acne

• definition
• Epidemiology
• history
• prophylaxis
• forecast

definition

Acne is generally understood to be the medical condition of the "Acne vulgaris". This skin disorder actually affects the sebum glands and hair follicles. These initially develop non-inflammatory comedones and, as the disease progresses, a number of inflammatory skin symptoms such as lumps, pustules and papules.

Epidemiology

Acne (Acne vulgaris) is the most common skin disease. Almost everyone is affected by it, with the disease usually beginning around the age of 12 and resolving on its own at the end of puberty. However, the disease can drag on until the age of 30. About a third of the cases have to be treated with medication.

The gender distribution is almost the same, but acne in boys is usually more severe. The increasing intake of the “pill” by women also plays a role here, as this is the Acne vulgaris often positively influenced. A genetic predisposition for this skin disorder is being discussed, since severe forms have been described in familial accumulation.

history

Acne was already known in ancient times. The origin of the name is not clear.

Causes of acne

Is caused Acne vulgaris due to the simultaneous occurrence of different parameters:

• Increase in sebum flow = Seborrhea
• Follicular hyperkeratosis = increased formation of cells at the base of the hair follicle and, as a result, cornification disorder
• Multiplication of germs (Corynebacterium acnes and granulosum) in the hair follicles and subsequent inflammation
• Influence of androgens

Acne begins with changes in the sebum glands. Stimulated by the sex hormones androgens and progesterone, which are increasingly formed during puberty (androgens) and in women premenstrually (progesterone), the glands enlarge and produce more sebum.

In addition, the inside of the hair follicle becomes horny, which is known as follicular hyperkeratosis. As a result, the follicle is enlarged from the inside by this keratinization and also “clogged” so that the sebum that is formed accumulates and a comedo (“blackhead”, sebum-filled cyst of the skin) is created. What exactly causes this hyperkeratosis is unknown.

Next comes a multiplication of certain bacteria (Corynebacterium acnes and granulosum). Physiologically, these exist in the hair follicles and break down the sebum. The increased number creates more decomposition products, which then cause inflammation of the comedones.

Read more on the subject at: Inflammation of the sebum - this must be observed!

Acne symptoms

Symptoms are limited to the skin; especially the face but also the chest and back are affected.

Acne goes through different stages of appearance:

• Non-inflammatory stage = acne comedonica
• Inflammatory stages:
• Papulopustular acne
• Acne nodulocystica / vulgaris conglobata
• Defect stage as a colorful image plus scars

Acne is the first to appear as "acne comedonica". This means the occurrence of "Comedones “, Which develop mainly on the chin, nose and forehead. A distinction is made between black (= open) and white (= closed), which usually coexist. The white comedones, however, become inflamed more frequently and are thus in the next stage, namely "acne papulopustulosa". This is characterized by inflammation, in the course of which pustules ("pimples" filled with pus) form. This form is then called folliculitis. After healing, scars remain, but they are generally not very noticeable.

If there is not healing but progression, an "acne nodulocystica" / "acne vulgaris conglobata" occurs. The spontaneous bursting or squeezing of the pustules causes infiltrates and abscesses (melting of tissue with the formation of pus), which can form a coherent system with several outlets ("fistulas") under the skin surface.

The most severe form of acne and thus the last stage combines all of the aforementioned skin changes. There are also very noticeable scars, so-called "acnekeloid". Popularly this is also referred to as "pockmarked".

Furthermore, as complications of acne, superinfection with other bacteria can occur (Staphylococci, Enterobacteria, Klebsiella, Proteus).

There are special forms or diseases that are similar in appearance:

• Acne cosmetica (caused by cosmetic items, especially in women over 20)
• Late acne (persistent acne in adult women due to increased androgen levels)
• Acne excoriée des jeunes filles (psychogenic influence)
• Acne tropica (severe acne vulgaris due to superinfection with staphylococci) Acne neonatorum (in newborns, probably due to androgens from the mother)
• Drug-induced acne (e.g. caused by corticosteroids, isoniazid, iodine, bromine)
• Acne fulminans (severe, acute onset acne with fever, joint and organ problems)

diagnosis

The diagnosis of Acne vulgaris is established clinically, i.e. based on the visible Skin changes. There may be different degrees of severity Pocchi can be determined, which among other things depend on the number of comedones, pustules, infiltrates, cysts, fistulas and scar. The classification is made into mild, moderate, severe and very severe acne. Are you interested in Diagnosis?

Acne on the back

Acne is particularly difficult to treat on the back because the affected ones Places difficult to reach are and the Skin mostly affected over a large area is. In the case of acne in particular, the back is often involved and so the pustules and nodules of acne often develop on the back of men.

• causes

Really, the causes and factors of acne on the back are no different from the causes and factors of acne on the face and other parts of the body. The Skin glands are overly active and produce too much sebumso that it becomes a Clogging of pores in which the natural bacteria of the human skin multiply excessively and cause inflammation.
However, some factors favor the development of acne on the back: This includes tight, synthetic clothingthrough which no or little oxygen to the skin can come.

• treatment

The treatment of pimples on the back is the same as for acne on other areas of the skin.

However, if the acne is more severe, treatment is with Benzoyl peroxide and Moisturizer more helpful.
In extreme acne stages, a systemic drug therapy become necessary. This must be discussed individually with the attending physician, as medical Aoptheken prescriptions are necessary for these agents, because the medication (e.g. Roaccutane, isotretinoin, Aknenormin) can cause serious side effects.

The therapy of acne

There are several therapeutic options:

• Lysis of the comedones
• Antibacterial therapy
• Decrease in sebum synthesis

Lysis is the most important therapeutic measure and is used in acne comedonica and papulopustulosa.

It is done using vitamin A acid / trans-retinoic acid, which is dabbed on the acne and dissolves the keratinization. This removes the sebum and prevents the formation of new comedones. However, it only takes effect after about three weeks and the therapy must be carried out until there is no longer any tendency to acne. This can drag on for years.

In the case of more severe inflammatory forms of papulopustular acne, antibacterial treatment is also carried out, either locally with antibiotics (Erythromycin, Clindamycin), Benzoyl peroxide or, if abscesses occur, systemically with the antibiotic tetracycline.

Another option for acne nodulocystica can be the production of sebum with the help of Isoretinoin / Cis retinoic acid blocked. In women, such a blockage can also be done with the antiandrogen Cyproterone acetate be initiated.

Both the active ingredient erythromycin and isoretinoin are available in the Aknefug drug group for the treatment of acne.

Finally, the most severe forms of acne can be treated with dapsone, a chemotherapy drug.

The complicating superinfections of acne are treated with antibiotics depending on the causative germ.

Frequently used, but not or only weakly effective measures are:

• special diets
• Peels
• Cleansing / disinfecting the skin
  or
• Use of UV light.

Homeopathic medicines can also have a positive effect on acne vulgaris. However, the skin and appearance must be carefully considered.
Read more about homeopathy and acne in our topic: Homeopathy for acne

There is also the option of mesotherapy.

Read more on the topic: Medicines for skin diseases.

Home remedies can also be used for acne. Further information on the topic can be found here:

• Home remedies for acne
• Home remedies for pimples
• Apple cider vinegar for acne

Acne medication

Treating acne with medication involves high levels Side effects and related Risksso that the attending physician must carefully consider whether external treatment of the acne may not be sufficient.
The most well-known active ingredients of acne medication are listed below:

• Erythromycin
• Doxycycline
• Isoretinoin
• Ethinylestradiol + dienogest
• Minocycline
• Adapalene
• Tetracycline
• Framycetin
• Tretinoin
• Ethinylestradiol + chlormadinone
• Estradiol
• Estradiol + Prednisolone
• Sodium bituminosulfonate + Chloramphenicol

Acne Diet

The ones in the Animal milk contains hormones, and bioactive molecules are according to the latest research (including Nurses Health Study II) responsible for a variety of skin problems and severe teenage acne. Of the Consumption of milk, skimmed milk, quark and cream cheese thus leads to the known skin problems. The study results were confirmed by associated studies.

Further studies in population groups that are not affected by acne (e.g. Papua New Guinea) clearly show that there is a lack of milk consumption and the consumption of carbohydrates with a high glycemic index. This glycemic index is a measure of the influence on blood sugar levels: A high glycemic index stands for a sharp rise in blood sugar levels.

The substances contained in cow's milk are naturally intended for the rearing of calves and should ensure that they grow quickly. If a person ingests these substances by consuming dairy products, there is an increase in IGF-1, one Messenger substance, who, if significantly increased, have insulin resistance and acne can cause.

By healthy, natural diet acne can be largely prevented:

To avoid are for it:

• Milk, whey, whey protein concentrates (protein power drinks), yogurt, cheese
• Cocoa, candy, chocolate, sugar
• Carbohydrates with a high glycemic index (french fries, white flour products)
• alcohol
• Nicotine / smoking

Well suited for a healthy lifestyle, however, are:

• Soy products
• Green tea
• vegetables
• regular exercise (exercise and a healthy weight)

Cream to treat acne

The market for cosmetics for the treatment of acne is quite large according to the demand and almost every cosmetic company has an extra line for blemished skin.
There are various creams, gels, washing lotions and facial serums that promise pure and radiant skin.

The really effective creams for severe acne usually contain at least one of the following four ingredients.

Antibiotics

Antibiotics such as tetracycline, clindamycin and erytromycin are to be used locally on the skin in the form of ointments. They reduce inflammation as the acne bacteria (Propionibacterium acnes) is braked.
In order to maintain a lasting effect and to prevent the development of resistance, it is advisable to use other preparations that also contain 5% benzoyl peroxide in parallel to the topical application of antibiotics. In addition, care must be taken that the application time of 8-12 weeks is not exceeded, since after this time the effectiveness on the bacteria is canceled.
A cream or ointment that contains antibiotics is only available from a pharmacy with a prescription.
Pregnant and nursing mothers should urgently refrain from using antibiotics.

2) Azelaic acid

Azelaic acid works positive for acne in three ways

1. comedolytic (skin impurities are loosened, pimples subside)
2. antimicrobial (kills bacteria)
3. anti-inflammatory

Also use creams and ointments Azelaic acid are only available with a prescription from the pharmacy and in contrast to antibiotics better tolerated and thus also compatible with pregnancy and breastfeeding.

3) benzoyl peroxide (BPO)

Benzoyl peroxide works antibacterialsince he is the membrane of the Acne bacteria (Propionibacteria) destroyed. In this way, the infection of the skin with the bacteria is reduced and the bacteria nevertheless do not form any resistance to the agent, as is the case with antibiotics.
BPO is used in Anoint and Creams in a concentration of 3 - 10 % applied.
Possible Contraindication for the application of BPO is one allergy against this active ingredient. As a side effect of using it, there may be a Dehydration of the skin come that with Sense of tension, peeling and redness can go hand in hand. In this case, the concentration of BPO in the product should be reduced and / or the product should be used less frequently.

Ointments and creams containing benzoyl peroxide are also freely available without a prescription and can be used in combination with antibiotics and retinoids.

4) retinoids

Tretinoin, isotretinoin and adapalene belong to the group of retinoids and are chemically produced active ingredients against acne that work with the Vitamin A are related.
They influence the growth and maturation of cells and they have an anti-inflammatory and comedolytic effect. This opens and breaks pimples.
Often occur as side effects local skin reactions such as redness, burning sensation and flaking so that accompanying skin care is recommended.
In addition, it is important to know that the use of retinoids makes the skin sensitive to light, and it does UV radiation to pigment disorders and sun allergy can come. From this it follows that under therapy with retinoids excessive sun exposure must be avoided and a strong sun protection factor must be used.

Retinoids are suspected of entering the metabolism too depressions and mental syndromes like Anxiety and panic disorders respectively.
Retinoids are only available with a prescription in pharmacies and absolutely not indicated for pregnancy and breastfeeding!

Therapy-accompanying care

Most cosmetic products for blemished skin and acne dry out the skin severely and lead to a feeling of tension, redness and flaking. For this reason, an accompanying moisturizer is recommended in order to alleviate the irritation of the skin as far as possible.

In accordance with the original interests, this additional care should not cause pimples (comedogenic) Contain ingredients.

For more detailed information on this topic, see: Pus pimples on the face - how do I get rid of them quickly?

rehabilitation

Rehabilitation is usually not necessary as the acne is self-limiting. A treatment of remaining cosmetically disturbing scars can, however, take place.

prophylaxis

There is no prophylaxis for acne, treatment is only given when it occurs Skin changes.

forecast

The prognosis for acne is good as it usually resolves on its own between the ages of 20 and 25. However, the most severe courses can leave noticeable scars.
A scar ointment such as Contractubex® is suitable for treating acne scars.
Here you can find more information on: The best way to remove acne scars