I. What are the commonly used retinoic acid drugs in clinical use
The most commonly used clinical drugs belong to the first generation of retinoic acid, including retinoic acid, isotretinoic acid (13-cis retinoic acid, Tylenol), and vincristine (Tristimethoprim). Oral isotretinoin has the best efficacy for acne and is the standard treatment regimen for acne, commonly used for moderate to severe acne where other methods are ineffective. Specific indications for application.
(i) Severe nodular cystic acne.
(ii) Extensive acne of the face and trunk.
(iii) Acne with significant scar formation.
④Resistance to general treatment (i.e., failure of conventional treatment) or recurrent acne.
⑤ Inability to tolerate systemic application of antibiotics or hormonal therapy.
⑥Severe psychological disorders due to acne requiring timely control of the condition.
(7) Certain variants of acne, such as eruptive acne, facial pustulosis, gram-negative bacillary folliculitis, etc.
Mechanism of action: It has therapeutic effects on all aspects of acne pathogenesis, not only controlling inflammation development, reducing sebum secretion, dissolving sebum, inhibiting abnormal keratinization of follicular sebaceous ducts, but also reducing or improving the formation of acne scarring.
Second-generation retinoic acid, including etretinate (avobenzone, neostigmine) and etretinate (avobenzone, somatostatin). It is mainly used for the treatment of severe psoriasis, such as pan-pustular psoriasis and erythrodermic psoriasis.
Second, the precautions for oral retinoic acid drugs are as follows
1, the side effects of these drugs are large, the common ones are dryness of the mouth, lips and eyelids, conjunctiva, hair loss, pigmentation, elevated blood lipids, gastrointestinal discomfort, joint and muscle pain, teratogenicity, etc.. Therefore, it is prohibited for people with liver and kidney insufficiency, hyperlipidemia, diabetes, and obesity. Generally speaking, the course of treatment is 2~6 months. Also with vitamin B1, B2, B6, glutamate, etc., can reduce the side effects of vitamin A acid drugs.
2, do not combine with tetracycline drugs, glucocorticoids, because there may be “pseudotumor-like symptoms”, manifested as increased intracranial pressure, headache, dizziness, nausea and vomiting, visual impairment, etc., but can be restored after stopping the drug.
3, do not combine with vitamin A, otherwise it is easy to cause vitamin A excess syndrome, manifested as digestive system symptoms such as nausea, vomiting, abdominal pain, diarrhea, hepatomegaly and pressure; neurological symptoms such as headache, dizziness, drowsiness, unresponsiveness, even irritability, increased cranial pressure; and skin, mucous membrane, eye discomfort, itching, etc.; so the system application of vitamin A drugs during the same time do not oral vitamin A Therefore, do not take vitamin A preparations and beverages containing vitamin A, health products, etc;
4, do not combine with methotrexate, azathioprine and other immunosuppressants, because it is more likely to lead to liver and kidney function damage and bone marrow suppression.
5, pay attention to the protection of the eyes, taking vitamin A drugs can cause a decrease in tear secretion, which leads to an increase in bacterial colonization. Therefore, some doctors recommend the regular use of artificial tears to reduce the incidence of eyelid conjunctivitis. Topical antibiotics are largely ineffective if conjunctivitis of the eyelid is already present. Note that contact lenses should not be worn during treatment.
6, protect the skin, after 1 month of applying retinoic acid drugs, there will be a reduction in facial sebum secretion, at this time the patient’s skin stratum corneum thickness may become thinner and the barrier function of the skin has mildly damaged. Therefore, it is necessary to use moisturizing emollients frequently, and also periodic topical glucocorticoids can be used to relieve the above symptoms.
7, pay attention to the psychiatric symptoms: a few patients will produce some depressive symptoms after the use of vitamin A acid. Therefore, patients with a history of depression or depression in the family, the medication must be used with caution, once the mood swings or any depressive symptoms, should immediately stop the drug and promptly seek medical attention.
8. Patients should not donate blood during the medication period and within 2 years after stopping the medication.
9.During the medication period and within 2 months after discontinuation, alcohol (including beer, yellow wine, white wine, etc.) and various ethanol-containing beverages should be avoided because they are likely to cause accumulation in the body and increase intracranial pressure.
10.These drugs are clearly teratogenic, so women of childbearing age should avoid pregnancy during and within 2 years after stopping the drugs. There is no authoritative information on the effects on men, and some doctors tend to treat them the same as women, that is, they cannot consider having children within 2 years of taking the drug.
11.These drugs may affect the epiphyseal closure and ligament development in children, so they are prohibited for children under 8 years old, and children under 13 years old need to weigh the pros and cons and use with caution.
12. Retinoic acid drugs have an accumulative effect in the body, and the incidence of side effects is related to the dose size. The higher the dose, the greater the side effects; therefore, close observation and regular follow-up are needed during the medication period, such as routine blood and urine tests, liver and kidney functions and bone
X-rays.
13, there are some patients who are allergic to retinoic acid and should be prohibited.