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Acne, Pimples, Acne scars, Acne marks, red marks | Ask Dr Daniel Chang
Acne, acne scars, pimples, whiteheads, blackheads…(Blackheads are open comedones, whiteheads are closed comedones, below is an example.)(courtesy of web-md)https://youtu.be/Dd3mEXe279EWe 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.
So what causes acne?
Well, to put it simply, it’s the blockage of our pores. And if we dont manage it carefully, it leads to acne scarring.
Most acne medications BOUGHT OVER THE COUNTER are drying to the skin. They work by reducing sebum. Benzoyl peroxide works by killing the P Acne bacteria.
The flipside of course is the triggering of skin irritation and inflammation. 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 Aestheic Physician to guide you thru the various treatment regimes.
So the question is- how do we treat acne?
In the latest 2016 guidelines released, the American Academy of Dermatology recommends combination treatment for acne.
The aim of treatment is to reduce acne outbreaks and minimise the dreaded acne scarring.I believe in the combination of good basic cleansing and toning, topicals+/- medication, chemical peels and laser treatment, to obtain optimum results. Acne should be actively managed to reduce the risk of permanent scarring.
The DC approach to ACNE
My approach is to divide and conquer.
Acne can be divided into non inflammatory, inflammatory and acne scars.
Non inflammatory: comedones, blackheads, whiteheads
1) Blackheads – extraction BY A PROFESSIONAL
2) Whiteheads – retinoids ( retacnyl, differin), AHA peels and scrubs to remove the gunk and unclog the pore. Retin A based creams work well on long term acne control, and have anti ageing benefits too.
Inflammatory: Angry, red, bumpy pimples
1) Benzoyl peroxide based treatment, plus minus oral antibiotics
2) Lasers and AHA based medical peels to control the oil, and increase exfoliation.
3) Blue light and antibiotics to kill p.acne bacteria.
Only when active acne is controlled, can we proceed to acne scar treatment.
Dr Daniel Chang’s 3 STEP ACNE Treatment Formula:
1- Laser/ Light/ Peel
2- Topical medication +/- oral
3- Lifestyle changes ( Pls refer to my lifestyle guide)
Treatment: Medical peels + Laser Light + Blue light therapy ( unclog pores, control oil,kill p. acne bacteria)
Dr Daniel Chang’s GOLDEN rules – 3 steps to acne free skin – DAILY SKINCARE REGIMEN:
Cleanse gently, splashing with warm water and pat dry
Apply moisturiser gently. No rubbing.
Dab anti acne cream, gently, no rubbing, with a cotton bud. Key to effective treatment here are ingredients containing retinoid and benzoyl peroxide. But balancing the side effects require time and careful use. Differin cream, clindoxyl and clindamycin are my top choices for this. (Retin A based creams like retacnyl, differin work best with benzoyl peroxide based antibiotic creams like clindoxyl, but these do cause skin irritation, so its important to learn how best to apply them onto your face.)
AVOID Acne triggers – Lifestyle GUIDE
Diet. Studies have shown that dairy products, food rich in GI, and fried oily food are a no no. They tend to provoke a hormonal surge, which is the trigger for acne. Thats probably why acne tends to affect people in developed countries, where the diet is so rich.
Lifestyle. Stress is no good. Thats why breakouts tend to occur after frequent OTs, after a flight (as the cabin air is super-drying to your skin), before an important photo-event etc. Keeping a regular exercise regime and sleeping sufficiently helps!
Contact. Minimise contact with your fingers. Dap, and not wipe, your face with a towel. Apply cosmetics sparingly. Use oil-free, non comedogenic products. And when applying acne treatment like benzoyl peroxide, retinoids, adopt a hands-free approach. All these serve to reduce inflammation. As for how to select the right products for your skin, and how to use them appropriately, please speak to your Aesthetic physician for further information.
Now, let me share with you my TOP skincare tips for acne control.
Cleanse, exfoliate and treat. Gently clean your face 2x a day, using a minimal touch technique. Dont overclean your face. (This is to remove all the old and dead skin that is clogging the pores, but not over irritating your skin.)
Use oil free or ‘non comedogenic’ makeup products. Remember, you use makeup to look more beautiful, not to look worsen your acne.
Never ever squeeze a pimple and minimise touching your face. I know its easier said than done. You risk scarring, darkening and spreading the pimple to other parts of your precious face
Wash your pillowcase, and your pillow on a regular basis. Your pillows otherwise collect all the sebum, makeup and dirt that contribute to pore clogging.
Common pitfalls: Lifestyle mistakes
No moisturiser used OR Mistaking aloe vera gel for moisturiser: – A well moisturised skin will help with sebum control and reduce clogging of pores, which leads to acne. And keep yourself well hydrated. Healthy skin starts from within. Oftentimes, the patients I see having breakouts do not use mositurisers. They may use aloe vera gel (which is NOT a moisturiser). Moisturising helps. The skin takes a month to get used to a new product. 2 months to stabilise. 3 months to gain good control.
Too much makeup. – When you cover your skin with heavy makeup, this becomes a vicious cycle as makeup clogs pores. If u run your fingers over your skin, you may feel mini bumps, common over the cheeks, jawline and forehead.
Habit of picking their pimples, squeezing them. – This is a NO no! Scar and pigmentation risk is high.
Different types of acne scars on the face can undergo different types of laser treatments for optimal results.
Types of acne scars:
these are deep, narrow, pitted scars
broad depressions with sloping edge
broad depressions with with sharply defined edges
flat, thin scars or depressed scars
Atrophic scars: Treatment with combination of fractional lasers, subcision +/- microneedling
Hypertrophic and keloidal scars: Combination of fractional lasers +/-microneedling, with silicone gel and steroid injections
Post inflammatory hyperpigmentation (PIH) (red, brown) in scars: Non ablative lasers like Dual Yellow Laser, QS NDYag, long pulse ND Yag, Pulse dye lasers and Alex lasers work well.
PIH (brown) PIH (red)
ice pick scars box scars atrophic scars rolling scars
(pictures courtesy of dermnetnz)
hypertrophic, keloidal scars
Unfortunately, true acne scars never completely disappear. Treatments can improve their appearance. They can be disguised with make-up. So moral of the story is, do not lack acne scarring happen.
Scars can be treated elegantly with 2 main modalities, RF Microneedles and C02 lasers.
The Fractional CO2 Laser technology is a skin resurfacing treatment that tightens open pores, reduces wrinkles and fine lines, controls sebum production and improves the appearance of acne scars. It involves a laser beam that resurfaces the skin, destroying tissue a millimeter deep in microscopic spots. The “injury” triggers the self-healing mechanism of the skin, stimulating collagen and smoothing wrinkles.
It is effective for skin rejuvenation as it treats various skin problems such as skin laxity, fine lines, wrinkles, age spots, blotches and pigmentation, to unveil beautiful skin safely with minimal discomfort and micro-downtime.
Next, I will do a review of existing treatments.
As mentioned, AHA and BHA work well for acne. They act to kill the P acne bacteria, exfoliate dead skin and control oil.
So my recommendations for chemical peels are the following:
Jessner -> TCA
Moving on, here is an example of the Black Gold Peel Laser, which works on the principle of targeting angry active acne…
This laser peel
Reduces oil gland activity, reduces bacterial inflammation, and promotes exfoliation, hence unclogging your pores to control your acne
It also serves to tighten and improve the appearance of your pores
And improves your skin tone, giving you a soft natural glow.
Common side effects include redness, mild bumps on the skin which are tolerable.
The non-ablative Brightening Laser uses an exclusive and versatile modified aesthetic device that gently corrects a range of skin problems. This unique Brightening Laser emits two shades of light: Yellow and Green, both of which have different functions. The combination of the two colours can penetrate more deeply and can be used together or separately, to help achieve a complexion that looks clearer, brighter, firmer and younger. In addition, the laser promotes re-growth of dull skin and reduces pigmentation and freckles for complete skin rejuvenation. This laser can also fade dark eye circles for a further brightened complexion.
It is effective in stimulating collagen production, the essential protein for giving your skin elasticity, that produces fast results in improving vascular lesions, pigmented lesions, melasma and acne, all in a painless treatment with no downtime.
(here is an example of adult onset acne)As a general rule of thumb I find that this laser, which serves to kill the P acne bacteria, shrink pores, and reduce oil production, is a good treatment to undergo. In addition, I would recommend the following coupled with a good skincare regime to get on top of your acne.Now acne can be classified into mild, moderate and severe. Below is a summary and their corresponding treatment.