Q I am a 30-year-old woman who has had pimples on my face for two years.

Although I have seen a specialist at a hospital, my skin has not improved much.

I have tried antibiotics, minocycline and tetracycline, but they don't work.

The doctor prescribed a facial wash and cream to apply on my face.

I also drink a lot of water.

However, none of these measures seem to help.

What can I do to get rid of my pimples and acne? How long will it take for me to recover?

A Pimples or acne is a very common skin problem that affects up to eight in 10 people at some point in their lives.

The condition is most commonly seen in teenagers, but can also persist or show up for the first time in adulthood.

There are many triggers of acne including stress, use of occlusive cosmetics, irregular sleeping habits and, for women, menstruation.

Occlusive agents form a film on the skin to prevent water loss, but can also feel greasy and cause acne outbreaks.

Acne and its subsequent complications, such as scarring and pigmentation of the skin, can be a source of severe mental distress in both teenagers and in adults.

As such, treatment for acne should begin early, and this treatment depends on the severity of the condition.

Mild acne can be treated with an anti-acne face wash and topical anti-acne formulations.

These include vitamin A creams, such as tretinoin and adapalene, benzoyl peroxide creams, and combination acne creams, such as Clindoxyl and Epiduo.

These topical creams should be applied all over the acne-prone skin and not only on the large pimples.

They should be applied daily for at least two to three months.

Even after the acne gets better, one should still continue applying the topical creams to keep the condition under control.

If there is no improvement after two to three months, an oral antibiotic can be prescribed.

Common oral antibiotics used to treat acne include doxycycline, minocycline and erythromycin.

Oral antibiotics have to be taken for at least six to eight weeks for an improvement to be seen.

If the response is good, treatment should be continued for at least four to six months.

When the antibiotics are stopped, the pimples may return after some time, and this may call for another course of antibiotics.

Different antibiotics can cause different side effects. Discuss with your doctor or dermatologist which antibiotic is the most appropriate one for you.

If there is a poor response to a particular antibiotic, a different antibiotic can be given. Otherwise, a strong acne medication called isotretinoin can also be prescribed.

Isotretinoin is the strongest medication for treating acne. It is taken orally for at least six to nine months. Improvement of the skin can be observed within a few weeks of starting this treatment.

A daily dose of 20mg to 30mg is usually enough for most patients to experience a good improvement in their skin. But some may need higher doses.

Common side effects of isotretinoin include dryness of the mouth, lips, eyes and skin.

Side effects that are less common include liver inflammation and elevated blood cholesterol levels, both of which are reversible when the medication is stopped.

Women who are planning to get pregnant should not take isotretinoin, as the medication can cause severe abnormalities in the unborn baby.

For this reason, sexually active women are required to undergo a pregnancy test before starting treatment with isotretinoin.

It is also mandatory for sexually active women to practise at least two forms of contraception while on this strong medication.

Other treatments that may help to clear acne include chemical peels and lasers. However, these are more costly and have less predictable results.

DR MARK KOH,
head and consultant at the dermatology service at KK Women's and Children's Hospital

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