”Acne is a common disease of adolescence, medically known as acne, which occurs mainly on the face, and in severe cases, even on the front and back of the body. The troublesome acne not only affects the face, but also frustrates one’s self-confidence and seriously affects various interpersonal interactions. How can we safely and effectively remove acne? 1, treatment for the cause of acne The main causes of acne are the following: endocrine factors (excessive sebum secretion), abnormal keratinization of follicular sebaceous glands (acne formation), microbial infections (inflammatory papules and pustules formation), and other factors (diet, stress, etc.). Therefore, in clinical treatment, we mainly focus on the above-mentioned aspects: suppressing sebum secretion, normalizing the keratinization of follicular sebaceous ducts, killing or suppressing pathogenic bacteria, adjusting the diet and relieving stress. As much as possible, treatment should be directed at multiple aspects of acne development. It should be targeted and focused. 2. Selection of drugs Different methods should be used for different lesions: acne: corrective keratinization drugs mainly, topical retinoids; papules/pustules: antibacterial drugs mainly (benzoyl peroxide and clindamycin, etc.); nodules and cysts: systemic retinoids mainly, which can be combined with anti-inflammatory and antibacterial drugs. Rational use of antimicrobials, antimicrobials have a definite efficacy on inflammatory acne, mainly tetracyclines, erythromycin and clindamycin, etc. They can be taken orally or used topically, and can be applied individually, but more often they should be combined and used in stages, and the course of treatment should not be too long. Antibiotic treatment for acne should pay attention to how to avoid or reduce the development of drug resistance. These include: ① Avoid using them alone to treat acne, especially for long-term topical application; ② Treatment should be started in adequate doses. Once effective, it is not advisable to reduce the dosage for maintenance. ③ When there is no efficacy after 2-3 weeks of treatment, it is necessary to stop or switch to other antibiotics in a timely manner. And pay attention to patient compliance and differentiate between gram-negative bacillary folliculitis: ④Ensure an adequate course of treatment. And avoid intermittent use: ⑤ Propionibacterium acnes is a parasitic bacterium of normal skin. Treatment is aimed at effectively inhibiting its reproduction. It is not to achieve complete eradication, so the dose should not be increased or the course of treatment extended without principle. It should not be used as a maintenance treatment or even as a relapse prevention measure: 6) Drug resistance of Propionibacterium acnes can be monitored if conditions permit. Guide the clinical rational use of drugs. Oral isotretinoin is the standard treatment for severe acne and is currently the most effective treatment for acne. Isotretinoin acts on all pathophysiological aspects of acne pathogenesis, and although the therapeutic effect is significant, its adverse effects are taken into account. Therefore, it should not be used as the first choice of treatment for mild acne. Indications for the application of oral isotretinoin: (1) severe nodular cystic acne and its variant forms; (2) inflammatory acne with scar formation; (3) moderate or severe acne that has failed to respond to the following treatments: 3 months of treatment with combination therapy. This includes those with systemic application of tetracyclines; ④ acne patients with severe psychological stress (disfigurement phobia); ⑤ gram-negative bacillary folliculitis; ⑥ frequent recurrences requiring repeated and long course systemic application of antibiotics: ⑦ a small number of patients who need rapid healing for some reason. Dose: The commonly used dose is 0.25-0.5 mg/(kg?d), and the dose should not exceed 0.5 mg/(kg?d) in order to reduce adverse reactions. The duration of treatment is determined by the patient’s body weight and the daily dose used. Counseling and explanation of the patient before the systemic administration of retinoic acid is very important. Patients should be informed of the many adverse effects, especially teratogenic effects, associated with retinoic acid. Patients should use strict contraception for 1 month prior to treatment and up to 3 months after the end of treatment. A small number of patients have experienced depressive symptoms with retinoic acid. Patients with a history of depression or family history should use the drug with caution and discontinue it as soon as mood swings occur or any depressive symptoms appear. 3. Individualized treatment The latest international classification of acne is based on the type of lesions rather than the number of lesions, and can be divided into mild, moderate and severe acne. Due to the wide variety of individual conditions, even for the same disease, treatment methods and responses can vary greatly, so the principle of individualization should be followed in treatment: individualization of treatment means, individualization of drug types, individualization of drug doses and individualization of treatment courses. 4, to the regular hospital treatment Patients should never go to beauty salons and institutions without medical qualifications to treat acne. The most common result of going to a beauty salon for acne treatment is that the acne is not removed, but the skin becomes thinner or becomes sensitive skin. 5.Other methods Lasers, intense pulsed light (IPL), pulsed dye lasers and fractional lasers are among the effective methods for treating acne and acne scarring at present. They can also be combined with medications. Intense pulsed light can help fade the red marks in the later stages of inflammatory acne. Fractional lasers have shown some improvement for acne scarring. Photodynamic therapy uses specific wavelengths of light to activate the porphyrins metabolized by Propionibacterium acnes. The treatment of acne is achieved through phototoxic reaction, induction of cell death and stimulation of macrophages to release cytokines and promote self-healing of lesions. Four to eight treatments are required for a course of treatment. There was slight itching during the treatment and some patients showed slight flaking after the treatment. No significant adverse reactions were found. Experiments have shown that photodynamic therapy can inhibit sebaceous gland secretion, reduce the number of acne and inflammatory lesions, and promote tissue repair to varying degrees. Fruit acid therapy: The mechanism of action of fruit acid is to reduce the adhesion of keratin-forming cells by interfering with the binding force of the cell surface, accelerate the shedding and renewal of epidermal cells, and at the same time stimulate dermal collagen synthesis and enhance moisturizing function. The higher the concentration of fruit acid, the longer the action time, the better its effect, but the relative adverse effects are also greater. Treatment protocol: Apply fruit acids (hydroxyacetic acid) at concentrations of 20%, 35%, 50%, and 70% once every 2-4 weeks for acne treatment, with 4 times being a course of treatment. Inflammatory lesions and non-inflammatory lesions had varying degrees of regression. The regression rate is 30% to 61%. Increasing the number of treatments can improve the efficacy. 6. Maintenance treatment of acne After the end of the course of systemic application of isotretinoin and antibiotics, if the symptoms of acne in the acute stage have improved (improvement rate >90%), maintenance treatment should be considered as much as possible to prevent relapse. This is because all current treatments for acne merely inhibit its pathogenesis, not cure it. Therefore. There is a need for maintenance therapy after treatment. After the initial systemic treatment is completed, topical retinoic acid is the main method of maintenance therapy. When accompanied by inflammatory damage. Combined application of peroxynivalenol can be considered. The necessity of maintenance treatment: ① Microcomedones are the early pathological process of all acne damage; ② The process of microcomedone formation remains permanent and persistent after acne clearance; ③ Avoiding microcomedone formation has an acne prevention effect; ④ The main mechanism of action of retinoic acid is to interfere with the pathological process of microcomedones. 7. Daily care Wash your face with water to remove the mixture of oil, dander and bacteria from the skin surface, but do not over-wash. Squeezing with hands is strictly prohibited. Harmful substances in the lesions can be squeezed into the surrounding tissues, inducing and aggravating inflammation. Squeezing the lesions in the danger triangle, bacteria can also travel retrograde to the brain via the cavernous sinus leading to intracranial infection. Pay attention to eating less sweets and fatty foods, eat more vegetables and fruits to prevent constipation, and keep your bowels open. Maintain emotional stability and get enough sleep. Adequate sleep and good mood can improve the immunity of the body, thus helping acne to improve and recover. Patients with acne should use cosmetics selectively. Avoid using oil and grease, powder-based skin care cosmetics and ointments and creams containing glucocorticoids. In conclusion, when choosing a treatment method, we should not only consider its efficacy, but also its safety, so that we can achieve the effect of safe acne removal.