Clinical Study On The Relation Between Female Acne, TCM Constitutional Types And Menstruation

BackgroundThe recurrent of Acne Vulgaris is really a difficult problem to women who always focus on their appearances, and it will then affect their qualities of life and daily life. Previous studies showed that treatment of TCM has a good effect for female acne, but there are still difficulties for healing some of female acne patients, this is probably due to the special nature of female patients in terms of menstruation, gynecological diseases, and through our clinical experiences, we also find out that there is a certain correlation between types of female acne, TCM constitutional types and menstruation. However, there is still a lack of strong evidence to prove the relationship between types of female acne and the above factors.ObjectiveThis study is designed to further investigate and analyze the correlation between female acne, TCM constitution types, menstruation and gynecological diseases by elucidating the perspective of TCM and western medicine to provide reference for the clinical diagnosis and scientific research of female acne.Methods1. "Clinical Survey of Female Acne Patients" is designed according to the objective of this study.2. Select 300 female acne patients with qualified inclusion criteria and clinical diagnosis from Guangdong Provincial Hospital as observed patients.3. Observed patients signed informed consent, researcher then fill in the questionnaires of "Clinical Survey of Female Acne Patients" from observing and inquiring the patients, at the same time, patients fill out the standardized questionnaires of TCM constitution types published by "China Association of Chinese Medicine" by themselves.4. Analyze the statistical data after finishing all the questionnaires.Results1. Total 300 cases of observed female acne patients, including 40 cases with sex hormone levels examination results.2. There are papular acne 125 cases (41.67%), pustular acne 109 cases (36.33%), nodular acne 50 cases (16.67%), cystic acne 6 cases (2.00%), acne conglobata 10 cases (3.33%), atrophic type 0 case (0.00%) and cachexia type 0 case (0.00%). Skin Damage grade Ⅰ 109 cases (36.33%), grade Ⅱ 129 cases (43.00%), grade Ⅲ 48 cases (16.00%), grade Ⅳ 14 cases (4.67%) Among these, papular acne and grade Ⅱ are most prevalent. Skin damage grade Ⅰ has the highest proportion in papular acne (68.80%), grade Ⅱ has the highest proportion in both pustular acne (60.55%) and nodular acne (52.00%), while cystic acne has the same 50.00% proportion for both grade Ⅲ and grade Ⅳ. Grade Ⅳ has the highest proportion in acne conglobata (60.00%). Differences in the distribution of different acne types and skin damage grades is statistically significant (P<0.05).3. TCM syndrome of wind-heat of lung channel 45 cases (15.00%), syndrome of accumulated dampness-heat 37 cases (12.33%), syndrome of coagulated phlegm-dampness 35 cases (11.67%), syndrome of fever due to Yin deficiency 92 cases (30.67%), syndrome of stagnant-heat and coagulated phlegm 43 cases (14.33%), syndrome of disharmony of Chong and conception channels 48 cases (16.00%). Syndrome of fever due to Yin deficiency is most common among these. Syndrome of wind-heat of lung channel has the highest proportion in papular acne (34.40%), syndrome of fever due to Yin deficiency has the highest proportion in pustular acne (40.37%), syndrome of stagnant-heat and coagulated phlegm has the highest proportion in nodular acne (50.00%), cystic acne (66.67%) and acne conglobata (90.00%). Distribution of acne types of different TCM syndrome is statistically significant (P<0.05).4. TCM constitution types, gentleness type 30 cases (10.00%), Qi deficiency type 25 cases (8.33%), Yang deficiency type 54 cases (18.00%), Yin deficiency type 37 cases (12.33%), phlegm-dampness type 5 cases (1.67%), dampness-heat type 115 cases (38.33%), blood stasis type 10 cases (3.33%), Qi depress type 18 cases (6.00%), special endowment type 6 cases (2.00%). Dampness-heat type is most prevalent among these. After determination of the main constitution types, according to the ratio of the order, there are Qi deficiency type 130 cases (43.33%), Yin deficiency type 129 cases (43.00%), phlegm-dampness type 123 cases (41.14%), dampness-heat type 111 cases (37.00%), Qi depress type 97 cases (32.33%), Yang deficiency type 90 cases (30.00%), blood stasis type 77 cases (25.67%), special endowment type 36 cases (12.00%). Pustular acne has the highest proportion in Yin deficiency type (16.51%), nodular acne and cystic acne each has the same highest proportion in gentleness type (both 14.00%), while acne conglobata and dampness-heat type has the highest proportion for each other correspondingly which is 70.00%. Distribution of acne types of different TCM constitution types is statistically significant (P<0.05)5. Regular menstrual cycle 232 cases (77.33%), advanced menstruation 9 cases (3.00%), retarded menstruation 52 cases (17.33%), irregular menstrual cycle 7 cases (2.33%). Less menstrual flow 110 cases (36.67%), medium menstrual flow 181 cases (60.33%), more menstrual flow 9 cases (3.00%). Bright red color 126 cases (42.00%), dark red colour 164 cases (54.67%), light red colour 10 cases (3.33%). The largest proportion among these are regular menstrual cycle, medium menstrual flow and dark red colour. Regular menstrual cycle has the highest proportion in nodular acne (82.00%) and acne conglobate (80.00%), while cystic acne has the highest proportion in retarded menstruation (33.33%). Syndrome of disharmony of Chong and conception channels has irregular menstrual cycles. Acne types of the menstrual cycle and TCM syndromes are statistically significant (P<0.05). Premenstrual acne has the largest percentage reached 246 cases (82.00%). In the case of the premenstrual performance, irritability 116 cases, breast tenderness 149 cases and bloating 84 cases based. It shows premenstrual discomfort is common to acne patients. In the of case of menstrual performance, breast tenderness 30 cases, headache 4 cases, body pain 8 cases, mouth sores 2 cases, diarrhea 43 cases, edema 2 cases, emotional abnormalities 9 cases and backache 106 cases based.Also, there are 213 cases with blood clots, and 113 cases with dysmenorrhea, it shows that blood clots has a considerable proportion which is needed to be concerned about.Distribution between menstrual cycle and acne types is statistically significant (P<0.05). Papular acne with no premenstrual bloating accounted for 96 cases (44.44%), nodular acne with premenstrual bloating has larger proportion of 23 cases (27.38%); syndrome of stagnant-heat and coagulated phlegm with emotional abnormalities in menstrual cycle accounted for 5 cases (11.63%), distributions of above factors are statistically significant (P<0.05)6. Gynecological inflammation 35 cases (cervicitis 12 cases, vaginitis 19 cases, pelvic inflammatory disease 3 cases, endometritis 1 case); tubal infertility lcase; gynecologic Oncology 10 cases (uterine fibroids 6 cases, ovarian tumors 4 cases); breast hyperplasia 42 cases; polycystic ovarian syndrome 9 cases. There is no statistically significant difference (P>0.05) between Female acne types and gynecological diseases.7. Syndrome of wind-heat of lung channel has less prone to pustular acne compared with papular acne, the relative risk is 0.136. Syndrome of stagnant-heat and coagulated phlegm has more prone to nodular acne compared with papular acne, the relative risk is 34.236. There are more prone of special endowment type, syndrome of stagnant-heat and coagulated phlegm and syndrome of accumulated dampness-heat to cystic acne compared with papular acne, the relative risk of 120.646-589.724.8.40 of 300 cases did sex hormone levels examination during follicular phase, estradiol (E2) with average 160.67±91.64nmol/L has horizontal low tendency. Six types of sex hormones (FSH, LH, PRL, TSTO, PRG, E2) do not have statistically significant on papular, pustular, nodular and cystic acne, or TCM syndrome of wind-heat of lung channel, syndrome of accumulated dampness-heat, syndrome of coagulated phlegm-dampness, syndrome of fever due to Yin deficiency, syndrome of stagnant-heat and coagulated phlegm and syndrome of disharmony of Chong and conception channels.Conclusion1. Papular acne is the most common acne type in this investigation, this is probably due to female patients who always focus on their appearances will go to see a doctor while they are still in slight conditions.2. Syndrome of fever due to Yin deficiency is the main syndrome throughout all cases, in accordance with the say of liver and kidney are related to the occurrence of female acne.3. Dampness-heat type is the most common TCM constitution type which is much higher than other 8 kinds of constitution types. Only seldom patients has a single constitution type, most of the patients have two or more, or even all biased constitution types except the gentleness type, it performs a variety of different constitutions. This may be due to the modern social reasons, environmental issues, eating habits, stress and other external factors that affect the stability of the constitution state and cannot simply belong to only 1 physical constitution.4. Female acne patients mostly have premenstrual acne, irregular menstruation and change of menstrual quantity.