Acne disease (acne)

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

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Sadly, acne affects people most often at the most romantic time of their lives. According to medical journals, only 10% of adolescents manage to pass the transitional age, keeping clean skin.

[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]

Causes of the acne

It is known that acne is a chronic disease that occurs when the combined effect of many factors, the main one of which is hormonal restructuring in the body. It is also known that most of the drugs used for the treatment of 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, but also to develop a strategy of supportive skin care after the completion of the course of treatment.

The main reason for the appearance of acne in adolescence is an increase in the concentration in the blood of male sex hormones, androgens, under the influence of which the sebaceous glands begin to secrete more sebum. There is some injustice in the fact that the same hormonal splash that ignites the fire in the blood of young men and women and makes them crave love, while making their skin so prone to acne. Why there is this strange relationship between sebum and androgens is not entirely clear. However, there is a theory that along with sebum on the surface of the skin chemical signals are released - pheromones that arouse the mutual interest of the sexes.

If the animals have sebaceous glands located at the base of the wool and continuously produce sebum for lubricating the hair, then on the face and other hairless areas of the human body they open into the cavity of the reduced hair follicles that produce thin hair follicles. For some reason the sebaceous glands located at the base of normal hair are rather small, but at the base of the hair, on the contrary, large and multi-lobed. Especially large and branched sebaceous glands are on the face and in the upper back, where most often and appear acne.

By itself, an increase in sebum secretion does not lead to the appearance of acne, but under the action of androgens in the sebaceous gland, other changes may occur. Then the sebaceous gland increases in size, which leads to the appearance of ugly enlarged pores on the face, and at the mouth of its duct thickens a layer of horny scales that slough faster than usual. Soon the scales clog the duct, clog it up like a potato water treatment plant. Not finding an outlet, sebum dilates the cavity of the sebaceous gland, in which it gradually accumulates more and more.

In addition to hormones, the pathogenesis of acne is played by bacteria - Propionibacterium acnes. These bacteria are normal representatives of the microflora of the sebaceous glands, but when they multiply too much, the immune system of the skin begins to fight them, which manifests itself in the form of inflammation. The bacterium P. Acnes feeds on the glycerin of sebum and leaves after its meal 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 manifestations of acne more pronounced.

Increased fat content of the skin

The increased fat content of the skin is usually associated with acne, but oily skin in itself is a cosmetic drawback, which many people have been fighting for many years. Now science has made great progress in understanding why the skin secrete more sebum, which is necessary, what its functions are and how it can affect the work of the sebaceous glands.

So, one of the main incentives to increase sebum production are male sex hormones - androgens. Recall that directly on the sebaceous gland is affected not by testosterone itself, but DHT is the substance into which testosterone is converted under the action of the enzyme 5-Alpha reductase.

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

The situation became even more complicated when it became clear that androgens are not, as previously thought, the only stimulus for the sebaceous glands. It turns out that some substances released by the nerve endings of the skin (one of them 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 drugs used to treat acne, irritate the skin), can provoke the appearance in the skin of substances that give the sebaceous glands a command to grow and increase productivity.

[20], [21], [22]

Symptoms of the acne

Eels are frustrating and demoralizing people of any age, and teenagers who tend to attach excessive importance to their appearance and can spend hours peering at themselves in the mirror, looking for nonexistent shortcomings, suffer particularly badly. And if the young people fixation on the exterior is still not so great, then girls, especially those whose acne is more pronounced than other peers, soon begin to see the reasons for their personal failures in eels. The dream of getting rid of them turns into an obsession - girls buy up all the acne remedies advertised on TV, wash their faces with soap ten times a day, rub them with alcohol, degrease lotions, and scrub them again, and also squeeze out acne, and often without even bothering to wash your hands. Alas, all these actions often lead only to a worsening of the situation.

[23], [24], [25], [26], [27]

Treatment of the acne

Acne is not a danger to the lives of patients, but it damages their appearance, and sometimes the damage is very significant. It is not surprising that doctors see their task first of all in eliminating the external manifestations of acne, such as excessive secretion of sebum, inflammatory elements on the skin, comedones, enlarged pores, scars remaining after healing of abscesses, disturbance of pigmentation, hyperemia and t . Therefore, in the arsenal of doctors treating acne, an honorable place is occupied by antibiotics for the treatment of inflammation caused by microorganisms.

Antibiotics for acne

At first glance, the use of antibiotics in the treatment of acne is justified. Undoubtedly, a powerful antibiotic, capable of destroying the microbial stuffing of the sebaceous gland, can completely clear the skin of the inflammatory elements. To speed up the process, you can assign any local antibacterial and anti-inflammatory drugs. Remaining comedones can be opened, and clean the ducts of glands in the beauty salon. But in fact, in this way you can only win a temporary victory over acne, which under certain conditions can turn into a crushing defeat.

As is known, microorganisms get used to antibiotics. Studies show that up to 85% of antibiotic-resistant strains of microorganisms are present in the skin of those patients with acne that have not been treated in any way. And after the course of treatment with antibiotics, this figure increases to almost 100%.

When discussing the use of antibiotics in the treatment of acne, two more compounds should be mentioned, which are considered as alternative antibiotics for the external treatment of inflammatory forms of acne of mild to moderate severity. It is fusidic acid and mupirocin, to which, according to some information, P. Acnes does not show resistance. Fusidic acid is an antibiotic for external use, is available as a 2% cream, has a high surface activity, has an extraordinary ability as well as glucocorticoids to penetrate intact skin

Mupirocin has a bactericidal effect on gram-positive microorganisms. Aureus and on resistant to tetracycline, erythromycin, fusidic acid of staphylococcus; as well as on gram-negative bacteria. The level of systemic absorption from the surface of the skin is extremely low. There may be a burning sensation, tingling, itching in the place of application of the ointment. Not recommended for use in pregnancy.

Although antibiotics are the most reliable means to overcome inflammation and prevent the occurrence of irreversible skin changes, you need to know that prolonged use of the same antibiotic or the erratic use of different antibiotics does more harm than good.

[28], [29], [30], [31], [32], [33], [34], [35]

Degreasing agents

Almost all doctors prescribe to patients alcohol-containing remedies for rubbing the face. Sometimes the patient receives a recommendation not to wash at all, but only to wipe the face with alcohol solution.

However, studies show that alcohol and acetone destroy the protective barrier of the skin, making it even easier for bacteria to penetrate the sebaceous glands. In addition, it is now established that substances that irritate the skin can cause aggravation of acne. Let us dwell on this in more detail.

As we have already said, the nerve endings around the sebaceous gland can excrete special substances - neuropeptides, which in turn are able to trigger an inflammatory reaction, and also stimulate the growth of the sebaceous gland and increase the size of its cells. It is shown that acne-affected people have more sensitive nerve endings in the skin than healthy people, and that these nerve endings are surrounded by a large number of mast cells that excrete mediators of inflammation.

Therefore, patients with acne are not advised to touch their face with their hands, wipe their face with tissues (even with cotton balls), touch their faces with animal wool and, of course, apply irritating chemicals to their faces. Accordingly, treating acne by means that cause skin irritation - it's like trying to blow out a well-inflamed bonfire. Since neuropeptides that are released from the sensitive nerves of the skin, increase inflammation and stimulate the growth of sebaceous glands, all skin irritants will contribute to the deterioration of the skin in acne.

[36], [37], [38], [39], [40]

For your ear and for the sun?

A strange situation has developed with ultraviolet radiation. On the one hand, scientists tirelessly investigate the damaging effect of UV radiation on the skin. Now it is already known that UV from both artificial light sources and from 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 aging of the skin is proved, its immunosuppressive role is shown. Meanwhile, many patients hear the recommendation to treat acne with UV irradiation (UFO). What explains the steady popularity of "solar" treatment for doctors?

Sunbathing should be limited time (from 10-15 minutes at the beginning of the holiday season to 1.5-2 hours in the midst of summer holidays, mainly in the morning hours). Secondly, the duration of sun exposure is determined by the type of skin and general health. Thirdly, children have enough of those doses of ultraviolet that they can get, being in the shade of trees.

The duration of sunbathing depends on the time of the year, the time of day and the geographical latitude. The course of treatment is 12-24 procedures. Conducting a second course of heliotherapy is possible not earlier than in 2-3 months.

Is it possible to recommend sun baths to patients with acne? Treatment of any disease, and acne, including, must be strictly individual. Medical appointments determine not only the clinical form of the disease, but also the stage of the process. And if the doctor appoints sunbaths, then these procedures should be taken as seriously as any other method of treatment. It is necessary to clarify the duration of procedures and their number, the time of day, the most preferable for bathing, and the procedure for the procedure. Abuse of healthy people by ultraviolet irradiation is undeniably detrimental to the organism, and no one disputes with this. "

[41], [42], [43], [44]

Retinoids

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

Indeed, retinoids are used for local and systemic treatment of psoriasis, hyperkeratosis, acne and other skin diseases for more than 15 years. Retinoids are divided into natural (the products of oxidation 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 show an immunomodulating and anti-inflammatory effect. This means that they interfere with the program to control the functioning of skin cells, encouraging them to produce less sebum, produce a thinner corneal layer, faster exfoliate dead cells, eliminating blockage. The antimicrobial action of retinoids has also been noted. Thus, they do reduce the skin's tendency to fat and acne, but like any other remedy for acne, it is not a panacea.

Acne and cosmetics

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

However, all this is true only as long as cosmetics do not exacerbate 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 inhibit the normal microflora of the skin, should not interfere with the work of immune cells. In doing so, it should cleanse the skin of excess sebum, destroy bacteria, remove dead skin cells, normalize keratinization, and reduce sebum production (or at least not stimulate it). Obviously, combining all these properties in one or even several cosmetic products is extremely difficult.

[45], [46], [47], [48], [49]

Peelings with acne

As studies show, in the treatment of acne, it can be very useful exfoliating agents based on Alpha and Beta-hydroxy acids.

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

As a rule, acne peeling with glycolic acid is carried out every 2-4 weeks in series of 4-8 procedures in 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 concentrations of up to 10% and pH 4. It is important that, in contrast to retinoids, glycolic acid can be used during pregnancy. However, we must remember that before and after peeling, as well as using cosmetics with glycolic acid at home, it is necessary to protect the skin from the sun and use cosmetics with UV filters.

Often, cosmetic products for problem skin contain, along with glycolic acid, salicylic acid (Beta-hydroxy acid, or BHA). Salicylic acid is soluble in fats, so it penetrates well into the sebaceous gland. Cosmetics with glycolic and salicylic acid can be used daily as part of normal skin care. In the means for home care is more often 2% salicylic acid. Peeling with more concentrated salicylic acid is usually done at intervals of 2-4 weeks.

The problem of comedogenicity

Many believe that with oily skin you need to buy cosmetics "without fat." This is explained by the fact that oils and fats can increase the fat content of the skin and clog pores. However, have you thought about what this mysterious "pocketing" of pores is and what role do fats play here? In fact, by themselves, fats can not block the ducts of the sebaceous glands. It can be said that the sebaceous glands clog themselves, as comedones, which then become inflamed and turn into acne, are formed against a background of increased secretion of sebum and intense flaking in the ducts of the sebaceous glands. It is then that sebum, mixed with peeled cells, turns into a tight cork, tightly covering the duct of the gland.

Many substances, which are not fats or oils, have a comedogenic effect, i.e. They are able to enhance the processes leading to a blockage of the sebaceous gland. Typically, these are substances that are used in cosmetics as thickeners, moisturizers, emollients (emollients of the skin), dyes. In addition, all substances that damage the skin or cause irritation of the skin can aggravate the inflammation and provoke blockage of the duct.

Low-fat cosmetics can be a source of problems. In contrast, some fats can even improve the condition of the skin. After all, the skin often lacks essential fatty acids, which it can not synthesize. Deficiency of essential fatty acids can lead to a violation of the barrier function of the skin, increased inflammation, the appearance of peeling 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 fat-free, but contain the right fats in the right proportion.

Active supplements in cosmetics against acne

Consider active supplements, which are most often found in cosmetics designed to combat acne.

Benzoyl peroxide is the number one agent that goes into many formulations against acne. Efficiency has been confirmed in numerous clinical trials, and it has been shown that it has both antibacterial and keratolytic effects, that is, it acts immediately on two pathogenetic factors.

Azelaic acid is a substance isolated from wheat. It has antimicrobial activity and normalizes keratinization. Although alone azelaic acid is ineffective, it works well in combination with other anti-acne agents, for example benzoyl peroxide, retinoids.

Glycolic acid is one of the ANA, most commonly used by cosmetologists 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 well into the sebaceous gland. Cosmetics with glycolic and salicylic acid can be used daily as part of normal skin care.

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

Zinc - is necessary for the normalization of the sebaceous glands, as well as for the work of antioxidant systems of the skin. It is often combined with sulfur and resorcinol

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

Essential oils with antiseptic properties. Among them, the most popular tea tree oil, but also used oil cloves, lemon, bergamot and some others.

Plant components of antibacterial and seborectic action. Most of the plant compounds came from alternative medicine, for example, nettle extract, birch buds, celandine, chamomile, calendula, etc., but now the properties of many plants are confirmed experimentally.

[50], [51], [52]

Light methods of treatment of acne

In recent years, lasers have increasingly used lasers to combat both inflammatory elements and postgraum complications (primarily scars). As a target for light of a specific wavelength emitted by a laser or other light source, there may be bacterial cells (more precisely, porphyrins within them) or the sebocytes themselves. The meaning of the impact lies in the thermal heating of the target, leading to its destruction. These are relatively new methods, which are still considered as an auxiliary treatment for acne. The results are encouraging and give grounds for considering them as quite promising and worthy of further close study.