Acne: causes, triggers and treatment protocol for acne

Acne – is a chronic multifactorial, polygenic disease that occurs due to overproduction of sebum, follicular hyperkeratosis, inflammation, lipid imbalance, some sex steroid hormones and genetic predisposition. 

Unfortunately, there is no shortcut and golden pill for acne.

To determine the cause, an in-depth examination.

Daria Miguleva – dermatologist, trichologist, esthetician-cosmetologist, expert and speaker of company TOTIS.

• What are the main causes and methods of examination of acne
• Can diet or psychosomatic disorder cause acne
• How appropriate is the treatment of demodicosis in acne
• Relative hyperandrogenism as a cause of acne in women
• What should home care be like for acne
• What professional procedures do you use to treat acnee
  

Daria Miguleva – dermatologist, trichologist, aesthetic cosmetologist, expert and speaker of company TOTIS What are the main causes and methods of examination of acne

D.M.:

The main causes of acne include:

diseases
• of the pituitary-adrenal-ovarian system (PCOS, metabolic syndrome, prolactinoma, adrenal adenoma), hormonal androgen disorder (hyperandrogenism);
diseases
• of the gastrointestinal tract (gastritis, colitis, cholecystitis, bile stasis, liver failure, chronic pancreatitis, enzyme deficiency, malabsorption disorder);
wrong eating behavior
• (excessive consumption of carbohydrates, dairy products, sugary products, fast foods, fried and fatty foods); insulin resistance (the amount of carbohydrate intake is very high, uncontrolled sugar intake leads to impaired insulin glucose tolerance and insufficient glucose utilization);
• incorrectly selected home care (overdrying of the skin, which leads to hypersecretion of the sebaceous glands (oily seborrhea));
• use of decorative cosmetics that contains lanolin, talc, petroleum jelly, mineral oils, synthetic dyes and fragrances;
• permanent injury to the skin (squeezing out rashes).
• List of examinations
to undergo before acne treatment: 

complete blood count;

biochemical blood test (hepatorenal tests);

1. lipidogram: cholesterol, triglycerides, atherogenic index, HDL, LDL VLDL;
2. vitamin D3 (25-OH), zinc, magnesium, copper, ferritin;
3. carbohydrate metabolism: glucose, insulin, glycated hemoglobin, HOMA index;
4. consultation of a gastroenterologist and a gynecologist-endocrinologist (if necessary, the expert will prescribe male
5. and female sex hormones, cortisol, prolactin, thyroid hormones).
6. Can diet or a psychosomatic disorder be the cause of acne

D.M.:

There is often a connection between the problem of rashes and nutrition, mainly patients who have

enzymatic deficiency

(often this may not be complete, but partial deficiency) . This is a reaction to the use of lactose, dairy products for such patients are "poison", as their use leads to endogenous intoxication. In patients prone to acne, the sebaceous gland is very sensitive and often reacts with rashes outside of menstruation.

Possibilities of acid peeling for the face when correcting persistent pigmentation

cortisol, which reduces the body's immunity and increases the level of pro-inflammatory cytokines.
In this case, the beautician should first of all involve a psychologist
, since the root cause must be dealt with. It is also necessary to check the deficiency of elements in the body that can reduce stress resistance.

It is recommended that the patient be referred for a test for total vitamin D (25- OH vitamin D).

In acceptable quantities, this vitamin maintains an optimal level of stress tolerance in the human body.

It is also necessary to monitor magnesium levels, which plays an important role in the functioning of the central nervous system

we. 

How expedient is the treatment of demodicosis in acne 

D.M.:

Demodex (

Demodex follikulorum

) – it is an opportunistic flora that is the microbiome for our skin. In healthy skin, opportunistic flora (for example: P.Acne, Demodex folicullorum, lipophilic yeast fungi, etc.) are controlled by other families of bacteria, which prevents them from reproducing. When the work of the epidermal barrier decreases, the local immunity of the skin is disturbed, and the opportunistic flora tends to multiply.

If the protective properties of the skin are violated, it easily provokes the appearance of inflammatory elements. Skin Demodex should not be fought as it is a skin microbiome that needs to be regulated.

With the help of home care, it is necessary to

restore the epidermal barrier of the skin

, as well as

to exclude internal pathologies

after consultation with related specialists.

After these issues are closed, the flora self-regulates, conditions are created in which it does not re-propagatesya. Relative hyperandrogenism as a cause of acne in women

D.M.: Relative hyperandrogenism – this is a condition that often occurs in the modern world.

Today, a huge number of women lead an active lifestyle, do business, self-development and strive to be in the flow.

Relative hyperandrogenism – a problem associated with a relative increase in male hormones (dihydrotestosterone, testosterone, etc.) and a relative decrease in female hormones or hypersensitivity to 5-alpha reductase receptors.

Against the background of such changes, the patient develops symptoms:

rashes on the lateral surface of the face, migrating to the neck;

hirsutism (hair grows above the upper lip, on the chin, in the navel area, around the areolas of the chest).

The exacerbation of rashes is often associated with
• menstruation
(in 10 days the exacerbation is brighter when estradiol decreases and progesterone rises) and
• stress
.

Stress increases the production of androgens by the adrenal glands and, as a result, provokes an exacerbation of rashes. Can acne breakouts go away during pregnancy/postpartum

JM:

It could happen with a 50/50 chance. If the patient had hyperandrogenism and before pregnancy her skin was prone to rashes, during pregnancy this tendency decreases, female sex hormones increase, and male sex hormones decrease.

Accordingly, the problems of relative hyperandrogenism are eliminated (due to the restructuring of the hormonal background and balancing the female and male sex hormoness).

What should home care be like for acne treatment

D.M.:  It is important to remember that – it's extra heat, it's extra fat.

Extra components on the skin exacerbate the problem

by creating an environment for the pathogenic flora where it is comfortable to multiply (no oxygen, a lot of fat).   The number one challenge in home acne skin care –

Maintain local immunity of the skin

and dermal barrier.

The key to success – healthy local skin immunity (when it is healthy, the pathogenic microbiome will not replicate). Of course, we do not rule out

internal pathologies

(gastritis, colitis, endocrinological diseases, etc.), but proper washing, proper toning, proper care cream – mandatory procedures. The key to success – healthy local skin immunity.

My favorites from German brand Dr.Spiller, represented by

TOTIS

:  Herbal Cleansing Gel Dr.Spiller (if not hypersensitive) morning and evening; Herbal Toner

Moisturizing Toner with Herbal Extracts Dr.Spiller.

 
• If the patient has
severe stage of acne
• :   
Hamamelis Astringent Dr.Spiller

Cleansing Toner for Oily Skin

Hamamelis Astringent Dr.Spillerlocally for blemishes;

Herbal Moisturizing Toner

Moisturizing Toner with Herbal Extracts Dr.Spiller
• for the whole face in the morning and evening after washing. 
• Scrubs The patient does not use the first month until the inflammatory process passes. Scrubs can be added to home care after a month of treatment.  

Care cream

will be relevant with a very light, emulsion texture. I prescribe

Herbal Active Complex Dr.Spiller

in the morning. It is herbal, anti-inflammatory, with salicylic acid, propolis and vitamin A. At night I prescribe

Acnoderm Gel Dr.Spiller

gel texture, it is anti-inflammatory, relieves swelling, redness, reduces the number of papulopustular elements. And also –

AHA Ginkgosome Gel Dr. Spiller

, which removes hyperkeratosis, resolves spots in places of post-inflammatory spots. 

Read also:

The role of home care in preventing the onset and exacerbation of couperosis in rosacea

  Sometimes I add topical retinoids and synthetic ones to my practice; preparations with azelaic acid, zinc, clindamycin. In difficult cases, such as conglobate acne, –

retinoids oral

but. 

Which professional treatments do you use to treat acneprofessional care

, alternating it with more active procedures

:

  1. Cleanse and tone the skin;

2.

 I make an enzyme peeling mask on herbal tonic, apply it on the skin under a film for 3-5 minutes and close it with a warm, damp towel. After a while, I wash it off. This gives loosening of the skin and removes excess hyperkeratosis;

3. I apply

Propolis Vitamin A Ampoules Dr.Spiller

– ampoule for problematic young skin with propolis and vitamin A, especially plentiful – locally in areas where hypersecretion of the sebaceous glands is strongly expressed;

4. I apply a cleansing mask with healing clay Terra California Clay Mask Dr.Spiller (if there are few breakouts), or

Herbal Mask with Aloe

Spiller or Terrasil Beauty Clay Mask Dr.Spiller – a cleansing mask for problematic skin, or I close the procedure with a Purifying Peel Off Mask Dr.Spiller (alginate mask), which contains tea tree oil, willow leaf extract, menthol, seaweed – anti-inflammatory components; For 15–20 minutes I make a sandwich sandwich: Propolis Vitamin A Ampoules Dr.Spiller + cream/clay mask + alginate mask.

5.

Remove alginate mask, wash off cream/clay mask, tone again with herbal toner, and reapply Propolis Vitamin A Ampoules Dr.Spiller;

6. Working on the skin with darsonval;

7.

I close the procedure with a care cream (Herbal Active Complex Dr.Spiller, Propolis Day Cream Dr.Spiller, Royal Jelly Cream Dr.Spiller).

If we are dealing with aging patients prone to rashes, – Thymovit E Cream Dr. Spiller. I do this treatment once every 2 weeks, alternating with a more active one.

Active treatments include peelings.

Most often I do azelaic-retinol peeling, I use 2 peels in 1 procedure: azelaic peeling

Azelaico peeling

from Simildiet 2-3 layers (contains azelaic acid, salicylic acid, lactic acid and arnica ), on top retinol

Lightening

from Innoasthetics from the official representative of the company TOTISPHARMA GROUP LTD. phytic and kojic acids. It will work on the differentiation of keratinocytes, reduce the activity of the sebaceous glands, remove and prevent post-inflammatory pigmentation. This procedure should be done no more than once every 2 weeks. The patient will have retinoid dermatitis – This is an absolute norm and an indicator of the result. The brighter it is in the patient, the better the result will be. This dermatitis is removed with cream masks and home care.

Methods for

scar correction

:

TCA peels with retinol overlay;

mesotherapy;

dermabrasion;

grinding.

• What is the actual recovery time for patients with acne
Acne – chronic disease, so it can periodically worsen. To avoid this,
• treatment results must be maintained continuously
.

The inflammatory process can be removed in 1.5–3 months due to the correct care system.

Next step – recovery and prevention of exacerbation (duration of treatment – 1.5–3 months.

Last step – beauty stage, when work is done with spots, scars.