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A Different type of acne: Sebaceous Filaments

Sebaceous filaments are composed of the natural keratinized lining of the upper portion of the hair follicle and may resemble black heads.

What is keratin?

Keratin (i.e. skin debris) is normally shed through the follicular opening. However, when this debris is retained and trapped by excess oils on the skin this creates a whitehead. When the blocked pore opens, it appears grayish-black to the naked eye creating a blackhead. Sebaceous filaments are composed of a small collection of sebum and debris and are typically flat, in contrast to black heads.

Is it the same as a black head?

No. A black head is when the pore is clogged by dead skin cells and sebum, whereas a sebaceous filament is the overproduction of sebum (oil) from the hair follicle with no occlusion.

In contrast to black heads, if you squeeze sebaceous filaments there is rarely any debris extruded. Therefore, avoid squeezing or over exfoliating sebaceous filaments because it may lead to cosmetically displeasing scarring and hyperpigmentation with minimal benefit.

Where does it occur?

Sebaceous filaments may occur anywhere on the face; however, are most prominent on the nose, forehead and chin.

How to treat sebaceous filaments:

The best topical treatment for sebaceous filaments and comedonal acne is prescription nighttime topical retin-a, specifically Tretinoin and Tazorac or over-the-counter adapalene gel in conjunction with a morning Salicylic acid wash—a keratolytic (destroying the excess keratin). Tretinoin skillfully speeds up the skin’s ability to turnover, opening up blocked pores and evening out dyspigmentation as well as promoting collagen synthesis.

When using topical retin-a products, both over-the-counter and prescription, I recommend to all my patients with both oily and dry, sensitive skin to start 2-3 times a week and then increase to nightly as it is very dry and can be irritating.

Proper cleansing and hydration of skin is essential to eliminate dirt, oil and skin debris and prevent sebaceous filaments from forming. The key is to find a face wash that is gentle and maintains hydration while not being too drying or leaving a greasy residue behind. There are numerous facial cleansers that claim to be excellent for acne-prone and oily skin; however, consumers may find these products irritating , drying and contain natural botanicals that may trigger a rash (allergic or irritant dermatitis).

Cleansers: My recommendations are to find a product that contain safe ingredients and gentle for patients with sensitive, oily and acne-prone skin. Cleansers that contain zinc pidolate— an ingredient that effectively cleanses debris and debris on the face while maintaining the skin’s natural pH. Hydrating face washes that contain hyaluronic acid provide that extra boos needed to maintain skin moisturize and integrity of the protective skin barrier while effectively removing excess oils. Apply a thin layer of the cleanser on the face, leave the cleanser on for 2-5 minutes and gently wash the cleanser off the face —avoid scrubbing the face with towels or cleansing cloths too aggressively.

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