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 Acnevulgarisisafolliculardisorderthataffectssusceptiblepilosebaceousfollicles 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 Althoughpeakprevalencemaybeatage17 acnemaybeginasearlyasage8andisnotuncommoninthe10 to12 year oldagegroupinwhichitisoftenoverlooked Bothsexesareaffectedequally butmaleshave onaverage greaterdegreesofseverity 流行病学 2 Asubstantialpercentageofadultsareaffectedeitherasacontinuationoftheirteenageacneoritsfirstappearanceinthethirdorfourthdecade 流行病学 3 Mostcasesofacnesubsideandinvolutespontaneouslyandcompletelywithinafewyearsoftheironset butasmallpercentageremainactive Thediseasemaycauseconsiderableemotionaldistressbecauseofitsappearance evenwhenthediseasehasinvolutedifscarringhastakenplace Thepsychosocialimpactonteenagersmaybedevastating 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 dependenthairThinningofscalphairOralcontraceptivesandeffectonacneHormonetestsCosmeticsandmoisturizers typeandfrequency 治疗史 Currenttreatment s topicalandsystemicOfacneOfotherdiseasesPasttreatment s topicalandsystemicOfacneOfotherdiseases 家族史和其它病史 FamilyhistoryofacneOtherskindisorders Atopy personalorfamilial becauseofoccasionalirritationtotopicalacnepreparations HidradenitissuppurativaDrugallergiesGeneralhealth especiallybutnotlimitedto HepaticdiseaseRenaldiseaseEndocrine PhysicalExamination LesiontypeNoninflammatory open closedcomedonesInflammatory papules pustules nodules cystsLocationFace neck back anteriorchest extremities GradationMild moderate severeComplicationsScarringtypeAtrophicHypertrophicKeloidsLocalizationSeverityDiscolorationLocalizationSeverity 其它皮损和并发病 Otherassociatedfindingsincludebutarenotlimitedto PostinflammatorymacularlesionsPostinflammatoryhyperpigmentationandhypopigmentationHirsutismforwomenAlopeciaforwomenAsymmetryofdistributionofacneExcoriations Diagnostictests辅助检查 Therearenodiagnostictestsforacnevulgaris However insomeinstancesdiagnostictestsareusedtodifferentiateandidentifyacne likeeruptionsortodetectthepresenceofsystemicconditionsthataggravateacne Suchtestsincludebutarenotlimitedto 用于鉴别 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 Topicaltreatmentalonemaybeindicatedforthefollowingtypesofacne mildtomoderatecomedonallesions superficialinflammatory papularorpustular andusuallynon scarring TopicalTherapy mostcommonlyused butnotlimitedtoBenzoylperoxide单用或与erythromycin sulfur合用Topicalantibiotics Tetracyclinelotion Clindamycinlotion gel Erythromycinlotion swabs gel MeclocyclinecreamTretinoinSalicylicacida HydroxyacidSulfur includingVleminckx ssolutionResorcinolMiscellaneous astringents soaps cleansers Treatment 2 Systemictreatmentmaybeindicatedforthefollowingtypesofacne Moderatetosevere scarringornon scarring orthatinpatientswithpersistenthyperpigmentation Systemictreatmentmayneedtobeusedaloneinpatientswhoareintoleranttotopicaltreatmentorinwhomsuchtreatmenthasfailed Systemictherapy mostcommonlyused butnotlimitedto OralAntibiotics Tetracycline Erythromycin Minocycline Trimethoprim sulfamethoxazole OtherIsotretinoin Primaryandonlyapproveduseisforsevere recalcitrant cysticacne refractorytoconventionalanti acnemeasures includingsystemicantibiotics Forwomenofchildbearingpotential AppendixAguidelinesapply Systemictherapy Hormonaltreatmentsmayincludethefollowing CorticosteroidsAnti inflammatoryactions highdoseAndrogensuppressantaction lowdoseSexhormones forwomenonly Estrogen oralcontraceptivemedication Antiandrogens Lesionaltherapy ExtractionofcomedonalcontentsDrainageofsuperficialpustulesandcystsExcisionofsinustractsandcystsIntralesionalcorticosteroidsCryotherapyDermabrasion scars Fillingmaterials scars Surgicalrepairs scars SystemicTherapy Othertreatmentsmayincludethefollowing DapsoneDiet inselectedcases UltravioletlightSuperficialexfoliationCarbondioxide acetoneslushSulfur resorcinol