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1、美国AAD痤疮指南 GuidelinesofCareforAcneVulgaris 注意本指南的时效性 Thisreportreflectsthebestdataavailableatthetimethereportwasprepared butcautionshouldbeexercisedininterpretingthedata Theresultsoffuturestudiesmayrequirealterationoftheconclusionsorrecommendationssetforthinthisreport 发表于1990年 定义Definition Acnevulgar
2、isisafolliculardisorderthataffectssusceptiblepilosebaceousfollicles primarilyoftheface neck anduppertrunk andischaracterizedbybothnoninflammatoryandinflammatorylesions 1累及敏感的皮脂腺 面 颈 躯干上部 疾病2有炎性和非炎性皮损 流行病学 1 Acneisadiseaseofhighprevalenceandaffectsmanypersonsintheirteenageyears Althoughpeakprevalence
3、maybeatage17 acnemaybeginasearlyasage8andisnotuncommoninthe10 to12 year oldagegroupinwhichitisoftenoverlooked Bothsexesareaffectedequally butmaleshave onaverage greaterdegreesofseverity 流行病学 2 Asubstantialpercentageofadultsareaffectedeitherasacontinuationoftheirteenageacneoritsfirstappearanceintheth
4、irdorfourthdecade 流行病学 3 Mostcasesofacnesubsideandinvolutespontaneouslyandcompletelywithinafewyearsoftheironset butasmallpercentageremainactive Thediseasemaycauseconsiderableemotionaldistressbecauseofitsappearance evenwhenthediseasehasinvolutedifscarringhastakenplace Thepsychosocialimpactonteenagers
5、maybedevastating 诊断 Diagnosticcriteria诊断标准A Clinical 一 临床Patienthistory病史 为了进行有效的治疗Duration toincludeprogressiontopointofmaximalseverityLocationSeasonalvariationAggravationbystress 对女性病人 ForwomenPremenstrualflare upMenstrualhistoryandpregnancystatusIncreaseofandrogen dependenthairThinningofscalphair
6、OralcontraceptivesandeffectonacneHormonetestsCosmeticsandmoisturizers typeandfrequency 治疗史 Currenttreatment s topicalandsystemicOfacneOfotherdiseasesPasttreatment s topicalandsystemicOfacneOfotherdiseases 家族史和其它病史 FamilyhistoryofacneOtherskindisorders Atopy personalorfamilial becauseofoccasionalirri
7、tationtotopicalacnepreparations HidradenitissuppurativaDrugallergiesGeneralhealth especiallybutnotlimitedto HepaticdiseaseRenaldiseaseEndocrine PhysicalExamination LesiontypeNoninflammatory open closedcomedonesInflammatory papules pustules nodules cystsLocationFace neck back anteriorchest extremitie
8、s GradationMild moderate severeComplicationsScarringtypeAtrophicHypertrophicKeloidsLocalizationSeverityDiscolorationLocalizationSeverity 其它皮损和并发病 Otherassociatedfindingsincludebutarenotlimitedto PostinflammatorymacularlesionsPostinflammatoryhyperpigmentationandhypopigmentationHirsutismforwomenAlopec
9、iaforwomenAsymmetryofdistributionofacneExcoriations Diagnostictests辅助检查 Therearenodiagnostictestsforacnevulgaris However insomeinstancesdiagnostictestsareusedtodifferentiateandidentifyacne likeeruptionsortodetectthepresenceofsystemicconditionsthataggravateacne Suchtestsincludebutarenotlimitedto 用于鉴别
10、 发现加重痤疮的系统原因 Diagnostictests辅助检查 Bacteriaculture e g gram negativefolliculitis Hormonalassay e g presenceofandrogenimbalance Biopsywhennecessarytodifferentiateacnefromotherdiseases Inappropriatediagnostictests RoutineallergytestingHairanalysis Treatment 1 Topicaltreatmentalonemaybeindicatedforthefol
11、lowingtypesofacne mildtomoderatecomedonallesions superficialinflammatory papularorpustular andusuallynon scarring TopicalTherapy mostcommonlyused butnotlimitedtoBenzoylperoxide单用或与erythromycin sulfur合用Topicalantibiotics Tetracyclinelotion Clindamycinlotion gel Erythromycinlotion swabs gel Meclocycli
12、necreamTretinoinSalicylicacida HydroxyacidSulfur includingVleminckx ssolutionResorcinolMiscellaneous astringents soaps cleansers Treatment 2 Systemictreatmentmaybeindicatedforthefollowingtypesofacne Moderatetosevere scarringornon scarring orthatinpatientswithpersistenthyperpigmentation Systemictreat
13、mentmayneedtobeusedaloneinpatientswhoareintoleranttotopicaltreatmentorinwhomsuchtreatmenthasfailed Systemictherapy mostcommonlyused butnotlimitedto OralAntibiotics Tetracycline Erythromycin Minocycline Trimethoprim sulfamethoxazole OtherIsotretinoin Primaryandonlyapproveduseisforsevere recalcitrant
14、cysticacne refractorytoconventionalanti acnemeasures includingsystemicantibiotics Forwomenofchildbearingpotential AppendixAguidelinesapply Systemictherapy Hormonaltreatmentsmayincludethefollowing CorticosteroidsAnti inflammatoryactions highdoseAndrogensuppressantaction lowdoseSexhormones forwomenonl
15、y Estrogen oralcontraceptivemedication Antiandrogens Lesionaltherapy ExtractionofcomedonalcontentsDrainageofsuperficialpustulesandcystsExcisionofsinustractsandcystsIntralesionalcorticosteroidsCryotherapyDermabrasion scars Fillingmaterials scars Surgicalrepairs scars SystemicTherapy Othertreatmentsmayincludethefollowing DapsoneDiet inselectedcases UltravioletlightSuperficialexfoliationCarbondioxide acetoneslushSulfur resorcinol
