If you’ve been struggling with breakouts for months despite using countless skincare products, it may be time to see a dermatologist in Singapore who specializes in acne treatment. Over-the-counter treatments can often help with mild acne, but recurring, painful, or scarring breakouts require a professional evaluation. Dermatologists can identify underlying causes, such as hormonal imbalances or bacterial resistance, and offer prescription solutions that address multiple factors at once.
Deep, painful cysts that won’t come out
Did you know that deep cystic acne can damage surrounding tissue without even forming visible whiteheads? Cystic acne occurs when infection and inflammation occur deep within hair follicles, creating dense nodules measuring 5 mm or more beneath the skin’s surface. These lesions remain painful for several weeks without forming visible whiteheads, which distinguishes them from pustular acne, which develops a shallow purulent center within a few days. The depth of cystic lesions makes them inaccessible to the active ingredients of over-the-counter (OTC) products, which typically only reach the epidermis and upper dermis.
Nodular and cystic lesions cause inflammatory reactions that destroy the surrounding collagen and elastic tissue, creating atrophic or hypertrophic scars even after the acne has resolved. Inflammatory mediators released by deep cysts—including interleukins, tumor necrosis factor, and matrix metalloproteinases—exacerbate tissue damage, which topical treatments cannot adequately prevent. Professional treatment includes intralesional corticosteroid injections to reduce inflammation.
Oral Isotretinoin is a treatment choice for severe cystic acne, targeting all four pathogenic factors: sebum production, follicular hyperkeratosis, Cutibacterium acnes proliferation, and inflammation. The drug may induce remission by atrophying sebaceous glands and normalizing keratinisation. Dermatologists monitor liver enzymes and lipid profiles and implement pregnancy prevention protocols during isotretinoin therapy because of its teratogenic effects.
Alternative systemic treatments include oral antibiotics combined with topical retinoids to achieve anti-inflammatory effects in addition to the antimicrobial impacts. Hormonal therapy using combined oral contraceptives or spironolactone aims to suppress androgen-induced sebum production in women with cystic acne on the jaw and lower face.
Acne is spreading to multiple areas of the face.
The spreading of acne from isolated areas simultaneously to the forehead, chin, cheeks, and jawline indicates systemic factors that require comprehensive treatment. This pattern suggests hormonal fluctuations, elevated cortisol levels due to stress, or the development of bacterial resistance to topical antimicrobials. The pattern of spread provides diagnostic clues: predominance of acne on the jawline suggests a hormonal aetiology, while consistent facial involvement suggests severe comedogenic or inflammatory processes.
A dermatological examination includes hormone levels (free and total testosterone, DHEA-S, luteinizing hormone, and follicle-stimulating hormone) in cases of widespread acne in adult women or in the presence of hirsutism and irregular menstruation. Bacterial culture and antibiotic susceptibility testing identify antibiotic-resistant strains of Cutibacterium acnes if lesions do not respond to standard topical antibiotics. Wood’s lamp examination shows folliculitis caused by Malassezia masquerading as acne, requiring antifungal rather than antibacterial therapy.
Combination therapy becomes important when acne affects multiple areas of the face and presents different lesion types. Dermatologists strategically administer treatments: retinoids for comedones, benzoyl peroxide and antibiotic combinations for inflammatory areas, and azelaic acid for post-inflammatory hyperpigmentation. Chemical peels using glycolic or salicylic acid accelerate cell turnover in affected areas while reducing bacterial load by altering pH.
Professional extraction procedures remove deep comedones and milia, which, if left untreated, perpetuate inflammatory cycles. Photodynamic therapy, which combines aminolevulinic acid with blue light, reduces sebaceous gland activity and bacterial populations over large areas of the face. Laser treatments using diode or erbium lasers directly target the sebaceous glands, stimulating collagen remodelling in acne-damaged skin.
Dark spots and sunken scars are forming.
Post-inflammatory hyperpigmentation (PIH) appears as brown or purple spots that persist for months after acne has healed. At the same time, atrophic scars create permanent textural changes, including “ice spike,” “box,” and “ripple” scars. Early scar formation indicates inflammatory processes that exceed the skin’s regenerative capacity, requiring intervention to prevent irreversible damage to the appearance. The time needed to avoid scar maturation is 12-18 months after injury, so prompt treatment is essential.
Did you know?
Acne scars form as a result of abnormal wound healing, when inflammation destroys the dermal structure faster than fibroblasts can deposit organised collagen, creating depressions that cannot be addressed by standard skin care once fully matured.
Dermatological scar prevention involves early anti-inflammatory treatment using combination therapy: topical retinoids increase cellular turnover, preventing follicle blockage, while oral antibiotics inhibit the release of inflammatory mediators. Silicone gel patches or topical silicone preparations applied to healing lesions modulate fibroblast activity and collagen organisation during the remodelling phase. Intralesional steroid injections facilitate the hypertrophic scars and keloids that form as a result of severe inflammatory acne.
For older scars, fractional CO2 laser resurfacing creates controlled microdamage that stimulates neocollagenesis while preserving surrounding tissue for rapid healing. The laser penetrates to a depth of 400-1400 micrometres, reaching the reticular dermis, where structural protein regeneration occurs. Treatment parameters should be determined by a medical professional based on the individual characteristics of the scar.
Subcision procedures release fibrous bands that adhere scars to the underlying tissue, which immediately improve contour irregularities. The procedure involves inserting a triangular needle parallel to the skin surface, mechanically disrupting scar adhesions, and stimulating wound healing. Chemical reconstruction of cutaneous scars (CROSS) involves the local application of high-concentration trichloroacetic acid to “ice-needle” scars, which causes controlled coagulation and subsequent collagen remodelling.
Dermal plasters containing hyaluronic acid or poly-L-lactic acid provide immediate volume restoration of atrophic scars while stimulating long-term collagen production. Platelet-rich plasma injections deliver growth factors that accelerate tissue regeneration when combined with microneedling or laser treatments.
Impact on Daily Life and Self-Esteem
Acne that interferes with productivity or social interactions, or that causes ongoing concern about skin appearance, requires professional psychological and dermatological care. The two-way relationship between stress and acne creates a persistent cycle: stress increases cortisol and androgen production, which worsens acne, while visible breakouts cause additional psychological stress. Dermatologists assess the impact on quality of life using validated tools such as the Dermatological Quality of Life Index or the Acne Quality of Life Questionnaire.
Important Note
Acne-related depression or social isolation requires professional attention, as dermatological treatment combined with psychological support can improve both skin condition and mental well-being. Acne treatment aims to address psychosocial consequences by eliminating breakouts using a combination therapy tailored to the individual’s disease manifestations. Oral Isotretinoin offers psychological benefits by improving symptoms in severe cases, although monitoring mood swings remains vital during treatment. Spironolactone is helpful for women with hormonal acne who also have premenstrual symptoms.
Our dermatologist says
Clinical experience shows that patients often delay seeing a specialist for months of unsuccessful self-treatment before seeking help, during which time the risk of scarring increases significantly. The cost of dermatological treatment is usually lower than the total cost of ineffective over-the-counter treatments, especially over the long term. Modern acne treatments offer better results than those available even ten years ago, thanks to integrated approaches that simultaneously address multiple pathogenic factors.
Treatment plans are adjusted based on the body’s response – initial therapy controls active breakouts, followed by maintenance therapy to prevent relapses. The therapeutic relationship allows for ongoing adjustments in treatment, taking into account lifestyle changes, hormonal status, and skin tolerance over time.
Concealing with mineral makeup can boost self-confidence while treatments are available. Dermatologists recommend non-comedogenic formulas with green-tinted primers to neutralise redness, followed by foundation and setting powder in the same shade. Learning how to apply the product correctly ensures coverage without aggravating acne with occlusive products or dirty applicators.
Cognitive behavioural therapy, combined with dermatological treatment, aims to correct negative thought patterns and avoidance behaviours that exacerbate stress-related acne. Stress-reduction techniques, such as mindfulness meditation and progressive muscle relaxation, can help reduce cortisol-induced acne flare-ups. Participation in support groups brings together patients facing similar challenges, reducing isolation and allowing them to share coping strategies.
Practical Application
- Document the nature of your breakouts for 2 weeks, recording the types of lesions, their locations, and their relationship to your menstrual cycle, stress, or dietary factors, to inform the evaluation during your consultation.
- Take weekly photographs of affected areas using consistent lighting and angles to monitor progress objectively, rather than relying on daily mirror checks, which may miss gradual changes.
- Discontinue using harsh scrubs, alcohol-based toners, and over-cleansing, which disrupt the skin’s barrier function and can worsen inflammation.
- Maintain your current gentle cleansing regimen with over-the-counter products while you wait for your professional consultation, rather than starting new products that may complicate the assessment.
- Develop a list of previously used treatments, including duration of use, concentration, and specific product names, to assist in selecting prescription medications.
When to seek professional help:
- Cysts or nodules larger than 5 mm that persist for more than two weeks
- New breakouts are appearing faster than previous breakouts heal
- Brown or purple spots that remain visible three months after breakouts have healed
- Development of sunken or raised scars at the site of prior breakouts
- Presence of acne on the jawline and lower face in adult women
- Breakouts that cause pain that interferes with sleep or daily activities
- Avoiding social situations because of skin appearance
- Using over-the-counter medications for 12 weeks without improvement
Next Steps
Early intervention prevents the formation of persistent scars, which become increasingly challenging to treat as they progress. Dermatologists develop individualised treatment plans that address both active breakouts and existing skin lesions, using medications and procedures. A professional assessment allows us to differentiate between types of acne that require different dealing approaches.
Whether you have persistent cystic acne, rapidly spreading facial breakouts, or early scarring, a Department of Health-certified dermatologist can perform a comprehensive evaluation and offer treatment options beyond over-the-counter options.
Frequently Asked Questions
How quickly do prescription medications work compared to over-the-counter (OTC) treatments?
Prescription medications typically show initial improvement within 4-6 weeks, with significant improvement occurring by week 12. Oral antibiotics reduce inflammation within 2-3 weeks, while Isotretinoin may cause a temporary worsening of the condition before improvement begins around week 6-8. Prescription retinoids and OTC retinol differ in bioavailability and receptor binding.
Do I need to take prescription medications continuously?
The duration of treatment depends on the type of medication and the severity of my acne. Oral antibiotics are usually continued for 3-6 months, after which maintenance therapy with topical treatments is initiated. Treatment with Isotretinoin lasts for 16-24 weeks, after which many patients experience continued remission. Hormonal medications may be used for more extended periods if they provide additional benefits beyond acne control. Prescription topical medications are often switched to a maintenance regimen with reduced frequency of use after improvement is achieved.
Can laser treatments replace prescription medications for severe acne?
Laser and light therapy complement, but rarely replace, systemic medications for severe inflammatory or cystic acne. These treatments can help reduce the number of active lesions and prevent scarring when combined with drug therapy. Photodynamic therapy may be effective for moderate inflammatory acne. Energy-based devices provide maintenance therapy after improvement is achieved with systemic medications.
What is the difference between visiting a general practitioner and a dermatologist in Singapore?
Dermatologists undergo additional specialised training after medical school, focusing on skin diseases. This training allows them to accurately diagnose different types of acne, identify related hormonal imbalances, and prescribe prescription medications such as Isotretinoin. Dermatologists perform procedures, including chemical peels, laser treatments, and scar correction, that are not available in general clinics.