There is nothing worse than waking up with an additional “friend or two” on your face in the form of a pimple on your previous clear skin. These “friends” always seem to pop in on the most unappropriated times, before an important day like your wedding or an interview where you have to look your best! It feels like your “friends “personality takes over your whole being and that they are the only thing the outside world will notice about you!
Acne vulgaris is an inflammatory skin disease characterised by areas of skin with seborrhoea, comedones, papules, pustules, nodules and possible scaring. Acne affects the face, upper part of the chest and the back. The lesions are caused by changes in the pilosebaceous unit, skin structures consisting of a hair follicle, hair, erector pili muscle and its associated sebaceous gland. Changes within this unit can be caused by six factors:
1. Retention hyperkeratosis
Keratosis can be referred to as the build-up or overgrowth of the Stratum Corneum layer. The subsequent inability of the body to slough off those dead cells creates a touch glue-like substance leading to follicular blockage. Studies have found that individuals suffering from acne lack the enzyme Protealase assisting with the breakdown of cellular glue between the dead cells that leads to blockages. Since the follicle is blocked, it creates a non – oxygenated environment within the follicle.
2. Hair is absent or very weak
The hair follicle acts as a wick, transporting sebum and other cellular debris to the surface of the skin, where it is ultimately removed. Inflammation or infection is rarely associated with this type of follicle, unless the hair becomes ingrown, absent or the opening of the hair follicle becomes clogged.
3. Effect of androgen hormones on the sebaceous gland
Androgen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone that stimulates or controls the development and maintenance of male characteristics. Androgens are a group of 3:
- DHEA (Dehydroepiandrosterone)
4. Sebum within the gland is thicker
Dihydrotestosterone (DHT) is synthesized from testosterone by the enzyme 5- alpha reductase in the sebaceous gland. With the presences of DHT in the sebaceous gland the sebum will change to a thicker, sticker consistency which can lead to further build up and enlargement of the sebaceous gland.
5. Activity of Proprioni Bacteria (P-acnes)
Propioni Bacterium exists on everyone’s skin regardless of acne; they are oxygen tolerant, anaerobic bacteria that prefer to grow in low oxygen environments. In a plugged follicle, the low oxygen levels and accumulating sebum creates a prime environment for the growth of P acnes as they use sebum as an energy source. P. Acnes bacteria use a specialize enzyme Lipase to digest fatty acids and triglycerides that are abundant in sebum. Fatty acids will provide a favorable pH to maintain a healthy acid mantle when secreted on the surface of the skin where triglycerides will add in lubrication for the skin. Due to the follicle blockage free fatty acids will produce in the lower levels of the hair follicle changing the pH of the follicle causing an inflammatory response. Further research indicates that the digestion of sebum by the bacterial enzymes can create comedogenic byproducts, a potential contributing factor to the severity of acne symptoms.
As the follicle becomes filled with sebum, dead skin cells and bacteria, it begins to swell. The follicle wall ruptures and spills into the dermis. White blood cells rush to the area and fight the bacteria. Redness and swelling occurs and pus is created. A new pimple has now been formed. If the rupture in the follicle wall happens near the surface, the pimple is usually minor and heals quickly. It is when the rupture occurs deep within the dermis that more severe lesions, such as nodules and cysts develop.
The following triggers can further aggravate the development of acne:
- Medication such as Prednisone which is a steroid used as an anti-inflammatory or as an immunosuppressant. Prednisone treats many different conditions such as allergic disorders, skin conditions (Eczema), ulcerative colitis, arthritis, psoriasis, or breathing disorders.Contraceptive pill can cause changes in hormone levels in your body—even if it's for the better—it's a change that can result in breakouts.
- There is a link to acne with physiological stress and physical stress. Both will release cortisol, which is our major stress hormone in our body. Cortisol works on the testosterone pathway contributing to the conversion of testosterone and the enzyme 5 alpha reductase present in the sebaceous gland to release Dihydrotestosterone( DHT) changing the consistency of the sebum as well as causing a general inflammatory response within the body and skin.
Designing a treatment plan to address all aspects of an over active sebaceous gland can be done to some extent however as therapists we cannot control our clients hormonal levels and lifestyle choices which may lead to stress.
Performing a thorough consultation to gain as much information about your clients skin conditions will distinguish the triggers and eliminate unrealistic client expectations.
We can assist them by introducing gentle yet effective treatments to reduce the amount of dead skin cell build up removing the plug in the follicle opening. Ingredients like Beta Hydroxy acids will assist to break down excess sebum and reduce inflammation within the sebaceous gland. Anti-bacterial ingredients such as Tea Tree can assist to keep P acnes under control. Azalaic acid is known for inhibiting the effects of the enzyme 5 alpha reductase to slow down the conversion in the consistency of the sebum.
By introducing a holistic approach addressing your client’s lifestyle, product use, professional treatments and taking the 6 factors mentioned above into account can assist you to achieve your client’s desired results.
|Article written by Nadine Vorster
Nimue National Educator at Grace Beauty Ltd.
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