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  • Dr. Henry Ngai

Is Acne Normal and Why Do I Have It?


Acne is a common problem in any medical and skin care practice. It affects a large portion of younger people in the society, men or women alike. For some, acne can be just an annoyance. However, for may, acne is disfiguring and causes emotional distress in the sufferer.


While many acne sufferers obtain reasonable control with over-the-counter acne products, some do not. By the time a patient presents himself or herself at the clinic, the patient has already tried a number of treatments and is often disappointed with the response.


Acne occurs at the time of puberty when there is a surge in male hormones or androgens in the body. All humans produce male hormones but, in the female, much of male hormones are converted to the female version. Androgens cause the sebaceous glands to secrete more sebum and thickening of the lining of the glands. The opening of the sebaceous glands become blocked with the accumulation of sebum within, leading to comedomes. The trapped sebum is a perfect breeding ground for bacteria which digest the sebum and produce inflammatory mediators which lead to swelling, redness and pus formation at the glands.


Lifestyle, food, choice of skin products, make-ups, medications and stress can affect the severity or acne. With COVID 19, the clinic is seeing more mask-related acne, even in people who have no acne issue in the past.


When one realizes the multifaceted etiology of acne, treatment of it is not one size fits all. Very often, we use a combination of topical therapies, oral medication and skincare regimen. Age, gender, lifestyle, skin sensitivity, past treatment experience and severity of acne are just some of the factors we consider when coming up with a treatment program.


For many people, light, lasers, chemical peels and acne surgery are great adjuncts to acne treatment. It significantly speeds up the clearing of the acne, brightens up the skin and reverses the scaring process. People who are on isotretinoin can also undergo acne treatment of such. In fact, my experience shows that these individuals have remarkably much better response to treatment than people who are not on it.


Acne treatment is typically long term. We have a discussion with the patients during those initial visits to counsel them regarding the importance of adhering to the treatment regime. No matter how well we can “fix” their acne, it is likely that they have to continue to use the acne products to minimize future breakouts.


For patients with acne recurrence, we can sometimes identify triggering factors, such as school examination, diet change, work stress, or a change in skin care products. No matter what it is, we diligently go through the patient’s history to see how we can help the patients to recognize these acne triggers and make the change. We might have to use a different regimen to treat their acne from the first time.


Acne is a challenging problem in some people. A careful history and skin analysis are necessary to direct a proper treatment regimen. Acne treatment is often long term but the result is gratifying. In-office acne treatment at our clinic in an integral part of a successful strategy in dealing with acne.

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