The Acne Care Bible: Dermatologist’s Tips for Acne Treatment & Prevention is a comprehensive review of the causes of physiologic and adult acne, promising to educate the layperson on everything they ought to know on acne treatment options
Acne Rosacea is a condition that commonly starts in one’s teenage years and the early signs of which go unnoticed. Several adults present to me for treatment in their mid-thirties and forties with symptoms that seem to date back to their teenage years. In this article, we hope to educate parents and teenagers on the warning symptoms of this condition that they may also seek early intervention. Including an excerpt from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, dermatologist at TWL Specialist Skin & Laser Centre.
Why is this important?
Firstly, acne rosacea can lead to long-term cosmetic disfigurement because it results in skin thickening. The most dramatic cosmetic disfigurement is a condition known as rhinophyma whereby one ends up with a bulbous-looking nose that has to be treated surgically. This is regarded as the end stage of acne rosacea. In addition, a lot of acne rosacea symptoms may be similar to acne but it does have some distinct differences. Acne rosacea is commonly mistaken as acne by non-dermatologists. Here are some of the key clinical features you can look out for if you suspect that either you or your child has acne rosacea.
A family history of rosacea
Red patches that occur predominantly over the sun-exposed areas of the face such as the cheeks, the forehead, and sparing areas such as the nasolabial fold under the jaw and around the eyes.
Increase the intensity of redness when exposed to the sun, coming out of a hot shower, intake of spicy foods, or hot soups.
Acne-like bumps that do not respond to conventional acne treatment.
Red, watery eyes with symptoms of irritation (ocular rosacea).
Rosacea is characterised by persistent facial redness which typically has a relapsing and remitting course. Photo Source: DermNet NZ
The key process that is occurring in acne rosacea is a state of overactivity of the skin’s blood vessels. In typical settings when we are exposed to heat, our blood vessels will expand, a process we call vasodilation which is an attempt to cool down by increasing blood flow to the surface of the skin, increasing heat loss. When we shift to a cold environment, this vasodilation in turn becomes vasoconstriction which is when the blood vessels contract.
This is responsible for the flushing that happens even in normal individuals when they are exercising and after they cool down, the redness then disappears. In acne rosacea, one of the key features observed is the inability of the skin to revert to its original state after exercise. You may get redder after exercise but it stays red.
How does this bother individuals suffering from acne rosacea?
My patients are bothered by it because it causes some degree of embarrassment and increases their self-consciousness. This is compounded by the fact that many of them could have suffered from this condition for many years. Insensitive comments from those around them could also make them more prone to feelings of embarrassment and shame. It’s important to understand that there is no specific cause of acne rosacea although they are well-defined genetic risk and trigger factors.
There is also some evidence that individuals who suffer from acne rosacea are colonized with a type of skin mite known as the Demodex mite. This is the basis for the treatment of acne rosacea with topical ingredients i.e. metronidazole. The treatments of the vasodilation can be with vasoconstrictors such as brimonidine. However, I tend not to use this in my practice as I find that it can cause significant rebound skin erythema without treating the underlying condition of skin inflammation. It can lead to an awkward demarcated area of skin “whiteness” which is equally disturbing cosmetically.
If you suspect that you have acne rosacea, what should you do?
First of all, if your symptoms are visible, it is good to visit a dermatologist just to ensure that appropriate medical treatment is administered from the earliest time possible. This may be in the form of cosmeceuticals, topical anti-inflammatories and calcineurin inhibitors, which have been used with success in individuals with acne rosacea. It is important to understand that you may have acne rosacea and also concomitant dry sensitive skin condition which may lead to some parts of your skin having flaking in addition to redness.
Acne rosacea itself does not cause flaking but it is possible to have both rosacea and flaking. An individual can have more than one condition happening at the same time. Your dermatologist will be able to discern the conditions affecting your skin and administer appropriate treatment. If your acne rosacea is of moderate severity, it is of utmost importance that we start you on medical treatment with oral antibiotics, such as doxycycline and erythromycin.
Some individuals will need oral isotretinoin, for severe cases of acne rosacea. Medical treatment is essential because although acne rosacea itself is not life-threatening, it has a cumulative effect which can lead to cosmetic disfigurement-mainly in the form of skin thickening. This is how I explain it in a simple way to my patients. If you have a lot of blood flow to your face all the time, the skin gets a lot more nutrients than what it’s supposed to. Over time, the body decides to use these nutrients to grow more skin. This is not entirely accurate because the entire process is very complex, but it’s a very simple schematic to try to understand what’s going on.
Can acne rosacea be cured?
The answer is no. It can never completely go away without treatment, but it can be successfully treated and maintained such that another person wouldn’t observe that you have acne rosacea. Thus as far as possible, you do not want your skin to be red. The goal of any dermatologist is to have to restore your baseline to one that is not red and have it maintained.
What are some of the medical treatments available for acne rosacea?
You have to treat acne rosacea with oral medications 70% of the time. This applies to moderate to severe cases of rosacea and it always involves oral antibiotics such as erythromycin, doxycycline which are not performing as antibiotics per se but they are anti-inflammatory. They are often used in conjunction with barrier creams such as those containing ceramide, as well as other types of moisturizers which function as cosmeceuticals. There is increasing evidence about the use of cosmeceuticals in the treatment of acne rosacea and I have personally used it with successful antioxidant serums in individuals with long-standing rosacea as part of maintenance treatment.
The AMINO ACID 360 MASQUE is a potent formula of skin brightening Vitamin C which also soothes inflamed acne and lightens scars. LARECEA™ Extract with lifting amino acids penetrate the epidermis to stimulate collagen regeneration. Visit https://drtwlderma.com/redness-rosacea/ for the full range of cosmeceuticals for acne rosacea treatment.
These are cosmeceuticals that have all been used in success in my clinical practice. The key thing is as long as it’s an antioxidant, it is able to suppress inflammation and the underlying process of inflammation.
In terms of pharmacotherapy, I often start my patients on an anti-inflammatory topical steroid for a period of two to three days just to bring down inflammation. This is by no means a long-term treatment, in fact, it should not be used beyond three days because it can cause rebound steroid acne and rebound redness. However, I had found it very useful in controlling the initial redness. I advocate the use of a good skin barrier repairing moisturizer that contains ceramide such as the Multi-CERAM moisturizer.
The MULTI-CERAM™ MOISTURISER 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.
I feel that cosmetic camouflage is an important part of acne rosacea treatment that we should not forget. As a teenager, while you are getting better with medical treatment, there is a process and there is a period of time where you will have visible redness on your face.
It is perfectly acceptable to start with a concealer for mild areas of redness but my personal preference for rosacea patients would be the use of color correctors. Specifically, we use the color green to counteract red and infuse this in a cosmeceutical base so that the effects are both natural and the formula is also well-absorbed by the skin to exert its skincare functions as well.
Long-term management of acne rosacea is really monitoring for flare-ups. Before you flare-up, it’s always best to know what triggers off your flare-ups. The good news is that it’s rather universal for treatment of rosacea and it would be firstly, UV exposure. Thus, sunblock is absolutely essential. A medical-grade sunblock with SPF 50 broad-spectrum protection.
The CUIONS and ZINCOOL UV-protective biofunctional textile face masks which I invented for our biomaterials arm are designed to be both therapeutic for treatment of the skin microenvironment as well as a practical (more effective) sun protection measure in the era of the COVID-19 pandemic. I currently recommend UV protective face masks for photoprotection as there is no need for reapplication of sunblock and UPF50+ textilesare also very efficient at blocking up to 98% of the suns’ rays.
You should avoid showers with warm water but rather go with cool water and totally avoid hot showers. Do not take any spicy foods or hot soups, refrain from activities such as going to the sauna where there is excessive heat and definitely never use facial steaming devices. The long-term management of acne rosacea will have to take into consideration scarring.
As mentioned before, the endpoint of rosacea is actually skin thickening and texture irregularities. If you do struggle with acne rosacea that is not well controlled, as you grow older and the disease progresses, you may observe enlarged pores and irregular skin texture. The end stage of acne rosacea is rhinophyma, whereby severe skin thickening on the nose area leads to cosmetic disfigurement. All these changes would become more prominent as you age as well due to the loss in collagen and elastin in your dermis.
Other aspects of treatment that we are going to focus on here are the physical therapies that are effective for acne rosacea. I have used in clinic LED red light therapies with some success as an adjunct physical treatment for patients on oral medication for rosacea. Red light stimulates the mitochondria of your skin to enter into a state of renewal and repair. It is free of side effects as well.
I also perform the carbon laser using the 1064 qs laser machine for my patients as there is some evidence for reducing redness, inflammatory papules and for improving the quality of skin with gentle ablation that helps to resurface the skin. A lot of adult patients who have had chronic rosacea starting from their teenage years will need fractional CO2 laser resurfacing.
A good proportion of our patients are teens and young adults, who experience changes in their skin and hair as they undergo hormonal changes associated with puberty. This is also associated with the start of pimples from which acne myths and questions arise. In this article, we explain the common acne myths, including excerpts from Acne Care Bible: Dermatologist’s Tips For Acne Treatment & Prevention by Dr. Teo Wan Lin, accredited Singapore dermatologist practising at TWL Specialist Skin & Laser Centre.
The Acne Care Bible is written for sufferers of adult acne, teenagers, as well as parents of teenagers who may want to equip themselves with knowledge on how to prepare their children for the start of puberty.
Acne Myths #1: Acne is caused by poor hygiene
Acne is not caused by poor hygiene. However, poor hygiene can exacerbate acne and trigger flare-ups in individuals who are acne-prone. This is evident in some individuals who do not wash their face yet are free of pimples. However, in an acne prone individual, they may have acne flare-ups if they do not wash their face or in outdoor camps where there is a reduction in the hygiene level.
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What does this mean?
It simply means that while acne is not directly caused by poor hygiene, if you have the genetics for developing acne, it is important for you to observe good personal hygiene. This also means that you should avoid touching your face and also be conscious of objects that you’re putting in contact with your face. For example your mobile phone or your pillow case. If you are sleeping on a dirty pillowcase, it is important to understand that these can also contribute to overgrowth of bacteria and can trigger off your acne as well. There are certain types of materials that are better for acne-prone skin. An example of this would be silk and copper ion polyester.
Silk pillow cases have been used because natural mulberry silk contains antibacterial properties, besides having a soft, smooth and breathable texture. When you are lying on such a material for extended periods of time such as when you are using it as a pillowcase material, it is important that the material is breathable and smooth to reduce friction on your skin.
For my acne-prone patients, I do recommend functional textiles (these are fabrics that have additional skincare properties) such as copper ion impregnated fabrics as a pillowcase material.
Why is this so?
Copper ions have been proven to play an important role in the healing of skin. Besides, it’s also antibacterial, killing 99.9% of bacteria in contact with the material.
The CUIONS™ ANTI-AGEING PILLOW CASE by Dr. TWL Biomaterials contains cotton polyester at a percentage that actively inhibits bacterial growth. Copper nanoparticle impregnation is also backed by clinical studies3,4,5 to have active skincare properties (anti-wrinkle, anti-ageing) due to stimulation of collagen growth6 through contact with copper ions actively released on contact with skin.
The CUIONS™ ANTI-AGEING + ANTI-ACNE COPPER SILK FACE MASK is sweat/water/splash resistant (suitable for pre/post sports), anti-ageing (copper ions stimulate collagen production/reduce wrinkles), anti-microbial7 (prevents mask acne/anti-odour), and UV-Protective (certified UPF 50+ protection for melasma/pigmentation)
The ZINCOOL ANTI-INFLAMMATORY + OIL CONTROL MASK is self cleaning with whiter than white technology, and incorporates superior skin cooling, creating a highly breathable skin microenvironment. It also has anti-inflammatory, bactericidal and sebum control functions to control maskne, and offers benefits for individuals who have facial eczema or are acne-prone.
Acne Myths #2: Facials helps to reduce your pimples
This is amongst the very widespread acne myths because when individuals look at their pimples, they assume that it is superficial and hence they try to remove it from the “surface”.
However, as you may have learnt from the previous chapters, acne is specifically caused by inflammation from the inside – starting from the deeper layers of your skin before it appears on the surface. For facials, many of these procedures involve painful extractions which result in worse scarring, and introduction of infection which does not solve the problem. You may find that your pimples flatten because of the direct “extraction”, but you will also notice that you have to do repeated physical extractions every month because the pimples will reoccur.
Many of my patients are so surprised when they are told that such “extraction” facials are not part of acne treatment, simply because of advertising indoctrination. Are there facials that help acne-prone skin? Yes, but these are medical facials which either use microdermabrasion, chemical peels or lasers to treat the problem. Also, these are also not the core of medical acne treatment, though they may function as useful adjuncts. Remember, anything that involves extraction is bad!
I have also seen individuals who developed rare infections i.e. facial viral warts from microbes that contaminates the instruments used in facials. This is because in facial parlours, instruments are not autoclaved. While it may be a new needle, it might not get rid of environmental bacteria such as mycobacteria which is present in tap water. When you are making a puncture in your skin, you are also introducing this bacteria into your skin.
What should you do?
If you suffer from mainly whiteheads and blackheads, then chemical peels which are reliant on using fruit acids i.e. alpha hydroxy acids, milk acids such as lactic acid will help to regulate the epidermal cell turnover, ensuring a healthy skin cycle. This reduces the number of dead skin cells. A way to think about it is, in individuals who struggle with acne, the retained skin cells act as “food” for acne bacteria to work on.
Vacuum-assisted microdermabrasion is also a better technique than extraction. Such procedures are known as medi-facials. My patients use a home microdermabrasion device known as the Silkpeel for spot-on acne treatment as the gentle suction prevents any trauma to the skin while assisting the acne bump to be extruded from the surface.
Acne Myths #3: Acne can never be cured. You can only wait it out as your acne clears when you’re older.
These types of acne myths are certainly untrue. Why do I say that? Firstly, if you do wait for your acne to disappear according to these acne myths, there are two possible outcomes. The first outcome being it may never disappear at all. There are many individuals who continue having acne way into adulthood.
The second scenario is much more common – it does disappear but only as one enters the age range of 18 to 21 years, that’s when one’s hormones stabilise. But in the six to seven years of having active acne, the individual would have developed moderate to severe scarring. This scarring is responsible for the ice pick and boxcar type of acne scars that you may see on certain individuals.
Dermatologists always treat acne because of the great psychosocial impact it has on the individual. During one’s teenage years, it is a complex development process on one’s emotional, physical and mental well-being.
Teenagers start to develop sexual attraction and awareness during this period thus they become more conscious of their physical appearance. This means that an individual who suffers from acne as a teenager may have deeper emotional scars compared to an individual who only develops acne later on in adulthood. We should never trivialise acne with acne myths in a teenager as we understand the great psychosocial impact it has on the sufferer.
Are you looking for dermatologist recommended skincare products in Singapore? This article features aninterview with our dermatologist, Dr. Teo Wan Lin, who is also the chief scientific officer of cosmeceutical skincare line Dr.TWL Dermaceuticals. She goes through the key principles of how effective skincare products work. Dr. Teo answers key frequently asked questions such as how long does it take for your skincare to show results, as well as important functions for each of your skincare products.
There are specific functions for each step in your skincare regimen. This article breaks down the criteria that dermatologist recommended skincare products must fulfil for your skincare regimen. These are useful tips for anyone who is searching for a dermatologist’s advice on how to build an effective skincare regimen for themselves.
Dr.Teo Wan Lin is the host of beauty podcast Dermatologist Talks: Science of Beauty which releases a new episode every Sunday. It is available on Spotify apple and Google podcasts.
What are the key features of dermatologist recommended skincare products?
Skincare regimens are important parts of dermatological treatment. Skin diseases such as acne, rosacea, eczema are all treated with topical therapy as first line. This includes gentle skincare that is also effective. The public needs to understand the difference with the skin as an organ, in that it is external and hence has the unique ability to absorb what is applied on it. This is the principle behind dermatologic therapeutics.
Oral medications are often required as adjuncts. However, a good skincare regimen will make all the difference in terms of the long term outcome. Dermatologist recommended skincare products are hence very relevant in the treatment of facial or body skin condition. This includes eczema or dry, sensitive skin conditions as well.
Let me explain, we traditionally explain the underlying cause of eczema as an issue with the skin barrier. According to a brick and mortar skin model, the bricks are the skin cells “corneocytes” and the mortar the glue “ceramide” joining these cells together. In eczema, the barrier is leaky. This results in allergens, i.e. environmental dust, pollutants, bacteria, to penetrate the barrier and cause an immune system response.
Dermatologist recommended skincare products, in this case, have a few basic functions to help eczema recover. Gentle cleansing with antibacterial properties can be beneficial for the skin microbiome. This is because eczema is driven by a super-antigen effect due to the bacteria Staphylococcus aureus. Skin infection in eczema patients is caused by this.
Moisturisers does not just help in barrier repair. It can also reduce inflammation depending on what active ingredients are present. Ceramides are clearly the key repairing ingredient for the skin barrier, as the skin cells are joined together by lipids. Phytoceramides are plant-derived, from plant seed oils and mimic the natural behaviour of moisturising ceramides present in skin. The role of moisturisers is beyond just repairing the skin barrier.
Dermatology research actually shows that frequent use of a dermatologist recommended skincare moisturiser can reduce reliance on topical steroids. This is critical for eczema which is a long term problem that requires maintainence. The issue is also the effectiveness of topical steroids is lost over repeated usage, a phenomenon known as tachyphylaxis.
A gold standard moisturiser is formulated as a prescription emollient device, a term coined by paediatric dermatologist Dr. Lawrence Eichenfeld. Such a moisturiser has additional anti-inflammatory properties which mimic the function of topical steroids in suppressing skin inflammation. This is achieved with botanical derivatives which have anti-inflammatory properties.
Use of wet-wraps together with such a dermatologist recommended skincare moisturiser for eczema can be a crucial part of eczema treatment.
Moisturising mists based off thermal water or deep sea water have also been studied in limited research studies. These seem to suggest that the composition of natural minerals in these waters can help to stabilise the skin microbiome and also soothe inflammation.
Use of these mists are twofold. Firstly, it is an effective way to deliver extra moisturising ingredients such as glycerin, hyaluronic acid and polyglutamic acid which penetrate your skin to the deeper layers. These moisturise the skin but also help encourage beneficial cell talk. Cell talk is essentially cross communication between cells for important skin healing physiological processes to occur.
The second function it performs is as a spray on liquid mist, which enhances the occlusive effect of wet wrap therapy. This increases the skin’s ability to absorb medications as well as skin repairing moisturiser ingredients. Hence, the use of dermatologist recommended skincare products for eczema can be seen as an important part of eczema treatment.
How long does it take for a product to show effectiveness?
For skin barrier-related concerns, such as dryness and flaking, effects can be seen within three days or even less. For sustained improvement, we always consider at least an entire skin cycle, which is about a month. For targeted skin concerns like hyperpigmentation, I think it is crucial to realize that a lot of over the counter active ingredients actually do not treat the condition. These ingredients marketed for hyperpigmentation are useful adjuncts for prevention.
However, if you truly suffer from melasma and sunspots for example, a dermatologist may recommend combination therapy with prescription creams or lasers. That does not mean that one should not use such skincare, as there are a lot of additional benefits from cosmeceuticals that can be seen after years of use as they help to reduce photoaging and oxidative stress.
Do dermatologist recommended skincare products always show visible results on the skin?
The key here is that “visible” is not necessarily the most accurate assessment of whether a product is doing its job for your skin or not. The reason is if you suffer from an existing dermatological condition, be it eczema, rosacea, perioral dermatitis or acne, these are medical conditions that need to be treated with therapeutics. These are often prescription medications.
The role of dermatologist recommended skincare products is to support the treatment process. It should not aggravate the condition. By this, it has to have minimal irritation potential, hence dermatologist recommended skincare products are often associated with suitability for sensitive skin as well. This is known as tolerability.
Effective and safe skincare can actually be suited universally, for all skin types. It should also have over-the-counter, nonprescription based functional active ingredients that can treat the condition. An example would be the use of botanical actives in managing acne. Chlorella vulgaris, argan oil and berberine are examples of active ingredients that we identified to have promising properties as natural acne treatments.
With the advent of maskne, botanicals are increasingly researched because of its low irritation potential when applied under occlusion. These also do not have the problem of antibiotic resistance, which is a common side effect of traditional acne treatments involving topical antibiotics.
In the case of acne and pimple treatments, dermatologist recommended skincare products generally do target the pimples and spots to bring down inflammation quickly. These results can be seen in a short time as well. For eczema and dry skin sufferers, an effective moisturiser should not sting when applied. This is a common problem with moisturisers as when the skin barrier is deficient, it can cause stinging when there are certain preservatives present in the formulation.
Skin should also look instantly smoother. This is because an effective moisturiser for eczema works to repair the gaps in the skin barrier that cause irregular skin texture and roughness. In addition, the best moisturiser for eczema should be able to bring down the sensation of itch as well.
These broad principles form the key premise of dermatologist recommended skincare products, which means it is able to work effectively across the entire range of skin types.
What are we looking out for for dermatologist recommended skincare products like cleanser, versus toner and serum or moisturiser?
For cleansers and toners, I think it is important to make sure that your skin does not feel dehydrated from their use. A good cleanser and toner is meant to deliver moisture to your skin and at the same time remove excess oil, enhancing the stability of your skin. For serum and moisturizer, I think the base result is it should not cause any irritation.
If you are attempting to use these to treat your skin problem like acne, rosacea or eczema for example, you must realize that these are actually cosmetic ingredients which can help in the treatment of certain disorders. They are however by no means should replace the treatment itself. Therefore, if you have an active skin concern, get evaluated first by a dermatologist. These cosmetic ingredients can be an accompaniment to your treatment regime. They can help you in terms of maintenance and that is what has been done for my patients.
When will we know if a product isn’t working?
I think that for serums and moisturizers, if you have mild dry skin or eczema, within a day or two, you will definitely see an improvement in terms of your skin texture as well as your symptoms. If you are not better, it does not necessarily mean that the product is not working. It could simply mean that you probably need medications. Your skin barrier, in the case of eczema, is failing. In addition, due to consistent inflammation, it is not sufficient for just barrier repair via moisturisers alone.
Singapore teledermatology services have undergone a fundamental change in the past 18 months with the evolving COVID-19 pandemic. From hardly existing in the realm of telemedicine prior to the pandemic, Teledermatology consultations are now increasingly becoming the primary mode of care for dermatological conditions in Singapore. In this article, we discuss the suitability of common dermatological conditions with teledermatology and guide you through on what to expect from Singapore teledermatology services.
Let us first explain what is telemedicine. Telemedicine is a new technology that provides medical information, as well as healthcare support remotely. The World Health Organization defines it as the delivery of healthcare services ,where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation for the continuing education of health care providers, all in the interest of evolving the health of individuals and their communities.
Now, the above definition has taken on a new meaning. In a post COVID-19 world, distance is not the sole factor. There is also an increasing need to create access to healthcare in a way that does not expose the individual to airborne COVID-19 pathogen. In response to this, the Ministry of Health is advancing regulatory and licensing measures for telemedicine providers in Singapore, including Singapore teledermatology services. More information on regulatory matters as well as a list of telemedicine providers in Singapore can be found at the Listing of Direct Telemedicine Providers on the Ministry of Health website.
In terms of the application of telemedicine to dermatology, there are a few factors to be considered. Firstly, dermatology, as an individual specialty, is very well suited to be conducted via teledermatology. Telemedicine requires that the diagnosis is made visually, as well as with information of symptoms collected via the teleconsultation. Dermatological conditions are all diagnosed by visual inspection. History taking can be complex as there are several subcategories in the field of dermatology, covering diseases of the skin, hair and nails. As such, history taking is best done via a teleconsultation, because extended contact time increases the risk of airborne COVID-19 transmission.
Are you looking for Singapore teledermatology services?
If so, seeking an accredited dermatologist is important. You may find the list of accredited dermatologists in Singapore here at the Dermatological Society of Singapore’s Members list. The range of rashes, that affect the skin is well studied by dermatologists. This means that they are trained to identify the morphology, or the gross appearance of rashes, just by inspection alone. Teledermatology, with high resolution photos that can be taken with cell phone cameras, is easy and accurate.
Stock photo of rash patches manifesting on skin
The teledermatology service should be structured such that there is a thorough approach to history taking, as well as accurate photos to support the examination. In certain cases, which are considered more serious TeleDermatology can serve as the initial consultation method to minimise waiting time. This also helps facilitate arrangements for the most expedient access to medical care, with minimal exposure to airborne COVID-19.
Singapore teledermatology services is a growing specialty. TWL Specialist Skin & Laser Centre, headed by accredited dermatologist Dr Teo Wan Lin, was amongst the first to offer teledermatology services in February 2020, and consistently offers that for its patients.
What conditions are suitable and not suitable for teledermatology?
Drug reactions, allergies which involve swelling of the eyes, the throat and difficulty breathing, as well as blistering diseases may not be suitable for TeleDermatology only. The approach to these conditions will be an initial teledermatology consult to determine actionable plan. This is followed by an in person, if necessary, photography and review session where blood pressure and temperature may be taken for further evaluation.
On the other hand, many conditions can be treated by teledermatology. At our Singapore dermatology practice, we currently treat the following conditions by teledermatology. It is very convenient for both the patient as well as safe in light of the COVID 19 pandemic in Singapore. Are you looking for a dermatologist in Singapore? Teledermatology is a right choice for you and your family for most dermatological conditions.
Acne Treatments via Teledermatology
Acne is a genetically influenced inflammatory condition affecting teenagers as well as adults. Treatment is usually a combination of oral medications such as oral antibiotics and topical creams. Severe cases may need oral isotretinoin. For our local teledermatology patients, who have acne, they are currently dispensed medications via our Singapore teledermatology services. The medications are delivered to them by courier. They can even get their medications for acne on the same day. This skincare pharmacy approach is a novel establishment in Singapore. The pharmacy itself is a partner to the teledermatology service. Custom compounded prescriptive creams are sent, together with your oral medications to aid in your recovery.
Stock photo of acne lesions appearing on facial skin
Eczema Treatment via Teledermatology
Eczema is another common condition that can be treated by teledermatology. In Singapore, many children and adults suffer from eczema. It is caused mainly by genetics that cause poor skin barrier function. As a result, the skin gets easily irritated, and develops infection and worsening symptoms. Teledermatology involves assessing the severity of the eczema condition, prescribing creams which are necessary to bring down inflammation. These creams cannot be accessed without a doctor’s prescription.
Singapore teledermatology services allows an accredited dermatologist to quickly and safely evaluate you, and get the medications delivered to you to your doorstep for treatment. Treatment of eczema early is important and can certainly be controlled with proper prompt intervention. Do check the status of your dermatologist, as not all supposed skincare doctors are actually accredited dermatologist recognised by the Ministry of Health.
Perioral Dermatitis Treatment via Teldermatology
Perioral dermatitis is a common mimic of hormonal acne that can also be treated by teledermatology. Singapore teledermatology services are increasing in demand because of the increased work from home situation, as well as the constantly changing COVID-19 pandemic. It is important to bear in mind that where it is possible, we should do our part to stay home and to reduce community transmission rates. Teledermatology, as a branch of telemedicine, is an important way for you to minimise exposure for yourself as well as for your loved ones, while getting the medical care that you need.
Perioral dermatitis looks a lot like hormonal acne. However, it is different in the sense that it is not just acne, but also a form of eczema. You may have acne-like pimples as well as pustules. The key here is the skin barrier is weakened, leading to a change in the skin surface bacteria. This condition is also very sensitive to triggers such as mint toothpaste or cosmetics, and even sunscreen. If you are worried that you have perioral dermatitis, book an appointment for Singapore teledermatology services today and have your condition treated.
Rosacea Treatment via Teledermatology
Rosacea is a condition where the skin’s blood vessels are hyperactive and the skin remains consistently red and inflamed. This is a problem because it can cause skin thickening as well as embarrassment for the patient. Rosacea must be treated with oral antibiotics. Severe cases respond to a course of oral isotretinoin. Consultation by teledermatology is appropriate for rosacea, because it is a visually diagnosed condition. The dermatologist will decide if you have a subtype of rosacea that needs more aggressive treatment. For example, papulopustular rosacea, or other types of rosacea.
If you suspect that you have rosacea and live in Singapore, do consider dermatologists via Singapore teledermatology services. Our centre prioritises teledermatology services with our dermatologist, and full nursing support is also administered via telemedicine. Our pharmacy supports same day delivery of medications to treat your condition in the most expedient manner, without you having leave the comfort and safety of your home.
TWL Specialist Skin & Laser Centre, as an accredited specialist dermatologist clinic, is privileged to be counted as one of our nations’ essential services. We will stay open during this trying period, with staff nurses assisting our dermatologist Dr. Teo Wan Lin to provide top notch medical dermatology care to our existing and new patients suffering from skin, hair and nail diseases.
We continue to prioritise our TeleDermatology services with integrated doorstep courier service, for our new patients and reviews. TeleDermatology is now in full swing after being launched and fully integrated with our specialist online skincare pharmacy – Dr.TWL Pharmacy. Patients who are deemed unsuitable for TeleDermatology and those who require procedures such as blood tests and medical treatments will continue to attend our clinic, with assurance of zero physical contact with other patients and our staff in full protective gear for your safety.
Phase 2 Circuit BreakerReopening Update: TeleDermatology and complimentary courier of medicine remains the default for all our non urgent dermatology consults. Urgent dermatology cases such as the following have to be seen in person and will be scheduled accordingly. These include blistering conditions, extensive >10% BSA involvement, drug allergies, severe infections, skin cancers and treatment procedures (non-cosmetic) will be scheduled for a physical consultation. We seek your understanding in keeping our nation safe.
All aesthetic dermatology services like botox, peels, lights and lasers will resume as of 19 Jun 2020 onwards – slots are available by booking only, no walk-in’s. Contactless payment remains the default and complimentary shipping of prescriptions available. For your safety, all medical staff wear the N95 mask and an eye shield for procedures, whereby we come within 1 meter distance of the patient. Our treatment rooms are sterilised by medical UVC lamps in between patients. Surgical masks are worn by default for other encounters like reception area.
Wrinkles, sagging and pigmentation of one’s skin are signs of premature ageing. Due to this, skin tightening is a popular cosmetic procedure to improve one’s appearance. However, while surgery has long been able to restore a youthful appearance, many prefer non-surgical face lifting and skin tightening treatment because it provides immediate results with minimal or no downtime.
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 talks about non-surgical skin tightening treatments.
What are the alternatives to surgical skin-tightening?
1. Non-invasive skin tightening procedures
Unlike surgical skin-tightening, patients will not incur puncture wounds, incisions or raw skin after the procedure. Temporary redness and swelling, would usually be the only side effects of the procedure. When performed by a board-certified dermatologist, little risk of other side effects is involved. This procedure can be performed on almost any part of your body and the results of the procedure tend to appear gradually. Regarding the details of the procedures, a session takes approximately 1 hour or less. Some patients may face some discomfort during the procedure.
Common procedures include:
Ultrasound
Heat produced by ultrasound treatments can stimulate collagen production. After one session, most people see modest lifting and tightening within 2 to 6 months. You may get more benefit from having multiple treatments.
Radiofrequency
A device is used against your skin to heat the tissue beneath. Most patients feel an immediate effect after the first session. Collagen production in the body takes time, the best results show in about 6 months. Some people benefit from having more than 1 treatment. The results from radiofrequency treatments can last 2-3 years when accompanied with appropriate skin care.
Laser treatment
Certain lasers allow heat to penetrate into the skin without damaging the top layer of the skin. These lasers are utilised for skin-tightening treatments all over the body and can be especially helpful for tightening loose skin on the belly and upper arms. 3 to 5 treatments may be needed to get results, which gradually appear between 2 and 6 months after the last treatment.
2. Minimally invasive skin tightening procedures.
Although they are unable to give you the results of a surgical procedure like a facelift, these procedures result in more evident changes than non-invasive procedures. They require less downtime than surgery while carrying less risk of side effects. Patients will be sedated during this type of procedure and will have a few days of downtime.
Radiofrequency
A thin tube (or needles) is inserted into the skin which provides heat to tighten loose skin at a precise location. This procedure is often used to tighten the skin at the neck or upper arms. Results are noticeable in a month. In some research studies, patients see gradual tightening and lifting for close to 1 year. After the procedure, you’ll need someone to drive you home and you may need to wear a compression garment for 4 or 5 days. You’ll also need to care for the wound.
Laser resurfacing
This is the most effective procedure for tightening loose skin. Unlike the laser treatment, this procedure requires some downtime. You’ll need to stay home for 5 to 7 days. Laser resurfacing gives you the fastest results. After you heal, your skin will appear tighter with less wrinkles within 2 weeks. Laser resurfacing can effectively tighten skin, usually showing more prominent results than any other skin-tightening procedure. Laser resurfacing diminishes fine lines, wrinkles, and dark spots on the skin, such as age spots. The tradeoff is that it requires downtime and has a greater risk of possible side effects, such as scarring.
Do skin-firming creams and lotions work?
Despite their promising claims, face-lift like results from a mere jar are highly unlikely. The result, if any, you see from a skin-firming cream will be subtle. These products tend to be good moisturisers at best resulting in plump skin and less noticeable fine lines and wrinkles. This result is temporary. To continue seeing any benefit, you need to apply the product every day. Dermatologists dispute the claim that a cream or lotion can lift sagging skin as these products are unable to penetrate the skin deeply enough to do this. Still, a small change may occur if the product contains a retinoid, such as retinol, which stimulates collagen production.
Who should avoid skin-tightening procedures?
Skin-tightening procedures should not be done on pregnant individuals, those with skin infections or patients with certain medications.
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.
