1. Daily care

Wash your face with warm water once or twice a day to clean your skin, and avoid squeezing or scratching the lesions with your hands. Avoid the use of oil and grease, powder cosmetics and ointments and creams containing glucocorticoids.

2. Common methods of acne treatment

(1) local topical drugs

Vitamin A acid (vitamin A acid cream, adapalene gel, tazarotene gel), benzoyl peroxide, antibiotics (clindamycin, erythromycin, chloramphenicol, etc.), azelaic acid, sulphur lotion and so on.

(2) Oral antibiotics

Preferred tetracyclines (minocycline, doxycycline, etc.), followed by macrolides (erythromycin), avoiding antibiotics commonly used in the treatment of systemic infections such as levofloxacin. The antibiotic course is usually 6 to 12 weeks.

(3) Oral isotretinoin

For severe acne, oral isotretinoin is the standard therapy and is currently the most effective treatment for acne. The regimen is aimed at achieving a minimum cumulative dose of 60 mg/kg.

(4) Anti-androgen therapy

For example, the oral contraceptive compound cyproterone acetate tablets (trade name Daying-35) is indicated for female patients with moderate or severe acne with manifestations of excessive androgen levels (e.g., hirsutism, seborrhea, etc.) or polycystic ovary syndrome. The application of oral contraceptives may also be considered in female patients with delayed acne and significant exacerbation of acne before menstruation.

(5) Oral glucocorticoids

Mainly used for violaceous or coalescing acne, following the principle of short-term, small dose, and combined with other methods.

(6)Others

For patients who cannot tolerate or do not want to accept medication, physical therapy, such as photodynamic therapy (PDT), fruit acid therapy, laser therapy, etc., can also be considered.

3. Graded treatment of acne

(1) Grade 1

Generally, localized treatment is used, and topical retinoid preparations are preferred.

(2)Grade 2

Combined topical retinoids and benzoyl peroxide or antibiotics, combined with oral antibiotics if necessary.

(3)Grade 3

Combination therapy is often required, with oral antibiotics combined with topical benzoyl peroxide and/or retinoids preferred. Antiandrogen therapy may also be considered in indicated female patients.

(4) Grade 4

Oral isotretinoin is the most effective treatment and can be used as first-line therapy. For those with more inflammatory papules and pustules, systematic application of antibiotics combined with topical benzoyl peroxide can also be used first, and then switch to sequential treatment with oral isotretinoin after the lesions improve significantly.

4. Maintenance therapy for acne

No matter what treatment method is used, after the lesions have subsided, maintenance therapy should be continued, preferring topical retinoids, maintenance therapy for 6 to 12 months, and benzoyl peroxide can be combined if necessary. [1]