The Ul­ti­mate Guide To Get­ting Rid Of Acne

A der­ma­tol­o­gist’s guide to the best treat­ment for every type of acne.

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You’ve prob­a­bly bat­tled zits in some ca­pac­ity through­out your life – whether it’s the odd pe­riod pim­ple, or full-blown cys­tic acne when you were a teenager. But hold your horses if you’ve been deal­ing with each bump the same way. Dous­ing your skin with tea tree oil or sal­i­cylic acid isn’t al­ways the way to go, and the wrong treat­ment can ac­tu­ally ex­ac­er­bate the con­di­tion.

Dr Teo Wan Lin, founder and med­i­cal di­rec­tor of TWL Spe­cial­ist Skin & Laser Cen­tre, de­codes the var­i­ous types of acne here, and how you can treat as well as pre­vent each one ac­cord­ingly.

HOR­MONAL ACNE

What does it look like? Red and bumpy, this tends to clus­ter around the mouth area and jaw­line, and flares oc­cur be­fore the start of your men­strual cy­cle each month. Hor­monal acne can be very se­vere, and may also be associated with ir­reg­u­lar men­strual cy­cles, and ex­cess fa­cial or body hair growth.

What causes it? It may not be sim­ply pim­ples when it oc­curs con­stantly around the jaw­line and mouth. If it’s a case of true hor­monal acne, check if your men­strual cy­cles are reg­u­lar and if you have ob­served ex­ces­sive hair growth on your body. Poly­cys­tic Ovar­ian Syn­drome (PCOS) can cause acne as well, and is ac­tu­ally a dis­or­der of your ovaries, which can lead to in­fer­til­ity if left un­treated.

Hor­monal acne is not caused by makeup, the cli­mate or the new mois­turiser you are us­ing (pro­vided the prod­uct has a non­come­do­genic la­bel on it).

How to treat and pre­vent it? If you have a re­cur­rent flare of more than five to eight pim­ples every month, you should see a der­ma­tol­o­gist who would prob­a­bly pre­scribe oral an­tibi­otics. If there is an ovar­ian prob­lem, your doc­tor will get you started on spe­cific oral con­tra­cep­tive pills to help reg­u­late your men­strual cy­cles as well.

Over-the-counter creams, like ben­zoyl per­ox­ide, will not help or pre­vent hor­monal acne, and may ac­tu­ally worsen the con­di­tion as it tends to ir­ri­tate the sen­si­tive skin around the mouth and cause eczema.

BLACKHEADS

What do these look like? We’re all fa­mil­iar with blackheads. These ap­pear like bits of black dirt stuck in open vis­i­ble “pores” which are ac­tu­ally hair fol­li­cles that also have oil glands (se­ba­ceous glands). What causes them? They are ac­tu­ally a form of acne we call open come­dones that are caused by an over­pro­duc­tion of oil, and tend to clus­ter around ar­eas like the nose. The build-up of ker­atin and oil around the fol­li­cle is ox­i­dised and turns black­ish be­cause the oil it­self is ox­i­dised by air. How to treat and pre­vent them? Open come­dones are best treated with a mix­ture of chem­i­cal peels con­tain­ing sal­i­cylic, lac­tic and gly­colic acids to con­trol the oil pro­duc­tion. Car­bon laser peels also help to shrink oil glands and re­duce the pro­duc­tion of oil.

While noth­ing over the counter can ac­tu­ally to­tally elim­i­nate blackheads, a good cleanser is also im­por­tant. For those with greasy skin, it may help to just wash the ex­cess oil off with a good cleanser. Look for la­bels with “der­ma­tol­o­gist-tested and for­mu­lated” for max­i­mum clin­i­cal ef­fi­cacy.

A good one should leave skin feel­ing clean – not squeaky clean – but still soft and mois­turised. Avoid harsh cleansers that con­tain strong lath­er­ing agents like SLS (sodium lau­reth sul­phate) as these can strip skin of mois­ture.

Pore strips help to phys­i­cally re­move the bits of ker­atin and ox­i­dised oil, but they tend to ac­cu­mu­late again and the prob­lem re­curs.

Prod­ucts with sal­i­cylic acid usu­ally don’t have high enough con­cen­tra­tions to be ac­tu­ally ef­fec­tive. Higher con­cen­tra­tions, on the other hand, can cause ir­ri­ta­tion.

Be­ware of fa­cial blot­ters to re­move oil as well. These can cause skin to feel de­hy­drated, re­sult­ing in your oil glands pro­duc­ing even more oil to com­pen­sate. If you must, use a fra­grance- and- al­co­hol-free baby wipe to take away ex­cess oil in­stead.

CYS­TIC ACNE

What does it look like? Large, an­gry-look­ing bumps that are red and painful. Cys­tic acne can ap­pear any­where on the face, chest or back since these ar­eas all pro­duce oil. These nasty bumps may also se­crete pus. What causes it? Cys­tic acne usu­ally starts off as white­heads (closed come­dones) or blackheads (open come­dones). If bac­te­ria gets trapped in­side the come­dones and is left un­treated, the in­fec­tion goes deeper into the skin, re­sult­ing in in­flamed bumps full of

pus, that are known as cysts. If a cyst bursts, the in­fec­tion can spread, caus­ing more break­outs. What’s more, it is, un­for­tu­nately, ge­netic. If a rel­a­tive had se­vere cys­tic acne, you have a greater chance of get­ting it, too. How to treat and pre­vent it? Cys­tic acne re­quires spe­cial­ist der­ma­to­log­i­cal care as it can leave deep scars and worsen if left un­treated. Also, it usu­ally can­not be pre­vented, so don’t brush it off.

Never pick your pim­ples or squeeze white­heads and blackheads as the bac­te­ria on your fin­gers can cause in­fec­tions. The way to re­move white­heads and blackheads is with pre­scrip­tion creams con­tain­ing tretinoin, or with chem­i­cal peels and mi­cro­der­mabra­sion.

If you suf­fer from cys­tic acne, con­sult a der­ma­tol­o­gist early. You will be given oral med­i­ca­tion to help shrink your oil glands.

PAPULES

What do they look like? These are small and raised red­dish bumps on the skin. What causes them? Like cys­tic acne, they are usu­ally caused by a bac­te­rial in­fec­tion that has been left un­treated, re­sult­ing in in­flam­ma­tion. How to treat and pre­vent them? As with cys­tic acne, you can get pre­scrip­tion creams from your der­ma­tol­o­gist. Again, to min­imise the risk of in­tro­duc­ing bac­te­ria to any area with papules, don’t pick or scratch at your pim­ples, blackheads or white­heads.

PUS­TULES

What do they look like? These are sim­i­lar to papules but are filled with yel­low­ish, liq­uid pus, and tend to have a yel­low­ish tip of dried pus – hence the name “pus­tules”. They usu­ally oc­cur in clus­ters – usu­ally at the tem­ple, along the hair­line or on the back of the neck. What causes them? Pus­tules are caused by sec­ondary skin in­fec­tions of acne bumps, and are known as gram-neg­a­tive fol­li­culi­tis. Hav­ing an ac­tive acne prob­lem in­creases your risk of get­ting gram-neg­a­tive fol­li­culi­tis due to the gram-neg­a­tive bac­te­ria found on skin. How to treat and pre­vent them? We can’t say this enough: Don’t pick your pim­ples as there’s bac­te­ria on your fin­gers which will cause in­fec­tions. Get your acne di­ag­nosed and treated by a der­ma­tol­o­gist with pre­scrip­tion an­tibi­otic creams and oral med­i­ca­tions that tar­get gram-neg­a­tive bac­te­ria. Your un­der­ly­ing acne prob­lem would also be con­sid­ered mod­er­ate to se­vere if you have an episode of gram-neg­a­tive fol­li­culi­tis.

COME­DONES

What do they look like? Open come­dones are blackheads and closed come­dones are white­heads or closed pim­ples that ap­pear as tiny bumps on the skin’s sur­face. The for­mer are fre­quently found on the fore­head and chin, while the lat­ter usu­ally ap­pear around the nose and cheeks. What causes them? Closed come­dones are caused by the un­der­ly­ing ge­netic ten­dency of the skin to be in­flamed and pro­duce these tiny seeds which slowly rise to the sur­face. Some types of makeup or skin­care prod­ucts can also cause acne. When shop­ping for makeup, look for the “non-come­do­genic” la­bel. For skin­care, the prod­ucts should be “der­ma­to­log­i­cally-tested”. How to treat and pre­vent them? Closed come­dones should not be ig­nored be­cause they de­velop into more se­vere forms of acne like papules, cys­tic acne and gram-neg­a­tive fol­li­culi­tis. Never try to prick and ex­tract any­thing from the closed bumps, or let any fa­cial aun­tie do so as this in­tro­duces more bac­te­ria to the area. And do not use scrubs with rough, ex­fo­li­at­ing bits as these only ir­ri­tate the skin – and are ac­tu­ally to­tally in­ef­fec­tive at re­mov­ing white­heads.

Fi­nally, when it comes to skin­care, do not use oil-based mois­turis­ers if you have any form of acne. Opt for emul­sions (oil-in-wa­ter for­mu­las) or hyaluronic acid serums in­stead. Dr Teo pre­scribes these for her pa­tients with acne as no mat­ter how oily one’s skin is, you still need mois­ture!

When it comes to skin­care, do not use oil-based mois­turis­ers if you have any form of acne. Opt for emul­sions (oil-in-wa­ter for­mu­las) or hyaluronic acid serums in­stead.

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