Acne is commonly known as acne, pimples, acne vulgaris, and acne vulgaris, and in ancient Chinese medicine, it was called facial sores and wine spurs. It is a common disease in dermatology. According to scholars, 95% of males and 85% of females suffer from acne of varying degrees during adolescence, so it is apt to call it “acne”. Acne is a chronic skin disease that occurs in the sebaceous glands of hair follicles, mostly on the head and face, neck, chest and back, and other areas rich in sebaceous glands. The pathogenesis of acne is not well understood. Endocrine factors The role of sebum and microorganisms in the hair follicle are the main factors in the development of acne 1. In men, the organs that secrete sex hormones are the testes and adrenal glands; in women, it is the ovaries, placenta and adrenal glands. Progesterone and dehydroepiandrosterone (DHA) in the adrenal cortex are also involved, and the latter may play an important role in early acne. Testosterone is converted to the more active 5-alpha dihydrotestosterone in the skin by 5-alpha reductase, which stimulates sebaceous gland cell turnover and lipid synthesis, resulting in increased sebum secretion and the production of thick, abundant sebum that cannot be completely excreted. At the same time, the follicular ducts become hyperkeratotic due to androgens, and the follicular walls become hypertrophic, preventing sebum excretion. The epithelial cells shed from the follicular walls increase and mix with the thick sebum to form a cheese-like substance, which is then plugged into the follicular opening to form acne. Later, the tip exposed outside the follicular opening gradually dries out and is discolored by air oxidation, melanin deposition, and dust pollution to form blackheads. The presence of Acinetobacter in the follicle, Staphylococcus albicans, and Bacillus ovalis, especially Acinetobacter, contains esterases that break down sebum, and the sebum in the follicle is broken down by lipases to produce more free fatty acids. In recent years, it has been suggested that the disease is immune-related and that the serum IgG level is increased in patients’ humoral immunity and increases as the disease worsens. Recently, it has been shown that low zinc in acne patients may affect the utilization of vitamin A and promote the keratinization of sebaceous glands in hair follicles. Low copper may weaken the body’s resistance to bacterial infection. In addition to the above factors, eating more animal fats and sugary foods, gastrointestinal disorders such as indigestion or constipation, mental stress, and other factors such as heat and humidity can have a negative impact on acne patients. In septic lesions, the affected tissue is abscessed, surrounded by many lymphocytes and multinucleated leukocytes, and sometimes staphylococci can be found. The periorbital skin is never involved. At the beginning, patients almost always have blackheads and oily seborrhea, and often have papules, nodules, pustules, abscesses, sinus tracts, or scarring, with various sizes and depths of damage, often with one or two types of damage predominating. Blackhead acne is the main damage of acne. It is a creamy semi-solid stuffed in the mouth of the sebaceous glands of the hair follicles. If squeezed with pressure, the head is black and the body is yellowish white with translucent sebum. Pustular acne is dominated by pustules, which are the size of grains of rice to green beans, and pustules formed at the top of the papules. After rupture, the pus is thicker and leaves a shallow scar after healing. They can be long-lasting or gradually absorbed. Some pus ulcers form prominent scars. 5. Atrophic acne Papular or pustular damage destroys glands, causing pit-like atrophic scars. The most serious type of lesion is polymorphic, with many pimples, papules, pustules, abscesses, cysts and sinus tracts, scarring, and keloids occurring in clusters. 8. Malignant acne is a greenish-red or purplish-red papule, pustule or nodule the size of a millet to a pea, which is light, soft, and contains pus and blood. This type is mostly seen in weak patients. 3. Examination: Check the shape of the lesion, its distribution, the presence of papules, pustules, blackheads, nodules, cysts, scars, etc. 4. It is easy to squeeze the acne and damage the dermis, leaving behind a lifelong regret of hollows and blemishes. Treatment can reduce the lesions, but they are difficult to subside completely and can be aggravated or reduced periodically with endocrine changes. Tetracycline can be used in small doses for a long course of treatment, starting with 0.25g 4 times a day for one month. Clindamycin is the best alternative to tetracycline. It is suitable for patients with severe inflammation or tetracycline resistance. 1) Ethylene estradiol In severe cases, ethylene estradiol 1mg can be taken internally once a day for 10 days as a course of treatment If used by female patients, it should be started 5 days after menstruation For female patients with premenstrual exacerbation, ethylene estradiol 0.25-0.5mg can be taken daily for 2-3 weeks after the start of menstruation It is prohibited for patients with embolic disease, hemiplegia, liver disease, and abnormal uterine bleeding 2) It has also been used for female patients Chorionic gonadotropin (500-1000 U intramuscularly once a week) is not applied 5-10 days before menstruation.3) Progesterone In severe cases and in female patients with premenstrual exacerbation, progesterone 10 mg intramuscularly 10 days before menstruation and 5 mg of anti-androgen therapy 5 days before menstruation can reduce the skin Antiandrogen therapy can reduce the free fatty acid content of the skin surface and reduce the number of bacteria on the skin surface, thus preventing or/and reducing the inflammatory reaction in and around the hair follicles to varying degrees and achieving a therapeutic effect.1) Ampicillin 20mg per dose 3 times a day.2) Ketofurazole 200mg per dose daily and change to 100mg per dose after one month.3) Cimetidine 400mg per dose 3 times a day and change to 200mg per dose 3 times a day after one month. (3) The above three drugs are very effective in the treatment of female acne.4) Ciprofloxacin (1 tablet daily for men for 4 weeks) 0,625mg for women on the 5th day of menstruation for 22 days.5) Methocarbamol (0,2g orally 3 times a day before meals) 4 weeks as a course of treatment.6 It is believed to have anti-androgenic effects, blocking the binding of dihydrotestosterone to hair follicle receptors, inhibiting sebum excretion, and reducing inflammation.7 Corticosteroids themselves can cause acne damage. For severe cystic acne and coalescent acne, small doses can reduce the inflammatory response, but they are only temporarily effective. Good for nodular and cystic lesions 13-cis-retinoic acid 1-2 mg/kg in two doses for 2-3 weeks If a second course is needed, it should be repeated after 8 weeks of discontinuation The lesions may continue to improve after discontinuation, but there may be dry skin, labial inflammation, digestive symptoms, malformations, etc. Pregnant patients should be contraindicated during and for 6 months after discontinuation of DDS, which may have anti-inflammatory effects For cystic and nodular damage 50mg orally twice daily for 1 to 2 months Attention should be paid to the hematological system Side effects of liver damage Zinc preparations Inhibit hair follicle keratinization or inflammation Zinc gluconate 70mg 3 times daily for 4 weeks or zinc sulfate 0,2g 2 to 3 times daily for 4 to 12 weeks Gastrointestinal side effects Vitamin class 1) Vitamin B2 B6 and multivitamin B2) Vitamin A (150,000 U per day for 4-8 weeks 3) Vitamin A 150,000 U per day and vitamin E 50 mg per day for 4-8 weeks Select topical treatment The purpose of topical treatment is anti-inflammatory, antibacterial, degreasing, remove excessive oil and grease from the skin surface, remove pore blockages, so that the sebum flow out of the skin to keep the skin clean and control the infection can be washed with hot water and soap 1 to 3 times a day with a better soap containing sulfur antibiotics 1% chlorine tincture (chloramphenicol) (+salicylic acid) 2% erythromycin alcohol 1% jessamine solution etc. Benzoyl peroxide has antiseptic, keratolytic and solubilizing effects, inhibits sebum secretion, reduces free fatty acids, but a few patients have reactions to benzoyl peroxide topical application, which can produce contact dermatitis, so a patch test should be done before using the drug. If there is local irritation after using the drug, such as erythema, flaking, etc., it should be suspended for 1 to 2 days and then continue to use it or start from a low concentration until the skin tolerates it. Physiotherapy mask There are two kinds of facial masks: herbal mask and inversion mask. Before doing so, both clean the skin first, then apply medicine, spray and massage, so that physical therapy, massage and medicine are integrated into one, and interact to achieve the purpose of treatment and beauty 1) herbal mask Add a small amount of honey to the mask powder and mix it with water to make a paste, then apply it to the face while applying the spray and massage techniques of Chinese medicine in the direction of acupuncture points and blood circulation. 2) Inverted mask Add different drugs to the base to make various creams and then apply the cream to the face while spraying and massaging for a few minutes Cover the eyes, nose, mouth and beard with skimmed cotton and then mix the plaster with water to make a thin paste and apply to the face immediately. Inject into severe nodules and cystic lesions with saline diluted with 0.05 to 1 ml (10 mg per ml) once a week for 3 to 4 consecutive times.