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Guide To Acne Treatments Prescribed By Dermatologists In Singapore

Credit: Siena Health

While there are tons of home remedies or over-the-counter (drug store) acne products out there that promise help, not all of them are backed by research and they may not work for stubborn/more severe acne.

In this article, we share the common acne treatments prescribed by dermatologists, their costs and how/where to get them in Singapore.

What Causes Acne? 

Acne vulgaris (medical term for acne) forms when a combination of sebum and dead skin cells build up in your pores and hair follicles, creating a blockage.

Your sebaceous glands create sebum to lubricate your skin and hair. Under normal circumstances, this is a good thing because this sebum also forms a barrier on your skin, protecting it from things like bacteria and other harmful environmental factors.

However, certain things can cause your body to kick its sebum production into high gear, which can lead to blocked pores, pimples, blemishes, and acne. 

Why Use Prescription Acne Medication?

While over-the-counter acne medications are effective at managing minor outbreaks of facial acne, many people experience persistent/more severe acne that just doesn’t go away with regular, store-bought treatments.

Prescription Strength Acne MedicationPrescription Strength Acne Medication
PotencyLow concentrationMore powerful with higher concentrations of active ingredients
AvailabilityCan be bought off the shelfAvailable by prescription only, after a doctor’s evaluation
UsageFor general public useIntended to be used by one person (patient himself/herself)
Over-the-counter Acne Products vs Prescription Strength Acne Medication

Common Acne Treatments Prescribed By Dermatologists

Acne can occur for a variety of reasons, ranging from skin bacteria to excessive levels of sebum production. Because of this, there are several different types of prescription drugs used to treat acne. And for each of those specific drug types, there are specific drugs that fall under them.

Prescription Topical Treatments (Gel/Cream)

Ingredient(s)How it works
AdapaleneAdapalene is a retinoid, a form of vitamin A. It works by exfoliating the skin (removing dead skin cells) to prevent blocked pores and soothes inflammation.

Known brands: Differin
Adapalene + Benzoyl peroxideAdapalene is a type of retinoid. It works by exfoliating the skin (removing dead skin cells) to prevent blocked pores and soothes inflammation. Benzoyl peroxide is an antimicrobial agent that works to soften and peel the skin’s outer layer as well as tackle the microbes which can trigger acne.

Known brands: Epiduo gel 0.1%/2.5% pump
ClindamycinClindamycin is an antibiotic that kills acne-causing bacteria. 

Known brands: Dalacin T gel
Clindamycin + Benzoyl peroxideClindamycin is an antibiotic that kills acne-causing bacteria. Benzoyl peroxide is an antimicrobial agent that works to soften and peel the skin’s outer layer as well as tackle the microbes which can trigger acne.

Known brands: Clindoxyl
Tretinoin Tretinoin is a retinoid, a form of vitamin A. It works by exfoliating the skin (removing dead skin cells) to prevent blocked pores and soothes inflammation. 

The main difference between Tretinoin and Adapalene is that Adapalene is used for acne, while Tretinoin can be used for acne and hyperpigmentation.

Known brands:
Stieva-A 0.025%, Stieva-A 0.05%, Retacnyl 0.025%, Retacnyl 0.025%
Common Topical Acne Medications Prescribed by Derms

Prescription Oral Medications

For mild to moderate acne, topical treatments alone can generally calm a breakout. However, in moderate to severe cases, oral medications may be prescribed to treat stubborn acne. 

Ingredient(s)How it works
DoxycyclineDoxycycline is an antibiotic that suppresses the growth of acne bacteria and decreases inflammation.

Known brands: Medomycin
Combination birth control pillsWomen with hormonal acne may be treated with combination birth control pills. These medications regulate hormones that can cause acne through a decrease in oil production.

Known brands: Yaz, Drospera (Generic Yaz), Yasmin, Liza (Generic Yasmin), Diane-35
SpironolactoneFor women with hormonal acne, Spironolactone slows down the body’s production of androgen hormones, such as testosterone. These hormones can make the skin produce too much oil, which clogs pores and causes acne. 

Known brands: Uractonum
IsotretinoinIsotretinoin is a potent oral medication that reduces the amount of sebum (oil) produced by the glands in the skin and clears inflammation. The use of Isotretinoin requires careful monitoring due to potential side effects.

Known brands: Acnotin, Accutane, Roaccutane, Oratane
Common Oral Acne Medications Prescribed by Derms

Which Acne Medication is Best For You?

The best acne medication for an individual can vary depending on various factors, including the type and severity of acne, skin type, medical history, and individual response to different treatments.

Because of this, there’s no “best” acne medication for everyone. The best approach is to consult with a dermatologist or healthcare professional who can evaluate your specific situation and provide tailored treatment options to help you manage your acne effectively.

Your provider may prescribe topical medication(s), oral medication(s) or a combination of both to address different aspects of acne formation, such as bacteria, inflammation, and excessive oil production.

Cost Of Acne Medications In Singapore

For most cases of mild to moderate acne conditions, the costs are relatively cheaper. Treating cystic acne may take a longer time as the chances of recurrence are higher.

At Siena, we offer a customised acne treatment plan based on your needs and budget:

  • Tele-consultation: $20
  • Topical medication: from $38
  • Oral antibiotics: from $24/month
  • Oral hormonal medication: from $12/month
  • Oral retinoids: from $68.50/month
  • Delivery: $0

Depending on the severity of the acne condition, the price will vary.

How To Get Prescribed Acne Medication

Traditionally for prescription products, you’d have to visit a medical provider in person to get a prescription. 

But now, thanks to the internet and technology, you can access prescription acne medication via virtual medical visits at Siena, a MOH-approved telemedicine provider. 

Telemedicine For Acne In Singapore

Whether you are struggling with hormonal acne, adult acne, cystic acne, persistent acne etc, simply answer an online medication evaluation to book a tele-consultation session ($20) with a licensed doctor at your convenience. If prescribed, your medication will be delivered discreetly, at no additional cost.

References

Acne (2012). Retrieved from https://www.womenshealth.gov/a-z-topics/acne

Physiology, Sebaceous Glands, (2021). Stat Pearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499819/

Makrantonaki, E, Ganceviciene, Zouboulis, C (2011, Jan-March). An update on the role of the sebaceous gland in the pathogenesis of acne. Dermato Endocrinology. 3(1), 41-49. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051853/

Zeichner, J. A., Baldwin, H. E., Cook-Bolden, F. E., Eichenfield, L. F., Fallon-Friedlander, S., & Rodriguez, D. A. (2017). Emerging Issues in Adult Female Acne. The Journal of clinical and aesthetic dermatology, 10(1), 37–46.retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300732/

Koster, M.I. (2009, July). Making an epidermis. Annals of the New York Academy of Sciences. 1170, 7-10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861991/

Acne: Tips for Managing. (n.d.). Retrieved from https://www.aad.org/public/diseases/acne/skin-care/tips

Clindamycin Topical. (2016, October 15). Retrieved from https://medlineplus.gov/druginfo/meds/a609005.html

Tretinoin Topical. (2019, March 15). Retrieved from https://medlineplus.gov/druginfo/meds/a682437.html

Baldwin, H. (2020). Oral Antibiotic Treatment Options for Acne Vulgaris. The Journal of Clinical and Aesthetic Dermatology. 13 (9), 26–32. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577330/

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Skin

Isotretinoin for Acne: How It Works, Potential Side Effects And Where To Buy In Singapore

Isotretinoin for Acne: How It Works, Potential Side Effects And Where To Buy In Singapore
Image credit: Gabriella Cetrulo

Acne is a common skin condition that affects over 80 percent of people at some point in life. 

While over-the-counter acne treatments are usually successful for light acne breakouts, many products that are great for milder forms of acne are almost totally ineffective against severe or persistent pimples. 

Commonly known by its original brand name Accutane, Isotretinoin is a potent drug that is U.S. Food and Drug Administration (FDA) approved in 1982 for hard-to-treat acne.

Read on to find out:

  • What is Isotretinoin;
  • How does Isotretinoin works;
  • How effective is Isotretinoin;
  • How to take Isotretinoin;
  • What to do if you missed a dose;
  • Potential side effects;
  • Pregnancy precautions; and
  • Where to buy Isotretinoin in Singapore.

What Is Isotretinoin?

Isotretinoin is available in capsule form and is a vitamin-A derivative (retinoid). Originally created to treat cancer, it is increasingly prescribed for the treatment of acne.

What Are The Requirements For Taking Isotretinoin?

Isotretinoin is typically used for patients with:

  • Severe, nodular acne or cystic acne; or 
  • Moderate to severe acne that has not responded to other acne treatments (such as over-the-counter treatments, topical benzoyl peroxide, topical clindamycin or oral antibiotics for acne); or 
  • Physical or emotional scarring.

What Is Moderate And Severe Acne?

In moderate acne, individuals present with more widespread blackheads and whiteheads, with many papules and pustules. Papules are small red bumps that may feel tender or sore. Pustules are similar to papules but have a white tip in the centre, which is a collection of pus.

In severe acne, individuals present with lots of large, painful papules, pustules, nodules or cysts; you might also have some scarring. Nodules present as large painful bumps and can be red or skin-coloured. Cysts are the most severe forms of acne. They are large and painful and often look like boils. Compared to nodules, cysts feel softer and are pus-filled.

What Is The Right Isotretinoin Dosage?

In Singapore, oral isotretinoin is available as 10 mg and 20 mg capsules (Acnotin® brand). Depending on your acne presentation and body weight, the dosage and treatment period required to treat the acne may vary among individuals. Many doctors start their patients on a graduated plan to help mitigate side effects and allow the body to adjust.

Which Brand Of Isotretinoin Is Better?

There are 4 brands of isotretinoin available in Singapore – Acnotin®, Nimegen®, Oratane® and Roaccutane®.

While the brand names are different, all of them contain isotretinoin as the active ingredient and are used for the treatment of moderate to severe acne, which has shown to be successful. They may differ slightly in the inactive ingredients but have little to no impact on the effectiveness of treatment.

How Does Isotretinoin Work?

Isotretinoin works by:

  • Reducing the size of oils glands in the skin and the amount of oil produced
  • Reducing the amount of bacteria in the skin
  • Slowing down the production of skin cells inside pores, preventing clogging of pores
  • Reducing skin inflammation

Unlike spot treatments, the drug addresses acne all over the body, including back, neck, and chest.

How Effective Is Isotretinoin?

First approved in 1982, Isotretinoin remains the most clinically effective prescription anti-acne treatment available that can clear acne and produce long-term remissions.

Isotretinoin is shown to be about 90% effective in reducing acne within 6 weeks of use. Most patients on Isotretinoin will be free of acne by the end of 4 – 6 months of treatment, depending on the dose administered.

How To Take Isotretinoin?

Follow these steps when you are taking Isotretinoin capsules:

  • Isotretinoin is usually taken twice daily for 15-20 weeks, or as directed by your doctor.
  • Swallow the capsule whole with a glass of water.
  • Do not chew or crush the capsule.
  • Take this medication with or after food.

What To Do If I Missed My Isotretinoin Capsule?

If you have forgotten to take a dose of Isotretinoin, take it as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and take the next one at the usual time.

Do not take two doses to make up for the missed dose.

What Are The Potential Side Effects Of Isotretinoin?

As with all medications, Isotretinoin comes with its own set of side effects. These side effects may vary among individuals and tend to subside when you stop taking the medication.

Here are some of the common side effects associated with Isotretinoin:

  • Worsening of acne during the first few weeks before improvement
  • Red, cracked and sore lips. This can be managed by applying lip balm frequently.
  • Irritated and dry eyes. Apply eye drops or artificial tears to relieve the dryness. Do not use contact lenses if irritation persists.
  • Dry skin, sometimes with peeling. Apply moisturiser regularly.
  • Dry mouth. You may drink more water or suck on sweets.
  • Dry nose. In severe cases, nose bleeding may occur. Apply white soft paraffin to the lining inside of your nose. If unresolved, consult your pharmacist or doctor about decreasing the dose of Isotretinoin.
  • Increased risk of sunburn. Avoid direct sun exposure for long durations and wear protective clothing if exposed to direct sunlight. Use a broad-spectrum sunscreen product with a Sun Protection Factor (SPF) of at least 30.

Do not take vitamin A or any vitamin supplement containing vitamin A while using Isotretinoin, unless otherwise directed by your doctor. Doing so may increase the chance of side effects.

If these side effects are persistent or severe, stop treatment immediately and consult your doctor.

Pregnancy Precautions

Isotretinoin can cause very serious birth defects in humans if taken during pregnancy.

Women of childbearing years should rule out pregnancy by taking a pregnancy test before starting treatment. 

For women who are sexually active, it is recommended to use 2 forms of effective birth control while on treatment and at least 4 weeks after stopping Isotretinoin. The most effective forms of birth control are birth control pills, patches, shots, implants or IUD. One of these forms of birth control should be combined with a condom, a diaphragm, or a cervical cap.

Avoid breastfeeding during treatment as it’s unclear if the drug passes to your baby through breast milk.

Blood donation by males and females on Isotretinoin is not allowed in case the blood is used for a pregnant woman.

Where To Buy Isotretinoin In Singapore?

In Singapore, Isotretinoin can only be obtained with a valid doctor’s prescription. 

While extremely effective, Isotretinoin can come with some serious side effects. It is important to use Isotretinoin under the supervision of a doctor. 

At Siena, a MOH-approved digital health clinic, we carry a wide range of acne treatments ranging from topical cream/gel, oral antibiotics, birth control pills to Isotretinoin (Acnotin®). Find out the root cause of your pimples and get a personalised, ongoing acne treatment care plan by connecting with one of our friendly doctors online. Click here to get started!

References

Categories
Birth Control Health Period Skin

Hormonal Acne Breakouts: How can I prevent it?

Do you find yourself breaking out 1-2 weeks before your period every month?

It is likely to be hormonal acne, a flare-up of blemishes every month due to a fluctuation in hormonal levels in the body. These may present as large, painful, cystic acne around the chin and jawline.

Less commonly, hormonal acne may be due to an underlying medication condition such as Polycystic Ovarian Syndrome (PCOS).

Why does hormonal acne flare up before my period?

About 2 weeks before your period, the hormones estrogen and progesterone drop dramatically, while you will also experience a slight increase in testosterone.

The drop in estrogen and progesterone can trigger your sebaceous glands to secrete more sebum – an oily substance that lubricates your skin. This oil provides the perfect breeding ground for bacteria, and thus causes clogged pores, pimples and cystic acne (those somewhat painful bumps just under the skin) – usually around the chin and jawline.

While testosterone is thought of as the ‘male’ sex hormone, it exists in slightly differing amounts in everyone. The increase in testosterone can trigger acne by over-stimulating oil glands, which ultimately creates a fertile breeding ground for bacteria on the skin – resulting in clogged pores and period acne. They can also change the skin cells that line hair follicles, making them sticky and more likely to clog pores.

So what can you do about hormonal acne?

For acne that is related to your period, intervention treatment needs to be hormonal as well to work.

Birth control pills or patch

Hormonal birth control – including birth control pills and patches raise estrogen levels and reduce the effects of testosterone on women. Lower levels of testosterone reduce sebum levels, directly reducing breakouts and possible acne due to less oil and bacteria growth.

According to WebMD, hormonal birth control increase a protein known as “sex-hormone binding globulin” (SHBG) in the blood. In turn, SHBG acts like a testosterone sponge soaking up testosterone in your blood. In simple words, lesser testosterone equals lesser sebum which results in less acne.

Be patient when you first start hormonal birth control to control acne. Some women may experience increased breakouts for the first few months. However, this normally goes away as your body adjusts to the change in hormones.

Some birth control pills and patches are specifically useful for controlling acne, including Yaz and Evra Patch. Speak with your doctor before deciding if this is right for you!

Exercise and eat well (Non-hormonal)

Drink more water as the drop in estrogen and increase in testosterone can leave your skin dehydrated and thus susceptible to sebum build-up and clogged pores. Studies have shown dairy products and high glycemic (GI) foods can trigger acne as well, so stay off milk related products and processed foods to keep your skin healthy.