What is acne?
Acne is commonly known as “acne”, also known as “acne”, “acne”, “acne”, etc. It usually occurs on It usually occurs on the face, neck, chest and back, shoulders and upper arms. It is a chronic inflammatory skin disease of the sebaceous units of the hair follicles and is characterized by whiteheads, blackheads, inflammatory papules, pustules, nodules, and cysts. This disease is prevalent in adolescence, but is not entirely limited by age stage, and can develop in almost all age groups, from children to adults. The results of a joint survey by the Chinese Dermatology Association and the China Youth Federation show that the prevalence of acne among adolescents aged 11 to 25 is over 80%, and among youth aged 26 to 35, the prevalence is over 15%.
How is acne formed?
Acne is a multifactorial disease. The pathogenesis is mainly due to
1. Hyperandrogenism/increased sebum synthesis and secretion
2. Clogging of pores due to keratinization of the sebaceous ducts of hair follicles
3, Propionibacterium acnes infection
4, the body’s immune response
During puberty, the level of androgens in the body is high, promoting the secretion of a large number of sebaceous glands. At this time, if the pores are blocked due to hyperkeratosis of the hair follicles, a large amount of secreted sebum is not effectively excreted, and then it accumulates locally to form acne. The sebum in acne is a good nutrient for the growth of bacteria. Propionibacterium acnes grows and multiplies in large numbers and decomposes sebum to form free fatty acids, which stimulates the inflammatory reaction of the hair follicle wall, resulting in a series of clinical manifestations such as acne, inflammatory papules, pustules and nodules.
In addition, genetic factors and some external environmental and psychological factors also have an influential role.
Acne typing
Clinically, acne is classified into the following types according to the main manifestations of the lesions.
Acne vulgaris
Papulosquamous acne
Pustular acne
Sclerosing acne
Cystic acne
Atrophic acne
Agglomeration acne
Necrotizing acne
Neonatal acne
Grading of acne
Grade I (mild) Acne predominantly with a few papules and pustules, less than 30 total lesions
Grade II (moderate) Acne, moderate number of papules and pustules, total number of lesions 31 to 50
Grade III (moderate) a large number of papules and pustules, occasionally large inflammatory lesions, total number of lesions 51-100, less than 3 nodules
Grade IV (severe) Nodular/cystic acne or coalescent acne with more than 100 total lesions and more than 3 nodules/cysts
Prevention and treatment section
How to effectively treat acne?
I. Topical drug treatment
1. Retinoids can promote the conversion of ductal epithelial cells, regulate the keratinization process, reduce the formation of microcomedema and help mature acne subside, and also have anti-inflammatory effects.
2.Peroxybenzoyl, an organic peroxide, has the function of sterilization, keratin exfoliation, dissolving acne and inhibiting sebum secretion
3.Antibiotics Commonly used are clindamycin and erythromycin, which can effectively kill Propionibacterium acnes and control inflammation.
4.Complex preparations Ketocinone gel, with antibacterial and anti-inflammatory, blood circulation and acne moisturizing repair effect.
Second, systemic treatment
1. Oral isotretinoin is the most effective sebaceous gland inhibitor and the only drug that can target all aspects of acne. It can shrink sebaceous glands and reduce sebum secretion, promote normal keratinization, inhibit the proliferation of Propionibacterium acnes and anti-inflammatory effects, which can fundamentally block the formation of acne. It is mainly used for moderate to severe acne and recurrent acne.
2.Antibiotics Commonly used antibiotics are tetracyclines and macrolides, which generally take 4-8 weeks to take effect. In recent years, the rapid increase in resistant strains of Propionibacterium acnes has been found, resulting in the inability to improve the condition.
3.Contraceptive pills have a strong anti-androgen effect, preventing the effect of dihydrotestosterone on the sebaceous glands and reducing sebaceous secretion, but this method is not applicable to male patients.
4, mask inversion treatment For mild to moderate acne can be used to drain acne, mask, inversion and other therapies. Inverted mask is a method that integrates medicine, massage and physical therapy into one, thus achieving therapeutic and cosmetic effects. Acne is caused by excessive sebum secretion that cannot be discharged and accumulates in the pores, stimulating the hair follicle sebaceous glands and causing inflammation. Facial masks are an important measure for facial skin beauty care, especially inverted masks, which have the functions of accelerating facial blood circulation, promoting metabolism, regulating sebum secretion, removing facial oil and dirt, as well as anti-inflammatory and antiseptic effects. Patients with acne will feel fresher and cleaner after mask care (make sure to take proper care), and the inflammatory reaction of “acne” will improve with facial belly care. It is even better to squeeze out the fat plugs from the acne damage one by one before each mask treatment. Therefore, the efficacy of mask treatment on acne is certain, and it is an ideal treatment for acne with a generalized skin rash.
5.Photodynamic therapy For acne patients who do not tolerate medication or do not want to receive medication, photodynamic is the best choice. The mechanism of photodynamic therapy for acne is to use light to activate exogenous or endogenous photosensitizers in target cells to induce cell death through the formation of singlet oxygen or other oxygen free radicals. The spectrum of blue light matches extremely well with the maximum peak absorption of fecal porphyrin III and protoporphyrin IX. Its use to irradiate Acinetobacter causes a photodynamic response of bacterial endogenous porphyrins to achieve a bactericidal effect. Blue light is the most effective wavelength for activating porphyrins and is used to treat mild to moderate acne, but its skin penetration is slightly poorer. Red light does not activate porphyrins as well as blue light, but can penetrate deeper into the tissue. In addition, 630nm light (i.e. red light) can stimulate macrophages to release cytokines and secondary promote fibroblast proliferation and growth factor production to achieve anti-inflammatory and pro-repair effects.
In addition, photodynamic, mask inversion combined system and topical medication can increase the efficacy and shorten the course of treatment.
What are the reasons for acne treatment failure?
Some patients do not do well after treatment. For this reason, we summarize the following main reasons.
1. Patients choose their own medications, resulting in improper medication and failure to achieve typological treatment.
2, the fear of drug side effects leading to insufficient dose or treatment time.
3, the use of drugs at the beginning, sometimes there will be aggravation of symptoms, mistaken for adverse reactions and stop treatment
4.Resistant to antibiotics.
5, the use of other drugs at the same time, drug interactions have occurred.
Prevention and proper treatment of acne
Develop good habits: pay attention to personal cleanliness and hygiene, keep your face and hands clean, and do not use your hands to squeeze, pinch or pinch acne. The dangers: one will lead to inflammation and the development of bacteria to the depths; the second is the evil of disfiguring scars.
1, after the occurrence of acne should go to the hospital to see a dermatologist as soon as possible, follow the doctor’s instructions, take the medication and apply the medication carefully, it is important to adhere to
2, do not apply topical drugs containing hormones, because although hormones can reduce the inflammatory reaction of skin lesions in the short term, long-term use will induce acne and aggravate the condition.
3, pay attention to a light diet and regular life, and strengthen exercise
4. Avoid using oily cosmetics, which cannot treat acne and contain acne-derived substances that can aggravate acne.
5, pay attention to some drugs will aggravate the condition: such as glucocorticoids, androgens, iodine, bromine and lithium, etc.
Can acne be cured?
Acne is a skin disease that can be cured, and most people can be cured without recurrence, but it requires a regular treatment and a long enough treatment course. Otherwise, acne will recur, giving you the illusion that it cannot be cured. Some people have acne that is self-limiting and develops during adolescence. Later, as they age, acne will gradually improve and subside, but some people do not heal on their own, and there is a tendency for acne to worsen and even leave scars.
Can acne fade on its own without treatment?
Acne does have a certain degree of self-limitation, as demonstrated by the fact that the disease has a certain age of onset and natural course. Most people are at high risk of developing acne during adolescence, after which it gradually resolves and subsides on its own. However, treatment is still needed due to.
1. Acne often leads to the formation of scars and marks on the face, some of which are difficult to treat and will exist for life, greatly affecting beauty and aesthetics. Early, timely and regular treatment can not only significantly shorten the course of the disease but also prevent the formation of scars.
On the contrary, some people develop acne after the age of 30, and the course of the disease lasts for a very long time, such as after the age of 40, and a few people cannot even remit on their own even at the age of 50.
What should I be aware of when taking retinoids?
Women of childbearing age or spouses taking oral retinoids must use reliable contraceptive measures, interrupt pregnancy once it occurs, and avoid taking them at the same time as vitamin A and tetracycline. The duration of contraception required by different retinoids generally varies. Isotretinoin, which we commonly use, has the shortest contraceptive time, requiring only 3 months, while some other retinoids require half a year or even more than 2 years. Therefore, women of childbearing age who are undergoing acne treatment must inform their doctor whether they are planning to become pregnant. In addition, taking retinoids with meals increases the bioavailability of the drug and improves its efficacy.
What is the proper treatment if an adverse reaction occurs?
Drugs used to treat acne can have varying degrees of adverse reactions during use.
For example, topical retinoic acid drugs and peroxynivalenes may sometimes cause reactions including erythema, dryness, itching, irritation and burning sensation, etc. In response to this situation, we find that most patients who experience such reactions are eager to cure the disease and overdose. If the above-mentioned adverse reactions occur and cannot be tolerated, you should consult your doctor promptly and discontinue the drug if necessary.
Antibiotics can cause different degrees of gastrointestinal reactions, serious drug-related hepatitis, intracranial hypertension, etc.; women using hormones can have edema, thrombosis, weight gain, breast pain, chloasma, etc. Some adverse reactions are reversible. Some adverse reactions are reversible and will disappear after stopping the drug. For example, if the ingredients of retinoids are acids, they are metabolized quickly and have good long-term safety; if the ingredients are esters, they are metabolized slowly and have poor long-term safety.
Can cosmetics cure acne?
Cosmetics themselves are used for the health and care of the skin. The biggest requirement for cosmetics is that they must be safe for the skin, non-irritating, moist and protective. Recently, however, there have been a number of so-called special healing cosmetics that do add low concentrations of pharmaceutical ingredients that have a very limited therapeutic effect on acne, but of course these added pharmaceutical ingredients are not new. The problem is that the concentrations of these drug ingredients are usually very low, below the therapeutic concentration of the drug, and therefore often insufficient to treat acne, and only have some suppressive effect on very mild acne. In addition, state verification of such cosmetics is mainly to verify their safety and not to critically examine their efficacy, so usually the state also does not allow any cosmetics to make any trade claims about their efficacy. Unfortunately, almost all cosmetic products advertise their miraculous “efficacy” and no one asks questions about this violation.
Can acne treatment work in a few days?
This is the most common advertising phrase used in all types of trade promotion. With the development of dermatological science, acne treatment is now easier and more reliable, but it should be clear that even short-term results are usually maintained for weeks or even months to prevent recurrence. We do not rule out the possibility that the medication will work within a few days, but a short treatment period of a few days is of little practical importance in the treatment of acne. In fact, almost all effective medications are more or less effective within a few days, but once they have been cleverly designed and packaged with a certain amount of trade promotion, they can become a miracle drug overnight and create a social sensation.
Is acne caused by unclean skin?
This is a viewpoint that has been strongly exaggerated, amplified and promoted by all kinds of skin cleanser sellers, as it facilitates the marketing of their products. Although clogged pores are an important part of acne development, it does not mean in any way that clogged pores are caused by unclean skin. In fact, acne sufferers take skin cleansing more seriously than anyone else, and they spend a lot of effort cleaning their facial skin almost daily. Clogged pores in acne patients are mainly caused by intrinsic causes in the skin itself, starting with abnormal keratinization of the pores, which ultimately leads to clogging. The cleansing of the skin is not the main problem. On the contrary, excessive cleansing sometimes aggravates the keratinization of the skin pores, which may further aggravate the clogging of the pores and worsen the condition. Many people buy a lot of various skin cleansing products (such as facial cleansers) in the hope of replacing medication to treat acne, which is not effective or necessary, and is a treatment that puts the cart before the horse.
Is acne caused by mites?
In fact, acne is caused by hyperkeratosis in the funnel of the hair follicle, sex hormone imbalance and hyperfunction of the sebaceous glands, the action of microorganisms in the sebaceous units of the hair follicle, inflammation and the immune response of the host. It is normal for something called follicles (commonly known as mites) to live in our hair follicles, just like bacteria exist on our skin nothing special, but sometimes follicles can indeed cause a disease called follicular dermatitis, but there is a big difference between this disease and acne, so don’t get confused.
What should I pay attention to with acne skin?
1, daily life should be careful to eat less spicy food and stimulating food.
2.Keep your skin clean. Be sure to wash your face with cleanser every night. Then apply moisturizing water.
3, keep a happy mood, learn to self-regulation, happy life.
4.Quit bad habits, such as smoking, drinking, staying up late, etc.
5, drink more water, eat more vegetables and fruits, and develop a daily bowel habit.