Acne is a chronic inflammatory skin disease that occurs in adolescents and involves the sebaceous glands of hair follicles. Untreated severe acne can leave behind hyperpigmentation and scarring, causing a great psychological and financial burden to the patient. Treatment for severe acne has been based on oral antibiotics or isotretinoin, but the results are not ideal for some patients. In fact, some new treatment methods are quite good, such as photodynamic therapy, which is a new technology that has been continuously developed in recent years and has the ability to kill Propionibacterium acnes, inhibit sebum secretion and anti-inflammatory effects, and can be used to treat severe acne with better treatment results. The following is a brief breakdown of some of the issues related to the mainstream approach to severe acne. Tracing the root cause of severe acne: A common cause of severe acne is the irregular treatment of mild to moderate acne. In the view of many patients, mild acne is simply a “no-brainer”, so they can go to the supermarket and buy a series of acne cleansers, “comedian” and some other so-called “pure herbal” preparations. The “pure Chinese medicine” preparation of the “ancestral” miracle medicine to smear on the line. These “acne” products in the early use of the process will often have a relatively good effect, but continue to use the problem came, “effect” is not obvious, some patients also occurred in the skin allergies, red blood and other phenomena. “Skin allergies and redness are usually related to the fact that these topical products contain more or less hormones. The actual dermatological disease is considered a small risk, so many people who do not have a medical background quietly opened up a “professional acne” “Miao Fang Qing Yan” “contract acne” workshop. The so-called “special effects” treatment was carried out by too many patients who chose these “institutions” with better treatment results than hospital doctors, and many of these patients’ conditions worsened. With the incorrect use of various “ancestral” “prescriptions”, a large number of inflammatory papules appeared, and the rashes soon formed pustules and cysts, which developed into severe acne. . Severe acne produces cosmetic stress, psychological stress and financial stress: Acne is not a symbol of youth, much less a sign of youth. If you can proudly consider yourself youthful every time you get acne, it means that your optimism has made you ignore some real skin problems. Acne, especially severe acne, often puts pressure on patients in many ways: cosmetic pressure, psychological pressure, and the resulting financial pressure to spend a lot of money on treatment. Mild acne can also lead to anxiety, depression and other psychological problems that affect the quality of life of many patients. Severe acne usually results in pustules, nodules, cysts and scarring on top of the original acne and inflammatory papules. If you are a gay man, you may be a little sloppy, “a little pit, a little scar” does not matter, but if you are a lesbian, it is different, you want to get rid of these “pits and scars” may need to spend a lot of your gold line and time to do fruit acids, to do laser to solve these problems. These treatments are often more expensive. Medications for severe acne: Treatment for severe acne often requires systemic oral medications. Commonly used medications include retinoids, antibacterial drugs and other drugs such as glucocorticoids. 1, retinoic acid drugs: retinoic acid is a compound structurally similar to vitamin A, which is absorbed quickly after oral administration. The drug has the effect of reducing the volume of sebaceous glands, inhibiting the activity of sebaceous glands, reducing sebum secretion, reducing the keratinization of hair follicle epithelial cells and inhibiting Propionibacterium acnes, as well as inhibiting the formation of superoxide and its enzyme activity, thus having an anti-inflammatory effect. Usually, the effect of isotretinoin treatment starts in the second week, that is, the sebum secretion is reduced and the inflammation begins to subside. By the 6th week, the effect is obvious. As the course of treatment increases, the cure rate and efficiency rate increases, and satisfactory results are obtained in 8 to 12 weeks. Patients may also experience some side effects in the process of use, such as dry mouth, dry eyes, dry nasal mucosa, dry skin, mild hair loss, arthralgia, the severity of adverse reactions is dose-dependent, the higher the dose, the more pronounced the symptoms. It should be noted that the metabolic cycle of retinoids is long and may lead to malformations, therefore, female acne patients of childbearing age should use and discontinue these drugs under the guidance of a doctor. Therefore, female acne patients of childbearing age should stop taking such medications under the guidance of a doctor. They should also visit a dermatologist for consultation before pregnancy. 2, antibacterial drugs: Another class of drugs for acne treatment is macrolide antibacterial drugs. Studies have found that up to 40% of patients are resistant to tetracycline and erythromycin drugs, resulting in poor acne treatment. 3, other drugs: Of course, when necessary, in addition to applying retinoids and antibacterial drugs to treat acne, we will also apply other drugs in combination with the patient’s condition, such as anti-androgen drugs (birth control pills, Advil), glucocorticoids and traditional Chinese medicine. Photodynamic therapy for severe acne: 1. The theoretical basis of photodynamic therapy for acne Photodynamic therapy is gradually being accepted by clinicians and patients as a safe and effective physical treatment method, and has become a new trend in acne treatment. There are two factors that affect the effect of photodynamic therapy: one is the sensitizing agent, and the other is the light source. The most commonly used sensitizing agent in China is aminoketovaleric acid, and the mainstream light source for this treatment is red light of a specific wavelength. Photodynamic treatment of acne is based on exogenous administration of photosensitizers such as ALA, which can be absorbed by epithelial cells and sebaceous glands of hair follicles and converted into endogenous photosensitizer PPIX through the heme synthesis pathway, and generates singlet oxygen and free radicals when irradiated by red light of specific wavelength, which selectively kills Propionibacterium acnes, inhibits sebaceous secretion and destroys the structure of sebaceous glands of hair follicles. In addition, 632 nm red light can stimulate macrophages to release cytokines and secondary promote fibroblast proliferation and growth factor production to achieve anti-inflammatory and pro-repair effects. 2.The steps of photodynamic therapy for acne Before treatment, if there is abscess formation on the face, perform incision and drainage, and clear the wound. After cleaning the skin with cleanser, take a supine position and use injected water to clean the lesions and surrounding skin. The photosensitizer is prepared in a 5 ml syringe using sterile water for injection into a solution with a concentration of 5-10%. A thin layer of sterile skimmed cotton is applied to the facial acne lesion and a 0.5 cm area around it, and then 1 ml of the prepared solution is evenly dripped onto the skimmed cotton until it is soaked through. After 1.5-2h exposure of skin lesions, irradiate with 632nm photodynamic therapy instrument, irradiation distance of 10-15cm for facial skin lesions, fine-tune the irradiation distance according to the patient’s sensitivity to light, irradiation time of 20-30min. after irradiation, patients are advised to avoid light and sunlight for 24-72h, treat once every 1 week, 3 times a course of treatment. 3.Preparation and instruction before, during and after photodynamic therapy Pre-treatment preparation: Know whether the patient has any previous history of light allergy, whether he/she has taken photosensitive drugs in the past two weeks; know the patient’s general condition, whether he/she has other systemic diseases, and whether he/she is pregnant or lactating. All patients signed an informed consent form. Use saline to clean the face before each treatment. Preparation for treatment: The most common adverse reaction during treatment is slight discomfort, burning sensation, and pins and needles at the site of illumination, which can be tolerated by most patients. Patients wear special goggles during treatment. Keep the light beam perpendicular to the irradiated area during the irradiation process. Post-treatment instructions: Patients are instructed to avoid bright light for 24 h, not to wash their faces for 48 h, and to avoid contact with hot water in the treated area for one week. 1 week later, they can basically resume normal outdoor activities, but they should also pay attention to avoiding light. Some patients may experience crusting and peeling of the face 2~3 d after treatment, so patients are advised to let it fall off naturally and avoid forced peeling. Mild and moisturizing drugs such as allantoin cream, vitamin E cream and silicone oil cream can be applied topically to relieve the tightness of the face. Patients are advised to eat less spicy and stimulating food, avoid fried food, eat more fruits and vegetables, low-fat and low-sugar diet, eat more food with high fiber, keep bowel movement smooth; regulate life routine, pay attention to rest, keep a comfortable mood, avoid staying up late and anxiety; avoid prolonged sun exposure and stay away from ionizing radiation to reduce oil secretion. In some patients, mild adverse reactions such as slight burning and stinging sensation, erythema, swelling and exudation do not need special treatment after treatment, and can generally subside on their own within 1 week. In rare cases, pustules appear after 2 days of treatment, which can be treated with topical anti-infective drugs such as fusidic acid ointment and can gradually subside. The hyperpigmentation that appears after the treatment usually fades within 3 months after the end of the treatment. 4.An example of photodynamic treatment for severe acne The patient, male, was treated with special effects of traditional Chinese medicine in a cosmetic institution for acne, and then visited the clinic with generalized pustules and cysts on his face. Non-pharmacological treatment of severe acne IPL treatment Intense pulsed light (IPL) is a non-invasive treatment method commonly used in the clinical treatment of acne. The IPL wavelengths used to treat acne are mainly high-energy blue light of a specific spectrum, which can penetrate the skin and efficiently kill Propionibacterium acnes, and also have a killing and inhibiting effect on Staphylococcus epidermidis and Malassezia ovata, and can remove inflammatory reactions and lipid plugs in the hair follicles. Without damaging the skin, pigment cells are selectively absorbed and destroyed by intense pulsed light, and the destroyed pigment cells are phagocytosed by tissue cells and lymphocytes and metabolized with the lymphatic tract to treat hyperpigmentation. Although IPL has great advantages in treating acne, many patients are not able to accept it for financial reasons because of the high cost of laser phototherapy.