(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The main character of this case is a 21-year-old boy. Due to poor rest, lack of sleep and excessive alcohol consumption, a large number of red papular nodules rapidly appeared on his face within 3 days, accompanied by purulent changes, which seriously affected his appearance and health, and he then came to our hospital. After oral medication and topical medication, the local rash gradually subsided and the color of the face gradually returned to normal.
Basic information】Male, 21 years old
Disease Type】Burgeoning acne
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2021
Treatment plan】Oral medication (prednisone acetate tablets, doxycycline hydrochloride tablets) + topical medication (fusidic acid sodium ointment)
[Treatment period] 60 days of home medication
【Treatment effect】Red papules, nodules and purulent inflammatory acne on the skin surface subsided, and the skin color gradually returned to normal
I. Initial consultation
Patient’s description at the time of consultation: Three days ago, red papules started to appear on the face due to excessive fun and lack of rest, as well as heavy alcohol consumption. On examination, it was seen that the red inflammatory papules were densely arranged on the forehead, both sides of the cheeks, in front of the ear screen, and around the mouth, and there were nodule-like changes when the inflammatory papules were touched by hand. Based on the occurrence, development and clinical manifestations of the condition, the probability of fulminant acne was considered to be high. After communicating with the patient about his condition, the patient agreed to perform routine blood tests for preliminary judgment. The routine blood test results showed that the leukocyte values were elevated and met the diagnostic criteria for fulminant acne.
(Interview)
II. Treatment process
After finalizing the treatment plan with the patient, we chose to take prednisone acetate tablets orally with doxycycline hydrochloride tablets and topical fusidic acid sodium ointment. Prednisone acetate tablets are glucocorticoids with anti-inflammatory, anti-allergic and immunosuppressive effects. The topical application of fusidic acid sodium ointment on the local skin surface can reach the lesion through the skin cell gap, thus achieving the purpose of anti-inflammation. After the patient returned to the clinic to understand the medication method, he nodded and said he would actively treat the disease at home, and instructed the patient to follow up at any time.
III. Treatment effect
After 60 days of medication, the patient returned to the clinic for a follow-up consultation and said that the rapidly growing acne and nodular changes on the face had gradually stabilized without new skin damage after 7 days of medication. In about 15 days, the red inflammatory papules that could be seen gradually became lighter in color and formed nodule-like changes, with a tendency to gradually soften, and the pus was also significantly absorbed. In about 30 days, the red inflammatory papules on the face basically subsided, and the nodule-like changes, although existing, had been significantly reduced, and the pus-like changes completely disappeared. The red inflammatory papules on the face completely disappeared on the 45th day of medication, and the inflammation-like changes were present in a small amount under the skin. By the date of follow-up, the red papular nodular changes and purulent changes on both sides of the patient’s cheeks had completely disappeared, with light brown depressed marks remaining on the skin surface. The patient was instructed to gradually stop the medication and observe for a period of time before proceeding to pigment removal treatment.
IV. Notes
I am glad that the patient recovered from the disease after active treatment. Patients are instructed to use prednisone acetate tablets in strict accordance with the doctor’s instructions on how to use the drug to avoid triggering centripetal obesity after prolonged application. Individuals taking doxycycline hydrochloride tablets can cause stomach pain and nausea, and patients are advised to take them after meals to be able to alleviate the side effects. Do not squeeze the pus with your hands to avoid leaving depressed pits after squeezing. Acne flare-ups are closely related to work and rest habits, so it is important to reduce late nights and eat less spicy and sweet foods to avoid aggravation of symptoms, and to ensure adequate rest.
V. Personal insights
1. Fulminant acne appears quickly but fades slowly, and the treatment period is long, so have enough patience.
2, glucocorticoids oral drugs can quickly relieve the aggravated state of violent acne, and are generally used as the first treatment drugs.
3. Tetracyclines can assist in the treatment of acne-like diseases, and doxycycline hydrochloride tablets and minocycline hydrochloride capsules can effectively improve the clinical manifestations of violent acne.
4. After the fulminant acne subsides, the face may be left with acne pits or hyperpigmentation or persistent erythema, which can be removed later by choosing the appropriate medication or physical therapy.