Types of acne. The methods of treatment

Acne (Latin acne, distorted Greek akmē top) is the collective designation of inflammatory diseases of sebaceous glands, more often the term is applied to acne and acne. Acne - acne, pimpled tubercles, dermal vysypnye elements. In the medical literature, acne is often simply called "acne" or "vulgar acne". However, these terms are not equivalent. Acne is a particular manifestation of acne, characterized by inflammation of the sebaceous glands.

Acne - acne, acne, small inflamed bumps on the skin. Acne is a particular manifestation of acne, characterized by inflammation of the sebaceous glands. Comedon (novolat. Acne comedonica) is a kind of cork that forms when the mouth of the hair follicle is obstructed by horny masses (lowered epithelium in a mixture with thick fat). When inflammation of comedones there are acne (acne, acne).

What kinds of acne (acne, acne, comedones) exist?

Due to the fact that due to the origin, development mechanism, and individual skin characteristics, acne is a very multifaceted disease, there is no single and comprehensive classification of acne. Below are several classifications, the study of which in the total gives the opportunity to correctly diagnose and choose the optimal treatment tactics.

Classification of the inflammatory nature of the appearance of acne (acne, acne, comedones) Comedones arise if the ducts of the sebaceous glands or the mouth of the hair follicles are clogged up with stoppers Such plugs consist of excesses of dense skin fat, mixed with keratinized scales of dead skin cells. If an infection gets into such a gland, a papule (nodule) or pustule (pustular) develops. After a while, the pus "melts" the epidermis and comes out. Inflammatory leukocyte infiltrate, surrounding the pimple, resolves. If the abscess was large, a scar may remain after healing.

Non-inflammatory manifestations of acne (acne / acne / comedones)

If the mash is formed in the upper part of the pore, open comedones are formed. In appearance, the sebaceous plug initially resembles a slightly white or transparent liquid, then the fat begins to harden and a dense white or yellow lump forms in the pore. If the pore was opened, then under the influence of oxygen, the fat begins to oxidize and acquires a characteristic black head - black dots (dark color is attached to the stopper by melanin, a product of tyrosine oxidation). If the congestion is formed in the lower part of the pore, deep under the skin, the sebaceous gland ducts expand from the excess of sebum and form the so-called adipose-accumulation of fat, cyst-like thrombi, which do not have an outlet on the surface of the skin.

Closed comedones can rise above the surface of the skin, and can be felt tactile by palpation in the form of small prosoid tubercles. They are best visible when stretching the skin. On the surface of the skin they often look like white knots of various sizes. Nodules the size of a millet are called miloons (milium - from lat. "Millet grain") or in the common people's "patsy".

If an infection gets into the comedon, inflammation develops. Then the comedon turns into a papule (nodule) or pustule (abscess).

Let's see how they differ.

Papula (nodule) - sharply delimited dense bespolostnoe, as a rule, slightly rising above the surface of the skin formation with a diameter of 1 mm to 3 cm. According to the western classification, papules with a diameter of more than 1 cm are called nodules. Papules (one of the types of inflammatory acne) look like dense red nodules, reminiscent of small balls on the surface of the skin. Redness is accompanied by suppuration and edema of the adjacent skin. Depending on the type of papule, the color varies from pink to bright red or bluish-purple. If you press on the papule, it changes its color to a pale color. The white inflamed head in the papule, unlike the pustule, we do not see. More often papules are formed from closed comedones. If the papule was formed in the place of an open comedone, an expanded mouth of the hair follicle with a dark-colored stopper is visible on its surface. Pustule (pustular) is a cavitary acute-inflammatory element with purulent contents, resulting from a purulent process in the epidermis or dermis.

Pustules are formed as independently (primarily), and again - from papules in the event that the papule begins to develop opportunistic or pathogenic microflora. The sizes of pustules vary from 1 to 10 mm. The shape is semi-spherical, conical or flat. Contents purulent purulent - on the surface we see a loose white head (which sometimes bursts), and on the edges of the ball red inflamed skin.

Color purulent content can be white, grayish, yellow or have a greenish tinge. The presence of a yellow or greenish shade indicates the attachment of a secondary infection. When the walls of the vessel collapse as a result of the inflammatory process, the contents mix with the blood.

Dermatoses with acneiform acne eruptions

Rashes, in which there are no comedones, are called acneiform. These include a large group of dermatoses: rosacea, rosacea, perioral dermatitis, skin tuberculosis, small-node sarcoidosis of the face, drug rash. For acneiform eruptions, the inflammation of the sebaceous-follicle follicle is primary. In diagnosis, they should be distinguished from acne.

Clinical classification proposed by Plewig and Kligman

b>Acne juveniles. Acne juveniles are found in a third of teenagers aged 12 to 16 years. According to statistics, girls suffer from acne more often than boys. In 75% of cases, juvenile acne is localized on the face, in 16% - on the face and back. In the vast majority of adolescents, acne disappears by the age of 18-20. However, sometimes acne is a long-lasting disease and occurs in 3% of men and 5% of women aged 40-50 and even 60 years ("physiological acne"). This variety refers to the manifestations of acne adults (acne adultorum).

Comedones (Acne comedonica). Comedones (acne comedonica) are bred as a result of blockage of the hair follicles by the accumulation of horny scales and sebum. Slightly expressed comedones in the absence of an inflammatory component are considered a variant of the physiological norm. The initial manifestation of acne is microcosmodes that do not manifest themselves clinically. Inflammation of open comedones occurs much less frequently than open - white dense non-inflamed nodules with a diameter of about 2 mm, covered with skin and not having an open exit to the surface. Inflammation in them is not expressed, but there are favorable conditions for its further development. Further accumulation of sebum in them leads to an increase in nodules and possible inflammation.

Papulopustular acne (Acne papulopustolosa). Papulopustular acne (acne papulopustulosa) is characterized by attachment to the closed or open comedones of the inflammatory process. This form of acne is characterized by the formation of inflammatory elements - papules (nodules) and pustules (pustules). The outcome of papulopustular acne depends on the depth of damage to the layers of the skin. The mild form usually heals without a trace, with the involvement of deep layers of the dermis in the inflammatory process and damage to its structure, the inflammatory elements heal with the formation of a scar scar. Comedones and papulopustular acne are the most common forms of acne. Other varieties of acne in clinical practice are rare, characterized by a more severe course and require a different treatment tactic.

Nodular-cystic acne (Acne nodulocystica) The nodular-cystic form of acne (acne nodulocystica) is characterized by the formation of purulent cystic cavities and infiltrates deep in the dermis, their tendency to fuse and the formation of inflammatory conglomerates. With the reverse development of such elements always heal with the formation of scars. This form of acne usually lasts a long time (for several years), even with an average degree of the process.

Lightning Acne (Acne fulminans) The rarest in appearance and the most severe form of acne disease in clinical manifestations are acne fulminans. It usually develops in adolescents 13-18 years, mainly in young men who have a papulopustular or nodular-cystic form of acne. On the skin of the trunk and upper limbs, areas of erythema with pustules are formed, and then ulcers. On the face, rashes are often absent. Subsequently, numerous scars form on the site of the rash, including keloids. The reasons for the development of the lightning form are not fully understood. Probably, a certain role is played here by toxic-allergic and infectious-allergic mechanisms. Usually, acne fulminans develops in patients with severe digestive disorders (ulcerative colitis, Crohn's disease, etc.), or after taking certain medications: tetracyclines, androgens, synthetic retinoids.

A lightning-fast form is characterized by a sudden, sharp onset and rapid development of the disease. The general symptoms and effects of intoxication come to the fore: malaise, a rise in body temperature above 38 ° C, fever, joint and muscle pain, abdominal pain, anorexia, a sharp deterioration in the state of health. Sometimes changes in organs and tissues develop: softening of the bones, enlargement of the liver and spleen. In the blood there is a high content of leukocytes, a decrease in the level of hemoglobin and acceleration of ESR, bacteriological culture of the blood - negative. On the face and trunk appear inflamed ulcer-necrotic areas.

Acne of adults (Acne adultorum)

If acne persists until the patient reaches adulthood or appears for the first time in adults, they are referred to manifestations of acne adultorum or acne of adults. They occur in 3-5% of men and women aged 40 to 50 years and older. In a number of cases, their later resumption is noted years after the resolution of juvenile acne.

Late acne (Acne tarda) This form is diagnosed if the rashes that started in adolescence did not stop before the age of 25. This form of acne is more common in women in the second half of the menstrual cycle and requires additional consultation of the gynecologist. In 20% of cases, adult women complain of the occurrence of rashes a few days before the onset of menstruation and the independent disappearance of acne with the onset of a new cycle. Often late acne is present all the time. Usually it is papular, papulopustular or nodular-cystic acne eruptions, often in the area of ​​the chin. The cause of late acne is often polycystic ovary complicated by hirsutism and anovulatory menstrual cycle. It is also necessary to exclude tumor lesions of the ovaries and adrenal glands.

Inverse acne (Aacne inversa, Hidradenitis suppurativa) In this case, the apocrine or large sweat glands of the armpits, the perineum, the pubis, the navel, and other sweat glands are involved in the inflammatory process again. It is manifested by the appearance of large tuberous painful nodes, which are absent and open with the release of purulent or purulent-bloody contents. Often, individual elements, merging, lead to an increase in the area of ​​the lesion. Inverse acne has a chronic course with frequent relapses and spread of lesions. Heals for a long time, after resolution in severe cases, scarring and fistulas are formed. They are predisposed to their development of increased body weight, traumatizing the corresponding zones with combs or tight clothing.

Bodybuilding acne (Bodybuilding acne) This form can also be called steroid acne. It is associated with the reception of steroid hormones: anabolic steroids, androgens, glucocorticoids. Developing as a result of this hyperandrogenism causes an increase in sebum secretion. Characteristic features: the monomorphism of rashes (all elements are at the same stage of development), the absence of comedones. Eruptions are mostly nodular-cystic elements, located on the upper chest, less often on the face, quickly regress after the drug is discontinued. The intake of anabolic steroids is often combined with vitamin cocktails, including B vitamins and causing the appearance of nodular-cystic acne. With this form of acne, endocrine disorders should be eliminated in patients.

Spherical, or heaped, acne (Acne conglobata) One of the most severe manifestations of acne is often a cutaneous manifestation of the kyotype of XYY in men against a background of dense seborrhea and polycystic ovary syndrome in women. Sharpous acne occurs in adolescence and persists, usually up to 40 years or more. Without treatment, rashes can persist for decades. It is characterized by the fusion of nodes and cysts into conglomerates, the formation of fistulous passages. Torso is more often affected: globular acne is manifested by multiple nodular-cystic elements and large comedones located not only on the seborrhea but also on the skin of the extremities, abdomen and back. Their healing occurs with the formation of keloid, hypertrophic and atrophic scars.

Pyoderma faciale Many researchers attribute pyoderma to the manifestation of rosacea, a severe form of acne, rather than acne. Piodermitis of the facial skin affects young women 15-40 years old. , Many of whom have never suffered from acne, develops acutely, in some cases during pregnancy or immediately after childbirth. Inflammatory elements are located exclusively on the face, while there are no comedones and general symptoms. Healing of elements occurs slowly, for a year or more. The disease begins, as a rule, on a hyperemic background. It is characterized by the appearance on the face of persistent erythema, against which rapidly developing large papules, cysts and nodes, merging into purulent conglomerates.

Acne of childhood (childhood acne)

Acne of newborns (Acne neonatorum) The appearance of acne in newborns is the borderline physiological state of this period and occurs as a result of the sexual (hormonal) crisis. Its manifestations also include breast engorgement, hydrocele, physiological vulvovaginitis. These conditions are caused by the action of maternal hormones obtained by the fetus in the intrauterine period. Acne rashes of newborns are closed comedones located on the nose, cheeks, chin and on the forehead in the form of point white or yellowish papules. As a rule, they disappear on their own without a trace for 1.5-2 weeks.

Acne of children (Acne infantum) In children, acne can appear at the age of 3-6 months and cause prolonged, severe forms of acne. Their development can be associated with a dangerous congenital pathology (hyperplasia or adrenal tumor) and requires careful examination of the child.

Acne caused by exogenous causes In this case, the rashes are associated with prolonged inhalation, ingestion or direct exposure to the skin of comedogenic substances, for example, mineral oils or other petroleum products, halogenated hydrocarbons, insecticides, detergents, etc.

Classification of acne according to severity of manifestations

I degree. One or two facial regions are affected. The main manifestations are open and closed comedones, with a significant prevalence of open comedones. Single surface papules and pustules are possible..

II degree. Several areas of the face and body are affected. A large number of both open and closed comedones. Single papules and pustules.

III degree. Against the background of open and closed comedones a large number of deep papules and pustules. Possible widespread hyperemia (reddening) of affected areas due to a pronounced inflammatory reaction. The phenomena are post-acne: scars, stagnant spots.

IV degree. It is characterized by the presence of large, more than 5 mm in diameter, cyanotic-purple painful infiltrates, conglobata elements (several large, adjacent nodes connected by fistulous passages), large cysts resolving with the formation of gross atrophic scars. One or more areas may be affected. In the diagnosis of this stage, the pronounced role plays a decisive role, and not the prevalence of manifestations.