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The Pimple Guide


This is not an easy question to answer, as several factors play a significant role. The most important common causes of these are:

- Excessive sebum production,

- A keratinisation disorder of the hair follicle, and

- Bacterial colonisation of the skin resulting in an inflammatory reaction.

Acne skin disease

Acne is a follicular skin disease, meaning that the pimples originate from the hair follicle. Most of our sebaceous glands end with their excretory duct in the hair follicle. Hormone changes during puberty can lead to an increased production of male sex hormones including testosterone. This causes the production of sebum on the hair shaft to increase, and with it the supply of nutrients for fat-loving pathogens such as propionibacteria. The pathogens metabolise the sebum and leave behind metabolic waste products (fatty acids), which then irritate the pore wall. As a reaction, the skin pore produces to put it simply more pore wall cells and cornified plugs form. This results in a blocked pore which expands like a sack and a blackhead also known as a comedone appears. Under the influence of the bacteria and the constantly increased sebum flow, inflammatory nodules (papules) and papules with white heads (pustules) can form and in the worst case even purulent ulcers and fistula tracts.

Different degrees of severity

Different forms of acne can be distinguished depending on the predominant skin changes:

- In acne comedonica, blackheads predominate.

- In the case of papulopustular acne, the skin is mainly characterised by papules and pustules in addition to a few comedones.

- The most severe form of acne is called acne conglobata. In addition to papules and pustules, highly inflamed and painful nodules and even purulent abscesses may develop.

Comedones - The most common dermatological lesions

The most common skin changes in acne are comedones, which are divided into closed and open comedones.

Closed comedones can be recognised as a whitish, raised nodule on the surface of the skin - this is why they are also called "whiteheads". Due to the closure of the pore, the sebum can no longer flow off properly and an underlayer forms in the depths, which can then easily become inflamed. However, the "whitehead" should not be confused with a nodule with a pus tip (pustule).

Open comedones are visible especially in the T-zone as small dot-like black skin changes. The pore is widened by the cornified sebum plug and a "black head" is visible due to the large amount of melanin from the melanocytes at the mouth of the duct. This is where the name "blackhead" originates from.

If the sebum can no longer drain away unhindered, the pore enlarges and inflammatory messenger substances may be released. As a result, the skin is red, sensitive and can bulge. This visible and palpable change, which protrudes above the skin level, is called a papule. The inflammatory overgrowth of the epidermis is not only clearly more visible than a blackhead, but also painful.

If pus also forms in the papule, this can be seen by a whitish-yellow pus tip. This type of "pimple" is called a pustule (from the Latin pus for pus). The pustule is a superficial pustule with a reddish border.

Additional causes

Skin care products can also cause acne in some circumstances. If you are prone to acne, it is important to check your skincare products for the words "non-comedogenic". Comedogenicity generally refers to the property of a substance to promote the formation of blackheads (comedones). The causes are lipids that are deposited in the pores in addition to the skin's own oil and "clog" them. Substances with comedogenic potential can be, for example, paraffin, fatty alcohols, but also coconut oil or cocoa butter. But be careful. So far, there is no uniform legal regulation or definition of when a product may carry the label "non-comedogenic" and when it may not. It is therefore always advisable to have a look at the ingredients of the skin care products. Another important aspect is how the skin reacts individually. Not every reaction to a substance is the same for everyone, i.e. one person gets comedones from a certain oil (for example, coconut oil), another may not. There are various lists of substances that are said to be comedogenic. However, these lists are so long that you will hardly find a product on the market that does not contain any of these substances. Besides skin care products, certain medication can also aggravate existing acne or even trigger acne. These include cortisone, anabolic steroids, for example in bodybuilding, antibiotics, some medicines for depression, but also high doses of vitamins (B1, B6 and B12).

From a cosmetic point of view, the skin with blackheads, papules and pustules can be well treated by the following treatment procedures: thorough cleansing, seborrhoea regulation, loosening or removal of keratinisation (prevention of follicular blockages), anti-inflammatory treatment. However, the combination of self-care and intensive cosmetic care in the beauty institute is essential.

There are some instances where only a professional can help

Severe inflammation of the skin, lumps or even purulent tumours (abscesses) should always remain in the hands of a dermatologist.

It may be necessary to surgically remove purulent tumours under the appropriate hygienic and anaesthetic conditions, so that the pus can drain away.

Depending on the severity of the acne, medical creams can be used for the treatment or even internal tablet therapy, over a longer period of time, may be necessary. However, regular treatments at a beauty institute should also support a medical treatments.

Professional treatment

The professional treatment is based on the condition of the skin and takes place approximately every two to four weeks at the beauty clinic, but can also be extended up to six weeks, should the condition of the skin improve. Regular treatments are important to improve and maintain the skin's appearance in the long term. Blackheads should always be cleaned out professionally, not by the client themselves. The risk of inflammation, scarring or hyperpigmentation is very high in self-treatment. The skin care professional can remove minor impurities, even those with moderate pus formation, under the right hygiene measures and with suitable aids (sterile needles). In this case, appropriate after-treatment with disinfecting agents is also ensured and inflammations are prevented. In addition, the skin care professional recommends suitable aftercare and home care tailored to the skin's appearance and needs.

Proper cleansing and astringent, clarifying facial toners form the basis. Excess skin oil and bacteria should be removed regularly. Use oil-free gels or light emulsions for your daily care. It is important that oily skin is also supplied with active ingredients and, above all, moisture. The skin's appearance can even worsen if it becomes too dry, for example, due to too much alcohol.

Keratolytic agents are effective because they target one of the four factors of acne development: they prevent excessive keratinisation at the hair follicle. For severe blemishes, masks, peelings and pimple pads (for local application) are very effective.

However, the skin should only be exfoliated once a week. Mechanical peelings with very fine abrasive particles should only be used on non-inflammatory skin, otherwise there is a risk of a scattered infection. If inflammatory papules and pustules are present, an enzymatic peeling is the better choice. Afterwards, a mask with activated charcoal or clay can be applied, which virtually "pulls" the impurities out of the skin and thus provides a more even and matt complexion.

Pimple marks

The most common marks caused by pimples are scars and hyperpigmentation. The causes lie in the skin's past inflammatory reaction, the intensity of the pimples (higher scarring potential with acne lesions) and on the other hand in unprofessional treatment (self-treatment or improper "squeezing") of the pimples.

The inflammation is intensified, bacteria are pressed deeper into the skin and tissue defects may develop (up to the dermis), which then heal with scar formation. Regeneration ("repair") of the defects takes place as part of the wound healing, but as a result a scar remains.

Acne scars are most often atrophic scars, i.e. deep scars that are below the level of the skin. Cosmetically, deep peeling, microdermabrasion or microneedling can be used for deep scars. This supports both the regeneration of the tissue and the absorption of active substances. After a few weeks, even hardened/older scars can become more elastic and less noticeable. The dermatologist can inject atrophic scars with hyaluronic acid. This lifts the scar tissue and visually restores it to the level of the skin.

Severe inflammations of the skin, lumps or even purulent (abscesses) should always be checked by a dermatologist.

Due to the natural degradation of the hyaluronic acid, the treatment must be repeated regularly. An alternative to this is laser treatment of acne scars. In this case the laser causes the smallest thermal injuries to the skin. Thereby, a regeneration with new formation of connective tissue is stimulated. As a result of the inflammatory reaction, unattractive brown-reddish, permanent discolourations can appear on the skin, so-called post-inflammatory (= after the inflammation) hyperpigmentation.

Skin inflammations such as pimples can stimulate melanin production. The resulting hyperpigmentation can then persist for weeks or even months.

In the treatment, the suppression of the pigmentation process (tyrosinase inhibition) and the reduction of existing pigment accumulations are essential. Active ingredients such as vitamin C, niacinamide or hexylresorcinol have a multi-layered effect: they break down the melanin, promote its removal and inhibit the production of the pigment. To accelerate the success, natural peeling cures may also be used here.

Christina Drusio

is part of the Dr. med. Schrammek owner family and management of Dr. med. Christine Schrammek Kosmetik GmbH & Co. KG. As an expert of sensitive skin, the Medical Specialist for Dermatology and Venerology is a valued speaker at international lectures and seminars.


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