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SKIN PROBLEMS

There are different types of acne:

  • Infantile acne /Neonatal acne;
  • Pseudofolliculitis barbae (razor rash);
  • Acne cosmetica;
  • Acne rosacea;
  • Acne aestivalis and many more.

Acne vulgaris is one of the most common skin problems. It is a chronic condition and affects 95% of the population at any stage of our lives.

It is most common during adolescence and puberty and is caused by an increase in the hormone testosterone, regardless of gender. Especially during puberty, oil (sebaceous) glands are stimulated which secrete excessive oil (sebum) in the skin. The function of the oil is to act as a natural moisturizer and to lubricate and protect the skin.

Under certain circumstances the oil glands become blocked with keratin (skin debris) and sebum (oil) and form microcomedo. This stage can be recognised by an early change in the appearance of the skin. The microcomedo may enlarge to form blackheads (open comedo) or whiteheads (closed comedo).

The microcomedo may become enlarged comedo with an excess of oil and this creates a perfect environment for the naturally occurring Propionibacterium. As the bacteria multiply, some of them become inflamed and this leads to various kinds of inflammatory lesions: papules, infected pustules, nodules or cysts.

In our practice we treat patients suffering from acne according to the South African Guidelines, updated and published in November 2005 in the South African Nursing Journal (SANJ).

We ensure that we grade the acne vulgaris accurately according to the level of severity because the treatment of acne depends on the grade of acne.

Below are descriptions of the grades:

Grade 1: This grade has comedones only. No inflammation is seen in any large amounts. Most people affected by this grade are in their early adolescence and the acne appears first on the forehead and nose. Blackheads and whiteheads are also commonly found around the eyes and chin.

Grade 2: This occurs if Grade 1 level acne is left untreated. More blackheads and whiteheads are present than at Grade 1 level. Inflammatory papules start developing and skin breakouts happen more often and look more prominent with slight inflammation. This grade of acne spreads to other parts of the face. It may also spread onto the shoulders, chest, and back.

Grade 3: Pustules (bumps with fluids or pus) as well as many more whiteheads and blackheads are present. Compared to Grade II acne, this stage presents a more inflamed and reddened skin. Other areas can be infected with acne such as the chest, neck, shoulders, and upper back. There is a potential for scarring with this grade of acne because the level of infection is higher than the other grades.

Grade 4: Nodules (large, hard bumps), cysts (closed boils), conglobate lesions or ulcers are present in addition to the symptoms of the previous grades of acne. This stage is often called the Cystic or Nodulocystic acne. Other than inflammation, this type of acne also causes severe pain particularly on the lesions because the infection is deep. Several sessions of treatment may be needed in order to see results.

During the first appointment we assess and grade the level of acne in the patient. We then prescribe appropriate topical and/or oral medication.

We also offer Intense Pulse Light therapy (IPL). IPL has received FDA approval for mild and moderate and inflammatory acne. Light decreases the sebum production, destroys the bacteria and causes shrinkage of the inflamed sebaceous glands. (See more on IPL).acne-from-tony-biological-pic-of-skin

We also use Diode laser treatment. Diode lasers can destroy sebaceous glands in the dermis, which is the thick middle layer of skin. This is done without harming the outer layer of skin.

One of the complications of acne is acne scarring. It is very important to deal with acne in the early stages to avoid this.

There are different types of acne scarring:

  • Ice pick scars – Deep pits that are the most common;
  • Box car scars – These usually occur on the temple and cheeks and can be superficial or deep, like chickenpox scars.
  • Rolling scars – Scars that give the skin a wave-like appearance;
  • Hypertrophic scars – Thickened, or keloid scars.

For acne scarring we offer the follow treatments:

  • Meso-needling/Dermal Needling
  • Mesotherapy
  • Injectable Fillers

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DRY SKIN

Dry skin (xerosis) can be an acquired or congenital condition. Most people at some stage in their lives can experience skin dryness. The degree of skin dryness can be different from mild to very severe, which leads to skin breakdown and infection. Dry skin often looks dull, lax and lines and wrinkles may even look more prominent. Multiple internal and external factors may contribute to this condition. Generally, as people age their skins become drier and less oily. This is largely due to increased transepidermal water loss from the thinned epidermal skin layer. The use of some cosmetics like alcohol containing toners, harsh soaps and frequent bathing in very hot water with bath salts and fragranced bubble baths may also contribute to skin dryness. Xerosis is also more frequent in people that are not consuming enough amounts of water daily and those that are regularly exposed to an air conditioned environment. Dry skin condition can also be seasonal, especially in South Africa where humidity levels in winter are very low.

We recommend the following treatments for improving skin hydration levels:

  • Mesotherapy
  • Dermal Needling
  • Chemical Peels
  • Microdermabrasion
  • Injectable Fillers
  • Innovative Facials

ENLARGED PORES

Pores (tiny dots you see on your skin) are actually small openings of hair follicles. Sweat glands and sebaceous glands end in pores and provide a way for your body to flush out toxins and regulate temperature via sweating as well as moisturize dry skin by producing sebum (skin oil).

Pores are more noticeable on parts of the face where sebaceous glands are more active, the so-called T-zone that includes the forehead, the nose and the chin. Different factors can affect pore size. Fair-skinned individuals with dry skin have smaller pores then people with oily skins. Accumulation of sebum and dead skin cells may cause blockage and enlargement of pores. Sun damage and the natural skin ageing process that lead to loss of collagen and reduced skin elasticity can also contribute to developing larger pores.

At Aesthetic Essentials we offer a number of treatments, which provide cleansing out of pores and stimulating collagen synthesis. These methods combined with a proper home care routine can promote lifelong improvement in the appearance of pores. The recommended treatments are as follows:

  • Microdermabrasion (MDA)
  • Chemical peels
  • Mesotherapy
  • Dermal Needling
  • Innovative facialss

Hyper-Pigmentation

Hyperpigmentation is the dark discoloration of the skin. It is a common skin problem that may occur at any stage of the life. More often we see pigmented skins in middle- age population. People with darker skin tones (African, Asian, and Mediterranean) are more prone to hyperpigmentation, especially if they have excess sun exposure

Skin hyperpigmentation is caused by different factors:

Exogenous causes, like ultraviolet exposure, photosensitizing agents, cosmetics and endogenous causes like Celiac disease, Porphyria, pregnancy, liver disease, Addison’s disease, Hemochromatosis, pituitary tumor, genetic factor, some skin conditions like postinflamatory hyperpigmentation after acne.

Prior to treat hyperpigmentation is advisable to diagnose and control the cause of the condition.

For treatment of skin hyperpigmentation we offer the following procedures:

  • Cosmelan
  • Chemical peeling
  • Microdermabrasion
  • Photo Facial

It is important to use sunscreen every day and re-apply a few times during a day, if necessary, to prevent hyperpigmentation.

It is advisable to use anti-pigmentation cosmetics a few weeks prior to performing the aesthetic procedure mentioned above, and to continue afterwards.

ROSACEA

Rosacea is a chronic, inflammatory skin condition and is a form of facial dermatitis. The presentation varies from skin redness to the enlargement of the nose. Histologically, dilated dermal blood vessels; enlarged sebaceous glands and an inflammatory cell infiltrate are seen.

There are different types of Rosacea

  1. Erythematotelangiectatic Rosacea: This is permanent redness (erythema) or a tendency to flush easily. Couperosis (redness) and telangiectasia (visible, enlarged capillaries) are seen. People with Rosacea have very sensitive skin, which often becomes dry and flaky. Untreated Erythematous Rosacea can turn into Acnetic Rosacea.
  2. Acnetic Rosacea: This presents with papules (red bumps) and pustules (bumps with pus in) on the permanent red skin. Because of this papulopustular rash, Rosacea can be easily mistaken for acne so it is important to get it diagnosed properly.
  3. Phymatous Rosacea. This causes the enlargement of the nose, called Rhinophyma. Thickening skin and irregular surface nodularities are visible. It might also be possible to see small blood vessels near the surface of the skin. Phymatous Rosacea sometimes also affects the chin (Gnathophyma), the forehead (Metophyma), cheeks and eyelids (Blepharophyma), and the ears (Otophyma).
  4. Ocular Rosacea: This presents as red, dry and irritated eyes and eyelids. The eyelids often develop cysts as well.

Those with these conditions should identify and avoid trigger factors like: sun exposure, emotional stress, hot weather, wind, heavy exercise, alcohol consumption, hot baths or showers, spicy foods and other foods high in histamines, certain fruits and certain cosmetics.

During the first appointment with us we will assess and confirm the diagnosis. We will take a full medical history; check and prescribe the appropriate treatment with topical or oral medication, and/or suggest Photo Facial. For dilated vessels couperosis we offer Lamprobe treatment.

Disorders of keratinization:

Fibromas – These are benign skin tumors and they can be flat, raised, small or large, single or multiple formations which can spread out. Fibromas typically occur on the face, neck or back.

Skin tags are one type of fibroma. They are slightly raised lesions commonly found on the neck, back, axilla (armpits), in body folds and the groin. They can be skin colored or hyper pigmented. Skin tags can become inflamed through repeatedly irritation from continuous rubbing.

Dermatosis Papulosa Nigra (DPT) – we see this skin condition often in the South African population, in both men and women and, for many, it is cosmetically undesirable. This condition is recognised by multiple seborrhoeic keratoses which are small bumps on the face, neck and upper chest. The causes of this are a combination of genetic factors and photo ageing (from UVA and UVB light exposure).

Seborrhoeic keratoses originate from the superficial layer of the skin. They have a scaly, pigmented appearance, flat on the skin.

Milia are small, white lesions which can be found in oily or dry skin and are the result of poor exfoliation. They are plugs of sebum covered with dead cells.

Sebaceous hyperplasia is a skin infection which results in enlarged sebaceous glands. They are seen as yellowish, soft small lesions on the skin.

Cherry Angiomas is a benign growth consisting of small blood vessels. They look like small blood spots.

Telangiectasia or angioectasia are small dilated blood vessels visible on the skin. They can develop anywhere on the body. With Lamprobe technology we can remove these small vessels on the face if the diameter of the vessels is about 1millimeter.

ABOUT THE LAMPROBE PROCEDURE

The medical doctor should assess the patient and assess whether there any suspicious lesions, in which case the patient will be referred to a dermatologist for further treatment.

Generally to treat small benign skin irregularities doctors use different methods, like cryotherapy with liquid nitrogen; cauterization with electrical frequency or lanceting.

In our clinic we use Lamprobe, which uses a blending of radio frequency currents. This method provides quick and effective treatment of common skin irregularities without penetrating the skin surface or inducing trauma on the surrounding tissue.

The procedure is very well tolerated, but to make it even more comfortable for patients, topical anaesthetic cream can be applied. For bigger lesions a local anaesthetic can also be injected local anaesthetic.

Home care advice after procedure:

In the treated area redness and scabbing may form. Please make sure, you don’t pick at the scabs, because prematurely removing the scabs may cause hyper- or hypo-pigmentation, or scarring. The doctor will advise you on how the cream should be applied on treated area. Sun protection cream must also be used but you should avoid direct sunlight. Please clean the treated area with gentle products (without alcohol) and don’t use any other form of peeling or bleaching product for at least 21 days. Please contact us for further information should you need to. Make sure you make an appointment for a follow up appointment with your doctor after 2-3 weeks.

Contact Details:

BluBird Medical Center
Cnr Athol Oaklands Road and Fort Street
Birnam 2196
011 440 7776
082 058 9935
info@aestheticessentials.co.za

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