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.
Are you wondering if it is necessary to incorporate a ‘wait time’ between each step of your skincare regime? Read on as we ask a dermatologist, Dr Teo Wan Lin, to find out.
1. Do you agree with the ‘waiting time’ skincare routine method? If so, why? If no, why?
From a dermatologist’s perspective, a skincare routine does not need ‘waiting time’. How well a product is absorbed by the skin depends on the active ingredient and the formulation of the product. It has to be cosmetically acceptable; asking someone to apply a heavy ointment in a humid climate like Singapore is unacceptable.
The ease of absorption is often perceived by users as how quickly the product disappears into the skin. However, this is not an accurate indicator of how well the product is functioning or if it is better absorbed than others.
There is a certain logic to layering your products. For ease of application, I recommend applying the lightest product, such as your serums, followed by lotion and lastly your cream or oilment.
In theory, so long as the product is applied onto the skin, the active ingredient will be absorbed by the skin. Yet, the perception of ease of absorption is subjective, simply because in a humid climate, users may not feel heavier creams are being absorbed even when it is already having an effect on your skin.
It is more important to consider the active ingredient of the product and how comfortable it goes to the skin rather than the waiting time.
2. There are clearly several steps to this ‘waiting time’ skincare routine method that is recommended, but is it even possible for our skin to absorb so much product? How much product are we able to absorb? Does it differ from person to person?
In my line of cosmeceuticals, we also advocate layering. Certain active ingredients are better delivered in a serum rather than lotion/cream as it is more effective. As long as one is applying products that are accurately formulated with evidence-based science such as in a dermatologist tested line, the active ingredients will be delivered to the skin and the user can enjoy its therapeutic benefit.
Instead of relying on ‘waiting time’, users can focus on how to enhance absorption of their product. A tip I tell my patients often is to apply skincare right after a shower, when the skin is slightly damp as it helps to enhance the skin’s ability to absorb the product.
Also, rather than considering the amount of product our skin is able to absorb, the more relevant question is to consider the environmental humidity and the formulation of product (cream/serum/ointment). The absorption of product is subjective on the environmental humidity.
Someone who applies an ointment will receive the therapeutic benefit of the medication but will not feel the product is being absorbed due to the greasy layer that is left on the skin. Consider again someone who applies a serum that contains nothing but the simplest of moisturizers, say glycerin. The user will feel this serum is very well-absorbed by the skin simply because it evaporates into the air.
3. What are the key steps/products/and or habits one should have to maintain a good complexion?
I always advocate proper skin cleansing. Most women do wear makeup. Yet, many makeup removers contain harsh astringents that can disrupt the skin barrier. Leaving behind makeup residue is also not desirable as it can cause bacteria and grime to build up, especially in our humid climate. For this reason, I always advocate the double cleansing method, such as with the Milk Cleanser and Honey Cleanser, for a thorough cleanse.
The second thing I would advocate is the use of cosmeceutical serums. The two must-have serums are Hyaluronic Acid serum and a stabilised Vitamin C serum. Hyaluronic acid helps the skin to retain moisture whilst Vitamin C is an essential antioxidant that helps to fight free radical damage.
One should also never forget sun protection. Your sunscreen should have UVA/B filters, an SPF of 30 to 50, and broad-spectrum protection. Above all that, a good sunscreen should contain antioxidants too. Another key thing is the amount of sunscreen applied, as people often apply too little sunblock needed. Reapplication every 3 to 4 hours is also advocated, especially when one is outdoors.
4. Do you feel that there are any skincare hacks out there that actually work?
Skincare ‘hacks’ can be dangerous as the skin is our largest organ and should be respected. There are no shortcuts to maintaining the health of your skin. When you visit a dermatologist, we often share with you the use of cosmeceuticals and retinoids for anti-ageing. Cosmetic procedures such as lasers are also available to help reverse effects of skin ageing.
A tip that everyone can abide by is to have a good diet rich in antioxidants, adopt a healthy lifestyle that has a sufficient amount of physical activity and to get adequate sleep every night.
One’s skin type is largely determined by the genetics of an individual.
The production of oil itself is genetically determined – if one has a family history of having oily skin, it is very likely that one would develop it as well, as this is directly linked to the production of androgens such as the male hormone testosterone at the onset of puberty which affects both males and females. Based on the proportion of patients at the clinic, there is a significant population of people with oily skin types in Singapore. This is because of overactivity of the sebaceous glands which are concentrated over the forehead nose and the chin area, but can also occur on any part of the face, as well as including the chest and back which are also the areas more acne-prone. Although further research needs to be done to prove the common belief that a humid climate like Singapore results in oily skin, what we do know is that climate changes can have an adverse impact on skin that is already diseased such as with underlying acne, facial eczema or rosacea which are the common skin conditions I see in my practice. Problems associated with oily skin type?
Acne is a major issue faced by those with oily skin. The cause of acne itself is multifactorial, involving primarily genetics which causes inflammation exacerbated by the production of oil often driven by hormonal factors, leading to the formation of whiteheads and blackheads. One of the ways of treating acne would include reducing oil production by the means of an oral medication known as isotretinoin or by physical methods, such as chemical peel microdermabrasion as well as laser treatments that will shrink the oil glands. To add clarity, while almost all acne prone patients have oily skin, this is not to say that having oily skin one definitely would suffer from acne.
Oily skin type and ageing
One popular belief is that individuals with oily skin do not age as quickly. A desirable side-effect of oily skin perhaps? Or perhaps not. Skin aging is due to a complex interplay of factors, with the key determining factor being a balance between one’s biology, influenced by genetics (have a look at how your parents are aging), as well as environmental aging, due to the exposure to ultraviolet rays, air pollutants, cigarette smoke as well as a stressful lifestyle. The key thing to note is that unhealthy skin ages poorly and much worse than healthy skin. In patients with facial eczema, for example, with dry dehydrated skin known as asteatosis, they are inherently unable to produce a fatty lipid known as ceramide, which helps to repair and restore the skin barrier. Without this, the skin is unable to protect itself from external allergens or changes in the environment and this can accelerate aging. Dehydrated skin has an unhealthy epidermis and dermis. As a result, this can accelerate aging in the form of wrinkles as well as the loss of volume. If one has oily skin, the production of oil can form a barrier between the skin and the environment and this is a sort of protection which reduces the formation of fine lines and wrinkles or what cause free radical formation. Nevertheless, if one has an underlying skin condition such as scarred skin due to previous cystic acne, it doesn’t matter that your skin is oily, one would expect skin aging to progress faster than in a normal individual. There is a study which shows that people with oily skin tend to look younger than their counterparts and this is well-proven in clinical practice. However, I would say that striving to have oily skin is actually not desirable, especially in a very humid climate like Singapore, as a shiny complexion could be quite embarrassing. Long-term overproduction of oil due to overactivity of the sebaceous glands can also lead to irregular skin texture and enlarged pores. It is best to strive for healthy radiant skin that is well moisturized but not oily. There is a difference between moisturizer and oil, as I have seen many patients with nodular cystic acne and oily skin who also suffer from facial eczema which is dry dehydrated skin. Well moisturized skin is smooth and radiant, and looks healthy – a key component of the skin’s moisture is from molecules such as ceramide and hyaluronic acid which is an abundant water molecule in the second layer skin known as the dermis. It is a myth that people with oily skin don’t really need moisturizer. In fact, you could have a lot of oil on your face and still have dehydrated skin that’s lacking in the key moisture molecules. Our patients who are on treatment for acne still use a good cosmeceutical moisturizer to lighten their scars, as well as Vitamin C and Hyaluronic acid serum that can restore the correct moisture balance in their skin to prevent excessive oil production known as reactive seborrhea. Reactive seborrhea occurs when one strips skin excessively of its natural oils causing the skin to produce even more oil. Can someone with oily skin type change to having normal skin with diligent skincare alone? The amount of oil produced by an individual is genetically determined and influenced by the secretion of one’s hormones. It is however possible with proper long term cosmeceutical skincare, that one’s skin becomes adjusted in terms of restoring the normal moisture level.
Using improper skin care such as harsh oily-skin cleansers may strip skin completely dry and this leads to a vicious cycle known as reactive seborrhea. The key ingredient involved in restoring skin moisture and not oil, is firstly a pure concentrated form of topical hyaluronic acid in our skin care. According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, “We use a 1% concentrated hyaluronic acid serum freshly-compounded for optimum absorption in a pharmaceutical setting. This is easily a hundred to a thousand times higher than the concentration available in cosmetic skin preparations boasting the same ingredients. Regular use of topical hyaluronic acid has the effect of visually filling and plumping up the dermis (the second layer of skin which tends to sag with dehydration and aging), leading to a poreless, even complexion”
In terms of cleansing, I would recommend using an antibacterial foaming cleanser. The honey cleanser is formulated to remove grime, oil, bacteria and other surface pollutants that tend to settle on the skin at the end of the day. The nature of oily skin is that it tends to be a breeding ground for bacteria as well as a certain type of yeast known as malassezia which thrives in a humid climate like Singapore. This is a non-chemical form of an antibacterial and antiseptic wash, using natural medical grade honey which helps in reducing the amount of grease on one’s face. As honey is a natural humectant, it traps moisture under the skin while cleansing. It thus helps to moisturize the skin and regulates the balance of the oils as well as health of the skin. For a targeted approach, treating oily skin – medically known as Hyperseborrhea, a visit to a dermatologist is recommended. This would typically involve counselling on the use of appropriate cosmeceuticals as well as a retinoid which can regulate oil production. Our patients would also undergo chemical peels (glycolic, lactic and salicylic acid peels) in combination with laser treatments that can help to shrink the oil glands and reduce oil production. From then on, once the amount of oil production is reduced, it is easier to maintain with topicals alone.
A skincare regime for oily skin type There is a recipe for healthy skin in the same way one is careful to have a healthy diet and lifestyle to prevent illness, rather than change one’s diet only after one gets sick. Whether or not you have dry, oily or combination skin, there is really skincare that is suited for you and the answer lies in dermatologist-tested cosmeceutical skincare. Cosmeceuticals are researched to include potent bioactive ingredients formulated to prevent the onset of aging, as well as to deliver nutrients to your skin. Such a skincare regimen, is likened to a healthy diet that will prevent skin problems from developing later. If you have an underlying skin condition, cosmeceutical skincare can also reduce the severity of acne and facial eczema. So it is indeed true, at least for cosmeceutical skincare, that there is a one-size-fits-all for all types of skin, as a recommendation for the basic healthy diet of skin.
The key conundrum in skincare that has been plaguing dermatologists in the last 50 years was really that the dermatologist-tested skincare (which is compatible with aging problem skin types) we advocated for our patients did not provide additional cosmeceutical benefits. These women then went looking for over-the-counter cosmetics skincare which promised them anti-aging, but clearly not without the irritation and side effects. Then the dermatological community turned its attention to clinically proven anti-oxidants in skincare and showed that cosmeceuticals were valid and important in the treatment of aging skin to restore skin health. The advent of cosmeceuticals promises the same level of non-irritating gentle skin cleansing and moisturizing, with all the power molecules antioxidants which can lighten scars, brighten your complexion and retard aging. What’s there not to love?
Do you suffer from symptoms such as skin redness, flaking, itch or stinging pain? Did you have eczema, asthma or sensitive nose when you were young, or have a family history of eczema or sensitive skin? Does your skin get red and itchy when you use makeup or skincare products, or when you are exposed to a dusty or sweaty environment? Does your skin act up when travelling to a cold or dry climate?
Dermatologists diagnose true “sensitive skin”, with a medical condition known as eczema, where common exposures to the environment or skincare and make up can trigger off flare-ups.
2. What Is Defined As Sensitive Skin Then?
People with sensitive skin are likely to have atopic dermatitis, which is a genetically determined condition where the skin is deficient in certain fats. The skin acts as a barrier to the environment and, without a proper functioning skin barrier, any dust, climate change, pet fur, or even emotional stress can trigger off a flare-up.
If you have never had any of these symptoms and suddenly experience “sensitivity”, especially soon after using a new skincare or makeup product, it might actually be a form of allergic contact dermatitis to an applied substance. This would be best reviewed by a dermatologist who might suggest a patch test and also receive appropriate medical treatment.
Undiagnosed and untreated skin sensitivity can become chronic and may result in scarring such as post-inflammatory hyperpigmentation which results in dark marks on one’s face.
Your dermatologist will prescribe you anti-inflammatory creams such as topical steroids of the appropriate strength and ceramide-rich emollients that replenish the skin barrier. In the case of any infection, oral antibiotics to clear the skin infection would also be prescribed. Oral steroids may also be required for severe eczema.
Here are three of the best skincare tips for people with sensitive skin:
1) Look for “dermatologically tested and formulated” labels that are produced in certified laboratories and that work with dermatologists rather than cosmetic brands.
2) Get your dermatologist to recommend a gentle cleanser formulated for effective cleansing of eczema-prone skin.
3) Get your sensitive skin treated first before using anti-ageing products
Many anti-ageing products contain stimulating ingredients which may worsen sensitive skin. If you do use them, look for a product that’s recommended by your dermatologist.
Meet with Dr. Teo Wan Lin, founder and Specialist Consultant Dermatologist of TWL Specialist Skin & Laser Centre, an accredited dermatologist specialising in medical and aesthetic dermatology. She integrates her artistic sensibility with her research background and specialist dermatologist training, by means of customised, evidence-based aesthetic treatments using state-of the-art machines, injectables (fillers and toxins) which work synergistically with her proprietary line of specialist dermatologist grade cosmeceuticals Dr.TWL Dermaceuticals.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email firstname.lastname@example.org. Alternatively, you may fill up our contact form here.