To treat acne, we must first understand why and how it happens. We all have hair follicles, structures in the skin which house hair. Sometimes, oil produced by the skin, also called sebum, combines with dead skin cells to clog the hair follicle. We also have a type of bacterium called P. acnes on our face most of the time. 

When hair follicles get clogged, acnes feed on the clogged, causing inflammation and infection.

Acne blemishes or lesions may take the form of whiteheads, blackheads, pustules, which are usually called pimples, cysts and nodules.

Whiteheads and blackheads are sebum plugs; if the sebum plug fills up the follicle entirely without air entering it, the sebum plug remains white, hence the term whitehead. If the sebum plug allows air to enter, the sebum reacts with it and turns black, become a blackhead. 

A pimple usually first appears as a red bump, and if pus forms inside, it becomes an acne pustule, which is a full-fledged pimple.

A cyst is basically an overgrown pimple; the infection has travelled deep into the skin, creating a bump which is filled with pus, and which may look red and angry. 

Nodular acne is similar to cystic acne in the sense that it is also formed deep underneath the skin, but nodular acne is usually harder due to its contents hardening over time. Both may be painful to the touch. 

People suffering from cystic acne or nodular acne usually have tried many different acne solutions, to no avail. There are many methods of treating acne as well as many avenues of treatment. Usually, treatments aim to achieve one or more of the following; that is, reduction of sebum, killing the bacteria and reduction of inflammation. 

1. Antibiotics

Antibiotics can be very effective to reduce acne by killing the bacteria causing the infection and inflammation. Used under a doctor’s prescription, they can reduce an outbreak and get the skin back to normal.

It is important to note that antibiotics for acne do come with potential side effects such as giddiness or an upset stomach. Some antibiotics may also cause increased sensitivity to the sun. Repeated use or misuse of antibiotics may cause increased antibiotic resistance. In certain cases, some people do not respond to anti-acne antibiotics. The antibiotics also do not address the main cause of the acne, which is the sebum clog. Antibiotics may take up to six weeks for their full effect and as with all antibiotics, the person taking them must fulfil the whole course.

2. Topical applications

Over the counter products such as creams, lotions and gels for acne containing benzoyl peroxide provides a fast and convenient solution. Benzoyl peroxide is an antiseptic and anti-microbial, helping to reduce the bacteria which causes acne on the skin. It also produces a peeling effect on the skin, shedding dead skin cells, drying up the excess sebum and killing the bacteria underneath. 

The good thing about benzoyl peroxide is that it is able to treat a spot specifically, making it suitable for a person who has the occasional pimple. For more severe or stubborn acne, acne without inflammation, like whiteheads and blackheads, benzoyl peroxide may not be the best solution. Cystic acne may also have deep inflammations that benzoyl peroxide cannot reach.

3. Isotretinoin

Doctors may prescribe isotretinoin for more severe cases of acne, such as acne appearing as nodules and cysts. Isotretinoin targets the production of sebum, reducing the main source of acne. This medication may take a few weeks for optimum effect, and maintenance therapy is recommended to prevent reoccurrence.

However, isotretinoin has several potentially serious side effects. As it reduces sebum, it also dries the skin. People who take isotretinoin may find themselves experiencing dry skin, cracked lips and dry scalp. They may also find themselves with thinning hair or dry hair which is prone to breaking.

It is recommended that breastfeeding mothers and pregnant women with acne do not take isotretinoin as it has been proven to cause birth defects and can pass into breast milk. Although isotretinoin has been proven to be successful in the management of severe and cystic acne, it is usually prescribed with care by doctors in light of the side effects listed above.

4. Extraction

Acne extraction remains very popular as people tend to feel gratified by the immediate exit of the sebum and waste materials. Sebum plugs such as whiteheads and blackheads which have a section that protrudes above the skin may be easier to extract.

Extraction aims to remove the clog around the hair follicle by applying force. Before the acne removal process starts, the patient may undergo exfoliation or steaming in order to open up the pores. When the sebum and other acne waste materials are removed, the inflammation is able to die down. In this case, it is better to head to a doctor for extraction to ensure the sterility of equipment used. A doctor is also able to advise on other concurrent methods of treatment, like for example, antibiotics.

The problem with extraction is that the force applied may force some bacteria and skin debris further into the hair follicle. This may increase the inflammation, and in worse cases, this creates a bigger cavity where more skin and sebum gets collected, leading to a larger acne blemish in the same spot. Sometimes, the extraction of the sebaceous material may also lead to scarring as the skin through which the material passes stretches or break. You may address the immediate problem by popping the pimple, but cause a more permanent one by creating an acne scar. Bear in mind that solutions for acne scarring are inevitably more difficult and costly than an acne treatment.

5. Aesthetic Device

Acne Laser complements topical and oral medication well. It can be done regularly to control excessive oil and frequent breakouts.

On top of everything, most acne patients will benefit from medical-grade exfoliative facial treatment (HydraFacial) to cleanse the skin thoroughly and to clear the infected clogged pores. Cleaning your face at home may not be good enough in moderate to severe acne cases.

The ultimate aim of acne treatment is to keep acne under control as early as possible and to prevent permanent scarring. We know that acne scars are difficult to treat! (See Types of Acne Scarring Treatment)

HydraFacial is available at S Aesthetics Clinic by DTAP