Latest inventory: Adverse reactions to acne treatments
Release date: 2016-11-18
In general, the side effects of acne treatments are not serious, mostly transient, but can affect patient compliance and force treatment interruption. Professor Morrell from the Department of Dermatology, Faculty of Medicine, University of North Carolina, USA, reviewed the side effects of acne treatments. The article was published in the recent Am J Clin Dermatol magazine and is described as follows:
Acne is a clinically very common chronic inflammatory or non-inflammatory disease of the skin. The site of the disease is usually located in areas with high density of hair follicle sebaceous glands, such as the face, chest and neck, and back. Typical acne manifestations include non-inflammatory skin lesions, such as Blackheads, as well as inflammatory lesions such as abscesses, papules or nodules.
At present, the clinical treatment strategy is mainly for hemorrhoids with serious severity or inflammatory reaction, and the individualized schemes are quite different. Now, various schemes are summarized one by one.
Topical medication
Topical medication is the main treatment for mild to moderate acne. Salicylic acid, benzoyl peroxide, azelaic acid, vitamin A, etc. for non-inflammatory acne, and additional antibiotics or other anti-inflammatory acne Bacteriostatic measures. Topical treatments have fewer side effects, mostly skin irritation. In general, gels, lotions, and solvents are more likely to cause dryness than skin creams and ointments.
Topical retinoid
Retinoic acid is a metabolic intermediate of vitamin A in the body, involved in epidermal differentiation, keratinolytic and other processes. Clinically common retinoid preparations are retinoic acid (1st generation), tazarotene (3rd generation), adapalene. (3rd generation), common adverse reactions were epidermal exfoliation, erythema, dryness, burning sensation or itching, and the severity was dose-related.
Among them, tazarotene is the most irritating, and about half of the patients in daily use have local skin irritation; adapalene has fewer adverse reactions and patients have high tolerance. In addition, the topical application of retinoic acid increases the sensitivity of the skin to ultraviolet light. Therefore, in daily life, it is necessary to use a combination of sunscreen or sunscreen.
Retinoic acid-mediated skin irritation often tends to be self-limiting, usually reaching the peak at 4 weeks after administration, and then the symptoms gradually improve. When benzoyl peroxide and salicylic acid are used in combination, the adverse effects of retinoic acid-mediated adverse reactions such as exfoliation and erythema are aggravated.
At present, retinoic acid mediates systemic adverse reactions, retinoic acid and adapalene are used for pregnancy class C. Pregnant women are used with caution, while tazarotene is pregnant for class X and pregnant women are banned. Recent studies have found that topical retinoids during early pregnancy do not increase the risk of spontaneous abortion or fetal birth defects.
Topical antibiotic
Topical antibiotics are commonly used to treat mild to moderate inflammatory acne. Commonly used drugs include clindamycin and erythromycin. Common skin irritation includes erythema, dry burning, etc., systemic adverse reactions such as diarrhea or pseudomembranous colon. Inflammation and the like are rare.
In addition, long-term use needs to consider the problem of bacterial antibiotic tolerance, especially erythromycin tolerance. Therefore, in antibiotic treatment, retinoic acid and / or benzoyl peroxide should be combined to avoid long-term maintenance or single use. Topical anti-toxicity is a Class B drug for pregnancy. Studies have shown that it is not teratogenic and can be safely used during pregnancy. Other topical drugs, benzoyl peroxide, are a class of non-antibiotic bacteriostatic drugs that inhibit the growth and reproduction of bacteria such as P. acnes by producing active oxygen components. Common adverse reactions include local erythema, dryness, and exfoliation. Limitations, systemic adverse reactions are rare, for pregnancy C drugs, pregnant women with caution.
The most commonly used glycolic drugs in dermatology include salicylic acid and glycolic acid. Local skin irritation is common after administration. Systemic adverse reactions are rare. However, when treating hyperkeratosis, high doses may cause salicylic acid toxicity. Reactions, such as toxic inner ear injury, hypoglycemia, gastrointestinal dysfunction, neurological disorders, increased respiratory rate, metabolic acidosis with respiratory alkalosis, etc., the symptoms of related adverse reactions will gradually improve after stopping the drug.
Glycolic acid is commonly found in cosmetics and is often used to treat hyperpigmentation and skin aging. Glycolic acid increases the UV sensitivity of the skin during daily use, and attention should be paid to sun protection. Glycolic acid is relatively safe in women who use it during pregnancy.
Azelaic acid is a kind of antibacterial and anti-inflammatory drugs, mainly used for treatment. Common adverse reactions include transient erythema, skin irritation, systemic adverse reactions are rare, and patients with darker skin should pay close attention to medication.
Dapsone is a class of antibacterial and anti-inflammatory drugs that can effectively relieve symptoms of inflammatory or non-inflammatory skin lesions. Oral dapsone can cause hemolytic anemia, especially in patients with G6PD deficiency. However, there are no clinical studies to find that topical use of dapsone can cause hemolytic anemia. The combination of dapsone with benzoyl peroxide requires attention to the symptoms of transient yellowing of the skin. Symptoms of systemic adverse reactions such as headache and nasopharyngitis are rare.
Sodium sulfacetamide is a kind of sulfonamide antibacterial agent that inhibits bacterial DNA synthesis. Clinically, 10% sulfaacetate combined with 5% sulphur is commonly used to treat acne. Adverse reactions are rare, mainly due to localized skin irritation. Patients with allergic reactions to topical sulfa drugs should be banned with sodium sulfacetamide, while patients with allergic reactions to oral sulfa drugs generally have a better tolerance to sodium sulfacetamide.
For the above drugs, after the occurrence of local skin symptoms, the frequency and dosage of the drug will be reduced accordingly. Benzoyl peroxide, salicylic acid, dapsone and sulfacetamide are the C drugs for pregnancy, and sebacic acid is the B drug for pregnancy. Therefore, sebacic acid and glycolic acid are safe for pregnant women.
Chemical stripping
Chemical stripping, commonly known as chemical peeling, uses chemical reagents to control the unsatisfactory skin. It is clinically combined with other therapies for the treatment of acne. The most commonly used drugs are trichloroacetyl, others include glycolic acid, salicylic acid, Jessner solution, etc. Common adverse reactions include erythema, skin flaking, pain, or itching. In patients with darker skin, symptoms of pigmentation after skin inflammation may occur, and other rare complications include infection and allergic reactions.
Oral antibiotic
Oral antibiotics are often used to treat severe acne, such as local antibiotic treatment or systemic acne, first-line oral antibiotics including tetracycline, sulfamethoxazole trimethoprim, amoxicillin, azithromycin and so on. When oral antibiotics are treated, other therapies should be combined to reduce the risk of anti-toxin tolerance and improve anti-toxic and antibacterial effects.
Tetracycline
Tetracyclines are first-line drugs for the treatment of acne. Commonly classified as tetracycline, doxycycline, minocycline, etc., pregnant women and children before 8 years of age are banned, and many types of adverse reactions are relatively rare, including susceptible female vaginal candida Disease, digestive discomfort, phototoxicity (shown in Figure 1), pigmentation (shown in Figure 2), benign intracranial pressure and Sweet syndrome.
Sweet syndrome is typically characterized by painful red nodules in the upper body with fever, wilting, and leukocytosis, requiring immediate termination of tetracycline administration. Taking a tetracycline medication immediately after falling asleep may lead to drug-mediated esophagitis. Therefore, it is recommended to take the medicine after meals and use a large amount of water to administer the medicine. After taking the medicine for 30 minutes, the patient goes to bed or lie down.
Figure 1. Doxycycline-induced photosensitive nail separation
Figure 2. Dimethyltetracycline-induced pigmentation
Other antibacterials
Other antibacterial agents used to treat acne include sulfamethoxazole trimethoprim (TMP-SMX), azithromycin, and amoxicillin. TMP-SMX can cause rare but serious adverse reactions, including Stevens-Johnson syndrome, hypersensitivity reactions, blood complications (such as thrombocytopenia, neutropenia, anemia, neutropenia, etc.). TMP-SMX is a Class C drug for pregnancy and is contraindicated for pregnant women.
Azithromycin is generally well tolerated and only causes mild transient gastrointestinal dysfunction. The combination of antacids before administration can be effectively relieved. A few recent studies have found that azithromycin may cause arrhythmia and increase cardiovascular mortality.
Amoxicillin is well tolerated, and the adverse reactions are similar to other conventional oral antibiotics and do not pose a risk of arrhythmia. Azithromycin and amoxicillin are pregnant class B drugs, and pregnant women are safer.
Hormone drugs
Hormone drugs are more effective in the treatment of moderate to severe female acne. Oral contraceptives (OCP) and androgen receptor blockers are commonly used to block sebum secretion by blocking sebaceous androgen receptors. Men and pregnant women are all hormones. Drug contraindications.
Oral contraceptive
Contraindications for oral contraceptives include history of stroke, history of venous thromboembolism, history of myocardial infarction, history of breast cancer, history of uncontrolled hypertension, history of smoking, history of threatened migraine, etc., so the patient's medical history should be fully evaluated before administration. And treatment history. There are many adverse reactions. Common transient adverse reactions include uterine bleeding, nausea and vomiting, breast tenderness, headache, lower extremity edema, etc., which are generally improved after 2-3 medication courses or drug reduction. Serious adverse reactions include venous thromboembolism, myocardial infarction, stroke, etc., and the risk is higher in patients with diabetes, threatened migraine, hypertension, and stroke.
Androgen receptor blocker
Spironolactone is the most commonly used androgen receptor blocker, and the adverse reactions are generally dose-dependent, including breast tenderness, menstrual disorders, dizziness, headache, irregular menstrual bleeding. In addition, spironolactone can also act as an aldosterone receptor agonist to promote urination, resulting in electrolyte imbalance such as blood pressure drop and hyperkalemia. Therefore, in the first month after administration, the patient should be closely monitored for potassium levels and the patient's diet. Avoid taking extra potassium.
Isotretinoin
Isotretinoin is a metabolite of vitamin A. It is usually used to treat severe inflammatory acne, nodular cystic acne, or refractory diseases. The adverse reactions are similar to those of hypervitamin A syndrome. Skin mucosa often occurs. Symptoms such as the eyes, gastrointestinal tract, nervous system, mental illness, and rheumatic diseases.
to sum up
At present, the treatment of acne is relatively mature, and most of the medications have fewer adverse reactions. Symptoms of skin irritation caused by topical medication can be gradually improved after the dose is reduced or decreased. Symptoms of adverse reactions to systemic medications are rare, but a few serious adverse reactions can threaten the safety of patients and require clinical vigilance. In summary, the basic principle of acne treatment is to improve the incidence of acne while minimizing the incidence of adverse reactions.
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