Acne - 粉刺https://en.wikipedia.org/wiki/Acne
粉刺 (Acne) 是由死皮細胞和皮脂堵塞毛囊引起的。此症狀的典型特徵包括黑頭或白頭、粉刺和油性皮膚。它主要影響皮脂腺較多的部位,如臉部、胸部上方和背部。痤瘡通常在青春期出現,估計西方國家有 80‑90% 的青少年受影響。某些農村社會的痤瘡發生率低於工業化社會。

在兩性中,雄激素似乎是主要機制之一,因其可促進皮脂分泌。另一個常見因素是皮膚上存在的痤瘡皮膚桿菌過度生長。

治療多採用外用藥物,如壬二酸、過氧化苯甲酰和水楊酸。抗生素與類維生素 A 可外用或口服治療痤瘡,但長期使用抗生素可能導致耐藥性。某些口服避孕藥對女性痤瘡有幫助。早期使用異維A酸積極治療,可降低長期併發症的風險。

治療
阿達帕林凝膠因抑制皮脂分泌且能減少痤瘡復發而廣泛使用。若起始劑量過高,可能會刺激皮膚。過氧化苯甲酰和壬二酸則適用於發炎性痤瘡,因其具抗炎作用。一般需持續使用 1 個月以上才能看到效果。

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

#Minocycline
#Isotretinoin
#Topical clindamycin
#Comedone extraction
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  • 軀幹區域的痤瘡,常見於軀幹上部與背部。
  • 典型的臉頰痘痘。
  • 背部可能會出現痤瘡。如果背部突然大範圍出現痤瘡,可能與藥物性皮疹(drug eruption)有關。
  • 典型的額頭痘痘,青春期的痤瘡往往從額頭開始。
  • 圖片中央可見白色、非發炎性的粉刺。
References Diagnosis and treatment of acne 23062156
痤瘡是美國最常見的皮膚病,屬於持續性的發炎性皮膚問題。治療的目標是針對導致痤瘡的四大因素:皮脂分泌過多、毛囊角化、痤瘡丙酸桿菌定植以及隨之產生的發炎。外用維他命A酸可同時預防與減少粉刺,並有效控制發炎與非發炎病變。過氧化苯甲醯是一種非處方的殺菌劑,不會促進細菌抗藥性。雖然單獨使用外用或口服抗生素亦有作用,與外用維A酸合併使用可提升療效。於抗生素治療中加入過氧化苯甲醯,可降低細菌抗藥性的風險。口服異維A酸已獲批准用於治療嚴重及頑固性痤瘡,需透過 iPLEDGE 計畫進行給藥。
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
常見的痤瘡局部治療包括 benzoyl peroxide (BP)、salicylic acid、抗生素、抗生素與 BP 的合併、retinoids、retinoids 與 BP 或抗生素的合併、azelaic acid 以及 sulfone 類藥物。長期以來,口服抗生素一直是痤瘡治療的關鍵,特別是對於中度至重度痤瘡。當與局部維A酸或口服抗生素一起使用時,療效最佳。Tetracycline、doxycycline、minocycline、trimethoprim/sulfamethoxazole (TMP/SMX)、trimethoprim、erythromycin、azithromycin、amoxicillin 以及 cephalexin 均有證據顯示其有效性。
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
建議始終使用外用維A酸治療痤瘡。當使用全身或局部抗生素時,應將其與過氧化苯甲酰或類視黃醇合併使用,但療程僅限 12 週。Isotretinoin 僅保留於對其他治療無效的嚴重痤瘡患者。雖然有研究顯示雷射療法、化學換膚等物理治療,以及純化蜂毒和特定飲食等補充方式可能有幫助,但其有效性仍未確定。
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
幾項研究探討不同食物對痤瘡患者的影響。研究發現,與食用高血糖負荷食物的痤瘡患者相比,食用低血糖負荷食物的患者往往出現較少的痤瘡斑點。另有研究檢視乳製品與痤瘡的關係,發現牛奶中的某些蛋白質似乎比脂肪或乳製品總含量更容易誘發痤瘡。其他研究則聚焦於 omega-3 脂肪酸和 γ-亞麻油酸,顯示痤瘡患者可能受益於多攝取魚類和健康油脂,以增加這些脂肪酸的攝取量。最近關於益生菌治療痤瘡的研究顯示出有希望的結果,但仍需更多研究驗證這些初步發現。
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.