Acne Liu Wali, Department of Dermatology, Guang’anmen Hospital, Chinese Academy of Traditional Chinese Medicine
I. Overview
Acne is a common chronic inflammatory skin disease of the sebaceous glands of hair follicles. It is characterized by blackheads or whiteheads, papules, pustules, nodules, cysts and other damage on the face and chest and back, and occurs in young men and women. In recent years, as people’s dietary structure changes and factors such as life stress and environmental pollution, the incidence of acne has been on the rise, and the age range of onset is gradually expanding.
The pathogenesis of acne is complex, with endocrine, microbial, immune, and psychological factors all playing a role in the development of acne, and there is a clear genetic background. The elevated level of androgens in the body during puberty leads to hyperfunction of the cortical glands and enhanced sebum secretion rate, which provides favorable conditions for the proliferation of Propionibacterium acnes and other bacteria.
Chinese medicine calls this disease acne, pulmonary wind acne, facial pimples, etc. It is believed to be caused by heat in the lung meridian, heat in the stomach and intestines, dysregulation of the flush, and mutual stagnation of phlegm and stagnation of phlegm.
Diagnostic points
(A) Diagnostic basis
1. Clinical manifestations
The age of onset of acne is 10-19 years old, but there are also post-pubertal or adult-onset cases. There are more males than females.
It occurs mainly on the face and chest and back of young men and women, and is mostly characterized as acne vulgaris, with blackheads or whiteheads, papules, pustules, nodules, cysts, and other damage, with some scarring. A small number of people can develop coalescent acne, necrotizing acne, atrophic acne, etc.
2. Diagnostic criteria.
(1) The onset of acne in adolescence, usually on the face, upper chest and back with well-developed sebaceous glands, symmetrically distributed.
(2) The lesions are follicular papules, pustules, nodules, cysts, blackheads and scars, accompanied by seborrhea, with a chronic course.
3. Clinical severity grading: Refer to Pill Sburv and the International Modified Acne Grading Method (Clinical Dermatology).
Grade I (mild): The main lesions are blackheads, disseminated to multiple, and inflammatory papules disseminated. The total number of lesions is 10-30.
Grade II (mild to moderate): The main lesion is acne with a moderate number of papules and superficial pustules, with a total number of 31-50 lesions confined to the face.
Grade III (more severe to moderate): The main lesions were deep-inflammatory papules and pustules, with 51-100 total lesions and <3< span=""> nodules, occurring on the face, neck, and chest and back.
Grade IV (severe): The main lesions were deep-inflammatory papules and pustules, with >100 total lesions and >3 nodular cysts, easily forming scars, and occurring on the upper body.
4.Differential diagnosis
(1) rosacea Prevalent in middle-aged people, lesions are mainly distributed on the tip of the nose, cheeks, forehead and jaw, the affected area is accompanied by capillary dilation, papules and pustules, and nasal redundancy is formed in late stage.
(2) Facially disseminated acne vulgaris occurs in adults, with lesions mainly consisting of corn to pea-sized papules or nodules, dark red or brown, soft to the touch, with central necrosis, and yellowish or brown spots on slide compression, mainly on the lower eyelids and nasolabial folds.
(3) Pharmacogenic acne The use of corticosteroids, bromine, iodine and other drugs can cause acne-like rashes, and the lesions are mostly generalized, without blackheads, with a heavy inflammatory reaction and variable age of onset.
(2) Key points of identification
1.Heat in the lung and stomach
It is equivalent to acne vulgaris stage I and II. Clinical manifestations include the appearance of red papules and blackheads and whiteheads on the face and back of the chest, with itching and pain. It may be accompanied by flushing of the face, heat, nasal breath, red tongue, thin yellow fur, and floating or fine pulse.
2.Dampness and heat accumulation evidence
Corresponds to acne vulgaris stage II and III. The lesions are painful papules and pustules with small nodules, or mainly pustules, with red and swollen roots, and oily and shiny skin. It is accompanied by bad breath, irritable and thirsty, constipation and red urine, a preference for cold drinks, a red tongue, a yellow and greasy coating, and a slippery pulse.
3.Blood stasis and phlegm coagulation evidence
Equivalent to nodular cystic acne. The lesions are nodules and cysts, dark in color, such as the size of a grain of rice, gradually to the size of a soybean, hard to the touch, recurrent, long-lasting, and easy to form scars. It may be accompanied by abdominal distension and loose stools, a dark tongue or petechiae, thick and greasy coating, and a slippery or astringent pulse.
4.Dysregulation of the flush and the capillary
Acne vulgaris can be seen in all stages of the disease. It is mostly seen in adult female patients, with papules around the mouth or on the jaw, aggravated before menstruation. It may be accompanied by irregular menstruation, breast swelling and pain, with a light red tongue, thin white coating and string pulse.
(C) Treatment routine
1.Treatment by Chinese medicine
Acne vulgaris usually occurs in young and middle-aged people, and the pathogenesis of acne vulgaris is mostly heat evidence.
(1) Heat in the lung and stomach
Treatment: Clearing lung heat and dispersing wind evils.
Remedy: Loquat and lung clearing drink plus reduction.
Loquat leaf, mulberry bark, silver flower, forsythia, burdock, peppermint, scutellaria.
(2) Dampness and heat accumulation evidence
Treatment: Detoxify and clear heat.
Radix Scutellariae Pinnatifida combined with Five Flavors Disinfectant Drink, plus or minus. Dandelion, daidin, silver flower, forsythia, wild chrysanthemum, scutellaria, raw gypsum, white flower and snake tongue herb.
(3) Blood stasis and phlegm coagulation
Treatment: Promote blood circulation, eliminate blood stasis, eliminate phlegm and disperse knots.
Remedy: Reduce Blood Stasis and Disperse Stagnation Pill.
(4) Dysregulation of the Qi and Qi
Treatment: Soothe the liver and regulate the Qi, and regulate the flushing.
Remedy: Plus Wei Yi Yao Wan plus or minus.
Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix Bupleurum, Poria, Rhizoma Atractylodes Macrocephala, Radix Scutellariae Sinensis, Radix Salviae Miltiorrhizae, Radix et Rhizoma Yi.
2 .Therapeutic methods of Chinese medicine
Chinese medicine mask (in-hospital preparation): applicable to all types of rashes, red papules and pustular lesions are more effective.
3 Western medicine treatment
(1) Internal medicine
(1) Antibiotics: Systematic application of antibiotics is effective for inflammatory acne. Commonly used drugs include tetracycline orally, 0.5g twice a day, and after the symptoms are reduced, change to maintenance amount of 0.25g once a day. Or memantine 0.1g twice daily, and reduce to once daily after a week. The course of treatment is usually 6-8 weeks. Erythromycin and doxycycline may also be used as appropriate.
② Estrogen: Female patients with severe lesions can take oral hirsutestrol at 0.25mg daily or daing-35: 1 tablet daily, starting on the 5th day of menstruation and stopping for 21 days. It can be repeated in the next menstrual cycle and can be taken continuously for several courses of treatment depending on the severity of the disease.
③Isotretinoin: It can inhibit the secretion function of sebaceous glands, has an anti-inflammatory effect, and reduces sebum secretion and blackhead acne formation. It is effective for cystic and coalescent acne. Take orally, 0.5-1mg/kg per day for 4 months. This drug has certain toxic side effects, and blood and liver and kidney functions should be checked when taking this drug.
(2) Topical drugs
① Antibiotics: topical application of 1% erythromycin ethanol solution, 1% chloramphenicol ethanol solution, 3% erythromycin 5% benzoyl peroxide gel, etc.
② Retinoic acid: 0.05% retinoic acid cream or gel, 0.1% adapalene gel, etc. for external use.
(3) Other therapies
① Blue light (415nm) acne treatment instrument lesion area irradiation to treat inflammatory lesions such as red papules and pustules.
② Red light (660nm) irradiation of the lesion area of the acne treatment instrument to reduce or eliminate inflammatory scars.
IV Care and regulation
1 Avoid squeezing the affected lesions with your own hands to prevent secondary infection or scarring.
2 Wash your face with warm water and sulfur soap or mild cleanser daily to keep your face clean and reduce oil and dirt, and choose cosmetics carefully.
3 Eat a light diet with less sugar and fatty foods and sugars, avoid spicy, tobacco, alcohol and other stimulating foods; eat more vegetables and fruits to keep the bowel movement smooth.
4 Emotional care: explain to patients the knowledge of the disease, strengthen emotional guidance, communication, maintain positive and optimistic emotions, pay attention to the regularity of life, so that they cooperate with the treatment.