The Silent Scars of Acne: Why I Take a Different Approach
A few years ago, Angela came to me for her acne issue. She had tried countless over the counter medicines or products and even visited a few clinics for acne treatments. What struck me the most is not the acne or the scars on her face but how she avoided looking at herself in the mirror. She looked stressed and her eyes turned teary during the consultation when she told me about her new acnes.
When she first came, she wore thick make up to cover up her acne and scars. This is when I realised that acne can leave scars in both the skin and the mind. She shared that she was also seeing psychologist for depression due to her acne. You might be surprised by the number of people struggling from depression or anxiety due to acne and how acne cause social withdrawal, low self-esteem and low self-confidence. I started her on topical medicine and oral antibiotic, combined with in clinic treatment like picosecond laser, blue light and chemical peel. I also looked into her lifestyle, diet and skin care. Her acne became better after several sessions and treatments and I proceeded to treat her acne scars. She had tried laser, radiofrequency microneedling, chemical peel, subcision and polynucleotide injection. Her acne scars became better over the years and now she can go out confidently without any make up.
The Challenges With Acne
Acne is a challenging chronic condition to treat. Every patient with acne issues tells a story and my approach is to listen before I treat. I would often ask for their family history, lifestyle, diet, skin care routine and even menses history (for female patients). The pathophysiology of acne involves four important factors which are excessive sebum production, hyperkeratinisation of pilosebaceous follicles, hyperproliferation of propionibacterium acnes bacteria and inflammation. Before starting treatments, I always tell my patient that they need to be patient as it takes time to see results and there is no magic treatment that can cure acne in a few days’ time. Often, I find myself behaving like a Sherlock Holmes, trying to hunt for the potential causes and aggravating factors.
Why is acne worse in some people? This may be due to genetic factors (family history of bad acnes); hormonal factors such as polycystic ovarian syndrome, Cushing disease, stress; and environmental factors such as high humidity, cosmetics, high glycaemic index food, dairy products and certain medicines. Lab investigation and even imaging may be necessary for further investigation. I believe that addressing acne issue comprehensively is the key to long term results. I remember detecting a pituitary microadenoma from a patient presenting with acne and excessive hair growth. She came in requesting for laser treatment for her acne and also hair removal. After delving deeper into her history, I sent off some lab tests and ordered an MRI brain for her. The pituitary microadenoma may have gone undetected for years if I just proceed with laser treatment for her acne and hair removal when I first saw her. She was then referred to an endocrinologist for co-management.
Treating Acne
In treating acne, I often use a combination approach which are medical treatment and lifestyle modification. Treatment of acne depending on the severity of acne. Mild acne cases would benefit from topical medicines such as benzyol peroxide, retinoids and antibiotic. For patient with moderate acne, oral antibiotic might be added. Patients with severe acne or acne conglobate may require oral isotretinoin to reduce sebum production, shrinks the sebaceous glands, reduces follicular occlusion, and inhibits the growth of bacteria. In females, especially those with polycystic ovary syndrome, oral antiandrogens such as spironolactone can be beneficial. I would combine with in clinic treatment such as picosecond laser, long pulse laser or radiofrequency microneedling, chemical peel and blue light.
We often think that scars are skin-deep, but for many people, they reflect deeper struggles with self-image. After controlling acne, reducing acne scars is the next treatment focus. Lasers and radiofrequency microneedling can help to stimulate collagen production and reduce acne scars. Subcision technique can be used to break the fibrous bands from deep acne scars and can be paired together with injectables such as polynucleotide to repair the underlying skin stimulate collagen production.
Conclusion
Acne may seem like a common problem but each person tells a unique story and there is no one-size treatment that fits all. Patience and consistence are the key. My goal as an aesthetic doctor is to provide personalized treatment plan that goes beyond clearing the acne, but to make my patients ‘look good, feel great’.
Are you suffering from acne and looking for professional solutions? Reach out to us at EHA Clinic for a non-obligatory consultation through WhatsApp today.
