| ObjectivesThe purpose of this study is to attempt to explore the influence mechanism of the Chiense medicine comprehensive therapy on the facial skin physiology of the patients with acne vulgaris from the perspective of the common factors correlated with facial skin physiology and acne.In this study, the Chinese medical comprehensive therapy is based on the multi-year clinical experiences on acne treatment by Dr. Fan. The therapy, which offers a full-range strategy mainly adapted for the facial inflammatory lesions in female patients with acne vulgaris, consists of a herbal formula, a topical herbal preparation, salvia point injection, and liquid nitrogen vapour freezing method, capable of eliminating excessive Yang in the exterior, superior part of the human body and invigorating deficient Yin in the interior, inferior part of the human body. This study approach is to observe the numerical fluctuation of skin physiological parameters, i.e. SC hydration, sebum content and skin surface pH, before and after the treatment, as well as the questionnaire collection of influence factors for elucidating the mechanism of action of the Fan's therapy on acne vulgaris.MethodsThe study discussed the risk factors for acne by means of the epidemiological analysis of current situation in both of the groups and the influence of the Fan's therapy on the common factors of acne and the facial skin physiology by means of the before-after study in the acne group. A total of 64 subjects, 48 patients with mild to moderate acne vulgaris in the acne group and 16 health volunteers in the control group, aged from 18 to 40 years, were enrolled for this study. There was no significance, P=0.272>0.05, in age between the acne group, which the average age was 25.35±3.14 years old, and the control group, which the average age 24.63±1.89 years old. In the study, all of them were arranged for the facial skin physiological examination and for filling out the questionnaire surveys, and the data correlated with the facial skin physiology and predisposing factors for acne would be collected by this pathway. When testing the facial skin physiology, the supine posture was adopted, and the four sites, i. e. the midpoint of the forehead, Ju Liao, Cheng Jiang, Jia Che, respectively, were taken in the hydration test, the two sites, i. e. the midpoint of the forehead, Ju Liao, in the sebum test, the one site, i. e. the midpoint of the forehead, in the pH test. Besides, the people in the acne group would undergo the Fan's therapy for four weeks, and, at the end of the treatment, once again receive the facial skin physiological examination for observing if the facial skin physiological parameters would change before and after treatment. Finally, assessment of efficacy of the Fan's therapy in the ance group would be completed for making sure which problem to be solved on earth.In this research, non-parametric statistics-Spearman's rank order correlation was first used to determine which condition, including. sweet, spicy or oily foods, acne, thirsty status, stool & urine status, hours of exposure to heat, sleep quality, mental stress, menstrual status, acne severity, could be main factor of the facial skin physiology. Then the difference analysis of the survey items between the acne group and the controlled group would be used for screening out the possible factors, which could induce acne, and the non-conditional logistic regression was further used to identify the risk factors of acne vulgaris. Comparing two sets of factors, which affect the facial skin physiology and acne, respectively, to identify the common factors, the study is to assess if the common factors would change before and after the treatment of the Fan's therapy.In the difference between two groups, the measurement data, e.g. SC hydration, sebum content and skin surface pH, symbolize as Mean±Standard Deviation (M±SD). Independent-samples t-test was used as the data of two different groups met the normal distribution, chi-square test as the categorical data, Mann-Whitney U test as the others. On the other hand, paired-samples t-test was used in the acne group as the factors belong to the measurement data in the differences between before and after treatment; on the contrary, Wilcoxon signed rank test was used as the ranked data. The significance level was set as P<0.05 for all tests.ResultIn the correlation test of the facial skin physiological parameters, there was a slight, negative correlation between SC hydration and the frequency of night urination(r=-0.253, P<0.05) and the hours of exposure to heat (r =-0.248, P<0.05), respectively. They revealed that the more frequency of night urination or hours of exposure to heat they displayed, the lower SC hydration their face could show. There was a moderate, positive correlation between sebum content and thirsty level (r=0.466, P<0.01) and sleep quality disorder (r=0.337, P<0.01), respectively. They suggested that the more problems with the thirsty level and the sleep quality they had, the more sebum content their face could display. Skin surface pH was moderately, positively correlated with abnormal menstrual periods (r=0.370,P<0.01), and was slightly, positively correlated with abnormal menstrual flow (r=0.259, P <0.05). They showed that they could display higher skin surface pH, when they had the tendency for longer or irregular menstrual periods or decrease menstrual flow. Among the three physiological parameters, sebum was the only one, moderately positively correlated with the number of acne lesions (r 0.464, P<0.01).It suggested that sebum content could determine the existence of acne vulgaris and the cut point of acne severity, therefore sebum content is the most representative one of the facial skin physiological parameters for the existence of acne vulgaris (OR=1.34 (95%CI; 1.12～1.61), P<0.01).Among the factors investigated, thirsty level-d (desire for drinking, urgency for drinking=1, normal, no desire for drinking=0; OR=24.55 (95 %CI; 1.75～345.17), P<0.05). sleep quality disorder (OR=12.19 (95%CI; 1.89～78.75), P<0.01) were the most representative ones of various complains for the existence of acne vulgaris, and both of them simultaneously were moderately, positively correlated with sebum content. The two complains, therefore, were the common factors of acne vulgaris and sebum content.The study on the efficacy of the Fan's therapy in the female patients with mild to moderate acne over a course of four weeks showed that 11 cases were cured,13 cases markedly effective,10 cases effective,2 cases ineffective, and the total effective rate was 94.4% in PPA or 70.8% in ITT. In the difference comparison of the facial skin physiological parameters between before and after treatment, SC hydration rose from 59.28±8.70 before the treatment to 61.94±8.03 after the treatment, t(35)=4.961, P<0.001, the average increment of SC hydration was 2.67 units,95%Ci between 1.58 and 3.76. Sebum content declined from 25.15±5.47 before the treatment to 22.46±3.72 after the treatment, t(35)=-2.440,P<0.05, the average decrement of sebum content was 1.69 units,95%CI between -3.09 and -0.28. Skin surface pH also declined from 5.43±0.20 before the treatment to 5.41±0.19, t(35)= -1.464, P>0.05s, with no statistically significance in the difference between before and after treatment.There was no significant correlation between the efficacy and the improvement level of facial skin physiology, regardless of SC hydration, sebum content or skin surface pH (P>0.05)In the difference comparison of the common factors between before and after treatment, there was a strong improvement in the thirsty level, z=-4.379, P <0.001, and a moderate improvement in the sleep quality disorder, z=-3.162, P<0.01.ConclusionThe Chinese medicine comprehensive therapy could correct the imbalance between Yin and Yang in the zang-fu organs of the human bodies with acne vulgaris, and decrease the symptoms of frequent thirst and difficulty sleeping due to Yin deficiency with internal heat and Yang deficiency with floating. The SC hydration and sebum content in the patients with acne vulgaris could be also improved by the Chinese medicine comprehensive therapy. |
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