What is acne? How to get rid of acne (pimples) on your face at home

Causes of acne

Propionibacterium acne, Staphylococcus epidermidis, Pityrosporum ovale and orbiculare constantly live on the skin of the face. Propionic bacteria produce lipase and increase the desquamation of the epithelium of the mouths of hair follicles, which leads to their blockage.

Many factors contribute to the development of acne:

• One of the reasons for the appearance of acne on the face is a “hormonal surge” in teenagers. Hair follicles, sebaceous and sweat glands exhibit increased sensitivity to androgens. Under their influence, the sebaceous gland begins to produce and secrete an increased amount of sebum.
• An increased amount of male sex hormones may be hereditary. Hereditary predisposition consists of an inadequate response of the sebaceous glands to increased levels of androgenic (male) hormones in the blood.
• Severe acne occurs in men with an XYY karyotype (tall, mild mental retardation, and aggressive behavior).
• Promotes the development of seborrhea acne.
• Eating large amounts of carbohydrates and diabetes mellitus create favorable conditions for the development of infection (carbohydrates are a good breeding ground for pyogenic microbes).
• Failure of the body's thermoregulatory system.
• Long-term use of corticosteroids.
• Long-term stress and depression.
• Petroleum products, lubricating oils and dioxin can cause acne if they come into contact with the skin.
• The development of acne is provoked by taking oral contraceptives, drugs containing bromine, phenytoin, and lithium salts.
• Prolonged squeezing of the skin or friction leads to mechanical closure of the follicle ducts and the development of acne.

Rice. 2. The photo shows the structure of a hair follicle. The sebaceous gland is indicated in yellow.

Types of rash and causes of its appearance

The content of the article

A rash is a visual change in the structure and color of the skin; it is characterized by redness, itching, peeling and even pain. The halo of the rash, despite its external integrity, consists of individual elements, which include:

• ulcers (defects on the surface of the epidermis caused by slowing down the regenerative processes in the upper layers of the skin);
• erosion (superficial epithelial defect without scar formation)
• papule (dense nodule located above the surface of the skin);
• vesicle (a fluid-filled capsule located in the upper layers of the epidermis);
• pustule (a cavity formation on the surface of the skin filled with pus);
• blister (an element on the surface of the skin caused by inflammation and swelling of the papillary dermis);
• nodes (dense, painless nodules on the skin);
• hemorrhages (subcutaneous hemorrhages caused by high permeability of the vascular walls);
• petechiae (pinpoint subcutaneous hemorrhages caused by capillary injury);
• ulcers (deeply located formations filled with pus).

Depending on the location of the skin rash, the source of the problem can be determined. In particular:

• Allergic reactions cause a rash on the hands and face;
• Infections are characterized by rashes on the torso (abdomen, back);
• STIs are localized on the genitals, inner thighs and skin around the anus;
• Stress weakens the immune system, so the rash is localized throughout the body (but, unlike allergies or rashes due to infections, the reaction to allergens and immunoglobulin will be negative)%;
• Problems of the gastrointestinal tract are expressed in the form of serious skin abnormalities (with ulcerative colitis - erythema nodosum (inflammation of the subcutaneous tissue and blood vessels in the form of nodes), with problems with the pancreas - atopic dermatitis, intestinal infections provoke pyoderma - ulcers on the skin);
• Rashes due to problems with blood or blood vessels appear on the abdomen and then spread throughout the body. It is characterized by the absence of itching.

How acne appears

Pimples on the skin of the face, chest and back appear in areas where a large number of sebaceous glands are located. In common forms, acne appears on the skin of the shoulders and forearms. The disease can be mild (open comedones), moderate in severity (closed comedones and papules), and severe (pustules).

Stage I: comedones formation

When the processes of exfoliation of the stratum corneum of the skin are disrupted, retention hyperkeratosis develops (delayed exfoliation). The mouth of the follicle becomes clogged with horny scales, as a result of which sebum accumulates in the cavity of the follicle. A microcomedone (milium) is formed, obstructing (closing) the excretory duct of the sebaceous gland. Over time, open and closed comedones are formed - non-inflammatory elements in acne.

Rice. 3. Microcomedones are formed when sebum accumulates in the ducts of the sebaceous glands and the mouths of the follicles. They look like small hemispherical nodules of milky color.

Rice. 4. In the photo, comedones are open in the area of ​​the external auditory canal. With open comedones, the openings of the follicles are open. Under the influence of environmental oxygen, the fats that make up sebum oxidize, which gives comedones a black color.

Rice. 5. The photo shows open comedones on the face.

Rice. 6. In the photo, the comedones on the face are closed. With closed comedones, the openings of the follicles are closed. Horny scales and sebum, having no way out, remain under the epithelium layer.

Rice. 7. The photo shows elements of acne. Mild - mild degree of severity. Modtrant - moderate severity. Severe - severe course - abundant papules and pustules, abscess formation and the formation of fistulous tracts.

Stage II: development of inflammation

Lack of oxygen, dead horny scales and sebum create conditions for the proliferation of propionobacteria acne - permanent representatives of the skin microflora.

• Acne propionobacteria have the ability to break down sebum and cause inflammation of surrounding tissues, which leads to the development of papules. With the formation of large inflammatory infiltrates, an indurative form of acne develops.
• When a staphylococcal infection is attached, pustules (ulcers) and microabscesses develop - pustular, abscessing, necrotic and phlegmonous acne. These forms of acne are severe.
• With necrotic acne, inflammation develops deep in the follicles. Most often, acne appears on the skin of the forehead and temporal area. Pustules with hemorrhagic contents appear on their tops. After opening them, a scab forms. The disease ends with the development of a smallpox scar.
• With phlegmonous acne, the inflammatory process penetrates and develops in the subcutaneous fatty tissue. When a purulent lesion is opened, thick, creamy pus is released. The course of the disease is long. Deep scars remain in place of acne.
• With the development of multiple abscesses, an infiltrate with several fistulous tracts is formed (nodular cystic acne). Extensive infiltrates after healing leave cyst-like formations.
• The fulminant form of acne is more often recorded in boys aged 14–17 years and women. The disease is extremely severe and has a malignant course. Symptoms of intoxication are significantly expressed, symptoms of arthralgia are noted, and the functioning of the gastrointestinal tract is disrupted.

Initially, areas of the skin turn red and swelling develops. After a few days, boil-like rashes appear on the skin. Pustules can reach enormous sizes. Foci of necrosis form. After healing, rough scars remain.

Rice. 8. The photo shows acne on the face (papular acne).

Rice. 9. The photo shows acne on the face. When a staphylococcal infection is attached, pustules (ulcers) and microabscesses develop - pustular and abscessing acne.

Rice. 10. The photo shows pustular acne.

Rice. 11. The photo shows an indurative form of acne. The inflammatory process affects neighboring areas and penetrates deep into the tissue. Pustules are located on a dense base. Infiltrates are often extensive, their surface is bumpy. The disease leaves rough, disfiguring scars.

Rice. 12. The photo shows nodular cystic acne. Nodes more than 1 cm in diameter, always painful, protrude deep into the dermis, often merge, forming extensive infiltrates with fistulous tracts. When healing occurs, cyst-like formations remain. The skin of the face is most often affected.

Rice. 13. The photo shows cystic acne.

Rice. 14. In the photo, the acne on the back and chest is conglobate (spherical). Nodules, ulcerations, cysts and abscesses are the main elements of inflammation. The diameter of the nodes reaches 1 - 4 cm. Merging, the nodes form sharply painful conglomerates. Long-term non-healing abscesses often form. Healing occurs with the formation of rough bridge-shaped scars. The skin of the torso and chest is affected, much less often - the face. Acne conglobates occur in men with an additional Y chromosome, less often in women suffering from polycystic ovary syndrome.

Rice. 15. The photo shows excoriated acne. The disease occurs when pimples are scratched and squeezed out. Sometimes this condition develops into neurosis, which is characterized by behavior deviating from the norm.

Stage III: acne healing

All types of juvenile acne leave scars. When the pustules heal, small atrophic (smallpox-like) scars remain, sometimes pigmented.

When spherical, abscessive and phlegmonous acne heals, hypertrophic and, less commonly, keloid scars remain, disfiguring the skin.

Rice. 16. Atrophic scars form after healing of pustular acne.

Rice. 17. The chronic course of the disease often ends with the formation of scar tissue.

Rice. 18. The photo shows acne keloid (keloid acne). In the back of the head, dense pink rashes are visible, which are inflammation of the follicles located at the border of smooth skin and scalp. The disease is long-lasting and torpid. The affected areas become sclerotic over time.

Rash caused by diseases of the blood and blood vessels

A rash due to diseases of the blood or blood vessels is caused by damage to the walls of the capillaries, as a result of which petechiae - small bright red dots - appear on the surface of the skin. Unlike ordinary hemorrhages, a rash due to blood diseases does not change color when pressed. Other signs indicate the disease:

• joint pain (knees, ankles);
• black stools, diarrhea, sharp pain in the abdomen as if poisoned;
• the rash covers the entire body.

Diseases that cause hemorrhagic rash include:

Idiopathic thrombocytopenic purpura (Werlhof's disease) is a blood disease in which small arteries and capillaries are blocked by blood clots. Mainly found in children, especially newborns. The disease has autoimmune causes of unknown etymology. Those. Your own immune cells perceive platelets as a foreign body and attack them. The rash is painless, occurs as a reaction to the administration of any medication, and is localized at the injection site.

Hemoblastosis. This is a malignant tumor that occurs very often in childhood. The rash has several types:

• hemispheres of red-brown color, covered with a crust;
• blisters with serous fluid inside;
• rashes similar to bruises, both large in size and in the form of bloody dots that appear without any reason.

In all cases, the rash causes severe itching. Blood tests for hemoblastosis show a significant increase in the number of leukocytes due to decreased immunity. Hemoglobin drops, lymph nodes enlarge. Platelet counts drop and the child gets tired quickly. The main cause of rash in diseases of the blood or blood vessels is a decrease in the number of platelets and a disruption in the synthesis of proteins involved in blood clot formation. This rash also occurs when taking medications that thin the blood (Aspirin, Warfarin, Heparin).

Diabetic angiopathy. This is a violation of the vascular capacity of the lower extremities, provoked by type 1 and type 2 diabetes mellitus. Due to the disease, the walls of blood vessels become thinner and become fragile. This causes skin dystrophy. Ulcers and erosions appear on the skin.

Seborrhea and acne

Hair follicles, sebaceous and sweat glands show increased sensitivity to male sex hormones. Under their influence, the sebaceous gland begins to produce and secrete an increased amount of sebum. The more sebum is produced, the more severe the acne. The balance between female and male sex hormones is disrupted (increasing the latter) in the period 14 - 25 years.

Increased sebum production is observed with seborrhea. Seborrheic background can be thick, liquid and mixed. Acne develops against the background of a thick or mixed form of oily seborrhea, which is most often recorded in adolescents, less often in boys. Mixed seborrhea appears more often on the face, dry seborrhea on the scalp. Long-term use of glucocorticoids, anabolic steroids, testosterone and progesterone, and disruptions in the functioning of the autonomic nervous system contribute to the development of seborrhea.

Rice. 19. The photo shows steroid acne. The disease occurs as a result of long-term use of fluorinated and non-fluorinated corticosteroids. There are no comedones. The rashes are of the same type and disappear after discontinuation of the drug.

The appearance of acne in an adult is a reason to consult an endocrinologist.

Nervous rash

Stress and nervous tension often cause skin rashes. Under the influence of a stressful situation, the immune system is suppressed. The body spends its resources to maintain the normal state of internal organs. For this reason, previously hidden diseases worsen. Also, weakened immunity provokes urticaria - a small rash similar to the reaction of the epidermis to the touch of nettles. This pathology is otherwise called nervous eczema. It, unlike a normal allergic reaction, is accompanied by the following symptoms:

• severe itching that is not relieved by antihistamines
• pulse quickens, hand tremors are felt
• restless sleep, night sweats
• panic attacks, feelings of anxiety and danger
• swelling of the face and limbs.

Typically, nervous eczema occurs after a traumatic situation or severe stress. Treating skin rashes with creams or medications does not help. Improvement comes only after the life situation normalizes. Itchy urticaria due to nervousness can be soothed by baths with sea salt, which also have a good effect on the nervous system.

How to get rid of acne on your face at home

How to get rid of acne on your face? This is a question that 9 out of 10 people have asked and are asking in their lives. Acne is reported in 85% of adolescents and 20% of adults. They appear on the face, back and chest. Half of all women experience acne on their faces regularly. Acne appears in a person up to the age of 50.

Acne is located on the skin of the face, chest and back - in areas where the largest number of sebaceous glands are located. The disease can be mild (open comedones), moderate in severity (closed comedones and papules), and severe (pustules).

Acne is a serious disease. Only a doctor knows how to get rid of acne on the face, back and chest. However, you can do a lot yourself at home.

Conducting a clinical and laboratory examination of the patient, finding out the causes of acne and identifying risk factors is the responsibility of the doctor before starting treatment.

Treating acne on the face, chest and back is not an easy task. As soon as acne appears, you should immediately consult a doctor. The doctor will help you understand the causes of the disease. Perhaps, along with external therapy, the doctor will recommend general therapy, hyposensitizing, detoxification and vitamin therapy. A mandatory component of complex treatment is a balanced and rational diet.

• Sexually transmitted infections, polycystic ovary syndrome, gastritis, which is caused by Heliobacter, are often combined with early forms of acne.
• Uterine fibroids, mastopathy, pelvic inflammatory diseases, recurrent candidiasis, bacterial vaginosis and other diseases caused by hormonal dysfunction are often combined with late forms of acne.

Drug treatment for acne must be adequate and consistent.

External therapy is prescribed for mild to moderate acne. It is intended to use creams, gels, ointments and lotions containing substances that:

• prevent the formation of comedones or destroy them,
• reduce sebum production,
• prevent the development of inflammation.

General therapy is prescribed when local therapy is ineffective and severe acne and involves the use of:

• antibiotics,
• synthetic derivatives of vitamin A (isotretinoin),
• specific immunotherapy drugs,
• antiandrogens.

Limiting the intake of easily digestible carbohydrates, the amount of animal fats, extractives and table salt are the basic principles of dietary nutrition in the treatment of acne.

Table of contents

1. Etiology and pathogenesis
2. Clinical manifestations
3. Principles of treatment

Acne (pimples, acne vulgaris, acne, comedones, acne vulgaris) is a chronic inflammatory skin disease that manifests itself as open or closed comedones and inflammatory lesions (papules, pustules, nodules).

In our company you can purchase the following equipment for acne treatment:

• M22 (Lumenis)
• Thermage (Solta Medical)

Today, acne, without exaggeration, can be called the most common skin disease among young people - according to statistics, up to 95% of boys and up to 83% of girls suffer from it. Approximately 60% of them have a mild form with a small number of rashes (so-called physiological acne). If acne occurs in adolescence, in 64% of adults, acne persists at the age of 20–30 years, in 43% at 30–40 years, in 15% at 40–50 years (more often in women).

Skin cleansing is an essential component of daily care.

Daily cleansing of the skin is a must when treating acne on the face and other parts of the body. Foams, gels and lotions are used for this purpose. They remove excess oil and do not dry out the skin. It is not recommended to use soap. The frequency of washing when treating acne should not exceed 1 - 2 times a day.

• Cleansing gel (France) cleanses the skin well. In this case, the hydrolipid film is not damaged.
• The cleansing gel is part of the Exfoliak series of medicinal cosmetics (France).
• Cleansing lotion and gel for washing are included in the preparations of the Klerasil Ultra series.
• Gel for cleansing facial skin is part of the products of the Cetaphil, Sebium and Sphingogel series.
• Cleansing gel for oily skin is part of the Zeniak series.

Degrease and disinfect the skin with alcohol solutions with antibiotics (5% chloramphenicol), 2% resorcinol, 1 - 2% salicylic acid solution, 5 - 10% alcohol solution of camphor.

Frequent washing leads to increased dryness of the skin and a decrease in its protective properties.

Cleansed skin is treated with tonic. For acne, preference should be given to tonics that contain keratolytics and comedolytics. These products have the ability to exfoliate dead cells, prevent the accumulation of sebum and horny scales in the mouths of the follicles, and reduce inflammation.

Rice. 20. The photo shows acne on the face.

Reducing sebum production, normalizing the processes of keratinization and death of epidermal cells, suppressing microflora and reducing inflammation are the basic principles in the treatment of acne.

Rash caused by digestive problems

The condition of the skin largely depends on the functioning of the internal organs. Using a map of rashes on the face, you can determine which organs have problems.

• pimples on the forehead indicate problems with the intestines;
• a rash along the hairline indicates problems with the gallbladder;
• pimples on the bridge of the nose - liver problems;
• ulcers on the temples - problems with the spleen;
• rashes above the lip - disruption of intestinal function;
• pimples on the nose - heart disease or endocrine disorders;
• rash on the chin - gynecological problems.

Using keratolytics to treat acne at home

In the cells of the epidermis, the process of keratinization constantly occurs, as a result of which keratin protein and fats are deposited in the stratum corneum, which is why it becomes strong and elastic. When the processes of exfoliation of the stratum corneum of the skin are disrupted, retention hyperkeratosis develops. The mouth of the follicle becomes clogged with horny scales, as a result of which sebum accumulates in the cavity of the follicle, forming microcomedones and open and closed comedones.

Keratolytic drugs normalize the keratinization processes occurring in the mouths of the follicles, preventing the formation of microcomedones and conditions for the development of bacteria.

Benzoyl peroxide (Baziron, OXU-5, OXU-10, Klerasil-ultra)

Benzoyl peroxide is an organic compound. The drug has been used in the treatment of acne for many years. It has the ability to kill propionic acid bacteria without causing the emergence of resistant strains. Its keratolytic and comedolytic action allows the drug to be used not only for the correction of open and closed comedones, but also for the treatment of inflammatory elements of acne. Benzoyl peroxide does not affect sebum production. The drug is available in various forms (cleansing gel, tonic, scrub, corrective preparations), which makes it convenient to use in various settings (at home, at work, while traveling, etc.).

Rice. 21. In the photo, Baziron and Retin-A are keratolytics and comedolytics, widely used in the treatment of acne of various locations.

Retinoid drugs

Preparations of the retinoid group are structurally close to vitamin A. A representative of the retinoid group is the drug Retin-A, containing tretinoin. It has a keratolytic and comedolytic effect, reduces sebum production, has a weak anti-inflammatory effect, and helps smooth the skin. The drug promotes the opening of closed comedones and their transition to papules, followed by healing without scars.

Adapalene (Klenzit, Differin) is a synthetic analogue of retinoic acid. Used topically for comedones. Adapalene in combination with an antibiotic (Klenzit-S) is used when inflammatory elements of acne appear. The retinoid isotretinoin (Roaccutane) is prescribed for severe acne.

Rice. 22. In the photo, Klenzit and Klenzit-S are synthetic analogues of retinoic acid. The drugs are widely used in the treatment of comedones.

Azelloic acid

Azelloic acid is included in the preparations Skinoren, Azelik, Azix-Derm. It stops the growth and reproduction of propionic acid bacteria. Under its influence, the fraction of free fatty acids in the surface lipids of the skin decreases and the proliferation of keratinocytes is inhibited. The drug is available in the form of cream and gel.

Rice. 23. The photo shows acne products Skinoren and Azelik for topical use with azeloic acid.

Salicylic acid

Salicylic acid has antimicrobial and keratolytic properties (coagulates proteins, including microbial ones), improves tissue trophism, and reduces pain.

Rice. 24. In the photo, the acne remedy is salicylic acid (solution for external use).

Resorcinol

Resorcinol is an antiseptic. By coagulating proteins, the drug thereby has a keratolytic effect and has an antipruritic effect.

When using acne products, carefully read the instructions for use of the drug and strictly follow its instructions. Stick to the drug use plan! Consult your doctor if side effects occur and discuss the results of acne treatment with your doctor.

Modern approach to the treatment of age-related acne in women

Terminology and epidemiology

Acne is a polymorphic multifactorial disease of the hair follicles and sebaceous glands, resulting from overproduction of sebum, follicular hyperkeratosis, inflammation, lipid imbalance, some sex hormones and genetic predisposition, manifested by both the appearance of inflammatory elements (papules) and a violation of the skin texture, increased oiliness , hyperpigmentation, etc.

The most common form of acne is acne vulgaris (acne vulgaris). They develop in 80-90% of adolescents during puberty, when the adrenal glands begin to actively synthesize large amounts of androgens that stimulate the formation of sebum. In girls, the disease usually debuts at 12-14 years of age, in boys at 14-15 years of age due to their later puberty [1-7].

The manifestation of acne in older age groups is classified as late acne (acne tarda). In recent years, the number of women with late forms of acne has been growing. According to Colleir Ch. et al. [5], in adolescence, the incidence of acne is almost the same in both sexes, while acne tarda is much more common in women. Thus, according to various studies, the proportion of patients aged 25-40 years with acne is 40-54%. In studies conducted by Dummont-Wallon G. et al., Rosso J., Williams C. et al., the average age of women with acne was 31.8, 32.4 and 26.5 years, respectively. A multicenter study conducted in the United States between 1990 and 1999 found that the average age of acne patients increased from 26.5 to 40.5 years [1-7].

Etiology and pathogenesis

Studies have shown that the development and course of acne largely depends on family (genetic) predisposition, as well as on skin type, color and national characteristics. Acne is a disease with a high familial prevalence (50%). There is a general pattern: the more common and severe acne is in previous relatives, the more severe and torpid the course of the disease will be in the next generation.

Different expressivity and allelic variations of genes that determine the development of sebaceous glands, their functional ability and enzyme activity can play a large role in the development of the disease and largely determine the severity of skin manifestations. A number of researchers point to the presence of a nuclear R-factor that determines genetic predisposition. These facts, with a certain degree of probability, can explain the development of mild forms in some individuals, and severe forms of the disease in others. In a study by Pang Y. involving 238 patients with acne and 207 healthy individuals, it was found that short repeat length of the CAG gene and specific androgen receptor halotypes are associated with the risk of developing acne and, therefore, can be considered as a reliable marker of susceptibility to this skin lesion [ 9-12].

The skin is an endocrine organ, a “mirror” of the metabolism of sex steroid hormones, the action of which is carried out through specific androgen receptors. Androgens enhance the differentiation and mitotic activity of epidermal cells, free testosterone of ovarian origin, dehydroepiandrosterone and androstendinone of adrenal origin stimulate the secretion of sebum and the size of the sebaceous glands. Progesterone, which is a precursor to testosterone, estrogens and adrenocorticosteroids, has a similar effect. It also enhances the secretion of the sebaceous glands due to androgenic and antiestrogenic activity. Hormonal imbalance in patients with acne can be expressed as the androgen/estrogens ratio, where an increase in the production of the former and a decrease in the production of the latter corresponds to the clinical picture of acne. In this regard, on the eve of menstruation in healthy women, under the influence of progesterone, the secretion of sebum increases and inflammatory elements of acne appear.

Hypersecretion of sebum is a consequence not only of high levels of androgens, but also of increased sensitivity of the sebaceous glands to them. An increase in sebum production leads to a decrease in the concentration of linoleic acid, which is the trigger for pathological follicular hyperkeratosis; the latter, in turn, creates favorable conditions for the development of facultative anaerobes Propionibacterium acnes and Propionibacterium granulosum, as well as other representatives of saprophytic and opportunistic microflora (Staphylococcus epidermidis, S. aureus, Pityrosporum ovale) and the formation of comedones. In addition, the secretion of the sebaceous glands itself is a substrate for the proliferation of P. acnes. In this case, sebum is hydrolyzed by bacterial lipases to free fatty acids, which promote inflammation and the formation of comedones. Inflammation is also enhanced by P. acnes, which produces neutrophil chemotaxis factors.

Thus, acne is an androgen-dependent skin condition. Changes in the state of the gonads, pituitary gland, and adrenal glands determine the pathological secretion of androgen levels. In addition, it was noted that insulin enhances androgenization by stimulating the synthesis of luteinizing hormone from the pituitary gland in patients with polycystic ovary syndrome. In patients with acne, a slight but stable increase in insulin levels was observed.

Considering that the pathogenesis of acne is based on increased sebum secretion and certain immune processes, it is the state of immunity that attracts attention and is insufficiently studied. It was found that the total number of leukocytes, lymphocytes, CD20+, CD8+ cells does not differ from the control group, the content of CD3+ and CD4+ lymphocytes is below the control level. The level of cells with a marker of apoptosis (CD95+ lymphocytes) is significantly increased in patients, mainly with severe disease. With a slightly increased number of segmented cells, there is a sharp decrease in their phagocytic activity and intensity of phagocytosis, while the indicators of humoral immunity are not changed.

It must be remembered that in the small intestine, as well as throughout the large intestine, there are lymphatic follicles. An abundance of first-order lymph nodes adjacent to the mesentery, second-order, accompanying the aorta and vena cava, ascend along the esophagus and trachea into the thoracic lymphatic duct, then form a common collector, which serves as a regulator-cleaner. The body's T-cell immunity is directly related to the evacuation function of the intestine. The state of the intestinal microflora plays a certain role in this case. The most dramatic changes in the intestinal microflora are characteristic of all stages of acne. The data obtained indicate a significant change in the immune status of patients with acne.

Data indicating a relationship between stress factors and the occurrence of acne are quite contradictory. Thus, Goulden V. et al. found that only 12% of 71% of women in whom stress was the cause of acne, call it a provoking factor of the disease [17]. At the same time, Poli F., Dumont-Wallon G. et al. noted that stress is one of the significant factors provoking the occurrence of acne in women; it was identified as a trigger factor in 34-50% of cases [1, 7].

The link between stress and acne exacerbation is currently explained by the production of neurotransmitters (substance P), which influence the differentiation and division of sebocytes and stimulate the production of sebum. In turn, the skin of people with a tendency to acne is characterized by an abundance of nerve endings, an increased number of nerve fibers capable of secreting substance P, as well as a large number of mast cells.

Diagnosis of acne in women

Diagnosis of late acne should include both objective and additional examination methods (Table 1) [11].

Table 1. Examination of patients with acne

Clinical picture

There are non-inflammatory and inflammatory clinical forms of acne. In the non-inflammatory form, closed or open comedones are determined, the precursors of which are microcomedones. Inflammatory elements are divided into superficial (papules and pustules) and deep (nodules, cysts, deep pustules).

The severity of acne varies: from superficial papulopustular elements that resolve without leaving a trace, to widespread deep nodular lesions that leave behind disfiguring scars. The severity of the process and the symmetry of the distribution of rashes allow us to assess the severity of the disease.

Unlike teenage acne, which is usually characterized by the prevalence of the pathological process, the predominance of moderate and severe forms of the disease, with late acne, the majority (70-80%) of patients are diagnosed with a comedonal and papulopustular form of the disease. The most severe manifestation of acne - acne conglobata - occurs in 15-20% of patients. The process is localized mainly in the face, less often in the upper third of the body. It should be noted that in patients with late forms of acne, in addition to acne, there are signs of skin dehydration due to previous drug treatment, irrational basic care, as well as background age-related changes in the skin.

Often, in patients with advanced acne, local or systemic use of antibiotics, as a rule, is ineffective: according to Rivera R. and Guerra A., 82% of women are resistant to antibiotic therapy [15]. Long-term torpid course and irrational treatment of the disease often lead to scarring and post-inflammatory hyperpigmentation.

We must not forget that acne belongs to a special group of skin diseases - psychosomatic dermatoses, during which the role of psycho-emotional disorders associated with the problem of “appearance defect” is great, which is especially pronounced in girls and women. Localization of pathological elements on open, visible areas of the skin brings deep psychological suffering to patients, reducing self-esteem, negatively affecting the quality of life, social status, professional activity, and personal relationships. According to some data, in the structure of the overall incidence of anxiety and depressive disorders, patients with acne occupy second place, ahead of many somatic and skin diseases, including oncological pathology. Patients with acne demonstrate higher levels of anxiety and depression compared to other dermatological patients: 30% of adolescents and 5% of adults with acne require active psychological and psychiatric care [8].

According to Tan JK et al., female gender, advanced age, and duration of the disease (more than 5 years) are additional factors that have a negative impact on the quality of life of patients, significantly reducing it [16]. Patients with acne are the most psychologically vulnerable; among them there is a large number (64%) of unemployed women with an unsettled personal life. Another study showed that in 40% of patients, a skin disease accompanied by a cosmetic defect leads to a decrease in their social status and negatively affects their professional activities.

Principles of treatment of late acne

Skin relief disorders that occur during a long torpid course of the disease and the hyperfunction of the sebaceous glands that patients already have require a balanced systematic approach using drugs that are safe for long-term use, which not only eliminate inflammatory elements, but also gradually eliminate other manifestations of acne. According to modern views, acne therapy should be carried out taking into account the prevalence and severity of the process, as well as the presence of changes in the hormonal and endocrine status of the woman. In addition, it is necessary to take into account the patient’s age, concomitant pathology, duration of the disease, and the effectiveness of previous therapy.

The main goals of acne 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.); • preventing the opening of comedones, pustules and the development of inflammation (antibacterial drugs for systemic and local 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); • improvement of the appearance of scars - only after achieving stable clinical remission (peeling, resurfacing, introduction of implants, corticosteroids; laser therapy, etc.).

For mild to moderate acne, which is characterized by the presence of non-inflammatory comedonal forms and superficial inflammatory papulopustular forms, mainly external therapy is required. In patients with severe acne (with severe dermal inflammation, purulent melting of the dermis), the prescription of combined oral contraceptives with an antiandrogenic effect in combination with topical anti-acne drugs, systemic antibiotics (for particularly severe forms) is indicated.

Systemic drugs that reduce sebum secretion include estrogens and androgens, which are prescribed to women when antibiotic therapy is ineffective. Systemic corticosteroids are used for adrenal hyperandrogenism. Treatment lasts 6-8 months. (until stable remission is achieved).

It is possible to use high-intensity blue light on acne elements and take zinc supplements, but the level of evidence for these types of therapy is low.

Antibacterial therapy is still relevant in cases of severe inflammation. P. acne is highly sensitive to antibiotics, but not all antibiotics are able to penetrate the follicles of the sebaceous glands. The most effective in this case are doxycycline, amoxicillin, and josamycin. In cases of severe suppurative processes with cystic forms, it is customary to prescribe combination therapy, including antibiotics, corticosteroids, as well as external use of antibacterial ointments containing benzoyl peroxide, clindamycin, lasting up to 2-4 months. External acne therapy should be long-term and carried out over several periods of epidermal renewal, which is due to the genetic nature of the disease.

An overview of recommendations for the treatment of acne in adult women is presented in Table 2.
Table 2. Recommendations for the treatment of acne in adult women

*All skin care products must be non-comedogenic and oil-free.
The need for non-comedogenic UVA/UVB sunscreens varies by geographic location. BPO – benzoyl peroxide; OK – oral contraceptives; PDT – photodynamic therapy; PIH – post-inflammatory hyperpigmentation.§ In the Russian Federation, the original preparation of azelaic acid is registered under the trade name Skinoren® The role of azelaic acid in the treatment of acne

In the process of searching for effective and safe drugs for the treatment of acne, researchers turned their attention to dicarboxylic azelaic acid, which was originally used to treat skin hyperpigmentation. The basis for this use of the drug was that with hypopigmentation caused by Pityrosporum, there is an increase in the production of C6–C12 dicarboxylic acids. In the 1970s Studies of azelaic acid have shown that it is effective in the treatment of hyperpigmentation and malignant melanoma without causing depigmentation in normal skin. It was later discovered that azelaic acid causes a therapeutic effect not only in hyperpigmentation, but also in the treatment of acne.

Main properties of azelaic acid:

• has an antibacterial effect on a number of aerobic and anaerobic microorganisms; • affects the final stages of epidermal keratinization; • in low (about 100 mM) concentrations it almost completely inhibits protein synthesis in P. acnes cells, exerting a bacteriostatic effect; • when the concentration increases to 500 mM, DNA and RNA synthesis is additionally inhibited and a bactericidal effect develops [13].

Under in vitro conditions, azelaic acid neutralizes the activity of reactive oxygen radicals (hydroxyl radical, superoxide anion radical), inhibits their production by neutrophils and can be considered as an antioxidant. In cell culture, azelaic acid has a weak effect or no effect at all on normal cells, but selectively penetrates into atypical cells of melanoma, carcinoma, lymphoma, exerting an antiproliferative and cytotoxic effect.

Despite the various pharmacotherapeutic properties of azelaic acid, it is mainly used to treat acne. This is due to its pronounced antibacterial, anti-inflammatory and antiproliferative effect, aimed at the main links in the pathogenesis of the disease in the absence of significant adverse reactions characteristic of other anti-acne drugs.

The original drug Skinoren® contains 150 mg of azelaic acid, micronized in 1 g of product, which is an advantage and distinguishes it from other products containing azelaic acid. It is a 1,7-heptane dicarboxylic acid HOOC-(CH2)7-COOH, which is an intermediate product of lipid metabolism and is not converted to any metabolites with obvious toxicity. Therefore, Skinoren® should be considered the safest of all anti-acne drugs.

Skinoren® normalizes the functioning of the sebaceous glands, hair follicles and the proliferation of P. acnes bacteria, which are constantly present on the skin, disrupted by acne. All these beneficial effects are achieved due to a local increase in the concentration of the natural product of lipid metabolism - the active principle of the drug azelaic acid.

The use of Skinoren® significantly reduces the number of inflamed and non-inflamed acne, and it acts not only on superficial papules, but also contributes to the disappearance of deep lesions - keloids and cysts.

The main indications for the use of Skinoren® are mild to moderate acne. For more severe forms, Skinoren® can be combined with antibiotics and isotretinoin, as well as with antiandrogen drugs. However, it should be borne in mind that since acne is not just an accumulation of inflammatory elements, but a disease of a complex nature, it responds slowly to any therapy. Thus, a clear clinical improvement is observed after 1 month. after starting to use Skinoren®, the main effects appear after 4 months, and the disappearance of deep lesions occurs after 5-6 months. Therefore, depending on the severity of acne, treatment with Skinoren® should be continued for a long time, for several months, until the maximum therapeutic effect is achieved [14].

As an additional therapy for acne, it is necessary to use medicinal cosmetics, which are an important component of the treatment program for patient management. When choosing cosmetics, it is necessary to take into account the patient’s skin type, data from hardware techniques that allow assessing the severity of oiliness, skin moisture and its pH.

In real practice, after stopping the inflammatory manifestations of acne, the attending physician often has to face difficulties in correcting post-acne, the most common manifestations of which are dyschromia and scars. To resolve dyschromia, superficial peels with α-hydroxy acids and medium peels with trichloroacetic acid (TCA) are successfully used. A good synergistic effect is achieved by the combined use of azelaic acid together with peels, as pre-peel preparation and post-peel care, especially in patients with dark skin, as a preventive measure hyperpigmentation and acne exacerbations. Visible results are provided by cryomassage courses (5-6 minutes 2-3 times a week, 10-15 procedures per course), mesotherapy, therapeutic massage courses (15 procedures) in combination with vitamin C electrophoresis.

To correct atrophic scars, chemical peels are used, most often median peels, microdermabrasion, laser resurfacing, filler injections, cryotherapy, and mesotherapy. The most effective are combined correction methods.

To treat hypertrophic scars, focal injection of corticosteroids, electrophoresis with corticosteroids, lidase, collagenase, beech therapy, phonophoresis with contractubex, madecassol, cryodestruction, ointment therapy, as well as surgical excision of scars with a large affected area are used.

conclusions

Thus, only a balanced, comprehensive therapeutic approach, taking into account all possible factors of the disease, provides a real opportunity to cure or alleviate the condition of patients with acne. The key to the success of therapy, especially for long-term, refractory acne, is the impact on the dermatological, hormonal-endocrine and psycho-emotional status of patients, which leads not only to lasting results, but also significantly improves the social adaptation and quality of life of patients. The use of azelaic acid opens up new possibilities in the treatment of acne, and also helps to increase the effectiveness and safety of local pharmacotherapy.

References 1. Dumont-Wallon G, Dreno B. Specificity of acne in women older than 25 years. Presse Med., 2008, 37: 585-591. 2. Williams C, Layton AM. Persistent acne in women: implications for the patient and for therapy. Am. J. Clin. Dermatol., 2006, 7: 281-290. 3. Del Rosso JQ, Bikowski J, Baum E. Prevalence of truncal acne vulgaris: a population study based on private practice experience. J. Am. Acad. Dermatol., 2007, 56: AB3. 4. Boathouse. D. Secrets of dermatology. St. Petersburg, 1999. P. 513. 5. Colleir Ch, Haper J, Cantell W. The prevalence of acne in adults 20 years and older. J. Am. Acad. Dermatol., 2008, 58: 56. 6. Samtsov A.V. Acne and acneiform dermatoses. M.: Utcom LLC, 2009. 7. Poli F, Dreno B, Verschoore M. An epidemiological study of acne in female adults: results of a survey conducted in France. J. Eur. Acad. Dermatol. Venereol., 2001, 15: 541-545. 8. Mayorova A.V., Shapovalov V.S., Akhtyamov S.N. Acne in the practice of a dermatocosmetologist. M.: “Clavel Firm”, 2005. 9. Masyukova S.A., Akhtyamov S.N. Acne: Problem and solution. Consilium Medicum, 2002, 4(5): 217-223. 10. Adaskevich V.L. Acne vulgar and pink. N. Novgorod: Publishing house NGMA, 2003. 11. Suvorova K.N., Kotova N.V. Severe forms of acne. International Medical Journal, 2000: 732-726. 12. Pang Y. et al. Combination of short CAG and GGN repeats in the androgen receptor gene is associated with acne rick in North East China, 2008. 13. Volkova E.N., Osipova N.K. Progressive technologies for managing patients with acne and post-acne. Ross. magazine leather and veins Bol., 2009, 5: 53-58. 14. Volkova E.N., Osipova N.K. External pathogenetic therapy for patients with acne and post-acne. Wedge. dermatol. and Venerol., 2010, 2: 72-77. 15. Rivera R, Guerra A. Management of acne in women over 25 years of age. Actas Dermosifiliogr., 2009, 100: 33-37. 16. Tan JK. et al. Divergence of demographic factors associated with clinical severity compared with quality of life impact in acne. J. Cutan. Med. Surg., 2008, 12 (5): 235-242. 17. Goulden V, Clark SM, Cunliffe WJ. Post-adolescent acne: a review of clinical features. Br J Dermatol 1997, 136: 66-70.

Antimicrobials for treating acne at home

For inflammatory elements of acne in the form of papules and pustules, antibacterial drugs for external use can be used independently, since they do not have the pronounced effectiveness of systemic antibiotic therapy.

Topical preparations suppress the growth of bacteria:

• Benzoyl peroxide (Baziron AS) gel.
• Azelloic acid (Skinoren) gel and cream.
• Fusidic acid ointment, cream.
• Erythromycin ointment.
• Clindamycin (Dalacin-gel).
• Lincomycin ointment.
• Metronidazole gel.
• Pyolysin ointment.
• Zenerite (erythromycin/zinc acetate) powder.
• Zinc hyaluronate (Curiosin) gel.

Degrease and disinfect the skin with alcohol solutions with antibiotics (5% chloramphenicol), 2% resorcinol, 2 - 5% salicylic acid solution, 5 - 10% alcohol solution of camphor.

Don't squeeze pimples! When squeezed, the infection spreads into the deep layers of the skin and non-inflamed elements.

Rashes due to liver diseases

In the early stages of liver disease, they practically do not manifest themselves at all. The earliest symptom is specific skin rashes. They are caused by an increase in the amount of bile acid in the blood, which causes general intoxication of the body. The skin takes on a yellowish tint.

With cholestasis (blockage of the bile ducts), the rash is localized on the feet and palms, looking like marks from a burn. With cirrhosis, liver cells die and the whole body becomes covered with spots. Parasitic liver diseases cause rashes resembling hives. They are localized in the lumbar region and abdomen.

Also characteristic is a combination of rash and spider veins, which cause severe itching, which intensifies at night. Taking antihistamines (allergy medications) does not provide relief. Increased bilirubin gives the skin a yellowish tint.

Therapeutic cosmetics for acne treatment

Modern medicinal cosmetics will help you get rid of acne. Her choice should be based on the form of acne and the severity of the disease. Medicinal cosmetics should have a keratolytic, sebum-regulating and antibacterial effect, and should clean and moisturize the skin well.

Today there are many lines of medicinal cosmetics for acne treatment on the market:

• Products from the Exfoliak series (France), including hygiene gel and creams for the treatment of acne of varying severity.
• Therapeutic cosmetics “Aven” from the “Cleanans” line. It has a sebum-regulating and keratoregulating effect.
• Products from the series “Clerasil Ultra”, “Cetaphil”, “Zeniac”.

Remedies for acne for sensitive skin are represented by La Roche Pose thermal water, Toleran Fluid protective emulsion, and Rosaliac products.

Efaklar products and the Klerasil Ultra treatment series are especially designed for oily skin.

Curiosin and Mederma gels, Piolysin ointment, Diaknel cream with a unique combination of retinaldehyde and glycolic acid prevent the development of scar tissue and even out the skin texture. They help smooth out the skin texture and prevent the formation of scars.

Rice. 25. The photo shows anti-acne products from the “Clerasil” line.

If you have acne, you should not sunbathe. Excessive sun exposure increases sebum production.

Symptoms

Pathology forms in problem areas where there is an increased volume of sebaceous glands. Visually manifests itself in the form of comedones and milia. Signs of acne:

• increased fat content of hair;
• Friday;
• scar formation;
• spread of painful nodes.

Pathology education:

1. Formation of hypersecretion of sebum.
2. Rapid increase in sebum.
3. Formation of follicular hyperkeratosis. Rapid spread of horny epithelium in the structure of hair follicles. The appearance of blackheads all over the body.
4. The active stage of the inflammatory process, characterized by the proliferation of bacteria. The microorganism is a lipophilic anaerobe; clogged areas of hair imply a favorable microclimate for the rapid spread of infection.

Inflammatory process. During the period of active reproduction, the infection actively releases harmful components characterized by reproduction. Inflammation manifests itself in all areas.

General therapy for acne

In cases where the use of external therapy for 3 months has not produced results, as well as in severe forms of acne, general (systemic) treatment is used, which includes the use of antibiotics, synthetic derivatives of vitamin A, specific immunotherapy and antiandrogens.

Antibiotic therapy

For acne, the use of macrolide and tetracycline antibiotics for 2 to 3 weeks is indicated. Antibiotics of the cephalosporin group and gentamicin are indicated for phlegmonous acne.

Synthetic vitamin A derivatives

The substance isotretinoin is a synthetic derivative of vitamin A. The retinoid isotretinoin (the drug Roaccutane) is a dermatoprotector. The drug has anti-inflammatory, anti-acne and antiseborrheic effects. When used, terminal differentiation of cells is normalized, proliferation of the epithelium of the sebaceous gland ducts is inhibited, the formation of detritus is reduced and its evacuation is facilitated, the production of sebum is reduced and the outflow of sebum is facilitated.

Rice. 26. The photo shows the results of acne treatment with Roaccutane.

Antiandrogens

Drugs in this group (Andokur, Diane-35, Zhanin, Cyproterone, Spironolactone) reduce sebum production. Antiandrogens are prescribed to women in case of prolonged acne, when antibiotic therapy and topical isotretinoin are ineffective. Antiandrogens are used only after consultation with a gynecologist and endocrinologist. Oral intake of antiandrogens must be combined with the use of a complex of medicinal cosmetics.

Specific immunotherapy

Specific immunotherapy is indicated in the treatment of phlegmonous acne. Treatment is prescribed and carried out under the supervision of a doctor. Toxoid, antifagin, gamma globulin and other drugs are used.

Rice. 27. In the photo there are acne on the face. Heavy current. Systemic treatment is required.

Rashes due to intestinal diseases

If the contents of the intestines are poorly removed from the body, then some of the toxins will begin to penetrate into the blood. The body begins to get rid of poisons itself through the excretory system. Because of this, the condition of the skin worsens, and it becomes characteristic of:

• increased fat content
• dull complexion
• acne, not only on the face, but also on the back, stomach, chest
• noticeable “black dots” similar to volcanic craters
• skin becomes dry and dehydrated
• After acne heals, scars remain.

After the New Year holidays, many people note a deterioration in their skin condition and notice minor rashes that go away on their own. They are associated with contamination of the body with toxins caused by eating large amounts of heavy food.

Proper care

Effective rejuvenation and normalization of water balance. Comprehensive cleaning:

• quickly removes visual scales from the surface, reduces the volume of subcutaneous fat;
• effective exfoliation of dead cells;
• comprehensive disinfection, maximum protection against overdrying and negative effects of external factors.

Cleaning is carried out using medicinal emulsions, solutions, and cosmetic soaps. Intended purpose: for skin characterized by a tendency to form pimples and blackheads. Mandatory absence of alcohol. Ignoring it will quickly damage the pH level and normal microflora inside the body.

The moisturizing effect normalizes water balance and removes excesses from the surface. Application of products based on hydrogel, liquid cream, emulsions. Anti-inflammatory medications and creams will help reduce the total number of comedones and the pronounced inflammatory process.

When to see a doctor

An appointment with a dermatologist is required when primary signs of pathology appear. If there is pain, there is a risk of spreading infection and harmful bacteria.

A comprehensive diagnosis by doctors at a specialized medical clinic determines:

• total number of elements;
• nature of neoplasms;
• location;
• speed of spread;
• duration of the inflammatory process.

Making a diagnosis is a quick way to determine complex drug therapy. A mild form of the disease is the use of medications, vitamin complexes, mechanical facial cleansing, peeling of damaged skin areas.

Peeling – with salicylic and pyruvic acid. Accompanied by mechanical cleaning - at the beginning of treatment the intensity is high. In addition, a set of procedures includes cosmetics and products with active ingredients from well-known manufacturers.

Acne with moderate inflammation – complex systemic clinical therapy. Purpose of laboratory tests: general urine analysis, according to Nechiporenko, blood biochemistry, study of the patient’s hormonal background. As prescribed by a specialist: general and local antibiotics, oral contraceptives with an antiandrogenic effect.

Complications – the doctor of a specialized clinic prescribes medications with active ingredients based on isotretinoin. There are contraindications - women planning pregnancy. Should be used with contraceptive medications.

Recommended Diet

The effectiveness of using a balanced diet is not a scientifically proven phenomenon. Dermatologists and cosmetologists recommend that patients with acne-prone skin:

• completely eliminate whole fat milk and easily digestible carbohydrates;
• limit the intake of sausages as much as possible: boiled, smoked, dry-cured sausage, frankfurters;
• consumption of canned food is prohibited;
• ban on mineral water with high sugar content and food coloring;
• limited consumption of sweets, pastries, cakes;
• Avoid fermented milk products as much as possible: cottage cheese, cheese;
• ban on mayonnaise;
• limited consumption of coffee and strong tea.

Personal balanced nutrition is formed in the presence of problems with the gastrointestinal tract.

Post-acne – a common consequence of acne

According to the latest data, acne resolves with the formation of post-acne in 40% of cases. This term refers to the occurrence of skin changes in places where the inflammatory process persists for a long time and the formation of the largest papules, pustules and nodules. Thus, post-acne may manifest itself:

• pigment spots - the result of squeezing out comedones, pustules and papules, as well as the action of sunlight, which led to a violation of pigment formation (most typical for patients with dark skin and late acne;
• stagnant or erythema spots - occur due to impaired microcirculation in the area of ​​inflammation;
• enlarged pores – a consequence of prolonged stretching of the walls of the sebaceous glands by excess sebum;
• pathological scars (atrophic (chipped, round, square), normotrophic, hypertrophic, keloid) - the result of severe facial acne, leading to damage to the perifollicular part of the dermis;
• atheromas - large subcutaneous cysts of the sebaceous glands, completely filled with sebum;
• milia or millet - small round white pimples that arise against the background of disturbances in the keratinization process.

Therefore, post-acne can reduce the quality of life no less than acne directly affecting the face. At the same time, the likelihood of developing post-acne increases with:

• severe papulopustular and conglobate forms of acne;
• persistence of the inflammatory process for more than a year, which is usually observed in the absence of treatment or its improper implementation;
• presence of post-acne in close relatives;
• squeezing out comedones, pustules, papules or exposure to other traumatic factors on the facial skin.

In this case, post-acne becomes not only a pronounced cosmetic defect, but can also lead to the development of a number of complications, including dangerous ones:

• exacerbation of herpes infection;
• depigmentation;
• formation of new scars;
• allergic dermatitis;
• persistent erythema (redness of the skin);
• secondary infection, which can result in erysipelas.

The risk of developing post-acne complications increases with trauma to the facial skin and especially with squeezing out acne.

Post-acne treatment

Treatment of the consequences of acne or post-acne is a more complex task than directly eliminating the inflammatory process. Nevertheless, it is no less important, since various scars, age spots and other traces of inflammatory elements represent a serious cosmetic problem and sharply reduce the quality of life of patients.

Today there are several methods for correcting post-acne. The choice of specific ones is made based on the severity of the situation. These include:

• chemical peels;
• hardware procedures;
• injection therapy;
• surgery.

But for treatment to be effective, especially for moderate and severe post-acne, it must be comprehensive and combine different methods of influencing the skin of the face. At the same time, it is important not to rush, but to systematically work on eliminating post-acne, since after each procedure the skin needs restoration.

For deep scars, before starting correction, subcision may be required, i.e., destruction of the adhesions that connect it to the surrounding tissues.

Chemical peels

To eliminate post-acne in the form of stagnant spots and shallow square scars, chemical peels of varying depths of exposure using various acids are used. In other cases, they can only act as a component of complex therapy. This:

• superficial chemical peels (salicylic, glycolic, pyruvate, milk);
• medium (Jessner peel, trichloroacetic peel);
• deep (phenolic).

Today, deep chemical peels are performed extremely rarely for post-acne conditions, since they often provoke a large number of complications.

Each chemical peel has its own indications and contraindications, not to mention the specifics of its implementation. Therefore, the choice of a specific one is carried out strictly on an individual basis.

Hardware procedures

Hardware methods are considered one of the most effective in the treatment of facial post-acne. These include:

• Classic dermabrasion is a procedure that involves using special tips with an abrasive surface to remove the top layer of skin. But its implementation is associated with severe painful sensations, which often forces it to be performed under general anesthesia. Therefore, today this method is used extremely rarely.
• Microdermabrasion is an analogue of classical dermabrasion, but involves a smaller depth of impact. Therefore, it is effective only against stagnant spots, square scars with a depth of no more than 0.5 mm.
• Laser resurfacing is one of the most effective methods for treating post-acne, including round and square scars of varying depths.

Injection therapy

Modern injection procedures used to improve the appearance of the face during post-acne include:

• Needling is a cosmetic procedure, the essence of which is to carry out numerous micro-perforations of the skin with a special roller. It is equipped with many needles, the length of which does not exceed 2 mm. Needling is most effective for removing congestive spots and atrophic superficial scars.
• Plasmolifting is a medical procedure that involves introducing platelet mass separated from the patient’s own blood into the deep layers of the dermis.
• Mesotherapy is a well-known cosmetic procedure, the essence of which consists of numerous intradermal injections of individually selected mesopreparations, which include vitamins, enzymes, amino acids, nucleotides, organic acids and other biologically active compounds.

Surgery

Today, scar removal can be done through traditional surgery or laser destruction. Surgical methods are used extremely rarely and only in the most complex cases, in particular with large hypertrophic and keloid scars. But in the latter case, there is a risk of re-formation of the scar, since keloids tend to grow due to mechanical trauma. To reduce this risk, long-acting suspension corticosteroids are injected into the scar area. In other cases, injections of enzyme preparations, in particular longidase and collagenase, are indicated.

Thus, acne treatment, although it can be quite complex and lengthy, is still much simpler than the fight against post-acne. Therefore, it is important to contact a dermatologist as soon as possible if acne of any nature appears on the face. This will allow you to notice the onset of the development of the disease at the earliest stages and eliminate it even before unsightly scars, age spots, etc. form on the face. But even if time is lost, do not despair. The modern level of development of medicine makes it possible to effectively combat acne of any severity, as well as post-acne, improving the appearance of the face and returning the patient to an active social life.

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