Tag Archive: Sensitive Skin

A Dermatologist Explains Under-Eye Care: Are Under-Eye Sunscreens Necessary?

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.

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 an 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.

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, as these 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, but 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.

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

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.

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.

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 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 organically-derived 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”, and as 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.

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.

Suffering from sensitive skin; eczema?

November 10, 2017

 

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 eczema 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.

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 Eczema. 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 if 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.

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 eczema 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 eczema may look very raw and uncomfortable. As they start to move around, eczema 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 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 eczema 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).

  • 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.

Skin Cancer Diagnostics by a Dermatologist

October 29, 2017

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What is dermoscopy?

Dermoscopy is a skin examination technique used to evaluate skin growths as well as pigmented skin lesions, without the need for surgery. The accuracy of the technique is dependent on the operator’s experience, and can help facilitate the diagnosis of potentially fatal skin cancers such as melanoma.

The use of dermoscopy involves advanced lens magnification together with an intense lighting structure incorporated in a portable handheld instrument known as a dermatoscope. This instrument reveals skin structures and patterns and can be attached to computers or smartphones for transmitting images.

Some techniques used in dermoscopic interpretation would include pigmentation colour and structure. In terms of colours, a trained dermatologist will pick up hues in pigmented lesions ranging from black, brown, red, blue, grey, yellow and white. Some tips on patterns and structures that dermatologists specialising in skin cancers would involve determining if a growth has the following features of asymmetry, heterogeny, uniformity. Dermoscopic examination also gives clues to keratin on the skin surface,blood vessels, borders, ulceration which can be signs of skin cancers.

© 2017 twlskin.com. All rights reserved.

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Meet with Dr. Teo Wan Lin, 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.

Viral Warts Treatment— Dermatologist Talks

October 17, 2017

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If you’ve ever been struck with a pesky wart 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 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 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 or 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.

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.

A Singapore Dermatologist’s Personal Skincare tips

April 13, 2017

Whether you are a local, or an expat that lives in Singapore, one is struck by the stark weather of this equatorial city- constantly humid with temperatures rising above 30 degrees celsius. The cause of our sweaty pimply skin, simply put, Singapore’s weather causes bad skin-acne on the face, pimples on the chest and back. True or false?

Also, too many aesthetic clinics and medi-spas are advertising some sort of acne treatment for our humid climate, how does one know if it’s going to work? Does bad skincare cause problems and what exactly constitutes good skincare?

As many of my patients have asked, I share my top tips on maintaining good skin in Singapore (which you could achieve on your own), and how to get treatment when you really need it.

1. If it’s bothering you, you may have a real skin problem. Do see a dermatologist.

Do you suffer from any of these: sensitive skin and break-outs if the products were not right? Constant red face? Having flaky itchy skin whenever you’re traveling? Always having a pimple breakout at that time of the month?

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

Acne on the chest and back is often actually a fungal infection known as pityosporum folliculitis. This sort of chest and back “acne” requires treatment with specific antifungal lotions and creams. People who are at risk include athletes or those living in a humid country like Singapore, as the constant sweating and the moist environment worsens it. When chest and back acne or fungal infections are left untreated, it leaves bad scars and even develops secondary bacterial infections.

If you always have a red face you may likely suffer from rosacea. Rosacea treatment is  with correct oral antibiotics and creams before anti-redness lasers (to eradicate the blood vessels) are used. Rosacea is triggered off by hot climates, spicy foods, emotions in certain people who are at risk. It is likely to be related to increased blood vessel sensitivity as well as certain mites that live on your skin (demodex mites).

If you have any such symptoms, stop all skincare products and promptly seek the care of a dermatologist rather than self-medicate, or adopt a “wait-it-out’ attitude. Some tips: Look for the labels “dermatologically tested and formulated” when it comes to choosing cleansers, moisturisers and cosmeceutical products. Avoid testing many different cosmetic products which have no scientific evidence proving effectiveness. Finally, where possible avoid dust, extremes of temperature and humidity, prolonged contact with sweat as these tend to worsen skin sensitivity.

2. Don’t use just any wash on your face, use a dermatologist-tested and formulated cleanser.

It almost feels like because Singapore is so warm we constantly need to keep washing  and keeping clean because of the sweat! As a dermatologist, I’ve heard from many patients with acne how they struggle to wash their face 3 times a day and are puzzled that they still have pimples. Cleansers perform one function, they emulsify the dirt, oil and bacteria in the foam which is rinsed off with water. Acne not due to dirt or bacteria, although they both can worsen people who already are prone to acne, such as those who have a family history of acne, so no amount of washing can actually get rid of acne.

There is a difference between normal cleansers and those which are dermatologist-tested/formulated. Cleansers approved by dermatologists are gentle on the skin, due to a good balance of the lathering agent and use of quality ingredients that do not strip the skin dry of it’s natural moisture while cleansing effectively. I personally formulate a honey-based cleanser which is suitable for both oily skin and sensitive skin types in Singapore (honey is a natural emulsifying agent which also has anti-bacterial properties) for my patients. Cleansers that leave your skin feeling squeaky clean is usually a bad sign, so stop using your supermarket cleanser and start looking carefully for those “dermatologist-tested and formulated” labels.

3. Don’t buy more scrubs or clay masks to clean your face better.

It amuses me that most of my patients are shocked when they hear this from me, their dermatologist, almost as if I am wrong to say that. Dermatologists do not agree with a lot of what beauty companies/aesthetics providers (who are not qualified dermatologists) are telling the public.  The beauty industry is limited by what they are allowed to use in their salons (none of the prescription medications that would actually work is found in these places) and are are very happy to include more products in your regimen to earn your dollar. Dermatologists have seen way too many complications because of an incomplete understanding of the actual science of how skin behaves. Scrubbing with harsh beady grains of sand would work if your skin was made of wood, like sandpapering it down. In reality, you do not brighten or “exfoliate’’ your skin with that but rather you are causing damage and irritation to your skin, that’s maybe even the cause of your sensitive skin and red face problems.

Clay masks? Totally unnecessary even for oily and acne-prone skin types because it’s actually the salicylic acid content in these masks that causes your acne to get better, but not without really dehydrating your skin after that (these masks are dry out your skin with an astringent). Most of my patients end up with a red itchy flaky face, on top of acne after they go on a clay-mask spree hoping that it would cure their oily face and acne. Dermatologists do not prescribe clay masks for any skin problem because there are much more effective options for treatment of oily skin and acne. What counts in a skin treatment product is the active ingredient in these masks and products, so again, start looking down the ingredient list of your next bottle!

4. Use cosmeceuticals but do thorough brand research first.

Haven’t heard of cosmeceutical yet?  It has become quite a fashionable word amongst the dermatologists community (for those in the know). It’s a marriage of two words “pharmaceuticals” and “cosmetics”. It’s actually referring to skincare with active ingredients best for skin that’s backed by dermatologists.

Am i too young? Or too old? Do i even need to get started?For best results, start on cosmeceuticals early, in your twenties for maintenance of your youth. If you are already in your thirties and forties or beyond, fret not, cosmeceuticals are a useful adjunct to the laser/filler/botox treatments recommended by your dermatologist and help to enhance and maintain the effects of such anti-aging treatments.

There are a myriad of cosmetic brands that claim wonders. Unfortunately, cosmeceuticals are not regulated by the HSA and so are not bound to their claims. Hence, it’s difficult for the consumer to know if a given product can do what it claims it can do, contains the ingredients it claims to, or if the ingredients are even active forms? Moreover, if the ingredients have phototoxic or photo reactive properties when exposed to the sun, among other concerns.What then? There is true evidence for the  anti-aging properties of cosmeceuticals, but you are wise to consult a dermatologist before you buy. The HSA does not regulate the effectiveness of anti-aging products available without a prescription.

5. Go for a chemical peel or a medi-facial monthly at your dermatologist’s office in your twenties. Lasers in your thirties and beyond.

What is true about acne and the humid Singapore climate is that it all encourages the build up of dead keratin (read: skin flakes) which plug the pores and cause inflammation. Even if you don’t have acne, the build-up of keratin on your face with reduced skin turnover as one grows older, or due to environmental conditions such as exposure to pollutants and to sun. All these cause free-radical damage and accelerated aging, makes one’s face look dull and hence lose the bright complexion of one’s youth. A regular chemical peel (salicylic, lactic or glycolic acids as suited for your skin type should be determined by your dermatologist) or a medi-facial (I would use a vacuum handpiece with customised chemical peel solutions for patients), would reduce your chances of having oily acne-skin breakouts and reverse early signs of mild aging. It’s affordable as well. However, this alone will not work for a lot of patients with more severe acne/oily skin, for which they may require laser treatments to shrink oil glands or take oral isotretinoin for control of severe acne.

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

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

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

Top Sensitive Skin Tips & Treatment by a Singapore Dermatologist – Say Goodbye to Troubled Skin and Hello to a Carefree You

December 12, 2016

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

 

What is sensitive skin? 

Patients with sensitive skin are likely to have atopic dermatitis, which is a genetically determined condition whereby the skin is deficient in fatty lipids that act as a barrier to the environment.

If you experience an acute episode of “sensitivity”, you may actually have a form of allergic contact dermatitis to a topically applied substance, for which you need to be reviewed by a dermatologist and receive appropriate medical treatment. Sometimes a patch test will be recommended.

I have sensitive skin- can I still use anti-aging cosmeceuticals and go for laser treatments?

After their inflammation is treated, patients should switch their skincare cosmeceuticals (ie. antioxidant, hydrating, anti aging products) and cosmetics permanently to a dermatologist tested and formulated line.

Skin rejuvenation treatments should only be performed by a dermatologist, who will choose the correct treatment and settings to ensure the best results without irritating the skin.

What are some symptoms? 

Do you have skin redness, flaking, itch or stinging pain tocommon exposures in the environment or to skincare or makeup?

What should I do if I find out I have sensitive skin?

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.

How do I care for sensitive skin?

There are a few ways to properly care for your sensitive skin. Here are three of the best ways:

  • 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.
  • Avoid dust, extremes of temperature and humidity, prolonged contact with sweat

© 2017 Dr Teo Wan Lin. All rights reserved.

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Dr. Teo Wan Lin is an accredited dermatologist at TWL Specialist Skin & Laser Centre that can treat and advise anyone with sensitive 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