Dermatologist Lyubov Khachaturian on the causes and treatment of acne

Acne is a cunning disease. On the one hand, it is so trivial and seemingly frivolous that it seems easier to do nothing and wait until everything goes by itself. On the other hand, acne can really ruin your life: terrible skin problems bring people to clinical depression and pre-suicidal states, as in Stephen King's “Losing Weight” story. The situation is aggravated by the fact that it is in the fight against acne that people tend to resort to traditional and unofficial medicine, to google treatment methods and to prescribe many, sometimes very strong drugs themselves. As a result, we have to fight not with acne, but with irreversible damage to the skin, as well as with planted liver, stomach and kidneys (thanks to the incorrectly chosen tablets). And this is definitely not going to go away.

In order to deal with the main controversial issues, we spoke with Lyubov Khachaturian, the founder and chief physician of the ROSH medical center. Khachaturian is a doctor of medical sciences at the Interstate University of Ruthenia (international diploma), a full member of the AESEM, the International Mesotherapists Society, a dermatovenereologist, a cosmetologist, a laser therapist and an expert in invasive techniques. She told us whether acne is directly related to the puberty period, what it can turn out to be, as well as how and from whom it should be treated.

Acne may appear in general at all, or for this need a predisposition?

Acne is a multifactorial disease: in order for it to occur, many different variables must coincide. It used to be that this is a teenage disease that starts because of hormones. But then it became clear that acne occurs at any age: for someone it occurs at 40-50 years old, for someone it starts, passes and returns. I always ask patients whether there were inflammations before, whether problems arose during adolescence. I answer that yes, there were, but then everything went away! The fact is that people only look at their momentary state and call the disease only severe exacerbations. And when they jump up a little sometimes, they think: "Just think, this is nothing."

Later they began to say that the appearance of acne is associated with heredity, and this is also true: you can do a genetic analysis and tell you which diseases you are prone to. But this is just a predisposition. It all depends on lifestyle, environment, nutrition, cosmetics, diseases that change the state of the body. The combination of these moments can develop in such a complex that will shoot in the form of acne. The same can happen with oncology, and with cardiovascular diseases - with anything. Genetics is such a story that even if something is embedded in you, but you do not smear every day with different creams, do not squeeze acne, watch the bowels, nutrition, psycho-emotional state, then the propensity does not shoot. A number of measures can be taken that will protect against future problems.

Acne cannot be tied only to age or genes, it occurs for a variety of reasons, and there is no universal answer. But it is important to understand that if there are problems with the skin, it means that you have something wrong with your health. Man is a closed self-regulating system, each part of which is occupied by something of its own. If there is a defect in some part, then the rest will first try to take on the additional load, but after a certain time the system will fail if it is not dealt with. The skin is a mirror of the body, the largest of our organs, and if something appears on it that was not there before, it is worth it to get confused. I am not talking only about inflammations - this applies to redness, peeling, papillomas, warts, moles. Do not self-medicate, as 99% of our population, and go to the doctor. For the good, which is sufficiently educated and prescribes drugs, whose action is well aware.

And how to understand that inflammation that has leaked out on the forehead is not the result of an extra cocktail on Saturday evening, but a reason to see a doctor?

Very simple. If you did not touch the skin, there were no injuries and wounds (refers to men who shave) - and you have a pimple jumped, then do not worry. Go to the pharmacy, buy alcohol, cauterize. But if the inflammation jumps over and over again, it is worth thinking. The microflora of the skin surrounds us like a spacesuit. We literally glow with the number of microbes that we have, but at the same time someone has acne, and someone does not. This means that someone has skin as a protective screen, and someone else has damage. If the immune system of the skin is all right, then it will send to the place of damage of those "soldiers" who suppress all inflammatory processes. If this does not happen, then something goes wrong.

That is, even a few systematically leaping acne - is there any reason to contact a specialist?

Of course. Everyone's immune system is different, it depends on the level of problems. For someone, everything is limited to one or two inflammations, someone says that exacerbations occur before menstruation (just at this moment the body is in an unstable state due to changes in the hormonal background), some people have food allergies that cause skin problems, but not everyone. Many come - and do not know why they started having acne, because before that, everything was more or less normal. It is necessary to contact immediately, but not when you already have the whole face in the abscesses.

If I see that my loved one has serious skin problems, and instead of treatment, he runs around the drugstores and buys all sorts of "beauty", how can I tactfully tell him about this?

That's a very difficult question. I am a doctor, and sometimes I cannot figure out how to tell a person who is sitting at my reception that he needs to treat the skin. People are offended. They believe that you climb into their personal affairs that do not concern you. Some will be grateful, while others will say: "What a nasty, I came to her with another problem, and she recounts my acne." But I still say. I will never do an aesthetic procedure if I see at least one inflammatory element on my face. It is absolutely contraindicated! In the West, for this license is selected. There are indications and contraindications for aesthetic procedures: inflammation, herpes, autoimmune diseases are contraindications, you cannot do Botox or prick the same hyaluronic acid. What can be biorevitalization, if a person has acne? I do not understand. In addition, when a person has inflammation on the face, in no case should you clean it. It will only get worse, and in two days you will be covered in exactly the same, because cleaning is a very serious procedure: after it the pores open, the skin becomes sensitive.

People are different. Someone because of any small pimple runs to the doctor, while others mask severe inflammation. The most difficult category - patients who actually tried to recover, went to the doctors, passed tests, but nothing happened. They worry, get nervous, start drinking antidepressants, which they themselves write out for themselves. The problem here is that they cannot find a person who, from beginning to end, will lead them through all the treatment. They give up. Sometimes a patient comes to see me, and I see that he has serious problems, a skin disease, and he asks me to give him a Botox injection. I look and think: "When will a person say that his problem is not wrinkles?" Then I ask: "But you do not see this problem?" And they answer me: “You know, I have been living with it for so many years, but you can cover up the inflammation, I’m also getting old.”

And what is the risk of too late an appeal to a specialist?

It all depends on the state in which the person comes. There are many classifications, but I like the simplest: mild, medium and severe acne. Light - the number of inflammatory elements is small, they appeared recently and only in one area, and in this case you can get rid of acne quickly and permanently. The middle form is already the presence of dense elements, the area captured by them is large (face, back, shoulders, buttocks), hypodermic bumps appear, which cannot be squeezed out: if you pierce them with a needle, blood will flow, but the lump will remain. And the severe form is when everything is at once and in large quantities, the skin relief is broken.

The result of treatment is associated with the stage of acne and with the individual abilities of the skin to recover (everyone has different possibilities of regeneration). At the initial stage, we will cure everything. If we address later, say, a few years after the onset of the disease, we will be able to relieve inflammation and even out the relief. In completely neglected cases, we relieve the aggravation, after which the patient must undergo annual courses of supporting procedures in order not to return to the inflamed state. But we are not gods: if the skin is damaged so much that irreversible changes have occurred to it, we will not be able to make it glossy.

That is, not all forms of acne can be cured?

As part of the editorial experiment for two journals, I treated girls with severe acne: they went to my receptions and then told me how the treatment was going on. One was younger and with more serious problems, the other is older and less serious. As a result, we saved the first acne, but she still has minor scars. The second one has everything in relief with relief, but it was not possible to save it from periodic small eruptions. This is due to symptom disorders: she needs to undergo hormone replacement therapy prescribed by an endocrinologist gynecologist, but she cannot do this because she has congenital liver disease. And I can't fix it. With this, of course, it is unpleasant to live, but one two-pimple on perfect skin with complete absence of foundation and disguised by kilograms of acne cosmetics, with which she came to me, are still different things.

Do you give advice on choosing cosmetics?

Yes of course. Usually for patients who are gradually moving away from drugs, I recommend the professional brands of caring lines. I am now talking only about those people who had problems - acne can return. I recommend them special creams, cleansers, some SOS-remedies in case of inflammation. Cosmetics depending on age and skin condition may vary. As for decorative products, I never call specific brands. I do not care if you use powder for two hundred euros or two hundred rubles a la "Swan's Down": it often happens that the compositions of these agents are not very different. I repeat, it is better to give preference to crumbly powders: they fit well on a moisturizer and also cover imperfections, but not as heavy as the tonal foundations.

When a person has decided that he still needs to be treated, which doctor should he go to - a beautician or a dermatologist?

You know, this separation happened not so long ago. In theory, all cosmetologists should be dermatologists. Recently, you can choose only cosmetology as your specialty and get a diploma in it, which is bad, because the field of knowledge has become very narrow, focused on aesthetic medicine and has moved away from diseases. In my opinion, if you are a good doctor, you should own your profession as it should. I believe that if there is a rash, you must still go to a dermatologist. The education system at the moment is such that not all cosmetologists can engage in treating skin problems. But if you find a good cosmetologist with a dermatological diploma, you can go to him.

What, regardless of the stage of acne, age and health problems, you can not do to any person with problematic skin?

Every patient who comes to me fills out a medical card. On the last page, he signs in accordance with the conditions of treatment. The last point: "You can not squeeze anything, go to the bath, sauna, solarium, apply foundation and self-medicate without the consent of the doctor." Solarium and sun - absolutely not. The sun's rays improve our overall condition, but are the strongest immunosuppressants, and people who suffer from acne always have problems with the immune system. In addition, you need to thoroughly wash - most of all I love ordinary baby soap.

And if the skin is dry?

Nothing wrong. When you have inflammations on your face, you cannot moisturize them, they need to be dried. You just need to apply the right cream then, there will be no dryness.

How is the treatment plan formed?

I start with a long consultation - I don’t know how some people manage to consult a patient in ten minutes. I ask everything since birth: what hurt, what allergy, what eats, how it lives. On the first page of our medical record there is a questionnaire that a person must fill out himself, and some leave it empty - they think that all these facts from the past do not matter. And everything is important: diseases of youth, some things related to sex life, even if you have ever had antritis, prostatitis or cystitis. From this consists the overall picture.

Then there are specific for each blood tests. Then I check all the patients on the bioresonance therapy device, and if its results are not enough, then we check the blood again. In some cases, we send to additional doctors, because any doctor must first of all be a good general practitioner, able to find the problem and refer the patient to the right specialist. With serious problems of the gastrointestinal tract, I send to a gastroenterologist, someone I send to an endocrinologist, some should work with a psychiatrist or psychotherapist. I'm talking about cases where the patient has no skin problems, but he constantly picks it up due to psychological problems. This is involuntary behavior, and when I see it, I realize that I can’t help with anything, you cannot cure it with ointment. It’s very hard to work with such people.

What is the duration of treatment for a person who is starting to treat acne?

Not less than six months, in severe cases - a year. But this does not mean that throughout the year you will have to go to the doctor every day: your first and a half months will be the most active. Yes, the first improvements may come in less than six months, but you will not be cured faster than this period. Often people in a couple of months see a positive result - and disappear. When the under-treated person comes back to me and says that I did not help him, I open the card and show him that he broke the treatment plan and did not follow my recommendations.

I warn about the terms of treatment in advance, although I can’t give an exact date a day. One dad brought his daughter to me and demanded a number from me: "Here I am a builder and I know for sure how much I will raise a wall, tell me too!" But this is not a building, it is impossible here. Much depends on the reaction of the person: someone has to prescribe a more benign procedure or lighter medications, so the period increases. And after the end of treatment, you need to go to supporting procedures: someone once a month, someone once a year. It’s like teeth: we all clean them twice a day at home, but we still need to go to the dentist every six months.

We are now in Moscow, your clinic is one of the most famous, and treatment with you is expensive. And many are frightened by the order of prices for procedures, even in other cities and with other specialists, so people rake all the money from the pharmacy shelves: they hope it will be cheaper. What is the real cost of acne treatment?

Difficult to say, because all the numbers are calculated individually. A year and a half ago, I had a patient who, with the most serious form of acne, that’s not a single living place on his face, came specially to us to the clinic from Vladivostok. He was 25 years old, and his psychological state was simply terrible - he came to me with the words: "I am ready to hang myself." He brought a huge folder with the results of analyzes, which he passed and spent on which he spent a hundred thousand rubles (in 2013) with a salary of three times less than this amount. And he killed me, how much unnecessary things he did.

It happens that a patient comes from another city - then I give him a list of tests and he hands them over. We are now all very mobile - a patient from Finland recently flew to us, for example, and she had to come to the reception every three months. If you see that there is no result, it does not mean that everything is in vain. Just go to another doctor and listen to another opinion. In our clinic, completely different people are treated: students, celebrities, and those who live from paycheck to paycheck. Someone can master certain things financially in a month, and to someone we paint the same program for three months.

The person has been treated, he did everything right, but what about the self-esteem, from which almost nothing remains? Do you advise patients something?

We must learn to love ourselves, to be strong and confident. If someone makes an incorrect remark to you, you just need to understand that these people behave like this because of their ignorance. From the point of view of a dermatologist, healthy skin should be smooth, evenly colored, well-hydrated, strong (resistant to any external influences), dense and able to withstand the forces of gravity. And do not pay attention to the point of view of strangers.

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