Acne

What is acne?

Acne occurs when dead skin cells, bacteria, and oil clog the hair follicles. It often manifests as pimples, whiteheads, pustules, papules, blackheads, or cysts. These lesions can develop on various parts of the body such as the face, back, neck, shoulders, and chest. Acne can range from mild to severe and due to its effect on appearance, it can cause physical discomfort as well as emotional distress.

While acne is most commonly associated with adolescence due to hormonal changes during puberty, it affects people of all ages, including adults. Adult acne is quite common and can persist well beyond the teenage years. Additionally, some people experience acne for the first time as adults, even if they did not have significant acne during their teenage years.

The presentation of acne in adults may differ from that in teenagers, with certain types of acne lesions, such as cystic acne, being more common in adults. Adult acne can also be influenced by factors such as occupational exposures, skincare habits, and underlying medical conditions.

Overall, acne is a common skin condition that can affect individuals of any age, and effective treatment options are available regardless of age. Consulting with a medical professional can help determine the most suitable treatment plan tailored to individual needs and circumstances.

What causes acne?

Acne is mainly caused by a combination of factors that lead to the blockage of hair follicles. This may lead to inflammation, making acne worse. The factors that are associated with acne include: 

• Excess oil production (sebum): the sebaceous glands in our skin produce an oily substance known as sebum. Hormonal changes, particularly during puberty, can stimulate these glands to produce more sebum. Excess sebum can mix with dead skin cells and clog hair follicles, leading to the formation of acne.
• Clogged hair follicles: when hair follicles become blocked by a combination of excess oil and dead skin cells, bacteria, particularly Propionibacterium acnes (P. acnes), can thrive, causing acne.
• Inflammation: when the body detects the presence of bacteria in clogged pores, it triggers an immune response, leading to inflammation. This inflammation can cause the surrounding skin to become red, swollen, and painful.

What are the symptoms of acne?

Acne presents a range of symptoms that can vary in severity and appearance, including:

• Pimples: pimples are raised bumps on the skin that may be red, pink, or flesh-coloured and often contain pus.
• Blackheads: small, dark-coloured bumps that appear on the skin's surface and are caused by clogged pores remaining open.
• Whiteheads: similar to blackheads, whiteheads are small bumps covered by a thin layer of skin, appearing white or flesh-coloured.
• Papules: papules are solid, raised bumps that are typically pink or red and may be tender to the touch.
• Pustules: pustules are similar to pimples but with pus at their tips. These raised bumps have a white or yellow centre surrounded by red, inflamed skin.
• Nodules: nodules are large, solid, painful lumps beneath the skin's surface that often persist for weeks or months.
• Cysts: cysts are deep, pus-filled lumps that are typically painful and may lead to scarring.
• Acne scars: severe cases of acne, especially cystic acne, can result in acne scars (link to service page) as the skin heals from inflammation and tissue damage.

Is acne painful?

Acne can be painful, especially when certain lesions become inflamed or infected. Inflamed lesions such as pimples, papules, pustules, nodules, and cysts can cause discomfort or pain, depending on their severity.

Among the different types of acne lesions, nodules and cysts typically cause more pain than surface-level pimples or blackheads. These deeper lesions can feel like hard, painful lumps beneath the skin, and the discomfort they cause can range from mild to severe. Additionally, secondary infections can occur when acne lesions become infected with bacteria, leading to additional pain, redness, and swelling. This infection worsens the discomfort associated with acne and can prolong the healing process.

In severe cases of acne, the healing process can also result in scarring as the skin attempts to repair itself. While scarring itself may not cause pain, the presence of scar tissue can sometimes be sensitive or tender. 

It's essential for those experiencing discomfort or pain due to acne to seek medical advice from a medical professional. Effective treatment options are available to manage acne symptoms and help you maintain healthy skin. Contact us today to book an appointment. 

Who is at risk of acne in Singapore?

In Singapore, as in many other parts of the world, acne can affect people of all ages and backgrounds. Acne is a common skin condition that can affect anyone, regardless of age, gender, or background.  However, certain factors may increase the risk of developing acne, including:

• Hormonal changes: puberty, menstruation, pregnancy, or medical conditions such as polycystic ovary syndrome (PCOS), hormonal fluctuations can occur. This can often trigger acne breakouts by increasing sebum production.
• Genetics: if your parents or siblings have had acne, you may be more likely to develop it, as family history is known to play a role in skin conditions such as acne.
• Medications: medications such as corticosteroids, androgenic steroids, and lithium, can worsen acne or trigger breakouts for some people.
• Diet: some studies suggest that a diet high in high-glycemic-index foods (such as sugary or processed foods) and dairy products may sometimes worsen acne. 
• Stress: a stressful lifestyle may exacerbate acne by triggering hormonal changes that increase sebum production.
• Environmental factors: frequent exposure to certain environmental factors, such as pollution or high humidity, can contribute to acne development by clogging pores and promoting bacterial growth.
• Hygiene habits: poor cleansing can allow sweat, dirt, oil, and dead skin cells to accumulate on the skin's surface, leading to clogged pores and acne breakouts. However, over-cleansing or using harsh cleansers can disrupt the skin's natural barrier, leading to dryness, irritation, and increased oil production, which can worsen acne. Leaving makeup on overnight can also clog pores and lead to acne breakouts. 
• Cosmetic use: some cosmetic products, particularly those that are comedogenic (tend to clog pores), may worsen acne.

How is acne diagnosed?

Diagnosing acne typically involves a combination of a physical examination, a medical history review, and sometimes additional tests or assessments. Here's how acne is typically diagnosed:

• Medical history:  your medical professional will start by asking about your medical history, such as past or current skin conditions, medications, skincare routines, and factors that may contribute to acne, such as hormonal fluctuations or dietary habits. 
• Physical examination: the skin will be examined, focusing on areas commonly affected by acne, such as the face, neck, chest, back, and shoulders. The types of lesions (pimples, blackheads, cysts) and their severity will be assessed.
• Additional tests: in some cases, other skin conditions must be ruled out. These conditions include folliculitis or rosacea. This may involve additional tests or examinations, such as skin biopsies, bacterial cultures, blood tests to assess hormone levels, or ultrasound imaging in suspected cases of polycystic ovary syndrome (PCOS).

What are the treatment options for acne in Singapore?

Once you have been diagnosed with acne, your doctor will work with you to develop a personalised treatment plan. This plan may involve a combination of topical treatments, oral medications, lifestyle modifications, and skincare recommendations to manage acne and prevent future breakouts. Regular follow-up visits may be scheduled to monitor progress and adjust treatment as needed.

In Singapore, several treatment options are available for acne. Here are some common treatment options for acne:

• Topical treatments:
  • Benzoyl peroxide: kills acne-causing bacteria and reduces inflammation.
  • Topical retinoids: prescription-strength retinoid creams or gels help unclog pores and reduce inflammation. 
  • Topical antibiotics: antibiotic creams or gels may help reduce acne-causing bacteria and inflammation.
• Oral medications:
  • Oral antibiotics: to reduce bacteria and inflammation in moderate to severe acne, antibiotics like doxycycline or minocycline may be prescribed.
  • Oral contraceptives: for females with hormonal acne, certain birth control pills containing oestrogen and progestin can help regulate hormone levels and reduce acne.
  • Isotretinoin: this powerful oral medication is reserved for severe cystic acne that has not responded to other treatments. It reduces oil production, prevents clogged pores, and can lead to long-term remission in many cases.
• Aesthetic procedures:
  • Chemical peels: a chemical solution is applied to the skin to exfoliate dead skin cells, unclog pores, and improve acne.
  • Microdermabrasion: this procedure uses a device to gently exfoliate the skin and remove dead skin cells, helping to improve acne and skin texture.
  • Laser or light therapy: laser light-based therapies, such as intense pulsed light (IPL) or a yellow laser, can target acne-causing bacteria, reduce inflammation, and promote skin healing.
• Intralesional injections: for large, inflamed cysts, a corticosteroid injection directly into the lesion can help reduce inflammation and speed up healing.
• Skincare products: dermatologists may recommend specific skincare products tailored to individual skin types and acne concerns, such as gentle cleansers, non-comedogenic moisturisers, and sunscreens.
• Lifestyle modifications: certain lifestyle changes, such as maintaining a healthy diet, managing stress levels, avoiding picking or squeezing acne lesions, and practising good skincare habits, may also be recommended to improve acne.

Frequently asked questions

How long does acne treatment take to work?

It mainly depends on factors such as the severity of acne, the treatment method, your response to treatment, and consistency in following the treatment regimen. Improvement should be noticeable within weeks to months of starting treatment. 

Can acne leave scars?

Yes, in several cases, severe acne lesions, particularly nodules and cysts, can lead to scarring as the skin heals. Early treatment of acne can help minimize the risk of scarring. Various treatment options are available for acne scars, including laser therapy, chemical peels, and microneedling.

Is acne contagious?

No, acne is not contagious. It is a common skin condition caused by factors such as genetics, hormones, and lifestyle habits and cannot be spread from person to person through contact.