Cosmetologist YULIANA SHIYAN: Acne in a teenager is considered common, although any diagnosis, including “simple acne,” should not be considered the norm. Moreover, the calm attitude of adults towards a rash on a teenager’s face does not make life easier for the child; this does not make his self-esteem higher, nor does his anxiety decrease. And if you notice that the child once again does not go out with friends and stays at home at every opportunity, then pay attention to this; this is hardly a normal desire to do homework.
For acne in teenagers, a variety of remedies are used:
- Azelaic acid
- Antibiotics, external and systemic, for example erythromycin, clindamycin
- Zinc preparations (internally and externally)
- Benzoyl peroxide
- Retinoids (internally and externally)
There is now a lot of information in the public domain about how to get rid of acne for a teenager. Buying ointment at a pharmacy is not a problem at all; advertisements for all kinds of zinerites and basirons are a dime a dozen. The main thing for parents in this flow of information and availability of medications is not to slip into self-medication.
Each of the drugs listed is good, and it seems that now we’ll buy it, apply it and we’ll have clear skin. But in fact, each drug has many nuances in use, for pustules one, for blockages another, for irritated skin a third. Most of them require supplementation for strengthening or reinsurance so that resistance (stability) of the flora does not form.
They have a side effect that is either considered normal or requires immediate cancellation. When and how to add oral medications to external treatment, and whether acne is purely teenage acne or requires additional specialists are separate questions. It is impossible to determine all this on your own and there is simply no knowledge. Therefore, you need to contact me and sign up for a consultation.
Severity of acne and duration of treatment in adolescents
Acne on a teenager's face can look different - small red rashes, pustules, blockages, blackheads, painful nodes. Acne on the back of a teenager is one of the signs of the severity of acne. And the remedy for acne (for teenagers) is selected depending on this degree of severity of the process. The duration of treatment depends on how severe the acne is and whether the doctor’s prescriptions are strictly followed.
Treatment may take 3 months, or maybe a year. Typically, teenagers are not burdened with multi-level home care and procedures, but it is still necessary to do the minimum for results. In any case, already in the first or second month the skin becomes clearer, this is very encouraging for both parents and children.
And at the same time relaxing. It is important not to interrupt this path halfway, as everything will quickly return to its roots, and perhaps twice as much effort will be required the second time.
Pyoderma in a child
If you take your baby's hygiene seriously, you can prevent many health problems. This also applies to skin pathologies - dermatitis, which has numerous varieties. The most common form of dermatitis in childhood (especially in the first months of life) is pyoderma.
Pyoderma is a purulent skin disease, which is a group of pathologies that develop against the background of penetration of pyogenic microorganisms into the skin. Parents should take into account the ways of transmission of pyoderma: germs are transmitted when the child comes into contact with sick people or a contaminated object.
The disease is most often diagnosed in childhood and has many types. There is an opinion that the cause of pyoderma lies in poor diet and poor hygiene. Although this is not entirely true. This skin pathology develops under the influence of various pathogens: streptococci, staphylococci, pneumococci, Pseudomonas aeruginosa, E. coli, etc.
Often the human body is the habitat of certain microorganisms, which are activated when protective functions are reduced, which leads to the appearance of their pathogenic qualities.
Since the protective function of newborns and infants is more weakened, pyoderma in such patients occurs in a severe form. This happens if treatment is not started in a timely manner and the baby is not properly cared for. In the body of children under 2 months of age, there is no independent production of antibodies. As a result, it is important to care for the baby’s skin throughout the body.
Onset of acne in adolescents and provocative diets
Acne in teenage girls often begins during the onset of the menstrual cycle, at 12-14 years of age. But it happens that black spots, greasiness, dense large blockages in the T-zone can be observed long before this, from 7-8 years. In general, this age in dermatology is considered the beginning of teenage acne. This earlier onset is now associated with “Western” nutrition.
Video - Moms about teenage acne
To mothers about teenage acne. Acne in teenagers. Pediatric dermatologist
Children's diets increasingly include foods with a high glycemic index (fast food, snacks, rolls, sweets, carbonated drinks, cocktails, etc.) and a colossal amount of dairy products (including sweets). All this is a provocation of increased work of the sebaceous glands, the early appearance of acne and significantly aggravates the course of acne.
Acne in a teenage boy may also first appear before the age of 10, but more often at 12-13 years of age. Pimples and blackheads of a teenager are something that can and should be dealt with. Practice shows that you can enjoy clean and well-groomed skin even at 15 years old.
Acne in children and adolescents
Acne is one of the most common skin lesions and is found not only in dermatological and cosmetological practice.
The problem of acne is often encountered by doctors of other specialties (pediatricians, neonatologists, gynecologists, endocrinologists), who in some cases take part in the examination and treatment of such patients. Sometimes decisions about prognosis and treatment choices require the opinion of various specialists.
Seborrheic acne associated with hormonal stimulation includes neonatal, infantile and juvenile acne, as well as adult acne. Neonatal and juvenile acne develop during periods of physiological natural hormonal changes, while infantile acne and adult seborrheic acne are caused by pathological changes in the secretion of pituitary gonadotropins, androgen production by the adrenal glands, gonads or genetic characteristics of steroid metabolism in the skin and the sensitivity of androgen receptors in the cells of the pilosebaceous structures of the skin . In all forms, additional exogenous provoking factors can play a significant role.
Neonatal acne does not pose a difficult task for a doctor; it is transient and disappears spontaneously after the elimination of fetoplacental hormones. In the first days after birth, under the influence of these hormones, the secretion of the sebaceous glands is increased, hyperplastic glands are visible in the form of small follicular yellowish-whitish smooth nodules. mainly on the nose and cheeks. On seborrheic areas, there is an abundant colonization of lipophilic and lipid-dependent yeast-like fungi Malassezia, which have an aggravating effect on neonatal acne and acne-like pustulosis of the scalp in newborns. Acne can be represented by a few superficial papulopustules and single comedones only on the skin of the face (cheeks, less often the forehead). The prevalence of neonatal acne, according to some authors, occurs in 20% of patients, more often in boys. After the third month, the rashes usually disappear, sebum secretion and colonization by lipophilic yeasts decrease. Systemic anti-acne therapy and topical antibiotics are not required. Regular hygiene procedures are necessary; the use of greasy ointments and oils on seborrheic areas should be avoided. It is advisable to use local drying and disinfectants, a 1% alcohol solution of chlorophyllipt, a 1% solution of clotrimazole, powder with boric and salicylic acid and dermatol.
Infant acne is rare, mainly in boys; rashes become noticeable from the second half of life and continue to appear for 2-3 years, sometimes up to 5 years. They are represented by more numerous and pronounced lesions of the facial skin: comedones, papules, pustules, and in rare cases, cystic nodules. A separate clinical type is conglobate infantile acne, which results in the formation of rough scars. The pathogenesis of infantile acne is associated with a transient increase in the blood of luteinizing and follicle-stimulating hormones and testosterone. In some cases, girls with infantile acne were diagnosed with 21-hydroxylase deficiency, which causes a disturbance in steroid metabolism in the adrenal glands with an increase in adrenal androgens, which may indicate congenital adrenal hyperplasia syndrome. Children with infantile acne need more careful attention from doctors and parents; in such cases, an examination by an endocrinologist and a study of the hormonal blood profile are required. Parents should be explained that the child needs long-term treatment by a dermatologist. Local patented anti-acne agents are used - topical retinoids (Differin), azelaninic acid (Skinoren), topical antibiotics - Zinerit or Dalacin-T. Systemic treatment is prescribed - short courses of antibiotics, preferably erythromycin, since tetracycline can have a negative effect on the teeth. For conglobate infantile acne, systemic treatment with retinoids (roaccutane) is indicated.
Juvenile acne represents a global problem for both doctors and patients due to the almost total prevalence of this disease (80-90% or more), long-term course, unpredictability of the outcome with the possibility of the formation of disfiguring scars or transition to adult acne. It is also possible that patients may experience psychological problems associated with the unaesthetic appearance of lesions on the face, which is especially difficult to experience in adolescence. Juvenile acne occurs between the ages of 8 and 21. They are divided into prepubertal, pubertal and postpubertal acne. With changing age periods, the amount of sebum and the percentage of its components increase. By puberty, when an increase in the sebaceous glands and their secretion manifests itself as an obligatory sign of sexual development, the content of waxy fats and squalene in sebum increases, the oxidized forms of which become comedogenic, that is, they contribute to the formation of comedones - “sebaceous plugs”. In sebum, the concentration of linoleic and linolenic fatty acids decreases, the deficiency of which aggravates keratinization disorders, and control over the proliferation of lipophilic Propionibacterium acnes, which inhabits the sebaceous glands, is disrupted, which leads to more severe acne. In the excretory ducts of the sebaceous glands, increased stimulation of androgen receptors entails a change in the processes of keratinization and desquamation of keratinocytes, resulting in the formation of invisible sebaceous plugs - microcomedones - in the depths of the follicle funnels. This process, which is the initial and fundamental process in the pathophysiology of acne, gives rise to the formation of the clinical picture of acne, manifested by a non-inflammatory rash in the form of comedones, and then by inflammatory papulopustular and nodular elements. Inflammation is stimulated by anaerobic P. acnes, the activity of which increases when the sebaceous ducts are occluded by microcomedones. They intensively produce proteolytic enzymes, pro-inflammatory substances, chemoattractants, the substances of their membranes interact with the so-called toll-like receptors on the membranes of monocytes and keratinocytes, initiating the secretion of pro-inflammatory cytokines. An additional role may be played by lipophilic micrococci and yeast-like fungi, as well as gram-negative bacilli, which cause an acne-like rash after long-term treatment of acne with antibiotics. In severe suppurative processes and fulminant acne, laboratory tests detect Staphylococcus aureus and Staphylococcus epidermidis.
The severity of acnepathy increases with age. During the adrenarche period, prepubertal acne begins to appear in the form of a comedonal rash, the peak of comedonal acne occurs at 12 years of age. Pubertal acne is characterized by a polymorphic picture with the presence of comedones and inflammatory elements. The peak prevalence of acne among adolescents and the most active lesions are observed in girls at 14, and in boys at 16 years of age. Most teenagers have mild forms of acne with a small number of comedones and single papulopustules; they are called physiological or minimal acne vulgaris. 15-20% develop “clinical” acne, requiring active and long-term pathogenetic treatment. However, a mild course can be replaced by an outbreak of acne activity with the spread of the rash not only on the face, but also on the back and chest, the appearance of conglobate and cystic acne, and the rapid formation of scars. This can be facilitated by new behavior patterns emerging in adolescents: the use of acnegenic cosmetics, excessive use of vitamins with anabolic agents in combination with bodybuilding, taking psychotropic drugs, oral contraceptives, sun exposure with suntan creams, etc.
The criteria for predicting the course of juvenile acne have not been specified. The tactic of refusing treatment in the hope that acne will disappear spontaneously with age is unjustified. At the same time, it should be borne in mind that modern highly effective systemic agents used during anti-acne therapy have side effects, which are especially unfavorable in children and adolescents, when the formation of the body's functional systems has not yet been completed. During this period, it is necessary to limit the use of drugs that adversely affect growth, skeletal formation, reproductive organs, the endocrine system, and metabolism (including tetracyclines, systemic retinoids, glucocorticoids, androgens).
The optimal solution should be understood as starting treatment for any form of acne and choosing drugs taking into account the severity of acne. The modern acne treatment algorithm involves staged implementation of measures within the framework of initial, basic and maintenance courses of therapy. According to the international agreement of 2002 (see diagram), treatment of mild forms - for comedonal acne - is reduced to local monotherapy with topical retinoids as first-choice drugs, and as an alternative treatment, azelaic or salicylic acid is prescribed, or combined treatment with topical retinoids and topical antibiotics is used - for papulopustular acne. Systemic antibiotic therapy is prescribed for inflammatory acne of significant severity; for very severe forms, the systemic retinoid roaccutane is used; for hyperandrogenic acne in females, oral antiandrogens are used.
Most patients who consult a dermatologist with acne vulgaris experience a mild to moderate course of the process. Therefore, in most cases, treatment is carried out with local anti-acne drugs. However, some patented products (benzyl benzoate, tritenoin) cause dermatitis and increase skin photosensitivity. The new topical retinoid differin, the active ingredient of which is adapalene, a derivative of naphthoic acid, significantly exceeds the effectiveness and safety of first-generation drugs. It normalizes the differentiation of keratinocytes, providing a powerful comedolytic and anti-comedogenic effect, and specifically affects follicular hyperkeratosis at the mouths of pilosebaceous follicles. Differin has better tolerability than other topical retinoids because it selectively binds to nuclear g-receptors of epidermal keratinocytes (not interacting with a-receptors). Differin has a pronounced anti-inflammatory effect and affects various parts of the inflammatory response. For example, the drug blocks toll receptors on cell membranes, preventing microbial induction of anti-inflammatory cytokines. Differin is prescribed once a day at night. The gel should be applied to clean skin on the affected areas in a thin layer, without rubbing. It is well tolerated and can be used in combination therapy at any time of the year. You should not prescribe simultaneously cosmetics with a drying and locally irritating effect (alcohol-containing solutions), as well as single-acting medications (keratolytics). When the pathological process is localized in the facial area, a package of Differin (30 g) is enough for 1.5 months.
We observed 42 children with mild to moderate acne during treatment with Differin. A side effect in the form of mild short-term peeling was observed in 3 children. Noticeable signs of improvement were noted in the 3rd week in 34.2%, in the 5th week in 65.7%, and in the 7th week in 88.6% of children. A sufficient therapeutic and cosmetic effect was achieved by the 4th month in 62.85%, moderate in 25.72%, and slight improvement in 11.43%. The average course of treatment is 1-3 months, if necessary - up to 6 months or more. Differin can be used as maintenance therapy for a long time (once a day or every other day), it is non-toxic, does not cause addiction or systemic side effects.
Differin is currently one of the most effective and acceptable drugs used to treat acne in children and adolescents.
K. N. Suvorova, Doctor of Medical Sciences, Professor I. E. Yudina, Candidate of Medical Sciences
RMAPO Ministry of Health of the Russian Federation, Children's Clinic LSO, Moscow
Symptoms
Facial skin lesions: comedones, papules, pustules, and in rare cases, cystic nodes.
Neonatal acne is similar to that which occurs in adolescents during puberty. In some cases, they may appear on other parts of the body, such as the neck, ears, or back.
Newborn acne should never be subjected to squeezing. This will not speed up treatment and recovery. You should always remember that there is a danger of introducing an infection into the baby’s body.
Before undertaking any treatment for inflammation that appears in children, it is necessary to clearly determine what exactly you are faced with. Perhaps this is not newborn acne at all, but an allergy. The symptoms may be similar and therefore in this situation it is better to consult a pediatrician and a dermatologist, since only they will be able to distinguish these skin rashes in children.
Juvenile acne represents a global problem for both doctors and patients due to the almost total prevalence of this disease (80-90% or more), long-term course, unpredictability of the outcome with the possibility of the formation of disfiguring scars or transition to adult acne. It is also possible that patients may experience psychological problems associated with the unaesthetic appearance of lesions on the face, which is especially difficult to experience in adolescence. Juvenile acne occurs between the ages of 8 and 21.
The diagnosis is clarified by a dermatologist using: dermatoscopy of rashes; skin pH measurements; bacteriological examination (if there are signs of infection).
Prevention
For children:
- Regular hygiene procedures
- Air and sunbathing
- Do not smear your face with baby creams, oils and lotions
- Keep skin clean and dry
- Do not squeeze pimples, this can cause infection of the sebaceous glands and inflammation.
For teenagers:
- Contact a dermatologist. A dermatologist can prescribe medication to determine the cause of acne.
- Switching to non-comedogenic cosmetics
- Using sunscreen cream
Read more about pediatric dermatology at the YugMed clinic
Streptoderma in children
Streptococcal impetigo in children
The favorite localization of inflammation in children is the skin of the face, hands and other open areas of the skin.
The disease begins with the appearance on a hyperemic background or externally unchanged skin of the primary morphological element of streptoderma - phlyctena with a diameter of 1 to 2-3 mm, surrounded by an inflammatory rim. At first, phlyctena is a tense vesicle, which soon becomes flabby, and its contents turn from light serous to cloudy or purulent. Subsequently, the conflicts dry out into honey-yellow crusts, after peeling off which a pink spot remains. Individual conflicts can be isolated from each other by areas of healthy skin or increase in size due to growth along the periphery and merge. The development of the elements is accompanied by severe itching, which is why children scratch the skin, spreading the infection to healthy areas where new conflicts form. The duration of streptoderma in children is 3-4 weeks.
Slit-like impetigo in children
This form of streptoderma in children is also called seizure or angular stomatitis. Phlyctens are usually localized in the corners of the mouth, less often - at the wings of the nose or in the corners of the eyes. In place of the opened blisters, shallow cracks, covered with yellowish crusts, form.
This type of streptoderma in children occurs with itching in the mouth, drooling, burning, and pain when eating. The protracted course of slit-like impetigo is promoted by caries, rhinitis, conjunctivitis, and the habit of licking lips. The infection is easily transmitted through kissing and sharing utensils, so familial cases of the disease are common.
Lichen simplex in children
This form of streptoderma in children belongs to the dry variety of streptococcal impetigo, i.e. it occurs without the formation of conflicts. The infection affects the face (perioral area, cheeks, chin), and less commonly, the skin of the trunk and limbs.
In this case, in the lesions, delimited lesions of a round or oval shape, white-pink in color, covered with small dry scales are formed. After exposure to the sun, the elements decrease or disappear completely, but the affected areas of the skin are less pigmented, which is why the skin takes on a mottled appearance.
Dry streptoderma in children usually occurs in the fall or spring, often in the form of epidemic outbreaks in children's groups.
Streptococcal diaper rash in children
With intertriginous streptoderma in children, inflammatory elements are located in the folds of the abdomen, inguinal-femoral, intergluteal, axillary region, and behind the ears. Primary elements - conflicts - merge into wet, eroded surfaces. The lesions have a bright pink color, scalloped borders and a rim along the periphery. Around the main focus there are screenings in the form of individual elements at different stages of evolution (vesicles, pustules, crusts).
Painful cracks and erosions often form in the skin folds, dramatically affecting the child’s well-being. This clinical variant of streptoderma in children is prone to chronicity and is often aggravated by the addition of a secondary fungal infection.
Vulgar ecthyma in children
Vulgar ecthyma in children refers to deep streptoderma of the skin. In most cases, it develops in weakened and often ill children, with poor hygienic skin care, and itchy dermatoses. Elements of streptoderma are localized on the legs, thighs, buttocks, lower back, and less commonly, the upper limbs and torso.
Initially, a phlyctena or pustule with serous-bloody or serous-purulent contents forms at the site of infection, which quickly dries into a soft yellowish-brown crust. When the crust is removed, a deep, painful ulcer is exposed, the bottom of which is covered with a dirty gray coating. After 2–4 weeks, a pigmented scar forms at the site of the ulcer.
Severe forms of ulcerative streptoderma in children include perforating and necrotic (gangrenous) ecthyma: in these cases, ulcers can penetrate deep into the dermis and subcutaneous fat.
The forms of streptoderma discussed above in children are often accompanied by a disturbance in the general condition, fever, and regional lymphadenitis.
