Views: 1 Author: Site Editor Publish Time: 2022-08-05 Origin: Site
Tretinoin can help us prevent skin sagging and wrinkles, and can also accelerate the shedding of waste keratinocytes, thereby rejuvenating and whitening the skin. It can also improve acne.
Tretinoin is an intermediate product of vitamin A, which mainly affects bone growth and promotes epithelial cell proliferation, differentiation, keratolysis and other metabolic effects. For the treatment of keratinizing diseases such as acne vulgaris (pimples), psoriasis (psoriasis), ichthyosis, lichen planus. Oral retinoids include viaminate capsules and isotretinoin capsules for acne treatment, acitretin and acitretin for psoriasis and other keratinizing diseases.
What is isotretinoin?
Among the tretinoin drugs, only isotretinoin has significant anti-acne and seborrhea effects. Isotretinoin is the only drug that can provide long-term relief, or even "cure" acne.
Isotretinoin can act on all pathogenic links of acne, including significantly inhibiting the secretion of sebaceous glands (even if you are a big oil field, it can also significantly reduce oil production), reducing the blockage of hair follicle skin gland ducts, maintaining patency, and inhibiting acne propionate Bacillus growth, reproduction, reduce the production of inflammatory mediators to achieve anti-inflammatory effects.
Long-term clinical use has confirmed that the isotretinoin low-dose full course of treatment (usually 6 months) has good therapeutic effect, good tolerance and high safety. Many friends were frightened after reading the instruction manual of isotretinoin.
Can they still eat with so many side effects? In fact, the detailed side effects on the instructions also show that this drug has a long history of use and more thorough research. On the contrary, drugs with unknown side effects are really terrible.
The most common side effect of isotretinoin capsules is dryness of the lips and mucous membranes, of course, this is also considered to be a sign of its onset, usually appearing in about 7-10 days of use (depending on the amount of isotretinoin used and individual differences, almost 100% incidence), cheilitis (incidence depends on dose and individual tolerance).
Dry skin on the face and body, and even isotretinoin eczema (caused by the lack of sebum moisture in the skin caused by the reduction of sebaceous gland secretion by more than 90% after oral administration of isotretinoin). Other rare ones include increased liver enzymes, and the reported probability of increased blood lipids is about 3-5% (the probability of occurrence is related to the dose of oral isotretinoin).
Most of the liver enzymes are only mildly elevated, and the abnormal value range of this level does not require drug treatment, and it can be recovered by itself by reducing or stopping the drug), headache, dizziness, muscle and joint pain, facial flushing, menstrual disorders, etc. May cause conjunctivitis, corneal opacity and even visual disturbances. The instructions are all there, and there are many rare adverse reactions, which will not be repeated.
The most important point to mention is that for pregnant women, fetal malformations can occur, so it is necessary to ensure that pregnancy is not possible one month before use, during use and three months after use. Even taking one orally during pregnancy can cause deformities in the baby. Female patients should be checked twice before taking the medicine to rule out the possibility of pregnancy, and blood is drawn every month during the taking of the medicine to rule out the possibility of pregnancy. Before taking the medicine, routinely check the blood routine, liver function and blood lipids, and draw blood to review the liver function and blood lipids every 1-2 months to prevent the corresponding adverse reactions. Although the possibility is small, it should not be sloppy in medicine. Female spouses who are trying to conceive should not take it.
Topical tretinoin is also a first-line drug for acne treatment, including 0.025%-0.1% tretinoin cream, 0.05% isotretinoin gel, 0.05%-0.1% tazarotene, 0.1% adapalene gel.
Tretinoin topical drugs have photosensitivity and need to be used in the dark, usually once a night, and avoid sun exposure during the day. Most people will experience tingling, erythema, peeling and other reactions when they first use it. Therefore, at the beginning of use, it is recommended that the drug be diluted with lotion or cream at a ratio of 1:1 and then rubbed on the affected area of ??acne, left for 10 minutes and washed off, and then gradually extended the stay time and concentration until overnight, and finally the place with acne can be used externally as a whole until it is completely Full topical use (except tazarotene) after tolerance. Generally, it will take effect after 1 month of use (10% effect), and the duration of external use usually takes 4-6 months to achieve good effect, and more than 80% of the effect can be achieved in 8 months. After the acne damage is eliminated, it should be maintained for half a year.
Tretinoin cream can not only reduce acne, but also reduce oil secretion, dilute the pigmentation left by acne, and another important point, better skin rejuvenation effect, which is often added to high-end skin care products as a tenderizer skin use. When using tretinoin, you should also pay attention to reducing side effects. You can use moisturizing lip balm and face cream to combat the lip mucous membrane and possible dry skin, and do a good job of sun protection to avoid pigmentation. Long-term use may make the skin sensitive and prone to redness. Therefore, usually You can use some medical skin care products that can repair the sebum film. In addition, you need to do strict sun protection work: such as physical sun protection methods such as sunshades, external sunscreen lotions, and less heavy sunscreens.
Tretinoin ointment is the most affordable but the most irritating. The third-generation Tretinoin adapalene is less irritating, milder, easier to tolerate, and has a better effect on non-inflammatory lesions (acne) than Tretinoin and isotretinoin (Chinese acne treatment guidelines), Compared with other Tretinoin drugs, it has better anti-inflammatory effect, so in addition to acne, it also has a good effect on inflammatory acne. The effects and side effects of tazarotene and isotretinoin topical are moderate. In addition to tazarotene, several other Tretinoin topical preparations can be used on the whole face. It should be mentioned that strict contraception is recommended for three months when using topical retinoids and after stopping use (such contraceptive time is sufficient, because there is currently no sufficient evidence to prove that topical retinoids will definitely cause teratogenicity) .
Fruit acids (alpha hydroxy acids, AHAs), namely α-hydroxy acids, are a class of non-toxic substances and related compounds that exist in nature. As early as 1974, the "father of fruit acid" famous dermatologist Dr. Van Scott and pharmacy expert Dr. Ruey Yu found that different concentrations of fruit acids have different cosmetic and therapeutic effects, mainly used for acne (acne), keratosis pilaris (chicken skin), ichthyosis and other keratotic diseases, dark brown acne marks (post-acne) Pigmentation), melasma and other pigmented diseases, as well as skin photoaging, enlarged pores and other treatments.
Commonly used in medical institutions are Coresculine and Winona, and of course there are other brands. Commonly used clinically are glycolic alcohol, mandelic acid (mandelic acid), citraconic acid, lactobionic acid, etc. The main one we use for acne is Glycolic acid, because it has the smallest molecular weight, penetrates most easily into the deep layers of the skin, and has the strongest effect of dissolving keratin plugs and exfoliating. Indications are mainly grade I acne with acne as the main manifestation, and grade II acne patients with less inflammatory papules (red inflamed acne) and acne. Inflammatory papules (red inflamed pimples) with too many salicylic acid treatments are more appropriate. There are four commonly used concentrations of glycolic acid (20%, 35%, 50%, 70%) for general medical and aesthetic treatment.
The concentration is usually used from low to high, and the concentration is gradually increased according to the patient's tolerance. Generally, it takes 4 to 6 times of treatment. Mandelic acid (mandelic acid) is very mild, has weak keratin dissolving and exfoliation effects, and is often combined with glycolic acid to play a better role in controlling oil secretion. Citric acid is weak in dissolving keratin and exfoliating, focusing on whitening and skin rejuvenation, and is often combined with glycolic acid. The main functions of lactobionic acid are moisturizing (comparable to hyaluronic acid), antioxidant and repairing.
There are different types and different concentrations of AHAs, and the main uses of each AHA are different. It needs to be selected according to the different problems of patients and beauty seekers, and flexible matching. High-concentration AHA must be done by professional doctors and nurses in hospitals, clinics and other medical institutions, otherwise there will be great risks, such as burns, pigmentation, and skin sensitivity. Sensitive skin is not suitable for AHA treatment in the unstable period. If you have acne at the same time, you can first repair the sensitive skin, and then perform low-concentration AHA treatment after the skin has normal tolerance. There are some patients whose T-zone is not sensitive but their cheeks are sensitive, and they can be treated with fruit acid in the T-zone (it is more appropriate if there is super-salicylic acid in this case), and at the same time, sensitive repair treatment can be performed. Some skin care products contain low-concentration fruit acids. Such products can be used at home, but due to the low concentration, the corresponding efficacy will be poor.
Salicylic acid, with molecular formula C7H6O3, is an extract of willow bark, a natural anti-inflammatory drug. The commonly used cold medicine aspirin is sodium acetylsalicylate, a derivative of salicylic acid, while sodium para-aminosalicylate (PAS) is a commonly used anti-tuberculosis drug. Salicylic acid can exfoliate, sterilize and reduce inflammation, so it is very suitable for treating acne caused by clogged pores. Many international mainstream acne products are salicylic acid, and the concentration is usually 0.5~2%.
Since salicylic acid is fat-soluble, it is easier to penetrate the skin barrier and act on the sebaceous glands and Propionibacterium acnes (an important bacteria in the pathogenesis of acne) deep in the skin, so it can not only be more effective than AHA. It can dissolve keratin plugs, treat acne (including blackheads), and the anti-inflammatory effect of salicylic acid is relatively strong, equivalent to 82% of hydrocortisone (a hormone, the anti-inflammatory effect of hormones is basically the strongest drug), more It is effective in the treatment of inflammatory acne (red acne and acne with pustules), as well as in the treatment of inflammatory skin diseases such as papules, pustular rosacea (rosacea), and seborrheic dermatitis.
In addition, like fruit acid, it can whiten, rejuvenate, improve wrinkles and reduce pores. Now medical and aesthetic institutions usually use supramolecular salicylic acid, which has been widely used in recent years. It can dissolve salicylic acid in water without using any organic solvent such as alcohol, and maintain a low pH value. Slow release of salicylic acid for 12 hours, effectively reducing the irritation of salicylic acid while improving bioavailability. It can be said that supramolecular salicylic acid has greatly avoided the stimulation and side effects of traditional salicylic acid, while exerting the positive energy of salicylic acid. The 30% supramolecular salicylic acid used by medical institutions is generally 4-6 times a course of treatment. It also has products for home use. There are also other household products with low concentrations of salicylic acid available on the market.
There are oral preparations of tretinoin, represented by isotretinoin capsules, which are mainly used for the treatment of moderate to severe acne, with low dose, full course of treatment, and regular treatment. Both salicylic acid and fruit acid have keratin exfoliation and antibacterial effects, and promote post-inflammatory hyperpigmentation (black acne marks) subsidence, whitening, and skin rejuvenation. But the biggest difference between the two is reflected in the lipid solubility and anti-inflammatory effects of salicylic acid.
Due to the strong anti-inflammatory ability of salicylic acid, salicylic acid is more effective for inflammatory acne. Since salicylic acid is fat-soluble, it is easier to enter the deep pores, and it is better to prevent P. acnes effect. AHA is mainly used for acne type and acne with less inflammatory papules and acne-based acne, and the effect is also very good, and it has more concentration options, which is easy to realize the individual differences in the tolerance of different patients to AHA.
After surgery, a low-concentration fruit acid product can achieve better curative effect, and the lactobionic acid home product in the fruit acid can achieve better moisturizing, anti-oxidative and repairing effects. A fruit acid also has a great advantage, that is, it can promote the production of mucopolysaccharides and collagen in the dermis, and the effect of skin rejuvenation is better than that of salicylic acid, and it is more suitable for the application of aging skin such as skin photoaging.
Sanzhong acid and external use of tretinoin in the treatment of acne are the most economical and effective, and the efficacy is also accurate. Therefore, as the first-line treatment drug for acne in the Chinese acne treatment guidelines, it is convenient for home use. Supramolecular salicylic acid has the least effect on the skin barrier function among the three external acids, so people with rosacea or combined acne can also use supramolecular salicylic acid safely, and it can also be used with caution in the stable period of sensitive skin.
Some researchers have found that low concentrations of superhydrosalicylic acid have a repairing effect on the skin barrier function (confirmed in animal experiments). Superhydrosalicylic acid is fat-soluble, so it penetrates more easily into the sebaceous ducts to relieve acne. It should be reminded that you must not use high concentrations of fruit acid and salicylic acid to brush acid at home, the consequences may be serious. It is recommended to fully understand the use method and precautions, and use it scientifically under the guidance of a dermatologist. Finally, we often combine various acids with intense pulsed light, acupuncture, oral drugs, etc. to treat acne, so as to achieve the best effect.