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Definition Acne 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 severity Location Seasonal variation Aggravation by stress 对女性病人For women Premenstrual flare-up Menstrual history and pregnancy status Increase of androgen-dependent hair Thinning of scalp hair Oral contraceptives and effect on acne Hormone tests Cosmetics and moisturizers: type and frequency 治疗史Current treatment(s): topical and systemic Of acne Of other diseases Past treatment(s): topical and systemic Of acne Of other diseases 家族史和其它病史Family history of acne Other skin disorders: Atopy, personal or familial (because of occasional irritation to topical acne preparations) Hidradenitis suppurativa Drug allergies General health, especially but not limited to: Hepatic disease Renal disease Endocrine Physical Examination Lesion type Noninflammatory ：open/closed comedones Inflammatory ：papules/ pustules/ nodules / cysts Location Face/neck/ back/ anterior chest/ extremities Gradation Mild, moderate, severe Complications Scarring type Atrophic Hypertrophic Keloids Localization Severity Discoloration Localization Severity 其它皮损和并发病Other associated findings include but are not limited to: Postinflammatory macular lesions Postinflammatory hyperpigmentation and hypopigmentation Hirsutism for women Alopecia for women Asymmetry of distribution of acne Excoriations Diagnostic 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 diseases Inappropriate diagnostic tests* Routine allergy testing Hair analysis Treatment （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 to Benzoyl peroxide 单用或与erythromycin ，sulfur 合用Topical antibiotics ：Tetracycline lotion ，Clindamycin lotion, gel ；Erythromycin lotion, swabs, gel ；Meclocycline cream Tretinoin Salicylic acid a-Hydroxy acid Sulfur: including Vleminckx’s solution Resorcinol Miscellaneous: astringents, soaps, cleansers Treatment （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 therapy most commonly used, but not limited to: Oral Antibiotics ：Tetracycline ；Erythromycin ；Minocycline ；Trimethoprim-sulfamethoxazole ；Other Isotretinoin, 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 therapy Hormonal treatments may include the following: Corticosteroids Anti-inflammatory actions: high dose Androgen suppressant action: l ow dose Sex hormones (for women only) Estrogen (oral contraceptive medication) Antiandrogens Lesional therapy Extraction of comedonal contents Drainage of superficial pustules and cysts Excision of sinus tracts and cysts Intralesional corticosteroids Cryotherapy Dermabrasion (scars) Filling materials (scars) Surgical repairs (scars) Systemic Therapy Other treatments may include the following: Dapsone Diet (in selected cases) Ultraviolet light Superficial exfoliation Carbon dioxide-acetone slush Sulfur-resorcinol * *