Acne

Acne (acne) - inflammation of the balance-hair apparatus with predominant involvement of the sebaceous glands. Depending on the reasons of formation distinguish the following types of acne.
Acne vulgaris, s. juvenilis, occur in young people of both sexes between puberty and 30 years as a complication occurs in conjunction with other clinical symptoms increased excretion of fat, comedones (see Seborrhea).
The etiology and pathogenesis of various forms A. vulgaris is uncertain. The main reason contributing to the occurrence is seborrhea, characterized not only by increased sebum, but the change in its chemical composition.
As the immediate causes indicate endocrine disorders, intestinal intoxication, metabolic disorders. Assume that the change in the chemical composition of sebum, and the accumulation of toxins, hormones, metabolites, either directly specify the development of the inflammatory process, or contribute to create under the influence of external factors, in particular of infection (Staphylococcus). In the development of severe forms A. vulgaris (A. indurata) often play the role of anemia, decreased feeding, gipovitaminoz.
Histopathological when A. vulgaris found inflammatory infiltrate around the sebaceous glands and hair follicles; A. papulosa and A. pustulosa infiltrate consists mainly of neutrophils and lymphocytes, A. Indurata - of histiocytes, plasma and giant cells. The excretory duct of the sebaceous glands expanded and made the horn masses and skin fat (comedo).
A. vulgaris is characterized vsapaniem on the skin of the face, upper back and chest, less external surfaces shoulders pink nodules in the magnitude of millet grain to small pea, hemispherical or conic form (A. papulata). Often in the center of the bundle is celebrated black point - comedo (A. punctata). In the future may form a small pustules (A. pustulosa) either opened or podsypaya with crusts. Upon healing remains small pigment spots or small scar.
Pour acne elements acute, often by sporadic more (sometimes very significant) or fewer. Often the rash of reach of large magnitude and form deep, heavy, painful infiltrates, skin over them bluish color (A. indurata). Infiltrates dissolve or softened and opened, releasing viscous oily-purulent fluid. Upon healing remain deep disfiguring scars, often hypertrophic (A. keloidea). Individual items may merge or connect a deep strokes, opened a few holes (A. confluens). Sometimes, the same process takes acute with the expressed suppuration (A. phlegmonosa).
Treatment mainly should be aimed at eliminating seborrhea. If necessary, also to normalize the function of the intestine. In many cases shown vitamins (a, E), hormones (ostestral or diethylstilbestrol 0,001 g 2-3 times) under the control of the content of 17-ketosteroids, urine. With sluggish for - non-specific stimulating therapy, for example autohemotherapy. In acute outbreaks and expressed suppuration (A. pustulosa, A. phlegmonosa) shows antibiotics (biomitsin, erythromycin, on average 6-8 million IU per course). A careful skin care: washing with warm water and soap, to degreasing - down 2% salicylic or rezortsinom alcohol. Prescribed drugs sulfur, mainly in the form stirs up sediment, milk Vidal, etc.; exposure erythermal doses of ultraviolet rays, in severe cases (A. indurata)and paraffin applications. In the summer time, heliotherapy, sea bathing.

Acne conglobata (dermatitis follicularis et perifollicularis conglobata). The etiology and pathogenesis is not clear. Occurs mainly in young age suffering from oily. The process is localized on the skin of the back, rarely chest and face. Characterized by the appearance of a very large, often double-comedogenic, about which consistently formed atrophic scars. In a further round of comedones occurs inflammatory infiltrate and formed sluggish abscess, which at the opening allocated sero-purulent exudate mixed with blood. Abscess cavity made sluggish by granulations. For long. Upon healing remain uneven scrofula-termoyadernye scars. Crops pus from newscritics abscesses or sterile, or planted diverse flora (Staphylococcus, Streptococcus, acid sticks). Many authors identify A. conglobata with folliculitis et perifolliculitis capitis abscedens et suffodiens Hoffmann (E. Hoffmann), A. keloidi, and with a chronic form of abscess pyoderma. Treatment is the same as when A. vulgaris and oily.

Acne keloidi [synonym: dermatitis papillaris capillitii (Kaposi), sycosis franiboesiformis ('alibert), folliculitis sclerotisans nuchae (Ehrmann)] is observed in middle-aged men. The etiology and pathogenesis is unknown. Histologically - inflammatory infiltrate around the follicle, consisting almost entirely of plasma cells and a small number of giant. Consistently infiltration is replaced by fibrous tissue. The follicle and sebaceous gland destroyed. The process is localized usually on the back, on the border of hair growth, it is rarely in the beard area. At the beginning of the disease appear follicular papules the size of millet grain, light pink color. Separate knots can nagnaivatsya, but most of them gradually turns into a dense fibrous papule normal skin color. Gradually increasing in number, they are first grouped, and then merge. Subjective feelings are absent. The course of chronic. The most effective radiotherapy.


Acne necrotics (Boeck), acne pilaris (Bazin), acne varioliformis (Hebra) are observed both in men and women after 40 years. The cause is not clear. Histologically - necrosis of epithelial mouths hair follicles and surrounding connective tissue. Around the site necrosis - inflammatory infiltrate with a predominance of neutrophils and fat cells, located mainly perivascular. In a separate vessel clots. The process is characterized by a rash mainly on the skin of the forehead, on the border with hairy part of the head, temples, less often on the scalp, face, back, chest, small pink nodules, in the centre of which forms a bubble, quickly podsyhanii in brown crust, hardly separated. Upon healing remains openoptions hem.
The course of chronic, and occasional outbreaks. Ointment from white sediment mercury (2-5%) or 5% sulphuric ointment quickly lead to a cure, but do not prevent relapses.

Acne rosacea is more frequently after 30 years. Characterized by reddening of the face, especially the nose and cheeks, aggravated by changes in temperature, after drinking hot annoying food, alcohol. Consistently redness becomes stable and takes stagnant. Formed telangiectasias. A. rosacea is often combined with seborrhea. Against this background, from time to time there are small red nodules, crowned with pustules. Often celebrated connection of the disease with infringements of secretory function of the stomach (anatsidnyh gastritis), spastic colitis, constipation, mostly women, with infringement of function of sexual glands (dysmenorrhea, menopause). Work out in the cold or in hot room contributes to the development of the disease; in some patients, there is damage to the eyes in the form of keratitis.
Treatment: non-irritating diet, the prohibition of hot food and drinking alcohol. When ahilii - gastric juice, hydrochloric acid. Shown sedatives, hydrotherapy, in case of need hormone therapy. Locally first cooling powders, agitated mixture, then in order to restore the violated vascular tone massage, annoying ointment (for example, an ointment of Wilkinson); when expressed telangiectasia - massage snow carbonic acid, electroacoustic, scarification.
Bromica Acne and acne jodica occur in some people after intake of salts of bromine and iodine. Characterized by acute vsapaniem on the skin of face, trunk, rarely limbs (shoulders, hips) painful nodules bright red pea-sized, in the centre of the pustules are formed. Histopathological - inflammatory infiltrate around the upper section of the hair follicle (mostly of neutrophils), followed by the formation of an abscess. The mechanism of occurrence certainly not installed. Possible direct irritant effect on the fabric of iodine and bromine allocated with sebum, and activate them staphylococci in the mouths of hair follicles. The disease passes quickly after discontinuation of the medication.

Acne professionalis - capodanno skin disease resulting from the influence of exogenous actions of some chemical substances (tar, pitch, lubricating oils, waxes, and so on). Characterized mainly by pollution of estuaries hair follicles with the subsequent development of inflammatory nodules or papulopustules.
Acne chlorica (candidate of Herxheimer reaction) was observed for workers in the elaboration of chlorine compounds (for example, the electrolysis of sodium chloride). Characterized by the formation of the skin, as well as in other areas of skin, sometimes throughout the body, the number of large comedones. Subsequently formed around them inflammatory nodules, pustules, abscesses and boils. Does this chlorine directly on skin or the disease caused by the inhalation of vapours is uncertain. In all forms of professional acne key importance is not so much healing as sanitary-hygienic and sanitary preventive measures.