To combat acne, we should first understand what causes acne. Acne, also known as acne vulgaris, is a skin condition that commonly occurs on the face, neck, back, and chest area. It usually starts around aged 7 to 12 years and resolves by the age of 30, but can still persist well into adulthood. It is caused by inflammation of the skin where hair follicles and sebaceous (oil-producing) glands are found. There are multiple factors that contribute to the formation of acne, such as hormones and genetics - often an imbalance of these factors cause the sebaceous glands to produce too much grease, and in time dead skin cells and oil build up in the hair follicles to form acne.
There are mainly 6 types of acne, which includes the following:
● Blackheads - sometimes known as closed comedones, they are an accumulation of sebum and keratin under the skin surface and appear black due to melanin (a skin pigment) rather than dirt
● Whiteheads - also known as open comedones, the follicles are filled with sebum and keratin but are completely blocked
● Papules - these are small, red bumps they may be painful to touch
● Pustules - these are red bumps with a build-up of pus are found under the skin surface
● Nodules - large and hard lumps that may be painful to touch
● Cysts - they are large lumps filled with pus and may result in permanent scarring if not treated properly
The treatment for acne may depend on the severity of your acne. Do you have extensive acne on your face? Are there more cysts and nodules rather than blackheads and whiteheads? Have you experienced any scarring or darkening of the skin (hyperpigmentation)? Are you currently taking any medications or using any skin products? Is it affecting your daily life?
For most mild cases, lifestyle modifications alone may improve acne. Often people have been using face soaps and scrubs that are too harsh on their skin. General tips include:
● Using a gentle (preferably unscented) face wash - these are usually pH 5.5-7 which is similar to our face pH. Soaps are generally more alkaline i.e., pH 9-10 which may be too harsh on the skin
● Look out for cleansers with benzoyl peroxide
● Avoid excessive scrubbing of skin - try to limit exfoliating your skin to once a week
● Avoid washing your face too many times - you should refrain from washing your face more than twice a day
● Limit the use of makeup, or try to use non-comedogenic makeup products
● Always remove your makeup before bed
● Do not try to pick at the blackhead or whitehead
● Change your bedsheets and pillow cases regularly
● Use a daily moisturiser - if your face is oily, use an oil-free moisturiser. If your face is dry, you may consider water-based emollients.
For moderate to severe cases, you may want to consider some topical creams or even oral medications. It is best to consult your doctor who will be able to recommend the best treatments for you. Topical creams include retinoids, azelaic acids, salicylic acids, or antibiotics including benzoyl peroxide. Do take note that topical retinoids in Singapore require a doctor's prescription.
Oral medications include isotretinoin and hormonal therapy. You should not be taking isotretinoin if you are pregnant or planning on getting pregnant as it is harmful to the development of your baby. If you are not pregnant, your doctor may encourage you to use some form of contraception to ensure that you will not be pregnant while on isotretinoin. At times, antibiotics may also be prescribed. These methods, including microdermabrasion and electrosurgeries, are often reserved for severe cases that have been resistant to previous forms of treatment.
In general, topical treatments may take up to 3-6 months for any noticeable effect. You should try to be patient and monitor your skin regularly before switching to different forms of treatment. In time, acne will often go away on its own.