Skin Problems
 
Acne and Acne Scar Treatments

» Acne – Incidence, Causes, Complications
1. WHAT IS ACNE?

Ask any teenager and he will be able to tell you. Whiteheads, blackheads, pimples, zits, red bumps, pussy bumps, and cysts – these are all signs of acne. Acne appears most commonly on the face, but can also occur on the neck, back, chest and shoulders. Occasionally you can get acne on the bumps or the scalp. To the dermatologist acne is the medical name for pimples or zits. Most people do not realise that blackheads or whiteheads (also called comedones) are in fact early acne. To prevent complications from acne or from getting acne scars, dermatologist treats acne early even when they are only comedones.

There are two stages of acne

- the non inflammatory acne consisting of comedones and these will not cause scarring and
- the inflammatory acne consisting of red bumps, painful pussy bumps and cysts which often leads to acne scars.

2. IS ACNE COMMON?

You are not alone.

It is estimated that 85% of people between the ages of 12 and 25 suffer from some kind of acne. In most cases, acne clears up as we get older. You can get acne up till mid or late thirties. In some cases, if not properly treated; it can leave permanent scars on the skin.

3. HOW DOES ACNE OCCUR?

Acne usually starts in puberty, when the body is experiencing changes in the levels of hormones.

This affects the activity of sebaceous (oil) glands, which produce an oily substance called sebum. Sebum travel through hair follicles (to which the oil glands open into) to the surface of your skin. However, skin cells which shed from your hair follicles stick with the sebum, causing the follicle and the skin opening to be clogged. Bacteria begin to grow, and whiteheads and blackheads will appear.

Your body will attempt to clear the clogged pores, and this result in the wall of the follicle weakening and rupturing. In the end, swelling or redness will develop, resulting in the red bump or pimple characteristic of acne.

4. HOW IS THE ACNE TREATED?

Acne treatment aims to unclog the plugged pores and to keep them clear. By doing this, the bacteria that grow in our clogged pores will be controlled and acne flare-ups will be reduced. Effective treatment should also regulate the secretion of sebum to a more manageable level.

Dermatologist treats acne with creams, oral medication, chemical peels, LED light or laser treatments depending on the severity of the acne.

5. HOW OFTEN SHOULD I CLEAN MY FACE?

It is important to remember that acne is not caused by dirt. Excessive washing can aggravate your condition. You should clean your face and twice a day is sufficient. A mild cleanser will do the job, without drying or irritating your skin. Avoid scrubs as this will irritate the skin

» Acne Medical Treatment
1. CAN BE ACNE BE CURED?

Unfortunately no.

Genes play a part. Have you ever wondered why some of your friends have good skin even though they are not bothered about their skin while some others have acne no matter how careful they are with their skin care?

Acne will have to run its course. For some people acne may clear by late teens while others may have acne till late adulthood. The aim of acne treatment is to clear acne and to prevent acne scar formation.

2. WHAT CAN I USE TO TREAT MY ACNE?

If your acne is mild with a few whiteheads or blackheads (the non-inflammatory acne) you can buy acne creams from the retail pharmacy. Products that contain benzyol peroxide, salicylic acid or antiseptic can remove the minor acne

However, if your acne continues to grow or if you have red bumps or painful bumps with pus, then you need to consult a dermatologist. These are the inflammatory acne and early treatment is important to prevent you from getting acne scars.

3. WHAT ACNE TREATMENT CAN MY DERMATOLOGIST OFFER?

Dr Joyce Lim uses prescription creams to treat acne as these are more specific and effective. There are creams that are comedolytic (ie they break open the comedones inside the skin) and which prevents the comedones from becoming inflamed and forming scars. If you have inflammatory acne then your dermatologist will give you an antibiotic gel or lotion

4. HOW LONG MUST I USE THE ACNE TREATMENT?

Generally acne improves only a few weeks after starting treatment. Usually by the third month the skin will be clear. However most dermatologist including Dr Joyce Lim will advise that you continue the acne treatment for at least 6 months – even though no acne is seen after 3 months. This is to clear any acne that is within the skin

5. WHAT SIDE-EFFECTS CAN I EXPERIENCE DURING ACNE TREATMENT?

Most acne treatments will cause the skin to peel. This is not skin allergy. If this happens your dermatologist will advise you on how to use the treatment to minimise this. If you are pregnant or planning to get pregnant you need to let Dr Joyce Lim know as she will then give you acne treatments that are safe in pregnancy
» Acne Treatment with Oral Medication
1. WHEN WILL A DERMATOLOGIST GIVE ME ORAL MEDICATION TO TREAT MY ACNE?

Dermatologist will prescribe oral medication if you have inflammatory acne with papules(red bumps) and pustules(pussy bumps) These inflammatory acne will heal with acne scars and therefore the faster you get rid of them the less likely that you will have acne scars.

2. WHAT ARE THE ORAL MEDICATIONS FOR TREATING ACNE?

There are three groups of oral medications – the oral vitamin A (isotretinion), the hormonal medication(birth control pills) and the oral antibiotics. Your dermatologist will discuss with you in detail which is suitable for you.

3. IS IT SAFE TO TAKE ORAL VITAMIN A (ISOTRETINION) TO TREAT MY ACNE?

Oral vitamin A (isotretinion) is the most effective oral treatment for acne as it treats primarily the oil glands. It shrinks the oil glands making them ineffective to cause acne and also stops the inflammation – the skin no longer feels oily, the acne disappears and the skin becomes smooth again. However, sometimes the skin can become too dry giving you dry chapped lips, dry eyes, dry and itchy skin and the nose may bleed. Let Dr Joyce Lim know if you are experiencing these side-effects as she can adjust your daily dose to reduce the side-effects. Other side-effects are rare and they include backaches, skin infection, mood changes – they are reversible once you stop the medication. The most serious side-effect for a female patient taking isotretinion is deformed babies - should she become pregnant while consuming the medication. There is a need to have blood test done before taking the medication to see if you have high blood cholesterol or any liver disease.

4. MY DERMATOLOGIST SAYS THAT I NEED ORAL CONTRACEPTIVES TO TREAT MY ACNE. WHY?

Hormones especially androgens can cause oil glands to become active and clogged, resulting in an oily pimple face. Hormonal medication helps to block the action of these hormones and thus reduce the formation of comedones. Some patients may experienced weight gain and a sense of bloatedness with these medication.

5. WHEN IS ORAL ANTIBIOTICS GIVEN TO TREAT ACNES?

Oral antibiotics are given if you have inflammatory acne. They are safe and effective. However most antibiotics can cause gastric and diarrhoea and in some females can encourage vagina yeast overgrowth. Therefore you should always follow the instructions closely and inform your dermatologist if you develop any side-effects.
» Acne Treatment with Chemical Peels
1. WHY DID MY DERMATOLOGIST SUGGEST CHEMICAL PEELS TO TREAT MY ACNE?

Chemical Peels are used to clear acne faster. It is a treatment for acne where one or more peeling agents are applied on the face/skin to dislodge the dead cell layer and the clogged pores and allow the acne creams to penetrate better. Repeated chemical peels lead to regeneration of new skin, stimulates collagen growth, clearance of acne and lightening or improvement of acne scars

2. WHAT HAPPENS DURING A CHEMICAL PEEL TREATMENT FOR ACNE?

When your dermatologist applies the peeling agent on the skin, you will feel a burning or prickling sensation. Sometimes you may have a sensation like ants crawling on the skin. Usually you will have a fan blowing a cold air during the chemical peel procedure to reduce the discomfort.

3. WHAT CAN I EXPECT AFTER A CHEMICAL PEEL TREATMENT FOR ACNE?

The changes in the skin depends on the peelings agents. The acne spots may look white and the clogged acne will be dislodged. Your skin becomes pink, turns brown and in the next few days will start to peel, like a mild sunburn. The skin returns to normal after a few days and the acne spots may be less. Most people are able to put on their makeup and return to their normal activities. Sometimes the skin may blister and form scabs and this takes several days to return to normal

4. HOW MANY CHEMICAL PEELS DO I NEED?

The number of Chemical peels depends on the severity of your acne and the peeling agents. Generally you may need several treatments to clear your acne. Your dermatologist will be able to advice you on which chemical peels to treat your acne and the number of peeling sessions needed to treat your acne.

5. CAN CHEMICAL PEELS REPLACE MY ACNE TREATMENT?

No. Chemical peels are added to your usual acne treatment to help clear your acne faster and chemical peels also help to reduce and prevent acne scars
» Acne Treatment with Light Source LED
1. WHAT IS THE LED LIGHT TREATMENT FOR ACNE?

LED light treatment or phototherapy uses light emitting diodes of various wavelengths and they are useful for the inflammatory acne.

The LED targets the metabolic product of the bacteria causing acne, the prophyrins, and produces an oxygen free radical which is toxic and result in killing of the bacteria. Optimal absorption occurs within the blue wavelengths (around 415 nm). The red light targets the deeper aspects of the disease, including inflammation deeper in the skin and possibly portions of the sebaceous gland. Red and blue light LED phototherapy can be used synergistically to treat active acne, the blue light helping to reduce bacteria counts and the red lights helping to heal the skin.

2. WHEN IS THE LED LIGHT TREATMENT GIVEN FOR ACNE?

LED light treatments are used to treat inflammatory acne. Clinical trials have shown that a treatment twice a week for 8 weeks, followed by once a week for 4 weeks helps to reduce bacteria counts and inflammation associated with acne, and therefore reduce the number of active acne lesions. The red light and blue light LEDs are alternated during treatments.

3. DOES LED LIGHT TREATMENT CURE ACNE?

No. It is to reduce and clear the inflammatory acne. The red LED lights reduces the red acne scars
» Acne Treatment with Laser
1. MY DERMATOLOGIST RECOMMENDS LASER TREATMENT FOR MY ACNE. WHY?

There are lasers that can reduce the size of your oil glands making acne less active and the skin less oily. These lasers are applied on the acne spots as well as the whole skin. These lasers also improve your acne scars and also remove the redness of the skin.

2. HOW MANY LASER SESSIONS DO I NEED TO TREAT MY ACNE?

Although lasers are effective in treating acne, you need several sessions to get a good control of your acne. Laser treatments are costly and you should not use this as a first line treatment for acne. Non laser treatments for acne are effective too. Your dermatologist will recommend laser treatments when active acne occurs with acne scars (especially the red acne scars).

3. IS LASER TREATMENT FOR ACNE PAINFUL?

Most laser treatments for acne are not painful. You may feel some warmness or a stinging effect. Usually no anaesthesia is required.

4. WHAT HAPPENS IMMEDIATELY AFTER LASER TREATMENT FOR ACNE?

The skin looks pink but this pinkness goes away within the next few minutes. You can resume your daily activities right after the laser treatment. The improvement in your acne or your acne scars comes in later

5. CAN LASER TREATMENTS FOR ACNE IMPROVE MY DEEP ACNE SCARS?

No. The laser treatments for acne are specifically targeted at the oil glands to improve active acne. The heat generated from the laser will stimulate collagen growth and will improve the superficial acne scars but not the deep scars. Your dermatologist may use the long pulse dye laser, the VBeam Perfecta to clear your acne as well as the red acne scars. If you have deep acne scars fractional lasers like the Fraxel restore laser or the Fraxel Re:pair laser will be better
» Acne scars
1. WHAT CAN BE DONE FOR ACNE SCARS?

There are many types of acne scars. They can be flat brown spots or red marks left after acne heals. These can be removed with creams, chemical peels or lasers. Inflammatory acne will heal with depressions in the skin. If these are shallow scars, creams, chemical peels or lasers can easily flattened and level out the scars. However if they are deep, looking like ice picks, then you will need subcision or scar surgery before applying laser treatments. Your dermatologist will be able to identify the types of acne scars you have and will recommend the best acne scar treatments for you

2. CAN CHEMICAL PEELS HELP ACNE SCARS?

Chemical peels are useful to improve superficial acne scars as well as to lighten the brown spots left behind by acne. Your dermatologist will decide what peeling agents to use and how many sessions you need

3. WHAT IS SUBCISION FOR ACNE SCARS?

Subcision is a minor surgical procedure to release the attachments of deep fixed scars from the skin below and make them movable. Your dermatologist will “slice” the base of these scars. After subcision there will be a bruise at the base of the scar.

4. WHAT IS LASER RESURFACING FOR ACNE SCARS?

Laser resurfacing as the name suggests is a procedure whereby a laser is used to resurface or smooth out deep acne scars. Fractional lasers are the best lasers for improving acne scars. They work by removing tiny columns of old scars while keeping the adjacent skin intact. Thousands of these microscopic laser columns penetrate deep into the scars, to remove old and damaged cells. The adjacent skin between the lasered columns is kept intact – this allows for better healing, faster healing and minimal side-effects – and eventually this too is replaced with new skin. Ask you dermatologist about Fraxel restore and Fraxel re:pair for treating your acne.

5. WHAT ABOUT FILLER INJECTIONS FOR TREATING ACNE SCARS?

Filler injections is a procedure where a filling substance usually hyaluronic acid is injected below the scars to lift them up. This only works for superficial scars and the filler effect lasts for a year. Dr Joyce Lim prefers to treat your acne scars with lasers rather than fillers as the results from laser treatments are more effective and long lasting. There is a role for filler injection – when you want to see results immediately while waiting for the other procedures to work.
» Adult Onset Acne
1. WHY DO SOME ADULTS GET ACNE?

Acne seen in adults arises from two groups. Some adults have acne during their teenage years and these acne persists into adult life, the so-called persistent acne. In another group the adults have clear skin and develop acne when they are in middle age, the late onset acne

2. HOW DIFFERENT IS ADULT ONSET ACNE FROM TEENAGE ACNE?

Adult onset acne usually occurs in women and they are more severe. The acne bumps are usually larger, more painful and deep seated. They tend to form on the lower half of the face, especially around the mouth, the chin and along the jawline. There is no link between adult onset acne and the digestive system, as it often believed.

3. IS THERE A REASON WHY SOME ADULTS GET ACNE?

There are some adults who are genetically prone to get acne and researchers found that 50% of the adults with acne had a first-degree relative (parent, sibling, or child) who had acne as well.

Hormones may play a role too. Some adults have hormonal swings leading to acne. Or women may get acne when they stop taking birth control pills or when they start to take birth control pills that contain only pregestins.

Cosmetics like oily sunblocks and greasy hair treatments may trigger acne in adults. Stress is another factor for acne onset in adults

4. IS ADULT ONSET ACNE ASSOCIATED WITH A MEDICAL PROBLEM?

Other than being more severe, adult onset acne is not related to any medical problems. However if the woman has excessive facial hair, thinning hair or bald patches on the scalp, and irregular periods and the acne is difficult to control, then she should see a dermatologist to exclude an underlying medical problem like polycystic ovaries (a condition that causes cysts to develop in the ovaries) or adrenal hyperplasia (a group of adrenal gland disorders

5. WHAT TREATMENTS ARE AVAILABLE FOR ADULT ONSET ACNE?

Generally the treatment options are similar to that for treating teenage acne except that most women need oral medication to get a better control of their acne.
 
...................................................
290 Orchard Road
#11-16/20, Paragon Medical Suites
Singapore 238859
T : 6834 9159
Email: drjoyce@joycelim.com
 
...................................................
290 Orchard Road
#11-16/20, Paragon Medical Suites
Singapore 238859
T : 6834 9159
Email: drjoyce@joycelim.com