acne

definition

Acne generally refers to the medical condition of "acne vulgaris" . This skin disorder actually affects the sebaceous glands and hair follicles. From these initially non-inflammatory comedones and in the further course of the disease a number of inflammatory skin symptoms such as knots, pustules and papules.

Acne is a skin condition that affects the sebaceous glands and hair follicles.

Epidemiology

Acne ( acne vulgaris ) is the most common skin disease. Almost every person is affected by it, whereby the disease usually begins around the age of 12 and goes back by itself at the end of puberty. However, the disease can also last until the age of 30 years. About one third of the cases must be treated with medication.

Gender distribution is approximately the same, but acne is usually more severe in boys. The increasing intake of the "pill" in women also plays a role, as it often has a positive effect on acne vulgaris . A genetic predisposition to this skin disease is discussed, as severe manifestations in familial clustering are described.

history

Acne was already known in ancient times. The origin of the name is not clear.

Causes of acne

Acne vulgaris is caused by the simultaneous occurrence of various parameters:

  • Increase in sebum flow = seborrhoea
  • Follicular hyperkeratosis = increased formation of cells on the floor of the hair follicle and as a result of this keratinization disorder
  • Propagation of germs ( Corynebacterium acnes and granulosum ) in the hair follicles and subsequent inflammation
  • Influence of androgens

The acne begins with changes in the sebaceous glands. Stimulated by the sex hormones androgens and progesterone, which are increasingly produced in puberty (androgens) and in women premenstrual (progesterone), enlarge the glands and produce more sebum.

In addition, the interior of the hair follicle, which is known as follicular hyperkeratosis, becomes corneal. As a result, the follicle is enlarged from the inside by this keratinization and additionally "clogged", so that accumulates the formed sebum and a comedo ("blackhead", filled with sebum cyst of the skin) is formed. What exactly causes this hyperkeratosis is unknown.

Next comes an increase of certain bacteria (Corynebacterium acnes and granulosum). These physiologically exist in the hair follicles and decompose the sebum. The increased number results in more decomposition products, which then cause inflammation of the comedones.

Symptoms of acne

The acne can be divided into different stages of appearance.

The symptoms are limited to the skin; especially the face but also the chest and back are affected.

Different stages of appearance will go through the acne:

  • Non-inflammatory stage = Acne comedonica
  • Inflammatory stages:
  • Acne papulopustulosa
  • Acne nodulocystica / vulgaris conglobata
  • Defective stage as a colorful picture plus scars

Acne appears first as "acne comedonica". This refers to the appearance of " comedones ", which develop mainly on the chin, nose and forehead. One differentiates between black (= open ) and white (= closed ), which usually coexist. However, the white comedones are more likely to become infected and are thus in the next stage, namely the "acne papulopustulosa". This is characterized by inflammation, in the course of which pustules (pus-filled "pimples") form. This form is called folliculitis. After healing, scars remain, but are generally not very noticeable.

If it does not come to the healing, but to the progression, a "Acne nodulocystica" / "Acne vulgaris conglobata" arises. Infiltrates and abscesses occur as a result of the spontaneous bursting or expression of the pustules (melting of tissue with formation of pus), which can form a coherent system with multiple outlets ("fistulas") under the skin surface.

The most severe form of acne and thus the last stage combines all the aforementioned skin changes. There are also very noticeable scars, so-called "acne cheloid". In the vernacular, this is also referred to as "pockmarked".

Furthermore, as complications of acne superinfection with other bacteria can occur ( staphylococci, enterobacteria, Klebsiella, Proteus ).

As special forms or from the picture similar illnesses occur:

  • Acne cosmetica (caused by cosmetics, especially in women older than 20)
  • Late acne (persistent acne in adult women due to increased androgen levels)
  • Acne excoriée des jeunes filles (psychogenic influence)
  • Acne tropica (severe acne vulgaris due to superinfection with staphylococci) Acne neonatorum (in neonates, probably due to androgens of the mother)
  • Drug-induced acne (eg, by corticosteroids, isoniazid, iodine, bromine)
  • Acne fulminans (severe, acutely starting acne with fever, joint and organ complaints)

diagnosis

The diagnosis of acne vulgaris is made clinically, that is, on the basis of visible skin changes. Different degrees of severity can be determined according to Pocchi, which among other things depend on the number of comedones, pustules, infiltrates, cysts, fistulas and scar. The classification is mild, moderate, severe and very severe acne. Are you interested in diagnostics?

Acne on the back

Especially on the back, the treatment of acne is difficult because the affected areas are difficult to reach and the skin is usually affected over a large area. Especially in the case of acne but a participation of the back is common and so often arise in men on the back of the pustules and knots of acne.

  • causes

Actually, the causes and factors for acne on the back do not differ from the causes and factors for acne on the face and other body parts. The skin glands are overly active and produce too much sebum that causes the pores to clog, causing the natural bacteria of the human skin to proliferate and cause inflammation.
Some factors, however, favor the development of acne on the back: This includes tight, synthetic clothing, which can bring little or no oxygen to the skin.

  • treatment

In the treatment of pimples on the back is the same procedure as the acne on other Hautstellen.Bei light pimples is sufficient antikomedogene care (remedy for pimples).

However, if the acne is more pronounced, treatment with benzoyl peroxide and moisturizer is more helpful.
In extreme cases of acne, systemic therapy with medication may be necessary. This must be discussed individually with the attending physician, as these remedies require medical Aoptheken prescriptions because the drugs (eg roaccutan, isotretinoin, acne-normin ) can cause serious side effects.

The therapy of acne

Therapeutically there are several possibilities:

  • Lysis of the comedones
  • Antibacterial therapy
  • Reduction of sebum synthesis

Lysis is the most important therapeutic measure and is used in acne comedonica and papulopustulosa.

It is made by vitamin A acid / trans retinoic acid, which is spotted on the acne and dissolves the keratinization. This eliminates the septic congestion and prevents the formation of new comedones. However, an effect does not occur until after about three weeks and the therapy must be carried out until there is no more tendency to acne. This can last for years.

In cases of severe inflammatory forms of papulopustular acne, there is also an antibacterial treatment, either locally with antibiotics ( erythromycin, clindamycin ), benzoyl peroxide or in the presence of abscesses systemically with the antibiotic tetracycline.

As a further option in acne nodulocystica, sebum production can be blocked with isoretinoin / cis-retinoic acid . In women, such a blockade can also be initiated with the antiandrogen cyproterone acetate .

Both the active ingredient erythromycin and isoretinoin are available in the drug group acnefug for the treatment of acne.

Finally, the most severe forms of acne can be treated with dapsone, a chemotherapy drug.

The complex superinfections of acne are treated with antibiotics depending on the causative agent.

Frequently used but not or only weakly effective measures are:

  • special diets
  • peelings
  • Cleansing / disinfecting the skin
    or
  • Application of UV light.

Homeopathic medicines can also positively influence acne vulgaris. Here, however, the skin and appearance must be considered exactly.
Read more about homeopathy and acne in our topic: Homeopathy for acne

In addition, there is the possibility of mesotherapy.

Home remedies can also be used for acne. Further information on the topic can be found here:

  • Home remedies for acne
  • Home remedies for pimples
  • Apple cider vinegar in acne

Medicines for acne

The treatment of acne with medication has high side effects and associated risks, so it must be carefully considered with the attending physician, whether an external treatment of acne can not be sufficient.
Attached are listed the most popular drugs for acne treatment:

  • erythromycin
  • doxycycline
  • Isoretinoin
  • Ethinylestradiol + dienogest
  • minocycline
  • adapalene
  • tetracycline
  • framycetin
  • tretinoin
  • Ethinylestradiol + chlormadinone
  • estradiol
  • Estradiol + prednisolone
  • Sodium Bituminosulfonate + Chloramphenicol

Diet in acne

Healthy diet can prevent acne.

The hormones contained in the animal milk, and bioactive molecules are responsible for a variety of skin problems and also the severe teenage acne, according to recent research results (including Nurses Health Study II). The consumption of milk, skimmed milk, quark and cream cheese leads to the well-known skin problems. The study results were confirmed by affiliated studies.

Further studies in non-acne populations (eg Papua New Guinea) clearly show that they lack milk intake and high glycemic index carbohydrates. This glycemic index is considered as a measure of the influence of blood sugar levels: A high glycemic index stands for a sharp rise in blood sugar levels.

The substances contained in cow's milk are thought to be natural for the breeding of calves and should cause them to grow rapidly. If a person ingests these substances through the consumption of dairy products, there is an increase in IGF-1, a messenger substance that can cause insulin resistance and acne if it is greatly increased.

Through a healthy, natural diet, acne can be prevented as far as possible:

To avoid are:

  • Milk, whey, whey protein concentrates (protein power drinks), yogurt, cheese
  • Cocoa, sweets, chocolate, sugar
  • Carbohydrates with high glycemic index (French fries, white flour products)
  • alcohol
  • Nicotine / smoking

Good for a healthy lifestyle, however:

  • soy products
  • Green tea
  • vegetables
  • regular sports (exercise and healthy weight)

Cream for the treatment of acne

For the treatment of acne there is a wide range of creams and ointments.

The market for acne cosmetics is quite large in line with demand, and almost every cosmetic company has an extra line against blemished skin.
So there are various creams, gels, washing lotions and facial serums to buy, which promise a pure and radiant skin.

The really effective creams for severe acne usually contain at least one of the following four ingredients.

1) antibiotics

Local antibiotics such as tetracycline, clindamycin, erytromycin on the skin in the form of ointments. It reduces inflammation by slowing the spread of acne bacteria ( Propionibacterium acnes ).
In order to maintain a lasting effect and to prevent the development of resistance, it is advisable to use other preparations in addition to the topical application of antibiotic, which additionally contain 5% benzoyl peroxide. In addition, care must be taken that an application period of 8-12 weeks is not exceeded, because after this time the effectiveness on the bacteria is lifted.
A cream or ointment containing antibiotics is only available by prescription from a pharmacy.
Pregnant and nursing mothers should urgently refrain from the use of antibiotics.

2) azelaic acid

Azelaic acid has a threefold positive effect on the acne

  1. comedolytic (skin blemishes are released, pimples fade)
  2. antimicrobial (kills bacteria)
  3. anti-inflammatory

Also, creams and ointments with azelaic acid are available only on prescription in the pharmacy and in contrast to antibiotics better tolerated and thus compatible with pregnancy and lactation.

3) Benzoyl Peroxide (BPO)

Benzoyl peroxide has an antibacterial effect as it destroys the membrane of acne bacteria ( propionibacteria ). In this way, the infestation of the skin with the bacteria is reduced and the bacteria still do not form a resistance to the agent, as is the case with antibiotics.
BPO is used in ointments and creams at a concentration of 3 - 10%.
Possible contraindication for the use of BPO is an allergy to this drug. As a side effect of the application it can come to a dehydration of the skin, which can be accompanied by distension, peeling and redness. In this case, the concentration of BPO in the product should be reduced and / or the product used less frequently.

Ointments and creams containing benzoyl peroxide are also available without a prescription and can be used in combination with antibiotics and retinoids.

4) Retinoids

Tretinoin, isotretinoin and adapalene belong to the group of retinoids and are chemically produced acne-related acne-related drugs.
They affect the growth as well as the maturation of the cells and they have an anti-inflammatory and comedolytic effect. This pimples are opened and dismantled.
Local side effects such as redness, burning and scaling often occur as side effects, so concomitant skincare is recommended.
In addition, it is important to know that the skin becomes light-sensitive through the use of retinoids and that under UV irradiation pigmentation and sun allergy can occur. It follows that under therapy with retinoids excessive sun exposure must be avoided and strong sun protection factor must be used.

Retinoids are suspected to lead to depression and psychic syndromes such as anxiety and panic disorder by entering the metabolism.
Retinoids are only available on prescription in the pharmacy and during pregnancy and lactation absolutely not indicated!

Therapy-related care

Most cosmetic products against blemished skin and acne dry out the skin and lead to distension, redness and dandruff. For this reason, an accompanying moisturizer is recommended to minimize the irritation of the skin as much as possible.

According to the original interests, this additional care should not contain pimple-promoting ( comedogenic ) ingredients.

rehabilitation

A rehabilitation is usually not necessary because the acne is self-limiting. However, a treatment of remaining cosmetically disturbing scars can be done.

prophylaxis

A prophylaxis of acne does not exist, is treated only when skin lesions occur.

forecast

The prognosis of acne is good, as it usually regresses by itself between 20 and 25. However, noticeable scars may be left behind on the most severe progressions.
For the treatment of acne scars is a scar ointment, such as Contractubex ® .
Here you can find more information about: Contractubex ® .


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