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Where looking good is understood!
SEPTEMBER NEWSLETTER
Ahh! The cool weather and varied colors of fall are welcome. This month’s Newsletter will discuss a topic that can put various colors in you skin--- acne. Acne also seems an appropriate topic to start the school year. This newsletter will be the first installment of a two part series.
Acne
What Causes Acne?
The medical community doesn’t know what causes acne! The primary cause seems to be related to the hormonal system. Genetics also tend to play a role.
Structures in the skin associated with acne include hair follicles and their associated oil glands. Yes, it may be hard to believe, but you have thousands of tiny hair follicles on your face and body even though they’re not visible.
An acne lesion starts when the oil and cells that shed from the ducts plug up the hair follicle opening at the skin surface. This becomes a closed comedo or whitehead. As more oil and cellular debris accumulate, the pore dilates and becomes an open comedo or blackhead (Note: contrary to popular belief, the color imparted to a blackhead is due to melanin and/or oxidized fatty acids and not dirt). A common skin bacterium, Propionibacterium acnes (P. acnes), degrades the oil in the duct and the resultant by-products are inflammatory to the skin. This inflammation causes the acne lesion to turn red. The irritating by-products attract white blood cells with the following effects: 1) The follicular wall thins which can lead to rupture and, 2) The accumulation of white blood cells can result in a pustule. Rupture of the duct leads to severe inflammation (cystic acne) which can result in scarring. It is not easy to determine which individuals will get scarring and the extent of scarring, so our advice is to treat acne early.
Complications from Acne
Scarring from acne can be either atrophic or hypertrophic. Atrophic scarring occurs when fibrosis from the inflammation and healing process pulls the skin below its normal level. This is the most common type of scarring. Atrophic scarring comes in three different forms: ice pick, boxcar (looks like a crater) and rolling scars. The type of scar determines the treatment. Hypertrophic scars occur when inflammation and fibrosis proliferate and the scar rises above the normal level of the skin. Hypertrophic scarring can easily occur on the back and chest due to skin tension. The best way to avoid acne scarring is to treat the acne early and effectively. Acne can result in post inflammatory hyperpigmentation (PIH). PIH is a condition in which the red color of the acne lesion persists for an indefinite period of time after the lesion resolves.
Acne Treatment
Acne treatment for whiteheads and blackheads or plugged pores can be attacked in a stepwise fashion. The first step is to cleanse the face twice a day with a gentle cleanser. The next step is to add mechanical exfoliation. Mechanical exfoliation can be accomplished with a scrub or with microdermabrasion. A simple scrub consists of mixing baking soda with a cleanser. The scrub is used two to three times per week. The goal is to cleanse and gently exfoliate the skin. Rubbing the skin raw or drying the skin out with harsh cleansers will make the acne worse. As a third step chemical exfoliation can be added. This can be a wash/cleanser, gel or a chemical peel with one or more of the following ingredients:
1. Alpha hydroxy acids such as lactic acid, glycolic acid, citric acid, etc.
2. Beta hydroxy acids with the only one being salicylic acid. The advantages of salicylic acid over the alpha hydroxy acids include the ability of salicylic acid to penetrate oil in the pores and to reduce inflammation.
3. Dicarboxylic acid also known as azelaic acid.
It is important when using a wash/cleanser to leave it on the affected area for 5 to 10 minutes before washing it off. A wash is used once or twice daily while a gel is applied once daily in the morning. Be sure to look at the ingredient list on the bottle or package to make sure that other irritating ingredients are kept to a minimum. This includes but is not limited to alcohols, menthol, camphor, colors and fragrances. A chemical peel is considered a more aggressive form of chemical exfoliation.
Many people with oily skin and acne think they need a moisturizer. Moisturizers are not necessary for oily skin. A good way to tell if your skin is oily is to wash your face in the morning, apply no makeup or skin care products, and then look at the shiny areas at the end of the day. The shiny areas indicate oil and these areas of your face do not require a moisturizer. A transparent instead of an opaque hair shampoo is recommended for acne prone skin.
If the response to the above measures is not adequate then topical tretinoin (Retin-A or other vitamin A derivatives) can be added to the regimen. Topical tretinoin is an effective prescription medication for treating acne. It is applied to clean dry skin prior to bed.
The above measures are primarily to promote exfoliation to unplug pores. There are no hard and fast rules in the treatment of acne. Skin varies with the season and so will your routine.
That concludes this month’s discussion of acne. Next month we will talk about treating the redness or inflammation associated with acne. Next month’s newsletter will also discuss the treatment of acne scars. We hope you enjoyed the information.
Sincerely,
The Staff at Integrated Skin Solutions- “Where looking good is understood!”
7424 NW River Park Drive (Hwy 9)
Parkville, MO 64152-5028
816.505.5550 Fax 816.505.4550
www.integratedskin.com
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