Acne vulgaris
Acne vulgaris is a chronic inflammatory disease of the hair follicles and sebaceous glands. It mostly occurs in young men and women. It occurs mainly on the face and back of the chest and other fatty areas, often accompanied by seborrhea. It is self-limiting and mostly heals or reduces after puberty. In Chinese medicine, it is equivalent to “lung wind acne” and “facial sores”.
Etiology
1. Endogenous factors: endocrine dysfunction, increased secretion of androgens or relatively high secretion, stimulation of sebaceous gland hypertrophy and hyperplasia, increased secretion of oil.
2, Causes: neuropsychiatric factors; dietary preferences for spicy, oily, dry constipation, sleep and other personal behavior factors; smoking, alcohol and other hobby factors; drug factors; cosmetics and skin conditioning factors, oily skin, etc.
Clinical manifestations
1.Punctate acne: Blackhead acne is the main damage of acne, is stuffed in the follicle sebaceous gland mouth of the cheese semi-solid, exposed in the hair follicle mouth of the outer end of the black, such as pressure squeeze, can be seen in the head is black and the body is yellow-white translucent lipid plugs discharge.
2.Papular acne: The lesions are mainly inflammatory papules, small hard papules from millet to pea size, light red to dark red. There may be a blackheaded pimple or an unblackened sebaceous plug at the tip in the center of the papule.
3, Pustular acne: Pustular manifestations are predominant, with pustules the size of grain to green beans, follicular pustules and pustules formed at the top of the papule, with thicker pus after breaking, leaving a shallow scar after healing.
4, nodular acne: When the inflammation site is deep, pustular acne can develop into thick-walled nodules of varying sizes, light red or purplish red. Some are located deeper and have significant elevation while in a hemispherical or conical shape. They can persist for a long time or be gradually absorbed, and some septic ulcers form significant scarring.
5.Atrophic acne: Papular or pustular damage destroys the glands and causes pit-like atrophic scarring. Fibrotic changes and atrophy can be caused by ulcerated pustules or naturally absorbed papules and pustules.
6. Cystic acne: Sebaceous cysts of varying sizes are formed, often secondary to purulent infection, and often bleed jelly-like pus after rupture, while inflammation is often not heavy, and later sinus tracts and scarring are formed.
Treatment】
1, general treatment: pay attention to dietary habits, eat less spicy, fat-rich food and sweets, eat more fresh vegetables and fruits, adjust the function of the digestive tract. Wash the affected area with warm water and soap, and avoid squeezing with hands.
2.Oral medications: antibiotics to control infection, endocrine regulation, micronutrient therapy (oral zinc for papules and pustular acne has a positive effect, and vitamin A acid).
3. Local treatment: Reduce sebum secretion, remove excessive pore blockages, achieve anti-inflammation, sterilization, light exfoliation, remove acne, and prevent secondary infection. It is possible to use V-A acid, benzoyl peroxide and antibiotics.
4.Physical therapy: Superficial X-ray treatment: can produce temporary inhibition of sebaceous glands and is effective for scarring acne. Ultraviolet therapy: It can inhibit the growth of bacteria, kill bacteria and reduce sebum secretion. Cryotherapy: Effective for scarring and coalescent acne.
[Prevention].
Avoid drinking alcohol, drinking more water, avoiding constipation, eating more fresh vegetables and fruits, and not taking acne-inducing drugs; reduce exposure to acne-inducing factors (such as mineral oil). Therefore, they must be relieved of their worries, treated correctly, and given instructions on what to pay attention to in their daily lives, such as not squeezing the damaged area with their hands and using the correct medication.
Seborrheic dermatitis
Seborrheic dermatitis is a chronic inflammatory skin disease that occurs in areas with high seborrhea. The cause is not well understood. Currently some researchers believe that the disease is based on seborrhea, the normal flora of the skin surface dysbiosis, the growth of Malassezia furfur increased.
Clinical manifestations
1. The rash is usually found on the scalp, eyebrows, eyelids, nose and sides, behind the ears, neck, forehead and upper back interscapular area, axilla, groin, umbilicus and other areas rich in sebaceous gland distribution.
2.Self-perceived symptoms are varying degrees of itching.
3.Infant seborrheic dermatitis often occurs in the first month after birth, the lesions are mostly on the scalp, forehead, between the eyebrows and cheeks, as exudative erythematous patches, with thick yellow greasy crust.
4, according to the different performance of lesions can be divided into dry and wet two categories. Dry is mostly erythematous desquamative damage, wet is mostly papules, blisters, scratching can produce erosion, exudation, and yellow scabs, often itchy, the disease is slow, recurrent, most often in the seborrheic area, often confined to the scalp, serious can be to the face, nasolabial folds, eyebrows, eyelids, the middle of the chest and back, umbilicus and groin or axillary development, the lesions are initially follicular small papules, gradually fused into varying sizes of The lesions start as small follicular papules and gradually fuse into yellow-red patches of varying size, covered with greasy scales and crusts, and in severe cases may present as mild exudative eczema-like dermatitis, confined to a certain area or generalized, or even develop into erysipelas.
Treatment
I. General treatment
Restrict sugar and fatty diet, avoid irritating food, avoid scratching, and live a regular life.
Second, local treatment
Mainly is to remove fat, sterilization, anti-inflammatory and anti-itch.
1, compound sulfur lotion (Ku’s lotion), 1 time per night for external use, 5% sulfur ointment for external use; selenium sulfide shampoo (Hilsen) or sulfur soft soap, 1-2 times a week to wash the hair.
2, antifungal preparations, such as 2% ketoconazole lotion (trade name Cele) or 1% bifenbendazole shampoo, bath, 3% clotrimazole cream, 2% miconazole cream, bifenbendazole cream, etc. can be used, but it should be noted that such drugs may have irritating and allergenic effect on the skin.
3, vitamin B6 cream, skin cream, vitamin E cream, etc., can be used in rotation, 1 to 3 times a day.
4, glucocorticoid preparations in the rash inflammation is heavy, itching is obvious, you can add discretion, such as 1% hydrocortisone cream or 0.1% hydrocortisone butyrate ointment, tretinoin chloramphenicol cream, 0.05% dexamethasone ointment, etc., choose one, 1 to 2 times a day topical application. Note that long-term application is not recommended for facial and thin skin lesions to avoid local side effects of hormones, such as acne, capillary dilation, skin atrophy and pigment changes.
III. Systemic treatment
1. Vitamin B complex, 2 tablets, 3/d orally; vitamin B6, 10-20 mg, 3/d orally; vitamin B complex injection, 2 ml, daily or once every other day intramuscularly.
2.Antihistamines 1-2 kinds can be chosen orally for the purpose of antipruritus.
3.Glucocorticoid Mainly applied for a short time when the inflammation is obvious or the rash is widespread and cannot be controlled by other treatments, prednisone can be given, 20-40mg/d, divided into 2-3 times orally.
4.Antibiotics When severe seborrheic dermatitis or obvious exudation, choose minocycline 50-100mg, 2/d orally or erythromycin or antifungal agent such as etravox 0.1-0.2, 2/d orally. The course of treatment is 1-2 weeks.
【Prevention】
Wash hair and bath regularly, keep skin clean to reduce microbial parasites, skin oil more people, should be 2-3 times a day with warm water, sulfur soap wash face, less or no cosmetics, diet should eat less animal fat, carbohydrates and stimulating food, avoid smoking, alcohol, eat more fresh vegetables and vitamin B-rich food.
Rosacea
Rosacea is a chronic skin disease that occurs mainly in the center of the face with red spots and dilated capillaries. It is also called rosacea because the nose is purple and red like wine dregs. It is mostly seen in middle-aged people between 30 and 50 years old, more women than men, but serious cases are usually seen in men.
Etiology
The exact cause of rosacea is unclear, and a variety of factors may trigger or aggravate the disease, including local vasodilatory nerve disorders, follicular worms and repeated local infections, use of spicy foods, alcohol consumption, hot and cold stimuli, mental tension, emotional excitement, and endocrine dysfunction. In recent years, H. pylori infection and the relationship between immune factors and this disease have also begun to attract attention.
Clinical manifestations]
The course of the disease is slow, usually divided into three stages, and there is no obvious boundary between the stages.
1, erythema capillarum dilatation phase: manifested as erythema mainly in the middle of the face, but also accumulated cheeks, forehead and chin. Initially, the erythema can be obvious when eating spicy and stimulating food, sudden change of temperature and mental and emotional tension and excitement, and then become persistent erythema, and gradually appear capillary dilation in the shape of dendrites, mainly distributed in the tip of the nose and nose. It is often accompanied by enlarged pores and increased sebum secretion. It can last for several months to several years, and then turn into the papulopustular stage.
2. Papulopustular phase: On the basis of erythema and capillary dilation, acne-like follicular papules and pustules appear repeatedly, but no acne is formed. The lesions can sometimes appear as deep inflammatory nodules or cysts.
3, nasal superfluous period: due to long-term congestion, repeated infection, connective tissue proliferation and abnormal enlargement of sebaceous glands in the nose, the formation of elevated nodules of different sizes, resulting in the appearance of the tip of the nose hypertrophy, deformity such as superfluous organisms. The enlarged sebaceous glands are visible on the surface of the nasal redundancy, and when squeezed, there are streaks of white sticky sebum overflowing. Severe nasal redundancy is mostly seen in men over 40 years old.
4, eye: mostly seen in postmenopausal women and nasal superfluous period of men. It manifests as blepharitis, conjunctivitis, occasionally causing keratitis and iritis, and patients may have dry eyes, foreign body sensation, tearing, photophobia, blurred vision and other symptoms.
Diagnosis
Based on the clinical manifestations and age of onset, this disease can be diagnosed and needs to be differentiated from the following diseases.
1, acne: younger age of onset, typical whiteheads and blackheads acne can be seen.
2. Seborrheic dermatitis: The distribution may not be limited to the face, but the scalp and other seborrheic areas may also be involved, with obvious scaling and pruritus. There is no obvious capillary dilation.
Treatment
1, general treatment: usually avoid spicy and stimulating food and alcohol, avoid exposure to the sun and excessive cold and heat stimulation, avoid mental tension, maintain a good state of mind and life rules. Gastrointestinal diseases should be treated in a timely manner, to keep the bowel movement smooth. Adjust endocrine disorders.
2, local medication: can be used topically to reduce erythema papules, pustules of anti-inflammatory and antiseptic drugs, can be used Lincomycin, fusidic acid cream, metronidazole gel, etc.. Some topical preparations have adverse reactions of local irritation, which should be explained to the patient, and should be stopped or changed when not tolerated. Topical application of all medications needs to be accompanied by topical application of mild skin care products, such as vitamin E cream, to reduce the irritation of the medication on the skin and to aid in the recovery of barrier function. Those with eye involvement can choose tetracycline eye ointment, aureomycin eye ointment, etc.
3. Systemic treatment: If the papules and pustules are more serious, or if mites are detected on site, oral medication can be used. Tinidazole, tetracycline, etc. can be used. For those who do not respond well to antibiotic treatment, a small dose of retinoic acid can be used. For those with combined H. pylori infection, they can be treated as H. pylori infection. For patients with severe rosacea during menopause, treatment with estrogen has some effect.
4.Other treatment: For those with obvious capillary dilation, laser treatment has satisfactory effect. The nasal superfluous stage can be treated with excision or grinding for cosmetic effect.
Section 4: Baldness
Alopecia areata is commonly known as “ghost shaving”. It is a term used to describe the unexplained loss of a large amount of hair in a short period of time, resulting in hair loss patches with neat borders of varying sizes. Patients are often unaware of this when they get a haircut or are discovered by others.
[Etiology and Pathology
The etiology of alopecia areata is not clear. Apart from hair loss, the patient is in good general health, but hair loss is usually preceded by mental overstrain or exertion. Early on, a lymphocyte-dominated infiltration of the hair bulb and hair papillae area can be seen. In the later stages, the number of inflammatory cells is significantly reduced, with a large number of resting and regressed hair follicles.
[Clinical manifestations].
Baldness can occur at any time from childhood to adulthood. It is usually a round patch of hair loss the size of a coin or larger. In rare cases, it can progress to complete loss of hair throughout the rest of the scalp body. During the active phase of the disease, lightly pulling on the hair at the edge of the patch can feel it very loose and can easily pull it out and see the shrinking and thinning of the hair follicle area.
[Treatment
In most cases, the hair will regrow on its own. In severe cases, patients need to see a doctor for medical treatment. Topical sebaceous steroids can be applied topically, or local seal. Topical application of 0.1% minoxidil solution can promote hair growth. If necessary, laboratory tests are also needed to exclude the possibility of systemic disease.
Hyperhidrosis
Hyperhidrosis is a disorder in which excessive secretion of sweat glands is caused by overexcitation of the sympathetic nerves. The sympathetic nerve governs sweating throughout the body. Normally, the sympathetic nerve regulates body temperature by controlling sweating and heat dissipation, but the sweating and facial flushing of patients with hyperhidrosis completely lose their normal control, leaving the patient in a state of helplessness, anxiety or panic on a daily basis.
Clinical manifestations
1. Generalized hyperhidrosis often has a moist skin surface and paroxysmal sweating. Local hyperhidrosis is common in the palms of the hands, feet and plantars, axillae, followed by the tip of the nose, forehead, pubic area, etc., mostly in adolescents, patients are often accompanied by peripheral blood circulation dysfunction, such as wet and cold, bruised or pale skin of the hands and feet, prone to frostbite, etc. Sweaty feet due to poor evaporation of sweat, resulting in impregnation of the epidermis of the soles of the feet and white, often accompanied by foot odor. When the armpit and pubic sweat, because the skin is thin and tender, often moist friction, easy to occur erosion erythema, accompanied by folliculitis, boils, etc.
2, palms sweating too much, hands too wet and afraid to shake hands with others, even when writing will be too much sweat on the hands and stain the paper;
3, foot sweating often make socks, insoles wet, can feel the bottom of the foot will slip when walking, and even too much sweat impregnated skin, making the skin white, between the toes erosion, often leading to fungal, bacterial breeding, causing foot odor, ringworm, etc.; armpit sweating can be seen sweat dripping down from the armpit, clothes are often soaked with sweat. When there is bacterial invasion infection, the armpit can not only emit an unpleasant odor (i.e., armpit odor), but also complicate skin inflammation, etc.