Cunliffe W J, Norris J F
Leeds Foundation for Dermatological Research, Leeds General Infirmary, UK.
Dermatologica. 1987;175 Suppl 1:133-7. doi: 10.1159/000248869.
Isotretinoin is of undisputed benefit in the treatment of acne. In doses of 1 mg/kg/day for 4 months the drug produces a highly significant reduction in sebum excretion rate (90 +/- 3%) in comedone formation as measured by assessing follicular casts (70 +/- 5%), and in surface Propionibacterium acnes. However, the mechanisms of long-term clinical remission are not well understood. There are however, risk factors which predetermine the outcome to treatment with isotretinoin. Younger subjects (14-19 years) and those who have had acne for less than 6 years, respond less well than older subjects. Subjects with more truncal acne also fare less well than those with predominantly facial acne. A return of the reduced sebum excretion rate to within 10% of the pre-treatment level also is a poor prognostic factor. This and future studies could lead to development of more logical dose regimes depending, for example, on the age of the patient; duration of acne and its site. However, until proven otherwise, this study confirms our earlier data, and that of the German multi-centres and Strauss et al (1), that the optimum dose schedule for treating acne patients is 1 mg/kg/day regime.
异维A酸在治疗痤疮方面的益处是无可争议的。以1毫克/千克/天的剂量服用4个月，该药物能使皮脂分泌率大幅降低（90±3%），通过评估毛囊角质栓来衡量，粉刺形成减少（70±5%），且皮肤表面的痤疮丙酸杆菌也减少。然而，长期临床缓解的机制尚不完全清楚。不过，存在一些决定异维A酸治疗效果的风险因素。较年轻的受试者（14 - 19岁）以及痤疮病史少于6年的受试者，其治疗反应不如年龄较大的受试者。躯干痤疮较多的受试者治疗效果也不如以面部痤疮为主的受试者。皮脂分泌率降至治疗前水平的10%以内后又回升，这也是一个不良预后因素。这项研究以及未来的研究可能会促使根据患者年龄、痤疮病程及其发病部位等制定更合理的给药方案。然而，在得到其他证据之前，本研究证实了我们早期的数据，以及德国多中心和施特劳斯等人（1）的数据，即治疗痤疮患者的最佳给药方案是1毫克/千克/天。
