Acne exacerbation: the role of exposome factors and current trends in maintenance therapy

Abstract

At the present stage, acne is considered as a multifactorial dermatosis, in the formation of which a significant role is played by genetically determined hyperandrogenism and impaired secretion of the sebaceous glands, as well as changes in the skin microbiome. It is known that the risk of occurrence and severity of the disease are significantly influenced by various environmental components, which are commonly called exposure factors. This article provides an analysis of studies on the influence of the most common exposure factors on the pathogenesis and clinical course of acne: diet, skin care, stress, novel coronavirus infection (COVID-19), environmental pollution and climatic conditions. It has been shown that these factors affect the main components of the skin barrier, affect the microbiota and immune reactivity, which subsequently leads to the activation of the leading pathological mechanisms of acne formation. Considering the variety of factors that provoke the disease, emphasis is placed on the need for proper skin care and pathogenetically substantiated therapy in a maintenance regimen with the appointment of topical retinoids and azelaic acid. Due to anti-inflammatory and comedonolytic effects, as well as inhibition of the growth of Cutibacterium acne, these active ingredients provide a complex effect on the main pathogenetic links of the disease. The article presents our own clinical observations of patients with acne, who underwent complex therapy and prevention of exacerbations with the use of Adaklin and Azix-Derm. It was noted that these drugs are effective both in the complex treatment and in the prevention of exacerbations in patients with mild to moderate acne, while the therapy is well tolerated by patients - the resulting adverse events are reversible, easily corrected with moisturizing agents and do not require discontinuation of drugs.