美国AAD痤疮指南

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DefinitionAcnevulgarisisafolliculardisorderthataffectssusceptiblepilosebaceousfollicles,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:HepaticdiseaseRenaldiseaseEndocrinePhysicalExaminationLesiontypeNoninflammatory：open/closedcomedonesInflammatory：papules/pustules/nodules/cystsLocationFace/neck/back/anteriorchest/extremitiesGradationMild,moderate,severeComplicationsScarringtypeAtrophicHypertrophicKeloidsLocalizationSeverityDiscolorationLocalizationSeverity其它皮损和并发病Otherassociatedfindingsincludebutarenotlimitedto:PostinflammatorymacularlesionsPostinflammatoryhyperpigmentationandhypopigmentationHirsutismforwomenAlopeciaforwomenAsymmetryofdistributionofacneExcoriationsDiagnostictests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)BiopsywhennecessarytodifferentiateacnefromotherdiseasesInappropriatediagnostictests*RoutineallergytestingHairanalysisTreatment（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,cleansersTreatment（2）Systemictreatmentmaybeindicatedforthefollowingtypesofacne:Moderatetosevere(scarringornon-scarring)orthatinpatientswithpersistenthyperpigmentation.Systemictreatmentmayneedtobeusedaloneinpatientswhoareintoleranttotopicaltreatmentorinwhomsuchtreatmenthasfailed.Systemictherapymostcommonlyused,butnotlimitedto:OralAntibiotics：Tetracycline；Erythromycin；Minocycline；Trimethoprim-sulfamethoxazole；OtherIsotretinoin,Primaryandonlyapproveduseisforsevere,recalcitrant,cysticacne,refractorytoconventionalanti-acnemeasures,includingsystemicantibiotics.Forwomenofchildbearingpotential,AppendixAguidelinesapply.SystemictherapyHormonaltreatmentsmayincludethefollowing:CorticosteroidsAnti-inflammatoryactions:highdoseAndrogensuppressantaction:lowdoseSexhormones(forwomenonly)Estrogen(oralcontraceptivemedication)AntiandrogensLesionaltherapyExtractionofcomedonalcontentsDrainageofsuperficialpustulesandcystsExcisionofsinustractsandcystsIntralesionalcorticosteroidsCryotherapyDermabrasion(scars)Fillingmaterials(scars)Surgicalrepairs(scars)SystemicTherapyOthertreatmentsmayincludethef