Background Knowledge 1: What is acne? Acne is one of the most common diseases in dermatology. According to statistics, 80% to 90% of teenagers suffer from acne. Acne tends to reduce and heal naturally after puberty, but a few people continue to have acne into their 40s. Acne is a lesion of the sebaceous units of the hair follicles on the skin and can manifest as acne, papules, pustules, cysts and scar formation. The most famous acne patient today is the athletic star Liu Xiang. The small pits on the star’s face are the scarring left after acne heals. There is a popular saying that “nine out of ten men have hemorrhoids”, meaning that the incidence of hemorrhoids is very high. In terms of incidence, acne is by no means inferior to hemorrhoids. Eight or nine out of ten people, regardless of gender, have had acne (as mentioned above). But why is it that when you walk down the street, most people’s faces are relatively flat, while Liu Xiang’s face has pits like the craters on the moon? This also starts with the pathogenesis of acne. Background Knowledge 2: How does acne come about Acne is caused by a variety of reasons, the most important related factors are sex hormone levels, heavy secretion of sebaceous glands, local bacterial proliferation, and abnormal keratinization of sebaceous ducts in hair follicles. During puberty, stimulated by androgens (androgens are also secreted by the adrenal cortex in women), sebum secretion increases and follicular sebaceous ducts become hyperkeratotic under the influence of androgens. As the ducts become smaller, narrower or blocked, sebum and other substances cannot be discharged normally and collect at the openings. Initially, these aggregates are loose, but as the pressure increases, they gradually become tighter and form lamellar concretions. At this point, the skin surface bulges with small white or black spiky papules called whiteheads or blackheads. The white curd-like masses in the extruded pimples are made up of these plate-like concretions. Nourished by these accumulating substances, some normal bacteria that were originally colonized in the skin begin to multiply abnormally, thus inducing inflammation in the skin, and red papules and pustules are formed. If the blockage continues to accumulate and the acne ruptures leading to increased local inflammation and destruction of local dermal tissue, nodules and cysts will form, eventually leaving scarring, or the acne pits on Liu Xiang Xiao’s face. By intervening at the early stage of acne and controlling the development of acne through various medical means such as reducing sebum secretion, unblocking hair follicles, and inhibiting local bacterial growth, acne can be prevented from becoming nodular or cystic in nature, reducing the risk of leaving scarring. Currently, the development of medications to treat acne through these aspects is more mature. Therefore, it does not matter if you have acne, as most acne can be controlled and cured by actively seeking medical attention at the initial stage. Can acne be squeezed or not? Squeezing acne is a major fetish for some people. A similar procedure is performed in dermatology: a pimple squeezer is used to squeeze out the keratinous contents of an open pimple, called “pimple removal”. This procedure can quickly improve the appearance and help improve the effectiveness of medications such as acne dissolvers; especially for deep, concentrated and persistent acne, topical medications combined with acne extrusion can be very effective. However, in the case of squeezing inflamed pimples or pus heads, scarring is likely. Nowadays, the treatment of acne relies mainly on topical and oral medication, and the results are basically satisfactory, and the operation of acne extrusion has been practiced less and less in medical institutions. Hospitals try not to perform this operation, and it is not recommended to do it at home. For one thing, it is not possible to distinguish between what can and cannot be squeezed, so it is easy to squeeze inflammatory acne and leave scars. Secondly, the risk of infection is increased by the lack of mechanical and skin disinfection, and the risk of scarring is further increased by local skin infection. If you are unlucky enough to squeeze inflammatory acne in the dangerous triangle of the face, there is also the possibility of the infection spreading to the skull, leading to cavernous sinus thrombophlebitis, a potentially life-threatening condition. Therefore, squeezing acne yourself is a very unwise practice. Acne, try not to touch it if you can. How is acne treated? Depending on the type and severity of the skin damage, acne has a systematic and standardized treatment method. Most people are unable to accurately determine their condition, and prompt medical attention is the best policy. For mild to moderate acne, if the damage is predominantly acne, or for acne patients with thicker skin, the use of retinoic acid or adapalene gel (Darvon) on the entire face (avoiding the eyes) is a better option. For papular and pustular acne, topical antibacterial medications such as benzoyl peroxide (Bansal) should be applied to the papules and pustules in addition to topical retinoids. Retinoids can reduce hyperkeratosis, remove pore-clogging plugs, and smooth sebum drainage, as well as lighten pigmentation and anti-wrinkle effects. However, the disadvantages are the long onset of action (about 2 months), mild skin irritation and flaking when first used, and the light instability of the drug itself. Adapalene (Daphne) belongs to the 3rd generation of retinoic acid. The special chemical structure of the drug makes it very stable, with low photosensitivity, and it is able to concentrate in the hair follicle area to bring out the best efficacy of retinoic acid drugs for acne treatment. Daphne is a gel-based preparation that does not add extra oil to the skin and is also suitable for oily skin; it can be used once a day and is very convenient. Benzoyl peroxide gel (Bansal) is a common treatment for papulopustular acne. It has bactericidal ability against Propionibacterium acnes, as well as inhibiting sebum secretion and keratolytic effect. It is the drug of choice for mild acne with a small number of papules and pustules as the main manifestation. It should be applied twice a day after washing the affected area with a mild facial cleanser and water before use. Treatment of moderate to severe acne requires oral medication. According to the U.S. 1998 classification, moderate acne is considered when there are 10 to 40 facial papules and pustules, and severe acne is considered when there are 40 to 100 lesions with five or more large, deep inflammatory nodules, and when it spreads to the chest and back. Severe acne with nodular cystic and aggregated acne is considered very severe. These types of acne need to be treated with internal medications prescribed in the hospital. Commonly used oral medications include minocycline (Maimane), the contraceptive pill Dareng-35, and oral retinoids (such as Tylenol). Treatment of severe acne should be differentiated between men and women In addition to the skin itself, severe acne in women mostly involves endocrine conditions. For these female patients, the menstrual regulating and anti-androgenic effects of da Vine-35 (an oral contraceptive) can be very effective. Because oral contraceptives are safe (normal people can take them) and have many beneficial “side effects” such as menstrual regulation, prevention of ovarian and endometrial cancer, and prevention of ectopic pregnancy, they can be beneficial for women with acne who have combined endocrine abnormalities and do not have contraindications to oral contraceptives. Oral retinoids can control abnormal skin keratinization and reduce sebum secretion, which is also effective for severe acne. However, oral retinoids have many side effects, including abnormal liver function, dyslipidemia, and slight mental effects. In addition, because oral retinoids are teratogenic, they are usually avoided in female patients who are preparing to become pregnant. What are “acne marks”? Many people still have dark or red “acne marks” on their face even after acne has cleared. Acne is often accompanied by localized skin inflammation. After the inflammation clears, most people have short-term post-inflammatory hyperpigmentation, which leaves a black acne mark. Slightly more severe inflammation, on the other hand, can cause local capillary dilation and hyperplasia, thus leaving red pimple marks. Both types of acne marks will slowly fade after acne control and do not require special treatment. Since retinoids have an adjusting effect on epidermal differentiation, topical application in moderation can accelerate the removal of acne marks. Ointments containing heparin-like substances, such as mucopolysaccharide polysulfate cream (Xiceto) and compounded heparin sodium allantoin gel (Conrad), are also helpful in removing acne marks due to their anti-inflammatory and skin healing effects. What should I do if I have acne scars? Pockmarked scars are very distressing, and trying your best to treat them can no longer fully restore the smoothness of your skin. Fortunately, some medical treatments can improve the appearance of scarring to some degree, such as fractional laser, microdermabrasion, chemical or laser skin peels, etc. Fractional laser has become a new star in the treatment of acne scarring due to its safety, short misuse period, short treatment process, and less pain, but its disadvantage is that it is expensive and it does not work back for deeper acne scarring. Therefore, in conclusion, it is important to stress again that acne should be treated promptly to avoid aggravation and scarring!