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About Acne & Scars

What Causes Acne and Pimples?

Pimples is the layman’s term for Acne Vulgaris, a medical condition of the skin.  Pimples are caused by a sequence of events and can be simply explained to be due to a few main factors:

1. Skin that is TOO OILY

When a person is going through hormonal changes in their life, such as during puberty, the skin becomes too oily (with a substance called sebum).  This excess oil mixes with the dead skin flakes on the skin to form a sticky paste that blocks the pores.

2. Too much DEAD SKIN FLAKES

Normal skin constantly sheds.  When there is a lot of dead skin flakes around, and there is a lot of oil produced by the skin,  these will become a sticky paste and block the pores of the oil glands.

3. BACTERIA Growth

Our skin has bacteria called Proprionebacterium Acnes, which infects the clogged pores and causes inflammation.  This inflammation can range from small tiny spots called papules, to large, pus filled lumps called nodules.

What Are Blackheads and Whiteheads?

When pores are blocked, the pores can be either open, where a small blackish plug can be seen.  These are called blackheads.  In the other situation, the pores are completely blocked and the plugs are below the surface of the skin.  In this situation, the blockage appears white, and are thus called whiteheads.

What are the Different Grades of Acne?

There is a medical classification of acne, which divides acne up into many different categories.  However for most people, acne can be broadly categorised into 3 categories:

1. Comedonal Acne – Where there are just small whiteheads and blackheads on the face, and occasional red spots.

2. Papular Acne – Where there are small red spots and inflammed pimples (without pus or deep lumps)

3. Nodulo-pustular Acne – Where there are deep lumps which are collections of pus called nodules, and angry red spots which have pus forming on the tops, called pustules.

The differing grades of acne are treated differently and have different after effects in terms of scarring, obviously worst with severe nodulo-pustular acne.

Is Acne just a Skin Condition?

Aside from scarring, its main effects are psychological, such as reduced self esteem and in very extreme cases, depression or suicide.  Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall long-term impact to individuals.  It is important that the entire spectrum of acne and acne related conditions is appreciated and treated by the doctor seeing you.

What Causes Scars?

During the acute inflammatory phase of acne, the skin is damaged by the infection and results in fibrous tissue called scars being formed.  In addition, the inflammation causes new blood vessels to be formed in the skin, making the scars purple.  Also, scars tend to develop more  brown pigment called melanin than the surrounding areas.  This leads to darkening (also called hyperpigmentation) of the scars.

What are the Different Types of Scars?

The different types of scars can be divided into:

1. Pigmented Scars – these are brown in color due to the increased pigment called melanin produced after recovery of the pimple.

2. Vascular Scars – these are purplish in color due to the increased tiny blood vessels called capillaries running through the scar.  This usually happens together with pigmentation.

3. Rolling Scars – these are depressed scars, which look like rolling hills.

4. Box-car Scars – these scars are punched-out and have steep walls.

5. Ice-pick Scars – these have a characteristic appearance of being pricked out by an ice pick.  They are deep and narrow.

6. Hypertrophic Scars – these are raised and bumpy scars that are stable and not growing rapidly.  They tend to be light colored.

7. Keloid Scars – these are raised, bumpy and growing rapidly.  They are usually dark and may have obvious  blood vessels running through them.

How is Acne Treated?

Acne treatment is very customised.  There are a large number of treatments available on the market today.  They range from:

1. Peels

2. Creams

3. Washes

4. Lasers

5. IPL

6. Photodynamic Therapy

7. Antibiotic Pills

8. Oral Retinoids

9. Injections

The treatment of acne is a science which relies on accurate diagnosis of the problem, and instituting the appropriate treatment.  These should only be prescribed by a doctor with appropriate experience in treating the problems.

How are Pimple Scars Treated?

Pimple scars have a variety of treatments.  We will be covering this in more detail soon.  Stay posted!

56 comments on “About Acne & Scars

  1. Hello sir,
    I just have a doubt that I would like to clarify.
    Will certain types of acne treatment have effect on facial hair growth?
    For example, i was told that applying turmeric to skin helps to heal the acne and the acne marks. However i was warned that my facial hair would drop off. I have severe blackmarks on my face and alot of ice pick scars. I am 17 years old btw. Is there a cost effective method that i can adhere to for treating my acne and scarring problem without having it affect my facial hair growth? Please help me sir. i am very demoralised with my current situation now. Thank you.

    • You can do chemical peel treatments for the black marks. I recommend either Mandelic or Glycolic peels for improving the skin without affecting your hair growth. I”m not sure about turmeric though. Ice pick scars are hard to treat, and may need subcision or sublative RF treatment.

  2. Hi, would like to enquire on the charges range for the removal pigmentation (brown spots).
    How long does the process takes and the down time after the treatment?

    • I like to couple laser treatment with topical growth factor serum which is excellent for resolving these. The treatment has no downtime and each treatment only takes me 10 minutes to complete. AFter the treatment your skin may be slightly red for about half an hour on average.

  3. Hey I have bad acne and also rough skin. There is pus w ich is making me have bumps. I also have dark spots because of these this does anyone have any treatments or tip

    P.s. preferably home remedies

    • You may try some home remedies, but bad acne should really be treated by a doctor if the home remedies don’t work. Over the counter you can try benzoyl peroxide, but this has quite a bit of irritation and is useful for mild acne. Try to avoid waiting too long to see a doctor, so that you don’t have too many scars. These are more difficult, painful and expensive to treat than acne itself. May I understand why you prefer home remedies to professional treatment? Acne treatment does not have to be expensive… Maybe my creams are even cheaper than a lot of skin-care counter creams out there…

  4. hi doctor, I am currently 20 years old. have been on Iso before and am now on a dose of antibiotics.

    My skin got really bad in October and the entire skin is clogged with white heads and black heads, especially the sides of my skin. My skin is also red and sensitive. How are your recommended treatments?

    • There are a lot of options for you, but I like to recommend our 3D facial program, which deep cleanses your skin using very fine microjets which are smaller than your pores. These are able to really clear out the blackheads and you can see the difference immediately after one treatment, without pinching or squeezing. I would probably add on some topical treatment, and rebalance the natural free fatty acids on your skin. These treatments can even be used on very sensitive skin, as they are non-irritating.

  5. Hello,

    1.
    I’m in my early 20’s and have had acne since early teenhood. I’ve visited GPs previously and was prescribed oral antibiotics and topical medication. This helped with a bulk of the acne but I still had recurring acne every month, in line with my menstruation cycle.
    – I’d like to find out the expected costs for treatment.

    2.
    Also, I am working in the corporate sector and personal grooming is very important to me. Hence, I need to wear makeup for up to 9-12 hours a day. Some doctors that I had visited absolutely discouraged the use of makeup.
    – I’d like to find out if you are able to work out a plan to incorporate the use of makeup.

    Thank you.

    • Use of make-up is possible, but please choose a good brand which is non-comedogenic. Monthly recurring acne needs to be examined in case you have more sinister conditions like underlying polycystic ovarian syndrome or hormonal imbalances that will lead to this problem. Some doctors would even recommend a course of oral contraceptives to control your acne problem. I can have a look at your skin and recommend a suitable course of treatment that you are comfortable with.

  6. hi im 20 and i have had acne since my teens. i tried Iso when i was 18, for 9months but i had to stop due to NS. my condition improved slightly then, but the acne returned after some time. my face is still very oily now, and i have rolling scars on my cheeks and two 3mm keloid scars on my jaw(which i tried two separate doses of injections on it, but i think there was a relapse). will my face stop becoming oily after a certain age? what kind of treatment can i seek to improve my condition now(regarding scars and oilyness)? will the acne continue to appear during/after treatment? thanks.

    • Hi Jy, Most people stop having oily skin after a while. Unfortunately there are some people who have persistent oily and acne prone skin till later in their life. Since you’re 20, in all likelihood the skin will improve as you mature. We have a range of treatments which can control your oily skin. The acne still appears initially, but after 2-3 months should be completely clear, with an average of 30-40% clearance in the first month. Scars can also be treated depending on the type of scars and the severity. I will customize a treatment plan for you that you can follow to achieve maximum results.

  7. i have pimples since i was 17 till now, 24. nowadays the pimples are worst & i think it is a nodular. please do advice me what to do. And may i know how much per consultation and the treatments.

    • Nodular acne needs to be treated more aggressively, as they have the potential to leave deeper scars. I usually like to start my patients on an antibiotic, or if the acne is bad, on a medicine like oral retinoids. Treat early before more scars form! Consultation is $80 for the first time, medicines are usually between $100-200 for a full set, including wash and creams.

  8. Hi.! For my acne is a bit strange. After my acne has swell down , it will automactically leave a black mark on my face. So how do you have to say for this? And its take a very long time to vanish the black mark.

    • The black mark is called “Post Inflammatory Hyperpigmentation”, or PIH for short. It is a temporary mark, which will subside usually in 6-9 months. To speed it up, I usually use a combination of a Q-switched Nd:YAG laser with Fractional CO2 for fastest results, or just a YAG laser if the patient can’t tolerate downtime (like most Singaporeans). Usually 4-5 treatments are required to achieve optimal results. The best solution to your problem is of course to PREVENT the acne in the first place. This is easily done using doctor-prescribed treatments that are effective against a wide spectrum of acne skin types.

    • Depending on the type of skin, different active ingredients are required. In acne prone skin, I like washes that contain some salicylic acid as I find this excellent for removing comedones that can block pores and cause acne. For eczema and very sensitive skin, it is best to use a skin wash that is soap-free like cetaphil. This preserves the skin’s natural barrier.

  9. hi i am 20 yr old male and having no2 and sometimes no 3 acne, but the main problem is tat i am having rolling scars and a few ice- pick scars. Can you recommend me treatments for it and how much will they roughly cause if i undertake them? thanks

    • Rolling scars are easier to treat. Sessions of fractional CO2 laser or Fractional Radiofrequency can effectively treat them. Ice pick scars are more challenging. You may need subcision first, before embarking on a series of laser or RF treatments. Cost of subcision depends on how much work needs to be done, but is between 200-1000 per session. Fractional CO2 laser is $480 session in a package of 5.

  10. Hi, i’m 24yrs old. Im having acne problem from my back, chest and arms. Pimples too on my face. Some of it leave me a brown scar and whiteheads. And some of my acne just gone by itself. I want to undergo a full treatment face and body. How much does it range? So i can know the budget. Thanks!! 🙂

    • Acne on the body is usually treated in my clinic with antibiotics and creams as a first line, and with Oral Retinoids as a second line treatment. usually these treatments are less than 200 per month.

  11. Hi ,

    I am 30 and I think i come under the category of ice pick scars.
    What treatment would you recommend? How may sessions will it take to achieve a smoother and more even surface skin and how much would it usually cost?

    Thanks!

    • Ice pick scars respond poorly to laser or RF treatments alone. Usually you will need subcision or even scar excision, followed by a series of fractional CO2 and RF treatments.

  12. Hi i am 28 years old And i am having light white Pimple kind of thing on my sholders and back from past 2 years. But now they increased more in number . No pain but when i press hard some little white cream kind comming out …

    Please help me how to reduce that pimples on my sholders (More in number)

    • Acne on the body is usually treated in my clinic with antibiotics and creams as a first line, and with Oral Retinoids as a second line treatment. usually these treatments are less than 200 per month.

  13. Hi .. I used to have smooth face but for the past 3 months ive been having pimples and it’s disturbingly scattered all over my face. How much is your consultation fee and how much is your treatment to remove scars and pigmentations..

    • Consultation is 50-80 and acne treatment ranges from 100-200 a month, scar treatment is about 280 per session for pigmented scars and 480 per session for pitted scars.

  14. I had squeezed all my acne when I was young and now my face is leaving scars like box-car scars. Can these scars still be treated? Thanks

    • Boxcar scars are treatable, usually with Fractional CO2 laser or Fractional Radiofrequency. If they are stretchable, they will not need subcision. If they are not stretchable, they will require subcision to free up the fibrous attachments below the scar. The simple test to do is just stretch the skin. If the scar gets flattened, that means subcision is not needed.

  15. How much you charge for co2 laser acne scars per treatment and radio frequency treatment.what different between both treatment?

    • Radiofrequency is able to treat deeper scars, as the penetration depth is up to 3.5mm. Fractional CO2 laser is only able to treat up to 1.5mm deep, so is only useful for superficial to moderate scarring.

  16. I am 31, and i get acne very often. I feel acne which i have is Nodulo. As per the above information. Generally in summer i see this happening very often. Can you please suggest some remedies.

    • Nodulocystic acne is one of the more serious forms of acne, and can leave deep scars which are very difficult to treat. One of the best treatments for nodulocystic acne in my opinion is Oral Retinoids. It should be administered by a doctor and monitored regularly to ensure that side effects like depression, liver and blood problems and pregnancy problems do not occur as the medicine is safe when carefully monitored but potentially harmful if not.

  17. I have face, chest, n back acne. Most of them are comedonal and some nodule pustular. It has been relapsing since about 1 month ago. I want to get a treatment but i am breastfeeding. Is it safe for me to get a treatment?

    • Many treatments are possible during breasteeding, however, some are less advised than others. For example, most antibiotics are possible, but patient must be aware of increased risk of oral thrush, a fungal infection which can affect both the mum and the baby. Commonly used creams like retinoids are considered safe as the amount found in the bloodstream after application are undetectable, hence there should be minimal secretion in the breast milk. Drugs containing oral retinoids should NOT be used as the manufacturer contraindicates this in breastfeeding.

  18. Hi there… My skin was clear suddenly few months ago it i started hvg the worst outbreak of acne… But
    Since im on a budget,i need to find out like how much will everything cost me so that i can prepare the fees before heading down… Thank you.

    • Ranges from below a hundred to several hundred, depending on the type and severity of acne, and the chosen treatment protocol. Come for a consultation and we will advise you on how best to work out a treatment plan that fits your budget.

  19. Im 23 this year. I’ve been having back acne since i was 18. But, my back acne always itch horribly which leaves me with scars. especially when the weather is hot & humid. Will the antibiotic helps?

    • Hi, antibiotics are just one of the treatments we prescribe to treat back acne. In serious cases, we like to use oral medication, which is a great medication for treating widespread acne. However, the side effects for this medicine are quite widespread and therefore we need to follow you up closely to optimize treatment.

  20. There are constant pimples forming on my forehead. I’ve already clipped up my fringes and tried many products and washes to stop it. I also cut down on various food! I don’t want to take pills, is there any ways to improve the situation??? intakes intakes.

    • Yes… The first line of treatment of acne after standard over-the-counter medications like Oxy-5 and washes, is to use retinoid creams. These are doctor prescribed and many of my patients are successfully treated without taking a single pill. (Like you, they do not wish to take pills).

  21. hi… I’m 20 this year I’ve been having this acne on my back, blackheads and white heads since i’m 17… I wanna have a smooth skin… This is my first time doing this and i’m not very sure… so can i know how many sessions should i go and how much does it cost??

  22. Hi, i’m facing back acne issues for years. i have tried creams prescribed by doctor at NSC. My biggest problem is that the acne goes away and comes back again. Wonder if TCS is able to cure my acne completely and stop the acne from coming back? If possible, what’s the cost that I should be expecting? Thanks.

    • It is possible to completely treat acne. However, we cannot guarantee that it will not relapse. Some form of maintenance treatment may be necessary in scattered cases…

  23. Hi, i m in my late 30’s n my acne n pimples are inactive now but i left with large open pores, i should be under no3- rolling scars. i heard laser is the better way to reduce. Ps advice how many sessions it will take to see result. What is the estimated cost?

    • Depending on the depth of the scars, you could take anywhere from 5-10 sessions of fractional CO2 laser or fractional Radiofrequency treatments. Most patients see an improvement with just one treatment, and skin gets better with each treatment. Depending on how smooth you want your skin to be eventually, the number of treatments will vary. For example gentlemen usually are not so particularly about having very smooth skin, so they will stop once the skin is reasonably smooth. Ladies usually have a higher expectation and therefore like to have more sessions. I’ve noticed that skin improves faster for young, nonsmokers and ladies. Older, smokers and men tend to have slower improvements to their skin.

  24. Hi about the back acne.how many sessions per month does it takes?,i have this back acne for more than 5 years. Never tried any treatment yet. And how much does it usually cost?

    • Back acne responds well to oral antibiotics, or if severe, to Oral Retinoids. Usually results are seen after a month, and complete clearance takes 3-4 months. Depending on the dose, Oral Retinoids are around $100 per month, antibiotics are maybe $30-40 a month.

  25. Hi. About back acne how many time per is the oral treatment for it? I have this back acne for more than 5 years. And btw how much does it cost?

  26. Hi. I am 22 this year and have been having acne on my back for about 1 yr plus. I have seek medication but they did not seems to improve. Is there any solutions to solve my problems?

    • Hi Karen,

      Acne on the back is easily treated, either using creams (sometimes not practical due to the large surface area) or with oral medications which are more convenient to take. IT usually takes 1 – 2 months to clear up by 50%.

  27. Im the type 1 of acne.Do you think,what is the best and fastest solution to treat it?and how much would it cost

    • Mild acne can be treated using just simple products like a good wash, basic creams, and for fastest results a salicylic acid peel. I usually customise the approach for the patient depending on the severity of the acne and the patient’s skin sensitivity.

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