黄褐斑的治疗进展

黄褐斑是一种获得性色素增加性皮肤病，病因复杂，治疗困难。外用药是黄褐斑治疗的首选，单用4%氢醌乳膏和三联疗法（4%氢醌乳膏+0.01%氟轻松+0.05%维A酸乳膏）为一线治疗方案，目前外用氨甲环酸治疗黄褐斑被证实安全有效，苯丙氨酸、丁雷锁辛也有一定疗效。外用木质素过氧化物酶、锌、西酸模精华、二乙酰伯尔定碱及转化生长因子β1仿生寡肽68、氟他胺等是近年的新方法。联合口服氨甲环酸能增加疗效。Q开关激光治疗黄褐斑疗效明显，但易复发和色素沉着。强脉冲光、点阵激光尚缺乏大样本研究，CO2激光和铒激光疗效显著，但极易造成亚洲患者的炎症后色素沉着，故不适于亚洲人群。顽固性黄褐斑患者可考虑化学或物理剥脱治疗，皮肤磨削术使97%患者的黄褐斑获得了永久性清除。     

黄褐斑患者组织病理特征分析

目的 探讨黄褐斑组与正常对照组组织病理学及超微结构差异。方法 分别取8例黄褐斑患者的皮损组织,16例面部色素痣皮损周围正常组织,分别取2 mm活检,进行HE染色、Fontana?Masson染色、Verhoeff?van Gieson染色,HMB45、NKI/beteb免疫组化及透射电镜观察。光镜下半定量及计算机图像定量分析。结果 黄褐斑组组织病理表现为以基底层、棘层为主的黑素颗粒增多,部分伴真皮黑素颗粒增加。黄褐斑组黑素细胞仅存在于表皮层,较正常皮肤黑素细胞数量无增加,但表皮层黑素细胞体积增大,染色强度增加,树突增多。8例黄褐斑患者均在真皮浅层及毛细血管周围观察到轻到中度的淋巴细胞浸润,8例黄褐斑患者均在真皮浅层观察到轻到中度的毛细血管扩张。电镜：黄褐斑组黑素细胞,角质形成细胞内都含有更多黑素小体,此外,还观察到黑素细胞树突伸入到真皮层。结论 8例黄褐斑患者中,仅有表皮型和混合型（表皮真皮型）2型,无单纯真皮型黄褐斑。炎症反应、毛细血管扩张可能引发或加重黄褐斑。     

黄褐斑的物理与化学治疗

黄褐斑的理化治疗包括强脉冲光、射频技术、激光及化学剥脱等.理化治疗作为黄褐斑治疗中的新技术,因其治疗周期短、有效率高受到越来越多的重视,并取得一定的进展.其中,强脉冲光、短波长激光及化学剥脱适合于表皮型黄褐斑的治疗;而混合型及真皮型黄褐斑的治疗可选择点阵激光,长波长激光联合短波长激光、剥脱性激光和强脉冲光.     

Hyperpigmentation and melasma

Facial and neck pigmentations are significant cosmetic problems. They are common in middle-aged women, related to endogenous (hormones) and exogenous factors (cosmetics, perfumes, sun exposure), and often represent paramount causes of emotional distress. Although melasma is the most common cause of facial pigmentation, there are many other forms including drug-induced and postinflammatory hyperpigmentation. We review pathogenesis, clinical and histopathological data, effect on quality of life, and treatment options in facial hyperpigmentation disorders.     

黄褐斑的物理与化学治疗

黄褐斑的理化治疗包括强脉冲光、射频技术、激光及化学剥脱等.理化治疗作为黄褐斑治疗中的新技术,因其治疗周期短、有效率高受到越来越多的重视,并取得一定的进展.其中,强脉冲光、短波长激光及化学剥脱适合于表皮型黄褐斑的治疗;而混合型及真皮型黄褐斑的治疗可选择点阵激光,长波长激光联合短波长激光、剥脱性激光和强脉冲光.     

黄褐斑的物理与化学治疗

黄褐斑的理化治疗包括强脉冲光、射频技术、激光及化学剥脱等.理化治疗作为黄褐斑治疗中的新技术,因其治疗周期短、有效率高受到越来越多的重视,并取得一定的进展.其中,强脉冲光、短波长激光及化学剥脱适合于表皮型黄褐斑的治疗;而混合型及真皮型黄褐斑的治疗可选择点阵激光,长波长激光联合短波长激光、剥脱性激光和强脉冲光.     

黄褐斑病因及发病机制的研究进展

黄褐斑是一种以面部或浅或深的棕黑色斑片为特征的色素性疾病.近年来研究发现,黄褐斑的发病机制涉及多个方面,基底膜结构受损、血管功能亢进、氧化应激.蛋白基因水平方面发现,黄褐斑皮损中脂类代谢相关基因的表达下调,非编码RNA H19基因显著低表达.分子生物学研究发现,多个信号转导通路如WNT通路、一氧化氮合酶与核因子κB通路在黄褐斑发病中起关键作用.另外神经调节也涉及黄褐斑的病理生理过程.     

Topical liquiritin improves melasma

Twenty women with a clinical diagnosis of melasma were treated with liquiritin cream on one side of the face and with a vehicle cream on the other side twice daily for 4 weeks. Patients were advised to avoid sun exposure and/or used topical sunscreen during the entire period of treatment. Inclusion criteria included an age range from 18 to 40 years and bilateral and symmetrical idiopathic epidermal melasma. Exclusion criteria included patients with dermal melasma (differentiated by Wood's light), melasma with pregnancy, and patients currently receiving hormone replacement therapy. Melasma pigmentary intensity was rated on a five-point scale in relation to the patient's normal facial skin (1, no difference; 2, slightly more pigmented; 3, moderately more pigmented; 4, markedly more pigmented; and 5, intensely more pigmented). The size of the lesions was measured directly using a millimeter grid scale. Ratings and measurements were made prior to treatment and at each of the follow-up visits (after 2, 4, 6, 8, and 10 weeks). Clinical evaluation was performed at week 4; the overall response was rated as excellent, good, fair, or poor. Color photographs were taken at the start and at week 4 of the study. Side-effects were observed and treated.     

线状黄褐斑1例

<正>临床资料患者,女,48岁。因额部线状色素斑1年,于2008年12月22日来我院就诊。患者1年前无明显诱因发现额部线状淡黄褐色斑,颜色逐渐加深,无自觉症状。既往身体健康,无明显强日光照射史,     

The vascular characteristics of melasma

BACKGROUND: The pathogenesis of melasma is not yet fully understood. Previous studies indicate that dermal environment such as fibroblasts may have an important role in the development of melasma. Recently, it has been suggested that interactions between the cutaneous vasculature and melanocytes might have an influence on the development of pigmentation. OBJECTIVES: We investigated the vascular characteristics in melasma lesions. The expression of vascular endothelial growth factor (VEGF), a major angiogenic factor of the skin, was also investigated in melasma. METHODS: Erythema intensity was quantified by the increase of the a* parameter using a colorimeter. Skin samples were obtained from lesional and non-lesional facial skin of 50 Korean women with melasma. Immunohistochemistry was performed to determine the expression of factor VIIIa-related antigen and VEGF in melasma. RESULTS: The values of a* was significantly higher in the melasma lesion than that of perilesional normal skin. Computer-assisted image analyses of factor VIIIa-related antigen-stained sections revealed a significant increase of both the number and the size of dermal blood vessels in the lesional skin. There was significant relationship between the number of vessels and pigmentation in melasma. The expression of VEGF was significantly increased in melasma CONCLUSIONS: These data suggest that increased vascularity is one of the major findings in melasma. VEGF may be a major angiogenic factor for altered vessels in melasma.     

联合治疗黄褐斑的研究进展

黄褐斑是一种常见的皮肤色素代谢障碍性疾病,因病因及发病机制复杂,单药治疗疗效不佳或不良反应较大,而联合治疗因疗效佳、不良反应小受到医生的亲睐。目前黄褐斑的治疗多样,主要有口服、外用药物,激光或光子疗法,多种方案联合治疗等。黄褐斑的治疗需根据患者病因、病程、临床分型、既往治疗情况等制定个性化治疗方案。多重治疗、序贯治疗或补充治疗应纳入黄褐斑治疗中。     

线状黄褐斑

报告线状黄褐斑2例。2例患者均为男性。1例在发病前有较强的13光照射史。2例患者在发病前均无额部外伤及药物长期服用史。皮损均发生存额部，黄褐色色素沉着斑呈线状分布，皮肤无萎缩。     

Therapeutical approaches in melasma

Melasma (cloasma) is a typical hypermelanosis and a common dermatologic skin disease that involves sun-exposed areas of the skin. It mostly affects women of reproductive age. Solar and ultraviolet exposure are the most crucial etiologic factors. Pregnancy, certain endocrine disorders and hormonal treatments, cosmetics, phototoxic drugs, and antiseizure medications are well-known inducing and exacerbating factors. A classification of melasma is based on Wood's light examination, classifying it in four major clinical types and patterns: epidermal, dermal, mixed, and indeterminate. Different treatment options are currently available for melasma. The choice of proper treatment should take into account the type of melasma to be treated, the skin complexion of the patient, possible previous treatments, the expectations and compliance of the patient, and the season in which the treatment is started.     

黄褐斑的治疗进展

目前黄褐斑的治疗方法众多，主要包括药物治疗、化学剥脱、光电疗法及中医中药等，单一疗法均疗效欠佳。目前认为综合治疗有较好的治疗效果，本文就黄褐斑的治疗进展作一综述。     

Senescent fibroblasts in melasma pathophysiology

It has been proposed that melasma is a photoageing skin disorder. The photoaged fibroblasts have been suggested as an important source of melanogenic factors which are involved in the regulation of pigmentation. To investigate whether melasma includes senescent cells, lesional and perilesional normal skin from 38 melasma patients was assessed using a cell senescence marker, p16^INK4A. The results showed that lesional dermal skin had more p16^INK4A‐positive senescent cells than perilesional skin. The impact of senescent fibroblasts was further investigated in a pilot study using radiofrequency (RF) intervention for melasma. It showed that the RF therapy decreased the number of senescent cells with increased expression of procollagen‐1, which were associated with reduced epidermal pigmentation. This leads us to the speculation that senescent fibroblasts may contribute to drive melasma and might be considered as a potential therapeutic target.     

光接触过敏原与黄褐斑的相关性研究

目的 探讨常见光接触过敏原与黄褐斑之间的相关性。方法 依循英国光学皮肤病研究组推荐的光斑贴试验操作步骤,从国家化妆品光感性皮炎诊断标准（GB17149.6-1997）、国家化妆品接触性皮炎诊断标准（GB17149.2-1997）及国家职业性皮肤病诊断标准（GBZ18-2002）中筛选出20种常见过敏原。对50例黄褐斑患者及30例正常人对照进行光斑贴试验。结果 50例黄褐斑患者中光斑贴试验阳性24例占48.0%,30例正常人对照中光斑贴试验阳性7例占23.33%,黄褐斑患者光斑贴阳性率显著高于对照组（P < 0.05）。结论 黄褐斑患者光斑贴试验阳性率高于正常人。