Author: Cai Yongqiang, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
Review: Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Chen Chuxiong
During the epidemic period, I don't know if you have found that there are many beautiful women and handsome men on the street? The beautiful eyes are gentle, and the handsome guy is heroic and refreshing, which makes people think of it. But I can dare to say that most people take off their masks and immediately "see the light to die"! Masks have become a fig leaf for most acne sufferers. If you want to confidently face the object you like, you have to understand the acne and then get rid of it from the root.
Acne, also known as acne, is a chronic inflammatory skin disease that occurs during puberty and involves mainly the sebaceous units of the hair follicles of the face. According to relevant statistics, the incidence of acne in the Chinese group is 8.1%, of which 95% of people will have different degrees of acne, and 3%-7% of acne patients will leave scars, which will have a greater impact on the physical and mental health of patients.
Clinicians' choice of acne treatment varies widely, with some treatments being uncertain, lacking evidence-based medical evidence, and irregular treatments that can even cause harm to patients. With the development of the times, the accumulation of experience, the treatment of acne is changing with each passing day, the following is the disease mechanism and main topical drugs and daily management summarized by Yixian Pharmacist according to the latest Chinese acne treatment guidelines.
pathogenesis:
The pathogenesis of acne is still not fully elucidated. Genetic factors play an important role in the occurrence of acne, especially severe acne. Hormone-induced hypersecretion of lipids by sebaceous glands in the genetic background, abnormal keratosis of the ducts of hair follicle sebaceous glands, proliferation of hair follicular microorganisms such as Propionibacterium acnes, inflammation and immune response are associated with it. Both diet and neuroendocrine regulatory mechanisms can affect the occurrence of acne.
First of all, the level of androgens in the body is increased, which can lead to hyperplasia of sebaceous glands and a large amount of lipid secretion, too much sebum to block the pores, more and more to form a small acne, acne is how to occur.
Secondly, the increase in the proportion of unsaturated fatty acids in lipid components and the decrease in linoleic acid content are also important factors leading to the occurrence of acne.
If the keratosis of the hair follicle sebaceous duct is abnormal, it can cause further blockage of sebum and aggravate the condition.
In addition, sebum-clogged pores can easily trigger a large multiplication of Propionibacterium acnes, resulting in increased inflammation.
The early stage of acne is only a closed acne, with the development of the disease, a large amount of lipid aggregation leads to further proliferation of acne bacillus, acquired immunity is activated, inflammation is aggravated, induces hair follicle wall rupture, lipids, microorganisms and hair into the dermis, resulting in a foreign body-like reaction. Erythema, pigmentation, and scarring are often left after acne lesions resolve, with differences varying from person to person.
Medication for acne – (topical treatment) and (systemic therapy)
Grades of acne: divided into 3 degrees, 4 grades, that is, mild (grade I): only acne; moderate (grade II): inflammatory papules; moderate (grade III): pustules; severe (grade IV): nodules, cysts. The grading of acne reflects the severity of acne and is also the basis for which treatment is used.
Topical drug treatment is the basic treatment of acne, mild and mild acne is mainly used with external drug treatment, and moderate to severe and severe acne can be supplemented by external drug treatment at the same time as systematic treatment.
Main topical drugs:
Tretinoins
Mechanism of action: topical tretinoins have the effect of improving follicular sebaceous ductal keratosis, dissolving micro-comedones and pimples, anti-inflammatory, preventing and improving post-acne inflammation pigmentation and acne scarring. In addition, it can also increase skin permeability, and in combination therapy, it can increase the efficacy of topical antibacterial and anti-inflammatory drugs.
Indications and drug options: Topical tretinoins can be used as a stand-alone first-line agent for mild acne, a combination of moderate acne, and the first choice for acne maintenance therapy. Commonly used drugs include the third-generation tretinoin drug adaparine and thazarotine.
Adapalene is better tolerated and is often used as a first-line option. Usage and precautions: It is recommended to apply at the same time at the acne lesion and the prone area before going to bed; mild skin irritation reactions such as local erythema, desquamation, tightness and burning sensation will often occur at the site of drug use, but with the prolongation of use, it is often gradually tolerated, and the stimulus response is recommended to stop the drug; in order to avoid the occurrence of skin irritation of tretinoin drugs, a lower starting concentration (if there is a selectable concentration), a small trial, a reduction in the number of uses and as far as possible in the case of dry skin and other measures can be taken The combination of skin barrier repair agents (emollient creams) and moderate sun protection can prevent photosensitivity reactions of tretinoins.
Benzoyl peroxide
Benzoyl peroxide can have a killing of Propionibacterium acnes, anti-inflammatory and mildly dissolution of acnes, the drug currently has no resistance to Propionibacterium acnes, can be used as the preferred antibacterial drug for inflammatory acne, can be used alone, can also be used in combination with topical tretinoins or topical antibiotics. Mild irritation may occur during use, and it is recommended to start with low concentrations and try them on a small scale. Drugs have an oxidative bleaching effect on clothing or hair, and should be avoided as much as possible. In addition, the oxygen radicals released by benzoyl peroxide can cause inactivation of all-trans tretinoin (first generation), and it is recommended that the two be used topically in stages.
Antibiotics for topical use
Antibiotics with anti-acne propionibacterium and anti-inflammatory effects can be used in the treatment of acne. Commonly used topical antibiotics include erythromycin, clindamycin, chloramphenicol and fusidic acid.
Topical antibiotics are theoretically suitable for superficial inflammatory acne lesions such as papules and pustules due to their less irritating reactions, but because topical antibiotics are easy to induce propionibacterium acnes resistance, they are not recommended as the first choice for antibacterial drugs, and are not recommended alone or for long-term use. It is recommended in combination with benzoyl peroxide, topical tretinoins, or other drugs.
Azelaic acid
Azelaic acid has mild dissolving acne and anti-inflammatory effects, and has a relieving effect on pigmentation, so adjuvant treatment with azelazanate cream can be selected for patients with abnormal coloration after inflammation.
The above are drugs that patients with mild acne can use topically on their own. For patients with moderate to severe disease, it is necessary to go to the relevant dermatology department of the hospital for diagnosis and grading, and under the basis of external drugs, they should be systematically treated (oral drugs: including oral retinoids, oral antibacterial drugs, oral antisebum secretion drugs and oral anti-androgen drugs, etc.). According to the patient's condition, it can also be combined with red and blue light, photodynamics, laser therapy, salicylic acid or compound acid or traditional Chinese medicine.
Some patients can appear erythema, scarring, pigmentation, etc. after acne treatment, and for post-acne erythema, you can choose strong pulsed light, pulsed dye laser, non-decorminant dot matrix laser and other treatments. For acne keloids, treatment is more difficult, take more comprehensive treatment, you can choose hormone seal injection or laser treatment. For post-inflammatory pigmentation, tretinoins, arbutin, glycyrrhizins, and other drugs can be used; fruit acid, intense pulsed light, and laser therapy are also effective treatments. It is recommended to consult a dermatologist for questions.
Leaving aside the influence of genetic factors, in daily life, how should we prevent the occurrence of acne? The following points generally need to be noted:
1, healthy diet: limit high sugar, greasy, spicy diet, dairy products, especially skim milk intake should also be limited; balanced diet, eat more vegetables, fruits, keep stool smooth.
2. Regular work and rest, avoid staying up late, and ensure adequate sleep.
3, scientific skin care: acne patients' skin is often accompanied by seborrhea, skin cleaning can choose to use oil-controlling moisturizing cleaner cleansing, remove excess oil, dander and microbial mixture on the skin surface, but can not be over-cleaned, avoid squeezing and scratching.
4. Reduce mental stress and relieve bad emotions. Acne patients, especially severe acne, are prone to anxiety and depression, and need to cooperate with psychological counseling.
5. Properly control weight and avoid excessive sun exposure.
6. Pay attention to regular follow-up consultation, and the doctor will adjust the treatment plan in time according to the treatment response to reduce the occurrence of sequelae.
bibliography:
1. 2019 Revised Edition of The Chinese Acne Treatment Guidelines