From Big Medical Encyclopedia

UGRY (acne) — an inflammation of sebaceous glands.

Depending on origins and features the wedge, pictures distinguish the following kinds of eels: ordinary

(acne vulgaris), keloid (acne keloidea), red (acne rosacea), necrotic (acne necrotica), medicamentous (acne medicamentosa) and professional (acne professional).

Ordinary eels (a synonym youthful eels) various expressiveness develop at young men and girls during puberty and gradually disappear by 25 — 30 years. A background for their emergence is seborrhea (see) with disturbances, characteristic of it: a hyper

plaziya of sebaceous glands, hypersecretion of skin fat and the change of its structure, a hyperkeratosis (see) leading to formation of comedones — grease and horn traffic jams in channels of sebaceous glands with partial or their full obturation. Direct activators of inflammatory process in sebaceous glands are microorganisms of Staphylococcus epidermidis and especially an anaerobe of Corynebacterium acnes (Propi-onibacterium acnes); patol. components of skin fat can also be the cause of an inflammation. An essential role in a pathogeny ordinary At. it is allocated for reactivity of skin, anatomic and functional features of sebaceous glands (see), to endocrine frustration, insufficiency of immune mechanisms.

Ordinary At. are, as a rule, localized on face skin, an upper back and a breast where the largest sebaceous glands are located. The separate element of acne rash represents an inflammatory small knot of bright pink color, semi-spherical or conical shape, up to 5 mm in the diameter (a papular eel). Quite often in the center U. in the mouth of a hair follicle or an output channel of a sebaceous gland the black point — a comedone (a dot eel) is located. At the expressed inflammation at top of a small knot the pustule (a pustular eel) is formed, edges it is opened or dries up with formation of a purulent crust (fig. 1). Pustular At. usually multiple. On site pustular At. during the healing there can be a dot scar. The disease proceeds in the form of flashes. Nek-ry patients have large deep dense painful knotty infiltrates of cyanotic-pink color (the condensed eels), to-rye slowly resolve, sometimes are exposed keloid a transform -

Fig. 1. Acne on face skin of the patient: 1 —

in the form of inflammatory small knots of conical shape (papular eels), 2 — in the form of the pustules covered with a purulent crust (pustular eels).

days (a keloid eel) or abscess (the abscessing eels), leaving the rough disfiguring hems. On skin of a forehead, cheeks, a chin there can be large painful sharply proceeding and inclined to suppuration flattened infiltrates — phlegmonous eels (fig. 2), to-rye sometimes merge (the merging eels). The most severe form ordinary At. the spherical (konglobatny) eels for the first time described in 1902 by Shpittserom and Lang (Spitzer, Lang) under the name «dermatitis follicula-ris et perifollicularis conglobata» are. They


of Fig. 2. Acne on face skin of the patient: pustular rashes of various depth and phlegmonous eels (are specified by shooters).

are observed generally at young men. Against the background of rough grease and porous skin with a large number of large and quite often double comedones and retentsionny cysts of sebaceous glands, or atheromas (see. An epidermoid cyst), on spin, less often on a face there are large spherical dermo-hypodermal infiltrates, to-rye gradually suppurate and form hypodermic abscesses. Separate nodes can merge in massive conglomerates, in to-rykh purulent cavities connect with each other and to surface layers of skin the numerous fistular courses. Cavities of abscesses and the fistular courses are filled with purulent granulations, the plentiful discharge has serous and purulent or gnoynokrovyanisty character. Inflammatory process, becoming aggravated, calming down, in some cases proceeds many years and leads to formation of the rough hems reminding hems at a scrofuloderma (see Tuberculosis extra pulmonary).

At gistol. a research ordinary At. around giperplaziro-bathing sebaceous glands and the related hair follicles inflammatory infiltrate, in Krom is found at papular, pustular and phlegmonous versions At. neutrophilic leukocytes and lymphocytes prevail, and at condensed and konglobatny At. — histiocytes, plasmatic and colossal cells, and also perifocal fibrosis. In expanded mouths of hair follicles and output channels of sebaceous glands the hyperkeratosis and comedones are noted.

Treatment ordinary At. it is directed first of all to elimination of seborrhea (see). At widespread and hard proceeding At. appoint antibiotics, an autohemotherapy (see), antistafilokok-kovy gamma-globulin, vitamin A on 100 thousand ME a day during 1V2 — 2 of month. In nek-ry cases apply estrogen (folliculin, diethylstulbestrole) and anti-androgens. Appoint local disinfecting therapy — rubdowns of 2 — 3% spirit solution boric or salicylic to - you. the shaken-up suspensions with sulfur, Ichthyolum, lotions and ointments with erythromycin or tetracycline. Widely use heliation (see), UF-radiation (see. Ultraviolet radiation), cryotherapy (see the Cryosurgery), applications by liquid nitrogen, diathermocoagulation (see) elements of rash. Comedones delete in the mechanical way, abscessing At. and atheromas open.

Keloidny eels (synonym: a sclerosing folliculitis of a nape of Ermann, papillary dermatitis of the head of Kaposha) — rare hron.

the disease which is observed at men at mature age. At it from fresh inflammatory elements allocate golden staphylococcus. Seborrhea and a bacterial sensitization contributes to a disease (see). Are localized by Keloidnye U., as a rule, on a nape in the fringe region of growth of hair. Gradually the small and dense, often merging follicular inflammatory small knots located parallel strips begin to arise. Small knots can suppurate, but are more often transformed to sosochkovidny keloid cicatrixes (see the Keloid).

At gistol. a research the purulent inflammation of hair follicles with the perifollikulyar-ny infiltrate consisting of lymphoid, plasmatic and colossal cells and also perifocal fibrosis is noted.

Treatment is carried out by antibiotics, lidazy; use an immunotherapy (an autohemotherapy, a staphylococcal vaccine, etc.), diathermocoagulation of separate elements; in some cases recommend a roentgenotherapy (see). Outwardly appoint desinfectants in the form of spirit solutions, suspensions and ointments.

Red eels affect face skin, is more often at women at the age of 30 years and are more senior. The disease develops against the background of neurovegetative and vascular lability, and also went. - kish. and endocrine frustration. The possible reason of development of inflammatory process consider golden and white staphylococcus or an iron woundwort acne, parasitizing in hair follicles and sebaceous glands.

Of a disease it is characteristic hron. current; aggravations are observed at emotional pressure» disturbance of a diet, overheating and a kereokhlazhdeniya, solar radiations, at non-compliance with rules of personal hygiene. For a wedge, pictures the congestive dermahemia of a forehead, cheeks and a chin, inflammatory bright pink or cyanotic-red papulopustules up to 5 — 7 mm, gradual development on these sites of teleangiectasias are characteristic (see). Sebaceous secretion on affected areas is increased. The keratitis can accompany a disease (see). The differential drtgnostika is carried out with a rozatseopo-dobny tuberculosis cutis (see Tuberculosis extra pulmonary) and the perioral dermatitis which is localized around a mouth and characterized by polymorphic rash, a diffusion erythema and a moderate itch.

At gistol. a research reveal sharp expansion of blood vessels in upper parts of a derma, around hair follicles and sebaceous glands, formation of the infiltrate consisting of limfoid-but-histiocytic elements and neutrophils, sometimes with colossal cells and also abscessing and perifocal fibrosis.

At red At. appoint tetracycline on 0,2 — 0,3 g 4 times a day, metronidazole on 0,25 g 2 times a day (during 4 weeks). Are recommended also nicotinic to - that on 0,05 g 3 times a day, drugs of a quinolinic row (delagil) on 0,25 g 2 times a day. Outwardly apply the shaken-up suspensions with Ichthyolum or sulfur, 5 — 10% of Shintoism-mitsinovuyu an emulsion, geliomitsino-vy or erythromycin ointments, rubdowns by the sterilized vegetable oil. Treatment by the G1 method M. is possible. Demyanovich: consecutive rubbing in in the centers of defeat of 60% of solution of sodium thiosulphate and 6% of solution salt to - you. On expanded vessels and separate papulopustules diathermocoagulation is recommended. Apply cryo-massage (see the Cryosurgery). The diet with an exception of sweet and hot dishes, alcohol is recommended.

Necrotic eels { a synonym eels ospennovidny) — the rare disease which is observed at women and men of mature age. The reasons it are not established; communication with a staphylococcal infection is supposed (see) and disbolism. Wedge. the picture is characterized by a rash of pink or purple-red perifol-likulyarny small knots, in the center to-rykh the center of a necrosis, similar to a pustule, which is gradually drying up in a bloody-black crust is formed. After falling away of a crust there is a profound ospennopodobny hem. Small knots are localized usually on skin of a forehead (on border of growth of hair), in temporal departments. The disease is chronic, proceeds in the form of flashes.

At gistol. a research the necrosis of epidermis and a derma in the field of mouths of hair follicles, formation of the perifocal infiltrates consisting of neutrophils and mast cells, and also fibrinferments of separate vessels is noted.

Treatment is carried out by antibiotics, apply the stimulating therapy (see), outwardly appoint rubdowns spirit solutions of desinfectants, greasings sulfur-tannin or Unguentum Erytgromycyni.

Medicine z N y e at-r and — the ugrepodobny rashes arising at use of a number of pharmaceuticals as inflammatory reaction of grease and hair complexes on direct or the mediated damaging effect of medicines. The most often medicamentous At. arise at use of drugs of bromine and iodine (see Bromoderlsh, Yododerma). Ugrepodobny rashes of nodular character with an insignificant inflammatory component and without tendency to pustulation can arise also at prolonged treatment by glucocorticoid drugs, napr, dexamethazone (see), corticotropin (see Adrenocorticotropic hormone), is more rare hydrazides isonicotinic to - you, napr, Tubazidum (see the Isoniazid), rat anti-acrodynia factors and B12, difenilgidantony, barbiturates (see), tetracycline (see), corticosteroid ointments (see Corticosteroids) and ointments on the basis of vaseline. At medicamentous At. the comedones which are localized preferential on face skin and trunks or on site uses of ointment are possible.


Carry out local disinfecting therapy as at ordinary At.

Professional eels result from long action on skin of products of processing of black coal, oil and slates (oils, combustible substances, asphalt, tar, chlorinated hydrocarbons, etc.) that leads to proliferation of epidermis, formation of comedones, obturation of sebaceous glands, and then as a result of infection — to development of inflammatory process. Skin of the most contaminated sites (forearms, trunks, are more rare — persons) dry, dirty-gray color; numerous follicular traffic jams and ugrepodobny small knots are characteristic, impetigo is frequent in combination with furuncles (see), folliculites (see), (see).

Treatment carry out by vitamin A on 100 thousand ME a day, ascorbic to - that on 0,3 g 3 times a day; outwardly appoint ointments with keratolytic and desinfectants, heat baths.

Treatment of all versions At. it is carried out as in usual policlinics by doctors-dermato logs,

and specialists in beauty shops and clinics.

The forecast at all versions At. favorable.

Prevention includes timely treatment of seborrhea, diseases went. - kish. path, endocrine frustration; observance of rules of personal hygiene. At medicamentous At. cancellation of drugs of iodine, bromine, etc. is recommended. Prevention professional At. the dignity consists in prevention or reduction of pollution of skin by observance of rules of personal hygiene and carrying out production. - a gigabyte. and dignity. - tekhn. the actions provided by special instructions of M3 With, SSR.

Bibliography: Yu. F. Seborey's queens and eels, Minsk, 1972, bibliogr.; The multivolume management on dermato-venereology, under the editorship of S. T. Pavlov, t. 3, page 524, M., 1964; B. A. Som and D about l of about in A. P. Occupational diseases of skin in the leading industries of the national economy, page 119, M., 1976; Pie wig G. and.

To 1 i g m a n A. M. Acne, Pathogenes\Morphologie, Therapie, B. u. a., 1978.

Yu. F. Korolev.