痤疮全身治疗英文版.ppt

acne systemictreatment andreasd katsambasathens greece 16theadvcongressvienna austria16 20may2007 acne treatment acne thereisnosingleanti acnemedicationthatactsagainstallfourpathophysiologicalfactorsofacne exceptisotretinoin systemictreatment oralantibiotics isotretinoin hormones acne systemictherapiesandtheirassociatedactivities oralantibiotics indications moderatetosevereacne acneresistanttotopicaltreatment acnecoveringlargepartofbodysurface oralantibioticsinacne suppressp acnesgrowth minimizeinflammatorymediatorssynthesizedbyp acnes tetraanderyhaveinherentanti inflammatoryactions decreaseofchemotacticfactorsandneutrofilsrecruitment reducecomedogenesisbydecreasingperifolicularlymphocyticinfiltrate modeofaction jeremyaetaljinvderm 121 20 27 2003 anti microbialtherapiesforacnevulgaris anti inflammatoryactionsofanti microbialdrugsintheireffectiveness antimicrobialdrugs newquinolones macrolides tetracyclines exerttheirtherapeuticeffectbothbybacteriocidalactionsandanti inflammatoryoranti immunologicalactions antioxidativeactiontowardsneutrophils inhibitionofcytokine chemokineproductionandadhesionmoleculeexpressionbykeratinocytes suppressionoftheantigen presentingabilityoflangheranscells muratak tokuray juoeh 2007 29 1 63 71 oralantibioticforacne firstline alternatives tetracyclineerythromycindoxycyclinetmp smxminocyclinelymecyclineazithromycin oralantibioticsforacne firstline 1 a katsambasetal clinicsinderm 22 412 418 20042 eggerssetal scweizrunschmedprax 95 35 1297 303 2006 oralantibioticsforacne alternatives whitegm standardoralantibioticsforacne 14 29 57 1999 modified sub antimicrobialdosesofdoxycylineinmoderateacne dose 20mgbd forseveralmonthsresult decreaseofcomedonesandinflammatorylesionscomment doxycylineinhibitsmatrixmetalloproteinaseandcytokines skidmoreetal archderm 139 459 2003 oralantibiotics poorresponders resistantp acnes gram folliculitis veryhighsebumexcretionrate problematicsideeffects causes p acnesresistance prevalenceofp acnesresistanceontheskinofacnepatients 10yearsurveillancedate 199134 5 tooneormoreusedanti acneantibiotics199755 5 tooneormoreusedanti acneantibiotics200064 tooneormoreusedanti acneantibiotics coatesp cunliffewetal brjderm 146 5 840 2002 propionibacteriaresistanceratesineurope j ross i snelling akatsambasetal brjderm148 467 478 2003 mainreasonforincreasedp acnesresistance theextensiveuseoftopicalformulationsoferythromycinandclindamycin eadyeetal dermatology206 1 54 2003 p acnesresistancetoerythromycin additionofzincsalts zincgluconate30mg 24h reducesresistanceofp acnesstrainstoerythromycin drenobetal eurjdermatol 15 3 152 5 2005 p acnesresistance erythromycin highclindamycin hightetracycline mediumdoxycycline mediumtrimethoprin mediumresistancetominocycline veryraremanagement isotretinoin minocycline j ross i snelling akatsambasetal brjderm148 467 478 2003 guidelinestoavoidp acnesresistance oralantibioticshouldnotbeusedasmonotherapy2 oralantibioticsshouldnotbeusedformorethan4months antibioticsshouldbecombinedwithtopicalretinoidstoenhanceefficacyagainstcomedonesandinflammatorylesions topicalbpoorazelaicacidmaybeaddedtooralantibioticstoreducethedevelopmentofp acnesresistance 1 thielitzh gollnickh hautarzt56 11 1040 20052 ochsendorff jdtschdermatolges 4 10 828 41 2006 topicalretinoids tr andoralantibiotics oa trincreasesfollicularcellturnover moreoaistransportedintothefollicularcanalwherep acnesresides increasedtissueconcentrationofoa reducedpotentialforlow concentrationinducedoaresistance katsambasaetal clinderm22 439 444 2004 futurecombinations acomparisonoftheefficacyandsafetyoflymecyclineplusadapalengel0 1 vs lymecyclineplusgelvehicleinmoderateinflammatoryacne cunliffewetal jaad49 3 s218 2003 futurecombinations results combinationtherapy lymecycline300mg d adapalengel0 1 wasfasterandsignificantlymoreeffectivethanorallymecycline300mg d vehicleinclearingbothinflammatorylesionsandcomedones irritationwasmilderinlym vehiclebutnots s cunliffewetal jaad49 3 s218 2003 poorresponders causegram folliculitis suddenonsetofmanypustules suddendeteriorationofacnemanagement isotretinoin 1mg kgr ampicilin poorresponders causeveryhighsebumexcretionrate s e r theexcessofsebumdilutetheantibioticandproducelowerandineffectiveconcentrationoftheantibioticinthepilosebaceousunit management doubledoseofantibiotic minocycline200mg d doxycyclin200mg d isotretinoinestrogen anti androgens poorresponders causemanagement resistantp acnesisotretinoin minocycline gram folliculitisisotretinoin ampicilin veryhighsebumisotretinoinexcretionratecypr acetate estrogensminocylcin200mg ddoxycycline200mg d antibiotics isotretinoin theonlyagentthatdisplaysactivityagainstallpathogeneticfactorsofacne oralisotretinoin reducessebumproduction normalizesfolliculardesquamation reducespacnesindirectly reducesinflammation consensus oralisotretinoinisthemainstayoftherapyforsevereacne targetsallpathophysiologicfactorsinacne mayachievedramaticresultseveninseveredisease nowusedmorefrequentlyinmoderate non responsiveacne sideeffectarecommon butusuallymanageable educationisvital sideeffects teratogenicity adversepsychiatricevents monitoring variablerateofrecurrence re treatmentmaybenecessary gollnicketal jamacaddermatol vol49 1 2003 anexpertviewonthetreatmentofacnewithsystemicantibioticsand ororalisotretinoininthelightoftheneweuropeanrecommendations oralisotretinoinshouldbeadministeredas2ndlinetherapyinthosecasesofsevereacne whichwereresistanttoorwhichdidnotrespondsuccessfullytoaninitialcombinationregimenwithsystemicantibioticsandtopicaltreatments topicalretinoids benzoylperoxide however anumberofprognosticfactors aswellaspsychosocialmorbidityshouldbetakenintoaccountwhenchoosingtheuseoforalisotretinoinasfirstlinetherapy drenobetal eurjdermatol 2006 16 5 565 71 isotretinoin dose 0 5 1mg kg withfood betterstartwithlowerdoseandincreaseaccordingtotolerability duration 16 30weekscumulativedose 120 150mg kg cdlowerthan120mg kgincreasesrateofrelapse patientcounseling crucial isotretinoin poorresponders patientswithmanymacrocomedones microcysts womenwithendocrineproblems polycysticovariansyndrome lateonsetadrenalhyperplasia causes treatmentofacne poorrespondersisotretinoin management gentleexcisionorcauteryundertopicalanesthesiabeforeisotreatment patientswithmanymacrocomedones microcysts cunliffewetal dermatology206 1 11 6 2003 treatmentofacne poorrespondersisotretinoin womenwithendocrineproblems womenwithsahasyndrome womenwithlateonsetacne treatmentofacne poorresponders management oralestrogensaloneorwithantiandrogensgiventogetherorafterisotreatmente g ethinylestradiol ee 35mg cyproteroneacetate cpa 2mgee25mg cpa50mgee25mg 100mglevonogestrelspironolactone25 50mg dprednisone2 5 5mg dindefinitelydexamethasone0 125 0 5mg d isotretinoin womenwithendocrineproblems carmineeetal clinendocrin57 2 213 2002leydenjetaljaad47 3 399 2002 treatmentofacne poorrespondersisotretinoin sideeffects management dermatitis cheilitismoisturizers hccreamarthralgia myalgialowerdoses nsaids aureousboilserythromycindepression idiosyncratic discontinuation patientswithproblematicsideeffects theassociationbetweendepressionandisotretinoininacne isotretinoin iso hasapositivepsychologicalimpactforthemajorityofpatientswhobenefitfromtreatment however itisimportanttorecognizethatdepressioncanoccurasanidiosyncraticsideeffectthatrequiresimmediatediscontinuationandurgent appropriatetreatment hersomketal jaad49 3 424 2003 hormonaltherapy excellentchoiceforwomenwhoneedoralcontraceptionforgynecologicreasons useearlyinfemalepatientswithmoderatetosevereacneorwithsahasyndrome usefulasacomponentofcombinationtherapyinwomenwithorwithoutendocrineabnormalities sometimesusedinwomenwithlate onsetacne gollnicketal jamacaddermatol vol49 1 2003 recommendedhormonaltestinginfemalepatientswithacne testsshouldbeobtainedinthelutealphaseofcycle withintwoweeksbeforeonsetofmenses hormonaltreatmentinacne newdevelopmentinsystemictreatmentofacne lipoxygenasinhibitors zileuton 1 micronizedisotretinoin1 rm5866