Acne vulgaris

Vulgar acne (synonyms: common acne, youthful acne, acne) - an inflammatory disease of the sebaceous glands, usually occurring during puberty.

Acne vulgaris is a multifactorial disease, manifested by a violation of keratinization of the hair follicles with perifollicular inflammatory reaction.

Sick girls aged 10-17 years, boys - 14-19 years. The most often severe form affects young men.

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of vulgar acne

The risk group includes persons who often come into contact with lubricating oils, dioxin, oil products. From drugs, the cause of the disease are lithium salts, phenytoin, corticosteroids (including for external use), oral contraceptives. The disease is sometimes inherited polygenically.

In the development of the disease, an important role is played by androgens, bacteria (Papionbacterium acne). Androgens, interacting with sebaceous glands, stimulate the secretion of sebum (the level and composition of androgens at the same time are in physiological limits). Lipase, which contains bacteria, breaks down fats to free fatty acids. Excess sebum and fatty acids cause an inflammatory reaction in the sebaceous glands and hair follicle. As a result, the walls of the follicle become cornified and blocked by sebaceous masses. If the mouth of the follicle is closed or narrowed, white eel (closed comedo) is formed, if open - horny masses move in the mouth of the follicle like a cork and black eel (open comedo) is formed. The black color of the stopper is given by melanin, a product of tyrosine oxidation. Stretched walls of the follicle can break, while its contents (sebum, fats, keratin, free fatty acids) penetrates into the dermis and the inflammatory process begins. So papules, pustules, knots are formed and, when healing, scars.

Increased sebum secretion, insufficient emptying of sebaceous glands and hyperkeratinization of hair follicles are a prerequisite for clogging the mouths of hair follicles with the formation of "black spots" of comedones. Comedones occur both in the liquid and in dense oily seborrhea.

[9], [10], [11], [12], [13], [14], [15], [16]

Pathomorphology

Comedon is a collection of keratinized cells, sebum and microorganisms. The follicular papule is characterized by the presence of a perifollicular infiltrate, consisting primarily of lymphocytes. Small areas of destruction of the wall of the epithelial vagina of the hair follicle can be observed.

Pustules localized within the follicle and containing mostly neutrophilic granulocytes are usually formed after the destruction of its wall, when the contents of the comedon enter the dermis. As a result, a granulomatous reaction develops with the appearance of macrophage elements and giant cells of foreign bodies. Perifollicular infiltrate can turn into a cyst containing a large number of neutrophilic granulocytes, histiocytes and plasmocytes with an admixture of giant cells of foreign bodies. Sometimes the latter closely adjoins the masses of keratin. The infiltrate is then replaced by a fibrous tissue. The epidermis along the edges of the destroyed areas of the hair follicle can grow.

Histogenesis

Attention is given to the increase in activity of the sebaceous glands, primarily due to an increase in the concentration in the blood of androgens and / or a decrease in the level of the androgen-binding protein; level 5 alpha-reductase; changes in microflora, especially the colonization of Cotynebacterium acne follicles, which produce bacterial lipase, which breaks down lipids into fatty acids; increased cornification of the epithelium of the sebaceous-glandular apparatus; secretion of inflammatory cytokines (IL-1, IL-2, IL-6, etc.); hereditary predisposition.

Symptoms of acne vulgaris

The clinical picture is polymorphic; comedones, papules, pustules, superficial and deep, abscessed and merged into continuous infiltrated lesions, sometimes with fistulas, cysts and scarring. The face and other so-called seborrheic sites are affected mainly. The disease develops mainly in adolescents, with age manifestations in most patients disappear completely or remain surface scars, only in relatively rare cases - keloids.

Special variants of common acne are: asné fulminans, observed predominantly in males, acute with fever, arthralgia, pustular ulcer lesions resistant to antibiotics; acne conglobata, which are a variant of chronic pyoderma, clinically manifested as fistulo-abscessed lesions with scarring, located mainly in the region of the shoulder girdle, axillae and buttocks, and in some patients with development of malignant neoplasms in these foci; acne necroticans, characterized by papulonecrotic rashes on the forehead skin, probably developing in persons sensitized to piococci; acne neonatorum in the form of acneiform eruptions, mainly on the cheeks of newborns as a consequence of the hormonal effects of the mother's body.

Eruptions occur without disturbance of the general condition and are more often localized to the skin of the face, chest, back, i.e., seborrheic areas. The clinical picture is manifested in the form of hemispherical knots of pink or pink-red color, the size of a pinhead to a pea (papular acne). Papules quickly transformed into pustules of various sizes, after the resolution of which on the surface formed crumbled yellow crusts. At the site of the resolution of ordinary acne, pigmentation or a superficial scar usually remains. Conglobatic acne is observed when the suppuration begins with deep layers of the skin, and hemispherical fluctuating nodes are formed. A few weeks later, the nodes are opened to form a cavity, from which a purulent yellow-green color is emitted a purulent liquid. After healing on the site of large conglobate blackheads, deep fossils remain.

Sometimes vulgar acne begins with a violation of the general condition of the patient (general weakness, headaches, arthritis, fever). In this case, there are numerous acne and abscessing nodes.

With timely treatment, the prognosis of the disease is favorable, spontaneous regression is observed by 30-35 years.

Differential diagnosis

Ordinary acne should be differentiated from medical ones, which differ from ordinary ones in that they occur in people taking long-term medications (bromine, iodine, corticosteroids, vitamins B6, B12, etc.), folliculitis and perifolliculitis.

[17], [18], [19], [20], [21], [22], [23]

Treatment of vulgar acne

Treatment of vulgar acne depends on the form of the disease. With a mild form, mainly external agents are prescribed - antibiotics (erythromycin ointment, clindomycin sulfate, synthamycin emulsion, helio-mucin ointment), benzyl peroxide, local retinoids (ayrol). With an average form other than the above local drugs are prescribed antibiotics (tetracyclines - doxycycline for 0.1 g 2 times a day for 7-10 days). In severe cases, roacutane is recommended for 0.5-1.0 mg / kg of the patient's weight, which suppresses the function of the sebaceous glands and prevents keratinization. It is advisable to appoint immunomodulators, vitamins, biogenic stimulants, treatment of concomitant diseases.