Acne
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Acne (lat. acne vulgaris)
is the most common disease of smear glands, located most on face and back, that´s why acne affects mainly the skin of face, back and chest. Acne is found among all races, both sexes, it arises since the early adolescence and it is supposed to affect almost 100% of the population at this age. Moderate forms of acne last about 4-5 years whereas more complicated ones can last far longer.
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The main cause of acne is still unknown, acne is perceived as a disease caused by more factors, especially:
- a disorder of bulb cornifying (it shows on skin by a rise of a so-called comeda),
- a smear gland dilatation and a greater smear production (the smear itself is comedogene, it causes an inflammation after being prickled in the skin, the patients have also a lower linoleic-acid level),
- a presence of bacteria (Propionibacterium acnes and P. granulosum, which produce fatty acids that cause the inflammation) and Pityrosporon ovale yeast fungi,
- male sexual hormones (androgens regulate the smear gland development and the smear production, they are supposed to influence the cornification, etc.). In the case of some of those who suffer from acne, a higher androgen or dihydroepiandrosteron level, mainly at those who suffer from complicated acne forms or endocrine syndroms, but most diseased have normal androgen levels. Furthermore, a higher activity of 5-alpha-reductasis, changing testosteron into dihydrotestosteron, is also typical of acne. A hyperandrogynous condition corresponds clinically to a grave form of acne that began abruptly, a hirsutism, regularity disorders of menstrual cycle, patients have a low voice and a high libido, an androgynous alopecy, obesity and other disorders.
A clinical count of acne includes both its inflammatory and non-inflammatory manifestations. Non-inflammatory lesions are comedons (open – black and close – white). Papulae, pustulae and nodulae rank among inflammatory efflorescences. A deep inflammation can make either an atrophic or a hypertrophic or even a keloid scar. The clinical count is so typical that a diagnosis requires hardly any auxiliary examination. Nevertheless, a cultivation of P. acnes and designation of its sensitivness to antibiotics, can help to cure grave acne forms.
In a laboratory examination we can find either normal or higher androgen level. A women´s blood-letting should be done two weeks before menstruation or peroral contraception should be laid off a month before.
Acne cure
An acne cure is always complex, individual and expected to influence all sorts of processes that could contribute to the acne rise. The aim of the acne cure is to modify the cornification and to decrease the smear production, the number of bacteria and the inflammation.
- Skin cleaning – a regular washing with warm water and anti-bacterial soaps as well as a mechanical peeling are recommended.
- Lokal cure - A-vitamin derivates in 0,025% (third generation retinoids – adapalen, 0,1% or tazaroten 0,1%), benzoyl peroxide 2,5%, 5%, 10%, erythromycine, tetracycline and clindamycine, azelainic acid 20%.
- Physical cure – cryoterapy, ultraviolet light (e. g. EXCILITE).
- Surgical cure – it is used for grave acne forms, when e. g. cysts or protuberances are treated or corticosteroides are injected.
- An overall cure is used for medium and grave acne forms:
- antibiotics (mainly tetracyclines – doxycycline, monocycline, also macrolides and trimethoprim) decrease the fatty-accid concentration, they are used for medium acne forms. In a cure of grave acne forms, they are possible to combine with hormonal therapy and local retinoide.
- a hormonal therapy is to influence the smear production. The hormonal therapy is successful mainly with the acne form which depends on hormone level. It is also recommended for inflammatory acne manifestations localized in the lower part of the face.
- isotretionoine is recomended to cure for grave acne forms, scar-prone acne or moderate acne forms that do not react to normal cure. Isotretionoine is teratogene, therefore an efficient contraception as well as clinical and laboratory check-ups belong to the therapy.
Because all those medicaments are available in the Czech Republic, it is very important to begin the therapy very early to prevent irreversible skin changes. Acne ranks among those diseases which deteriorate the quality of human life, moreover in the time of adolescence, when young people look for their place in the society, for work, for partners. A dermatologist´s aid can be very important.
Prof. MUDr. Jana Hercogová, CSc.