Is there a right way to use Stieva A?

Stieva-A is a tradename for Retin-A, aka Tretinoin. A simple google search of any of these words "Stieva A", "Retin-A" or "Tretinoin" will lead to various articles on how this chemical treats cystic acne.

Cystic acne occurs due to clogged pore which leads to build up of oil/sebum within the pore which gets inflamed with bacteria. See diagram on the right.

How Stieva-A works is that it opens up clogged pores and increases the production of skin cells in the outermost layer of the skin (epidermis). But it does not remove acne. All it does is to make the "already inflamed" skin surfaces up and reduce changes of other pores being clogged.

There are two downsides to Stieva-A:

1. It stimulates both the healthy and inflamed skin which can cause the skin near the cysts to generate more sebaceous glands that produces oily sebum. This results in new ports clogging as old cysts open. 
2. It thins the skin before thickening the skin. This results in the skin more prone to sunburn and sensitive. 

I am trying to make sense to the creams which Niks Maple Clinic provided and here are some of the synergistic relationships.

1. Glycolic Acid + Stieva-A: Glycolic acid acts as a skin peel which increases the absorption of Stieva A into the skin
2. Clindamycin (Antibiotics) + Stieva-A: Using antibiotic will get rid of 10-20% more pimples by killing acne bacteria as they are being released from deep pores

In the past, I screwed up a lot by being really greedy with using Stieva-A, thinking that applying a thick layer, twice daily and 7 days a week will increase the changes to speed up recovery. However, I was so wrong. My skin got really dry, flaky and burning sensation.

Understanding the mechanism of how Stieva-A helps to understand the best way to use it. Since Stieva-A does not cure acne and simply opens up clogged pores, with possibility that leads to generation of more sebaceous glands, it is important to apply on clean skin and with topical antibiotics to reduce chances of healthy skin being inflammed. It is not advisable to apply too thick a layer as the skin takes time to unclog the pores and stimulate new cells to grow. A very small amount and thin layer will do. The reason why it is recommended to be applied at night is that it is chemically unstable and degrades when exposed to sunlight, resulting in ineffectiveness.

The human skin has 4 key physiological loss-prevention processes to moisturize the skin.

1. Sebum production - Sebum has high triglyceride content which acts as a emollient that reduces Transepidermal Water Loss (TEWL) 
2. Natural Moisturizing Factor (NMF) production - NMF has high free amino acid content which acts as humectant to hold on or draws moisture. The amino acids are produced when the proteins in the skin's stratum corneum are broken down. If NMF occurs, it means that your skin is already in quite a bad state.
3. Desquamation - Natural skin shedding which happens when the skin's stratum corneum is well hydrated. However abnormal desquamation is not good either.
4. Formation of intercellular lipids as skin barriers - Intercellular lipids have high ceramides which prevent TEWL and loss of NMF. 

I found this diagram which very well depicts the regeneration of new skin. It takes about a month for cells to multiply and make their way through the various layers of the skin to the epidermis layer. During the process, dead skin cells that are awaiting to be exfoliated can be prone to breakouts if it clogs the skin, along with sebum and bacteria. Besides fighting excessive "oiliness", it is important to keep dead skin cells from collecting on the skin and keep the underlying skin cells moisturized for natural desquamation.

Besides advising "less is more" for Stieva-A, the last advice I have is to be patient. It takes time for skin to go back to healthy state. Drink more water and be diligent in skin care routine.

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5 stars to Vichy Normaderm range products

It is my first time using Vichy  products and I kinda love the Normaderm range, particularly Normaderm Tri-Active Anti-imperfection Hydrating Care and Normaderm Hylauspot. 

These two products have some key ingredients that are for targeting sensitive acne prone skin: 

1) salicyclic acid - correct abnormal shedding of cells, unclog pores (but does not have effect on sebum production and does not kill bacteria)

2) glycolic acid (peeling the skin to remove brown spots)

3) LHA or lipohydroxy acid (similar to salicyclic acid, exfoliates and unblock pores)

4) Glycerin - humectant

5) Silicons - emollient

6) Sodium hyaluronate (present in Hylauspot, anti-ageing)

What I like about it is that is has a very light feel and fast absorbing.  There is a cooling sensation that somewhat tames the acne and preventing it from further erupting. The exfoliating ingredients are pretty effective as my skin does peels lightly on those areas i apply the Hylauspot. Depending on the "stage" of acne, for some spots, it purges the pus and pimple head, and for others, it shrinks it till it retreats (about 3-5 days). 

I have also bought the Aqualia Thermal UV. While it seems to spread easily and absorb easily, I found it difficult to apply my liquid foundation (Clinique Even Better) on it. The makeup seems to become cakey, which does not usually happen when I use the sunscreen. 

Vichy Normaderm Tri-active: ***** (5 stars)

Vichy Normaderm Hylauspot: ***** (5 stars)

Vichy Aqualia Thermal UV: ** (2 stars)

Left: Triactiv
Centre: Aqualia Thermal UV
Right: Hylauspot 

Far left: Triactiv (without spreading)
Second to the left: Triactive (after spreading once)
Second to the right: Hylauspot (without spreading)
Far right: Hylauspot (after spreading once)

Effects of coffee on acne

Though I am not a coffee addict (I only drink once a while), I enjoy drinking coffee. Especially with milk and sugar. But I noticed some side effects whenever I drink coffee, i.e. I will develop new acne bumps. Devin Mooers and Paula M both wrote articles on whether coffee triggers acne. There are quite a number of bads. Milk, Sugar, Mycotoxins, giving rise to hormonal imbalance, inhibition of glucose metabolism, etc.

There are also counter research being done to show that coffee may reduce acne as it reduces insulin which caffeine does the opposite. Does it mean that decaf coffee (Black and without sugar) is the way to go?

PPP laser clinic

I believe I was one of the initial clients of PPP laser clinic. What attracted me to it was how laser medical facials was made so affordable and I do not have to spend 1.5hrs lying in a facial salon to "clean" my skin.  When I first signed on the package with PPP, it costs about $50 per trip, the nurses will help me clean my face before the doctors start to perform the microdermabrasion before the IPL. The process takes less than 10 mins which I can easily afford the time. As the client base grew, it became less and less an enjoyable experience. There were many "cuts", in order to save time. But I believe the other reason is to cut costs. Overall there were 5 points which I didn't like.

1) Nurses stop cleaning the make up on your face. Instead, you have you do it yourself with the cleansing towel they provided.

2) Nurses stop putting on the conductive gel for the IPL. In order to avoid burning the skin, the doctors does the IPL at some distance away from your skin. I found the light very irritating and I would often tear unconsciously after the IPL even though I am wearing the goggles. It was uncomfortable and I would always ask for a wet cotton to be placed between the googles and my eyes. But still, it is still not very effective.

3) At the end of the treatment, we have to put on the moisturizer on our own, which previously the nurses will do so after they clean the conductive gel away.

4) There are variations in service level between the doctors. Some doctors were more passionate on helping. Some doctors were just going through the motion as if it is a part time job for them.

5) The queue is relatively long. I always spend more time waiting then the treatment itself. The waiting time could be as long as an hour. Then again, it depends on location and weather.

What I like is that the nurses do not hard sell the package unlike the facial salons and has progressed to adopt a point system which one could redeem other types of treatments.

However, I have since stopped going as I don't feel as enjoyable. While it has some effects on the skin, I do not want to cure it at the expense of my eyes which is constantly "exposed" to IPL light. I do not want to develop Photokeratitis or Cataracts. I treasure my eyes more and will never wish to be blinded by regular IPL sessions.

Ma Chérie Moisture Shampoo (Non-sponsored)

I am not a beauty blogger and hence I do not get sponsored. Sometimes when I read online for reviews of products, I am quite skeptical as most of them are sponsored and naturally they will write positive reviews. I am not sponsored, in fact a friend of mine and I analysed this product because of our project on Shampoo.

Personally, I have been using this product for a few months. Previously I tried many other products, which include Sukin Shampoo, which I blogged about in my previous posting. I like Ma Chérie Moisture Shampoo and Conditioner as it has this unique fragrance. The product range is developed by Shiseido and the signature ingredients is Honey Gelee, Champagne, Hydroxyethylurea and Inositol. There are 32 ingredients listed and costs about $2.521 per 500ml, but retails at about $20.50. It is not unusual for the price difference as consumers are paying for marketing, distribution, etc.

A closer look at the selection of surfactant, Ma Chérie uses amphoteric surfactants such as sodium cocoamphoacetate and sodium taurine cocoyl methyltaurate, in combination with traditional SLS. Amphoteric surfactants are supposedly milder than anionic surfactants, but I still feel the cleansing and foaming effect due to SLS.

There several conditioning agents and humectants used such as Arginine, locust bean hydroxypropyl trimonium chloride, polyquaterium-10, sorbitol, gly\utamic acid, dimethicone, ammonium lactate, butylene glycol, etc. All in all, these ingredients add up to the claim of "Moisturizing". My hair scalp releases less sebum and my hair smells better due to the nice fragrance. One thing I wish is that the fragrance could last longer. But based on the profile of the fragrance (floral), which is a middle note the scent typically last for less than an hour.