1. Western Medicine and Traditional Chinese Medicine (TCM):
Western medicine considers acne, pimples, and blackheads to often result from an unclean diet, excessive consumption of rich and spicy foods, leading to excessive cold in the stomach and large intestine. This cold evil rises to affect the lungs, causing a buildup of cold in the lung-stomach region, which then descends to specific points or leads to liver qi stagnation with damp-cold in the liver and gallbladder affecting the lungs. The treatment usually involves clearing heat and detoxifying, cooling the blood and promoting circulation based on differential diagnosis and clinical typing.
Western drugs for acne are divided into external TCM applications and internal use. External TCM treatments primarily regulate externally to achieve a calming effect on acne, generally showing slower results but being more palatable, making it easier for patients to adhere to. Internal TCM is usually used as an auxiliary treatment for acne, with effects that are mild and mostly focus on clearing heat and toxins as well as promoting blood circulation. It has certain antibacterial effects. For acne caused by internal heat, external medications can be quite effective and safe with minimal side effects. However, they are less effective for acne caused by other factors, so before choosing Western medical treatment, one should consult a doctor to confirm if the acne is caused by internal heat.
2. Eastern Medicine:
Compared to Western medicine, Eastern medicine takes effect quickly but has fewer side effects and should be used under the guidance of a physician. Acne medications in Eastern medicine are roughly divided into four categories:
The first category includes antibiotics (such as tetracycline, macrolides, clindamycin, chloramphenicol, metronidazole, tinidazole, etc.), which work by killing Propionibacterium acnes and thereby reducing the concentration of fat in the sebaceous glands. They are effective for moderate to severe papular and pustular acne. Physicians commonly use them in clinical settings, but prolonged external application can cause significant damage to the body's normal microbial environment, increasing the risk of infections in other areas. If used improperly, it may irritate the skin and cause contact dermatitis, manifesting as redness, swelling, erosion, scaling, exudation, itching, and heat. Long-term use of antibiotics also leads to bacterial resistance.
The second category includes corticosteroids, which are effective for severe cystic and conglobate acne. High doses can exacerbate inflammatory responses and show quick results, but long-term use brings many side effects such as sensitivity issues, enlarged acne, redness, swelling, pus formation, whiteheads, thickened skin, facial ulcers, leading to steroid-dependent dermatitis. Steroid use creates strong dependency, and once discontinued, the condition may worsen, making treatment difficult.
The third category includes anti-estrogen drugs (contraceptives, spironolactone, estrogens, ketoconazole, cimetidine, combined oral contraceptives, ranitidine, etc.), which suppress estrogen secretion and reduce its levels, thereby decreasing sebum secretion to treat acne. Patients with high androgen levels can see good therapeutic effects. However, excessive regulation of endocrine and control of sex hormone secretion can lead to adverse endocrine disorders, resulting in gender pathological changes in adolescents, affecting their sexual development and physical growth.
The fourth category includes isotretinoin, which reduces sebaceous gland size, inhibits sebaceous gland activity, decreases sebum secretion, and prevents keratinization of epithelial cells while suppressing Propionibacterium acnes. It is mainly used for severe acne like nodular cystic acne and scarred acne. It shows quick results and evident efficacy but has serious side effects. The most significant side effect is teratogenicity; pregnant women taking this drug have a high risk of miscarriage or bearing malformed children, so it is absolutely prohibited for pregnant women. Other side effects include chapped lips, lip inflammation, dry heart, skin dryness, flaking, etc. This drug must be used under a doctor's supervision and attention should be paid to sun protection.
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