comedonal acne

Comedonal acne, precusor lesions


Acne is one of the most common dermatological problems, experienced by approximately 80% of Western adolescents. If left untreated it can be the source of significant physical sequelae and psychological problems. Prevalence studies show that acne breakouts, comedogenesis, is not just a problem of youth but for some, it persists into middle age. Study of comedonal acne finds its importance in treatment since they are precursor of all acne lesions.

Effective acne management involves understanding of its mode of development. Prevention from scars, one of the major complications of long-term acne inflammation motivates patients to pay attention to initial lesions and seek treatment promptly. There are four major changes associated with development of comedonal acne (blackheads and whitehead). First an increase in skin lipids production, second a proliferation of ductal epidermis, third a colonization of bacteria specially Propionibacterium acnes, fourth an addition of inflammation to the scenario.

Sebum excretion and production is hormonally adjusted and the role of androgens is well known in hormonally mediated acne lesions. Regulation of sebaceous glands excretion is one of the rationales in treating acne breakouts and whitehead removal. Change in lipid composition of epidermal ducts in particular a decrease in linolenic acid fraction of the skin surface lipids preceded by hyperproliferation of ducts may explains comedonal acne (blackheads and whiteheads) formation. Virtual skin comedonal acne treatment may aim at regulation of sebum, reduction of inflammation, control of bacteria and reduction of hypercornification.

Comedonal acne and its pathology

What are comedones? Comedones are small papules (bumps) with a color similar to that of the skin, their head might get open and darkened. Comedones are divided into two major categories, open comedones or blackheads and closed comedones or whiteheads (see photo). Hyperproliferation of ductal keratinocytes is mainstay of comedonal acne pathophysiology. Here you can read more of pathology of comedone formation.

Open comdedones, closed comedones

An open comedone is a noninflamed follicular opening containing a teratotic plug that appears black. Skin blackheads (see photo) are open comedones with a hyperpigmented head. In open comedones accumulation of melanin (epidermal pigment) makes them darker almost black colored. Nose blackheads are commonly seen due to the larger skin pores of the area. In contrast, the obstruction of sebaceous follicles by sebum and desquamated epithelial cells forms a closed comedone (whiteheads). Excessive proliferation of epithelial cells in sebaceous ducts cause formation of comedones. Comedones usually are precursors of acne.

Sebaceous unit

Sebaceous ducts (follicles) are tubules that conduct sebaceous glands secretions, sebum, to the surface of the skin. Comdeonal acne is usually associated with hyperactivity of sebaceous glands and hypercornification of sebaceous follicles (overproduction of epithelium lining the ducts).

Comedonal acne etiology

Hormonal part (DHT) and comedones treatment: Hormonal factors obviously play an important role in development of a comedo. Sebaceous glands ( part of sebaceous follicles ) are extremely sensitive to androgenic stimulation, and their enlargement usually precedes other obvious signs of puberty even before any sign of acne breakouts. They are under endocrine control and so it is not surprising that sebum production varies with age and sex. Among androgens DHT, dihydrotestosterone increase is more noticeable.This excessive activity is one of aggravating factors in management of hormonal acne. Increase in linoleates and free fatty acids also is seen in conjunction with comdonal acne. Increase in sebum production is associated with increase in free fatty acids rather than an increase in essential fatty acids. Males have a significantly greater sebum production than females.

Emotional influences also significantly affect comedone formation. As with any disease whose course is prolonged , the importance of psychological factors in acne therapy has been repeatedly stressed and should be seriously taken into account for comedonal acne treatment. There seems to be no doubt that stressful situations such as final examinations regularly cause exacerbations in patients. This is probably the result of increased glucocorticoid secretion by the adrenal glands that seem to potentiate the action of androgens.

Environmental agents also play a major role in determining the severity and extent of acne breakouts and affect its treatments. In most cases the manifestations are worse in winter and improves during the summer, suggesting a salutary sequel of sunlight on acne lesions. However, in some cases exposure to sunlight worsens the disease. The constant friction caused by protective devices such as a helmet, shoulder pads or pillows will make management of body lesions more difficult simultaneous with higher likelihood of scar lesions. Rupture of sebaceous follicles is among other aggravating factors. Rupture could be result of skin injury by mechanical squeezing of lesions, abrasive skin scrubbing or resurfacing methods such as dermabrasion. To get rid of nose comedones scrubs could bring satisfactory results if your facial skin is clear otherwise. However presence of active inflammation is a contraindication for facial scrubbing. Here you can find more information on comedones aggravating factors.

Treatment approaches

While treatment of inflamed comedones is critical in any management protocol to treat acne, suppression of naive comedones to prevent further relapse is equally important in maintenance treatment. Salicylic acid  as well as lactic acid/glycolic acid preparations such as creams and cleansers are effective in treatment of comedonal acne. Other keratolytic agents such as retinoids may be used for treatment, however, they are saved for more severe cases. A more recent study suggest use of an inositol mask to treat open comedones.  There are two important points that acne patients should be aware of. To get rid of various types at least six to eight weeks of therapy is essential since this period of time may be required before improvement is noted, improvement may be noted earlier. Second, body lesions including back, chest and shoulder lesions respond more slowly to treatment than do those on the face. Inflammatory lesions are represented as papules, postules, nodules, cysts, macules and scar lesions. Papules and postules are more superficial compare to the rest of inflammatory acne and their cure takes a shorter period of time, 5-10 days. Nodules are deep-seated structures and tend to remain for as long as eight weeks before finally resolving. Cysts are not very common but when they occur they may reach several centimeter in diameter. Cystic acne is considered a severe form of acne and its treatment should be consulted with a physician. To get rid of cystic acne combination therapy is required. Efficacy of acne treatment natural products have been investigated and scrutinized by several lines of study which proved their clinical utilization still dubious.

“Acne Treatment Serum” bioengineered to prevent and treat comedonal acne, clear skin, regulate skin secretions fight colonized bacteria and resolve inflammation.

Acne treatment kit is especially formulated to target comedonal acne. Increased sebum production is controlled during the day by “Day Effect”, part of acne/blackheads treatment kit, and overnights by high potency serums. Depletion of essential fatty acids is associated with sebaceous gland hypertrophy and hyperkeratinizaton of the ducts, two features relevant to comedones as well as cystic lesions. Acne treatment serum also helps with skin reconstruction to rid scarring. “Day Effect” and “Acne Treatment” by providing the skin with essential fatty acids regulate sebum production and help get rid of whiteheads and blackheads. By continuous use of this skin care pigmentation and acne spots dramatically diminished.

“One-Step Cleanser and Toner” is an aimed weapon to clear blackheads and its bacterial colonization. It employs antibacterial agents which efficiently kill bacteria without developing resistance. “Day Effect” also contains benzoyl peroxide and keeps fighting bacterial colonization during the daily activities.

Acne inflammation which is far greater in cystic acne, is controlled by various botanical extracts, essential oils and anti inflammatory agents present in the serums such as acne serum, “Day Effect” and “One-Step Cleanser and Toner”.

Bioflavanoids and Green Tea Extract help to mitigate stratum corneum changes as a result of depletion of its antioxidants. propionibacterium acnes’ activity may be accounted for lipid peroxidation which in turn results in antioxidants depletion in the skin and subsequent aggravation of comedones.