Abstract: Set in a dermatology clinic, the dialogue between Dr. Mei and apprentice Xiao Dou elucidates acne pathogenesis: androgen-stimulated sebaceous overproduction combines with keratinocytes to obstruct follicles, forming comedones (oxidized to lipofuscin deposits). Under hypoxic conditions, Propionibacterium acnes metabolizes sebum, triggering inflammatory responses that manifest as erythema, edema, and pustules. Traditional Chinese Medicine diagnostics correlate facial acne distribution with internal imbalances: forehead/brow/nasal lesions indicate lung-heat and cardiac fire, perioral/cheek eruptions suggest spleen-stomach damp-heat, while mandibular acne reflects liver qi stagnation. Therapeutically, salicylic acid demonstrates multifunctional efficacy: its lipophilic nature enables keratin dissolution and pore unclogging, while suppressing sebaceous activity and microbial proliferation, coupled with anti-inflammatory and epidermal renewal properties. This narrative integrates pathophysiological mechanisms with lifestyle interventions to promote evidence-based skincare paradigms.

Key words: Acne pathogenesis, Salicylic acid treatment, Evidence-based dermatology