Hormonal Acne Treatment in Singapore

These have different jobs and are often used together. A hormonal pattern does not automatically mean an oral hormonal medicine is required.

Option	Where it fits	What to discuss
Topical medicines	Initial treatment or maintenance, alone or combined with other treatments	Irritation, using them consistently, pregnancy suitability
Combined contraceptive pill	Suitable women, particularly where contraception is also wanted	Medical history, clot risk, whether the formulation suits
Spironolactone	Persistent acne in suitable women	Pregnancy avoidance, side effects, other medicines, monitoring
Oral antibiotics	A time-limited course for inflammatory acne	Duration, the topical alongside it, what happens after
Isotretinoin	Severe, nodular, scarring or unresponsive acne	Monitoring, pregnancy prevention, other risks
AviClear	In my practice, selected papular acne with small raised inflammatory bumps	Expected benefit, discomfort, redness, pigment changes, cost and alternatives
AGNES RF	In my practice, selected nodular, cystic or comedonal acne	Why focal treatment fits; discomfort, swelling, pigment changes and other procedural risks
Gold PTT	Selected inflammatory acne where sebaceous gland targeting suits the pattern	Number of sessions, discomfort, aftercare, cost and alternatives

Where hormonal treatment becomes the rational choice

When the history suggests a hormonal contribution, I consider whether hormonal treatment would offer a useful alternative to repeated antibiotics. Combined oral contraceptives reduce androgen activity, while spironolactone blocks androgen effects on the skin. Suitability depends on the person as well as the acne pattern. [1,4]

Some women have persistent acne despite an adequate topical regimen. Adding hormonal treatment may help; it does not mean topical medicines have no role.

Topical treatment still matters

Topical retinoids help prevent blocked pores. Benzoyl peroxide and other topicals help control inflammatory acne, and azelaic acid is worth considering where acne and pigmentation coexist. A hormonal pattern does not make any of these ineffective. [1]

Clascoterone is a topical androgen-receptor inhibitor. Two phase 3 trials involving male and female participants found that 1% cream applied twice daily improved facial acne compared with its vehicle, the cream base without the active drug. Adverse events were uncommon and mostly mild, although local skin reactions occurred. These trials do not establish superiority over spironolactone or isotretinoin. [7]

The clinic carries clascoterone. It is a topical option I can consider when an oral hormonal medicine is unsuitable or not preferred, subject to its own suitability assessment.

Oral contraceptive pills: which type, and what risks?

A combined oral contraceptive pill contains an oestrogen and a progestogen. It can be useful for acne in suitable women, especially when contraception is also wanted. Improvement usually takes around two to three months; I review both the skin response and tolerability rather than judge it after a few days. [6]

Pills differ in their ingredients and risk profile. No single formulation is consistently best for everyone’s acne. [6]

Pill types differ mainly in their progestogen, and that affects both the likely skin response and the estimated venous clot risk. Cyproterone acetate with ethinylestradiol is restricted in Singapore to acne that has not responded to topical therapy or systemic antibiotics, and a progestogen-only pill is a contraceptive option rather than an acne treatment. For the types, the clot-risk estimates and the Singapore restrictions, read contraceptive pills for acne. [6,12,13,15]

Before prescribing, I assess blood pressure, smoking, migraine, clot history, relevant family history and other medicines. Migraine with aura, previous clots, significant cardiovascular risks, current breast cancer and some liver conditions may rule out a combined pill; smoking at age 35 or older is another important concern. [14]

Possible side effects include changes in bleeding, nausea, breast tenderness and headaches. Sudden breathlessness, chest pain or one-sided leg swelling needs urgent medical assessment. [12,14,15]

Spironolactone

In the SAFA randomised trial, women taking spironolactone did better than those on placebo, and the difference was larger at 24 weeks than at 12. That is the reason to give it time rather than expect a quick answer. [4,5]

Side effects include menstrual changes, breast tenderness, dizziness and increased urination. It is not used for acne in pregnancy. Monitoring depends on age, kidney function and other medicines. A 2026 study enrolled women aged 45 and older taking spironolactone for dermatological conditions, not acne alone; risk varied with age and accompanying conditions. It had no younger comparator group. Separate research in healthy young women found limited usefulness from routine potassium testing. These findings inform individual assessment rather than one testing schedule for everyone. [10,11]

The dose, any gradual increase and the monitoring plan are discussed individually. Blood pressure and symptoms such as light-headedness also matter when treatment is started or adjusted. Read about dosing, follow-up and monitoring in my spironolactone guide.

Spironolactone is sometimes prescribed alongside a combined contraceptive pill in women for whom the pill is suitable. This provides contraception and may reduce menstrual irregularity associated with spironolactone. The pill requires its own assessment of risks and suitability; the combination is not appropriate for everyone. [17]

Antibiotics and isotretinoin

An oral antibiotic can help control inflammatory acne, but the plan needs a review point and a strategy beyond the course. Guidelines advise limiting systemic antibiotic use and combining it with appropriate topical treatment, including benzoyl peroxide to help limit antibiotic resistance. [1,2]

Isotretinoin is for severe acne, acne that is scarring, acne carrying a substantial psychological burden, or acne that has not responded adequately. It needs proper counselling, monitoring and strict pregnancy precautions. [1]

More on isotretinoin and its side effects.

Where AviClear, AGNES RF and Gold PTT fit

I personally perform these procedures. Which one I suggest depends on the lesions present, previous treatment and whether a procedure offers a useful role in the overall plan.

AGNES RF: insulated microneedles deliver radiofrequency into the deep dermis, which suits lesions that can be targeted individually. I tend to choose it for selected nodular, cystic or comedonal acne — see AGNES acne treatment.

AviClear: I tend to choose AviClear for papular acne, meaning small raised inflammatory bumps. It uses a laser to target oil glands across the treated area. A prospective study reported improvement continuing through 26 weeks after treatment, but had no control group and cannot show that it is better than medication. Discomfort, redness, swelling, dryness or a temporary flare can occur; blistering, pigment changes, infection and scarring are also possible. [8,16]

Gold PTT: gold microparticles are worked into the follicle and then heated by laser. I discuss it where the pattern suits it — see gold photothermal therapy for acne.

Using more than one: I sometimes combine AGNES RF and AviClear when different lesion types coexist. I explain the purpose of each procedure and the additional cost and recovery considerations. The studies cited here do not establish that the combination is superior to either procedure alone.

Topical treatment remains an option for comedonal acne. Widespread nodular or cystic acne, particularly when scarring, may need systemic treatment such as isotretinoin. Procedures do not replace assessment for an underlying endocrine condition. [1]