Unit14-B-Acne Vulgaris(粉刺).doc

Unit 14 Dermatological Diseases 169 * Unit 14 Dermatological DiseasesText B Acne VulgarisIntroductionThis article is about a skin disease commonly found during adolescence.Acne vulgaris (cystic acne or simply acne) is a common human skin disease,characterized by areas of skin with seborrhea ( scaly red skin)，comedones (blackheads and whiteheads)， papules (pinheads) , pustules (pimples)，nodules (large papules) and possibly scarring. Acne affects mostly skin with the densest population of sebaceous follicles ； these areas include the face, the upper part of the chest, and the back (Fig. 14-3). Severe acne is inflammatory, but acne can also manifest in noninflammatory forms. The lesions are caused by changes in pilosebaceous units,skin structures consisting of a hair follicle and its associated sebaceous gland， changes that require androgen stimulation.这篇文章是关于青春期常见皮肤病。寻常痤疮（囊性痤疮或粉刺）是一种常见的皮肤病，以局部皮肤出现脂溢性皮炎（,鳞状红色皮肤），黑头粉刺（黑头和白头粉刺），丘疹（针头），脓疱（青春痘），结节（大丘疹）和疤痕为特征。痤疮通常分布于皮肤毛囊皮脂腺最密集处；其中包括面部，胸的上部和背部（图14-3）。重度痤疮是一种炎症反应，但也可以以非炎症形式存在。这种损害的原因来自于毛囊皮脂腺单位功能的改变，该单位是由毛囊和皮脂腺组成，而功能改变需要雄激素的刺激。Acne occurs most commonly during adolescence, and often continues into adulthood. In adolescence，acne is usually caused by an increase in testosterone, which accrues during puberty, regardless of sex. For most people, acne diminishes over time and tends to disappear or at the very least decreases by age 25. There is，however，no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties, and beyond.青春痘最常发生在青春期，并经常持续到成年。在青春期，无论男女，睾酮的分泌量均明显增加，这将导致痤疮的发生。对于大多数人来说，痤疮随着时间的推移而逐渐减少，并且会逐渐消失，或者至少到25岁时开始减少。但是，没有办法预测多久会完全消失，而有些人会一直好发痤疮直到他们三十岁、四十多岁或更大的年龄段。Some of the large nodules were previously called “cysts” and the term nodulocystic has been used to describe severe cases of inflammatory acne. The “cysts”，or boils that accompany cystic acne,can appear on the buttocks,groin,and armpit area,and anywhere else where sweat collects in hair follicles and perspiration ducts. Cystic acne affects deeper skin tissue than does common acne.一些大的结节以前被称为“囊肿”，同时结节性囊肿一直被用来描述炎症性痤疮。“囊肿”或疖病，伴随囊性痤疮，可以出现在臀部，腹股沟和腋下地区，以及其他一些富含分泌汗液的毛囊及汗腺导管的地方。囊肿性痤疮对皮肤组织的影响比普通痤疮更大。Aside from scarring, its main effects are psychological, such as reduced self-esteem and in very extreme cases, depression or suicide. Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall long-term impact to individuals.疤痕比较突出，它会影响心理健康，如减少自尊，在非常极端的情况下会导致抑郁症或自杀。痤疮通常出现在青春期，此时人们已经往往开始活跃的社交活动。因此，提倡早期积极的治疗以减少对个体的长期影响。cFig. 14-3 Different types of Acne Vulgaris A: Cystic acne on the face；B： Subsiding tropical acne of trunk;C: Extensive acne on chest and shouldersSigns and symptomsTypical features of acne include ： seborrhea (increased oil-sebum secretion) , comedones (blackheads and whiteheads )，papules ( pinheads )，pustules ( pimples )，nodules ( large papules)，and possibly scarring. The appearance of acne varies with skin color. It may result in psychological and social problems.痤疮的典型特征包括：脂溢性皮炎（增加皮脂分泌），黑头粉刺（黑头和白头粉刺），丘疹（针头），脓疱（青春痘），结节（大丘疹），和可能的疤痕。痤疮的出现会导致皮肤颜色变化。这可能会引起心理和社交问题。ScarsAcne scars are the result of inflammation within the dermis brought on by acne. The scaris created by the wound trying to heal itself resulting in too much collagen in one spot.Physical acne scars are often referred to as “ice pick” scars. This is because the scars tend to cause an indentation in the skins surface. There is a range of treatments available. Although quite rare,the medical condition atrophia maculosa varioliformis cutis also results in “acne- like” depressed scars or the face.疤痕痤疮疤痕是痤疮诱发真皮层发炎的结果。疤痕是伤口愈合过程中过多的胶原蛋白沉积在一个地方的结果。身体上的痤疮疤痕常被称为“冰锥”疤痕。这是因为这些疤痕会导致皮肤表面的压痕。针对上述情况有一系列的有效治疗方法。虽然非常罕见，但天花样斑疹样萎缩性皮肤也导致在皮肤表面形成“痤疮”样的凹陷疤痕英文详解词典 acne 医学详解词典皮肤 英汉医学缩略语词典because 汉英医学缩略语词典because 中医术语详解词典because Ice pick scars ： Deep pits, that are the most common and a classic sign of acne scarring.Box car scars： Angular scars that usually occur on the temple and cheeks,and can be either superficial or deep, these are similar to chickenpox scars.Rolling scars： Scars that give the skin a wave-like appearance.Hypertrophic scars ： Thickened, or keloid scars.冰锥疤痕：类似皮肤上的深坑，这是最常见的最典型的痤疮疤痕。棚车疤痕：带角的伤痕，通常发生在太阳穴和脸颊处，可 浅可深， 类似于水痘疤痕。滚动疤痕：使皮肤呈现波浪般的外观。属于增生性瘢痕或瘢痕疙瘩。PigmentationPigmented scars is a slightly misleading term，as it suggests a change in the skins pigmentation and that they are true scars； however，neither is true. Pigmented scars are usually the result of nodular or cystic acne (the painful bumps lying under the skin). They often leave behind an inflamed red mark. Often，the pigmentation scars can be avoided simply by avoiding aggravation of the nodule or cyst. Pigmentation scars nearly always fade with time taking between three months to two years to do so, although can last indefinitely if untreated.色素沉着色素沉着疤痕这一名称有误导作用，因为它提示色素沉着是疤痕的必要条件。然而，事实并非如此。色素沉着疤痕通常是由结节性或囊肿性痤疮所致（皮下疼痛性结节样红斑），消退后遗留炎性红色斑点。通常可以通过阻止结节或囊肿性痤疮的恶化来避免色素沉着。色素沉着疤痕几乎总是随着时间逐渐消退，耗时三个月至2年，如果不加治疗，疤痕可无限期地持续下去。CausesAcne develops as a result of blockages in the follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcodo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen ( DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo. Comedones are the direct result of sebaceous glands becoming clogged with sebum,a naturally occurring oil,and dead skin cells. In these conditions，the naturally occurring largely commensal bacterium propionibacterium acnes cancause inflammation,leading toinflammatory lesions (papules,infected pustules,or nodules) in the dermis around the microcomed or comedone，which results in redness and may result in scarring or hyperpigmentation.痤疮的发展是由于毛囊被堵塞。角化过度、角质及皮脂形成的栓子堵塞毛孔（微小粉刺）是早期的变化。随着肾上腺功能初现，硫酸脱氢表雄酮分泌逐渐增加，随后皮脂腺扩张、皮脂分泌增加 。扩大的微小粉刺形成开放或闭合性粉刺（黑头粉刺）。黑头是由皮肤自然产生的油脂和死亡的皮肤细胞共同构成的皮脂堵塞皮脂腺的直接结果。在这种情况下， 皮肤共生菌痤疮丙酸杆菌自然地可引起炎症，导致真皮层粉刺周围产生炎症病变（丘疹、脓疱或结节，感染，），导致红肿、疤痕或色素沉着过多。HormonalHormonal activity，such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty,an increase in sex hormones called androgens cause the follicular glands to grow larger and make more sebum. Use of anabolic steroids may have a similar effect.Development of acne vulgaris in later years is uncommon，although the incidence of rosacea, which may have a similar presentation, is increased in older age groups. True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy，or disorders such as polycystic ovary syndrome and Cushings syndrome.激素荷尔蒙的活动，如月经周期和青春期，可能会导致痤疮的形成。在青春期，性激素称为雄激素分泌的增加导致滤泡腺增大，皮脂分泌增多。使用合成类固醇可能有类似的效果。在以后的几年，痤疮的发展是罕见的，酒糟鼻与痤疮有类似的临床表现，但它的发病多在 中老年人群中。成年女性寻常痤疮可能是另一些生理或疾病状态的潜在表现，如怀孕、多囊卵巢综合征和库欣综合征 。GeneticThe predisposition for specific individuals to acne is likely explained by a genetic component, which has been supported by twin studies as well as studies that have looked at rates of acne among first degree relatives. The genetics of acne susceptibility is likely polygenic, as the disease does not follow classic Mendelian inheritance pattern. 遗传遗传因素可解释个人痤疮易感性的差异， 这一观点已经被对双胞胎及患者一级亲属中痤疮发病率的相关研究所支持。痤疮的遗传易感性可能是多基因遗传病，与那此不遵循孟德尔遗传模式的疾病一样。PsychologicalWhile the connection between acne and stress has been debated, scientific research indicates that “increased acne severity” is “significantly associated with increased stress levels. ” The National Institutes of Health (USA) list stress as a factor that “can cause an acne flare. ” A study of adolescents in Singapore “ observed a statistically significant positive correlation between stress levels and severity of acne. ”心理虽然关于痤疮和压力之间的联系一直争论不休，科学研究表明，“痤疮的严重程度”与“增加的生活压力水平”显著相关。 美国国家卫生研究院 将压力列为可引起痤疮的因素。在新加坡青少年中进行的一项研究观察到 压力水平和痤疮严重程度呈正相关DietThe relationship between diet and acne is not very clear as there is no good quality evidence. However, a high glycemic load diet is associated with worsening acne. There is also a positive association between the consumption of milk and a greater rate and severity of acne. Other associations such as chocolate and salt are not supported by the evidence. Chocolate however does contain a varying amount of sugar that can lead to a high glycemic load, and it can be made with or without milk. There may be a relationship between acne and insulin metabolism and a dated trial found a relationship between acne and obesity.饮食饮食与痤疮之间的关系不是很清楚，因为没有可靠的证据。然而，高糖负荷饮食与痤疮恶化有关。还有，牛奶的消费量与痤疮发生率及严重程度密切相关。其他因素，没有证据表明巧克力和盐与痤疮有关 。当然，巧克力的含糖量可有较大变化，高含糖量同样可以导致高糖负荷， 就牛奶而言有相同现象。痤疮和胰岛素代谢可能有一定关系， 连续观察研究表明痤疮和肥胖有关联。MedicationsBenzoyl peroxideBenzoyl peroxide is a first-line treatment for mild and moderate acne vulgaris due to its effectiveness and mild side-effects ( primarily an irritant dermatitis). It works against the “P. acnes” bacterium,and normally causes just dryness of the skin,slight redness，and occasional peeling when side effects occur. This topical does increase sensitivity to the sun as indicated on the package, so sunscreen should be used during the treatment to prevent sunburn. Benzoyl peroxide has been found to be nearly as effective as antibiotics with all concentrations 2. 5% ,5. 0%， and 10% equally effective. Unlike antibiotics, benzoyl peroxide does not appear to generate bacterial resistance.药物过氧苯甲酰是用于治疗轻中度寻常痤疮的一线用药，因为它有良好的疗效和相对轻微的副作用（主要用于刺激性皮炎）。它针对痤疮丙酸杆菌，通常使皮肤干燥，微微发红，脱屑是偶尔 发生的副作用。本品可增加皮肤对阳光的敏感性，正如在说明书中提及的，所以在治疗期间应使用防晒霜来防止晒伤。过氧化苯甲酰被发现在下列所有浓度下几乎与抗生素一样有效，包括2.5%，5.0%、10% 。而且不像抗生素，过氧化苯甲酰不会产生细菌耐药性。AntibioticsAntibiotics are reserved for more severe cases. With increasing resistance of P. acnes worldwide,they are becoming less effective. Commonly used antibiotics,either applied topically or taken orally, include erythromycin, clindamycin, and tetracyclines such as minocycline.Sometimes benzoyl peroxide topical medication is combined with a salt of hydroxyquinoline, such as potassium hydroxyquinoline sulphate, which has antibacterial properties.抗生素抗生素用于更严重的病例。随着全球痤疮丙酸杆菌耐药性的增加，他们变得不那么有效。无论是外用或口服，常用的抗生素包括红霉素、克林霉素、四环素类抗生素，如四环素。有时，外用过氧化苯甲酰结合羟基喹啉类药物，如硫酸钾羟基喹啉，具有抗菌性能。HormonesIn females,acne can be improved with hormonal treatments. The common combined estrogen/ progestogen methods of hormonal contraception have some effect, but the antiandrogen cyproterone in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane 35 is not available in the US A, but a newer oral contraceptive containing the progestin drospirenone is now available with fewer side effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case.激素激素治疗可改善女性痤疮的病情。常见的激素避孕药由结合雌激素/孕激素组成，能起到一定疗效，而抗雄激素药物与雌 二醇 （达英35 ，炔雌醇环丙孕酮片）联合能有效降低雄性激素水平。达英35在美国 未得到应用，但一种新的口服避孕， 它含有孕激素屈螺酮 ，目前批准使用，且副作用比达英要轻。两种药均可用于血液测试表明雄激素水平异常增高的病例，但其实在不具备高雄激素水平的病例中仍然有效。 Topical retinoidsTopical retinoids are medications that normalize the follicle cell life cycle. Like isotretinoin ,they are related to vitamin A,but they are administered topically and they generally have much milder side effects. They can，however,cause significant irritation of the skin. The retinoids appear to influence the cell life cycle in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol,a form of vitamin A，has similar, but milder, effects and is used in many over-the-counter moisturizers and other topical products. Topical retinoids often cause an initial flare-up of acne and facial flushing.外用维A酸外用维A酸药可帮助毛囊滤泡细胞维持正常生命周期。像异维A酸，它们与维生素A有关(类似于维生素A)，但他们是局部给药，而且一般来说副作用较温和。然而，它们也可以引起皮肤的显著刺激。 维A酸似乎可以影响毛囊内表面细胞的生长周期。这有助于防止 这些细胞 的过度角化，从而有助于缓解阻塞。 视黄醇，是维生素A的一种，它与维生素A有类似的作用，但起效更温和，所以可以用在在许多非处方护肤品和其他外用产品中。外用维A酸常常会引起的痤疮的突然爆发及面部皮肤潮红。Oral retinoidsIsotretinoin is very effective for severe acne as well as moderate acne that does not improve with other treatments. Improvement is typically seen after one to two months of use. After a single course about 80% of people are improved with more than 50% completely so. About 20% of people require a second course. A number of adverse effects may occur including： dry skin,nose bleeds，muscle pains,increased liver enzymes，and increased lipid levels in the blood. If used during pregnancy there is a high risk of abnormalities in the baby and thus women of child bearing age are required to use effective birth control. Psychiatric side effects such as depression and suicide are unclear.口服维A酸在其他治疗无效的情况下，异维A酸对重度及中度痤疮很有疗效，通常在使用一到两个月后病情有明显改善。经过一个疗程后约80%的人病情得到了50%以上的改善。约有20%的人需要第二疗程。用药期间可能出现一些副作用包括：皮肤干燥，鼻出血，肌肉痛，肝酶升高，血脂水平升高。如果在怀孕期间用药，胎儿发育异常的风险将会明显增高，因此，育龄妇女用药需要采取有效的避孕措施。 其他有关精神方面的副作用，如抑郁和自杀还尚不清楚。Alternative medicineGiven the link between a high-glycemic diet and aggravation or induction of acne，avoidance of sugary foods is a mainstay of natural recommendations for prevention and treatment of acne. Larger, more rigorous trials are needed to definitely determine whether this approach is effective.Numerous natural products have been investigated for treating patients with acne. Some of these,such as azelaic acid,are widely used in conventional medicine as well，highlighting that not all natural approaches should be labeled alternative. ”替代治疗鉴于高血糖饮食可加重或诱导痤疮，避免进食含糖食物是预防和治疗痤疮的主要生活干预措施。需要更大规模和更严格的试验来进一步确定这种方法的有效性。许多天然物质已经被研究用于痤疮的治疗。其中的一些，如壬二酸，已经被广泛应用于传统医学，但是需要强调的是，不是所有的天然物质均可作为备用治疗方案。Azelaic acid, a naturally-occurring hydrocarbon found in whole grains among other sources, has been repeatedly shown effective for mild-to-moderate acne when applied topically at a 20% concentration. Application twice daily for six months is necessary, and treatment has been sho