I.1 Definition
Acne is a skin disease caused by chronic inflammation of the pilosebaceous follicles characterized by comedones, papules, pustules, nodes, and cysts at the site of predilection.
Acne is a disease of chronic inflammation fulgaris pilosebaceous follicles that commonly occurs in adolescence and can heal itself. Clinical features of acne vulgaris often polymorphic, consisting of a variety of skin disorders in the form of blackheads, papules, pustules and scarring caused by abnormalities of either the active or scar tissue that hipertofik hipotrofik.
I.2 Epidemiology
Acne vulgaris, or more commonly called acne is a skin disease that many people we encountered, especially in Indonesia, a disease affecting the skin organ is mainly encountered in adolescence and young adulthood, women usia15 - 19 years and in men aged 17-21 years, but often also a younger age or older, affected by this disease.
Based on several studies have shown that the frequency of acne, vulgaris on the human population is quite high, even by well-known investigators in the field of acne Kligman no one human being through life without a dikulitnya acne. Which raised doubts whether the acne is a disease or simply a sign of physiological life alone. Just like growing a beard and mustache others.
This has become an obstacle for acne vulgaris, although it does not endanger life but is often a problem because cosmetics are not uncommon due to psychological complaints of the patient to the social environment around them, causing even less confident in aindividu, the embarrassment to gather-together and so forth.
It attacks acne vulgaris and skin appendages of the skin so the fat kelenjer skin areas that are more commonly affected is the skin that contain lots of oil glands is the face, neck, chest, shoulders, upper back and upper arms.
I.3 Skin Histology and Derivatives (integument)
The skin is an organ that serves to protect the material and influence along with Integumennya (ie nails, hair, and several kinds of glands).
The skin consists of 2 (two) layers:
Epidemic (a specialized epithelium derived from ektodern)
The epidermis is a squamous epithelium-lined with a layer of horn, made up of four different cell types, cell keratin cells, melanocytes, the cells of five layers or strata:
stratum germinativum or stratum basale layer of the seed or are located above the dermis
Startum spinosum or a layer or layers of cells Taju thorns.
Startum granulosum or granular layer.
Startum corneum or outermost layer berzat horn horn.
Dermis
Under the epidermis and the inner is usually difficult to set limits because together with subcutaneous tissue (hypordemis). Dermis, composed of two layers of tissue that is composed of irregular bond:
Papillary layer of the surface
Reticular layer below it.
Cellular components of the dermis is fibroblasts and macrophages, fat cells are single or in groups, chromatophore cells and melanocytes. Munkin smooth muscle fibers can be found in the dermis, which is arranged to form a file associated with hair follicles (muscular erector
pili) and bertebar throughout the dermis. The contractions cause the skin to shrink the area in question apparently. In the skin of the face and neck a number of skeletal muscle fiber ends
the fine fabric of elastin fibers.
Hypodermic
Hypodermic a bottom layer of skin (fascia suberfisialis) is actually not part of the skin but it looks just as expansion of the inner dermis. In the hypodermis found: fat cells, panikulus adiposus, number and size varies according to body regions and according to individual nutritional circumstances.
Hair
Is an elastic yarn hair keratin that develops from epithelial invagination of the epidermis. Hair growth is influenced by sex hormones, especially androgens in certain areas like the scalp, face and pubis are also influenced by the adrenal and thyroid hormones.
Mitotic activity in hair follicles and sebaceous glands under the influence of androgens.
Skin glands, consisting of:
- Sebaceous glands, or skin oil glands
- Sweat gland
- Mamma gland
Sebaceous glands in the dermis pda found embedded in almost all parts of the body except the area that has no hair. Is a gland that usually have banayak asiner estuary acini in a short duct, and usually at the top of the follicle. Sebaceous glands are glands holokrin, with the result of secretions prior to release with the rest of the cells die, the result consists of a complex mixture of lipids that contain triglycerides, free fatty acids and their esters and esters kolertrol. The main factor mnegatur these sebaceous glands in males are the testes and in women testostoren is a combination of ovarian and adrenal androgens.
Sebaceous gland flow is continuous and if there is interference with the normal flow of sebum secretion and is one of the reasons would be the onset of acne or acne vulgaris. Sweat glands are widespread in the skin, is a coiled gland tubulosa simplex, memepunyai nekresi function, or apocrine glands merokrin.Mamma glands, glands that secrete milk functioning.
I.4 Etiopatogenesa
Etiopatogenesa of acne are:
A. The production of sebum (fats) which increased
2. Changes in skin surface lipid composition
3. Sebaceous gland duct obstruction
4. Colonization of bacteria on the site
This is the basis patogenisis important as the treatment of acne. To
the onset of acne vulgaris cope with the need for good cooperation between the patient
and his doctors.
Systematically Sjarif Wasitaatmadja M (1987) suggested several factors
either exogenous or endogenous is thought to affect the formation
acne vulgaris such as:
Genetic factors,
Acne vulgaris may be a genetic disease caused by an increased sensitivity pilosebsea unit to normal androgen levels. Even suspect the existence of these genetic factors play a role in determining the shape and the clinical picture, the spread of lesions and disease duration. At over 80% of patients had at least one sibling has the same and the ore than 60% of patients had at least one parent with acne vulgaris as well.
Racial factors,
Possible race play a role in the onset of acne vulgaris filed because the fact of the races tertenu like mongoloid who suffer from acne more often than Causcasian, blacks were better known than whites.
Seasonal factors,
high temperatures, greater humidity, and ultraviolet light that causes acne vulgaris more often occur in summer than winter. In the skin temperature increase of 1 degree Celsius rise in the rate resulting ekresi sebum increase by 10%.
Dietary factors
Still debated, there are investigators who agree the food effect on the incidence of acne, those that are counterproductive. Types of food that is often associated with the onset of acne is a high-fat foods (nuts, milk fatty meats, ice cream), foods high in carbohydrates (sweets syrop), high beryodida foods (foods of marine origin) and spicy. According to the pro foods can alter the composition of sebum and increase the production of sebaceous glands.
Inflection factor,
There are 3 (three) classes of microorganisms that are floranormal skin, acne C, S epidermis, and P ovale. This is the role of microbes that can form the enzyme lipase breaks down triglycerides into free asamlemak komedogenik nature.
Psychological factors,
Emotional stress in some patients can cause a recurrence of acne, possibly through the mechanism of the increased production of androgens in the body.
Endocrine or hormonal factors
Factor activity of sebaceous glands
Sedikitnyaproduksi Memepengaruhi much sebum. In patients with acne vulgaris sebumnya production of normal.Semua higher in this factor is not the same effect on each individual patient and generally multifaktora, in other words all the factors of acne vulgaris can mempengaruhi.patogenesa. Sebaceous glands in the skin boils down to the hair follicle, forming a unit pilosebsea, the hair follicles with one or more glands, together with the smooth muscle associated with these follicles.Sometimes sebaceous gland empties directly to the surface of the skin.
Back and front area of the scalp sebaceous glands in jumlahyang contained more and larger. At these areas there are 400 -900 Kelenjar/Cm2 while in other places of less than 100 kelenjar/cm2. Sebaceous glands are glands that produce sebum or fat that is useful to form the skin surface fat that serves to protect the skin.Sebum consists of a mixture of various lipids such as triglycerides, free fatty acids, cholesterol esters night skualen and cholesterol ester.
Pathogenic factors that occur in the formation of lesions of acne vulgaris include:
Blockage of the sebaceous gland pad lines with keratin and sebum that will begin to harden siinfra infun dibum. With effect kertinisasi factors, hormonal and fat composition of sebum then this process occurs. Period would preclude spending cap for the production of sebum from the gland wall and invite the emergence of follicular inflammation.
Testoren and androgen hormones that affect produksisebum, an increase of this hormone will affect the weight ringannyapenyakit.
Hormonal changes will result in changes in biochemical composition of fats and fat-breaking enzyme from skin microorganisms. Almost all components of sebum are komedogenik but are considered the most komedogenik are free fatty acids and skualent, are esters, cholesterol, triglycerides have a weak effect.
Acne vulgeris not include infectious diseases, the role of microorganisms C.Akne S.epidermis, P ovale to the formation of eruption can not be ruled out.Hialurronidase this microorganism secretes enzymes and lipase, and chemotactic factors. Lipase breaks down fats into free fatty acids komedogenik.Chemotactic factor thought to contribute to the inflammatory process that occurs after the blockage.
Clinical I.5
The place is a predilection for acne vulgaris on the face, shoulders, upper chest, and back atas.Lokasi skin, such as the neck, upper arms, and glutea sometimes - sometimes terkena.Erupsi polymorphic skin with symptoms predomoinan one satumya, blackheads, papules are not beradang and pustules, and cysts that beradang.Dapat nodes accompanied by intense itching, but the general complaint is a complaint estetis.Komedo pendeita patognomonis for acne is a symptom of a papule billion, which contain middle clogging sebum, when the black due to melanin-containing elements are called blackheads blackheads black ataun trebuka (black comedones, open comedones). Was when brewarna white because it is more preformance sehuingga mengandungb no melanin element called closed comedones or blackheads and white (white, closed comedones)
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