维A酸类药物治疗色素沉着性皮肤病的进展

Retinoids in the treatment of pigmentary disorders

临床研究表明，外用维A酸类药物对黄褐斑、日光性黑子及炎症后色素沉着等常见色素沉着性皮肤病具有明确的疗效，联合氢醌和糖皮质激素或对甲氧酚治疗黄褐斑和炎症后色素沉着效果更明显。要保证其疗效、减少不良反应及防治复发，须规范用药。实验室研究也证明，维A酸类药物通过对黑素细胞、角质形成细胞及相关酶的直接和间接作用影响黑素生成、转运和分布。与氢醌等脱色剂合用时，可促进其渗透，增加对黑素细胞的毒化活性，发挥协同作用。

Clinical trials have shown that topical retinoids have definite curative effects on pigmentary disorders such as chloasma, solar lentigo, and postinflammatory hyperpigmentation. The combination with hydroquinone and corticosteroids or p-hydroxyanisole increases the potency of retinoids in the treatment of ehloasma and postinflammatory hyperpigmentation. Regular application is warranted to ensure the efficacy of retinoids, minimize adverse effects and prevent relapse. Laboratory experiments have shown that tretinoids affect the generation, distribution of melanin by direct or indirect acting on melanocytes, keratinocytes and pertinent enzymes. Besides, tretinoids can synergistically promote the permeation of other bleaching agents such as hydroquinone and enhance their melanocytotoxic and depigmenting activity.