The disease of sebaceous glands which is characterized by obstruction and an inflammation of hair follicles is called an acne (acne), or an acne disease. The variety of the causes and clinical displays of an acne, its frequent occurrence at different age, the caused cosmetic problems do this disease urgent for many medical experts. Basic elements at an acne are pustulous and papular eels, comedones, nodal educations and cystous cavities. In effective treatment of an acne the large role is played by an individual and integrated approach.
The disease of sebaceous glands which is characterized by obstruction and an inflammation of hair follicles is called an acne (acne), or an acne disease. The variety of the causes and clinical displays of an acne, its frequent occurrence at different age, the caused cosmetic problems do this disease urgent for many medical experts.
The concept "acne disease" reflects cause and effect dependence of skin manifestations on the general condition of an organism. In developing of an acne the large role is played by infections, violations in the genetic, endocrine and immune device, digestive and psychological frustration.
Acne rash meets practically at any age: from the neonatality period till an old age. Before an acne was considered as especially teenage problem, however within the last decades acne cases at patients of 25-35 years became frequent. The most often found form of an acne are the youthful eels observed at patients of 12-24 years almost in 90% of cases. Acne rash brings many experiences concerning the appearance to people of any gender and age.
Signs, acne symptoms
Vysypny elements at an acne are presented by the closed and open comedones, papular and pustulous eels, nodal and cystous educations. The closed comedones represent not inflammatory nodular formations of white color which do not have an exit to the surface of skin. Further accumulation in a time of a secret of a sebaceous gland, cages of an epithelium, a pigment, dust leads to formation of the open comedones having the black, acting over a surface skin, a top. Typical places of localization of comedones – skin of a forehead and a chin.
Further accession to already available obstruction of a hair follicle of inflammatory process leads to development of papulo-pustulous eels, and in severe forms – cystous cavities, flegmonozny and necrotic acne elements. Papular eels (Latin "papula" - a small knot, a spot) – an eminence, a dense hillock over skin the size to a pea of reddish and cyanotic color. Multiple papules give an uneven look to skin. Papules can be exposed to the return development or further transition to pustula. Pustulous eels (Latin "pustula" - a gnoynichok) – a painful bubble with purulent contents of softer, than a papule, consistences. Small, to 5 mm in the diameter, pustula usually begin to live completely, after large pustul often there are cicatricial defects.
Further development of inflammatory elements of an acne can lead to emergence of knots and cystous cavities. Knots represent the large infiltrates (diameter more than 5 mm) located in a term and hypodermic and fatty cellulose. At the return development knots break up, izjyazvlyatsya and begin to live a hem. Cysts are the band educations filled with pus, crimson and cyanotic color. Healing of cysts also happens to formation of a hem.
Mechanism of development of an acne
The mechanism of developing of an acne is caused by mutual action of 4 factors:
- Excessive increase in secretion of sebaceous glands. Hyper secretion of skin fat leads to decrease in its bactericidal properties and change of a consistence. The secret of sebaceous glands becomes dense, forming traffic jams in channels and blocking them. It is often observed during rough puberty at teenagers and in the last week of a menstrual cycle at women.
- Follicular . Violation of normal process of continuous renewal of cells of hair follicles is the cornerstone of development of a follicular giperkeratoz. The thickening of a superficial horn layer of hair follicles along with grease traffic jams creates an additional obstacle for outflow of a secret of sebaceous glands.
- Reproduction of propionic bacteria of an acne (Propionibacterium acnes). The microorganisms living in a large number on skin of healthy people are under certain conditions capable to cause development of acute inflammatory reactions. Grease and horn traffic jams of hair follicles are the favorable environment for their strengthened reproduction and active activity. The leading role in emergence of an acne belongs to propionic bacteria of an acne.
- Inflammation. Active reproduction of propionic bacteria of an acne leads to response of fabrics and development of an inflammation in them.
Endogenous reasons of an acne
Dysfunction of sebaceous glands – hyper secretion of skin fat is the cornerstone of emergence of acne rash. It occurs under the influence of a number of the internal and external reasons creating favorable circumstances for development of an acne.1. Testosterone and acne.
One of the most common causes of acne rash in the teenage period – hormonal reorganization of an organism. Active emission of steroid hormones, in particular androgens – male sex hormones, both and at young men causes the strengthened secretion of sebaceous glands in girls. Skin fat changes the properties, turning from liquid in dense and viscous.
Features of a hormonal background and skin reactions can be descended. Therefore the probability of emergence of teenage eels at young people whose parents had an acne is much higher, than at their peers with not burdened heredity.2. Premenstrual acnes.
Level of steroid hormones at women fluctuates during a menstrual cycle and increases in its final phase. Emergence of acne rashes approximately one week prior to periods at 70% of women is connected with this circumstance. Even those who do not suffer from an acne often note emergence of single spots on a chin on the eve of monthly.3. "Hormonal" spots.
Emergence of spots and eels in the teenage period is physiologically caused. However, if spots remain at mature age, then it is a serious signal to think of the health. Usually existence of such spots demonstrates violations of production of sex hormones.
Endocrine frustration in activity of adrenal glands or a hypophysis also influence developing of an acne. So, the condition of a giperandrogeniya (excess of male sex hormones – androgens) often is followed by emergence of an acne. Therefore for the adults having an acne disease not only visit of the cosmetologist or dermatologist, but also a number of laboratory researches, consultations of the endocrinologist and the gynecologist is obligatory (for women).
4. Giperkeratoz. The thickening of a superficial horn layer of skin – – can develop under the influence of a number of factors: hormonal background, deficiency of vitamin A, impact on skin of harmful chemicals (for example, lubricant oils) or mechanical factors (friction, pressure). Reinforced horn scales along with the changed skin fat clog up pores, being the favorable environment for development of microbic process.
5. Digestive tract diseases. Many researchers put emergence of an acne into direct dependence on character of food and condition of digestive tract of the patient. Really, prevalence in a diet of carbohydrate food and deficiency of irreplaceable amino acids and useful fats is led to hyperfunction of sebaceous glands. In certain cases correction of food allows to normalize secretion of skin fat and to get rid of an acne.
According to medical statistics, at more than 50% of people of an acne arises against the background of already available gastritis and dysbacteriosis, at 30% - against the background of pathological conditions of intestines. Places of localization of rashes depend on defeat of this or that department of a digestive tract. Rashes in a nose bridge, cheeks, corners of a mouth can indicate changes in a pancreas, in temporal area – a gall bladder, over an upper lip – thick, and on a forehead – a small intestine. Therefore the condition of a digestive tract plays an important role in maintenance of health of skin. The normal intestinal microflora for 70% providing immunity of the person interferes with formation of new spots and provides healing of already available.
6. Individual microflora of skin. In skin and mouths of sebaceous glands of the healthy person there live propionbakteriya of acne and granulosum, epidermalny , pincers, mushrooms etc. Under normal conditions they do not cause any problems, however violation of balance in an organism (a giperandrogeniye, spots or an acne) leads to their active reproduction and inflammatory processes in skin.
7. Stress. Directly stress does not cause formation of eels, however its influence on the hormonal and immune status of an organism is capable to aggravate display of an acne, causing new acne rashes and weakening protective mechanisms.
8. Violations of immune system. Easing of immunity can be caused by a variety of reasons: stresses, diseases of a gastrointestinal tract etc., but the consequence decrease in resilience of an organism to various adverse effects always has. Against the background of decrease in protective mechanisms of skin even usually "neutral" microorganisms are capable to do considerable harm.
Exogenous reasons of an acne
- Cosmetics (komedogenny cosmetics as causes of eels). The so-called, komedogenny cosmetics i.e. which is clogging up pores and promoting emergence of spots can serve as "provoker" of developing of an acne and: creams, powder, lotions, blush etc. Oils (corn, coconut, mineral, peach, almond, soy), lanolin, vaseline, oleic acid, sulfur, , sorbitanoleate, sodium laurylsulphate, a myristyllactate, etc. belong to substances-komedogenam. Masking of spots by means of cosmetics even more aggravates the course of an acne. Therefore upon purchase of care products and decorative cosmetics it is necessary to choose production with an inscription: "not komedogenno" (non comedogenic).
- Heat and humid climate. To aggravate the course of an acne or high humidity and hot climate can cause its emergence. Rashes are more often localized on a breast, a neck, a back – those zones which are most irritated then.
- Sun and ultraviolet. Ultraviolet in moderate doses dries and disinfects spots, and solar suntan levels skin color, masking, thereby, acne elements of an acne. However, the surplus of ultraviolet renders absolutely opposite effect. Strengthening of secretion of skin fat and an additional siccation of a horn layer conduct to an exacerbation of an acne and increase in number of spots. This mechanism works also at suntan at the open beach, and in a sunbed.
- Professional engagement with toxic substances. Professional activity of many people is connected with direct contacts with the household and production chemicals (for example, oil products, lubricant oils, chlorine etc.) causing emergence of an acne through development of a giperkeratoz of skin and hair follicles.
- Expression of spots. Attempts to squeeze out spots and by that independently to get rid of them can result in opposite result. At expression of spots the infection gets into deeper layers of skin, obsemenyat not inflamed elements, leading to their infection and suppuration. Expression of spots in a face of a nasolabial triangle since danger of a drift of an infection with blood current in brain covers is big is especially dangerous. Face peel by means of a srub in the period of inflammatory rashes on skin has to be excluded. Effective and safe treatment of an acne can be carried out only at the specialist dermatocosmetologist.
- Continuous friction and mechanical pressure upon skin (when carrying he, hard collars, etc. clothes) causes emergence of an acne in these zones.
- Medicamentous acne. In treatment of many diseases of internals the steroid hormones causing emergence medicamentous an acne are applied today. Such form of an acne differs in the sudden appearance of eels coinciding on time with the beginning of reception of corticosteroids. Emergence of an acne is observed also at the women stopping accepting contraceptive pills.
- Excessive cleanliness. Excessive cleanliness as it is not paradoxical, can also provoke emergence of an acne. Frequent washing dries up face skin, lowers its protective properties and aggravates displays of an acne. At the same time, washing of hands has to be regular to exclude an infection rating from an inflammation source on all surface of skin.
Stages of development of an acne
Development of an acne is the cornerstone the violations in work of sebaceous glands leading to formation of grease and horn traffic jams in their channels. On a surface of traffic jams (comedones) pathogenic bacteria begin to breed actively, causing irritation and a purulent inflammation of surrounding fabrics. Acne rashes are mainly localized in a chin, a nose, a forehead, a back and a breast - zones, the greatest congestion of sebaceous glands. Elements of an acne can carry not inflammatory (comedones) or inflammatory (papules, pustula) character.
Depending on weight of a course of an acne allocate 4 stages of process.
- 1 stage. Easy form of display of an acne. It is characterized by existence on skin of the closed and open comedones without inflammation signs, single papules. Treatment of an acne at this stage does not represent difficulties.
- 2 stage. Moderate display of an acne. Acne elements on skin are presented by a large number of the closed and open comedones, spots (10-20 papules) with inflammation signs. The forecast of treatment at this stage long (6-8 weeks), but favorable.
- 3 stage. Severe form of display of an acne. The same signs, as at the second stage are noted, but the quantity of inflammatory elements on skin increases up to 20-40 pieces. Purpose of specialized therapy is required.
- 4 stage. Extremely severe form of display of an acne. It is characterized by a large number of papules, , knots (more than 40 elements). Demands serious specialized treatment.
Treatment of an acne
- Prevention of developing of new comedones. Includes the correct care of problem skin and actions for the general improvement of an organism.
- Removal of already available comedones. It is carried out by means of komedolitichesky medicines and komedo-extractors in house conditions or in beauty shops.
- Reduction of release of skin fat. Achievement of notable clinical effect is possible at decrease in secretion by 30 and more percent. Medicines of group of retinoid, hormones – estrogen, anti-androgens are applied.
- Removal of inflammatory process and prevention of its distribution. It is reached by use of antibacterial medicines outwardly and inside.
- Reduction of cosmetic shortcomings of scarring. It is made by method of a dermabraziya, laser therapy, cryotherapy.
- Passing of a course of procedures in beauty shop plus active home care by the recommended medicines.
- The combined treatment by external means the medicines of system influence (having effect on all organism).
- Use of the medicines influencing all chain of the mechanism of development of an acne (hyper secretion of skin fat, the raised orogoveniye of hair follicles, reproduction of microbes, an inflammation).
- Existence of chronic processes in an organism (gynecologic, endocrine, gastrointestinal diseases, the centers of a chronic infection) can interfere with the carried-out treatment of an acne and reduce its efficiency. Therefore in parallel with treatment of an acne it is necessary to carry out treatment of the accompanying pathology.
At treatment of an acne apply a large amount of medicines of external action now.
Medicines of external action in treatment of an acne
Benzoilperoksid has the strong keratolitichesky and bleaching effect thanks to what over 20 years it is applied in dermatology to treatment of ikhtioz and pigmentation of skin. The horny fabrics and the expressed antibacterial action allow to use its dissolve property and for treatment of easy and average degree of an acne. The combination of a benzoilperoksid to antibiotics, azolny connections, sulfur medicines as a part of the combined medicines considerably increases efficiency of its application.
Azelainovy acid renders the expressed antikomedogenny, antibacterial and anti-inflammatory action, however does not influence production of skin fat in any way.
Tretinoin is a synthetic retinoid, a vitamin A analog. It is applied at treatment of an acne outwardly at inefficiency or individual intolerance of a benzoilperoksid. Eliminates the available comedones, and interferes with emergence of processes of an orogoveniye of an epithelium and reduction of secretion of skin fat, new at the expense of normalization.
Benzoilperoksid, azelainovy acid and are medicines of the first row in treatment of an acne. They are effective at prolonged use (of the 3rd and more months). Sometimes their use causes irritation of skin that, as a rule, is eliminated with reduction of frequency of drawing by skin or decrease in concentration. At treatment of an acne these medicines unacceptably simultaneous application of two and more means, and also differences of temperatures and active insolation.
Antibiotics of external application. In treatment of an acne resort to external use of antibiotics in cases of lack of effect of treatment by medicines of the first row or the combined therapy at treatment of the complicated disease forms. Antibiotics it is necessary to refer development of effect of accustoming and tolerance of propionic bacteria to shortcomings of treatment of an acne.
Erythromycin is considered one of the most effective antibiotics concerning an acne. High antibacterial and anti-inflammatory activity of erythromycin is even more expressed in its combination with zinc. Zinc, in turn, reduces secretion of sebaceous glands and loosens a time, facilitating local effect of erythromycin.
Klindamitsin does not cause accustoming of skin microflora and is highly active concerning propionibakteriya and stafilokokk.
System antibiotics are applied inside in combination with local therapy at moderate degree of a course of an acne. From antibiotics of tetracycline group apply minocycline or doxycycline thanks to their high antimicrobic activity, bystry absorption and intensive accumulation in sebaceous glands more often. Less often in treatment of an acne erythromycin and medicines of sulfanylamide group are used .
Treatment of an acne by means of system antibiotics assumes their long (not less than a month) reception. During this period steady accustoming of microflora of skin can develop intestines and a vagina. As other complications from reception of antibiotics serve ulcer damages of a gullet, stomach ulcer, a softening of nail plates (), emergence of a hyperpegmentation on skin and nails etc.
It is necessary to consider interaction of antibiotics with other medicines their effect was not blocked. At not expressiveness or a long absence of effect of treatment by antibiotics it is necessary to consider a question of change of medicine or purpose of medicines-retinoidov.
Anti-androgens. In treatment of an acne at women the combination of external treatment and reception of the hormonal contraceptives containing anti-androgens or an estrogenic profile is possible. Severe forms of an acne demand combined (external and the general) treatment.
Lack of clinical effect of the carried-out treatment is more than 3 months one of indications to Izotretinoin's appointment, a synthetic analog of vitamin A. Advantage of this medicine is its impact on all mechanisms of developing of an acne (increase in secretion of skin fat, follicular, reproduction of microorganisms, an inflammation). The course of treatment izotretinoiny makes from 4 months to one year.
Hardware methods of treatment of an acne belong to additional and are applicable only at a stage of comedones. Massage and face peel, superficial cryotherapy, laser therapy, a darsonvalization, etc. concern to them.
Surgical manipulations have no broad application in treatment of an acne since leads to formation of rough hems. In treatment of abstsediruyushchy forms of an acne perhaps obkalyvany the purulent centers kortikosteroidny medicines.
From experience of complex treatment of an acne
As practice shows, the best result is yielded by an integrated approach in treatment of an acne. As earlier it was already noted that doctors of many specialties are called to solve a problem of an acne in the commonwealth, observed patients with an acne disease needed to undergo comprehensive examination at the dermatologist, the gastroenterologist, the endocrinologist, the gynecologist. The choice of methods and duration of a course of treatment was defined by degree of expressiveness and weight of course of an acne with individual characteristics.
The course of treatment of an acne averaged 7-8 months. At the first stage it included external treatment by azelainovy acid and gel with metronidazole, and also doxycycline reception. Cryomassage and a darsonvalization were in addition appointed. In a month the course carried out a chemical peeling with fruit acids in gradually increasing doses. Correction of the revealed violations in endocrine, sexual, digestive systems was in parallel conducted. In a month intermediate assessment of efficiency of treatment of an acne showed a stable tendency to improvement: disappearance of pustulous rashes was noted in 89%, reduction of quantity of comedones – at 71,2% of patients, process of a salootdeleniye decreased. Further permanent remission was observed.
Forecast of treatment of an acne
When forecasting the remote results of an acne it is necessary to consider the next moments:
- The acne is a chronic, disease hard to cure since hereditary predisposition or provocative factors can cause a new aggravation, even in case the disease did not renew within several years. However, knowing the reasons provoking a new wave of acne rashes it is possible to control accurately and to quickly remove exacerbations of an acne, not to allow development of rough cicatricial changes of skin (post-acne) and formation of resistant cosmetology defects.
- If the disease already arose, then changes in skin have irreversible character, and it will be impossible to achieve its former perfect condition.
- The full-fledged course of treatment of an acne is the long process taking 4 months and more.
- Treatment of an acne can proceed with process aggravations, especially in the first months when there is a suppression of mechanisms of development of a disease.
- Carrying out a full course of treatment of an acne, without breaks is necessary even if there occurred noticeable improvement. Undertreated the acne at any time can declare itself a new aggravation.
In spite of the fact that the acne of adults is that disease which will accompany you all life, you should not fall into despair. The modern choice of techniques and medicines of external and system application allow to facilitate considerably the course of an acne, to carry out timely prevention of its aggravations, to avoid serious complications and destructive changes of skin. Today treatment of an acne is carried out at all stages of development of a disease, allowing to achieve good cosmetic results and long remission.