Thielitz Anja, Gollnick Harald
University Clinic of Dermatology and Venereology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Am J Clin Dermatol. 2008;9(6):369-81. doi: 10.2165/0128071-200809060-00003.
Topical retinoids represent a mainstay of acne treatment because they expel mature comedones, reduce microcomedone formation, and exert anti-inflammatory effects. The first-generation retinoid tretinoin (all-trans retinoic acid) and the synthetic third-generation polyaromatics adapalene and tazarotene are approved for acne treatment by the US FDA, whereas topical tretinoin, isotretinoin (13-cis retinoic acid), and adapalene are accredited in Canada and Europe. Topical retinoids have a favorable safety profile distinct from the toxicity of their systemic counterparts. Local adverse effects, including erythema, dryness, itching, and stinging, occur frequently during the early treatment phase. Their impact varies with the vehicle formation, skin type, frequency and mode of application, use of moisturizers, and environmental factors such as sun exposure or temperature. The broad anti-acne activity and safety profile of topical retinoids justifies their use as first-line treatment in most types of non-inflammatory and inflammatory acne. They are also suitable as long-term medications, with no risk of inducing bacterial resistance, for maintenance of remission after cessation of initial combination therapy.
局部用维甲酸类药物是痤疮治疗的主要手段，因为它们能排出成熟的粉刺，减少微粉刺的形成，并发挥抗炎作用。第一代维甲酸类药物维甲酸（全反式维甲酸）以及合成的第三代多芳香族化合物阿达帕林和他扎罗汀已获美国食品药品监督管理局批准用于痤疮治疗，而局部用维甲酸、异维甲酸（13-顺式维甲酸）和阿达帕林在加拿大和欧洲也已获批。局部用维甲酸类药物具有良好的安全性，与全身用药的毒性不同。局部不良反应，包括红斑、干燥、瘙痒和刺痛，在治疗早期经常出现。其影响因剂型、皮肤类型、使用频率和方式、保湿剂的使用以及阳光照射或温度等环境因素而异。局部用维甲酸类药物广泛的抗痤疮活性和安全性证明了它们在大多数非炎性和炎性痤疮类型中作为一线治疗药物的合理性。它们也适合作为长期用药，在初始联合治疗停止后维持缓解状态时不会产生诱导细菌耐药性的风险。
