The COVID pandemic worldwide is unprecedented. We at TWL Skin started our Specialist Dermatology Telemedicine (or ‘teledermatology’ in short) service early in January as an accompaniment to the launch of our online skincare pharmacy Dr.TWL Pharmacy. This turns out to form the bulk of our consultations since COVID affected our sunny Singapore shores in March
As an accredited specialist dermatology clinic by the Ministry of Health, TWL Specialist Skin & Laser Centre helmed by Dr. Teo Wan Lin, remains open as part of an offsite specialist dermatology clinic offering essential medical dermatology care during this pandemic. Since Singapore’s circuit breaker was commenced, and now extended till 1 June 2020, our lives have all changed at least in one way or another. We check in with our dermatologist and medical director Dr. Teo Wan Lin, on how a day in the life of a dermatologist is like in the time of COVID!
How has your daily routine changed? How so in your specialist dermatology practice?
I used to start my day with horse riding at my club, swimming or attending a fencing lesson with my coach. These days, I get up early to garden, I am starting a lot of seedlings and rebooting my hydroponic system to get self-sufficient!
Work wise, I usually start at 10am and that is pretty much the same other than that I work from home most days, seeing patients via our teledermatology service.
My clinic TWL Specialist Skin and Laser Centre is a specialist dermatology practice and our medical dermatology services fall under essential services in this time of the Circuit Breaker. I started teledermatology consultations last month for the safety of our patients and staff. It was timely that we had finally launched the service in January for our overseas patients who had requested for it, and is now available for all our patients with doorstep contactless delivery service of prescription medications. Our online skincare pharmacy Dr.TWL Pharmacy also delivers prescriptive cosmeceuticals by our pharmacist and myself to specific skin concerns such as pigmentation, oily acne prone skin, sensitive skin and eczema.
Tell us more about the “new” day in your specialist dermatology practice?
My new day actually includes a lot more time for self-care! As I am not physically in the clinic other than for urgent procedures, I’ve also had to skip my regular in-clinic laser toning treatments for anti-ageing maintenance regime! I have that extra bit of time though working from home with self care which I believe is absolutely critical in this stay home period, for both our physical and mental wellbeing. So I’m doing my own home facial treatment these days with our medifacial kit, the SilkPeel, which comes with 3 cosmeceutical solutions similar to what we do in our clinic, but for home use!
Mentally, my new day is similar to my usual work day mindset. I am actually a workaholic when it comes to executing my ideas so nothing much has changed from there! I’m definitely spending a lot of time on gardening and researching on the topic of urban farming, which has been my passion for a long time.
I am working with my team at Dr.TWL Biomaterials to bring a portable Aquaponic set up prototype to fruition really soon, to be available for pre-order via our site. This allows breeding of both edible fish like tilapia as well as hydroponic growth of vegetables without the use of chemical solutions but rather fish waste. It’s also in the right direction for sustainability, and this covid pandemic has taught us that self-sufficiency may be a basic need, not just a bonus.
Dr. Teo, do you order your meals in or do you cook?
I cook all my meals usually unless I’m going out over the weekend- before the circuit breaker I had already been having home cooked meals. During the work week I use an electric lunchbox at work which I prepare the night before and simply steam it right at work!
What are you doing now with some extra at-home time?
Work wise, our consultations are fully teledermatology via a secure medical database system, which we make use of to provide top notch specialist dermatology care virtually as we would with any patient face to face. This gives me more control over my time and I am super excited to share that I am starting a personal blog on best skincare and skincare tips as a dermatologist’s guide for the public! I started opera lessons at the beginning of last year. I am practising my all time favourite song now Un Bel Di Vedremo from Madame Butterfly by Puccini, my lessons are now via zoom!
What is the first thing you want to do once this is over?
I can’t wait to start riding again, go for my fencing training, meet all my friends and loved ones. Going for my evening runs with my dog on the polo field, that’s exhilarating for me. Also just seeing patients, the personal touch is so important. That’s exactly why I became a doctor, because I really cherish the human connection and this is something that we clearly took for granted before COVID.
Chemical peels are designed to improve the appearance of the skin by gently stimulating the top layer of skin cells known as the epidermis by applying a solution composed of fruit derived acids such as alpha-hydroxy acids, glycolic acid, lactic and salicylic acid. This stimulates the skin to regenerate, to be smoother and less wrinkled.
Who is Chemical Peel for?
Chemical peels are helpful for acne prone as well as normal skin, as a regular form of anti-ageing treatment to maintain one’s youthful appearance. In general, patients with fairer skin and lighter hair are ideal candidates. However, depending upon the type of skin problem encountered, darker skinned patients may also experience good results.
If you are looking to minimise or eliminate the lines around your eye or mouth area, wrinkles that are caused by sun damage, aging and hereditary factors, aging spots, mild scarring, certain kinds of acne, skin pigmentation such as sun spots, age apots, liver spots, freckles or splotching due to the consumption of birth control pills or dull skin texture and colour, chemical peels are effective treatment methods.
It is also good to note that chemical peeling can also be seen as a cost-effective solution for those who are currently undergoing other treatment modalities such as lasers for a skin rejuvenation purposes. Chemical peels are also more beneficial than beautician facials, in terms of skin rejuvenation and as an adjunct to acne treatment.
What should I know about Chemical Peels?
Chemical peels were developed and should be performed by a dermatologist, rather than an aesthetician or a beautician. Find out more about what a dermatologist is here. A thorough evaluation is imperative before embarking upon a chemical peel. In Singapore, if you are not a medical doctor, you will not have access to prescription strength chemical peels which actually work. Hence, it is not recommended to visit beauty parlors or aestheticians who offer chemical peels that either may be dangerous (it should only be performed under medical supervision) or provide not much benefit.
After a chemical peel, one’s skin is also temporarily more sensitive to the sun. It is pertinent to avoid overexposing the areas that have been treated with chemical peels to the sun as the new skin is fragile and more susceptible to complications. It is advised to protect your skin from the sun with an application of sunscreen and minimising direct contact with the sun by wearing hats or seeking shade with umbrellas.
The eye area is protected during the chemical peel and skin is first thoroughly cleansed to remove excess oils. During the procedure, one or more chemical solutions such as glycolic acids are used. As the chemical solution comes into contact with the skin, most patients would experience a warm sensation which lasts about three to seven minutes. Depending on the indication for the peel, the dermatologist will select the proper chemical peel agent and apply the selected solution to the skin. As these applications produce a controlled environment whereby a small amount of damage is induced on the skin, to trigger off new collagen formation.
What to expect after chemical peels?
Patients usually experience a reaction similar to a sunburn. There generally is no downtime beyond with superficial peeling of the skin, which presents as redness and mild flaking. Use a cosmeceutical moisturiser to soothe and maximise the post-treatment benefits on your skin. The Radiance Fluide contains phytoceramides to repair the skin barrier and oligopeptides to enhance collagen growth. See your skin become less greasy, more radiant and healthy after your first peel!
Whether you are a local, or an expat that lives in Singapore, one is struck by the stark weather of this equatorial city- constantly humid with temperatures rising above 30 degrees celsius. The cause of our sweaty pimply skin, simply put, Singapore’s weather causes bad skin-acne on the face, pimples on the chest and back. True or false?
Also, too many aesthetic clinics and medi-spas are advertising some sort of acne treatment for our humid climate, how does one know if it’s going to work? Does bad skincare cause problems and what exactly constitutes good skincare?
As many of my patients have asked, I share my top skincare tips on maintaining good skin in Singapore (which you could achieve on your own), and how to get treatment when you really need it.
Skincare Tip #1. If it’s bothering you, you may have a real skin problem. Do see a dermatologist.
Do you suffer from any of these: sensitive skin and break-outs if the products were not right? Constant red face? Having flaky itchy skin whenever you’re traveling? Always having a pimple breakout at that time of the month?
Acne on the chest and back is often actually a fungal infection known as pityosporum folliculitis. This sort of chest and back “acne” requires treatment with specific antifungal lotions and creams. People who are at risk include athletes or those living in a humid country like Singapore, as the constant sweating and the moist environment worsens it. When chest and back acne or fungal infections are left untreated, it leaves bad scars and even develops secondary bacterial infections.
If you always have a red face you may likely suffer from rosacea. Rosacea treatment is with correct oral antibiotics and creams before anti-redness lasers (to eradicate the blood vessels) are used. Rosacea is triggered off by hot climates, spicy foods, emotions in certain people who are at risk. It is likely to be related to increased blood vessel sensitivity as well as certain mites that live on your skin (demodex mites).
If you have any such symptoms, stop all skincare products and promptly seek the care of a dermatologist rather than self-medicate, or adopt a “wait-it-out’ attitude. Some skincare tips: Look for the labels “dermatologically tested and formulated” when it comes to choosing cleansers, moisturisers and cosmeceutical products. Avoid testing many different cosmetic products which have no scientific evidence proving effectiveness. Finally, where possible avoid dust, extremes of temperature and humidity, prolonged contact with sweat as these tend to worsen skin sensitivity.
Skincare Tip #2. Don’t use just any wash on your face, use a dermatologist-tested and formulated cleanser.
It almost feels like because Singapore is so warm we constantly need to keep washing and keeping clean because of the sweat! As a dermatologist, I’ve heard from many patients with acne how they struggle to wash their face 3 times a day and are puzzled that they still have pimples. Cleansers perform one function, they emulsify the dirt, oil and bacteria in the foam which is rinsed off with water. Acne not due to dirt or bacteria, although they both can worsen people who already are prone to acne, such as those who have a family history of acne, so no amount of washing can actually get rid of acne.
There is a difference between normal cleansers and those which are dermatologist-tested/formulated. Cleansers approved by dermatologists are gentle on the skin, due to a good balance of the lathering agent and use of quality ingredients that do not strip the skin dry of it’s natural moisture while cleansing effectively. I personally formulate a honey-based cleanser which is suitable for both oily skin and sensitive skin types in Singapore (honey is a natural emulsifying agent which also has anti-bacterial properties) for my patients. Here’s a skincare tip, cleansers that leave your skin feeling squeaky clean is usually a bad sign. Stop using your supermarket cleanser and start looking carefully for those “dermatologist-tested and formulated” labels.
Skincare Tip #3. Don’t buy more scrubs or clay masks to clean your face better.
It amuses me that most of my patients are shocked when they hear this from me, their dermatologist, almost as if I am wrong to say that. Dermatologists do not agree with a lot of what beauty companies/aesthetics providers (who are not qualified dermatologists) are telling the public. The beauty industry is limited by what they are allowed to use in their salons (none of the prescription medications that would actually work is found in these places) and are are very happy to include more products in your regimen to earn your dollar.
Dermatologists have seen way too many complications because of an incomplete understanding of the actual science of how skin behaves. Scrubbing with harsh beady grains of sand would work if your skin was made of wood, like sandpapering it down. In reality, you do not brighten or “exfoliate’’ your skin with that but rather you are causing damage and irritation to your skin, that’s maybe even the cause of your sensitive skin and red face problems.
Clay masks? Totally unnecessary even for oily and acne-prone skin types. The skincare tip here is to know that it’s actually the salicylic acid content in these masks that causes your acne to get better, but not without really dehydrating your skin after that (these masks are dry out your skin with an astringent). Most of my patients end up with a red itchy flaky face, on top of acne after they go on a clay-mask spree hoping that it would cure their oily face and acne.
Dermatologists do not prescribe clay masks for any skin problem because there are much more effective options for treatment of oily skin and acne. What counts in a skin treatment product is the active ingredient in these masks and products. So the skincare tip here is to start looking down the ingredient list of your next bottle!
Skincare Tip #4. Use cosmeceuticals but do thorough brand research first.
Haven’t heard of cosmeceuticals yet? It has become quite a fashionable word amongst the dermatologists community (for those in the know). It’s a marriage of two words “pharmaceuticals” and “cosmetics”. It’s actually referring to skincare with active ingredients best for skin that’s backed by dermatologists.
Am I too young? Or too old? Do i even need to get started? As a skincare tip for best results, start on cosmeceuticals early, in your twenties for maintenance of your youth. If you are already in your thirties and forties or beyond, fret not, cosmeceuticals are a useful adjunct to the laser/filler/botox treatments recommended by your dermatologist and help to enhance and maintain the effects of such anti-aging treatments.
There are a myriad of cosmetic brands that claim wonders. Unfortunately, cosmeceuticals are not regulated by the HSA and so are not bound to their claims. Hence, it’s difficult for the consumer to know if a given product can do what it claims it can do, contains the ingredients it claims to, or if the ingredients are even active forms?
Moreover, if the ingredients have phototoxic or photo reactive properties when exposed to the sun, among other concerns. What then? There is true evidence for the anti-aging properties of cosmeceuticals, but you are wise to consult a dermatologist before you buy. The HSA does not regulate the effectiveness of anti-aging products available without a prescription.
Skincare Tip #5. Go for a chemical peel or a medi-facial monthly at your dermatologist’s office in your twenties. Lasers in your thirties and beyond.
What is true about acne and the humid Singapore climate is that it all encourages the build up of dead keratin (read: skin flakes) which plug the pores and cause inflammation. Even if you don’t have acne, the build-up of keratin on your face with reduced skin turnover as one grows older, or due to environmental conditions such as exposure to pollutants and to sun. All these cause free-radical damage and accelerated aging, makes one’s face look dull and hence lose the bright complexion of one’s youth.
One of the best skincare tip we can give is a regular chemical peel (salicylic, lactic or glycolic acids as suited for your skin type should be determined by your dermatologist) or a medi-facial (I would use a vacuum handpiece with customised chemical peel solutions for patients), would reduce your chances of having oily acne-skin breakouts and reverse early signs of mild aging. It’s affordable as well. However, this alone will not work for a lot of patients with more severe acne/oily skin, for which they may require laser treatments to shrink oil glands or take oral isotretinoin for control of severe acne.