Scars, Pores, And Milia: A Singaporean Doctor Answers Readers’ Skin Questions

Scars, Pores, And Milia: A Singaporean Doctor Answers Readers’ Skin Questions undefined

The skin is often seen as an indication of health when it comes to appearance and complexion. As it is our largest organ, problems with skin can be visually apparent, which is why people may seek help quickly when it comes to skin issues.

Dr Chua Cheng Yu is an aesthetic doctor at Veritas Medical Aesthetics. He recently responded to DoctorxDentist reader questions regarding various skin concerns. In no particular order, here are a few key takeaways.

What are ice pick scars?

ice pick scars on skin


Ice pick scars are a type of acne scar condition that gets its name from the deep and narrow impressions they leave on the face or body (like small stab wounds caused by ice picks). They are considered difficult to treat because of their sharp and deep indentations. [1]

Treatment of scars is determined by their shape, size, and location

a woman looking in the mirror


The method of scar treatment is determined by the shape, size, and exact location of the scars. For example, punch excisions cannot be performed on scars that are too wide, while an elliptical incision might generate better outcomes for such scars. [1]

Consult your doctor for a better picture of your condition.

A combination of lasers could treat multiple kinds of scars

a handheld scar treatment device


In some instances, patients report having a mix of ice pick scars and boxcar scars. In such cases, Dr Chua recommends using a combination of lasers including some ablative lasers.

Deeper scars might benefit from punch excisions and microsurgery for more effective results. [2]

Micro-needling radiofrequency may not work very well for acne scars

medical illustration of skin undergoing collagen induction therapy


If you are suffering from acne scars, micro-needling radiofrequency treatments should be avoided. They do not work on all kinds of scar patterns. 

How can you treat dark scars on legs and arms from bug bites?

a woman applying cream to bug bites on her legs


If bug bites (such as those from sand flies) form dark scars, they may be post-inflammatory hyperpigmentation marks and can fade with time. For faster removal of stubborn post-bite marks, topical skincare and certain pigmentation lasers can work. For people with post-inflammatory hyperpigmentation, avoiding the sun and applying sunblock is crucial. [3]

Resurfacing lasers can help tighten pores

a woman receiving medical laser treatment


If you're looking for an effective way to tighten your pores, resurfacing lasers can work well (both ablative options such as fractional CO2 and non-ablative options such as Thulium). [2]

The frequency of resurfacing lasers depends on your condition

a woman having pigmentation removed from her cheek


The combination and frequency of laser treatments are determined by your individual condition. 

Non-ablative options can be repeated more frequently, but it also depends on:

  • individual skin type,
  • skin condition,
  • and necessity.

Whiteheads and clogged pores are common in women

a woman washing her face in her bathroom


It is common for ladies to have clogged pores in the lower face which lead to whiteheads, especially near that time of the month. Regular exfoliation and oil control regimes can treat the issue gradually. BHA is a useful ingredient to look out for in OTC skincare, whilst retinoids are commonly used in higher concentration in medical skincare. [4]

Be sure to get a proper diagnosis from your doctor

a female doctor speaking to a patient


Sometimes, you might be diagnosing your own condition inaccurately. See a doctor for proper evaluation because other facial growths could mimic stubborn whiteheads.

There are retinoids that can help treat milia

a hand with skin cream on a finger


In Singapore, there are two retinoids that are available over the counter to deal with milia; Differin and Epiduo.

Differin can prevent milia but it will not treat milia. Electrocautery or CO2 laser ablation and a treatment regime may be needed. Consult your doctor. [5]

Milia can be treated permanently with energy-based devices such as ablative lasers or microneedling RF

a man receiving laser treatment on his face


The success rate for the removal of milia seeds with ablative lasers is quite high, with costs being around a few hundred dollars (depending on your condition).

Experienced beauticians may also be able to help with the extraction of milia, but they recur easily. Energy devices could treat milia in a more efficient and safe manner. Microneedling RF may not be useful for acne scars, but is extremely useful for treating milia and preventing recurrence, i.e. permanent treatment. [6]

Similar conditions may be slightly harder to deal with

a xanthelasma on an eye


Other conditions with similar traits, such as syringomas or xanthomas, may be much tougher to remove and more stubborn.

A syringoma is a benign adnexal tumour of the eccrine sweat duct that usually appears in the eyelid area, though it can also appear on other parts of the body.

A xanthoma (shown above) is a lesion that occurs when fat deposits occur under the skin. They can appear near the eyes but also on hands, limbs, or the neck.

Consult your doctor for proper treatment. [7] [8]

Can self-harm scars be treated in Singapore?

a man with self harm scars on an arm


There are different treatment modalities for hypertrophic scars, from topical skincare to steroid injections, lasers, and even surgery. Certain fractional ablative lasers such CO2 can work, but there is extensive downtime.

Non-ablative fractional lasers (such as the Erbium-Glass and Thulium) have good outcomes with minimal downtime. [9]

Whatever your skin condition may be, make sure that you receive professional medical advice before treating and managing the issue. You can check in with an experienced medical professional and find out about the various options out there.


Would you like to ask any related skincare questions?

You can Ask A Doctor right away, or view the complete list of DoctorxDentist Sessions.

References:

1. Fabbrocini G, Annunziata MC, D’Arco V, et al. Acne Scars: Pathogenesis, Classification and Treatment. Dermatology Research and Practice. 2010;2010:1-13. doi:10.1155/2010/893080 Accessed May 2019. 

2. Chan NPY, Ho SGY, Yeung CK, Shek SYN, Chan HH. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers in Surgery and Medicine. 2010;42(9):775-783. doi:10.1002/lsm.20974 Accessed May 2019. 

 3. C.B. Lynde; J.N. Kraft, C.W. Lynde. Topical Treatments for Melasma and Postinflammatory Hyperpigmentation. Skin Therapy Letter Vol 11 No. 9 November 2006. Accessed May 2019.

 4. Stephan John Kempiak and Nathan Uebelhoer. Superficial Chemical Peels and Microdermabrasion for Acne Vulgaris. Semin Cutan Med Surg 27:212-220 © 2008.  Accessed May 2019.

 5. Cho E, Cho SH, Lee JD. Idiopathic Multiple Eruptive Milia Occurred in Unusual Sites. Annals of Dermatology. 2010;22(4):465. doi:10.5021/ad.2010.22.4.465  Accessed May 2019.

 6. Harald Voth and Günter Reinhard. Periocular milia en plaque successfully treated by erbium:YAG laser ablation. Journal of Cosmetic and Laser Therapy. https://www.tandfonline.com/doi/abs/10.3109/14764172.2011.552612. Published 2011. Accessed May 6, 2019. 

 7. Friedman SJ, Butler DF. Syringoma presenting as milia. Journal of the American Academy of Dermatology. 1987;16(2):310-314. doi:10.1016/s0190-9622(87)70041-3 Accessed May 2019.

 8. Parker F. Xanthomas and hyperlipidemias. Journal of the American Academy of Dermatology. 1985;13(1):1-30. doi:10.1016/s0190-9622(85)70139-9  Accessed May 2019.

 9. Choe J-H, Park Y-L, Kim BJ, et al. Prevention of Thyroidectomy Scar Using a New 1,550-nm Fractional Erbium–Glass Laser. Dermatologic Surgery. 2009;35(8):1199-1205. doi:10.1111/j.1524-4725.2008.34428.x Accessed May 2019.

1115 views 6 May 2019 Medically reviewed by Dr Chua Cheng Yu on 30 May 2019.
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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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