皮脂腺及皮下脂肪疾病

972170 寻常痤疮细菌感染病因学探讨/范志莘…//临床皮肤科杂志.-1996,25(6).-371～373参132例寻常痤疮患者的皮损内容取材,同时进行需氧菌和厌氧菌培养.其中有112例分离到细菌,细菌培养阳性率84.8%.112例共分离出137株细菌,其中需氧菌75株,厌氧菌62株,痤疮丙酸杆菌的分离率为     

寻常痤疮与正常人皮肤微生物的对比

目的探讨寻常痤疮与正常人皮肤表面微生物的差异及细菌耐药性问题,为痤疮的病原学研究及痤疮的抗生素治疗提供科学的理论依据。方法对寻常痤疮面部皮损内容物及正常人面部皮肤表面进行细菌培养、分离及鉴定。对培养出细菌分别进行体外抗生素药物敏感试验。结果 137例寻常痤疮面部皮损中细菌总检出率高于89例正常人面部皮肤。144例寻常痤疮中有137例面部皮损中分离出细菌306株(阳性率95.14%)。主要是痤疮丙酸杆菌102株(33.33%)、表皮葡萄球菌95株(31.05%)。96例正常人中有89例面部皮肤表面分离出223株细菌(阳性率92.71%)。主要是痤疮丙酸杆菌67株(30.04%)、表皮葡萄球菌44株(19.73%)。寻常痤疮及正常人皮肤表面均未分离出念珠菌;痤疮丙酸杆菌对抗生素的耐药率寻常痤疮患者高于正常人,耐药率前2位为:甲硝唑,克林霉素;表皮葡萄球菌对抗生素的耐药率寻常痤疮患者高于正常人。耐药率前5位依次为青霉素、红霉素、克林霉素、复方新诺明、苯唑西林。结论寻常痤疮皮损中主要细菌是以痤疮丙酸杆菌及表皮葡萄球菌混合感染常见。治疗寻常痤疮时应避免使用甲硝唑、青霉素、红霉素、克林霉素。可选择米诺环素、喹奴普汀、万古霉素、呋喃妥因。     

基质辅助激光解吸附电离飞行时间质谱技术对痤疮患者痤疮丙酸杆菌的鉴定

目的了解基质辅助激光解吸附电离飞行时间质谱(MALDI-TOF MS)技术鉴定痤疮丙酸杆菌的效果。方法应用MALDI-TOF MS技术对痤疮患者皮损分离的91株菌株进行鉴定。结果 70株为痤疮丙酸杆菌,19株为其他厌氧菌或兼性厌氧菌(表皮葡萄球菌8株、颗粒丙酸杆菌3株、头状葡萄球菌2株、蜡样芽胞杆菌1株、产芽孢梭状芽孢杆菌1株、贪婪丙酸杆菌1株、克氏柠檬酸杆菌1株、毗邻颗粒链菌1株、结核硬脂酸棒状杆菌1株),2株无鉴定结果。结论 MALDI-TOF MS技术鉴定痤疮丙酸杆菌快速而准确,值得选用。     

高强度窄谱蓝光对寻常痤疮表皮分离菌的抗菌作用研究

目的 评价高强度窄谱蓝光对寻常痤疮致病菌的抗菌作用.方法 取67例轻、中度痤疮患者皮损内容物进行细菌培养、分离并鉴定菌种.用高强度窄谱蓝光对培养所得的各种细菌进行照射,观察照光前后细菌数量、形态及超微结构的变化.结果 皮损处检出痤疮丙酸杆菌(32.4%)、颗粒丙酸杆菌(6.9%)、表皮葡萄球菌(35.3%)、金黄色葡萄球菌(4.9%)、溶血葡萄球菌(7.8%)、孔氏葡萄球菌(1.0%)、棒状杆菌(9.8%)及肺炎克雷伯菌(1.0%)和B群链球菌(1.0%).照光后痤疮丙酸杆菌和表皮葡萄球菌较未照光组菌量显著减少(P<0.05),菌落明显变小.结论 高强度窄谱蓝光有抗痤疮表皮分离菌作用.     

寻常性痤疮患者粉刺与脓疱皮损中细菌的分离研究

共采集４２例寻常性痤疮患者标本１２８份，其中粉刺７２份，脓液５６份，进行需氧和厌氧培养。结果发现从痤疮皮损中分离出的细菌，最多的是需氧的革兰阳性球菌和厌氧的革兰阳性相菌，基它种类仅为少数。从粉刺和脓液中培养出的细菌种类差异不明显，而细菌的阳性率有一定差异，其结果对我们探讨寻常性痤疮的发病机理及研究治疗方法有一定意义。     

皮脂腺及皮下脂肪疾病

952244 寻常性痤疮患者粉刺与脓疱皮损中细菌的分离研究/孔俐君…//临床皮肤科杂志。-1995,24(3).-151 42例患者共采集标本128份,其中粉刺72份,脓液56份,进行需氧和厌氧培养。结果发现从痤疮皮损中分离出的细菌,最多的是需氧的革兰阳性球菌和厌 氧的革兰阳性杆菌,其它种类仅为少数。从粉刺和脓液中培养出的细菌种类差异不明显,而细菌的阳性率有一定差异,其结果对我们探讨寻常性痤疮的发病机理及研究治疗方法有一定意义。表1参4     

克林霉素磷酸酯凝胶多中心治疗寻常痤疮

我们于1995年4月至1995年9月在中国医学科学院、中国协和医科大学皮肤病研究所、江苏省人民医院、苏州医学院附属第一医院对克林霉素凝胶治疗寻常痤疮(苏州第四制药厂)进行临床验证,现将结果总结如下。一、资料和方法(一)临床资料:寻常痤疮患者为受试对象,征得患者同意,并愿配合整个治疗过程,由主管医师记入登记表。有典型的临床症状及体征。从患者炎症部位取材做厌氧及需氧细菌培养,痤疮丙酸杆菌阳性率达50%以上,其它细菌达50%左右。治疗前1个月内已接受过对寻常痤疮有影响的药物如抗生素、性激素、皮质类固醇、维Ａ酸、过氧化苯甲酰等;对…     

痤疮患者痤疮丙酸杆菌对克林霉素和甲硝唑的敏感性分析

目的了解本地区痤疮患者痤疮丙酸杆菌对克林霉素(CLI,Clindamycin)和甲硝唑(MNZ,Metronidazole)的耐药情况。方法体外分离、培养痤疮丙酸杆菌,采用基质辅助激光解吸附电离飞行时间质谱(MALDI-TOF MS)技术进行鉴定,并按照琼脂稀释法进行药敏实验。结果 212例痤疮患者中分离出156株痤疮丙酸杆菌,对CLI和MNZ的耐药率分别为:28.21%(44/156)和100%(156/156),CLI和MNZ能抑制90%受试菌所需的最低抑菌浓度(MIC_(90))为:MIC_(90 CLI)≥256,MIC_(90 MNZ)≥256。结论本地区痤疮患者痤疮丙酸杆菌对MNZ 100%耐药、CLI 28.21%耐药,且均为高度耐药。     

青春期后痤疮严重程度影响因素的调查分析

目的了解青春期后痤疮严重程度的主要影响因素。方法对187例患者进行问卷调查,部分患者进行血清性激素水平的检测,肾上腺和卵巢的B超检查,细菌培养及耐药性试验。结果男性、阳性家族史、油性皮肤、嗜食油腻者、经常便秘者、工作压力较大者、伴发脂溢性皮炎者的痤疮较严重;痤疮的严重程度随着年龄的增长而减轻(P<0.1)。62.5%(20/32)患者雄激素水平升高(P<0.05),6.49%(5/77)女患者合并了多囊卵巢。细菌培养的分离率由高到低依次为耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、表皮葡萄球菌、痤疮丙酸杆菌;需氧菌的耐药率由高到低依次为青霉素、红霉素、氯洁霉素……。结论多种因素影响着青春期后痤疮的严重程度;对于顽固难治的患者,尚需考虑多囊卵巢及多重耐药菌株存在的可能。     

环丙沙星霜治疗化脓性皮肤病临床观察

采用分组对照观察环丙沙星霜（ＣＩＰ）外用治疗化脓性皮肤病。ＣＩＰ组患者１１３例，痊愈８５例，显著进步１６例，痊愈率７５．２％，总有效率８９．４％；新霉素软膏（ＮＭ）组６３例，痊愈３２例，显著进步１４例，痊愈率５０．８％，总有效率７３．０２％；治疗组的痊愈率和总有效率显著高于对照组（Ｐ＜０．０１）。两组未见明显副作用。同时还对患者进行了细菌培养和药敏试验及ＣＩＰ最小抑菌药物浓度（ＭＩＣ）试验。     

Effects of topical erythromycin on aerobic and anaerobic surface flora

The contents of acne lesions from 30 men with inflammatory acne vulgaris, obtained before and at the conclusion of 4 weeks of topical 2% erythromycin therapy, were cultured on aerobic and anaerobic plates. Sensitivity testing of cultures was performed with discs containing 50 mg erythromycin, in order to ascertain the prevalence of erythromycin-resistant strains of Propionibacterium acnes and aerobic micrococci. The percentages of patients in whom erythromycin-resistant micrococci could be isolated increased from 3 to 60% during topical erythromycin therapy, but no resistant P. acnes strains were isolated either before or after therapy. Considering the widespread use of topical antibiotics, long-term studies on their ecological effects are desirable.     

Study of elastolytic activity Propionibacterium acnes and Staphylococcus epidermis in acne vulgaris and in normal skin.

Histopathological sections of anetoderma-like scars from 10 patients with acne vulgaris showed a selective absence of elastic fibers around pilosebaceous follicles. This finding is similar to the histologic changes of "perifollicular elastolysis" reported by Varadi. Bacteria isolated by anaerobic and aerobic cultures of swabs of the skin surface and pus of these 10 patients, 12 others with active acne vulgaris and 8 normal subjects were studied with particular attention to Staphylococcus epidermis and Propionibacterium acnes. These organisms were analysed for production of an elastolytic enzyme which might play a role in the observed selective loss of elastic fibers. No elastolytic activity was produced by S. epidermidis or P. acnes isolated from any of these individuals. Thus, we cannot attribute the perifollicular loss of elastic fibers in acne scarring to an elastase produced by organisms. The observed absence of elastic fibers might result from tissue necrosis produced by leukocytes during the inflammatory phase, followed by collagenous scar formation without regeneration of elastic fibers.     

Differentiation of various Propionibacterium species from acne-vulgaris efflorescences]

Samples of pustules taken from 37 patients with acne (a. vulgaris, a. papulopustulosa, a. conglobata) were examined using different culture mediums for the growth of anaerobic to microaerophilic coryneforms. We identified 46 isolates of Propionibacteria which were tested according to their morphological, biochemical, serological, and phagelysotopic reactions. Three types of Propionibacteria were found: P. acnes (33), P. granulosum (11) and P. avidum (2). Nine samples showed P. acnes combined with P. avidum, four samples from patients with acne conglobata showed P. granulosum or P. avidum only. Tests from 37 patients are too limited to reach definite conclusions. We are not able to suggest any correlation between type and degree of clinical acne, and the isolated Propionibacteria. These data indicate that pustules from patients with acne of all clinical degrees can contain P. acnes as well as other anaerobic coryneforms. Therefore, other species of anaerobic bacteria, particularly those of the "propionibacteria type", should be included in any discussion about the aetiological factors of acne.     

The frequency of polycystic ovary syndrome in females with resistant acne vulgaris

Background Acne vulgaris in females may be resistant to treatment in spite of topical and systemic therapy for a sufficient period. In this condition, acne may be a manifestation of underlying endocrine conditions such as polycystic ovary syndrome (PCOS). Objective To evaluate the frequency of PCOS in females with resistant acne vulgaris. Patients and methods This case‐controlled study was conducted in the Department of Dermatology and Venereology in The Teaching Hospital in Al‐Najaf during the period from October 2007 to November 2008. One hundred and twenty‐three female patients with resistant acne vulgaris were included in this study. One hundred and twenty‐three women, age‐matched, without acne were enrolled as a control group. Detailed history, clinical examination, abdominal ultrasound study, and hormonal assays were obtained for the patients and the control group. Results One hundred and twenty‐three females with resistant acne were included; their ages ranged from 17 to 40 years with a mean of 25.016 ± 6.041 (SD). One hundred and twenty‐three control women without acne were enrolled; their ages ranged from 17–40 years with a mean of 26.014 ± 6.251 (SD). The patients and the control group are age‐matched (P = 0.192). It was found that 63 patients (51.2%) with resistant acne have PCOS in comparison to only eight control women (6.2%). The difference is highly significant. Conclusion Polycystic ovary syndrome is an important contributing factor in females with resistant acne vulgaris.     

青春痤疮片治疗寻常痤疮临床疗效观察

目的比较青春痤疮片与甘草锌治疗寻常痤疮的疗效。方法将110例分为两组,试验组60例,服用青春痤疮片,对照组50例,服用甘草锌。两组共治疗12周。结果试验组有效率为86.67%,对照组为72.00%(P<0.05)。结论青春痤疮片治疗寻常痤疮疗效优于甘草锌。     

阿达帕林凝胶个体化治疗寻常痤疮的临床研究

目的 评价0．1％阿达帕林凝胶个体化治疗寻常痤疮的疗效和安全性。方法 81例轻、中度寻常痤疮患者，根据个体情况每日外用0．1％阿达帕林凝胶1．3次，总疗程6～8周。随机选择其中30例每周复诊，拍摄照片观察比较，指导调整治疗剂量。结果 81例和其中30例痤疮患者痊愈率(总皮损数减少≥90％)分别为44．4％和73．4％；治疗中，皮脂溢出减少发生率83．3％；不良反应发生率39．5％，未影响治疗。结论 本药个体化治疗寻常痤疮疗效良好，合理地增加日用药剂量可提高痊愈率；本药刺激性较低，患者皮肤对此药耐受性较好：疗程中阿达帕林凝胶可明显减少皮脂溢出。     

复方多黏菌素B软膏治疗寻常痤疮临床疗效观察

目的观察复方多黏菌素B软膏治疗寻常痤疮的疗效及安全性。方法将156例寻常痤疮患者分为两组,试验组外用复方多黏菌素B软膏每日2次,对照组外用5%过氧苯甲酰凝胶每日2次,疗程均为4周。结果试验组患者经治疗4周后皮损数量明显较治疗前减少,与对照组相比差异有统计学意义(P<0.05);皮损消退显效率两组无明显差异(P>0.05);不良反应发生率试验组低于对照组(P<0.05)。结论复方多黏菌素B软膏治疗Ⅰ、Ⅱ级寻常痤疮有效,且不良反应少。     

Single nucleotide polymorphisms of toll‐like receptor‐4 protect against acne conglobata

Background Former studies have shown that Propionibacterium acnes may stimulate expression of toll‐like receptor 4 (TLR4) in keratinocytes of patients with acne vulgaris. Objective To investigate the impact of single nucleotide polumorphisms (SNPs) of the TLR4 gene in acne vulgaris. Methods Genomic DNA was isolated from 191 patients with acne vulgaris and 75 healthy controls. Asp299Gly and Thr399Ile SNPs were defined after cutting of the PCR products by restriction enzymes. Sebum of lesions was cultured for P. acnes. Results No differences in SNP allele frequencies were found between patients and healthy controls. 46.5% of carriers of wild‐type alleles were suffering from acne conglobata compared with 28.6% of carriers of SNP alleles (P = 0.040). After adjusting for gender, family history of acnes, intake of any therapy and skin isolation of P. acnes, carriage of TLR4 gene SNPs was the only independent variable linked with a protective role against acne conglobata (OR = 0.269, P = 0.014). No differences were found in the amount of pro‐inflammatory cytokines released by peripheral blood mononuclear cells isolated from patients with acne conglobata carrying only wild‐type alleles and SNP alleles. Conclusions Carriage of gene SNPs is protective against the development of acne conglobata even in the presence of P. acnes.