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.
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.
The following is a transcript from Dr. Teo Wan Lin’s podcast, Dermatologist Talks: Science of Beauty on fillers and vaccines. Subscribe to her podcast on a journey to discover the science of beauty. We’ll cover the science behind active ingredients and get deep into the cosmetic formulations. Stay on trend with the latest on botanical actives, technology and be part of our FUTURE OF BEAUTY.
29 DEC 2020: Hi guys, this is Dr. Teo Wan Lin, and welcome to this week’s dermatology flash briefing. The Moderna COVID-19 vaccine apparently causes swelling and inflammation in patients with cosmetic facial fillers. The FDA advisory committee reviewing the new Moderna vaccine, has come out to state this very specific side effect that has involved several trial participants who have had cosmetic facial fillers. I want to just quickly share with you guys today what exactly this is about, how it occurs, and if that’s something we ought to be worried about.
What exactly are dermal fillers?
Dermal fillers are used primarily for facial augmentation. The filling agents are meant to restore fullness in one’s appearance that could be lost over time with age as a result of subcutaneous fat atrophy, or a side effect of certain medications such as retroviral medications. The ideal facial filler should have the following properties: first of all, it should have physiologic compatibility with your body – meaning that it readily incorporates itself with your tissues. It should be free of complications or side effects, and ideally, it doesn’t degrade with time. But this is, of course, untrue for the commonest type of facial filler which is used in most cosmetic practices – that would be hyaluronic acid based and they should be relatively easy to administer. You also have alternatives such as those that are collagen based, or hydroxylapatite based – for example, Sculptra is from poly l lactic acid.
What are the side effects of facial fillers?
In terms of the known side effects from using these facial fillers as injectables, some of the common complications that occur would be tenderness, bleeding, bruising. When lumps and nodules occur, this can be because of inappropriate injection techniques, or accumulation of the filler in a more superficial location than expected.
So what’s the deal with the fillers and vaccines?
Now what’s happening with the Moderna vaccine and this painful facial swelling that occurs where facial fillers have been previously injected, its best thought of as an allergic reaction, or basically an immunological reaction. The key thing here is the process of injecting a vaccine, essentially causes the immune system to be stimulated. That in turn results in the body recognizing that the facial filler in that case, is not a part of the body tissues, and the body starts to mount an immunological reaction against it. Based on the cases that were reported to the FDA, the profile of these patients essentially had swelling and inflammation in the area that was administered the filler. A couple of the patients had the cheek filler 6 months prior to the vaccine, and one patient had lip filler done just 2 days after the vaccine. In all of these scenarios, the patients were treated with oral steroids, anti-histamines, and was observed that their reaction resolved.
What exactly is an allergic reaction?
Typically it is considered a medical event due to an immune system respond to a perceived allergen. It is not likely that these individuals would have developed this response had they not been given the vaccine. The reason is because facial fillers are medically engineered to be biocompatible, but in the case where you’ve had a vaccine, your immune system will start to detect that these substances that were injected, are actually not part of your body tissues.
What are your thoughts, as a dermatologist?
As a dermatologist, I have some opinions with regards to the observation of these adverse events. First of all, we do expect that massive rollout of vaccinations against the COVID19 virus is expected to be happening internationally, and I feel that it is a very important part in ensuring that we get some level of control and immunity in a very severe pandemic like COVID 19. In terms of immunological reactions that are occurring in response to facial fillers in this case, we note that the attendings have actually treated these patients with oral steroids.
We know that oral steroids suppress your immune system, and in fact, make you more vulnerable to the virus. Personally, I have not given oral steroids as far as possible to many of my patients in the last few months. For patients who otherwise would have benefitted from steroid therapy for chronic inflammatory disorders such as severe eczema, I have certainly been a lot more cautious in terms of exploring other therapies before using oral steroids. The reason is because it’s been known to worsen the prognosis in the event you do get COVID, and also, because it reduces your body’s natural immune system response – you’re going to be more susceptible to catching COVID.
The answer is not an easy one. Facial fillers are used in millions of people internationally, and it is not as if it is the first time we are hearing of an adverse reaction. Another known complication from facial filler injections that is relevant in the context of the modern vaccine would be non-allergic inflammatory responses- we call these granulomatous reactions. These don’t occur so quickly, and we right now have no long term data as to what the vaccination would do in terms of individuals who are going to have fillers or have had fillers, and who are going to receive the vaccine.
What are granulomatous reactions?
These granulomatous reactions are usually non-painful lumps, and it is all a part of inflammation that is caused by the immune system being stimulated. In fact, in 2017, there was a case report about a granulomatous reaction to a dermal filler that was hyaluronic acid based in the Journal of Cosmetic and Laser Therapy. A granulomatous reaction is a delayed onset inflammatory nodule that is usually painless, that occurs much later than the so-called allergic reaction in individuals who have painful swellings, such as those who have received the Moderna vaccine and found that the site of the facial filler injection previously became painful. The key thing here is that in order for us to diagnose a granulomatous reaction, it’s going to take a longitudinal study for as long as 5 years before we can determine if it was truly a problem in individuals who received the vaccine, and also had the facial filler injected.
In 2015, in the Journal of Dermatologic Surgery, there was a series whereby the author conducted a retrospective chart review of patients who were treated with HA fillers, within a 5 year period, to evaluate for delayed onset nodules. The conclusion was that although they are pretty uncommon, it is important to be aware of this side effect, and to have a management protocol in place. In their conclusion, the authors also said that from the patients responses and from the literature, that these nodules are immune-mediated in nature.
What I’m trying to say is that because we are currently in an unprecedented public health situation internationally, where we have a raging pandemic that’s deadly, we may have to reconsider the risk that we might be taking with aesthetic treatments. Now, I do perform facial filler and botox injections, but the truth is, vaccinations are going to be a priority for most people and most countries in order for us to get the pandemic under control. I feel that the public should realize that we are also not going to be 100% certain how these facial fillers will further on be affected by these vaccines -for example, the development of granulomatous reactions. The truth is, if you already had a facial filler, I certainly don’t think that should deter you from getting a vaccines because these are established complications. If you do have it then, visit an accredited dermatologist who will be able to diagnose it accurately and will be able to treat it.
A word of caution here, not all painful filler related swellings are due to an immunologic response to the vaccine, depending on the characteristics observed during clinical examination, your dermatologist will also evaluate you for other differential diagnoses which may also include atypical infections. These are usually a result of poor aseptic technique, which introduces environmental bacteria into the deeper tissues.
Overall, my two cents is that if you are thinking of getting a facial filler, as a dermatologist, I feel that you certainly can wait. The reason is really because the cost of human life in this pandemic, simply outweighs any other considerations that one may have.
The human facial structure is a composite of skin (the epidermis and dermis) the subcutaneous fat, the SMAS layer, the muscle and ageing affects all these structures dynamically, fillers only address one part of the ageing equation – restoration of volume. In terms of restoring facial structure and facial sagging – which can be corrected with other technologies such as: radiofrequency, High Intensity Focused Ultrasound, which do not involve injection of other substances into your body tissues. A board-certified dermatologist or plastic surgeon will be able to advise you on these options.
The CollagenUp Facial Wand is a FDA approved device that includes cleansing + treatment + toning + radiofrequency + red photon + blue photon + EMS functions for the ultimate home-based skin rejuvenation system.
Advances in our understanding of textile cosmeceuticals in the form of polysaccharides,polymers and nanoparticle materials can create an optimal skin microenvironment that stimulates collagen production, improving the hydration of the stratum corneum that creates plumpness and firmness of the skin.
In conclusion, if you’ve had a facial filler before, don’t let that deter you from getting the vaccine, as the cost of human life is much greater and this is a known filler complication (definitely enhanced by the vaccine) but the benefits will outweigh the risks. If you ARE thinking of getting fillers done, my personal opinion is that you may wish to consider alternatives, given the current context of our pandemic.
It is important to maintain a healthy barrier between your skin and the mask to minimize the chance of skin irritation. In this chapter on maskne skincare, we will touch on the fundamentals of the skin microbiome – the balance of good and bad bacteria and yeasts on one’s skin, and the importance of skin care to maintain the microbiome balance.
Maskne skincare recommendations for mask-wearing
The wearing of an occlusive face mask has implications for the absorption of skincare applied. A moist and humid environment increases the absorption of any topical applied to the skin, which in the case of acne treatments, can increase the irritation potential of the active ingredient(s)
When mixed with sweat, certain active ingredients may also be biochemically altered and cause dermatitis (eczema). Sunscreens commonly cause irritation in individuals with eczema, and wearing a chemical sunscreen (as opposed to a physical sunscreen) under occlusion and sweat will increase the chance of developing sensitivity to the sunscreen.
Choice of Cleanser
A gentle emulsifying cleanser is important for thorough cleansing. For individuals who wear makeup, double cleansing is recommended to remove residual sweat, grime, oil, and make-up build-up. For non-acne prone individuals who wish to prevent maskne, it may be time to get started on a gentle cleanser with antibacterial properties.
My personal maskne skincare recommendation is the cleanser from my cosmeceutical line formulated with medical-grade honey. Medical grade purified honey functions as a broad-spectrum antimicrobial with natural emulsifying properties.
Medical grade honey is used in the Miel Honey Cleanser which has natural emulsifying, antibacterial, anti-fungal properties for gentle and effective cleansing in eczema-prone individuals. Natural honey is also a humectant, trapping a layer of moisture for protection after cleansing.
Choice of Acne Pimple Cream
When it comes to maskne skincare, avoid acne spot creams with synthetic active ingredients such as retinoids, benzoxyl peroxide, salicylic acid as these will cause increased skin irritation (irritant contact dermatitis) when applied under the occlusion of a face mask. Individuals who apply retinoids for night acne treatment may find that wearing a mask in the day increases the risk of retinoid dermatitis, a form of eczema that leads to redness and flaking on the skin.
There are many different formulations of acne pimple creams. The ones that we are familiar with would be benzoyl peroxide, salicylic acid and even sulphur or tea tree oil base formulas. These have largely fallen out of favor in dermatologists in the last 2 years primarily because of irritation potential.
Benzoyl peroxide is also known to bleach fabrics and may alter the structural integrity of the face mask, rendering it less effective for control of droplet spread. Anti-inflammatory acne spot creams are recommended. Acne formulations with botanical actives such as Chlorella Vulgaris work by regulating sebum production, whilst natural moisturizing factors like amino acids fight inflammation and have additional moisturizing properties to protect the skin barrier.
The Blemish Spot Cream is formulated with an algae extract, Chlorella Vulgaris, that reduces the activity of oil glands and has anti-inflammatory properties. Natural Moisturising Factors (NMF) in the form of amino acids help to reduce scarring and promote wound healing of the pimple.
In the ideal maskne skincare routine, hydrocolloid acne patches are a maskne product that can be helpful because of the following reasons: 1. Prevents touching or picking which can lead to infection and scarring 2. Creates a moist microenvironment for faster and better healing 3. Increases absorption of active ingredients in pimple cream (non-irritating anti-inflammatory formulas recommended; avoid those with salicylic acid or retinols if you have sensitive skin) 4. Absorbs fluid to aid in quick resolution of acne papule/cyst
Hydrocolloid patches can sometimes contain active ingredients i.e. salicylic acid and benzoyl peroxide, hyaluronic acid and niacinamide, although it can certainly be used on its own with benefits as above. Overall, it helps acne papules heal faster by reducing inflammation.
Use of powder formulations to control excess oil and moisture
Mineral zinc oxide has anti-microbial and oil regulating properties. I currently recommend a loose powder formula for my acne-prone patients, as a maskne product as part of treatment for their oily skin. The benefits of using a zinc oxide powder formula for individuals suffering from maskne are as follows: control of bacteria as zinc oxide is antimicrobial, control of sebum regulation and absorption of excess moisture in those who suffer from hyperhidrosis (excess sweating). In addition, zinc oxide is an inert ingredient which means it is not affected by changes in pH or sweat.
For dry skin: Use protective emollient creams that contain barrier repairing ceramides and humectants such as polyglutamic acid, hyaluronic acid and natural moisturizing factors like amino acids. Avoid urea or lactate based humectants as this will likely cause skin irritation when mixed with sweat on the skin. Avoid occlusives such as white soft paraffin as this may increase the incidence of acne mechanica
The Multi-CERAM Cream is a new generation “Smart Moisturiser” formulated as a Prescription Emollient Device. It is formulated with an optimal skin lipid mixture, containing a mixture of plant-derived phytoceramides and synthetic ceramide. Antioxidants that fight skin inflammation are incorporated for optimal treatment of eczema.
For combination/oily skin: Use serums and emulsions/lotions rather than cream formulas. Cosmeceutical formulations containing plant anti-oxidants like Portulaca Oleracea, Centella Asiatica, Brassica Oleracea are anti-inflammatory and can be helpful in maintaining healthy skin function.
The Radiancé Fluide™ Hydrating Emulsion contains amino acids, oligopeptides and niacinamide for regeneration and skin brightening, specially formulated for a lightweight feel to impart a radiant glow.
The Elixir-V™ Total Recovery Serum is an intensely nourishing concentrate of deep hydrating, lifting and tightening peptides for the perfect V-face look.
Predominant outdoor mask wear in warm, humid climates
A maskne skincare tip would be to use serum or lotion vehicles instead of cream formulas. Choose humectants and emollients instead of occlusives (petroleum jelly, mineral oil-based liquid paraffin). This applies to both dry and combination/oily skin. The occlusive effect of the face mask in combination with a humid climate can lead to worsening of facial eczema and trigger occlusion acne
The Mineral Booster™ is power-packed with amino acids for repair, potent plant root extracts for UV-protection and polyglutamic acid for superior moisture retention.
When it comes to sunscreen as part of the ideal maskne skincare routine, the following issues are of concern here:
1. The oil solvent in sunscreen formulations can be comedogenic and can trigger off flare-ups of conditions such as perioral dermatitis. 2. The chemical sunscreen components (azobenzenes, cinnamates) can cause irritant contact dermatitis, which can be worsened by the occlusive effect of a face mask as well as by sweat accumulation on the skin. 3.The waterproof formula is necessary due to moisture and sweat build up under the face mask and will require frequent reapplication. 4. Reapplication of sunscreen under the face mask throughout the day may not be practical.
When one develops irritation after applying sunscreen, it is often due to chemical sunscreen components mixing with sweat. Some individuals feel stinging whenever they wear sunscreen, and it is usually not because they are allergic to sunscreen itself but it’s simply because the chemical block components can be altered via exposure to UV-light and when mixed with sweat (ammonia content).
The Sun Protector is exquisitely formulated for humid climates. It is a broad-spectrum sunscreen that also regenerates and soothes sensitive skin.
The relevance of UV-protection is not to be undermined. For normally healthy individuals, it is an important step to the prevention of photo-aging and skin cancers. For photosensitive individuals i.e. on acne treatment (retinoids/oral tetracycline), rosacea, lupus, post-laser, it is a key part of dermatological treatment. Sunscreen requirements should include broad-spectrum protection minimum SPF 30+, although the standard in dermatology practices are SPF 50+. Physical sunscreens are preferred over chemical sunscreens due to the inert formula of physical blockers, being less likely to trigger dermatitis.
Fabrics with ultraviolet-protective function (UPF
One part of maskne skincare, is the type of face mask chosen. All fabrics confer some level of protection from ultraviolet light, although for a garment to qualify as ultraviolet protective, there are key requirements, based on the current European guidelines. The design of the garment has to cover a maximal body surface area. Following which, the UPF-rating of the material itself depends on scientific measurements such as fiber chemistry, porosity, concentration, fluorescent whitening agents, UV-absorbers, and other finishing chemicals. While natural fibres such as cotton, silk and linen are breathable, they often confer very minimal to no UV protection. All approved UV-protective garments are synthetic in nature.
Currently, I recommend UV-protective fabrics for fabric masks, as a practical solution for sun protection during the pandemic. UPF 50+ qualifies for excellent protection according to the Skin Cancer Foundation Seal of Recommendation guidelines. A UPF 50 fabric blocks 98 percent of the sun’s rays and allows two percent (1/50th) to penetrate, thus reducing your exposure risk to UVA and UVB radiation, which causes photoaging, pigmentation and skin cancers.
Implications for individuals with skin pigmentation concerns
Given that it is highly recommended to wear a face mask during the COVID pandemic, it may be a turning point in dermatological care for the treatment of pigmentary disorders. Dermatologists are always looking at the topic of sun protection with great interest because firstly, it is the biggest contributor, other than our own genetics, to skin cancer. Secondly, it is the most significant external factor affecting aging, pigmentation disorders such as melasma and solar lentigines (sun spots). Sun protection advice for individuals suffering from facial pigmentation has been traditionally centered on the use of broad-brimmed hats, broad-spectrum sunscreens with minimum SPF 30.
With current recommendations to wear face masks, it is timely to revisit the topic of UV-protective clothing. In countries where there is a culture of sunbathing, there are higher rates of skin cancer, especially in individuals who are of a lighter skin phototype/have light-colored eyes i.e. blue or green eyes. The benefits of UV protective clothing is as such – offers gold standard protection with UPF 50+, not affected by factors such as reapplication (of sunscreen) or water-resistance. Fabrics are conferred with ultra-violet protection properties by way of specific material treatments, and are also required to meet the basic requirements of maximal skin coverage.
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.
Sensitive skin is typically characterized by dryness, flaking, sensations of stinging and itching associated with skin redness. It is actually a form of dermatitis otherwise known as eczema. I see a large number of patients who come in with complaints of persistent sensitive skin. What they often do not realise is that it is a form of eczema. Eczema can be caused by genetic factors and also external factors such as a change in environment and climate, presence of pollen, animal fur and dust. In this article, I shall share a few tips that I usually expound on with my patients and hopefully shed some light on this condition.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she tells us the science behind sensitive skin – a form of eczema.
What causes eczema?
Eczema is due to a defect in the skin barrier. The skin is best characterized by a brick and mortar model whereby the bricks of the skin cells are joined together by this cement which holds the skin cells together. People who have sensitive skin or eczema actually have defective ceramide which is the cement of the brick wall which is the skin. This is genetically determined and people who develop eczema in the later part of their lives can also have their condition triggered off by environmental factors such as differences in humidity from dry to humid weather and vice versa. The use of harsh cleansers can also cause eczema to develop over one’s lifetime.
Does ageing cause eczema?
With regards to the development of sensitive skin with age, the same concept of our body’s organ degenerating with age, our skin also degenerates. The main thing is the quality and quantity of ceramide which is produced throughout one’s lifetime decreases with age. On that note, skin can become more sensitive with age.
What should I look out for in sensitive skin products?
The ingredients that are essential for sensitive skin would be a moisturizer and a gentle cleanser. A gentle cleanser such as one that is formulated with minimal laureate sulfate content, which is the foaming component of a cleanser, would be beneficial for a patient who suffers from skin sensitivity. In addition, the use of a ceramide-containing moisturizer is essential. Traditional moisturizers contain humectants such as glycerine which trap water under the skin. Increasing research in dermatology shows that one should be replacing the defective and deficient ceramide content in the skin barrier by applying ceramide rich moisturizers. More information on using Dr.TWL’s Multi-CERAM Moisturizer for eczema treatment can be found here.
Dr.TWL Multi-CERAM Moisturizer is an ultra intensive skin moisturiser for total skin barrier repair with pharmaceutical grade ingredients. It contains phytoceramides which aids in skin barrier repair and multi-ceramide which aids in skin lipid restoration.
Dr.TWL Honey Cleanser is a blend of nature-derived emulsifiers. It is anti-flaking and supples skin. It is also recommended for all skin types as it is a gentle cleanser.
Where is ceramide from?
Sources of ceramide can be plant-derived, synthetic or from animals. Bovine ceramide is the typical source of ceramide used in moisturizers. Plant-derived ceramides which are phytoceramides is what I use in my practice. It contains these lipids which are extracted from plant seed oils.
Dr.TWL Radiance Fluide Hydrating Emulsion contains LARECEA™ Extract for regeneration and skin brightening ingredients for a dewy glow. It is specially formulated for a light-weight feel to impart a radiant glow without make-up. It also contains ceramide and grape seed oil, perfect for individuals with eczema and sensitive skin.
What ingredients should I avoid if I have sensitive skin?
The ingredients that one should avoid when you have sensitive skin will be things like astringents, so any alcohol-based gel, toners or lotions should be avoided because these tend to dry up the skin further. In addition, irritating ingredients such as alpha hydroxy acids and salicylic acids are commonly used for the treatment of acne as well as for skin exfoliation, these will definitely trigger off skin sensitivity.
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.
Custom beauty? You have probably heard this term recently, with the launch of multiple custom skincare lines. Fresh off the press for us at Dr.TWL Dermaceuticals though, is our new division of Custom Cosmeceutical Makeup. Read on in the first of a 2-part interview with our founder, accredited dermatologist Dr. Teo Wan Lin
What is the Pi-π Cosmeceutical Custom Makeup Lab about?
ThePi- π Cosmeceutical Custom Makeup Lab offers scientifically created skin-tone matched cosmeceutical makeup, including colour correction concealers, as an extension of my established skincare arm, Dr.TWL Dermaceuticals. Our Flagship offering includes an in-house Dr.TWL Lip Lab which features a 100% edible, anti-ageing cosmeceutical, the LipSerum Stick™, which is a solid state lipstick customised to any shade you want! Our advanced colour science system recommends different shades of each color- pinks, berrys, reds, nudes and corals that would uniquely flatter different skin tones.
Why does makeup— including concealers, foundations, lipsticks— need to be customised? Why not a generic “works for all” product, like most mass produced brands?
Why a generic “works for all” product is not ideal for makeup is because of the variety and uniqueness of skin tones. Every individual’s skin tones is different—based on our scientific database, we have on record at least 100 shades of distinct skin tones, whereas most makeup brands have at most 6 or 7 colour shades for foundations and concealers. This variation in skin tones translates into different shades of each lipstick colour that would work ideally for each individual.
What are the advantages of the LipSerum Stick, compared to store bought lipsticks, other than the fact it can be customised to any colour?
Store bought lipsticks cause allergies in individuals with existing lip conditions like eczema and cheilitis. The lips are also one of the first areas to suffer ageing related concerns such as lip discolouration, wrinkles and loss of volume. I then came up with the idea of a topically applied lip cosmeceutical serum with anti-ageing salmon roe DNA, which is also suitable for eczema sufferers, that could also be customised with your favourite lip pigment.
What are the limitations of traditional lipstick selections?
Lipstick brands have a limited selection of colours. Everyone has a favourite colour for a different mood—pinks, berrys, reds, nudes and corals— but did you know that different shades of each can be created to flatter different skin tones? We worked with veteran makeup artists and scientist to create the Dr.TWL Advanced Colour Science System to recommend the perfect lip colour match for each skin tone, whether you want it classic, sweet, sexy or nude.
What’s so unique about this custom makeup lab? Is it just custom blend makeup?
It’s the first dermatologist-led custom makeup laboratory in the world which fuses both skincare and makeup, via the use of cosmeceutical bases and unlimited variations of colours for foundations, concealers, colour correctors to match every skin tone, via our Advanced Colour Science System developed by our team of scientists, in consultation with veteran makeup artists. It’s not just custom blended for you, it’s cosmeceutical base is adjusted to target underlying skin conditions such as pigmentation, blemishes and ageing.
What was your inspiration for the Custom Cosmeceutical Makeup Lab?
My patients who I treat for a variety of skin conditions such as acne, pigmentation, rosacea, eczema and sensitive skin. There is a lack of sensitive-skin compatible makeup for these patients who need coverage and camouflage during the skin healing process. Besides, Singapore has a diverse ethnic mix which includes darker skin tones that many makeup brands do not cater for. I treat a lot of darker skin toned patients in my practice who cannot find their perfect foundation/concealer match.
What were some of the problems with the mass market makeup products that you faced?
Previously, I would recommend patients with sensitive skin/eczema issues to use pure mineral makeup, which has the lowest risk for causing skin irritation and allergies, as pure mineral pigments are chemically stable/inert with no reactions. However, I soon realised that the these commercial brands also had additives such as bismuth oxychloride and talc which function as bulking agents, and these were irritating to skin, with some even reporting that they felt the texture was that of “cut glass”!
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.
In my previous articles, I have talked about cosmeceuticals and the importance of incorporating them in our daily routines. However, how do we enhance the skin absorption of these cosmeceuticals? Here I will be talking about the limitations of topical formulations and how we can overcome them to ultimately achieve the results that we desire.
The problem with topical formulations for your skin
The outermost layer of the skin, called the stratum corneum, acts as a natural barrier. It prevents foreign material from entering our system, shields us against environmental factors and prevents excessive water loss. The skin is a formidable barrier to the passage of substances into and out of the body, but it can be manipulated to allow it to become a viable pathway for drug administration.
Drug products applied to the skin’s surface penetrate the skin layers to a certain extent, where they can exert their effects. This is the case for topical formulations for treatment of skin disorders such as acne, dermatitis, and psoriasis. However, very few drugs are suitable for delivery by the topical route, as passive penetration through the skin is limited to very small molecules (<500Da), which are neutral and relatively lipophilic. Some considerations of dermatologists would be the vehicle of the topical, specifically if it is in a lotion, cream or ointment form, in increasing order of absorption and effectiveness. This however, is often limited by user preferences, with ointment formulas (more efficacious) deemed cosmetically less acceptable.
The skin is the largest organ of the human body, comprising 15% of body weight and therefore its use to deliver medicine to the body is not a new concept by any means. Advancements made by modern science are improving the skin’s potential as a route for drug administration. Dermatologists are at the forefront of research relating to transdermal drug delivery, given the unique accessibility of the largest organ of the body.
Owing to the drawbacks of topical formulations, transdermal patches have been developed to improve drug delivery through the skin and this is an area that my team has actively researched in the last year as an adjunct to our cosmeceutical formulations.
I have always been interested in finding new methods to allow my patients to achieve optimal results from our cosmeceuticals, thus in this article I shall share some tools which I employ in my clinical practice to achieve optimal absorption of cosmeceutical active ingredients.
Wet Wrap/Occlusion Skin Therapy & Facial Masks
A well known method employed by dermatologists to treat severe eczema known as wet wrap is actually a simple process involving applying a wet textile together with topical medications to skin, to increase absorption of skincare. An example of how and when wet wraps are used— during particularly intense eczema flares with severe itch or pain, wet wrap therapy rehydrates and enhances the absorption of topical medications applied on the skin. The fabric wraps are soaked in water and applied to the affected skin on the body. Wet wraps are best done after bathing, moisturising and applying topicals, then left overnight.
Wet wraps work via 3 different ways:
● Cooling — as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness
● Moisturising — cosmeceuticals covered over with wet bandages are deeply absorbed in to the skin to provide a longer-lasting moisturising effect
● Absorption — enhanced absorption of any topicals into both the superficial and deeper layers of skin where inflammation is present
Facial sheet masks work in a similar way, on the basis of occlusion. This means that when there’s a topical which is applied on the skin and also in contact with something moist such as a sheet mask, there is increased absorption of the topicals by the skin. In my practice, whenever I want to increase absorption of cosmeceuticals and moisturisers that are dispensed to patients, I would advise them to apply a wet cotton sheet (as a wet wrap) on to their face to increase absorption.
I would consider masking as something which is very good to do if you are already diligent with other aspects of skin health such as cleansing and applying cosmeceuticals. Using a face mask would deliver moisture and clinically active ingredients to the skin—so it is important to look out for ingredients such as glycerin, ceramide and hyaluronic acid, as well as evidence-based antioxidants for anti-ageing such as oligopeptides, vitamin C ( I use sodium ascorbyl phosphate which is a neutral, rather than acidic form of vitamin C, that has minimal skin irritation). Here’s a tip, use a cosmeceutical moisturiser like the Radiance Fluide™ and increase your skin’s absorption by applying it on damp skin, plus a soft wet cotton towel over it.
Performing a facial massage, such as with the aid of a facial roller before application of cosmeceuticals could increase the skincare absorption, leading to better effects of the anti- aging skincare. Local massage is an established treatment method of improving surgical scars, by stimulating blood flow and improving wound healing. A peer-reviewed study published in a medical journal Complementary Therapies in Medicine led by author Miyaji Akane at the Institute for Liberal Arts, Tokyo Institute of Technology (Tokyo Tech) and colleagues at Tokyo Healthcare University and the Research and Development Center, MTG Co. Ltd. in 2019 had examined the effects of using a facial roller on facial skin and blood flow. The study concluded that there was significantly increased vascular (blood vessel) dilation with use of the facial massage roller. This means that there will be increased absorption of any cosmeceuticals applied on the face following the massage.
My recommendation would be manual rather than electric facial rollers as the latter may cause excessive pressure and irritation (being automated) and is also dependent on user training as well as the manufacturer’s settings, with a potential risk of overheating of electric components. Manual facial massage is a self-regulated process as the user can immediately sense irritation and apply just the right amount of pressure.
Transdermal medications (usually in the form of a patch) are a little more modern and complex. Great strides in transdermal drug delivery have been made since the first transdermal drug was approved by the FDA in 1979.
Transdermal drugs bring medication through the skin, to the bloodstream. Once in the bloodstream, the ingredients circulate and take effect at a targeted location. Medication is delivered steadily and can be stopped simply by removing the patch. Since your body doesn’t have to digest the medicine through the stomach, a higher concentration reaches the bloodstream. The medication permeates the skin in a controlled fashion thus attaining more ready levels of the drug in the body.
The science behind polymers and transdermal drug delivery systems
Polymers are vital in a transdermal drug delivery system. Systems for transdermal delivery are assembled as a multilayered polymeric laminates consisting of a drug reservoir sandwiched in between 2 polymeric layers:
● An outer impervious backing — prevents the loss of drug
● An inner polymeric layer — functions as an adhesive and rate-controlling membrane There are 3 types of transdermal drug delivery systems:
● Reservoir systems
In this system, the drug reservoir is embedded between a backing layer and a rate-controlling membrane.
● Matrix Systems
In this system, the drug reservoir is either dispersed in an adhesive polymer or in a hydrophilic or lipophilic polymer matrix.
● Micro-reservoir Systems
This system is a combination of the above 2 systems. The drug reservoir is formed by suspending the drug in an aqueous solution and then dispersing the solution in a lipophilic polymer to form thousands of microscopic spheres of drug reservoirs.
Polymers used in transdermal delivery systems should have biocompatibility with the drug and other components of the system. They should also provide consistent, effective delivery of a drug throughout the product’s intended shelf life.
An example of a common polymer used are silicones, also known as polysiloxanes, made of many repeating units of siloxanes. Siloxanes are chains of alternating silicon and oxygen atoms that are often combined with carbon and/or hydrogen. Medical grade silicones are silicones that undergo specific testing for their biocompatibility and have been deemed appropriate to be used for medical applications. Topical silicone therapy is often used by plastic surgeons and dermatologists to treat and heal scars.
Key considerations of a polymer patch used for transdermal drug delivery would be —conformability of the material to be applied to irregular skin or scar surfaces, sensitive regions such as the face/eye area and the overall durability and biocompatibility of medical grade polymers.
The process of skin ageing relates to the ability of the body’s natural healing processes. The same cells which are activated during cell injury are the ones which lose function with ageing, and are responsible for loss of collagen, elastin and the overall loss of volume and elasticity of skin. Specifically, antiageing cosmeceuticals target and stimulate cells known as fibroblasts, which are best thought of as the “soldiers” of wound healing which produce collagen to seal up injured or damaged skin. Injury to the skin occurs over a gradual process in the case of ageing, due to the slowing of one’s biological clock and photodamage.
For the last year, my team and I worked with a material scientist to develop a transdermal delivery patch, the QRASER™ Transdermal absorption patch, launched in July 2019. This patch works via a matrix system of drug delivery. In this system, the drug reservoir is dispersed in an adhesive polymer matrix. The transdermal delivery patch uses a unique polymer technology that mimics the natural hydration and homeostasis of the skin barrier, to enhance cosmeceutical absorption. The focus is on improving absorption via optimisation of the skin healing microenvironment.
The result? Healthy collagen production thus reducing fine lines and wrinkles.
In conclusion, cosmeceuticals in the arena of dermatologist-led skincare research will be increasingly prominent in the next decade of “smart skincare”. This should be emphasised along with understanding of how these topicals work, the limitations of skincare absorption and potential technologies such as transdermal delivery patches which can optimise the anti-ageing benefits of cosmeceutical skincare.
Dr. Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, is one of Singapore’s prominent dermatologists specialising in medical and aesthetic dermatology. She is also the founder of Dr.TWL Dermaceuticals which specialised in cosmeceutical skincare. In July 2019, a material science arm Dr.TWL Biomaterials was launched focusing on novel biomaterials for skin and hair application. Click here for the links to our product and here to read more about Dr.TWL Dermaceuticals and here to read more about Dr.TWL Biomaterials.
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