难治部位白癜风的治疗进展

白癜风是一种与黑素细胞缺失有关的色素脱失性皮肤病,易诊难治,尤其对难治部位,诸如嘴唇、生殖器、头皮、眼睑、肘膝部及四肢、掌跖足底等疗效更差.就近年来对难治部位的有效疗法,如药物、外科移植术、光疗及联合疗法等进行概述.根据难治部位的临床特点,选用合理的治疗方案,以提高难治部位的疗效,指导临床治疗.     

难治部位白癜风的治疗进展

白癜风是一种与黑素细胞缺失有关的色素脱失性皮肤病,易诊难治,尤其对难治部位,诸如嘴唇、生殖器、头皮、眼睑、肘膝部及四肢、掌跖足底等疗效更差.就近年来对难治部位的有效疗法,如药物、外科移植术、光疗及联合疗法等进行概述.根据难治部位的临床特点,选用合理的治疗方案,以提高难治部位的疗效,指导临床治疗.     

银屑病的光疗疗效与临床关系

银屑病是一种多基因疾病,可在多种诱因下发病.光疗是治疗银屑病的有效方法之一,特别是对于特殊部位的难治、顽固性斑块性皮损,光疗可以获得较好的疗效.目前,用于银屑病治疗的光疗主要有长波紫外线、中波紫外线、准分子激光以及光疗和各类药物联合治疗.轻中度银屑病患者,一般用单一光疗即可,中重度银屑病患者,尤其是其他常规方法疗法不佳者,一般采用药物联合光疗疗效较好,但需注意联合治疗的不良反应.临床治疗中,光疗疗效和发病年龄、部位、银屑病类型等各种因素有关.     

240例银屑病患者治疗的回顾性调查报告

银屑病顽固难治,其疗法据国内统计多达253种.为了解银屑病常用疗法的远期疗效、复发情况及副作用等,我们对门诊银屑病患者的既往治疗情况进行回顾性调查,现将调查结果报告如下. 调查对象与方法我们于1985年4月～5月在皮肤科门诊对凡接受过银屑病治疗有一年以上的患者,共240例,无选择性地进行治疗的回顾性调查,内容包括一般情况、临床症状、既往治疗情况及患者对银屑病疗法的评价四个方面,共16个问题,33项,由医师询问及检查病人后逐一填表.     

局部注射糖皮质激素加抗生素治疗22例头部脓肿性穿掘性毛囊周围炎

头部脓肿性穿掘性毛囊周围炎是发生于头皮部位的慢性化脓性皮肤病,对常规抗生素、手术及激光治疗无效,是临床上较为难治的皮肤病之一.我们近6年在门诊采用皮损内注射糖皮质激素加抗生素联合治疗22例患者,取得满意疗效.     

光疗在白癜风治疗中的临床应用

白癜风是一种常见的慢性获得性色素减少性疾病,其发病机制尚不清楚,可能的机制有自身免疫、黑素细胞自毁、神经精神因素、表皮因子失衡及遗传因素等.临床上治疗白癜风的方法很多,光疗及其联合疗法是目前有效的治疗方法之一,尤其适用于泛发性及难治性白癜风.而临床应用中,光疗疗效受多因素影响,如疾病分型、患病年龄、皮损部位等.因此了解各种光疗的作用机制,适应证,临床疗效及不良反应,有助于临床医生选择最佳的治疗方案.     

丹毒的临床研究进展

丹毒是一种累及皮肤深部组织的感染性皮肤病,多由A组B群溶血性链球菌引起.少见部位、复发性和难治型丹毒近年屡有文献报道,其中少见部位丹毒因发病机制特殊,常规丹毒的防治疗效甚微.丹毒患者合并症多而复杂,手术治疗造成脉管损伤以及术后的放化疗等使得丹毒易复发,滥用抗生素和糖皮质激素及耐药菌的出现等,导致难治型丹毒.各型丹毒相互关联、相互影响引起了单纯青霉素类抗生素疗效不佳等诸多问题.因此,阐述各型丹毒的发病机制和防治措施,改善患者的预后有一定意义.     

四联疗法治疗白癜风疗效观察

白癜风临床常见,易诊难治,病因复杂,采用单一疗法往往难以取得满意疗效,我科自2004年8月至2007年10月,采用四联疗法（内服白癜风胶囊、甲氧沙林片,外用补骨脂酊、卤米松霜）治疗白癜风62例,并设对照组进行比较,取得了较好疗效,现将结果报告如下。     

白癜风的治疗

光化疗法和皮质类固醇是治疗白癜风一线疗法，不管是进展期和静止期均适用。PUVA的皮质类固醇治疗无效的稳定期白癜风患者，根据其发病部位、临床分型等因素合理选择表皮移植等外科疗法可以提高疗效。对非外科的其他疗法如卡泊三醇、假过氧化化氢酶、UVB等也做了简要介绍。     

中汽疗法联合窄谱中波紫外线照射治疗寻常性银屑病临床观察及护理

目的探讨中药蒸汽熏蒸疗法（中汽疗法）与窄谱中波紫外线（NB—UVB）联合治疗寻常性银屑病的临床疗效及护理要点。方法分析、总结中汽疗法与光疗联合治疗380例寻常性银屑病的临床资料,对两种治疗手段联合后的治疗效果进行评价;将心理护理、中汽护理与NB．UVB照射护理有效的结合,贯穿治疗的始终,观察对患者临床治疗效果的影响。结果中汽疗法与光疗联合治疗寻常性银屑病,配合心理、中汽及照射护理措施治疗,疗效满意,总有率达84．62％。结论应用中汽疗法与光疗联合治疗寻常性银屑病具有临床疗效好、应用方便、不良反应少等特点。3种护理方法相结合,贯穿治疗可提高临床疗效。     

特殊部位白癜风的治疗进展

白癜风的治疗近年有了长足的进展,医生可以依据中国《白癜风治疗共识2009版》,根据患者的病期、型别、皮损面积、病程等诸多因素制定安全有效、合理的方案。但是白癜风的病因及发病机制目前仍未完全明确,在白癜风治疗中依然存在很多难题,如黏膜部位、肢端部位、累积毛发部位的白癜风仍然很难治疗。本文针对以上难题进行了国内外文献综述,旨在为临床医生治疗难治部位白癜风提供更多的治疗对策。     

难治性白癜风的治疗进展

近年来白癜风治疗有了长足发展，目前欧洲、英国、日本、中国都制定了相关诊疗共识，大部分患者可以依此制定有效、合理的治疗方案，但白癜风治疗中仍存在难点，如特殊部位白斑（黏膜及薄嫩部位、毛发部位、肢端部位）、大面积白斑和残留不规则白斑的治疗等。针对以上难题本文对近五年来国内外文献进行了综述。     

Chemical peeling with phenol : For the treatment of stable vitiligo and alopecia areata

Chemical peeling with 88% phenol was carried out on 142 sites of stable vitiligo (hairy-126, non hairy-16) and on 69 sites of alopecia areata (AA). After cleansing and defatting, phenol was applied on affected areas till a uniform frost appeared. On healing, all the lesions of vitiligo showed perifollicular pigmentation in hairy areas and perilesional repigmentation in non hairy areas. These were further treated with PUVA/PUVASOL. After the healing, 82.5% of hairy sites and 81.3% of non hairy sites showed repigmentation. In cases of AA, patients developed vellus hair. In AA, 72.5% had good regrowth and 27.5% had poor response. Side effects seen were hypopigmentation (58 AA), hyperpigmentation (11 AA), persistent erythema (42 vitiligo, 28 AA), demarcation lines (4 AA), secondary bacterial infection (2 vitiligo, 5 AA) and superficial scarring (2 vitiligo, 7 AA). The wounding action of phenol is useful to repigment the vitiligo patches and for induction of regrwoth of hair in alopecia areata.     

PUVA treatment of vitiligo: a retrospective study of Turkish patients

BACKGROUND: Psoralen plus ultraviolet A (PUVA) is considered to be the treatment of choice for subtotal vitiligo; however, it is time consuming and carries certain health risks for both patients and physicians. This study attempts to evaluate the efficacy of the treatment in Turkish vitiligo patients. METHODS: We have performed a retrospective study of 33 patients with vitiligo who received systemic PUVA therapy during the period 1985 to 1997, and have evaluated their response to treatment. RESULTS: Overall, 28 patients (84%) showed some improvement; 12 patients experienced a repigmentation of 51-75% and six patients achieved greater than 75% repigmentation. Face and trunk lesions showed better repigmentation than other areas, whereas hands, feet, perioral, and periorbital areas were generally refractory to treatment. The age of the patient, age at onset of the disease, sex, disease duration, and degree of depigmentation prior to initiation of therapy had no influence on PUVA-induced repigmentation. CONCLUSIONS: The distribution of vitiliginous skin must be taken into consideration before the initiation of PUVA therapy, as the response to treatment varies greatly with different body sites; hands, feet, perioral, and periorbital regions are particularly treatment resistant.     

308nm准分子激光治疗儿童白癜风疗效观察

目的评价308nm准分子激光治疗儿童白癜风的疗效及安全性。方法采用自身对照的方法,用Xt-rac颠峰准分子激光系统治疗85例稳定期儿童白癜风患者(年龄≤12岁)的自身对称或相邻皮损,每周治疗1～3次,共30次,每隔10天及治疗结束3天后评价疗效。结果治疗的皮损痊愈12例,显效45例,好转21例,无效7例,显效率为67.1%,有效率为91.8%;未治疗的皮损仍为色素脱失斑。面颈部疗效优于躯干四肢,躯干四肢优于肢端,面颈部非节段型优于节段型。结论308nm准分子激光治疗稳定期儿童白癜风疗效高、副作用少,其疗效与皮损部位有关。     

Epithelial grafting for vitiligo requires ultraviolet A phototherapy to increase success rate

Background Phototherapeutic techniques were introduced into medical practice by the ancient Egyptians. It is considered a cornerstone in the management of resistant vitiligo; yet, failures are very well known. Recently, the introduction of surgical techniques provided a major development in the management of vitiligo and replaced other conventional unsuccessful therapies. Objectives The aim of this work is to find out if phototherapy, which failed to resolve the vitiligo problem in patients, is still required in the treatment strategy after epithelial grafting of the same cases. Methods Twenty‐five vitiligo patients, nonresponding to classic phototherapy, were treated surgically. Ultrathin Thiersch grafts and suction blister grafts were used. Phototherapy using untraviolet A (UVA) bulbs in combination with psoralen or khellin was used postoperatively immediately after take of grafts onto recipient sites. Results In spite of reactivation of depigmentary effects at grafted areas, phototherapy acted as a stimulator for melanocytic proliferation and function and as an immunosuppressant, halting the melanocytic destructive process. The application of UVA phototherapy resulted in successful treatment in the patients receiving it. Conclusion The success of epithelial grafting in patients with vitiligo can be increased by UVA phototherapy.     

Topical immunomodulators are effective for treatment of vitiligo

Vitiligo is a common, acquired, depigmenting disease of the skin. Although the pathogenesis of vitiligo is still unclear, it is postulated that topical immunomodulators exert therapeutic effects on treatment of vitiligo. We reviewed the treatment of vitiligo with topical immunomodulators and topical steroids to evaluate the efficacy of immunomodulators in treatment of vitiligo. We reviewed 52 patients treated with topical immunomodulators and 27 patients with topical steroids. To evaluate the efficacy, repigmentation of vitiligo was reviewed. Between the two treatments, the duration from the start of treatment to onset of repigmentation was significantly shorter in the topical immunomodulator group (P = 0.002). However, no statistically significant differences were found in sex, age, mean disease duration, sites of vitiligo lesion and ratio of patients who showed response. We may suggest topical immunomodulator as an alternative to topical steroids for treatment of vitiligo.     

白癜风287例临床分析

目的分析白癜风患者的临床特点及发病诱因,为制定防治措施提供依据。方法对2010年10月-2011年10月本科门诊的287例白癜风患者临床资料进行分析,内容包括性别、年龄、病史、发病部位、家族史、伴发疾病及诱因,用SPSS17.0软件进行统计学分析。结果男143例,女144例,平均发病年龄(18.9±14.4)岁,4～8岁为高峰发病期(14.29%)。寻常型白癜风有272例(94.77%)。患者全身各部位均可发病,但曝光部位(头、面、颈及手足)发病率较高,占67.25%。33例有阳性家族史,68例有诱发因素,其中有外伤史者27例,精神心理因素者28例。结论本地区白癜风男女发病比例相近,以青少年居多,寻常型最常见,好发于面颈部,外伤及精神心理因素为常见诱因,且有家族史患者病情较重。