Acne, Skin Cancer & Minor Skin Surgery
Acne Vulgaris, or ‘common acne’, is the inflammation of the pilosebaceous unit, which is made up of the sebaceous glands and the small hairs associated with them. Sebaceous glands produce sebum, which is a lipid mixture that keeps the skin hydrated, but on occasion the glands become blocked with the sebum or dead skin. If build-up occurs, then bacterium known as P. acnes will begin to grow within the follicle. Thus, two types of lesions are formed, either inflammatory or non-inflammatory. Yes, I mentioned that acne itself is an inflammation of the unit. The non-inflammatory aspect refers to the situation before P. acnes has a chance to colonize the blocked-up gland, but inflammation occurs afterwards.
There are a number of causative factors involved with acne; unfortunate genetics, high levels of androgens and testosterone, friction and manipulation of the skin, a diet high in sugars and carbohydrates, cosmetics, and certain medications. Although some of these factors can be manipulated and thus effect one’s acne, it is, more often than not, necessary to use acne medication for full control. Both inflammatory and non-inflammatory lesions can be treated.
Initially, you begin with either open or closed comedones. Open comedones are colloquially called ‘blackheads’, which closed ones are called ‘whiteheads’. These whiteheads become infected with P. acnes, and turn into one of three different types of inflammatory lesions – papules, pustules, or nodules/cysts. Severity of one’s acne is graded based on multiple factors, such as the number of lesions, scarring, bloody or purulent drainage, and the presence of sinus tracts (or connections) between the individual lesions.
Closed comedones are difficult to treat because the sebaceous mass is stuck behind the very small follicular hole. It’s common to start with retinoic acid, benzoyl peroxide, or any topical applications. Oral antibiotics aren’t necessary. Treatment will often take weeks to months before any change is noted. Treating mild acne, or less than twenty pustules, requires the same treatment as closed comedones. It’s only necessary to add oral antibiotics if the topicals aren’t working.
Treatment of moderate acne, noted as more than twenty pustules and seen as temporarily disfiguring, requires combination treatment, usually beginning with a topical retinoid and benzoyl peroxide. Oral treatment is necessary for patients with increased numbers of pustules. Treatment continues until no new lesions appear, then is slowly tapered down. For those that respond well to oral antibiotics, they may continue to take low doses for extended periods of time.
Severe acne is often seen as nodulocystic acne, which can include any but not necessarily all of the following acne: cystic acne (some cysts on the face, back, and chest), diffuse cystic acne (lots of cysts), pyoderma fasciale (inflamed cysts generally seen in females), and acne conglobata (cysts that are connected to each other). All of these, in any combination, require very aggressive treatment. Treatment is focused on preventing scarring. It will often require the strongest topical preparations, such as tretinoin gel or adapalene. Finally, prednisone or another steroid can be used to try and control only the most extensive cystic acne.