Acne is a disease caused by inflammation of the oil glands of the skin and is not due to toxins in the blood. Isolated pimples are formed in the same way as full- blown acne.
THE PROCESS OF PIMPLE FORMATION:
The pimples on the face, neck and back are produced as follows:
- Obstruction of the sebaceous follicle by remnants of the horny layer à follicle becomes distended with sebum and the sebum mixed with the flakes of the horny layer dries out à As the sebum becomes old and drier it becomes browner à blackheads.
- The sebaceous glands continue to produce sebum and the distension of the gland and follicle becomes more obvious à
- The sebum disintegrates with the action of bacteria found on the surface of the skin à and the bacteria begin to multiply à (red-head)
- Inflammation progresses on to pus formation à yellow-head. The pus filled glands may rupture and cause surrounding scarring (fibrosis).
THE CAUSE OF ACNE
The exact underlying cause is not clear at this stage. It seems that there is an alteration in the nature of the sebum secreted so that it more easily thickens and hardens to form a plug that obstructs the sebaceous gland. Some people seem to inherit more sebaceous glands on their face and other areas. It also seems that hormone related chemistry induces changes in the sebum components.
Acne and comedones tend to occur in sun-exposed areas and there is a distinct possibility that Vitamin A depletion in these areas is an important cause of acne. Vitamin A is known to control sebaceous gland activity and the quality of the sebum secreted.
A thickened horny layer is also instrumental in acne formation. People are unaware that if they expose themselves to the sun, the UV light may well kill off the bacteria and sterilise existing acne, but UV exposure promotes a thickened horny layer of the skin and that thicker horny layer can more easily obstruct the follicle of the sebaceous glands. In Europe this is often called Majorca acne. Excessive exfoliation of the horny layer may also lead to obstruction of the follicle.
The bacteria responsible for the degradation of the sebum are found on the skins of people who do not have acne and they probably play their role only in the transformation of sebum into pus. These bacteria are inversely controlled by the pH of the skin. Skin pH is usually between 4.5 to about 6.5.. The lower the pH, the better the acid mantle, and the fewer bacteria are found.
THE TREATMENT OF ACNE
People often make the mistake of believing that acne is a manifestation of dirty blood or dirty skin. They treat the skin by scrubbing it with harsh chemicals frequently only to exacerbate the condition. Other people believe in harsh ‘tonics’ to ‘purify’ their blood. The treatment is difficult but should be focused on the specific causes of acne.
The skin care therapist cannot address the hormonal problems leading to a change in the consistency of the sebum. However, it is possible to influence all the other important factors:
- Reduce the activity of the sebaceous glands.
- Reduce the possibility of sebaceous gland obstruction.
- Dissolve the keratin-sebum plugs.
- Reduce the acid mantle to the lower normal levels.
- Treat the
However, the most important point to stress is that when the skin care therapist treats acne, only the symptoms to a large extent are treated. The basic physiological reasons for acne may still exist. It is important to understand this because even when acne has been ‘cured’ the conditions for it to recur still exist. Acne treatment needs to last for many, many years and for this reason it should also be kind to the skin and work with the natural physiology of the skin.
- REDUCTION OF SEBACEOUS GLAND HYPER-ACTIVITY
This is best done by using topical vitamin A either in the kinder cosmetic forms or through the harsher medicinal form. In some people only a very low dose of vitamin A is required to reduce the activity of the sebaceous glands and produce less sebum. It seems that the nature of the sebum is also changed.
Other people need to use higher doses of vitamin A before they reduce the action of the sebaceous glands.
- REDUCE THE POSSIBILITY OF SEBACEOUS GLAND OBSTRUCTION The exposure to harsh UV rays should be reduced.
The thickened Horny layer can be treated with:
- vitamin A Original moisturising gel or the creams
- Alpha hydroxy acids
- benzoyl peroxide
- Dissolve the keratin plugs.
- Sensible skin cleaning: here the important value of mineral oil should never be forgotten. Try not to use the harsh soaps
- AHA
- Peeling
- Reduce the acid mantle:
- Alpha Toner This can be watered down if it feels too strong. Encourage people to use it neat.
- Acid
- TREAT THE INFECTION Benzoyl-peroxide
This is a prime indication for peeling of the skin. Peeling will sterilise the acne spots almost immediately (many people can feel that the pain in the spot stops within 20 minutes of a treatment. However, this has to be repeated for subsequent crops of acne until the basic skin problem has become controlled. Once the skin is controlled then peeling is no longer required.
If the above regime is not adequate then only should one resort to the use of antibiotics, hormones or systemic treatments with vitamin A (Roaccutane etc.).
Important point is that when we treat acne we only treat the symptoms so the treatment must be long-lasting. Another discouraging fact is that generally the treatments for acne first make the condition worse before the acne improves.
This aggravated phase may last several months.
If the acne is not too bad then I usually treat the people with Moisturising Gel and Forte Alpha toner. If that does not work well enough then I add the Alpha spot solution. If still not improved then I resort to peeling.
If acne is bad at first consultation then I immediately do a light peel (even though they are not on vitamin A – one light peel is not going to de-stabilise the skin) to give the person confidence that we can actually control the acne. They start the Moisturising gel and then we start the program of repeated peels.
Solar comedones to show comedones from sun exposure.
