What kind of illness is acne?

  Acne (acne vulgaris)

What kind of illness is acne?

Acne is a skin condition that most people experience, and I think it's often annoying because it's mainly on the face. It often heals even if left untreated, but it can be troublesome because it takes time, new acne appears one after another, and acne scars may remain depending on how it heals.

 

Here, I would like you to understand what kind of skin disease and what causes acne, and then what kind of treatment can be done in daily acne care and hospitals.

 

1. What kind of illness is acne?
2. What Causes Acne? ~ About the mechanism ~
3. What is the treatment for acne in the hospital?
4. Acne care at home
5. What kind of illness is acne?

"Acne" is an inflammatory papule, pustule, or exacerbation that matches the pores, which is common in seborrheic areas such as the face, upper back, and precordium, which is seen in adolescent men and women in their 10s and 30s. It is a chronic inflammatory disease that forms papules and nodules.

 

Initially, it begins with the formation of keratin plugs in the pores called "comedo" (comedo).

There are different types of acne, ranging from micro acne, which is almost invisible to the eye, to closed acne (so-called "white acne", which is a hair follicle oil gland filled with keratin-like substances and is white. 

It is categorized into open-faced acne (so-called "black acne", in which hair follicles open and black-tone oxidized keratin-like substances can be seen inside).

 

Even if it looks normal, micro-acne is already present in the place where acne is formed, and it is said that the number of this micro-acne is proportional to the severity of acne.

Then, when inflammation occurs using this acne as a foothold and spreads to the surrounding normal hair follicles, it becomes the next stage of inflammatory acne (so-called "red acne"), which clinically changes to red papules and pustules. ..

 

It seems that people are often worried about acne when this inflamed red acne appears.

 

Furthermore, when the inflammation deepens to the dermis and subcutaneous fat, it becomes an abscess, and when the inflammation is repeated many times, it becomes a state called a hard nodule.

Usually, acne of various stages is often mixed, which is also a characteristic of acne.

 

As for the general course of acne, shallow inflammatory acne in the epidermis often heals in about 1 week to 10 days even if left untreated, but deep acne may take several weeks to disappear.

In addition, if the inflammation is strong, it may leave a pitted acne scar or a raised hypertrophic scar after relieving.

 

Other special acne includes neonatal acne (transient acne that occurs about 2 weeks to 3 months after birth, caused by maternal sex hormones) and acne-collecting acne (a severe form of acne). , Acne, a state in which nodules are frequently connected and connected, depending on the constitution), steroid acne (caused by continuous use of oral steroids and external preparations), drug-induced acne, etc.

 

To understand the mechanism of acne, we first need to understand the structure of the pores and sebaceous glands.

 

The part of the hair that is buried in the skin is called the hair follicle, and the part at the exit of the pore is called the hair follicle opening.

The sebaceous gland is an organ that secretes sebum, but its exit is open at the top of the hair follicle, and the part of the hair follicle above the sebaceous gland opening is called the hair follicle fungus.

 

The place where many developed sebaceous glands are gathered is called the seborrheic site. The areas of seborrhea are the scalp, face (so-called T-zone such as the forehead, glabellar, and nasal wings), sternum, scapula, and axilla, which coincide with acne-prone areas.

Here, the following three are important factors that cause acne.

 

I: Overproduction of sebum due to hormonal balance (endocrine factor)

Ⅱ: Keratinization of hair follicle opening

Ⅲ: Bacterial infection (p.acnes)

First of all, regarding the hormone balance of I, what is important is the blood androgen (male hormone) derived from the adrenal glands.

 

Sebum secretion in the sebaceous glands is controlled by this androgen, and the peak of sebum secretion in both men and women is from puberty to around 20 years old.

This corresponds to the exacerbation of acne from around puberty.

 

In addition, it is often exacerbated before physiology that progesterone (yellow body hormone) secreted before physiology has an androgen-like action and that the androgen action becomes dominant due to decreased secretion of estrogen (follicle hormone). It is thought to be the cause.

 

After that, the androgen concentration in the blood becomes almost constant and gradually decreases from around 40 years old for females and around 50 years old for men.

Excessive secretion of sebum by this androgen, its composition, decomposition products, etc. lead to keratinization of II and bacterial infection of III.

 

Next, regarding II, when sebum is decomposed by indigenous bacteria on the skin to produce free fatty acids, this stimulates the exit of hair follicles and causes keratinization of the hair follicle funnel.

As a result, the opening of the hair follicle becomes narrower, and this condition is the "micro acne" that is the pre-stage of acne that appeared in.

As the outlet becomes narrower, sebum accumulates further in the hair follicles and mixes with bacteria to form a keratin-like structure peculiar to acne. In addition to this, factors such as constitution and filth are added, and the state where the pores are completely clogged is called "acne".

 

Finally, regarding III, it is thought that P. acnes, which is resident in the hair follicles, is most involved in acne inflammation.

P. acnes produces a variety of extracellular enzymes, of which lipase is considered to be an important cause. Lipase breaks down sebum to produce free fatty acids, which are thought to be involved in inflammation such as hair follicle destruction.

 

However, P. acnes cannot explain all the causes and inflammation of acne, which is why acne is distinguished from mere superficial skin infections.

 

What is the cure for acne in the hospital?

As we have seen above, acne has various stages, and treatment is required according to each stage. In other words, it is necessary to divide into "acne" (the early stage of acne, which is not yet inflamed) and "red acne", which is inflamed.

 

First of all, regarding acne, the main body of acne is "clogging due to the keratin-like substance at the opening of hair follicles", so adapalene, which is a type of retinoid of vitamin A derivative, is used as a drug with anti-acne action to remove the clogging of pores. 

External use of benzoyl peroxide (BPO), which is a type of oxidizing agent, is used. These external agents have the effect of exfoliating keratin and are called external peeling agents.

 

Next, for red acne, treatment targeting P. acnes, which is deeply involved in this inflammatory reaction, is common, but we will consider it separately for antibacterial action against the bacterium itself and anti-inflammatory action against inflammation.

Antibiotics are generally used as antibacterial drugs, but external use of clindamycin or nadifloxacin is used. In addition, the above-mentioned benzoyl peroxide (BPO) does not act as an antibiotic but has an antibacterial effect due to the free radicals of the decomposition products.

 One of the weaknesses of external antibiotics is the possibility of the emergence of resistant bacteria due to long-term use, but there is the advantage that resistant bacteria do not emerge with benzoyl peroxide, which is not an antibiotic.

 

In addition, antibiotics that also have anti-inflammatory effects include tetracycline-based minocycline, doxycycline, macrolide-based roxithromycin, and clarithromycin, which are used for moderate or higher inflammatory acne. 

Panem-based faropenem and new quinolone-based oral medications may be used as antibiotics with strong bactericidal action. Oral administration of antibiotics can be expected to be highly effective, but the response may be poor, and the causes may be an increase in drug-resistant P. 

 

acnes and the fact that the drug concentration in the lesion does not increase. In this case, there are few other treatment options, and we may consider using uninsured treatment together.

 

In addition, various vitamins and Chinese herbal medicines are often used in combination to reduce the secretion of sebum from the sebaceous glands.

The above are the insurance treatments that are currently mainly performed in Japan. (Refer to acne treatment guidelines)

It has been said that acne treatment in Japan is delayed in that there are few options compared to overseas, but in recent years it has become possible to prescribe new external preparations, so I feel that the situation has improved a little. 

There are still drugs in clinical trials, and it is expected that there will be more options for insurance treatment in the future.

 

In addition, non-insurance treatments include chemical peels, anti-androgen treatments, and phototherapy for bactericidal purposes.

 

In our hospital, of course, insurance treatment is of course, but if the effect is poor, as an out-of-insurance treatment, we aim for oily skin, chemical peeling aimed at improving texture, destruction of sebaceous glands attached to hair follicles, and bactericidal effect. 

We are also actively using long-pulse Alex laser facials and the introduction of vitamin C and tranexamic acid ions to reduce sebum and suppress conversion to lipid peroxides to improve acne.

 

Guidelines for the treatment of acne vulgaris (Japanese Dermatological Association)

Acne care at home

Acne is a chronic inflammatory disease, and it goes without saying that regular self-care is important. Here, I would like to think about skincare and precautions in daily life to prevent acne from getting worse.

 

I. Things to be aware of in daily life

You may have experienced acne worsening after having an irregular life such as a night out, having a disorderly diet, or changing your work or school environment.

 There are many myths around here, and it is difficult to know what is true, but in reality, medically, no direct relationship between diet and stress and acne has been shown.

 Decreased sleep time and exacerbations of acne have been reported, but this area may be difficult to prove medically. In the end, you may be indirectly involved by feeling stressed and messing with acne, or by reducing your sleep time.

 

In any case, a regular life rhythm and a well-balanced diet are important for maintaining good health, regardless of acne, so I don't think there is anything to keep in mind.

 

II. Skincare in everyday life

Here I would like to think about face washing and makeup.

 

Face wash

The basics of washing your face are to gently wash your face twice a day with a mild facial cleanser and wipe off the water with a towel without rubbing. It is necessary to thoroughly remove sebum by washing your face, but rubbing can lead to exacerbation of inflammation.

 There is no difference in function depending on the shape of the face wash, but it is better to lather with the palm of your hand than to lather on the face, and then roll the lather to wash.

 

It is also important to thoroughly wash off the face wash with water. It should be noted that "for sensitive skin" is often for dry skin, and sebum is often not sufficiently removed.

Makeup

First of all, regarding basic cosmetics such as lotion, serum, and milky lotion, even acne patients should use at least lotion to reinforce the barrier function of the epidermis.

 

I think it's best to stop putting on the lotion and apply it by pressing it with your entire palm. In addition, use beauty essence and milky lotion that contain moisturizing ingredients such as hyaluronic acid.

 

Next, regarding make-up, it seems that there was a time when we used to give instructions such as "Do not put on makeup on acne areas", but this is not the case nowadays. In order to reduce the stress caused by acne as much as possible and increase satisfaction, it is necessary to provide makeup guidance that does not worsen acne.

 

First of all, for foundation, powder type with low oil content is recommended, and liquid type should be avoided because it blocks hair follicles. Apply as thinly as possible around the oily eyes, nose, and mouth. It's best to avoid hiding with a concealer as much as possible, but if you really care about it, use the minimum amount to cover the color of your acne.

 

It is important to make up points such as eye makeup and lipstick. By doing this positively, you can divert your eyes and mouth, and as a result, make acne less noticeable.

 

As an overall precaution for cosmetics used by acne patients, it is important to choose one that is mild and has a low oil content.