Eels (akne) is a disease of hair follicles and sebaceous glands which meets at 80 % of teenagers and persons of young age. Among various clinical versions akne most often there are vulgar eels.

Osnovnye development factors ugrej: - Disbalans lipidov - At patients akne superfluous education skin is marked sala. - Participation mikroorganizmov.

Tolko 3 groups of microorganisms are the reason of inflammatory process in grease zhelezah: • P.acne • Staphylococcus epidermidis and others kokki • lipofilnye yeast of sort Pityrosporum (P.ovale et orbiculare).

Eti microorganisms always are present in komedonah (eels). They constantly are on a surface of a healthy face skin and are a part of normal microflora.

U patients akne the combination drozhzhepodobnoj (P.ovale) and bacterial flora (P.acne) is more often comes to light. These activators lead to mouth corking zhelezy.

Hormonal infringements Uchityvaja, that vulgar eels usually appear in pubertatnom the period when sexual glands actively start to function, a considerable role in patogeneze akne is taken away to sexual hormones. Akne arise at women with infringement menstrualnogo a cycle with a syndrome giperandrogenii, at long reception androgenov or anabolic gormonov.

Znachitelnuju a role in patogeneze akne hereditary predisposition (plays genetically determined type of secretion of sebaceous glands and congenital endokrinnaja a pathology. Among possible factors patogeneza - considerable decrease in the maintenance of zinc in whey of blood at patients akne and a status immune statusa.

illness Displays Naibolee are extended vulgar or youthful eels who meet at 80 % of persons at the age of 15-24 years. Disease is characterised by occurrence on the person (less often - on a breast and a back) komedonov, small to 5 mm in diameter of heat-spots of bright red colour. Vysypanija, being resolved, leave pigmentation, is more rare - superficial scars. Salootdelenie it is raised, the skin has characteristic fat shine, hair also fat, probably insignificant poredenie.

Kolichestvo komedonov can increase, a mouth of hair follicles extend and gape. Komedony arise not only on the person, a back and a breast, but also in zaushnyh areas, on volosistoj head parts. Inflammatory reaction around komedonov becomes more expressed, are formed large glubokolezhashchie inflammatory sites. So there are indurativnye akne.

Cherez some weeks sites are opened with cavity education from which viscous pus - flegmonoznye akne is allocated. After healing remain deep disfiguring a skin rubtsy.

Samoj the widespread form with the expressed inflammation eels are konglobatnye. They it is characterised by occurrence on a back, a breast and the person of the large sites which are settling down deeply in a skin. Sites can reach 1,5-2 sm in diameter. Such sites are extremely painful. Merging, sites form conglomerates, there can be abscesses after which opening remain is long not healing ulcers, and subsequently - rough hems with crosspieces and svishchevymi hodami.

Odnim from rare variants inflammatory akne at which there is a sharp transformation typical inflammatory akne in the extremely expressed destructive inflammation, are lightning akne. Basically young men suffer. Appear plural painful izjazvljajushchiesja with sites nekroza the inflammatory sites disseminated gnojnichki, settling down against reddening. Process is accompanied by a fever, pains in joints. Healing occurs to education rough rubtsov.

Dostatochno seldom meets piodermija persons - the sharply-inflammatory and hard proceeding form akne. Piodermiej persons suffer the young women transferred emotional stress or earlier receiving androgeny apropos endokrinnyh of diseases is more often. Dermatoz it is characterised by the sudden beginning and fast progressing. At all patients process is localised in the central part of the person, in the field of a forehead, temples, a chin. There is an expressed face edema with a cyanotic shade of a skin, and in 1-2 days - painful furunkulopodobnye knotty vysypanija, reminding konglobatnye akne, big (more than 5 mm) gnojnichki.

Dlja treatments of various forms akne apply Treatment of eels the various techniques which choice depends from concrete bolnogo.

Pishchevye factors, various kinds of a food, a diet have no value for development akne and selection terapii.

Naruzhnaja therapy does not influence education of skin fat. Various means, detergenty can reduce quantity of skin fat temporarily only. However at use of clearing means it is not necessary to resort to peeling preparations which can call irritation of integuments, travmu.

Komedonalnye akne Nevospalennye komedony - the earliest display of disease (it is frequent at teenage age). Treatment, as a rule, is preventive, and switches on the external means reducing education komedonov and suppressing development of pathogenic flora. Choice means - preparations of salicylic acid, the means containing sulphur, azelainovaja acid, retinola palmitat, tretinoin, adapalen, izotretinoin, benzoilperoksid.

Tretinoin - highly active means which slows down deskvamativnyj process and reduces education mikrokomedonov and komedonov. The preparation is used in various concentration and forms: a cream of 0,025 %, 0,05 %, 0,1 %; gel of 0,01 % and 0,025 %. At good shipping tretinoin apply 1 time a day on the amazed sites, since smaller concentration with the subsequent transition to bolshej kotsentratsii.

Azelainovuju acid 2 times a day on problem sites of a skin as apply in the form of 20 % of a cream highly effective means and at intolerance tretinoina and other preparations. Azelainovaja acid reduces activity of oxidation-reduction processes and quantity of polynonsaturated fat acids (for example, arahidonovoj), perniciously influences on P.acne. Azelainovaja acid also reduces postinflammatory hyperpigmentation. Antimicrobic and antikeratinizirujushchee action azelainovoj acids is connected with synthesis inhibition belka.

Kak tretinoin, and azelainovuju acid apply within several months before achievement clinical remissii.

Inflammatory forms akne the Easy form Pri treatment of the easy form komedonalnyh akne with insignificant quantity gnojnichkov expediently to use naruzhno spirit the solutions containing salicylic acid, rezortsin, antibiotics, benzoilperoksid, ointments with antibiotics. Preparations of sulphur, salicylic acid, rezortsina possess peeling and antibacterial action. The means which are switching on niatsinamid and a-gidroksikisloty, also are effective enough in external terapii.

Benzoilperoksid in the form of gel or a solution of 1-10 % 1 time a day during 2-3 ned is put. The preparation possesses keratoliticheskim, deskvamativnym action, improves oxygenation of fabrics, leads to education of various forms of active oxygen, perniciously influences on P.acne, suppressing their growth. However benzoilperoksid does not possess the expressed anti-inflammatory activity, and it is the most rational to apply it of 3 % a solution in a combination about 3 % erythromycin or 7 % a solution with glikolevoj kislotoj.

Naruzhnaja antibacterial therapy switches on eritromitsinovuju, tetratsiklinovuju, linkomitsinovuju ointments, klindamitsin. Antibiotics in the form of ointments put 2 times a day. They suppress reproduction P.acne and others bakterij.

Odnako the greatest therapeutic effect is reached at a combination benzoilperoksida and eritromitsinovoj oin tments which put on integuments is long, before achievement of clinical effect, i.e. before the occurrence termination even individual papuleznyh and pustuleznyh vysypanij. n

Retinoevuju ointment put also it is long on the sites amazed akne. It is necessary to remember: various derivatives tretinoina and retinola cannot be used with peeling means and at raised insoljatsii, in a combination to the UFO-IRRADIATION. At fat seboree spend the preventive therapy which is switching on kriomassazh, clearing and peeling means, ekstraktsiju komedonov.

the Heavy form Dlja treatments of heavy forms akne with expressed pustulizatsiej, destruktsiej fabrics, heavy kistoznym and nagnoitelnym process applies a combination of system and external therapy. The exception makes izotretinoin, applied as monoterapija.

K to the system means influencing education of skin fat, an estrogen, androgeny, spironolakton concerns, izotretinoin.

Zhenshchinam with is long proceeding akne, at an inefficiency of antibacterial therapy and external application tretinoina, appoint an estrogen and androgeny. Thus defining factors are infringement menstrualnogo a cycle, girsutizm, gipertrihoz, nadpochechnikovaja or jaichnikovaja giperandrogenija. Androgeny and an estrogen renders therapeutic effect at akne by influence on development of skin fat and a status grease zhelez.

Diane-35 appoints only to women of reproductive age in the presence of hormonal infringements and at an inefficiency usual terapii.

Spironolakton uses, as antiandrogen, on 100-200 mg a day. It can render effect and in small doses - 25-50 mg. The preparation influences on steroidogenez in adrenal glands and sexual glands. Course of treatment is spent by some months and also apply only at women. Thus the quantity of skin fat and pathological elements sharply decreases. At pregnancy therapy spironolaktonom protivopokazana.

Odnovremenno with spironolaktonom use of others protivougrevyh means, and also peroralnyh contraceptives which appoint to women with jaichnikovoj giperandrogeniej is possible. Peroralnye contraceptives reduce superfluous level androgenov, increasing quantity of the globulin connecting free testosteron (jaichnikovyj and nadpochechnikovyj). In connection with suppression by a secretion estrogen gonadotropina education androgenov.

Kombinirovannye an estrogen-progestinovye contraceptives decreases are most effective at reception of high doses. Use of low doses progestina, norgestimata, etc. renders therapeutic effect only after 2-4 mes reception, at their cancellation there are relapses. Most rasprostranenymi preparations are etinilestradiol, tsiproteron which are appointed both separately, and in common. System kortikosteroidy apply at nadpochechnikovoj giperandrogenii.

Lechenie an estrogen and antiandrogenami therapy lasts from several months to several let.

Antibakterialnaja has important value in therapy akne. The superfluous quantity of skin fat, presence P.acne for which the listed conditions are the favorable environment, promote development of the expressed inflammation. P.acne are high-sensitivity to the various antibiotics, however not all antibiotics are capable to get into the follicular device, a sebaceous gland on what their efficiency depends. System antibacterial therapy assumes doxycycline application, klindamitsina, to-trimoksazola, erythromycin, tetratsiklina. Doxycycline, minotsiklin, to-trimoksazol better rastvorimy in fats; it is proved, that they are most effective in comparison with other antibacterial means. Optimum doses tetratsiklina and erythromycin - 500-1000 mg a day, doxycycline - from 100 to 200 mg. At achievement of positive clinical effect (from 4 to 6 ned, sometimes to 4 mes) it is expedient reduction dozy.

Dlja achievements by a rack, long remisii is necessary application of antibiotics by faltering courses during long vremeni.

Pri intolerance of antibiotics is supposed ipolzovanie to-trimoksazola (trimetoprima 80 mg and sulfametoksazola 400 mg) 2 times a day or trimetoprima 100-200 mg in sutki.

Sistemnaja antibacterial therapy does not exclude external application of antibacterial ointments (benzoilperoksid and erythromycin, klindamitsin) which appoint to 2-4 mes for long suppression proliferatsii P.acne. At heavy kistoznyh, nagnoitelnyh processes antibiotics apply in a combination with kortikosteroidami.

U patients with kistoznymi forms akne, leaving cicatricial changes, keloidnye skin changes, hyperpigmentation at peroralnoj antibacterial therapy only partial remission is reached. For avoidance of complications and optimum selection of therapy purpose izotretinoina.