Disease description.
Acne vulgaris (Acne), commonly known as acne, is a chronic inflammatory disease of the sebaceous glands of the hair follicles and is one of the most common diseases in dermatology.
Pathogenesis
Acne is a multifactorial disease, and its pathogenesis is mainly related to sex hormone levels, sebaceous gland secretion, proliferation of Propionibacterium acnes, abnormal keratinization and inflammation of follicular sebaceous ducts.
Clinical manifestations
The lesions mainly occur on the face, but also on the upper chest and back and shoulders, and occasionally on other areas, while the periorbital skin is never involved. At the beginning, patients almost always have blackheads and oily seborrhea, but also often have papules, nodules, pustules, abscesses, sinus tracts or scarring, and the size of various kinds of damage varies in depth, and often one or two of them are predominant, with a long duration of the disease and mostly without conscious symptoms. Most patients can heal naturally or have their symptoms reduced after puberty.
1, Dot acne (Dot 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 squeezed, can be seen in the head is black, while the body is yellow-white translucent fat plugs discharge.
2.Papule sex acne (Papule sex acne) The lesions are mainly inflammatory papules, small hard papules from millet to pea size, light red to dark red, with a blackheaded pimple or unblackened sebaceous plugs at the center of the papule.
3.Pustular acne (Pustular acne) is dominated by pustular manifestations, with pustules the size of grains to green beans, follicular pustules and pustules formed at the tip of the papule, with thicker pus after breaking, leaving shallow scarring after healing.
4.Nodular acne (Nodular acne) When the inflammation site is deeper, pustular acne can develop into thick-walled nodules of varying sizes, light red or purplish red, some in deeper locations, with significant elevation and in hemispheres or cones, they can exist for a long time or gradually absorbed, and some pus ulcerated to form significant scarring.
5, Atrophic acne (Atrophic acne) papular or pustular damage destroys the glands, causing pit-like atrophic scarring, and ulcerated pustules or naturally absorbed papules and pustules can cause fibrous changes and atrophy.
6.Cystic acne (Cystic acne) forms sebaceous cysts of varying sizes, often secondary to purulent infection, and often bleeds jelly-like pus after rupture, while inflammation is often not heavy, and later forms sinus tracts and scarring.
Polymerized acne is the most severe form of acne, with many pimples, papules, pustules, abscesses, cysts and sinus tracts, scarring, and keloidal clusters.
8, malignant disease acne (Evil disease sex acne) damage for millet to bean-sized greenish-red or purplish-red papules, pustules or nodules, light soft, and contains pus and blood, they do not heal for a long time, later healed leaving tiny scar, also do not feel pain, infiltration is also rare, this type is mostly seen in patients with physical weakness.
Disease grading
Severity grading helps to choose the correct treatment plan, and is currently graded according to the international modified method as follows.
1. Mild (Grade I): mainly acne with a few papules and pustules and less than 30 total lesions;
2.Moderate (Grade II): acne, moderate number of papules and pustules, total lesions of 30-50;
3.Moderate (Grade III): a large number of papules and pustules, occasionally large inflammatory lesions, widely distributed, total lesions between 51-100, less than 3 nodules;
4. Severe (Grade IV): Nodular, cystic and or sexual acne with pain and cyst formation, with more than 100 total lesions and more than 3 nodules or cysts.
Differential diagnosis
1, Rosacea Most often occurs in middle-aged people, also known as rosacea. The distribution of lesions can be similar to acne, such as on the, tip of the nose, both cheeks, forehead and chin. There can be localized capillary dilation, papules, and pustules in the late stages of nasal redundancy formation. Rosacea does not have the typical appearance of acne.
2.Occupational acne Acne-like damage at the contact site of workers who come into contact with industrial oils such as petroleum, motor oil and paraffin.
3, pharmacogenic acne Patients who take corticosteroids, bromine, iodine and other drugs can develop acne, the onset of a wide range of sites, the front and back can be involved, stopping the drug on its own.
Acne prevention
1, scars, excessive scar hyperplasia is an important complication of trauma, trauma, there are many causes of scars, such as: burns, trauma, trauma, acne (acne), ear piercing, vaccination, all can form different degrees of scar hyperplasia and scars.
The main purpose is to remove the factors that cause scar growth, reduce the growth of scars, prevent scars from causing deformities and dysfunctions to the body, and pay attention to minimizing mechanical, chemical, and thermal stimulation of the affected area when serious, avoiding repeated pulling, rubbing, and infection.
3, usually pay attention to prevent trauma, burns, ear piercing, eyebrow line, etc. to avoid damage to the dermis, especially the parts of the poor service free function, such as the chest, back of the shoulder, etc.
4. After acne heals, dark spots are usually left behind. These spots are as unsightly as acne because when acne grows, the germs stimulate the pigment cells near the acne, so dark spots are left behind after acne heals, and this reaction is called inflammatory pigmentation.
Acne diagnosis and differentiation
Acne can be diagnosed based on the fact that the patients are mostly young people, that it occurs on the face and upper chest and back, and that there are blackheads and pimples, but it should be differentiated from
1. Acne-like drug rash caused by bromine and iodine There is a history of taking drugs, there is no typical blackhead pimples, the rash is generalized, and the onset is not limited by age.
2, occupational acne Contact with coke distillation oil, machine oil, petroleum, paraffin, chloronaphthalene and other compounds can cause acne-like rash, usually related to the occupation, while working personnel often occur in the same damage, the damage is often very dense, often occurring in contact with the site, such as the back of the hand, forearm, elbow, etc.
3, rosacea Most often seen in middle-aged people, the rash occurs only on the face, with the central part of the rash, often accompanied by hair cell vasodilation.
4.Facial disseminated acne vulgaris The damage is mostly dark red or brownish papules and small nodules, and the lesions are arranged in a dike pattern at the lower edge of the eyelid, with applesauce-colored changes visible on slide compression, and the damage is not consistent with hair follicles.
What is the best food for acne?
First, eat more foods rich in vitamin A. Vitamin A can promote the proliferation of epithelial cells, which can mediate skin sweat glands and eliminate acne. Foods rich in vitamin A include goldenseal, leeks, carrots, spinach, milk, animal liver, etc.
Second, eat more foods rich in vitamin B2. Vitamin B2 maintains the body’s hormonal balance and has a protective effect on the skin. Foods rich in vitamin B2 include animal offal, milk, eggs and green leafy vegetables, etc.
Third, eat more foods rich in vitamin B6. The main ones are animal liver, kidney, egg yolk, milk, dried yeast, grain and wheat germ, fish and vegetables (carrot, spinach, shiitake mushroom). Health and wellness
The fourth is to eat more foods rich in zinc. Such foods include oysters, animal liver, lean meat, milk, eggs, etc., of which oysters and other seafood are more abundant. Health knowledge
The fifth is to eat more cool food. These foods are mainly lean pork, mushrooms, silver fungus, black fungus, celery, bitter melon, cucumber, winter melon, wild rice, mung bean sprouts, soybeans, tofu, lotus root, watermelon, pear, etc.
What not to eat for acne
Do not smoke, do not drink alcohol or strong tea, eat less spicy food (such as chili, onion, garlic, etc.), eat less greasy food (such as animal oil, vegetable oil, etc.), eat less sweets (such as sugar, coffee, etc.), and eat less “hair” (such as dogs, mutton, etc.).
Preventive care
1) Pay attention to facial cleanliness: wash your face with warm water, because cold water is not easy to remove oil, hot water promotes sebum secretion, no irritating soap, sulfur soap has certain benefits for acne, do not use snow cream and other greasy cosmetics.
2) A reasonable diet: eat more vegetables and fruits, less fat, sugar and spicy and other stimulating foods, and keep your bowels open.
3) Do not squeeze the pimples with your hands to avoid pus inflammation and the formation of scars and pigmentation after the pustules break down and are absorbed, which affects the beauty. Antimicrobials are effective for heavy infections.
4) Treatment: The use of retinoic acid, vitamin, and vitamin A can improve the keratinization process and will help reduce and eliminate acne. It has been reported that benzoyl peroxide has obvious efficacy in treating acne. After it is applied to the human surface, it can slowly release oxygen and has obvious bactericidal effects. Take 0.5~1% zinc sulfate solution, 30ml 3 times a day. Generally, it is used for 4 to 8 weeks. A small amount of vitamin B6 cold cream can be rubbed locally during the medication period, which also has a good effect.
For women with acne who also have abnormal menstruation, a small dose of ethylene estradiol, 0.25 mg orally daily, can be used for artificial cycles, which can lead to improvement of acne and return to normal menstruation. At the same time, the combination of Chinese acne prescription and physiotherapy with drugs can activate blood circulation, adjust blood flow and improve skin circulation to achieve the effect of healing.
5) Combining work and rest and keeping a happy spirit are very beneficial to the treatment of acne. Don’t be burdened by acne, so as not to cause neuroendocrine disorders and aggravate acne. If you feel that the acne on your face is not a problem, you do not have to use medication. You can wait for it to fade naturally, as it usually does not leave any traces after it fades.
6) Eat kelp to prevent acne. According to medical researchers, there are very few people with acne in the teenage population who eat more kelp. Zinc is an essential trace element for the human body, which not only enhances the immune function of the body, but also participates in the normal metabolism of the skin, enabling the normal differentiation of epithelial cells, reducing the keratinization of the ducts of the sebaceous glands of hair follicles, and facilitating the discharge of sebaceous secretions.
Treatment course.
According to the nature and severity of acne lesions, acne can be classified into 3 or 4 grades: Grade 1 (mild): acne only; Grade 2 (moderate): inflammatory papules in addition to acne; Grade 3 (moderate): pustules in addition to acne and inflammatory papules; Grade 4 (severe): nodules, cysts or scarring in addition to acne, inflammatory papules and pustules. The classification of acne reflects the severity of acne and the nature of the lesions, so the treatment of acne should be based on the classification and the selection of appropriate drugs and treatments. The treatment plan for acne is not set in stone, but should be flexible according to the patient’s actual situation, fully reflecting the principle of individualized treatment.
Acne Treatment Process
Classification
Treatment rules
Grade 1
Topical treatment is generally used. If only acne is present, topical application of retinoids is the best choice. Medical skin care products that exfoliate, dissolve acne, inhibit sebum production, and are antibacterial may also be used as adjunctive treatments.
Grade 2
The usual treatment for Grade 1 acne is used, but oral antibiotics may be used for those with more inflammatory papules and pustules where topical treatment is not effective. Combination therapy, such as oral antibiotics combined with topical retinoids, or physical therapy such as blue light, photodynamic therapy, or fruit acid therapy, can also be used for this type of acne.
Grade 3
Patients in this category often require a combination of treatments, with systemic antibiotics as one of the basic treatments and a sufficient course of treatment. The most commonly used combination therapy is oral antibiotics combined with topical retinoids, or topical benzoyl peroxide.
Grade 4
Oral isotretinoin is the most effective treatment for this group of patients and can be used as first-line therapy. For inflammatory papules and pustules, a combination of systemic antibiotics and peroxymethylphenidate can be used first, and then oral isotretinoin can be used to treat cysts and nodules after the lesions have improved significantly.
Physical therapy–phototherapy
Light therapy method
Advantages
General indications
Red and blue light treatment
① Red and blue light acne treatment is short and fast, a single treatment time only takes about 30 minutes, a course of treatment can see the obvious acne effect. It is easy and fast, and no need to take a vacation during the treatment.
The treatment process is safe and has no side effects, no drug resistance and no dependence.
③There is no stimulation to the skin and the treatment process is painless.
④The thermal effect of the red and blue treatment process is small, which can avoid the damage of the thermal effect on the skin.
It mainly targets inflammatory papules.
Compared with traditional laser treatment, fractional laser has a broader clinical use, and can be used to treat acne marks, fine wrinkles, skin aging, chloasma, coffee spots, enlarged pores, dullness and other skin problems, especially for acne marks with obvious treatment effects. The clinical use of fractional laser has proven the extraordinary effect of this ultra-minimally invasive, safe and fast laser skin resurfacing system, fading acne scars step by step and restoring smooth and delicate skin.
①Acne and post-acne scars, hyperpigmentation;
②Eye lids, crow’s feet and other fine lines around the eyes, dry lines removal;
③Effective improvement of facial and forehead wrinkles, joint folds and stretch marks;
④Treatment of pigmented lesions such as freckles and cheekbone mother spots;
⑤ Tightening and lifting of the skin;
⑥Stretch marks and other deep scars.
Photodynamic therapy (PDT)
A new technique based on the interaction of light, photosensitizers and oxygen, using photodynamic reflections to diagnose and treat diseases.
①Medium to severe acne, acne that cannot be controlled by traditional methods;
②Acne that cannot tolerate the stimulation of topical medications;
③Acne that is not suitable for antibiotics and other acne that needs to avoid the side effects of oral medication.