13-順式維甲酸在治療痤瘡的應用

The use of Isotretinoin(Roaccutane)in the Treatment of Acne

口服13——順式維甲酸治療難治的結節性囊腫性痊瘡有突出的療效。本研究的目的旨在確定在港澳、廣東及中國治療嚴重痤瘡所用孩藥的較低劑量,並對中度座瘡使用該藥進行了臨床試驗研究。嚴重難治的結節性囊腫性痤瘡60例。40例使用本藥劑量為0.2mg/公斤/日-20例為0.4mg/公斤/日。中度16例,經其它治療無効並有瘢痕形成傾向,以0.2mg/公斤/日治療,療程為16周。所有病例經6〜8周治療後,30%病人好轉。經16周治療後,80〜90%病例病情好轉。但40例重度座瘡病人經0.2mg/公斤/日該藥治療-其中8例輕度復發,須接受第二療程治療。有人主張對嚴重痊瘡病人該藥治療劑量為0.5mg〜1.0mg/公斤/日,我們考慮到中國人患痊瘡較美國白人程度輕,故使用本藥0.2〜0.4mg/公斤/日治瘡了60例嚴重建瘠病人,也得出明顯的臨床療效。

The oral administration of isotretinoin has been demonstrated that it is highly effective in the treatment of severe,recalcitrant nodulocystic ance.The purpose of the study is to determine a lower dose level of isotretinoin in the treatment of severe acne in Macao,Hong Kong,and Guangdong,China,and to proceed clinical trial in the treatment of moderate acne with isotretinoin.60 patients with severe,recalcitant,nodulocystic acne,33 male,27 female,17 to 36 years of age.40 patients were treated with 0.2 mg/kg/day;20 patients with 0.4mg/kg/day of isotretinoin for 16 weeks.16 moderate,treatment-resistant acne patients with tendency of scar formation,7 male,9 female,17 to 24 years of age,were treated with 0.2 mg/kg/day of isotretinoin for 16 weeks.All patients had an 30%improvement in their acne severity after 6 to 8 weeks treatment,80%to 90%after 16 weeks treatment.There was continued improvement during the 2 months after cessation of therapy.But 8 of the 40 severe acne patients who received 0.2 mg/kg/day of isotretinoin had mild relapse,received a second course therapy.The common side effects are cheilitis,dry skin,dry month,dry nose,pruritus and musculoskeletal pains.No patient had to discontinue because of side effects.Changes in laboratory parameters were minor and transient.The recommended daily dosage of isotreinoin for severe acne is 0.5~1.0mg/kg/day.We notice that acne is less common in Chinese than in white American populations.In the past 5 years,We treated 60 severe ance patients in a daily dosage of 0.2-0.4mg/kg/day,and showed similar clinical success.The sole indication of isotretinoin is severe nodulocystic acne.In the past 2 years,we tried to treat 16 moderate acne patients,and the trial showed good results in complete clearance of acne and preventing scar formation.Isotretinoin may use not only for severe nodulocystic acne but also for moderate,treatment re・sistant acne with tendency of scar formation.