Acne

what causes it?

Acne vulgaris affects most people at some point in their lives. It is a chronic inflammation of the pilosebaceous unit, which involves the following factors:

  • Excess activity of a type of hormone (androgens)
  • Excess oil production
  • Hair follicles clogged by oil and dead skin cells
  • Propionibacterium acnes bacteria
  • Excessive inflammatory response

External factors may trigger or aggravate acne:

  • Hormones: Pregnancy or certain conditions such as polycystic ovarian syndrome
  • Certain medications: corticosteroids, certain oral contraceptives, androgens or lithium
  • Diet: skim milk and carbohydrate-rich foods. Evidence on chocolate is inconclusive
  • Stress
acne-formation

Evidence-Based Treatments

to treat acne and acne scars safely and effectively

49485381_6132914508574_6298298896514809856_n
49604095_6132913358374_1911431201734787072_n

Fractional Energy Devices

Fractional Energy Devices treat active acne together with concomitant post inflammatory erythema and depressed scarring. The choice of which device to use would for the acne scar treatment depends on the depth of the scarring present and patient factors.

  • Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue. Fractional Erbium Glass laser produces sustained improvement in active acne in more than 70% of patients even after 1 year follow up
  • Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of lasers.
  • Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.
  • Fractional Microneedle Radiofrequency uses insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety. Fractional Microneedle Radiofrequency has shown more than 70% reduction in acne after 3 treatments.

Discovery Pico Plus Carbon Laser Peel

Using a carbon photo-enhancer that penetrates into pores, Carbon Laser Peel targets active acne and coarse pores, as well as producing a controlled peel to improve the skin’s radiance and promote a smooth glowing complexion.

Unlike most carbon laser peel using nanosecond lasers, we use the high power picosecond laser, Discovery Pico Plus, to produce more photoacoustic effects. Unlike most picosecond lasers, Discovery Pico Plus has a photothermal mode as well which, together with the carbon photo-enhancer, kills acne bacteria and stimulates collagen renewal.

49663543_6132983281974_5531009440125288448_n
agnes

Selective sebaceous gland electrothermolysis (e.g. AGNES)

A special insulated radio frequency probe is used to apply radiofrequency energy to the sebaceous glands causing recurrent acne. Mean reduction of more than 80% after 3 sessions were observed in studies.

Vascular lasers

Vascular lasers (such as pulsed dye lasers, yellow lasers, long pulsed diode or NdYAG) target haemoglobin in blood vessels destroying them. They are useful for inflammatory acne but don’t help with depressed scarring.

1
14290664_6068485515174_508964888_n

Hydradermabrasion

Hydradermabrasion incorporates the simultaneous medicinal serum infusion (such as chemical peels, antioxidants, etc), crystal-free exfoliation and vacuum extraction. The vacuum extraction unblocks the pores, the serum infusion treats the acne, while the exfoliation stimulates skin renewal.

Intense Pulsed Light and Photodynamic therapy

Intense Pulsed Light (with special acne and vascular filters) and blue/red phototherapy kill acne bacteria and generate an anti-inflammatory effect

49585421_6132913830374_4109854390225993728_n
spa-facial-Small

Chemical Peels

Chemical peels target most of the pathophysiological factors involved in acne vulgaris. They:

  • exfoliate dead skin cells
  • induce keratolysis and have comedolytic effects
  • decrease sebum production and pore size
  • have anti-inflammatory and anti-bacterial properties
  • promote the penetration and absorption of other topical therapies by reducing the barrier effect of the stratum corneum

Intralesional steroid injections

Corticosteroid injections work rapidly for acne cysts, with quick relief sometimes within 24 hours. However, they do not control acne and should only be used on an ad-hoc basis.

acne
4847-female_applying_face_cream-1200x628-FACEBOOK
acne-medication

Medications

Topical medications (creams, gels, etc)

  • Antimicrobials treat active acne by killing acne bacteria: 
  • Retinoids (vitamin A derivatives) control acne by reducing pore blockage and comedone formation

Oral medications

  • Antibiotics kill acne bacteria and reduce inflammation
  • Oral contraceptives reduce hormonal stimulus of the sebaceous glands
  • Anti-androgens reduce the effect of androgens on the sebaceous glands
  • Oral retinoids address all four pathogenic factors involved in the development of acne: follicular hyperkeratinization, inflammation, sebum production and Propionibacterium acnes growth

1Aesthetics's View

dr wan's perspective

 

 

Acne is a complex and multifaceted process that starts from blockage of the pores but is influenced by the individual response to inflammation and bacterial infection.

Dr Wan believes that an aggressive multipronged approach combining treatments, medications and lifestyle changes should be utilized to quickly achieve tight acne control to prevent permanent scarring. All factors contributing to the pathogenesis of acne should be simultaneously addressed for complete suppression of the acne process.

An overly conservative approach restricting usage of effective treatments and medications for acne may result in irreversible scarring, hence Dr Wan first achieves tight control before gradually de-escalating therapy.

Grade-I-mild-acne-showing-comedones-with-few-inflammatory-papules-and-pustules

Mild acne

  • Hydradermabrasion, carbon peel, chemical peels, photodynamic therapy
  • Topical medications and skin care
  • More stubborn cases may require fractional energy devices such as fractional radiofrequency, or oral medications
  • Body acne usually requires oral medications

Moderate to severe acne

  • Hydradermabrasion, carbon peel, chemical peels, photodynamic therapy
  • Skin care, topical and oral medications with a low threshold for low dose oral retinoids
  • Fractional energy devices
    • Fractional radiofrequency if there is little or no scarring
    • Fractional laser if there is shallow scarring
    • Fractional microneedle radiofrequency if there is deeper scarring
  • Selective sebaceous gland electrothermolysis can be used for acne consistently re-occurring in the same areas.
Moderate-Acne

Let Us Help

With your most pressing concerns

Address:1Aesthetics, Medical & Surgery#14-90 The Central Tower 18 Eu Tong Sen StreetSingapore 059818 Mon-Sat 11 AM to 8 PM Phone / WhatsApp:+65 66125173 Email:info@1aesthetics.com 

WordPress Theme built by Shufflehound.
All Rights Reserved.