Acne

Perhaps nothing causes such great moral suffering to such a large number of young people at the same time as acne (or acne, as one prefers to call this unpleasant phenomenon).

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Epidemiology

Sadly, acne most often strikes people during the most romantic time of their lives. According to medical journals, only 10% of teenagers manage to get through puberty with clear skin.

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Causes acne

It is known that acne is a chronic disease that occurs due to the combined action of many factors, the main one being hormonal changes in the body. It is also known that most of the products used to treat acne affect only the symptom of the disease, but not its cause. That is why in the treatment of acne it is important not only to cure acne rashes, but also to develop a strategy for maintaining skin care after the completion of the course of treatment.

The main cause of acne in adolescence is an increase in the concentration of male sex hormones, androgens, in the blood, which causes the sebaceous glands to secrete more sebum. There is some injustice in the fact that the same hormonal surge that lights a fire in the blood of young men and women and makes them passionately desire love, simultaneously makes their skin so susceptible to acne. Why this strange relationship between sebum and androgens exists is not entirely clear. However, there is a theory that along with sebum, chemical signals, pheromones, are released onto the surface of the skin, awakening mutual interest between the sexes.

If in animals the sebaceous glands are located at the base of the hairs and continuously produce sebum to lubricate the hair, then on the face and other hairless areas of the human body they open into the cavity of reduced hair follicles that produce fine vellus hair. For some reason, the sebaceous glands located at the base of normal hair are quite small, but at the base of vellus hair, on the contrary, they are large and multi-lobed. Particularly large and branched sebaceous glands are found on the face and upper back, where acne most often appears.

Increased sebum secretion itself does not cause acne, but androgens can cause other changes in the sebaceous gland. Then the sebaceous gland increases in size, which leads to the appearance of unsightly enlarged pores on the face, and at the mouth of its duct, a layer of horny scales thickens, which peel off faster than usual. Soon the scales clog the duct, clogging it like potato peelings clog a water pipe. Finding no outlet, sebum stretches the cavity of the sebaceous gland, in which it gradually accumulates more and more.

In addition to hormones, bacteria - Propionibacterium acnes - play an important role in the pathogenesis of acne. These bacteria are normal representatives of the microflora of the sebaceous glands, but when they multiply too much, the skin's immune system begins to fight them, which manifests itself in the form of inflammation. The P. acnes bacterium feeds on glycerin in sebum and leaves behind a fair amount of free fatty acids. These fatty acids, in turn, disrupt the process of formation of horny scales in the mouth of the sebaceous gland and make the manifestations of acne even more pronounced.

Increased oiliness of the skin

Excessive oiliness of the skin is usually associated with acne, but oily skin itself is a cosmetic problem that many people struggle with for years. Science has now made great strides in understanding why the skin produces more sebum, what it is needed for, what its functions are, and how to influence the sebaceous glands.

So, one of the main stimuli for increasing sebum production are male sex hormones - androgens. Let us recall that it is not testosterone itself that directly affects the sebaceous gland, but DHT - a substance into which testosterone is converted under the action of the enzyme 5-Alpha-reductase.

Further studies have shown that excessive oiliness of the skin can be observed not only with increased levels of testosterone in the blood or skin, but also with increased sensitivity of some sebaceous glands to the action of DHT, with hyperactivity of 5-alpha-reductase in some sebaceous glands, as well as with insufficient activity of aromatase enzymes that destroy DHT in the skin. The metabolism of female sex hormones - estrogens - also affects the sebaceous glands, since they are antagonists of testosterone. And more recently, data have been obtained indicating that the skin can synthesize steroid hormones from DHEA or even cholesterol, with sebocytes responsible for the synthesis, and keratinocytes for the destruction of androgens.

The situation became even more complicated when it was discovered that androgens were not, as previously believed, the only stimulus for the sebaceous glands. It turns out that certain substances secreted by the nerve endings of the skin (one of them is called substance P) can also provoke an increase in the sebaceous glands and stimulate the production of sebum. In particular, substances that irritate the skin (and many products used to treat acne irritate the skin) can provoke the appearance of substances in the skin that give the sebaceous glands the command to grow and increase productivity.

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Symptoms acne

Acne upsets and demoralizes people of all ages, and teenagers, who are generally inclined to attach excessive importance to their appearance and can spend hours meticulously examining themselves in the mirror, looking for non-existent flaws, suffer especially hard. And if young men are not so fixated on appearance, then girls, especially those whose acne is more pronounced than other peers, soon begin to see the reasons for their personal failures in acne. The dream of getting rid of it turns into an obsession - girls buy up all the acne products that are advertised on TV, wash their faces with soap ten times a day, wipe them over and over with alcohol, degreasing lotions, cleanse with scrubs, and also mercilessly squeeze acne, often without even bothering to wash their hands. Alas, all these actions often only lead to a worsening of the situation.

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Treatment acne

Acne does not pose a threat to the life of patients, but it does damage to their appearance, and sometimes the damage is quite significant. It is not surprising that doctors see their task primarily in eliminating the external manifestations of acne, such as excessive secretion of sebum, inflammatory elements on the skin, comedones, enlarged pores, scars left after healing of abscesses, pigmentation disorders, hyperemia, etc. Therefore, in the arsenal of doctors treating acne, antibiotics for the treatment of inflammation caused by microorganisms occupy an honorable place.

Antibiotics for acne

At first glance, the use of antibiotics in the treatment of acne is quite justified. Undoubtedly, a powerful antibiotic capable of destroying the microbial filling of the sebaceous gland can completely clear the skin of inflammatory elements. To speed up the process, you can prescribe some local antibacterial and anti-inflammatory agents. The remaining comedones can be opened, and the gland ducts can be cleaned in a beauty salon. But in fact, this method can only achieve a temporary victory over acne, which under certain conditions can turn into a crushing defeat.

As is known, microorganisms get used to antibiotics. Research shows that the skin of acne patients who were not treated with anything contains up to 85% of antibiotic-resistant strains of microorganisms. And after a course of antibiotic treatment, this figure increases to almost 100%.

When touching on the topic of antibiotic use in acne treatment, two more compounds should be mentioned that are considered as alternative antibiotics for the topical treatment of mild to moderate inflammatory acne. These are fusidic acid and mupirocin, to which, according to some data, P. acnes does not show resistance. Fusidic acid is an antibiotic for external use, is available as a 2% cream, has high surface activity, and has an extraordinary ability, like glucocorticoids, to penetrate intact skin.

Mupirocin has a bactericidal effect on gram-positive microorganisms St. aureus and on staphylococci resistant to tetracycline, erythromycin, fusidic acid; as well as on gram-negative bacteria. The level of systemic absorption from the skin surface is extremely low. A burning sensation, tingling, itching at the site of application of the ointment are possible. It is not recommended to use during pregnancy.

Although antibiotics are the most reliable means of fighting inflammation and preventing irreversible skin changes, you need to know that long-term use of the same antibiotic or indiscriminate use of different antibiotics does more harm than good.

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Degreasing agents

Almost all doctors prescribe alcohol-containing products for wiping the face to patients. Sometimes the patient is advised not to wash at all, but only to wipe the face with an alcohol solution.

However, studies show that alcohol and acetone destroy the skin's protective barrier, making it even easier for bacteria to penetrate the sebaceous glands. In addition, it has now been established that substances that irritate the skin can cause an exacerbation of acne. Let's look at this in more detail.

As we have already said, the nerve endings around the sebaceous gland can secrete special substances - neuropeptides, which in turn can trigger an inflammatory reaction, as well as stimulate the growth of the sebaceous gland and an increase in the size of its cells. It has been shown that people suffering from acne have more sensitive nerve endings in their skin than healthy people, and that these nerve endings are surrounded by a large number of mast cells that secrete inflammatory mediators.

Therefore, acne patients are advised not to touch their face with their hands, wipe their face with tissues (even cotton wool), touch their face to animal fur, and, of course, apply irritating chemicals to their face. Accordingly, treating acne with products that irritate the skin is like trying to blow out a well-burning fire. Since neuropeptides released from the sensitive nerves of the skin increase inflammation and stimulate the growth of sebaceous glands, all products that irritate the skin will contribute to the deterioration of the skin condition with acne.

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By the ear and into the sun?

A strange situation has developed with ultraviolet radiation. On the one hand, scientists are tirelessly studying the damaging effect of UV radiation on the skin. It is now known that UV from both artificial light sources and the sun can cause changes in the genetic apparatus of cells, which after many years can lead to the development of actinic keratosis or even skin cancer. The role of UV radiation in the development of premature skin aging has been proven, its immunosuppressive role has been shown. Meanwhile, many patients hear the recommendation to treat acne with UV irradiation (UVR). What explains the persistent popularity of "solar" treatment among doctors?

Sunbathing should be limited in time (from 10-15 minutes at the beginning of the resort season to 1.5-2 hours at the height of summer holidays, mainly in the morning). Secondly, the length of time spent in the sun is determined by the type of skin and general health. Thirdly, children usually get enough of the ultraviolet radiation they can get while in the shade of trees.

The duration of sunbathing depends on the season, time of day and latitude. The course of treatment is 12-24 procedures. A repeat course of heliotherapy is possible no earlier than after 2-3 months.

Can sunbathing be recommended to patients with acne? Treatment of any disease, including acne, should be strictly individual. Doctor's prescriptions are determined not only by the clinical form of the disease, but also by the stage of the process. And if the doctor prescribes sunbathing, then these procedures should be taken as seriously as any other method of treatment. It is necessary to clarify the duration of the procedures and their number, the time of day most preferable for bathing, and the method of performing the procedure. Abuse of ultraviolet radiation by healthy people is undoubtedly harmful to the body, and no one argues with this."

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Retinoids

There are many legends about retinoids. For example, there is a persistent myth that after treatment with oral medications (for oral administration) isotretinoin (Roaccutane, Accutane), girls will never be able to become mothers. There is another extreme, when the patient immediately demands to be prescribed Roaccutane, rejecting all alternatives.

Indeed, retinoids have been used for local and systemic treatment of psoriasis, hyperkeratosis, acne and other skin diseases for over 15 years. Retinoids are divided into natural (oxidation products of vitamin A (retinol), which are present in low concentrations in the blood) and synthetic, which in turn are divided into three generations of drugs.

The effectiveness of retinoids is determined by the fact that they interact with nuclear receptors, affecting the growth and differentiation of skin cells, the activity of the sebaceous glands, and also exhibit immunomodulatory and anti-inflammatory effects. This means that they interfere with the control program of skin cells, prompting them to produce less sebum, produce a thinner stratum corneum, and exfoliate dead cells faster, eliminating blockages. Retinoids also have an antimicrobial effect. Thus, they do reduce the skin's tendency to oiliness and acne, but, like any other acne remedy, they are not a panacea.

Acne and cosmetics

Since all medications only eliminate the symptoms of acne, but do not affect the causes that led to its occurrence, the main condition for maintaining problem skin in good condition is proper cosmetic care. Cosmetics, unlike medications, can be used daily for a long time, and its use does not require any special preparation.

However, all this is true only as long as cosmetics do not aggravate the problems. Therefore, cosmetics for problem skin should not irritate the skin, should not contain comedogenic substances, should not destroy the epidermal barrier, should not suppress the normal microflora of the skin, should not interfere with the work of immune cells. At the same time, it should cleanse the skin of excess sebum, destroy bacteria, remove dead skin cells, normalize keratinization, and also reduce sebum production (or, at least, not stimulate it). Obviously, it is extremely difficult to combine all these properties in one or even several cosmetic products.

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Peels for acne

Studies show that exfoliating products containing alpha and beta hydroxy acids can be very helpful in treating acne.

Most often, cosmetologists and dermatologists use glycolic acid - one of the AHA. Glycolic acid causes exfoliation of horny scales covering the skin, improves the outflow of sebum, reduces hyperkeratosis of the sebaceous gland ducts. In addition, glycolic acid promotes deeper penetration of medicinal substances (retinoids, antibiotics) into the skin.

As a rule, for acne, glycolic acid peeling is performed every 2-4 weeks in series of 4-8 procedures each. In addition, patients can use cosmetics with glycolic acid at home (moisturizing creams, lotions, etc.). For home care, glycolic acid preparations are used in a concentration of up to 10% and with a pH of 4. It is important that, unlike retinoids, glycolic acid can be used during pregnancy. However, it should be remembered that before and after peeling, as well as when using cosmetics with glycolic acid at home, it is necessary to protect the skin from the sun and use cosmetics with UV filters.

Often, cosmetics for problem skin contain, along with glycolic acid, salicylic acid (beta-hydroxy acid, or BHA). Salicylic acid is soluble in fats, so it penetrates the sebaceous gland well. Cosmetics with glycolic and salicylic acid can be used daily as part of regular skin care. Home care products often contain 2% salicylic acid. Peeling with more concentrated salicylic acid is usually carried out at intervals of 2-4 weeks.

The problem of comedogenicity

Many people believe that if you have oily skin, you need to buy “fat-free” cosmetics. This is explained by the fact that oils and fats can increase the oiliness of the skin and clog pores. However, have you ever wondered what this mysterious “clogging” of pores is and what role fats play here? In fact, fats themselves cannot clog the ducts of the sebaceous glands. We can say that the sebaceous glands clog themselves, since comedones, which then become inflamed and turn into acne, are formed against the background of increased secretion of sebum and intense peeling in the ducts of the sebaceous glands. It is then that sebum, mixed with exfoliated cells, turns into a dense plug, tightly closing the duct of the gland.

Many substances that are neither fats nor oils have a comedogenic effect, i.e. they can intensify the processes that lead to blockage of the sebaceous gland. As a rule, these are substances that are used in cosmetics as thickeners, moisturizers, emollients (skin softening substances), dyes. In addition, all substances that damage the skin or cause irritation can increase inflammation and provoke blockage of the duct.

Non-greasy cosmetics can be a source of problems. On the contrary, some fats can even improve the condition of the skin. After all, the skin often lacks essential fatty acids, which it cannot synthesize. Deficiency of essential fatty acids can lead to disruption of the skin's barrier function, increased inflammation, flaking and itching. Moreover, a number of scientists believe that it is the lack of essential fatty acids in the sebaceous gland that is the main cause of excessive flaking in the ducts of the sebaceous glands. So, with acne, the skin needs cosmetics that are not free of fats, but contain the necessary fats in the right proportions.

Active additives in cosmetics against acne

Let's look at the active additives that are most often found in cosmetic products designed to combat acne.

Benzoyl peroxide is the number one remedy included in many acne formulations. Its effectiveness has been confirmed in numerous clinical trials, and it has been shown to have both antibacterial and keratolytic effects, i.e. it acts on two pathogenic factors at once.

Azelaic acid is a substance isolated from wheat. It has antimicrobial activity and normalizes keratinization. Although azelaic acid alone is not very effective, it works well in combination with other anti-acne agents, such as benzoyl peroxide, retinoids.

Glycolic acid is one of the AHAs most commonly used by estheticians and dermatologists as an exfoliating agent for acne.

Salicylic acid (BHA) - has an exfoliating and anti-inflammatory effect. Salicylic acid is soluble in fats, so it penetrates the sebaceous gland well. Cosmetics with glycolic and salicylic acid can be used daily as part of regular skin care.

Sulfur and resorcinol (phenol hydroxide) are exfoliating and antibacterial agents, traditional components of "chatterboxes" that were prepared at the pharmacy according to a doctor's prescription for wiping oily skin prone to acne.

Zinc - is necessary for normalizing the sebaceous glands, as well as for the functioning of the skin's antioxidant systems. It is often combined with sulfur and resorcinol

Clay is an excellent absorbent that removes impurities and excess sebum from the surface of the skin.

Essential oils that have an antiseptic effect. Among them, tea tree oil is the most popular, but clove, lemon, bergamot and some others are also used.

Plant components with antibacterial and sebum-regulating action. Most of the plant compounds came from folk medicine, for example, nettle extract, birch buds, celandine, chamomile, calendula, etc., but now the properties of many plants have been confirmed experimentally.

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Light Therapies for Acne Treatment

In recent years, lasers have been increasingly used to combat both inflammatory elements and post-acne complications (primarily scars). Bacterial cells (or more precisely, porphyrins inside them) or sebocytes themselves can be used as a target for light of a certain wavelength emitted by a laser or other light source. The purpose of the effect is to heat the target, leading to its destruction. These are relatively new methods that are still considered as an auxiliary treatment for acne. The results are encouraging and give reason to consider them as quite promising and worthy of further, most careful study.