Acne vulgaris
Acne vulgaris - Clinic
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in 15% due to gravity is a dermatological drug therapy is indicated
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by improper diet (dairy products, carbohydrates with high glycemic index) may be the acne worse
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the treatment is to prevent the appearance of scars
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course for inflammatory forms are topical combination products (benzoyl peroxide in combination with clindamycin or adapalene) the first-line therapy
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it comes under an optimal external treatment after approximately 3-6 months to no satisfactory response, the administration of oral isotretinoin is indicated
Epidemiology
The acne comes in all age groups, neonates (acne neonatorum in) and also in adults beyond the 40s (acne tarda before), but their frequency shows a clear peak in adolescence. Acne has in recent years in countries with a Western lifestyle has increased in frequency in. The disease is often easy in and over a short period only. acne is a need of treatment in about 15% of adolescents, with boys and girls about equally often in ill. Severe cases such as acne conglobata are more frequently observed in males.
Acne - suffering often does not correlate with the objective severity
In addition to complex curves of acne in the form of acne fulminans, a by hemorrhagic, painful ulcers in combination with general symptoms such as fever or polyarthralgia marked variant, or Akneerkrankungen, the hypertrophic scars or Spontankeloiden associated with acne is one of the diseases that regardless of the severity often with a high psychological burden on affected parties go hand in hand. acne is so serious disease and not as a problem to be understood as a slight puberty.
Department of acne
In addition to seborrhea identify non-inflammatory lesions in the form of closed and open comedones (blackheads) the Comedonica acne, while inflammatory lesions in the form of papules and papulopustules the image of Acne papulopustulosa characterized. If, in addition to the appearance of inflammatory and melt fistulierenden node, the abandonment of typical bridge-like scars, the so-called Fistelkomedonen heal with, and cysts is the most severe form of acne before the acne conglobata.
Classification of severity
International use different scales to objectify the severity of acne. Below is an evaluation system shown that the
Acne lesions regressed, comedones (blackheads), papules and papulopustules (nodes and purulent nodules and inflammatory nodes strongly oriented).
|
Severity |
Comedones |
Papules and pustules |
Node |
|
MILD |
few to a few |
few to a few |
no |
|
MODERATE |
few to many |
few to many |
few to a few |
|
HARD |
many |
numerous and / or excessive |
many |
These scales are particularly important for clinical studies. In practice, they play no great importance, since the objective severity of acne in particular often do not correlate with the subjective complaint degrees.
Pathogenesis of acne
The lesions characterizing the disease are the result of different, mutually influencing factors .
Based on recent studies, the inflammatory changes are not only a consequence of proinflammatory effective bacterial metabolic products Propioniobacterium acnes lipases or as hyaluronidases. At the outset of acne patients is inflammatory responsiveness of the follicle a given. Even for the formation of comedones is an immunological basis, discusses the follicles are arranged in order of leukocytes, especially T-lymphocytes, is mediated to the particular.
Diet and acne
A high consumption of dairy products and foods with high glycemic index can worsen acne through increased 5-alpha-dihydrotestosterone levels. The glycemic index describes the effect of carbohydrates on blood sugar. Foods with a high glycemic index induce a strong increase in insulin. These include for example fried potatoes, chips or very white bread, which is used for making hamburgers.
Diagnosis
The diagnosis is made clinically. Laboratory tests are not necessary.
Differential Diagnosis
The comedo is the central efflorescence, which characterizes the acne and also the separation of other diseases localized in the face makes it possible (Table 1).
Table 1 Differential diagnoses and key clinical distinction helps to define
|
Disease |
Differentiation opportunities for acne |
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Perioral dermatitis |
Localisation stresses perioral, and periocular perinasal, no comedones; |
|
Rosacea |
next papules and telangiectasias also papulopustules and persistent erythema in the cheek area, no blackheads |