Inflammatory skin disease that appears especially during adolescence, comedonic acne can create a non-negligible aesthetic damage.
- Comedonic acne: what it is
- Because it is common in adolescents
- Causes of comedonic acne
- Comedonic acne remedies
- How to prevent comedonic acne
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Sometimes it is a few pimples and black or white points scattered here and there on the forehead, around the nose, on the chin or in the back of the cheeks, towards the ears: signs, all in all, harmless, which come and go and create a relative cosmetic damage .
Other times, however, juvenile acne can become a real problem because the lesions become inflamed , swollen and infected, resulting not only unpleasant to see, but also painful, difficult to manage in everyday life and a source of great psychological discomfort. especially when they are located on the face or other exposed areas.
Although the disorder is more frequent and marked in adolescence and in males , it is not only boys who suffer from it: even adult women can find themselves with unwanted signs on the face or in other parts of the body, generally starting from 25-30 years, perhaps without ever having suffered from comedonic acne before. In these cases, we speak of late acne.
Why does this happen? What causes more or less annoying comedones, papules and pustules? And above all, how to make them go away and prevent them from returning?
Comedonic acne: what it is
L ‘ Acne is an inflammatory disease of the skin that affects essentially the hair follicle, a structure similar to an elongated bag structure, dead-end, from which the hair is born, which then comes out to the surface through the duct follicle.
Each hair follicle is associated with a sebaceous gland, housed in the dermis, which produces a viscous material formed by fatty acids (sebum) and pours its oily secretions into the rounded base of the follicle itself. From here, even the sebum, like the hair, goes up the duct of the follicle to reach the surface, where it helps to form the hydrolipidic microfilm that protects the skin from excessive dehydration and external aggressions and keeps it soft.
When, for some reason, the sebaceous gland begins to produce excess sebum or the hair duct narrows, the fatty material begins to accumulate in the follicle and the characteristic lesions of comedonic acne appear , namely:
- comedones (small, greasy, subcutaneous bumps, also called “white spots” due to their characteristic light or skin-like color)
- “blackheads” (comedones open on the surface, which become “dirty” due to dust, pollution or other substances that enter the first part of the hair duct)
- papules (lesions of variable shape, usually less than 5 mm in diameter, more or less inflamed, usually a little swollen and red)
- pustules (lesions that are somewhat larger and inflamed than papules which usually contain small amounts of pus in the center due to the presence of bacteria)
- nodules and cysts (harder and deeper formations of papules and pustules, generally inflamed and often infected; in some subjects, the cysts can give rise to real abscesses).
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In the latter case, we speak of cystic acne (also called nodular or conglobate), the form that determines the greatest aesthetic compromise, both when acute lesions are present and after their healing, due to the high tendency to leave residual scars . Fortunately, it is also the less common form. The most frequently encountered variants are, on the other hand, the mild-moderate ones, that is comedonic acne and acne vulgaris , typical of adolescence.
Regardless of the type, acne tends to occur mainly on the skin of the face, neck, shoulders, chest and back, in areas where there is a greater number of sebaceous glands . The most severe forms of acne are often linked to a family-like predisposition, mainly related to hormonal factors, and tend to affect mainly boys and young adult men.
Because it is common in adolescents
Although it can also appear at other times in life, acne is considered a typical disorder of adolescence , since in the vast majority of cases it arises and resolves in this phase of life or in early adulthood.
Conversely, this inflammatory skin disease practically never occurs before puberty, corresponding to the phase of sexual development which usually occurs around 10-14 years in females and 11-15 years in males. In particular, between the ages of 13 and 18, there is a real “hormonal storm” which, especially in the male, has no equal in the rest of life.
In this phase, there is a peak in the production of androgens , which are the typical “male sex hormones”, but which are also produced to a lesser extent by the female body. One of the main functions of these hormones is to stimulate the sebaceous glands associated with the hair follicles to produce significant amounts of sebum , resulting in an increase in the greasiness of the skin and the risk of developing comedonic acne or more difficult forms to manage.
Of course, since not all teenagers suffer from acne and some teens experience mild acne while others more severe, androgens cannot be blamed for the problem, but they certainly play a major role.
Causes of comedonic acne
The appearance of comedonic acne and other variants of acne pathology is determined by the combination of a series of unfavorable factors that lead to total or partial obstruction of the hair follicles and their subsequent inflammation and infection.
As mentioned, a key role is played by the sebaceous glands and their hyper-stimulation due to the change in hormonal levels typical of adolescence. In women, physiological situations such as pregnancy and endocrine or gynecological pathologies (such as polycystic ovary syndrome, PCOS) can also cause transient or persistent forms of acne. Similarly, drug therapies that directly or indirectly affect the production of androgens can facilitate the onset of acne (for example, corticosteroid , testosterone, or lithium treatments ).
Another favoring element is represented by the excessive proliferation of skin cells (keratinocytes) that line the duct of the follicle, through which the sebum reaches the surface of the epidermis. If the keratinocytes multiply too much, the duct narrows and is more likely to be occluded by sebum , which will begin to accumulate at the bottom of the follicle.
In this way, comedones are formed first and then papules , more or less inflamed. The subsequent evolution to pustules occurs when the excess sebum draws some bacteria to the bottom of the follicle that feed on it to survive, such as Propionibacterium acnes, and others that take advantage of the weakening of the inflamed skin to proliferate, such as Staphylococcus aureus.
More generally, all the factors internal or external to the body that promote hormonal imbalances and the occlusion of the hair follicle can cause the appearance of acne:
- stress
- obesity
- use of poor qualitycreams and cosmetics
- taking medications that increase the activity of the sebaceous glands
- inadequate cleaningof the skin, in defect or in excess.
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Comedonic acne remedies
To effectively control acne manifestations and reduce associated aesthetic damage, over the years dermatological research has made available numerous therapies, which must be chosen according to the type of acne present (comedonic, vulgar, nodular acne, etc. ), the severity of the skin condition (mild, moderate or severe) and the location of the lesions.
In milder forms of comedonic acne , characterized by non-inflamed comedones and papules, self-care can be carried out using over -the-counter anti-acne products to be applied locally on the lesions, identified with the help of the pharmacist.
Among these, creams, gels and solutions based on benzoyl peroxide (or benzoyl peroxide) or on retinoids derived from vitamin A can be proposed first of all.
All these substances have a keratolytic action , which means that they are able to reduce the amount of cells in the epidermis that lines the hair follicle duct, preventing it from closing and / or facilitating its opening and excess sebum. .
Some substances used to counteract acne also have antibacterial activity, thus also reducing the risk of infection and the consequent formation of inflamed pustules with pus and abscesses.
If only non-inflamed comedones are present, a chemical peel can also be performed with salicylic acid and glycolic acid solutions available at the pharmacy, simply by passing a small amount on the skin affected by black and white points. The keratolytic and antiseptic action of these compounds allows to free the ducts of the clogged follicles, facilitating the escape of sebum and improving the appearance of the skin. This approach can be associated with photodynamic therapy, based on exposure to light with a calibrated wavelength and intensity.
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To improve acne control, the use of preparations to be applied and left to act on the skin is combined with that of specific antiseptic cleansers for acne-prone skin. In addition to promoting the disappearance of lesions, these products reduce the appearance of sensitization, skin dryness, redness and discomfort (sensation of “skin tightening”) that typically arise during topical acne treatment.
To get a real benefit, it is important to use specific cleansers correctly, i.e. no more than 1-2 times a day, massaging them gently and without rubbing, after having diluted them in a little water, and leaving them to act for a few minutes. . In this regard, it should be emphasized that a thorough cleaning of acne skin is a fundamental complement to therapies, but it must not be excessive: vice versa, there is a risk of inducing a worsening of the disorder.
If comedones and papules are not too numerous, but have a certain tendency to become infected and turn into pustules , the topical remedies already mentioned can be used in combination with antibiotics also to be applied locally, on prescription and for short periods.
When, on the other hand, the lesions are localized on the face or extended over large surfaces and appear characterized by significant inflammation , infection and the formation of nodules or cysts, before intervening in any way it is good to undergo the evaluation of a dermatology specialist to receive the indications. treatment and the most appropriate practical management advice in different cases.
A targeted specialist approach is essential in severe forms of acne because if you use inappropriate drugs, creams or cleansers or use them incorrectly you risk not only promoting the worsening of the lesions and facilitating the development of residual scars , but also compromising the integrity and appearance of the surrounding healthy skin.
The more severe variants of acne (acne with pustules and cystic acne), not adequately controlled by topical treatment, require the use of systemic therapies , mainly including antibiotics by mouth (often, combined with topical belzoyl peroxide) or, in a minority share of subjects with oral retinoids (especially in the presence of acne with nodules).
Against comedonic acne that affects the female population in adulthood, in addition to topical products to be applied on the skin, it may be useful to provide hormonal treatment, particularly in the forms associated with gynecological or endocrinological problems, such as PCOS.
For example, if signs of hyper-androgenism are present , such as thinning, brittleness and hair loss or hypertrichosis (increased growth of body hair), treatment with anti-androgen drugs (which antagonize the action of hormones), or with estrogen-progestogen birth control pills (with this second option, it can take 1-2 months before seeing an improvement in the appearance of the skin).
In these cases, to obtain an effective control of both the skin problem and the underlying pathology and avoid pharmacological interference, the acne treatment must be planned in agreement between the dermatologist, gynecologist and endocrinologist, after having formulated a precise diagnosis , also taking into account the age and characteristics of the patient.
How to prevent comedonic acne
Given that the physiological oscillation of hormonal levels is at the origin of the majority of acne cases , a 100% effective prevention of the disorder is not feasible even by adopting all possible lifestyle and skin care strategies.
This does not mean that there are some useful tips to follow to support the topical and systemic therapies already seen, which help to improve the clinical outcomes and reduce the risk of acne recurring after obtaining an initial improvement in the appearance of the skin and disappearance of most of the lesions. The main ones consist of:
- follow a healthy and balanced diet, based on fresh foods and rich in fruits and vegetables, which are an important source of antioxidantvitamins and mineral salts useful for maintaining healthy and radiant skin
- drink at least 1.5-2 liters of water a day, because the skin must be hydrated above all “from the inside”, avoiding drinks containing sugars and additives and alcoholinstead
- there are no foods that cause acne, but sweets, fatty foods, sausages, chocolate and junk-food in general should be consumed in moderation as they are unhealthy for the body and able to promote unfavorable weight gains that affect the balance hormonal and skin health
- in case of a strong tendency to acne, try to eliminate milkfrom the diet for a few weeks to see if the skin situation improves
- never touchthe lesions, except for the necessary washing procedures and application of topical products, and do so only after washing your hands
- do not apply disinfectants that are not specificfor acne-prone skin to lesions (for example, common alcohol)
- in the presence of injuries, do not apply cosmetics; even after healing, limit the use of cosmetics as much as possible and use only high quality products, designed for skin with acne
- apply only high quality moisturizersor creams designed for acne skin, avoiding any other type of formulation (masks, peelings, sunscreens, etc.) without first consulting your doctor
- also for cleaning the skin, use only specific cleansers for skin with acne and avoid too frequent washing, which destabilizes the skin barrier, promotes dehydration and sensitization and stimulates the production of sebum by the sebaceous glands
- do not expose yourself to the sunduring acne treatments because drugs can induce photosensitization reactions; moreover, the treated skin is dehydrated and weakened, therefore easily damaged by ultraviolet rays
- even if you are not applying anti-acne products, limit sun exposure because the sun tends to favor the appearance of acne (even when it seems to induce an initial improvement).
