Factors that affect acne development and complications = Фактори, що впливають на розвиток та ускладнення акне

90 UDC 616.5-003.871-07-08 DOI http://dx.doi.org/10.5281/zenodo.17313539 D. M. Zapolska FACTORS THAT AFFECT ACNE DEVELOPMENT AND COMPLICATIONS Odesa National Medical University Authors information Zapolska D.M. https://orcid.org/0000-0002-5721-6836 Summary. Zapolska D. M. FACTORS THAT AFFECT ACNE DEVELOPMENT AND COMPLICATIONS. The purpose of the study was to analyze the factors that stimulate the development and complications of acne. We observed 95 patients aged 18 to 35 years (45 men and 50 women) suffering from moderate and severe forms of acne. According to data obtained its worth to conclude that quite often, self-medication led to a worsening of acne, the total number of cases of self-medication among men was 15.5%, among women - 12%. The COVID19 pandemic of 2020-2022 also negatively affected the nature of the course of acne, about 16% of respondents under our observation associated the worsening of acne with the previous infection. The virus had a greater impact on the complications of acne in men - only 11.1%, in women only - 6.0%. The author concludes the worrying fact that a large number of patients, especially women - 14.0% (men only 6.7%), associated the exacerbation of the disease with the intervention of cosmetologists, carrying out irrational aesthetic procedures, mechanical peeling, peeling etc. The mentioned conditions are generally considered to be dangerous factors that can serve as etiological factors initiating skin lesions of inflammatory and inflammatory-infectious nature. Key words: acne, complications, COVID19, skin scars, etiological factors, pathophysiological mechanisms, diagnostic, treatment. Реферат. Запольська Д. М. ФАКТОРИ, ЩО ВПЛИВАЮТЬ НА РОЗВИТОК ТА УСКЛАДНЕННЯ АКНЕ. Одеський національний медичний університет, e-mail: [email protected]. Метою дослідження був аналіз факторів, які стимулюють розвиток та ускладнення акне. Під спостереженням були 95 пацієнтів віком від 18 до 35 років (45 чоловіків та 50 жінок), які страждали на середньотяжкі та тяжкі форми акне. Згідно з отриманими даними, можна зробити висновок, що досить часто самолікування призводило до погіршення акне, загальна кількість випадків самолікування серед чоловіків становила 15,5%, а серед жінок - 12%. Пандемія COVID-19 2020-2022 років також негативно вплинула на характер перебігу акне, близько 16% респондентів, які перебували під нашим спостереженням, пов'язували погіршення акне з попередньою інфекцією. Вірус мав більший вплив на ускладнення акне у чоловіків - лише 11,1%, лише у жінок - 6,0%. Автор робить висновок про тривожний факт стосовно того, що велика кількість пацієнтів, особливо жінок – 14,0% (і лише 6,7% чоловіків), пов’язували загострення захворювання з втручанням косметологів, проведенням нераціональних естетичних процедур, механічним пілінгом та відлущуванням, що загалом вважаємо небезпечними чинниками, які в змозі слугувати етіологічними чинниками, ініціюючими запальні та запально-інфекційні ураження шкіри. Ключові слова: акне, ускладнення, COVID19, шкірні рубці, етіологічні чинники, патофізіологічні механізми, діагностика, лікування Acne is a global health problem that affects all ethnic groups and age groups. The highest prevalence of the disease is observed in adolescence, when almost 85% of people experience -------------------------------------------- © Zapolska D. M. 91 varying degrees of acne severity. However, modern epidemiological studies from 2015 to 2025 show that about 15-20% of acne cases are diagnosed in adult women, and this figure is increasing [1, 3]. Sex differences in the frequency and course of acne are confirmed by many works: boys are more often affected in adolescence, while after 25 years of age women predominate. This difference is explained by hormonal factors, the peculiarities of the functioning of the sebaceous glands and the sensitivity of the skin to androgens [2, 5]. Geographic and ethnic characteristics also influence the course and complications of acne. Patients with dark skin phototypes (Fitzpatrick IV–VI) are more likely to develop postinflammatory hyperpigmentation, while atrophic scars are more common in Caucasian populations. Post-acne complications occur, according to various data, in 40–55% of patients who have had moderate or severe acne. It is important to note that even mild forms of acne can lead to scarring if improperly treated or if the skin is manipulated independently [7, 9]. Thus, the epidemiology of acne and post-acne complications confirms the significant prevalence of this problem among the population of different countries of the world, which necessitates the improvement of treatment and prevention methods. Just like acne, post-acne complications are a common problem of modern dermatology, which affects mainly young people and can, without proper treatment, persist throughout life. Complications of acne occur in different climatic regions with different frequencies, but the leaders include countries of Central and South Asia, South America. The activity and severity of clinical manifestations of acne depend on the combination of a large number of etiopathogenetic factors. The study of mechanisms that accelerate the transition of mild and moderate forms of acne into severe forms of the disease is a priority task of modern dermatovenereology [7, 8]. It is known that the transformation of moderate acne into a more severe form of the disease is associated with specific factors that sometimes the dermatologist does not pay due attention to during treatment. For example, the influence of irrational aesthetic manipulations, aggressive laser technologies, the use of cosmetics, topical antibiotics, antiseptics, and mechanical intervention often stimulate the transition of mild forms of acne to severe [4, 6]. The purpose of the study - analyze the factors that stimulate the development and complications of acne. Materials and methods We observed 95 patients aged 18 to 35 years (45 men and 50 women) suffering from moderate and severe forms of acne. Written consent was obtained from patients to include the results of their examination and treatment in scientific work. At the same time, most patients clearly identified periods of exacerbation of the disease and were aware of factors that stimulate the worsening of the course of acne. When processing the data obtained, an analysis of the patient's personal perception of factors influencing the course of acne was carried out, as well as the presence of documentary evidence of certain deviations in each specific case (clinical, laboratory, daily). It is important to note that acne (moderate and severe forms) had a rather strong impact on the emotional state of patients, so 82.6% of men and 89.7% of women noted a decrease in social activity, according to them, it was the exacerbation of acne that repeatedly forced them to refuse to meet with peers. Results and their discussion The most common factors stimulating the exacerbation of acne include self-medication, most patients hide episodes of unsuccessful treatment of acne on their own, only after a long confidential conversation can the extent of self-intervention be found out. The total number of cases of self-medication among men was 7 (15.5%) people, among women - 6 (12%). Selfmedication often led to serious complications and irreversible skin changes. The most frequent manipulations that patients performed at home include: mechanical removal of inflammatory elements and foci of suppuration, self-scrubbing of the facial skin in aseptic conditions, skin treatment with acids, alcohol tinctures, use of super-thick ointment forms, use of other homemade topical agents. Three (6.7%) men identified alcohol as a trigger factor that stimulated the exacerbation of acne, while none of the women considered alcohol a trigger factor for acne. At the same time, dietary violations, especially the use of sweets, more often contributed to the exacerbation of acne 92 in women - 9 (18%) and only in 6 (13.3%) men. Also, a significant role in stimulating acne activity was played by irrational antibacterial topical therapy, as two (4.4%) men and 4 (8%) women used clindamycin and erythromycin topically for a long time, which provoked the exacerbation of acne (like gram-negative acne) and caused an increase in inflammatory elements in the affected areas. Among the factors that influenced the course of acne in women, one can single out the use of contraceptives in 2 (4%) and dysmenorrhea in 4 (8%) people. At the same time, 2 (4%) patients clearly noted an improvement in the course of acne after discontinuation of contraceptives. Most of the women 43 (86%) under our observation had previously been observed by a gynecologist, it was the violation of the level of sex hormones that prompted doctors to prescribe contraceptives. The COVID19 pandemic of 2020-2022 also affected the nature of the course of acne, so 8 (16.1%) respondents under our observation associated the worsening of the course of acne with the previous SARS infection. The virus had a greater impact on the complications of acne in men - only 5 (11.1%) people, in women only - 3 (6%). Some patients (3 (6%) people) believe that the negative impact of the virus on the secretory activity of the sebaceous glands in the form of hypersecretion, the formation of comedones continues even now, even a year after the previous COVID infection. Of particular note are cases of topical corticosteroids used by acne patients, which, incidentally, are not included in any global guideline. There were 3 (6.7%) such patients in our observation group, and two of them were prescribed combined corticosteroids in the form of ointment by doctors (according to the patients in one case “to relieve skin inflammation”, in the other “to eliminate concomitant contact dermatitis”). All three patients used TCS for a long time (more than 3 months), which significantly worsened the course of acne, and in one case led to the development of steroid rosacea. A fairly large number of patients, especially women - 7 (14%) (men only 3 (6.7%), associated the exacerbation of the disease with the intervention of a beautician. Most often, it was about mechanical facial cleansing during the period of activation of acne. Such interventions deepened acne and stimulated its transition to a more severe form. At the same time, 6 (12%) respondents, despite the complications, continued aggressive treatment with a beautician, which indicates a low level of awareness of modern acne treatment methods. Some patients were unable to identify any of the known trigger factors for acne - 9 (20%) men, 3 (6%) women. Respondents believed that the disease was not related to anything and was a completely independent pathology that could be transmitted genetically through generations. It should be noted that 2 (4.4%) men under our observation did not consider facial lesions to be a serious problem at all and consulted a doctor for completely different reasons (in one case, eczema, in the other, skin mycosis). As for acne, in their opinion, it is not a disease at all and does not require treatment. Conclusion Quite often, self-medication led to a worsening of acne, the total number of cases of selfmedication among men was 15.5%, among women - 12%. The COVID19 pandemic of 2020-2022 also negatively affected the nature of the course of acne, about 16% of respondents under our observation associated the worsening of acne with the previous infection. 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