How Do I Choose the Best Acne Vulgaris Treatment?

Acne is a chronic, self-limiting, inflammatory disease of the hair follicle sebaceous glands that often occurs in young men and women. It mainly invades many parts of the sebaceous glands such as the face, back, and chest, and is often accompanied by sebum overflow. After puberty, most of them naturally heal or reduce .

Basic Information

Visiting department

dermatology

Multiple groups

Young men and women

Common locations

Face, back and chest

Common causes

Factors such as androgen, sebum production, and acnes infection, genetic

Common symptoms

acne

Causes of acne vulgaris

The exact etiology is not yet clear. It may involve factors such as androgens, sebum production, and acne infection. Genetics are also an important aspect. Serum androgen precursors increased significantly in patients with severe acne, but only increased levels of androgen in tissues in mild patients. Hyperfunction of sebaceous glands and excessive production of sebum are also an important factor in the occurrence of acne. The immune response caused by acnes infection is related to the occurrence of inflammatory skin lesions.

Clinical manifestations of acne vulgaris

Skin lesions are mainly distributed on the face and chest and back. The initial basic damage is acne without obvious inflammation. Acne is a small nodule with a large needle. "Blackheads" are located at the top of the open mouth of the hair follicle and can squeeze out harder fat plugs. Small nodules that are located in the skin without "blackheads" but are accessible, are called "whiteheads" or "closed acne". As the course of the disease progresses, various inflammatory skin lesions and sequelae can occur, including red papules, small pustules, inflammatory nodules, cysts, abscesses, sinus tracts and scars. According to the main manifestations of the disease, it is divided into the following clinical types:

Pimples acne

It is mainly inflammatory pimples, and acne is sometimes seen in the center of the pimples.

2. Pustular acne

Mainly small pustules, accompanied by inflammatory pimples.

3. Cystic acne

There are many sebaceous cysts of various sizes, which become abscesses after infection, often ulcerating and purulent, forming sinus tracts and scars.

4. Nodular acne

The invasion site is deep, forming deep inflammatory nodules.

5. Atrophic acne

Many pit-like atrophic scars remain after the inflammatory lesions have subsided.

6. Polymeric acne

Skin lesions are polymorphous, and various inflammatory and non-inflammatory lesions can occur. The condition is often severe.

7. Fulminant acne

Occasionally seen in young men. Suddenly, many severely inflammatory skin lesions appear, forming nodules and ulcers. In addition to local pain and discomfort, it can also be accompanied by general fever and multiple joint pain. Significant scars are left at a later stage.

Most of the occurrence of this disease starts at puberty, but individual cases can be as early as 6 to 8 years old, or as late as 30 years old. The natural course varies, but the vast majority of patients recover on their own or their symptoms improve after puberty. The acne period of a few patients can be extended to 30 to 40 years old. Severe fluctuations are common, some lessening in the summer and some worsening during the menstrual period.

Acne vulgaris diagnosis

A diagnosis can be made based on the above symptoms and signs.

Acne vulgaris treatment

The treatment of acne is very complicated. Because of the self-limiting nature of acne, the natural course of disease fluctuates significantly, and the response to placebo is quite significant, so the evaluation of the efficacy is not easy. The four main principles of acne treatment are: correcting abnormal keratinization of the hair follicles; inhibiting the secretion of sebaceous glands; reducing the number of bacteria (especially acne bacteria) in the hair follicles; eliminating local inflammatory reactions. The performance of acne varies, and the choice of treatment should be targeted. For example, acne-based acne and highly inflammatory acne are very different in treatment.

General processing

People with acne tend to have extremely oily skin, and it is often helpful to wash your face with soap or a cleansing germicide. Eat less crustacean, chocolate, sweets, milk and greasy foods, and eat more vegetables. Seafood and iodized salt can sometimes aggravate the condition. Although there is still disagreement about the necessity of diet control, the clinical experience of patients should be respected, and alcohol and spicy foods should be avoided.

2. External use

(1) Retinoic acid Retinoic acid (all-trans retinoic acid) preparation is applied externally, which is mainly suitable for treating acne mainly acne. Retinoic acid has no antibacterial effect, and if combined with benzoyl peroxide or other antibiotics, the effect is better.

(2) Benzoyl peroxide This medicine is formulated into a 2.5% to 10% lotion or gel for external use. According to the patient's tolerance, gradually increase the concentration. Apply twice a day. The main effect is to reduce the number of A. acnes and to reduce the hydrolysis of triacylglycerol. In addition, it also inhibits abnormal keratinization processes such as acne (weaker than retinoic acid). Adverse reactions include dry skin, irritation, and allergic contact dermatitis. This product is often used in combination with other therapies, which can significantly improve the efficacy.

(3) Antibiotics The main role is to destroy the acne bacteria in the hair follicle and inhibit its ability to produce pre-inflammatory mediators. It has obvious effect on inflammatory acne. Long-term topical antibiotics are prone to drug-resistant strains. Combining erythromycin with benzoyl peroxide (such as 3% erythromycin and 5% benzoyl peroxide in Bimaxen) can prevent this from happening.

(4) Sulfur, retinoxin and salicylic acid can be formulated into lotions, creams and pastes with appropriate concentration for external use.

(5) Azelaic acid can be used for both inflammatory and non-inflammatory acne. There are three effects in the treatment of acne, namely antibacterial effect, anti-acne effect and anti-inflammatory effect. Its adverse reactions are less than that of retinoic acid, and the skin is red, but it is not accompanied by desquamation and dryness, and has no light sensitivity. In addition, this product can reduce skin pigmentation after inflammation.

(6) Nicotinamide 4% nicotinamide gel has a good effect in the treatment of moderate to severe acne, and its mechanism of action is to remove the superoxide anion free radicals that cause inflammation and inhibit the chemotaxis of white blood cells.

(7) Glucocorticoid Cream application of chloramphenicol is also effective. The drug is particularly effective in the treatment of nodules and cystic acne with plastic (polyethylene film) packets.

3. Internal use

(1) Antibiotics Tetracycline and its similar broad-spectrum antibiotics are often used in acne treatment with significant effects. In addition, antibiotics also have anti-inflammatory effects.

(2) Isotretinoin (13-cis-retinoic acid) is suitable for severe and stubborn nodular cystic acne; other types of acne that are not effective with general therapies and may seriously affect patients' physical and mental health can also be used as appropriate . Sometimes it can be slightly shortened, because if the skin lesions have subsided by 70% to 80%, the condition will continue to improve after stopping the drug. After adequate treatment, most cases can be resolved in the long term. A few cases of relapse after discontinuation can be given a second course of treatment after 8 weeks of discontinuation.

(3) Glucocorticoids Prednisone is usually used. It is only used in cases where the skin inflammation is obvious and ineffective with other antibiotics. For acne with severe inflammation and prednisone in the early stage, prednisone can effectively control symptoms and prevent adverse consequences. For female cases with 11 or 12 hydroxylase blockers or excessively high androgen content, the combination of a small amount of glucocorticoids and estrogen can reduce the plasma androgen content to a greater extent and improve the efficacy.

(4) dapsone This medicine has a certain anti-inflammatory effect, mainly used for severe nodular cystic acne and fulminant acne, and can be combined with antibiotics.

4. Local injection therapy

The advantage of intradermal injection of the drug is to give full play to the local effect of the drug and greatly reduce the impact on the whole body. Triamcinolone acetate suspension, triamcinolone acetoacetate, and betamethasone suspension are commonly used in clinical practice.