Mild acne, being the commonest type of acne affecting majority of adolescents and teenagers need not be actively treated. The following are a few of the most frequently asked questions on mild acne:
What Comprises Mild Acne?
Acne is divided into different types depending upon the severity of the eruptions. Mild acne denotes a few eruptions of the comedones, both the open and closed varieties. This is the most common type of acne that makes its first appearance in adolescence. Most cases of mild pimples do not require any active treatment and they rarely cause any scarring. Upto 20 comedones may be considered as mild. Some authors include upto 15 papules also in the mild acne category.
How is Mild Acne Formed?
The study of how acne is formed is a fascinating one.The arrival of puberty causes a surge of androgenic hormones in the body. They have specific action on the sebaceous glands, which start secreting thick, sticky oily sebum into the hair follicle ducts. The hormones also act on the lining cells of the follicular wall, which become thickened and keratinous. This cellular debris and the sticky sebum accumulate in the hair follicle duct and form a plug to close the pore. This plug is known as a microcomedone.
When the keratinous plug pushes out under a thin layer of the skin, it is known as closed comedone or whitehead. When the opening is open, it widens under the pressure from the plug to form a blackhead or open comedone.
The black color of the blackheads is not due to dirt accumulation, but due the action of oxygen in the atmosphere on the fatty acids of the sebum.
What is the Clinical Appearance of a Comedone?
Closed comedones or white heads present as skin colored, white or slightly reddish bumps on the facial skin. Open comedones or blackheads have wide rimmed opening with a characteristic black plug covering the opening. This black color is not due to dirt, but caused by oxidization of the sebum when it comes in contact with the atmospheric oxygen. The treatment of mild comedonal acne does not warrant the use of oral medications; topical applications will work well in most cases.
Does Mild Comedonal Acne Cause Scarring?
This is an important question which requires specific clarification, as it may have a bearing in treatment decisions both by the patient and the physician. Though rare, mild comedonal acne can cause scarring in some affected teens. A family history of acne scars and hard, wide open comedones should prompt the sufferer to seek prompt medical treatment.
When Should Mild Acne be Treated?
Almost everyone at least once in their lifetime will suffer from mild attacks of acne, mostly of the comedonal type, or a few cases of scattered papules (skin colored bumps). Most of these do not warrant any treatment and will go away by themselves. The following are the indications for seeking treatment if you are suffering from mild acne:
- A family history of acne scarring.
- Widespread comedonal acne.
- Large comedones which are hard in consistency are more prone for ice pick scars and should be treated early.
- The habit of picking at the comedones and squeezing or picking at the blackheads can cause worsening and inflammation of the acne bumps and warrants early treatment.
Is it Advisable to Extract the Comedones?
Actually, it is not the comedones that are extracted, but the mixture of the oily sebum and the cellular debris blocking the hair duct within the comedones that is being extracted.
- Clearing the blocked ducts in a blackhead will result in faster healing, if done properly.
- Never squeeze or scrub the comedones; this will worsen the acne and may precipitate an inflammatory reaction resulting in scarring.
- Do not try to extract contents from a whitehead or a closed comedone. Breaking of the sebum and debris into the dermis may result in inflammatory acne formation.
- The procedure should be carried out by an experienced dermatologist or cosmetologist only, with a comedone extractor.
Mild acne treatment is carried out through topical applications, topical retinoids being the most preferred agents.
Sources:
- Diane T, Gollnick H et al. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. J Am Acad Dermatol, 2009;60:S1-50.
- Simpson NB & Cunliffe WJ. Disorders of the Sebaceous Glands in Rook’s Textbook of Dermatology. 2004; 7: 43.1-43.75.
Disclaimer
The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, Dr.Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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