papular acne
Introduction
Introduction The papular acne lesions are mainly inflammatory small papules, and the hard small papules from millet to pea are pale red to deep red. The center of the papule may have a blackhead acne or a sebaceous plug that does not become black at the top.
Cause
Cause
There are many factors in the pathogenesis of acne, and its pathogenesis is still not very clear. Endocrine factors, the role of sebum, and microbes in hair follicles are major factors in the pathogenesis of acne.
There is a close relationship between acne and sexual endocrine. There is very little morbidity before puberty. People with loss or decline in sexual function, such as eunuchs who have been castrated by ancient courts, are not affected. People with reduced sexual function, such as testosterone, can promote the growth of beards and the occurrence of acne. When treating diseases with corticotropin or corticosteroids, it often causes acne rash, and women often have acne attacks before menstruation. Reduced symptoms of acne during pregnancy. Both men and women have androgens and estrogens. Organs that secrete sex hormones are testes and adrenal glands in men; in women, the ovaries, placenta, and adrenal glands. Androgens and estrogens have different ratios in men and women, and changes in ratios may cause acne.
The development of sebaceous glands and the secretion of sebum are also associated with increased androgen levels. Among them, testosterone increases sebaceous gland activity, and progesterone and adrenal cortex are also involved in dehydroepiandrosterone (DHA), which may be involved in initial acne. makes an important impact. Testosterone is converted into 5-alpha dihydrotestosterone with higher activity by 5- reductase in the skin, which stimulates sebaceous gland cell turnover and lipid synthesis, causing increased sebum secretion, resulting in a thicker and more sebum that cannot be completely excreted. Gradually accumulate in the hair follicle mouth, and the hair follicle catheter is also hyperkeratized by androgen action. The hair follicle wall is thick and prevents sebum excretion. The epithelial cells that fall off the hair follicle wall are mixed with thick sebum to become a cheese-like substance. The acne is formed in the mouth of the hair follicle, and the tip exposed to the outside of the hair follicle is gradually dried, and the black acne is formed by the oxidation of air, the deposition of melanin, and the pollution of dust. Corynebacterium acne, Staphylococcus aureus and Pediococcus ovale, which are present in hair follicles, in particular, Corynebacterium acne contain esterases that decompose sebum, and sebum in hair follicles is decomposed by lipase to produce more free fatty acids. Free fatty acids can cause non-specific inflammatory reactions around the hair follicles and hair follicles. When the tiny ulcers and free fatty acids on the acne wall enter the nearby dermis, the blackheads squeezing the nearby cells, so that their antibacterial power is reduced. It is susceptible to inflammation caused by bacterial infection, so the patient develops papules, pustules, hard nodules, nodules and abscesses.
In recent years, some people think that this disease is related to immunity. In the humoral immunity of patients, serum IgG levels increase, and increase with the severity of the disease. Corynebacterium acne produces antibodies in patients, and circulating antibodies reach a local pathogenesis involved in early inflammation. About the relationship between trace elements and acne. Recently, it has been proved that the low zinc in patients with acne may affect the utilization of vitamin A, promote the keratinization of the hair follicle sebaceous glands, and the low copper will weaken the body's resistance to bacterial infection. In short, the trace elements of zinc, copper and iron in patients with hemorrhoids are low, and the increase of manganese can affect the metabolism of fat and the secretion of sex hormones in the body. In addition, the skin resistance is low, which may have a certain relationship with the incidence of hemorrhoids. In addition, heredity is also an important factor in the development of this disease. In addition to the above factors, eating animal fats and carbohydrates, gastrointestinal disorders such as indigestion or constipation, mental stress, hot and humid climate and other factors can have adverse effects on acne patients, mineral oil contact or iodide, bromide Or oral administration of certain other drugs can also aggravate the deterioration of acne.
Examine
an examination
Related inspection
Urine routine cellular immunological examination blood routine ESR equation K value
Check the shape and distribution of lesions, whether there are papules, pustules, blackheads, nodules, cysts, scars, etc.
1. Acne: Includes whiteheads and blackheads. It is a conical papule that is consistent with the hair follicle. It does not redden or bulge and the skin surface. If the number is small, it is not easy to detect. The hand can touch the large skin lesions contained in the skin. It can be closed or open. The top of the open acne is yellowish white, and blackheads can also be formed by pigmentation. The extrudable head is black and the lower part is a white translucent grease plug. Acne is an early damage to acne that can form inflammatory papules when aggravated.
2. Pimples: Inflammatory papules that develop from acne, with red papules.
3. Pustules: A mung bean-sized pustule can be formed on the basis of papules.
4. Cyst nodules: If the inflammation continues to develop, dark red nodules or cysts of varying sizes can be formed, which can be fluctuating when squeezed.
Diagnosis
Differential diagnosis
Point acne
Blackhead acne is the main damage of acne. It is a cheese-like semi-solid embedded in the hair follicle of the hair follicle. It is black at the outer end of the hair follicle. If it is squeezed by pressure, the head is black and the body is yellow-white and translucent. The fat plug is discharged.
2. Papular acne
The skin lesions are mainly inflammatory small papules, and the hard small papules from millet to pea are light red to deep red. The center of the papule may have a blackhead acne or a sebaceous plug that does not become black at the top.
3. Pustular acne
Puss is the main expression, pustules are the size of grain to mung bean, pustules are formed at the tip of follicular pustules and papules, and the pus is thicker after the break, leaving a shallow scar.
4. Nodular acne
When the inflamed area is deep, pustular acne can develop into wall thick nodules of varying sizes, showing a reddish or purplish red color. Some are deeper and have a prominent bulge in a hemispherical or conical shape. They can be long-term or gradually absorbed, and some purulent ulcers form a significant scar.
5. Atrophic acne
Papular or pustular lesions destroy the gland, causing a pit-like atrophic scar. Broken pustules or naturally absorbed papules and pustules can cause fibrosis and atrophy.
6. Cystic acne
The formation of sebaceous gland cysts of different sizes, often secondary to purulent infection, often sheds bloody jelly-like pus after rupture, and the inflammation is often not heavy, and later forms the sinus and sputum.
7. Polymeric acne
It is the most serious type of damage. The skin lesions are polymorphous. There are many acne, papules, pustules, abscesses, cysts and clusters of sinus, scars and keloids.
8. AIDS acne
The damage is from cyan to fuchsia-sized cyan or purplish papules, pustules or nodules. It is soft and soft, and contains pus and blood. They will not heal for a long time. After the healing, they will leave tiny scars, no pain, and little infiltration. . This type is more common in patients with weak bodies.
Check the shape and distribution of lesions, whether there are papules, pustules, blackheads, nodules, cysts, scars, etc.
