Thielitz Anja, Krautheim Andrea, Gollnick Harald
Department of Dermatology and Venereology, Otto-von-Guericke University Magdeburg, Germany.
Dermatol Ther. 2006 Sep-Oct;19(5):272-9. doi: 10.1111/j.1529-8019.2006.00084.x.
The pathogenesis of acne, the most common skin disease, is complex and multifactorial. Clinical experience has demonstrated that parallel targeting of various pathogenetic factors, achieved either by mono- or combination therapy with appropriate drugs, represents the most effective approach to treating acne. Topical retinoids have been shown to expulse mature comedones, reduce microcomedone formation, and exert immunomodulatory effects. They have broad anti-acne activity without the risk of inducing bacterial resistance, which justifies their use as first-line treatment in most types of noninflammatory and inflammatory acne and makes them uniquely suitable as long-term medication to maintain remission after cessation of initial combination therapy. Systemic isotretinoin as a monotherapeutic agent strongly affects all four major pathogenetic factors and has been, in the hand of experienced dermatologists, a potent and safe agent for the treatment of severe and recalcitrant acne forms for more that 20 years. However, patient counseling, careful monitoring, and evaluation and management of adverse events are necessary. The use of isotretinoin has experienced a drawback now that its indication has been lowered from a first-line to a second-line medication.
痤疮是最常见的皮肤疾病，其发病机制复杂且具有多因素性。临床经验表明，通过使用适当药物进行单一治疗或联合治疗来同时针对各种致病因素，是治疗痤疮最有效的方法。外用维甲酸已被证明可排出成熟粉刺、减少微粉刺形成并发挥免疫调节作用。它们具有广泛的抗痤疮活性，且不存在诱导细菌耐药性的风险，这使得它们在大多数非炎症性和炎症性痤疮类型中作为一线治疗药物使用具有合理性，并且使其特别适合作为长期用药，在初始联合治疗停止后维持缓解状态。系统使用异维甲酸作为单一治疗药物会强烈影响所有四个主要致病因素，在经验丰富的皮肤科医生手中，20多年来一直是治疗重度和顽固性痤疮的有效且安全的药物。然而，需要对患者进行咨询、仔细监测以及对不良事件进行评估和管理。由于异维甲酸的适应证已从一线用药降至二线用药，其使用现在存在一个缺点。
