Frequently Ask Questions
Your doctor told me that after applying your acne creams, my face will get worse first before it can get better, as more pimples will pop out initially. She said this is to clear my clogged pores. I am enduring this now even though the huge and irritating pimples are very depressing. But last night, a friend who used to visit your clinics told me your theory is crap, because good acne treatment should not create more acne and inflammation in order to reduce them later. She stopped your treatment and visited another doctor, who gave her Oratane, which she said cleared her acne and is giving her good skin now. What is your response?
Oratane is an oral treatment for acne. Topical and oral treatments are both accepted means of treating acne. They are not mutually exclusive and can be used in combination or separately.
Topical treatment has many benefits and, if correctly instructed, can be used for the long term without side effects. The right topical acne medication offers long-lasting preventive results, plus the bonus of smooth beautiful skin because it also acts to renew the skin and slow down skin aging. But they take time to act. Depending on the severity of acne prior to starting topical treatment, the initial clearing phase may take 3 weeks to 3 months. Topical acne treatment does not cause acne breakout or inflammation. It merely clears out the clogged pores that are already present, which are bound to result in acne breakout with or without treatment. In so doing, the creams reduce, not increase, the inflammation that would have occurred during breakout. For patients with serious acne, deeper and larger clogs will start clearing after the smaller and shallower ones. If they find the resulting larger pimples difficult to manage, we may prescribe oral antibiotics to reduce the inflammation and give faster results.
Oral acne treatment gives faster results because the medication goes through the blood stream. However, there are well-documented side effects, of which many of our patients appear to be aware. Further, it does not offer lasting effect and acne often breaks out as soon as the oral medication is stopped. The following are the common oral acne medications used in Singapore:
- Oral contraceptive pills: Unless the patient intends to go on contraception or is suffering from hormonal disturbances, this, with its many side effects, is not a good option. It is also not suitable for older patients.
- Isotretinoin (eg Oratane, Roaccutane, Nemegen): This is an effective treatment for severe acne, but is known to cause initial cystic acne breakout if the patient has moderate to severe acne to start with. It also has several known side effects. Blood test is a must prior to starting this medication and close medical supervision is essential. There is no guarantee that acne will not break out after stopping the oral medication and patients are encouraged to continue with topical medication to prevent relapses. Isotretinoin is also the most expensive of the oral treatments described here.
- Oral antibiotics: This is a safe supplementary treatment for acute acne flare. However, owing to the potential risk of developing antibiotic-resistant P. Acnes bacteria, it should not be used long term.
- Spironolactone: This drug is a diuretic, with side effects like gynaecomastia, tiredness, alopecia, nausea, pruritis, changes in libido, headache, breast pain, menstrual disorders, blood disorders, liver and kidney problems.
Our clinics offer both topical and oral acne treatments. We do accede to patient’s request for oral acne medication after we are satisfied that the patient understands the potential risks involved and will do so under proper medical supervision. For those who have no preference between topical and oral treatments, our first-line treatment is usually topical, unless the acne is severe, in which case the oral option will be discussed. First-line topical treatment may, where indicated, be supplemented with subsequent oral treatment.
As for your friend who used to visit our clinics, she would already have gone through the initial clearing phase with our topical treatment when she visited the other clinic for oral treatment. So there you go. Well, we do not have a problem with that and are glad that her problem is finally resolved.
The Straits Times report referred to a study by a Nanyang Technological University team using nanoparticle zinc oxide. None of our products uses nanoparticles. Despite their promises in cosmetics, nanoparticles raise significant safety issues and there are calls to tighten their use in cosmetics, especially in the European Union. This is why despite pressures from competition and calls from some of our patients and customers, we have resisted deploying nanoparticles in our products, until there is clear consensus regarding their safe use in cosmetics.
Acne Vulgaris is a skin condition with many possible causes, among them genetics, puberty, hormonal changes due to medical conditions, stress aggravation, mood swings and use of inferior skin care products. A great majority of acne cases are caused by underlying factors such as genetics and puberty. These factors cannot be interfered with by the use of acne therapy, therefore the resulting acne can only be controlled but not fully eradicated, until after the underlying factors have taken their natural course, such as the conclusion of the puberty episode. A very small proportion of acne cases are caused by specific medical conditions, which will resolve rapidly with acne therapy, once the medical condition is treated.
For the majority of acne cases caused by multi-year underlying factors, the importance of proper management cannot be underestimated, even if eradication cannot be fully achieved while the underlying factors continue to prevail. In the past, the only treatment available for moderate to severe acne was the ingestion of oral antibiotics for years, with considerable side effects. In recent years, effective topical skin care products have emerged, which not only can curb and manage acne effectively, but at the same time improve skin texture and rejuvenate the skin. These products, with little side effects, form the core of Niks acne therapy and are far superior than long-term oral medication.
Cessation of Niks anti-acne products, or switching to inferior products, while the underlying acne-causing factors continue to prevail, will certainly lead to breakouts. This has nothing to do with your skin being "addicted" to Niks products, or "sensitized" to reject other skin care products.
The short answer is we don't know and don't care, because we do honest and serious skin care, rather than pulling a fast one on consumers. Why? First, there are no such things as "all-natural" or "all-organic" cosmetic or skin care products. While most "natural" ingredients were first discovered and isolated from plant sources, they are no longer obtained from plants because it would be too expensive, apart from being cosmetically unappealing. Instead, versions that are molecularly identical (or almost identical) are chemically synthesised in factories. For example, allantoin, a "natural" ingredient, is no longer extracted from the root of the comfrey plant, but chemically derived from uric acid. Such synthetic allantion is "bioidentical" to that derived from plant, but is no less "chemical" than any "non-natural" ingredients. So "natural" or "organic" ingredients do not mean ingredients that have never been chemically processed. At best, they mean ingredients whose molecular structures are identical (or almost identical) to some naturally occurring plants. In any event, can you pluck a leave and stuff it into your jar of moisturizer? Every ingredient that claims to be natural or organic has to be chemically extracted and/or dissolved in chemcial solvents, before it can be used to formulate skin care products. Further, anyone who knows any chemistry knows that it is downright impossible to formulate any skin care product without using any synthetic ingredient. Why? Because skin care products are not just made of active ingredients. The active ingredients need to be mixed with functional ingredients, or the vehicle, to be cosmetically usable, and functional ingredients are almost invariably synthetic. The most honest "natural" or "organic" skin care products use active ingredients that are as natural as they can be, but still have to use synthetic functional ingredients. The rest use synthetic ingredients liberally but claim to be natural or organic.
But why are naturally occurring molecules necessarily safer or better than man-made ones in the first place? Is cocaine, a perfectly natural fruit, safe? Poison ivy is as "natural" as it can be but causes intense allergic contact dermatitis. Aristolochia (Birthwort) plants, commonly found in Asia and used widely in herbal medicine, is actually highly carcinogenic (http://www.nutraingredients.com/Research/Sequencing-experts-unravel-secret-of-cancer-causing-herbal-remedy). On the other hand, man-made molecules (such as antibiotics) save thousands of lives each day, not to mention giving comfort to millions who suffer from various skin conditions.
The fact is there are good and bad natural ingredients, just as there are good and bad man-made ingredients. Whether an ingredient is good or bad cannot be determined just by whether it is natural or man-made. Simple commonsense, isn’t it? So we are bewildered to find so many consumers being hookwinked by the ludicrous lie that "natural", natural-sounding or "organic" ingredients are necessarily superior to synthetic ones.
Blemish Concealer is both a concealer and a pimple treatment cream. It can be used primarily as a pimple treatment, or as a concealer/foundation. When used primarily as a pimple cream, it should be used day and night on the affected areas. When used primarily as a foundation/concealer, it should be used in the day only. It can also be used in the day as a foundation, and in the night as pimple treatment.
For sure, Glycol 10 and Glycol 12 contain 10% and 12% glycolic acid respectively. To these two products we have added a blend of herbal extracts known to mitigate the irritability of glycolic acid without compromising its efficacy. This is why these two products are far less irritating than other products that contain the same concentrations of glycolic acid.
Like many of our cleansers, the citrus cleanser is soapless. It is not meant to lathe, but to cleanse without causing dryness. You just need to use 20 cent coin size of the cleanser, gently rub on the face and rinse gently. You should feel the skin smooth and soft without being tight.
I am using Glycol 10 and would like to upgrade to Glycol 12 because I find that while Glycol 10 doesn't irritate my skin and is good at keeping pimples at bay, I want a stronger AHA product to target stubborn blackheads. Can I use Glycol 12 in the long run, not so much for lightening scars, but mostly to target blackheads and unclog oily skin? Can Glycol 12 smoothen pitted scars?
Both Glycol 10 and 12 smoothen the skin and improve scars and Glycol 12 is stronger in both actions. The choice depends in part on your skin's tolerance for AHA. If your skin is not dry and you have no tolerance issues with Glycol 10, you can start with using Glycol 10 in the day and Glycol 12 at night. If there isn't any irritation, then it is fine to use long term. Topical treatment of pitted scars requires long term use of glycolic products before results can be seen.
Such statistics are meaningless unless you know in sufficient detail how the "studies" producing the statistics were conducted. Recently, the British authorities, which are far more serious than Singapore in policing newspaper advertisements, banned a well-known advertisement by a top global brand because the statistics cited were not based on proper studies (see www.dailymail.co.uk/femail/article-1107205/Banned-Estee-Lauder-ordered-pull-advert-wrinkle-cream-claims-proved-false.html). The newspapers are littered with many such similar advertisements everyday.
The scientific and medical community has an agreed set of criteria as to what constitute a proper scientific/medical study. We only cite studies that meet such criteria, most of which are also published in reputable peer-reviewed journals. A set of such journal papers are available for reading at Niks Shop Salon.
It is common industry knowledge that when a product claims to be "preservative-free", it means "paraben-free" 99% of the time, ie the product uses non-paraben preservatives such as caprylyl glycol, sodium benzoate or iodopropynyl butylcarbamate. If a sales person tells you that her products are truly preservative-free, ask her how does she manage to keep her products free from harmful micro-organisms and oxidation? In the absence of preservatives, there are only two ways to ensure that your cream or serum does not come with microbes: either the product has a shelf life of not more than a few weeks, or it does not contain water (called anhydrous). It is basic science that cosmetic ingredients, in the presence of water, must attract micro-organisms within a few weeks, unless you add substances that inhibit such growth, ie preservatives. Some preservatives have other functions (eg anti-oxidant or fragrance), so some manufacturers conveniently call them by their other names. Some are natural ingredients (eg some clove extracts) and so not described as preservatives. Even denatured alcohol, at a sufficiently high concentration, can serve as preservative. Regardless of whether manufacturers acknowledge these as preservatives or not, the fact remains that they are in fact acting as preservatives.
Some manufacturers use ingredients like tocopheryl acetate, retinyl palmitate or ascorbic acid as preservatives but misrepresent them as "anti-oxidants", even though such ingredients cannot possibly have any anti-oxidant effect at those low concentrations. Others use ingredients like phenoxyethanol as preservatives but hide them under "fragrances" as they do have a nice smell. Still others replace common preservatives with more exotic ones and go on to demand higher prices for being "preservative-free".
We take a pragmatic approach and use preservatives appropriate to and cost-effective for the product at hand. All the preservatives we use are safe at the concentrations used (based on available peer-reviewed research) and we do not misrepresent them as something else or hide them under other categories.
We shall take this opportunity to address those so-called "lists of pore-clogging ingredients". We never fail to be amused by such lists, which never state the concentrations beyond which those ingredients are supposed to clog pores. Even carcinogens are only carcinogenic beyond certain threshold concentrations. They also never state whether a supposedly offending ingredient will still clog pores when used alongside other ingredients, as they do in the real world. For instance, if stearic acid is supposed to clog pores, then at what concentrations? 0.01%? 0.1%? 1%? Or 100%? And what happens when stearic acid is mixed with other ingredients, as they must in order to form a product? We won't be surprised if you get a breakout after applying pure stearic acid (or any of those listed ingredients) on your face. But who would do that in real life? So it is meaningless to talk about "pore-clogging ingredients", because whether an ingredient in a product will clog pores or not depends on its concentration in that product as well as the other co-ingredients in the product. These factors, of course, vary from product to product. So there is no such thing as a pore-clogging ingredient, only a pore-clogging product. For us, all our products, including Vitamin C Nourishing Creme, are tested to be non-comedogenic.
Some years ago, there was an email hoax claiming that Sodium Laureth Sulfate was carcinogenic. The hoax was quite quickly put down by the health authorities, but from time to time rumours continue to surface that the poor substance is just somehow bad for the skin. It is true that Sodium Laureth Sulfate is potentially irritating to the skin at a sufficiently high concentration. But few skin care products, if any, deploy the ingredient at those concentrations. Sodium Laureth Sulfate plays a useful role in pore-unclogging products and we use it in two of our products for acne-prone skin, at concentrations well below the irritation thresholds.
The three refer to a group of similar products. Companies out to promote their own products did circulate the lie that mineral oil clogs pores or causes cancer. This lie was laid to rest in a paper by Dr Joseph DiNardo, published in the January 2005 issue of the prestigious Journal of Cosmetic Dermatology. Dr DiNardo found that while industrial grade mineral oil may be comedogenic, cosmetic grade mineral oil is not, and so consumers searching for effective skin care products need not look for those claiming to be “mineral oil free”. The lie that mineral oil can cause cancer is even more ridiculous. If you look at the official web sites of the national consumer watchdogs of major advanced countries, you will find advisories debunking this absurd myth. The fact is that cosmetic grade mineral oil is one of the most effective moisturizers available in the market.
Camphor Pore Minimizing Masque and Zinc & Sulfur Mask are suitable. They are not over-drying. However, you need maintenance products to sustain clearer skin. These could be Clear & Refining Toner, Anti-Blemish Serum, Ace Beta Renewing Cream, Vitamin C Serum or Acne Lotion.
The short answer is quite a number of products recommended by The Skin Cancer Foundation of the United States actually contain these ingredients! The official answer is these ingredients are approved for use by both the Food and Drug Administration (FDA) of the US and the European Commission, not to mention Singapore's Health Sciences Authority. Out of curiosity, we did a quick search on the internet and found that almost all of the sites that claim that these ingredients may cause cancer are out to promote so-called "natural" or "organic" products. The basis of their foolish claim is merely that these ingredients have something to do with silicone.
The internet is a wonderful medium, but is also unregulated and unverified. We urge you to ask a few questions when surfing for skin care information. Is the web site independent, or out to sell or promote something? Does the site cite any evidence published in a reputable, peer-reviewed medical journal? Is the site sponsored by some commercial entities? Has the information been checked against other independent sites (not sites that look similar or cross-linked) or written sources? Many unscrupulous companies spread lies on the Internet in order to advance their own commercial interests.
Niks Aroma Acne Clear Gel soothes and calms inflammation from acne. Niks Anti-Blemish Serum combines AHA, BHA, anti-oxidants and multi-vitamins to exfoliate, lighten scars and smoothen and nourish the skin. If you wish to control inflammation and clear clogged pores at the same time, then use Aroma Acne Clear Gel in the day and Anti-Blemish Serum at night.
Niks Ultrafine Soothing Cleansing Lotion is made from pure plant extracts and is generally suitable for all skin types. However, in the case of acne-prone skin that is not under treatment or control and is oily, the lotion's light milky texture may not appeal. But if the acne-prone skin is dry due to treatment, then the lotion will feel very comfortable. If the skin's acne is not under control and it feels oily most of the time, then Niks Marine Facial Cleanser or Niks Refreshing Sebum Cleanser would be a better choice.
Niks Clear & Refining Toner contains AHA and BHA for smoothening and oil control action, while Niks Vita C Brightening Spray helps brighten the skin, fight free radicals and strengthen collagen. If you wish to have the best of both products, you can apply the former in the day and the latter at night.
If the veins are very small, Anhydrous K Serum twice a day and Vitamin C Nourishing Cream twice a day may improve the veins over a few months. If the veins are larger, laser procedures would probably be required. Meanwhile, if you need to cover up your veins, Niks Shop Salon stocks a wide range of camouflage cosmetics to help you achieve flawless coverage.
Niks Glycol 12 at 12% AHA is for oily skin and Niks Glycol 15 at 15% AHA is for mature skin. Both are not suitable for sensitive skin or dry skin. Niks Shop Salon does not stock products with AHA higher than 15% as we believe that such products are best used with the advice of a physician.
Niks Intensive Barrier Repair Cream is suitable for the face while Niks Anti-itch Oatmeal Moisturizing Cream is suitable for the body. Use of Niks Aroma Shower & Bath Oil for shower or bath offers particularly comforting relief.
Niks Quadri-enriched Revitalising Cream is suitable for all skin types and age groups for anti-aging and firming. Niks Anhydrous C10 Cream, which offers stable delivery of L-ascorbic acid through a waterless base, is also aimed at anti-aging and firming. L-ascorbic acid also helps in collagen building, improves uneven skin tone, increases sun protection, reduces wrinkles and helps in healing of new scars. But the C10 is slightly acidic and those with sensitive skin may feel slightly tingling at the beginning. Although this is harmless and their skin will get used to it when texture improves, some may prefer the Quadri-enriched.
Both creams are excellent for long-term use. The longer they are used, the better the results, especially if users are also undergoing low-grade glycolic peel regularly. The mature and middle-age skin will benefit the most. An ideal routine is to use C10 in the day followed by Niks Gentle Sun Protect , and the Quadri-enriched at night.
Some of the Niks products that target blackheads are:
|Cleansers||Beta Acne Wash, Refreshing Sebum Cleanser|
|Toners||Clear and Refining Toner, Acne Lotion|
|Serum||Anti-Blemish Serum, Vitamin C Serum|
|Treatment gel||Glycol 10, Glycol 12, Aroma Acne Clear Gel.|
|Scrubs||Many to choose from to dislodge blackheads, eg Soft Grain Scrub or scrubs with AHA.|
|Masques||Camphor Pore Minimizing Masque|
The variety of products cater to different degrees of severity. We suggest that you speak to our sales consultants at Niks Shop Salon, who will be able to help you choose products suitable for your condition.
AHA stands for alpha-hydroxy acid and is a group of organic carboxylic acids derived from different fruit acids, comprising glycolic acid (from fermented milk), citric acid (from citrus fruits), malic acid (from unripened apples), mandelic acid (from bitter almonds) and tartaric acid (from fermented grapes).
So far glycolic acid is the most popular anti-ageing and whitening acid used in skin care products. Physicians worldwide have established that regular use of glycolic acid can result in significant improvement in skin appearance. It can also be used to treat acne scars. However, it may cause some irritation to the skin, which is largely harmless. We have AHA products in different concentrations to suit different skin types. Please consult our sales consultants at Niks Shop Salon for the products that suit you. AHA has been around for four decades and so far there has been no report of adverse long-term effect when used properly.
Other than concentration, the effectiveness of glycolic acid in treating scars also depends on scar type, acidity of the product, form of the glycolic acid (neutralized or not, esterified or not) and skin tolerance. We invite you to consult our sales consultants in Niks Shop Salon to select the products that suit you best.
Niks Anhydrous K Serum contains high concentrations of vitamin K1 and retinol in a stabilised waterless base and is best suited for dark circle. Niks Golden Wrinkle Drops contains retinol with a moisturizing base and is ideal for fine lines and dehydrated lower eye bag. Niks Intensive Firming Eye Cream contains powerful peptides that target both photo-damaged and aging wrinkles. Niks Wrinkle Capsule, in a convenient capsule format, contains anti-wrinkle peptide in a ceramide base that also relieves skin dryness. If your skin is not very dry or sensitive, then Niks Retinol I, which contains a high 1% concentration of retinol, is very effective for static wrinkles and lines caused by aging. Niks Vitamin A Eye Gel, which contains retinyl palmitate in a gel base, is suitable for normal or oily skin with fine lines, eye bag or dark eye circle.
|Scar Type||Recommended Products|
|Acne scars||Glycol 10, Glycol 12 and Glycol 15 treat different grades and types of acne scars.|
|Post-peel burns, post-IPL or post-laser scars||Golden Lipid Complex, Skin Repair Cream and Golden Wrinkle Drops are suitable|
|Bruises||Anhydrous K Serum and products with L-ascorbic acids, like Vitamin C Nourishing Crème, Vitamin C Serum and Anhydrous C10/C20 are suitable.|
|Dehydrated scars||Quadri-Enriched Nourishing Cream, which contains copper derivatives, helps the healing.|
I am currently using Niks Glycol 12, Niks Citrus Cleansing Lotion and Niks Aroma Acne Clear Gel. I am experiencing tiny bumps over my cheeks area, which I have not experienced before. Does use of the above products cause outbreaks of tiny bumps on the face before the acne can be completely healed? Is the AHA or tretinoin forcing clogged pimples to surface first before they can be completely healed?
If you had had comedomes on your checks before, the products you use will cause the comedomes to be extruded and surface slowly. This may happen for 6-8 weeks.
If, in addition to what you have described, you also have signs of dryness and itchiness, then the breakout could be due to over-exfoliation. In that case, you should stop the AHA and tretinoin temporarily. After the itch has disappeared, you can resume less frequent use of the AHA and tretinoin products, eg on alternate days instead of daily. You should also use moisturizer and sunscreen to protect your skin. If the problem persists, please visit Niks Shop Salon to consult our Sales Consultants or consult your doctor.
Niks Vitamin C Serum contains 8% pure L-ascorbic acid with a mixture of other Vitamin C ingredients. It also contains low concentration of BHA for the purpose of oil control. Owing to the combination of ingredients, it does not behave like ordinary BHA products and does not cause drying and flaking. It is recommended for acne-prone skin and you need not worry about the BHA in this moisture-rich serum.
Some of the other Niks Vitamin C products are:
- Niks Vitamin C Nourishing Crème has no BHA and is a very light-weight moisturizer with anti-inflammatory plant extracts. It is soothing and calming, with rich anti-oxidants.
- Niks Anhydrous C10/C20 Creams have high concentration of Vitamin C and are ideal for acne scar treatment.
- Niks Intensive Face-lift Complex incorporates a newer form of Vitamin C, C-ester. It also contains three other powerful anti-oxidants.
- Niks BCE Serum with Ferulic Acid contains 20% Vitamin C stablilised by ferulic acid.
To deal with pigmentation, it is mandatory to use sunblock everyday everywhere, indoors or outdoors. Otherwise, sunlight will render whatever whitening creams you apply ineffective.
The following substances (in descending potency) have proven whitening effects through inhibiting the production of melanin:
- Kojic acid
- Retin A or isotretinoin cream (doctor’s prescription only)
- Mandelic acid
- Glycolic acid
- Vitamin C
- Mulberry acid
- Licorice extract
- Azelaic acid
It has been established that combinations of these substances increase whitening effectiveness without increasing skin irritation. We have a wide range of such combination creams to combat pigmentation of different skin types and ages.
If you are suffering from any of the following:
- Atopic eczema
- Photodermatitis (sensitive to sun exposure, ie your face turns red and itchy after exposure to the sun)
- The skin is just dry and itchy without other visible skin abnormality (eg "fishscale-like" skin appearance on both shines)
You should, in your choice of skin care products,
- avoid offending substances
- stick to simple products (preferably fewer than 10 ingredients)
- use chemical-free sunscreens, preferably physical block with zinc oxide or titanium dioxide
- opt for milder surfactants
- adopt anti-irritants like aloe vera, allantoin, chamomile and bisabolol
The following ingredients, though serving specific purposes on other skin types, may cause irritation in sensitive skin:
|Aromatics||Menthol, benzyl alcohol, cinnamates|
|Penetrants||Propylene or butylene glycol, alpha-hydroxy acids (AHA)|
|Surfactants||Sodium lauryl sulfate, quaternary ammonium compounds|
|Sunscreens||PABA (para-aminobenzoic acid), benzophenones, cinnamates|
|Abrasives||Polyethylene beads, bismuth oxychloride, mica|
|Others||Tretinoin, benzoyl peroxide|