Tag Archive: pimples

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.

—–

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.

 

 

 

 

 

 

 

 

 

 

 

 

Why See a Dermatologist?

May 29, 2018

 

What is a dermatologist?

A dermatologist (skin specialist) is a qualified medical specialist who has obtained qualifications to specialise in the diagnosis, treatment and prevention of skin, nail and hair diseases. Dermatologists are trained in cosmetic skin problems and aesthetic procedures. Only doctors listed as dermatologists by the Ministry of Health are recognised dermatologists. Cosmetic lasers, treatments, botulinum toxin and filler injections were developed by dermatologists. Aesthetic doctors are not skin specialists, they are family practitioners(GPs) who need to be accredited by the Dermatological Society of Singapore to carry out these procedures. Having a diploma in dermatology (Dip Derm) or a diploma in family practice dermatology (Dip FP Dermatology) does not qualify a doctor to be a dermatologist.

— Dermatological Society of Singapore

In this article, we break down some common FAQ, tips that have helped our patients and media friends navigate their way in their skincare journey with us. We hope it can help you to make the right decision about the health of your skin.  Find an accredited dermatologist here.

 

  1.       What can a dermatologist tell you that an “aesthetic doctor” can’t about your skin?

There are a few layers to answering this question actually. Firstly, there is actually no such thing as an aesthetic doctor, either a dermatologist, plastic surgeon or a general practitioner as aesthetic medicine is not considered a medical speciality.

The public should refer to the Singapore Medical Council guidelines with regards to the “aesthetic doctor” label, which actually is not an approved qualification or title, as the practice of “aesthetic medicine” is actually the realm of specialist dermatologists and plastic surgeons. Procedures such as chemical peels and lasers, botulinum toxin and fillers re developed and used by dermatologists, but are increasingly practised by non-dermatologists such as general practitioners (GP, family practice doctors). Having a diploma in dermatology (Dip Derm) or a diploma in family practice dermatology (Dip FP Dermatology) does not qualify a doctor to be a dermatologist. In Singapore, GPs require additional Certifications of Competency (COC) to carry out such treatments in Singapore, which is administered by the Dermatological Society of Singapore.(Source: Dermatological Society of Singapore)

So the real question should be.. what a GP who offers treatment for dermatological conditions can’t tell you, compared to a dermatologist.

A dermatologist (skin specialist) is a qualified medical specialist who, through additional years of special training, has obtained qualifications to specialise in the diagnosis, treatment and prevention of skin, nail and hair diseases affecting persons of all ages. Dermatologists are also trained in cosmetic skin problems and aesthetic procedures. In Singapore, to qualify as a dermatologist, a doctor needs to obtain a post-graduate degree in general internal medicine or paediatrics which may take up to 5 years before acceptance into a full-time dermatology training programme in a recognised dermatological institute lasting 3 years. At the end of this training, the Ministry of Health certifies the doctor as a dermatologist. Only doctors listed as dermatologists by the Ministry of Health are recognised dermatologists.

Dermatologists are experts in the treatment of skin conditions such as acne, eczema, psoriasis, skin infections, skin allergy, skin cancers and hair loss. Dermatologists also treat all kinds of cosmetic problems of the skin and provide advice on skin health. Special treatments such as surgery for skin cancers and pre-cancerous skin conditions, the use of ultraviolet light therapy, laser therapy, intense pulsed light (IPL), radio-frequency therapy, botulinum toxin and filler injections and hair transplantations are also carried out by dermatologists. In fact, many cosmetic lasers and treatments were initially developed by dermatologists.

At the end of the day, be it in skin or other specialities, the public should just be discerning as to the qualifications of the doctor, and what a medical specialist accredited by the Ministry of Health is trained to do for specialised conditions, as long as they are not misled to believe that they are seeing a skin or an aesthetic specialist when they are seeing a general practitioner.

 

  1.   “Aesthetic Doctors (General practitioners) and Dermatologists – Are treatments offered the same?

The practice of medicine is really as much an art as well as a science, meaning that while many general practitioners would say they have experience treating say dermatological conditions in the family practice setting, there is a real difference in training, knowledge and experience of a dermatologist. A specialist dermatologist takes additional years (at least 5 years) and goes through specialist accreditation managing complex medical and cosmetic dermatology conditions as well as complications associated with treatment. Certainly, for straightforward cases of any medical condition, family practice doctors are able to treat but would not be able to distinguish or diagnose conditions as accurately as a specialist dermatologist.

 

  1. Tell me about an example where it mattered to see a qualified dermatologist

         A case study in point: Adult Patient with pimples

If you are an adult and still struggle with pimples, then be warned your case would not be as simple as the on-off breakouts that teenagers have, which is physiological acne. Both would respond to some degree to conventional acne medication such as topical and oral antibiotics but would have a limited effectiveness if the true underlying cause is not considered. There may be a much more serious underlying medical condition, for example.

When acne persists into adulthood, dermatologists are trained to consider and work with specialist gynaecologists to diagnose and rule out secondary factors such as Polycystic Ovarian Syndrome, which is associated with irregularities of the menstrual cycle, excess facial hair growth, weight gain as well as acne, which is actually treated most effectively with a hormonal contraceptive pill. Dermatologists would also perform adjunctive treatments like chemical peels for a quick response, to remove existing blackheads (open comedones)  and whiteheads( closed comedones) and reduce the appearance of scars. While one may wonder if the beautician or aesthetic doctor could perform the same peel, be warned that if you struggle with sensitive dry yet acne prone skin, your condition could get much worse when it is not managed by an accredited dermatologist. The choice and duration of the chemical peel (concentration, composition and source) are operator dependent.

In addition, your dermatologist may suggest that chemical peels may not be suitable for you at all if you have underlying facial eczema, and may treat your eczema at the same time as acne. Anecdotally, I have had experience with patients who attended my clinic and were purportedly recommended with “oxygen facials” by “aesthetic doctors” for their sensitive skin for years. They actually were diagnosed with facial eczema, which is a medical condition managed by dermatologists. There is no evidence for using oxygen facials or any type of “facials” to treat facial eczema and in fact, could worsen the condition. If left untreated, it could spread and lead to severe infections and scarring.

© 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.

 

A Singapore Dermatologist’s Personal Skincare tips

April 13, 2017

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 tips on maintaining good skin in Singapore (which you could achieve on your own), and how to get treatment when you really need it.

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?

If you have any of these symptoms, stop self-medicating and applying a bunch of anti-redness or “sensitive skin” products if you have these symptoms, it’s just going to make it worse. All of the above can be treated with proper medications. Eczema treatment for flaky, sensitive and itchy skin, hormonal acne treatment for pimples around that time of the month, and sometimes it isn’t even really acne. I’ve seen cases of perioral dermatitis that have been wrongly diagnosed as acne and obviously did not improve.

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 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.

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. Cleansers that leave your skin feeling squeaky clean is usually a bad sign, so stop using your supermarket cleanser and start looking carefully for those “dermatologist-tested and formulated” labels.

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 because 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 again, start looking down the ingredient list of your next bottle!

4. Use cosmeceuticals but do thorough brand research first.

Haven’t heard of cosmeceutical 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?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.

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. 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.

© 2017 Dr. Teo Wan Lin. All rights reserved.

—–

Dr. Teo Wan Lin is a leading dermatologist in Singapore and also the Medical Director of TWL Specialist Skin & Laser Centre

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