Conditions - Acne
What is acne and who gets it?
Acne can affect anyone. Most people with acne are aged between 12 to 25 years old, but adult acne is very common. Boys are more commonly affected than girls, and about 8 in 10 teenagers develop some degree of acne. Acne usually affects the face, but it may also affect the back, neck and chest. Untreated acne usually lasts about 4 to 5 years before settling spontaneously. However, untreated acne may leave scars which last a lifetime.
What causes acne?
Underneath the skin surface lies small sebaceous (oil) glands. These glands are responsible for producing oil (sebum) which keeps your skin supple and smooth. The pores on our skin allow the sebum to escape onto the skin surface. For many reasons, be it congenital, familial or due to hormonal changes (during puberty), your glands make more oil. This will make the skin feel greasy, and acne is likely to become worse.
The pores on our skin can become plugged (blocked). This is due to the skin at the top of the pores becoming thicker, or when dead skin cells block these openings. The plugs at the top of the pores are known as comedones (blackheads and whiteheads). When oil continue to collect under these comedones, you can see small swellings called pimples or papules. In the majority of cases, the condition do not progress, and this is considered as mild-to-moderate acne, with small numbers of pimples, blackheads and whiteheads.
Pore that is congested with oil becomes an ideal environment for bacterial growth. The bacteria involved in acne is called Propionibacterium Acnes. They live on normal skin and usually does not cause problems. However, if there is increased growth of them, the immune system may react to it, resulting in inflammation. The surrounding skin then becomes red and filled with pus (pustules). If the condition worsens, these pustules become larger to form cysts and nodules.
What happens after acne?
Any inflamed spot will eventually heal. However, the area of the skin that was affected may remain discoloured for weeks to months after the initial acne has subsided (post-inflammatory hyperpigmentation). Occasionally, a depressed scar may be left on the skin which was initially inflamed. These scars do not fade completely and may accompany you for a long time to come, without treatment.
Some myths and common misconceptions about acne
• Some people believe that there is no treatment for acne. This is untrue. When used correctly, most acne can be cured or controlled.
• Acne is something which you will outgrow, and no treatment is needed. Whilst it is true that some people outgrow their acne conditions, it does leave scars if untreated at an early stage. Therefore, to prevent scarring, which is a lot more difficult and costly to treat, it is crucial that acne treatment be instituted early and appropriately.
• Acne is not caused by poor hygiene. Excessively washing your face may in some case makes acne worse.
What are the treatment aims for acne?
There are 2 main aims of acne treatment:
1. To clear as much of the acne and spots as possible.
There are many different type of acne treatment. Each of them work slightly differently, targeting the various contributing factors to acne formation. It is crucial that you adhere to the prescribed treatment as much as possible to see best results. Even with the best treatments, patience is still key to acne treatment success. We recommend at least 6 to 8 weeks of sticking to a regimen before deciding if it is working of not.
2. To prevent scarring from acne.
Severe acne, especially those with active inflammation, should be treated as soon as possible. The longer we leave active inflammatory acne untreated, the more likely that scars will form. Therefore, to prevent a more difficult problem, which will cost more to treat, with usually more painful treatments, we will treat severe inflammatory acne aggressively.
Skincare for people with acne
Good skin always starts at home. If you suffer from acne, this is especially true.
Cleansing is one of the most important steps in any skin care regimen. For those suffering from acne, we will definitely encourage a good cleaning routine. We believe in a 2-step cleansing, one with a hydrating cream cleaser, and two with a cleanser containing acids such as glycolic or salicylic acid.
Vitamin C is also known to help with oil control and is used in many acne treatments. Therefore, do consider adding a Vitamin C based serum into your skin care.
As many of the acne treatments can dry out the skin, ensure you use an appropriate strength moisturiser. The requirements of your skin may change with time, therefore, it is important that you discuss any changes in your skin’s comfort levels with your doctor, so the appropriate changes can be made.
Topical treatments for acne
Various gels, lotions and creams are used to treat acne. Different preparations work in different ways.
1. Benzoyl peroxide
Benzoyl peroxide is a common topical treatment. It has three actions - it kills germs (bacteria), reduces inflammation and helps to unplug blocked pores. Therefore, it often works well to clear inflamed spots and it helps to clear blackheads and whiteheads (comedones).
It commonly causes mild skin irritation. If your skin does become irritated then stop using it until the irritation goes. Then try again with a lower strength, or reduce the time it is left on your skin before washing off. You should aim to put on twice daily when you get used to it.
Retinoids are good at unplugging blocked pores. They also have some effect on reducing inflammation. Therefore, one is often used early on in acne to help to unblock pores and to treat blackheads, whiteheads and mildly inflamed spots.
When you use a topical retinoid, you may develop some skin redness and skin peeling. This tends to settle over time. The spots may sometimes become a little worse before improving.
Your skin may be more sensitive to sunlight. Therefore, it is best to apply at night and wash off in the morning. A sun protection cream may also help if you are out in the sun.
The most common side-effects are burning, irritation and dryness. Therefore, you may be advised at first to use a low-strength, less frequent application and for a shorter duration.
3. Topical Antibiotics
There are various topical antibiotic preparations. They reduce the number of bacteria and reduce inflammation. However, they have little effect on unplugging blocked pores. So, they are usually good at treating inflamed acne but blackheads and whiteheads may remain.
They may cause mild irritation but generally cause fewer side-effects than the other topical preparations. Topical antibiotics are usually prescribed in combination with other medicines (see below). Using them alone can increase the risk that the germ will become used to the antibiotic and make the treatment less effective.
Medical treatments for acne
1. Antibiotic tablets
Antibiotics work by killing germs (bacteria) that contribute to the cause of acne. They also have a direct effect of reducing inflammation. Antibiotics usually work well to clear inflamed acne spots and any surrounding skin inflammation.
However, they have little effect on unplugging blocked pores - which you can see as blackheads and whiteheads (comedones). So, if you only have mild acne with just blackheads and whiteheads, you are better off using a topical treatment that unblocks holes in the skin (pores). If you have a lot of blackheads and whiteheads as well as inflamed acne spots, you may be advised to use a topical treatment such as benzoyl peroxide in addition to taking an antibiotic tablet.
2. The pill (a hormone treatment)
The combined contraceptive pill (the pill) may help some women if their acne seems to be partly related to their hormonal changes. For example, acne that began or became worse in adulthood, or if acne seems to flare up around the time of a period. It is the oestrogen part of the pill that is thought to help.
3. Isotretinoin tablets
Isotretinoin greatly reduces the amount of oil (sebum) made by your sebaceous glands. It works very well and usually clears spots even in severe cases. However, it is normally used only on the advice of a specialist after other treatments have been tried first. There are potential side effects associated with Isotretinoin and it is essential that there is regular follow up with your doctor.
Aesthetic treatments for acne
Aside from appropriate skin care usage, topical and oral treatments, adjuvant treatments done by an aesthetic doctor can also help with your recovery from acne.
1. Chemical Peels
Various chemical peels can help with acne treatments as well. Some examples are: Salicylic acid peels and Jessner's peels (equal parts salicylic acid, lactic acid, and resorcinol, an antiseptic exfoliant). These peels penetrate deep into skin to unclog pores while also skimming the surface to erode blackheads and fade post-pimple marks. Another advantage of salicylic acid: It lingers in the pores, where it continues to keep them clear over time.
Lasers are a treatment option performed by a doctor, and it is aimed at preventing light-to-moderate acne, although it has shown some promise in the treatment of severe acne (cysts/nodules). Lasers work primarily on the premise of exciting compounds that bacteria produce called porphyrins. When the laser light excites the porphyrins, this damages the bacterial wall, effectively killing the bacteria. Fewer acne bacteria should help reduce symptoms of acne. Laser treatment may also reduce sebum (skin oil) levels. Lower sebum levels are associated with lower incidence and severity of acne. Lastly, lasers may have anti-inflammatory properties. Since acne is at its root an inflammatory disease, reducing inflammation can help reduce acne as well.
How long is treatment needed?
Regardless of which treatment is used, it is normal to take up to 4 to 6 weeks for there to be any improvement that you can see. There is often a good response to treatment by 6 to 8 weeks. However, it can take up to 4 months (sometimes longer) for maximum response to a treatment and for the skin to be generally free of spots.
The most common reason for a treatment failure is because some people think that treatment is not working after a couple of weeks or so and give up. Therefore, we would strongly advise you to continue with any treatment for at least 8 weeks before deciding if it is working or not. If there is no improvement after 6 weeks of taking a treatment regularly and correctly, do not give up without consulting your doctor. Adding in another treatment or a change to a different or more powerful treatment will usually be advised and is likely to work. Although treatment can usually clear most spots, there is no treatment that will make your skin perfect and the odd spot may remain.
Will acne return after treatment?
Once the spots have cleared, acne commonly flares up again if you stop treatment. Therefore, after the spots have gone or are much reduced, it is common to carry on with a maintenance treatment to prevent acne from flaring up again. It is common to need maintenance treatment for 4-5 years to keep acne away.
Maintenance treatment is usually with either benzoyl peroxide or a topical retinoid. These can both be used indefinitely. The dose used to prevent spots from returning is often lower than that used to treat acne.
Acne is a very common skin condition, and can be successfully treated or controlled in majority of cases. Inflamed acne needs to be treated early and aggressively to prevent scarring, which is much more difficult and costly to treat. There are many options for effective acne treatment and we are committed to helping you regain your confidence.
Interested to find out more?
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About VIDASKIN Clinic
VIDASKIN Clinic is a premier medical & aesthetic clinic in Wheelock Place, Orchard, Singapore providing a comprehensive range of medically proven solutions.
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