general treatment
Healthy diet: eat less high-sugar diet and dairy products, such as French fries, bread, whole milk and so on. Eat more yogurt, vegetables, fruits and coarse grains.
Good living habits: avoid staying up late and living irregularly, avoid exposure, and pay attention to personal hygiene.
Cleansing the skin: choose clean water or suitable cleaning products to keep the skin clean. If you need makeup, choose cosmetics that won't clog pores or oil-free cosmetics, and be sure to remove makeup in time.
Psychological counseling: acne will affect patients' social interaction and study, resulting in different degrees of psychological pressure. Excessive psychological pressure will lead to more serious acne. In the treatment of acne, psychological counseling and mental health education can not only help patients reduce their psychological pressure, but also alleviate their illness.
medicine
External drug therapy
Generally, acne patients can only use external drugs. For patients with poor efficacy of topical drugs or moderate to severe acne, it is necessary to adopt a combination of topical drugs and oral drugs. These drug treatments must be carried out under the guidance of a doctor.
Commonly used drugs for external use include the following categories:
Vitamin a acid
Tretinoin for external use is the first choice for mild to moderate acne.
The main functions of these drugs are to regulate the differentiation of epidermal keratinocytes, improve the keratinization of sebaceous glands in hair follicles, dissolve micro-acne and acne, and resist inflammation. They also have the effects of controlling pigmentation after acne inflammation and improving acne scars.
The combination of tretinoin drugs with anti-inflammatory and antibacterial drugs can increase the skin permeability of related drugs.
Topical tretinoin drugs often have mild skin irritation reactions such as local erythema, desquamation, tightness and burning sensation, but they can gradually disappear with the extension of use time.
benzoyl peroxide
Peroxide can slowly release new ecological oxygen and benzoic acid after external use, which has the functions of killing Propionibacterium acne, dissolving acne and astringing, and can be used as one of the first choice external antibacterial drugs for inflammatory acne.
antibiotic
Include erythromycin, clindamycin, fusidic acid cream, etc. Because topical antibiotics are easy to induce drug resistance of Propionibacterium acnes, it is not recommended to use them alone, but to use them in combination with benzoyl peroxide or topical retinoids.
nonane diacid
It can reduce the flora of skin surface, hair follicle and sebaceous gland, especially inhibit propionibacterium acne and dissolve acne. It is effective for different types of acne and can be made into 15%~20% cream for external use. The adverse reactions were local mild erythema and tingling.
Systematic drug therapy
Systemic therapy is generally used for patients with moderate or severe acne or patients with ineffective topical drugs. Some systemic drugs can cause fetal malformation. Therefore, pregnant women should avoid systemic treatment, which should be carried out under the guidance of a doctor. Commonly used systemic drugs are as follows:
antibiotic
Systematic treatment is the first choice for patients with moderate and severe acne. However, antibiotics are easy to cause drug resistance of Propionibacterium acnes and Propionibacterium non-acnes. Therefore, it is very important to standardize the selection and course of treatment of antibacterial drugs or to use them in combination with other therapies to improve the curative effect and prevent drug resistance.
Heterogeneous A acid
At present, the most effective acne medicine, acne patients without contraindications can take it as soon as possible.
Vitamin A acid can reduce oil secretion, inhibit abnormal keratinization and blackhead acne formation, and inhibit propionibacterium acne, which has a good effect on nodular, cystic and polymeric acne.
At the same time, we should pay attention to its side effects, including dry lips, desquamation, elevated blood lipids and so on. These drugs also have definite teratogenic effects, and female patients should strictly use contraception before treatment 1 month, during treatment and 3 months after treatment.
Hormone drugs
Antiandrogen drugs: only suitable for female patients with abnormal androgen, and commonly used drugs include the following two categories:
Oral contraceptives: contraceptives are generally composed of estrogen and progesterone, which can antagonize androgens, directly act on sebaceous glands and reduce sebum secretion. These drugs are only used for female acne patients.
Spironolactone: It has mild antiandrogen effect and is not suitable for male acne patients to use for a long time.
Glucocorticoid: It is suitable for severe nodular acne, aggregated acne, inflammatory stage of cystic acne and fulminant acne. For severe nodular or cystic acne, glucocorticoid can be injected into the skin lesions.
At the same time, we should pay attention to avoid long-term high-dose use of glucocorticoid, so as to avoid adverse reactions, including hormonal acne or folliculitis, which will complicate the condition.
physiatrics
Photodynamic therapy: light and moderate skin lesions can be combined with red and blue light irradiation to destroy propionibacterium acne through photodynamic effect and reduce inflammatory reaction. The main adverse reactions include pain, scab, erythema and pigmentation.
Laser therapy: This therapy is mainly used for scar treatment. When patients reach the late age when acne is basically controlled, laser therapy can be considered to treat the scars left by acne. At present, 1450nm laser, intense pulsed light, pulsed dye laser and dot matrix laser are effective methods to treat acne and acne scars.
Surgical therapy
This disease generally does not require surgical treatment.
Traditional therapy in China
Chinese patent medicine or traditional Chinese medicine therapy should be used according to the principle of syndrome differentiation and treatment. Acupuncture, cupping, ear sticking and other external treatments of traditional Chinese medicine have certain curative effects. However, there is no large-scale clinical study to prove the safety of traditional Chinese medicine.
Patients need to consult Chinese medicine practitioners or pharmacists in detail before taking medicine, and it is not appropriate to carry out Chinese medicine treatment on their own, which will increase the risk of illness.
Other treatments
At the same time of external use of drugs, acne can be squeezed out with a acne squeezer. Suppurative lesions sometimes require incision and drainage; After cleaning the skin lesions, medical massage or drug spray combined with plaster inversion can achieve the purpose of treatment and beauty.
Comprehensive treatment plan
Graded clinical manifestations
First choice of treatment, second choice of treatment.
Treatment is not recommended.
Female optional
Maintenance therapy
Mild acne
Topical retinoic acid
Benzoyl peroxide, salicylic acid, acne, fruit acid, traditional Chinese medicine
Oral and topical antibiotics
-
-
Moderate level 1
Inflammatory papule
Local retinoic acid+benzoyl peroxide/local antibiotics
Benzoyl peroxide+antibiotics for external use
Oral antibiotics+topical retinoic acid and/or benzoyl peroxide/topical antibiotics, blue light, fruit acid and traditional Chinese medicine.
Single oral or topical antibiotics
Oral antiandrogen drugs
-
Moderate grade Ⅱ
Papules, pustules
Oral antibiotics+topical retinoic acid+benzoyl peroxide/topical antibiotics
Oral isotretinoin, fruit acid, red (blue) light, photodynamic therapy, laser therapy and traditional Chinese medicine.
Monosystemic therapy or local monotherapy
Oral antiandrogen drugs
Vitamin A acid or+benzoyl peroxide is used for external use alone.
serious
Nodules and cysts
Oral isotretinoin alone or+benzoyl peroxide/local antibiotics
Strong inflammatory reaction can take antibiotics+benzoyl peroxide/topical antibiotics first, and then take isotretinoin orally.
Oral antibiotics+topical retinoic acid and/or benzoyl peroxide, photodynamic therapy, systemic glucocorticoid (combined with oral isotretinoin in the early stage of polymerized acne), and traditional Chinese medicine.
Local monotherapy, oral antibiotic monotherapy
Oral antiandrogen drugs