Acne

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Acne
Body Parts: Head Neck Chest Back
Medical Subjects: Skin
Overview

What Is Acne

Is acne and acne vulgaris the same thing?

Not exactly.

There are many types of acne, and the most common type is "acne vulgaris", also known as "acne" and "whelk". In addition to acne vulgaris, acne has some special types, such as acne vulgaris and acne vulgaris.

In this paper, the discussion of acne, unless otherwise specified, mainly refers to acne vulgaris.

What disease is acne?

Acne is commonly known as acne, whelk, pore blockage, acne propionibacterium breeding factors such as hair follicle infection and inflammation, in the process, androgen also play a role.

Acne occurs frequently in the face, neck, chest, back and other areas with rich sebaceous glands, and the most common is the face. Acne has black heads, hoary heads, papules, pustules, nodules and other manifestations, the late may also form pigmentation and scars, sometimes commonly known as acne marks and pits.

Most acne condition improve after about 25 year of age, but there are small groups that last longer. Acne generally affects aesthetics and self-confidence, brings negative emotions to patients, and seriously affects the quality of life. Therefore, standardized and comprehensive treatment is very important.

Treatment of acne requires a multi-pronged approach, including improvement of lifestyle, external drugs, oral drugs and even physical and chemical treatment. Be sure to get treatment from a regular medical facility.

In addition, patients with acne may feel shame and remorse due to their illness, and many negative emotions appear. At this time, we need the understanding and care of our family and friends to help them insist on reasonable treatment and get out of the psychological dilemma.

Is acne common?

Acne is very common. Studies have found that more than 95% of people have varying degrees of acne, 3%–7% of acne patients will leave scars.

Overall, the incidence of acne is higher in women than in men.

Although acne is most common in teenagers and many people can naturally get better after 25 years old, about 50% of women and 40% of men over 25 years old still have acne. After age 40, acne affects approximately 1% of men and approximately 5% of women.

Cause

What Is The Cause Of Acne

Does face grow blain and splanchnic problem concern?

There is no clear and direct relationship between facial acne and such internal organs as heart, liver and kidney.

Acne refers to the chronic inflammation of local hair follicle sebaceous glands. The hair follicle sebaceous glands are only found in the skin, and the deepest part is only in the subcutaneous tissue, not even in the muscular layer. They are really "irrelevant" to internal organs.

Want to ask why love grows blain on the face, basically still blame the sebaceous gland that secretes grease.

In the face, scalp, upper back and chest, the distribution of sebaceous glands is much more than in the lower part of the trunk and the skin of the four limbs; The forehead, nose and two sides of nose ala are the richest areas of sebaceous glands (i.e. T area with the most oil).

Because of this, the face became the best part of acne.

What are the common causes of acne?

  • Heredity: Some studies support that genetic factors may lead to acne in some people, and individuals with acne among close relatives have an increased risk of acne, the so-called "genetic susceptibility", and there are multiple candidate genes that may be related to acne.
  • Hormone(commonly known as hormones): Acne may be facilitated by changes in the activity of a variety of hormones associated with acne, including testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulfate, insulin-like growth factor (IGF-I), and growth hormone. For example, increased androgens during adolescence cause hypertrophy of sebaceous glands and secretion of sebum, and acne is easy to occur.
  • Infection: The occurrence of acne is closely related to propionibacterium acnes. Propionibacterium acnes is the normal flora on the skin, and is safe with the skin. However, after the formation of acne, the local environment changes, resulting in a large number of proliferation, will make acne worse or repeated.
  • Lifestyle: An unhealthy lifestyle may promote or aggravate acne.
  • Smoking: Smoking increases the risk of getting acne.
  • Diet: High glucose diet was associated with increased acne; Milk intake may be associated with the development or exacerbation of acne, particularly low-fat and skimmed milk, but the evidence for this is weak. Other diets, such as chocolate and salt, have not been shown to have anything to do with acne.
  • Obesity: Acne is associated with obesity.
  • Vitamin B12: Acne may be caused or exacerbated by vitamin B12 when it exceeds the recommended daily intake.
  • Stress factors: Such as mental factors such as stress and excessive pressure may cause or aggravate acne, but the exact relationship between these mental factors and acne is still controversial.

Is acne associated with menstrual cycles?

The morbidity of some adult female acne patients is related to the menstrual cycle, manifested as premenstrual morbidity or exacerbation. The acne is limited to the perioral area, forehead, brow or one side of the cheek, and the number is small. Most of these patients have normal menstruation.

Acne in patients with polycystic ovary syndrome has a similar manifestation, but it is often characterized by infrequent menstruation, menopause/amenorrhea, obesity, and hirsutism, which are easy to identify.

Can acne be caused by drugs?

Drugs can cause acne.

Glucocorticoids (such as dexamethasone and prednisone) are common, and the possible mechanism is the physiological dysfunction of sebaceous glands, causing acne-like skin damage. The mechanisms of action of other acne-causing drugs, such as iodides and bromides, are not well understood.

Is acne hereditary?

As mentioned earlier, acne has a genetic predisposition. If you have acne in your immediate family, your chance of developing acne will be increased.

Is acne contagious?

Although the occurrence of acne and propionibacterium acne has a certain relationship, but acne is not contagious. Everyone has propionibacterium acne on their face, which is the normal flora of the skin. Acne is only caused or exacerbated by an imbalance in the growth of propionibacterium acnes.

Symptom

What Symptom Does Acne Have

What are the manifestations of acne?

Non-inflammatory skin lesions (acne):

  • Open acne: Also known as blackheads, blackheads, needle size, central to the expansion of the pores, pores with black lipid plug.
  • Closed acne: Also called hoary head, hoary head acne, closed mouth, for the size of a needle, white or reddish rash.

Inflammatory skin lesions:

  • Papules: Particles that develop further from acne and are usually red and painful.
  • Pustules: Red skin lesions, the top can have white pus point, there will generally be pain.
  • Nodules and cysts: It was a solid or hollow inflammatory lesion (pimple) under the skin with a diameter of > 5 mm.

Scar formation:

It is also equivalent to scarring and is a result of inflammation of the acne dermis, with an estimated 95% of acne vulgaris patients likely to have varying degrees of scarring.

Scars most often occur in severe nodular cyst acne, but can also occur in any form of acne vulgaris patient.

Acne is divided into hypertrophic scar and atrophic scar according to whether excessive collagen deposition or collagen reduction occurs during healing.

Post-inflammatory hyperpigmentation:
Commonly known as acne marks, refers to the dark brown patches left after the acne lesions subsided.

Post-inflammatory erythema
Like scars and acne marks, erythema after acne inflammation is also a sequela manifested as persistent redness in the late stage of acne, and some parts can disappear over time.

What is atrophic scar after acne?

Atrophic scars are the most common acne scars and are caused by collagen loss during inflammatory healing.

Atrophic scar can be further divided into ice cone scar, box car scar and roller scar.

  • The icicle scar was narrow (less than 2 mm), deep in the scar and extending into the dermis.
  • Box car scar is round or oval alternate scar, sharp edge, size between 1.5~4 mm
  • The roller scar was wider than the cone scar (4–5 mm) and had a wavy depth pattern.

What kind is hyperplastic scar after acne?

Hypertrophic scars are uncommon and are characterized by an increased collagen content following an abnormal healing response.

The hypertrophic scar is still on the original wound edge, whereas keloids can form scar tissue outside the edge.

Keloids from acne often occur in men, often after acne in the trunk, rather than on the face.

What are the characteristics of acne?

  • Papules are the most common form of skin lesions in acne, but often multiple forms of skin lesions co-exist.
  • Patients themselves may feel itching or pain, with pain being more common.
  • Acne usually develops slowly, persists, is mild and severe, and has recurrent episodes.
  • It can gradually relieve in the later stage as you get older, but the sequelae of cicatrix always exist.

How is the severity of acne graded?

At present, there is no unified grading standard in the world. The acne guidelines in China mainly classify acne into three degrees and four levels according to the nature of skin lesions, which have certain guiding significance for the selection of treatment options. Specifically as follows:

  • Mild (Grade I): acne only.
  • Moderate (grade II): inflammatory papules.
  • Moderate (Grade III): pustules occur.
  • Severe (Grade IV): nodules and cysts.

Acne In addition to acne vulgaris, what are the special types?

  • Polymeric acne;
  • Fulminant acne
  • Necrotizing acne;
  • Neonatal acne;
  • Infantile acne;
  • Acne in children;
  • Drug-induced acne;
  • Occupational acne.

What is convergent acne?

Acne rosacea is a serious form of acne that occurs after adolescence and is more common in men. It often occurs in the chest, shoulder, back and neck, or in the arm.

Skin lesions have acne, papules, pustules, nodules and cysts, the skin often form a large suppurative, ulceration, the abscess, cysts often contain offensive purulent material. After recovery, often left obvious scar.

Patients with acne vulgaris have an increased risk of developing squamous cell carcinoma.

What is fulminant acne?

Fulminant acne refers to a patient with mild acne for several months or years who suddenly aggravates the disease with fever and arthralgia, and even suffers from weight loss, anemia, leukocytosis, and erythrocyte sedimentation rate increase. Men are more common.

The combination of glucocorticoids and antibiotics is effective. Mild cases can be treated outpatient, while severe cases require hospitalization.

Fulminant acne is not a simple chronic acne flare-up, but a disease closely related to immunity.

What is necrotic acne?

Necrotic acne, also known as acne-like acne, is characterized by follicular papules (inflammation of hair follicles that leads to small rashes protruding from the skin surface), pustules, necrosis and pitting scars on the forehead. In addition, skin lesions can also affect the retroauricular region, the leading edge of the hairline, the nose, ears, cheeks, and trunk.

What is baby acne?

Acne can occur in infants, less frequently, more than within three months of birth and almost exclusively in boys.

The cause of the disease is not very clear, it may be due to certain genetic factors, and some scholars believe that it is caused by the introduction of maternal androgens into the body in the fetal stage. Children with infantile acne have an increased risk of reoccurrence during adolescence and their parents may also have a history of more severe acne.

Infantile acne also presents as papules, acne and pustules on the cheek, although it is generally more severe.

What is drug-induced acne?

Drug-induced acne usually occurs after long-term application of drugs, and it is more likely to occur on the face and back.

The skin lesions presented as follicular papules and hills herpes mimicking acne vulgaris. The course of the disease progresses slowly and there are generally no systemic symptoms.

Easy to cause acne drugs are glucocorticoids, iodide, bromide, etc.

What is occupational acne?

Some acne is related to the occupation, called occupational acne:

  • For workers exposed to mineral oil and tar for a long time, impurities in the oil can block hair follicle mouth and secondary bacterial infection can promote acne. Their acne is more intensive, flushing, in addition to the face is more common, but also more common in the limbs vulnerable to clothing friction parts.
  • Acne caused by contact with halogenated hydrocarbon compounds is also called chloroacne, and its occurrence is related to the proliferation of a cell (ductal epithelial cell) in sebaceous glands and the proliferation of the outer root sheath of hair follicles.
  • Long-term contact with asphalt can also lead to acne, which is mainly manifested as spatialization of hair follicles (thickening of cutin), blackheads and acne-like lesions.
Detect

How To Check For Acne

How to diagnose acne vulgaris in acne?

Acne vulgaris can be diagnosed by asking the doctor about the medical history and observing the morphology of the rash. Generally, no special examination is required.

What disease does acne need to be distinguished from?

Rose acne:

Also known as rosacea, rosacea, there can be a variety of skin manifestations. Skin lesions were predominantly central to the face, with persistent redness, papules, pustules, flushing, telangiectasia, and warty skin changes (e.g., rhinophyseal) seen in the central part of the face.

Acne vulgaris is acne but without telangiectasia, which can be distinguished from rose acne.

Facial disseminated miliary lupus:

It occurs in adults, without gender difference, and is apt to occur around the eyes, especially under the eyelid;

Skin lesions were single red or crimson hemispheric papules, grain to pea-sized, smooth-surfaced, soft-textured, without noticeable sensation;

The papules can fuse with each other to form irregular lesions, and obvious atrophic scars are left after healing. The color of applesauce can be seen through doctor's pressing diagnosis with glass sheets, which is easy to distinguish from acne.

Miliary papules:

Commonly known as aliphatic granule, it is a benign mass in nature, originating from the epidermis or its appendages (such as sweat glands and sebaceous glands), and can occur at any age and gender. Clinically, it can be divided into two types: primary and secondary.

The primary disease begins in the newborn and is formed by undeveloped sebaceous glands. The injury can occur spontaneously and disappear naturally. Secondary lesions often occur with abrasions, burns, epidermolysis bullosa, delayed dermal porphyria, lichen planus bullosa, and may be related to sweat duct damage.

Skin lesions were opalescent or yellow pinhead to corngrain-sized firm papules, apex rounded, covered with an extremely thin epidermis; It is common around the eye, cheek, forehead and external ear.

Perioral dermatitis:
Perioral dermatitis is common in women aged 20–45 years old, and is mainly manifested as small red particles, pustules and erythema with dandruff at the mouth. It is very important that there is no acne in perioral dermatitis. In addition to perioral, it may also grow on the skin around the eyes and nose, so it can also be called perioral dermatitis.

How is drug-induced acne distinguished from acne vulgaris?

Drug-induced acne occurs not only at the age of puberty, but also with a clear history of drug use or drug contact, a slow course of disease, and remission or regression of acne after drug discontinuation. However, acne vulgaris often occurs during adolescence, with obvious acne and no definite medication history.

Prevention

How To Prevent Acne

Can acne vulgaris be prevented?

There is currently no effective way to prevent acne vulgaris. Vaccines against inflammatory acne have been successfully tested in mice but have not so far proved effective in humans.

What precautions need to be taken against career-related acne?

  • Strengthening publicity and education: recognizing the relationship between occupation and acne, many occupation-related acne occur unconsciously, and workers do not realize that the incidence of acne is related to occupation; Even specialists may be misdiagnosed without careful history questioning.

  • Strengthening occupational protection: many workers fail to seriously implement the national regulations on occupational protection at work, resulting in the occurrence of related diseases. Work should pay attention to strict dust, oil, gas, reduce occupation.

  • Active intervention: workers with occupational exposure should clean relevant pollutants in time.

Treatment

How Is Acne Treated

Which department should acne go to see a doctor?

You should see a doctor in the dermatology department of a regular hospital.

What does a doctor need to assess a patient's condition before starting treatment for acne?

  • Type and severity of rash in acne: helpful in choosing treatment.
  • Presence of acne scars: Those with scars can choose more aggressive treatment, and need to add treatment for scars.
  • Presence of post-inflammatory hyperpigmentation: If hyperpigmentation is present, treatment for hyperpigmentation and for the elimination and prevention of inflammatory skin lesions is required.
  • Female menstruation and signs of androgen excess: Symptoms of abnormal menstruation and excessive androgen require additional tests and may consider endocrine therapy.
  • Acne Treatment History: If you have a previous history of unsuccessful acne treatment, your doctor may switch options or use a more aggressive treatment.
  • Psychological impact of acne on patients: If patients have excessive psychological pressure due to acne, doctors will choose a more active treatment plan and psychological counseling for patients.

How should acne be treated?

The therapeutic purposes of acne are to inhibit excessive keratosis of hair follicles, reduce sebum secretion, inhibit bacterial proliferation, and fight inflammation. In case of excessive androgen secretion, antiandrogen treatment is required. Specific treatment measures include:

  • Adjust your lifestyle: Change bad diet and living habits, and learn to clean and care for the skin properly. See "Life" below.
  • Medication: Include topical medication and oral medication.
  • Physical and chemical therapy: Include laser and photon therapy, chemical exfoliation therapy, etc. It is often used as an adjuvant or alternative treatment for acne and can also be used to treat acne sequelae, such as scars.
  • Psychological counseling: Necessary psychological counseling should be provided for patients with acne who have obvious psychological problems such as anxiety and depression.

What are the commonly used external drugs for acne treatment?

Topical vitamin a acid drugs:

  • Commonly used ones include vitamin A acid cream and adapalene gel, which can regulate hair follicle keratosis, inhibit propionibacterium acne and resist inflammation.

  • The external use of vitamin A acid drugs exfoliates the outermost layer of the skin. External use may cause burning sensation, erythema and desquamation, indicating that the drugs are working, not the aggravation of the disease.

  • Most of the skin can adapt to and tolerance, stimulation phenomenon can gradually disappear. In addition, vitamin A acid drugs have teratogenicity, so banned during pregnancy and pregnancy.

Benzoyl peroxide:

  • Has effect in reducing propionibacterium acne, resis inflammation, dissolving acne, and exfoliating epithelium.

  • Can cause dry skin, mild erythema and occasional desquamation. Benzoyl peroxide is not sensitive to light and can be used during the day without protection from light.

External antibiotics:

  • Commonly used clindamycin, fusidic acid, erythromycin, etc., has the effect of reducing the number of propionibacterium acne, anti-inflammation.
  • Treatment of acne with antibacterial agents alone may cause bacterial resistance, and repeated topical use of the same antibiotic should be avoided as much as possible, and preferably in combination with other drugs that are not antibiotics.

Azelaic acid: Has antibacterial, acne dissolving, mild anti-inflammatory, and post-inflammatory pigmentation improving effects.

Salicylic acid: For patients who cannot tolerate topical vitamin A acids, try topical salicylic acid, which also dissolves acne.

What are the commonly used oral drugs for acne treatment?

  • Oral antibacterial drugs: It can inhibit the growth of Propionibacterium acnes in the sebaceous glands of hair follicles, and the tetracyclines have direct anti-inflammatory effect. Preferred tetracyclines (such as doxycycline, minocycline, etc.), and other roxithromycin, azithromycin, etc.
  • Oral Isoretinoic Acid: Used for nodular and cystic acne and also for mild acne that is resistant to other treatments or may cause significant scarring.
  • Anti-androgen drugs: suitable for acne patients with excessive androgen. Commonly used drugs have compound oral contraceptive, spironolactone, generally used for female population.

Why does the treatment of acne use diuretic spironolactone?

Spironolactone is a diuretic, but because it has an anti-androgenic effect, it can lead to a decrease in androgen activity, so it can be used to treat acne vulgaris, especially female facial acne in the premenstrual period.

Is there toxic side effect with spironolactone treatment acne?

The initial dose of spironolactone was 40–120 mg per day, which was orally taken in 2–3 times. After 1–3 months, if the reaction is good and the side effects are mild, the dosage can be increased to 160–200 mg/d; When significant efficacy is achieved, the drug is further reduced to the daily minimum effective amount for maintenance.

Adverse reactions mainly include changes in the endocrine system, such as gynecomastia, loss of libido, and impotence. Female irregular menstruation, breast pain, etc., in addition can also cause high blood potassium, dizziness, headache and gastrointestinal reactions, etc. Disabled for pregnant women.

How do acne patients choose their own treatment?

Go to a dermatology department of a regular hospital and see a professional doctor to choose the most appropriate regimen. Doctors in the development of personalized treatment, mainly with reference to the following principles:

  • Mild and moderate (grade I and II) acne are mainly treated with external medicine, while moderate and severe (grade III and IV) acne are treated with oral medicine and supplemented by external medicine.
  • Topical vitamin A acids are effective for both acne and inflammatory acne and are the first choice for most newly treated patients.
  • For mild acne (Grade I) patients with acne vulgaris, vitamin A acid drugs can obtain good curative effect.
  • External benzoyl peroxide or external antibiotics are suitable for patients with mild inflammatory acne (grade II); Patients with moderate to severe inflammatory acne (grades III and IV) often require more aggressive treatment with oral antibiotics.
  • The combination of benzoyl peroxide or retinoids is recommended for patients receiving oral or topical antibiotics to reduce the risk of bacterial resistance.
  • Oral contraceptives or spironolactones may be effective in women with moderate to severe acne, even in the absence of excessive androgens.
  • Improvement of acne needs a certain period of time, and treatment needs to be persisted for a period of time to see whether a treatment is effective or not.
  • Acne is prone to repeated attacks, so acne should also be maintained after the improvement of treatment, external use of vitamin A acid drugs is a very good maintenance treatment program.

Can acne be treated with physical and chemical therapies?

Sure.

Common physical and chemical therapies include:

  • Remove acne: Sometimes open acne can be squeezed out with an acne extruder, and closed acne can be squeezed after being picked open with an injection needle, taking care not to burst hair follicles. Because they do not have professional technology, do not have health conditions, it is recommended not to squeeze acne.
  • Photodynamic and red and blue light: It can inhibit sebum secretion, kill propionibacterium acne, improve keratosis of sebaceous gland duct, and prevent and reduce scar. However, the efficacy and cost-effectiveness are still questionable.
  • Laser and strong pulse light; Has effects in inhibiting sebum secretion, resisting inflammation, and promoting erythema regression in late stage of inflammatory acne. Some lasers can also improve acne scars.
  • Radio frequency: It is effective for improving acne scars and reducing the risk of pigmentation during treatment.
  • Chemical exfoliation therapy: Including fruit acid, salicylic acid and compound acid, can reduce acne and improve skin quality, and is mostly used for mild and moderate acne and pigmentation after acne.

How to treat scar formation after acne?

Scar formation can be divided into atrophic scar and hypertrophic scar, and the treatment methods are as follows:

Atrophic scar:

Laser grinding is the gold standard for the treatment of atrophic acne scars. However, Asian people due to the deep color, the overall grinding will form a long time after the serious pigmentation.

With the advent of lattice laser, this problem is solved. The lattice laser can promote the skin regeneration and repair the original atrophic scar by stimulating the deep cells in the dermis.

Hypertrophic scar:

For hypertrophic scars, local injection of glucocorticoids flattens and softens the lesion, but telangiectasia may occur, although the problem can be resolved with a 595 nm laser.

Can acne be cured?

It can be basically cured, but it is prone to repeated attacks, and the risk of recurrence cannot be completely avoided after treatment.

Many cases of acne improve around the age of 25, but they can persist into middle age and may develop permanent scars.

Life

What Should Acne Patients Pay Attention To In Life

What should acne patients notice on diet?

  • Drink less or no low-fat milk and skim milk, especially people who can definitely cause or aggravate acne after drinking milk. If you want milk, consider sugar-free yogurt. Be sure to drink pure milk, you can consider whole milk.
  • Avoid foods with a high glycemic index (greater than 70) and a high glycemic load (greater than 20).

What should acne patients pay attention to in life?

  • Avoid sun exposure.
  • Carry out facial skin cleaning and moisturizing correctly; Appropriate USES warm water and close to the skin pH detergent to clean the face, in order to reduce oil attached to the face plug pores; Avoid oily cosmetics.
  • Don't squeeze acne by yourself.

Does acne use sulfur soap to wash a face effectively?

It is not recommended because sulphur soap is an alkaline product which impairs the skin barrier function and is prone to side effects such as dry, irritated, tight and red skin. When you wash your face at ordinary times, you can choose other milder and more reliable products, such as amino acid facial cleanser.

Blain (acne) grow on nose cannot squeeze, be true?

Not by hand, to be exact.

In fact, acne in various places can not be squeezed by hand. Especially not on the nose.

The triangle area surrounded by the nasal root and bilateral corners of the mouth is also called the "danger triangle". Since there is no venous valve for the vein here (blood easily reverses flow) and it is communicated with the skull, during extrusion, bacteria may break down into the blood vessel under pressure and enter the intracranial blood vessel from the superficial vein of face. In case of intracranial infection, it may be life-threatening.

So acne on the nose can't literally crowded.

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