A sebaceous gland disease characterized by blockage and inflammation of the hair follicles is called acne (acne), or acne. The variety of causes and clinical manifestations of acne, its frequent occurrence at different ages, caused by cosmetic problems make this disease relevant for many medical professionals. The main elements in acne are pustular and papular acne, comedones, nodules and cystic cavities. In the effective treatment of acne, an individual and integrated approach plays an important role.
A disease of the sebaceous glands, characterized by blockage and inflammation of the hair follicles, is called acne (acne), or acne. The variety of causes and clinical manifestations of acne, its frequent occurrence at different ages, caused by cosmetic problems make this disease relevant for many medical professionals.
The concept of "acne" reflects a causal dependence of skin manifestations on the general condition of the body. In the occurrence of acne, an important role is played by infections, disorders in the genetic, endocrine and immune apparatus, digestive and neuropsychiatric disorders.
Acne is found at almost any age: from the neonatal period to old age. Previously, acne was considered a purely teenage problem, but over the past decades, cases of acne in patients aged 25-35 have become more frequent. The most common form of acne is youthful acne, observed in patients 12-24 years old in almost 90% of cases. Acne brings a lot of anxiety about their appearance to people of any gender and age.
Signs of Acne
Rashes with acne are represented by closed and open comedones, papular and pustular acne, nodular and cystic formations. Closed comedones are non-inflammatory nodular formations of white color that do not have access to the surface of the skin. Further accumulation in the pores of the secretion of the sebaceous gland, epithelial cells, pigment, dust leads to the formation of open comedones with a black tip protruding above the surface of the skin. Typical localization of comedones is the skin of the forehead and chin.
Further attachment to the already existing blockage of the hair follicle of the inflammatory process leads to the development of papulopustular acne, and in severe forms - cystic cavities, phlegmonous and necrotic acne elements. Papular acne (lat. "Papula" - nodule, pimple) - elevation, dense tubercle over the skin the size of a pea reddish-cyanotic color. Multiple papules give an uneven appearance to the skin. Papules can undergo reverse development or further transition to pustules. Pustular acne (lat. "Pustula" - pustule) - a painful vesicle with purulent contents softer than papule, consistency. Small, up to 5 mm in diameter, pustules usually heal without a trace, after large pustules, scar defects often remain.
Further development of the inflammatory elements of acne can lead to the appearance of nodes and cystic cavities.The nodes are large infiltrates (with a diameter of more than 5 mm) located in the dermis and subcutaneous fat. With the reverse development, the nodes disintegrate, ulcerate and heal with a scar. Cysts are abdominal masses filled with pus of a purplish-cyanotic color. Healing of cysts also occurs with the formation of a scar.
Acne Development Mechanism
The mechanism of acne is due to the mutual action of 4 factors:
- Excessive increase in secretion of the sebaceous glands. Hypersecretion of sebum leads to a decrease in its bactericidal properties and a change in consistency. The secretion of the sebaceous glands becomes dense, forming plugs in the ducts and blocking them. Often observed during rapid puberty in adolescents and in the last week of the menstrual cycle in women.
- Follicular hyperkeratosis. The basis for the development of follicular hyperkeratosis is a violation of the normal process of constant renewal of hair follicle cells. Thickening of the superficial stratum corneum of the hair follicles along with sebaceous plugs creates an additional obstacle to the outflow of secretion of the sebaceous glands.
- Propion Propion Bacteria Acne Propagation (Propionibacterium acnes). Microorganisms living in large numbers on the skin of healthy people, under certain conditions, can cause the development of acute inflammatory reactions. Grease-horn plugs of hair follicles are a favorable environment for their enhanced reproduction and active life. The leading role in the appearance of acne belongs to propionic bacteria acne.
- Inflammation. Active propagation of propionic bacteria acne leads to a response of tissues and the development of inflammation in them.
Causes and classification of acne
Acne is a chronic dermatological disease, manifested by the formation on the surface of the skin of various rashes in nature. The development of this pathology is based on increased secretory activity of the sebaceous glands with subsequent blockage and inflammation of the hair follicles. There are a large number of factors that, to one degree or another, influence the onset of this disease.
To date, acne is an extremely common problem among the population. According to statistics, this disease is diagnosed in more than 80% of adolescents, about 8% of people aged 25 to 34 years and 3% of people over 35 years of age. While in adolescence, boys and girls are almost equally often confronted with this disease, then in adulthood, female representatives significantly prevail among patients.
As we have said, this pathology does not pose any serious threat. However, it has a significant impact on the mental state of a person, can cause a decrease in self-esteem and quality of life. Timely treatment of acne helps to reduce the number of rashes, up to their complete disappearance.
First of all, let's look at the classification of this disease. Depending on the clinical manifestations, there are:
- Open and closed comedones,
- Papular elements
- Pustular acne,
- Nodular and conglobate formations.
In more detail about how each of these forms appears, we will talk below.
Four main pathogenetic factors underlie the occurrence of acne. The first of these is increased production of sebum. Due to the excessive secretory activity of the sebaceous glands, the secretion secreted becomes more dense and forms plugs. The second important factor is the thickening of the stratum corneum of the epidermis, which also creates obstacles for the removal of sebum out. A significant role in the development of this pathology is assigned to the infectious flora, namely the bacteria Propionibacterium acnes.When the hair follicles are blocked, favorable conditions are created for the active reproduction of these microorganisms, due to which inflammation subsequently develops.
Many factors can contribute to an increase in the secretory activity of the sebaceous glands. One of the most significant factors in adolescence is the increased production of male sex hormones. An increase in the level of steroid hormones also plays a role in the appearance of acne and in the premenstrual period. Hereditary predisposition, endocrine disorders, vitamin deficiency, problems with the gastrointestinal tract, stress, the use of poor-quality cosmetics, living in regions with a hot climate - all this can lead to the formation of acne.
Separately, it is worth talking about self-squeezing acne. As you know, attempts to independently squeeze out the elements that have arisen often lead to an even greater aggravation of the situation. This is due to the fact that with mechanical action, the infectious flora spreads to deeper layers and seeds new areas of the skin.
Exogenous Causes of Acne
- Cosmetics (comedogenic cosmetics as causes of acne). The so-called comedogenic cosmetics, that is, clogging the pores and promoting the appearance of acne: creams, powder, lotions, blush, etc., can serve as a “provocateur” for the occurrence of acne. Comedogen substances include oils (corn, coconut, mineral , peach, almond, soy), lanolin, petroleum jelly, oleic acid, sulfur, squalene, sorbitan oleate, sodium lauryl sulfate, myristyl lactate, etc. Acne masking with cosmetics even exacerbates the course of acne. Therefore, when buying care products and decorative cosmetics, you should choose products with the inscription: "not comedogenic" (non comedogenic).
- Heat and humid climate. To exacerbate the course of acne or cause its appearance, high humidity and a hot climate can. Rashes are often localized on the chest, neck, back - those areas that are most irritated with sweat.
- The sun and ultraviolet. Ultraviolet in moderate doses dries and disinfects acne, and a sun tan evens out skin color, masking the acne elements of acne. However, an excess of ultraviolet radiation has the exact opposite effect. Increased sebum secretion and additional drying of the stratum corneum lead to exacerbation of acne and an increase in the number of acne. This mechanism works when tanning on an open beach, and in the solarium.
- Professional contact with toxic substances. The professional activity of many people is associated with direct contacts with household and industrial chemicals (for example, petroleum products, lubricants, chlorine, etc.), which causes the appearance of acne through the development of hyperkeratosis of the skin and hair follicles.
- Squeezing acne. Attempts to squeeze acne and thereby get rid of them yourself can lead to the exact opposite result. When acne is squeezed out, the infection penetrates into the deeper layers of the skin, seeds the non-inflammatory elements, leading to their infection and suppuration. It is especially dangerous to squeeze out acne in the face of the nasolabial triangle, because there is a great risk of infection with blood flowing into the meninges. Facial cleansing with a scrub during the period of inflammatory skin rashes should be excluded. Effective and safe treatment of acne can only be done by a specialist dermatocosmetologist.
- Constant friction and mechanical pressure on the skin (when wearing hats, tight collars and other clothes) causes the appearance of acne in these areas.
- Medical acne. In the treatment of many diseases of internal organs, steroid hormones that cause the appearance of drug acne are used today. This form of acne is characterized by the sudden appearance of acne, which coincides in time with the start of taking corticosteroids.Acne also occurs in women who stop taking birth control pills.
- Excessive cleanliness. Excessive cleanliness, if not paradoxical, can also provoke the appearance of acne. Frequent washing dries the skin of the face, lowers its protective properties and exacerbates the manifestations of acne. At the same time, hand washing should be regular in order to prevent the spread of infection from the source of inflammation over the entire surface of the skin.
Definition of the disease. Causes of the disease
Acne - inflammatory disease of the sebaceous glands and hair follicles.
Our skin has three layers:
1. the top layer is the epidermis,
2. the middle layer is the dermis,
3. the underlying layer is hypodermis (subcutaneous fat).
The epidermis itself consists of several layers, the uppermost of which is called horny, consists of dead cells of corneocytes and performs a protective function.
Derma is the most important layer of the skin; it is in it that the entire “life” of the skin is maintained. Derma is intertwined with blood vessels and is full of nerve endings. It is here that the main cells - fibroblasts - originate and work on the beauty of our skin. In addition, in the dermis are sebaceous and sweat glands, as well as hair follicles.
Hypoderama consists of connective tissue of loose texture and fat cells - adipocytes. The thickness of the subcutaneous fat depends on its location on the body and nutrition.
Of greatest interest to us are the sebaceous glands, the appendages of the skin that are in the dermis.
The sebaceous glands produce sebum; it shines treacherously on the skin of the face, especially in the forehead, nose and chin, the so-called “T-zone”. This type of gland is hormone-dependent. The production of sebum occurs under careful multi-level control, which involves:
- adrenal cortex and genital glands.
Any hormonal jump causes the sebaceous glands to actively secrete sebum.
Seborrhea is a skin disease that is manifested by pathological activity of the sebaceous glands. The clinical manifestations of seborrhea are that you can observe enlarged pores, gaping or clogged with comedones, oily or dry peeling, greasy hair. With such an active production of sebum, its composition changes; laboratory tests revealed an excess of androgens and a low estrogen content. Also, the amount of linolenic acid in the composition of sebum decreases - this helps to increase the alkaline level of the skin, violate the barrier properties and multiply microorganisms on its surface.
Among the causes of acne, the first place is occupied by a change in the microbial flora of the skin. When studying the isolated microbial flora in patients with acne, a large number of anaerobic lipophilic corynebacteria, aerobic micrococcal bacteria, and gram-positive rods are found.
In the process of inflammation, three microorganisms participate:
- corynebacteria (Propionibacterium acnes),
- cocci (Staphylococcum epidermidis),
- lipophilic fungi (Pityrosporum ovale et orbiculare).
The leading role in triggering the inflammatory process is played by Propionibacterium acnes, which produce various enzymes, including lipase. This enzyme is able to damage the wall of the follicle from the inside. The role of the immune system cannot be excluded, the decrease in the function of which is a favorable factor for the propagation of P. acnes. The hormonal status of the patient plays a key role in the occurrence of acne, namely hyperandrogenism - an increase in male sex hormones (testosterone and dihydrotestosterone). There are certain receptors on the sebaceous glands that are sensitive to androgens. Accordingly, with an increase in the level of these hormones, the sebaceous gland begins to pathologically actively produce sebum.In addition, the hereditary factor can be attributed to the causes of acne.
All of the above etiological factors can be attributed to endogenous, that is, having an internal nature of occurrence. As for the exogenous causes that affect the onset and development of the disease from the outside, then they, first of all, include exposure to sunlight. With active insolation, skin immunity is significantly reduced, which, again, is a favorable factor for the propagation of P. acnes.
One of the reasons for the spread of acne in recent years has become a fashion for fitness and sports, and here we can not help but mention bodybuilders. Due to their high-calorie nutrition and the use of anabolic steroids and testosterone derivatives, they are at risk for acne, taking these drugs without consulting a doctor and taking into account real indications for use, namely for gaining muscle mass. Taking anabolics leads to a sharp activity of the sebaceous glands in both men and women, even if in the past there were no skin problems. Subsequently, one can observe various forms of acne, from acne vulgaris to conglobate forms of acne. In addition to the acquired disease in women, a decrease in voice, male-type hair growth, and the disappearance of menstruation can be observed. In men, the concentration of sperm in the seminal fluid decreases. The first item in the treatment in this case will be the abolition of testosterone derivatives and anabolics.
Acne Development Stages
The development of acne is based on disturbances in the sebaceous glands, leading to the formation of sebum-horn plugs in their ducts. On the surface of traffic jams (comedones), pathogenic bacteria begin to multiply actively, causing irritation and purulent inflammation of the surrounding tissues. Acne eruptions are predominantly localized in the area of the chin, nose, forehead, back and chest - areas with the largest accumulation of sebaceous glands. Elements of acne can be non-inflammatory (comedones) or inflammatory (papules, pustules) in nature.
Depending on the severity of the course of acne, 4 stages of the process are distinguished.
- Stage 1. A mild form of acne. It is characterized by the presence on the skin of closed and open comedones with no signs of inflammation, single papules. Acne treatment at this stage is not difficult.
- 2 stage. Mild acne. The elements of acne on the skin are represented by a large number of closed and open comedones, acne (10-20 papules) with signs of inflammation. The prognosis of cure at this stage is long (6-8 weeks), but favorable.
- 3 stage. Severe manifestation of acne. The same signs are noted as in the second stage, but the number of inflammatory elements on the skin increases to 20-40 pieces. The appointment of specialized therapy is required.
- 4 stage. Extremely severe form of acne. It is characterized by a large number of papules, pustules, nodes (more than 40 elements). Requires serious specialized treatment.
Acne - what is it
The main predisposing factor for the occurrence of acne is seborrhea. This disease is accompanied by impaired functioning of the sebaceous glands and is manifested by excessive secretion of sebum.
In addition to hypersecretion of the sebaceous glands, seborrhea is accompanied by a change in the composition of sebum. Against the background of an increase in cholesterol and FFA (free higher fatty acids) and a decrease in the content of SFA (free lower fatty acids), a sharp decrease in the bactericidal properties of sebum occurs.
Violation of the natural resistance of the skin creates a favorable background for the excessive reproduction of opportunistic microorganisms (white staphylococci) and colonization of the skin with pathogenic microorganisms (staphylococci, streptococci, etc.)
The acne code for ICD 10 depends on the form of the disease. Acne is classified as L70. Further, depending on the form of acne, a qualifying code is indicated:
- 0 - for common acne (L70.0),
- 1 - for spherical eels,
- 2 - for smallpox eels,
- 3 - for tropical eels,
- 4 - for baby eels,
- 5 - excoriated acne,
- 6 - for other forms of acne,
- 7 - for unspecified forms of acne.
How acne occurs
The skin is the largest human organ in mass and area. It performs a number of important functions: exchange, heat regulating, receptor, protective.
The skin consists of three layers:
- epidermis - the outer layer of the skin, includes five layers located above the dermis and performing primarily a barrier function,
- dermis - the skin itself, connective tissue located between the epidermis and underlying organs, from which it is separated by a layer of connective tissue - subcutaneous tissue,
- subcutaneous tissue - loose connective tissue, often rich in fatty deposits,
The uppermost layer of the epidermis - the stratum corneum - has a protective function. and has no living cells, but consists of dead cells. The thickness of this layer may be different, depending on the intensity of the mechanical load on the skin area. The water-lipid mantle covers the stratum corneum of the epidermis as a spacesuit and protects the skin from harmful external influences, microorganisms and moisture loss. Its normal level of acidity (pH) is 4.5-5.5. However, with acne, fungal and other diseases, the acidity of the skin changes.
The water-lipid mantle has its own microflora, on it in symbiosis live epidermal staphylococcus, bacteria and some acne fungi in a certain proportion, which is strictly individual. These bacteria maintain an acidic environment on the skin and prevent pathogens from entering it. However, if this balance is disturbed, some bacteria begin to multiply too actively. In addition, violations in the upper layer of the epidermis reduce its protective and barrier function, and can lead to the penetration into the skin (especially with a certain pathology inside the body) of a foreign infection from the external environment. All this together leads to the development of acne.
Changes in the chemical composition of the water-lipid mantle can be caused by many reasons. Thus, during puberty (adolescence), acidity changes and the production of sebum increases due to hormonal changes. Thin duct of the sebaceous glands become clogged, deformed, as a result, comedones, adipose appear, and with the active development of pathogenic microflora - acne.
Thus, acne is a lipid metabolism disease. We can say that patients with acne have a special hypersensitivity (like a kind of allergy) to bacteria.
Symptoms of Acne (Acne)
Acne occurs in those areas of the skin where the most sebaceous glands are located. Visually, one can observe the presence of comedones (open and closed), miliums. In addition, signs of acne are oily hair, spots, scars, papulopustular elements, nodes (often painful). In some forms - greasy shine or vice versa - peeling and dull complexion.
- Prevention of the emergence of new comedones. Includes proper care for problem skin and general health improvement measures.
- Removing existing comedones. It is carried out using comedolytic drugs and comedo extractors at home or in beauty salons.
- Decreased sebum secretion. Achieving a tangible clinical effect is possible with a decrease in secretion by 30 percent or more. Retinoid drugs are used, hormones - estrogens, antiandrogens.
- Removing the inflammatory process and preventing its spread. It is achieved by the use of antibacterial drugs externally and orally.
- Reducing scarring cosmetic imperfections. It is produced by the method of dermabrasion, laser therapy, cryotherapy.
Causes of Acne
Previously, acne (acne) was associated exclusively with hormonal disorders. Subsequently, it was proved that acne is a polyetiological disease, the development of which may be due to a significant number of provoking factors.
The frequency of acne in women and men does not differ, but in men the disease is more severe.
For reference. The main causative agent of acne (acne) are propionibacteria acne. Also, the disease can be associated with the colonization of the skin:
- epidermal streptococci,
- Staphylococcus aureus (rarely Staphylococcus aureus),
Severe acne is also often associated with the presence of an acne tick (demodicosis) in a patient.
An important role in the development of acne is played by heredity. It should be noted that in patients with severe forms of acne (or in the presence of severe acne in a hereditary history), recurrent and poorly treatable forms of hydradenitis are often observed.
- Passing a course of procedures in a beauty salon plus active home care with recommended drugs.
- Combined external treatment with systemic drugs (which have an effect on the whole body).
- The use of drugs that affect the entire chain of the mechanism of development of acne (hypersecretion of sebum, increased keratinization of hair follicles, reproduction of microbes, inflammation).
- The presence of chronic processes in the body (gynecological, endocrine, gastrointestinal diseases, foci of chronic infection) can interfere with the treatment of acne and reduce its effectiveness. Therefore, in parallel with the treatment of acne, concomitant pathology should be treated.
In the treatment of acne, a large number of external drugs are currently used.
Pathogenesis of Acne (Acne)
The main phases of acne development:
- hypersecretion of sebum
- increased sebum production,
- follicular hyperkeratosis - an increase in the corneal epithelium at the mouth of the hair follicle, resulting in the appearance of comedones (black dots),
- active reproduction of propyonibacterium acnes. Since this microorganism is a lipophilic anaerobic, a clogged hair follicle with sebum accumulated in it is an excellent medium for active reproduction of propionibacterium acnes,
- inflammation: during active reproduction, bacteria secrete various chemicals that are mediators of inflammation, this leads to inflammatory elements in both the surface and deep layers of the skin.
Etiology and pathogenesis of acne
Acne is a polyetiological disease. A leading factor is the genetic predisposition inherited from parents to children. This is confirmed by genetic research and the study of the degree of manifestation of the disease in close and distant relatives. The inheritance mechanism is polygenic, which explains the variability of symptoms and their severity in different people. It is noted that genetic factors are responsible for more than half the cases of the disease.
In addition to the genetic characteristics, acne formation is promoted by a number of exogenous and endogenous factors.
Topical acne treatments
Benzoyl peroxide It has a strong keratolytic and whitening effect, due to which it has been used in dermatology for more than 20 years to treat ichthyosis and skin pigmentation. Its ability to "dissolve" keratinized tissues and a pronounced antibacterial effect allow the use of benzoyl peroxide for the treatment of mild to moderate acne. The combination of benzoyl peroxide with antibiotics, azole compounds, sulfur preparations as part of combined preparations significantly increases the effectiveness of its use.
Azelaic acid It has a pronounced anti-comedogenic, antibacterial and anti-inflammatory effect, but does not affect the production of sebum.
Tretinoin It is a synthetic retinoid, an analogue of vitamin A. It is used in the treatment of acne externally with inefficiency or individual intolerance to benzoyl peroxide. Eliminates existing comedones, and prevents the emergence of new ones due to the normalization of keratinization of the epithelium and a decrease in the secretion of sebum.
Benzoyl Peroxide, Azelaic Acid and Tretinoin are first-line drugs in the treatment of acne. They are effective for prolonged use (from 3 months or more). Sometimes their use causes skin irritation, which, as a rule, is eliminated by reducing the frequency of application to the skin or reducing the concentration. In the treatment of acne with these drugs, the simultaneous use of two or more agents, as well as temperature extremes and active insolation, is unacceptable.
Topical antibiotics. The external use of antibiotics in the treatment of acne is resorted to in cases where there is no effect of treatment with first-line drugs or combination therapy in the treatment of complicated forms of the disease. The disadvantages of treating acne with antibiotics include the development of the effect of addiction and insensitivity of propionic bacteria.
Erythromycin considered one of the most effective antibiotics for acne. The high antibacterial and anti-inflammatory activity of erythromycin is even more pronounced in its combination with zinc. Zinc, in turn, reduces the secretion of the sebaceous glands and loosens the pores, facilitating the local action of erythromycin.
Clindamycin non-addictive skin microflora and highly active against propionibacteria and staphylococci.
Systemic antibiotics used orally in combination with local therapy for moderate acne. Of the tetracycline antibiotics, minocycline or doxycycline is more often used due to their high antimicrobial activity, rapid absorption and intensive accumulation in the sebaceous glands. Less commonly used in the treatment of acne are clindamycin, erythromycin, and sulfa drugs.
Treatment of acne with systemic antibiotics involves their long-term (at least a month) intake. During this period, intestinal and vaginal dysbiosis, stable habituation of the skin microflora can develop. Other complications from taking antibiotics are ulcerative lesions of the esophagus, stomach ulcer, softening of the nail plates (onycholysis), the appearance of hyperpigmentation on the skin and nails, etc.
The interaction of antibiotics with other drugs should be taken into account so that their effect does not overlap. If the effect of antibiotic treatment is not expressed or is prolonged, the question of changing the drug or prescribing retinoids should be considered.
Antiandrogens. In the treatment of acne in women, a combination of external treatment and the use of hormonal contraceptives containing antiandrogens or an estrogen profile are possible. Severe forms of acne require combined (external and general) treatment.
The absence of a clinical effect from the treatment for more than 3 months is one of the indications for the administration of Isotretinoin, a synthetic analogue of vitamin A. The advantage of this drug is its effect on all mechanisms of acne (increased secretion of sebum, hyperkeratosis follicular, multiplication of microorganisms, inflammation). The course of treatment with isotretinoin is from 4 months to a year.
Hardware Acne Treatments belong to additional ones and are applicable only at the stage of comedones. These include massage and facial cleansing, surface cryotherapy, laser therapy, darsonvalization, etc.
Surgical procedures they are not widely used in the treatment of acne, because it leads to the formation of rough scars.In the treatment of abscessed forms of acne, chipping of purulent foci with corticosteroid drugs is possible.
Classification and stages of acne (acne)
In 1991, at a consultation of experts from different countries, the International Classification of Acne in Severity was adopted:
- light (single comedones, single papules and pustules),
- medium (single comedones, single papules and pustules, single nodes),
- severe (multiple papules and pustules, the presence of conglobate nodes).
Among the many classifications of acne, it makes sense to consider the most popular acne suggested by G. Plewig and A.M. Kligman in 1993:
1. Youth acne
d) fulminant acne
2. Acne adults
3. Acne in childhood
a) acne in newborns
4. Acne caused by exogenous causes
5. Acne caused by mechanical factors
6. Acneform rashes
The most common of these forms of acne:
We will consider them in more detail.
Comedonal form is a harbinger of the papulopustular stage. May occur in children from 8 years old. There is greasy skin and hair. Then, at the mouth of the sebaceous glands, micro comedone appears, which subsequently turns into a closed comedone (not an inflamed bodily or white tubercle with sebaceous contents), which cannot be freely evacuated to the skin surface due to the hypertrophied, narrow mouth of the sebaceous gland. However, with such a blockage, sebum does not stop its production, but accumulates in the cavity of a closed comedone, resulting in an increase in pressure on the walls of the sebaceous gland, which leads to a papular-pustular form of acne.
Papulopustular form characterized by rashes (papules and pustules), comedones (open and closed), spots. In severe cases, scarring may occur at the site of inflammatory elements. Localization in this case will be not only on the face, but also on the back, décolleté.
Conglobate form refers to severe acne. It is clinically manifested by large painful elements that rise above the level of the skin, combining several nodes at once. More often localized on the back. When the nodes open, ulcers appear that do not last long. Such acne regresses up to several months. Scars always remain.
In the vast majority of cases, acne occurs against a background of changes in hormonal activity during puberty.
An increase in the synthesis of sex hormones is accompanied by:
- increased secretion of sebaceous glands of sebum,
- a change in the normal composition of sebum,
- a decrease in the bactericidal and antifungal properties of sebum,
- narrowing of the follicular tubules and their hyperkeratinization (excessive keratinization and accumulation of dead, unpeeled cells),
- excessive fluid retention by skin cells (accompanied by the absence of free fluid in the epidermis, necessary to stimulate enzyme activity),
- increased sensitivity of the skin to the effects of various irritants.
In the vast majority of cases, the hormonal causes of acne are associated with increased secretion of testosterone, dihydrotestosterone, dehydroepiandrosterone, insulin-like growth factor 1.
Hormonal acne after the end of the puberty (post-puberty) is observed much less frequently due to the normalization of the hormonal background. Severe hormonal acne in adults may be due to their presence of:
- androgen (increased levels of androgens leads to damage to the sebaceous and hair follicles, epidermis),
- polycystic ovary syndrome,
- Cushing's syndrome
- tumors affecting the pituitary gland, adrenal glands, ovaries,
- adrenogenital syndrome
- absolute hyperandrogenism due to a deficiency of thyroid hormones,
- estradiol deficiency.
In women, single acne may be associated with an increase in androgen levels before menstruation.
Late acne in adults can be associated with MARSH-syndrome (the development of a patient's melasma, acne, rosacea, seborrhea, hirsutism).
The genetic cause of severe spherical or conglobate acne in men can be the presence of an additional Y chromosome in the karyotype (XYY Jacobs syndrome).
It is important to remember that treatment of acne with hormonal contraceptives should be agreed with the gynecologist. These drugs for the treatment of acne should be prescribed only after a hormonal examination of the patient.
Exogenous (external) causes of acne
External causes of acne include the following:
- Cosmetics. The abuse of cosmetics (creams, powder, blush, lotions, etc.) containing fats. The latter close the pores, enhance comedonogenesis, exacerbating the disease. At the same time, fat-free products do not affect acne.
- Hot and humid climate. Climatic conditions can affect the severity of acne, as heat and increased humidity stimulate the function of the sebaceous glands.
- Sunlight and ultraviolet radiation. Direct sunlight, carrying a large number of ultraviolet rays, negatively affects the skin as a whole, having a damaging effect on keratinocytes. At the same time, some researchers dispute the ability of insolation to provoke acne, explaining the negative effect of sunlight on photosensitization caused by taking medications used to treat acne.
- Occupational exposure to toxins and contaminants. In people employed in chemical production or in contact with chemicals, acne through the development of hyperkeratosis of the skin and hair follicles is diagnosed in most cases. Also, work in dusty or smoky conditions exacerbates the disease, provoking the occurrence of comedonogenesis in employees of coal mines, flour mills, and kitchen workers.
- Squeezing acne. Almost all people who suffer from acne try to get rid of the problem by squeezing the contents of a clogged follicle. The effect of such actions is exactly the opposite of expectations. Mechanical trauma caused by external exposure, leads to the spread of inflammation in the surrounding tissue. Infection, the penetration of which is inevitable in the absence of sterility, also exacerbates this process. As a result, inflammation affects the deeper layers of the skin, leaving behind rough scars and scars.
- Medical acne. Some drugs are provocateurs of acne by directly affecting the pathogenesis of acne. Basically, these drugs have an androgenic effect (systemic corticosteroid therapy, anabolics, oral progestin-only contraceptives). In addition, lithium salts, anticonvulsants (anticonvulsants), isoniazid provoke acne.
- Excessive cleanliness. There is a myth about acne, according to which dirt on the skin provokes a disease. In fact, it is noted that excessive cleanliness and abuse of antiseptics worsen the condition of the skin. This is because the propagation of propionic bacteria is usually restrained by the normal microflora of the skin. With the frequent use of antibiotics, personal hygiene products with antiseptics (in particular, abuse of soap and detergents with triclosan), the composition is disturbed and the number of beneficial bacteria antagonizing Propionibacterium acnes decreases. Experts do not recommend using products with an antibacterial effect too often. The hypothesis is confirmed by studies in which the efficacy of applying applications with lactobacilli to the skin of patients with acne has been proven.As a result of the restoration of normal skin microflora, the severity of inflammation decreased, and the number of bacterial colonies sown from the skin was reduced.
From the experience of complex treatment of acne
As practice shows, the best result is given by an integrated approach in the treatment of acne. Since it was previously noted that acne was called upon to be solved in the community by doctors of many specialties, the observed patients with acne had to undergo a comprehensive examination by a dermatologist, gastroenterologist, endocrinologist, gynecologist. The choice of methods and duration of treatment was determined by the severity and severity of the course of acne, taking into account individual characteristics.
The average course of acne treatment was 7-8 months. At the first stage, it included external treatment with azelaic acid and gel with metronidazole, as well as taking doxycycline. Additionally, cryomassage and darsonvalization were prescribed. A month later, the course was carried out chemical peeling with fruit acids in gradually increasing doses. In parallel, correction of the revealed violations in the endocrine, reproductive, digestive systems was carried out. A month later, an intermediate assessment of the effectiveness of acne treatment showed a steady improvement trend: the disappearance of pustular rashes was noted in 89%, the decrease in the number of comedones in 71.2% of patients, the process of sebum secretion decreased. Subsequently, persistent remission was observed.
Acne - causes and mechanism of development
Under the surface of the skin there are many hair follicles, from which hair grows, penetrating the surface of the skin through its pores (Fig. 7a). At the base of each hair follicle, there are many small sebaceous glands that produce sebum. This fat comes from the sebaceous glands through narrow channels, first into the lumen of the hair follicle, and then (along the hair shaft) it rushes out to the skin surface.
The development of acne is associated with two points:
- Strengthening the function of the sebaceous glands at the base of the hair follicles -
increased production of sebum is directly related to an increase in the production of androgens (male sex hormones) by the adrenal glands. These hormones are produced in both sexes, but in women - to a lesser extent. That is why acne develops during puberty in adolescents.
- Keratosis of the epithelium inside the follicle -
the surface of each hair follicle inside is covered with layers of epithelial cells. An increase in the rate of desquamation of epithelial cells from the inner surface of the follicle - leads to an increase in the number of desquamated dead cells in its lumen.
An increase in the production of sebum and an increase in the number of desquamated cells lead to the formation of plugs that clog the pores of the skin (Fig. 7b). These plugs are called acne vulgaris. Acne may look:
→ in the form of white tubercles, if the cork is formed deep in the pore (Fig. 9),
→ in the form of black dots inside the pores if the cork is formed at the skin surface (Fig. 10).
The formation of plugs leads to the fact that skin fat, which is constantly formed by the sebaceous glands, cannot go outside and accumulates in the lumen of the hair follicle (Fig. 7b). An enclosed space with a nutrient medium inside is an ideal place for infection to develop, and therefore bacteria that enter the hair follicle from the skin surface begin to multiply intensively there.
This leads to the development of inflammation in and around the follicle. Inflammation can occur for a long time without the formation of pus, in this case this formation is called papule (Fig. 10). The papule looks like a red, inflamed tubercle on the surface of the skin. Papules can disappear without a trace with time, but usually they transform into pustules. The pustule is already a classic pimple with pus inside (Fig. 11).
In addition, with more severe forms of acne, large inflammatory formations - nodules and cysts can form.Nodules are dense, painful papules of large sizes, inside of which there is also no pus (Fig. 12). Cysts arise, as a rule, when trying to squeeze acne deep in the skin, as a result of which the pus penetrates deeper into the tissue (Fig. 13).
Acne Complications (Acne)
The consequences of acne are, as a rule, enlarged pores, post-inflammatory pigmentation, erythema spots, milia, scars, atheromas. In cosmetology, this is called "post-acne."
Enlarged pores are a consequence of the fact that sebaceous glands actively produce sebum, as a result, sebum accumulates in the mouths of the sebaceous gland, with the extension and hypertrophy of the wall of the sebaceous gland.
Dark spots appear as a consequence of pigmentation disorders as a result of active insolation during the disease, extrusion, and trauma to the elements.
Erythema spots. What we observe in the place of a former pimple is nothing but a stagnant spot. It appears due to a violation of blood microcirculation during the inflammatory process.
Milium - formed round capsules with sebaceous contents, which are localized quite superficially, under the epidermal film, mainly on the eyelids, around the eyes, on the temples, less often in the lower third of the face. Almost never inflamed, but subject to mechanical removal. They appear due to a violation of keratinization: the stratum corneum (the uppermost) thickens, and the sebaceous contents cannot be evacuated to the surface of the skin, forming in the capsule subcutaneously.
Scarring various types more often develop in severe forms of acne, when damage to the perifollicular part of the dermis occurs. More often clinically we observe atrophic and keloid scars, red spots.
Atheromas - a rarer complication, but it also occurs. It looks like a large subcutaneous mound, from one to several centimeters, with a black dot in the middle (comedone). If you mechanically remove the comedone, then through the remaining hole you can squeeze out the contents of a whitish color, with an unpleasant odor. Atheroma infection is dangerous. In this case, it becomes painful and will be subject to urgent removal.
I would like to pay special attention to such a dangerous form of acne complications as sepsis, since most patients with acne have a habit of frequent trauma and self-squeezing comedones and inflammatory purulent elements. Sepsis is a serious infectious disease with a very small percentage of recovery, in other words, blood poisoning. The most dangerous area in this regard is the nasolabial triangle. It is in this anatomical zone that the vessels of the skin are very closely intertwined with the vessels of the brain. Through these vessels, blood flows to the brain, and if an infection gets inside the bloodstream will carry it directly to the brain.
How acne is formed.
The actual process of acne formation looks like this. As a result of pathogenic effects or hormonal disorders, changes in the chemical composition in the upper layers of the epidermis occur. The secretion of sebaceous glands increases and the composition of sebum changes. The process of updating the hair follicle cells is disrupted and the stratum corneum thickens (follicular hyperkeratosis). There is a bacterial imbalance (reproduction of some bacteria and inhibition of others). As a result, an inflammatory reaction begins.
If redness, inflammation, acne, subcutaneous painful elements appear on the skin - this is a signal of the body that the person is not healthy!
Reasons for the appearance
According to the condition of the skin, one can judge human health. The presence of inflammatory elements indicates diseases and disorders in the body. Another factor affecting the appearance of acne is defective or irregular cleansing and the use of poor-quality cosmetics.
Acne appears for the following reasons:
- excessive activity of the sebaceous glands,
- enlarged pores
- keratosis of the epithelium inside the follicle,
- hormonal disruptions
- premenstrual period
- imbalance of the autonomic nervous system,
- change in the composition of sebum,
- stress, depression, excitement, anxiety,
- loss of immunity
- the use of cosmetics not by type of skin,
- gastrointestinal tract diseases
- violation of the thyroid gland,
- lack of vitamins in the body,
- excessive sun exposure and excessive visits to the solarium,
- high humidity and hot climate,
- skin dehydration,
- improper or unbalanced nutrition,
- alcohol and smoking abuse.
Acne treatment prognosis
When predicting long-term results of acne, the following points should be considered:
- Acne is a chronic, intractable disease, because a hereditary predisposition or provoking factors can cause a new exacerbation, even if the disease has not recurred for several years. However, knowing the reasons that provoke a new wave of acne, you can clearly control and quickly relieve acne exacerbations, prevent the development of gross cicatricial changes in the skin (post-acne) and the formation of persistent cosmetic defects.
- If the disease has already occurred, then the changes in the skin are irreversible, and it will not be possible to achieve its previous ideal state.
- A full course of acne treatment is a long process that takes from 4 months or more.
- Acne treatment can occur with exacerbations of the process, especially in the first months, when the mechanisms of the development of the disease are suppressed.
- It is necessary to conduct a full course of acne treatment, without interruption, even if there is a noticeable improvement. Untreated acne at any time may declare itself a new exacerbation.
Despite the fact that acne in adults is the disease that will accompany you all your life, do not fall into despair. The modern choice of methods and drugs for external and systemic use can significantly alleviate the course of acne, timely prevent its exacerbations, and avoid serious complications and destructive skin changes. Today, acne treatment is carried out at all stages of the development of the disease, allowing to achieve good cosmetic results and prolonged remission.
Endogenous (internal) causes of acne
The following factors are related to endogenous (internal) causes of acne:
- Hormones. Male sex hormones (testosterone and its active metabolites having androgenic activity) can stimulate sebum formation and increase the functional activity of the sebaceous glands. For this reason, acne occurs in 90% of adolescents of both sexes during puberty. Androgens are normally synthesized by both the testicles in young men and the ovaries in girls. Steroid hormones of the adrenal cortex, anabolic steroids and synthetic derivatives of cortisol used in the treatment of inflammatory diseases, dystrophy, allergic and autoimmune diseases have a similar structure and function. Therefore, some medications can also cause acne.
- Cyclic fluctuations in hormone levels. In addition to puberty, other situations are possible, accompanied by changes in the activity of the sex glands. These phenomena include the menstrual cycle and pregnancy in women. In some of them, exacerbation of acne occurs during pregnancy or before the onset of menstruation.
- Endocrine disorders in patients of both sexes. Acne, as a symptom, often accompanies some endocrine diseases (Itsenko-Cushing's disease and syndrome, hyperthyroidism, polycystic ovaries, metabolic disorders, etc.).These pathologies are often accompanied by general changes in the functioning of the endocrine glands, which cannot but lead to an increased risk of acne or an exacerbation of an existing skin problem.
- Dysregulation of the reproduction of skin cells (hyperkeratosis). Normally, skin cells renew and die at the same frequency. Hyperkeratosis is a pathological condition in which the division of skin cells accelerates with a simultaneous violation of the exfoliation of dead keratinocytes. Follicular hyperkeratosis observed with acne affects skin cells deep in the hair follicle. The reason for these changes lies in hereditary, immune and hormonal factors leading to pathological proliferation of keratinocytes deep in the hair follicle. It is still not clear whether primary or secondary hyperkeratosis in the pathogenesis of acne. Some data suggest that this process precedes inflammatory changes and is caused by the release of cytokines by immune cells under the influence of conditional pathogenic skin microflora, congenital changes in the immune system. Other studies have found abnormally high levels of interleukin-1-alpha in already formed comedones. Most likely, there is an excessive proliferation of keratinocytes, supported both by the innate features of the immune system, and arising from the immune response to the colonization of the hair follicle Propionibacterium acnes and other microorganisms. In addition, sebum with impaired physico-chemical properties can increase the permeability of the skin and stimulate an inflammatory reaction.
- Gastrointestinal diseases as a cause of acne. There was a point of view that considered functional and organic pathologies of the digestive system a possible cause of acne. However, this opinion was criticized due to a lack of knowledge about the mechanisms of the relationship between skin inflammation and pathologies of the gastrointestinal tract. Meanwhile, in recent years, it has been discovered that the state of the gastrointestinal tract and intestinal microflora can indeed affect the immune response and inflammation not only in the skin, but throughout the body. The researchers assigned the leading role to the normal intestinal microflora, the status of which affects inflammatory processes. It is proved that a decrease in the number of lactobacilli living in the lumen of the gastrointestinal tract leads to a number of disorders. These include a tendency to obesity, cancer, metabolic disorders, an increase in blood lipids and, which is especially important in the case of acne, inflammatory changes in the body’s immune system. Thus, gastrointestinal diseases can indeed affect the risk of and the severity of acne. Some signs of acne show a connection between eating foods rich in fats and carbohydrates (especially fast food, pastries, chocolate, chips, snacks, baked goods) and the severity of skin rashes. The effectiveness of the diet, bowel cleansing, colon hydrotherapy is not proven by facts. An interesting fact: the inhabitants of Polynesia, for example, isolated from civilization, practically do not suffer from acne. However, when switching from the usual food for them to the menu of an ordinary average resident of most of the civilized world, they often have skin problems.
- Individual skin microflora as a cause of acne. The skin of every person is the "home" for thousands of species of microbes. Some of them can lead to worsening acne symptoms, inflammation and suppuration of the skin with the formation of purulent pustules and cysts. The leading role is given to Propionibacterium acnes, an anaerobic gram-positive bacterium whose vital product is propionic acid. Propionibacterium acnes lives deep in the pores and hair follicles, using sebum as an optimal nutrient medium.Normally, a small amount of nutrients limits the growth of bacteria. However, with increased sebum production, the microbe receives much more substrate suitable for use as food. As a result, the colony grows, the number of bacteria increases, leading to the manifestation of pathogenic properties and inflammation. An important role in this process is played by the microbial vital products, enzymes secreted by them, which have pro-inflammatory properties (trigger inflammation through TLR receptors on the membrane of immune cells). In addition, processing sebum, the bacterium changes its physicochemical properties, which irritates the skin, reduces immunity and increases the permeability of the deep sections of the follicle and sebaceous glands for other conditionally pathogenic microbes (mainly from the staphylococcus family). The inflammation induced by propion bacteria acne exacerbates hyperkeratosis, which, in turn, becomes one of the causes of blockage of the ducts of the sebaceous glands. It is necessary to eliminate this “closed cycle” to normalize the condition of the skin.
- Stress as a cause of acne. Mental stress and stress are a risk factor and can trigger an exacerbation of acne. The reason for this lies in the close connection of the nervous and endocrine systems with the skin. Stress can trigger acne in several ways. Firstly, mental stress activates the synthesis of the substance propionbacteria, a neuropeptide produced by the terminal sections of sensitive nerve fibers in the skin. This substance acts as a pro-inflammatory agent, increasing the severity of inflammation. Secondly, the release of corticotropic hormone and catecholamines into the blood during stress stimulates increased secretion of sebum and provokes the formation of comedones. In addition, the sympathetic part of the autonomic nervous system involved in response to stress also leads to an increase in the function of the sebaceous glands. The severity of acne is directly dependent on the load on the nervous system. This means that the greater the stress, the greater the likelihood of exacerbation of acne.
- Immune system disorders as a cause of acne. In some people, increased production of sebum, accompanied by the formation of black spots, does not lead to suppuration of clogged sebaceous glands and extensive inflammation, while in other patients, acne is not limited to the appearance of comedones and almost immediately turns into an inflammatory form. This is because local or general failure of the immune system can affect the course of acne. Moreover, just one increased production of sebum is not enough to start the disease. It is known that the role of microbes (mainly Propionibacterium acnes) in the pathogenesis of acne plays an important role. Normally, immunity suppresses the reproduction of opportunistic flora. People with congenital abnormalities of the immune system or acquired pathologies accompanied by impaired immune status are more likely to suffer from severe forms of acne. In patients with severe acne, polymorphism of genes encoding inflammatory mediator molecules and enzymes, such as tumor necrosis factor (TNF-alpha, interleukin-1-alpha, a number of cytochrome P450 proteins, steroid hydroxylases, utilizing excess androgens, etc., is often detected). ) As a result, there is a violation of the immune response to the expansion of Propionibacterium acnes, which leads to pathological inflammation. In addition, in such patients, a genetically determined violation of the quality of sebum with a low content of immunoglobulins, essential fatty acids with anti-inflammatory properties, and a high concentration of free fatty acids with pro-inflammatory properties is detected. For this reason, hereditary features of the immune system are also factors that play an important role in the pathogenesis of acne.
How to treat acne correctly -
If you are not able to independently maintain your face skin in good condition - be sure to seek the advice of a dermatologist. The treatment of acne in adults and adolescents is the same, but the exception is women who can use hormonal contraceptives as additional therapy.
How to treat acne - will depend primarily on what kind of inflammatory elements are on the skin of the face. The treatment will be different in situations where there is -
- when there is only acne
- acne only (papules and / or pustules)
- with a mixed form of acne (acne + acne),
- in the presence of nodules and cysts.
Below you can see the list and description of drugs, as well as the scheme (Fig. 14), which shows what needs to be applied with each form of acne.
Duration of treatment -
To achieve any noticeable improvement in the condition of the skin of the face, up to 4 weeks of treatment is necessary. the standard course of treatment is about 6 weeks. However, with persistent acne, treatment can take up to four months (and sometimes longer) to get a good result and get rid of not only acne, but also post-inflammatory skin pigmentation.
Signs and Symptoms of Acne
Mostly acne is accompanied by local symptoms in the form of polymorphic elements on the skin of the face and trunk. The primary elements of acne can be represented by comedones - black dots on the skin that occur when the excretory ducts of the sebaceous glands are blocked, white comedones are closed, papules, pustules, cysts, nodules, and cicatricial changes. The black color of comedones is due to the oxidation of the pigment melanin in contact with air. Clinically, all of these skin pathologies are successive stages of the same process. Comedones are caused by blockage of the sebaceous glands. When an infection is attached, the contents of the gland become purulent, which leads to inflammation and the formation of papules, pustules and cysts, which usually rise above the surface of the skin. In such cases, acne is accompanied by dermatitis, erythema and soreness. Severe inflammation is allowed by sclerotic changes, leading to the appearance of scars and nodes consisting of connective tissue.
Most often, acne is localized on the face, back, chest, and proximal part of the upper limbs, that is, where there are areas of the skin containing a large number of sebaceous glands. In almost 100% of patients, facial skin is affected, in 50% - the skin of the back, in 15% - of the chest and shoulder girdle. The skin is greasy to the touch, has a greasy sheen, which reflects the excess production of sebum. The pores are enlarged, secrete a large amount of fat. The color of the skin is dull, unhealthy, foci of hyperpigmentation are possible.
General or systemic symptoms of acne can occur in patients with severe illness. Possible slight increase in body temperature during the period of exacerbation, subfebrile condition and arthralgia. More often, acne affects the psychological state of the patient. Acne on the face and body often causes discomfort, self-doubt, feelings of inferiority, self-isolation, social discrimination. In adolescence, this is perceived especially sharply, up to clinically pronounced depression and even suicidal thoughts. Studies have shown a significant impact of the presence of acne on quality of life, a decrease which is comparable to serious somatic diseases. The severity of acne does not always correspond to the degree of impact on the psychological state of the patient. Even moderate manifestations of the disease can have a significant impact on the life of the patient.
The development mechanism - 4 factors
Acne is the result of certain disorders in the body. There are 4 factors that cause skin problems:
- Excessive secretion of sebum, followed by a decrease in its bactericidal properties and a change in composition.
- Thickening of the stratum corneum of the skin inside the hair follicles. The result is a protein blockage called keratin. So the body reacts to local irritation.
- Active propagation of propionobacteria acne in connection with the formation of sebum-horn plugs.
- Inflammation as a reaction to the activity of microorganisms.
Acne Treatment (Acne)
Treatment should be comprehensive, when choosing a tactic, you need to consider the anamnesis.
With a mild degree of the disease, external therapy is usually sufficient. Active procedures are prescribed in the clinic, such as mechanical cleanings, chemical peels. As a rule, a course of peelings based on salicylic, pyruvic acid is prescribed; in the middle of the course, mechanical cleaning is performed. Sometimes, at the initial stage of treatment, mechanical cleanings are required quite often. Therefore, the course of chemical peels can also be completed by mechanical cleaning. Be sure to simultaneously prescribed home preparations of pharmacy or professional brands.
When treating moderate acne, systemic therapy is included in the external treatment. The necessary tests are prescribed (clinical blood test, biochemical blood test, general urinalysis), the hormonal status of the patient is examined. Given the results of the tests, antibiotics or oral contraceptives with an antiandrogenic effect are prescribed.
In severe forms, isotretinoin-based preparations (Roaccutane) are used. This drug is used only for severe forms of acne. For women who may potentially become pregnant, it is contraindicated and, as a rule, is prescribed together with contraceptives. The drug has a number of side effects, this applies to changes in laboratory parameters and such manifestations as headaches, dry skin. Therefore, patients with severe acne who are taking isotretinoin-based drugs should be under the strict supervision of a physician.
Post-acne treatment is often more complicated and takes longer than treating acne itself. That is why it is very important to consult a doctor on time when the first symptoms of acne appear.
Apart from the post-acne complex, I would like to single out such a factor as the psychosomatic state of the patient. Often such patients are constrained, clamped. Because of the "spoiled" person they try to lead a closed lifestyle, they develop a lot of complexes and grievances, low mood. That is why the doctor first of all needs to establish close, stable contact with the patient, sometimes parallel work with a psychologist is required. Such patients need to specify each prescribed drug and highlight the real results.
White subcutaneous plugs - closed comedones - are also quite common. Closed comedone is a tubercle on skin of flesh or white color, slightly protruding above the surface of the skin. It can be subtle, it only feels like some unevenness, if you run your hand over the skin. Inflammation and any painful phenomena are not observed.
Million (white eel) is a dense superficial cyst of the sebaceous gland. looking like a little white seed. These are painless, non-inflammatory nodules of a whitish color, 0.5-3 mm in size, containing thick sebum and keratin. Usually observed on the so-called T-zones of the face, as well as on the cheeks, eyelids, less often - on the trunk and genitals.
Papula nodules (papules) - usually called acne - is a more severe case. Papules are dense, sharply defined pimples with a diameter of 1-3 mm, slightly rising above the dermis. They do not have a purulent head. Papules are usually formed from closed comedones. If the papule is formed from an open comedone, a dark cork is visible, the widened mouth of the hair follicle. Can be both inflammatory and non-inflammatory in nature. If inflammation occurs, then scars may remain, so papules must be treated necessarily.It should be said that papules can be a symptom of some serious diseases, such as chickenpox, measles, syphilis, smallpox, anthrax, lichen planus. Therefore, with the appearance of numerous rashes, it is urgent to consult a doctor!
Types of inflammation on the skin
There are several types of skin inflammation:
- Acne is the result of blockage of the sebaceous ducts.
- Acne - inflammation of the sebaceous glands and hair follicles, followed by the formation of black dots and nodules.
- Papules are subcutaneous inflammatory elements. Occur during the accumulation of secretions in comedones, followed by compression of the tissues. As a rule, it comes to the formation of pus. In some cases, resolve to this point.
- Pustules are a rash in the form of small balls with purulent contents.
- Nodules are a type of papule. They have a crimson hue and reach a few centimeters in diameter.
- Cysts are large inflammatory elements with purulent filling. Leave traces in the form of scars, pigmentation, spots and enlarged pores,
- Comedones are plugs in the ducts of the sebaceous glands. They arise due to the accumulation or clogging of the mouths of the hair follicles with sebum. They are whiteheads (closed comedones) and black dots (open comedones).
For effective prevention of acne, it is important to exclude provoking factors:
- active insolation
- extrusion and trauma of inflammatory elements.
A timely visit to a dermatologist or dermatologist-cosmetologist will help to identify the disease in the early stages. The doctor will correct home care, pick up preparations that are suitable specifically for your type and condition of the skin, and if necessary, prescribe mechanical cleanings and chemical peels. Once a year it is necessary to undergo a full medical examination to identify and exclude various diseases. For example, chronic tonsillitis or caries will maintain general immunity at a constantly reduced level, being the foci of chronic infection, and against the background of reduced immunity, propionibacterium acnes will actively multiply.
1. Benzoyl peroxide -
Benzoyl peroxide is a bactericidal agent that kills bacteria that cause inflammation of the hair follicles in the skin. It also has a weak keratolytic effect, i.e. exfoliates dead skin layers. Effective in the following forms of acne -
- in the presence of acne
- with a mixed form of acne (acne with acne).
Appoint only in the presence of acne - impractical!
The agents may have a benzoyl peroxide concentration of 2.5%, 5% or 10%. Clinical studies have shown that higher concentrations do not provide significant benefits. Therefore, we recommend that you use a concentration of 2.5% for the first month, and then switch to 5%.
Benzoyl Peroxide Lotions, Creams and Gels -
Persa-Gel 5, Proderm Cream, Proactive, On-the-Spot ® Acne Treatment (Neutrogena), Mary Kay, Desquam (gel, lotion, soap) are all US products. The French produce - Baziron gel, Eklaran cream ... There is also - Oksigel (India), Benzoyl Peroxide Gel (India), Benzakne gel (Poland) ...
Important : the most effective treatment will still be the appointment of not pure benzoyl peroxide, but its combination with an antibiotic or retinoids -
- "Epiduo" (France), Effezel (France) - contain benzoyl peroxide + Adapalen retinoid,
- “Duac-gel” (Great Britain) - benzoyl peroxide + clindamycin antibiotic.
Application Scheme -
the drug should be used 1 or 2 times a day, 20 minutes after washing the face skin with mild detergents. The drug should be applied only to areas of the skin affected by acne. Most people notice the result after 5 days, but they need a course of treatment of at least 6 weeks in order to cleanse the entire skin of the face and achieve stable remission.
Possible side effects -
- during use, the skin may be dry and tense,
- itching or burning sensation may occur temporarily
- redness and peeling of the skin at the application sites is possible.
Side effects are usually mild and disappear immediately after use. Also keep in mind that benzoyl peroxide makes your skin more sensitive to sunlight, so avoid too much sun and ultraviolet radiation, or wear sunscreen. Avoid getting benzoyl peroxide on clothing and hair, as peroxide has a whitening effect.
2. Salicylic acid -
Salicylic acid helps to dissolve the substrate that the plugs (acne) are made of, and also helps exfoliate surface dead skin cells. Creams, gels, and salicylic acid lotions with concentrations of 0.5% or 2% are available for the treatment of acne. Salicylic acid-based acne preparations come in 0.5% or 2% concentrations. An example is the Clearasil line of products (Klerasil) in the form of lotion, cream and gel.
Keep in mind that salicylic acid is completely ineffective for acne, but it can be used for acne. But keep in mind that even with acne, its effect will be 2 times weaker when compared with retinoids. In most cases, you should not believe what is written about the wonderful properties of salicylic acid for acne on various forums and blogs. Programmers and professional bloggers write all this nonsense - solely to increase the attendance of their projects.
Features of the use of salicylic acid -
If you still decide on this remedy, then be prepared that at the beginning of regular use the skin will be a little red and inflamed for the first time. Skin peeling will also be present. In addition, in people with dark skin, the use of salicylic acid causes the appearance of age spots on the skin.
Inflammatory, non-inflammatory and post-inflammatory forms of acne
Each form of acne has its own distinctive features:
- non-inflammatory - closed comedones, open comedones, nodules,
- inflammatory - follicular papules, pustules, nodes, draining sinuses,
- post-inflammatory - cysts, scars (atrophic, hypertrophic, keloid), spots (vascular, hyperpigmented, hypopigmented).
3. Retinoids -
Retinoid preparations are derivatives of vitamin A. These drugs prevent the appearance of blackheads (comedones), and they also contribute to their removal from the pores. Retinoids for the treatment of acne are available in the form of gels, creams and lotions. Retinoids are prescribed when there is ‹only acne›, as well as with a mixed form of acne - Examples of modern drugs with retinoids -
- with Tretinoin - Retin-A (USA), Irol (Switzerland), Locacid (France),
- with Adapalen - Klenzit (India), Differin (France), Deriva (India),
- with Tazaroten - Zorak (Germany), Tazret-gel (India).
Among monocomponent retinoids, the most effective are in the form of lotions, and creams are the least effective.
Examples of combined agents with retinoids -
there are also agents in which a retinoid is combined with an antibiotic or beoyl peroxide. Such remedies are most effective if you have not just acne, but have purulent acne or a tendency to their appearance -
- "Deriva-S", Klenzit-S - adaptalen + antibiotic clindamycin,
- “Epidouo” (France) - adaptal in combination with benzoyl peroxide?
- "Isotrexin" - contains Isotretinoin retinoid + erythromycin antibiotic.
Application Scheme -
the drug is used 1 time per day in the evening (at bedtime). A good effect will become noticeable after 6-8 weeks, and you will see a lasting improvement after a 3-month course of treatment. Start using the drug 3 times a week, gradually moving to daily use (this is necessary so that the skin gradually gets used to it). Apply to all areas of acne-affected skin about 20 minutes after washing your face with a mild detergent.
Possible side effects -
- mild skin irritation and burning
- not during pregnancy
- increased sensitivity to the sun (use sun protection during periods of high solar activity),
- It is undesirable to undergo chemical peeling procedures against the background of the use of retinoids, because severe skin irritation possible.
4. Azelaic acid -
Azelaic acid has an antibacterial effect, it also exfoliates dead skin layers. It can be prescribed as an independent remedy in the presence of acne only, and as an additional remedy for retinoids or benzoyl peroxide in a mixed form of acne (acne with acne).
Examples of gels or creams with azelaic acid -
→ Skinoren (Germany),
→ Acne-dermis (Poland),
→ Azogel (Russia).
Application Scheme -
usually applied 2 times a day (or 1 time per day, if the skin is especially sensitive). As a rule, you need to use azelaic acid for 1 month before your acne improves. Plus - the drug does not increase the sensitivity of the skin to the sun, which is important in the summer season. Also, the drug avoids the development of post-inflammatory pigmentation after healing of purulent foci. Causes less skin irritation than other drug groups.
At every age, certain types of acne occur. The following classification exists:
- Acne of the newborn in the form of closed comedones. The reason for the appearance is the ingress of maternal sex hormones into the baby's blood. Passes without a trace in a few weeks, subject to hygiene rules.
- Acne infants in the form of papules and inflammatory elements. The reason for the appearance is an excess of plasma testosterone.
- Teenage and youthful acne in the form of papules and pustules with purulent contents. The cause of the appearance is puberty.
- Adult (later) acne occurs in men and women after 30 years. The reason for the appearance is the presence of serious diseases, including hormonal ones.
The degree is determined by the external signs of the disease. The number of comedones and various inflammatory elements is taken into account. Only 4 degrees:
- Easy. Up to 10 eels and comedones.
- Medium. From 10 to 30 comedones and papules with purulent contents.
- Heavy. A large number of comedones, several dozen papules and a small number of pustules.
- Very heavy. The skin is affected by papules and pustules. There are more than 5 nodes. Disturbing pain.
5. Drugs with sulfur -
May be effective in treating acne with an inflammatory component (i.e., for acne). But with acne, using such drugs is pointless. Sulfur-containing preparations can change skin color and, as a rule, have an unpleasant odor. It is best to use a cream or gel containing sulfur, 1 time per day, before bedtime (examples of drugs).
A single treatment with this tool will allow you to use benzoyl peroxide only 1 time per day, which means that bacteria will become less addicted to benzoyl peroxide. We do not see other advantages in preparations with sulfur.
Antibiotics for acne -
Antibiotics for acne are most often used externally (as part of creams and gels), less often in the form of tablet preparations. Gels with antibiotics are prescribed for all forms of acne, except for the form when there is only acne without inflammation. And in no case should you use ointment forms of antibiotics!
- Antibacterial creams and gels -
usually contain antibiotics such as erythromycin and clindamycin. Usually prescribed for acne, with a mixed form of acne (acne with acne). Examples of gels with clindamycin: “Klindovit”, “Dalacin”, “Klindatop”.
There are combined drugs where the antibiotic is combined with drugs of other groups. Such drugs are preferable and stronger, but before using them, you need to consult a dermatologist:
→ “Duac-gel” - contains clindamycin and benzoyl peroxide,
→ “Deriva-S”, “Klenzit-S” - clindamycin and adapalene (retinoid),
→ "Isotrexin gel" - erythromycin and isotretinoin (retinoid).
→ Zinerit is an effective combination drug based on erythromycin and zinc.
- Oral antibiotics -
Antibacterial tablets should be prescribed only by a doctor. Usually they are prescribed only for cystic form of acne. However, oral antibiotics can be prescribed for acne and acne with acne, if the standard local therapy of the latter has not been successful.
Cortisone Injection -
In order to help patients with cystic form of acne, large deep acne - doctors often use injections of steroidal anti-inflammatory drugs, such as cortisone. This quickly and noticeably improves the appearance of such patients, and eliminates the need for surgical intervention. Side effects of this treatment are: thinning of the skin, lightening of the skin, the appearance of small blood vessels (spider veins) on the treated area.
Isotretinoin (analogues - Roaccutane, Aknetin, Aknekutan) is a retinoid for systemic exposure to the body in the form of capsules that must be taken orally. It is used exclusively in people with cystic form of acne. This drug is very effective and is used annually to treat acne in millions of patients around the world, but it has serious contraindications and side effects.
Application Features -
this drug is prescribed for 5-6 months. Blood tests are done monthly to check liver function and triglyceride levels. The drug has many potential serious side effects, which makes it a bad choice for people with mild to moderate forms of acne. However, if the doctor prescribes the drug correctly, given the patient’s history, the drug is safe enough and you are unlikely to be bothered by anything more than dry lips or periodic muscle pain.
Isotretinoin is strictly contraindicated in pregnant women. Women of childbearing age who take isotretinoin need unconditional contraception. It is also necessary to avoid pregnancy within 1 month after discontinuation of therapy, but after this time there is absolutely no risk for you and the unborn baby.
Acne treatment in women -
Oral contraceptives may be used to supplement the main treatment for adolescent girls and women. First of all, this treatment method is recommended for healthy women who also need contraception. Also, hormonal contraceptives are prescribed for those women whose traditional methods of acne treatment (described above) do not give a good result.
In addition to oral contraceptives in women, androgen blockers, for example, Spironolactone, can also be used. Read more about these treatments - here.
Acne - treatment at home
So, we already said that the correct treatment of acne requires at least an initial consultation by a dermatologist, so that the doctor selects the right drugs for you based on your particular type of acne. Using this information, you can well be treated at home. Home acne treatment on the face covers not only the basic therapy, which is described in detail above, but also ...
- Daily skin care -
use only mild detergents that do not cause irritation (e.g. Neutrogena or Dove).
- Local skin treatment -
treatment with preparations with benzoyl peroxide, azelaic acid or gel with an antibiotic is carried out 2 times a day. Skin treatment with local retinoids - only 1 time per day. Everything will depend on what your doctor prescribes: it can be 1 drug or a combination of 2 drugs.
- What forms of drugs are better to use -
remember that for dry skin, the forms of preparations in the form of creams are more suitable, for oily skin - in the form of gels.Lotions are suitable for all skin types (but they still have a small drying effect).
- If you use makeup -
cosmetics and skin care products often lead to clogging of pores and the formation of acne - due to the fact that such funds are created on a fat basis. Use only light moisturizing creams and makeup made exclusively on a water basis!
Procedures for reducing acne scars -
For those patients who have acne gone, but left them with permanent scars on the skin of the face - there are several treatment options. They may include both surgical and conservative procedures. The methods described below are effective against atrophic scars (Fig. 21). Methods to get rid of red spots after acne will be significantly different.
1. Professional and home chemical peels -
With this method, facial skin is treated with acid-containing products. Depending on how significant results need to be achieved, acids of various concentrations are used. Low concentrations allow dissolution of the uppermost surface layer of the skin, consisting of dead skin cells, which minimizes surface scars. And high concentrations of acids can deal with significant scarring skin changes.
Chemical peels can be -
→ professional medium / deep peeling,
→ surface chemical home peels.
The former allow you to smooth out quite deep atrophic scars after acne, the latter will help reduce only small grooves.
Pustula "Pustula" is a small ball, at the very top of which there is a white spot (purulent head). Around the pustule is usually observed painful redness - inflammation. Pustules can cause very severe pain. This defeat of the epidermis occurs not only on the face, but also on different areas of the body. In principle, these rashes are not dangerous, but treatment is required, since pustules are of an infectious nature. And you need antiseptic treatment, and in severe cases, antibiotic treatment.
2. Grinding the skin with abrasives -
There are several methods of abrasive grinding of the skin:
- Microdermatography Method -
in this case, the surface of the skin is treated with a stream of air containing crystals of abrasives. As a result, the most superficial dead skin layer is removed.
- Dermatography Method -
is a more radical method that removes significant scars and scars. Skin grinding occurs here with the help of abrasive disks and brushes, to a much greater depth than with microdermatism.
Knots and cysts
In more serious cases, deep subcutaneous seals are observed - nodes and cysts. Knots are deep subcutaneous seals with a diameter of more than 5 mm in red or cyanotic-crimson color, painful on palpation. After their healing, scars may remain (of various types - atrophic, hypertrophic, keloid). Cysts are nodes that are reborn due to inflammatory processes, usually very painful, have a reddish-cyanotic color.
3. Laser skin resurfacing -
This is one of the most effective methods to help either get rid of the scars completely, or significantly reduce them. Laser exposure will stimulate collagen synthesis and skin renewal. With this pathology, only two types of lasers will be especially effective -
→ fractional lasers (especially Fraxel Restore),
→ CO2 lasers (carbon dioxide).
How long does the result last after treatment?
After you cleanse your face of acne, blackheads and spots - acne may swell again if you completely stopped treatment. To prevent this from happening, remember the need for maintenance therapy. It is needed for everyone, without exception, if you certainly want acne to go away forever.
The duration of therapy in adolescents can reach 4-5 years, until the teenage period ends (there will be an age older than 20 years). In a small number of cases, acne can persist up to 30 years, in which case you will have to regularly use maintenance therapy.
Supportive treatment, as a rule, consists in using topical agents:
- daily facial skin care with mild detergents,
- use of funds with azelaic acid or retinoids.
The frequency of their use as a preventive measure, of course, will be lower than during the treatment of acne. So, for example, a single skin treatment procedure every 2 days should be enough to avoid the return of acne and spots. But using antibiotics for maintenance therapy is unacceptable.
We hope that our article on the topic: Acne treatment - turned out to be useful to you!
Degrees of acne
The clinical forms of acne are divided into non-inflammatory and inflammatory. The non-inflammatory form of acne is open and closed comedones, miliums. Inflammatory forms are superficial papules and pustules, nodes and cysts, as well as deep inductive, conglobate, complicated abscessed, phlegmonous, fulminant, acne-keloid, scarring acne.
The severity of the disease, according to the classification proposed by the American Academy of Dermatology, is evaluated as follows:
- 1st degree - the presence of comedones and single papules,
- 2nd degree - papular rash and a small number of pustules,
- 3rd degree - papules, pustules and from 3 to 5 nodes,
- 4th degree - a pronounced inflammatory reaction in the deep layers of the dermis with the formation of multiple painful nodes and cysts.
However, the following classification of Acne, proposed in 2000 (G Plewig M A Kligman), which is often used and more understandable to patients, is most convenient:
- 1 degree (mild) - less than 10 comedones and papulopustules in a limited area of the skin.
- Grade 2 (moderate, medium) - up to 20 comedones and 25 papulopustules in two or more skin areas.
- Grade 3 (severe) - many comedones (over 21), many papulopustules (over 26), conglobal and inductive elements, a common form and severe psychosocial disturbances.
What diseases should acne be differentiated with when diagnosed? It is important to know that acne can be a symptom of others, sometimes very serious diseases. This is, for example, rosacea pustular. pustular acne syphilis, infiltrative suppurative trichophytosis, acneiform dermatoses. It is also possible such a form of the disease as medical acne, which is a reaction of the body to certain drugs, disappears when they are canceled
Causes of Acne
Acne is almost always the result of a number of causes. However, they can be divided into two large groups - internal (endogenous) and external (exogenous).
Endogenous (internal) causes of acne are associated with disorders or abnormalities in the patient’s body.
Exogenous (external) causes are various external effects on the skin that can cause the appearance of acne.
In each case, the cause may be either individual single factors or a combination of various endogenous and exogenous factors. The exact reason or a set of reasons will help to establish a thorough examination, which we will definitely carry out in our clinic.
Endogenous causes of acne
Among the endogenous causes, first of all, it is worth highlighting the physiological changes that naturally occur in the body and can provoke the appearance of acne. This is primarily a change in hormonal levels:
- in adolescence, when hormones have not yet been established,
- during pregnancy or after an abortion,
- before menstruation.
Some pathologies of internal organs can also be accompanied by acne.So, acne is possible in some diseases: ovarian dysfunction with polycystic disease, diseases of the pituitary and adrenal glands, etc. Rashes are also observed in diseases of the gastrointestinal tract, such as imbalance of the intestinal microflora, gastritis, pancreatitis, hepatitis, disorders of the gall bladder, constipation, leading to intoxication of the body.
In men, with active sports and taking anabolics and sports nutrition to improve muscle relief, various kinds of acne eruptions can sometimes occur.
Very often, acne is a consequence of stress. Even a single stress leads to the release of hormones, which can lead to disorders in the endocrine system, and as a result cause the appearance of acne. Chronic stress leads to a constant increased release of hormones and a decrease in immunity, which opens the way for many infections, including inflammatory forms of acne.
Viral diseases are another cause of skin rashes. Not only the acute phase of herpes, but also the carriage of the herpetic group of viruses reduces immunity, and as a result, the body can not cope with the violation of the microbial flora. Bacteria bloom on the skin, and acne becomes chronic lingering.
Hyperkeratosis is a thickening of the stratum corneum, clogging of pores exacerbates acne.
Areas of rashes and their connection with diseases of internal organs
There is a classification of acne rash zones - the Zakharyin-Ged zone - which, as a geographical map, makes it possible to understand where the malfunction of the body occurred. This classification relates the areas of acne and internal organs of a person.
Zakharyin-Geda zones are limited areas of the skin (zone) in which, with diseases of the internal organs, reflected pains often appear, as well as changes in sensitivity in the form of pain and temperature hyperesthesia.
Exogenous Causes of Acne
Among the exogenous (external) causes of acne, it is first of all worth noting the incorrect and erratic use of various cosmetics, especially tonal products and correctors. It provokes acne and improper daily care, excessive enthusiasm for cosmetic aesthetic procedures. This, for example, cleansing, which can not be done in the presence of inflammatory elements on the skin.
And squeezing something in the area of the nasolabial triangle and nose bridge is generally dangerous - this can lead to inflammation of the meninges and meningitis.
Another provoking factor is excessive insolation. The skin in the sun and in the tanning bed seems to be dried, however, compensatory, this leads to increased sebum secretion, clogged pores and exacerbation of acne. In addition, the sun is a great immunosuppressant.
Excessive skin friction, frequent washing, lotion rubbing, "clean" syndrome - all this also leads to increased acne, because the protective layer of the skin is washed off with "their" microbes, which play a huge role in the epidermal barrier. Microcracks form on the overdried skin - the entrance gate for infection.
Contact with certain chemical compounds intensifies acne.
What types of microorganisms cause inflammation with acne
Inflammatory processes with acne are most often caused by the following types of microorganisms:
- Propionbacterium acnes-gram positive lipophilic bacillus
- Propionbacterium granulosum
- Pyogenic cocci: staphylococcus epidermis is et al. -
- The yeast-like lipophilic fungi of Malassezia.
Hormones for acne and their role
It has long been known that Acne is a hormone-dependent disease, that is, one of the factors in the appearance of acne is hormonal imbalance. Hormones such as testosterone, dehydroepiandrosterone, insulin-like growth factor-1 (IGF-1, somatomedin C) are usually provocative. Their overproduction leads to excessive work of the sebaceous glands and even a change in the composition and quality of sebum.
But not only these hormones cause acne.Imbalance in the hormonal balance of the pituitary gland, cerebral cortex, ovaries, adrenal glands, and thyroid gland can also lead to acne. Therefore, we must remember that in addition to a dermatologist, you need to contact specialist endocrinologists if you find any violations in blood tests.
Acne exacerbation 5-7 days before the onset of menstruation is due to an increase in the level of steroid hormones and a change in the hydration of the follicle epithelium.
The appearance of rashes on the skin may also be after taking or canceling some birth control drugs.
During stress, the adrenal glands produce more androgens, which causes overactive sebaceous glands and a decline in immunity - as a result, acne blooms. Nevertheless, often enough, young girls gynecologists prescribe contraceptives with an absolutely normal hormonal background. It is not reasonable for gynecologists to prescribe external (topical) acne therapy without consulting a dermatologist.
Acne treatment is a complex process
So, we see that acne can also be an independent disease, caused for example by improper care (usually these are mild forms of acne). But much more often, acne is a symptom of disorders in the body. That is why symptomatic treatment with external drugs, even if it leads to temporary improvements, often does not give lasting results, because it does not eliminate the cause of the disease. As a result, acne becomes more severe.
Patients with complex, neglected, severe forms that require serious comprehensive treatment often turn to our clinic. And our methods allow us to defeat the ailment even in difficult cases - of course, with the exact implementation of the recommendations of our experts.
Acne treatment is often not just an acne treatment. This treatment of the whole organism, putting in order and harmony the work of its various organs and systems. And this requires a comprehensive examination and the establishment of all possible causes of the disease, and careful observance of all the recommendations of doctors.
Mixed form - acne and acne
Assign one of the following complexes:
- retinoid and benzene peroxide,
- retinoid and antibiotic
- retinode, benzene peroxide and antibiotic,
- azelaic acid and benzene peroxide,
- azelaic acid and antibiotic.
With a mild effect, an retinoid and an oral antibiotic are additionally prescribed.
Treatment is based on the use of a drug with benzene peroxide. With insufficient effect, other drugs are prescribed:
- gel with antibiotic
- combined drug benzoyl peroxide and antibiotic.
In the absence of the desired result, an oral antibiotic course is additionally prescribed.
Folk remedies for the treatment of acne on the face
Folk methods have proven effective in combating acne. Natural remedies help relieve inflammation and reduce the number of rashes.
Home-made cosmetics are stored in the refrigerator for no more than 30 days. Immediately after cooking, place in a dark container with a tightly screwed lid.
Soothe inflammation, relieve redness and have a drying effect. After use, be sure to moisturize the skin.
Take 2 tbsp. l black clay. Dilute with a decoction of chamomile or calendula to a porridge-like consistency. Apply on face and stand for 10-15 minutes. Repeat 2 times a week.
Take 2 tbsp. l crushed oatmeal flakes. Mix with 1 tbsp. l kefir. Insist for five minutes. Apply to skin and leave for 10 minutes. Repeat 2-3 times a week.
Peel the tomato and mash thoroughly with a fork. Add 1 tsp. soda. Apply to skin and soak for 20-25 minutes. Repeat once a week.
They are used as the main treatment for acne. To put in the morning and in the evening or once a day.
- Take 3 tbsp. l olive oil, 1 tbsp. l shea butter and 2 tsp beeswax. Melt in a water bath.Add 2 capsules of vitamin E and lecithin to the tip of the knife. Mix 1 tbsp. l rose water and 1 tbsp. l aloe juice. Pour into the oil mixture and mix.
- Pour 100 ml. boiling water 2 tsp. dry chamomile leaves and 1 tbsp. l birch buds. Cool. Melt in a water bath 1 tsp. beeswax and 1 tbsp. l olive oil. Add 3 drops of vitamin A, 1 tbsp. l butter and strained broth of herbs. Stand on the stove for a minute, stirring constantly. Remove from heat and cool.
- Mix 1 tbsp. l honey, 1-2 drops of iodine, 1 tsp. Vaseline and 1 tbsp. l castor oil.
They cleanse the skin and help relieve inflammation. They have a tonic effect. To achieve a good result, apply daily in the morning and evening.
- Pour 1 tbsp. l dry wormwood with a glass of boiling water. Insist half an hour. Strain. Add 30 ml. freshly squeezed juice of viburnum and 1 tsp. salt.
- Mix ½ cup of rose water, a quarter cup of still mineral water, 1 tsp. apple cider vinegar, ½ tbsp. l sweet almond oil, 5 drops of tea tree oil, 2 drops of lavender oil. Insist 4 days. Shake before use.
- Take 1 tbsp. l apple cider vinegar, 1 tbsp. l water, 5 drops of essential oil of geranium, palmarosa and tea tree, 1-2 ml. Polysorbate 80. Mix and insist 2 weeks. Shake well before use.
They have a pronounced anti-inflammatory effect.
- Take 1 tsp. St. John's wort, wormwood and hops. Pour 250 ml. boiling water, cover and cool. Strain the broth and add half a glass of vodka and 2 tbsp. l apple cider vinegar. Wipe your face 2 times a day, moving along the massage lines. Rinse off 15 minutes after application.
- Hold the onion over the steam for 5-10 minutes and squeeze the juice. Mix onion juice and calendula in a 1: 1 ratio. Apply to a cotton pad and apply to the skin. Hold for 10 minutes, then rinse. Repeat 3 times a day.
- Mix propolis alcohol tincture and water in a ratio of 1: 1. Wipe your face daily before going to bed.
Pills: hormones or antibiotics?
Appointed by the attending physician after a preliminary examination. It is necessary to correctly determine the type of inflammation, the degree of acne and the form of the disease. Dosage is selected individually.
For the treatment of acne, the following types of tablets are most often prescribed:
- Antibiotics - erythromycin, levomycetin, metronidazole, tetracycline, doxycycline and others.
Each drug has a range of contraindications. For example, pregnancy, the period of breastfeeding, individual intolerance to the components of the composition.
- Hormonal - Jess, Yarina, Jeanine, Diane, Median and others.
They have contraindications such as pregnancy, the period of breastfeeding, individual intolerance, diseases of the gastrointestinal tract, liver, kidneys and others.
- Retinoids. Roaccutane is considered the most popular drug from this group.
The tool has many contraindications and side effects, therefore it is prescribed only after examination. It has such contraindications as children under 12 years of age, pregnancy, pregnancy planning, breastfeeding, hypervitaminosis A, individual intolerance and others.
They are used to treat acne at different stages. The most popular drugs:
- Bepanten is a universal skin treatment.
It helps not only relieve inflammation, but also eliminate irritation, dryness and peeling. Contraindication - hypersensitivity to the components of the composition.
- Boro Plus - cream for the treatment of acne and post-acne.
It accelerates regeneration and has an antiseptic effect. Contraindication - individual intolerance to the components of the composition.
- Levomekol is a treatment for ulcers.
Relieves inflammation and swelling, draws pus to the surface. With prolonged use, addiction occurs. Contraindication - allergy to chloramphenicol, methyluracil, ethylene glycol.
Considered an alternative to creams and ointments.They have a light texture, therefore they are quickly absorbed and do not leave oily skin. Such drugs help in the treatment of acne:
- Effezel is a gel for the treatment of acne at different stages.
It has antibacterial and anti-inflammatory effects. Contraindication - hypersensitivity to any component of the composition.
- Dalacin is a universal gel for the treatment of various types of acne.
It is applied by courses no more than 5 weeks. It is used only as directed by a specialist in the absence of contraindications.
- Metrogil is a gel for the treatment and prevention of rashes.
Often prescribed in combination with other drugs. It has various contraindications. For example, age up to 12 years, pregnancy, lactation and others.
Help speed up the acne treatment process. However, with an overdose, a reverse reaction is possible. The following vitamins are used:
- retinol (A),
- tocopherol (E),
- L-isomer of ascorbic acid (C),
- niacin (nicotinic acid, PP),
- B vitamins
Vary by species. Anti-inflammatory drugs are popular. They have antiseptic and bactericidal properties. Differ in low cost, the minimum number of contraindications and high efficiency. Zinc, sulfuric, heparin and ichthyol ointment has proven itself well.
Antimicrobials are also in demand. Such ointments inhibit the growth of pathogenic bacteria and prevent the spread of infection. Among them, one can distinguish Skinoren, Curiosin, Tsinovit.
These drugs are used exclusively in courses and have contraindications.
Another variety is hormonal ointment. Used only as directed by your doctor. The effect is achieved in a short time, however, getting used to it just as quickly comes with a subsequent decrease in efficiency. Advantan, Sinaflan, Fluorocort are used to treat acne.
Salon treatments for treatment
Modern cosmetology offers a number of procedures for treating problem skin. The most popular are:
- Mesotherapy - injections of therapeutic mesococktails.
The composition is selected individually. Antibacterial and reducing substances are used, as well as vitamins.
- Ozone therapy - ozone injections.
Introduction under the skin of a mixture of gases - ozone and oxygen. It has antimicrobial, self-regulating and healing effect.
- Peeling - removal of the stratum corneum of the skin.
In the struggle for clean skin, chemical, glycolic and multacid peels are used.
- Magnetotherapy - the effect on the body of various magnetic fields.
Promotes resorption of nodules and ulcers. Helps eliminate post-acne and scarring.
- Darsonvalization - the impact of alternating pulsed currents of high voltage and frequency.
It has anti-inflammatory and seboregulatory effects. Promotes narrowing of pores, healing of scars, scars and post-acne.
The dermatologist’s recommendations for acne treatment can be found in the video.
Home Acne Treatment
Care for problem skin at home will be effective subject to the following rules:
- regular skin cleansing in the morning and evening,
- treatment of problem areas with tinctures, ointments, gels and other anti-inflammatory drugs,
- selection of a daily complex, including a cleanser, toner and cream by skin type,
- additional care in the form of masks.
How to deal with acne with diet
Acne is often associated with malnutrition. It is worth revising your diet and include foods that contain:
- fiber - fruits and vegetables,
- proteins - lean meats, fish, poultry, seafood, dairy and sour-milk products,
- Vitamin A - spinach, carrots, cucumbers, black currants, apricots, sorrel, olive oil, beef liver,
- Vitamin E - Pistachios, Almonds, Peanuts, Walnuts,
- vitamin B - buckwheat, wheat groats, legumes, cabbage, cheeses,
- omega acids - fish oil, flax seeds,
- zinc - braised beef, asparagus, liver, bran.
Some foods will have to be excluded from the diet. Otherwise, the diet will not give the desired result.
- fine flour bakery products,
- fast food,
- spicy, salty, spicy,
- fatty food,
- smoked meats
- canned food
- fatty meat and fat
- carbonated drinks,
- strong tea and coffee,
Problem Skin Care Tips
Regular cleansing is the key to clean and healthy skin. However, the procedure should be carried out correctly. During washing, you need to make soft massage movements with pads. It is advisable to pre-foam the cleanser in your hands. Brushes and hard sponges can damage the skin and spread the infection, so they will have to be abandoned.
It is better to wipe the face with disposable paper towels without dyes and fragrances. You can also get a separate towel for your face, if you can change to a clean one every 2-3 days.
After cleansing, try to wipe the face with a cotton pad moistened with tonic. It is advisable to use an anti-inflammatory agent. It should be noted that the cream will be better absorbed if applied to skin that is slightly moist from the tonic. Active components penetrate the deeper layers of the epidermis along with water.
How to get rid of acne on your face
After acne treatment, marks remain on the skin. Among folk methods, parsley broth is popular.
The plant is famous for its whitening properties, so it helps to quickly get rid of post-acne.
You can also try pharmacy products:
- salicylic alcohol,
- hydrogen peroxide,
- Sulfuric ointment.
Any remedies give a temporary effect in the absence of proper care. Recurrence of acne can be avoided if you continue to monitor the skin after completion of therapy. This will help:
- the use of cosmetics by skin type,
- the use of acne-prone skin cream,
- the use of acne masks 1-2 times a week,
- change of pillowcases every 2-3 days,
- the allocation of a separate towel for the face,
- passing routine examinations to monitor health status,
- selection of cosmetics without artificial colors and flavors,
- rejection of caps made of synthetic materials.