Acne

What is Acne?

Acne is a skin inflammatory condition that virtually affects every adolescent at some point during their teenage years. However, some adults may remain affected during their twenties or thirties.

What causes Acne?

  • The sebaceous glands that produce sebum become overactive leading to excessive sebum production. This occur in particular over our face, neck, upper chest and back.
  • The combination of excessive oil and skin cells clogs up normal hair follicle on the skin.
  • Propionibacterium bacteria in the deeper part of the hair follicles acts on the sebum, causes inflammation of the skin which manifests as painful pimples.

What are the symptoms and presentations of Acne?

Patients with acne tends to present with

  • Skin greasiness (Seborrhea)
  • Comedones (black and white heads)
  • Inflamed red papules (dots), some with the presence of pus
  • Painful deep red angry nodule (hard lumps)
  • Uneven skin surface with scarring
  • Pigmentary changes due to previous acne lesions

Who is at risk of Acne in Singapore?

Acne affects up to approximately 88% of the adolescence locally. Although acne occurs during teenage years, the symptoms can continue 5 to 10 years and persist into adulthood in some patients. Acne can affect both males and females, though teenage boys have a predisposition for developing severe acne.

What are the common triggers of Acne in Singapore?

  • Hormonal triggers
    More than 50% of female having acne flare before and during first few days of their menstrual cycle. Underlying medical conditions such as Polycystic Ovarian Syndrome (PCOS) can lead to acne development.
  • Stress
    Acne can be aggravated by stress though the supporting medical evidence remains limited.
  • Diet
    A high-glycemic index diet such as biscuit, ice cream, sugary drinks, sweets, milk and dairy products can aggravate acne.
  • Cosmetics/Facial products
    Oil-based cosmetics often block skin pores, causing acne outbreak.
  • Drugs
    Medications such as steroids, ciclosporin, lithium, iodides can cause acne.

How is Acne Diagnosed?

Acne skin condition is a clinical diagnosis. Your doctor will obtain a history of the progress of acne throughout the years (adolescence to adulthood), the treatment options that have tried, responses to various treatment and clinically examine your acne rash. Your doctor, rarely may offer further tests such as swab tests, biopsy if the diagnosis is unclear. Blood tests may be offered in certain treatment of severe acne.

What are the treatment options for Acne ?

Acne should be treated as early treatment can prevent scarring.

Treatment options include:

Mild Acne: Topical Medications

  • Benzoyl peroxide
  • Salicylic acid
  • Sulfur
  • Glycolic acid
  • Azelaic acid
  • Alpha hydroxyl acid
  • Topical antibioics
  • Vitamin A cream (Adapalene, Tretinoin)
  • Tea tree oil

Moderate or Severe Acne: Oral Medications

  • Antibiotics
  • Oral contraceptive pills
  • Isotretinoin

FAQS

Although there is no direct genetic linkage, having parents or siblings with severe acne increases your risk of developing acne.

There is currently no cure for acne. Having said that, with the progress of medical advancement over the years, there are various effective acne medical treatments available. You may wish to consult your doctor on your acne skin to treat the condition early.

The psychosocial negative impact associated with acne is often neglected until one’s quality of life is severely compromised. Acne is associated with low self-esteem, depression and anxiety. Fortunately, Acne is a condition completely curable. Acne scars are very much preventable with prompt early treatment.

Scarring may occur in some patients over time as a complication due to untreated acne. The risk of acne scarring also increases if you have a tendency to pick or squeeze your acne. Although acne scars are not life threatening, it can be associated with a negative psychosocial impact. Hence it is important to treat acne early to prevent complication.

  • Avoid overly layering of makeup and facial products
    -Less is more. Look for facial products that are non-comedogenic, lighter and serum based.
    -Do proper band research before settling for cosmeceutical products. As a general guide, hunt for labelling such as ‘dermatologist-tested or recommended’. If in doubt, have a word with your trusted skin doctor.
  • Keep to a good 3 basics: wash, moisturizer and sunblock
    -Facial wash functions by emulsifying and removing the bacteria, excessive oil and dirt on the face. A gentle wash with a good balance of cleansing yet not stripping the skin natural moisturizer is the ideal choice.
    -Scout for water or lotion-based moisturizer.
    -Sunblock with SPF 40 and above with PA coverage for UVA and UVB are advisable.
  • Avoid washing face excessively, or use of harsh facial scrub
    -Contrary to the belief of after scrub glow and squeaky clean skin after repeated washing, these steps can aggravate acne by removing the skin’s protective barrier layer.
  • Caution with choice of facial masks
    -Some facial masks can either clog up the pores or overly dry out the skin.
  • No picking, squeezing or self-extracting acnes, milias, white and blackhead
    -If not done properly, these can result in scarring.
  • Look after your diet
    -Encourage healthy balanced eating of whole grains, vegetables, fruits and fish.
  • Avoid exposure to extreme weather, intense sun, humidity and dusty environment
  • Treat concurrent underlying skin issues
    -Skin conditions such as eczema or psoriasis can worsen acne condition.
  • Review your pill bag
    -Speak to your doctor for possible alternatives if you are on hormonal pills, steroids, thyroid and mood stabilizer medication that may trigger acne.
  • Stay happy and stress free
    -Raging insurmountable stress can aggravate acne, hence relax and don’t be unhappy.

Patients with acne may notice certain makeup products such as foundations, concealers can worsen acne breakouts. Opting for lighter makeup products which are non-comedogenic is an option for patients with acne-prone skin.

Acne is not contagious and you will not catch acne by skin contact or touching with another person.

There is no clinical evidence of allergy leading to development of acne. Nonetheless, patients may notice certain skin products causes an allergic condition known as contact dermatitis that sometimes is mistaken as acne. You are advised to consult your doctor on your acne condition to obtain the appropriate skin treatment.

You are advised to avoid diet with high glycemic content such as sugar, diary or milk, chocolate, oily food, refined grains, oily food or fast food.

Daily adequate hydration with 6 to 8 glasses of water helps the body to flush out skin toxin, keep the skin supple, hydrated and elastic. This reduces the skin pores from clogging. You may wish to seek advice from the doctor on medical ways of managing acne if the acne persists or worsens.

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