Acne is one of the most common skin diseases

Acne (acne) is one of the most common skin diseases in the practice of a dermatologist.

It occurs more often in young people during puberty, but can affect the skin at a more mature age, often leading to the formation of cosmetic defects (spots, scars) and emotional discomfort. According to statistics, acne affects up to 80% of the population aged 12 to 25 years, and approximately 30-40% of people over 25 years of age.

The disease is based on chronic inflammation of the sebaceous glands, resulting from their blockage, increased sebum production (seborrhea) and exposure to the bacteria Propionibacterium acnes.

Where is increased fat content possible?

The content of the article

Problem areas:

• upper back;
• facial part, especially the chin, forehead and cheeks;
• cervical and thoracic parts of the body;
• genitals in both sexes;
• peripapillary zone.

These are the most common and most common, but there may be others. The only places on the body where acne cannot appear are the palms and feet. Due to the too thick and rough layer of the epidermis, incapable of this kind of inflammation.

How do changes in the functioning of the sebaceous glands affect the condition of the skin?

Changes in sebum secretion are one of the factors in the development of acne. Sebocytes in the sebaceous glands synthesize free fatty acids even without the participation of propionibacteria. This makes it likely that aseptic inflammation will develop without the presence of a bacterial component.

With hyperseborrhea, not only the amount of sebum produced changes, but also its composition, in particular, the content of linoleic acid in it decreases. Its deficiency can cause follicular hyperkeratosis40. This is due to the ability of linoleic acid to regulate keratinocyte differentiation10.

Regulation of the level of sebum secretion is also entrusted to hormones. Estrogens suppress, and progesterone and androgens, on the contrary, stimulate the process of sebum production.

Against the background of hyperseborrhea and increased keratinization of the skin, inflammation and blockage of the sebaceous gland channels occurs. Since it becomes impossible for air to get inside them, conditions are created for the proliferation of P. Acnes10.

Causes

• Dry skin;
• Hormonal changes in the whole body;
• Infection;
• Too much sebum production.

In addition to these reasons, there is another factor that was recently established by scientists - heredity.

Let's look at each reason in more detail.

Dry skin

One of the most common reasons. Due to dryness, the skin exfoliates and its particles clog the pores, which causes inflammation. It is very important to consider several points that cause excessive dry skin:

• Age. Over the years, the skin gradually loses many of its important properties, which include moisture retention.
• Environment. Dry and cold air, low humidity, and so on.
• Shower with hot water. Leads to the destruction of the protective layer of the skin.
• Allergic diseases.
• Hygiene products. Using regular soap on sensitive areas of the skin: facial skin, intimate areas, can cause dryness and cause acne.

Hormonal background

The reason lies in the incorrect proportion of sex hormones in the blood. Androgens (male hormones) play a very important role here. If their level is exceeded, then excess secretion begins from the sebaceous and sweat glands, which is the reason for the appearance of acne. You can also isolate progesterone, a hormone secreted in pregnant women. Leads to clogging of pores and, as a result, sebaceous inflammation appears.

Lack of estrogen can also cause excessive oily skin.

How to prevent it?

Despite the fact that the level of gland secretion is genetically determined, the appearance of acne can be reduced by reducing risk factors
. First of all, by reducing the intake of substances into the body that provoke an increase in the secretion of the sebaceous glands. The main ones are: - large amounts of spicy and salty foods, - added sugar and chocolate, - nicotine and other toxic substances from tobacco smoke. - alcohol. This is another reason why teenagers should avoid drinking and smoking. But the hygiene factor in the prevention of acne is far from leading. Bacteria will remain on the skin in any case, no matter how thoroughly a person washes his face.

Sebum production

There are 3 factors that can affect the amount of sebum production. Androgen, or rather its excess in the blood, is one of the reasons. Rarely, but still there is a special disease called “seborrhea”. And of course, a very common cause in the 21st century is poor nutrition.

Here is a list of products that promote the active secretion of sebum:

• carbonated drinks;
• alcoholic drinks;
• products in the production of which dyes were used;
• caffeinated drinks (black tea, coffee;
• sweet and flour;
• spicy, smoked food.

What are sebaceous glands?

Each hair is equipped with a sebaceous gland, and sometimes more than one. Their excretory ducts open in the hair follicle and release about 20 g of sebum per day. The composition of sebum includes29:

• fatty acid;
• glycerol;
• alcohols;
• wax esters;
• cholesterol;
• metabolites of steroid hormones, etc.

Sebaceous glands are located almost throughout the body, but their largest number is on the face, back, and scalp. These zones are called seborrheic. At the same time, their smallest number is on the border of the lips, the back of the hands, but on the soles and palms there are none at all. 29

In seborrheic areas, the density of sebaceous glands can reach 900 per 1 cm2. The sebaceous glands begin to manifest their functions as actively as possible in adolescence; this period can last up to 25 years. 29

When secretory function is disrupted, skin problems begin. If there is not enough sebum secreted, it flakes off, and signs of aging appear faster. And when too much content of the sebaceous glands is secreted, rashes may appear. 29

Sebocytes (cells of the sebaceous glands) are sensitive to sex steroid hormones. The cytoplasm of their cells contains enzymes that convert androgens into dihydrotestosterone, which promotes the secretion of more sebum. 29

Treatment and prevention

It would be best and safest to contact a competent doctor - an endocrinologist, so that further treatment takes place under his strict supervision. You will have to start with a healthy diet that limits the consumption of foods that are harmful to good skin condition. And it won’t hurt to start special cosmetic skin care.

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How to fight?

One of the most common methods of dealing with acne is squeezing it out. Beauty salons even provide deep facial cleansing services, which supposedly helps get rid of acne forever. However, such procedures do not affect any of the factors in the formation of acne. The improvement is only temporary
and does not affect the further development of the disease.
Some cosmetic products allow you to gently remove the keratin plug from the sebaceous gland duct, improving the outflow of secretions and preventing the proliferation of bacteria. There are also products with an antibacterial effect that continue to act even when inflammation has already begun in the sebaceous gland. A qualified dermatologist will select products
suitable for your specific skin type and severity of symptoms. But if these measures are not enough, then the treatment of acne requires serious medical intervention and the use of special medications.

Vulgar acne

One of the most common skin diseases, affecting up to 85% of people aged 12 to 25 years and 11% of people over 25 years of age. Acne can lead to disfigurement and permanent scarring. But even mild cases cause significant emotional distress and have serious psychosocial consequences. Acne is a disease of the hair follicles and sebaceous glands. Four interrelated factors are important in pathogenesis: 1. Pathological follicular hyperkeratosis

– this is a violation of the processes of keratinization, which leads to blockage of the follicular duct by horny scales and the formation of a comedon (black head).
Subsequently, closed comedones turn into inflammatory papulopustular elements and transform into open comedones. In closed comedones, the drainage of sebum and waste products of Propionibacterium acnes is completely blocked. The created oxygen-free conditions are an optimal environment for the rapid proliferation of microorganisms. 2. Excessive formation of sebaceous gland secretion
, which is a substrate for the proliferation of P.acnes, and also leads to pronounced cosmetic defects due to the formation of deep sebaceous cysts (atheromas).
3. Microbial colonization
, in particular the proliferation of P. acnes.
4. Inflammation and immune response
. Acne is not a primarily immune disorder. P.acnes causes inflammation in the dermis (deep layers of the skin), and the epithelium (surface layers of the skin) is damaged by proteolytic enzymes. First, migration of lymphocytes occurs at the site of inflammation. Neutrophilic leukocytes penetrate the lesion and it is they who contribute to even greater damage to the follicle epithelium as a result of lytic enzymes. Highly active radicals (oxygen free radicals, hydroxyl groups, hydrogen peroxide superoxides) accumulate in the dermis, which further damage cells and support inflammation. Inflammation develops at any stage of acne. Today there is no single classification of acne. Existing classifications of acne are based on the clinical picture of the disease or on an assessment of its severity. The most successful is the etiopathogenetic classification. In this review, it is presented with the aim of expanding the understanding of this problem, which will allow us to determine the significance of the disease and optimize the creation of drugs for local and systemic use for the above-mentioned disease.

Acne severity

The severity of the disease is most often assessed using the Cook method - mild, moderate and severe.

- mild degree is diagnosed mainly in the presence of non-inflammatory elements - closed and open elements. With this degree of severity, it is possible to have less than 10 papulopustular elements on the facial skin.

- moderate severity of acne is characterized by the presence of papulopustular elements on the face and / or torso in an amount of more than 10, but less than 40.

- severe degree is characterized by the presence of more than 40 papulopustular elements, as well as conglobate and cystic acne.

Sebum control: how to remove excess sebum

Home corrective care based on mattifying formulas that absorb sebum will help control excess sebaceous secretions. In cosmetics for oily problem skin, look for mattifying, moisturizing and restoring components, hydroacids, hydrofixatives, amino acids and antioxidants.

Important: If, after self-care, oily shine and imperfections do not go away, consult a dermatologist. The specialist will prescribe tests, based on the results of which he will adjust your individual sebum removal system.

Alexander Prokofiev, dermatovenereologist, La Roche-Posay brand expert, tells what proper care for oily skin should be to control sebum:

• Any beauty routine begins with regular cleansing. Oily skin requires special attention. Choose non-comedogenic formulas with a mattifying effect.
• Exfoliate the stratum corneum regularly - dead cells mix with sebum and clog pores. Use gentle skin renewal products (scrubs, peelings, gomages) based on exfoliating ingredients, such as AHA, LHA and salicylic acids, 1-2 times a week.
• Products containing different types of clays and their derivatives have an additional cleansing and mattifying effect. For example, Masks absorb excess sebum well, attracting various impurities, thereby cleansing and ridding the skin of blackheads. Apply the mask 1-2 times a week, the next step after intensive cleansing.
• Finish cleansing your skin by applying a mattifying lotion or toner. Give preference to products that do not dry out the skin. The lotion will also prepare the skin for basic care.
• Basic corrective care should be aimed at additional regulation of skin oiliness, have protective, restorative properties and maintain skin hydration, preventing transepidermal moisture loss. As part of corrective care, pay attention to hygroscopic components, such as glycerin and hyaluronic acid.
• Use Sanskrin - UVA and UVB rays disrupt the protective barrier of the epidermis, provoke active sebum production and discomfort.

Skin as an indicator of human health

The human body is a unique living system; there is nothing unnecessary in it. Every organ, every part of the body, every cell has its own purpose. Skin is the outer covering of the body, the border between the outside world and our inner space.

. It actively participates in all vital processes of the body, the metabolic process, especially water, mineral, fat, carbohydrate, vitamin and energy, and performs a number of important functions: immune, protective, secretory, receptor, etc.

Protective function.

The most important role in the implementation of the skin's protective mechanisms belongs to the epidermis. The barrier properties of the skin, as an organ of mechanical protection, are ensured by significant electrical resistance, the strength of collagen and elastic fibers, and elastic subcutaneous fatty tissue. The compact stratum corneum and water-lipid mantle protect the skin from drying out, many chemical and physical damaging effects, and microbial flora. This is facilitated by the rejection of keratinized epithelium and the secretion of sebaceous and sweat glands. In addition, the skin has sterilizing properties due to the acidic reaction of the water-lipid mantle, and the low molecular weight fatty acids contained in it inhibit the growth of pathogenic flora (“its own sterilizer”). The body is protected from the damaging effects of ultraviolet rays from the sun by thickening the stratum corneum and increasing pigmentation. Melanin absorbs visible light and ultraviolet rays throughout the entire range.

Secretory function.

This function is carried out as a result of the secretory activity of the sebaceous and sweat glands. The sebaceous glands produce sebum. In the sebaceous glands, the secretion is in a liquid or semi-liquid state. Released to the surface of the skin and mixed with sweat, sebum forms a water-lipid mantle. It protects the skin and has bactericidal and antifungal activity. In addition to the secretory function, the sebaceous glands also perform an excretory function. Toxic substances formed in the intestines and many medicinal substances are released from sebum. The amount of sebum produced is different for each person; it is uneven in different areas of the skin. The largest amount of sebum is secreted on the skin of the scalp, forehead, cheeks, nose (up to 1000 sebaceous glands per 1 cm2), in the central part of the chest, interscapular area, upper back and perineal area. The chemical composition of sweat is not constant and can change depending on the amount of fluid drunk, emotional stress, mobility, general condition of the body, ambient temperature, as well as the topography of the sweat glands. Sweat is released constantly and continuously. On average, 750-1000 ml of sweat is released per day, up to several liters in high temperatures.

Skin is an immune organ.

Healthy skin is a barrier to most microorganisms. The protective function of the skin is explained not only by mechanical factors - the stratum corneum, the water-lipid mantle, high elasticity and subcutaneous fatty tissue. Currently, there is information about the immune activity of the main structures of the skin that implement the immune response. It is possible to consider the epidermis as an organ functionally similar to the thymus gland. T lymphocytes make up 90% of all skin lymphocytes and are located primarily in the epidermis and upper layers of the dermis. B lymphocytes are found in the middle and deep layers of the dermis.

Respiratory and resorption functions.

In places where sebaceous and sweat glands are abundant, and the stratum corneum is poorly defined, the resorption (absorption) properties of the skin are enhanced: fat-soluble drugs are absorbed - iodine, phenol, pyrogallol, resorcinol, salicylic acid, boric acid, etc. With inflammatory changes in the skin's resorption capacity increases, so it is necessary to use medications externally with caution, without exceeding therapeutic concentrations.
The respiratory function of the skin provides a person with about 1% of all gas exchange. But this small percentage is important. If you cover a person with varnish, he will quickly begin to suffocate, his heart will slow down, his temperature will drop, and even death is possible - this can be considered as a consequence of a combination of suffocation and impaired heat transfer. Regular adherence to hygiene procedures ensures clean skin, and at the same time “clean” breath. Skin respiration increases with rising air temperature, increasing oxygen content in the air, during heavy muscular work and digestion. Thermoregulatory function.
Thermoregulation is significantly influenced by the state of blood and lymph circulation and the excretory ability of the sebaceous and sweat glands. The secretion of the sweat glands cools the skin by evaporating it to maintain a constant body temperature. An increase in ambient temperature leads to dilation of skin vessels, an increase in the volume of blood flowing through it (sometimes up to 1 liter) and increased heat transfer. When the external temperature decreases, the vessels narrow, and heat transfer decreases sharply. The heat exchange of the skin is impaired in some skin diseases. Heat transfer increases with vegetative dystonic and discirculatory disorders.

Exchange function.

The role of the skin in metabolism is significant due to its depositing ability. The hydrophilicity of the skin causes the retention of intracellular and extracellular fluid and minerals, vitamins, and microelements. Carbohydrates, cholesterol, iodine, bromine, amino acids, bile acids and waste products formed during lipid peroxidation are deposited in the skin. In this regard, long before general metabolic disorders, the following appear in the skin: itching - in case of liver dysfunction, pustular rash - in case of latent diabetes mellitus. Many chemicals that penetrate the stratum corneum remain there for a long time.

Receptor function.

The receptor functions of the skin are provided by a variety of different sensitive nerve endings and sensory bodies, distributed unevenly throughout the skin. There is tactile (sense of touch and pressure), pain and temperature (sense of cold and heat) skin sensitivity. The skin continuously reacts to a variety of irritations coming from the environment, from the central nervous system and internal organs. The skin is like a screen on which functional and organic changes in the activity of internal organs, the central nervous system, endocrine and immune systems are projected. Often, even with a slight disorder in the activity of the body and its individual functions and systems, changes occur in the skin that suggest one or another pathology. Following the rules of skin hygiene is, first of all, a way to protect your health from the effects of external environmental factors. Many diseases enter our body through the skin, and we have the power to prevent most of them.

Clinical picture of acne

Acne rashes are divided into non-inflammatory (open or closed comedones), inflammatory (papules, pustules, nodes) and post-inflammatory (scars, hypo- and hyperpigmentation).

Comedones are non-inflammatory elements resulting from blockage of the mouths of hair follicles. Slightly expressed comedones are a physiological phenomenon. At the beginning of the development of acne, microcomedones transform into so-called “closed” comedones, that is, those that do not have free communication with the surface of the skin. They are non-inflammatory nodules with a dense consistency, up to 2 mm in diameter, consisting of sebum, horny scales and bacterial bodies. “Open” comedones look like yellowish-black dots. The black-colored tip of an open comedone is made of melanin, not debris.

Papules are a red inflammatory element, rising above the surface of the skin, of a hard consistency with a diameter of up to 0.5 cm.

Pustules are an inflammatory element with purulent contents, having a hemispherical shape. Typically resolve without scar formation, post-inflammatory hyperpigmentation may occur.

Nodes are convex, painful formations of a red-violet color, filled with contents of pus and sebum. They often leave scars.

Most patients have comedonal and papulopustular forms of acne. All others are relatively rare, but also deserve attention.

Conglobate acne is a severe form of acne, most common in men aged 20 to 30 years. They are localized mainly on the back, less often on the face and chest. It is characterized by the gradual appearance of multiple extensive, deeply located nodular cystic elements. They can merge. Some of them retain a dense consistency, others soften during development and open with the release of purulent exudate. After healing, stagnant bluish-colored spots persist for quite a long time and scars remain.

Excoriated acne - this form occurs mainly in patients against the background of constant attempts to remove any, even minimal, manifestations of acne. It is characterized by a small number of typical acne formations on the skin and a large number of wounds covered with crusts.