21. Friction, Occlusion, Mechanical Irritation
Doctor Jacob here, and today we're talking about friction, occlusion and mechanical irritation. So these things are all lumped up into once concept called acne mechanica. It's basically some mechanical problem where the skin is being manipulated by outside environment influences. If you think about let's say a person who's going on a hiking trip and they're wearing a backpack, and they're sweating, and the straps of the backpack are rubbing against the shoulders and the backpack is sitting right in the middle of the back, and there's sweating, but the sweat doesn't evaporate because of the backpack over the back, so the back really gets kind of extra moisture from the sweat - that's going to be a big setup for acne breakouts, in an acne-prone patient. That's a combination of friction, occlusion and mechanical irritation all in one scenario. Friction from the straps of the backpack and the backpack itself, rubbing as the hiker walks, occlusion meaning something that's resting and sealing something else, so the backpack would seal the sweat into the back in that situation, and mechanical irritation from the sweat.
So that's all something that you can think about in many other situations, for example the forehead. If a patient has a hat on and is sweating a lot, and the hat rubs or a visor rubs on the forehead if you have a helmet, or something that rubs against the chin for a face mask in a baseball player, and basically there are these comedones which are really tiny and they're very early stages - they call them micro-comedones - and when they're rubbed by the friction, whether it's the helmet or the visor, or whatever, they cause a little bit of rupture which triggers inflammation, which causes acne breakouts. So without removing the mechanical irritation it can be nearly impossible to cure this type of acne.
Something that people often do is they lean on their fist against their chin when they're studying, or when they're sitting at the table eating - whatever it is, if there's a habit where something is being touched or rubbed repetitively, it will rupture the little micro-comedones right in that area.
Also, for example somebody takes a long car ride in a hot car that doesn't have air conditioning in it, and they have their back against the car seat and they're sweating a lot, that will undoubtedly in the acne-prone patient lead to a breakout of acne on the back. So friction, occlusion and mechanical irritation.
If you have a target area where you keep getting acne breakouts, think really carefully about things that happen to that area during your day. Is it being rubbed by a hat, is your belt rubbing that waistline, are you sitting against a hot car and your back is breaking out? Just think about things carefully and you can often figure out these mysteries.
Before we wrap up, I'd like to add one modern cause of friction and mechanical irritation, and that's the ultrasonic brushes, which are more popular nowadays. If you don't use a very sensitive or soft brush head, specifically designed for people with sensitive skin or with acne, the ultrasonic brushes can rupture the micro-comedones, the small clogged pores, and that rupture releases the contents into the dermis, into the skin, causes the inflammation and can trigger acne. So that's why I'm not a fan of these ultrasonic brushes, unless you're using the real sensitive skin or acne-prone skin attachment, and don't overdo it. So ultrasonic brushes can cause acne mechanica.
That does it for today. I'm Doctor Jacob, we'll see you next time.
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