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In seborrhea, an increase in sebum secretion
causes excessive development of the lipophilic portion of the
hydrolipid film. Most affected are skin areas with a rich occurrence
of sebaceous glands: the face, chest, shoulders and back. Seborrhea
promotes skin conditions such as acne, seborrheic eczema and rosacea,
as well as fungal and bacterial infections. The most common form
of acne, acne vulgaris or simplex, generally appears during puberty.
Young adults are also increasingly being affected by impure, oily
skin.
Acne covers a whole group of diseases that affect the sebaceous
glands, hair follicles and surrounding tissue. The primary visible
skin change are comedones, which can take the form of closed "whiteheads"
and/or open "blackheads". The latter are less likely to cause
inflammation in the surrounding connective tissue. Other visible
signs are papules, nodules, and pustules.
Endogenous and exogenous causes of acne
The pathophysiological basis of comedo formation and therefore
of acne is seborrhea accompanied by sebaceous gland obstruction,
which is caused by disturbed cornification (hyperkeratosis) of
the hair follicle and of the excretory ducts of the sebaceous
glands. The existence of a genetic predisposition to this cornification
disturbance is a matter of discussion.
Acne is the most common hormone-induced skin change and manifests
itself mainly during puberty (acne vulgaris or simplex). Acne
vulgaris, which affects around 80 percent of 11-30 year-olds,
is probably caused by a heightened response of the sebaceous glands
as well as the epithelia of the hair follicles and the excretory
ducts of the sebaceous gland to physiological androgen concentrations.
Psychological stress can also lead to impure, acne-prone skin.
Acne vulgaris can take various forms:
 Acne comedonica
(black/whiteheads)
Acne papulo-pustulosa,
which is caused by bacterial invasion of a comedo and leads to
secondary perifollicular inflammation with papules and pustules.
Acne conglobata,
in which, besides comedones, papules and pustules, there are painful
nodules and abscesses with fistular openings in the face and upper
body. These often heal only with scarring.
Impure, acne-prone skin in adults
Impure, acne-prone skin, either persisting or recurring beyond
the age of 30, is becoming increasingly frequent. A genetic predisposition,
psychological stress, drug ingestion, exposure to occupational
noxae, as well as the use of comedogenic and excessively greasy
skincare products are common causes of impure, acne-prone skin.
Stress factors, such as the dual demands of family and job, not
infrequently precipitate the onset of impure skin, particularly
in older patients.
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Acne vulgaris papulo-pustulosa |
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Schematic diagram::How acne develops:
A Plug of horny lamellae and sebum in the excretory duct of
the hair follicle and blackened on the surface by oxidation (blackhead).
B Spherical, skin-coloured or whitish-looking closed comedo
(whitehead) CThe increased build-up of sebum puts pressure
on the follicle walls, which are further damaged by various bacterial
substances (enzymes, free fatty acids). D The trapped, bacteria-contami-nated
sebum overflows the surrounding tissue, causing an inflammatory reaction.
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Dermatological therapeutic
options
Vitamin A derivatives (retinoids, skin "peels") and benzoyl peroxide
preparations are the main products used for topical treatment. In
addition, topical antibiotics such as tetracycline, which admittedly
can cause increased UV sensitivity, or erythromycin can be applied.
Antibiotic treatment also acts on the pathophysiologically important
Propionibacteria and the pathogens that can cause secondary infections
but can result in bacterial resistance. In the case of severe, therapy-resistant
acne, systemic (internal) treatment with antibiotics or isotretinoin
is necessary. In women, contraceptives containing oestrogen and an
anti-androgenical gestagen fraction are also used. The drug treatment
of severe forms of acne often dries out and severely stresses the
skin. During and after such treatment, the skin needs intensive care.
For milder forms of impure, acne-prone skin, the daily use of adequate
cleansing and other skincare products that cleanse and clarify the
skin as well as prevent the onset of acne is usually sufficient.
Cleansing of impure, acne-prone skin
Physiologically mild, sebum-reducing, antibacterial cleansing products
are ideal for cleansing impure, acne-prone skin, as well as for preventing
microcomedones from developing further. After thorough cleansing,
the use of a comedolytic, antibacterial toner has proven particularly
useful.
Moisturising of impure, acne-prone skin
Moisturisers should be hydrophilic and non-greasy, and should counteract
the causes of impure, acne-prone skin (seborrhea, follicular hyperkeratosis,
microbial invasion of comedones). An everyday moisturiser should have
a mattifying effect on shiny skin, and a tinted day cream can help
conceal blemishes. The specific treatment of isolated areas of inflammation
can be achieved using a suitable concealing cream. Generally speaking,
products with ingredients that act specifically on the follicles -
where impure skin develops - should be used.
SUMMARY:
Impure, acne-prone skin is caused by seborrhea, follicular hyperkeratosis
and the microbial invasion of comedones. Young adults are increasingly
being affected by impure, oily skin. Cleansing and moisturising
products containing physiologically effective ingredients designed
to act specifically on the follicles should be used to regulate
disturbed skin function. |
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