Replies to This Discussion

Permalink Reply by Sandee Regier on August 18, 2011 at 11:46pm

A nodule and a cyst are similar, but the cyst is filled with pus, in other words they are a grouping of pustules. Nodules are deep in the skin and as such cause deeper inflammation. They can be quite painful and repeatedly inflame because their contents remains locked up in the tissue. So, I still wonder if you think these are cysts or nodules? The nodule being deep in the tissue would have to undergo a restructuring or clean itself up you might say. I've successfully used manual lymphatic drainage techinque (Dr. Vodder) to do this restructuring. MLD is even effective on repair of scarred and fibrous tissues. It removes waste from cellular metabolism and allows greater circulation of nutrients in the soft tissue. I've seen case studies where it has repaired burn scar contractures! Which always has amazed me. The second thing I believe has been effective is the proper use of Vitamin A because it is so important to the building of cells and increasing skin thickness. Perhaps instead of opening the skin with a lancet (in order not to introduce bacteria) you might try things we know push certain ingredients deeper into the skin like ultrasound, galvanic current, or use of LED/Blue light for reducing bacteria at a deeper level.

Permalink Reply by Laura Cooksey on August 19, 2011 at 6:31pm

Hm, I have opened up what looked like a nodule and gotten it to extract.  Doesn't always happen but I always try anyway.  Call me fearless.....  If you open it up, put some bpo on it to allow the oxygen to penetrate into it - it might help it clear faster. 

 

I think the difference is that nodules are inflamed below the surface and hard on top and a cyst is inflamed throughout. 

 

Permalink Reply by Sally Connor on August 20, 2011 at 12:37pm

Hi Mary Lou, I have included some information here and at the end some definition.

Sandee, you have reminded me about the role lymphatic massage plays in treating acne. Important technique!

In a non-medical setting, as I am in, and as a licensed esthetician, I can legally extract open comodones, but not closed comodones. The use of lancets by estheticians is illegal in my state.

Mary Lou, be sure to check if the use of lancets is legal in your state, though I think this is intended more for helping release the impaction from a visible surface-looking pustule. 

 

There are differences of opinion re. extractions even among the experts.

For instance whether or not to do them. Dr. Marmur, chief of Dermatologic and Cosmetic Surgery at the Mount Sinai Medical Center in NYC says "extractions (pustule type & open comodones) tricky and unnecessary and can be unsafe too. She does not recommend them."

Dr. Fulton, a Dermatologist MD PH.D and recognized leader in the treatment of acne uses extraction in his clinic, but, he cautions "only after and in conjunction with a skin care program which first loosens the impactions. Because some benefit of speeding up the healing of current lesions, he would advocate extraction of mature acne lesions as your skin care program dislodges them." 

 

Re. cysts/nodules and what they are:

 

As a comedo grows it either becomes inflammed or non-inflammed. In the non-inflammed route the micro-comedo matures into a closed comedo (whitehead). The closed comedo opens and becomes a blackhead, which finally works its way out or we extract it once the skin has been prepared. 

When the pathway of inflammation happens the lesion will develop first into a papule and then into a pustule (pimple). Or it may become a deeper and more severe lesion such as a nodule or cyst.

 

Another comment by Dr. Fulton re. extraction and depth of a lesion: "...in a pustule, a sea of pus has risen to the surface. It's relatively easy to remove with a minimum of pressure. If the lesion is an inflamed papule or nodule, it certainly will be worse by squeezing. It is already inflamed and the troublesome impaction, especially if it is a nodule, is often deep underneath the surface.  Squeezing  will invariably make the rupture in the follicle wall many times worse inviting greater inflammation and correspondingly greater scarring."

Dermatologist have methods to get at these deeper lesions other than extraction. Estheticians have some other techniques as well that do not include extraction. Sandee, you mentioned some.

 

Now some further definition re. inflamed path of acne:

 

Papule: If the impaction erupts, then a sore red bump or pimple results (papule). One papule may develop spontaneously or several may come in rapid succession if set off by physical or mental stress.

Pustule: A couple of days later when the pimple becomes further inflamed and pus forms near the surface, a pustule has developed. (note - a pustule is not a whitehead)

Nodule: When the break in the follicular wall is deep down at the very bottom of the follicle, then a sore red lump forms. Compared to a papule, a nodule is larger, deeper, and feels firm to the touch. Nodules will fester as deep, inflamed bumps until the lesions finally drain or the breaks spontaneously heal and go into remission.

Cysts: Cysts develop in one of two ways. Several troubled follicles may erupt together forming a vast area of inflammation. This creates a lesion that can be as big or bigger than the end of your little finger. The other form of development is an intense inflammatory response in one follicle causing thousands of white blood cells to stream into the troubled area. A large pus-filled lesion forms looking almost like a boil. Actually, any lesion that is one centimeter or larger is defined as a cyst.

 

Hope his information is helpful. I was formerly a teacher and love the education part of esthetics :)

Good luck,

Sally

 

 

Permalink Reply by Sally Connor on August 20, 2011 at 1:24pm

Oh, and I like what Laura said about using benzoyl peroxide. BP.

comments from Dr. Fulton:

Like salicylic acid BP disintegrates the top layer of the skin.

Benzoyl Peroxide is one of the best available treatments for acne today. Though sometimes there are formulation flaws esp. when it is in oily bases.

It can cause peeling and loosening of impactions and also fight the baceria down in the pore.  The benzoyl part of the molecule pulls the peroxide down into the pore.  Because , C. acnes bacteria are anaerobic, they cannot survive in the presence of oxygen. As oxygen is pulled into the pore it kills the bacteria.

Cold therapy (ice cube - freeze water in a styrofoam cup, rub it 2 -3 min.over lesion) reduces inflammation and boosts the effectiveness of BP.

For deeper lesions, steroid injections quickly help reduce inflammation and can lessen or prevent scarring.

Sulfur added to BP - BR becomes twice as effective.

Oral zinc sometimes helps reduce inflammation in the more severe grades of acne. 100mg/day, but this is not for a client who gets one or two lesions ocassionaly.

It is really important to check for products and/or ingredients that can cause flare-ups. Comedogenic.

 

Sally

Permalink Reply by Rachel Poissant on August 20, 2011 at 4:12pm

This is all so very informative.  As I start to work more with clients with acne, I begin to get worried that I don't know what I'm doing. I've been a praciting Aesthetician for a year now.  I just want to be the very best I can be. 

Can you fill me in on the role of retinol in acne?

Thank you!

Permalink Reply by Laura Cooksey on August 23, 2011 at 2:55pm

I have a really great article on my website about all the retinoids and the one we use most at our acne clinic.   I use retinyl propionate for noninflamed acne - it's amazing!  Here's the article link.     Topical Retinoids in Skin Care

 

@Rachel - do you know about my training dvd for acne specialists?  Email me if you would like to know more - laura@facerealityacneclinic.com

Permalink Reply by Sally Connor on August 25, 2011 at 3:11pm

Laura, I really enjoyed the article. It's very informative!!

Permalink Reply by Sally Connor on August 25, 2011 at 2:33pm

Retinol ... here's how we get to Retinol:

First, it's all about forms of Vitamin A acid therapy. 

Vitamin A not only peels and opens up impacted pores, but it also irritates and peels the lining down inside the follicle unblocking and preventing further formation of impactions. It can cause a 'worse before better' reaction, but the results in clearing acne are dramatic.  Vitamin A does not combat bacteria action in the pore, though. Benzoyl Peroxide does and is regularly used for that part of fighting acne. Both are drying and cause peeling.

Okay, so that is about why we use Vitamin A acid therapy for acne.                                     The related names can be somewhat confusing even as they are used among the experts:

Vitamin A acid is also called tretinoin and retinoic acid (James Fulton MD, Ph.D). 

Retin-A, Retin-A micro, and Renova are brand names that use a concentration of tretinoin, a retinoic acid (Ellen Marmur, MD).

Dr. Marmur continues about retinoic acids ...

The various forms of retinoic acid (tretinoin, tazarotene, adapalene) available on prescription are all chemical derivatives of vitamin A. 

Retinol, Retinaldehyde, and Retinyl palmitate are over the counter (OTC) versions of retinoic acid and are less effective as in order above; retinyl palitate being the weakest of the OTC versions. Nonprescription retinol is a weaker analog (a synthetic copy), which must be converted to retinoic acid inside the skin cells in order to work.

On a related note:

Acneic skin can adapt to various peeling preparations and after a while they loose effect. So varying the irritant (that which causes peeling) is a way around this. That might involve increasing the % of the active ingredient, or switching up ingredients (combining or changing).

The ability to change things up to retain the desired acne client response (gentle, continued peeling) is referred to as the "art of medicine".

 

: )

Permalink Reply by Mary Lou Coleman on August 30, 2011 at 6:50pm

Heavens!  Thank all of you for your thoughtful and detailed responses. I feel I know much more now than I did, and can approach treating nodules and cysts better.