acne vulgaris

acne vulgaris

Acne – androgen-stimulated inflammation of the sebaceous glands, leading to the formation of comedones, papules, inflammatory pustules and (sometimes) scarring; first detected during puberty and adolescence. Frequency. Almost all adolescents have acne of varying severity. 15% of adolescents seek medical help. Men are more often affected.

Risk factors

• • Use of androgenic steroids (eg, abuse of anabolic steroids) and some oral contraceptives
  • Cosmetics (including cleansing creams, moisturizers, etc.) based on various oils
  • Constant rubbing or irritation of the same areas of the skin (tight clothing, etc.)
  • Puberty disorder
  • Hot and humid climate.

Classification and clinical picture

• • Papular juvenile acne
  • Pustular acne juveniles
  • Superficial acne: characterized by comedones, open (blackheads) or closed (whiteheads), inflamed papules, superficial cysts and pustules
  • Deep acne: characterized by deep-seated inflamed nodules and pus-filled cysts, abscesses, often scarring
  • Cystic or nodular acne is characterized by large cystic lesions, abscesses, widespread fistulas, and thickened, bumpy scars.
  • Comedones: papules consisting of keratinized masses emerging from hair follicles with inflammatory manifestations
  • Compacted acne: deep infiltration of subcutaneous tissue, large papules and pustules, extensive and hypertrophic scars.

Research methods

• • Determination of testosterone content in rare cases when acne develops de novo in an adult
  • Examination for Demodex folliculorum.

Differential Diagnosis

• • Acne professional – a consequence of constant contact with resins, oils, lubricants
  • Folliculitis
  • Acne rosacea (usually no comedones)
  • Acne that occurs when taking glucocorticoids.

Treatment: Management Tactics

• • Hygiene procedures
  • Gentle skin cleansing with mild toilet soap 1 or 2 r/day
  • More frequent use of soap (especially special) irritates the skin, increases the secretion of the sebaceous glands, makes it difficult to treat with benzoyl peroxide and retinoic acid products.
  • With the ineffectiveness of therapy and the cyclicity of lesions in women, oral contraceptives are prescribed according to the traditional scheme for a period of at least 6 months.
  • Ultraviolet irradiation leads to some improvement in untreated acne, but worsens the effect of drugs used to treat acne.
  • Determination of plasma lipids, liver function tests and tests for the presence of pregnancy

carried out in patients taking isotretinoin before treatment and then monthly throughout the course.

• • Depending on the type of acne
  • Superficial pustular lesions: sun or UV, topical clindamycin and retinoic acid products, benzoyl peroxide, oral tetracycline
  • Deep acne. The effect of local treatment is doubtful. Broad-spectrum antibiotics (tetracycline, if ineffective – minocycline, during pregnancy – erythromycin)
  • Hardened acne. Triamcinolone acetonide suspension injection (2.5 mg/ml)
  • Oral isotretinoin : with the ineffectiveness of antibiotic therapy and deep lesions.
  • Full physical activity, hardening.
  • Topical medications can cause redness and dryness of the skin, and greasy creams can make the skin worse.
  • There is no specific and effective therapy for acne vulgaris, treatment can only reduce skin manifestations, and the results of therapeutic measures are detected no earlier than 4 weeks from the start of treatment.

Drug therapy

• • Topical application of products is most effective for comedones and non-cordial inflammation.
  • Benzoyl peroxide should be applied to washed and dried skin at bedtime as a 5% gel for 2-3 weeks, then as a 10% gel until acne disappears completely (approximately 8-12 weeks). Benzoyl peroxide should not be used in acute inflammatory skin reactions; with the appearance of redness and peeling of the skin, treatment should be continued.
  • Tretinoin (airol) in the form of a 0.025-0.05% cream, lotion or gel should be applied to dry skin at bedtime (with irritation – every other day)
  • The gel strongly dries the skin, it is preferable for application on the chest and back. With insufficient effect and good tolerance, apply in 0.1% concentration
  • The drug at first often causes an increase in the skin process, since it destroys previously formed keratin plugs -y- Do not apply to the eyelids, corners of the mouth, nasolabial folds
  • The effect is observed not earlier than 3-4 weeks.
  • Erythromycin (applications on pustules) or clindamycin topically in the form of 2% aqueous solution (effective for pustular lesions).
  • In more serious cases
  • Tetracycline 250 mg 4 times a day for 7-10 days, then switch to the minimum effective dose
  • Tetracycline should not be prescribed during pregnancy and children under 8 years of age.
  • Photosensitivity is possible, therefore it is recommended to avoid insolation
  • Tetracycline should not be given concomitantly with antacids, dairy products, and iron products.
  • Erythromycin 250 mg 4 times a day for 7-10 days, then switch to the minimum effective dose
  • Erythromycin can be given during pregnancy, but topical agents are preferred
  • Erythromycin , when administered simultaneously with terfenadine and astemizole, can cause cardiac disturbances detected on the ECG.
  • The use of isotretinoin is associated with severe dose-dependent side effects, it may help patients with pustular rashes when other therapy has failed. Assign 0.5-1.0 mg / kg / day in 2 doses for 12-16 weeks. A second course can be carried out after 8 weeks a  Isotretinoin nbsp; – due to teratogenicity – is contraindicated in pregnancy and women of childbearing age who do not use reliable methods of contraception
  • Side effects: severe dryness of the skin and mucous membranes, cheilitis, disorders of lipid metabolism and liver function.

Surgery. Large comedones are removed with an extractor after dissection of a thin layer of the epithelium located directly above the comedon. Many dermatologists do not recommend this procedure.

Complications

• • Globular acne – large confluent inflammatory acne, leading to the formation of scars
  • Scars
  • Psychological complications (anxious and depressive states). The prognosis is favorable.

Prevention

• • Sunscreens (excluding oil-based products)
  • Elimination of emotional stress – it is not uncommon for acne to become inflamed under stress. Synonym. Juvenile acne See also Acne rosacea, fig. 3-27 ICD. L70.0 Acne vulgaris