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Acne
Overview
The skin disease known as acne affects almost everyone. Sebum, an oil that keeps skin from drying out, and dead skin cells block pores, resulting in lesions. (often known as pimples). Acne, also known as acne vulgaris, is brought on by sebum clogging the skin's pores and hair follicles. Although the face is the most commonly affected area, acne can appear anywhere on the body, including the chest, shoulders, and upper back. Hormonal changes, stress, puberty, menstrual cycles, pregnancy, birth control pills, greasy or oily cosmetics and hair products, a few medications (such as steroids, testosterone, estrogen, and phenytoin), high humidity and excessive sweating, and excessive skin contact, contact, or rubbing can all contribute to acne.
Acne can be treated with topical lotions and ointments, systemic medications, and dietary adjustments. Topical remedies include prescribed cleansers and ointments. Systemic therapy is employed to address acne and may include hormonal therapies or antibiotics. The primary dietary, hydration, and lifestyle changes for acne are regular exercise and improved diet. Prompt acne treatment can significantly decrease the likelihood of future acne scarring.
Consulting Doctor
1) Dermatologists: These doctors specialize in the diagnosis and treatment of skin conditions, including acne. They are the most common healthcare providers for acne treatment.
2) Primary Care Physicians (PCPs): Your family doctor or general practitioner can often diagnose and treat mild to moderate cases of acne. They may refer you to a dermatologist for severe or complex cases.
3) Pediatricians: For children and teenagers with acne, a pediatrician can provide initial treatment and guidance.
4) Endocrinologists: If hormonal imbalances are contributing to acne, an endocrinologist may be involved in diagnosis and treatment.
5) Obstetricians/Gynecologists: For females with hormonal-related acne, gynecologists can help address underlying hormonal issues and discuss treatment options.
6) Allergists: In some cases, allergies may contribute to skin conditions, including acne. Allergists can identify and manage such allergies.
Symptoms
Taking into account the clinical picture of the disease, there are:
1. Comedonal acne;
2. Papulo-pustular acne of mild to moderate severity;
3. Severe papulo-pustular acne, nodular acne of moderate severity;
4. Severe nodular acne,
5. Acne conglobata.
Acne is localized mainly on the skin of the face, upper extremities, upper chest and back and is manifested by papules, pustules and nodes, as well as open and closed comedones.
Comedo is a clinical manifestation of the accumulation of sebum and keratin in the hair follicle. There are closed and open comedones. A closed comedone differs from an open one in that the keratin masses are not so compact, and the hair follicle opening is narrow.
Papular acne are inflammatory nodules that are conical or hemispherical in shape and up to 2–4 mm in diameter. Pustular acne can occur primarily or transform from papular acne.
Nodular acne is characterized by the development of nodules on the skin of seborrheic areas. In patients with acne conglobata, in addition to comedones and papulo-pustular acne, numerous large nodes appear, localized mainly on the skin of the back and back of the neck. The consistency of the nodes is initially dense, but gradually they soften. The skin above them acquires a bluish-pink color, becomes thinner, and holes appear in it, from which pus is released. Part of the separately located nodes merges into massive infiltrates with numerous fistulous passages, purulent openings and cavities filled with sluggish, gelatinous granulations, the process can become widespread.
The clinical picture of acne in adults and adolescents has its own characteristics in terms of the ratio of lesions in the lower and upper parts of the face:
In adults,
1. The U-zone (cheeks, around the mouth and the lower part of the chin) is usually affected, and in adolescents - the T-zone (forehead, nose, upper chin).
2. Papules and pustules may be absent.
3. Comedones are always present in adolescent acne, but may be absent in adults. Inflammation in adults is usually more pronounced.
In women , there are 3 subtypes of acne:
1. Persistent (persistent) acne - observed in approximately 80% of women and is characterized by the onset of the disease in adolescence with a gradual transition into adulthood.
2. Late-onset acne - first appears in women after 25 years of age. Both subtypes have similar clinical features.
3. Recurrent acne - develops in women who had a history of acne in adolescence, resolved within a few years.
Causes
Following are the factors that cause Acne
1) A change in the hormonal background can affect the functioning of the sebaceous glands, forcing them to produce more sebum (fat), which leads to clogged pores, the appearance of comedones and pimples;
2) Heredity;
3) Stress;
4) The use of certain drugs, such as corticosteroids.
5) Frequent squeezing of the skin (for example, with a telephone receiver) or the habit of touching the face with hands.
Prevention
In most cases, acne can be treated with various over-the-counter acne medications (lotions, creams, gels). The most common ingredients in acne products include benzoyl peroxide , azelaic acid, resorcinol, salicylic acid , and sulfur. Benzoyl peroxide destroys the bacteria that cause acne. Azelaic acid has antibacterial, anti-inflammatory and keratolytic effects. Resorcinol, salicylic acid and sulphur , although not as widely used today as they used to be, can help remove comedones (both closed and open).
It is recommended to apply anti-acne products every day on the affected areas after cleansing the skin. If the skin begins to dry out and becomes irritated, reduce the frequency of application to once every two to three days. Do not squeeze or open pimples and pustules on your own, this can spread the infection and lead to scarring. Cleanse your face with a mild soap or other gentle cleanser (preferably one made specifically for problem skin) twice a day. Wash your hair every day. Use moisturizers and cosmetics that are water-based and labeled “non-comedogenic,” which means these products won’t clog pores.
Use face masks that remove excess sebum. Avoid stress. Consult your doctor if acne progresses, if your skin condition is severe, or if acne scars remain.
Treatment
Following are the goals for treaing Acne
1) To reduce inflammation;
2) Decrease in the number of R. acnes ;
3) Decreased sebum formation;
4) Reducing the effect of androgens on the sebaceous glands.
General notes on therapy
Acne treatment is carried out depending on the severity of the disease and includes systemic and topical therapy. When determining the severity of dermatosis, the following criteria are taken into account: the prevalence, the depth of the process, the number of elements, the impact on the psycho-emotional sphere, the formation of scars. There are mild, moderate and severe acne, but there is currently no consensus on how to assess the severity of the disease.
Systemic therapy
1) Antibacterial drugs
2) Hormonal preparations.
3) Systemic retinoids
External therapy
1) Topical retinoids
2) Azelaic acid
3) Benzoyl peroxide
4) Antibacterial drugs
5) Combined drugs
With a mild degree of acne, only external therapy is prescribed, with an average degree - external therapy, if necessary, is combined with systemic therapy, with a severe degree, systemic therapy is the main one.
The action of modern external preparations is based on their influence on the main pathogenetic mechanisms underlying acne: follicular hyperkeratosis, an increase in the P number . acnes and inflammation.
In order to reduce the antibiotic resistance of P. acnes , it is necessary to adhere to the following principles in the treatment of patients with acne:
1) the duration of the use of antibacterial drugs should not exceed 8 weeks;
2) the combined use of systemic and topical antibacterial drugs without external use of drugs containing benzoyl peroxide should be avoided;
3) it is necessary to limit the use of antibacterial drugs both in frequency of prescription and in duration;
4) it is not recommended to use systemic and topical antibacterial drugs as monotherapy and maintenance therapy for acne;
Topical antibiotics should be avoided in combination with retinoids (including adapalene) without the addition of benzoyl peroxide.
There are no requirements for hospitalization.
Tests Required for Diagnosis
Acne is diagnosed based on clinical observations.
Systemic signs of hyperandrogenemia (irregular menstrual cycle, clitoral hypertrophy, and changes in secondary sexual characteristics), as well as later menarche, should be considered when performing an examination. Treatment-resistant acne may indicate the presence of endocrine disorders such as polycystic ovary syndrome, pituitary hyperplasia, or virilizing tumours; thus, symptoms such as amenorrhea, hypermenorrhea, oligomenorrhea, infertility, and metabolic syndrome should be considered.
An evaluation is recommended for middle childhood acne to rule out congenital adrenal hyperplasia and androgen-producing tumours.
Laboratory study
Includes measuring free testosterone, dehydroepiandrosterone sulfate, luteinizing hormone, and follicle-stimulating hormone levels, as well as performing a glucose tolerance test.
Differential Diagnosis
The criterion for diagnosis is the presence of comedones. Acne is differentiated from rosacea, rosacea-like (perioral) dermatitis, small nodular sarcoidosis of the face, manifestations of secondary syphilis - papular seborrheic and papulopustular syphilis and other papular dermatoses, drug-induced acne that occurs while taking a number of drugs (hormonal drugs, including systemic glucocorticosteroids, anabolic steroids, androgens, thyroxine, antiepileptic drugs, barbiturates, anti-tuberculosis drugs, azathioprine, cyclosporine A, chloral hydrate, lithium salts, iodine, chlorine, bromine, disulfiram, cetuximab, thiouracil, some vitamins, especially - B 1, B 2 , B 6 , B 12 , D2).
Other experts, such as endocrinologists or gynaecologists - endocrinologists, are called in as needed.
Useful info
In dermatological diseases, research shows that psychometric tools can help the clinician better select a therapeutic proposal and identify patients with psychological impact, even if the clinical condition is considered mild.
The development of indicators, instruments or questionnaires is based on evidence that there is discrepancy between physician or health worker and patient assessments of disease severity and treatment success, as well as varying responses to established therapy and varying levels of patient satisfaction with the same clinical condition.
Acne-related research indicates a negative impact on quality of life, including the presence of signs and symptoms of depression and anxiety, such as anger and low self-esteem. The use of disease-specific questionnaires such as the Acne Quality of Life (Acne-QoL), already translated and validated for Brazilian Portuguese, quantifies the impact of acne on quality of life.
References
Thus, at the present stage, acne is considered a non-infectious disease, the pathogenesis of which is inflammation. It accompanies acne throughout the disease cycle, leading to post-inflammatory erythema, hyperpigmentation, and scarring. Acne is primarily a chronic disease that requires ongoing maintenance therapy.
At present, acne therapy is represented by various methods, a combination of external and systemic drugs, the appointment of which takes into account the type of acne, the severity of the disease, etiopathogenetic data, and the psychosomatic status of the patient. The availability of modern highly effective agents allows successful therapy for any form of acne, both mild and severe, complicated and destructive processes, and lead to stable clinical remission. Acne in adult women is considered a separate subtype of acne, distinct from acne vulgaris or acne in adolescence, not only because of differences in clinical status and etiopathogenesis but also because of their chronic course, which can continue until the postmenopausal period.
Certain characteristics, such as more sensitive and less oily skin, and multiple etiopathogenic factors, such as the modern woman's increased work and household activities, stress, sleep disturbances, dietary supplements, and certain types of contraceptive methods, make treatment more difficult.
Recent data on its chronicity, including TLR stimulation, demonstrate that the control of the innate immune response has contributed to the understanding of the mechanism of action of the drugs used in its treatment.
The literature shows that the impact on quality of life does not always correlate with acne severity. In some cases, women with mild clinical conditions show a lower quality of life. Research has also shown that the psychological impact of acne appears to affect more women than men. In any case, the attention of the doctor, a good, patient attitude with adequate local and / or systemic treatment, although not completely effective, has a positive effect on the quality of life.
