Acne is the most common skin disorder affecting around 85% of the population as so many people, have an acne encounter at some stage, in their life. In our previous article, we discussed nutrient deficiencies present in acne and rosacea suffers, today we are talking about the mechanics of acne and the different types of acne.
Severe acne causes, not just a teenager’s problem
Despite teenage acne being some of the most problematic to treat, due to hormone derived acne, adults suffer from the condition to a great extent. Teenage acne often presents during puberty, increases in the androgen hormone lead to stimulation of oil produced by the sebaceous glands. Hair follicles in the dermis become congested with sebum, and you can think of acne as a roadblock in the skin. Environmental factors such as emotional stress, skin care products, food types and medications can all stimulate the sebaceous gland and create the environment for bacteria growth.
The three criteria that make the perfect storm for aggressive acne
- Bacteria + Sebum = Irritation
- Enclosure + Sebum = Closed Comedone
- Enclosure + Bacteria + Sebum = Full-blown Acne
Sebum. An oily substance that aids in the lubrication of the skin and helps prevent dehydration. Over production or excessive sebum production clogs the sebaceous canal; this clogging or filling of the sebaceous duct produces a nutrient for bacteria to breed. We have now created an environment to clog the pores of the skin.
Bacteria. Taking up residence on our skin and hair Propionibacterium acnes (P. acnes) the bacteria responsible for the onset of the most common acne, (acne vulgaris).
Enclosure. As the sebaceous channel blocks, creating a keratinaceous plug, in turn, preventing the sebum from wicking; forming the reference to a closed system or enclosure of environment. The keratinaceous plug is the precursor to blackheads (comedones) and whiteheads (milia). Mixing with perspiration outside contaminants or hair soil, the production of milia and comedones begins. Once we have the formation of the white or blackheads with the enclosed system, infection often occurs. An aggressive, active acne can form, producing cysts and nodes; frequently causing deeper lesions and a lumpy appearance to the skin or even welts showing on the dermis surface.
The earlier you seek acne treatment, the easier it will be to get it under control
I have acne! That statement is one of the issues when people start to look at acne treatment from shops and chemists. What type of acne do you have, how is it being caused and what are the aggressors or triggers. Correct and early diagnosis is preferable in the treatment of acne as there are many types.
The formation of acne
Acne vulgaris. One of the most frequent acne types, acne vulgaris, is caused by the androgenic male hormone. It can also be one of the most stubborn of the acne types to get under control. Early prevention is key when discussing teenage acne; although this also rings true for adults. Washing your skin once or twice a day using products that are noncomedogenic, any non comedogenic product will say so on the label. Teenagers that are experiencing breakout need to look closely at their diet and skin cleanliness.
Most teenagers experience an increase in the androgenic hormone, and if there are no roadblocks on the outer dermis and excessive contaminants, the chance of severe acne is greatly minimized. Fast food diets with high carbohydrate, sodium and sugar levels should be avoided. There is an undeniable fact that as the modern fast food, takeaway dinner culture has increased, so too the prevalence of acne.
Other common types of acne include
Acne Mechanica. You know those annoying acne spots you get where your glasses are touching your face? It is often not the extra sweating in the area; although it does not help the problem, it is often from the irritation from the frame material. People that work on building sites and have to wear hard hats also suffer this kind of acne regularly.
Acné Excoriée. Counseling may help with this type of acne, derived from a nervous habit. Excessive picking at the skin coined the term (picker’s acne). It is imperative to get the ‘picking’ under control as it opens up the skin to infection and often results in dreadfully infected acne.
Acne Cosmetica. This type of acne comes from that beauty product you bought, causing an almost instant breakout. If you have sensitive skin or prone to breakout, it is a best practise always to purchase noncomedogenic beauty products. I wrote about an acne trigger in Image Skincare, I Conceal Flawless Foundation and how it has no place in our acne clinic.
Acne Conglobata. Feel free to complain to mum and dad about this one as it is genetic disposition acne. If acne has always run in the family genetics are often the cause. In some cases this is not true, rather an environmental factor is influencing the family. For example, diet, many people are not from where they originate from, we are in a multicultural world. Asian races can often suffer from acne when living in other countries. You are very much what you eat, and when that drastically changes, it can manifest in skin conditions.
Cystic Acne. Remember above (Enclosure + Bacteria + Sebum = Full-blown Acne)? Preventing Cystic acne in many ways does come down to your skin routine. Regular cleansing, exfoliating and having general good skin habits helps alleviate the occurrence of Cystic acne. Directly caused by sebum production, dead skin cells and bacteria cystic acne produces that stereotypical angry, pustules looking acne.
Mild Acne or Non-inflammatory acne. We often see this kind of acne with the ingrown hair. A hair follicle becomes impacted creating a micro comedones. It is micro as it has not yet protruded through the outer epidermis, presenting as a slight bump just under the skin’s surface. As the comedone forms, you start to see the small white bump just below the surface of the skin.
Propionibacterium consumes sebum, fatty acids and waste material are produced that begins to irritate the walls of the hair follicle. Skin cells begin to gather blocking and creating the keratinaceous plug and the forming of non-inflammatory lesions resulting in whiteheads (closed comedones).
Inflammatory Acne. Non-inflammatory acne if left unchecked will turn into inflamed acne, and it just get’s worse from there. Infected lesions turn into open comedones excreting their contents, and this may also result in swollen and sore, inflamed lesions. Walls of the hair follicles begin to rupture, producing small raised bumps on the skin, varying in size shape and colour. Milia forms, epidermal cysts firm and white papules developing in clusters. Pustules result after white blood cells begin to invade the area causing further inflammation and aggravation to the area. Pustules, small pus-filled skin blisters found at the opening of hair follicles resulting in aggressive, active acne.
Acne treatment best practises require a clinical, sterile environment
Similar to medical skin needling, we are often treating an exposed epidermis that is open to infection. We need to be thinking about a medical clinic level of the sterile environment. Granted all treatments should have a standard of sterility, all tools should always be sterilised, and nothing is to be left in the room from previous clients.
Regardless of the type of acne, you suffer from the excess production of sebum has to be addressed. Excess sebum is the catalyst to all acne types. This is where acne treatment is starting to evolve, there are normally two types of acne treatment from here; dermatologist or doctor led and aesthetician. Until recent years, the approach has been to address the excess sebum production with a treatment of peels and acne topical products. Dermatologists or doctors go down the root of medications, oral and topical antibiotics being the top treatments. We looked into drugs and medications used in acne treatment not very long ago, and it is of my opinion that it is not the best approach in the treatment of acne.
As we discussed earlier in the article acne has several incubators or triggers that begin the road that ends in acne. In the greater percentage of acne sufferers, we can combat, control and cure acne; there are a few people that do not respond to new treatments and these tend to be teenagers or young adults with severe hormonal led acne.
Even with severe hormonal acne, it is prudent to engage the newest thoughts on acne treatment before going down the road of antibiotics. Stopping the production of excess sebum by balancing out our body, supplementing missing nutrients with specially formulated dietary supplements and using the latest science in Retinoids. Natural Dermatology, the process of fixing the skin conditions by finding out what is wrong with our bodies chemical factory and addressing that first. If there is an advancement in acne and rosacea treatment, then it is in the formulation of product lines similar to Advanced Nutrient Programme. ANP produces a particular supplement; Skin Accumax is one of the latest products in the fight against acne and rosacea and addresses nutrient deficiencies present in many acne and rosacea sufferers.
Acne is also an emotional thing
Apart from our bodies chemical process being hindered by dietary concerns, it is also influenced by our emotional stress levels. Big meeting tomorrow, mortgage payment due and a host of life’s trials and tribulations all impact on the emotional stress we carry. Over recent years, research into physiological pressures has shone much light onto the treatment of acne. It stands to reason that if we are under emotional stressors, this will manifest in many ways depending on the individual.
We are entering a time where overall wellness is important to us; from occupational health influencing organisations to the understanding that our emotional state affects our general wellbeing.
What is the process of acne treatment?
Even if we are treating acne from the inside, we still need to follow a traditional treatment plan.
As mentioned earlier excess sebum production is the cause of all acne; causes enlarged pores and linked to an oily T-Zone. Therefore, our first step is to address the excess sebum. We follow a plan of cleansing, desincrustation, extraction, epidermis calming followed by laser & light therapy if the patient is suitable.
Cleanse. Not dissimilar to the cleanser you can buy in the store, but contains salicylic acid. Salicylic acid aids in the neutralising of bacteria while gently exfoliating the skin. Many acne targeted cleansers also contain soothing and calming ingredients, green tea and seaweed extracts are commonplace in acne targeted cleansers.
Desincrustation. Often this begins with a facial steamer, aiding in softening the skin. The premise behind desincrustation is to facilitate the extraction process while limiting damage to the dermis. Special facial masks are used to soften further the keratinaceous plugs formed by the overproduction of sebum.
Extractions. After the desincrustation phase, extractions are performed where needed. Depending on the comedone fingers, swabs or specific comedone extraction tools are used. Extraction of milia or pustules requires special lancets.
Calming the skin. Following extractions is an antibacterial mask, this mask is designed to calm the skin and restore moisture. The primary aim is to restore the natural balance back to the skin.
IPL & Laser Therapy. For clients that are suitable laser and IPL therapy is used to reduce further bacteria levels of the skin and aid in the prevention of secondary infections. Contraindications of using this type of device would include pregnancy, high blood pressure, heart conditions, epilepsy, asthma or darker skinned people.
Taking healthy habits home
Good acne treatment does not end at the clinic, being aware of lifestyle habits and taking the home care advice and implementing it rounds off the treatment of acne.
Don’t be a picker. Picking at acne spreads bacteria and heightens the occurrence of secondary infections. Picking can and does cause deep, infected lesions; it also makes acne scarring more prevalent.
Over cleansing. Despite skin cleanliness and eliminating contaminants and hair soil is regarded as a best practice. Cleansing beyond twice a day can cause more breakout problems. Over cleansing strips, the skin of moisture irritates the skin and can cause secondary infections to take hold easier.
Take control of a healthy diet. Acne aggressors include; carbohydrates, carbonated drinks, dairy, iodine, offal, red meat, shellfish, processed sugars, and wheat. A Gluten free diet has brought relief to many acne sufferers. Probiotics, as research into acne, continues, unhealthy bacteria in the gut can aid in the acne trigger process. Taking a Probiotic could be considered a healthy habit and aids in the acne treatment. Zeolite supplements and Spirulina are exceptional at removing toxins from the body and could be regarded as a good practise for overall wellbeing. Improving free radical protection, and removing heavy metals.
Acne is the bane of so many people’s lives but with a regular professional treatment plan, some examination and changes to lifestyle habits and taking control of emotional stressors it is manageable if not curable.
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