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How do I treat and prevent adult acne if I have oily, combination skin? (photo)

Acne & Scars Skin, Hair & Nails

I'm a 39 year old female with oily combination sensitive skin. Recently been having red and painful pimples on and off. It takes a long time to heal, and usually leaves a scar. I have tried using antibiotic cream like T3 Mycin, but it doesnt help anymore. What kind of treatment will you recommend for treating adult acne, and preventing recurrence?

How do I treat and prevent adult acne if I have oily, combination skin? (photo)
DOCTOR’S ANSWER (3)

Acne is due to any of the following four processes, either occurring singly or in combination.

1. Increased/Excessive oil(sebum) production

2. Hyperkeratinization or increased buildup of dead cells and debris in the hair follicles

3. Increased colonization of P. Acnes bacteria on the skin/hair follicles

4. Increased sensitivity of the sebaceous(oil) glands to hormones like androgens

Hence, any factor that can lead to the above can cause acne. In adults, the usual surge in progesterone during the pre-menstrual period and the high levels of androgens in female conditions like Polycystic Ovarian Syndrome can all cause acne. Similarly, stress resulting in elevated levels of stress hormones can increase the activity of sebaceous glands and cause acne.

Genetic disposition plays a part too and we are all born with different skin types. People with oily and combination skin types like in your case, are predisposed to getting acne. Using the wrong products for our skintype can also cause irritation to the skin and result in increased sebum production and buildup of debris in the hair follicles, resulting in acne.

Diet plays an important role as well. Lifestyle and diet modifications including avoidance of dairy products and high glycaemic index(sugary) foods have been shown to improve acne.

 Treatment and prevention of adult acne include:

I. A good skincare regime that’s suitable for the individual skin type

II. Pharmacological therapies: Topical and oral medications

III. Non-pharmacological therapies: Lifestyle and diet modifications

IV. Procedures: Intralesional steroid/antibiotic injection for inflamed large acne lesions, manual extraction of comedomes,and laser therapy.

Treatment and prevention of acne is a journey and long process and you will need to be patient to see improvement. More importantly, you should get a proper assessment by a good doctor who will look into the possible causes of your acne and come up with an individualised therapy plan for you.

908 views 8 Nov 2018

Sorry to hear that you are still suffering from acne. At your age, you are suffering from this condition known as adult onset acne.

Contrary to conventional belief, acne is not a problem faced only during teenage years. Increasing we see adults coming to seek treatments for their acne issues. Adult onset acne tends to afflict females much more than males. And in my practice, I see women between the ages of 30s to 50s coming to see me for acne breakouts. 

 Adult onset acne has a very strong hormonal basis, from my experience, its main characteristics are as follows: 

1. Afflict more women than men 

2. Acne lesions tend to congregate at the U-zone of the face (Chin, skin above the upper lips, corners of the nose, even jawline) 

3. Highly associated with menstrual cycles 

4. Not as straightforward to treat as teenage acne 

You stated that you are using T3 Mycin. This is an antibiotic gel, with the main medication being clindamycin. It usually has good effect but with larger cystic lesions, it should not be used alone. I would advise you to stop that medication. In fact, in my practice, for even mild to moderate acne, I do not recommend topical antibiotics as a monotherapy (sole treatment method). Antibiotic resistance quickly build up in such situations. 

The short answer is that there is no known cure for acne. But I still actively treat it because I want to prevent acne scarring in patients. With the right management, we can reduce the intensity and even the frequency of breakouts.

In my practice, modalities I tend to use to treat adult onset acne include but not limited to:

1. Oral isotretinoin (with monitoring) 

2. Oral antibiotics if required 

3. Medical extractions of cystic acne lesions 

4. Acne Clear Facial (combination of active ingredients to encourage unclogging of sebum plugs and gentle exfoliation, including Blue Light PDT to kill off P.acnes Bacteria) 

5. Topical medications and selected home-use skincare 

Hope that helps. 

Thank you!  

 Regards 

 Dr Heng 

1033 views 7 Nov 2018

Adult acne is truly annoying and can be a challenging condition to treat, especially if you have combination or sensitive skin.

The appearance of acne during adulthood can be surprising, especially if you did not have acne in your younger days. 

Skin conditions caused by overproduction of oil are usually associated with puberty, but doctors are finding that it is becoming increasingly common in adult women. 

It was reported that an estimate 40% of women struggle with adult acne at one point in their lives. 

What are the causes of Adult Acne?

There are various factors that contribute to adult acne, but whether it erupts in your teens or in your adult years, the definition is the same. 

An acne is a localized inflammation resulting from the over activity of oil glands. Changes in hormones often affect oil glands, such as the end of a menstrual cycle, the onset of menopause, or discontinuing the intake of birth control pills.

An increase in stress levels can also cause breakouts because stress causes an increase in the cortisol hormone. The hormone androgen, a male hormone found both in men and women, can worsen acne because it stimulate oil glands and enhances pore blockage.

Some experience adult acne as a result of genetic disposition while others experience it as a side effect of medications.

What are the types of acne?

Types of Acne

Oil, dead skin cells, or bacteria can clog pores. 

If the comedones are open, it is called a blackhead. 

If it is closed, they are known as whiteheads. 

Papules and pustules are the term for red bumps that are caused by inflammation in the hair follicles while nodules are the painful red bumps caused by the build up of oil secretions deep within hair follicles. 

Acne filled with pus is known as a cyst and it usually can cause scarring.

How do I treat adult acne?

The good news is Adult Acne is treatable. There is a wide array of acne treatments in Singapore, including doctor-prescribed topical medications that can address the issue and oral medications for severe cases. 

There are several other medications that will help your acne apart from topical antibiotics that you have already tried.

Topical medications include retinoids while oral medications include antibiotics, isotretinoin and anti-androgens such as contraceptive pills.

Other patients who prefer more natural routes try applying manuka honey, tea tree oil, and fruit acids as a gentler alternative.

More permanent treatments include Agnes selective sebaceous gland treatment which destroys selected oil glands that repeatedly cause acne. 

How do I prevent adult acne?

Non-comedogenic skin care is also a key part of preventing new Adult acne. It is best to get advise from your aesthetic doctor/dermatologist on the most suitable skin care for your sensitive skin.

HydraFacial MD is a medical treatment facial that helps to deep cleanse and hydrate your skin to prevent new acne outbreaks. It is suitable for sensitive and combination skin types.

How do I find the best doctor for Adult Acne treatment in Singapore?

1.Experience with Acne and Acne scarring treatment

- Find a doctor who is passionate about acne treatment and is thorough in his consultation.

- Acne can be caused by many factors and it is important that your doctor takes a detailed history and examination to find the best treatment/s that are suitable for your oily/sensitive skin type. 

2. Cost-Effective

Given that acne treatments are likely to take months and multiple medications/treatments for good recovery, seeking cost effective medical solutions is definitely a must.

Hope this helps!

Warmest regards,

Dr Justin Boey 

1078 views 7 Nov 2018
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