Problematic skin in a teenager: recommendations for parents

Table of contents

1. Etiology and pathogenesis
2. Clinical manifestations
3. Principles of treatment

Acne (pimples, acne vulgaris, acne, comedones, acne vulgaris) is a chronic inflammatory skin disease that manifests itself as open or closed comedones and inflammatory lesions (papules, pustules, nodules).

In our company you can purchase the following equipment for acne treatment:

• M22 (Lumenis)
• Thermage (Solta Medical)

Today, acne, without exaggeration, can be called the most common skin disease among young people - according to statistics, up to 95% of boys and up to 83% of girls suffer from it. Approximately 60% of them have a mild form with a small number of rashes (so-called physiological acne). If acne occurs in adolescence, in 64% of adults, acne persists at the age of 20–30 years, in 43% at 30–40 years, in 15% at 40–50 years (more often in women).

How to cure hormonal acne

Chronic inflamed acne on the face due to hormonal imbalance is treated exclusively in an inpatient or outpatient setting based on a confirmed diagnosis. The doctor prescribes hormonal therapy according to a special regimen, prescribes a diet and gives recommendations for mechanical cleaning and treatment of the affected areas of the epidermis. Treatment of identified gynecological ailments and vitamin therapy are mandatory. All stages of complex treatment, used together, and under the strict supervision of a dermatologist and gynecologist, will allow a woman to get rid of a serious problem and live enjoying clear facial skin.

Etiology and pathogenesis

The main sex hormones that regulate the activity of the sebaceous glands are androgens . They affect the development and increase in the size of the sebaceous glands in androgen-dependent areas of the skin, the hyperproduction of sebum and the proliferation of keratinocytes in the ducts of the sebaceous glands, the hair canal and the mouths of the pilosebaceous follicles.

According to the inflammatory concept of acne, the chain of pathogenetic events begins with androgen-induced inflammation of the sebaceous gland . This causes proliferation and active desquamation of keratinocytes in the upper part of the pilosebaceous follicles. Progressive hyperkeratosis and the associated difficulty in the outflow of sebum lead to the formation of comedones , which subsequently transform into papules and pustules or spontaneously regress.

Overproduction of sebum contributes to changes in its qualitative composition. In sebum, the concentration of linoleic acid decreases, which suppresses the expression of transglutaminase and is involved in the synthesis of the main components of the intercellular matrix. This leads to an increase in the pH of sebum and a change in the permeability of the walls of the follicles and the stratum corneum of the epidermis.

Sebum stagnation creates anaerobic conditions that are optimal for the proliferation of propionibacterium acnes in the pilosebaceous follicles. They secrete substances that damage the walls of ducts and glands, as well as factors that attract neutrophils.

The release of lysosomal enzymes by neutrophils further reduces the strength of the follicle wall, which ultimately leads to their rupture. The contents enter the dermis, where local inflammation develops according to the “foreign body reaction” type.

Exogenous factors contributing to the development of acne:

• taking sex hormones, anabolic steroids ( Fig. 1 );
• high glycemic index diet;
• smoking;
• whole milk;
• fast food;
• chocolate;
• various occupational hazards;
• hot and humid climate.

Rice. 1. Acne on the shoulder and back of an athlete due to the use of anabolic steroids (Danish national service on dermato-venereology)

https://www.danderm-pdv.is.kkh.dk/atlas/4-120-9.html

Consequences of acne

Acne can cause more than just rashes. Some people believe that acne is a skin condition that eventually outgrows, but it can have a profound and lasting impact on one's life. Many people experience one or more of the following after acne appears.

Acne scars: When the breakout goes away, it leaves behind a permanent scar. Some scars cause indentations in the skin. The rest are gradually disappearing. It's impossible to predict who will develop scars after their acne goes away, but the following factors increase your risk:

• acne has been present for a long time because the teenager does not treat it or the treatment does not work;
• One or more close blood relatives have had acne in the family.

Dark spots on the skin: As acne breakouts fade, some people see the area where acne once was. This completely flat spot can be pink, red, purple, black or brown, and is often mistaken for a permanent acne scar. Source: Modern Treatments and Rehabilitation of Acne Vulgaris. Barinova A.N. Russian family doctor, 2022. p. 5-18.

Clinical manifestations

The general picture of acne is characterized by polymorphism ( Fig. 2 ). The evolution of acne elements is as follows:

Clinical forms of acne:

• Prepubertal acne
• Juvenile acne
• Late acne
• Indurative acne
• Acne conglobata

Prepubertal (pre-adolescent) acne - occurs at the age of 7-12 years and is caused by the onset of puberty. There is an increase in skin oiliness and a large number of comedones, mainly on the forehead and in the central part of the face (T-zone).

Juvenile (ordinary, vulgar) acne is the most common type of acne. They are open and closed comedones, papules and pustules located on the forehead, nose, cheeks, temples, often on the chest and back. In girls, 5–7 days before the onset of menstruation, the rashes become more numerous.

Late-onset acne (adult acne) occurs more often in women. There are relatively few rashes - unlike youthful ones, they are located in the lower part of the face (on the cheeks, chin, around the mouth) and on the neck. Almost half of patients have a rash on their body. Papules exist for a long time (1–3 weeks), are painful, there are usually few or no comedones, exacerbations are associated with stress. Late acne also includes postmenopausal with the predominant formation of comedones and the absence of pronounced inflammation.

Indurative acne is characterized by an active inflammatory reaction and a predominance of deep-lying, dense, painful nodes that merge with each other. Subsequently, they heal through scars ( Fig. 3 ).

Acne conglobata - it affects mainly men with very oily skin. With age, there is a tendency to recovery, but outbreaks of the disease occur from time to time. The main morphological element is a large red painful hemispherical node. At first it is dense, but later softens. The nodes can merge and turn into abscesses, after opening which remain long-term non-healing ulcers and fistulas that heal with rough scars. Sometimes, when nodes merge, draining sinuses are formed. The disease is almost never limited to the skin of the face - on the contrary, the largest nodes are usually located on the chest and back.

To assess the severity of acne in clinical practice, it is convenient to use the recommendations of G. Plewig and M. Kligman ( Table 1 ).

Table 1. Determination of acne severity according to G. Plewig and M. Kligman (2004)

A separate form of the disease is medicinal acne, which occurs while taking certain medications - these are glucocorticosteroids, anabolic steroids, androgens, thyroxine, antiepileptic drugs, barbiturates, anti-tuberculosis drugs, azathioprine, cyclosporine A, lithium salts, iodine, chlorine, bromine preparations, cetuximab , some vitamins (for example, group B).

Rice . 2. Polymorphism of acne elements on the patient’s cheek (Danish national service on dermato-venereology)

https://www.danderm-pdv.is.kkh.dk/atlas/4-102-4.html

Rice. 3. Scars on the face that appear after healing of large inflammatory elements of acne (Danish national service on dermato-venereology)

https://www.danderm-pdv.is.kkh.dk/atlas/4-133.html

Diagnostics

If your teen has acne, a dermatologist can diagnose acne by looking at the breakouts. During your appointment, your dermatologist will also note what types of acne they are and where the breakouts appear on the skin. This will help your dermatologist create an effective treatment plan. Sometimes what looks like pimples is another problem. For example, some people mistake hidradenitis suppurativa, also called acneinversa, for everyday acne. Treatment for this condition is different from that for acne. Another disease that can be mistaken for acne is perioral dermatitis. This often causes rashes that look like pimples around the mouth. Whether your teen has stubborn acne or another condition, a dermatologist can accurately diagnose acne vulgaris and create a treatment plan tailored to your teen's needs.

Principles of treatment

A carefully collected anamnesis will allow the specialist to understand what tactics should be used in the treatment of acne in a particular patient.

Among the general recommendations, it is worth mentioning the possibilities of diet . You should eat more vegetables, avoid fast food, whole milk and casein-containing products, chocolate, saturated fats, trans fats, easily digestible carbohydrates, foods with a high glycemic index, and also eat regularly and properly, and monitor your weight.

A basic acne control strategy involves the following steps:

• Cleansing - you can use emulsions, solutions and foams that have a neutral pH (5.5–7.0). It is important that they do not contain anionic surfactants (surfactants) that increase alkalization of the stratum corneum of the epidermis. The fact is that this leads to its swelling, maceration and increased blockage of the mouths of the pilosebaceous follicles.
• Exfoliation - its purpose is to smooth the surface of the skin, free the mouths of the sebaceous hair follicles from accumulated secretions, exfoliate corneocytes and restore the normal outflow of sebum. This procedure should not be overused, since aggressive exfoliation leads to damage to the epidermal barrier, which is clinically expressed by redness, irritation, peeling and increased sensitivity of the skin.
• Skin nutrition - active ingredients may include: vitamin D, vitamin B2, vitamin C, genistein, daidzein, kigelia, tea tree oil, papaya, various prebiotics, formononetin, equol, apricot extract, basil extract, cornflower extract, chondrius algae extract Crispus, ginkgo biloba extract, etc.
• Sun protection is very important, since ultraviolet and infrared rays activate sebum production and reduce local immunity in the skin, which often leads to exacerbation of acne after sun exposure.

Avocutin (butyl avocadate) was biotechnologically isolated from avocado oil , a fatty acid ester that can suppress the synthesis of 5-alphareductase, an excess of which is present in the skin of people with acne. It has been established that as a result of using a product containing 3% avocutin, the oiliness of the skin of the face and scalp is reduced by a third in the first two weeks of use.

A fairly universal cosmetic ingredient that will also be useful for acne is bitter aloe extract (Aloe Ferox Extract). It destroys and blocks the activity of many pathological microorganisms - streptococci, staphylococci and propionibacteria.

To treat acne, you can use chemical peels, creams and gels with tretinoin, 20% azelaic acid cream, 10% sulfacetamide lotion, 2.5–10% benzoyl peroxide gels, various antibiotics (erythromycin, clindamycin), as well as injection procedures: PRP therapy (injection of platelet-rich plasma into the skin) or mesotherapy (for example, hyaluronic acid modified with vitamin C, cysteine ​​and glutathione).

Western acne treatment consensus recommends a combination of topical retinoids with topical and systemic antimicrobial therapy. It has been proven that its effectiveness significantly exceeds monotherapy with these drugs, which is due to complementary mechanisms of action aimed at various pathogenetic factors of the disease:

• retinoids (tretinoin) reduce excessive desquamation of the epithelium, exhibit comedolytic and some anti-inflammatory effects;
• local antibiotics (benzoyl peroxide) reduce the number of propionibacteria in acne lesions and have some keratolytic effect;
• systemic antibiotics (doxycycline, minocycline) suppress inflammation and inhibit the proliferation of Propionibacterium acnes.

It is impossible not to mention systemic retinoids - isotretinoin preparations. They are typically used to treat severe and treatment-resistant forms of acne. For some patients, one course of oral isotretinoin is enough to achieve remission of the disease, while others require additional courses. One study found that 38% of patients treated with systemic retinoids had no signs of acne during a 3-year follow-up period, 17% had their disease controlled with topical therapy, 25% required topical and systemic antibiotics, and 20% received a repeat course. isotretinoin. Relapse was more common in young patients and girls. However, it should be remembered that for all its effectiveness, isotretinoin has serious side effects associated with the development of depression and possible suicide of patients.

Hardware treatment of acne can be used in cases where therapy with systemic retinoids is ineffective or contraindicated. There are at least 2 methods of effectively influencing the inflammatory elements of acne:

1. Deep heating of the skin, which leads to normalization of sebum formation and improved cleansing of the mouths of hair follicles. Such heating can be carried out by an IPL system ( M22 ) or an RF device ( Thermage ).
2. Exposure of the anaerobic bacteria Propionibacterium acnes to broadband pulsed light in the blue part of the spectrum in order to induce the formation of free radicals from the uroporphyrin metabolite in these bacteria and their subsequent death. This method is implemented in IPL systems equipped with a special filter ( M 22 IPL , Acne filter with passbands 400–600 nm and 800–1200 nm).

Questions from our users:

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When to see a doctor

Experts recommend not delaying a visit to the doctor if symptoms of inflammation and blockage of the sebaceous glands appear. You should not put up with an unpleasant cosmetic effect or try to cope with it using home methods, at the risk of intensifying the pathological process. Moreover, modern medicine has at its disposal many effective methods of combating the disease, depending on the type and general condition of the skin.

Are you experiencing symptoms of comedones?

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