A doctor of any profile has to diagnose and treat acne from time to time. The choice of treatments for acne should be based on an adequate clinical assessment of its severity. You should always take into account the state of the endocrine background, concomitant diseases and conditions. That is why dermatologists often resort to the help of other specialists in the management of acne patients — gynecologists, endocrinologists, urologists, therapists.
Acne, or acne (acne) — chronic inflammatory disease of the sebaceous glands resulting from their blockage and increased production of sebum (seborrhea). It is known that seborrhea and acne are quite widespread: 60 & ndash; 80% of people aged 12 to 24 suffer from this disease in one form or another.
Modern approaches to the treatment of acne include the appointment of various systemic and external drugs that affect the links of pathogenesis that have been well studied to date: hyperplasia and hypersecretion of sebum, follicular hyperkeratosis, reproduction of Propionibacterium acnes and other microorganisms, inflammation in the dermis.
How to choose an acne treatment
The choice of treatments for acne should be based on an adequate clinical assessment of the severity of acne, as well as the type of skin rash. You should always take into account the state of the endocrine background, concomitant diseases and conditions. That is why dermatologists often resort to the help of other specialists in the management of acne patients — gynecologists, endocrinologists, urologists, therapists, etc.
Recently, when choosing methods of treating a patient with acne, an increasing role is given to his psychosocial status. It is known that acne can have a significant psychological impact on the patient, causing anxiety, depression, social maladaptation, interpersonal and work difficulties. The problem of external unattractiveness generates dysmorphophobia — neurotic disorder, manifested by the fear of imaginary external deformity. This disorder is very typical for puberty and is accompanied by a large number of complaints, the desire to change one's appearance, to correct an imaginary physical defect. At the same time, the nature of complaints and their emotional coloring do not always depend on the severity of clinical manifestations. For example, many of the patients under our observation with a mild course of the disease were much more worried about their illness than patients with more severe forms. Conversely, patients with severe acne were more reserved in describing their complaints.
Diagnosis and classification of acne
In some cases, patients are also diagnosed with dysmorphomania — belief in the presence of a physical defect or deformity. It is a delusional disorder characterized by ideas of attitude and a depressed background of mood, as well as an active, intrusive appeal to specialists to correct a physical handicap. In such situations, psychoneurologists can provide significant assistance in treatment. At the same time, the illustrated features of the emotional and mental status of patients with acne dictate the urgent need for the active use of modern and effective drugs.
Specialists are well aware that in the case of successful treatment of this dermatosis, the emotional background and behavior of patients changes significantly.
As for the definition of the severity of acne, there is no single classification. However, most researchers distinguish three degrees of severity of the disease — light, medium and heavy. Mild acne is diagnosed in the presence of mostly closed and open comedones, with virtually no signs of inflammation. With mild acne, there may be less than 10 papulopustular elements on the skin of the face. With moderate severity, more than 10, but less than 40 papulopustular elements are noted on the face. The severe form is characterized by the presence of more than 40 papulopustular elements, as well as abscessing, phlegmonous (nodular-cystic) or conglobate acne. A mild degree requires the appointment of only external therapy. Patients with moderate to severe acne
Acne treatmentFor mild acne, one of the modern external agents is prescribed. The currently widely used drugs belong to the groups of drugs already well known to physicians: topical retinoids, benzoyl peroxide, azelaic acid and external antibacterial agents. In moderate and severe forms, in addition to the listed drugs, systemic antibiotics (tetracyclines, erythromycin) are used, in females — antiandrogens (cyproterone acetate, dienogest), as well as systemic retinoids (isotretinoin). Thus, modern means for topical therapy are indicated for any severity of acne. However, until recently, they were not widely used due to the large number of side effects and/or low efficiency in severe and moderate forms of the disease. Besides, monotherapy with topical antibacterial agents (erythromycin, clindamycin, etc.) with excessively long courses has created another serious problem — insensitivity of the pathogen (P.acnes) to the therapy.
Most recently, two new external preparations have appeared at the disposal of specialists, which have deservedly taken a leading position in the treatment of acne in many dermatological schools in Western Europe and America. These are adapalene (Differin) and benzoyl peroxide (Baziron AC). Differin is available in the form of a gel and cream 0.1%, baziron AC — in gel form 2.5%, 5% and 10%.
More recently, two new external preparations have appeared at the disposal of specialists, which have deservedly taken a leading position in the treatment of acne in many dermatological schools in Western Europe and America. These are adapalene (Differin) and benzoyl peroxide (Baziron AC). Differin is available in the form of a gel and cream 0.1%, baziron AC — in gel form 2.5%, 5% and 10%.
Differin is recommended both as monotherapy (for mild forms), and in combination with topical or systemic antibiotics, antiandrogens. The drug is also indispensable at the stage of transferring a patient from systemic therapy (systemic antibiotics, systemic retinoids, antiandrogens) to external therapy.
It is important to emphasize that all current topical acne medications must be prescribed for the long term.
A stable positive effect when using adapalene (Differin) and benzoyl peroxide (Baziron AC) is possible only with constant use for four to six months. This is due to the fact that such drugs should act on the skin for several periods of renewal of the epithelial layer. It is known that the average duration of skin epithelium renewal is 28 days. You should also always remember the need for effective photoprotection when prescribing drugs with a keratolytic effect in the summer and the use of modern non-comedogenic products for gentle cleansing and moisturizing of the skin. Patients should be warned against rubbing drugs, using them in excessive amounts, using alcohol solutions and other agents with a drying effect.
At present, the questionable effectiveness of a strict diet, enterosorbents and autohemotherapy in patients with acne has been shown. It is also not recommended to prescribe active ultraviolet irradiation for moderate and severe forms due to the proven comedogenic effect and a decrease in local immune protection against the background of acute and chronic exposure to UV radiation. Antibiotics of penicillin, cephalosporin and other series, which are inactive against P.acnes, are not shown. Wide surgical opening of cystic cavities is contraindicated because it leads to the formation of persistent scars. Finally, external glucocorticosteroids are contraindicated in the treatment of acne. At present, it is most optimal to prescribe modern topical and/or systemic drugs as early as possible.
According to www.lvrach.ru
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