During pregnancy, women commonly experience many physiological changes, including changes in hormone levels, such as increases in androgen levels. This may result in acne development or worsening of acne, as well as an increase in hair growth. The safety of common skincare agents used for acne as well as bleaching creams and hair removal products for pregnant women are often undermined, even though most skincare products are safe and not expected to cause malformations or adverse effects on the developing foetus. In this article, learn how women can still look and feel their best with a pregnancy-safe skincare routine, without putting their developing foetus at risk.
How does the skin change during pregnancy?
During pregnancy, a change in hormonal levels and blood flow can cause changes in the skin. Firstly, there may be an increase in pigmentation – dark patches developing on facial skin, a condition known as chloasma. To prevent worsening, avoid sun exposure as the rays can cause more dark spots to form. Many women tend to become more acne-prone during pregnancy as well. Lastly, stretch marks are also common during the second and third trimesters.
Are topical antibacterials safe?
Topical antibacterials such as clindamycin and erythromycin are used either by itself or as adjunct topical treatments for acne. A study showed that clindamycin resulted in no increased risk of malformations among 647 women with use in the first, second or third trimester of pregnancy. Furthermore, consuming erythromycin during pregnancy has not been associated with causing abnormal birth defects in several thousand women.
Skincare ingredients to avoid
The amount of drug absorbed from the skin after applying retinoids is very low, however, there have been 4 published case reports of birth defects in the literature associated with topical tretinoin use. How harmful the use of retinoids is during pregnancy is unclear as 2 prospective studies that examined use during the first trimester of pregnancy with 96 and 106 women did not find an increased risk of major malformations. However, until data on larger groups of subjects are collected, it is recommended that women should switch to other safer alternatives other than retinoid-based products. One of the most safe and effective is glycolic acid, in addition to topical benzoyl peroxide and topical salicylic acid.
Skin whitening agent – Hydroquinone
Clinically, hydroquinone is used as a topical depigmenting agent for skin conditions such as melasma, and cosmetically, it is used as a skin-whitening agent. Research has shown that an estimated 35% to 45% is systemically absorbed following topical use in humans. Based on current available evidence, topical use of hydroquinone during pregnancy is not associated with increased risk of major malformations or other adverse effects for the foetus. However, due to fairly substantial absorption compared with other skincare products, it is recommended to be used sparingly or switch to other safer alternatives. Studies show that alpha hydroxy acids, such as citric and lactic acids, are effective in treating hyperpigmentation, and they are generally safe to use in pregnancy.
According to Dr. Teo Wan Lin, in her book Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare:“most people think organic skincare is either eco-friendly, natural or vegan. Here’s the catch, they can and cannot be. 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).
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.”
Pregnancy-safe skincare ingredients
Many use sunscreens to protect their skin from the sun’s harmful UV rays. Research conducted shows that sunscreens have very limited systemic absorption. Additionally, sunscreens have been used in pregnant women to treat or prevent melasma, and there have been no adverse events reported. One can consider mineral-based sunscreens, which include zinc oxide and titanium dioxide, that protect the skin by forcing the UV rays to bounce off of the skin entirely.
The SunProtector™ is formulated with physical blockers like titanium dioxide and zinc oxide that effectively blocks blue light emitted by indoor devices. It is a pregnancy-safe skincare product that contains Portulaca Oleracea (Purslane) and Oligopeptides in our SunProtector™ are potent antioxidants which actively fight free radicals generated by blue light as well as airborne pollutants – for comprehensive protection.
The first pregnancy-safe skincare ingredient is Glycolic acid is an alpha hydroxy acid that can be found in many skincare products. There have not been any studies analysing the use of glycolic acid in pregnant women, however, application of topical glycolic acid during pregnancy is safe as only a small amount is expected to be absorbed systemically, hence it will unlikely cause harm to the foetus.
The nextpregnancy-safe skincare ingredient is the inclusion of shea butter, which acts as a phytoceramide. It is a plant-derived, ceramide-like molecule that helps to maintain a healthy protective skin barrier in the skin. There are new sources of ceramides such as phytoceramides (ceramide-like molecules derived from plant seed oils).
The Radiancé Fluide™ Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. A pregnancy-safe skincare product that is specially formulated for a light-weight feel to impart a radiant glow without make-up.
Functional dermatology refers to the use of pharmaceutically active, botanical ingredients. A lot of drugs are actually derived from plants – it applies these principles to formulas. This includes natural ingredients specifically tailored to individual patient concerns like pigmentation, oily/acne prone skin and eczema. As scientific knowledge of dermatology advances, so will the discovery of the immense potential of botanical and plant extracts in both skin and hair cosmeceuticals. Furthermore, botanical cosmeceutical extracts do not involve the synthetic ingredients that often have an environmental impact in the manufacturing process.
These ingredients would also be safe for pregnant women, who wish to continue their anti-ageing skincare throughout pregnancy. This narrowed down the choice of ingredients to plant-derived actives which had also demonstrated efficacy in the laboratory testing phase.
Many cosmetic and skincare products contain the ingredient salicylic acid and the amount of systemic absorption varies. Many published studies show that there is no increase in the baseline risk of adverse events, such as major malformations, preterm birth, or low birth weight in women who have taken low-dose acetylsalicylic acid during pregnancy. Additionally, since only a small proportion of salicylic acid will be absorbed through the skin, it is highly unlikely to cause harm to a developing baby, hence can be considered as another pregnancy-safe skincare ingredient.
Bozzo P, Chua-Gocheco A, Einarson A. Safety of skin care products during pregnancy. Can Fam Physician. 2011;57(6):665-667.
Sheet masks work on the basis of occlusion, meaning when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. The question of efficacy is not so much of whether it is a traditional mask (presumably referring to clay masks or gels applied onto skin as it is) or sheet mask, but really depends on what is the active ingredient contained in the mask. With precise active ingredients, the type of mask (sheet or gel for instance) becomes secondary in terms of efficacy, as in my practice for example, whenever I want to increase absorption of any topical that is dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.
Are overnight masks more effective?
It is too much to generalise to say that overnight masks are more effective because it really depends on the active ingredients. All sleeping mask formulas are the same as moisturisers, as these are leave-in rather than wash-off ingredients. They work by absorbing onto the skin to produce moisturising effects. In leaving a topical on the skin for more than 12 hours for example, it would be important to first ascertain suitability of the ingredients, preservative and vehicle, including concentrations and types, and all of the components being intended to be applied on the skin for an extended period and not as a wash off.
It is really a good marketing invention, because this encourages people to apply the proper amount of moisturiser, which is a really liberal amount, overnight, as during the day they may not be as inclined to because of whitish cream residue that may be seen under makeup. If the active ingredients contain irritating substances such as lactic, salicylic, glycol acids or retinols, one could actually develop skin irritation or skin allergies from masking over an extended period. Most topicals would be fully absorbed into the skin within a couple of hours, so it’s not necessary to leave something on overnight. It is more important to consider that a liberal amount of a good moisturiser is used during sleep, as that is when the skin repairs itself.
The Radiance Fluide 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.
Is it necessary to mask the skin? What are the benefits of masking?
I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture to the skin and include ingredients (wash-off) which cannot be incorporated into leave-on moisturisers. The benefits of masking is largely associated with increasing skin moisture, so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as potent antioxidants which can be plant derived.
Can you overdo masking? If yes, how do you know if you are overdoing it?
If you are using some form of cosmetic clay masks, I do not recommend doing so as these frequently contain astringents which excessively dries out the oil on one’s face using salicylic and lactic acids, typically marketed as products for acne prone skin. I do not recommend any of my acne patients to do that because when they are on medical treatment for acne, a common side effect is dry dehydrated skin. Conversely, one who is doing a home masking regimen that is marketed for reducing oily skin as well as acne, in place of seeking medical treatment for acne, it is possible that he or she ends up using masks containing salicylic and lactic acids (or clay derived products that dries out the skin) too often and may develop skin allergies or eczema. Overdoing masking in this case leads to skin that is dry, irritated, flaky and some people may develop more severe reactions. It is therefore important to get your skin condition properly diagnosed by an accredited dermatologist, rather than simply relying on DIY methods.
My preference for a wash-off face mask is a gel mask formula – Amino Acid 360° Masque. This enables a gentle, non-astringent effect, delivers vitamin C(for acne scars) and other antioxidants in a soothing gel that can be refrigerated to cool post-laser/chemical peel skin, and can also be tolerated by eczema/rosacea patients as well.
Can you mask daily?
Yes definitely. When the mask contains cosmeceutical active ingredients clinically proven to work on skin, these help to reverse the process of photoaging can have a skin brightening effect. As long as the mask delivers moisture and appropriate antioxidant ingredients instead of astringents (such as clay or charcoal) there is no limit to the number of times one can mask. Another tip I have for budget DIY masks? Use your favourite ceramide-based moisturiser this way. For intensive treatment, apply a liberal amount of this moisturiser up to 3 times a day and on top of it use a soft damp cotton towel or the blank mask sheets (without essences) to increase absorption.
Can you combine different masks at one time? Or use one after another? And if so, what are some good combinations to follow?
I would not recommend that because of the types of ingredients that may be present in masks that specifically target for example oily skin. In this case, some people may consider their T zone to be oilier and decide to use salicylic or lactic acid infused mask for those areas and a hydrating mask for other areas. In theory, this may seem like a good idea. However, from a dermatologist’s perspective, it is much more efficient in the treatment of oily skin, to apply chemical peel that contains a higher concentration of salicylic acid, lactic acid or glycolic acid as a procedure done at a dermatologist’s office and subsequently rinse it off, rather than having very low concentrations present in a leave-on mask, because the effects will most likely be not as good and over time, may cause skin irritation.
Are there certain masks better suited for certain skin types (eg: peel-off, clay, cream for dry skin, oily skin etc.)?
I typically do not recommend astringent masks (which may include those marketed as clay types or for oily skin) for any skin condition, even super oily skin, because these are not proven to help acne treatment. The face mask that I would recommend would be those for skin moisturisation.
How do you choose the right mask if you have a few different skin problems (eg: dull complexion, dehydrated skin, breakouts all at once) – which skin problem should you address first?
The key thing here is looking at the root of each of these conditions and treating them. For example, a dull complexion is actually related to the ageing process where the skin cells turnover at a slower rate than somebody who is more youthful. In terms of addressing this problem, I would recommend using cosmeceuticals which are applied on to the skin and absorbed, together with chemical peels as well as lasers if necessary as recommended by your dermatologist. Dehydrated skin is quite tricky, because if your skin is so dry that it starts flaking or becomes red, you may be suffering from a form of facial eczema and it is important to have it treated medically, understanding that this is not about face masking at all. In terms of breakouts, acne itself is considered a medical condition that can be treated. It is also not treatable by skincare or face masks on their own. If the acne is severe enough, one may require oral medications, or if it is hormonal, medications like oral contraceptive pills may help to control the underlying problem.
Must I follow strictly to the time stated on the instructions during mask applications? What can go wrong if the mask is applied for longer than required?
For sheet masks, when the mask has dried up due to the process of evaporation, there would really be no point in applying that to one’s skin as there will be no extra benefits. Also, if the active ingredients contain something which is meant to control oil production, it can cause the skin to be very irritated and dry with excessive application. In fact, it may cause problems as excessively long application could increase the likelihood of skin allergy towards such active ingredients.
With clay masks or other types of astringent masks for example, it can certainly cause the skin to develop facial eczema when applied for too long.
The 360 Conscious Mask Bar
Our 360 Conscious Mask Bar subscription is a “Skin & Hair Gym” membership based on the principles of ethnobotany and clean cosmeceuticals. The Mask Bar is a gender neutral self-care concept centred on a universal compact Home Mask Bar System, with hyperpersonalised cosmeceutical essence vials delivered on a monthly subscription basis to your home.
The Mask Bar subscriptions comes with 2x Polysaccharide masks per month, and 3x customized cosmeceutical essence vials, and a 4L Mask Bar. The energy-efficient 4L Mask Bar is designed to toggle between optimal preset temperatures of 8°Celsius for anti-inflammatory cold therapy and 55°Celsius for relaxing thermal therapy for scalp and hair treatment.
The 360° Conscious Mask Bar also comes with private access to skin and haircare masterclasses by Dr. Teo Wan Lin. The dermatology masterclass series focuses on the science of skincare/haircare and the treatment of common dermatological conditions such as rosacea, acne and eczema. Class material includes video tutorials, transcripts and worksheets. A private access code will be sent to your inbox with the purchase of the Mask Bar System.
Exfoliation, or the removal of dead skin cells from the outermost layer of the skin, is an important and necessary part of any skincare routine. However, if the word ‘exfoliation’ conjures up the action of scrubbing your face with harsh granules, you may be doing more harm to your skin than good. So what is the right exfoliation technique for your skin? In this article we will give you tips on how to exfoliate the face, including excerpts from Skincare Bible: Dermatologist’s Tips for Cosmeceutical Skincare by Dr. Teo Wan Lin,dermatologist at TWL Specialist Skin & Laser Centre.
Types of exfoliation
Exfoliation can happen in two forms: physical and chemical.
Physical exfoliation: Physical exfoliation relies on the rubbing of granules, particles or materials (cloths, sponges) over the face to remove dead skin cells by gentle mechanical force.
While this kind of exfoliation can leave you feeling refreshed, the technique can be too harsh for the skin, especially for individuals with acne-prone or sensitive skin. Physical exfoliation may even weaken the skin’s barrier function and leave your skin red or irritated.
This is a no-no for those with active acne, rosacea and eczema.
Chemical exfoliation: Chemical exfoliation relies on fruit enzymes and gentle acids to slough off dead skin. This mechanism is much more controlled, gentler than physical exfoliation and suitable for acne-prone and sensitive skin types (lactic acids, polyhydroxy acids, salicylic acids).
Chemical peels should be performed at a dermatologist’s office under medical supervision. The active ingredient used is much more concentrated and effective, and hence has the potential to cause severe skin irritation. These peels have to be washed off right after the procedure, and otherwise have the potential to cause severe chemical burns. When used appropriately, chemical peels are a safe and effective way to remove dead skin cells and increase collagen production, inhibit pigmentation, reduce active seborrhoea and have an anti-ageing effect overall. With regular use, these treatments exfoliate the face and improve fine lines, wrinkles, skin discolouration and texture.
Glycolic, lactic or salicylic acid is commonly used. An accredited dermatologist is best able to identify the type of peel for your skin. Some
Individuals with active eczema or rosacea will not be suitable for chemical peels, hence it is important to get diagnosed and treated.
Types of exfoliating acids
The two most well-known type of exfoliating acids is alpha hydroxy acids (AHA) and beta hydroxy acids (BHA).
AHAs: Alpha hydroxy acids work by causing skin cells to detach from the outermost layer of skin, making them easier to slough off. Once the dead skin cells are removed, new cells can rise to the surface.
Common AHAs used as chemical exfoliants are lactic, glycolic and mandelic acid.
Glycolic acid: Glycolic acid is the strongest AHA as it has the smallest AHA molecule. As such, it is able to penetrate deeper into the skin and can exfoliate the face at lower concentrations compared to other acids. However, if you are just beginning to try out chemical exfoliants, a different acid should be considered
Lactic acid: Apart from exfoliating, lactic acid also moisturises. Individuals with dry skin can consider lactic acid for this dual function.
Mandelic acid: With a larger molecular structure, mandelic acid is not able to penetrate deeply into the skin. This makes it a gentle AHA and safe to use, especially for people with sensitive skin.
BHAs: Beta hydroxy acids (BHAs) differ from other AHAs as they are oil-soluble. This property allows them to penetrate deeper into our skin and pores.
BHAs exfoliate the face by softening the outermost layer of skin cells and dissolving unwanted skin debris. They also have anti-inflammatory and antibacterial properties, making them ideal for individuals with oily and acne-prone skin.
How to exfoliate the face: home-use chemical exfoliation
Online vendors are often providing home chemical peel kits which I would never recommend for the above reasons. Many doctor skincare products contain low doses of glycolic acids (AHAs) and lactic/salicylic acids but I have intentionally omitted these in my cosmeceutical formulations.
In my clinical practice, I have observed that the use of such clinical formulations over a period of time is one of the biggest risk factors do developing skin sensitivity, which really is a form of eczema known as irritant contact dermatitis. I would recommend using active ingredients such as a stabilised, pH neutral form of vitamin C (sodium ascorbyl phosphate as opposed to the acidic L-ascorbic acid) hyaluronic acid, phyto-antioxidant plant extracts such as Brassica oleracea (Larecea™) which have been proven to have robust anti-oxidant, UV-protective abilities without the risk of irritation.
The best at-home chemical peel equivalent
The effects of the SilkPeel Home Facial Peel System are that of microdermabrasion which has a similar effect to microscopic skin exfoliation. This is achieved in a clinical setting with chemical peel acids such as glycolic acid, salicylic acid and lactic acid. These, however, are legally used only by trained medical personnel, and should not be supplied to home users. This silk peel provides an at home chemical peel system that is both safe and effective. It has the additional benefit of delivering bioactive cosmeceuticals to the skin, with the use of the Amino Acid Masque for example.
The key feature of our SilkPeel is the CUIONS microcrystalline head. The microcrystalline head effectively performs gentle microdermabrasion when used together with the Amino Acid Masque. This is a home-equivalent to in-clinic diamond microdermabrasion — the home facial kit version designed to be much less irritating to the skin while performing the function of microdermabrasion. We have engineered the copper ion head specifically to have a less abrasive structure than the traditional diamond heads, while retaining the microdermabrasion feature to gently exfoliate dead skin cells. It is suitable for sensitive skin, and can be done safely at home without medical supervision.
Benefits of exfoliation
We shed dead skin cells naturally as new skin cells slowly travel up from the deepest skin layers to the surface. On average, this process takes about 27 days. As we age, this cell turnover process slows down.
When we exfoliate the face, we remove the build-up of dead skin cells. Regular exfoliation can reveal younger, brighter skin with an even tone.
The benefits of chemical exfoliation may make it tempting to use AHAs and BHAs often. However, too much exfoliation can disrupt your skin barrier and cause the skin to become red and inflamed.
Discuss with your dermatologist how often you should get chemical peels.
Are you looking to exfoliate the face with a chemical peel procedure? TWL Specialist Skin and Laser Centre offers in-clinic photorejuvenation chemical peel procedures.Click button on bottom left to schedule an appointment with us.
What constitutes a ‘skin problem’? It is best defined in laypersons terms as a visible disorder of the skin that has affected your quality of life. Based on the symptoms of the disease, it’s important to consider that all almost all skin conditions start mild, and they progress over a period of time. Acute dermatological conditions such as rashes related to infections or hives tend to be related to an underlying systemic disorder such as a viral infection. A dermatologist is trained to distinguish between acute and chronic skin problems. He or she can also identify the underlying cause of the skin rashes, and recommend comprehensive care for your condition including the types of products that should be used.
Sudden Red Rashes due to Viral or Bacterial Exanthems
Some helpful screening questions for acute rashes in dermatology would be the presence of fever, coryzal symptoms i.e. cough, runny nose, sore throat. A dermatologist can decide if it is related to the underlying infection or it’s a separate dermatological disorder. Rashes linked to underlying infections are known as exanthems and can be diagnosed with a full blood count, which can show a viral or bacterial infection. If it is due to an allergy, the eosinophils can be raised.
Exanthems are treated symptomatically with a combination of topical steroids, antihistamines, moisturizers and gentle cleansers.
Itchy Red Rashes on the Face and Body
However, one could also have concomitant skin reactivity or sensitivity, known as eczema. There are different forms of eczema under the term dermatitis. Seborrheic dermatitis, atopic dermatitis, perioral dermatitis are all forms of eczema.
If you are struggling with acne that is persistent over a period of several months with more pimples and if you are already an adult struggling with this issue, then you should also visit dermatologists. This is especially so if over the counter medicated creams for acne such as those containing benzoyl peroxide salicylic acid are not working for you. It may be a sign that your acne requires specialist treatment.
In addition, acne causes scarring, that can cause psychosocial distress in the medium to long term. It is important to understand that acne, can cause psychological problems, so it is best to have it treated promptly to minimize further scarring. If you are suffering from eczema and have been using a gentle cleanser and a dermatologist recommended moisturizer for some time without improvement, you should see a dermatologist. This is also because the condition may progress, and you will likely need prescription topical steroids.
Is my skin condition due to my skincare products? Is it bad to use different face products?
Perioral dermatitis in particular looks like hormonal acne, and is sometimes misdiagnosed by non-specialists. It presents as a cluster of red bumps around the mouth area, which may be itchy or painful. The condition can be caused by the use of many different types of products in individuals who like to experiment with skincare. Switching skincare very often, especially products which contain AHAs, BHAs like salicylic acid can be a risk for those predisposed to developing perioral dermatitis. Gentle dermatologist recommended cleansers are best, as opposed to cosmetic cleansers. For makeup removal, micellar water can cause more skin dryness than oil emulsion “milk cleansers” which are gentler on eczema-prone sensitive skin.
In perioral dermatitis, oil-based cleansers can trigger off flareups. Toothpaste can also aggravate the dermatitis. An SLS-free toothpaste, or a mint-free formula can be beneficial. Sunblocks and sunscreens are necessary in preventing sun-induced skin sensitivity. However, certain formulas can trigger off perioral dermatitis. A dermatologist recommended sunblock such as the SunProtector which contains skin soothing anti-oxidant purslane extract (portulaca oleracea), with a combination of both physical block and chemical sunscreen is best for broad-spectrum UV protection in sensitive skin.
Certain brands of chemical sunscreen will irritate sensitive skin. However, pure physical sunblocks tend to leave a whitish cast and have poor cosmetic effect. At Dr. TWL Dermaceuticals, we formulate a sunscreen which is a combination of both physical and chemical block, which does not leave a whitish cast and is dermatologist recommended for rosacea, acne-prone, eczema type skin.
Perioral dermatitis needs to be diagnosed and treated by a dermatologist
Treatment of perioral dermatitis is challenging and usually a course of oral antibiotics, together with topical treatment. It is important for an individual who’s suffering from this condition to visit an accredited dermatologist for accurate diagnosis and treatment. This condition traditionally does not respond well to topical cream management. Skincare moisturizers can actually worsen perioral dermatitis. Traditional dermatologist recommended moisturizers may not work well in patients with perioral dermatitis.
Occlusive ingredients such as mineral oil and paraffin in particular will trigger flare-ups and must be avoided. Preservative-free hyaluronic acid based moisturizers such as the 1% pure hyaluronic acid serum by Dr.TWL Dermaceuticals is prescribed in the clinic for skin conditions such as eczema, rosacea and acne may be better tolerated. It is multi-molecular weighted, which ensures optimal absorption of the serum. Common preservatives in skincare formulations can actually trigger perioral dermatitis, and are not dermatologist recommended.
Dr. Teo Wan Lin is the host of a beauty podcast- Dermatologist Talks: Science of Beauty, which covers the latest in skincare active ingredients, dermatology news and beauty technology. Listen to her podcast here.
In this Conscious Beauty blog series which ties in with the launch of my podcast- Dermatologist Talks: Science of Beauty- I will be sharing about skincare tips in common dermatological conditions. Do you suffer from facial redness or flushing? Facial erythema can be caused by acne, rosacea, eczema and even autoimmune diseases like lupus. Most commonly, facial redness is due to rosacea. It is a disorder where the skin’s blood vessels are abnormally active leading to persistent skin inflammation. This article will focus on dermatologist rosacea skincare tips, medical therapies, as well as the role that a rosacea skincare routine has to play in treatment.
Rosacea Symptoms, Signs and Diagnosis
Rosacea is a dermatological condition characterised by the tendency of one’s skin to become flushed or red. This can happen in the presence of certain triggers or when the disease is advanced, it may present as persistent redness. It is a condition affecting many in Singapore. It can also be fully treated by a dermatologist.
How does the skin look like? Firstly, there is persistent flushing, which presents as redness on the face. In skin of color, the redness may not be obvious. However the individual over time develops skin textural changes, which can become disfiguring. Irregular skin texture, enlarged pores and eventual skin thickening are medium to long term complications of untreated rosacea.
In general, onset of the skin inflammation occurs when one is between 30 to 50 and tends to affect fair skinned individuals from a Celtic or Scandinavian ancestry. It is also seen commonly in Chinese people in Singapore.
Rosacea is diagnosed visually, examining the skin around the nose and eyes, and from asking more questions. Before giving you a diagnosis, your dermatologist would have to rule out other medical conditions that can look like rosacea. Medical tests can help to rule out conditions like lupus and allergic skin reactions.
Family history: It is more likely for you to get rosacea if you have a family member who also has rosacea. It is possible that people inherit the gene for rosacea.
Immune system: Research has found that many people who have acne-like rosacea, or papulopustular rosacea, react to a bacterium called bacillus oleronius. This reaction causes their immune system to overreact.
Intestinal bug: H Pylori is a bug that causes infections in the intestine. This bug is also common in those with rosacea. There is a hypothesis about the Helicobacter pylori bacteria colonizing the gut of rosacea patients, which explains why treatment with metronidazole can be effective in treatment.
Skin mite: Demodex is a mite that lives around the nose and cheek areas on the skin. This is where rosacea often appears. Studies have found that people with rosacea have large numbers of this mite on their skin.
Processing of protein: The protein cathelicidin usually protects the skin from infection. How the body processes this protein may determine whether a person gets rosacea.
Topical treatment can include brimonidine, metronidazole and azelaic acid. However, these have irritating side effects.There is increasing evidence to support the use of cosmeceuticals, which do not have side effects, for the adjunct treatment of rosacea. At TWL Specialist Skin & Laser Centre, our dermatologist uses cosmeceuticals for the treatment of mild to moderate rosacea, in combination with oral treatment where necessary. Anti-inflammatory oral antibiotics may be required for papulopustular subtypes i.e. tetracycline, erythromycin, to reduce skin inflammation. In severe papulopustular variants, isotretinoin may be required. Light therapies and lasers may be of value as adjunct treatments.
Rosacea Skincare Tip #1 Respect the Skin Barrier When Cleansing and Moisturising
We’re going to talk about the role of the skin barrier in rosacea.
The skin barrier is best thought of as the physical “wall” that separates the external and our internal cell environment. An intact skin barrier protects from external allergens and environmental damage. An individual with rosacea may have associated eczema, making face redness worse. This can be pre-existing childhood eczema or due to external factors such as harsh drying skincare.
When you suffer from a dermatological condition like rosacea, it is important to have it treated by an accredited skin specialist. Your rosacea skincare routine affects skin barrier function. When it is intact, there is less inflammation and facial redness will improve.
In your rosacea skincare routine, gentle cleansers are recommended. For foaming cleansers-these can be amino- acid based or formulated with lower SLS (sodium laureth sulfate) content. SLS- free cleansers usually contain alternatives like ammonium-laureth sulfate. Laureth sulfates can all strip the skin of moisture. SLS-alternative foaming cleansers can be natural emulsifiers, such as soy-based or honey. Medical-grade honey is purified and retains bioactive properties. It is a broad-spectrum anti-microbial. It inhibits bacteria, fungi and also moisturises the skin.
The function of gentle cleansers for rosacea can be two-fold. First by emulsifying the dirt, oil and grime in a lather which is then rinsed off. Second, the best cleanser leaves a beneficial residual effect on skin. It continues to act after the cleanser is washed off. This is possible with medical-grade honey cleansers that have a natural humectant property, trapping water under the skin’s surface. This reduces trans-epidermal water loss (TEWL).
If you wear makeup, double-cleansing is recommended. The type of cleanser to remove makeup has to effectively dissolve oil-soluble makeup pigments. An oil cleanser or a oil-in-water cleanser (usually formulated as a milk cleanser) will be gentler on your skin then a micellar formulation.
Rosacea Cleansing Tips Explained by a Dermatologist
Gentle skincare is key. The goal of a rosacea skincare routine is to maintain integrity of skin barrier while avoiding agents that cause inflammation/flushing. Non-soap cleansers with synthetic detergents (pH 4.0-6.5) are better tolerated than traditional soaps (pH >6.5). Avoid harsh topicals such as toners, exfoliating agents and astringents. In erythematotelangiectatic rosacea and facial erythema (flushing), telangiectasia, eczema-like features such as skin sensitivity (burning or stinging sensation), dryness and scaling can be present. The redness can also affect other areas e.g. scalp, ears, neck and chest.
Repair the skin barrier while undergoing rosacea treatment. Facial redness can be caused or worsened due to facial eczema. If you have itch, swelling and skin flaking, you may have dermatitis, which can co-exist with other dermatological conditions.
The Best Type of Moisturiser for Sensitive Skin
Moisturisers in your rosacea skincare routine should target barrier repair. The best moisturiser for sensitive skin and rosacea is one with ceramides. Ceramide-dominant moisturisers with an optimal lipid ratio help to replenish dehydrated skin. The gold standard moisturiser is formulated as a Prescription Emollient Device with additional anti-inflammatory ingredients. Hyaluronic acid and polyglutamic acid are additional hydrating molecules that do not leave a greasy feel in a tropical climate like Singapore. Polyglutamic acid is more effective than hyaluronic acid in attracting water molecules, but can be more expensive.
Rosacea Skincare Tip #2 Anti-Oxidants Target Inflammation
Inflammation occurs in rosacea. In papulopustular rosacea, inflammatory papules and pustules are present in addition to persistent face redness. Phymatous rosacea is a subtype of rosacea that shows thickened and coarse skin. Enlarged pores (dilated hair follicles on facial skin) may be a sign of rosacea, due to tissue overgrowth. Irregular skin texture can be due to nodules. These changes can get worse as one ages. Cosmeceutical skincare containing anti-oxidants fight inflammation in a healthy skincare regimen.
Importantly, skin inflammation in rosacea should be treated medically. This is because the end stage of persistent inflammation is a condition known as rhinophyma. Rhinophyma is disfiguring and surgical methods, including fractional CO2 laser resurfacing, may be required treatment when the disease is advanced.
Dermocosmetics are the latest development in cosmetic dermatology. There is evidence supporting botanical anti-inflammatories in skincare formulations.
As a rosacea skincare tip, active ingredients such as Gingko Biiloba, Camellia Sinensis, Aloe Vera, and Allantoin are beneficial in treatment. Gingko Biloba works for redness because of active terpenoids. Gingko reduces blood vessel hyperactivity through its anti-inflammatory effect. Polyphenols are powerful antioxidants that fight free radicals. Green tea known as camellia sinensis is a source of polyphenols that are anti-inflammatory. It has been shown to reduce UVB-induced inflammation. Bioactives in aloe vera include aloin, aloe emodin, aletinic acid, choline and choline salicylate which are anti-inflammatory. It can also balance the skin microbiome. Allantoin is a derivative of glyoxylic acid from the comfrey plant. It is a humectant and attracts moisture, restoring barrier function in patients with facial redness.
Common Misdiagnoses of Rosacea
Acne rosacea is the commonest subtype seen in dermatologist offices. It commonly occurs over the nose, forehead, cheeks and chin. An accredited dermatologist will be able to correctly diagnose, based on clinical examination, as well as symptoms derived from history taking. It mimics acne and can be mistaken for pimples. It is also possible for early rosacea to be misdiagnosed as facial eczema coexisting with acne, because of the background redness. The papule-pustular variant can appear with acne-like bumps, cysts, or nodules. The facial redness is due to visible blood vessels, also known as telangiectasia.
The flushing and skin swelling can look like sensitive skin or eczema. It also mimics the enlarged pores of oily skin-types, when in fact the thickened skin is due to rosacea. Flaking, redness and red bumps around the mouth can be due to perioral dermatitis. It can affect the eyes, resulting in blepharitis, where one develops red and irritated eyes. This can be confused with findings of ocular rosacea- dryness, irritation and a foreign body sensation. Other dermatological conditions that can mimic rosacea include seborrheic dermatitis, lupus erythematosus, polycythaemia rubra vera and carcinoid syndrome which are less common. Steroid-induced acne may be a consideration if there is a history of using steroid creams on the face.
Rosacea Skincare Tip #3 Sunprotection
While it has multifactorial origins, lifestyle factors affect rosacea significantly. Sun exposure, consumption of alcohol, emotions, spicy foods, medications, menopausal hot flushes, exercise and stress can trigger flare ups.
Sun protection is an essential component of a rosacea skincare routine. It is critical in treatment of all facial redness which is photosensitive. The cheeks are the most affected. As it is now covered by a face mask in a post-COVID19 world, sunblock may not be a practical measure of photoprotection. I have suggested in my research paper on maskne that UPF50+ biofunctional textiles be used as primary photoprotection with a face mask design. This means there is no need for reapplication.
However, as a rosace skincare tip, sunblock can also cause facial stinging in rosacea patients. A UPF50+ textile provides maximum broad spectrum UV-protection without any risk of skin irritation. For uncovered areas like the forehead, neck and upper chest, a broad-spectrum sunscreen is necessary. To prevent stinging, look for a sunscreen that is dermatologist-recommended. Also, UV-blocking ingredients such as titanium oxide and zinc oxide function as physical blockers are less sensitising. Look for additional protective ingredients such as dimethicone, cyclomethicone to prevent irritation from sunscreen ingredients.
Dermatologist’s Tip: Top Rosacea triggers
Various environmental or lifestyle factors can exacerbate rosacea. Heat, sunlight, stress, hot or cold weather, exercise, alcohol, spicy foods and certain skin care products. Emotions can also increase the frequency of disease flares. To reduce flushing after encounter with stimuli, applying cool compresses and transferring to cool environments may be helpful. Cold therapy can be harnessed for its anti-inflammatory effects.
Rosacea Skincare Tip #4 Cosmetic camouflage
The use of cosmetic products such as green colour correcting concealers can help. Cosmetic camouflage is a recognised intervention as part of rosacea treatment. Green-tinted concealers or foundation helps to camouflage facial redness. This can be followed by a flesh-coloured facial foundation to achieve a natural look. I develop a line of color-correcting concealers in my skincare makeup line that helps with concealing.
Dermatologist’s Tip: Best Concealer for Rosacea? It’s Green
Based on color science, green neutralises red, a color on the opposite end of the colour wheel. Cosmetic camouflage is an important part of rosacea treatment. It can alleviate psychosocial distress. Patients suffer significant embarrassment from episodes of facial redness. This perpetuates a cycle that makes the chronic condition more stressful.
Rosacea Skincare Tip #5 A daily skincare ritual can help with your skin and also boost your mood
Stress is a major trigger factor for rosacea. Some scientific ways to reduce psychological stress include cognitive reframing and mindfulness activities. Adopting a daily skincare ritual is beneficial mentally and physically for rosacea treatment. We have discussed the essential steps in a skincare regimen for sensitive, reactive skin. This maintains a healthy skin barrier, restores the skin microbiome and provides anti-oxidants to help protect. However, the additional value of a daily skincare ritual is that it improves psychological well being.
Self-care is a concept that allows the mind to re-charge together with the body. As a rosacea skincare tip, having a bed-time ritual for example, is healthy for sleep hygiene. Starting your work day with a ritual, can make you more productive. I created the 360 Conscious Mask Bar as a complete self-care concept with anti-inflammatory benefits for rosacea, sensitive/reactive skin patients. Cold therapy/ cryotherapy can be relaxing and soothing both physically and psychologically.
Conscious Beauty by Dr.TWL Dermaceuticals stars model-actress Sara Malakul Lane, international burlesque performer Sukki Singapora and dermatologist at TWL Specialist Skin & Laser Centre Dr. Teo Wan Lin. Feminine beauty as a modern tale told by the girls themselves, through the lens of fashion model-turned photographer Sabrina Sikora. E-book version only.100% of proceeds received from CONSCIOUS BEAUTY will go to charitable causes supported by Dr.TWL Dermaceuticals – Action for AIDS Singapore and the United Nations World Food Programme. Available on Amazon Kindle, and the Dr. TWL Dermaceuticals website.
“Your healing journey towards beauty, begins with your consciousness of the inner world,” Dr. Teo Wan Lin
Dr. Teo Wan Lin is an accredited dermatologist practising at TWL Specialist Skin & Laser Centre. An expert in dermocosmetics for skin diseases, the skin microbiome and biofunctional textiles, her work has been published in top dermatology journals. Her additional research interest is in the brain-skin connection which emphasises psychological wellbeing in sufferers of chronic skin disorders. In her journey of helping dermatology patients for over a decade in practice, she strongly believes that true beauty has to begin from the inside rather than from the external.
There has been a lot of skincare advice thrown around the internet- but not all of it is good. In fact, some of these “advice” may be harmful to your skin. It’s time to clear the air and put these skincare myths to rest, so that you can start making informed decisions when it comes to your skin.
Skincare Myth #1: Skin problems like pigmentation, acne and sensitive skin can be treated with skincare products and facials
Almost every brand is boasting a special cleanser or cream that can treat these problems over the counter, be it in the form of lightening cleansers or anti-acne cleansers or anti-redness creams. The truth is, healthy skin can be maintained with cosmeceutical skincare recommended by dermatologists, but when you have any one of these issues, they are actually true medical conditions of the skin.
My advice is, if you have any of these symptoms, stop self-medicating and applying a bunch of anti-redness or “sensitive skin” products. See a dermatologist as soon as you can because all of the above can be promptly treated with proper medications. This will probably save you a lot of pain, money and regret in the medium to long term.
I have seen so many patients who have spent thousands of dollars on online supplements, fad diets, facials at spas or aesthetic centres, did not get better and actually had a true dermatological condition, such as perioral dermatitis (which looks like acne, for example, but occurs in adults) and rosacea which can be effectively treated by a dermatologist with the correct medications.
Skincare Myth #2: Scrub and use a clay mask.
Dermatologists do not agree with a lot of what beauty companies/aesthetics providers are telling the public. 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, if you imagine using it like a sandpaper. In reality, you do not brighten or “exfoliate’’ your skin with that; 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 are also 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 and causing facial eczema in the long term. Yes it is possible to have oily acne prone skin and facial eczema at the same time.
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, so, do thorough brand research, check the ingredient list of your next bottle or just go with what your dermatologist would recommend.
TheSilkpeel Home Medi-facial Kit is a home chemical peel equivalent. The effects of the SilkPeel Home Facial Peel System are that of microdermabrasion which has a similar effect to microscopic skin exfoliation.
“Glass skin, a poreless appearance of the skin, popularised by K-beauty isn’t a myth. Cosmeceuticals such as polyglutamic acid, which is a large molecule, sits on the surface of the skin while functioning as a humectant 5x more effective than hyaluronic acid. The SilkPeel system utiliizes polyglutamic acid based solutions with potent antioxidants delivered via vacuum microdermabrasion that helps to achieve a translucent appearance of the skin, reducing the appearance of pores,” accredited dermatologist, Dr. Teo Wan Lin.
Skincare Myth #3: Lower SPF coverage is fine, since SPF represents the duration of sun protection, not the quality.
I read this in a beauty magazine about an aesthetic doctor’s sunscreen product and honestly this is the sort of stuff that would make a dermatologist cringe, because it is dangerous to spread this sort of belief and sun protection isn’t just about beauty but also skin cancers. It is very enticing given our humid climate when such brands promise that their sun protection mist offers lightweight cover without leaving a white stain.
Skin cancer can be avoided with good sun protection. In fact, you should never go without a good sunscreen because the harmful sun rays is also the number one cause of ageing. However, beware of the dangers of misleading labels on sunscreens. You should go for a sunscreen recommended by your dermatologist that is at least SPF 30.
A sunscreen should effectively block both UVB and UVA rays, which is possible with an agent that has an SPF of 30 or greater. It is also important that your sunscreen is labeled with the term “broad spectrum”, which means it protects your skin against UVA rays. There are differences between 15, 30, and 50. SPF is measured in the laboratories whereby the amounts applied at 2g/cm2 and this never happens in real life.
And on top of that, most of us don’t apply sunscreen properly. SPF (sun protection factor) is derived by taking the time it takes you to burn with sunscreen on and dividing it by the time taken for you to burn without sunscreen on. SPF specifically protects against ultraviolet B (UVB) rays that cause sunburn. I would recommend a minimum of SPF 30 for an everyday sunscreen and SPF 50 when outdoors for extended periods of time.
The SunProtector is SPF 50/PA+++ and is exquisitely formulated for humid climates. It is a broad-spectrum sunscreen that also regenerates and soothes sensitive skin. Designed with unique pigments blended to be almost invisible under make-up.
In the current COVID-19 situation, people might think that there is no need to pay attention to stay at home skin care, since staying home is the safest environment for the skin. Whilst it’s true that the home environment is generally a lot more conducive than the outdoor environment for skin, such as avoiding onslaughts from the sun’s ultraviolet, there may be some lesser-known “dangers” to your skin while staying home. In this article, we seek to explore these lesser known stay at home skin care “dangers” and some tips to keep them at bay.
Stay At Home Skin Care “Dangers”
First of all, when indoors and leaving the air conditioning turned on all the time, you may not be paying attention to the ambient humidity. The combination of a dry environment caused by the air conditioner as well as the fact that it is a lot cooler than our usual climate, can increase a phenomenon known as transepidermal water loss. This essentially refers to evaporation of our skin’s innate moisture levels to the environment and this can cause a bit of dry skin in individuals who otherwise have normal skin. For people who are prone to dry sensitive skin, this constant indoor air condition environment may be severe enough to trigger an attack or flare up of eczema.
The other thing in the entire context of us staying home all the time, would be there is definitely less physical activity than if we went about our daily activities. This is especially so for people who are dependant on domestic help, for example, then they may be extremely sedentary during this stay home period and lack of exercise is not good for the skin as it is for the human body as a whole. The skin, like any organ, relies on perfusion or circulation and blood flow to deliver nutrients to it, and even more so, being the largest organ in the human body.
Furthermore, if you are gaining a lot of weight without exercise, that is detrimental to your skin in the long run because fats cells secrete testosterone. Testosterone is the male hormone that causes people to be more prone to acne and greasy skin. Finally, if you are always looking to snacking when you are at home, do bear in mind that if you are eating a lot of deep fried snacks like potato chips or sweets like chocolates and dairy, all these can increase your risk of inflammatory skin conditions, in particular conditions such as adult acne.
Stay At Home Skin Care Tips
The situation of the COVID-19 pandemic and us having to spend a lot of time at home, is a good opportunity for us to pay attention to what is first of all essential, efficient and sustainable, rather than “oh you know I got more time now I’m just going to add on a million and one things to my stay at home skin care regime”. It could be very opportunistic for beauty brands to advise anything otherwise. Therefore, from a dermatologist’s perspective, my advise doesn’t change whether it is in the time of a pandemic or in an ordinary day.
The basic principles are if you are suffering from a skin condition, please get it treated by an accredited dermatologist, rather than going around trying all sorts of different products or googling to see on beauty forums what people use or DIY methods. This is because none of these will work if you truly have a persistent skin problem, that is, anything lasting more than 2-3 weeks and is recurrent or chronic.
If you don’t get that out of the way, no matter how wonderful your skincare regime is, you’re not going to see results. In fact, it would be a blind process trying to encourage somebody to do a stay at home skin care regime, just because they are spending more time at home.
If you have healthy skin or say you are experiencing a little bit of ageing and want to optimise what you do for your skin, it is a good time for people to realise that facials, medispas and even what we consider therapeutic treatments such as cosmetic lasers or HIFU (High Intensity Focused Ultrasound) technology for aesthetic purposes, are not essential services. In a time such as now, these aesthetic services will not be available and are therefore not sustainable.
On the note of sustainability, it is important to see that whatever is science based and is a topical will fare better as stay at home skin care. If you are able to apply the topical yourself, the good news is that you are in full control of it and you do not need anyone else to apply it for you. Nonetheless, it is important to be a voice of discernment in this case so we hopefully can help people on this topic of science-based topicals, or cosmeceuticals.
Cosmeceuticals are cosmetics infused with pharmaceutically bioactive ingredients. There is currently limited regulatory control on cosmeceuticals, so it is important to do your brand and ingredient list research. As a general rule of thumb, we would recommend including plant antioxidants, so look out for an ingredient such as centella or portulaca oleracea which is something that we have included in all of our antioxidant skincare formulations.
In addition, we recommend as basics for stay at home skin care, the use of a stabilised vitamin C serum and a ceramide-based moisturiser. Stabilised vitamin C, such as sodium ascorbyl phosphate, is effective in conferring would healing benefits to skin even at concentrations of 5% or less. This is whilst avoiding the pitfall of skin irritation as with raw un-stabilised ascorbic acid, which is often formulated in higher concentrations at >10% to counter the ease of degradation in atmospheric oxygen. Ceramides, on the other hand, are like to the skin, the cement used to stick brick walls together, and help maintain healthy skin barrier function to regulate water loss which any good moisturiser should.
There is no point in using just serums blindly in a stay at home skin care routine, because at some point in time you do need a cream. This is so even if your skin is very greasy and the key thing is to avoid occlusive creams like paraffin and vaseline. Instead, go for a moisturising cream well formulated with ceramides, which will be helpful even if you have greasy skin. In fact, to treat the greasiness on skin, moisturisers play an important role to target the underlying seborrhea, often a form of reactive seborrhea whereby the skin produces even more oil because of stripping away of its natural oils.
Conversely, with a good moisturiser that hydrates the skin, the skin would gradually learn to produce less oil and become less greasy. For intense hydration and oil control on greasy skin, a well formulated Hyaluronic Acid serum in the range of 1% concentration is essential and would prove essential in stay at home skin care. Do note most commercial brands have concentrations of hyaluronic acid much lower.
A good cleanser also plays an important part in any stay at home skin care routine. If you are wearing makeup, makeup removal is done either with a micellar formulation or an oil based emulsion which essentially both function to dissolve pigments, and the same with mascara, eye makeup and lipstick. However, when staying at home and not really putting on makeup, the second layer in cleansing the skin is probably more important and it may be worth looking closely into the function of your cleanser’s ingredients.
In our practice, we recommend a Honey Cleanser. Honey is naturally anti-bacterial and the cleanser further contains an Arnica Montana flower extract that soothes and calms the skin. The cleanser is also gentle on the skin, and avoids the use of skin-drying surfactants such as sodium laureth sulphate which strips away the skin’s natural oils.
We can’t emphasise enough the importance of using a good cleanser and cleansing regularly. Even if you’re not outdoors, don’t get exposed to pollutants or don’t sweat, know that your body naturally produces some oil. This is the case even if you think your skin is very dry, and excess oil on the skin surface contacts and oxidises with particulates in your house environment, which is how clogged pores are formed.
There could also be lots of indoor pollutants and the indoor environment may not actually be necessarily much better than the outdoors.Very limited studies have been done with indoor pollutants like benzenes, volatile agents, formaldehyde emitted from your furniture, paintwork etc and how these affect the skin. Nonetheless, it is postulated that these will generate some form of free radical formation on the surface of your skin, which contributes to skin ageing. Keeping your skin clean and moisturised is no doubt an important part of cosmeceuticals in a stay at home skin care routine.
The COVID pandemic worldwide is unprecedented. We at TWL Skin started our Specialist Dermatology Telemedicine (or ‘teledermatology’ in short) service early in January as an accompaniment to the launch of our online skincare pharmacy Dr.TWL Pharmacy. This turns out to form the bulk of our consultations since COVID affected our sunny Singapore shores in March
As an accredited specialist dermatology clinic by the Ministry of Health, TWL Specialist Skin & Laser Centre helmed by Dr. Teo Wan Lin, remains open as part of an offsite specialist dermatology clinic offering essential medical dermatology care during this pandemic. Since Singapore’s circuit breaker was commenced, and now extended till 1 June 2020, our lives have all changed at least in one way or another. We check in with our dermatologist and medical director Dr. Teo Wan Lin, on how a day in the life of a dermatologist is like in the time of COVID!
How has your daily routine changed? How so in your specialist dermatology practice?
I used to start my day with horse riding at my club, swimming or attending a fencing lesson with my coach. These days, I get up early to garden, I am starting a lot of seedlings and rebooting my hydroponic system to get self-sufficient!
Work wise, I usually start at 10am and that is pretty much the same other than that I work from home most days, seeing patients via our teledermatology service.
My clinic TWL Specialist Skin and Laser Centre is a specialist dermatology practice and our medical dermatology services fall under essential services in this time of the Circuit Breaker. I started teledermatology consultations last month for the safety of our patients and staff. It was timely that we had finally launched the service in January for our overseas patients who had requested for it, and is now available for all our patients with doorstep contactless delivery service of prescription medications. Our online skincare pharmacy Dr.TWL Pharmacy also delivers prescriptive cosmeceuticals by our pharmacist and myself to specific skin concerns such as pigmentation, oily acne prone skin, sensitive skin and eczema.
Tell us more about the “new” day in your specialist dermatology practice?
My new day actually includes a lot more time for self-care! As I am not physically in the clinic other than for urgent procedures, I’ve also had to skip my regular in-clinic laser toning treatments for anti-ageing maintenance regime! I have that extra bit of time though working from home with self care which I believe is absolutely critical in this stay home period, for both our physical and mental wellbeing. So I’m doing my own home facial treatment these days with our medifacial kit, the SilkPeel, which comes with 3 cosmeceutical solutions similar to what we do in our clinic, but for home use!
Mentally, my new day is similar to my usual work day mindset. I am actually a workaholic when it comes to executing my ideas so nothing much has changed from there! I’m definitely spending a lot of time on gardening and researching on the topic of urban farming, which has been my passion for a long time.
I am working with my team at Dr.TWL Biomaterials to bring a portable Aquaponic set up prototype to fruition really soon, to be available for pre-order via our site. This allows breeding of both edible fish like tilapia as well as hydroponic growth of vegetables without the use of chemical solutions but rather fish waste. It’s also in the right direction for sustainability, and this covid pandemic has taught us that self-sufficiency may be a basic need, not just a bonus.
Dr. Teo, do you order your meals in or do you cook?
I cook all my meals usually unless I’m going out over the weekend- before the circuit breaker I had already been having home cooked meals. During the work week I use an electric lunchbox at work which I prepare the night before and simply steam it right at work!
What are you doing now with some extra at-home time?
Work wise, our consultations are fully teledermatology via a secure medical database system, which we make use of to provide top notch specialist dermatology care virtually as we would with any patient face to face. This gives me more control over my time and I am super excited to share that I am starting a personal blog on best skincare and skincare tips as a dermatologist’s guide for the public! I started opera lessons at the beginning of last year. I am practising my all time favourite song now Un Bel Di Vedremo from Madame Butterfly by Puccini, my lessons are now via zoom!
What is the first thing you want to do once this is over?
I can’t wait to start riding again, go for my fencing training, meet all my friends and loved ones. Going for my evening runs with my dog on the polo field, that’s exhilarating for me. Also just seeing patients, the personal touch is so important. That’s exactly why I became a doctor, because I really cherish the human connection and this is something that we clearly took for granted before COVID.
Many beauty writers have asked me what the ideal skincare routine should be, for today’s busy woman. Is there even such a routine? I have outlined the following— which are frequently asked questions posed by readers and my patients. In the following article, I plan to outline, in a scientific manner the way I have structured my own skincare routine. I recommend this also for my own patients and readers. It is important to learn how to efficiently apply cosmeceuticals as well as to understand the scientific basis for such a routine.
Dr.TWL Dermaceuticals is a dermatologist formulated cosmeceutical skincare range that is produced in a EUROISO22716 manufacturing facility, the gold standard in skincare manufacturing. The Dr.TWL Research and Development Team includes chemists working under the supervision of a pharmaceutical engineer and an accredited Singapore dermatologist.
Why do I need to have a different skincare routine in the morning or night?
Skincare routines recommended by dermatologists contain cosmeceutical active ingredients which help to repair and rejuvenate skin via topical absorption. Day skincare routines should include active ingredients like plant based anti-oxidants to actively fight photoaging due to sun exposure, cosmetic enhancers that can double up as skincare makeup. Dr.TWL develops a range of colour correction concealers to use with skin tone concealers for daytime use, they function as skincare that’s also makeup. They are infused with a cosmeceutical oligopeptide base— these function as makeup with pigments to cancel out redness, blemishes, pigmentation spots and sallowness, as well as skincare to treat and heal these problem areas.
Difference between Day and Night Cosmeceutical Actives
Night- Cosmeceutical Actives
Some ingredients, such as retinols or retinoids cause sunsensitivity and should only be used at night and not in the day, due to the potential of sun exposure. Skin repairing ingredients such as phytoantioxidants, as well as ceramide based moisturisers (which tend to be thicker formulations, unsuitable for day time) help to regenerate the skin during the sleep cycle, which is an important time for cellular rest and repair.
Day Cosmeceutical Actives
Vitamin C serum, for example, is a potent antioxidant that should be incorporated in the daytime routine(and night as well) especially because it helps to actively fend of the free radical formation due to sun-induced ageing (photoaging). Same goes for phyto(plant-derived) antioxidants.
Texture of product
Daytime routines should include a gentle cleanser to remove debris, brighten and prep skin for absorption, minimum vitamin C based cosmeceutical, a moisturiser and sunscreen. The texture of all these products should be as “light” as possible while fulfilling the function of delivering the active ingredients, because wearing heavy creamy thick products on the face disturbs application of makeup and gives a greasy look in our humid climate. The priority of daytime skincare would be to give the user the feel of the product being instantly absorbed and as invisible on skin as possible.
Cleansing differences between day and night
For normal to dry skin- gentle milk cleansing is recommended in the morning, to fulfil the function of removing debris, oil and residual skincare products overnight. For oily, acne-prone skin, an emulsifying cleanser helps to remove excessive oil and to prep skin for absorbing skincare. Night cleansing for those who wear makeup is a double cleanse— oil-soluble makeup pigments have to be dissolved in an oil or micellar formula, while the residue should be removed in a lathering(foaming) formula. Double cleansing is especially important for those with combination or oily skin.
Are there any products reserved for day-time use or night-time use?
Depends on the active ingredients— as above, if it contains retinols or its derivatives it would be sun-sensitising and should only be used at night, same with any topical cosmeceutical ingredients with the potential for skin irritation, these should be reserved at night. For daytime- plant derived anti-oxidants and vitamin C help to stave off photoaging by fighting free radical formation.
What are the products you would recommend for a day-time skincare routine?
What are the products you would recommend for a night-time skincare routine?
Double cleansing with an emulsion cleanser for makeup removal and a gentle cleanser thereafter, an antioxidant serum ( such as containing Resveratrol, vitamin C, phytoantioxidants) and a moisturiser containing ceramide.
Some dermatologists are known to recommend sunscreen-use at night. Would you say you agree? Why?
I do not think it is necessary nor practical. Sunscreen is meant to protect against the damaging UV rays, which can cause sun induced photoaging and skin cancers. Sunscreens tend to contain some oil- based solvents and sleeping in it will cause stains on pillowcases.
Will having a separate day-time and night-time routine have a significant positive impact on your complexion?
I would say having evidence based cosmeceutical active ingredients in your regimen is the key determinant of the efficacy of a routine. It is important to respect that certain ingredients as above are best incorporated into either a morning or nighttime routine due to its innate functions to maximise benefits and reduce side effects.
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.