Dra. Deyanira Sáenz de Villanueva
Dr. Carlos Villanueva Ochoa
MULTIMEDICA VISTA HERMOSA
It is the most common skin disease, it is characterized by chronic inflammation of the pilosebaceous unit, it affects most teenagers and it tends to disappear as a person becomes closer to turning 20 years old, although occasionally it lasts longer. This disease is suffered by men in a small majority of cases.
Androgens and hereditary tendencies are important regarding its Clinically it appears as a polymorphic eruption which primarily affects the face, chest and back. Most patients have skin with an oily or seborrheic aspect. It is possible to classify Acne lesions under Inflammatory and Non-inflammatory; comedones are the most common lesions under the non-inflammatory classification, and they are a result of follicular occlusion and can be of two types: open or closed. Open comedones are also known as blackheads and closed comedones are small and pale or whitish papules. Inflammatory lesions develop from preexisting non-inflammatory lesions and they include papules, pustules and nodules. Acne Vulgaris has been classified in severity levels according to the number and spread of the lesions. Severe forms of Acne can show a diversity of skeletal striated muscles, and such forms are less frequent than acne vulgaris and they can include:Acne ConglobataAcne KeloidalisAcne Fulminans andAcne Inversa.
There exists a clear link between Acne and diverse psychological factors and such link is composed of three aspects: Anxiety, stress or frustration are occasionally linked to the worsening of the cutaneous process; the responsible mechanism is unknown, although it could be due to hormonal alterations related to stress. Additionally, severe acne can lead to important psychiatric alterations, such as symptoms of depression or social phobias which improve as acne improves. The presence of different species of Staphylococcus, Demodex Folliculorum, P. Ovale and Propionibacterium Acnes has been found in the lesions and such presence transforms sebum triglycerides into free fatty acids which have a local irritating effect and increase inflammation. Lately, the influence of a person´s diet on the exacerbation of the lesions has been proven, especially when there is an abuse of dairy products or by-products and carbohydrates (sweets and soft drinks).
The treatment must focus on correcting pathogenic mechanisms. Lesions must not be handled and special diets must not be recommended; most patients see an improvement by washing the area with water and soap (exfoliating or keratolytic) and externally applying Benzoyl Peroxide or Adapalene.
When there is a presence of inflammatory Acne it is recommended to orally take tetracycline or tetracycline derivatives for a period of two to three months. Antiandrogens must be reserved in female patients with established hormonal alterations. Vitamin A derivatives, like Isotretinoin, are used only for persistent Acne cases, Inflammatory Cystic Acne or Acne Conglobata.
Handling superficial Scars and post inflammatory marks can be done with chemical exfoliations (superficial peeling) or Microdermabrasion (ultra-peel). In case of atrophic Scars it is necessary to surgically close them and to later perform a deep dermabrasion which can be surgical and with a diamond burr, or using ablative fractional CO2 laser. When the Scar is hypertrophic we use intralesional infiltration of triamcinolone.
Among non-invasive treatments, it is possible to use intense pulsed light (IPL), LEDs and blue light which help fight P. Acnes; facials can provide improvement if they are performed accurately and without inflaming preexisting lesions.
It is most important toprevent scars which are consequences that will affect the patient after going through the active Acne problem and which unfortunately are the most difficult to treat, as the patient will never have skin like they had before. For that reason, it is very important to visit a dermatologist in order to obtain an early diagnosis and to handle the problem adequately.