Acne and treatment of the acne

What acne?

The acne is a skin disease which causes the fatty skin, of small cysts, the red buttons and the white heads at the majority of the teenagers. The acne involves an ignition (redness, pus, pain) prolonged opening of the hair (pilosébacé opening).

The acne is characterized by the fatty skin and several types of often associated buttons. One distinguishes the rétentionnelles lesions (open comedo or not black and closed comedo or microkyste), the inflammatory lesions (papule or button red, pustule or white head and bulky, painful red buttons or nodules), the cysts and the marks or scars which can be temporary or final. The affection generally begins with adolescence and ends most of the time before the 25 years age.

What causes the acne?

The acne is often family and joins the fatty skin, it begin with the obstruction from the opening from the hair and gland sébacée (pilosébacé follicule) by a horn stopper which forms a microcomédon then a microkyste. The bacteria which proliferate in the follicule (propionibacterium acnes) release from the substances which cause the ignition of the microkyste and involve a red button and a white head.

One thus recognizes several big factors in the development of the acne:

- The increase in the production of sebum is responsible for a fatty skin, this one is primarily under the dependence of the male hormones (androgens) at the man and the woman. It is thought that the sébacée gland is too sensitive to the androgens which it can synthesize besides.
- The obstruction of the opening of the hair by a horn stopper causes the rétentionnelles lesions (microcomédon then open comedones or black spots and closed comedones which form small grains color flesh or microkystes). Several factors influence the obstruction of the follicule pilosébacé like the composition of the sebum, the rate of the male hormones, the bacteria and of the substances produced by the cells of the skin (cytokines).
- There exists an anomaly of the microbial flora (microbes living normally on the skin). The proprionibacterium acnes plays a crucial role and supports occurred of red buttons starting from the comedo but the acne is not an infection caused by these bacteria.
- The ignition causes the papules or red buttons, the pustules or heads white and the bulky painful red buttons or nodules. The ignition is caused by substances manufactured by the bacteria and perhaps also by fatty-acids coming from the sebum.
- The family factors play also a part in the development of the acne. The teenagers carrying acne have one of their relative who presents acne in almost a case on two (45%) whereas the parents of those which do not present acne are touched by this affection only approximately once on ten (8%).
- The acne is influenced by male hormones but it is seldom caused by a disordered state or a disease of endocrine glands (syndrome of the ovaries polykystic at the woman, congenital deficit in 21 hydroxylase or rarer affection). It is more probably about an over-sensitiveness of gland sébacé to the male hormones.
- Certain particular forms of acne have specific causes. The acne of new born is induced by the passage of the maternal hormones in the blood of new born, the induced acne is caused by the catch of drugs (pill, cortisone, antiepileptic…) or of poisons, an exposure to the ultra-violets, the cosmetic acne is caused by the application of creams comedogenes.
Which are the subjects at the risk?

One considers that the majority of the teenagers are touched by the acne, 95% of the boys and 83% of the girls are more or less affected. An important acne which requires the recourse of the doctor is rarer, it touches approximately a patient on five. The family factors are predisposing. If the acne touches especially the teenager, it is not rare in the adult (late acne).

A male excess of homone is in question among certain women who present also irregular rules, an excessive pilosity (hirsutism), and a fall of hair (alopécie). A hormonal assessment and an echography of the ovaries make it possible to highlight these cases (syndrome of the ovaries polykystic, congenital deficit in 21 hydroxylase).

Certain forms of acne particular to new were born (acne néonatale), caused by the catch of drugs (induced acne), the exposure to the ultra-violets or the application of cosmetics comedogenes (cosmetic acne).

Which are the symptoms of the acne?

The acne comprises several type of demonstrations, it prevails with the face (99%), the back (70%) and the level of the thorax (15%).

Fatty or hyperséborrhée skin – the fatty skin accompanies toujour the acne, it can be moderate or very awkward.
Rétentionnelles lesions – These lesions testify to the obstruction of the follicule of the hairs and often precede occurred by the red buttons. The rétentionnelles lesions prevail in the middle of the face (face, nose, chin) or zone T and can extend to the high part of the back and the thorax. Certain acnes comprise especially rétentionnelles lesions whose unsuited assumption of responsibility is a factor of failure of the treatment.
- Closed Comedo: they form small pimples color flesh which one observes better up to date curling or when one slightly tightens the skin between two fingers. – Open Comedo or not black: everyone recognizes them easily, they represent another stage of the comedo which open with the skin by the opening of the hair. The contact of the comedo with the air causes its black coloring, consequence of a process of oxidation.
Inflammatory lesions
- Papules: they form elevated red spots
- Pustules: they result in white heads which surmount inflammatory papules
- Nodules: They form large red and painful buttons.
Cysts
The cysts form buttons under the skin of color flesh which the pressure lets leave a substance blanchâtre, thick and malodorous.
Lesions séquellaires
The temporary marks are erased gradually after a few months (3 to 12) whereas the final marks persist but can be attenuated by adapted treatments.
- Temporary Marks. Red spots: the white papules and heads leave red spots which often persist several months after their disappearance. Brown spots: the patients with skin subdue or coloured frequently develop coloured spots which persist of the months after the disappearance of the papules of acne.
- Final Scars. White spots: these spots have a a little ruffled surface (elastolyse périfolliculaire), they are sometimes numerous on the level of the back or the thorax. Depressed scars: they sometimes broad but not very deep at edge are rounded or small, deep on board precipice (scars in ice pick). Scars in relief (chéloïdes): they form buttons hard and elevated preferentially located at the level of the mandibles, top of the back or thorax.

How to diagnose the acne?

The diagnosis of acne is simple, the patients or their entourage generally identifies the nature of the affection. The dermatologist is the doctor more adapted to make this diagnosis which seldom poses problem to him. The interrogation makes it possible to make sure that there do not exist starting factors (solar or ultraviolet exposure), of medicamentous catch, of use of cream comedogene or hormonal anomaly.

Which affections can be confused with the acne?

Certain affections can resemble the acne and sometimes be confused with it.

Rosacée: it touches the adults and causes red buttons and white heads identical to those which one observes during the acne but it accompanies by rednesses (blotches, érythrose) and sometimes by puffs of heat. Rosacée can be accompanied by an attack occulaire and become complicated of a thickening of the skin of the nose (rhynophyma).

Folliculites: they form multiple red buttons and white heads which are the consequence of a surface infection of the opening of the hair. There are several varieties. Some prevail on the level of the circumference of the mouth (dermite perish-oral), they can be secondary with the application of a cream to the cortisone or the proliferation of a parasite (démodécidose). The contamination of a germ during shaving causes sometimes bacterial folliculites (staphilococca). The antibiotic catch to the long course can induce folliculites trunk (folliculites with gram negative) whose treatment is delicate. The mushroom proliferation can also involve folliculites, it can be a question of Malassezia furfur generally responsible for the pityriasis versicolor or seldom for Candida albicans.

Peudo-folliculites of the beard: they are frequent at the subjects with coloured skin. they result in red buttons around incarnated hairs of barb.

Elastolyse with cyst and comedones (disease of Favre and Racouchaud): this affection touches the adults who were exposed too much to the light and the sun, it arises in the form of microkystes and of black spots located around the eyes. The skin is thick and yellowish and present deep wrinkles.

Hidrosanédite (disease of Verneuil): this chronic affection and invalidating involves red and painful nodules in the groin, the armpits and under the buttocks.

Other affections posing very seldom a problem of diagnosis with the acne: milium, warts plane, sclerosis tuberose of Bourneville, érythémateux lupus, disease of Behcet, sarcoidosis, syphilis.

Which is the evolution of the acne?

The acne is an affection which is generally prolonged during several years, on average during 4 to 6 years but sometimes longer. The persistent acne at the adulthood is not rare, especially at the women.

Which is the treatment of the acne?

The acne interferes with quality of life and must thus be taken with serious and treated effectively. The dermatologist has a very effective arsenal but a prolonged treatment and a regular follow-up are always necessary to obtain satisfactory results.

Which are our possibilities

•  Local Treatments

- Treatment of the rétentionnelles lesions (microkystes)
Cleaning of skin: the dermatological cleaning of skin is essential to the treatment of the acne or prevails the microkystes (microkystic acne). If there exist microkystes, a dermatological cleaning of skin is necessary before beginning a treatment by roaccutane®. The cleaning of skin realized by the dermatologist comprises a microincision of the surface of the skin then an extraction of the comedones. This act is a little painful but the efforts are réompensés by a faster and more complete result.

Rétinoïdes: they fight counter the comedones, it is thus the base of the treatment of the acne because there exists always an obstruction of the pilosebaceous follicules. They are essential with the treatment of the cystic acnes. One finds the trétinoïne (Locacid®, Kétrel®, Rétacnyl®, Effederm®), the isotrétinoïne (Roaccutane gel®, antibiotrex®) and the adapalene (cream-coloured Différine® and freezing). The dermatologist uses the trétinoïne enters to, 025 and 0,05% and the adapalene which also attacks the inflammatory lesions. These products are always irritating and must be applied with precaution. The application is to be done the remote evening of the toilet (to respect at least a one hour deadline after washing). It is necessary to apply very little product and to spread out it over the whole of the face without rubbing the skin. It is necessary to avoid the hot areas (circumference of the eyes and the mouth, neck). It is always preferable to begin the treatment one day out of two (especially with the trétinoine with 0,05% or if one uses benzoyl peroxide in parallel). The application of a hydrating cream is essential the morning, especially at the beginning of treatment. Lastly, it is necessary to examine its skin before each application and to suspend the treatment a few days (1 to 4) if the skin becomes red, shovel or if it one has feelings of burns. When one supports the product well one day out of two, it is possible to apply it daily but one will not hesitate to stop temporarily the treatment so irritations appear. The treatment by rétinoïde often joins peroxide benzoyl and/or a local or general antibiotic treatment. The rétinoïdes weaken the skin with the sun. It is thus necessary to use a solar shield the morning. This treatment against is indicated during the pregnancy and breast feeding.

Acid azélaïque (Skinoren®): the azélaïque acid is effective on the rétentionnelles lesions but also on the inflammatory lesions. This treatment applies twice a day, it is moderately irritating. This treatment is not used much in France because it is not dealt with by the health insurance.

Fruit acids: creams with the fruit acids (15%) peuvents sometimes to be associated with the rétinoïdes. Their application always causes piccotements without gravity and of short duration. The peelings with the glycolic acid (20 to 70%) sometimes effectively supplement cleanings of skin. The treatment by the fruit acids is a cosmetic treatment of complement.

Preparation with salycilée resorcin: these ancestral preparations react to the sun. They are sometimes irreplaceable among patients who do not tolerate the local rétinoïdes. This treatment against is indicated during the pregnancy and breast feeding.

- Treatment of the inflammatory lesions (red buttons)
Peroxidize Benzoyl: the benzoyl peroxide exists out of soap (Pannoxyl pain®), in cream and gel (Brévoxyl®, Cutacnyl®, Eclaran®, Pannogel®, Pannoxyl®, Effacné®). The concentrations of the products vary from 2,5 to 10%. The benzoyl Peroxide is a little irritating but very effective on the inflammatory red lesions. We recommend to use it without rubbing, only on bottons red. The benzoyl peroxide fades clothing definitively (like bleach), it is thus necessary to pay great attention during its application, we recommend his use the evening with a linen room of white color. The treatment by benzoyl peroxide joins sometimes the rétinoïdes and/or a local or general antibiotic treatment. The benzoyl peroxide can react to the sun. It is thus necessary to apply it the evening and to use a solar shield the morning.

Local antibiotics: One can use the érythromycine (Eryfluid®, Stimycine®, Erythrogel®) in gel or lotion or the clindamycin (Dalacine T topic®). These products contain alcohol and/or propylene glycol which are irritating. The local antibiotic treatment joins the treatment by rétinoïdes sometimes and/or peroxidizes Benzoyle with a treatment or general.

Rétinoïdes: they are surtouts effective on the rétentionnelles lesions, one finds the trétinoïne, the isotrétinoïne and the adapalene which fights in parallel against the inflammatory lesions.

Acid azélaïque (skinoren®): the azélaïque acid is effective on the rétentionnelles lesions but also on the inflammatory lesions. This treatment applies twice a day, it is moderately irritating.

Dermocorticoide: the specialized dermatologist prescribed sometimes very punctually of the strong cortisonées creams which can help to decrease the ignition of a large painful cyst. It is not a question of a treatment of the acne strictly speaking.

Treatments by the lasers and the lamps
The lasers diode with 1450nm (smoothbeam Candela®) is sometimes used to reduce the inflammatory lesions of the acne if one does not want to use antibiotics.

Electroluminescent diodes (LED): the blue lights (415 Nm) and reds (632 Nm) are sometimes useful for the treatment of the inflammatory lesions of the acne if one wants to avoid antibiotics.

Dynamic Phothérapie: the blue and red lights can be used in conjunction with a liquid photosensitizing (Acid aminolevulinic delta) to treat the inflammatory lesions of the acne. This treatment is not validated yet in France.

• Treatments by oral way
Antibiotics
A prolonged antibiotic treatment is often necessary to the assumption of responsibility of the acne. The dermatologist has the choice between the tétracyclines (doxycycline, lymécycline, minocycline) and the érythromycine, one more rarely uses sulphamides. The acne is not an infection but these antibiotics fight effectively against the ignition. The tétracyclines can involve digestive disorders (nauseas, vomiting), they must be absorptive with large water glass, at least two hours before laying down it to avoid an ulceration of the esophagus. The tétracyclines react to the sun, it is thus necessary to use a total screen every two hours and not to make a sun bath. Occurred of a cutaneous allergy (urticaria) is possible. The tétracyclines can also involve other very rare complications (disorders endocriniens, cutaneous, hematologic, musculo-skeletal, neurological, disorders of the immune system, a syndrome of over-sensitiveness, a syndrome lupic or a pseudo serum disease). The tétracyclines should not be used during the pregnancy nor in the child of less than 8 years (risk of coloring of dental enamel).

- Summarized characteristics of the doxycycline by the French agency of public health of the products of santépdf

Zinc gluconate (Rubozinc®)
Its effectiveness is modest. Are utility is limited to the light acnes, in complement of the local treatments. Posology is of two gélules per day the morning with jeun for three months then of one per day.

Isotrétinoine (roaccutane®, curancé®, procuta®, contracné®)
The reading of the side effects of this drug can worry you, the serious side effects of the isotrétinoïne (Roaccutane®) are rare whereas its benign undesirable effects are frequent but easy to deal with. The knowledge of the side effects should not dissuade you from a treatment if this one is justified by a severe acne, it is necessary nevertheless scrupulously to follow the indications of your dermatologist and to carry out well the follow-up necessary. Contraception and its follow-up must be strict.

A treatment by isotrétinoïne is often necessary if the acne is severe, if it resists the antibiotic treatments good led during at least three months or perdure to the adulthood. The isotretinoine decreases the production of sebum by 70% and standardizes épidermique keratinization, it is anti inflammatory and reduces the proliferation of propioni bacterium acnes. The regulation of isotrétinoïne is very regulated because the drug can involve malformations of the fetus at a woman who would take it during a pregnancy. Contraception is obligatory at the woman during the treatment by isotrétinoïne, it must begin one month before the beginning from the treatment and continue at least a month afterwards. A control of the absence of pregnancy by a monthly blood testing is essential, it must be made to the maximum three days before the regulation and seven days before the delivery of the product. The patient must sign a form of enlightened assent and be capable to include/understand well the information delivered by the dermatologist. If there exist microkystes, a dermatological cleaning of skin is necessary before beginning a treatment by roaccutane®, their presence involves an aggravation at the beginning of treatment, she can be possibly severe. The treatment can seldom involve complications at the level cutaneous, ocular, osseous, hepatic, renal, allergic, metabolic, neurological, psychiatric (see note roaccutane®). The roaccutane® comprises obligatory undesirable effects, they are general easily taken of load by simple measurements that you will indicate your dermatologist (your treatment by roaccutane®). The roaccutane causes a drying of the skin and mucous membranes which must be dealt with by adapted creams (your treatment by roaccutane®). A regular medical monitoring is essential (every month among women, every three months at the men). It is necessary to make a blood test before the beginning of the treatment then one month afterwards and then every month at the women and every three months at the men.

Treatment by roaccutane in short
Proportioning and posology of the roaccutane®: the daily amount of roaccutane which your doctor prescribes you depends on several factors, it can vary from 20 to 100 Mg per day in function the type and the importance of your acne, your weight and can be different for a second or a third treatment. The usual amount is of 0,5 Mg per kilogram of body weight is 35 Mg per day for an adult of 70 kg.

Duration of the treatment by roaccutane®: the duration of the treatment depends on your acne and of the amount which is prescribed to you because the dermatologist seeks to obtain a total amount (for all the treatment) variable between 120 and 150 Mg per kilogram of body weight. It is in general necessary to count 8 to 12 months treatment.

Undesirable effects and complications of the roaccutane®: The teratogenicity (risk of malformation of the fetus in the event of catch during a pregnancy) must be avoided by a very strict follow-up. The isotrétinoïne often involves benign undesirable effects, but can cause many complications which are fortunately rare or very rare (note of the roaccutane®). The benign undesirable effects are often proportional to the amount and can be dealt with by reduction of that Ci and/or adapted care, they obliges only seldom with the interruption of the treatment. The skin dries and its embrittlement always require the use of a hydrating stick with lip, a cream hydrating for the face and the body and of a solar shield. Sometimes it is necessary to put a fatty cream on the mucous membrane narinaire and of the artificial tears in the eyes. The port of the lenses is not always possible during the treatment (it depends on the abundance of your tears). The solar exposure is contra-indicated, it is necessary to apply a solar shield every two hours if the climate is sunny. It is possible to bathe with the sea if the bath does not last more than thirty minutes and if one applies the screen before, it is not possible to consider activities prolonged in full sun during the treatment It is necessary to wait six months at one year after the treatment by isotrétinoïne before considering a laser treatment (depilation, rednesses), an surgical operation on the skin or a correction of the scars (dermabrasion, relissage).

Very frequent undesirable effects (1/10): eye (blépharite, conjunctivitis, ocular dryness, ocular irritation), blood (weakens, increase sedimentation test, thrombopénie, thrombocythemy), liver (rise in transaminases), skin [chéilite, dermites, dryness of the skin, located exfoliation, prurit, érythémateuse eruption, cutaneous brittleness (lesions due to frictions)], articulations and muscles (arthralgies, myalgias, back painses in particular at the teenagers), metabolism (rise in blood triglycerides, reduction in the circulating HDL).

Frequent undesirable effects (1/100): Blood (neutropenia), nervous sytème (cephalgias), respiratory disorders (épistaxis, dryness, rhinopharyngitis) investigations (rise in blood cholesterol, rise in the glycemia, hématurie, protéinurie).

Rare undesirable effects (1/1000-1: 10000) or very rare (1/100000): fulminant acne, alopécie, arthritis, bronchospasme, cataract, colitis, convulsions, depression, diabetes, glomerulonephritis, digestive hemorrhage, hepatitis, hyperostose, infection, lymphadenopathy, opacities corneal, pancréatite, vascularity (note of Roaccutane®).

The follow-up of the treatment by roaccutane®: Blood assessment before the beginning of the treatment, after one month of treatment then every month at the women and every three months at the men. monthly consultation of follow-up among women, quarterly at the men.

Information records on the isotrétinoine
- Summarized characteristics of the product by the French agency of public health of the products of santépdf
- Note of Roaccutane® by the laboratory Rock pdf
- Form of agreement of care and contraception by the medical agency francçaise of écurite of health products pdf
- Your treatment by isotrétinoïne, Doctor Abimelec. pdf

Treatment hormonal
The hormonal treatment of the acne is very important at the woman. It often makes it possible to avoid a treatment by isotrétinoïne, avoids the repetition of the acne to the stop of the treatments and débrassage the women of an often awkward late acne. The dermatologist or the gynecologist often recommends a hormonal treatment which contains a estrogene and progestatif a antihormone male (Diane®, Bellara®, Jasmine®, Jasminelle®) sometimes in association with complementary a antiandrogene treatment (acetate of cyprotérone®). These treatments allow occasion consequently an effective contraception. It is the gynecologist who initially prescribes the pill which makes sure of the absence of against indication and realizes followed it of this treatment (clinical examination, blood test, smear). These hormonal treatments have the same disadvantages as the catch of a pill, they against are indicated in the event of vascular antecedents or of cardiovascular risk factors, diabetes, porphyrie, disease of the liver or cancer of the genital sphere.

Many contraceptives worsen the acne, in particular those which contain derivatives of the nortestostérone (adépal®, minidril®, trinordiol®, ludeal®, microval®, mirena®).

The interruption of a contraception is often the occasion of a push of acne at a woman whose pushes had been amended.

Which treatments according to your form of acne?

For considering the startup treatment, it is necessary to eliminate the factors which can cause or worsen the acne: exposure to the ultra-violet, creams comedogene, pill stimulating the acne, inductive drug, hormonal dysfunction. It is also necessary to seek the factors starting like an exposure to the sun or in cabin three weeks before (return from holidays), the stop of a pill three months before or the use of a new cream bought in perfumery.

The light acne is dealt with by the local treatments (antibiotic, benzoyl peroxide and/or rétinoïdes), the moderate acne requires moreover the antibiotic catch by oral way (tétracyclines, erythromycine) whereas the severe acne almost always implies the catch of isotrétinoïne (roaccutane®). In addition, the realization of cleanings of dermatological skin is often essential to accelerate the cure of the microkystic acnes. The recourse to the laser and dynamic phototherapy is seldom essential but to little be useful to certain patients who do not wish to take antibiotics by oral way.

Apart from the isotétinoïne (roaccutane®), a local and general treatment gives only few results after one month, one can count on 20% of improvement after two months, 60% to 6 months and 80% to 8 months. The isotrétinoine gives a faster improvement and more complete, one can discount 80% of improvement after 4 months of treatment of an acne of the face whereas it is necessary to count 6 months for an acne of the back. One in general obtains 100% of improvement after 6 to 8 months of treatment.

Acne
light

Moderate acne

Acne
severe

Late acne woman

Late acne man
Local treatment
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General antibiotics
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Isotrétinoïne
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If necessary

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Hormonal treatment
To discuss at the woman

Obligatory contraception at the woman

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Particular cases

Acne of new born: it disappears all alone and does not require any treatment.

Acne beginner of the small child: she profits from cosmetics anti acne like the diacnéal, sébium AKN, expholiac and of creams to alpha hydroxyacides like neostrata cream 15 AHAou exostrate

Excoriée acne: it is about a banal acne associated with marks with scrapings, the buttons “are torn off” as soon as they point and one observes wounds, crusts and scars. This acne often occur among women who are anxious and their buttons do not support. It is necessary to consider an energetic treatment of the acne and sometimes an associated psychological support.

Acne of the expectant mother: The majority of the treatments against are indicated, particularly the isotrétinoïne. Can be used without risk: Erythromycine local or by general way, glycolic acid in cream or lotion (15%). There does not exist proof of the harmlessness of the local rétinoïdes (trétinoïne, adapalene), benzoyl peroxide, local clindamycin. The tétracyclines against are indicated.

Induced acnes
The acne can be caused by cosmetics, drugs, the sun and the ultra-violets (push of acne to the return from holidays) or poisons.
Certain creams known as comedogenes cause acne after several weeks of application, this is why it is necessary to avoid using the creams of perfumeries and those marketed by small marks little known. It is necessary to privilege ls famous brands of dermocosmetic sold in pharmacies and parapharmacies.
The first treatment of the induced acne is the stop of the accused product, it is necessary nevertheless to start a specific treatment according to the type of this acne which is often rétentionnelle (cysts).

Drugs and substances which can cause acne
Contraceptive
Pill
Implant
Coil

Hormones

Antidepressants
Nerve sedatives

Antiépileptiques

Others
drugs
Adépal
Enidrel
Enovid
Implanon
Minidril
Miréna
Ortho-
Novum
Planor
Stédiril
Trentovlane
Triella
Cortisone
Androgens
DHEA
Lithium
Phénothiazine
Haloperidol

Hydantoins
Phenobarbital
Triméthadione

Vitamin
B12
Brominate
Ciclosporine
Azathioprine
Gold salts
Anti
tuberculous
Anti EGF

Other suceptibles substances and radiations to induce acne
Poisons: Chlorinate, Brome (syrups, cordarone)
Rays: ultraviolet rays & sun, X-rays
Cosmetics known as comedogenes (to be wary of the marks little known, the specific for black skin or métissées cosmetics sold in specialized stores or of the cosmetics sold in perfumeries and beauty parlors)
Oils: Industrial oils, Oil of cade

Treatment of the marks and the scars

Raising of scars
It is a precondition necessary to the relissage of deep scars. The dematologist “raises” the round scar with a circular lancet. One can carry out a dermabrasion or a relissage a few weeks afterwards.

Dermabrasion
The dermabrasion is an ancestral technique whose results are tested. One can hope for 30 to 40% of results on moderately deep scars. This technique is hardly any more practiced since the advent of the lasers. The dermabrasion is in general carried out under sometimes local general anesthesia. The expert dermatologist or surgeon plastics technician uses a strawberry which “sandpapers” the skin to the derm superficei or means. It is necessary to count ten days of sick leave and three months of rednesses. the cost of this intervention is of about a 1500 with 2500€. It is necessary to be protected from the sun at least six months after the intervention. There exist risks of marks and pigmented scars, dépigmentées or in relief. Several meetings are sometimes necessary.

Traditional laser of relissage (CO2, Erbium-yag)
The laser of relissage (laser resurfacing) makes it possible “to smooth” the scars which are not too deep, this treatment allows améilorer the “marks” but the results are imperfect and this intervention is very expensive (2000 with 4000€) and is not stripped of complications. A ten days sick leave is necessary, of rednesses persist during one to six months, it exists risks of pigmentation, EPD

Acne conglobata, cosmetic acne, acne of the expectant mother, acne of the teenager, acne of the adult, acne of new born, excoriée acne, fulminant acne, induced acne, infantile acne, teenage acne, microkystic acne, acne néonatale, papulous acne, late acne, common acne.

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Acid azelaic: This drug available in the form of cream was initially designed to fade the spot brown, but it was then used to treat the acne. This drug not refunded by the health insurance is used rather little in France.

Glycolic acid (acid alpha hydroxyacetic, AHA, acid of fruit): it is an acid coming from the fruits (canes with sugar, beet, melon, pineapple and grape). It is used in dermatology in the form of creams and of lotions whose concentration varies from 5 to 70% to carry out surface exfoliations of the skin (peeling).

Acid of fruit (see glycolic acid): many acids resulting from the fruits are used in dermatology, most known is the glycolic acid, but one uses also the acids kojic, citric.

Acne: consecutive affection with an anomaly of the follicules of the sébacé type characterized by the appearance of lesions with type of microkystes and black spots (rétentionnelles lesions), of more or less bulky red buttons and white heads (lesions known as inflammatory). The association of these various varieties of lesions forms the youthful polymorphic acne.

Acne estivalis: consecutive acne with a solar exposure.

Acne conglobata: it is a severe form of acne which touches the young man. The acne conglobata is characterized by very important and very wide lesions. The lesions are bulky and form nodules and abscesses which suppurent with cysts and comedones. This form of severe acne leaves important and unaesthetic scars.

Cortisonic acne: it is about a complication which meets the patients who must take of cortisone by oral way to the long course. This form of acne also meets among patients who apply a long time creams to cortisone, in particular for dépigmenter their skin.

Acne of contact: form acne characterized by the appearance of lesions to the seat of application of creams supporting the acne (creams comedogenes) or of oils which are used in certain professions.

Acne of the child: it is a form of teenage acne of which the appearance before the usual age must make seek a particular cause (taken drug, application of a cream comedogene, early puberty, disease of endocrine glands).

Excoriée acne of the young girls: form acne usually found in anxious young women, the lesions of the acne are modified by the handling repeated with the nails and the fingers. One finds wounds, crusts and scars. The treatment of this form of acne is difficult.

Acne fulminans: it is a variety rare and serious or a very severe acne is accompanied by fever and a faintness general.

Induced acne: it is an acne caused by the catch of the drugs, poisons or the exposure to the ultra-violets.

Teenage acne: it is the most usual variety of the acne. The teenage acne meets starting from adolescence and appears by inflammatory lesions red and painful (papules, pustules) and cystic rétentionnelles lesions (comedones, microkystes) of the face and trunk which join a fatty skin (séborrhée).

Mechanical acne: lesions of folliculites to which the aspect is close to the acne, the factors of frictions or pressure have a role in the development of this variety of acne. The mechanical acne is of easy diagnosis because its localization is in connection with the port of certain clothing, with the profession or the practice of sports.

Medicinal acne: consecutive acne with the catch of certain drugs (hormones, the B12 vitamin, lithium, iodine, barbiturates and the antituberculeux ones).

Acne néonatale: eruption of buttons (red buttons, white heads) on the face and the cheeks appearing in first weeks of life. This form of acne would be related to the passage of hormones of the mother in the blood of the newborn. No treatment is necessary, it is necessary to avoid the supporting factors (milk of toilet, creams).

Nodulokystic acne: this form of acne appears by the presence of bulky buttons under the skin (cysts and nodules). This acne often severe and is disseminated on the face and behind the ears.

Rose acne: to see rosacée

Local Antibiothérapie: it is the use of antibiotics to be applied directly to the skin in the shape of liquid, in cream or gel. The use of local antibiotics on the buttons of acne for an antimicrobic purpose and acts against the ignition (redness, pain).

Alopécie: it is a fall of hair or hairs localized or diffuses, it is of short duration or is prolonged in time. The alopécie can be temporary or irreversible (alopécie cicatricial). The fall of hair appears quickly in the event of effluvium télogègne (isotrétinöine) but to be unperceivable little in the case of a family alopécie (alopécie androgenic) for example.

Scar of acne: mark or final after-effect consecutive with the buttons of acne.

Atrophic scar: it appears by a small white spot whose surface is slightly fripée. One preferentially finds it on the level of the trunk (high of the back, thorax) but also of the face or they very many and are often gathered.

Scar chéloïde: scar in relief which does not disappear in the year from its appearance. It is more frequent on the level top of the body (high of the back and the thorax) and of the jaw, particularly at the patients with coloured skin.

Hypertrophic scar: scar in relief which usually disappears during the first year from its appearance. It is more frequent on the level top of the body (high of the back and the thorax) and of the jaw.

Scars in ice pick: this mark of acne forms a small deep hole (1 to 3 mm) on board precipice.

Fibrous scar: This mark of acne forms a broad depression (3 to 8 mm) on board Nets

Soft inclined scar: these marks of acne form broad depressions (3 to 8 mm) whose edges are soft inclined.

Collagen: one of the component of the matrix of the skin synthesized certain cells of the derm (fibroblasts). Bovine collagen is used in injection to fill the wrinkles and the scars.

Comedo: pilosébacé follicule whose opening (pore) is closed by a cluster of compact cells which adhere the ones to the others. The comedo the symptom of microkystic acne (rétentionnelle). The closed comedo is distinguished (microkyste) which appears by a pimple color of the normal skin and the closed comedo (black spot), when the dilated pore lets see the remains of cells to which the black color testifies to oxidation. The comedones sit on the face and the upper part of the trunk.

Filling (produced): they are substances (hyaluronic acid, collagen) intended to fill depressions of the skin (wrinkles or scars).

Cytokine: substance synthesized by the cells of the body, it has effects varied on fabrics or other cells.

Elastoïdose with cysts and comedones (disease of Favre and Racouchaud): this affection touches the adults who were exposed too much to the light and the sun, it arises in the form of microkystes and of black spots located around the eyes. The skin is thick and yellowish and present deep wrinkles.

Elastolyse périfolliculaire: to see atrophic scar.

Favre and Racouchot (Disease of): to see Elastoïdose with cysts and comedones

Pilosébacé follicule: it is about a structure which sits in the skin and comprises the root of the hair. A sébacée gland and a muscle associated with the hair (muscle arrector) are attached to each follicule. The sébacée gland opens in the follicule or it pours the sebum. The muscle arrector forms part of the lower portion of the follicule.

Folliculite: they form multiple red buttons and white heads which are the consequence of a surface infection of the opening of the hair. There are several varieties. Some prevail on the level of the circumference of the mouth (dermite perished oral), they can be secondary with the application of a cream to the cortisone or the proliferation of a parasite (démodécidose). The contamination of a germ during shaving causes sometimes bacterial folliculites (staphilococca). The antibiotic catch to the long course can induce folliculites trunk (folliculites with Gram negative) whose treatment is delicate. The mushroom proliferation can also involve folliculites, it can be a question of Malassezia furfur generally responsible for the pityriasis versicolor or seldom for Candida albicans.

Folliculite with Gram-negative bacilli: folliculites due to germs which do not take the coloring of Gram (Gram-negative) – Enterobacter, Klebsielle, or Proteus. The negative folliculites with Gram touch the face and the trunk at subjects covered by tétracyclines for their acne. The negative folliculites with Gram can induce a diffuse folliculite among patients who use jacuzzi contaminated by the pseudomonas aeruginosa.

Sébacée gland: gland annexed to the pilous follicule producing the sebum. These glands are localized on all the safe body with the palms and the plants. The sébacées glands are numerous in the seborrheic areas – zone T = face, nose, cheeks, high of the thorax.

Hidrosadénite (disease of Verneuil): this chronic affection and invalidating involves red and painful nodules in the groin, the armpits and under the buttocks. The treatment is difficult.

Hirsutism: excessive development at the woman of a pilosity dependant on the male hormones and normally present only at the man (moustache, chin, high of thorax, white line). The secondary hirsutism is the consequence of an excess of production of male hormones and joins other signs of masculinisation. The cause can be of origin ovarienne (ovaries polykystic) or related to the glands suprarenals. The primary education hirsutism is the consequence of an excess of transformation of the male hormones in the skin; it frequently joins a fatty skin and/or a androgenic alopécie and/or an acne.

Hyperséborrhée: consecutive demonstration with the excessive production of sebum. The skin luisante is covered with a fatty film. Hyperséborrhée is localized with the scalp and in the middle of the face (zone T), but also on the upper part of the back and the chest. Hyperséborrhée appears separately or perhaps accompanied by acne. Hyperséborrhée can be the consequence of a hormonal disorder (excess of manufacture of male hormones or hyperandrogénie) that the doctor must possibly seek.

Isotrétinoïne: this drug belongs to the family of the rétinoïdes which act on the cells of the skin and the size of sébacées glands. The isotrétinoïne (roaccutane®, contracné®, curacné®) is prescribed during the severe acnes (nodulokystic, conglobata) which resisted the usual treatments. This drug by oral way can involve varied side effects (risk of malformation in the event of pregnancy, hepatitis). It is however a remarkably effective and useful treatment in the acne.

Cyst: large button under the skin which results from an accumulation of remains of cells of the skin (kératinocytes).

Épidermique cyst: large button under the skin which results from an accumulation of remains of cells of the skin (kératinocytes). Their origin comes from the surface part of the pilous follicule. Examples of cysts épidermques are the grains of milium, the cysts épidermoïdes, the cysts of the purses.

Érythémateux Lupus: auto-immune disease of unknown cause whose development blames of the family and immunizing factors. The érythémateux lupus reach almost all the bodies and is very often accompanied by a sensitivity to the sun.

Microcomédon: it is the initial stage of development of the comedo.

Auto-immune disease: the immune system allows the defense of the organization against the germs and in general what he regards as foreigner. This complex defense system calls upon cells (cellular immunity) and with substances which they secrete (immunity humorale). In the event of dysfunction of the system, the cells of defense are mistaken sometimes in adversary and consider that your own cells are foreign, your system immune can then start a “attack” for the détruires. This fratricidal attack can touch any part of the body and induce sometimes severe dysfunctions. The knotty periarteritis, the disseminated acute érythémateux lupus, the disease of Behcet, the disease of Crohn, scleroderma, the diabetes of the type 1, the thyroïdite of Hashimito, sarcoidosis, the bulleuse pemphigoïde, vitiligo and the skinwool are examples of autoimmune diseases.

Microkyste: to see comedo

Milium: very small surface épidermique cyst. The closed comedo is with a pilosébacé follicule filled with cells of the skin at the end of the lifetime (kératinocytes). The grains of milium are frequent and the consequence of the obstruction of the pilar openings of the sleeping bags. They disappear often all alone, but their ablation with vaccinostyle is easy.

Nodule: bulky button covering of one of diameter higher than 1 cm.

Ovaries polykystic (syndromes of) or disease of Stein Leventhal: it is an affection which results in the absence of rules (amenorrhoea) and an infertility (impossibility of designing a child). There exist marks in connection with the male excess of hormones: an excess of pilosity and/or an acne and/or a fall of hair and an excess of weight. A blood test shows a male excess of hormones and an echography of the ovaries shows multiple cysts.

Peroxidize benzoyl: it is a drug which has anti-bacterial properties, anti-inflammatory drugs used in the treatment of the acne. This substance available in cream and bread fades clothing definitively. The Benzoyl peroxide can react to the sun (photosensitivity), It is thus necessary to apply it the evening and to use a solar shield the morning.

Peeling (exfoliation): treatment which allows the elimination of the surface layers (skin, surface derm) and/or average (average derm) of the skin.

Surface Peeling (surface exfoliation): treatment which allows the elimination of the surface layer of the skin (skin). The surface peeling gives a blow of glare (pinker and brilliant skin), narrowed temporarily the pores of the skin, contributes to the elimination of the brown spots surface and decreases the visibility of the superfielles wrinkles temporarily. The peeling is not painful but sometimes a little unpleasant (tinglings, brûluress). There are few risks of complication with a surface peeling, some croûtelles and a temporary exaggeration of the pigmentation is possible.

Average Peeling (average exfoliation): treatment which allows the elimination of the surface layers of the skin (skin, surface derm). The trichloracetic acid with 33% allows an average exfoliation. The average peeling is a little painful, but can in general be carried out without anesthesia. The average peeling gives a blow of glare (pinker and brilliant skin), contributes eliminates the brown spots surface and reduces the visibility of the superfielles wrinkles. The average peeling involves crusts which last 8 days to the maximum. This peeling can give a temporary exaggeration of the pigmentation, especially for the matt skins.

Deep Peeling (major exfoliation): treatment which allows the average elimination of the layers of the skin (skin, surface derm and means). Certain preparations with the phenol (Baker Gordon, Finzi) allow a major exfoliation. The deep peeling is always carried out under general anesthesia. The deep peeling eliminates the brown spots, the average wrinkles and decreases the visibility of certain scars. The deep peeling is an surgical operation whose continuations are difficult (bandages 8 days, seepage 8 days, social ousting 10 days, rednesses 2 months). It is necessary to count two weeks of sick leave and a solar ousting 6 months. The deep peeling causes rednesses during several months and can involve a discoloration of the skin, an exaggeration of the pigmentation or scars.

Resorcin: substance derived from phenol used in the composition of creams exfoliantes.

Rétinoïdes: designate a family of drugs derived from vitamin A. One finds forms local (cream, lotion, freezing) or used by oral way (roaccutane®, soriatane®). The rétinoïdes act on fabrics by modulating their growth and their differentiation. One uses the rétinoïdes in the acne (isotrétinoïne) or the psoriasis (acitrétine).

Rosacée: it touches the adults and causes red buttons and white heads identical to those which one observes during the acne but it accompanies by rednesses (blotches, érythrose) and sometimes by puffs of heat. Rosacée can be accompanied by an ocular attack and become complicated of a thickening of the skin of the nose (rhinophyma).

Papule: small button in relief, firm and without liquid.

Sarcoidosis: chronic affection of unknown cause being able to touch the majority of the bodies (skin, lung, eye, liver, ganglia, bone). This affection is characterized by a particular aspect of fabrics observed under the microscope. The pulmonary demonstrations are most frequent, but the cutaneous demonstrations of sarcoidosis can be at the origin of its discovery.

Sébocystomatose: to see hidrosadénite

Subcision: section of the fibrous adhesions located under a retractile scar in ice pick.

Syphilis: transmissible sexual infectious illness due to the tréponème. It is about a potentially serious rare affection which is in recrudescence in the homosexual community. The treatment of choice is penicillin.

Verneuil (disease of): this chronic affection and invalidating involves red and painful nodules in the groin, the armpits and under the buttocks.