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Acne is never welcomed. It is pure embarrassment to have spots and an even bigger pain to try to get rid of them.

As the old adage goes, you have to know your enemy to defeat him, so here, our Derm in the house, Dr Teo Wan Lin breaks it down for us and gives us the best professional advice on how best to handle the different kinds of zits.

 

 

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Take this as your free skin consultation. You’re welcome.

 

Blackheads

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What does it look like

These appear like dots of black dirt stuck in open visible ‘pores’ which are actually hair follicles that also have oil glands (sebaceous glands)

 

What causes it?

These are actually a form of acne we call open comedones, caused by an over-production of oil, and tends to cluster around areas like the nose. The buildup 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 it?

Blackheads are best treated with with a mixture of chemical peels, containing salicylic acid, lactic and glycolic acids to control the oil production. In-clinic treatments with carbon laser peels also help to shrink oil glands and reduce production of oil. A good cleanser is important too.

Unfortunately, nothing you can buy from over the counter actually works well. Pore strips help to physically remove the bits of keratin and oxidised oil but it tends to accumulate again and the problem recurs. Off the shelf products which contain salicylic acid usually have too low concentrations to be actually effective and higher concentrations can cause irritation. Beware of facial blotters to remove oil because it can cause the skin to paradoxically feel ‘dehydrated’ and the oil glands to produce even more oil to compensate.

For patients with greasy skin in the day, it may help to just wash the grease off with a good cleanser rather than keep blotting. Either that, or use a fragrance/alcohol-free baby wipe to wipe off the grease before touching up makeup. For cleansers, look for the labels ‘’dermatologist-tested and formulated’’ for maximum clinical efficacy. I advocate the use of cleansers that are medical-grade honey based, as honey is a naturally derived emulsifier, unlike chemical lathering agents, and also possesses antibacterial properties, without stripping away the skin’s natural oils.

 

Cystic acne

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What does it look like?

These are larger painful bumps which are red and can appear anywhere on the face, chest or back which produce oil. It may feel ‘boggy’ and also secrete pus. A less severe form of cystic acne is papules, which are small red bumps caused by inflammation.

 

What causes it?

Cystic acne is caused by inflammation. It starts off as either whiteheads or blackheads (closed or open comedones) which when left untreated gets infected with superficial skin bacteria. Picking on pimples and an excess of a certain skin bacteria also causes cystic acne. Overall, it is determined genetically, so if you have a relative with bad acne, you likely have the genetics that will increase your risks of this type of acne as well.

 

How to treat and prevent it?

Cystic acne is a severe, scarring form of acne which warrants specialist dermatologist care as it can leave terrible scars and get worse if untreated. It usually cannot be prevented, but you can control it to a certain extent. If you have a family history, don’t treat your acne problem lightly. Never pick your pimples or squeeze your whiteheads or blackheads as the bacteria on your fingers will cause infection. The way to remove whiteheads and blackheads is with prescription creams containing tretinoin, and with chemical peels and microdermabrasion.

See a dermatologist early, you definitely need oral medication to treat cystic acne and also may need a stronger form of anti-acne medication known as isotretinoin which helps to shrink your oil glands. Isotretinoin has to be taken under close medical supervision as it can have side effects on one’s liver and cholesterol levels.

If you had cystic acne in the past, you may be struggling with inflammatory scars which can be red, raised or indented. You can improve the appearance of acne scars with cosmeceuticals. I prescribe the Elixir-V Total Recovery Serum  for my acne scar patients to use in conjunction with fractional lasers and chemical peels. The active ingredients are medically proven to lighten scars and aid in wound healing, while powerful antioxidant extracts stimulate collagen formation.  

 

ALSO READ: Are you a culprit of these 5 daily mistakes that cause acne?

 

Pustules

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What does it look like?

These are similar in size to acne papules except they have a yellowish tip at the top with dried pus, hence the term “pustule”. They tend to occur in groups or clusters, common areas would be the temple and hairline.

 

What causes it?

Pustules are caused by secondary skin infection of the acne bumps and is known as gram-negative folliculitis, which is sometimes found together with acne itself. Having an active acne problem increases your chance of getting this severe form of acne.

 

How to treat and prevent it?

Don’t pick your pimples as there’s bacteria on your fingers which will cause infection. Get it diagnosed and treated by a dermatologist with prescription antibiotic creams and oral medications that target the gram-negative bacteria.

 

Whiteheads

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What does it look like?

Whiteheads (closed pimples) are seen as tiny bumps on the skin surface. These tend to occur especially over the forehead and chin, whereas blackheads occur over the nose and cheeks. Hidden pimples those that appear ‘stuck’ under the skin’s surface, are actually whiteheads.

 

What causes it?

The cause of whiteheads is a genetic tendency of the skin to be inflamed and produce these tiny seeds which slowly rise to the skin’s surface. Some types of makeup or skin-care products can actually cause this so always look for the non-comedogenic label  on your makeup, and for skin-care, look for dermatologically tested labels.

 

How to treat and prevent it?

Whiteheads should not be ignored because they develop into more severe forms of acne like papules and cystic acne. Never try to prick and extract the closed bumps or let any facial therapist do that because it will introduce bacteria. I personally treat closed comedones with a specialised machine with a vacuum handpiece (much gentler than microdermabrasion) that gently extracts blackheads and whiteheads without pain or scarring, at the same time infusing a customised blend of fruit-based acids that exfoliate the skin.

Do not use scrubs with rough beady material as these only irritate the skin further besides being totally ineffective at removing whiteheads. In terms of skincare, do not use oil-based moisturisers if you have any form of acne, opt for emulsions (oil in water) or hyaluronic acid serum (water-molecule based skin hydration), which I prescribe for my patients with acne as no matter how oily one’s skin is, you still need moisture.

 

Derm in the House:

Everything you want to know about your skin and skincare regime. We talk to accredited dermatologists to address A-Z topics about skin concerns most women have.

For more stories from this series, click here.

 

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