Acne is a complex problem that involves the activity of sebaceous glands in the dermis, cell turnover in the epidermis, hormonal changes, and the activity of surface bacteria. In general, the epidermis of skin consists of at least 4 cells layers that continuously turnover within 30 days. In the upper layer (stratum corneum) resides the lipid barrier that keeps bacteria from entering skin and maintains skin fluids from exiting. If the maturation index (cell turnover) is sluggish, the dead cells accumulate and plug (white or black heads) the open canals that connect the sebaceous glands to the skin surface. Since the canals are skin cell lined, they normally contain skin bacteria. Once the canal is blocked, the bacteria proliferate within the conduit that can lead to acne. Increase activity of the sebaceous glands from stress and hormones increases the production of sebum. If the sebum is allowed to exit through its opening and not blocked, then normal acid oil is spread on the skin surface. Sebum not only lubricates naturally the skin but also suppresses the activity of skin bacteria.
Important aspects of treatment are intended to protect the lipid epidermal barrier, unplug the sebum plug, encourage cell turn-over to lift (desquamate) epidermal cells with their pigment granules (melanosomes), and suppress the activity of the sebaceous glands and surface bacteria. Your physician-specialist will discuss these basic concepts and more advanced treatments for your individual concerns. The modalities and goals for the treatment of adolescent or adult-onset acne may differ.
- Use twice daily a gentle facial wash. Avoid scrubbing your skin with an abrasive cloth or over-washing your face with a facial soap or lotion. Maintain the normal surface oils that lubricate and provide an acidic layer on your skin’s surface to suppress bacterial activity. The goals are to gently cleanse skin of dead cells and debris, reduce further inflammation from aggressive “cloth abrasion” or “squeezing pimples”, and lastly, avoid the feel of “squeaky” clean skin.
- Use a mechanical soft brushing device only once per day during your daily shower. These devices may be timed to allow effective micro-abrasion of the upper dead layer cells of the epidermis (stratum corneum) on the forehead, nose, cheeks, and neck. The gentle removal of dead skin cells, debris, and make-up from the surface may loosen plugs of white and black-heads that block the sebaceous gland openings. Again, one should avoid over-use of this mechano-abrasion method that can result in creating irritations and sensitivity to your already inflamed skin. Your physician and skin care specialist can advise you whether this technique is right for your skin.
- A licensed physician and skin care professional can best recommend the application of topical cosmeceuticals (non-comedogenic moisturizing gels, exfoliators, drying agents), as well as topical drugs (antibiotics, retinoids, pigment inhibitor, sunscreen blockers). Your physician-specialist is able to determine the type, dosages, frequency and sequences of evidence-base additive treatments such as lights (LED, intense pulse light, laser),microdermabrasion, micro-needling, pigment-suppressors, scar modifiers, and monitored use of oral anti-acne and hormonal medications.
Dr. Sasaki and his Medical SkinCare Center will provide you with more evidenced-based care to maintain not only the health of your skin but also the treatment of sebaceous adenomas, acne, pigmentations, and elevated or depressed scars.