Acne: Focus on Five 

We all have encountered a sudden outburst of acne at some point in our lives. Whether it was puberty, pregnancy or the few pimples that appear just before monthly menstruation.

The 3 main reasons how and why acne happen:

  1. Sebaceous Gland Hyperactivity

Sebum is continuously produced by the sebaceous glands and secreted to the skin surface through the hair follicle pore. This is controlled hormonally. Active acne is seen during puberty due to the increase in androgen which promotes sebum production. For women, the sebaceous gland activity also increases post ovulation due to the surge in Luteinizing Hormones, and this explains the acne breakouts just before menstruation.

  1. Keratinocytes Clumping

In acne patient, the keratinocytes (cell in the top skin layer) tends to stick together and block the pore, creating open comedones ‘blackhead’ or closed comedones ‘whitehead’. This clogged pore is a great nutritional source for bacteria.

  1. Impact of Bacteria

Propionibacterium acnes – commonly found on the surface of the skin in an adult face with or without acne. The increase in sebum production and keratinocytes clumping leads to an increase in P. acnes around the hair follicle.


The 5 essential steps of  acne management are:

  1. Exfoliation – Normalize Keratinization

The first step to control acne is to prevent the exfoliated keratinocytes from clumping together. Retinoids are great to achieve this. Many dermatologists prescribe some form of retinoids as part of ‘Acne Care Management’ due to the ability to eradicate existing comedones and prevent new ones.

  1. Reduce Bacteria

Depending on the severity of the acne, anti-bacterial medications such as Topical Clindamycin and Oral Tetracycline / Doxycycline are commonly used in the treatment of acne.

Benzoyl Peroxide can also eliminate bacteria, however by generating reactive oxygen species in the sebaceous follicle causing free radical formation, this may lead to accelerated aging of the skin therefore it should be used sparingly.

  1. Remove Pore-Clogging Material

AHAs and BHAs (Salicylic Acid) are used to loosen the keratinocytes, therefore ‘unclogging’ the pores. This is usually done in clinics and known as ‘chemical peel treatment’. 

  1. Manage Inflammation

Anti-inflammatory products such as Salicylic Acid helps soothe active acne. For severe cystic type acne, the physician may even suggest intralesional steroids in order to prevent scarring.

  1. Decrease Sebum Production

It is also recommended to have hormone profile test done, as many women who suffer from persistent acne turns out to have Polycystic Ovarian Syndrome, and by managing the excess testosterone with anti-androgen oral treatment, drastic improvement can be seen even after 1 month of this hormonal stabilization treatment.

The 5 steps mentioned are mainly for prevention of future eruptions, therefore optimal results will only be seen between 6-8 weeks from commencement of treatment.

“Patience is not the ability to wait, but the ability to keep a good attitude while waiting”

So…stay positive, ensure good compliance to the recommended treatment plan and that clear radiant skin will be yours again in due time!




Baumann, L. (2009). Cosmetic Dermatology: Principles and Practice. McGrawHill,  pp121-125.