Isvy-Joubert Anne, Nguyen Jean-Michel, Gaultier Aurélie, Saint-Jean Mélanie, Le Moigne Marie, Boisrobert Elodie, Khammari Amir, Dreno Brigitte
Department of Dermatology, Nantes University Hospital, Nantes, France.
Clinical Research Department, Methodological Unit, Nantes, France, INSERM U892, 9 quai Montcousu 44093, Nantes, France.
Eur J Dermatol. 2017 Aug 1;27(4):393-398. doi: 10.1684/ejd.2017.3062.
The prevalence of acne in the adult population is increasing, particularly in women. Spironolactone regulates sebaceous gland activity by blocking androgen receptor. To evaluate retrospectively the efficacy of spironolactone in women with acne. Data from 70 women of at least 20 years, treated for their acne between 2010 and 2015 with low-dose spironolactone (≤150 mg/day), were analysed. Remission was defined by the number of retentional lesions inferior or equal to five and inflammatory lesions inferior or equal to two on the face. Variables influencing the response were studied using the Cox model. The mean age was 31.3 years; 39 (56%) women had prior courses of isotretinoin and 53 (76%) had an oral contraception prior to treatment. Remission data from a median treatment period of six months (95% CI: 4-9) were obtained from 47 (71%) women. Markers for a positive response to spironolactone were a high number of inflammatory lesions at inclusion (OR: 1.08; 95% CI: 1.03-1.13; p = 0.001) and relapse with previous isotretinoin (OR: 2.46; 95% CI: 1.09-5.54; p = 0.03). The marker for a negative response was an association with oral contraceptives containing first or second-generation progestin (OR: 2.77; 95% CI: 1.35-5.71; p = 0.005). This retrospective data analysis confirms that the use of low doses of spironolactone is a valuable alternative in women with acne in whom oral isotretinoin has failed. Moreover, the analysis shows that first and second-generation oral contraceptives decrease the efficacy of spironolactone, confirming the interest of using two third or fourth-generation oral contraceptives.
成人痤疮的患病率正在上升，尤其是在女性中。螺内酯通过阻断雄激素受体来调节皮脂腺活动。为了回顾性评估螺内酯治疗女性痤疮的疗效。分析了2010年至2015年间70名至少20岁、接受低剂量螺内酯（≤150毫克/天）治疗痤疮的女性的数据。缓解的定义为面部潴留性皮损数量小于或等于5个且炎性皮损数量小于或等于2个。使用Cox模型研究影响反应的变量。平均年龄为31.3岁；39名（56%）女性曾接受过异维A酸治疗，53名（76%）女性在治疗前曾使用口服避孕药。47名（71%）女性获得了中位治疗期为6个月（95%可信区间：4 - 9）的缓解数据。对螺内酯反应阳性的标志物是纳入时炎性皮损数量较多（比值比：1.08；95%可信区间：1.03 - 1.13；p = 0.001）以及既往使用异维A酸后复发（比值比：2.46；95%可信区间：1.09 - 5.54；p = 0.03）。对反应阴性的标志物是与含有第一代或第二代孕激素的口服避孕药有关（比值比：2.77；95%可信区间：1.35 - 5.71；p = 0.005）。这项回顾性数据分析证实，对于口服异维A酸治疗失败的女性痤疮患者，使用低剂量螺内酯是一种有价值的替代方法。此外，分析表明第一代和第二代口服避孕药会降低螺内酯的疗效，这证实了使用第三代或第四代口服避孕药的益处。
