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Comedones, sebaceous formations under the skin that feel like many ‘white balls’ are often seen in transparency or even appear slightly protruding so that the surface of the skin appears irregular and rough to the touch. They are closed comedones that have accumulated and gradually stratified. In any case, the pimples under the skin are always unsightly and are to be treated. In fact, these lesions can persist for months without showing signs of inflammation, or they may over time ignite suddenly forming large and deep pimples (nodules and cysts) that often leave acne scars. They are a sign of acne comedonica, which is the topic of this article.
Comedones as a symptom of acne comedonica
Acne comedonica is an inflammatory disease characterized by the appearance of blackheads called ‘comedoni’ and more or less reddened pimples. Let’s find out what are the natural and pharmacological remedies and what behaviors we can implement so that the symptoms do not get worse.
What is comedonic acne? Comedonic acne is a physiological manifestation typical of adolescence, in the age group between 13 and 20 years, in which hormonal changes, in particular the increase in androgen secretion such as testosterone, (for this the males are the most affected subjects), determines imbalances in the whole organism. 30% of the Caucasian population suffers (it is rare in the eastern populations and in the subjects with black skin) and can persist even up to 30 – 40 years. It is also very frequent in women, manifesting itself in certain periods of the menstrual cycle and in fertile age.
Comedones: what are they and how are they classified?
In medical terms, acne is defined as ‘inflammatory dermatosis of the pilosebaceous follicle’, or of hair follicles that also produce sebum. Comedones are formed by dilatation of the follicle orifice and can be distinguished in:
- Open comedones: these are commonly called blackheads, where the dilation of the follicle orifice causes excessive fat production and subsequent penetration of bacteria (oxidation in contact with air gives the characteristic black color).
- Closed comedones: they are white spots where the opening of the follicle is so small that it seems almost closed and consequently the fat inside is less exposed to air and oxidation phenomena.
The formation of blackheads, therefore, causes the obstruction of the aforementioned follicle with consequent increase in cell death and accumulation of keratinized cells (i.e. the cells of the outermost layer of the skin, endowed with keratin) determining first the formation of blackheads and then those of inflammatory lesions.
More in particular the phases can be summarized as follows:
- Increased sensitivity of hormone pilosebaceous follicles due to hormonal changes.
- Higher follicle response with hyper production of sebum and increased cell turnover (turnover)
- Keratin cap formation due to excess sebum and increased cell turnover
- The onset of inflammation and infection, the latter linked to the presence of a bacterium, Propionibacterium acnis.
Comedonic acne can be divided into different types depending on the symptoms and their size.
Also, depending on the number of comedones present, we can classify a comedonic acne in:
- Slight, when the comedones are less than 20
- Moderate, when the number is between ≥20 and ≤ 100
- Grave, when the number is greater than 100.
In most cases the pathology occurs at the level of the face (95 – 99%), especially on the forehead and on the nose but sometimes also on the cheekbones and on the chin. In severe cases it may extend to other areas of the body such as behind the ears, on the upper back (60%) and sometimes even on the chest at the level of the thorax (15%).
Comedones are generally formed for 3 causes that can reinforce each other.
Excessively oily skin
Oily skin is always in all cases tends to be acneic, that is, it tends to form white points and black points from which the inflamed pimples originate. You may not have had an obvious acne picture yet, but only a few black spots or pimples every now and then, if you add other factors, your skin can develop full acne. Thus, oily skin can be called the basic comedogenic factor.
Repeated application of comedogenic cosmetics
This is the main trigger. If on a more or less fat skin we apply cosmetics (moisturizers, sun, makeup etc) comedogenic or even moisturizing, the pores will tend to occlude and will form the comedones, more or less numerous, more or less deep, which will appear as pimples under the skin. With what you apply to the skin of your face, you cannot be too careful; only buy and use strictly non-comedogenic products.
But unfortunately, the absence of comedogenic substances is often not enough. It is the hydration itself that causes comedogenesis. The skin cells swell and, at the pores, obstruct the leakage of the sebum to the surface.
At the beginning you will seem to cure, protect and make your skin softer and smoother, but, after about ten days or a few weeks, you will begin to notice the appearance of strange pimples under the skin that will become more numerous and stratified.
A sudden increase in male hormones
The male hormones, also produced in women, are the basis of oily skin and acne, but their sudden increase, due to the formation of polycystic ovaries or other disorders, may be the cause of a sudden appearance of pimples under the skin that often they quickly become inflamed and deep.
How to get rid of comedones naturally
The disease can be treated by various natural therapies including home remedies, herbal and homeopathic preparations and alternative therapies such as oriental medicine or aromatherapy. Natural remedies are to be used in all cases in which acne is mild and does not require a pharmacological intervention. Granny’s ‘remedies’ against acne, include all those solutions that can be used to reduce local symptoms. Among these remedies we can mention:
Mask with honey and cinnamon
Mask with honey and cinnamon, which exploits the emollient properties of honey and the disinfectant and antibacterial properties of cinnamon. Simply mix a couple of tablespoons of honey with a couple of teaspoons of cinnamon and apply the mixture on the area to be treated for at least 20 minutes and then rinse well with lukewarm water.
Raw potatoes, which thanks to the content of different minerals and starch help to purify the skin and reduce the amount of sebum. Raw potatoes should be applied for at least half an hour directly on the area to be used. Lemon juice, which has astringent and purifying properties, thanks to its citric acid content. With about ten drops on a cotton ball, it is advisable to gently rub the affected parts and rinse well with water. It can also be combined with substances with a soothing action such as milk or rose water to create a facial cleansing tonic.
Clay mask, a substance whose purifying action has long been known. To prepare it, just dissolve a couple of tablespoons of clay in water until you obtain a homogeneous consistency. Apply the mixture on the area to be treated and keep in place for at least 20 minutes removing all residues well with water.
Garlic, which helps to fight inflammation and infection, thanks to its antibacterial and disinfectant properties. After crushing a couple of cloves of garlic, gently rub them on the affected area and then wash well with water.
Apple cider vinegar
Apple cider vinegar, for its exfoliating and disinfectant properties, mixes a part of vinegar with one of distilled water, dabbing the affected area with a cotton swab soaked in the mixture.
Bicarbonate, to be used to make a natural exfoliating peeling, to be prepared with half a tablespoon of baking soda and a teaspoon of warm water. The mixture should be gently rubbed to remove dead cells and impurities.
Herbal preparations against comedones
Among the most suitable natural remedies for the treatment of comedonic acne we have herbal preparations. Among these are more indicated:
Homeopathic cures for comedones
Homeopathy can also be an effective natural remedy against acne. In particular, the most appropriate remedies are:
What are the alternative remedies for comedones?
In addition to home remedies, herbal medicine and homeopathy, there are also other natural remedies that can be used to treat comedonic acne. Among these we mention:
To be used in cases of acne associated with stress, Bach flowers are used to recreate the balance between a subject, himself and the environment that surrounds it. The most suitable for acne is Crab Apple, also known as a flower purification and used in the treatment of all skin diseases.
Exploits the purifying and antibacterial action of essential oils to reduce the formation of blackheads and boils, eliminate excess sebum and dead cells. The most suitable essential oils are sandalwood (thanks to the content of farnesol with antibacterial action), that of lavender (which has healing and regenerative properties), that of lemon (thanks to the purifying and astringent action of citric acid) and that of myrrh (which possesses antiseptic properties). The essential oils should be applied on the part to be treated with a cotton swab, rubbing gently, or they can be combined with their moisturizing cream.
Traditional Chinese medicine heals acne by acupuncture, by applying needles on Tai Chong points (located on the back of the foot) and Tai Xi (located at the level of the upper edge of the internal malleolus). These points should rebalance the neuroendocrine situation of the organism.
How to get rid of comedones with medical and behavioral therapies
Mild comedonic acne can be treated by taking daily precautions and natural remedies to keep your skin clean and healthy. In the more severe forms, however, the treatment of comedonic acne involves the use of specific drugs.
To prevent and alleviate the appearance of this skin problem, it is advisable to daily cleanse the face using delicate products specifically designed to treat the problems of impure skin, subsequently moisturizing the skin with creams that are not excessively greasy.
To help the skin get rid from impurities it is also possible to resort to some natural remedies such as clay masks or those made with honey, burdock or oatmeal. You can also make a delicate scrub with bicarbonate, lemon and honey or by mixing sugar and egg white. Even if no food is forbidden, it is advisable to follow a balanced diet rich in fruit, vegetables, fish and foods rich in vitamins.
When the skin is affected by a severe form of comedonic acne, the dermatologist may prescribe the use of appropriate drugs. The most common are topical creams and gels containing retinoic acid, a substance with an exfoliating and anti-inflammatory power.
Avoid the practice of removing blackheads mechanically, that is by squeezing them with your fingers or with special tools. This habit, however, can lead to the worsening of comedonic acne and the proliferation of further impurities. It is also inadvisable to excessive exposure to the sun which, although giving an initial beneficial effect, can later cause a worsening of acne for the thickening of the skin layer that prevents the follicles from getting rid of excess sebum. In the same way, it is important not to wash the skin too often. Eliminating the layer of sebum, in fact, could cause an excessive reaction of the sebaceous glands.
In the most serious cases, acne should be treated with pharmacological remedies, following the instructions of the doctor scrupulously. It is also good to know some behavioral norms that can help reduce the symptoms or prevent them.
Pharmaceutical products to treat comedones
The drugs to be used for acne should be administered exclusively by the doctor after careful assessment of the symptoms and possible causes. The most commonly used are:
They are mainly used in women through contraceptive pill (based on estrogen and progesterone) to regulate hormone levels and restore balance.
Are drugs, derived from vitamin A, quite aggressive that are used topically (i.e. applied locally in the form of ointment or cream) and whose function is to regulate the growth and differentiation of epithelial cells. The most used are isotretinoin, retinoic acid, retinal and adapalene.
They are used to treat infections related to acne and caused by Propionibacterium acnis. Those most commonly used are erythromycin, metronidazole and clindamycin and are usually administered directly on lesions in the form of cream or ointment.
They are used as an alternative to antibiotics to avoid the phenomenon of antibiotic-resistance by bacteria. The most commonly used are benzoyl peroxide and azelaic acid, both are used in the form of cream to be applied locally.
How to prevent the formation of comedones? Usually comedonic acne is a disease that resolves with age. However, there are precautions that can help prevent the formation of comedones and pimples or speed up the healing process.
- Follow a healthy diet preferring foods such as fruits and vegetables, rich in antioxidants and vitamins, whole grains, legumes, blue fish, rich in omega 3 and omega 6 and flax seeds that help to maintain healthy skin. Instead avoid all foods that can increase the aging state of the skin such as fatty and processed foods, fried foods, refined foods and alcohol.
- Avoid exposure to the sun, in fact, exposure to UV rays is one of the causes and therefore can exacerbate the problem, if it already exists, or favor its appearance.
- Wash the skin gently, without rubbing too much and use natural cleansers, not very aggressive, and suitable for the treatment of skin with acne.
- Avoid washing the skin too much or too often, as an excess of cleaning could cause an aggravation of the inflammation due to the loss of the natural lipid film that is above the skin.
- Avoid squeezing, scratching, crushing or rubbing pimples and blackheads, to prevent further infection and avoid scars.
- Use dermatologically tested makeup products and clean the skin with suitable and non-aggressive products.
- Reduce and manage stress. For example, you can devote yourself to yoga, pilates or autogenous training sessions to learn how to deal with anxiety and stress.
- Wash the pillowcases often to remove impurities and bacteria and change them at least 2-3 times a week.
Comedone scars: how to get rid of them? Comedonic acne is a skin condition that can leave considerable scars. It is not easy to repair skin damage, although there are many techniques ranging from glycolic acid based creams to laser treatments. Let’s analyze the possible more or less invasive remedies to eliminate this skin imperfection.
How to eliminate acne scars? The treatment of comedonica acne scars consists of various remedies and the choice of the most suitable depends on the shape, depth and location thereof.
The scars caused by severe acne, in fact, can be distinguished in two large types:
1. hypertrophic scars: characterized by an excess of connective tissue that remains
2. atrophic lifting spots: characterized by poor connective tissue that remains slightly endorsed.
In turn, the atrophic scars can be divided into:
- Ice-pick: characterized by thin but deep cavities in the dermis
- boxcar: characterized by a more or less deep depression depending on the tissue of collagen destroyed with defined edges
- rolling scars: characterized by large depressions with rounded edges.
Acne can range from mild to severe; mild acne usually does not leave scars, severe acne, on the other hand, leaves more or less deep scars on the forehead, cheeks and chin that last for a lifetime.
Possible remedies: creams, peeling, laser, dermabrasion. The post-acne scars are blemishes are more or less evident and unfortunately the existing treatments cannot completely erase them. However, improvements are also possible on old signs. The systems to improve the scars due to acne are many, and they vary according to the type of scar. Let’s see what can be used:
Creams for external use smooth the skin progressively
These creams are based on:
- Hyaluronic acid: which is a component of the skin that has the task of keeping it hydrated and toned. It has the property of filling any depressions and is therefore indicated to mitigate mild acne scars.
- Glycolic acid: it is an acid derived from sugar cane that, thanks to its ability to penetrate even in the deeper layers of the skin, causes a deep exfoliation of the superficial layer of the skin. Stimulating cell turnover, brings a new layer of skin to light and then smoothes the scars.
Filler is a technique that consists in injecting under the skin substances such as collagen or hyaluronic acid which are used to fill scars. The substance should be injected with very fine needles after applying an anesthetic cream. Fillers can give good results in cases of atrophic acne but are temporary. The benefits, in fact, have a variable duration depending on six cases and must be repeated every six months.
Peeling is a valid method of treatment both in the preventive phase and in the one dedicated to the reduction of scars due to acne. It consists in the application on the skin of an acid substance capable of promoting skin exfoliation and stimulating the regeneration of the skin. The peeling with glycolic acid is widely used at various concentrations but salicylic acid, trichloroacetic acid or phenol can also be used.
Chemical piling may be superficial if it affects only the superficial layer of the skin, or deep if they also affect the dermis which is the deepest layer. Deep peels are very aggressive and are performed by the dermatologist or plastic surgeon under total anesthesia. Piling with low concentration glycolic acid (40%) can also be performed in beauty centers but, to obtain an appreciable result, it takes four or five sessions that can cause a burning sensation that almost always disappears in a few minutes, leaving only a slight redness.
It is a lighter version of dermabrasion, in fact, instead of dermabrasor, microcrystals of aluminum oxide are used, to exfoliate the skin and remove dead cells. Treatment is not very painful and can also be done without local anesthesia.
It is a cosmetic surgery treatment that eliminates the superficial layer of the skin. Once they were used for such interventions, traditional ablative lasers that required long healing times, today the new fractional lasers result in a healing in a short time, with satisfactory results.
The CO2 (carbon dioxide) laser is the one that until today gives the best results. Currently, among the most innovative and least invasive systems, able to give good results on acne scars, there is the non-ablative fractional laser. It does not eliminate the superficial layer of skin, but creates thermal stimulation microareas beneath the surface layer that promote tissue self-repair. An operation that takes place in the laboratory without anesthesia. Generally it takes from four to six sessions at a distance of one month and leaves only a redness and a slight swelling for about two days. To do this, general anesthesia is necessary and has a demanding convalescence consisting of at least two weeks of medications and controls. This is the reason why, despite the good results, this type of intervention is often avoided and it is preferable to other less effective but easier solutions for post-intervention management.
A middle way between the two solutions is the fractional laser in the ablative CO2 version. A maximum of two interventions are needed with a recovery time of one week. Before the laser peeling of the face, a visit is necessary that determines the quantity and depth of scars, the type of skin, and the state of health of the patient and of course all preoperative clinical examinations will be performed.
It consists in stimulating the skin to produce collagen and elastin, then to the cellular exchange, through microferitis caused by a roller equipped with numerous needles. To obtain improvements it is necessary to do at least 3/4 sessions and the same will be visible after at least 2/3 months necessary for the formation of new collagen. Each treatment lasts 15-20 minutes and is done after applying an anesthetizing cream to the skin.
The scars that are extremely endorsed require a real surgical treatment. For this intervention there are several techniques:
Punch: consists of removing, with a special tool, the part of skin containing the scar and in suturing, then, the margins with very thin and reabsorbable thread in order to create a very thin scar and not endorsed The new scar can be corrected with other techniques including that of skin graft taken from other parts of the body.
Subincision: consists in detaching the scars, with special needles called Nokor needles, from the subcutaneous part to which it is adherent, allowing its elevation.
Both techniques are performed under general anesthesia and require rather long healing times. The edema and swelling, in fact, remain very evident for over 15 days and frequent dressings are necessary. As already said repeatedly every type of scar requires the most suitable treatment that will be chosen by the dermatologist.
Often it is necessary to use more treatments to obtain a satisfactory but not definitive result because, unfortunately, none of them can definitively eliminate comedone scars.