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The purpose of the article is to show the importance of the role of a cosmetologist and share successful experience in managing a patient with acne in a beauty salon, relieving the main symptoms of the disease using cosmeceutical products from the company DMK (Danne Montague-King).<hr /> Alina Askevich, pharmacist-cosmetologist, leading specialist in the Southern region of DMK Ukraine Anna Nosonova, dermatovenereologist, cosmetologist, assistant at the department of dermatovenereology and cosmetology with a course of dermatovenereology and aesthetic medicine of the Faculty of Professional Education of ZSMU<hr /> Despite the need for an integrated approach in the treatment of acne, patients with this problem most often turn to cosmetology clinics for the purpose of aesthetic correction of skin imperfections. At this stage, it is important how the cosmetologist behaves: whether he will demonstrate his competence or carry out a one-time “cleaning” procedure. The cosmetologist’s management tactics for such a patient must necessarily include consultation with related specialists to find and eliminate the cause of the disease. A diagnostic examination of patients suffering from ulcerative disease includes an analysis of the disease history, identifying hereditary predisposition, duration of the disease, factors influencing the course of the disease: stress, pregnancy, menstrual cycle, seasonal exacerbation, the nature and effectiveness of previous treatment. But this absolutely does not mean that the cosmetologist should let the patient go for this period. On the contrary, a large number of professional formulas of modern cosmeceuticals expands the specialist’s capabilities in treating and improving the condition of a patient’s skin with acne and prevents the appearance of post-acne (scars, post-inflammatory hyperpigmentation). Materials and methods Under observation was patient A., 17 years old, diagnosed with moderate acne, complicated by malaseziosis of the skin, who sought help due to the presence of papulopustular elements, closed and open comedones. When collecting an anamnesis, it was found out that elements of PD first began to appear in her at the age of 12 years (puberty). The patient also complained of seborrhea of the scalp, hirsutism, and increased sweating. Based on this, a consultation with related specialists (dermatologist, gynecologist-endocrinologist, gastroenterologist) was scheduled. Cosmetological correction included procedures with DMK preparations once every 7 days. To maintain and consolidate the results of professional cosmetic procedures, comprehensive home care is prescribed. During the treatment process, a mandatory photo report was carried out, which is very important in the management of such patients, in order to assess the dynamics of treatment and analyze the further choice of procedures. Results and their rationale In the pathogenesis of acne, four factors play a leading role. The initial link is hereditarily caused hyperandrogenism (HA). Hyperandrogenism can manifest itself as an absolute increase in the amount of hormones (absolute GA) or as an increased sensitivity of receptors to a normal or reduced amount of androgens in the body (relative GA). The main causes of relative hyperandrogenism are increased activity of the enzyme 5-alpha-reductase type I, increased density of nuclear dihydrotestosterone (DHT) receptors or an increase in the free fraction of testosterone in the blood (Table 1) . Thus, the changes in hormonal levels noted above lead to an increase in the size of the sebaceous glands and their increased functioning. Table 1. Acne pathogenesis factors <table align="left" border="1" cellpadding="0" cellspacing="0" style="width:643px"><tbody><tr><td style="width:235px"> 1 factor (initial link)</td><td style="width:408px"> hereditary hyperandrogenism (usually relative)</td></tr><tr><td style="height:34px; width:235px"> Factor 2 (key link)</td><td style="height:34px; width:408px"> follicular hyperkeratosis</td></tr><tr><td style="width:235px"> 3 factor</td><td style="width:408px"> Hypercolonization of Malassezia, Proprionibacterium acne</td></tr><tr><td style="width:235px"> 4 factor</td><td style="width:408px"> inflammation </td></tr></tbody></table> The key link in the pathogenesis of acne is follicular hyperkeratosis. In the increased volume of sebum, the concentration of essential alpha-linolenic acid (all-cis-9, 12, 15-octadecatrienoic acid) decreases. Linolenic acid (LA) is a major regulator of keratinocyte differentiation. The predominance of the processes of proliferation and dyskeratosis over desquamation of the epithelium ultimately leads to the closure of the pilosebaceous follicle (SVF) duct. This creates favorable conditions for the proliferation of propionbacterium acne (Propionibacterium acnes and Propionibacterium granulosum) and lipophilic fungi of the genus Malassezia. Antigens of microorganisms attract mononuclear phagocytes and neutrophils to the SVF from the peripheral blood, which produce interleukins 1-alpha, 1-beta and 8; tumor necrosis factor alpha, stimulate the complement system. These pro-inflammatory cytokines activate the enzyme cyclooxygenase, resulting in the formation of the main inflammatory mediator, leukotriene B4 (LTB4), from arachidonic acid. LTB4 stimulates neutrophils, T lymphocytes, monocytes and eosinophils with their subsequent release of hydrolytic enzymes and nitrogen monoxide (NO). Destruction of the wall of the sebaceous gland with the release of its contents into the dermis causes a picture of inflammation, which manifests itself in the form of papules, pustules, nodules and cysts. [1]. Taking into account all the above aspects of etiopathogenesis, the following work was carried out with the patient. 1. Consultation with a dermatologist. A diagnosis of acne of moderate severity, complicated by malaseziosis of the skin, was made. Antifungal drugs were prescribed (Sporagal, sulsen paste 1% on the scalp), a diet with a decrease in the consumption of sugar, groceries and gluten-containing products and an increase in the consumption of vegetables and lean meat. 2. Consultation with a gastroenterologist. No pathologies were found. 3. Consultation with a gynecologist-endocrinologist. Hyperandrogenemia was detected with correction by COCs. 4. Professional procedures for skin therapy with DMK preparations were carried out in a cosmetology office. The first procedures were aimed at eliminating inflammation and resolving papulopustular elements. The patient complained more about these symptoms. For this purpose, the following formulas were used: Quick Peel (superficial, absorbable acid peeling), Alkaline Wash (alkaline peeling). Then a deep skin revision procedure was carried out, including elimination of hyperkeratosis (Prozyme enzyme peeling), desincrustation (Sebum Soak), and detoxification (Dermatox). During professional procedures, it was mandatory to apply enzyme masks (Enzyme Masque No. 1 and/or Enzyme Masque No. 1 + Enzyme Masque No. 3). The range of effects of Enzyme Masque No. 1 is aimed not only at eliminating the symptoms of acne (hyperkeratosis, cutting off the SVF), but also at cleansing cells and intercellular space by starting the process of reverse osmosis, improving lymphatic drainage and oxygenation. As a result of the application of enzyme masks, messenger enzymes, or “ second messengers ,” are launched - intracellular signaling molecules released in intracellular signaling cascades in response to receptor stimulation, which leads to the activation of secondary effector proteins, triggering a cascade of their own enzymatic reactions. The antioxidant metalloenzyme superoxide dismutase (SOD) destroys potentially dangerous oxygen molecules in cells, helps in wound healing, softens scar tissue, promotes collagen formation, which simultaneously prevents the formation of post-acne. This treatment allowed to restore skin homeostasis. To restore the epidermal barrier, DMC formulas were used to moisturize, tone, regenerate, increase immunity, and strengthen antioxidant protection. Herb &amp; Mineral Mist Plus, Beta gel and Direct Delivery Vitamin C Serum, Acu Creme, Solar Damage Gel, Transdermal Sunblock SPF-30 were applied The main DMK procedures that were performed to eliminate the symptoms of PD are listed in Table 2. 5. Comprehensive home care was prescribed , including: cleansing (Acu-klen), toning (Acumist), active lotion for the treatment of urticaria (Acu-klear), soft moisturizing cream (Acu-moist), immunomodulating serum (Beta Gel), sunscreen (Transdermal Sunblock SPF-30), benzoyl peroxide lotion BP 10%, dietary supplement containing PUFAs (DMK efa+). 6. To camouflage skin defects caused by UV elements and inflammation, the patient used DMK Cosmetics decorative cosmetics. Thanks to a specially developed composition (extracts of cumin, rosemary, tea tree leaves, castor seed oil, cranberry seeds, pomegranate seeds, aloe Barbados leaf juice, zinc oxide), it supported the treatment and at the same time improved the psycho-emotional state and quality of life of the patient. conclusions There is no one “miracle cure” for treating acne. Only an integrated approach makes it possible to obtain stable remission when treating the patient:<ul><li style="text-align: justify;"> consultation of related specialists;</li><li style="text-align: justify;"> carrying out professional procedures (for example, DMK/Danne Montague-King cosmeceuticals).</li><li style="text-align: justify;"> purpose of home care products and Make up camouflage.</li></ul> The above experience opens up new possibilities in the treatment of numerous patients suffering from acne (results in photos 1-6 ). <hr /><img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/files/Tema%20DMK%201.JPG" style="height:360px; width:480px" /><img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/files/Tema%20DMK%202.JPG" style="height:360px; width:480px" /><img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/files/Tema%20DMK%203.JPG" style="height:360px; width:480px" /><img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/files/Tema%20DMK%204.JPG" style="height:360px; width:480px" /><img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/files/Tema%20DMK%205.JPG" style="height:360px; width:480px" /><img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/files/Tema%20DMK%206.JPG" style="height:360px; width:480px" /><hr /> First published in <a href="https://afisha.bhub.com.ua/event/magazines/kosmetolog/kosmetolog-2016-6-50grn">Cosmetologist 6/2016</a>

The role of a cosmetologist in the treatment of acne