Acne in teenagers and adults is a troubling condition, affecting one’s self-esteem and confidence levels. In my clinical practice as a dermatologist, acne vulgaris, colloquially known also as pimples, forms at least 50% of the daily load of patients I see. There are many aspects to be addressed within the dermatology consultation.
This varies from the cause of pimples, to questions about effective acne treatments, DIY formulas, over the counter acne creams and prescription medications. I have sought to share as many of these treatment pearls in the following article as comprehensively as possible, and hope it can help shed some light on the best acne treatments available.
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 is the founder of Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Dr. TWL Pharmacy is the only full fledged online specialist dermatologist compounding pharmacy in Singapore and is jointly headed by a trained pharmaceutical engineer for strict quality controls.
Why do pimples form and what exactly is happening to your skin when a pimple forms
Pimples is the colloquial term for Acne Vulgaris. This refers to an inflammatory condition of the skin that presents with blackheads and whiteheads, otherwise known as closed comedones and open comedones respectively, inflamed papules as well as acne cysts. The cause of Acne Vulgaris is multifactorial.
First of all, it is determined by one’s genetics. Individuals with a family history of acne tend to have a higher chance of developing acne. This is brought on by the onset of puberty which leads to the secretion of the male hormone, testosterone. Testosterone, in turn triggers oil production in both men and women. That being said, sebum, the oily substance secreted by your sebaceous glands, is essential for the entire process of acne formation.
The third thing that occurs due to one’s genetics, is the process of inflammation itself which leads to comedone formation. All pimples whether whiteheads or blackheads arise first as microcomedones under the surface of the skin.
When they reach the surface of the skin, they become visible. The process that drives this is a mix of genetics, the presence of sebum as well as some form of dysregulation of the process of follicular keratinisation i.e. the way your skin retains dead skin cells around your skin pores.
Aside from genetics, there is also the involvement of a bacterium known as Propionibacterium acnes – a heavy commencer in individuals who suffer from acne. Finally, a lot of acne flare-ups can be due to the secondary bacterial infection of existing acne bumps known as gram-negative folliculitis. This tends to present with pus-filled papules and tend to have a yellowish tip.
I have observed that I always get acne in the same spot
While I do hear this coming from my patients quite often, i.e. “I always get this one pimple now and then on my cheek, chin, forehead…”, there is no scientific answer to this. From my personal experience, this could be due to one of the following. Firstly, if you tend to pick at your pimples, there is a condition known as acné excoriée. The entire name of this condition in french is acné excoriée des jeunes filles meaning acne excoriée of young girls.
There is an element of this compulsive picking of acne and this is the main reason why I find my patients having acne at the same spot. They constantly pick at it so even when it is healing, it does not get the chance to heal and picking introduces secondary bacterial infection.
The second reason why is because you are suffering from some form of acne that is related to occlusion. Some people wear helmets or face masks. If acne develops around that area, it is a type of acne known as occlusion acne. It could also be due to the application of comedogenic, hair waxes etc.
The third thing, if you are talking specifically about acne on the chin, you have to consider perhaps it is not acne at all. There is a condition known as perioral dermatitis. Perioral dermatitis looks very similar to acne and if you are seeing a non-specialist, it is very easy to be confused. This is because the bumps look very similar to acne, except that it is a mixture of eczema and inflammation, acne bumps, or it could even be acne rosacea.
All about Acne Creams
When you apply a pimple-clearing product to your pimple, what happens to the spot? What are some of the ingredients that you’d want to look out for in a pimple product, and what should you avoid? Are pimple drying lotions ok for the skin and how do they work?
If you find yourself searching online for answers to these questions, you are not alone. These are some frequently asked questions by sufferers of acne and I shall seek to clarify them here. There are a few categories of pimple-clearing creams. The first being the good old-fashioned creams that simply dry out the skin and reduce sebum production.
Pimple Drying Medications
This category would include topicals that contain the following active ingredients: benzoyl peroxide, salicylic acid, calamine lotion, sulfur-containing lotions. In some mild cases these creams may lead to an improvement in acne itself.
Pimple Creams Containing Antibiotics
The second category of acne treatment creams would be those containing antibiotics. The commonest antibiotic-acne gels would be those which contain clindamycin or erythromycin as an active ingredient.
These work on the premise that a lot of cystic acne is caused by secondary bacterial inflammation. As with all topically applied antibiotics especially in a chronic skin condition like acne which is not primarily due to skin infection, there is a huge problem with using topical antibiotics.
Topical antibiotics work well in a short-term simply because the skin has never been exposed to it. But very quickly the body learns to identify the antibiotic and develops resistance.
This is particularly concerning because the resistance doesn’t just take place in the skin level. Exposure of the topical antibiotics on the skin level leads to resistance systemically as well. For example, it could lead to antibiotic resistance when one is older.
The main thing about antibiotics is that it is a mere short-term fix and does not work after some time. There are other combinations of antibiotic gels, such as clindamycin combined with benzoyl peroxide which is the active ingredient present in the OXY pimple cream. The benzoyl peroxide component has been proven to reduce the emergence of bacterial resistance.
Prevention Creams – Retinoids for Acne Treatment of Whiteheads and Blackheads
The third category of pimple creams which I consider more preventive rather than treatment sort of cream is the retinoid category. These are the vitamin A derivative creams. We have heard of creams like tretinoin and adapalene which may have differing trade names. Both these creams are Vitamin A derivatives and they work via preventing microcomedone formation.
However, when you apply these creams, you should not apply it to inflamed active pimples as this can worsen the inflammation process. Rather they should be used in conjunction with active acne treatments prescribed by a dermatologist which is proportionate to the severity of your acne as preventive treatment. When you start applying a retinoid cream for example, you only get to see the result 2-3 weeks later.
A Dermatologist’s Recommendation of the Ideal Pimple Cream – New Generation Anti-Inflammatory, Anti-Sebum Pimple Creams
The fourth category of acne treatment creams is actually what I actively advocate now and which we have formulated in a highly effective Blemish Spot Cream under Dr.TWL Dermaceuticals. It is targeted at reducing inflammation itself. I am very convinced that botanicals have a prominent role to play in cosmeceuticals.
Cosmeceuticals are no longer just confined to the realm of having anti-ageing properties but are also adjuncts for the treatment of many medical skin conditions. I have used botanicals extracts successfully in the treatment of rosacea for example.
For acne, I incorporate an algae extract from chlorella vulgaris which actively reduces the oil gland activity. This is combined with amino acids such as methionine and serine that help to heal the skin when you apply it. The main thing is that when you try to dry up an active pimple, very often you get more inflammation as you are burning the skin around it.
What you need to do is to try to get the pimple to heal as quickly as possible. This is so that you minimise the risk of scarring. At the same time, this also treats the underlying problem of acne pimples which keep forming.
Are there different pimple creams best suited for the different types of acne (eg blackheads whiteheads, red swollen pimples)?
For tretinoin and adapalene which are the two main available form of vitamin A creams, these should not be used for red, painful, swollen acne treatment. They are best suited for comedonal acne which would be your blackheads and your whiteheads. For drying pimple creams, like benzoyl peroxide, salicylic acid, calamine lotion, I don’t recommend applying these to areas that have broken skin.
If you apply these to broken skin, the irritation and drying potential is just going to be multiplied. Potentially, you are going to end up with something that looks like a chemical burn. That is something much redder with a lot of peeling flaking and bad scarring.
Instead, I would recommend using an anti-inflammatory product with botanical-based extract that doesn’t contain anything irritating like salicylic acid. For example, the one we use is based on an algae. There is no issue applying this over areas with broken skin, although it also really depends on the formulation itself.
In addition, for a correctly labelled and medicated acne cream, i.e. not just a cosmetic product, there would be very clear indications of use available.
Does my skin ever get used to pimple-clearing products – is that why my pimple never seems to heal?
If you are using a medication like clindamycin and erythromycin, then yes because you develop real bacterial resistance which stops the medication from working. If you are using something which is drying such as the first category I spoke about earlier, or something anti-inflammatory, there is no evidence that your skin can actually develop a form of resistance to that. It is simply that the severity of acne has progressed or in the first place it wasn’t sufficient acne treatment.
Adult Acne Treatment
For patients with mild acne, they will have approximately 3-5 pimples every month and they tend to be of the teenager age group. Once you are past your teenage years, from the age of 21 onwards, it is a different ballgame of what dermatologists term as adult acne. If you still suffer from acne then, meaning having an average of more than 5 pimples every month after the age of 18, it is at the minimum, a case of moderate acne.
Moderate severity acne means that while you don’t have severe scarring or cystic acne, it is still very persistent and would need to be treated medically by an accredited dermatologist. In my clinical experience, moderate acne does not respond well to topicals only regimens. Topicals are only useful as an adjunct in the treatment of moderate acne.
On the other hand, using appropriate cleansers and pimple-clearing gels works well and is sufficient for mild acne. It may be a selection bias by default, given that attendances at a dermatologist practice would be moderate cases.
This is because the mild cases perhaps get treated at the GP level before they do get to us. Moderate cases of adult acne would need more treatment than just topicals. According to international dermatology guidelines, there are two options for the treatment of adult cystic acne.
Oral Acne Treatments
Firstly, the oral pathway for which I must emphasise that there are many oral medications that are safe and effective that have been widely prescribed by dermatologists internationally for decades. Examples of commonly prescribed medications include low dose oral antibiotics like doxycycline, erythromycin. These function primarily as anti-inflammatory medications to prevent comedone formation.
Minocycline is less frequently used these few years as it has been linked to a few rare cases of hypersensitivity syndrome, on top of potentially causing blue-grey skin discolouration.
Erythromycin in particular is safe for pregnant and lactating individuals. Oral contraceptive pills such as Diane-35 and Estelle-35 contains estrogen as well as cyproterone, which blocks androgen (testosterone activity). Androgens are male hormones that trigger off oil production, exacerbating adult hormonal acne.
Women with a history of irregular menstrual periods with cystic acne may have undiagnosed polycystic ovarian syndrome (PCOS). Such individuals will benefit from joint management of a dermatologist and a gynaecologist. Treatment of PCOS is with hormonal therapy, which will benefit adult acne treatment as well as preventing infertility.
Non-Oral Acne Treatments and Physical Therapies
Secondly, we have the non-oral pathway for acne treatment which involves physical therapies that have to be administered in a clinic setting. For example the usage of LED wavelengths, blue-light, two times a week for one month.
Blue light is therapeutic for treating acne that is especially worsened by the bacteria Propionebacterium Acnes. This has been proven to be effective in a regimen of twice weekly 30 minutes duration for a one month regimen.
Chemical Peels and Lasers for Acne Treatment – Can they be used independently?
Use of chemical peels and specific lasers like the carbon laser helps to shrink the oil glands of someone with active acne, especially in individuals that may not want to go on oral medications.
I always recommend those with persistent moderate acne to go for a short course of a safe antibiotic such as erythromycin or doxycycline in conjunction with any of these physical therapies. This is the most cost-effective option that targets inflammation that goes on in acne rather than blindly treating it from the surface.
For severe acne, you may suffer from deep painful cysts which often involve pus and bleeding and there will be a lot of scarring. The treatment for this is very straightforward, our first line is always this medication called isotretinoin.
The medication is also known as accutane or oratane which are brand names of the forms of isotretinoin available. Isotretinoin is an extremely effective oral medication which works essentially by shrinking your oil glands.
Without oil, your skin simply doesn’t produce acne. However, isotretinoin use does come with drawbacks like increased sun sensitivity, dryness of the lips and eyes. One also has to monitor your liver function and cholesterol levels whilst on isotretinoin.
A lot of patients in my practice have asked me to gauge the number of days to determine if an acne product works and my answer is simply this.
The Wound Healing Process of a Pimple’s Life Cycle
When a pimple forms it is best viewed as an injury caused by inflammation to the skin. You may go by the principles of wound-healing, especially when it only involves the top two layers of the skin (the epidermis and dermis).
Within the first 2-3 days of a cyst, there should be signs of pus draining. Should there be blood coming out of it, soon one should observe the redness and swelling resolving as well.
Acne That Does Not Heal
Acne may progressively accumulate and get larger instead of reducing in size. For example, the acne may get more painful, accumulate more pus and blood that doesn’t seem to be draining. When this occurs, one has to consider that there is an underlying cyst forming.
What is An Acne Cyst?
The formation of an acne cyst involves the collection of haemoserous material – blood, sebum, dead skin, keratin and debris. These substances subsequently get “cordoned off” by the body with a wall around it. This is part of the immune system’s response to inflammation. Acne cysts do not respond well to any topical treatment.
Proper Treatment of An Acne Cyst
Acne treatment of cysts involves a combination of the following. Firstly, an injection known as an intralesional steroid injection helps to reduce inflammation locally. It is injected right into the centre of the nodule and within 3 days, swelling will reduce the underlying swelling.
It is very important for the injection to be administered. This is because untreated acne cysts can lead to more severe problems like facial abscesses with drainage of pus.
Furthermore, it can spread to other parts of your face which is rare but has been documented. Concurrently, large painful acne cysts should be treated with an oral antibiotic such as amoxicillin, sufficient to treat the secondary bacterial infection that causes this reaction.
In the light of the Covid lockdown, our clinic is open to TeleDermatology services for acne treatment. This includes complimentary doorstep courier of prescription, contactless delivery within 3 working days. Same day delivery can also be arranged.
If you suffer from mild to moderate acne, you may try these over the counter cosmeceuticals proven for acne treatment.
Acne occurs when the oil glands under the skin, scientifically known as sebaceous glands, become clogged with sebum, an oily substance. This process is known as inflammation, and it is often genetically determined. Hence, if you have a family history of acne, you are at high risk.
A normal amount of sebum usually keeps the skin healthy. Your oil glands become active once you reach adolescence due to hormones and this is when acne usually starts. When clogged, bacteria grows in the glands. This leads to swelling, bumps and visible blackheads and whiteheads on the skin’s surface.
Acne can still affect adults. In fact, many adult females suffer from acne breakouts around the chin, especially during certain times of their menstrual cycle. This should be differentiated from other conditions such as perioral dermatitis, which may look similar but is treated differently.
Under proper dermatologist care, acne can be fully treated with the correct medications, creams and light treatments. For patients who prefer not to be on oral medications, some forms of laser therapies are safe and effective acne treatment methods too. Blue light, a type of light therapy is designed to treat acne when it is active by killing Propionebacterium Acnes on the skin, which causes acne inflammation. Non ablative and ablative resurfacing lasers can treat subsequent acne scarring after it subsides.
In addition to treatment, prevention against future acne breakouts are also crucial. Diet and proper skincare are also important factors in contributing to one’s acne condition. Therefore, holistic counselling with specific advice about how to manage your condition is important.
For mild to moderate acne, you may consider over the counter dermatologist formulated cosmeceuticals such as the Anti-Acne Bundle here.
2. Use hair regrowth products
Originally prescribed only in my dermatologist practice, the Copper Peptide Hair Regrowth Serum uniquely contains Copper tripeptide, a novel molecule that stimulates hair growth. Clinically proven to have similar efficacy to that of 5% minoxidil, stimulating growth without irritation side effects or toxicity. Studies show collagen production is increased, strengthening existing hair and thickening the hair shaft.
In conjunction with the hair serum, one can consider cosmetic camouflage for a quick fix. I often recommend the Kerabuilt Follicle Hair Fibres, integrated with Biomimetic Hair Technology for natural-looking, instant results. In addition, it is chemical-free and hypoallergenic, recommended even for those with hair loss and sensitive scalps.
In my dermatology practice, almost all patients suffering from hair loss had also done their due research online about possible causes of hair loss before seeing me. The real problem though, medical websites are not written for the layperson and the lists of diagnoses of conditions that lead to hair loss simply leave the hair loss sufferer worried and fearful. Those that do their research on forums and beauty websites are none the wiser, as they suggest many non-evidenced backed methods of hair growth or causes of hair loss which is simply unscientific and wrong information.
There are many different causes of hair loss, which can occur at the same time or individually, and dermatologists are best positioned conduct a thorough history taking, medical evaluation/examination and may recommend blood tests and other tests before diagnosing the cause of hair loss. For some rare causes of hair loss, especially of what is termed scarring alopecia, a scalp biopsy, which is where samples of the scalp are taken for microscopic examination may be required.
3. Consult a dermatologist for scarring on the skin
Treatment of scars on one’s skin can be in the form of chemical peels or lasers, which can be both ablative and non-ablative. Your dermatologist will advise which treatment option is best suited for your skin. In the meantime, a good concealer consists of a colour corrector. Orange is well suited to conceal dark scars and pigmentation whereas green conceals redness. Follow up with a CC cream with cosmeceutical active ingredients to treat and conceal your blemishes at the same time – achieving an overall even complexion.
While acne is a common skin disease, it is often difficult to treat severe acne, like the nodulocystic form. Also known as cystic acne or nodular acne, such severe forms can cause significant damage to the skin and affect one’s self-esteem.
Is my acne mild or severe?
If you find that you have only one or two pimples appearing at a certain time of the month, it is considered physiological acne and it is mild. The occasional outbreak you experience is often resolved on its own.
However, if the original blackhead or whitehead becomes badly infected by surface bacteria that it triggers the skin’s inflammatory response, a cyst wall may form around the original site of inflammation.
How do I know if I have cystic acne?
Cystic acne, or nodular acne, are larger and more severe than the typical pimple. These nodules feel like stubborn, firm bumps under the skin and can last for months. You can get them on the face, neck, back, chests or shoulders.
What causes cystic acne?
Cystic acne develops from milder forms of acne. Oil and dead skin skins that clog the oil gland also traps bacteria within, causing inflammation. You may also be genetically disposed to developing cystic acne, if your parents had severe nodules, you are more likely to get it.
Hormones are also another major cause for cystic acne, which may explain why they can develop during puberty. Hormonal changes that take place during pregnancy can also trigger cystic acne.
What happens when your cystic acne is not treated?
Treatment of cystic acne can be challenging as topical treatment is usually less effective. If left untreated, your cystic acne may become a permanent scar. This can be painful, red and get secondarily infected over time. If the condition worsens, an abscess will develop, that is a collection of pus under the skin.
Do not squeeze or pick the pimple, as it introduces more bacteria to an already infected cyst. Extraction of the cyst with sharp objects by non-medical professionals should also be avoided, as they are not safe and sterilized in a medical environment. Doing so only introduces potential for bacteria to affect you, even if you are not acne prone.
For example, we have been referred patients who had what started as an ordinary pimple, infected by a rare infection known as atypical mycobacteria. The bacteria originated from tap water with use of an unsterilized instrument by a facialist, leading to granulomatous infection of the skin and led to a sequence of biopsies as well as several months of oral antibiotics for treatment.
How should you treat cystic acne?
When you develop a single bump that becomes large and painful, it is a sign that your acne may be severe. If the acne does not disappear after a maximum of 2 months, it is unlikely that it is just normal physiological acne. This warrants medical treatment before the cystic acne worsens. Over-the-counter acne treatments are less effective against cystic acne and it is best to visit an accredited dermatologist as soon as possible.
Under the care of a dermatologist for assessment, one would expect an injection of triamcinolone, a steroid that can reduce swelling and inflammation, leading to the resolution of the cyst wall.
Another common therapy is oral isotretinoin, known for its efficacy for cystic acne. Severe acne tends to be unresponsive to drugs such as oral tetracycline or topical adapalene/benzoyl peroxide. It helps to fight acne by reducing the size and activity of your oil glands and reducing acne-causing bacteria. However, isotretinoin also has side effects, limiting its usefulness for certain patients. Side effects include liver damage, depression, behavioural change and risk of causing serious birth defects. Isotretinoin can also make your skin feel very dry. Your eyes will also feel drier than normal.
Cosmeceuticals should also be used in tandem with oral medications. Use moisturizers regularly, such as Multi-CERAM™ Moisturizerfor a healthy and hydrated skin barrier. Vitamin Cserums have anti-acne abilities and help to accelerate healing scars. An anti-bacterial cleanser is also essential to allow a thorough cleanse, consider a gentle cleanser such as Miel Honey™ Cleanser.
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 photodamage, acne and vitamin A deficiency.
Excessive sebum production from pores
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 from pores
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.
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.
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.
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.
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.
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 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.
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.
Infusion of potent serums
In a medifacial, topical infusion 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 radiationafterwards.
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 seeing 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. There is either seeing 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. 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 minimum 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. Seeing a dermatologists also entails treatment 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. This is so that they are not misled to believe that they are seeing a dermatologist, a skin or an aesthetic specialist when they are seeing a general practitioner.
2. Seeing a Dermatologist or an Aesthetic Doctor (General practitioners) offers the same treatments?
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 seeing a dermatologist specialist.
3. Tell me about an example where it mattered seeing a 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. This is 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. Acne in such a circumstance 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, seeing a dermatologist could 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 and without seeing a dermatologist, it could spread and lead to severe infections and scarring.
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.