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JAAD:口服抗生素治疗痤疮 如何能省时又省钱?

2015-04-08 sapphira 译 MedSci原创

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痤疮是毛囊皮脂腺单位的一种慢性炎症性皮肤病,对心理和社交影响很大,但青春期后往往能自然减轻或痊愈,也有部分不痊愈者。临床表现以好发于面部的粉刺、丘疹、脓疱、结节等多形性皮损为特点。


痤疮的发生主要与皮脂分泌过多、毛囊皮脂腺导管堵塞、细菌感染和炎症反应等因素密切相关。进入青春期后人体内雄激素特别是睾酮的水平迅速升高,促进皮脂腺发育并产生大量皮脂。同时毛囊皮脂腺导管的角化异常造成导管堵塞,皮脂排出障碍,形成角质栓即微粉刺。毛囊中多种微生物尤其是痤疮丙酸杆菌大量繁殖,痤疮丙酸杆菌产生的脂酶分解皮脂生成游离脂肪酸,同时趋化炎症细胞和介质,最终诱导并加重炎症反应。

最近,口服抗生素治疗青春期痤疮的实际有效疗程与治疗指南上所写的是否有差别引起了人们的关注,但是成人痤疮的口服抗生素疗法有效疗程是否与指南上有差别仍不得而知。临床上的治疗时间往往长于指南上推荐的疗程,可能造成不必要的人力物力财力的浪费。

美国的一组科学家最近对这个问题进行了回顾性的调查研究,研究对象范围很广泛,希望可以找出21岁及以上成年人痤疮口服抗生素治疗的最佳时间和对应的花费。结果显示,在17448个调查病案中,84.5%(14737人)是按照指南上的疗程治疗的,尽管这之中有12040人并没有用副维A酸治疗。如果每个人的疗程缩短到指南上所写的时间的话,平均每个人可以节省592.26美元。按照临床最普遍的治疗周期(90-179天)来算,普通药物和品牌药物的平均个人费用分别是103.77美元和1421.61美元。

总地来说,尽管维A酸并没有恰当使用,但是大部分口服抗生素疗程还是遵循了指南,抗生素治疗的花费对短疗程和用普通药物的人来说更低些。但是这项调查也可能存在一些缺陷,比如患者依从性不能保证,数据也缺乏关于每个患者痤疮严重程度、个体差异和临床结果的信息。

原始出处:

Straight CE1, Lee YH2, Liu G3, Kirby JS4.Duration of oral antibiotic therapy for the treatment of adult acne: A retrospective analysis investigating adherence to guideline recommendations and opportunities for cost-savings.J Am Acad Dermatol. 2015 Mar 7. pii: S0190-9622(15)00115-2. doi: 10.1016/j.jaad.2015.01.048. [Epub ahead of print]

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    2016-01-12 小梁同志

    好像没说具体时间吧

    0

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    2015-07-15 皮肤小生

    0

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