Acne
Description:
Acne, eels (from Greek άκμή) — an inflammation of sebaceous glands.
Pathogeny of development of an acne
Acne symptoms:
A variety of elements of the rash which is localized on face skin, an upper half of a breast and back where the largest sebaceous glands are located is clinically observed. In the basis of acne elements there is an inflammatory process melting local fabrics with formation of pus. A pustule (a purulent bubble), being opened, it is exempted from contents, drying up, forms crusts after which removal there are cyanotic-pink hems.
Hems after an acne.
* ice pick: deep deepenings, are most typical
* boxed scar: the angular hems located usually on temples and cheeks can be superficial or deep, are similar to hems after chicken pox
* rolling scar: give to skin wavy structure
* hypertrophic scar: keloid cicatrixes.
Deep acnes are painful. The clinical picture is diverse, with the continuous long-term course of process.
Symptoms. The most common form of an acne is acne vulgaris. This form is widespread among teenagers most often. Excess products of skin fat glands of the same name hammer a time with the dying-off korneotsita, blocking skin follicles. Accumulation of these korneotsit in channels happens because of disturbance of keratinization which usually leads to peeling of cells. Skin fat is laid under the blocked time, providing a fine environment for reproduction of microorganisms: Propionibacterium acnes, Malassezia.
Propionibacterium acnes: anaerobic gram-positive bacterium. Consumes fatty acids of skin fat, and for products of one of metabolites — butyric acid — and received the name. The bacterium is sensitive to a benzoilperoksid and tetracyclines. But as recently tetratsiklinrezistentny strains are observed, macroleads, for example, azithromycin entered practice. Also drugs of a ftorkhinolonovy row, for example, адифлоксацин are used.
The bacterium is sensitive to ultraviolet because of endogenous metabolites of biosynthesis gem — porphyrine and копорфирин III. Hypothetically it makes sense to use aminolevulinic acid, but at people it is followed by development of side effects.
The person and upper part of a neck are surprised most often, but the breast, a back and shoulders can be also involved. On skin eels, papules, pustules, small knots and inflammatory cysts can be found (cystous an acne). These cysts contain pus. Noninflammatory grease cysts (epidermoid cysts) can be connected with an acne. Later acnes can remain hems.
Acne in a back - to (at the left) and after treatment (on the right)
Inflammation of sebaceous glands (acne) in a face
Acne reasons:
Etiologies remain obscure. In the development mechanism the main role is assigned to the seborrhea reducing bactericidal effect of skin fat and leading to activation of coccal flora. The important part in the mechanism of an acne disease is assigned to a bacterium of Propionibacterium acnes and products of its life activity. Acnes ordinary (youthful eels, an acne disease) develop at young men and girls during puberty and gradually disappear by 25 — 30 years. Emergence and an exacerbation of an acne are also influenced by periods, stresses, a heat, the increased humidity and genetic factors. It is known that also the cosmetics containing lanolin and paraffin are the reason of an acne. Also acne rash can be side effect of some drugs.
Different types of an acne
Pathomorphologically seborrhea, a hyperplasia of sebaceous glands, hypersecretion of skin fat, the hyperkeratosis leading to formation of comedones — grease and horn traffic jams in channels of the sebaceous glands with partial or their full obstruction having an appearance of black points are noted.
The acne is the inflammatory disease of skin caused by changes in pilosebatsionny structures (consist of a hair follicle and a sebaceous gland). Hyper keratinization and formation of a plaque from a keratin and skin fat leads to increase in sebaceous glands, especially during maturing of skin in the pubertal period. Increase in products of skin fat arises at an adrenarkha when products of a degidroepiandrosteron amplify. Accumulation of skin fat can lead to development of an infection. The immune system destroys bacteria, and pus "is packed" into accumulations under epidermis. Patients try to get rid of pustules, deleting them independently and in unsterile conditions. Such damage to the subject layers breaks thin structure of a derma and generates the weakened zone which is attacked by bacteria. As a result, the immune system leads to spread of an acne. The term "acne" happens from Ancient Greek "άκμή" — the culmination of a rupture of skin. For the first time this nosology is mentioned in the works Aëtius Amidenus ( ; the doctor at court of Justinian I).
Distinguish from the reasons:
* heredity
* hormonal activity (periods, puberty period)
* awkward age
* the stress activating adrenal glands
* hyperactive sebaceous glands
* accumulation of dead skin cells
* microorganisms
* the skin damages which are followed by an inflammation
* use of anabolic steroids
* use of the drugs containing halogens (fluorine, chlorine, bromine, iodine), lithium and barbiturates
* influence of high doses of chlorine (for example, as professional harm)
Initially main reason of an acne considered disturbance of hormonal activity, further found out that narrowing of follicular channels (hyper keratinization) and keeping by liquid skin are also important etiological agents. The hormones provoking an acne are: testosterone, dihydrotestosterone, дегидроэпиандростерон, and also insulinopodobny growth factor-1.
The acne in the post-pubertal period is observed seldom. It can be connected with a syndrome of a polycystosis of an ovary or Cushing's syndrome. In a menopause of an acne develops because of a lack of oestradiol (acne climacterica).
Recently scientists revealed communication of an acne with consumption of dairy products. It is considered that in cow's milk there can be impurity of sex hormones and an insulinopodobny growth factor-1. Seafood contains iodine that can lead to strengthening of symptoms of an acne. Food with the high content of carbohydrates can also lead to an acne as excess of carbohydrates leads to increase in synthesis of fatty acids, including of what skin fat consists. At patients with an acne it is possible to reveal low levels of vitamins A and E.
Treatment of the Acne:
Prolonged treatment also demands endurance. It is directed to elimination of seborrhea.
At the heavy course of an acne appoint antibiotics, earlier appointed also a number of methods which according to modern data, are not considered it is proved effective: an autohemotherapy (transfusion of own blood), anti-staphylococcal gamma-globulin, vitamin A on 100 000 ME a day up to 2 months, estrogen (folliculin, diethylstulbestrole). Locally — rubdowns 2 — 3% solution of boric or salicylic acid, UF-radiation, cryotherapy, rash diathermocoagulation. Comedones delete, open abscessing of an acne. The dezinkrustation — removal of a fatty core of an eel by means of vacuum or galvanization is applied. Prevention of youthful eels consists in treatment of seborrhea. Maintenance of a healthy lifestyle is important. It is very important to keep to a diet (to exclude refractory fats, oils). Pathogenetic use of drugs of zinc is justified. Zinc oppresses activity of sebaceous glands and reduces an inflammation, reducing fosfatazny activity of neutrophils.
