Tretinoin - "water pressure pinching off..."

[Squash]

I am absolutely NOT going to praise traditional acne medication, but what I've always found was, that a few medications actually WORKED to lessen/eliminate my acne, but using them was not sustainable in the long run because of the frightening, unnatural side-effects.

BUT, then I thought to myself; these meds CAN teach me something about how my acne forms on my skin.

I'm going to talk about 2 specific medications that have worked for me, and the state of my skin/acne while on them:
- Tretinoin creme (Retin-A, Differin, ...)
- Isotretinoin pills (Accutane, Claravis, ...)

Tretinoin creme
I've used this stuff for about 1-2 years to control my acne, and it's safe to say that it actually WORKED to keep my acne to a minimum, although it had side-effects that were sometimes worse than acne:
- Red/pink skin EVERYWHERE I used it
- Could not stay in the sun for 5 mins or peeling sunburn would take over
- Crazy oiliness
- Dry/peeling skin

To my understanding it works as a 'skin cell destroyer' (much like chemotherapy with cancer, basically a topical Accutane), making your Epidermis (?) especially thin and thus sensitive. I think the skin then tries to protect this thin skin by producing a lot of oil. But. Acne isn't formed. I don't get that, because that basically confirms traditional belief that a pimple forms when dead skin cells block the pore; these dead skin cells are not there, because the skin is so thin. So, basically, can anyone give an explanation that integrates the Wai-theorie (High water pressure in true skin pinches off sebum canals)?

Isotretinoin pills
Accutane works as an internal destroyer, and inhibits, which is to us interesting, sebum production. It gave me a mild form of the tretinoin creme side-effects (which are superficial/skin deep), but give me countless internal side-effects.
While I was on this drug I would eat amazing amounts of cooked protein (250g+ a day), but my acne was well under control. Skin wasn't as oily and the ONLY TYPE of acne I developed (on my maintenance dose of 10mg/day which I used over a year) was deep, under the skin whiteheads. No cysts (not big enough), no inflammation, no redness. BUT these under-the-skin whiteheads came closer and closer to the surface as time progressed (sometimes taking a few months), and when they came to the surface, they turned into a BIG INFLAMED pimple.
So, sebum production was lessened, but (according to Wai's theory) my true skin's water pressure was VERY high (250g protein/day). So this would mean:

Low sebum production + very high pinching off sebum canals = under the skin whiteheads

Does that make any sense?

Could I have anyone's input on this?
Thanks

[Squash]

I'm sorry, but I sometimes still find the 'water pressure pinching off-theory' hard to believe. The sebaceous glands, in some pictures, appear to be so close to the epidermis. There is almost no room to be pinched off by the dermis! See picture(s) below:






Then again, 'dead skin cell' blockage doesn't really explain deep, under the skin cysts, as the blockage must be somewhere in the dermis, where there exist no dead skin cells (I'm not sure on this one).

[abicahsoul]

On isoretinoin pills I recall having almost no sebum production at all. Or none at all.. more or less..

I guess the true skin is the pinkish layer just above the glands? I don't see why that isn't enough to pinch off? The cysts form I guess from inflammation or sth that goes down in the hair roots/pores that looks like big upside down carrots.. )

Well.. believe it or not.. But from experience I'd say that's just it.. Cuz all the time I do sth that strays frmo the diet I get a reaction.. and when I go kosher: the sebum is literally pushed out over a few weeks like grains of sand..

Thats my experience..

[Squash]

On isoretinoin pills I recall having almost no sebum production at all. Or none at all.. more or less..

I guess the true skin is the pinkish layer just above the glands? I don't see why that isn't enough to pinch off? The cysts form I guess from inflammation or sth that goes down in the hair roots/pores that looks like big upside down carrots.. )

Well.. believe it or not.. But from experience I'd say that's just it.. Cuz all the time I do sth that strays frmo the diet I get a reaction.. and when I go kosher: the sebum is literally pushed out over a few weeks like grains of sand..

Thats my experience..

Hey Abicah, thanks for your quick reply!

No, that's the epidermis. The true skin is the thickest middle layer (palest color in first pic) where the majority of the hair shaft is located. This is where supposedly lymph veins (I see somthing that looks like a lymph vein just under the fat tissue in the first pic) secrete their lymph fluid. (??)

[RRM]

Tretinoin creme
...
To my understanding it works as a 'skin cell destroyer'

Not just that. As you know, Accutane diminishes the production of sebum, and though scientists still dont fully understand all the exact effects of (iso)tretinoin,
we may assume that effects of topical tretinoin is somewhat similar.
The simple fact that oil production is increased, this supports my notion that sebum and oil are not the same,
and one may be stimulated without stimulating (or even diminishing) the other.

that basically confirms traditional belief that a pimple forms when dead skin cells block the pore

Actually, there are more ways to chemically eliminate the top layer of the skin, and yet they are not known to cure acne.
So that we may assume that the anti-acne action of tretinoin may be attributed to its more specific effects.

Isotretinoin pills
....
Low sebum production + very high pinching off sebum canals = under the skin whiteheads
Does that make any sense?

To me it does.

I'm sorry, but I sometimes still find the 'water pressure pinching off-theory' hard to believe. The sebaceous glands, in some pictures, appear to be so close to the epidermis. There is almost no room to be pinched off by the dermis! See picture(s) below:

As you can see in the second image, there is space between the glands and the upper skin,
so that there is always room for the canal getting pinched off.
Its not at all the case that the glands are stuck against the outer skin, leaving no room for fluid.
The glands are clearly totally inside the true skin, surrounded with interstitial fluid, subjected to the pressure of that fluid.
And so is the entry point where the sebum and oil fills the (hair) follicle.

Then again, 'dead skin cell' blockage doesn't really explain deep, under the skin cysts, as the blockage must be somewhere in the dermis, where there exist no dead skin cells (I'm not sure on this one).

Do you have experience with deep cystic acne?
When they first form, you feel a needle-point pain deep inside your skin, while the surface is not yet blocked at all, and totally normal. (no blackhead required)
Thats before the swelling starts.
Then, gradually, the pain starts spreading inside the skin and the skin starts swelling, and the skin becomes red-ish.
In the next stage the surface of the skin becomes irritated and looks 'blocked'.
In the final stage some of the pus surfaces, appearing like a small yellow spot in the middle of the swelling.
Eventually the cysts may burst open.
It may also be that the pus never surfaces, and that finally the cyst dissolves.

The true skin is the thickest middle layer (palest color in first pic) where the majority of the hair shaft is located. This is where supposedly lymph veins (I see somthing that looks like a lymph vein just under the fat tissue in the first pic) secrete their lymph fluid. (??)

The lymph system is like the blood system (though without the stimulus of the pumping heart), with an (more) extensive network of bigger and smaller canals/veins/vessels/capillaries.
Lymph is considered a part of the interstitial fluid and interstitial fluid becomes lymph when it enters a lymph capillary.
Due to high hydrostatic pressure in the lymph vessels, lymph fluids leak into the interstitial space, causing edema, locally.
When there is no such water retention, the skin is softer. (very noticeable)

[Squash]

Tretinoin creme
...
To my understanding it works as a 'skin cell destroyer'

Not just that. As you know, Accutane diminishes the production of sebum, and though scientists still dont fully understand all the exact effects of (iso)tretinoin,
we may assume that effects of topical tretinoin is somewhat similar.
The simple fact that oil production is increased, this supports my notion that sebum and oil are not the same,
and one may be stimulated without stimulating (or even diminishing) the other.

This is very interesting. But what is sebum good for then? I mean, if oil protects the skin well enough (against dehydration, germs, w/e), why expell sebum? Does this also explain that some people have acne while having a very dry face (low oil production, high sebum production)? I can recall reading something like 'if someone has an oily face AND has facial edema, the chances are high that this person also has acne' in the Free Acne Book. This then, would be a false statement, according to yourself, as 'oily' is not 'sebum-y'. And also, on Accutane I can recall having a significantly less oily complexion, which means: Accutane lessens sebum AND oil production. Tretinoin creme would have to do the same.

Actually, there are more ways to chemically eliminate the top layer of the skin, and yet they are not known to cure acne.
So that we may assume that the anti-acne action of tretinoin may be attributed to its more specific effects.

That's true. Chemical peels and stuff.. Although chemical peels specifically only momentarily remove a lot of skin layers and they are allowed to grow right back. Tretinoin creme suppresses the epidermis's thickness by chronically killing off skin cells.

As you can see in the second image, there is space between the glands and the upper skin,
so that there is always room for the canal getting pinched off.
Its not at all the case that the glands are stuck against the outer skin, leaving no room for fluid.
The glands are clearly totally inside the true skin, surrounded with interstitial fluid, subjected to the pressure of that fluid.
And so is the entry point where the sebum and oil fills the (hair) follicle.

Hmmm. I've seen a lot of pictures of hair follicles and they all look different. No consistency. Someone needs to find an actual legit/real picture of the skin layers including sebaceous glands.[/u][/b]

Do you have experience with deep cystic acne?

I (luckily) have very little experience with cysts. I think I may have had 1 or 2 in my life, but I'm not sure and wasn't really focusing on the feeling they gave me (stinging, pain, etc). I do think that the whole facts that cysts exist takes down the 'dead skin cells and sebum form a plug'-theory, now, actually. This would mean your theory is more likely the truth.[/u][/b]

The lymph system is like the blood system (though without the stimulus of the pumping heart), with an (more) extensive network of bigger and smaller canals/veins/vessels/capillaries.
Lymph is considered a part of the interstitial fluid and interstitial fluid becomes lymph when it enters a lymph capillary.
Due to high hydrostatic pressure in the lymph vessels, lymph fluids leak into the interstitial space, causing edema, locally.
When there is no such water retention, the skin is softer. (very noticeable)

Hmm... I'm going to have to take your word on that, because it's a long time ago I've opened a physiology book (unless that information is governmentally controlled as well), so I can't really argue.[/u][/b][/quote]
^See bold^

I know that I can be a pain in the ass, RRM, but at least I keep you sharp.

Also, great title change. It's more suitable.

[abicahsoul]

I am in shock! Oil and sebum not the same stuff? This is really confusing..

Also I see I spelled wrong.. isotretinoin it should of been..

I just offer an alternative version to the dry face - low oil high sebum, and still acne: in fact that's how I understood when I read the acne free book?: that because the sebum (or oil?) gets pinched off and creates inflammation, and blockage, much of the the smooth oily sebum (?) doesnt' reach the skin surface to protect the skin against moisture loss?.. Or something like that?

[RRM]

I know that I can be a pain in the ass, RRM, but at least I keep you sharp.

I dont perceive you that way right now, but im sure you can; who cant?
Questioning using rational reasoning is always good for this site;
it helps explaining stuff.

But what is sebum good for then? I mean, if oil protects the skin well enough (against dehydration, germs, w/e), why expell sebum?

The body has various ways with dealing with situations.
The metabolism of molecules often can go different pathways, for example.
The reason for that is flexibility; being able to cope with changing conditions.
Oil and sebum have different capacities as their properties are different.
Please read the thread that i linked to.

Does this also explain that some people have acne while having a very dry face (low oil production, high sebum production)?

Yes.
Whether the efflux of both oil and sebum are blocked, or just that of sebum only, depends on to what extend the sebum canals are pinched off.
When completely pinched off, the oil from that canal cannot be secreted either.

I can recall reading something like 'if someone has an oily face AND has facial edema, the chances are high that this person also has acne' in the Free Acne Book. This then, would be a false statement, according to yourself, as 'oily' is not 'sebum-y'.

How would that be false?
Does that statement exclude anything?
If i say that oil and sebum are different, does that imply that a high production of one usually does not coincide with a high production of the other?

And also, on Accutane I can recall having a significantly less oily complexion, which means: Accutane lessens sebum AND oil production. Tretinoin creme would have to do the same.

Why are you so sure about that?
Are their effects on the skin the same?
Do they act through the same pathways?

Although chemical peels specifically only momentarily remove a lot of skin layers

Not the ones that you have to apply daily. (eg containing cortisol)

I've seen a lot of pictures of hair follicles and they all look different. No consistency.

Did one of them ever show you that the sebaceous glands are in the outer skin?

Someone needs to find an actual legit/real picture of the skin layers including sebaceous glands.

Are you saying that these images are incorrect?
Sure, the scale and proportions, but actual mistakes?

The lymph system is like the blood system (though without the stimulus of the pumping heart), with an (more) extensive network of bigger and smaller canals/veins/vessels/capillaries.
Lymph is considered a part of the interstitial fluid and interstitial fluid becomes lymph when it enters a lymph capillary.
Due to high hydrostatic pressure in the lymph vessels, lymph fluids leak into the interstitial space, causing edema, locally.

Hmm... I'm going to have to take your word on that, because it's a long time ago I've opened a physiology book (unless that information is governmentally controlled as well), so I can't really argue.

You can easily find this information online. In Wikipedia, for example.
http://en.wikipedia.org/wiki/Lymph