Evidence-based Clinical Chinese Medicine

Volume 11: Acne Vulgaris

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• Publisher: WSPC
• Year: 2019
• eBook ISBN: 9789813272668
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

The eleventh volume in the Evidence-based Clinical Chinese Medicine series is a must read for Chinese medicine practitioners interested in dermatology. Using a 'whole evidence' approach, this book aims to provide an analysis of the management of acne vulgaris with Chinese and integrative medicine.

This book describes the understanding and management of acne vulgaris with conventional medicine and Chinese medicine. Chinese medicine treatments used in past eras are analysed through data mining of classical Chinese medicine books. Several treatments are identified that are still used in contemporary clinical practice.

Attention is then turned to evaluating the current state of evidence from clinical studies using an evidence-based medicine approach. Scientific techniques are employed to evaluate the results from studies of Chinese herbal medicine, acupuncture and other Chinese medicine therapies. The findings from these reviews are discussed in terms of the implications for clinical practice and research.

Chinese medicine practitioners and students can use this book as a desktop reference to support clinical decision making. Having ready access to the current state of evidence for herbal formulas and acupuncture treatments allows practitioners to be confident in providing evidence-based health care.

This book provides an innovative 'whole evidence' approach to the management of acne vulgaris. Multiple types of evidence from different sources are reviewed and synthesized to provide a summary of the available evidence.

Interventions, including oral and topical Chinese herbal medicine, body and ear acupuncture and combinations of these therapies, are evaluated for their effect on acne lesion count and severity, and impact on health-related quality of life.

Chinese medicine treatments that have been frequently used in clinical studies provide guidance for patient care. This book links formulas, herbs and acupuncture points with treatment efficacy, providing the reader with potential for creating new formulas.

The editors of this series are internationally recognised, well-respected leaders in the field of Chinese medicine and evidence-based medicine with strong track records in research.

Contents:

• Introduction to Acne Vulgaris
• Acne Vulgaris in Chinese Medicine
• Classical Chinese Medicine Literature
• Methods for Evaluating Clinical Evidence
• Clinical Evidence for Chinese Herbal Medicine
• Pharmacological Actions of Frequently Used Herbs
• Clinical Evidence for Acupuncture and Related Therapies
• Clinical Evidence for Combination Therapies
• Summary and Conclusions
• Glossary
• Index

Readership: Chinese medicine practitioners and students.Chinese Medicine;Chinese Herbal Medicine;Acupuncture;Acne Vulgaris;Dermatology0 Key Features:

• A focus on the management of acne vulgaris with Chinese medicine comprising information from a vast array of resources. Much of the content is sourced from the Chinese literature, which is inaccessible to many practitioners
• The systematic evaluation of traditional and classical treatments provides historical background, context and origins of Chinese medical management of acne vulgaris, and draws parallels with contemporary practice
• Assessments of the evidence from clinical studies using scientific methods
• By providing this information in an easy to use reference, practitioners can focus on providing high quality care supported by the best available evidence

1

Introduction to Acne Vulgaris

OVERVIEW

Acne vulgaris is a chronic skin condition that primarily affects adolescents. Periods of relapse and remission are common, and may extend well into adult life. Acne vulgaris has considerable impact on a patient’s health-related quality of life, and is a significant financial burden. Treatment selection is based on disease severity and patient preference, and includes both topical and systemic options. Early initiation, along with adherence to the induction and maintenance phases of treatment, improves long-term outcomes.

Definition of Acne Vulgaris

Acne is a chronic, inflammatory skin disease.¹ Acne vulgaris typically presents at puberty,² but may also present in children,³ and can persist well into adult life.⁴ Acne often presents as seborrhoea (excess oil accumulation on the skin),⁵ with non-inflammatory and/or inflammatory lesions.⁴

Acne vulgaris is the most common form of acne,² and was ranked eighth in global disease prevalence in 2010.⁶ Other variants of acne include acne fulminans (acne maligna), acne neonatorum, occupational acne, drug-induced acne, acne necrotica, hyperandrogen acne (including polycystic ovarian syndromes), acne inversa, tropical acne, acne mechanica, excoriated acne, acne aestivalis, acne cosmetic, and acne rosacea (rosacea).

Clinical Presentation

Acne is considered a disease of the pilosebaceous unit,⁷ where excess sebum production and alteration of keratinisation contribute to follicular blockage.⁸ Acne lesions most often occur on the face (99% of cases),⁴ with the back and chest affected to a lesser extent.⁹ This reflects the distribution of pilosebaceous units that are in greater concentration on the face, back and chest.² The three types of acne lesions are described in Table 1.1.^4,10

Acne lesions in preadolescents (children aged 7 to 12 years, or before menarche in girls) usually present as comedones on the forehead and centre of the face, and inflammatory lesions are uncommon.¹¹ Lesions are usually triggered by androgen production in children⁴ as a result of adrenarche and testicular/ovarian maturation.³

Acne develops from a subclinical microcomedo (a blockage of the follicular opening) into closed or open comedones.⁴ In moderate to severe cases, an inflammatory response leads to papules, pustules and nodules (cysts) which vary in size.⁴ Conglobate acne is a rare form of acne,¹² with extensive inflammatory nodular lesions which may coalesce to form sinus tracts.⁴

Acne vulgaris is categorised according to presentation. Many classification and grading systems exist,¹³ but no consensus has been reached on the best or most appropriate system for clinical practice or research.^1,4 Acne vulgaris is usually categorised according to predominant lesion type: (1) comedonal, (2) mild-moderate papulopustular acne, (3) severe papulopustular acne or moderate nodular acne, and (4) severe nodular acne or conglobate acne.^4,12 These categories may overlap somewhat, with a patient with mild-moderate papulopustular acne also presenting with non-inflammatory comedones. Regardless, categorisation can assist with identifying appropriate pharmacological treatments.

Table 1.1 Types of Acne Lesions

Lesion Type	Subtype	Description
Comedonal	Closed (whitehead)	Small lesions containing keratin, sebum and bacteria, with barely visible follicular opening
	Open (blackhead)	Small lesions containing keratin, sebum and bacteria, with visible follicular opening and mass of dark-coloured skin debris
Papulopustular	Papules	Well-circumscribed inflammatory lesions with non-fluid filled swelling
	Pustules	Inflammatory lesions containing visible purulent material
Nodular	Nodules/cysts	Solid, raised, inflamed lesions varying in size and depth of tissue involvement

Many patients experience multiple recurrences of acne lesions over several years.⁴ Despite this, acne is self-limiting in 60% of cases.⁸ For some, acne vulgaris will continue into adulthood,¹ and the reasons why acne persists are not clear.² As such, there is no way to predict which patient is likely to suffer from adult acne.⁸

Acne scarring and pigmentation can be a permanent negative outcome of acne,⁸ and present to some extent in up to 95% of acne sufferers.¹⁴ In addition to physical scars, acne vulgaris can impact on psychological well-being.¹² The impact of acne severity on quality of life is highly individual — patients with mild disease may report significant impact on quality of life, while others with more severe disease may experience lower burden.¹⁵ Guidelines recommend assessing a patient’s quality of life when considering therapeutic options.⁴

Epidemiology

Estimates of acne prevalence vary according to the approach used.⁴ Acne vulgaris is one of the most common skin conditions, affecting more than 645 million people globally (9.4%).⁶ The prevalence of acne in general population surveys ranges from 0.1% in Tanzania to 8.9% in Cameroon.¹⁶ Data from a large Chinese study of over 17,000 adolescents and adults estimated prevalence at 8.1%.¹⁷

Reported prevalence was higher in people from Germany, with acne present in 26.8% of the 896 participants.¹⁸ Acne was reported to peak between 14 and 29 years of age.¹⁸ Acne prevalence is lower in rural and non-westernised countries.¹⁹ Two populations have been identified which have no cases of acne: the Kitavan people of the Trobriand Islands near Papua New Guinea, and people from Aché in Paraguay.¹⁹

In adolescents, prevalence has been reported to be as high as 93.2%.¹⁶ High prevalence has been reported in Brazilian adolescents (96.0%),²⁰ Australian adolescents (93.3%)²¹ and Chinese late adolescents (81.5%).¹⁵ Acne vulgaris prevalence is lower in Malaysian students (67.5%),²² Serbian secondary school students (51.8%),²³ and Egyptian secondary school students (54.2%).²⁴ Peak preval...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Disclaimer
• Foreword
• Purpose of This Book
• Authors and Contributors
• Members of Advisory Committee and Panel
• Professor Charlie Changli Xue
• Professor Chuanjian Lu
• Acknowledgments
• Contents
• List of Figures
• List of Tables
• 1. Introduction to Acne Vulgaris
• 2. Acne Vulgaris in Chinese Medicine
• 3. Classical Chinese Medicine Literature
• 4. Methods for Evaluating Clinical Evidence
• 5. Clinical Evidence for Chinese Herbal Medicine
• 6. Pharmacological Actions of Frequently Used Herbs
• 7. Clinical Evidence for Acupuncture and Related Therapies
• 8. Clinical Evidence for Combination Therapies
• 9. Summary and Conclusions
• Glossary
• Index