Cunliffe W J, van de Kerkhof P C, Caputo R, Cavicchini S, Cooper A, Fyrand O L, Gollnick H, Layton A M, Leyden J J, Mascaró J M, Ortonne J P, Shalita A
Leeds General Infirmary, UK.
Dermatology. 1997;194(4):351-7. doi: 10.1159/000246134.
Oral isotretinoin (Roaccutane) revolutionized the treatment of acne when it was introduced in 1982.
Twelve dermatologists from several countries with a special interest in acne treatment met to formally review the survey of their last 100 acne patients treated with oral isotretinoin. The primary purpose of the survey was to identify the types of acne patients who were prescribed oral isotretinoin and how the patients were managed.
Of the 1,000 patients reviewed, 55% of those who received oral isotretinoin had those indications treated historically, i.e. severe nodular cystic acne or severe inflammatory acne, not responding to conventional treatment. Forty-five percent of patients who were prescribed oral isotretinoin however had either moderate or mild acne. Most patients in this group had moderate acne (85%). However, 7.3% had mild acne on physical examination. The criteria for prescribing oral isotretinoin in this less severe group of patients included acne that improves < 50% after 6 months of conventional oral antibiotic and topical combination therapy, acne that scars, acne that induces psychological distress and acne that significantly relapses during or quickly after conventional therapy. Treatment is usually initiated at daily doses of 0.5 mg/kg (but may be higher) and is increased to 1.0 mg/kg. Most of the physicians aimed to achieve a cumulative dose of > 100-120 mg/kg. Mucocutaneous side-effects occur frequently but are manageable while severe systemic side-effects are rarely problematic (2%). The teratogenicity of oral isotretinoin demands responsible consideration by both female patients and their physicians. Significant cost savings when treating acne patients with oral isotretinoin as compared to other treatment modalities were further proven in this study.
Our recommendation is that oral isotretinoin should be prescribed not only to patients with severe disease but also to patients with less severe acne, especially if there is scarring and significant psychological stress associated with their disease. Acne patients should, where appropriate, be prescribed isotretinoin sooner rather than later.
口服异维甲酸（泰尔丝）于1982年问世后，彻底改变了痤疮的治疗方法。
来自多个国家的12位对痤疮治疗有特殊兴趣的皮肤科医生会面，正式回顾他们最近治疗的100例口服异维甲酸的痤疮患者的调查情况。该调查的主要目的是确定开具口服异维甲酸的痤疮患者类型以及患者的管理方式。
在审查的1000例患者中，接受口服异维甲酸治疗的患者中有55%的这些指征曾接受过治疗，即重度结节囊肿性痤疮或重度炎症性痤疮，对传统治疗无反应。然而，开具口服异维甲酸的患者中有45%患有中度或轻度痤疮。该组中的大多数患者患有中度痤疮（85%）。然而，7.3%的患者体检时患有轻度痤疮。在这组病情较轻的患者中开具口服异维甲酸的标准包括在传统口服抗生素和局部联合治疗6个月后改善<50%的痤疮、会留下疤痕的痤疮、引起心理困扰的痤疮以及在传统治疗期间或之后迅速复发的痤疮。治疗通常从每日剂量为0.5mg/kg（但可能更高）开始，然后增加到1.0mg/kg。大多数医生的目标是达到累积剂量>100 - 120mg/kg。皮肤黏膜副作用经常发生但可控制，而严重的全身副作用很少出现问题（2%）。口服异维甲酸的致畸性需要女性患者及其医生认真考虑。与其他治疗方式相比，本研究进一步证明了用口服异维甲酸治疗痤疮患者可显著节省费用。
我们的建议是，口服异维甲酸不仅应开给重症患者，也应开给病情较轻的痤疮患者，特别是如果其疾病伴有疤痕和明显的心理压力。痤疮患者应在适当的时候尽早开具异维甲酸。
