Acne vulgaris and the most popular and new cosmetological treatments

Acne vulgaris is a disease that has an enormous impact on appearance of the skin of the patients and also on their quality of life. Long‐term dermatological treatment, which often lasts years, and disease relapses contribute to the occurrence of low self‐esteem and depression. Acne is one of the 10 most common diseases in the world and the most common inflammatory skin disease. Many methods of dermatological treatment that bring very good results are available. However, educating people with acne on how to take care of their skin on a daily basis to minimize the bleak effects of the disease is an extremely important element. Contemporary cosmetology creates an environment for not only taking care of the skin at home, but also develops in‐office treatments with exfoliation of the dead epidermis as an extremely important and priority part of treatment. The cosmetologist can propose both chemical and apparatus methods, which are selected individually for each client.

cysts and infiltrates that cause acne scars. 7 The course of acne, the appearance of the skin during treatment, as well as the occurrence of possible acne scars, and postinflammatory discoloration affect the quality of life of people suffering from acne. Scientific research shows that their quality of life is significantly reduced and differs to a large extent from the quality of life of the healthy people. Patients are ashamed of their appearance, and isolate themselves from their peers, which further leads to an increased level of anxiety and shame, and finally to depression. 8 For this reason, cooperation between dermatologists, psychologists, and cosmetologists is very important when it comes to patients with acne.
Many cosmetological methods are available for people with acne. They include both well-known treatments and new modalities that can exfoliate dead epidermis and reduce skin eruptions and acne scars. 9 This review article shows how a cosmetologist can help patients with acne vulgaris.

| Cosmetic acids
Cosmetic acids have an established position in the treatment of acne and have been used for this purpose for a long time. First of all, acneprone skin should be cared for with gentle exfoliation. Excess of C.
acnes bacteria and strong keratosis of the hair follicles can negatively influence the skin with acne. Regular exfoliation helps to cleanse the skin pores, reduces the colonization of C. acnes bacteria, eliminates inflammation, and opens the sebaceous glands. However, it should be remembered that this type of treatment should be preceded by skin preparation, treated as a supplement to anti-acne therapies and conducted in close cooperation with a dermatologist. Chemical peels penetrate the skin to different depths depending on the concentration and type of exfoliant used. The most commonly recommended and used acids include glycolic, mandelic, azelaic, salicylic, and trichloroacetic acid (TCA). Researchers show that the combination of several substances gives much better results than using them separately. 10,11 Salicylic acid is an organic compound that belongs to the group of aromatic hydroxycarboxylic acids. Its use decreases the pH of the skin, which improves the protective properties against various pathogens. Allergy to salicylates can be a problem in some people, so it is important to exclude any contraindications to treatments with a given type of acid. It should be noted that salicylic acid has a milder effect than most acids and is often used to treat noninflammatory lesions. 12,13 Glycolic acid belongs to organic compounds classified as αhydroxy acids. It has a low molecular weight and therefore penetrates well into the epidermis. It can be obtained from natural materials (sugar cane, pineapple, sugar beet) and chemical sources. At lower concentrations, it has a moisturizing effect, while at higher concentrations, above 20%, it has an exfoliating effect. Concentrations above 50% stimulate regenerative processes and improve skin elasticity. 14,15 Azelaic acid belongs to the group of carboxylic acids. It is an organic chemical compound characterized by many positive effects on the skin. This acid inhibits the growth of C. acnes bacteria and exerts an anti-inflammatory, antiseborrheic, exfoliating, and lightening effect (it inhibits melanin synthesis). More importantly, it can be used to treat inflammatory lesions in acne vulgaris. 16,17 TCA is used not only in anti-acne therapies but also in removing skin discolorations and acne scars. It is one of the strongest acids and has different side effects depending on the concentration used. The depth of TCA penetration can be determined by observing the degree of whitening of the epidermis; it is the so-called frosting effect. If the whitening is not clear, it means that a superficial peeling has been performed. When the skin frost is mild, it means that the peel was superficial. Visible frosting of the epidermis indicates that the dermal-epidermal border was damaged (medium-deep peel). If the skin has a slightly yellowish tint with the frosting, it means that the peel was deep. A yellowish tinge on the skin indicates the release of plasma within the coagulated proteins. In the case of using TCA alone, side effects can appear, such as strong epidermis exfoliation, redness of the skin, as well as its increased sensitivity. 18-20

| Microdermabrasion
Microdermabrasion has been a very popular treatment for many years. These procedures are of several types, for example, corundum, diamond, and oxybrasion. Diamond microdermabrasion has been the most popular method for years. In this treatment, controlled exfoliation is conducted under vacuum using different degrees of gradation of diamond crystals. Other factors that contribute to the final effect are the force of pressure of the cosmetologist's hand, work velocity and time, during which the diamond-tipped wand acts on the skin. [21][22][23] Microdermabrasion affects not only the surface of the epidermis but also many processes that take place in the skin. During the procedure, inflammatory mediators that stimulate cell division within the epidermis are released. Furthermore, the synthesis of collagen, elastin, and glycosaminoglycans is stimulated in the dermis. Diamond microdermabrasion treatment is often combined with cosmetic acids, as well as sonophoresis, needle-free mesotherapy, and needle mesotherapy. [24][25][26] Thanks to the exfoliation of the outer layer of the dead epidermis, penetration of the active substances used in the abovementioned treatments improves.
Scientific research has shown for years that the synergy of at least two cosmetic treatments gives better results than a single treatment. tympanites, and diarrhea. The research results confirm that drinking alkaline water significantly improves health conditions. [36][37][38][39] Hydrogen purification is a relatively new procedure used in cosmetology for mechanical exfoliation of the epidermis. Treatment uses alkaline water, which is obtained using the device and the process of electrolysis. The pH of the alkaline water prepared for the treatment ranges from 8 to 10. Thus, it is highly alkaline and has a negative oxidation-reduction potential. During electrolysis, a direct current is passed between two electrodes (cathode and anode), which are separated by a semipermeable membrane. The elements contained in water are broken down into hydrogen ions (H+), which move toward the cathode, and hydroxyl ions (OH−), which move toward the anode. H+ ions form ionized alkaline water. In addition, it contains alkaline elements such as calcium, magnesium, potassium, hydrogen, and alkaline hydroxyl ions. Negative OH− ions create acidic water, which additionally contains chlorine, sulfur, phosphorus, positive acid ions, and oxygen. The main factor responsible for the reduced oxidation potential of alkaline water is the active molecular hydrogen contained in alkaline water.
Indications for treatment include not only acne vulgaris, but also enlarged vessels, sensitive skin, discolorations, loss of firmness, shallow wrinkles, skin prone to seborrhea, skin requiring cleansing, or open blackheads. In the method, two treatment modules can be

| CON CLUS IONS
It affects not only the skin, but also the soul of the patients. Poor

FU N D I N G I N FO R M ATI O N
We received no funding for this project.

CO N FLI C T O F I NTE R E S T S TATE M E NT
All the authors declare that there is no conflict of interest.

E TH I C A L S TATEM ENT
Authors declare human ethics approval was not needed for this study.

DATA AVA I L A B I L I T Y S TAT E M E N T
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.