In the previous article, we talked about how acne forms and how diet affects acne. Starting today, we will talk about medications as well as other treatments. Treatment must also be based on the cause of the disease. Let’s first review the process of acne formation. Under normal conditions, the sebum produced by the sebaceous glands is excreted through the sebaceous ducts from the openings of the hair follicles. When sebum is produced in excess and the sebaceous ducts are clogged, the sebum cannot be discharged properly and acne is formed. Microorganisms in the follicle, which are fed by sebum, begin to multiply. The metabolic products produced by the microorganisms will stimulate the skin to produce localized inflammation, resulting in the formation of inflammatory acne. Eventually, the secretion builds up, sometimes bursting the opening of the follicle, allowing the secretion to escape and the inflammation to subside; but sometimes the secretion breaks out and spreads, leading to widespread inflammation under the skin and the formation of the ultimate acne monster, nodular/cystic acne. For acne to form, one of the above factors is missing. Acne will not form if the sebaceous gland ducts have normal openings and sebum is excreted normally; acne will not form if the sebaceous gland ducts are hyperkeratotic but sebum production is low; and acne will not form if there are no microbial infections in the hair follicles. For those who can’t see it, think of a sebaceous duct as a clogged drain. So, multiple factors trigger acne and multiple strategies are needed to treat acne. Today, we will mainly introduce topical treatment medicines. I. Unclogging pores – for follicular epithelial overgrowth and keratinization Use acid! Dissolve the blocked channels open and promote the renewal of the stratum corneum, suppressing acne at the mildest stage and playing a preventive role. 1, hydroxy acids According to its hydroxyl position is mainly divided into α-hydroxy acids (AHA) and β-hydroxy acids (BHA). High school chemistry parents remember? Hydroxy acid is a molecule with a hydroxyl group – OH and a carboxyl group – COOH substances. AHA, or fruit acids, include lactic acid, glycolic acid, amygdalic acid, tartaric acid, malic acid, citric acid, and so on. Among them, lactic acid belongs to the skin’s natural moisturizing factor (NMF), which has a good moisturizing effect, is mild and dry skin friendly, and can also reduce oil secretion and improve pore size when used by oily skin. AHA is especially suitable for mild to moderate acne with acne scarring or uneven skin tone. ②Salicylic acid is the only BHA available, which is a lipophilic hydroxy acid that allows better penetration into the skin and improves epithelial keratinization. Salicylic acid’s low therapeutic concentration makes it more suitable for oily and sensitive skin, and is one of the ingredients in most acne skin care products. Salicylic acid has also a certain anti-inflammatory properties, million gold oil aspirin you know? The scientific name is called acetylsalicylic acid. Low concentrations of hydroxy acids can promote epidermal exfoliation and stimulate epidermal renewal by degrading the structure of bridge grains connecting cells and dissolving the adhesion between keratinocytes. High concentrations of hydroxy acids (i.e. chemical peels) will not only reach deeper treatment levels, but will also directly denature cells and tissues, which is dangerous and therefore must be performed by a medical professional. Fruit acid peeling although powerful, but the operation is dangerous, must find a reliable doctor oh. 2, Vitamin A Derivatives of vitamin A, is the core of acne treatment. It has the ability to reduce keratinocyte adhesion (dissolve acne, eliminate precursor micro-powder), inhibit melanin synthesis (reduce the formation of acne marks), anti-inflammatory and antioxidant, and stimulate the generation of collagen and other effects. A miracle drug! Knock on wood! Vitamin A acid in addition to acne have awesome effect, there is a certain anti-aging, promote the role of collagen regeneration, but the drug is never utility and side effects accompanied, and then the good drugs have to be used scientifically. Suggestions for use: 1, use should start with a low concentration, slowly build up tolerance. Please use low concentration medical skin care products, prescription products to be used under the guidance of a physician! 2, Vitamin A acid has photosensitivity, must be used at night, so, once a night can be. 3, improper use will induce “Vitamin A acid drug dermatitis”, erythema, itching, dryness, flaking and other symptoms. 4, pregnancy and lactation is prohibited, its effect on the fetus is not yet clear. Products are described below. Each retinoid can provide different activity, tolerability, and efficacy due to the different receptors it binds to. (First-generation retinoic acid binds α, β, γ receptors, third-generation retinoic acid selectively binds β , γ receptors) First-generation retinoic acid: irritating, photosensitizing, all-trans retinoic acid, isotretinoin, etc. ① Retinoic acid cream, Dewi Cream: the concentration of the blue packet is 0.025%, and the concentration of the yellow one is 0.1%, in order to build up the tolerance to start from a low concentration. ② Isotretinoin gel: for severe acne, can also be used to reduce pores, irritation, sensitive skin caution. The second generation of retinoic acid: avitamin A ester, avitamin A, mainly used for psoriasis. The third generation of retinoic acid: low concentration, good efficacy, more gentle, adapalene, tazarotene, etc.. ① Adapalene (Daphne): the most gentle miracle drug, please use it on the whole face! Don’t just dab it on your pimples. Imagine as a pore-unclogging, acne-preventing medication, applying it to only one side of your face, and asking for a mental image of the other half of your face. …… The latest opinion is that simultaneous medication on both affected and non-affected areas is the key to acne healing. However, other retinoids are slightly more irritating, so it’s better to dab them on. Second, energy conservation – treatment for increased sebum production Cleansing One characteristic of acne patients is that they basically have large oily skins, so cleansing and de-oiling is the basis of acne management and the application of other topical treatments. The main purpose of cleansing products is to remove dirt, oil, and cosmetics attached to the stratum corneum to reduce follicle clogging, and their main ingredient is surfactant, which removes the attached oil by adsorption. ① Soap-based products Most contain anionic surfactants (e.g., alkyl carboxylic acid lipids, SLS/SLES), which are saponified by lipids and alkali, and have strong cleansing power and are alkaline (pH 7.5-9.5). Suitable for oily fields and brown skin. Like sulfur soap kind of cleaning power extremely strong products please advanced players to use, ordinary users do not force to use. Sulfur has an oil control and sterilization effect, but the cleaning power is too strong, please use discretion. ② nonionic surfactants and amino acid surfactants, such as acylglycinate, not only has a mild cleaning ability, but also the pH value of neutral to weakly acidic, more consistent with the physiological conditions of the skin, dry skin and sensitive skin applicable. Many cleansing products are mixed formulations, you can choose according to your skin type skin condition. Please be careful not to wash your skin five times a day! Don’t wash with too cold or too hot water either! The sebum on the surface of the skin effectively protects and moisturizes the skin, reducing external damage to the skin. Washing your face is not like brushing the dishes, and over-cleaning can cause damage to the barrier function. Therefore, you should choose products that can effectively clean and take into account gentleness to achieve a clean and non-tight effect as the standard. Intercellular lipids and sebaceous membranes provide a good barrier for the skin. A refreshing moisturizer should also be used after cleansing, otherwise the skin will think why is there no sebum to protect me?! Fag happy, and in turn secrete more oil. It’s also important to streamline your daily skincare routine, reduce the use of heavy sealers (such as oil-based creams and serums), and pay attention to ingredients when buying skincare and makeup products to avoid stepping on mines. And please give away any masks you have in your hands, promise me, okay? The mask will only exacerbate the sebaceous gland blockage. For reducing oil production, topical products are not the best way to treat the symptoms. The main culprit of excessive sebum secretion is the soaring high androgen, after the conversion of androgen (testosterone → dihydrotestosterone) can be directly combined with the sebaceous androgen receptor, stimulate the sebaceous gland development and sebum secretion. So, all of you in the Big Apple, you need to pay attention to whether or not androgens are too high? There are many reasons for elevated androgens, the most common being puberty when the gonads are developing, well, that’s how acne comes about. I am, when I was young, a face of acne, now acne no longer, people are also old… In addition, the diet favors sweets, that is, high GI diet will also cause androgen. See → “acne” from the mouth, these you have to pay attention to So, in addition to the correct daily cleaning, the oil fields have to pay attention to whether other aspects of the problem. For example: is not eating too sweet, too much stress; is not polycystic ovary syndrome (PCOS), if acne serious, repeated + irregular menstruation + hairy or obese please move to the obstetrics and gynecology department to do the relevant examination and treatment Oh; simple hyperandrogenism, please cooperate with the spironolactone, cimetidine for acne treatment. Sterilization and anti-inflammation – treatment for microbial infection Although acne has microbial infection, it is not an infectious disease, but a chronic inflammation of the sebaceous glands of the hair follicles. Therefore, the medication is different from infectious diseases. 1. Antibiotics When acne occurs, the proliferation of Propionibacterium acnes is the most common, and can also be accompanied by other bacterial (e.g. Staphylococcus aureus) infections. Commonly used antibiotics include fusidic acid, clindamycin, chloramphenicol, metronidazole and so on. When the inflammation is obvious, systemic medication can be used, commonly used doxycycline, minocycline. The above drugs should be used under the guidance of a doctor, their own indiscriminate use of bacterial drug resistance, and finally no drugs available, God can not help. 2, other antimicrobial agents are mainly benzoyl peroxide (BPO), and other azelaic acid, tretinoin, sulfur and so on. The antibacterial property of benzoyl peroxide (BPO) lies in the fact that it can release oxygen molecules to penetrate deep into the hair follicles after use, and Propionibacterium acnes is an anaerobic bacterium, which is one of the standard medications for acne treatment as it can rapidly inhibit the target bacterium through the creation of an aerobic environment unfavorable to its survival and does not produce drug resistance. Suggestions for use: 1, BPO has 2.5%, 5.0% and 10.0% concentration, and like Vitamin A acid should start from a low concentration, generally use 2.5%, 5.0% can be used, the use of 10% is not very meaningful. 2, BPO theoretically can also be coated all over the face, but the beginning of a low concentration of spot coating the affected area is better, if you think it is still too stimulating, you can first apply a layer of skin cream and then on the medicine. 3, BPO is not photosensitive, so it can be used during the day, and can be used as a long-term acne prevention. 4, BPO side effects are mainly redness, stinging, dryness, peeling, burning sensation. 5, BPO intolerance can choose azelaic acid, sulfur as an alternative. Fourth, sun protection, we all know that acne is a light exacerbation of the disease, right? Then do not properly sunscreen! UV rays will not only make the skin more oily, but also lead to acne pigmentation. Five, acne and acne scars must wait until the acne is good and then treat the acne scars, or else while growing while treating really not worth it, and scientific anti-acne, early control, the chances of leaving marks and scars are also much smaller. For the sake of our face, a little patience, OK ~ Conclusion: acne causes complex, affecting many factors, the treatment should also be comprehensive treatment, this article is mainly to introduce some mainstream topical products, and other photoelectricity, physical, and systemic medication and other treatments. Acne treatment is a psychological battle, so the first step must be to set the right mindset, the repetition of the treatment process is normal, do not be impatient, listen to what formulas and false propaganda is the biggest irresponsibility to themselves. Acne has different treatment options for different levels and different people, so it’s important to find a professional doctor who can customize a “private anti-acne program” based on your own situation. In addition, some skin conditions that are not acne can also look like acne, so it’s best to go to the hospital to see a doctor to determine the cause of the problem before treatment. Acne is a disease, it must be treated, and it is not difficult to do so, so I hope that everyone can be cured as soon as possible.