Vulgar acne

Acne vulgaris (synonyms: common acne, acne vulgaris, acne rash) is an inflammatory disease of the sebaceous glands, usually occurring during puberty.

Acne vulgaris is a multifactorial disease characterized by impaired keratinization of sebaceous hair follicles with a perifollicular inflammatory reaction.

Girls aged 10-17 years old and boys aged 14-19 years old are affected. Boys most often suffer from the severe form.

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Causes of acne vulgaris

The risk group includes people who frequently come into contact with lubricating oils, dioxin, and petroleum products. Among the medications, the disease is caused by lithium salts, phenytoin, corticosteroids (including those for external use), and oral contraceptives. The disease is sometimes polygenically inherited.

Androgens and bacteria (Papionbacterium acne) play an important role in the development of the disease. Androgens, interacting with the sebaceous glands, stimulate the secretion of sebum (the level and composition of androgens are within physiological limits). Lipase, which bacteria contain, breaks down fats into free fatty acids. Excess sebum and fatty acids cause an inflammatory reaction in the sebaceous glands and hair follicle. As a result, the follicle walls become keratinized and clogged with sebaceous masses. If the follicle opening is closed or narrowed, a whitehead (closed comedo) is formed; if it is open, the horny masses move into the follicle opening like a plug and a blackhead (open comedo) is formed. Melanin, a product of tyrosine oxidation, gives the plug its black color. The stretched walls of the follicle can break through, and its contents (sebum, fats, keratin, free fatty acids) penetrate into the dermis and the inflammatory process begins. This is how papules, pustules, nodes and, when healing, scars are formed.

Increased secretion of sebum, insufficient emptying of the sebaceous glands and hyperkeratinization of the hair follicles are the prerequisite for the blockage of the mouths of the hair follicles with the formation of "blackheads" comedones. Comedones occur with both liquid and thick oily seborrhea.

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Pathomorphology

A comedone is an accumulation of keratinized cells, sebum, and microorganisms. A follicular papule is characterized by the presence of a perifollicular infiltrate consisting mainly of lymphocytes. Small areas of destruction of the wall of the epithelial sheath of the hair follicle may be observed.

A pustule located inside the follicle and containing predominantly neutrophilic granulocytes is usually formed after the destruction of its wall, when the contents of the comedo enter the dermis. As a result, a granulomatous reaction develops with the appearance of macrophage elements and giant foreign body cells. The perifollicular infiltrate can turn into a cyst containing a large number of neutrophilic granulocytes, histiocytes, and plasma cells with an admixture of giant foreign body cells. Sometimes the latter are closely adjacent to keratin masses. The infiltrate is then replaced by fibrous tissue. The epidermis at the edges of the destroyed areas of the hair follicle can grow.

Histogenesis

Significance is given to increased activity of the sebaceous glands, primarily due to an increase in the concentration of androgens in the blood and/or a decrease in the level of androgen-binding protein; the level of 5 alpha-reductase; changes in microflora, primarily colonization of follicles by Cotynebacterium acne, which produces bacterial lipase that breaks down lipids into fatty acids; increased keratinization of the epithelium of the sebaceous glandular apparatus; secretion of inflammatory cytokines (IL-1, IL-2, IL-6, etc.); hereditary predisposition.

Symptoms of acne vulgaris

The clinical picture is polymorphic; comedones, papules, pustules, superficial and deep, with abscess formation and merging into continuous infiltrated lesions, sometimes with fistulas, cysts and scar formation. The face and other so-called seborrheic areas are mainly affected. The disease develops mainly in adolescents, with age the manifestations in most patients disappear without a trace or superficial scars remain, only in relatively rare cases - keloids.

Special variants of common acne are: acene fulminans, observed mainly in males, occurring acutely with fever, arthralgia, pustular-ulcerative lesions resistant to antibiotics; acne conglobata, which is a variant of chronic pyoderma, clinically manifested by fistulous-abscessing lesions with scarring, located mainly in the shoulder girdle, armpits and buttocks, and in some patients with the development of malignant neoplasms in these lesions; acne necroticans, characterized by papulonecrotic rashes on the skin of the forehead, probably developing in individuals sensitized to pyococci; acne neonatorum in the form of acneiform rashes, mainly on the cheeks of newborns as a result of hormonal effects of the mother's body.

The rash appears without any disturbance of the general condition and is most often localized on the skin of the face, chest, back, i.e. on seborrheic areas. The clinical picture manifests itself in the form of hemispherical nodules of pink or pink-red color, the size of a pinhead to a pea (papular acne). Papules quickly transform into pustules of various sizes, after the resolution of which dried yellow crusts form on the surface. At the site of the resolution of common acne, pigmentation or a superficial scar usually remains. Conglobate acne is observed when the suppurative process begins from the deep layers of the skin, and hemispherical fluctuating nodes are formed. After a few weeks, the nodes open up to form a cavity from which a viscous yellow-green purulent fluid is released. After healing, deep scars remain at the site of large conglobate acne.

Sometimes acne vulgaris begins acutely with a disturbance of the patient's general condition (general weakness, headaches, arthralgia, fever). In this case, numerous acne rashes and abscessing nodes appear.

With timely treatment, the prognosis for the disease is favorable; spontaneous regression is observed by the age of 30-35.

Differential diagnosis

Common acne should be differentiated from drug-induced acne, which differs from common acne in that it occurs in people who have been taking various medications (bromine, iodine, corticosteroids, vitamins B6, B12, etc.) for a long time, and from folliculitis and perifolliculitis.

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Treatment of acne vulgaris

Treatment of acne vulgaris depends on the form of the disease. In mild cases, topical agents are mainly prescribed - antibiotics (erythromycin ointment, clindomycin sulfate, syntamycin emulsion, heliomycin ointment), benzyl peroxide, local retinoids (airol). In moderate cases, in addition to the above-mentioned topical agents, antibiotics are prescribed (tetracyclines - doxycycline 0.1 g 2 times a day for 7-10 days). In severe cases, roaccutane is recommended at 0.5-1.0 mg / kg of the patient's weight, which suppresses the function of the sebaceous glands and prevents keratinization. It is advisable to prescribe immunomodulators, vitamins, biogenic stimulants, and treatment of concomitant diseases.