Miranti Shanna M
Ms. Miranti is with Riverchase Dermatology and Cosmetic Surgery in Naples, Florida.
J Clin Aesthet Dermatol. 2024 Nov-Dec;17(11-12 Suppl 1):S14-S17.
Acne is a chronic dermatologic disorder that can require long-term treatment. To prevent recurrence after oral treatment for severe acne, topical maintenance treatment is recommended; however, there is little guidance or research on maintenance regimens. This article briefly summarizes literature on oral isotretinoin and topical retinoids and presents a case series of patients who received tazarotene 0.045% lotion as maintenance following oral isotretinoin. While oral isotretinoin is efficacious, relapse/remission rates range from 0 to 69 percent depending on the definition of relapse/remission, dose, and duration of treatment/follow-up. In addition, oral isotretinoin is a known teratogen, and long-term use (>2 courses of 15-20 weeks) is not recommended. Topical treatments such as retinoids are recommended for maintenance, and some studies support that adapalene and tazarotene provide a benefit. Tazarotene 0.045% lotion is efficacious and safe, with demonstrated reductions in acne, acne-induced post-inflammatory hyperpigmentation, and melasma. In my clinic, patients with severe recalcitrant acne received once-daily oral isotretinoin for at least 20 weeks until clinically clear. On the day of last isotretinoin dose, once-daily topical tazarotene 0.045% lotion was initiated for 6 to 12 months. A total of 12 patients completed 24.3 (6.7) weeks (mean [standard deviation]) of isotretinoin (cumulative dose: 184.6 [75.1] mg/kg) and 13.0 (6.7) months of post-isotretinoin tazarotene 0.045%. No patients relapsed and all showed subjective visual improvements in acne-related scarring with topical tazarotene. None discontinued tazarotene due to adverse events. These case reports show that tazarotene 0.045% lotion may be an effective and safe treatment to prevent relapse after initial oral isotretinoin treatment.
痤疮是一种慢性皮肤病，可能需要长期治疗。为预防重度痤疮口服治疗后的复发，建议进行局部维持治疗；然而，关于维持治疗方案的指导和研究很少。本文简要总结了关于口服异维A酸和局部维甲酸的文献，并介绍了一系列患者的病例，这些患者在口服异维A酸后接受0.045%他扎罗汀洗剂作为维持治疗。虽然口服异维A酸有效，但复发/缓解率根据复发/缓解的定义、剂量以及治疗/随访时间的不同，在0%至69%之间。此外，口服异维A酸是一种已知的致畸剂，不建议长期使用（超过2个疗程，每个疗程15 - 20周）。推荐使用维甲酸等局部治疗进行维持治疗，一些研究支持阿达帕林和他扎罗汀有治疗效果。0.045%他扎罗汀洗剂有效且安全，已证明可减少痤疮、痤疮引起的炎症后色素沉着和黄褐斑。在我的诊所，重度难治性痤疮患者每天口服异维A酸至少20周，直至临床症状消退。在最后一次口服异维A酸的当天，开始每天一次外用0.045%他扎罗汀洗剂，持续6至12个月。共有12名患者完成了24.3（6.7）周（均值[标准差]）的异维A酸治疗（累积剂量：184.6 [75.1] mg/kg）以及异维A酸治疗后13.0（6.7）个月的0.045%他扎罗汀治疗。没有患者复发，所有患者在使用他扎罗汀局部治疗后，痤疮相关瘢痕在主观视觉上均有改善。没有患者因不良事件而停用他扎罗汀。这些病例报告表明，0.045%他扎罗汀洗剂可能是预防初始口服异维A酸治疗后复发的一种有效且安全的治疗方法。
