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Skin Treatment

Acne Management

WHAT IS ACNE?

According to World Health Organisation criteria [1], acne is defined as a chronic disease based on its clinical characteristics. It is estimated to affect 9.4% of the global population, making this a prevalent and most common skin disorder.

Acne, or acne vulgaris, is a very common skin disorder that affects more than 85% of teenagers [2] and it typically starts at puberty and slowly resolves in the 20s, although there are some who continue to have acne way into their 40s and 50s.

Acne is a multifactorial skin issue caused by overactive oil glands, hormones, and bacterial infection. When oily secretions under the skin block the tiny opening of hair follicles, it can lead to the development of spots such as blackheads, whiteheads, and cysts on the skin. Acne commonly occurs on the face, neck, back, and chest.

WHAT ARE THE DIFFERENT TYPES of acne?

Depending on the severity of the condition, acne symptoms may vary. Acne can be classified as mild, moderate or severe, and the type of treatment you will require will largely depend on the type of acne you have and where.

comedones

Comedones

Small bumps; do not cause pain or swelling. Two types: Closed comedones, commonly known as whiteheads, and open comedones (blackheads)

Papules

Papules

Raised area of skin; tender & sore; Small red or pinkish in colour

Nodules

Nodules

Severe form of acne; hard, large and painful lesions; buried deep under the skin. Nodular acne can last for weeks or even months

Cystic acne

Cysts

A most severe form of acne; if left untreated, there is a risk of permanent scarring. Large lumps filled with pus (looks similar to boils); cause pain and discomfort. Buried further below than nodules

WHAT CAUSES ACNE?

Acne occurs when oil and dead skin cells clog up the pores. This combination causes swelling, leading to infection and pus. Aside from puberty, genetics, hormonal imbalance and using oil-based skin products are also factors behind its appearance. Acne typically appears on the face, chest, and back.

Factors that influence the development and severity of acne include genetics, androgens (hormones), smoking, excess sweating and stress. Medical conditions such as Cushing's syndrome and polycystic ovary syndrome are known to induce acne eruptions. Lithium, bromides, and iodides can also trigger acne.

Severe acne can leave significant scarring.

WHAT ARE THE DIFFERENT TYPES of acne scars?

Cystic pimples are inflammatory acne which involves more white blood cells rushing to the area, and because there are more enzymes in that area, it leads to more destruction. The skin then tries to desperately heal itself, which results in a scar. There is a major difference between acne marks and scars.

Acne marks are usually pigmentation left after the acne is healed. Acne scars leave an indent on the skin as follows:

Rolling Scar Acne

Rolling scars

Caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance.

Boxcar scars

Boxcar scars

Broad depressions with sharply defined edges.

Ice pick acne scars

Ice-pick scars

Small, deep holes in the surface of the skin that look like the skin has been punctured with a sharp object.

Hypertrophic Scars

Hypertrophic scars

A cutaneous condition characterised by deposits of excessive amounts of collagen, which gives rise to a raised scar, but not to the degree observed with keloids.

ACNE & ITS PSYCHOLOGICAL EFFECTS ON ACNE SUFFERERS

Those who suffer from acne and acne scars may lack self-confidence, experience social withdrawal, and feel insecure, inferior, and depressed. The psychological impact is far worse than the physical.

ACNE TREATMENT: AMARIS B.'s CUSTOMISED APPROACH TO ACNE & ACNE SCARS

During the consultation, Dr Ivan Puah will assess your clinical condition and grade the severity of your acne condition to determine the appropriate treatment for you. It is tailored based on the following:

  • The type of acne
  • Severity of acne
  • Your psychological state (how it affects you)

Acne Treatment Process

Acne treatment is a process, so we often recommend a "staged approach" to treat acne. We dispense treatments or medications only when they are medically necessary. With the stage approach, acne treatment is more affordable for patients. Also, with the stage approach, you will be able to monitor your progress and see the improvement.

Acne treatments may include:

  • Oral medication, such as antibiotics
  • Topical Cream & Gel
  • Doctor's prescribed skincare (for acne)
  • Prescription medication
  • Chemical Peel
  • Curated Facial

Acne Scar Plan

Atrophic acne scars can be treated:

  • Pico Laser (Scar treatment mode)
  • Facial fat grafting


Hypertrophic acne scars will respond well to:

  • Chemical Peel
  • Intralesional triamcinolone injection

Acne Medications

Topical agents are used to treat mild acne. Oral antibiotics are prescribed to treat moderate acne. Severe acne is treated with isotretinoin.

ACNE MANAGEMENT PROGRAM BY DR IVAN PUAH

If you are suffering from acne, you would probably have gone through periods of extremely low self-confidence and feelings of despair. Indeed, acne can affect sufferers physically (acne scars) and psychologically.

At Amaris B. Clinic, we have seen many patients who have spent a lot of money trying a variety of "over-the-counter" acne treatments and skin care with little success. Needless to say, this can be extremely frustrating.

Dr Ivan Puah

Dr Ivan Puah, the Medical Director of Amaris B. Clinic, holds a Graduate Diploma in Family Dermatology from NUS and boasts over 17 years of clinical experience in addressing various dermatological concerns. His proficiency encompasses the treatment of skin laxity, wrinkles, fine lines, hyperpigmentation, acne scarring, and more.

Dr Puah's knowledge and skill are further acknowledged through his appointment as a trainer-to-doctor by Merz Singapore and Allergan Singapore.

Dr Ivan Puah

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acne management FAQS

What is a chemical peel?

A chemical peel involves applying an acid-based formula to the skin to exfoliate layers of the skin. This will reveal fresher, clearer-looking skin beneath the surface.

Chemical peel treatments, also referred to as "superficial exfoliating treatments," harness the power of naturally occurring acids and active ingredients to deeply exfoliate and brighten the skin and are effective in preventing future outbreaks. The amount of skin that is being exfoliated will depend on the type of formula used, the strength, and how long it is left on the skin.

What are the benefits of Chemical Peel in treating acne?

  • Reducing inflammation and oil production and clearing clogged pores
  • Reducing the appearance of open pores
  • Removing dead skin cells
  • Targeting blemishes, acne and pigmentation

What is Pico Laser (Scar Treatment Mode)?

Picolaser is a non-invasive skin laser, that is performed by trained medical doctors to address common skin issues, including pigmented lesions, acne scars, and sunspots.

This skin laser can treat acne scars by creating a "thermal injury" in the targeted area. The injured skin will then trigger the body's natural healing process. It also enhances elastin production in the skin for a brighter and softer complexion.

Picolaser sends ultra-short pulses of energy, without heat, to targeted areas and shatters the problematic pigment, which is then eliminated naturally by the body.

Reference

[1] Zouboulis Cc. Acne As A Chronic Systemic Disease. Clin Dermatol. 2014 May-Jun;32(3):389-96. DOI: 10.1016/j.clindermatol.2013.11.005. Epub 2013 Nov 23. PMID: 24767186.

[2] Ayer, J., & Burrows, N. (2006). Acne: More Than Skin Deep. Postgraduate Medical Journal, 82(970), 500-506. https://doi.org/10.1136/pgmj.2006.045377

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