Acne is a chronic inflammatory skin disease of the sebaceous glands, with a prevalence of 70% to 87%. Its psychological and social impact on adolescents exceeds that of asthma and epilepsy, bringing great blows and relentless torment to the mental, psychological and emotional well-being of patients.
1. Pathophysiological factors for the occurrence of acne Fu Yu, Department of Endocrinology, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine The occurrence of acne is closely related to many factors such as excessive sebum secretion, follicular sebaceous duct obstruction, bacterial infection and inflammatory response. The pathophysiological basis for acne is the rapid development of sebaceous glands and excessive sebum secretion, which is directly governed by androgens. After puberty, the level of androgens, especially testosterone, rises rapidly. The rise in androgen levels can promote the development of sebaceous glands and produce large amounts of sebum. In addition, progesterone and dehydroepiandrosterone in the adrenal cortex also have some pro-sebum secretion effects. Acne patients have higher wax ester content in sebum and lower linoleic acid content, and the decrease in linoleic acid content can reduce essential fatty acids around the hair follicle and promote keratinization of the follicular epithelium; abnormal keratinization of the follicular sebaceous gland ducts is another important factor. Impaired secretion and discharge of large amounts of sebum predisposes to bacterial infections. A variety of microorganisms are present in the hair follicle, with Propionibacterium acnes infection being the most important. Propionibacterium acnes is an anaerobic bacterium, and the obstruction of sebum discharge creates a good local anaerobic environment for it to proliferate. The esterase produced by Propionibacterium acnes can break down triacylglycerols in sebum and produce free fatty acids, the latter being the main factor leading to inflammatory damage in acne. In addition, P. acnes can also produce peptides that chemotactic neutrophils, activate complement and cause leukocytes to release various enzymes, inducing or aggravating inflammation. In addition to the above factors, the occurrence of acne in some patients is also related to the immune function of the body, especially in some specific acne such as convergent acne and fulminant acne, where the immune response plays an important role.
2. Grading of acne
Acne classification is an important basis for acne treatment and efficacy evaluation. According to the nature and severity of acne lesions, acne can be divided into three grades: Grade 1 (mild): acne only; Grade 2 (moderate): inflammatory papules in addition to acne; Grade 3 (moderate): pustules in addition to acne and inflammatory papules; Grade 4 (severe): nodules, cysts or scarring in addition to acne, inflammatory papules and pustules
3. Treatment of acne
Cleansing
Topical treatment
Systemic treatment (antibiotics, retinoids, hormones)
Intra-dermal injection
Physiotherapy
Surgical treatment (picking, incision, etc.)
4. Chinese medicine has good effect on acne
Chinese medicine is called “acne”, “pulmonary wind acne” and “facial pimples”. As early as 2,000 years ago, acne was discussed in the Nei Jing (The Book of Internal Medicine), and in the Su Wen (The Book of Anger), it was said: “Acne is born when sweating and seeing dampness. Zhang Jiebin note: “form labor sweat, sitting and lying when the wind, cold thin, liquid condensation for, that is, acne, if the depression and slightly larger, is into a small section, is named acne.” It reveals the cause and pathogenesis of acne. Jin Ge Hong’s “Post-Elbow Preparedness and Urgency Formula” says: “When you are young and full of qi, your face is full of pimples”. It was recognized that the onset of acne was age-related, and that it was the result of the exuberance of qi and yang during adolescence. In the book “The Golden Guide to Medicine and Surgery”, it is said: “Lung wind acne, which is caused by blood heat in the lung meridian, occurs on the face of the nose, with broken bumps, shaped like millet crumbs, red and swollen and painful, with white powder juice breaking out. For a long time, all become white flakes, it is appropriate to take loquat clear lung drink, external application of upside down powder, slowly from the work also.”
The dampness becomes phlegm, and the phlegm-dampness condenses; the blood-heat in the body, or the spicy food, which helps to generate internal heat, and the blood-heat stagnates over time.
Chinese medicine treatment
The lung meridian contains heat: the acne is red, painful and itchy, with dry mouth and tongue, yellow urine, dry stool, red tongue with yellow coating and floating pulse. The main treatment is to clear the lung and cool the blood, and the commonly used formula is Loquat Paste Clear Lung Drink.
Dampness and heat in the spleen and stomach: Acne appears intermittently, with yellowish-white rice-grain seborrhea, pus, more oil on the skin, bad breath, bitterness, loss of appetite, stagnant stools, and a red tongue with yellow fur, so the main remedy is Scutellaria Baicalensis and Plain Stomach San.
Blood stasis and phlegm coagulation: Acne lasting longer, hard texture, persistently not subsiding, painful to touch, or severe orange peel face, women with low menstrual flow, dysmenorrhea, or acne aggravated during menstruation, with dark tongue and thin coating, and astringent pulse; to activate blood and resolve phlegm, soften hardness and disperse nodules. Raw licorice, etc.
5. Life guidance for acne
Living: Be as regular as possible
Diet: Eat less spicy and oily foods
Local cleaning: Wash your face carefully, each time with soap or facial cleanser, 2-3 times a day.
Skin care products: water-based, should not use ointment skin care products
Note: Do not squeeze inflammatory papules, nodules and cysts