Hardware methods for treating problem skin

Olga Pavlova, dermatocosmetologist, teacher at the training center of the SportMedImport Group of Companies (Russia, St. Petersburg).

Acne (acne vulgaris) is a chronic recurrent skin disease, mainly of young people, which is the result of overproduction of sebum and blockage of hyperplastic sebaceous glands with subsequent inflammation.

Currently, four main mechanisms for the formation of this disease have been established:

• hyperproduction of secretions by the sebaceous glands;
• follicular hyperkeratosis;
• activity of bacteria (Propionibacterium acnes);
• inflammation.

Hyperproduction of sebaceous secretions

The activity of the sebaceous glands is regulated mainly by hormonal mechanisms, therefore endocrine disorders (organic or functional) are a common cause of acne development. During puberty, with the formation of individual hormonal status, increased oiliness of the skin often appears. Acne affects up to 80% of teenagers and young adults, and only by the age of 24 this figure drops to 10%. It is known that acne can occur after puberty - against the background of various diseases of the sexual sphere: menstrual disorders, polycystic ovary syndrome, ovarian cancer, etc. A change in the normal ratio between androgens and estrogens also leads to the appearance of seborrhea. In such patients, hyperandrogenemia in combination with hypoestrogenemia is most often detected. In men, hyperandrogenemia occurs due to endocrine dysfunctions, androgen-producing tumors, etc. Hyperproduction of sebum can also occur during long-term use of glucocorticoids, progesterone, and anabolic hormones.

Follicular hyperkeratosis

With a long course of seborrhea, compensatory hyperkeratosis of the mouths of the hair follicles gradually develops. There is a disruption of the normal processes of keratinization; increased keratinization in the upper part of the follicle funnel leads to the accumulation of sebaceous gland secretions in the lower part of the funnel due to narrowing of the narrow part and disruption of the outflow of sebum from the follicle. Histologically, in the early stages, you can see small sebaceous plugs - microcomedones, which do not manifest themselves clinically. However, further accumulation of secretion and its pressure on the wall of the follicle leads to the formation of a cystic cavity and the appearance of clinical signs of the disease in the form of closed comedones. An increase in the amount of sebum in the follicle leads to its squeezing out of the duct of the hair follicle. This is how open comedones (blackheads) are formed, which can remain on the skin for a long time.

Propionibacterium acnes

It is known that various saprophytic microorganisms are present on the surface of the skin.

The most important role in the pathogenesis of acne development is played by Propionibacterium acnes, which are not the direct cause of the disease, but at the same time contribute to the development of local inflammatory processes.

Propionibacterium acnes are facultative anaerobes, so the accumulation of sebum inside the follicle leads to the colonization of these microorganisms. The vital activity of these bacteria is accompanied by metabolic processes with the release of proteolytic enzymes, which have a damaging effect on the epithelium of the follicle. In addition, Propionibacterium acnes secrete lipases that break down sebum triglycerides into free fatty acids, which also irritate the wall of the hair follicle and lead to the development of an inflammatory reaction.

Inflammation

Damage to the epithelium by bacterial enzymes causes inflammation around the sebaceous glands. At an early stage, migration of lymphocytes to the site of inflammation occurs, later they are joined by lymphocytes, neutrophils and macrophages. Due to the inflammatory reaction, free radicals, hydroxyl groups, and superoxides of hydrogen peroxide accumulate in the dermis. These substances further damage cells and support inflammation. In addition, the contents of the pilosebaceous follicle, due to impaired permeability of the epithelium, penetrate into the dermis and there also causes an inflammatory reaction.

Therefore, it should be emphasized that inflammation can occur in different layers of the skin, causing a variety of clinical manifestations .

A set of local procedures

Acne is a problem consisting of many pathogenetic links that are inextricably linked, which means that treatment of acne should be comprehensive, including diet, drug therapy (external and internal), home skin care, as well as the use of traditional and hardware cosmetology products.

Hardware physiotherapy currently has a whole arsenal of methods that can significantly improve treatment results and promote sustainable remission of the disease. The choice of treatment for acne should be based on an adequate clinical assessment of the severity, as well as the type of skin rash. When prescribing physiotherapeutic procedures, you should clearly understand the objectives of treatment, based on knowledge of the pathogenesis of the disease.

Thus, a set of local procedures for treating acne should look like this:

• correction of hyperproduction of sebum;
• fight against hyperkeratosis;
• correction of pathogenic flora;
• treatment of inflammation;
• reduction of post-acne manifestations.

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Correction of hyperproduction of sebum

Along with drug therapy and methods of therapeutic cosmetology, hardware techniques allow normalization of sebum production, which include:

• ultrasonic peeling;
• phonophoresis, iontophoresis;
• microcurrent therapy;
• biooxytherapy in combination with medicinal cosmetics.

Ultrasonic peeling – cleansing facial skin using ultrasound. Under the influence of a high-intensity ultrasonic wave, the contact medium applied to the skin “boils,” which causes the rupture of intermolecular bonds, the destruction of desmosomes of keratinocytes and their exfoliation. In addition, ultrasound increases the permeability of cell membranes, improves metabolic processes, and stimulates the processes of reepithelialization of the epidermis.

The main advantage of ultrasonic peeling is minimal trauma and lack of skin irritation after the procedure, as well as obtaining an almost instant result. The procedure is painless, does not require a rehabilitation period and can be recommended to patients of any age. The procedure can be performed on both the face and body. To achieve a positive result, it is necessary to carry out at least 6 procedures; to consolidate the result, it is recommended to complete the full course, which includes 12-15 procedures 2-3 times a week. As a rule, ultrasound therapy can achieve long-term effects; the course of procedures must be repeated after 5–6 months.

Phonophoresis . This is a method in which the effect of ultrasound on tissue is combined with the introduction of active substances (medicines and cosmetics) into the deep layers of the skin. Under the influence of ultrasound, the permeability of the epidermis, cell membranes and vessel walls increases - for substances with a small molecular weight.

Advantages of phonophoresis:

• when administered by ultrasound, the active substance is not destroyed;
• synergism between the action of ultrasound and the active substance is ensured;
• With the help of ultrasonic phonophoresis, medicinal and cosmetic preparations are painlessly introduced into the deep layers of the skin, while micromassage, warming and saturation of tissues with oxygen occur.

To correct the hyperproduction of sebum, sulfur-containing drugs, which have a pronounced sebum-regulating and anti-inflammatory effect, are most often used.

Iontophoresis is a combined effect on the body of a direct electric current and an ionized medicinal substance administered through it. Drugs in solution dissociate predominantly into ions and charged hydrophilic complexes. When such solutions are placed in an electric field, the ions contained in them move towards opposite poles, penetrate deep into the tissues and exert their pronounced therapeutic effect.

To treat seborrhea using iontophoresis, preparations of sulfur, zinc, B vitamins, etc. are administered.

Microcurrent therapy is one of the electrotherapeutic methods of influencing the human body, which uses a weak pulsed electric current in the range from 10 to 600 μA with a frequency of 0.1–300 Hz.

It is known that any pathological process (photoaging, damage, inflammation, etc.) is accompanied by a change in the membrane potential of cells in the damaged area, the integrity of the membrane charge and the phase nature of its operation are disrupted. A small current is able to penetrate the pathological focus, restoring the polarization of the cell membrane and the correct ratio of the “resting potential” / “action potential” phases and thus normalizing the functioning of cells.

By restoring the functional activity of tissue at the cellular level, microcurrent therapy simultaneously acts on the epidermis, dermis, subcutaneous fatty tissue, facial muscles and blood vessels.

Microcurrent therapy has a wide range of applications in dermatocosmetology. In addition to anti-aging procedures, this technique is undoubtedly used for hardware treatment of acne. Using certain modes of the microcurrent therapy device, the cosmetologist has the opportunity to work with positive and negative electrodes, carry out iontophoresis, disincrustation, and introduce bipolarly charged therapeutic agents. It is also possible to influence individual inflammatory elements, accelerating their resolution and reducing post-inflammatory manifestations.

Microcurrent therapy procedures are carried out in courses of 6–10 procedures, 2–3 times a week. 2-3 courses per year are recommended, with monthly maintenance procedures.

Biooxytherapy , or oxygen therapy, is also known as “oxygen mesotherapy” and “mesotherapy without needles”. The effect of this procedure is based on the fact that epidermal cells receive oxygen not from the blood, like all other organs, but directly from the air. As is known, the rate of gas penetration through cell membranes is proportional to its concentration. Air contains about 20% oxygen. If you increase the oxygen concentration and its pressure, the rate of oxygen exchange in the epidermal cells will also increase. This gives many positive results, but the main thing is that it accelerates the penetration of active cosmetic preparations and the removal of cellular metabolic products.

As is known, Propionibacterium acnes is a facultative anaerobe, so an increase in oxygen concentration in the skin will have a detrimental effect on the growth of its population. Thus, oxygen therapy has found its application in the correction of problem skin. The combination of highly concentrated oxygen with medicinal cosmetics provides a significant improvement in the course of this disease, manifested in a decrease in the number of inflammatory elements, resorption of post-inflammatory manifestations, and improvement in complexion.

Fighting hyperkeratosis

Techniques to combat hyperkeratosis by thinning the stratum corneum and evening out skin texture and color include:

• peelings (mechanical, chemical, physical);
• disincrustation (microcurrent, classical).

Brossage (mechanical peeling) is the mechanical exfoliation of the surface layers of the skin using rotating attachments. Such attachments mechanically remove the stratum corneum of the epidermis, open pores, and activate microcirculation. As a result, the skin becomes smooth, even, prepared for better penetration of active cosmetics.

Disincrustation - the use of direct electric current in combination with an alkaline solution. This procedure uses a negatively charged electrode (cathode), which interacts with a negatively ionized disincrustant solution, which promotes saponification of sebum both on the surface of the skin and in its deeper layers, and also leads to the opening of pores, loosening of the stratum corneum, and increased intensity of blood supply and cellular metabolism. As a rule, disincrustation is a stage of mechanical, ultrasonic or combined facial cleansing. There are four stages of facial cleansing:

1. Working with a negative galvanic current electrode: softening fat plugs, opening pores, saponifying comedones at a depth of about 0.5 mm, degreasing, alkalizing the skin.
2. Cleansing the skin of saponification products (with water or tonic). Extraction of comedones using mechanical or ultrasonic methods.
3. Application of treatment concentrate, serum and mask.
4. Working with a positive electrode of galvanic current: closing pores, restoring acid-base balance, normalizing microcirculation.

Normalization of saprophytic flora

Hardware techniques that affect pathogenic flora include:

• phototherapy, light-heat therapy;
• ultraviolet irradiation;
• laser therapy (Nd:YAG laser);
• biooxytherapy;
• Darsonvalization.

Broadband pulsed light. To date, there is no method that can claim universality. Physiotherapeutic methods, considered auxiliary in clinical medicine, have become one of the main ones in aesthetic medicine. One of the most effective modern technologies is LHE, developed and patented by Radiancy.

LHE technology uses a specially selected composition of inert gases in the emitter lamp, which makes it possible to create a light range from green to infrared (from 600 to 900 nm). In this case, the yellow and green parts of the spectrum penetrate to the depth of the sebaceous gland and are absorbed by the chromophore porphyrin. During this chemical reaction, atomic oxygen is released, causing peroxidation of the bacterial walls. Radiation from the infrared region of the spectrum has an anti-inflammatory effect, and also helps to open pores, improve microcirculation, and activate phagocytosis.

The course of therapy is 4–8 weeks. As usual, patients receive 2 sessions per week with an average duration of 20–30 minutes. The procedures are very well tolerated by patients and practically do not interrupt them from their daily activities, which, combined with the effectiveness of the method, significantly improves their quality of life.

No side effects were recorded in practice at all. Immediately after the procedure, the development of mild transient erythema is observed. Rarely, after the first 2-3 procedures, an exacerbation reaction is possible, associated with massive destruction of bacteria and acceleration of the evolution of morphological elements. Subjective sensations are practically absent or limited to a mild burning sensation in the area of the rash, which passes very quickly.

Clinical improvement in the course of the disease is observed in 40–50% of patients already in the second or third procedure, and resolution of most papulopustular elements is recorded mainly by 3–4 weeks of treatment. The effectiveness of the course of therapy is estimated to be up to 90%.

LHE therapy for acne does not exclude the use of combination treatment and the use of external agents.

Thus, the LHE therapy method is modern, safe and highly effective, which allows us to recommend its widespread use for the treatment of acne.

Laser therapy. Currently, there are different types of lasers used to treat acne. These lasers differ both in output characteristics and in the interaction of their radiation with tissue.

One of the principles contributing to the success of acne treatment can be considered the effect on pathologically altered blood vessels, which can radically influence the morphofunctional state of microcirculation in inflamed areas of the skin and promotes the absorption of transmitted laser energy by the protein structures of the shell of microorganisms.

The neodymium laser is the most deeply penetrating laser: with a spot diameter of 8 mm, penetration into tissue is 6 mm. The laser beam is proportionally absorbed by five chromophores: deoxyhemoglobin, oxyhemoglobin, protein, water (15% absorption) and melanin (10% absorption).

The methodology for acne treatment procedures using the Nd:YAG laser is based on the use of the phenomenon of homogeneous photothermolysis at a depth of up to 4 mm. Treatment of acne lesions using an Nd:YAG laser is pathogenetic, due to the direct sterilization of inflammation, normalization of microcirculation by coagulation of blood vessels in the area of inflammation and stimulation of trophic processes by enhancing revascularization.

The procedure is performed on an outpatient basis, without the use of anesthetics, using the recommended parameters:

Due to the pathogenetic nature of the technique, laser procedures are carried out daily for 3 days at the limit of the patient’s individual tolerance, since the larger the size of the uniform element, the more energy will be required to warm it up and sterilize it. The effectiveness of treatment is assessed the next day by reducing the severity of signs of inflammation.

After regression of the formed elements, the procedures are stopped. For severe forms of acne, a repeat course of 3 procedures is performed every 3–5 days.

Anti-inflammatory therapy

Undoubtedly, internal and external drug therapy is of paramount importance in the fight against inflammation, but hardware techniques can also gently and delicately relieve the negative manifestations of the inflammatory process, significantly improving the appearance of patients. Such techniques include:

• phototherapy, light-heat therapy;
• laser therapy (Nd:YAG laser);
• microcurrent therapy, phoresis, lymphatic drainage;
• biooxytherapy in combination with medicinal cosmetics;
• Darsonvalization.

Darsonvalization is exposure to pulsed alternating currents of high frequency and high voltage, but of low strength. This method of electrotherapy is named after the French physiologist d'Arsonval, who first studied this phenomenon and proposed using it in medical practice. D'Arsonval currents mainly affect peripheral nerve endings and the central nervous system, increasing skin tone and enhancing lymph and blood circulation. Based on this, darsonvalization is widely used in the treatment of various cosmetic skin defects. Darsonvalization is carried out to improve the functional state of the skin, increase its elasticity, trophism, and also causes inhibition of the activity of the sweat and sebaceous glands, which is manifested by a decrease in secretion and a decrease in the release of sweat and sebum.

Other techniques, one of the effects of which is an anti-inflammatory effect, were described above.

In conclusion, I would like to note that at present, not everything is completely clear in the etiology and pathogenesis of acne, and no one can guarantee a relapse after the most successful treatment. However, knowledge of modern means of dermatology, classical and hardware cosmetology, acne treatment and post-acne correction, their adequate selection allows you to keep the disease under control, prevent the appearance of persistent skin defects and provide the patient with a presentable appearance. Of course, treating problem skin is by no means an easy task, but the joy of knowing that you can bring real benefits to the patient is worth the effort.

This article is part of the special project HARDWARE MEDICINE

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SPECIAL PROJECT. HARDWARE MEDICINE

First published: KOSMETIK international journal, No. 4 (46), 2011, pp. 80-84