Treatment of acne vulgaris: a literature review / Lečenje običnih akni (acne vulgaris) – pregled literature

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Abstract

Acne vulgaris is a common skin disease, which affects individuals of all races and ages. In Caucasians, almost 85% of individuals between 12 and 25 years, as well as 25% of adults, are affected with some forms of acne. The pathophysiology of acne is multifactorial, and thus, the treatment must cover all the possible causes of acne. For this reason, acne therapy is mostly a combination therapy, with the main goal to achieve clinical improvement, without scarring and residuals, as much as possible. The treatment should be planned individually, depending on the clinical appearance, severity and psychological profile of the patient. The treatment usually takes time and requires dedication and patience of both the patient and the physician.

Sažetak

Definicija: Obične akne (lat. acne vulgaris) predstavljaju hronično inflamatorno oboljenje pilosebacealne jedinice, koje se učestalo javlja u doba puberteta. Epidemiologija: Smatra se da oko 85-100% adolescenata i mlađih odraslih u uzrastu 12-24 godine, boluje od ovog oboljenja godinama (bar povremeno). U grupi adolescenata, učestalost i težina kliničke slike, kao i sklonost ožiljavanju je veća kod muškaraca, dok je sklonost ka perzistiranju promena i nakon puberteta više izražena kod osoba ženskog pola.

Patofiziologija: U nastajanju akni učestvuje više faktora. Rane karakteristike oboljenja, kao što su seboreja i formiranje komedona, posledica su androgene sekrecije adrenalnog porekla. Sa postepenim razvojem gonadalne aktivnosti, androgeni poreklom iz testita i ovarijuma, dovode, na nivou genetski predisponiranih folikula, do više izražene seboreje i komedogeneze. Drugi faktori koji su odgovorni za formiranje komedona su iritantni efekat lipidnih sastojaka sebuma, aktivnost lokalnih citokina, naročito interleukin 1- alfa i kolonizacija mikroorganizmima, naročito Propionibacterium acnes.

Kliničke varijante: Prvi klinički znaci oboljenja su seboreja i komedoni (otvoreni i zatvoreni). Tokom sledećih nekoliko meseci, javljaju se upalne promene, koje se sastoje od papula i površno lokalizovanih pustula, veličine do 5 mm. Mogu da se jave i dublje lokalizovane upalne promene, kao što su nodulusi, pustule veće od 5 mm i pseudociste. Posledica upalnih promena je stvaranje ožiljaka, koje može biti udruženo sa gubitkom kolagena, u vidu atrofičnih makularnih i „icepick” ožiljaka, ili se, zbog izražene fibrozne reakcije ispoljava u vidu hipertrofičnih ožiljaka.

Terapijski principi: S obzirom na multifaktorsku patofiziologiju akni, lečenje se mora usmeriti protiv, što je moguće više činilaca koji učestvuju u njihovom nastajanju i prilagoditi kliničkoj slici.

Cilj terapije podrazumeva uglavnom kombinovanu terapiju, a najvažnije je postizanje kliničkog poboljšanja, sa što je manje moguće izraženim ožiljavanjem i reziduama.

Neupalne akne: Koriste se topikalni lekovi koji deluju antiseboroično, npr. spironolakton i antikomedogeno, npr. retinoidi i azelaična kiselina.

Upalne akne: Za lečenje blažih i srednje teških oblika upalnih akni, potrebno je primeniti benzoil-peroksid, klindamicin, azelaičnu kiselinu. Za srednje teške upalne oblike, koji zahvataju veće površine kože, lečenje se sprovodi sistemskom primenom antibiotika, najčešće tetraciklina, eritromicina i azitromicina. Nodulo-cistične akne, kao i srednje teški oblici koji ne daju zadovoljavajući odgovor na primenjenu konvencionalnu lokalnu i sistemsku terapiju, akne sa izraženim ožiljavanjem, kao i pacijenti sa psihološkim problemima, predstavljaju indikaciju za sistemsku primenu isotretinoina.

Zaključak: Lečenje se planira individualno, u odnosu na kliničku sliku i težinu oboljenja, kao i psihološki profil obolelog. Lečenje je dugotrajno i zahteva obostranu predanost i istrajnost i obolelih i lekara.

Keywords:
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