PORES GALORE

People attach a great deal of identity and pride to the appearance of their skin, especially that on the face. The corollary of this is loss of self-esteem and well-being when a skin disorder triggers a depressive illness.

PORES GALORE

People attach a great deal of identity and pride to the appearance of their skin, especially that on the face. The corollary of this is loss of self-esteem and well-being when a skin disorder triggers a depressive illness.  One of the most common sources of irritation about skin has to do with “enlarged pores”.  People often ask, “What can I do about my pores?”  There are a variety of effective treatments that will improve skin texture, in particular reduce the appearance of pores.  But the underlying day to day events that take place within the “pores” are diverse and fascinating.  No wonder our pores often increase in prominence with advanced life.     

Pores are actually known in scientific circles as “pilosebaceous units, (PSU’s) because they are inward pouches of the surface skin that function to grow hair (pilo) and produce the protective surface oil, (sebaceous).  The “pilo” unit is the bottom portion of the in-pouch that grows hair, while the upper portion of the in-pouch is lubricated by sebum from “sebaceous glands”.  Both hair and sebaceous oil on the skin has evolutionary advantage in protecting skin from historical challenges.

Adolescents expect some acne, but for Jason, the duration of his acne was unacceptable.  He was now in his mid 20’s when he explained that “enough is enough”.  He was getting married in the summer.  There wasn’t one day of the week that he wasn’t broken out in deep and large pimples that were leaving plenty of red marks and depressed scars on his face.  He recalls at puberty that his skin became very oily.  He was always careful to wash with anti-acne soap, but despite this, his PSU’s were plugged up with clumps of cellular debris.  It wasn’t poor hygiene, rather it was a genetic defect in the ability of the cells to clear the follicle along with a great deal of sebaceous oil production since hormones of puberty.  So these in-pouches were now closed off from the outside world by a firm clump of cellular oily debris, providing the perfect hiding place for the culprit bacteria that cause acne.  These bacteria simply feed and multiply within this niche, unless the blockage is reversed.  Reducing oil gland size and function is also a goal in acne therapy.  Jason was explained that 3 Photodynamic therapy sessions, (light based peels), and some other acne topical products would reduce his oil gland size, and restore pore ventilation.  Indeed, with his commitment to the combination approach, he was able to achieve remission. Additionally he noticed uniformly colored, brighter skin which suited him as was married and moved to his first career position. 

Ross recalls trouble with angry red pores on his cheeks, for decades.  He complained that his skin flaked like dandruff, and in fact he did also experience a great deal of dandruff.  He had used a “couple of creams” that “helped for awhile”. However, he was noticing that the redness and extent of the scaly red face was increasing. Even his brows were red and scaly in patches.  He was an otherwise healthy 57 year old that had a common skin condition that takes place within the follicle.  He was very curious about the cause of his intensely red pores, and accordingly he learned that his pores were home to a dense population of a fungus, and a small common skin mite, known to increase in numbers, especially in elderly skin.  The fungus and the mite were possibly helpful to one another but the Photodynamic Therapy sessions that Ross did, along with an anti-fungal medication that he used topically reduced sebaceous gland size and reduced the load of these undesired residents within his pores.  He was very pleased with the reduction in scaling and redness. 

Almost everyone knows someone with prominent Rosacea, as it is a very common and conspicuous condition.  The stigma of severe Rosacea cost Adelle her job, for now.  She was on extended sick leave for her skin condition, as she was so red, swollen, and sensitive most days that she was unable to present her face in public on the job.  She wanted nothing more than to get back to work.  She recalls her dad had a very red enlarged and knobby nose.  She was relieved that she didn’t have that manifestation, but she did note that the pores seemed “huge and red”.  While Rosacea affects the skin in diverse ways, it is true that many people have troubled pores with loads of a skin mite, and possibly a bacteria living within.  The controversy rages about the role of the mite +/- the bacteria, but it is known that Intense Pulsed Light will burst the mites dramatically.  Adelle was highly enthusiastic about her course of Intense Pulsed Light therapy, and she accordingly completed her course of treatments to achieve neutral appearing, asymptomatic status.  She was happy to get back to work. 

Art was a 45-year old man who grew a very dense, coarse, dark brown beard.  Unfortunately, he almost always suffered some red bumps, “in-growns”, on his neck.  He usually dealt with this folliculitis by reducing his shaving frequency, which in turn made him appear unkempt at the workplace.   He had tried many ‘creams’, but to date nothing made much of a difference until an antifungal topical therapy.  He was also advised to “miniaturize” or eliminate the follicle with a medical hair removal laser.  He endured some discomfort and some minor irritation for the next few days, but within a week he was happy, and after a total of four laser sessions he shaved only some peach fuzz once per week.  From that point forward, he had no further troubles with “ingrowns” in the area.  He was thrilled to have shaving freedom in that zone!

The common theme was “troubled pores”.  We notice them, we suspect trouble within, and we are often correct.   The mysteries of life within the pores are unraveling themselves, and as medicine advances, there will be more directed and effective therapies, with lights and lasers well represented among the therapeutic options. 

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