Acne is a chronic inflammation of the sebaceous glands of hair follicles caused by a combination of factors. It is a common disease in dermatology, the most common of which is common acne.
I. Diagnosis
In young men and women, acne vulgaris is a symmetrically distributed form of acne, papules, and pustules on the face, back, and other seborrheic areas. The sebaceous plugs can often be squeezed out.
Classification of acne
Acne vulgaris can be graded according to the severity of the lesions, which is useful for guiding treatment and evaluating the efficacy.
In 1970, Pillsbury classified acne into four grades according to the number of different types of lesions. This grading method is relatively simple and easy to implement.
C. Treatment of acne
(A) Topical drug treatment
1. Vitamin A acid drugs: Such drugs can regulate the differentiation of epidermal keratin-forming cells, so that acne dissolves and is discharged. Some varieties of sea oil anti-inflammatory and reduce the role of sebum secretion. Common side effects are local irritation and photosensitivity.
2.Peroxymethylene
This drug is peroxide, which can slowly release neo-oxygen and benzoic acid after topical application, with the effect of killing Propionibacterium acnes, dissolving acne and astringency. Common side effects are bleaching clothes and local irritation.
3.Antibiotics: Erythromycin, chloramphenicol or clindamycin (clindamycin) topical application has been proven to be effective in treatment.
4, other drugs: such as azelaic acid, sulfur, aminophenyl sulfone, etc. are also used for treatment.
(B) Oral medication
1.Antibiotic treatment
Combined with antibiotic pharmacokinetics especially selective distribution in the seborrheic site, tetracyclines should be preferred, followed by macrolides, others such as sulfamethoxazole-methoprene (cotrimoxazole) and metronidazole can also be used as appropriate, but β-lactam antibiotics should not be selected. Among the tetracyclines, the 1st generation tetracyclines such as tetracycline are poorly absorbed orally and have low sensitivity to Propionibacterium acnes; the 2nd generation tetracyclines such as minocycline, doxycycline and lymetetracycline should be preferred.
2. Retinoic acid
Oral isotretinoin is the standard treatment for severe acne and is currently the most effective method for treating acne. Isotretinoin acts on all pathophysiological aspects of acne pathogenesis, and although the therapeutic effect is significant, it is not used as the first choice of treatment for mild acne as much as possible, considering its adverse effects.
3.Hormonal treatment of acne
(1) Anti-androgen therapy
It is believed that androgens play a role in the development of acne. Female patients with moderate or severe acne should be treated with contraceptives if they have high androgen levels, high androgen activity such as seborrhea, acne, hirsutism, androgenic alopecia (SAHA) or polycystic ovary syndrome (PCOS).
Other anti-hormonal treatments such as Ativan and Metformin.
(2) Glucocorticoid therapy
Oral glucocorticoids have the function of inhibiting androgen secretion caused by hyperadrenocorticism, anti-inflammatory and immunosuppressive effects. Oral administration is used only in patients with more severe inflammation and in small amounts, for short periods of time.
(C) Physical and chemical treatment of acne
For acne patients who cannot tolerate medication or do not want to receive medication, physiotherapy is the best choice. At present, the physical therapies commonly used to effectively treat acne are photodynamic therapy, laser therapy and fruit acid therapy.
1.Photodynamic therapy
The use of specific wavelengths of light activates the porphyrins metabolized by Propionibacterium acnes, and achieves acne treatment through phototoxic reactions, induction of cell death and stimulation of macrophages to release cytokines and promote self-healing of lesions. At present, we mainly use blue light (415nm), blue light and red light (630nm) combined therapy and red light + 5-Aminoketovaleric acid (5-AALA) therapy to treat various types of common acne.
2.Fruit acid peeling therapy
The application of different concentrations of fruit acids (hydroxyacetic acid) plays a role in promoting the discharge of keratin and keeping the pores open. It has different degrees of efficacy for inflammatory lesions and non-inflammatory lesions.
3.Laser therapy
450nm laser, intense pulsed light (IPL), pulsed dye laser and fractional laser are among the effective methods for treating acne and acne scarring, and can also be combined with medication. Intense pulsed light can help fade the red marks in the later stages of inflammatory acne. Fractional laser has a certain degree of improvement for acne scarring.
4.Acne picking This is currently one of the effective methods of acne treatment, but it is necessary to use medication at the same time to fundamentally inhibit the production and development of acne.
5. Glucocorticoid injection within nodules and/or cysts Helps to rapidly eliminate inflammation and is a very effective treatment for larger nodules and cysts
(iv) Cosmetic adjuvant treatment of acne
Educate patients to avoid using cosmetics that cause acne. Use acne cosmetics that contain active ingredients such as sebum inhibitors, keratolytics, and antiseptics.
These cosmetics should also be “mild” because common acne treatments tend to be irritating to the skin, such as causing dryness and flaking of the skin. Therefore, acne cosmetic products used in conjunction with acne treatments should be active and not irritating to the skin, while also helping to restore the damaged skin barrier function.
This will improve the patient’s compliance with the treatment and thus improve the efficacy. Patients with acne should also choose appropriate sunscreen products to reduce the aggravating effect of UV rays on acne. For patients with more oily skin, water or gel-like sunscreen products can be used, with chemical sunscreens being preferred.