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Is it a “Zit” or a “Cold Sore?”

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Dermatological problems are quite common amongst various individuals. One such issue is the development of either a Skin sore or a Zit. Individuals are concerned as to the nature and extent of these issues. A zit or commonly known as pimple is a swollen spot on the skin, which occurs as a result of sebum ( secretion of the sebaceous glands) getting trapped within the dead skin cells[1]. Skin renewal is a continuous and natural process where dead skin cells are replaced by new ones. However, in certain instances the dead cells are not shred off and remains attached together at the opening of skin pores (opening of sebaceous glands). This results in trapping of sebum, leading to the characteristic swelling and inflammation. The trapped sebum favours the growth of bacteria called Propionobacterium acnes that causes infection and inflammation[1].

Skin sore or pressure ulcer develops when blood supply to the concerned portions of the skin abruptly decreases or stops. Due to lack of circulation and oxygen supply, the skin cells suffer necrosis and dies. This results in development of an opening or crater on the skin surface, which forms the basis of pressure ulcer.  Skin sores usually develops in individuals who becomes bed ridden due to chronic illness or becomes confined to wheelchairs due to their physical disabilities. Cold sore is a special type of skin sore where the body tries to reserve its heat content by reducing peripheral circulation to the skin. This causes increase in viscosity of the blood which causes the characteristic reduced circulation.

In both situations the peripheral circulation to the skin is compromised which leads to the development of skin sores or pressure ulcers. If skin sores are not managed, often they lead to the development of infections. In more advanced cases, anaerobic bacteria that inhabit the microenvironment of the sores can get into the bloodstream. This may result in the development of septicaemia or simply infection of the blood which can lead to end organ damage (for example damage to brain, kidneys and lungs) ultimately resulting in death of an individual[5]

A comparison of both the conditions and their probable preventive & management strategies are provided in table 1.

Zit or Pimple Cold sore/Skin sore/pressure ulcer
Physical Features Thickening of skin, and signs of inflammation and pain. Excess accumulation of sebum and its consequent reaction with air can make these portions black in appearance. Cracked, blistered, or a scaly skin[5,6].
Yellowish tinges on the clothes and bed sheets.
Reddish hue that does not go away even after relieve of pressure.
Painful pressure points in shoulders, elbows, buttocks, hips and heels[5,6].
Patient’s responsibilities to reduce such episodes Regular washing of the skin with neutral cleansers helps to peel off the dead skin cells that are attached to the skin pores. The cleansers should contain benzoylperoxide and salicyclic acid that helps to shed the dead skin cells.Topical applications, like addition of antibacterial cleansers like triclosan is also useful.Before the cleansers are applied the skin should be washed with warm water and left to dry[1,2,3]. Changing body positions and postures, at least after every two years.
Exercising by taking short walks for 2-3 times a day. This helps to generate heat and increases peripheral circulation.
Protecting and supporting the pressure points with wedges and pillows[5,6].
Adequate intake of fluids like water, milkshake and juices that ensures circulation and nutrient supplementation[5,6].
Rinsing open sores and covering the same with clean and aseptic clothing.
Care Giving Interventions Topical application of nicotinamide(Vitamin B12)  and/or clindamycin[2,3].
In mild to moderate conditions drugs like doxycycline and minocyline are very effective and time tested[3].
However, in severe conditions drugs like accutane are used[2,3].
Although these drugs are effective, but have a decreased toleration profile due to incidences of stomach cramps and vomiting[3].
The bed sheets are sprinkled with corn starch to avoid friction with skin surface by reducing wrinkling of the same.
Regular observation and application of topical antibiotics with Physician advice[5,6].
Putting foam and air cushions below the pressure points so as to absorb such pressures on those points.
Tilting the head of the affected person but no more than 30 degree.
Using lidocaine injections may relieve the patients from pain associated with the sore[4].

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References :


[0]Anderson, Laurence.( 2006). Looking Good, the Australian guide to skin care, cosmetic medicine and cosmetic surgery. AMPCo. Sydney. ISBN 0-85557-044-X.

[1]Siegle, R. J.; Fekety, R.; Sarbone, P. D.; Finch, R. N.; Deery, H. G.; Voorhees, J. J. (1986). "Effects of topical clindamycin on intestinal microflora in patients with acne". Journal of the American Academy of Dermatology 15 (2): 180–185. doi:10.1016/S0190-9622(86)70153-9. PMID 2943760. edit

[2]Handfield-Jones, S.; Jones, S.; Peachey, R. (1988). "High dose nicotinamide in the treatment of necrobiosis lipoidica". British Journal of Dermatology 118 (5): 693–696. doi:10.1111/j.1365-2133.1988.tb02572.x. PMID 2969260.

[3]Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R (2010). Tzortzopoulou, Aikaterini, ed. "Adjusting the pH of lidocaine for reducing pain on injection". Cochrane Database Syst Rev 12 (12): CD006581

[4]Fernandez, R; Griffiths, R (2012). Fernandez, Ritin, ed. "Water for wound cleansing". Cochrane database of systematic reviews (Online) 2: CD003861

[5]O'Mathúna, DP; Ashford, RL (2014). "Therapeutic touch for healing acute wounds.". The Cochrane database of systematic reviews 7: CD002766

[6]https://www.flickr.com/photos/caitlinator/2739337639

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