What is acne?
Acne vulgaris is a chronic inflammatory skin disease of the sebaceous glands of the hair follicles that occurs in adolescence. The incidence of acne is 70-87%, and the clinical incidence of facial acne is higher in females, with a greater psychological and social impact on adolescents. Early treatment of this disease is important. Timely and standardized diagnosis and treatment can shorten the course of the disease and avoid or reduce the occurrence of various complications.
What factors are associated with the onset of acne?
The development of acne is mainly related to excessive sebum secretion, blockage of hair follicle sebaceous ducts, bacterial infection and inflammation, as well as diet, emotions, medications and many other factors.
Is acne endocrine related?
The pathophysiological basis for acne is the rapid development of sebaceous glands and excessive sebum production, which is governed by androgens. Testosterone levels rise rapidly after puberty, and testosterone is converted to dihydrotestosterone in the skin. The latter can bind to androgen receptors in sebaceous gland cells, promoting sebaceous gland development and producing large amounts of sebum. In addition, the reduced content of linoleic acid in the sebum of acne patients can reduce the essential fatty acids around the hair follicle, causing hyperkeratosis of the hair follicle epithelium and the formation of keratin.
What are the manifestations of acne.
Acne can manifest itself as blackheads, whiteheads, inflammatory papules, pustules, nodules, cysts, etc. After acne heals, it is easy to form hyperpigmentation, i.e. acne marks, enlarged pores or even scar-like damage, which affects beauty and can even be disfiguring.
Grading of acne.
The grading of acne helps in the treatment and evaluation of the efficacy of acne. According to the nature and severity of the lesions, they can be classified into 3 degrees and 4 grades: Grade 1 (mild): acne only Grade 2 (moderate): acne + inflammatory papules Grade 3 (moderate): acne + inflammatory papules + pustules Grade 4 (severe): acne + inflammatory papules + pustules + nodules, cysts or scarring.
What are the principles of acne treatment?
The principles of acne treatment are lipid removal, dissolution of keratin, antiseptic and anti-inflammatory, and individualization of treatment.
How is mild acne treated?
Mild acne refers to acne with only whiteheads or blackheads, and does not require systemic medication. Topical retinoid preparations are sufficient.
How to treat moderate to severe acne?
Grade 2 acne can be treated with topical agents such as retinoic acid, which regulates the normal keratinization of cells, and topical antibiotics such as benzoyl peroxide, etc. Grade 3 acne requires systemic antibiotics in addition to topical agents. In order not to leave complications such as a large number of acne scars and pits, it is best to combine physical therapy (antibiotics, isotretinoin, etc.) with medication such as red and blue light and photodynamic therapy. Short-term application of glucocorticoids is also required if necessary.
What are the physiotherapy treatments for acne?
For patients who cannot tolerate medication or do not receive medication, and for patients with grade 4 acne, physiotherapy or combined physiotherapy is a good choice. The physical treatments carried out in our department are: photodynamic therapy, semiconductor laser, laser or intense pulsed light, and fruit acid therapy.
What is the principle of red and blue light treatment for acne?
Red and blue light treatment for acne is based on the characteristics of the light action of Propionibacterium acnes, that is, Propionibacterium acnes can produce endogenous fecal porphyrins and can absorb protoporphyrins through its cell wall receptors. These two porphyrins are the important material basis for Propionibacterium acnes to maintain normal metabolism and keep its form and function. The absorption of specific wavelengths of light activates porphyrins, producing monomorphic oxygen and free radicals, which inactivate Propionibacterium acnes and play a role in treating acne.
Is red and blue light selective for acne treatment?
The absorption peak of porphyrins is in the wavelength range of 400-700nm. Blue light has a strong absorption peak at 415nm, but because blue light has a limited penetration depth, it is only effective for mild to moderate acne. In particular, the efficiency of red light plus blue light treatment can reach 80%, and it can accelerate the elimination of acne marks and smooth out fine lines.
Can photodynamic therapy treat acne?
Photodynamic is an exogenous photosensitizer, such as ALA, applied topically to the skin lesion, which is absorbed by the sebaceous units of the hair follicle and participates in the hemoglobin synthesis pathway to produce protoporphyrin, which is excited by specific wavelengths of light to produce singlet oxygen and free radicals, thus selectively acting on the sebaceous units of the hair follicle and Propionibacterium acnes with minimal damage to the surrounding tissue.
Is photorejuvenation effective for acne?
The light source of photorejuvenation is intense pulsed light with a wavelength of 500-1200nm. While rejuvenating the skin, it can treat lesions with only papules and pimples, while quickly removing the purple-red acne marks caused by acne. However, intense pulsed light treatment for acne must be performed by a physician with a detailed medical history, strict selection of indications, and individualization of treatment parameters, otherwise serious side effects may occur.
What are the advantages of phototherapy for acne?
1.Reducing the systematic application of drugs and avoiding adverse reactions caused by drugs.
2, Effective selection of special populations, such as pregnant women (except photodynamic), etc. and those who cannot tolerate drug treatment.
3.No pain and other suffering.
4, While treating acne, it can smooth out fine skin lines, brighten skin tone, and make skin smoother and softer.
Can post-acne scarring be treated?
Severe and long-lasting acne is very likely to leave behind acne marks and even scarring such as pits of varying sizes, causing great psychological and social obstacles to patients. In the past, post-acne scarring was usually treated with grinding, but the treatment was not ideal because of the large invasive area and the number of treatments. In recent years, our department has introduced the fractional laser imported from Germany with huge investment, which can improve the depressed scar left after various diseases and also has good effect on some of the hyperplastic scar. Of course, the treatment provider must have rich clinical experience.
Fruit acid therapy for acne Fruit acids are commonly found in fruits, sugar cane, and yogurt. They are highly permeable, safe in action, and do not damage the barrier function of the skin. The mechanism is that fruit acids can interfere with cell surface binding to reduce the adhesion of keratin-forming cells, accelerate the shedding and renewal of epidermal cells, and at the same time stimulate dermal collagen synthesis and enhance moisturizing function. The treatment concentration is 20%, 35%, 50%, 70%, etc., once every 2-4 weeks. If combined with red and blue light, intense pulsed light, etc. will have a better treatment effect.
Will acne recur after treatment?
Since all current treatments for acne only inhibit the process of its development, but not cure it, maintenance treatment is very important after the acute acne is controlled. Maintenance treatment is generally applied mainly with topical medications such as retinoic acid, or combined with Banzai gel, for a maintenance period of 6-12 months.
Acne patients should pay attention to those issues in daily life?
1. Avoid emotional tension and keep a happy mood. Ensure sufficient sleep.
2.Minimize the consumption of greasy and fried foods, sugar, chocolate and spicy and stimulating foods. Eat more vegetables and fruits rich in vitamin C and foods rich in calcium.
3, pay attention to personal hygiene, avoid scratching and squeezing, wash your face with warm water, but frequent washing will aggravate acne.
4.Avoid taking drugs that may cause or aggravate acne.
5.Avoid using thick cosmetics and excessive makeup.
Knowledge of medication for acne.
Benzoyl Peroxide Gel (Bansai)
Principle of action.
Benzoyl peroxide is a peroxide, which can slowly release eco-oxygen and benzoic acid after topical application, and has the effects of killing Propionibacterium acnes, dissolving acne and astringency.
In addition, Bansai can release glycerin moisturizing factor while absorbing undesirable sebum to make the skin moisturized and soothed.
Antibiotics.
Oral antibiotics are one of the effective methods of treating moderate to severe acne.
Antibiotic selection should follow the following principles.
1. Drugs that are sensitive to Propionibacterium acnes.
2. Drugs that are selectively distributed to the seborrheic site. Based on this, tetracyclines (second generation), followed by macrolides, should be preferred, while antibiotics such as penicillin and cephalosporins are extremely weak against Propionibacterium acnes.