Acne commonly known as acne, is a chronic inflammatory disease of the hair follicle sebaceous glands, the most common disease of dermatology, the incidence of the population is also high, and the severity of acne is different, its treatment effect is also uneven, unsatisfactory, acne diagnosis and treatment guidelines at home and abroad are constantly updated, its purpose is mainly to provide people with more effective diagnosis and treatment methods, and tretinoin drugs are derivatives of vitamin A, the status of this type of drug in the treatment of acne is unquestionable, and is regarded as one of the three magic weapons of dermatologists.
First, the classification of tretinoin drugs
The first generation of tretinoins is a natural metabolite of tretinoin, mainly all trans tretinoin and non-aromatic synthetic derivatives, including isotretinoin, tretinoin, tretinoin and the like.
Second-generation tretinoin drugs are synthesized by artificial, single aromatic tretinoin or synthetic tretinoin, including etretidate, avi A ester, aretinoic acid.
The third generation of tretinoin is a multi-aromatic tretinoin or receptor selective tretinoin, including aromatic ethyl tretinoin, aromatic tretinoin, methanesulfo aromatic tretinoin, tazarotene, adapalene, bezarotene and the like.
The clinical treatment of acne tretinoins are mainly the first and third generation of drugs, and the second generation of tretinoins is mainly used for the treatment of psoriasis and keratinous skin diseases.
Second, topical tretinoin drugs
Topical tretinoin creams or gels can be said to be the first choice for topical use in the treatment of mild acne vulgaris, as well as for combinations of moderate acne and post-acne maintenance therapy. Its main role is to improve and correct the keratosis of the hair follicle sebaceous glands, dissolve micro-acne and pimples, anti-inflammatory, prevent acne production, improve inflammatory pigmentation and scarring of acne, but also increase skin permeability, in combination therapy can increase the efficacy of topical antibacterial and anti-inflammatory drugs.
Representative drugs are mainly retinoin cream, isotretinoin gel, viramine vitamin E cream, adapalene gel and other zarotein gel and so on.
Topical tretinoins may produce uncomfortable reactions, including possible flushing, burning, itching, dryness and tightness, erythema and other reactions, it is recommended to take a low concentration, local affected area to apply, and with moisturizing products, those with obvious symptoms can be suspended for several days and then try, with the extension of treatment time, these symptoms are gradually fading, and indeed patients with more serious reactions are recommended to suspend use. This type of drug has a phenomenon of photodegradation, which will increase the sensitivity of the skin to ultraviolet rays, and should avoid sun exposure and apply sunscreen products outside. Tretinoin and adapalene are used in class C in pregnancy, pregnant women should use with caution, tazarotene is class X for pregnancy, and pregnant women are contraindicated.
3. Oral tretinoin drugs
Oral drugs are mainly to inhibit the secretion of lipids in the sebaceous glands, regulate the abnormal keratosis of the sebaceous ducts of the hair follicles, improve the anaerobic environment of the hair follicles and thus reduce the reproduction of Propionibacterium acnes, anti-inflammatory and prevent scarring. Oral isotretinoin or retinoid capsules are the most effective of the system's oral treatment of severe acne medications and can be used alone or in combination. It is currently the only oral drug for the four key pathophysiological links of acne incidence.
Representative drugs: Virmin ester capsules, isotretinoin softgels
It is mainly used for moderate or moderate to severe acne replacement treatments with poor effects of other treatments; patients with acne with scarring or scarring tendencies need to be used as soon as possible; frequent recurrent acne other treatments are ineffective; acne with severe seborrhea; mild to moderate acne has a need for rapid efficacy.
Oral retinoids should be taken immediately after meals in order to increase the bioavailability of their oral absorption. The Chinese Acne Guidelines recommend a starting dose of 0.25 to 0.50 mg/kg/day (1 isotretinoin softgel = 10 mg). The course of treatment depends on the improvement of skin lesions and the dose of medication, it is recommended to take it continuously for not less than 4 months, and the cumulative dose is recommended to be no less than 60mg/kg, so as to ensure a certain cumulative dose of the drug, which can reduce the risk of acne recurrence to a certain extent.
A common adverse effect of oral retinoids is dryness of the mucous membranes of the skin, and it is recommended to use them in conjunction with skin moisturizing barrier repair products. This type of drug has a clear teratogenic effect, female patients of childbearing age should be strictly contraceptive in the first 1 month, during the period of taking, and within 3 months after discontinuation, and whether the use of isotretinoin in men will cause fetal abnormalities is not yet based on the exact basis, but for safety reasons, it is recommended to strictly control contraception within one month after stopping the drug. Children under 12 years of age try not to use. Avoid taking in combination with tetracyclines and vitamin A drugs. Patients with obvious depressive symptoms or depression should be used with caution, patients with high blood lipids should be used with caution, and regular testing of liver function and blood lipids during oral administration is recommended.
In short, retinoins are widely used in the treatment of acne, thereby removing acne, inhibiting the formation of acne, and also inhibiting local inflammation, reducing the possibility of acne scars and acne scars, as long as the use of standardized use, rational use, strictly in accordance with the guidance of specialists for treatment, as far as possible to avoid discomfort reactions, its clinical efficacy will certainly be the best.