Acne is a common skin condition in teenagers but is increasing seen in middle aged females as well.
Acne is highly treatable and should be treated early to prevent scarring.
Teenage Acne (Acne Vulgaris)
It can present with blackheads, whiteheads, red bumps, pus spots, nodule (large bumps) and cysts (larger pus filled lesion) on the face, chest and back. Occasionally, the scalp is also affected. It can leave different types of scarring such as ice pick, rolling and box scars. It tends to improve after the age of 20 but not every patient will grow out of acne.
To improve your acne, you can try a low refined sugar diet (take foods with a low glycemic index), take probiotics, try to find ways to de-stress. Please use non-comedogenic facial products to prevent blackheads and whiteheads. Gentle facial products suitable for sensitive skin is preferred to reduce inflammation of the skin. You should omit heavy make up where possible.
Topical Acne Treatments
1. Antibiotic and Benzoyl Peroxide Combinations: Clindoxyl Gel Adv, Clindoxyl Gel, Benzaclin gel
Antibiotic kills Propionibacterium that causes acne. The Benzoyl peroxide has anti-comedomal effect and also prevents Propionibacterium becoming resistant to antibiotic. You should not use topical or oral antibiotics on its own to prevent antibiotic resistance. Benzoyl Peroxide can bleach clothing dyes, therefore you may want to use white pillow case, towel or wear white underclothes if applicable. This treatment can be used preventatively when applied to areas that are prone to acne, especially if you have a lot of acne most of the time. Alternatively, for occasional breakouts, you can apply it as a spot treatment. Special note regarding these products, the tube needs to be replaced every 2 to 3 months once the product is opened. Check with the pharmacy regarding expiry.
2. Retinoids: Retinol, Tretinoin (Stieva, Retisol, Vitamin A Acid, Retin-A Micro etc), Adapalene (Differin, Differin XP), Biacna (also contains antibiotics)
This is used primarily for blackheads and whiteheads. This will cause some peeling of the skin as it exfoliates the skin and unclog the pores. Some worsening of acne may occur at the beginning of starting this treatment. It sometimes causes redness and irritation, mostly in patients with sensitive skin. You can start using this medication 3 times a week and increase the frequency gradually to nightly if tolerated. If irritation occurs, stop the medication for several days until the reaction settles and restart the medication at a lower frequency. Alternatively, you may ask the doctor to change your cream to one with a lower concentration. This medication makes your skin more sensitive to sunlight, and It is also degraded by sunlight. It is therefore best to be used at night time. This cream should not be used if you are pregnant.
3. Tactupump, Tactupump forte (Benzoyl peroxide & adapalene): see retinoid above. This treatment will bleach clothing, towel or pillowcase.
4. Dapsone (Azone) This treatment is particularly good for hormonal acne in females. It is used once a day to acne prone areas. This cannot be used at the same time as Benzoyl Peroxide. The combination will cause yellow staining of the skin.
Systemic Treatment for Acne
1. Oral Antibiotics
Tetracyclines: Tetracycline, Doxycycline, Minocycline
2. Hormonal Treatments:
This is best for mature onset acne in females that occurs in the lower jaw area. It can also be very good if your acne gets worse before a period. If you have polycystic ovarian syndrome (PCOS), or if you also have hirsutism (coarse hairs of upper lips, chin, abdomen) and irregular periods without PCOS, the treatment is also appropriate.
Examples of hormonal treatments:
Birth Control Pills: Diane, Yaz, Alesse
3. Isotretinoin (Accutane/Clarus/Epuris):
This treatment is derived from Vitamin A. This treatment reduces inflammation, normalize the pore and reduce sebum production. This is useful for scarring acne, severe or nodulocystic acne, acne excoree and acne that is resistant to other forms of treatment.
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Non- Medicinal Therapy
Blu-U, Red-LED light
IPL (Intense Pulsed Light)
Hormonal acne tends to affect middle age females in the chin, jaw and upper neck area. Blackheads and whiteheads are less often seen. It tends to worsen before or during a menstrual period. Topical medications similar to teenage acne can be used. Aczone (dapsone) gel is commonly used for this condition. For treatment during pregnancy, we can use Finacea (azelaic acid) gel or oral erythromycin antibiotics. For more severe cases, hormonal treatment maybe required, such as combined oral contraceptive pills in younger patients and Aldactone (spironolactone) in older patients. Occasionally, Epuris/Clarus (oral isotretinoin) is used but the result is usually short lived unlike that in teenager acne. Maintenance therapy can be considered with this medication with adequate contraception.
For Red Scars- Intense Pulsed Light, Vascular laser (e.g. Pulsed Dye Laser)
For depressed scars- Dermapen (Micro-needling), Non-Ablative Fractional lasers, Subcision, TCA Cross, Micro-needling & Radiofrequency, Platelet Rich Plasma (PRP)
For Hypertrophic or Keloid scars: Intralesional steroids, Pulsed dye laser