The Causes of Acne

Dr Tan Hiok Hee
Senior Consultant Dermatologist

Acne is an extremely common condition that affects almost everybody at some time in their lives. It usually starts during the teenage years but may also appear for the first time in adulthood. Find out more about acne treatment and acne scar removal.

What causes acne?

Acne is a disorder of the pilosebaecous glands. It involves the skin in and around the hair follicles and their oil-producing glands, which are also called the sebaceous glands. The sites that are affected by acne include the face, chest and back.

Acne starts with the formation of comedones, whiteheads and blackheads. These form because the cells lining the opening of the hair follicle become too sticky and cause a plug or obstruction to occur. Sebum then starts to accumulate below this plug.

Bacteria in the deeper part of the hair follicle and beneath the sebum blockage release chemicals which act upon the sebum and break it down to release other chemicals.

These chemicals cause inflammation, making the skin around the hair follicle red and inflamed, resulting in a pimple. In bad cases, pus may develop within the pimple. Large, painful swellings called nodules and cysts may develop and result in scarring after the condition has eventually settled. These acne scars can either be depressed and sunken, or bulging and hard.

Kinds of Acne Treatment

Consult your dermatologist early. Waiting to “outgrow” acne can be a serious mistake, since medical treatment can improve your appearance and prevent development of severe acne scars.

a) Treatment applied to the skin

Patients with mild acne usually respond well to such topical treatment. Topical treatments include retinoids, which are vitamin A derived creams or gels, as well as benzoyl peroxide containing preparations and antibiotics (erythromycin and clindamycin gel and lotions).

Some lotions or creams may make the skin red or flaky but these side effects are usually temporary. Consult your dermatologist if the lotions or creams cause excessive redness or irritation.

b) Oral Acne Treatment

If your acne becomes worse and you have a lot of inflamed spots, topical treatment alone may not be adequate. Your dermatologist will probably prescribe antibiotic tablets, such as doxycycline, erythromycin and minocycline. These have been shown to be safe and effective for most cases of acne. To be effective, they need to be taken for at least 6 weeks, and often up to a few months.

c) For Severe Acne

In very serious cases, or in cases of severe nodulocystic acne, a tablet called isotretinoin may be given. This medication is a vitamin A derivative and almost all cases of acne will respond well. It can cause a range of side effects such as dryness of the skin and lips, and photosensitivity. You will need to consult a dermatologist to discuss the use of this drug, and it cannot be taken during pregnancy. In the hands of the expert, this medication is safe and extremely effective.

Acne Scar Removal

Acne should be treated to reduce the possibility of scars. Once the acne is controlled, acne scars can be effectively treated and the appearance of the scars can be improved.

Treatment of acne scars depends on several factors, including the type of scars and the patient’s skin type. We can employ treatments such as chemical peels, non-ablative lasers as well as CO2 fractional lasers to treat the acne scars. Scars that are raised (keloids) can be treated with injections into the thickened areas to flatten them.


Are you struggling with acne or acne scars? Thomson Specialist Skin Centre can help diagnose the real cause of your breakouts and recommend the best Singapore acne treatments for your particular case.