Tan Jerry, Tanghetti Emil, Baldwin Hilary, Stein Gold Linda, Lain Edward
J Drugs Dermatol. 2019 Mar 1;18(3):255-260.
Atrophic acne scarring is a frequent occurrence among acne patients. These facial marks are often very emotionally distressing for the patient and can result in adverse impact to quality of life. While most clinicians consider scarring as a sequela of moderate to severe acne, recent studies have found that scars are also associated with mild acne. Risk factors include time to effective treatment, severity of acne, family history, and excoriations. New data shows that early and effective acne treatment can reduce the development of new scars, confirming the widespread perception of this approach in prevention. It is also becoming clear that the inflammatory process drives both the development of acne lesions and atrophic scars. This implies that inhibiting activation of inflammatory pathways early is key to preventing scars. Data also suggests a useful role for adapalene for the treatment of well-established acne scars with scar remodeling accompanied by the production of new collagen and elastic tissue. Acne guidelines and recommendations continue to highlight the central role of retinoids, with fixed-dose combination retinoids being particularly important due to targeting of multiple inflammatory pathophysiologic factors and for patient convenience. Higher concentrations of retinoids such as adapalene 0.3%/benzoyl peroxide 2.5% (A0.3/BPO2.5) have shown increased efficacy, particularly among patients with moderately severe and severe acne – a population at high risk for scarring. Further, controlled study of A0.3/BPO2.5 in patients with moderate acne (mean, 40 acne lesions per half face) and mild-moderate scarring demonstrated A0.3/BPO2.5 was significantly superior to vehicle in reducing scar counts from baseline over 24 weeks. While scar counts lessened on the A0.3/BPO2.5 side, counts increased on the vehicle side during the study. This occurred in the setting of active acne, where the efficacy of A/BPO is well known, emphasizing the dual actions of A0.3/BPO2.5 in both treatment and prevention. J Drugs Dermatol. 2019;18(3):255-260.
萎缩性痤疮瘢痕在痤疮患者中很常见。这些面部瘢痕常常给患者带来极大的情感困扰，并可能对生活质量产生不利影响。虽然大多数临床医生认为瘢痕是中度至重度痤疮的后遗症，但最近的研究发现，瘢痕也与轻度痤疮有关。风险因素包括有效治疗的时间、痤疮的严重程度、家族史和搔抓。新数据表明，早期有效的痤疮治疗可以减少新瘢痕的形成，证实了这种预防方法的广泛认知。越来越清楚的是，炎症过程既驱动痤疮皮损的形成，也驱动萎缩性瘢痕的形成。这意味着早期抑制炎症途径的激活是预防瘢痕的关键。数据还表明，阿达帕林在治疗已形成的痤疮瘢痕方面具有有益作用，可伴随瘢痕重塑并产生新的胶原蛋白和弹性组织。痤疮指南和建议继续强调维甲酸的核心作用，固定剂量复方维甲酸尤为重要，因为它针对多种炎症病理生理因素且方便患者使用。更高浓度的维甲酸，如0.3%阿达帕林/2.5%过氧化苯甲酰（A0.3/BPO2.5）已显示出更高的疗效，尤其是在中度至重度痤疮患者中——这是一个瘢痕形成风险较高的人群。此外，对中度痤疮（平均每半侧面部有40个痤疮皮损）和轻度至中度瘢痕患者进行的A0.3/BPO2.5对照研究表明，在24周内，A0.3/BPO2.5在减少瘢痕数量方面显著优于赋形剂。在研究期间，虽然使用A0.3/BPO2.5一侧的瘢痕数量减少，但赋形剂一侧的数量增加。这发生在活动性痤疮的情况下，A/BPO的疗效是众所周知的，强调了A0.3/BPO2.5在治疗和预防方面的双重作用。《皮肤药物杂志》。2019年；18（3）：255 - 260。
