Say NO! comedones: care for problem skin

Dermatovenereologist (cosmetologist)

Baichorova

Marua Azretovna

21 years of experience

Dermatologist (cosmetologist)

Make an appointment

The constant process of skin renewal can cause blockage of the sebaceous glands and follicles. Getting into microscopic holes, excess sebum and dead cells of the exfoliated epidermis lead to the appearance of blackheads or pimples. Experts have united them under the name “comedones”. The situation is aggravated by the lack of proper skin care, exposure to unfavorable sanitary conditions, as well as the intense production of sebum, the excess of which clogs the ducts and hair follicles.

The vast majority of cases of comedones are observed on oily facial skin: on the nose, forehead and cheeks. According to most medical specialists, such a pathology is true evidence of hormonal imbalances, hidden dermatological problems and malfunctions of the liver and gastrointestinal tract. Therefore, patients who experience discomfort from their appearance are advised not to focus on the cosmetic problem, but to undergo a comprehensive examination to identify possible diseases of the internal organs.

Pathogenesis

Comedones occur as a result of excess sebum synthesis and disruption of the keratinization process - the formation and exfoliation of cells in the stratum corneum of the skin. As a result, characteristic plugs are formed at the mouth of the hair follicles, which fill them. Thus, sebum loses the opportunity to leave the follicle and begins to accumulate in it, forming cysts.

The removal of toxins through the pores of the skin is also impaired. They interact with sebum, forming a thick, glue-like mass. A mixture of toxins, sebum, partially released from the narrowed mouth of the follicle, as well as skin bacteria and dust, becomes dark under the influence of oxygen. This is manifested by the formation of black dots on the skin. When the orifice is completely blocked, the follicle greatly increases in volume, which leads to the formation of a white nodule.

Open comedones on the back and acne on the face. Photo: Chinese Medical Journal / Open-i (CC BY-NC-SA 3.0) and Roshu Bangal / Wikipedia (CC BY-SA 4.0)

Scheme 1. Treatment of enlarged pores after acne

If we have very wide pores as a legacy of youthful acne, we cannot do without a laser.

Platinental uses fractional laser photothermolysis. Gentle, but very effective laser perforation of the skin Asclepion Dermablade allows you to remove the top layer of skin, even out its tone and achieve porcelain smoothness.

A week after laser resurfacing, the result is strengthened with the help of 5-6 mesotherapy procedures with the Japanese drug SAKURA. The cocktail is compiled individually by a cosmetologist - in a special proportion to improve blood flow and narrow pores.

Patient, 35 years old.

The problem of acne and post-acne: active inflammation, scars, uneven skin, enlarged pores.

Home care: Ultra Milk Cleanser, Even Skintone Serum, Ultra C Sheer Facial Cream, Ultra A Smoothing Complex (Ultra A Treatment Serum), Ultra Hydrating Gel, Protective Moisturizer Cream SPF 30+. All – Ultraceuticals

Procedures in the clinic: fractional laser peeling + 8 Vitapeel Ultraceuticals

Classification of comedones

In clinical practice, comedones are divided into 2 types:

• Open. They are plugs of sebum and skin cells that block the entrance to the hair follicle. Oxidizing upon contact with air, they become black, which is why they look like black dots with a diameter of 0.5-1.0 mm.
• Closed. Clogged hair follicles, which, due to the secretion accumulated in them, expand, forming small cysts. On the skin they look like nodules about 1 mm in diameter, white or reddish.

Since comedones are one of the manifestations of acne, in clinical practice the American Academy of Dermatology classification is used to assess skin lesions. It includes 4 degrees of disease severity:

• I degree. The presence of comedones and up to ten papules - small pink blisters, sometimes with a black dot in the center.
• II degree. A combination of comedones and papules, with the appearance of no more than 5 pustules - pustules.
• III degree. Combination of comedones and papulopustular rash. In this case, no more than five nodes appear on the skin.
• IV degree. Severe inflammation of the skin with the formation of painful nodes and cysts.

Also, to assess the severity of comedonal lesions, the Cook scale² can be used, which evaluates the severity of the pathological process in points:

• 0 points. The presence of several small comedones or papules, which are noticeable only upon careful examination.
• 2 points. There are 1-2 open or 20-30 closed comedones on the skin. At the same time, up to ¼ of the surface of the facial skin is covered with small papules in a total number of up to 6-12 pieces.
• 4 points. Small papules or comedones are observed on more than ½ of the facial skin. There may also be several pustules and large comedones protruding above the surface of the skin.
• 6 points. About ¾ of the face is covered with papules and/or large open comedones, which are combined with many pustules.
• 8 points. Skin rashes are located on almost the entire surface of the face, large pustules appear.

Figure 1. Open and closed comedones. Image: mikrostoker/Depositphotos

Why do you need to get rid of them?

The usual closed comedones are white. Some people ignore single comedones, but in vain! The risk of inflammation is high: redness appears, then a painful papule, turning into a pustule filled with pus. In fact, this is the beginning of the development of a skin disease - acne.

According to the international classification of acne, the formation of comedones is the zero or initial stage of acne development . Treatment for comedones is necessary to prevent the development of more severe forms of acne.

Symptoms of comedones

Early signs of comedones are roughening of the skin and visually noticeable enlargement of pores, which is often combined with increased oiliness and a tendency to peeling. In this case, the color of the skin often changes - it may acquire a grayish or greenish tint.

Next, comedones are formed directly. Externally, depending on the type, they appear as black dots or white nodules. The last few protrude above the skin level and are prone to inflammation, which leads to redness of the skin and moderate pain when touched.

Most often, comedones are located on the skin of the face, upper chest and back. The quantity depends on the individual characteristics of the body, concomitant diseases and can range from 3-7 to 100-150 pieces.

Risk factors

In addition to the main reasons, there are a number of factors that increase the risk of developing comedones. The most significant include:

• Hereditary predisposition.
• Frequent stress and emotional overstrain, lack of sleep.
• Natural fluctuations in hormonal levels, including during puberty and the transition to menopause.
• Endocrine diseases: hyperthyroidism, diabetes mellitus type 1 and 2, polycystic ovary syndrome, hyperandrogenism.
• Poor nutrition: excessive consumption of flour and confectionery products, whole milk products, fatty and fried foods.
• Smoking and excessive consumption of alcoholic beverages.
• Pathologies of the gastrointestinal tract: gastritis, peptic ulcer of the stomach and duodenum, dysbacteriosis.
• Friction or pressure on the skin, such as the use of mobile phones, helmets, tight collars and backpacks.

Pregnancy and the onset of menopause

One of the important triggering factors for comedones is hormonal imbalance.
Quite often this is due to a change in the ratio between male and female sex hormones (androgens and estrogens). Natural hormonal changes in the body, for example, occur during pregnancy and at the beginning of menopause. The sebaceous glands are also part of the endocrine system and are controlled by androgen receptors. Steroid sex hormones (dihydrotestosterone) are responsible for the synthesis of sebum. As a result of sharp fluctuations in the ratio of androgens and estrogens, the synthesis of sebum is stimulated, and the division of cells in the stratum corneum of the skin increases, which often leads to the formation of comedones.

Complications of comedones

With prolonged exposure to trigger factors, as well as improper treatment, comedones can lead to various dermatological complications. The most common among them are:

• Ostiofolliculitis. Inflammation of the hair follicle or sebaceous gland. Externally it resembles a subcutaneous node. In this case, the skin over the boil becomes thinner, becomes bluish, and a white dot appears in the center - a purulent core.
• Intradermal cysts. They are a subcutaneous cavity formation and are the result of purulent melting of inflamed comedones. After healing, a rough connective tissue scar is left.

Is it possible to squeeze out comedones?

Despite the fact that one of the treatment options for this pathology is facial cleansing with mechanical removal of comedones, you cannot squeeze them out yourself. Possible complications:

• Post-inflammatory erythema. Redness of the skin, a residual phenomenon after inflammatory skin lesions. It occurs as a result of damage to local blood vessels or due to strong pressure on the skin, including when trying to squeeze out a comedone on your own.
• Pyoderma. When manually removing a comedonal rash, there is a high risk of introducing infection (pathogenic staphylococci and streptococci) into the damaged follicles. In addition to ostiofolliculitis, such actions can provoke the appearance of a boil, carbuncle, various forms of impetigo and other variants of pyoderma.
• Scarring. Rough mechanical impact on comedones, especially closed forms, often leads to deep skin damage and the formation of persistent connective tissue scars that look like pink or whitish stripes or spots.

Diagnostics of comedones

The diagnosis is established by external examination of the affected areas of the skin by a dermatologist. If necessary, dermatoscopy is performed - examination using magnifying glasses of a dermatoscope.

Interviewing the patient also plays an important role, helping to identify existing risk factors and concomitant diseases. If the latter are present, additional consultations with related specialists (for example, an endocrinologist), laboratory or instrumental studies may be prescribed.

Differential diagnosis of comedones is carried out with other skin diseases that may have similar manifestations. These include:

• Hyperplasia of the sebaceous glands.
• Warts.
• Milia.

How are closed comedones formed?

The mechanism of formation of white comedones involves 2 disorders:

• Hyperkeratosis - a violation of the exfoliation of keratinized cells inside the ducts of the sebaceous glands, scales accumulate and block the duct;
• Changes in the composition of sebum - it becomes thicker and denser, gluing the scales together, making it even more difficult for skin secretions to come out.

Closed comedones are formed in the presence of both disorders, as well as due to the narrowness of the excretory duct , i.e. pores. The release of the contents of the pores becomes impossible and a blockage forms (the initial stage of acne).

Treatment of comedones

Therapy must be comprehensive. This involves treating not only skin lesions, but also eliminating the cause of their appearance, for example, prescribing hormonal therapy for endocrine pathologies. The fight against comedones directly includes the use of medications and mechanical removal of acne.

Drug therapy

An effective method of treating comedones is the use of comedolytics (retinol, retinoic acid, zinc, salicylic acid). These are medications that can prevent blockage of the hair ducts, normalizing the growth of skin cells and the secretion of sebum.

Mechanical removal of comedones

A dermatologist or cosmetologist can remove comedones mechanically. In this case, a Uno spoon or a Vidal needle is used. As a preliminary preparation, skin cleansing can be carried out - chemical peeling and microdermabrasion. Their goal is to remove particles of dust, bacteria and sebum from the surface of the skin, thereby preventing the development of complications. After the procedure, special cosmetics with anti-comedogenic properties are applied to the skin.

Other methods of cleaning the skin are also used:

• Disincrustation. It involves removing comedones using weak current discharges.
• Ultrasonic cleaning. The technique is based on the use of ultrasonic waves that gently cleanse pores. Helps improve the overall condition of the skin.
• Vacuum cleaning. The essence of the technique is to remove plugs using a vacuum.

You can’t squeeze out comedones yourself! Only a cosmetologist or dermatologist can remove comedones. Photo: kukuruzaphoto / freepik.com

Cosmetology procedures for removing comedones in the salon

A corrective home routine can be supplemented with salon beauty treatments on a regular basis or courses. Procedures and salon care are selected individually by a cosmetologist based on the type, condition and needs of your skin. Aesthetic procedures do not replace the basic steps of regular home care: daily cleansing, toning, moisturizing and mattifying will help oily, problem skin stay clear and look healthy for a long time.

List of salon treatments for comedones:

• Cleaning (mechanical, ultrasonic, hardware);
• Peels of various types and depths of exposure (superficial, medium, deep);
• Phototherapy – the procedure reduces acne, smoothes post-acne (pigmentation and scars);
• Biodermabrasion or Microdermabrasion (resurfacing) - procedures fight hyperkeratosis and enlarged pores, improve microcirculation, help skin cells regenerate faster, reduce post-acne, and are suitable for treating non-inflammatory forms of rashes.

Alternative therapy

In the fight against comedones, especially against the background of acne, the following natural remedies can be an effective addition to the main treatment³:

Tea tree oil. Gels containing at least 5% tea tree oil can be as effective as benzoyl peroxide lotions. Possible side effects include mild itching, burning, redness and dry skin.

Brewer's yeast. When taken internally, a strain of brewer's yeast called Hansen CBS may help reduce acne. A common side effect is increased gas production in the intestines (flatulence).

Factors contributing to acne

There are reasonable claims that the phenomenon of comedones appears on the face due to the abuse of cosmetics, hormonal disorders, poor ecology, long-term use of antibiotics or hormones, and stress. Also, a photo with signs of the disease is expected with a genetic predisposition.

Features of nutrition and skin care

Nutritional correction for comedones involves excluding from the diet foods that increase sebum production. First of all, these are foods with a high glycemic index or fast carbohydrates. These include:

• Confectionery.
• Chocolate.
• White bread and pastries.
• Sweet carbonated drinks.
• Dairy and fermented milk products: milk, kefir, yogurt, fermented baked milk, cottage cheese, cheese.
• Trans fats: fast food and processed foods.
• Alcohol, coffee.

Why do comedones “love” those with a sweet tooth?

Consumption of large quantities of confectionery products is associated with a sharp increase in blood glucose levels, which entails a response increase in the production of insulin by the pancreas.
The hormone insulin takes part in the activation of androgen receptors in the sebaceous glands, while simultaneously increasing the level of dihydrotestosterone. As a result, sebum production increases, which is one of the provoking factors for the appearance of comedones. Whole milk and refined foods also contribute to a sharp increase in glucose and insulin levels. Figure 2. Products that provoke the appearance of comedones. Image: artcherich/freepik.com

We also note a number of products that can help to cleanse the skin faster and prevent the appearance of new comedones. This list includes:

• Products rich in zinc: chicken and beef liver, boiled beef tongue, roast beef, pumpkin and watermelon seeds, pine nuts.
• Fatty varieties of sea fish rich in omega-3 fatty acids: mackerel, tuna, sardines, salmon, cod liver.
• Vegetables and berries: carrots, sea buckthorn, parsley, celery, raspberries, blueberries, black currants.

Caring for problem skin at home should take into account the following tips and recommendations:

• Regular cleansing of the skin with special products for excessive oiliness. At the same time, cosmetics should not foam, contain alcohol or surfactants. You can also use toners containing comedolytics for additional cleansing and moisturizing.
• When using creams, you should give preference to products with a more liquid texture, without intense fatty components.
• Application of peelings and polishing agents. These procedures and medications allow you to maintain the effects of the treatment at home. In this case, you should choose products with a low concentration of active ingredients and avoid harsh scrubs.

Hollywood Secrets

Many people, including world-famous people, are prone to skin problems. They use different approaches to combat acne and comedones. For example, Megan Fox makes oxygenating and restorative face masks and cleanses her skin daily morning and evening. Cameron Diaz gave up fast food, and Rihanna gave up alcoholic drinks (these products provoke acne). Victoria Beckham eats salmon every day, Scarlett Johansson washes her makeup brushes once a week and never goes to bed with makeup on her face.

Prevention

You can prevent the appearance of new comedones by paying attention to the following preventive recommendations:

• Do not squeeze out any skin rash yourself.
• Follow the rules of personal hygiene and skin care.
• Refuse excessive use of cosmetics, avoid using low-quality cosmetic products.
• Normalize your diet, avoid foods that increase sebum production.
• Avoid stress, overwork, lack of sleep.
• Give up bad habits: smoking, alcohol abuse.
• Treat endocrine and somatic diseases in a timely manner.
• Regularly visit a dermatologist or cosmetologist to promptly identify skin changes and correct them.