Malignant acne

Introduction The acne lesions are cyan or magenta papules, pustules or nodules that are the size of millet to broad bean. They are light and soft, and contain pus and blood. They will not heal for a long time, and then they will leave tiny scars and no pain. There is also little infiltration. This type is more common in patients with weak bodies. 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.

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.

1, hemorrhoids and sexual endocrine have a close relationship, rarely before puberty, people with loss or decline in sexual function, such as the ancient court castrated eunuch not onset, people with reduced sexual function, such as the application of testosterone can promote the growth of beard and hemorrhoids The occurrence of acne-prone rash is often caused by corticotropin or corticosteroids. Women often have acne attacks before menstruation. Reduced symptoms of acne during pregnancy. Both men and women have androgens and estrogens. The organ that secretes sex hormones is the testis and adrenal glands in men, and the ovaries, placenta, and adrenal glands in women. Androgens and estrogens have different ratios in men and women, and changes in ratios may cause acne.

2. The development of sebaceous glands and the secretion of sebum are also related to the increase of androgen. Among them, testosterone increases the activity of sebaceous glands, and progesterone and dehydroepiandrosterone (DHA) in the adrenal cortex also participate in the action. May play an important role. 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.

3. 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.

4. 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.

5. In addition, heredity is also an important factor in the occurrence 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.

an examination

Related inspection

Skin smear microscopy skin microscopy

Check the shape and distribution of lesions, whether there are papules, pustules, blackheads, nodules, cysts, scars, etc.

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.

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