Acne can be a very distressing ordeal that a lot of you may already have had to encounter. Some people say it’s a rite of passage; a journey we all have to take as we go into puberty and will subside as we grow older.
But what if the acne doesn’t go away? Some of us have acne longer than we’d hope for, following us well into adulthood. A study in Singapore revealed that 41% of adults treated at the National Skin Centre had dealt with acne since their adolescent years and that majority of them suffered from adult-onset acne. 
Fret not! With advancements in technology, modern medicine has a plethora of ways to deal with various acne conditions. Let aesthetic doctor, Dr. Lim Luping, walk you through all you need to know about acne removal treatments such as the types of medication, in-clinic procedures costs and many more.
Learning about acne and acne removal treatments can help give you a better idea of how to deal with even the most severe outbreaks.
What is Acne?
Acne is a chronic or long term skin condition affecting the hair follicle and sebaceous gland, which are both part of the pilosebaceous units in the skin. The sebaceous gland naturally opens into a hair follicle to secrete sebum — a combination of complex oils that help protect the skin from dehydration, bacteria, and other important functions.
Acne occurs when the hair follicles become clogged up with oil and dead skin cells. They present on the skin as comedones or inflamed red and angry bumps with or without pointing pus.
What are the common types of Acne?
Acne conditions can be divided into two broad categories:
- Non-inflammatory acne
- Inflammatory acne
Closed Comedones — usually <0.5mm and skin-coloured bumps.
Open Comedones — <0.5mm, skin-coloured bump with a black pore opening
Inflammatory acne occurs when bacteria C Acnes infect the comedones resulting in inflammation, redness, and swelling.
Inflammatory acne can be further classified into 4 other groups based on their appearance and diameter.
These are between 0.5mm to 0.5cm red, swollen, firm bumps which may be tender.
These are between 0.5mm to 0.5cm red, swollen, and tender bumps with a white or yellow pus tip, pointing and ready to burst.
These are over 0.5 cm red, firm, and tender bumps.
These are over 0.5 cm bumps filled with pus ready to discharge, red and painful. Occurs when blockage and inflammation occurs deep in the hair follicle
Common sites of acne are the face, forehead, chin, chest, upper back, and shoulders as these areas have the most oil glands.
What causes Acne?
Acne is caused by a series of issues that affect the pilosebaceous units in the skin. What is directly impacting the acne formation is based on a list of physiological events at the skin, namely:
Main causes of Acne
Excessive sebum production — Sebaceous glands produce too much sebum or oil compounds which accumulate at the hair follicles.
Improper exfoliation — The dead cells of the hair follicles do not exfoliate properly due to inadequate vitamin A in the follicles, thus plugging them with dead cells, sebum, and other debris.
Bacterial growth — A rise in C. Acnes bacterial activity within the clogged follicles, then possibly bringing inflammation in the form of acne outbreaks.
Looking deeper, there are some underlying factors within your own body that could be the root of or further worsen your acne outbreaks.
Underlying Factors Contributing to Acne
Genetics — If one or both parents have had acne conditions, then it increases the chance of their children having acne.
Pubertal years — Acne occurs mostly between 12 and 30 years old. In fact, 80-85% of people with acne fall into this age group, where there is an increase in androgens, or male hormones, in the body.
Hormonal changes in midlife — Hormonal changes can result in acne especially in women when the balance between the estrogens and androgens is disrupted.
Stress — Stress can aggravate acne as well due to the resultant hormonal imbalances.
Read also: How Mindful Breathing Helps Reduce Stress
Medications — Certain antidepressants, steroids, and lithium may worsen your acne conditions.
Medical conditions — Some medical conditions may result in an overproduction of androgens such as polycystic ovarian disease syndrome (PCOS).
How is Acne diagnosed?
As with any medical condition, a diagnosis involves a physical examination of the exhibited symptoms and taking note of the patient’s medical history.
The physical examination for an acne diagnosis will cover the areas of the body which contain the most oil glands such as the face, jawline, shoulder, neck, chest, and back.
The doctor will take note of the different types of lesions or acne formations which can possibly be a combination of comedones, papules, and pustules.
How is Acne treated?
Acne treatment is administered based on the severity and types of lesions that we observed during the examination.
General treatment options for acne include topical and oral medication. An exhaustive list of the possible treatment options are as follows:
Treatments that can be administered at home
Topical medication — Such as acne creams, gels, lotions, and washes. However, proper application of medication should be advised or they may irritate the skin and aggravate the condition further.
Oral medication — Such as oral supplements, antibiotics, contraceptives or isotretinoin
Treatments that are administered in-clinic
Acne Removal energy devices — Such as Acne Clear Laser treatment, Intense Pulsed Light (IPL) treatment, Light-emitting diode (LED) treatment and fractional radiofrequency treatment
Therapy treatments — Ultrasonic extraction, Plasma treatment, Acne hydra peel, Chemical peels
Depending on the severity of acne, different treatments can be recommended. Usually, a combination of treatments can result in a synergistic effect and faster control of the condition.
The most effective treatment route will be able to target the main causes of acne by reducing sebum overproduction, normalising the hyperkeratinization of the cells to improve skin exfoliation, reduce bacterial growth on the skin and hair follicles and prevent inflammation.
We can work to resolve the acne condition, minimise scarring as the acne heals, manage skin globally to prevent new acne from developing, and prevent future scarring.
What do I do for Acne Removal if over the counter creams do not work?
Generally, counter creams would work if your acne is mild. Mild acne means that there are less than 5 small acne bumps and should resolve quickly within the week without scarring. Mild acne usually occurs only once in a few months.
Aside from that, anyone who has acne cyclically or persistently requires medical help.
For instance, premenstrual acne would be most effectively treated by oral contraceptives to overcome the heightened androgen levels. If your acne condition is made up of a combination of papules and pustules, oral antibiotics and topical treatments should be sufficient for acne removal.
Beyond that, if the above treatments prove ineffective, you may need to progress to in-clinic options which could involve laser treatments, extractions, chemical peels, and oral isotretinoin.
Related: Should I see a skin doctor for cystic acne on my cheek, or can I use OTC products?
What are the complications of Untreated Acne?
Untreated acne can lead to a range of different problems that can have a lasting effect on the patient.
Scarring — Untreated acne can lead to scars that are potentially permanent such as ice pick scars, box scars, rolling scars, or atrophic scars.
Blemishes —**There could also be darkened spots due to hyperpigmentation or post-inflammatory redness that can take a long time to fade
**Psychological issues — With these long-term changes to your appearance, it may result in reduced self-confidence and self-esteem. In some cases, people may deal with depression with the potential impact it has on their social life.
Read also: Do I need to see a psychiatrist for possible acne-related depression?**
Acne removal treatment is recommended if you have:
- cyclical acne
- continually-active acne
- aggravated acne
Depending on how big the lesions are, the continual production of acne will possibly result in large or small scarring.
Even though effective treatments for acne scars are available, if the scars are too deep, the complexion cannot revert completely to the pre-acne smoothness, scarless and poreless condition. Acne scar treatments also tend to be more costly.
It is advised to seek professional medical advice if your acne condition seems to be persistent despite self-administered treatment, to prevent permanent damage to your skin.
What are the specific Topical Prescription Medications for Acne Removal?
Topical medication such as salicylic acid, lactic acid, and glycolic acid can improve the exfoliation of dead cells so that the sebaceous glands are not clogged up. Their drying properties help to reduce oil production as well.
Benzoyl peroxide has antibacterial properties  which can be combined with topical antibiotics to reduce the antibiotic resistance effect.
Topical medication also includes Retinoids, Tretinoin, Differin and Epiduo which can come in different strengths and mediums such as gel, lotion, or creams. They reduce the overproduction of dead cells and prevent the clogging of the hair follicles. This leads to a reduction in comedone formation.
These topical medications are applied over the active acne areas and other acne-prone areas of the skin. With regular use in low doses, they can reduce fine lines and improve the texture of the skin too.
Topical antibiotics such as Erythromycin and Clindamycin work to reduce bacterial growth on the face to prevent any inflammation of comedones.
There are also new supplement formulations available from doctors’ clinics that include combinations with vitamin B3, zinc, green tea (epigallocatechin) antioxidants, triethyl citrate, ethyl lanolate, GT peptide, and honokiol.
These have a combined effect in:
- reducing sebum production
- normalising keratinisation of the skin
- conferring anti-microbial properties
- helping with inflammation symptoms and improving the skin healing process.
Also read: How do I decide which OTC acne treatment such as benzoyl peroxide, salicylic acid, AHA, sulphur and resorcinol is the best for me?
What are some side effects of using medication for Acne Removal?
Some topical medications such as acid-based products like alpha hydroxy acid (AHA), beta hydroxy acid (BHA), tretinoin, and salicylic acid have a drying effect and can cause irritation if they are not used properly. This is especially so for people with sensitive skin which can result in redness and irritation after usage.
Topical antibiotics, if overused beyond 6 months, may lead to antibiotic-resistant bacteria which make using further antibiotic treatments ineffective in dealing with acne.
Oral antibiotics may cause stomach upset with prolonged use, which can also cause antibiotic resistance.
In rare cases, using oral contraceptives may result in weight gain or depression.
Oral isotretinoin is unsuitable for females who are trying to or already are pregnant as it may affect the health of the fetus. Cholesterol levels may also be increased but the occurrence can be detected during the doctor’s pre-treatment examination to check your cholesterol levels in the first month.
Read more: How can taking isotretinoin affect the foetus during pregnancy?
Across the board, depending on the type of medication and patient’s physiology, side effects of medication for acne removal may manifest in the form of:
- skin irritation
Read also: What should I do if I develop a skin rash while on isotretinoin treatment?
The best way to avoid this is to partner with your medical professional to ensure optimal results and minimize the side effects.
What are the common Acne Surgical Procedures?
Acne surgery is the use of various surgical procedures for the adjuvant treatment of active acne and post-acne scarring.
Common clinical treatments for Acne Removal
1. Acne Laser Treatment
Laser light energy has indeed been shown to be effective in the treatment of acne.  It can reduce inflammatory lesions, resolve the acne quickly, reduce bacterial activity, control oil balance by reducing sebaceous gland activity, improve exfoliation and, decrease blemishes and potential scarring.
2. Fractional Radiofrequency (RF) Treatment
Fractional RF devices are able to transmit thermal energy deep within the skin to help reduce inflamed acne lesions and improve acne scars as well. It is effective enough to treat severe acne scars. 
3. Chemical PeelsChemical solutions containing salicylic acid or glycolic acid are applied to the face much like a face mask. The procedure is able to unclog the hair follicles, reduce inflammation  and improve pores and blemishes. The more superficial scars can also be improved.
4. Steroid Injections
For cysts and nodules, steroid injections can be administered to reduce the swelling and inflammation. Ultimately, it can help to resolve the lesion quickly. 
Also read: Where can I seek treatment for cystic acne in Singapore? What is the best cystic acne treatment?
5. Acne Hydrapeels
A specialised facial treatment applied to the surface of the skin to help exfoliate it, reduce comedone formations, and cleanse pores deeply to remove dirt, sebum and dead cells.
6. Acne Extraction
Done manually or with the help of an ultrasonic medical instrument, comedones can be cleared of sebum accumulation.
7. Plasma Acne Treatment
It helps to reduce inflammation and redness of more serious lesions to hasten their healing and resolve the condition.
8. Rejuran Injections
The next stage of acne removal treatment when your skin has achieved acne control is the repair and restoration of skin texture and smoothness.
Rejuran is a special combination of salmon extract and polynucleotides which can be injected when the larger acne areas have improved. It has powerful anti-inflammatory and regenerative properties.
Rejuran takes your global skin improvement to the next level. This injection can help to:
- Further improve the acne condition
- Reduce post-inflammatory redness, hyperpigmentation, and discoloration
- Reduce enlarged pores
- Reduce acne scars
- Achieve smoothness in the skin
- Improve skin elasticity
- Improve oil control
- Enhance skin hydration
- Restore original complexion
Also read: Is Microneedling for You?: The Complete Guide (2021)
What are possible side effects to in-Clinic Acne Removal treatments?
After most of the treatments including laser procedures, there might be a temporary redness in the skin which should subside quickly. Acne extraction procedures should not have any side effects if done by an experienced therapist.
Read more: What are the benefits and side effects of Laser on facial skin?
Generally, most in-clinic acne removal treatments are non-invasive and have no downtime which means you can undergo a procedure and meet your friends for a lunch date right after!
What is an Acne Removal procedure like?
Most of the in-clinic acne removal treatments are comfortable, safe, effective, and have minimal to no downtime. The doctors and staff are highly experienced, highly skilled, patient, and attentive, to ensure the patient experience is smooth and pleasant.
For laser treatments, your face would first be cleansed and then you would wear protective eyewear. The process would take about 10 to 15 minutes. After the laser treatment, we will proceed with ultrasonic and plasma acne treatment to clear your acne.
Fractional Radiofrequency Treatment
Fractional radiofrequency treatment would first involve a numbing cream that is applied for 20 minutes. After cleansing of the numbing cream, the procedure will be administered by the doctor.
This procedure might result in a slight downtime of 1 to 2 days where there may be slight redness in the skin. You would be advised on post-treatment skincare and to avoid direct exposure to the sun for a week.
Chemical peel procedures similarly involve the follow steps:
- Facial cleansing
- The chemical solution is applied to the face for the main part of the treatment.
- A neutralising agent is used to remove the chemical peel afterward.
This procedure may result in temporary redness of the skin for 3 to 4 days and possibly dryness and skin peeling for 4 to 5 days. Within a week, all these post-treatment symptoms should subside.
After most acne removal procedures, you would also be prescribed some skincare products and sunblock for self-application. You may also receive healing and calming devices to help reduce the redness that comes after treatment.
Related: How effective are the various types of chemical peels for acne scars?
Rejuran injection will be the next stage of their treatment. It involves the following steps:
- Application of numbing cream for 30minutes
- Cleansing of face to remove the numbing cream
- Injection of Rejuran for skin healing and repair.
How much does Acne Removal cost in Singapore?
Depending on the type of acne removal treatment, the cost to pay will vary. Most in-clinic acne removal treatments will certainly be more expensive than prescribed medication or self-administered treatments.
Do note that these prices may vary between clinics and health retail stores.
Most topical medication
$40-$80 per bottle
more than $60 a month
$35 a month
$180 a month
Manual acne extraction
$60 per session
Laser treatments for acne removal
$180 per session
Generally, acne removal procedures would range between $150 to $500 per session depending on the treatment. Usually, there should be a number of regular sessions performed over intervals ranging from bimonthly to monthly.
It would be performed until improvements to the acne condition are sustained, then a modified maintenance regime can be adopted.
Are Acne Removal Procedures Medisave Claimable?
Unfortunately, they are not Medisave claimable.
How Can I Manage Acne After an Acne Removal Procedure?
Maintenance of the health of your skin is essential. It all comes down to paying attention to your skin and taking good care of it.
This means adopting a suitable skincare routine. Ensure that you hydrate your skin with water-based products and continue the usage of homecare topicals, especially with the appropriate application of anti-acne skincare on vulnerable areas of the face.
On top of that, you can make use of products that help to control sebum oil on your skin and also avoid excessive exposure to sunlight.
For some acne conditions, it is important to keep to the regular monthly laser treatment appointments to prevent further acne outbreaks and regular anti-acne medi-facials to help keep the skin clean and clear.
Related: Is there a skincare cure for acne in case of post-isotretinoin relapse?
What Are Some Home Remedies for Acne Removal?
There are some home remedies available that may help to deal with mild acne problems.
Tea tree oil — It has anti-inflammatory and anti-microbial properties to curb some acne causes
Green tea extract —It also has anti-inflammatory and anti-microbial properties. Additionally, it contains antioxidants as well.
Witch hazel — It has anti-inflammatory properties
Aloe vera — It also has anti-inflammatory properties
However, do remember that these are only home remedies and may work for those who have the occasional and sporadic one or two pimples but may not be sufficient for more serious cases of acne.
Acne can be frustrating to deal with but with the proper acne removal treatments and medical advice, you can resolve the problem. Try not to squeeze pimples. With a proper skincare routine and help from a trusted aesthetic doctor, your acne will be managed in no time!
I would love to help you on your acne recovery journey. Check out what we have to offer at our Acne Removal Clinic.
Alternatively, head on down to Eeva Medical Aesthetic Clinic's website to see the range of services that we provide.
To book a consultation with us, click here.
If you have any further questions, head over to aesthetic doctor Dr. Lim Luping’s profile to book a consultation!