The Straits Times
Mind Your Body | Health Help | Doc Talk By Dr Jean Ho
Jul 9, 2009
Acne is an age-old enemy.
For some, it passes through like a breeze on a balmy evening, barely perceptible and fading into the night. For others, it sweeps over like a hurricane, leaving carnage and destruction in its wake.
Patient TG was 17 years old when he found himself in a desperate battle with acne. He walked into my consultation room one day, with anxious parents in tow, feigning a cavalier demeanour as boys at this age would. It wasn’t long before I discovered the silent anguish behind this facade.
‘He has been skipping classes for two months, staying at home all the time. We are very worried about him,” said his mother.
Looking at TG, I realised why he had become a recluse. His acne was of the most severe kind.
There were swellings all over his face, neck and upper torso which were red and painful. They were filled with pus and threatened to bleed at the slightest pressure. There was no time for delay. Acne, not controlled and treated properly and quickly, can result in permanent and disfiguring scars.
The emotional suffering that young people with acne go through is multifold: A lowered feeling of self-worth, loss of confidence and even depression.
I counselled the patient and his parents before starting treatment. Initially, TG returned fortnightly for follow-ups. When his condition improved, I saw him on a monthly basis. As his face cleared, his personality began to bloom. It was wonderful seeing the change in him.
Also called pimples or zits, acne affects 90 per cent of adolescents and starts as early as eight to 10 years of age. It begins with little yellowish bumps on the nose, forehead and even chest, progressing to red, painful swellings with pus. Acne begins when the oil glands fire up at puberty. The oil (or sebum), which is supposed to lubricate and protect our skin, wreaks havoc instead.
This happens when too much sebum is produced and is of an inferior quality. The oil on the skin surface causes the dead cells of the outer layers of skin (the horny layer) to become more sticky. They clump together and plug the openings of the oil glands. The oil is trapped within the glands, like a clogged sewer, causing an overgrowth of acne-causing bacteria. The glands swell and eventually burst and acne appears. It sets off a chain reaction.
However, the problem does not stop there. As acne bulldozes its way through the skin, it pulls down the fibrous support of the skin. That is why scarring is so common after acne.
The key to preventing scarring is to treat acne as early as possible.
Acne has been attributed to various factors, such as genetics, hormonal imbalance, stress, diet, lifestyle and cosmetics. It is an inter-play of some or all of these factors.
The treatment for acne starts with the right skin care. Oily skin requires a more robust cleanser to remove excess oil, yet it should be gentle enough not to disrupt the surface pH and the delicate skin barrier. Certain face washes may also be formulated with ingredients which combat acne such as alpha-hydroxy acids, salicylic acid and benzoyl peroxide.
Gentle exfoliation removes the unwanted layer of dead skin which clogs oil glands. I recommend that this be done once a week. The scrub should feel gentle on the skin.
Avoid greasy cosmetics and sunscreens which may block the oil glands, causing more acne. If you must use a concealer or foundation, look for non-comedogenic ones. This means that the products have been proven not to clog oil glands or to cause a breakout.
Blackheads can be cleared regularly with pore strips or gentle extraction. However, the same cannot be said for whiteheads because these are so tightly sealed that they can only be extracted with force. This will most certainly cause a pimple to erupt in its place. Products that target zits are widely available over the counter or at clinics. Some ingredients to look out for include zinc to fend off infection, vitamin C and B5 for skin repair and poly-hydroxyacids which maintain normal skin renewal.
Yet, too often, I see patients who have used the wrong product or the wrong combinations. The result is often a red and sensitive face with no end to acne in sight. Non-prescription remedies can only do so much. If your acne has not significantly improved despite your efforts after one to two months, it is time to see a dermatologist.
One of the most effective and proven drugs for acne is retinoic acid, which is available only on prescription. If the acne is severe, I would suggest a course of oral medication. For those who are not keen on popping pills, chemical peels and light therapy are also effective.
Patients should no longer have to suffer the stigma of acne or acne scars
Dr Jean Ho is a consultant dermatologist with special interests in paediatric dermatology and laser surgery. She practises at Mount Elizabeth Medical Centre.