Acne scarring Guide Singapore 2022 | All about acne

Acne scarring. Acne. Pimples. Blackheads. Whiteheads. Acne marks. Rosacea. Melasma. What do these have in common?

Singapore is getting hotter…The world is getting hotter…We are getting hotter…With global warming comes global acne. In these next few weeks, I will be discussing about DERMATOLOGY’S most common problem, ACNE. One thing is for sure, there is no quickfix,  no one size fits all. Every skin is different. And every ACNE is a pain. ACNE: acne scars, pimples, whiteheads, blackheads… (Blackheads are open comedones, whiteheads are closed comedones)

We have all battled with acne before. Some more than others, some ongoing, some successfully conquered. Our hot humid climate does not help one bit. This, coupled with our natural tendencies for oil glands to go into overdrive has left notable battle scars. How many of us have been bothered by these thru our teens? Who amongst us had struggled, tried numerous over the counter cleansers, toners and cosmetic products but to no avail, or worse still, triggering more outbreaks? This should never be a battle fought alone. This is a battle best fought with the help of your Doctor and his array of treatments.

how-acne-develops

How can I remove acne scars?

What’s the best treatment for acne scars?

Acne scars, how to best treat them?

Can Acne scars be removed?

Here is an acne scar treatment guide.

  1. Home based topicals | Retin A is the gold standard
  2. Soft tissue fillers | Profhilo, Gouri. Sculptra. Rejuran. Nucleofill. Hyperdilute Radiesse |
  3. Steroid injection | For keloids and hypertrophic scars
  4. Laser resurfacing. | Erbium laser. Co2 Laser.
  5. Other energy-based procedures | RF and HIFU to promote neocollagenesis
  6. Skin microneedling | Sylfirm X etc

The collagen produced from the above procedures is semi permanent and serves to fill up your acne scars. However, all collagen will fade with time, in line with natural ageing.

Pitted scars, Box scars, Rolling scars | Acne scars treatment Singapore

Do acne scars go away?

How long does it take for acne scars, acne marks to fade?

If you are concerned about an acne mark, be it a red or brownish mark on your face that you got from a pimple gone wrong, chances are it would eventually fade. However, it may take 6 months or more. If you’re upset about acne marks, talk to your doctor, who may be able to advice you on some treatment options.

Do acne scars go away naturally?

Acne scars NEVER fade completely on its own. Depressed acne scars often become more obvious with age as skin loses collagen and elastin. Thankfully there are treatments to address this concern. Acne marks, like Post-inflammatory hyperpigmentation or redness may lighten on its own but this would take several months.

How to best treat acne marks?

  1. Retin A
  2. Whitening cream for brown spots
  3. Laser and medical peel

So what causes acne?

Well, to put it simply, ACNE is the blockage of our pores. And if we dont manage it carefully, it leads to acne scarring.  Pimples. Blackheads. Whiteheads. Acne marks all these fall under the umbrella of acne. Acne Marks refers to the pigmentation after acne heals, it can be brown or red.

What are common acne medications?

Most acne medications BOUGHT OVER THE COUNTER are drying to the skin. They work by reducing sebum. The retinoids are well known for this. There are super effective for comedones. Examples include differin and retin A.

Benzoyl peroxide works by killing the P Acne bacteria and are super effective for angry red pimples.

The flipside of these topicals is the triggering of skin irritation and inflammationSome have tried tea tree oil, but with mixed results. In my clinical experience, its best to stick to medical grade topical creams under the supervision of your doctor for ideal results.

differin for acne

What is the goal of acne treatment?

Never attempt to wage this battle alone. Acne is not rocket science, but there is a complex range of conditions. If over the counter medications do not work after 2 weeks, it is time to enlist the help of your friendly dermie to guide you thru the various treatment regimens. Remember, start low and go slow. =) 

The ultimate goal is clean and clear skin. The process is a journey. A journey with your doctor as your support partner, guiding you thru a careful tailored myriad of skincare, lasers, medical peels and oral medication. 

acne, pimples, breakouts, zits
Acne

How do we treat acne?

  1. skincare – topical creams +/- oral antibiotics
  2. medical peels – mandelic, salicylic peels
  3. specials – nano second laser (Gold Photothermal Laser treatment) and Sylfirm x
carbon Laser treatment
acne scarring singapore

What is acne scarring?

The term “scarring” refers to a fibrous process in which new collagen is laid down to heal a full-thickness injury. It affects 30% of those with moderate or severe acne vulgaris. It is particularly common in nodulocystic acne, acne conglobata and acne fulminans. It may also be a long-term consequence of infantile acne.

What are the types of acne scars?

Most acne scars are atrophic or depressed – namely ice pick or pitted scars , box scars and rolling scars. The treatment would depend on the type of scars we are treating and patient factors.

Effectiveness of treatments for acne scarring

TREATMENT TYPEICE PICK SCARSROLLING SCARSBOX PICK SCARS
Ablative fractionated resurfacing+++++
Non-ablative fractionated Resurfacing ++++
Needling++++
TCA/CROSS++ ++
Fillers++
Subcision++
Excision   
Punch Excision+++++
Acne scar treatment options

courtesy of :

Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017 Sep;10(9):12-23. Epub 2017 Sep 1. PMID: 29344322; PMCID: PMC5749614.

– no role/evidence; + fair; ++ good; +++ great efficacy

TCA/CROSS: trichloroacetic acid/chemical reconstruction of skin scars

How do we treat acne scarring?

1. Fractional lasers

2. TCA cross

3. Injectibles skinboosters, Rejuran, Gouri, Sculptra, profhilo + subcision

What about keloidal and hypertrophic scars?

Combination helps.

1. Shincort to flatten the scar

2. Pulse dye laser to reduce the redness

3. RF microneedles- example is sylfirm x break down scar tissue, remodel collagen and disrupt the blood supply to the scar.


Moving on, we will touch on Sylfirm X, and its role in rosacea, melasma and acne scarring.

What is rosacea?

Rosacea is a common skin condition marked by facial redness and visible blood vessels. It causes your face cheeks nose to feel warm burning and swollen. There is no 1 size fits all treatment, and depending on your rosacea severity and extent, involves

1. Topical cream – brimonidine

2. Oral antibiotics – anti inflammatory

3. Treatment – sylfirm X rf micro needling

What is melasma?

Melasma is a common skin problem. The condition causes dark, discolored patches on your skin. It’s also called chloasma, or the “mask of pregnancy,” when it occurs in pregnant women. The condition is much more common in women than men, though men can get it too.

MELASMA TREATMENT

What is Sylfirm x?

Sylfirm X is the latest innovation in RP (repeated ultra-short pulse) microneedling technology that reacts to ONLY abnormal blood vessels and tissue to selectively treat increased pigmentation and vascular lesions—it is the only RF microneedling device approved to safely treat neovascularities including hard-to-treat conditions like rosacea and melasma.

This latest generation system is clinically proven to safely and effectively address a number of issues, including wrinkles, redness, acne scars, minimizing pores, and improving the overall look and tone of the skin.

sylfirm X the ultimate

What are sylfirm x reviews?

Realself rates this RF microneedling treatment as worth it. The key is finding a provider who is skilled in performing this treatment.

What are the benefits of sylfirm x?

  • Melasma
  • PIH
  • Redness
  • Acne
  • Acne Scars
  • Keloids and hypertrophied scar
  • Wrinkles
  • Stretch Marks
  • Rosacea

What is sylfirm X price of treatment in Singapore?

Prices start from 699-800 per session.

How many sessions do i need?

Generally, once a month treatment for 6 sessions would be ideal for acne scars and pores.

For Melasma, maintainence is necessary so a subsequent treatment every 2-3 months would be beneficial.

Sylfirm X treatment Singapore

Post care instructions from Sylfirm X

Sylfirm X | Post Care Instructions | Dr Daniel Chang

  1. Immediately after treatment, your face may feel slightly stinging like a “sun-burnt” effect.  It may look pinkish red and feel tight.
  2. This redness and stinging sensation can last 24 – 48 hours.  During this period, wash your face gently with plain water or gentle soaps.
  3. Cooling | A face mask in the fridge helps this aspect.
  4. Hydrating | A moisturiser works well.
  5. Recovery | Key is sunblock +/- skin repair creams.
  6. Depending on the laser energy levels used, your face may look bronze (golden brownish) after 2 days.  You might see tiny brown “pixels”, which can look like a brown net over your face.
  7. This signifies the start of the recovery period.  You are allowed to apply makeup to camouflage the bronze look.
  8. You may experience dry skin flaking off (pixels dropping off) which usually resolves completely in 5 – 7 days.
  9. It is highly advisable to avoid prolonged exposure to the sun for 2 weeks.
  10. Apply sunblock regularly.  This is usually applied last, just under your makeup.
  11. Your doctor might add other creams or oral antibiotics to the above regime, depending on your skin type.
  12. Do not apply any acidic, harsh or biting products like Retinoids, AHA & BHA (e.g. glycolic, salicylic acid) lotions or strong acne creams (e.g. benzoyl peroxide) on your face for 10 days after.

So I hope this segment on acne scars has been helpful. Have a blessed week ahead. Stay safe and take care!

Dr Daniel Chang
Dr Daniel Chang




REFERENCES

1. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45:109–117. [PubMed] [Google Scholar]

2. Kang S, Cho S, Chung JH, et al. Inflammation and extracellular matrix degradation mediated by activated transcription factors nuclear factor-kappaB and activator protein-1 in inflammatory acne lesions in vivo. Am J Pathol. 2005;166:1691–1699. [PMC free article] [PubMed] [Google Scholar]

3. Layton AM. Optimal management of acne to prevent scarring and psychological sequelae. Am J Clin Dermotol. 2001;2:135–141. [PubMed] [Google Scholar]

4. Kircik LH. Re-evaluating treatment targets in acne vulgaris: adapting to a new understanding of pathophysiology. J Drugs Dermatol. 2014;13:s57–60. [PubMed] [Google Scholar]

5. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3:20–31. Jul. [PMC free article] [PubMed] [Google Scholar]

Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017 Sep;10(9):12-23. Epub 2017 Sep 1. PMID: 29344322; PMCID: PMC5749614.


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