Acne:
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| skin pimples |
Acne is a chronic inflammatory skin disease of the sebaceous unit of the hair follicle. It mainly occurs in adolescents and has a great impact on the mental and social life of adolescents, but it can often relieve itself or heal naturally after puberty. The clinical manifestations are pleomorphic skin lesions such as acne, papules, pustules, and nodules on the face.
Reason:
The occurrence of acne is closely related to factors such as excessive sebum secretion, clogged hair follicle sebaceous duct, bacterial infection and inflammatory reaction. After entering puberty, the level of androgens, especially testosterone, rises rapidly in the human body, which promotes the development of sebaceous glands and produces a large amount of sebum. At the same time, abnormal keratinization of the hair follicle sebaceous duct leads to blockage of the duct, obstruction of sebum discharge, and the formation of keratinous embolism or micro-acne. Many microorganisms in hair follicles, especially Propionibacterium acnes, multiply. Lipase produced by Propionibacterium acnes breaks down sebum to produce free fatty acids. At the same time, it chemically attracts inflammatory cells and mediators, and ultimately induces and aggravates the inflammatory response.
Clinical manifestations:
Skin lesions are usually on the face and upper chest and back. The non-inflammatory skin lesions of acne are manifested as open and closed acne. The typical skin lesions of closed comedones (also called whiteheads) are skin-colored papules about 1 mm in size without obvious hair follicle openings. Open comedones (also known as blackheads) appear as dome-shaped papules with obvious expansion of the hair follicle opening. The further development of acne will evolve into various inflammatory skin lesions, manifested as inflammatory papules, pustules, nodules, cysts and so on. The inflammatory papules are red, ranging from 1 to 5 mm in diameter; the pustules are the same size and are filled with white pus; the nodules are larger than 5 mm in diameter, with induration and tenderness; the cysts are deeper and filled with a mixture of pus and blood. These skin lesions can also fuse to form large inflammatory plaques and sinuses. After the inflammatory skin lesions subsided, pigmentation, persistent erythema, sunken or hypertrophic scars are often left. According to the nature and severity of acne lesions, acne is divided into grades 3 and 4: Grade 1 (mild): only acne; Grade 2 (moderate): In addition to acne, there are some inflammatory papules; Grade 3 ( Moderate): In addition to acne, there are more inflammatory papules or pustules; Grade 4 (severe): In addition to acne, inflammatory papules, and pustules, there are nodules, cysts or scars.
Diagnosis:
According to the characteristics of adolescents, the skin lesions are distributed on the face, chest and back. The main manifestations are whiteheads, blackheads, inflammatory papules, pustules and other pleomorphic skin lesions, which are easy to diagnose clinically, and other examinations are usually not required. Sometimes it needs to be distinguished from rosacea, facial disseminated miliary lupus, sebaceous adenoma, etc.
Treatment:
1. Daily care:
Wash your face with warm water once or twice a day to clean your skin and avoid squeezing or scratching the skin lesions with your hands. Avoid oils, powdered cosmetics and ointments and creams that contain glucocorticoids.
2. Common methods of treating acne:
(1) External use of retinoic acid (retinoic acid cream, adapalene gel, tazarotene gel), benzoyl peroxide, antibiotics (clindamycin, erythromycin, chloramphenicol, etc.), Azelaic acid, sulfur lotion, etc.
(2) Oral antibiotics. Tetracyclines (minocycline, doxycycline, etc.) are the first choice, followed by macrolides (erythromycin). Avoid antibiotics commonly used to treat systemic infections, such as levofloxacin. The course of antibiotics is usually 6 to 12 weeks.
(3) Oral isotretinoin For severe acne, oral isotretinoin is the standard treatment method, and it is also the most effective way to treat acne. The course of treatment aims to achieve a minimum cumulative dose of 60 mg/kg.
(4) Anti-androgen therapy such as oral contraceptive compound cyproterone acetate tablets is suitable for women with moderate to severe acne, high levels of androgen (such as hairiness, seborrhea, etc.) or polycystic ovary syndrome. Female patients with late-onset acne and premenstrual acne can also consider oral contraceptives.
(5) Oral glucocorticoids are mainly used for fulminant or agglomerated acne, following the principles of short-term, low-dose, and combined application with other methods.
(6) Others For patients who cannot tolerate or are unwilling to receive drug treatment, physical therapy, such as phototherapy, can also be considered
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