目前常見的青春痘治療藥物(摘錄自Dr. Fulton研究論文) @

目前常見的青春痘治療藥物(摘錄自Dr. Fulton文章 INTERNATIONAL JOURNAL OF COSMETIC SURGERY and AESTHETIC DERMATOLOGY Volume 4, Number 2, 2002)

青春痘是危害眾多消費大眾肌膚的頭號殺手，從年輕時只要一個不小心，可能就會造成愛美人士的終身遺憾。大家對青春痘的治療的藥物大都聽說過，但是也多半是懵懵懂懂的，因此Dr. Hsieh將陸續的把Dr. Fulton關於青春痘的一些文章簡要的摘錄下來並加以翻譯，除了想提供一個較為可靠、安全的資訊外，也希望能對諸多身陷青春痘風暴的人們有一些些的貢獻。

(Dr. Fulton關於青春痘的研究論文很多，另外他也寫了一本關於青春痘的專書“Acne RX”，我只能簡單將幾個重點逐漸翻譯出來，讓大家有個大致上的認識)

目前青春痘最常見的治療藥物包括以下幾種：

Tetracycline四環黴素
Tetracycline became a major treatment agent in the 1950s and 1960s. The ingestion of tetracycline would diffuse into the pore and inhibit the Corynebacterium acnes. However, this antibiotic only inhibited about 50% of the bacteria and reduced the fatty acids about 50%. The remaining residual bacteria, fatty acids and other components of sebum were enough to continue on with the acne problem in most patients. In a few patients the results from the tetracycline was really dramatic but in most it was hardly better than a placebo.

四環黴素在50到60年代是青春痘治療的主要藥物，口服四環黴素可以滲入毛孔去抑制皮膚挫瘡桿菌。然而這種抗生素只能抑制50%的細菌以及減少50%的脂肪酸，剩餘的細菌、脂肪酸及皮脂膜組成在大多數人還會繼續形成痘痘問題，對一些人來說，四環黴素有著非常神奇的效果，但是對大多數的人使用四環黴素的效果比使用安慰劑者也好不了多少。

One lipid soluble tetracycline called minocycline still remains popular today. This is the one antibiotic that occasionally does help in pustular acne. However, by the time the patients come to our medical office they have often received several tetracyclines including minocycline, so we have found the topical skin care program more effective. However, if the patient comes in on minocycline and feels they are improved we will leave them on the antibiotic for several weeks until the topical skin care program takes hold.

一種較新的脂溶性四環黴素叫做minocycline到目前為止還十分普遍，這種抗生素偶爾對膿疱型痘痘會有幫助，然而許多的病患在到我們診所之前就已經接受多種的四環黴素治療，其中也包括了minocycline，所以我們發現局部的皮膚照護療程可能更重要。但是如果病患接受minocycline治療而且感覺痘痘情形有所改善的話，我們會讓他持續接受抗生素治療數個星期，而後再開始局部的皮膚照護療程。

Vitamin A Acid維生素A酸
1969, doctors at the University of Pennsylvania developed vitamin A acid for the topical treatment of acne (6). This therapeutic agent was commercialized by Johnson & Johnson and became tretinoin or Retin-A®. It was a major breakthrough in the topical treatment of acne. No topical treatments had really been effective to that point. The use of vitamin A caused the skin to peel and this released the acne impactions. Sometimes the acne would get worse before it got better as the pores were evacuated. It was helpful to combine this treatment with effective acne facials or extractions to remove the impactions once they had been loosened up.

1969年，賓州大學的醫師們發展出維生素A酸來局部治療痘痘，這種治療藥物被Johnson & Johnson公司製成tretinoin or Retin-A®商業藥劑而行銷。它是局部治療青春痘的一大突破，沒有一種青春痘的局部治療藥物能像它如此有效。使用維生素A會造成皮膚層的剝除，因此可以緩解青春痘的緊壓性，有時候當毛孔被吸擠時，痘痘狀況會先變壞再變好。一旦痘痘被維生素A酸給鬆解後，合併有效的痘痘清除術來除去緊壓的痘痘粉刺會更有效果。

Benzoyl Peroxide過氧苯醯

In 1972 doctors at the University of Miami developed the gels of benzoyl peroxide (6). The benzoyl molecule pulled the peroxide into the pore where it released free radical oxygen that killed the bacteria and opened up the acne impactions. This has become a mainstay of treatment not only in the doctor's office but also in the esthetician office and in the drug store. The combination of vitamin A in the morning and benzoyl peroxide at night became the main active therapeutic program. This cleared the complexion in about 2 months. The birth of an effective topical treatment was accomplished.

在1972年，邁阿密大學的醫師們發展出過氧化苯醯的凝膠，苯醯分子可以將過氧化分子拉進毛孔而釋放出氧自由基來殺死細菌並鬆解掉痘痘粉刺。過氧苯醯不僅在診所，甚至在美容工作室及藥局都已經成為痘痘主要的治療藥物之一早上合併使用維生素A酸，晚上使用過氧苯醯成為痘痘治療的主要療程，這樣的療程可以在兩個月左右清除掉複雜的痘痘問題。

Alpha Hydroxyacids
Van Scott's development of the alpha hydroxyacids paralleled Kligman, Fulton and Plewig's development of tretinoin (8). The alpha hydroxyacids such as glycolic acid or lactic acid worked differently. They dissolved the attachment plaques between cells and caused the dead cells to fall off rapidly. This generated new skin cells from below that did not stick. The combination of benzoyl peroxide scrub cleanser in the morning, followed with an alpha hydroxyacid lotion, and later on the application of a vitamin A gel is currently the treatment of choice for our topical therapy for acne.

在維生素A酸發展的同時，果酸也被發展出來，包括甘醇酸或乳酸在內，各有不同的作用方式。果酸可以溶解細胞間的連結並使死亡的細胞快速脫落，這樣就讓下層新生的皮膚細胞不會和老舊的細胞黏連在一起。在早上使用過氧苯醯洗劑，接著使用果酸的乳液再加上維生素A凝膠是我們局部治療痘痘粉刺的首選治療方式。

Isotretinoin (Accutane®)口服A酸
In 1979 isotretinoin became available for the systemic use in the treatment of acne (9). When ingested orally over a 5 month period the oil glands shrunk, the oil sebum level fell and the acne cleared up. Interestingly, the acne stayed clear on many individuals after the drug use was discontinued and the oil production resumed. The reason for this is unknown. Accutane® is still a major treatment for severe cystic acne. Patients must read, understand and sign a detailed informed consent form before starting therapy.

在1979年口服A酸(Isotretinoin)被使用在全身性的A酸治療上，當服用5個月的時間後，皮膚的脂腺會緊縮，皮脂的油性程度會減少，痘痘開始消失。有趣的是，當停止服用A酸後，在許多人身上發現油性分泌會回復但是痘痘情況還是保持的不錯，造成這種情形的原因還不清楚。口服A酸對嚴重的囊疱型痘痘還是一個主要的治療方式，病人必須確實了解並簽下同意書後才開始接受治療。