What characterises oily or combination skin?
Oily skin generally has a thicker texture, dilated pores, and a dull, greasy and shiny appearance. This appearance is due to excess sebum, which promotes the appearance of skin blemishes such as “blackheads” and “pimples”. For combination skin, blemishes are usually located on the T-zone: the forehead, nose and chin. The rest of the face and body may have normal or even dry skin. Combination skin is imbalanced and easily damaged.
What causes acne?
Acne is an inflammatory skin condition affecting the pilo-sebaceous follicle. Three related factors are responsible for acne:
. hyperseborrhoea, hyperkeratinisation and bacterial proliferation.
Hyperseborrhoea: this is excess production of sebum resulting from hormonal activity triggered during puberty. The skin becomes oily and shiny. In addition, there is a risk of a qualitative sebum abnormality, meaning that sebum composition differs from that of healthy sebum. It is thicker and has a more difficult time flowing out of the follicle, which increases the risk that comedones will form.
. Hyperkeratinisation: the excessive multiplication of skin cells in the follicle duct wall clogs the pore and keeps sebum from evacuating. This causes comedones to appear, which are small skin wheals that are either skin-coloured (closed comedone or microcyst), making skin look granular; or have a black centre (open comedone) indicating melanin (skin pigment) is present on the comedone’s surface.
. Bacterial multiplication: sebum is an ideal nutrient medium for certain bacteria, particularly Propionibacterium acnes which is naturally present on everyone but that in acne cases will multiply in the pilo-sebaceous follicle and cause inflammation. The comedone then turns into a painful red pimple called a papule (inflammatory lesion).
What are the various types of skin blemishes?
Acne has several types of lesions, often with increased seborrhoea (called hyperseborrhoea).
. Comedonal lesions:
Closed comedones or microcysts,
Open comedones or “blackheads”, and sometimes larger cysts (more than 5 millimetres) called macrocysts.
. Inflammatory lesions:
Inflamed lesions: papules, pustules and nodules due to retentional lesion inflammation.
. Scars from possible lesions:
Hyperpigmented spots secondary to inflammation on olive or black skin.
The condition lasts several years, with inflammatory flare-ups, as long as the retentional lesions (comedones) persist.
Who is affected?
In rare cases, acne can affect newborns — due to the mother’s androgen hormones — or older infants. Acne is an adolescent dermatosis. It takes on a polymorphic aspect that combines the different types of lesions.
The condition generally begins around the ages of 12 to 14 years and affects the oiliest areas of the skin such as the face, and often the chest and back to a variable degree. Acne is caused by an imbalance in hormonal secretions during puberty.
In women, particularly after the age of 30, acne appears more on the lower face (jaw) and neck. There is often a hormonal component added to the traditional causes of acne.
What is different about acne in women?
The factors that promote the appearance of acne in adulthood are:
. unsuitable cosmetics, sun, diet, etc. Smoking also promotes this phenomenon: over 41% of smokers have acne versus 9% of non-smokers.
. Genetics may also play a role. Indeed, when there is a family history, it is common to see this type of skin problem appear in adulthood.
. Lastly, some medicated treatments such as contraceptives, hormones and anti-depressants can cause pimples and other blemishes to appear.
Unlike an adolescent’s skin, the skin of an adult woman is less seborrhoeic, meaning that it produces less sebum. Blemishes are mainly located on the lower face (chin, neck and lower jaw). They are chronic and recurring inflammatory (pimples) and comedonal (blackheads) lesions. To correct these skin problems, it is necessary to use appropriate treatments, which are not the same as those used for adolescent acne.
Did you know?
Problems with skin blemishes:
50% of women over the age of 25 have problems with skin blemishes.
40% of these women did not have acne in adolescence.