Acne. Etiopathogenesis. Epidemiology and classification. Therapeutic and diagnostic and preventive measures.
Facial acne rash, also known as acne is a chronic inflammatory disease of the sebaceous glands, resulting from clogging of them, which leads to increased production of sebum. The disease recorded in the ICD-10 code for a register L70 and refers to the unit of diseases layers of the skin and to the class of diseases of the skin and subcutaneous fat.
Since antiquity Greek and Roman physicians have learned to recognize the symptoms of the disease and treated it. Therapeutic and diagnostic activities carried out in acne are described in scientific works of doctors as Aristotle, Hippocrates, and Aetius Etius. The emergence of “acne” like term in modern medical terminology associated with the name Etiusa (5th century BC), as well as name of the Byzantine physician Aetius. The etymology of the term comes from the word «acne» (pimples). However, there is an erroneous interpretation, according to which, “acne” translated as “the climax”.
Manifestation of the disease in adolescence can be for the year before menarche. Among those exposed to acne at the age till 20 years, dominated by women – 40%. The course of the disease in puberty on average 4-5 years. However, in clinical practice, reported cases of the disease lasting up to 50 years. It is worth noting that African Americans and Asians are less susceptible to this disease than other ethnic groups. The appearance of acne is also hereditary nature. Experts from the International Cochrane (TCC) suggest that the disease is characterized by polygenic inheritance, and polymorphism duplications GGN & CAG androgen receptor gene.
In the development of acne, as described above, genetic factors play important role. Transmission of the disease occurs in an autosomal dominant manner. However, in addition to heredity in clinical practice, secrete a number of reasons contributing factors that can lead to acne.
- Hormonal status and presence of hormonal problems (puberty, menstruation, hormonal disruptions – increase the level of testosterone, dihydrotestosterone, and insulin-like growth factor 1).
- Acne mite (demodex folliculorum)
- Exposure to stress (increase level of adrenal gland activity).
- Infectious agents (bacterias).
- The use of anabolic steroids in sport (subject to the athletes and bodybuilders).
- Skin lesions, accompanied by infection and inflammation of the skin.
- Overactive work of sebaceous glands.
- The use of chlorine and chlorine-containing solutions.
- Chemical elements such as fluorine, bromine, iodine and lithium.
Development Mechanism of acne rather complicated. In the current medical literature there are 4 acne development mechanism:
- Abnormal follicular hyperkeratosis.
- Seborrhea (increased secretion of the sebaceous glands)
- proprionibacterium (bacteria)
Classification of acne.
To date, there are a number of classifications, which are successfully implemented in medical practice and are widely used in clinical practice.
Thus, the classification is performed: On the severity, Ethiopathogenesis basis and clinical picture,
Classification of acne on the clinical picture (Kligman A. and G. Plevig – 1994):
- Newborn Acne (a. neonatorum, as the name occurs in newborns)
- Baby Acne (a infantum. Conglobata acne).
- Adult Acne (a adultorum, shapes: Tropical, postmenopausal, premenstrual, hyperandrogenism in women, hyperandrogenism men, bodybuilders, doping acne, men with XYY polysomes et al.).
- Youth acne (a juvenilis, shapes: Comedonic, Pustular, conglobata, inverse, mechanical, etc.).
- Contact acne, when you use some chemicals (a. Verenata, lipstick induced hair, different makeup chlorine and bleach, various oils, resin and tar).
- Comedonic acne are result of physical effects of exogenous factors (shape – a aestivalis, solar acne, comedones as well as due to x-rays.).
Classification on the basis of the Ethiopathogenesis of acne (Kotova NV and Suvorova KN):
- Idiopathic acne (a. Neonatorum, a. juvenile (teenager), premenstrual, postmenopausal, hyperandrogenism in women, in men with XYY chromosomes polysomes, and Klinefelter’s syndrome).
- Induced acne (related to exogenous factors, cosmetics, oils and various others).
- Special forms of acne (facial pyoderma, resistant form of acne, gram-negative folliculitis).
Classification of acne on severity (A. Kligman and Plevig – 2004):
- Comedones form of an acne: the number of comedones – less than 20, the number of papules – less than 10, the size of papules smaller than 1 cm, also no nodules and cysts, no any inflammation and there is no scarring on the skin.
- Papules-pustular form of an acne: the number of comedones – more than 20, the number of papules – 10 – 20, the size of papules smaller than 1 cm, less than 10 knots and no cysts.
- Nodal (average) form of acne: number of comedones – more than 20, the number of papules – more than 20, size of papules smaller than 1 cm, there are 10 – 20 knots and cysts, inflammation is strong expressed, there are scars.
- Conglobata (severe) form of acne: number of comedones – a lot of, number of papules – much less than comedones, size of papules 1cm, more than 20 knots and cysts, also intense and deep inflammation on the skin, there are scars.
The clinical manifestations of the disease is characterized by polymorphism of acne elements. Thus, with seborrheic dermatitis on the skin can appear open and closed comedones. Depending on the severity of the inflammatory process, part of comedones turns into pustules and papules.
So, what is this – open and closed comedones?
Open comedones, also known as black heads or black dots, are formed as a result of the blockage of the hair follicles of horny masses. Thus, black points are blocked the outlet of the hair follicle by its epithelium like a cork from champagne. The black color of comedones heads gives substance melanin, which in turn is a product of tyrosine oxidation.
Closed comedones, also known as white heads, is a cyst with a diameter up to 2 mm. White heads often can be the cause of inflamed papules and pustular rash.
MoH have developed clinical guidelines for screening and diagnosis of patients with acne.
The list of diagnostic measures include:
- Medical history (history of the disease, family history), and the identification of concomitant diseases, that contributing to the development of acne.
- Laboratory diagnostic methods: Hormonal analysis (FSH, LH, 17-SCE, cortisol, estradiol, progesterone, etc.), Blood chemistry (alkaline phosphatase, creatinine, bilirubin, etc.).
- Instrumental methods of diagnostics: ultrasound examination of the adrenal glands, pelvic, testicular, prostate, and R-graphy of the skull (for exclude Sheehan’s syndrome).
The symptoms of acne can simulate a number of diseases, which should be considered in the differential diagnosis. It is necessary to take into account factors such as age, gender, genetic factors, etc. Differential diagnosis of neonatal acne is conducted with such a disease as hyperplasia of the sebaceous glands, which occurs in about 50% of cases in healthy children and also prickly heat, that occurs in the first days of life. Differentiation is performed with comedones acne and with very similar to the eruption of acne (occupational acne, “pomade acne” and contact acne). The differential diagnosis of acne is also conducted with such a diseases as: trihoepitelioma, trihodiskoma fibrofollikuloma (Birt–Hogg–Dubé syndrome). This diseases associated with genetic factors and have non-inflammatory etiology.
Acne rosaceous is differentiated too. The presence of rosaceous acne may indicate the detection in patient teleangioektaziya, erythema and papules. Blackheads (closed comedones) are differentiated with the Favre-Racouchot syndrome, and with a dilated pores of Winer. Whiteheads are differentiated with colloidal milliumami, vellus cysts and cutaneous osteoma.
Treatment measures for acne should be complex. Must be using medicines of following pharmacological groups: anti-bacterial, anti-inflammatory and medicines that reduce the activity of sebaceous glands. Also, to get rid of blackheads apply such treatments as chemical peels, plucked massage, cryotherapy and laser therapy. Don’t delete acne in home, because it is fraught with the appearance of traces of acne – scars, blemishes and bruises. Today at the pharmacological industry there is a huge number of creams, ointments and other medicines that contribute to acne cures. Among the ointment is worth mentioning drugs such as Differin gel, Vishnevsky ointment, ointment ihtiolovaya, Baziron gel.
To prevent the development of diseases, first of all necessary to ensure a thorough skin care. It is necessary to exclude the use of various oils, fatty creams which contain vaseline and lanolin. When buying cosmetics, should pay attention to the marking «non-comedogenic». Also it is necessary to refrain from buying cheap cosmetics with questionable quality.