Acne - prevention and care published in Kosmetik International 2003 (5), 27-31 Acne is one of the most frequent skin problems beauty institutes are confronted with. Acne customers and above all the younger generation among them often go through a personal ordeal and generally have high expectations of a cosmetic treatment. cne is a disease of the sebaceous follicles be congested or completely blocked. The (the Latin word folliculus means tube) which sebaceous follicles widen and fill with a mixture of A lead into the hair canal (Fig. 1). Sebum sebum and horny cell residues resulting in the which is produced in the sebaceous glands formation of the well-known blackheads or greases skin and hairs, forms a sliding film and whiteheads. Lesions of the sebaceous glands will seals the hair canal against the outside. Just subsequently lead to irritations of the skin. Such around the area where the hair grows to the environment is the perfect living condition for surface the horny layer is more delicate and has a anaerobic bacteria as for example the funnel-like indentation. Thus the sebum released propionibacterium acnes (P. acnes). also transports all the horny layer cells to the surface which have been peeled off. Comedogenic substances Sebum contains among others: Triglycerides (oils) ca. 41% P. acnes produces a series of fatty acids with wax ester ca. 25% comedogenic effects. Additional substances fatty acids ca. 16% causing acne are mineral oils (oil acne), tar (tar squalene ca. 12% acne), chlorinated hydrocarbons (chloracne), diglycerides ca. 2% drugs (acne medicamenta) and cosmetic cholesterol ester ca. 2% substances. Greasing elements take a top cholesterol ca. 1-2% position on the list of cosmetic substances as for example lanolin, cetyl alcohol, saturated fatty acids and their esters which however only react with a simultaneously humid and oily skin. In cases of sensitive skin, ethoxilated alcohols and polyethylene glycols (PEG) play an important part as both are used as emulsifiers and solubilizers. With the influence of ultraviolet rays and atmospheric oxygen they develop peroxides which on their turn will generate aggressive radicals thus causing the so-called Majorca acne. As these substances are widely used the cosmetician is advised to carefully study the INCI declaration. Even today sun protection products still contain these substances. Ethoxilated alcohols can be recognized on the INCI declaration either by their middle or final syllable –eth, as for example ceteareth-10. Acne can also be fostered by tight-fitting clothes as they create a moist and greasy environment. Influence of hormones There are various forms of acne as well as Fig. 1: Sectional view of the skin with horny layer (yellow), various different terms. They frequently depend sebaceous glands (orange) and hair root. on the current hormonal condition and may appear before the menstruation, ovulation or after The flow of sebum is controlled by hormones like pregnancy. According to Gollnick (1993) four testosterone and specifically increases when major factors are responsible for the development reaching puberty. In case the formation of horny of acne: celIs is also increased (hyperkeratosis) the sebum - follicle hyperkeratosis flow around the exits of the sebaceous glands will - sebaceous gland hyperplasia Kosmetik Konzept KOKO GmbH & Co.KG • D-42799 Leichlingen • Moltkestr. 25 • Tel. 02175-990951 • page 1 of 3 Acne - prevention and care page 2 of 3 - microbial hypercolonization Clinical studies show that specific liposomal - inflammation and immune reaction concentrates without any additional active agents Furthermore, the genetic disposition, environmen- reduce the number of comedones by more than tal influences and the mental condition play an 60 % (Fig. 2) and the efflorescences by more than important part. Naturally, the formation of 70 % within a period of 28 days. comedones is specifically increased in areas with Whether the essential linoleic acid taken in with a higher density of sebaceous glands as for nutrition also has positive effects on acne is not instance the face, décolleté area, the back and yet proved as it is differently metabolized in the shoulders. The disease may develop minor or skin. Isolated studies show that the consumption more serious symptoms and the WHO (World of animal fats and chocolate products containing Health Organization) compiled a list with 10 hydrogenated fats have a rather supporting different grades of acne. influence on acne. Extended studies however will Sebaceous gland hyperplasia may even develop not permit any generalization here. It is on the elderly skin with isolated nodules of undisputed though that a calorie reduction for yellowish colour, mostly to be found on the front overweight individuals may also decrease the and cheeks of men with very oily skin. In general production of sebum and androgen which will the frequency of acne cases decreases in the result in a general improvement of the symptoms. thirties with the exception of a certain group of women with a tendency to develop acne in this Dermatological treatment stage of life. Also in these cases a hormonal influence is assumed. According to the developing factors of acne the dermatological treatment applies active agents Linoleic acid and nutrition which above all have - sebum-liquefying Acne vulgaris which is the most common form of - sebum-suppressive acne, of grade 1 or 2 responds pretty well to topic - keratosis-impeding linoleic acid products prescribed by - anti-microbial dermatologists and also used in beauty institutes - anti-phlogistic as preventive measures. Preparations with linoleic - immune-suppressive and acid in combined form which simultaneously have - regenerating effects. a vehicle function are more effective in this Frequently the active agents have simultaneous connection. A very interesting supplier of linoleic effects. The phosphatidylcholine mentioned above acid for skin care purposes are liposomes and which is rich in linoleic acid and can also be used nanoparticles, i.e. cell-like structures which are in cosmetic products has sebum-liquefying, only visible with the help of electron microscopes. keratosis-preventive, lightly sebum-suppressive The base substance of liposomes is and regenerating effects for example. Several phosphatidylcholine (INCI declaration: lecithin). authors even describe an anti-bacterial effect Nanoparticles have an additional and very useful regarding P. acnes. property: They are able to store and transport In dermatological practices especially products sensitive substances as for example vitamin A with vitamin A-acid or other retinoids are applied which also supports acne prevention. for the treatment of hyperkeratosis. Azelaic acid also influences the cornification process while salicylic acid has keratolytic effects. Locally Reduzierung der Anzahl der Komedonen in % Reduzierung der Anzahl der Komedonen in % applied antibiotics like erythromycin or tetracycline nach 14 und 28 Tagen im Vergleich zum 0. Tag for example are used in case of inflammations and also impede the growth of P. acnes. 70 60 Benzoyl peroxide also acts as an anti-bacterial 50 substance. A hormone treatment for women with 40 progesterone causes sebum suppression. It is behandelt 30 unbehandelt recommended to pay attention to the appropriate 20 composition of base creams as well as the 10 cosmetic products used in order to avoid 0 counterproductive effects. Specifically emulsifiers 14 Tage 28 Tage and fatty substances may impede the healing process. More and more DMS bases are applied Fig. 2: Reduction of acne vulgaris comedones [%] due to in dermatological products and individual unilateral application of liposomal phosphatidylcholine after 14 pharmacy preparations as their composition and and 28 days (Source: Nattermann Phospholipid GmbH); structures are similar to the skin (DMS = Derma green: treated, blue: untreated Membrane Structure). A series of pharmaceutical active agents is also applied systemically. Kosmetik Konzept KOKO GmbH & Co.KG • D-42799 Leichlingen • Moltkestr. 25 • Tel. 02175-990951 • page 2 of 3 Acne - prevention and care page 3 of 3 A careful cleansing of acne foci accompanies the Active agent concentrates like D-panthenol, aloe therapeutic treatment. Peelings may be very vera and hyaluronic acid soothe the skin and helpful in this respect as they facilitate an opening reduce the skin reddening which resulted from the of the follicles. A light massage in combination treatment. with a peeling treatment may support the removal In case of major cornifications, milia and scars a of congestions in the sebaceous glands. combination of a DMS base cream with a low fat Only experienced and well-trained personnel content, vitamin A nanoparticles and liposome however should manually squeeze the come- concentrate is recommended. dones by applying light pressure. Optimal hygienic Healing earth can also be used as a base for conditions and a competent cleansing technique masks especially for cases of seborrhoe oleosa. are important preconditions. The individual In contrast to cream bases they will completely be treatment however depends on the specific acne removed after about 20 minutes. In case of any symptoms. A close cooperation between derma- inflammations diagnosed however the mask never tologist and cosmetician generally is indis- should begin to dry. In this connection the mask is pensable in order to achieve best results. to be covered with moist compresses. Only physicians should be trusted with the For