肉霉杆菌毒素注射在美容皮肤科学中的应用

本文介绍子肉毒杆菌毒素（ＢＴ）注射附皱法的历史，作用机理、产品准备、注射方法、美容除皱的技术操作；包括眉间纹、额头纹、鱼尾纹与颈阔肌纹，并发症与不良反应，适应症与禁忌症，肉霉杆菌毒素注射除皱法，安全、高效、值得推广。     

肉毒杆菌毒素注射在美容皮肤科学中的应用

本文介绍了肉毒杆菌毒素 (BT)注射除皱法的历史 ,作用机理、产品准备、注射方法、美容除皱的技术操作 ;包括眉间纹、额头纹、鱼尾纹与颈阔肌纹 ,并发症与不良反应 ,适应症与禁忌症。肉毒杆菌毒素注射除皱法 ,安全、高效 ,值得推广。     

皮肤美容及整容

20111045长期重复应用A型肉毒毒素面部除皱的疗效和安全性评价/潘卫利(浙江省医院皮肤科),陆威,陶小华∥中华医学美学美容杂志.-2010,16(5).-307~309对52例多次使用国产A型肉毒毒素注射面部除皱者进行了回顾性分析总结。每次注射除皱部位均包括额纹、鱼尾纹、眉间纹、鼻背横纹。于注射前和注射后1周、1个月、3个月及再次注射时,分别进行疗效和     

A型肉毒毒素消除面部上三分之一皱纹的临床观察

目的通过局部注射A型肉毒毒素,观察其去除面部上三分之一皱纹的临床疗效。方法在产生额纹、鱼尾纹、眉间纹、鼻背纹的局部肌肉内,注射浓度为4 u/0.1m l的适量A型肉毒毒素。结果A型肉毒毒素治疗面部上三分之一皱纹有效率为100%,显效率90.32%,疗效维持时间3~10个月。副作用局限、轻微、短暂。结论A型肉毒毒素局部注射治疗面部上三分之一皱纹是安全、有效、简单非侵入性疗法。     

A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效

目的:探讨A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效。方法:选择年龄30~60岁有眶周皱纹患者60例,随机分为3组,A组给予A型肉毒毒素注射,B组给予Lux1540 nm非剥脱点阵激光治疗,C组给予A型肉毒毒素注射联合Lux1540 nm非剥脱点阵激光治疗。每例患者在治疗前,治疗后14 d、1、3、6个月随访并行疗效评估。结果治疗1个月后,三组患者眶周皱纹、纹理、弹性、水分均有所改善,与治疗前比较,差异均有统计学意义(P值均<0.05)。肉毒毒素注射联合Lux1540 nm非剥脱点阵激光的C组患者,其皱纹、纹理、弹性、水分的远期效果改善更加明显。结论 A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗可同时改善眶周的皱纹和纹理,同时具有紧致眶周皮肤的作用,是眶周皮肤年轻化治疗的理想治疗方案。     

24 MHz高频超声对健康成人面部皮肤厚度的检测分析

目的 采用高频超声方法,检测了解健康成人面部多个部位皮肤表皮及真皮厚度.方法 招募108例健康成人,采用24 MHz高频超声检测前额、眉间、眼睑、颞部、鼻背、颧骨、面颊和下颌8个部位表皮及真皮厚度.结果 在面部的不同部位,前额表皮最厚(0.208 9±0.031 3)mm,面颊真皮最厚(1.054 2±0.286 6)...     

葡萄酒色痣超声图像分析

目的 探讨葡萄酒色痣（PWS）的超声特征及其诊断价值。方法 收集上海交通大学医学院附属第九人民医院2015年1月至2016年1月经病理或临床证实并经超声检查的PWS患者128例（病灶162处）。根据超声表现,将PWS分为平坦型、增厚型、结节型,对其超声特征进行回顾性分析。结果 平坦型PWS患者共95例,病灶118处,病灶处皮肤层厚度显著高于相应健侧,但两者厚度差异主要在0.2 mm以下;低回声79处（67%）,未见血流信号75处（64%）,测及静脉频谱15处,峰值（3.33 ± 1.80） cm/s。增厚型PWS患者17例,病灶24处,病灶处皮肤层厚度（1.80 ± 0.70） mm,亦显著高于相应健侧［（1.14 ± 0.43） mm］,差异有统计学意义（t = 6.834,P < 0.001）;病灶低回声24处（100%）,不丰富血流信号15处（62%）,测及静脉频谱18处,峰值（6.61 ± 3.87） cm/s。结节型PWS患者16例,病灶20处,病灶厚度（6.45 ± 4.68） mm,低回声18处（90%）,丰富血流信号15处（75%）,测及静脉频谱15处,峰值（10.00 ± 5.39） cm/s,动脉频谱19处,收缩期峰值（24.58 ± 13.82） cm/s,阻力指数0.59 ± 0.13。增厚型和结节型PWS皮损厚度显著高于平坦型（均P < 0.05）,结节型显著高于增厚型（P < 0.05）;3型静脉峰值亦各不相同（F = 10.630,P < 0.001）,且增厚型和结节型PWS皮损静脉峰值显著高于平坦型（均P < 0.05）,而结节型与增厚型差异无统计学意义（P > 0.05）。结论 超声对PWS的诊断具有一定的价值。     

射频联合A型肉毒毒素改善下面部松弛的临床观察

 

目的:探讨射频联合A型肉毒毒素注射改善下面部松弛的临床疗效及安全性。方法：纳入40例要求改善下面部松弛的求美者,随机分为对照组和试验组各20例,对照组采用A型肉毒毒素颈阔肌注射治疗,试验组采用下面部射频治疗联合A型肉毒毒素颈阔肌注射治疗,分别于治疗前,治疗后1、3及6个月对求美者进行标准化摄影,采用Photoshop CS6测量两组治疗前后下面部提升的距离和角度,采用重复测量方差分析方法对数据进行统计学处理。结果：40例求美者均完成治疗。对照组与试验组相比,治疗1、3个月后下颌缘轮廓缩小及提升差异不明显;治疗后6个月下颌缘轮廓缩小及提升差异明显（P值均＜0.05）。结论：射频联合A型肉毒毒素注射可改善下面部松弛,提高远期疗效,且疗效可靠、安全,值得临床推广应用。

     

A型肉毒毒素治疗皱眉纹疗效的影响因素分析

目的:分析接受A型肉毒毒素(保妥适(R))治疗皱眉纹患者的有效性,以及年龄、性别和皱纹程度对疗效的影响.方法:对170例尽力皱眉时皱眉纹的严重程度为中、重度的患者单次注射保妥适(R)20U,在注射前,注射后7、30、60、90、120 d进行疗效评价.疗效评价指标包括研究者对患者尽力皱眉时和平静时皱眉纹的严重程度评分;患者对治疗后皱眉纹改善的总体评估;患者治疗后对自身年龄的评估.结果:20U的A型肉毒毒素注射治疗皱眉纹,注射后30d,主要疗效标准有效率为94.12%,120d仍有52.94%的患者有效.影响疗效因素分析结果显示女性效果好于男性;平静状态时皱眉纹评分越低者效果越好;年龄对于疗效影响相对轻微:尽力皱屑状态下皱眉纹程度越重的患者可能注射后改善越明显,但中度患者在治疗后100%可以将皱眉纹程度改善到轻度或没有皱纹.结论:20 U的A型肉毒毒素注射治疗65岁以下中国人皱眉纹非常有效.男性患者可能需要酌情增加剂量:如果平静状态时皱眉纹评分为重度的患者建议联合其他治疗来提高疗效.     

A型肉毒毒素皮内注射治疗玫瑰痤疮持久性红斑及潮红专家共识

A型肉毒毒素是一种神经毒素, 广泛用于皮肤美容。有证据表明, 皮内注射A型肉毒毒素能改善玫瑰痤疮患者面部皮肤潮红及持续性红斑, 但对治疗浓度、剂量、操作方法、疗程、治疗间隔等均存在差异。中华医学会皮肤性病学分会玫瑰痤疮研究中心、中国医师协会皮肤科分会玫瑰痤疮专业组在玫瑰痤疮诊疗指南的基础上, 参考新近文献并结合诸多专家临床应用经验撰写本共识, 为A型肉毒毒素皮内注射治疗玫瑰痤疮提供更科学、规范的参考依据。     

Botulinum toxin A in the treatment of the wrinkles in the upper third of the face

The practice of botulinum toxin injections is unavoidable in the correction of facial aging. In effect botulinum toxin allows to erase dynamic wrinkles, by transient and reversible muscular relaxation. This is the best wrinkle treatment for the upper part of the face: glabellar lines, horizontal forehead lines and crow's feet. This technique requires a good understanding of facial muscular anatomy, in order to correctly apply the basics of injection. Every patient is unique and only a big experience will allow to refine and personalise injections.     

24MHz高频超声对健康成人不同部位皮肤厚度的检测

目的:利用高频超声检测健康成人全身多个部位皮肤表皮及真皮厚度。方法:招募80名健康成人,采用频率24MHz高频超声检测前额、颧部、面颊、下颌、颈部、前臂和腹部7个部位表皮及真皮厚度。结果:检测的7个部位中表皮最厚的部位为前臂[(0.2061±0.02862)mm],真皮最厚的部位为腹部[(1.5819±0.31710)mm],颈部的表皮[(0.1764±0.02812)mm]和真皮[(0.9616±0.18852)mm]最薄(P<0.05);男性所有检测部位表皮、真皮厚度显著大于女性(P<0.05);无论男性还是女性,<40岁组的前额、颧部和面颊的真皮厚度显著大于≥40岁组(P<0.05);BMI<24组的腹部表皮、颧部真皮、颈部真皮厚度显著小于BMI≥24组(P<0.05)。结论:健康成人不同部位的表皮、真皮厚度有差异;男性皮肤表皮、真皮厚度均大于女性;面部真皮厚度与年龄有关。     

Botulinum B treatment of the glabellar and frontalis regions: a dose response analysis

BACKGROUND: Botulinum toxin injections represent the most commonly performed cosmetic procedure in the US. There is an enormous reported experience documenting the efficacy of botulinum toxin A injections. There is very limited published information about the efficacy and appropriate dosage of botulinum toxin B injections. OBJECTIVE : The aim of this study was to evaluate the dosage response and side effect profile of botulinum toxin B injections. METHOD : Twenty-six subjects received botulinum B injections to their glabellar area. Eighteen subjects received botulinum B injections to their frontalis region. Three different dosages were used. In the glabellar treated subjects the low dose group received a total of 1875 units; the medium dose group received a total of 2500 units; and the high dose group received a total of 3125 units. In the frontalis treated group, the low dose group received a total of 2250 units; the medium dose group received a total of 3000 units; and the high dose group received a total of 3750 units of botulium B toxin. RESULTS: In the glabellar group, most subjects showed some evidence of paralysis at 2 months. Only in the high dose group did a significant cadre of treated subjects still show a significant response at 3 months after treatment. In the frontalis group, response was often still seen at 2 months. However, at 3 months most subjects showed no continued effect from botulinum B toxin. CONCLUSION: Botulinum B toxin injections represent an alternative to botulinum A treatment for glabellar and frontalis hyperkinetic wrinkles. At the doses utilized in this study, the effect does not generally appear to last as long as has been reported with botulinum A injections. However, the onset of action may be sooner with botulinum B injections.     

Efficacy and safety of 3- and 5-injection patterns (30 and 50 U) of botulinum toxin A (Dysport) for the treatment of wrinkles in the glabella and the central forehead region

OBJECTIVE: To investigate the efficacy and safety of 2 injection site patterns (3- and 5-injection patterns [30 and 50 U]) of botulinum toxin A (Dysport; Ipsen Pharma, Ettlingen, Germany), in the treatment of glabellar and central forehead wrinkles. DESIGN: Multicenter, double-blind, placebo-controlled, randomized, 16-week trial. SETTING: Twenty-three German dermatologic centers. PATIENTS: Two hundred twenty-one patients with moderate or severe glabellar wrinkles when frowning maximally.Intervention Centers were randomly assigned to the 3-injection site pattern (3 injections of 10 U of botulinum toxin A or placebo) or 5-injection site pattern (5 injections of 10 U of botulinum toxin A or placebo). All centers used 3 sites in the procerus and corrugator muscles; the 2 additional sites were approximately 1-cm cranial from the corrugator sites. MAIN OUTCOME MEASURE: Wrinkle severity was graded by 4 independent experts blinded to the treatment received using digital photographs and a standardized clinical scale (range, 0 [no wrinkles] to 3 [severe wrinkles]). A reduction of at least 1 point between weeks 0 and 4 was considered a therapeutic success (responder). RESULT: One hundred ten patients (73 receiving botulinum toxin A vs 37 receiving placebo) received 3 injections; 111 patients (73 receiving botulinum toxin A vs 38 receiving placebo) received 5 injections. After 4 weeks, the proportions of responders were 86.1% vs 18.9% and 86.3% vs 7.9%, respectively (P<.001 for both). No major adverse effects were observed. CONCLUSIONS: The 3 central injection sites are essential for the treatment of glabellar wrinkles. The 2 additional injection sites in the forehead region, targeting the frontalis muscle, did not significantly improve efficacy.     

强脉冲光对巴马香猪糖皮质激素诱导的皮炎模型皮肤组织病理的影响

目的 探讨强脉冲光对巴马香猪糖皮质激素诱导的皮炎模型皮肤组织病理的影响.方法 选用2月龄雌性巴马香猪5只,将颈部两侧白色皮毛区作为实验靶皮肤区域,右侧外用0.05％卤米松乳膏每日涂药2次,连续用药60d,形成糖皮质激素诱导的皮炎模型.随机选3只给予强脉冲光治疗糖皮质激素诱导的皮炎区域,能量为25 J/cm2,每3周1次,共3次;另2只不给予治疗作为自然恢复组观察9周.局部皮肤组织做HE染色,观察各组皮肤病理变化.结果 巴马香猪糖皮质激素诱导的皮炎模型组经强脉冲光治疗后,表皮角质形成细胞层数为( 6.27±1.26)层,较自然恢复组(2.98±0.92层)明显增加(t=3.27,P＜0.01);真皮胶原纤维厚度为( 1.88±0.19) mm,也较自然恢复组(0.84±0.15 mm)明显增加(t=4.25,P＜0.01),真皮内扩张的毛细血管消退.结论 强脉冲光能有效增加皮肤厚度,消除皮肤红斑,增加皮肤弹性.     

Pulsed ultrasound measurements of depth and regression of basal cell carcinomas after photodynamic therapy: relationship to probability of 1-year local control

BACKGROUND: The regression of clinical basal cell carcinoma (BCC) after photodynamic therapy (PDT) is poorly understood, but is potentially important when, as is increasingly the case, a second treatment is contemplated. High-frequency pulsed ultrasound provides noninvasive information on skin and lesion thickness. OBJECTIVES: To relate pulsed ultrasound measurements before and after PDT to the probability of local control of BCC by PDT. METHODS: Skin thickness and lesion thickness were measured by 20-MHz pulsed ultrasound in 181 patients diagnosed as having BCC. Maximal lesion thickness was determined by repeatedly sampling the BCCs. Measurements were made immediately prior to PDT with aminolaevulinic acid plus 630 nm visible light, and then at 1, 6 and 12 months. RESULTS: Skin thickness in individual patients did not vary with time in this study (mean +/- SD 2.3 +/- 0.6 mm; P = 0.8). In contrast, BCC mean +/- SD maximal thickness 4-6 weeks after PDT was significantly smaller than pretreatment (0.6 +/- 0.8 mm vs. 1.3 +/- 0.8 mm; P < 0.001). The overall probability of 1-year local control fell from 85% when only BCCs 相似文献   

Botulinum toxins types A and B for brow furrows: preliminary experiences with type B toxin dosing

BACKGROUND : Facial lines resulting from hyperactivity can be misleading manifestations of negative emotions, fatigue and stress. They may also contribute to a perception of facial aging. A well established treatment is botulinum toxin type A (BTX-A). Recently, botulinum toxin type B (BTX-B) has become available for the treatment of cervical dystonia. There has been little comparison on the efficacy of the two different types of botulinum toxins, nor is there information on appropriate dosing of BTX-B for facial muscles. OBJECTIVES : The purpose of this pilot study was to observe the effects of BTX-B in comparison to BTX-A, on patients with brow furrows assessing initial efficacy and duration of effect. METHODS : Patients were injected with BTX-B in two different dose conversions against BTX-A to the corrugator-procerus complex. Some patients received a conversion of 50 units of BTX-B (total of 1000 units) to one unit of BTX-A while others received a conversion of 100 units of BTX-B (total of 2000 units) to one unit of BTX-A. The patients treated with BTX-A received a total of 20 units. These patients were clinically assessed prior to treatment and 3 days, 1 week, 4 weeks, 12 weeks and 16 weeks after treatment. RESULTS : Both types of botulinum toxin were effective at improving glabellar frown lines. The onset of actions occurred slightly sooner (2-3 days) with BTX-B than with BTX-A (3-7 days). Duration of effect with BTX-A was at least 16 weeks. With 1000 units of BTX-B, dose duration was 6-8 weeks and with 2000 units of BTX-B, duration was 10-12 weeks. SUMMARY : Both types of botulinum toxin are effective at correcting deep glabellar furrows. At least with the doses used, BTX-B has a quicker onset of action and BTX-A has longer benefit for glabellar wrinkles. These data strongly suggest that further dose ranging studies of BTX-B are necessary and indicated in controlled double blind studies in a larger patient population.     

Exaggeration of Wrinkles after Botulinum Toxin Injection for Forehead Horizontal Lines

There have been no long-term complications or life-threatening adverse effects related to botulinum toxin treatment for any cosmetic indications. Nevertheless, there are well-known, mild side effects of botulinum toxin treatment on the upper face, though most of them are self limited with time. However, excluding brow ptosis, reports about site specific side effects are few and anecdotal. We experienced cases of exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines, and report them here. In our cases, new appearance of a noticeable glabellar protrusion following botulinum toxin injection on the forehead was observed in 2 patients. Also, a new deep wrinkle on one side of the forehead just above the eyebrow appeared in another 2 patients. The exaggerated wrinkles nearly disappeared without treatment by week 4 in all subjects. These exaggerations of wrinkles may be caused by hyperactivity and overcompensation of untreated muscles. With the increasing availability of diverse botulinum toxin for cosmetic purposes, physicians and patients should be aware of this temporary change after therapeutic injections. We recommend explaining this possible effect prior to injection, for better understanding of treatment for cosmetic indications.     

特应性皮炎患者皮肤屏障与水闸蛋白1表达的相关性研究

目的 研究特应性皮炎（AD）患者皮肤屏障功能情况,并分析其与水闸蛋白1（claudin-1）表达的相关性。 方法 纳入AD患者和健康人各11例。应用皮肤经表皮失水率测定仪和皮肤高频超声检测仪测定受试者经表皮失水率、表皮厚度与表皮致密度,并用双抗体夹心ELISA法定量检测血清中脱落claudin-1表达量。应用单因素方差分析和t检验比较不同组别之间相关参数的差异;应用Pearson相关系数分析不同参数之间的相关性。 结果 AD患者皮疹部位经表皮失水率为（36.9 ± 34.2） g·m-2·h-1,非皮疹部位为（9.1 ± 6.0） g·m-2·h-1,均高于健康对照［（4.4 ± 3.1） g·m-2·h-1］;AD患者皮疹部位表皮厚度（0.23 ± 0.04） mm,显著高于非皮疹部位［（0.18 ± 0.03） mm］和健康对照［（0.18 ± 0.02） mm］。AD患者皮疹部位有其特征性表皮下低回声带。AD患者claudin-1表达量为（0.80 ± 0.88） ng/ml,显著低于健康人［（1.73 ± 1.85） ng/ml］;claudin-1与表皮厚度显著负相关（r = -0.61）,与经表皮失水率的倒数显著正相关（r = 0.44）。 结论 AD患者损伤的皮肤屏障功能与claudin-1表达相关,屏障功能状态可用经表皮失水率、经表皮失水率倒数和表皮厚度进行定量表述。     

Botulinum toxin A: its expanding role in dermatology and esthetics

The use of botulinum toxin A in cosmetic dermatology has increased in popularity due to the efficacy and relative safety of the treatment. Botulinum toxin A is one of eight exotoxins produced by Clostridium botulinum, a Gram-positive, spore-forming anaerobe. Flaccid paralysis results from the denervation of muscle fibers at the neuromuscular junction after botulinum toxin A administration. While treating blepharospasm, the Carruthers incidentally found that botulinum toxin A improved glabellar frown lines. Dynamic rhytides occur in areas of dynamic motion. These types of lines may be improved with botulinum toxin A. There are two types of botulinum toxin A commercially available (BOTOX and Dysport); only BOTOX is currently available in the US. The efficacy and tolerability of BOTOX was best demonstrated with a multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines in 264 patients. There was a significantly greater reduction in glabellar line severity with BOTOX. The effect was maintained for the duration of the study (120 days). There was low occurrence (5.4%) of mostly mild blepharoptosis in the BOTOX group. In another prospective study, it was found that about 1% of BOTOX patients reported severe headache. Botulinum toxin A can provide an alternative treatment of palmar and axillary hyperhidrosis when options such as topical agents (aluminum chloride) and iontophoresis have failed.