The effect of retinol on skin with mild acne

Nosological classification (ICD-10)

• A09 Diarrhea and gastroenteritis of presumably infectious origin (dysentery, bacterial diarrhea)
• A15-A19 Tuberculosis
• B05 Measles
• E50 Vitamin A deficiency
• E50.0 Vitamin A deficiency with conjunctival xerosis
• E50.4 Vitamin A deficiency with keratomalacia
• E50.5 Vitamin A deficiency with night blindness
• E55.0 Active rickets
• H01.1 Non-infectious dermatoses of the eyelid
• H10.1 Acute atopic conjunctivitis
• H10.9 Conjunctivitis, unspecified
• H16 Keratitis
• J04 Acute laryngitis and tracheitis
• J06 Acute upper respiratory tract infections of multiple and unspecified localization
• J18 Pneumonia without specifying the pathogen
• J20 Acute bronchitis
• J22 Acute respiratory infection of the lower respiratory tract, unspecified
• J39.9 Upper respiratory tract disease, unspecified
• J42 Chronic bronchitis, unspecified
• J44.9 Chronic obstructive pulmonary disease, unspecified
• K20 Esophagitis
• K25 Stomach ulcer
• K26 Duodenal ulcer
• K29.5 Chronic gastritis, unspecified
• K29.9 Gastroduodenitis, unspecified
• K52 Other non-infectious gastroenteritis and colitis
• K74 Fibrosis and cirrhosis of the liver
• L11.0 Acquired keratosis follicularis
• L30.9 Dermatitis, unspecified
• L40 Psoriasis
• L44.0 Pityriasis red hairy pityriasis
• Q80 Congenital ichthyosis
• T14.1 Open wound of unspecified body area
• T30 Thermal and chemical burns of unspecified location
• T33-T35 Frostbite

The effect of retinol on skin with mild acne

 Acne, or acne (acne vulgaris) is a chronic disease of the sebaceous glands. The peak incidence occurs during puberty. According to statistics, about 80% of teenagers face the problem of acne. Often, acne entails an aesthetic and psychological problem.

Unfortunately, due to the lack of information about acne, most teenagers self-medicate and seek medical help too late, when scars have already formed and a mild form of acne has developed into a moderate or severe form. At the same time, timely contact with a dermatologist allows you to localize the disease in the early stages and prevent the formation of scars and cosmetic defects.

Skin structure

Human skin consists of 3 layers: epidermis, dermis and hypodermis. The epidermis is the upper, constantly renewed layer of skin. It is connected to the dermis by a special structure - the basement membrane (Fig. 1). This is a very important education.

Rice. 1. Cellular elements of the skin

On the basement membrane there is a layer of germ cells that continuously divide, ensuring skin renewal. The main cells of the epidermis are keratinocytes, which repeat in miniature the path of every organism living on earth. They are born, go through a certain development path and eventually die. The death of keratinocytes is a programmed process. Having broken away from the basement membrane, they gradually move to the surface of the skin, lose their nucleus and turn into a horny cell - a corneocyte. The life span of keratinocytes is 3–4 weeks. Among the germ cells on the basement membrane there are large process cells - melanocytes and Langerhans cells. Langerhans cells in the epidermis and macrophages located in the dermis act as guards, that is, they protect the skin from external invasion and regulate the activity of other skin cells.

Melanocytes produce granules of the pigment melanin, which gives the skin a certain shade, from golden to dark or even black. The dermis plays the role of a frame that provides the mechanical properties of the skin, its elasticity, strength and extensibility. The dermis resembles a combination of a water and spring mattress, where the role of springs is played by collagen and elastin fibers, and the space between them is filled with a viscous gel consisting mainly of hyaluronic acid. Important cells of the dermis are fibroblasts, whose main tasks are the synthesis and destruction of intercellular substance. The entire dermis is penetrated by the finest blood and lymphatic vessels. Blood flowing through the vessels shines through the epidermis and gives the skin a pink tint. The dermis also contains sebaceous and sweat glands.

You can imagine how the sebaceous gland works if you mentally press your finger on the skin and make a depression in it that reaches the dermis (Fig. 2).

Rice. 2. Sebaceous gland

The secretion of the sebaceous gland consists of sebum and destroyed sebaceous gland cells. Normally secreting sebaceous glands provide softening of the upper layer of the skin, sebum smoothes the horny scales, creating a smooth surface. The production of sebum is regulated by male sex hormones - androgens. The higher the level of androgens in the skin, the faster the sebaceous gland cells multiply and the more sebum is released to the surface of the skin. Therefore, the skin of adolescents, experiencing hormonal storms during puberty, often suffers from excess sebum production - seborrhea. Seborrhea is associated not only with an increase in the quantity, but also with a change in the quality of sebum (the sebum becomes denser).

Causes of acne

A major role in the development of the disease is played by hereditary predisposition, which is manifested by the high sensitivity of receptors to male sex hormones - androgens. The genetic factor determines the number and structure of the sebaceous glands, as well as the sensitivity of receptors to hormones. Sebaceous glands have different numbers of receptors. This explains the fact that some people experience clinical acne only on the chin or back.

Under the influence of androgens, the sebaceous gland begins to secrete more sebum and increase in size.

When the normal exfoliation of keratinocytes is disrupted, the sebaceous gland becomes blocked, it stretches and increases in size, and comedones are formed. This creates favorable conditions for the proliferation of Propionibacterium acnes, which are normal representatives of the microflora of the sebaceous glands. Their activity is associated with the overproduction of sebum. The protective function of the skin deteriorates, other microorganisms, staphylococci, streptococci and other pathogens of purulent infections, join. Inflammation develops.

The primary element of acne is a comedone, which can be open or closed. An open comedone looks like black dots 1-3 mm in diameter - this is oxidized sebum plus melanin pigment. Dark-skinned people have darker blackheads than light-skinned people. Closed comedones appear as white heads up to 2 mm in diameter. The greatest danger is a closed comedone, which can become inflamed.

The inflammatory elements in acne are papules and pustules. A papule is a cavity-free formation that rises above the surface of the skin, red in color, up to 5 mm in diameter. A pustule is a cavity formation filled with purulent contents, a white tip with a red rim.

Rice. 3. Pustule (left); papule (right)

If you figuratively imagine what underlies acne, you can draw a small jug buried in the sand. That is, the main inflammation is in the sebaceous gland, which is located directly deep in the skin, and on its surface there is a “neck of the vessel” in the form of a black dot with a blocked outlet or an abscess. When extruded, the black dot or “neck” is extruded, but the rest of the element is mechanically crushed and spreads into the surrounding tissue. As a result, inflammation occurs in the deeper layers of the skin, which can lead to scarring and worsening acne.

According to the severity of acne, it is classified:

– Mild form - open and closed comedones, less than 10 papules and pustules.

– Moderate form - papules and pustules on the face and/or body in an amount of more than 10, but less than 40 pieces.

– Severe form - more than 40 papules and pustules, the presence of cysts, nodes, tendency to scarring.

The choice of treatment tactics for acne depends on the severity of the skin process. The earlier treatment is started, the greater the chance of avoiding the formation of scars on the skin. Therefore, acne treatment requires an effective approach in the early stages. There are various treatments for acne, but retinoids are the basic first-line treatment.

Vitamin A occupies a special place among vitamins due to its unique ability to affect all living skin cells, regulating all processes of division and intercellular interaction. The biologically active form of vitamin A is not retinol itself, but its derivative, trans-retinoic acid. In the cell, retinoids bind to nuclear receptors. Local use of retinoids leads to a reduction in the stratum corneum and faster renewal of the epidermis, normalizes the functioning of the sebaceous glands, reduces the division of melanocytes, controls pigmentation, and has an anti-inflammatory effect. Retinoids penetrate the skin directly through the stratum corneum or through the excretory ducts of the glands. The disadvantage of using retinoids is that the skin may become dry and sensitive.

Research on the effect of retinol on the skin

Selection criteria for study participants

At the beginning of the study, I developed criteria for selecting study participants.

Selection criteria for study participants : the participant's desire to participate in the study and the ability to follow the protocol, the age of the male or female participant from 13 years to 18 years, the presence of mild acne, the absence of systemic therapy and external therapy for more than 2 weeks, localization of the clinical picture of acne on the face.

Exclusion criteria from the study: moderate and severe acne, age under 13 years and over 18 years, other skin diseases that may interfere with the assessment of acne, hypersensitivity of the skin, participation in any other clinical studies.

From 32 applicants, 12 study participants were selected.

The study was carried out in the autumn. The duration of the study was 4 weeks. The study was carried out visually and using an Aramo ASL skin diagnostic device, which has a registration certificate from the Ministry of Health of the Russian Federation.

Study parameters

Skin diagnostics were carried out before starting retinol use and after 4 weeks of retinol use. Control examinations of study participants were carried out weekly to identify possible adverse skin reactions to retinol, such as retinoic dermatitis, and their timely correction. The study was conducted according to the following parameters:

1. Oily skin. The method for determining skin oiliness is sebumetry. The readings of this method depend on the activity of the sebaceous glands and reflect the amount of sebum produced. The method is based on the photometric assessment of greasy stains that remain on the adhesive film after its contact with the skin. This special film is sensitive to fats and changes its optical density depending on the amount of fat. The film is applied to the skin for 30 seconds. Then the optical transmittance of the film is measured and the fat content per 1 cm2 is calculated.

Rice. 4

1. Skin moisture. Using a sensor, we determine the moisture content in the stratum corneum of the skin.

Rice. 5

1. Determination of pore size. We assess the skin relief using a skin visiometer, which determines the depth and height of various points depending on how they absorb and reflect light.
2. Determination of sebaceous gland activity. The study is carried out under ultraviolet light and consists of measuring the intensity of the sebum glow.
3. Skin sensitivity. To study the sensitivity of the skin, an X60 lens with polarization is used, which makes it possible to view deeper layers of the skin, including capillary vessels.
4. Determination of the number of papules and pustules. Using a magnifying lamp, we determine the number of inflammatory elements.

Rice. 6

Research results

After 4 weeks of using retinol, study participants obtained the following results:

1. Skin oiliness decreased in all study participants by an average of 55%.

Rice. 7

1. Skin moisture decreased by an average of 70% in all study participants.
2. The vast majority of study participants had enlarged pores at the beginning of the study. After using retinol, my pores were significantly reduced.
3. By the end of the study, the activity of the sebaceous glands decreased by an average of 50%.

Rice. 8

1. Since the use of retinol leads to a reduction in the stratum corneum and stimulation of the skin's immune cells, skin sensitivity increased significantly in all participants. Based on the results of weekly follow-up examinations, two study participants were prescribed medications to reduce skin irritation and flaking.
2. The number of papules and pustules decreased significantly. Three study participants still had single inflammatory elements in the T-zone.

Conclusion

Based on the results of the study, we can conclude that the use of retinol for mild acne gives positive results. The functioning of the sebaceous glands is normalized and their size is reduced, follicular hyperkeratosis is eliminated and the outflow of sebaceous gland secretions is restored, and the inflammatory process on the skin is stopped.

It should be remembered that at the first signs of acne, you must consult a dermatologist, who, based on the diagnostic results, will prescribe a course of treatment. Timely contact with a dermatologist allows you to localize the disease in the early stages and prevent the formation of scars and cosmetic defects. Under no circumstances should you self-medicate.

of the Center for Aesthetic Medicine Dr. Shumskaya for assistance in conducting the research!

Literature:

1. Margolina A. A., Hernandez E. I., Zaikina O. E. New cosmetology. - M.: Publishing House "New Cosmetology", 2000. - 204 p.
2. Hernandez E. I., Margolina A. A. New cosmetology. Fundamentals of modern cosmetology. — M.: Publishing House “New Cosmetology”, 2012–600 p.
3. Hernandez E. I. Acne and increased oily skin. - M.: Publishing House "Cosmetics and Medicine", 2012–200 p.

Composition and release form

in dark glass bottles of 10 ml; in a cardboard pack 1 bottle or in dark glass bottles of 10 ml, complete with a dropper; 1 set in a cardboard pack.

Since the late 70s, drugs from the retinoid group have found widespread use in the treatment of various forms of acne. Retinoids are a class of biologically active substances that are structurally close to vitamin A or have A-vitamin properties.

All these substances are divided into natural and synthetic or aromatic. Natural (that is, found in nature) include retinol, retinal and retinoic acid. Synthetic (aromatic), that is, created by chemical synthesis of molecules not found in nature, include etretinate, acitretin, adapalene and tazarotene. All medications containing natural retinoids in adequate quantities are well tolerated by the human body, which in the process of ontogenesis has developed enzymatic and receptor systems that perceive and metabolize them.

Drugs in this group have the following main effects on the skin:

• improve keratinization;
• reduce sebum secretion;
• stimulate healing.

One of the most effective is Retinol palmitate (RP) in an oil solution. The effect of retinol palmitate can be divided into local and general. Local effects on the skin include inhibition of keratinization processes, reduction of sebum secretion and increased proliferation of epithelial cells. The general effect is stimulation of humoral and cellular immunity, macrophage function, enhancement of erythro- and myelopoiesis, activation of epithelialization in internal organs, improvement of dark adaptation, inhibition of the growth of epithelial tumors.

The use of cheaper retinol acetate instead of retinol palmmitate for the treatment of acne is not recommended, since retinol acetate introduced inside is converted into retinol under the action of hydrolases, which is esterified in the intestines to retinol palmmitate and is absorbed in this form. Retinol palmitate taken orally does not undergo these changes and is absorbed without additional preparation, which increases its bioavailability. After absorption, it enters the liver, where it is stored in combination with lipoprotein. In the blood, retinol is complexed with retinol-binding protein and prealbumin, and is recognized by target cells (sebocytes, epithelial cells of the skin, eyes and gastrointestinal tract) through receptors. Cell surface receptor proteins release vitamin A from its complex with the transport protein and transport it into the cell, where it binds to intracellular proteins. Its activity at the cellular level is modulated by two types of nuclear receptors that are capable of changing gene expression. The elimination period for retinol is about a day. The vitamin is excreted by the kidneys, where it is partially reabsorbed. Complete elimination occurs within about a month.

Effective doses for acne are at least 300,000 IU per day. The course of treatment is 12-16 weeks, the dose is not reduced during the course, maintenance treatment is not prescribed. The intervals between courses are 4-8 weeks. Retinol palmitate

It is recommended to take it orally late in the evening before bedtime or in the early morning hours. Fat-soluble vitamins are better absorbed in the presence of additional dietary fat. It is recommended that while taking the drug in the evening, eat a sandwich with butter or 2-3 tablespoons of sour cream, or a salad seasoned with vegetable oil or sour cream. In the early morning hours, the drug is taken during or after breakfast. An oil solution of retinol palmitate is dosed in drops from an eye pipette or using a special dropper - one drop contains 3300 IU. When prescribing large doses, a disposable syringe with a volume of 1-5 ml can be used, into which 1-3 ml of solution is drawn from the bottle, poured into a spoon and taken orally. Vitamin A is unstable and is quickly destroyed when exposed to light and oxygen. In the process of producing an oil solution of retinol palmitate, technology is used that protects retinol from destruction in bottles during storage. The air in the bottles above the oil solution is replaced by an inert gas. When storing an opened package of oil solution for a long time, the vitamin A content in 1 ml changes and difficulties arise with dosage, so an opened bottle can be used for no more than 2 weeks.

Prof.
Albanova V.I., Shishkova M.V. Seal

Indications for the drug Retinol palmitate

Vitamin A deficiency (hypo- and avitaminosis A); eye diseases (retinitis pigmentosa, xerophthalmia, hemeralopia, keratomalacia, conjunctivitis, eczematous lesions of the eyelids), skin diseases accompanied by dryness and delayed epithelization (ichthyosis, ichthyosiform erythroderma, psoriasis, variable erythrokeratoderma, keratoderma, lichen planus pilaris (Devergie's disease), acne, seborrhea, hair diseases, neurodermatitis, follicular keratosis, superciliary ulerythema, baldness, burns, wounds, frostbite, epidermolysis bullosa, congenital pachyonychia, leukoplakia, familial benign pemphigus Hailey-Hailey, Darier's follicular dyskeratosis), skin tuberculosis; infectious and colds (measles, pneumonia, dysentery, tracheitis, bronchitis, acute respiratory infections), rickets, malnutrition, erosive gastroduodenitis, gastric and duodenal ulcers, cirrhosis of the liver (as part of complex therapy).

The benefits of vitamin A for problem skin

Products with vitamin A accelerate the renewal of the epidermis, enhance its protective function and reduce moisture loss, and also increase the production of collagen and elastin - the main building proteins of the skin132.

Due to the regenerative effects of vitamin A, it is used for excessive dry skin, severe inflammation, burns and frostbite. In the case of acne, it works in two ways132:

• accelerates keratinization of the outer layers of the epidermis and exfoliation of dead cells, suppressing keratosis of the sebaceous glands, which prevents the appearance of blackheads and acne;
• By influencing the immune system, it helps the body fight inflammation.

But use products with vitamin A with caution, as they can cause sensitivity to ultraviolet radiation. And with dosage, nausea, menstrual irregularities, vomiting, and peeling of the skin appear.

Side effects

Rarely - manifestations of hypervitaminosis A: in adults - drowsiness, lethargy, headache, facial flushing followed by peeling, nausea, vomiting, possible exacerbation of liver disease, gait disturbance, pain in the bones of the lower extremities; in children - short-term increase in body temperature, drowsiness, increased sweating, vomiting, skin rashes. Increased intracranial pressure (infants may develop hydrocephalus, protrusion of the fontanel).

With a dose reduction or temporary discontinuation of the drug, side effects disappear on their own. In some cases, on the first day of use, itchy maculopapular rashes may occur, requiring discontinuation of the drug.

When high doses are prescribed for skin diseases, after 7–10 days of treatment, an exacerbation of the local inflammatory reaction is observed, which does not require additional treatment and subsequently decreases. This effect is associated with the myelo- and immunostimulating effects of the drug.

Properties and types of vitamin A

Vitamin A is a term that refers to several substances - retinol, tretinoin and its derivatives (retinoids), as well as beta-carotene and some other carotenoids. Vitamin A, together with vitamins D, E, K, belongs to the fat-soluble group.

Retinoids are actively used in the treatment of dermatological diseases - acne, rosacea (red pimples* on the cheeks) - due to their properties, they have the following effects132:

• improves exfoliation of the stratum corneum of the epidermis;
• promotes healing of inflamed acne*;
• reduces sebum secretion;
• reduces the colonization of bacteria responsible for the appearance of acne on the face (usually on the forehead, cheekbones and cheeks)*.

Only a dermatologist can justify which form and why will be most effective for the patient.

Directions for use and doses

Inside, after eating early in the morning or late in the evening.

For mild to moderate vitamin deficiency: adults - up to 33,000 IU/day; children - 1000–5000 IU/day depending on age.

For eye diseases (hemeralopia, xerophthalmia, retinitis pigmentosa): adults - 50,000–100,000 IU/day and at the same time 0.02 g of riboflavin.

For skin diseases: adults - 50,000–100,000 IU/day; for acne and ichthyosiform erythroderma - 100,000–300,000 IU/day. Children are prescribed at a rate of 5000–10000 IU/kg per day.

In gastroenterology - 50,000 IU per day.

Single doses of retinol palmitate for adults should not exceed 50,000 IU and for children - 5,000 IU. Daily doses for adults are 100,000 IU and for children - 20,000 IU.

Pimples* on the cheeks: causes

If small pimples* appear on the face from time to time, but in general the skin is not problematic, it is enough to get rid of several “bad” habits:

• clean makeup brushes;
• stop touching your face with your hands;
• Use a regular face towel instead of a disposable paper one.

The causes of deeper acne*, widespread throughout the face or body, which does not go away for a long time, can be4,50:

• unbalanced diet;
• bad habits;
• genetic predisposition;
• hormonal disorders;
• problems with the gastrointestinal tract;
• stress;
• incorrectly selected skin care products.

The exact cause of acne can only be determined after undergoing diagnostic tests at a dermatologist's office.