Wilson B B
Department of Dermatology, University of Virginia Health Sciences Center, Charlottesville.
Prim Care. 1989 Sep;16(3):695-712.
Acne vulgaris is a disease of the pilosebaceous unit that affects nearly all persons to some degree during the teenage years. It is a disease that should be treated because of the anxiety and disfigurement it causes in the affected patient. Acne therapy is directed against the three probable pathogenic processes in acne: (1) abnormal keratinization of the sebaceous follicle, (2) excessive production of sebum, and (3) proliferation of bacteria in the follicle. Superficial acne consisting of comedones and small papulopustules will frequently respond to topical therapy such as retinoic acid, benzoyl peroxide, and topical antibiotics. Deeper lesions require systemic antibiotics of which tetracycline is the drug of choice. Severe, recalcitrant cystic acne usually responds well to the oral retinoid, isotretinoin. The severe teratogenic effects of isotretinoin on a developing fetus make this a risky drug to prescribe for women with childbearing potential. In such cases the greatest precautions should be taken to avoid pregnancy during a course of isotretinoin. Such precautions include pregnancy testing, contraceptive counseling, and the use of at least two effective forms of birth control in sexually active women.
寻常痤疮是一种累及毛囊皮脂腺的疾病，在青少年时期几乎所有人都会在某种程度上受到影响。由于它给患者带来焦虑和毁容，所以是一种需要治疗的疾病。痤疮治疗针对痤疮可能的三个致病过程：（1）皮脂腺毛囊的异常角化，（2）皮脂过度分泌，以及（3）毛囊内细菌的增殖。由粉刺和小丘疹脓疱组成的轻度痤疮通常对局部治疗有反应，如维甲酸、过氧化苯甲酰和局部用抗生素。较深的损害需要使用全身性抗生素，其中四环素是首选药物。严重的、难治性囊肿性痤疮通常对口服维甲酸类药物异维甲酸反应良好。异维甲酸对发育中的胎儿有严重的致畸作用，这使得它成为给有生育潜力的女性开的一种有风险的药物。在这种情况下，在服用异维甲酸疗程中应采取最大的预防措施以避免怀孕。这些预防措施包括妊娠试验、避孕咨询，以及对有性生活的女性使用至少两种有效的避孕方式。
