Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris
INTRODUCTION
引言
英文原文
Acne vulgaris is a common cutaneous disorder characterized by chronic or recurrent development of papules, pustules, or nodules on the face, neck, trunk, or proximal upper extremities. The pathogenesis of acne vulgaris involves the interaction of multiple factors that result in the formation of comedones and the development of inflammation.
对应中文
寻常痤疮是⼀种常⻅的⽪肤病，表现为慢性或复发性丘疹、脓疱或结节，累及⾯部、颈部、躯⼲或上肢近端。寻常痤疮的发病机制涉及多种特定因素相互作⽤，这些因素可导致粉刺形成和发炎。
英文原文
Acne vulgaris is most frequent among adolescents and young adults but is not limited to these ages. The severity of skin involvement varies from minimal involvement to disfiguring and highly inflammatory presentations. Hyperpigmentation, scarring, and negative psychosocial effects are common complications.
对应中文
寻常痤疮最常⻅于⻘少年和年轻成⼈，但并不限于这些年龄段。⽪损程度不⼀，从轻微受累到损容性和显著炎性表现不等。常⻅的并发症为⾊素沉着过度、瘢痕形成和社会⼼理不良影响。
EPIDEMIOLOGY
流⾏病学
英文原文
Acne vulgaris is common and occurs most frequently in adolescents and young adults. Estimates of the prevalence of acne vulgaris in adolescents range from 35 to over 90 percent.
对应中文
寻常痤疮是⼀种常⻅病，好发于⻘少年和年轻成⼈。据估计，⻘少年寻常痤疮的患病率为35%⾄90%以上。
英文原文
Acne often begins in the preadolescent period (ages 7 to 12 years) and resolves in the third decade, but may persist into adulthood or develop de novo in adulthood. Adolescent acne exhibits a male predominance; in contrast, postadolescent acne predominantly affects women.
对应中文
痤疮发病通常始于⻘春期前(7-12岁)并在20多岁消退，但也可能持续⾄成年期或在成年期新发。⻘春期痤疮主要累及男性，⽽⻘春期后痤疮主要累及⼥性。
英文原文
The prevalence of acne decreases with increasing age. A survey of over 1000 adults in the United States found the following rates of self-reported acne in men and women:
- 20 to 29 years: 43 and 51 percent, respectively
- 30 to 39 years: 20 and 35 percent, respectively
- 40 to 49 years: 12 and 26 percent, respectively
- Ages 50 and older: 7 and 15 percent, respectively
对应中文
痤疮患病率随年龄增⻓⽽降低。美国⼀项调查在1000余例成⼈中发现，男性和⼥性⾃述痤疮发⽣率如下：
1. 20-29岁：分别为43%和51%
2. 30-39岁：分别为20%和35%
3. 40-49岁：分别为12%和26%
4. ≥50岁：分别为7%和15%
英文原文
Of note, studies using a clinical examination typically find a lower prevalence than survey studies that document self-reported acne.
对应中文
需注意，相⽐有记录证实⾃述痤疮的调查研究，采⽤临床检查的研究显示痤疮患病率通常更低。
英文原文
Infantile acne, a variant of acne vulgaris, may begin in infancy. Mid-childhood acne (acne that develop in children ages one to six years) is uncommon and may be an indicator of an underlying condition.
对应中文
婴⼉期可能出现婴⼉痤疮，这是寻常痤疮的亚型。⼉童期中期痤疮(⻅于1-6岁⼉童)并不常⻅，可能提示存在基础疾病。
PATHOGENESIS
发病机制
英文原文
Acne vulgaris is an inflammatory disorder of the pilosebaceous unit, which is comprised of the hair follicle and sebaceous gland. The pathogenesis of acne involves a complex interplay of host factors, such as androgen-mediated stimulation of sebaceous glands, dysbiosis within the microbiome of the pilosebaceous follicle, and innate and cellular immune responses, and may be influenced by factors such as genetics and, possibly, diet.
对应中文
寻常痤疮是⼀种累及⽑囊⽪脂腺单位(由⽑囊和⽪脂腺组成)的炎性疾病。痤疮发病机制涉及宿主因素的复杂相互作⽤，例如雄激素介导的⽪脂腺刺激、⽑囊⽪脂腺的微⽣物群失调、固有和细胞免疫应答，还可受到遗传、甚⾄饮⻝等因素的影响。
英文原文
Lesion development—The microcomedo (a small, hyperkeratotic plug composed of corneocytes in the lower portion of the follicular infundibulum; plural “microcomedones”) is considered the precursor for the clinical lesions of acne vulgaris, which include closed comedones (often colloquially called “whiteheads”), open comedones (often colloquially called “blackheads”), and inflammatory papules, pustules, and nodules. The process by which microcomedones develop and evolve into other acne lesions remains to be elucidated but may involve interaction of four main pathogenic factors:
- Follicular hyperkeratinization
- Increased sebum production by sebaceous glands
- Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes), an anaerobic diphtheroid that is a normal component of skin flora
- Inflammation
对应中文
⽪损形成—微⼩粉刺是⼀种较⼩的过度⻆化栓，由⽑囊漏⽃部下段的⻆化细胞构成，⽬前认为它是寻常痤疮临床⽪损的前期病变；此类临床⽪损包括闭合性粉刺(通常俗称“⽩头”)、开放性粉刺(通常俗称“⿊头”)，以及炎性丘疹、脓疱和结节。微⼩粉刺形成及进展为其他痤疮⽪损的过程仍不明确，但可能涉及4种主要致病因素的相互作⽤：
1. ⽑囊⻆化过度
2. ⽪脂腺的⽪脂⽣成增加
3. 痤疮丙酸杆菌(Cutibacterium acnes，旧称Propionibacterium acnes)，这是⼀种属于正常⽪肤菌群的厌氧性类⽩喉菌
4. 炎症
Sebaceous glands and the role of androgens
⽪脂腺和雄激素作⽤
英文原文
Androgens contribute to the development of acne by stimulating the growth and secretory function of sebaceous glands, leading to increased sebum production. Increased sebum production is thought to provide a growth medium for C. acnes. C. acnes utilizes triglycerides in sebum as a nutrient source by hydrolyzing them into free fatty acids and glycerol. The anaerobic, lipid-rich environment in microcomedos allows these bacteria to thrive.
对应中文
雄激素通过刺激⽪脂腺的⽣⻓和分泌功能，导致⽪脂⽣成增加，进⽽促发痤疮。⽪脂⽣成增加为痤疮丙酸杆菌提供了⽣⻓基质。痤疮丙酸杆菌以⽪脂中的⽢油三酯为营养来源，将其⽔解为游离脂肪酸和⽢油。微⼩粉刺中富含脂质的厌氧环境有利于这些细菌⽣⻓。
英文原文
Clinical observations support the importance of androgens for the development of acne. Although the majority of patients with acne have normal androgen levels, androgen excess due to conditions such as polycystic ovarian syndrome, congenital adrenal hyperplasia, or adrenal or ovarian tumors can cause acne. In addition, acne typically does not develop prior to adrenarche (the prepubertal period in which levels of DHEAS rise), with the exception of infantile acne, a condition seen in infants that results from excess androgen production by immature adrenal glands or gonads. Moreover, men with androgen insensitivity do not produce sebum and do not develop acne.
对应中文
临床观察结果⽀持雄激素对痤疮发病具有重要作⽤。⼤多数痤疮患者的雄激素⽔平正常，但某些疾病引起雄激素过多时可能出现痤疮，例如多囊卵巢综合征、先天性肾上腺⽪质增⽣症、肾上腺/卵巢肿瘤。此外，痤疮发病通常不会早于肾上腺功能初现(⻘春期前DHEAS⽔平升⾼的时期)，但婴⼉痤疮例外，它⻅于婴⼉，原因是未成熟的肾上腺或性腺⽣成雄激素过多。⽽且，雄激素不敏感的男性不会产⽣⽪脂，也不会发⽣痤疮。
Cutibacterium acnes and inflammatio
痤疮丙酸杆菌和炎症
英文原文
The ability of C. acnes, the prominent commensal bacteria within the microbiome of pilosebaceous follicles, to activate innate and adaptive immune responses may contribute to the inflammatory response observed in acne. Sequencing of the C. acnes genome has led to the identification of bacterial properties that may contribute to inflammation and virulence. Critical factors may include virulence-associated genes in certain C. acnes strains, C. acnes production of enzymes that promote degradation of the follicular wall and follicular rupture, and C. acnes surface proteins that trigger humoral and cell-mediated immune responses.
对应中文
痤疮丙酸杆菌是⽑囊⽪脂腺微⽣物群中主要的共⽣菌，能够激活固有和适应性免疫应答，这会促成痤疮中的炎症反应。痤疮丙酸杆菌基因组测序发现了⼀些可能促成炎症和毒⼒的细菌特性。关键因素可能包括：某些痤疮丙酸杆菌菌株中的毒⼒相关基因，痤疮丙酸杆菌产⽣促使⽑囊壁分解和⽑囊破坏的酶，痤疮丙酸杆菌表⾯蛋⽩诱发体液和细胞介导的免疫应答。
Genetics
遗传
英文原文
Individuals with close family members with acne are at increased risk for the disorder, supporting a genetic component to the disease. Case-control studies have demonstrated a more than threefold risk among individuals with affected first-degree family members. A large twin study of monozygotic and dizygotic twins also supported the heritable nature of acne. An important role for genetics in mild acne is less certain due to the almost ubiquitous occurrence in young adolescents.
对应中文
近亲中有痤疮患者时，个体发⽣痤疮的⻛险增加，这提示该病存在遗传因素。病例对照研究表明，⼀级亲属受累时，个体发病⻛险增⾄3倍以上。⼀项针对单卵双胎和双卵双胎的⼤型双⽣⼦研究也⽀持痤疮具有遗传性。轻度痤疮在低龄⻘少年中⼏乎普遍存在，因此遗传因素对其重要作⽤还不太明确。
ASSOCIATED FACTORS
相关因素
英文原文
Skin trauma — Repetitive mechanical trauma caused by scrubbing affected skin with soaps, detergents, astringents, or other agents may worsen acne by rupturing comedones, promoting the development of inflammatory lesions.
对应中文
⽪肤创伤—使⽤肥皂、去垢剂、收敛剂或其他制剂擦洗患处⽪肤时，造成的反复机械创伤可能使粉刺破裂⽽加重病情，从⽽促发炎性⽪损。
英文原文
Diet — The role of diet in acne is an evolving concept. Several studies suggest an association between acne and increased milk consumption and high glycemic load diets. Increased levels of insulin-like growth factor (IGF) related to dairy consumption or high glycemic load diets and natural hormonal components of milk or other bioactive molecules in milk are hypothesized to play a role.
对应中文
饮⻝—饮⻝在痤疮中的作⽤尚⽆定论。⼏项研究提示，痤疮与奶类摄⼊增多和⾼⾎糖负荷饮⻝有关。推测的作⽤机制包括：与奶类摄⼊或⾼⾎糖负荷饮⻝相关的胰岛素样⽣⻓因⼦(IGF)增加、奶类所含天然激素成分以及奶类中的其他⽣物活性分⼦。
英文原文
Stress — Psychologic stress is often proposed as a potential exacerbating factor for acne. Some studies have found an association between stress and increased acne severity.
A prospective cohort study in 94 secondary school students compared acne severity and sebum production at times of high stress (midterm examinations) and low stress (summer holidays) [47]. Sebum production did not appear to be related to stress, but increased acne severity, as assessed by an examiner blinded to the hypothesis of the study, did appear to be associated with stress, particularly in boys.
Similarly, a study of 22 university students found that greater acne severity appeared to correlate with increased perceived stress around the time of school examinations.
对应中文
压⼒—通常认为⼼理压⼒可能会加重痤疮。⼀些研究发现⼼理压⼒与痤疮加重有关。
⼀项纳⼊94例中学⽣的前瞻性队列研究⽐较了在压⼒⼤(期中考试)和压⼒⼩(暑假)时，痤疮的严重程度和⽪脂的产⽣情况。结果发现⽪脂⽣成与压⼒⽆关，但痤疮加重确实与压⼒有关(由⼀名对研究假设不知情的检查者评估严重程度)，尤其是在男孩中。
同样，⼀项针对22例⼤学⽣的研究发现，痤疮加重与考试期间的感知压⼒增加有关。
英文原文
Insulin resistance — Insulin resistance may play a role in acne. Insulin resistance may stimulate increased androgen production and is associated with increased serum levels of insulin-like growth factor-1 (IGF-1), a finding linked to increased facial sebum excretion.
There is a normal rise in insulin resistance and IGF-1 during puberty, the typical time of onset of acne. In addition, some studies have found higher serum IGF-1 levels in women with postadolescent acne than in women without acne or a positive correlation between serum IGF-1 levels and acne lesion counts in women. Moreover, a cross-sectional study of 100 postadolescent males with acne found a higher prevalence of insulin resistance in males with acne than in 100 age-matched controls (22 versus 11 percent).
对应中文
胰岛素抵抗—胰岛素抵抗可能在痤疮中起了⼀定作⽤。胰岛素抵抗可能会刺激产⽣更多的雄激素， 并会使⾎清IGF-1⽔平升⾼，⽽⾎清IGF-1⽔平升⾼与⾯部⽪脂排泄增加相关。
⻘春期的胰岛素抵抗和IGF-1⽔平都会出现正常的升⾼，⽽⻘春期正是发⽣痤疮的典型时期。此外，⼀些研究发现，⼥性⻘春期后痤疮患者的⾎清IGF-1⽔平⽐⽆痤疮的⼥性⾼，或者⼥性患者的⾎清IGF-1⽔平与痤疮⽪损数量之间呈正相关。此外，⼀项关于100例男性⻘春期后痤疮患者的横断⾯研究发现，相⽐于100例年龄匹配的对照者，男性痤疮患者的胰岛素抵抗患病率更⾼(22% vs11%)。
英文原文
Body mass index — Studies evaluating the relationship between acne vulgaris and weight have yielded varied results, resulting in uncertainty regarding the relationship between these conditions. One of the largest studies, a population-based study of over 600,000 Israeli adolescents and young adults (mean age 19 years), found an inverse relationship between excess weight and acne. As body mass index (BMI) increased, risk for acne progressively decreased, with diagnoses of acne in 20 and 16 percent of underweight (BMI <18.5) males and females, respectively, compared with 13 and 11 percent of severely obese (BMI >35) males and females, respectively. The adjusted OR for acne in severely obese individuals was 0.53 (95% CI 0.42- 0.64) for males and 0.5 (95% CI 0.37-0.62) for females. Individuals with a BMI of 18.5 to 22 were defined as the reference group.
In contrast, a case-control study of approximately 200 adolescents and young adults (ages 10 to 24) with moderate to severe acne and approximately 350 controls with no acne or mild acne found a correlation between low BMI and a reduced risk for moderate to severe acne that was most evident among males. In addition, a cross-sectional, survey-based study of approximately 3600 young adults (ages 18 and 19) in Norway found an association between rising BMI and increased risk for acne among females.
对应中文
BMI—数项研究评估了寻常痤疮与体重的关系，但结果不⼀，因此不能确定两者的关系。⼀项⼈群研究是最⼤型研究之⼀，纳⼊了600,000多例以⾊列⻘少年和年轻成⼈(平均19岁)， 发现超重与痤疮呈负相关。随着BMI增⾼，痤疮的⻛险逐渐降低，体重低下者(BMI<18.5)中的男⼥痤疮发⽣率分别为20%和16%，⽽在重度肥胖者(BMI>35)中分别为13%和11%[55]。重度肥胖者中痤疮的调整优势⽐：男性为0.53(95%CI 0.42-0.64)，⼥性为0.5(95%CI 0.37-0.62)。BMI介于18.5-22的个体作为参照组。
⼀项病例对照研究纳⼊了约200例中⾄重度痤疮⻘少年和年轻成⼈(10-24岁)，以及约350例⽆痤疮或 有轻度痤疮的对照者，发现低BMI与中⾄重度痤疮⻛险降低相关，其中在男性中关联最为明显。此外，⼀项基于调查的挪威横断⾯研究纳⼊约3600例18岁或19岁的年轻成⼈，发现在⼥性中BMI增加与痤疮⻛险增加相关。
CLINICAL MANIFESTATIONS
临床表现
英文原文
Classic features — The typical distribution of acne vulgaris correlates with areas of the body with large, hormonally responsive sebaceous glands, including the face, neck, chest, upper back, and upper arms. One or more types of active lesions may be present, including:
1. Closed comedones – Noninflammatory; <5 mm; dome-shaped; smooth; skin-colored, whitish, or grayish papules
2. Open comedones – Noninflammatory, <5 mm papules with a central, dilated, follicular orifice containing gray, brown, or black, keratotic material
3. Papulopustular acne – Inflamed, relatively superficial papules and pustules, typically <5 mm in diameter
4. Nodular acne – Deep-seated, inflamed, often tender, large papules (≥0.5 mm) or nodules (≥1 cm)
对应中文
典型特征—寻常痤疮⼀般发⽣在有较⼤的激素敏感性⽪脂腺部位，包括⾯部、颈部、胸部、上背部和上臂。患者可能有⼀种或多种活动性⽪损，包括：
1. 闭合性粉刺–直径<5mm、圆顶状、⾮炎性平滑丘疹，呈肤⾊、发⽩或发灰
2. 开放性粉刺–直径<5mm的⾮炎性丘疹，中央有扩张的⽑囊⼝，内含灰⾊、棕⾊或⿊⾊的⻆化物质
3. 丘疹脓疱型痤疮–相对浅表的炎性丘疹和脓疱，直径通常<5mm
4. 结节性痤疮–累及⽪肤深部的炎性⼤丘疹(≥0.5mm)或结节(≥1cm)，常有压痛
COMPLICATIONS
并发症
英文原文
Psychologic effects — Acne vulgaris can contribute to significant psychologic morbidity and, rarely, to mortality due to suicide. Embarrassment, anxiety, and lowered self-esteem related to the appearance of affected skin or disfiguring scars can impact the social lives and employment of affected individuals.
对应中文
⼼理影响—寻常痤疮可促发严重的⼼理并发症，少数情况下还会导致⾃杀身亡。⽪肤受累或损容性瘢痕会使患者出现尴尬、焦虑和低⾃尊，从⽽影响社会⽣活及就业。
英文原文
Gram-negative folliculitis—Patients with acne vulgaris who have been treated with long-term systemic antibiotics (usually tetracyclines) may develop gram-negative folliculitis. These patients exhibit an initial response to the oral antibiotic, followed by apparent resistance to the treatment and worsening of acne.
Inflammatory papules, pustules, and nodules typically appear on perinasal skin and the central face. A culture of lesions will yield gram-negative organisms, such as Enterobacter, Klebsiella,Pseudomonas, Proteus, or Escherichia species.
对应中文
⾰兰阴性⽑囊炎—⻓期全身性使⽤抗⽣素(通常是四环素类)治疗寻常痤疮可能会发⽣⾰兰阴性⽑囊炎。这些患者表现出对⼝服抗⽣素的初步反应后，会出现对治疗的明显耐药并且痤疮加剧。
炎性丘疹、脓疱和结节通常出现在⿐周⽪肤和⾯中部。⽪损组织培养将发现⾰兰阴性菌，例如肠杆菌属、克雷伯菌属、假单胞菌属、变形杆菌属或埃希菌属。
英文原文
Acne fulminans — Acne fulminans is a disorder characterized by an acute eruption of large, inflammatory nodules and friable plaques with erosions, ulcers, and hemorrhagic crusts. This rare condition primarily affects adolescent males with pre-existing acne vulgaris. Acne fulminans may be triggered by isotretinoin therapy or may occur spontaneously. The pathogenesis is unclear. Lesions usually involve the trunk but may be present elsewhere.
Acne fulminans may occur in association with systemic symptoms (eg, fever, malaise, bone pain, arthralgias), erythema nodosum, and laboratory and radiologic abnormalities. Potential laboratory abnormalities include leukocytosis, anemia, and an elevated erythrocyte sedimentation rate or C-reactive protein. Radiographs may reveal osteolytic lesions of the bone, particularly in the sternum, clavicles, sacroiliac joints, or hips.
对应中文
暴发性痤疮—暴发性痤疮是⼀种以⼤型炎性结节和易碎性斑块急性发作为特征的疾病，伴有糜烂、溃疡和⾎痂。这种罕⻅疾病主要⻅于既已存在寻常痤疮的⻘春期男性。暴发性痤疮可由异维A酸治疗诱发，也可⾃发发⽣，其病理机制仍不明。病灶通常累及躯⼲，但也可能发⽣在其他部。
暴发性痤疮可能会伴有全身性症状(如发热、不适、⻣痛及关节痛)、结节性红斑以及实验室和影像学检查异常。可能出现的实验室检查异常包括⽩细胞增多、贫⾎、红细胞沉降率或C反应蛋⽩升⾼。X光检查可发现⻣骼的溶⻣性改变，尤其是胸⻣、锁⻣、骶髂关节或髋关节。
英文原文
Solid facial edema — Solid facial edema (Morbihan’s disease) is a rare complication of acne that presents as facial soft tissue edema and erythema. The condition may wax and wane in severity but usually does not spontaneously resolve without treatment. Improvement with isotretinoin with or without ketotifen, systemic glucocorticoids, or clofazimine has been reported.
对应中文
实性⾯部⽔肿—实性⾯部⽔肿是⼀种罕⻅的痤疮并发症，表现为⾯部软组织⽔肿和红斑。该病时轻时重，但不治疗⼀般不会⾃愈。已有报告指出单⽤异维A酸或与酮替芬、全身性糖⽪质激素或氯法⻬明联合使⽤都可改善症状。
SUMMARY
总结
英文原文
1. Acne vulgaris is a common skin condition in adolescents and young adults that may also occur at other ages. The clinical manifestations of acne vulgaris vary widely, and the psychologic impact can be significant.
2. Acne vulgaris is a disorder of the pilosebaceous follicles. Follicular hyperkeratinization, sebum production, Cutibacterium acnes, and inflammation are involved in the pathogenesis. The temporal sequence of events leading to the formation of acne lesions is unknown but likely involves both host factors and dysbiosis within the microbiome of the pilosebaceous follicle.
3. Androgens induce sebum production and are an important factor in the development of acne vulgaris. Hyperandrogenism may cause acne, but most patients with acne vulgaris do not have androgen excess.
4. The role of diet in acne vulgaris is an evolving concept. A contributory effect of milk and high glycemic index diets has been proposed, but prospective trials are necessary to clarify the relationship between diet and acne.
5. Typically, acne vulgaris occurs on areas of the body with hormonally sensitive sebaceous glands, including the face, neck, chest, upper back, and upper arms. Open comedones, closed comedones, and inflammatory papules, pustules, or nodules are the characteristic lesions.
6. Common sequelae of acne vulgaris include postinflammatory hyperpigmentation and scarring. Acne fulminans is a serious complication of acne vulgaris that may present as an acute eruption of inflamed nodules and friable plaques and systemic symptoms. Other cutaneous complications of acne vulgaris include gram-negative folliculitis and solid facial edema.
7. The diagnosis of acne vulgaris rests upon the patient’s history and physical examination. Laboratory tests are not necessary for most patients. Patients with additional clinical findings suggestive of hyperandrogenism should be tested for androgen excess.
8. Although acne vulgaris is often easily diagnosed, the differential diagnosis includes a wide variety of skin diseases and acneiform eruptions.
对应中文
- 寻常痤疮是⻘少年和年轻成⼈中的常⻅⽪肤病，也⻅于其他年龄。其临床表现差异很⼤，可造成显著的⼼理影响。
2. 寻常痤疮是⼀种⽑囊⽪脂腺疾病。发病机制涉及⽑囊⻆化过度、⽪脂⽣成、痤疮丙酸杆菌和炎症。各个事件导致痤疮⽪损形成的时间顺序不明，但很可能涉及宿主因素和⽑囊⽪脂腺的微⽣物群失调。 - 雄激素能诱导⽪脂⽣成，是寻常痤疮发病的重要因素。雄激素过多症可能引起痤疮，但⼤多数寻常痤疮患者并不存在雄激素过多。
4. 饮⻝在寻常痤疮中的作⽤尚⽆定论。现已提出奶类和⾼⾎糖指数饮⻝可促发该病，但还需前瞻性试验来证实饮⻝与痤疮之间的关联。 - 寻常痤疮⼀般发⽣在有激素敏感性⽪脂腺的身体部位，包括⾯部、颈部、胸部、上背部和上臂。典型⽪损包括开放性粉刺、闭合性粉刺和炎性丘疹、脓疱或结节。
- 寻常痤疮的常⻅后遗症包括炎症后⾊素沉着过度和瘢痕。暴发性痤疮是寻常痤疮的⼀种严重并发症，可表现为炎性结节和易碎斑块的急性发作以及全身症状。寻常痤疮的其他⽪肤并发症包括⾰兰阴性⽑囊炎和实性⾯部⽔肿。
7. 寻常痤疮的诊断取决于患者的病史和体格检查。⼤多数患者不必进⾏实验室检查。其他临床表现提示雄激素过多症时，应检测是否存在雄激素过量。
8. 虽然寻常痤疮通常较易诊断，但鉴别诊断包括多种⽪肤病和痤疮样⽪疹。
REFERENCES
1.Thiboutot D, Zaenglein AL, Dellavalle RP, Levy ML, Owen C, Ofori AO. Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris. UpToDate. 2021;Mar 15. Available from: https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris