Friday, May 7, 2010

Q & A Tweets: "black heads?"

I get many questions on my Twitter account @DrLillian that I try to answer as much as possible. That brought me to the idea of these upcoming posts. I will start posting these Q & A's here on my blog as a reference to those micro-blogging posts as they are also great topics for this blog.

So here goes.. I'll start with one of the question that I received on twitter when I asked my followers on which topic they wanted me to talk about. This question was one of them "black heads and oily skin ?"
In this post I will discusses how to deal with black heads which is mostly in medical terms mean the term "comedones" they are either black or white. There is no difference in their treatment, it is basically the same unless there are pustules which will not be our discussion in this post. 

One of the common questions I get in my clinical practice is if there are pills that can get rid of them and my answer is that it mostly only responds to topical treatments that are "Comedolytics" which means dissolving of black or white heads (i.e, getting rid of them).  I will mention here what I found useful in my own practice and what I found to be effective. 

I will divide my treatment regimen into 3 categories:
1- Treatments you can find over the counter here in Jeddah, Saudi Arabia.
2- Prescribed treatments by a Dermatologist ( This is based according to a dermatological practice based in Saudi Arabia, in other countries it may differ)
3-Treatments that are done in a Cosmetic Medical Spa.

Over the counter (OTC) treatments:
There are some effective treatments that you can find in your local Hyper supermarkets like "Hyper Panda" and "Danoub" in the skin care and make up ails like Neutregena, Clean & Clear, and Clearasil are the most popular in the gulf region.
Most of these treatments if you look into their active ingredient its mostly based on "Salicylic Acid" in some concentrations up to 2% in the form of soap, gel washes, cream, and toners. Now salicylic acid is a good comedolytic but at the same time it has a drying effect on the skin when used too much.
Going into more things that are available OTC in pharmacies. They also usually contain Salicylic acid, AHA, and Glycolic acid. Which all have a comedolytic effect as well a s some level of superficial peeling. Some of these come as home treatment kits. Examples of these OTC's are Rexol, DDF skin care, NeoStrata, and Vichy.

Prescription topical black and white heads acne medications:
This is when its time to add a vitamin A derivative topical treatment, they help expulsion of present comedones and pervent formation of new ones. Which are adaplene (eg, differen) , isotretinoin (eg, Isotrexine), and tretinoin (eg, Retin A). Their disturbing side effect that makes most patient find it unpleasant to continue with it, is its initial irritation effect on the skin with flaking, redness and in some cases slight burning sensation. These side effects usually last 3-4 weeks, then the skin adapts to it and becomes less irritated when applied.
Again we can use comediolytics such as peeling agent very carefully with strict instructions to higher concentrations more than OTC also containing Salicylic acid, and AHA.
Azalaic acid has been mentioned in textbooks which can be added to help with comedonal acne treatment, and well as adding benzyl peroxide in the regimen has been reported to help.

Treatments that are done in a dermatological office:
Ill start with simple things like acne treatment medical spa facials which extracts comedones by a specialized beautician with application of steam to open up the pores and allow easy expulsion manually. It shouldn't be done forceful, then its finished with special drying masks.
Then there is the comedonal extraction procedure done by the dermatologist with a certain kind of technique and instrument.
lastly application of professional peels that fastens the response to the treatments given for the patient to apply at home. There are different types of professional peels containing different components and some are combined. Mainly they are salicylic acid, AHA, and TCA. Which has to be applied either by the doctor or by a trained nurse under the supervision of a doctor in the office.

My usual last word of advice to all my patients with black and white heads is that they have to be very careful with what they apply on their face and areas affected. They always have to make sure that any cosmetic, or cosmecutical which can be makeup, powder, cream, lotion, fluid, gel, or even soap has to be labeled as "Non comedogenic", "Non pore clogging", or "for acne prone skin" written on the box clearly or they shouldn't apply it at all, because comedonal prone skin is very sensitive to topical applications, if its too thick or not appropriate for their skin type then it makes them prone to develop more comedones.

With that I come to the conclusion of this part of the question "Black heads?" next post will be to answer the part of "Oily skin?".

Hope that this was helpful. There will an Arabic translation post on same topic in the next post.

This post is purely for educational purpose only. Any kind of skin problems including acne should be evaluated by a physician in order to make the proper diagnosis then treat accordingly. This I strongly advice.

Write to you soon...

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