Acne (adult) in SIngapore

What is Adult Acne?

Adult acne is acne that occurs after adolescence, in adults over the age of 25 in Singapore. Acne, also known medically as acne vulgaris, is a skin condition where your hair follicles become plugged with oil, dirt and dead skin cells, causing whiteheads, blackheads or pimples.
Acne usually happens in teenagers who are going through puberty, but it can happen to older adults as well. It is a distressing condition that many adults face, but can be managed with proper skincare techniques and treatments.

What are the common causes of Adult Acne in Singapore?

Frankly, it’s the same few factors of adolescent acne at play that contribute to adult acne. The four factors directly affecting acne are:

1. Excess oil production
2. Clogged pores
3. Bacteria
4. Inflammation

Some other indirect factors that influence acne are:

• Hormones – these can be affected by the menstrual cycle in women and affect oil production.
• Stress – this affects hormones, immunity, oil production, and inflammation.
• Contact irritation – irritation caused by harsh cleansers or razors can lead to inflammation of the skin
• Personal care products – hair products, thick makeup, use of unclean makeup brushes and sponges can clog up your pores.
• Diet – this is rather controversial but there is sufficient evidence to suggest high glycemic index food and dairy products can cause more acne in some patients.
• Medication – some medications like corticosteroids, anabolic steroids and anti-epileptics may cause acne.
• Underlying diseases – Polycystic ovarian syndrome (PCOS) or endocrine disorders may cause acne.

Inform your doctor if you have any other severe or persistent symptoms along with acne, as they may be signs of an underlying condition that requires medical attention.

What are the common symptoms of Adult Acne in Singapore?

Symptoms of adult acne may include:

• Blackheads – open plugged pores
• Whiteheads – closed plugged pores
• Papules – red bump with no pus
• Small pustules/pimples – inflamed papules with pus
• Redness
• Swelling
• Irritation
• Nodules – big, solid, painful lumps under the skin
• Deep cysts – painful, pus-filled lumps under the skin

What are the risk factors for Adult Acne?

• Greasy or oily substances - When your skin comes into contact with oily or greasy substances like lotions or creams, or if your skin is unwashed after a long day, the oil could accumulate in your skin and cause acne. To get rid of bacteria, grease and dirt that could clog pores, wash your skin with a cleanser daily.
• Genetics - If you have a family history of acne, you are more likely to develop acne problems. Genetics tend to affect your skin type, and the amount of oil naturally secreted by your skin. Despite being a natural protective barrier and waterproof layer, too much oil can spell bad news for your skin.
• Hormones - Hormonal changes during puberty or pregnancy tend to trigger acne. People with acne tend to have lower levels of estrogen and higher levels of other hormones such as testosterone (male hormone that causes production of sebum), insulin (helps with sugar absorption) or glucocorticoid (steroid hormone regulating body’s fluids and temperature). Insulin may also result in the production of more androgens, thereby increasing production of oil by the hair follicles. Hormones may also be affected by other factors like stress and medication.
• Diet - High glycaemic index foods are broken down quickly by the body and cause a spike in blood glucose, thereby raising insulin levels, causing increased inflammation and oil production. Some of these high carbohydrate foods include:
  -- Soft drinks
  -- White bread
  -- Potatoes
  -- Potato chips
  -- French fries
  Besides high-glycaemic carbohydrates, other things like dairy, saturated fats and trans fats are also known to stimulate the production of hormones that cause excess oil to be secreted by oil glands, as well as increased inflammation.

What are the treatments options for Adult Acne in Singapore?

• Topical medications - These are lotions, gels and creams that are applied topically onto the skin. Some of these can be obtained over-the-counter (OTC), while others require a prescription. OTC acne medications can contain the active ingredient salicylic acid or benzoyl peroxide. They help to reduce oil production and inflammation, which helps to treat existing acne and prevent the formation of new ones. In the case where OTC acne products are not strong enough, doctors may give prescription medications. These may contain tretinoin (a vitamin A derivative), a stronger version of benzoyl peroxide, or an antibiotic called clindamycin. They are better able to kill bacteria for those with moderate or severe acne.
• Oral medications - These are systemic treatments since they are absorbed throughout the entire body. They are also only available through a doctor’s prescription and are used to target moderate to severe acne that cannot be treated with topical medications. There are a few types of oral medications available for acne:
  a) Antibiotics
  These are medications used to fight bacteria and infection, such as tetracycline. They are commonly used together with topical medication when topical medication alone is not enough.
  -- Spironolactone
  Can be used in women with deep seated acne or lower jawline and neck acne. Spironolactone slows down the production of androgen hormones such as testosterone. These hormones can produce excessive oil which can lead to acne.
  -- Oral contraceptive pills
  Can be used in women who have acne and require contraception. Choosing the right contraceptive pill can help with the acne as well. However, use of contraceptive pills does increase the risk of blood clots, heart attack and increase in blood pressure. As such, this is not recommended for older women with acne or when contraception is not required.
  b). Isotretinoin
  This is a strong drug belonging to the retinoid family that shrinks oil glands such that they produce less oil. It also helps to regulate normal skin cell turnover such that the cells don’t obstruct the release of bacteria and excess oil from the pores. Isotretinoin is mostly used for people with serious cystic acne. However, your doctor may prescribe such medication if your acne doesn’t improve with other acne drugs. Unfortunately, isotretinoin may have serious side effects and is harmful to foetuses, so be sure to consult your doctor before taking it.
• Medical procedures - If all else fails, there’s also medical procedures for severe acne. They can be done in the doctor’s office, but may be painful or cause some scarring. Below are some procedures that your doctor could recommend.
  -- Drainage and extraction
  Your doctor may manually drain large cysts in your skin, removing the fluids, dirt, pus and dead skin that have accumulated in the cyst. Some steroids may be injected into the cyst to aid healing and reduce the possibility of scarring.
  -- Laser therapy
  There is a variety of light and laser devices for the treatment of acne. These devices are able to target bacteria, improve sebaceous gland activity and reduce inflammation. They are also used to treat acne scars.
  -- Chemical peels and microdermabrasion
  These are non-invasive, exfoliating methods used to help remove the outermost layer of the skin, also called the epidermis. In this process, whiteheads and blackheads can be removed.