Still plagued by acne at 23

This story was first published in The Sunday Times on July 18, 2013

Q I am a 23-year-old male student. I have had pimples on my face since secondary school.

Although I have seen a specialist at a hospital, my acne does not seem to have improved much.

The acne growth is still active and leaves scars on my face.

I have tried isotretinoin and almost all types of anti-acne antibiotics, such as minocycline and tetracycline, but they are not effective.

Instead of improving my acne condition, these antibiotics cause gastric pain and I have no appetite.

The doctor has also prescribed a facial wash and lotion to be applied on my face.

I drink lots of water and eat healthy food such as fruit and vegetables daily.

What can I do to get rid of my pimples? How long will it take for me to recover?

A Acne is often a chronic disease and not just a self-limiting disorder of teenagers.

There is good evidence that acne can persist into adulthood in as many as 50 per cent of individuals.

Unfortunately, the reason why acne becomes chronic in some patients is not well understood and it is currently difficult to determine which patients will have a chronic course of the disease.

Factors that have been linked to a chronic course include genetics, stress-related production of adrenal androgens (male hormones), colonisation of Propionibacterium acnes (bacteria that is believed to be one of the triggers of acne), and specific subtypes of acne.

Acne is not caused by things such as eating the wrong kinds of food or poor hygiene.

Having acne does not mean you have to wash your face more often.

On the contrary, washing your skin too much can irritate it, particularly if you use soap, and this may cause inflammation of the skin that can interfere with acne therapy.

Acne warrants early and aggressive treatment as it can be a psychologically damaging condition that lasts for years.

Negative psychological outcomes, including anxiety, depression and social withdrawal, have all been reported among individuals with acne and acne scars.


Physical scars and persistent hyperpigmentation (darkening of the skin) are not uncommon as a result of acne and are usually expensive and difficult to treat effectively.

Maintenance therapy is often needed for optimal outcomes.

There are many types of medication for the treatment of acne.

But large advertising campaigns for non-prescription products can easily create unrealistic expectations.

In general, acne management involves the use of a combination of various types of cream - with a retinoid-based cream (vitamin A derivative cream) as a cornerstone - and, in severe cases, even oral medication.

Most products have to be used for a long time, sometimes at least three to four months, before there is a noticeable improvement.

Some of these types of treatment have considerable side effects which may necessitate reducing the dosage or changing to an alternative form of medication or therapy.

For example, antibiotics such as doxycycline and erythromycin can upset the stomach, which you experienced.

The use of enteric-coated doxycycline and erythromycin (pills with a special coating that prevents the release and absorption of the active ingredients until they reach the intestines) can help mitigate this side effect.

Alternatively, a different antibiotic such as Bactrim can be considered if you are not allergic to this class of antibiotics.

Isotretinoin, a vitamin A derivative which is commonly used for treating acne, can cause dryness of the lips and skin as well as sensitivity to light.

Its side effects are usually dose-dependent. Thus, a lower starting dose and gradual dose increment may make the treatment more tolerable.

There are some patients who experience an acne flare when oral antibiotics are discontinued, despite the continuing use of topical retinoids.

There are also some cases where long-term oral antibiotic therapy is required as an alternative to the use of oral isotretinoin.

Adjunct treatments, such as chemical peels (use of chemicals to remove a superficial layer of skin) and light therapy (exposure to light of a certain wavelength to kill the acne-causing bacteria), can be considered in certain cases to improve and maintain the acne treatment response.


Acne scars arise as a result of the inflammatory response to acne lesions.

Data shows that the degree and duration of inflammation are directly related to the likelihood of scarring.

Thus, the best method of managing acne scars is to prevent them by treating acne early and continuing therapy for as long as necessary.

There are a variety of scars and also of treatment options that can be used to achieve significant cosmetic improvement.

But it must be noted that none of the currently available treatment methods achieve complete resolution of scars.

Combining treatment methods may boost improvement compared with using one method alone.

Acne treatment often requires a lot of patience. Many of the treatment methods start working only after several months.

But it can be worth the wait, and is certainly better than constantly switching treatment methods, which can easily give people the feeling that nothing will help.

Do see a dermatologist to evaluate your condition to help you decide on the best management plan to control your acne.

DR RAYMOND KWAH, consultant dermatologist at Raffles Skin & Aesthetics Centre at Raffles Hospital

This story was first published in The Sunday Times on July 18, 2013

To subscribe to The Straits Times, please go to