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Acne: causes and treatment




Acne is a form of human acne. It is characterized by the manifestation of open or closed comedones, chronic inflammatory processes on the skin, the consequence of which is the formation of lenticular or miliary papules, purulent pustules or inflammatory nodules.

Acne is a common disease. The peak of the development of the disease occurs at puberty, appearing earlier in girls as a result of hyperstimulation of the secretion glands of external secretion with the formation of seborrhea and microcomedo. Further development of the process leads to the formation of open and closed comedones.

The prevalence of the disease among the male and female population is approximately equal. But, in men, the disease is often more long lasting and more severe. By the age of 20, a spontaneous regression of the disease may occur, turning into a chronic, recurring process with changes on the skin — rash, pigment spots, keloid scars.

Causes of Acne

The basis of the genesis of acne are:

  • pathologies of the holocrine glands;
  • skin diseases associated with follicular hyperkeratosis;
  • skin diseases of inflammatory origin;
  • multiple microbial colonization on the skin.

Pathologies that alter the condition of the skin, due to functional disorders in the holocrine glands and alter the cellular composition of the lipid secretion, are a favorable background for the development of acne.

A provoking factor in the development of the disease are:

  • Pathological increase in androgens associated with genetic genesis.
  • The effect of testosterone derivatives on the cellular composition of the secretion, leading to hypersecretion and the formation of hyperkeratosis.
  • Stimulation of microbial growth as a result of increased lipid secretion.
  • Change hormonal levels.
  • Acceptance of hormonal drugs.
  • Changes in hormonal levels at different periods (the period of birth, puberty, the period of breastfeeding).
  • Inflammatory diseases of the reproductive system.
  • Discontinuation or replacement of contraceptive drugs.
  • Androblastomas and adrenal tumors androgen-genesis genesis.
  • Polycystic ovary .
  • Skin irritation as a result of the action of soap, scrub, peeling procedure, which reduce the protective skin barrier.
  • Injuries and stresses.

The level of sensitivity of sebaceous cells to the action of sex hormones depends on which area of ​​the skin acne is damaged - rich in sebaceous ducts or the defeat of a separate area of ​​skin.

How does acne manifest?

In different patients, the combination of etiological factors is individual. The clinical picture of the disease and the response to the treatment process are different for each person. Hypertrophy and hyperactivity of the sebaceous ducts leads to hyperproduction of fatty lipids, causing:

  • Gluing with excess lipid fats, dead flakes of the upper stratum corneum of the epidermis. This makes it difficult to timely clean them from the skin, causing accumulation of fat, germs and dirt in the mouth of the hair follicle. A dark-colored crust is formed, blocking the duct - the formation of an open form of comedones. With a fatty liquid consistency, the dilation of the ducts is negligible, and comedones are small. Thick consistency is the cause of the appearance of large comedones. In the case of a constricted sebaceous duct, accumulation of lipids and horny scales causes dilation of the duct with the formation of prosodiform nodules - closed comedones.
  • In the ducts closed by sebaceous accumulations, all conditions are created for the favorable development of various types of microorganisms. The waste products of the microbial flora cause disturbances in the acid-base balance, which leads to a decrease in the protective functions and enhanced reproduction of microorganisms in the fat deposits. Changes in the composition of free and bound fatty acids in sebum cause severe irritation and provoke symptoms of seborrheic dermatitis.
  • Violation of fat flow causes fat accumulation. The stopper blocks the exit of the fat out. Stretching of the inner walls of the ducts occurs, and microscopic cysts are formed. Under the action of multiple causes - as a result of self-removal of formations, using mechanical or hardware cleansing of the face - cysts break with the release of sebaceous secretion into the surrounding tissues. As a result - inflammatory reactions with the formation of papules (nodules). The accession of the infection provokes the manifestation of pustules (ulcers).
  • A long-lasting inflammatory process, existing acne disease over the years, leads to malnutrition of tissues, contributes to sclerotic skin changes, decrease in tone and its reserve capacity. On the skin, this is reflected in small atrophic scars, uneven pigmentation and deterioration of the texture.

Classification and characteristic signs of acne

Uniform classification of acne does not exist. The clinical classification is due to years of research on the etiological signs, developmental mechanism and individual characteristics of the skin. By combining all these factors an appropriate diagnosis is made and an adequate treatment program is drawn up.

Youth acne

It is characterized by rash:

  • comedones;
  • papulopustular acne;
  • knotty cystic acne;
  • lightning acne, characterized by severe form of flow. It occurs in puberty boys. It is characterized by acute onset, rapid spread of inflammatory foci and ulcerations on the face and body, followed by severe scarring. Symptomatology is manifested by deterioration of the general condition, fever, anemia.

Acne in adults

  • Acne, which is not stopped during puberty, is manifested by late acne . Characterized by the manifestation of the weaker sex in the luteal phase of the menstrual cycle. Symptoms manifested papules and the formation of deep cystic cavities on the chin.
  • The inverse form of acne is a type of chronic pyoderma. Symptomatic due to the appearance in the armpits and folds of the urogenital triangle painful nodular formations in the form of an abscess. Ripening, produce pus and bloody-purulent substrate. During healing, scars of retracted form and fistulas are formed.
  • Steroid acne . The manifestation is due to the intake of various types of steroid hormones. It is characterized by the monomorphism of the eruptions and the absence of comedones. The formation of nodular cystic eruptions is noted on the chest, sometimes on the face. After the cancellation of hormones, there is a rapid deterioration.
  • Acne spherical or piled up is a consequence of the chromosomal abnormality in the male and Stein-Leventhal syndrome in women. Due to the merger of nodular and cystic formations in the characteristic seals with fistulous passages. This form of the disease affects the body and lasts for years without appropriate medical intervention.
  • Pink acne is characteristic of females of all ages. In acute form occurs during pregnancy and in the postpartum period. Large papules, nodular and cystic rashes on brightly hyperemic skin are noted.

Exogenous Acne Disease

A provoking factor in the occurrence of acne is comedogenic substances that contribute to the blockage of sebaceous ducts. They may be contained in medicinal preparations, aerosols or cosmetics for skin care.

Acne, as a result of mechanical stress

This form of acne lesions is a response to prolonged mechanical action on the skin caused by pressure or friction. An analogous form is excoriated acne when attempts are made to remove scanty-sized lesions, or nonexistent at all (under the influence of a neurosis).

Acneiform diseases

This form of the disease is characterized by chronic inflammation of the skin, with the formation of acne, but there is no formation of comedones. This disease includes the manifestation of rosacea and perioral dermatitis.

Classification of the disease according to the severity of the clinical course

  • The first degree of severity is acne, affecting the face partially or completely. Manifested papulapustulami and comedones, with a predominance of open forms of comedones. Perhaps a single manifestation of papulapustul.
  • The second degree is characterized by partial lesion of the skin on the face and body. Manifested by single rashes papulapustul and comedones of both forms.
  • In the third stage of the disease, severe inflammation of the skin is noted with a large number of closed and open comedones and deep-seated papules and pustules. Characteristic scar formation with stagnant spots on the skin.
  • The fourth stage is due to the formation of large blue-purple knotty-cystic conglobate acne with fistulous passages. By permission of education remain atrophic coarse nodes. Diagnosis is determined by the severity of lesions, and not by their prevalence.

Acne Diagnosis and Treatment

Diagnosis of acne in its various manifestations is based on the clinical course of the disease. Does not cause much difficulty. To confirm the diagnosis, histopathological examination and differentiated diagnostics are used, which excludes:

  • pustular stage of rosacea;
  • oily seborrhea;
  • pustular stage of pustular syphilide;
  • demodicosis and folliculitis;
  • tuberous sclerosis and sarcoidosis.

The treatment uses an integrated approach:

  • Antibacterial drugs.
  • Means that promote the regulation of sebaceous secretions - retinoid and antiandrogenic drugs.
  • Immunocorrective and antimicrobial agents.
  • Rubbing with solutions that have a disinfectant and degreasing effect, which include antibiotics.
  • Individually selected vitamin complex.

Physiotherapy sessions:

  • UV irradiation.
  • Electrocoagulation of pustular rashes.
  • Electrophoresis.
  • Cryotherapy.

The duration of the course of treatment is three months, followed by maintenance therapy, which takes the same time.

Acne prevention

Prevention of acne is the timely treatment and daily hygiene of the skin.

Possible complications

  • Extensive suppuration;
  • keloid scars on the skin;
  • no redness and pigmentation of the skin;
  • exacerbation of the disease.

It should be noted that drug treatment, drugs for internal use and drugs of external action should be chosen individually only by a dermatologist.

    | 14 December 2014 | | 1 631 | Uncategorized