| Research background:Acne vulgaris is a common disfiguring skin disease,which seriously affects the appearance and physical and mental health of patients,but its pathogenesis is not completely clear.Recent studies have shown that oxidative stress plays a role in the occurrence and development of acne vulgaris recently.The study found that compared with healthy patients,patients with acne vulgaris had significantly higher serum levels of malondialdehyde(MDA)and lower levels of superoxide dismutase(SOD)and catalase(CAT)by Sarici.This study suggests that oxidative stress may play a role in the pathogenesis of acne vulgaris,and the antioxidant defense system may undergo major changes.The findings of AlShobaili are consistent with it,and that serum oxidative products and antioxidant enzymes are significantly associated with disease activity.With the increase of acne vulgaris severity,the contents of oxidation products protein carbonyl(PC)and malondialdehyde(MDA)were significantly increased,and the contents of antioxidant enzymes superoxide dismutase(SOD)and glutathione(GSH)were significantly decreased.However,these studies were mainly cross-sectional studies at one time point and not take into account differences in the incidence patterns of acne severity over time.We observed that even in patients with acne vulgaris of the same severity,the pattern may include the following two different onset patterns.One is the sudden aggravation of the disease at a specific time,and the severity of the subsequent onset is significantly higher than the previous basic level.The other belongs to the group of acne patients with long-term stable and periodic attacks,and the severity of the attack peak has no significant long-term difference.Whether the difference between the two types of pathogenesis is related to oxidative stress ability of the two groups,there are few studies at home and abroad.The studies are of great significance to the study of the pathogenesis of acne vulgaris,and can provide a more complete classification method and treatment strategy for clinical treatment.Research purpose:1.By comparing the clinical characteristics of different onset patterns related to time,the clinical features and risk factors of different onset patterns were discussed.2.To explore the mechanism of oxidative stress in the classification of different pathogenesis patterns,and to provide basis for the treatment of acne vulgaris.Research subjects and methods:1.A survey was conducted on 321 acne patients who visited the dermatology outpatient clinic in the first affiliated hospital of Chengdu Medical College from August 2021 to February 2022.Two doctors in our hospital jointly assessed the skin lesions of the patients and determined the acne classification(Grade I,only acne;Grade II,with comedones and inflammatory papules;Grade Ⅲ,with comedones,inflammatory papules and pustules;Grade Ⅳ,with comedones,inflammatory papules,pustules and nodules,cysts),grouping(Breakthrough group:breakthrough cycle aggravated onset pattern;Period group:Periodic onset pattern).The contents include general condition incident mode,type,location of the skin lesion,transformation characteristics of the skin lesion when the disease aggravates,and the analysis of the relevant factors leading to the sudden aggravation of the patient’s skin lesion.The data were analyzed by SPSS 21.0 software.The chi-square test was used for comparison between two groups or multiple groups.If the frequency of occurrence was equal to 0 or the number of cells with theoretical frequency less than 5 exceeded 20%,Fisher’s exact probability method was used.Measurement data conforming to normal distribution were expressed as mean±standard deviation(Mean±SD);those conforming to skewed distribution were expressed as median(interquartile range)M(P25,P75),and Mann-Whitney was used for comparison between two groups test.Relevant risk factors were analyzed by binary logistic regression,single-factor primary screening was performed first,and significant variables were included in multivariate regression analysis.P<0.05 was considered statistically significant for differences.2.Acne patients with different onset patterns(65 in the breakthrough group and 63 in the period group)were selected.Collected 5ml of cubital venous blood on an empty stomach in the morning at 8-10 and the serum after centrifugation.The contents of oxidative indicators(TOS,PC,MDA)and antioxidant indicators(TAC,CAT,GSH-Px,SOD)in vivo were measured by ELISA or colorimetric method.GraphPad Prism 7.00 was used for statistical analysis of experimental data,and normality and homogeneity of variance tests were performed on the measurement results.The data were expressed as mean±standard deviation(Mean±SD).One-way analysis of variance was used for the comparison of serum oxidation and antioxidant indexes,and two-way analysis of variance was used for the comparison of multiple groups of samples between the same-level breakthrough group and the period group.P<0.05 was considered statistically significant.Research result:1.General situation investigation and analysis(1)A total of 321 questionnaires were collected in the outpatient clinic.There were 183 patients in the breakthrough group,including 71 males and 112 females;138 patients in the period group,including 64 males and 74 females.It was no significant difference in gender(P>0.05).(2)In the breakthrough group,38 cases(20.77%)were aged 10-19 years,115 cases(62.84%)were aged 20-29 years,24 cases(13.11%)were aged 30-39 years,and 6 cases(3.28%)were aged 40-49 years;In the period group,32 cases(23.19%)were aged 10-19 years,92 cases(66.67%)were 20-29 years old,10 cases(7.25%)were 30-39 years old,and 4 cases(2.90%)were 40-49 years old.It was no significant difference in age between the breakthrough group and the period group(Mann-Whitney test showed P>0.05).(3)The careers of the breakthrough group and the period group were mainly students.There were 107 cases(58.47%)in the breakthrough group and 76 cases(55.07%)in the period group.It was no significant difference in occupation between the breakthrough group and the period group(P>0.05).(4)Both the breakthrough group and the period group were mainly unmarried people.There were 139 cases(75.95%)in the breakthrough group and 120 cases(86.96%)in the period group.Marital status had a significant impact on the different incidence patterns of acne(P<0.05),and unmarried people were more likely to break through the cycle.2.Distribution in different onset modes and the characteristics of skin lesion transformation when the disease aggravated(1)In grade Ⅰ,the breakthrough group and the period group had more acne on the forehead and cheeks.It was no significant difference in the distribution of acne between the breakthrough group and the period group(P>0.05).(2)In grade Ⅱ,the acne and inflammatory papules in the breakthrough group and the period group were more likely to occur on the cheeks and forehead.It was no significant difference in the distribution of acne and inflammatory papules between the breakthrough group and the period group(P>0.05).(3)In grade Ⅲ,there was a significant difference in the distribution of pustules between the breakthrough group and the period group when the disease worsened(P<0.05).When the disease group worsened in the breakthrough,the skin lesions were mainly papules and pustules distributed on the cheeks and forehead,and the new pustules on the cheeks were the transformation characteristics.The skin lesions of the patients in the cycle group were mainly papules and pustules before and during the aggravation,mainly distributed on the cheeks and foreheads.(4)In grade Ⅳ,there were significant differences in the distribution of pustules,nodules and cysts between the breakthrough group and the period group when the disease worsened(P<0.05).In the breakthrough group,when the disease worsened,the skin lesions were mainly papules,pustules,nodules and cysts distributed on the cheeks and jaws.And new pustules,nodules and cysts appeared on the cheeks and jaws as the transformation characteristics.The skin lesions of the patients in the period group were mainly papules,pustules,nodules and cysts before the aggravation.And the aggravated skin lesions were mainly papules and pustules,which were concentrated on the cheeks and foreheads.3.Logistic regression analysis was used to analyze the risk factors that may lead to the sudden aggravation of acne.Univariate logistic regression analysis found a total of 7 factors:changing lifestyle behaviors(OR=1.660,P=0.033),changing routine living habits(OR=2.160,P=0.002),increased psychological stress(OR=2.007,P=0.003),emotional instability(OR=1.731,P=0.017),increased staying up late(OR=1.976,P=0.003),a large amount of high-fat diet(OR=1.975,P=0.003),and menstrual irregularity(OR=0.446,P=0.003)were all related to the incidence of acne in the breakthrough group.After multivariate logistic regression analysis,it was found that the behavior of changing routine living habits(OR=1.998,P=0.009),increased psychological stress(OR=2.075,P=0.004),increased staying up late(OR=1.914,P=0.010),and a large amount of high-fat diet(OR=2.038,P=0.004)were the risk factors for the breakthrough group,and menstrual irregularity(OR=0.356,P=0.001)was the risk factor for the period group.4.Analysis of serum oxidation indexes in breakthrough group and period groupThe average levels of serum oxidation products TOS,PC and MDA were related to the severity of acne vulgaris.With the aggravation of the disease,the higher the average content of oxidation products,the greater the difference between the breakthrough group and the cycle group,and the difference in lipid oxidation was the most significant(P<0.05),suggesting that the occurrence and development of acne vulgaris is related to the imbalance of oxidation-antioxidant system,especially lipid oxidation may be involved in the key link of disease development.5.Analysis of serum antioxidant indexes in breakthrough group and period groupThe average levels of serum TAC,CAT,GSH-Px,and SOD were related to the severity of acne vulgaris.With the aggravation of the disease,the lower the average content of antioxidant substances,the greater the difference between the breakthrough group and the cycle group at the same level.The occurrence and development are related to the deficiency of antioxidant substances,and the deficiency of antioxidant enzymes may play a certain role in the occurrence and development of the disease.Early high-dose antioxidant therapy may be a new idea for the treatment of acne vulgaris.Research conclusion:Unmarried people are more likely to experience aggravation of the breakthrough cycle.When the disease worsened,the distribution of skin lesions in the breakthrough group and the period group were different in grades Ⅲ and Ⅳ.Changes in living habits,high psychological stress,increased staying up late,and a large amount of high-fat diet were risk factors for the development of the breakthrough group.There were significant differences in the levels of oxidative stress in the breakthrough group and the period group,with the most significant difference in lipid peroxidation,and oxidative stress was involved in the occurrence and development of acne.Therefore,its different pathogenesis patterns should be considered in clinical diagnosis,so as to better guide clinical treatment. |
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