acne vulgaris
Introduction
Introduction to Acne Vulgaris Acnevulgaris (acnejuvenilis) is a kind of chronic inflammation of hair follicles and sebaceous glands. It mainly occurs in the fatty areas such as the face and chest and back. It has self-limiting and multi-form skin lesions. Such as acne, pimples, pustules, nodules, often accompanied by seborrhea, most of the recovery or relief after puberty. In the past, acne was considered to be a sebaceous gland disease, which substantially damaged hair follicles, sebaceous glands, and epidermis. It belongs to the category of "pulmonary acne" of traditional Chinese medicine. basic knowledge The proportion of illness: the incidence rate of adolescents is about 10% Susceptible people: young people Mode of infection: non-infectious Complications: scars
Cause
Acne vulgaris
Infection (30%)
Normal parasitic acne in the hair follicle: Acne acnes (PA), Pityrosporum and Staphylococcus epidermidis, when free fatty acids increase, Acne acnes can not produce enough enzyme to break down sebum, stagnant fatty acids make non-specific around the hair follicle Inflammatory reaction, acne propionate can also secrete low molecular weight polypeptide, attract neutrophils into the hair follicle, causing the release of its hydrolase, causing the hair follicle epithelial leakage to rupture, causing the hair follicle contents to enter the surrounding dermal tissue, resulting from simple inflammation to A series of clinical manifestations of papules, abscesses, nodules, and cysts.
Androgen increased (25%)
The development of sebaceous glands and the production of sebaceous glands are dominated by androgens, and the increase of androgen is affected by age, endocrine, genetic factors, etc. The sebaceous glands of acne patients are larger, and the sebaceous glands secrete more products than normal people, due to increased secretion of sebaceous glands, sebum The level of linoleic acid is relatively reduced, and the negative correlation between the two affects the synthesis of fat, which leads to the lack of fatty acids in the follicular epithelium, which induces excessive keratinization of the follicles, which prevents the epithelial cells from falling off normally, resulting in excessive hair follicles and sebum. Can not be smoothly discharged, deposited in the mouth of the hair follicle, forming acne.
Increased 5-reductase (10%)
5-reductase in the skin of patients with acne is higher than normal, 5-reductase can cause increased sebum, women with severe acne, sudden onset, irregular menstruation, and elevated androgen, suggesting potential ovarian dysfunction.
Dietary factors (10%)
Diet can also affect acne, such as fat, sugar, spicy, cocoa, cheese, peanuts, etc. can increase sebum production and increase inflammation.
Other factors (10%)
Mental stress, bad habits such as staying up late can cause acne.
Prevention
Acne vulgaris prevention
Eat less sweets, sweet and spicy food, avoid drinking, drink plenty of water, avoid constipation, eat more fresh vegetables and fruits, do not eat acne-producing drugs, reduce contact-induced acne (such as mineral oil), youth Young people in developmental period are more unstable, sensitive, and susceptible to irritation. At this time, they pay special attention to their appearance. Therefore, they are extremely depressed and guilty about acne. They often use drugs or take inappropriate measures. Therefore, they must be relieved of their concerns, treated correctly, and guided. Things to be aware of in daily life, without squeezing the damage and using the medicine correctly.
Complication
Acne vulgaris complications Complications scar
Touching the area of the acne by hand will also increase the acne due to excessive stimulation of the skin. If the acne is squeezed by hand, it will cause purulent inflammation. After the abscess is broken, scars and pigmentation will form, which will affect the appearance.
Symptom
Acne vulgaris symptoms Common symptoms Pustule acne polymerized acne acne blackhead acne papules acne scar hypertrophic scar whitehead acne nose long acne nose acne
The disease is more common in young people, more men than women, damage occurs in the cheeks, forehead, ankle and nasal buccal and other fatty areas, followed by the chest, back and shoulders, acne from the beginning, whiteheads and blackheads Two kinds of acne, containing keratin and sebum, whitehead acne, also known as closed acne, skin color pimples, needle size, hair follicle opening is not obvious, not easy to squeeze the fat plug, blackhead acne is also known as open acne, the center of the papule is enlarged The pores and the fat plug are blocked in the hair follicle mouth and squeezed by hand. The top is black and the body is yellow translucent fat plug. Because the top is exposed on the skin surface, sebum is oxidized and dust is affected, forming blackheads, so it is called blackhead acne. In addition to sebum oxidation and keratin detachment debris, acne also contains a plurality of charred hair, the course of the disease is chronic, light and heavy, women often periodically increase before menstruation, the disease is self-limiting, the vast majority The patient gradually relieves after puberty, so that the disease is common in young people aged 17 to 18, and as early as 10 to 13 years old, late after puberty or adult onset, more men than women, damage is good in the face , Forehead, chin and nose and cheek sulcus, followed by the back and upper chest, periorbital skin never involved.
1. Acne vulgaris is the most common, the damage begins with a conical papule that is consistent with the hair follicle. The top is yellowish white. This is composed of keratinocytes with hair follicle endothelial fat and hair follicle wall detachment. The apex is deposited by melanin. Blackhead acne, such as a finger squeezed to extrude the head black and the body is white translucent fat plug, which is characteristic of acne and early attack damage, the light is only the blackhead acne of the hair follicle, no pimples Slightly heavy is the formation of inflammatory papules around the blackheads. If the inflammation is intensified, small pustules from rice grains to peas may appear at the tip of the papules, leaving temporary pigmentation or small pit-like scars after rupture or absorption, if the inflammation continues to expand. And in-depth, the formation of red or dark red nodules of varying sizes under the skin, or slightly higher than the leather surface, such damage can exist for a long time, or gradually absorbed, or formed a scar after the pus, and some damage It is an oval cyst with large soybeans to the fingertips. It is dark red or normal skin color. It has a fluctuating feeling when squeezed. The inflammatory reaction is often not heavy. If it is not cured for a long time, it can be purulent and become abscess. When several abscesses are converging nearby, It is a polymeric acne. Therefore, the damage of acne is pleomorphic. The change is the process of disease development. It can occur in one patient at the same time. It is often caused by one type of damage. Most patients after puberty Symptoms are relieved year by year; so that they disappear, but there are pustules, nodules, abscesses, and cysts are left with depressed or hypertrophic scars, which affects the appearance.
2. Acne conglobata is a heavier type of acne. It occurs in young men and occasionally in women. The beginning of the disease is often insidious, mainly distributed in the back, buttocks and cheeks. The shoulders, neck, face, upper arms and thighs can be equally involved. They are formed by numerous blackheads, pimples, pustules, abscesses and cysts. The lesions are mainly cysts and nodules. The cysts are often soft, large and irregular. The plaque is purple-red. After the ulceration, the stenchy or mucous serous effusion is formed, which forms a fistula. The abscess can form a deep depressed scar. The course of the disease is stubborn and often lasts for many years without retreating. The patient occasionally has a whole body. Symptoms such as fatigue, discomfort, fever, and joint pain.
3. Acne fulminans (acne fulminans) are more common in juvenile and young men, individually seen in adults, the clinical features of sudden onset, skin lesions mainly in the chest and back, followed by neck, mostly follicular inflammation papules, pustules Inflammatory reaction is severe, nodules and cystic lesions are rare, local pain is obvious, easy to form erosion, ulcer, superficial scar after healing, often have fever when onset, can be as high as 39 ° C or more, with multiple joint pain, fatigue, appetite Insufficient, myalgia, headache, etc., increased white blood cells, accelerated erythrocyte sedimentation rate, decreased complement, increased gamma globulin, increased immune complexes and other immune abnormalities in laboratory tests, and its pathogenesis may be related to patients with acne short sclerotia (C Type III or IV allergic reaction of acid bacillus is better than antibiotics in the treatment of corticosteroids. This disease needs to be differentiated from polymeric acne and necrotizing acne.
4. Neonatal acne (acne neonatorum) is rare, can occur within 3 months, but also occurs from 3 months to 2 years old, more boys than girls, the cause of this disease is unknown, often have a clear family history, may be related to heredity Related factors, skin lesions mainly occur on the cheeks, but also the amount and jaw, blackheads, papules and pustules, occasional nodules and cysts, blackhead damage subsides within a few weeks, pimples and pustules can be cured in 6 months Leaves a pit-like scar, a small number of children can last for more than 1 year, and easily relapse during adolescence.
5. Tropical acne refers to hemorrhoids that occur in high temperature, high humidity areas. Skin lesions can affect the back, shoulders, neck and arms, thighs and buttocks, mainly nodules and indurated cysts, which can be destructive. Scars can be relieved if the patient leaves this climatic condition.
6. Clustered orbital acne occurs in 30 to 50 years old, which is a large acne of localized clusters on the lateral side of the lower eyelid and the surface of the tibia. There are 5 to 50 large patients, and most patients have photoelastic fiber disease, and There is no obvious relationship between acne.
7. acne necrotica (acne necrotica) also known as acne-like acne or frontal acne, never occurred before puberty, common in 20 to 50 years old, a little more men, may be accompanied by seborrhea, mainly in the amount, And the scalp leading edge, also seen in the cheeks, nose and trunk, the damage begins with brownish red, clusters of hair follicles around the papules and pustules, often with umbilical fossa and rapid necrosis with adhesive hemorrhagic molting, 3 to 4 weeks After the suede peels off leaving scars, such as damage to recurrent scars can be reticular, the subject subjective burning or itching.
8. Premenstrual acne (premenstrual acne) is exacerbated or afflicted before menstruation, many of whom do not suffer from acne during puberty, damage is often limited to the jaw, eyebrows, can also appear in one cheek, a small number, with menstruation The cycle changes and changes.
In recent years, the Pillsbury classification has been used to classify acne into four grades:
I degree (mild) manifested as blackheads, sporadic or multiple; sporadic inflammatory papules.
II degree (moderate) in addition to the degree of performance, there are deep inflammatory papules, mainly in the face.
The third degree (severe) is characterized by a deeper degree of inflammatory papules, which can be found in the chest, back, and neck in addition to the face.
The IV degree (severe-clustering) showed a degree of cyst plus III, and more scars were formed after the healing. The site of occurrence was the same as III degree, but the rash was heavier.
Examine
Examination of acne vulgaris
Histopathology: hair follicle papules showed significant lymphocytic infiltration around the hair follicles mainly CD3 and CD4, part of the hair follicle wall ruptured, and formed pustules in the hair follicle, mainly containing neutrophils, infiltration around the hair follicle can develop into cysts, In addition to a large number of neutrophils, there are monocytes, plasma cells and foreign body giant cells. Keratin particles are common in the vicinity of giant cells. During the healing process, inflammatory infiltration is replaced by fibrosis, and blackheads contain keratinocytes. Sebum and certain microorganisms, in the general section, the lipids were removed by fixation, only keratinocytes were seen, and the black top of the acne was caused by melanin.
Diagnosis
Diagnosis and diagnosis of acne vulgaris
diagnosis
Most of the patients are young men and women, the damage is acne, papules, pustules, and it is more common in the face, chest and other parts of the sebaceous glands, symmetric distribution, not difficult to diagnose.
Traditional Chinese medicine pathogenesis and syndrome differentiation: Chinese medicine believes that this disease is a congenital endowment abnormality and diet, over-eating fat and sweet taste, lung and stomach damp heat, fumigation on the upper, relapsed poisonous evil and disease.
Differential diagnosis
1. Rosacea: more common in adults, it occurs in the middle of the face, the affected area is flushed with blood, accompanied by telangiectasia, papules, pustules, no acne.
2. Acne-like drug eruption: due to taking or topical bromine, iodine drugs, causing systemic rash, face, body acne, but no blackheads, inflammatory reaction is heavier, age of onset is not limited.
