retinoids

维甲酸
  • 文章类型: Journal Article
    背景:寻常痤疮通常影响成年人,青少年,和9岁或以上的青春期前。
    目的:本研究的目的是为痤疮的治疗提供循证建议。
    方法:一个工作组进行了系统审查,并应用了建议分级,评估,发展,和评估方法,用于评估证据的确定性并制定和分级建议。
    结果:本指南提出了18项循证建议和5项良好实践声明。对过氧化苯甲酰提出了强有力的建议,局部类维生素A,局部抗生素,和口服多西环素。口服异维A酸强烈建议用于严重的痤疮,造成社会心理负担或疤痕,或标准口服或局部治疗失败。有条件的建议是局部使用的克拉维酮,水杨酸,和壬二酸,以及口服米诺环素,sareccine,联合口服避孕药,和螺内酯.将局部疗法与多种作用机制相结合,限制全身抗生素的使用,将全身性抗生素与局部治疗相结合,对于较大的痤疮病灶,增加病灶内注射皮质类固醇激素是推荐的良好实践声明.
    结论:分析是基于系统评价时现有的最佳证据。
    结论:这些指南为寻常痤疮的治疗提供了循证建议。
    BACKGROUND: Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.
    OBJECTIVE: The objective of this study was to provide evidence-based recommendations for the management of acne.
    METHODS: A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.
    RESULTS: This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.
    CONCLUSIONS: Analysis is based on the best available evidence at the time of the systematic review.
    CONCLUSIONS: These guidelines provide evidence-based recommendations for the management of acne vulgaris.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    本文件代表EORTC皮肤淋巴瘤肿瘤组(EORTC-CLTG),并对2006年和2017年发布的早期版本进行了跟进,为治疗真菌病和Sézary综合征(MF/SS)提供了更新的标准。它考虑了2017年后引入临床实践的最新相关出版物和治疗方案。通过一系列连续的书面磋商和一轮讨论,在作者之间建立了共识。治疗方案被分配到每个疾病阶段,只要有可能和临床上有用,分为第一行和第二行选项,注释有证据水平。对先前版本的主要更改包括掺入了氯甲因,Brentuximabvedotin,和莫加穆利珠单抗,关于使用聚乙二醇化干扰素α的建议(在重组非聚乙二醇化干扰素撤出后),并增加了关于支持治疗和老年患者护理的段落。尽管如此,针对皮肤的治疗是早期MF的最合适选择,大多数患者的预期寿命正常,但可能会出现发病率和生活质量受损的问题.在晚期疾病中,治疗选择最近有所扩大。大多数患者接受多次连续治疗,其中治疗通常具有相对短的响应持续时间。对于这些患者,预后仍然很差,只有高度选择的子集才能通过同种异体干细胞移植实现长期缓解。了解疾病,它的流行病学和临床课程,其最合适的管理正在逐步推进,并且有充分的希望,这将导致进一步改善MF/SS患者的护理。
    On behalf of the EORTC Cutaneous Lymphoma Tumours Group (EORTC-CLTG) and following up on earlier versions published in 2006 and 2017 this document provides an updated standard for the treatment of mycosis fungoides and Sézary syndrome (MF/SS). It considers recent relevant publications and treatment options introduced into clinical practice after 2017. Consensus was established among the authors through a series of consecutive consultations in writing and a round of discussion. Treatment options are assigned to each disease stage and, whenever possible and clinically useful, separated into first- and second line options annotated with levels of evidence. Major changes to the previous version include the incorporation of chlormethine, brentuximab vedotin, and mogamulizumab, recommendations on the use of pegylated interferon α (after withdrawal of recombinant unpegylated interferons), and the addition of paragraphs on supportive therapy and on the care of older patients. Still, skin-directed therapies are the most appropriate option for early-stage MF and most patients have a normal life expectancy but may suffer morbidity and impaired quality of life. In advanced disease treatment options have expanded recently. Most patients receive multiple consecutive therapies with treatments often having a relatively short duration of response. For those patients prognosis is still poor and only for a highly selected subset long term remission can be achieved with allogeneic stem cell transplantation. Understanding of the disease, its epidemiology and clinical course, and its most appropriate management are gradually advancing, and there is well-founded hope that this will lead to further improvements in the care of patients with MF/SS.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    局部和全身性类维生素A长期用于治疗鱼鳞病和其他角质化病症。由于需要长期使用类维生素A治疗这些疾病,通常从童年开始,必须考虑许多临床问题。系统性类维生素A具有涉及骨骼和眼睛的已知副作用。此外,需要考虑潜在的精神和心血管影响.避孕问题,对于有生育潜力的患者,还必须考虑全身使用类维生素A与激素避孕的附加心血管和骨骼效应。成立了儿科皮肤病研究联盟(PeDRA)在鱼鳞病中使用类维生素A工作组,以解决这些问题,并根据现有证据和专家意见建立有关在鱼鳞病中使用类维生素A的最佳实践。
    Topical and systemic retinoids have long been used in the treatment of ichthyoses and other disorders of cornification. Due to the need for long-term use of retinoids for these disorders, often beginning in childhood, numerous clinical concerns must be considered. Systemic retinoids have known side effects involving bone and eye. Additionally, potential psychiatric and cardiovascular effects need to be considered. Contraceptive concerns, as well as the additive cardiovascular and bone effects of systemic retinoid use with hormonal contraception must also be deliberated for patients of childbearing potential. The Pediatric Dermatology Research Alliance (PeDRA) Use of Retinoids in Ichthyosis Work Group was formed to address these issues and to establish best practices regarding the use of retinoids in ichthyoses based on available evidence and expert opinion.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

       PDF(Pubmed)

  • 文章类型: Journal Article
    Acne is a common inflammatory skin disorder affecting the pilosebaceous unit. Patients with mild-to-moderate acne can be treated with a combination of topical, systemic, and physical therapeutic approaches, with different results depending on patient, disease, and treatment characteristics. Herein we describe and discuss the common and alternative treatment options used for mild-to-moderate acne, by comparing three widely distributed guidelines (American Academy of Dermatology, European Academy of Dermatology and Venereology, and Italian Society of Dermatology and Venereology.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

  • 文章类型: Journal Article
    Lichen planus is a benign inflammatory disorder of unknown etiology that may affect the skin, mucosae, scalp, and nails. When the nails are affected, it may lead to permanent destruction with severe functional and psychosocial consequences. Therefore, prompt diagnosis and early treatment are essential, even in mild cases. There are currently no guidelines for the management of nail lichen planus and the published literature on treatment is limited. The aim of this review is to provide practical management recommendations for the classical form of nail lichen planus, especially when restricted to the nails. Topical treatment has poor short-term efficacy and may cause long-term side effects. Instead, intralesional and intramuscular triamcinolone acetonide should be considered first-line therapies. Oral retinoids are second-line choices, and immunosuppressive agents may also be considered.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

  • 文章类型: Duplicate Publication
    牛皮癣是一种慢性,多系统,影响大约1%儿童的炎症性疾病,发病最常见于青春期。该指南解决了银屑病治疗中出现的重要临床问题,并提供了基于证据的建议。将注意小儿牛皮癣患者,认识到独特的生理学,药代动力学,以及18岁以下患者的患者-父母-提供者互动。这里回顾的主题反映了成人指南部分中讨论的主题,排除那些无关紧要的话题,或者缺乏足够的信息,儿科患者。
    Psoriasis is a chronic, multisystem, inflammatory disease that affects approximately 1% of children, with onset most common during adolescence. This guideline addresses important clinical questions that arise in psoriasis management and provides evidence-based recommendations. Attention will be given to pediatric patients with psoriasis, recognizing the unique physiology, pharmacokinetics, and patient-parent-provider interactions of patients younger than 18 years old. The topics reviewed here mirror those discussed in the adult guideline sections, excluding those topics that are irrelevant to, or lack sufficient information for, pediatric patients.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

  • 文章类型: Journal Article
    科学进步正在不断提高痤疮的知识,并有助于改进治疗方案;临床医生定期更新其实践模式以反映当前标准非常重要。改善痤疮成果的全球联盟是一个对痤疮研究和教育感兴趣的国际皮肤科医生小组,自2001年以来一直定期开会。作为一个群体,我们不断评估有关痤疮的文献。本补充侧重于为管理痤疮患者的医疗保健从业人员提供相关的临床指导,强调证据基础可能稀疏或需要日常实践解释的领域。
    Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

  • 文章类型: Journal Article
    背景:化脓性汗腺炎(HS)是一种痛苦的,衰弱,和对病情知之甚少,诊断欠佳,管理,和治疗。支持各种治疗方式的证据很少。
    目的:纳入科学证据和专家意见,为HS患者的评估和管理提供有用的指导。
    方法:加拿大皮肤科医生和外科医生专家小组根据现有证据和临床经验制定了声明和建议。小组对声明和建议进行了分析和完善,并且使用改良的Delphi技术进行投票,预设的截止协议为75%。
    结果:专家小组接受了10项具体声明和建议。这些被分为4个领域:诊断和评估,治疗和管理,合并症和多学科方法,和教育。
    结论:这些声明和建议将有助于提高对HS的认识,并为涉及诊断和管理的决策提供框架。证据表明,抗菌和抗肿瘤坏死因子疗法可有效治疗HS。作者的临床经验支持了这一点。进一步的临床研究和多学科管理团队的建立将继续推进加拿大的HS管理。
    BACKGROUND: Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse.
    OBJECTIVE: To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS.
    METHODS: An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%.
    RESULTS: Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education.
    CONCLUSIONS: These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti-tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    为了提供治疗真菌病(MF)和Sézary综合征(SS)的共同标准,欧洲癌症-皮肤淋巴瘤研究和治疗组织特别工作组(EORTC-CLTF)于2006年发表了其关于这些肿瘤的治疗方案的阶段性适应选择的共识建议.从那以后,对MF/SS的病理生理学和流行病学的认识有了进步,暂存系统已经修改,新的结局数据已经公布,新的治疗方案也被引入.本文件的目的是更新最初的建议,同时铭记仍然只有数量有限的对照研究来支持MF/SS的治疗决定,并且治疗通常取决于机构的经验和可用性。通过一系列连续的书面咨询和一轮讨论,在作者之间建立了关于治疗建议的共识。根据疾病阶段提出推荐的治疗方案,在可能的情况下,将其分为一线和二线选项,并得到牛津循证医学中心(OCEBM)设计的证据水平的支持。针对皮肤的治疗仍然是早期MF的最合适选择,大多数患者可以期待正常的预期寿命。对于晚期疾病的患者,预后依然严峻,并且仅针对高度选择的患者子集,异基因干细胞移植(alloSCT)可以延长存活时间。基于我们对MF/SS的分子病理学的日益理解,对治疗选择的对照临床试验的开发和研究存在高度需求。
    In order to provide a common standard for the treatment of mycosis fungoides (MF) and Sézary syndrome (SS), the European Organisation for Research and Treatment of Cancer-Cutaneous Lymphoma Task Force (EORTC-CLTF) published in 2006 its consensus recommendations for the stage-adapted selection of management options for these neoplasms. Since then, the understanding of the pathophysiology and epidemiology of MF/SS has advanced, the staging system has been revised, new outcome data have been published and novel treatment options have been introduced. The purpose of the present document is to update the original recommendations bearing in mind that there are still only a limited number of controlled studies to support treatment decisions for MF/SS and that often treatment is determined by institutional experience and availability. This consensus on treatment recommendations was established among the authors through a series of consecutive consultations in writing and a round of discussion. Recommended treatment options are presented according to disease stage, whenever possible categorised into first- and second-line options and supported with levels of evidence as devised by the Oxford Centre for Evidence-Based Medicine (OCEBM). Skin-directed therapies are still the most appropriate option for early-stage MF, and most patients can look forward to a normal life expectancy. For patients with advanced disease, prognosis is still grim, and only for a highly selected subset of patients, prolonged survival can be achieved with allogeneic stem cell transplantation (alloSCT). There is a high need for the development and investigation in controlled clinical trials of treatment options that are based on our increasing understanding of the molecular pathology of MF/SS.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

  • 文章类型: Journal Article
    皮肤红斑狼疮(CLE)是一种罕见的炎症性自身免疫性疾病,临床表现不均匀。迄今为止,没有专门针对这种疾病实体患者的治疗剂获得许可,局部和全身药物大多使用“标签外”。本指南的目的是欧洲小组委员会就CLE患者的治疗策略达成广泛共识。由欧洲皮肤病学论坛(EDF)指导,并由欧洲皮肤病与性病学会(EADV)支持。总的来说,16名欧洲与会者参加了该项目,并就所有建议达成了一致。局部皮质类固醇仍然是治疗局部CLE的主要手段。和其他外用药物,如钙调磷酸酶抑制剂,被列为替代的一线或二线局部治疗选择。在所有严重和/或广泛的皮肤病变的CLE患者中,建议使用抗疟疾药物作为一线和长期系统治疗。特别是在有疤痕和/或全身性疾病发展的高风险患者中。除了抗疟药,对于高活性和/或重度CLE,建议将全身性皮质类固醇作为一线治疗.二线和三线全身治疗包括甲氨蝶呤,类维生素A,氨苯砜和霉酚酸酯或霉酚酸,分别。沙利度胺只能用于选择治疗难治性CLE患者,最好是除了抗疟药。几种新的治疗选择,如B细胞或干扰素α靶向药物,需要在临床试验中进一步评估,以评估其治疗CLE患者的有效性和安全性。
    Cutaneous lupus erythematosus (CLE) is a rare inflammatory autoimmune disease with heterogeneous clinical manifestations. To date, no therapeutic agents have been licensed specifically for patients with this disease entity, and topical and systemic drugs are mostly used \'off-label\'. The aim of the present guideline was to achieve a broad consensus on treatment strategies for patients with CLE by a European subcommittee, guided by the European Dermatology Forum (EDF) and supported by the European Academy of Dermatology and Venereology (EADV). In total, 16 European participants were included in this project and agreed on all recommendations. Topical corticosteroids remain the mainstay of treatment for localized CLE, and further topical agents, such as calcineurin inhibitors, are listed as alternative first-line or second-line topical therapeutic option. Antimalarials are recommended as first-line and long-term systemic treatment in all CLE patients with severe and/or widespread skin lesions, particularly in patients with a high risk of scarring and/or the development of systemic disease. In addition to antimalarials, systemic corticosteroids are recommended as first-line treatment in highly active and/or severe CLE. Second- and third-line systemic treatments include methotrexate, retinoids, dapsone and mycophenolate mofetil or mycophenolate acid, respectively. Thalidomide should only be used in selected therapy-refractory CLE patients, preferably in addition to antimalarials. Several new therapeutic options, such as B-cell- or interferon α-targeted agents, need to be further evaluated in clinical trials to assess their efficacy and safety in the treatment of patients with CLE.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

公众号