13 Years of Acne: Experiencing Acne in Mid 20s

Acne Journey: From Teen to Adult

What is acne? What acne means?

Acne, scientifically referred to as acne vulgaris, is a prevalent and frequently persistent dermatological condition characterised by the obstruction and inflammatory response within pilosebaceous units, typically involving the accumulation of sebum and dead skin cells. 

Often, terms loosely used to describe acne are, pimples (a symptom of acne, usually used to describe a singular bump), blemishes (a mark or any discoloration on the skin which usually is a result of acne), breakout (referring to many pimples appearing suddenly) , hyperpigmentation (type of acne scar that is usually just a blemish or discoloration of skin) and zits (another word for pimples).

Manifesting as the formation of various lesions, including papules, blackheads, whiteheads, and occasionally more profound, discomfort-inducing nodules or cysts, acne primarily affects regions such as the face, chest, shoulders, and back. 

Other forms of acne or skin conditions that look similar to acne include: rosaceas, milia, acne keloidalis nuchae, folliculitis, keratosis pilaris, sebaceous filaments and sebaceous hyperplasia. 

Luckily, or rather unfortunately, one of us struggles with facial acne and the other with body acne. You can count on us to share about our experiences with different forms of acne!

What are the top factors that cause acne?

1. Genetics: A family history of acne may increase the likelihood of developing the condition. For instance, if your parents struggled with acne or are still struggling, likely you will too.

2. Bacteria: The bacterium Propionibacterium acnes or now better known as Cutibacterium acnes, which is naturally present on the skin, can multiply in the clogged hair follicles, causing inflammation and the formation of acne lesions. 

Like all baterias, it is not all bad. As per a research paper from 2013 featured in the Journal of Investigative Dermatology, specific variations of Propionibacterium acne (P. acnes) are linked to overall skin well-being and might contribute to skin protection (refer to the statement: "Certain strains were highly associated with acne, and other strains were enriched in healthy skin.").

3. Hormonal changes: Fluctuations in hormones, especially during puberty, menstrual cycles, pregnancy, and certain medical conditions, can contribute to increased oil production and the development of acne. Personally, I struggle with hormonal issues since the start of puberty which plays a huge part of acne development over the years.

4. Excess oil production: The sebaceous glands in the skin produce an oily substance called sebum. When there is an overproduction of sebum, it can lead to clogged pores.

5. Dead skin cells: Skin cells shed regularly, but sometimes they don't shed properly and can mix with the excess sebum, leading to the formation of plugs in the hair follicles.

6. Clogged pores: Pores clogged from sebum, bacteria, dirt, hormones, dead skin cells, ingrown hairs often causes acne. In a nutshell, this is what you get from all the previous factors mentioned.

7. Diet: Sugary or refined carbohydrates, diary, food your body is sensitive to tend to cause acne. Lack of hydration sometimes causes acne too.

What types of acne are there?

Before getting into understanding what skincare we need, it is best to understand as a whole what are the types of pimples we are getting. We might not be dermatologists, but it definitely helps to understand the terms used by the professionals when treating our acne condition.  

Often, we hear the term “breakout” used often in the acne community which is often used to describe a large amount of pimples popping up in a short period of time which covers all kinds of acne. It is a loosely used term that is not usually accurate at times since not all types of acne spreads everywhere on your skin.

In the following, I will rank the types of acne pimples ascendingly from the least painful to the most painful which happens to be also easiest to treat to hardest to treat (according to my experience).

1. Comedones 

Personally, I struggle with this the most when I do skincare. Maybe it is because they do not hurt and usually are never painful due to it being a noninflammatory acne. Usually, these types of acne are easily treated with over the counter treatments and there is no need for professional help from dermatologists or doctors.

1. Blackheads (Open Comedones): Small, dark bumps on the skin's surface caused by the oxidation of sebum and dead skin cells within an open hair follicle. Apparently, the nose is the favourite hangout spot for blackheads.

2. Whiteheads (Closed Comedones): Small, flesh-coloured bumps with a closed surface. They result from blocked hair follicles filled with sebum and dead skin cells. Uneven skin texture? Yes mam, here is the culprit. 

2. Papules 

From here onwards, these types of acne are painful since they are considered inflammatory acne. These pimples are RED and swollen. 

Papules are small, raised, red or pink bumps without a visible centre of pus. They can be tender to the touch. These are usually tempting to squeeze out of impatience but I highly discourage it as it usually doesn’t pop satisfyingly and it hurts like hell.

3. Pustules

Pustules are inflamed pimples with a visible centre of pus. They are often red at the base and have a white or yellowish head. Highly poppable, lowest pain to satisfying pop ratio. 10/10 should NOT pop though it is tempting.

4. Nodules

Nodules are large, solid, painful lumps beneath the skin's surface. Nodules are deeper and more severe than pustules or papules. Ah the start of cystic acne, my condolences. Chances are, you need professional help at this stage if you want to get rid of this fast. Or you can suffer with me.

5. Cysts

Cysts are deep, painful, pus-filled lesions that can cause scarring. Cysts are larger and more severe than nodules. Sometimes, when these pop, the amount of blood is insane and it hurts so bad it's basically a wound on your face that scars. At this point, it is usually highly recommended to get professional help from doctors and dermatologists.

Other forms of skin conditions you might mistake for acne:

1. Rosacea

Rosacea is a chronic inflammatory skin condition that is often seen as persistent redness or flushing on cheeks, nose area or central face area. It typically is highly persistent and usually requires assistance from professional help like a dermatologist.

2. Milia or Milium

Milia or also known as milk spots or oil seeds, are small, white cysts that appear on the skin and are easily confused with whiteheads. Milium is used to describe a singular spot. These bumps are usually not painful and harmless other than causing uneven skin texture, though at times it might cause itchiness or form a raised patch of skin. They usually disappear after a few weeks, but it is possible to get it removed professionally as well. I personally don’t recommend doing it on your own as it can lead to scarring if done wrongly. 

3. Acne keloidalis nuchae

Acne keloidalis nuchae is a type of folliculitis that is commonly seen as red, itchy bumps that looks like acne or pimples on the scalp or the back of heads near the neck area. This condition is also called by these terms: Acne keloidalis, Dermatitis papillaris capillitia, Folliculitis keloidalis, Folliculitis keloidalis nuchae, Folliculitis nuchae, Keloidal folliculitis and Sycosis framboesiformis. In my opinion, I often see men suffering from skin conditions in Singapore. It might be from the weather or tendencies to wear tight helmets and caps or having skin injury from getting haircuts at the base of the heads.

4. Keratosis pilaris

What types of acne scars are there?

With wounds, comes scars, the unfortunate truth of acne. Similar to my sentiment of understanding types of pimples, it is highly recommended to understand more about the scars before going into skincare. In the following, I will rank the acne scars ascendingly from the easiest to heal to the hardest (according to my experience).

• Hyperpigmentation 

1. Macules 

1. Flat, red spots left after an acne lesion has healed. They are not raised or inflamed but may take time to fade. If you get these thank the gods because these are probably one of the easiest ‘scars’ to fade. Technically, it is not even considered a scar since there is no change in texture but eh if it is healed but still has discoloration we shall just consider it as a scar.

2. Post-Inflammatory Hyperpigmentation (PIH)

1. Darker spots or discoloration left on the skin after an acne lesion has healed. 

• Atrophic Scars (Scars that basically leave a cavity on your skin. They are not large pores.)

1. Ice Pick Scars

1. Deep, narrow pits that extend into the skin, resembling the marks left by an ice pick.

2. Boxcar Scars

1. Depressed areas with sharp edges, resembling the scars left by chickenpox.

3. Rolling Scars

1. Broad depressions with a sloping edge, giving the skin a wave-like appearance.

• Hypertrophic Scars 

1. Raised, thickened scars that develop when there is an overproduction of collagen during the healing process. These scars stay within the boundaries of the original acne lesion. However, on bad days such scars can become Keloid Scars.Keloids are a type of hypertrophic scar that extends beyond the boundaries of the original acne lesion. 

My unsolicited advice for people dealing with acne

Year 2024 marks another year in which acne has plagued my life. Depressing, isn't it? Initially, it was a sign of puberty and growth. Now, at 24 years old, it has transformed into a phase often known as 'adult acne' or the 'second coming of puberty.'

As dramatic as I made it sound, to most people, my severity of acne isn't 'that bad.' Here's a photo of my acne-scarred face below.

"Yikes, hope it gets better soon" or "Oh, it's not that bad" are probably the most common responses I have received over the years. As someone without much acne, you probably wonder, "What is the best response I can give when someone talks about their struggles with acne?" The answer, at least if it were directed to me, would be, "I don't understand your struggles, but I hope you won't give up on your journey, and it's okay to have it." Sometimes, the comforting presence is enough; sometimes, not much needs to be said, so don't worry if you have a friend and you want to be there for them. Your presence means something to them.

"What are the questions I should avoid?" and "How do I not offend someone with acne?" 

Here are some examples of questions NOT to ask someone struggling with acne:

• Do you not wash your face every day?

• Do you not change your towels often?

• Do you not change your pillowcase often?

• Have you tried Accutane?

• Why not go and visit a dermatologist?

• Are you drinking enough water?

• Are you too stressed out?

• Are you sleeping enough?

• Do you exercise enough?

Honestly, the list goes on, but I'm sure you get the idea with these examples. The tricks and tips you've heard about, chances are everyone struggling with long-term acne, hormonal acne, probably heard it a million times. As a friend, family member, or loved one, how you can show you care is really:

1. Check out what skincare products we are already using and love using; get the refill. 
2. Don't make any remarks about the acne condition.

On the other hand, if you struggle with acne, like I do or even worse, I'd just love to give you a hug and say, "It's okay. I know it's so hard some days. I know sometimes we just want to rip off our skin, scratch off our skin, peel off our skin, but we can't. I know how much it hurts sometimes to see improvement for weeks only to be ruined by a single cheat day. I know how lonely it is to walk down the street, to scroll social media and all we see are clear, perfect glass skin that we can only dream about having. But hey, you aren't alone; we aren't alone.

Skin heals, and scars fade. New pimples, acne come and go. There are good days and there are bad days, sometimes more bad than good when struggling with life with acne. So what can we do about our acne? How do we remove acne? Should I pop my pimples or not? How do I cure my acne? What skincare products should I use for my acne-prone skin? How do I remove my acne scars quickly?

I wouldn't say I am an expert about acne since I am not a dermatologist, but I am definitely able to share my experiences in posts like this one (hopefully future ones too). Acne, like pretty much all chronic problems, are mentally and physically draining so it is important to balance between 'curing' acne and accepting acne.

Everyone's skin is different but let me know how I can help in the comments below!