Spot on

Nurse prescriber Naruschka Henriques gives practical tips for diagnosing and treating common types of acne

NARUSCHKA HENRIQUES

Naruschka Henriques has been the head of cosmetic dermatology at The Botonics Plastic Surgery Group in Harley Street, London since 2011. As a dedicated and experienced independent nurse prescriber, Henriques is an esteemed authority in non-surgical aesthetics. In her more than decade long full-time career in aesthetics, Henriques has treated tens of thousands of very happy patients.

Acne is a common skin problem that affects individuals of all ages. Beyond discomfort, it causes psychological disturbances affecting self-esteem, confidence, and overall body image. It is important to know the different types of acne and how to diagnose and treat them well in order to have healthy skin.

In this article, we will focus on practical guidelines for diagnosing and treating the most common types of acne.

WHAT IS ACNE?

Acne is a chronic inflammatory dermatological condition that results in pimples, blackheads, whiteheads, nodules, or cysts. This mostly happens when hair follicle openings are blocked by sebum oil mixed with dead cells leading to the growth of bacteria, most commonly Propionibacterium acnes (P. acnes). Below are the common types of acne and how they can each be treated:

1. Whiteheads (closed comedones)

Small flesh-coloured bumps, which have a white or yellowish centre are referred to as whiteheads, which are also called closed comedones. These can occur when pores plug up due to excessive oil and dead cells under the skin’s surface.

To identify whiteheads, look out for small raised bumps where pores are not open.

These blemishes usually appear on the face, especially the nose, chin and forehead areas. Although the inflammation rate is generally low, untreated conditions may see these develop into acne-like lesions.

Treatment

• Topical retinoids: These form the backbone of treatment for acne since they unclog the pores while speeding up cell turnover, reducing the formation of comedones such as whiteheads. Through regulation of cell division within the epidermis, these drugs prevent the accumulation of keratinocytes which cause pore blockages. Topical retinoids also go beyond dealing with present spots to preventing future ones, making them an integral part of managing acne.

• Salicylic acid: Salicylic acid is a betahydroxy acid, which is an efficient exfoliant that helps clear dead cells and unclog pores. Because it can get deep into the pores, salicylic acid is highly useful in treating acne by breaking down sebum and debris build-up. When regularly used, salicylic acid prevents clogged pores, soothes inflammation, and helps to avoid future outbreaks, enhancing clearer, healthier skin in general.

• Benzoyl peroxide: Existing as an antibacterial potentiator, benzoyl peroxide eliminates P. acnes bacteria thereby reducing acne symptoms. Moreover, it decreases inflammatory reactions associated with acne lesions, resulting in quicker recovery processes. This allows patients to use it in combination with antifungal treatments which not only help fight bacteria but also prevent further breakouts, leading to a better complexion.

2. Blackheads (open comedones)

Unlike whiteheads, blackheads are open comedones, and since their holes remain open, all trapped dirt will oxidise, turning it into a blackhead. These tiny black dots appear more often on the nose, chin, or forehead compared to anywhere else on the face.

If not attended properly, though generally less inflamed compared to other types of acne, they might contribute to congestion of the skin, causing more acne-related problems.

Treatment

• Topical retinoids: These medications are very effective in thwarting blackhead formation by accelerating the generation of cells and blocking up the pores. They prevent the accrual of dead skin cells within pores by regulating the proliferation of skin cells, hence avoiding blackhead build-up. Continuous use of topical retinoids helps to keep clear pores and avoid recurrence of blackheads, giving much smoother, blemish-free skin.

• Salicylic acid: This skincare ingredient effectively dissolves dirt trapped within skin pores, enabling the removal of blackheads. By going deep into pores, salicylic acid eliminates excess oil and dead skin cells, preventing the occurrence of blackheads and leaving patients with a clearer complexion.

• Manual extraction: This procedure entails applying moderate pressure around the visible stalks to push out blocked debris. In competent hands and under sterile conditions, practitioners can safely remove these blemishes without injuring surrounding tissue.

3. Papules

Papules are tiny red bumps which develop due to inflammation of hair follicles caused by excessive oiliness as well as bacterial infection. At times, they may be painful or painless depending on whether there is pus inside them or not. The presence of such eruptions often signifies an impending acne flare-up, which causes concern because they tend to be quite prominent on the face and painful when touched.

Treatment

• Topical antibiotics: These drugs help reduce swelling while inhibiting the multiplication of bacteria inside hair follicles.

• Azelaic acid: This is a naturally-occurring acid that has antibacterial and anti-inflammatory properties, making it an effective way to treat papules.

• Ice therapy: Applying ice to the affected area can help reduce inflammation and alleviate pain associated with papules.

4. Pustules

Pustules are similar in appearance to papules but they contain pus, hence their whitish or yellow colouring. They are usually red at the base and can be surrounded by inflammation. These breakouts often indicate that acne is progressing and can be quite painful.

The ideal approach should address specific causative factors responsible for their development, such as excessive oil production accompanied by bacterial overgrowth. However, one should avoid squeezing or pricking pustules because doing so increases the chances of further inflaming them, leading to scarring.

Treatment

• Topical or oral antibiotics: Tested by dermatologists, these drugs target microbes which infect hair follicles, thereby curing pustular eruptions. Whether applied topically or taken orally, antibiotics work against P. acnes bacteria, lessening inflammation as well as speeding up healing of infected pimples.

• Benzoyl peroxide: Benzoyl peroxide is widely available as an over-the-counter medication that kills bacteria, reduces swelling during the healing process and clears up pustules on the face. It eliminates P. acnes bacteria because it has antimicrobial effects, while its anti-inflammatory actions soothe redness and swelling around acne lesions. Regular use of benzoyl peroxide dries up such blemishes, stopping new breakouts from happening, making it an essential part of any regimen targeting healthier skin free from acne.

• Warm compress: The application of a warm compress on pustules may soften the skin, encourage natural drainage of pus and speed up the healing process. Gentle warming increases blood flow to the affected area thereby reducing inflammation and discomfort associated with pustules. When used together with other acne treatment methods, this simple technique can bring relief and promote a clearer complexion.

5. Cysts

Cysts are large, painful lesions that form deep within the skin. These are filled with pus and can lead to permanent damage if not addressed properly. Because they are deeper and more serious, cysts often require medical intervention for treatment to be effective. Dealing with cystic acne involves a comprehensive strategy that aims at reducing inflammation and controlling bacterial growth as well as preventing further complications.

While it may be tempting for patients to do so at home, trying to cure these problems can only worsen them, leading to the development of increased inflammation while making patients prone to scarring. The patient must engage a dermatologist in coming up with a custom-made treatment plan which addresses their individual needs, thereby promoting better healing in such cases of severe cystic acne.

Treatment

• Intralesional corticosteroid injections: Intralesional corticosteroid injections happen when dermatologists inject steroids into the cyst directly, reducing irritation and shortening its healing process. This targeted approach reduces pain associated with cystic acne while preventing further complications from arising. Dermatologists use medication in the specific region affected by injecting it, efficiently dealing with cysts while avoiding scar development. This solution is preferable in patients who have severe or persistent cases as it offers comfort.

• Oral isotretinoin: Also known as accutane, this medication is reserved for severe cases of cystic acne. It works by significantly reducing oil production and preventing clogged pores. Dermatologists prescribe it carefully because of its potency, often as a last resort due to potential side effects. Taking oral isotretinoin requires close follow-up throughout treatment so that all risks are minimised and the best results are obtained concerning the management of severe cystic acne.

• Incision and drainage: When cystic acne reaches a severe stage, dermatologists may opt for incision and drainage. This involves the delicate opening of the cyst to let out its contents, which relieves pain and minimises chances of complications. Although effective in giving immediate relief, this procedure must be carried out under aseptic conditions to prevent infection or scarring from taking place.

Dermatologists only perform incision and drainage when other treatments have failed, indicating its significance in the management of severe cystic acne.

Dealing with acne can be a frustrating experience, but with the right approach, it is manageable. By understanding the different types of acne and tailoring treatment options to suit individual needs, clearer skin is within reach. Whether it’s whiteheads, blackheads, papules, pustules, or cysts, there are effective treatments available to help achieve the complexion your patient desires. With patience and perseverance, your patient can conquer acne and embrace healthy, radiant skin.