Acne is a disease of the hair follicles and sebaceous glands, which can manifest itself both on the skin of the face and on other parts of the skin. In case of acne, 5 types of different inflammatory elements may be present on the skin:
- Acne (open and closed) -
open eels look like black dots in the pores of the skin (fig. 1), and closed ones look like bumps on the skin surface of white color (fig. 2).
- Acne -
Acne on the face can occur in the form of papules and pustules.
→ Papules are an inflamed bump of red color on the skin surface, inside of which there is no cavity with pus (Fig. 3). A papule may last several months and pass without a trace, or it may be transformed into pustules in a few days.
→ Pustule is an inflammatory focus inside of which there is a cavity with pus (Fig. 4). As a rule, on the skin for acne can be found at the same time and papules, and pustules.
- Nodules (pic.5) -
nodules appear in the later stages of acne, and are large, dense and painful bumps under the surface of the skin. Inside the nodules there is no cavity with pus, and they resemble papules, only of large size.
- Cysts (pic.6) -
they are large pustules, i.e. very large lesions filled with pus. After the cysts have healed (as well as after the nodules have healed), scars and pigment spots form on the skin.
Acne - causes and mechanism of development
Under the surface of the skin there are many hair follicles, of which grow hair that penetrates to the surface of the skin through its pores (Fig. 7a). At the base of each hair follicle there are many small sebaceous glands that produce sebum. This fat comes from the sebaceous glands through the narrow channels first into the lumen of the hair follicle, and then (along the hair shaft) it rushes out to the surface of the skin.
The development of acne is associated with two points:
- Strengthening the function of the sebaceous glands at the base of the hair follicles -
The increased production of sebum is directly related to the increase in adrenal androgen production (male sex hormones). These hormones are produced in both sexes, but in women - to a lesser extent. That is why acne develops during puberty in adolescents.
- Keratosis epithelium inside the follicle -
the surface of each hair follicle is covered with epithelial cells from the inside. The increase in the rate of exfoliating epithelial cells from the inner surface of the follicle leads to an increase in the number of desquamated dead cells in its lumen.
An increase in sebum production and an increase in the number of desquamated cells lead to the formation of plugs that clog the pores of the skin (Fig. 7b). Such traffic jams are called acne vulgaris. Acne may look like:
→ in the form of white bumps, if a cork is formed deep in the pores (Fig.9),
→ in the form of black spots inside the pores, if a stopper forms at the surface of the skin (Fig.10).
The formation of traffic jams leads to the fact that the sebum that is constantly formed by the sebaceous glands cannot come out and accumulates in the lumen of the hair follicle (Fig.7b). The enclosed space with the nutrient medium inside — an ideal place for the development of infection, and therefore the bacteria that have fallen into the hair follicle from the surface of the skin — begin to multiply rapidly there.
This leads to the development of inflammation in and around the follicle. Inflammation for a long time can occur without the formation of pus, in this case, such a formation is called papule (Fig. 10). The papule looks like a red, inflamed bump on the surface of the skin. Papules may disappear without a trace over time, but they usually transform into pustules. The pustule is already a classic pimple with pus inside (Figure 11).
In addition, with more severe forms of acne, large inflammatory formations can form - nodules and cysts. Nodules are dense, painful papules of large size, inside of which there is also no pus (Fig. 12). Cysts occur, as a rule, when trying to squeeze acne deep in the skin, as a result of which pus penetrates deeper into the tissues (Fig. 13).
How to treat acne correctly -
If you are not able to maintain your skin in good condition on your own, you should definitely consult a dermatologist for advice. Acne treatment in adults and adolescents is the same, but the exception is women who can use hormonal contraceptives as an additional therapy.
How to treat acne will depend primarily on what kind of inflammatory elements are on the skin of the face. Treatment will be different in situations where there is -
- when there is only acne,
- acne only (papules and / or pustules),
- with a mixed form of acne (acne + acne),
- in the presence of nodules and cysts.
Below you can see the list and description of the drugs, as well as the scheme (Fig. 14), which shows that you need to use acne for every form.
The duration of treatment -
In order to achieve any noticeable improvement in the condition of the skin of the face, up to 4 weeks of treatment is necessary. The standard course of treatment is about 6 weeks. However, with persistent acne, treatment can take you up to four months (and sometimes longer) to get a good result and get rid of not only acne, but also post-inflammatory skin pigmentation.
Topical treatment (gels, creams and lotions)
1. Benzoyl peroxide -
Benzoyl peroxide is a bactericidal agent that kills bacteria, which cause inflammation of the hair follicles in the skin. It also has a weak keratolytic effect, i.e. exfoliates dead skin layers. Effective with the following forms of acne -
- in the presence of acne,
- with a mixed form of acne (acne with acne).
Assign only in the presence of acne - impractical!
Agents can have a benzoyl peroxide concentration of 2.5%, 5% or 10%. Clinical studies have shown that higher concentrations do not provide significant benefits. Therefore, we recommend the first month to use a concentration of 2.5%, and in the future to switch to 5% of the funds.
Benzoyl peroxide lotions, creams and gels -
"Persa-gel 5", Prodder-cream, Proactive, "On-the-Spot® Acne Treatment "(Neutrogena), Mary Kay, Desquam (gel, lotion, soap) - these are all the means of production in the USA. The French produce - Baziron-gel, Eclaran-cream ... India), Benzacne Gel (Poland) ...
Important: The most effective treatment is still not the appointment of pure benzoyl peroxide, and its combination with an antibiotic or retinoids -
- "Epiduo" (France), Effezela (France) - contain benzoyl peroxide + retinoid Adapalen,
- "Duac-gel" (UK) - benzoyl peroxide + clindamycin antibiotic.
Application Scheme -
The preparation should be used 1 or 2 times a day, 20 minutes after washing the skin of the face with mild detergents. The drug should be applied only on the skin areas of the person affected by acne. Most people notice the result after 5 days, but they need a course of treatment for at least 6 weeks in order to thoroughly clean the entire skin of the face and achieve stable remission.
Possible side effects -
- during the period of use the skin can be dry and tense,
- temporarily itching or burning may occur,
- redness and peeling of the skin on the application sites is possible.
Side effects are usually mild and disappear immediately after use. Also keep in mind that benzoyl peroxide makes the skin more sensitive to sunlight, so you should avoid too much sun and ultraviolet radiation, or wear sunscreen. Avoid getting benzoyl peroxide on clothes and hair, as peroxide has a whitening effect.
2. Salicylic acid -
Salicylic acid contributes to the dissolution of the substrate of which congestion (acne) consists, and also promotes exfoliation of the superficial dead skin cells. For the treatment of acne, creams, gels and lotions of salicylic acid with concentrations of 0.5% or 2% are released. Salicylic acid acne preparations come in at 0.5% or 2% concentration. An example is the Clearasil line of products (Klerasil) in the form of a lotion, cream and gel.
Keep in mind that salicylic acid is not at all effective for acne, but it can be used for acne. But note that even with acne - its effect will be 2 times weaker when compared with retinoids. In most cases, you should not believe what is written about the wonderful properties of salicylic acid in acne in various forums and blogs. All this nonsense is written by programmers and professional bloggers - solely to increase the attendance of their projects.
Features of salicylic acid use -
if you do decide on this remedy, then be prepared that at the beginning of regular use the skin will at first be slightly red and inflamed. There will also be flaking skin. In addition, for people with dark skin, the use of salicylic acid causes the appearance of age spots on the skin.
3. Retinoids -
Retinoid preparations are derivatives of vitamin A. These preparations prevent the appearance of blackheads (comedones), and they also facilitate their removal from the pores. Retinoids for the treatment of acne are available in the form of gels, creams and lotions. Retinoids are prescribed when there is ‹only acne›, as well as with a mixed form of acne - <угри с="">угри>
Examples of modern agents with retinoids -
- with Tretinoin - Retin-A (USA), Ayrol (Switzerland), Lokatsid (France),
- with Adapalen - Klenzit (India), Differin (France), Derive (India),
- with Tazaroten - Zorak (Germany), Tazret-gel (India).
Among monocomponent retinoids, the most effective are in the form of lotions, creams are the least effective.
Examples of combined agents with retinoids -
There are also agents in which the retinoid is combined with an antibiotic or bezoyl peroxide. Such tools are most effective if you do not just have acne, but have purulent acne or a tendency to their appearance -
- "Deriva-S", Klenzit-S - adapalene + clindamycin antibiotic,
- "Epido" (France) - adapalene in combination with benzoyl peroxide?
- "Isotrexin" - contains a retinoid Isotretinoin + antibiotic erythromycin.
Application Scheme -
the drug is used 1 time per day in the evening (before bedtime). A good effect will be noticeable after 6-8 weeks, and you will see a lasting improvement after a 3-month course of treatment. Start using the drug from 3 times a week, gradually moving to daily use (this is necessary so that the skin gradually gets used). Apply to all skin areas affected by acne, approximately 20 minutes after washing your face with a mild cleanser.
Possible side effects -
- slight irritation and burning of the skin,
- not during pregnancy
- increased sensitivity to the sun (use sun protection during periods of high solar activity),
- It is undesirable against the background of the use of retinoids to undergo chemical peeling procedures, since possible severe skin irritation.
4. Azelaic acid -
Azelaic acid has an antibacterial effect, it also exfoliates dead skin layers. It can be prescribed as an independent remedy if there are only acne, and as an additional remedy for retinoids or benzoyl peroxide with a mixed form of acne (acne with acne).
Examples of gels or creams with azelaic acid -
→ Skinoren (Germany),
→ Acne-derma (Poland),
→ Azogel (Russia).
Application Scheme -
It is usually applied 2 times a day (or 1 time a day, if the skin is especially sensitive). As a rule, you need to use azelaic acid for 1 month before your acne improves. Plus - the drug does not increase the sensitivity of the skin to the sun, which is important in the summer season. Also, the drug avoids the development of post-inflammatory pigmentation after healing of purulent foci. Causes less skin irritation than other groups of drugs.
5. Preparations with sulfur -
May be effective in treating acne with an inflammatory component (i.e., acne). But with acne use of such drugs is meaningless. Preparations containing sulfur can change the color of the skin and, as a rule, have an unpleasant odor. Use a cream or gel containing sulfur, preferably 1 time a day, before going to bed (examples of preparations).
A single treatment with such a tool will allow to use benzoyl peroxide only once a day, which means that the bacteria will be used to benzoyl peroxide less. We see no other advantages in preparations with sulfur.
Antibiotics for acne -
Antibiotics for acne are most often used externally (as part of creams and gels), less often in the form of tablet preparations. Gels with antibiotics are prescribed for all forms of acne, except for the form, when there is only acne without inflammation. And in any case it is impossible to apply the ointment forms of antibiotics!
- Antibacterial creams and gels -
usually contain antibiotics such as erythromycin and clindamycin. Usually prescribed for acne, with a mixed form of acne (acne with acne). Examples of gels with clindamycin: "Clindovit", "Dalatsin", "Klindatop".
There are combined drugs, where the antibiotic is combined with drugs of other groups. Such drugs are preferable and stronger, but before using them you need to consult with a dermatologist:
→ "Duac-gel" - contains clindamycin and benzoyl peroxide,
→ "Deriva-S", "Klenzit-S" - clindamycin and adapalen (retinoid),
→ "Isotrexin gel" - erythromycin and isotretinoin (retinoid).
→ Zinerit, an effective combination drug based on erythromycin and zinc.
- Oral antibiotics -
Antibacterial tablets should be prescribed only by a doctor. Usually they are prescribed only in the cystic form of acne. However, oral antibiotics can be prescribed for acne and acne with acne, if the standard local therapy of the latter did not bring success.
Cortisone Injection -
In order to help patients with the cystic form of acne, large deep acne - doctors often use injections of steroid anti-inflammatory drugs, such as cortisone. This quickly and noticeably improves the appearance of these patients, and eliminates the need for surgical intervention. Side effects of such treatment are: thinning of the skin, skin lightening, the appearance of small blood vessels (spider veins) on the treated area.
Isotretinoin (analogues - Roaccutane, Aknetin, Aknekutan) is a retinoid for systemic effects on the body in the form of capsules that need to be taken orally. It is used exclusively in people with cystic acne. This drug is very effective and is used annually to treat acne in millions of patients around the world, but it has serious contraindications and side effects.
Application features -
this drug is prescribed for 5-6 months. Blood tests are done monthly to check liver function and triglyceride levels. The drug has many potential serious side effects, making it a poor choice for people with mild and moderate forms of acne. However, if the doctor prescribes the drug correctly, given the patient's history, the drug is safe enough and you are not likely to be disturbed by anything more than dry lips or recurrent muscle pain.
Isotretinoin is absolutely contraindicated for pregnant women. Women of childbearing age who take isotretinoin need unconditional contraception. It is also necessary to avoid pregnancy within 1 month after discontinuation of therapy, but after this time there is absolutely no risk for you and the unborn child.
Acne treatment in women -
Oral contraceptives can be used as a supplement to the main treatment in adolescent girls and women. First of all, this method of treatment is recommended for healthy women who also need contraception. Also, hormonal contraceptives are prescribed for those women whose traditional acne treatment methods (described above) do not give a good result.
In addition to oral contraceptives, women can also use androgen blockers, such as Spironolactone. Read more about these treatments. here.
Acne - home treatment
So, we have already said that the correct treatment of acne requires at least a primary consultation of a dermatologist in order for the doctor to select the right drugs for you taking into account your type of acne. Using this information, you can easily be treated at home. Home treatment for acne on the face covers not only the basic therapy, which is described in detail above, but ...
- Daily skin care -
use only mild detergents that do not cause irritation (for example, Neutrogena or Dove).
- Skin treatment with topical preparations -
treatment with drugs with benzoyl peroxide, azelaic acid or gel with an antibiotic is carried out 2 times a day. Skin treatment with local retinoids - only 1 time per day. Everything will depend on what your doctor prescribes: it can be 1 drug or a combination of 2 drugs.
- What forms of drugs is better to use -
Remember that for dry skin forms of preparations in the form of creams are more suitable, for oily skin - in the form of gels. Lotions are suitable for all skin types (but they still have a slight drying effect).
- If you use cosmetics -
Cosmetics and skin care products often lead to clogged pores and the formation of acne - due to the fact that such products are created on a fat basis. It is necessary to use only light moisturizing creams and makeup, made exclusively on a water basis!
Procedures to reduce acne scars -
For those patients who have acne gone, but left them with permanent scars on the skin of the face - there are several treatment options. They may include both surgical and conservative procedures. The methods described below are effective precisely against atrophic scars (Fig. 21). Methods to get rid of red spots after acne - will be significantly different.
1. Professional and home chemical peelings -
With this method, the skin of the face is treated with acidic products. Depending on how significant results need to be achieved, various concentrations of acids are used. Small concentrations can dissolve the uppermost surface layer of the skin, consisting of dead skin cells, which allows to minimize surface scars. A large concentration of acids can deal with significant cicatricial changes in the skin.
Chemical peels can be -
→ professional medium / deep peeling,
→ surface chemical home peels.
The first allows you to smooth deep enough atrophic scars after acne, the second will help reduce only small depressions.
2. Grinding leather with abrasives -
There are several methods for abrasive grinding of the skin:
- Microderma method -
in this case, the skin surface is treated with a stream of air containing abrasive crystals. As a result, the most superficial dead skin layer is removed.
- Dermatological method -
is a more radical method of removing significant scars and scars. Grinding of the skin occurs here using abrasive discs and brushes, to a much greater depth than with microdermatics.
3. Skin polishing with lasers -
This is one of the most effective methods to help either get rid of scars completely, or significantly reduce them. Laser exposure will stimulate collagen synthesis and skin renewal. With this pathology, only two types of lasers will be particularly effective.
→ fractional lasers (especially Fraxel Restore),
→ CO2 lasers (carbon dioxide).
How long is the result after treatment?
After you have cleared acne, blackheads and blemishes - acne can swell up again if you completely stop the treatment. To prevent this from happening, remember about the need for maintenance therapy. It is necessary for all, without exception, if you certainly want acne gone forever.
The duration of treatment in adolescents can reach 4-5 years, until the adolescence period ends (the age is over 20 years old). In a small number of cases, acne can persist up to 30 years, in which case you will have to regularly use maintenance therapy.
Supportive treatment, as a rule, consists in the use of topical agents:
- daily facial care with mild detergents,
- use of azelaic acid or retinoids.
The frequency of their use as a prophylactic measure will naturally be lower than during acne treatment. For example, a single skin treatment every 2 days should be enough to avoid the return of acne and blemishes. But the use of antibiotics for maintenance therapy is unacceptable.
We hope that our article on the topic: Treatment of Acne - proved to be useful to you!
Author: editors of the portal.