Acne is a chronic inflammatory skin disease of the hair follicular sebaceous unit, which can be diseased in people of all ages, mostly in young men and women aged 15 to 30 years, and skin lesions tend to occur on the cheeks and forehead, followed by the chest, back and shoulders, mostly symmetrical distribution, often accompanied by enlarged pores and seborrhea. All types of lesions include acne at the mouth of the hair follicle, inflammatory papules, pustules, and nodules, cysts, and scarring. The onset of acne is mainly associated with increased androgen levels and sebum secretion. In addition, it is also associated with bacterial infections, abnormal keratosis of sebaceous glands, inflammation and other causes.
Lesions begin with conical papules consistent with hair follicles, such as whiteheads (closed acne) and blackheads (open pimples); inflammatory papules can form (small pustules at the apex, see Figure 1); continue to develop red nodules or cysts of varying sizes, with a sense of fluctuation during squeezing, and even suppuration to form abscesses, and often form sinus tracts and pus scars after rupture. The disease is generally self-consciously mild, and there may be pain when inflammation is obvious. The course of acne is chronic, mild and severe, and most patients gradually resolve by mid-term, and some may leave red marks and pigmentation, hypertrophic or atrophic scars.
Figure 1
Grading and types of acne
Acne can be divided into 4 grades according to the nature of the lesion, regardless of the number of lesions.
Grade 1 (mild): only acne.
Grade 2 (mild to moderate): Inflammatory papules in addition to acne.
Grade 3 (moderate): Pustules in addition to acne, inflammatory papules.
Grade 4 (severe): nodules, cysts, or scarring in addition to acne, inflammatory papules, and pustules.
In addition to the above grades 1 to 4 manifestations, there are many special types of acne.
Polymeric acne is a more severe type, manifested as severe nodules, cysts, sinus tracts and scars, more likely to occur in young men; fulminant acne refers to a small number of patients with sudden exacerbation of the disease, sudden appearance of multiple inflammatory follicular papules, pustules, ulcers, blood scabs, rashes fused into tablets, and fever, arthralgia, anemia and other systemic symptoms.
Chemically inducible acne includes both pharmaceutical and non-pharmacological factors. Drugs related to drug-induced acne include corticosteroids, psychotropic drugs, halogen drugs, molecularly targeted drugs, etc., with inflammatory lesions as the main manifestation; non-drug factors include mineral oils, halogen compounds, cosmetics, cigarettes, etc., which are more common in acne.
In addition, for female friends, there are several special cases of acne. One is acne before menstruation. The androgens in women's bodies mainly come from the adrenal glands and ovaries, under normal circumstances, estrogen and androgen levels remain relatively balanced, but in the pre-ovulation period of the menstrual cycle, androgens in the blood will rise, which is why some women will have acne before each menstruation.
The other is that when the ovarian has a polycystic change, the estrogen, progesterone, androgens it secretes increase. While androgens mainly include androstenedione and testosterone, the increase in free testosterone has a highly promoting effect on the secretion of sebaceous glands. This is an important reason why polycysticism causes acne. In addition, many patients with PCOS may also develop diabetes mellitus (see The Heaven and Earth link for details).
Are diabetics prone to acne?
Diabetes itself is an endocrine disorder as well as a metabolic disease. Patients with endocrine disorders are related to blood glucose metabolism and acne. If the patient's male hormone is secreted abnormally, it will make people acne. Diabetic patients can easily lead to endocrine disorders because of abnormal insulin secretion, which may also lead to the occurrence of acne. For the treatment of these patients, first determine the patient's blood glucose status, and then according to the patient's personal blood glucose situation hypoglycemic treatment, after the blood sugar is normal, acne and other symptoms will improve.
Daily prevention of acne
Daily skin cleansing should choose water or appropriate cleansing products to remove excess oil, dandruff and bacterial mixtures from the surface of the skin, but not excessively clean, pay attention to oil control and moisturizing, and use mild moisturizing lotion externally. Avoid exposure to the sun in high temperature weather, such as summer outdoor activities should take sun protection measures, if you do not pay attention to sun protection, but often apply oily lotion or foundation cream, etc., then it may increase the incidence of acne.
Avoid rubbing or pressing the skin, and avoid squeezing or scratching the lesions with your hands. Compression may cause sebaceous sebaceous discharge to be obstructed, resulting in acne, so skin that often has acne should avoid holding a phone for a long time, and avoid wearing a helmet, tight collar or strap for a long time.
Dietary restrictions should be appropriate to induce or aggravate acne of high glycemic index food and milk intake, high-sugar diet, dairy products, etc. will induce acne or make acne worse, so eat less sweets and milk, you can drink yogurt. Although current studies have shown that greasy diets (such as foie gras, animal fats) do not make acne more serious, it is recommended to eat less high-fat foods for the sake of adolescent health.
In terms of the external living environment, the bed sheets and bedding should be kept clean to prevent acne patients from inducing dermatitis due to damaged skin barrier and mite infection.
Other aspects, such as keeping the stool unobstructed, avoiding staying up late, avoiding excessive psychological pressure, and washing the body in time after exercise, all require the patient's own attention.
Heaven and Earth Link: The Relationship between POLYCYS and Diabetes
Polycystic ovary syndrome (PCOS) is a common endocrine metabolic disorder in women of childbearing age. It is characterized by clinical or biochemical manifestations of excessive androgens, persistent anovulation, and ovarian polycystic changes, and is characterized by hirsutism, acne, menstrual abnormalities, infertility, etc., often accompanied by insulin resistance and obesity. In addition, the chance of developing long-term complications such as diabetes, hypertension, and endometrial cancer in PCOS is higher than normal. Polycystic ovary syndrome (PCOS) can affect women of all ages: adolescents and fertility patients are mainly manifested as menstrual abnormalities, acne, hirsutism, infertility, etc. Middle-aged and elderly people are prone to diabetes, hyperlipidemia and cardiovascular diseases.
Knowledge Base: Rosacea is not the same as acne
Rosacea and common acne, although both have acne in the name, but the two are very different diseases. Acne is a common inflammatory disease of the sebaceous glands of hair follicles, clinically manifested as acne with black and white heads, inflammatory papules, pustules, nodules, cysts, etc. Rosacea is a chronic inflammatory skin disease that occurs in the middle of the face, mainly involving facial blood vessels and peripheral units of hair follicle sebaceous glands, manifested by skin flushing and erythema, papules, pustules, telangiectasia, etc. In the past, the rosacea that ordinary people said was a manifestation of the disease. It is more common and is mostly female, but in men it is generally more severe (especially rhinoplastic and eye). The causes of rosacea are more complex and related to a variety of factors, mainly genetic factors, neurovascular dysfunction, skin barrier function damage, immune inflammatory response, of course, there are many aggravating factors, such as follicular infection, sun exposure, frequent drinking, spicy and irritating food, high temperature and cold stimulation, mood, endocrine disorders, etc. can promote the onset of the disease.