Acne vulgaris or Acne is a common skin condition that results in the formation of comedones (black heads/ white heads), papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of the hair follicles and sebaceous glands. Acne vulgaris is caused by the bacteria Cutibacterium Acnes, under the influence of normal circulating dehydroepiandrosterone (DHEA). Acne can present as noninflammatory lesions, inflammatory lesions, or a mixture, developing mostly on the face but also on the back and chest.
As Acne Vulgaris and Fungal Acne may look similar, one may mistake it for Fungal acne which is also known as Pityrosporum folliculitis or Malassezia folliculitis. It is a type of infection that develops in your skin’s hair follicles.
As most people associate Acne outbreak with maturing from a teenager to a young adult, it typically occurs between the ages of 10 and 30 and usually disappears with age. In adolescence, men are affected more frequently than women, while women suffer more frequently from acne in adulthood than men.
That being said, adult onset acne is actually more common than we think.
What are the causes of acne?
Acne is caused by a combination of different factors. Androgens, a type of hormone, causes sebum production to increase.
Dead skin cells and sebum clog the pores of the skin and form blackheads/ whiteheads (comedones). The bacteria (Cutibacterium acne/ propionibacteria) then causes an inflammatory reaction as they colonize the pores.
The body’s immune system gets activated by this reaction, which leads to inflammatory cells migrating towards the affected area and causes further inflammation. Eventually, painful and swollen pimples can form. With a change in hormonal balance, acne often improves in early adulthood but can also last longer or occur at a later age.
Ultimately, genetics also plays a part in acne development, extent and severity. However, acne is not caused by a single gene, but instead by a series of genes that influence the probability of disease.
There are also a number of factors which can trigger acne:
- Mechanical irritation of the affected skin area (e.g. by scratching, pressing the acne lesions as well as wearing tight- fitting clothing
- Certain metabolic diseases
- Nutrition (worsening of acne through consumption of dairy products and sugary foods: Foods with high glycaemic index)
- Climatic conditions (worsening of acne in humid climate)
- Being overweight
- Stress
- Menstrual cycle in women
- Application of cosmetics, hair products, and soaps that irritate or clog the skin
- Certain medications (creams and tablets containing cortisone, lithium, some antiepileptics, etc.)
- Exposure to sunlight can contribute to the worsening of acne
What are the symptoms of acne?
The typical symptoms are blackheads (open comedones), white heads (closed comedones), pimples (ie. Papules / pustules) or nodular/ cystic lesions on the skin. Most often Acne occurs on the face, but other parts of the body such as shoulders and back can be susceptible as well.
The skin around these spots is sometimes inflamed, red and painful. As time goes by, the affected skin may become darker or scarred. Only in extremely rare and severe cases do systemic symptoms such as fever, joint pain, and general fatigue occur.
Since acne often represents a psychological burden for those affected, additional psychological symptoms can occur, such as depression, anxiety, and social isolation.
1. Non-inflammatory: Comedonal acne
Whiteheads (closed comedones): small round lesions containing whitish material (sebum and dead skin cells).
Black heads (open comedones): small round lesions that look like dark spots on the surface
2. Inflammatory: Affected areas are red and can be painful
- A) Mild/moderate acne
- Small, reddish spots and bumps that may be filled with pus
- B) Nodulocystic acne
- More severe form of acne
- Palpable hard lumps and knots of the skin larger than 5 mm
- Cystic lesions containing pus
- Scars may form during healing
Acne grading
The severity of acne can be categorised as mild, moderate or severe.
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Mild acne
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Moderate acne
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Severe acne
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<20 comedones <15 inflammatory lesions Or, total lesion count <30
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20–100 comedones 15–50 inflammatory lesions Or, total lesion count 30–125
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>5 pseudocysts Total comedo count >100 Total inflammatory count >50 Or total lesion count >125
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The inflammatory lesions are compared with a set of standard photographs to determine the grade, which may be 1 (very mild) to 12 (exceptionally severe) for example.
How to treat / cure Acne?
For best results, it is best to seek professional help from an aesthetic doctor or dermatologist.
At M-Aesthetic Clinic, we offer the full range of Acne Treatments in our Singapore clinic. There are 3 major pathways to treat acne and depending on the severity and extent of acne, a combination of different pathways will help to control, reduce and eradicate the breakout.
1. Topicals
Mild acne can be treated with topical medicine in creams, gels, and washes with benzoyl peroxide, retinoids, clindamycin or salicylic acid.
Benzoyl peroxide targets the bacteria that causes acne, controls oil production and reduces comedones.
Clindamycin targets the bacteria component in acne.
Salicylic acid on the other hand works by easing inflammation and unclogging pores.
Retinoids help to control sebum production, dries up acne quickly and targets comedones and blocked pores.
2. Oral Medications
Moderate acne is often treated in combination with oral antibiotics such as doxycycline, minocycline, azithromycin, erythromycin, and tetracycline.
It helps to internally eradicates acne bacteria, reduces inflammation and reduces acne swelling.
Hormonal pills help to balance the hormones in the body. In doing so, it regulates the production of sebum and reduces new acne breakouts.
Isotretinoin capsules treats moderate-severe cystic acne by reducing sebum production, increasing the skin cell turnover rate and treats blocked pores/ comedones.
3. Acne Cortisone Injections
The acne injection procedure helps to shrink and improve the appearance of large inflammatory acne cysts and cystic acne over 24 hours.
This treatment reduces inflammation, flattens swollen cystic acne and speeds up healing and recovery of your acne breakout.
How does the Cortisone Injection work?
A solution of corticosteroid/cortisone is injected directly into the active acne cyst/papule. Cortisone has anti-inflammatory properties and works by reducing the inflammation of the swollen acne cyst/ papule thereby helping to decrease the redness, swelling and pain.
The acne cyst/ papule will shrink and flatten noticeably over the next 24 hours. While some acne cysts may not flatten or disappear completely, most cystic acne and blemishes will resolve within a week of treatment when combined with Acne Laser Treatment.
4. Acne Medications
Apart from the above Acne Treatments, there are medications such as Isotretinoin that help to eradicate active acne. Conditions do vary amongst individuals and an examination would have to be performed first to determine the suitability.
5. Treatments
Acne Laser Treatment
Using a 2-step approach (Gold Laser & Spectra XT Toning Laser), a combination of these two laser treatments can treat Acne and inflamed skin lesions.
- Gold Laser: Destroys acne bacteria and also eradicates acne. It reduces redness and inflamed skin by targeting the abnormal blood vessels and inflammation.
- Spectra XT Toning Laser: Controls sebum production and soothes inflamed skin.
There is no downtime for both of these laser treatments.
Advanced Medical Infusion Treatment & Photolight Therapy
It deep cleanses and helps to exfoliate & remove overlying dead skin and debris, treats Acne, brightens complexion and infuses anti-aging nutrients and anti-oxidants into the deep skin layer
Step 1: Diamond Brightening Microdermabrasion which helps to get rid of dirt on the skin.
Step 2 : Deep Cleansing goes deeper into the skin layers and pores to eliminate dirt and grime
Step 3 : Chemical exfoliation vacuum system extracts white heads, black heads and dead skin over the skin surface to give your skin a deep cleanse
Step 4 : Micro-Infusion of anti-ageing nutrients and anti-oxidant ingredients to the skin. Using Micro-Puncture technology, micro-columns are created into the underlying skin layer and a combination of anti-ageing nutrients and anti-oxidant ingredients are delivered into the skin to repair the skin.
Step 5 : Photo rejuvenation to calm inflammation, targets redness and swelling of acne, treats the skin with quick and powerful light energy of specific wavelengths that penetrates below the skin’s surface.
Step 6: Diamond Mask to calm the skin down.
Conclusion
Although, we can’t avoid acne totally, understanding the causes, symptoms and suitable treatments help to control it and treat it effectively and quickly.
At M-Aesthetic Clinic, Dr Ho Rui Ming believes that every individual is unique and hence a personalised and customised acne treatment plan will be done according to your lifestyle, habits and skin condition.
If you are suffering from an acne outbreak or would like to remove acne scars, get in touch with us today.
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