Closed Comedones 101

Kapil Pathak
Sep 8, 2018 · 3 min read

Acne is a multi-causative disease of the sebaceous glands and hair follicles. Despite the availability of effective treatments, it has increased over the past decade and is the most common in the world. The disease affects up to 85–95% of adolescents and up to 25% of people older than 25 years.

Despite the absence of an immediate threat to life and health, acne eruptions are one of the most unpleasant cosmetic problems. Depending on the severity of the flow, they often lead to neuropsychic disorders, especially in adolescence and in young and middle-aged women, often leave behind uneven skin, scars, pigment spots. Variations of rashes can be inflammatory and non-inflammatory (comedones) of nature.

Comedones — what is it

The mechanism of occurrence

Comedones are one of the manifestations of acne. Usually they arise against the background of the pathological condition of the skin, which consists in the violation of hormonal and nervous regulation by the function of the sebaceous glands. This condition is expressed in the increased secretion of sebum with a low content of linoleic acid, which is part of the structure of cell membranes. As a result, there is a violation of the processes of keratinization of the flat epithelium in the upper parts of the hair follicles; their mouths decrease or close completely; disruption of the separation of fat, which stretches the walls of the follicles.

Types of comedones

Open comedones

In the follicles accumulate, in addition to sebum, necrotic and destroyed cells of the epidermis, dust, particles of cosmetics. They, like a cork, clog the hair follicle. At the exit point of the cork to the surface, the oxidation of its upper layer occurs under the influence of oxygen, as a result of which it acquires a black color and looks like a black dot — open gums. This is the least dangerous and traumatic appearance.

Closed comedones

In contrast, a closed comedo do not have an outlet and remain under a layer of skin. They look like whitish balls or nodules, towering above the skin surface. Reducing the content of linoleic acid leads to a decrease in the protective function of the epithelium and the acidity of sebum.

All these factors are a favorable condition for the activation and reproduction of propionbacteria, epidermal staphylococcus, fungi, to isolate inflammatory mediators (biologically active substances). There are inflammatory processes in closed comedones and surrounding tissue, purulent acne, which is not only unaesthetic, but also painful, can go to furuncles and abscesses. After them, there are uneven skin and scars, from which you can get rid only with the help of special cosmetic procedures.

Places of primary localization of elements — forehead, nose, cheeks, chin, upper parts of the back, less often — the area of ​​the front surface of the chest.

Treatment of comedones

It includes all means of prevention. Expressed antibacterial and destructive effect on comedones possess 0.1% cream and Differin gel (applied daily to the skin at night 4–8 weeks), as well as cream or lotion Tretinoin (applied 1–2 times a day for 4–6 weeks) . Effective means are Jessner’s peels (resorcinol, lactic and salicylic acid) and gas-liquid (exposure to the skin with a saline solution under high pressure).

Women of childbearing age, if there are hormonal disorders and there is no effect of conventional treatment, antiandrogenic drugs are prescribed under the supervision of a gynecologist-endocrinologist.

In cosmetology salons, removal of comedones is carried out as a result of complex deep cleaning of the face: the horny epithelium is removed, the gland ducts of glands are opened, which are cleared of sebaceous plugs and dirt, and oxygen is accessed to the cells. Cleaning is carried out manually (manual cleaning) with the use of special tools in the form of a needle and a loop, conducting microdermabrasion , chemical peeling, or using special ultrasound devices that cause cell vibrations and ejection of comedones.

A common method of combating comedones — the use of laser peeling , in particular — CO2 laser. As a result of its use, the upper layer of the skin is removed, the epidermis is completely renewed. This leads to a normalization of metabolic processes, circulation and functioning of the sebaceous glands. The likelihood of new comedones is significantly reduced.

Methods and means of skin care, methods of treatment, frequency and number of procedures are selected by cosmetologists individually, depending on the type and prevalence of the pathological process.