We all know that Chinese people love face, whether it is external or internal, is so important to the country. However, at the age of youth, there are many young boys and girls who are often troubled by the problem of face. Among them, there is nothing more upsetting than their “acne”, which in medical terms is called acne vulgaris. This is a chronic inflammatory disease of the sebaceous glands of the hair follicles that is most common during adolescence.
I. Let’s look at how acne occurs.
(1) After puberty begins, androgen production increases, causing the sebaceous glands to enlarge and sebum secretion activity to increase.
(2) Abnormal keratinization of the ducts of the sebaceous glands of the hair follicles in acne patients, with the caliber of the ducts becoming smaller. When the epithelial cells shed from the walls of the hair follicles mix with sebum then embolism is formed in the mouth of the hair follicles, thus forming acne.
(3) Microbial infection, mainly Propionibacterium acnes, followed by oval spores and white staphylococcus, Propionibacterium acnes hydrolyzes glycerol triphosphate into glycerolipids and free fatty acids, and can produce some small molecule peptides, free fatty acids can stimulate the hair follicle to cause inflammatory reactions, free fatty acids and small molecule peptides have a chemotactic effect on neutrophils, and the hydrolase produced by the latter makes the hair follicle wall The latter hydrolytic enzymes cause the hair follicle wall to leak or even rupture, and the follicle contents enter the surrounding dermis, resulting in a series of clinical manifestations from inflammatory papules to cystic damage.
(4) Genetics may also be an important factor in the development of this disease.
(5) Immunologic factors. Propionibacterium acnes-mediated cellular immunity also enhances the inflammatory response to acne.
(6) Other factors, such as diet, emotional stress and the internal and external use of certain chemical factors such as isoniazid and corticosteroids can also cause acne-like eruptions.
Second, acne occurs and what kind of performance?
1, lesion characteristics: the disease is mostly seen in young men and women aged 15 to 30 years old, there is excessive sebum phenomenon, pores more obvious. The first is acne, can be divided into white head acne and black head acne, white head acne is closed acne, skin-colored or dark red papules, no black head, not easy to squeeze out lipid embolism, more likely to cause inflammation around the follicle; black head acne is open acne, for the obvious enlargement of the pores in the small black spots, more easily squeezed out yellow-white lipid embolism. Acne can evolve into inflammatory papules, pustules, nodules, abscesses, and cysts during the course of its development, and finally into scarring.
Clinically, acne is often divided into papular acne, pustular acne, cystic acne or nodular acne, atrophic acne, convergent acne (manifested as severe nodules, cysts, sinus tracts and scarring), fulminant acne (acne that suddenly worsens with fever, joint pain, anemia and other symptoms), neonatal acne, medicated acne, premenstrual acne, etc.
2. Prevalent sites: Acne is often symmetrically distributed, with damage occurring mainly on the face, especially on the forehead, cheeks and chin, followed by the chest, back and shoulders.
3. The course of the disease is chronic, sometimes mild and sometimes severe, and often lasts for several years or gradually resolves in middle age, leaving hyperpigmentation, atrophic or hypertrophic scars.
4, conscious symptoms: generally no conscious symptoms, inflammation can have pain when obvious.
Third, let’s learn more about the classification of acne, against which level we are classified?
Clinically, according to the Pillsbury classification, according to the shape of the lesion, the number of the number, the occurrence of the site, etc. is divided into I ~ Ⅳ degrees.
Grade I (mild): Blackhead acne disseminated to most and/or with disseminated inflammatory papules.
Grade II (moderate): The number of inflammatory papules increases and may be dense but limited to the face, or some superficial pustules occur on the basis of grade I.
Grade III (severe): nodular lesions appear on the basis of grade II, which may involve the neck and chest and back in addition to the face.
Degree IV (severe – clustered): cysts and scars appear on the basis of degree III, and may involve the upper body.
IV. About the diagnosis of acne
After understanding the above knowledge about pimples, I believe it is not difficult to match the number based on the age of onset, the areas with more sebaceous glands such as the face, upper chest and back, more oil, as most scattered papules or pustules, symmetrical distribution, etc.
Five, acne should also be distinguished from the following diseases
(A) rosacea
Most of them develop in middle age, usually in the middle of the face, with diffuse erythema, papules, pustules and dilated capillaries.
(B) Occupational acne
It often occurs in workers who are in frequent contact with tar, motor oil, petroleum, paraffin, etc. It can cause acne-like rash with dense damage and may be accompanied by follicular keratinization; in addition to the face, it can also be seen on the back of the hands, forearms, elbows and other areas in contact with mineral oil.
(C) Facial disseminated lupus cornea
The lesions are brownish-yellow or dark red hemispherical or slightly flattened papules, symmetrically distributed on the eyelids, nasolabial folds and forehead, often fusing into a dike on the lower eyelids.
VI. About the treatment of acne
Our principles are.
① Correcting abnormal keratinization in the hair follicles.
② Reducing sebaceous gland activity.
③ Reducing the intrafollicular flora, especially Propionibacterium acnes.
④ anti-inflammatory and prevention of secondary infections.
⑤ Regulation of hormone levels.
1. General treatment: To prevent the recurrence or aggravation of acne, we should start from the following aspects
①Cautious diet: eat less hot, spicy and stimulating food and food with high sugar and fat content; prohibit smoking and alcohol, do not drink strong tea; eat more fresh vegetables and fruits appropriately, especially high-fiber vegetables and fruits; drink an appropriate amount of water.
②Pass stool: smooth stool will make the toxins that stay in the intestine excreted in a very short time.
③ Smooth emotions: Good emotions can prevent the triggering or aggravation of acne, and also help in the treatment of this disease.
④Good sleep: The period of sleep is the time when skin metabolism is at its peak. Therefore, getting enough sleep not only maintains the normal secretion function of the sebaceous glands, but also promotes the discharge and normal metabolism of sebum.
⑤ Use cosmetics carefully: For people with different skin nature, choose cosmetics and skin care products that are suitable for you. Generally speaking, people with oily skin should choose medical skin care products that control oil and clear acne; while people with dry skin should choose skin care products with good moisturizing effect; people with neutral skin, which is the most ideal kind of skin, can choose a larger range of skin care products, and can choose suitable skin care products according to their own situation. This will not only achieve a satisfactory skin care effect, but also will not induce acne.
(6) Reduce allergens: Some patients develop acne because they are exposed to some allergenic substances such as mineral oil. Therefore, avoiding contact with allergens in actual life is an important part of acne prevention that cannot be ignored.
The reason why people go to squeeze with their hands is because there will be an effect of reducing the condition after squeezing. However, they do not know that after squeezing, a small depression will be left on the skin during the recovery process, which has a great impact on the beauty of the skin.
⑧ Reasonable medication:For people who have been sick, they should go to a regular hospital in a timely manner, and under the guidance of a doctor, use medication reasonably, and refrain from seeking medical advice in an emergency. Corticosteroids and drugs containing bromine and iodine should be used with caution. When these drugs are used, there will be an illusion of “very satisfactory effect”, but once they are stopped, there will be a rebound or aggravation.
2.Topical treatment
(1) Vitamin A acid: should start from low concentration, commonly used, 0.05%~0.l% Vitamin A acid cream or gel, the side effects of this drug is mild irritation, such as local flushing, desquamation, burning sensation.
(2) benzoyl peroxide, benzoyl peroxide is a strong disinfectant, has dissolved blackhead acne and control the role of infection, but should avoid causing contact dermatitis.
(3) Antibiotics, erythromycin or chloramphenicol can be formulated into alcohol preparations. Such as chloramphenicol rub, the effect is better.
(4) Other, such as 5% sulfur lotion, compound sulfur lotion and white lotion, etc.
3.Medication for internal use
In addition to local treatment in heavier cases, the following methods can be used at the discretion of the doctor’s guidance.
(1) Oral antibiotics to inhibit Propionibacterium acnes and to reduce free fatty acids in sebum, for a course of 6-8 weeks. Tetracycline, erythromycin, etc. are available.
(2) Retinoic acid preparations are mainly used to reduce sebum secretion, control abnormal keratinization and blackhead acne formation, and are more effective for moderate-to-severe acne such as cysts and acne conglobata. If 13-cis-retinoic acid is taken orally at 0.5~1mg/kg per day for 4 months, most patients can be cured. This drug can act directly on the sebaceous glands and has a strong inhibitory effect on the production of sebum. It also has an inhibitory effect on Propionibacterium acnes.
(3) Hormones: Sex hormone drugs are suitable for severe female patients, such as Daing-35; glucocorticoids are indicated for severe nodular cystic acne, the inflammatory phase of coalescent acne and fulminant acne, and nodular and cystic damage can be injected intradermally into the skin lesions.
(4) Others: Blue light irradiation, red light irradiation, photodynamic therapy, fruit acid peeling, fractional laser, and keloidoplasty, these are some of the booming treatments that are solving the facial problems that are plaguing more and more young boys and girls.
In short, acne is preventable and controllable, as long as we correctly understand this disease, understand this disease, treat this disease, we will be able to guard our face, will be successful through the flowers of youth.