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
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.
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 for Acne
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.
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
Chemical Peels for Acne
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.
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
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.
Dr Wan Chee Kwang
FOUNDER / MEDICAL DIRECTOR
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.