Fendrich Z, Jandová E, Finsterlová M
Katedra farmakologie a toxikologie Farmaceutické fakulty Univerzity Karlovy, Hradec Králové.
Ceska Slov Farm. 2000 Mar;49(2):62-7.
An inevitable condition for the pharmacist is a basic knowledge of dermatological changes which are prominent in acne and solar impairment of the skin to be able to recommend in a qualified manner an effective and safe treatment to the patient. However, sufferers of the more serious forms of acne should always be referred to their general practitioner, or preferentially a dermatologist. Acne vulgaris is an androgen-induced disorder, but three major mechanisms for the development of the disease have been identified: hypertrophy of the sebaceous gland, hyperkatosis of the follicular epithelium, and proliferation of microbial flora, particularly Propionibacterium acnes. The basis of all lesions is the microcomedone which is developed into the ripe comedone. Inflammatory lesions are thought to be due to proliferation of P. acnes. In the selfmedication of common acne, benzoyl peroxide, which in a 5-10% lotion exerts antimicrobial and keratolytic properties, proved to be useful. Patients appreciate a lot its instant effect which is visible after just one day of treatment. Salicylic acid is another effective drug, which, when used on the long-term basis, has comedolytic properties; it reduces the number of microcomedones and counteracts plugging of the follicles. In addition, in healthy young women who take oral contraception, a triphasic combined oral preparations of contraceptives with newer progestins, notably with norgestimmate, which is practically free of androgenic effects, are recommended with advantage for the treatment of moderate acne vulgaris without any adverse effects. Solar impairment of the skin, the so-called solar ageing, is clinically indistinguishable from biological ageing. Changes connected with solar impairment appear mostly in the dermis, where solar elastosis develops, the skin gets drier and wrinkle formation appears. For the treatment, hydroxy acids are recommended, namely salicylic acid, which is very effective, because in combination with a suitable vehicle it produces desquamation or exfoliation. Desquamation is beneficial as it gives a youthful appearance to the skin.
对药剂师来说，掌握皮肤病学变化的基本知识是必不可少的，这些变化在痤疮和皮肤日光损伤中很突出，以便能够以专业的方式为患者推荐有效且安全的治疗方法。然而，患有较严重痤疮的患者应始终转诊给他们的全科医生，最好是皮肤科医生。寻常痤疮是一种雄激素诱导的疾病，但已确定该疾病发展的三个主要机制：皮脂腺肥大、毛囊上皮角化过度以及微生物菌群增殖，尤其是痤疮丙酸杆菌。所有病变的基础都是微粉刺，它会发展成成熟的粉刺。炎症性病变被认为是由于痤疮丙酸杆菌的增殖所致。在寻常痤疮的自我药疗中，5-10%洗剂形式的过氧化苯甲酰具有抗菌和角质溶解特性，已被证明是有用的。患者非常欣赏它的即时效果，治疗一天后就可见效。水杨酸是另一种有效药物，长期使用时具有溶粉刺特性；它可减少微粉刺的数量并对抗毛囊堵塞。此外，对于服用口服避孕药的健康年轻女性，推荐使用含有新型孕激素（尤其是几乎无雄激素作用的诺孕酯）的三相联合口服避孕药，以治疗中度寻常痤疮且无任何不良反应。皮肤的日光损伤，即所谓的光老化，在临床上与生物老化难以区分。与日光损伤相关的变化大多出现在真皮层，在那里会出现日光性弹力纤维变性，皮肤变得更干燥并出现皱纹。对于治疗，推荐使用羟基酸，即水杨酸，它非常有效，因为与合适的赋形剂结合时会产生脱屑或剥脱作用。脱屑是有益的，因为它能使皮肤呈现年轻外观。
