Simple acne (acne vulgaris) is one of the most frequent dermatological diseases, affecting, acc. to certain data, as much as 15% of the entire population. It is estimated that approximately 85% of the population in the age between 12 and 25 years suffer of acne. In girls, the peak incidence of acne occurs between the 14th and the 17th year of life, while in boys, it is between the 16th and the 19th year of life, however, the first changes are observed much earlier – in children between the 10th and the 12th year of life. Acne may also be seen in adult persons after the 25th year of life and may periodically recur in women.
The mechanism of acne occurrence is multiple and associated with a number of causes, such as:
• the activity of sex hormones
• excessive secretion of sebum (seborrhoea) and its changed composition
• infection with Propionibacterium acnes bacteria
• acneiform keratosis follicularis
• excessive porokeratosis
• obstruction of the hair-sebaceous follicle ostium
• inflammation development around sebaceous follicles
A number of fables are associated with acne. Acne by no means results from inappropriate diet, i.e., excessive consumption of fatty foods, carbohydrates, chocolate or dairy products. Drinking large water volumes will not help in the problem elimination. Contrary to common opinions, exposition to sun radiation is not a good method of treatment – sun tan only masks acne changes a little. Quicker peeling of sunburned skin may partially restore the patency of sebaceous ducts, however, the overall benefits are rather short-term in character.
The mechanism of occurrence of acne changes
Enhanced seborrhoea (sebum secretion), resulting from stimulation of the sebaceous glands (mainly by androgens), and of keratosis disorders in hair follicle ostia lead to their obstruction. In effect, sebum elimination from the glands becomes more and more difficult, causing dilation of the ducts of the sebaceous glands.
The above-mentioned processes lead to the occurrence of micro-blackheads. In the course of increasing dilation of the sebum draining ducts, closed blackheads (white) occur. In result of oxidation of the fats, which are contained in sebum, they become visible as dark spots – open blackheads (black).
In blocked hair follicles, anaerobic conditions develop with accumulation of compact, dense sebum. This environment favours the development of Propionibacterium acnes - commensal bacteria, also included in the normal bacterial flora of the skin also in healthy persons. These anaerobic bacteria decompose sebum via the enzymatic pathway, hydrolysing triglycerides and releasing free fatty acids and chemotactic factors. Free fatty acids are irritating substances which enhance exfoliation processes. The chemotactic factors attract and inform leukocytes about infection occurrence. The leukocytes, in order to neutralise P. acnes bacteria, release hydrolytic enzymes. Unfortunately, these enzymes damage not only the cells of the bacteria abut also the cells of hair follicles, contributing to destruction of walls of the sebaceous glands. This wall destruction may cause wall breaking and leakage of the hair follicle contents on to skin. This results in enhanced inflammation condition, leading to papular and postular eruptions on the skin. When similar changes appear simultaneously in many neighbouring sebaceous glands, a large purulent infiltration develops.
Methods of simple acne treatment
The goals of acne treatment include protection against excessive keratosis, suppression of bacterial growth and seborrhoea reduction. The therapy may be local or systemic. The basic principle of this therapy is as follows: patients with light acne undergo local treatment, patients with moderate symptoms receive oral and local treatment with antibiotics, while persons affected by severe form of acne, receive oral doses of isotretonoids. Combined therapies are often administered, consisting of two or more preparations. The patients have to be aware that the therapy is rather long – lasting several months or several years.
Proper hygiene and care of acneous skin
Skin with susceptibility to acne requires special care. Beside medical recommendations, also very important is the adherence to certain general suggestions, regarding its care. Skin should not be cleaned of blackheads by hand. Blackheads should be removed, using special tools and disinfecting skin after the operation. In the care of skin with susceptibility to acne, proper moisturising is important by application of appropriate moisturising creams or gels. Skin should be cleaned with special washing agents with anti-seborrhoeic and anti-infectious properties, which do not cause irritation. Washing bars or special soaps are recommended for body washing. Dermocosmetics may be used separately or in combination with pharmacological treatment.
The mechanism of acne occurrence is multiple and associated with a number of causes, such as:
• the activity of sex hormones
• excessive secretion of sebum (seborrhoea) and its changed composition
• infection with Propionibacterium acnes bacteria
• acneiform keratosis follicularis
• excessive porokeratosis
• obstruction of the hair-sebaceous follicle ostium
• inflammation development around sebaceous follicles
A number of fables are associated with acne. Acne by no means results from inappropriate diet, i.e., excessive consumption of fatty foods, carbohydrates, chocolate or dairy products. Drinking large water volumes will not help in the problem elimination. Contrary to common opinions, exposition to sun radiation is not a good method of treatment – sun tan only masks acne changes a little. Quicker peeling of sunburned skin may partially restore the patency of sebaceous ducts, however, the overall benefits are rather short-term in character.
The mechanism of occurrence of acne changes
Enhanced seborrhoea (sebum secretion), resulting from stimulation of the sebaceous glands (mainly by androgens), and of keratosis disorders in hair follicle ostia lead to their obstruction. In effect, sebum elimination from the glands becomes more and more difficult, causing dilation of the ducts of the sebaceous glands.
The above-mentioned processes lead to the occurrence of micro-blackheads. In the course of increasing dilation of the sebum draining ducts, closed blackheads (white) occur. In result of oxidation of the fats, which are contained in sebum, they become visible as dark spots – open blackheads (black).
In blocked hair follicles, anaerobic conditions develop with accumulation of compact, dense sebum. This environment favours the development of Propionibacterium acnes - commensal bacteria, also included in the normal bacterial flora of the skin also in healthy persons. These anaerobic bacteria decompose sebum via the enzymatic pathway, hydrolysing triglycerides and releasing free fatty acids and chemotactic factors. Free fatty acids are irritating substances which enhance exfoliation processes. The chemotactic factors attract and inform leukocytes about infection occurrence. The leukocytes, in order to neutralise P. acnes bacteria, release hydrolytic enzymes. Unfortunately, these enzymes damage not only the cells of the bacteria abut also the cells of hair follicles, contributing to destruction of walls of the sebaceous glands. This wall destruction may cause wall breaking and leakage of the hair follicle contents on to skin. This results in enhanced inflammation condition, leading to papular and postular eruptions on the skin. When similar changes appear simultaneously in many neighbouring sebaceous glands, a large purulent infiltration develops.
Methods of simple acne treatment
The goals of acne treatment include protection against excessive keratosis, suppression of bacterial growth and seborrhoea reduction. The therapy may be local or systemic. The basic principle of this therapy is as follows: patients with light acne undergo local treatment, patients with moderate symptoms receive oral and local treatment with antibiotics, while persons affected by severe form of acne, receive oral doses of isotretonoids. Combined therapies are often administered, consisting of two or more preparations. The patients have to be aware that the therapy is rather long – lasting several months or several years.
Proper hygiene and care of acneous skin
Skin with susceptibility to acne requires special care. Beside medical recommendations, also very important is the adherence to certain general suggestions, regarding its care. Skin should not be cleaned of blackheads by hand. Blackheads should be removed, using special tools and disinfecting skin after the operation. In the care of skin with susceptibility to acne, proper moisturising is important by application of appropriate moisturising creams or gels. Skin should be cleaned with special washing agents with anti-seborrhoeic and anti-infectious properties, which do not cause irritation. Washing bars or special soaps are recommended for body washing. Dermocosmetics may be used separately or in combination with pharmacological treatment.
