Acne, a four letter word

Most of us remember those “acne-ugly” years. Whether it was an occasional break-out or an absolute hormone revolt, it is likely to have left us scarred, literally and figuratively.

The Anatomy of a Pimple

Most of us are aware that Sebum and inflammation are the main actors in this drama. But the exact process (from normal sebaceous gland to comedone, papule, pustule, cyst and scar) bears some examination.

We start with the normal function of a healthy skin.

The skin covering most of your body is scattered with fine (in most cases) nearly invisible hairs, and each of these hairs has a number of attendant glands. The sebaceous gland excretes sebum which reaches the surface of the skin along the hair follicle.  Just the right amount of sebum keeps the skin and hair surface moist and prevents them from becoming cracked/brittle and dry.

“Sebum is an oily substance secreted by the sebaceous glands in mammalian skin. Its main purpose is to make the skin and hair waterproof and to protect them from drying out. An excess of sebum, however, can make the skin or hair oily, and it can begin to smell when broken down by bacteria outside the body. The sebaceous glands are usually attached to hair follicles, but they also exist in some hairless areas of the human body, such as the eyelids, where they add sebum to tears to keep the eye moist.” The wiseGEEK http://www.wisegeek.org/what-is-sebum.htm Jan 2015
 

 Puberty often triggers the process, although acne can be a lifelong affliction.

With all the hormonal changes in puberty, the sebaceous glands are inclined to enlarge and create more sebum than can be effectively used by the skin. In most people, this condition improves with age. Others are less fortunate and suffer their entire adult lives with varying degrees of acne. Should a follicle become blocked (with accumulated dead skin cells and oxidised sebum) the gland still continues to produce sebum which collects in the now sealed hair follicle. Bacteria (which normally occur in the follicle) are also trapped with the sebum and proliferate in the (now) anaerobic environment. The body’s natural immune system responds with inflammation. (There is, however, some debate as to whether inflammation and anti-oxidative stress are symptoms of acne or if they are not underlying conditions which promote acne.) The characteristic pimples, boils and abscesses that affect the skin all begin with a build-up of a mixture of sebum, bacterium and dead leukocytes (white blood cells).

acne_how

Healthy Living http://www.knowabouthealth.com/basic-facts-about-formation-of-pimple/2688/ Jan 2015

The immune response plays a significant role in scarring.

“What many people may not realize is that acne scarring is primarily due to the body’s own immune response to infection, and not the infection itself.” The Science of Acne http://thescienceofacne.com/how-do-acne-scars-form/ Jan 2015

 

When there is an injury to the skin, the body sends out white blood cells to contain and neutralise infection. Neutrophils are the first, and most numerous types of white blood cell to reach the follicles and surrounding tissue. On reaching the site of infection, these cells often self-destruct (apoptosis) to release their contents (anti-microbial molecules, DNA and proteases) into the environment. The proteases (enzymes which break down tissue) are not discriminating and they remove much of the surrounding tissue (including the elastin and collagen matrix) which has been exposed to the invading bacteria. Whilst this effectively sterilizes the area, the underlying structure which supports healthy, normal skin is also destroyed. In cases of persistent infection and inflammation and where the elastin and collagen framework has been damaged, there is no effective guide to direct the regrowth of the complex and delicate skin tissue, so the body does a simple and tough patch-job to heal the wound.

Scar tissue comprises mostly of dense bundles of collagen which are usually aligned in one direction (unlike the normally occurring multi-directional web). The resulting tissue is denser, less elastic and impermeable to the migration of many cell types.  This means that the original hair follicles, sweat glands and blood vessels do not regrow. This also explains why some scars are never replaced with healthy tissue.

In addition to changes in texture and tone, an area which is scarred may show changes in levels of pigmentation. Melanocytes (melanin producing cells) either proliferate or overproduce pigment resulting in spots or patches of skin which are darker than normal (hyperpigmentation). Alternatively, they may be destroyed or depleted tending to give the skin a light or pinkish appearance.

 Prevention is the best Solution

 If you adopt the below lifestyle practices, you will go a long way to limiting the damage and scarring that acne can cause:

  • Drink plenty of fresh, clean water;
  • Eat plenty of fresh fruit and vegetables;
  • Avoid overuse of fat and sugar laden, highly processed foods or drinks;
  • Get plenty of exercise, being sure to wash any perspiration off your skin once you are done;
  • Avoid unprotected exposure to direct sunlight;
  • Keep your skin clean;
  • Use clinically proven dermatological skin care products and cosmetics;
  • Investigate the use of oral medications with your medical practitioner.

 Whilst your acne is active, you need to seek medical advice as to which topical treatments will best suit your condition. These can be broken roughly into two groups which are commonly used in mild to moderately severe cases of acne: topical antimicrobials work to inhibit the Propionibacterium acnes (P. acnes) populations and reduce inflammation (Benzoyl peroxide, Erythromycin and Sodium sulfacetamide are often prescribed); topical retinoids (derived from Vitamin A) help to unclog pores and improve the levels of collagen in the skin by accelerating the normal renewal process in the skin.

Dealing with the Damage

 At the Aesthetics Centre, we have found the following treatments to be particularly effective in treating many of the concerns that acne sufferers are faced with:

Chemical Peels

When treating scarring rather than active acne, exfoliation is the key. Chemical skin peels help to improve the overall appearance and condition of your skin. As with topical retinol products,  the acids commonly used in chemo-exfoliation unlock the chemical bonds of the cells on the surface of the skin. The shed skin is replaced with softer, smoother, more elastic and even toned skin. Chemical peels are also very effective in clarifying the skin, especially those containing salicylic acid.

 Microneedling                                                                                                                                                     

Microneedling (specifically using the Dermapen®) makes microscopic punctures into the deeper layers of your skin, allowing the applied serums and products to penetrate to where they can be the most effective. In addition, this process helps to stimulate the replacement of damaged collagen with better organised less dense collagen fibres. This in turn softens your scars, and reduces some of the fibrous thickening associated with scarring.  Your skin will also be stimulated to produce new and more elastin, which makes your scars stretch and move better, giving your skin a better texture.

Laser Resurfacing

If your scarring is extensive and more severe, you may want to consider undergoing laser resurfacing. In this instance, the laser uses light to burn your skin. These wounds stimulate the accelerated repair and replacement of your damaged skin. As the light is able to penetrate deeply into your skin, the treatment is more intense and the results are more profound and may require fewer repetitions.

Photodynamic Therapy

Photodynamic therapy (PDT) is a non-invasive therapy that utilises light treatments (and may include the application of a photosensitising agent, typically 5-aminolevulnic acid (ALA)). PDT is used to shrink the skin’s sebaceous glands (decreasing sebum production), to normalise the shedding of dead cells within the hair follicles (thus eliminating the blockages) and to target and kill the bacteria (P. acnes) associated with acne break outs.

In conclusion

You do not have to face acne, or its aftermath alone. Make an appointment with your medical practitioner to discuss your condition and your treatment options with her. Your program can be tailored to your pocket and your lifestyle, so that you can enjoy a better-looking skin in minimal time. Treat your acne as soon as possible, the longer you leave your condition, the more difficult it becomes to contain and rectify the damage it can cause to your skin. Most of acne’s legacy is more than skin deep, and can prevent you from enjoying your life to the fullest in ways you are not even, perhaps, aware.

Written by Kim Magennis

January 2015

 

REFERENCES:

AcneNet http://www.skincarephysicians.com/acnenet/prescriptmeds.html Jan 2015

AgingSkinNet http://www.skincarephysicians.com/agingskinnet/acne_scars.html Jan 2015

Healthy Living http://www.knowabouthealth.com/basic-facts-about-formation-of-pimple/2688/ Jan 2015

Medical News Today http://www.medicalnewstoday.com/articles/249182.php Jan 2015

Natural News, http://www.naturalnews.com/031605_inflammation_acne.html Jan 2015

Skin Medica http://www.skinmedica.com/beautytalk/how-to-avoid-acne-scars  Jan 2015

The Journal of Clinical and Aesthetic Dermatology http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780801/ Jan 2015

The Science of Acne http://thescienceofacne.com/how-do-acne-scars-form/ Jan 2015

The wiseGEEK http://www.wisegeek.org/what-is-sebum.htm Jan 2015

About Health http://acne.about.com/od/acnetreatments/a/pdt.htm  Jan 2015

DISCLAIMER

*Results may vary per individual on all treatments and products. **The testimonials given are those of the clients and pertain to the results that they obtained and that each individual's results and opinions will still vary. ***The information on this website and specific page is not meant to diagnose any condition or provide conclusive treatment options for a given condition. The final decision on such treatments can only be made after a full history is obtained in person and a physical examination is done as part of a consultation in person. The information contained in this communication is confidential and may be legally privileged.
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