A Healthy Summer | Summer acne is coming, are you using the right anti-acne drugs?

In the hot summer, the skin secretes more lipids, and sweating clogs the pores, which can cause the proliferation of hair follicle microorganisms such as Propionibacterium acnes and inflammatory reactions. Irregular diets such as cold and spicy food and staying up late can also cause abnormal hormone levels, thereby inducing sebaceous gland hyperplasia and excessive lipid secretion. Therefore, summer is the peak season for acne. So, how should acne be treated? Faced with a wide variety of treatment drugs, how should we choose?

The treatment options for acne patients recommended by the Chinese Acne Treatment Guidelines (2019 Revised Edition) are as follows:

Topical treatments

1. Topical retinoic acid

Commonly used drugs include tretinoin cream and adapalene gel, which are used for local treatment of mild to moderate acne vulgaris with acne, papules and pustules as the main manifestations. Clean the acne-affected area before going to bed, apply a thin layer to the affected area after drying, once a day, and be careful to avoid contact with the eyes and lips. Increasing the dosage will not enhance the efficacy or speed up the onset of action, but may cause skin redness, desquamation or other discomfort. Some patients will experience short-term aggravation of skin lesions within 2 to 4 weeks of use. For this reason, a lower starting dose, small-scale trial, and reduced number of uses should be used. At the same time, skin barrier repair agents should be used in combination with appropriate sun protection. It is particularly important to note that tretinoin drugs are contraindicated for pregnant women and women planning pregnancy.

2. Benzoyl peroxide

Benzoyl peroxide is a non-antibiotic antibacterial drug that can be used as the first choice for topical antibacterial drugs for inflammatory acne. It can be used alone or in combination with topical retinoic acid drugs or topical antibiotics. This drug has an oxidative bleaching effect on clothing or hair, so contact should be avoided as much as possible.

3. Topical antibiotics

Topical antibiotics, including erythromycin, lincomycin and its derivatives clindamycin, chloramphenicol, chloramphenicol and fusidic acid, are theoretically suitable for superficial inflammatory acne lesions such as papules and pustules because they rarely cause irritation. However, because topical antibiotics can easily induce drug resistance in Propionibacterium acnes, they are not recommended as the first choice for acne treatment, nor are they recommended for single or long-term use. It is recommended to use them in combination with benzoyl peroxide, topical retinoids or other drugs.

Systemic therapy drugs

1. Oral isotretinoin

It needs to be taken with a fat meal to increase its oral bioavailability. The course of treatment depends on the disappearance of skin lesions and the dosage taken, and is usually not less than 16 weeks. It usually takes 3 to 4 weeks to take effect. After the skin lesions are controlled, the dosage can be appropriately reduced and the consolidation treatment can be continued for 2 to 3 months or longer. Most of the adverse reactions of isotretinoin are similar to the symptoms of vitamin A overdose (mainly dry skin and mucous membranes), and most of them are reversible. Isotretinoin has a clear teratogenic effect. Women of childbearing age and their spouses should strictly practice contraception within 3 months before and after taking the medicine.

2. Antibiotics

Antibacterial treatment against Propionibacterium acnes is one of the commonly used methods for treating acne, especially moderate and severe acne. Tetracycline antibiotics, such as doxycycline and minocycline, are the first choice. If there is no effect after 2 to 3 weeks of treatment, stop using the antibiotics in time or switch to other treatments; ensure a sufficient course of treatment and avoid intermittent use. Do not increase the dose or extend the course of treatment without principles, and do not use it as a maintenance treatment or even a measure to prevent recurrence. Avoid using antibiotics alone. Combining topical retinoic acid drugs or benzoyl peroxide can effectively improve the efficacy and reduce the drug resistance of Propionibacterium acnes. When acne relapses, antibiotics that have been effective in previous treatments should be selected to avoid arbitrary changes to avoid drug resistance.

3. Hormones

Including anti-androgens (estrogen, progesterone, spironolactone and insulin sensitizers, etc.), glucocorticoids (prednisone, dexamethasone, etc.). Anti-androgens are suitable for acne with hyperandrogenism, such as skin lesions distributed in the lower 1/3 of the middle face, irregular menstruation, obesity, hirsutism, significant seborrhea, androgenic alopecia, etc.; female post-pubertal acne; acne that is significantly aggravated before menstruation, etc. However, long-term high-dose use should be avoided to avoid adverse reactions, such as hormonal acne or folliculitis.

Developing good living habits such as reducing the intake of spicy and sweet foods, eating more vegetables and fruits, reducing staying up late, paying attention to facial cleansing, and choosing the right skin care products can reduce the occurrence of acne.