The causes of spots appearance (or, scientifically, acne) can be various factors. But the mechanism of development, typically involves four main elements.

Lets consider the four main causes of acne:

Elevated levels of male sex hormones (hyperandrogenic)

Hyperactivity sebaceous

Cornification of skin tissue (follicular hyperkeratosis)

Acne and Bacteria

Hyperactivity sebaceous
Not many people know that virtually the entire surface of the skin is covered with microscopic sebaceous glands. The only exceptions are palms and soles.

However, these glands cover the body not uniformly: the largest and most frequently are located on face particularly on nose and cheeks, as well as on the upper chest, above the shoulder-blades and between them.

The sebaceous glands lie at a level of about 0.5 mm below the surface of the skin. In places of the highest concentrations of sebaceous glands (scalp, forehead, chin, back), their number reaches 800 or more per 1 cm2.

In the course of life, the depth of the skin and the magnitude of the sebaceous glands are changing. The younger the child, the greater its sebaceous glands, the more they work, and closer they located.

However, over the years, the activity of these glands gradually slow down, some of them dying. The chemical composition and texture of sebum is changing. This continues until the beginning of puberty: the action of hormones (in particular, male sex hormones – androgens) sebaceous glands increase their secretary activity increases, reaching the “maximum life” for 18-25 years.

The sebaceous glands are different from short hair and long hair. The largest glands are located just where there are typical elements of acne – in the places of greatest congestion. They consist of many parts and that is why they are called sebaceous follicles.

The main objective of the sebaceous glands, as it follows from their names – producing sebum. It serves as a lubricant for the hair during their growth, softens the upper layer of the epidermis, protects the skin from the water, microorganisms, giving it elasticity. Within 24 hours the sebaceous glands secrete up to 20 g secretion, consisting of fatty acids, fats, cholesterol, glycerol, etc. Mingling with the sweat, the fat forms a thin pellicle of water-fat emulsion (“acid mantle of the skin”), which plays an important role in maintaining the normal state of the skin.
But it is only in cases where the functioning of the sebaceous glands is normal.

Unfortunately, this is not always. For example, in the life of every young person – whether boy or girl – sooner or later there comes a time when the natural physiological reasons, the sebaceous glands overactive suddenly begin to work. Moreover, sebum is not only secreting much more – it changes its composition and texture, becoming denser. Used in combination with microscopic particles of dead skin, a fat forms a dense cap on the “exit” from the follicle – a special pouch, which gives the beginning of each growing on the surface of the skin hair.

The result of this blockage is first jamming, and then a significant increase in the size of the follicle. If the problem persists and the excess fat is not displayed outside, then inside the “cameras” are hothouse conditions for the reproduction of various bacteria and other microorganisms. In particular, begins to actively propagate bacteria Propionibacterium acnes. (In fact, in normal circumstances it is the representative of the normal micro flora of the sebaceous glands, but when it is propagating too fast, the immune system of the skin begin fighting with it, which is manifested with inflammation).

Accelerated secretion of sebum leads to the fact that in its composition predominate fatty acids, which are synthesized by cells of the sebaceous glands of glucose. However, the relative content of exogenous fatty acids (linoleic and linolenic acids) is decreasing. Found out that lack of these fatty acids breaks the barrier function of skin, which further facilitates the bacteria access to the sebaceous glands. In particular, except Propionobacterium acnes, in the sebaceous glands soon mastered staphylococcus, streptococcus and other pathogens of purulent infections

As a result there is the formation of numerous blackheads, or acne.

Thus, it becomes clear why the treatment of acne goes along well-defined pattern.

It consistently includes the regulation of sebum, the normalization process of keratinization in the sebaceous glands, creating conditions for free flow of sebum from the ducts, control of inflammation – both by reducing the intensity of the immune response, and through various measures aimed at reducing the number of bacteria Propionobacterium acnes.

Finally, as an additional measure carried out the restoration of skin barrier function, which allows block the bacteria that are trying to settle in the sebaceous glands.

Elevated level of male sex hormones (hyperandrogenic)
As it is already known, the appearance of acne causes disruption of sebaceous glands follicle. Sebaceous gland produces sebum which softens the skin, protects against the external environment and, moreover, helps to grow hairs, which cover almost the entire surface of our body.

However, specifically that breach may result in different factors. One reason lays in the imbalance between male (androgens) and female (estrogens) hormones. Therefore, almost any violations of hormonal background acne may appear. That is why it is so often becomes a “companion” of adolescent during puberty, and also appears on girls with unsteady menstrual cycle, during pregnancy or after abortion.

In addition, hormone levels will depend on many external and internal factors not related to age: the psychological state, physical activity, climatic conditions, receiving different drugs (e.g. contraceptives or antidepressants), and so on.

However, for youth physiological reasons is enough for the appearance of acne. For example, it is known that a certain excess of androgens during adolescence is necessary for proper development of the organism, both for girls and boys. Because these hormones are needed not only for the formation of sexual function, they also affect the development of many organs, including skin.

The sudden change of hormonal levels in the follicle, change and processes of keratinization (peeling of old skin flakes). Under the influence of steroid hormones (in particular, testosterone, dehydroepiandrosterone, androstenedione) in the course of complex chemical reactions in the skin, a rapid increase in the number of sebocytus - secretary cells of sebaceous glands. Moreover, sebum not only increases: changes and its structure, it becomes sticky and thick, with far more likely probability of blocking the follicle.

(Normally, sebum oil is liquid, and acne does not occur even with problematic oily skin).

This leads to the formation of comedones – tallow-keratin plug, which “clogs” way out of the follicle, creating a favorable environment for bacteria, Propionibacterium acnes. Waste products of these bacteria have a strong irritant during the contact with the surrounding tissues. It develops inflammation. A constantly growing hair follicle can rupture with the formation of ulcers.

Since the increase in steroid hormone levels observed in the last phase of the menstrual cycle, about 70% of women associate acne with menstruation. Fortunately, this is not always happening in severe form: usually before menstruation, few small spots may appear on the neck and chin.

In general, gynecological hormonal problems and the appearance of acne are closely related. In particular they may be accompanied by such diseases as polycystic ovaries. The reason is the same – hormonal imbalance. The same applies to the risk of acne for women after an abortion.

On the appearance of acne can affect pituitary diseases, adrenal, male and female sexual organs. Thus, in hyperandrogenism (increased male hormone – androgens – in women) acne occurs often.

That is why, in contrast to the youthful acne, acne in adults (over 20) people should be an occasion not only to visit a dermatologist. It is also necessary to consult an endocrinologist, and for women – a gynecologist. Also the need for a series of laboratory tests may appear.

Hyperandrogenic often has a hereditary nature and can be one of two types. In one case, there is an absolute increase in the level of hormones in the body, while another – just exacerbation of sensitivity to elevated or depressed levels of a hormone.

There are very few women that associated the appearance of acne with the menstrual cycle, but the absolute majority (not to mention the men) do not. It is known that the admission of certain oral contraceptives can reduce acne.

If a woman has a cycle violations and for example excessive hairiness on the body, it is unlikely that hormones play a big role in causing acne. There is also no clear evidence of the impact on their pregnancy: some women get rid of acne completely, but there are no less and of those whose picture does not change or even worse.

In addition, experts particularly warn against fairly widespread misconceptions among youth regarding the fact that the beginning of sexual activity can help to “cure” acne teenage girls. Their no conformation of this, but the risk of getting venereal decease along with acne is high.

Cornification of skin tissue (follicular hyperkeratosis)

The outer layer of human skin is constantly renews with peeling of dead scales. Superficial horny scales of the epidermis in normal contain a certain amount of the protein keratin. Delay peeling horny plates or augmented of keratin (as a result of constant irritation of the skin or eating disorders) lead to the development of hyperkeratosis.

The same pattern can be observed in the hair follicles. However, sometimes the stratum corneum is growing too quickly, leading to plug of comedones. There is an excessive thickening of the horny layer in the crater of hair follicles, where the duct of sebaceous glands opens.

This process is called “follicular hyperkeratosis”, and is another common cause of acne. Risk factors in follicular hyperkeratosis are heredity, and lack of vitamins A and C. The disease is appearing in the form of small red pimples and so-called “Goose skin”. Because the disease is primarily cosmetic problem and does not constitute a direct threat to health, many dermatologists do not cure it, citing refusal that it is a hereditary condition. However, you must understand that cosmetic defects can also cause damage to health, causing irritability, and at a young age creating serious psychological complexes.

Typical manifestations of follicular hyperkeratosis are rough, hardened skin, small reddish pimples, rashes, “goose bumps” on hands and hips.

Rash elements with follicular hyperkeratosis – small, dense, piloted nodules in the very base of the follicle. Around the element red rim is forming. Typically, rash concentrated on the hands – on the side and rear surfaces of thigh – on the side and front surfaces, on the buttocks. In a generalized form of follicular hyperkeratosis observed extensive destruction of the body and the inner surfaces of hands and feet.

Follicular nodules and plaques the size of a match head for many years can remain in the same area. The skin is rough to the touch.

In the occurrence of the disease play a big part plays genetic predisposition, as well as hypovitaminosis A and C.

Vitamin A deficiency leads to the development of follicular hyperkeratosis I type. Neck of hair follicle is surrounded piloted nodules and plaques. The skin of the buttocks, elbows and knees, extensor surfaces of hands and feet becomes dry, rough, low fat, crude. When you touch it feels like sandpaper.

Deficiency of vitamin C causes follicular hyperkeratosis type II. Ducts clogged hair follicles or blood pigment. Affects extensor surface of the thighs and abdominal area. Hemorrhagic rash may occur if vitamin C and K.

Follicular hyperkeratosis is common in childhood and adolescence, especially among children with allergies. In terms of physical discomfort hyperkeratosis is a slight itching, but the main reason for seeking medical attention are still unpleasant external display of the disease affecting the exterior of the patient.

From a medical point of view of follicular hyperkeratosis differs from acne. For example, on the face of the elements of follicular hyperkeratosis, dry, rough, small and uniform in size. The diagnosis is usually based on a thorough examination of the skin, without special laboratory diagnostics.

Treatment of follicular hyperkeratosis is mostly symptomatic, because to get rid of it is impossible. And it must be remembered that in some cases the appearance of this disease is a symptom of the pathology of internal organs, so before the treatment is necessary prior consultation physician, an endocrinologist and a dermatologist. In this case, successful treatment of the underlying disease will eventually normalize and condition the skin.

Avoid attempts to cope with hyperkeratosis with mechanical effects such as scrubs and peels: it will only worsen the skin condition. It is also necessary to avoid pressure or friction on the skin areas affected by hyperkeratosis.

On the other hand, the use of cosmetics with emollients (fat components) softens the skin, reduces irritation and improves its appearance, especially in winter.

Localized in the open areas of the body (arms, thighs), follicular hyperkeratosis is apparent cosmetic defect. Its display can be a starting mechanism for the formation of complexes, psychological problems and physical discomfort. Not being a potential threat to the health of the patient, follicular hyperkeratosis, however, is inherited.

Acne and Bacteria

As it is known, the appearance of acne “start” at a time when the clogged follicle accumulate and begin to multiply rapidly bacteria. More precisely, even not harmful: in fact, the main “culprits” of acne – the so-called propionic acid bacteria acne (Propionibacterium acnes) – are constantly present on the skin of any person. Them company dozens of other microorganisms, including Propionibacterium granulosum, Staphylococcus aureus, Staphylococcus epidermidis, fungi Malassezia (they cause dandruff and seborrheic dermatitis), as well as the tiny mites Demodex (Demodex), plays an important role in causing rosacea.

We did not notice because they are with us in a kind of symbiotic relationship, due to its relatively small size they do not interfering our life, but not helping our existence.

For 2-3 years before the onset of puberty quantity P. acnes on the skin increases sharply: from 1-10 to several million bacteria per 1 cm2. This, incidentally, also serves as one of the reasons why acne got just such a name.

The number of bacteria on the skin and in the follicle is not connected directly with the severity of acne. This amount is determined by the composition of substances on the skin surface, some of which bacteria are used in food, while others, conversely, and impede their growth. In addition, the growth of bacteria affects the access of oxygen and acidity of the skin. P. acnes are living quietly in the follicle below the skin without the need of oxygen.

In itself, its presence does not threaten to follicle and almost never leads to acne. Another thing is that plugging the follicles creates for these bacteria, a kind of incubator – and that’s when just formed, and acne.

Actually inflammation at the site of acne is the excessive multiplication of these bacteria. In particular, the propionic acid bacteria acne produces enzymes that cleave triglycerides of sebum into free fatty acids, which irritate the follicle cells. P. acnes form different substances, officials mediators (mediators) of inflammation. These substances penetrate beyond the follicle and attract cells, white blood cells from the surrounding follicle connective tissue. P. acnes bind to molecules of leukocytes, after which they emit a range of substances: interleukins 8 and 12, tumor necrosis factor. These substances, in turn, affect other cells, which leads to the development of inflammatory reaction.

People with severe forms of acne tend to have aggravated allergic reaction to the waste products of these bacteria, which is why they develop more serious swelling and inflammation in the localization of acne. In such cases, in addition to proper treatment of acne are often prescribed, and antihistamines.

Despite the fact that the bacteria “cause” acne, acne is not contagious. Participation of bacteria in the development of acne is considered a secondary, but necessary for the appearance of inflammatory components of acne.

This explains the effectiveness of antibiotics and antiseptics, as one of the main treatments for acne and skin care, prone to the formation of acne.

Conclusion

The four main factors, “triggering” mechanism of acne, of course, do not cover many other reasons that acne can appear at a specific person. But these cause dozens: from hazardous working conditions and contact with various substances before taking certain medications or wearing uncomfortable clothes. However, the main conclusion to be drawn to every person suffering from acne (no matter whether they are teenagers or adults) – in case you have not helped ordinary means, you should immediately seek help from a doctor-dermatologist.

Arsenal of modern medicine has ample tools and treatments for acne, and in most cases it is possible not merely to defeat acne, but also get rid of the external signs that it ever was on you!

The treatment of acne should be prescribed by your dermatologist as well and may vary depending on your sex, age, duration of the break-out, clinicopathologic examination (identifying type, localization and abundance of the elements) and the results of complete examination (helps to detect concomitant diseases). The treatment course should be determined individually for each patient and may include hormonal treatment, immune system improvement or topical treatment only, etc.  Self-treatment is ineffective and even dangerous, since it may worsen acne break-out and cause complications including scars.

The acne treatment approach depends on the type of acne break-out, but the common principles are the following:

* inhibition of sebaceous gland function;
* elimination of dead skin cells blocking the canals of sebaceous glands;
* elimination of bacteria causing skin inflammation.

Acne therapy consists of special skin care and medicines. The medicines for treating acne may come in a form of ointments, creams, masks, tablets for peroral administration and even injections(in severe cases). However, today most dermatologists recommend their patients to use medicines for topical use, i.e. lotions, creams, ointments, etc.

Sclerosing is used for treating small but deeply localized vascular tumors, especially cavernous and mixed Hemangioma on the face and tip of the nose. For sclerosing a 70% alcohol is used.
The disadvantages of sclerosing therapy include painfulness and prolonged course of the treatment.
The advantage of injection therapy against other conservative methods consists in its simplicity.
One of the new methods of treatments of spreading Hemangioma in children is hormonal therapy with prednisolone.  Hormonal therapy is a rather efficient method of treatment, however its high effectiveness (98%) does not provide desired cosmetic effect.  This method stops the vascular tumor growth and is used as a supplemental treatment.
Cryogenic therapy (treatment with low-temperature impact) is used for simple Hemangioma of any localization. It does not require anesthesia and is carried out in the outpatient setting.

Simple Hemangioma is red or purple in color, well-defined and located on the surface of the skin. It grows predominantly from under its sides and affects the skin and several millimeters of subcutaneous fat. The surface of Hemangioma is usually smooth, though sometimes it could be uneven or bulging. When pressed, Hemangioma turns pale but later restores its color.
Cavernous hemangioma is located under skin in a form of a circumscribed nod. It looks like a tumor covered with bluish or unaltered skin at the top. When pressed, Hemangioma recedes and turns pale (resulting from blood outflow).
Mixed Hemangioma represents combination of surface (simple) and subcutaneous (cavernous) Hemangioma.
Mixed Hemangioma consists of tumor cells originating from vessels and other tissues. The appearance, color and consistency of Hemangioma depend on the tissues the tumor consists of.