Posts Tagged ‘pustules’
Acne is a disease state in which skin cells that line a hair or sebaceous follicle are shed, but fail they to make it to the surface of the skin to be sloughed away. An acne lesion begins when sebum (oil) causes skin cells to stick together and clog a follicle. When oil and dead skin cells collect in the follicle, bacteria quickly multiplies, specifically Propionbacterium (P.acne bacteria). The bacteria causes the release of free fatty acids, which irritate the follicle and cause inflammation.
We usually refer to acne lesions simply as blemishes or pimples, however there are specific names used for acne lesions. A non-inflammatory acne lesion is known as a comedo that develops when a hair follicle has become clogged with dead skin cells and oil. When bacteria infects an acne lesion and the follicular wall ruptures it is known as an inflammatory lesion. An inflammatory lesion is elevated and the skin surrounding it is usually red and sensitive.
A non- inflammatory, very tiny hard blockage under the skin. It is the smallest acne lesion and is not visible at the skins surface. This is the beginning stage of a blocked follicle. Micro-comedones develop into open or closed comedones as trapped sebum (oil) increases.
Closed Comedones (Whiteheads or Milia)
A small non- inflammatory bump at the surface of the skin. Dead skin cells and oil become trapped inside the follicle, and the opening to the follicle is closed.
Open Comedones (Blackheads)
A small non- inflammatory, plug at the surface of the skin. Dead skin cells and oil block the opening to a follicle creating a plug. Unlike a whitehead the opening to the follicle is open, allowing the dead skin cells and sebum at the opening to be exposed to oxygen. When exposed to oxygen the dead skin cells and sebum (oil) will oxidize and appear black. Blackheads develop in follicles that are large.
Inflamed small red or pink bumps on the skin with out an opening. Papuals do not contain pus, however they can develop into a pustule or a nodule. As a papule becomes more inflamed pus will form and it will develop into a pustule, if the lesion is deep it will develop into a nodule.
An inflamed, pus filled acne lesion. Pustules are what are commonly called pimples and the white or yellow center is often called a “head”. A pustule is surrounded by a circle of red inflamed skin.
Nodules & Cysts
Nodules and cysts are large inflamed acne lesions that develop deep within the skin. They are severe forms of acne that often cause scars. You should never attempt to pop or extract cyst or nodules, they need to be treated medically.
A large, solid, inflamed, pus- filled lesion that is located deep within the skin. A nodule will feel firm because the puss hardens inside the lesion. The body’s immune system responds by trying to keep the bacteria from spreading and skin cells will grow or wrap around the follicle. Nodules are often referred to as cysts.
A large, soft, inflamed sac -like lesion that is located deep within the skin. Cysts are filled with fluid or a semi-fluid that consists of white blood cells, dead skin cells, and bacteria.
The main objectives in treating acne are to reduce oil production, bacteria, inflammation and to alter keritinization (build up of skin cells). The exact treatment will depend largely on the degree of acne being treated. The treatment for acne will depend on the grade or severity of the condition.
Dead skin cells called are shed into the follicle and are then carried to the skins surface and are sloughed off. Sebum (oil) can cause the skin cells to become cohesive or sticky and then they clump up in what is known as cohesion. The follicle will become blocked when skin cells are not shed properly, this is why treatments that exfoliate dead skin cells and increase skin cell turn over are recommended for acne. The goal is to exfoliate dead skin cells and prevent and break up existing cohesion “clump of skin cells”.
– Microdermabrasion: Not recommended for “active” moderate to severe acne
– Chemical Peels
– Tretinoin ( Retin-A)
– Topical AHA/ BHA: Retinols/ Vitamin A, Glycolic Acid, Salicilic Acid
– Azelaic Acid, also has an antimicrobial effect
Sebum (oil) production
Those prone to acne often produce excessive amounts of sebum (oil). When there is an increase in Androgen hormones such as testosterone, the oil glands become larger and produce more sebum (oil)
– Oral contraceptives can help to reduce the effects androgen hormones in women thus reducing oil
– Acne laser treatments
– Blue Light RF: When Blue light is combined with RF energy it causes sebaceous gland atrophy (shrinks the oil gland) which decreases oil production.
– PDT Photodynamic Therapy With Levulan ALA: When used with IPL will also treat hyper-pigmentation, rosacea, broken blood vessels
Some bacteria is normally present on the skin, including P. acne bacteria (Propionibacterium acnes). There is an increased level of bacteria in acne. Bacteria thrives in an eviroment that is deprived of oxygen so products that intoduce oxygen into the skin work to fight bacteria, this includes benzoyl peroxide. The use of oral antibiotics for acne is usually only recomended for short term use because the body can become tolerant to antibiotics. It is also believed that long term use of oral antibiotics contributes to acne cysts.
– Oral Antibiotics: Tetracycline, Minocycline
– Topical Antibiotics: Tetracycline, Erythromycin, Clindamycin
– Benzoyl Peroxide
– Blue Light Therapy
– High Frequency ( not as effective as blue light, often used after acne extractions)
The P. acne bacteria releases lipase which converts the lipids in the sebum (oil) in to free fatty acids which irritant the skin and cause inflammation. Reducing bacteria will in turn reduce inflammation, because the bacteria contributes to the free fatty acids that irritate skin.
– Salicylic Acid: Topical salicylic acid treats acne by reducing swelling and redness
– Nicomide: A member of the Vitamin B family, also used for rosacea. Topical version available over the counter.
– Zink Oxide: Look for sunblock and mineral makeup with zinc oxide, it has anti-inflammatory properties in addition to being a physical UVA/ UVB
- Croyo-Slushy: anti-bacterial, anti-inflamatory and mild exfoliation properties
“It is easier to stay out of trouble than get out” Mark Twain
Corecting acne scars can be very challanging and expensive, you are always better off treating and controlling acne thus preventing acne scars. Acne cysts are most likely to cause scars, a diluted corticosteroid injection can be used to reduce cysts and inflammation.
Post Inflammatory Hyper-pigmentation (PIH) is name used for the dark spots left by acne or other skin lesions. The skin responds to inflammation by stimulating the melanocyte to over produce pigment cells. PIH can be prevented, treated and controlled with the use of topical products like hydroquinone and tretinoin. Topical Hydroquinone 4% is a prescription strength cream used to “suppress” the melanocyte which can help to prevent PIH and treat existing hyper pigmentation.
Depressed and ice pick scars are usually treated with a “leveling treatment” such as laser resurfacing or a deep chemical peel like the Obagi Blue Peel. Injectable fillers are also used to plump skin and reduce acne scars. Combining a leveling treatment with fillers will provide better results. As the skin ages, the loss of elasticity and collagen will cause acne scars to look worse. Anti-aging treatments and good sun protection can help slow this process. A facelift will also improve the appearance of acne scars because it tightens the skin.
Before you start an acne treatment
Many of the treatments and products mentioned in this post are prescription strength drugs or medical treatments. There are contraindications for some acne treatments, so it is important to consult with your doctor or skin health professional before starting an acne treatment program. Woman that are pregnant or nursing need to consult with their doctor before using ANY acne treatments, as many are not approved for use in pregnant or nursing women. The content provide in this post is intended to be informative and does not replace medical or professional treatment.
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Rosacea is primarily a facial vascular disorder in which blood vessels are functionally and structurally abnormal. Currently rosacea can’t be cured, however it can be effectively treated and controlled. Rosacea is a progressive skin disorder, that should be treated when symptoms first begin. Treatment should be aimed at treating the underlying vascular issues associated with rosacea. Vascular Lasers and IPL treatments are extremely effective at treating existing redness and broken blood vessels. In addition to avoiding rosacea triggers, topical products can be used to prevent flushing and further damage that can accelerate the progression of the disorder.
Laser and IPL Therapy
Both Laser and IPL therapy are very effective at treating telangiectasia (broken blood vessels), generalized redness and flushing. IPL therapy can also be enhanced with Levulan to get the added benefit of treating acne, rosacea papules and pustuals.
Lasers that are absorbed well by hemoglobin are used to treat vascular concerns. The laser energy is absorbed by the blood vessel and creates heat within the vessel which damages the vessel wall and permenatly closes that vessel. The treated vessels are then absorbed by the body. Although there isn’t a cure for rosacea, studies show that laser treatment can permantly remove damaged facial blood vessels and with repeated treatment blood vessels will not always be created to replace the old vessel. Facial blood vessels treated with lasers are sometimes replaced with connective tissue. This is good news, because this will permently reduce the number of blood vessels in the face, near to the level of vessels found in healthy skin.
Lasers have a single wavelength that work at a very specific depth. So any idividual laser has it’s limitations. KTP 532 nm and Pulsed Dye: 577 -585nm lasers are well absorbed by hemoglobin and are very effective at treating superfical blood vessels in the face, while Nd:YAG 1064nm lasers are also well absorbed by hemoglobin, they are effective at treating vessels that are located deeper in the skin.
Intese Pulsed Light (IPL)
IPL skin treatments are known by many names including Fotofacial, Photofacial, Photoderm and Photo rejuvenation. Intense Pulsed Light (IPL) differs from lasers because IPL uses a wide spectrum of wavelengths at the same time (for example: 500nm — 1200nm) that can target any chromophore in that range, while lasers have a single wavelength. You can think of the laser like a sniper that can precisely hit a single target with one shot, and IPL is like a grenade that hits several targets at once. IPL uses special cut-off filters that can be selected to target chromophors in a certain range within the skin. When treating rosacea or any vascular concern, the intended target is hemoglobin. The advantage IPL treatments have over laser treatments is that IPL can target vessels at different depths.
Combined Laser and IPL Therapy
Best results are achieved when you combine IPL and Laser treatments. IPL and Laser treatments can be done independently, however combining technologies at the same treatment time will provide a better result. This type of treatment is fairly aggressive and should only be done by someone that is very experienced in combining these technologies.
Oral and Topical Products
Topical Metronidazole Gel
Metronidazole is topical agent used to treat rosacea, available only by prescription. The primary action of Metronidazole is anti-inflamatory. Metronidazole is effective at reducing papules and pustules and has a fairly minimal effect at reducing inflammation. Unfortunately, it isn’t effective for treating broken blood vessels or flushing.
Antibiotics have long been used to treat rosacea, however they work primarily through their anti-inflammatory properties rather than antibacterial. Antibiotics are effective at reducing papules, pustules, and inflammation. The limitation with antibiotics is that they are not effective at treating telangiectasia or flushing.
Antihistamines are effective at reducing facial inflammation, swelling and burning associated with rosacea. Histamine contributes to swelling, itching and burning. Histamine has also been shown to play a role in inflammation and redness.
Sunblock with Zinc Oxide
UV rays can penetrate the skin and activate sensory nerves that release potent vasodilators, as well as creating heat in the skin causing facial flushing. Zinc oxide reflects both UVA and UVB rays, blocking out heat from the sun. Topical zinc oxide also has significant healing properties when applied to damaged skin and has been shown to decrease inflammation in both the epidermis and dermis.
Dimethicone is a silicone based ingredient with moisturizing ability. Dimethicone is also a protective ingredient that has been shown to reduce flushing caused by skin irritants.
Free radicals have been shown to cause structural damage to vascular walls and many free radicals are potent blood vessel dilators. Dietary and topical antioxidants help to block the damaging effects of free radicals.
Studies show that vitamin C can protect blood vessel walls from free radical damage and reverse existing vascular damage. People with rosacea should get plenty of vitamin-C in their diet, and may want to consider a vitamin-C supplement. In addition to being a great antioxidant, topical vitamin-C has anti-inflammatory qualities.
*This post is intended for informational purposes only.