How Do You Treat Adolescent Acne in Your Practice?

Abstract

Acne vulgaris is a primary inflammatory disorder involving the pilosebaceous unit. The pathophysiology of acne vulgaris is multifactorial, including increased sebum production, hyperkeratinization of the follicular infundibulum, inflammation, and cutibacterium acnes. Acne vulgaris mostly affects adolescents but may continue to adulthood, with 26% of women and 12% of men reporting acne in their 40s. The primary lesion types in acne are comedones (open or closed) and inflammatory lesions (papules, pustules, and nodules). The typical distribution involves the sebaceous gland-rich areas of the face, upper back, chest, and shoulders. Secondary changes such as scarring, post-inflammatory hyperpigmentation, or erythema must also be noted. The main therapy for acne vulgaris includes topical agents, systemic antibiotics, and hormonal therapy. Acupuncture has been shown to be effective in treating acne vulgaris. In a systematic review and meta-analysis acupuncture was not significantly different compared to guideline recommended treatments in treating acne vulgaris but had fewer side effects, and thus it may be a treatment option. Another systematic review and meta-analysis in showed that fire needling, a modality of acupuncture, combined with pharmaceutical medication was better compared to pharmaceutical medication alone in the treatment of moderate-severe acne; fire needling alone was better than pharmaceutical medication alone; and that that there was no significant difference in the recurrence rate in both fire needling and pharmaceutical medication. In addition, fire needling was also associated with fewer adverse reactions.

This article is a case report. A 17-year-old female patient had been suffering from recurrent acne for 6 years, and it had worsened in the past year. She had been to see a dermatologist several times and was diagnosed with adolescent acne. She had tried various topical ointments without any effect. There was a history of acne on her father’s side of the family. She has been mainly vegetarian for about 6 months. She disliked vegetables, meat, seafood, and dairy products, but she liked sweets. She had noticeable oily facial skin, large pores on the cheeks, grainsized red inflamed pimples on the cheeks and lower jaw, with yellow and white pustules at the tip, and more pronounced cysts and dark red pigmentation on the lower jaw. Te acupuncture prescription was LI 11, SP 9, SP 6, ST 40, SP 10, LR 3, K I3, LR 14, Uterus, ST 29, TaiYang, GV20, Ear Shenmen, Ear Liver. Needle sizes 34G, 0.5cun, 1cun, and 1.5cun were used respectively, with perpendicular insertion, without manipulation. The needles were retained for 40 minutes. Treatment was given once a week. The patient was advised to avoid sugary foods, increase her intake of green vegetables and fruit, and increase her exercise. In the meantime, supportive psychological counseling was provided. After six treatments, her condition had improved remarkably. Her facial acne had mostly disappeared, and the hard nodule in the groin area had flattened and was a lighter color. Her menstrual cycles had normalized to a 31-day cycle with biphasic pattern of basal body temperature. Her menstrual flow was less heavy, without clots and abdominal pain. Her moods were better, with no more crying spells or anxiety. She asked to return to normal study at school after finish the six session of acupuncture.

Abstrak

Acne vulgaris merupakan gangguan inflamasi primer yang melibatkan unit pilosebaceous. Patofisiologi acne vulgaris bersifat multifaktorial, antara lain peningkatan produksi sebum, hiperkeratinisasi infundibulum folikuler, inflamasi, dan Cutibacterium Acnes. Acne vulgaris sebagian besar mempengaruhi remaja namun dapat berlanjut hingga dewasa, dengan 26% wanita dan 12% pria dilaporkan mengalami jerawat di usia 40-an. Jenis lesi primer pada akne adalah komedo (terbuka atau tertutup) dan lesi inflamasi (papula, pustula, dan nodul). Distribusi tipikal melibatkan area yang kaya akan kelenjar sebaceous di wajah, punggung atas, dada, dan bahu. Perubahan sekunder seperti jaringan parut, hiperpigmentasi pasca inflamasi, atau eritema juga harus diperhatikan. Terapi utama acne vulgaris meliputi agen topikal, antibiotik sistemik, dan terapi hormonal. Akupunktur telah terbukti efektif dalam mengobati acne vulgaris. Dalam tinjauan sistematis dan meta-analisis akupunktur tidak berbeda secara signifikan dibandingkan dengan perawatan standar dalam mengobati acne vulgaris dengan efek samping yang minimal, dan dengan demikian dapat menjadi pilihan pengobatan acne vulgaris. Tinjauan sistematis dan meta-analisis lainnya menunjukkan bahwa fire needling, salah satu modalitas akupunktur, dikombinasikan dengan obat-obat standar lebih baik dibandingkan dengan obat standar saja dalam pengobatan jerawat sedang-berat; akupunktur fire needling saja lebih baik daripada obat farmasi saja; dan bahwa tidak ada perbedaan yang signifikan dalam tingkat kekambuhan baik pada akupunktur fire needling maupun obat-obatan standar. Selain itu, fire needling juga dikaitkan dengan efek samping terapi yang lebih sedikit.

Artikel ini merupakan laporan kasus. Seorang pasien wanita berusia 17 tahun menderita jerawat berulang selama 6 tahun, dan memburuk dalam setahun terakhir. Pasien telah berobat ke dokter kulit beberapa kali dan didiagnosis dengan acne adolescent. Pasien telah mencoba berbagai salep topikal namun masih belum menunjukkan perubahan. Pasien mempunyai riwayat jerawat di pihak keluarga ayahnya. Pasien merupakan vegetarian selama sekitar 6 bulan terakhir. Pasien tidak menyukai sayuran, daging, makanan laut, dan produk susu, namun menyukai makanan manis. Pasien memiliki kulit wajah berminyak, pori-pori besar di pipi, jerawat merah meradang di pipi dan rahang bawah, dengan pustula kuning dan putih di ujungnya, dan kista yang lebih menonjol serta pigmentasi merah tua di rahang bawah. Titik akupunktur yang digunakan antara lain LI11, SP9, SP6, ST40, SP10, LR3, KI3, LR14, Uterus, ST29, TaiYang, GV20, Ear Shenmen, Ear Liver. Ukuran jarum yang digunakan 34G, 0,5cun, 1cun, dan 1,5cun, perpendicular, tanpa manipulasi. Jarum ditahan selama 40 menit. Perlakuan diberikan seminggu sekali. Pasien disarankan untuk menghindari makanan manis, memperbanyak asupan sayur dan buah hijau, serta memperbanyak olahraga dan juga diberikan konseling psikologis suportif. Setelah enam sesi perawatan, kondisinya membaik. Jerawat di wajah sebagian besar telah hilang, dan bintil keras di area selangkangan sudah rata dan berwarna lebih terang. Siklus menstruasinya menjadi normal menjadi siklus 31 hari dengan pola bifasik suhu tubuh basal. Aliran menstruasinya tidak terlalu deras, tanpa gumpalan dan sakit perut. Suasana hati lebih baik, tidak dijumpai kembali kecemasan. Pasien dapat kembali belajar normal ke sekolah setelah menyelesaikan enam sesi akupunktur.