal acne.
What are the side effects of a chemical peel?
The side effects of the treatment tend to be mild and temporary. Most side effects subside after 3 days.
Scabbing of the skin (due to skin cells being removed)
Increased sensitivity to the sun
How is a chemical peel performed at your clinic?
A certified nurse will hand you a consent form for the chemical peel before proceeding to explain in detail what you can expect during the peel and the benefits. The peels we use in our clinic are: Lactic Acid, Salicylic Acid and Glycolic Acid. Before the procedure, your face will be cleansed and eye protection like goggles or gauze may be applied. During chemical peel, the nurse will use a cotton pad or brush to apply the chemical solution to your face. You may feel a slight stinging sensation however the nurse will assess the skin and monitor the reaction to the acid. Once complete, the chemical solution will be removed or a neutralizing solution will be added. The strength and peel times are tailored to individual patients skin type and needs. After the peel, we will apply AMINO ACID 360° MASQUE and leave it on for 10 minutes to soothe the skin. It contains a potent concoction of skin brightening Vitamin C which soothes inflamed acne and lightens scars. LARECEA™ Extract with lifting amino acids penetrate the epidermis to stimulate collagen regeneration, resulting in all round 360 degrees lifting effect for a youthful, smooth contour of face.
If I cannot make it down for a chemical peel at your clinic, would there be alternative treatments that can be performed at home?
Our online specialist skincare pharmacy Dr. TWL Pharmacy supplies custom compounded topicals powered by botanical actives, for various skin conditions delivered to your doorstep. This is also part of a teledermatology service integrated with the specialist skincare pharmacy, a unique service developed for our overseas patients and a current necessity given the healthcare situation worldwide. There is complimentary courier service locally and subsidised international shipping for our prescription medications.
The following are alternatives for home peels:
Our Dr. TWL Home Chemical Peel System– By Prescription via Teledermatology only. This system incorporates active peeling agents suitable for home use formulated by our in house team, with recovery serums and skin healing emollients included in the package. From $80 upwards depending on prescription and need. Please book in here for your consultation.
Home Medi-Facial Aesthetic Treatments with our Custom Mask Bar Service Our on-site skincare pharmacy is manned by trained technicians who compound topical prescriptives for skin concerns such as acne/greasy skin, pigmentation, scars and sensitive/eczema prone skin to be used with our newly launched FDA-approved skin devices for a full home facial experience. The SilkPeel, a state-of-the art microdermabrasion device with copper ion technology, suitable for antiageing and skin resurfacing is used with our prescriptive medifacial solutions and has been proven to have similar benefits as in-office chemical peels. For post-peel skin healing and tightening, the CollagenUP Wand utilises Radiofrequency technology with our MoistureMax Polysaccharide Mask Sheet for the Custom Mask Bar which delivers monthly mask essence vials with a complimentary 4L Beauty Fridge. Find out more about the science of our home medi-facials here
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. Our consultations are now available via teledermatology here . Our online skincare pharmacy is also available for over the counter prescriptives to be delivered directly to your doorstep.
To book an appointment with Dr Teo, book directly here with our integrated online booking system, call us at +65 6355 0522 or email email@example.com for assistance. Alternatively, you may fill up our contact form here.
Acne occurs when the oil glands under the skin, scientifically 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 grows in the glands. This leads to swelling, bumps and visible blackheads and whiteheads on the skin’s surface.
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.
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, some forms of laser therapies are safe and effective acne treatment methods too. Blue light, a type of light therapy is designed to treat acne when it is active by killing Propionebacterium Acnes on the skin, which causes acne inflammation. Non ablative and ablative resurfacing lasers can treat subsequent acne 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.
For mild to moderate acne, you may consider over the counter dermatologist formulated cosmeceuticals such as the Anti-Acne Bundle here.
2. Use hair regrowth products
Originally prescribed only in my dermatologist practice, the Copper Peptide Hair Regrowth Serum uniquely contains Copper tripeptide, a novel molecule that stimulates hair growth. Clinically proven to have similar efficacy to that of 5% minoxidil, stimulating growth without irritation side effects or toxicity. Studies show collagen production is increased, strengthening existing hair and thickening the hair shaft.
In conjunction with the hair serum, one can consider cosmetic camouflage for a quick fix. I often recommend the Kerabuilt Follicle Hair Fibres, integrated with Biomimetic Hair Technology for natural-looking, instant results. In addition, it is chemical-free and hypoallergenic, recommended even for those with hair loss and sensitive scalps.
In my dermatology practice, almost all patients suffering from hair loss had also done their due research online about possible causes of hair loss before seeing me. The real problem though, medical websites are not written for the layperson and the lists of diagnoses of conditions that lead to hair loss simply leave the hair loss sufferer worried and fearful. Those that do their research on forums and beauty websites are none the wiser, as they suggest many non-evidenced backed methods of hair growth or causes of hair loss which is simply unscientific and wrong information.
There are many different causes of hair loss, which can occur at the same time or individually, and dermatologists are best positioned conduct a thorough history taking, medical evaluation/examination and may recommend blood tests and other tests before diagnosing the cause of hair loss. For some rare causes of hair loss, especially of what is termed scarring alopecia, a scalp biopsy, which is where samples of the scalp are taken for microscopic examination may be required.
3. Consult a dermatologist for scarring on the skin
Treatment of scars on one’s skin can be in the form of chemical peels or lasers, which can be both ablative and non-ablative. Your dermatologist will advise which treatment option is best suited for your skin. In the meantime, a good concealer consists of a colour corrector. Orange is well suited to conceal dark scars and pigmentation whereas green conceals redness. Follow up with a CC cream with cosmeceutical active ingredients to treat and conceal your blemishes at the same time – achieving an overall even complexion.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she shares about the importance of taking care of your neck area.
Treatment of Blackheads
How do I get rid of blackheads?
First and foremost, it is important to know what blackheads are and how they arise. Blackheads, the colloquial term for open comedones, are a type of acne caused by an overproduction of oil, and tend to cluster around areas like the nose. The buildup of keratin and oil around the follicle is oxidised and turns blackish because the oil itself is oxidised by air.
Open comedones are best treated with:
A mixture of chemical peels, containing salicylic acid, lactic and glycolic acids to control the oil production.
Carbon laser peels to help shrink oil glands and reduce production of oil.
Prescription creams, containing tretinoin, that accelerate skin regeneration.
Oral medication will be necessary for acne, and a medication known as isotretinoin, may be prescribed to help to shrink your oil glands, which has to be taken under close medical supervision.
I do not recommend manual extractions as they can cause more inflammation, infections, and scarring. I personally treat both open and closed (whiteheads) comedones using a specialised machine with a vacuum handpiece that gently extracts blackheads and whiteheads without pain or scarring, at the same time infusing a customised blend of fruit-based acids that exfoliate the skin. Last year, we launched the Dr.TWL SilkPeel Home Medi-Facial Kit with our biomaterials team.
The device basically combines the microdermabrasion benefits that we use in our clinic with a very gentle chemical peel effect to increase the absorption of the cosmeceuticals. This allows for the physical removal of the debris from both open and closed comedones (ie. Blackheads and whiteheads), reducing the appearance of blackheads and preventing subsequent formation.
How do I reduce the formation of blackheads?
A good cleanser is important. For cleansers, look for the labels ‘’dermatologist-tested and formulated’’ for maximum clinical efficacy. I personally use a cleanser based on medical-grade honey which I have partnered with a laboratory to formulate, it effectively cleanses away dirt, bacteria and grime, as honey is a naturally derived emulsifier, unlike chemical lathering agents, and also possesses antibacterial properties, without stripping away the skin’s natural oils. Overall, a good cleanser should leave the skin feeling clean (not squeaky clean though as this usually means overcleansing) and also still soft and moisturised. It’s a misconception to go for really ‘strong’ harsh cleansers because it generally strips the skin of all moisture with strong lathering agents like SLS (Sodium Laureth Sulfate) leaving the skin red and flaky while the acne problem doesn’t go away.
Pore strips help to physically remove the bits of keratin and oxidised oil but it tends to accumulate again and the problem recurs.
Products which contain salicylic acid usually have too low concentrations to be actually effective and higher concentrations can cause irritation.
Beware of traditional facial blotters to remove oil because it can cause the skin to paradoxically feel ‘dehydrated’ and the oil glands to produce even more oil to compensate. For patients with greasy skin in the day , it may help to just wash the grease off with a good cleanser rather than keep blotting. Either that, or use a fragrance/alcohol-free baby wipe to wipe off the grease before touching up makeup.
How often should I go for treatments?
It depends on your skin condition. We recommend patients to firstly get their skin condition properly diagnosed by an accredited dermatologist, who would then subsequently recommend a regimen most suitable for them.
The Dangers of Dealing with Blackheads yourself
Can you extract them at home?
Never pick your pimples or squeeze your blackheads (or whiteheads) as the bacteria on your fingers will cause infection, subsequently causing inflammation which may result in the formation of cystic acne.
Cystic acne is a severe form of acne which warrants specialist dermatologist care as it can leave terrible scars and can be secondarily infected leading to cysts and abscesses (collections of pus under the skin) if left untreated. See a dermatologist early, you definitely need oral medication and also may need a stronger form of anti-acne medication known as isotretinoin which helps to shrink your oil glands. Isotretinoin has to be taken under close medical supervision as it can have side effects on one’s liver and cholesterol levels.
Do not use scrubs with rough beady material as these only irritate the skin further besides being totally ineffective at removing blackheads, whiteheads and definitely can worsen cystic acne. Persistent acne is not normal and should be treated by an accredited dermatologist to avoid infections and scarring.
What happens if you leave them be? Will they form pimples?
If you leave them alone, there is a chance of secondary infection in which these blackheads develop into active pimples. Otherwise, they remain as black dots on the skin which may be rather unsightly.
Some people think by putting toner, you close the pores. Is this true?
Toners with an alcohol base as an astringent draws water and oil out via an osmotic difference. They may provide symptomatic relief right after application, where the skin feels dried up instantaneously and the appearance of blackheads is subdued due to the temporary removal of debris. However, over time, I find that this gives rise to a condition known as reactive seborrhea. The skin being subjected to these harsh agents, decides that it is dehydrated and paradoxically, produces even more oil. Hence, I did not include any toners in the skincare regimen I designed. Instead, my recommendation for people with oily, acne-prone skin with blackheads is the Miel Honey™ Cleanser: a very effective anti-bacterial, anti-grease cleanser which also leaves a moisturising barrier. Medical-grade honey has a humectant property, meaning it is able to trap water underneath the skin. Additionally, we developed a specialised type of blotting paper for people with severely oily skin to help with the removal of oily patches throughout the course of the day. Our Anti-Inflammatory Oil Blotting Linen contains an extract of Cannabis Sativa which helps to restore the skin barrier when it comes into contact with the skin’s oil. This is unlike traditional blotters which dehydrate the skin causing it to produce even more oil. Finally, the use of a very lightweight moisturiser throughout the day, such as our Mineral Booster™, helps to restore the natural equilibrium of the skin with the environment. Overall, I find this cosmeceutical regimen is more sustainable for someone who is looking to reduce the production of oil and the appearance of blackheads, especially when used in combination with topical prescriptive items.
Read more on the Top Acne Tips and Treatments here.
Skin irritation? Breakouts? Allergies? Think it may be due to bad diet and unhealthy lifestyle? Or maybe because of your dirty beddings or perhaps pollution? All of that may be possible contributors to your unlikely skin concerns but have you ever wondered that maybe the problem could be in the makeup that you use?
Makeup is all fun and games until you learn about the risk it comes with using them. If using makeup products is part of your daily routine, then it is important to know about what you put on your skin! Did you know that the average woman ingests about 6 tons of lipstick in her lifetime? You may not notice because you don’t literally eat your lipstick, but every time lipstick gets unto your teeth, or whenever it transfers on to your food when you eat, the main thing is it’s now down your tummy! So before anything else, it’s now time to question on whether or not the products that you use are safe for you.
You may be reading the ingredient list of your makeup products but do you think that’s all it is? Some companies hide “certain substances” or mask it under deceptive titles. Others may have listed them, but what’s lacking is that there is not enough information on the potential harm it may cause for their consumers.
Certain ingredients used in the production of makeup and cosmetics can cause more harm than benefits and these can cause problems that may put your health at serious risk. Issues related to the use of products with these harmful ingredients may associate with skin allergies, cancer, weakened immunity, and more.
“For patients who suffer from sensitive skin and allergies, it’s often a vicious cycle with makeup products which are used for concealing the skin imperfections, and the same preservatives and ingredients in these products cause an exacerbation of the underlying skin condition,” says accredited dermatologist Dr. Teo Wan Lin.
How about for those without skin problems? Dr. Teo says, “Makeup is in direct contact with skin, and as skincare can deliver benefits to skin via topical absorption, makeup can also be used as a means to improve the health of the skin when it is incorporated with cosmeceutical active ingredients as an anti-ageing formula— while at the same time offering concealing of imperfections, which can improve individuals’ self-esteem. For products applied to mucosal areas such as the eyes and lips, it’s worthwhile to switch to pure mineral colorants in cosmeceutical bases because these are sensitive areas that are prone to irritation, and have thinner skin that will cause any harmful substances to be directly absorbed.”
We have listed down below the Top 5 harmful chemicals that are used in the production, preservation, and manufacturing of makeup products that you may be using everyday. Guess what, these ingredients don’t have to be present in your makeup— if you switch to mineral makeup for the eyes and lips!
This chemical is most commonly found in perfumes, colour cosmetics, nail polish, and hair care products. Phthalates are linked to endocrine disruption, developmental and reproductive toxicity, and cancer. Phthalates may be labeled as phthalate, DEP, DBP, DEHP and “fragrance”. Some companies intentionally exclude this on their ingredients list. Products that list “fragrance” on the label should be avoided to prevent possible exposure to phthalates.
Paraben…paraben… One of the most famous ingredients for makeup. Though you may not know much about this chemical, you’ve probably heard about this already because you may have previously encountered the term “paraben-free” on some beauty products and wonder what does it mean. Parabens are preservatives used in a wide variety of personal care products and foods to prevent the growth of microbes. Parabens are not water soluble and can penetrate the skin. As a result, repeated application of a product or multiple products containing parabens could mean almost continuous exposure. These endocrine-disrupting chemicals can be absorbed through skin, blood and the digestive system.
Effect of Paraben: causes endocrine dysfunction, interferes with male reproductive functions, and can lead to rapid skin ageing and DNA damage.
Paraben may be labeled as ethylparaben, butylparaben, methylparaben, propylparaben, isobutylparaben, isopropylparaben, and other ingredients ending in –paraben.
Lead has continuously been a very controversial component of lipstick. But did you know that it is often used in makeup foundation and whitening toothpaste as well? High levels of lead may pose a very serious risk on our health and studies have shown that there is no safe amount of lead exposure as though even at small amounts, lead can be very dangerous. Medical experts are clear that any level of lead exposure is unhealthy. The FDA or Food and Drug Administration has been determined to limit the usage of lead in lipstick and in a variety of other cosmetics. Read here.
Exposure to lead has been linked to a host of health concerns:
Neurotoxicity: It has been linked to learning, language and behavioral problems.
Reduced fertility in both men and women
Hormonal changes and menstrual irregularities
Delayed onset of puberty in girls and development of testes in boys.
Talc is used as an ingredient in face powders, blush, and eyeshadows. The incorporation of asbestos in talc is due to poor regulations involving cosmetic-grade talc, which is also known as talcum powder. Talc and asbestos are minerals that form together. That means talc mined for commercial uses can be contaminated with asbestos — a known cause of lung cancer and mesothelioma. Before purchasing any product that has talc, make sure it is labeled as asbestos-free. Health concerns of asbestos may include skin irritation, cancer, organ system toxicity.
Mainly used for preservation of our beauty products and personal care products such as moisturizer, lip products, hair products, makeup, sunscreen, antiperspirant/deodorant, fragrance, creams. Butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT) are chemicals are linked to several health concerns including endocrine disruption and organ-system toxicity.
Don’t get fooled by this because butylated compounds are also used as preservatives in food like meats, sausage, poultry, baked goods, beer, etc.
We have no control over the ingredients or manufacturing of the mass market makeup available in the market, but is that where custom blend mineral makeup can perhaps fill a need? “Custom blend mineral makeup has its advantages especially for eye and lip makeup because pure minerals are utilised. The eyelid and lip area are high-risk locations and naturally have thinner and more sensitive type of skin—known as mucosal skin. “ says Dr. Teo, who remarks that she has been seeing an increasing number of patients in her practice with eyelid and lip eczema, often triggered by makeup products such as mascara, eyelash extensions and lipsticks.
Especially if the sources are clearly labelled and audited, the risk of manufacturing contamination for sensitive products such as lipsticks and eye shadows, which is of the highest concerns to regulatory authorities like the FDA and HSA as well, due to the risk of ingestion and absorption, is eliminated. “When produced in smaller batches, custom blended mineral makeup is preservative free and avoids the problems of lead contamination in mass market manufacturing, which is important in lip products because of the lead content which is inevitably ingested.” Dr. Teo says.
How does one avoid getting these toxic chemicals incorporated into your daily routine? Also, isn’t it time that skincare is infused into makeup, since both are applied for long hours on the skin? Head over here to get your hands on cosmeceutical make-up.
Dr. TWL Dream Concealer™
100% Mineral Pigments Without Bulking Agents
FDA Eye/Lip Approved
LARECEA™ Extract [Regeneration]
PEACH Covers dark circles on light skin
ORANGECancels dark circles brown spots on medium to deep skin
PALE PURPLEConceal brown spots on light skin dullness
PURPLE Brightens/Neutralizes dull yellow on medium skin
PINKBrightens/Neutralizes dull yellow on light skin
BLUE Neutralizes sallowness & hyperpigmentation on fair skin
Is PHA (polyhydroxy acid) suitable for all skin types? How does it compare to AHAs and BHAs?
Polyhydroxy acids encompass gluconolactone and lactobionic acids. It has been reported in medical papers as early as 2004 to be effective and better tolerated by sensitive, aging skin.
PHAs works similarly to AHAs by causing the dead skin cells (keratinocytes) to shed at a higher rate, causing reduction in skin irregularities such as uneven pigmentation and texture. In addition, they fulfil the same function of allowing cosmeceutical ingredients such as hyaluronic acid and vitamin C serums to penetrate deeper into the skin.
Is there a possibility of suffering from a chemical burn using skincare products that contain PHA?
PHAs are not as commonly used as AHAs and BHAs, especially as chemical peels in dermatologists’ office setting mainly because the depth of penetration and effectiveness may be less. However, in skincare, the medical literature seems to report that it is a much gentler and moisturising type of chemical exfoliant than the other acids present in skincare, which translates into a much lower risk of skin irritation. In fact, PHAs are large molecules which function as humectants meaning that they trap water under the skin, prevent trans-epidermal water loss and have moisturising properties.
Is there one form of PHA that’s stronger than the others? eg. Lactobionic acid vs Gluconolactone
Clinical studies to date have grouped the use of gluconolactone and lactobionic acids under PHAs which differ from glycolic acids in the fact that they have a larger molecular structure, penetrate the dermis less and hence is less irritating in addition to having humectant (moisture trapping) properties. I am unaware of any head-to-head study which show whether one form of PHA is stronger than the other.
When should I use PHA? Should I use it in the toner, serum, moisturiser, or cleanser step?
The use of PHAs in skincare has been well-reported to have good exfoliating effects but without the irritation that glycolic (AHA) or salicylic acids (BHA) have. However, I generally do not put in chemical exfoliants in skincare because there is always a risk of skin becoming sensitive after being exposed to it on a daily basis.
There are some studies indicating that compared to glycolic acids which are incorporated in several brands of skincare, those which incorporate PHA are much more suited for people with sensitive, eczema skin. However, I would not prescribe that for my patients with eczema and rosacea in the first place due to the risk of irritation.
What should I be looking out for when I use PHAs?
I would say PHAs seem to be rather novel because it’s a term that hasn’t been used in the recent times but our knowledge of it has stemmed since the 1970s and clinical studies have been done with it since 2004. I think it’s important to prioritise, so the main concern really would be to ask yourself what your skin concern is. If it is anti-aging, then chemical exfoliation itself is not going to give you a miracle result.
Chemical exfoliation can be achieved with glycolic acids, BHAs and in this case PHAs may have the same function but with reduced skin irritation. However, chemical peels alone do not satisfactorily target all skin aging concerns, which lasers in combination with a good cosmeceutical regimen can achieve. It is important to caution that while all anti-aging treatments are aimed at increasing collagen production in the skin, an accredited dermatologist still needs to access the individuals’ problems and side effects before recommending combination treatment.
PHAs should be used in conjunction with cosmeceutical ingredients such as vitamin C as well as phyto which are plant-derived antioxidants that have been proven to fight free radical damage which is the key process in anti-aging. Nevertheless, PHAs are a beneficial form of chemical exfoliation and should be placed in the same category as the use of AHAs and BHAs in chemical peels.
One more thing to add, the clinical results in terms of the depth of skin penetration are likely to be less with PHAs. For patients with other forms of skin concerns, for example acne, they may still find that glycolic acid is much more effective in reducing oil control. If their concern is a medical condition like eczema and rosacea, then certainly I would recommend not using any form of chemical exfoliant at all and rather get treated by a dermatologist.