| 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 is not just
a problem of youth but for some, it persists into middle age. Study
of comedones finds its importance in blackheads treatment since they are
precursor of all acne lesions. Effective acne management involves
understanding of its mode of development. Prevention
from acne scarring, 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 a comedone (blackheads and whitehead). First an increase in secretion
of sebum, 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 this process. Regulation of sebum 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 comedones (blackheads and whiteheads) formation.
Virtual skin blackheads treatment may aim at regulation of sebum, reduction
of inflammation, control of bacteria and reduction of hypercornification.
What comedones are? Comedones are small papules
(bumps) with a color similar to that of the skin, their head might
get open and darkened (blackheads). Comedones are divided into two
major categories, open comedones or blackheads and closed comedones
or whiteheads. Skin blackheads are open comedones
with a hyperpigmented head. In blackheads 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. Excessive
proliferation of epithelial cells in sebaceous ducts cause formation
of comedones. Comedones usually are precursors of acne. Sebaceous
ducts (follicles) are tubules that conduct sebaceous glands secretions
( sebum ) to the surface of the skin. Blackheads are usually associated
with hyperactivity of sebaceous glands and hypercornification of
sebaceous follicles (overproduction of epithelium lining the ducts).
Hormonal
part (DHT) and comedones treatment: Hormonal factors obviously
play an important role in development of a black head. 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 treatment. Increase in linoleates and free fatty acids
also is seen in conjuction with blackheads. 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
blackheads 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. 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 its management more difficult simultaneous
with higher likelihood of scar lesions. Rupture of sebaceous follciles
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 blackheads scrubs could bring satisfactory results if your facial skin is clear otherwise. However in inflammatory cases of acne scrubbing is not recommended.
Salicylic acid preparations such as creams and cleansers are effective in treatment of whiteheads and blackheads. Other keratolytic agents such as retinoids may be used for treatment, however, they are saved for more severe cases. There are two important
points that acne patients should be aware of. To get rid of various acne forms 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 ( cystic acne ) 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.
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