The most common type of acne seen in dermatology is the “big red pimple”. Because acne seriously affects the patient’s image, it is necessary to treat it for the sake of “saving face”. We often refer to “big red pimples” as inflammatory papules or pustules. In the previous article, we introduced the form of inflammatory papules and pustules, but this time we will talk about how to treat them. Inflammatory papules usually evolve from acne, when the patient squeezes the acne with his hands or other factors cause the acne to become inflamed and infected, an inflammatory papule will form, and if the infection is further aggravated, a pustule will form. Pustules and papules are treated in the same way, but are very different from acne. The cause of inflammatory acne is an inflammatory infection, so the first step is anti-inflammatory treatment. A commonly used topical medication is benzoyl peroxide gel, which is usually used in combination with topical anti-inflammatory medications. Commonly used topical anti-inflammatory medications include clindamycin hydrochloride rub and fusidic acid ointment. Benzoyl peroxide is a bactericidal agent that targets Propionibacterium acnes and can reduce drug resistance when used in combination with anti-inflammatory drugs. Let’s talk about the most important issue for patients: how to use the medicine? 1. Clindamycin hydrochloride is a liquid. When using it, dip a small cotton swab into a small amount of the drug and apply it to the pustules. After cleansing the face in the morning and evening, apply the medication to the acne area and then apply skin care products (avoiding the medicated area). If the patient’s skin is particularly dry, it is okay to apply skin care products first and then apply the medication. Clindamycin hydrochloride rub is used once a day in the morning and once a day in the evening. 2. Benzoyl peroxide gel: After using clindamycin hydrochloride or fusidic acid at night, apply benzoyl peroxide gel again. Benzoyl peroxide gel is highly irritating and can cause skin peeling and redness, so just apply it to the acne, not a large area or even the whole face to avoid stimulating the skin. During topical treatment, if the patient has menstrual disorders, he or she can take oral menstrual regulating drugs at the same time; patients who are prone to fire and constipation need to adjust their diet and take oral fire-clearing and laxative drugs. All of these will play an auxiliary role in the treatment of acne. Second, oral tetracycline antibiotic treatment When the above treatment is not effective, oral antibiotics are needed to strengthen the treatment. There are many kinds of oral antibiotics that people commonly use: penicillins, cephalosporins, aminoglycosides, macrolides and so on, but not all of them can be used to treat acne. Penicillin and cephalosporin antibiotics can treat gram-positive bacteria, while Propionibacterium acnes is a gram-negative bacterium. Drugs that target this bacterium and act on the sebaceous glands need to be taken, and tetracycline antibiotics are preferred to reduce the number of Propionibacterium acnes on the skin for the purpose of making acne better. However, tetracycline antibiotics have the side effect of dilating the blood vessels in the brain, and some patients may experience dizziness and headache after taking the medication, which can be recovered after stopping the medication. If patients cannot tolerate or are allergic to tetracyclines, they can use macrolide antibiotics such as erythromycin, azithromycin, and doxycycline. Because tetracyclines are not commonly used, the incidence of drug resistance is much lower. If patients can tolerate them, try to use tetracyclines. Our acne treatment guidelines require that oral antibiotics be used continuously for 6-8 weeks with no interruptions in between. Some patients feel better after taking them for a period of time and stop taking them privately, but when the symptoms worsen, reapplying the medication may not be effective. When a patient has both inflammatory papules or pustules and acne at the same time, treatment should be mainly anti-inflammatory, and acne should be treated after the inflammation subsides. The treatment of inflammatory acne is also a constant battle, and regular and continuous medication is required to achieve therapeutic results. It is emphasized that patients should never squeeze pustules. It may seem that squeezing out the pus will make the acne heal quickly, but the inflammation deep in the follicle is still there, and squeezing it out will not heal the acne and will cause the lesions to leave scars. Pustules will absorb on their own when medication is used properly, and they are better treated than scars. Therefore, if you tolerate pustules for a while, you will get a scar-free face in return.