Acne Cream in Singapore: Which Ones Work, and When You Need a Prescription
Medical Director Dr Sin Yong explains which acne creams have evidence, what benzoyl peroxide and adapalene do, which need a prescription in Singapore, and why cystic acne needs more than a cream.
WhatsApp to Enquire →Key facts ↓The acne creams with the strongest evidence are benzoyl peroxide, topical retinoids such as adapalene and tretinoin, and topical antibiotics used together with benzoyl peroxide. In Singapore, benzoyl peroxide is sold over the counter; adapalene is classed as prescription-only, though pharmacists may supply 0.1% in small amounts; stronger retinoids, antibiotic and combination creams need a doctor. Deep, cystic acne usually needs oral treatment. See acne treatment in Singapore.
- Guideline: the 2024 American Academy of Dermatology guideline makes 18 evidence-based recommendations, with strong recommendations for benzoyl peroxide, topical retinoids and topical antibiotics [1].
- Strength: in three double-blind studies of 153 people, 2.5% benzoyl peroxide reduced inflamed spots as well as 5% and 10%, with less peeling, redness and burning than 10% [2].
- Adapalene: in a meta-analysis of 900 patients, adapalene 0.1% gel matched tretinoin 0.025% gel in reducing total spots, worked faster in the first week and was better tolerated [3].
- Combination: in a 12-week trial of 517 people, a fixed gel of adapalene 0.1% and benzoyl peroxide 2.5% worked better than either alone, with differences seen from week one [4].
- Resistance: in Singapore teenagers, 26 of 174 acne bacteria cultures (about 15 in 100) were antibiotic-resistant, and 58 in 100 of those students had never taken antibiotics [5].
Which acne creams actually work?
Acne has four drivers: plugged follicles, oil production, the skin bacterium C. acnes and inflammation. A cream works when its active ingredient acts on the drivers that dominate your acne, so the label to read is the ingredient and its strength, not the brand. The 2024 American Academy of Dermatology guideline strongly recommends benzoyl peroxide, topical retinoids and topical antibiotics, and conditionally recommends clascoterone, salicylic acid and azelaic acid [1]. Singapore's own guideline, written for a multi-ethnic Asian population, sets out treatment by grade along similar lines [6].
| Ingredient | What it does | Evidence | How it is usually obtained in Singapore |
|---|---|---|---|
| Benzoyl peroxide | Kills C. acnes, eases inflammation, no bacterial resistance | Strong [1] | Over the counter, as washes, gels and creams |
| Salicylic acid | Loosens plugs in pores | Conditional [1] | Over the counter |
| Adapalene | A retinoid: normalises the follicle lining so plugs stop forming | Strong for retinoids [1] | Prescription-only; 0.1% may be supplied by a pharmacist in limited amounts |
| Tretinoin | A stronger retinoid with the same action | Strong for retinoids [1] | Prescription |
| Topical antibiotics (e.g. clindamycin) | Reduce bacteria and inflammation | Strong, but only with benzoyl peroxide [1] | Prescription |
| Azelaic acid | Reduces bacteria, inflammation and dark marks | Conditional [1] | Depends on product and strength |
| Fixed combinations (retinoid with benzoyl peroxide or antibiotic) | Act on several drivers at once | Better than single agents in trials [4] | Prescription |
Benzoyl peroxide in Singapore: which strength, and how to use it
Benzoyl peroxide is the most useful acne product you can buy without a prescription. It kills acne bacteria by releasing oxygen, calms inflammation, and bacteria do not become resistant to it. Higher strengths are not clearly better. In three double-blind studies of 153 people with mild to moderate acne, 2.5% reduced inflamed spots as well as 5% and 10%, with less peeling, redness and burning than 10% [2].
Use a thin layer over the whole acne-prone area, not only on spots, starting every other night and building up as your skin tolerates it. A wash is gentler than a leave-on gel and suits the chest and back. It can bleach towels, pillowcases and dark clothing. Expect some dryness in the first two to four weeks, and judge it after 8 to 12 weeks of consistent use.
Adapalene in Singapore: how it works and how to start
Adapalene is a topical retinoid. It changes how the lining of the follicle sheds, so plugs loosen and new ones stop forming, which makes it the main treatment for blackheads and closed comedones and a base for almost every acne plan. Singapore's National Drug Formulary lists adapalene as a prescription-only medicine, with an exemption that lets a pharmacist supply topical preparations up to 0.1% without a prescription, in limited amounts and only from age 12.
In a meta-analysis of five trials and 900 patients, adapalene 0.1% gel matched tretinoin 0.025% gel in reducing total spots, acted faster in the first week and was better tolerated [3]. Pairing it with benzoyl peroxide adds to the effect: in a 12-week trial of 517 people, a fixed combination gel worked better than either ingredient alone [4]. Start with a pea-sized amount for the whole face every second or third night, moisturise, and use sunscreen daily. A brief flare of small spots in the first weeks can be purging, explained in skin purging vs breakout. Retinoids are avoided in pregnancy and while trying to conceive.
When do you need a prescription acne cream, and what about cystic acne?
A prescription is worth considering when acne has not improved after 8 to 12 weeks of consistent over-the-counter treatment, when it leaves dark marks or scars, or when spots are deep and painful. Prescription options include stronger retinoids, antibiotic creams and combination gels. Antibiotic creams should never be used alone: resistance is already common, and in a Singapore study of teenagers about 15 in 100 acne bacteria cultures were resistant, more than half of them in students who had never taken antibiotics [5]. Combining with benzoyl peroxide limits this.
No cream alone is enough for cystic acne. Nodules and cysts sit deep in the skin, beyond what topicals reach, and they are the type most likely to scar. The guideline strongly recommends oral isotretinoin for acne that is severe, scarring or not responding to standard treatment, and supports oral antibiotics with topicals for moderate acne [1]. Creams still have a place alongside oral treatment and for maintenance afterwards. See cystic acne treatment, isotretinoin and procedures and, for spots on the forehead, forehead acne.
How are acne creams chosen at IN Eternity Clinic?
Dr Sin Yong confirms the type and grade of acne first, because some acne-like rashes, such as fungal folliculitis or rosacea, do not respond to acne creams at all. He then chooses the simplest combination that acts on your main drivers, sets the strength and how often to use it, and explains how to manage dryness. Prescription medicines are started only after an in-person assessment, and pregnancy, breastfeeding or plans to conceive change the choices.
Where acne is moderate or severe, oral treatment or, for suitable women, hormonal treatment may be added; see hormonal acne. In-clinic care such as chemical peels, extraction of closed comedones and laser aimed at inflammation supports the medical plan rather than replacing it. Progress is reviewed after six to twelve weeks, then the routine is stepped down to maintenance. Products are not sold as a condition of treatment. Costs follow the plan and are explained at consultation. Results vary, and suitability is decided at an in-person assessment.
What Dr Sin Yong looks for
- The type of acne: comedonal, inflamed, cystic, hormonal, or a lookalike such as fungal folliculitis.
- The grade, and any dark marks or early scarring.
- Products already tried, at what strength and for how long.
- Skin sensitivity, and how dryness has been tolerated.
- Pregnancy, breastfeeding or plans to conceive, which change the medicines used.
General clinical observations used at consultation; they describe what is checked, not any individual result.
Frequently asked questions
Which acne cream works for acne?
The acne creams with the strongest evidence contain benzoyl peroxide, a topical retinoid such as adapalene or tretinoin, or a topical antibiotic combined with benzoyl peroxide. Which suits you depends on whether blocked pores or inflamed spots dominate. Give any cream 8 to 12 weeks of consistent use before judging it.
Can I buy benzoyl peroxide in Singapore without a prescription?
Yes. Benzoyl peroxide washes, gels and creams are sold over the counter in Singapore pharmacies. A 2.5% strength reduced inflamed spots as well as 5% and 10% in trials, with less irritation, so a higher strength is not necessarily better. It can bleach fabrics.
Can I buy adapalene in Singapore?
Adapalene is listed as a prescription-only medicine in Singapore, but there is an exemption allowing a pharmacist to supply topical preparations up to 0.1% without a prescription, in limited amounts and from age 12. Stronger retinoids and combination gels need a doctor.
What is a prescription acne cream?
A prescription acne cream contains a medicine that needs a doctor's assessment, such as tretinoin, a topical antibiotic like clindamycin, or a combination gel with a retinoid and benzoyl peroxide or an antibiotic. These are used when over-the-counter products have not worked or acne is marking the skin.
Is there an acne cream for cystic acne?
Creams alone are not enough for cystic acne, because nodules and cysts sit too deep and are the type most likely to scar. Oral treatment, often isotretinoin for severe or scarring acne, is usually needed, with creams used alongside and for maintenance afterwards.
How long does an acne cream take to work?
Most acne creams take 8 to 12 weeks to show their full effect. The first few weeks are about getting used to the cream, and retinoids can cause a short flare of small spots. If there is no clear change after about 12 weeks, the plan should be changed.
Can I use benzoyl peroxide and adapalene together?
Yes, and the combination worked better than either alone in a 12-week trial of 517 people. Using both can be drying, so many people apply them on alternate nights at first, or use a fixed combination gel prescribed by a doctor.
Which acne creams are safe in pregnancy?
Retinoids such as adapalene and tretinoin are avoided in pregnancy and while trying to conceive. Azelaic acid is generally considered acceptable, and benzoyl peroxide on limited areas may be considered. Tell your doctor if you are pregnant or planning pregnancy so the plan can be adjusted.
Book an assessment
IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, Singapore 228210. By appointment with Medical Director Dr Sin Yong. Monday to Saturday, 11am to 8pm. WhatsApp or call +65 8815 3008. At IN Eternity Clinic a consultation fee applies, and it is waived if you go ahead with any medical treatment; the fee is S$120.
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References
- Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024;90(5):1006.e1-1006.e30. doi:10.1016/j.jaad.2023.12.017
- Mills OH, Kligman AM, Pochi P, Comite H. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol 1986;25(10):664-667. doi:10.1111/j.1365-4362.1986.tb04534.x
- Cunliffe WJ, Poncet M, Loesche C, Verschoore M. A comparison of the efficacy and tolerability of adapalene 0.1% gel versus tretinoin 0.025% gel in patients with acne vulgaris: a meta-analysis of five randomized trials. Br J Dermatol 1998;139 Suppl 52:48-56. doi:10.1046/j.1365-2133.1998.1390s2048.x
- Thiboutot DM, Weiss J, Bucko A, et al. Adapalene-benzoyl peroxide, a fixed-dose combination for the treatment of acne vulgaris: results of a multicenter, randomized double-blind, controlled study. J Am Acad Dermatol 2007;57(5):791-799. doi:10.1016/j.jaad.2007.06.006
- Tan HH, Tan AW, Barkham T, Yan XY, Zhu M. Community-based study of acne vulgaris in adolescents in Singapore. Br J Dermatol 2007;157(3):547-551. doi:10.1111/j.1365-2133.2007.08087.x
- Oon HH, Wong SN, Aw DCW, Cheong WK, Goh CL, Tan HH. Acne management guidelines by the Dermatological Society of Singapore. J Clin Aesthet Dermatol 2019;12(7):34-50. PMID 31531161
These sources describe mechanisms and general evidence. They are not a promise of any individual result; suitability is decided at an in-person assessment.