Tag Archive: Sensitive Skin

Sensitive Skin & Eczema Product – 5 Quick Questions Answered

February 3, 2020

Sensitive skin is typically characterized by dryness, flaking, sensations of stinging and itching associated with skin redness. It is actually a form of dermatitis otherwise known as eczema. I see a large number of patients who come in with complaints of persistent sensitive skin. What they often do not realise is that it is a form of eczema. Eczema can be caused by genetic factors and also external factors such as a change in environment and climate, presence of pollen, animal fur and dust. In this article, I shall share a few tips that I usually expound on with my patients and hopefully shed some light on this condition.

Eczema Dermatologist Dr Teo Wan Lin
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of  “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare”  which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she tells us the science behind sensitive skin – a form of eczema.

What causes eczema? 

Eczema  is due to a defect in the skin barrier. The skin is best characterized by a brick and mortar model whereby the bricks of the skin cells are joined together by this cement which holds the skin cells together. People who have sensitive skin or eczema actually have defective ceramide which is the cement of the brick wall which is the skin. This is genetically determined and people who develop eczema in the later part of their lives can also have their condition triggered off by environmental factors such as differences in humidity from dry to humid weather and vice versa. The use of harsh cleansers can also cause eczema to develop over one’s lifetime. 

Does ageing cause eczema? 

With regards to the development of sensitive skin with age, the same concept of our body’s organ degenerating with age, our skin also degenerates. The main thing is the quality and quantity of ceramide which is produced throughout one’s lifetime decreases with age. On that note, skin can become more sensitive with age.

What should I look out for in sensitive skin products? 

 The ingredients that are essential for sensitive skin would be a moisturizer and a gentle cleanser. A gentle cleanser such as one that is formulated with minimal laureate sulfate content, which is the foaming component of a cleanser, would be beneficial for a patient who suffers from skin sensitivity. In addition, the use of a ceramide-containing moisturizer is essential. Traditional moisturizers contain humectants such as glycerine which trap water under the skin. Increasing research in dermatology shows that one should be replacing the defective and deficient ceramide content in the skin barrier by applying ceramide rich moisturizers. More information on using Dr.TWL’s Multi-CERAM Moisturizer for eczema treatment can be found here.

Dr.TWL Multi-CERAM Moisturizer is an ultra intensive skin moisturiser for total skin barrier repair with pharmaceutical grade ingredients. It contains phytoceramides which aids in skin barrier repair and multi-ceramide which aids in skin lipid restoration.
Dr.TWL Honey Cleanser is a blend of nature-derived emulsifiers. It is anti-flaking and supples skin. It is also recommended for all skin types as it is a gentle cleanser.

Where is ceramide from? 

Sources of ceramide can be plant-derived, synthetic or from animals. Bovine ceramide is the typical source of ceramide used in moisturizers. Plant-derived ceramides which are phytoceramides is what I use in my practice. It contains these lipids which are extracted from plant seed oils.

Dr.TWL Radiance Fluide Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. It is specially formulated for a light-weight feel to impart a radiant glow without make-up. It also contains ceramide and grape seed oil, perfect for individuals with eczema and sensitive skin.

What ingredients should I avoid if I have sensitive skin? 

The ingredients that one should avoid when you have sensitive skin will be things like astringents, so any alcohol-based gel, toners or lotions should be avoided because these tend to dry up the skin further. In addition, irritating ingredients such as alpha hydroxy acids and salicylic acids are commonly used for the treatment of acne as well as for skin exfoliation, these will definitely trigger off skin sensitivity.

© 2020 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.

Combination Skin: Best Dermatologist Care Tips

January 7, 2020

Have you noticed that some parts of your skin are dry while other parts are oily? This is known as combination skin. Combination skin is characterized by an oily T-zone while the cheeks are either normal or dry. How to tell if you have combination skin? Wash your face with your normal cleanser, then wait an hour. If your T-zone is oily whereas your cheeks are either normal or dry, you have combination skin.

Combination skin is thought to be one of the most common skin types. When it comes to skincare routines, hydrating creams are too hydrating, oil-absorbing masks are too absorbing, balancing lotions never seem to do much balancing… It can be tricky to figure out how to care for your skin properly.

Singapore Dermatologist on Combination Skin
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of  “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare”  which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she tells us the science behind combination skin – skin that is both dry and oily.

Skin that is both dry and oily boils down to an underlying pathology of the skin which is much more common in acne-prone individuals is known as seborrhea, which is overactivity of the oil gland. It is part of the causes of teenage and adult acne. Even when you have seborrhea, it is possible for you to have a deficiency in the ceramide content of your skin barrier leading to dry skin.

The production of ceramide is genetically determined. You could have inherited both the genes for oily skin as well as dry skin. The commoner scenario we see would be someone with acne and oily skin who started using over the counter medication such as those that contain retinol or benzoyl peroxide and these will break down the skin barrier and it can result in the skin being dry, sensitive and acne-prone.

Individuals with combination skin often have breakouts over the greasy T-zone area. This can be exacerbated, in the case of some women, especially during the time of their monthly menstrual cycles. On the other hand, their cheek areas can be very dry and when they travel, especially when there is a change in climate, these areas can become dry, flaky and sensitive especially if they are using skincare that is slightly harsher on their skin.

The recommended skincare routine for combination skin should address both the oiliness of the T-zone, which can sometimes get quite uncomfortable especially in a humid climate like Singapore, as well as the potential dryness that may occur over the cheek areas. An important thing to note would be a gentle emulsifying cleanser is recommended for combination skin such as the Honey Cleanser.

Honey itself is a natural emulsifier which means it produces foam without the need for strong chemical lathering agents such as the laureth sulfates. At the same time, it is a natural humectant which means that it traps moisture under the skin. As a result, it helps to balance out the production of sebum without over-stripping the skin of its natural oils.

Combination Skin Care Cosmeceuticals
From left to right: Hyaluronic Acid SerumVitamin C Serum, Radiance Fluide Hydrating Emulsion, Milk Cleanser, Honey Cleanser, SunProtector, Elixir-V Eyes, Mineral BoosterElixir-V Serum

Individuals with combination skin should focus on using hydrating serums such as Hyaluronic Acid Serum, Vitamin C Serum and Elixir-V Serum as these contain cosmeceutical active ingredients which function as treatment over their T-zone to regulate oil production.

Also, use hydrating emulsions rather than creams, the former is an oil in water mixture rather than a pure cream formula. This helps to moisturize the skin without the cream becoming too thick or greasy. Finally, the excess grease over the T-zone can be addressed with the use of blotting papers (such as those infused with active ingredients like cannabis sativa). These blotting papers are infused with cannabis sativa, an extract of the hemp plant which helps to moisturize the skin and regulate oil production, at the same time physically removing excess grease over the T-zone. One should follow with a hydrating mist such as the Mineral Booster which helps to regulate the skin barrier.

© 2020 TWL Specialist Skin and Laser Centre. All rights reserved.

Cosmeceutical Makeup – Dermatologist Recommended Concealers for Anti-Ageing

November 9, 2019
 

Custom beauty? You have probably heard this term recently, with the launch of multiple custom skincare lines. Fresh off the press for us at Dr.TWL Dermaceuticals though, is our new division of Custom Cosmeceutical Makeup. Read on in the first of a 2-part interview with our founder, accredited dermatologist Dr. Teo Wan Lin

 
What was the inspiration behind the Pi- π Cosmeceutical Custom Makeup Lab? Check out this interview with our founder Dr. Teo Wan Lin to find out more.
Dr.TWL Dream Concealer comes in a range of colours including peach, pink, green, lilac, and orange to correct underlying skin concerns.
Dr.TWL Dream Concealer in various colors to correct skin concerns.

What is the Pi-π Cosmeceutical Custom Makeup Lab about?

ThePi- π Cosmeceutical Custom Makeup Lab offers scientifically created skin-tone matched cosmeceutical makeup, including colour correction concealers, as an extension of my established skincare arm, Dr.TWL Dermaceuticals. Our Flagship offering includes an in-house Dr.TWL Lip Lab which features a 100% edible, anti-ageing cosmeceutical, the LipSerum Stick™, which is a solid state lipstick customised to any shade you want! Our advanced colour science system recommends different shades of each color- pinks, berrys, reds, nudes and corals that would uniquely flatter different skin tones.

Why does makeup— including concealers, foundations, lipsticks— need to be customised? Why not a generic “works for all” product, like most mass produced brands?

Why a generic “works for all” product is not ideal for makeup is because of the variety and uniqueness of skin tones. Every individual’s skin tones is different—based on our scientific database, we have on record at least 100 shades of distinct skin tones, whereas most makeup brands have at most 6 or 7 colour shades for foundations and concealers. This variation in skin tones translates into different shades of each lipstick colour that would work ideally for each individual.

What are the advantages of the LipSerum Stick, compared to store bought lipsticks, other than the fact it can be customised to any colour?

Store bought lipsticks cause allergies in individuals with existing lip conditions like eczema and cheilitis. The lips are also one of the first areas to suffer ageing related concerns such as lip discolouration, wrinkles and loss of volume. I then came up with the idea of a topically applied lip cosmeceutical serum with anti-ageing salmon roe DNA, which is also suitable for eczema sufferers, that could also be customised with your favourite lip pigment.

What are the limitations of traditional lipstick selections?

Lipstick brands have a limited selection of colours. Everyone has a favourite colour for a different mood—pinks, berrys, reds, nudes and corals— but did you know that different shades of each can be created to flatter different skin tones? We worked with veteran makeup artists and scientist to create the Dr.TWL Advanced Colour Science System to recommend the perfect lip colour match for each skin tone, whether you want it classic, sweet, sexy or nude.

What’s so unique about this custom makeup lab? Is it just custom blend makeup?

It’s the first dermatologist-led custom makeup laboratory in the world which fuses both skincare and makeup, via the use of cosmeceutical bases and unlimited variations of colours for foundationsconcealerscolour correctors to match every skin tone, via our Advanced Colour Science System developed by our team of scientists, in consultation with veteran makeup artists. It’s not just custom blended for you, it’s cosmeceutical base is adjusted to target underlying skin conditions such as pigmentation, blemishes and ageing.

What was your inspiration for the Custom Cosmeceutical Makeup Lab?

My patients who I treat for a variety of skin conditions such as acnepigmentationrosacea, eczema and sensitive skin. There is a lack of sensitive-skin compatible makeup for these patients who need coverage and camouflage during the skin healing process. Besides, Singapore has a diverse ethnic mix which includes darker skin tones that many makeup brands do not cater for. I treat a lot of darker skin toned patients in my practice who cannot find their perfect foundation/concealer match.

What were some of the problems with the mass market makeup products that you faced?

Previously, I would recommend patients with sensitive skin/eczema issues to use pure mineral makeup, which has the lowest risk for causing skin irritation and allergies, as pure mineral pigments are chemically stable/inert with no reactions. However, I soon realised that the these commercial brands also had additives such as bismuth oxychloride and talc which function as bulking agents, and these were irritating to skin, with some even reporting that they felt the texture was that of “cut glass”!
 
Here’s how to get your hands on our custom cosmeceutical makeup. By online appointment booking at https://drtwlderma.com/customised-lip-lab-experience/ to be guaranteed of no-wait time. Our on-site Custom Cosmeceutical Makeup Lab is located as part of my dermatology practice — TWL Specialist Skin & Laser Centre at Royal Square Novena Medical Suites.
 
Both the Dream Concealer Colour Correctors and LipSerum Stick™ can be purchased ready to wear or via full customisation appointment. Our website is fully integrated with our online Magic Mirror tool which allows one to try on your chosen lip colour wherever you are.

© 2019 TWL Specialist Skin & Laser Centre. All rights reserved.

Eczema Management with Best Ceramide Moisturisers

September 21, 2019

In patients with Eczema, there is an inherent defect of the epidermal barrier of the skin. When this barrier is compromised, bacteria and allergens are able to enter and thus there is an increased risk of secondary infections, which, in turn, can lead to aggravation of eczematous symptoms. It is believed that the best way to manage eczema is to repair the skin barrier or prevent its dysfunction, in which ceramide moisturisers play a critical role.

According to accredited dermatologist Dr Teo Wan Lin  who is an expert on sensitive skin and eczema, “I formulated the Dr Twl Dermaceuticals Multi-CERAM™ Moisturiser after years of prescribing other brands of ceramide moisturisers which I found did not meet the underground clinical needs of patients, at a competitive price point. The high cost of manufacturing ceramide moisturisers lies in its reliance on synthetic sources of ceramide as well as bovine (cow derived) ceramide.”

“In the Dr Twl Dermaceuticals Multi-CERAM™ Moisturiser, which is very competitively priced with a high ceramide content, the novel focus and dermatological concept is on using multiple sources of ceramide for total skin lipid restoration, rather than just relying solely on the expensive synthetic and animal derived ceramide which results in low concentrations of ceramide being used in other ceramide moisturisers, or high price point which is prohibitive.

In the Multi-CERAM™ Moisturiser, phytoceramides are used — these are plant seed oil derived sources of ceramide that directly repair the skin barrier. This is in addition to containing plant anti-oxidants which incidentally combat cellulite, large amounts of glycerin which functions as a humectant, preventing trans-epidermal water loss, as well as Sodium Hyaluronate (Hyaluronic acid), a natural component of the skin, for dermal hydration,” Dr. Teo says.

Eczema Skin

What are Ceramides?

Ceramides are lipids that are naturally found in the intercellular “mortar” within the outer layer of s the statue corneum. They make up 40-50% of the lipid component of the lamellar lipids and are integral to the function of the epidermal barrier. 

In patients with psoriasis, eczema and other dry skin conditions, reduced levels of Ceramides are observed. 

Ceramide Moisturiser for Eczema Skin
Eczema Skin Needing Ceramides

The stratum corneum is comprised of corneocytes compressed within a lipid bilayer, which is made up of 40-45% Ceramides, 25% Cholesterol & 10-15% Free Fatty Acids. If incorporated in the wrong ratio, barrier repair may be impeded. These 3 major components of the stratum corneum bind the protein-rich corneocytes into a water impermeable protective barrier. A deficiency in Ceramides results in excessive transepidermal water loss, dry skin and increased permeability to environmental irritants, allergens and microorganisms. Thus, reduced levels of Ceramides is associated with dermatological disorders such as atopic dermatitis. 

Studies show that if topical ceramides is applied in the correct ratio with cholesterol and free fatty acids, it can help to improve the epidermal barrier in people with Atopic Dermatitis (AD), thereby reinforcing barrier function. Therefore, ceramide moisturisers and cleansers have been proven to provide substantial relief from the symptoms of eczema. 

Ceramide Dominant PED for Eczema

In order for ceramide-containing products to have a positive effect on the skin barrier function, ceramides should be present abundantly in an optimal ratio with other barrier repair ingredients. Our Multi-CERAM Moisturiser is uniquely formulated to ensure the delivery of an optimal ceramide, cholesterol and free fatty acid ratio. In fact, this moisturiser is formulated as a Prescription Emollient Device (PED), the gold standard in eczema management – Eichenfield et al. (2014) [on PubMed], and also the optimal moisturer for barrier protection against maskne – Teo (2020) [on PubMed].

By restoring healthy barrier function, the Dr. TWL Dermaceuticals Multi-CERAM Moisturiser helps to support ceramide synthesis and further augmenting skin barrier repair and skin health in general.

Ceramide Moisturiser

The Multi-CERAM™ Ceramide Moisturiser is uniquely formulated treat Eczema using: 

  • Ceramide 1 (EOP) which is significantly deficient in eczema patients and Ceramide 3 (NP) which is linked to the transepidermal water loss experienced in eczema patients. 
  • Phytoceramides which aids the repair of skin barrier 
  • Sodium Hyaluronate for skin hydration
  • Ceramide complex (ceramides, cholesterol & FFA) which delivers ceramides topically in optimal ratios to aid in the reinforcement of the recovery of the skin barrier. 

Management for patients with Eczema 

A daily maintenance routine is vital. One of the main changes in eczema is a disruption and reduction in the layers of corneocytes in the stratum corneum. When the stratum corneum is well hydrated, it swells, allowing increased permeability of topical formulations. The key to managing eczema is through the regular use of a ceramide moisturiser with high ceramide content after showering or washing hands. 

Successful management requires a holistic approach:

1. Avoid triggering factors 
2. Maintain skin care through regular use of a moisturiser and a moisturising cleanser 
3. Pharmacotherapy during acute exacerbations
4. Compliance of skin care products suggested by a dermatologist

Find out more about eczema by clicking here.

A Singapore Dermatologist Talks: Enhancing Skin Absorption of Cosmeceuticals

August 21, 2019

by: Dr. Teo Wan Lin

In my previous articles, I have talked about cosmeceuticals and the importance of incorporating them in our daily routines. However, how do we enhance the skin absorption of these cosmeceuticals? Here I will be talking about the limitations of topical formulations and how we can overcome them to ultimately achieve the results that we desire.

 

The problem with topical formulations for your skin

 

 

The outermost layer of the skin, called the stratum corneum, acts as a natural barrier. It prevents foreign material from entering our system, shields us against environmental factors and prevents excessive water loss. The skin is a formidable barrier to the passage of substances into and out of the body, but it can be manipulated to allow it to become a viable pathway for drug administration.

Drug products applied to the skin’s surface penetrate the skin layers to a certain extent, where they can exert their effects. This is the case for topical formulations for treatment of skin disorders such as acne, dermatitis, and psoriasis. However, very few drugs are suitable for delivery by the topical route, as passive penetration through the skin is limited to very small molecules (<500Da), which are neutral and relatively lipophilic. Some considerations of dermatologists would be the vehicle of the topical, specifically if it is in a lotion, cream or ointment form, in increasing order of absorption and effectiveness. This however, is often limited by user preferences, with ointment formulas (more efficacious) deemed cosmetically less acceptable.

The skin is the largest organ of the human body, comprising 15% of body weight and therefore its use to deliver medicine to the body is not a new concept by any means. Advancements made by modern science are improving the skin’s potential as a route for drug administration. Dermatologists are at the forefront of research relating to transdermal drug delivery, given the unique accessibility of the largest organ of the body.

Owing to the drawbacks of topical formulations, transdermal patches have been developed to improve drug delivery through the skin and this is an area that my team has actively researched in the last year as an adjunct to our cosmeceutical formulations.

I have always been interested in finding new methods to allow my patients to achieve optimal results from our cosmeceuticals, thus in this article I shall share some tools which I employ in my clinical practice to achieve optimal absorption of cosmeceutical active ingredients.

Wet Wrap/Occlusion Skin Therapy & Facial Masks

A well known method employed by dermatologists to treat severe eczema known as wet wrap is actually a simple process involving applying a wet textile together with topical medications to skin, to increase absorption of skincare. An example of how and when wet wraps are used— during particularly intense eczema flares with severe itch or pain, wet wrap therapy rehydrates and enhances the absorption of topical medications applied on the skin. The fabric wraps are soaked in water and applied to the affected skin on the body. Wet wraps are best done after bathing, moisturising and applying topicals, then left overnight.

Wet wraps work via 3 different ways:

●  Cooling — as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness

●  Moisturising — cosmeceuticals covered over with wet bandages are deeply absorbed in to the skin to provide a longer-lasting moisturising effect

●  Absorption — enhanced absorption of any topicals into both the superficial and deeper layers of skin where inflammation is present

Facial sheet masks work in a similar way, on the basis of occlusion. This means that when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. In my practice, whenever I want to increase absorption of cosmeceuticals and moisturisers that are dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.

I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture and clinically active ingredients to the skin—so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as evidence-based antioxidants for anti-ageing such as oligopeptides, vitamin C ( I use sodium ascorbyl phosphate which is a neutral, rather than acidic form of vitamin C, that has minimal skin irritation). Here’s a tip, use a cosmeceutical moisturiser like the Radiance Fluide™ and increase your skin’s absorption by applying it on damp skin, plus a soft wet cotton towel over it.

Facial Massage

 

Performing a facial massage, such as with the aid of a facial roller before application of cosmeceuticals could increase the skincare absorption, leading to better effects of the anti- aging skincare. Local massage is an established treatment method of improving surgical scars, by stimulating blood flow and improving wound healing. A peer-reviewed study published in a medical journal Complementary Therapies in Medicine led by author Miyaji Akane at the Institute for Liberal Arts, Tokyo Institute of Technology (Tokyo Tech) and colleagues at Tokyo Healthcare University and the Research and Development Center, MTG Co. Ltd. in 2019 had examined the effects of using a facial roller on facial skin and blood flow. The study concluded that there was significantly increased vascular (blood vessel) dilation with use of the facial massage roller. This means that there will be increased absorption of any cosmeceuticals applied on the face following the massage.

My recommendation would be manual rather than electric facial rollers as the latter may cause excessive pressure and irritation (being automated) and is also dependent on user training as well as the manufacturer’s settings, with a potential risk of overheating of electric components. Manual facial massage is a self-regulated process as the user can immediately sense irritation and apply just the right amount of pressure.

Transdermal delivery

Transdermal medications (usually in the form of a patch) are a little more modern and complex. Great strides in transdermal drug delivery have been made since the first transdermal drug was approved by the FDA in 1979.

Transdermal drugs bring medication through the skin, to the bloodstream. Once in the bloodstream, the ingredients circulate and take effect at a targeted location. Medication is delivered steadily and can be stopped simply by removing the patch. Since your body doesn’t have to digest the medicine through the stomach, a higher concentration reaches the bloodstream. The medication permeates the skin in a controlled fashion thus attaining more ready levels of the drug in the body.

The science behind polymers and transdermal drug delivery systems

Polymers are vital in a transdermal drug delivery system. Systems for transdermal delivery are assembled as a multilayered polymeric laminates consisting of a drug reservoir sandwiched in between 2 polymeric layers:

● An outer impervious backing — prevents the loss of drug

● An inner polymeric layer — functions as an adhesive and rate-controlling membrane There are 3 types of transdermal drug delivery systems:

● Reservoir systems

In this system, the drug reservoir is embedded between a backing layer and a rate-controlling membrane.

● Matrix Systems

In this system, the drug reservoir is either dispersed in an adhesive polymer or in a hydrophilic or lipophilic polymer matrix.

● Micro-reservoir Systems

This system is a combination of the above 2 systems. The drug reservoir is formed by suspending the drug in an aqueous solution and then dispersing the solution in a lipophilic polymer to form thousands of microscopic spheres of drug reservoirs.

Polymers used in transdermal delivery systems should have biocompatibility with the drug and other components of the system. They should also provide consistent, effective delivery of a drug throughout the product’s intended shelf life.

An example of a common polymer used are silicones, also known as polysiloxanes, made of many repeating units of siloxanes. Siloxanes are chains of alternating silicon and oxygen atoms that are often combined with carbon and/or hydrogen.
Medical grade silicones are silicones that undergo specific testing for their biocompatibility and have been deemed appropriate to be used for medical applications. Topical silicone therapy is often used by plastic surgeons and dermatologists to treat and heal scars.

Key considerations of a polymer patch used for transdermal drug delivery would be —conformability of the material to be applied to irregular skin or scar surfaces, sensitive regions such as the face/eye area and the overall durability and biocompatibility of medical grade polymers.

The process of skin ageing relates to the ability of the body’s natural healing processes. The same cells which are activated during cell injury are the ones which lose function with ageing, and are responsible for loss of collagen, elastin and the overall loss of volume and elasticity of skin. Specifically, antiageing cosmeceuticals target and stimulate cells known as fibroblasts, which are best thought of as the “soldiers” of wound healing which produce collagen to seal up injured or damaged skin. Injury to the skin occurs over a gradual process in the case of ageing, due to the slowing of one’s biological clock and photodamage.

For the last year, my team and I worked with a material scientist to develop a transdermal delivery patch, the QRASER™ Transdermal absorption patch, launched in July 2019. This patch works via a matrix system of drug delivery. In this system, the drug reservoir is dispersed in an adhesive polymer matrix. The transdermal delivery patch uses a unique polymer technology that mimics the natural hydration and homeostasis of the skin barrier, to enhance cosmeceutical absorption. The focus is on improving absorption via optimisation of the skin healing microenvironment.

The result? Healthy collagen production thus reducing fine lines and wrinkles.

In conclusion, cosmeceuticals in the arena of dermatologist-led skincare research will be increasingly prominent in the next decade of “smart skincare”. This should be emphasised along with understanding of how these topicals work, the limitations of skincare absorption and potential technologies such as transdermal delivery patches which can optimise the anti-ageing benefits of cosmeceutical skincare.

Dr. Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, is one of Singapore’s prominent dermatologists specialising in medical and aesthetic dermatology. She is also the founder of Dr.TWL Dermaceuticals which specialised in cosmeceutical skincare. In July 2019, a material science arm Dr.TWL Biomaterials was launched focusing on novel biomaterials for skin and hair application. Click here for the links to our product and here to read more about Dr.TWL Dermaceuticals and here to read more about Dr.TWL Biomaterials.

Footnote:

TWL Specialist Skin and Laser Centre grants parties a limited license to use and/or republish this article on for any legitimate media purpose, provided that you:

(1) reference TWL Specialist Skin and Laser Centre as the source and include a hyperlink to the original release on the company website; (2) do not modify any press release wording; and (3) do not modify or add hyperlinks, including but not limited to ad links, within the press release.

Under-Eye Skincare: Are Sunscreens Necessary? 5 profound facts from a dermatologist

April 30, 2019

It is not necessary to use a specific sunscreen dedicated to the under-eye area if the sunscreen you’re using is already a medical grade sunscreen that has been dermatologist-tested and ophthalmologist-tested. Nevertheless, sunscreen should not be applied too close to the eye area such as the lid margin because the very nature of effective sunscreens means that it would contain chemical and physical components that may be irritating to the eye.

If you are worried about sun exposure to skin around the eyes, you may consider using the SunProtector™, a lightweight soothing sunscreen that is dermatologist-tested and formulated to be suitable for use on the entire face including the under eye area.

1. The question remains: Why does the under eye area require extra protection?

The difference between the under-eye area and the rest of the skin is that the under-eye area has much more delicate and thinner skin. This explains why we tend to get dark eye circles from those areas, which is due to genetic factors such as the blood vessels being seen much more prominently in areas of thin skin.

In addition, with certain practices such as applying eye makeup over many years as well as wearing contact lenses, the process of dragging and pulling the areas of skin around the eye can make it much more susceptible to wrinkling and laxity. Natural facial expressions, such as smiling can also cause natural creases at the periorbital area, known as crow’s feet, or when one is laughing in the area near the nose known as bunny lines.

It is much more necessary to eliminate bad practices in handling of the skin around the eye area, and to advocate good eye moisturising and antioxidants in the form of a cosmeceutical eye cream and daily sun protection. One eye cream product you may opt for is the Elixir-VTM Eyes, which is a dermatologist-formulated eye cream that targets regeneration and repair of skin around the eye area with pharmaceutical-grade bioactive ingredients.

Also, as a tip, use your ring finger instead of the index finger to apply any sort of eye cream or makeup, in order to avoid exerting repeated high pressure (from the index finger) over the delicate eye area, which drags down the skin and may cause or worsen eye bags and wrinkles. More importantly, to fight aging effects on the skin and in general, one should have an overall healthy lifestyle, with frequent exercise, adequate sleep, a diet filled with antioxidants, reduced alcohol intake and should stop smoking habits.

2. If someone were to look for additional protection for the under-eye area, would an under-eye sunscreen benefit in any way?

The premise overall is that there is no need for a specific under eye sunscreen, other than a sunscreen that is formulated for the face and tested by a dermatologist in a laboratory environment. If one is to experience irritation with such sunscreens, it may help to look for a pure physical sunblock made up of Zinc Oxide and Titanium Dioxide, rather than chemical sunscreen components. Physical sunblock components tend to be less irritating although conferring less broad spectrum protection compared with one that is a combination of physical and chemical components.

It is more important that one re-applies sunscreen regularly, rather than to apply an additional type of sunscreen. This is because layering different sunscreens one on top of the other does not increase the efficacy beyond the time period that the sunscreen is effective for. Conventional wisdom is to reapply sunscreen every 3 to 4 hours, especially when outdoors. However, there are many aspects to aging around the eye area and one of the reasons is actually not due to sun exposure. Rather, due to the fact that skin around the eye area is much more delicate, hence more prone to daily tugging for example for people who wear eye make-up and contact lens wearers.

For these individuals, it is much more advisable to use a good eye cream which can be applied both day and night, to moisturise the eye area and packed with antioxidants to reverse free-radical damage caused by sun exposure and environmental pollutants, and also to get adequate sleep at night. Having a pair of good sunglasses is also helpful to protect the cornea from UV damage.

3. Can exposure to the sun make the under-eye area more susceptible to dark spots or lead to other undesirable effects?

Under-eye Sunscreen Dermatologist Skincare

This is not a very realistic scenario as when someone has excessive exposure to sunlight, it happens over the entire face and is never just localized to one area. Someone who has extensive sun damage in their life will find that they are more prone to get pigmentation as well as dark spots as well as the entire face including the eye area.

It is far more common to notice such pigmentation at facial areas of more prominence such as the cheek bones rather than the under-eye or say the under the chin area which are relatively protected from sun due to the facial bone structure. In addition, if you have been undergoing treatments such as phototherapy for other skin conditions, it is always advisable to wear protective eyewear.

4. Will sunglasses work as well as an under-eye sunscreen would?

Sunglasses are a good way to block out UV radiation and it is a form of physical protection. It is advisable to wear sunglasses primarily within the context of preventing excessive harmful UV exposure to the eyes for example the cornea. At the same time, when one applies a good quality medical-grade sunscreen together with physical measures such as a broad-rimmed sun hat and a pair of sunglasses, the amount of UV exposure to the face as well as the under eye area can be reduced.

5. How can you take extra care of the under-eye area?

As mentioned, the eye is a very delicate area. It is well-said that the eyes are the windows to one’s soul and are very often the first feature that one notices. For someone who actively looks after their skin and does treatments such as lasers and peels, ageing in the eye area starts to become more obvious because these lasers and peels do not target the eye area and are often the top giveaway signs of a person’s age.

So it is indeed very important to take extra care of the eye area, where prevention is key as well as using a good eye cream. In terms of physical treatments that can be done for the eye area, you may consider treatments such as CO2 laser resurfacing, as well as plasma nitrogen treatment which is very safe and uses ionic plasma nitrogen to help to resurface and tighten skin around the eye area.

© 2019 TWL Specialist Skin and Laser Centre. All rights reserved.

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Meet with Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.

To book an appointment with Dr Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may book an appointment online by clicking here.

Organic Skincare – 7 Bold Truths by a Singapore Dermatologist

November 23, 2017

With the term “organic skincare” gaining popularity among the masses, I was recently asked, more than once by different people, what I felt were the benefits relating to organic skincare and why people should be using that. Perhaps my answers would surprise people but I feel that it is time the public gets a honest take on this topic by a dermatologist.

Let me first clarify my position, I am an accredited dermatologist and practice evidence-based medicine, whereby specialist recommendations are always made based on peer-reviewed journal publications or at least on an international consensus of the medical community. The terms “organic skincare”, “all-natural”, “chemical-free”, “pregnancy-safe” skincare are rampant in mass media these days, so I certainly don’t fault the lay person or even beauty writers who get the impression that this is the real thing.

In light of these, I seek to discuss “organic skincare” in this article. You will discover my choice of putting the term in parentheses and hopefully this will open your eyes to what the term really means, and does not, information only your dermatologist would tell you about . Without bias, I personally formulate a cosmeceutical skincare line myself as an adjunct to my cosmetic dermatology practice, with natural ingredients which are also evidence-based for anti-ageing and skin rejuvenation, but by the end of the article you will discover for yourself why I do not label any of the skincare as “organic”, and why “organic” is not exactly my key priority when it comes to skincare.

1. To a dermatologist, organic skincare does not exist

First and foremost, the term “organic skincare’’ itself is not regulated and from a dermatologist perspective, organic skincare does not exist as anything more than a marketing fad. Organic is a term relating to food or farming practices, and is applied correctly to vegetables or other crops which are grown without the use of chemical pesticides.

If organic skincare manufacturers are keeping to the above definition at all, what this should mean is that were plant derived ingredients are used in skincare, these are grown in a chemical pesticide-free environment. What would be surprising to the lay person is that neither the FDA or HSA (in Singapore) makes any provision in their regulation of cosmetics for labelling “organic skincare”. As such, any skincare label touting this would be responsible for their own definitions of such and the consumer should be wary of such claims and what it implies.

2. There are no specific benefits to skin of using an organic skincare brand

Contrary to popular belief, there are no specific dermatological advantages of using such a brand over any ordinary skincare. In fact, most of these eco-skincare brands often go untested and unquestioned as well. Often, these organic skincare brands boast plant or nature derived ingredients, without “preservatives” and parabens, also being touted as “home-made”. Despite the seemingly positive branding surrounding these skincare, the associated pitfalls are not different from any other cosmetic skincare — they all have the ability to cause irritation, or allergic reactions in individuals who are susceptible, such as those with sensitive skin i.e. atopic dermatitis.

3. An important factor to consider in anti aging skincare is the effectiveness measured by bioactivity of the active ingredients as well as the scientific literature surrounding it

Plant-derived ingredients, depending on the source and type, may have anti-oxidant or moisturising properties, but simply including it in the skincare does not guarantee that it is effective. Bioactivity has to be measured by a trained chemist or scientist, which is when the extract is carefully distilled or harvested from the plant in such a way that the effectiveness is proven in the laboratory and can be measured.

4. The safety of organic skincare is not guaranteed and could be even riskier than normal skincare with chemical preservatives

Brands touting “organic skincare”, especially when home-made, lack the stringent quality controls present in a laboratory setting, which is required for the formulation of dermatologist-grade cosmeceutical skincare. One real danger of certain types of “organic skincare”’ is that they are not regulated for safety, in terms of bacterial contamination. Preservatives such as parabens have gotten some bad press in recent years but the overall consensus in the dermatological community and by the FDA is that they are still regarded as safe and necessary to reduce bacterial growth in applied creams.

The lack of “preservatives” is again a questionable label because this means that something else should be added to the product to increase the shelf-life of such a product which is meant for public sale. If not, this product should state the expiry of within 2 weeks to a month maximum of opening, because bacterial contamination will set in and this will cause problems when applied to skin.

Furthermore, the current Singapore Health Sciences Authority — HSA requirements for cosmetic skincare distributed via public sale, requires that the production facility acquires a basic certificate of Good Manufacturing Practices (GMP) before it is allowed approval. Home-made formulas that are sold online or by individual proprietors are hence on a “at your own risk basis”. A

s a dermatologist, I do not recommend using any home-made or naturally derived products (from plants etc.) on a DIY basis because the irritation and allergy risk, i.e. phototoxic or photoallergic risks are high. Besides, the benefits of plant ingredients can only be harvested and extracted under a controlled laboratory setting with proper testing, as in the case with cosmeceutical skincare. Anything else, the public would be better off with a simple dermatologist-recommended pharmacy-brand moisturiser that is free from fragrances.

5. Problem-skin can’t be treated with ANY type of skincare but can be worsened with certain products

If you have problem skin, no amount of good skincare can treat medical skin conditions such as acne, eczema (dry sensitive skin) or rosacea (a condition that results in red flushed face with pimples). Such conditions require treatment with prescription medications and can be well controlled. These also do not disappear on their own so waiting to “outgrow” the condition, no matter what age you are at, is not a wise idea.

Also, avoid consulting the internet, or beauty forums as suggestions there are not based on medical evidence and could even result in worsening of the condition or create a new problem, such as skin irritation or allergies from these DIY remedies.

I have encountered patients who developed phototoxic or photoallergic reactions from citrus (lemon/ orange juices) applied to their skin. A common misconception is that these DIY home remedies are ‘’natural and organic” but from a dermatologist perspective, this is not true.

There are no skin benefits to applying lemon or orange juice such as vitamin C, which is only beneficial when one ingests it as a fruit or a juice. Topically applied vitamin C needs to be in a certain formulation, either ascorbic acid or Sodium Ascorbyl Phosphate — I incorporate a nano-formulated form of SAP in the cosmeceutical Vita C Gold which I prescribe in my practice for it to have brightening and anti-oxidant properties for skin.

Applying orange or lemon juice directly will simply result in skin irritation due to the acidic nature of these juices, worse still, some individuals may react to sunlight (UVA component) with the citrus component and develop a severe skin allergy that can result in scarring or pigmentation.

Organic skincare mask dermatologist singapore

6. Facials, organic or not, makes no difference to your acne-prone skin

The above also applies to skincare services (e.g. facials) similarly labeled with the “organic” term, that organic skincare does not offer any true differentiation from any ordinary cosmetic skincare. Similar to any individually-applied skincare products, it is pertinent to know what is in the products applied during facials and skincare services. As your skin absorbs whatever you apply on them, it is important to always read through the labels and ingredient list, conduct prior research and then a patch test on the inner part of your arm. This helps to prevent any form of skin allergy and sensitivity you might get from trying such new products.

Besides, most aestheticians and facialists use instruments such as extractors and needles which are not medically sterilised (i.e. autoclaved, there is a difference between a new clean needle vs a sterilised instrument). This may lead to infections and scarring, besides having absolutely no benefit in the treatment of acne. Acne is primarily a inflammatory process, worsened by hormones, genetics and oil production.

Treatment of acne by dermatologists involves addressing inflammation using oral or topical medications, as well controlling hormonal and oil production factors, via medications or certain cosmeceuticals. Comedonal extraction is only sometimes performed by dermatologists, as the preferred method of eliminating comedones is by the use of retinoids, which modulate the way skin turnovers, as well as with chemical peels whereby the top layer of skin dissolves with glycolic, lactic and salicylic acids, preventing the accumulation of keratin (read: dead skin cells) which can worsen comedonal acne.

7. Environmentally friendly? Perhaps. Skin-friendly, not necessarily

Most people think organic skincare are either eco-friendly, natural or vegan. Here’s the catch, they can and cannot be. Organic skincare products can have components which are organically farmed and also approved by the FDA (which simply means it does not contain toxic or banned ingredients), but having the HSA or FDA approval does not necessarily mean that these are effective or deliver significant benefits.

Organically farmed produce can be friendlier on the environment in general, as less pesticide use means less harmful release of chemicals to the environment which accumulates as waste and potentially harms wildlife. However, these can also come at a greater cost, and by no means does that translate into any real benefits when incorporated into skincare which is not consumed but applied.

In fact, organic skincare often boasts essential oils which can cause both allergic( in susceptible individuals) and irritant contact dermatitis( due to the concentration of most essential oils, it is not medically advisable to apply any type of essential oil directly to skin as it can result in a chemical burning type of reaction).

For truly beneficial skincare that has measurable scientific results, I would recommend using cosmeceuticals instead. Cosmeceuticals refer to skincare that is a combination of cosmetics and pharmeceuticals. They have drug-like benefits, such as improving appearance by means of its ability to affect the structure and function of the skin as recognised by dermatologists and research scientists. Read more about cosmeceuticals here.

For patients with otherwise healthy skin, whether they are in their twenties, thirties or beyond and who are interested in maintaining youthful skin in a cost-effective manner, I would suggest getting started on cosmeceuticals, and regular medical grade chemical peels supervised by a dermatologist, who would determine the concentration and type of acid suitable for your skin.

A chemical peel treatment is designed to improve the appearance of the skin by gently stimulating the top layer of skin cells (epidermis) by applying a solution composed of fruit derived acids such as alpha-hydroxy acids, glycolic acids, lactic and salicylic acids. This stimulates the skin to regenerate, smoothening out wrinkles.

Rounding up the discussion here, I hope readers have gained some insight on the labelling of skincare as “organic” and what that doesn’t mean. It is not a defined or regulated term in dermatology and can lead to great misconceptions by the public, in addition to brands riding on a fad which delivers no real benefits skin-wise. As a dermatologist, I am all for public education for skin health. Skin health is not about “aesthetics”, the skin is an organ of the body just like the heart, lungs and the liver, and these tend to degenerate due to genetics, age as well as poor lifestyle habits.

Healthy skin certainly looks good, but in the pursuit of beauty, one should always be wise, consult a dermatologist if you have a skin issue such as acne or skin sensitivity, rather than trying all sorts of products. While there is no miracle product that exists that can cure your skin woes, non-dermatologist-tested cosmetic skincare can worsen problem skin. If you have healthy skin and desire some radiance and want to preserve your youth, then go for cosmeceuticals, instead of ‘‘organic skincare” or any other type of skincare fad.

© 2017 Dr Teo Wan Lin. All rights reserved.

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Meet with Dr. Teo Wan Lin, consultant 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.

Dermatologist’s Guide to Atopic Dermatitis & Sensitive Skin

November 10, 2017
Dermatologist Treatment for Atopic Dermatitis Troubled Skin

Formerly known as Besnier prurigo, Eczema — also known as atopic dermatitis — is the most common form of dermatitis. It is categorised as a chronic, itchy skin condition. Eczema is less common in adults and more commonly affects 15–20% of children. It is almost impossible to predict whether the condition of one’s eczema will improve by itself or not in an individual.

Sensitive skin is a condition that persists life-long. In a meta-analysis of over 110,000 subjects, it was found that children who developed atopic dermatitis before the age of 2 had a much lower risk of persistent disease than those who developed eczema later in childhood or during adolescence. 20% of children with eczema still had persistent disease 8 years later. Fewer than 5% had persistent disease 20 years later.

Genetics in Atopic Dermatitis

Since ‘atopic tendency’ such as eczema, asthma and hay fever can be passed down through the family, knowing one’s own family history of asthma, eczema or hay fever is very useful in diagnosing atopic dermatitis in infants. The complex interaction between genetic and environmental factors causes and triggers atopic dermatitis. Defects in skin barrier function make the skin more susceptible to irritation by contact irritants such as soap, the weather, temperature and non-specific triggers.

The appearance of eczema varies from person to person. In acute eczema flares, inflamed, red, sometimes blistered and weepy patches are common. In between such eczema flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas. The appearance and feel of eczema varies from one’s ethnic origin, age, types of creams applies, the presence of infection or an additional skin condition. However, there are some general patterns to where the eczema is found on the body according to the age of the affected person.

Atopic Dermatitis Changes with Age

Although eczema can manifest itself in older people for the first time, the onset of eczema is usually seen before a child turns two. It is widely distributed amongst infants less than one-year-old. It is unusual for an infant to be affected with atopic dermatitis before the age of four months. However, they may suffer from infantile seborrhoeic dermatitis or other rashes prior to this.

As infant’s tend to scratch at their itchy skin with their sharp baby nails, the appearance of eczema in infants tend to be usually scaly, dry, and red. The signs of eczema are physically first apparent on cheeks of infants. Due to the moisture retention of nappies, the appearance of eczema in the napkin area is frequently spared. However, just like other babies, if wet or soiled nappies are left on too long, they can develop irritant napkin dermatitis. Although, eczema is often worst between the ages of two and four it usually improves after four and it may clear altogether by the time one enters into teenhood.

As toddlers tend to scratch vigorously at their itchy skins, the appearance of their atopic dermatitis may look very raw and uncomfortable. As they start to move around, the dermatitis tends to become more thickened and localised. Body parts and areas such as the extensor aspects of joints, specifically the elbows, wrists, knees and ankles and even genitals are most commonly affected in this age group. This changes as the child grow older. The pattern frequently shifts from extensor aspects of the joints to the flexor surfaces of the same joints, such as creases. This is when the affected skin often becomes lichenified; thickened and dry from constant rubbing and scratching.

However, the extensor pattern of eczema persists into later childhood in some children. Older school-age children tend to develop a flexural pattern of eczema which commonly affects the elbow and knee creases and other susceptible areas such as the scalp, eyelids, earlobes, and neck. It is possible for school-age children to develop recurrent acute itchy blisters on their palms, fingers and sometimes on the feet, medically known as pompholyx or vesicular hand/foot atopic dermatitis

Many children in this age group tend to develop a ‘nummular’ pattern of atopic dermatitis. This refers to the appearance of small coin-like areas of eczema scattered over the body. Commonly mistaken for a fungal infection such as a ringworm, the appearance of these round patches of eczema are usually red, dry and itchy. Most of the eczema tends to improve during school years and it may completely clear up by the time they reach their teenage years. However it is important to note that the barrier function of the skin is never entirely normal.

The presence of atopic dermatitis in adults are varied in many ways. Despite having a possibility to have a diffused pattern of eczema, eczema in adults is usually more dry and lichenified compared to eczema in children. Eczema is adults are commonly persistent, localised, and possibly confined to the eyelids, nipples, flexure, and hands or all of these areas. Hand dermatitis in adult atopic tends to appear thickened, dry but may also be blistered at the same time. Infections such as staphylococcal infections are both recurrent and a prominent possibility. Occupational irritant contact dermatitis can trigger eczema. This most often affects hands that are regularly exposed to water, detergents and /or solvents.

As eczema can be triggered by physical, environmental and cosmetic factors, particular occupations such as hairdressing, farming, domestic duties, domestic and industrial cleaning and caregiving tend to expose the skin to various irritants and, sometimes, allergens, aggravating eczema. As it is easier to choose a more suitable occupation from the outset than to change it later, tt is wise to bear this in mind when considering career options. Having atopic dermatitis does not exclude contact allergic dermatitis (confirmed by patch tests in children and adults).

Treatments

  • It could take many months to years to treat eczema and treatments plans often includes:
    – Intermittent topical steroids
    – Reduction of exposure to trigger factors
    – Ceramide based moisturisers (such as the Multi-CERAM which helps restore healthy skin barrier function)
    – In some cases, management may also include one of more of the following:
    – Antibiotics
    – Antihistamines
    – Crisabarole ointment
    – Phototherapy
    – Topical calcineurin inhibitors, such as pimecrolimus cream or tacrolimus ointment
    – Oral corticosteroids
    – Longstanding and severe eczema may be treated with an immunosuppressive agent.
    – Azathioprine
    – Ciclosporin
    – Methotrexate
  • Clinical trials of biologics such as Dupilumab are promising cures for eczema.

© 2017 twlskin.com. All rights reserved.

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Meet with Dr. Teo Wan Lin, consultant 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.

Viral Warts Treatment — 7 Best Tips from a Dermatologist

October 17, 2017

If you’ve ever been struck with pesky viral warts over your palms or soles at least once in your life, you’ve probably been left wondering what caused it. Nope, it is no longer just a childhood infection, adults are increasingly attending my clinic with concerns about stubborn warts that don’t go away and are plain annoying. In this article, I share my experience with the common concerns of those of you who are troubled by viral warts.

1. What exactly are viral warts?

Warts, also known as verruca, are growths of the skin due to human papillomavirus (HPV) infection. Several subtypes are known, and they all look different. The initial infection occurs in the top layers of the skin, it reprogrammes the skin to cause excessive growth of the keratinocytes (skin cells), leading to thickening of the skin where the viral wart has started. The most common subtypes of HPV are types 2, 3, 4, 27, 29, and 57. Warts appear first like an area of hardened skin, and when one looks carefully, one may find tiny black dots centrally, which is due to thrombosed(or clotted) tiny blood vessels.

2. Who gets viral warts?

Warts are traditionally more commonly found in school-going children and teenagers but can affect people of any age group. People suffering from eczema, whereby their skin barrier is genetically defective, are also prone to getting viral wart infections from areas of broken skin. Those who are immune suppressed are at high risk of getting larger, persistent and multiple warts. These include patients who are pregnant, on medications such as azathioprine or ciclosporin, or with human immunodeficiency virus (HIV) infection.

Nevertheless, it’s perfectly normal to have a healthy young adult to suffer from viral warts as well, especially in areas of friction and contact, such as the palms and soles. The palms and soles of feet are subject to small cuts and wounds due to contact on a day to day basis. HPV virus, which is present on surfaces, then has the potential to infect the skin.

3. Is your gym giving you viral warts?

Moving on to the causes of viral warts. HPV is contagious and is most commonly spread by direct skin-to-skin contact. Another way it occurs is via scratching or picking warts, whereby the virus may be spread to other areas of uninfected skin. Common places where people pick up the wart virus are at public areas such as pools, bathrooms and gyms. Sharing footwear, slippers and shoes, walking barefoot and handling shared gym equipment that has not been properly disinfected. So yes, a good proportion of adults who visit dermatologists for treatment of their viral warts actually get it from shared gym equipment, especially when small cuts are present.

4. Do I need to see a dermatologist to diagnose viral warts?

Warts are common and have a typical appearance, with painful areas of hard skin, almost like a callus, and black dots centrally. While tests are usually not required to diagnosis viral warts, there are some cases whereby the appearance or the location of the wart is unusual, leading to a missed diagnosis of a potential skin cancer. In such cases, dermatologists usually would perform either a dermatoscopic examination or may recommend a skin biopsy to distinguish viral warts from other growths such as seborrhoeic keratosis and skin cancer. It may be necessary sometimes to perform a skin biopsy for diagnosis, especially to rule out rare infections( in people who are immunosuppressed) and also skin cancers.

5. When to get your wart treated by a dermatologist

Small warts which otherwise don’t hurt or bother in any way can sometimes be left alone. However, once you suspect you may have a wart, do get it checked out by a dermatologist rather than using DIY methods. I have seen several patients who have used corn plasters or DIY freeze kits bought online over their wart, which all became worse after their self-treatment. I do not recommend corn plasters as these typically contain salicylic acid which is a keratolytic, essentially dissolving the thicker layers of skin overlying the wart, often causing irritation and blistering, but does not actually treat the underlying viral wart.

Many end up with complications of skin infection. DIY freeze kits are not permitted legally in Singapore. However, I have had patients who purchased such kits online or overseas and ended up having severe blistering and infections, some even requiring drainage after that. The reason is that these freeze kits contain liquid nitrogen, which is meant to kill off the virus-infected skin cells and should be applied by a trained healthcare professional upon the direction and assessment of a dermatologist.

Importantly, there are variations of the appearance of viral warts as well, which may lead to misdiagnosis or delayed diagnosis. I have seen cases of squamous cell carcinoma, a potentially lethal form of skin cancer, for example, which had been undiagnosed because of an assumption that it was just a stubborn wart that would not go away.

6. How does wart treatment work?

The truth is, once you get a viral wart infection, the virus affects your skin’s DNA where it has infected, causing all new skin cells to be produced with the HPV virus. What that means is the treatment of viral warts is not like that of a skin growth or cyst, whereby cutting it out fully results in removal and a cure.

Viral warts are persistent because they are alive, and in order to eliminate the wart virus one has to rely on stimulating the body’s own immune system to overcome the wart virus. Hence, surgeries whereby the wart is excised does not work because the HPV virus replicates and would grow the wart again.

Viral Warts Treatment Virus Dermatologist
Illustration of Virus

The location of the wart, the morphology as well as the underlying health status of the patient affects the type of treatment chosen as well. There are subcategories of warts as follows which your dermatologist will diagnose you with:

Common warts and plantar warts are those commonly appearing over the palms and soles, with characteristic pinpoint black dots centrally due to clotted blood vessels, a result of the HPV virus infection. Plane warts as the name suggests, have a plane or a flat surface and are found over areas of the knuckles, the knees and the elbows. Another type known as filiform warts are protuberant with a thread-like elongated stalk and are common in areas such as the face. Mucosal warts affect areas such as the lips, inside the mouth and also the anal/genital region.

7. What treatments are available for viral warts?

First of all, make sure the growth you are dealing with is indeed a viral wart. From there, depending on the type of viral wart, your dermatologist will suggest one or a combination of the following.

Topical treatment

Use of topical treatment alone in the treatment of viral warts is uncommon and is usually used in combination with topical treatment i.e. creams, ointments and lotions formulated for wart treatment usually contain active ingredients such as salicylic acid. Salicylic acid is a keratolytic, which means it works by dissolving dead skin cells. Another anti-viral ingredient used is podophyllin, which destroys skin cells i.e. cytotoxic, but is prohibited in pregnancy.

Cryotherapy

Cryotherapy is the use of liquid nitrogen to freeze areas of infected skin. It is performed every one to two weeks. It is a safe and effective treatment except that it requires multiple sessions, with a success rate of about 60–70% for 3 months of regular treatments. It causes blistering and may subsequently leave a scar after treatment.

Electrosurgery and Laser Vaporisation

Electrosurgery and laser vaporisation would be used for larger or stubborn warts. Surgical paring is performed under local anaesthesia and the base of the wart is burned, destroying both healthy tissues together with the bulk of virus infected tissue. Wound healing is expected within two weeks generally. However, about 20%- 30% of warts do recur within a few months, although the rate of recurrence decreases with proper monitoring by a dermatologist.

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

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

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.

3 Questions About Sensitive Skin Answered By a Dermatologist

October 3, 2017

By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre

Many patients that come to me say: “I have super sensitive skin and I break out easily from using the wrong kinds of products.” However, from a dermatologist’s point of view, skincare or makeup alone (especially if labelled non-comedogenic like most brands on the market are) do not cause breakouts or pimples. These are instead signs of acne-prone skin, which is a medical condition that needs to be treated with prescription medication.

1. How Do I Know If I have Sensitive Skin?

Make a visit to an accredited dermatologist. They will usually ask you the following questions:

Do you suffer from symptoms such as skin redness, flaking, itch or stinging pain? Did you have eczema, asthma or sensitive nose when you were young, or have a family history of eczema or sensitive skin? Does your skin get red and itchy when you use makeup or skincare products, or when you are exposed to a dusty or sweaty environment? Does your skin act up when travelling to a cold or dry climate?

Dermatologists diagnose true “sensitive skin”, with a medical condition known as eczema, where common exposures to the environment or skincare and make up can trigger off flare-ups.

2. What Is Defined As Sensitive Skin Then?

People with sensitive skin are likely to have atopic dermatitis, which is a genetically determined condition where the skin is deficient in certain fats. The skin acts as a barrier to the environment and, without a proper functioning skin barrier, any dust, climate change, pet fur, or even emotional stress can trigger off a flare-up.

 If you have never had any of these symptoms and suddenly experience “sensitivity”, especially soon after using a new skincare or makeup product, it might actually be a form of allergic contact dermatitis to an applied substance. This would be best reviewed by a dermatologist who might suggest a patch test and also receive appropriate medical treatment.

Undiagnosed and untreated skin sensitivity can become chronic and may result in scarring such as post-inflammatory hyperpigmentation which results in dark marks on one’s face.

3. So What Is The Solution To Sensitive Skin ?

RADIANCÉ FLUIDE™ is dermatologically formulated for sensitive skin to provide moisture and hydration, providing a light-weight feel in the day for a radiant makeup base.

Your dermatologist will prescribe you anti-inflammatory creams such as topical steroids of the appropriate strength and ceramide-rich emollients that replenish the skin barrier. In the case of any infection, oral antibiotics to clear the skin infection would also be prescribed. Oral steroids may also be required for severe eczema.

Here are three of the best skincare tips for people with sensitive skin: 

1) Look for “dermatologically tested and formulated” labels that are produced in certified laboratories and that work with dermatologists rather than cosmetic brands.

2) Get your dermatologist to recommend a gentle cleanser formulated for effective cleansing of eczema-prone skin.

3) Get your sensitive skin treated first before using anti-ageing products
Many anti-ageing products contain stimulating ingredients which may worsen sensitive skin. If you do use them, look for a product that’s recommended by your dermatologist.

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

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Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.

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.