Cleanse the sebaceous glands. How to normalize the work of the sebaceous glands: rules for skin care, cleansing the face, basic nutrition, home and medical ways to normalize the work of the glands, advice from dermatologists. How do sebaceous plugs form? Effects

Skin diseases

acne

Inflammatory disease sebaceous glands, them excretory ducts and hair follicles.

The causes of disruption of the sebaceous glands can be:

• increased production of sebum (most often occurs in adolescence);
• blockage of the ducts of the sebaceous glands with dust or cosmetics due to improper cleansing of the skin;
• endocrine diseases in which the level of male sex hormones increases (for example, polycystic ovaries, tumors of the adrenal glands and ovaries);
• violation intestinal microflora or long-term use of corticosteroids.

Up to 80% of adolescents and about 11% of people over 25 suffer from acne, and in half of women and even more often in men, acne is severe.

Depending on the causes and features clinical picture There are several types of acne.

The most common:

• acne vulgaris (vulgar, or youthful);
• rosacea (pink, or red, acne),
• acne medical and professional.

Modern methods of treatment give a favorable prognosis for all types of acne, but in severe cases treatment may be lengthy.

Demodex

Causes of demodicosis

The tick is located in the mouths of the hair follicles, most often it lives in the hair follicles of the eyebrows and eyelashes, in the ducts of the sebaceous glands of the skin of the face. The tick can also exist outside this environment. In the formed specimen of demodex, the body is transparent in color and has an oblong shape. The length of demodex is 0.1 - 0.4 mm. The body consists of 2 parts and is covered with scales that help the mite cling to the hair follicle; on the first lobe of the body there are legs and a "mouth", it feeds on skin cells, sebum. The digestive system of the iron mite is special because it has no excretory openings. Demodex can live for several weeks. During this time, he needs to lay larvae in the hair follicles and sebaceous ducts. Demodex larva develops over 2-3 days.

Pathological increase in the number of microorganisms leads to the appearance clinical symptom demodicosis: acne and rashes are formed on the surface of the skin of the face, identical with the manifestations of rosacea and rosacea. First of all, they are localized on the nose, forehead, chin, cheeks, sometimes on the eyelids. A non-objectively unhealthy person will be able to feel itchy skin. When demodex affects the skin of the eyelids, itching, redness of the eyes appears, and eyelash loss can begin.

Patients often complain about severe itching eyelids (itching worse in the evening), heaviness in the eyes, redness and inflammation of the edges of the eyelids. Then inflammation of the eyelid margin is accompanied by inflammation of the conjunctiva, which is what causes the patient's complaints, such as redness of the eye, tearing, feeling of a foreign body in the eye.

Diagnosis of demodicosis

Microscopy is used to diagnose demodicosis. If Demodex has affected the eyes, then the eyelashes of both the upper and lower eyelids are taken for analysis from the patient. Under a microscope, a specialist can easily detect a large number of ticks, its eggs, as well as discarded chitinous shells. The doctor will be able to conduct the test right in the presence of the patient and immediately tell about its results.

If the skin of the face is affected by demodex, then a scraping is taken from its affected areas and examined under a microscope. Skin scrapings are taken from the nasolabial folds, chin, forehead. Demodex, which is considered an opportunistic tick, can be found in scrapings in a healthy person, but in a patient with demodicosis, the number of ticks increases significantly. Before scraping, doctors advise not to wash during the day before the procedure.

Treatment of demodicosis

Demodicosis, unfortunately, is difficult to treat. This is a long process that requires perseverance and perseverance from the patient. The cure can take from 1.5 months to six months. Because demodicosis is often caused by malfunctions gastrointestinal tract The patient is referred for an appointment with a gastroenterologist. Diseases such as cholecystitis and pancreatitis, as well as intestinal dysbacteriosis, appear in the bulk of patients with demodicosis. In addition to all this, you may need to consult a neurologist, gynecologist, endocrinologist. Getting rid of concomitant pathologies will make it possible to solve the problem of demodicosis.

Treatment of demodicosis is focused on increasing the protective qualities of the body, as well as on the elimination of demodex, the causative agent of the disease. Also, antihistamines are prescribed, because the tick causes allergic reactions. To combat demodex, both pills and local funds- creams, sprays, ointments. It must be admitted that the tick is reliably protected from the action of medicinal preparations by its own multi-layered outer covers, which complicates the treatment.

For any patient, the treatment of demodicosis is prescribed individually, taking into account the characteristics of the course of the disease. To get rid of the tick, preparations containing metronidazole are used. Although in recent times cases of demodicosis have become more frequent, for the treatment of which metronidazole is not quite successful. This is probably due to the fact that for almost all the years of using the substance, Demodex has developed resistance to it. As a result, other drugs are used, including, for example, ornidazole.

If demodicosis has affected the eyes, then it is necessary to treat the eyelids with alcohol solutions of herbs (eucalyptus, calendula). After that, apply ointments on them (prenacid, demalan). Demalan is considered an effective remedy for eliminating the demodex mite. This ointment has metronidazole and biologically active substances from the cornea of ​​animals that stimulate tissue repair. Demalan is applied not only to the eyelids, but also to the affected areas of the face. Prenacid removes the toxic-allergic reaction of the skin. If purulent blepharoconjunctivitis / blepharitis has developed, antibacterial substances are prescribed - ointments and drops “colbiocin” or “eubetal-antibiotic”. In addition to all this, it can be useful to carry out self-massage of the eyelids - with wet fingers for 1-2 minutes. In addition, physiotherapy procedures are used to treat demodicosis, including magnetotherapy, local ozone therapy. After the main course of treatment, it is possible to rub burdock oil into the edges of the eyelids for 1.5-3 months to stimulate the growth of eyelashes.

To prevent re-infection, when treating demodicosis, certain rules must be followed. You need to change your pillowcase daily. It is recommended to wipe your face after washing not with a towel, but with disposable paper napkins. You can not give other people your cosmetics or use someone else's. Creams are much better to use in tubes, and not in jars, so as not to bring the pathogen into the cosmetic. You need to wash or clean your own things that come into contact with the skin of the face - hats, gloves, scarves. Eyeglass temples should be washed every day with warm soapy water, and razors should be treated with alcohol, as they can also be infested with mites. During the treatment period, it is necessary to exclude alcohol and spicy food from the diet, do not visit baths and saunas, do not long time in the sun.

Couperose (telangiectasia)

Violation of blood circulation in the skin, in which meshes of dilated capillaries appear on the skin, redness, spider veins. Couperose is a cosmetic defect requiring dermatological and cosmetic treatment.

Most often, women with thin, sensitive, dry skin, susceptible to external influences, suffer from rosacea. The cause of the development of rosacea can be hereditary thinness and fragility of blood vessels, hormonal disorders (including those associated with age or taking hormonal contraceptives), liver disease, excessive physical exercise, aggressive environment ( sharp drops temperatures or living in too harsh a cold or vice versa too hot climate), as well as the abuse of "aggressive" food (spicy, hot), alcohol and smoking.

Couperose is usually localized in the area of ​​​​the wings of the nose, on the cheeks, chin or on the forehead. The capillaries lose their elasticity and expand. Outwardly, this is manifested by the appearance vascular networks, asterisks (telangiectasias), redness of the skin. Over time, the redness becomes permanent, the color of the spots changes to a more saturated red-blue, they give the face an unhealthy, unaesthetic look.
The success of the treatment of rosacea directly depends on the time of the visit to the doctor. The sooner you start treatment, the easier and faster you will get rid of the vascular networks.

Depending on the severity of the disease, various methods can be used to treat it.

If you “catch” rosacea at a very early stage, then you can get rid of it by adjusting your diet: you should exclude spicy and too hot dishes, pickled foods, liver, red wine and reduce the consumption of dairy products, chocolate, citrus fruits - and using special cosmetic products with anti-couperose effect that can strengthen the walls blood vessels.

If these funds are not enough, mesotherapy, ozone therapy, soft chemical peels are used to treat rosacea. All these methods improve blood circulation, and mesotherapy additionally strengthens the walls of blood vessels.

But only a laser can remove spider veins. This procedure is called laser coagulation of blood vessels (laser soldering, gluing). Without damaging the skin, the laser literally glues the damaged vessel together, blood stops circulating through it, and the “asterisk” disappears. The procedure is painless, effective, leaves no marks on the skin and has virtually no contraindications.

If there is a tendency to develop rosacea, then, even after completing treatment, you should observe preventive measures to avoid the appearance of vascular "asterisks" and meshes in the future.

You should use special cosmetics, in no case use products that contain alcohol, avoid rough towels, washcloths, and do not use scrubs. In the sunny season, sensitive skin needs additional protection from ultraviolet rays - sunscreen. To strengthen the walls of blood vessels, the doctor may prescribe you vitamin C and drugs based on rutin.

With proper treatment and subsequent compliance with all the doctor's recommendations, the possibility of a relapse - that is, a new appearance of "spider veins" - is reduced to zero.

Rosacea

Rosacea(another name is rosacea) is characterized by reddening of the skin and the formation of small bumps, which then increase in size and become the cause of the appearance purulent acne. Quite often, this disease is inherited. Development is due to impaired blood supply, innervation of blood vessels. This can be caused by a variety of factors: prolonged exposure to the sun, frost, diseases of the gastrointestinal tract, alcohol abuse, caries, etc.

As a rule, rosacea is localized on the forehead, nose, cheeks, and also occurs on the chin, neck, and décolleté. Begins to appear usually after 35-40 years. Fair-skinned people are more prone to this disease. At an early stage, redness is temporary, then it becomes permanent. After some time, small dense red pimples, spider veins appear. Sometimes these symptoms are accompanied by dryness of the mucous membrane of the eyelids, which leads to redness, inflammation and tearing.

Currently, it is customary to distinguish several stages of the disease:

• erythematous
• erythematous-papular
• papulo-pustular
• nodular or nodular.

When rosacea starts, rhinophyma forms when the nose takes on a pineal shape. This pathology appears due to venous stasis of blood, which leads to a change in the size and color of the nose. It becomes reddish-bluish or purple. A serious complication is damage to the cornea of ​​​​the eyes.

The clinical picture of the disease is very bright, so it does not take much time to make a diagnosis. Before prescribing treatment, it is necessary to find out the cause of the appearance of skin pathology. To this end, a thorough examination Special attention refers to the state of the digestive system and hormonal changes.

Rosacea treatment should be complex, it depends on the identified cause. As a rule, doctors recommend a special diet from which spicy dishes, hot drinks, alcohol. With caution, you should take foods that promote vasodilation. On an individual basis, specialists prescribe medications, vitamin complexes.

Local treatment includes the use of creams, gels, anti-inflammatory baths, lotions, massage. To eliminate the network of blood vessels, patients are forced to resort to laser, radio wave therapy. An operation is performed to get rid of the pineal nose.

Scarring

Scars can appear on the skin as a result of injuries, burns, operations, or as a consequence of acne. Not being a disease in the full sense of the word, scars, however, can cause serious psychological discomfort.

It is customary to distinguish between several types of scars:

• Hypotrophic- scars, sinking relative to the surface of the skin. Such scars occur after acne (post-acne), chickenpox or minor skin injuries. Striae (stretch marks) belong to the same species.
• Normotrophic- scars that are on the same level with the skin, they are not as visible on the surface of the skin as other types of scars, occur as a result of shallow wounds and burns.
• Hypertrophic- These are dense scars that rise above the surface of the skin. These scars are prone to flaking, itching, and ulceration. They can appear as a result of: significant injuries, burns of 3-4 degrees, surgical intervention, prolonged suppuration of the wound, or injury to other types of scars (for example, normotrophic). More often hypertrophic scars are formed in people with a genetic predisposition to the formation of this type of scarring.
• Keloid - special kind scars. Such scars rise strongly above the skin, have a burgundy or cyanotic color and a dense structure, are often covered with tubercles, and can be painful when pressed. On their surface, irritation and itching often occur, leading to the formation of ulcers. This type of scar is characterized by growth beyond the original wound and recurrence after surgical excision. Perhaps this is the most unfavorable outcome of skin damage. The main role in the occurrence of keloid scars is played by genetic predisposition.

The formation of a scar of any kind is the replacement of damaged skin with connective tissue. As a rule, the final scar is formed in a year. Therefore, it is better to start treatment without waiting for the end of this process. However, in modern aesthetic medicine There are ways to correct and old scars. The choice of treatment method depends on the age of the scar, its type, location and size.

In general, all methods of scar correction are divided into invasive (surgical excision) and non-invasive (physiotherapy). Invasive methods suggest surgical excision of scar tissue and the imposition of a cosmetic suture to form a new inconspicuous scar. The excision of the scar itself can be performed not only with a scalpel, but also with a laser, cold, and even medication - the introduction of a drug into the scar. Non-invasive methods- this is an effect that does not violate the integrity of tissues. Its main goal is to gradually turn the pathological scar into a normotrophic one, that is, one that is on the same level with the surface of the skin and is almost invisible. Non-invasive scar treatments are less traumatic and have a better prognosis.

MICRODERMABRASIA

One of the most effective ways scar removal. This method is especially relevant for the correction of "sinking" scars and scars that only slightly protrude above the skin surface. With the help of a special apparatus, a stream of solid crystals is directed to the scar under high pressure. Very carefully, layer by layer of microparticles, the scar is removed. They do not damage the surrounding tissues, but suit for light skin“shake-up”, due to which the synthesis of collagen fibers is activated in the skin, and its relief is smoothed. Gradually, the surface of the scars is smoothed out, and the edges are aligned with the surrounding skin. As a rule, for the complete removal of a scar or scar, it is necessary to undergo a course of procedures with an interval of 1-2 weeks.

For microdermabrasion, devices can also be used in which, instead of abrasive microparticles, nozzles with a diamond tip are used. Then the procedure becomes a little more traumatic, but also more effective.

With the advent of lasers in aesthetic medicine, new methods of scar treatment have also appeared. Modern laser technologies allow you to permanently get rid of scars and scars of any origin. As a rule, scar removal is complex procedure using different types of lasers.

LASER GRINDING

Formally, laser resurfacing is invasive method, but modern lasers allow the doctor to act with precision, so the procedure is very delicate, non-traumatic, and the risk side effects practically absent. The essence of this method is as follows: the laser delicately and with an accuracy of up to a micron “cuts off” the scar tissue layer by layer. The main problem in carrying out such operations is the bleeding that inevitably occurs when the dermis is destroyed. But modern laser systems"seal" the vessels, preventing bleeding. Under the influence of a laser beam, the synthesis of collagen is launched - a “building material” for skin renewal and a new smooth skin is formed. In addition, laser radiation has a bactericidal effect, which eliminates the risk of infection and complications. Laser resurfacing allows for the correction of all types of scars, primarily hypertrophic, normotrophic and atrophic, which no other method of scar treatment allows.

CHEMICAL PEELING

A course of peeling with fruit acids can reduce the density of the scar and smooth its surface, turning a hypertrophic scar into an almost imperceptible normotrophic one.

MESOTHERAPY

Intradermal administration of biologically active and therapeutic drugs is one of the main procedures for removing stretch marks and scars. Due to specially selected ingredients of the mesotherapeutic cocktail, it is possible to significantly reduce the density of the scar, align it with the skin surface. In addition, mesotherapy triggers the regeneration of skin cells, stimulates collagen synthesis and restores the aesthetic appearance of the skin. The skin becomes healthy, elastic, tightened. Using the method of mesotherapy, you can correct all types of scars, except for keloids.

Scar correction can be quite a lengthy process, and an integrated treatment approach gives the best results.

Update: December 2018

The condition of the skin depends on the hormonal background, hygiene habits of a person, the level of immunity and heredity. Inflammation of the sebaceous glands is the most common disease of the dermis, which develops due to the negative impact of these factors. In the medical literature, this condition is referred to as "acne" or "acne", for most people the more familiar word is "pimples". However, regardless of the name, this disease affects the appearance of a person, can reduce his self-esteem and repel other people from him. Therefore, its elimination is a priority for most patients.

You can learn detailed information about the causes of acne, prevention, methods of correct and effective treatment from this article.

Fundamentals of anatomy

Almost the entire surface of the body is covered with sebaceous glands. These are small formations that produce sebum, with short and branched excretory ducts. A particularly large number of them are located around the hair - on average, there are 7-9 glands around one hair follicle. Also, in most people, their accumulation can be found in the following areas of the body:

• Face. Separately, it should be noted the skin around the lips, forehead and cheeks;
• Back, especially in its upper half;
• Neck and chest;
• Armpits;
• Member and labia minora;
• Skin around the nipples.

Acne can occur anywhere on the body, but these areas are the most commonly problematic. A person has only two places where acne cannot form. These are the palms and feet. In these places, the skin has a special structure - it has a thickened epidermis, there are no sebaceous glands and hair follicles.

Why acne occurs

The causes of inflammation can be divided into 4 main groups: hormonal changes, increased dryness of the skin, excessive production of sebum and infection. In some cases, one person may have several causes of the disease. At the same time, it is important to eliminate each of them in order to obtain the optimal effect from the treatment.

It is also important to consider heredity as a factor in the development of acne. Scientists have proven that parents with severe acne in the present or past, children are more susceptible to this disease. Knowing this fact, it is possible to carry out preventive measures in a timely manner, correcting the condition of the dermis.

Restructuring of the hormonal background

The amount of sebum produced is most affected by the ratio of sex hormones in the blood of a person. Of fundamental importance are:

1. Androgens(testosterone, dihydrotestosterone, DHEA-S). Male hormones lead to increased work of not only sebaceous, but also sweat glands. Therefore, an increase in their concentration can lead to acne;
2. Progesterone. This is the "hormone of pregnancy", which is intensively produced in women after the middle of the menstrual cycle and immediately after conception. Causes swelling of the excretory duct, which leads to stagnation of sebum;
3. Estrogens(estrone, estriol, estradiol). These substances relieve swelling and restore the patency of the excretory ducts of the glands, somewhat reduce their secretion. A lack of estrogen can also cause acne.

There are moments in the lives of people of both sexes when hormonal changes are the norm. In this case, the formation of acne is a temporary effect and does not require special treatment, except in cases of infection. However, when changing the amount of sex hormones against the background of the disease, it is necessary to carefully approach the issues of therapy. In this case, it may be necessary to consult not only a general practitioner, but also a gynecologist, andrologist or endocrinologist.

To distinguish the disease from the norm, it is necessary to know the periods when hormonal changes occur. These include:

Above were listed the conditions in which the occurrence of acne is considered a variant of the norm. In all other cases, the appearance of acne should be considered a sign of the disease.

Increased dry skin

A fairly common cause of inflammation skin glands is their blockage by horny scales. With excessive dryness of the skin in a person, its surface layer begins to quickly exfoliate. These particles of the epidermis can close the sebaceous ducts and lead to the formation of acne.

Many factors influence the degree of moisture in the skin. The most important of them are:

• Age over 40. Over the years, the body's ability to restore is inevitably depleted. It is more difficult for the cells of the dermis to retain the required amount of moisture and trace elements, so it must be additionally moisturized with the help of cosmetics;
• Climate. This term refers not only to weather conditions, but also to the surrounding microclimate: indoor temperature, air humidity, the use of gadgets to control temperature.
  • Negative influence renders dry and frosty air, low air humidity, the use of air conditioners, heat convectors, heat guns, etc.;
  • positive influence has warm and humid air (optimal is sea), air humidifiers for rooms. If it is necessary to use thermal elements or air conditioners, it is recommended to combine them with air humidifiers.
• Hot bath or shower. The surface of the skin in a healthy person is protected by a lipid layer that prevents it from drying out. High temperature water destroys this natural defense, which can be a factor in acne;
• Hygiene products. Using regular soap to wash your face or intimate areas may cause dryness. Since the protective layers of the dermis are more vulnerable in these areas, it is necessary to use special lines of hygiene products to care for them, for example: milk or foam for washing the face, micellar water, tonic lotion, soap for intimate hygiene and others.
• Skin diseases such as allergic dermatitis, psoriasis, eczema, etc.;
• Endocrine diseases, for example: diabetes mellitus, hypothyroidism, Itsenko-Cushing's syndrome / disease.

In the treatment of inflammation of the sebaceous glands great importance plays revealing harmful factors. Therapy may not bring any effect for a long time if the cause of acne formation is not identified and eliminated.

Excess sebum production

At the moment, only three reasons are reliably known that can enhance the work of the glands: an increased content of androgens (described above), certain foods and the disease "seborrhea". In the course of research by domestic doctors, it was determined that products with a high content of fatty acids have the greatest harm to the skin. These include:

• Chocolate and cocoa;
• Nuts;
• Some types of cheese: feta cheese, suluguni, pigtail cheese and other pickled cheeses;
• Fatty meats (veal, beef, lamb, etc.) and products of their processing.

Carbonated and caffeinated drinks can also become a factor in the development of acne. Some scientists believe that the substances contained in them also increase the production of fat.

The next significant factor is the disease, the only sign of which is the presence of oily skin. Until now, scientists have not identified the causes of seborrhea. It is believed that this disorder is inherited and develops under the influence of adverse factors (described above).

Joining the infection

Microorganisms are the main cause of inflammation. When certain bacteria penetrate the skin, immune processes are activated, pus is formed, and surrounding tissues are damaged. Against the background of an unfavorable course of the disease, bacteria can spread to neighboring areas and contribute to the formation of large conglomerates of acne.

At the moment, the role of only one type of microbe in the development of acne has been proven - Propionobacterium Acne ( Latin name- Propionibacterium acne). That is why in the treatment of patients with this disease are necessarily used antimicrobials local or general action.

Appearance and symptoms

Basically, there are two groups of acne. The first includes acne that occurs only due to blockage of the excretory ducts. The second option develops with a combination of inflammation with the closure of the mouth of the gland. They must be distinguished from each other, since the tactics of treatment depend on this. Each of the species has its own characteristic features, such as appearance, soreness and density when palpated.

To determine your acne variant, it is enough to use the information from the table below:

After determining the type of acne, it is also necessary to find out the severity of the disease. Only then can the optimal treatment option be determined. It is strongly recommended to consult a dermatologist for this purpose, as self-treatment can lead to incomplete recovery from the disease and irreversible damage to the skin.

The severity of the disease

To find out how severe the disease is, it is enough to determine the nature of acne and count the number of these elements. Currently, there are the following criteria for pathology:

• Light degree. A person has only non-inflammatory elements or the number of papules, pustules less than 10;
• Moderate course. The number of papules and pustules is from 10 to 40;
• Severe illness. Papules and pustules in total more than 40 (all over the body) or the presence of indurative, conglobate acne is noted.

It should be noted that any severity of acne is treated at home. However, the more severe the pathology is, the higher the risk of irreversible skin damage.

Treatment

Therapy of any form of the disease is recommended to be carried out under the supervision of a general practitioner or dermatovenereologist, who will determine the optimal tactics. The treatment regimen for blockage of the sebaceous glands is determined by the severity of the disease and the cause that caused the development of acne. In cases where it is not possible to find out the cause, the doctor is guided solely by the severity of the disease.

Definitions of treatment tactics

There are several areas of acne therapy - diet, cosmetic procedures(daily skin care), the use of topical preparations and systemic treatment. Diet changes are indicated for all patients. For the rest of the nuances, there are the following recommendations for the selection of the volume of therapeutic measures:

Diet

It has been proven that a small change in diet can significantly reduce the number of acne. The exclusion of certain products allows you to reduce the secretion of the sebaceous glands and eliminate one of the risk factors for acne.

• It is recommended to exclude: carbonated drinks, cocoa, nuts, pickled cheeses (brynza, suluguni, etc.);
• Should be limited: chocolate, meat with a high content of fatty acids (veal, pork, lamb and others), coffee.

Cosmetic skin care

Elimination of acne must necessarily include this component of therapy. It is needed to increase the moisture of the skin and reduce flaking - this will help reduce the likelihood of blockage of the glands. For optimal results, the following hygiene guidelines must be observed:

1. Problem areas of the skin should be washed 2 times a day. More frequent or less frequent care can negatively affect the condition of the skin;
2. Water for procedures should be used at room temperature, as large temperature changes cause severe peeling of the epidermis;
3. After washing, the skin should be blotted with a soft towel, and not rubbed with it;
4. It is necessary to abandon the use of alcohol-containing lotions, sharply alkaline or acidic agents. Their pH (acidity) should be neutral or slightly deviate from this value (pH = 7±1.5);
5. Scrubs should not be used, as mechanical irritation of the dermis can increase the production of sebum;
6. For additional moisturizing of the skin, you can use Physiogel or Cetafil cream, 1-2 times a day. According to national guidelines, these products are optimally suited for the complex treatment of acne.

The selection of daily care products is carried out with the help of the attending doctor. As already mentioned, for this purpose, you can use both general cosmetic lines (Nivea, Dove, etc.), and specialized means("Aisida", "Xemoz" and others).

Local therapy

This healing method It consists in applying drugs to problem areas of the skin. At the moment, there are several groups of drugs for local application. These are antiseptic and keratolytic (exfoliating) substances, preparations with vitamin A and combined agents. The standard treatment regimen involves the use of one pharmacological drug from each group, or a drug with a combined effect.

Preparations with retinoic acid

This group has complex impact on the dermis - they reduce the activity of the inflammatory process, prevent over-education horny scales and weaken the work of the sebaceous glands. Currently, Adapalen (Differin) is considered the optimal pharmacological preparation. It is highly effective and easy to use, but it acts rather slowly - the first effects of its use develop after 4-6 weeks.

Adapalene is available in the form of a gel and cream, applied once a day, at bedtime, at the end of hygiene procedures. After that, the face is not wiped and not moisturized. Average duration course - 3 months.

Antimicrobial treatment

Medicines from this group should be prescribed in the presence of inflammation of the sebaceous glands, that is, when papules, pustules, conglobates and other elements occur. At the moment, dermatologists recommend using one of the following antibacterial agents:

It is necessary to apply any antibacterial drug 2 times / day after washing on clean, dry skin. He needs to give time to act for 20-30 minutes. During this time, do not wipe or wet the skin.

Combined drugs

This group was developed by pharmacologists for the convenience of patients. The presence in one "bottle" of several active ingredients allows you not to buy several drugs, but to limit yourself to one. Also, combined products are easier to use - one application of them allows you to have a complex effect on the dermis.

Here are the most common and effective combinations:

General treatment methods

This method of therapy is resorted to only in severe stages of the disease or on an individual basis with moderate severity (for example, with the ineffectiveness of local treatment). The main goals when using drugs with a systemic effect are to eliminate harmful microbes, reducing desquamation of the epidermis or eliminating the causes of the disease.

Antibiotic therapy

Acne pathogens show the least resistance to two groups of antibiotics - tetracyclines and macrolides. These groups include different drugs, from which it is necessary to choose one that is best suited for a particular patient. This task for the attending physician - it is strongly not recommended to prescribe treatment on your own.

At the moment, in order to eliminate purulent inflammation of the sebaceous glands, the following antibiotics are widely used:

During therapy, the following principles must be observed:

1. The minimum course of therapy is 10 days. This duration prevents the formation of resistance in bacteria to the antibiotic, which will allow in the future to conduct a second course in case of recurrence of the disease;
2. You should not interrupt the course of antibiotics, except in cases of intolerance;
3. In the presence of comorbidities (diabetes, atrial fibrillation, thrombosis of arteries or veins, etc.) the dose and type of antimicrobial agent must be agreed with the doctor, since drugs can affect each other;
4. Alcohol should be completely avoided while taking medications, as the combination can lead to severe liver damage.

Retinoic acid preparations

According to modern recommendations, for the treatment of severe forms of acne, only one pharmacological preparation from this group is used - Isotretinoin (Acnecutane, Roaccutane). It reduces the work of the sebaceous glands throughout the body and reduces the peeling of the epidermis. Despite its high efficiency, retinoic acid has a large number of side effects. Of these, dyspeptic disorders (nausea, loose stools, abdominal pain), weakness, dizziness, and decreased performance are most often manifested in patients.

It is important to note that it is only used for severe acne resistant to other therapies. Isotretinoin absolutely contraindicated during pregnancy, at the time of its reception, a woman needs to take care of adequate contraception.

Hormonal correction

This procedure is carried out only as prescribed by a gynecologist. It is shown to women who laboratory methods confirmed the existence of any hormonal disorder. For this purpose, various drugs can be used, depending on whether a woman is planning a pregnancy in the next 6 months or not.

If there are no plans to conceive, hormonal contraceptives are usually recommended, in the form of pills, applicators, vaginal rings, implants, etc. When planning pregnancy, it is possible to use "cyclic hormone therapy" - estrogen in the first phase of the cycle and progesterone after the middle of the menstrual cycle.

Elimination of acne during pregnancy

This is a rather complex issue that has not been finally resolved to date. The fact is that before prescribing the drug to a pregnant woman, full-fledged clinical trials should be carried out on this particular group of people. However, pharmacological companies and independent associations of doctors are wary of conducting these experiments, because of the likelihood of complications in the fetus or mother. Therefore, no topical preparation has been confirmed to be safe.

Nevertheless, the accumulated experience of domestic doctors allows the following scheme to be used for the treatment of pregnant or breastfeeding women:

1. Diet, with the exclusion of all products that increase the production of sebum (chocolate, nuts, fatty varieties meat, etc.);
2. Daily hygiene care for affected skin, using moisturizing funds;
3. It is possible to use azelaic acid preparations, but only with the permission of a dermatologist, gynecologist or therapist;
4. In severe purulent acne, Josamycin may be prescribed after the 14th week of pregnancy.

Regardless of the gestational age, it is forbidden to use retinoic acid preparations (both local and systemic) and tetracycline antibiotics. These drugs have a pronounced side effect on the development of the fetus.

Prevention

Measures to prevent the development or reduce the intensity of acne are recommended to start from puberty (13-15 years). It is at this time that the period of activity of the sebaceous glands begins, which can lead to the formation of acne. Preventive measures are quite simple, they include:

• A diet aimed at reducing the production of sebaceous secretion;
• Daily washing, using moisturizing cosmetic lines;
• Prevention of excessive drying of the skin (from exposure to temperatures, dry air, chemicals, etc.).

FAQ

Question:
How to suspect the presence of a hormonal disorder in a woman as the cause of acne?

First of all, you should pay attention to the regularity of the menstrual cycle. Also, very heavy or scanty discharge, the presence of spotting between periods, male pattern hair growth (along the midline of the abdomen, on the back, in the chin area, on the cheeks or under the nose) are also considered a pathological sign.

Question:
Can you pop pimples on your own?

No, because this procedure leads to an increase in the inflammatory process. Also, the possibility of pus entering the bloodstream and the development of a severe infection (sepsis or meningitis) is not excluded.

Question:
Why is it impossible to dry the skin with inflammation of the sebaceous glands on the face?

At the same time, its peeling intensifies, and the horny scales close more of the excretory ducts of the sebaceous glands. Accordingly, the number of comedones, milia and other acne elements increases in a person.

Question:
Can physical therapy be used to treat acne?

Indications for physiotherapy are quite limited - this is the presence of comedones or milia in a limited area of ​​\u200b\u200bthe body. However, its effectiveness has not been proven in scientific studies. Physiotherapy contraindicated with acne inflammatory nature(papules, pustules, conglobates, etc.), as it leads to increased blood supply to tissues and aggravates inflammation.

Question:
Are there any features of the treatment of blockage of the sebaceous glands in a child?

Acne in newborns, in the vast majority of cases, resolves on its own and does not require therapy. Most often, teenagers face this problem. The treatment regimen for children older than 8 years is carried out in the same way as for adults. If the child is younger, it is necessary to abandon retinoic acid preparations and the use of systemic antibiotics (except for Josamycin).

Increased oily skin worries many girls who are thinking about how to normalize the sebaceous glands. This problem is not only cosmetic defect but also a sign of disease in the body.

The sebaceous glands are located throughout human body. In the area of ​​the face, forehead, nasolabial triangle, on the head, their work is most active. As a result of improper functioning of the sebaceous glands, excess fat is produced on the face. Excess fat provokes the formation of acne, gives the skin an ugly shine and creates other problems.

The main reasons causing increased fat secretion, experts include both internal and external factors.

• Hormonal disbalance. Hormonal disturbances or changes in their levels during puberty increase the activity of the glands. In women in adulthood, this is noted in the second half of the menstrual cycle.
• UV exposure. According to the research of modern scientists, under the influence of direct ultraviolet radiation, the work of the sebaceous glands is disrupted. The top layer of the skin thickens, which leads to clogged pores and the appearance of cosmetic defects.

• Disruption of the immune system. Diseases contribute to increased production of fat on the skin of the face thyroid gland, diabetes mellitus, ovarian dysfunction, overweight.
• Wrong nutrition. Availability on the menu fatty foods, fast food leads to disruption of the digestive tract and increased production of fat by the sebaceous glands.
• Wrong care. Non-compliance with the rules of hygiene, the selection of cosmetic products that are not suitable for the type of skin, lead to increased oiliness of the skin.

Reestablish normal functioning glands allows an integrated approach to the problem.

Diet to normalize the functioning of the glands

Changing the diet is the first thing to do to reduce the activity of the sebaceous glands.

The following foods should be excluded from the diet:

• carbonated drinks;
• alcoholic products;
• fatty, fried, spicy;
• smoked and canned foods;
• products containing dyes, flavors and flavor enhancers;
• bakery and confectionery products;
• strong coffee and black tea.

The following products should be present in the menu in greater quantities:

• fresh vegetables and seasonal fruits
• dairy and dairy products;
• cottage cheese;
• lean meat;
• cereal porridge.

The condition of the skin is positively affected by the use of red fish, sauerkraut, fresh herbs, nuts. From drinks recommended green tea, herbal decoctions, clean water.

Effective pharmaceutical preparations

Pharmaceutical products differ in a wide variety both in the principle of action and in price category.

When choosing cosmetics that allow you to improve the condition of the skin, experts recommend using products from the same series.

• La Roche Posay. The company offers products to reduce the activity of the sebaceous glands. At the moment it is a favorite among similar products. Thermal water is the main ingredient. The brand produces a wide range of products that improve the functioning of the sebaceous glands and reduce skin greasiness. Of these, there is a Cleanser - Effaclar Gel and a special mask Effaclar to control the production of fat and narrow pores. Also in the series is a preparation for skin toning, makeup removal and moisturizing.

• Avene. Another popular company that produces a wide range of products for oily skin. The most famous remedy is the Cleanance gel. It is suitable for young skin prone to acne. In addition to it, there is a sebum-regulating cream.

• Vichy. Well-known cosmetics for the care of problematic and oily skin. The company has released a separate line of products that restore the functioning of the sebaceous glands - Normaderm. It consists of a washing gel, mask, lotion, day cream.

• Retinoic ointment. A drug for a quick effect. Differs in low cost. Apply to problem areas twice a day. Effective for acne and rashes, normalizes the sebaceous glands. The course of application is no more than 1 week.

In case of acne caused by clogged pores, Zinc, Salicylic ointment, Chlorhexidine, Salicylic-zinc paste, Aspirin tablets, vitamins A, E.

How to reduce fat formation on the face: folk methods

Not only the pharmaceutical preparation has positive effect to the work of the sebaceous glands. At home, decoctions of medicinal herbs and recipes from natural ingredients allow you to restore the condition of the skin.

• Clay mask. The recipe uses grape puree and 2 teaspoons of clay (white, blue or pink). The ingredients are combined and applied to cleansed skin. Leave to dry completely, then remove with warm water.

• Decoction of medicinal herbs. For daily use, prepare a decoction of herbs. Chamomile, calendula, horsetail are brewed in a glass of water. The resulting decoction is wiped or rinsed with a face. Medicinal herbs relieve inflammation, improve complexion, narrow pores. In addition to rinsing, the decoction is used to make ice cubes that rub the skin.

• Nettle compress. For cooking, use a tablespoon of dry nettle in a glass of boiling water. The resulting broth is infused for an hour. Then they take clean gauze and moisten it in nettles. The resulting compress is applied to the skin for 10 minutes.

• Starch mask. The recipe uses a tablespoon. potato starch, a teaspoon of lemon juice and 3 teaspoons of kefir. The ingredients are thoroughly mixed and applied to the skin for 15 minutes.

In addition to the recipes listed, oatmeal masks, lime, lemon or cucumber juice tonics help well. To natural ingredients add a preparation based on vitamin A or E.

Features of oily skin care

Increased production of fat is associated with improper skin care techniques. For this reason, a change in hygiene rules and the selection of suitable cosmetics help to regulate processes.

Normalization of the work of the glands is possible if a number of rules are observed.

• minimization negative impact on the skin. Alcohol-containing products, fatty creams and frequent scrubbing should be excluded from everyday life.
• Regular care. It includes daily makeup removal before bedtime, cleansing, moisturizing and nourishing the skin.
• Competent selection of cosmetic products. Cosmetic products are selected depending on the type of skin. For cleansing, gels, mousses and foams with anti-inflammatory action are used.

• The right choice of decorative cosmetics. Tonal foundations are selected with a light texture, powders - with a matting effect. It is not recommended to use cream textures for blush or shadows.
• Application of folk recipes. In addition to regular care with cosmetic products, it is recommended to use folk recipes. They include rinsing the face with infusions of chamomile, horsetail, nettle, linden.
• Diet correction. Increased greasiness of the skin contributes to malnutrition. The menu should include lean varieties meat and fish, fresh vegetables and fruits, cereals. It is recommended to minimize the consumption of sweet, starchy, fatty, alcoholic products.

Compliance with the rules of care can significantly reduce the risk of skin problems resulting from improper functioning of the sebaceous glands.

There are skin diseases that are treated by both dermatologists and cosmetologists. These include something that everyone can have, which you can not pay attention to, but which you really want to get rid of, as this affects aesthetic appearance skin. So, these are problems that spoil the appearance and cause not so much physical as moral suffering. Let us dwell here only on the most frequent ones - Acne, seborrhea and various formations on the skin.

Acne vulgaris or juvenile acne

Acne- the most common skin disease in adolescents and young people, that is, the most socially active part of the population. This unpleasant disease affects about 85% of people aged 12 to 25 in European countries, so clean skin This age is the exception rather than the rule. Presence inflamed pimples, pustules and abscesses, black dots (comedones), spots and scars, greasy, untidy appearance of the skin in the most prominent places causes difficulties in communication, professional device, reduces self-esteem, often leads to the formation of significant psycho-emotional disorders, up to the desire for complete isolation. Some young people stop leaving the house, drop out of school and work, become isolated, and in the end, a minor and completely banal skin problem develops into a personal tragedy. A patient who has addressed to a dermatologist about acne has serious psychological problems. Shyness, guilt, a sense of social unacceptability, anger, a state of depression, disbelief in the possibility of a cure are expressed to one degree or another. Intense experiences exacerbate the course of the disease. In stressful situations, patients, especially women, open the skin, squeeze out Acne, which further worsens the appearance of the skin due to the accompanying inflammation. On such injured areas, scars and spots remain that do not go away for a long time.

Acne- a long-term disease, often aggravated (in girls, as a rule, monthly) and often resistant to ongoing treatment. Today we know much more about acne than ten years ago, and a competent specialist can always help the patient. In this regard, the opinion that existed in the past that acne will disappear by itself with age, and therefore it is not worth spending effort on treating them, now sounds simply absurd. It is not always possible to immediately find the right individual approach, but the efforts made and the persistence shown are always rewarded with a good result. In the arsenal of specialists there are a number of effective drugs of different groups. The choice of the drug depends on the form of the disease, the prevalence of certain symptoms, the sex of the patient, the presence of contraindications.

Acne is more often divided into:

1. acne with a predominance of comedones (white and black dots with mild inflammation);
2. papulo-pustular acne (there are comedones, inflamed nodules - what is usually called acne, pustules, sometimes single large painful seals, gradually turning into abscesses such as boils);
3. conglobate acne (along with all of the above, there are long-term painful seals that leave pronounced scars after healing).

Most patients eventually develop the habit of squeezing comedones and pustules, constantly touching the inflamed skin, which is why bloody crusts, spots, superficial scars are added to everything described.

Many factors are involved in the development of acne, the action of which is ultimately realized in the sebaceous hair follicles. Not all follicles are affected, but only those with a special structure, located on the face and upper body, with large sebaceous glands, wide (up to 2.5 mm) ducts and thin, almost invisible hairs. The sebaceous glands are the target organ for sex hormones, especially testosterone. Under the influence of testosterone, produced by the sex glands, especially actively in adolescence, the size and number of sebaceous glands increase significantly, the production of sebum increases, and its composition changes. In addition, in the development of acne, a violation of the keratinization of the ducts of the sebaceous glands, difficulty in the outflow of sebum to the surface of the skin, increased reproduction of microbes in the accumulated sebum and subsequent inflammation are essential. With the help of modern medicines almost all factors involved in the development of the disease can be influenced.

With the initial manifestations of acne (usually at the age of 8–13 years), when the clinical picture is dominated by increased oily skin and comedones (whitish nodules and black dots), and there are not so many inflammatory elements, retinoic and salicylic acid preparations are used externally. Both acids have the ability to dissolve comedones, and salicylic acid is much weaker in this regard. With papulo-pustular acne, it is advisable to use antibiotics, retinoids, benzoyl peroxide (benzoyl peroxide), traditional external agents (salicylic, chloramphenicol, resorcinol alcohols). severe forms acne, including acne conglobata, should be treated with oral retinoids, and only if there are contraindications, other methods of treatment (antibiotics, immunomodulators) are used. As with papulopustular acne, it is preferable to use a combination of different drugs.

Problems solved in the course of treatment and ways to solve them:

• decrease in sebum production (retinoids, especially retinoic acid, hormonal preparations- estrogens, progestins or antiandrogens, spironolactones);
• reduction of inflammation - antibiotics (tetracyclines, erythromycin, lincomycin, clindamycin) and local anti-inflammatory and microcirculation-improving agents, including zinc oxide, sulfur, tar, ichthyol, resorcinol;
• prevention of the appearance and elimination of comedones (retinoids, especially retinoic acid, salicylic alcohol);
• prevention of scarring early start treatment, retinoids, curiosin, contractubex, exclusion of traumatic rashes).

Features of acne treatment with drugs of different groups

Currently, retinoids are the most effective group of drugs for the treatment of acne. Their use solves several problems at once - reducing the production of sebum and inflammation, preventing the appearance and elimination of comedones and scars. Two isomers of retinoic acid (tretinoin and isotretinoin) are used externally for the treatment of acne. Roaccutane and Retinol palmitate are used for internal treatment of acne conglobata and widespread papulo-pustular acne resistant to other external agents.

Roaccutane (isotretinoin) (Hoffmann-La Roche, Switzerland) is produced in capsules for oral administration of 10 and 20 mg (30 pieces per pack). Assign at the rate of 0.5-1.0 mg / kg of body weight per day, taken in equal parts 2 times a day after meals for 12-16 weeks. If necessary, repeated courses break should be at least 8 weeks. Roaccutane is a highly effective drug, however, its use is limited high cost and many side effects. Treatment is always carried out under the supervision of a specialist.

Retinol palmitate(vitamin A) - a domestic drug, it is produced in capsules for oral administration of 33,000 and 100,000 IU, as well as in oil solution 100,000 IU / ml. Effective doses for acne are at least 300,000 IU per day. The course of treatment is 12-16 weeks. The intervals between courses are 4-8 weeks. Retinol palmitate is inferior to Roaccutane in effectiveness, however, its tolerance is better, and the cost is much lower.

For external treatment of acne, preparations containing all-trans retinoic acid (tretinoin) and 13-cis-retinoic acid (isotretinoin) are used. All-trans-retinoic acid is contained in the following foreign preparations: Retin-A - 0.05% cream in tubes of 30 g (Silag, Switzerland), Lokacid - 0.05% cream in tubes of 30 g and 0.1% solution in 15 ml vials (Pierre Fabre, France). External preparations with 13-cis-retinoic acid, which has a higher bioavailability, are produced only in Russia - Retinoic ointment 0.1% and 0.05% and Retasol ® (FNPP "Retinoids"). Ointments and solution are recommended to be applied to previously cleansed skin 1-2 times a day. Upon reaching the effect, it is recommended to reduce the concentration or reduce the frequency of application of the drug. The duration of treatment is 12-16 weeks.

Drugs from the group of retinoids have a number of side effects. The most serious of them are teratogenicity and embryotoxicity. In this regard, women of childbearing age are prescribed retinoids with reliable contraception and a negative pregnancy test. AT outpatient card upon appointment systemic treatment they usually make a note about the woman's awareness of possible side effects, and abroad dermatologists suggest that women fill out and sign a special form in order to avoid further prosecution in case of side effects. External treatment with drugs of this group is stopped when pregnancy occurs. negative impact on reproductive function men do not have retinoids.

In the first or second week of treatment, most patients experience an exacerbation reaction, which is expressed in redness, moderate itching, and peeling of the skin. The patient should be warned about the reaction, and if important events in life are coming at this time, then it is better to postpone the start of treatment. Usually these phenomena disappear on their own within a few days, after which there is a persistent improvement. Dryness of the lips, cracks in the corners of the mouth, peeling of the skin are frequent during the treatment process, they are eliminated by using a neutral moisturizer for the face and body, hygienic lipstick or lip gel, limiting the use of detergents when washing and washing. With the systemic administration of retinoids, dryness of the nasal mucosa, nosebleeds, conjunctivitis, urethritis, increased levels of transaminases and lipids in the blood, and increased skin sensitivity to sunlight are sometimes observed. Taking this into account, before the start of treatment and monthly during the course of treatment, a biochemical blood test is performed, it is recommended to use protective sunscreen, avoid direct sunlight.

Contraindications

pregnancy and lactation, abnormalities in the biochemical analysis of blood (hyperlipidemia, increased activity of ALT, AST and alkaline phosphatase), renal and hepatic insufficiency, hypervitaminosis A, drug intolerance. It is impossible to prescribe simultaneously retinoids inside and out, ultraviolet irradiation, preparations with keratolytic and exfoliating effects, exfoliating cosmetic procedures and products (scrubs, peeling). The action of retinoids is weakened by the simultaneous use of glucocorticosteroid drugs and alcohol intake.

Antibiotics

Of the wide range of antibiotics for the treatment of acne, only tetracyclines, erythromycin, lincomycin, josamycin and clindamycin are used. The appointment of antibiotics inside is indicated for the defeat of a large area of ​​the skin, the predominance of pustules. During pregnancy, of these drugs, only erythromycin can be used.

Antibiotics of the tetracycline group have an advantage over other groups, since they are lipophilic and easily reach the main object of their action - the sebaceous glands. They can be prescribed for a long time - 2-3 months in a small dose. In this case, they block the production of bacterial lipases, the main link in the development of inflammation. An important advantage of this method is the possibility long-term treatment without disturbing the composition of the intestinal flora. The daily dose of tetracycline is 1000 mg (10 tablets of 0.1 g or 4 tablets of 0.25 g), doxycycline hydrochloride - 50 mg (1 capsule of 0.05 g once a day), unidox solutab - 50 mg ( 1/2 tablet of 0.1 g), metacycline - 600 mg (2 times a day, 0.3 g). Antibiotics of the tetracycline group at the indicated doses are always well tolerated, and the side effects characteristic of long-term use in a bacteriostatic dose, does not develop. Tetracyclines are contraindicated in concomitant fungal diseases, pregnancy (last trimester), liver dysfunction, leukopenia, children under 8 years of age, kidney disease. During treatment, insolation is not recommended, ultraviolet irradiation, retinoids for internal use, hormonal contraceptives, psychotropic, anticonvulsant and antidiabetic drugs are not prescribed. The absorption of tetracycline is weakened in the presence of food, especially milk and dairy products, as well as trace elements - aluminum, calcium, magnesium, iron. Their use should be avoided during treatment. Tablets are taken separately from meals.

Doxycycline, Metacycline and Unidox Solutab are better absorbed and can be taken with or after meals with plenty of water. Unfortunately, the resistance of microorganisms to the drugs of this group quickly develops, and when re-administered, they are rarely effective.

Erythromycin belongs to the group of macrolides, the daily dose - 500-1000 mg is distributed in 3-4 doses 1-1.5 hours before meals. The drug is produced in tablets or capsules of 0.1, 0.25 and 0.5 g. Possible side effects include nausea, vomiting, diarrhea, liver dysfunction. The drug is contraindicated in case of individual intolerance, liver diseases with impaired function. It should be borne in mind that erythromycin is inactivated by dairy products and acidic drinks, and also increases blood levels and enhances the toxic effect of carbamazepine (tegretol, finlepsin) and theophylline.

Clindamycin (lincomycin group) is prescribed in a daily dose of 0.6 g, divided into 2 doses, is available in capsules of 0.15 g and called Dalacin C - 0.15 and 0.3 g each. The course of treatment is 7-10 days. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with erythromycin and vitamins of group B. Lincomycin is prescribed in a daily dose of 1500-2000 mg (2 tablets 3-4 times a day), is available in capsules of 0.25 g. Duration of treatment and side effects similar to clindamycin.

Josamycin or vilprafen in a daily dose of 1000 mg (1 tab. 2 times a day between meals) is used for 2-4 weeks, then 1 tab. within 8 weeks. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with lincomycin, weakens the effect of hormonal contraceptives.

In case of intolerance to antibiotics, they resort to sulfanilamide preparations, usually co-trimoxazole (biseptol, septrin, groseptol, cotrifarm 480). The drug is prescribed at 480-960 mg (1-2 tablets) 2 times a day during or after meals with an interval of 12 hours. During treatment, it is recommended to drink plenty of fluids, monitor the condition of blood and urine, avoid solar and ultraviolet radiation, and do not prescribe ascorbic acid.

It is logical to assume that the local use of the above antibiotics can be much more effective and safer than the internal one. However, studies show that topical erythromycin, clindamycin, and tetracycline are only effective for mild acne, especially when combined with zinc, retinoids, or benzoyl peroxide. External application of 1% erythromycin ointment (Ung. Erythromycini 1%) has a positive effect only in combination with other external and internal agents, the gel with clindamycin Dalacin T (Pharmacy, USA) is more effective. Easy to use Eriderm (Eryderm, Abbott Labor, USA) - 2% solution of erythromycin. Levomycetin, boric, resorcinol alcohols are also used for drying and cauterization of individual rashes. Combined preparations are effective - Zinerit ("Yamanouchi", the Netherlands) - a solution of erythromycin and zinc acetate and Benzamycin, a gel for external use, in tubes of 20 g, ("Rhone-Poulenc Rohrer", USA), containing 3% erythromycin and 5% benzoyl peroxide. All of the above drugs are prescribed 2 times a day. As with oral antibiotics, topical preparations tend to cause the development of antibiotic-resistant strains of microorganisms, so their repeated administration is often ineffective. Resistance of strains of Propionibacterium acnes (the main microorganism that multiplies in the sebaceous glands of patients) to commonly used antibiotics was found in 60% of patients. Strengthening of resistance depends on the duration of therapy, resistance to erythromycin develops more often.

Other antiseptics and disinfectants. One of the successful modern approaches treatment is the use of benzoyl peroxide - a lipophilic compound due to the presence of a benzoic acid residue in its composition. When applied to the skin, benzoyl peroxide decomposes under the action of air into peroxide and inactive benzoic acid, which remains on the surface of the skin. Active oxygen compounds damage the walls of bacteria, destroying them, the content of fatty acids decreases, which prevents inflammation. At the same time, the same compounds have a damaging effect on the horny scales, which is clinically expressed by skin peeling, which accompanies the therapeutic effect. Benzoyl peroxide preparations do not affect comedones, therefore, if they predominate, they are not used. Different companies offer this drug under the names Benzakne (Polfa, Poland), Desquam (Bristol-Myers, USA), Oxy 5 and Oxy 10 (SmithKline Beach, UK), Baziron (Galderma, France). Benzoyl peroxide is produced in the form of 2%, 5%, and 10% gel, 5% and 10% lotion. Treatment begins with the application of a lower concentration of the drug to the face, then it is increased. On the back and chest immediately apply more high concentration. Benzoyl peroxide is applied to previously cleansed skin once a day. Side effects include an exacerbation reaction in the first days of use, dryness and flaking of the skin, discoloration of hair and linen when the drug comes into contact with them. Intolerance is not uncommon, therefore, before starting treatment, it is recommended to conduct a skin test - the drug is applied to a small area of ​​​​the skin of the flexor surface of the forearm for 48 hours. In the absence of itching and redness, you can apply the drug on the face.

A good effect, especially in the presence of comedones, has a combination of local application of benzoyl peroxide in the morning, and Retinoic ointment in the evening.

Azelaic acid inhibits the growth of microorganisms and reduces the content of free fatty acids on the surface of the skin. Cream or gel Skinoren (Schering, Germany), containing 20% ​​and 15% azelaic acid, respectively, is applied to the skin of the face (both on the affected and free areas from rashes) 2 times a day. When applied, local skin irritation is possible. Skinoren is used in complex therapy acne, its use as an independent remedy usually does not bring success.

Zinc hyaluronate is part of the Curiosin gel (Gedeon Richter, Hungary), has a healing and antimicrobial action. It can be applied when a small amount rashes, since the effectiveness of the drug is low. The gel is applied to cleansed skin twice a day, there may be a burning sensation and redness of the skin at the application sites.

Povidone-iodine (Betadine) is used to lubricate pustules in a concentrated (10%) or diluted 1:1 solution with water 1-2 times a day. It is undesirable to use in fair-skinned and red-haired patients due to hypersensitivity to iodine. The diluted solution cannot be stored.

With a small number of comedones in the initial stage of the disease, salicylic alcohol 2-3% is effective. It is used 2 times a day, trying not to apply to the entire affected area in order to avoid overdrying, but only to certain areas.

Sulfur is an anti-inflammatory agent, it is included as one of the components in most external agents (ointments and talkers) traditionally used in the treatment of acne. However, in recent years, its comedogenic effect has been discovered, i.e. it can cause the formation of comedones.

hormone therapy

Therapy with sex hormones is possible only in women. Estrogens (ethinylestradiol) and antiandrogens (cyproterone acetate, spironolactone) can be used for treatment. Estrogens reduce the secretion of the sebaceous glands, however, not as significantly as retinoids. They can be used simultaneously with local administration of retinoic acid, antibiotics or benzoyl peroxide, which increases the therapeutic effect. To achieve a good result, estrogens must be given for a long time - at least 5 cycles. The first signs of improvement are noticeable only towards the end of the second or third cycle. Estrogens have many side effects - nausea, fluid retention in the body, swelling of the legs, weight gain, breast tenderness, skin pigmentation, and an increased risk of vascular thrombosis. Risk factors for side effects include smoking, alcohol consumption, obesity, vascular diseases. Cyproterone acetate for the treatment of acne is used only in combination with estrogens. Of the combined preparations, Diane-35 and Janine (Schering, Germany) are used. The drug is prescribed 1 tablet per day, starting from the first day of the cycle, for 21 days with a break of 7 days. The antiandrogenic drug Cyproterone or Androkur (Schering, Germany) is prescribed 1 tablet (10 mg) per day, starting from the first day of the cycle for 15 days, a new course is started 4 weeks after the start of the first one. Glucocorticosteroid drugs are prescribed orally or parenterally only for abscessing and fulminant acne, which are extremely rare. External use of corticosteroid ointments is not indicated.

Drugs of other groups

Zincteral ("Polfa", Poland) contains zinc sulfate, the deficiency of which is often found in patients with acne. Tablets of 0.124 g are prescribed 1-2 times a day during or immediately after meals for 1-2 months. Nausea may occur during the first week of use. The drug enhances the action of retinoids, but weakens - tetracyclines. Homeopathic treatments include injections of Cutis compositum or Traumeel (Heel, Germany). Phytotherapy is still widely used as adjuvants - applications of slurry from badyagi for resorption of individual large knots, lotions with green tea, calamus rhizome, raspberry shoots. Inside appoint infusions of plants with estrogenic action (hop cones, sage leaves).

Skin care

Many patients, feeling the increased sebum secretion characteristic of acne, try to wash their face as often as possible using soap and a sponge. At the same time, the skin dries up, but sebum secretion does not become significantly lower, since the washing out of fats occurs only from the surface of the skin, without affecting the sebaceous glands themselves, located in its depths. In this regard, frequent washing of the skin (no more than 1 time per day), the use of sponges and washcloths are not recommended in order to avoid irritation and injury. Now many use antimicrobial soap. But it changes the state of the microbial flora only on the surface of the skin and does not significantly affect the course of the disease. At the same time, antimicrobial additives contained in soap can cause irritation or allergic reactions. To clean the skin, it is better to use a mild neutral soap for sensitive skin or special cosmetics intended for this purpose (cleansing with milk, then tonic), and to eliminate the shine of the face associated with the release of sebum to the surface, cosmetic wipes or special matting agents. The widely held belief that makeup should not be used for acne has also now been reconsidered. Modern high-quality cosmetics that do not irritate the skin, well mask existing defects, do not significantly disturb perspiration, are not applied to the skin in a thick layer, and can be used during the day. It should be removed at home. Some medicines require the use sunscreen. It is better to prefer gels and milk, and also be sure to quickly remove them from the skin indoors. Scrubs and peels may be recommended to smooth the surface of the skin and give it freshness, but are contraindicated during treatment with retinoids, benzoyl peroxide and tetracyclines.

The use of therapeutic masks with a drying effect and detergents is limited during treatment with retinoids and alcohol solutions. If there are pustules on the skin and severe inflammation, massage and cosmetic cleaning of the skin are contraindicated.

Diet

Both in the past and now, most dermatologists always recommend a fairly strict diet. Our long-term observations have shown that the benefits of such restrictions are small, and only in a few patients there is a clear relationship between the consumption of certain foods (mainly chocolate) and increased rashes. Usually we recommend that patients follow a reasonable diet, no frills, include more fermented milk products and greens in the diet. However, 2-3 days of fasting during an exacerbation always give a positive result. In general, when prescribing modern therapeutic agents, there is no need to follow any diet to achieve a good result. If the patient is to take part in a festive feast, it is better to cancel for 2-3 days oral administration drugs and prescribe enterosorbents (Polifepan, Enterosgel, etc.).

• The initial stage - a few small black dots appear on the nose and forehead (usually in children) - Salicylic alcohol, Retinoic ointment, Skinoren, medical cosmetics.
• The same, but with significant oily skin - Retinoic ointment, Salicylic alcohol.
• Numerous black dots and separate inflammatory nodules and pustules - Retinoic ointment, Salicylic alcohol, for pustules - alcohols with antibiotics, Dalacin T, Povidone-iodine.
• The predominance of inflammation with a small number of comedones - Retinoids (Retinoic ointment, Retasol ®), benzoyl peroxide (Benzacne, Desquam, Oxy 5 and Oxy 10, Baziron), external preparations with antibiotics (Dalacin T, Zinerit, Eriderm, Benzamycin).
• The predominance of pustules in a common process (face, back, chest) - antibiotics, in some cases - retinoids inside (Roaccutane, Retinol palmitate), externally - benzoyl peroxide, disinfectants.
• Separate large painful ulcers on the face - antibiotics, externally - antibiotic ointments and benzoyl peroxide.

Seborrhea and seborrheic dermatitis

In recent years, what used to be united by one term “seborrhea” began to be divided into 2 concepts - seborrhea of ​​the head and seborrheic dermatitis (damage to smooth skin).

Seborrheic dermatitis is a chronic inflammatory skin disease. It affects 1-3% of adults (mostly men). Seborrheic dermatitis, along with acne, refers to disorders of sebum secretion. Indeed, both diseases are often combined in the same person and the same areas of the skin are affected - the so-called "seborrheic zones" - the face, chest (decollete) and middle part back along the spine (interscapular region), where the largest sebaceous glands with wide ducts are located, releasing a large amount of sebum. The sebaceous glands of this type actively develop and increase in size during puberty. The composition of sebum also changes, it becomes more viscous, the components contained in it contribute to increased keratinization, which corresponds to peeling that is visible to the eye. Smaller glands, but also secreting a large amount of sebum, are located on the scalp. Their purpose is to provide fatty lubrication of the hair, to make it invulnerable to external influences. These glands are also more active during puberty. In adolescents and adults, the most mild form seborrheic dermatitis is characterized by flaking of the skin and its excess fat without inflammation - on the scalp it is dandruff, and on the face and chest - accumulations of fatty scales in the skin folds - near the wings of the nose, in the nasolabial fold, on the bridge of the nose, less often - on the chest and back. Oily scales soaked in sebum serve as a good breeding ground for the development of lipophilic fungi Malassezia furfur or Pityrosporum ovale. In turn, the immune system responds to them by developing allergic dermatitis, the disease enters its second, more unpleasant phase, and ceases to be limited mild manifestations. There are itching, burning, at first mild, then more intense reddening of the skin, severe peeling, hair loss. The manifestations of the disease are aggravated by the patients themselves - constant combing, attempts to remove crusts, remove accumulations of scales from the hair, the use of "folk" remedies, and the most powerful ones, inevitably lead to increased redness, the appearance of scratches and wounds, the multiplication of other microbes, the development of complications pustular process. Usually in this condition, patients turn to a dermatologist, although everything could be corrected much earlier.

With any manifestation of the disease, attention should be paid to the diet. Sometimes its correction is enough to prevent further development illness. Alcohol, sweets and starchy foods should be limited, regardless of the type of food. With itching and inflammation, smoked, salty, pickled foods, spicy seasonings, strong broths, instant coffee, citrus fruits, kiwi, pineapples and juices from them are also temporarily limited.

Treatment depends on the stage of development and the clinical picture of the disease. With the appearance of dandruff without the presence of inflammation, you can limit yourself to only external treatment, in more serious cases, internal treatment is also necessary. External treatment includes keratolytic, glucocorticosteroid, antiseptic, disinfectant and antifungal agents. Antifungal drugs usually start treatment, they can be used for a long time without the risk of side effects. Various dosage forms- creams, gels, shampoos. Shampoos with antifungal substances - Nizoral, Keto-plus, Perkhotal, Mycozoral, Sebozol contain 1-2% ketoconazole. Tee/Jel anti-dandruff shampoo contains 0.75% piroctone olamine and 2% salicylic acid. Creams and gels are applied 2 times a day, shampoos - 3 times a week. Various other medicinal substances that also have antifungal properties include zinc pyrithionate, tar, sulfur, resorcinol, and selenium disulfide. Drugs containing these compounds are available in the form of shampoos for the treatment of dandruff (Friderm-Tar, T/Jel-Newtar, Friderm-Zinc) and ointments for the treatment of smooth skin lesions (Skin-cap, Birch tar, tar and sulfur-tar ointments). Prescription forms are also used: Vidal's milk, alcohol solutions with sulfur, boric acid, tar. After hair treatment, it is obligatory to change combs and hair brushes, hats.

With severe inflammation, anti-inflammatory, antiseptic and disinfectants are used. With wetting and severe swelling of the foci, lotions with resorcinol 1%, decoctions of herbs are used. The crusts are usually lubricated with alcohol solutions (salicylic, resorcinol, boric alcohol ). Corticosteroids have a rapid anti-inflammatory effect - they are used on the head in the form of solutions - Elokom, Diprosalik (Schering-Plough USA), Lokoid (Janssen-Silag Belgium), Belosalik (Belupo, Croatia), on seborrheic zones - in the form of ointments and creams - Elokom, Diprosalik, Belosalik, Hydrocortisone ointment. It should be noted that only non-fluorinated glucocorticosteroids in the form of easily absorbed creams and emulsions (Advantan emulsion, Elokom cream, Lokoid cream) or weak (Prednisolone, Hydrocortisone) ointments can be used on the skin of the face, which is much thinner than in other areas. Preparations of this group are not suitable for long-term use due to the risk of undesirable effects - thinning of the skin, vasodilation, the appearance or intensification of acne. When it is possible to remove acute inflammation (usually in 3-5 days), and with residual peeling, they are replaced by preparations containing vitamin A - emulsion-based ointments Videstim ® , Radevit ® (FNPP Retinoids, Russia). It is known that vitamin A (retinol palmitate) reduces sebum secretion by reducing the size of the sebaceous glands and keratinization, and also has the properties of a local immunomodulator. Videstim ® contains 0.5% retinol palmitate on an emulsion basis, Radevit ® contains 1% retinol palmitate, ergocalciferol and tocopherol acetate (vitamins A, D and E). Drugs are used for a long time, including for the purpose of preventing relapses. In recent years, the local immunomodulator pimecrolimus, supplied to Russia under the name Elidel, has also been used in the treatment. Keratolytic agents are used for severe peeling and crusting. Apply sulfur-salicylic ointment 2-5% 1.5-2 hours before washing the hair under a scarf, on the face - 1 hour before washing, 10% urea ointment Karboderm (Ukraine). A particularly good effect is brought by combined preparations that combine the keratolytic properties of salicylic acid and anti-inflammatory glucocorticosteroids - Diprosalik, Belosalik. Internal remedies include vitamin A (retinol palmitate) in a daily dose of 100,000–200,000 IU (once at night for 2 months), B vitamins, in particular brewer's yeast (“Merz” Germany and domestic companies), brewer's yeast with the addition of zinc and selenium Nagipol, multivitamin-mineral complexes, preparations with selenium (Selevit, Triovit), zinc (Zincteral). To reduce fat formation in women, hormone therapy (Diana-35, Janine) and antiandrogens (Androkur) are used - see below. above. Despite successful therapy, the disease often recurs. A rational approach to diet and a careful selection of skin and hair care products are necessary to maintain a favorable treatment result for as long as possible.

prof. IN AND. Albanova

Owners of oily skin can face a variety of problems - from the shine on the face on a hot day to the impossibility of using decorative cosmetics due to its runoff. Intense secretion of sebum can also lead to acne. Oily skin, in addition to the natural type of epithelium, may be the result of improper functioning of the sebaceous glands. What can cause a violation and how to normalize the work of the sebaceous glands on the face?

How to reduce the work of the sebaceous glands on the face? Reasons for excess fat

The sebaceous glands are located throughout the body. The most intense sebaceous glands work in the forehead, chin, back, nose, chest and shoulders. It is in these places that unwanted rashes are most often localized.

Causes of excessive sebum secretion can be:

1. Hormones. Hormonal adjustment body during puberty or with age-related changes in the body, can lead to this pathology. Women often experience an increase in oily skin during the second phase of the menstrual cycle. The reason may be the hormone testosterone, the high level of which is typical for men.
2. Ultraviolet radiation. Leading researchers in the field of cosmetology have long found out that direct sunlight not only benefits our skin, but also causes early aging. UV radiation leads to a thickening of the stratum corneum of the skin, which becomes an obstacle to the secretion of sebum. This provokes blockage of the glands, which leads to the appearance of defects.
3. Wrong care. This item includes both skin cleansing and the use of care and decorative cosmetics. Maintaining good hygiene is important for the normalization of the skin condition. It is recommended to wash your face twice a day. by special means without alcohol and soap. It is necessary to carefully remove makeup before going to bed and never go to bed with decorative cosmetics on the skin. You should also choose the right care, consisting of products for oily skin. It is important to remember that this type of skin also needs to be moisturized and toned.
4. Wrong nutrition. Eating fast food, fatty and high-calorie foods, canned food can disrupt the functioning of the sebaceous glands and lead to increased oiliness of the skin.
5. Poor quality cosmetics. Cosmetics, which include components of poor quality or harmful to the skin, can provoke oily skin. This category also includes cosmetics containing oils or silicones.
6. Diseases and disorders of the immune system. Diabetes mellitus, obesity, ovarian dysfunction, thyroid disease and other pathologies can cause increased secretion of sebum.

Problem skin care tips

There are several important rules, which should be followed by owners of oily skin:

External care can significantly improve the condition of the face during an exacerbation and maintain a good result on an ongoing basis.

Diet

Proper nutrition in many cases helps to normalize the condition of the skin.

The diet for oily skin includes the following recommendations:

1. Exclusion of junk food. These are spices, sausages, canned food, fatty foods, and oils.
2. Focus on fresh vegetables and fruits. Restrains secretory function sebaceous glands also buckwheat porridge, fish, black bread, sour-milk and dairy products.
3. Consume vitamins. Eat fruits and berries in the summer. A large amount of vitamin C contains black currants, rose hips, apricots and citrus fruits. Eat eggs, legumes, beef, vegetables, and dried fruits to get your B vitamins. In winter, drink vitamin complexes.
4. Drink clean water. It is better to replace tea and coffee with purified water without gas, to which you can add a slice of lemon or apple for taste.

To select the most accurate diet for the body, it is recommended to visit a nutritionist and an allergist.

Pharmacy funds

Pharmacy cosmetic brands offer wide range various products for oily skin:

1. La Roche Posay. At the moment, it is a clear favorite among brands of skin care cosmetics. Their products are made on the basis of thermal water from the source of the same name. The brand has a range of products designed for oily skin. Among them are Effaclar Gel - a cleanser for oily and problematic skin, Effaclar Mask, which controls sebum production and narrows pores, as well as many other products that can be found in a pharmacy or in an official online store.
2. Avene. The firm also has a line of effective sebum control products. For example, Cleanance cleansing gel, which is suitable for young, rash-prone skin, as well as sebum-regulating cream and others.
3. Vichy. Expensive, but effective cosmetics of this brand will also help to cope with oily skin. Vichy has a whole line of skin care products problematic skin called Normaderm. It includes a day cream, washing gel, mask, lotion and cream for problem areas.

In pharmacies, you can also ask for samplers of some products. This will allow you to test the tool before buying and not make a mistake in choosing.

Folk recipes

Proven products have been tested by the people for years, many of them are used in professional cosmetology.

1. Mint tincture. The product is suitable for normalizing oily skin with enlarged pores. A small bunch of leaves must be kept in a liter of boiling water for 20 minutes. Wash your face several times a week.
2. Starch mask. A tablespoon of starch should be mixed with a teaspoon lemon juice and three tablespoons of kefir. The mask should be applied for 15 minutes.
3. Clay mask. Two teaspoons of white clay must be combined with grape puree. After complete drying, the mask must be washed off.

Excessive production of sebaceous glands on the face is already a medical, not cosmetic, defect, and this already needs to be treated.

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