Acne

Acne is a chronic inflammatory disease of the pilosebaceous unit. Effective acne treaments involve correcting the biology that drives clogged pores and inflammation, while protecting the skin barrier to prevent scars and long-term sensitivity.

 

Acne affects adolescents and adults, and it can involve the face, jawline, chest, back, and shoulders. Modern acne care is highly evidence-based, with clear guidance on topical therapies, systemic treatments to prevent scarring and psychosocial burden.

What is acne?

 

Acne vulgaris is a condition where pores become blocked and inflamed, leading to comedones (blackheads and whiteheads) and inflammatory lesions (papules, pustules, nodules, cysts). It is driven by interacting processes in the follicle and sebaceous gland.

 

Why does acne occur?

 

Acne forms when four core mechanisms converge:

  1. Follicular hyperkeratinisation (sticky skin cells block the pore)
  2. Increased sebum production (oil glands become more active)
  3. Cutibacterium acnes activity within the plugged follicle
  4. Inflammation (immune signals amplify redness, swelling, and tenderness)

These are well-established drivers of acne pathophysiology and explain why multi-target treatment works better than single-product approaches.

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Categorisation


Clinically, acne is commonly categorised by type of lesion and severity:

 

By lesion type

  • Non-inflammatory: open vs closed comedones (blackheads vs whiteheads)
  • Inflammatory: papules/pustules
  • Nodulocystic: deeper nodules/cysts with higher scarring risk 


By severity (practical)

  • Mild: comedonal ± few inflammatory lesions
  • Moderate: more widespread inflammatory lesions
  • Severe: nodules/cysts, scarring, or significant psychosocial burden—often requires systemic therapy 


This matters because acne is not treated “by product,” but by severity and scarring risk.

Risk factors and triggers


Acne risk and flare patterns are influenced by:

  • Genetics and family history
  • Hormonal influences (puberty, menstrual cycles, PCOS; “adult female acne”)
  • Stress and sleep disruption 
  • Occlusion and friction (helmets, masks, sports gear; “acne mechanica”)
  • Medications
  • Dietary patterns (selected patients): Evidence remains mixed overall, but higher glycaemic-load patterns and dairy have been associated with acne in systematic reviews; we treat diet as an adjunct, not the primary therapy.

Signs and symptoms

 

Acne may present as:

  • Blackheads and whiteheads
  • Red bumps (papules), pustules
  • Painful deeper lumps (nodules/cysts)
  • Post-acne marks: redness (PIE) and brown pigmentation (PIH)
  • Scars: atrophic vs hypertrophic

 

Why do acne lesions form

 

A pore becomes blocked (hyperkeratinisation), sebum accumulates, and C. acnes thrives in the low-oxygen environment. The immune system responds with inflammation, which creates the red, tender lesions. When inflammation is deep or prolonged, it increases the risk of scarring, especially in Asian skin.

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FAQs

How can acne be treated?

At The Skin Longevity Clinic, acne treatment is structured to:
(1) stop new lesions, (2) calm inflammation, (3) protect the barrier, (4) prevent scars, and (5) maintain results.

1) Topical therapy (foundation of most plans)
Guidelines strongly support combinations of:

  • Benzoyl peroxide (anti-inflammatory, reduces bacterial resistance risk)
  • Topical retinoids (normalize pore turnover; comedone control; maintenance)
  • Topical antibiotics only in combination (never as monotherapy)
  • Other evidence-supported options may include azelaic acid and other agents depending on skin type and marks. 

2) Oral therapy 

  • Oral antibiotics  for inflammatory 
  • Hormonal options for appropriate patients 
  • Oral isotretinoin for severe acne, scarring risk, significant psychosocial burden, or failure of standard therapy. This option strongly recommended in modern guidelines when indicated and appropriately monitored. 

3) In-clinic procedures

Depending on acne type and skin sensitivity, procedures may support faster clearance and reduce post inflammatory hyperpigmentation and scars.  Guidelines also discuss physical modalities as part of specialist care pathways when appropriate.
 

4) Scar and mark prevention

Why choose Dr Rachel Ho & The Skin Longevity Clinic for acne in Singapore?

At The Skin Longevity Clinic, Dr Rachel Ho’s approach is:

  • Guideline-aligned and evidence-based, reflecting current recommendations for topical and systemic therapy choices and escalation pathways 
  • Barrier- and longevity-focused: control acne without creating chronic irritation, sensitivity, or rebound inflammation
  • Strategic skincare pairing 

Doctor Rachel’s Takeaway

Acne is a chronic inflammatory follicular disease driven by hyperkeratinisation, sebum biology, microbial activity, and immune inflammation. The best outcomes come from combination therapy matched to severity, early control to prevent scarring, and a maintenance plan that supports long-term skin function.