What causes acne?
Acne starts in the hair follicle and its oil gland. Four things interact. Dead skin cells block the follicle, a process called hyperkeratinisation. Androgen hormones increase oil. The bacterium Cutibacterium acnes multiplies. Inflammation then follows. Poor hygiene is not the cause.
Treatment is matched to those drivers. One visit does not settle acne. Care runs over time, and most plans go on to a maintenance stage. How you respond depends on the grade, cause, skin type, hormones and how closely you follow the plan. Results vary.
What makes acne worse?
Acne starts inside the follicle, but several things can push it along. Hormonal shifts, such as the days before a period or coming off the pill, raise oil output. Pore-blocking skincare and make-up, some medicines and supplements, and anabolic steroids can trigger breakouts. On the back and chest, sweat, humidity and friction from gym wear or backpacks add to it. Picking or squeezing pushes inflammation deeper and raises the risk of a dark mark or scar.
What are the grades of acne?
Open and closed comedones, meaning blackheads and whiteheads, with little inflammation.
Red, inflamed papules and pustules alongside comedones.
Deep, tender nodules and cysts. This grade is the most linked to scarring, so early medical care matters. If you have this grade, try not to wait.
What is cystic acne, and why treat it early?
Cystic acne means deep, tender nodules and cysts in the dermis. It is the grade most linked to lasting scars, and these lumps do not respond to skincare. Medical treatment comes first, and at this stage it aims to limit scarring as much as to settle the spots. Some of the medicines used need checks and monitoring. Deep, painful lumps are a reason to see a doctor early rather than wait.
How is back and chest acne treated?
Back and chest acne gets the same assessment as facial acne, with particular care to rule out fungal folliculitis, which looks similar and is common there. Body breakouts often run deeper and mark more readily. The plan follows the grade, and oral treatment is often considered when acne is widespread. Showering and changing soon after exercise and looser fabrics reduce friction, but they rarely settle established acne alone.
Is it acne or fungal acne?
Malassezia folliculitis, often called fungal acne, is driven by yeast. It shows up as uniform bumps of one type, often itchy, commonly on the chest, back and shoulders. It does not respond to usual acne treatment, and some antibiotics can make it worse. If several acne treatments have not helped, ask whether this may be the cause.
How does Dr Sin Yong approach acne?
Dr Sin Yong grades the acne and rules out look-alikes such as fungal folliculitis before choosing anything. Where adult jawline acne comes with irregular periods or excess hair, he looks for a hormonal cause, which may mean blood tests. Any existing scars are mapped at the same examination.
Medicine comes first, and laser sits alongside it, never in its place. He prescribes at the clinic where a medicine suits you, and sets the first review when the plan is made. At that review he decides whether to continue, adjust or add a step.
He declines a light-only plan, because a laser does not act on oil production or blocked follicles. Scar work waits until active acne is under control.
Acne that is very severe, unusual or linked to another medical condition is referred to a dermatologist.
“Getting the acne controlled first isn't a delay. It's the sequence.”
Acne treatment in Singapore: medical management
Medicine is the first-line step. Topical and oral options target skin-cell build-up, oil, bacteria, or more than one of these at once. Some need a check before starting and monitoring during use. Your doctor goes through the side effects of each option first. Some medicines act on one driver and others on several, and the choice follows your grade.
Which acne treatment suits which grade?
Treatment steps up with the grade, starting with the least invasive option that fits. Over-the-counter products suit occasional spots, and prescription treatment starts when acne persists, inflames or marks. The 2024 American Academy of Dermatology guideline made 18 recommendations, strongly recommending benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline, with isotretinoin for severe acne. [4]
| Step | What it involves | Usually considered for |
|---|---|---|
| Skincare and over-the-counter care | Gentle cleanser, non-comedogenic moisturiser, sunscreen; benzoyl peroxide or salicylic acid | Occasional spots or a few comedones, with no marks |
| Prescription topicals | Retinoids, antimicrobials and fixed combinations | Persistent comedonal or inflamed acne, or acne leaving marks |
| Oral treatment | A time-limited antibiotic course with a topical, or hormonal therapy for some women | Moderate inflamed acne, widespread body acne, cyclical jawline acne |
| Oral isotretinoin | A monitored course with strict pregnancy prevention | Nodulocystic or scarring acne, or acne that has not responded |
| In-clinic support | Laser directed at inflammation, alongside medicine | Inflamed acne, at any step |
| After control | Pigment care for marks, scar treatment for pits | Once active acne is quiet |
What do acne medicines act on?
Each medicine acts on one or more of the four drivers. The choice follows your grade, and side effects are discussed before any course starts.
| Medicine | What it acts on | Limits and checks |
|---|---|---|
| Topical retinoids, such as tretinoin or adapalene | Shedding inside the follicle, which blocks pores | Dryness and an early flare; avoided in pregnancy |
| Benzoyl peroxide, azelaic acid, topical antibiotics | Bacteria and inflammation in the follicle | Topical antibiotics are paired with benzoyl peroxide to limit resistance |
| Oral antibiotics, such as doxycycline | Inflammation and bacterial load | A time-limited course; avoided in pregnancy; can worsen fungal folliculitis |
| Hormonal therapy, such as spironolactone or some combined pills | The effect of androgens on oil glands | Not used in men or in pregnancy; may need blood tests |
| Oral isotretinoin | Oil gland activity, and several drivers at once | Strict pregnancy prevention, blood tests and regular review |
Can laser treat acne?
R2 Glow works on inflammatory activity in the skin, not on pigment.
Directed at inflammation around the follicle and at the blood vessel component.
Neither laser takes the place of medical care. Light does not reduce androgen-driven oil or follicle blockage, so a light-only plan addresses just one driver of the four.
How strong is the evidence for light and laser in acne?
It is weaker than the evidence for medicines. A 2016 Cochrane review of 71 randomised trials with 4,211 participants found high-quality evidence on light therapies for acne lacking. Most trials were small, about two-thirds were industry-sponsored, and none of the trials it included studied the lasers named here. [6] That is one reason R2 Glow and the 675 nm laser sit alongside medicine, not in its place.
Some newer lasers, at 1726 nm, are built to heat the oil glands rather than the inflammation. They are not among the lasers listed on this page.
Do facials, peels or cortisone injections help acne?
They can support a medical plan, but none of them treats the processes that cause acne. A Hydrafacial is not used here as an acne treatment, and extraction is avoided over inflamed or cystic spots. A dilute steroid injection into one painful cyst aims to calm that lesion only. It does not stop new cysts and can leave a dent or pale patch.
Are dark acne marks the same as scars?
Post-inflammatory hyperpigmentation is a colour change. The skin surface stays intact. In Fitzpatrick III to V skin, which covers most of Singapore, these marks can be the longer-lasting problem. Scarring is a change in structure, with ice-pick, boxcar and rolling types. Each needs a different approach, so assessment separates the two. A dark mark is pigment in skin that is still whole. A scar is a change in the skin itself, so treating one as the other misses the problem.
The order of treatment matters
Why can acne look worse before it settles?
Topical retinoids speed up the shedding of cells in the follicle, which can bring blocked pores to the surface at once. This temporary flare is called purging, and it often comes with dryness. Purging shows as your usual kind of spots, in your usual areas, during the early weeks of regular use. Spots in new areas, burning or lasting redness point to irritation instead, and the plan may need to change.
Why does acne come back?
Acne is managed over time rather than settled in one course, and its drivers can return. Hormonal shifts, stopping a plan early, new pore-blocking products and some medicines can all bring it back. Most plans move into a maintenance stage once things are calmer, often with a topical treatment used long term. Acne that returns is reassessed, because its pattern may have changed.
What acne treatment cannot do
Treatment for active acne does not remodel scars that have already formed. Laser alone cannot manage acne. Usual acne treatment will not resolve fungal folliculitis. No single method fits every presentation, and timing cannot be quoted in advance. Laser in particular addresses only inflammation, so it cannot stand in for medical care.
What are common acne mistakes?
Pushes inflammation deeper and raises the risk of a mark or scar.
Acne is not a hygiene problem, and scrubbing irritates inflamed skin.
Leaves the drivers in place, so spots often return.
Raises irritation, which can leave dark marks in Asian skin.
Bleaching creams and DIY acids bought online can burn or mark the skin.
How does acne treatment change in pregnancy and breastfeeding?
Several standard acne medicines are avoided in pregnancy, so the plan changes and is agreed with your obstetrician. Tell the clinic if you are pregnant, planning a pregnancy or breastfeeding.
| Group | Examples |
|---|---|
| Avoided in pregnancy | Isotretinoin, oral tetracyclines such as doxycycline, topical retinoids, spironolactone, hydroquinone |
| Generally used after discussion | Azelaic acid, topical clindamycin, benzoyl peroxide on limited areas, low-strength glycolic acid |
| Deferred until after delivery and breastfeeding | Lasers, energy devices, injectables, medium-depth peels and scar work |
| While breastfeeding | A plan built around feeding, widened once it ends |
Do teenagers get the same acne treatment as adults?
The principles are the same: the grade decides the plan. Topical retinoids and benzoyl peroxide form the base, and oral treatment follows the grade. Some acne through puberty is normal, but painful lumps, marks or dents are treated early, because scars are made while acne is active. For anyone under 18, a parent or guardian attends, gives consent and takes part in the plan.
Who needs more care
Suitability is decided in person, and no single approach fits every presentation. Some medicines need assessment and monitoring, so they are not simply started on request. Deep, tender nodules or cysts deserve early medical attention because of the link with scarring. Uniform, itchy bumps on the chest or back should raise the question of fungal folliculitis, as some antibiotics can worsen it. Back, chest and shoulder acne is common, and it gets the same assessment as acne on the face. Surface area and how easily an area can be reached then shape the plan.
When should I see a doctor for acne, and who can I see?
Book a doctor's assessment if spots hurt, leave marks or dents, or have not eased after a few months of steady over-the-counter care. Sudden adult acne with irregular periods, excess hair or scalp thinning, uniform itchy bumps, or acne that flares after a new medicine are also reasons.
Polyclinics and GPs assess and treat acne. Subsidised National Skin Centre appointments are for eligible Singapore citizens and PRs referred by a polyclinic, a CHAS clinic or a subsidised public hospital clinic. A private doctor can see you without that referral.
What are the side effects, and when should I call?
Every option carries side effects, and they are explained before you start. See complication care for more.
Dryness, peeling and early purging with retinoids. Mild redness and warmth after laser.
Pigment change, blistering or infection after laser, more often in darker skin. Oral medicines carry their own effects, and some need blood tests.
Report any change in mood or low spirits to your prescriber promptly. Thoughts of harming yourself need urgent help: go to A&E or call 995.
Fever, spreading redness, pus, or a red hot lump: a doctor the same day, or A&E if none can see you. A rash, a severe headache or a change in vision while taking an oral medicine also needs same-day advice.
Trouble breathing or swallowing, or swelling of the tongue or throat.
How much is acne treatment in Singapore?
Fees are not published. They depend on your grade, whether medicine alone or a combined approach is needed, the areas involved, and how the plan is staged. Cost is set out at consultation, before anything is agreed. A plan for the face differs from one that also covers the back, chest and shoulders.
Why is the fee set only after assessment?
The plan does not exist until the acne is graded and look-alikes are ruled out. Topical care for comedonal acne on the face and a combined plan for nodular acne across the back are different undertakings. A written quote follows the examination, and the consultation can end with no treatment advised. The process is set out under how quotes are given.