notes by dr Claudio Italiano
After the success of the pages on mycoses, ie skin infections due to microbial agents,
the fungi, we continue with this other page on acne.
How many times have you gone to the doctor because your daughter or your child, adolescent,during puberty, presented to the face and body of the annoying "pimples", that is
those lesions of the skin, with the "points" of pus above, like small volcanoes to which is wanted to squeeze the contents, to get out the sebum and / or the
pus ?
And how many times have you noticed that on the skin of your son or your daughter there are dots of grayish-black color, like the heads of a pin, which, if squeezed between the fingernails of two fingers, make the sebum come out, as if was it a "white worm" of fat with a blackish head? These are technically called "vulgar acne" skin lesions, commonly called "pimples" and black dots on oily skin, called "comedoni".
But let's see what it is.
Acne vulgaris is usually a spontaneous, typical of
adolescents and young people, although in 10-20% of adults too. It's
characterized by oily skin distributed over the forehead, follicles
clogged with dead skin cells and oil from the skin, blackheads or whiteheads,
pimples, and possible scarring. It primarily affects areas of the skin with a
relatively high number of oil glands, including the face, upper part of the
chest, and back. The resulting appearance can lead to anxiety, reduced
self-esteem and, in extreme cases, depression or thoughts of suicide.
Genetics is thought to be the primary cause of acne in 80% of cases.The role of diet and cigarette smoking is unclear, and neither cleanliness nor exposure to sunlight appear to play a part. During puberty, in both sexes, acne is often brought on by an increase in hormones such as testosterone. A frequent factor is excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.. During puberty, when the hormonal constellations are rearing up and the sex hormones (estrogens and testosterone) begin to rise, giving rise to the menstrual cycle in the woman and to the maturation of the male gonad, with secondary characters (hair growth, beard in the man , virile voice for volume increase of the larynx, breasts, the cycle and the hips in the woman etc. etc.) then the skin becomes even fatter, because it increases the sebaceous secretion. In the hair follicles, where the sebum comes out, since this is, so to speak more dense, the follicle orifice is blocked and small cysts are formed, which appear to the naked eye as blackish "dots", just the comedones. It is clear that the boys are predisposed, as they often have an incongruous diet (diet), they are obese, they prefer chocolate, paprika, hamburgers, fats, cream, lard, lard, mayonnaise (cf. correct diet and fiber diet in the diet).
Fruits and vegetables are far from being fed, not even talking about it! So the skin becomes unctuous, and comedones appear on the skin, that is the "blackheads". The outlets of the sebaceous glands, corked by keratin material, are the place where germs are teeming. In particular yeasts, that is imicetes, P. orbiculare and bacteria, Propionibacterium acnes, which are lipophilic, ie they love to stay between the fats of the sebum, causing an infection and inflammation inside the cyst, with breaking of the wall itself and give aesthetic fibrosis, especially if the boy, you want to the itch, or because they make fun of the idiots of teenagers like him, continues to squeeze the pimples!
The comedone, ie the sebaceous cyst, can be opened, black or closed point, white point. And it looks like a small papule, that is an excrescence of the skin, like a microscopic "volcano" of 1-2 mm. The fact is that the comedones can not be squeezed, because hardly, squeezing them, comes out the sebum; on the contrary, often the purulent material, if squeezed, penetrates deeply into the subcutaneous one, incites and determines reactions from "foreign body" that we call granulomas. These give rise to ugly scarring scars, up to constitute real nodes and nodules of the skin. In women it is possible to have polycystic ovary syndrome which must be absolutely cured by the gynecologist, otherwise the skin lesions will not heal.
I am reminded of a joke, that of the father who goes to the doctor and asks the doctor what he can give as a remedy to his son for acne. The doctor prescribes an ointment. After some time the parent returns and reports that the treatment has not taken effect. Then the doctor patiently prescribes antibiotic pills ... some time passes and the parent becomes dissatisfied with the treatment. This time the doctor, gesturing and putting his hands together as a prayer, says: "Your child needs this special drug! And the absent-minded parent replies:" The mutual pass?
Now, joking aside, with this joke we want to mean that the treatment is
long and difficult. But never need to be discouraged. Who writes, has some
experience and can tell you that in summer, in his seaside Milazzo, it is
difficult to see boys with acne, among those that go between our waves sauces,
because, without their knowledge, the the sea water and the sun, and the heat
with the sweat, are able to deeply cleanse the hair follicles, removing the
sebum and the keratin cap that was deposited there, determining a deep cleansing
of the skin.
Careful cleansing of the face, to eliminate blackheads; go to the clear visagist,
use those cleaning gels (eau nettoyant, topexan etc.)
Never try to squeeze the pimple or rub the skin violently, traumatizing it !!
Sometimes the dermatologist doctor, to whom we always refer you, can prescribe
an antibiotic like tetracycline or erythromycin
You can use retinoic acid, benzoyl peroxide, salicylic acid for topical use, to
rub and clean.
Cystic acne can be treated with isotretinoin, a synthetic retinoid.
Estroprogestinal therapy, if necessary, under strict control of the
gynecologist.If a woman is affected by polycystic ovaries, in addition, after
treatment with inositol, you should prescribe the estroprogestestiny, as this
pathology, PCOS, is affected by acne and hirsutism.
Two news also on:
Acne rosacea.
Acne rosacea is rather a woman's prerogative, especially if stressed, aged over
30 years. It is characterized by an erythema (ie a red rash) in the face,
characterized by telangiectasia and supoerficial pustules. They are emotional
patients who respond exaggeratedly to prolonged stressful stimuli, to alcohol
intake, to heat, to sun exposure, as opposed to acne vulgaris. If this type of
acne persists, nose deformation may occur (rhinophyma) , eye and eyelid
disorders (keratitis, blepharitis, iriditis, chalazion).
Therapy
- No stress, no acne rosacea, so if the reason is the stress that causes your
husband or your boss, eliminate the problem at the root!
- Antibiotic drugs with tetracycline and metronidazole
- Visiting the eye care professional as well as the dermatological one, of
course.
- Avoid cortisone for topical use, because instead of treating these
preparations can make the picture worse and give hair.
Last thing, hoping to have been useful, I wish you never need those with bags,
doctors and lawyers, and I refer you to the other beautiful and simple pages of
internal medicine, edited for you.