Acne Treatment in Kota Kinabalu

Acne is the condition I see most, and it's the one where I've built the most structure — because acne rewards structure in a way that most skin conditions don't.

The problem isn't usually diagnosis. With eczema, psoriasis or fungal infection, working out what you're looking at is often the hard part. With acne, you can usually see what it is. The hard part is the sequence — what to do first, what to add later, how fast to push, and when to stop pushing.

So here's the whole thing.

Three phases: Clear, Fade, Maintain

Clear — around 3 months

The goal in this phase is narrow and specific: stop new breakouts from forming.

Not fading the marks. Not perfecting your skin. Just getting the active process under control, because nothing else works until that's done.

The method is gradual escalation. We start the active ingredients at a level your skin tolerates, and we titrate the concentration upward over time while watching how your skin is coping.

That second half matters as much as the first. Push too fast and you get irritation — and irritated skin in an acne patient is not a neutral cost. It's uncomfortable, it makes people abandon treatment, and inflammation itself contributes to the marks we'll be trying to fade later. So this phase is a controlled climb, not a race.

Expect around three months. That's not slow treatment; that's how long the skin cycle takes. Judging the programme at week four is judging it before it's had a chance.

Fade — around 3 months

Once breakouts are under control, we shift focus.

This is where we add pigment actives to fade the marks left behind — mostly the post-inflammatory hyperpigmentation that acne leaves in skin like ours.

Note the order. We don't start fading marks while new lesions are still forming, and there's a specific reason for that which I'll come back to, because it's one of the most important things on this page.

Expect around another three months.

Maintain — ideally ongoing

Acne is not something you complete and walk away from.

Maintenance is preferably lifelong, or at minimum for about a year, after which we can trial stopping and see what your skin does.

I know that's not what people want to hear. But the alternative — clearing your skin, stopping everything, and watching it come back over six months — is the cycle almost every acne patient has already been through several times before they reach me. Maintenance is what breaks it.

How I assess you at the first visit

I grade acne using the IGA scale, which gives us a consistent measure to track against rather than relying on impressions.

But the grade isn't what changes the plan most. What changes the plan most is the type.

If it's mainly comedonal — blackheads and whiteheads rather than inflamed lesions — the approach is different, and deliberately gentler. I try to reduce the need for strong actives here, usually working with salicylic acid and a stepped retinoid escalation. Hitting comedonal acne with everything is unnecessary and buys irritation you didn't need.

If it's mild through severe inflammatory acne, that's where the main protocol applies.

If it's severe, we may need a longer antibiotic course, or intralesional steroid injection for individual large lesions.

And I always check whether it's actually acne. Fungal acne, rosacea, and dermatitis all get treated as acne, sometimes for months. So does hormonally-driven acne, which needs a different investigation. And body acne behaves differently from facial acne. Getting this wrong at the start means everything downstream is aimed at the wrong target.

The protocol we use

For mild through severe inflammatory acne, the core is a combination of active ingredients, introduced with titrationrather than all at once.

The actives are benzoyl peroxide, azelaic acid and a retinoid, optimised together and escalated in a defined sequence. The titration is the part that does the work — the same ingredients thrown at your face on day one would irritate most people into quitting within a fortnight.

Oral doxycycline as a bridge in most cases — bringing inflammation down while the topicals are being built up to their working concentration. Bridge is the operative word. It's there to get you through the climb, not to be the treatment.

Compounded preparations for some patients — where the skin is hypersensitive, or where I want a combination that doesn't exist as a commercial product. A licensed pharmacy prepares it to prescription. It isn't exotic; it's a way of fitting the preparation to the person rather than the other way round.

About isotretinoin

I'm a GP with a strong interest in skin. I don't prescribe isotretinoin.

I do have a view on it, though.

After years of treating acne, I think isotretinoin is overused.

It's a powerful medication, and powerful medications get reached for. I've seen a patient started on isotretinoin for two small pimples and kept on it for years. That's not a marginal judgement call — that's a mismatch between the size of the problem and the size of the intervention.

And in my experience, most acne — including a good deal of severe acne, I'd say 80 to 90% of it — can be controlled well without isotretinoin. That's a large part of why the protocol is built the way it is: to get results through optimised topical treatment and a properly-run sequence rather than defaulting to the strongest available option.

If you're on it, or being offered it, three things I'd want you to know:

It requires strict monitoring, and that's not optional.

Many patients I've seen were started on it without proper counselling on side effects, and without the discussion about contraception that must accompany it in anyone who could become pregnant. If that conversation didn't happen with you, that's a gap, and it's worth going back and having it.

And a great many patients tell me isotretinoin "didn't work" when what actually happened is that they stopped it early. Isotretinoin works on a cumulative dose over a realistic duration. Stop partway because your skin looks good, and it rebounds — and then people conclude the drug failed, when nobody had explained what completing the course actually meant.

Where there's a genuine need for it, I refer.

Sunscreen, in this climate

Sunscreen is non-negotiable regardless of humidity, weather or how much you sweat.

I know it feels counterintuitive when your skin is oily and it's 33 degrees. But you're on actives — retinoids in particular increase sun sensitivity — and the marks we're spending three months fading in the Fade phase will darken and persist with sun exposure. Skipping sunscreen undoes the second half of the programme.

The practical problem here is genuine: by midday your face is sweaty and the sunscreen feels unpleasant.

What I suggest: clean the face with plain water, pat dry, and reapply. Plain water — not another round of cleanser, which strips skin that's already being worked hard by actives. That's a thirty-second routine and it solves most of the discomfort problem.

Marks, scars, and the order things must happen in

At your first visit I'll explain the difference between the two things acne leaves behind, because patients use "scars" for both and they're not the same.

Marks are colour changes — post-inflammatory hyperpigmentation and post-inflammatory erythema. The skin's structure is intact; the colour isn't.

Scars are structural — ice pick, rolling, boxcar. The skin's architecture has actually changed.

And I'll tell you straight, at the start rather than after you've spent money: marks we can usually clear quite well. Scars I can improve to some degree, but not eliminate. I'd rather set that expectation on day one than let you discover it at month six.

For scar procedures, I refer out.

Now the part that matters most, and it's the reason the phases are ordered the way they are:

Nothing you do to marks or scars will hold while active acne is still breaking out.

The inflammation is continuing in the deeper layers, slowly but persistently. You can treat the marks and they'll look better for a while — and then the inflammation from underneath surfaces, and they worsen back.

So people spend money on procedures for scarring while their acne is still active, get a temporary improvement, watch it regress, and conclude the procedure didn't work. The procedure may have been fine. The sequence was wrong.

Control the acne first. Then address what it left behind. That's not me delaying you — it's the only order in which the work holds.

What I'd ask of you

Give it three months before you judge it. The Clear phase takes about that long, and quitting at week five is the single most common reason people never get to see their own results.

Tell me if it's irritating your skin. Don't push through silently. Irritation is information — it means we're escalating faster than your skin will take, and adjusting is straightforward if I know.

Bring everything you've been using. All of it, including anything from social media, anything unlabelled, and anything you're slightly embarrassed about. I won't lecture you. Knowing what's already been on your skin frequently explains why it looks the way it does.

Don't pop them. There's a separate article on why, but briefly: scarring happens mainly through two routes — large nodulocystic lesions, and popping. One of those is under your control.

Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred.

I'm a GP with a strong interest in skin, not a dermatologist. Where something needs specialist assessment, isotretinoin, or scar procedures, I refer.

简要说明

我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan（皮肤与暗疮）。我是对皮肤有专长的普通科医生，不是皮肤专科医生。

痘痘是我看得最多的问题，也是我建立最多结构的一个——因为痘痘对「结构」的回报特别高。

问题通常不在诊断。湿疹、干癣、真菌感染，难的是判断你在看什么；痘痘难的是顺序——先做什么、后加什么、推进多快、什么时候该停手。

三个阶段：清除（Clear）、淡化（Fade）、维持（Maintain）

清除期（约3个月）：目标很窄很明确——阻止新的痘痘形成。不是淡化痘印，不是让皮肤完美，就是把活跃的过程控制住，因为在那之前其他都做不了。

做法是逐步加强：从你皮肤能耐受的浓度开始，随时间往上调，同时观察皮肤的承受状况。后半句和前半句一样重要——推太快会刺激，而在痘痘患者身上，刺激不是没有代价的：不舒服、导致中断治疗，而发炎本身又会造成我们之后要淡化的痘印。所以这是一段受控的爬升，不是竞速。

请预期约三个月。 那不是治疗慢，那是皮肤周期的长度。第四周就下判断，是在它有机会之前就下判断。

淡化期（约再3个月）：痘痘受控后，转而加入色素活性成分来淡化留下的痕迹，主要是我们这种肤色常见的炎症后色素沉着（PIH）。请注意顺序——新的痘痘还在长的时候，我们不会开始淡化痘印，理由稍后说明，那是这一页最重要的观念之一。

维持期（最好长期）：痘痘不是「做完就走」的事。维持最好是长期的，至少约一年，之后可以试着停下来看皮肤的反应。我知道这不是大家想听的。但另一个选择——皮肤清了、全部停掉、半年内又长回来——正是几乎每位痘痘病人在来找我之前已经经历过好几次的循环。维持就是打断这个循环的东西。

初诊评估：我用 IGA 分级，以便有一致的标准可以追踪。但改变治疗计划最多的不是分级，而是类型：

• 以粉刺为主（黑头白头而非发炎性）：做法刻意更温和，我会尽量减少强效成分的需要，通常是水杨酸加上阶梯式的 A 酸。用全套去打粉刺型痘痘是不必要的，只会换来本来不需要的刺激。

• 轻度至重度发炎性痘痘：主要的治疗方案适用于此。

• 重度：可能需要较长的抗生素疗程，或对个别大颗病灶做病灶内类固醇注射。

• 我一定会确认它到底是不是痘痘：真菌性痘疮、玫瑰痤疮、皮肤炎都常被当成痘痘治疗好几个月；荷尔蒙相关的痘痘需要不同的检查；身体的痘痘和脸上的行为也不一样。

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我们使用的治疗方案：对轻度至重度发炎性痘痘，核心是活性成分的组合，并且以「逐步加量」的方式导入，而不是一次全上。

活性成分是过氧化苯甲酰（BPO）、杜鹃花酸、A 酸，一起优化并依既定顺序逐步加强。真正起作用的是「逐步加量」这件事——同样的成分如果第一天就全部往脸上招呼，多数人会在两周内被刺激到放弃。

多数情况以口服 doxycycline 作为过渡，在外用药建立到有效浓度的过程中先把发炎压下来。「过渡」是关键词——它是帮你度过爬升期的，不是治疗本身。 部分病人会用调配药（皮肤高度敏感，或我想要市面上没有的组合）。

关于口服 A 酸（isotretinoin）

我是对皮肤有专长的普通科医生。我不开立口服 A 酸。

不过我对它确实有看法。

治疗痘痘多年后，我认为口服 A 酸被过度使用了。它是强效药，而强效药容易被伸手去拿。我见过病人因为两颗小痘痘就被开始使用，而且一用好几年。

依我的经验，多数痘痘——包括相当一部分重度痘痘，我会说八到九成——可以在不用口服 A 酸的情况下控制得很好。 这也是这套方案会建立成现在这样的重要原因：透过优化的外用治疗和正确执行的顺序取得成果，而不是预设去用最强的选项。

如果你正在使用、或被建议使用，三件事我希望你知道：

1. 它需要严格监测，这不是可选项。

2. 我见过很多病人在开始使用时，没有被妥善告知副作用，也没有进行必要的避孕讨论（对任何可能怀孕的人而言）。如果这个对话没有发生在你身上，那是一个缺口，值得回去补上。

3. 很多病人告诉我口服 A 酸「没效」，实际发生的是他们提早停药了。 它的效果建立在足够的累积剂量和实际所需的疗程长度上。皮肤看起来好了就中途停掉，就会反弹——然后大家断定是药失败了，而其实是没有人解释过「完成疗程」是什么意思。

   
   

真的有需要时，我会转介。

防晒（在这个气候）：不论湿度、天气、流多少汗，防晒都不能省。 你正在用活性成分（A 酸尤其会增加光敏感），而我们在淡化期花三个月要淡掉的痘印，会因日晒而变深、变持久。不擦防晒等于把疗程的后半段作废。

实际问题是：到了中午脸上都是汗，防晒变得很不舒服。我的建议：用清水洗脸、轻轻拍干、重新补擦。 清水就好，不要再用一次洗面乳——皮肤已经在被活性成分锻炼了。这是三十秒的动作，能解决大部分不适。

痘印、痘疤，以及事情必须发生的顺序

初诊我会解释两者的差别，因为病人常把两者都叫「疤」：

• 痘印是颜色的改变（PIH、PIE）——皮肤结构完整，颜色不对。

• 痘疤是结构性的（冰锥型、滚动型、箱车型）——皮肤的构造真的改变了。

我会直说，而且是在你花钱之前：痘印通常可以处理得不错；痘疤我可以改善一些，但无法消除。 疤痕的疗程我会转介出去。

最重要的部分，也是阶段要这样排序的原因：

只要痘痘还在活跃地长，你对痘印和痘疤做的任何处理都留不住。

发炎仍在更深的层次持续进行，缓慢但不间断。你可以处理痘印，它会好看一阵子——然后底下的发炎浮上来，它们又变回去。

所以有人在痘痘还活跃的时候花钱做疤痕疗程，得到暂时的改善，看着它退回去，然后断定疗程没效。疗程可能没问题，错的是顺序。

先控制痘痘，再处理它留下的东西。这不是我在拖延你——这是唯一能让成果留住的顺序。

我希望你做到的：给它三个月再评价（清除期就是这么长，第五周放弃是多数人从未看到自己成果的最主要原因）；刺激了就告诉我（不要默默硬撑，刺激是资讯，代表我们加强得比你的皮肤能承受的快）；把用过的东西全部带来（包括网路上买的、没有标示的、你觉得不好意思的，我不会说教）；不要挤（另有专文，但简单说：疤痕主要透过两条路径产生——大颗的结节囊肿型病灶，以及挤压。其中一条在你的控制之内。）

Klinik Dr Tan (Skin & Acne)，Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu。WhatsApp：017-234 7328。建议预约。需要专科评估、口服 A 酸或疤痕疗程时，我会转介。