By Ms Lew Hui Li & Ms Chong Hui Ying

Acne or acne vulgaris is a skin condition that occurs when a pore get clogged with dead skin cells, oils and a type of bacteria called Propionibacterium acnes (P. acnes). Acne is triggered by many factors:

• Hormones
• Stress
• Poor hygiene
• Wrong skin care products
• Sun
• Unhealthy diet

Inflammatory Acne Types (More severe)

It is more likely to cause complications such as scarring or pitting.
Examples: Papules; Pustules; Nodules; Cysts

Treatment- Mild Acne

Mild acne can be treated with over-the-counter (OTC) medications, such as gels, soaps, pads, creams, and lotions, that are applied to the skin. OTC acne remedies may contain the following active ingredients:

• Resorcinol: helps break down blackheads and whiteheads
• Benzoyl peroxide: kills bacteria, accelerates the replacement of skin, and slows the production of sebum
• Salicylic acid: assists the breakdown of blackheads and whiteheads and helps reduce inflammation and swelling.
• Retin-A: helps unblock pores through cell turnover
• Azelaic acid: strengthens cells that line the follicles, stops sebum eruptions, and reduce bacteria growth.

Treatment- Moderate Acne

A skin specialist, or dermatologist, can treat more severe cases.

• Corticosteroid injection: help prevent scarring, reduce inflammation, and speed up healing.
• Oral antibiotics: combat the growth of bacteria and reduce inflammation, erythromycin and tetracycline are commonly prescribed for acne
• Oral contraceptives: help control acne in women by suppressing the overactive gland.
• Topical antimicrobials:  reduce P. acnes  (example: clindamycin)
• Retinoic acid derivatives: unclog pores and prevent whitehead and blackhead from developing (example: adapalene, tretinoin)

Prevention and Management Tips

Ever wonder how strong the sunlight in Malaysia is?

Putting aside the scorching temperature and blinding brightness, there’s something within Malaysia’s sunlight that is more worrying – Ultraviolet radiation (UV).  According to the Who Health Organisation (WHO) INTERSUN program, the level of UV radiation can be measured using UV Index such as below:

And unsurprisingly, Malaysia in general is usually exposed under UV index 9 to 11+ most of the time all year round.

You may wonder what’s the big deal about UV radiation.

To understand that we’ll need to look into the types of UV radiation that we are commonly exposed to in the atmosphere – UVA and UVB.

Up to 95% of the UV radiation that reaches Earth’s surface is UVA. UVA rays are much more prevalent on Earth and are always present regardless of season or time of day due to its longer wavelength giving it the ability to penetrate through clouds and glass. Although they are less intense than UVB, UVA can penetrate the skin more deeply and cause skin aging and wrinkling. Exposing to UVA also leads to injury in the DNA of the skin. In order to prevent further DNA damage, the skin darkens, causing skin tanning. Even though UVA does not cause significant damage to the epidermis, the outermost layer of skin where most skin cancers occur, they do still bring damage to a deeper layer of the epidermis and thus still contribute to and may initiate skin cancer to develop.

UVB on the other hand is known to be the main reason our skin reddens and gets sunburn when exposed to sunlight for too long. Because of their shorter wavelength, they can only reach and damage the more superficial layer of the epidermis, but they play a big role in the development of skin cancer. UVB intensity varies throughout the day and usually is most intense between 11.00 am to 3.00 pm in Malaysia. UVB does not pass through glass significantly, but it can be reflected and bounce back on a reflective surface, hitting your skin twice.

So to summarise:

So how do we protect ourselves from the harm of UV rays?

One way is to apply sunscreen or sunblock. To evaluate how effective the sunscreen is, you can look at its Sun Protection Factor (SPF). The SPF value of a sunscreen indicates how much longer it will take for your skin to redden and get sunburnt by UVB rays when the sunscreen is applied, compared to when you do not apply any sunscreen. If you usually get sunburnt within 10 minutes under the sun when not applying sunscreen, applying a sunscreen with SP15 will delay the time till sunburnt to 15 times longer. So now your skin takes 150 minutes to get sunburnt.

Some of you may think: What if I want to prevent my skin from darkening because of sunlight exposure?  Then you should be checking out the PA value of the sunscreen. Basically, the more + is added to the back of PA, the better the protection against UVA.

•             PA+ = Some UVA protection.

•             PA++ = Moderate UVA protection.

•             PA+++ = High UVA protection.

•             PA++++ = Extremely High UVA protection.

Since we want to reduce the damage of both UVA and UVB, it is always better to look for broad-spectrum sunscreen and provides protection towards both types of UV rays.

Here we recommend you always use a broad-spectrum sunscreen with at least SPF 15 for daily activity. However, for extended outdoor activities, at least SPF 30 sunscreen should be applied. Keep in mind that sunscreens will start to lose effectiveness over time regardless of its SPF value, so it is important to reapply them every 2 hours. If you are going for a swim or activities that will cause heavy sweating, choose a sunscreen that indicates water-resistant or sweat resistant. Water-resistant sunscreen will remain effective for 40 minutes when swimming while sweat-resistant sunscreen will last 80 minutes when sweating. There is no “waterproof” or “sweatproof” sunscreen so you will still need to reapply the sunscreen frequently.  In order to let sunscreen function properly, always apply it 30 minutes before going out.

Apart from using sunscreen, you can protect yourself from UV rays by wearing clothing with UV cutting properties. Look for clothes with higher UPF (Ultraviolet Protection Factor). The higher the UPF, the less UV can penetrate through the clothing. Clothing with a UPF rating of 30 will allow only 1/30th (about 3 percent) of UV to pass through it and the UPF rating of 50 will only let 2 percent of UV to penetrate.

Even if you are unable to find clothes that claim to have UPF, you can choose to wear more tightly-woven but loose-fitting clothing as they provide more barrier between your skin and the sun. Clothes made from mixture or fully heavyweight natural fabrics like cotton, linen and light synthetic fabrics like polyester, nylon and spandex are some of the good choices. Wearing darker and more vibrant colour clothing will also absorb more UV and prevent them from reflecting other parts of your body when compared to clothing with pale colours. Remember clothes will also start to stretch and lose their colour after being worn and washed for some time, and therefore loses some of its sun-protective effects. So I guess that gives us more reason to buy new clothes once in a while.

Even with the above precautions taken, it is still best to stay in the shade as much as possible when going out. Wearing UV-blocking sunglasses and wide-brimmed hats helps too.

Hopefully, with this, you will be able to protect yourself from the damage of UV better in the future. Stay healthy, stay safe!

CHICKENPOX

Chicken pox, a common infection in children caused by a virus known as varicella-zoster virus. It is a highly contagious disease that spread from person to person causing the infected person to develop fever and a blister like rash. The rash crops up first on the face and trunk and can spread over the entire body. It can be transmitted through the air when someone with chicken pox sneezing or coughing or by touching the watery stuff that comes out from the chicken pox blisters.

Symptoms of chickenpox

1. Fever
2. Loss of appetite
3. Tiredness
4. Headache
5. Rash starting as small, itchy red spots like pimples all over the body including the mouth

Chicken pox infection generally will results in lifelong immunity. But the virus may remain hidden and reactivate as shingles in a proportion of adults and sometimes children.

SHINGLES

Shingles is an acute infection caused by the herpes zoster virus, the same virus as causes chickenpox. Shingles occurs because of exposure to chickenpox or reactivation of the herpes zoster virus. The virus remains latent (dormant) in nerve roots for many years following chickenpox. Thus, shingles only happens in people who already had chicken pox. Usually adults age ≥ 50yo will be affected.

Symptoms

1. Pain in the affected nerve area, ranging from a tingling sensation to very severe burning pain that indicating nerve damage.
2. Mild fever
3. Tiredness
4. Unilateral, localized rash that become blisters

DIFFERENCES OF CHICKENPOX AND SHINGLES

How is chicken pox and shingles being treated?  

General:

• Keep the infected child at home (about 7 days from the onset of rash).
• Drink plenty of water to prevent dehydration.
• Take analgesic (eg.paracetamol, mefenamic acid, diclofenac) for fever or to  reduce pain.
• Stay cool and wear loose-fitting clothes, preferably made of cotton.
• Take balanced meals
• Keeps hands clean

For itchiness:

• Apply cooling gel or calamine lotion on the rash.
• Keep fingernails short and clean to prevent scratching and possible scarring.
• Use a cool compress to soothe the itch
• Antihistamine medications (eg. Cetirizine, loratadine or chlorpheniramine) may be prescribed if the itch is very bad.

Antiviral medication to slow down the progression and stop the growth of virus. Example : acyclovir, famicyclovir , valacyclovir. It is usually prescribed for those at risk for severe disease, such as:

• Those older than 12 years old.
• Those with chronic lung disease/skin disease.
• Those on long term salicylate therapy (like aspirin).
• Those receiving short, intermittent, or aerosolized course of steroid therapy.
• Some groups of pregnant mother.

Antiviral topical treatment to speed up the healing of the sores and decrease the symptoms (like tingling, pain, burning or itching).

• Apply the antiviral cream 6 times per day for at least 5 days to stop the growth of virus.
• Apply the cream onto the affected area and rub in gently. Make sure the cream is enough to cover all affected area.
• Apply to skin only. Do not apply this medication in the eyes or nose, inside the mouth, or inside the vagina.                                                           

SUPPLEMENTS

Multivitamin and mineral

A high-potency multivitamin and mineral supplement may help to protect against cell damage. Look for a supplement with all the key ingredients, including vitamins C, E and selenium for antioxidant support. Vitamin B12 may help to support the formation of  myelin (a layer that cover the nerves). Keeping the myelin sheath healthy may even make the reactivation of the virus – which causes the symptoms of shingles – less likely.

Lysine

Lysine play an important role in the immune system. Combined supplement of lysine and zinc may help to reduce infection in people with compromised immune system. Lysine is also important for the body’s production of collagen, a protein that’s essential for healthy skin.

Probiotic

Probiotics are made of good live bacteria and/or yeasts that naturally live in our body. When you get an infection, there is more bad bacteria knocking the system out of balance. Good bacteria then works to fight off the extra bad bacteria and restore the balance within the body. Therefore, probiotic supplements are a way to add good bacteria to the body, supporting the immune system and controlling inflammation.

References

1. Morgan, C. and Slater, O., n.d. Chickenpox and Shingles. [online] Natures Best. Available at: <https://www.naturesbest.co.uk/pharmacy/pharmacy-health-library/chickenpox-and-shingles/> [Accessed 20 June 2021].
2. PORTAL MyHEALTH. 2012. Chickenpox – PORTAL MyHEALTH. [online] Available at: <http://www.myhealth.gov.my/en/chickenpox/> [Accessed 4 July 2021].
3. PORTAL MyHEALTH. 2017. Varicella-Zoster Viral Infection – PORTAL MyHEALTH. [online] Available at: <http://www.myhealth.gov.my/en/varicella-zoster-viral-infection/> [Accessed 5 July 2021].

Types

Technically there is a huge difference between sunblock and sunscreen. Sunblock, as its name suggested, uses physical blockers like zinc or titanium oxide to guard the skin against UV rays. On the other hand, sunscreen uses active ingredients that readily absorb the sun’s rays. The active ingredients of sunscreens are more easily absorbed into the skin.

Choose The Right One

1. Broad Spectrum Sunscreen

This type of sunscreen protects against both UVA and UVB rays. UVA rays are the one that contribute to skin cancer and premature aging while UVB rays can cause sunburn. Only products that pass a certain test can be labeled “broad spectrum.” Most of the products aren’t broad spectrum hence they can only protect against sunburn, not skin cancer or skin aging.

2. Sun Protection Factor (SPF)

SPF is a measure of how much UVB light can be filtered out by a sunscreen. The American Dermatology Association (ADA) recommends using an SPF of at least 30. SPF 15 blocks about 93 percent of UVB rays, while SPF 30 blocks about 97 percent of UVB rays. 

3.Your Skin Type

For those who have dry skin should pick a sunscreen that doubles as a moisturizer.

For those who have oily and acne-prone skin, a water-based sunscreen instead of oil-based sunscreen is recommended.

On the other hand, for those with skin that is more sensitive and prone to irritation, they shall avoid products with alcohol, preservatives, fragrances, and oxybenzone.

The best sunscreen for kids should be at least SPF50. Choose sunscreens that are specifically made for kids as adult sunscreens can sometimes irritate their gentle skin. Babies need even stronger sun protection, as their skin is thinner and more. sensitive.

4.Level Of Sun Exposure

Duration of exposure to sunlight, the weather, and type of activities while being exposed to the sun are the factors that need to be taken into consideration. Typically, the strength of the sun is measured by the Ultraviolet (UV) Index, which ranges from 1 (low) to 11+ (extreme). These UV rays are the strongest from 10 a.m. to 4 p.m., and when the UV Index is at 8 or above, our unprotected skin can burn in 15 minutes or less.

For instances,

– Outdoors: choose sunscreen with at least SPF 30 or higher if you are mostly outdoors for an extended period (two hours or more), depending on your skin color.

– Sports/swimming: choose a sweat-resistant or water-resistant sunscreen with at least SPF 30 or higher, depending on your skin color, and reapply every 40 to 60 minutes.

– Every day: choose sunscreen with at least SPF 15 on regular basis if you will be in the sun and shade.

5. Types of Formulation and Packing

Sunscreen formulation refers to how a sunscreen is formulated either an oil-in-water or water-in-oil emulsion. It can be formulated in lotion, gel or cream thus it will give different textures and looks on an individual’s skin.

There are few common sunscreen formulations available on the market such as sunscreen sprays, sunscreen lotion and sunscreen stick. In general, all sunscreens have a shelf life of three years from the date of manufacture.

6. Water Resistance

There is a myth saying that “water resistant” means “waterproof.” No sunscreens are waterproof or “sweatproof,” you’ll need to reapply once you expose your skin to water with the product on, after a stipulated amount of time. Usually, reapplication of sunscreen at least every 2 hours is most favorable. If a product’s label makes claims of being water resistant, it must indicate whether it lasts for 40 minutes or 80 minutes while swimming or sweating.

Tips for sun-safe

• Wear clothing and wide-brimmed hat to protect the skin as much as possible. Pair up with sunglasses that block at least 99 percent of UV light to protect your eyes
• Look for shade. Limit direct exposure to the sun, especially between the hours of 10 a.m. and 4 p.m., when UV rays are the strongest.
• Avoid tanning beds and sunlamps. 
• Always remember to apply sunscreen or sunblock 15 minutes before you go outdoor to maximize the benefit of sunscreen.

References

1. How to choose the best sunscreen, according to these dermatologists. [Internet]. Better By Today. 2019 [cited 5th June 2022]. Available from: https://www.nbcnews.com/better/lifestyle/how-choose-best-sunscreen-according-these-dermatologists-ncna1002451?featureFlag=true#anchor-NextconsidertheSunProtectionFactorSPF
2. How to Choose Sunscreen. [Internet]. StyleCraze. 2022 [cited 5th June 2022]. Available from https://www.stylecraze.com/articles/things-to-consider-when-choosing-a-sunscreen/
3. How Does Sunscreen Work to Protect Your Skin? [Internet]. Colorescience. 2018.[cited 5th June 2022]. Available from https://www.colorescience.com/blogs/learn/how-does-sunscreen-work-to-protect-your-skin
4. Sunscreen: How to Help Protect Your Skin from the Sun. [Internet]. FDA. 2021. [cited 5th June 2022]. Available from https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun
5. Choose the Right Sunscreen. [Internet]. cancer.org 2018. [cited 5th June 2022]. Available from https://www.cancer.org/latest-news/choose-the-right-sunscreen.html
6. How To Choose Sunscreen To Suit Your Skin Type. [Internet]. Dermaster. 2021.  [cited 5th June 2022]. Available from https://dermaster-thailand.com/en/resource/how-to-choose-sunscreen-to-suit-your-skin/

What is acne? Acne or pimples can present as whiteheads or blackheads (close and open comedones) or inflamed papules, nosules or cysts. (1)

The severity of acne is often categorized as:

• Mild which is mostly whiteheads and blackheads, with a few papules and pustules;
• Moderate which is more widespread whiteheads and blackheads, with many papules and pustules;
• Severe which has lots of large, painful papules, pustules, nodules or cysts and you may also have some scarring! (2)

So, how is acne formed? There are three main factors for acne formation. Let’s see the factors as belows:

1. The skin cells are not shredded properly which cause plugging of pores.
2. Androgen hormones which are present in both males and females regulate oil production in the skin. During adolescence, increased androgens or increased response to androgen can cause increased oil or sebum production.
3. Overgrowth of Propionibacterium acnes bacteria within hair follicles.
4. All the above factors will eventually cause inflammation and swelling of the hair follicles, result in acne formation. (1)

Do you know what factors that may worsen acne?

• Milk and foods with high glycemic index such as white rice, glutinous rice, white bread, cornflakes, fried noodles, boiled potato, watermelon and the tarik may worsen acne.
• Stress may also worsen acne. In some studies, exam stress worsens their acne.
• Smoking may worsen acne too when smoker has lower level Vitamin E and cause higher level of oxidized sebum.

Acne Do’s

1. Wash your face twice a day with water and gentle, oil-free cleanser.
2. If you wear make-up, preferably use oil-free and water-based products and remove them before sleep.
3. Apply acne medication to manage blemishes. Make sure you understand how to apply them correctly to get maximum benefit.
4. Use a water-based moisturizer to keep skin soft, smooth and hydrated if necessary.
5. Shampoo regularly and keep your hair off your face if you have long hair.
6. Replace cosmetic sponges and old brushes regularly to reduce bacteria.
7. Drink plenty of water, eat balanced diet and exercise regularly.
8. Stop smoking
9. Seek the advice from doctor if your skin condition doesn’t improve.

Acne Don’t

1. Do not ignore your acne as it may cause permanent scarring
2. Do not squeeze or pick your acne as this can deepen the inflammation and cause scarring.
3. Do not use harsh scrubs and cleansers that may irritate or dry your skin.
4. Do not expose your skin to extreme temperature or sunlight.
5. Do not use greasy oil-based cosmetics that can clog pores and trigger breakouts.

Treatment for Acne

Mild Acne
You may use commercial products. Otherwise, one topical agent can be considered.

Moderate Acne
A combination of 2 topical agents or if more severe, an oral antibiotic (prescription-only) to be prescribed by a doctor.

Severe Acne
In presence of nodulocystic acne or acne not responding to treatment, referral to a dermatologist is required. (1)

Reference

• Patient Information Leaflet Acne Vulgaris. Malaysia: Ministry of Health, Dermatological Society of Malaysia, Academy of Medicine Malaysia; June 2012.
• NHS. Acne [Internet]. United Kingdom; 2019 [updated 2022 July 12; cited 2022 Aug11]. Available from: https://www.nhs.uk/conditions/acne/diagnosis/

What is nappy rash?

Nappy rash is a skin irritation around the area covered by the baby’s nappy. It can look like a mild pink or red rash just covering some of their skin, or across their whole nappy area. If left untreated, nappy rash can develop blisters and even open sores.

Some babies have skin conditions that make them particularly sensitive. Eczema, psoriasis and impetigo can make nappy rash worse because of a breakdown in the skin.

Nappy rash will affect 1 in 3 babies before the age of 2. There are things we can do to help avoid these rashes and to treat them if and when they do occur. 

Signs and symptoms of nappy rash

The skin on the child’s bottom and genitals will look inflamed and sore. On children with darker skin, the inflammation might look brown, purple or grey. On children with lighter skin, the inflammation might look red. Some areas of skin might be raised or swollen, and there might be breaks in the skin. These breaks are called ulcers. Skin folds aren’t usually affected because wee doesn’t get into them. But nappy rash might sometimes go up onto the child’s tummy or spread up towards the baby’s back.

The rash can be uncomfortable and even painful, which can make the child irritable.

4types of nappy rash

1. BACTERIAL 

Most rashes are an irritation of the skin caused or aggravated by contact with the wee and poo. The rash starts with a slight reddening of the skin in the nappy area and can progress to soreness and discomfort.

• The most common type of nappy rash is a mild bacterial rash.
• The skin looks red and sore and can almost appear shiny.
• This is usually caused when the baby’s bottom is in contact with a wet or dirty nappy for a long period of time.
• A normal disposable nappy is made of plastic and traps heat and moisture inside. This combined with the wee or poo, makes a perfect breeding ground for bacteria.

2. FRICTION 

Nappy rash can be caused by chaffing or rubbing if skin is very sensitive or the nappy is the wrong size.

• A common cause of nappy rash is friction caused by the nappy rubbing against the baby’s delicate skin.
• Whether the parents use disposables or reusable do check the fit of the nappy.
• It should be snug around the tummy but not too tight – parents should be able to fit their finger inside the waist band.
• The tabs should come around the sides and sit on the frontal sticky tape without having to cross over or meet – Most brands have a logo on their tape. Parents should sit be able to see this once the nappy is fastened.
• The leg ruching should not leave deep red indents in the babies’ skin. If it does, it is too tight.
• Conversely a too loose nappy can cause chafing between the thighs.
• Check the size chart on the nappies but remember every baby is different, so it may be a case of using the parents’ intuition. 

3. FUNGAL

A bright red, moist rash with white or red pimples which spreads to the folds of the skin, may indicate that the baby has a thrush infection and requires a prescribed cream.

• This kind of rash can sometimes happen if the baby is on antibiotics or if they have thrush.
• A fungal rash shows as tiny red spots and the genitals can appear slightly swollen.
• This needs to be treated using an anti-fungal cream, available on prescription from the GP.
• This should be applied thinly to the affected area.
• If the nappy rash is fungal it is important that we avoid our usual barrier cream as this can make the condition worse.

4. ALLERGY 

Occasionally nappy rash can become persistent and can be related to other skin conditions like eczema or allergies.

Some babies have sensitivities or allergies to the various components of their nappies or wet wipes.

Normal nappies are made using:

• Polypropylene     
• Polyester
• Polyethylene
• Latex or PVC
• Chlorine bleached pulp
• Adhesives
• Dyes
• Perfumes
• Lotions

Prevention of baby’s nappy rash

Prevention is always better than treatment.

Parents can reduce the chance of their child getting nappy rash by keeping their nappy area clean and dry. Change the child’s nappy frequently and give their bottom air as often as we can. Parents also can :

• use good quality, disposable nappies
• try to leave the baby’s nappy off whenever possible. This will keep the baby’s skin dry and away from any contact with wee or poo. Try laying the baby on a towel during tummy time or any floor play. Parents should always watch that they have not wet or soiled the towel so that they are not left on a damp towel
• only use warm water to clean the rash area
• avoid soaps and perfumed baby wipes as these can irritate the skin
• use soft towels or cotton wool when drying the skin, and dab the area gently
• apply a barrier cream after changing every nappy. Products containing zinc cream, zinc oxide ointment and petroleum jelly are all suitable. You can also ask your pharmacist about nappy rash creams
• do not use talcum powder or antiseptics

When should the parents or caretaker see a doctor?

See a doctor if:

• the rash doesn’t clear up in one week
• there are blisters, crusts or pimples
• the baby has a fever
• the rash is spreading
• the baby is very upset
• if the parents have a son, the end of his penis is red and swollen or has a scab

The doctor or pharmacist may need to give patients a medicated cream to treat the nappy rash. If it is caused by eczema or a skin infection, the doctor will need to give the patients the right treatment.

References

1. https://www.johnsonsbabyarabia.com/en/nappy-rash
2. https://raisingchildren.net.au/newborns/health-daily-care/poos-wees-nappies/nappy-rash
3. https://www.healthdirect.gov.au/nappy-rash
4. https://www.pregnancybirthbaby.org.au/nappy-rash#what
5. https://www.mamabamboo.com/blogs/news/nappy-rash

What exactly is a stretch mark?

A stretch mark is a type of scar that develops when our skin stretches or shrinks quickly. The abrupt change causes the collagen and elastin, which support our skin, to rupture. As the skin heals, stretch marks may appear. (1)
They’re common during puberty or pregnancy, in which they usually form during the last trimester. (2) The indented streaks (stretch marks) normally appear on the abdomen, breasts, hips, buttocks, thighs or other places on the body.(3) Stretch marks may also be influenced by the hormonal changes associated with puberty, pregnancy, bodybuilding, or hormone replacement therapy.(2)
Over time stretch marks may diminish, but will not disappear completely.(2) They aren’t painful or harmful, but some people don’t like the way they make their skin look.

How stretch mark looks like?

Stretch marks don’t all look alike. They vary depending on how long you’ve had them, what caused them, where they are on your body and the type of skin you have.(3)
When stretch marks first appear, they tend to be red, purple, pink, reddish-brown, or dark brown, depending on your skin color. Early stretch marks may feel slightly raised and can be itchy.
In time, the color fades and the narrow bands sink beneath your skin. If you run your finger over a mature stretch mark, you often feel a slight depression.(1)

Who are more prone to getting stretch marks?

Anyone can develop stretch marks, but some factors increase your likelihood of getting them, including:

• Being female
• Having a personal or family history of stretch marks
• Being pregnant, especially if you’re young
• Rapid growth in adolescence
• Rapidly gaining or losing weight
• Using corticosteroids
• Having breast enlargement surgery
• Exercising and using anabolic steroids
• Having a genetic disorder such as Cushing’s syndrome or Marfan syndrome(3)

How to treat stretch marks?

Stretch marks are harmless and often fade over time. Treatment can make them fade, but they may never completely disappear.
The following treatments are among those available to help improve the appearance and texture of stretch marks. None has been proved to be more consistently successful than the others.

1. Retinoid cream. Derived from vitamin A, retinoids — such as tretinoin (Retin-A, Renova, Avita) — that you apply to your skin may improve the appearance of stretch marks less than a few months old. Tretinoin, when it works, helps to rebuild a protein in the skin called collagen, making the stretch marks look more like your normal skin. Tretinoin can irritate your skin.
   If you’re pregnant or nursing, talk with your doctor about other treatment options, because possible side effects of retinoid cream may affect the baby.
2. Light and laser therapies. A variety of light and laser therapies are available that might stimulate growth of collagen or promote elasticity. Your doctor can help you determine which technique is appropriate for you.
3. Microneedling. This type of treatment involves a hand-held device with tiny needles that stimulate collagen growth. This technique has less risk of pigmentation changes than does laser therapy so is the preferred initial approach for people with darker skin.(3)
4. Stretch mark creams, lotions, and gels. Researchers have studied many of the creams, lotions, and gels sold to treat stretch marks. While no one product seems to help all of the time — and some don’t seem to help at all — researchers have discovered some helpful hacks.
   If you want to try one of these creams, lotions, or gels to fade stretch marks, be sure to use the product on early stretch marks. Treatment seems to have little effect on mature stretch marks. You should massage the product into your stretch marks. Taking time to massage the product gently into your skin may make it more effective. Applying the product every day for weeks may also increase effectiveness of the products. If you see results, they take weeks to appear.(1)

Work with your doctor to choose the most appropriate treatment or combination of treatments for you. Factors to consider include:

• How long you’ve had the stretch marks
• Your skin type
• Convenience, as some therapies require repeated doctor visits
• Cost
• Your expectations

How to prevent formation of a stretch mark?

Collagen and elastin are proteins in the skin that contribute to the skin’s strength, resilience, flexibility, and help skin that has been stretched to recover to its original state. Boosting the production of collagen and elastin helps prevent stretch marks from occurring.Stretch marks can also derive from nutritional deficiencies. Consuming foods that contribute to the skin’s health, such as zinc-rich foods, foods high in vitamin A, C, D, and protein rich foods, can help suppress stretch marks. (4)

References

1. Stretch marks: Why they appear and how to get rid of them. (n.d.). https://www.aad.org/public/cosmetic/scars-stretch-marks/stretch-marks-why-appear
2. Wikipedia contributors. (2022, December 22). Stretch marks. Wikipedia. https://en.wikipedia.org/wiki/Stretch_marks
3. Stretch marks – Symptoms and causes. (2022, August 23). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/stretch-marks/symptoms-causes/syc-20351139
4. Skin: Layers, Structure and Function. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/10978-skin

Aging is an inevitable process that all people experience. The progress of aging depends heavily on diet. Therefore, diet that rich in adequate nutrients and antioxidants play significant roles in delaying skin aging process. They can protect the skin from UV-induced skin aging, fight against oxidative stress, neutralize free radicals and scavenge reactive oxygen species.

Figure 1.0: Comparison of the Changes between Healthy skin and Aging skin.

Table 1.0: Comparison of Young Skin and Aging Skin

Vitamin C (Ascorbic Acid)

Vitamin C is a water-soluble, powerful antioxidant that protects skin from oxidative stress and repairs UV-induced skin aging. Besides, it also promotes the productions of collagen and elastin. This results in decrease in wrinkles, and increase in skin’s elasticity. According to a study conducted by Abdullah et al. (2019), both enzymes lysyl hydroxylase and proyly hydroxylase are crucial in Types I and III Collagen production. They rely on Vitamin C as an essential co-factor. Examples of foods that rich in Vitamin C are kiwi, strawberry, lemon, orange, guava, papaya, green peppers, red peppers, etc.

Vitamin E (Tocopherol)

Vitamin E is a fat-soluble potent antioxidant. It delays skin aging by fighting against oxidative stress and moisturizing the skin. A study from Keen et al. (2016) showed that the skincare products with the range between 2% to 20% of topical Vitamin E are able to minimize lipid peroxidation, thus delaying skin aging. It works by reducing wrinkles and enhancing the stratum corneum’s capacity to retain moisture and promote skin antioxidant protection. Examples of foods that rich in Vitamin E are broccoli, corn oil, sunflower seeds, mango, nuts (almond, hazelnuts and peanuts), etc.

Alpha Lipoic Acid (ALA)

ALA is a very potent antioxidant. ALA and its reduced form Dihydrolipoic Acid play significant roles in producing intracellular antioxidants and removing free radicals (Isaac et al., 2015). Examples of foods and supplements are broccoli, internal organs, potato, red meat, spinach, tomato, ALA supplements, etc.

Astaxanthin

It is a reddish-orange pigment that present in a wide variety of aquatic creatures. Examples included marine fishes, shrimps, crustaceans, etc. It is a potent antioxidant that plays a significant role in delaying skin aging by fighting against oxidative stress. In a study by Tominaga et al. (2017), long-term intake of astaxanthin may prevent age-related skin degeneration and preserve skin disorders resulting from environmental exposure. Examples of foods and supplements are algae, crayfish, krill, shrimp, salmon, trout, yeast, astaxanthin supplements, etc.

Coenzyme Q10 (CoQ10)

It is a well-known free radical scavenger. It helps to neutralizes reactive oxygen species, thus protecting cells from oxidative stress. According to a study conducted by Zhao et al. (2019), CoQ10 are able to shield astrocytes (cells) from UVB-induced oxidative stress by regulating PKA-ERK 1/2 signalling pathway. Examples of foods and supplements are fatty and oily fishes (salmon and tuna), internal organs, soybean, spinach, whole grains, CoQ10 supplements, etc.

Protein

Protein is needed to preserve the firmness, shape and integrity of the skin. Besides, it plays a crucial role in boosting cell regeneration. Diet high in protein promotes collagen production that results in smooth, radiant, moisturized and healthy skin. Examples of foods that rich in protein are lean meats (beef, lamb and pork), poultry (chicken, duck, goose and turkey), egg, fatty fishes, prawn, crab, lobster, mussels, oysters, scallops, tofu, etc.

Collagen Supplement

It helps to improve skin texture, retain moisture, and slow down the aging process. It has a variety of formulations and a broad range of origins like porcine, bovine and marine fishes, etc. In a study conducted by Czajka et al. (2018), oral administration of fish-derived collagen hydrolysate low-molecular-weight collagen peptide (LMWCP) promotes the regeneration of collagen fibers and elastic tissues in the skin. At a dose of 1000 mg once daily, it can significantly improve skin moisture, suppleness and wrinkles.

Water

Water helps our body stays hydrated and revitalized, and assists in maintaining the suppleness of skin. Individuals who drink plenty of water are less likely to get marks, creases compared to those who don’t. This helps to slow skin aging. In a study that conducted by Palma et al. (2015), consuming more than 2 L water daily encourages both superficial and deep hydration of the skin. As a result, skin looks moisturized, younger and healthier.

Conclusion

In conclusion, diet and nutrition that are adequate, balanced, moderate and diversified plays a crucial role in delaying skin aging. Besides, individuals should also consume at least five servings of fruits and vegetables daily, and avoid overconsumption to maintain healthy, radiant skin.

References

1. Abdullah. M & Attia, F.N. 2019. Vitamin C (Ascorbic Acid). In: StatPearls
2. Keen, M.A. & Hassan, I. 2016. Vitamin E in dermatology; Indian Dermatology Online Journal, 7(4):311-315.
3. Tominaga, K., Hongo, N., Fujishita, M., Takahashi, Y & Adachi, Y. 2017. Protective effects of astaxanthin on skin deterioration; Journal of Clinical Biochemistry and Nutrition; 61(1):33-39
4. Zhao, Q., Ma, Y.M., Jing, L., Zheng, T.X., Jiang, H.F., Li, P.A. & Zhang, J.Z. 2019. Coenzyme Q10 Protects Astrocytes from Ultraviolet B-Induced Damage Through Inhibition of ERK 1/2 Pathway Overexpression; Neurochemical Research; 44(7):1755-1763.
5. Isaac, V.L., Chiari-Andréo, B.G., Marto, J.M., Moraes, J.D., Leone, B.A., Corrêa, M.A. & Ribeiro, H.M. 2015. Rheology as a Tool to Predict the Release of Alpha-Lipoic Acid from Emulsions Used for the Prevention of Skin Aging; Biomed Research International.
6. Czajka, A., Kania, E.M., Genovese, L., Corbo, A., Merone, G., Luci, C. & Sibilla, S. 2018. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing; Nutrition Research. 57:97-108.
7. Palma, L., Marques, L.T., Bujan, J. & Rodrigues, L.M. 2015. Dietary water affects human skin hydration and biomechanics. Clinics in Cosmetic Investigation Dermatology. 8, 413