ACNE: pathogenesis and modern treatment methods

Acne (acne) is a chronic inflammatory skin disease characterized by damage to the pilosebaceous follicle, the main symptoms of which are:

• open and closed comedones (acne);
• inflammatory painful nodules (pimples), pustules (ulcers) and nodes;
• wide pores;
• oily skin.

Acne is a problem not only for teenagers, it is also typical for patients aged 25-35 years (later acne).

Causes of acne

Can be internal and external .

Internal causes include hormonal dysfunctions (increased levels of androgens, low levels of progesterone, insulin resistance, etc.), thickening of the stratum corneum of the epidermis (hyperkeratosis), deficiencies of vitamins, micro- and macroelements, and taking certain medications.

External reasons include:

• cosmetics with comedogenic effects;
• solar insolation (excessive ultraviolet radiation causes increased secretion of sebum and additional drying of the stratum corneum, which leads to exacerbation of acne);
• contacts with household and industrial chemicals (petroleum products, lubricating oils, chlorine).
• self-squeezing out acne (in this case, the infection penetrates into the deeper layers of the skin, inoculates non-inflamed elements, leading to their infection and suppuration);
• abuse of hygiene products (paradoxical as it may seem);
• high humidity and hot climate.

What's happening?

The algorithm for the development of inflammation of the sebaceous duct is simple:

1. Blockage;
2. Getting infected;
3. Inflammation;
4. Acne.

It is clear that it is possible to prevent the “birth” of a pimple even before the development of the inflammatory process, at the initial stage. If you notice changes in the condition of your skin, start adjusting your usual cosmetic products before you need an acne product.

But what to do if rashes are already ruining your reflection in the mirror and your life? First you need to identify the "enemy".

What does acne look like?

Acne on the skin in adults can manifest itself in different ways depending on the severity of the inflammation process. Acne in adults is localized in areas where the glands are highly active and the pores are maximally enlarged. Cheeks and cheekbones are less prone to acne.

Acne in an adult can be of several types regarding external manifestations:

• Black dots. Occurs on the surface of the skin. Black dots are skin pores in which the secretion of the sebaceous glands, keratinized epidermis, and dust have accumulated.
• Closed comedones. The skin pores are filled with condensed secretions and, as they oxidize, acquire a gray-black color.
• Nodules. Subcutaneous painful inflammation. Noodles feel like hard bumps to the touch.
• Papules. Small reddish pimples without purulent contents.
• Pustules. Everyone knows “classic” acne. They are accompanied by the discharge of pus.

Acne in adulthood occurs in several stages:

• Easy. Moderate oily skin, a small number of blackheads.
• Average. More intense oily shine, from 10 to 20 whiteheads and blackheads.
• Moderate. A significant number of comedones with obvious signs of acute inflammation are formed on the skin.
• Heavy. Large painful pustules, regular inflammatory processes.

Medical treatment of acne and seborrhea

There are skin diseases that are treated by both dermatologists and cosmetologists. These include things that everyone may have, that you may not pay attention to, but that you really want to get rid of, since it affects the aesthetic appearance of the skin. So, these are problems that spoil the appearance and cause not so much physical as mental suffering. We will focus here only on the most common ones - Acne, seborrhea and various formations on the skin.

Acne vulgaris or juvenile acne

Acne

– the most common skin disease in adolescents and young people, that is, the most socially active part of the population. This unpleasant disease affects about 85% of people aged 12 to 25 years in European countries, so clear skin at this age is the exception rather than the rule. The presence of inflamed pimples, pustules and ulcers, blackheads (comedones), spots and scars, a greasy, untidy appearance of the skin in the most visible places causes difficulties in communication, professional organization, reduces self-esteem, and often leads to the formation of significant psycho-emotional disorders, even the desire for complete isolation. Some young people stop leaving home, give up school and work, become isolated, and eventually a minor and completely banal skin problem develops into a personal tragedy. A patient who consults a dermatologist about acne has serious psychological problems. Shyness, guilt, a sense of social unacceptability, anger, depression, and disbelief in the possibility of a cure are expressed to varying degrees. Intense experiences aggravate the course of the disease. In stressful situations, patients, especially women, pick at the skin and squeeze out acne, which further worsens the appearance of the skin due to associated inflammation. In such injured areas, scars and spots remain that do not go away for a long time.

Acne

– a long-term disease, often exacerbating (in girls, usually monthly) and often resistant to treatment. Currently, we know much more about acne than ten years ago, and a competent specialist can always help a patient. In this regard, the opinion that existed in the past that acne will go away on its own with age, and therefore there is no need to waste effort on treating it, now sounds simply absurd. It is not always possible to immediately find the right individual approach, but the efforts made and perseverance shown are always rewarded with a good result. Specialists have a number of effective medications from different groups in their arsenal. The choice of drug depends on the form of the disease, the predominance of certain symptoms, the gender of the patient, and the presence of contraindications.

Acne is most often divided into:

1. acne with a predominance of comedones (white and blackheads with mild inflammation);
2. papulopustular acne (there are comedones, inflamed nodules - what are usually called pimples, pustules, sometimes single large painful lumps, gradually turning into ulcers such as boils);
3. conglobate acne (along with all of the above, there are long-term painful lumps that leave pronounced scars after healing).

Over time, most patients develop the habit of squeezing out comedones and pustules, constantly touching the inflamed skin, which is why bloody crusts, spots, and superficial scars are added to everything described.

Many factors take part in the development of acne, the action of which is ultimately realized in the pilosebaceous follicles. Not all follicles are affected, but only those with a special structure, located on the face and in the upper part of the body, with large sebaceous glands, wide (up to 2.5 mm) ducts and thin, almost invisible hairs. The sebaceous glands are the target organ for sex hormones, especially testosterone. Under the influence of testosterone, produced by the gonads especially actively in adolescence, the size and number of sebaceous glands increase significantly, the production of sebum increases, and its composition changes. In addition, in the development of acne, disruption of the keratinization of the sebaceous gland ducts, difficulty in the outflow of sebum to the surface of the skin, increased proliferation of microbes in accumulated sebum and subsequent inflammation are essential. With the help of modern medicines it is possible to influence almost all factors involved in the development of the disease.

At the initial manifestations of acne (usually at the age of 8–13 years), when the clinical picture is dominated by increased oily skin and comedones (whitish nodules and blackheads), and there are not many inflammatory elements, preparations of retinoic and salicylic acids are used externally. Both acids have the property of dissolving comedones, and salicylic acid has a much weaker effect in this regard. For papulopustular acne, it is advisable to use antibiotics, retinoids, benzoyl peroxide (benzoyl peroxide), traditional external agents (salicylic, chloramphenicol, resorcinol alcohols). Severe forms of acne, including conglobate acne, should be treated with retinoids prescribed orally, and only if there are contraindications, other treatment methods (antibiotics, immunomodulators) should be used. As with papulopustular acne, it is preferable to use a combination of different drugs.

Problems solved during the treatment process and ways to solve them:

• reduction in sebum production (retinoids, especially retinoic acid, hormonal drugs - estrogens, progestins or antiandrogens, spironolactones);
• reduction of inflammation - antibiotics (tetracyclines, erythromycin, lincomycin, clindamycin) and local anti-inflammatory and microcirculation-improving agents, including zinc oxide, sulfur, tar, ichthyol, resorcinol;
• prevention of the appearance and elimination of comedones (retinoids, especially retinoic acid, salicylic alcohol);
• preventing the appearance of scars (early initiation of treatment, retinoids, curiosin, contractubex, avoiding trauma to rashes).

Features of acne treatment with drugs of different groups

Currently, retinoids are the most effective group of drugs for the treatment of acne. Their use solves several problems at once - reducing sebum production and inflammation, preventing the appearance and elimination of comedones and scars. Two isomers of retinoic acid (tretinoin and isotretinoin) are used for external treatment of acne. Roaccutane and Retinol palmitate are used for internal treatment of conglobate acne and common papulopustular acne resistant to other external agents.

Roaccutane (isotretinoin) (Hoffmann-La Roche, Switzerland) is available in capsules for oral use of 10 and 20 mg (30 pieces per package). Prescribed at the rate of 0.5–1.0 mg/kg body weight per day, taken in equal parts 2 times a day after meals for 12–16 weeks. If repeated courses are necessary, the break should be at least 8 weeks. Roaccutane is a highly effective drug, however, its use is limited by high cost and many side effects. Treatment is always carried out under the supervision of a specialist.

Retinol palmitate

(vitamin A) is a domestic drug, it is produced in capsules for oral use at 33,000 and 100,000 IU, as well as in an oil solution at 100,000 IU/ml. Effective doses for acne are at least 300,000 IU per day. The course of treatment is 12–16 weeks. The intervals between courses are 4–8 weeks. Retinol palmitate is inferior in effectiveness to Roaccutane, however, it is better tolerated and the cost is much lower.

For external treatment of acne, preparations containing all-trans retinoic acid (tretinoin) and 13-cis-retinoic acid (isotretinoin) are used. All-trans retinoic acid is contained in the following foreign preparations: Retin-A – 0.05% cream in tubes of 30 g (Silag, Switzerland), Lokatsid – 0.05% cream in tubes of 30 g and 0.1% solution in 15 ml bottles (“Pierre Fabre”, France). External preparations with 13-cis-retinoic acid, which has higher bioavailability, are produced only in Russia - Retinoic ointment 0.1% and 0.05% and Retasol® (FNPP "Retinoids"). It is recommended to apply ointments and solution to previously cleansed skin 1-2 times a day. Once the effect is achieved, it is recommended to reduce the concentration or reduce the frequency of application of the drug. Duration of treatment is 12–16 weeks.

Drugs from the retinoid group have a number of side effects. The most serious of them are teratogenicity and embryotoxicity. In this regard, women of childbearing age are prescribed retinoids with reliable contraception and a negative pregnancy test. In the outpatient card, when prescribing systemic treatment, a note is usually made about the woman’s awareness of possible side effects, and abroad dermatologists offer women to fill out and sign a special form in order to avoid further prosecution in the event of side effects. External treatment with drugs of this group is stopped when pregnancy occurs. Retinoids do not have a negative effect on the reproductive function of men.

In the first or second week of treatment, most patients experience an exacerbation reaction, expressed in redness, moderate itching, and peeling of the skin. The patient should be warned about the reaction, and if he is facing important life events at this time, then it is better to postpone the start of treatment. Typically, these phenomena go away on their own within a few days, after which a lasting improvement occurs. Dry lips, cracks in the corners of the mouth, peeling of the skin are common during the treatment process; they are eliminated by using a neutral moisturizing cream for the face and body, hygienic lipstick or lip gel, and limiting the use of detergents when washing and washing. With systemic administration of retinoids, dry nasal mucosa, nosebleeds, conjunctivitis, urethritis, increased levels of transaminases and lipids in the blood, and increased sensitivity of the skin to sunlight are sometimes observed. Taking this into account, before the start of treatment and monthly during treatment, a biochemical blood test is performed, it is recommended to use sun protective creams, and avoid direct sunlight.

Contraindications

pregnancy and lactation, abnormalities in biochemical blood tests (hyperlipidemia, increased activity of ALT, AST and alkaline phosphatase), renal and liver failure, hypervitaminosis A, drug intolerance. Retinoids cannot be prescribed simultaneously internally and externally, ultraviolet irradiation, drugs with keratolytic and exfoliating effects, exfoliating cosmetic procedures and products (scrubs, peeling). The effect of retinoids is weakened by the simultaneous use of glucocorticosteroid drugs and alcohol intake.

Antibiotics

Of the wide range of antibiotics used to treat acne, only tetracyclines, erythromycin, lincomycin, josamycin and clindamycin are used. Prescription of antibiotics orally is indicated when a large area of ​​skin is affected, with a predominance of pustules. During pregnancy, only erythromycin can be used among these drugs.

Antibiotics of the tetracycline group have an advantage over other groups, since they are lipophilic and easily reach the main object of their action - the sebaceous glands. They can be prescribed for a long time - 2-3 months in a small dose. In this case, they block the production of bacterial lipases, the main link in the development of inflammation. A significant advantage of this method is the possibility of long-term treatment without disturbing the composition of the intestinal flora. The daily dose of tetracycline is 1000 mg (10 tablets of 0.1 g or 4 tablets of 0.25 g), doxycycline hydrochloride is 50 mg (1 capsule of 0.05 g once a day), Unidox Solutab is 50 mg ( 1/2 tablet of 0.1 g), metacycline - 600 mg (2 times a day, 0.3 g). Antibiotics of the tetracycline group in the indicated doses are always well tolerated, and side effects characteristic of long-term use at a bacteriostatic dose do not develop. Tetracyclines are contraindicated in concomitant fungal diseases, pregnancy (last trimester), liver dysfunction, leukopenia, children under 8 years of age, and kidney disease. During treatment, insolation is not recommended, ultraviolet irradiation, retinoids for internal use, hormonal contraceptives, psychotropic, anticonvulsant and antidiabetic drugs are not prescribed. Absorption of tetracycline is weakened in the presence of food, especially milk and fermented milk products, as well as trace elements - aluminum, calcium, magnesium, iron. Their use should be avoided during treatment. Tablets are taken separately from meals.

Doxycycline, Metacycline and Unidox Solutab are better absorbed and can be taken with or after meals with plenty of water. Unfortunately, microorganisms quickly develop resistance to drugs in this group, and when re-prescribed they are rarely effective.

Erythromycin belongs to the group of macrolides, the daily dose is 500-1000 mg divided into 3-4 doses 1-1.5 hours before meals. The drug is available in tablets or capsules of 0.1, 0.25 and 0.5 g. Possible side effects include nausea, vomiting, diarrhea, and liver dysfunction. The drug is contraindicated in case of individual intolerance, liver diseases with impaired liver function. It should be borne in mind that erythromycin is inactivated by dairy products and acidic drinks, and also increases blood levels and enhances the toxic effect of carbamazepine (tegretol, finlepsin) and theophylline.

Clindamycin (lincomycin group) is prescribed in a daily dose of 0.6 g, divided into 2 doses, available in capsules of 0.15 g and under the name Dalacin C - 0.15 and 0.3 g. The course of treatment is 7–10 days. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with erythromycin and B vitamins. Lincomycin is prescribed in a daily dose of 1500–2000 mg (2 tablets 3–4 times a day), available in capsules of 0.25 g. The duration of treatment and side effects are similar to clindamycin.

Josamycin or vilprafen in a daily dose of 1000 mg (1 tablet 2 times a day between meals) is used for 2–4 weeks, then 1 tablet. within 8 weeks. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with lincomycin and weakens the effect of hormonal contraceptives.

If antibiotics are intolerant, they resort to sulfonamide drugs, usually co-trimoxazole (Biseptol, Septrin, Groseptol, Cotripharm 480). The drug is prescribed 480-960 mg (1-2 tablets) 2 times a day during or after meals with an interval of 12 hours. During treatment, it is recommended to drink plenty of fluids, monitor the condition of the blood and urine, avoid solar and ultraviolet irradiation, and do not prescribe ascorbic acid.

It is logical to assume that local use of the above antibiotics may be much more effective and safer than internal use. However, research shows that topical application of erythromycin, clindamycin and tetracycline is effective only for mild acne, especially in combination with zinc, retinoids or benzoyl peroxide. External use of 1% erythromycin ointment (Ung. Erythromycini 1%) has a positive effect only in combination with other external and internal agents; gel with clindamycin Dalacin T (Pharmacia, USA) is more effective. Easy to use Eryderm (Abbott Labor, USA) – 2% solution of erythromycin. Levomycetinic, boric, and resorcinol alcohols are also used to dry and cauterize individual rashes. Combination preparations that are effective are Zinerit (Yamanouchi, Netherlands) - a solution of erythromycin and zinc acetate and Benzamycin, gel for external use, in 20 g tubes (Rhone-Poulenc Rorer, USA), containing 3% erythromycin and 5% benzoyl peroxide. All of the above drugs are prescribed 2 times a day. Like antibiotics prescribed orally, external medications tend to cause the development of antibiotic-resistant strains of microorganisms, so their repeated prescription is often ineffective. Resistance of Propionibacterium acnes strains (the main microorganism that multiplies in the sebaceous glands of patients) to commonly used antibiotics was found in 60% of patients. Increased resistance depends on the duration of therapy; resistance to erythromycin develops more often.

Other antiseptics and disinfectants. One of the successful modern approaches to treatment is the use of benzoyl peroxide, a lipophilic compound due to the presence of a benzoic acid residue in its composition. Benzoyl peroxide applied to the skin breaks down under the influence of air into peroxide and inactive benzoic acid, which remains on the surface of the skin. Active oxygen compounds damage the walls of bacteria, destroying them, and the content of fatty acids decreases, which prevents inflammation. At the same time, the same compounds also have a damaging effect on the horny scales, which is clinically expressed by peeling of the skin that accompanies the therapeutic effect. Benzoyl peroxide preparations have no effect on comedones, so they are not used if they predominate. Various companies offer this drug under the names Benzacne (Polfa, Poland), Desquam (Bristol-Myers, USA), Oxy 5 and Oxy 10 (SmithKline Beecham, UK), Baziron (Galderma, France). Benzoyl peroxide is available in the form of 2%, 5%, and 10% gel, 5% and 10% lotion. Treatment begins with applying a lower concentration of the drug to the face, then it is increased. A higher concentration is immediately applied to the back and chest. Benzoyl peroxide is applied to previously cleansed skin once a day. Side effects include an exacerbation reaction in the first days of use, dryness and flaking of the skin, discoloration of hair and linen when the drug comes into contact with them. Intolerance is common, so before starting treatment it is recommended to conduct a skin test - the drug is applied to a small area of ​​skin on the flexor surface of the forearm for 48 hours. If there is no itching or redness, you can apply the drug to your face.

A combination of topical application of benzoyl peroxide in the morning and Retinoic ointment in the evening has a good effect, especially in the presence of comedones.

Azelaic acid inhibits the growth of microorganisms and reduces the content of free fatty acids on the skin surface. Skinoren cream or gel (“Schering”, Germany), containing 20% ​​and 15% azelaic acid, respectively, is applied to the facial skin (both affected and rash-free areas) 2 times a day. When used, local skin irritation is possible. Skinoren is used in the complex treatment of acne; using it as an independent remedy usually does not bring success.

Zinc hyaluronate is part of the Curiosin gel (Gedeon Richter, Hungary), has a healing and antimicrobial effect. It can be used for a small number of rashes, since the effectiveness of the drug is low. The gel is applied to cleansed skin twice a day; a burning sensation and redness of the skin at the application sites are possible.

Povidone-iodine (Betadine) is used to lubricate pustules in a concentrated (10%) or diluted 1:1 solution with water 1-2 times a day. It is undesirable to use in fair-skinned and red-haired patients due to increased sensitivity to iodine. The diluted solution cannot be stored.

For a small number of comedones in the initial stage of the disease, salicylic alcohol 2–3% is effective. It is used 2 times a day, being careful not to apply to the entire affected area to avoid drying it out, but only to individual areas.

Sulfur is an anti-inflammatory agent; it is included as one of the components in most external agents (ointments and mash) traditionally used in the treatment of acne. However, in recent years, its comedogenic effect has been discovered, i.e. it can cause the formation of comedones.

Hormone therapy

Sex hormone therapy is only possible for women. Estrogens (ethinyl estradiol) and antiandrogens (cyproterone acetate, spironolactone) can be used for treatment. Estrogens reduce the secretion of the sebaceous glands, although not as significantly as retinoids. They can be used simultaneously with topical retinoic acid, antibiotics or benzoyl peroxide, which increases the therapeutic effect. To achieve a good result, estrogens must be given for a long time - at least 5 cycles. The first signs of improvement are noticeable only towards the end of the second or third cycle. Estrogen has many side effects - nausea, fluid retention in the body, swelling of the legs, weight gain, breast tenderness, skin pigmentation, increased risk of vascular thrombosis. Risk factors for side effects include smoking, alcohol consumption, obesity, and vascular diseases. Cyproterone acetate for the treatment of acne is used only in combination with estrogens. Of the combination drugs, Diane-35 and Janine (Schering, Germany) are used. The drug is prescribed 1 tablet per day, starting from the first day of the cycle, for 21 days with a break of 7 days. The antiandrogenic drug Cyproterone or Androcur (“Schering”, Germany) is prescribed 1 tablet (10 mg) per day, starting from the first day of the cycle for 15 days, a new course begins 4 weeks after the start of the first. Glucocorticosteroid drugs are prescribed orally or parenterally only for abscess and fulminant acne, which is extremely rare. External use of corticosteroid ointments is not indicated.

Drugs of other groups

Zincteral (Polfa, Poland) contains zinc sulfate, a deficiency of which is often found in patients with acne. Tablets of 0.124 g are prescribed 1-2 times a day during or immediately after meals for 1-2 months. There may be nausea in the first week of use. The drug enhances the effect of retinoids, but weakens the effect of tetracyclines. Homeopathic treatments include injections of Cutis compositum or Traumeel (Heel, Germany). Herbal medicine is still widely used as an auxiliary means - applications of badyagi pulp for resorption of individual large nodes, lotions with green tea, calamus rhizome, raspberry shoots. Infusions of plants with estrogenic effects (hop cones, sage leaves) are prescribed internally.

Skin care

Many patients, feeling the increased sebum secretion characteristic of acne, try to wash their face as often as possible using soap and a sponge. At the same time, the skin dries out, but sebum secretion does not become significantly lower, since fat is washed out only from the surface of the skin, without affecting the sebaceous glands themselves, located in its depths. In this regard, frequent washing of the skin (no more than once a day), or the use of sponges and washcloths is not recommended to avoid irritation and injury. Many people now use antimicrobial soap. But it changes the state of the microbial flora only on the surface of the skin and does not have a significant effect on the course of the disease. At the same time, antimicrobial additives contained in soap can cause irritation or allergic reactions. To cleanse the skin, it is better to use soft neutral soap for sensitive skin or special cosmetics intended for this purpose (cleansing with milk, then tonic), and to eliminate the shine of the face associated with the release of sebum to the surface, use cosmetic wipes or special mattifying wipes facilities. The widely held belief that decorative cosmetics should not be used for acne has also now been revised. Modern high-quality cosmetics that do not irritate the skin, mask existing defects well, do not significantly disturb sweating, and are not applied to the skin in a thick layer and can be used during the day. It should be removed at home. Some medications require the use of sunscreen. It is better to prefer gels and milk, and also be sure to quickly remove them from the skin indoors. Scrubs and peels may be recommended to smooth the surface of the skin and give it freshness, but are contraindicated during treatment with retinoids, benzoyl peroxide and tetracyclines.

The use of therapeutic masks with a drying effect and detergents is limited during treatment with retinoids and alcohol solutions. If there are pustules on the skin and severe inflammation, massage and cosmetic cleansing of the skin are contraindicated.

Diet

Both in the past and now, most dermatologists always recommend following a fairly strict diet. Our long-term observations have shown that the benefit of such restrictions is small, and only in a few patients there is a clear connection between eating certain foods (mainly chocolate) and increasing rashes. We usually recommend that patients adhere to a reasonable diet, without excesses, and include more fermented milk products and greens in their diet. However, 2-3 days of fasting during an exacerbation always gives a positive result. In general, when prescribing modern therapeutic agents, there is no need to follow any diet to achieve a good result. If the patient is to take part in a festive feast, it is better to stop taking oral medications for 2-3 days and prescribe enterosorbents (Polyphepan, Enterosgel, etc.).

Our recommendations for treating acne

• Initial stage - a few small black dots appear on the nose and forehead (usually in children) - Salicylic alcohol, Retinoic ointment, Skinoren, medicinal cosmetics.
• The same, but for significantly oily skin - Retinoic ointment, Salicylic alcohol.
• Numerous black spots and individual inflammatory nodules and pustules - Retinoic ointment, Salicylic alcohol, on pustules - alcohols with antibiotics, Dalatsin T, Povidone-iodine.
• The predominance of inflammation with a small number of comedones - Retinoids (Retinoic ointment, Retasol®), benzoyl peroxide (Benzacne, Desquam, Oxy 5 and Oxy 10, Baziron), external preparations with antibiotics (Dalacin T, Zinerit, Eriderm, Benzamycin).
• The predominance of pustules in a common process (face, back, chest) - antibiotics, in some cases - retinoids internally (Roaccutane, Retinol palmitate), externally - benzoyl peroxide, disinfectants.
• Individual large painful ulcers on the face - antibiotics, externally - antibiotic ointments and benzoyl peroxide.

Seborrhea and seborrheic dermatitis

In recent years, what was previously united by one term “seborrhea” has begun to be divided into 2 concepts – seborrhea of ​​the head and seborrheic dermatitis (damage to smooth skin).

Seborrheic dermatitis

– chronic inflammatory skin disease. It affects 1-3% of adults (mostly men). Seborrheic dermatitis, along with acne, is a disorder of sebum secretion. Indeed, both diseases are often combined in the same person and affect the same areas of the skin - the so-called “seborrheic zones” - the face, chest (décolleté area) and the middle part of the back along the spine (interscapular region), where the largest sebaceous glands with wide ducts that secrete large amounts of sebum. Sebaceous glands of this type actively develop and increase in size during puberty. The composition of sebum also changes, it becomes more viscous, the components it contains contribute to increased keratinization, which corresponds to peeling visible to the eye. Smaller glands, but also secreting large amounts of sebum, are located on the scalp. Their purpose is to provide fat lubrication to the hair and make it invulnerable to external influences. These glands also become more active during puberty. In adolescents and adults, the mildest form of seborrheic dermatitis is characterized by flaking of the skin and its excess oiliness without inflammation - on the scalp it is dandruff, and on the face and chest - accumulations of fatty scales in the skin folds - near the wings of the nose, in the nasolabial fold, on the bridge of the nose , less often - on the chest and back. Fatty scales soaked in sebum serve as a good breeding ground for the development of lipophilic fungi Malassezia furfur or Pityrosporum ovale. In turn, the immune system reacts to them with the development of allergic dermatitis, the disease enters its second, more unpleasant phase, and is no longer limited to mild manifestations. Itching, burning, at first mild, then more intense redness of the skin, severe peeling, and hair loss appear. The manifestations of the disease are aggravated by the patients themselves - constant scratching, attempts to remove crusts, remove accumulations of scales from the hair, the use of “folk” remedies, and the most powerful ones, inevitably lead to increased redness, the appearance of scratches and wounds, the proliferation of other microbes, and the development of complications of the pustular process. It is usually in this condition that patients turn to a dermatologist, although everything could have been corrected much earlier.

For any manifestation of the disease, you should pay attention to your diet. Sometimes its correction is enough to prevent further development of the disease. Alcohol, sweets and starchy foods should be limited, regardless of the type of food. For itching and inflammation, smoked, salted, pickled foods, spicy seasonings, strong broths, instant coffee, citrus fruits, kiwi, pineapples and juices from them are also temporarily limited.

Treatment depends on the stage of development and clinical picture of the disease. If dandruff appears without inflammation, you can limit yourself to only external treatment; in more serious cases, internal treatment is also necessary. External treatment includes keratolytic, glucocorticosteroid, antiseptic, disinfectant and antifungal agents. Antifungal drugs are usually the starting point for treatment and can be used long-term without the risk of side effects. Various dosage forms are used - creams, gels, shampoos. Shampoos with antifungal substances - Nizoral, Keto-plus, Perhotal, Mycozoral, Sebozol contain 1-2% ketoconazole. Ti/Jel anti-dandruff shampoo contains 0.75% piroctone olamine and 2% salicylic acid. Creams and gels are applied 2 times a day, shampoos - 3 times a week. Various other medicinal substances that also have antifungal properties include zinc pyrithioneate, tar, sulfur, resorcinol and selenium disulfide. Medicines containing these compounds are available in the form of shampoos for the treatment of dandruff (Friderm-tar, Ti/Jel-Newtar, Friderm-zinc) and ointments for the treatment of smooth skin lesions (Skin-cap, birch tar, tar and sulfur-tar ointments ). Prescription forms are also used: Vidal milk, alcohol solutions with sulfur, boric acid, tar. After hair treatment, it is necessary to change combs, hair brushes, and hats.

For severe inflammation, anti-inflammatory, antiseptic and disinfectants are used. For weeping and severe swelling of the lesions, lotions with resorcinol 1% and herbal decoctions are used. The crusts are usually lubricated with alcohol solutions (salicylic, resorcinol, boric alcohols). Corticosteroids have a rapid anti-inflammatory effect - they are used on the head in the form of solutions - Elokom, Diprosalik (Schering-Plough USA), Lokoid (Janssen-Cilag Belgium), Belosalik (Belupo, Croatia), on seborrheic areas - in the form of ointments and creams - Elokom, Diprosalik, Belosalik, Hydrocortisone ointment. It should be noted that on the skin of the face, which is much thinner than in other areas, only non-fluorinated glucocorticosteroids can be used in the form of easily absorbed creams and emulsions (Advantan emulsion, Elokom cream, Lokoid cream) or weak (Prednisolone, Hydrocortisone) ointments. Drugs in this group are not suitable for long-term use due to the risk of undesirable effects - thinning of the skin, dilation of blood vessels, appearance or worsening of acne. When it is possible to relieve acute inflammation (usually in 3-5 days), and with residual peeling, they are replaced by drugs containing vitamin A - emulsion-based ointments Videstim®, Radevit® (FNPP “Retinoids”, Russia). It is known that vitamin A (retinol palmitate) reduces sebum secretion by reducing the size of the sebaceous glands and keratinization, and also has the properties of a local immunomodulator. Videstim® contains 0.5% retinol palmitate on an emulsion basis, Radevit® - 1% retinol palmitate, ergocalciferol and tocopherol acetate (vitamins A, D and E). The drugs are used for a long time, including for the purpose of preventing relapses. In recent years, the local immunomodulator pimecrolimus, supplied to Russia under the name Elidel, has also been used in treatment. Keratolytic agents are used for severe peeling and crusting. Apply sulfur-salicylic ointment 2-5% 1.5-2 hours before washing hair under a scarf, on the face - 1 hour before washing, 10% ointment with urea Carboderm (Ukraine). A particularly good effect is brought by combination drugs that combine the keratolytic properties of salicylic acid and anti-inflammatory glucocorticosteroids - Diprosalik, Belosalik. Internal remedies include vitamin A (retinol palmitate) in a daily dose of 100,000–200,000 IU (once at night for 2 months), B vitamins, in particular brewer’s yeast (Merz Germany and domestic companies), brewer’s yeast with the addition of zinc and selenium Nagipol, multivitamin-mineral complexes, preparations with selenium (Selevit, Triovit), zinc (Zincteral). To reduce sebum production in women, hormone therapy (Diane-35, Janine) and antiandrogens (Androcur) are used - see above. Despite successful therapy, the disease often recurs. A rational approach to diet and careful selection of skin and hair care products are necessary to maintain a favorable treatment result for as long as possible.

prof. IN AND. Albanova

What is the difference between adult acne and teenage acne?

If high levels of testosterone and acne in adolescence are the norm, then acne in adulthood in women makes us seriously think about our health.

The main differences between teenage and adult acne:

• Origin. Adult acne, unlike teenage acne, has a different hormonal nature. During adolescence, inflammation occurs due to changes in the body and constant hormonal fluctuations. Hormonal acne in mature women is a clear sign of impaired production of sex hormones, and, therefore, problems with the reproductive system. Adult acne, unlike teenage acne, is characterized by hormonal imbalance and requires additional consultation with an endocrinologist.
• Floor. Acne affects all teenagers - both girls and boys. Acne in adulthood is often observed in women; men suffer extremely rarely.
• Area of ​​location of inflammatory foci. If in adolescents the T-zone is more often affected, then in adults it is the lower third of the face.
• Course of the disease. Adolescence is characterized by a large number of comedones - sebum is produced under the influence of sex hormones and the skin is less sensitive during this period. The regeneration processes of adult skin proceed more slowly (the regeneration cycle of adult skin is at least 60 days). Often spots form at the site of inflammation.
• Preparations for the treatment of acne. Young skin tolerates active substances – acids and retinoids – more easily. Mature skin is not as oily and should be taken care of more carefully.

Price for acne treatment in Moscow

• BBL /BBL photorejuvenation at the gene level
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  SKIN PHOTOTHERAPY
  BENEFIT UP TO 25%
  Area of ​​influence	Specialist. price, rub.	price, rub.
  Forehead	5 900
  Face	14 900	19 900
  Neck	11 950	15 950
  Cleavage	14 900	19 900
  Face+Neck	20 200	26 900
  Face+Neck+Décolleté	26 950	35 900
  Cheeks	9 900
  Chin	5 900
  Hands	8 200	10 900
  Forearms	13 450	17 900
  Back (subscapular area)	12 900
  Back (to the end of the shoulder blades)	15 900
  Full back	23 900	31 500
  One flash	500

  ACNE TREATMENT FOREVER CLEAR
  Face	13 450	17 900
  Cheeks	7 500	9 900
  Shoulders	12 900
  Back	14 950	19 900
  Neckline/chest	12 650	16 900
  Zone 10 cm* 10 cm	12 900

  REMOVAL OF VESSELS AND ROSACEA
  Forehead	5 900
  Cheeks	9 900
  Nose	5 900
  Chin	6 900
  Face	19 900
  1 category / 1 zone	11 950	15 900

  PHOTO REJUVENATION FOREVER YOUNG
  Area of ​​influence	Specialist. price, rub.	price, rub.
  Face	24 700	32 900
  Neck	20 200	26 900
  Cleavage	23 170	30 900
  Hands	14 200	18 900
  Forearms	19 800
  Face+Neck	37 500	49 900
  Face+Neck+Décolleté	48 700	64 900
  LIFTING SKIN TYTE
  Face/lower third	14 900	19 900
  Full face	25 100
  Neck	18 700	24 900
  Cleavage	21 900
  Face + neck	31 200	41 900
  Face + neck + décolleté	41 200	54 900
  Cheeks	15 100
  Hands (pair)	12 700	16 900
  Inner surface of hands (pair)	22 900
  Elbows (pair)	11 900	15 900
  Inner thigh (pair)	29 900
  Belly (upper zone)	16 900
  Belly (lower zone)	18 900
  Full belly	26 900	35 800
  Patellar region	14 900	19 900

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  Neoplasma modeling ACR Regen Lab / Switzerland
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  Name of service	Specialist. price, rub.	price, rub.
  Classic set "Regen ACR Extra"	28 860	33 950
  Royal set "Regen ACR Plus"	37 360	43 950
  Additional test tube for the set (red or blue)	16 960	19 950
  Gold tube with hyaluronic acid	21 210	24 950
  Neoplasma modeling Regen ACR / Scalp	15 210	17 900

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  Use 1 tube (10 ml)	10 960	12 900
  Use 1 tube (20 ml)	14 360	16 900
  Using 2 (10 ml +20 ml)	16 320	19 200
  Using 2 tubes (20 ml +20 ml)	20 310	23 900
  Scalp /1 tube	10 960	12 900
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  Use 1 tube (10ml)	7 570	8 900
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  Scalp / 1 tube (10ml)	7 560	8 900
  Scalp / 2 tubes (10ml+10ml)	9 260	10 900

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  Make an appointment

  Read also:  Ushakov Nikolay Gennadievich - plastic surgeon

What are the causes of back acne?

Western doctors call acne on the back of adults “bacne.” And although the foci of inflammation are not as noticeable as acne on the face, this does not make it any easier.

The causes of acne in adults on the back are the same as on the face:

• genetic predisposition
• hormonal imbalance
• poor nutrition

But the formation of acne on the back of an adult is also provoked by external factors:

• Cloth. Constantly wearing synthetic fabrics creates a favorable environment for the proliferation of microbes.
• Ultraviolet. Sun rays damage the skin and reduce immunity.
• Poor hygiene. Lack of hygiene procedures contributes to the accumulation of sebum on the skin.

Treatment for back acne in adults may vary. In women, acne on the back may indicate diseases of the reproductive system. Often women are addicted to diets, which provokes hormonal imbalance. In men, acne on the back is associated with fluctuations in the level of male hormones.

Terms

Purulent forms of acne are provoked by the activity of infectious bacteria inside the clogged sebaceous gland. First, comedones appear from the blockage of the sebaceous duct, which can grow into blackheads and pimples. The term “acne” is used to generally refer to inflammatory skin diseases associated with disruption of the normal functioning of the pores.

A comedon is a plug of dense sebum at the mouth of the hair follicle. The black color of its tip is due to the oxidation product of tyrosine contained in sebum. This is how unpleasant black dots appear in enlarged pores.

Acne is the general name for pimply skin diseases. Rashes have many types and causes.

Acne is the result of inflammation of the sebaceous glands of human skin. Acne develops from comedones.

Causes of acne on the chin?

Flawless facial skin can be marred by acne on the chin of an adult woman. Such imperfections not only spoil the aesthetic appearance, but also cause discomfort. The situation is aggravated by attempts to disguise acne on mature skin with foundation.

Rashes on the chin indicate a hormonal imbalance, poor diet, or improper skin care.

Acne in adult women often occurs during the premenstrual period, when the level of steroid hormones increases. Approximately 70% of women associate the appearance of acne with menstruation. Often, the problem of acne in adult women appears a week before the start of menstruation.

Acne on the chin can occur during menopause, which is associated with hormonal changes.

Benefits of acne treatment at Telos Beauty Prof

• Safety. Our doctors use only high-quality certified products and devices certified in the Russian Federation.
• Quality. The high level of knowledge and extensive practice of doctors allow us to carry out procedures with minimal trauma, no complications and a short recovery period. Can be used at any time of the year.
• Comfort. We will do everything to ensure that the procedure takes place in comfortable conditions and you enjoy it.
• Result guarantee . A powerful effect, our doctors use their own methods of combined procedures to achieve 100% results.
• Escort. We take care of you throughout the entire period of rehabilitation, monitor and answer all questions.
• Rehabilitation. Fast recovery period, non-traumatic techniques.
• Effect . The result is noticeable immediately after the session. Due to the correctly selected method of influence, a sustainable effect is achieved.

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Diagnostics

For an experienced dermatologist, an external examination of the patient’s skin is enough to immediately make the correct diagnosis. Specialized laboratory research methods allow us to clarify the mechanism of development of the disease and the presence of pathologies of internal organs: blood tests for hormonal balance and internal infections, tomography of the gastrointestinal tract and liver. It is possible to prescribe additional measures as part of a standard examination if the patient has a history of serious diseases of the internal organs.