Acne can persist for many years, acting in a serious aesthetic problem, and often untreated - leaves disfiguring marks the end of life. In about 15 percent. acne patients have run heavy and require a general treatment. The underlying disease is the number of factors, including the genetic and increased sebum caused by hyperactivity of the sebaceous glands (which could be associated with increased androgen levels or an excessive sensitivity of the sebaceous glands of these hormones).
Hormonal disorders found to be quite rare and are the most common: adrenal hyperandrogenism or functional hyperprolactinemia. Seborrhea and rapid flow of sebum dissolve the lipid lives, lowers cholesterol, ceramides, and linoleic acid. This is one factor causing increased, abnormal keratinization ducts of the sebaceous glands and hair follicle, which leads to the formation of mikrozaskórników. A large role, in addition to disorders of keratinization of hair follicles, plays a relative deficiency of linoleic acid, release of inflammatory mediators in the skin and the presence of the bacteria Propionibacterium acnes.
The formation of comedones is caused by increased amount of free fatty acids resulting from the action of lipases produced by Propionibacterium acnes. The biofilm that forms the P. acnes causes their adhesion to the wall lives, hydrolytic enzymes cause the destruction of the walls of the sebaceous glands, which increases inflammation and also causes this reaction resembles a foreign body.
Faces of acne
Isolated several varieties of acne, depending on the advantage of efflorescence and severity of acne punctate, maculopapular pustular acne phlegmonous, which consists of acne nodular cystic acne and focused and acne phlegmonous with erythrocyte general, acne reversed, acne cosmetic acne professional, mature women acne, acne, and acne newborn infants. There are various factors exacerbate lesions. They are premenstrual period (60-70 per cent. Women), diet with a high glycemic index, the sun (acne Mallorca), and mental stress. Professional Acne occurs after contact with mineral oils, chlorine, coal tar. Cosmetic acne occurs in people using cosmetics clogging sebaceous glands. It is also known acne medicaments a - e.g., the application. Corticosteroids, androgens, and anti-anti-TB drugs, as well as vitamins B6 and B12.
Course of illness
Skin lesions usually localized on the face - mainly the forehead, chin and cheeks, and on the back and upper chest. There has been a lot of skin eruptions, such as whiteheads, which are small lumps in color, blackheads - with dark pin resulting from the oxidation are present in tallow fatty acids, pustules, nodules, cysts. The remnant of these changes is hypertrophic scars, atrophic and discoloration.
The disease is usually long, often for many years. Treatment should be individually tailored to each patient, multidirectional, affecting individual elements etiopathological disease. The patient must know that it is usually long and requires regularity and consistency, and to be effective, it must be comprehensive.
It is extremely important also sufficiently long maintenance therapy for maintaining the obtained effect and proper skin care.
Treatment
In more severe forms of acne treatment should be general, for several months, based on antibiotics, hormones or isotretinoin, which is a derivative of vitamin A. In the lighter forms the basis for a local treatment: benzoyl peroxide, topical antibiotics, retinoids, azelaic acid. In about 60 percent. cases of acne patients sufficient to treat topical drugs.
The formulations are applied to the entire treated skin, it is wrong to use them only spot due to the presence mikrozaskórników, which is the starting point for all the changes are not visible to the naked eye. Topical therapy may be used alone, in alternation therapy, or combination therapy and as adjunctive therapy in the treatment of general and as maintenance treatment for obtaining the status of asymptomatic after treatment with antibiotics or benzoyl peroxide. In monotherapy acne comedones can only be used retinoids, the lighter varieties of acne - benzoyl peroxide or azelaic acid.
In alternation therapy or a combination combines several drugs, usually an antibiotic or an antibiotic retinoid benzoyl peroxide. The combination of more than one active substance in a formulation increases the efficacy of the therapy, so it is worth to combine drugs with different mechanisms of action and different points of the handle.
Power pharmaceuticals
According to the latest recommendations should not use antibiotics alone, because it is ineffective and leads to drug resistance bacteria. Most antibiotics recommended for topical application to clindamycin, erythromycin, erythromycin cyclic carbonate.
Retinoids for topical use this group of drugs, which normalizes keratinization, has a keratolytic, prevents mikrozaskórników and has little effect on the suppressive function of the sebaceous glands. In addition, topical retinoids inhibit the production of interleukins and interferons and inhibit migration of T lymphocytes and macrophages, thereby reducing the inflammation. Benzoyl peroxide is a very effective antibacterial agent. To work both on P. acnes and S. aureus. It is mainly found in gels in a concentration of 5-10% or cleansers. It works on both the inflammatory lesions and noninflammatory.
Azelaic acid has anti-inflammatory, antibacterial, antiseborrheic and przeciwzaskórnikowe inhibit the formation of discoloration. With long-term use outside reduces the tendency to form scars. It also has antioxidant effects.
In the topical treatment also use other substances, such as sulfur (sulfur ppm) - which provide a comedolytic and antiseborrheic, resorcinol, which has antiseptic and exfoliating, and salicylic acid. It has anti-inflammatory and brighteners, comedolytic, eliminates blackheads, reduces pore size, smoothes the skin.
Activities supporting
Due to excessive keratinization escape the sebaceous follicles, it is also recommended to use the substance peeling, removing dead skin elements. This allows you to unblock clogged sebaceous glands. It is extremely important regular exfoliation of the skin because it regulates sebum, purifies and tightens pores, lightens discolorations and smooths existing acne scars.
Most are used for this purpose dermo-cosmetics comprising alpha and beta hydroxy acids, glycolic acid, pyruvic acid, salicylic acid, mandelic. Dermatologists very willing to recommend patients to these preparations, since they facilitate the treatment and accelerate the expected results. Now it becomes almost an integral part of the therapy. Use in the oily skin also found kaolin, or particulate clay, which absorbs excess sebum, astringent and antibacterial. Similar properties have also zinc, which regulates sebaceous glands, to absorb excess sebum and zinc oxide healing properties.
Cons therapy
Most active acne preparations used in excess causes irritation: redness, dryness, burning. Patients discourage then for further treatment, sometimes recognize these symptoms as symptoms of allergies, medications odstawiają what triggers a relapse. That is why it is crucial to properly choose treatment, and combining it with products that nurture the skin, moisturizing and restorative lipid coat. Recommend to be preparations containing eg. Ceramides, moisturizers: NMF components, as well as substances soothing: thermal water, provitamin B5, allantoin, tannin, azulenes. The association of active drug substances responsible for the correct structure of the hydrolipidic is the key to success in the treatment of acne.
In the ointment for acne avoids a greasy creams based on fats of natural vegetable oils, are increasingly being replaced by these other substrates, e.g.,., Silicone. An important role is played by polyunsaturated fatty acids of the family of essential fatty acids, such as linoleic acid and linolenic acid. They never use too intense preparations to dry out and degreasing the skin, which consequently enhance secretion of sebum. The skin should be washed with the mild detergent that does not destroy the hydrolipidic film and restore the proper pH. Best used micellar fluid, soft foams or gels without soap. In addition to the proper medical treatment prescribed by a doctor, it is necessary to use light, gentle moisturizing creams or emulsion-matting that will prevent adverse effects of therapy.
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