【病例学习第22期】Acne痤疮

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Acne

LM, an 18-year-old woman who has suffered from acne for the past 2 years, comes to the pharmacy. In the past, the pharmacist has helped her in the selection of several different OTC products; however, LM has had little success. LM appears to have 10 to 20 lesions located around her jaw line and chin with several lesions appearing erythematous and pustular. She has no involvement of her chest, back, or shoulders. Recently, LM went to see a dermatologist who diagnosed her with moderate acne and gave her 2 prescriptions: adapalene (Differin) 0.1% cream to be applied to the affected area at bedtime and clindamycin (Cleocin-T) 1% lotion to be applied to the affected area daily. She was instructed by the dermatologist to use each product after cleansing her skin and to return in 2 months for a follow-up appointment. When picking up her prescriptions, LM asks the pharmacist, “Why do I need 2 medications for my acne—shouldn’t I just try one to start?” How should the pharmacist respond?

ANSWER

The treatment of acne is based on severity, which varies according to the number, type, and distribution of lesions. Monotherapy with a topical retinoid (eg, adapalene) is appropriate for mild forms of acne. For moderate forms of acne, combination therapy is often necessary. Erythematous and pustular (inflammatory) lesions require treatment with an agent possessing antimicrobial properties to decrease colonization of Propionibacterium acnes. Although topical retinoids are effective in normalizing keratinization, preventing comedone formation, and improving penetration of other topical agents, they do not possess antimicrobial properties. Given the severity of acne and evidence of inflammatory lesions, the optimal regimen for LM is a combination of a topical retinoid and an antimicrobial agent. LM should be counseled on the unique role of each medication and the importance of initiating both therapies now. LM should apply the topical agents to acne-prone areas of her face—not limited to individual existing lesions, because therapy is largely preventive. The pharmacist should inform LM that her acne may worsen upon initiation of therapy, but she should notice an overall improvement within 1 to 2 months.


痤疮
LM，女，18岁，近两年长痤疮。她来到药房。以前药师已经帮她选过几种不同的OTC产品，但几乎没起什么作用。现在LM下巴周围有10－20处皮损，有几处呈红斑和脓疱。不过，她的胸背部、肩部都没有受累。最近，她去看了皮肤科医师， 被诊断为中度痤疮，处方为：0.1％阿达帕林膏，睡前局部外用；克林霉素洗液，白天局部外用。皮肤科医生还教LM洗净脸后使用这两种药，2个月后复诊。LM拿着处方问药师：“为什么我要用两种药，开始用一种不行吗？”药师如何回答？
回答
痤疮的治疗根据严重程度，严重程度则与病损的数目、类型、分布有关。单用维甲酸类（如阿达帕林）适用于轻症痤疮。中度痤疮常需要联合治疗。红斑型和脓疱型皮损的治疗需要含有抗微生物制剂的药物，以减少短小棒状杆菌的定植。尽管局部用维甲酸类可使角质化皮肤恢复正常，抑制粉刺形成，并能改善其他药物的穿透作用，但他们没有抗菌作用。考虑到痤疮的严重程度以及炎性皮损的存在，LM的最佳办法是局部联合用维甲酸类和抗微生物制剂。药师应告知LM每种药物各自的作用以及现在应用两种药物联合治疗的重要性。她用药的部位还应包括面部有痤疮倾向的的区域，而不是仅局限于个别皮损存在的区域。因为治疗大半是预防性的。药师应告知她，痤疮在开始治疗的时候可能会加重，但一两个月后应有全面的好转。

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选为答案

挺好的给分吧

学习了。

回复 1# clinphar

我已认领本文，争取48小时内完成译文。

谢谢分享，已认真阅读。

谢谢，学习了。

Good good study, Day day up

痔疮真的是一件很麻烦的事，，， 以前还不是很明白后来接触医学之后才慢慢了解到。