Retinoids are effective medications for acne and wrinkles. Experts' opinion

The best creams and gels for acne.

October 22, 2022
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Content

• Why do acne appear on the face?
• How to choose an acne cream
• 10 best creams and gels for acne
• Zenerite
• Delex-Acne
• Baziron
• Klenzit-S from Glenmark
• Differin
• Juniper from Mi&Ko
• Clearasil Ultra
• Lumene Nordic Girl! Clear It Up!
• Skinoren
• Effaclar Duo + by La Roshe-Posay

Thanks to modern acne treatments, you can quickly and permanently solve the problem. We have created a selection of the best creams and gels for those with problem skin.

Both women and men experience pimples and acne, and at any age.

How to solve the problem of teenage acne?

To cure acne in teenagers, you need to act in several directions at the same time. It is easier to stabilize the health of young skin than to rid the skin of an adult of long-standing problems. The sooner measures are taken and remedies for teenage acne are selected, the sooner the skin will again delight its owner with freshness and beauty.

• Go to a dermatologist. A medical examination will help identify chronic and acute diseases of internal organs that affect the condition of the skin. The doctor will select a line of medicinal cosmetics and pharmaceuticals that can safely remove teenage acne.
• Follow skin care rules. Washing at least 2 times a day + maintaining climatic balance (avoid hypothermia, drying out by the wind, sunburn). Even healthy skin needs daily care, and in adolescence it is necessary to use special acne products for teenagers.
• Play sports or at least be physically active. Walking in the fresh air for at least an hour every day is required. It is advisable to visit a sports section; swimming, fitness, football, and cycling are suitable.
• Adjust your diet. More vegetables, fruits, dairy products, less fatty meat, fried and smoked foods; nutritionists recommend completely forgetting about carbonated drinks and fast food.

You should not squeeze or touch pimples with dirty hands, this catalyzes the inflammatory process and triggers the development of new lesions.

Why do acne appear on the face?

Among the causes of acne are such non-obvious, but very possible, as lack of vitamin D, stress, poor environment, use of sunscreen, and long conversations on the phone.

Now let's look at the common causes of acne on the face.

1. Hormonal imbalance.
   Typically, acne appears in women during PMS, in teenage girls and in pregnant women. This is due to the fact that the level of steroid hormones in the blood increases - the sebaceous glands begin to work more intensely. Due to hypersecretion of sebum, the protective abilities of the skin are reduced. The skin secretion thickens, the ducts become clogged with plugs that block the sebaceous glands.
2. Follicular hyperkeratosis.
   In this case, the cells with hair follicles are poorly renewed. The stratum corneum of the hair follicles becomes thicker, which prevents the outflow of secretions from the sebaceous glands.
3. Excessive proliferation of propionic bacteria.
   There are millions of different microorganisms on the human skin and mucous membranes. But sometimes they begin to multiply uncontrollably, and inflammation is possible. Pimples appear because such bacteria feed on the sebaceous plugs of the hair follicles.
4. Lack of zinc in the body.
   When there is a lack of zinc in the human body, the skin produces an excessive amount of sebum - hence pimples and acne.
5. Improper skin care.
   If you use skincare products that are not suitable for your skin type or use low-quality decorative cosmetics, it is quite possible that you will develop acne.
6. Poor nutrition and gastrointestinal problems.
   The appearance of the skin often depends on the health of the internal organs.
   Therefore, with diseases of the intestines and stomach, acne may appear. A balanced diet (less sugar, fast food, baked goods) is also important. Read also Vitamins for hair loss: 10 of the best Review of the best vitamins for hair.

DRUGS USED FOR TREATING ACNE (Part 1)

Preferanskaya Nina Germanovna Associate Professor, Department of Pharmacology, Faculty of Pharmacy, First Moscow State Medical University named after. THEM. Sechenova, Ph.D.

This disease can occur at almost any age, from early childhood to old age, but most often occurs during rapid puberty in adolescents and in girls in the last week of the menstrual cycle. In almost 90% of cases, juvenile acne occurs, observed in patients 12–18 years old. However, over the past decades, cases of acne have become more frequent (up to 11%), which occur at older ages.

One of the most common causes of acne during adolescence is hormonal changes in the body. The active release of steroid hormones, especially androgens (male sex hormones), in both girls and boys, causes increased secretion of the sebaceous glands. Sebum changes its properties, turning from liquid into a dense and viscous secretion. There is hypersecretion of sebum, blockage of pores, papulopustular acne, nodular and cystic formations occur. The dense secretion of the sebaceous glands forms plugs in the ducts, clogs them and forms microcomedones. In the future, comedones are formed; they can be open (blackheads - blackheads) or closed (whiteheads - whiteheads). Comedones are localized on the skin of the face, chest, back, and later on the back of the neck. Open comedones look like black dots that clog the mouths of the hair follicles; when they are squeezed out, a white or brownish plug is released, consisting of thick sebum and horny scales. The black color of comedones is caused by melanin and not by pollution or oxidized sebum.

Closed comedones are small, slightly raised hemispherical papules of white color, and have a very small follicular opening. Closed comedones are the main potential source of inflammatory acne, when, along with sebaceous plugs, the superficial stratum corneum of the hair follicles thickens, and the compacted horny scales create an additional obstacle to the outflow of sebaceous gland secretions. Thickening of the superficial stratum corneum of the skin (hyperkeratosis) can develop under the influence of changes in hormonal levels, vitamin A deficiency, exposure to harmful chemicals or mechanical factors (friction, pressure) on the skin. All this creates a favorable environment for the development of the microbial process. The population of propionic bacteria, anaerobic pleomorphic diphtheroids (Propionibacterium acnes, Propionibacterium granulosum and Propionibacterium avidum) is growing, the staphylococcal flora (Staphylococcus epidermidis) and the yeast-like lipophilic fungus (Malassezia furfur) are activated.

If acne persists into adulthood, then this is a serious signal to think about your health. The appearance of acne can directly depend on the nature of nutrition and the state of the gastrointestinal tract. Very often, exacerbation of acne is associated with exogenous causes, such as masking acne with cosmetics, improper hygiene, a humid hot climate, the bad habit of touching areas of rashes unnecessarily, or even worse, squeezing out pimples.

There are mild, moderate and severe degrees of acne. For mild forms of acne, products for external use are mainly used. Treatment of moderate and severe forms should be comprehensive - local and systemic means.

PRODUCTS FOR EXTERNAL USE

First-line drugs in the treatment of acne - Benzoyl peroxide , Azelaic acid and Tretinoin - are effective with long-term use (3 months or more). Sometimes their use causes skin irritation, which is usually eliminated by reducing the frequency of application to the skin or reducing the concentration. The simultaneous use of 2 or more products is unacceptable; temperature changes and active insolation are harmful (Latin insolatio/insolare - “expose to the sun”).

√ Benzoyl peroxide has been used in dermatology for more than 20 years, has a pronounced antibacterial effect, promotes the dissolution of keratinized tissue, which allows it to be used for the treatment of mild to moderate acne. Treatment begins with a low concentration of the drug for 2–3 weeks, the concentration is gradually increased and used until the skin manifestations completely disappear. If local irritation is observed during treatment, the intervals between applications should be increased. The combination of benzoyl peroxide with antibiotics, azole compounds and sulfur preparations in combination preparations significantly increases their effectiveness. The drug is available in the form of a gel for external use under TN: “ Baziron AS ” (2.5 and 5% tube 40 g), “ Eclaran” (5 and 10% tube 45 g).

√ Azelaic acid has a pronounced antibacterial and anti-inflammatory effect. Prevents the formation of comedones and promotes their removal, while exhibiting an anti-comedogenic effect. Has a depigmenting and anti-acne effect. When using preparations containing azelaic acid, the production of fatty acids is reduced, oiliness is reduced and skin pores are cleansed. The drug under the TN " Skinoren" is available in the form of a 20% cream (tube, 30 g) and 15% gel (tube, 5, 15, 30 and 50 g).

Other preparations containing azelaic acid are “ Azelik” gel 15% (tube 30 g), “ Azik-Derm” cream 20% (tube 30 g).

√ Tretinoin is a synthetic retinoid, an analogue of vitamin A, produced under the technical names “ Isotretinoin” and “ Retin-A” (Retin ointment, 0.05 and 0.1% 10 g), “ Airol Roche” cream 0.05%, used for treatment of acne externally in case of ineffectiveness or individual intolerance to benzoyl peroxide. Eliminates existing comedones and prevents the appearance of new ones by normalizing the processes of keratinization of the epithelium and reducing the secretion of sebum.

√ Isotretionin + Erythromycin (TN " Isotrexin" , 10 g tube) - a combined retinoid gel with a macrolide antibiotic - has an antiseborrheic, anti-inflammatory and keratolytic effect, stimulates the growth of epithelial cells and affects their differentiation. Inhibits the terminal differentiation of sebocytes and hyperproliferation of the epithelium of the excretory ducts of the sebaceous glands, normalizes the composition and facilitates the removal of secretions, reduces the production of sebum and reduces the inflammatory reaction around the sebaceous glands. It affects comedonogenesis, inhibits follicular keratinization, and prevents the occurrence of acne caused by Propionibacterium acne. Erythromycin has a bacteriostatic effect against Propionibacterium acne. When used, side effects may occur in the form of burning, irritation, peeling of the skin, hyperemia, photosensitivity (increased sensitivity when in contact with sunlight).

√ “ Curiozin” (gel 10 and 5 g) contains zinc hyaluronate 15.4 mg, is used to treat acne of varying severity, promotes tissue restoration, improves cellular nutrition processes, and has antimicrobial activity. Hyaluronic acid is directly involved in the process of maintaining skin elasticity and turgor, has a stimulating effect on cell proliferation and restoration, has a beneficial effect on local microcirculation, and takes part in the process of natural wound healing. Zinc provides an antiseptic effect and accelerates wound healing. It is eliminated quite quickly after use, so the burning sensation and feeling of skin tightness that occurs at the beginning of treatment usually go away on their own.

ANTIBIOTICS FOR EXTERNAL USE

Treatment of acne with topical antibiotics is much safer than systemic antibiotics. Antibiotic therapeutic efficacy when used topically is significantly inferior to drugs containing benzoyl peroxide or azelaic acid, so the use of external antibiotics is justified only in case of intolerance to first-line drugs. The external use of antibiotics for acne is used to treat complicated forms of the disease. The disadvantages of antibiotic treatment include the development of an addictive effect and resistance of propionic bacteria.

√ Erythromycin ointment 1% (10, 15 g). The high antibacterial and anti-inflammatory activity of erythromycin is even more pronounced in its combination with zinc, produced under the trademark “ Zinerit” . Zinc, in turn, reduces the secretion of the sebaceous glands and loosens the pores, facilitating the local action of erythromycin.

√ Clindamycin (Dalacin) is a bacteriostatic antibiotic from the lincosamide group, which has a wide spectrum of action, is not addictive to skin microflora and is highly active against propionic bacteria and staphylococci. TN " Klindovit" gel 1% (30 g tube) - the drug is active against all strains of Propionibacterium acnes; after application to the skin, the amount of free fatty acids on its surface decreases from approximately 14 to 2%. The drug quickly accumulates in comedones, exhibiting antibacterial activity. The gel is applied in a thin layer to the previously cleaned and dried affected area of ​​the skin 2-3 times a day. To obtain a therapeutic effect, treatment should be continued for 6–8 weeks, and if necessary, can be continued for up to 6 months. An alcohol solution for external use containing 1% clindamycin per 100 ml is produced under the trademark " Zerkalin" . Excipients are ethanol, purified water and propylene glycol. The solution is applied to the affected area of ​​previously cleansed and dried skin 2 times a day, morning and evening. Klenzit S is a combined gel containing Clindamycin + Adapalene. Adapalene, a retinoid metabolite with an anti-inflammatory effect, normalizes the processes of keratinization and epidermal differentiation. Reduces the binding of follicular epithelial cells involved in the formation of microcomedones. Suppresses chemotaxis and chemokinetic reactions of human polynuclear cells. The gel is applied externally once a day (before bedtime) to previously cleansed and dried affected areas of the skin. The course of treatment is 2–4 weeks. If necessary, repeat the course of treatment. At the beginning of treatment, acne may worsen. If skin irritation occurs, the drug should be temporarily stopped or discontinued. It is necessary to avoid exposure to the sun and the use of artificial UV radiation (solarium).

√ Tetracycline (3% ointment). Tetracycline is a broad-spectrum antibiotic. It is used externally in the treatment of purulent skin infections (acne), prescribed for children over 11 years of age and adults. The drug is applied directly to the affected area of ​​the skin in a thin layer 1-2 times a day. With prolonged use of the drug, redness, discoloration of the skin, itching, slight burning at the site of application of the ointment, and photosensitivity may occur.

√ Levomycetin-Acri is available as an animent and solution for external use, used for bacterial skin infections caused by sensitive microorganisms. It has a bacteriostatic effect with a wide spectrum of action, disrupts the process of protein synthesis in the microbial cell. It is applied topically in the form of alcohol solutions and 5–10% liniment; the drug is applied to the affected surface several times a day.

√ Fusidic acid (fusidic acid) is used for skin and soft tissue infections caused by susceptible microorganisms. A cream is produced for external use under the Fusiderm . For external use, fusidic acid is applied in a thin layer to the affected areas of the skin 2-3 times a day for 7 days. In the area of ​​the affected areas, the drug penetrates deeply into the skin. When treating acne vulgaris, long courses of therapy are required.

√ Antiseptics are often used for acne on the chest and back. A mixture of salicylic alcohol 40 ml with the addition of 3 tablets of chloramphenicol (chloramphenicol) is moistened with a cotton swab and the rash areas are wiped morning and evening for 2-3 weeks. A mixture of salicylic alcohol + boric alcohol + chloramphenicol is also used. Based on salicylic acid, a whole series of very effective anti-acne lotions that do not contain ethanol are produced for problem skin. Lotions can quickly relieve inflammation, heal and eliminate acne of any complexity from the skin, and also stimulate the rapid healing of damaged skin areas. Benzoic acid has an antimicrobial effect, which inhibits the activity of enzymes in microbial cells and prevents the growth of bacteria. In medicine, it is used for skin diseases as an external antiseptic.

√ Dr. Theiss's acne cream - a combined drug - has a dermatoprotective, bactericidal, antibacterial effect; when used, the drug cleanses the skin and eliminates acne. The main active ingredient is triclosan, a chlorine-containing phenol derivative, which has an antiseptic effect. Triclosan is active against gram-positive and most gram-negative bacteria. Ethyl alcohol, sulfur in biosulfur, sodium tetraborate have an antiseptic and disinfectant effect, sulfur has antiparasitic and dermatoprotective properties. Glycerin gives the skin elasticity and protects it from drying out. The drug frees the excretory ducts of the sebaceous glands from horny masses, sebum, dust and causes a nonspecific anti-inflammatory effect.

How to choose an acne cream

When treating acne and pimples, an integrated approach is required, so just cream or gel is not enough. To choose the “right” remedy, you need to determine the cause of the rash. By the way, it often happens that one specific cream does not solve the problem, so you need to try several products. For acne, pharmaceutical creams or gels are usually prescribed, which contain anti-inflammatory components:

• acids (azelaic, salicylic, kojic). They relieve inflammation, cleanse pores, and make skin tone more even.
• essential oils with anti-inflammatory and calming effects (green tea, tea tree, aloe vera, eucalyptus, calendula).
• absorbent minerals that absorb secretions from the sebaceous glands, as well as natural antibiotics (zinc, camphor, sulfur).
• hyaluronic acid (for deep skin hydration).
• retinoids, demethyl sulfoxide - for healing damage, regulating the functioning of the sebaceous glands.
• cosmetic oils that help regenerate the skin (grape seed, olive, peach).

As for acne creams with antibiotics and hormones, they act faster, but they should be prescribed exclusively by a dermatologist. Treating the skin with such drugs is only allowed for a short period of time. If you use hormonal or antibacterial agents uncontrollably, unwanted side effects such as withdrawal syndrome or skin atrophy may develop.

Causes of acne

Photos from open sources

Is it possible to prevent the occurrence of the disease?

It is impossible to prevent the occurrence of the disease, but it is possible to provide prevention or improve its course. For each degree of acne, the LIBREDERM laboratory has developed an algorithm for maintenance therapy with Seracin, which includes from one to three stages:

1. Cleans without drying.
2. Basic care and regulation of the sebaceous glands.
3. Additional care – correction of local imperfections and evening out skin tone.

To prevent the development of the disease, teach your child from 11-12 years of age to wash his face 2 times a day using Seracin cleansing gel.

The gel is designed taking into account the cleansing needs of oily skin and acne-prone skin. It contains antibacterial and anti-inflammatory components of plant origin, as well as an effective cleansing complex represented by modern and safe surfactants. Washing with Seratsin gel removes excess sebum and frees the skin from keratinized epithelium, due to which the pores are cleared of sebaceous plugs, and metabolic processes in the skin are normalized.

Zenerite

One of the most popular remedies for acne and acne, which contains an antibiotic (erythromycin) and zinc salts. Erythromycin prevents the growth of bacteria, and zinc salts work as an antiseptic. If you have been prescribed "Zinerit" for acne, remember that it is not advisable to use it often and for a long time, because addiction develops and the drug simply stops working.

Zenerite

Astellas Pharma Europe, Russia

Zenerite powder for solution preparation (external use), 30 milliliter bottle - a medicinal product for the treatment of acne.
Resistant to cosmetic products. from 533

5.0 1 review

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Treatment with retinoids: drugs, properties, effectiveness

Manufacturers produce quite a few forms of retinoids. The most popular drugs that have successfully shown themselves in anti-acne therapy and skin rejuvenation are described here.

1. Tretinoin. The “flagship” among retinoids in terms of potency.

   It consists of retinoic acid and is very effective even for severe forms of acne and deep wrinkles, but it produces significant side effects if used incorrectly (irritation, burns). Presented on the market in the form of lotions, creams, gels, and capsules for oral administration.

2. Isotretinoin

   . Slightly inferior in strength to tretinoin, but at the same time has a lower risk of side effects. It is mainly used to treat acne and skin rejuvenation. Available in the form of ointments, creams, tablets Roaccutane and Acnecutane.

3. Tazarotene

   . The active ingredient is tazaratenic acid. Provides an excellent effect in the treatment of acne, but the side effects are also pronounced. As an anti-wrinkle treatment, tazarotene can be used for shallow wrinkles. Available in the form of creams, ointments 0.05% or 0.1%. Not recommended for hypersensitivity or severe dry skin. If we compare tretinoin and tazarotene, cosmetologists advise using tretinoin as a more studied drug.

4. Adapalene. The main component is an artificial analogue of retinoic acid.

   It is effective against acne, but is practically useless for skin rejuvenation purposes, since it does not penetrate deep into the skin sufficiently to reduce the depth of wrinkles. Available in the form of Differin gel or cream (0.1%), Clenzit gel (0.1%), there is also a lotion form that shows the best results. Adapalene has virtually no side effects and has a gentle therapeutic effect. You can combine it with benzoyl peroxide based products.

5. Retinol. The main substance is retinoic acid.

   It acts more slowly than other retinoids (the effect is visible after 12 weeks). Popular due to its low side effects. Treatment with retinoids usually begins with it. Common medications are Rapid Wrinkle Repair creams (Neutrogena), SkinCeuticals. The concentration of products with retinol ranges from 0.01-0.4%.

Patients ask where to purchase these drugs, often asking about JSC Retinoids. This enterprise is not a company producing only retinoids; it also produces other pharmacological drugs. You can buy vitamin A preparations at any trusted place, and it is highly desirable that the exact concentration of the active substance is indicated on the packaging.

Reviews from patients and opinions of cosmetologists

Very often, retinoids turn out to be the “saving” remedy that desperate patients come to after using all kinds of medications for acne and acne.
Most of those who have used vitamin A products note their high effectiveness. There are reports of side effects, but the use of any drug (not just retinoids) is in one way or another connected with the individual reaction of the body, so you must read the instructions carefully. Cosmetologists recommend treatment with retinoids under the supervision of specialists to reduce the risk of adverse events and achieve the best results. This article is for informational purposes only, please consult your doctor for details!

Delex-Acne

This gel works well if you have mild to moderate skin breakouts. "Delex-Acne" is also prescribed for demodex (skin mites). An excellent product for home daily facial skin care, it is also used for the active treatment of acne as part of complex therapy. Delex-Acne contains sulfur, calendula and nettle. The acne gel does not contain hormones, antibiotics or alcohol, and therefore has no age restrictions for use. If you choose this gel, then it is optimal to combine it with lotion from the same series. You should use Delex-Acne gel no more than several times a week so as not to dry out the skin. The disadvantages of the product are that the smell is not very pleasant and that you can’t buy Delex-Acne in every pharmacy.

Delex-Acne

, Russia

The gel is characterized by anti-inflammatory, absorbable, antibacterial and sebostatic (drying) effects.
The drug in gel form is considered optimal for use in case of oily seborrheic skin, since the use of creams and ointments can increase the proliferation of harmful microorganisms. from 150

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ACNE IN TEENAGERS

Juvenile acne (blackheads) is the most common skin disease in children and adolescents. The onset of the disease usually occurs in girls aged 12-14 years, in boys at 14-15 years old - due to late puberty. Currently, the myth that the development of acne depends on the nature of nutrition, age hygiene, and sex life has been debunked. Acne is a disease of the sebaceous glands and hair follicles, the functioning of which is associated with the exchange of sex hormones. It is generally accepted that the skin is the main link in the metabolism of sex steroid hormones, and the main “targets” for them are the epidermis, hair follicles and sebaceous glands. Changes in the functional activity of the endocrine system in adolescents at different periods of puberty have their own characteristics. At each stage of development, the sequential inclusion and functioning of endocrine glands, hormones and biologically active substances occurs. They are in close interaction with the synthesis of testosterone (Te) and sex steroid binding globulin (SSBG) secreted by hepatocytes. In addition, the mechanisms of central regulation of the hypothalamic-pituitary system change, which affects the secretion of sex steroid hormones. During puberty, with acne, the ratio between androgens and estrogens is disrupted, and there are twice as many androgens as in healthy individuals. Thus, in the development of acne, the leading role is given to Te and its metabolite - dihydrotestosterone (DTT), the biosynthesis of which is 20-30 times higher compared to healthy people, and in boys this process is more intense than in girls. At the same time, the biosynthesis of some skin enzymes also increases: the activity of 3-hydroxydehydrogenase and 5-reductase is also significantly increased compared to the norm. The latter converts free Te into DHT, which is the main hormone involved in the hypersecretion of the sebaceous gland.

Hypersecretion of sebum is a consequence of high levels of androgens and increased sensitivity of the sebaceous glands to them.

Of decisive importance in this regard are: the direct effect of the increased content of androgens in the blood on the hair follicles and sebaceous glands; increasing the sensitivity of target cells, sex steroid receptors, to circulating androgens; a combination of these two factors.

The secretion of sebum and the size of the sebaceous glands are stimulated by free testosterone of testicular or ovarian origin, dehydroepiandrosterone and androstenedione of adrenal origin. Progesterone, a precursor to testosterone, estrogens and adrenocorticosteroids, has the same effect. Progesterone enhances the secretion of the sebaceous glands due to androgenic and antiestrogenic activity. This fact explains the increase in sebum secretion and the appearance of acne elements before menstruation in women.

An increase in the level of androgens in the blood can be of a temporary physiological nature, for example, during the premenstrual period in women.

Sometimes high levels of free testosterone are caused by decreased levels of sex hormone binding globulin (SHBG). This protein, to which 65% of Te circulating in the blood binds, is synthesized in the liver. The rest combines with albumin, and only 2% of circulating total testosterone remains in the active, unbound form. Therefore, markers of latent hyperandrogenism in males are an increase in the free fraction of Te, and not total testosterone, and a decrease in PSSG (N. E. Kushlinsky, V. A. Samsonov, S. A. Masyukova, I. V. Salamova, 1996).

In women, an important pathogenetic link in hyperandrogenism is the disruption of androgen binding by specific sex steroid binding globulin (SSB), and its concentration is two times higher than in men. This sex difference is explained by the fact that estrogens stimulate, and androgens inhibit, the production of dry eye hormones.

Genetic factors are the trigger point in the development of acne, and, according to K. N. Suvorova (2000), different expressivity and allelic variations of genes that determine the development of the sebaceous glands and their functional ability, and the level of enzymes and hormones to a large extent determine the severity of clinical manifestations . In addition, there is a message about the presence of a nuclear R-factor that determines genetic predisposition. These facts can probably explain the fact that some patients develop quickly passing physiological acne, while others develop more severe forms. According to numerous studies, the likelihood of developing acne in adolescents, if there is a disease in the family or among relatives, ranges from 50-70%.

In addition to androgenic stimulation, hypersecretion of sebum by the sebaceous glands, in most patients the onset of acne is accompanied by hyperkeratinization of the base of the follicle, which leads to blockage of the follicular duct by horny scales and the formation of a microcomedone or a clinically visible closed one (white head); or open (black head). Subsequently, damage and rupture of the duct occurs, with the subsequent development of perifocal inflammation. Retention hyperkeratosis of the acrocrone of the follicle and hyperplasia of the follicular epithelium are decisive in the development of the disease.

Blockage of the sebaceous gland duct entails the cessation of air access, and the resulting oxygen-free conditions are optimal for the proliferation of P. acnes, which is why closed comedones are called a “time bomb.” P. acnes is normally found in sebaceous glands and follicles. The skin also contains staphylococci (epidermal and aureus), micrococci, fungi of the genus Candida and Pytirosporum ovale. Moreover, the number of colonies of microorganisms is proportional to the severity of acne elements: comedones - open and closed, papules, pustules. The outcome of inflammation, as well as the predominance of one of the pathogenetic factors, largely determines the variety of clinical forms of the disease.

An important aspect is the participation of P. acnes in the development of inflammation: they synthesize various chemoattractants that attract leukocytes to the site of inflammation, lipases and a number of enzymes that lead to damage to the follicle wall. They are capable of inducing the production of anti-inflammatory cytokines by mononuclear cells: IL-8, IL-1, TNF, etc., and synthesize antigens that stimulate the production of antibodies, the number of which is increased in patients with acne compared to healthy people. P. acnes produces vasoactive amines like histamine, which increase inflammation. If comedones and papular-pustular rashes are characterized by a high contamination of P. acnes, then with nodular-cystic rashes the amount of P. acnes is minimal. The formation of conglobate acne is probably associated not so much with the number of microorganisms as with a delayed-type hyperreaction (DTH) in the dermis, which may explain the high therapeutic effect of isotretinoin.

The uniqueness of propions largely determines the characteristics of the resolution of inflammatory acne elements. Unlike most strepto- and staphyloderma, inflammatory acne elements resolve more slowly, despite intensive treatment. Torpidity to therapy is due to the resistance of P. acnes to destruction by neutrophils and monocytes, persistence in phagocytic cells, where microorganisms remain viable for a long time, despite antibiotic therapy. In addition, overproduction of sebum does not make it possible to create the necessary concentration of the antibiotic in the ducts of the sebaceous gland. This may explain the prescription of long courses of antibiotics in the treatment of acne.

Thus, genetic predisposition, androgenic stimulation, increased sebum secretion and follicular hyperkeratosis lead to blockage of the sebaceous gland duct with comedones. As a result of the proliferation of P. acnes and the formation of inflammation around the follicle and sebaceous gland, non-inflammatory and inflammatory acne elements (papule, pustule, nodule) are formed. Depending on the nature of the inflammation and the spread of the pathological process in the dermis, the lesions can thicken, infiltrate or abscess with the formation of cysts, which determines the variety of clinical manifestations of the disease. During therapy or spontaneously when acne elements resolve, spots, depigmented scars, hypertrophic or disfiguring keloid scars remain.

Often in adolescents, the onset of the disease is accompanied by the appearance of non-inflammatory and inflammatory acne elements, which are regarded as “physiological” acne. They accompany the pubertal hormonal crisis and, due to their insignificant manifestation (comedones, single papular-pustular acne elements), can spontaneously and completely disappear without treatment. “Clinical” acne occurs in 15% of patients and requires treatment lasting from several months to a year or more or until spontaneous remission is achieved, usually occurring by age 25.

According to the modern classification, the following clinical varieties of juvenile acne are distinguished (G. Plevig, A. Kligman, 1993, 2000).

• Comedonal acne.
• Papular-pustular acne.
• Conglobate acne.
• Inverse acne.
• Lightning acne.
• Mechanical acne.

The development and course of dermatosis depend on the following factors: family (genetic) predisposition, clinical form of the disease, skin type and color. When conducting clinical diagnostics, it is necessary to take into account the following features of acne:

• type of rash (inflammatory or non-inflammatory);
• the number of rashes and their prevalence, size and location;
• severity of complications (pigmentation, excoriation, scars);
• assessment of psychosocial status (anxiety, depression, social maladjustment, etc.);
• if necessary, bacterial culture with determination of sensitivity to antibiotics, studies of hormonal status, skin biopsy for differential diagnosis with other dermatoses;
• patients with severe and often recurrent forms of acne should be examined for the presence of concomitant pathology;
• measurement of the level and rate of sebum excretion (SES);
• creating a trusting relationship between doctor and patient.

In the pathogenesis of acne, primary and secondary factors leading to the development of the disease are distinguished.

Basic principles of treatment: it is necessary to reduce the secretion of the sebaceous gland, reduce inflammation, reduce the colonization of the skin by Propionbacterium acnes and other microorganisms, normalize the mitotic activity of keratinocytes and eliminate blockage of the sebaceous gland duct.

Treatment in many cases is a difficult task, and the use of various therapeutic methods and cosmetics leads only to clinical remission, less often to cure. The choice of therapy is determined not only by the severity of acne, but also by the general condition and psycho-emotional characteristics of the individual.

Currently, recommendations and an algorithm for the pathogenetic treatment of various forms of acne have been developed (XX World Congress of Dermatology, Paris, 2002).

The main objectives in treatment are:

• preventing the formation of comedones (preventive measures and tips for caring for “problem” skin);
• removal of comedones (acne toilet, comedo extraction, tretinoin, retinoic acid, adapalene, salicylic acid, resorcinol);
• reduction in sebum production (retinoids systemically and externally, hormonal drugs - antiandrogens, estrogens, etc.);
• prevention of the opening of comedones, pustules and the development of inflammation (systemic antibiotics and antibacterial drugs for external use);
• combination therapy (systemic antibiotics and topical retinoids or sequential use of glucocorticoids, systemic retinoids, for severe forms of acne);
• preventing the appearance of scars (early initiation of treatment, retinoids, eliminating the possibility of mechanical injury to acne elements);
• improving the appearance of scars only after achieving stable clinical remission (peeling, resurfacing, introduction of implants, corticosteroids; laser therapy, etc.).

The choice of treatment method depends on the following factors: the clinical form of the disease, the nature of acne elements (non-inflammatory, inflammatory), severity (mild, moderate, severe), depth, localization and extent of the process (see Table 1).

For example, comedonal acne is best treated with topical retinoids, while for mild inflammatory acne, retinoids, topical antibiotics, VPO, etc. are indicated. In addition to the severity of acne lesions, complications of dermatosis in the form of scar formation, pigmentation, and also psychosocial problems.

In practice, systemic and topical retinoids are the first choice drugs and were first used for the treatment of acne about 30 years ago by Stuttgen and Baer. First, second and third generation retinoids have general and local effects and are capable of causing a specific biological response as a result of binding and activation of retinoic acid receptors - RAR (retinoid acid receptor).

The mechanism of action of retinoids is to inhibit the processes of keratinization (keratinization), reduce sebum secretion, and also the activity of R. acnes and increased proliferation of epithelial cells of the skin and sebaceous glands, thus affecting all parts of the pathogenesis of the disease.

Indications for external therapy are: mild non-inflammatory and inflammatory forms of acne, as well as non-inflammatory forms of moderate severity.

It is possible to use it in combination with systemic medications for moderate and severe forms of inflammatory acne.

The group of synthetic retinoids of the new (third) generation includes adapalene (Differin), a derivative of naphthoic acid, which has not only the properties of retinoids, but also an anti-inflammatory effect.

The anticomedogenic-comedolytic effect of differin is based on selective interaction with nuclear γ-receptors of epithelial cells (RAR-γ), as a result of which the processes of differentiation of keratinocytes in the infundibulum of the sebaceous gland are improved and the production of sebum is normalized (duct blockage is prevented), as well as the proliferation of skin corneocytes. Thus, differin prevents the formation of microcomedones and promotes the removal of the “keratin plug” (comedogenic and comedolytic effect).

The anti-inflammatory effect of differin has also been studied in vitro and in vivo. It has been established that the drug inhibits the release of cytokines (markers of inflammation) - IL-1, IL-8, IL-12 - through competitive binding to TLR2 receptors of monocytes. In addition, inhibition of lipoxygenase and arachidonic acid, which is involved in the regulation of lipid metabolism in the skin, is observed. The unique pharmacological properties of differin explain its advantages (anti-inflammatory effect, better tolerability) over trans-retinoic and retinoic acid.

One of the disadvantages of external retinoids is their weak effect on hypersecretion of the sebaceous glands, which requires, in some cases, the administration of systemic retinoids (isotretinoin) in adequate doses for severe forms of acne. The drugs are prescribed for a long time (up to three months or more), as well as for prophylactic purposes to prevent the appearance of new acne elements.

For the treatment of conglobate acne, the basic drug is isotretinoin-roaccutane at 0.5-1.0 mg/kg of body weight per day until a total cumulative dose of 120 mg/kg is reached. In addition, treatment with antibiotics gives temporary results, and frequent relapses are observed after their discontinuation. In adolescence, the use of antibiotics should be limited to short courses of no more than four to six weeks, so the emphasis is on the use of topical drugs with multidirectional effects, especially for mild to moderate juvenile acne.

For mechanical acne (pathomymia), psychological rehabilitation, the establishment of trusting relationships with adolescents and the prescription of sedatives in combination with topical pathogenetic drugs are necessary.

For severe fulminant and inverse acne, treatment begins with the prescription of glucocorticoids (prednisolone) in a daily dose of 20-30 mg with a gradual dose reduction by 0.05 mg every five days until the drug is completely discontinued. Prednisolone is prescribed in combination with antibiotics (according to antibiotic sensitivity), and then switched to isotretinoin in adequate doses: 0.5-1.0 mg/kg body weight per day until a total cumulative dose of 120 mg/kg is reached.

Systemic therapy (oral antibiotics, isotretinoin), often in combination with topical medications, is indicated for the treatment of patients with moderate to severe acne. Basic antibiotics are tetracyclines: tetracycline - daily dose of 500 mg twice a day, tetracycline monohydrate - 0.1 mg twice a day, minocycline - 0.1 mg twice a day; macrolides: erythromycin 500 mg twice a day, josamycin: 500 mg twice a day. Alternative drugs for antibiotic intolerance are cotrimoxazole 480 mg twice or timethoprim 100-200 mg from 14 to 21 days. If one antibiotic is ineffective, in some cases it can be replaced with another. However, long-term antibiotic therapy may cause P. acnes resistance, rendering treatment ineffective.

When treating with isotretinoin, it should be remembered that young men with damage to the trunk respond worse to treatment with small doses, so they should be prescribed a starting dose of 1.0 mg/kg, and in older people and sensitive (white) skin - 0.5 mg/kg day, with mandatory monthly biochemical monitoring.

On the pharmaceutical market for topical (external) therapy, various commercial companies offer modern drugs with comedogenic, keratolytic, antibacterial, anti-inflammatory and antiandrogenic properties. One of their disadvantages is their weak effect on hypersecretion of the sebaceous glands, which in some cases requires the use of systemic retinoids (isotretinoin) in adequate doses. The drugs are prescribed for a long time (up to three months or more), as well as for prophylactic purposes - to prevent the appearance of new acne elements.

The basic drugs for external treatment of acne, as well as for systemic treatment, are retinoids, as well as antibacterial drugs - benzoyl peroxide (Baziron AC), local forms of antibiotics (clindamycin, erythromycin, tetracycline, mupirocin, fusidic acid) and systemic antibiotics; alternatives are azelaic acid, hyaluronic acid.

Azelaic acid - a natural dicarboxylic acid (skinorene) has an antimicrobial and anti-inflammatory effect, normalizes keratinization processes, blocks 5-α-reductase and the conversion of testosterone to 5-dihydrotestosterone.

In cosmetology, β-hydroxy acids (salicylic acid) are used, as well as resorcinol in small concentrations (1-3%), α-hydroxy acids (AHA) - malic, tartaric, citrus, lactic and glycolic acids. It should be remembered that topical antibiotics are not recommended to be combined with systemic antibiotics.

The antibacterial drug baziron AS, containing benzoyl peroxide, does not develop resistance in microorganisms, so it can be used for long courses of treatment, as well as as maintenance therapy. In addition, the risk of developing microbial resistance to antibiotics is reduced when they are combined with benzoyl peroxide [8]. Water-based gel for external use, Baziron AS, in addition to antibacterial and anti-inflammatory, also has comedolytic and moisturizing effects. The combined preparation Baziron AS contains an “acrylic copolymer - glycerin” system, which ensures controlled absorption of sebum and skin hydration: the gel is indicated for all skin types, including sensitive ones.

An important place in the rehabilitation of patients with acne and the prevention of the development of complications is given to compliance with recommendations for facial skin care (acne-toilet) using maintenance therapy with topical retinoids, cleansing lotions, gels that do not have a comedogenic effect. Each of these drugs for topical and systemic action has its own advantages and side effects, so it is very important to follow the recommendations given by your doctor.

S. A. Masyukova , Doctor of Medical Sciences, Professor Z. S. Bekmagomaeva, S. A. Razumova, N. V. Gunina SIUV MO RF, Moscow

Baziron

Acne gel "Baziron" exfoliates dead skin cells, which often “clog” pores, which is why pimples and blackheads form. The drug contains benzene peroxide and green tea, which dry out inflamed skin, normalize its cellular respiration and reduce secretions from the sebaceous glands. "Baziron" helps well with blackheads and subcutaneous pimples. The product perfectly moisturizes the skin.

Baziron AS

Galderma, Switzerland

Baziron AS is an allergy-resistant drug; the composition of this drug has been thoroughly tested for allergens, which ensured that the risk of an allergic reaction when using it is minimized.
The product has been dermatologically tested to identify any side effects that may irritate the skin, suitable for dry and sensitive skin. Does not contain alcohol. It also has anti-comedogenic properties, that is, it opens the fullicles and removes comedones (blackheads) on the nose. from 426

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My child does not have inflammation, but there are “black spots” and an oily sheen on the skin. Does it need to be treated?

If there is a clear tendency to acne and the formation of comedones - “blackheads” and white non-inflammatory nodules, which are often localized on the skin of the forehead and nose, a more active effect is recommended. It is strictly unacceptable to take a wait-and-see approach, otherwise soon the “nodules” and “dots” will turn into red inflammatory elements, and then into purulent ones. In this case, we recommend that teenagers wash themselves with Seracin cleansing gel and wipe the skin with Seracin lotion twice a day. After each cleansing, Seracin mattifying cream should be applied to the skin. Lotion for deep cleansing of pores helps reduce the number of open comedones - AHA acids in its composition gently exfoliate the cells of the stratum corneum of the skin, and Sulfur in a bioavailable form regulates the activity of the sebaceous glands. Mattifying cream Seracin has anti-inflammatory, bactericidal activity and in a short time is able to normalize the functioning of the sebaceous glands and restore metabolism in the skin. It is worth paying attention to the cosmetic mattifying effect of this cream - it significantly reduces the appearance of oily skin.

Klenzit-S from Glenmark

This acne gel contains the antibiotic clindamycin, which fights acne by reducing inflammation. And adapalene (a derivative of vitamin A) moisturizes and regenerates the skin. If you find a pimple on your face in the evening and smear it with Glenmark Clenzit-S gel, the pimple will be gone in the morning. You can use the product for no longer than three months (once a day), because addiction may develop. Improvement in skin condition occurs after a week of using Klenzit-S. During treatment, peeling, burning and redness of the skin are possible. But after three weeks the skin gets used to it. It is better to wash your face with gentle, soft products at this time. During pregnancy and frequent exposure to the sun, you cannot be treated with Klenzit-S gel.

Klenzit-S

Glenmark Pharmaceuticals, India

A preparation for external use for the treatment of acne.
Before use, you should consult your doctor. from 486

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Can a teenager outgrow acne?

Modern ideas about acne have changed radically. Thus, the previously prevailing approach that “acne can be left untreated”, “the child must outgrow it”, is categorically unacceptable. Acne is a chronic disease that is accompanied by periodic exacerbations and increasing severity of clinical manifestations, which leads to the formation of scars, age spots and other manifestations of post-acne. Considering the special psycho-emotional background of adolescents, the presence of acne and scars on the face causes them psychological discomfort and reduces their social activity.

Differin

The active ingredient in this gel for acne and pimples is adapalene (retinoid). Differin is indicated for people with combination and oily skin. Judging by patient reviews, this drug really works, although it is inexpensive. An important advantage of this gel is that it removes acne and scars on the skin. You can use Differin for a long time because it does not contain an antibiotic.

Differin

Laboratoires Expanscience, France

A drug for the treatment of acne, for external use.
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How to get rid of acne marks

COLLOST® gel activates microcirculation processes in the area where there were acne, which helps to quickly eliminate spots that appear after acne. Using the gel will help even out the skin texture and also activate the process of tissue restoration. After using this gel, the skin becomes elastic and its texture is evened out, which is important if you have deep acne scars.

Often medications help make acne defects visually invisible. COLLOST® gel not only copes with this task, but also promotes the rapid formation of new tissue at the site of damage. This product has quality certificates, which confirms the safety of its use. You can undergo a course of procedures with COLLOST® gel in cosmetology centers in your city.

Juniper from Mi&Ko

Acne cream perfectly fights acne and other imperfections of problem skin. “Juniper” can be applied not only to the face, but also to other areas of the body where there are rashes. Use the cream morning and evening. The drug relieves inflammation and destroys bacteria, nourishes the skin, moisturizes, and reduces sebum production. Juniper cream is suitable for both teenagers and those who have pimples and acne due to hormonal imbalances or with age. According to customer reviews, the cream smells nice, has a comfortable texture, is not tested on animals and is inexpensive.

Types of skin rashes

Photos from open sources

Juniper from Mi&Ko cream

MiKo, Russia

Face cream Juniper consists of 24% organic raw materials. The new formula contains lavender hydrolate and boswellia extract, which instantly improve complexion, eliminate dryness and inflammation, and protect the skin from stress. A unique extract of wintergreen leaves eliminates rashes and stimulates skin renewal. With Juniper cream, your skin will be healthy and smooth, which will be the key to self-confidence!
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Clearasil Ultra

Clearasil cream is sold in almost any store or pharmacy. Contains salicylic acid, cocoglycosin, allantoin, aloe extract, glycerin, lavender extract, Italian immortelle extract, cistus Montpelient extract. The product relieves inflammation well, is applied precisely and quickly solves the problem of acne and acne. The instructions say that the Klerasil cream will remove a pimple in 4 hours! The drug has a slight mattifying effect. And although the tube of cream is small and not cheap, Klerasil is used very sparingly, so it will last for a long time.

Clearasil Ultra

Reckitt Benckiser, Netherlands

Active components relieve inflammation, redness and irritation, normalize the structure of the epidermis, and promote exfoliation of dead cells.
Thanks to AcceladermTM technology, the cream enhances the effect, allowing the active ingredients to penetrate deeply into all layers of the skin. from 205

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Lumene Nordic Girl! Clear It Up!

This acne cream tightens pores, removes oily shine and is great for spot application. Featuring Lumene Nordic Girl! Clear It Up! There are no dyes, parabens or mineral oils, so the product is suitable even for sensitive skin. The cream contains salicylic acid, arctic plantain extract and vitamin B3. The product relieves pain from subcutaneous inflammation, cools, evens out skin texture, and removes acne scars. The cream is absorbed well and does not leave a film, so it can be applied both under and on foundation.

Lumene Nordic Girl! Clear It Up!

Farmia, Finland

Cream for oily and combination skin Lumene Nordic Girl!
Clear It Up! Oil Free Moisturizer helps control shine while effectively hydrating skin and tightening pores. Helps deal with acne. With regular use, it helps reduce the appearance of blemishes. Consists of 100% plant ingredients. from 535

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Skinoren

This cream contains azelaic acid, which helps regulate sebum secretion, fights pathogenic bacteria, and relieves inflammation. “Skinoren” has proven itself well even in advanced stages of acne, although long-term treatment with this remedy is undesirable. Skinoren dries out the skin, so it is better not to use it if you have peeling. Apply the cream morning and evening to the affected areas of the skin and rub in lightly.

Skinoren

Intendis Manufacturing, Italy

Skinoren is a drug for the treatment of acne vulgaris or juvenile acne and hyperpigmentation.
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There are also artificial analogues of vitamin A - adapalene and azarotenic acid.

How do retinoids work?

Dermatological centers are constantly studying the properties of retinoid preparations, providing an assessment of their effectiveness. It was found that topical retinoids (forms for external use) contribute to the regression of inflammatory papules, reduce the external manifestations of acne, and activate local immunity. Systemic retinoids (oral forms) normalize sebum production, facilitate its secretion, eliminate hyperproliferation, and reduce the population of propionobacteria in acne lesions.

All retinoids have the following effects to one degree or another:

• Anti-inflammatory;
• Healing;
• Immunomodulatory;
• Sebostatic.

The use of retinoids for acne is based on their ability to reduce sebum production and speed up the exfoliation of dead skin cells. As a remedy for wrinkles, vitamin A-based products have proven themselves to be excellent thanks to the proven effects of smoothing the skin's microrelief, increasing its elasticity, stimulating its own collagen and lightening age spots. The production of stem keratinocytes increases, and the required level of moisture is maintained in the deep layers of the dermis, as a result of which the skin is rejuvenated “from the inside.”

Effaclar Duo + by La Roshe-Posay

Cream-gel is indicated for inflammation of the skin, for mattifying and deep moisturizing, prevention and treatment of acne. Effaclar Duo + contains thermal water (moisturizes the skin), prokerad (fights post-acne), lipo-hydroxy acid salicylic acid (renews epidermal cells, regulates sebum production, lightens spots on the skin). An excellent remedy for treating moderate acne. The instructions say that the positive effect occurs within 12 hours after the first use of the cream-gel. Effaclar Duo + is suitable not only for spot treatment of acne, but also for the entire face. The product has a good texture, is quickly absorbed, dries out rashes, does not leave a greasy sheen or stickiness, and does not tighten pores. Can be used as a base for makeup.

Effaclar Duo+

La Roche-Posay, France

Effaclar DUO(+) against the re-formation of imperfections. Light cream-gel EFFACLAR DUO(+) moisturizes the skin for 24 hours and provides a long-lasting mattifying effect. By adding two new active ingredients - Aqua Posae Filiformis and Mannose - the product restores the skin microbiome, which helps reduce the incidence of inflammation. Efaklar DUO(+) contains Prokerad, which prevents the appearance of residual marks from imperfections (post-acne) in the form of red and dark spots. Is an excellent base for makeup.
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