Royal North Shore Hospital, Sydney, NSW
Royal North Shore Hospital, Sydney, NSW.
Med J Aust. 2017 Jan 16;206(1):41-45. doi: 10.5694/mja16.00516.
Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production; altered keratinisation; bacterial colonisation of hair follicles on the face, neck, chest and back by Propionibacterium acnes; and an inflammatory response in the skin. The exact way these processes interact and the order in which they occur in the pathogenesis of acne are still unclear. Scarring that occurs from acne, particularly severe acne, can persist a lifetime and have long lasting psychosocial effects. Depression, social isolation and suicidal ideation are frequent comorbidities in acne. Despite the plethora of topical and systemic treatments available for acne, there is a relative lack of quality evidence for its application. Of the systemic treatments available, oral isotretinoin remains the most effective well established treatment for acne that targets all the aetiological factors. Current guidelines for the treatment of acne are based largely on expert consensus and advocate a combination of topical agents in mild to moderate cases and reserve the use of systemic therapies for moderate to severe or refractory cases of acne. However, given the psychosocial impacts of acne, there is a strong argument for early, effective treatment with systemic therapy when topical and general measures have failed.
痤疮是一种源于雄激素诱导的皮脂过度分泌、角质形成细胞异常角化、痤疮丙酸杆菌定植于面颈部、胸背部毛囊、皮肤炎症反应等多因素所致的毛囊皮脂腺慢性炎症性疾病。这些过程的相互作用方式以及它们在痤疮发病机制中的发生顺序尚不清楚。痤疮导致的瘢痕，尤其是严重的痤疮瘢痕，可能会持续一生，并产生长期的心理社会影响。抑郁、社交孤立和自杀意念是痤疮的常见合并症。尽管有大量的痤疮局部和系统治疗方法，但在其应用方面缺乏高质量的证据。在现有的系统治疗方法中，口服异维 A 酸仍然是针对所有病因的最有效、最成熟的痤疮治疗方法。目前的痤疮治疗指南主要基于专家共识，主张在轻度至中度病例中联合使用局部药物，将系统治疗保留用于中度至重度或难治性痤疮病例。然而，鉴于痤疮对心理社会的影响，如果局部和一般措施失败，有充分的理由早期采用全身治疗进行有效治疗。
