Acne, or acne (lat. Acne vulgaris ) is an inflammatory disease of the sebaceous glands and hair follicles, which ranks eighth in the global incidence structure. Most often registered in Western Europe, North and Latin America.
In particular, in the United States, this problem occurs in approximately 85% of people aged 12 to 25 years, and at the age of 40 years, the incidence of acne is 26% in women and 12% in men. Acne affects all age groups and is accordingly classified into neonatal, childhood, adolescent and adult acne .
Find out in the article on estet-portal.com which factors in the development of acne are leading and influence the severity of the disease .
Pathogenesis of acne development
The pathogenesis of acne development is complex, but includes four key factors with interrelated mechanisms:
- increased sebum production;
- hyperkeratinization of the infundibular part of the follicle;
- inflammation;
- infection caused by Cutibacterium acnes (Gram-positive facultative anaerobes that live deep inside the follicles and in the pores of the skin).
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When looking at a person, we first of all pay attention to the face, so problems arise in forming a first impression. Adolescents and adults with acne have higher rates of anxiety , low self-esteem and depression compared to those without the problem.
The relationship between the concentration of sex hormones and the course of acne
Adults with severe acne have much higher unemployment rates than age-matched groups without acne. The deterioration in the quality of life in patients with acne is equivalent to impairment in asthma, epilepsy or arthritis.
Risk factors for developing acne
Risk factors for developing acne include:
- heredity;
- rare genetic conditions (Apert syndrome);
- endocrine disorders, in particular polycystic ovary syndrome;
- metabolic syndrome.
Acne has a high probability of inheritance - in the general population it causes the disease in 81% of cases. Unlike bizygotic twins, in monozygotic twins the level of sebum secretion and the presence of acne are almost identical, so heredity is one of the most important reasons for the development of acne .
Diagnosis of acne is based on clinical examination data. The primary lesions are comedones (closed or open) and inflammatory elements (papules, pustules and nodules).
They are predominantly localized in areas where there are many sebaceous glands : on the face, upper back, chest, shoulders. Secondary changes include scarring, hyperpigmentation, or erythema , which also affect treatment.
The severity of acne manifestations is very variable: from mild forms to severe fulminant disease with systemic symptoms - fever, arthralgia, lytic bone damage.
When collecting anamnesis, you need to find out whether there is a heredity burden , pay attention to the symptoms and signs of hyperandrogenism or other endocrine disorders, in particular excess cortisol and growth hormone .
The use of hormonal therapy and antibacterial drugs in the treatment of acne
For example, menstrual irregularities and hirsutism indicate polycystic ovary syndrome, while the sudden onset of acne may be a sign of a gonadal tumor.
Hormonal effects as a cause of acne
In patients with atypical, very severe or treatment-resistant manifestations, especially with a sudden onset , as well as in women with signs of androgen excess, laboratory and instrumental studies should be performed.
In case of polycystic ovary syndrome, it is necessary to determine total and free testosterone in the blood serum.
If adrenal hyperplasia is suspected, the contents are determined:
- thyrotropin;
- cortisol;
- dehydroepiandrosterone sulfate;
- 17-hydroxyprogesterone.
Therapeutic tactics depend on the type of damage, their severity and location. First of all, you need to analyze your skin care routine : frequency of washing, choice of cleansing and moisturizing products. Most patients are advised to avoid scrubs, astringents and other irritating products , and to wash their face twice a day using a gentle cleanser for sensitive skin.
All about the use of systemic retinoids in the treatment of acne
The patient should understand that the initial period of acne treatment until clinical improvement is sometimes 8-12 weeks, and secondary pigmentary changes or erythema completely disappear after a few months. To prevent further darkening of hyperpigmentation, it is advisable to use sunscreen .
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