CAMAGÜEY.- Juvenile acne, also known as acne vulgaris, is an inflammatory disease of the pilosebaceous unit (anatomical structure of the skin that includes the hair follicle and the sebaceous gland) that mainly affects adolescents and young adults. It is characterized by a clinical polymorphism composed of non-inflammatory lesions (comedone) popularly known as blackheads or pimples, inflammatory lesions (papules, pustules, nodules, cysts) and residual lesions (scars).

The definition was in charge of Dr. Ailén Delgado Valdés, specialist in Dermatology and Comprehensive General Medicine (MGI), and Instructor Professor, from the Amalia Simoni teaching surgical clinical hospital here in Camagüey.

— It refers to the condition in the juvenile stage, but exactly, at what time does it start?

— It usually coincides with puberty, which is why it is considered a disease of adolescents.

— Does it have a preference for skin color and gender?

— It affects everyone equally and both sexes, although with its specificities. It is estimated that 85% of adolescents are affected by this condition, although it can present at earlier ages, that is, between birth and 11 years. The incidence rate of this disease varies according to the population analyzed. Some authors state that the incidence of juvenile acne is 91% in males and 79% in females during adolescence and that it decreases to 3% in adult males and 12% in adult females.

"However, there are insufficient epidemiological data on this disease and its prevalence in many communities. It is believed to be much higher than the figure reported in research, because these data only represent the population that preferred to seek medical help."

- Is it hereditary?

— The role of genetic predisposition is controversial, it is known that the size, quantity and activity of the sebaceous glands are inherited. The XYY genotype (a condition that occurs when males have two copies of the chromosome, and in each of the cells of the body) predisposes to severe acne.

— Its origin then?

— The etiopathogenesis (the key to the origins of a disease) is multifactorial and its development is produced by the interaction of four fundamental factors, which are: Sebaceous hypersecretion, keratinization alteration (continuous differentiation process that leads, on the surface skin, to the constitution of the horny layer, resistant and relatively impermeable to water) of the pilosebaceous follicle, bacterial alterations and an inflammatory response of the patient.

"Sebaceous hypersecretion is given by androgen stimulation that occurs at the beginning of development and is related to the degree of severity of the process, being an essential condition, but not sufficient in the appearance of acne. Regarding the alterations of the keratinization of the follicle determine symptoms of follicular obstruction of great importance in the process of comedogenesis (formation of pimples) and the starting point of this lesion is that the remaining lesions develop.

"Regarding the microbiology of acne, the participation of microorganisms that colonize the skin and specifically the pilosebaceous follicle is essential. These germs are: Staphylococcus Epidermidis and Malassezia, but the most important is Propionibacterium acnes, which it requires for its growth of an environment rich in lipids and a source of nitrogen that in the skin usually comes from corneocytes (cells that make up the majority of the epidermis of human skin), it has a relevant activity in the late phases by promoting an inflammatory reaction leading to the appearance of papules and pustules".

— Can stress, so common nowadays, be related to this condition?

— Medical practice has suggested over the years that there is a great influence of stress on the course of acne and although it was not exactly known today, it has been possible to verify that there is an underlying molecular mechanism related to the expression on the part of sebaceous gland cells of receptors for multiple neuroendocrine mediators, thereby affecting the clinical course of acne.

— Exogenous and endogenous behaviors that promote it?

— The consumption of some medications, exposure to chlorinated compounds, excessive sweating, hormonal changes associated with puberty, pregnancy and menstruation have also been implicated in the appearance of acne. Of course, there is no acne without pimples

— Does acne lead to other diseases?

— It causes serious implications for physical, psychological and social health, and undoubtedly affects the quality of life. It can last many years, it generates persistent scars and causes adverse effects on the psychological development of the adolescent who suffers from it. Young people are victims of prejudice, stigma and myths from family and friends.

"To all this is added doubt, misinformation and incorrect practices related to its etiology, its progression and treatment, as well as the high percentage of people who take medication at their own risk and the low interest in their physical and psychological management due to part of those who suffer from it.

"Juvenile acne is a visible disease, so psychological morbidity can be significant, especially since in adolescence the image and self-perception can determine behavior and social interactions. In these patients, behavioral changes can be observed, low self-esteem, altered body image to which is added the negative impact at a social level, the inhibition of contacts with professionals and colleagues and in love relationships, they avoid participation in sports and recreational activities and shame affects the emotional sphere, lead the patient to school refusal, not to attend school, social isolation, depression, anxiety, frustration and even suicidal ideas".

— What are the most affected body sites?

— The face and to a lesser extent the back, shoulders and trunk.

— Does acne have any classification?

— This is a controversial issue, but currently it is preferred to classify it according to its severity into non-inflammatory acne, inflammatory and mixed forms.

"Non-inflammatory includes those forms in which only blackheads are observed (open (blackhead) or closed (whitehead) skin pore, or hair follicle filled with oil, dead skin cells, and bacteria), as clarified open and closed, while inflammatory acne is made up of papules, pustules and nodules.

"The mixed forms combine the presence of blackheads and papulopustular lesions.

Each of these forms is subdivided into mild, moderate, or severe depending on the number and type of lesions that occur, and special forms of acne are left out of this classification.

"According to its severity, acne in its mild form represents blackheads, as well as papules and pustules that are small or scarce in a number less than 10. In moderate acne, a greater number of papules and pustules is observed, and also blackheads in number between 10 to 40 lesions, there may be a mild extension to the trunk Moderate to severe acne is characterized by numerous papules and pustules, and blackheads between 40 to 100 and sometimes large and deep nodules, the lesions usually affect the face, chest and back as for severe acne, which is also called nodulo-cystic acne, the lesions are large, painful and pustular, associated with innumerable papules and blackheads.

"The black color of open blackheads is related to the compact arrangement of keratinocytes that form a dark keratin plug due to melanin deposited there."

— Does it leave sequelae?

— The main sequelae of both inflammatory and non-inflammatory acne lie in the scars that can appear punctate, wavy, depressed with vertical or hypertrophic edges.

— What would be the behavior to follow with these people?

— It is very important to provide them with psychological support, through a good doctor-patient relationship. Explain to them the nature of the disease, its evolution and that, in addition, it is self-limiting since it generally does not persist after 29 years of age, only in some cases it can extend to 30 or 40 years. The treatments are long, so the results will only be observed in the long term.

— What would you advise those affected?

— The first thing is to go to the dermatologist in their health area, since the treatments are individualized and avoid self-medication. In general, they should avoid the use of harsh alkaline soaps as well as excessive cleaning, rest and regular sleep, moderate exposure to sunlight, careful use of cosmetics, and not traumatizing injuries are recommended, in addition, although nutritional factors have not been demonstrated, keep in mind that some patients present exacerbation with the intake of chocolate and other fatty foods, which can be eliminated if the affected person identifies them as a cause of worsening acne. A balanced diet rich in fruits and vegetables should be taken.

Translated by Linet Acuña Quilez