Acne vulgaris is commonly known as acne. It is a chronic inflammatory skin disease of the sebaceous glands of the hair follicles. Although acne vulgaris can often be naturally reduced or healed after puberty, acne vulgaris itself and the scarring and acne marks caused by untimely treatment can seriously affect the psychology of the patient and have a great impact on social life, causing varying degrees of mental stress and economic burden.
In Chinese medicine, it is thought to be related to internal heat from yin deficiency, inflammation from deficiency fire or internal toxicity from damp heat fumigating the skin. Western medicine believes that it is mainly related to hyperandrogenism, increased sebum secretion, hyperkeratosis of the epithelium at the mouth of the hair follicle, Propionibacterium acnes and genetic factors. After puberty, the level of androgens in the body, especially testosterone, rises rapidly, promoting the development of sebaceous glands and producing large amounts of sebum. At the same time, abnormal keratinization of the sebaceous ducts of the hair follicles causes blockage of the ducts, which leads to the formation of keratin plugs, or microcomedones. A variety of microorganisms, especially Propionibacterium acnes, proliferate in the hair follicles. The lipase produced by Propionibacterium acnes breaks down sebum to produce free fatty acids, which also chemotactic inflammatory cells and mediators, eventually inducing and aggravating inflammatory responses.
Clinical Manifestations It occurs mainly on the face, and in some cases, also on the chest and back. Acne lesions can be classified as non-inflammatory or inflammatory. The non-inflammatory ones are acne, which are divided into open and closed. Closed acne (also known as whiteheads) are skin-colored papules about 1 mm in size with no visible follicular opening. Open acne (also known as blackheads) is a dome-shaped papule with a significantly dilated follicular opening. The acne progresses to various inflammatory lesions that appear as inflammatory papules, pustules, nodules, and cysts. Inflammatory papules are red in color and range from 1 to 5 mm in diameter; pustules are uniform in size and filled with white pus; nodules are larger than 5 mm in diameter and are hard and painful to touch; and cysts are deeper in location and filled with a mixture of pus and blood. These lesions may also fuse to form large inflammatory plaques and sinus tracts, etc. Inflammatory lesions often leave behind hyperpigmentation, persistent erythema, and depressed or hypertrophic scarring after they have resolved. Clinically, acne is classified into 3 or 4 grades according to the nature and severity of acne lesions: Grade 1 (mild): acne only; Grade 2 (moderate): some inflammatory papules in addition to acne; Grade 3 (moderate): more inflammatory papules or pustules in addition to acne; Grade 4 (severe): nodules, cysts or scarring in addition to acne, inflammatory papules and pustules.
Diagnosis Diagnosis can be made based on the age of onset and the characteristics of the lesions, and no other tests are usually necessary.