Acne is one of the common skin condition affecting teenage years. Acne tends to resolve in the third decade of life but some can persist until 40 years old. The exact mechanisms of causing Acne are not fully understood. It is thought to be caused by familial tendency, exogenous and endogenous hormones, Propionibacterium acnes (acne bacteria), inflammation, distension and occlusion of hair follicles.

Flares of Acne are triggered by:

  • Polycystic ovarian syndrome
  • Certain medications such as steroids, hormones, anticonvulsants and etc
  • Applications of occlusive comestics
  • High environmental humidity
  • Diet high in dairy products and high glycaemic foods

Acne most commonly affects those areas of the body that have the largest, hormonally-responsive sebaceous glands, including the face, neck, chest, upper back and upper arms. Features include open comedones (blackheads), closed comedones (whiteheads), inflammed papules and pustules. In severe Acne, scarring and postinflammatory hyperpigmentation can occur, which can be greatly distressing for patients.

 Acne can be classified based on severity:

  • Mild Acne: total lesion count <30
  • Moderate Acne: total lesion count 30-125
  • Severe Acne: total lesion count >125

Treatment (my preferred treatment)

For mild Acne:

  • Epiduo gel (to be applied at night and then wash it off the following morning)    OR
  • Retrieve cream (to be applied at night and then wash it off the following morning, not to be used in pregnancy)  OR
  • Topical antibiotic such as Clindatech (not to be used as sole therapy as it can increase resistance of bacteria) 

For moderate Acne:

  • The use of one of above topical treatments  AND
  • Oral antibiotic such as Doxycycline, Minomycin, Erythromycin and etc (Doxycycline and Minomycin can cause photosensitivity of skin and not to be used in pregnancy)   OR
  • Oral contraceptive pill such as Diane35, Yaz and etc (for female as part of contraception)  OR
  • Spironolactone (sometimes used in women but can cause drop in blood pressure and elevated potassium level)

For severe Acne:

  • The use of one of above topical treatments  AND
  • Oral isotretinoin (only dermatologist can prescribe, not to be used in pregnant women or at least one month before women plan to become pregnant, regular blood tests to monitor liver function and cholesterol is required)

Scar due to Acne on the face can be treated with laser treatment. A non-ablative laser generates light beams that selectively target and heat the water chromophore in the skin. This stimulates neocollagenesis, allowing the repair of the atrophic scarring. It has minimal risk of causing infection, redness, swelling, itching and scarring.