Dr. Teo Wan Lin was invited as a key opinion leader on cosmeceutical skincare at the press conference for Dior Skincare’s Capture Totale Serum, held at Capella Hotel, Sentosa. The author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare”, launching islandwide in bookstores January 2020, Dr. Teo shared her thoughts on anti-ageing and the science of cosmeceutical formulations.
“The earlier we start anti-ageing treatment, such as preventive skincare, the better off we are at combating the signs of ageing.’ Dr. Teo emphasised the urgency of preventing anti-ageing, an ongoing process starting in the mid-twenties and aggravated by biological factors such as genetics as well as environmental exposures.
“My research into cosmeceutical active ingredients demonstrates that when serums are correctly formulated and delivered they are able to fight free radicals effectively, such as that caused by photoageing and environmental stressors”. As a prominent researcher in the area of cosmeceutical skincare, she shared tips on choosing the right skincare products for an efficient regimen.
“Another important concept in skincare is how well absorbed it is- for example, the New Generation Vector biofermented lipo-peptide enhances the penetration of the floral complex by 30%,” Dr. Teo shared that women are extremely well educated on the importance of a skincare regimen these days— starting with double cleansing, application of Antioxidant serums before moisturising and sunblock. A good serum can be efficiently incorporated as a day and night serum in a skincare regimen.
On the importance of organic active ingredients used in Skincare, as well as the extraction and processing process, cosmetic giants are becoming increasingly aware of clean beauty. “From a dermatologist perspective, it is reassuring that the Dior Scientists maintain purity of these extracts with strict pharmaceutical engineering principles— there are especially critical steps to prevent loss of clinical activity, as well as environmental contamination which can affect the final product.”
Some final thoughts on anti-ageing from Dr. Teo included the following.
A dermatologist’s approach to ageing “We stage objectively using a scale known as the Glogau Photoageing Scale, named after a dermatologist Dr. Richard Glogau and is graded on a scale of 1-4, with most of us in the audience here today at 2 or a 3, which means we have some early to moderate signs of ageing, such as pigmentation spots, fine lines and some changes in our skin texture.”
The Dior Scientists also created the Dior Skin Scanner with this approach in mind, as it offers the public an objective scientific evaluation which previously was only assessable via a dermatologist’s visit.
This also means that the earlier we start anti-ageing treatment, such as preventive skincare, the better off we are at combating the signs of ageing— this includes the ability of the skin to fight free radicals effectively, such as that caused by photoageing and environmental stressors.
More skincare and cosmeceutical formulation tips can be found in Dr. Teo’s new book “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare”, which is available via www.drtwlderma.com, as an e-book via Barnes & Noble, Apple Books and in major bookstores island wide.
NOTES TO EDITOR: Dr. Teo Wan Lin, Medical Director of TWL Specialist Skin & Laser Centre, is an accredited dermatologist , specialising in both medical and cosmetic dermatology. She is a Fellow of the Academy of Medicine, Singapore, College of Physicians, Chapter of Dermatologitsts and a Member of the Royal College of Surgeons (UK).
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 email@example.com. Alternatively, you may fill up our contact form here.
In this series of articles, I shall expound on the science and chemical aspects of skin lightening agents used for hyperpigmentation, both prescription and over-the-counter alternatives such as cosmeceuticals. In the first installment, we shall cover the commonest prescription medications used for skin lightening – hydroquinone, and its derivatives.
Cosmeceuticals are topicals that have both cosmetic and pharmaceutical effects. They enhance the beauty through constituents that provide additional health-related benefit. Cosmeceuticals are commonly used for hyperpigmentation. Hyperpigmentation involves the need for skin lightening agents which includes cosmeceuticals. Cosmeceutical agents selectively target hyperplastic melanocytes and inhibit key regulatory steps in melanin synthesis.
Cosmeceuticals are commonly used for hyperpigmentation. Pigmentary disorders are the third most common dermatologic disorder and cause significant psychosocial impairment. These disorders are generally difficult to treat, hence, the need for skin lightening agents including cosmeceuticals.
Common active ingredients in cosmeceuticals for treating hyperpigmentation include the following: Ascorbyl phosphate (Vitamin C), Niacinamide (derivative of Vitamin B12) and plant-derived (phyto-antioxidants) which include grape seed extracts, white flower complexes and grape fruit extracts.
What Are Some Prescription Medications For Treating Hyperpigmentation?
Here are some compounds found in prescription medications that have been used to treat hyperpigmentation.
Hydroquinone competitively inhibits melanin synthesis by inhibiting sulfhydryl groups and acting as a substrate for tyrosinase and dermatologists have traditionally relied on prescription medication hydroquinone at concentrations of 1-4% to treat cases of hyperpigmentation.
What is hydroquinone and what is it used for?
Hydroquinone (HQ) is a chemical belonging to the family of phenols. Hydroquinone competitively inhibits melanin synthesis. Specifically, it blocks sulfhydryl groups and acts as a substrate (receptor) for tyrosinase, an enzyme involved in pigmentation.
Dermatologists have traditionally relied on prescription medication such as hydroquinone at concentrations of 1-4% to treat cases of hyperpigmentation, especially those related to solar lentigo, freckles (ephelides) and melasma.
It is also sometimes prescribed to treat post-inflammation hyperpigmentation. However, the use of hydroquinone is not without side effects of skin irritation. There have also been cases of skin de-pigmentation, a form of permanent scarring.
What are the concerns involving the usage of hydroquinone?
As hydroquinone is carcinogenic and may cause DNA Damage, over-the counter skin bleaching agents containing hydroquinone are banned, and should be used under strict medical supervision for a period of time only. Clinical studies supporting these side effects were based on ingested and injected forms of hydroquinone which are not used clinically in dermatologists’ offices. There has been no evidence of skin cancer or organ cancers developing as a result of hydroquinone applied topically.
However, I have phased out the use of hydroquinone for treating most pigmentation problems in my practice and relied more on over-the-counter active ingredients in cosmeceuticals which are mainly plant-derived and still demonstrate clinical efficacy for the treatment of pigmentation problems.
With the recent safety concern regarding the use of hydroquinone, the need for alternative natural, safe and efficacious skin lightening agents is becoming all the more necessary.
What is it?
It is a derivative of hydroquinone. Its mechanism of action is unclear. It acts as a substrate for tyrosinase, thereby inhibiting the formation of melanin precursors.
What is it?
A phenol that blocks tyrosinase activity (pigment cell producing activity).
1. Kojic Acid
What is it?
Kojic acid occurs in nature as a water-loving fungus byproduct. It helps to block the progression of pigmentation by stopping the production of the enzyme tyrosinase. It is also a powerful antioxidant which means that it engulfs free radicals that are responsible for skin aging.
What is it?
Arbutin is one of the most widely prescribed skin-lightening and depigmenting agent worldwide. It is a derivative of hydroquinone, and is a naturally occurring plant derived compound.
How does it work?
Arbutin prevents the growth and maturation of the cell component responsible for hyperpigmentation known as the melanosome. Notably, it is less toxic to the pigment cells than hydroquinone. Melanosomes are the pigment granules confer skin with colour and sun protection. They are also the cell engines whereby the body produces, stores and transports pigments known as melanin. The use of arbutin is limited by its concentration. While higher concentrations may be more effective, there is a greater risk for hyperpigmentation which can occur as a paradoxical side effect.
Is it effective?
Although there have been no randomized controlled trials on using arbutin for treating hyperpigmentation, it has been proven in many clinical studies to still be effective.
Dr.TWL Pharmacy is a proprietary specialist skincare pharmacy run by Dr. TWL Dermaceuticals, providing custom compounded prescriptive cosmeceuticals for common skincare concerns. It is located on-site at TWL Specialist Skin & Laser Clinic, a Ministry of Health accredited dermatology practice headed by dermatologist Dr. Teo Wan Lin. The pharmacy formulates skincare prescriptives for the treatment of various skin concerns including acne, hyperpigmentation, anti-ageing, excessive oil production, age spots and skin sensitivity/redness.
Have you noticed that some parts of your skin are dry while other parts are oily? This is known as combination skin. Combination skin is characterized by an oily T-zone while the cheeks are either normal or dry. How to tell if you have combination skin? Wash your face with your normal cleanser, then wait an hour. If your T-zone is oily whereas your cheeks are either normal or dry, you have combination skin.
Combination skin is thought to be one of the most common skin types. When it comes to skincare routines, hydrating creams are too hydrating, oil-absorbing masks are too absorbing, balancing lotions never seem to do much balancing… It can be tricky to figure out how to care for your skin properly.
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 tells us the science behind combination skin – skin that is both dry and oily.
Skin that is both dry and oily boils down to an underlying pathology of the skin which is much more common in acne-prone individuals is known as seborrhea, which is overactivity of the oil gland. It is part of the causes of teenage and adult acne. Even when you have seborrhea, it is possible for you to have a deficiency in the ceramide content of your skin barrier leading to dry skin.
The production of ceramide is genetically determined. You could have inherited both the genes for oily skin as well as dry skin. The commoner scenario we see would be someone with acne and oily skin who started using over the counter medication such as those that contain retinol or benzoyl peroxide and these will break down the skin barrier and it can result in the skin being dry, sensitive and acne-prone.
Individuals with combination skin often have breakouts over the greasy T-zone area. This can be exacerbated, in the case of some women, especially during the time of their monthly menstrual cycles. On the other hand, their cheek areas can be very dry and when they travel, especially when there is a change in climate, these areas can become dry, flaky and sensitive especially if they are using skincare that is slightly harsher on their skin.
The recommended skincare routine for combination skin should address both the oiliness of the T-zone, which can sometimes get quite uncomfortable especially in a humid climate like Singapore, as well as the potential dryness that may occur over the cheek areas. An important thing to note would be a gentle emulsifying cleanser is recommended for combination skin such as the Honey Cleanser.
Honey itself is a natural emulsifier which means it produces foam without the need for strong chemical lathering agents such as the laureth sulfates. At the same time, it is a natural humectant which means that it traps moisture under the skin. As a result, it helps to balance out the production of sebum without over-stripping the skin of its natural oils.
Individuals with combination skin should focus on using hydrating serums such as Hyaluronic Acid Serum, Vitamin C Serum and Elixir-V Serum as these contain cosmeceutical active ingredients which function as treatment over their T-zone to regulate oil production.
Also, use hydrating emulsions rather than creams, the former is an oil in water mixture rather than a pure cream formula. This helps to moisturize the skin without the cream becoming too thick or greasy. Finally, the excess grease over the T-zone can be addressed with the use of blotting papers (such as those infused with active ingredients like cannabis sativa). These blotting papers are infused with cannabis sativa, an extract of the hemp plant which helps to moisturize the skin and regulate oil production, at the same time physically removing excess grease over the T-zone. One should follow with a hydrating mist such as the Mineral Booster which helps to regulate the skin barrier.
The ageing process is different for each person, but there are certain signs of ageing that are considered “premature” if you notice them before you turn 35. Our environment and lifestyle choices can cause our skin to age prematurely. We will discuss here 3 ways on how to prevent premature ageing.
1. Use an anti-ageing sunscreen
The sun emits a type of energy known as the ultraviolet radiation. There are 2 types of UV radiation— UVA rays which is mainly the culprit behind Premature Ageing (wrinkles, dark spots, and sagging skin) while UVB rays is responsible for sunburn, and both contribute to skin cancer.
One way to protect your skin from premature ageing and of course skin cancer is to wear a sunscreen that has SPF and is broad-spectrum.
SPF only measures protection against UVB so it’s important to wear a ‘broad spectrum’ sunscreen which blocks both UVA and UVB.
The fix: Shield, repair, and brighten your skin from the harmful sun rays with Dr. TWL Dermaceuticals SunProtector™️
✔️ Broad Spectrum
Contains Collagen Hydrosylate for skin regeneration, Oligopeptides for skin repair, and Portulaca Oleracea Extract for skin soothing.
2. Avoid dragging your skin to reduce ageing effects
Our skin is very delicate and we want to avoid excessively tugging it whenever we apply our skincare or makeup products because this can cause our skin to show early signs of ageing. Mishandling of the skin especially around our eyes like aggressive removal of eye makeup and heavily dragging eye care products and any other skincare product unto our skin can cause eye wrinkles, crow’s feet, and other skin irritations. It is especially important to take extra care with the under-eye area which has thinner and more delicate skin.
The fix: Use your ring finger in applying your skincare/makeup products. Our ring finger is said to have the lightest touch and it distributes an equal amount of pressure when used upon the skin.
Using a Jade Roller is also proven effective in applying skincare products like serum and cream for complete absorption while lifting our skin.
In my previous articles, I have talked about cosmeceuticals and the importance of incorporating them in our daily routines. However, how do we enhance the skin absorption of these cosmeceuticals? Here I will be talking about the limitations of topical formulations and how we can overcome them to ultimately achieve the results that we desire.
The problem with topical formulations for your skin
The outermost layer of the skin, called the stratum corneum, acts as a natural barrier. It prevents foreign material from entering our system, shields us against environmental factors and prevents excessive water loss. The skin is a formidable barrier to the passage of substances into and out of the body, but it can be manipulated to allow it to become a viable pathway for drug administration.
Drug products applied to the skin’s surface penetrate the skin layers to a certain extent, where they can exert their effects. This is the case for topical formulations for treatment of skin disorders such as acne, dermatitis, and psoriasis. However, very few drugs are suitable for delivery by the topical route, as passive penetration through the skin is limited to very small molecules (<500Da), which are neutral and relatively lipophilic. Some considerations of dermatologists would be the vehicle of the topical, specifically if it is in a lotion, cream or ointment form, in increasing order of absorption and effectiveness. This however, is often limited by user preferences, with ointment formulas (more efficacious) deemed cosmetically less acceptable.
The skin is the largest organ of the human body, comprising 15% of body weight and therefore its use to deliver medicine to the body is not a new concept by any means. Advancements made by modern science are improving the skin’s potential as a route for drug administration. Dermatologists are at the forefront of research relating to transdermal drug delivery, given the unique accessibility of the largest organ of the body.
Owing to the drawbacks of topical formulations, transdermal patches have been developed to improve drug delivery through the skin and this is an area that my team has actively researched in the last year as an adjunct to our cosmeceutical formulations.
I have always been interested in finding new methods to allow my patients to achieve optimal results from our cosmeceuticals, thus in this article I shall share some tools which I employ in my clinical practice to achieve optimal absorption of cosmeceutical active ingredients.
Wet Wrap/Occlusion Skin Therapy & Facial Masks
A well known method employed by dermatologists to treat severe eczema known as wet wrap is actually a simple process involving applying a wet textile together with topical medications to skin, to increase absorption of skincare. An example of how and when wet wraps are used— during particularly intense eczema flares with severe itch or pain, wet wrap therapy rehydrates and enhances the absorption of topical medications applied on the skin. The fabric wraps are soaked in water and applied to the affected skin on the body. Wet wraps are best done after bathing, moisturising and applying topicals, then left overnight.
Wet wraps work via 3 different ways:
● Cooling — as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness
● Moisturising — cosmeceuticals covered over with wet bandages are deeply absorbed in to the skin to provide a longer-lasting moisturising effect
● Absorption — enhanced absorption of any topicals into both the superficial and deeper layers of skin where inflammation is present
Facial sheet masks work in a similar way, on the basis of occlusion. This means that when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. In my practice, whenever I want to increase absorption of cosmeceuticals and moisturisers that are dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.
I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture and clinically active ingredients to the skin—so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as evidence-based antioxidants for anti-ageing such as oligopeptides, vitamin C ( I use sodium ascorbyl phosphate which is a neutral, rather than acidic form of vitamin C, that has minimal skin irritation). Here’s a tip, use a cosmeceutical moisturiser like the Radiance Fluide™ and increase your skin’s absorption by applying it on damp skin, plus a soft wet cotton towel over it.
Performing a facial massage, such as with the aid of a facial roller before application of cosmeceuticals could increase the skincare absorption, leading to better effects of the anti- aging skincare. Local massage is an established treatment method of improving surgical scars, by stimulating blood flow and improving wound healing. A peer-reviewed study published in a medical journal Complementary Therapies in Medicine led by author Miyaji Akane at the Institute for Liberal Arts, Tokyo Institute of Technology (Tokyo Tech) and colleagues at Tokyo Healthcare University and the Research and Development Center, MTG Co. Ltd. in 2019 had examined the effects of using a facial roller on facial skin and blood flow. The study concluded that there was significantly increased vascular (blood vessel) dilation with use of the facial massage roller. This means that there will be increased absorption of any cosmeceuticals applied on the face following the massage.
My recommendation would be manual rather than electric facial rollers as the latter may cause excessive pressure and irritation (being automated) and is also dependent on user training as well as the manufacturer’s settings, with a potential risk of overheating of electric components. Manual facial massage is a self-regulated process as the user can immediately sense irritation and apply just the right amount of pressure.
Transdermal medications (usually in the form of a patch) are a little more modern and complex. Great strides in transdermal drug delivery have been made since the first transdermal drug was approved by the FDA in 1979.
Transdermal drugs bring medication through the skin, to the bloodstream. Once in the bloodstream, the ingredients circulate and take effect at a targeted location. Medication is delivered steadily and can be stopped simply by removing the patch. Since your body doesn’t have to digest the medicine through the stomach, a higher concentration reaches the bloodstream. The medication permeates the skin in a controlled fashion thus attaining more ready levels of the drug in the body.
The science behind polymers and transdermal drug delivery systems
Polymers are vital in a transdermal drug delivery system. Systems for transdermal delivery are assembled as a multilayered polymeric laminates consisting of a drug reservoir sandwiched in between 2 polymeric layers:
● An outer impervious backing — prevents the loss of drug
● An inner polymeric layer — functions as an adhesive and rate-controlling membrane There are 3 types of transdermal drug delivery systems:
● Reservoir systems
In this system, the drug reservoir is embedded between a backing layer and a rate-controlling membrane.
● Matrix Systems
In this system, the drug reservoir is either dispersed in an adhesive polymer or in a hydrophilic or lipophilic polymer matrix.
● Micro-reservoir Systems
This system is a combination of the above 2 systems. The drug reservoir is formed by suspending the drug in an aqueous solution and then dispersing the solution in a lipophilic polymer to form thousands of microscopic spheres of drug reservoirs.
Polymers used in transdermal delivery systems should have biocompatibility with the drug and other components of the system. They should also provide consistent, effective delivery of a drug throughout the product’s intended shelf life.
An example of a common polymer used are silicones, also known as polysiloxanes, made of many repeating units of siloxanes. Siloxanes are chains of alternating silicon and oxygen atoms that are often combined with carbon and/or hydrogen. Medical grade silicones are silicones that undergo specific testing for their biocompatibility and have been deemed appropriate to be used for medical applications. Topical silicone therapy is often used by plastic surgeons and dermatologists to treat and heal scars.
Key considerations of a polymer patch used for transdermal drug delivery would be —conformability of the material to be applied to irregular skin or scar surfaces, sensitive regions such as the face/eye area and the overall durability and biocompatibility of medical grade polymers.
The process of skin ageing relates to the ability of the body’s natural healing processes. The same cells which are activated during cell injury are the ones which lose function with ageing, and are responsible for loss of collagen, elastin and the overall loss of volume and elasticity of skin. Specifically, antiageing cosmeceuticals target and stimulate cells known as fibroblasts, which are best thought of as the “soldiers” of wound healing which produce collagen to seal up injured or damaged skin. Injury to the skin occurs over a gradual process in the case of ageing, due to the slowing of one’s biological clock and photodamage.
For the last year, my team and I worked with a material scientist to develop a transdermal delivery patch, the QRASER™ Transdermal absorption patch, launched in July 2019. This patch works via a matrix system of drug delivery. In this system, the drug reservoir is dispersed in an adhesive polymer matrix. The transdermal delivery patch uses a unique polymer technology that mimics the natural hydration and homeostasis of the skin barrier, to enhance cosmeceutical absorption. The focus is on improving absorption via optimisation of the skin healing microenvironment.
The result? Healthy collagen production thus reducing fine lines and wrinkles.
In conclusion, cosmeceuticals in the arena of dermatologist-led skincare research will be increasingly prominent in the next decade of “smart skincare”. This should be emphasised along with understanding of how these topicals work, the limitations of skincare absorption and potential technologies such as transdermal delivery patches which can optimise the anti-ageing benefits of cosmeceutical skincare.
Dr. Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, is one of Singapore’s prominent dermatologists specialising in medical and aesthetic dermatology. She is also the founder of Dr.TWL Dermaceuticals which specialised in cosmeceutical skincare. In July 2019, a material science arm Dr.TWL Biomaterials was launched focusing on novel biomaterials for skin and hair application. Click here for the links to our product and here to read more about Dr.TWL Dermaceuticals and here to read more about Dr.TWL Biomaterials.
TWL Specialist Skin and Laser Centre grants parties a limited license to use and/or republish this article on for any legitimate media purpose, provided that you:
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Any detailed research you may have done about the skin would have returned you with the term ‘skin barrier’, or in scientific terms the ‘stratum corneum barrier’. You may be aware of how important the skin barrier’s function can affect the condition of the skin, but how exactly does the skin barrier work?
Skin hydration and the stratum corneum barrier has been active areas of study for many years. Yet, consumers are only beginning to get their interest piqued about the skin barrier, largely due to many marketing techniques. Before you commit to any product or treatment that promises to ‘repair’ the skin barrier, have a read on what these terms and processes mean.
The Stratum Corneum Skin Barrier
The skin barrier prevents foreign material from entering the human body. But it does more than just that. It also prevents water loss and serves as a shield against environmental factors. The barrier works to maintain the body’s homeostasis (or stable equilibrium) level. The loss of water from the body through evaporation from the surface of the skin is common, thus a need to keep our corneocytes hydrated.
Corneocytes are the cells found in the stratum cornum layer, that is the outermost layer of the epidermis. These cells are formed through cornification, where the skin cells develop tough protective layers or structures, creating a physical barrier for the skin. When deprived of water, dry skin may be more prone to crack open at stress.
The environment’s humidity also affects the corneocytes. As the level of humidity can vary, corneocytes get their source of hydration from the body, in order to maintain equilibrium with the environment. This may explain why our skin feels drier in winter. The skin battles harsh winds, depleting the skin’s moisture layers.
Skin Barrier Hydration
Skin hydration is an important factor when considering how to attain healthy skin. We look at the stratum corneum’s water content when analyzing skin hydration, with healthy skin containing more than 10 per cent water.
A mixture of water-soluble compounds called natural moisturizing factor (NMF) have been found to affect water content levels. The arrangement of lipids (fats) in the stratum corneum is also important, as it serves as an effective barrier to the passage of water through the layer. A poor arrangement can lead to transepidermal water loss (TEWL). TEWL is essentially when water diffuses and evaporates from the skin surface. Even though this is a natural process, excess TEWL is undesirable as it can lead to many unwanted skin conditions.
TEWL and Moisturizers
TEWL has been one of the most commonly used methods in the skin care industry to measure skin hydration as it directly correlates with skin barrier dysfunction. Healthy skin would score a low TEWL value as it would mean less water loss.
In the same vein, most moisturizers are put to the test by using TEWL values. A good moisturizer should help decrease TEWL. Moisturizers have remained as a ‘staple’ in basic skincare. Yet, not many may fully understand its function, thus some are unable to choose a suitable moisturizer for their skin needs. An effective moisturizer should protect the skin by stimulating and augmenting its natural barrier function, whilst catering to the skin’s requirement for moisture. Environmental attacks on the skin are also shielded with a proper moisturizer which can slow down skin ageing.
What happens if the water content of the stratum cornum falls below a desirable level? Normal desquamation is not able to take place, that is the shedding of the outermost skin layer. With insufficient hydration, skin cells will adhere to one another and accumulate on the surface layer. Visible changes associated with this phenomenon include dryness, roughness, scaling and flaking.
Certain cosmetic ingredients have become a cult favourite in recent years by targeting the stratum cornum water content, such as glycerol (also known as glycerin) and hyaluronic acid.
This ingredient exists in the stratum cornum as a natural endogenous humectant. It has shown that changes in the stratum cornum’s water content correlate with the glycerol content in the layer. Such results have driven the development of glycerol-containing moisturizers. Check the ingredient list of your moisturizer, this star ingredient should appear in any effective moisturizer.
Though it is known as a major component of the dermis (deeper layer of the skin), hyaluronic acid is also found present in the outermost layer. It plays an important role in regulating the skin barrier function and hydration. Although the skin care industry may recognize hyaluronic acid as a powerful humectant (attracts water to hydrate the skin), this molecule also participates in cellular functions. Hyaluronic acid influences cell-cell interactions that lead to normal structure of the skin barrier.
Though the mechanisms for skin hydration remain complex, a simple understanding about the skin structure and function is crucial when looking for an appropriate product or treatment. With these complex terms tackled, you are now one step closer to understanding your skin and its needs. If your current skincare routine does not yield desired results, you can consider cosmeceuticals as the alternative. A combination of ‘cosmetics’ and ‘pharmaceuticals’, cosmeceuticals are products with bioactive ingredients that can bring pharmaceutical effects to the skin barrier and health.
One’s skin type is largely determined by the genetics of an individual.
The production of oil itself is genetically determined – if one has a family history of having oily skin, it is very likely that one would develop it as well, as this is directly linked to the production of androgens such as the male hormone testosterone at the onset of puberty which affects both males and females. Based on the proportion of patients at the clinic, there is a significant population of people with oily skin types in Singapore. This is because of overactivity of the sebaceous glands which are concentrated over the forehead nose and the chin area, but can also occur on any part of the face, as well as including the chest and back which are also the areas more acne-prone. Although further research needs to be done to prove the common belief that a humid climate like Singapore results in oily skin, what we do know is that climate changes can have an adverse impact on skin that is already diseased such as with underlying acne, facial eczema or rosacea which are the common skin conditions I see in my practice. Problems associated with oily skin type?
Acne is a major issue faced by those with oily skin. The cause of acne itself is multifactorial, involving primarily genetics which causes inflammation exacerbated by the production of oil often driven by hormonal factors, leading to the formation of whiteheads and blackheads. One of the ways of treating acne would include reducing oil production by the means of an oral medication known as isotretinoin or by physical methods, such as chemical peel microdermabrasion as well as laser treatments that will shrink the oil glands. To add clarity, while almost all acne prone patients have oily skin, this is not to say that having oily skin one definitely would suffer from acne.
Oily skin type and ageing
One popular belief is that individuals with oily skin do not age as quickly. A desirable side-effect of oily skin perhaps? Or perhaps not. Skin aging is due to a complex interplay of factors, with the key determining factor being a balance between one’s biology, influenced by genetics (have a look at how your parents are aging), as well as environmental aging, due to the exposure to ultraviolet rays, air pollutants, cigarette smoke as well as a stressful lifestyle. The key thing to note is that unhealthy skin ages poorly and much worse than healthy skin. In patients with facial eczema, for example, with dry dehydrated skin known as asteatosis, they are inherently unable to produce a fatty lipid known as ceramide, which helps to repair and restore the skin barrier. Without this, the skin is unable to protect itself from external allergens or changes in the environment and this can accelerate aging. Dehydrated skin has an unhealthy epidermis and dermis. As a result, this can accelerate aging in the form of wrinkles as well as the loss of volume. If one has oily skin, the production of oil can form a barrier between the skin and the environment and this is a sort of protection which reduces the formation of fine lines and wrinkles or what cause free radical formation. Nevertheless, if one has an underlying skin condition such as scarred skin due to previous cystic acne, it doesn’t matter that your skin is oily, one would expect skin aging to progress faster than in a normal individual. There is a study which shows that people with oily skin tend to look younger than their counterparts and this is well-proven in clinical practice. However, I would say that striving to have oily skin is actually not desirable, especially in a very humid climate like Singapore, as a shiny complexion could be quite embarrassing. Long-term overproduction of oil due to overactivity of the sebaceous glands can also lead to irregular skin texture and enlarged pores. It is best to strive for healthy radiant skin that is well moisturized but not oily. There is a difference between moisturizer and oil, as I have seen many patients with nodular cystic acne and oily skin who also suffer from facial eczema which is dry dehydrated skin. Well moisturized skin is smooth and radiant, and looks healthy – a key component of the skin’s moisture is from molecules such as ceramide and hyaluronic acid which is an abundant water molecule in the second layer skin known as the dermis. It is a myth that people with oily skin don’t really need moisturizer. In fact, you could have a lot of oil on your face and still have dehydrated skin that’s lacking in the key moisture molecules. Our patients who are on treatment for acne still use a good cosmeceutical moisturizer to lighten their scars, as well as Vitamin C and Hyaluronic acid serum that can restore the correct moisture balance in their skin to prevent excessive oil production known as reactive seborrhea. Reactive seborrhea occurs when one strips skin excessively of its natural oils causing the skin to produce even more oil. Can someone with oily skin type change to having normal skin with diligent skincare alone? The amount of oil produced by an individual is genetically determined and influenced by the secretion of one’s hormones. It is however possible with proper long term cosmeceutical skincare, that one’s skin becomes adjusted in terms of restoring the normal moisture level.
Using improper skin care such as harsh oily-skin cleansers may strip skin completely dry and this leads to a vicious cycle known as reactive seborrhea. The key ingredient involved in restoring skin moisture and not oil, is firstly a pure concentrated form of topical hyaluronic acid in our skin care. According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, “We use a 1% concentrated hyaluronic acid serum freshly-compounded for optimum absorption in a pharmaceutical setting. This is easily a hundred to a thousand times higher than the concentration available in cosmetic skin preparations boasting the same ingredients. Regular use of topical hyaluronic acid has the effect of visually filling and plumping up the dermis (the second layer of skin which tends to sag with dehydration and aging), leading to a poreless, even complexion”
In terms of cleansing, I would recommend using an antibacterial foaming cleanser. The honey cleanser is formulated to remove grime, oil, bacteria and other surface pollutants that tend to settle on the skin at the end of the day. The nature of oily skin is that it tends to be a breeding ground for bacteria as well as a certain type of yeast known as malassezia which thrives in a humid climate like Singapore. This is a non-chemical form of an antibacterial and antiseptic wash, using natural medical grade honey which helps in reducing the amount of grease on one’s face. As honey is a natural humectant, it traps moisture under the skin while cleansing. It thus helps to moisturize the skin and regulates the balance of the oils as well as health of the skin. For a targeted approach, treating oily skin – medically known as Hyperseborrhea, a visit to a dermatologist is recommended. This would typically involve counselling on the use of appropriate cosmeceuticals as well as a retinoid which can regulate oil production. Our patients would also undergo chemical peels (glycolic, lactic and salicylic acid peels) in combination with laser treatments that can help to shrink the oil glands and reduce oil production. From then on, once the amount of oil production is reduced, it is easier to maintain with topicals alone.
A skincare regime for oily skin type There is a recipe for healthy skin in the same way one is careful to have a healthy diet and lifestyle to prevent illness, rather than change one’s diet only after one gets sick. Whether or not you have dry, oily or combination skin, there is really skincare that is suited for you and the answer lies in dermatologist-tested cosmeceutical skincare. Cosmeceuticals are researched to include potent bioactive ingredients formulated to prevent the onset of aging, as well as to deliver nutrients to your skin. Such a skincare regimen, is likened to a healthy diet that will prevent skin problems from developing later. If you have an underlying skin condition, cosmeceutical skincare can also reduce the severity of acne and facial eczema. So it is indeed true, at least for cosmeceutical skincare, that there is a one-size-fits-all for all types of skin, as a recommendation for the basic healthy diet of skin.
The key conundrum in skincare that has been plaguing dermatologists in the last 50 years was really that the dermatologist-tested skincare (which is compatible with aging problem skin types) we advocated for our patients did not provide additional cosmeceutical benefits. These women then went looking for over-the-counter cosmetics skincare which promised them anti-aging, but clearly not without the irritation and side effects. Then the dermatological community turned its attention to clinically proven anti-oxidants in skincare and showed that cosmeceuticals were valid and important in the treatment of aging skin to restore skin health. The advent of cosmeceuticals promises the same level of non-irritating gentle skin cleansing and moisturizing, with all the power molecules antioxidants which can lighten scars, brighten your complexion and retard aging. What’s there not to love?