Acne - 粉刺https://en.wikipedia.org/wiki/Acne
粉刺 (Acne) 是由死皮细胞和皮脂堵塞毛囊引起的。该病的典型表现包括黑头、白头、粉刺以及油性皮肤。主要影响皮脂腺较多的部位,如面部、上胸部和背部。痤疮通常发生在青春期,估计影响西方世界 80‑90% 的青少年。部分农村社会的痤疮发病率低于工业化社会。

在男女中,雄激素被认为是发病机制之一,因为它可增加皮脂分泌。另一个常见因素是痤疮皮肤杆菌的过度增殖。

常用的局部治疗包括壬二酸、过氧化苯甲酰和水杨酸。抗生素和维A酸类药物可外用或口服用于治疗痤疮,但抗生素治疗可能导致耐药性。某些口服避孕药可帮助预防女性痤疮。早期积极使用异维A酸(Isotretinoin)治疗,可降低长期并发症的风险。

治疗
阿达帕林凝胶因抑制皮脂分泌并降低痤疮复发而被广泛使用。但首次使用时若剂量过大,可能会刺激皮肤。另一方面,过氧化苯甲酰和壬二酸适用于炎症性痤疮部位,因为它们具有消炎作用。通常需要持续使用 1 个月以上才能见效。

#Benzoyl peroxide [OXY-10]
#Adapalene gel [Differin]
#Tretinoin cream

#Minocycline
#Isotretinoin
#Topical clindamycin
#Comedone extraction
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  • 躯干区域的痤疮,常见于躯干上部和背部。
  • 典型的面颊痘痘。
  • 背部可能会出现痤疮。如果背部突然大范围出现痤疮,可以考虑drug eruption(药物性皮疹)。
  • 典型的额头痘痘。青春期痤疮常从额头开始。
  • 在图片中心可见白色、非炎症性粉刺。
References Diagnosis and treatment of acne 23062156
痤疮是美国最常见的皮肤病,是一种持续的炎症性皮肤问题。治疗的目标是解决导致痤疮的四大因素:皮脂分泌过多、皮肤细胞堆积、痤疮丙酸杆菌定植以及由此产生的炎症。外用维甲酸通过预防和减少粉刺,同时抑制炎症,能够有效控制炎症性和非炎症性病变。过氧化苯甲酰是一种非处方的杀菌剂,不会促进细菌耐药性。虽然外用和口服抗生素单独使用也有作用,但与外用维甲酸联合使用可增强疗效。在抗生素治疗中加入过氧化苯甲酰可降低细菌耐药风险。口服异维A酸已获批准用于治疗严重和顽固性痤疮,需通过 iPLEDGE 计划进行管理。
Acne, the most common skin condition in the United States, is a persistent inflammatory skin problem. Treatment aims at addressing four main factors contributing to acne: excessive sebum production, skin cell buildup, Propionibacterium acnes colonization, and resulting inflammation. Topical retinoids effectively manage both inflammatory and non-inflammatory lesions by preventing and reducing comedones while addressing inflammation. Benzoyl peroxide, available over-the-counter, is a bactericidal agent without promoting bacterial resistance. While topical and oral antibiotics work alone, combining them with topical retinoids enhances their effectiveness. Adding benzoyl peroxide to antibiotic therapy lowers the risk of bacterial resistance. Oral isotretinoin, approved for severe and stubborn acne, is administered through the iPLEDGE program.
 Guidelines of care for the management of acne vulgaris 26897386
常见的痤疮局部治疗包括 benzoyl peroxide (BP)、salicylic acid、抗生素、抗生素与 BP 联合使用、retinoids、retinoids 与 BP 或抗生素联合使用、azelaic acid 和 sulfone 类药物。长期以来,口服抗生素一直是痤疮治疗的关键,尤其适用于中度至重度痤疮。与局部维A酸和口服抗生素联合使用时,疗效最佳。Tetracycline、doxycycline、minocycline、trimethoprim/sulfamethoxazole (TMP/SMX)、trimethoprim、erythromycin、azithromycin、amoxicillin 和 cephalexin 均有有效性证据。
Common topical treatments for acne include benzoyl peroxide (BP), salicylic acid, antibiotics, combinations of antibiotics with BP, retinoids, combinations of retinoids with BP or antibiotics, azelaic acid, sulfone agents. Oral antibiotics have long been a key part of acne treatment, especially for moderate to severe cases. They work best when used alongside a topical retinoid and BP. Tetracycline, doxycycline, minocycline, trimethoprim/sulfamethoxazole (TMP/SMX), trimethoprim, erythromycin, azithromycin, amoxicillin, cephalexin have all shown evidence of effectiveness.
 Acne Vulgaris: Diagnosis and Treatment 31613567
治疗痤疮时,始终建议使用外用维A酸。 在使用全身或局部抗生素时,应将其与过氧化苯甲酰和类视黄醇联合使用,但疗程不应超过 12 周。 Isotretinoin 保留用于对其他治疗无反应的严重痤疮病例。 虽然有部分证据支持激光疗法、化学换肤等物理治疗,以及纯化蜂毒和特定饮食等补充方法,但其疗效仍不确定。
Topical retinoids are always recommended for treating acne. When using systemic or topical antibiotics, it's important to combine them with benzoyl peroxide and retinoids, but only for up to 12 weeks. Isotretinoin is reserved for severe cases of acne that haven't responded to other treatments. While there's some evidence for physical treatments like laser therapy and chemical peels, as well as complementary approaches such as purified bee venom and certain diets, their effectiveness is still uncertain.
 Effects of Diet on Acne and Its Response to Treatment 32748305 
NIH
几项研究探讨了不同食物对痤疮患者的影响。研究发现,与摄入高血糖负荷食物的痤疮患者相比,摄入低血糖负荷食物的患者往往出现的痤疮斑点更少。另有研究关注乳制品与痤疮的关系。牛奶中的某些蛋白质似乎比脂肪或乳制品的总含量更容易诱发痤疮。其他研究主要集中在 omega-3 脂肪酸和 γ-亚油酸,提示痤疮患者可能受益于多食鱼类和健康油脂,以增加这些脂肪酸的摄入。近期关于益生菌治疗痤疮的研究显示出有希望的结果,但仍需更多研究来证实这些早期发现。
Several studies have evaluated the significance of the glycemic index of various foods and glycemic load in patients with acne, demonstrating individuals with acne who consume diets with a low glycemic load have reduced acne lesions compared with individuals on high glycemic load diets. Dairy has also been a focus of study regarding dietary influences on acne; whey proteins responsible for the insulinotropic effects of milk may contribute more to acne development than the actual fat or dairy content. Other studies have examined the effects of omega-3 fatty acid and γ-linoleic acid consumption in individuals with acne, showing individuals with acne benefit from diets consisting of fish and healthy oils, thereby increasing omega-3 and omega-6 fatty acid intake. Recent research into the effects of probiotic administration in individuals with acne present promising results; further study of the effects of probiotics on acne is needed to support the findings of these early studies.