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From acne to ageing: How to get healthy, beautiful skin in Singapore

Our biggest organ and our first line of defence, our skin is also the face we present to the rest of the world. Verne Maree talks to a nutritionist and a couple of dermatologists for the latest on skincare research, trends, products and treatments in Singapore.

Enjoy the sun in moderation
Enjoy the sun in moderation


For beautiful skin that glows with health, how you live your life is more important than the application of expensive products. Cardiovascular exercise, for one, is vital for circulating blood and lymph through the smallest vessels to bring hydration and nutrients to skin cells and flush away toxins.

Unsurprisingly, the same lifestyle factors that control your weight, keep your bones strong, protect your heart, balance your blood sugar and more, will also keep your skin healthy; sufficient rest, regular exercise and the best possible nutrition.

Eating for Great Skin

Nutritionist Karin G. Reiter
agrees that deficiencies of certain nutrients will affect your skin, and that eating the right foods can greatly enhance your appearance. A major cause of skin damage is the chemical process known as oxidation.

“Pollution, smoking, excessive sunlight and sugar are the worst culprits,” she reckons. “Aside from avoiding cigarette smoke and sunburn, the next best thing you can do for skin health is to eat a diet rich in antioxidants and low in processed, sugary foods.” That means fresh fruit and vegetables for the vitamins, plant polyphenols, carotenoids and glutathione that they contain. Just two Brazil nuts a day will give you all the selenium you need.

Antioxidant Facts

What are antioxidants?

Nutrients that work to defend your body’s cells – including skin cells – against the damage of oxidation.

Vitamins and minerals essential for healthy skin:
Vitamin A
The B vitamins
Vitamin C
Vitamin E
Essential fatty acids (EFAs)

Foods to choose:
Good fats: extra virgin olive oil, natural coconut oil, avocado, raw and unsalted nuts and seeds such as sesame, chia and flax
Whole grains: brown, red, black and wild rice, quinoa, millet, amaranth, buckwheat, oats
Vegetables: especially orange, red and dark green – sweet potatoes, beetroots, carrots, spinach, broccoli – at least five a day
Fruit: vitamin C-rich kiwis, red and black grapes, watermelon, berries, pomegranates, papaya and more
Lean protein: beans, lentils, deep-water wild-caught fish
Superfoods: raw cacao, wheat germ, Brazil nuts, green tea

Avoid at all costs:
Sugar, chocolate, peanuts, coffee and alcohol
White bread, pasta, rice and other refined carbohydrates
Processed, boxed or packaged foods, preservatives, fillers and dairy products

Ah, the attack of the invisible spot
Ah, the attack of the invisible spot


Breakout Bad
Even the most expensive skin product will not fix a nutritional deficiency that sets the stage for hormonal imbalances that lead to skin troubles such as acne.

“The quality of our food directly determines how good or bad our skin will look. Painful and disfiguring skin complaints like eczema and psoriasis are often the result of diet,” Karin believes.

Dermatologist Dr Lim Kar Seng, who sees a lot of eczema, reminds me that the triad of eczema, hay fever and asthma are closely related. “There is a genetic component,” he explains: “People who have a family history of any one of these conditions will be more susceptible to eczema.”

That’s just part of the story: food allergy and intolerance are also linked to eczema – and to its sniffly siblings, of course, and so it’s common practice to test sufferers for a possible allergy. “In children under four with moderate to severe eczema that doesn’t respond well to treatment, you’ll often find an underlying allergy; dairy products, peanuts and seafood are the top three.”

My own weak and puling baby sister survived both food allergies and asthma to become a strapping – even formidable – woman. Back in the sixties, her condition was relatively rare, but it’s become increasingly commonplace in the new generation. The same goes for eczema, according to Dr Lim, but why is that so?

His surprising answer is that we’ve become too clean, too fastidious. As societies progress and standards of hygiene rise, we’re sloughing off our natural protective layer with over-zealous soaping and scrubbing.

“When you use harsh, commercial soaps or exfoliate too vigorously or too often, you’re removing the natural moisturising factors on the surface of the skin that form a natural barrier against irritants such as heat and dust.”

What does he suggest we do instead? “Stay away from harsh soaps in favour of non-soap cleansers or a gentle, moisturising soap.” That’s good news: I’ve been using only Cetaphil cleanser – even for removing mascara – ever since a friend recommended it to me nearly ten years ago. It’s inexpensive, it’s effective and it’s safe to use on babies.

Speaking of which, the anxious parents of today tend to over-protect their offspring from environmental bacteria. This, studies show, prevents them from building up a natural immunity to these naturally occurring organisms.

How is eczema treated? “For the earlier stages, using a good moisturiser with a topical steroidal cream generally does the trick,” Dr Lim replies. “But once it has reached the oozing, infected stage, it’s generally necessary to prescribe an antibiotic, because once the skin’s defences have been breached, infection can spread dangerously fast.’

He also sees a lot of acne sufferers, because acne is a major problem in this humid part of the world. Much more research needs to be done on the undoubted link between acne and diet question, but studies have established a link between acne and a diet that’s high in dairy, particularly so where the diet has a high glycaemic index.

Apparently, a high glycaemic load initiates a cascade of hormonal reactions that starts with the release of insulin. Current thinking is that it does indeed affect acne in ways that we are only starting to understand, although dietary manipulation may not, on its own, be sufficient to prevent acne. (For an overview of the research, go to www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/.)

Though he sometimes feels that the role of nutrition is being over-played, Dr Lim has an open mind on the subject. “I believe that modern science and medicine has barely scratched the surface. Take gluten, for example; why are so many of us intolerant? And many Asians, myself included, are developing intolerances to dairy milk in our 30s and 40s. This may have a lot to do with our immune systems’ reactions to the hormones, steroids and other foreign substances that contaminate mass-produced milk.”

So much for the causes; how does a dermatologist treat acne?

“We always recommend a good face-wash. If you have an oily skin, you need a cleanser for an oily skin – but be careful: many people have combination skins, with an oily T-zone and normal or dry cheeks, for example.”

For milder cases, topical retinoid for exfoliation is indicated, together with topical antibiotics for the larger spots. “We sometimes recommend a HydroFacial treatment with dermabrasion to deeply hydrate and exfoliate the skin, or a laser treatment to help with oil and bacterial control. But laser reaches only halfway into the dermis, so it’s not ideal for larger pustules that extend much deeper.”

For those larger pustules, he will prescribe systemic treatment such as oral antibiotics, or even, for more resistant cases, a product such Roaccutane that works by suppressing sebum production and reducing inflammation.

Slap it on and you'll be as happy as this lady
Slap it on and you’ll be as happy as this lady


Sun Salutation
We can’t talk about skin and not mention sun exposure. Maintaining healthy levels of vitamin D3 – and that means making it yourself, as it’s impossible to get what you need through food or supplements alone – is essential for overall health in ways we are only starting to understand. And no, a few minutes’ exposure to the early morning or late afternoon sun is not enough. Midday is when the UVB rays that cause us both to tan and to produce vitamin D3 are at their strongest.

But moderation is key, and the golden rule is never to allow your skin to burn: too much sun increases the risk of skin cancer and ages our skin. As nutritionist Karin says, balance is the key – as with most things in life.

“I do get outside into the sun regularly. Being outdoors makes me happy and I feel energised afterwards. But I do monitor how much time I spend in the sun.”

The time required to make sufficient vitamin D varies according to a number of environmental, physical and personal factors and may vary between individuals.

“Regularly going outside for up to 15 minutes around the middle of the day without sunscreen (or perhaps using sunscreen only on the more vulnerable face and neck) is suggested as the best way to get enough vitamin D. The more skin that is exposed, the greater the chance of producing sufficient vitamin D.”

Protect yourselves against harmful rays
Protect yourselves against harmful rays


Ageing Beautifully
Cosmetic dermatologist
Dr Marinos Petratos shares his time between two offices, one in New York and the other in Athens. He had just delivered a talk at the September Aesthetics Asia 2014 Exhibition & Congress when he made time to chat to me at the stand of NEOAsia, industry distributors for American brand NeoStrata.

Described as one of the early pioneers in clinical cosmetic dermatology, Dr Petratos was among the first to use injectable fillers and chemical peels such as alphahydroxy acids (AHAs) and polyhydroxy acids (PHAs).

“Twenty years ago,” he points out, “we knew so little about the skin’s ability to absorb substances; in fact, we thought that nothing got in through our skin! Now we know differently. We understand that many substances – both harmful and beneficial – are easily absorbed in this way. Some are absorbed more slowly, others more quickly. The reasons AHA stings a bit is that it’s so quickly absorbed. PHAs have larger molecules that are absorbed more slowly, so they don’t sting at all.”

What do his patients come to him for? “Overwhelmingly, they come to me for help in rejuvenating their ageing skins,” he replies.

This is a phenomenally lucrative business that is steadily growing. Twenty or 30 years ago, a smallish percentage of the population would have visited a dermatologist at some time for a specific skin disorder such as suspicious moles or other growths, dermatitis or eczema, or severe acne, perhaps. Now, everyone faced with the “problem” of an ageing skin is a potential patient. It’s no wonder so much research and development is being done in this field.

Dr Petratos says he’s particularly excited about the advanced new products that companies like NeoStrata are bringing out.

One such new product is NeoStrata’s Skin Active Line Lift*, which targets deep wrinkles and lines. It uses what he describes as a new anti-ageing breakthrough: patented Aminofil technology, “a novel amino acid derivative for the treatment of fine lines and rhytides”. Clinical trials, including a 16-week trial on Caucasian women aged from 40 to 65 years, show that it significantly thickens the skin, increasing its hyaluronic acid content and promoting collagen growth.

(* RRP $114 plus GST from The Dermatology Practice and other outlets)

Through its volume-building effect, it promises to reduce the appearance of nasolabial folds and lines between the eyebrows, and fade lines and wrinkles around the eyes and the mouth. It’s a two-step treatment – first a rollerball “activator” and then a “finishing complex”. It’s well worth a go, I feel, so I’ve been applying it every night for the past six weeks and will continue at least until I’ve emptied the bottles. (You’re supposed to use it morning and night, but I find it interferes with the layer of makeup foundation that a woman of a certain age is morally bound to apply before leaving home in the morning.)

He sounds a note of warning, though: “Choose a brand that you can trust. You have to remember that the cosmetic industry is relatively unregulated. Unlike the medical industry, which is subject to the strict requirements of bodies such as the US FDA, not every new beauty product that comes onto the market has necessarily been tested for safety and efficacy.”

The elegant doctor is an enthusiastic proponent of “layering”: he believes that using one product in the morning and another in the evening, or one product over another, has a synergistic effect where the whole is more than the sum of its parts.

To effectively treat acne – even active acne – he might prescribe a PHA cleanser, followed by a glycolic acid peel, followed by topical antibiotics if necessary. AHAs and PHAs can also be used extensively as adjunctive therapies in combination with drug therapies when treating various skin conditions such as seborrhoeic dermatitis, melasma (pigmentation), keratosis (scarring) and psoriasis, as well as pre- and post-laser treatments for photo-damaged or ageing skin.

If he had one piece of advice to protect one’s skin from ageing, what would that be? The answer is predictable: “Stay out of the sun. Twenty or 30 years ago, we didn’t know exactly how solar radiation damaged the skin; now, we do. More especially, we didn’t know that it’s the UVA rays, rather than the UVB rays, that cause the real photo-damage, so the sun-screen preparations of the time didn’t protect against them; they only warded off the UVB rays, which are the ones that give you the obvious burn.

“What’s more,” he adds, “the gradual depletion over the past 50 years or so of the ozone layer, which protects the earth from the sun’s ultraviolet radiation, has increased the incidence of hyper-pigmentation, photo-ageing and skin cancers.”

I’m particularly interested in the Heliocare range, which contains a powerful photo-protective antioxidant agent, a herbal extract from a particular fern, Polypodium leucotomos, that has been patented as Fernblock.

Researched at Harvard Medical School, it claims the ability to “protect your skin from ageing caused by environmental aggressors”, particularly the sun’s UVB rays. The range includes an oral capsule, ideal for tennis-players or golfers, for example, and especially for swimmers. Note that the oral capsule doesn’t block UVB radiation or prevent burning; you still need proper topical protection. It’s available at Guardian stores; I picked up a bottle last month from the Changi Terminal 2 outlet before jetting off for a scorching weekend on a Malaysian island.

As ever, prevention is better than cure.


Want to chat to the experts?

Karin G Reiter
Medical Nutritionist and Personal Trainer
9855 6643

Dr Lim Kar Seng
The Dermatology Practice
38 Irrawaddy Road
#07-60 Mount Elizabeth Novena Hospital
6694 3290 | https://www.thedermatologypractice.com

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