外用药

全反式维甲酸(Tretinoin)

维甲酸又称维A酸,常用的维甲酸类药物包括全反式维甲酸、阿达帕林、他扎罗汀。其中,全反式维甲酸用于治疗痤疮、皮肤萎缩等,可以配制成乳霜、凝胶、溶液等剂型,外用于皮肤上,一般每天晚上使用一次。[2]

(了解更多:美国国家医学图书馆)

作用机制:

具有调节角质细胞分化、减少皮脂分泌、溶解粉刺以及抗炎的作用。

用药注意:

阳光会加重维甲酸对皮肤的刺激,应尽量避免日晒,或采用防晒措施;

用药期间,避免同时使用其它可导致皮肤刺激或破损的药物、化妆品或清洁用品等。

外用维甲酸常会出现轻度的皮肤刺激,如红斑、脱屑、疼痛、烧灼感,为了减少刺激可以从低浓度用起。

  1. "Tretinoin." MedlinePlus. 2010. American Society of Health-System Pharmacists, Inc. 2011. link.
  2. Zaenglein A. "Topical retinoids in the treatment of acne vulgaris." Seminars in Cutaneous Medicine and Surgery. 2008; 27(3): 177-1832.
  3. Yentzer B, McClain R, Feldman S. "Do topical retinoids cause acne to flare?" Journal of Drugs in Dermatalogy. 2009; 8(9): 799-801.
  4. Leyden JJ, et al. "Effects of topical retinoid therapy on acne lesions: a psychometric assessment." Cutis. 2012; 90(1): 46-50.

阿达帕林(Adapalene)

阿达帕林,商品名达芙文,也是一种维甲酸类药物,主要用于治疗轻中度痤疮,外用,通常每天使用一次。[1-2]

(了解更多:美国国家医学图书馆)

作用机制:

痤疮的产生和毛囊细胞分化过快、以及毛孔堵塞有关,阿达帕林通过抑制毛囊上皮细胞的分化与增殖而减少粉刺的形成[1,2],此外,其还具有抗炎作用。[3]

用药注意:

阳光照射会刺激皮肤,应尽量减少日晒。[1,2]

可能会出现红肿、瘙痒、皮肤脱落或干燥等副作用。[1,2,4]

  1. "Adapalene." MedlinePlus. 2008. American Society of Health System Pharmacists, Inc. 2011.
  2. Noble S, Scott L, Waugh J. "Adapalene: A Review of its Use in the Treatment of Acne Vulgaris." Drugs. 2004; 64(13): 1465-78. Abstract. PubMed. 9 Feb, 2005. link.
  3. Irby C, Yentzer B, Feldman S. "A review of adapalene in the treatment of acne vulgaris". Journal of Adolescent Health. 2008; 43(5): 421-424.
  4. Poulin Y, et. al. "A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuosly improves efficacy among patients with severe acne vulgaris: Results of a randomized controlled trial." British Journal of Dermatology. 2011; 164(6): 1376-1382.

他扎罗汀(Tazarotene)

他扎罗汀是另外一种外用维甲酸类药物,用于治疗银屑病和痤疮[1],通常每天使用一次,可以与其它药物联合使用。[2]

(了解更多:Wiki百科 )

作用机制:

和其他外用维甲酸药物类似,他扎罗汀有调节角质细胞分化、减少皮脂分泌、溶解粉刺以及抗炎的作用[3]。临床试验中,12周的疗程后平均皮损消退率为50%。[4-6]

用药注意:

孕妇禁用,育龄女性也要严格避孕,以防对胎儿造成出生缺陷;

应避免阳光照射,一般晚上用药;

副作用发生率约为10-30%,不良反应有皮肤干燥、脱屑、灼热感、刺痛、红斑和瘙痒。

  1. "Tazarotene (Topical)." MedlinePlus. 2006. Thomson Healthcare. 2000.
  2. Del Rosso JQ and Tanghetti E. "A status report on topical tazarotene in the management of acne vulgarism." Journal of Drugs in Dermatology. 2013; 12(3): s53-78.
  3. Chivot M. "Retinoid Therapy For Acne: A Comparative Review." American Journal of Clinical Dermatology. 2005; 6(1): 13-9.
  4. Berson S, et. al. "Tazarotene Cream in Acne Clinical Study Investigator: Effects of Tazarotene 0.1% Cream in the Treatment of Facial Acne Vulgaris: Pooled Results from Two Multicenter, Double-Blind, Randomized, Vehicle-Controlled, Parallel-Group Trials." Clinical Therapeutics. 2004; 26(11): 1865-73.
  5. Berson D, et. al. "Once-daily Tazarotene 0.1% Gel Versus Once-Daily Tretinoin 0.1% Microsponge Gel for the Treatment of Facial Acne Vulgaris: A Double-Blind Randomized Trial." Cutis. 2002; 69(2): 12-9.
  6. Feldman SR, Werner CP and Alio Saenz AB. "The efficacy and tolerability of tazarotene foam, 0.1%, in the treatment of acne vulgarism in 2 multi center, randomized, vehicle-controlled, double-blind studies." Journal of Drugs in Dermatology. 2013; 12(4): 438-46.

过氧化苯甲酰(Benzoyl peroxide)

过氧化苯甲酰是一种抗菌剂,既可以作为处方药,又可以用于非处方药,可以配制成乳剂、凝胶、洗剂等。[1,2,4,5]

(了解更多:美国国家医学图书馆 )

作用机制:

过氧化苯甲酰有杀灭痤疮丙酸杆菌、溶解粉刺和收敛的作用[1-6],也有助于减少炎症反应[7-9]。可以配制成2.5%、5%、10%不同浓度的乳霜、凝胶或洗剂等,2.5%的浓度和更高浓度的疗效类似,但副作用相对少些[6,10]

用药注意:

刚开始使用时,少数敏感肌肤会出现红斑、瘙痒、干燥等刺激反应。[6]

约1-3%的患者会出现过敏反应,伴随有炎症或结硬皮。[3]

  1. "Benzoyl Peroxide". MedlinePlus. 2010. American Society of Health-System Pharmacists, Inc. 2011 link.
  2. Berger, et. al. Andrew's Diseases of the Skin. Philadelphia: W.B. Saunders Company, 2000.
  3. Drobil M, Lindemayr H. "Contact Sensitization to Benzoyl Peroxide." Contact Dermatitis. 1981; 7(3): 137-40.
  4. Ives T. "Benzoyl Peroxide." American Pharmacy. 1992; 32(8): 33-8.
  5. Weinberg J. "The Utility of Benzoyl Peroxide in Hydrophase Base (Brevoxyl) in the Treatment of Acne Vulgaris." Journal of Drugs in Dermatology. 2006; 5(4): 344-9.
  6. Sagransky M, Yentzer B, Feldman S. "Benzoyl peroxide: A review of its current use in the treatment of acne vulgaris." Expert Opinion on Pharmacotherapy. 2009; 10(15): 2555-2562.
  7. Dutil M. "Benzoyl peroxide: Enhancing antibiotic efficacy in acne management." Skin Therapy Letter. 15(10): 5-7.
  8. Harper J. "Benzoyl peroxide development, pharmacology, formulation and clinical uses in topical fixed combinations." Journal of Drugs in Dermatology. 2010; 8(9): 482-487.
  9. Tanghetti E, Popp K. "A current review of topical benzoyl peroxide: New prospectives on formulation and utilization." Dermatologic Clinics. 2009; 27(1): 17-24.
  10. Fakhouri T, Yentzer B, Feldman S. "Advancement in benzoyl peroxide-based acne treatment: Methods to increase both efficacy and tolerability." Journal of Drugs in Dermatology. 2009; 8(7): 657-661.

壬二酸(Azelaic Acid)

商品名为“Azelex”,是一种浓度为20%的壬二酸霜,外用,通常每天使用两次。[1]

(了解更多:美国国家医学图书馆)

作用机制:

壬二酸能够促进皮肤修复、防止毛孔堵塞,从而减少粉刺的形成,同时,它也具有杀灭痤疮丙酸杆菌[1]和抗炎的作用[2]

用药注意:

壬二酸的副作用通常比较轻微和短暂,可能会出现局部皮肤刺激,如瘙痒、刺痛和烧灼感,发生率为1-5%。

  1. "Azelaic acid topical." MedlinePlus. 2008. American Society of Health System Pharmacists. 2011.
  2. Thiboutot D. "Versatility of azelaic acid 15% gel in treatment of inflammatory acne vulgaris." Journal od Drugs in Dermatology. 2008; 7(1):13-16.

克林霉素(Clindamycin)

这是一种外用抗生素,可以配制成水剂、凝胶、泡沫或乳液,通常每天使用两次。[1,2]

(了解更多:美国国家医学图书馆 )

作用机制:

可以杀灭痤疮丙酸杆菌。

用药注意:

可能会出现灼烧感、瘙痒、脱皮、红斑和皮肤干燥等不良反应,也有腹泻、结肠炎的报道。[1,3]

  1. "Clindamycin." MedlinePlus. 2010. American Society of Health-System Pharmacists, Inc. 2011 link.
  2. Krochmal L, et. al. "The Safety and Efficacy of Clindamycin Phosphate Foam 1% Versus Clindamycin Phosphate Topical Gel 1% for the Treamtent of Acne Vulgaris." Journal of Drugs and Dermatology. 2005; 4(1): 48-56.
  3. Cambazard F, et. al. "A Multicentre, Single-Blind, Randomized Comparison of a Fixed Clindamycin Phosphate/ Tretinoin Gel Formulation (Velac) Applied Once Daily and a Clindamycin Lotion Formulation (Dalacin T) Applied Twice Daily in the Topical Treatment of Acne Vulgaris." The British Journal of Dermatology. 2000; 143(3): 498-505.

红霉素(Erythromycin)

红霉素是一种外用抗生素,可以配制成凝胶、药膏、溶液等,通常每天使用两次[8],常和过氧化苯甲酰配合使用。

(了解更多:美国国家医学图书馆 )

作用机制:

可以杀灭痤疮丙酸杆菌。[1-2]

用药注意:

常见的不良反应包括脱皮、皮肤干燥、瘙痒、红斑等。[2]

为了避免引起刺激,在皮肤上用其它药之前,最好咨询医生是否可以同时使用。[2]

  1. Berger, et. al. Andrew's Diseases of the Skin. Philadelphia: W.B. Saunders Company, 2000.
  2. "Erythromycin". MedlinePlus. 2008. American Society of Health-System Pharmacists, Inc. 2011 link. link.

氨苯砜(Dapsone)

商品通常为5%浓度的外用凝胶,每天使用两次。

(了解更多:美国国家医学图书馆 )

作用机制:

氨苯砜是有抑制炎症反应的作用,也有抗氧化作用和一定的抗菌性。[1]可以使痤疮减少30-45%。

用药注意:

与口服氨苯砜(通常用于治疗麻风病或其他皮肤疾病)不同,用于治疗痤疮的外用氨苯砜不会出现严重的不良反应[4,5],它的副作用通常较轻,比如皮肤干燥、皮疹、灼烧感等。[6]
  1. Kircik L. "Harnessing the anti-inflammatory effects of topical dapsone for management of acne." Journal of Drugs in Dermatology. 2010; 9(6): 667-671.
  2. Tanghetti E, Harper JC and Oefelein MG. "The efficacy and tolerability of dapsone %5 gel in female vs male patients with facial acne vulgarism: gender as a clinically relevant outcome variable." Journal of Drugs in Dermatology. 2012; 11(12): 1417-21.
  3. Tan J. "Dapsone 5% Gel - A New Option in Topical Therapy for Acne." Skin Therapy Letter. 2012; 17(8): 1-3.
  4. Stotland M, Shalita A, Kissling R. "Dapsone 5% gel: A review of its efficacy and safwty in the treatment of acne vulgaris." American Journal of Clinical Dermatology. 2009; 10(4): 221-227.
  5. Fleischer A, et. al. "Dapsone gel 5% in combination with adapalene gel 0.1%, benzoyl peroxide gel 4% or mosturizer for the tretment of acne vulgaris: A 12-week, randomized, double-blind study." Journal of Drugs in Dermatology. 2010; 9(1): 33-40.
  6. Tan J. "Dapsone 5% Gel: A New Option in Topical Therapy for Acne." Skin Therapy Letter. 2012; 17(8): 1-3.

磺胺醋酰钠(Sodium sulfacetamide)

磺胺醋酰钠是一类磺胺药,有抗菌活性,皮肤外用。[1,3]

(了解更多: wiki百科)

作用机制:

可以抑制痤疮细菌的生长,也有抗炎作用。[1-4]

用药注意:

临床试验中不良反应的发生率低于2%,常见的包括产生刺痛感和灼烧感。[4]

  1. Bettoli, et. al. Fast Facts-Acne. Oxford, UK: HealthPress Limited, 2004.
  2. Fulton, James E. Acne Rx. James E. Fulton Jr., M.D., PhD: 2001.
  3. "Sodium Sulfacetamide Topical." Drugs.com. 2009. Cerner Multum, Inc. 1996-2006.
  4. Draelos Z. "The multifunctionality of 10% sodium sulfacetamide, 5% sulfur emollient foam in the treatment of inflammatory facial dermatoses." Journal of Drugs in Dermatology. 2010; 9(3): 234-236.

口服药

异维A酸(Accutane)

商品名为“泰尔丝”或“特维丝”,通常为口服用,是一种治疗重度痤疮的特效药,通常用药15-20周可完全清除或缓解症状。[1-2]

(了解更多: 异维A酸)

作用机制:

减少皮脂分泌,调节毛囊导管角化,减少痤疮丙酸杆菌繁殖,抗炎。[1]

用药注意:

可引起诸多副作用,包括出生缺陷[1-3]、口唇干燥、皮肤干燥、关节炎、肌肉骨骼疼痛、血脂升高、眼睛不适等[1-2,4-7]

妊娠或即将妊娠的女性禁止使用。育龄期女性或其配偶在开始服用前3个月、治疗期间以及停药后3个月要严格避孕。

哺乳期、肝肾功能不全和维生素A过量患者禁用。

  1. "Isotretinoin." MedlinePlus. 2011. American Society of Health-System Pharmacists, Inc. 2011. link.
  2. McLane J. "Analysis of Common Side Effects of Isotretinoin." Journal of the American Academy of Dermatology. 2001; 45(5): 188-94.
  3. Erikson J, Honein M, Paulozzi L. "Continued Occurrence of Accutane-Exposed Pregnancies." Teratology. 2001; 64(3): 142-7. Abstract. PubMed. 2002. link.
  4. Bewley A, et. al. "Isotretinoin Causing Acute Aseptic Arthropathy." Clinical and Experimental Dermatology. 1995; 20(3): 279-281.
  5. Campanella M, V De Francesco, Stinco G. "Acute Arthritis During Isotretinoin Treatment for Acne Conglobata." Dermatology. 1997; 194(2): 195.
  6. Ceyrac, Lehucher D. "Acute Arthritis After Isotretinoin." Dermatology. 1999; 198(4): 406-07.
  7. Cunliffe W, Goulden V, Layton A. "Long-Term Safety of Isotretinoin as a Treatment for Acne Vulgaris." British Journal of Dermatology. 1994; 131(3): 360-3.

口服抗生素 (Oral antibiotics)

如多四环素、米诺环素、左氧氟沙星、复方新诺明等,口服抗生素一般适用于中度至重度痤疮,通常每天服用一次。

作用机制:

口服抗生素可以阻止痤疮丙酸杆菌的生长繁殖[1],同时也有抗炎作用[2-4]

用药注意:

抗生素仅对50%左右的患者有效,治愈程度中等。[5-8]

抗生素治疗痤疮时要注意避免或减少耐药性的产生,最好避免单独使用,疗程也不宜过长。

用药时要注意一些不良反应,较常见的包括胃部不适、腹泻、恶心、呕吐、头昏、头痛、眩晕等[2]

四环素类不宜用于孕妇、哺乳期女性以及小于16岁的儿童;

大环内酯类和四环素类联合其他药物使用时要注意药物的相互作用。

  1. Kawabata S, Kurokawa I, Nishijima S. "Antimicrobial Susceptibility of Propionibacterium Acnes Isolated from Acne Vulgaris." European Journal of Dermatology. 1999; 9(1): 25-8.
  2. "Tetracycline." MedlinePlus. 2008. American Society of Health-System Pharmacists, Inc. 2011 link.
  3. Mays RM, et al. "New antibiotic therapies for acne and rosacea." Dermatology and Therapy. 2012; 25(1): 23-37.
  4. Perret LJ, and Tait CP. "Non-antibiotic properties of tetracyclines and their clinical application in dermatology." Australasian Journal of Dermatology. 2013; [ahead of print].
  5. Torok HM. "Extended-release Formulation of Minocycline in the Treatment of Moderate-to-severe Acne Vulgaris in Patients Over the Age of 12 Years." The Journal of Clinical and Aesthetic Dermatology. 2013; 6(7): 19-22.
  6. Leyden JJ, et al. "A randomized, phase 2, dose-ranging study in the treatment of moderate to severe inflammatory facial acne vulgarism with doxycycline calcium." Journal of Drugs in Dermatology. 2013; 12(6): 658-63.
  7. Kawaya A, Wada T, and Oiso N. "Clinical effectiveness of once-daily levofloxacin for inflammatory acne with high concentrations in the lesions." The Journal of Dermatology. 2012; 39(1): 94-6.
  8. Chiou WL. "Oral tetracyclines may not be effective in treating acne: dominance of the placebo effect." International Journal of Clinical Pharmacology and Therapeutics. 2012; 50(3): 157-61.
  9. Garner SE, et al. "Minocycline for acne vulgarism: efficacy and safety." Cochrane Reviews. 2012; 15: 8.M
  10. Kim SJ and English JC. "Minocycline-Induced Hyperpigmentation." Journal of Pediatric and Adolescent Gynecology. 2011; 25(1): 77-78.
  11. Johnston S. "Feeling blue? Minocycline-induced staining of the teeth, oral mucosa, schlerae and ears - a case report." British Dental Journal. 2013; 215(2): 71-3.

口服避孕药(Oral contraceptives)

包括孕酮和雌激素。

作用机制:

口服避孕药可以对抗雄激素的作用,也可以作用于毛囊皮脂腺,减少皮脂分泌,从而起到缓解痤疮症状的作用。研究表明,皮损平均消退30-60%。[1-4]

用药注意:

吸烟者服用避孕药会增加心脏病的风险[2]

可能的不良反应有:少量子宫出血、乳房胀痛、恶心、体重增加、深静脉血栓及出现黄褐斑等。

  1. Berger, et. al. Andrew's Diseases of the Skin. Philadelphia: W.B. Saunders Company, 2000.
  2. Salvaggio HL and Zaenglein AL. "Examining the use of oral contraceptives in the management of acne." International Journal of Women's Health. 2010; 2: 69-76.
  3. "Estrogen and Progestin (Oral Contraceptives)." MedlinePlus. 2011. American Society of Health-System Pharmacists, Inc. 2011 link.
  4. Bettoli, et. al. Fast Facts-Acne. Oxford, UK: HealthPress Limited, 2004.

安体舒通(Spironolactone)

也称为螺内酯、阿尔达克通,是抗雄激素治疗常用的药物,可用于治疗雄激素升高型痤疮 。

(了解更多:美国国家医学图书馆)

作用机制:

抑制雄激素与受体结合,从而抑制皮脂腺的功能。

用药注意:

不良反应包括月经不调、疲劳、嗜睡、恶心、头昏、头痛和高钾血症。

孕妇禁用,男性患者也不推荐使用。

  1. "Spironolactone." MedlinePlus. 2009. American Society of Health System Pharmacists, Inc. 2011.
  2. NH Shear. "Help for Recalcitrant Acne -- A Role for Spironolactone?" Journal Watch Dermatology (October 2000). 8 April 2008.

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