Plewig Gerd, Dressel Heidrun, Pfleger Maike, Michelsen Silke, Kligman Albert M
Department of Dermatology and Allergology, Ludwig-Maximilian-University Munich, Germany.
J Dtsch Dermatol Ges. 2004 Jan;2(1):31-45. doi: 10.1046/j.1439-0353.2004.03739.x.
Isotretinoin is well known in the therapy of acne papulopustulosa and acne conglobata. No study has investigated the pathophysiological changes of the skin of acne patients, especially when low dose oral isotretinoin is given in combination with topical tretinoin.
28 patients were treated for 6 months with oral isotretinoin. In the acne conglobata group (A-C) patients were treated with 10 mg (Group A) or 20 mg isotretinoin (Groups B, C) in combination with topical 0.05% tretinoin cream. Group C was treated the first 2 weeks with 0.05% betamethasone valerate cream instead of tretinoin cream. In the acne papulopustulosa group, the patients received 0.5 mg isotretinoin/kg bodyweight and 0.05% tretinoin cream, either alone (Group E), or with oral methylprednisolone during induction (Group D).
Acne conglobata--A reduction of inflammatory lesion by 87-94% and of non-inflammatory lesions by 81-88% was achieved (Groups A-C). A reduction of sebaceous gland size by 35-58%, sebum production by 90-95%, follicular keratinization by 55-70% and Propionibacteria by 33-73% was seen (Groups B and C better than Group A). In Group A the amount of lipids was only reduced by 6%, in Group B by 35% and in Group C by 40%. Acne papulopustulosa--Sebum excretion rate and follicular keratinization were reduced in Group D by 89% and 50% respectively, with isotretinoin alone by 94% and 53%. The amount of lipids was reduced in Group D by 40% and in Group E by 21%.
Because of the efficacy and cost-benefit relationship of isotretinoin in the treatment of acne compared to other therapeutic approaches, further use low dose isotretinoin in the described settings seems to justified.
异维A酸在丘疹脓疱性痤疮和聚合性痤疮的治疗中广为人知。尚无研究调查痤疮患者皮肤的病理生理变化，尤其是低剂量口服异维A酸与外用维甲酸联合使用时。
28例患者接受口服异维A酸治疗6个月。在聚合性痤疮组（A-C组），患者分别接受10毫克（A组）或20毫克异维A酸（B组、C组）联合0.05%外用维甲酸乳膏治疗。C组在治疗的前2周使用0.05%戊酸倍他米松乳膏而非维甲酸乳膏。在丘疹脓疱性痤疮组，患者接受0.5毫克/千克体重的异维A酸及0.05%维甲酸乳膏治疗，单独使用（E组），或在诱导期联合口服甲泼尼龙（D组）。
聚合性痤疮——炎症性皮损减少87%-94%，非炎症性皮损减少81%-88%（A-C组）。皮脂腺大小减少35%-58%，皮脂分泌减少90%-95%，毛囊角化减少55%-70%，痤疮丙酸杆菌减少33%-73%（B组和C组优于A组）。A组脂质含量仅减少6%，B组减少35%，C组减少40%。丘疹脓疱性痤疮——D组皮脂排泄率和毛囊角化分别减少89%和50%，单独使用异维A酸时分别减少94%和53%。D组脂质含量减少40%，E组减少21%。
与其他治疗方法相比，由于异维A酸在痤疮治疗中的疗效和成本效益关系，在所述情况下进一步使用低剂量异维A酸似乎是合理的。
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