Pink acne (rosacea) is a chronic disease of the sebaceous glands and hair follicles of the facial skin, combined with an increased sensitivity of the skin capillaries to heat.

At first, flushes are observed, and later, telangiectasias appear on the face. Despite the name, the disease has nothing in common with common blackheads, although it is quite often combined with them. Pink acne leads to severe cosmetic defects. In Latin, “rosacea” means “rose-like.

Aetiology and pathogenesis

Current esearch proves the role of genetic factors in the development of the disease.

Currently, there are the following pathogenetic concepts, each of which reflects the specific pathogenesis of a particular group of patients with this dermatosis: exogenous factors (alimentary, meteorological, presence of foci of concomitant infection, including presence of Demodex folliculorum mite in the skin), disorders of gastrointestinal tract, endocrine and nervous systems, immune status changes, primary pathological vascular responses, role of components of kallikrein-kinin and coagulating systems.

Triggering factors are usually found to have a long history of flushes (sudden redness of the face with a feeling of heat) in response to hot drinks, spicy food, or alcohol. Exacerbation may be caused by insolation, as well as overheating – for example, working at a hot stove. Pink acne sometimes appears against a background of common acne or seborrhea, but more often on clear skin.

Classification of rosacea

Subtype 1 – erythematous-teleangiectatic

Subtype 2 – papulopustular-pustular

Subtype 3 – phimosis

Subtype 4 – ophthalmomorosacea

Special forms of rosacea:

Steroid-induced
Granulomatous
Lightning (fulminant)
Conglobal
Clinic Rosacea-Lymphedema

Erythematous rosacea. The onset of rosacea is erythema lividum, which is caused by mechanical stimuli, insolation, temperature changes, consumption of hot drinks, alcohol, spicy food, emotional outbursts, and other nonspecific factors.

Papular rosacea. Isolated or clustered inflammatory pink-red papules 3-5 mm in diameter of dense elastic consistency of rounded outline, hemispherical shape, with poorly contoured borders, with smooth, shiny surface appear.

Pustular rosacea. With further progression of the disease, many of the nodules overgrow, forming papulopustules 1-5 mm in size with yellow or greenish-yellow contents.

Rhinophyma (rhinophyma). Depending on the clinical and histological picture, there are four types of rhinophyma: glandular or glandular, fibrous, fibroangiomatous, and actinic.

Ophthalmic Morosacea. Involvement of the eyes in the pathological process is observed in 20-60% of patients. The spectrum of ophthalmologic diagnoses is very wide and includes blepharitis, chalazia, conjunctivitis, iritis, iridocyclitis, and keratitis.

Steroid rosacea. Steroid rosacea is defined as rosacea that worsens after treatment with external, highly active corticosteroids,

Granulomatous rosacea. Rashes are localized in the periorbital or perioral regions and present as red-brown papules 2-4 mm in diameter, hemispherical or flat in shape, with a smooth, shiny surface, sharp borders, and rounded outlines

Conglobate rosacea. In addition to hyperemia, papules, pustules, and telangiectasias, the clinical picture includes nodular, bluish-red, spherical elements up to 1.5-2 cm in diameter.

Fulminant rosacea. It occurs suddenly, against a background of general well-being. Severe edema and purplish or bluish-red erythema, papules, pustules, and large nodular elements are formed.

Gramnegative rosacea. Sometimes, as a result of prolonged general or local treatment of rosacea with antibiotics, mainly tetracyclines, numerous folliculitis may suddenly appear with a significant amount of Gram-negative bacteria in the contents.

Rosacea lymphedema (Morbihan’s disease). The disease begins with the appearance of bright pink erythema and edema in the forehead, upper eyelids, and bridge of the nose. Later, as a result of a chronic persistent course, edema of the upper half of the face becomes persistent and significant thickening occurs.

Rosacea therapy

General therapy. The most commonly used general therapies for rosacea are antibiotics, metronidozole, and isotretinoin.

Local therapy for rosacea

Erythematous stage: cold lotions with a weak tea solution, infusions of herbs (chamomile, succession, sage, St. John’s wort). Exposure duration 20-30 minutes 5-6 times a day.
Papulopustular form: retinoid ointments (locacid, airol, atrederm, retin A, diferin)

Prevention

Stop drinking alcohol, avoiding hot drinks and hot soups. It is not the caffeine in tea and coffee that causes worsening of the disease, but the high temperature of the drink. The temperature of the food should be just above body temperature.

Meals should be divided, 4-5 times, with approximately equal time intervals between meals.
In addition, it is necessary to exclude other factors that cause dilation of blood vessels in the face: smoking, psychological and emotional stress, high-temperature water procedures (hot baths, baths, saunas, etc.).

Acne

(Greek ἀκμή – point, peak, bloom) or acne is an inflammatory skin disease caused by changes in the pilosebaceous structures (consisting of the hair follicle and sebaceous glands).
The term acne comes from the ancient Greek and is associated with the culmination of skin breakdown. This nosology was first mentioned in the writings of Aetius of Amides, a physician at the court of Justinian I.

Etiology, pathogenesis, and pathanatomy.

The causes of the disease remain unclear. In the mechanism of development the main role is assigned to seborrhea, which reduces the bactericidal effect of sebum and leads to activation of coccus flora. An important role in the mechanism of acne disease is assigned to the bacterium Propionibacterium acnes and the products of its vital activity.

Common acne (acne of youth, acne) develops in boys and girls during puberty and gradually disappears by the age of 25-30. The appearance and exacerbation of acne is also affected by menstruation, stress, heat, high humidity and genetic factors. Cosmetic products containing lanolin and paraffin have also been known to cause acne. Acne can also be a side effect of certain medications.

Various types of acne

Patomorphologically there are seborrhea, sebaceous gland hyperplasia, sebum hypersecretion, hyperkeratosis, leading to the formation of comedones – sebaceous plugs in the sebaceous gland ducts with partial or complete blockage, which look like black dots.

Hyperkeratinization and plaque formation of keratin and sebum leads to an increase in sebum production, especially during puberty skin maturation. Increased sebum production occurs during adrenarche, when dehydroepiandrosterone production increases.

An accumulation of sebum can lead to the development of an infection. The immune system destroys bacteria, and pus “packs up” in accumulations under the epidermis. Patients try to get rid of pustules by removing them on their own and in non-sterile conditions. Such damage to the underlying layers disrupts the delicate structure of the dermis and generates a weakened area that is attacked by bacteria. As a result, the immune system leads to the spread of acne.

Causes of acne include:

Heredity hormonal
activity (menstruation, puberty), hormonal imbalances
GI diseases (digestive tract)
demodecosis (acne mite)
transitional age stress
activating adrenal glands
overactive sebaceous glands
accumulation of dead skin cells microorganisms but also injuries.

The use of anabolic steroids the use of drugs containing halogens (fluorine, chlorine, bromine, iodine), lithium and barbiturates. It was further discovered that follicular narrowing (hyperkeratinization) and fluid retention in the skin were also important etiologic agents. The hormones that provoke acne are testosterone, dihydrotestosterone, dehydroepiandrosterone, and insulin-like growth factor 1.

Acne in the postpubertal period is rare. It can be associated with polycystic ovary syndrome or Cushing’s syndrome. During menopause, acne develops due to a lack of estradiol (acne climacterica).

Acne classification

Comedonal form: mostly closed comedones on the chin, forehead and nasal wings, but without inflammatory lesions (pustules).
Papulopustular form: mostly open and closed comedones and papules, with few pustules.
Nodular form: pustules (more than 25 units), with open and/or closed comedones are present on the forehead, nose, chin and cheeks.
Severe form: conglobate (confluent) acne, pustules coalesce to form deep, painful confluent nodules, large areas of skin are inflamed. High risk of skin scarring.

Clinical picture

Clinically, there is a variety of rash elements localized on the skin of the face, upper half of the chest and back, where the largest sebaceous glands are located. At the base of the acne elements there is an inflammatory process that melts the local tissues with the formation of pus. The pustule (purulent vesicle), when opened, is freed from its contents, dries out, and forms crusts, which leave a bluish-pink scar after removal.

Symptoms

The most common form of acne is acne vulgaris. In adolescents, this form is the most common. The excessive production of sebum by the glands of the same name clogs the pores with dead root cells, blocking the skin follicles. The accumulation of these corneocytes in the ducts is due to impaired keratinization, which usually leads to exfoliation of the cells. The sebum is deposited under the blocked pores, providing the perfect environment for the reproduction of microorganisms: Propionibacterium acnes, Malassezia.

Propionibacterium acnes: An anaerobic gram-positive bacterium. It consumes fatty acids from sebum and gets its name from the production of one of its metabolites, propionic acid. The bacterium is sensitive to benzoyl peroxide and tetracyclines. But since tetracycline-resistant strains have recently been observed, macrolides, such as azithromycin, have come into use. Fluoroquinolone drugs, such as adifloxacin, are also used.

The bacterium is sensitive to ultraviolet light because of the endogenous metabolites of heme biosynthesis, porphyrin and coporphyrin III. Hypothetically, it makes sense to use aminolevulinic acid, but in humans it is accompanied by the development of side effects.

The face and upper neck are most commonly affected, but the chest, back, and shoulders may also be involved. The following rash elements can be found on the skin: papules, pustules, inflammatory cysts (cystic acne). These cysts contain pus. Non-inflammatory sebaceous cysts (epidermoid cysts) can be associated with acne. Acne can leave scars.

Treatment and prevention

Treatment is long and requires endurance. It is aimed at eliminating seborrhea.

With a severe course of acne antibiotics are prescribed, previously also prescribed a number of methods, which according to current data, are not considered to be proven effective: autohemotherapy (transfusion of own blood), anti-staphylococcal gamma globulin, vitamin A 100,000 IU per day for 2 months, estrogens (folliculin, diethylstilbestrol). Topically – wiping with 2-3% salicylic acid solution, UV irradiation, cryotherapy, diathermic coagulation of the rash. In addition to vitamin A, other nutraceuticals are also promising: for example, omega-3 PUFAs[3] and myo-inositol.

Comedones are removed, abscessed acne is opened. Disincrustation – removal of the fatty core of acne by vacuum or galvanization – is used. Prevention of juvenile acne consists in the treatment of seborrhea. It is important to maintain a healthy lifestyle. It is very important to follow a diet (exclude refractory fats, oils). The use of zinc preparations is pathogenetically justified. Zinc inhibits sebaceous gland activity and reduces inflammation by reducing neutrophil phosphatase activity.

Ancient
Rome: bathing, use of mineral water.
1800s: use of sulfur.
1920s: use of benzoyl peroxide.
1930s: use of laxatives.
1950s: use of antibiotics.
1960s: Introduction of tretinoin.
1980s: Introduction of isotretinoin (Roaccutane).
1990s: Laser.
Currently, the treatment of acne can be summarized in five areas:

Normalization of the shedding of dead skin cells Destruction of P. acnes (propionibacillus acnes)

Anti-inflammatory effect

Hormonal influence

Combination of the previous areas

Exfoliation of the outer layers of the skin. This manipulation can be performed by using abrasives, scrubs or chemically.

Chemical exfoliants are acids. Three subclasses of acids are currently used in cosmetology: alpha-hydroxy-, beta-hydroxy- and polyhydroxy acids.

Topical bactericidal agents

Preparations containing benzoyl peroxide are used for mild acne. Benzoylperoxide has both keratolytic and bactericidal effects, killing P. acnes. Benzoylperoxide does not cause bacterial resistance. But its frequent use does cause drying of the skin, local irritation and redness. Triclosan can also be used, but it is less effective.

Topical antibiotics

Oternally, erythromycin, clindamycin, stiemycin, or tetracycline antibiotics are used. There are a number of combination therapies.

Oral antibiotics

Macrolides (erythromycin, azithromycin) or tetracyclines (oxytetracycline, doxycycline, minocycline, limecycline) are used.
Sometimes trimethoprim is used.

Hormonal therapy

In women, hormonal treatment of acne is effective. Combination preparations of estrogen and progestogen are used in combination with estrogen more effective. Spironolactone can also be used, especially in patients with polycystic ovary syndrome. Cortisone can also be injected locally.

The most common first-generation retinoids are retinyl palmitate, retinol, retinaldehyde and tretinoin (retinoic acid). Retinoids affect the life cycle of skin cells, thus normalizing keratinization and desquamation of epithelial cells.

Gels containing retinoids: Effexel (adapalene and benzoyl peroxide, which has antimicrobial activity and does not cause resistance), Klenzit (adapalene), Isotrexin (isotretinoin and the antibiotic erythromycin). There is evidence that erythromycin in combination with isotretinoin is effective against erythromycin-resistant strains of P. acnes. However, adapalene is the drug of first choice for the treatment of acne according to the Global Alliance to Improve Outcomes in Acne.

Fourth generation retinoids: tripharotene.

Retinoids used orally. To treat severe and resistant forms of acne, isotretinoin is used.

Phototherapy

Lamps generating wavelengths of 405-420 nm are used.
Porphyrin generates free radicals when exposed to wavelengths less than 420 nm. Neodymium laser is also actively used, which provides local sterilization of inflammatory foci.

Less common drug salicylic acid: used for mild cases of acne;

zinc: used in the form of oxide or in combination with hyaluronic acid – zinc hyaluronate;

Prospects of acne treatment

Scientists are developing genetic treatments for acne – scientists are looking for possible genes responsible for this pathology. The use of phages that kill bacteria is also planned.

Glycemic Index

High insulin levels that result from eating foods with a high glycemic index (GI) affect acne and reducing the amount of these foods can help improve acne by regulating the imbalance of insulin in the blood. Studies show that a low GI diet can reduce acne by more than 50% in as little as 12 weeks.

Interesting facts about rosacea and acne