Rough facial skin due to self-medication for acne

Having acne all over his face, spreading down to his neck for many years without healing, Mr. Hung bought corticoid medicine to apply on himself, causing his facial skin to become rough and abnormally inflamed.

Mr. Hung (28 years old, Binh Dinh) went to Tam Anh General Hospital in Ho Chi Minh City for a check-up on the morning of April 6 due to pustules mixed with blackheads. The skin with acne was inflamed, rough, swollen, spreading from the forehead, the corners of the eyes, both cheeks down to the neck. He said he had applied acne cream but it did not get better, so he recently bought corticoid medicine to use, but his skin became more swollen, then his face became dark and pitted.

Dr. Dang Thi Ngoc Bich, a specialist in Dermatology - Skin Aesthetics, used LED light to check and found that the skin was oily, inflamed, flaky, with inflamed and clogged pores... The patient continued to have her skin examined with a high-resolution camera to assess the acne condition in the T-zone and U-zone.

In 5 minutes, the skin scanner outlines the patient's facial contours in 3D, with details of pores, wrinkles, moisture, elasticity, acne structure and analysis of the deep layers of the skin. The results show that Mr. Hung is 2 years older than his actual age, with larger pores than normal, with an average size of about 0.43 mm, and the U-shaped area has a lot of oil due to overactive sebaceous glands.

On the other hand, the test results showed that the patient's facial skin was infected with propionibacterium acnes bacteria, leading to pustules and pitted scars. The inflamed areas due to complications of self-applying corticosteroids further blocked the sebaceous ducts, causing the acne to swell.

Doctor Bich is examining Mr. Hung's skin with a skin scanner with a high-resolution camera. Photo: Dinh Tien — Doctor Bich is examining Mr. Hung's skin with a skin scanner with a high-resolution camera. Photo: *Dinh Tien*

The patient was prescribed topical antibiotics to help reduce swelling and inflammation, and stopped taking corticosteroids. The doctor instructed Mr. Hung on how to properly care for his acne-prone skin. After the acne cleared, the patient's skin was examined again to have a suitable treatment plan for dark spots and acne scars.

After more than 2 months of acne treatment, Mr. Hung's face was no longer inflamed, pus had reduced, and pain had gone away. On the morning of June 6, he returned for a check-up and was treated for hidden acne. Doctor Bich said that the patient must undergo at least 10-12 weeks of treatment with oral medication, topical medication, and facial care products (facial cleanser, toner, etc.). After the acne is gone, the patient will be treated to reduce dark spots and scars with laser, electrophoresis, microneedling, HA injections, etc.

Doctor Dang Thi Ngoc Bich said that more than 80% of the world's population suffers from acne (red acne, blackheads, whiteheads, hidden acne, cystic acne, whiteheads, pustules), mainly under 30 years old. There are many factors that cause acne such as: family factors, hormonal changes (puberty, menstrual cycle, pregnancy), use of cosmetics and drugs containing corticosteroids; eating a lot of sugar, fat, smoking, having some diseases that affect the sebum secretion process such as seborrheic dermatitis, folliculitis...

About 20-30% of patients need medical treatment. Currently, there are many methods that support and coordinate together to treat acne, from applying medicine, taking medicine, laser, IPL, electrophoresis, microneedling... To choose the appropriate acne treatment methods, it is necessary to analyze the skin (skin examination) so that the doctor can see the overall condition of the damage, and give a treatment regimen suitable for each patient. During the treatment, patients should not arbitrarily use cosmetics, do not apply skin masks, do not apply products with unknown ingredients, especially those containing corticosteroids that cause skin atrophy, dilation of blood vessels, facial edema, roughness, acne, keloid scars, concave scars...

Corticoid treatment needs to be closely monitored by a doctor. Because at first, when using topical corticosteroids, the skin is smooth, acne is reduced, but if abused, after a few months, the skin becomes thinner, the immune system is suppressed, acne flares up violently, infection, causing itching. If the patient scratches, the skin will become inflamed, swollen, and pus again.

Long-term abuse of corticosteroids causes drug dependence (drug addiction) and many side effects of the drug such as: acne rash, pustules, inflammatory acne, osteoporosis, adrenal insufficiency, gastric and duodenal ulcers...

To reduce acne, patients should wash their face with clean water 2-3 times a day but do not rub hard. For oily skin, patients can use oil-controlling cleanser as prescribed by the doctor. In addition, patients should not touch their face or squeeze acne, especially the T-shaped area of the face near the maxillary sinuses and cranial sinuses. Infection in this area can cause facial swelling, cavernous sinusitis; more seriously, the inflammation will spread into the skull and cause meningitis.

You should limit the use of sweet, fatty foods, alcoholic beverages, caffeine... Instead, increase exercise, eat lots of green vegetables, foods high in fiber, eat fruits rich in antioxidants, drink 1.5-2 liters of water per day.

Dinh Tien

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