Have you noticed that some parts of your skin are dry while other parts are oily? This is known as combination skin. Combination skin is characterized by an oily T-zone while the cheeks are either normal or dry. How to tell if you have combination skin? Wash your face with your normal cleanser, then wait an hour. If your T-zone is oily whereas your cheeks are either normal or dry, you have combination skin.
Combination skin is thought to be one of the most common skin types. When it comes to skincare routines, hydrating creams are too hydrating, oil-absorbing masks are too absorbing, balancing lotions never seem to do much balancing… It can be tricky to figure out how to care for your skin properly.
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 combination skin – skin that is both dry and oily.
Skin that is both dry and oily boils down to an underlying pathology of the skin which is much more common in acne-prone individuals is known as seborrhea, which is overactivity of the oil gland. It is part of the causes of teenage and adult acne. Even when you have seborrhea, it is possible for you to have a deficiency in the ceramide content of your skin barrier leading to dry skin. The production of ceramide is genetically determined. You could have inherited both the genes for oily skin as well as dry skin. The commoner scenario we see would be someone with acne and oily skin who started using over the counter medication such as those that contain retinol or benzoyl peroxide and these will break down the skin barrier and it can result in the skin being dry, sensitive and acne-prone.
Individuals with combination skin often have breakouts over the greasy T-zone area. This can be exacerbated, in the case of some women, especially during the time of their monthly menstrual cycles. On the other hand, their cheek areas can be very dry and when they travel, especially when there is a change in climate, these areas can become dry, flaky and sensitive especially if they are using skincare that is slightly harsher on their skin.
The recommended skincare routine for combination skin should address both the oiliness of the T-zone, which can sometimes get quite uncomfortable especially in a humid climate like Singapore, as well as the potential dryness that may occur over the cheek areas. An important thing to note would be a gentle emulsifying cleanser is recommended for combination skin such as the Honey Cleanser. Honey itself is a natural emulsifier which means it produces foam without the need for strong chemical lathering agents such as the laureth sulfates. At the same time, it is a natural humectant which means that it traps moisture under the skin. As a result, it helps to balance out the production of sebum without over-stripping the skin of its natural oils.
Individuals with combination skin should focus on using hydrating serums such as Hyaluronic Acid Serum, Vitamin C Serum and Elixir-V Serum as these contain cosmeceutical active ingredients which function as treatment over their T-zone to regulate oil production.
Also, use hydrating emulsions rather than creams, the former is an oil in water mixture rather than a pure cream formula. This helps to moisturize the skin without the cream becoming too thick or greasy. Finally, the excess grease over the T-zone can be addressed with the use of blotting papers (such as those infused with active ingredients like cannabis sativa). These blotting papers are infused with cannabis sativa, an extract of the hemp plant which helps to moisturize the skin and regulate oil production, at the same time physically removing excess grease over the T-zone. One should follow with a hydrating mist such as the Mineral Booster which helps to regulate the skin barrier.
© 2020 TWL Specialist Skin and Laser Centre. All rights reserved.
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Vitamin C
Melanin is the culprit behind the dark spots that give us an uneven complexion. It is a brown pigment found in the basal layer of the epidermis.
This pigment is synthesised by melanocytes. The process of melanin synthesis is termed melanogenesis. Melanocytes go through different stages of maturation, becoming more pigmented at each stage.
Certain stimulants trigger a gene to produce more of tyrosinase, a copper-containing enzyme that converts tyrosine into melanin. Stimulants that activate the melanocyte include hormones, inflammation (such as acne) and external environmental conditions (ultraviolet light that causes the production of free radicals).
One simple way to reduce melanin production is to use broad-spectrum sunscreens with zinc oxide, titanium dioxide or iron oxide. These substances help block UVA and UVB light, thus impeding the stimulation of melanocytes.
Pigmentary disorders
Common hyperpigmentation disorders that involve the darkening of an area of skin due to increased melanin include melasma, lentigo, and post-inflammatory hyperpigmentation.
Melasma is usually caused by chronic exposure to ultraviolet radiation or a spike in hormones due to pregnancy or the use of oral contraception. It can be found at the epidermis, dermal layer or mixed, depending on the location of the pigment.
A lentigo is a light or dark brown area of discoloration that can range from 1mm to 1cm across, and is caused by an increased number of melanocytes. Its outline is usually discrete, but can also be irregular. Simple lentigines arise mostly during childhood on areas not exposed to the sun. Solar (or senile) lentigines are found on the backs of hands or on the face, most commonly after middle age.
Post-inflammatory hyperpigmentation (PIH) is the skin’s response to inflammatory skin disorders. Common causes are acne and atopic dermatitis. PIH is caused by the overproduction of melanin caused by skin inflammation.
Treating hyperpigmentation
Hydroquinone: For 50 years, hydroquinone has been the gold standard treatment for hyperpigmentation. This compound inhibits tyrosinase activity, thus limiting the amount of melanin to be produced. It also alters melanosome formation, possibly degrading melanocytes.
However, prolonged use of topical hydroquinone has shown to have side effects such as ochronosis and permanent depigmentation. Ochronosis is a disorder with blue-black discoloration. As such, hydroquinone is banned in cosmetic formulations and only available through a prescription that should be carefully managed by an accredited dermatologist.
Retinoids are forms of vitamin A that can treat acne, photodamage and PIH. They have various pathways that lead to skin lightening effects, such as accelerating epidermal turnover, reducing pigment transfer and slowing the production of tyrosinase.
With common side effects being erythema, skin irritation, dryness and scaling, it is recommended to use a retinoid only under the supervision of an accredited dermatologist. Corticosteroids (steroid hormones) have anti-inflammatory abilities and are often prescribed along with retinoids to prevent excess irritation.
Arbutin is a botanically derived compound found in cranberries, blueberries, wheat and pears. Though arbutin is a derivative of hydroquinoine, it has shown to be a more controlled way of inhibiting the synthesis of melanin as it does not permanently destroy melanocytes.
Kojic acid is a naturally occurring fungal substance. Its skin-lightening ability works by inhibiting the activity of tyrosinase. However, frequent use can cause side effects of contact dermatitis or erythema (redness of the skin).
Azelaic acid is known to be effective for treating PIH and acne. Azelaic acid depigments the skin in several ways. It can inhibit tyrosinase or reduce levels of abnormal melanocytes. This means that azelaic acid does not influence normal skin pigmentation but only acts on the proliferation of unwanted melanocyte activity. Side effects are mild and only last for a short period of time. Irritation, burning sensation or mild erythema may emerge, taking 2 to 4 weeks to subside.
Niacinamide is a derivative of vitamin B3. It works by decreasing the transfer of melanosome to keratinocytes. Niacinamide is a stable ingredient as it is unaffected by light, moisture or acids. This ingredient is often incorporated into cosmeceuticals due to its safety profile.
Vitamin C or L-ascorbic acid is a naturally occurring antioxidant that helps with skin lightening. It prevents tyrosinase from converting tyrosine to melanin. Vitamin C is also favored for its anti-inflammatory and photoprotective properties. However, L-ascorbic acid is highly unstable and rapidly oxidized. It is not used in the treatment of PIH.
Stable forms of vitamin C include magnesium ascorbyl phosphate or sodium ascorbyl phosphate. For safe and effective results, consider a dermatologist-formulated serum VITA C GOLD™ Serum,a formulation tested for bio-activity in a laboratory.
As seen above, there are various treatment options to treat common hyperpigmentation disorders. Recognizing the underlying cause for pigmentation is critical for proper treatment and choosing the best-suited therapy. Visit an accredited dermatologist for effective and safe treatments catered to your condition.
© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
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Vitamin C
The benefits of Vitamin C are well-known – an efficient collagen booster, and an amazing ability to treat effects of photoageing and hyperpigmentation. A favoured ingredient in skincare products, this vitamin helps to gently brighten and smoothen the skin.
Whilst Vitamin C is a naturally occurring antioxidant in the botanical world, humans do not possess the enzyme L-glucono-gamma lactone oxidase for the production of Vitamin C. When administered orally, Vitamin C is not efficiently delivered to the dermis. The concentration of the vitamin when introduced into the body is not sufficient to allow an activated effect. In the practice of dermatology, topical vitamin C is frequently recommended as an adjunct to treatments, which results in a drive towards newer advanced delivery forms of the vitamin into the dermis or discovery of more stable Vitamin C compounds.
Vitamin C exists in two forms – L-ascorbic acid and D-ascorbic acid. L-ascorbic acid is the chemically active form of Vitamin C, but it is not stable in nature. When exposed to light, Vitamin C may get oxidized to Dehydro Ascorbic Acid for example, which loses the beneficial activity of the vitamin. This gives rise to the interest of stable ascorbate molecules for dermatological uses.
What are the common Vitamin C derivatives?
Not all forms are physiologically effective as some will not be delivered to the dermis in sufficient quantity, or will not convert to a chemically active form in the skin.
Some stable derivatives of L-ascorbic acid are Magnesium Ascorbate, Magnesium Ascorbyl Phospahte, Sodium Ascorbate, Sodium Ascorbyl Phospate, and Calcium Ascorbate, with varying effectiveness.
What is the most stable Vitamin C derivative?
Sodium ascorbyl phosphate is a stable and effective derivative of Vitamin C. It is significantly more stable than magnesium ascorbyl phosphate and ascorbyl palmitate. The stability is attributed to the introduction of a phosphate group into the second position of the cyclic ring.
How does sodium ascorbyl phosphate work?
At our skin’s pH of 7, ascorbic acid is present in a form called ascorbate anion. This form has poor penetration ability into the skin and is unable to prevent effects of photodamaging due to low antioxidant concentrations.
With sodium ascorbyl phosphate, antioxidant levels are substantial and can be absorbed into deeper skin layers and allow effective photoprotection. With ongoing research on this stable derivative, it is understood that sodium ascorbyl phosphate is absorbed in the skin and converted by enzymes into ascorbic acid, increasing the intracellular concentration of ascorbic acid.
Skin cells continuously take up sodium ascorbyl phosphate and convert it into ascorbic acid by the process of dephosphorylation, with the help of the enzyme acid phosphatase in the skin layer. This process allows elevated levels of ascorbic acid in the skin long after the introduction of sodium ascorbyl phosphate to the skin.
How does sodium ascorbyl phosphate help acne?
As a potent antioxidant, sodium ascorbyl phosphate can help improve acne conditions by combating oxidation of sebum and comedogenesis.
According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she said: “Patients with acne are found to have a higher concentration of polar lipids, which are by-products of squalene oxidation. Squalene is most abundant lipid in our skin and is highly susceptible to oxidation due to its structure. It has six carbon double bonds, allowing atmospheric oxygen to bind. This produces squalene oxides that are highly comedogenic, as it causes inflammatory reactions that further depletes the level of antioxidants in our skin and leads to acne. Sodium ascorbyl phosphate is useful in acne treatment as it prevents sebum oxidation.”
How does sodium ascorbyl phosphate prevent sebum oxidation?
Sodium ascorbyl phosphate works as an antioxidant to neutralise free radicals, reducing oxidative stress. When exposed to UV light, reactive oxygen species such as the superoxide ion, peroxide and singlet oxygen are generated. Sodium ascorbyl phosphate works to protect the skin from oxidative damage to sebum by donating electrons to neutralise the free radicals.
How does sodium ascorbyl phosphate fight ageing?
Sodium ascorbyl phosphate is an oxygen species scavenger, protecting against UV damaging and enhancing properties of sunscreen. Photodamage such as sunburn cell formation, DNA fragmentation and lipid peroxidation can be prevented. The protective effect of sodium ascorbyl phosphate comes from the maintenance of a healthy ascorbic acid level in the skin tissue.
Sodium ascorbyl phosphate reduces UV susceptibility and protects against damage from UV exposure.
Are there any side effects of sodium ascorbyl phosphate?
Formulations containing sodium ascorbyl phosphate are considered safe and has shown no side effects in multiple clinical studies conducted.
Which Vitamin C serum should I use?
Although sodium ascorbyl phosphate boasts many desirable benefits, it is important to choose a Vitamin C serum that is well-formulated to allow its benefits to be realised. Avoid concocting your own serum of Vitamin C, as it may lead to phytophotodermatitis if you include ingredients such as lemon, lime or bergamot oranges.
For a reliable and effective serum, you may consider Vita C Gold™ Serum. Dermatologist-formulated and tested for bio-activity in a laboratory, it is completely safe for use. It is a concentrated serum containing nano-formulated sodium ascorbyl phosphate as a powerful and stable antioxidant.
© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.
Vitamin C is likely to be no stranger to any of us, we see it present in plenty of fruits and vegetables like oranges, grapefruits or pineapple. Yet, it is rather new to most of us to have Vitamin C on our face. This obsession with Vitamin C could be why you are googling up on this ingredient now, and we are about to tell you.
The vitamin brings benefits to the skin that we love: antioxidative, photoprotective, antiaging, and anti-pigmentary effects.
Vitamin C in our body
Vitamin C is the most abundant antioxidant in human skin. Antioxidants work to reduce the damage that free radicals can bring to our skin cells. We are unable to synthesize vitamin C as we do not have the enzyme needed to do so. Even as we consume high doses of vitamin C supplements, only a small fraction of the vitamin will remain in our body and skin cells. This brings us to rely on external supplements, with topical application being the most common form.
What should the concentration of my Vitamin C be?
When choosing a Vitamin C product, you may come across the different concentrations available. Of what percentage of the Vitamin C should we be using? That really depends on the type of Vitamin C in use. Conventional Vitamin C derivatives such as Ascorbic Acid may require 10 to 20 percent to have any reasonable efficacy, and is limited inherently by the fact that higher concentrations, for instance above 20 percent, may cause irritation to the skin. On the other hand, studies have shown that a mere 1 percent concentration of Sodium Ascorbyl Phosphate – considered to be a new generation of Vitamin C derivatives, has strong antimicrobial efficacy against acne.
What are the common forms of Vitamin C?
Out of all the various forms of Vitamin C, L-ascorbic acid is conventionally recognised as one of the most biologically active molecules. This compound is likely to be found at a pH below 3.5 for greater stability and permeability. Above that, the acid becomes very unstable in aqueous solutions and is prone to immediate oxidation, turning to a brown colour when oxidized.
Other formulations of vitamin C are magnesium ascorbyl phosphate, ascorbyl-6-palmitate and sodium ascorbyl phosphate. These formulations are stable at neutral pH of 7. As a water-soluble derivative of Vitamin C, magnesium ascorbyl phosphate is more stable in water but less potent than L-Ascorbic acid.
Sodium Ascorbyl Phosphate is one of the most stable and effective forms of Vitamin C. As it will not oxidize as easily, it is a preferable choice for skin care formulations. A well-formulated product allows sodium ascorbyl phosphate to penetrate the skin epidermis without causing irritation. You may consider a dermatologist-formulated product such as Vita C Gold™ Serum, a Vitamin C formulation that has been tested for bio-activity in a laboratory, for safe and effective results.
Different formulations of Vitamin C exists, and you may decide which forms would be preferable in your skincare by weighing in on the cost, potency, texture or formulation. Although the conventional L-ascorbic acid is perhaps the most potent derivative of Vitamin C, it oxidizes too quickly when exposed to oxygen to be much efficacy on the skin. One may prefer newer Vitamin C derivatives – Sodium Ascorbyl Phosphate, which are much more stable and able to deliver better efficacy even at lower concentrations.
Vitamin C helps to produce collagen
Vitamin C is required by our bodies to produce collagen, making this vitamin crucial for anti-ageing. Think of it as an anti-ageing shield your skin needs to reduce the damage your skin suffered, and also to prevent future damage. The vitamin facilitates enzymes that lead to the stability of collagen fibers. It also increases expression of collagen and synthesizes inhibitors to block enzymes from degrading collagen.
Vitamin C has anti-pigmentary effect
Vitamin C plays an important role in skin-lightening, as it inhibits an enzyme called tyrosinase. This enzyme works by converting tyrosine into melanin, so by reducing the activity of tyrosinase, our skin cells produce less melanin.
Should I DIY my own Vitamin C serum?
According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she says: “Concocting your own serum of Vitamin C can be dangerous as it can lead to phytophotodermatitis, a condition where itchy blisters and reddened patches appear on the exposed skin. The redness and blistering will settle down in a few days, but it leaves pigmentation at the same sites. Phytophotodermatitis results from the action of UV radiation on a plant chemical called furocoumarins. Citrus fruits such as lemon, lime or bergamot oranges are often responsible for the reaction.”
It is best to avoid DIY recipes for Vitamin C or you may end up with rashes that scar for a long time.
© 2017 TWL Specialist Skin and Laser Centre. All rights reserved.
—–
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.
