As the rainy season approaches, the extra humidity can really mess with our skin by blocking our pores, causing breakouts and worsening existing acne. This can knock our confidence and self esteem, making us hesitant to go out or participate in everyday activities and has us just not feeling like our best self. And unfortunately acne is not always limited to teenagers, adult acne can be something we are faced with in our twenties, thirties and even forties!  Luckily, there are things that we can do to improve the quality and appearance of our skin during the wet season, but first let’s unravel the mystery of acne and pimples.

So what is acne? What are pimples? 

The skin on our face has ‘sebaceous glands,’ or as we’ll call them, the ‘oil factories.’ These factories work tirelessly to keep your skin hydrated. Some people have more active oil glands than others; this is the determinant of whether we have dry or oily skin and sometimes this process can be affected by circulating hormones like testosterone. Those that produce more oil than needed can end up having blocked pores, leading to inflammation and those pesky red bumps we all know too well.

Another way that pores get blocked can be due to increased humidity, something we are all familiar with, living in Singapore. High humidity can irritate the very sensitive oil factories to produce more oil than is necessary and in turn cause blocked pores, inflammation and acne. Sometimes acne can be exacerbated by a bacteria called Propionibacterium acnes. This bacteria normally lives on our face, along with many other organisms and we usually get along peacefully, until it overgrows or takes advantage of its environment. It thrives in the clogged pores and adds to the inflammation.

So what can be done to clear up the acne? Here are some general measures at home you can take action yourselves:

1. Cleanse Like a Pro: Twice daily cleansing is essential. 

Choose the right cleanser for your skin type: gentle for dry skin, and for oily skin, something more robust. 

Over the counter face washes that contain salicylic acid can be useful. And remember, just like you’d never go to bed angry, never go to bed with makeup on —your skin will thank you!

2. Double Trouble Cleansing: If you’ve been wearing make up or sunblock, double cleansing ensures that all the product is removed from your face and from your pores.

It is important to point out that excessive washing (more than what I have suggested) can cause dryness and dermatitis.

3. Post-Workout Ritual: If you’re a gym enthusiast, cleanse immediately after sweating it out. Sweat is another culprit that can clog those pores.

4. Healthy Environment: Make sure that you’re changing your face towels and pillowcases regularly or the bacteria and oil will just slide back onto your face after cleansing.

I suggest using a different face towel every 1-2 days and changing your pillowcase 1-2 x a week if you’ve got acne prone or oily skin. 

5. Moisturise Wisely: For oily skin, opt for lighter, water-based, oil-free products.

Your skin will breathe a sigh of relief.

6. Exfoliation Station: Weekly exfoliation is quite beneficial for oily skin. This removes dead skin cells and unblocks pores.

You can exfoliate mechanically; with something like a face scrub and this physically clears and unblocks the pores or you can exfoliate chemically; usually acids which strip away the top layer of your skin, unblock pores and allow new skin to grow freely.

One of my favourite over the counter skin products are ‘daily’ skin peels, which I only use 1-2 x a week before moisturising at night. 

7. Sunscreen Savvy: Sunscreen is a non-negotiable, but choose lightweight options to avoid clogging pores. And as a side note, always go for the 50+ SPF that covers both UVA and UVB. 

8. Hands Off: Resist the urge to pick or squeeze pimples.

It’s a fast track to infection and scarring.

9. Healthy Body: Food, alcohol and smoking can affect our skin more than we realise.

Be mindful of this when making such choices in your daily life. 

If all of the above doesn’t help and/or you get acne throughout the year, then please see your GP, and these are some of the things that we can do. 

Those with mild acne, your doctor can prescribe one or a combination of the below:

• Benzoyl peroxide

This is essentially an antiseptic and it reduces the amount of bacteria on your face. To better explain what it does – it’s essentially a medical grade, heavy duty cleanser for people with oily skin and inflammatory acne. The most common side-effect is skin irritation – dryness and redness. If necessary, you can switch to a lower strength.

• Retinoid creams

These are vitamin A based products that work by promoting cell turnover, which removes dead skin and unblocks pores. 

• Topical antibiotics

These are better given in combination with other products, like the above. They are good in mild inflammatory acne (red, painful pimples), but won’t do much for small, flesh coloured ones or blackheads. Used alone topical antibiotics can increase bacterial resistance. 

If you have moderate acne (lots of red pimples) or you don’t respond to creams/gels, then the next step would be oral treatment. 

• Oral antibiotics

Such as Doxycycline, which you would take once a day for 3-6 months. This fights the bacteria on your skin, but also reduces the inflammation in the pores. You need to take it with food, as it can give you a bit of reflux or vomiting on an empty stomach. It can also make you more sensitive to the rays of the sun, so slip on that sunscreen more often than usual. 

• An alternative oral therapy for our female patients is the contraceptive pill.

Not every pill is created equal, so we have to choose a combined pill that has an oestrogen (great for skin) and a specific type of progesterone which blocks the male hormone (testosterone) responsible for triggering our oil glands and subsequently exacerbating acne. 

In severe acne cases, isotretinoin, an oral and potent form of vitamin A may be the answer. 

This treatment is very effective, but it comes with responsibilities: blood tests, discussions about side effects, and strict birth control for women. 

Blood tests are necessary before starting isotretinoin and then every 3-6 months thereafter. The reason for this is that isotretinoin can rarely affect your liver function or your cholesterol levels. If this happens, we usually just stop the isotretinoin and keep checking your blood test until it normalises. 

In female patients it’s very important to recommend two forms of contraception while on this medication and for a month after stopping. This is because if anyone gets pregnant while taking this medication, the likelihood of there being a deformity to the baby is really high. You are also not allowed to donate blood while taking isotretinoin for this very reason. 

There have also been some studies that have suggested that isotretinoin can affect mood negatively in a small number of people, so it’s generally not advised to start this if you have a history of depression. The duration of treatment can vary, depending on response, but generally as a rule, it is good to remain on isotretinoin for 6-9 months after you get your perfect skin. This reduces relapse episodes by 50%.

See your GP for assessment to make sure that acne is not caused by something else more serious such as:

• Polycystic ovarian syndrome, this is a hormone imbalance that can occur in women and is likely if acne is coupled with irregular periods and/or weight gain and/or extra body hair. 

• Some regular medications can trigger acne, we can check your medications.

• Stress can most definitely exacerbate acne, so it’s important to address this with your doctor or psychologist. 

In addition, what you’re experiencing may not be acne, it’s important to have an assessment with your doctor if you’re unsure:

• If you have pimple like lesions with lots of redness and sensitivity to sunlight, this could be rosacea

• If you have pimple like lesions around the nose and/or mouth only, you could be experiencing periorificial dermatitis

• If your ‘acne’ is centred around the T zone and around the hairline /scalp with scaly, flaky skin, this could be seborrheic dermatitis

Well, I hope you’ve learned something about acne from this article and you now have a plan for the rainy season. Don’t put up with feeling down about yourself because of acne when there is so much we can do! I hope you feel empowered to take action and feel confident. 

This article is written by Dr Sanja Cook, who is based in IMC Katong. Click here to book an appointment to see her or call +6733 4440 (ext. 4).