Stretch marks are common and can affect both men and women, however they are more frequent among women and usually occur at one’s thighs, buttock, lower back, chest, upper arm and knee. Although they rarely cause medical problems, stretch marks are considered a major aesthetic concern and may be distressing to some individuals. In this article, we will discuss the causes of stretch marks, how they form, and the treatment options available.
What exactly is a stretch mark?
A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin that supports our skin, to rupture. As the skin heals, stretch marks may appear. When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on one’s skin colour. Early stretch marks may feel slightly raised and can be itchy while over time, the colour fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you can feel a slight depression.
Causes of stretch marks
Stretch marks occur typically during pregnancy, puberty, obesity or certain medical conditions e.g. Cushing syndrome. Other triggers include hormonal imbalance, extended periods of mechanical stretch or any structural changes to the skin can lead to stretch marks. Chronic use of oral or topical corticosteroids can also contribute to the development of marks.
Stretch marks can form via three main mechanisms:
No specific gene has been identified as the cause of marks developing on the skin. However, stretch marks have been identified among identical twins, families and inherited genetic skin conditions, suggesting genetic predisposition, that certain individuals may have a greater tendency of developing stretch marks based on their genes.
A hormonal imbalance can contribute to the development of stretch marks. A hormone called adrenocorticotrophic causes an increased rate of protein breakdown, hence less collagen and elastin fibres are produced and the skin is less flexible and resilient to withstand stretching, causing marks to form. This effect is similar to that caused by corticosteroids, which explains why chronic use of the drug is more prone to developing stretch marks.
Rapid expansion or contraction of the skin causes it to stretch beyond its usual elastic ability. Fibres in themiddle skin layer stretch to accommodate when growth is slow. However, with sudden stretching, the dermis may tear, causing the deeper skin layers to be seen and forming marks.
Who is more prone to stretch marks?
One who is undergoing puberty and has growth spurts, pregnant women, one who undergoes rapid weight loss or gain or is weight training and experiencing rapid muscle growth. Those who apply a corticosteroid to their skin for a long time can also cause stretch marks. Individuals who have Cushing’s disease or Marfan syndrome may also see stretch marks.
It is important to have your stretch marks reviewed by your dermatologist, as there are a few medical conditions which may mimic these marks. Like any scar, stretch marks are permanent, but treatment helps to make them less noticeable. Consulting an accredited dermatologist would help you in seeking an effective treatment. In addition, there are also specifictreatments which should only be performed by a qualified dermatologist to reduce the appearance of these marks.
How to treat stretch marks
Topical treatments only have mild effects in reducing the appearance of stretch marks. Still, many patients prefer non-laser approaches, thus topicals remain as a common approach. It is recommended to use products on early stretch marks as in general, early stretch marks respond better to treatment than the older lesions.
Tretinoin is a retinoid, helping to boost fibroblast production, which are molecules responsible for the structural support in our cells and synthesize collagen, hence helping to make early stretch marks less noticeable. In one study, people who applied this prescription cream every night for 24 weeks had less noticeable stretch marks while those who didn’t apply the cream saw their early stretch marks grow. It is not recommended to use tretinoin during pregnancy as it carries a risk of birth defects
Plant extracts such as Centella Asiatica can boost the cells that produce elastic fibers and collagen. Researchers have found that products containing centella may help prevent stretch marks. Resveratrol, naturally occurring in grapes and berries, can also boost skin elasticity.Elixir-V™ Total Recovery Serum contains a potent combination of phytochemicals, including resveratrol, to help fight ageing effects.
The Elixir-V™ Total Recovery Serum contains intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.
A randomized, double-blind, placebo-controlled study in pregnant women showed that the severity of stretch marks can be reduced by topical application of moisturisers.Radiance Fluide™ Hydrating Emulsion, a dermatologist-designed lightweight moisturizer formulated with niacinamide, helps stimulate collagen synthesis, tighten and lift stretch marks. The Radiance Emulsion formula is recommended for use with Qraser Custom Cut Mask, uniquely engineered with several properties which are beneficial for creating a healthy skin microenvironment, and helping the balance of growth factors that stimulate collagen production.
The Radiance Fluide™ Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. Specially formulated for a light-weight feel to impart a radiant glow without make-up.
They help to induce the production of collagen and improve the appearance of stretch marks. Salicylic acid, lactic acid and glycolic acid are most commonly used.
In this process, a targeted injury is caused to trigger collagen production and to deposit elastin. Topical therapies are also more effective after microdermabrasion, as your active ingredients can better penetrate the dermis layer. In a study conducted, microdermabrasion was found to be as effective as the daily application of topical 0.05% tretinoin cream in the reduction in the severity of early stretch marks.
Different types of light treatment are also available to stimulate collagen production in the dermis layer. Examples include infrared light devices, intense pulsed light (IPL) and ultraviolet light.
Such lasers are effective in reducing scars as they create a deliberate wound to induce healing of the skin. The treatment of stretch marks using the laser showed clinical improvement, with the laser inducing the formation of collagen. There are rarely complications, and the cooling of the stretch marks before and immediately after the use of the laser further helps to protect the skin.
Wollina U, Goldman A. Management of stretch marks (with a focus on striae rubrae). J Cutan Aesthet Surg. 2017;10(3):124-129. doi:10.4103/JCAS.JCAS_118_17
The old adage ‘you are what you eat’ has never been so true when it comes to skincare. Research has proven that an imbalanced balanced diet and bad eating habits are important factors in skin aging. In this article, we will explore the science behind an anti-aging diet, and the antioxidant-rich superfoods that play a part in your skin’s health.
Our skin is the largest organ in our body, and the primary line of defence that protects the body from external aggressors. Skin aging is a complex process, and can be categorized by chronological aging, and photo-aging, which can be affected by both internal and external factors. As the main way for our body to get the energy and nutrients it needs for function, people have gradually realized our diet’s importance to the skin.
UV exposure induces oxidative stress in the skin, which eventually, leads to skin inflammation. When the degree of inflammation exceeds the defenses of the body’s immune system to clear up, immune cells such as macrophages begin secreting pro-inflammatory factors and free radicals, accelerating skin inflammation and injury. This process is known as inflammaging.
The Dr.TWL SunProtector is formulated with physical blockers like titanium dioxide and zinc oxide that effectively blocks UV radiation. Portulaca Oleracea (Purslane) and Oligopeptides in our SunProtector are potent antioxidants which actively fight free radicals generated by UV exposure as well as airborne pollutants – for comprehensive protection.
DNA damage to the skin is manifested as photo-aging in the form of wrinkles, loss of elasticity, irregular texture, hyperpigmentation. These are a result of oxidative stress that cannot be repaired at the same rate as a younger person’s skin. Superfoods with a high antioxidant concentration can actually help to boost these processes of DNA repair and combat the results of free radical generation.
“Sunscreen itself performs a fundamental role of protecting your skin from damaging ultraviolet radiation. Both UVA and UVB have been implicated in photoaging. As well as in carcinogenesis, which is a process of skin cancer formation. Simply put, when we have ultraviolet radiation exposure, as we grow older, our skin becomes less and less able to handle the oxidative stress and the ensuing free radical generation. All of which permit DNA damage to occur at the cellular level,” accredited dermatologist Dr. Teo Wan Lin. Listen to our podcast Dermatologist Talks: Science of Beauty Ep 34 where Dr. Teo discusses more about photoaging and sun protection.
Anti-aging diet: What are superfoods?
Skin health is influenced by your genetics, your lifestyle, which incorporates your diet, as well as factors such as how frequently you exercise and the type of exercise. These factors influence skin health, which in turn affects skin aging. Additionally, skincare which includes topicals being applied to the skin, plays a role in skin aging as well. These are more precisely termed as dermocosmetics or cosmeceuticals, which have pharmaceutically active properties in over the counter cosmetics.
Superfoods, with the exception of fish, are mostly plant-based foods that are nutritionally dense and confer many benefits to your overall health, and in this case, the skin. We are well aware that proper nutrition is critical for the healthy functioning of the body systems. We also know that as our body ages, every single organ ages in tandem with our biological clock as a result of both genetic as well as environmental factors.
The free radical theory of aging states that organisms age because cells accumulate free radical damage over time. A free radical is an atom that is unstable because it has only one unpaired electron in its shell rather than two. They can interact with DNA, proteins and fatty acids in the body, causing breaks in the DNA chain, protein-protein linking and oxidative damage. Oxidative stress, therefore, eventually leads to aging, so foods that contain antioxidants have been a key topic of research. Here are some of the natural antioxidants and their effect in alleviating skin aging.
Which is better for my skin, eating superfoods or using skincare products?
In relation to an anti-aging diet, it is crucial to note that the use of skin products has one very specific advantage, it is directly applied to the skin. Because the stratum corneum is designed in a way that is able to absorb what’s applied to it, we expect that if you’re using pharmaceutically active ingredients, cell changes can be positively manipulated to benefit your skin health and reduce oxidative stress. Skincare on its own is a critical part of the maintenance of the skin barrier, which is the way your body protects itself from the external allergens from any adverse environmental exposures. If that barrier is depleted, then we certainly expect that your skin will malfunction.
The short answer to this complex question is you cannot have healthy skin with a poor diet when you’re older. Unless you’ve won the genetic lottery and there are definitely individuals who eat junk food and yet still have very good skin. However, their overall health will suffer. If your health is poor, your skin will also age as you grow older. Therefore, the bottom line is that eating superfoods is more effective in the long run.
What consists of an anti-aging diet?
There are certain combinations of superfoods for the best results. For example, the well-known rainbow diet, which includes lots of different colours in your diet. It stems from the presence of carotenoids and anthocyanins in colored fruits and vegetables.
There has yet to be a study that talks about the proportion of all these superfoods in a diet. However, what studies have actually shown is that when they incorporated a nutraceutical dietary intervention in an aging population, there were significant overall psychological and physical benefits. It suffices to say that everything in the plant and the mushroom kingdom has antioxidants and is suitable for an anti-aging diet.
Many of these, such as broccoli, cabbage, kale have been classified as superfoods because of the dense nutritional content per gram of the food that’s being served, as well as unique actives that are present in these vegetables that help to fight oxidative stress. In particular, we know that studies have been done on broccoli and the cruciferous vegetables of the Brassica family that show that it actually has cancer-fighting properties. This can therefore help in your anti-aging diet.
What are the best superfoods for my skin?
It’s good to focus on the different colours of foods. There are the brightly colored carotenoid-rich fruits and vegetables in orange, red and yellow. As well as anthocyanin-rich blue, purple produce such as blueberries and beetroot. Soya, in particular, is a phytoestrogen, having a positive benefit on your skin. There have been studies done in Japan on the benefits of consuming soy products such as miso or soy beans, when it comes to anti-aging.
How long does it take to see the results of a superfood-rich anti-aging diet?
Studies have to be done for a dermatologist to categorically state that there is a specific time period after which we expect to see results, and these are not available at the moment. It’s also very difficult to conduct such a study because of many confounding factors, such as there not being a standardised ‘superfoods diet’.
Instead, the importance of nutraceuticals in your diet should be highlighted, as they affect your body systemically. Nutraceutical intervention can be a potential active therapy to address the lifestyle component of the skin exposome concept, which explains the skin aging process.
On the other hand, skincare products are a lot more measurable in terms of what we expect to see. For example, in my clinic and my skincare arm Dr.TWL Dermaceuticals, we use retinoid-like peptides. However, they do not contain retinoid or retinol side effects such as irritation. Usually, within two to three weeks of using the topicals, the individual will have a subjective improvement in skin hydration, elasticity, and radiance. Additionally, there have been studies showing cells in a lab environment as well as in clinical studies, where results are actually measurable as well.
Grow your own food
Understanding the benefits of an antioxidant-rich, anti-aging diet, how do you go about incorporating more of these superfoods into your diet? According to research conducted by University of Florida Institute of Food and Agricultural Sciences in 2016, gardening and growing your own food helps people develop a lasting habit of eating enough fruits and vegetables.
Furthermore, you get to decide what kinds of fertilizers and pesticides come into contact with your food. Commercial produce breeders often develop new varieties based on high yields and fast growth. In this process, there might be a compromise of nutrients and flavor. In your own garden, you can pick the variety that’s important to you, and be able to have the farm-to-table experience right at home.
Living in an urban area like Singapore, having a garden may not be a viable option. Instead, opt for urban farming with the easy-to-assemble SOLAR-ALGA Organic Urban Tower Farm. The first certified organic system, It is a compact hydroponic and aeroponic system that grows 45 different plants in just 0.14sqm of space.
Complimentary with the SOLAR-ALGA, grow your own fruits and vegetable seedlings such as spinach, cucumber and cauliflower in the Mira-Sponge seedling Nursery. Get a head start on growing your own food for an anti-aging diet with the MiraFoam tray, providing the perfect micro environment for seedling germination and growth.
We know that long term exposure to blue light from digital devices can cause eye strain, hence, the advent of blue light filtering glasses. However can blue light, or visible light, damage the skin as well? In this article we will explain what visible light is, the effects of blue light on skin, and dermatologist tips on how to protect your skin from visible light damage.
What is visible light?
Visible light (VL) is radiation encountered at the earth’s surface with wavelengths of 400-700 nm. It can be seen by the human eye as it emits light from electronic devices such as computers, cell phones, television screens. Blue light is the part of the visible light spectrum that contains the highest energy.
How is it different from UV rays?
UVA and UVB light from the sun fall under the category of invisible light, as we cannot see these rays. However, they are present during daylight hours and can have many effects on the skin. UVB light from the sun has a shorter wavlength, and is associated with causes sunburn, while UVA light causes deeper damage like reduction of production of collagen and oxidative stress.
What are the sources of visible light?
The primary source of VL comes from the sun. Other than that, artificial sources of VL is from our electronic devices, lightbulbs and lasers. The natural source of VL from the sun is especially important for other organisms to survive. Living organisms including bacteria, fungi, animals, and plants use blue light to adapt to changing ambient light, blue light is used for photosynthesis. Ocean organisms depend on VL to obtain sunlight. Red light is able to penetrate through depths of 2m and blue light able to reach up to 200-300m.
What does red and blue light therapy do to your skin?
Visible light can be beneficial for our skin when used in therapeutic, controlled settings such as adjunct treatment for dermatological conditions. However, it can also be detrimental to the skin if exposed to high intensities of it from the sun.
Blue light has anti-inflammatory and antiproliferative properties. The use of therapeutic visible light to treat dermatological conditions include blue light for psoriasis, atopic dermatitis or eczema, rosacea, acne and others. On the other hand, red light is used in dermatology for skin resurfacing and rejuvenation. Furthermore, alopecia, acne, skin fibroblasts modulation, and pre-cancerous and cancerous skin lesions can be treated by red light. The combination of red and blue light also cures seborrheic dermatitis, pityriasis versicolor, and acne.
Is blue light bad for your skin?
Recently, scientists have recognised the role of VL in the production of pigment in the skin. Pigmentary disorders such as melasma and post-inflammatory hyperpigmentation (PIH) disproportionately affect individuals with Fitzpatrick skin types (FST) III to VI.
Some studies have shown that exposure to high intensity blue light from the sun can cause more hyperpigmentation in darker skinned individuals, compared to when exposed to UV irradiation. However, there is a lack of evidence about the role of VL from artificial sources in pigmentation production. Because, the LED light used in studies was much higher in intensity as compared to the LED devices used in daily life.
“Blue light is a very popular topic because we are exposed to a lot of devices in our homes that emit blue light. For example our mobile phones, iPads, our computer screens; especially now so with more people working from home. The key premise of this question is that there was a study done a few years ago by dermatologists that demonstrated amongst individuals with existing pigmentation problems.
Exposure to high doses of blue light, the kind of blue light that is present in solar radiation, is much more intense than the blue light coming from your devices. Therefore, with these individuals that already had pigmentation, exposure to high doses of blue light from the sun was observed to make their pigmentation worse. Putting this into context, it’s much more important to preach avoidance of UV exposure as well as sun protection. This is because the sun is the biggest producer of blue light”, accredited dermatologist Dr. Teo Wan Lin.
What ingredients protect against blue light?
According to Dr. Teo, how to protect your skin against blue light is to keep in mind that “if you do already have pigmentation, please be more conscious to reduce the amount of screen time you have. Secondly, you may want to actively incorporate serums that contain potent antioxidants. This refers to cosmeceuticals that have been proven in clinical settings to reduce the process of free radical damage caused by environmental stresses. For example, I’m referring to active ingredients such as Centella Asiatica, resveratrol, vitamin C – and many other botanical extracts that have proven benefits of antioxidant properties.”
Photoprotection is currently the number one recommendation for prevention of the effect of blue light on skin. Seeking shade, using photoprotective outer-wear such as UPF50+ materials, and daily use of a broad spectrum sunscreen with SPF >30 is recommended. Known VL blockers include physical filter iron oxide which can be found at various concentrations in sunscreens.
Individuals have to take note that skin protected by sunscreen with higher concentrations of titanium, zinc, and iron compounds can offer better protection to VL. Sunscreen containing high amounts of iron oxide was found to be highly effective in reducing hyperpigmentation. Since sunscreens do not label the iron oxide percentage, one must ensure the sunscreen to go on white as a sign if it protects against VL.
The SunProtector which is what we use in our dermatologist practice, is a broad-spectrum sunscreen that contains both the ceramide, the UVA blocking component, as well as physical blockers such as titanium oxide and zinc oxide. It is also includes Portulaca oleracea extract also known as purslane as well as oligopeptides, both of which are well-established in scientific literature to block melanin production due to its antioxidants abilities.
With regards to a specific anti-blue light product, look for a physical sunscreen. I always recommend broad-spectrum sunscreens that contain UVA and UVB protection – and this usually involves the use of both chemical sunscreens as well as physical sunscreens such as zinc oxide, titanium dioxide. If your sunscreen has both zinc oxide and titanium dioxide These would be effective in blocking high-energy blue light that is radiated from your devices.
Menopause officially begins one year after your last period, and can bring many changes to a woman’s body – especially to the skin. In this article, we explore how menopause affects the skin, traditional estrogen treatment, and promising cosmeceuticals in preventing and treating signs of aging in menopause skin.
How does menopause affect the skin?
Estradiol levels, one of the three major estrogen hormones secreted by the body, declines to nearly zero after menopause. This estrogen-deficient condition can lead to a dramatic reduction in overall skin health and appearance, due to the negative impact on dermal cellular and homeostatic mechanisms. These changes appear in the form of loss of collagen, loss of elasticity, increased MMP (enzymes that break down collagen) activity, which result in dryness, wrinkles, impaired wound healing, decreased antioxidant activity. These changes may affect self-esteem, psychological health, and increased physical perception of aging.
Traditional estrogen treatment
Since the 1940s, estrogen hormone preparations have been a popular treatment for menopausal women to treat symptoms such as hot flush (sudden feeling of heat, mostly over the face, neck and chest). This Menopausal Hormone Treatment (MHT) was later changed to include the addition of progestin to avoid the development of health conditions such as endometrial hyperplasia, and cancer.
There have been few studies that measure the effects of normal dosage of MHT on skin health, with most studies on the effects of estrogen on skin health dating from the time estrogenic dosage of MHT was as much as 10x the amount in present day treatment. Furthermore, in most of the research, there has been large and usually unmeasured and uncontrolled effects of exposure to smoking, environmental aggressors, race, and aging.
Hence, while traditional treatments such as local hormone treatment have generally been regarded as effective in reversing skin aging in estrogen-deficient or menopausal skin, the uncertainty of the long term side effects has led to the development of newer therapeutic agents in the form of botanicals .
Cosmeceuticals to treat estrogen-deficient, menopausal skin
Cosmeceuticals represent the blending of cosmetics and pharmaceuticals. One of the greatest sources of new cosmeceutical ingredients are from plants. Plants are rich in antioxidants as they must survive constant UV exposure. Botanicals are also considered safe as they meet the FDA’s criteria of substances that are safe to use in topical over-the-counter formulations.
Resveratrol, a compound derived from grape, has been well researched for its anti-aging properties, and can be beneficial in the treatment of estrogen-deficient, menopausal skin in post-menopausal women. Recent studies reports that resveratrol has anti-inflammatory properties that protect against UV radiation from the sun, and oxidative stress. It also helps to stimulate production of collagen in fibroblasts, and inhibition of melanogenesis – helping to prevent the formation of pigmentation and dark spots.
The Elixir V Serum is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides. It contains Larecea™ our trademarked extract of Brassica oleracea (a botanical extract from cruciferous family plants) and a super-power Japanese Knotweed plant extract which is a source of trans-resveratrol, a potent anti-oxidant that enhances cellular regeneration at night, without the irritation effects of traditional retinoids.
Phytoestrogens & Isoflavones
Selective estrogen receptor modulators (SERMs) are examples of possible therapeutic agents that can send estrogen’s important skin health signals in place of decreased estrogen levels. Recent research has found that phytoestrogens (plant-derived compounds) that contain SERMs can play a major role in treatment for aging and estrogen-deficient skin.
The Mineral Booster is a dual function refreshing mist to increase absorption of skincare at night, for a perfect look with make-up & during touch-ups in the day. It contains skin-calming & repairing active ingredients, including precious rice bran extract, licorice extract, and Glycine Max Soybean Extract – that is a rich source of phytoestrogens and isoflavones. Suspended in a purified deep sea water mist harvested 600m below sea level using sophisticated technology. Perfect for tropical and humid climates.
Many studies have examined phytoestrogens which act as SERMs and help to send estrogen’s signals in place of decreased levels of estrogen. Isoflavone is a phenolic compound classified as an phytoestrogen. Isoflavones are found in high quantities in soybeans and other legumes. Phytoestrogens have been found to act as an anti-aging ingredient, resulting in increased production of collagen and hyaluronic acid in the skin.
They are also potent antioxidants, with anti-inflammatory properties. Studies conducted in 30 post-menopausal women found that treatment with isoflavone-rich, concentrated soy extract caused significant increase in skin thickness and number of collagen and elastin fibres. Additionally, creams and lotions containing phytoestrogens and isoflavones in a 12-24 week study showed improvement in skin dryness, thickness, facial wrinkles, increased hyaluronic acid, and type I and III collagen production. In these studies, no significant adverse effects after topical application of these cosmeceuticals.
Novel botanical compounds
In a study conducted by Lephart and Naftolin, two plant-derived compounds have been shown to improve the condition of the skin, especially in estrogen-deficient, menopausal skin. 4’acetoxy resveratrol (4AR) and equol are 2 novel botanical compounds that were associated with improvements in 8 skin parameters in a cohort of post-menopausal women.
The results show that for skin firmness around the eyes, Equol was associated with a 78% improvement, while 4AR associated with 68% improvement from baseline. For skin smoothness, equol was associated with 63% and 71% improvement for 4AR, while rates of frown lines and wrinkles were 72% for equol, and 77% for 4AR. Even skin tone improved 70% for equol and 83% for 4AR. Radiance and brightness rates were similar (73% for equol, 72% for 4AR), while rates of pore size (52% vs 63%), skin spots and discoloration (56% vs 73%), and hydration showed slight favoring of 4AR with equol at 71% and 4AR at 72%.
Overall, the percentage improvements were very similar for the 2 botanical compounds. This indicates that topical application of plant compounds with SERMs can play a major role as cosmeceuticals in the skin care industry, showing significant improvement in estrogen-deficient skin.
Lephart, E.D., Naftolin, F. Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatol Ther (Heidelb) (2020). https://doi.org/10.1007/s13555-020-00468-7
Desmawati, D., & Sulastri, D. (2019). Phytoestrogens and Their Health Effect. Open access Macedonian journal of medical sciences, 7(3), 495–499. https://doi.org/10.3889/oamjms.2019.044
The term “skin lightening”, along with “whitening” and “fair” have often been marketed in products, particularly in Asia. Aside from being unhealthy and unsustainable, skin lightening treatments and procedures can often be dangerous. In this article, dermatologist answers 5 common questions on skin lightening, shedding light on dangerous practices, and giving tips on how to even skin tone instead of whiten it; including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.
Can you actually lighten your skin?
In the context of achieving a fairer skin tone, I think it is important to define if we are talking about eliminating uneven pigmentation, for example, or actually bleaching one’s skin to go to a lighter skin colour. The latter I do not recommend but in terms of making one’s skin tone more even and eliminating dark spots, there are various forms of pigmentations that you should know about including sun spots – otherwise known as solar lentigo, freckles, other medical conditions such as post inflammatory hyperpigmentation and melasma.
There are specific topical medications, lasers, as well as pills that one can use to treat these conditions. For the case of actually going to a completely lighter skin tone that is not natural for one’s genetically determined skin type, I do not recommend that and we can address that later in this chapter
What are the steps to take to achieve a fairer skin tone? Can we break it down into lifestyle, treatments and skincare?
To achieve a fairer skin tone, I will focus on how to enhance one’s skin health, so that you get less of the common hyperpigmentation conditions. We start off with genetics. Everyone is born with a certain skin type – we call that phototype. The dermatological grading of this is the Fitzpatrick phototype. For Asians, we tend to be between type III to type V. When it boils down to why people of a certain skin type, for example in phototype III, have varying amounts of skin fairness or pigmentation, it is said to be influenced by various factors.
Lifestyle certainly plays a role, as our skin contains melanin, a light-absorbing pigment molecule that also gives our skin its color. When we are exposed a lot to the sun, we activate the melanin-producing cells, melanocytes, that can cause one’s skin tone to get darker. The amount of exposure to sunlight is therefore one important factor.
Other lifestyle habits like smoking, exposure to pollution and stress for example, can lead to a process known as free radical generation in our skin and this can increase one’s risk to hyperpigmentation or risk of existing areas of pigmentation to get even darker. Unhealthy lifestyle is definitely part of factors that cause our skin to be less radiant and can also cause the skin to appear as a dull complexion with uneven skin tone.
In terms of treatment, chemical peels and lasers help to stimulate one’s skin cells, restoring it to a normal cell cycle of a young person. Overall, this causes skin to look much more radiant with an even skin tone and a fairer complexion, whilst also reducing the amount of skin surface irregularities. The lasers work by causing the skin’s natural cells to eat up areas of pigmentation – this is beneficial for those hoping to achieve more even skin tone.
Certain skincare ingredients have shown effectiveness for even skin tone. For example, retinoids (which are prescription only), and oligopeptides which is what I incorporate in my skincare as it is non-irritating with potent anti-ageing properties and stimulate one’s immune cells to eat up pigmentation and has been proven to cause lighter skin tone.
Is it realistic to maintain a lighter skin tone than you’re naturally born with?
This is a very important question as it goes back to the premise of this series. Our skin tone is genetically determined and we refer to the Fitzpatrick phototype classification as mentioned above. It is unhealthy to want to bleach one’s skin and remove one’s natural melanin which is protective. There are ways to achieve that, but it is not practised in dermatologist’s offices because it is a dangerous method. The only indication for using bleaching creams will be to lighten small areas of hyperpigmentation such as sun spots or in cases of the medical condition – melasma.
To want to lighten one’s skin entirely, it is very dangerous because it can increase your risk of skin cancer as well as accelerate skin ageing. Such treatments are reserved for medical conditions such as vitiligo whereby one has lost significant amount of skin pigmentation through an autoimmune disease and is cosmetically disfiguring. In those cases, if the body surface area is involved very significantly, it can be an indication for the dermatologist to lighten the rest of the skin as well to help the overall cosmetic appearance.
What is the fastest way to lighten my skin tone naturally?
One’s skin tone often appears dark because of uneven pigmentation that has developed over the years with ageing and sun damage, as well as having dull skin. A quick in-office treatment will be a chemical peel performed by a dermatologist, using glycolic or lactic acids in combination with a laser treatment. In my clinic, we do both as part of a skin rejuvenating treatment on the same day. The results of this is usually apparent right after treatment, especially after applying the Amino Acid Masque which contains Vitamin C and various plant extracts that helps to shrink the pores and helps in brightening the skin tone.
To shed light on them, what are some controversial skin whitening and skin lightening methods?
More than controversial, some alternative skin lightening methods can be dangerous. In particular, do be wary of cosmetic products that promise exaggerated or miraculous results, as recommended by the Health Sciences Authority with some recent high profile cases of illegal cosmetics. Such products when purchased from unfamiliar sources may be prohibited, for example due to the dangerously high levels of mercury. This toxic heavy metal is in fact prohibited as an ingredient in skincare formulations as it can cause rash, skin discolouration and blotching. Chronic exposure to mercury may also cause damage to kidneys, digestive and nervous systems.
Another controversial method would be skin lightening creams containing ingredients such as hydroquinone and retinoids (tretinoin), which which can cause serious adverse reactions. While these substances may be commonly used in a dermatologist’s office as treatment for skin conditions, the potency requires it to be prescribed only by an accredited medical professional under strict medical supervision.
Other means of skin lightening such as intravenous glutathione treatments (injection) can be unsafe. Glutathione is an antioxidant naturally found in our cells and has skin-lightening abilities by converting melanin to a lighter color and cause reduction of melanin production as a whole. As with any treatments involving direct delivery to the bloodstream, additional caution should be exercised in consultation with an accredited medical professional. While glutathione has been proven safe for oral and topical treatments, we cannot say the same when it is injected into the bloodstream, given the inadequate safety data presently. Serious skin disorders, kidney dysfunction and thyroid function impairment have been reported in some cases.
Skin cancer is the 6th most common cancer in Singapore. As in the case of all suspected cancers, early detection is crucial for a positive prognosis. Are you searching for a skin cancer dermatologist in Singapore? Dr. Teo Wan Lin is an expert skin cancer dermatologist in Singapore who performs mole screenings, diagnosis of skin cancers and surgical treatment. She has published on the topic of skin cancers, including a first author publication on T-cell lymphomas in the prestigious Journal of Clinical Oncology and on morpheaform basal cell cancers in the International Journal of Dermatology.
There are two main types of cancers that occur on the skin. The first is what we term as malignant melanoma, and the second category would be non melanoma skin cancers.
We’re gonna start with the diagnosis of a skin cancer. The two main types of skin cancers can be distinguished primarily by the presence of pigment, specifically melanocytes. Melanocytes are the cells that produce pigment and appear commonly as what we describe as moles. When a skin cancer arises from a mole known as melanocytic naevus, it has the potential to be a melanoma.
What are the warning signs of a mole that is cancerous?
We use the acronym ABCDE, which stands for the following A for asymmetry B for borders C for two different colors and D represents diameter. So, a mole that is larger than 6 millimeters large in diameter is more suspicious than one that is smaller than that. Lastly, E for evolution, meaning if an existing mole changes or evolves, either by becoming itchy, if it bleeds, if there is a sudden increase in size or if the mole or part of it disappears. Now these are warning signs.
Non-melanoma skin cancers
Moving on to non-melanoma skin cancers. Now, these are actually the more common type of skin cancers in Asia, and can be further divided into the following the basal cell cancers and the squamous cell cancers. These two types of cancers are distinguished based on The origin of the cancer, whether they come from the basal layer of cells, or whether they arise from the superficial layer known as the keratinocyte layer.
The key thing about non-melanoma skin cancers, is that the prognosis is generally good, as long as one gets diagnosed and treated early. Diagnosis is via clinical examination and may require biopsy.
If you have a family member who has had a skin cancer before you are considered at higher risk than the general population. Especially if you develop a mole, or a new growth that seems to be changing. If you have not noticed it before and you have suddenly noticed it, it may be time to get evaluated by an accredited skin cancer dermatologist.
What does a skin cancer dermatologist do in the context of management?
First of all, if you have a suspicious growth, it is important to rule out the diagnosis of a skin cancer, which, in the context of this article can be either melanoma, or non melanoma skin cancer. Most moles, however, are not melanoma. They may appear atypical, meaning slightly different from your regular most because they present with features of dysplasia. Dysplastic moles can have irregular borders, multiple colors and can be fairly large as well.
An accredited skin cancer dermatologist who specializes in the treatment of skin cancers will be able to diagnose a melanoma or a dysplastic mole using tools such as clinical examination, dermoscopy. If necessary, your skin cancer specialist will suggest a biopsy.
The most important thing to note is this. If you have a diagnosis of a dysplastic mole, which is a histological diagnosis, you are on the average at higher risk of acquiring melanoma in your entire lifetime, compared to an individual who does not have the diagnosis.
The good news is that early stage melanoma can be effectively cured with surgical acquisition, as long as there is no lymph node or organ involvement. However, the danger is a lot of moles may be hidden, such as on the buttock area or on the soles of your feet, which is not easily self-monitored. When you may discover that a mole has been growing there for some time, it may be a little late.
If a mole has any of atypical features, it needs to be diagnosed promptly. For the treatment of non-melanoma skin cancers, the prognosis is generally good as long as the diagnosis is made early. The problem with non melanoma skin cancers is that when it’s diagnosed and treated late, there is significant morbidity. Realistically, it leaves a larger surgical scar, there may be a lot more tissue loss, as opposed to if it were diagnosed in the early stage and removed at that time.
Some of the characteristic diagnostic features of basal cell cancers would be a pearly pink or pearly white nodule or papule, located on any part of your body. The face is one of the commonest areas. A basal cell cancer when closely examined shows signs of increased blood vessels from the surface, also known as telangiectasia.
For squamous cell cancers, a lot of these look like bumps, where there is excessive dead skin. Some individuals who have had significant amount of sun exposure in their lifetime may develop several precancerous growth known as actinic keratosis. Actinic keratosis are not squamous cell cancers but must also be treated in order to prevent transformation into squamous cell cancers.
Teo WL, Tan SY. Loss of Epstein-Barr virus-encoded RNA expression in cutaneous dissemination of natural killer/T-cell lymphoma. J Clin Oncol. 2011 Apr 20;29(12):e342-3. doi: 10.1200/JCO.2010.31.4096. Epub 2011 Jan 31. PMID: 21282547.
Teo WL, Wong CH, Song C. Morpheaform facial basal cell carcinoma – a 16-year experience in an Asian center. Int J Dermatol. 2012 Nov;51(11):1396-8. doi: 10.1111/j.1365-4632.2010.04767.x. Epub 2011 Dec 16. PMID: 22171721.
The following is a transcript from Dr. Teo Wan Lin’s podcast, Dermatologist Talks: Science of Beauty on fillers and vaccines. Subscribe to her podcast on a journey to discover the science of beauty. We’ll cover the science behind active ingredients and get deep into the cosmetic formulations. Stay on trend with the latest on botanical actives, technology and be part of our FUTURE OF BEAUTY.
29 DEC 2020: Hi guys, this is Dr. Teo Wan Lin, and welcome to this week’s dermatology flash briefing. The Moderna COVID-19 vaccine apparently causes swelling and inflammation in patients with cosmetic facial fillers. The FDA advisory committee reviewing the new Moderna vaccine, has come out to state this very specific side effect that has involved several trial participants who have had cosmetic facial fillers. I want to just quickly share with you guys today what exactly this is about, how it occurs, and if that’s something we ought to be worried about.
What exactly are dermal fillers?
Dermal fillers are used primarily for facial augmentation. The filling agents are meant to restore fullness in one’s appearance that could be lost over time with age as a result of subcutaneous fat atrophy, or a side effect of certain medications such as retroviral medications. The ideal facial filler should have the following properties: first of all, it should have physiologic compatibility with your body – meaning that it readily incorporates itself with your tissues. It should be free of complications or side effects, and ideally, it doesn’t degrade with time. But this is, of course, untrue for the commonest type of facial filler which is used in most cosmetic practices – that would be hyaluronic acid based and they should be relatively easy to administer. You also have alternatives such as those that are collagen based, or hydroxylapatite based – for example, Sculptra is from poly l lactic acid.
What are the side effects of facial fillers?
In terms of the known side effects from using these facial fillers as injectables, some of the common complications that occur would be tenderness, bleeding, bruising. When lumps and nodules occur, this can be because of inappropriate injection techniques, or accumulation of the filler in a more superficial location than expected.
So what’s the deal with the fillers and vaccines?
Now what’s happening with the Moderna vaccine and this painful facial swelling that occurs where facial fillers have been previously injected, its best thought of as an allergic reaction, or basically an immunological reaction. The key thing here is the process of injecting a vaccine, essentially causes the immune system to be stimulated. That in turn results in the body recognizing that the facial filler in that case, is not a part of the body tissues, and the body starts to mount an immunological reaction against it. Based on the cases that were reported to the FDA, the profile of these patients essentially had swelling and inflammation in the area that was administered the filler. A couple of the patients had the cheek filler 6 months prior to the vaccine, and one patient had lip filler done just 2 days after the vaccine. In all of these scenarios, the patients were treated with oral steroids, anti-histamines, and was observed that their reaction resolved.
What exactly is an allergic reaction?
Typically it is considered a medical event due to an immune system respond to a perceived allergen. It is not likely that these individuals would have developed this response had they not been given the vaccine. The reason is because facial fillers are medically engineered to be biocompatible, but in the case where you’ve had a vaccine, your immune system will start to detect that these substances that were injected, are actually not part of your body tissues.
What are your thoughts, as a dermatologist?
As a dermatologist, I have some opinions with regards to the observation of these adverse events. First of all, we do expect that massive rollout of vaccinations against the COVID19 virus is expected to be happening internationally, and I feel that it is a very important part in ensuring that we get some level of control and immunity in a very severe pandemic like COVID 19. In terms of immunological reactions that are occurring in response to facial fillers in this case, we note that the attendings have actually treated these patients with oral steroids.
We know that oral steroids suppress your immune system, and in fact, make you more vulnerable to the virus. Personally, I have not given oral steroids as far as possible to many of my patients in the last few months. For patients who otherwise would have benefitted from steroid therapy for chronic inflammatory disorders such as severe eczema, I have certainly been a lot more cautious in terms of exploring other therapies before using oral steroids. The reason is because it’s been known to worsen the prognosis in the event you do get COVID, and also, because it reduces your body’s natural immune system response – you’re going to be more susceptible to catching COVID.
The answer is not an easy one. Facial fillers are used in millions of people internationally, and it is not as if it is the first time we are hearing of an adverse reaction. Another known complication from facial filler injections that is relevant in the context of the modern vaccine would be non-allergic inflammatory responses- we call these granulomatous reactions. These don’t occur so quickly, and we right now have no long term data as to what the vaccination would do in terms of individuals who are going to have fillers or have had fillers, and who are going to receive the vaccine.
What are granulomatous reactions?
These granulomatous reactions are usually non-painful lumps, and it is all a part of inflammation that is caused by the immune system being stimulated. In fact, in 2017, there was a case report about a granulomatous reaction to a dermal filler that was hyaluronic acid based in the Journal of Cosmetic and Laser Therapy. A granulomatous reaction is a delayed onset inflammatory nodule that is usually painless, that occurs much later than the so-called allergic reaction in individuals who have painful swellings, such as those who have received the Moderna vaccine and found that the site of the facial filler injection previously became painful. The key thing here is that in order for us to diagnose a granulomatous reaction, it’s going to take a longitudinal study for as long as 5 years before we can determine if it was truly a problem in individuals who received the vaccine, and also had the facial filler injected.
In 2015, in the Journal of Dermatologic Surgery, there was a series whereby the author conducted a retrospective chart review of patients who were treated with HA fillers, within a 5 year period, to evaluate for delayed onset nodules. The conclusion was that although they are pretty uncommon, it is important to be aware of this side effect, and to have a management protocol in place. In their conclusion, the authors also said that from the patients responses and from the literature, that these nodules are immune-mediated in nature.
What I’m trying to say is that because we are currently in an unprecedented public health situation internationally, where we have a raging pandemic that’s deadly, we may have to reconsider the risk that we might be taking with aesthetic treatments. Now, I do perform facial filler and botox injections, but the truth is, vaccinations are going to be a priority for most people and most countries in order for us to get the pandemic under control. I feel that the public should realize that we are also not going to be 100% certain how these facial fillers will further on be affected by these vaccines -for example, the development of granulomatous reactions. The truth is, if you already had a facial filler, I certainly don’t think that should deter you from getting a vaccines because these are established complications. If you do have it then, visit an accredited dermatologist who will be able to diagnose it accurately and will be able to treat it.
A word of caution here, not all painful filler related swellings are due to an immunologic response to the vaccine, depending on the characteristics observed during clinical examination, your dermatologist will also evaluate you for other differential diagnoses which may also include atypical infections. These are usually a result of poor aseptic technique, which introduces environmental bacteria into the deeper tissues.
Overall, my two cents is that if you are thinking of getting a facial filler, as a dermatologist, I feel that you certainly can wait. The reason is really because the cost of human life in this pandemic, simply outweighs any other considerations that one may have.
The human facial structure is a composite of skin (the epidermis and dermis) the subcutaneous fat, the SMAS layer, the muscle and ageing affects all these structures dynamically, fillers only address one part of the ageing equation – restoration of volume. In terms of restoring facial structure and facial sagging – which can be corrected with other technologies such as: radiofrequency, High Intensity Focused Ultrasound, which do not involve injection of other substances into your body tissues. A board-certified dermatologist or plastic surgeon will be able to advise you on these options.
The CollagenUp Facial Wand is a FDA approved device that includes cleansing + treatment + toning + radiofrequency + red photon + blue photon + EMS functions for the ultimate home-based skin rejuvenation system.
Advances in our understanding of textile cosmeceuticals in the form of polysaccharides,polymers and nanoparticle materials can create an optimal skin microenvironment that stimulates collagen production, improving the hydration of the stratum corneum that creates plumpness and firmness of the skin.
In conclusion, if you’ve had a facial filler before, don’t let that deter you from getting the vaccine, as the cost of human life is much greater and this is a known filler complication (definitely enhanced by the vaccine) but the benefits will outweigh the risks. If you ARE thinking of getting fillers done, my personal opinion is that you may wish to consider alternatives, given the current context of our pandemic.
WHY YOU SHOULD APPLY YOUR SKINCARE PRODUCTS WITH YOUR RING FINGER
How we apply our skincare is very important. Have you ever wondered why most skincare brands recommend in their product directions to use the ring finger and not any other fingers in applying and gently massaging the product unto your skin especially when it involves the eye area? That is because out of our 5 fingers, our ring finger is said to have the weakest touch. The manner on how you massage your face while cleansing it and how you apply your skincare and makeup products, even just simply scratching it or wiping it can add up to protecting the quality of your skin.
Our skin is very delicate and we want to avoid excessively tugging it whenever we apply our skincare or makeup products because this can cause our skin to show early signs of ageing. Applying with our ring finger gives an equal amount of pressure when applying products. You can easily cause wrinkles with too much pressure, and our ring finger is recommended for the least amount of pressure and pull.
Most especially when it comes to applying eye creams, using our ring finger is the best. The skin around our eyes is the most delicate among the rest, and it is most commonly the first to show the earliest sign of ageing. Mishandling of the skin around our eyes like aggressive removal of eye makeup and heavily dragging eye care products and any other skincare product unto our skin can cause eye wrinkles, crow’s feet, and other skin irritations.
That being said, no matter how the ring finger is said to be the lightest, we still have to be mindful whenever we use it to come into contact with our skin. Same with any other finger. Always work your serums, eye creams, and any other product into your skin using light, tapping motions making sure to avoid rubbing and tugging. No matter how expensive your skincare product is, the manner on how you apply it will tell how to get the most out of it.
HOW TO APPLY YOUR SKINCARE- EYE CREAM
Ever looked in the mirror and thought “My eye wrinkles are becoming more obvious each day”?
The Elixir-V™ Eyes is an eye cream that is meant to prevent dark eye circles, excessive puffiness of the eyes and eye wrinkles. Like the Elixir-V serum, it contains potent oligopeptides used for lifting and repair and our signature Larecea™ extract for regeneration. An additional ingredient is niacinamide, used for brightening. While the Elixir-V serum is meant for the skin, the Elixir-V Eyes is focused on protecting the beauty of your eyes. We believe that your eyes are the most noticeable and beautiful parts of your face. Hence, it is meant to anti-age the sensitive skin around your eyes.