Teenage acne occurs in most adolescents aged 12-18 years. They develop due to increased sebum production and follicular hyperkeratosis, and are provoked by hormonal changes in puberty and burdened heredity. The number of rashes varies from a few small acne to multiple cystic elements. Diagnosis is carried out with the help of clinical examination, bacteriological and hormonal tests. Treatment of acne in adolescents includes local remedies (antibiotics, retinoids, azelaic acid), systemic medications, proper care cosmetics and hardware methods.
L70.0 Acne vulgaris
Teenage acne (“vulgar acne”) is the most common skin problem that occurs in 90% of adolescents. In girls, they occur on average after 12 years, in boys — at 14-15 years, which correlates with the timing of the onset of puberty. The clinical forms in which serious treatment is required are up to 15%. Acne of childhood is detected much less frequently — about 7 cases per 10 thousand of the population. Pustular rash on the skin causes psychological discomfort, in severe cases it causes complete isolation from peers and society.
Adolescent acne is a polyethological problem, but hormonal changes of the puberty period are considered to be the trigger factor in modern dermatology. At this time, the level of androgens (testosterone and dihydrotestosterone) in the blood is rapidly increasing, stimulating the work of the sebaceous glands of the body. In addition to endocrine causes, the following factors can provoke acne:
- Heredity. The probability of acne in a teenager with a burdened family history is 50-70% or more. This is due to unfavorable combinations of gene alleles that regulate the development and functional activity of the sebaceous glands. The nuclear R-factor, which determines the genetic predisposition, is important.
- Bacteria. With the stagnation of sebum, conditionally pathogenic forms of microorganisms are activated: propionobacteria, epidermal staphylococci, micrococci. Their number is rapidly increasing, which is clinically manifested by the inflammation of comedones, the formation of large acne. Less often, Candida and Pytirosporum ovale fungi become the cause of the disease.
- Stress. During a stressful situation, adrenal hormones are intensively produced, which affect hormone-dependent sebaceous glands. They act like androgens — they activate the production of sebum and disrupt its chemical composition, which provokes the reproduction of pathogenic microflora.
- Improper skin care. Independent treatment of teenage acne with the use of harsh cleansers and alcohol chatterboxes further violates the microflora and lipid barrier of the skin. The skin becomes dry and sensitive, but inflammatory elements continue to appear on it.
In the mechanism of formation of teenage acne, the greatest importance is attached to 2 factors: hyperandrogenemia and genetic predisposition. They cause an increase in the size and enhanced functioning of the sebaceous glands, which is accompanied by follicular hyperkeratosis. As a result, the ducts of the glands become clogged, the pH and biochemical composition of the secretion change, favorable conditions for the reproduction of bacteria are created.
If a blockage has occurred in the outer part of the excretory duct, open comedones (black dots) appear. With hyperkeratosis of the deep part of the canal, excess sebaceous and horny masses accumulate in it, and a closed comedone is formed. Active reproduction of microorganisms in the sebaceous glands leads to inflammation. Inflammatory elements appear on the skin — papules, pustules, nodes.
Propionic bacteria play an important role in the development of acne. They secrete chemoattractants that increase the influx of leukocytes and pro-inflammatory biomolecules into the focus of inflammation. Microorganisms enhance the synthesis of interleukins, promote the production of specific antibodies. It has been established that P. acnes are resistant to destruction by phagocytes, so the acne caused by them can have a torpid course.
The most convenient classification for determining the clinical form and diagnosis is recognized by J. Plewig and A. Kligman (G. Plewig, A. Kligman), proposed in 1993. The authors suggested dividing acne into childhood acne and teenage acne. The latter, in turn, according to morphological characteristics, are comedonal, papulopustular, conglobate and inverse. Lightning-fast and mechanical forms are less common. According to the severity of acne , there are:
- Easy. In a teenager, no more than 10 comedones and small papulopustular elements are detected at the same time. The rash covers only one area of the body, most often occurs on the face. The treatment is successful, scarring practically does not remain.
- Moderate. Up to 25 pustules and up to 20 comedones are present on the skin, while the lesion affects 2 or more anatomical zones (face, chest, back). Against the background of the disease, the child begins to have psychosocial problems.
- Heavy. It is characterized by numerous comedones and papulopustular acne, the treatment of which is difficult, and after resolution, scars often remain. Indurative and conglobate elements appear.
Small open comedones have the appearance of black dots up to 1 mm in size, which are located mainly in the T-zone of the face, may be in the upper back and chest. Closed comedones are small white nodules that do not hurt when pressed and do not become inflamed, but create aesthetic discomfort and the effect of non—smooth skin. When inflammation is attached, the skin around the elements turns red and swells, a white point — an abscess – forms in their center.
When deeply located youthful acne elements merge, nodular cystic acne forms. Outwardly, they look like purple-red knots, they hurt a lot when touched. Purulent cavities can be opened, in this case, a wound remains in place of the element, after healing of which a scar is visible. With the lightning-fast form of teenage acne, ulcers quickly ulcerate, leaving behind long-term non-healing wounds. With inverse acne, inflammation affects the sweat glands.
Large inflammatory elements leave noticeable scars and purple post-acne marks that do not go away on their own and can disappear only after hardware exposure. Serious cicatricial complications are observed after self-extrusion of purulent elements, which is accompanied by skin injuries and the spread of infection throughout the face. Teenage acne is combined with pigmentation, excoriation.
Large ulcers in the nasolabial triangle area are dangerous with the risk of involvement of cerebral vessels in the infectious process. During the moderate and severe forms of teenage acne, psychological problems inevitably occur — a decrease in self-esteem, increased anxiety, phobic disorders. Some adolescents develop depression and social maladaptation due to the long-term existence of acne and scars.
A clinical examination of a teenager is conducted by a pediatric dermatologist. He evaluates the condition of the skin, determines the type and number of acne, identifies complications — scars, pigmentation. The doctor collects in detail the anamnesis of the disease and the life of the child, is interested in heredity. An endocrinologist, an allergist-immunologist, a psychologist and other specialists can be connected to the diagnosis. To identify the causes of teenage acne, prescribe:
Bacteriological sowing. For diagnosis, a discharge from purulent elements or skin scraping is taken. Laboratory technicians determine the composition of the microflora of the epidermis, identify potentially pathogenic microorganisms. To choose a treatment, a test for the sensitivity of bacteria to antibiotics is performed.
Hormonal profile. With recurrent acne, which occurs in severe form, the doctor is interested in the hormone levels of the gonads, adrenal glands, pituitary gland and hypothalamus. In adolescent girls, blood is taken for examination on different days of the month to assess the increase in androgens in the second phase of the menstrual cycle.
Given the variety of etiological factors and drug resistance of bacteria, the treatment of pathology is a difficult task. The choice of therapeutic methods depends on the severity, clinical variant of teenage acne, the presence of complications and the psychological state of the teenager. The World Congress on Dermatology developed the basic principles of pathogenetic treatment:
Reduction of sebum production. To normalize the work of the skin glands, local retinoids are applied to children with mild forms of the disease in the form of creams, and systemic retinoids are recommended for severe cases of the course. If necessary, hormonal drugs are used — antiandrogens, estrogens.
Relief of inflammation. For this purpose, azelaic acid, local antibacterial ointments and lotions are prescribed. Common and deep teenage acne is an indication for the selection of systemic antibiotics.
Removal of comedones. To dissolve the stratum corneum and reduce sebum accumulations, agents with benzyl peroxide, salicylic acid, adapalene are used. Acid peels show high efficiency. If conservative methods are ineffective, comedone extraction can be carried out.
There is no scientifically-based evidence of the connection between nutrition and teenage acne, so dieting does not apply to routine methods. However, in some adolescents, the treatment was more effective when limiting dairy products and sweets. Children suffering from obesity are selected a hypocaloric diet in order to reduce weight and thereby normalize the hormonal background.
An important place is given to cosmetic care products. They do not treat acne, but prepare the skin for the application of drugs, normalize sebum and keratinization. For routine care, teenagers are selected cleansing gels and lotions, tonics with soothing and antibacterial components, creams for moisturizing and nourishing the skin.
Complex treatment includes hardware and physiotherapy methods. Phototherapy and ozone therapy of teenage acne gives a good effect, with deep cystic acne, laser spot exposure helps. After the acute phase subsides, mesotherapy, median acid peels, dermabrasion are performed to resolve scars.
Prognosis and prevention
Up to 95% of teenage acne successfully respond to treatment and disappear in 20-24 years. Only 5% of people have acne that continues into adulthood. This is a chronic recurrent skin disease, but modern methods of complex therapy help to cope with rashes and prevent irreversible skin changes. Treatment of teenage acne is carried out at any stage, and in combination with hardware methods it is possible to achieve a good cosmetic result.
Primary prevention of the disease is difficult, since hormonal changes are inevitable in adolescence. To reduce the risk of severe forms of teenage acne, it is necessary to select the right skin care products, in no case squeeze out pimples and black dots. Teenagers with oily skin and a tendency to copious rashes definitely need a dermatologist’s consultation.