Sacchidanand Sarvajnamurthy Aradhya, Lahiri Koushik, Godse Kiran, Patwardhan Narendra Gajanan, Ganjoo Anil, Kharkar Rajendra, Narayanan Varsha, Borade Dhammraj, D'souza Lyndon
Consultant Dermatologist, Sujala Polyclinic and Laboratory, Bengaluru, Karnataka, India.
Consultant Dermatologist, Wizderm Speciality Skin and Hair Clinic, Kolkata, West Bengal, India.
Indian J Dermatol. 2017 Jul-Aug;62(4):341-357. doi: 10.4103/ijd.IJD_41_17.
Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of , and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.
痤疮是一种慢性炎症性皮肤病，其发病机制涉及四个主要因素，如雄激素诱导的皮脂分泌增加、角质化改变、痤疮丙酸杆菌定植和炎症。印度市场上有几种痤疮单一疗法和联合疗法可供选择并开具处方，包括维甲酸、过氧化苯甲酰（BPO）、抗感染药和其他各类药物。尽管标准指南和建议概述了轻度、中度和重度痤疮的治疗方法，但印度市场上各类药物治疗的相关性和定位仍不明确。本文讨论了印度现有的局部和口服痤疮治疗方法、印度痤疮整体管理面临的挑战以及印度皮肤科医生的建议。专家认为，在局部治疗中，联合疗法优于单一疗法，因为单一疗法疗效较低、耐受性差、存在安全问题、有不良反应且会出现细菌耐药性。维甲酸类药物在粉刺性痤疮和维持治疗中更受青睐。如果疗效不佳，对于丘疹脓疱性痤疮，推荐使用BPO-维甲酸或维甲酸-抗菌药物联合疗法；对于脓疱结节性痤疮，推荐使用维甲酸-BPO或BPO-抗菌药物联合疗法。口服药物通常推荐用于重度痤疮。低剂量维甲酸类药物经济实惠，患者接受度更高。抗生素应在炎症在临床上可见时一直使用。对于雄激素水平高的女性应给予抗雄激素治疗，并将其添加到治疗方案中以调节月经周期。对于迟发性高雄激素血症，应使用口服皮质类固醇。专家建议，早期开始治疗与有效的治疗结果直接相关，并可预防并发症。
