Acne( acne, acne) - Causes, symptoms and treatment. MF.

Acne is a chronic dermatosis of the face, back and chest. This skin lesion can often be found under such names as acne, seborrhea, acne, vulgar acne vulgaris.

Acne is a consequence of the interaction of several pathological factors, resulting in an increase in the production of sebaceous secretion, thickening of the stratum corneum of the sebaceous glands, irregular peeling of these necrotic cells and blockage with horny scales of the follicle duct. All this leads to active reproduction in the follicle of the opportunistic microorganism-Propionbacterium acnes and, accordingly, to the onset of the inflammatory process.

Each hair follicle is surrounded by the sebaceous gland and connected to it by means of an appropriate duct. The sebaceous secret, produced by the gland, covers the skin and hair, thereby not only protecting them from all environmental influences, but also moisturizing them accordingly. Excess amount of fat glues the keratinized cells, thus forming a stopper in the mouth of the hair follicle. This sebaceous-hairy plug most often provokes the bulging of the follicle wall.

Thus, most of the elements of the rash are formed in acne. This so-called milium or closed comedones - not inflammatory hemispherical nodules, white, the size of a pinhead. Open comedones are the black dots formed as a result of the oxidation of this sebaceous-hairy plug. With the active multiplication of bacteria in the follicle, inflammatory elements are formed, which are manifested by papules of red color, conical shape, with a corolla of hyperemia around and with a pustular element on the apex.

It is especially dangerous to form such elements in the area of ​​the nasolabial triangle, where there is a very dense and superficially located venous network, which creates favorable conditions for the penetration of infection into the vessels and the development of purulent meningitis. The active movement of the facial muscles contributes to the spread of the process. Therefore, in the nasolabial triangle area, it is strictly forbidden to squeeze out any inflammatory elements and when forming such a consultation of a dermatologist or surgeon is necessary.

It is necessary to say and about severe forms of acne: conglobata acne, cysts, abscesses. Conglobata or globular acne is a large subcutaneous node, a dense consistency, formed in the depth of the hair follicle and causing pain when touching. This type of element is also called draining, which underlines the prevalence of the process. Nodular-cystic and phlegmonous elements are quite rare, poorly amenable to standard treatment and are resolved through the formation of scars.

The causes of the appearance of acne

A provoking factor is the hormonal changes in the body. This explains the fact that acne is more common in adolescents, pregnant women, girls and women in the last 7 days of the menstrual cycle( luteal phase), as well as in people taking hormonal drugs.

Excessive skin irritation by various means of care: soap, peeling, scrubs reduce the barrier function of the skin and open pathogenic organisms to the follicles.

The presence of a genetic factor can not be denied, since it is proven that the sensitivity of the sebaceous glands to the action of androgens or the thickening of the stratum corneum of the sebaceous gland can be inherited.

There are the following variants of acne :

• steroid, which occurs when inappropriate use of hormonal agents;
• acne is an infant that occurs on the face, in the first months of life. Independently pass, but can last several years;
• necrotic acne, this is itchy scalp acne;
• neurotic acne, occurs as a result of squeezing or ripping off acne, resulting in erosion( skin defect) and scars;
• fulminant acne acne , a rare form, occurs in young men aged 13-17 years, accompanied by malaise, weakness, increased fatigue, increased temperature, joint pain;
• professional acne , occur under the influence of oils, tar, lubricating oils, DDT, herbicides and other chemicals.

Symptoms of Acne Disease

With acne illness on the skin of the face, back, chest are formed inflammatory elements, in the form of pustules, nodules( less than 5 mm in diameter) and nodes( more than 5 mm in diameter), as well as non-inflammatory elements - comedones, those same "blackpoints "and white( called milium ).On the skin of the face appears a greasy shine of the T-zone( this is a nadpole, the transition from the nose to the cheeks, the chin).With an independent pressure on acne, there are erosions and scars. Sometimes keloid scars can form( this scar with increased formation of connective tissue).

In patients with hyperandrogenia( increased content of male sex hormones( androgens)), there may be signs of virilization( this is a thinning of the hair on the head, hirsutism( this is increased hairiness)) and premature puberty. The nodules can become purulent are called cysts) or hemorrhagic( filled with blood).Very often, all these signs are accompanied by psychological problems, including depression, increased anxiety.

Photo of acne Photo of acne on the back

Photo of conglobate acne

Photo of cyst

What diseases can be confused with acne disease

Despite the fact that today acne is a fairly common skin problem, it is necessary to know what pathological conditions of the face they need to be distinguished from. Rosacea and rosacea-like dermatitis, the disease is apparently quite similar to each other, and with the manifestations of seborrhea.

Rosacea( rosacea, couperose) is a chronic facial dermatosis formed on the background of an angioneurosis( trigeminal nerve), dysfunctional disturbance of the gastrointestinal tract and irritating effects on the skin of the face of various environmental factors( direct sunlight, wind, rain and snow),as well as with the use of hot food and alcoholic beverages. Most often, with this pathology, the nose, forehead, cheeks and chin suffer, where ample papules, pustules and vascular sprouts are noted against the background of severe redness. This problem is most striking people after 40 years. With the prolonged existence of the process, a thickening of the subcutaneous fat and sebaceous glands of the tip and wings of the nose develops, which is manifested by thickening and the formation of the tuberous surface of the nose.

Photo Rosacea( rosacea, couperose)

Rosacea-like dermatitis( perioral dermatitis, steroid dermatitis, dermatitis stewardess) is a problem of the face skin of girls and young women, provoked by the active irritating effect of cosmetic products and the irrational use of hormonal external agents on the skin of the face. This problem is manifested by red-pink papules and pustules on the background of reddened skin, grouped around the mouth and eyes.

Photo Rosaceum-like dermatitis

Diagnosis of acne

To diagnose a visual examination is sufficient, and to determine the cause, the following tests will help:

• blood test for hormones( free testosterone, FSH, LH, estradiol, 5-testosterone( DHT) and 5-androstenediol).Analyzes should be given on an empty stomach for women 5-7 days from the beginning of the menstrual cycle, for men it is not important, preferably up to 10 am;
• biochemical blood test( especially liver function), fasting for women of ultrasound, also on the 5th-7th day of the menstrual cycle( to exclude polycystic ovaries);
• analysis for intestinal dysbiosis;At any changes of analyzes - consultation of the doctor for correction of a status( the gynecologist, the gynecologist-endocrinologist, the therapist, andrologist, the gastroenterologist);
• clinical blood test( if there is inflammation, as it will aggravate the course of acne) in the presence of abscesses-an analysis of pathogenic flora and antibiotic sensitivity

Acne treatment

In severe acne, it is necessary to isolate and identify the microbial flora by seeding the contents of the pustules with the sensitivity of the sown flora to antibiotics. It is also necessary to determine the level of androgens followed by a consultation with a gynecologist and an endocrinologist. The parameters of the general blood test are determined, where, in the presence of abnormalities, a control study is performed every 10 days. Blood monitoring for liver function status( biochemical study: blood cholesterol, total bilirubin and fractions, triglycerides, AlAt, AsAT) is necessary for treatment with systemic retinoids, but we will talk about this below.

The main approach in the treatment of acne should be directed to the correct and careful care of problem skin. The use of alcohol-containing and other aggressive agents on the face can further break the barrier functions of the skin and lead to an aggravation of the process. Therefore, cleansing the skin or washing it with gentle cleansers can only contribute to a positive result during treatment. It is possible to use cosmetics of the following dermatological lines: Uriyazh - Iseak, Bioderma - Sebium, Aven - Klinans.

In the presence of inflammatory elements on the face skin, treatment should begin with the appointment of external antibacterial agents: "Zinerit", gel "Dalatsin T", ointment "Imex", as well as various prescriptions of drugs manufactured in pharmacy chains according to prescriptions of dermatologists. Often a good effect has Metrogil gel, but it has a phototoxic effect, which you need to know and remember.

When remission of acute inflammatory process in the treatment, agents that influence the process of keratinization of epidermal cells are added, thereby reducing the formation of comedones. This property is azelaic acid, produced as an official "Skinoren", and the cream form of this drug additionally has a depigmenting property.

A combination of these drugs( skinorin and antibacterial external agents) has a positive effect with 15-20 sessions of selective phototherapy or the appointment of procedures with a helium-neon laser.

Increasingly, in recent years, benzoyl peroxide is used in the treatment of acne 2.5%;5%;10% - "Basiron AS", which possesses not only antimicrobial, but also keratolytic action, i.e.promotes softening and rejection of the outer layer of the skin. It must be remembered that it is unacceptable to use the bason in the active sun.

Differin 0.1% is an analog of vitamin A - retinoid for external use, which has anti-inflammatory effect and comedonolytic activity. It also helps stabilize the processes of rejection of keratinized cells. The phototoxic effect of this drug is known, as well as contraindications for use in pregnant and lactating women. Lokatsid and Retin-A-similar preparations.

In the treatment of mild forms of acne, often a combination of the above drugs. Self-use of external means is possible here. Often the positive effect is also of the people's means.
Lotions with infusions of herb St. John's wort will help to remove acute inflammation and reduce redness of the skin. To do this, 1-2 tablespoons of herbs for 1 hour insist in a glass of boiling water. Then, the infusion is cooled and moistened with a gauze napkin folded into 6-8 layers and covers the most damaged part of the skin for 15 minutes. The procedure is repeated for one and a half hours, followed by a 3-hour rest. On the skin of the chest and back, it is possible to use 10% tincture of calendula flowers on 40 ° alcohol in the form of wipes 2 times a day.

In severe forms of seborrhea and moderate manifestations, in addition to external therapy, drugs are administered orally. Broad-spectrum antibiotics have the goal not only to combat Propionibacterium acnes, but also to reduce fat production. Here the drug of choice is tetracycline( 500 mg-2 times a day) and doxycycline( 100-200 mg per day) applied for 2-4 weeks. These drugs are prohibited for consumption during the active sun, because they have a phototoxic effect, as well as pregnant, nursing and children under 13 years old. Despite the fact that the erythromycin Propionbacterium acnes is most often resistant, this drug can be used in pregnant, nursing and children( 500 mg 2 times a day-2-4 weeks).

Staphylococcal vaccine is often indicated.

To reduce the effect of androgens on the sebaceous glands, women and girls are prescribed combined oral contraceptives. Most often used "Jess", "Diane-35", appointed for a long time, for 6 months or more.

The most effective is the appointment of systemic retinoids. This is the so-called "Roaccutane", which is prescribed if the above treatment is ineffective, with mandatory monthly monitoring of liver function. There is a certain approach to the appointment of a daily dose of the drug, selected exclusively individually. In connection with the presence of teratogenic and embryotoxic action, contraindication is an established and planned pregnancy, as well as lactation. To maintain the liver, in complex treatment shows the use of hepatoprotectors( Essential forte( 2 capsules) or karsil( 1 tablet) 3 times a day for 1 month).Prednisolone may be prescribed, alone or in combination with roaccutane.

For large and deep nodes, intraocular administration of corticosteroids is given every 2-3 weeks. This procedure can lead to discoloration and thinning of the skin. Paraffin applications and ultraviolet irradiation in erythematous doses are also shown.
Acne vulgaris is one of the most common diseases. The main complaints are the appearance of acne, black spots, greasy shine of the skin. The disease does not threaten life, but how much mental suffering brings, especially among young people. Many parents believe that this disease should not be paid attention, they say, the child will grow up, the hormonal background will change, and everything will pass by itself, yes, maybe someone will be solved independently, but this is a rarity;so it's better to start treatment at an early stage.

The disease affects 70 to 80% of the adolescent population( of which women appear in the age of 10-17 years, and men aged 14-19 years), and about 10-12% of adults over 25 years of age, with more diseases moreheavy. Often the disease is accompanied by psychological problems, including anxiety, depression. Do not shut yourself in, and remember, the sooner you start treatment, the better.

Acne Prevention

These tips will help you reduce the effects of acne.

• Do not apply to the skin cosmetics based on lanolin and Vaseline, which clog pores.
• Do not use products containing oils.
• Do not abuse products such as chocolate, carbonated drinks, nuts, coffee.
• Pick up cosmetics to cleanse the skin, according to your skin type. The cosmetician will help you in this.
• Initiate treatment at an early stage.

Complications of acne disease

Complications include suppuration, scars after the solution of the rash may remain redness or pigmentation, which can persist for several months;often relapses( exacerbations).

Doctor dermatologist Kuklin TP