How to reduce the increased activity of the sebaceous glands. Blockage and inflammation of the sebaceous glands: symptoms, treatment, causes, what to do

Many girls and teenagers are thinking about how to reduce oily facial skin. In the world there is a lot of different advice on this matter. True, not all recommendations are equally effective. Some advise contacting a beautician for help, this is a good approach to solving the problem, but it also does not always help. So you often have to independently solve the problem at home. Fortunately, there are many different recipes for getting rid of oily skin on the face. You can try everything, and then choose those methods that seem most suitable, simple and effective.

Golden Rule

So, the first rule that should be taken into account is that if you decide to figure out how to reduce the fat content of your facial skin, you need to be aware of the need for regular daily care. Simply put, you will have to do some manipulations every day and carry it out. Otherwise, even contacting a beautician will not help.

Please note that sometimes you need to make a variety of face masks. They are recommended to either alternate every other day, or apply to the face once a week. Too frequent scrubs and masks can only aggravate the situation. Procedures should be both morning and evening. In the middle of the day, it is not necessary to carry out various manipulations with the skin. Is it recommended to wash your face after long walks to remove dust and dirt from your face.

Causes

How to reduce oily skin? The causes of this disease are varied. Depending on them, you must independently choose a way to deal with the disease. There are a lot of options for the development of events.

The first and most common reason is hormones. The skin becomes oily and worsens mainly in adolescents and pregnant women. Therefore, you shouldn't be surprised. Even if there were no prerequisites for deterioration, hormones can play a trick on you.

The next reason is a violation of the sebaceous glands. This may be a hereditary disease. Or simply due to any health problems, these violations occur. Of course, with the exception of hormonal failure.

Also, oily skin of the face appears due to the formation of comedones in the body. These are "blackheads", blackheads that are deep under the skin. They appear, as a rule, due to clogged sebaceous glands.

Improper nutrition can also cause a lot of skin problems. Therefore, it is worth paying attention to this. Wondering how to reduce oily skin at home? Then just use the recommendations of cosmetologists and just women who were able to cope with this problem. What advice should you follow?

steam baths

Regardless of the reasons for the appearance of our today's problem, steam baths help to cope well with the disease. They cleanse the skin without harm, open the pores. This approach pleases many women - it requires almost no costs, does not cause allergic reactions, and also gets rid of facial skin problems very quickly.

In addition to defeating oiliness in this way, you can remove acne. All you need is to do steam baths 2 times a month (or better once a week). The face is steamed, then wiped with a towel. You can wash with cool water.

If you want to get rid of acne at the same time, after steaming, squeeze out some blackheads on problem areas. They will quickly disappear. This method does not help oily skin too quickly, but it relieves other problems extremely easily. The result, according to women, is visible after about 2 months of using steam baths. For this venture, it is recommended to additionally purchase a special dispenser - a machine that helps to carry out the procedure.

Proper cosmetics

It's hard to believe, but decorative cosmetics also play a role for the skin on the face. Wrongly chosen, it will only cause harm. Therefore, you will have to be careful. The following advice does not so much treat oily skin as it prevents this phenomenon.

What is it about? Are you facing a problem called "oily skin"? And how to deal with it at home? It's not that hard to do. Perform daily care. And pay attention to what cosmetics you have chosen. Suitable for oily skin. When choosing decorative cosmetics, pay attention to the inscriptions. If there is a mark "for oily skin", you can purchase one or another product. Otherwise, you will only make the situation worse.

Ice cubes

The next recipe for healthy facial skin is the use of ice. Not quite standard, but very effective method of getting rid of fat. All that is required of you is to treat your skin with ice cubes daily. Thus, the production of fat from the sebaceous glands will decrease and then normalize.

Just swipe ice cubes over your face, as if washing your face. Movement should be light, no rubbing. It is this that is extremely effective at home. In any case, the girls are pleased with both the cost of preparing the product and the result. It is noted that it will be noticeable in a week.

Wash your face with ice in the morning and evening. If you carry out the procedure only once a day, its effectiveness will decrease significantly. Learn it. The habit of treating your face with ice will develop over time. In order to prevent the re-formation of excess fat, this method is also suitable.

Cinnamon to the rescue

The following advice can be called universal. If you are thinking about how to reduce oily skin at home, you can try using a special mask with the addition of cinnamon. This spice not only normalizes the sebaceous glands, but also rejuvenates the skin.

Add 1 teaspoon of cinnamon to 1 tablespoon of liquid bee honey. Mix well and apply on face for 10-15 minutes. Wash off with warm water afterwards. Do not apply any cosmetics immediately after the procedure. This mask, according to many women, is extremely effective. In just a few applications, it gets rid of acne, blackheads and fat. It can be used both for daily procedure and once a week.

Nutrition

How to reduce oily skin from the inside? You can do this by normalizing your diet. Often it is violations in the diet that cause problems with the sebaceous glands. So, it is the right diet that will help to cope with the disease.

This approach doesn't get the best reviews. After all, not everyone likes to restrict themselves in food. If you have serious disorders of the sebaceous glands, it is recommended to go on a diet - exclude all fatty, floury, smoked and sweet. Everything else is allowed, but in small quantities. The effect is noticeable only after 2-3 months at least. It is advisable to choose a diet together with a beautician. In this matter, the advice of a specialist will not be superfluous.

Special cosmetics

How to reduce oily skin? Now this is not a problem. The most effective method is the use of special caring cosmetics. Manufacturers provide entire lines of products for oily skin. Over time, they should help fight the problem. A variety of ointments, gels, scrubs - all this is sold in cosmetics stores. These tools are the best help to correct the situation with the skin.

But, as women assure, the method has one significant drawback - this is the reaction of the body. Choosing a daily skin care product is not easy. One lotion is suitable for someone, but at the same time it is not suitable for another person. Such issues will have to be addressed as well with the help of a cosmetologist. Perhaps this is the only complaint of girls.

In the depths of the human skin, there are sebaceous and sweat glands, which tend to produce not only sebum, but also sweat. In addition, the entire skin of the human body, except for the skin of the palms and feet, is endowed with hairs.

Some of them are visible, others are invisible. Hair follicles that cover the skin tend to penetrate deep into the skin, while they are located next to the sweat and sebaceous glands. Pimples or acne and acne are a pathology of the skin of the face, as well as some other parts of the body, accompanied by an inflammatory process of both hair follicles and sweat, as well as the sebaceous glands that are adjacent to them.

Acne is an inflammatory process of the hair follicles, as well as the sebaceous glands that are located next to them. Since a particularly large number of small hairs is observed on the skin of the back, face, open part of the chest and chin, in most cases these areas are affected. Each small hair contains a bulb located deep in the skin. Next to the bulb, one can observe the sebaceous gland, which tends to produce sebum, which is released onto the surface of the skin to lubricate it. In fact, the production of this fat is really necessary, since only in this way it is possible to protect the skin not only from drying out, but also from cracking.

As a result of blockage of the mouth of small hairs, bacteria that are constantly present on the skin receive favorable conditions for their reproduction. bacterium Propionibacterium acnes considered to be the most active causative agent of this disease. Gradually, the bacteria begin to multiply, thereby causing an inflammatory process, which in turn leads to redness, soreness, and swelling of the entire area around the hair follicle. If the infection begins to develop further, then the patient will also have suppuration. At the moment of a breakthrough, the skin is cleansed not only from an excessive amount of sebum, but also from the infection itself.

In adolescents, acne develops between the ages of twelve and fifteen, with the onset of puberty. The most common cause of the development of this disease is considered to be an increase in the amount of sex hormones in the blood, namely androgens. The sebaceous glands, which are located very close to the hair follicles, begin to synthesize a large amount of sebum due to an increase in the level of androgens. As a result, there is a blockage of the ducts of the sebaceous glands, which are designed to remove sebum to the outside. Since sebum remains under the skin, it becomes the cause of infection, and, consequently, acne. In girls, acne occurs mainly before the onset of menstruation. This happens due to the fact that it is during this period that the amount of female sex hormones, namely progesterone, increases in their blood. Most often, all adolescents manage to get rid of this disease only by the age of twenty to twenty-five, that is, during the completion of puberty. There are also cases when the development of acne is associated with the presence of one or another endocrine pathology such as polycystic ovary syndrome in girls.

Most often, immediately after the completion of puberty, acne disappears without a trace once and for all. If a person has numerous purulent acne already at an older age, then this can be considered a signal that there is some kind of disease in his body. In this case, a consultation with a dermatologist is necessary.

In the case of the development of acne in the fairer sex after twenty-five to thirty years, you should be wary, since this condition may be one of the signs of a particular disorder of the endocrine system. Seborrheic acne is sometimes observed with polycystic ovaries. Other signs of polycystic ovaries include both increased facial hair growth and hair loss in the temporal region, as well as infertility and menstrual irregularities. In addition, pathologies of the thyroid gland, pituitary gland, or adrenal glands. Sometimes acne also occurs against the background of the use of oral contraceptives or during pregnancy. There are also cases when these phenomena, on the contrary, help to forget about acne forever.

Improper diet - eating foods containing a sufficiently large amount of cholesterol, as well as excessive consumption of sweets, can provoke excessive sebum secretion, which in turn causes acne. Especially often this disease affects people who suffer from obesity.
Prolonged exposure to direct sunlight can also cause acne, as in this case there is excessive keratinization of the skin. Short sunbathing, on the contrary, helps to get rid of acne, and also has a beneficial effect on the entire skin.
Hereditary predisposition: in most cases, acne develops in people with oily skin. It's no secret that oily skin can be inherited.
Lack of zinc in the body increases the production of sebum, while causing the development of acne. Zinc deficiency is most often observed in people who eat a monotonous diet.

Acne - how to get rid of them? Modern and effective methods of therapy

In fact, to get rid of acne, you need to spend a lot of time and effort, since the treatment of this condition involves careful adherence to all recommendations for caring for the skin of the face. If you are interested in knowing whether you can cope with acne on your own or you can’t do without the help of a specialist, then count the number of acne on one half of your face. If there are less than ten of them, then in your case we are talking about a mild degree of acne, which you can get rid of at home. If there are more than ten of them, then you have a complex pathogenesis of acne, which cannot be dealt with without the help of a specialist.

Proper care for oily skin.
Reduced activity of the sebaceous glands, which tend to synthesize sebum.
Prevention of the development of comedones, and in case of their occurrence - a timely course of therapy.
Therapy with antibiotic drugs in case of severe forms of acne, accompanied by the occurrence of numerous purulent acne.

Facial skin care as a method of acne treatment

If we are talking about oily skin, then the patient should carry out the following kind of hygiene procedures every day: in the mornings, you should wash your face with cool water, but in the evenings, use special solutions to care for the skin, wiping them with a cleansed face. The most popular today are such skin care products for acne as: salicylic acid , camphoric acid , 5% chloramphenicol alcohol, and resorcinol. A small amount of the solution should be applied to a cotton swab, and then wipe the affected areas of the skin with it. In this case, it is strictly contraindicated to use fatty creams. In no case should you squeeze out acne, as this can cause the development of some other infectious pathology. In addition, extrusion can injure the skin, which subsequently contributes to the formation of scars. Both in the morning and in the evening, you should wash your face only with special products intended for skin care. You can buy them at any pharmacy.

Today, there are a huge number of cosmetic products that can be used in the fight against acne. With all this, not all of them are able to produce the proper therapeutic effect.

Among the truly effective cosmetics are:

Tretinoin helps to minimize the synthesis of sebum, and also inhibits the activity of bacteria that cause the formation of acne. This cosmetic product is recommended to be applied in the morning and evening, after cleansing the skin of the face. The course of therapy with this drug is at least four weeks.
Adapalene ( Differin) comes in the form of a cream. With its help, it is possible to prevent the development of comedones, reduce the inflammatory process and accelerate the healing process of acne. This cream is applied only to cleansed skin immediately before going to bed. To forget about acne forever, Adapalen therapy should be continued for one to two months.
Benzoyl peroxide ( Baziron AS) - helps to reduce the production of sebum, prevents the growth of bacteria, accelerates the recovery of affected areas, and also reduces inflammation. This drug is produced in the form of a gel, which should be applied to damaged areas of the skin twice a day. The disappearance of acne during therapy with this medication is noted no earlier than a month from the date of the start of treatment.
Skinoren ( azelaic acid) prevents blockage of the ducts of the sebaceous glands, and also reduces the activity of bacteria that tend to cause the development of acne. This cosmetic product is available in the form of a cream, which should be applied to cleansed skin twice a day. The course of therapy with this medication is three months.

Antibiotic drugs in the fight against acne in most cases are prescribed only to those patients who have a severe form of this pathology, accompanied by the occurrence of numerous purulent acne. Both the choice of antibiotic drug and its dose, as well as the duration of therapy, are within the competence of a dermatologist. Antibiotic drugs can be prescribed topically in the form of gels, creams, ointments, or systemically in the form of tablets and injections. As for the systemic use of antibiotics, it is possible only if the doctor has all the necessary information regarding the sensitivity of bacteria to certain medications.

Erythromycin is considered to be one of the most effective antibiotic agents that can be used in the fight against acne. Quite effective is a drug called Zinerit, which includes erythromycin. In addition to erythromycin, Zineryt also contains zinc, a substance that tends to reduce sebum production. Zineryt should be applied to all affected areas of the skin with a special applicator twice a day. Regular use of this medication makes it possible to get rid of acne in ten to twelve weeks.
Clindamycin ( Dalacin acne gel) is another antibiotic drug with which you can forget about acne. This remedy should be applied in a very thin layer to the affected areas of the skin twice to thrice a day.

Treatment of the consequences of acne

As soon as the inflammatory process subsides and the acne disappears, you will notice that spots or scars have appeared on your skin at the sites of the lesion. By the way, scars in most cases occur as a result of squeezing or scratching a pimple. To get rid of spots and acne, you should seek help from a beautician who will perform a superficial peeling of the face. Do not forget that quite often this procedure contributes to the re-development of acne, so it should be carried out only by highly qualified specialists.

In the fight against acne, you can use the help of some folk recipes, namely:

Lemon. To cleanse the skin of an excessive amount of sebum, as well as reduce its fat content, you should wipe the skin of your face with a slice of lemon every day before going to bed.
Grapefruit. The juice of this fruit is used to cleanse oily skin. In this case, not pure juice is used, since a few more drops should be added to it. camphor alcohol. It is recommended to wipe the oily skin of the face with the resulting mixture every day.
Chamomile is considered to be a very common folk medicine in the fight against acne. In this case, it is recommended to make a special infusion from this plant. The recipe for its preparation is simple: we take one tablespoon of the flowers of this plant and steam them in one glass of boiled water. The resulting infusion is necessary to wipe the oily affected areas of the skin.
Oak bark helps reduce oily skin and also treats acne. We take twenty grams of raw materials, pour it with two hundred milliliters of boiled water and leave it to boil over low heat for thirty minutes. After that, let the broth cool, filter it and wipe the affected areas of the skin with it twice a day.
Curd mask for the face is also very effective in fighting acne. It is not difficult to prepare such a mask: you need to take one tablespoon of cottage cheese and mix it with a little salt, as well as one tablespoon of juice lemon or grapefruit. Mix everything thoroughly, after which the resulting mixture is applied to the skin of the face. Remove the mask after ten minutes with a non-greasy cream.
To get rid of blackheads, we prepare a special lotion: we take two tablespoons of carefully chopped peppermint leaves and steam them in one glass of boiled water. The resulting infusion is filtered, after which we add one teaspoon to it. lemon juice, three teaspoons of calendula tincture and the same boric alcohol. The resulting product should wipe the inflamed areas of the skin in the morning and evening. In the evening, it is best to carry out this procedure just before going to bed.

All of the above traditional medicine can be used only for simple forms of acne.

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We figured out: is it possible to defeat acne with pills

Little troubles that you want to get rid of immediately and forever. They can appear at any age and stay for a long time. Guessed? This problem is called acne. There are many ways to fight, choose the option that suits you - and preferably together with a specialist.

Before you start fighting acne, you need to see a doctor. After all, as a rule, the problem lies inside the body, and there are a lot of reasons for the appearance of "intruders".

Firstly, acne on the face can occur during adolescence due to the establishment of hormonal levels during puberty. An increase in the amount of androgens in both men and women leads to an increase in sebum production.

Also one of the reasons is hormonal changes during menstruation. At the end of the menstrual cycle, just before menstruation, women experience an increased release of steroid hormones. The skin becomes oily and rashes may appear.

Doctors advise attacking acne from all sides. It is necessary to act not only from the outside, but also from the inside. What acne pills to use? Which of them are effective and how?

Oil-reducing pills, or retinoids, are the most effective group of medications for treating acne. They not only help reduce oily skin, but also eliminate the appearance of scars. In the first week of use, the situation may worsen, itching and peeling of the skin may appear, but then these changes disappear within a few days.

Like any drug, retinoids have side effects. Tablets should not be taken simultaneously with creams and ointments, during the reception it is necessary to limit sunbathing, and it is also forbidden to carry out exfoliating cosmetic procedures (peels). The action of retinoids is weakened by alcohol intake.

The use of hormonal contraceptives reduces the level of androgens (male sex hormones that cause acne).

Reviews about the use of hormonal drugs:

- Good afternoon! To begin with, my skin is oily, with inflammation, enlarged pores and blackheads. Problematic skin started as simple blackheads on the nose. After the arrival of the first menstrual cycle, the hormonal background was disturbed, and acne began to come out. At first I fought on my own. Seeing my poor skin, the gynecologist advised me to drink the oral contraceptive "Jess" for 6 months, because it contains a small dose of hormones. I made up my mind, got tested and started drinking. The gynecologist immediately warned me not to expect a quick result, because. it takes time for "Jess" to fit into the body. The first two months passed, no cosmetic effect was observed, the skin was still strewn with acne. Only the breasts increased in size, the stomach did not hurt during menstruation, the cycle was on schedule. The third one came. I started seeing results. Acne was reduced, the skin became smooth, all the tuberosity, which was just above the cheekbones, disappeared, I lost two kilograms. And I was so afraid to get better, but, looking at the scales, I was very happy. After 3 months I passed the tests, they were good, and I continued the treatment. For 6 months of use, I didn’t feel dizzy, I didn’t feel sick, my appetite was, as always, good. (Olga, 20 years old)

- Started taking Jess. After a week of use, she noted that her breasts had increased significantly. But something wasn't right. Firstly, my appetite increased, I began to eat everything. M is a constant feeling of hunger. The weight has not changed, but plus everything, I feel sick all the time, my head is spinning. In the second week, a rash appeared all over my body, as if a herd of rabid mosquitoes had bitten me. It turned out that this is urticaria - a side effect that is described in the instructions. "Jess" I stopped taking. Two days later, everything returned to normal, nausea and other side effects disappeared. I will not recommend these OK, it seems to me that it is not worth the risk, but everyone is individual - they suit someone, someone does not. They did not suit me, given that I took tests for hormones. (Natalia, 27 years old)

This is possible with the use of antibiotics. The appointment of these drugs is indicated only for the defeat of a large area of the skin, mainly with pustular rashes. Such acne pills are prescribed only by a doctor, because many drugs have contraindications.

Acne Pill Reviews:

- Because of the spring beriberi, my forehead was sprinkled with small pimples. As soon as I started taking Unidox Solutab, the pimples disappeared in just 2 days!

But, starting treatment with pills, I noticed a huge number of side effects. As they say, one heals, the other cripples. But I developed a little system for myself that helped me take pills without any side effects.

Take the tablets after a heavy meal.
The use of the drug "Linex" to maintain the intestinal microflora. Thanks to him, the entire course of taking antibiotics, my intestines felt great. I didn't have any ulcers or gastritis.
The use of Complivit. I started drinking it to maintain immunity. I think that antibiotics kill the immune system completely. (Tatiana, 24 years old)

- Due to skin problems, I was prescribed the drug Unidox Solutab. Along with getting rid of acne, I received the following side effects: as a result, after taking seven tablets out of ten, my body began to become dehydrated. They could not stop vomiting and diarrhea, called an ambulance - they took me to the hospital, where the doctors explained to me that this drug was prescribed necessarily in tandem with drugs that protect the stomach, after which I had to restore the gastrointestinal tract for another six months. Therefore, when taking this drug, read the instructions carefully, there are just a mountain of side effects! And it is better not to drink such a strong antibiotic, anyway, it does not have a very good effect on the body. (Maria, 25 years old)

Also, in order to reduce the number of acne, doctors advise you to follow a diet, lead a healthy lifestyle and get as much positive emotions as possible!

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acne pills, problem skin, acne treatment

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Medical treatment for acne and seborrhea

There are skin diseases that are treated by both dermatologists and cosmetologists. These include something that everyone can have, which you can ignore, but which you really want to get rid of, as this affects the aesthetic appearance of the skin. So, these are problems that spoil the appearance and cause not so much physical as moral suffering. Let us dwell here only on the most frequent ones - Acne, seborrhea and various formations on the skin.

Acne vulgaris or juvenile acne

Acne is the most common skin disease in adolescents and young people, that is, the most socially active part of the population. This unpleasant disease affects about 85% of people aged 12 to 25 in European countries, so clear skin at this age is the exception rather than the rule. The presence of inflamed pimples, pustules and abscesses, blackheads (comedones), spots and scars, greasy, untidy appearance of the skin in the most prominent places causes difficulties in communication, professional device, reduces self-esteem, often leads to the formation of significant psycho-emotional disorders, up to the desire to complete isolation. Some young people stop leaving the house, drop out of school and work, become isolated, and in the end, a minor and completely banal skin problem develops into a personal tragedy. A patient who has addressed to a dermatologist about acne has serious psychological problems. Shyness, guilt, a sense of social unacceptability, anger, a state of depression, disbelief in the possibility of a cure are expressed to one degree or another. Intense experiences exacerbate the course of the disease. In stressful situations, patients, especially women, open the skin, squeeze out Acne, which further worsens the appearance of the skin due to the accompanying inflammation. On such injured areas, scars and spots remain that do not go away for a long time.

Acne is a long-term disease, often aggravated (in girls, as a rule, monthly) and often resistant to ongoing treatment. Today we know much more about acne than ten years ago, and a competent specialist can always help the patient. In this regard, the opinion that existed in the past that acne will disappear by itself with age, and therefore it is not worth spending effort on treating them, now sounds simply absurd. It is not always possible to immediately find the right individual approach, but the efforts made and the persistence shown are always rewarded with a good result. In the arsenal of specialists there are a number of effective drugs of different groups. The choice of the drug depends on the form of the disease, the prevalence of certain symptoms, the sex of the patient, the presence of contraindications.

Acne is more often divided into:

acne with a predominance of comedones (white and black dots with mild inflammation);
papulo-pustular acne (there are comedones, inflamed nodules - what is usually called acne, pustules, sometimes single large painful seals, gradually turning into abscesses such as boils);
conglobate acne (along with all of the above, there are long-term painful seals that leave pronounced scars after healing).

Most patients eventually develop the habit of squeezing comedones and pustules, constantly touching the inflamed skin, which is why bloody crusts, spots, superficial scars are added to everything described.

Many factors are involved in the development of acne, the action of which is ultimately realized in the sebaceous hair follicles. Not all follicles are affected, but only those with a special structure, located on the face and upper body, with large sebaceous glands, wide (up to 2.5 mm) ducts and thin, almost invisible hairs. The sebaceous glands are the target organ for sex hormones, especially testosterone. Under the influence of testosterone, produced by the sex glands, especially actively in adolescence, the size and number of sebaceous glands increase significantly, the production of sebum increases, and its composition changes. In addition, in the development of acne, a violation of the keratinization of the ducts of the sebaceous glands, difficulty in the outflow of sebum to the surface of the skin, increased reproduction of microbes in the accumulated sebum and subsequent inflammation are essential. With the help of modern medicines, it is possible to influence almost all the factors involved in the development of the disease.

With the initial manifestations of acne (usually at the age of 8–13 years), when the clinical picture is dominated by increased oily skin and comedones (whitish nodules and black dots), and there are not so many inflammatory elements, retinoic and salicylic acid preparations are used externally. Both acids have the ability to dissolve comedones, and salicylic acid is much weaker in this regard. With papulo-pustular acne, it is advisable to use antibiotics, retinoids, benzoyl peroxide (benzoyl peroxide), traditional external agents (salicylic, chloramphenicol, resorcinol alcohols). Severe forms of acne, including acne conglobata, should be treated with oral retinoids, and only if there are contraindications, other methods of treatment (antibiotics, immunomodulators) are used. As with papulopustular acne, it is preferable to use a combination of different drugs.

Problems solved in the course of treatment and ways to solve them:

decrease in sebum production (retinoids, especially retinoic acid, hormonal drugs - estrogens, progestins or antiandrogens, spironolactones);
reduction of inflammation - antibiotics (tetracyclines, erythromycin, lincomycin, clindamycin) and local anti-inflammatory and microcirculation-improving agents, including zinc oxide, sulfur, tar, ichthyol, resorcinol;
prevention of the appearance and elimination of comedones (retinoids, especially retinoic acid, salicylic alcohol);
prevention of scarring (early start of treatment, retinoids, curiosin, contractubex, exclusion of injury to rashes).

Features of acne treatment with drugs of different groups

Currently, retinoids are the most effective group of drugs for the treatment of acne. Their use solves several problems at once - reducing the production of sebum and inflammation, preventing the appearance and elimination of comedones and scars. Two isomers of retinoic acid (tretinoin and isotretinoin) are used externally for the treatment of acne. Roaccutane and Retinol palmitate are used for internal treatment of acne conglobata and widespread papulo-pustular acne resistant to other external agents.

Roaccutane (isotretinoin) (Hoffmann-La Roche, Switzerland) is produced in capsules for oral administration of 10 and 20 mg (30 pieces per pack). Assign at the rate of 0.5-1.0 mg / kg of body weight per day, taken in equal parts 2 times a day after meals for 12-16 weeks. If necessary, repeated courses break should be at least 8 weeks. Roaccutane is a highly effective drug, however, its use is limited by high cost and many side effects. Treatment is always carried out under the supervision of a specialist.

Retinol palmitate (vitamin A) is a domestic drug, it is produced in capsules for oral administration poiME, as well as in an oil solution poIU/ml. Effective doses for acne at least IU per day. The course of treatment is 12-16 weeks. The intervals between courses are 4-8 weeks. Retinol palmitate is inferior to Roaccutane in effectiveness, however, its tolerance is better, and the cost is much lower.

For external treatment of acne, preparations containing all-trans retinoic acid (tretinoin) and 13-cis-retinoic acid (isotretinoin) are used. All-trans-retinoic acid is contained in the following foreign preparations: Retin-A - 0.05% cream in tubes of 30 g (Silag, Switzerland), Lokacid - 0.05% cream in tubes of 30 g and 0.1% solution in 15 ml vials (Pierre Fabre, France). External preparations with 13-cis-retinoic acid, which has a higher bioavailability, are produced only in Russia - Retinoic ointment 0.1% and 0.05% and Retasol ® (FNPP "Retinoids"). Ointments and solution are recommended to be applied to previously cleansed skin 1-2 times a day. Upon reaching the effect, it is recommended to reduce the concentration or reduce the frequency of application of the drug. The duration of treatment is 12-16 weeks.

Drugs from the group of retinoids have a number of side effects. The most serious of them are teratogenicity and embryotoxicity. In this regard, women of childbearing age are prescribed retinoids with reliable contraception and a negative pregnancy test. In the outpatient card, when prescribing systemic treatment, a note is usually made about the woman's awareness of possible side effects, and abroad, dermatologists suggest that women fill out and sign a special form in order to avoid further prosecution in case of side effects. External treatment with drugs of this group is stopped when pregnancy occurs. Retinoids do not have a negative effect on the reproductive function of men.

In the first or second week of treatment, most patients experience an exacerbation reaction, which is expressed in redness, moderate itching, and peeling of the skin. The patient should be warned about the reaction, and if important events in life are coming at this time, then it is better to postpone the start of treatment. Usually these phenomena disappear on their own within a few days, after which there is a persistent improvement. Dryness of the lips, cracks in the corners of the mouth, peeling of the skin are frequent during the treatment process, they are eliminated by using a neutral moisturizer for the face and body, hygienic lipstick or lip gel, limiting the use of detergents when washing and washing. With the systemic administration of retinoids, dryness of the nasal mucosa, nosebleeds, conjunctivitis, urethritis, increased levels of transaminases and lipids in the blood, and increased skin sensitivity to sunlight are sometimes observed. Taking this into account, before the start of treatment and monthly during the course of treatment, a biochemical blood test is performed, it is recommended to use protective sunscreen, avoid direct sunlight.

Contraindications

pregnancy and lactation, abnormalities in the biochemical analysis of blood (hyperlipidemia, increased activity of ALT, AST and alkaline phosphatase), renal and hepatic insufficiency, hypervitaminosis A, drug intolerance. It is impossible to prescribe simultaneously retinoids inside and out, ultraviolet irradiation, preparations with keratolytic and exfoliating effects, exfoliating cosmetic procedures and products (scrubs, peeling). The action of retinoids is weakened by the simultaneous use of glucocorticosteroid drugs and alcohol intake.

Antibiotics

Of the wide range of antibiotics for the treatment of acne, only tetracyclines, erythromycin, lincomycin, josamycin and clindamycin are used. The appointment of antibiotics inside is indicated for the defeat of a large area of the skin, the predominance of pustules. During pregnancy, of these drugs, only erythromycin can be used.

Antibiotics of the tetracycline group have an advantage over other groups, since they are lipophilic and easily reach the main object of their action - the sebaceous glands. They can be prescribed for a long time - 2-3 months in a small dose. In this case, they block the production of bacterial lipases, the main link in the development of inflammation. An essential advantage of this method is the possibility of long-term treatment without disturbing the composition of the intestinal flora. The daily dose of tetracycline is 1000 mg (10 tablets of 0.1 g or 4 tablets of 0.25 g), doxycycline hydrochloride - 50 mg (1 capsule of 0.05 g once a day), unidox solutab - 50 mg ( 1/2 tablet of 0.1 g), metacycline - 600 mg (2 times a day, 0.3 g). Antibiotics of the tetracycline group at the indicated doses are always well tolerated, and side effects characteristic of long-term use at a bacteriostatic dose do not develop. Tetracyclines are contraindicated in concomitant fungal diseases, pregnancy (last trimester), liver dysfunction, leukopenia, children under 8 years of age, kidney disease. During treatment, insolation is not recommended, ultraviolet irradiation, retinoids for internal use, hormonal contraceptives, psychotropic, anticonvulsant and antidiabetic drugs are not prescribed. The absorption of tetracycline is weakened in the presence of food, especially milk and dairy products, as well as trace elements - aluminum, calcium, magnesium, iron. Their use should be avoided during treatment. Tablets are taken separately from meals.

Doxycycline, Metacycline and Unidox Solutab are better absorbed and can be taken with or after meals with plenty of water. Unfortunately, the resistance of microorganisms to the drugs of this group quickly develops, and when re-administered, they are rarely effective.

Erythromycin belongs to the group of macrolides, the daily dose -mg is divided into 3-4 doses 1-1.5 hours before meals. The drug is produced in tablets or capsules of 0.1, 0.25 and 0.5 g. Possible side effects include nausea, vomiting, diarrhea, liver dysfunction. The drug is contraindicated in case of individual intolerance, liver diseases with impaired function. It should be borne in mind that erythromycin is inactivated by dairy products and acidic drinks, and also increases blood levels and enhances the toxic effect of carbamazepine (tegretol, finlepsin) and theophylline.

Clindamycin (lincomycin group) is prescribed in a daily dose of 0.6 g, divided into 2 doses, is available in capsules of 0.15 g and called Dalacin C - 0.15 and 0.3 g each. The course of treatment is 7-10 days. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with erythromycin and vitamins of group B. Lincomycin is prescribed in a daily dose of 1500-2000 mg (2 tablets 3-4 times a day), is available in capsules of 0.25 g. The duration of treatment and side effects are similar to clindamycin.

Josamycin or vilprafen in a daily dose of 1000 mg (1 tab. 2 times a day between meals) is used for 2-4 weeks, then 1 tab. within 8 weeks. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with lincomycin, weakens the effect of hormonal contraceptives.

In case of intolerance to antibiotics, they resort to sulfanilamide preparations, usually co-trimoxazole (biseptol, septrin, groseptol, cotrifarm 480). The drug is prescribed pomg (1-2 tablets) 2 times a day during or after meals with an interval of 12 hours. During treatment, it is recommended to drink plenty of fluids, monitor the condition of blood and urine, avoid solar and ultraviolet radiation, and do not prescribe ascorbic acid.

It is logical to assume that the local use of the above antibiotics can be much more effective and safer than the internal one. However, studies show that topical erythromycin, clindamycin, and tetracycline are only effective for mild acne, especially when combined with zinc, retinoids, or benzoyl peroxide. External application of 1% erythromycin ointment (Ung. Erythromycini 1%) has a positive effect only in combination with other external and internal agents, the gel with clindamycin Dalacin T (Pharmacy, USA) is more effective. Easy to use Eriderm (Eryderm, Abbott Labor, USA) - 2% solution of erythromycin. Levomycetin, boric, resorcinol alcohols are also used for drying and cauterization of individual rashes. Combined preparations are effective - Zinerit ("Yamanouchi", the Netherlands) - a solution of erythromycin and zinc acetate and Benzamycin, a gel for external use, in tubes of 20 g, ("Rhone-Poulenc Rohrer", USA), containing 3% erythromycin and 5% benzoyl peroxide. All of the above drugs are prescribed 2 times a day. As with oral antibiotics, topical preparations tend to cause the development of antibiotic-resistant strains of microorganisms, so their repeated administration is often ineffective. Resistance of strains of Propionibacterium acnes (the main microorganism that multiplies in the sebaceous glands of patients) to commonly used antibiotics was found in 60% of patients. Strengthening of resistance depends on the duration of therapy, resistance to erythromycin develops more often.

Other antiseptics and disinfectants. One of the successful modern approaches to treatment is the use of benzoyl peroxide - a lipophilic compound due to the presence of a benzoic acid residue in its composition. When applied to the skin, benzoyl peroxide decomposes under the action of air into peroxide and inactive benzoic acid, which remains on the surface of the skin. Active oxygen compounds damage the walls of bacteria, destroying them, the content of fatty acids decreases, which prevents inflammation. At the same time, the same compounds have a damaging effect on the horny scales, which is clinically expressed by skin peeling, which accompanies the therapeutic effect. Benzoyl peroxide preparations do not affect comedones, therefore, if they predominate, they are not used. Different companies offer this drug under the names Benzakne (Polfa, Poland), Desquam (Bristol-Myers, USA), Oxy 5 and Oxy 10 (SmithKline Beach, UK), Baziron (Galderma, France). Benzoyl peroxide is produced in the form of 2%, 5%, and 10% gel, 5% and 10% lotion. Treatment begins with the application of a lower concentration of the drug to the face, then it is increased. A higher concentration is immediately applied to the back and chest. Benzoyl peroxide is applied to previously cleansed skin once a day. Side effects include an exacerbation reaction in the first days of use, dryness and flaking of the skin, discoloration of hair and linen when the drug comes into contact with them. Intolerance is not uncommon, therefore, before starting treatment, it is recommended to conduct a skin test - the drug is applied to a small area of the skin of the flexor surface of the forearm for 48 hours. In the absence of itching and redness, you can apply the drug on the face.

A good effect, especially in the presence of comedones, has a combination of local application of benzoyl peroxide in the morning, and Retinoic ointment in the evening.

Azelaic acid inhibits the growth of microorganisms and reduces the content of free fatty acids on the surface of the skin. Cream or gel Skinoren (Schering, Germany), containing 20% and 15% azelaic acid, respectively, is applied to the skin of the face (both on the affected and free areas from rashes) 2 times a day. When applied, local skin irritation is possible. Skinoren is used in the complex therapy of acne; its use as an independent remedy usually does not bring success.

Zinc hyaluronate is part of the Curiosin gel (Gedeon Richter, Hungary), has a healing and antimicrobial effect. It can be used with a small amount of rashes, since the effectiveness of the drug is low. The gel is applied to cleansed skin twice a day, there may be a burning sensation and redness of the skin at the application sites.

Povidone-iodine (Betadine) is used to lubricate pustules in a concentrated (10%) or diluted 1:1 solution with water 1-2 times a day. It is undesirable to use in fair-skinned and red-haired patients due to increased sensitivity to iodine. The diluted solution cannot be stored.

With a small number of comedones in the initial stage of the disease, salicylic alcohol 2-3% is effective. It is used 2 times a day, trying not to apply to the entire affected area in order to avoid overdrying, but only to certain areas.

Sulfur is an anti-inflammatory agent, it is included as one of the components in most external agents (ointments and talkers) traditionally used in the treatment of acne. However, in recent years, its comedogenic effect has been discovered, i.e. it can cause the formation of comedones.

hormone therapy

Therapy with sex hormones is possible only in women. Estrogens (ethinylestradiol) and antiandrogens (cyproterone acetate, spironolactone) can be used for treatment. Estrogens reduce the secretion of the sebaceous glands, however, not as significantly as retinoids. They can be used simultaneously with local administration of retinoic acid, antibiotics or benzoyl peroxide, which increases the therapeutic effect. To achieve a good result, estrogens must be given for a long time - at least 5 cycles. The first signs of improvement are noticeable only towards the end of the second or third cycle. Estrogens have many side effects - nausea, fluid retention in the body, swelling of the legs, weight gain, breast tenderness, skin pigmentation, and an increased risk of vascular thrombosis. Risk factors for side effects include smoking, alcohol consumption, obesity, and vascular disease. Cyproterone acetate for the treatment of acne is used only in combination with estrogens. Of the combined preparations, Diane-35 and Janine (Schering, Germany) are used. The drug is prescribed 1 tablet per day, starting from the first day of the cycle, for 21 days with a break of 7 days. The antiandrogenic drug Cyproterone or Androkur (Schering, Germany) is prescribed 1 tablet (10 mg) per day, starting from the first day of the cycle for 15 days, a new course is started 4 weeks after the start of the first one. Glucocorticosteroid drugs are prescribed orally or parenterally only for abscessing and fulminant acne, which are extremely rare. External use of corticosteroid ointments is not indicated.

Drugs of other groups

Zincteral ("Polfa", Poland) contains zinc sulfate, the deficiency of which is often found in patients with acne. Tablets of 0.124 g are prescribed 1-2 times a day during or immediately after meals for 1-2 months. Nausea may occur during the first week of use. The drug enhances the action of retinoids, but weakens - tetracyclines. Homeopathic treatments include injections of Cutis compositum or Traumeel (Heel, Germany). Phytotherapy is still widely used as adjuvants - applications of gruel from badyagi for resorption of individual large nodes, lotions with green tea, calamus rhizome, raspberry shoots. Inside appoint infusions of plants with estrogenic action (hop cones, sage leaves).

Skin care

Many patients, feeling the increased sebum secretion characteristic of acne, try to wash their face as often as possible using soap and a sponge. At the same time, the skin dries up, but sebum secretion does not become significantly lower, since the washing out of fats occurs only from the surface of the skin, without affecting the sebaceous glands themselves, located in its depths. In this regard, frequent washing of the skin (no more than 1 time per day), the use of sponges and washcloths are not recommended in order to avoid irritation and injury. Now many use antimicrobial soap. But it changes the state of the microbial flora only on the surface of the skin and does not significantly affect the course of the disease. At the same time, antimicrobial additives contained in soap can cause irritation or allergic reactions. To clean the skin, it is better to use a mild neutral soap for sensitive skin or special cosmetics designed for this purpose (cleansing with milk, then tonic), and to eliminate the shine of the face associated with the release of sebum to the surface, use cosmetic wipes or special matting facilities. The widely held belief that makeup should not be used for acne has also now been reconsidered. Modern high-quality cosmetics that do not irritate the skin, well mask existing defects, do not significantly disturb perspiration, are not applied to the skin in a thick layer, and can be used during the day. It should be removed at home. Some medicines require the use of sunscreen. It is better to prefer gels and milk, and also be sure to quickly remove them from the skin indoors. Scrubs and peels may be recommended to smooth the surface of the skin and give it freshness, but are contraindicated during treatment with retinoids, benzoyl peroxide and tetracyclines.

The use of therapeutic masks with a drying effect and detergents is limited during treatment with retinoids and alcohol solutions. If there are pustules on the skin and severe inflammation, massage and cosmetic cleaning of the skin are contraindicated.

Diet

Both in the past and now, most dermatologists always recommend a fairly strict diet. Our long-term observations have shown that the benefits of such restrictions are small, and only in a few patients there is a clear relationship between the consumption of certain foods (mainly chocolate) and increased rashes. Usually we recommend that patients follow a reasonable diet, no frills, include more fermented milk products and greens in the diet. However, 2-3 days of fasting during an exacerbation always give a positive result. In general, when prescribing modern therapeutic agents, there is no need to follow any diet to achieve a good result. If the patient is to take part in a festive feast, it is better to cancel oral administration of drugs for 2-3 days and prescribe enterosorbents (Polifepan, Enterosgel, etc.).

The initial stage - a few small black dots appear on the nose and forehead (usually in children) - Salicylic alcohol, Retinoic ointment, Skinoren, medical cosmetics.
The same, but with significant oily skin - Retinoic ointment, Salicylic alcohol.
Numerous black dots and individual inflammatory nodules and pustules - Retinoic ointment, Salicylic alcohol, for pustules - alcohols with antibiotics, Dalacin T, Povidone-iodine.
The predominance of inflammation with a small number of comedones - Retinoids (Retinoic ointment, Retasol ®), benzoyl peroxide (Benzacne, Desquam, Oxy 5 and Oxy 10, Baziron), external preparations with antibiotics (Dalacin T, Zinerit, Eriderm, Benzamycin).
The predominance of pustules in a common process (face, back, chest) - antibiotics, in some cases - retinoids inside (Roaccutane, Retinol palmitate), externally - benzoyl peroxide, disinfectants.
Separate large painful ulcers on the face - antibiotics, externally - antibiotic ointments and benzoyl peroxide.

Seborrhea and seborrheic dermatitis

In recent years, what used to be united by one term “seborrhea” began to be divided into 2 concepts - seborrhea of the head and seborrheic dermatitis (damage to smooth skin).

Seborrheic dermatitis is a chronic inflammatory skin disease. It affects 1-3% of adults (mostly men). Seborrheic dermatitis, along with acne, refers to disorders of sebum secretion. Indeed, both diseases are often combined in the same person and the same areas of the skin are affected - the so-called "seborrheic zones" - the face, chest (decollete area) and the middle part of the back along the spine (interscapular region), where the largest sebaceous glands with wide ducts that secrete a large amount of sebum. The sebaceous glands of this type actively develop and increase in size during puberty. The composition of sebum also changes, it becomes more viscous, the components contained in it contribute to increased keratinization, which corresponds to peeling that is visible to the eye. Smaller glands, but also secreting a large amount of sebum, are located on the scalp. Their purpose is to provide fatty lubrication of the hair, to make it invulnerable to external influences. These glands are also more active during puberty. In adolescents and adults, the mildest form of seborrheic dermatitis is characterized by peeling of the skin and its excessive oiliness without inflammation - on the scalp it is dandruff, and on the face and chest - accumulations of fatty scales in the skin folds - near the wings of the nose, in the nasolabial fold, on the bridge of the nose , less often - on the chest and back. Oily scales soaked in sebum serve as a good breeding ground for the development of lipophilic fungi Malassezia furfur or Pityrosporum ovale. In turn, the immune system reacts to them with the development of allergic dermatitis, the disease enters its second, more unpleasant phase, and ceases to be limited to mild manifestations. There are itching, burning, at first mild, then more intense reddening of the skin, severe peeling, hair loss. The manifestations of the disease are aggravated by the patients themselves - constant combing, attempts to remove crusts, remove accumulations of scales from the hair, the use of "folk" remedies, and the most powerful ones, inevitably lead to increased redness, the appearance of scratches and wounds, the multiplication of other microbes, the development of complications pustular process. Usually in this condition, patients turn to a dermatologist, although everything could be corrected much earlier.

With any manifestation of the disease, attention should be paid to the diet. Sometimes its correction is enough to prevent further development of the disease. Alcohol, sweets and starchy foods should be limited, regardless of the type of food. With itching and inflammation, smoked, salty, pickled foods, spicy seasonings, strong broths, instant coffee, citrus fruits, kiwi, pineapples and juices from them are also temporarily limited.

Treatment depends on the stage of development and the clinical picture of the disease. With the appearance of dandruff without the presence of inflammation, you can limit yourself to only external treatment, in more serious cases, internal treatment is also necessary. External treatment includes keratolytic, glucocorticosteroid, antiseptic, disinfectant and antifungal agents. Antifungal drugs usually start treatment, they can be used for a long time without the risk of side effects. Various dosage forms are used - creams, gels, shampoos. Shampoos with antifungal substances - Nizoral, Keto-plus, Perkhotal, Mycozoral, Sebozol contain 1-2% ketoconazole. Tee/Jel anti-dandruff shampoo contains 0.75% piroctone olamine and 2% salicylic acid. Creams and gels are applied 2 times a day, shampoos - 3 times a week. Various other medicinal substances that also have antifungal properties include zinc pyrithionate, tar, sulfur, resorcinol, and selenium disulfide. Drugs containing these compounds are available in the form of shampoos for the treatment of dandruff (Friderm-tar, Ti / Gel-Nyutar, Friderm-zinc) and ointments for the treatment of smooth skin lesions (Skin-cap, birch tar, tar and sulfur-tar ointment ). Prescription forms are also used: Vidal's milk, alcohol solutions with sulfur, boric acid, tar. After hair treatment, it is obligatory to change combs and hair brushes, hats.

With severe inflammation, anti-inflammatory, antiseptic and disinfectants are used. With wetting and severe swelling of the foci, lotions with resorcinol 1%, decoctions of herbs are used. The crusts are usually lubricated with alcohol solutions (salicylic, resorcinol, boric alcohols). Corticosteroids have a rapid anti-inflammatory effect - they are used on the head in the form of solutions - Elokom, Diprosalik (Schering-Plough USA), Lokoid (Janssen-Silag Belgium), Belosalik (Belupo, Croatia), on seborrheic zones - in the form of ointments and creams - Elokom, Diprosalik, Belosalik, Hydrocortisone ointment. It should be noted that only non-fluorinated glucocorticosteroids in the form of easily absorbed creams and emulsions (Advantan emulsion, Elokom cream, Lokoid cream) or weak (Prednisolone, Hydrocortisone) ointments can be used on the skin of the face, which is much thinner than in other areas. Preparations of this group are not suitable for long-term use due to the risk of undesirable effects - thinning of the skin, vasodilation, the appearance or intensification of acne. When it is possible to remove acute inflammation (usually in 3-5 days), and with residual peeling, they are replaced by preparations containing vitamin A - emulsion-based ointments Videstim ® , Radevit ® (FNPP Retinoids, Russia). It is known that vitamin A (retinol palmitate) reduces sebum secretion by reducing the size of the sebaceous glands and keratinization, and also has the properties of a local immunomodulator. Videstim ® contains 0.5% retinol palmitate on an emulsion basis, Radevit ® contains 1% retinol palmitate, ergocalciferol and tocopherol acetate (vitamins A, D and E). Drugs are used for a long time, including for the purpose of preventing relapses. In recent years, the local immunomodulator pimecrolimus, supplied to Russia under the name Elidel, has also been used in the treatment. Keratolytic agents are used for severe peeling and crusting. Apply sulfur-salicylic ointment 2-5% 1.5-2 hours before washing the hair under a scarf, on the face - 1 hour before washing, 10% urea ointment Karboderm (Ukraine). A particularly good effect is brought by combined preparations that combine the keratolytic properties of salicylic acid and anti-inflammatory glucocorticosteroids - Diprosalik, Belosalik. Internal remedies include vitamin A (retinol palmitate) in a daily dose of IU (once at night for 2 months), B vitamins, in particular brewer's yeast (Merz Germany and domestic companies), brewer's yeast with the addition of zinc and selenium Nagipol , multivitamin-mineral complexes, preparations with selenium (Selevit, Triovit), zinc (Zincteral). To reduce fat formation in women, hormone therapy (Diana-35, Janine) and antiandrogens (Androkur) are used - see above. Despite successful therapy, the disease often recurs. A rational approach to diet and a careful selection of skin and hair care products are necessary to maintain a favorable treatment result for as long as possible.

Acne vulgaris or juvenile acne

Acne- the most common skin disease in adolescents and young people, that is, the most socially active part of the population. This unpleasant disease affects about 85% of people aged 12 to 25 in European countries, so clear skin at this age is the exception rather than the rule. The presence of inflamed pimples, pustules and abscesses, blackheads (comedones), spots and scars, greasy, untidy appearance of the skin in the most prominent places causes difficulties in communication, professional device, reduces self-esteem, often leads to the formation of significant psycho-emotional disorders, up to the desire to complete isolation. Some young people stop leaving the house, drop out of school and work, become isolated, and in the end, a minor and completely banal skin problem develops into a personal tragedy. A patient who has addressed to a dermatologist about acne has serious psychological problems. Shyness, guilt, a sense of social unacceptability, anger, a state of depression, disbelief in the possibility of a cure are expressed to one degree or another. Intense experiences exacerbate the course of the disease. In stressful situations, patients, especially women, open the skin, squeeze out Acne, which further worsens the appearance of the skin due to the accompanying inflammation. On such injured areas, scars and spots remain that do not go away for a long time.

Acne- a long-term disease, often aggravated (in girls, as a rule, monthly) and often resistant to ongoing treatment. Today we know much more about acne than ten years ago, and a competent specialist can always help the patient. In this regard, the opinion that existed in the past that acne will disappear by itself with age, and therefore it is not worth spending effort on treating them, now sounds simply absurd. It is not always possible to immediately find the right individual approach, but the efforts made and the persistence shown are always rewarded with a good result. In the arsenal of specialists there are a number of effective drugs of different groups. The choice of the drug depends on the form of the disease, the prevalence of certain symptoms, the sex of the patient, the presence of contraindications.

Acne is more often divided into:

acne with a predominance of comedones (white and black dots with mild inflammation);
papulo-pustular acne (there are comedones, inflamed nodules - what is usually called acne, pustules, sometimes single large painful seals, gradually turning into abscesses such as boils);
conglobate acne (along with all of the above, there are long-term painful seals that leave pronounced scars after healing).

With the initial manifestations of acne (usually at the age of 8–13 years), when the clinical picture is dominated by increased oily skin and comedones (whitish nodules and black dots), and there are not so many inflammatory elements, retinoic and salicylic acid preparations are used externally. Both acids have the ability to dissolve comedones, and salicylic acid is much weaker in this regard. With papulo-pustular acne, it is advisable to use antibiotics, retinoids, benzoyl peroxide (benzoyl peroxide), traditional external agents (salicylic, chloramphenicol, resorcinol alcohols). Severe forms of acne, including acne conglobata, should be treated with oral retinoids, and only if there are contraindications, other methods of treatment (antibiotics, immunomodulators) are used. As with papulopustular acne, it is preferable to use a combination of different drugs.

Problems solved in the course of treatment and ways to solve them:

decrease in sebum production (retinoids, especially retinoic acid, hormonal drugs - estrogens, progestins or antiandrogens, spironolactones);
reduction of inflammation - antibiotics (tetracyclines, erythromycin, lincomycin, clindamycin) and local anti-inflammatory and microcirculation-improving agents, including zinc oxide, sulfur, tar, ichthyol, resorcinol;
prevention of the appearance and elimination of comedones (retinoids, especially retinoic acid, salicylic alcohol);
prevention of scarring (early start of treatment, retinoids, curiosin, contractubex, exclusion of injury to rashes).

Features of acne treatment with drugs of different groups

Currently, retinoids are the most effective group of drugs for the treatment of acne. Their use solves several problems at once - reducing the production of sebum and inflammation, preventing the appearance and elimination of comedones and scars. Two isomers of retinoic acid (tretinoin and isotretinoin) are used externally for the treatment of acne. Roaccutane and Retinol palmitate are used for internal treatment of acne conglobata and widespread papulo-pustular acne resistant to other external agents.

Retinol palmitate(vitamin A) - a domestic drug, it is produced in capsules for oral administration of 33,000 and 100,000 IU, as well as in an oil solution of 100,000 IU / ml. Effective doses for acne are at least 300,000 IU per day. The course of treatment is 12-16 weeks. The intervals between courses are 4-8 weeks. Retinol palmitate is inferior to Roaccutane in effectiveness, however, its tolerance is better, and the cost is much lower.

Contraindications

Antibiotics

Erythromycin belongs to the group of macrolides, the daily dose - 500-1000 mg is distributed in 3-4 doses 1-1.5 hours before meals. The drug is produced in tablets or capsules of 0.1, 0.25 and 0.5 g. Possible side effects include nausea, vomiting, diarrhea, liver dysfunction. The drug is contraindicated in case of individual intolerance, liver diseases with impaired function. It should be borne in mind that erythromycin is inactivated by dairy products and acidic drinks, and also increases blood levels and enhances the toxic effect of carbamazepine (tegretol, finlepsin) and theophylline.

In case of intolerance to antibiotics, they resort to sulfanilamide preparations, usually co-trimoxazole (biseptol, septrin, groseptol, cotrifarm 480). The drug is prescribed at 480-960 mg (1-2 tablets) 2 times a day during or after meals with an interval of 12 hours. During treatment, it is recommended to drink plenty of fluids, monitor the condition of blood and urine, avoid solar and ultraviolet radiation, and do not prescribe ascorbic acid.

A good effect, especially in the presence of comedones, has a combination of local application of benzoyl peroxide in the morning, and Retinoic ointment in the evening.

hormone therapy

Drugs of other groups

Skin care

Diet

The initial stage - a few small black dots appear on the nose and forehead (usually in children) - Salicylic alcohol, Retinoic ointment, Skinoren, medical cosmetics.
The same, but with significant oily skin - Retinoic ointment, Salicylic alcohol.
Numerous black dots and separate inflammatory nodules and pustules - Retinoic ointment, Salicylic alcohol, for pustules - alcohols with antibiotics, Dalacin T, Povidone-iodine.
The predominance of inflammation with a small number of comedones - Retinoids (Retinoic ointment, Retasol ®), benzoyl peroxide (Benzacne, Desquam, Oxy 5 and Oxy 10, Baziron), external preparations with antibiotics (Dalacin T, Zinerit, Eriderm, Benzamycin).
The predominance of pustules in a common process (face, back, chest) - antibiotics, in some cases - retinoids inside (Roaccutane, Retinol palmitate), externally - benzoyl peroxide, disinfectants.
Separate large painful ulcers on the face - antibiotics, externally - antibiotic ointments and benzoyl peroxide.

Seborrhea and seborrheic dermatitis

In recent years, what used to be united by one term “seborrhea” began to be divided into 2 concepts - seborrhea of the head and seborrheic dermatitis (damage to smooth skin).

Seborrheic dermatitis is a chronic inflammatory skin disease. It affects 1-3% of adults (mostly men). Seborrheic dermatitis, along with acne, refers to disorders of sebum secretion. Indeed, both diseases are often combined in the same person and the same areas of the skin are affected - the so-called "seborrheic zones" - the face, chest (decollete area) and the middle part of the back along the spine (interscapular region), where the largest sebaceous glands with wide ducts that secrete a large amount of sebum. The sebaceous glands of this type actively develop and increase in size during puberty. The composition of sebum also changes, it becomes more viscous, the components contained in it contribute to increased keratinization, which corresponds to peeling that is visible to the eye. Smaller glands, but also secreting a large amount of sebum, are located on the scalp. Their purpose is to provide fatty lubrication of the hair, to make it invulnerable to external influences. These glands are also more active during puberty. In adolescents and adults, the mildest form of seborrheic dermatitis is characterized by peeling of the skin and its excessive oiliness without inflammation - on the scalp it is dandruff, and on the face and chest - accumulations of fatty scales in the skin folds - near the wings of the nose, in the nasolabial fold, on the bridge of the nose , less often - on the chest and back. Oily scales soaked in sebum serve as a good breeding ground for the development of lipophilic fungi Malassezia furfur or Pityrosporum ovale. In turn, the immune system reacts to them with the development of allergic dermatitis, the disease enters its second, more unpleasant phase, and ceases to be limited to mild manifestations. There are itching, burning, at first mild, then more intense reddening of the skin, severe peeling, hair loss. The manifestations of the disease are aggravated by the patients themselves - constant combing, attempts to remove crusts, remove accumulations of scales from the hair, the use of "folk" remedies, and the most powerful ones, inevitably lead to increased redness, the appearance of scratches and wounds, the multiplication of other microbes, the development of complications pustular process. Usually in this condition, patients turn to a dermatologist, although everything could be corrected much earlier.

Treatment depends on the stage of development and the clinical picture of the disease. With the appearance of dandruff without the presence of inflammation, you can limit yourself to only external treatment, in more serious cases, internal treatment is also necessary. External treatment includes keratolytic, glucocorticosteroid, antiseptic, disinfectant and antifungal agents. Antifungal drugs usually start treatment, they can be used for a long time without the risk of side effects. Various dosage forms are used - creams, gels, shampoos. Shampoos with antifungal substances - Nizoral, Keto-plus, Perkhotal, Mycozoral, Sebozol contain 1-2% ketoconazole. Tee/Jel anti-dandruff shampoo contains 0.75% piroctone olamine and 2% salicylic acid. Creams and gels are applied 2 times a day, shampoos - 3 times a week. Various other medicinal substances that also have antifungal properties include zinc pyrithionate, tar, sulfur, resorcinol, and selenium disulfide. Drugs containing these compounds are available in the form of shampoos for the treatment of dandruff (Friderm-tar, Ti / Gel-Nyutar, Friderm-zinc) and ointments for the treatment of smooth skin lesions (Skin-cap, birch tar, tar and sulfur-tar ointment ). Prescription forms are also used: Vidal's milk, alcohol solutions with sulfur, boric acid, tar. After hair treatment, it is obligatory to change combs and hair brushes, hats.

With severe inflammation, anti-inflammatory, antiseptic and disinfectants are used. With wetting and severe swelling of the foci, lotions with resorcinol 1%, decoctions of herbs are used. The crusts are usually lubricated with alcohol solutions (salicylic, resorcinol, boric alcohols). Corticosteroids have a rapid anti-inflammatory effect - they are used on the head in the form of solutions - Elokom, Diprosalik (Schering-Plough USA), Lokoid (Janssen-Silag Belgium), Belosalik (Belupo, Croatia), on seborrheic zones - in the form of ointments and creams - Elokom, Diprosalik, Belosalik, Hydrocortisone ointment. It should be noted that only non-fluorinated glucocorticosteroids in the form of easily absorbed creams and emulsions (Advantan emulsion, Elokom cream, Lokoid cream) or weak (Prednisolone, Hydrocortisone) ointments can be used on the skin of the face, which is much thinner than in other areas. Preparations of this group are not suitable for long-term use due to the risk of undesirable effects - thinning of the skin, vasodilation, the appearance or intensification of acne. When it is possible to remove acute inflammation (usually in 3-5 days), and with residual peeling, they are replaced by preparations containing vitamin A - emulsion-based ointments Videstim ® , Radevit ® (FNPP Retinoids, Russia). It is known that vitamin A (retinol palmitate) reduces sebum secretion by reducing the size of the sebaceous glands and keratinization, and also has the properties of a local immunomodulator. Videstim ® contains 0.5% retinol palmitate on an emulsion basis, Radevit ® contains 1% retinol palmitate, ergocalciferol and tocopherol acetate (vitamins A, D and E). Drugs are used for a long time, including for the purpose of preventing relapses. In recent years, the local immunomodulator pimecrolimus, supplied to Russia under the name Elidel, has also been used in the treatment. Keratolytic agents are used for severe peeling and crusting. Apply sulfur-salicylic ointment 2-5% 1.5-2 hours before washing the hair under a scarf, on the face - 1 hour before washing, 10% urea ointment Karboderm (Ukraine). A particularly good effect is brought by combined preparations that combine the keratolytic properties of salicylic acid and anti-inflammatory glucocorticosteroids - Diprosalik, Belosalik. Internal remedies include vitamin A (retinol palmitate) in a daily dose of 100,000–200,000 IU (once at night for 2 months), B vitamins, in particular brewer's yeast (“Merz” Germany and domestic companies), brewer's yeast with the addition of zinc and selenium Nagipol, multivitamin-mineral complexes, preparations with selenium (Selevit, Triovit), zinc (Zincteral). To reduce fat formation in women, hormone therapy (Diana-35, Janine) and antiandrogens (Androkur) are used - see above. Despite successful therapy, the disease often recurs. A rational approach to diet and a careful selection of skin and hair care products are necessary to maintain a favorable treatment result for as long as possible.

prof. IN AND. Albanova

Oily skin can be annoying, and sometimes you may feel like there's nothing you can do about it. In people with oily skin, the sebaceous glands produce too much sebum. While oily skin is linked to genetic factors, hormones, and other factors, there are several ways to take care of oily skin. To reduce the production of sebum, consult a dermatologist, the doctor will advise medications, it is also important to clean such skin regularly, and you can also try some natural remedies to reduce the production of sebum.

Steps

Medicines

Preparations with retinoids. If you have oily, acne-prone skin, then you should probably see a dermatologist and discuss retinoid treatment. This type of medication is used to treat acne and excess sebum. Preparations with retinoids are both in the form of tablets (isotretinoin) and in the form of creams or gels (tretinoin, adapalene, tazarotene). Oral retinoids are often more effective than creams or gels. However, it is likely that the doctor will prescribe creams or gels, as they have fewer side effects compared to pills.

Androgen inhibitors. Excess sebum production can be caused by excess androgenic hormones. If the skin is oily because of this, then the doctor will prescribe androgen inhibitor drugs, such as spironolactone or cyproterone. These medications help reduce the amount of sebum produced by the body. Preparations can be both oral and topical.

Contraceptive drugs with estrogen. If you are a girl and suffer from excessive sebum production, then you can try taking hormonal contraceptives. In some cases, they help make the skin less oily, however, in other girls, they only exacerbate the problems. Ask your doctor if this option will work for you.

Contraceptive drugs reduce the amount of androgens in the body, and this, in turn, reduces the production of sebum.

Light therapy and laser therapy. Light therapy and laser therapy are often used to reduce sebum production. Photodynamic therapy and diode laser therapy can reduce sebum production by the sebaceous glands. Many dermatologists recommend light or laser therapy along with other treatments. But remember that some medications can make your skin sensitive to light, so laser therapy may not be right for you.
- Light and laser therapy may be good options for those who cannot use medication, such as pregnant women. These treatments are non-invasive and fairly safe.
- Multiple treatments are often required for best results, and they can be quite expensive.
Do not use rough materials for washing. A lot of people think that rubbing the skin will get rid of fat better, but in fact, this can aggravate the skin condition. Do not use sponges or washcloths. Scrubbing the skin with such materials damages the skin and makes it more oily. Do not use such rough products, and if you want, use only soft materials.

Adjust skin care measures as needed. The production of sebum depends on the season. Hormone levels also fluctuate every week or every month. All this can affect the production of sebum. If you notice that your skin has become more oily than usual, then start washing with an oily skin cleanser more often.
- You can use toners or make clay skin masks if your skin has become more oily. Apply toners or masks only to oily areas of the face or body. These products are very drying to the skin.
- For example, in summer the sebaceous glands can produce more secretion than in winter. And this means that you need different means for washing in winter and summer.
Folk remedies
1. Make an egg white mask. Periodically arrange a "spa day" for yourself and make an egg white mask - this will help reduce sebum production. Egg whites are a natural remedy that absorbs sebum. To make a mask, mix egg white with honey. Add some flour to make the mask into a paste-like consistency. Apply the mask to the face or parts of the body where excess sebum is produced.
  - Wash off the mask with warm water after 10 minutes.
2. Make masks out of baking soda. Baking soda masks help reduce skin secretion. Mix baking soda with water in a ratio of 3:1. Then apply the resulting paste on your face with light massage movements and leave it on the skin for about five minutes. After that, rinse with warm water and dry your face.