{"id":221,"date":"2020-03-20T12:25:42","date_gmt":"2020-03-20T10:25:42","guid":{"rendered":"http:\/\/dr-bocanescu.com\/?p=221"},"modified":"2020-03-20T12:25:42","modified_gmt":"2020-03-20T10:25:42","slug":"ce-trebuie-sa-stim-despre-acnee","status":"publish","type":"post","link":"http:\/\/dr-bocanescu.com\/en\/ce-trebuie-sa-stim-despre-acnee\/","title":{"rendered":"Ce trebuie sa stim despre acnee?"},"content":{"rendered":"<ol><li><strong>Defini\u0163ie.<\/strong><\/li><\/ol>\n\n\n\n<p>Acneea vulgar\u0103 (AV) este o afec\u021biune cu determinism genetic \u0219i expresie metabolico-hormonal\u0103, observat\u0103, de obicei, la adolescen\u021bi \u0219i adul\u021bii tineri, cu implicarea ariilor cutanate bogate \u00een glande sebacee \u0219i foliculi pilo\u0219i (fa\u021ba \u0219i partea superioar\u0103 a trunchiului), clinic manifest\u00e2ndu-se printr-un polimorfism lezional, iar uneori, din cauza aspectului inestetic, printr-un puternic handicap fizic, psihic \u015fi social.<\/p>\n\n\n\n<p>        <strong>Etiopatogenie.<\/strong><\/p>\n\n\n\n<ul><li>Principalele verigi etiopatogenice ale AV sunt: a) hipersecre\u021bia sebacee, care este consecin\u021ba perturb\u0103rii raportului dintre androgeni \u0219i estrogeni); b) hiperkeratinizarea infundibular\u0103, care const\u0103 \u00een reten\u021bia materialului keratinic \u00een ductul sebaceu, respectiv ostiul folicular; c) factorul microbian, care const\u0103 \u00een degradarea sebumului sub ac\u021biunea unor enzime (lipaze, proteaze, hialuronidaze), provenite din anaerobii facultativi (P. acnes). Ulterior, se pot asocia \u015fi alte colonii bacteriene \u2013 St. aureus, Peptostreptococcus spp. etc.; d) deregl\u0103rile metabolice (dislipidemie local\u0103) \u0219i imune (hipersensibilizare specific\u0103 primar\u0103, hiporeactivitate nespecific\u0103 secundar\u0103), care se accentueaz\u0103, de obicei, \u00een formele avansate, severe de boal\u0103.<\/li><li>Cercet\u0103ri recente eviden\u0163iaz\u0103 \u015fi alte perturb\u0103ri: a) activarea receptorilor toll-like (TLR-2); b) eliberarea factorilor proinflamatori (IL-1alfa, IL-6, IL-8, IL-12, TNF-alfa); c) exprimarea moleculelor de adeziune intercelular\u0103 (ICAM-1); d) activarea inflamazomului (NLRP-3). Totodat\u0103, trebuie de men\u0163ionat c\u0103, \u00een formele conglobate de acnee, degradarea fibrelor de colagen se datoreaz\u0103 metaloproteinazelor \u015fi \u00een special matrix metaloproteinazei 9 (MMP-9).<\/li><li> Multipli factori, cum ar fi stresul psihologic, factori alimentari si altele influenteaz\u00e3 homeostazia hormonal\u00e3 a pielii. Stresul activeaz\u00e3 axa hipotalamo-hipofizo-suprarenal\u00e3 (HPA) si sistemul nervos simpatic. Acest lucru duce la eliberarea de diferiti neurotransmit\u00e3tori, citokine si hormoni, cum ar fi CRH si melanocortinici, care posed\u00e3 receptori la nivel cutanat si pot agrava acneea. \u00cen timp ce laptele contine IGF-1 si precursori de androgeni, o diet\u00e3 bogat\u00e3 \u00een carbohidrati creste nivelul de insulin\u00e3. Ambele duc la cresterea productiei si secretiei de sebum, la o schimbare a compozitiei sebumului, inflamatie si keratinizare folicular\u00e3 anormal\u00e3.  <\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn%3AANd9GcTV-n43ejtVJaNjzGQiSDMVlDLvOodSeHh-se9ffNRCEBzN8-ck\" alt=\"Imagini pentru milk and carbs\"\/><figcaption><br><\/figcaption><\/figure>\n\n\n\n<ul><li><strong>Tablou clinic.<\/strong><\/li><\/ul>\n\n\n\n<p>Sub aspect clinic, acneea debuteaz\u0103 la pubertate sau \u00een pragul pubert\u0103\u021bii, de obicei pe un teren seboreic preexistent, caracteriz\u00e2ndu-se printr-un polimorfism lezional vast:<\/p>\n\n\n\n<p>a) leziuni preinflamatorii \u2013 microcomedoane \u015fi \/ sau comedoane (imaginea al\u0103turat\u0103 mai sus, partea din st\u00e2nga);<\/p>\n\n\n\n<p>b) leziuni inflamatorii:<\/p>\n\n\n\n<ul><li>u\u015foare \u2013 micropapule \u015fi \/ sau papule (imaginea al\u0103turat\u0103 mai sus, partea din dreapta),<\/li><li>moderate \u2013 eritem, papule, pustule (imaginea al\u0103turat\u0103 ma jos),<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"http:\/\/e-dermatologie.md\/chestiute\/uploads\/2015\/08\/inflamatorie-moderata.jpg\"><img src=\"http:\/\/e-dermatologie.md\/chestiute\/uploads\/2015\/08\/inflamatorie-moderata.jpg\" alt=\"inflamatorie moderata\" class=\"wp-image-714\"\/><\/a><\/figure><\/div>\n\n\n\n<ul><li>severe \u2013 eritem, pustule, noduli, chisturi, abcese (imaginea al\u0103turat\u0103 mai jos);<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"http:\/\/e-dermatologie.md\/chestiute\/uploads\/2015\/08\/inflamatorie-severa.jpg\"><img src=\"http:\/\/e-dermatologie.md\/chestiute\/uploads\/2015\/08\/inflamatorie-severa.jpg\" alt=\"inflamatorie severa\" class=\"wp-image-715\"\/><\/a><\/figure><\/div>\n\n\n\n<p>c) leziuni postinflamatorii (cicatrici, discromii).<\/p>\n\n\n\n<p>5 tendin\u0163e contemporane \u00een evolu\u0163ia acneei:<\/p>\n\n\n\n<ul><li>Cre\u015fterea num\u0103rului de adres\u0103ri primare la medicii de familie si dermatologi.<\/li><li>Cre\u015fterea adresabilit\u0103\u0163ii b\u0103ie\u0163ilor.<\/li><li>Cre\u015fterea cazurilor de acnee tardiv\u0103 (21-35 ani).<\/li><li>Cre\u015fterea cazurilor cu un num\u0103r mai mare de asocieri morbide: AV + alte manifest\u0103ri de hiperandrogenism: dermatit\u0103 seboreic\u0103, alopecie androgenic\u0103, hirsutism, dismenoree, ovare (micro-) polichistice etc.<\/li><li>Cre\u015fterea num\u0103rului de efecte adverse la medica\u0163ia topic\u0103 antiacneic\u0103, inclusiv dup\u0103 manopere cosmetice.<\/li><\/ul>\n\n\n\n<p>Forme clinice grave: sindromul PAPA (acnee chistic\u0103, piodermie gangrenoas\u0103, artrit\u0103 steril\u0103), sindromul SAPHO (acnee sever\u0103, sinovit\u0103, hiperostoz\u0103, osteomielit\u0103 a sternului, pustuloz\u0103 palmar\u0103), triada folicular\u0103 Pillsbury (acnee conglobat\u0103, hidrosadenit\u0103 cronic\u0103 supurativ\u0103 axilar\u0103 \u015fi perineofesier\u0103\/boala Verneuil, perifolliculitis capitis abscedens et suffodiens Hoffman\/acnee cheloidian\u0103 nucal\u0103) \u015fi boala Dowling-Degos (acnee nodulo-chistic\u0103 a fe\u0163ei \u015fi toracelui, pigmenta\u0163ia reticular\u0103 a pliurilor).<\/p>\n\n\n\n<p>       <strong>Diagnostic.<\/strong><\/p>\n\n\n\n<p>De\u0219i diagnosticul clinic al AV nu constituie o problem\u0103, uneori, de un real folos, pot servi urm\u0103toarele explor\u0103ri: hormonale, biochimice, imune, bacteriologice, histologice, psihologice etc.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn%3AANd9GcTUBuN_lFj6SmSrAWHR7EXK3sMvfVRrN5yQz0rw1oDI8w0MkTre\" alt=\"Imagini pentru acne\"\/><\/figure>\n\n\n\n<p>         <strong>Tratament.<\/strong><\/p>\n\n\n\n<p>Tratamentul AV are drept scop: a) combaterea hipersecre\u021biei sebacee \u2013 antiandrogeni majori (acetat de ciproteron + etinilestradiol) \u0219i minori (cimetidin\u0103, spironolacton\u0103); b) combaterea hiperkeratozei foliculare \u2013 retinoizi (Isotretinoin); c) combaterea florei microbiene \u0219i reducerea inflama\u021biei \u2013 antibiotice (cicline \u015fi macrolide); d) combaterea dezechilibrului imun \u2013 imunomodulatoare (licopid, imunofan), e) retinoizi- de exemplu Dapsona. De asemenea, sunt binevenite vitaminele (complexul B, \u00een special B6) \u0219i microelementele (sulfatul de zinc, gluconatul de zinc), diverse topice cu ac\u021biune antiseboreic\u0103 \u0219i antiacneic\u0103 \u2013 acid salicilic, acid azelaic, acid glicirizinic, alfa-hidroxi-acizi (AHA), acid retinoic, peroxid de benzoil, acetat de Zn, hialuronat de Zn, ihtiol, natrium bitumino-sulfonat etc., m\u0103\u0219ti cosmetice, manopere fizioterapice (electroforeza), laserul ( CO2, ND-YAG), microneedling cu Dermapen, peeling-uri superficiale si profunde cu diversi acizi.<\/p>","protected":false},"excerpt":{"rendered":"<p>Defini\u0163ie. Acneea vulgar\u0103 (AV) este o afec\u021biune cu determinism genetic \u0219i expresie metabolico-hormonal\u0103, observat\u0103, de obicei, la adolescen\u021bi \u0219i adul\u021bii tineri, cu implicarea ariilor cutanate bogate<span class=\"excerpt-hellip\"> [\u2026]<\/span><\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/posts\/221"}],"collection":[{"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/comments?post=221"}],"version-history":[{"count":1,"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/posts\/221\/revisions"}],"predecessor-version":[{"id":222,"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/posts\/221\/revisions\/222"}],"wp:attachment":[{"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/media?parent=221"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/categories?post=221"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/dr-bocanescu.com\/en\/wp-json\/wp\/v2\/tags?post=221"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}