Definition.
Acne is a chronic inflammatory skin disease involving hair follicles and sebaceous glands, mainly manifesting as whiteheads and blackheads, papules, pustules, nodules and cysts, etc. Severe acne often leaves behind depressed scarring of varying degrees.
Etiology.
There are many causes of acne, including endocrine factors, microbial infections, improper use of cosmetics or medications, improper diet, staying up late, etc. As people’s pace of life accelerates and the pressure of work or study increases, the incidence of acne is increasing, and the proportion of residual symptoms also increases.
Morbidity characteristics.
Acne most often involves the face, but can also occur in areas with high sebum secretion such as the forehead and back. During adolescence, mild acne can be regarded as a physiological phenomenon and can be left untreated. However, more severe acne often affects aesthetics, and delayed treatment can easily lead to scarring, hyperpigmentation, and many other sequelae, which cannot be completely removed once scarring is formed. As a disfiguring disease, acne is not life-threatening, but it can seriously affect the quality of life and physical and mental health of patients, and even cause low self-esteem.
Differential diagnosis.
Acne is a common clinical condition with complex etiology and diverse manifestations, and is also often misdiagnosed and needs to be differentiated from the following diseases.
1. Facial disseminated acne vulgaris One of the most commonly misdiagnosed diseases as acne, the point of differentiation is that it is mostly distributed on the lower eyelids and around the nose, flat papules or small nodules, dark red or brown, soft in texture, and can be applesauce in the slide press test.
2, rosacea Prevalent in middle age, adolescence can also develop, nose and perinasal lesions are predominant, the lesions are often surrounded by a red halo, capillary dilation.
3, nodular sclerosis often appear in early childhood, occurring around the nose, cheeks, clusters of distribution, no inflammatory response.
4, furunculosis folliculitis uniform in size, similar in shape, relatively uniform in distribution, prevalent at the forehead and back, often preceded by a history of long-term systematic use of glucocorticoids or broad-spectrum antibiotics, fungal microscopy or culture is positive.
Treatment.
The treatment of acne requires a combination of regulation and treatment. Under the proper guidance of a doctor, the “root cause” of the disease should be found and removed.
1, self-regulation Maintaining a normal biological clock and good sleep is an important condition for the treatment of acne, and it is necessary to properly avoid eating spicy and stimulating food, fatty, sweet and greasy, more vegetables and fruits, and keep the bowels open; for patients with low estrogen levels or high androgens, if there are no contraindications, they can eat more soy milk.
2, local cleaning Choose suitable cleansing products to remove excessive oil on the skin surface, but not excessive cleaning. Do not squeeze or scratch the lesions with your hands.
3.Daily care Acne treatment drugs often lead to dry and sensitive skin, which is not good for the barrier function of the skin, so you can choose mild moisturizing products and avoid using too greasy skin care products.
4.Topical medication Topical medication is suitable for those who have a light rash, according to the different types of lesions, the targeted selection of different types of topical medication, such as vincristine, adapalene, peroxymethylphenidate, clindamycin, chloramphenicol, selenium disulfide, salicylic acid, sulfur-containing preparations and so on.
5. Oral medications are suitable for those with moderate to severe acne, excessive seborrhea, and those with poor results from topical application alone. For those with obvious symptoms of infection, choose antibiotics that are sensitive to Propionibacterium acnes such as minocycline, doxycycline, roxithromycin, azithromycin, etc. Other types of infections need to choose antibiotics for other types of acne; for aggregated acne, eruptive acne and moderate to severe acne where other methods are not effective, choose oral isotretinoin treatment, which can significantly inhibit sebaceous gland secretion and regulate follicular sebaceous gland ducts It can significantly inhibit the secretion of sebaceous glands and regulate the keratinization of sebaceous ducts in hair follicles, thus inhibiting the reproduction of Propionibacterium acnes;
For female patients with low estrogen, high androgen, and polycystic ovary syndrome, we can consider the use of Da-Ying-35 and spironolactone. Chinese medicine is also effective in treating the symptoms.
6, physical and chemical therapy Mild and moderate acne can be treated with red and blue light, intense pulsed light, and various near-infrared wavelength lasers; moderate and severe acne can be treated with photodynamic therapy, using 5-aminoketovaleric acid to generate photosensitive substances, and then treating with red or blue light; acne with depressed scarring can be treated with fractional laser; closed acne needs to be picked out with acne needles or peeled off with fruit acids first, and then acne picking.
Precautions
1, no matter what kind of treatment, must be based on the regular hospital, beauty salons to see the “disease” and use cosmetics instead of drugs and other acts, often bring irreversible and serious consequences.
2, acne treatment course should be sufficient, after the remission of the condition is often not the time to reduce the amount of drugs, but the need to continue to use drugs, repeated discontinuation of drugs, drugs can easily lead to drug resistance.
3, Some drugs such as isotretinoin and vincristine have serious side effects such as being prone to fetal malformations, and women need strict contraception during and for two years after medication.
4. The effect of combined treatment often far exceeds that of monotherapy, physical therapy can reduce the amount of drugs, and combined treatment is generally recommended.
5.Male patients who use anti-androgen therapy such as spironolactone may experience breast development and sexual hypogonadism, which are generally reversible, but still need to be chosen carefully when other feasible treatments are available.
6, most of the topical drugs used to treat acne have certain irritating reactions and are easily allergic. The dosage and frequency of medication should be adjusted at any time during use, and the medication should be discontinued if allergies are present.