How does acne come about? During puberty, under the stimulation of androgens (androgens are also secreted by the adrenal cortex part of the female body), the body’s sebum production increases and the ducts of the hair follicle sebaceous glands are also affected by androgens and become hyperkeratotic. As the ducts become smaller, narrower, or blocked, sebum and other substances cannot be discharged properly and collect at the openings. Initially, these aggregates are loose, but as the pressure increases, they gradually become tighter and form lamellar concretions. At this point, the skin surface bulges with small white or black spiky papules called whiteheads or blackheads. The white curd-like masses in the extruded pimples are made up of these plate-like concretions. Nourished by these build-ups, some of the normal bacteria that were originally colonizing the skin begin to multiply abnormally, thus inducing inflammation in the skin, and red papules and pustules are formed. If the blockage continues to accumulate and the acne ruptures leading to increased local inflammation and destruction of local dermal tissue, nodules and cysts will form, eventually leaving scarring.
Grading of Acne Treatment The grading of acne reflects the severity of acne and the nature of the lesions, so acne treatment should be based on its grading and the selection of appropriate treatment drugs and tools. Whether acne is graded according to the International Modified Classification, which is based on the number of lesions, or the Acne Classification, which emphasizes the nature of the lesions, the treatment options are basically the same. Of course, the treatment plan for acne is not set in stone and should be flexible according to the actual situation of the patient, fully reflecting the principle of individualized treatment.
Grade 1: Topical treatment is generally used. If only acne is present, topical vitamin A acid preparations are the best choice. Some medical skin care products that have the effects of exfoliating, dissolving acne, inhibiting sebum secretion, and antibacterial can also be used as an adjunctive treatment.
Grade 2: Treatment for grade 1 acne is usually used, but those with more inflammatory papules and pustules and poor topical results can be treated with oral antibiotics or the currently internationally recognized Forever Young BBL light for inflammatory acne. This type of acne can also be treated with combination therapy, such as oral antibiotics combined with topical retinoic acid preparations, or coupled with combination therapy such as photodynamic therapy or fruit acid therapy.
Grade 3: These patients often require a combination therapy approach in which the systematic use of antibiotics is one of their basic treatments and an adequate course of treatment is ensured. The most commonly used combination therapy is oral antibiotics plus topical retinoic acid preparations and also topical peroxybenzoyl. Hormonal therapy has also been used with good results in female patients who require contraception or have other gynecologic indications. Other combination therapies described in the guidelines may also be used (e.g., 2940 nm erbium laser, photodynamic therapy, etc.), but attention should be paid to the interactions and contraindications between tetracyclines and isotretinoin agents and the development of photosensitivity.
Grade 4: Oral isotretinoin is the most effective treatment for this group of patients and can be used as first-line therapy. For those with more inflammatory papules and pustules, a combination of systemic antibiotics and topical peroxynivalenol can also be used first, and then switch to oral isotretinoin for the remaining lesions such as cysts and nodules after these lesions have significantly improved. The methods used for grade 3 acne described above and the combination treatments described in this guideline can also be tried.