A Dermatologist’s Guide to the Best Treatment for Every Type of Acne

by Dawn Chen
LIFESTYLE  |  April 19, 2017
  • Don’t just apply tea tree oil to every blackhead or bump you see.
    1 / 7 Don’t just apply tea tree oil to every blackhead or bump you see.

    You’ve probably battled zits in some capacity throughout your life – whether it’s the odd period pimple, or full-blown cystic acne when you were a teenager. But hold your horses if you’ve been dealing with each bump the same way. Dousing your skin with tea tree oil or salicylic acid isn’t the way to go, and the wrong treatment can actually exacerbate the condition.

    Dr Teo Wan Lin (@drteowanlin), founder and medical director of TWL Specialist Skin & Laser Centre, decodes the various types of acne below, and how you can treat and prevent each one accordingly.

    (Also Read: This Easy Skin Detox Rids Acne And Gives You A Glowing Complexion)

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  • Hormonal acne
    2 / 7 Hormonal acne

    What does it look like?

    Red and bumpy, these tend to cluster around the mouth area and jawline, and flares occur before the start of your menstrual cycle each month. Hormonal acne can be very severe, and may also be associated with irregular menstrual cycles, and excess facial or body hair growth in females.

    What causes it? 

    It may not be simply pimples when it occurs constantly around the jawline and mouth. Hormonal acne is also not caused by makeup, the climate or the new moisturiser you are using (provided the product has a non-comedogenic label on it). 

    If it’s a case of true hormonal acne, check if your menstrual cycles are regular and if you have observed excessive hair growth over your body. Polycystic Ovarian Disease (known as PCOS) can cause acne as well, and is actually a disorder of your ovaries which can lead to infertility if left untreated.

    How to treat and prevent it?

    If you have a recurrent flare of more than five to eight pimples every month, you should see a dermatologist who would probably prescribe you oral antibiotics. If there is an ovarian problem, your doctor will get you started on specific oral contraceptive pills to help regulate your menstrual cycles as well. 

    Over the counter creams like benozyl peroxide will not help or prevent hormonal acne and may actually worsen the condition as it tends to irritate the sensitive skin around the mouth and cause eczema.

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  • Blackheads
    3 / 7 Blackheads

    What does it look like?

    We’re all familiar with blackheads. These appear like bits of black dirt stuck in open visible ‘pores’ which are actually hair follicles that also have oil glands (sebaceous glands).

    What causes it? 

    These are actually a form of acne we call open comedones, caused by an overproduction of oil, and tends to cluster around areas like the nose. The build-up of keratin and oil around the follicle is oxidised and turns blackish because the oil itself is oxidised by air.

    How to treat and prevent it? 

    Open comedones are best treated with a mixture of chemical peels, containing salicylic, lactic and gylcolic acids to control the oil production. Carbon laser peels also help to shrink oil glands and reduce production of oil. 

    A good cleanser is also important. Nothing over the counter actually can totally eliminate blackheads. Pore strips help to physically remove the bits of keratin and oxidised oil but they tend to accumulate again and the problem recurs. 

    Products which contain salicylic acid usually have too low concentrations to be actually effective and higher concentrations can cause irritation. Beware of facial blotters to remove oil as well, since they can cause skin to feel ‘dehydrated’, causing your oil glands to produce even more oil to compensate. If you must, use a fragrance- and- alcohol-free baby wipe to take away excess oil instead. 

    For those with greasy skin, it may help to just wash the excess oil off with a good cleanser rather than with blotters. For cleansers, look for the labels ‘dermatologist-tested and formulated’ for maximum clinical efficacy. A good cleanser should leave skin feeling clean – not squeaky clean – but still soft and moisturised. Avoid harsh cleansers that contain strong lathering agents like SLS (Sodium Laureth Sulphate) as these can strip skin of moisture. 

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  • Cystic acne
    4 / 7 Cystic acne

    What does it look like?

    These are large, angry-looking bumps that are red and painful. Cystic acne can appear anywhere on the face, chest or back since these areas all produce oil. These nasty bumps may also secrete pus. 

    What causes it?

    Cystic acne is caused by inflammation. It may start off as a whitehead (closed comedone) or blackhead (open comedone) which gets infected with superficial skin bacteria if left untreated. Picking on pimples which leads to an excess growth of a certain skin bacteria (propionibacterium) can also cause cystic acne. 

    Overall though, cystic acne is unfortunately genetic. If you have a relative with bad acne, you’re likelier to have it as well. 

    How to treat and prevent it?

    Cystic acne is a severe form of acne that needs specialist dermatological care as it can leave deep scars and worsen if left untreated. It usually cannot be prevented, so don’t brush it off.

    Never pick your pimples or squeeze whiteheads and blackheads as the bacteria on your fingers can cause infections. The way to remove whiteheads and blackheads is with prescription creams containing tretinoin, and with chemical peels and microdermabrasion. 

    If you suffer from cystic acne, consult a dermatologist early. You will be given oral medication to help shrink your oil glands. 

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  • Papules
    5 / 7 Papules

    What does it look like?

    These are small, red bumps that are also caused by inflammation, but are less severe compared to cystic acne. 

    What causes it? 

    Inflammation and infection from picking on skin. 

    How to treat and prevent it? 

    Similar to cystic acne, you can get prescription creams from your dermatologist. Again, don’t pick or scratch at your pimples, blackheads or whiteheads or you risk introducing bacteria to the area. 

    (Also Read: 10 Best Superfoods for Glowing Skin)

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  • Pustules
    6 / 7 Pustules

    What does it look like?

    These are similar in size to acne papules, but have a yellowish tip at the top with dried pus, hence the name ‘pustule’. Pustules tend to occur in groups or clusters, usually at your temple or hairline. 

    What causes it?

    Pustules are caused by secondary skin infections of acne bumps and are known as gram-negative folliculitis. Having an active acne problem increases your chance of getting gram-negative folliculitis which is caused by a species of bacteria found on human skin (known as gram-negative bacteria).

    How to treat and prevent it?

    We can’t say this enough: Don’t pick your pimples as there’s bacteria on your fingers which will cause infections. Get your acne diagnosed and treated by a dermatologist with prescription antibiotic creams and oral medications that target gram-negative bacteria. Your underlying acne problem would also be considered moderate to severe if you have an episode of gram-negative folliculitis. 

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  • Comedones
    7 / 7 Comedones

    What does it look like?

    This term encompasses both open and closed comedones. Open comedones are blackheads and closed comedones are whiteheads (closed pimples) which appear as tiny bumps on the skin surface. 

    Closed comedones are frequently found on the forehead and chin, and open comedones usually appear around the nose and cheeks.

    What causes it?

    Closed comedones are caused by the underlying genetic tendency of the skin to be inflamed and produce these tiny seeds which slowly rise to the skin’s surface. Some types of makeup or skincare products can also cause acne. When shopping for makeup, look for the label ‘non-comedogenic’. For skincare, the products should be ‘dermatologically-tested’. 

    How to treat and prevent it?

    Closed comedones should not be ignored because they develop into more severe forms of acne like papules, cystic acne and gram-negative folliculitis. Never try to prick and extract the closed bumps or let any facial auntie do so as this only introduces more bacteria to the area! 

    I personally treat closed comedones with a specialised machine with a vacuum hand piece that gently extracts blackheads and whiteheads without pain or scarring while infusing a customised blend of fruit-based acids that exfoliate the skin.

    Do not use scrubs with rough, exfoliating bits as these only irritate the skin – all while being totally ineffective at removing whiteheads. When it comes to skincare, do not use oil-based moisturisers if you have any form of acne. Opt for emulsions (oil in water) or hyaluronic acid serums instead. I prescribe these for my patients with acne as no matter how oily one’s skin is, you still need moisture! 

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