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Acneea la adulți: cauze și prevenție

Acneea la adulți: cauze și prevenție

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Vrem să arătăm bine, să avem o piele frumoasă și chiar dacă acneea o asociem cu adolescența, din păcate, este o problemă întâlnită și la maturitate. Dr. Smaranda Nica, medic specialist dermatolog, ne spune care sunt cauzele acneei la adulți și cum o putem combate.

 

Tipuri de acnee la maturitate

Acneea la adulți, cunoscută și sub numele de acnee tardă, este acea formă de acnee ce apare sau persistă după vârsta de 25 de ani, iar femeile sunt mai afectate decât bărbații.

Din punct de vedere al manifestărilor, leziunile sunt aceleași ca și la adolescenți: comedoane (puncte negre și puncte albe), leziuni inflamatorii, roșii (coșuri sau noduli), iar localizările sunt similare (față, gât, trunchi).

Au fost, însă, descrise două tipuri distincte de acnee tardă: acneea comedoniană, cea mai frecventă, caracterizată prin prezența preponderent de comedoane (puncte albe/negre), având uneori câteva leziuni inflamate, ce afectează de regulă întreaga față, dar cu un număr mai mare de leziuni în partea superioară a acesteia;

acneea inflamatorie, caracterizată prin prezența de  papule (umflături), pustule (coșuri cu puroi) și noduli, afectând, de regulă, partea inferioară a feței, așa numita „zonă U“ (bărbia, zona din jurul gurii, mandibula).

Indiferent de forma clinică, severitatea este ușoară sau moderată, mai rar existând forme severe ca în adolescență.

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Cauzele acneei la adulți

Cauzele de bază ale apariției acneei la maturitate rămân aceleași ca și în adolescență: producția în exces a sebumului; tendința de formare a comedoanelor cauzată de coezivitatea celulelor de la suprafața pielii, care nu se elimină foarte ușor și produc dopuri care obturează canalele de evacuare a sebumului;

proliferarea locală a unei bacterii ce face parte din flora microbiană normală (în special, a speciei Cutibacterium/Propionibacterium acnes); inflamația, ca rezultat al factorilor de mai sus.

Există însă factori secundari, care pot fi promotorii acestor modificări. Factorii hormonali sunt cei mai importanți, creșterea hormonilor androgeni fiind cea mai frecvent implicată în apariția acneei la femeile adulte.

Cauza principală de hiperandrogenism este sindromul ovarelor polichistice, însă creșteri ale hormonilor androgeni apar și în anumite tumori ovariene sau ale glandelor suprarenale, iar la bărbați creșterea poate fi cauzată de administrarea de steroizi anabolizanți sau de suplimente cu testosteron.

Totuși, o valoare normală a hormonilor androgeni nu semnifică faptul că aceștia nu sunt implicați; uneori, cantitatea este normală, dar răspunsul la aceștia este exagerat.

Fumatul a fost, și el, corelat cu apariția acneii la maturitate, unele studii demonstrând că fumătorii au mai multe leziuni noninflamatorii (puncte negre/albe) decât cei care nu fumează.

Produsele cosmetice folosite în exces (poate cea mai frecventă cauză secundară) astupă porii, accentuează „dopurile“ comedoanelor deja existente și contribuie lent la creșterea numărului punctelor negre/albe și, într-un final, la apariția de leziuni inflamate.

Mai mult decât atât, aplicarea machiajului cu pensule sau bureți constituie un factor iritativ suplimentar. Din păcate, cu cât apar mai multe leziuni, cu atât femeile încearcă să le acopere mai mult, întreținând cercul vicios.

Se speculează și alți factori secundari, însă studiile sunt limitate și nu se poate spune cu certitudine dacă și care este legătura cu acneea tardă. Printre aceștia se numără: stresul, dieta scăzută în fructe, legume, pește, precum și factorii genetici.

 

Obiceiuri „bune“ care duc la apariția acneei la adulți

Așa cum am spus anterior, folosirea de prea multe produse cosmetice sau folosirea de cosmetice ce nu sunt noncomedogenice.

Pielea feței nu are nevoie „hăinuță“, așa cum am auzit undeva, ea trebuie lăsată să respire, bineînțeles, fără a o ignora în totalitate. Un alt obicei (poate nu neapărat considerat bun sau rău, însă extrem de important în apariția acneei) este sprijinirea bărbiei, mandibulei sau frunții cu mâna pentru a susține capul.

Multă lume face acest gest în mod involuntar, mai ales dacă lucrează la birou, iar dacă azi ai astupat două minute porii, peste trei zile te trezești cu coșuri la acel nivel.

Stoarcerea coșurilor cred că deja este considerat un obicei „rău“, însă puțini dintre cei care au coșuri se pot abține să nu le stoarcă.

Această manevră  rupe pereții punctelor albe/negre (care sunt ca niște mici butoiașe cu grăsime și bacterii), jumătate din conținut iese afară, jumătate se „revarsă“ sub piele, inflamând leziunile din jur. Și, cum le spun pacienților mei, un coș stors=10 noi coșuri.

 

Acneea și stilul de viață

Am punctat deja că fumatul agravează, dieta scăzută în fructe, legume sau pește se pare că ar avea și ea un rol, iar stresul, deși nedovedit prin studii clinice, sunt convinsă că influențează.

Aș mai aborda un alt subiect în ceea ce privește stilul de viață: există multe persoane care fac sport și merg la sală. Nedemachierea înaintea unui efort fizic susținut (în cazul femeilor) și nespălarea feței de transpirație după acesta pot fi factori favorizanți în apariția de noi coșuri.

 

Prevenția acneei

Prevenția este relativ simplă: spălarea corectă, dimineața și seara, cu un săpun/gel de duș destinat special pielii grase; evitarea folosirii cremelor grase sau a oricărui tip de ulei pe față;

dacă există o tendință de „încărcare“ a feței, adică pori mai dilatați, mai plini de sebum, se poate face fie un gomaj 1-2 ori pe săptămână, fie o procedură numită microdermabraziune;

evitarea folosirii zilnice de fond de ten sau pudră, preferând un BB cream, eventual care conține și factor de protecție solară, iar în cazul în care totuși este nevoie de fond de ten, acesta să fie oil-free, de tip mat; demachierea feței înainte de culcare și înaintea unui efort fizic intens.

 

Boli indicate de acnee

Da, acneea poate semnala anumite afecțiuni. Poate să fie una dintre manifestările unei probleme hormonale, în principal a hiperandrogenismului, așa cum am spus mai sus: sindromul ovarelor polichistice, tumori ovariene sau ale glandelor suprarenale.

Din acest motiv, un consult endocrinologic este indicat tuturor persoanelor care dezvoltă acnee la maturitate.

 

Tratament

În privința tratamentului, nu se face diferența în funcție de vârstă, ci în funcție de forma clinică și de severitate, folosind creme, pastile sau combinații, iar ca adjuvant, proceduri complementare.

Bineînțeles, înainte de toate, dacă se găsește o cauză internă, hormonală, aceasta trebuie tratată prima. Din punct de vedere dermatologic, mai întâi se tratează leziunile active, iar ulterior, dacă este cazul, se trece la tratamentul cicatricilor.

Particularitatea acneei la adulți, în ceea ce privește tratamentul: răspunsul este adesea destul de lent, iar recidiva nu este rară, mai ales dacă sau din cauza faptului că indicațiile pentru tratamentul de menținere (care este obligatoriu) nu sunt întotdeauna respectate cu strictețe.

 

Dr. Smaranda Nica este medic specialist dermatolog la Clinica Dermestet, www.dermestet.ro

Foto: Shutterstock

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