Acne vulgaris (2)
Acne vulgaris is considered to be common in young males. But from our statistic data, it can be seen that in 202 cases of acne vulgaris, female cases reach the amount of 143, occupying 70%. There are only 59 male cases, amounting 30%, contrary to the usual conception. The reason is that in the human body, most of the endocrine hormones are metabolized in the liver and in chronic hepatitis patients, the biological effect of the hormones varies according to the disease condition of the liver and there may also be imbalance between hormones. Therefore, dysfunction of the liver may cause endocrine disorder. In clinical practice, it is possible to know the abnormal metabolism of hormones on the basis of the nutritional and developmental conditions, as well as the clinical symptoms and signs of the patient. Repeated and obstinate acne is a typical picture of abnormal male hormone metabolism causing chronic inflammation inside and around the sebaceous glands. In chronic hepatitits patients with acne, the degree of endocrine abnormality is also measured by his (her) nutrition, development and body build as explain below:
- The first situation is that children with chronic hepatitis are liable to have hepatic malnutrition and anemia. Therefore they are weak and vulnerable to disease; they are pale and lean, poorly developed, short in statue, underweight and give the appearance of dwarfism. But in female chronic hepatitis patients, if deficiency is confined to female sex hormone, their stature would belong to the long thin type with long limbs, abundant hair, underdeveloped secondary sexual characteristics, menstrual disorders and dysmenorrhea.
- The second situation is that chronic hepatitis patients are liable to have nutritional disorders, hypoalbuminemia or chronic anemia due to various causes (hemorrhoids, menstruation and epistaxis (鼻出血), or following operation or postpartum hemorrhage such as insufficient blood supply to the pituitary leading to endocrine disorder, hepatic edema and excessive retention of adipose tissue. The latter causes marked increase of body weight and secondary obesity.
- The third situation is hyperfunction of the adrenal cortex. This disease includes adrenogenital abnormoality (腎上腺性徵異常) and hypercorticalism (腎上腺皮質功能亢進). The clinical features of the former are masculinization, hypertension and multiple acne formation. Female patients present pseudohermaphroditism (假兩性畸形) or post-adolescent masculinization. Male patients show sexual precocity after 4-5 years of age and macrophallus (巨陰莖). The clinical features of the latter are obesity and hypertension, full moon face, buffalo like concentric obesity, lean limbs, excessive hairs over face, back and extremities. Masculinzation occurs in females, showing alteration of pitch, slow growth, short stature, weakness of muscles, backache and multiple acne.
It should be noted that children suffering from chronic hepatitis since infancy may present symptoms of dermal wetness-heat and respiratory system illnesses such as asthma. They tend to take long time hormonal drugs and hence, the same clinical symptoms of hyperadrenocorticism (腎上腺皮質功能亢進) may arise. Therefore, it is not strange that in our statistic data, females with abnormal liver percussion dullness had a higher incidence of acne.
Introduction of cases
Case 8
Ju (code number 2111), female, age 27 years.
Her first visit was on April 2000 and complained of excessive sebaceous gland secretion and hairiness especially over the forearm, axilla and legs, requiring shaving 2-3 times a week. There were many blackheads forming popular eruptions over the head, face and back of the trunk. These acne relapsed repeatedly and were treated by dermatologists for may times with anti-inflammatory drugs and vitamin A but it did not show apparent effectiveness. In addition, she had frequent episodes of gastric illness, hoarseness of voice due to exogenous disease, coughing, constipation, irregular menstruation and dysmenorrhea.
Physical examination: poor nourishment and development, height 152 cm, body weight 43.18kg, constitution index 18.69, may acne scars over skin of face and back, multiple acne on right cheek, tongue enlarged with faint teeth prints, marked anomaly of hypochondria, percussion tenderness over hepatic region, hepatomegaly of 3cm, venous varicosity of both limbs. Clinical diagnosis was chronic hepatitis with TCM classification of “liver stagnation and lung dryness form”, “wetness-heat vaporization form” and “blockage of channels and blood stasis form” and also associated with endocrine disorder, acne vulgaris and inferior vena cava hypertension.
After three parcels of TCM drugs, the liver was normal, and continuation of TCM treatment lead to gradual disappearance of clinical symptoms. At the administration of 18 parcels of TCM drug, menstruation occurred. The menstrual blood decreased significantly and was bright red without clots. The stools were dry and tenesmus was present. Acne occurred on the neck at a later time but they disappeared during the TCM treatment. A total 54 parcels of TCM drugs were taken and the course of therapy stopped after achievement of clinical cure.
Case 9
Kwok (code number 448), female, age 16 years.
She first visited the clinic on April, 1998 with the complaint of repeated acne over the face, poor appetite recurrent morning nausea and vomiting for several years. The illness was associated with wetness-heat abdominal pain, bowl movements right after meal and alternation of diarrhea with constipation. Menarche appeared at 10 years of age, and she had frequent dysmenorrhea and blood clots.
Physical examination: thin constitution, underdeveloped, anemic, multiple acne on face, tongue enlarged with teeth prints, marked percussion tenderness over hepatic region, hepatomegaly of 3cm. She was diagnosed as chronic hepatitis with symptoms belonging to the following 3 forms: wetness-heat vaporization, deficiency of qi and blood, blockage of channels and blood stasis and with the association of anemia, endocrine disorder, acne vulgaris, irregular menstruation and dysmenorrhea.
After 3 parcels of TCM drugs, the liver was normal. The menses came in time, bright in color and without clots, and dysmenorrhea was transient. Systemic TCM therapy was given in the following 6 weeks, during that time she felt well, the acne disappeared menstruation became normal and without pain. She noticed that there was an impressive development of the breasts.
香港肝炎中藥製劑研究中心
主任醫師 黃國雄
2001年11月6日