Learn about symptoms and causes of acne, self help treatment options, medication and when to seek medical help.

What is Acne? 

Acne is a skin condition that occurs when sebum, an oil which is produced by your skin, along with dead skin cells clog your skin pores, creating whiteheads and blackheads. Bacteria on your skin can sometimes infect these acne spots and cause swelling and redness. The acne can develop into papules, pustules, nodules and cysts (refer to diagram below). It can occur on your face, chest or back.

What are the possible causes of Acne?

Acne may be caused by: 

• Hormonal changes – An increase in testosterone during puberty can make your skin produce too much sebum. Hormonal changes during menstrual periods and pregnancy can also lead to acne episodes in women. A medical condition known as polycystic ovary syndrome (PCOS), in which there are hormonal changes, can also cause acne in women.
• Using ‘comedogenic’ (pore-clogging) cosmetic products – Make sure that any products you use have ‘non-comedogenic’ on the label. These products are less likely to clog your pores.
• Certain medications, including steroids, lithium and some seizure medications
• Stress – Several studies show acne worsens during stressful periods.
• Wearing headbands, backpacks, face masks and other items that rub against your skin
• Smoking
• Diet – Eating foods high in sugar may worsen acne.
• Picking or squeezing your acne can make it worse and lead to scarring

What are the symptoms of Acne?

The main types of acne are:

• Blackheads: Small dark-coloured or yellowish spots 
• Whiteheads: Similar to blackheads but with a paler centre. Unlike blackheads they are completely under the skin.
• Papules: Small red bumps that can be tender.
• Pustules: Like papules but with a white tip caused by pus.
• Nodules: Large, solid bumps under the skin that can be painful.
• Cysts: Sometimes known as cystic lesions or cystic acne, these are the most severe type of acne. They are large painful bumps filled with pus and are under the skin.

What can I do to treat Acne?

Acne can be treated in the following ways. You can ask your pharmacist to recommend a suitable treatment.

Over-the-counter acne creams, lotions and gels containing:

• Benzoyl peroxide (https://www.healthhub.sg/a-z/medications/381/Topical-Acne-Preparations)
• Sulphur
• Salicylic acid

Pharmacy only medications which can be obtained through the pharmacist without prescription:

• Adapalene gel or cream (https://www.healthhub.sg/a-z/medications/31/Adapalene-Gel-or-Cream)
• Adapalene with benzoyl peroxide gel
• Azelaic acid cream
• Clindamycin gel/lotion
• Clindamycin with benzoyl peroxide gel (https://www.healthhub.sg/a-z/medications/106/Clindamycin)
• Erythromycin solution/lotion

When do I need to see a doctor?

If your acne is not getting better after a four to six weeks use of product/s recommended by your pharmacist, you should see a doctor or dermatologist. You should also see a doctor or dermatologist if you experience any of the following:

• Your acne is severe with many papules and pustules
• You have any nodules, cysts or scars
• Your acne is infected. Acne such as Pustules and beyond may be infected and need to be treated with the right medication to avoid scarring. 

Your doctor or dermatologist may prescribe other medications depending on your condition.

What else can I do to manage this condition?

You can maintain healthy skin and reduce the number of flare-ups by:

• Avoiding heavy make-up and oil-based skincare and suncare products. Use products that are labelled ‘non-comedogenic’.
• Having a regular gentle skincare routine. Wash your face up to two times a day and remove all make-up before going to bed. Avoid harsh scrubbing or skin peeling products , which can damage the skin and worsen breakouts      . 
• Having regular sleep schedules with at least seven to eight hours of sleep every night.
• Whenever possible, avoid using washcloths, sponges and other tools as they can irritate the skin.
• When in use, keep facial sponges, make-up brushes and other make-up tools clean.
• Touching your face throughout the day can cause acne to flare. Avoid doing so. Picking, popping or squeezing your acne can increase the risk for scarring and dark marks on the skin.
• Managing your stress.
• Washing your hair regularly as oil from your face can cause acne on your forehead. Try to tie up your hair so that this will not leave more sebum on your face.

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.