Tag Archive: chemical peel

How to reduce stretch marks

February 24, 2019

 

Stretch marks are extremely common. Yet, those squiggly lines on your skin are never welcomed. While such forms of dermal scarring are not medically dangerous, it can be aesthetically unpleasant to patients, causing distress.

Common occurrence of stretch marks includes the thigh, buttock, lower back, chest, upper arm and knee. Striae rubrae and striae albae are the two recognizable forms of stretch marks. Striae rubrae are flesh-toned scars, often accompanied by redness and ruptured capillaries that cause a subtle violet appearance. They then progress to striae albae – silvery, wrinkled scars that are hypopigmented (lighter than your usual skin colour).  

What causes stretch marks

Stretch marks, or striae distensae, occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include endocrine imbalance (a type of hormone), extended periods of mechanical stretch or any structural changes to the skin can lead to stretch marks. Chronic use of oral or topical corticosteroids can also contribute to the development of stretch marks.

Stretch marks are formed via three main mechanisms:

  1. Genetic predisposition
  2. Hormonal disorders
  3. Mechanical disorders/stretching of the skin

Genetic predisposition

No specific gene has been isolated as the cause of stretch marks developing. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions. This suggests genetic predisposition, that certain individuals may have a greater tendency of developing stretch marks based on their genes.

Hormones

A hormonal imbalance can contribute to the development of stretch marks. A hormone called adrenocorticotrophic causes an increased rate of protein breakdown. In turn, this leads to less collagen and elastin fibres being produced. With less collagen and elastin, the skin is less flexible and resilient to withstand stretching, causing stretch marks.

This effect is similar to that caused by corticosteroids, which explains why patients on long-term use of the drug are more prone to developing stretch marks.

Mechanical stretch

Rapid expansion or contraction of the skin causes it to stretch beyond its usual elastic ability. Fibres in the middle skin layer (dermis) stretch to accommodate when growth is slow. But with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming stretch marks.

In pregnancy, stretch marks frequently appear in the third trimester.

How to treat stretch marks

Topicals:               

Topical treatments only have mild effects in reducing appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach.

  • Tretinoin: Boost fibroblast production. Fibroblasts are molecules responsible for the structural support in our cells and synthesize collagen. Best for striae rubrae (for newly developed stretch marks), poor for striae albae (stretch marks that have been around for some time).
  • It is not recommended to use tretinoin during pregnancy as it carries a risk of birth defects
  • Phytochemicals: Plant extracts such as Centella Asiatica can boost the cells that produce elastic fibers and collagen. Resveratrol, naturally occurring in grapes and berries, can also boost skin elasticity. Elixir-V™ Total Recovery Serum contains a potent combination of phytochemicals, including resveratrol, to help fight ageing effects
  • Moisturizers: They can be applied as an adjuvant to treat stretch marks. Look out for moisturizers with active ingredients such as niacinamide. Apart from its brightening abilities, niacinamide stimulates collagen synthesis. You may consider Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide.

While ingredients such as cocoa butter or olive oil are commonly marketed as effective in reducing stretch marks, it has not been scientifically proven to show results.

Chemical peels: They help to induce the production of collagen and improve the appearance of stretch marks. Salicylic acid, lactic acid and glycolic acid are most commonly used.

Microdermabrasion: In this process, physical agents such as aluminium oxide is used for skin resurfacing. A targeted injury is caused to trigger collagen production and to deposit elastin. Topical therapies are also more effective after microdermabrasion, as your active ingredients can better penetrate the dermis layer.

Light therapy: Different types of light treatment are available to stimulate collagen production in the dermis layer. Examples include infrared light devices, intense pulsed light (IPL) and ultraviolet light.

Ablative lasers: Such lasers are effective in reducing scars as they create a deliberate wound to induce healing of the skin.

Stretch marks are not medically dangerous, but if you are seeking for an effective treatment, it is best to consult an accredited dermatologist for best results.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

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

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

 

A Dermatologist’s Guide to Exfoliation

January 20, 2019

Exfoliation, or the removal of dead skin cells from the outermost layer of the skin, is an important and necessary part of any skincare routine. However, if the word ‘exfoliation’ conjures up the action of scrubbing your face with harsh granules, you may be doing more harm to your skin than good.

So what is the right exfoliation technique for your skin?

Benefits of exfoliation

We shed dead skin cells naturally as new skin cells slowly travel up from the deepest skin layers to the surface. On average, this process takes about 27 days.  As we age, this cell turnover process slows down.

When we exfoliate, we remove the build-up of dead skin cells. Regular exfoliation can reveal younger, brighter skin with an even tone. 

Types of exfoliation

Exfoliation can happen in two forms: physical and chemical.

  • Physical exfoliation: Physical exfoliation relies on the rubbing of tiny granules or particles over the face to remove dead skin cells by physical force.

While this kind of exfoliation can leave you feeling refreshed, the technique can be too harsh for the skin, especially for individuals with acne-prone or sensitive skin. Physical exfoliation may even weaken the skin’s barrier function and leave your skin red or irritated.

For those of you without sensitive or acne-prone skin, physical exfoliation can still be an option. However, make sure to look out for exfoliating agents that are not too large.

  • Chemical exfoliation: Chemical exfoliation relies on fruit enzymes and gentle acids to slough off dead skin. This mechanism is much gentler than physical exfoliation and more suitable for acne-prone and sensitive skin types.

Types of acids

The two most well-known type of exfoliating acids is alpha hydroxy acids (AHA) and beta hydroxy acids (BHA).

AHAs: Alpha hydroxy acids work by causing skin cells to detach from the outermost layer of skin, making them easier to slough off. Once the dead skin cells are removed, new cells can rise to the surface.

Common AHAs used as chemical exfoliants are lactic, glycolic and mandelic acid.

Glycolic acid: Glycolic acid is the strongest AHA as it has the smallest AHA molecule. As such, it is able to penetrate deeper into the skin and can exfoliate at lower concentrations compared to other acids. However, if you are just beginning to try out chemical exfoliants, a different acid should be considered.

Lactic acid: Apart from exfoliating, lactic acid also moisturizes. Individuals with dry skin can consider lactic acid for this dual function.

Mandelic acid: With a larger molecular structure, mandelic acid is not able to penetrate deeply into the skin. This makes it a gentle AHA and safe to use, especially for people with sensitive skin.

BHAs: Beta hydroxyl acids (BHAs) differ from other AHAs as they are oil-soluble. This property allows them to penetrate deeper into our skin and pores.

BHAs exfoliate by softening the outermost layer of skin cells and dissolving unwanted skin debris. They also have anti-inflammatory and antibacterial properties, making them ideal for individuals with oily and acne-prone skin.

Chemical peels

Chemical peels are often done at a dermatologist’s office where the chemical agent used can be much more concentrated. Glycolic, lactic or salicylic acid is commonly used. A certified dermatologist is best able to identify the type of peel for your skin.

With regular use, these treatments exfoliate the surface skin and improve fine lines, wrinkles, skin discolouration and texture.

Chemical exfoliation at home

Most patients prefer to do chemical exfoliation on their own. However, this can cause skin sensitivity and redness for certain individuals over time without proper medical supervision.

As a result, Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, recommends using active ingredients such as stabilised vitamin C (sodium ascorbyl phosphate), hyaluronic acid, phyto plant extracts or LARECEA™ extract. These ingredients are proven to deliver health to your skin without the sensitivity that AHA or BHA might cause when used without medical supervision.

Over-exfoliation

The benefits of chemical exfoliation may make it tempting to use AHAs and BHAs often. However, too much exfoliation can disrupt your skin barrier and cause the skin to become red and inflamed.

If you are a beginner to AHA and BHA, start slow. If you do not have sensitive skin, exfoliate every other day. Those with sensitive skin should stick to exfoliating once a week. Discuss with your dermatologist how often you should get chemical peels.

© 2019 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.

 

 

Brightening dark spots

December 25, 2018

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

Melasma

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

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

Postinflammatory hyperpigmentation (PIH)

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

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

Freckles

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

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

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

Solar lentigo

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

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

Treatments

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

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

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

For freckles, use topical or laser/light therapies.

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

Bleaching agents

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

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

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

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

Retinoids

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

Chemical peels

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

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

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

Laser and light treatments

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

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

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

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

Cosmeceuticals

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

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

Understanding Enlarged Pores & How to Treat Them

August 24, 2018

Enlarged facial pores are a cosmetic concern that plague individuals with oily skin types. Even though this condition besets a majority of individuals, especially those who live in humid climates, treatment options for large pores are elusive or unreliable.

Large pores may not be health-threatening or a disease symptom, but they can be the reason why we refuse to get up close with a mirror. A skin pore usually refers to an enlarged opening of pilosebaceous follicles. The pilosebaceous unit has the hair follicle, the sebaceous (oil) gland and skin muscles.

The mechanism by which visible facial pores occur remains unclear, but three possible causes have emerged: loss of skin elasticity, hair follicle size and excessive sebum production. Other potential factors that can influence this skin condition include genetics, chronic photodamageacne and vitamin A deficiency.

Excessive sebum production

Oily skin results from excess production of sebum by the oil glands, which fills the follicles and leaks onto the skin surface. During the menstrual cycle, sebum production levels are higher. Pore size is also larger during the ovulation phase. A surge of three hormones during the ovulation phase triggers the oil glands – luteinizing hormone, follicle-stimulating hormone and progesterone.

Severe acne

Previous cases of inflamed acne can destroy hair structures and leave them susceptible to influence by androgenic stimulation. Androgen is a hormone that exerts a major effect on sebocyte (cells found in oil glands) proliferation and sebum secretion. This means acne inflammation may cause you to be more prone to androgen activity, bringing about change in follicle volume and size.

Loss of skin elasticity

A main feature of skin’s ageing process is the loss of elasticity. Our skin’s collagen and elastin framework that supports skin resilience become less efficient due to ageing and chronic photodamage. A protein, crucial for elastic fiber assembly, called microfibril-associated glycoprotein-1 is also produced less over time. Without it, tissues around follicles provide less structural support and there is a loss of thickness in the skin dermal layer. Such changes lead to skin fragility, sagging and enlarged pores.

Hair thickness

The volume of our pores is dependent on the size of the hair follicle. There are dermal papilla cells in our hair follicles that contain androgen receptors. Our pore size is affected by the androgen activity in hair follicles.

Treatment options

Topical therapies

  • Topical retinoids are often considered as first-line therapies to reverse collagen and elastin-associated changes caused by aging and photodamage. Retinoids are vitamin A derivatives and were previously used as anti-ageing therapies before the efficacy for improving the appearance of facial pores were discovered.

Commonly used retinoids are tretinoin, isotretinoin and tazarotene for skin rejuvenation, regulating sebum production, and the reduction of wrinkles and large facial pores. Isotretinoin is the most potent inhibitor of sebum production.

Patients are advised to consult their dermatologist before any use of retinoids as side effects – such as inflammation, burning, redness or dry skin – are common.

  • Niacinamideis another cosmetic ingredient that can reduce sebum production.

 

  • Chemical peelscan also help rejuvenate the skin and improve the appearance of large pores. At the epidermal or dermal level, the application of acids induces the temporary breakdown and regeneration of healthier cells. Glycolic acid, lactic acid and salicylic acid are commonly used for chemical peels.

Oral therapy

Common oral therapies targeted at enlarged pores are anti-androgens, such as oral contraceptives, spironolactone and cyproterone acetate. They modulate sebum levels by blocking androgen action.

Lasers and ultrasound devices

Advanced devices have been developed to deliver targeted thermal or ultrasound energy to the skin. Such therapies work by remodelling the collagen fibers near our pores for increased skin elasticity and decreased sebum production. Non-ablative lasers helps with facial pore minimalisation and improved appearance of photoaged skin.

Hair removal

Pore volume may decrease with hair removal, especially so if patients have thick and dark facial hair. Laser or intense pulsed light sources can create photothermal destruction of the hair follicles to minimise appearance of large pores.

 

© 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.

What Is A Medifacial?

August 17, 2018

 

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.

—–

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

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

 

 

 

 

 

 

 

 

 

 

 

 

Everything You Need to Know About Melanin & Dark Spots

July 19, 2018

 

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

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

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

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

Pigmentary disorders

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

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

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

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

Treating hyperpigmentation

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

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

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

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

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

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

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

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

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

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

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

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

—–

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.

Understanding the layers of your skin

July 14, 2018


Our skin is the largest organ in the body, and the most visible. Yet, few of us really understand how it works. When searching the internet for causes and treatments of our skin conditions, for example, we often come across terms like ‘epidermis’ and ‘dermis’ that are literally Greek and hard to understand.

As a result, it’s difficult to know exactly how to care for our skin. As our outer layer endures harsh external conditions such as environmental pollutants, UV rays, pressure, temperature, and others, how can we best protect and keep it in good health?

To answer this question, we need to start with a skin 101 primer.

Our epidermis

The outermost layer of the skin is known as the epidermis. It consists of four layers of closely packed cells. Skin cells found in these layers are called keratinocytes. They manufacture and store keratin which is the protein that makes up the main structure of our hair, skin and nails.

From deep to superficial, the four skin layers in the epidermis are stratum basale (deepest), stratum spinosum, stratum granulosum and stratum corneum (outermost).

In the epidermis of certain body parts with thicker skin, such as palms, soles and digits, there is an additional layer of cells called stratum lucidum. It is found wedged between the stratum corneum and the stratum granulosum.

The dermis

The dermis refers to the inner layer of skin found between the epidermis and subcutaneous (=under the skin) fat. The dermis layers are made of connective tissues, linked by interwoven fibres of collagen and elastin, packed in bundles.

Collagen takes up 70% of the weight of the dermis. Collagen fibers provides the skin with structural support and tensile strength. Collagen proteins also bind to water, keeping the skin well hydrated. Accounting for 2% of the weight of the dermis, elastin fibers allow movement and are responsible for the elasticity of the skin.

Caring for the skin we see

In the outermost layer, known as the stratum corneum, the keratinocytes are actually dead cells pushed up from deeper layers. As these cells travel to the surface, they undergo keratinization, the process whereby the contents of the cell develop tough keratin proteins. Other components such as cholesterol, ceramides and free fatty acids in the stratum corneum also work together to give a toughness to the skin that can withstand all sorts of chemical and mechanical insults.

In this way, the stratum corneum becomes a barrier that prevents dehydration of underlying tissues and serves as a mechanical protection for the more delicate layers below. It is also the layer most crucial in maintaining the skin’s moisture.

The stratum corneum layer is usually replaced with cell division and renewal in a cycle of 4 weeks.

Ageing and exposure to ultraviolet radiation can stress the skin, leading to poor skin barrier function and an increase in water loss. The barrier function can also be affected by other factors such as a deficiency in fatty acids and lipids, detergents (usually from harsh cleansers) or dehydration.

Caring for your skin then should involve a regimen of protecting it from the sun with UV protection, using cleaners and other products that do not dehydrate the skin, and maintaining the moisture in the skin through moisturizers. Cleansers, in particular, can contain harsh surfactants that emulsify to remove grease and dirt but can irritate the skin. Use a gentle cleanser with a natural emulsifier instead. For example, Dr TWL’s  Miel Honey™ Cleanser uses medical-grade honey as a natural emulsifier, leaving the skin both clean and gently moisturized.

Many cosmetic treatments work by causing a change in the epidermal layer, thereby encouraging it to renew itself faster. Procedures targeting the epidermis include some forms of chemical peelslasers, intense pulse light (IPL), microneedling or topical drugs.

Caring for the skin beneath

The dermis, the layer beneath the epidermis, gets thinner and loses its elasticity over time.

Various cosmetic treatments available often aim to restore the amount of collagen lost during the ageing process, such as medium and deep chemical peels, microneedling, microfocused ultrasound and ablative lasers. Fillers can also restore the volume of collagen in the dermis layer, correcting fine lines and wrinkles.

Lasers, IPL or resurfacing treatments can differ according to the skin layer that it targets – the epidermis or dermis layer. Non-ablative treatments focus on the dermis while leaving the epidermis intact. Ablative lasers treat both dermis and epidermis layers.

Chemical peels can reach different levels of the skin depending on the frequency, the peeling substance (typically an acid), the concentration of the substance, and skin condition of the patient. In a controlled manner, skin cells are destroyed in a chemical peel to stimulate regeneration of a smoother epidermis and new collagen in the dermis.

© 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.

 

 

What causes our skin to age?

June 13, 2018

What causes our skin to age?

We know that ageing is a natural process that cannot be changed. Fine lines, wrinkles, sagging and dark spots are some changes in the skin as we grow older. While some of these changes are unavoidable, certain signs of ageing are actually caused by sun damage and can be avoided. Some knowledge of the mechanism of the human ageing process can allow you to be more adept at ways to slow down such effects.

The process of skin aging can be classified into 2 groups: extrinsic ageing and intrinsic ageing. The two processes are biologically different.

Extrinsic ageing

This factor includes physical, chemical or environmental factors that the skin is exposed to. A major contributor to extrinsic ageing is UV radiation. Cumulative exposure to the sun in an individual’s lifetime can add up to cause significant damage to the skin.

Other external factors are cigarette smoking, air pollution, and exposure to cold, heat, dust and smog. Our lifestyle choices can also take a toll on our skin e.g. exercise, sleeping habits, diet or stress. Varying circumstances through all these factors can cause oxidative stress. This leads to some extent of dysfunction across our cells, mitochondria, DNA and could manifest as inflammation, cellular membrane damage or even immune dysfunction for instance.

UVA and UVB radiation causes photoageing. As UVA can penetrate deeper into the skin (greater penetration depth) and generate unwanted radicals, it is said to be more responsible for photoageing. UVB rays are mostly absorbed by the outer skin layers and causes DNA damage within the outer skin cells.

Photoageing

Photoageing is a slow process resulting from chronic exposure to UV radiation. Skin type and accumulative lifetime exposure to the sun can determine the degree of photoageing. When UV light penetrates the skin, cells produce melanin to form as a protective barrier (this is also how a tan is developed!). The melanin pigment helps to reflect some of the rays. The rest of the radiation that is not reflected will be absorbed by the skin cells. This can damage the cells that function to develop tissue fibers for the skin’s structure.

In photoaged skin, the epidermis (outermost skin layer) becomes more fragile and less elastic. There is greater damage of elastic tissue and a decrease in cellularity. It can cause elastosis, where there is an overgrowth of elastic fibers. Rough spots called actinic keratoses can also be caused by excessive UV exposure, which can be precancerous skin lesions.

Antioxidant and skin ageing

UV radiation causes oxidative damage. This means it produces excessive free radicals within the skin cells. Free radicals are formed when atoms or molecules loose electrons. They are generated by our own bodies during normal metabolic process, but external sources such as from UV radiation may cause excessive amounts. Excessive free radicals can lead to human skin disorders and premature skin ageing for example. Exposure to air pollutants can also trigger the release of free radicals.

The human skin has antioxidant enzymes to help protect against free radicals, such as superoxide dismutase (SOD) and glutathione (GSH) biosynthesizing enzymes. Other antioxidant molecules you may be familiar with are vitamins A, C and E. Antioxidants protect cells by interacting with the free radicals and neutralizing them by “donating” electrons to prevent unwanted damage.

You can think of the antioxidants as the ‘good’ molecules in your fight against ageing. However, these antioxidants reduce in number over time, thus a weaker ability to combat against free radicals and against ageing. With weaker defence against free radicals, the skin begins to show signs of photoageing.

Intrinsic ageing

Intrinsic ageing can also be understood as genetically programmed ageing. Structural proteins such as collagen and elastin, a major component of the dermis, and organelles such as mitochondria are produced less over the course of time. DNA functions and repair abilities decline with time. Thinning and loss of the skin’s elasticity happens as visible manifestations of these changes. Chronologic ageing can also be caused by hormonal changes.

Preventing the ageing process

To improve skin quality, there are various treatments available.

  • Sunscreens have been long perceived as a vital prevention measure to reduce UV damage. Look for a dermatologist tested sunscreen with minimum SPF30. Apply and reapply religiously (every 3 hours for optimal protection).
  • Retinoids have shown to reverse sun damage and can improve the skin’s extracellular matrix (which provides structural and biochemical support to cells).
  • Cosmeceuticals may serve as a ready consistent supply of antioxidants
  • Dermal fillers can restore volume loss and remove skin wrinkles
  • Chemical peels use acids to regenerate and improve the appearance of aged skin

On your own, certain lifestyle habits can be changed to slow down the process of skin ageing. Adequate exercise and sleep are vital in general regulation of bodily functions which combat aging. Quitting smoking can cut out exposure to unwanted chemicals and pollutants. A diet rich in antioxidants can also be helpful. Keep hydrated and cleanse your skin regularly to remove dirt and pollutants / chemicals (which may cause oxidative stress) from the skin.

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

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

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

A Dermatologist Guide to Alpha Hydroxyl Acid (AHA) Facial Treatments

May 31, 2018

 

Alpha Hydroxyl Acid (AHA) Facial Treatments

Alpha hydroxy acids (AHA) are naturally-occurring compounds possessing unparalleled benefits to the skin and extensively used in a dermatologist’s office. Most AHAs are non-toxic and are often present in food and fruits, thus also known as fruit acids.

The types of AHA used commonly for cosmetic purposes are glycolic acid and lactic acid. Glycolic acid, found in sugar cane, has the smallest molecule of all the AHAs and is the most widely used acid in skincare. Lactic acid is present in sour milk and tomato juice and can be found in our bodies as a byproduct of metabolic processes.

Certain types of AHA have lipophilic (ability to dissolve in lipids/fats) side groups in its chemical structure such as mandelic acid and benzylic acid. Such acids are more soluble in lipids over the conventional water-soluble AHAs, thus are often used for oily and acne-prone skin.

Uses as a peeling agent

AHAs are commonly used in peeling procedures as a short intense exposure to the acid produces benefits to the skin. A chemical peel is the application of one or more chemical exfoliating agents to the skin, and by exerting a controlled epidermal injury, it allows regeneration of new epidermal and dermal tissue. Such treatments are often used to treat skin disorders and conditions for aesthetic improvement.

Using controlled higher concentrations of AHAs, application to the skin for short times can achieve substantial desquamation (skin peeling). This renewal of skin cells is useful in anti-ageing, reducing hyperpigmentation and improving radiance. It is important to have a chemical peel conducted by an accredited dermatologist, to prevent uneven peeling and dermal wounding.

In contrast to other peeling agents, such as phenol or salicylic acid, most of the AHAs are nutritive and physiologic.

Pre-peeling preparation

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, to prepare the skin for a regeneration phase, pre-treatment is necessary. The cosmetic conditions most suitable for a chemical peel would be features of photo ageing, such as solar lentigines, sallowed complexions, rough and textured skin, fine lines or wrinkles, acne scarring or hyperpigmentation. Whilst most skin types can opt for an AHA chemical peel, it is imperative to first seek assessment by an accredited dermatologist who will cater the peel, such as the acid type, strength, frequency and duration, for variability of individual skin conditions. Performed properly by a trained dermatologist, risk of scarring from a chemical peel is drastically reduced. The level of expertise in administering peels ensures a good outcome.

Prior to the actual application of the chemical peel substance, the skin will need to be thoroughly cleansed to remove oil and debris before being rinsed and dried.

Treatment with Chemical Peel

The peeling agent (AHAs) will be applied on the skin using an applicator or a brush. The duration of allowing the peeling agent to be in contact with the skin varies according to the skin’s conditions as assessed by the dermatologist. With superficial peels, some sensation of heat and stinging may be experienced, before the peeling agent is neutralized (where applicable) and thoroughly cleansed off after the duration of contact recommended by the dermatologist. The chemical peel treatment is completed at our clinic with application of a hydrating Amino Acid Masque to soothe and calm the skin post-peel. Additional post peel care requires the use of sunscreens and other photoprotective agents, due to sun sensitivity post-treatment. It should be noted that regular application of sunscreen is advocated as it can reduce sun damage and aggravating of skin conditions.

How does a chemical peel work?

For superficial peels, the acid causes breakdown and decreases cohesiveness of corneocytes, that are found at the outermost part of the epidermis. Desquamation occurs, allowing renewal from lower epidermal layers. By weakening and ‘ungluing’ the cells in the inner stratum layer, it leads to uniform exfoliation of the outermost stratum layers.

With a low PH, most acid peels need to be properly neutralized to prevent acidification of the skin. To avoid burning, AHA peels are neutralized with basic salts such as sodium bicarbonate or sodium hydroxide.

A chemical peel does not compromise the barrier structure or integrity of the skin, as the mechanism of action of AHAs on the skin is a more targeted action for epidermal skin renewal.

Conclusion

As a treatment that improves skin texture and counters the effects of ageing, chemical peels continue to be relied on for various skin conditions. It is also safe for the skin and human health in general, as extensively tried and tested by dermatologist’s. A range of AHA formulations and concentrations are available for the dermatologist to administer therapy according to the patient’s requirements.

Speak to your dermatologist today for a tailored experience.

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

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

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

 

A Dermatologist’s Guide to Skin Resurfacing

February 9, 2018

What is skin resurfacing?

Regardless of the technique employed, skin resurfacing is a form of controlled, targeted injury to your skin. By stimulating your skin to heal from the injury, the new skin cells that form after would be smoother, tighter and more youthful. Skin resurfacing can be achieved through different techniques to treat different aspects of skin damage and conditions, mainly laser, dermabrasion and chemical peels.

Are you suitable for skin resurfacing?

These treatments can help skin that suffers from acne, damage from sun exposure, ageing effects, hyperpigmentation, scars and wrinkles. Any skin condition that you wish to treat likely has an appropriate treatment at your dermatologist, go for a professional diagnosis before having any skin resurfacing treatments done.

Chemical Peel

Before the peel, your face will be cleansed thoroughly to remove oil and to prep the skin for penetration. A gentle, medically formulated milk/fruit acid solution is applied, which removes the epidermis layer, allowing the acid to penetrate into the first layer of the dermis. Various acids can be used in different combinations to remove the surface layer of the skin. Note not all acids are the same nor are all chemical peels the same, best to have an accredited dermatologist assess and recommend the most suitable peel for your skin.

According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she says: “A chemical peel removes the damaged epidermis to reveal a brighter complexion. You may experience a warm sensation after the chemical application, and stinging when the peel is removed. Depending on the concentration of acids used, you may need some time to recover before resuming activities.”

Dermabrasion

To smoothen scars and wrinkles, dermabrasion is a surgical technique that uses anesthesia and/or a freezing agent before smoothening skin surface irregularities. With a high-speed rotating brush, the surface layer of the skin will be removed till ideal results are obtained.

Laser Resurfacing

A wand is passed over your skin and emits a pulse of high-intensity light to damage the surface layers of the skin. The different invisible wavelengths of light stimulates various layers of skin for rejuvenation. Shield goggles will be provided to protect your eyes during the treatment.

Two types of lasers are commonly used in laser resurfacing: carbon dioxide and erbium. Both lasers work to vaporize damaged skin cells in the epidermis.

What can I expect after the treatment?

Follow-up care is essential to ensure a smooth progress for skin healing and resurfacing. Patients may experience uneven pigmentation of the skin at the treated area after the treatment, but this effect will subside when the skin restores its original level of pigment. Meanwhile, sunscreen is an absolute must to protect the skin as chemical peels along with other resurfacing treatments will render your skin temporarily more sensitive to the sun. At this stage, it is also imperative to use skincare catered for sensitive skin, which are dermatologist-tested, to mitigate risk of irritation and flare ups during the course of recovery post-treatment.

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

—–

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.