目的:评估各种预防和管理策略对面部和躯干痤疮外用类维生素A引起的刺激的一致性水平,以试图减轻其并尽可能地减少治疗中断。
方法:在回顾了现有的科学医学文献后,确定了痤疮中局部类维生素A引起的刺激管理中的4个不同的不确定性区域。由133名皮肤科医生(Delphi方法)创建并评估了一份包含34项建议的问卷。
结果:在82.3%的建议中(34个中的28个),达成了一定程度的协议(22项建议中的协议≥85%,6项建议中的协议≥70%).具有最高一致性的结果集中在特定的患者教育策略上(解释刺激是治疗开始时的预期反应,并且随着时间的推移而趋于减少),逐渐和/或间隔施用局部类维生素A(在夜间预防和/或减少皮肤刺激),以及使用佐剂产品的重要性,特别适用于有痤疮倾向的皮肤,水合作用,光保护,和皮肤清洁。这些建议反映了管理与局部类维生素A相关的刺激和促进长期依从性的综合方法。
结论:面部和躯干痤疮中的局部类维生素A引起的皮肤刺激是预期的,温和,如果遵循适当的预防和管理指南,反应可控,这意味着它不应该成为停止治疗的理由。
OBJECTIVE: To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible.
METHODS: After reviewing the scientific medical literatura currently available, 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified. A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists (Delphi methodology).
RESULTS: In 82.3% of the recommendations (28 out of 34), some level of agreement was reached (≥85% agreement in 22 recommendations and≥70% agreement in 6). The results with the highest level of agreement focused on specific patient education strategies (explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time), gradual and/or spaced application of topical retinoids (at night time to prevent and/or reduce skin irritation), and the importance of using adjuvant products, specific for acne-prone skin, hydration, photoprotection, and skin cleansing. These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence.
CONCLUSIONS: Skin irritation caused by topical retinoids in facial and trunk acne is an expected, mild, and controllable reaction if proper prevention and management guidelines are followed, meaning that it should not be a reason for treatment discontinuation.