Acne - Causes, Symptoms, Diagnosis and Treatment
Acne is a particular manifestation of acne - skin sprinkler elements, and do not reflect the full clinical picture of the disease. The term "acne" includes various types of acne in adolescence, adult acne, dermatoses and group akneiformnymi rash (acne rosacea, rosacea, sarcoidosis melkouzelkovy face, perioral dermatitis, lupus). Depending on the type of acne and acne flow is determined by the method of its treatment.
Acne
Acne - Skin sprinkler elements, and do not reflect the full clinical picture of the disease. Acne is a disease characterized by inflammation of the sebaceous glands, develops due to various reasons and has its own characteristics, depending on the patient's age and pathogenetic mechanisms of its occurrence. The term "acne" includes various types of acne in adolescence, adult acne, dermatoses and group akneiformnymi rash (acne rosacea, rosacea, sarcoidosis melkouzelkovy face, perioral dermatitis, lupus). Depending on the type of acne and acne flow is determined by the method of its treatment.
comedones. The disease causing gram-positive bacillus Propionibacterium acnes. The appearance of acne - a fairly common phenomenon in the age from 12 to 24 years, it occurs in 60-80% of people. One-third of patients required therapeutic treatment of acne. The urgency of the treatment of acne is determined by their influence on the psycho-emotional state of the patient. Acne causes psychological discomfort and feelings about the aesthetic appearance of problems. Patients with symptoms of acne suffer from the loss of attractiveness, they have reduced self-esteem, they do not adapt to society, suffer anxiety and depression. The decision on the treatment of acne is dictated by the elimination of psychological problems, such as BDD (fear, the idea of contrived ugliness of appearance) and the desire for a free socialization in the society.
seborrhea. When oily secretion secreted by the sebaceous glands, characterized by a decrease of bactericidal properties, which causes the active bacteria and the creation of prerequisites for the inflammation of the skin and the appearance of acne.
Follicular hyperkeratosis
The emergence of black-spot acne is a serious aesthetic problem for patients with acne. The appearance of acne accompanied by increased keratinization of epithelial cells in the hair follicles of craters, in which open ducts of the sebaceous gland (follicular hyperkeratosis). Usually this process takes place at a moderate pace, so that the horny scales have time to exfoliate at the mouth of the follicle, and along with the sebum stand out. Hyperkeratosis prevents normal outflow of sebum and leads to its accumulation in the follicle. The accumulation of dead cells and sebum leads to clogged pores and causes black dots - microcomedo clinically not manifest itself. With further accumulation of sebum and pressure on the clogged follicle is its cystic expansion, which clinically manifested in the form of closed comedones (non-inflammatory dense knots). Further development of the process causes atrophic changes in the sebaceous glands and enlarged pores. So there are black-spot acne or open comedones. This sebum has a dense structure, bad is expelled due to large concentrations of horny scales. Black secretions staining, visible from the expanded pores, due to their content of pigment melanin.
Reproduction
microorganisms.Skin and hair follicles populated by a variety of human saprophytic and opportunistic pathogens (Staphylococcus epidermidis, Mycobacterium, Clostridium, Demodex mites, etc.). When clogged pores and accumulation of sebum creates favorable conditions for their reproduction within the hair follicles.
Inflammation
A special role in the development of inflammatory process in acne plays Propionibacterium acnes (acne propionic acid bacteria). Its reproduction in the follicle and release of waste products are irritating to the tissues and cause a local inflammatory reaction. The inflammatory process may occur at any stage of acne, affect superficial or deep layers of the skin, which explains the diversity of forms and clinical manifestations of the disease.
neonatal acne (acne neonatorum).
2. The common acne (acne juveniles).
3. Adult Acne (acne adultorum).
4. Acne is caused by mechanical factors (acne mechanica).
5. exogenous acne (acne venenata, cosmetic acne, contact acne).
hydrocele, physiological vulvovaginitis. These states are due to the influence of maternal hormones produced fruit in utero. Acne baby - is closed comedones, are located on the nose, cheeks, chin and forehead in the form of point white or yellowish papules. They usually disappear on their own without a trace within 1.5-2 weeks.
Acne children (acne infantum)
In children acne can occur at the age of 3-6 months and cause a prolonged, severe forms of acne. Their development may be associated with dangerous congenital pathology (hyperplasia or a tumor of the adrenal glands), and requires a thorough examination of the child.
acne comedonica) Brasil as a result of blockage of the hair follicles accumulation of horny scales and sebum. Weakly expressed comedones in the absence of an inflammatory component is the option of the physiological norm. The initial manifestation of acne are Microcomedones, does not manifest itself clinically. In the next stage are formed closed comedones, i.e. white dense non-inflamed nodules of about 2 mm diameter covered by the skin and do not have open to the surface. Inflammation is not expressed in them, but there are favorable conditions for its further development. Further accumulation of sebum in them increases the nodules and the transformation of closed comedones into open (black comedones or black spot acne).
Uzlovatokistoznye acne (acne nodulocystica)
For uzlovatokistoznoy forms of acne (acne nodulocystica) characterized by the formation of purulent cystic cavities and infiltrates deep into the dermis, their penchant for mergers and the formation of inflammatory conglomerates. When reversal of such elements always heal with scar formation. This form of acne is typically carried out a long time (several years), even in moderate extent process.Lightning acne (acne fulminans)
The most rare at onset and most severe form of clinical manifestations of acne - a lightning acne (acne fulminans). Usually develops in adolescents 13-18 years old, with or papulopustuleznuyu uzlovatokistoznuyu form of acne. For lightning-fast form is characterized by sudden, abrupt onset, the appearance on the trunk ulcer-necrotic areas increase in symptoms of intoxication. Lightning form of acne is close in its current form to a gangrenous pyoderma.
Causes of lightning forms are not fully understood. Probably, certain role is played here by toxic-allergic and infectious-allergic mechanisms. Usually, acne fulminans occurs in patients with severe lesions of the digestive system (ulcerative colitis, Crohn's disease, etc.), Or after taking certain drugs: tetracycline, androgens, synthetic retinoids.
Rapid development of the disease. At the forefront are common symptoms, and symptoms of intoxication: the rise in body temperature above 38 ° C, pain in joints and muscles, abdominal pain, anorexia, a sharp deterioration of health. Sometimes develop changes in organs and tissues: bone softening, enlarged liver and spleen. In the blood - increased content of white blood cells, decrease in hemoglobin and ESR acceleration, bakposev blood - negative. On the skin of the trunk and upper limbs are formed areas of erythema with pustules, and then ulcers. On the face of no rash. Subsequently, on the site of lesions formed numerous scars, including keloid.
Papulopustuleznye acne (acne papulopustulosa)
For papulopustuleznyh acne (acne papulopustulosa) is characterized by adherence to the open or closed comedones inflammation. This form of acne is characterized by the formation of inflammatory elements - papules (knots) and pustules (pustules). Exodus papulopustuleznyh acne depends on the depth of layers of skin lesions. Mild usually heals completely, with the involvement of the inflammatory process in the deep layers of the dermis and damage to its structure inflammatory elements heal with scar defect.Comedones and blackheads papulopustuleznye - the most common form of acne. Other varieties of acne in clinical practice are rare, characterized by more severe and require different treatment strategies.
consult a gynecologist. In 20% of cases of adult women complain about the appearance of rash for a few days before menstruation and disappear independently of acne with the beginning of a new cycle. Often, late acne permanently present. This is usually papular, papulopustuleznye or nodular-cystic acne items. The cause of acne is often a late polycystic ovarian complicated hirsutism and anovulatory menstrual cycle. It is also necessary to exclude neoplastic lesions of the ovaries and adrenal glands.
Globular or piled up acne (acne conglobata)
One of the most severe manifestations of acne - spherical (heaped) Acne - common in men on the background of seborrhea thick. Acne appear multiple spherical elements and large uzlovatokistoznymi comedones disposed not only on sites seborrhea, skin and extremities, abdomen and back. Their healing occurs with the formation of keloids, hypertrophic and atrophic scars. Globular acne occur in adolescence and stored, usually up to 40 years or more.
Inverse acne (acne inversa, hidradenitis suppurativa)
Clinic inverse acne is associated with secondary involvement in the inflammatory process of apocrine sweat glands or large armpits, perineum, mons pubis, navel and others. Predispose to their development increased body weight, injury respective zones scratching or tight clothing. The disease is characterized by the formation of bumpy painful infiltrates with purulent or bloody-purulent discharge. The individual elements merge to result in an increase in lesion area. Heal a long time with the formation of fistulas and scars. Inverse eels have a chronic course with frequent relapses.
Pyoderma skin (Pyoderma faciale)
Many researchers attribute to the appearance of rosacea pyoderma, not acne. Piodermity skin suffer more young women 20-40 years old. The disease begins on the face of the emergence of persistent erythema, amid a rapidly evolving papulopustuleznye rashes and nodes, merging then purulent conglomerates. Inflammatory elements exclusively localized in the face, while no comedones and general symptoms. The healing elements is slow, for a year or more.
Acne Bodybuilding (Bodybuilding acne)
The emergence of bodybuilding acne is associated with the reception of androgens or anabolic steroids. Emerging as a result of this hyperandrogenism causes increased secretion of sebum. This effect arises as a result of long-term use of glucocorticoids. Acceptance of anabolic steroids is often associated with vitamin cocktails, which include B vitamins and causes the appearance of acne uzlovatokistoznyh. In this form of acne patients is necessary to exclude endocrine disorders.
sweating, and so on. d.).
perioral dermatitis, lupus, sarcoidosis persons, drug rash. For primary akneiformnyh rash is an inflammation of sebaceous hair follicle. In the diagnosis, they should be distinguished from acne.
UFO should take into account the nature of the clinical manifestations, the severity of acne and the individual course of the disease.
Outdoor
acne therapy.The use of external resources is almost always used in treatment of acne. Their pharmacological action is aimed at suppressing the mechanisms of development of acne: excess sebum, hyperkeratosis, microbial breeding, the development of the inflammatory process.
The external agent of acne lubricate the entire area of affected skin (face, chest, back) instead of the individual elements of acne. Allowable combinations of drugs, but their simultaneous application. Treatment is carried out for a few months before the disappearance of eels. In the future, you want to support the course with less frequent application of external preparations. For external use for acne, the following drugs: synthetic retinoids, derivatives of azelaic acid, benzoyl peroxide and antibiotics. However, they all have a slightly pronounced effect on the hypersecretion of sebum.
Treatment of acne with retinoids
Retinoids are synthetic analogues of retinol (vitamin A). Method of production - solutions, creams and gels. Indications for the use of retinoids is mild acne, is accompanied by an increased allocation of sebum, as well as intolerance of benzoyl peroxide. Preparations with retinol dissolve comedones, normalize the processes of keratinization of hair follicles, have an antibacterial effect and may reduce the secretion of sebum.
Treatment of acne azelaic acid
Azelaic acid is a member of gels and creams for external use. The therapeutic effect of azelaic acid is associated with the process of normalization of keratinization walls of hair follicles, the suppression of enhanced microbial growth and development of inflammation in the sebaceous glands. Suitable for patients with a moderate form of comedones or blackheads papulopustuleznyh, as well as in cases of inefficiency or poor tolerability benzoilperoxide and retinoids. Noticeable improvement usually occurs within a month, and the most pronounced effect is achieved after 2-3 months.
Treatment of acne benzoyl peroxide
Benzoyl peroxide - the active ingredient, which is part of the many outdoor products, used in dermatological practice for over 20 years. With a powerful keratolytic ( "dissolving" dead skin tissue) and the bleaching action, benzoyl peroxide medications used in the treatment of ichthyosis, pigmented lesions. And benzoyl peroxide is effective against acne. The drug is available in different dosage forms (lotions, liniments, creams, gels) and concentrations (10%, 5%, 2.5%). It may be used alone or in complex drugs in combination with erythromycin, sulfur, or gidroksihinolonom imidazoles. The indications for the use of benzoyl peroxide is a mild acne, characterized by the formation of comedones and inflammatory elements.
Perhaps the use of the combined resources from acne including benzoyl peroxide and erythromycin. This gel is prepared immediately before use. Keratolytic, antibacterial and anti-inflammatory effect of benzoyl peroxide in combination with bacteriostatic antibiotic erythromycin propionic acne bacteria to give good results in the treatment of acne.
Treatment of acne with antibiotics
In the treatment of acne topically antibiotics commonly used in cases of ineffectiveness or intolerance retinoids, benzoyl peroxide and azelaic acid. Sometimes antibiotics are used as a supplementary drug for the first three main drug. 1% liniment or lotion that contains the antibiotic clindamycin is used to treat moderate forms of acne with no effect on the use of other drugs. Penetrating into the sebaceous glands, clindamycin stops multiplication of staphylococci and propionibacteria.
Successfully used a preparation containing particulate complex of zinc acetate and erythromycin for preparing the lotion. Erythromycin effective against acne and propionic bacteria Staphylococcus epidermidis, and zinc suppresses excessive sebum secretion. Indications for use of the drug are mild to moderate acne flow. From the tetracycline antibiotics in the treatment of acne often used doxycycline and minocycline. These antibiotics tend to accumulate in the sebaceous glands, have high antimicrobial activity and are better tolerated by patients.
By its action erythromycin close to tetracycline antibiotics, but it quickly develops resistance microflora. As the drug of choice in the treatment of acne can be used during pregnancy and breastfeeding, in pediatric practice, as well as in case of failure or intolerance to tetracyclines.
Treatment of acne with antibiotics ineffective
Lack of effect of antibiotic treatment of acne can be caused by addiction flora to antibiotics in the event of prolonged use or the development of gram-folliculitis (inflammation of hair follicles caused by Gram-negative bacteria). To determine the sensitivity of microorganisms to antibiotic conducted bacteriological seeding discharge acne elements. Then the question of replacing the antibiotic or the appointment of retinoids.
Treatment of acne in both men and women have their differences. In men, symptoms of seborrhea and multiple acne on the torso observed increased separation of sebum, so their treatment requires antibiotics in high doses in combination with isotretinoin. Isotretinoin - drug group synthetic retinoid that inhibits the secretion of sebum. Already after 2 weeks of treatment of sebum production is reduced by 90% and remained at this level for several months. After the cessation of the use of isotretinoin secretion of sebum returns to normal limits. In addition, during treatment with isotretinoin normalize the processes of keratinization in the hair follicles, reducing the number of comedones and propionibacteria and related inflammatory manifestations of them.
In the treatment of acne in women may benefit from hormone therapy. To solve the question of the appropriateness of hormone therapy should be a gynecologist-endocrinologist after analyzing the hormonal woman. Acceptable combination of topical treatment of acne with hormonal combined oral contraceptives containing estrogen and antiandrogens profile. Usually, this treatment effect is 3-6 months and there is a long time.
Acne Treatment antiandrogens
Among kombinirovannnyh estrogen-progestin oral contraceptive ethinyl estradiol and cyproterone are most effective, which may be administered in the treatment of acne, both separately and in combination with each other. Corticosteroid anti-androgens are used for the suppression of hyperandrogenism of adrenal origin. The duration of acne treatment with antiandrogens and estrogen can last for months or even years.
Treatment of severe acne
Severe cases of acne require a combination therapy, combining standard local and general treatment. Women in such cases, you can assign contraceptives with estrogens or anti-androgens after prior consultation of the gynecologist-endocrinologist.
Physical methods for the treatment of acne
Strongly contraindicated general warm-up procedures (massage, heating, hot baths) for acne, t. To. Can exacerbate inflammation. However, the use of local medicinal hot compresses helps remove comedones and resorption of infiltration. For this purpose the Alibura solution containing copper and zinc sulfates.
phototherapy and ozone therapy can be used in the treatment of acne. To correct the scars that remain after the resolution elements of acne, mesotherapy is appointed.
In the acute phase of acne usually do not resort to surgical manipulation. In the formation of cystic cavities are affected by liquid nitrogen (cryotherapy) or fine needle is introduced into a solution of triamcinolone. Surgical dissection of cystic cavities leads to scarring. Multiple subcutaneous keratin cysts (whitehead) may remove the laser.