Tag Archive: exfoliation

A Dermatologist’s Guide on Polyhydroxy Acid (PHA)

June 13, 2019

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Is PHA (polyhydroxy acid) suitable for all skin types? How does it compare to AHAs aacnnd BHAs?

Polyhydroxy acids encompass gluconolactone and lactobionic acids. It has been reported in medical papers as early as 2004 to be effective and better tolerated by sensitive, aging skin.

PHAs works similarly to AHAs by causing the dead skin cells (keratinocytes) to shed at a higher rate, causing reduction in skin irregularities such as uneven pigmentation and texture. In addition, they fulfill the same function of allowing cosmeceutical ingredients such as hyaluronic acid and vitamin C serums to penetrate deeper into the skin.

Is there a possibility of suffering from a chemical burn using skincare products that contain PHA?

PHAs are not as commonly used as AHAs and BHAs, especially as chemical peels in dermatologists’ office setting mainly because the depth of penetration and effectiveness may be less. However, in skincare, the medical literature seems to report that it is a much gentler and moisturizing type of chemical exfoliant than the other acids present in skincare, which translates into a much lower risk of skin irritation. In fact, PHAs are large molecules which function as humectants meaning that they trap water under the skin, prevent trans-epidermal water loss and have moisturizing properties.

Is there one form of PHA that’s stronger than the others? eg. Lactobionic acid vs Gluconolactone  

Clinical studies to date have grouped the use of gluconolactone and lactobionic acids under PHAs which differ from glycolic acids in the fact that they have a larger molecular structure, penetrate the dermis less and hence is less irritating in addition to having humectant (moisture trapping) properties. I am unaware of any head-to-head study which show whether one form of PHA is stronger than the other.

When should I use PHA? Should I use it in the toner, serum, moisturiser, or cleanser step?

The use of PHAs in skincare has been well-reported to have good exfoliating effects but without the irritation that glycolic (AHA) or salicylic acids (BHA) have. However, I generally do not put in chemical exfoliants in skincare because there is always a risk of skin becoming sensitive after being exposed to it on a daily basis.

While there are some studies which have shown that compared to glycolic acids which are incorporated in several brands of skincare, those which incorporate PHA are much more suited for people with sensitive, eczema skin, I would not prescribe that for my patients with eczema and rosacea in the first place.

What should I be looking out for when I use PHAs?

I would say PHAs seem to be rather novel because it’s a term that hasn’t been used in the recent times but our knowledge of it has stemmed since the 1970s and clinical studies have been done with it since 2004. I think it’s important to prioritise, so the main concern really would be to ask yourself what your skin concern is. If it is anti-aging, then chemical exfoliation itself is not going to give you a miracle result. Chemical exfoliation can be achieved with glycolic acids, BHAs and in this case PHAs may have the same function but with reduced skin irritation. However, chemical peels alone do not satisfactorily target all skin aging concerns, which lasers in combination with a good cosmeceutical regimen can achieve. It is important to caution that while all anti-aging treatments are aimed at increasing collagen production in the skin, an accredited dermatologist still needs to access the individuals’ problems and side effects before recommending combination treatment.

PHAs should be used in conjunction with cosmeceutical ingredients such as vitamin C as well as phyto which are plant-derived antioxidants that have been proven to fight free radical damage which is the key process in anti-aging. Nevertheless, PHAs are a beneficial form of chemical exfoliation and should be placed in the same category as the use of AHAs and BHAs in chemical peels.

One more thing to add, the clinical results in terms of the depth of skin penetration are likely to be less with PHAs. For patients with other forms of skin concerns, for example acne, they may still find that glycolic acid is much more effective in reducing oil control. If their concern is a medical condition like eczema and rosacea, then certainly I would recommend not using any form of chemical exfoliant at all and rather get treated by a dermatologist.

© 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 on milia treatment

February 25, 2019

 

They may be small, but we definitely do not want these small, pesky bumps around. Milia, sometimes called ‘milk spot’ or ‘oilseed, are tiny white bumps that are benign, but hard to remove. You may have attempted to squeeze it out, given that milia can be cosmetically unappealing, but that would only worsen it.

If you are hoping to know the causes of those tiny bumps under your eyes, and how to get rid of it, read on.

Understanding what is milia – the white bumps under your eyes

Milia are keratin-filled bumps of 1-3 mm in diameter, arising from the outermost layer of the skin. Keratin is a structural protein that makes up your hair, nails and skin.

They are classified into primary and secondary milia.

What causes milia?

Primary milia is the most common, occurring spontaneously without a known stimulus. Secondary milia is induced by various stimuli, typically when the skin undergoes some form of trauma. This could be dermabrasion, physical trauma e.g. x-rays, inflammatory skin diseases e.g. acne or use of topical or systemic drugs.

Primary milia are connected to the sheath of our hair follicles, near our oil glands. Secondary milia connect to our sweat glands, rarely to hair follicles or the outermost skin layer. Milia are formed when there is an obstruction of the hair follicles or sweat glands.

Primary milia

Such form of milia is common in newborns, typically found on the face or scalp. They tend to disappear within weeks. In adults, benign primary milia occur spontaneously, often randomly distributed across cheeks and eyelids, and sometimes at the genitalia. While milia found on newborns go away in time, milia that develop later in life tend to persist.

Rarer forms of milia include milia en plaque, where multiple keratin-filled bumps are found in a cluster. It occurs without any apparent trigger and can arise spontaneously on healthy skin of predisposed individuals. Affected areas are often reddish, found under the eyes, on the ears, head or neck.

Multiple eruptive milia have a wider distribution than simple primary milia. It may be spontaneous or an inherited genetic condition. The bumps can be found distributed over the face, neck, upper chest, back and arms. It often numbers in the hundreds and can develop over a period of weeks to months.

Secondary milia

Secondary milia occur anywhere following traumatic stimuli after the skin is damaged in some way. Medications that may trigger secondary milia include topical steroids, penicillamine, benoxaprofen and cyclosporine. Other conditions can include contact dermatitis, skin grafts, second-degree burns and radiotherapy. In children, superficial abrasions can also lead to secondary milia.

Treating milia: can it be done at home or by a dermatologist?

Milia is benign and does not have any symptoms, thus treatments are only necessary if requested by the patient. However, all treatments must be recommended by your dermatologist.

  • Evacuation: For individual milium, the most effective way is to nick it with a scalpel blade, followed by applying pressure with a blunt edge. It is important to only have it done at a dermatologist’s office, as it may result in scarring when done without professional expertise. Any puncture of the skin may also cause infection.
  • Laser therapy: CO2 laser ablation can treat individual or multiple milia with minimal complications or recurrences
  • Oral prescription: Tretinoin or minocycline is often prescribed.
  • Microdermabrasion: A skin-resurfacing procedure to help gently sand the outer skin layer, causing cell turnover. Skin that grows back is smoother.
  • Electrolysis: Current is applied through a tiny needle on the milium, piercing through the keratin-filled bump. The contents of the milium are then soften, thus easy to remove.

Patients should not attempt milia extraction at home on themselves. While milia alone do not have any side effects, improper technique can cause skin trauma, leading to scarring or injury. If you would like to remove milia professionally, consult an accredited dermatologist.

© 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.

 

 

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.

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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.