Acne is a cutaneous disease, which begins in the pilosebaceous follicle; it affects mostly teen-agers, in fact the production of sex-hormones is the first cause of this affection. The 93% of patients resolve the problem by 25 years of age, but 7% can continue untill 45 years. In genetic predisposed subjects, the hyperseborrea, associated to the infection of the follicle, can prime the pathogenetic process.
The first step is the hyperkeratosis of the follicle with formation of the “Comedo”, which is black when it is opened and white when it is closed. The second step is the infection of the follicle, caused from the “Propionibacterium Acnes”, which is the causative infective micro-organism. The typical lesions range from comedo and cysts (papulo-nodular) to pustules.
ACNE and HORMONES: generally acneic patients do not have hormonal diseases, sometimes an hormonal dysfunction, in female, can be hypothesized, but a periferical hypersensitivity to sex-hormones (androgens) is the most probable cause. In female non-responders to classical anti-acne therapies or with menstrual-disorders or with hyperandrogentic features (hyperthicosis, androgenetic alopecia) it is useful to check the hormonal state with hematic analisys and pelvic echography, and eventually it is possible to prescribe anticonceptive pills (estro-progestative) or other anti-androgen drugs.
ACNE and ALIMENTATION: in the past eating particular foods was related to pathogenesis of acne, now this connection has been denied. ACNE and U. V. RADIATION: normally the U.V. radiation is worthwhile for acne, in fact, after the summer period there is generally an improvement. Sometimes a worsening of acne has been described after solar exposition (so called “acne Mallorca”), because a hot and dump climate favouring the sweat, when it is associated to achantosis of the epidermis due to the U.V. exposition,can provoke the occlusion of follicles and the following formation of acne lesions.
THERAPY: the therapy of acne is based on topical substances: antiseptics and antibiotics, retinoids, azelaic acid, keratolityc ointments and in more severe forms a systemic therapy is associated to the topical one: antibiotics, retinoids. hormonal drugs and anti-androgens. The use of “Peeling” (see chapter VI) is a useful method either in active forms (salicilyc acid, piruvic acid) or in inactive forms (glycolic acid. tricloroacetic acid), with an improvement of acne and of the status of the skin.