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王瑞艳

王瑞艳

副主任医师 
左箭头 返回医生主页 门诊信息 患者投票 科普文章 患者问诊 临床经验 心意礼物 患友会

医学科普

为什么医生建议痤疮病人服用避孕药

发表者:王瑞艳 931人已读

痤疮患者在一般的抗痤疮治疗效果不好的情况下,我会建议他们去看妇产科医生,加用避孕药,他们通常会问我:","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"“为啥皮肤科医生会建议我使用避孕药来治疗痤疮呢?”","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"是这样的,对于成年后痤疮,也就是25岁以后患痤疮的女性朋友们,","27:\"12\"|31:2"],[20,"如果在常规的抗痤疮治疗效果不好的情况下,我会建议他们去咨询妇产科医生","27:\"12\"|31:2|8:1"],[20,",看是否适合服用避孕药来进行痤疮的治疗。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"其实,道理挺简单的。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"就像有的肠胃病患者,医生会开具一些有安神、治疗抑郁的药物,但并不是说患者就患了抑郁症,而是缓解患者失眠焦虑的状况,从而调节肠胃功能。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"痤疮患者服用避孕药,当然不是发挥其避孕的功效,而是通过其所含的成分来治疗痤疮。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"14\"|31:2"],[20,"\n","7:3"],[20,"避孕药最重要的功能,就是解决雄性激素分泌过多的问题。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,{"gallery":"https://uploader.shimo.im/f/c7IuW4RdkW0aDlJE.gif"},"29:0|30:0|3:\"1\"|4:\"auto\"|crop:\"\"|frame:\"none\"|ori-height:\"1\"|ori-width:\"1\""],[20,"\n","7:3"],[20,"雄性激素对痤疮有啥影响","0:\"%23021eaa\"|27:\"12\"|31:2|8:1"],[20,"\n\n","7:1"],[20,"不客气的说,雄性激素就是痤疮发病的始动因素之一。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"大家都知道,痤疮的发生,跟皮脂腺分泌息息相关,皮脂腺的分泌增多不仅会导致毛孔堵塞形成粉刺,还会给痤疮细菌提供养分,埋下感染的隐患。","27:\"12\"|31:2"],[20,"(>>>戳戳这里查看更多关于痤疮发病的内容)","0:\"%23576b95\"|16:\"http%3A%2F%2Fmp.weixin.qq.com%2Fs%3F__biz%3DMzU3Nzc5NDM5Mg%3D%3D%26mid%3D2247483667%26idx%3D1%26sn%3D7043c2404c12c211e687919e169fc587%26chksm%3Dfd7e7924ca09f032e22a9a6a943cbc4e987ce744ee8a0e60dffd5327344fd875a6e5eb687cbd%26scene%3D21%23wechat_redirect\"|27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"而","27:\"12\"|31:2"],[20,"雄性激素,能促进皮脂腺分泌增多","27:\"12\"|31:2|8:1"],[20,",你说恐不恐怖?","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"你可以这样理解整个过程,雄性激素只是一种激素,必须有相对应的受体,雄性激素才能发挥作用。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"而这个雄性激素受体,虽然在毛囊汗腺都有分布,但是在皮脂腺中分布是最密集的。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"也就是说,雄性激素很容易刺激皮脂腺的分泌。","27:\"12\"|31:2|8:1"],[20,"\n\n","7:3"],[20,"这就像明星开演唱会一样,虽然哪里都有粉丝,但是某个城市的粉丝数量是最多的,那这座城市演唱会的效果一定更加爆炸。","27:\"12\"|31:2"],[20,"\n\n","7:3"],[20,"雄性激素就是明星,雄性激素受体就是粉丝,这座城市就是皮脂腺,而爆炸的效果,就是长痘长痘长痘!","27:\"12\"|31:2"],[20,"\n\n","7:3"],[20,"在很多科学研究中,也有很多证据表明雄性激素跟痤疮的关系:","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"1.青春期的患者,往往伴随雄性激素提升有痤疮症状出现;","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20,"2.雄性激素受体缺乏或不敏感者不发生痤疮;","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20,"3.高雄性激素相关的疾病如多囊卵巢综合症往往伴有痤疮;","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20,"4.口服雄性激素可促进皮脂分泌;","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20,"5.重度痤疮患者可伴有血中雄性激素水平升高。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"哪些痤疮症状可能跟雄性激素分泌变多有关","0:\"%23021eaa\"|27:\"12\"|31:2|8:1"],[20,"\n","7:1"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"虽然雄激素与痤疮发病关系密切,但大多数女性痤疮患者雄性激素水平在正常范围内,不过,如果使用避孕药等性激素进行治疗的话,很多雄性激素水平正常的患者也会收到不错的治疗效果。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"一般来说,跟雄性激素相关的痤疮症状,都有一定的特征:","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"1.月经前皮损加重,皮损主要分布于面部中下1/3,尤其是下颌部位;","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20,"2.发病年龄较晚,或病程迁延,多属于青春期后痤疮。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20,"3.常规抗生素治疗甚至异维A酸治疗反应较差,或者停药后迅速复发。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"对于这种特征的女性痤疮患者,就可以使用抗雄性激素治疗的手段啦!","27:\"12\"|31:2"],[20,"\n\n","7:3"],[20,"大家注意了是女性痤疮患者,","27:\"12\"|31:2"],[20,"男性痤疮患者一般不用抗雄性激素治疗的!","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"口服避孕药为什么可以抗雄性激素?","0:\"%23021eaa\"|27:\"12\"|31:2|8:1"],[20,"\n","7:1"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"口服避孕药是一种有效的抗雄激素治疗手段。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"避孕药中的雌激素,","27:\"12\"|31:2"],[20,"可以通过减少卵巢和肾上腺皮质功能亢进引起的雄激素分泌过多,来降低血清中活性雄激素的浓度,起到抗皮脂分泌作用。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"同时,雌激素还可减少游离睾酮量,有缩小皮脂腺的体积并抑制皮脂腺细胞内脂质合成的作用。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"避孕药中的另一个重要成分是孕激素。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"孕激素是5-α还原酶的抑制剂,","27:\"12\"|31:2"],[20,"它可以通过负反馈抑制作用,使血浆中的睾酮和脱氢睾酮量降低;","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"不仅如此,孕激素还可以抑制皮脂腺细胞和角质形成细胞转化睾酮的能力,","27:\"12\"|31:2"],[20,"醋酸环丙孕酮还可以阻断雄激素与其受体结合","27:\"12\"|31:2|8:1"],[20,"。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"此外,雌激素和孕酮还可以直接作用在毛囊皮脂腺,减少皮脂分泌和抑制粉刺生成。","27:\"12\"|31:2"],[20,{"gallery":"https://uploader.shimo.im/f/dm3Eh1wn3Kg01urZ.gif"},"29:0|30:0|3:\"1\"|4:\"auto\"|crop:\"\"|frame:\"none\"|ori-height:\"1\"|ori-width:\"1\""],[20,"\n\n","7:3"],[20,"目前常用于痤疮治疗的避孕药有","27:\"12\"|31:2"],[20,"复方醋酸环丙孕酮片(达英35)","27:\"12\"|31:2|8:1"],[20,"和","27:\"12\"|31:2"],[20,"优思明","27:\"12\"|31:2|8:1"],[20,"。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"口服避孕药常见不良反应包括类早孕反应(恶心,呕吐,食欲不振,乏力),胸部触痛,头痛,阴道出血等。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"这些症状多出现在治疗的早期,为雌激素短期突然增加所致。随着服药周期增加可逐渐减轻或消失,通常不影响治疗。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"还有哪些抗雄性激素治疗的手段?","0:\"%23021eaa\"|27:\"12\"|31:2|8:1"],[20,"\n","7:1"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"除了口服避孕药外,常见的激素治疗手段还有雄性激素受体阻断剂。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"其实原理很简单,我们需要对抗雄性激素的话,要么抑制雄性激素的产生,要么让雄性激素不再发挥作用。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"如果说口服避孕药是前者的话,那使用雄性激素受体阻断剂就是后者。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"常见的雄性激素受体阻断剂是安体舒通,又称螺内酯。","27:\"12\"|31:2|8:1"],[20,"他可以竞争性抑制二氢睾酮与皮肤靶器官的受体结合,从而影响其作用,抑制皮脂腺的生长和皮脂分泌。","27:\"12\"|31:2"],[20,"\n\n","7:3"],[20,"值得注意的是,螺内酯的说明书上写的是利尿药,没有治疗痤疮这个适应症,不过我们皮肤科医生有时会给痤疮病人开具这个药。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"口服螺内酯可减少30-50%皮脂分泌,推荐量为50-100mg/d,与餐同时服用。部分患者每天服用50mg,甚至25mg即可达到控制炎性丘疹甚至囊肿的效果。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"这种低剂量服用对患者耐受性好,一般不需要检测血清钾水平。当年龄较大的妇女伴有其他疾病,或存在多毛症,雄激素性脱发需要高剂量治疗时应该定期检测血清钾水平。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"需要注意的是,妊娠期女性禁止服用螺内酯,螺内酯会导致男性胎儿的生殖器畸形等多种严重的问题。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"同时,也不推荐男性患者服用螺内酯,可能会出现乳房发育、乳房胀痛等问题。","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"写在最后","0:\"%23021eaa\"|27:\"12\"|31:2|8:1"],[20,"\n","7:1"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"没想到吧,我们认知中的避孕药和利尿药,还有治疗痤疮的功能。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"其实生活中很多时候都是这样,我们对一个人,或一件事有了刻板印象,就很难再更改。","27:\"12\"|31:2"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"不过,最后需要强调一下:","27:\"12\"|31:2"],[20,"皮肤科医生是没有资格开具避孕药的,如果皮肤科医生认为你的病情需要使用避孕药,会让你咨询妇产科医生,并最终由妇产科医生来开处方。","27:\"12\"|31:2|8:1"],[20,"\n\n","7:3"],[20,"不要自己瞎买避孕药吃,一定要去找医生,一定遵医嘱!!!","27:\"12\"|31:2|8:1"],[20,"\n","7:3"],[20," ","27:\"12\"|31:2"],[20,"\n","7:3"],[20,"我是王瑞艳,让我陪着你,对抗皮肤病。","27:\"12\"|31:2"],[20,"\n","7:3"}}">北京空总医院皮肤科王瑞艳

大家好,我是王瑞艳。

 

很多大龄女性痤疮患者在一般的抗痤疮治疗效果不好的情况下,我会建议他们去看妇产科医生,加用避孕药,他们通常会问我:

 

“为啥皮肤科医生会建议我使用避孕药来治疗痤疮呢?”

 

是这样的,对于成年后痤疮,也就是25岁以后患痤疮的女性朋友们,如果在常规的抗痤疮治疗效果不好的情况下,我会建议他们去咨询妇产科医生,看是否适合服用避孕药来进行痤疮的治疗。

 

其实,道理挺简单的。

 

就像有的肠胃病患者,医生会开具一些有安神、治疗抑郁的药物,但并不是说患者就患了抑郁症,而是缓解患者失眠焦虑的状况,从而调节肠胃功能。

 

痤疮患者服用避孕药,当然不是发挥其避孕的功效,而是通过其所含的成分来治疗痤疮

 

避孕药最重要的功能,就是解决雄性激素分泌过多的问题。

                

雄性激素对痤疮有啥影响

 

不客气的说,雄性激素就是痤疮发病的始动因素之一。

 

大家都知道,痤疮的发生,跟皮脂腺分泌息息相关,皮脂腺的分泌增多不仅会导致毛孔堵塞形成粉刺,还会给痤疮细菌提供养分,埋下感染的隐患。(>>>戳戳这里查看更多关于痤疮发病的内容)

 

雄性激素,能促进皮脂腺分泌增多,你说恐不恐怖?

 

你可以这样理解整个过程,雄性激素只是一种激素,必须有相对应的受体,雄性激素才能发挥作用。

 

而这个雄性激素受体,虽然在毛囊汗腺都有分布,但是在皮脂腺中分布是最密集的。

 

也就是说,雄性激素很容易刺激皮脂腺的分泌。

 

这就像明星开演唱会一样,虽然哪里都有粉丝,但是某个城市的粉丝数量是最多的,那这座城市演唱会的效果一定更加爆炸。

 

雄性激素就是明星,雄性激素受体就是粉丝,这座城市就是皮脂腺,而爆炸的效果,就是长痘长痘长痘!

 

在很多科学研究中,也有很多证据表明雄性激素跟痤疮的关系:

 

1.青春期的患者,往往伴随雄性激素提升有痤疮症状出现;

2.雄性激素受体缺乏或不敏感者不发生痤疮

3.高雄性激素相关的疾病如多囊卵巢综合症往往伴有痤疮

4.口服雄性激素可促进皮脂分泌;

5.重度痤疮患者可伴有血中雄性激素水平升高。

 

哪些痤疮症状可能跟雄性激素分泌变多有关

 

虽然雄激素与痤疮发病关系密切,但大多数女性痤疮患者雄性激素水平在正常范围内,不过,如果使用避孕药等性激素进行治疗的话,很多雄性激素水平正常的患者也会收到不错的治疗效果。

 

一般来说,跟雄性激素相关的痤疮症状,都有一定的特征:

 

1.月经前皮损加重,皮损主要分布于面部中下1/3,尤其是下颌部位;

2.发病年龄较晚,或病程迁延,多属于青春期后痤疮

3.常规抗生素治疗甚至异维A酸治疗反应较差,或者停药后迅速复发。

 

对于这种特征的女性痤疮患者,就可以使用抗雄性激素治疗的手段啦!

 

大家注意了是女性痤疮患者,男性痤疮患者一般不用抗雄性激素治疗的!

 

口服避孕药为什么可以抗雄性激素?

 

口服避孕药是一种有效的抗雄激素治疗手段。

 

避孕药中的雌激素,可以通过减少卵巢和肾上腺皮质功能亢进引起的雄激素分泌过多,来降低血清中活性雄激素的浓度,起到抗皮脂分泌作用。

 

同时,雌激素还可减少游离睾酮量,有缩小皮脂腺的体积并抑制皮脂腺细胞内脂质合成的作用。

 

避孕药中的另一个重要成分是孕激素。

 

孕激素是5-α还原酶的抑制剂,它可以通过负反馈抑制作用,使血浆中的睾酮和脱氢睾酮量降低;

 

不仅如此,孕激素还可以抑制皮脂腺细胞和角质形成细胞转化睾酮的能力,醋酸环丙孕酮还可以阻断雄激素与其受体结合

 

此外,雌激素和孕酮还可以直接作用在毛囊皮脂腺,减少皮脂分泌和抑制粉刺生成。               

 

目前常用于痤疮治疗的避孕药有复方醋酸环丙孕酮片(达英35)优思明

 

口服避孕药常见不良反应包括类早孕反应(恶心,呕吐,食欲不振,乏力),胸部触痛,头痛,阴道出血等。

 

这些症状多出现在治疗的早期,为雌激素短期突然增加所致。随着服药周期增加可逐渐减轻或消失,通常不影响治疗。

 

还有哪些抗雄性激素治疗的手段?

 

除了口服避孕药外,常见的激素治疗手段还有雄性激素受体阻断剂。

 

其实原理很简单,我们需要对抗雄性激素的话,要么抑制雄性激素的产生,要么让雄性激素不再发挥作用。

 

如果说口服避孕药是前者的话,那使用雄性激素受体阻断剂就是后者。

 

常见的雄性激素受体阻断剂是安体舒通,又称螺内酯。他可以竞争性抑制二氢睾酮与皮肤靶器官的受体结合,从而影响其作用,抑制皮脂腺的生长和皮脂分泌。

 

值得注意的是,螺内酯的说明书上写的是利尿药,没有治疗痤疮这个适应症,不过我们皮肤科医生有时会给痤疮病人开具这个药。

 

口服螺内酯可减少30-50%皮脂分泌,推荐量为50-100mg/d,与餐同时服用。部分患者每天服用50mg,甚至25mg即可达到控制炎性丘疹甚至囊肿的效果。

 

这种低剂量服用对患者耐受性好,一般不需要检测血清钾水平。当年龄较大的妇女伴有其他疾病,或存在多毛症,雄激素性脱发需要高剂量治疗时应该定期检测血清钾水平。

 

需要注意的是,妊娠期女性禁止服用螺内酯,螺内酯会导致男性胎儿的生殖器畸形等多种严重的问题。

 

同时,也不推荐男性患者服用螺内酯,可能会出现乳房发育、乳房胀痛等问题。

 

写在最后

 

没想到吧,我们认知中的避孕药和利尿药,还有治疗痤疮的功能。

 

其实生活中很多时候都是这样,我们对一个人,或一件事有了刻板印象,就很难再更改。

 

不过,最后需要强调一下:皮肤科医生是没有资格开具避孕药的,如果皮肤科医生认为你的病情需要使用避孕药,会让你咨询妇产科医生,并最终由妇产科医生来开处方。

 

不要自己瞎买避孕药吃,一定要去找医生,一定遵医嘱!!!

 

我是王瑞艳,让我陪着你,对抗皮肤病。

本文是王瑞艳医生版权所有,未经授权请勿转载。

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发表于:2020-02-23 09:31

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