美国AAD痤疮指南.ppt

美国AAD痤疮指南Guidelines of Care for Acne Vulgaris 注意本指南的时效性This report reflects the best data available at the time the report was prepared,but caution should be exercised in interpreting the data.The results of future studies may require alteration of the conclusions or recommendations set forth in this report.发表于1990年定义 DefinitionAcne vulgaris is a follicular disorder that affects susceptible pilosebaceous follicles,primarily of the face,neck,and upper trunk,and is characterized by both noninflammatory and inflammatory lesions.1累及敏感的皮脂腺面、颈、躯干上部疾病2有炎性和非炎性皮损流行病学（1）Acne is a disease of high prevalence and affects many persons in their teen age years.Although peak prevalence may be at age 17,acne may begin as early as age 8 and is not uncommon in the 10-to 12-year-old age group in which it is often overlooked.Both sexes are affected equally,but males have,on average,greater degrees of severity.流行病学（2）A substantial percentage of adults are affected either as a continuation of their teenage acne or its first appearance in the third or fourth decade.流行病学（3）Most cases of acne subside and involute spontaneously and completely within a few years of their onset,but a small percentage remain active.The disease may cause considerable emotional distress because of its appearance,even when the disease has involuted if scarring has taken place.The psychosocial impact on teenagers may be devastating.诊断 Diagnostic criteria 诊断标准A.Clinical（一）临床Patient history 病史为了进行有效的治疗Duration,to include progression to point of maximal severityLocationSeasonal variationAggravation by stress对女性病人For womenPremenstrual flare-upMenstrual history and pregnancy statusIncrease of androgen-dependent hairThinning of scalp hairOral contraceptives and effect on acneHormone testsCosmetics and moisturizers:type and frequency治疗史Current treatment(s):topical and systemicOf acneOf other diseasesPast treatment(s):topical and systemicOf acneOf other diseases家族史和其它病史Family history of acneOther skin disorders:Atopy,personal or familial(because of occasional irritation to topical acne preparations)Hidradenitis suppurativaDrug allergiesGeneral health,especially but not limited to:Hepatic diseaseRenal diseaseEndocrinePhysical ExaminationLesion typeNoninflammatory：open/closed comedonesInflammatory：papules/pustules/nodules/cystsLocationFace/neck/back/anterior chest/extremitiesGradationMild,moderate,severeComplicationsScarring typeAtrophicHypertrophicKeloidsLocalizationSeverityDiscolorationLocalizationSeverity其它皮损和并发病Other associated findings include but are not limited to:Postinflammatory macular lesionsPostinflammatory hyperpigmentation and hypopigmentationHirsutism for womenAlopecia for womenAsymmetry of distribution of acneExcoriationsDiagnostic tests 辅助检查There are no diagnostic tests for acne vulgaris.However,in some instances diagnostic tests are used to differentiate and identify acne-like eruptions or to detect the presence of systemic conditions that aggravate acne.Such tests include but are not limited to:用于鉴别、发现加重痤疮的系统原因Diagnostic tests 辅助检查Bacteria culture(e.g.,gram-negative folliculitis)Hormonal assay(e.g.,presence of androgen imbalance)Biopsy when necessary to differentiate acne from other diseasesInappropriate diagnostic tests*Routine allergy testingHair analysisTreatment（1）Topical treatment alone may be indicated for the following types of acne:mild to moderate comedonal lesions,superficial inflammatory(papular or pustular),and usually non-scarring.Topical Therapy:most commonly used,but not limited toBenzoyl peroxide 单用或与 erythromycin，sulfur合用Topical antibiotics：Tetracycline lotion，Clindamycin lotion,gel；Erythromycin lotion,swabs,gel；Meclocycline creamTretinoinSalicylic acida-Hydroxy acidSulfur:including Vleminckxs solutionResorcinol Miscellaneous:astringents,soaps,cleansersTreatment（2）Systemic treatment may be indicated for the following types of acne:Moderate to severe(scarring or non-scarring)or that in patients with persistent hyperpigmentation.Systemic treatment may need to be used alone in patients who are intolerant to topical treatment or in whom such treatment has failed.Systemic therapymost commonly used,but not limited to:Oral Antibiotics：Tetracycline；Erythromycin；Minocycline；Trimethoprim-sulfamethoxazole；OtherIsotretinoin,Primary and only approved use is for severe,recalcitrant,cystic acne,refractory to conventional anti-acne measures,including systemic antibiotics.For women of childbearing potential,Appendix A guidelines apply.Systemic therapyHormonal treatments may include the following:CorticosteroidsAnti-inflammatory actions:high doseAndrogen suppressant action:l ow doseSex hormones(for women only)Estrogen(oral contraceptive medication)AntiandrogensLesional therapyExtraction of comedonal contentsDrainage of superficial pustules and cystsExcision of sinus tracts and cystsIntralesional corticosteroidsCryotherapyDermabrasion(scars)Filling materials(scars)Surgical repairs(scars)Systemic TherapyOther treatments may include the following:DapsoneDiet(in selected cases)Ultraviolet lightSuperficial exfoliationCarbon dioxide-acetone slushSulfur-resorcinol后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用主要经营：网络软件设计、图文设计制作、发布广告等公司秉着以优质的服务对待每一位客户，做到让客户满意！致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider field