Acne (acne) is common

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Manifests in several forms of acne, Zaan open and closed, and papules and pustules, and cysts. The hormone androgen is responsible for _ posed in genetically susceptible individuals and _, where he works to stimulate the sebaceous glands in the skin and fatty secretions increase.
Basics of diagnosis:
• Shows at the age of puberty, may be delayed appearance of a third or fourth.
• The Zaan open (blackheads) and closed (whiteheads) characteristic of acne.
• one of the most common skin lesions.
• vary according to severity of its forms is either a blackhead or purely inflammatory papules or pustules, or cysts or nodules.
• appear on the face can also appear in the top section of the trunk such as the chest and shoulder.
• may turn to scars as a result of disease or because of tampering by the patient.


General considerations:
Manifests in several forms of acne, Zaan open and closed, and papules and pustules, and cysts. The hormone androgen is responsible for _ posed in genetically susceptible individuals and _, where he works to stimulate the sebaceous glands in the skin and fatty secretions increase. As acne is more common in males and unity, do not go away is always raised automatically when they reach adulthood. And found that the rate of infection was 12% in women and 3% in men over the age of 25 years and down those rates, even after the age of 44.


How is made up acne?
Coincides skin lesions usually with activity seborrheic of the sebaceous glands, and summed up the mechanism to be acne increase the secretion of sebum blocking the nozzle pilonidal constitute secretions fat accumulated in turn, a favorable environment for bacteria acne (bacteria Albroobion) to multiply exponentially with liberation and irritation caused by the accumulation of fatty acids immune reaction to sebum outside the follicles, giving the appearance inflammatory as we see on the surface of the skin.
And is still a mechanism controlled by antibiotics, the disease vague to some extent, but may show its effectiveness because of its anti-bacterial or anti-inflammatory, and when confronting the state of resistance to the treatment of acne at one of the women, may doubt the high rate of the hormone androgen to have and can be associated or not associated with hirsutism , and irregular periods, and the emergence of some male secondary characteristics. The polycystic ovary syndrome (PCOS) the specific cause of the most common.


Clinical findings:
May find a little soreness, pain and itching. These lesions occur mainly on the face, and neck, the upper chest, back and shoulders.
The Zaan of the basic signs for acne vulgaris.
Valzaanat closed are very small, and color of the flesh which is a non-inflamed eruptions give the appearance of skin texture or rough.
The open Zaanat usually slightly larger and contain a substance inside is black.
It can be seen inflamed papules and pustules, and dilated pores, acne and cysts, and some scars.
Acne manifests in different ways according to age, in pre-adolescence in the initial infection often seen Zaan, The inflammatory lesions in adolescents are often found in the middle of the face and stretches of the ocean with the progress of a young age.
Women in the third and fourth decades (and probably with no prior history with acne) appears to have acne with papular lesions on the chin and around the mouth.


Differential Diagnosis
• pretend rosacea in adults in the form of papules and pustules in the middle third of the face, but for acne vulgaris is characterized by the expansion of capillaries, and flush (redness of the face), and the absence of Zaan. The irritation pimples on the faces of patients injecting antibiotics or suffering from inflammation of the outer ear that we should be planting to exclude bacterial folliculitis Gram-negative bacteria.
• may develop in patients who count on systemic corticosteroids or topical fluorinated steroids, may cause or worsen acne in the use of oils or creams irritating.
• The pimples may occur as a result of infection, ringworm (Safeeh infections).
• lesions on the back are the most Aedala and when he spoke of a single cluster, the folliculitis, and miliary and - less commonly - folliculitis caused by Malassezia is suspected to occur.
• Bacterial culture - a test antibiotic against staphylococci - and monitor response to treatment will help in the differential diagnosis.
• Andalmassaben acquired immuno-deficiency virus, the folliculitis is common and may be Ancodea or Aaousinea.


Complications:
• cysts.
• Changes Altsbgah.
• severe scarring.
• psychological problems.


Treatment:
General Standards
• Patient Education:
When the scars seem disproportionate to the severity of injuries the doctor to pay attention to that patient may manipulate pests. It is therefore necessary to educate the patient in an appropriate manner from the complications of this act. It is often anxiety and depression is the underlying cause of acne lacerated when young girls.
Better for the patient to know that treatment requires at least 4-6 weeks until improvement begins to appear, and that these lesions may take months old, even disappear. Thus, the rule on the amount of improvement related to the number of new lesions formed after 6-8 weeks of starting treatment. The treatment requires additional time to show the improvement in the back and chest, as these regions are slower to respond to treatment.
If the patient uses Mrihama Hair should contain Gly and non-oily substances. The Council has to avoid exposure to residual oils and cocoa butter (cocoa oils) and greases.

• Diet:
The diet "low carbohydrate", which cause weight loss help to improve acne in males aged 15-25 years, and this improvement is linked to decrease resistance to insulin. As noted accompanied by hyperinsulinism with acne in women, "Suiat menarche."
The metabolic syndrome with hyperinsulinemia could also be a manifestation of infection with polycystic ovary syndrome PCOS and this finding indicates the possibility of a common mechanism of pathogenesis of acne in adult women and men alike.

• Zaana count:
Treatment depends on the diversity and severity of the lesions. Where Zaanat require different treatment for cystic lesions and pimples. When assessing the severity of the disease sequelae must be taken into account. . Individuals who appear to have only a few new lesions per month (which Taatndb or leave after the inflammatory hyperpigmentation) require to be addressed more attention compared with patients who have lesions heal without any sequelae. Soaps play a small role in the treatment of acne were not what the patient's skin where the fat using gentle soaps to avoid irritation, which limits the utility of topical treatments, which itself caused some irritation.

1. Ritnoidat Topical
Alteritinoin very effective in cases of acne and Zaana Zaana compound in the treatment of some cases of severe acne, but the usefulness of specific Balthaj wrought. Starting dose to 0.025% in the form of cream (not gel) and should be used by the patient initially twice a week at night and then increase the dose to become every day to night for this and there are a few of the patients can not use it until this low-dose more than three times a week, but with This has caused an improvement to have. Dose is the size of a lentil, and is the amount sufficient to cover the entire face. To avoid irritation, the patient must wait 20 minutes after washing the face to put the Quran. The Adapalene gel 0.1%, reformulated tretinoin are options for patients who happen to have the irritation of this standard dose of Alteritnoin. Some patients, particularly adolescents get better on the gel of 0.01%. The use of Alteritnoin during pregnancy is contra-indicated, although the absorption of a few. There are some patients who have sensitivity to light when used for this and should warn patients that Sathaj count during the first four weeks of treatment.
(Tarazotene Gel) a dose of 0.05% or 0.1% (Tazorae) Hugh Trretnoin topical is used to treat psoriasis and acne and can be used in patients who have an intolerance to other Tritnoiinat.


2. Benzoyl peroxide:
Benzoyl peroxide products are available concentration of 2.5%, 4%, 8%, 10%. But showed the same dose of 2.5% efficiency caused by 10% and less irritation. In general Aljlat water-based and not alcohol backs because they cause less irritation.

3. Antibiotics:
The use of topical antibiotics have demonstrated their ability to reduce pimples and Zaan.

•. Papular inflammatory acne:
Antibiotics Antibiotics are the mainstay for the treatment of inflammatory acne, and can be used topically or orally.
 selected antibiotics by mouth are tetracycline and doxycycline.
 minocycline is often effective in acne non-responsive or resistant to previous treatment with antibiotics, but more expensive.
 rarely may be the use of other antibiotics such as TMP-SMZ, clindamycin (150 mg twice daily), or cephalosporins (cephalexin or cefadroxil).
 It can be used as clindamycin phosphate, erythromycin topical.
 topical treatments Topicals probably equivalent to about 500 mg / d of oral tetracycline, which is half the usual initial dose.

Used topical antibiotics Topical antibiotics in the three cases are:
1. For the treatment of mild papular acne which can be controlled with topical treatments alone.
2. For patients who refuse or can not afford the antibiotics by mouth.
3. To keep (weaned) patients under good control _ _ to the oral formulations of topical preparations.
To reduce the resistance must be used benzoyl peroxide benzoyl peroxide with antibiotics in the composition of topical preparation.

• Mild acne:
 the first choice of topical antibiotics in terms of efficacy and lack of proportion of acne resistant P acnes is a combination of erythromycin or clindamycin with benzoyl peroxide topical gel.
 can be used to clindamycin (T Cleocin) is (lotion, gel, lotion) or one of the many varieties of the gel or topical erythromycin solution twice daily in addition to benzoyl peroxide in the morning.
 combination of erythromycin or clindamycin with benzoyl peroxide is available as an item on prescription.
 This is in addition to the cream Tritnoin tretinoin 0.025% gel or 0.01% at night because it could increase the improvement, including that it works a different mechanism.


• moderate acne:
 tetracycline (500 mg twice daily), doxycycline (100 mg twice a day), minocycline (50-100 mg twice daily), all effective despite the fact that minocycline is more expensive.
When initiating treatment Balminowsklin start with 100 mg in the evening for 4-7 days, then 100 mg twice daily, to reduce the incidence of the rotor.
 Select a date for the patient to Arajek within 6 weeks and then after 3-4 months.
If the patient's skin Schaaf completely, you must Namrh identification of a dose of 250 mg of tetracycline, 100 mg of doxycycline, 50 mg of minocycline every 6-8 weeks _ while topical treatment is based _ to reach the lowest level of the dose systemic necessary to maintain the integrity of the patient's skin.
 In general, dose reduction to zero without further treatment leads to immediate recurrence of acne.
 tetracycline, minocycline, and doxycycline use prohibited when there is pregnancy, but can be used erythromycin by mouth.

 It is important to discuss the issue of contraceptive failure when prescribing antibiotics to women taking oral contraceptives.
The women need to use other methods of contraception (mechanical) as well, and should take notice in the event of breakthrough bleeding (the middle of the menstrual cycle breakthrough bleeding)
You can add or oral contraceptives Spironolactone (50-200 mg daily) as the anti-androgens in women who suffer from acne resistant to antibiotics, or when women who happen to have relapse after treatment Balaazotritnoan.


• severe acne:
 Alaazotritinoin:
 emulators of vitamin A, and is used to treat severe cystic acne that does not respond to conventional treatment. Alaazotritinoin given a dose of 0.5 to 1 mg / kg / day for 20 weeks so that not less than the total dose given during this period from 120 mg / kg, and are usually sufficient to manage the severe cystic acne.
 should be given to patients prior to Alaazotritinoin severe scars in the absence of good control of the disease using antibiotics.
 pregnancy is absolutely contraindicated because of the effects of Aazotritinoin Almaskhh of the fetus; and therefore must conduct tests Msalian two to make sure there is no pregnancy before giving Alaazotritinoin for women of childbearing age, with the re-test after pregnancy once a month. And apply medication for one month only, with the use of two types of drugs effective contraception, and the patient must be aware of the characteristics of this medicine before eating, and subject to monitoring during the treatment period.

 get side effects in most patients, is to:
• dryness of the skin and mucous membranes (dry lips, nasal hemorrhages, xerophthalmia).
• Headaches: and then think about the false brain tumor.
• depression sometimes.
• high triglycerides in the blood: in 25% of cases.
• High cholesterol: 15%.
• Allibobrotinat low concentration of high density: 5%.
• a slight increase in liver function tests.
• the high level of fasting glucose in the blood.
• Many of the reactions, such as poor night vision, symptoms of musculoskeletal or symptoms of gastrointestinal, dry skin, paper hair, the appearance of lesions granular form in the appearance of acne, excessive bone growth (in the cases of the application of very high doses or use of medication for a very long time), pain moderate to severe muscle (but rarely require reducing the dose or stop medicine).
- Laboratory investigations: When all patients; be calibrated cholesterol, triglycerides, liver function tests before treatment and after the start of treatment at 4 weeks. Return high levels of both liver enzymes and triglycerides to normal values ​​at the end of treatment.
- According to the count Alaazotritinoin in remission for a long time when 40-60% of patients, and make them more responsive to traditional treatments. In rare cases, not only responds to the counting Aazotritinoin as it should, but may recover by repeating the treatment.
• Intralesional injection
- For moderate to count, he uses the "Trellamiknolon" in the form of hanging right in the lesion dose (2.5 with / ml per lesion) where the effect is often to accelerate healing of deep papules and cysts - if any.
• Laser, Knit (Tzhaj) skin:
- In order to get better cosmetic results, through eradication and vaccination for deep scars, lesions, and abrasion is effective (surface). This procedure is not without side effects Kvrt pigmentation or hypopigmentation, or Althzz, or scarring ... show these effects when less-skinned black.
- It is not recommended corrective surgery during the first 12 months of use Alaazotritinoin.
- Resort to laser or light treatment Almottagoah photodynamic therapy as an alternative when conventional treatments fail or can not be applied to the existence of contra-indicated (Kalaazotritinoin when pregnant).


Warning:
Linux acne vulgaris in a gradual and spontaneous, and can not predict when will relapse. Disease may continue during adolescence and leads to severe scarring if not treated, if treatment is continued improvement over 3-6 months.
If there is relapse during treatment must be drawn to the possibility of bacterial resistance to P acnes.
Acne vulgaris is a chronic disease and tends to heightened during periods of intermittent, even during treatment. When you get cured Pallaizotratonin systemic treatment in 60% of cases, and in 20% of cases gets relapse within 3 years and then needs to the line of a new treatment