口服异维A酸后使用外用他扎罗汀维持痤疮治疗:概述和病例报告

Shanna Miranti
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Additionally, some retinoids such as tretinoin and tazarotene are indicated for the treatment of fine wrinkles and certain pigmentation disorders, and some studies have shown that adapalene and tazarotene may also reduce acne-induced scarring. Tazarotene 0.045% polymeric emulsion lotion is a well-tolerated retinoid that has demonstrated efficacy in acne treatment and may reduce acne-induced post-inflammatory hyperpigmentation (PIH) and melasma. Further, tazarotene lotion provides rapid and sustained improvements in skin barrier function/moisturization. Herein is presented a report of patients with acne who received maintenance treatment with topical tazarotene 0.045% lotion after an initial course of oral isotretinoin. \nMethods: Patients with severe recalcitrant acne vulgaris were treated with once daily oral isotretinoin for at least 20 weeks until deemed clinically clear. All patients received 40 mg isotretinoin once daily for the first 30 days. 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引用次数: 0

摘要

介绍:寻常痤疮是一种常见的皮肤病,可能需要数月或数年的治疗。痤疮对生活质量有负面影响,任何严重程度的痤疮都会增加疤痕等长期后遗症的风险。严重/结节囊肿型痤疮的常见治疗方法包括口服异维A酸、口服抗生素联合外用药(过氧化苯甲酰或维A酸)、口服联合避孕药或口服螺内酯(女性)。虽然不建议长期使用口服抗生素和异维A酸,但有关维持治疗的指导或发表的研究很少。外用维甲酸类药物是初期痤疮治疗的主要药物,在初期口服治疗结束后,可以外用维甲酸类药物进行维持治疗。此外,一些维甲酸类药物,如曲替诺和他扎罗汀,可用于治疗细小皱纹和某些色素沉着疾病,一些研究表明,阿达帕林和他扎罗汀也可减少痤疮引起的瘢痕。他扎罗汀 0.045% 聚合乳液洗剂是一种耐受性良好的维甲酸类药物,在治疗痤疮方面具有显著疗效,可减少痤疮引起的炎症后色素沉着(PIH)和黄褐斑。此外,他扎罗汀乳液还能快速、持续地改善皮肤屏障功能/保湿效果。本文报告了在口服异维A酸初始疗程后,接受 0.045% 他扎罗汀乳液局部维持治疗的痤疮患者的情况。治疗方法严重顽固性寻常痤疮患者接受每天一次的异维A酸口服治疗,持续至少20周,直至临床症状消失。所有患者在最初的 30 天内每天一次口服 40 毫克异维A酸。然后,剂量增加到每公斤体重 1 毫克(治疗新手)或每公斤体重 1.5 毫克(重复治疗)。20 周后,皮肤达到临床痊愈的患者在最后一次服用异维A酸的当天开始接受每天一次的局部他扎罗汀 0.045% 洗剂单药治疗。异维A酸治疗后6个月和1年进行随访。结果显示患者(12 人)的平均年龄为 17.8 岁(标准差 [SD]:3.8),大多数为女性(58.3%)和白人(66.7%)。患者平均口服异维A酸 24.3 周(标准差:6.7),平均累积剂量为 184.6 毫克/千克。一名患者在开始使用他扎罗汀之前需要重复使用异维A酸。异维A酸治疗后,患者平均接受了13.0个月(SD:6.7)的他扎罗汀0.045%乳液治疗。没有患者复发,所有患者在接受他扎罗汀维持治疗后,痤疮相关瘢痕的主观视觉效果都有所改善。没有人因不良反应而停用他扎罗汀乳液。 结论:在完成初始口服异维A酸或其他治疗后,有关痤疮维持治疗的指导或研究很少。外用他扎罗汀 0.045% 聚合乳液洗剂曾在减少中重度痤疮患者的痤疮和 PIH 以及减少黄褐斑和/或 PIH 患者的色素沉着方面显示出良好的疗效、安全性和耐受性。本文中的病例报告显示,他扎罗汀 0.045% 乳液可能是一种有效、安全的治疗方法,可用于预防重度顽固性痤疮患者在初次口服异维A酸治疗后复发。资金来源:Ortho DermatologicsOrtho Dermatologics
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Maintenance Acne Treatment With Topical Tazarotene after Oral Isotretinoin: Overview and Case Reports
Introduction: Acne vulgaris is a common dermatologic disorder that may require treatment over months or years. Acne negatively impacts quality of life, and acne of any severity increases the risk of long-term sequelae such as scarring. Common treatments for severe/nodulocystic acne include oral isotretinoin, an oral antibiotic combined with a topical (benzoyl peroxide or a retinoid), an oral combined contraceptive, or oral spironolactone (females). Though oral antibiotics and isotretinoin are not recommended for long-term use, there is scarce guidance or published research on maintenance therapy. Topical retinoids—a mainstay of initial acne treatment—may be prescribed for maintenance once initial oral treatments are complete. Additionally, some retinoids such as tretinoin and tazarotene are indicated for the treatment of fine wrinkles and certain pigmentation disorders, and some studies have shown that adapalene and tazarotene may also reduce acne-induced scarring. Tazarotene 0.045% polymeric emulsion lotion is a well-tolerated retinoid that has demonstrated efficacy in acne treatment and may reduce acne-induced post-inflammatory hyperpigmentation (PIH) and melasma. Further, tazarotene lotion provides rapid and sustained improvements in skin barrier function/moisturization. Herein is presented a report of patients with acne who received maintenance treatment with topical tazarotene 0.045% lotion after an initial course of oral isotretinoin. Methods: Patients with severe recalcitrant acne vulgaris were treated with once daily oral isotretinoin for at least 20 weeks until deemed clinically clear. All patients received 40 mg isotretinoin once daily for the first 30 days. The dosage was then increased to 1 mg/kg of bodyweight (treatment naïve) or 1.5 mg/kg (repeat treatment). After 20 weeks, patients who achieved clinically clear skin initiated once-daily topical tazarotene 0.045% lotion monotherapy on the day of their last isotretinoin dose. Follow up visits occurred at 6 months and 1-year post-isotretinoin treatment. Results: Patients (n=12) had a mean age of 17.8 years (standard deviation [SD]: 3.8) and the majority were female (58.3%) and White (66.7%). Oral isotretinoin was used for an average of 24.3 weeks (SD: 6.7), with a mean cumulative dose of 184.6 mg/kg. One patient required a repeat course of isotretinoin prior to tazarotene initiation. Post-isotretinoin, patients received tazarotene 0.045% lotion for an average of 13.0 months (SD: 6.7). No patients relapsed and all showed subjective visual improvements in acne-related scarring with tazarotene maintenance treatment. None discontinued tazarotene lotion due to adverse events.  Conclusions: There is little guidance or research published on acne maintenance treatment after initial oral isotretinoin or other treatments are complete. Topical tazarotene 0.045% polymeric emulsion lotion has previously demonstrated good efficacy, safety, and tolerability with acne and PIH reductions in patients with moderate-to-severe acne, as well as dyspigmentation reductions in patients with melasma and/or PIH. The case reports presented here show that tazarotene 0.045% lotion may be an effective and safe treatment to prevent relapse after initial oral isotretinoin treatment for severe recalcitrant acne. Funding: Ortho Dermatologics
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