【藥事知多D】暗瘡藥知多D:抗生素
暗瘡藥有很多種。
其中一種便是抗生素。
至於抗生素到底又跟暗瘡有什麼關係呢?
哦,在相當程度上,暗瘡其實算是一種細菌感染,主要源自痤瘡桿菌(Propionibacterium acnes)這種厭氧菌(Anaerobes)。
痤瘡桿菌較容易生存在一個低氧、無氧的環境。要是毛囊出現堵塞,便可能會製造一個有利的環境刺激痤瘡桿菌大量繁殖並分解皮脂成為游離脂肪酸誘發暗瘡。
所以理論上,只要能夠KO這些痤瘡桿菌,便可能會減少游離脂肪酸(Free Fatty Acids, FFA)的產生,治療暗瘡。
至於常用的抗生素主要有以下兩類:
一、四環素(Tetracycline),例如Doxycycline、Minocycline、Tetracycline
除了可能會KO痤瘡桿菌外,四環素原來還可能會減少皮脂腺(Sebaceous Gland)裡的角蛋白(Keratin),減少毛囊角栓(Follicular Plug)的產生,減少毛孔堵塞。[1]
在副作用上,因為四環素能夠跟鈣質結合,所以較容易會沉積在一些鈣化進行中的組織裡,例如正在處於發育時期的牙齒、骨骼,從而可能會造成色素沉澱,讓牙齒發黃、染灰、變啡,影響外觀,所以一般不建議孕婦、10歲以下的兒童使用,一來避免妨礙胎兒的骨骼成長,二來減少兒童的牙齒出現變色的機會。
還有四環素可能會導致皮膚出現光敏感性(Photosensitivity),俗稱「光敏感」,簡單說,便是「見光死」……不、不、不,更正,應該是見光便致敏。所以一般建議需要做好防曬措施。
在用法上,因為四環素能夠跟鈣質結合,自然不宜跟奶類製品、豆類製品、乾果果仁、綠葉蔬菜(例如波菜)這些蘊含豐富鈣質的食品同服,避免裡面的鈣質妨礙四環素在消化道的吸收。
所以最理想的服藥時間當然是餐前服用,目的在避免兩者在消化道裡相遇。
相較Tetracycline而言,Doxycycline的藥效較佳。
至於相較Tetracycline而言,Minocycline的藥效同樣較佳,因為Minocycline擁有較大的脂溶性,所以較能滲進皮脂腺裡面提升藥效。[2]
在副作用上,相較Doxycycline、Tetracycline而言,Minocycline的副作用較多[3],這或許是因為Minocycline的結構跟Doxycycline、Tetracycline略有不同吧?
所以Minocycline還可能會出現其他副作用,例如皮膚色素過度沉著(Hyperpigmentation)。[4]
二、Macrolide,例如Erythromycin
除了可能會KO痤瘡桿菌外,Macrolide還擁有消炎的技能,紓緩暗瘡的炎症症狀。
說到暗瘡,相較四環素而言,兩者的藥效沒有明顯的差異,不過Erythromycin的抗藥性一般較高。[5][6]
針對抗藥性,常用的對策主要有以下兩個:
第一,要是Erythromycin結合鋅(Zinc),便可能會促進Erythromycin進入毛皮脂單位(Pilosebaceous Unit)提升實力。[7]
第二,要是Erythromycin配合Benzoyl Peroxide這種外用暗瘡藥,內外夾擊,雙管齊下,理論上,或許可以減低出現抗藥性的機會。
在副作用上,主要是腸胃不適,所以一般建議餐後服用。
在使用上,相較四環素而言,Erythromycin一般是後備。簡單說,一般只會在四環素這個正選不能上場的情況下才會使用,例如用藥者不能適應四環素的副作用,或者痤瘡桿菌已經對四環素出現抗藥性。[5][6]
(如欲了解更多用藥資訊,歡迎看看「小小藥罐子」網誌。)
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Reference:
1. Sadick NS. Antibiotics: unapproved uses or indications. Clin Dermatol. 2000;18:11-16.
2. Chosidow O, Poli F, Naline E, et al. Comedonal diffusion of minocycline in acne. Dermatology. 1998;196:162.
3. Sturkenboom MCJM, Meier CR, Jick H. Stricker BHC. Minocycline and lupuslike syndrome in acne patients. Arch Intern Med. 1999;159:493-497.
4. Mouton RW, Jordaan HF, Schneider JW. A new type of minocycline-induced cutaneous hyperpigmentation. Clin Exp Dermatol. 2004;29:8-14.
5. Ross JI, Snelling AM, Carnegie E, et al. Antibiotic-resistant acne: lessons from Europe. Br J Dermatol. 2003;148:467-478.
6. Eady EA, Gloor M, Leyden JJ. Propionibacterium acnes resistance: a world wide problem. Dermatology. 2003;206:54-56.
7. Tan HH. Topical antibacterial treatments for acne vulgaris: comparative review and guide to selection. Am J Clin Dermatol. 2004;5:79-84.
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【藥事知多D】暗瘡藥知多D:異維A酸
《史記》在〈刺客列傳〉中說:
女為悅己者容。
其實男生都會「為悅己者容」。
不過再怎麼悉心打扮,最後還是可能會敵不過一粒小小的暗瘡。
這時候,怎麼辦?
唔……藥罐子便在這裡跟大家分享一種暗瘡藥,稱為異維A酸(Isotretinoin)。
一般主要有以下四個作用原理:[1][2]
第一,誘發皮脂腺(Sebaceous Gland)萎縮,減少皮脂分泌,簡單說,便是「控油」。
第二,抑制毛囊(Follicle)裡面的痤瘡桿菌(Propionebacterium acnes)繁殖。
痤瘡桿菌是一種厭氧菌(Anaerobes),較容易生存在一個低氧、無氧的環境。
要是毛囊堵塞,便可能會製造一個有利的環境刺激痤瘡桿菌大量繁殖並分解皮脂成為游離脂肪酸誘發暗瘡。
所以只要KO這些痤瘡桿菌,便可能會減少游離脂肪酸的產生,治療暗瘡。
第三,抑制炎症反應,紓緩暗瘡的炎症症狀。
第四,改善毛囊角化(Keratinization),減少毛囊角栓(Follicular Plug)的產生,減少毛孔堵塞。
簡單說,異維A酸主要採用「全方位」的策略同時解決暗瘡的不同成因。
理論上,異維A酸一般會留作備胎做最後的殺著,適用於治療一些連其他暗瘡藥都宣告無效的暗瘡或者一些較嚴重的暗瘡,例如囊腫性痤瘡(Nodulocystic Acne)。[3]
在用法上,必須持之以恆,一般建議連續服用6個月做一個療程。
大家可能會問:
「咦?藥罐子!既然這種藥是一擊必殺,那為什麼還要左試右試,試到其他暗瘡藥都不行才用這種藥呢?」
其實能夠讓一種藥從首選淪為次選,要不是藥性,當然便是毒性,簡單說,便是「副作用」。
對,相較其他暗瘡藥而言,異維A酸的副作用一般較多、較廣、較深,而且一般跟劑量構成正比關係,簡單說,劑量愈大,副作用愈大[4]。
一般而言,一字記之曰:乾!
對,眼會乾、鼻會乾、嘴唇會乾、皮膚會乾,從而可能會出現眼乾、流鼻血、唇炎(Cheilitis)、皮膚脫屑(Skin Desquamation)。
還有服藥期間還可能會短暫升高體內的膽固醇、三酸甘油脂(Triglycerides)的水平[5],一般建議在開始服藥前、服藥後第4、8個星期檢測肝功能,同時檢測體內的血脂水平,定期監測,以策安全。[6]
除此之外,還可能會出現頭痛、肝腫大(Hepatomegaly)、假性腦腫瘤(Pseudotumor Cerebri)、關節痛(Arthralgia)的副作用。[7]
最後Isotretinoin擁有致畸性(Teratogenicity),從而可能會增加孕婦誕下畸胎的風險,所以必須做好風險管理,有人建議服藥前1個月、服藥期間、停藥後至少3個月,女性必須做足避孕措施。[4]
簡單說,服藥期間,暫時不要搞出人命,這就是說,要靚唔要命。
(如欲了解更多用藥資訊,歡迎看看「小小藥罐子」網誌。)
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YT➡️https://www.youtube.com/channel/UCQOMojMd6q7XnESMWwldPhQ
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著作➡️藥事知多D、用藥知多D、藥房事件簿、家居用藥攻略(各大書店有售)
Reference:
1. Zaenglein AL, Thiboutot DM. Acne vulgaris. In: Horn TD, Mancini AJ, Mascaro JM, et al, eds. Dermatology. London, Mosby, 2003:531-544.
2. Ortonne JP. Oral isotretinoin treatment policy: Do we all agree? Dermatology. 1997;195(Suppl):34-37.
3. Goulden V. Guidelines for the management of acne vulgaris in adolescents. Paediatr Drugs. 2003;5:301-313.
4. Charakida A, Mouser PE, Chu AC. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf. 2004;3:119-129.
5. Cooper AJ, Australian Roaccutane Advisory Board. Treatment of acne with isotretinoin: recommendations based on Australian experience. Australas J Dermatol. 2003;44:97-105.
6. Altman RS, Altman LJ, Altman JS. A proposed set of new guidelines for routine blood tests during isotretinoin therapy for acne vulgaris. Dermatology. 2002;204:232-235.
7. Kunynetz RA. A review of systemic retinoid therapy for acne and related conditions. Skin Therapy Lett. 2004;9:1-4.
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