Primary Care Research Centre, University of Southampton, Southampton, UK
University of Nottingham, Nottingham, UK.
Drug Ther Bull. 2023 Dec 27;62(1):6-10. doi: 10.1136/dtb.2023.000051.
Acne vulgaris is very common and can have significant negative impact on people. While sometimes a transient problem, acne may persist for many years and often leads to permanent scars or pigment changes. Guidelines unanimously advise topical treatments as first-line, although differ in recommending either topical benzoyl peroxide or topical retinoid (mainly adapalene) alone or in combination. Guidance published by the National Institute for Health and Care Excellence advises counselling patients regarding avoidance of skin irritation when starting topical treatments and promoting adherence (treatments take 6-8 weeks to work). Oral antibiotics are currently overprescribed for acne but have a role when coprescribed with a non-antibiotic topical treatment. Hormonal treatments, such as the combined contraceptive pill, are also effective and there is growing evidence for the use of spironolactone for women with persistent acne. Recent guidance from the Medicines and Healthcare products Regulatory Agency regarding isotretinoin has implications for specialist prescribing and monitoring, and increasing public awareness of potential risks of mental health problems and sexual dysfunction. Although acne is associated with psychiatric disorder, the mental health effects of isotretinoin remain controversial.
寻常痤疮非常常见，可对人们造成严重的负面影响。痤疮有时是一过性问题，但也可能持续多年，常导致永久性瘢痕或色素改变。指南一致建议外用药物为一线治疗，但在推荐单独使用或联合使用外用过氧化苯甲酰或外用维 A 酸（主要是阿达帕林）方面存在差异。英国国家卫生与保健优化研究所发布的指南建议在开始外用药物治疗时告知患者避免皮肤刺激，并促进患者坚持治疗（治疗需 6-8 周才起效）。目前，口服抗生素在痤疮治疗中被过度应用，但当与非抗生素外用药物联合应用时具有一定作用。激素治疗，如复方口服避孕药，也有效，并且越来越多的证据表明螺内酯可用于治疗持续性痤疮的女性。近期，药品和保健产品监管局关于异维 A 酸的指南对专科医生的处方和监测具有影响，并提高了公众对精神健康问题和性功能障碍潜在风险的认识。尽管痤疮与精神障碍有关，但异维 A 酸对精神健康的影响仍存在争议。
