Something getting under your skin? A dermatologist has the answers to your frequently asked skincare questions.
Our skin is the largest organ of our body and the most complicated one. It doesn’t help that the skincare market releases new beauty products every other month. How do you know which moisturiser works best for you? What’s your skin type? These questions are just the tip of the iceberg. That’s why we asked about your skincare concerns on Instagram and boy did you deliver. Next, we reached out to Dr. Teo Wan Lin, a board-certified dermatologist at TWL Specialist Skin & Laser Centre, to answer all your skincare questions.
She specialises in both medical and cosmetic dermatology, with expertise in acne, allergies, eczema, pigmentation, skin cancer, hair loss conditions and skin rejuvenation. On top of that, she’s also the host of a Spotify podcast called Dermatologist Talks – Science of Beauty, and author of the Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare. Plus, she has her own skincare line called Dr. TWL Dermaceuticals. Read on for her expert advice!
Skincare questions answered by a dermatologist
1. What’s the correct order to apply skincare products?
Apply the product with the lightest texture first and progress to the heaviest texture. This is to respect the cosmetic formulation so there’s maximum absorption via the topmost layer of skin. Start with cleansing because it helps you maintain a healthy skin microbiome, which is the balance of good and bad bacteria. If you wear makeup, perform double-cleansing. First, use an oil-based cleanser to dissolve the oil-soluble pigments found in makeup, then use an emulsifying face wash to cleanse residual grime, dirt and makeup products.
After cleansing, you may choose to apply a toner. However, be conscious that alcohol-based toners are usually astringent, which claim to minimise your pore size and reduce oiliness. The best toners actually help to balance the oil production on your skin by regulating the sebaceous gland activity, rather than simply dehydrating it, which is what traditional toners do.
The next step? Treat your skin by repairing the skin barrier with a good moisturiser. Then, deliver active ingredients such as antioxidants to the skin. These help to reverse any signs of free radical damage caused by environmental aggressors. If it’s daytime, consider using sunblock. We’ve heard of serums, emulsions (which I think are synonymous with lotions), creams and ointments, which are the most common formulas. The order of application: serum, lotion, cream.
Sunblock, which can be formulated as a lotion or cream, should always be the last step. In a tropical climate like Singapore, it’s much more common to encounter lotion-based sunscreens. Humidity levels make it quite uncomfortable to use cream-based sunscreens, which are more appropriate for a temperate climate.
2. How do you get rid of blackheads?
Blackheads are a form of acne which are due to open comedones. The blackness comes from oxidised dead skin material or debris, mixed with serous fluids from acne itself. Blackheads can be treated like other forms of acne. Topical treatments that are effective include retinoids and chemical peels.
If the condition is more severe, which is common in combination with other types of acne, you’ll see whiteheads and more than five to eight papules occurring each month. That’s considered moderate acne. If the acne is cystic in nature, it’s classified as severe acne. These types of acne require medication for treatment.
3. How can you make your tan fade faster?
It’s important to understand that sunscreens may not actually prevent tanning. But they do reduce the amount of ultraviolet radiation to your skin. This minimises your chances of getting sun damage and sunburns, which are bad for photoaging and skin cancer formation processes. Tip: use conventional sunscreen application (every three to four hours with minimum SPF 30) and avoid the sun when it’s at its hottest from 9am to 5pm in this part of the world where it’s equatorial.
4. Can you reduce the size of your pores?
You may experience enlarged pores due to underlying skin conditions such as rosacea and acne, which is associated with excessive production of facial oils. I focus on treating my patients with a combination of home devices that utilise physical microdermabrasion, plus the delivery of antioxidant cosmeceutical formulas.
5. Any tips on how to treat eczema?
Eczema is inherently a genetic condition. Some individuals have exogenous eczema, which means the eczema is triggered by contact with something they’re allergic to. In these cases, avoid the contactant. For treatment, you have to repair the skin barrier with what we call a PED or Prescription Emollient Device type of moisturiser. This needs to be used liberally and frequently to restore healthy barrier function to the skin. A PED moisturiser is used together with topical corticosteroids prescribed by your dermatologist. Generally speaking, such an approach is safe and effective, depending on the severity of your eczema.
6. What’s the biggest money-wasting skincare product people shouldn’t buy?
I’d say we generally don’t need toner. That’s because 95% of toners are actually astringents that dry out the skin. Often, these are alcohol-based, which means they try to close your pores and reduce oily skin. I don’t think that can truly be achieved with such toners. They may dry out the skin excessively and cause, for example, reactive seborrhea in some individuals. This is where the facial skin overcompensates with oil production in response to being dehydrated.
7. What’s your advice on skin tag removal at home?
Skin tag removal should not be done at home. Skin tags, if properly diagnosed by a dermatologist, have to be removed by either electrocautery or CO2 laser vaporisation. I don’t recommend any at-home methods because that will be dangerous in terms of scarring and possible infection.
8. What are some ways to fade facial scars?
Facial scars from acne, specifically deeper acne scars, are what we call ice pick or boxcar type scars. We treat the scars using certain types of lasers such as CO2 laser fractional resurfacing, in combination with retinoids. Plus, other topical cosmeceutical active ingredients including vitamin C and centella asiatica, which promote wound healing and collagen synthesis, to reduce the amount of scarring.
9. When do you pop a pimple and when do you leave it alone?
You should never pop a pimple unless you see pus accumulating at the tip, like it’s almost coming out on its own. Even then, try not to squeeze it. Allow it to drain naturally instead. One method: when you’re coming out of the shower and your skin is slightly damp, the steam helps to increase blood vessel activity around the pimple. The increased blood flow can help the expulsion of what we call haemoserous content that’s in the pimple itself.
When draining the pimple, ensure that your hands are clean and washed. Use a moist cotton pad to gently press around the pimple with minimum pressure. If the fluid doesn’t drain, stop immediately and allow the pimple to resolve. Apply a non-irritating pimple cream. I usually prescribe a blemish spot cream and rely on hydrocolloid patches – they’re useful for blind pimples and pimples with a head.
10. What’s the difference between AHAs, BHAs and retinol?
AHAs refer to Alpha Hydroxy Acids such as glycolic acid. BHAs, on the other hand, refer to Beta Hydroxy Acids such as salicylic acid. These acids are fruit acids – also known as superficial acids. They help to shed superficial skin cells and enhance the rate of cellular renewal to increase skin radiance. AHAs and BHAs can be helpful in the treatment of certain skin conditions, such as mild to moderate acne, or photoaging.
Retinol is a vitamin A derivative related to retinoid, which is a prescription cream. Both ingredients are helpful in stimulating collagen production in your skin. They also help with the treatment of acne, acne scars and photoaging.
11. How do you get rid of or prevent millia?
Millia can be treated with extraction, electrocautery or CO2 laser vaporisation. It can’t really be prevented because we don’t really know the cause of it in most cases.
12. Any recommended products to reduce eye bags?
Eye bags are often a combination of fatigue, poor lifestyle factors and genetics. Unless they’re due to an underlying health condition that causes excessive water retention known as edema. With age, there can be increased sagging of skin and that contributes to the appearance of eye bags. Maintaining good dermal integrity around the eye area is helpful as it’ll minimise the chance of sagging.
However, if you look at childhood photos and see that you always had these bags, it’s unlikely that it’ll get better when you grow older. Under such circumstances, it’s unlikely that any treatment, other than surgically removing excess fat under your eyes, will make a dramatic difference. A good eye cream can help maintain dermal integrity and minimise sagging around the undereye area.
13. What are the best treatments for hyperpigmentation?
Treatments depend on the type of hyperpigmentation you have. For example, if you have acne, treat the active acne. Post-inflammatory hyperpigmentation generally resolves with moisturiser and reduces the inflammation that’s causing it. Other common types of hyperpigmentation are sunspots or solar lentigo. They’re sometimes known as age spots because they increase with age. The 532-nanometer Q-switch laser (a non-invasive laser treatment) is the best option, along with topical antioxidant cosmeceutical ingredients such as centella asiatica, which reduce pigmentation and inflammation.
For the treatment of melasma, a multifaceted approach is required. I usually treat it with a combination of the 1064-nanometer Q-switch laser and chemical peels, alongside topical prescription and non-prescription cosmeceuticals. Hydroquinone is an example of a prescription ingredient that can be used. For non-prescription, antioxidant cosmeceuticals such as Vitamin C in a stabilised form can reduce pigment formation. Sun protection is fundamental, as it treats and prevents the root cause of these problems.
14. How do you take care of oily skin in a way that balances it out without causing it to become dry?
It’s paradoxical but oily skin can be dehydrated simply because of inappropriate treatment. A lot of people with oily skin buy strong, deep cleansing facial washes. This actually strips the skin of natural moisture and causes it to produce even more oil. The recommendation? Use a gentle cleanser. If you suffer from acne, use a cleanser with antibacterial properties.
In my practice, we use an antimicrobial honey cleanser made from medical grade honey, which has these properties. In the era of maskne, this is very helpful because it can treat the skin microbiome. The honey also leaves a humectant layer on the skin to prevent it from drying out.
Now that all your important skincare questions have been answered by a dermatologist, are you ready to give your skin the right TLC?