Auriculotherpy in Treating Acne Rev 9112014

I.
INTRODUCTION
Acne vulgaris, the most common skin disorder, affects virtually all individuals at
least once. Incidence peaks in 18 years olds, but substantial numbers of 20 to 40 years old
also develop the disease. The effects of acne should not be underestimated. It can persist
for years; produce disfigurement and permanent scarring; and have significant
psychosocial consequences, including diminshed self-esteem, embarrassement, social
withdrawal, depression, and unemployment. The extent and severity of these effects
underline the importance of providing adequate therapy, which produces satisfactory
results in most cases.
Many factors can be the trigger of acne, some of them are hormonal imbalance in
age of puberty, familial influence, cosmetics, and stress . Another factor of facial acne is
tropical climate like Indonesia which has the high humidity that cause tropical people are
easy to sweat, and susceptible to dust.
There are many options for acne therapy, can be conventional (with medicine) and
nonconventional therapy such as acupuncture, herbal agents,or hypnosis. Despite of its
therapeutic effect, conventional therapy has some weaknesses, for example the use of
topical retinoid can cause dryness and erythema, the effect of long term systemic
antibiotic can cause antibacterial resistant or teratogenic effect in consuming the
isotretinoin oral. Therefore, the effective and safe treatment should be chosen. This study
proposes the acne treatment by auriculotherapy method.
I.1. Working hypothesis
The hypothesis of this study is whether a scientific auriculotherapy can treat acne
patients by reducing the acne lesions and thus improve the quality of self esteem of
patients. The aim of this study is to assess the effectiveness of auriculotherapy in treating
acne.
The study takes place in Riau Province, Indonesia where 14 patients were
recruited.
I.2. Related researches about acupuncture and auriculotherapy in treating acne

Generally, there are many methods nonconventional therapy for treating acne like
acupuncture and auriculotherapy. Evidence pooled together in a systemic review has
shown that acupuncture plus moxibustion is safe and effective for the treatment of acne,
Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 1

and possibly better than routine western medicine [15]. In one randomized controlled trial,
acupuncture treatment of moderate acne vulgaris was associated with reduction of
inflammatory lesions and improvement of the quality of life, but there was no non-
acupuncture control for comparison [16]. Finally, one trial found body acupuncture to
have some effect in the treatment of acne vulgaris, and that the addition of laser auricular
irradiation may improve efficacy [17]
In general, acupuncture is believed to stimulate the nervous system and cause the
release of neurochemical messenger molecules. Then resulting biochemical changes
influence the body’s homeostatic mechanism, thus promoting physical and emotional
well-being. Stimulation of certain acupuncture points has been shown to affect areas of the
brain that are known to reduce sensitivity to pain and stress [18] Acupuncture may help to
treat acne through one or more of the following general mechanism, but as yet we have no
specific inflammation from studies on people with acne:
 Reducing inflammation, by promoting release of vascular and immunomodulatory
factors [19]
 Enhancing natural killer cell activities and modulating the number and ratio of
immune cell types [20]
 Increasing local microcirculation which aids dispersal of swelling [21].
There was positive improvement of facial acne vulgaris by auriculoacupuncture

and auriculotherapy [22]. Both auriculoacupuncture and auriculotherapy appear to
provide some promising therapeutic results in the treatment of adolescent mild to
moderate acne vulgaris. The potential advantages of using auriculoacupuncture and
auriculotherapy to treat facial acne vulgaris include reduced cost of therapy, lack of
significant adverse effects, and better patient adherence and acceptance [22].
According S.O.F.A (La Société Française d’Auriculothérapie), auriculotherapy is
explained by neuroembryologic and neurogenetic mechanisms: "In the embryological and
fetal development, at ear appears an identic cartography which lays between the brain and
the whole body. This neurophysiological correspondence allows to send therapeutic
requests to the brain by strumming the touch screens at ear. If these requests are
meaningful and relevant, then the brain attempts under many laws of neurophysiology,
correct or mitigate the problem(s) [23]. Figure 14 shows the mode action of
auriculotherapy.

Figure 14. Diagram shows the mode of action of auriculotherapy [24].
Based on that principal method, this study is proposed.
I.3. Literature review of Acne

I.3.1. Definition of acne
Acne is a chronic inflammatory disease of the pilosebaceous units. It is a
pleomorphic disorder with multifactorial pathogenesis [1]. Acne vulgaris is a common
self-limited disease that present with a variety of lesions, including open and closed
comedones, pustules, nodules, and inflammatory papules. Although nearly universal in the
teenage years, acne may continue until the third through fifth decades [2].
I.3.2. The risk factor of acne

Acne can begin at any age, but hormonal influences make it more common in the
middle to late teenage years. There is a slight predominance in men, who also commonly

have more severe involvement. Despite the disparate sex ratio, more women seek
treatment. There may be a familial influence, especially in severe cases [2].
Clinical acne was more prevalent in African American and Hispanic women (37%,
32% respectively) than in Continental Indian, Caucasian and Asian (23%, 24%, 30%
respectively) women. All racial groups displayed equal prevalence of both subtypes of
acne with the exceptiom of Asians, for whom inflammatory acne was more prevalent than
comedonal (20% vs 10%) acne, and in Caucasians, for whom comedonal acne was more
prevalent than inflammatory (14% vs 10%) acne. The percentage of type of acne in
different race and ethnicity is shown in Figure 1 [3].
Figure 1. Prevalence of acne subtypes by race and ethnicity

Patients who have recently received systemic corticosteroidal agents may develop
severe acne rapidly. Similarly, those who take anabolic steroids to build muscle mass may
develop severe acne suddenly. Other medications have a tendency to exacerbate acne,
including lithium and birth control agents such as medroxyprogesterone (Depo-Provera)
and oral contraceptive agents [2].
The use of specific cosmetic agents, ranging from abrasive cleansers to
foundations and moisturizing creams, may exacerbate acne on an individual and
idiosyncratic basis. Unfortunately, no cosmetics or toiletries are guaranteed to be free of
acnegenicity [2].
Patients often focus on foods as potent agents that may exacerbate acne vulgaris.
However, there is no convincing evidence that dietary factors play a role in producing or
exacerbating acne. Many women, for instance, have perimenstrual acne flares that they

attribute to diet rather than to their changing hormonal milieu. A practical approach is to
allow patients to eat any foods they do not believe make their acne worse [2].
Many lines of clinical evidence suggest that components of the nervous system,
such as psychological and neurogenic factors, can influence the course of the disease.
Stress is a definite etiological factor, as many patients report that, their acne flares during
periods of stress. Evidence of the nervous system’s involvement in skin pathophysiology
provides possible link between stress or psychiatric disturbances and many dermatological
diseases. Emotional stressors appear to play a role in acute acne exacerbations but not in
chronic acne vulgaris [4].
I.3.3.Pathogenesis of acne
Acne vulgaris is of multifactorial origin with both intrinsic and extrinsic factors
contributing to the final outcome. There are four principal pathogenetic events: [5]
1. Abnormal follicular keratinization with retention of keratinous material in the
follicle.
The initial event is abnormal keratinization of the infrainfundibular portion of
sebaceous follicles, leading to the impaction of adherent horny lamellae within
the follicle. The cause of this retention hyperkeratosis is unknown although
both the formation of free fatty acids and the follicular deficiency of the fatty
acid linoleic acid have been implicated at different times. Impacted follicles,
which are the precursors of comedones and inflammatory lesions, are not
detectable clinically. They are termed ‘microcomedones’. With the recent
complete mapping of the P.acnes genome, there is now a better understanding
of the causes of the microcomedone. P.acnes biofilm produces a biological
glue that holds corneocytes together to form the keratin plug, which leads to
the infundibular obstruction. Biofilms are an important defense mechanism of
bacteria. Microorganisms within biofilms are 50 to 500 times more resistant to
antimicrobial therapies than free-floating (planktonic) bacteria. Isotretinoin and
benzoyl peroxide may alter the vitality of the P.acnes biofilm. The
microcomedones may not be the central cause of acne, but merely a reflection
of the action of P.acnes secreting substances into sebum as they try to set up
their biofilm [5].

2. Increased sebum production
The role of sebum is poorly understood. Acne patients have increased sebum
secretion by the sebaceous follicles. Sebum production is known to be under
the influence of androgens, which are increased in some patients, particularly
females, with acne. Dehydroepiandrosterone sulfate, the major adrenal
androgen, is significantly higher in girls and adult women with acne than in
age-matched controls. Insulin-like growth factor 1 is also increased in adult
women with acne. Androgens also play a role in prepubertal acne in males.
There are elevated levels of 17-hydroxyprogesterone in male patients with
acne. Of interest is the finding that some women with acne have polycystic
ovaries. Premenstrual acne flares may occur. Furthermore, the injection of
sebum into the skin produces inflammatory lesions that mimic those of acne.
The onset of sebum secretion and expansion of the propionibacterial skin flora
occur earlier in children who develop acne than in children who do not.
Despite this findings a recent report found that no correlation between levels of
sebum secretion and the number of acne lesions [5].
3. The presence of the Gram-positive anaerobic diptheroid Propionibacterium

acnes
P.acnes is the bacterial species most consistently isolated from lesions of acne,
although it is present in only 70% of early inflammatory lesions [5].
Propionibacterium acnes is an anaerobic diphtheroid that populates sebaceous
follicles and is a normal constituent of cutaneous flora [1].
Bacteria are not essential for the formation of comedones. P.acnes produces
several factors, other than its biofilm, which may be of pathogenetic
importance. These include lipases and proteases, chemotactic factors, and heat
shock proteins. P.acnes can, in some way, activate the complement system and
it may stimulate the release of hydrolases from neutrophils. These may in turn
damage the follicular wall, leading to the liberation of the contents of the
follicle into dermis and the consequent inflammatory reaction. P.acnes also has
T-cell mitogenic activity. It also triggers cytokine responses in acne by
activation of toll-like receptor 2 (TLR2). Toll like receptors may also result in
the accumulation of pustule. The resolution of acne lesions may involve the
regulation of CD4 T-cell responses to P.acnes. Other studies suggest that an

overly vigorous immune response to P.acnes may be the fundamental problem
in patients with inflammatory acne [5].
4. Inflammation
Inflammation is a direct or indirect result of P.acnes proliferation. Follicular
rupture and extension into dermis result in formation of the inflammatory
lesions of acne vulgaris-papules, pustules, and nodules [5].
In addition to these 4 basic mechanisms, genetic factors, stress, and possibly
diet may influence the development and severity of acne [6].
The pathogenetic factors of acne is shown in Figure 2 [1].
Figure 2. Pathogenesis of acne
I.3.4. Classification of acne

Many methods for measuring acne have been described, ranging from global
assessments to lesion counting. Correct classification of lesion type is essential for
choosing the most effective therapy. At the 1990 Consensus Conference on Acne
Classification, a global evaluation of lesions and their complications (e.g., drainage,
hemorrhage, and pain) was proposed. Psychosocial impact, failure to respond to previous
therapies, and occupational disability are 3 additional factors used in grading acne [1].
Table 1 shows the acne classification by severity of inflammatory lesions.

Table 1. Acne Classification by severity of inflammatory Lesions
The pictures of mild, moderate and severe acne are shown in figure 3, 4, and 5.
Figure 3. Mild acne [9].

Figure 4. Moderate acne [9].
Figure 5. Severe Nodulocystic Acne [9].
The other acne classification is based on number and type of lesion. It is shown in
table 2. [7]
Grade Comedone Papule/pustule Nodule,cyst,sinus Inflamasi Scar
Mild <10 <10 - - -
Moderate <20 >10-50 - + ±
Severe >20-50 >50-100 ≤5 ++ ++
Very >50 >100 >5 +++ +++

severe
(-) none, (±) can be found, (+) few, (++) several to many, (+++) numerous to extensive
Table 2. Acne classification based on number and type of lesion
To give treatment recommendations based on disease activity, the EU Guidelines

group has considered how best to classify acne patients. It has used the following simple
clinical classification: [8]
1. Comedonal acne
2. Mild-moderate papulopustular acne
3. Severe papulopustular acne, moderate nodular acne
4. Severe nodular acne, conglobate acne
I.3.5. Diagnosis and differential diagnosis of acne

History
Acne vulgaris is a chronic, intermittent disease which may persist long past the
teenage years; it is unusual to find acne activity in the third and fourth decades of life.
Acne becomes rare in women after menopause but can persist into the sixth decade in
some men. Acne lesions are usually asymptomatic, although the nodules can be painful.
Occasionally, patients complain of itching in the acne lesions. More darkly pigmented
patients may be bothered by the postinflammatory hyperpigmentation than by the
acneiform lesions [2].
Physical Examination
The diagnosis of acne vulgaris is usually uncomplicated. Differential diagnoses
mainly include rosacea, perioral dermatitism bacterial folliculitis and drug-induced
acneiform eruptions, The presence of comedones confirms the diagnosis of acne vulgaris
[6].
The primary sites of acne are the face, chest, shoulders and back. Lesions consist
of open comedones (whiteheads), closed comedones (blackheads), pustules, erythematous
papules, and deeper nodules (cysts) [2].
Comedones
A comedo, or basic acne lesion, is a hair follicle that has become clogged with oil
and dead skin cells. Comedones (the plural of comedo) can develop into bumps called

whiteheads and blackheads. Products that may trigger comedones are called
"comedogenic." Makeup labeled "noncomedogenic" is less likely to clog pores and
contribute to acne [9]. Figure 6 shows the formation of comedones.
Figure 6. Comedones [9].
Blackheads (open comedones)

Blackheads are comedones that are open at the surface of the skin. They are filled
with excess oil and dead skin cells. It's not dirt that causes the comedone to turn black.
The oil's reaction to air causes the black color. Blackheads can frequently be treated with
over-the-counter medications [9].
The source of the pigmentation in open comedones (blackheads) is disputed. It has
been attributed to the presence of active melanocytes in the uppermost follicle, but a more
recent study failed to confirm this. It is now suggested that densely packed, often
concentric, horny material, interspersed with sebaceous material and bacterial breakdown
products, may be responsible for the observed pigmentation [5]. Figure 7 shows the
clinical appearance of open comedo.

Figure 7. Blackheads [9].
Figure 8. Whiteheads [9].

Whiteheads (closed comedones)
Comedones that stay closed at the surface of the skin are called whiteheads. This
happens when oil and skin cells prevent a clogged hair follicle from opening. Many of the
same over-the-counter medicines that treat blackheads are also effective against
whiteheads [9]. Figure 8 shows the clinical appearance of whiteheads.
Papules
Papules are comedones that become inflamed, forming small red or pink bumps on
the skin. This type of pimple may be sensitive to the touch. Picking or squeezing can make

the inflammation worse and may lead to scarring. A large number of papules may indicate
moderate to severe acne [9]. Papules are shown in Figure 9.
Figure 9. Papules [9].
Pustules
Pustules are another kind of inflamed pimple. They resemble a whitehead with a
red ring around the bump. The bump is typically filled with white or yellow pus. Avoid
picking or squeezing pustules. Picking can cause scars or dark spots to develop on the skin
[9]. Figure 10 shows the appearance of pustules.

Figure 10. Pustules [9].
Figure 11. Nodules [9].

Nodules
Nodules are large, inflamed bumps that feel firm to the touch. They develop deep
within the skin and are often painful. Nodules should be treated by a dermatologist. Over-
the-counter treatments may not be powerful enough to clear them up, but prescription
drugs can be effective [9]. Nodules are shown in Figure 11.
Cysts
Cysts are large, pus-filled lesions that look similar to boils. Like nodules, cysts can
be painful and should be treated by a dermatologist. People who develop nodules and
cysts are usually considered to have a more severe form of acne. Figure 12 shows the form
of Cysts.

Figure 12. Cysts [9].
One type of lesion may predominate, but varieties often are found in various
phases of development. When eruptive inflammatory acne lesions are all in the same stage
od development, a common cause is systemic corticosteroid administration in the
preceding few weeks or months [2].
The severity can range from mild acne with only comedones to severe nodular
acne with a marked potential for disfiguring scars. Patients with severe acne often do not
appreciate the severity of the scarring because they have not seen their noninflamed faces
in months to years. The scarring process also may embed follicular epithelium remnants in
the dermis, leading to the development of epidermoid cysts [2].
A common form of acne-acne excoriée- is caused by picking of facial lesions or
perceived facial lesions. The physical examination shows excoriated, crusted lesions with
few, if any, primary comedones or inflammatory lesions [2].
Laboratory Evaluation
Acne vulgaris is diagnosed clinically, and laboratory studies usually are not useful.
The combination of severe acne with hirsutism, irregular menses, and obesity in women
may warrant a gynecologic endocrinology evaluation for polycystic ovary syndrome. This
evaluation may conclude obtaining serum levels of total and free plasma testosterone and
dihydroepiandrosterone sulfate (DHEAS) [2].

Differential Diagnosis
Although many acne diagnoses present no difficulties, certain conditions or
overlapping conditions may be confusing. Differential diagnosis may be stimulated by this
noninclusive list: rosacea, ulerythema ophryogenes, Gram negative folliculitis,
steatocystoma multiplex, steroid acne, drug eruptions, perioral dermatitis, iododermas,
verruca vulgaris, verruca plana, sarcoidosis, infectious folliculitis, keratosis pilaris,
syringomas [1].
I.3.6. The Treatment of acne

Therapy for acne vulgaris varies according to the types of lesions present as well
as the severity. Additionally, patient expectation varies remarkably between affected
individuals. Some patients with “minor” disease may go to extraordinary lengths to treat
acne, whereas some with severe disease may choose minimal or no treatment. In general,
acne that is primarily comedonal responds best to topical retinoid agents and acid
products. Inflammatory lesions such as papules and pustules require either topical
antibiotic agents when minor or oral antibiotic agents when major. The mechanism of
action of antibiotics for acne is not perfectly clear as these agents are not only microbial :
They diminish inflammatory cell chemotaxis, modify the complement pathways, and
inhibit the polymorphonuclear leukocyte chemotactic factor and lipase production in
P.Acnes [2].
Combinations of comedolytic agents and antibiotic agents are beneficial for the
majority of these patients. Acne that is more severe, unresponsive to several systemic
antibiotics, and characterized by mainly nodular lesions may be a good candidate (for
systemic isotretinoin therapy). Another useful approach for the acute treatment of painful
nodules is intralesional corticosteroid injection [2].
International Acne Treatment Algorithm provides the recommendations for
treatment of acne depending on the severity. It is the consensus of opinions expressed
during the 9th Congress of European Academy of Dermatology and Venerology in
Geneva in 2002, as shown in Table 3 [10].
Table 3 International Acne Treatment Algorithm 1

Grade I (Mild) Grade II-III Grade IV Maintenance
(Moderate) (Severe)

Topical Retinoids Topical Retinoids Isotretinoin Topical Retinoids
Benzoyl peroxide Benzoyl peroxide Or Benzoyl peroxide or
or topical or topical topical antibiotic
antibiotic antibiotic
Oral antibiotic Topical retinoids,
Oral antibiotic,
Hormonal therapy
Hormonal therapy
Acne vulgaris is a multifactorial disease process. Multiple treatments are available

that target one or a few of the key pathogenetic elements. The most effective available
drug, the systemic retinoid isotretinoin, targets all four of the primary follicular changes
observed in acne vulgaris. The objectives of acne therapies are shown in Table 4.
_________________________________________________________
Benzoyl peroxide Antimicrobial
Weakly comedolytic
Topical retinoids Comedolytic
Anti-inflammatory
Systemic antibiotics Anti-inflammatory
Antimicrobial
Oral contraceptives Sebosuppressive
Systemic retinoids Comedolytic
Anti-inflammatory
Sebosuppressive
Indirectly antimicrobial
__________________________________________________________
Table 4. Acne treatments and their mechanism of action in acne vulgaris [11].
From several therapies of acne, we can see how their actions in acne lesion, it is
shown in figure 13.

Figure 13. How various drugs work in treating acne [13]
Topical therapy.
Retinoids, benzoyl peroxide, and antibiotics all have level I evidence in support of
their use. A combination of two of these therapies may be more effective than either
alone. This is so with a combination of topical retinoids and topical erythromycin or
clindamycin, and the combination of either of these two antibiotics with benzoyl peroxide.
There is no evidence relating to the relative efficacy of different retinoids. Salicylic acid
can be used when retinoids are not tolerated. Clindamycin and Salicylic acid combined are
also effective. The use of topical antibiotics can be associated with the development of
bacterial resistance. Topical retinoids are both comedolytic and anti-inflammatory while
benzoyl peroxide is antimicrobial, weakly comedolytic, but mostly important, breaks the
biofilm around P.acnes [5].
Systemic therapy.
Systemic antibiotics used in acne vulgaris have both antimicrobial and
antiinflammatory properties. They reduce P. Acnes within follicles, thereby inhibiting
production of bacterial-induced inflammatory cytokines [6]. Oral antibiotics are an
important treatment option for moderate to severe acne. It was in the 1950s that oral
tetracycline and erythromycin were used to treat acne. Since then, antibiotics used to treat
acne have come to include doxycycline, minocycline, trimethoprim/sulfamethoxazole,
amoxicillin, azithromycin and cephalexin [11]. The Academy Guidelines suggest that
doxycycline and minocycline are more effective than tetracycline. However, a systematic
review in 2008 of seven randomized trials concluded that there was insufficient evidence
to support the use of one tetracycline over another and that the dose used has no effect on
efficacy. Tetracycline was found to be effective in a small study in blocking acneiform
eruption of cetuximab. It should be noted also that the use of minocycline is associated

with an increased incidence of autoimmun diseases; the appearance of p-ANCA is a
marker for the early development of these diseases. Erythromycin can be substituted in
pregnant women and in children. Trimethroprim-sulfamethoxazole, and oral cephalexine
have also been used. Isotretinoin is approved for severe, recalcitrant nodular acne and for
less severe forms that are resistant to treatment. It is a powerful teratogen. Mood
disturbances have also been reported. There is a relatively high of relapse (41% in one
study) on cessation of the drug [5].
The European Directive states: “oral isotretinoin should only be used in severe
acne, nodular and conglobate acne, that has or is not responding to appropriate antibiotics
and topical therapy”. The inference of this being that it should now not be used at all as
first line therapy [8]. For many reasons, systemic isotretinoin must be considered the first-
choice treatment for severe acne: clinical effectiveness, prevention of scarring and quick
improvement of a patient’s quality of life. The EMEA recommendations include the
following points:
 To start at the dosage of 0,5mg/kg daily;
 Not recommended for patients under 12 years of age;
 To monitor laboratory parameters, primarily liver enzymes and lipids, before
treatment, 1 month after starting and every 3 months thereafter [8].
Sexually active women who use unreliable forms of birth control are poor
candidates for this therapy. Dual-method contraception control in women at risk of
becoming pregnant should be started at least 1 month before beginning therapy and should
continue 1 month after the cessation of therapy. A negative pregnancy test should be
obtained before beginning isotretinoin therapy and at monthly during the treatment course
[2]. Topical retinoid monotherapy is as effective as the combination of retinoid with
minocycline for maintenance therapy [8]. Estrogen-containing oral contraceptives can be
useful in the treatment of some women. They are sebosuppressive in their activity. The
oral contraceptive Tricyclen has been approved by the US Food and Drug Administration
as the only hormonal acne therapy. These agents should not be administered to pregnant
women [5].
The oral antiandrogens spironolactone and cyproterone (but not finasteride) can be
useful in some women. These treatments, which decrease androgen expression, are based
on the requirement for androgens in the pathophysiologic development of acne [6]. As an
antiandrogens, spironolactone has produced good results in the PCOS patient, as well as in
the patient without PCOS, but who has menstrual acne flares and deep cystic acne [14].

Other therapies.
Procedure-oriented acne treatments are being introduced nearly every day. Light,
laser, and photodynamic treatments are all currently being utilized in the treatment of
acne. Blue and red light target different pathogenetic factors in acne Blue light (405-420)
reacts with porphyrins produced by P.acnes creating reactive oxygen species that damage
the bacterial cell wall and cause bacterial death. Red light (660nm) is anti-inflammatory.
Clinical trials are few in number and offer no long-term follow-up to date. Photodynamic
therapy (PDT) again utilizes blue light reacting with a porphyrin in the sebaceous gland.
Sebaceous gland damage and destruction is the hypothesized mechanism of action of PDT
in acne vulgaris. Controlled clinical trials are lacking at this time [11]. There is limited
evidence for the use of chemical peels, comedone removal, herbal agents and
hypnosis/biofeedback. Lasers and/or surgery may be needed to correct severe acne
scarring. Acne scars can be physically and emotionally troublesome to some individuals.
I.3.7. Complications and Psychological impact of acne

The major sequela of acne is scarring, which usually results from nodulocystic
lesions. Therapy for scarring usually requires surgical procedures such as collagen
injection, dermabrasion and excision. Gram-negative folliculitis may develop in patients
who receive prolonged antibiotic therapy and is heralded by the sudden flare of pustules or
nodules in a patient who has been improving [2].
Study methodologies, including case-control and cross sectional surveys, have
demonstrated psychological abnormalities including depression, suicidal ideation, anxiety,
psychosomatic symptoms, including pain and discomfort, embarrassment and social
inhibition. Effective treatment of acne was accompanied by improvement in self-esteem,
affect, obsessive-compulsiveness, shame, embarrassment, body image, social
assertiveness and self-confidence. Acne is associated with a greater psychological burden
than a variety of other disparate chronic disorders.
II. MATERIALS AND METHODS
II.1. Materials

Auriculotherapy is like other medical intervention, needs an aseptic procedures:
using handskoon, alcohol disinfectant, using sterile ASP (Aigulles Semi Permanent) .
II.2. Methods
II.2.1. Methods and number of cases
Male and female volunteers between the age of 15 and 30 years with mild to
moderate facial acne were recruited using word-of-mouth. The patients’s domiciles are in
Riau Province, Indonesia. All the 14 cases were outpatients, with the illness course within
6 months in 1 cases, 6 months to 1 year in 3 cases, and over 1 year in 10 cases. To this
patients are explained the auriculotherapy methods and its mechanism of action in treating
acne. After patients agreed to follow the study in 3 sessions, then signed the informed
consent.
Therapy sessions conducted 3 times with a minimum interval of 4 weeks and
observations conducted during 4 months. Assessment is done through observation of the
therapeutic effect of the patient's condition and interview with patients. The development
of the therapeutic effect is compared through photographs taken in 4 times : before
therapy (day 0), 1 month after first therapy (day 30), 1 month after second therapy (day
60) and 1 month after third therapy (day 90). This study lasted for four months from july
2014 to October 2014.
II.2.2. Inclusion and Exclusion criteria

Criteria for inclusion in the study were male or female (between the ages of 15 and
30 years) in any grade of facial acne vulgaris, not in using any treatment of acne (topical
or systemic therapy) for 1 month prior to the beginning of the study and during the study.
Prior to beginning the study, the author met with each volunteer to take a health history
and perform a classification/grading of acne. The acne grading system used in this clinical
study is based on the 1990 Consensus Conference on Acne Classification (by severity of
inflammatory lesions) and the EU guideline (based on disease activity) :
 Comedonal acne: Presence of open and closed comedones but usually no

inflammatory papules or nodules
 Mild acne: Presence of comedones and a few papulopustules
 Moderate acne: Presence of comedones, inflammatory papules, and pustules; a
greater number of lesions are present than in milder inflammatory acne

 Nodulocystic acne: Presence of comedones, inflammatory lesions, and large
nodules greater than 5 mm in diameter; scarring is often evident
Patients were asked not to use conventional therapies such as tretinoin, isotretinon,
or antibiotics while enrolled in this study. Exclusion criteria were patient in treatment of
acne by topical or systemic therapy.
II.2.3. Assessment criteria

The evaluation is based on the observation of of lesions condition of patients and
interview with patients. The assessment is cathegorized:
Cured: All lesions completely disappeared
Markedly effective: more than half of total lesions disappeared
Improved : less than half of total lesion disappeared
Failed : no obvious improvement of the lesions
II.2.4. Treatment strategy and the choosing point of auriculotherapy points in

treating acne
The points mentioned in this study are mapped according to the latest
"International Nomenclature of Auricular Cartography” submitted to WHO via the World.
Federation of Chinese Medicine Societies, published in September 2011.
 Omega (ω) : C18
 Point Genitale (FSH/LH) : F16
 Trigeminal nerves ( V1 and/or V2 and/or V3s) : B17, B16, C15
 Point Maitre Reticulee (PMR) : H13
 F/VB (right ear) F10
And in two patient, adding personalization therapy : ‘stress point’, Cosmonaute (F6).
The treatment starts in the side of pathology (area of acne) and is done bilaterally, except
the F/VB point only in right ear.
The reasons for selecting this regimen:
- Point Omega (ω) : representation of the innervations of neuroectodermal tissue
and all its derivatives

- Point Genitale (FSH/LH): to maintain the best genital endocrine function. In acne
cases, it is considered as the imbalance of hormonal state so by puncturing this
point, the optimized state can be achieved. The sebaceous gland is also influenced
by estrogen, whom secretion is influenced by FSH.
- Trigeminal branch nerves (V1 and/or V2 and/or V3sensoric): representation of the
sensory innervations of face. In this study, it depends on the dominant lesions of
the acne in patient, it can be V1, V2, or V3 or combination of this trigeminal
branch nerves.
- Point Maitre Reticulee (PMR): point master of the skin. It is a great filter for all
general transient information by the reticular formation. It is a pluripotent point. In
acne cases, it is important since the pathology occurs at the skin.
- F/VB (on right ear): the liver and gall bladder point, which regulate the fat
metabolism. In acne patient, the lipid metabolism is one of trigger factor of acne
arises.
- Cosmonaute : representation of sympathic ganglion of superior lumbar (D12,L1),
for aiding a good regulation of human stress.

Figure 15 Figure 16
III. RESULT AND DISCUSSION
III.1.Summary statistics
Distribution patient by sex
Figure 17 shows the distribution by sex of patient. From the total 14 patients: 4 males
(29%), 10 females (71%).
Distribution by Sex
29%
Males
Females
71%
Figure 17. Distribution by sex

Ages population of study
The ages of patients are spread from 15 until 30 years old. It is shown in figure 18.

Ages
35
30
25
20
15
Ages
10
5
0
Figure 18. Ages of patients
Type of acne
Figure 19 shows the distribution by type of acne. From 14 patients: 1 comedonal acne, 5
mild acne,7 moderate acne, 1 nodular acne
Types of Acne
7
7
6 5
5
4
Types of Acne
3
2 1 1
1
0
Comedonal Mild Moderate Nodulocystic
Figure 19. Distribution by type of acne
III.2. Result
Result will be presented qualitatively by comparing before and after treatment of
auriculotherapy. It will use the assessments criteria (cured, markly effective, improved

improved or failed) and explain descriptively. The evaluation is done by comparing the
photographs and interviewing the patients.
In 14 patients, 11 follow the therapy until finished, 2 loss to follow-up after first
treatment (presented at the first session, but did not represent at the second treatment a
month later), 1 out of inclusion criteria in the middle of study (due to the use of
conventional acne treatment: tretinoin, systemic antibiotics and intralesion injection)
In the summary tables (table 3), we find the essential elements for each patient:
 Initials
 Sex
 Age
 Type of acne
 History (anamnesis)
 Points of auriculotherapy
 Dates of auriculotherapy
 Result _di tabel belum diedit, mestinya 4 point: cured, markedly effective,
improved, failed

Anamnesis Treatment points Date of treatment Result
N Initi Age
Sex Menstrua improv faile
o al (years) Since Stress Food Cosmetics Right ear Left ear I II III
tion ed d
3 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 10/07/20 10/08/20 26/09/20

1. P F 16 - - + - +
years F/VB H 14 14 14

2. Y F 17 - + + - +

3. R M 17 - - - - +
Loss to
2 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 10/07/20 Loss to
4. R F 17 - - + - follow ? ?
years F/VB H 14 follow up
up
Loss of
2 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 10/07/20 Loss of
5. Y F 22 - - - - follow ? ?
years F/VB H 14 follow up
up

6. R F 18 - + + - +
year F/VB H 14 14 14

7. R M 16 - + - - +

8. F M 16 - - - - +

9. L F 27 - - - + +
10 1 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 31/7/201 28/08/20 26/09/20

Z F 29 - - - + +
. year F/VB H 4 14 14

R F 28 - - - - +
. years F/VB H 14 14 14

Y F 16 - - + - +
. year F/VB H 14 14 14

R M 26 + - - - +
. years F/VB +Cosm H + cosm 14 14 014
Out of
inclusion
6
14 ω,PMR,V2,V3,FSH/ ω,PMR,V2,V3,FS 27/07/20 30/08/20 criteria
I F 24 mont + + + + ? ?
. LH,F/VB +Cosm H/LH+ Cosm 14 14 in the
hs
middle of
study

Description of each patient
I. Patient 1: P,female, 16 y.o.
Type of acne: Mild acne
Description of skin : less than 20 whiteheads on the forehead, cheeks and chin; 5 papules
on the forehead,cheeks and chin; 6 pustules on the forehead and 1pustule on the chin; dark
spots (+ ) on the cheeks and chin.
Having acne during: 3 years
Acne trigger: Menstruation (+)
Auriculotherapy points: It starts on right ear because the lesions exist on both side and
can be done from right side. V1 is chosen from trigeminal nerves because the dominant
lesion on forehead.
Right ear : ω,PMR,V1 ,FSH/LH,F/VB
Left ear : ω,PMR,V1,FSH/LH
.
Kasih nama figure

Before therapy (day 0) : After first therapy (day 30):

After second therapy (day 60): After third therapy (day 90):
Kasih nama figure
Before therapy (day 0):

After 3rd therapy (day 90):
Kasih nama figure
Evaluation:
From photograph foto yang mana??: The lesions reduce more than half of total lesions,
mainly on forehead and cheeks.
From interview to patient: There is an improved after auriculotherapy, the pimples are
reduced and the new pimples do not arise.
Assessment categorized: markly effective

II. Patient 2: Y,female, 17 y.o.
Type of acne : Mild acne
Description of skin: there area several whiteheads on the cheeks, 5 papules on the right
cheeks and 6 on the left cheeks, some pustules on the cheeks and chin.
Having acne during : 3 years
Acne trigger : Certain food (peanuts) (+), Menstruation (+)
Auriculotherapy points : It starts on right ear because the lesions exist on both side and
lesion on cheeks.
Left ear: ω,PMR,V2,FSH/LH
Kasih nama figure

Kasih nama figure

Kasih nama figure
From photograph : The lesions is reduced more than half of total lesions, mainly on
cheeks.
reduced, but toward the menstruation period, a new pimple still arises but not as much as
usual.

III. Patient 3: R,Male, 17 y.o.
Type of acne : moderate acne
Description of skin: more than 20 blackheads and whiteheads on the forehead, cheeks and
chin, more than 20 papules and pustules on the cheeks,5-6 pustules on left temple,some
dark spots on the cheeks,acne scar (+) on the cheeks.
Acne trigger : (-)
lesion on the cheeks. At the first therapy, there are little bleeding on ω and V2 of left ear.
Right ear : ω,PMR,V2,FSH/LH,F/VB
Befor
Kasih nama figure

Kasih nama figure

Kasih nama figure
Evaluation:
From photograph : The lesions are reduced more than half of total lesions, mainly on
cheeks, forehead and left temple.
lessen than usual, the oily skin is reduced, and the new pimples do not arise.

IV. Patient 4: R,female, 17 y.o.
Type of acne : mild acne
Description of skin: some whiteheads and papules on the cheeks,5 pustules on the right
cheek and 1 on the left cheek, 2-3 papules on right cheek,acne scar (+) on the right and left
cheeks
Acne trigger : Menstruation (+)
lesion on the cheeks.
Kasih nama figure
Before therapy (day 0) :

Kasih nama figure
Evaluation:
Patient did not come in second treatment without information. She is categorized in loss to
follow up.
V. Patient 5: Y,female, 22 y.o.

Description of skin: some whiteheads on the cheeks, 3-5 papules on the jawline , acne
scar (+) on the cheeks
Acne trigger : (-)
lesion on cheeks.

Kasih nama figure
Kasih nama figure
Evaluation:
Patient is categorized in loss to follow up because in second therapy, she did not come.
VI. Patient 6: R,female, 17 y.o.

Description of skin: 10-12 whiteheads on the left and right cheeks, some papules and
pustules on the cheeks and forehead
Having acne during : 1 year
Acne trigger : Certain food (peanuts) (+), Menstruation (+)
lesion on forehead.

Kasih nama figure

Kasih nama figure

Kasih nama figure
Evaluation:
cheeks and forehead.
lessen and the new pimples do not arise.
VII. Patient 7: R, Male,16 y.o.

Description of skin: multiple whiteheads and blackheads on the cheeks, forehead and
temple; more than 15 papules and pustules on the cheeks and temple, 2-3 papules on the
forehead, a few dark spots (+) on the cheeks
Acne trigger : Certain food (peanut) (+)
Auriculotherapy points : It starts on the right ear because the lesions exist on both side and
lesion on the cheeks.

Kasih nama figure

Kasih nama figure

Evaluation:
From photograph : The lesions are reduced more than half of total lesions, mainly on right
cheek and forehead.
reduced, and the new pimples do not arise.
VIII. Patient 8: F, Male, 16 y.o.

Description of skin : multiple whiteheads and blackheads on the cheeks and foreheads,
>20 papules and pustule on the right and left cheeks and forehead, some dark spots (+) on
the both cheeks.
Acne trigger : (-)
Auriculotherapy points : : It starts on the right ear because the lesions exist on both side
and can be done from right side. V2 is chosen from trigeminal nerves because the
dominant lesion is on the cheeks.

Kasih nama figure

Kasih nama figure
Before therapy (day 0)
After 3rd therapy (day 90)

Kasih nama figure
Evaluation:
From photograph : The lesions are reduced less than half of total lesion. There are still
some papules and pustules left on the cheeks and forehead. New lesions arise on the
different area of last acne.
From interview to patient: There is an improved after auriculotherapy, the last pimples are
lessen but the new pimples breakout in other area.
Assessment categorized: improved
IX. Patient 9. L,female, 27 y.o.

Description of skin:several whiteheads on the cheeks, forehead and chin; 2-3 papules on
the cheeks, 5-6 pustules on the foreheads and chin,acne scars (+) on the cheeks.
Acne trigger : cosmetic (+)
and can be done from right side. V1 is chosen from trigeminal nerves branches because the
dominant lesion are on the forehead.

Kasih nama figure

Kasih nama figure

Kasih nama figure
Evaluation :
From photograph : The lesions are reduced more than half of total lesions, mainly on the
forehead and cheeks.
lessen, the oily skin is reduced, and the new pimples do not arise.
X. Patient 10. Z,female, 29 y.o.

Description of skin: multiple whiteheads on the cheeks and foreheads, more than 15
papules on the cheeks and foreheads, 5-6 pustules on the left and right cheeks, some dark
spots (+) on the cheeks.
Having acne during: 1 year
Acne trigger : Menstruation (+), cosmetic (+)
dominant lesions are on the cheeks.
left ear : ω,PMR,V2,FSH/LH

Kasih nama figure

Kasih nama figure

Kasih nama figure
Evaluation:
cheeks and forehead.
lessen and the new pimples do not arise.
XI. Patient 2. R,female, 28 y.o.

Description of skin: several whiteheads on the cheeks and chin,1-2 papules on the right
cheeks, 1 pustule on forehead, acne scar (+)
Acne trigger : (-)
dominant lesion on the cheeks.

Kasih nama figure

Kasih nama figure
After therapy (day 90):

Kasih nama figure
Evaluation:
From photograph : The papules and pustules are totally disappeared.
cured and the new pimples do not arise.
Assessment categorized: cured
XII. Patient 12: Y,female, 16 y.o.

Description of acne: multiple whiteheads on the cheeks,more than 15 papules on the
cheeks and forehead, 3-5 pustules on the cheeks, some dark spots on the cheeks, several
acne scar (+) on the cheeks
Acne trigger : Stress(+), Menstruation (+)
Auriculotherapy points : It starts on the right ear because the lesions exist on both side and
lesion on the cheeks

Kasih nama figure

Kasih nama figure

Kasih nama figure
Evaluation:
From photograph : The lesions are reduced less than half of total population, some
papules and pustules still exist on cheeks.
From interview to patient: After first therapy, there is an improved after auriculotherapy,
some pimples are lessen. But then the new pimples still breakout on different
area,especially due to menstruation period, but not as much as usual.
Assessment categorized: improved
XIII. Patient 13: R,Male, 26 y.o.

Type of acne : Comedonal acne
Description of skin: multiple blackheads on the cheeks and forehead, acne scar(+) on the
cheeks, 2 papules on left cheek.
Acne trigger : stress (+)

dominant lesion is on the cheeks. At first therapy, there is a little bleeding on the area of
puncture on PMR and Point Genital. It is added the cosmonaute since the stress is a trigger
of his acne.
right ear : ω,PMR,V2,FSH/LH,F/VB+Cosm
left ear : ω,PMR,V2,FSH/LH+Cosm
Kasih nama figure

Kasih nama figure
After third therapy (day 90):

Kasih nama figure
Evaluation:
From photograph : The blackheads (open comedones) are still the same between before
and after therapy,no obvious improvement of blackhead. The papules are reduced.
From interview to patient: Patient said that there is no improvement of his blackheads
comedones, no reducing in its number between before and after therapy.
Assessment categorized: failed
XIV. Patient 14. I,female, 24 y.o.

Type of acne : Nodulocystic Acne
Description of acne: there are multiple pustules and nodules on the left cheeks and chin,
2 nodules on the left cheek and 2 on chin.
Having acne during: 6 month
Acne trigger : Certain food (chocolate, peanuts) (+), Menstruation (+), stress (+)
Auriculotherapy points : Because the lesions are on the left side of face, it is started on
that side of ear. The cosmonaute point is added because stress is one of her acne trigger.
On the left ear, V2 and V3(s) are punctured to cover the area of lesion on the cheeks and
the left chin. Whereas on right side, V is not punctured due to no lesion on the right side.

At the first therapy, there is little bleeding on the punctured area of ω and PMR on the left
ear.
Left ear : ω,PMR,V2,V3 s, FSH/LH +cosm
Then right ear : ω,PMR,FSH/LH,F/VB +cosm
Kasih nama figure
After first therapy (day 30):

Kasih nama figure
Evaluation :
In the middle of this study, patient used dermatologist prescription : retinoid topical,
systemic antibiotic (doxycycline), and intralesional corticosteroid injection in some
nodules. The lesions became more severe and the new lesions rised. Because of this
conventional therapy, patient is excluded in this study, but the auriculotherapy still
continue in one more session.
From 14 patients, only 11 patients can be evaluated, 2 loss to follow-up, and 1 out of the
inclusion criteria in the middle of study. Based on assessment criteria, from 11 patients : 1
cured, 7 markly effective, 2 improved,1 failed. –edit series keterangan ga bisa dihapus
tulisan column 2,1 Tabel … menunjukkan…..

8
5
Column2
4
Column1
3 Total
0
cured markly effective improved failed
III.3.Discussion
Based on our experiment, Result of this study shows auriculotherapy is effective
in treating inflammatory lesions of acne (especially papules and pustules). Ten patients
with mild and moderate acne have an improvement of their acne lesion. But for
comedonal lesions is ineffective, there is no improvement and reduce of blackheads of
patient R (P13). It would be interesting to further study, to recruit more number of patients
to assess better result.
Some of female patients are sensitive to hormonal fluctuation toward the
menstruation period and their acne breakout. Maybe it is needed to treat auriculotherapy
timely to get an optimal effect. Many factor influence the arising of acne, some of them
can be modified, some of them can not. The hormonal fluctuation at puberty age also take
an important role. In this study, more than 50 percent patient are in teenage age, so it
requires continuous therapy following the chronic pathophysiology of acne.
There are no serious side effect of auriculotherapy. Pain in the area of

auriculopuncture are felt by some patient in some days after therapy.In some patients,
there is a slight bleeding in some point of auriculotherapy like Point Maitre Reticulee
(PMR),omega (ω) , Point Genitale (FSH/LH) and trigeminal nerves. Those point
represent the neurovascular bundle that save the strong potential deposit following the
pathophysiology of acne.

For the optimal therapy, it should follow the pathology of each patients, depending
on the chronicity of their acne. We should also pay attention to the history of patient so
personalisation therapy can be added. The based auriculotherapy for acne is not complex
i.e:
 Omega (ω)
 Point Genitale (FSH/LH)
 Trigeminal nerves ( V1 and/or V2 and/or V3s)
 Point Maitre Reticulee (PMR)
 F/VB (right ear)
Acne scar is one of acne complication that become a psychosocial problem in

majority of acne patients. For further study, it can assess the effectiveness of
auriculotherapy in treating acne scar.
IV. CONCLUSION
Acne is a chronic inflammatory disease of the pilosebaceous units with
multifactorial pathogenesis. There are some risks factors that influence the rising of acne,
such as hormonal imbalance, familial,some systemic corticosteroidal, contraceptive
agents, cosmetics, food, and emotional stress , with or without convincing evidence. Acne
is associated with a greater psychological burden (deprssion, anxiety, embarrasment and
social inhibition,etc) than a variety of other disparate chronic disorders. Effective
treatment of acne can reduce this psychological side effects.
Auriculotherapy contributes in reducing or healing acne where other conventional
therapies have side effects such as erythema, dryness, mood disturbances and the serious
teratogenic effect . Our experiment shows that (paparkan kembali hasil penelitian secara
umum) Auriculotherapy is good in decreasing the inflammatory lesions of acne. This
study has recruited over a period of four months, fourteen patients who had acne vulgaris
consist of mild and moderate acne without using conventional therapy. Ten patients
have improvement of reducing acne.
A study on a larger number of patients and over a longer period would strengthen
the power of these results and clarify the optimal frequency of subsequent sessions of
auriculotherapy in treating acne.

REFERENCE
[1]. Oberemok ss, Shalita AR. Acne Vulgaris, I: Pathogenesis and diagnosis. CME
Department of Dermatology, State University of New York Downstate Medical
Centre, Brooklyn. 2002;70: 101-104.
[2]. Fleischer AB, Feldman SR, Katz AS, Clayton BD. 20 Commons problems in
dermatology. New York: McGraw-Hill College.2000:.3-17
[3]. Perkins AC, Cheng CE, Hillebrand GG, Miyamoto K, Kimball AB. Comparison of
the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian
and African American women. J Eur Acad Dermatol Venerol. 2011; 25 (9):1054-
1060
[4]. Singh LK, Pangx, Alexacos N, Letournaeu R, Theoharides TC. Acute
immobilization stress triggers mast cell degranulation via corticotrophin releasing
hormone, neurotension and substance p: A link to neurogenic disorder Brain
Behave Immun, 1999;13:225-39.
[5]. Weedon D. Weedon’s Skin pathology third edition. 2010. Churcill Livingstone
Elsevier. London.2010:399
[6]. Haider A, Shaw JC. Treatment of acne vulgaris. JAMA.2004;292(6):726-735
[7]. Cunliffe WJ, Gollnick HPM. Topical therapy in: Cunliffe WJ, Gollnick HPM, eds.
Acne. diagnosis and management. London: Martin Dunitz Ltd, 2001:107-114
[8]. Nast A, Dreno B, Bettoli V, Degitz K, Erdmann R, Finlay AY et al. European
evidence-based (S3) guidelines for the treatment of acne. JEADV 2012;26
(Suppl.1):1-29
[9]. http://www.webmd.com/skin-problems-and-treatments/acne/ss/slideshow-acne-
dictionary
[10]. Jacky WK. Acne Vulgaris. Grades of severity and treatment options. SA Fam
Pract.2003;45(9):32-36
[11]. Harper JC. An Update on the pathogenesis and management of acne vulgaris. J Am
Acad Dermatol 2004;51(1):S36-38
[12]. Tan, JKL. Psychosocial Impact of Acne Vulgaris: Evaluating the Evidence.2006.
[13]. http://www.merckmanuals.com/professional/dermatologic_disorders/acne_and_rel
ated_disorders/acne_vulgaris.html. 2013.
[14]. Keri J, Shiman M. An update on the management of acne vulgaris. Clinical,
Cosmetic and Investigational Dermatology.2009;2:105-110.
[15]. Li B et al. Evaluation of therapeutic effect and safety for clinical randomized and
controlled trials of treatment of acne with acupuncture and moxibustion. Zhongguo
Zhenjiu [Chinese] 2009;29:247-251.
[16]. Son BK et al. Efficacy of ah shi point acupuncture on acne vulgaris. Acupuncture
in medicine 2010;28:126-129.

[17]. Lihong S. He-Ne laser auricular irradiation plus body acupuncture for treatment of
acne vulgaris in 36 cases. J Tradit Chin Med 2006;193-194
[18]. Hui KK et al. Acupuncture, the limbic system, and the anticorrelated networks of
the brain. Auton Neurosci 2010; 157: 81-90
[19]. Zilstra FJ et al. Anti-inflammatory actions of acupuncture. Mediators inflamm
2003; 12: 59-69
[20]. Kawaita K et al. Do Japanese style acupuncture and moxibustion reduce symptoms
of the common cold? eCam 2008; 5: 481-489
[21]. Komori M et al. Microcirculatory responses to acupuncture stimulation and
phototherapy. Anesth Analg 2009; 108: 635-640
[22]. McKee D, Oring K, et al. Treating Facial Acne In Adolescents And Young Adults
With Auriculoacupuncture And Auriculotherapy: A Pilot Study. Medical
Acupuncture 2005. 16(1)
[23]. Gueguen J, Barry C, et al. Evaluation de l’efficacité de la pratique de
l’auriculothérapie. Inserm 2013.
[24]. Alimi D, Poulain P, Brulé S et al. Randomized controlled study assesing the action
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cancer tumors. Rev. Odont.Stomat 2012;41: 245-259.
Informed Consent form for participating study

I the undersigned (?):
Name :
Sex :
Address :
Age :
willing to participate in a study conducted by doctors berty sania with title “ Contribution
of auriculotherapy in treating acne” during 3 sessions (once a month for 3 months). I will
not resign unless the specific reasons.
I have read the foregoing information, or it has been read to me. I have had the
opportunity to ask questions about it and any questions that I have asked have been
answered to my satisfaction. I consent voluntarily to participate as a participant in this
study.
Print Name of Participant__________________
Signature of Participant ___________________
Date ___________________________

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I.

I.1. Working hypothesis

I.2. Related researches about acupuncture and auriculotherapy in treating acne

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 1

There was positive improvement of facial acne vulgaris by auriculoacupuncture

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 2

I.3. Literature review of Acne

I.3.2. The risk factor of acne

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 3

Figure 1. Prevalence of acne subtypes by race and ethnicity

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 4

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 5

3. The presence of the Gram-positive anaerobic diptheroid Propionibacterium

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 6

The pathogenetic factors of acne is shown in Figure 2 [1].

Figure 2. Pathogenesis of acne

I.3.4. Classification of acne

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 7

Figure 3. Mild acne [9].

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 8

Figure 5. Severe Nodulocystic Acne [9].

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 9

Table 2. Acne classification based on number and type of lesion

To give treatment recommendations based on disease activity, the EU Guidelines

I.3.5. Diagnosis and differential diagnosis of acne

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 10

Figure 6. Comedones [9].

Blackheads (open comedones)

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 11

Figure 8. Whiteheads [9].

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 12

Figure 9. Papules [9].

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 13

Figure 11. Nodules [9].

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 14

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 15

I.3.6. The Treatment of acne

Table 3 International Acne Treatment Algorithm 1

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 16

Acne vulgaris is a multifactorial disease process. Multiple treatments are available

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 17

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 18

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 19

I.3.7. Complications and Psychological impact of acne

II. MATERIALS AND METHODS

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 20

II.2.2. Inclusion and Exclusion criteria

 Comedonal acne: Presence of open and closed comedones but usually no

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 21

II.2.3. Assessment criteria

Failed : no obvious improvement of the lesions

II.2.4. Treatment strategy and the choosing point of auriculotherapy points in

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 22

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 23

III. RESULT AND DISCUSSION

Figure 17. Distribution by sex

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 24

Figure 18. Ages of patients

Figure 19. Distribution by type of acne

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 25

Dr. Berty SANIA, Mémoire DIU Auriculothérapie, 2014 Page 26

3 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 10/07/20 10/08/20 26/09/20

3 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 10/07/20 10/08/20 26/09/20

2 ω,PMR,V2,FSH/LH, ω,PMR,V2,FSH/L 10/07/20 10/08/20 10/09/20