The pimples are not squeezed clean and become meat buns

Everyone wants their face to be smooth and white, but the problem of acne always bothers us. Adolescence is the time when boys and girls are most vain, but there will always be the trouble of acne. I thought I would no longer have acne after I started working, but due to the high stress and late nights, acne started appearing on my face again. There are many types of acne, mainly caused by bacteria and mites. After squeezing a pimple, it always turns into a red bag.

Acne is a chronic inflammatory skin disease of the pilosebaceous unit that mainly occurs in adolescents and has a great psychological and social impact on them, but it often subsides or heals naturally after puberty. The clinical manifestations are characterized by polymorphic skin lesions such as acne, papules, pustules, nodules, etc. that are prone to occur on the face.

The occurrence of acne is closely related to factors such as excessive sebum secretion, blockage of the sebaceous gland ducts of the hair follicles, bacterial infection and inflammatory response. After entering puberty, the level of androgens, especially testosterone, in the human body increases rapidly, promoting the development of sebaceous glands and producing a large amount of sebum. At the same time, abnormal keratinization of the sebaceous gland ducts of the hair follicles causes blockage of the ducts, hindering the excretion of sebum and forming keratin plugs, also known as micro-acne. Various microorganisms, especially Propionibacterium acnes, multiply in large numbers in the hair follicles. The lipase produced by Propionibacterium acnes breaks down sebum to produce free fatty acids, while also attracting inflammatory cells and mediators, ultimately inducing and aggravating the inflammatory response.

Clinical manifestations

Skin lesions often occur on the face and upper chest and back. Non-inflammatory lesions of acne appear as open and closed comedones. The typical skin lesions of closed comedones (also known as whiteheads) are skin-colored papules about 1 mm in size with no obvious hair follicle openings. Open comedones (also called blackheads) appear as dome-shaped papules with significantly enlarged follicular openings. Acne will further develop into various inflammatory skin lesions, manifesting as inflammatory papules, pustules, nodules and cysts. Inflammatory papules are red and vary in diameter from 1 to 5 mm; pustules are uniform in size and filled with white pus; nodules are larger than 5 mm in diameter and feel hard and painful to the touch; cysts are located deeper and are filled with a mixture of pus and blood. These lesions may also fuse to form large inflammatory plaques and sinus tracts. After the inflammatory skin lesions subside, pigmentation, persistent erythema, and depressed or hypertrophic scars are often left behind. Clinically, acne is divided into 3 degrees and 4 levels according to the nature and severity of acne lesions: Level 1 (mild): only comedones; Level 2 (moderate): in addition to comedones, there are also some inflammatory papules; Level 3 (moderate): in addition to comedones, there are also more inflammatory papules or pustules; Level 4 (severe): in addition to comedones, inflammatory papules and pustules, there are also nodules, cysts or scars.

diagnosis

Based on the characteristics of onset in adolescents, distribution of skin lesions on the face, chest and back, and the main manifestations of polymorphic skin lesions such as whiteheads, blackheads, inflammatory papules, pustules, etc., it is easy to diagnose clinically and usually no other examinations are required. Sometimes it is necessary to differentiate it from rosacea, disseminated miliary lupus faciis, sebaceous adenoma, etc.

treat

1. Daily care

Wash your face with warm water once or twice a day to clean your skin, and avoid squeezing or scratching skin lesions with your hands. Avoid using oily and powdery cosmetics and ointments and creams containing glucocorticoids.

2. Common methods of acne treatment

(1) Topical medications: Retinoic acid (retinoic acid cream, adapalene gel, tazarotene gel), benzoyl peroxide, antibiotics (clindamycin, erythromycin, chloramphenicol, etc.), azelaic acid, sulfur lotion, etc.

(2) The first choice of oral antibiotics is tetracycline (minocycline, doxycycline, etc.), followed by macrolides (erythromycin). Avoid antibiotics commonly used to treat systemic infections such as levofloxacin. The course of antibiotics is usually 6 to 12 weeks.

(3) Oral isotretinoin For severe acne, oral isotretinoin is the standard treatment and currently the most effective method for treating acne. The treatment course aims to achieve a minimum cumulative dose of 60 mg/kg.

(4) Anti-androgen therapy, such as the oral contraceptive cyproterone acetate combined tablets, is suitable for female patients with moderate to severe acne accompanied by symptoms of excessive androgen levels (such as hirsutism, seborrhea, etc.) or polycystic ovary syndrome. Female patients with delayed-onset acne and acne that is significantly aggravated before menstruation may also consider using oral contraceptives.

(5) Oral glucocorticoids are mainly used for fulminant or aggregated acne, following the principles of short-term, low-dose, and combined with other methods.

(6) For patients who cannot tolerate or are unwilling to accept drug treatment, physical therapy can also be considered, such as photodynamic therapy (PDT), fruit acid therapy, laser therapy, etc.