Eels represent private display of an acne disease - skin vysypny elements, and do not reflect all completeness of a clinical picture of a disease. The concept "acne disease" includes different types of acne rashes at youthful age, eels of adults, and also group of a dermatosis with akneiformny rashes (pink eels, a rozatsea, melkouzelkovy persons, perioralny dermatitis, skin tuberculosis). Depending on type of eels and the course of an acne disease the method of its treatment is defined.
In medical literature the acne disease is often called just by "eels" or "vulgar eels". However these terms are not equivalent. Eels represent private display of an acne disease - skin vysypny elements, and do not reflect all completeness of a clinical picture of a disease. The acne disease which is characterized by an inflammation of sebaceous glands develops in force of various reasons and has the characteristics depending on age of the patient and pathogenetic mechanisms of its emergence. The concept "acne disease" includes different types of acne rashes at youthful age, eels of adults, and also group of a dermatosis with akneiformny rashes (pink eels, a rozatsea, melkouzelkovy persons, perioralny dermatitis, skin tuberculosis). Depending on type of eels and the course of an acne disease the method of its treatment is defined.
Both vulgar eels, and acne disease are manifestation of chronic inflammatory process of sebaceous glands of the person, breast and back as a result of which comedones are formed. The disease is caused by grampolozhitelny sticks of Propionibacterium acnes. Appearance of eels – quite widespread phenomenon: aged from 12 up to 24 years it occurs at 60-80% of people. Therapeutic treatment of an acne disease is required from a third of patients. Relevance of treatment of eels is defined by their influence on a psycho-emotional condition of the patient. Eels cause psychological discomfort and experiences concerning esthetic problems of appearance. Patients with displays of acne rash suffer from appeal loss, they reduce a self-assessment, they badly adapt in society, feel alarm and a depression. Making decision on treatment of eels is dictated by elimination of psychological problems, in particular to dysmorphophobia (fear, idea of far-fetched ugliness of appearance) and aspiration to free socialization in society.
Development of an acne disease
In emergence of eels genetic predisposition has important value. Development of an acne disease happens under the influence of the certain factors allowing to track the mechanism of emergence of eels, development and course of an acne disease.
Excessive release of skin fat
Excessive release of skin fat serves one of displays of seborrhea. At seborrhea the secret allocated by sebaceous glands is characterized by decrease in bactericidal properties that causes active reproduction of bacteria and creation of prerequisites for an inflammation of skin and emergence of eels.
Appearance of black and dot eels represents a serious esthetic problem for patients with an acne disease. Appearance of eels is followed by the raised orogoveniye of epitelialny cages in funnels of hair follicles in which output channels of a sebaceous gland (a follicular giperkeratoz) open. Usually this process proceeds at moderate speed, so, that horn scales manage to slushchivatsya in the mouth of a follicle and together with skin fat are allocated outside. Giperkeratoz interferes with normal outflow of a secret of sebaceous glands and conducts to its congestion in a follicle. The congestion of dead cages and skin fat leads to obstruction of a time and causes emergence of black points – the microcomedones which are clinically not proving. In process of further accumulation of skin fat and pressure upon the corked follicle there is its cystous expansion that is clinically shown in the form of the closed comedones (not inflamed dense small knots). Further development of process causes atrophic changes in a sebaceous gland and expansion of a time. So there are black and dot eels or open comedones. At the same time skin fat has dense structure, is badly removed outside because of a big congestion of horn scales. Black coloring of the secret seen from an expanded time is caused by the maintenance of a melanin pigment in it.
Reproduction of microorganisms
Skin and hair follicles of the person are populated with a set of saprofitny and opportunistic microorganisms (epidermalny staphylococcus, mikobakteriya, klostridiya, pincers , etc.). At obstruction of a time and a congestion of skin fat favorable conditions for their reproduction in hair follicles are created.
A special role in development of inflammatory process at an acne disease is played by Propionibacterium acnes (a propionic bacterium of an acne). Its reproduction in a follicle and release of waste products render irritant action on fabrics and cause local inflammatory reaction. Inflammatory process can arise at any stage of an acne disease, mention superficial or deep layers of skin, than and the variety of forms and clinical displays of a disease speaks.
Classification of an acne disease
The existing classifications of acne rash are based, as a rule, on clinical manifestations of eels or on degree of their expressiveness. The fullest classification of eels was offered in 1994 by scientific G. Plevig and A. Kligman (Plewig, Kligman).
1. Eels of children's age (childhood acne).
- Eels of newborns (acne neonatorum).
- Eels of children (acne infantum).
2. Youthful eels (acne juveniles).
- Comedones (acne comedonica).
- Uzlovatokistozny eels (acne nodulocystica).
- Lightning eels (acne fulminans).
- Papulopustulezny eels (acne papulopustulosa).
3. Eels of adults (acne adultorum).
- Late eels (acne tarda).
- The spherical or heated-up eels (acne conglobata).
- Inverse eels (acne inversa, hidradenitis suppurativa).
- Pyoderma faciale.
- Bodybuilding acne.
4. The eels called by mechanical factors (acne mechanica).
5. Eels exogenous (acne venenata, cosmetic acne, contact acne).
Eels of children's age (childhood acne)
Eels of newborns (acne neonatorum)
Appearance of eels in newborns is a boundary physiological condition of this period and results from sexual (hormonal) crisis. Also treat its manifestations a nagrubaniye of chest glands, to the gidrotsela, physiological vulvovaginit. These states are caused by effect of the maternal hormones received by a fruit in the pre-natal period. Acne rashes of newborns are the closed comedones located on a nose, cheeks, a chin and on a forehead in the form of dot white or yellowish papules. As a rule, they pass independently into nothingness within 1,5-2 weeks.
Eels of children (acne infantum)
At children eels can appear at the age of 3-6 months and cause long, severe forms of an acne disease. Their development can be connected with dangerous congenital pathology (a giperplaziya or a tumor of adrenal glands) and demands careful inspection of the child.
Youthful eels (acne juveniles)
Youthful or vulgar eels (acne juveniles) – occur at a third of teenagers aged from 12 up to 16 years. Statistically, girls have acne rash more often than boys. In 75% of cases youthful eels are localized on a face, in 16% - on a face and a back. At the vast majority of teenagers acne rash disappears by 18-20 years. However, sometimes the acne disease proceeds is long and occurs at 3% of men and 5% of women at the age of 40-50 and even 60 years ("physiological an acne"). This version belongs to manifestations of eels of adults (acne adultorum).
Comedones (acne comedonica)
Comedones (acne comedonica) brazutsya as a result of obstruction of hair follicles by a congestion of horn scales and skin fat. Poorly expressed comedones in the absence of an inflammatory component are considered as option of physiological norm. As initial display of an acne disease serve the microcomedones which are not proving clinically in any way. At the following stage the closed comedones, that is the white dense not inflamed small knots with a diameter about 2 mm covered with skin and which do not have an open exit to a surface are formed. The inflammation in them is not expressed, but there are favorable conditions for its further development. The further congestion in them skin fat leads to increase in small knots and transformation of the closed comedones in opened (black comedones or black and dot eels).
Uzlovatokistozny eels (acne nodulocystica)
Formation of purulent cystous cavities and infiltrates deeply in a term, their tendency to merge and formation of inflammatory conglomerates is characteristic of an uzlovatokistozny form of eels (acne nodulocystica). At the return development such elements always begin to live with formation of hems. This form of eels usually proceeds is long (till several years), even at medium-weight extent of process.
Lightning eels (acne fulminans)
The most rare on emergence and the heaviest form of an acne disease on clinical manifestations are lightning eels (acne fulminans). Develops usually at teenagers of 13-18 years having the papulopustulezny or uzlovatokistozny form of eels. The sudden, sharp beginning, emergence on a trunk of ulcer and necrotic sites, increase of symptoms of intoxication is characteristic of a lightning form. The lightning form of an acne disease is close on the current to a gangrenous form of a piodermiya.
The reasons of development of a lightning form are not up to the end studied. Possibly, a part is played here by toksiko-allergic and infectious and allergic mechanisms. Usually, acne fulminans develops at the patients suffering from severe damages of digestive organs (ulcer colitis, a disease Krone, etc.), or after reception of some drugs: tetratsiklin, androgens, synthetic retinoid.
Development of a disease prompt. To the forefront there are general symptoms and the phenomena of intoxication: rise in body temperature over 38 °C, joint and muscles pain, in a stomach, anorexia, sharp deterioration in health. Sometimes changes in bodies and fabrics develop: softening of bones, increase in a liver and spleen. In blood – the increased maintenance of leukocytes, decrease in level of hemoglobin and acceleration of SOE, blood – negative. On skin of a trunk and the top extremities sites of an eritema with pustula, and then and sores are formed. On a face of a rash are absent. Subsequently on the place of rashes numerous hems including keloidny are formed.
Papulopustulezny eels (acne papulopustulosa)
Accession to the closed or open comedones of inflammatory process is characteristic of papulopustulezny eels (acne papulopustulosa). This form of acne rash is characterized by formation of inflammatory elements - papules (small knots) and (gnoynichok). The outcome of papulopustulezny eels depends on depth of defeat of layers of skin. The easy form usually begins to live completely, when involving in inflammatory process of deep layers terms and damage of its structure inflammatory elements begin to live with formation of cicatricial defect.
Comedones and papulopustulezny eels – the most often found forms of eels. Other kinds of acne rash in clinical practice meet rather seldom, are characterized by heavier current and demand other tactics of treatment.
Eels of adults (acne adultorum)
If eels remain before achievement of mature age by the patient or appear for the first time at adults, then carry them to manifestations of acne adultorum or eels of adults. They occur at 3-5% of men and women aged from 40 up to 50 years and are more senior. In some cases their late renewal later after permission of youthful eels is noted years.
Late eels (acne tarda)
This form of eels is more often observed at women and demands additional consultation of the gynecologist. To 20% of cases adult women complain of developing of rashes some days before the beginning of periods and independent disappearance of eels from the beginning of a new cycle. Quite often late eels are present constantly. Usually it is papular, papulopustulezny or knotty and cystous acne elements. Often serves as the reason of late eels ovaries, complicated by a girsutizm and an anovulyatorny menstrual cycle. It is also necessary to exclude tumoral damages of ovaries and adrenal glands.
The spherical or heated-up eels (acne conglobata)
One of the heaviest displays of an acne disease – the spherical (heated-up) eels – occurs at men against the background of dense seborrhea. Spherical eels are shown by the multiple uzlovatokistozny elements and large comedones located not only on sites of seborrhea, but also on skin of extremities, a stomach and a back. Their healing happens to formation of keloidny, hypertrophic and atrophic hems. Spherical eels arise at youthful age and remain, as a rule, up to 40 and more years.
Inverse eels (acne inversa, hidradenitis suppurativa)
The clinic of inverse eels is connected with secondary involvement in inflammatory process of apokrinny or big sweat glands of axillary hollows, area of a crotch, a pubis, a navel, etc. The increased body weight, traumatizing the corresponding zones of a raschesama or close clothes contribute to their development. The disease is characterized by formation of hilly painful infiltrates with purulent or bloody and purulent separated. Separate elements, merging, lead to increase in the area of defeat. Heal it is long with formation of fistulas and hems. Inverse eels have a chronic current with a frequent recurrence.
Piodermit face skin (Pyoderma faciale)
Many researchers carry piodermit to manifestation of a rozatse, but not an acne disease. From Piodermit of face skin young women of 20-40 years suffer more often. The disease begins emergence on a face of a resistant eritema against the background of which the papulopustulezny rashes and knots merging then promptly develop in purulent conglomerates. Inflammatory elements are localized only on a face, at the same time there are no comedones and the general symptomatology. Healing of elements happens slowly, within a year and more.
Bodybuilding of an acne (Bodybuilding acne)
Emergence bodybuilding of an acne is connected with reception of androgens or anabolic steroids. Developing thereof the giperandrogeniya causes strengthening of secretion of skin fat. The similar effect results also from long reception of glucocorticoids. Reception of anabolic steroids is often combined with the vitamin cocktails including vitamins of group B and causing appearance of uzlovatokistozny eels. At this form of eels at patients it is necessary to exclude endocrine frustration.
The eels called by mechanical factors (acne mechanica)
Emergence of this type of eels is connected with mechanical obstruction of channels of follicles as a result of pressure or friction (carrying a close headdress, plaster, at the expressed perspiration etc.).
The eels called by the exogenous reasons
Toxic acnes, professional acnes (Acne venenata)
Arise at contact of the person with the chemicals and structures leading to obstruction of a time and emergence of eels (tar, lubricant oils, chlorine, etc.).
Cosmetic acnes (Acne cosmetica)
Appear as a result of excessive or misuse of cosmetics (is more often than face creams).
Acne from detergents (Acne detergicans)
Develop from frequent use of the detergents leading to formation of comedones.
Solar acnes (Acne aestivalis, acne Majorca)
The acne rashes which are shown or becoming aggravated in roast and a humid climate.
Rashes at which there are no comedones are called akneiformny. The big group of a dermatosis treats them: rozatsea, pink eels, perioralny dermatitis, skin tuberculosis, persons, medicinal rash. For akneiformny rashes the inflammation of a grease and hair follicle is primary. At diagnostics they should be distinguished from acne rash.
Treatment of eels
Treatment of an acne disease diet
There are no scientifically based proofs of direct dependence of emergence of eels on character of food of the patient today. Nevertheless, many of them note aggravation of an acne disease at consumption of a citrus, chocolate, coffee, pork, red wine, cheeses.
The conducted researches showed that the qualitative structure of a secret of sebaceous glands does not depend on character of food of the patient. Also dependence of weight of course of an acne disease on the general caloric content of food, amount in it of fats, carbohydrates, proteins, mineral connections and vitamins is not established. Therefore it is impossible to speak unambiguously about treatment of eels by means of a dietotherapy. The matter is resolved by doctors in each case individually. The general recommendations about character of food of patients with an acne disease are submitted on decrease in body weight and restriction of the drinks and foodstuff stimulating secretion of sebaceous glands.
Treatment of eels of Ural federal district
Part of patients with an acne disease connect reduction of manifestation of eels with insolation. Really, ultra-violet radiation stimulates peeling of the horny epithelium and immune processes in skin.
But, on the other hand, ultraviolet promotes oxidation of components of skin fat, increasing, thereby, their komedogenny properties. In high doses ultraviolet leads to decrease in local immunity of skin and burdening of an acne disease. Therefore at purpose of procedures of Ural federal district it is necessary to consider the nature of clinical manifestations, degree of expressiveness of eels and an individual course of disease.
External therapy of eels
Application of external means is practically always used in complex treatment of eels. Their pharmacological action is directed to suppression of mechanisms of development of an acne disease: excessive release of skin fat, giperkeratoz, reproduction of microorganisms, development of inflammatory process.
Grease with external means from eels all site of the affected skin (a face, a breast, a back), but not separate elements of acne rash. The combination of medicines, but not their simultaneous drawing is admissible. Treatment is carried out within several months before disappearance of eels. Further the supporting course with less frequent use of external medicines is required. For external application at an acne disease the following medicines are used: synthetic retinoida, derivatives of azelainovy acid, and antibiotics. However all of them have poorly expressed action on hyper secretion of skin fat.
Treatment of eels of a retinoidama
Retinoida are synthetic analogs of Retinolum (vitamin A). Release forms – solutions, creams and gels. As indications to application of retinoid serves the easy degree of an acne disease which is followed by the increased release of skin fat and also intolerance of a benzoilperoksid. Medicines with Retinolum dissolve comedones, normalize processes of an orogoveniye of hair follicles, have antibacterial effect and reduce secretion of skin fat a little.
Treatment of eels azelainovy acid
Azelainovy acid is a part of gels and external application creams. The medical effect of azelainovy acid is connected with normalization of processes of an orogoveniye of walls of hair follicles, suppression of the strengthened reproduction of microbes and development of an inflammation in a sebaceous gland. Is suitable for application by patients with comedones or a medium-weight form of papulopustulezny eels, and also in cases of inefficiency or bad shipping of a benzoilperoksid and retinoid. Noticeable improvement usually occurs in a month, and most expressed effect is reached in 2-3 months.
Treatment of eels benzoilperoksidy
Benzoilperoksid – the active component which is a part of many external medicines is applied in dermatological practice over 20 years. Possessing powerful keratolitichesky ("dissolving" the horny fabrics) and the bleaching action, medicines of a benzoilperoksid are used in treatment of ikhtioz, pigmentary educations. It is effective and concerning eels. Medicine is produced in various dosage forms (lotions, liniment, creams, gels) and concentration (10%, 5%, 2,5%). It can be applied in pure form or as a part of complex medicines in combination with erythromycin, sulfur, gidroksikhinolony or imidazoles. The indication to application of a benzoilperoksid is the easy degree of an acne disease which is characterized by formation of comedones and elements of an inflammation.
Application of the combined an acne disease medicine including and erythromycin is possible. This gel prepares just before application. Keratolitichesky, antibacterial and anti-inflammatory effect of a benzoilperoksid in combination with bakteriostatichesky action of an antibiotic of erythromycin on propionic bacteria of an acne yield good results in treatment of eels.
Treatment of eels antibiotics
In treatment of eels locally antibiotics are usually applied in cases of inefficiency or intolerance of retinoid, a benzoilperoksid and azelainovy acid. Sometimes antibiotics are used as additional medicine to the first three main medicines. 1% the liniment or lotion containing an antibiotic is used for treatment of a medium-weight form of an acne disease in the absence of effect of use of other medicines. Getting into sebaceous glands, stops reproduction of propionibakteriya and stafilokokk.
The medicine containing a powder complex of erythromycin and acetate of zinc for lotion preparation is successfully used. Erythromycin is effective concerning propionic bacteria of an acne and epidermalny staphylococcus, and zinc suppresses an excessive salootdeleniye. As indications to use of this medicine serve easy and average degrees of a course of an acne disease. From antibiotics of a tetracycline row in treatment of eels doxycycline and minocycline are more often applied. These antibiotics have property to collect in sebaceous glands, have high antimicrobic activity and are better transferred by patients.
On the action erythromycin is close to antibiotics of a tetracycline row, however to it stability of microflora quickly develops. As choice medicine at treatment of eels can be used during pregnancy and breastfeeding, in children's practice, and also in case of inefficiency of tetratsiklin or their intolerance.
Treatment of eels at inefficiency of antibiotics
Lack of effect of treatment of eels antibiotics can be caused by accustoming of flora to antibacterial medicine in case of its long use or development of a grammotritsatelny follikulit (an inflammation of the hair follicle caused by gramotritsatelny bacteria). For establishment of sensitivity of microflora to an antibiotic bacteriological crops separated acne elements are carried out. Further the question of replacement of an antibiotic or of purpose of retinoid is raised.
Treatment of eels at men and women has the differences. At men symptoms of seborrhea and multiple trunk blackheads observe the raised office of skin fat therefore for their treatment antibiotics in high doses in combination with izotretinoiny are required. Izotretinoin – the medicine of group of synthetic retinoid suppressing secretion of skin fat. Already 2 weeks later after an initiation of treatment production of skin fat decreases by 90% and remains at this level up to several months. After the termination of use of an izotretinoin secretion of skin fat comes back to norm limits. Besides, against the background of treatment izotretinoiny processes of an orogoveniye in hair follicles are normalized, the number of comedones and propionibakteriya and related inflammatory manifestations decreases.
In treatment of eels at women hormonal therapy can be effective. The gynecologist-endocrinologist after the analysis of a hormonal background of the woman has to resolve an issue of expediency of hormonal therapy. The combination of local treatment of eels to reception of the hormonal combined oral contraceptives containing anti-androgens or an estrogenic profile is admissible. Usually at such treatment the effect is shown in 3-6 months and observed is long.
Treatment of eels anti-androgens
Among the contraceptives combined estrogen-progestinovykh the most effective are and an ethenylestradiol which can be appointed at treatment of eels as separately, and in a combination with each other. Kortikosteroidny anti-androgens are applied to suppression of a giperandrogeniya of nadpochechnikovy genesis. Duration of treatment of eels anti-androgens and estrogen can proceed within several months and even years.
Treatment of a serious acne illness
Hard cases of an acne disease demand the combined therapy combining standard local and general treatment. To women in such cases purpose of contraceptives with estrogen or anti-androgens after preliminary consultation of the gynecologist-endocrinologist is possible.
Physical methods of treatment of eels
Are categorically contraindicated at an acne disease the general warming procedures (massage, warmings up, hot bathtubs) since can aggravate an inflammation. However, application of local hot medicinal compresses promotes removal of comedones and a rassasyvaniye of infiltration. Alibur's solution containing sulfates of copper and zinc is for this purpose used.
In treatment of an acne disease the phototherapy and an ozonoterapiya can be applied. For correction of the cicatricial changes remaining after permission of elements of an acne disease the mesotherapy is appointed.
In the sharp period of an acne disease usually do not resort to surgical manipulations. When forming cystous cavities influence them liquid nitrogen (cryotherapy) or a thin needle enter inside solution of a triamtsinolon. Surgical opening of cystous cavities leads to formation of hems. It is possible to remove multiple hypodermic keratin cysts (miliuma) with the laser.