The typical presentation of acne is the appearance of open and closed comedones. They can then be added inflammatory lesions as papules or pustules. By healing, injuries can leave elevated or depressed scars.
Studies indicate a high correlation between acne, low self-esteem, shame, anxiety and depression and social dislocation. Particularly social isolation. Acute acne must be taken seriously and not leave it to advance, you can stop and you can avoid the damage that occurs in the skin and the psyche.
Classification:
1. Comedonal acne.
Is characterized by the presence of open comedones, classic black dots. Closed comedones are also observed with a barely perceptible hole, which are elements of 1 to 3 mm. across, white surface, covered with epidermis. Both injuries are the basis of acne, from which subsequent inflammatory phenomena occur.
2. Acne papules - pustules.
Characterized by papules, from 1 to 5 mm. in diameter, red, sensitive; and pustules.
3. Cystic acne nodule.
Inflammatory lesions of more than 5 mm in which nodules are observed.
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Pathogeny.
The pilo sebaceous unit consists of the hair follicle and sebaceous gland. As we see in this scheme.
Acne is caused by the clogging of the sebaceous unit Pilosebaceous.
This obstruction retains sebum produced by the sebaceous gland and hair follicle cells keratinized.
Excess sebum production usually begins around age nine stimulated by increased production of adrenal androgens, and is accompanied by a higher rate of desquamation of the squamous epithelium that lines the inside of the follicle. Thus follicular ostium becomes obstructed ("the follicle entrance"), primarily in the form microscopic ("microcomedone"). As the sebum production continues, the follicle widens to become visible to the eye, forming the basic acne lesion: the comedo. The oxidation of fat that makes up the comedo, darkens, becoming the regular appearance of "black spot". If widening of the follicular ostium is proportionally lower the widening of the interior of the follicle, the cap is not visible and the lesion appears on the skin as a "white point".
1. This obstruction contributes to the overpopulation of the bacteria Propionibacterium acnes, which causes inflammation of the tissues involved, mediated by immune cells: CD4 T lymphocytes and neutrophils, which infiltrate the area and cause disruption of the follicular wall, causing that the content of the follicle, that is, lipids, cellular components and bacteria spread to the surrounding dermis.
2. Sebum composition containing a large amount of free fatty acids, together with the keratin, contribute to the inflammatory process.
3. Local inflammatory response is accentuated by mediators released in this process: cytokines, peptides and other, causing the appearance of papules. Increased inflammation leads to the formation of pustules, and extension leads to the formation of cysts.
4. Nodules are formed when inflammation occurs on a deeper level and involves several hair follicles. These tend to leave scars.
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Erbium Laser Using Lotus II in the treatment of acute acne.
The Erbium Laser II Microfraccional Lotus produces an exfoliation of the superficial layers of the skin. This favors the ostium opening and the drainage of the accumulated contents (sebum, epidermal cells, and bacteria). This means that on one hand allows drainage preventing super infection content and secondly has a bactericidal effect.
In this biopsy the Lotus Laser II was used with fractional hand piece, short pulse 600mj. We can observe a surface damage and colagenogenesis to 0.45 mm. (Image 2)
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The Lotus Laser II also comes with a long pulse with which we achieve a greater depth of penetration and cause damage to the sebaceous gland. We seek to produce long pulse fibrosis and contraction of the gland. A smaller gland will be less productive in sebum.
We see patients who are constant in treatment. Those that can perform a laser treatment once every 20 days or once a month, acne episodes are less significant and more sporadic.
The fractional part with long pulse also produces a profound stimulation of collagen which improves skin texture and reduces scars caused by acne. In this biopsy we can see how long pulse acts. Lotus Laser II, long pulse, fractional hand piece, 300 mj energy was used. The laser light energy Lotus II produced a crater in the epidermis that is occupied by red blood cells. You can see the collagen contraction at 1.60 mm from the epidermis. (Image 3).
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Lotus II, is it effective in all types of acne?
In cystic and pustule acne first we use Lotus II with a Zoom 1-2 mm hand piece. We drilled all pustule cyst. This Facilitates drainage of the contents.
This kind of treatment has a bactericidal effect and Allows the penetration of drugs.
In this study we used the Lotus II hand piece with a zoom of 2 mm. Can be seen in the central lower part of the study the absence of tissue produced by laser drilling and the effect collagen contraction thereabout (Image 4).
The Lotus II acne treatment is quick, painless, with rapid recovery. No contraindications or adverse effects. Their application produces only a slight redness and leaves no bruising or swelling. The patient is allowing their immediate social and vocational reintegration. These treatments can be done all year round, even in summer, with the only caution of the use of proper sunscreen.
Another technology that is revolutionizing the treatment of severe acne is the Scarlet, novel radiofrequency micro needles. We refer to it in another communication . |
