Given a diversity of reasons, it might be hard to define what Asian skin is exactly. How does a dermatologist categorise Asian skin and its characteristics?

“Asian skin falls under the category of  ‘ethnic skin’ or ‘skin of colour’ in dermatology. This is due to the amount of melanin present. Under the Fitzpatrick phototype classification system, Asian skin types fall under phototypes three, four, and five.

This is very relevant as it affects one’s susceptibility to getting skin cancers and photosensitivity in general. Secondly, skin that has more melanin has higher innate ultraviolet protection. Hence, skin of colour may have fewer signs of photoageing compared to phototypes one and two who are of the same chronological age.”

Are there common skin conditions that affect Asian skin and how do we treat these concerns?

“Pigmentation is a very relevant skin concern amongst Asian skin types. The melanin that is photo-protective also predisposes to increased post inflammatory hyperpigmentation (PIH). PIH develops in response to acute or chronic inflammation, most commonly as a form of scarring.

In terms of treatment of PIH, it is important to understand that the key lies not in ‘bleaching’ the skin or abrasively resurfacing the skin. This may seem counterintuitive but the key concept in treatment of PIH in pigmented skin types is to minimise inflammation.

Another common skin disorder in Asian skin types is melasma. Melasma is distinct from other types of pigmentation because of the location of the pigmentation, which is in the deeper dermal layers. Ablative treatments such as CO2 laser resurfacing should be avoided. It is important to distinguish the types of pigmentation (i.e. PIH, melasma, solar lentigo (sunspots), freckles (ephelides) so that the treatment modality is appropriate to the diagnosis.

A reason to visit an accredited dermatologist for diagnosis and treatment of pigmentation disorders is that inappropriate understanding or wrong diagnosis of pigmentation can lead to worsening of treatment outcome. As an example, using a prescription bleaching cream like hydroquinone generally does not have beneficial effects in post-inflammatory hyperpigmentation but is indicated for the treatment of melasma. On its own, hydroquinone should not be used for longer than three months due to the risks of paradoxical darkening.

Incorporating over the counter cosmeceuticals such as plant-based anti-oxidants in one’s skincare regimen is a safe and effective method to prevent and treat pigmentation, and can synergise with the effects of laser treatments leading to better treatment outcome and maintenance.”

What are some things to note of when picking out skincare products for Asian skin?

“A lot of skincare products available are for individuals living in temperate climates as opposed to our unique tropical climate in Singapore with high humidity. As a dermatologist practicing in Singapore, the key message for women is that we need to bear in mind that we have close to 100 per cent humidity levels. This means that the day moisturisers should be hydrating emulsions and serums as opposed to cream formulas, which are prevalent in cosmetic brands.

Secondly, I generally avoid AHA and BHAs in skincare products targeted for oily skin types. What can be well tolerated in a temperate climate on a lighter skin prototype may cause irritation on Asian skin types in an equatorial climate like Singapore, which gets near 100 per cent of the sun’s UV rays.

In my experience, any amount of AHA exposure especially in a leave-on home-use skincare product increases the risk of irritant contact dermatitis even for individuals with oily, acne prone skin. As a result, these individuals end up having oily and dehydrated skin.”

What are some up-and-coming Asian skincare trends on your radar?

“The focus on the skin microbiome is certainly one of them. The microbiome is essentially a complex host of flora comprising various microorganisms that enable you to maintain healthy skin function. From a dermatologist’s point of view, there are two major ways to influence your microbiome.

The first is through cosmeceuticals. These have immunomodulatory effects, usually through botanical antioxidants. The second – which is the area of my focus – is with bio-functional textiles. It is an area of my research in bio-functional textiles incorporating metallic ions such as zinc, silver and copper into garments that are worn on the skin to stabilise the skin’s bacteria.

My white paper on maskne has just been published in the Journal of American Academy of Dermatology in November, which characterises the role of bio-functional textiles in maintaining microbiome balance without use of antibiotics.”

As a dermatologist, what is your definition of “healthy Asian skin”?

“Healthy skin is a universal definition and can be applied to skin of colour, which covers Asian skin, as well as other skin types such as the caucasian phototypes.

Firstly, the skin barrier should be healthy. This forms the basis of the skin as an organ – its function beyond cosmetic – as it forms a barrier between the internal and external environment. The skin barrier is best visualised as a brick and mortar model. The bricks are your skin cells where the corneocytes are bound together by these fatty lipids of ‘cement’ known as ceramide.

With this as the fundamental of healthy skin, we can then build on the additional characteristics such as skin radiance, vitality, elasticity, smoothness and softness. While these characteristics may seem to be subjective, the advent of deep learning technologies allow objective assessment of these qualities which have become a very important part of the evaluation of skin health and beauty.

How we achieve skin radiance and vitality – a key element in all Asian skincare trends like glass, jelly or mochi skin – is by targeting the skin cell mechanisms. In ageing, inflammation occurs at the cellular level, causing a phenomenon known as cell senescence, in which cells are no longer able to conduct DNA repair as it was able to at its prime. The use of topical antioxidants can retard this process while botanically derived antioxidants are the main source of molecules that can specifically replenish cell energy.”

Based on your work and interactions with patients, how has the pandemic impacted Asian skin and our skincare habits?

“The pandemic has definitely affected the incidence of acne mechanica, now known as maskne. I characterised the clinical features of maskne in the ‘O-zone pattern’ in my paper as distinct from physiologic acne in the T-zone. Adult women who are struggling with acne have a predominant hormonal distribution in the U-zone. Mask-wearing has significantly aggravated this issue.

I believe many are now more conscious of their skincare habits and hygiene, especially since we’re living in a very humid climate. Mask-wearing has also created an occlusive microenvironment over our face. Wearing sunscreen as well is an issue as the comedogenicity of most sunscreens increase with occlusion and is impractical with mask-wearing. I currently recommend UPF 50+ bio-functional textiles as the gold standard of sun protection for the lower half of the face.”

If you can debunk some highly misconceived beliefs about Asian skin, what would they be?

“The point that Asians generally look younger than their Western counterparts is partly a myth and partly backed by science. The scientific aspect of this is that since Asians have more melanin and are thus more UV protected, it results in a difference as photo-ageing is a significant part of skin ageing.

However, in our population, there are certainly individuals that age more dramatically than their counterparts. Apart from the amount of melanin found in the skin, other environmental and lifestyle factors play a part. One should not neglect the importance of a healthy lifestyle and the consumption of an antioxidant-rich diet.

One factor that I find makes all the difference in two individuals undergoing cosmetic treatments is the amount of physical activity – specifically high intensity interval exercises – as these exercises increase insulin sensitivity, a significant factor in inflammaging.

An individual’s facial bone structure also plays a huge role in how one ages. The most beautiful woman in the history of Egypt, Nefatiti is famed for her beautiful face structure, which plays a significant role in how she aged. When there’s age-related atrophy, the bone structure determines how everything holds up.”

You mentioned that the requirements for healthy skin are universal. What exactly are these requirements?

“The requirements of healthy skin first starts with a healthy skin barrier, which is the topmost layer of the skin. Moving downwards, we have the function of humectant molecules, which are free amino acids that function as natural moisturising factors. In addition to naturally occurring hyaluronic acid molecules, polyglutamic acid is also an important molecule that helps retain moisture in the skin and is in fact 10 times more effective than hyaluronic acid.

The second would be a healthy skin microbiome. The skin microenvironment is determined by the genetics, composition of oil production, and external factors such as temperature, pH, humidity, and the presence of biofluids.

The third requirement of healthy skin boils down to a healthy body. The skin is best viewed as a composite of our body’s organ functions. Lifestyle factors contribute very significantly to the process of skin ageing. For example, high intensity interval exercises are more beneficial than other types of exercises to reduce insulin resistance. Another example would be the consumption of an antioxidant rich diet.”

Can you share with us your personal tips to maintain healthy and radiant Asian skin?

“It is important to understand that the material you use on your skin matters whether it is when cleansing the face or when applying makeup. The method of application – think technologies such as radio frequency and microdermabrasion – can significantly enhance the absorption of topicals. For example, a patting motion when cleansing or applying product is gentler on your skin as opposed to rubbing or using any facial cloths.”

What makes the Dior Capture Totale Super Potent Serum a must-have for Asian skin?

“It is a very efficient serum that combines both potent antioxidants, which is the patented Floral Complex containing Longoza, as well as acetylated hyaluronic acid that helps strengthen the skin barrier. The floral extract goes beyond your typical antioxidant as it has been shown to directly target the mitochondria – the energy house of ageing skin stem cells – which is key to revitalising aged skin.

As a dermatologist, I emphasise skin health above all. I have to say that the use of injectables without adjunct cosmeceuticals that target skin health is not sustainable. Rather, it can lead to an artificial, disconnected look.

The bio-fermented lipoprotein is also an effective vector to carry the Longoza extract into skin cells for it to exert its effects. Most importantly, the research at the Helios institute shows that these effects are demonstrated via detailed proteonomic analysis.”