Acne

ACNE, a collective term for skin diseases characterized by the development of nodular eruptions with formation of follicular pustules. Acne vulgaris, a skin disease localized on the face and in the shoulder girdle area (rarely on the entire back and, exceptionally, in other areas). It begins at the time of puberty and by mature age disappears even without treatment. In the initial stages of the disease, skin changes are limited to hyperkeratosis, which leads to the formation of horny plugs in the follicular outlets with subsequent retention of sebaceous secretion. As a result, non-inflammatory white nodules with a black dot in the center (comedo) are formed. When pressure is applied to the nodule from the sides, a white salve-like mass with a black head is spirally extruded from its tip. Subsequently, the eruptions become inflamed and even suppurate (A. pustulosa). If the purulent foci reach large sizes and merge with each other, extensive chronic inflammatory abscesses (A. confluens) may form. Sometimes fairly large and deep nodules form that are little inclined to soften (A. indurata). Histologically, in addition to hyperkeratosis, phenomena of subacute purulent inflammation of the surrounding perifollicular tissue with granulomatous foci rich in giant cells are observed. The pathogenesis is apparently complex (seborrhea, anemia, gastrointestinal disorders - constipation). Apparently, changes in the function of the sebaceous-hairy apparatus during the period of puberty play a role here. The same conditions create the soil for infection with acne-bacillus, which Unna, Sabouraud and other dermatologists attribute primary importance to; others attribute the same role to staphylococci. Treatment consists in timely emptying of the ducts of the sebaceous glands by means of exfoliating agents (sulfur preparations, salicylic acid), puncture and expression of comedo, massage and the application of disinfectants. To prevent new eruptions, restriction of fat consumption in food, especially solid fats, and observation of the proper function of the gastrointestinal tract are recommended. Acne keloid (dermatitis papillaris capillitii, sycosis keloidea, folliculitis sclerotisans nuchae, etc.), a chronic follicular dermatitis of the skin of the occipital region, almost exclusively in men, sometimes involving the hairy scalp. Scattered conical follicular small red-brown papules, often with a pustule at the apex, gradually merging, form a continuous keloid plaque of various sizes, surrounded by a crown of dense papules and pustules. Path-anatomically, chronic folliculitis and perifolliculitis are noted, the infiltrate of which inevitably undergoes fibrous organization. The cause is not precisely established. Apparently, exogenous factors (staphylococci and friction from collars) and endogenous factors (seborrhea) play a role. A. k. stubbornly resists cure. X-rays, radium, cauterization with snow carbon dioxide, surgical intervention, galvanocautery sometimes give a favorable effect. Acne rosacea, a chronic skin disease manifested by the development of redness with a prominent network of dilated small vessels on the prominent parts of the face, mainly on the tip of the nose, of venous type. To the vascular changes are joined acne-like folliculitis of chronic-inflammatory nature and superficial pustules (see separate table). In the long process, thickening of the skin may develop, which sometimes leads to the formation of voluminous tumors on the nose (rhinophyma). Histologically, in addition to dilatation of the vessels, a round-cell infiltrate is observed (with a small amount of plasma cells, but without giant cells!). In the hypertrophic form, there is proliferation of the connective tissue of the sebaceous glands. Pathogenesis. Acne rosacea usually develops in mature age with chronic hyperemia of the facial skin (alcoholism, diseases of the gastrointestinal tract and female genital sphere, prolonged skin irritations, diseases of the nasal cavity, etc.). Treatment consists in eliminating the causal factors. Locally, astringent and weakly disinfecting ointments are used (avoid irritating agents), scarification; in rhinophyma - excision of tumors with a microtome knife. Acne scrofulosorum - acne-like chronic-inflammatory folliculitis and pustules, occurring on the body in scrofulous and anemic subjects and accompanied by the formation of deep sluggish ulcers, healing with smallpox-like scars. Some authors classify A. scrofulosorum as tuberculids. Pyogenic etiology is more probable. A. necrotica s. varioliformis, flat papulo-pustular eruptions, with a crust immersed in the skin, after the removal of which depressed scars remain. Sabourau sees the cause of the disease in staphylococcal infection, other authors in mixed infection with staphylococci and acne-bacillus. A. conglobata Lang's begins with the appearance of non-inflammatory comedo-like nodules, spread, unlike ordinary comedones, all over the body and tending to group, and on reverse development giving scar-like atrophy. Subsequently, chronic-inflammatory phenomena may join (plaques with a vegetating or ulcer-vegetating surface and scrofuloderma-like scars). Histologically, a peculiar formation of branched epithelial cysts is also noted. The cause of the disease is probably staphylococcal infection. A similar form in clinical and histological picture is A. chlorica, developing in workers engaged in electrolytic production of chlorine. A. jodica and bromica are morphologically similar to A. vulgaris and develop in seborrheic subjects after prolonged administration of these drugs. A. professionalis develops when working with certain mineral (lubricating) oils in the form of acne-like red-brown papulo-pustules, usually located on the extensor surfaces of the limbs. Acne albida - see Milium. Acne syphilitica - see Syphilis.