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Acne treatment

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.

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, who holds a Graduate Diploma in Family Dermatology, has been treating acne for over 17 years. Treating acne and acne scars is a multifaceted process, and it should be tailored according to your clinical condition.

WHAT IS ACNE?

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.

DIFFERENT TYPES & FORMS OF ACNE

Depending on the severity of the condition, acne symptoms may vary. Acne sufferers may experience one or more of the following:
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Comedones: Small bumps; do not cause pain or swelling. Two types: Closed comedones, commonly known as whiteheads, and open comedones (blackheads)

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

Pustules: Looks like a bigger form of whitehead, but more inflamed and filled with yellowed pus at the centre, surrounded by red skin. Commonly known as pimples.

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

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.

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.

WHAT CAUSES ACNE?

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.

DIFFERENT TYPES & FORMS OF ACNE SCARS

Acne marks are usually pigmentation left after the acne is healed. Acne scars leave an indent on the skin as follows:
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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: Broad depressions with sharply defined edges.

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: 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. Like keloids, they form at the sites of pimples, body piercings, cuts and burns. They often contain nerves and blood vessels.

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 CLINIC'S CUSTOMISED APPROACH TO ACNE & ACNE SCARS

Acne is one of the most prevalent skin issues that affect people of all ages, especially teenagers. At Amaris B. Clinic, we practise personalised medicine, where treatments are proposed and planned for based on your condition because we understand acne is a complex condition and the severity varies.

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

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
• Microdermabrasion skin renewal
• Curated Facial

Atrophic acne scars can be treated:
• Picolaser (Scar treatment mode)
• Facial fat grafting

Hypertrophic acne scars will respond well to:
• Chemical Peel
• Microdermabrasion skin renewal
• Intralesional triamcinolone injection

WHAT TYPE OF MEDICATIONS WILL THE DOCTOR PRESCRIBE?

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

WHAT IS 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.

Benefits of Chemical Peel include:

• 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 MICRODERMABRASION?

Microdermabrasion uses a controlled vacuum suspension of crystals to gently exfoliate the skin. This process can remove 2 to 5 layers of dead skin, aid in lymphatic drainage, and promotes new collagen production. It is an excellent treatment not just to treat congested skin but also for overall skin rejuvenation, such as improving the appearance of sun-damaged skin.

It is non-invasive and is safe and suitable for most skin types as it effectively reduces comedones, balances oily or dry skin, and diminishes fine lines.

WHAT IS PICOLASER (SCAR TREATMENT MODE)?

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

Picolaser 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.

IS ACNE TREATMENT WORTH IT?

Wanting to proceed with acne treatment is a personal decision. If you have tried various methods to clear your skin but are not achieving the result you yearn for, we recommend you come for a consultation and assessment with Dr Ivan Puah to understand how our acne treatment can help you achieve your skin goals.

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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