Acne is commonly known as acne, acne and acne, and ancient Chinese medicine called it facial sore and wine thorn. It is a common and frequently-occurring disease in dermatology. According to scholars' statistics, 95% of men and 85% of women have acne in adolescence to varying degrees, so it is appropriate to call it "acne".
Acne (acne) is a chronic skin disease that occurs in sebaceous glands of hair follicles, mostly in areas rich in sebaceous glands such as head, face, neck, chest and back.
During the treatment, the diet is light and spicy food is not allowed.
Special reminder, you must wait for the diagnosis before you can treat the symptoms.
Etiological analysis:
In recent years, some people think that this disease is related to immunity. In the humoral immunity of patients, the serum IgG level increased, and it increased with the aggravation of the disease. Corynebacterium acne produces antibodies in patients, and circulating antibodies reach the local area to participate in the pathogenic process of early inflammation.
Regarding the relationship between trace elements and acne, recent studies have proved that low zinc content in acne patients may affect the utilization of vitamin A, promote the keratinization of sebaceous glands in hair follicles, and low copper content will weaken the body's resistance to bacterial infections. In a word, low zinc, low copper and high manganese in acne patients may affect the body's fat metabolism and sex hormone secretion, and low skin resistance may have a certain relationship with the onset of acne.
In addition, heredity is also an important factor in the occurrence of this disease. In addition to the above factors, gastrointestinal dysfunction such as eating animal fat and sugar food, indigestion or constipation, mental stress, hot and humid climate and other factors can have adverse effects on acne patients. Contact with mineral oil or oral iodide, bromide and other drugs will also aggravate acne.
There are many pathogenic factors of acne, and its pathogenesis is not very clear at present. Endocrine factors, sebum in hair follicles and the role of microorganisms are the main factors of acne.
Acne is closely related to sexual endocrine.
Treatment suggestion:
1, pay attention to adjust the function of digestive tract, eat less animal fat, sweets and irritating food, and wash the affected area with warm water, sulfur or other soap to reduce fat and diminish inflammation.
2. Don't pick or squeeze acne by hand, and don't use oily cosmetics and corticosteroids.
3. Bromine and iodine drugs are prohibited.
4. Explain to patients that acne is a common phenomenon caused by endocrine changes in adolescence, mainly due to changes in sex hormones. Treatment can alleviate skin lesions, but it is difficult to completely disappear, and it can be periodically aggravated or alleviated with endocrine changes.
5. For oral treatment, you can take compound Li Xiao scar-removing and acne-removing seal medicine.
Broad-spectrum antibiotics can control inflammation, and antibiotics, especially tetracycline, should be the first choice. Tetracycline can inhibit the chemotaxis of Propionibacterium acnes and leukocytes, and significantly reduce the concentration of free fatty acids in sebum. Tetracycline can be used in small dose and long course of treatment, starting from 0.25g, four times a day for one month, and then decreasing by 0.25g every two weeks until it reaches 0.25g a day in another month. The dosage and time of erythromycin are the same as tetracycline. When other antibiotics were ineffective, minocycline (minocycline) was 50mg, twice a day, and it was reduced to 50mg after 2-3 weeks, with a daily dose of/kloc-0. Clindamycin is the best substitute for tetracycline, which is suitable for patients with severe inflammation or tetracycline resistance. The initial dose was 0. 15g twice a day. After the disease was controlled, it was reduced to/kloc-0 times a day, with an average course of treatment of about 3 months. It can cause severe diarrhea, pseudomembranous colitis and other side effects, so it is only used for patients with severe dermatitis and no intestinal diseases.
Sex hormones cannot be used routinely.
1) Diethylstilbestrol: Severe patients can take 1mg diethylstilbestrol orally, once a day, and 1 day is a course of treatment. If female patients use it, they should start using it five days after menstruation. For female patients with premenstrual aggravation, diethylstilbestrol 0.25 ~ 0.5 mg can be taken every day for two or three weeks after menstruation begins. Patients with embolic diseases, hemiplegia, liver diseases and abnormal uterine bleeding are prohibited.
2) Some people also give chorionic gonadotropin to female patients, 1 time per week, with intramuscular injection of 500 ~ 1000 U, not within 5 ~ 10 days before menstruation.
3) Progesterone: For female patients with severe disease and premenstrual aggravation, progesterone 10 mg can be injected intramuscularly on day10 and 5mg on day 5.
Anti-androgen: Anti-androgen therapy can reduce the content of free fatty acids on the skin surface and the number of bacteria on the skin surface, thus preventing or/and alleviating the inflammatory reaction around hair follicles to varying degrees and achieving therapeutic effects.
1) Spironolactone: 20mg each time, three times a day.
2) Ketoconazole: 200mg daily, 100mg daily after one month.
3) Cimetidine: 400mg each time, 3 times a day, 200mg each time after 1 month, 3 times a day.
The above three drugs have great effects on female acne.
4) Compound norethindrone 1 tablet for men for 4 weeks every day, and 0.625mg for women on the fifth day of menstrual cramps for 22 days.
5) Take cimetidine 0.2g orally, three times a day. Take the medicine before meals for 4 weeks as a course of treatment. It is considered that it has anti-androgen effect, which can block the combination of dihydrotestosterone and hair follicle receptor, inhibit sebum secretion and alleviate inflammation.
Corticosteroids themselves can cause acne damage. For severe cystic acne and acne conglobata, a small dose can reduce the inflammatory reaction, but it is only temporarily effective, and there will be many side effects after long-term application, so it is generally not used as much as possible. Prednisone 10mg is commonly used, 2 ~ 3 times a day, and gradually reduced after effective, and the time should not be too long, and pay attention to its side effects. At present, it is advocated to use it in combination with female hormones or antiandrogens, and the effect is better.
Tretinoin can inhibit hyperkeratosis, prevent the formation of new obstruction and inflammation, reduce sebum secretion and the formation of acne, and has a good effect on nodules and cystic lesions. 13- cis retinoic acid 1 ~ 2 mg/kg, taken twice for 2 ~ 3 weeks. If the second course of treatment is needed, it should be repeated after 8 weeks of drug withdrawal. Skin lesions can continue to improve after drug withdrawal, but there are dry skin, cheilitis, digestive tract symptoms, deformity and so on. Pregnant women should take contraceptive measures during taking medicine and half a year after stopping taking medicine.
Dapsone (DDS) may have anti-inflammatory effect and is suitable for cystic and nodular lesions. Pay attention to the side effects of blood system and liver damage after oral administration of 50mg twice a day 1 ~ 2 months.
Zinc preparation can inhibit keratinization or inflammation of hair follicles. Zinc gluconate 70mg, 3 times a day for 4 weeks, or zinc sulfate 0.2g, 2-3 times a day for 4- 12 weeks, has gastrointestinal side effects.
vitamin
1) Vitamins B2 and B6 and vitamin B complex.
2) Vitamin A daily 1.5 million U for 4-8 weeks.
3) Vitamin A 65,438+0.5 million U and vitamin E 50 mg daily for 4-8 weeks.
Off-site treatment
The purpose of treatment is to diminish inflammation, sterilize, remove fat, remove excess greasy skin, remove pore blockage and make sebum flow smoothly. Keep skin clean and control infection. You can wash your face with hot water and soap 1 ~ 3 times a day, especially with medicated soap containing sulfur.
Antibiotics 1% chlorine tincture (chloramphenicol+salicylic acid), 2% erythromycin alcohol, 1% lincomycin solution, etc.
Benzoyl peroxide has the functions of sterilization, exfoliation, dissolution, inhibition of sebum secretion and reduction of free fatty acids. However, a small number of patients react to benzoyl peroxide, which can produce contact dermatitis. Therefore, patch test should be done before taking the medicine, and it should be reused if there is no response. Experiments show that it is effective to use 3.5% benzoyl peroxide lotion, cream and other preparations for external use 1 ~ 2 times a day.
Tretinoin can exfoliate, such as 0.05% ~ 0. 1% tretinoin cream or solution, and apply 1 ~ 2 times a day. Note: If irritation-reactive erythema and desquamation occur locally after medication, you should stop using/kloc-0 for ~ 2 days, and then continue to use it, or use/kloc-0 for ~ 2 months from low concentration to skin tolerance.
White emulsion (zinc sulfate 4.5, potassium sulfate 4.0, rose water or water added to 100) reduces sebum, inhibits infection, dilates hair follicle mouth and promotes sebum discharge. 1 ~ twice a day.
7. Physiotherapy: There are two kinds of masks: traditional Chinese medicine mask and inverted mask. Before you do it, you should clean your skin, then apply medicine, spray and massage, and integrate physical therapy, massage and medicine to interact with each other to achieve the purpose of treatment and beauty.
1) traditional Chinese medicine mask: add a little honey to the mask powder, mix it with water to make a paste, and then apply it to the face. At the same time, spray and massage along the meridians according to the direction of acupuncture points and blood circulation.
2) Inverted facial mask is to add different drugs into the matrix to make various creams, then apply the cream to the face and spray massage for a few minutes. Cover your eyes, nose, mouth and beard with absorbent cotton, then mix the gypsum with water to make it into a thin paste, immediately apply it on your face, paying attention to exposing your nostrils and mouth, and take it off when the gypsum becomes soft and hard and then cold from heat.
Triamcinolone acetonide suspension 0.05 ~ 1 ml (containing 10mg per ml) was diluted with normal saline and injected into severe nodules and cysts, once a week, 3 ~ 4 times in a row.
Preventive strategies:
1. Eat more fruits and vegetables.
In particular, fruits and vegetables that are beneficial to reducing sebum secretion and promoting acne healing, such as apples, pears, tomatoes, watermelons, cucumbers, loofah, wax gourd and bitter gourd. However, it should be noted that high-sugar fruits such as litchi, orange and durian should be eaten less.
2. Wash your face often
Cleanliness of oily skin and facial skin is very important. You should wash your face with hot water several times a day. You can choose soaps that inhibit sebum secretion, such as sulfur soap and boric acid soap, and the skin on your nose should be cleaned.
3. Avoid mechanically squeezing acne
Although removing the fatty thrombus of acne is beneficial to the healing of acne, it is not recommended to mechanically squeeze it with hands and instruments, because it is easy to cause the fatty thrombus to squeeze into the dermis after extrusion, causing further deep inflammation, and it is easy to leave pigmentation and spots, especially for friends with spotted physique. If it is really necessary to eliminate fat embolism, it is recommended to use a special acne squeezer to squeeze acne with obvious blackheads, and at the same time pay attention to disinfection to avoid infection, or go to the hospital for care.
4. Pay attention to facial cleaning: wash your face with warm water, because cold water is not easy to remove oil, and hot water promotes sebum secretion without irritating soap. Sulfur soap is good for acne. Don't use oily cosmetics such as vanishing cream.
5. Reasonable diet: eat more fruits and vegetables, eat less stimulating foods such as fat, sugar and spicy food, and keep the stool unobstructed.
6. Don't squeeze acne by hand to avoid purulent inflammation. After the abscess is broken and absorbed, it will form scars and pigmentation, which will affect the appearance. Antibiotics are effective for serious infections.
7. eat kelp to prevent acne. According to medical researchers, among teenagers who eat more kelp, few people suffer from acne, which is related to the high zinc content in kelp. Zinc is an essential trace element in human body, which can not only enhance the immune function of the body, but also participate in the normal metabolism of the skin, make epithelial cells differentiate normally, reduce the keratinization of sebaceous ducts in hair follicles, and facilitate the discharge of sebaceous secretions.
health education
1, don't squeeze the acne by hand, so as to avoid suppuration and inflammation, and the abscess will form scars and pigmentation after absorption, which will affect the appearance. Antibiotics are effective for serious infections.
2, combining work and rest, maintaining a happy mental state is very beneficial to the treatment of acne. Don't bear the burden of acne, so as not to cause neuroendocrine disorders and aggravate acne. If you feel that the acne on your face doesn't matter, you don't need to take medicine, and wait for it to subside naturally, because acne generally won't leave any traces after it subsides.
3. Get into the habit of exercising every day. Moderate exercise can promote metabolism and have a good effect on the body and skin, but don't heat it for 5 minutes. Keep it up. Remember, even 3 minutes of gymnastics every day is the secret of keeping beautiful skin.