acne vulgaris is not induced by bacteria. Antibiotics is not the first drug in treatment of acne vulgaris. there are no specific criteria for diagnosis.

What do You mean for resistant acne? Resistant To antibiotics or to all therapeutics ?

Resistant acne means not responding to routine line of topical and systemic drugs.

Do you include isotretinoin ? And if included in what doses ?

Is this acne patient like drink whole milk every day?

The acne patients have to avoid some food, such as milk, beef, fried food(fried chichen, French fries, grilled steak. Acne patients have to avoid drinking beer and alcohol.

Just now we don´t have scientific evidence that dietary factors, hygiene and face-washing and sunlight have a great importande in the management of acne.

http://fampra.oxfordjournals.org/content/22/1/62.full.pdf+html

Face washing improves symptoms in acne vulgaris patients. The acne lesion around the lips is related to oil of food. We recommend that patients try to wash off the sebum and grease containing chili and a variety of food debris on the face.

Diet affects significantly pathogenesis of acne. The scientific evidence is increasing with the exploring of pathogenesis of acne.

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0625.2009.00924.x/full

Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2009.04002.x/full

Diet and acne: a review of the evidence

http://ajcn.nutrition.org/content/86/1/107.full.pdf

A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470941/

Ismail NH, Manaf ZA, Azizan NZ. High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatol. 2012 Aug 16;12:13. doi: 10.1186/1471-5945-12-13.

http://www.biomedcentral.com/content/pdf/1471-5945-12-13.pdf

High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study

Dear Hao

What I published was a meta-analysis of a lot of published studies. All we know that there are a lot of studies that says that diet is important and others that say the opposite. So we need to join all the studies in a meta-analysis.

Some papers you show conclude for the need of more studies and that insulin resistance and obesity increases inflammation (acne). OK, we already know that for rheumatoid arthritis, psoriasis, and all inflammatory diseases is the same , but they already exist....

However I understand that it can be different in China because some studies are in Malaysian people.

Dear Prof. Américo

Acne vulgaris is a kind of multifactorial disease. Scientifically, the etiology and pathogenesis of acne vulgaris need to be studied. However, acne vulgaris significantly affects patients' quality of life. The scientific data publish in journal is not enough to improve patients' life. Clinically, dermatologists are trying their best to treat acne and avoid the side effect of some medicine, and tell patients how to prevent acne as possible. Their clinical knowledge is not just base on scientific data, but also long time Clinical working experience. The clinical knowledge from working experience is important for doctors. The acne patients really have to avoid hot pepper, milk, beef, fried food(fried chichen, French fries, grilled steak) and drinking beer and alcohol.

Thank you, Prof. Américo. I am glad to speak to you about acne. You are welcome!

dear sir, resistant acne is not seen in the routine cases. grading acne is important, and also to realise that acne has an underlying hormonal relation,

recurrence of acne is very much related to stress, sun, food, medication, sebum secretions, etc. maitaning the Ph of the skin may infact help to treat acne that is resistant

Dear Satyaprasad Venkata: Do you think inflammation of acne is induced by lipid abnormal oxidation? I think acne patients are in dyslipidemia.

Very rarely we do come across resistant acne. The clinical characteristics we had noticed are- 1. more of cystic nature 2. majority of lesions are closed comedones 3. trunkal location 3. male sex. Before we conclude the acne is resistant we have to exclude factors like drug, hormone, topical agents (comedogenic) , the type of treatment and compliance to treatment. If you have excluded these we may call the acne as resistant. As the question itself suggested the treatment of such condition is disappointing. One of our patients ultimately resulted in renal amyloidosis and died of it.

Prof Criton

Is there a general criteria to decide on resistant acne vulgaris. How to differentiate the same from recurrent acne