3 Steps to Acne Clear Skin

Can you treat my acne?

Are you frustrated that your acne hasn't gotten any better? Do you have acne that rears its ugly head only during adulthood and you can't really understand why? Can I achieve healthy skin once again?

Acne vulgaris remains one of the most common chronic skin conditions to afflict mankind. We know understand that acne is the result of abnormal cell turnover (clogged pores), and an increased oil (sebum) production. These are directly influenced and driven by hormones, and creates an ideal microenvironment for inflammation and infection by the P.acnes bacteria to take place.

Step 1: Treat Acne Early

how acne forms

The primary purpose of treating acne early is to reduce the risk of scarring and bring the condition under control. There is a definite increased risk of the development of acne scars if your acne has been left untreated. 

Before discussing the treatment options, we need to determine how mild or severe your acne is.  Acne can take the form of comedones (whiteheads and blackheads), papules and pustules. Although there are several acne grading systems in the literature, there is no universal systems that is used consistently worldwide. Acne can be graded according to the predominant lesion type, for example, do you have predominantly inflammatory, comedomal or cystic acne. It can also be graded according to the number of acne lesions you may have.

Acne classification and grading. Habif, Clinical Dermatology, 5th ed. Elsevier, 2009.
photographs to show acne severity
Hayashi et al. Establishment for grading criteria for acne severity. Journal of Dermatology 2008.;35:255-260.

The treatment of acne must take into account both the predominant lesion type and how severe the acne burden is for each individual.  Treatments are aimed at reducing inflammation, P. acnes bacteria, normalising cell turnover and/or reducing sebaceous gland activity. Given the recent insights into the risk of antibiotic resistance in the treatment of acne, the Global Alliance to Improve Outcomes in Acne has advised judicious use of antibiotics for acne treatment. 

Generally, for mild acne or comedomal acne; you may be prescribed a topical retinoid cream. Topical retinoids work by unclogging pores, reducing inflammation and P.acnes bacterial load. It can however cause some skin irritation, especially on Asian skin. This is why most of my patients are taught a specific way on how to use the product. Recently, Epiduo gel, which has a fixed dose combination of a retinoid ( 0.1% Adapelene) and 2.5% Benzoyl peroxide has proven to be clinically effective for mild to moderate forms of acne when applied once daily.

For individuals with a more moderate form of acne, oral antibiotics such as doxycycline should be considered in the treatment regime. However, oral antibiotics should only be used short term and must be combined with topical retinoids and/or benzoyl peroxide formulations to reduce resistance and increase acne lesion clearance. 

At the other end of the spectrum, for severe or nodule-cystic acne subtype, we may consider the drug oral isotretinoin. It is known by trade names such as Oratane, Accutane and Acnotin. Oral Isotretinoin is the only oral medication that effectively targets all the abnormal processes underlying acne formation. It reduces oil secretion by 90% within 6 weeks of treatment, reduces whiteheads and blackheads by 90% within 3 months and has an anti-inflammatory effect. Most individuals can expect a dramatic improvement after 1-2 months of treatment.

Step 2: Maintaining Acne Clear Skin

acne prone skin treatments singapore

With the body of knowledge now available, acne vulgaris is considered a chronic inflammatory condition of the pilo-sebaceous glands. This means that acne can lasts up to 10 years or more, even with treatments. The goal here is to minimise acne flare ups, and keep skin healthy and inflammation at bay for as long as possible. Once acne is under control with the initial stages of treatment, it is easy to be complacent and forgo maintenance treatment.

Many are not aware that even before acne becomes evident, miniature forms of whiteheads may begin to form under the skin. It is so small that it is not perceptible to touch and feel. We call these microcomedomes. During the early stages of acne development, microcomedomes together with inflammatory mediators results in the red angry flares of acne we are so familiar with.

A maintenance treatment that comprises of a topical retinoid and/or benzoyl peroxide helps prevent acne from recurring. The combination of these two powerful medicines helps in the prevention of microcomedomes by unclogging pores, reducing inflammation and killing off the P.acnes bacteria. A new formulation, the Epiduo Forte Gel, comprises 0.3% Adapalene with 2.5% Benzoyl peroxide, making this antibiotic-free and once daily gel convenient and clinically effective for everyday usage. 

Step 3: Acne Scar Treatments

Acne scar treatments are a large topic by themselves. Suffice to say, we want to prevent acne scarring in the first place. However, if you do develop acne scars as a result of untreated acne, there are various procedures available to improve the appearance of your acne scars. It is important to first understand that there are different types and subtypes of acne scars. They are further graded on a visual scale and by manual stretchability of the scar.

Types of acne scars for acne scar removal
acne scar grading will lead to better treatments

Once we have determined the type and grading of your acne scarring, we usually combine treatments that are specific to each scar type.

The acne scar removal program synergizes various treatment methods. These include Subcision, TCA CROSS, punch excision, Dermal Fillers, INFINI skin resurfacing, Lasers for pigmentation and anti-inflammatory injections for keloids may be added to achieve the best results where needed.

Acne scarring is a very common condition due to a delay in treatment and often an underestimation of the severity of the acne process. Acne scarring is usually a mixed pattern of scars. Each specific scar type will respond better to a corresponding treatment. A combination approach that synergizes the different treatment modalities safely and effectively to bring about the most optimal outcome is the desired goal.

Our focus is on improving your skin the best way possible, taking into account your skin type, skin colour, downtime, lifestyle and budget. While it can be confusing sometimes to determine which treatments to go for, given the vast number of available options, we take a pragmatic approach and advise you accordingly the best approach available based on the latest evidence and clinical experience. With the acne scar removal program, individuals can expect a 1-2 grade improvement in their acne scars over a 6 month period.