Treatment of acne on the face. Three stages of acne: the most important thing is to prevent exacerbations Treatment of acne skin

Dear friends, hello!

I believe that we will return to the women's problems that we have talked about recently, and more than once.

And today I want to talk to you about acne.

And although I discuss this problem in some detail in my book “,” which many of you purchased, and provide there an algorithm for recommendations for various forms of acne, requests to talk about acne continue to come.

Well, let's delve into the essence of this problem and look at it:

• What is called “acne”?
• How do acne form?
• What are they?
• How to treat them depending on the form and severity?
• What could be a comprehensive solution to this problem?

But first, let's remember the anatomy and physiology of the sebaceous glands.

The structure of the sebaceous glands

Sebaceous glands are appendages of the skin. They are distributed unevenly throughout the body.

They are absent on the palms, soles and dorsum of the feet.

Most of them are on the face and scalp: 400-900 per 1 square centimeter. Less (but still a lot) on the upper body: chest, back.

The sebaceous glands produce sebum, which enters the mouth of the hair follicle (and hair covers almost our entire body), which is something like a case for a part hidden from ours. This case is covered with stratified keratinizing epithelium. This means that in its lower layers new cells are born, which, as they grow and develop, move upward, become denser, and turn into horny scales that mix with the secretion of the sebaceous glands.

And then, thanks to the contractions of the small muscles that lift the hair, this composition comes to the surface of the skin. Horny scales are removed naturally during hygiene procedures, and fat is distributed over it, forming a thin film 7-10 microns thick. At the same time, the secretion of the sweat glands enters here, which, together with sebum, forms a water-lipid mantle on the surface of the body.

It gives the skin elasticity, prevents it from drying out, maintains a constant body temperature, and suppresses the growth of bacteria.

Normally, approximately 20 grams of sebum are produced per day.

This process is regulated by hormones at four levels: hypothalamus, pituitary gland, adrenal glands, gonads. Therefore, many diseases of the endocrine system can be accompanied by the appearance of acne.

And now attention:

The main hormone that increases sebum production is testosterone. There are receptors for it on the membranes of sebaceous gland cells. Testosterone interacts with them and, under the action of the enzyme 5-alpha reductase, is converted into its active metabolite - dihydrotestosterone, which directly increases sebum production.

The sensitivity of sebaceous gland cell receptors to it and the activity of 5-alpha reductase are inherited, so in many cases the problem of acne can be traced from generation to generation.

Interestingly, sebaceous glands of different locations have different numbers of testosterone receptors.

Therefore, if your pimples appear all the time in the same places, for example, on the chin or back, it means that the sebaceous glands located here are rich in these same receptors.

Estrogens, on the contrary, suppress sebum secretion, but this effect is less pronounced than the sebum-forming effect of testosterone.

Some people experience acne before menstruation, and this is also understandable: progesterone, which commands the parade during this phase, has an androgenic and antiestrogenic effect on the sebaceous glands.

It also participates in the regulation of sebum secretion, so it can also affect the appearance of acne.

How do acne form?

Acne, or acne, is a CHRONIC RECURRENT disease accompanied by blockage and inflammation of the hair follicles.

One pimple is not a disease, and two pimples are not a disease, and the appearance of acne 1-2 days before menstruation is also not a disease.

Pimples become a “disease” when some of them disappear, others appear, and these are not just black dots, but red lumps in the skin, sometimes with suppuration.

But it all starts with the formation of comedones. What it is?

A comedon is essentially a cyst - a cavity filled with certain contents. In the case of acne, the contents of the cyst include sebum, horn cells, particles of dust and cosmetics.

How did they get there? - you ask.

Firstly, some people often produce more sebum than necessary, and it does not have time to be removed from the hair follicle.

Secondly, with acne there is hyperkeratosis, so there is not only an excess of sebum, but also horny scales, which also contribute to the formation of a plug.

Dust particles are the result of poor skin cleansing, and cosmetic products are comedogenic and non-comedogenic. Comedonogenic clog pores and prevent sebum from coming out. They contain lanolin, coconut oil, flaxseed oil, and wheat germ oil. For this reason, people who are prone to acne should choose cosmetics that are labeled “non-comedogenic.”

As long as this entire mixture is below the surface of the skin, nothing is visible. But over time, the plug becomes larger and larger, and one day it reaches the surface of the skin, starting to protrude. Small white dots – closed comedones – become visible. They are also called “miliums,” which means “millet” in Latin.

What happens next? The plug continues to grow in size and eventually breaks through the skin. Once out, it oxidizes and turns black under the influence of oxygen. This is how “black dots” or open

Most often, comedones can be seen on the skin of the forehead, nose, and chin.

Here's what it looks like live:

A clogged hair follicle is an ideal environment for the proliferation of acne propionbacteria, which are anaerobes (i.e. they live without access to oxygen). They begin to multiply intensively and secrete biologically active substances that cause inflammation of both the hair follicle itself and the tissues surrounding it.

But microorganisms are friendly guys and really love to team up with their brothers in mind. Joining propionbacteria are epidermal staphylococci, streptococci and those that live on the surface of the skin. Inflammation intensifies.

It is now clear that 4 factors may be to blame for the development of acne:

1. Excess secretion of the sebaceous glands.
2. Follicular (occurring in the hair follicle) hyperkeratosis, i.e. thickening of the stratum corneum.
3. Reproduction of bacteria in the sebaceous plug.
4. Inflammation inside the hair follicle and surrounding tissues.

It follows that to treat acne you need:

1. reduce sebum production,
2. reduce the thickness of the stratum corneum,
3. if there are inflammatory elements (nodules, pustules on a hyperemic background), connect.

Causes of acne

The following contribute to the appearance of acne:

1. Hormonal excesses: hormonal changes in adolescents, hormonal imbalance with an increase in the level of male sex hormones, endocrine diseases of the adrenal glands, pituitary gland, taking hormonal drugs, etc.
2. Vitamin A deficiency (leads to hyperkeratosis).
3. Stress.
4. Wrong cosmetics.
5. Insufficient skin care.
6. Excessive skin care.
7. Hot and humid climate.
8. Squeezing pimples.
9. Friction, pressure on certain areas, which causes a protective reaction of the skin in the form of increased reproduction of the stratum corneum, including in the hair follicles.

It has also been noted that the development of acne is influenced by certain foods and problems with the gastrointestinal tract.

Acne severity

Treatment for acne depends on its severity.

There are 4 degrees of acne severity.

1 tbsp. There are closed comedones (white rashes that resemble millet). There are no inflamed nodules or pustules.

2 tbsp. There are open (blackheads), closed comedones, nodules (inflamed lumps) and single pustules. There are no more than 20 elements of nodules and pustules.

3 tbsp. Multiple nodules and pustules (20-40 pieces).

4 tbsp. More than 40 elements: pustules, nodules and large compactions in the skin (nodules).

For grades 1 and 2, external remedies are sufficient.

For grades 3 and 4, systemic therapy is prescribed.

Let's look at it in a little more detail.

1. If there are only comedones on the face, treatment begins with drugs containing Adapalene (trade names: Differin, Adaklin, Klenzit) or Azelaic acid(Skinoren, Azelik, Azix-Derm).

Adapalene (Differin and analogues) – a structural analogue of vitamin A. It resolves plugs, removes comedones, and reduces inflammation.

Shown from 12 years old. Pregnant women should not take it, but breastfeeding women can (at least that’s what is written in the instructions for Differin).

Improvement is noticeable only after 4-8 weeks of use, and lasting improvement occurs after 3 months.

Available in gel and cream form.

The gel is intended for oily skin, the cream is for dry and sensitive skin, because... it contains moisturizing ingredients. Don't let this bother you. Acne does not always occur on oily skin.

Adapalene is applied in the evening, 1 time per day, otherwise it may cause.

Azelaic acid (Skinoren and analogues) – loosens the stratum corneum, opens pores, removes plugs, reduces skin oiliness, destroys acne propionbacteria and has an anti-inflammatory effect.

It would seem that the drug acts on all parts of the pathogenesis of acne and is good in all respects, but for some reason the reviews indicate that it is less effective compared to Differin.

What do you say?

During pregnancy and lactation, its use is possible (they write, however, that in consultation with the doctor). Children from 12 years old.

Apply it 2 times a day, morning and evening. Exposure to the sun during treatment is NOT contraindicated for them.

By analogy with Adapalene, the gel is for combination and oily skin, the cream is for normal and dry skin.

Visible improvement after 4 weeks. It needs to be used for several months.

Both drugs are applied to all problem areas, and not just to individual pimples.

1. If comedones alternate with inflammatory elements (nodules, pustules), but there are few of the latter, then either combination preparations containing Adapalene and the antibiotic Clindamycin (Klenzit C) or a product based on Benzoyl peroxide(Baziron AS). It provides a more pronounced antibacterial effect. In the latter case, it is better to alternate it with Adapalene: in the morning Baziron AS, in the evening Differin, because Differin will work with comedones, and Baziron will work with inflammatory elements.

Why it’s remarkable Baziron AS: it destroys not only propionbacteria acne, but also Staphylococcus epidermidis. Plus softens the plug, plus suppresses sebum production.

By the way, do you know what the abbreviation “AS” means? Nothing comes to my mind.

Shown also from 12 years old. It is not recommended for pregnant and lactating women, although it has virtually no systemic effect.

Apply 1-2 times a day to rashes.

The effect is visible after 4 weeks, it should be used for at least 3 months.

Baziron AS gel is available in different concentrations of the active ingredient: 2.5% and 5%. If taking it for the first time, recommend a lower concentration (2.5%). If the first effect is insufficient - 5%.

When using it, you should not stay in the sun for a long time.

Galderma's laboratory did not stop at developing Differin and Baziron. She combined them in one preparation Effezel, which contains Adapalene and Benzoyl Peroxide.

If your skin is decorated with comedones, nodules, or pustules, you don’t have to bother using two products, but buy one.

Effezel gel is applied once a day in the evening. But it's prescription.

1. For multiple inflammatory elements on the skin, antibacterial external agents are prescribed: Dalatsin 1%, Klindovit, Zinerit, etc.

Dalatsin and Klindovit apply 2 times a day. Children from 12 years old.

Lotion Zenerit contains erythromycin and zinc, therefore it dries the skin, has an anti-inflammatory effect, and destroys bacteria (propionbacterium acne and epidermal streptococcus).

Its other advantages:

1. Can be used in the sun.
2. Suitable for pregnant and lactating women.
3. Can be worn under makeup.
4. Has no age restrictions.

The course of treatment is 10-12 weeks.

But, as doctors and patients say, the effect is magical. Roaccutane suppresses the activity of the sebaceous glands and even reduces their size. It is prescribed 1-2 times a day for a long time (16-24 weeks, sometimes longer).

What else?

If acne develops in a woman against the background of hyperandrogenism, the following medications with an antiandrogenic effect are required: Diane-35, Chloe, Yarina, etc.

In the complex treatment of acne, proper skin care is important. You can recommend Avene medicinal cosmetics (Clinans series), Bioderma (Sebium line), La Roche Pose (Efaklar), etc.

Write all your comments, questions, additions below in the comment box.

If you are not yet a blog subscriber, you can subscribe to the newsletter and I will send you notifications when new articles are released. As a thank you for subscribing, you will immediately receive a collection of valuable work items by email.

The subscription form is located under each article and in the right column.

With love to you, Marina Kuznetsova

In Rus', the wedding could be canceled if the bride had scars or excessive acne, so to this day, with any illness in a child, parents say: “it will heal before the wedding.” However, it happens that acne does not go away before the wedding, and for many years the hated pimples distort the beauty of the most delicate parts of the body. A dermatovenerologist will prescribe antibiotics, an endocrinologist will prescribe hormones, a cosmetologist will prescribe peeling, and a nutritionist will select a chocolate bar, but even modern remedies often turn out to be useless, and traditional recommendations have long been refuted. For what reason does acne bypass some people and haunt others until old age? Why does the disease primarily affect the face? Why are there so many different ways to treat one disease and how to make the right choice?

Why does the skin need fat?

Sebum is produced in the sebaceous glands and is released through the pilaris to the surface of the skin to protect it from environmental conditions and infections. It is no coincidence that the composition of shoe polish follows the composition of sebum: glycerin compounds protect the skin from drying out, wax prevents swelling, fatty acids have bactericidal and fungicidal properties. In addition, sebum stabilizes the epidermis, preventing it from breaking and cracking. This is especially true for areas of the skin that are prone to strong stretching - eyelids, lips, anus, nipples in women, foreskin and glans penis in men. Therefore, despite the absence of hair, these parts of the body are equipped with unique sebaceous glands, the ducts of which open directly to the surface of the skin. However, why does sebum, which is so necessary for health, suddenly become the cause of the development of a disease?

Pathogenesis of acne

The pathological process starts when the rate of sebum formation prevails over the rate of its release onto the skin surface. The high rate of formation of lard is accompanied by a change in its composition towards the predominance of less fluid components, aggravating the separation process. In turn, stagnation of sebum in the hair funnel leads to its oxidation, the products of which slow down the desquamation of the stratum corneum of the epidermis, and this further disrupts the patency of the funnel.

Shape of open comedones
If the hair follicle is overfilled with sebum, but the hair funnel remains permeable, then an open comedon is formed. This is a mild form of acne, which is characterized by dark spots on the skin, which is caused by the oxidation of the amino acid tyrosine into the pigment melanin:

Form of closed comedones
If there is no patency of the hair funnel, then a closed comedon is formed. The walls of the follicle stretch, increasing their permeability to immune cells. The breakdown products of sebum components and dead skin cells activate the immune system, which triggers the inflammatory process. There is redness (papule stage), and then the appearance of a white head (pustule stage) - this is a pimple with a cavity filled with fat and pus:

Nodal form
In a favorable case, the inflammatory process resolves with the restoration of the patency of the hair funnel. Otherwise, the immune system melts the follicle, and its tissues are gradually replaced by dense connective tissues, forming a node. Large nodes often merge into a homogeneous formation, so this form is sometimes called drain acne:

Scar formation
The more extensive and deeper the inflammatory process, the higher the likelihood of subsequent scarring. Scar formation occurs in conditions of poor blood supply, so the formed tissue sinks below the surface of healthy skin. The connective tissue of the scar does not contain follicles and sebaceous glands, but the aesthetic consequences of scarring are obvious:

The listed forms of acne reflect not only the sequence of stages of pathogenesis, but also the severity of the disease. Moreover, in each clinical case, pathogenesis can spontaneously be limited to a mild form of open comedones or reach severe nodular forms and scarring. The stage and severity of the disease in a particular person depends on the presence or absence defining And predisposing factors. Individually, each of the factors does not play a significant role in the development of acne, but their simultaneous combination in one person is inevitably accompanied by severe acne on large areas of the skin with a long-term course. Only by establishing the combination of these factors and the stage of the disease in a particular patient can an individual treatment strategy be prescribed. Next, I will list these factors in the context of the manifestation of acne in time (age) and space (skin surface), and also dwell on the role of infection in the pathogenesis of the disease.

Age-related periods of acne exacerbation

Infant acne
The formation of sebum is a hormone-dependent process and is normally activated during periods of intense growth of the body and, accordingly, the skin. Therefore, for the first time, acne is observed in 20-50% of newborns and in infants of the first year of life, which is associated with high concentrations of androgens, which enter first through the placenta and then with mother’s milk, and are also synthesized by the adrenal glands in girls and testicles in boys. In infants, acne manifests itself to the stage of closed comedones without an inflammatory process due to the immature immune system:

Juvenile acne
By 6-12 months of life, the synthesis of testosterone by the testicles decreases, and the embryonic adrenal glands completely atrophy - sebum production decreases and the appearance of the skin normalizes. However, the sexual constitution, the number and size of the sebaceous glands are already predetermined, therefore the manifestation of acne in the first year of life makes it possible to predict the recurrence and severity of the disease in adolescence, when the level of androgens increases again. In addition, adolescents have a more mature immune system, which practically guarantees a pronounced inflammatory process.

Post-pubertal acne
By the age of 25-30, the amplitude of fluctuations in the concentration of sex hormones decreases, therefore the activity of the sebaceous glands and the severity of acne decreases. However, in half of adults, acne persists until age 40. The disease persists longer in people with a strong sexual constitution and worsens in women during the premenstrual period and during pregnancy. Only by the age of 50, during the onset of menopause, the incidence sharply decreases to 3-5%. In old age, acne is extremely rare in women with low concentrations of estrogens, which have antiandrogenic activity.

The described dynamics of morbidity throughout life indicates the determining role of the hormonal factor in the development of acne. Since the sexual constitution is inherited, acne is observed in 78% of first-generation descendants. However, a strong sexual constitution is not the only congenital factor that determines the development of acne and does not independently guarantee the disease. After all, an increase in sebum production can be compensated for by its timely release onto the surface of the skin. On the other hand, the process of sebum secretion can be complicated due to the congenital characteristics of the skin and the depth of the sebaceous glands.

Localization of acne on the body surface

The sebaceous glands are extremely unevenly distributed over the surface of the body. Most of the sebaceous glands are in the skin of the head, neck and shoulder girdle, the least are in the lower part of the body, the skin of the extremities, and they are completely absent in the skin of the feet and palms. The predominant distribution of sebaceous glands in the upper part of the body is due to the fact that, under the influence of gravity, the secreted sebum easily spreads over the rest of the skin surface. Therefore, there is less need for sebaceous glands in the lower half of the body. Nature, an economical and unsentimental housewife, has placed more than half of all sebaceous glands in the scalp, at the same time rewarding us with a noticeable disease from afar.

In turn, the typical distribution of acne lesions in certain areas of the head depends on the thickness of the skin. The skin on the surfaces of the forehead, cheekbones, nose and chin has the greatest thickness, and the presence of acne lesions is most typical for these areas of the head. Below are indices of the thickness of the skin of different areas of the face relative to the thickness of the skin of the eyelids, taken as a unit:

A similar factor also determines the typical localization of acne in the upper back, the skin of which has a record thickness, second only to the heels. The thicker the stratum corneum of the skin, the deeper the sebaceous glands are located, and since the secretion of sebum occurs passively without the participation of muscles, its evacuation through the narrow and longer canal of the hair follicle slows down.

An opposite example would be the eyelids, lips, anus, nipples mentioned above in women, the foreskin and glans of the penis in men, which have many sebaceous glands, but their superficial location in thin skin facilitates the secretion of sebum, which eliminates the development of acne, so their photographs will not be;)

If in adulthood acne persists exclusively in the classic zones of its localization, where the thickness of the skin is maximum, then this indicates the determining role of the structural features and regeneration of the skin in the development of the disease in a particular clinical case.

Infectious factor

The microorganism Propionibacterium acnes was first blamed for causing acne in 1909, when it was found in people with the condition. For this, the microorganism was named after the disease. As it turned out later, it was unfair. In , and in the years it has been proven that P. acnes is found equally in people with acne and in healthy people, and the amount of the pathogen does not correlate with the severity of the disease. Since then, P. acnes has been considered a representative of the normal human microflora.

The nutrient substrate for P. acnes is sebum, to reduce the bactericidal properties of which the bacterium synthesizes a special enzyme, RoxP. A year ago, results were published in the journal Nature demonstrating the antioxidant properties of this enzyme and the ability to protect the skin from the development of psoriasis, eczema and dermatitis. Taking this into account, the authors suggested that colonization by P. acnes is mutually beneficial for both the microorganism and the person.

If acne develops, stagnation and oxidation of sebum further reduces its antibacterial properties, increasing the opportunity for P. acnes to colonize deeper into hair follicles. In this case, the inflammatory process is activated not only by the breakdown products of sebum and follicle tissue, but also by antigens of the microorganism. However, the contribution of P. acnes to the overall inflammatory response in acne has not yet been assessed.

Thus, infection of the sebaceous glands cannot be a determining factor in the development of acne. P. acnes can only modulate the immune response and serve as a predisposing factor that enhances the inflammatory response.

Acne therapy and prevention

I’ll start the last chapter by debunking several myths, and then move on to science-based remedies with an acceptable safety profile and tested by my wife (by the way, she is also a doctor with many years of experience in fighting acne).

Diet, facial hygiene, sunlight and tobacco
The myth about the effect of diet on acne dates back to 1931, when a study was published on impaired glucose tolerance in people with acne. Since then, patients with acne have traditionally been recommended a low-carbohydrate diet, which is based only on the ability of insulin to stimulate the synthesis of androgens. However, as early as 1969, it was demonstrated that the consumption of chocolate and fats does not increase the amount and composition of sebum and does not affect the severity of the disease in people with acne. A systematic review of studies published up to 2013 also found no evidence of the benefits of low-carb diets, facial hygiene, sunlight exposure or smoking cessation. So you shouldn’t accuse people with acne of being unclean and unable to control their habits and love of sweets. They are already stressed.

Antibiotics
European recommendations for severe acne suggest the use of broad-spectrum antibiotics in maximum doses continuously for more than 3 months. The goal of therapy is complete clearance of acne lesions from P. acnes. It is necessary to take into account that P. acnes is on the skin of all your relatives and friends, so after completion of therapy, your skin will again be colonized by this bacterium. Since P. acnes is not the root cause of acne, antibiotic monotherapy does not make sense and is only advisable as part of a set of measures aimed at eliminating the factors determining the development of the disease. However, antibiotic therapy for severe acne, even as part of a set of measures, can achieve only a moderate effect in 1/2-2/3 of cases. We should not forget about the consequences of high-dose and long-term therapy with a broad-spectrum antibiotic - the development of resistance of opportunistic microflora, digestive disorders, exacerbation of infectious diseases of the ENT organs and urogenital tract, etc. For these reasons, the Global Alliance to Optimize Acne Therapy has called for limited use of antibiotics with this disease.

Thus, the use of antibiotics may be advisable as part of complex therapy for severe acne in order to suppress the inflammatory reaction during the systemic immune response to the presence of P. acnes in the foci of the disease. It is advisable to select an antibiotic based on the sensitivity of the microorganism to the drug. For mild to moderate severity of the disease, antibiotic therapy is irrational, and the potential benefit of using an antibiotic is negligible given the high risk of side effects.

Hormone therapy
Antiandrogen therapy is a direct way to address the root cause of acne. Estrogens suppress the synthesis of androgens in the adrenal glands, thereby reducing sebum production, which in turn reduces the number of acne lesions by 31-57%. Most often, estrogens are taken as part of complex oral contraceptives (COCs), less often - as a single drug. In cases where the use of estrogens is contraindicated, drugs that block androgen receptors are prescribed. Unfortunately, the use of estrogens and androgen receptor blockers is unacceptable for men, as it inevitably leads to feminization.

As my wife put it about the effectiveness of COCs: “the result is on the face.” However, the abolition of COCs and subsequent pregnancy ruined the whole result - moderate acne returned. Contraindications prevented me from getting hooked on COCs again, so I had to look for other ways to fight for beauty.

Zinc
It is no coincidence that zinc salts are included in various acne ointments. In 1974, acne was found to be more severe in patients with low blood zinc levels. However, the first studies showed the ineffectiveness of external use of zinc sulfate, but skin irritations from its use were more common than in the placebo group. Meanwhile, high-dose oral zinc supplements for severe acne have demonstrated efficacy comparable to that of antibiotics without side effects on the skin.

Taking high doses of zinc salts increases its secretion through the sweat and sebaceous glands, in the secrets of which it reaches its maximum concentration. The mechanism of action of zinc salts is explained by its ability to suppress P. acnes by inhibiting the enzymes of the microorganism, which reduce the bactericidal activity of sebum. In addition, zinc salts inhibit the conversion of testosterone to the more powerful androgen dehydrotestosterone. Since zinc accumulates primarily in the skin, its antiandrogenic effect manifests itself primarily here.

Thus, zinc preparations are able to reduce sebum production and also limit the colonization of the sebaceous glands by P. acnes, which reduces the inflammatory response in severe acne with infectious complications.

Exfoliants
Exfoliation is aimed at increasing the exfoliation of the stratum corneum of the epithelium in order to accelerate the evacuation of sebum through the hair funnels. There are many procedures and products that enhance exfoliation, but I will tell you about one that you can use yourself.

Superficial peeling has been used for skin rejuvenation since ancient Egypt. In the Middle Ages in Europe, fruit acids were used for this purpose, including tartaric acid in wine. Baths filled with sour wine are, of course, luxurious. I recommend the external use of glycolic acid, which gradually reduces the thickness of the stratum corneum of the epidermis, which speeds up the process of evacuation of sebum, and with long-term use will smooth out already formed scars.

Retinoids
Fat-soluble vitamin A preparations easily penetrate the skin and accumulate in the sebaceous glands, where they have an anti-inflammatory effect and facilitate exfoliation of the stratum corneum of the epidermis, mainly in the area of ​​the hair funnels. In addition, retinoids accelerate the natural regeneration of the skin, preventing the formation of new scars. Overall, monotherapy with cutaneous retinoids alone can reduce the number of acne lesions by 71%. Given their high effectiveness and good safety profile, topical retinoids are approved for the treatment of acne in the USA, Canada and the EU.

Using this complex of products for moderate acne, the first visible results were achieved after 2-3 months. Inflammation decreased significantly, papules and pustules disappeared. After 6 months, a result comparable to that obtained previously with the use of combined oral contraceptives was achieved: minor traces of scarring and isolated closed comedones remained. Here are links to these drugs:

1) Cream with retinol (reduces inflammation, accelerates the evacuation of sebum and skin regeneration, preventing the formation of scars)
2) Glycolic acid (accelerates the evacuation of sebum, smoothes existing scars)
3) Zinc, 250 tablets of 22 mg (reduces the formation of sebum, suppresses the colonization of P.acnes in the follicles)

A few recommendations for use:
Exfoliants and retinoids should not be applied to thin skin (lips and eyelids). Also, during the period of use of these drugs, it is necessary to refrain from sunbathing and solarium, and therapy is best carried out in autumn and winter. Application regimen - one evening we apply retinoids, the second - glycolic acid. If after using them the skin turns red and peels, apply a thinner layer and add a break day. Effective doses of zinc for severe acne are high - increase gradually from 22 to 100 mg/day. If gastrointestinal disorders begin, reduce the dosage. To prevent these effects, take zinc only after meals. In some patients, zinc supplementation causes a temporary exacerbation of acne as a result of immune activation and inflammation. These effects should disappear after a few weeks. If no improvement is observed, you should stop using zinc. High doses of zinc and retinoids are contraindicated during pregnancy.

If you liked this article, read mine. And so as not to miss updates -! And if you don’t have a LiveJournal account, subscribe to updates on

»» No. 9-10 "98 »» New medical encyclopedia

ACNE - HOW TO TREAT IT?

Head of the Department of Dermatovenereology with the clinic of St. Petersburg State Medical University named after. acad. I.P. Pavlova, Dr. med. sciences, professor Evgeny Vladislavovich Sokolovsky

Associate Professor of the Department of Dermatovenerology with the clinic of St. Petersburg State Medical University named after. acad. I.P. Pavlova, Ph.D. honey. Sciences, Member of the Board of the St. Petersburg Association of Cosmetologists Elena Alexandrovna Arabian

Assistant at the Department of Dermatovenereology with the clinic of SP6SMU named after. acad. I.P. Pavlova, Ph.D. honey. sciences Tatyana Valerievna Krasnoselskikh

Do you know that:

• a clear relationship between the occurrence or severity of acne and the total calorie content of food, its content of carbohydrates, fats, proteins, minerals, amino acids, vitamins and the nature of nutrition has not been established
• the lipid composition of the secretion of the sebaceous glands in patients with different nutritional patterns is absolutely the same
• worsening of the disease after consuming certain foods (chocolate, pork, cheese, red wine, citrus fruits, coffee) may be due to reactive dilation of superficial skin vessels, which increases sebum secretion or inflammatory response
• The question of prescribing a diet is decided individually. General recommendations include a low-calorie diet, limiting foods and drinks that increase sebum secretion.

Before talking about the treatment of acne (its pathogenesis and clinic were described in World of Medicine, No. 7, 1998), it is necessary to dwell on the principles that patients should follow when caring for their skin.

1. Daily cleansing of the skin.

Most patients can use various antibacterial soaps, foams or gels for washing. Some patients, especially those with signs of liquid seborrhea, probably due to a decrease in the barrier properties of the skin, do not tolerate frequent washing. They develop erythematosquamous rashes or worsen the course of the disease. In such cases, for daily cleansing of the skin, we can recommend lotions and tonics for oily skin or traditional hydroalcoholic talkers, which contain salicylic, boric acids, resorcinol, etc.

2. When caring for your facial skin, you should avoid greasy creams and ointments that cause clogging of hair follicles.

The most preferred form is an emulsion or liquid cream, as well as a gel. Makeup should be used with caution due to the potential comedogenic effects of decorative cosmetics. You should use skin care products and makeup labeled "non-comedogenic".

Currently, a fairly large number of different drugs are used in the treatment of acne. Their use and other modern methods of treating this disease are based on knowledge of the four main pathogenetic mechanisms of the disease:

• hyperproduction of sebum,
• follicular hyperkeratosis,
• activation of bacterial flora,
• inflammation.

The choice of treatment methods should be based on:

- medical history data (hereditary predisposition, duration and factors influencing the course of the disease - stress, premenstrual and seasonal exacerbations, the nature and effectiveness of previous treatment). For women, it is necessary to collect a detailed gynecological history: menstrual cycle, pregnancy, childbirth, oral contraception

- adequate clinical assessment of the disease: degree of severity, type of rashes, their localization and prevalence, type of lesions (inflammatory or non-inflammatory) and severity of complications (scars, areas of hyperpigmentation and excoriation).

Recently, an increasing role has been given to assessing the psychosocial status of a patient with acne. It is known that acne has a significant psychological impact on the patient, causing anxiety, depression, social maladjustment, interpersonal and work difficulties. These points should be clarified during a conversation with the patient for possible psychotherapeutic or medicinal correction of the identified features.

There is no uniform classification of the severity of acne. However, most researchers distinguish three degrees of severity:

• light - the presence of mainly closed and open comedones with virtually no signs of inflammation. With a mild degree, there may be less than 10 papulopustular elements on the facial skin
• average - from 10 to 40 papulopustular elements on the facial skin
• heavy - more than 40 papulopustular elements on the skin of the face, as well as abscess, phlegmonous (nodular-cystic) or conglobate acne.

Mild acne requires only external therapy. Patients suffering from moderate to severe forms of acne require topical and oral treatment.

For mild acne, one of the modern external remedies is prescribed.

Benzoyl peroxide(OXY5, OXY10) has been used in dermatology for more than 20 years. Due to its powerful keratolytic effect, the drug was widely used in the external treatment of ichthyosis. The whitening properties of benzoyl peroxide are used for various changes in skin pigmentation. Due to its pronounced oxidative effect, benzoyl peroxide has a significant antibacterial effect on P.acnes and Staph.epidermidis (even antibiotic-resistant ones), without causing the emergence of resistant strains. Thanks to its keratolytic effect, the drug has an effect on comedogenesis. Apparently, benzoyl peroxide also has a direct anti-inflammatory effect, since during therapy the number of papulopustular elements quickly decreases. The drug is indicated as monotherapy for mild acne, accompanied by the appearance of comedones and inflammatory elements.

Exist combined benzoyl peroxide preparations with antibacterial agents, sulfur preparations, azole compounds. Their efficiency is usually higher.

Synthetic analogue of vitamin A tretinoin(Airol, Retin-A) is prescribed externally in case of intolerance and ineffectiveness of benzoyl peroxide. The drug has a very high comedolytic effect and normalizes the keratinization of the epithelium of the hair follicle, reducing the likelihood of inflammation in it, and also causes a slight decrease in sebum production.

Azelaic acid(Skinoren) has a pronounced effect on the final stages of keratinization, preventing the formation of comedones. The antibacterial effectiveness of the drug is due to its active transport into bacteria. Resistant forms of flora do not develop. This remedy also has an anti-inflammatory effect, but does not affect sebum production.

It should be noted that therapy with benzoyl peroxide, tretinoin or azelaic acid is effective only with long-term use (at least 3 months). In some cases, they can cause skin irritation - simple dermatitis. In such situations, a reduction in the frequency of applications or a decrease in the concentration of the drug is indicated (many products are available in different concentrations). It is not recommended to simultaneously apply two or more of these products to the skin, or use them in severe frosts and active insolation.

Antibacterial In most cases, the drugs are second-line drugs and are prescribed externally in case of intolerance or ineffectiveness of benzoyl peroxide, tretinoin and azelaic acid. Combination external therapy is also possible, including one of the three drugs of choice and an antibiotic.

Antibacterial drugs do not have a comedolytic effect, so it is advisable to prescribe them if papulopustular elements predominate in the patient, but not with acne comedonica. External use of antibiotics in the treatment of acne, which creates high concentrations of drugs at the site of application, can lead to the development of resistance of normal skin microflora and, in particular, P. acnes. This leads not only to treatment failure, but also to the transfer of resistance factors to other microorganisms, which causes the emergence of multi-resistant strains of skin flora. Until the late 1970s, P. acnes was susceptible to all topical antimicrobials. Currently, the number of resistant strains is increasing, but it remains unclear whether this resistance is the result of long-term general antimicrobial therapy or external treatment.

A generally accepted antibiotic in the treatment of acne is erythromycin, which has high antibacterial and anti-inflammatory activity. The modern combination of erythromycin with zinc (Zinerit) has significantly increased the effectiveness of the antibiotic against P. acnes and reduced the risk of the emergence of resistant strains. The presence of zinc in such a chelate complex reduces the production of sebaceous gland secretions, reduces the adhesion of follicular epithelial cells, increases the absorption of erythromycin and potentiates its action. When using Zinerit, the number of both inflammatory (papules and pustules) and non-inflammatory elements of acne (comedones) is significantly reduced.

The drug is widely used for mild and moderate forms of acne. A noticeable improvement is observed after 2 weeks. Sometimes dry skin may occur, so it is advisable to use the drug when there is increased sebum secretion.

Another antibiotic for external use - clindamycin(Dalacin). No cases of flora resistance to it have yet been identified.

In addition to modern external means, traditional preparations of sulfur, salicylic acid, resorcinol, zinc pyrithioneate.

For acne moderate severity the described external therapy is prescribed, but, as a rule, it is combined with systemic antibiotics.

Antibiotics from the group tetracycline- drugs of choice for the treatment of acne. It is preferable to take doxycycline or minocycline, since they are well absorbed, better tolerated and accumulate intensively in the sebaceous glands. Their antimicrobial activity is higher than that of other drugs in this group. Much less commonly, erythromycin, clindamycin and sulfonamide drugs are used for systemic treatment of moderate cases of acne. It should be emphasized that the effectiveness of antibacterial agents is due not only to their direct bacteriostatic effect on P. acnes. Tetracycline and erythromycin have a direct anti-inflammatory effect. For example, they are able to reduce the production of P. acnes chemotactic factor and the migration of neutrophils, and also reduce the level of activated oxygen. Tetracyclines reduce collagenase levels and affect the mechanisms of chronic inflammation. It is possible that antibiotics also affect immune responses in the skin, in particular affecting the level of cytokines.

The positive effect of antibiotic therapy for moderate types of acne is observed only with long-term treatment (at least 1 month). In this regard, it is necessary to take into account a number of side effects that occur with prolonged use of these drugs:

1. Dysbacteriosis - disorders of the gastrointestinal tract (nausea, diarrhea - in 5% of patients) and vaginal candidiasis (in 6% of patients). Dysbacteriosis can also result in gram-negative and pityrosporum folliculitis. Gram-negative folliculitis is caused by Klebsiella, Escherichia, Proteus serratia, Pseudomonas. Clinically, it manifests itself as an acute rash of multiple pustules, nodes, or looks like an ordinary exacerbation of acne. Gram-negative folliculitis is extremely difficult to treat. In case of folliculitis caused by bacterial flora, it is necessary to discontinue the antibiotic received and prescribe ampicillin or sulfonamide drugs. For gram-negative folliculitis caused by fungi of the genus pityrosporum, the use of imidazole drugs externally and internally is indicated. If gram-negative folliculitis often recurs, then it is advisable to discontinue any antibacterial therapy and switch to treatment of acne with isotretinoin.

2. Development of resistance of normal microflora intestines and skin. When using doxycycline, the risk of developing resistance is considered the lowest, erythromycin - the highest.

3. Phototoxic reactions described in tetracyclines, to a greater extent in doxycycline, therefore, during the treatment period, exposure to the sun and tanning in a solarium should be avoided. Apparently, the severity of photoreactions depends on the dose of the drug.

4. Drug interactions . It is believed that when tetracyclines and hormonal contraceptives are taken simultaneously, the effectiveness of the latter is reduced by 6-7 times.

5. Other complications . While taking tetracycline, onycholysis, ulcerative esophagitis, and benign increase in intracranial pressure (headaches, attention problems, congestive optic discs) may occur;
minocycline - grayish-bluish pigmentation of the skin and nail plates, caused by the formation of melanin-drug complexes and existing up to 8-15 months. after the end of therapy. If there is no effect from antibacterial therapy or it is very weak, then the doctor must figure out why this is happening. A low effect of antibiotic therapy is possible:
- with the development of flora resistance,
- with the appearance of gram-negative folliculitis.
In both cases, a microbiological study is indicated. In the future, the issue of changing the antibacterial drug or prescribing synthetic retinoids (isotretinoin). In women, it is also possible to prescribe combined oral contraceptives with an estrogen profile or antiandrogens in addition to external hormone therapy. The effect of such treatment is observed after 3-6 months and can be long-lasting - in patients, sebum production decreases and the number of both inflammatory and non-inflammatory acne decreases significantly. This method of treatment is possible only after consultation with a gynecologist-endocrinologist and a thorough study of the patient’s hormonal levels, that is, it must be prescribed strictly according to indications.

During treatment severe forms acne requires a combination of standard external therapy and general treatment. Antibacterial drugs are prescribed in long courses (up to three or more months). In women with severe manifestations of acne, when antibiotics are ineffective, after examination by a gynecologist-endocrinologist, combined oral contraceptives with an estrogen profile or antiandrogen drugs are prescribed. If after 3 months there is no effect of treatment, isotretinoin is prescribed.

Isotretinoin (Roaccutane) is a synthetic analogue of vitamin A. This drug effectively affects all parts of the pathogenesis of acne. It significantly reduces the production of sebum, reduces the formation of comedones as a result of normalizing the level of differentiation of epithelial cells of the wall and mouth of the hair follicle. When taking isotretinoin, the number of P. acnes decreases, which, apparently, is directly related to a decrease in sebum secretion, since this microorganism uses sebum as a source of nutrition. The number of P. acnes remains reduced for a long time after discontinuation of therapy.

Isotretinoin has a general anti-inflammatory effect due to its regulatory effect on the processes of chemotaxis and phagocytosis, which are altered in patients with acne. Isotretinoin is the most effective drug. The question of its use should be considered in patients with severe forms, especially in the presence of abscess, phlegmonous and conglobate acne with the formation of disfiguring scars and persistent pigmentation disorders. Isotretinoin can also be prescribed for moderate types of acne:
- if long-term repeated courses of antibacterial therapy do not bring the desired result
- if, after several successful courses of conventional therapy, relapses quickly occur
- with a tendency to form scars
This remedy is indicated for patients with acne accompanied by severe psychosocial disorders and for the treatment of such severe forms of acne as acne fulminans.

In most cases, a course of treatment of at least 4 months is required, in 10% of cases - 6 months and in 3% of cases - more than 10 months. Residual effects of acne gradually resolve even after discontinuation of the drug. Remission in many cases lasts several years. To reduce the likelihood of relapse, the total dose of the drug should reach at least 120 g/kg.

Isotretinoin is contraindicated:

• pregnant women, due to the potential teratogenicity of retinoids
• nursing mothers, in cases of hypervitaminosis A
• with hypersensitivity to the active substance of the drug.

• with liver failure
• with renal failure
• with hyperlipidemia
• with diabetes

Isotretinoin should not be combined with:

• with vitamin A (due to the risk of hypervitaminosis A)
• with tetracyclines (due to the risk of increased intracranial pressure)

For women of childbearing age, the drug is prescribed only after a negative pregnancy test result (it is advisable to start treatment on the second or third day of the next menstrual cycle) and against the background of effective contraception. After completion of therapy, four weeks later, a pregnancy test must be performed.

The drug must be taken under the supervision of a specialist. During therapy, clinical and laboratory monitoring is carried out (levels of AST, ALT, triglycerides, cholesterol, alkaline phosphatase, creatinine in the blood serum). If hyperlipidemia is detected and after completion of treatment, it is recommended to repeat laboratory tests after two weeks.

To additional methods acne treatment, indicated only for acne comedonica, includes facial cleansing and a special pinch facial massage. Superficial cryotherapy is often used, which can speed up the resolution of nodular cystic elements. Darsonvalization, cauterization, and laser therapy are used for selected non-inflammatory acne. Surgical procedures have very limited use for acne. Opening cystic cavities is contraindicated because it leads to the formation of permanent scars. Sometimes for abscessed acne, injecting the lesions with corticosteroids is used.

Do you know that:
question about the purpose of ultraviolet irradiation (UVR)
A patient with acne should decide on a purely individual basis:

• many patients note an improvement in the course of acne
  illnesses in the summer, after sun exposure
• UV irradiation causes superficial exfoliation in small doses
  can stimulate an immune response in the skin on the other hand
• UVR enhances the comedogenic properties of squalene,
  contained in sebum
• Ultraviolet radiation in high erythemal doses causes a sharp decrease
  local immune defense and worsening acne

Main symptoms:

• Skin shine
• Pronounced greasiness of the skin
• Pustules on the skin
• Increased greasiness of hair
• The appearance of nodules on the skin
• Pimples on the skin
• Black spots on the skin

Blackheads or acne are inflammations of the sebaceous glands that appear as a result of their contamination and are accompanied by increased production of sebum. These formations can occur in people of different age categories.

Acne is one of the most common skin diseases. In any of its forms, acne occurs in almost 80% of people, especially at the age of puberty, and causes a huge number of problems for boys and girls. But acne can also occur in people over 25 years of age (most often observed with metabolic disorders). During pregnancy it is observed due to hormonal imbalances in the female body.

The most common areas for rashes are the face, back and chest. It is worth noting that if an infection gets into the inflamed gland, it turns into an abscess. After healing of such a pathological formation, a small scar may remain. Treatment of acne is possible only under the supervision of doctors and cosmetologists.

Before acne fully matures, it goes through several stages of growth. First, small bumps appear on the skin - these are small sebaceous plugs. Next, the fat contained in these plugs undergoes a process of oxidation and black dots appear on the faces of adolescents and adults.

Etiology

Doctors divide rashes into two types (depending on the cause that triggered the appearance of acne):

• acne that appears as a result of disruption of the internal processes of the body;
• acne, which is a reaction to an external irritant.

The cause of the first group of acne is hormonal changes in the body of adolescents. Heredity plays an important role. People in adulthood may also experience rashes. In such cases, this is due to the presence of chronic diseases or infections. A separate case worth considering is the occurrence of acne in women during pregnancy.

The second group appears when:

• contact with skin of substances such as oils or greases. Products that contain tar can provoke acne;
• inept use of cosmetics that contain various fats;
• prolonged rubbing, pressure of clothing or underwear on the skin, which causes clogging of the epidermis;
• athletes taking steroids;
• women's use of hormonal contraceptives;
• stress;
• increased sweating;
• acne can occur as a side effect from taking certain pharmaceutical drugs;
• improper skin care.

Varieties

In addition to the usual type of acne, globular acne can be found in adolescents and adults. They are located deeper under the skin than normal ones. In this case, it is quite problematic for the pus to come out, which is why the infection can spread to deeper tissues. Such acne tends to merge with each other.

But the most common types of acne are:

• closed. They look like a white tubercle. A characteristic feature is that plugs are not visible on the surface of the skin. This type of acne most often occurs on the face;
• open. They have a dark color, which makes the plugs inside the pores very visible. Many people are sure that they get this color because particles of dust or dirt are retained on the face, but this is not at all true. Doctors attribute this effect to skin pigmentation. This type of acne is most common on the back;
• abscess. It is a complicated form of ordinary acne.

Acne on the face or back does not have pronounced symptoms. The most common occurrence of acne is in teenagers and women during pregnancy. The most commonly affected areas are the forehead, nose and chin. Acne appears during puberty, as it is at this time that sebum production increases. An increase in the amount of male sex hormone in the body can contribute to the formation of acne.

Acne inflammation, after full maturation, does not cause any complications. The only reminder of acne may be spots on the face or small scars. But this can also be avoided if you seek help from cosmetologists who will carry out a professional procedure for cleaning the face or other areas. You should avoid laser therapy during pregnancy.

Diagnostics

Acne in adolescents is diagnosed through a physical examination. Information about:

• lifestyle;
• self-care for your skin;
• place in life of diets and medications.

In most cases it is not provided. But it is necessary to do it when specialists suspect a hormonal disorder in the body (it is not taken into account only during pregnancy).

During the physical examination, the skin of the face, neck, shoulders, back and other areas with acne is examined. To do this, special lighting and tools are used to examine a particular area in order to see in detail:

• the entire area of ​​skin affected by the rash;
• depth of the lesion;
• possible inflammatory processes;
• changes in skin color.

Treatment

Removing acne in teenagers and treating acne in women and men in adulthood involves reducing the amount of subcutaneous sebum production, removing dead skin cells and killing bacteria with the help of medications. In any case, the method of treatment depends on the severity of the disease and the area of ​​inflamed skin.

Means and methods of treatment are prescribed depending on the severity of the rash. There are 3 degrees:

• initial- closed or open acne, without inflammation. The amount in the affected area should not exceed ten elements;
• average— diagnosed when there are up to 40 pimples on the affected area;
• heavy- there are more than 50 acne spots on the skin of the face, face or back. Often severe acne contains pus.

The mildest degree of rash is treated with cosmetics - creams, gels, ointments or lotions. People in adolescence undergo acne treatment under the supervision of their parents.

Moderate and severe forms are treated not only with means for external use, but by taking drugs orally. In some cases, antibiotics are used in treatment, and in case of hormonal disorders, hormones are used. Such therapy is carried out only under the supervision of doctors and cosmetologists.

Tips for treating acne during pregnancy are aimed at overall improvement of skin condition. Women need:

• drink plenty of fluids, but only non-carbonated drinks;
• eat fresh fruits and vegetables;
• exclude mayonnaise from your diet.

There are folk remedies for getting rid of acne on the face, chest and back, but they have virtually no positive effect. Only highly qualified doctors know how to get rid of acne. Women during pregnancy should not treat acne on their own. The use of any pharmaceutical and folk remedies should be agreed with your doctor.

Surgery is performed extremely rarely. It is indicated for complicated forms of acne, when the formations develop into a cyst. In general, teenage rash responds very well to treatment. In most cases, it is possible to achieve complete disappearance of inflammation and prevent the formation of new acne.

Prevention

Acne prevention products for teenagers, adult men, women (and during pregnancy) include:

• regular and careful skin care;
• using only high-quality cosmetics;
• you need to monitor the quality of the food you eat;
• adhere to a healthy lifestyle;
• eliminate the effects of severe stress on the body;
• minimize communication with unpleasant people;
• monitor hormonal levels;
• at the slightest symptoms, seek help from a doctor.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

In the practice of dermatologists and cosmetologists, acne, or acne, is the most common disease. About 65% of the younger generation suffers from it, and according to some statistics - 95%. Of these, 30% are people over 30 years of age. In approximately 7% of patients, this disease occurs after 40 years of age. Much more is now known about the causes and mechanisms of acne than even 5-10 years ago. However, an increase in incidence in the last 10 years has been observed not only among adolescents, but also among the adult population.

Causes and mechanisms of development

Prevention and treatment of acne are quite complex, despite the availability of effective treatment methods and medications. This disease is a chronic dermatosis of the skin, characterized by excessive function of the sebaceous glands, their chronic inflammation and blockage of the ducts in the so-called seborrheic zones. Seborrheic zones are areas of the skin with the maximum location of the largest sebaceous glands - the face, shoulders, back, upper parts of the anterior surface of the chest.

Most patients are concerned about the manifestations of the disease in the form of various forms of rashes on the face, which often leave so-called (post-inflammatory hyperpigmentation and scarring changes on the skin).

Acne is a genetically determined disease. It is based on a hereditary predisposition to dysfunction of the pilosebaceous follicle. The fact is that the hair follicle and sebaceous gland are hormonally dependent structures. Male sex hormones (androgens) have a stimulating effect on the sebaceous glands. Therefore, two main factors influence the increase in lard production:

1. Increased concentration of androgens (male sex hormones) in the blood.
2. Increased sensitivity of the sebaceous glands to androgens. This factor is the main and genetically determined one, on which the development of the disease and the severity of its course mainly depend.

An imbalance of sex hormones in the body can be expressed by:

• in an absolute increase in the content of androgens (male sex hormones) in the blood;
• in a relative increase in androgens, i.e. with their normal amount, but a decrease in the concentration of female sex hormones (estrogens).

Currently, the main links in the mechanism of acne development are quite well studied. This:

1. Hyperplasia of the sebaceous glands, that is, their enlargement due to excessive division and, accordingly, an increase in the number of glandular cells.
2. Increased secretion of sebum with altered physico-biochemical properties.
3. excretory ducts - excessive keratin content in keratinized epithelial cells and a delay in their desquamation, which leads to narrowing of the excretory ducts of the sebaceous glands and blockage of them with horny masses and dirt.
4. Reproduction of certain types of propionbacteria and other pathogenic microorganisms.
5. The occurrence of inflammatory processes in the walls of follicles expanded by secretomes with a transition to the surrounding structures of the dermis.

The following factors can provoke the implementation of a genetic predisposition, lead to an exacerbation of acne, and contribute to its more severe course:

1. Diseases of the endocrine system, mainly the thyroid gland, ovaries, male genital organs, pituitary gland, adrenal glands, pancreas with disruption of its endocrine (blood) function.
2. Diseases of internal organs, especially the liver and pancreas with disruption of its excretory (into the lumen of the duodenum) function, as well as the intestines and kidneys.
3. Severe or moderate, but long-term psycho-emotional disorders.
4. Poor nutrition and unhealthy lifestyle.
5. Long-term and disordered use of antibiotics, antibacterial and glucocorticoid drugs.
6. Excessive exposure to sunlight, which initially leads to a significant reduction in inflammation and the number of acne elements, but after 3-4 weeks - to a sharp exacerbation of the disease.

Clinical course of the disease

A generally accepted system for classifying the severity of clinical manifestations has not been developed. However, the treatment of facial acne depends on their definition: the intensity of therapy and the choice of methods and drugs. Therefore, most specialists in practice distinguish between the following degrees of severity:

1. Mild degree, which is characterized by the presence on the face of mostly open and closed without inflammatory signs - redness and swelling of the surrounding tissue. There may be up to 10 papular (small elements of a rash without a cavity, rising above the surface of the skin) and/or pustular (vesicles with purulent contents) elements on the skin of the face.
2. Moderate severity is accompanied by the presence of more than 10, but less than 40 papular and pustular elements.
3. A severe degree of the disease is diagnosed in cases where the number of papular and pustular elements on the face is 40 or more. In addition, abscesses, phlegmons or. The latter occur in the dermis or subcutaneous fat. They are a jumble of elements of dense consistency, spherical in shape with an uneven surface and purplish-red color with a bluish tint.

Mild acne

Average degree

Severe disease

Acne conglobata

Importance of examination

Treatment of acne requires a preliminary examination in order to try to identify the main factors contributing to the onset or exacerbation of the disease, as well as in order to prepare the body for systemic treatment, that is, to correct the functioning of other organs and systems.

Such an examination may include:

• clinical blood and urine tests;
• biochemical blood tests for glucose and electrolytes;
• determination of the content of thyroid hormones and sex hormones in the blood;
• examination of the gastrointestinal tract (if necessary);
• sampling and culture of the contents of pustules or conglobate acne for microflora and its sensitivity to antibiotics, etc.

Sometimes the patient needs consultations with other specialists - a gynecologist, endocrinologist, gynecologist-endocrinologist, gastroenterologist and even a nutritionist.

Methods for treating acne

When treating the disease, the following are used:

1. Normalization of nutrition.
2. Drug therapy.
3. Laser treatment.

The importance of proper nutrition

Among adolescents and older people, there are frequent cases of nutritional (dietary) obesity associated with the consumption of foods high in carbohydrates and fats. Many people adhere to a certain diet in order to “preserve their figure.” As a result, a significant decrease in body weight is accompanied by insufficient intake of essential elements into the body, including vitamins and microelements, especially zinc.

It has been absolutely proven that the image and nature of nutrition are not triggers in the development of acne pathology. However, the nature of nutrition has a significant impact on the severity of any disease. Therefore, a diet for acne is of considerable importance in normalizing metabolic processes, the effectiveness of medications, and reducing the severity of the disease.

Dietary nutrition involves limiting fats, carbohydrates, strong drinks (brewed tea, coffee), spices and extractives. It should be balanced and include a sufficient amount of fruits (low in glucose), vegetables and seafood. At the same time, the treatment does not involve adherence to a strict diet and the use of sorbents to cleanse the intestines, due to their ineffectiveness and sometimes harm to the body.

Principles of drug therapy

1. Retinoids, mainly the latest generation - Baziron AS (Benzoyl peroxide) and Differin (adapalene).
2. Azelaic acid.
3. Antibacterial agents for external use.

But if for the treatment of mild acne it is enough to use only external agents, then for moderate and severe forms of the disease it is also necessary to take systemic drugs. These include:

1. Systemic antibiotics.
2. Systemic retinoids Roaccutane (isotretinoin).
3. Antiandrogen drugs (for women) - Dienogest, Cyproterone acetate.

Antibiotics occupy a special place in treatment. The more active and longer the inflammatory processes, including on the face, the higher the likelihood of post-acne formation and its severity. Over the past decades, it has been proven that antibiotics for acne with inflammatory elements are the most effective treatment, especially tetracycline antibiotics. However, every year there is a rapid increase in the resistance of pathogenic microorganisms to them. In addition, they have side effects (especially with long-term ingestion) such as allergic reactions, negative effects on the liver, and dysbacteriosis.

In this regard, recent studies have attracted attention in the field of the use of various regimens of the antibiotic Azithromycin (Sumamed) for moderate and severe forms of acne. It has the ability to accumulate over time and specifically in areas of inflammation, preventing the reproduction and growth of Propionbacterium acnes - the main microorganisms involved in the development of inflammatory processes in acne.

The following Azithromycin dosage regimens were used:

• 0.5 g per day for 3 days monthly; in moderate forms, such use of the drug for 3 months leads to a significant (statistically) decrease in the number of inflammatory elements in different areas of the face;
• 0.5 g 3 times a week for 3 months is clinically highly effective, safe and without side effects in 80.7% of people with moderate and severe forms of the disease;
• 0.5 g 3 times a week for 2 months without the use of local drugs; the drug was used in persons with moderate and severe forms of the disease; when using this regimen, in 90.4% of patients, already in the first month of treatment, the number of inflammatory elements decreases by 20%; the most pronounced facial cleansing is observed by the end of the second month in 61.5%, and the achieved positive effect persists for 4 months.

Another effective antibiotic is Doxycycline. This was proven in a comparative randomized, double-blind, controlled study of two antibiotics. Doxycycline was taken 0.1 g per day for 3 months, Sumamed - 0.5 g per day for 4 days per month every 4 consecutive months. Both drugs turned out to be comparable in their effectiveness, but the clinical effect of Doxycycline was statistically significantly more effective in people over 18 years of age. Thus, these two antibiotics are effective and safe in the treatment of acne.

Drug therapy

Laser treatment

Compared to other hardware techniques, laser treatment of acne is well tolerated and produces lasting and rapid results after a single procedure. It is assumed that its effectiveness is associated with the destruction of porphyrin contained in propionbacteria, and therefore with a detrimental effect on the latter.

Various types of sources are used to treat acne. For example, for mild to moderate illness, a laser with blue light is used. Treatment is carried out 2 times a week for 4 weeks, after which most of the elements disappear. This type of beam does not cause pain or complications.

Infrared laser (1450 nm) causes pain and possible hyperpigmentation and scarring and is therefore used with local anesthetics and cooling solutions. 4 procedures are carried out - 1 procedure monthly. The result is the disappearance of most acne and remission within six months.

With long-term progression of acne, dynamic changes in the vessels of the microvasculature are characteristic, which are expressed in the expansion and increase in the number of terminal lymphatic vessels, the restructuring of venules and post-capillaries, disruption of their hemodynamic reaction and metabolic processes. Copper vapor lasers with green and yellow wavelengths have a good effect on these pathological changes. They are used for severe forms of the disease with the presence of dense and widespread conglobate acne with purulent discharge and fistulas.

On the 2nd day after fractional photothermolysis

The correct choice of drugs and methods, the volume and intensity of therapy require an individual approach to each patient, taking into account the prevalence of acne elements and the severity of the disease.