SPOT ON

You’ve probably battled zits in some capacity throughout your life – whether it’s the odd period pimple, or full-blown cystic acne when you were a teenager. But hold your horses if you’ve been dealing with each bump the same way. Dousing your skin with tea tree oil or salicylic acid isn’t always the way to go, and the wrong treatment can actually exacerbate the condition.

Dr Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, decodes the various types of acne here, and how you can treat as well as prevent each one accordingly.

HORMONAL ACNE

What does it look like? Red and bumpy, this tends to cluster around the mouth area and jawline, and flares occur before the start of your menstrual cycle each month. Hormonal acne can be very severe, and may also be associated with irregular menstrual cycles, and excess facial or body hair growth.

What causes it? It may not be simply pimples when it occurs constantly around the jawline and mouth. If it’s a case of true hormonal acne, check if your menstrual cycles are regular and if you have observed excessive hair growth on your body. Polycystic Ovarian Syndrome (PCOS) can cause acne as well, and is actually a disorder of your ovaries, which can lead to infertility if left untreated.

Hormonal acne is not caused by makeup, the climate or the new moisturiser you are using (provided the product has a noncomedogenic label on it).

How to treat and prevent it? If you have a recurrent flare of more than five to eight pimples every month, you should see a dermatologist who would probably prescribe oral antibiotics. If there is an ovarian problem, your doctor will get you started on specific oral contraceptive pills to help regulate your menstrual cycles as well.

Over-the-counter creams, like benzoyl peroxide, will not help or prevent hormonal acne, and may actually worsen the condition as it tends to irritate the sensitive skin around the mouth and cause eczema.

BLACKHEADS

What do these look like? We’re all familiar with blackheads. These appear like bits of black dirt stuck in open visible “pores” which are actually hair follicles that also have oil glands (sebaceous glands).

What causes them? They are actually a form of acne we call open comedones that are caused by an overproduction of oil, and tend to cluster around areas like the nose. The build-up of keratin and oil around the follicle is oxidised and turns blackish because the oil itself is oxidised by air.

How to treat and prevent them? Open comedones are best treated with a mixture of chemical peels containing salicylic, lactic and glycolic acids to control the oil production.

Carbon laser peels also help to shrink oil glands and reduce the production of oil.

While nothing over the counter can actually totally eliminate blackheads, a good cleanser is also important. For those with greasy skin, it may help to just wash the excess oil off with a good cleanser. Look for labels with “dermatologist-tested and formulated” for maximum clinical efficacy.

A good one should leave skin feeling clean – not squeaky clean – but still soft and moisturised. Avoid harsh cleansers that contain strong lathering agents like SLS (sodium laureth sulphate) as these can strip skin of moisture.

Pore strips help to physically remove the bits of keratin and oxidised oil, but they tend to accumulate again and the problem recurs.

Products with salicylic acid usually don’t have high enough concentrations to be actually effective. Higher concentrations, on the other hand, can cause irritation.

Beware of facial blotters to remove oil as well. These can cause skin to feel dehydrated, resulting in your oil glands producing even more oil to compensate. If you must, use a fragrance- and- alcohol-free baby wipe to take away excess oil instead.

CYSTIC ACNE

What does it look like? Large, angry-looking bumps that are red and painful. Cystic acne can appear anywhere on the face, chest or back since these areas all produce oil. These nasty bumps may also secrete pus.

What causes it? Cystic acne usually starts off as whiteheads (closed comedones) or blackheads (open comedones). If bacteria gets trapped inside the comedones and is left untreated, the infection goes deeper into the skin, resulting in inflamed bumps full ofpus, that are known as cysts. If a cyst bursts, the infection can spread, causing more breakouts. What’s more, it is, unfortunately, genetic. If a relative had severe cystic acne, you have a greater chance of getting it, too.

How to treat and prevent it? Cystic acne requires specialist dermatological care as it can leave deep scars and worsen if left untreated. Also, it usually cannot be prevented, so don’t brush it off. Never pick your pimples or squeeze whiteheads and blackheads as the bacteria on your fingers can cause infections. The way to remove whiteheads and blackheads is with prescription creams containing tretinoin, or with chemical peels and microdermabrasion.

If you suffer from cystic acne, consult a dermatologist early. You will be given oral medication to help shrink your oil glands.