One of the most common skin condition in Singapore is acne, also known as acne vulgaris. It is a skin disease of the hair follicles of the face and upper torso, affecting almost all teenagers during puberty. Although most adolescents suffer from breakouts, it is not uncommon for adults. Factors such as hormonal fluctuations or menstruation, over-active sebaceous gland, clogged pores, emotional stress and anxiety, hot and humid weather conditions, and oil-based makeup are likely causes for the often chronic and inflammatory skin condition.
Acne vulgaris is typical teenage acne which occurs when comedones, papules, pustules, nodules and/or cysts are formed due to a blockage and inflammation of hair follicles and their accompanying oil glands. Pimples often affect those especially with oily skin when follicles are clogged with sebum, dead skin cells and hair all clumped together (to form what’s known as plugs) and these plugs start to swell up when infected with bacteria Propionibacterium or P. acnes. Severity and frequency of acne depends on the strain of bacteria. Acne usually takes place on the face, in particular T-zone (forehead, nose and chin), scalp, and upper trunk such as the chest, shoulders and even back.
Types of Acne
Blackheads and Whiteheads
Medically known as comedones, they are non-inflammatory acne. While whiteheads appear as firm white bumps, these pus-filled zits have no opening on the skin so all the “debris” are trapped within the pore. As it does not come into contact with oxygen, it remains “white” as no oxidization occurs. However, blackheads are open comedones where sebum and dead skin cells are clogged in the hair follicle and when the clog is exposed to oxygen, it turns black due to oxidation (a reaction of oil with oxygen).
Acne papule is a type of inflamed blemish, also known as pimple or zit. They appear as red bumps on the skin’s surface that are firm and tender, and the skin around it is also usually slightly swollen and red. But unlike comedones, papules do not have any visible center and do not appear to be widened. Papules occur when there is a break down in the follicle wall surrounding your pores due to severe inflammation.
These tender red bumps appear much larger, like more inflamed whiteheads with a whitish or yellowish pus-filled center, and have a pink or red base. The pus in pustules is a sign of the body trying to fight against the dirt and bacteria that has invaded the pore. The pus is a natural reaction of the body’s immune system which consists of mostly dead white blood cells. Pustules occur when the walls of the affected pore or pores begin to break down.
Dermatologists generally term any lump underneath the skin that’s at least one centimeter in size as nodules. These hard, painful, inflamed acne lesions occur when clogged, swollen pores are further irritated and grow larger. Nodular acne takes place when bacteria P. acnes get trapped inside the clogged pore. Unlike pustules and papules, nodules may lead to an infection that affects the deeper layers of the skin with no visible head or center. These are severe enough to cause dark spots or scarring.
Cystic acne is the most severe form of acne and it is the largest type, forming much deeper within the skin than nodules and are usually a result of severe infection, and hence most likely to scar. These large, soft red or white lesions are also often painful to touch. Cystic acne is most common in teenage boys and young men who tend to get it on the face, back, upper arms and shoulders. But women usually get cystic acne on the bottom half of the face.
When you suffer from acne, there is no quick or easy way to get rid of it. But medical experts advise that it is best to treat it as soon as possible to prevent it from turning into scars. Acne treatment therapy takes into account several factors such as the severity of your acne, medical and family history, allergies, skin type and sensitivity. Solutions for patients are broad; starting with buying the right cleanser for acne prone skin to long term skin management treatments. Often combined treatments are more effective at targeting the different processes of acne to give a better outcome.
To treat persistent acne problems, your medical doctor may first recommend using over-the-counter or prescriptive topical treatments that have anti-bacterial and anti-inflammatory properties to help calm and soothe the skin.
For skincare products targeted towards acne, benzoyl peroxide and salicylic acid are two common active ingredients that are effective for most people. However, its effectiveness is also dependant on the dosage, application regimen, skin type, and where the outbreaks typically occur. While benzoyl peroxide is often used to kill bacteria, salicylic acid helps to open up pores and to encourage new cell growth.
Other popular acne creams like topical retinoids, derivative of vitamin A, is also effective in treating blackheads, whiteheads, pustules, and papules by keeping pores clear and preventing oily build-up. But it needs to be applied properly to avoid possible side effects such as sun sensitivity and dry or peeling skin.
A topical steroid that is often used to treat any skin redness and swelling due to allergies, illness, injury, or acne may also be used. However, hydrocortisone cream works better to combat acne when it’s combined with other treatments.
Antibiotic creams are another prescription treatment option that target the bacterial infection and can treat inflamed skin and red, painful pimples. As antibiotics don’t clear clogged pores, doctors would usually prescribe these in combination with over-the-counter benzoyl peroxide creams or topical retinoids. However, topical medications may not be as effective for those who have developed persistent cysts and nodules.
Topical medications may not get deep enough to effectively treat acne outbreaks. This is where oral medications, sometimes called systemic medications come in to work internally to improve the skin condition. With some medications, you take just once a day and others you take more often. Note that all oral acne medications are available by prescription only.
Birth control pills which regulate menstrual cycles, is also a popular oral medication is used to help reduce acne. Another oral option is spironolactone, a blood pressure medication that, when used in controlled low dosages, can help with hormonal acne as it blocks androgen hormone receptors in the skin.
Oral antibiotics like doxycycline are a mainstay of treatment for inflammatory acne, and they work by reducing bacterial load and inflammation. Antibiotics have proven in many studies to be safe and effective in treating acne. A course of treatment may last at least three months.
For mild cases, dapsone, an anti-infective medicine that fights bacteria, is said to be a well-tolerated prescription anti-inflammatory with some efficacy in hormonal acne. But for more severe cases, oral retinoids like Isotretinoin (Acnotin, Roaccutane) a derivative of vitamin A, works extremely well. It has an anti-inflammatory effect and can reduce oil secretion by 90% within six weeks of treatment, whiteheads and blackheads by 90% within three months. However, topical medications can't get deep enough to effectively treat severe cystic or nodular acne.
Dos and Don’ts
Don't squeeze, pop, or pick at pimples.
Doing so can force debris deeper into the dermis, spreading an infection to other tissue and worsening inflammation. Know that popping pimples can also extend the healing time and increase the chance of a permanent scar.
Do treat your acne ASAP!
Begin treating acne early, as soon as it comes up, and seek professional help immediately if your acne isn't getting any better with over-the-counter treatments. Quick treatment helps to keep breakouts to a minimum and prevent it from worsening.
Your objective is to calm inflammation and avoid doing anything that will further irritate the skin. Avoid harsh products like scrubs and skincare products with strong ingredients. Look for a simple but effective at-home routine that takes care of excess oil, get rid of acne-causing bacteria and prevent blemishes and acne spots from worsening.
Don’t overcleanse or scrub your face.
By washing your face more often – even with the right cleanser, will not reduce acne. Wash your face twice a day with a gentle cleanser is good but anything more may in fact cause your skin to go into overdrive mode or irritations. You can exfoliate but be sure that the granules of your scrub are not too harsh and don’t scrub too often. Use a chemical exfoliant, such as a cleanser with lactic or glycolic acid.
Don’t wait too long to see a medical doctor.
Seek professional help when your skin doesn't respond to over-the-counter skincare products. Some acne may be harder to kick and require stronger medications – topical and/or oral prescription-strength acne medication may be required to treat more severe acne.
Light Based Therapies:
For more stubborn cases of acne, laser therapy such as Aerolase and Fotona, is useful in reducing inflammation and the number of acne-causing bacteria on the skin. Other light therapy such as LED light also helps.
Studies show that lasers and other light treatments can reduce acne but these treatments alone can rarely clear acne. For best results, multiple treatments as well as combined treatments, such as topical or oral medicine may be recommended.
Broadband Light - BBL Forever Clear
This is acne treatment uses the power of light to comfortably and effectively clear acne (in teenagers and adults). While blue BBL light eliminates acne-causing bacteria at its source, deep down in the pores, yellow BBL light reduces the inflammation and acne-associated redness to give you healthy, luminous skin. Finally, infrared light in rapid, gentle pulses help to initiate the body’s natural healing process.
Non Light-based Treatments:
Cortisone shots also known as intralesional corticosteroid injection, or steroid shots, are used for treating inflammation, to help shrink large acne cysts or deep nodules. A very dilute corticosteroid is injected directly into the blemish.
This treatment quickly reduces inflammation, flattens and heals the breakout in just a few days.
However, cortisone shots don't work on pustules or pus-filled pimples. As it shrinks inflamed tissue, cortisone shots are best for large, cystic blemishes on both the face and body. Although cortisone shots have plenty of benefits, they can’t clear up acne. While they help huge breakouts heal up quickly, they can't stop more breakouts from forming.
To keep acne flares under control, try to book regular aesthetic facials to treat acne. These facials are specially designed to help one manage and maintain acne outbreaks. This clarifying facial combines ultrasonic deep cleansing and extractions to help clear clogged pores and comedones, along with IPL and a clay mask to calm and sooth inflamed skin.