Seborrheic Acne-prone Skin
In seborrhoea, an increase in sebum secretion (i) causes excessive development of the lipophilic portion of the hydrolipid film. Most affected are skin areas with a rich occurrence of sebaceous glands (i): the face, chest, shoulders and back. Seborrhoea promotes skin conditions such as acne, seborrheic eczema and rosacea, as well as fungal and bacterial infections.
Acne covers a whole group of diseases that affect the sebaceous glands (i), hair follicles and surrounding tissue. The primary visible skin lesion is comedones, which can take the form of closed "whiteheads" and/or open "blackheads". Blackheads are less likely to cause inflammation in the surrounding connective tissue. Other visible signs of acne are papules, nodules, and pustules.
Acne...
Endogenous and exogenous causes of acne
The pathophysiological basis of comedo formation and therefore of acne is seborrhoea accompanied by sebaceous gland obstruction, which is caused by disturbed cornification (hyperkeratosis) of the hair follicle and of the excretory ducts of the sebaceous glands (i). The existence of a genetic predisposition to this cornification disturbance is a matter of discussion.
Acne is the most common hormone-induced skin change and manifests itself mainly during puberty (acne vulgaris or simplex). Acne vulgaris, which affects around 80 percent of 11-20 year-olds, is probably caused by a heightened response of the sebaceous glands (i) as well as the epithelia of the hair follicles and the excretory ducts of the sebaceous gland to physiological androgen concentrations.
Schematic diagram:
How acne develops
A Plug of horny lamellae and sebum in the excretory duct of the hair follicle and blackened on the surface by oxidation (blackhead)
B Spherical, skin-coloured or whitish-looking closed comedo (whitehead)
C The increased build-up of sebum puts pressure on the follicle walls, which are further damaged by various bacterial substances (enzymes, free fatty acids).
D The trapped, bacteria-contaminated sebum enters the surrounding tissue, causing an inflammatory reaction.
Acne can take various forms:
When we say acne, we usually mean acne vulgaris or simplex, which is the skin condition occurring in puberty especially on the face and back and the most common form of acne.
Acne vulgaris can be further differentiated according to the severity of the skin lesions:
- Acne comedonica (blackheads/whiteheads)
- Acne papulopustulosa, which is caused by bacterial invasion of a comedone and leads to secondary perifollicular inflammation and formation of papules and pustules.
- Acne conglobata, in which, besides comedones, papules and pustules, there are painful nodules and abscesses with fistular openings on the face and upper body. These often heal only with scarring.
Acne in adults
Acne that persists or comes back again in later years, at around the age of 30, is becoming increasingly prevalent. The acne occurring in adults is often only mild or moderately severe but in many cases difficult to treat with the common forms of therapy. Acne that occurs for the first time in later years is rare and usually associated with certain medications, situations of stress or contact with various comedogenic substances (e.g. chlorine).
- Acne vulgaris papulo-pustolosa
Dermatological therapeutic options, skin cleaning and care
Vitamin A derivatives (retinoids, skin "peels") and benzoyl peroxide preparations are the main products used for topical treatment, although the benzoyl peroxide preparations often dry out the skin. In addition, antibiotics such as tetracycline, which, however, can cause increased UV sensitivity, or erythromycin can be applied. Antibiotic treatment is also effective against the pathophysiologically important propionibacteria and pathogens that can cause secondary infections but can result in bacterial resistance. In severe cases of therapy-resistant acne, systemic (internal) treatment with isotretinoin is necessary. In women, contraceptives containing oestrogen (i) and an anti-androgen gestagen fraction are also used.
Syndets should be used instead of soap to cleanse acne-prone skin. After cleansing, tinted acne skincare products containing particularly keratolytic or/and antibacterial additives are normally used during the day. Fat-free and soothing skincare products can also be of value as an adjuvant to therapy.
